Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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Τρίτη 19 Νοεμβρίου 2019

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com, Telephone consultation 11855 int 1193,




Biomolecules, Vol. 9, Pages 748: What Happened to the Phycobilisome? Biomolecules, Vol. 9, Pages 748: What Happened to the Phycobilisome? Biomolecules doi: 10.3390/biom9110748 Authors: Beverley R. Green The phycobilisome (PBS) is the major light-harvesting complex of photosynthesis in cyanobacteria, red algae, and glaucophyte algae. In spite of the fact that it is very well structured to absorb light and transfer it efficiently to photosynthetic reaction centers, it has been completely lost in the green algae and plants. It is difficult to see how selection... Biomolecules 02:00 Mark above section as read  Medicina Medicina, Vol. 55, Pages 748: TZAP Mutation Leads to Poor Prognosis of Patients with Breast Cancer † Medicina, Vol. 55, Pages 748: TZAP Mutation Leads to Poor Prognosis of Patients with Breast Cancer † Medicina doi: 10.3390/medicina55110748 Authors: Yu-Ran Heo Moo-Hyun Lee Sun-Young Kwon Jihyoung Cho Jae-Ho Lee Background and Objectives: ZBTB48 is a telomere-associated factor that has been renamed as telomeric zinc finger-associated protein (TZAP). It binds preferentially to long telomeres, competing with telomeric repeat factors 1 and 2. Materials and Methods: We analyzed... Medicina Mon Nov 18, 2019 02:00 Medicina, Vol. 55, Pages 746: A Consecutive 25-Week Program of Gait Training, Using the Alternating Hybrid Assistive Limb (HAL®) Robot and Conventional Training, and Its Effects on the Walking Ability of a Patient with Chronic Thoracic Spinal Cord Injury: A Single Case Reversal Design Medicina, Vol. 55, Pages 746: A Consecutive 25-Week Program of Gait Training, Using the Alternating Hybrid Assistive Limb (HAL®) Robot and Conventional Training, and Its Effects on the Walking Ability of a Patient with Chronic Thoracic Spinal Cord Injury: A Single Case Reversal Design Medicina doi: 10.3390/medicina55110746 Authors: Kanazawa Yoshikawa Koseki Takeuchi Mutsuzaki Background and Objectives: In this study, we examined the effect of a consecutive 25-week gait... Medicina Mon Nov 18, 2019 02:00 Medicina, Vol. 55, Pages 747: Could the Combination of Two Non-Psychotropic Cannabinoids Counteract Neuroinflammation? Effectiveness of Cannabidiol Associated with Cannabigerol Medicina, Vol. 55, Pages 747: Could the Combination of Two Non-Psychotropic Cannabinoids Counteract Neuroinflammation? Effectiveness of Cannabidiol Associated with Cannabigerol Medicina doi: 10.3390/medicina55110747 Authors: Mammana Cavalli Gugliandolo Silvestro Pollastro Bramanti Mazzon Background and Objectives: Neuroinflammation is associated with many neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS). In this study, we investigate... Medicina Mon Nov 18, 2019 02:00 Mark above section as read  Microorganisms Microorganisms, Vol. 7, Pages 576: Phylogeny of Anoxygenic Photosynthesis Based on Sequences of Photosynthetic Reaction Center Proteins and a Key Enzyme in Bacteriochlorophyll Biosynthesis, the Chlorophyllide Reductase Microorganisms, Vol. 7, Pages 576: Phylogeny of Anoxygenic Photosynthesis Based on Sequences of Photosynthetic Reaction Center Proteins and a Key Enzyme in Bacteriochlorophyll Biosynthesis, the Chlorophyllide ReductaseMicroorganisms doi: 10.3390/microorganisms7110576Authors:Johannes F. ImhoffTanja RahnSven KünzelSven C. NeulingerPhotosynthesis is a key process for the establishment and maintenance of life on earth, and it is manifested in several major lineages of the prokaryote tree of life. The... Microorganisms 02:00 Microorganisms, Vol. 7, Pages 575: A Role for COX20 in Tolerance to Oxidative Stress and Programmed Cell Death in Saccharomyces cerevisiae Microorganisms, Vol. 7, Pages 575: A Role for COX20 in Tolerance to Oxidative Stress and Programmed Cell Death in Saccharomyces cerevisiaeMicroorganisms doi: 10.3390/microorganisms7110575Authors: Keerthiraju Du Tucker GreethamIndustrial production of bioethanol from lignocellulosic materials (LCM′s) is reliant on a microorganism being tolerant to the stresses inherent to fermentation. Previous work has highlighted the importance of a cytochrome oxidase chaperone gene (COX20) in improving... Microorganisms Mon Nov 18, 2019 02:00 Microorganisms, Vol. 7, Pages 574: The Effects of Flavomycin and Colistin Sulfate Pre-Treatment on Ileal Bacterial Community Composition, the Response to Salmonella typhimurium and Host Gene Expression in Broiler Chickens Microorganisms, Vol. 7, Pages 574: The Effects of Flavomycin and Colistin Sulfate Pre-Treatment on Ileal Bacterial Community Composition, the Response to Salmonella typhimurium and Host Gene Expression in Broiler ChickensMicroorganisms doi: 10.3390/microorganisms7110574Authors: He Yang Dong Yan Zhang The composition of the bacterial community affects the intestinal health and growth performance of broiler chickens. The main purpose of this study was to explore the effects of flavomycin and colistin... Microorganisms Mon Nov 18, 2019 02:00 Microorganisms, Vol. 7, Pages 573: Kinematic Locomotion Changes in C57BL/6 Mice Infected with Toxoplasma Strain ME49 Microorganisms, Vol. 7, Pages 573: Kinematic Locomotion Changes in C57BL/6 Mice Infected with Toxoplasma Strain ME49Microorganisms doi: 10.3390/microorganisms7110573Authors:María de la Luz Galván-RamírezAngel Gustavo Salas-LaisSergio Horacio Dueñas-JiménezGerardo Mendizabal-RuizRamón Franco TopeteSofía Citlalli Berumen-SolísLaura Roció Rodríguez PérezKarina Franco TopeteChronic infection with the intracellular parasite Toxoplasma gondii produces an accumulation of cysts in the brain and muscle, causing... Microorganisms Mon Nov 18, 2019 02:00 Microorganisms, Vol. 7, Pages 572: The Type III Accessory Protein HrpE of Xanthomonas oryzae pv. oryzae Surpasses the Secretion Role, and Enhances Plant Resistance and Photosynthesis Microorganisms, Vol. 7, Pages 572: The Type III Accessory Protein HrpE of Xanthomonas oryzae pv. oryzae Surpasses the Secretion Role, and Enhances Plant Resistance and PhotosynthesisMicroorganisms doi: 10.3390/microorganisms7110572Authors:Taha Majid Mahmood SheikhLiyuan ZhangMuhammad ZubairAlvina HanifPing LiAyaz FarzandHaider AliMuhammad Saqib BilalYiqun HuXiaochen ChenCongfeng SongMeixiang ZhangHansong DongMany species of plant-pathogenic gram-negative bacteria deploy the type III (T3) secretion... Microorganisms Mon Nov 18, 2019 02:00 Mark above section as read  Molecules Molecules, Vol. 24, Pages 4190: A Survey of Molecular Imaging of Opioid Receptors Molecules, Vol. 24, Pages 4190: A Survey of Molecular Imaging of Opioid Receptors Molecules doi: 10.3390/molecules24224190 Authors: Paul Cumming János Marton Tuomas O. Lilius Dag Erlend Olberg Axel Rominger The discovery of endogenous peptide ligands for morphine binding sites occurred in parallel with the identification of three subclasses of opioid receptor (OR), traditionally designated as μ, δ, and κ, along with the more recently defined opioid-receptor-like... Molecules 02:00 Molecules, Vol. 24, Pages 4191: Synthesis and Antiproliferative Evaluation of Novel Hybrids of Dehydroabietic Acid Bearing 1,2,3-Triazole Moiety Molecules, Vol. 24, Pages 4191: Synthesis and Antiproliferative Evaluation of Novel Hybrids of Dehydroabietic Acid Bearing 1,2,3-Triazole Moiety Molecules doi: 10.3390/molecules24224191 Authors: Fang-Yao Li Lin Huang Qian Li Xiu Wang Xian-Li Ma Cai-Na Jiang Xiao-Qun Zhou Wen-Gui Duan Fu-Hou Lei To discover novel potent cytotoxic diterpenoids, a series of hybrids of dehydroabietic acid containing 1,2,3-triazole moiety were designed and synthesized. The target compounds... Molecules 02:00 Molecules, Vol. 24, Pages 4187: NAD Analogs in Aid of Chemical Biology and Medicinal Chemistry Molecules, Vol. 24, Pages 4187: NAD Analogs in Aid of Chemical Biology and Medicinal Chemistry Molecules doi: 10.3390/molecules24224187 Authors: Anais Depaix Joanna Kowalska Nicotinamide adenine dinucleotide (NAD) serves as an essential redox co-factor and mediator of multiple biological processes. Besides its well-established role in electron transfer reactions, NAD serves as a substrate for other biotransformations, which, at the molecular level, can be classified as protein post-translational... Molecules 02:00 Molecules, Vol. 24, Pages 4188: The Versatile Role of Matrix Metalloproteinase for the Diverse Results of Fibrosis Treatment Molecules, Vol. 24, Pages 4188: The Versatile Role of Matrix Metalloproteinase for the Diverse Results of Fibrosis Treatment Molecules doi: 10.3390/molecules24224188 Authors: Hong-Meng Chuang Yu-Shuan Chen Horng-Jyh Harn Fibrosis is a type of chronic organ failure, resulting in the excessive secretion of extracellular matrix (ECM). ECM protects wound tissue from infection and additional injury, and is gradually degraded during wound healing. For some unknown reasons, myofibroblasts... Molecules 02:00 Molecules, Vol. 24, Pages 4189: DNA-Templated Fluorescent Nanoclusters for Metal Ions Detection Molecules, Vol. 24, Pages 4189: DNA-Templated Fluorescent Nanoclusters for Metal Ions Detection Molecules doi: 10.3390/molecules24224189 Authors: Chunxia Song Jingyuan Xu Ying Chen Liangliang Zhang Ying Lu Zhihe Qing DNA-templated fluorescent nanoclusters (NCs) have attracted increasing research interest on account of their prominent features, such as DNA sequence-dependent fluorescence, easy functionalization, wide availability, water solubility, and excellent biocompatibility.... Molecules 02:00 Molecules, Vol. 24, Pages 4186: Determination of Urinary Hydroxyl PAHs Using Graphene Oxide@Diatomite Based Solid-Phase Extraction and High-Performance Liquid Chromatography Molecules, Vol. 24, Pages 4186: Determination of Urinary Hydroxyl PAHs Using Graphene Oxide@Diatomite Based Solid-Phase Extraction and High-Performance Liquid Chromatography Molecules doi: 10.3390/molecules24224186 Authors: Yuanman Liu Ziling Li Ziyang Zhang Tengwen Zhao Manman Wang Xuesheng Wang A diatomite supported graphene oxide composite (GO@Dt–NH2) was fabricated and explored as a solid-phase extraction adsorbent coupled with high performance liquid chromatography... Molecules 02:00 Molecules, Vol. 24, Pages 4185: Identifying Promiscuous Compounds with Activity against Different Target Classes Molecules, Vol. 24, Pages 4185: Identifying Promiscuous Compounds with Activity against Different Target Classes Molecules doi: 10.3390/molecules24224185 Authors: Christian Feldmann Filip Miljković Dimitar Yonchev Jürgen Bajorath Compounds with multitarget activity are of high interest for polypharmacological drug discovery. Such promiscuous compounds might be active against closely related target proteins from the same family or against distantly related or unrelated targets.... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4183: Optimization of Ultrasound-Assisted Extraction Conditions Followed by Solid Phase Extraction Fractionation from Orthosiphon stamineus Benth (Lamiace) Leaves for Antiproliferative Effect on Prostate Cancer Cells Molecules, Vol. 24, Pages 4183: Optimization of Ultrasound-Assisted Extraction Conditions Followed by Solid Phase Extraction Fractionation from Orthosiphon stamineus Benth (Lamiace) Leaves for Antiproliferative Effect on Prostate Cancer Cells Molecules doi: 10.3390/molecules24224183 Authors: Siti Hasyimah Suhaimi Rosnani Hasham Mohamad Khairul Hafiz Idris Hassan Fahmi Ismail Nor Hazwani Mohd Ariffin Fadzilah Adibah Abdul Majid Primarily, optimization of ultrasonic-assisted... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4184: Two-Step Azidoalkenylation of Terminal Alkenes Using Iodomethyl Sulfones Molecules, Vol. 24, Pages 4184: Two-Step Azidoalkenylation of Terminal Alkenes Using Iodomethyl Sulfones Molecules doi: 10.3390/molecules24224184 Authors: Millius Lapointe Renaud The radical azidoalkylation of alkenes that was initially developed with α-iodoesters and α-iodoketones was extended to other activated iodomethyl derivatives. By using iodomethyl aryl sulfones, the preparation of γ-azidosulfones was easily achieved. Facile conversion of... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4182: Current Trends on Seaweeds: Looking at Chemical Composition, Phytopharmacology, and Cosmetic Applications Molecules, Vol. 24, Pages 4182: Current Trends on Seaweeds: Looking at Chemical Composition, Phytopharmacology, and Cosmetic Applications Molecules doi: 10.3390/molecules24224182 Authors: Salehi Sharifi-Rad Seca Pinto Michalak Trincone Mishra Nigam Zam Martins Seaweeds have received huge interest in recent years given their promising potentialities. Their antioxidant, anti-inflammatory, antitumor, hypolipemic, and anticoagulant effects are among the... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4181: 8-Hydroxyquinoline Glycoconjugates: Modifications in the Linker Structure and Their Effect on the Cytotoxicity of the Obtained Compounds Molecules, Vol. 24, Pages 4181: 8-Hydroxyquinoline Glycoconjugates: Modifications in the Linker Structure and Their Effect on the Cytotoxicity of the Obtained Compounds Molecules doi: 10.3390/molecules24224181 Authors: Monika Krawczyk Gabriela Pastuch-Gawołek Aleksandra Pluta Karol Erfurt Adrian Domiński Piotr Kurcok Small molecule nitrogen heterocycles are very important structures, widely used in the design of potential pharmaceuticals. Particularly, derivatives of 8-hydroxyquinoline... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4180: Key-Marker Volatile Compounds in Aromatic Rice (Oryza sativa) Grains: An HS-SPME Extraction Method Combined with GC×GC-TOFMS Molecules, Vol. 24, Pages 4180: Key-Marker Volatile Compounds in Aromatic Rice (Oryza sativa) Grains: An HS-SPME Extraction Method Combined with GC×GC-TOFMS Molecules doi: 10.3390/molecules24224180 Authors: Widiastuti Setyaningsih Tomasz Majchrzak Tomasz Dymerski Jacek Namieśnik Miguel Palma The aroma of rice essentially contributes to the quality of rice grains. For some varieties, their aroma properties really drive consumer preferences. In this paper, using a dynamic headspace... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4176: Carnosic Acid Attenuates Cadmium Induced Nephrotoxicity by Inhibiting Oxidative Stress, Promoting Nrf2/HO-1 Signalling and Impairing TGF-β1/Smad/Collagen IV Signalling Molecules, Vol. 24, Pages 4176: Carnosic Acid Attenuates Cadmium Induced Nephrotoxicity by Inhibiting Oxidative Stress, Promoting Nrf2/HO-1 Signalling and Impairing TGF-β1/Smad/Collagen IV Signalling Molecules doi: 10.3390/molecules24224176 Authors: Sonjit Das Saikat Dewanjee Tarun K. Dua Swarnalata Joardar Pratik Chakraborty Shovonlal Bhowmick Achintya Saha Simanta Bhattacharjee Vincenzo De Feo Cadmium (Cd) imparts nephrotoxicity via triggering oxidative stress... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4177: Cu(II)-Catalyzed C-N Coupling of (Hetero)aryl Halides and N-Nucleophiles Promoted by α-Benzoin Oxime Molecules, Vol. 24, Pages 4177: Cu(II)-Catalyzed C-N Coupling of (Hetero)aryl Halides and N-Nucleophiles Promoted by α-Benzoin Oxime Molecules doi: 10.3390/molecules24224177 Authors: Chunling Yuan Lei Zhang Yingdai Zhao We first reported the new application of a translate metal chelating ligand α-benzoin oxime for improving Cu-catalyzed C-N coupling reactions. The system could catalyse coupling reactions of (hetero)aryl halides with a wide of nucleophiles (e.g., azoles,... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4178: A Newly Discovered Phenylethanoid Glycoside from Stevia rebaudiana Bertoni Affects Insulin Secretion in Rat INS-1 Islet β Cells Molecules, Vol. 24, Pages 4178: A Newly Discovered Phenylethanoid Glycoside from Stevia rebaudiana Bertoni Affects Insulin Secretion in Rat INS-1 Islet β Cells Molecules doi: 10.3390/molecules24224178 Authors: Jing He Nai-Liang Zhu Jing Kong Ping Peng Lin-Fu Li Xiao-Lu Wei Yan-Yan Jiang Yan-Ling Zhang Bao-Lin Bian Gai-Mei She Ren-Bing Shi The tea-like beverage Stevia rebaudiana Bertoni (Stevia) is popular in China because it reduces blood glucose and has... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4179: Curcumin Nicotinate Selectively Induces Cancer Cell Apoptosis and Cycle Arrest through a P53-Mediated Mechanism Molecules, Vol. 24, Pages 4179: Curcumin Nicotinate Selectively Induces Cancer Cell Apoptosis and Cycle Arrest through a P53-Mediated Mechanism Molecules doi: 10.3390/molecules24224179 Authors: Ying-chun He Lan He Ramina Khoshaba Fang-guo Lu Chuan Cai Fang-liang Zhou Duan-fang Liao Deliang Cao Curcumin is an anticancer agent, but adverse effects and low bioavailability are its main drawbacks, which drives efforts in chemical modifications of curcumin. This study... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4175: Anti-Acetylcholinesterase Activities of Mono-Herbal Extracts and Exhibited Synergistic Effects of the Phytoconstituents: A Biochemical and Computational Study Molecules, Vol. 24, Pages 4175: Anti-Acetylcholinesterase Activities of Mono-Herbal Extracts and Exhibited Synergistic Effects of the Phytoconstituents: A Biochemical and Computational Study Molecules doi: 10.3390/molecules24224175 Authors: Acharya Balkrishna Subarna Pokhrel Meenu Tomer Sudeep Verma Ajay Kumar Pradeep Nain Abhishek Gupta Anurag Varshney Alzheimer's disease (AD), a neurodegenerative disease, is the most common form of dementia. Inhibition... Molecules Mon Nov 18, 2019 02:00 Molecules, Vol. 24, Pages 4174: Experimental Data and Modelling of the Solubility of High-Carotenoid Paprika Extract in Supercritical Carbon Dioxide Molecules, Vol. 24, Pages 4174: Experimental Data and Modelling of the Solubility of High-Carotenoid Paprika Extract in Supercritical Carbon Dioxide Molecules doi: 10.3390/molecules24224174 Authors: Dorota Kostrzewa Agnieszka Dobrzyńska-Inger August Turczyn The studies of solubility of the paprika extract with a high concentration of carotenoids in carbon dioxide under the pressure of 20–50 MPa and at temperatures of 313.15–333.15 K were carried out using the... Molecules Mon Nov 18, 2019 02:00 Mark above section as read  Nanomaterials Nanomaterials, Vol. 9, Pages 1640: Direct Observation of Monolayer MoS2 Prepared by CVD Using In-Situ Differential Reflectance Spectroscopy Nanomaterials, Vol. 9, Pages 1640: Direct Observation of Monolayer MoS2 Prepared by CVD Using In-Situ Differential Reflectance Spectroscopy Nanomaterials doi: 10.3390/nano9111640 Authors: Yina Wang Lei Zhang Chenhui Su Hang Xiao Shanshan Lv Faye Zhang Qingmei Sui Lei Jia Mingshun Jiang The in-situ observation is of great significance to the study of the growth mechanism and controllability of two-dimensional transition metal dichalcogenides (TMDCs). Here, the... Nanomaterials 02:00 Nanomaterials, Vol. 9, Pages 1639: Influence of Annealing Temperature on Weak-Cavity Top-Emission Red Quantum Dot Light Emitting Diode Nanomaterials, Vol. 9, Pages 1639: Influence of Annealing Temperature on Weak-Cavity Top-Emission Red Quantum Dot Light Emitting Diode Nanomaterials doi: 10.3390/nano9111639 Authors: Chun-Yu Lee Ya-Pei Kuo Peng-Yu Chen Hsieh-Hsing Lu Ming Yi Lin In this report, we show that the annealing temperature in QDs/Mg-doped ZnO film plays a very important role in determining QLEDs performance. Measurements of capacitance and single carrier device reveal that the change of the device... Nanomaterials 02:00 Nanomaterials, Vol. 9, Pages 1637: DOPO-Functionalized Molybdenum Disulfide and its Impact on the Thermal Properties of Polyethylene and Poly(Lactic Acid) Composites Nanomaterials, Vol. 9, Pages 1637: DOPO-Functionalized Molybdenum Disulfide and its Impact on the Thermal Properties of Polyethylene and Poly(Lactic Acid) Composites Nanomaterials doi: 10.3390/nano9111637 Authors: Wenelska Homa Popovic Maslana Mijowska The fabrication of conventional or biodegradable polymers with improved thermal and fire-resistant properties is an important task for their successful application in various branches of the industry. In this work, few-layered... Nanomaterials Mon Nov 18, 2019 02:00 Nanomaterials, Vol. 9, Pages 1636: One-Step Hydrothermal Synthesis of P25 @ Few Layered MoS2 Nanosheets toward Enhanced Bi-catalytic Activities: Photocatalysis and Electrocatalysis Nanomaterials, Vol. 9, Pages 1636: One-Step Hydrothermal Synthesis of P25 @ Few Layered MoS2 Nanosheets toward Enhanced Bi-catalytic Activities: Photocatalysis and Electrocatalysis Nanomaterials doi: 10.3390/nano9111636 Authors: Zhou Zhang Wang Wang Xu Wang Liu P25 loaded few layered molybdenum disulfide (MoS2) nanosheets (P25@MoS2) are successfully synthesized through a facile one-step hydrothermal process. The bi-catalytic activities, i.e., photocatalytic and... Nanomaterials Mon Nov 18, 2019 02:00 Nanomaterials, Vol. 9, Pages 1638: V3S4 Nanosheets Anchored on N, S Co-Doped Graphene with Pseudocapacitive Effect for Fast and Durable Lithium Storage Nanomaterials, Vol. 9, Pages 1638: V3S4 Nanosheets Anchored on N, S Co-Doped Graphene with Pseudocapacitive Effect for Fast and Durable Lithium Storage Nanomaterials doi: 10.3390/nano9111638 Authors: Wu Miao Zhou Zhang Liu Guo Liu Construction of a suitable hybrid structure has been considered an important approach to address the defects of metal sulfide anode materials. V3S4 nanosheets anchored on an N, S co-coped graphene (VS/NSG) aerogel were successfully... Nanomaterials Mon Nov 18, 2019 02:00 Nanomaterials, Vol. 9, Pages 1635: Synthesis of Mn0.5Zn0.5SmxEuxFe1.8−2xO4 Nanoparticles via the Hydrothermal Approach Induced Anti-Cancer and Anti-Bacterial Activities Nanomaterials, Vol. 9, Pages 1635: Synthesis of Mn0.5Zn0.5SmxEuxFe1.8−2xO4 Nanoparticles via the Hydrothermal Approach Induced Anti-Cancer and Anti-Bacterial Activities Nanomaterials doi: 10.3390/nano9111635 Authors: Sultan Akhtar Suriya Rehman Munirah A. Almessiere Firdos Alam Khan Yassine Slimani Abdulhadi Baykal Manganese metallic nanoparticles are attractive materials for various biological and medical applications. In the present study, we synthesized unique Mn0.5Zn0.5SmxEuxFe1.8−2xO4... Nanomaterials Mon Nov 18, 2019 02:00 Nanomaterials, Vol. 9, Pages 1632: Reveal the Deformation Mechanism of (110) Silicon from Cryogenic Temperature to Elevated Temperature by Molecular Dynamics Simulation Nanomaterials, Vol. 9, Pages 1632: Reveal the Deformation Mechanism of (110) Silicon from Cryogenic Temperature to Elevated Temperature by Molecular Dynamics Simulation Nanomaterials doi: 10.3390/nano9111632 Authors: Jing Han Yuanming Song Wei Tang Cong Wang Liang Fang Hua Zhu Jiyun Zhao Jiapeng Sun Silicon undergoes a brittle-to-ductile transition as its characteristic dimension reduces from macroscale to nanoscale. The thorough understanding of the plastic deformation... Nanomaterials Mon Nov 18, 2019 02:00 Mark above section as read  Nutrients Nutrients, Vol. 11, Pages 2825: Consumption of Meat and Dairy Products Is Not Associated with the Risk for Rheumatoid Arthritis among Women: A Population-Based Cohort Study Nutrients, Vol. 11, Pages 2825: Consumption of Meat and Dairy Products Is Not Associated with the Risk for Rheumatoid Arthritis among Women: A Population-Based Cohort Study Nutrients doi: 10.3390/nu11112825 Authors: Björn Sundström Lotta Ljung Daniela Di Giuseppe Diet has gained attention as a risk factor for the development of rheumatoid arthritis (RA), especially with regards to food of animal origin, such as meat and dairy products. By using data from national patient registers... Nutrients 02:00 Nutrients, Vol. 11, Pages 2826: Impact of Vitamin D on Physical Efficiency and Exercise Performance—A Review Nutrients, Vol. 11, Pages 2826: Impact of Vitamin D on Physical Efficiency and Exercise Performance—A Review Nutrients doi: 10.3390/nu11112826 Authors: Michał Wiciński Dawid Adamkiewicz Monika Adamkiewicz Maciej Śniegocki Marta Podhorecka Paweł Szychta Bartosz Malinowski Vitamin D deficiency amongst athletes and the general population seems to be a prominent problem. The most recognized role of vitamin D is its regulation of calcium homeostasis; there is a strong relationship... Nutrients 02:00 Nutrients, Vol. 11, Pages 2824: Exercise Mitigates the Loss of Muscle Mass by Attenuating the Activation of Autophagy during Severe Energy Deficit Nutrients, Vol. 11, Pages 2824: Exercise Mitigates the Loss of Muscle Mass by Attenuating the Activation of Autophagy during Severe Energy Deficit Nutrients doi: 10.3390/nu11112824 Authors: Marcos Martin-Rincon Alberto Pérez-López David Morales-Alamo Ismael Perez-Suarez Pedro de Pablos-Velasco Mario Perez-Valera Sergio Perez-Regalado Miriam Martinez-Canton Miriam Gelabert-Rebato Julian William Juan-Habib Hans-Christer Holmberg Jose A L Calbet The loss... Nutrients 02:00 Nutrients, Vol. 11, Pages 2823: Dietary Trace Minerals Nutrients, Vol. 11, Pages 2823: Dietary Trace Minerals Nutrients doi: 10.3390/nu11112823 Authors: Elad Tako Dietary trace minerals are pivotal and hold a key role in numerous metabolic processes. Trace mineral deficiencies (except for iodine, iron, and zinc) do not often develop spontaneously in adults on ordinary diets; infants are more vulnerable because their growth is rapid and intake varies. Trace mineral imbalances can result from hereditary disorders (e.g., hemochromatosis, Wilson... Nutrients 02:00 Nutrients, Vol. 11, Pages 2821: Plasma versus Erythrocyte Vitamin E in Renal Transplant Recipients, and Duality of Tocopherol Species Nutrients, Vol. 11, Pages 2821: Plasma versus Erythrocyte Vitamin E in Renal Transplant Recipients, and Duality of Tocopherol Species Nutrients doi: 10.3390/nu11112821 Authors: Camilo G. Sotomayor Ramón Rodrigo António W. Gomes-Neto Juan Guillermo Gormaz Robert A. Pol Isidor Minović Manfred L. Eggersdorfer Michel Vos Ineke J. Riphagen Martin H. de Borst Ilja M. Nolte Stefan P. Berger Gerjan J. Navis Stephan J. L. Bakker Redox imbalance is an adverse... Nutrients 02:00 Nutrients, Vol. 11, Pages 2822: Temporal Trends in Maternal Food Intake Frequencies and Associations with Gestational Diabetes: The Cambridge Baby Growth Study Nutrients, Vol. 11, Pages 2822: Temporal Trends in Maternal Food Intake Frequencies and Associations with Gestational Diabetes: The Cambridge Baby Growth Study Nutrients doi: 10.3390/nu11112822 Authors: Clive Petry Ken Ong Ieuan Hughes Carlo Acerini David Dunger Previous studies have suggested that in the first decade of this century the incidence of gestational diabetes (GDM) in pregnancy rose worldwide. In the Cambridge Baby Growth Study cohort we observed that this temporal... Nutrients 02:00 Nutrients, Vol. 11, Pages 2820: Cholesterol Disturbances and the Role of Proper Nutrition in CKD Patients Nutrients, Vol. 11, Pages 2820: Cholesterol Disturbances and the Role of Proper Nutrition in CKD Patients Nutrients doi: 10.3390/nu11112820 Authors: Anna Gluba-Brzozka Beata Franczyk Jacek Rysz Chronic kidney disease (CKD) is a widespread disease with increasing prevalence in the modern society. Lipid disturbances are common in this group of patients. In most patients with CKD atherogenic dyslipidemia is observed. Dyslipidemia in patients with renal diseases increases the risk... Nutrients Mon Nov 18, 2019 02:00 Nutrients, Vol. 11, Pages 2819: Lactobacillus plantarum P2R3FA Isolated from Traditional Cereal-Based Fermented Food Increase Folate Status in Deficient Rats Nutrients, Vol. 11, Pages 2819: Lactobacillus plantarum P2R3FA Isolated from Traditional Cereal-Based Fermented Food Increase Folate Status in Deficient Rats Nutrients doi: 10.3390/nu11112819 Authors: Aynadis Tamene Kaleab Baye Susanna Kariluoto Minnamari Edelmann Fabrice Bationo Nicolas Leconte Christèle Humblot Folate deficiencies are widespread around the world. Promoting consumption of folate-rich foods could be a sustainable option to alleviate this problem. However,... Nutrients Mon Nov 18, 2019 02:00 Nutrients, Vol. 11, Pages 2818: Enhanced Triacylglycerol Content and Gene Expression for Triacylglycerol Metabolism, Acyl-Ceramide Synthesis, and Corneocyte Lipid Formation in the Epidermis of Borage Oil Fed Guinea Pigs Nutrients, Vol. 11, Pages 2818: Enhanced Triacylglycerol Content and Gene Expression for Triacylglycerol Metabolism, Acyl-Ceramide Synthesis, and Corneocyte Lipid Formation in the Epidermis of Borage Oil Fed Guinea Pigs Nutrients doi: 10.3390/nu11112818 Authors: Ju-Young Lee Kwang-Hyeon Liu Yunhi Cho Kun-Pyo Kim Triacylglycerol (TAG) metabolism is related to the acyl-ceramide (Cer) synthesis and corneocyte lipid envelope (CLE) formation involved in maintaining the epidermal... Nutrients Mon Nov 18, 2019 02:00 Nutrients, Vol. 11, Pages 2816: The Effect of Various Doses of Phenylalanine Supplementation on Blood Phenylalanine and Tyrosine Concentrations in Tyrosinemia Type 1 Patients Nutrients, Vol. 11, Pages 2816: The Effect of Various Doses of Phenylalanine Supplementation on Blood Phenylalanine and Tyrosine Concentrations in Tyrosinemia Type 1 Patients Nutrients doi: 10.3390/nu11112816 Authors: Willem G. van Ginkel Hannah E. van Reemst Nienke S. Kienstra Anne Daly Iris L. Rodenburg Anita MacDonald Johannes G.M. Burgerhof Pim de Blaauw Jennifer van de Krogt Saikat Santra M. Rebecca Heiner-Fokkema Francjan J. van Spronsen Tyrosinemia... Nutrients Mon Nov 18, 2019 02:00 Nutrients, Vol. 11, Pages 2813: Rural–Urban Differences in Dietary Behavior and Obesity: Results of the Riskesdas Study in 10–18-Year-Old Indonesian Children and Adolescents Nutrients, Vol. 11, Pages 2813: Rural–Urban Differences in Dietary Behavior and Obesity: Results of the Riskesdas Study in 10–18-Year-Old Indonesian Children and Adolescents Nutrients doi: 10.3390/nu11112813 Authors: Esti Nurwanti Hamam Hadi Jung-Su Chang Jane C.-J. Chao Bunga Astria Paramashanti Joel Gittelsohn Chyi-Huey Bai Obesity has become a significant problem for developing countries, including Indonesia. High duration of sedentary activity and high intake of... Nutrients Mon Nov 18, 2019 02:00 Nutrients, Vol. 11, Pages 2815: Vitamin B12 Status Upon Short-Term Intervention with a Vegan Diet—A Randomized Controlled Trial in Healthy Participants Nutrients, Vol. 11, Pages 2815: Vitamin B12 Status Upon Short-Term Intervention with a Vegan Diet—A Randomized Controlled Trial in Healthy Participants Nutrients doi: 10.3390/nu11112815 Authors: Ann-Kathrin Lederer Luciana Hannibal Manuel Hettich Sidney Behringer Ute Spiekerkoetter Carmen Steinborn Carsten Gründemann Amy Marisa Zimmermann-Klemd Alexander Müller Thomas Simmet Michael Schmiech Andrea Maul-Pavicic Yvonne Samstag Roman Huber Vegans... Nutrients Mon Nov 18, 2019 02:00 Nutrients, Vol. 11, Pages 2814: Are There Adverse Events after the Use of Sexual Enhancement Nutrition Supplements? A Nationwide Online Survey from Japan Nutrients, Vol. 11, Pages 2814: Are There Adverse Events after the Use of Sexual Enhancement Nutrition Supplements? A Nationwide Online Survey from Japan Nutrients doi: 10.3390/nu11112814 Authors: Chiharu Nishijima Etsuko Kobayashi Yoko Sato Tsuyoshi Chiba Dozens of safety alerts for sexual enhancement and weight loss dietary supplements have been launched from the government not only in Japan but also overseas. However, adverse events have been reported only for the use of... Nutrients Mon Nov 18, 2019 02:00 Nutrients, Vol. 11, Pages 2812: Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions Nutrients, Vol. 11, Pages 2812: Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions Nutrients doi: 10.3390/nu11112812 Authors: Maria Vittoria Ristori Andrea Quagliariello Sofia Reddel Gianluca Ianiro Stefano Vicari Antonio Gasbarrini Lorenza Putignani Autism spectrum disorder (ASD) is a complex behavioral syndrome that is characterized by speech and language disorders, intellectual impairment, learning and motor dysfunctions.... Nutrients Mon Nov 18, 2019 02:00 Nutrients, Vol. 11, Pages 2817: Butyric Acid and Leucine Induce α-Defensin Secretion from Small Intestinal Paneth Cells Nutrients, Vol. 11, Pages 2817: Butyric Acid and Leucine Induce α-Defensin Secretion from Small Intestinal Paneth Cells Nutrients doi: 10.3390/nu11112817 Authors: Akiko Takakuwa Kiminori Nakamura Mani Kikuchi Rina Sugimoto Shuya Ohira Yuki Yokoi Tokiyoshi Ayabe The intestine not only plays a role in fundamental processes in digestion and nutrient absorption, but it also has a role in eliminating ingested pathogenic bacteria and viruses. Paneth cells, which reside at... Nutrients Mon Nov 18, 2019 02:00 Mark above section as read  Pathogens Pathogens, Vol. 8, Pages 243: Aggregatibacter Actinomycetemcomitans: Clinical Significance of a Pathobiont Subjected to Ample Changes in Classification and Nomenclature Pathogens, Vol. 8, Pages 243: Aggregatibacter Actinomycetemcomitans: Clinical Significance of a Pathobiont Subjected to Ample Changes in Classification and Nomenclature Pathogens doi: 10.3390/pathogens8040243 Authors: Nørskov-Lauritsen Claesson Birkeholm Jensen Åberg Haubek Aggregatibacter actinomycetemcomitans is a Gram-negative bacterium that is part of the oral microbiota. The aggregative nature of this pathogen or pathobiont is crucial to its involvement in human... Pathogens Mon Nov 18, 2019 02:00 Pathogens, Vol. 8, Pages 242: Com1 as a Promising Protein for the Differential Diagnosis of the Two Forms of Q Fever Pathogens, Vol. 8, Pages 242: Com1 as a Promising Protein for the Differential Diagnosis of the Two Forms of Q Fever Pathogens doi: 10.3390/pathogens8040242 Authors: Vranakis Mathioudaki Kokkini Psaroulaki Coxiella burnetii is the causative agent of acute and chronic Q fever in humans. Although the isolates studied so far showed a difference in virulence potential between those causing the two forms of the disease, implying a difference in their proteomic profile, the methods... Pathogens Mon Nov 18, 2019 02:00 Mark above section as read  Plants Plants, Vol. 8, Pages 521: Responses of Rice Growth to Day and Night Temperature and Relative Air Humidity—Dry Matter, Leaf Area, and Partitioning Plants, Vol. 8, Pages 521: Responses of Rice Growth to Day and Night Temperature and Relative Air Humidity—Dry Matter, Leaf Area, and Partitioning Plants doi: 10.3390/plants8110521 Authors: Stuerz Asch Asymmetric changes of day and night temperature have already been observed because of Climate Change. However, knowledge on environmental conditions either during day or night serving as trigger for growth processes is scarce. In this study, one rice (Oryza sativa) variety (IR64)... Plants Mon Nov 18, 2019 02:00 Plants, Vol. 8, Pages 520: Cunninghamia lanceolata PSK Peptide Hormone Genes Promote Primary Root Growth and Adventitious Root Formation Plants, Vol. 8, Pages 520: Cunninghamia lanceolata PSK Peptide Hormone Genes Promote Primary Root Growth and Adventitious Root Formation Plants doi: 10.3390/plants8110520 Authors: Hua Wu Renhua Zheng Zhaodong Hao Yan Meng Yuhao Weng Xiaohong Zhou Liming Zhu Xiangyang Hu Guibin Wang Jisen Shi Jinhui Chen Phytosulfokine-α (PSK-α) is a newly discovered short peptide that acts as a phytohormone in various plants. Previous studies have shown... Plants Mon Nov 18, 2019 02:00 Mark above section as read  Religions Religions, Vol. 10, Pages 636: The Anuvrat Movement: A Case Study of Jain-inspired Ethical and Eco-conscious Living Religions, Vol. 10, Pages 636: The Anuvrat Movement: A Case Study of Jain-inspired Ethical and Eco-conscious Living Religions doi: 10.3390/rel10110636 Authors: Michael Reading From proclaiming the equality of all life forms to the stringent emphasis placed upon nonviolent behavior (ahimsa), and once more to the pronounced intention for limiting one's possessions (aparigraha), Jainism has often been pointed to for its admirably ecofriendly example. Incorporating some of this... Religions Mon Nov 18, 2019 02:00 Religions, Vol. 10, Pages 635: French Salafists' Economic Ethics: Between Election and New Forms of Politicization Religions, Vol. 10, Pages 635: French Salafists' Economic Ethics: Between Election and New Forms of Politicization Religions doi: 10.3390/rel10110635 Authors: Mohamed-Ali Adraoui This article sheds light on the way in which activities such as the production and consumption of wealth are conceptualized, interpreted and put into practice within quietist Salafist communities in France. Unlike their jihadi and politicized counterparts, quietist Salafis in lands where Islam is the minority... Religions Mon Nov 18, 2019 02:00 Mark above section as read  Robotics Robotics, Vol. 8, Pages 97: A Pedestrian Avoidance Method Considering Personal Space for a Guide Robot Robotics, Vol. 8, Pages 97: A Pedestrian Avoidance Method Considering Personal Space for a Guide Robot Robotics doi: 10.3390/robotics8040097 Authors: Yutaka Hiroi Akinori Ito Many methods have been proposed for avoiding obstacles in robotic systems. However, a robotic system that moves without colliding with obstacles and people, while still being mentally safe to the persons nearby, has not yet been realized. In this paper, we describe the development of a method for a mobile robot... Robotics Mon Nov 18, 2019 02:00 Mark above section as read  Sports Sports, Vol. 7, Pages 240: Exploring Children's Physical Activity Behaviours According to Location: A Mixed-Methods Case Study Sports, Vol. 7, Pages 240: Exploring Children's Physical Activity Behaviours According to Location: A Mixed-Methods Case Study Sports doi: 10.3390/sports7110240 Authors: Irfan Khawaja Lorayne Woodfield Peter Collins Adam Benkwitz Alan Nevill The school environment is ideally placed to facilitate physical activity (PA) with numerous windows of opportunity from break and lunch times, to lesson times and extracurricular clubs. However, little is known about how children interact... Sports Mon Nov 18, 2019 02:00 Sports, Vol. 7, Pages 239: Vitamin D Status Differs by Sex, Sport-Season, and Skin Pigmentation among Elite Collegiate Basketball Players Sports, Vol. 7, Pages 239: Vitamin D Status Differs by Sex, Sport-Season, and Skin Pigmentation among Elite Collegiate Basketball Players Sports doi: 10.3390/sports7110239 Authors: Jennifer B. Fields Daniel C. Payne Sina Gallo Deanna R. Busteed Margaret T. Jones Vitamin D plays a key role in bone health, musculoskeletal function, and sport performance. Collegiate athletes competing in indoor sports may be at greater risk of vitamin D deficiency due to limited outdoor time.... Sports Mon Nov 18, 2019 02:00 Mark above section as read  Toxins Toxins, Vol. 11, Pages 674: A Novel Adsorbent Albite Modified with Cetylpyridinium Chloride for Efficient Removal of Zearalenone Toxins, Vol. 11, Pages 674: A Novel Adsorbent Albite Modified with Cetylpyridinium Chloride for Efficient Removal of Zearalenone Toxins doi: 10.3390/toxins11110674 Authors: Zhang Zhang Wang Dong Cheng Xu Shan Zearalenone (ZEN) is a non-steroidal estrogenic mycotoxin and constitutes a potential health threat to humans and livestock. This study aimed to explore the potential of albite modified by the cationic surfactant cetylpyridinium chloride (CPC) as ZEN adsorbent.... Toxins Mon Nov 18, 2019 02:00 Toxins, Vol. 11, Pages 673: Missiles of Mass Disruption: Composition and Glandular Origin of Venom Used as a Projectile Defensive Weapon by the Assassin Bug Platymeris rhadamanthus Toxins, Vol. 11, Pages 673: Missiles of Mass Disruption: Composition and Glandular Origin of Venom Used as a Projectile Defensive Weapon by the Assassin Bug Platymeris rhadamanthus Toxins doi: 10.3390/toxins11110673 Authors: Walker Robinson Undheim Jin Han Fry Vetter King Assassin bugs (Reduviidae) produce venoms that are insecticidal, and which induce pain in predators, but the composition and function of their individual venom components is poorly understood.... Toxins Mon Nov 18, 2019 02:00 Toxins, Vol. 11, Pages 672: Cloning and Immunosuppressive Properties of an Acyl-Activating Enzyme from the Venom Apparatus of Tetrastichus brontispae (Hymenoptera: Eulophidae) Toxins, Vol. 11, Pages 672: Cloning and Immunosuppressive Properties of an Acyl-Activating Enzyme from the Venom Apparatus of Tetrastichus brontispae (Hymenoptera: Eulophidae) Toxins doi: 10.3390/toxins11110672 Authors: Xiao-Mei Zhang Hua-Jian Zhang Min Liu Bin Liu Xia-Fang Zhang Cheng-Jun Ma Ting-Ting Fu You-Ming Hou Bao-Zhen Tang Venom injected into the host plays vital roles in facilitating successful parasitization and development for parasitoid wasps, especially... Toxins Mon Nov 18, 2019 02:00 Mark above section as read  Vaccines Vaccines, Vol. 7, Pages 188: Trends in Socioeconomic Inequalities in Full Vaccination Coverage among Vietnamese Children aged 12–23 Months, 2000–2014: Evidence for Mitigating Disparities in Vaccination Vaccines, Vol. 7, Pages 188: Trends in Socioeconomic Inequalities in Full Vaccination Coverage among Vietnamese Children aged 12–23 Months, 2000–2014: Evidence for Mitigating Disparities in Vaccination Vaccines doi: 10.3390/vaccines7040188 Authors: Vo Huynh Anh Do Doan Nguyen Nguyen Van There has been no report on the situation of socioeconomic inequalities in the full vaccination coverage among Vietnamese children. This study aims to assess the trends and changes... Vaccines Mon Nov 18, 2019 02:00 Mark above section as read  Viruses Viruses, Vol. 11, Pages 1077: HBV Infection in HIV-Driven Immune Suppression Viruses, Vol. 11, Pages 1077: HBV Infection in HIV-Driven Immune Suppression Viruses doi: 10.3390/v11111077 Authors: Loredana Sarmati Vincenzo Malagnino Worldwide, approximately 10% of all human immunodeficiency virus (HIV)-infected people are also chronically coinfected with hepatitis B virus (HBV). HBV infection has a poor prognosis in HIV-positive people and has been documented by an increased risk of developing chronic HBV infection (CHB), progression to liver fibrosis and end-stage... Viruses 02:00 Viruses, Vol. 11, Pages 1076: Review on Outbreak Dynamics, the Endemic Serotypes, and Diversified Topotypic Profiles of Foot and Mouth Disease Virus Isolates in Ethiopia from 2008 to 2018 Viruses, Vol. 11, Pages 1076: Review on Outbreak Dynamics, the Endemic Serotypes, and Diversified Topotypic Profiles of Foot and Mouth Disease Virus Isolates in Ethiopia from 2008 to 2018 Viruses doi: 10.3390/v11111076 Authors: Ashenafi Kiros Wubshet Junfei Dai Qian Li Jie Zhang Foot and mouth disease (FMD) endemicity in Ethiopia's livestock remains an ongoing cause for economic concern, with new topotypes still arising even in previously unaffected areas. FMD outbreaks... Viruses Mon Nov 18, 2019 02:00 Viruses, Vol. 11, Pages 1075: Molecular Detection and Characterization of the First Cowpox Virus Isolate Derived from a Bank Vole Viruses, Vol. 11, Pages 1075: Molecular Detection and Characterization of the First Cowpox Virus Isolate Derived from a Bank Vole Viruses doi: 10.3390/v11111075 Authors: Kathrin Jeske Saskia Weber Florian Pfaff Christian Imholt Jens Jacob Martin Beer Rainer G. Ulrich Donata Hoffmann Cowpox virus (CPXV) is a zoonotic orthopoxvirus (OPV) that infects a wide range of mammals. CPXV-specific DNA and antibodies were detected in different vole species, such as common voles... Viruses Mon Nov 18, 2019 02:00 Viruses, Vol. 11, Pages 1074: Characterization and Pathogenicity of the Porcine Deltacoronavirus Isolated in Southwest China Viruses, Vol. 11, Pages 1074: Characterization and Pathogenicity of the Porcine Deltacoronavirus Isolated in Southwest China Viruses doi: 10.3390/v11111074 Authors: Yujia Zhao Huan Qu Jingfei Hu Jiayu Fu Rui Chen Cheng Li Sanjie Cao Yiping Wen Rui Wu Qin Zhao Qigui Yan Xintian Wen Xiaobo Huang Porcine deltacoronavirus (PDCoV) is a newly emerging enteric pathogen in swine that causes diarrhea in neonatal piglets and creates an additional economic burden... Viruses Mon Nov 18, 2019 02:00 Viruses, Vol. 11, Pages 1073: Towards Understanding KSHV Fusion and Entry Viruses, Vol. 11, Pages 1073: Towards Understanding KSHV Fusion and Entry Viruses doi: 10.3390/v11111073 Authors: Stephen J. Dollery How viruses enter cells is of critical importance to pathogenesis in the host and for treatment strategies. Over the last several years, the herpesvirus field has made numerous and thoroughly fascinating discoveries about the entry of alpha-, beta-, and gamma-herpesviruses, giving rise to knowledge of entry at the amino acid level and the realization that,... Viruses Mon Nov 18, 2019 02:00 Mark above section as read  Vision Vision, Vol. 3, Pages 63: Hughes's Reverspectives: Radical Uses of Linear Perspective on Non-Coplanar Surfaces Vision, Vol. 3, Pages 63: Hughes's Reverspectives: Radical Uses of Linear Perspective on Non-Coplanar Surfaces Vision doi: 10.3390/vision3040063 Authors: Thomas V. Papathomas Patrick Hughes Two major uses of linear perspective are in planar paintings—the flat canvas is incongruent with the painted 3-D scene—and in forced perspectives, such as theater stages that are concave truncated pyramids, where the physical geometry and the depicted scene are congruent. Patrick... Vision Mon Nov 18, 2019 02:00 Mark above section as read  Water Water, Vol. 11, Pages 2418: Characteristics of Water Isotopes and Water Source Identification During the Wet Season in Naqu River Basin, Qinghai-Tibet Plateau Water, Vol. 11, Pages 2418: Characteristics of Water Isotopes and Water Source Identification During the Wet Season in Naqu River Basin, Qinghai-Tibet Plateau Water doi: 10.3390/w11112418 Authors: Xi Chen Guoli Wang Fuqiang Wang Denghua Yan Heng Zhao Climate change is affecting the discharge of headstreams from mountainous areas on the Qinghai–Tibet Plateau. To constrain future changes in discharge, it is important to understand the present-day formation mechanism and components... Water Mon Nov 18, 2019 02:00 Water, Vol. 11, Pages 2417: Parameter Uncertainty of a Snowmelt Runoff Model and Its Impact on Future Projections of Snowmelt Runoff in a Data-Scarce Deglaciating River Basin Water, Vol. 11, Pages 2417: Parameter Uncertainty of a Snowmelt Runoff Model and Its Impact on Future Projections of Snowmelt Runoff in a Data-Scarce Deglaciating River Basin Water doi: 10.3390/w11112417 Authors: Yiheng Xiang Lu Li Jie Chen Chong-Yu Xu Jun Xia Hua Chen Jie Liu The impacts of climate change on water resources in snow- and glacier-dominated basins are of great importance for water resource management. The Snowmelt Runoff Model (SRM) was developed to simulate... Water Mon Nov 18, 2019 02:00 Water, Vol. 11, Pages 2416: Does Crop Rotation Enhance Groundwater Health? A Review of the Winter Wheat Fallow Policy in the North China Plain Water, Vol. 11, Pages 2416: Does Crop Rotation Enhance Groundwater Health? A Review of the Winter Wheat Fallow Policy in the North China Plain Water doi: 10.3390/w11112416 Authors: Ming Lei Yuqian Zhang Yuxuan Dang Xiangbin Kong Jingtao Yao Agricultural water management is a vital component of realizing the United Nation's Sustainable Development Goals because of water shortages worldwide leading to a severe threat to ecological environments and global food security.... Water Mon Nov 18, 2019 02:00 Mark above section as read
Biomolecules, Vol. 9, Pages 748: What Happened to the Phycobilisome?Biomolecules, Vol. 9, Pages 748: What Happened to the Phycobilisome? Biomolecules doi: 10.3390/biom9110748 Authors: Beverley R. Green The phycobilisome (PBS) is the major light-harvesting complex of photosynthesis in cyanobacteria, red algae, and glaucophyte algae. In spite of the fact that it is very well structured to absorb light and transfer it efficiently to photosynthetic reaction centers, it has been completely lost in the...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Antioxidants, Vol. 8, Pages 566: Fibroblasts to Keratinocytes Redox Signaling: The Possible Role of ROS in Psoriatic Plaque Formation Antioxidants, Vol. 8, Pages 566: Fibroblasts to Keratinocytes Redox Signaling: The Possible Role of ROS in Psoriatic Plaque Formation Antioxidants doi: 10.3390/antiox8110566 Authors: Barygina Becatti Prignano Lotti Taddei Fiorillo Although the role of reactive oxygen species-mediated (ROS-mediated) signalling in physiologic and pathologic skin conditions has been proven, no data exist on the skin cells ROS-mediated communication. Primary fibroblasts were obtained... Antioxidants Mon Nov 18, 2019 02:00 Mark above section as read  Atmosphere Atmosphere, Vol. 10, Pages 723: Impact of Sea Breeze Circulation on the Transport of Ship Emissions in Tangshan Port, China Atmosphere, Vol. 10, Pages 723: Impact of Sea Breeze Circulation on the Transport of Ship Emissions in Tangshan Port, China Atmosphere doi: 10.3390/atmos10110723 Authors: Fang Shang Dongsheng Chen Xiurui Guo Jianlei Lang Ying Zhou Yue Li Xinyi Fu A sea breeze is a local circulation that occurs in coastal regions from the poles to the equator. The adverse influence of ship emissions on air quality in coastal areas may be aggravated by the onshore flow of sea breeze circulation.... Atmosphere Mon Nov 18, 2019 02:00 Atmosphere, Vol. 10, Pages 722: Observational Analysis of the Characteristics of the Synoptic Situation and Evolution of the Organized Warm-Sector Rainfall in the Coastal Region of South China in the Pre-Summer Rainy Season Atmosphere, Vol. 10, Pages 722: Observational Analysis of the Characteristics of the Synoptic Situation and Evolution of the Organized Warm-Sector Rainfall in the Coastal Region of South China in the Pre-Summer Rainy Season Atmosphere doi: 10.3390/atmos10110722 Authors: Zhaoming Liang Robert G. Fovell Ying Liu The characteristics of the synoptic situation and the evolution of the organized warm-sector rainfalls (OWSRs) in the coastal region of South China in the pre-summer rainy... Atmosphere Mon Nov 18, 2019 02:00 Atmosphere, Vol. 10, Pages 721: Intercomparison of Ground- and Satellite-Based Total Ozone Data Products at Marambio Base, Antarctic Peninsula Region Atmosphere, Vol. 10, Pages 721: Intercomparison of Ground- and Satellite-Based Total Ozone Data Products at Marambio Base, Antarctic Peninsula Region Atmosphere doi: 10.3390/atmos10110721 Authors: Klára Čížková Kamil Láska Ladislav Metelka Martin Staněk This study aims to compare the ground-based Brewer spectrophotometer total ozone column measurements with the Dobson spectrophotometer and various satellite overpass data available at Marambio Base during the period 2011–2013.... Atmosphere Mon Nov 18, 2019 02:00 Atmosphere, Vol. 10, Pages 720: Recently Strengthened Influence of ENSO on the Wintertime East Asian Surface Air Temperature Atmosphere, Vol. 10, Pages 720: Recently Strengthened Influence of ENSO on the Wintertime East Asian Surface Air Temperature Atmosphere doi: 10.3390/atmos10110720 Authors: Hainan Gong Lin Wang Wen Chen Previous studies have indicated that El Niño–Southern Oscillation (ENSO) exerts a significant influence on the East Asian winter climate. This study reveals an interdecadal strengthening of the connection between ENSO and the East Asian surface air temperature... Atmosphere Mon Nov 18, 2019 02:00 Mark above section as read  Behavioral Sciences Behavioral Sciences, Vol. 9, Pages 116: Older Adults' Perceptions of Psychotherapy in Cyprus Behavioral Sciences, Vol. 9, Pages 116: Older Adults' Perceptions of Psychotherapy in Cyprus Behavioral Sciences doi: 10.3390/bs9110116 Authors: Ioanna Katsounari The purpose of the study was to explore older adults' views and perceptions of psychotherapy in Cyprus. A total of 25 older adults, aged between 65–89, participated in semi-structured interviews. Thematic analysis identified three main themes: Familiar term/Unfamiliar process; existential crises during this... Behavioral Sciences 02:00 Mark above section as read  Biomolecules Biomolecules, Vol. 9, Pages 747: Investigating the Systems-Level Effect of Pueraria lobata for Menopause-Related Metabolic Diseases Using an Ovariectomized Rat Model and Network Pharmacological Analysis Biomolecules, Vol. 9, Pages 747: Investigating the Systems-Level Effect of Pueraria lobata for Menopause-Related Metabolic Diseases Using an Ovariectomized Rat Model and Network Pharmacological Analysis Biomolecules doi: 10.3390/biom9110747 Authors: Ji Hong Oh Seon-Eun Baek Won-Yung Lee Ji Yun Baek Tuy An Trinh Do Hwi Park Hye Lim Lee Ki Sung Kang Chang-Eop Kim Jeong-Eun Yoo This study was conducted to evaluate the biological activities of Pueraria lobata (PL)... Biomolecules Mon Nov 18, 2019 02:00 Biomolecules, Vol. 9, Pages 745: Molecular Dynamics Simulations Suggest a Non-Doublet Decoding Model of –1 Frameshifting by tRNASer3 Biomolecules, Vol. 9, Pages 745: Molecular Dynamics Simulations Suggest a Non-Doublet Decoding Model of –1 Frameshifting by tRNASer3 Biomolecules doi: 10.3390/biom9110745 Authors: Caulfield Coban Tek Flores In-frame decoding in the ribosome occurs through canonical or wobble Watson–Crick pairing of three mRNA codon bases (a triplet) with a triplet of anticodon bases in tRNA. Departures from the triplet–triplet interaction can result in frameshifting,... Biomolecules Mon Nov 18, 2019 02:00 Biomolecules, Vol. 9, Pages 746: Pharmacological Discrimination of Effects of MK801 on Thalamocortical, Mesothalamic, and Mesocortical Transmissions Biomolecules, Vol. 9, Pages 746: Pharmacological Discrimination of Effects of MK801 on Thalamocortical, Mesothalamic, and Mesocortical Transmissions Biomolecules doi: 10.3390/biom9110746 Authors: Okada Fukuyama Nakano Ueda N-methyl-d-aspartate/glutamate receptor (NMDAR) is one of the major voltage-sensitive ligand-gated cation channel. Several noncompetitive NMDAR antagonists contribute to pathophysiology of schizophrenia and mood disorders; however, the effects of inhibition... Biomolecules Mon Nov 18, 2019 02:00 Mark above section as read  Brain Sciences Brain Sciences, Vol. 9, Pages 329: Vestibular Compensation after Vestibular Dysfunction Induced by Arsanilic Acid in Mice Brain Sciences, Vol. 9, Pages 329: Vestibular Compensation after Vestibular Dysfunction Induced by Arsanilic Acid in Mice Brain Sciences doi: 10.3390/brainsci9110329 Authors: Taeko Ito Kouko Tatsumi Yasumitsu Takimoto Tadashi Nishimura Takao Imai Toshiaki Yamanaka Noriaki Takeda Akio Wanaka Tadashi Kitahara When vestibular function is lost, vestibular compensation works for the reacquisition of body balance. For the study of vestibular dysfunction and vestibular... Brain Sciences Mon Nov 18, 2019 02:00 Mark above section as read  Cancers Cancers, Vol. 11, Pages 1815: Nucleocytoplasmic Shuttling of STATs. A Target for Intervention? Cancers, Vol. 11, Pages 1815: Nucleocytoplasmic Shuttling of STATs. A Target for Intervention? Cancers doi: 10.3390/cancers11111815 Authors: Sabrina Ernst Gerhard Müller-Newen Signal transducer and activator of transcription (STAT) proteins are transcription factors that in the latent state are located predominantly in the cytoplasm. Activation of STATs through phosphorylation of a single tyrosine residue results in nuclear translocation. The requirement of tyrosine phosphorylation... Cancers 02:00 Cancers, Vol. 11, Pages 1814: A Novel Calcium-Mediated EMT Pathway Controlled by Lipids: An Opportunity for Prostate Cancer Adjuvant Therapy Cancers, Vol. 11, Pages 1814: A Novel Calcium-Mediated EMT Pathway Controlled by Lipids: An Opportunity for Prostate Cancer Adjuvant Therapy Cancers doi: 10.3390/cancers11111814 Authors: Figiel Bery Chantôme Fontaine Pasqualin Maupoil Domingo Guibon Bruyère Potier-Cartereau Vandier Fromont Mahéo The composition of periprostatic adipose tissue (PPAT) has been shown to play a role in prostate cancer (PCa) progression. We recently reported... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1813: Evaluation of the Accuracy of Liquid-Based Oral Brush Cytology in Screening for Oral Squamous Cell Carcinoma Cancers, Vol. 11, Pages 1813: Evaluation of the Accuracy of Liquid-Based Oral Brush Cytology in Screening for Oral Squamous Cell Carcinoma Cancers doi: 10.3390/cancers11111813 Authors: Deuerling Gaida Neumann Remmerbach This study evaluates the accuracy of the results of liquid-based oral brush cytology and compares it to the histology and/or the clinical follow-ups of the respective patients. A total of 1352 exfoliated specimens were collected with an Orcellex brush from... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1812: Synergistic Autophagy Effect of miR-212-3p in Zoledronic Acid-Treated In Vitro and Orthotopic In Vivo Models and in Patient-Derived Osteosarcoma Cells Cancers, Vol. 11, Pages 1812: Synergistic Autophagy Effect of miR-212-3p in Zoledronic Acid-Treated In Vitro and Orthotopic In Vivo Models and in Patient-Derived Osteosarcoma Cells Cancers doi: 10.3390/cancers11111812 Authors: Ju Yeon Oh Eun Ho Kim Yeon-Joo Lee Sei Sai Sun Ha Lim Jang Woo Park Hye Kyung Chung Joon Kim Guillaume Vares Akihisa Takahashi Youn Kyoung Jeong Mi-Sook Kim Chang-Bae Kong Osteosarcoma (OS) originates from osteoid bone tissues... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1811: Mitigating Effect of 1-Palmitoyl-2-Linoleoyl-3-Acetyl-Rac-Glycerol (PLAG) on a Murine Model of 5-Fluorouracil-Induced Hematological Toxicity Cancers, Vol. 11, Pages 1811: Mitigating Effect of 1-Palmitoyl-2-Linoleoyl-3-Acetyl-Rac-Glycerol (PLAG) on a Murine Model of 5-Fluorouracil-Induced Hematological Toxicity Cancers doi: 10.3390/cancers11111811 Authors: Jinseon Jeong Yong-Jae Kim Do Young Lee Ki-Young Sohn Sun Young Yoon Jae Wha Kim 5-Fluorouracil (5-FU) is an antimetabolite chemotherapy widely used for the treatment of various cancers. However, many cancer patients experience hematological side effects following... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1810: The Gasdermin E gene Potential as a Pan-Cancer Biomarker, While Discriminating between Different Tumor Types Cancers, Vol. 11, Pages 1810: The Gasdermin E gene Potential as a Pan-Cancer Biomarker, While Discriminating between Different Tumor Types Cancers doi: 10.3390/cancers11111810 Authors: Joe Ibrahim Ken Op de Beeck Erik Fransen Marc Peeters Guy Van Camp Due to the elevated rates of incidence and mortality of cancer, early and accurate detection is crucial for achieving optimal treatment. Molecular biomarkers remain important screening and detection tools, especially in light... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1809: Bulk and Single-Cell Next-Generation Sequencing: Individualizing Treatment for Colorectal Cancer Cancers, Vol. 11, Pages 1809: Bulk and Single-Cell Next-Generation Sequencing: Individualizing Treatment for Colorectal Cancer Cancers doi: 10.3390/cancers11111809 Authors: Ioannis D. Kyrochristos Demosthenes E. Ziogas Anna Goussia Georgios K. Glantzounis Dimitrios H. Roukos The increasing incidence combined with constant rates of early diagnosis and mortality of colorectal cancer (CRC) over the past decade worldwide, as well as minor overall survival improvements in the... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1808: hENT1 Testing in Pancreatic Ductal Adenocarcinoma: Are We Ready? A Multimodal Evaluation of hENT1 Status Cancers, Vol. 11, Pages 1808: hENT1 Testing in Pancreatic Ductal Adenocarcinoma: Are We Ready? A Multimodal Evaluation of hENT1 Status Cancers doi: 10.3390/cancers11111808 Authors: Jerome Raffenne Remy Nicolle Francesco Puleo Delphine Le Corre Camille Boyez Raphael Marechal Jean François Emile Peter Demetter Armelle Bardier Pierre Laurent-Puig Louis de Mestier Valerie Paradis Anne Couvelard Jean Luc VanLathem John R. MacKey Jean-Baptiste Bachet... Cancers Mon Nov 18, 2019 02:00 Mark above section as read  Cells Cells, Vol. 8, Pages 1461: The Role of MicroRNAs upon Epithelial-to-Mesenchymal Transition in Inflammatory Bowel Disease Cells, Vol. 8, Pages 1461: The Role of MicroRNAs upon Epithelial-to-Mesenchymal Transition in Inflammatory Bowel Disease Cells doi: 10.3390/cells8111461 Authors: Éva Boros István Nagy Increasing evidence suggest the significance of inflammation in the progression of cancer, for example the development of colorectal cancer in Inflammatory Bowel Disease (IBD) patients. Long-lasting inflammation in the gastrointestinal tract causes serious systemic complications and breaks the homeostasis... Cells 02:00 Cells, Vol. 8, Pages 1460: Carbamazepine Enhances Adipogenesis by Inhibiting Wnt/β-catenin Expression Cells, Vol. 8, Pages 1460: Carbamazepine Enhances Adipogenesis by Inhibiting Wnt/β-catenin Expression Cells doi: 10.3390/cells8111460 Authors: Im Kim Chau Um Carbamazepine is a drug that is widely used in the treatment of epilepsy and bipolar disorder. The prevalence of obesity in patients treated with carbamazepine has been frequently reported. However, whether carbamazepine affects adipogenesis, one of the critical steps in the development of obesity, remains unclear.... Cells Mon Nov 18, 2019 02:00 Cells, Vol. 8, Pages 1459: Novel Epigenetic Biomarkers in Pregnancy-Related Disorders and Cancers Cells, Vol. 8, Pages 1459: Novel Epigenetic Biomarkers in Pregnancy-Related Disorders and Cancers Cells doi: 10.3390/cells8111459 Authors: Karin-Kujundzic Sola Predavec Potkonjak Somen Mioc Serman Vranic Serman As the majority of cancers and gestational diseases are prognostically stage- and grade-dependent, the ultimate goal of ongoing studies in precision medicine is to provide early and timely diagnosis of such disorders. These studies have enabled... Cells Mon Nov 18, 2019 02:00 Cells, Vol. 8, Pages 1457: Natural Histogel-Based Bio-Scaffolds for Sustaining Angiogenesis in Beige Adipose Tissue Cells, Vol. 8, Pages 1457: Natural Histogel-Based Bio-Scaffolds for Sustaining Angiogenesis in Beige Adipose Tissue Cells doi: 10.3390/cells8111457 Authors: Margherita Di Somma Wandert Schaafsma Elisabetta Grillo Maria Vliora Eleni Dakou Michela Corsini Cosetta Ravelli Roberto Ronca Paraskevi Sakellariou Jef Vanparijs Begona Castro Stefania Mitola In the treatment of obesity and its related disorders, one of the measures adopted is weight reduction by... Cells Mon Nov 18, 2019 02:00 Cells, Vol. 8, Pages 1456: Differential Roles of Lipin1 and Lipin2 in the Hepatitis C Virus Replication Cycle Cells, Vol. 8, Pages 1456: Differential Roles of Lipin1 and Lipin2 in the Hepatitis C Virus Replication Cycle Cells doi: 10.3390/cells8111456 Authors: Victoria Castro Gema Calvo Ginés Ávila-Pérez Marlène Dreux Pablo Gastaminza Although their origin, nature and structure are not identical, a common feature of positive-strand RNA viruses is their ability to subvert host lipids and intracellular membranes to generate replication and assembly complexes. Recently, lipin1, a cellular... Cells Mon Nov 18, 2019 02:00 Cells, Vol. 8, Pages 1458: Emerging Role of Cellular Prion Protein in the Maintenance and Expansion of Glioma Stem Cells Cells, Vol. 8, Pages 1458: Emerging Role of Cellular Prion Protein in the Maintenance and Expansion of Glioma Stem Cells Cells doi: 10.3390/cells8111458 Authors: Stefano Thellung Alessandro Corsaro Alessia G. Bosio Martina Zambito Federica Barbieri Michele Mazzanti Tullio Florio Cellular prion protein (PrPC) is a membrane-anchored glycoprotein representing the physiological counterpart of PrP scrapie (PrPSc), which plays a pathogenetic role in prion diseases. Relatively... Cells Mon Nov 18, 2019 02:00 Cells, Vol. 8, Pages 1454: Mitochondrial Mass Assessment in a Selected Cell Line under Different Metabolic Conditions Cells, Vol. 8, Pages 1454: Mitochondrial Mass Assessment in a Selected Cell Line under Different Metabolic Conditions Cells doi: 10.3390/cells8111454 Authors: Anna Costanzini Gianluca Sgarbi Alessandra Maresca Valentina Del Dotto Giancarlo Solaini Alessandra Baracca Changes of quantity and/or morphology of cell mitochondria are often associated with metabolic modulation, pathology, and apoptosis. Exogenous fluorescent probes used to investigate changes in mitochondrial... Cells Mon Nov 18, 2019 02:00 Cells, Vol. 8, Pages 1455: miRNA-29b Inhibits Prostate Tumor Growth and Induces Apoptosis by Increasing Bim Expression Cells, Vol. 8, Pages 1455: miRNA-29b Inhibits Prostate Tumor Growth and Induces Apoptosis by Increasing Bim Expression Cells doi: 10.3390/cells8111455 Authors: Subhayan Sur Robert Steele Xingyi Shi Ratna B. Ray Prostate cancer is one of the most common cancers among men. Currently available therapies improve patient survival against local prostate cancer but have shown severe side effects. Advanced prostate cancer is still incurable. Studies have suggested the involvement of... Cells Mon Nov 18, 2019 02:00 Mark above section as read  Dentistry Journal Dentistry Journal, Vol. 7, Pages 108: Is the Use of Antimicrobial Photodynamic Therapy or Systemic Antibiotics More Effective in Improving Periodontal Health When Used in Conjunction with Localised Non-Surgical Periodontal Therapy? A Systematic Review Dentistry Journal, Vol. 7, Pages 108: Is the Use of Antimicrobial Photodynamic Therapy or Systemic Antibiotics More Effective in Improving Periodontal Health When Used in Conjunction with Localised Non-Surgical Periodontal Therapy? A Systematic Review Dentistry Journal doi: 10.3390/dj7040108 Authors: Animesh Pal Sanjeev Paul Rachel Perry James Puryer Periodontal disease can be treated in several ways. This paper reviewed whether antimicrobial photodynamic therapy (aPDT) in addition... Dentistry Journal Mon Nov 18, 2019 02:00 Mark above section as read  Diagnostics Diagnostics, Vol. 9, Pages 196: Identification of Pneumococcal Serotypes by PCR–Restriction Fragment Length Polymorphism Diagnostics, Vol. 9, Pages 196: Identification of Pneumococcal Serotypes by PCR–Restriction Fragment Length Polymorphism Diagnostics doi: 10.3390/diagnostics9040196 Authors: García-Suárez González-Rodríguez Cima-Cabal Yuste Vazquez Santiago Streptococcus pneumoniae shows more than 90 capsular serotypes that can be distinguished by their reactivity against antisera. The main objective of this work was the development of a molecular method for serotyping without the... Diagnostics Mon Nov 18, 2019 02:00 Diagnostics, Vol. 9, Pages 195: Neonatal Mass Urine Screening Approach for Early Detection of Mucopolysaccharidoses by UPLC-MS/MS Diagnostics, Vol. 9, Pages 195: Neonatal Mass Urine Screening Approach for Early Detection of Mucopolysaccharidoses by UPLC-MS/MS Diagnostics doi: 10.3390/diagnostics9040195 Authors: Iskren Menkovic Anne-Sophie Marchand Michel Boutin Christiane Auray-Blais Mucopolysaccharidoses (MPSs) are lysosomal storage disorders caused by deficiencies of enzymes involved in the catabolism of glycosaminoglycans (GAGs). Various treatments such as enzyme replacement therapy and/or hematopoietic... Diagnostics Mon Nov 18, 2019 02:00 Mark above section as read  Healthcare Healthcare, Vol. 7, Pages 149: Nutritional Knowledge and Self-Reported Nutritional Practice against Malnutrition among Physicians in Jeddah, Saudi Arabia Healthcare, Vol. 7, Pages 149: Nutritional Knowledge and Self-Reported Nutritional Practice against Malnutrition among Physicians in Jeddah, Saudi Arabia Healthcare doi: 10.3390/healthcare7040149 Authors: Alkhaldy The new era of healthcare emphasizes the integration of nutritional care into healthcare management to improve patient outcomes. Previous studies indicated that nutritional knowledge among physicians is insufficient. Thus far, only a limited number of studies have assessed... Healthcare 02:00 Mark above section as read  Heritage Heritage, Vol. 2, Pages 2763-2783: X-Ray Dating of Ancient Linen Fabrics Heritage, Vol. 2, Pages 2763-2783: X-Ray Dating of Ancient Linen Fabrics Heritage doi: 10.3390/heritage2040171 Authors: De Caro Giannini Lassandro Scattarella Sibillano Matricciani Fanti We propose a new method for dating ancient linen threads by inspecting their structural degradation by means of wide-angle X-ray scattering. X-ray dating of a textile sample can be performed nondestructively and on a submillimeter area, e.g., 0.2 0.5 mm2, exploiting new table-top... Heritage Mon Nov 18, 2019 02:00 Mark above section as read  International Journal of Environmental Research and Public Health IJERPH, Vol. 16, Pages 4574: The Role of Environmental Tax in Alleviating the Impact of Environmental Pollution on Residents' Happiness in China IJERPH, Vol. 16, Pages 4574: The Role of Environmental Tax in Alleviating the Impact of Environmental Pollution on Residents' Happiness in China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224574 Authors: Yu Liu Rong-Lin Li Yang Song Zhi-Jiang Zhang Background: Environmental tax has been implemented by the government in response to the demands of the residents to control environmental pollution. However, a tax has a wide effect on many... International Journal of Environmental Research and Public Health 02:00 IJERPH, Vol. 16, Pages 4572: Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era IJERPH, Vol. 16, Pages 4572: Strengthening Routine Immunization Services in an Angolan Comuna: The Fight against the Burden of Unvaccinated Children in the Sustainable Development Goals Era International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224572 Authors: Mattia Fattorini Calistus Wilunda Gloria Raguzzoni Cecilia Quercioli Gabriele Messina Maria Pia Fantini Giovanni Putoto In May 2018, the non-governmental organization (NGO) Doctors... International Journal of Environmental Research and Public Health 02:00 IJERPH, Vol. 16, Pages 4573: Demand for a Housing Offer Addressed to Senior Citizens in Poland IJERPH, Vol. 16, Pages 4573: Demand for a Housing Offer Addressed to Senior Citizens in Poland International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224573 Authors: Katarzyna Przybyła Maria Hełdak Izabela Kurtyka-Marcak The purpose of this study is to identify the willingness of pensioners to move from an apartment/house to an apartment/house located in a housing estate specifically designed for senior citizens. As such, this article forms part... International Journal of Environmental Research and Public Health 02:00 IJERPH, Vol. 16, Pages 4570: Analysis of Health in Environmental Assessments—A Literature Review and Survey with a Focus on Denmark IJERPH, Vol. 16, Pages 4570: Analysis of Health in Environmental Assessments—A Literature Review and Survey with a Focus on Denmark International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224570 Authors: Humboldt-Dachroeden Fischer-Bonde Gulis In the European Union, the Environmental Impact Assessment (EIA) Directive (2014/52/EU) and Strategic Environmental Assessment (SEA) Directive (2011/92/EU) emphasise the assessment of population and human... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4571: Specific Eccentric–Isokinetic Cluster Training Improves Static Strength Elements on Rings for Elite Gymnasts IJERPH, Vol. 16, Pages 4571: Specific Eccentric–Isokinetic Cluster Training Improves Static Strength Elements on Rings for Elite Gymnasts International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224571 Authors: Schärer Tacchelli Göpfert Gross Lüthy Taube Hübner In gymnastics, coaches are constantly searching for efficient training methods in order to improve the athletes' performance. Therefore, in this study we aimed to... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4568: Heatwave Events and Mortality Outcomes in Memphis, Tennessee: Testing Effect Modification by Socioeconomic Status and Urbanicity IJERPH, Vol. 16, Pages 4568: Heatwave Events and Mortality Outcomes in Memphis, Tennessee: Testing Effect Modification by Socioeconomic Status and Urbanicity International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224568 Authors: Li Akkus Yu Joyner Kmet Sweat Jia Heatwave studies typically estimate heat-related mortality and morbidity risks at the city level; few have addressed the heterogeneous risks by socioeconomic status (SES)... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4566: The Impacts of Green Innovation Input and Channel Service in a Dual-Channel Value Chain IJERPH, Vol. 16, Pages 4566: The Impacts of Green Innovation Input and Channel Service in a Dual-Channel Value Chain International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224566 Authors: Li Chen Huang Gui Liu This paper constructs a dual-channel value chain composed of one altruistic manufacturer and one altruistic retailer, where the manufacturer makes green innovation input for green products and sells its green products to its customers... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4567: Validity and Reliability of the Emergency Severity Index in a Spanish Hospital IJERPH, Vol. 16, Pages 4567: Validity and Reliability of the Emergency Severity Index in a Spanish Hospital International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224567 Authors: Luis Miguel Cairós-Ventura Maria de las Mercedes Novo-Muñoz José Ángel Rodríguez-Gómez Ángela María Ortega-Benítez Elena María Ortega-Barreda Armando Aguirre-Jaimehahah Saturation in hospital emergency departments is one of the main safety problems for the patient,... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4569: Assessment of Knowledge, Attitude and Practice towards Prevention of Respiratory Tract Infections among Hajj and Umrah Pilgrims from Malaysia in 2018 IJERPH, Vol. 16, Pages 4569: Assessment of Knowledge, Attitude and Practice towards Prevention of Respiratory Tract Infections among Hajj and Umrah Pilgrims from Malaysia in 2018 International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224569 Authors: Goni Hasan Naing Wan-Arfah Deris Arifin Baaba Respiratory tract infection (RTI) is a major public health challenge during the Muslim pilgrimage to Makkah. This study aims to evaluate... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4565: Informing Behaviour Change: What Sedentary Behaviours Do Families Perform at Home and How Can They Be Targeted? IJERPH, Vol. 16, Pages 4565: Informing Behaviour Change: What Sedentary Behaviours Do Families Perform at Home and How Can They Be Targeted? International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224565 Authors: Lauren Arundell Kate Parker Jo Salmon Jenny Veitch Anna Timperio Home-based interventions targeting children's sedentary behaviours have had limited and inconsistent effectiveness, possibly due to a mismatch between the behaviours... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4564: Symptoms of Discomfort and Problems Associated with Mode of Delivery During the Puerperium: An Observational Study IJERPH, Vol. 16, Pages 4564: Symptoms of Discomfort and Problems Associated with Mode of Delivery During the Puerperium: An Observational Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224564 Authors: Martínez-Galiano Delgado-Rodríguez Rodríguez-Almagro Hernández-Martínez Despite abundant literature on antenatal and delivery care received by pregnant women, there is a wide knowledge gap on the prevalence of symptoms of discomfort... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4563: Valuing Acute Health Risks of Air Pollution in the Jinchuan Mining Area, China: A Choice Experiment with Perceived Exposure and Hazardousness as Co-Determinants IJERPH, Vol. 16, Pages 4563: Valuing Acute Health Risks of Air Pollution in the Jinchuan Mining Area, China: A Choice Experiment with Perceived Exposure and Hazardousness as Co-Determinants International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224563 Authors: Li This paper analyzes the choice of illness-cure combinations to estimate people's willingness to pay (WTP) for the reduction of acute health risks correlated with air pollution caused... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4561: Adapting Digital Social Prescribing for Suicide Bereavement Support: The Findings of a Consultation Exercise to Explore the Acceptability of Implementing Digital Social Prescribing within an Existing Postvention Service IJERPH, Vol. 16, Pages 4561: Adapting Digital Social Prescribing for Suicide Bereavement Support: The Findings of a Consultation Exercise to Explore the Acceptability of Implementing Digital Social Prescribing within an Existing Postvention Service International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224561 Authors: Karen Galway Trisha Forbes Sharon Mallon Olinda Santin Paul Best Jennifer Neff Gerry Leavey Alexandra Pitman This paper... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4562: Investigation the EMG Activities of Lower Limb Muscles When Doing Squatting Exercise in Water and on Land IJERPH, Vol. 16, Pages 4562: Investigation the EMG Activities of Lower Limb Muscles When Doing Squatting Exercise in Water and on Land International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224562 Authors: Calvin H.N. Yuen Christine P.Y. Lam Kate C.T. Tong Jessica C.Y. Yeung Chloe H.Y. Yip Billy C.L. So (1) Background: Squatting is one of the common closed-kinetic chain (CKC) exercises for knee rehabilitation. Some patients cannot perform... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4559: Organizational Strategy and Corporate Social Responsibility: The Mediating Effect of Triple Bottom Line IJERPH, Vol. 16, Pages 4559: Organizational Strategy and Corporate Social Responsibility: The Mediating Effect of Triple Bottom Line International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224559 Authors: Abdul Kaium Masud Harun Ur Rashid Tehmina Khan Seong Mi Bae Jong Dae Kim Limited research in the area of the triple bottom line (TBL) mediation effect on the relationship between organizational strategic performance (OSP) and corporate social... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4557: The Association between Metabolic Syndrome and Biochemical Markers in Beijing Adolescents IJERPH, Vol. 16, Pages 4557: The Association between Metabolic Syndrome and Biochemical Markers in Beijing Adolescents International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224557 Authors: Yao Zhao Yingjie Yu Hong Li Mingying Li Dongran Zhang Dandan Guo Xiaohui Yu Ce Lu Hui Wang Objective: To describe the prevalence of metabolic syndrome (MetS) in adolescents and its association with several MetS-related biochemical markers. Methods:... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4560: Links between Cognitive Status and Trace Element Levels in Hair for an Environmentally Exposed Population: A Case Study in the Surroundings of the Estarreja Industrial Area IJERPH, Vol. 16, Pages 4560: Links between Cognitive Status and Trace Element Levels in Hair for an Environmentally Exposed Population: A Case Study in the Surroundings of the Estarreja Industrial Area International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224560 Authors: Marina M. S. Cabral Pinto Paula Marinho-Reis Agostinho Almeida Edgar Pinto Orquídia Neves Manuela Inácio Bianca Gerardo Sandra Freitas Mário R. Simões Pedro A. Dinis... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4556: Decreased Vertical Trunk Inclination Angle and Pelvic Inclination as the Result of Mid-High-Heeled Footwear on Static Posture Parameters in Asymptomatic Young Adult Women IJERPH, Vol. 16, Pages 4556: Decreased Vertical Trunk Inclination Angle and Pelvic Inclination as the Result of Mid-High-Heeled Footwear on Static Posture Parameters in Asymptomatic Young Adult Women International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224556 Authors: Jakub Michoński Marcin Witkowski Bożena Glinkowska Robert Sitnik Wojciech Glinkowski The influence of high-heel footwear on the lumbar lordosis angle, anterior pelvic tilt,... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4558: Oral Health Status and Need for Oral Care in an Aging Population: A Systematic Review IJERPH, Vol. 16, Pages 4558: Oral Health Status and Need for Oral Care in an Aging Population: A Systematic Review International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224558 Authors: Dorina Lauritano Giulia Moreo Fedora Della Vella Dario Di Stasio Francesco Carinci Alberta Lucchese Massimo Petruzzi Background. The world population is aging. This phenomenon is accompanied by an increase in the number of elderly with dementia, whose... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4555: Policy Debates Regarding Nicotine Vaping Products in Australia: A Qualitative Analysis of Submissions to a Government Inquiry from Health and Medical Organisations IJERPH, Vol. 16, Pages 4555: Policy Debates Regarding Nicotine Vaping Products in Australia: A Qualitative Analysis of Submissions to a Government Inquiry from Health and Medical Organisations International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224555 Authors: Daniel A Erku Kylie Morphett Kathryn J Steadman Coral E Gartner Australia has maintained a highly restrictive regulatory framework for nicotine vaping products (NVPs) and the regulatory... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4554: Help or Hindrance? The Alcohol Industry and Alcohol Control in Portugal IJERPH, Vol. 16, Pages 4554: Help or Hindrance? The Alcohol Industry and Alcohol Control in Portugal International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224554 Authors: Maria Margarida Paixão Mélissa Mialon The influence of the alcohol industry, also known as "corporate political activity" (CPA), is documented as one of the main barriers in implementing effective alcohol control policies. In Portugal, despite an alcohol consumption... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4553: Variations in the Distribution of Chl-a and Simulation Using a Multiple Regression Model IJERPH, Vol. 16, Pages 4553: Variations in the Distribution of Chl-a and Simulation Using a Multiple Regression Model International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224553 Authors: Jiancai Deng Fang Chen Weiping Hu Xin Lu Bin Xu David P. Hamilton Chlorophyll a (Chl-a) is an important indicator of algal biomass in aquatic ecosystems. In this study, monthly monitoring data for Chl-a concentration were collected between 2005 and 2015... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 IJERPH, Vol. 16, Pages 4552: Assessing Agricultural Livelihood Vulnerability to Climate Change in Coastal Bangladesh IJERPH, Vol. 16, Pages 4552: Assessing Agricultural Livelihood Vulnerability to Climate Change in Coastal Bangladesh International Journal of Environmental Research and Public Health doi: 10.3390/ijerph16224552 Authors: Muhammad Ziaul Hoque Shenghui Cui Lilai Xu Imranul Islam Jianxiong Tang Shengping Ding The adverse impacts of climate change exert mounting pressure on agriculture-dependent livelihoods of many developing and developed nations. However, integrated and spatially... International Journal of Environmental Research and Public Health Mon Nov 18, 2019 02:00 Mark above section as read  International Journal of Molecular Sciences IJMS, Vol. 20, Pages 5805: Current and Future Concepts for the Treatment of Impaired Fracture Healing IJMS, Vol. 20, Pages 5805: Current and Future Concepts for the Treatment of Impaired Fracture Healing International Journal of Molecular Sciences doi: 10.3390/ijms20225805 Authors: Carsten W. Schlickewei Holger Kleinertz Darius M. Thiesen Konrad Mader Matthias Priemel Karl-Heinz Frosch Johannes Keller Bone regeneration represents a complex process, of which basic biologic principles have been evolutionarily conserved over a broad range of different species. Bone represents... International Journal of Molecular Sciences 02:00 IJMS, Vol. 20, Pages 5804: Role of HYBID (Hyaluronan Binding Protein Involved in Hyaluronan Depolymerization), Alias KIAA1199/CEMIP, in Hyaluronan Degradation in Normal and Photoaged Skin IJMS, Vol. 20, Pages 5804: Role of HYBID (Hyaluronan Binding Protein Involved in Hyaluronan Depolymerization), Alias KIAA1199/CEMIP, in Hyaluronan Degradation in Normal and Photoaged Skin International Journal of Molecular Sciences doi: 10.3390/ijms20225804 Authors: Hiroyuki Yoshida Yasunori Okada Photoaged skin is characterized clinically by apparent manifestations such as wrinkles and sagging, and histologically by an accumulation of abnormal elastin and a severe loss of collagen... International Journal of Molecular Sciences 02:00 IJMS, Vol. 20, Pages 5802: A Novel 'Candidatus Liberibacter asiaticus'-Encoded Sec-Dependent Secretory Protein Suppresses Programmed Cell Death in Nicotiana benthamiana IJMS, Vol. 20, Pages 5802: A Novel 'Candidatus Liberibacter asiaticus'-Encoded Sec-Dependent Secretory Protein Suppresses Programmed Cell Death in Nicotiana benthamiana International Journal of Molecular Sciences doi: 10.3390/ijms20225802 Authors: Zhang Wang Liu Fan Zhang Zhou Li 'Candidatus Liberibacter asiaticus' (CLas) is one of the causal agents of citrus Huanglongbing (HLB), a bacterial disease of citrus trees that greatly reduces fruit... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5803: Impact of Nitrogen Nutrition on Cannabis sativa: An Update on the Current Knowledge and Future Prospects IJMS, Vol. 20, Pages 5803: Impact of Nitrogen Nutrition on Cannabis sativa: An Update on the Current Knowledge and Future Prospects International Journal of Molecular Sciences doi: 10.3390/ijms20225803 Authors: Simone Landi Roberto Berni Giorgia Capasso Jean-Francois Hausman Gea Guerriero Sergio Esposito Nitrogen (N) availability represents one of the most critical factors affecting cultivated crops. N is indeed a crucial macronutrient influencing major aspects, from plant... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5801: Calcium Polyphosphate Nanoparticles Act as an Effective Inorganic Phosphate Source during Osteogenic Differentiation of Human Mesenchymal Stem Cells IJMS, Vol. 20, Pages 5801: Calcium Polyphosphate Nanoparticles Act as an Effective Inorganic Phosphate Source during Osteogenic Differentiation of Human Mesenchymal Stem Cells International Journal of Molecular Sciences doi: 10.3390/ijms20225801 Authors: Luan Phelipe Hatt Keith Thompson Werner E. G. Müller Martin James Stoddart Angela Rita Armiento The ability of bone-marrow-derived mesenchymal stem/stromal cells (BM-MSCs) to differentiate into osteoblasts makes them the... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5800: The Regulation of NFE2L2 (NRF2) Signalling and Epithelial-to-Mesenchymal Transition in Age-Related Macular Degeneration Pathology IJMS, Vol. 20, Pages 5800: The Regulation of NFE2L2 (NRF2) Signalling and Epithelial-to-Mesenchymal Transition in Age-Related Macular Degeneration Pathology International Journal of Molecular Sciences doi: 10.3390/ijms20225800 Authors: Hyttinen Kannan Felszeghy Niittykoski Salminen Kaarniranta Age-related macular degeneration (AMD) is a mounting cause of loss of sight in the elderly in the developed countries, a trend enhanced by the continual ageing of the population.... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5798: Interactive Effects of Salicylic Acid and Nitric Oxide in Enhancing Rice Tolerance to Cadmium Stress IJMS, Vol. 20, Pages 5798: Interactive Effects of Salicylic Acid and Nitric Oxide in Enhancing Rice Tolerance to Cadmium Stress International Journal of Molecular Sciences doi: 10.3390/ijms20225798 Authors: Mohammad Golam Mostofa Md. Mezanur Rahman Md. Mesbah Uddin Ansary Masayuki Fujita Lam-Son Phan Tran Cadmium (Cd) is one of the prominent environmental hazards, affecting plant productivity and posing human health risks worldwide. Although salicylic acid (SA) and nitric... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5799: An Update on Antibodies to Necleosome Components as Biomarkers of Sistemic Lupus Erythematosus and of Lupus Flares IJMS, Vol. 20, Pages 5799: An Update on Antibodies to Necleosome Components as Biomarkers of Sistemic Lupus Erythematosus and of Lupus Flares International Journal of Molecular Sciences doi: 10.3390/ijms20225799 Authors: Gian Marco Ghiggeri Matteo D'Alessandro Domenico Bartolomeo Maria Ludovica Degl'Innocenti Alberto Magnasco Francesca Lugani Marco Prunotto Maurizio Bruschi Systemic lupus erythematosus (SLE) is an autoimmune disease with variable clinical expression.... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5797: B Vitamins and Fatty Acids: What Do They Share with Small Vessel Disease-Related Dementia? IJMS, Vol. 20, Pages 5797: B Vitamins and Fatty Acids: What Do They Share with Small Vessel Disease-Related Dementia? International Journal of Molecular Sciences doi: 10.3390/ijms20225797 Authors: Rita Moretti Costanza Peinkhofer Many studies have been written on vitamin supplementation, fatty acid, and dementia, but results are still under debate, and no definite conclusion has yet been drawn. Nevertheless, a significant amount of lab evidence confirms that vitamins of the B group... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5796: Carotenoid Cleavage Dioxygenases: Identification, Expression, and Evolutionary Analysis of This Gene Family in Tobacco IJMS, Vol. 20, Pages 5796: Carotenoid Cleavage Dioxygenases: Identification, Expression, and Evolutionary Analysis of This Gene Family in Tobacco International Journal of Molecular Sciences doi: 10.3390/ijms20225796 Authors: Qianqian Zhou Qingchang Li Peng Li Songtao Zhang Che Liu Jingjing Jin Peijian Cao Yongxia Yang Carotenoid cleavage dioxygenases (CCDs) selectively catalyze carotenoids, forming smaller apocarotenoids that are essential for the synthesis of apocarotenoid... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5795: Behavioral Impairments and Oxidative Stress in the Brain, Muscle, and Gill Caused by Chronic Exposure of C70 Nanoparticles on Adult Zebrafish IJMS, Vol. 20, Pages 5795: Behavioral Impairments and Oxidative Stress in the Brain, Muscle, and Gill Caused by Chronic Exposure of C70 Nanoparticles on Adult Zebrafish International Journal of Molecular Sciences doi: 10.3390/ijms20225795 Authors: Sreeja Sarasamma Gilbert Audira Prabu Samikannu Stevhen Juniardi Petrus Siregar Erwei Hao Jung-Ren Chen Chung-Der Hsiao There is an imperative need to develop efficient whole-animal-based testing assays to determine the... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5794: Heat Shock Proteins in Glioblastoma Biology: Where Do We Stand? IJMS, Vol. 20, Pages 5794: Heat Shock Proteins in Glioblastoma Biology: Where Do We Stand? International Journal of Molecular Sciences doi: 10.3390/ijms20225794 Authors: Rebeca Piatniczka Iglesia Camila Felix de Lima Fernandes Bárbara Paranhos Coelho Mariana Brandão Prado Maria Isabel Melo Escobar Gustavo Henrique Doná Rodrigues Almeida Marilene Hohmuth Lopes Heat shock proteins (HSPs) are evolutionary conserved proteins that work as molecular chaperones and perform... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5793: The Chemokine CXCL16 Is a New Biomarker for Lymph Node Analysis of Colon Cancer Outcome IJMS, Vol. 20, Pages 5793: The Chemokine CXCL16 Is a New Biomarker for Lymph Node Analysis of Colon Cancer Outcome International Journal of Molecular Sciences doi: 10.3390/ijms20225793 Authors: Manar AbdelMageed Haytham Ali Lina Olsson Gudrun Lindmark Marie-Louise Hammarström Sten Hammarström Basel Sitohy Chemokines are important in the development and progression of tumors. We investigated the expression of CXCL14 and CXCL16 in colon cancer. Expression of mRNA was... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5792: PI3K/mTOR Pathway Inhibition: Opportunities in Oncology and Rare Genetic Diseases IJMS, Vol. 20, Pages 5792: PI3K/mTOR Pathway Inhibition: Opportunities in Oncology and Rare Genetic Diseases International Journal of Molecular Sciences doi: 10.3390/ijms20225792 Authors: Petra Hillmann Doriano Fabbro The phosphatidylinositol 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) signaling pathway has been implicated as a cancer target. Big pharma players and small companies have been developing small molecule inhibitors of PI3K and/or mTOR since the 1990s. Although... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5791: VEGF-A and ICAM-1 Gene Polymorphisms as Predictors of Clinical Outcome to First-Line Bevacizumab-Based Treatment in Metastatic Colorectal Cancer IJMS, Vol. 20, Pages 5791: VEGF-A and ICAM-1 Gene Polymorphisms as Predictors of Clinical Outcome to First-Line Bevacizumab-Based Treatment in Metastatic Colorectal Cancer International Journal of Molecular Sciences doi: 10.3390/ijms20225791 Authors: Apostolos Papachristos Polychronis Kemos Theodora Katsila Eirini Panoilia George P. Patrinos Haralabos Kalofonos Gregory B. Sivolapenko Bevacizumab is used to treat metastatic colorectal cancer (mCRC). However, there are... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 IJMS, Vol. 20, Pages 5790: Tellimagrandin II, A Type of Plant Polyphenol Extracted from Trapa bispinosa Inhibits Antibiotic Resistance of Drug-Resistant Staphylococcus aureus IJMS, Vol. 20, Pages 5790: Tellimagrandin II, A Type of Plant Polyphenol Extracted from Trapa bispinosa Inhibits Antibiotic Resistance of Drug-Resistant Staphylococcus aureus International Journal of Molecular Sciences doi: 10.3390/ijms20225790 Authors: Yu-Wei Chang Wan-Chun Huang Chun-Yu Lin Wen-Hung Wang Ling-Chien Hung Yen-Hsu Chen The emergence of methicillin-resistant Staphylococcus aureus (MRSA) has become a critical global concern. Identifying new candidates of... International Journal of Molecular Sciences Mon Nov 18, 2019 02:00 Mark above section as read  Journal of Clinical Medicine JCM, Vol. 8, Pages 2017: Pharmaceutical Aspects of Artificial Nutrition JCM, Vol. 8, Pages 2017: Pharmaceutical Aspects of Artificial Nutrition Journal of Clinical Medicine doi: 10.3390/jcm8112017 Authors: Emilie Reber Markus Messerli Zeno Stanga Stefan Mühlebach Artificial nutrition, including enteral (EN) and parenteral (PN) nutrition, is indicated whenever adequate oral nutrition fails to sufficiently supply the necessary nutrients to the body. It is a convenient, efficacious, safe, and well-tolerated form of clinical nutrition in the hospital... Journal of Clinical Medicine 02:00 JCM, Vol. 8, Pages 2015: Maternal and Neonatal Hair Cortisol Levels Are Associated with Infant Neurodevelopment at Six Months of Age JCM, Vol. 8, Pages 2015: Maternal and Neonatal Hair Cortisol Levels Are Associated with Infant Neurodevelopment at Six Months of Age Journal of Clinical Medicine doi: 10.3390/jcm8112015 Authors: Rafael A. Caparros-Gonzalez Borja Romero-Gonzalez Raquel Gonzalez-Perez Lidia Lucena-Prieto Miguel Perez-Garcia Francisco Cruz-Quintana Maria Isabel Peralta-Ramirez Background: Maternal stress during pregnancy can affect fetal development during certain sensitive periods. Objective:... Journal of Clinical Medicine 02:00 JCM, Vol. 8, Pages 2013: Influence of Antisynthetase Antibodies Specificities on Antisynthetase Syndrome Clinical Spectrum Time Course JCM, Vol. 8, Pages 2013: Influence of Antisynthetase Antibodies Specificities on Antisynthetase Syndrome Clinical Spectrum Time Course Journal of Clinical Medicine doi: 10.3390/jcm8112013 Authors: Cavagna Trallero-Araguás Meloni Cavazzana Rojas-Serrano Feist Zanframundo Morandi Meyer Silva Costa Molberg Andersson Codullo Mosca Barsotti Neri Scirè Govoni Furini Lopez-Longo Martinez-Barrio Schneider ... Journal of Clinical Medicine Mon Nov 18, 2019 02:00 JCM, Vol. 8, Pages 2014: Systemic Lidocaine Infusion for Post-Operative Analgesia in Children Undergoing Laparoscopic Inguinal Hernia Repair: A Randomized Double-Blind Controlled Trial JCM, Vol. 8, Pages 2014: Systemic Lidocaine Infusion for Post-Operative Analgesia in Children Undergoing Laparoscopic Inguinal Hernia Repair: A Randomized Double-Blind Controlled Trial Journal of Clinical Medicine doi: 10.3390/jcm8112014 Authors: Lee Choi Byon Lee Lee Systemic lidocaine can provide satisfactory post-operative analgesia in adults. In this study, we assessed whether intravenous lidocaine is effective for post-operative analgesia and recovery in children... Journal of Clinical Medicine Mon Nov 18, 2019 02:00 JCM, Vol. 8, Pages 2012: Effects of Non-Invasive Ventilation Combined with Oxygen Supplementation on Exercise Performance in COPD Patients with Static Lung Hyperinflation and Exercise-Induced Oxygen Desaturation: A Single Blind, Randomized Cross-Over Trial JCM, Vol. 8, Pages 2012: Effects of Non-Invasive Ventilation Combined with Oxygen Supplementation on Exercise Performance in COPD Patients with Static Lung Hyperinflation and Exercise-Induced Oxygen Desaturation: A Single Blind, Randomized Cross-Over Trial Journal of Clinical Medicine doi: 10.3390/jcm8112012 Authors: Maud Koopman Martijn A. Spruit Frits M.E. Franssen Jeannet Delbressine Emiel F.M. Wouters Denny Mathew Anton Vink Lowie E.G.W. Vanfleteren The effects... Journal of Clinical Medicine Mon Nov 18, 2019 02:00 JCM, Vol. 8, Pages 2011: Combined Effects of MMP-7, MMP-8 and MMP-26 on the Risk of Ischemic Stroke JCM, Vol. 8, Pages 2011: Combined Effects of MMP-7, MMP-8 and MMP-26 on the Risk of Ischemic Stroke Journal of Clinical Medicine doi: 10.3390/jcm8112011 Authors: Fang-I Hsieh Hung-Yi Chiou Chaur-Jong Hu Jiann-Shing Jeng Huey-Juan Lin Jiunn-Tay Lee Li-Ming Lien Ischemic stroke (IS) is multifactorial causation combining with traditional cardiovascular disease (CVD) and genetic risk factors. Combined effects of MMP-7, MMP-8 and MMP-26 on the risk of IS remain incompletely... Journal of Clinical Medicine Mon Nov 18, 2019 02:00 JCM, Vol. 8, Pages 2010: Association between Sleep Duration and Subclinical Thyroid Dysfunction Based on Nationally Representative Data JCM, Vol. 8, Pages 2010: Association between Sleep Duration and Subclinical Thyroid Dysfunction Based on Nationally Representative Data Journal of Clinical Medicine doi: 10.3390/jcm8112010 Authors: Woojun Kim Jeongmin Lee Jeonghoon Ha Kwanhoon Jo Dong-Jun Lim Jung-Min Lee Sang-Ah Chang Moo-Il Kang Min-Hee Kim Background: Sleep duration is an identified risk factor for adverse health outcomes. As the endocrine system is closely intertwined with sleep duration and... Journal of Clinical Medicine Mon Nov 18, 2019 02:00 Mark above section as read  Journal of Functional Biomaterials JFB, Vol. 10, Pages 52: Intrinsic Cellular Responses of Human Wharton's Jelly Mesenchymal Stem Cells Influenced by O2-Plasma-Modified and Unmodified Surface of Alkaline-Hydrolyzed 2D and 3D PCL Scaffolds JFB, Vol. 10, Pages 52: Intrinsic Cellular Responses of Human Wharton's Jelly Mesenchymal Stem Cells Influenced by O2-Plasma-Modified and Unmodified Surface of Alkaline-Hydrolyzed 2D and 3D PCL Scaffolds Journal of Functional Biomaterials doi: 10.3390/jfb10040052 Authors: Inthanon Janvikul Ongchai Chomdej Polycaprolactone (PCL), a hydrophobic-degradable polyester, has been widely investigated and extensively developed, to increase the biocompatibility for tissue engineering.... Journal of Functional Biomaterials Mon Nov 18, 2019 02:00 Mark above section as read  Journal of Imaging J. Imaging, Vol. 5, Pages 86: Usage of Vertical Fisheye-Images to Quantify Urban Light Pollution on Small Scales and the Impact of LED Conversion J. Imaging, Vol. 5, Pages 86: Usage of Vertical Fisheye-Images to Quantify Urban Light Pollution on Small Scales and the Impact of LED Conversion Journal of Imaging doi: 10.3390/jimaging5110086 Authors: Stefan Wallner The aim of this work was to develop an easy and quick technique for characterizing various lighting situations, that is, single lamps or illuminated signs and to quantify impacts on small scales like streets, buildings and near areas. The method uses a DSLR-camera equipped... Journal of Imaging Mon Nov 18, 2019 02:00 Mark above section as read
Antioxidants, Vol. 8, Pages 566: Fibroblasts to Keratinocytes Redox Signaling: The Possible Role of ROS in Psoriatic Plaque FormationAntioxidants, Vol. 8, Pages 566: Fibroblasts to Keratinocytes Redox Signaling: The Possible Role of ROS in Psoriatic Plaque Formation Antioxidants doi: 10.3390/antiox8110566 Authors: Barygina Becatti Prignano Lotti Taddei Fiorillo Although the role of reactive oxygen species-mediated (ROS-mediated) signalling in physiologic and pathologic skin conditions has been proven,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
09:33
Induction of growth cessation by acacetin via β-catenin pathway and apoptosis by apoptosis inducing factor activation in colorectal carcinoma cells. Related ArticlesInduction of growth cessation by acacetin via β-catenin pathway and apoptosis by apoptosis inducing factor activation in colorectal carcinoma cells. Mol Biol Rep. 2019 Nov 16;: Authors: Prasad N, Sharma JR, Yadav UCS Abstract Acacetin, a bioflavanoid, contains anti-inflammatory and anti-cancer activities as shown in different experimental models. However, its anticancer potential and mechanism of action against colorectal cancer cells... pubmed: cell cycle arrest Mon Nov 18, 2019 15:12 Association and clinicopathologic significance of p38MAPK-ERK-JNK-CDC25C with polyploid giant cancer cell formation. Related ArticlesAssociation and clinicopathologic significance of p38MAPK-ERK-JNK-CDC25C with polyploid giant cancer cell formation. Med Oncol. 2019 Nov 16;37(1):6 Authors: Liu K, Lu R, Zhao Q, Du J, Li Y, Zheng M, Zhang S Abstract BACKGROUND: We previously showed that cobalt chloride (CoCl2) induction of polyploid giant cancer cells (PGCCs) was characterized by abnormal cell cycle-related protein expression and G2/M arrest. The role of the p38MAPK-ERK-JNK... pubmed: cell cycle arrest Mon Nov 18, 2019 15:12 Long non-coding RNA NEAT1 promotes bladder progression through regulating miR-410 mediated HMGB1. Related ArticlesLong non-coding RNA NEAT1 promotes bladder progression through regulating miR-410 mediated HMGB1. Biomed Pharmacother. 2019 Nov 14;121:109248 Authors: Shan G, Tang T, Xia Y, Qian HJ Abstract LncRNA NEAT1 is reported as a crucial oncogene in multiple cancers. But, its biological role in bladder cancer is barely understood. Therefore, we concentrated on the function and role of NEAT1 in bladder cancer. Firstly, NEAT1 expression in bladder... pubmed: cell cycle arrest Mon Nov 18, 2019 15:12 Synthesis and characterization of zinc oxide nanoparticles from Morus nigra and its anticancer activity of AGS gastric cancer cells. Related ArticlesSynthesis and characterization of zinc oxide nanoparticles from Morus nigra and its anticancer activity of AGS gastric cancer cells. J Photochem Photobiol B. 2019 Nov 09;202:111698 Authors: Tang Q, Xia H, Liang W, Huo X, Wei X Abstract Gastric cancer was a foremost one among the majority of regular carcinoma cases globally. Even the achievements on enhanced treatment approaches and early findings cannot decrease the mortality and morbidity... pubmed: cell cycle arrest Mon Nov 18, 2019 15:12 Mark above section as read  !@ Rare Cancers Prevalence and correlates of non-tissue prostate cancer diagnosis in the United States. Related ArticlesPrevalence and correlates of non-tissue prostate cancer diagnosis in the United States. J Geriatr Oncol. 2019 Nov 13;: Authors: Aksenov L, Gansler T, Sineshaw HM, Fedewa S, Yabroff KR, Jemal A, Moul J Abstract BACKGROUND: Given the potential complications of prostate biopsies, it is sometimes reasonable in selected patients to make a non-tissue diagnosis of prostate cancer. Little is known about prevalence and factors associated with... !@ Rare Cancers Mon Nov 18, 2019 14:46 Mark above section as read  J Clin Neurosci Corrigendum to "The local thermal effect of using monopolar electrosurgery in the presence of a deep brain stimulator: Cadaveric studies on a lamb brain" [J. Clin. Neurosci. (2019) 134-139]. Related ArticlesCorrigendum to "The local thermal effect of using monopolar electrosurgery in the presence of a deep brain stimulator: Cadaveric studies on a lamb brain" [J. Clin. Neurosci. (2019) 134-139]. J Clin Neurosci. 2019 Nov 13;: Authors: Tipper G, Taqvi AA, Singh A, Pohl U, Low H PMID: 31734161 [PubMed - as supplied by publisher] J Clin Neurosci Mon Nov 18, 2019 15:12 Mark above section as read  pubmed: epilepsy treatment Risk factors associated with drug resistant focal epilepsy in adults: A case control study. Related ArticlesRisk factors associated with drug resistant focal epilepsy in adults: A case control study. Seizure. 2019 Nov 05;73:46-50 Authors: Roy PL, Ronquillo LH, Ladino LD, Tellez-Zenteno JF Abstract PURPOSE: Using an adult cohort of patients with focal epilepsy, we aimed to identify risk factors for development of drug-resistant epilepsy, which if identifiable would allow patients to receive appropriate counsel and earlier surgical treatment.... pubmed: epilepsy treatment Mon Nov 18, 2019 15:02 Ginsenoside compound K alleviates sodium valproate-induced hepatotoxicity in rats via antioxidant effect, regulation of peroxisome pathway and iron homeostasis. Related ArticlesGinsenoside compound K alleviates sodium valproate-induced hepatotoxicity in rats via antioxidant effect, regulation of peroxisome pathway and iron homeostasis. Toxicol Appl Pharmacol. 2019 Nov 14;:114829 Authors: Zhou L, Chen L, Zeng X, Liao J, Ouyang D Abstract Sodium valproate (SVP) is a first-line treatment for various forms of epilepsy; however, it can cause severe liver injury. Ginsenoside compound K (G-CK) is the main active ingredient... pubmed: epilepsy treatment Mon Nov 18, 2019 15:02 Perampanel attenuates epileptiform phenotype in C6 glioma. Related ArticlesPerampanel attenuates epileptiform phenotype in C6 glioma. Neurosci Lett. 2019 Nov 14;:134629 Authors: Mayer J, Kirschstein T, Resch T, Porath K, Krause BJ, Köhling R, Lange F Abstract Epileptic seizures are frequent in patients with glioma, and anticonvulsive treatment is often indicated. Glioma cells release glutamate via the Xc- antiporter system, which appears to be a major pathomechanism of glioma-associated seizures and excitotoxicity.... pubmed: epilepsy treatment Mon Nov 18, 2019 15:02 Cenobamate: new hope for treatment-resistant epilepsy. Related ArticlesCenobamate: new hope for treatment-resistant epilepsy. Lancet Neurol. 2019 Nov 13;: Authors: Arnold S PMID: 31734104 [PubMed - as supplied by publisher] pubmed: epilepsy treatment Mon Nov 18, 2019 15:02 Safety and efficacy of adjunctive cenobamate (YKP3089) in patients with uncontrolled focal seizures: a multicentre, double-blind, randomised, placebo-controlled, dose-response trial. Related ArticlesSafety and efficacy of adjunctive cenobamate (YKP3089) in patients with uncontrolled focal seizures: a multicentre, double-blind, randomised, placebo-controlled, dose-response trial. Lancet Neurol. 2019 Nov 13;: Authors: Krauss GL, Klein P, Brandt C, Lee SK, Milanov I, Milovanovic M, Steinhoff BJ, Kamin M Abstract BACKGROUND: More than a third of patients with epilepsy are treatment resistant, and thus new, more effective therapies to... pubmed: epilepsy treatment Mon Nov 18, 2019 15:02 Mark above section as read  Head and Neck Assessment of Oral Mucositis among Patients Undergoing Radiotherapy for Head and Neck Cancer: An Audit. Related ArticlesAssessment of Oral Mucositis among Patients Undergoing Radiotherapy for Head and Neck Cancer: An Audit. Kathmandu Univ Med J (KUMJ). 2019 Jan.-Mar;17(65):61-65 Authors: Luitel A, Rimal J, Maharjan IK, Regmee P Abstract Background Radiation-induced oral mucositis is one of the major ionizing radiation toxicities and normal tissue injuries resulting from radiotherapy. It occurs in up to 80% of head and neck cancer irradiated patients, reaching... Head and Neck Mon Nov 18, 2019 14:39 Validation of the French Versions of the Speech Handicap Index and the Phonation Handicap Index in Patients Treated for Cancer of the Oral Cavity or Oropharynx. Related ArticlesValidation of the French Versions of the Speech Handicap Index and the Phonation Handicap Index in Patients Treated for Cancer of the Oral Cavity or Oropharynx. Folia Phoniatr Logop. 2019 Nov 15;:1-14 Authors: Balaguer M, Farinas J, Fichaux-Bourin P, Puech M, Pinquier J, Woisard V Abstract CONTEXT: Nowadays, clinical tools are available to evaluate the functional impact of speech disorders in neurological conditions, but few are validated... Head and Neck Mon Nov 18, 2019 14:39 Genome-Wide Profiling of Acquired Uniparental Disomy Reveals Prognostic Factors in Head and Neck Squamous Cell Carcinoma. Related ArticlesGenome-Wide Profiling of Acquired Uniparental Disomy Reveals Prognostic Factors in Head and Neck Squamous Cell Carcinoma. Neoplasia. 2019 Nov 14;21(11):1102-1109 Authors: Tuna M, Liu W, Amos CI, Mills GB Abstract Acquired uniparental disomy (aUPD) leads to homozygosity facilitating identification of monoallelically expressed genes. We analyzed single-nucleotide polymorphism array-based genotyping data of 448 head and neck squamous cell... Head and Neck Mon Nov 18, 2019 14:39 Allergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Related ArticlesAllergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol. 2019 Oct 31;129:109759 Authors: Testa D, DI Bari M, Nunziata M, Cristofaro G, Massaro G, Marcuccio G, Motta G Abstract Allergic rhinitis (AR) is the most prevalent allergic disease in children and can be associated with asthma (A); this association can have significant effect on child's quality of life. The... Head and Neck Mon Nov 18, 2019 14:39 A retrospective study of patients with Robin sequence: Patient characteristics and their impact on clinical outcomes. Related ArticlesA retrospective study of patients with Robin sequence: Patient characteristics and their impact on clinical outcomes. Int J Pediatr Otorhinolaryngol. 2019 Nov 07;129:109769 Authors: Hamilton S, Dzioba A, Husein M Abstract INTRODUCTION: Robin sequence (RS) is a congenital set of abnormalities of the head and neck, consisting of a hypoplastic mandible (micrognathia), a tongue that is displaced posteriorly (glossoptosis), and obstruction... Head and Neck Mon Nov 18, 2019 14:39 Remote leptomeningeal dissemination in olfactory neuroblastoma mimicking multiple parasagittal meningiomas: a diagnostic and therapeutic challenge. Related ArticlesRemote leptomeningeal dissemination in olfactory neuroblastoma mimicking multiple parasagittal meningiomas: a diagnostic and therapeutic challenge. World Neurosurg. 2019 Nov 14;: Authors: Martinez-Perez R, Hardesty D, Palmer J, Zachariah M, Otto B, Carrau R, Prevedello D Abstract BACKGROUND: Olfactory neuroblastoma (ON) is a highly aggressive and locally recurrent neoplasm. Distant systemic metastases are not uncommon, but remote leptomeningeal... Head and Neck Mon Nov 18, 2019 14:39 Effect of obturators on facial form following surgery for head and neck cancer and impact on the perception of appearance. Related ArticlesEffect of obturators on facial form following surgery for head and neck cancer and impact on the perception of appearance. J Dent. 2019 Nov 14;:103230 Authors: Coward TJ, Richards R, Fenlon MR, Scott BJJ Abstract OBJECTIVES: To describe the correlation between changes in the surface area and depth of the face in individuals wearing an obturator compared with it not being in place, and self-reported Quality of Life in relation to appearance.... Head and Neck Mon Nov 18, 2019 14:39 Corrigendum to "Subtle Eyelid Retraction after Lower Blepharoplasty" [Journal of Plastic, Reconstructive & Aesthetic Surgery, 72 (10), 2019, 1682-1687]. Related ArticlesCorrigendum to "Subtle Eyelid Retraction after Lower Blepharoplasty" [Journal of Plastic, Reconstructive & Aesthetic Surgery, 72 (10), 2019, 1682-1687]. J Plast Reconstr Aesthet Surg. 2019 Nov 13;: Authors: Harounian J, Wulc AE, Brackup AB, Ramesh S PMID: 31734234 [PubMed - as supplied by publisher] Head and Neck Mon Nov 18, 2019 14:39 Sclerotherapy for lymphatic malformations of head and neck: Systematic review and meta-analysis. Related ArticlesSclerotherapy for lymphatic malformations of head and neck: Systematic review and meta-analysis. J Vasc Surg Venous Lymphat Disord. 2019 Nov 13;: Authors: De Maria L, De Sanctis P, Balakrishnan K, Tollefson M, Brinjikji W Abstract BACKGROUND: Percutaneous sclerotherapy is a commonly used modality for treatment of lymphatic malformations (LMs) of the head, face, and neck. The safety and efficacy of sclerotherapy with various agents for... Head and Neck Mon Nov 18, 2019 14:39 Image-guided surgery of head and neck carcinoma in rabbit models by intra-operatively defining tumour-infiltrated margins and metastatic lymph nodes. Related ArticlesImage-guided surgery of head and neck carcinoma in rabbit models by intra-operatively defining tumour-infiltrated margins and metastatic lymph nodes. EBioMedicine. 2019 Nov 13;: Authors: Sun P, Zhang Y, Li K, Wang C, Zeng F, Zhu J, Wu Y, Tao X Abstract BACKGROUND: The infiltrative nature and lymphatic metastasis of head and neck squamous cell carcinoma (HNSCC) are the main reasons leading to its poor prognosis. METHODS: A multimodal... Head and Neck Mon Nov 18, 2019 14:39 Treatment Outcomes of Arytenoid Dislocation by Closed Reduction: A Multidimensional Evaluation. Related ArticlesTreatment Outcomes of Arytenoid Dislocation by Closed Reduction: A Multidimensional Evaluation. J Voice. 2019 Nov 13;: Authors: Wu X, Mao W, Zhang J, Wei C Abstract OBJECTIVE: This study aimed to investigate the treatment outcomes of arytenoid dislocation by a multidimensional evaluation. METHODS: From April 2010 to May 2018, the records of 57 patients with a history of arytenoid dislocation were reviewed. All the patients were... Head and Neck Mon Nov 18, 2019 14:39 The clinical characteristics of patients with an isolate epiglottic collapse. Related ArticlesThe clinical characteristics of patients with an isolate epiglottic collapse. Auris Nasus Larynx. 2019 Nov 13;: Authors: Sung CM, Kim HC, Yang HC Abstract OBJECTIVE: We analyzed the clinical characteristics of patients with isolated epiglottic collapse (IEC) who had an epiglottic anteroposterior (AP) collapse as the only cause of snoring during drug-induced sleep endoscopy (DISE). METHODS: A retrospective analysis of 334 consecutive... Head and Neck Mon Nov 18, 2019 14:39 An update on autoimmune inner ear disease: A systematic review of pharmacotherapy. Related ArticlesAn update on autoimmune inner ear disease: A systematic review of pharmacotherapy. Am J Otolaryngol. 2019 Oct 28;:102310 Authors: Strum D, Kim S, Shim T, Monfared A PMID: 31733712 [PubMed - as supplied by publisher] Head and Neck Mon Nov 18, 2019 14:39 Mark above section as read  radioactive iodine The impact of thyroid diseases starting from birth on reproductive function. Related ArticlesThe impact of thyroid diseases starting from birth on reproductive function. Hormones (Athens). 2019 Nov 16;: Authors: Krassas GE, Markou KB Abstract The aim of this review is to provide relevant information regarding the impact of thyroid disease, starting from birth and mainly concerning hyperthyroidism and hypothyroidism, on reproduction. Hyperthyroidism occurs much less commonly in children than hypothyroidism, with Graves' disease... radioactive iodine Mon Nov 18, 2019 15:11 Mark above section as read  Latest Results for Current Microbiology Enzymatic Characteristics of a Polyphosphate/ATP-NAD Kinase, PanK, from Myxococcus xanthus Abstract NAD kinase is a crucial enzyme for production of NADP+. Myxococcus xanthus is a gram-negative soil bacterium that forms fruiting bodies and spores under starvation, and it accumulates polyphosphate (poly(P)) during early development. We found that M. xanthus NAD kinase (PanK) utilized both ATP and poly(P) as phosphoryl donors; therefore, PanK was designated as a poly(P)/ATP-NAD kinase. Unlike other poly(P)/ATP-NAD kinases, PanK hardly exhibited NADH kinase activity. The... Latest Results for Current Microbiology Mon Nov 18, 2019 02:00 Mark above section as read  Larynx Genetic factors in isolated and syndromic laryngeal cleft. Related ArticlesGenetic factors in isolated and syndromic laryngeal cleft. Paediatr Respir Rev. 2019 Oct 08;: Authors: Li Y, Rui X, Li N Abstract A laryngotracheoesophageal cleft (LC) is a rare congenital anomaly of the upper aerodigestive tract resulting from the absence of fusion of the posterior cricoid lamina, which affects an abnormal communication between the larynx, trachea and esophagus. The genetic etiology of LC remains elusive. The involvement... Larynx Mon Nov 18, 2019 18:53 Mark above section as read  Neuro-Oncology A multi-institutional analysis of clinical outcomes and patterns of care of 1p/19q codeleted oligodendrogliomas treated with adjuvant or salvage radiation therapy Abstract Purpose Practice patterns vary for adjuvant treatment of 1p/19q-codeleted oligodendroglioma patients. This study evaluates the outcomes of adjuvant (aRT) versus salvage radiation therapy (sRT) in a multi-institutional cohort. Methods Oligodendroglioma patients with confirmed 1p/19q codeletion who were treated with RT with or without chemotherapy... Neuro-Oncology Mon Nov 18, 2019 02:00 Mark above section as read  Thyroid Res Pract Severe hypothyroidism-associated acute renal failure – A case series from North India and review of literature Namrata S Rao, Abhilash Chandra, Kiran Preet MalhotraThyroid Research and Practice 2019 16(3):121-127 Background: Several cases of complete or partially reversible renal failure have been reported in association with severe hypothyroidism, which have responded to thyroxine replacement. However, its risk factors, pathology, pathophysiology, and time of recovery remain unclear. Aim: We report our experience with 31 cases of renal failure in association with severe hypothyroidism, from a goiter-endemic... Thyroid Res Pract Mon Nov 18, 2019 00:00 Cord blood thyroid-stimulating hormone as a screening tool for congenital hypothyroidism: A single-center 5-year experience Mahmood Dhahir Al-MendalawiThyroid Research and Practice 2019 16(3):144-144 Thyroid Res Pract Mon Nov 18, 2019 00:00 Assessment of serum midkine level in benign and malignant thyroid nodules. Can midkine be a marker of thyroid malignancy? Nermin Ahmed Sheriba, Maram Mohamed Mahdy, Rana Hashem Ibrahim Elattary, Maha Mohamed El-NabarawyThyroid Research and Practice 2019 16(3):95-99 Background: Thyroid nodules are a common clinical problem. The prevalence of malignancy in thyroid nodules is currently about 5%–15%. Fine-needle aspiration biopsy (FNAB) has improved the preoperative prediction of malignancy, but still has disadvantages including operator variability and nondiagnostic reports. Midkine (MK) is a novel heparin-binding... Thyroid Res Pract Mon Nov 18, 2019 00:00 Extensive squamous metaplasia in papillary carcinoma of the thyroid: A potential diagnostic pitfall Subhash Yadav, Rajiv Kumar, Munita Bal, Asawari PatilThyroid Research and Practice 2019 16(3):137-139 It is a rare event to find squamous cells in the thyroid gland. Squamous metaplasia (SM) of the thyroid follicular epithelium is one of such conditions. SM can occur in association with nonneoplastic as well as neoplastic thyroid lesions. Here, we report a case of papillary carcinoma of the thyroid in a 26-year-old female showing extensive SM. On immunohistochemistry, squamous as well as papillary... Thyroid Res Pract Mon Nov 18, 2019 00:00 Morphological variations of the thyroid gland: An insight on embryological and clinicoanatomical considerations Honnegowda Thittamaranahalli Muguregowda, G Krishna, KG PrakashThyroid Research and Practice 2019 16(3):100-104 Background: The thyroid gland, a highly vascular endocrine gland, is composed of two lateral lobes connected by isthmus. A wide range of morphological alterations of the thyroid gland such as hypoplasia, ectopy to hemiagenesis, and genesis are common because of disturbed embryogenesis. The significance of diagnosing such extensions of the thyroid gland is crucial. It may alter the normal... Thyroid Res Pract Mon Nov 18, 2019 00:00 Thyroidology and public health: Challenges within the medical profession Sanjay KalraThyroid Research and Practice 2019 16(3):93-94 Thyroid Res Pract Mon Nov 18, 2019 00:00 Role of nuclear grooves in the cytological diagnosis of papillary carcinoma thyroid Archana S Bhat, Lisa Varma, Hilda Fernandes, CS JayaprakashThyroid Research and Practice 2019 16(3):105-107 Introduction: It is well known that nuclear grooves play a major role in the diagnosis of papillary carcinoma thyroid (PCT). Furthermore, grooves are found in many nonneoplastic lesions of thyroid. Aims: The aim of this study is to calculate the percentage of nuclear grooves in histopathologically proven cases of papillary carcinoma and nonneoplastic lesions (Hashimoto's thyroiditis... Thyroid Res Pract Mon Nov 18, 2019 00:00 A case-based approach to aggressive variants of papillary thyroid carcinoma with literature review Joseph Antoine Flordelis Chatto, Annette Laurente SalillasThyroid Research and Practice 2019 16(3):128-136 Papillary thyroid caarcinoma (PTC) is the most common thyroid and endocrine malignancy. Although considered to be indolent, aggressive variants have been identified, including the Tall Cell (TCV), Columnar Cell (CCV), Hobnail (HPTC) and Solid Variants (SVPTC). The objective of this study is to pre-operatively recognize the cytologic features of these variants. Four cases with final diagnoses... Thyroid Res Pract Mon Nov 18, 2019 00:00 Iodine nutrition status in Graves' disease: A single-center study from Bangladesh Md Abu Jar Gaffar, A B. M. Kamrul-Hasan, Afsar Ahammed, Muhammad Abul Hasanat, Md FariduddinThyroid Research and Practice 2019 16(3):108-112 Context: An increase in occurrence of Graves' disease (GD) has been reported in many countries after the introduction of the salt iodization program. Aims: To observe iodine nutrition status in GD. Settings and Design: Cross-sectional observational study conducted in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka,... Thyroid Res Pract Mon Nov 18, 2019 00:00 Diagnostic issue and caveats of immunoreactivity for Ki67 in hyalinizing trabecular neoplasm with a review of literature Veer Karuna, Priya Gupta, Mamta Gupta, Kriti GroverThyroid Research and Practice 2019 16(3):140-143 Few benign and malignant tumors of thyroid lesion share many histological features, including papillary and trabecular pattern, hyalinized stroma, calcification, nuclear grooving, and nuclear inclusion. The lesions those have these common features are hyalinizing trabecular tumor, papillary thyroid carcinoma, medullary carcinoma, paraganglioma, trabecular follicular adenoma (TFA), and poorly differentiated... Thyroid Res Pract Mon Nov 18, 2019 00:00 Prognostic efficacy of thyroid profile with sequential organ failure assessment score in predicting mortality in intensive care unit patients Arvind Mishra, Rohin Saini, Madhukar Mittal, Dandu Himanshu, Kamlesh Kumar Gupta, Abbas Ali MahdiThyroid Research and Practice 2019 16(3):113-120 Introduction and Objectives: Thyroid hormone changes in critically ill patients are commonly observed phenomenon. This is known as sick euthyroid syndrome. Sequential organ faillure assessment (SOFA) score is used to track and determine the extent of a person's organ function or its rate of failure. We performed a prospective observation study to analyze... Thyroid Res Pract Mon Nov 18, 2019 00:00 Trend toward early euthyroxinemia in admitted patients of Graves' disease on carbimazole therapy Aparajita Roy, Rahul Gupta, Anshita Aggarwal, Bindu KulshreshthaThyroid Research and Practice 2019 16(3):145-146 Thyroid Res Pract Mon Nov 18, 2019 00:00 Mark above section as read  American Journal of Primatology Phylogeographic evidence for two species of muriqui (genus Brachyteles) Northern and southern muriquis group into two different genetic clusters separated by roughly 2.0 million years ago. Abstract The taxonomy of muriquis, the largest extant primates in the New World, is controversial. While some specialists argue for a monotypic genus (Brachyteles arachnoides), others favor a two‐species classification, splitting northern muriquis (Brachyteles hypoxanthus) from southern muriquis (B. arachnoides). This uncertainty affects how we study the differences between these... American Journal of Primatology Sun Nov 17, 2019 18:49 Mark above section as read  Current Treatment Options in Oncology Management of V600E and V600K BRAF -Mutant Melanoma Opinion statement The optimal management of advanced stage BRAF-mutated melanoma is widely debated and complicated by the availability of several different regimens that significantly improve outcomes but have not been directly compared. While there are many unanswered questions relevant to this patient population, the major uncertainty in current practice is the choice between BRAF/MEK inhibitors or immunotherapy for those with previously untreated metastatic or high-risk disease.... Current Treatment Options in Oncology Mon Nov 18, 2019 02:00 Mark above section as read  Lasers in Surgery and Medicine Single Ablative Fractional Resurfacing Laser Treatment For Forearm Actinic Keratoses: 6‐Month Follow‐Up Data From An Intrapatient Comparison Between Treated and Untreated Sites Background and Objectives Actinic keratoses (AK) are common pre‐cancerous lesions, which are associated with ultraviolet light exposure and aging. Wounding therapies such as fractionated laser resurfacing (FLR) have been previously demonstrated to effectively treat facial AK. However, the effectiveness of FLR on other sites commonly afflicted with AK has not been studied in detail. Previously, our group has reported that treatment of aged skin with wounding therapies including dermabrasion and ablative... Lasers in Surgery and Medicine Sun Nov 17, 2019 18:33 Percutaneous Interstitial Nd:YAG Laser Therapy for Axillary Osmidrosis Background and Objectives To investigate the effects of percutaneous interstitial Nd:YAG laser irradiation on the apocrine glands and molecules involved in odor production (apolipoprotein [ApoD], androgen receptor [AR]) in the subcutaneous tissue of a pig. Study Design/Materials and Methods Skin on the back of healthy adult miniature pigs was exposed to pulsed Nd:YAG laser irradiation at 5 or 10 W, or continuous Nd:YAG laser irradiation at 10 W. Samples were taken 1 hour, 1 week, and 1 month... Lasers in Surgery and Medicine Sun Nov 17, 2019 18:29 Mark above section as read  PeerJ Computer Science Bibliographic revision of Mesacanthion Filipjev, 1927 (Nematoda: Thoracostomopsidae) with description of a new species from Jeju Island, South Korea A new species of the genus Mesacanthion Filipjev, 1927 was discovered during a survey of natural beaches of Jeju Island in South Korea. The new species Mesacanthion jejuensis sp. nov. shares general morphology of the genus such as the outer labial and cephalic setae being situated at the middle of cephalic capsule, well-developed mandibles with two columns united by a curved bar, and three equally sized and shaped teeth shorter than the mandibles. The new species belongs to a group of Mesacanthion... PeerJ Computer Science Mon Nov 18, 2019 02:00 First palaeoneurological study of a sauropod dinosaur from France and its phylogenetic significance Despite continuous improvements, our knowledge of the palaeoneurology of sauropod dinosaurs is still deficient. This holds true even for Titanosauria, which is a particularly speciose clade of sauropods with representatives known from numerous Cretaceous sites in many countries on all continents. The data currently available regarding the palaeoneurology of titanosaurs is strongly biased towards Gondwanan forms (Argentina above all, but also India, Malawi and Australia). In contrast, the palaeoneurology... PeerJ Computer Science Mon Nov 18, 2019 02:00 Acquisition of fungi from the environment modifies ambrosia beetle mycobiome during invasion Microbial symbionts can play critical roles when their host attempts to colonize a new habitat. The lack of symbiont adaptation can in fact hinder the invasion process of their host. This scenario could change if the exotic species are able to acquire microorganisms from the invaded environment. Understanding the ecological factors that influence the take-up of new microorganisms is thus essential to clarify the mechanisms behind biological invasions. In this study, we tested whether different forest... PeerJ Computer Science Mon Nov 18, 2019 02:00 A recombinase polymerase amplification-lateral flow dipstick assay for rapid detection of the quarantine citrus pathogen in China, Phytophthora hibernalis Phytophthora hibernalis, the causal agent of brown rot of citrus fruit, is an important worldwide pathogen and a quarantine pest in China. Current diagnosis of the disease relies on disease symptoms, pathogen isolation and identification by DNA sequencing. However, symptoms caused by P. hibernalis can be confused with those by other Phytophthora and fungal species. Moreover, pathogen isolation, PCR amplification and sequencing are time-consuming. In this study, a rapid assay including 20-min recombinase... PeerJ Computer Science Mon Nov 18, 2019 02:00 Angiogenic signaling in the lungs of a metabolically suppressed hibernating mammal (Ictidomys tridecemlineatus) To conserve energy in times of limited resource availability, particularly during cold winters, hibernators suppress even the most basic of physiologic processes. Breathing rates decrease from 40 breaths/minute to less than 1 breath/min as they decrease body temperature from 37 °C to ambient. Nevertheless, after months of hibernation, these incredible mammals emerge from torpor unscathed. This study was conducted to better understand the protective and possibly anti-inflammatory adaptations that... PeerJ Computer Science Mon Nov 18, 2019 02:00 Host dietary specialization and neutral assembly shape gut bacterial communities of wild dragonflies Host-associated gut microbiota can have significant impacts on host ecology and evolution and are often host-specific. Multiple factors can contribute to such host-specificity: (1) host dietary specialization passively determining microbial colonization, (2) hosts selecting for specific diet-acquired microbiota, or (3) a combination of both. The latter possibilities indicate a functional association and should produce stable microbiota. We tested these alternatives by analyzing the gut bacterial... PeerJ Computer Science Mon Nov 18, 2019 02:00 Mark above section as read  Current Allergy and Asthma Reports Conditioning Regimens for Hematopoietic Cell Transplantation in Primary Immunodeficiency Abstract Purpose of Review Hematopoietic cell transplantation (HCT) is an established curative treatment for children with primary immunodeficiencies. This article reviews the latest developments in conditioning regimens for primary immunodeficiency (PID). It focuses on data regarding transplant outcomes according to newer reduced toxicity conditioning regimens used in HCT for PID. ... Current Allergy and Asthma Reports Mon Nov 18, 2019 02:00 Mark above section as read  Anti-Cancer Drugs - Published Ahead-of-Print Targeted therapy clinical trials in ovarian cancer: improved outcomes by gene mutation screening Epithelial ovarian cancer is the most common and leading cause of death for gynaecologic cancer in the western world. Current standard treatments with limited selection of chemotherapies cannot meet patients' urgent needs. Novel targeted therapies may improve patients' survival rate with less side effects that have been demonstrated by using approved medicines such as poly ADP-ribose polymerase and angiogenesis inhibitors. Many classes of targeted therapies impacting cell signalling pathways related... Anti-Cancer Drugs - Published Ahead-of-Print Fri Nov 15, 2019 02:00 A case of pelvic giant cell tumor of bone, complete remission with denosumab: long duration of response Although giant cell tumor of bone has been considered as a disease with benign course, it can lead to bone destruction and serious morbidity. A 19-year-old case was presented with hip pain. There was a recurrence after 9 months of curative surgical resection and zoledronic acid use, and as surgical morbidity would be high, antiosteoclastic receptor activator of nuclear factor kappa B ligand inhibitor denosumab treatment was administered. She had a complete remission after 18 months of denosumab treatment.... Anti-Cancer Drugs - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Berberine inhibits proliferation and migration of colorectal cancer cells by downregulation of GRP78 Objective Human colorectal cancer (CRC), a highly malignant and metastatic carcinoma, is resistant to many present anticancer therapies. The inhibition of tumor survival and growth through receptor suppression is a promising way to treat CRC. The study aimed to investigate the effect of a natural plant triterpenoid, berberine (BBR), on SW480 cells and whether its role is mediated by Glucose-regulated protein 78 (GRP78). Methods MTT assay, wound healing assay, and Annexin V-FITC assay were... Anti-Cancer Drugs - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Effect of miR-196a inhibition on esophageal cancer growth in vitro Esophageal cancer has recent shown a higher incidence but lower 5-year survival rate after normal clinical treatment in China. The aim of this study was to observe whether the inhibition of miR-196a affects esophageal cancer cell growth by modulating the nuclear factor-κB target gene and to detect the possible cooperative therapeutic effects on esophageal cancer by knocking down miR-196a expression combined with the specific inhibitor of nuclear factor-κB target genes. Thus, anti-miR-196a or sotrastaurin,... Anti-Cancer Drugs - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Mark above section as read  Journal of Neurosurgical Anesthesiology - Published Ahead-of-Print Neurosurgical Interventions for Neurotrauma in the Obstetric Population: A Systematic Review Trauma requiring neurosurgical intervention in the obstetric population is rare. Provision of care must include consideration for both maternal and fetal well-being, and conflicts may arise. Management strategies to reduce elevated maternal intracranial pressure (ICP) and provide adequate surgical exposure, for example, may compromise uteroplacental perfusion. There is scarce literature to guide anesthetic care and few resources summarizing management of these uncommon cases. We conducted a systematic... Journal of Neurosurgical Anesthesiology - Published Ahead-of-Print Thu Nov 14, 2019 02:00 Mark above section as read  International Journal of Cancer Effectiveness of the AS04‐adjuvanted HPV‐16/18 vaccine in reducing oropharyngeal HPV infections in young females – results from a community‐randomized trial We studied effectiveness of the AS04‐adjuvanted HPV‐16/18 (AS04‐HPV‐16/18) vaccine against human papillomavirus (HPV) oropharyngeal infections associated with the increase of head/neck cancers in western countries. All 38631 resident adolescents from 1994‐95 birth cohorts of 33 Finnish communities were invited in this community‐randomized trial (NCT00534638). During 2008‐2009, 11275 girls and 6129 boys were enrolled in 3 arms of 11 communities each. In Arm A, 90% of vaccinated girls/boys, and in... International Journal of Cancer Sun Nov 17, 2019 16:24 Mark above section as read  Thyroid Mucosa-Associated Lymphoid Tissue Lymphoma of the Thyroid Gland: A Systematic Review of the Literature Objective: Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type of the thyroid gland is a rare indolent malignant disease encountered in approximately 0.5% of patients with Hashimoto thyroiditis (HT). The purpose of the present systematic review was to accumulate the current evidence in the field. Study Design: We searched the Medline, Scopus, EMBASE, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials CENTRAL databases from inception to May... Thyroid Mon Nov 18, 2019 09:48 Mark above section as read  Systematic Reviews - Latest Articles Screening for thyroid dysfunction and treatment of screen-detected thyroid dysfunction in asymptomatic, community-dwelling adults: a systematic review This systematic review was conducted to inform the Canadian Task Force on Preventive Health Care recommendations on screening for thyroid dysfunction (TD). The review sought to answer key questions on the bene... Systematic Reviews - Latest Articles Mon Nov 18, 2019 02:00 Mark above section as read  Otology & Neurotology - Published Ahead-of-Print The Importance of the Temporal Bone 3T MR Imaging in the Diagnosis of Menière's Disease Background: The aim of this study was to evaluate endolymphatic hydrops using the 3T temporal bone magnetic resonance imaging (MRI), performed according to the chosen protocol, and determine whether it could be applied as an objective diagnostic tool for Menière's disease. Methods: 105 participants diagnosed with probable (n = 50) and definite (n = 55) Menière's disease were included in this prospective study at Vilnius University Hospital, Santaros Clinics. Audiometry, vestibular function... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Electrode Array Type and Its Impact on Impedance Fluctuations and Loss of Residual Hearing in Cochlear Implantation Hypothesis/Objective: Determine variables associated with electrode impedance fluctuations and loss of residual hearing in cochlear implant (CI) recipients. Background: CI recipients with postoperative hearing preservation demonstrate superior speech perception with an electric-acoustic stimulation (EAS) device as compared with a CI-alone device. Maintaining superior speech perception over time relies on long-term hearing preservation; therefore, understanding variables that may contribute... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Comparison of Spontaneous Temporal Bone Cerebrospinal Fluid Leaks From the Middle and Posterior Fossa Objectives: To compare patients surgically managed for spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone arising from the middle cranial fossa (MCF) and posterior cranial fossa (PCF) and to describe the surgical management of posterior fossa CSF leaks. Study Design: Retrospective case review. Setting: Academic tertiary center. Patients: Adult patients presenting with spontaneous temporal bone CSF leaks undergoing operative repair between January 2010 and August 2018.... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Factors Associated With Facial Nerve Paresis Following Gamma Knife for Vestibular Schwannoma Objective: Evaluate the incidence of and potential contributory factors to facial nerve paresis and other cranial neuropathies (CN) following stereotactic radiosurgery with Gamma Knife (GK) for primary treatment of vestibular schwannoma (VS). Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Charts were reviewed for all adult patients receiving primary GK treatment for unilateral VS between 2005 and 2013. Patients with NF2 or previous surgery... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Systematic Review and Network Meta-analysis of Cognitive and/or Behavioral Therapies (CBT) for Tinnitus Objective: To evaluate the efficacy of cognitive and/or behavioral therapies in improving health-related quality of life (HRQOL), depression, and anxiety associated with tinnitus. Data Sources: EMBASE, MEDLINE, PubMed, PsycINFO, and the Cochrane Registry were used to identify English studies from database inception until February 2018. Study Selection: Randomized controlled trials (RCTs) comparing cognitive and/or behavioral therapies to one another or to waitlist controls for the treatment... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Postoperative Healthcare Utilization of Elderly Adults After Cochlear Implantation Objective: To determine the association between geriatric age and postoperative healthcare utilization after cochlear implantation. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: : Older adults (>59 yr) who underwent unilateral cochlear implantation from 2009 until 2016. Intervention(s): : Standard electrode length cochlear implantation. Main Outcome Measure(s): : Postoperative surgical and audiological visit rate after cochlear... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Risks of Intracochlear Pressures From Laser Stapedotomy Hypothesis: Surgical manipulations during laser stapedotomy can produce intracochlear pressure changes comparable to pressures created by high-intensity acoustic stimuli. Background: New-onset sensorineural hearing loss is a known risk of stapes surgery and may result from pressure changes from laser use or other surgical manipulations. Here, we test the hypothesis that high sound pressure levels are generated in the cochlea during laser stapedotomy. Methods: Human cadaveric heads underwent... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 On the Relationship Between Menière's Disease and Endolymphatic Hydrops The relationship between Menière's disease and endolymphatic hydrops is ambiguous. On the one hand, the existence of cases of endolymphatic hydrops lacking the classic symptoms of Menière's disease has prompted the assertion that endolymphatic hydrops alone is insufficient to cause symptoms and drives the hypothesis that endolymphatic hydrops is a mere epiphenomenon. Yet, on the other hand, there is considerable evidence suggesting a relationship between the mechanical pressure effects of endolymphatic... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Long-Term Stability and Functional Outcome of an Active Middle Ear Implant Regarding Different Coupling Sites Objectives: Indication and implantation of active middle ear implants (AMEI) are well established. Choice of the coupling site depends from the individual anatomical situation. Long-term stability of different coupling sites in terms of functional outcome and complications are rare and were investigated in this study. Design: Retrospective analysis of 41 consecutive patients (45 ears) with coupling of the AMEI at the incus, stapes, and round window. Analysis of preoperative, postoperative,... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 3D-Printed Microneedles Create Precise Perforations in Human Round Window Membrane in Situ Hypothesis: Three-dimensional (3D)-printed microneedles can create precise holes on the scale of micrometers in the human round window membrane (HRWM). Background: An intact round window membrane is a barrier to delivery of therapeutic and diagnostic agents into the inner ear. Microperforation of the guinea pig round window membrane has been shown to overcome this barrier by enhancing diffusion 35-fold. In humans, the challenge is to design a microneedle that can precisely perforate the thicker... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Intratympanic Diltiazem-Chitosan Hydrogel as an Otoprotectant Against Cisplatin-Induced Ototoxicity in a Mouse Model Hypothesis: Local administration of the calcium-channel blocker (CCB), diltiazem, via intratympanic (IT) chitosan-glycerophosphate (CGP) hydrogel will protect against cisplatin-induced ototoxicity. Background: Cisplatin induces calcium-mediated apoptosis of cochlear outer hair cells (OHCs). Previous work demonstrated otoprotection and reduced auditory brainstem response (ABR) threshold shifts in a cisplatin-induced ototoxicity mouse model treated with multiple doses of IT diltiazem given... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Balloon Eustachian Tuboplasty Combined With Tympanocentesis Is not Superior to Balloon Eustachian Tuboplasty in Chronic Otitis Media With Effusion—A Randomized Clinical Trial Objective: Balloon Eustachian tuboplasty (BET) appears to be a promising therapeutic option for Eustachian tube dysfunction. However, data are lacking on its effect in adults with chronic otitis media with effusion (COME) and whether it should be combined with tympanocentesis. The aim of our study was to determine if there is a beneficial effect of BET combined with tympanocentesis compared with BET only and provide data on the effect of BET in adults with COME. Study Design: Randomized clinical... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 A Possible Role of Video-Head Impulse Test in Detecting Canal Involvement in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus Objective: To describe the possible diagnostic role of video-head impulse test (vHIT) in patients presenting with positional downbeat nystagmus (PDN) due to benign paroxysmal positional vertigo (BPPV) involving the anterior canal (AC) or the non-ampullary arm of the posterior canal (PC). Patients: Three patients presenting with positional vertigo, PDN, symmetrical cervical and ocular vestibular-evoked myogenic potentials, and selective deficit of the vestibulo-ocular reflex (VOR) gain for... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Cochlear Implantation in Craniometaphyseal Dysplasia Objective: Describe the first case of cochlear implantation (CI) for auditory rehabilitation of a patient with craniometaphyseal dysplasia (CMD) and progressive mixed hearing loss. Patients: A 65-year-old woman with known autosomal dominant CMD presented with progressive mixed hearing loss and declining benefit from conventional hearing aids. Computed tomography and magnetic resonance imaging revealed hyperostosis of the entire craniofacial skeleton. Hearing evaluation demonstrated pure-tone... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Hearing Preservation Outcomes Using a Precurved Electrode Array Inserted With an External Sheath Objectives: Describe audiologic outcomes in hearing preservation cochlear implantation (CI) using a precurved electrode array inserted using an external sheath and evaluate association of electrode positioning and preservation of residual hearing. Study Design: Retrospective review. Setting: Tertiary otologic center. Patients: Twenty-four adult patients who underwent hearing preservation CI with precurved electrode array. Interventions: CI, intraoperative computed tomography... Otology & Neurotology - Published Ahead-of-Print Fri Nov 15, 2019 02:00 Mark above section as read  Otology & Neurotology Published Ahead-of-Print Mark above section as read  The American Journal of Surgical Pathology - Published Ahead-of-Print Assessment of Tumor-infiltrating Lymphocytes Using International TILs Working Group (ITWG) System Is a Strong Predictor of Overall Survival in Colorectal Carcinoma: A Study of 1034 Patients The presence of increased tumor-infiltrating lymphocytes (TILs) is established as a positive prognostic factor in many malignancies including colorectal carcinoma (CRC). However, multiple different approaches have been used to assess TILs. In 2014, the International TILs Working Group (ITWG) proposed a standardized methodology for evaluating TILs, initially in the context of breast cancer, but subsequently expanded to other malignancies. To date, the efficacy of the ITWG system has not been investigated... The American Journal of Surgical Pathology - Published Ahead-of-Print Thu Nov 14, 2019 02:00 HPV-related Sinonasal Carcinoma: Clinicopathologic Features, Diagnostic Utility of p16 and Rb Immunohistochemistry, and: EGFR: Copy Number Alteration The prevalence and prognostic value of human papillomavirus (HPV) infection and epidermal growth factor receptor (EGFR) alteration in sinonasal squamous cell carcinoma (SNSCC) are not known. The reliability of p16 overexpression as a surrogate for HPV infection in SNSCC is also unclear. We investigated the prognostic and diagnostic significances of HPV infection, EGFR alteration, and p16 expression in SNSCC. We analyzed high-risk HPV infection by HPV-RNA in situ hybridization and EGFR gene copy number... The American Journal of Surgical Pathology - Published Ahead-of-Print Thu Nov 14, 2019 02:00 Transcriptionally Active HPV and Targetable EGFR Mutations in Sinonasal Inverted Papilloma: An Association Between Low-risk HPV, Condylomatous Morphology, and Cancer Risk? Sinonasal inverted papillomas (IPs) commonly recur, and transform to malignancy in 5% to 10% of patients. It has long been debated whether IPs are caused by high-risk or low-risk (lr) human papillomavirus (HPV) and whether the HPV is transcriptionally active. EGFR mutations have also been recently implicated in the pathogenesis of IP with an unclear relationship to HPV status. IP cases over a 10-year period were tested for p16 by immunohistochemistry and for transcriptionally active hrHPV and lrHPV... The American Journal of Surgical Pathology - Published Ahead-of-Print Thu Nov 14, 2019 02:00 Molecular Profiling of Noncoding Mutations Distinguishes Nevoid Melanomas From Mitotically Active Nevi in Pregnancy The accurate recognition of subtle melanomas and their distinction from benign mimics is an oft-recurring diagnostic problem, critical for patient management. Melanomas that bear resemblance to benign nevi (so-called nevoid melanomas, NMs) and benign mitotically active nevi in pregnancy (MANP) are 2 lesions particularly prone to error. Molecular data, including analysis of noncoding regions, in MANP and NM are very limited. This study sought to identify differences in clinical, pathologic, and molecular... The American Journal of Surgical Pathology - Published Ahead-of-Print Thu Nov 14, 2019 02:00 Mark above section as read
Induction of growth cessation by acacetin via β-catenin pathway and apoptosis by apoptosis inducing factor activation in colorectal carcinoma cells.Related ArticlesInduction of growth cessation by acacetin via β-catenin pathway and apoptosis by apoptosis inducing factor activation in colorectal carcinoma cells. Mol Biol Rep. 2019 Nov 16;: Authors: Prasad N, Sharma JR, Yadav UCS Abstract Acacetin, a bioflavanoid, contains anti-inflammatory and anti-cancer activities as shown in different experimental...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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ESR statement on new approaches to undergraduate teaching in Radiology Abstract Medical education is evolving and electronic learning (e-Learning) strategies have now become an essential asset in radiology education. Radiology education is a significant part of the undergraduate medical curriculum and the use of e-Learning in radiology teaching in medical schools is on the rise. If coupled with clinical decision support systems, e-Learning can be a practical way of teaching students clinical decision making, such as selecting the diagnostic imaging... Imaging 02:00 Mark above section as read  Odontology Genetic polymorphisms influence gene expression of human periodontal ligament fibroblasts in the early phases of orthodontic tooth movement Abstract Genetic polymorphisms could be involved in the individual rate of OTM (orthodontic tooth movement) corresponding to the clinical phenomenon of "slow movers" and "fast movers". This study evaluated, if genetic polymorphisms in RANK, RANKL, OPG, COX2 and IL6 are associated with the expression of RANKL, OPG, COX2 and IL6 by human periodontal ligament (hPDL) fibroblasts during OTM. Primary hPDL fibroblasts from periodontal connective tissue of teeth extracted from 57 human... Odontology Mon Nov 18, 2019 02:00 Mark above section as read  pubmed: "am j case rep"[jour... Severe Cobalamin Deficiency Disguised as Schistocytes: A Case Report. Related ArticlesSevere Cobalamin Deficiency Disguised as Schistocytes: A Case Report. Am J Case Rep. 2019 Nov 17;20:1691-1694 Authors: Koubaissi SA, Degheili JA Abstract <strong>BACKGROUND</strong> Vitamin B12, also known as cobalamin (Cbl), is a major player in both erythropoiesis and myelination of the central nervous system. The 2 main manifestations of vitamin B12 deficiency are bone marrow failure and demyelinating disease. These manifestations... pubmed: "am j case rep"[jour... Mon Nov 18, 2019 16:12 Mark above section as read  pubmed: "int j surg case rep... Successful cardiopulmonary resuscitation following minimally invasive pectus excavatum repair: A case report. Related ArticlesSuccessful cardiopulmonary resuscitation following minimally invasive pectus excavatum repair: A case report. Int J Surg Case Rep. 2019 Oct 31;65:255-258 Authors: Glithero KJ, Tackett JJ, DeMason K, Burnweit CA Abstract INTRODUCTION: Pectus excavatum is the most common congenital chest wall deformity. The minimally invasive repair of pectus excavatum (MIRPE) is the most commonly practiced method of surgical treatment and there is concern... pubmed: "int j surg case rep... Mon Nov 18, 2019 16:17 Clinical progression of renal vein leiomyoma: A case report. Related ArticlesClinical progression of renal vein leiomyoma: A case report. Int J Surg Case Rep. 2019 Nov 04;65:249-254 Authors: Dhawan K, Bansal N, Gupta NM, Dhawan S Abstract INTRODUCTION: Vascular leiomyoma originating in the renal vein is a rare entity. Our case allowed us charting of progression of renal vein leiomyoma for 8-years' duration. Apart from intraluminous growth causing displacement of viscera, the leiomyoma did not show any aggressive... pubmed: "int j surg case rep... Mon Nov 18, 2019 16:17 Jejunal perforation complicating dermatomyositis. Related ArticlesJejunal perforation complicating dermatomyositis. Int J Surg Case Rep. 2019 Apr 10;65:245-248 Authors: Lee D, Jeong WS, Hyun CL, Kim J Abstract INTRODUCTION: Small bowel perforation is rare in dermatomyositis (DM). However, it is associated with high rates of morbidity and mortality. In line with the SCARE criteria, we describe a case of jejunal perforation for a DM patient (Agha et al., 2018 [1]). CASE PRESENTATION: A 63-year-old... pubmed: "int j surg case rep... Mon Nov 18, 2019 16:17 Ceramic liner fracture in ceramic on ceramic Total hip arthoplasty: A case report. Related ArticlesCeramic liner fracture in ceramic on ceramic Total hip arthoplasty: A case report. Int J Surg Case Rep. 2019 Nov 05;65:242-244 Authors: Pawar ED, Yadav AK, Sharma A, Harsoor A Abstract INTRODUCTION: Revision rates of total hip arthoplasty have decreased after introducing total hip arthroplasty using ceramic component due to reduce wear and osteolysis. CASE REPORT: 29 year old male case of bilateral hip avascular necrosis operated... pubmed: "int j surg case rep... Mon Nov 18, 2019 16:17 Cesarean scar pregnancy: A case report with surgical management after initially effective conservative treatment. Related ArticlesCesarean scar pregnancy: A case report with surgical management after initially effective conservative treatment. Int J Surg Case Rep. 2019 Nov 06;65:238-241 Authors: Tsakiridis I, Chatzikalogiannis I, Mamopoulos A, Dagklis T, Tsakmakidis G, Athanasiadis A, Kalogiannidis I Abstract INTRODUCTION: The incidence of cesarean scar pregnancies (CSPs) is increasing, possibly due to higher rates of cesarean sections. We report a case of a CSP... pubmed: "int j surg case rep... Mon Nov 18, 2019 16:17 A case with hepatic portal vein gas who required delayed elective surgery. Related ArticlesA case with hepatic portal vein gas who required delayed elective surgery. Int J Surg Case Rep. 2019 Nov 06;65:233-237 Authors: Ikegame K, Iimuro Y, Furuya K, Nakagomi H, Omata M Abstract INTRODUCTION: Hepatic portal venous gas (HPVG) is believed to be an indication for emergent surgery because it is associated with high mortality rate. However, the recent increase in the use of modern abdominal computed tomography (CT) has resulted in... pubmed: "int j surg case rep... Mon Nov 18, 2019 16:17 A case of thymoma in myasthenia gravis: Successful outcome after thymectomy. Related ArticlesA case of thymoma in myasthenia gravis: Successful outcome after thymectomy. Int J Surg Case Rep. 2019 Nov 05;65:229-232 Authors: Dahal S, Bhandari N, Dhakal P, Karmacharya RM, Singh AK, Tuladhar SM, Devbhandari M Abstract INTRODUCTION: Thymic abnormalities occur as hyperplasia and thymoma. Myasthenia gravis is commonly present in thymoma. Thymectomy possesses risk due to anatomical proximity with vital thoracic structures and myasthenia... pubmed: "int j surg case rep... Mon Nov 18, 2019 16:17 Surgical outcome of collateral ligament injury with metacarpal head fracture in a near amputation after power saw injury: Case report. Related ArticlesSurgical outcome of collateral ligament injury with metacarpal head fracture in a near amputation after power saw injury: Case report. Int J Surg Case Rep. 2019 Nov 02;65:225-228 Authors: Liawrungrueang W Abstract INTRODUCTION: The incidence of thumb amputation is high in developing and industrialized countries. A power saw injury is very traumatic to the soft tissue and neurovascular system, and thus difficult for orthopedic and plastic... pubmed: "int j surg case rep... Mon Nov 18, 2019 16:17 Mark above section as read  International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Grisel syndrome, sigmoid sinus thrombosis and rheumatic carditis: Case report of a rare association. Related ArticlesGrisel syndrome, sigmoid sinus thrombosis and rheumatic carditis: Case report of a rare association. Int J Pediatr Otorhinolaryngol. 2019 Nov 09;129:109774 Authors: Cucuzza ME, D'Ambra A, Evola FR, Greco F, Smilari P Abstract Grisel's syndrome (GS) is a non traumatic atlanto-axial rotatory subluxation of C1-C2 joint. A six year old girl, 20 days after an episode of fever, developed a torticollis and a 3/6 heart murmur. The echocardiography... International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Mon Nov 18, 2019 16:11 Allergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Related ArticlesAllergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol. 2019 Oct 31;129:109759 Authors: Testa D, DI Bari M, Nunziata M, Cristofaro G, Massaro G, Marcuccio G, Motta G Abstract Allergic rhinitis (AR) is the most prevalent allergic disease in children and can be associated with asthma (A); this association can have significant effect on child's quality of life. The... International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Mon Nov 18, 2019 16:11 A retrospective study of patients with Robin sequence: Patient characteristics and their impact on clinical outcomes. Related ArticlesA retrospective study of patients with Robin sequence: Patient characteristics and their impact on clinical outcomes. Int J Pediatr Otorhinolaryngol. 2019 Nov 07;129:109769 Authors: Hamilton S, Dzioba A, Husein M Abstract INTRODUCTION: Robin sequence (RS) is a congenital set of abnormalities of the head and neck, consisting of a hypoplastic mandible (micrognathia), a tongue that is displaced posteriorly (glossoptosis), and obstruction... International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Mon Nov 18, 2019 16:11 Linguistic adaptation and validation of Italian version of OSA-18, a quality of life questionnaire for evaluation of children with obstructive sleep apnea-hypopnea syndrome (OSAS). Related ArticlesLinguistic adaptation and validation of Italian version of OSA-18, a quality of life questionnaire for evaluation of children with obstructive sleep apnea-hypopnea syndrome (OSAS). Int J Pediatr Otorhinolaryngol. 2019 Oct 17;129:109727 Authors: Arezzo E, Festa P, D'Antò V, Michelotti A, De Vincentiis GC, Sitzia E, Giuliani M, Piga S, Galeotti A PMID: 31734562 [PubMed - as supplied by publisher] International journal of pediatric otorhinolaryngology,http://goo.gl/4YdRhz Mon Nov 18, 2019 16:11 Mark above section as read  Human physiology Genetic architecture of subspecies divergence in trace mineral accumulation and elemental correlations in the rice grain. Related ArticlesGenetic architecture of subspecies divergence in trace mineral accumulation and elemental correlations in the rice grain. Theor Appl Genet. 2019 Nov 16;: Authors: Tan Y, Sun L, Song Q, Mao D, Zhou J, Jiang Y, Wang J, Fan T, Zhu Q, Huang D, Xiao H, Chen C Abstract KEY MESSAGE: Genome differentiation has shaped the divergence in element concentration between rice subspecies and contributed to the correlation among trace minerals in the... Human physiology Mon Nov 18, 2019 16:10 Arsenic induces human chondrocyte senescence and accelerates rat articular cartilage aging. Related ArticlesArsenic induces human chondrocyte senescence and accelerates rat articular cartilage aging. Arch Toxicol. 2019 Nov 16;: Authors: Chung YP, Chen YW, Weng TI, Yang RS, Liu SH Abstract Arsenic-contaminated drinking water is known to be a serious human health problem. A previous epidemiological study has indicated that arsenic levels in blood were higher in arthritis patients compared to age-matched control subjects. Bone is known as an important... Human physiology Mon Nov 18, 2019 16:10 Outbreaks of Mucorales and the Species Involved. Related ArticlesOutbreaks of Mucorales and the Species Involved. Mycopathologia. 2019 Nov 16;: Authors: Walther G, Wagner L, Kurzai O Abstract The order Mucorales is an ancient group of fungi classified in the subphylum Mucoromycotina. Mucorales are mainly fast-growing saprotrophs that belong to the first colonizers of diverse organic materials and represent a permanent part of the human environment. Several species are able to cause human infections... Human physiology Mon Nov 18, 2019 16:10 Flexural strength, biocompatibility, and antimicrobial activity of a polymethyl methacrylate denture resin enhanced with graphene and silver nanoparticles. Related ArticlesFlexural strength, biocompatibility, and antimicrobial activity of a polymethyl methacrylate denture resin enhanced with graphene and silver nanoparticles. Clin Oral Investig. 2019 Nov 16;: Authors: Bacali C, Baldea I, Moldovan M, Carpa R, Olteanu DE, Filip GA, Nastase V, Lascu L, Badea M, Constantiniuc M, Badea F Abstract OBJECTIVE: The study evaluates the effect of adding graphene-Ag nanoparticles (G-AgNp) to a PMMA auto-polymerizing... Human physiology Mon Nov 18, 2019 16:10 Relationship between Resting Systemic Arterial Blood Pressure and Pain Sensitivity Parameters in Young Healthy Indian Medical Students. Related ArticlesRelationship between Resting Systemic Arterial Blood Pressure and Pain Sensitivity Parameters in Young Healthy Indian Medical Students. Kathmandu Univ Med J (KUMJ). 2019 Jan.-Mar;17(65):51-56 Authors: Mendpara SJ, Akhani PN, Palan BM, Harsoda JM Abstract Background Pain interests clinicians and researchers alike. Several animal and human studies have attempted to establish and explain the relationship between blood pressure and nociception.... Human physiology Mon Nov 18, 2019 16:10 The inhibition of lactoperoxidase catalytic activity through mesna (2-mercaptoethane sodium sulfonate). Related ArticlesThe inhibition of lactoperoxidase catalytic activity through mesna (2-mercaptoethane sodium sulfonate). J Inorg Biochem. 2019 Nov 12;203:110911 Authors: Jahanbakhsh S, Dekhne MS, Kohan-Ghadr HR, Bai D, Awonuga A, Morris RT, Yang Z, Abu-Soud HM Abstract Here, we show that mesna (sodium-2-mercaptoethane sulfonate), primarily used to prevent nephrotoxicity and urinary tract toxicity caused by chemotherapeutic agents such as cyclophosphamide... Human physiology Mon Nov 18, 2019 16:10 Serotonin 5-HT2A receptor expression and functionality in postmortem frontal cortex of subjects with schizophrenia: Selective biased agonism via Gαi1-proteins. Related ArticlesSerotonin 5-HT2A receptor expression and functionality in postmortem frontal cortex of subjects with schizophrenia: Selective biased agonism via Gαi1-proteins. Eur Neuropsychopharmacol. 2019 Nov 14;: Authors: García-Bea A, Miranda-Azpiazu P, Muguruza C, Marmolejo-Martinez-Artesero S, Diez-Alarcia R, Gabilondo AM, Callado LF, Morentin B, González-Maeso J, Meana JJ Abstract Serotonin 5-HT2A receptors (5-HT2ARs) have been implicated in schizophrenia.... Human physiology Mon Nov 18, 2019 16:10 Comparative analysis of fresh chondrocytes, cultured chondrocytes and chondroprogenitors derived from human articular cartilage. Related ArticlesComparative analysis of fresh chondrocytes, cultured chondrocytes and chondroprogenitors derived from human articular cartilage. Acta Histochem. 2019 Nov 13;:151462 Authors: Vinod E, Kachroo U, Amirtham SM, Ramasamy B, Sathishkumar S Abstract INTRODUCTION: Interest in chondroprogenitors arose due to their inherent stem cell like properties, and their initial characterization was based on identification of a small percentage of CD49e positive... Human physiology Mon Nov 18, 2019 16:10 Cognition and Reward Circuits in Schizophrenia: Synergistic, Not Separate. Related ArticlesCognition and Reward Circuits in Schizophrenia: Synergistic, Not Separate. Biol Psychiatry. 2019 Oct 03;: Authors: Robison AJ, Thakkar KN, Diwadkar VA Abstract Schizophrenia has been studied from the perspective of cognitive or reward-related impairments, yet it cannot be wholly related to one or the other process and their corresponding neural circuits. We posit a comprehensive circuit-based model proposing that dysfunctional interactions... Human physiology Mon Nov 18, 2019 16:10 Mark above section as read  O.R.L. Journal for oto-rhino-laryngology and its borderlands Radiofrequency Coblation-Assisted Resection of Skull Base Neoplasms Using an Endoscopic Endonasal Approach Objectives: We describe our early experiences with resecting skull base tumors using a radiofrequency ablation-assisted endoscopic endonasal approach. Ninety-seven patients with skull base tumors who were admitted to the Otorhinolaryngology department at Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital between January 2014 and December 2016 were operated on using a radiofrequency ablation-assisted endoscopic endonasal approach. Complete resection was achieved in all patients.... O.R.L. Journal for oto-rhino-laryngology and its borderlands Mon Nov 18, 2019 12:42 Mark above section as read  Journal of plastic, reconstructive & aesthetic surgery : JPRAS Intraluminal fluid infusion in a rat jejunum ischemia/reperfusion model is associated with improved tissue perfusion and less mucosal damage. Related ArticlesIntraluminal fluid infusion in a rat jejunum ischemia/reperfusion model is associated with improved tissue perfusion and less mucosal damage. J Plast Reconstr Aesthet Surg. 2019 Oct 04;: Authors: Yalcin D, Saçak B, Yalcin M, Yildirim A, Karademir B, Ercan F, Celebiler Ö Abstract OBJECTIVE: This study used an experimental model mimicking early postoperative enteral feeding after the transfer of free jejunal flap and tested the hypothesis... Journal of plastic, reconstructive & aesthetic surgery : JPRAS Mon Nov 18, 2019 16:02 Response to: Letter to the editor: Wasted research time and its impact on training in plastic surgery. Related ArticlesResponse to: Letter to the editor: Wasted research time and its impact on training in plastic surgery. J Plast Reconstr Aesthet Surg. 2019 Nov 06;: Authors: Sepehripour S, Dheansa BS PMID: 31734235 [PubMed - as supplied by publisher] Journal of plastic, reconstructive & aesthetic surgery : JPRAS Mon Nov 18, 2019 16:02 Corrigendum to "Subtle Eyelid Retraction after Lower Blepharoplasty" [Journal of Plastic, Reconstructive & Aesthetic Surgery, 72 (10), 2019, 1682-1687]. Related ArticlesCorrigendum to "Subtle Eyelid Retraction after Lower Blepharoplasty" [Journal of Plastic, Reconstructive & Aesthetic Surgery, 72 (10), 2019, 1682-1687]. J Plast Reconstr Aesthet Surg. 2019 Nov 13;: Authors: Harounian J, Wulc AE, Brackup AB, Ramesh S PMID: 31734234 [PubMed - as supplied by publisher] Journal of plastic, reconstructive & aesthetic surgery : JPRAS Mon Nov 18, 2019 16:02 Outcomes with microsurgery of common peroneal nerve lesions. Related ArticlesOutcomes with microsurgery of common peroneal nerve lesions. J Plast Reconstr Aesthet Surg. 2019 Apr 11;: Authors: Terzis JK, Kostas I Abstract OBJECTIVES: The purpose of this retrospective study is to present our results with peroneal nerve lesions, to examine the relative significance of various factors, to assess their effect on outcome, and to establish guidelines of treatment for the microsurgical management of these difficult lesions.... Journal of plastic, reconstructive & aesthetic surgery : JPRAS Mon Nov 18, 2019 16:02 Mark above section as read  Infectious disorders drug targets,http://goo.gl/XqkpND Granulomatosis with Polyangiitis (GPA) in a 15-year-old girl with facial Acne-like ulcers: A Case Report. Related ArticlesGranulomatosis with Polyangiitis (GPA) in a 15-year-old girl with facial Acne-like ulcers: A Case Report. Infect Disord Drug Targets. 2019 Nov 14;: Authors: Jamali Moghadam SR, Salehi MR, Mojtahedi SY, Fadaei N, Dadras O, Seyed Alinaghi SA, Mohammadifirouzeh M Abstract Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis (WG), is a multisystem autoimmune disease of unknown etiology often misdiagnosed as pneumonia.... Infectious disorders drug targets,http://goo.gl/XqkpND Mon Nov 18, 2019 17:06 Mark above section as read  pubmed: snoring The clinical characteristics of patients with an isolate epiglottic collapse. Related ArticlesThe clinical characteristics of patients with an isolate epiglottic collapse. Auris Nasus Larynx. 2019 Nov 13;: Authors: Sung CM, Kim HC, Yang HC Abstract OBJECTIVE: We analyzed the clinical characteristics of patients with isolated epiglottic collapse (IEC) who had an epiglottic anteroposterior (AP) collapse as the only cause of snoring during drug-induced sleep endoscopy (DISE). METHODS: A retrospective analysis of 334 consecutive... pubmed: snoring Mon Nov 18, 2019 15:56 Mark above section as read  Oncology Critical role of interleukin (IL)-17 in inflammatory and immune disorders: An updated review of the evidence focusing in controversies. Related ArticlesCritical role of interleukin (IL)-17 in inflammatory and immune disorders: An updated review of the evidence focusing in controversies. Autoimmun Rev. 2019 Nov 14;:102429 Authors: Ruiz de Morales JMG, Puig L, Daudén E, Cañete JD, Pablos JL, Martín AO, Juanatey CG, Adán A, Montalbán X, Borruel N, Ortí G, Martín EH, García-Vidal C, Morales CV, Vázquez VM, González-Gay MÁ Abstract Interleukin 17 (IL-17) is a proinflammatory cytokine that... Oncology Mon Nov 18, 2019 14:57 Significance of TIM3 expression in cancer: From biology to the clinic. Related ArticlesSignificance of TIM3 expression in cancer: From biology to the clinic. Semin Oncol. 2019 Nov 06;: Authors: Solinas C, De Silva P, Bron D, Willard-Gallo K, Sangiolo D Abstract Targeting inhibitory immune checkpoint molecules has dramatically changed treatment paradigms in medical oncology. Understanding the best strategies to unleash a pre-existing immune response or to induce an efficient immune response against tumors has emerged as... Oncology Mon Nov 18, 2019 14:57 Mark above section as read  Nature Communications - current - nature.com science feeds Inhibition of DNA damage response at telomeres improves the detrimental phenotypes of Hutchinson–Gilford Progeria Syndrome Nature Communications, Published online: 18 November 2019; doi:10.1038/s41467-019-13018-3Hutchinson–Gilford progeria syndrome causes premature aging. Here the authors show that activation of the DNA damage response at dysfunctional telomeres and transcription of telomeric non-coding RNAs contributes to the pathogenesis, which can be ameliorated by treatment with sequence-specific telomeric antisense oligonucleotides. Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Interspecific introgression mediates adaptation to whole genome duplication Nature Communications, Published online: 18 November 2019; doi:10.1038/s41467-019-13159-5Whole genome duplication (WGD) presents new challenges to the establishment of optimal allelic combinations and to the meiotic machinery. Here, the authors show that adaptive gene flow from Arabidopsis arenosa could rescue the nascent A. lyrata from extinction following WGD. Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Quorum sensing modulates the formation of virulent <i>Legionella</i> persisters within infected cells Nature Communications, Published online: 18 November 2019; doi:10.1038/s41467-019-13021-8The pathogenic bacterium Legionella pneumophila infects lung macrophages and environmental amoebae. Here, Personnic et al. show that the pathogen reversibly forms virulent, antibiotic-tolerant subpopulations during infection of macrophages and amoebae, in a process regulated by the Lqs quorum-sensing system. Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Microbial reduction of metal-organic frameworks enables synergistic chromium removal Nature Communications, Published online: 18 November 2019; doi:10.1038/s41467-019-13219-wInteractions between electroactive bacteria and metal oxides are used for bioremediation. Here, the authors report on the application of Fe(III)-containing metal organic frameworks as substrates for bacterial growth which allow for remediation of lethal levels of chromium with high efficacy over several cycles. Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Geodynamic evolution of southwestern North America since the Late Eocene Nature Communications, Published online: 18 November 2019; doi:10.1038/s41467-019-12950-8The tectonic evolution of southwestern North America remains debated. Here, the authors present a complete time-dependent geodynamic model of the tectonic evolution of southwestern North America, which can explain the extensional collapse of the Basin and Range Province since the Late Eocene. Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Controlled nonlinear magnetic damping in spin-Hall nano-devices Nature Communications, Published online: 18 November 2019; doi:10.1038/s41467-019-13246-7Nonlinear damping enhancement imposes strict limitations on the operation and efficiency of magnetic nano-devices. Here the authors show that nonlinear damping can be controlled by the ellipticity of magnetization precession, which provides a route for the implementation of efficient active spintronic and magnonic devices driven by spin current. Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 A network-based approach to identify deregulated pathways and drug effects in metabolic syndrome Nature Communications, Published online: 18 November 2019; doi:10.1038/s41467-019-13208-zMetabolic syndrome is characterized by complex phenotypes that increases the risk of cardiovascular disease and type 2 diabetes. Here the authors' integrative network analysis suggests BTK inhibitor ibrutinib to be a promising treatment through its obesity-associated inflammation lowering effect. Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Key drivers of cloud response to surface-active organics Nature Communications, Published online: 18 November 2019; doi:10.1038/s41467-019-12982-0Aerosol-cloud interactions are a large source of uncertainty in radiative forcing estimates. Here, the authors show that the radiative effects of clouds are influenced by a combination of aerosol particle distribution, environmental conditions and atmosphere dynamics. Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Inhibition of DNA damage response at telomeres improves the detrimental phenotypes of Hutchinson–Gilford Progeria Syndrome Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Interspecific introgression mediates adaptation to whole genome duplication Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Quorum sensing modulates the formation of virulent <i>Legionella</i> persisters within infected cells Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Microbial reduction of metal-organic frameworks enables synergistic chromium removal Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Geodynamic evolution of southwestern North America since the Late Eocene Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Controlled nonlinear magnetic damping in spin-Hall nano-devices Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 A network-based approach to identify deregulated pathways and drug effects in metabolic syndrome Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Key drivers of cloud response to surface-active organics Nature Communications - current - nature.com science feeds Mon Nov 18, 2019 02:00 Mark above section as read  International Journal of Surgery Physical recovery after laparoscopic vs. open liver resection - a prospective cohort study. Related ArticlesPhysical recovery after laparoscopic vs. open liver resection - a prospective cohort study. Int J Surg. 2019 Nov 14;: Authors: Kampf S, Sponder M, Bergler-Klein J, Sandurkov C, Fitschek F, Bodingbauer M, Stremitzer S, Kaczirek K, Schwarz C Abstract BACKGROUND: While the number of laparoscopic liver resections (LLRs) is increasing worldwide, its impact on physical recovery remains unclear. We hypothesized that LLR is associated with better... International Journal of Surgery Mon Nov 18, 2019 14:54 Long non-coding RNA MALAT1 as a valuable biomarker for prognosis in osteosarcoma: A systematic review and meta-analysis. Related ArticlesLong non-coding RNA MALAT1 as a valuable biomarker for prognosis in osteosarcoma: A systematic review and meta-analysis. Int J Surg. 2019 Nov 14;: Authors: Liu M, Yang P, Mao G, Deng J, Peng G, Ning X, Yang H, Sun H Abstract BACKGROUND: Long non-coding RNA metastasis-associated lung adenocarcinoma transcript 1 (lncRNA, MALAT1) has been found to be aberrantly expressed in osteosarcoma, while high MALAT1 expression is correlated with both... International Journal of Surgery Mon Nov 18, 2019 14:54 Mark above section as read  pubmed: "j inorg biochem"[jo... Mark above section as read  Dysphonia Defining the Anatomy of the Vagus Nerve and Its Clinical Relevance for the Neurosurgical Treatment of Glossopharyngeal Neuralgia. Related ArticlesDefining the Anatomy of the Vagus Nerve and Its Clinical Relevance for the Neurosurgical Treatment of Glossopharyngeal Neuralgia. Stereotact Funct Neurosurg. 2019 Nov 15;:1-5 Authors: Krüger MT, Dong CCJ, Honey CR Abstract The neurosurgical treatment of glossopharyngeal neuralgia includes microvascular decompression or rhizotomy of the nerve. When considering open section of the glossopharyngeal nerve, numerous authors have recommended... Dysphonia Mon Nov 18, 2019 15:41 Mark above section as read  The Journal of Antibiotics - Issue - nature.com science feeds A new indole glycoside from <i>Kitasatospora</i> sp. MG372-hF19 carrying a 6-deoxy-α-<span class="small-caps">l</span>-talopyranose moiety The Journal of Antibiotics, Published online: 18 November 2019; doi:10.1038/s41429-019-0258-9A new indole glycoside from Kitasatospora sp. MG372-hF19 carrying a 6-deoxy-α-l-talopyranose moiety The Journal of Antibiotics - Issue - nature.com science feeds Mon Nov 18, 2019 02:00 Mark above section as read  http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Safety and efficacy of superior turbinate biopsies as a source of olfactory epithelium appropriate for morphological analysis. Related ArticlesSafety and efficacy of superior turbinate biopsies as a source of olfactory epithelium appropriate for morphological analysis. Eur Arch Otorhinolaryngol. 2019 Nov 16;: Authors: Garcia ECD, Rossaneis AC, Pipino AS, Gomes GV, de Rezende Pinna F, Voegels RL, Doty RL, Verri WA, Fornazieri MA Abstract PURPOSE: There is no standardized approach for preserving olfactory function in the side of the nose where biopsy of the olfactory epithelium... http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Mon Nov 18, 2019 15:34 Mark above section as read  pubmed: "world neurosurg"[jo... Remote leptomeningeal dissemination in olfactory neuroblastoma mimicking multiple parasagittal meningiomas: a diagnostic and therapeutic challenge. Related ArticlesRemote leptomeningeal dissemination in olfactory neuroblastoma mimicking multiple parasagittal meningiomas: a diagnostic and therapeutic challenge. World Neurosurg. 2019 Nov 14;: Authors: Martinez-Perez R, Hardesty D, Palmer J, Zachariah M, Otto B, Carrau R, Prevedello D Abstract BACKGROUND: Olfactory neuroblastoma (ON) is a highly aggressive and locally recurrent neoplasm. Distant systemic metastases are not uncommon, but remote leptomeningeal... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Incidence and Implications of Incidental Durotomy in Transforaminal Endoscopic Spine Surgery: Case Series. Related ArticlesIncidence and Implications of Incidental Durotomy in Transforaminal Endoscopic Spine Surgery: Case Series. World Neurosurg. 2019 Nov 14;: Authors: Telfeian A PMID: 31734429 [PubMed - as supplied by publisher] pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Ruptured Distal Superior Cerebellar Artery Aneurysm After Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Case Report and Review of the Literature. Related ArticlesRuptured Distal Superior Cerebellar Artery Aneurysm After Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Case Report and Review of the Literature. World Neurosurg. 2019 Nov 14;: Authors: Dominguez L, Saway B, Benko MJ, Guilliams E, Marvin EA, Entwistle JJ PMID: 31734428 [PubMed - as supplied by publisher] pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 The Early Neurosurgical World Wide Web - Experiences Focused on Awake Craniotomy. Related ArticlesThe Early Neurosurgical World Wide Web - Experiences Focused on Awake Craniotomy. World Neurosurg. 2019 Nov 14;: Authors: Mehdorn HM Abstract The importance of international cooperation in neurosurgery incl. site visits to foreign hospitals is highlighted. The development of knowledge about function localization in brain surgery serves as an example. International cooperation led to modern day neurosurgery as shown e.g. in awake craniotomy.PMID:... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Title: Clinical Outcome After Microvascular Decompression According to the Progression Rates of Hemifacial Spasm. Related ArticlesTitle: Clinical Outcome After Microvascular Decompression According to the Progression Rates of Hemifacial Spasm. World Neurosurg. 2019 Nov 14;: Authors: Lee JA, Kong DS, Lee S, Park SK, Park K Abstract OBJECTIVE: The progression rate for clinical manifestations in hemifacial spasm (HFS) varies; however, little is known about the factors contributing to such observations. The purpose of this study was to identify the independent factors... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Tumours of the Neurohypophysis - One unit's experience and literature review. Related ArticlesTumours of the Neurohypophysis - One unit's experience and literature review. World Neurosurg. 2019 Nov 14;: Authors: Borg MA, Jaunmuktane DZ, Dorward MN Abstract PURPOSE: To evaluate and understand the clinical behaviour and radiological correlates of tumours originating from the posterior pituitary gland. To review the management strategy for these rare tumours and add to the limited existing literature. METHODS: Retrospective... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 IMMERSING PATIENTS IN A VIRTUAL REALITY ENVIRONMENT FOR BRAIN MAPPING DURING AWAKE SURGERY. SAFETY STUDY. Related ArticlesIMMERSING PATIENTS IN A VIRTUAL REALITY ENVIRONMENT FOR BRAIN MAPPING DURING AWAKE SURGERY. SAFETY STUDY. World Neurosurg. 2019 Nov 14;: Authors: Delion M, Klinger E, Bernard F, Aubin G, Minassian AT, Menei P Abstract OBJECTIVE: Brain mapping by direct electrical stimulation (DES) during awake craniotomy is now a standard procedure which reduces the risk of permanent neurologic deficits. Virtual reality technology (VR) immerses the patient... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Undiagnosed obstructive sleep apnea as a predictor of 90-day readmission for brain tumor patients. Related ArticlesUndiagnosed obstructive sleep apnea as a predictor of 90-day readmission for brain tumor patients. World Neurosurg. 2019 Nov 14;: Authors: Caplan IF, Glauser G, Goodrich S, Chen HI, Lucas TH, Lee JYK, McClintock SD, Malhotra NR Abstract BACKGROUND: Previously undiagnosed OSA is a known contributor to negative postoperative outcomes. The STOP-Bang questionnaire is a screening tool for obstructive sleep apnea (OSA) that has been validated... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 From the Occipital Condyle to the Sphenoid Sinus, extradural extension of the far lateral transcondylar approach with endoscopic assistance. Related ArticlesFrom the Occipital Condyle to the Sphenoid Sinus, extradural extension of the far lateral transcondylar approach with endoscopic assistance. World Neurosurg. 2019 Nov 14;: Authors: Tardivo V, Labidi M, Passeri T, Bernat AL, Zenga F, Voormolen E, Penet N, Froelich S PMID: 31734422 [PubMed - as supplied by publisher] pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Intramedullary Spinal Metastatic Renal Cell Carcinoma: Systematic Review of Disease Presentation, Treatment and Prognosis with Case Illustration. Related ArticlesIntramedullary Spinal Metastatic Renal Cell Carcinoma: Systematic Review of Disease Presentation, Treatment and Prognosis with Case Illustration. World Neurosurg. 2019 Nov 14;: Authors: Barrie U, Elguindy M, Pernik M, Adeyemo E, Aoun SG, Hall K, Reyes VP, El Ahmadieh TY, Bagley CA PMID: 31734421 [PubMed - as supplied by publisher] pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Oblique Lateral Interbody Fusion (OLIF) with Supplemental Anterolateral Screw and Rod Instrumentation: a Preliminary Clinical Study. Related ArticlesOblique Lateral Interbody Fusion (OLIF) with Supplemental Anterolateral Screw and Rod Instrumentation: a Preliminary Clinical Study. World Neurosurg. 2019 Nov 14;: Authors: Liu J, Feng H Abstract OBJECTIVE: This study aimed to evaluate the technical details, clinical effectiveness, and complications of oblique lateral interbody fusion (OLIF) supplemented with anterolateral screw-rod instrumentation in managing degenerative lumbar diseases.... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Effect of Sevoflurane Postconditioning on the Incidence of Symptomatic Cerebral Hyperperfusion after Revascularization Surgery in Adult Patients with Moyamoya Disease. Related ArticlesEffect of Sevoflurane Postconditioning on the Incidence of Symptomatic Cerebral Hyperperfusion after Revascularization Surgery in Adult Patients with Moyamoya Disease. World Neurosurg. 2019 Nov 14;: Authors: Yoon HK, Oh H, Lee HC, Cho WS, Kim JE, Park JW, Choi H, Park HP Abstract OBJECTIVE: Various experimental studies reported neuroprotective effects of sevoflurane postconditioning against cerebral ischemia-reperfusion injury. We thus... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Non-Contrast T2-Weighted MR Sequences for Long Term Monitoring of Asymptomatic Convexity Meningiomas. Related ArticlesNon-Contrast T2-Weighted MR Sequences for Long Term Monitoring of Asymptomatic Convexity Meningiomas. World Neurosurg. 2019 Nov 14;: Authors: He JQ, Iv M, Li G, Zhang M, Hayden-Gephart M Abstract BACKGROUND: Gadolinium based contrast agents (GBCA) used to enhance MRs have been linked to tissue deposition, including in the brain. The management of indolent tumors such as meningiomas requires frequent MRs to monitor for interval growth.... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Comparative analysis of continuous suturing, interrupted suturing, and cyanoacrylate-based lid techniques for end-to-end microvascular anastomosis: laboratory investigation. Related ArticlesComparative analysis of continuous suturing, interrupted suturing, and cyanoacrylate-based lid techniques for end-to-end microvascular anastomosis: laboratory investigation. World Neurosurg. 2019 Nov 14;: Authors: Bot GM, Zhao X, McElenney BK, Meybodi AT, Belykh E, Lawton MT, Preul MC Abstract OBJECTIVE: Mastery of the microsurgical anastomosis is an indispensable component of neurosurgical training. However, in many resource-limited... pubmed: "world neurosurg"[jo... Mon Nov 18, 2019 16:47 Mark above section as read  pubmed: future oncology Mark above section as read  Audiology Cognitive Decline Begins in the Earliest Stages of Hearing Loss The association between hearing loss and impaired cognition may be present at earlier levels of hearing loss than previously recognized, and the current 25 dB threshold for defining adult hearing loss may be too high, according to a new study (JAMA Otolaryngol Head Neck Surg. 2019; doi: 10.1001/jamaoto.2019.3375). Researchers at Columbia University Vagelos College of Physicians and Surgeons examined the data of 6451 individuals aged 50 or older who underwent pure-tone audiometry and cognitive testing... Audiology Fri Nov 15, 2019 15:31 Mark above section as read  pubmed: sleep apnea Evaluation of the Efficacy of Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients with Morbid Obesity: a Multicenter Study. Related ArticlesEvaluation of the Efficacy of Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients with Morbid Obesity: a Multicenter Study. Obes Surg. 2019 Nov 16;: Authors: Mahdy T, Emile SH, Madyan A, Schou C, Alwahidi A, Ribeiro R, Sewefy A, Büsing M, Al-Haifi M, Salih E, Shikora S Abstract BACKGROUND: Single anastomosis sleeve ileal (SASI) bypass is a newly introduced bariatric and metabolic procedure. The present multicenter study aimed to... pubmed: sleep apnea Mon Nov 18, 2019 17:46 Association of obstructive sleep apnea with severity of patients hospitalized for acute asthma. Related ArticlesAssociation of obstructive sleep apnea with severity of patients hospitalized for acute asthma. Ann Allergy Asthma Immunol. 2019 Nov 14;: Authors: Oka S, Goto T, Hirayama A, Faridi MK, Camargo CA, Hasegawa K Abstract BACKGROUND: Studies suggest that obstructive sleep apnea (OSA) is associated with suboptimal disease control and worse chronic severity of asthma. However, little is known about the relations of OSA with acute asthma severity... pubmed: sleep apnea Mon Nov 18, 2019 17:46 Comparison of one-anastomosis gastric bypass and Roux-en-Y gastric bypass for treatment of obesity: a 5-year study. Related ArticlesComparison of one-anastomosis gastric bypass and Roux-en-Y gastric bypass for treatment of obesity: a 5-year study. Surg Obes Relat Dis. 2019 May 24;: Authors: Bhandari M, Nautiyal HK, Kosta S, Mathur W, Fobi M Abstract BACKGROUND: Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. One-anastomosis gastric bypass (OAGB) has been reported to have equivalent or better weight loss, with added advantages of being technically... pubmed: sleep apnea Mon Nov 18, 2019 17:46 Mark above section as read  ScienceDirect Publication: Medical Hypotheses Trazodone and Mirtazapine: A possible opioid involvement in their use (at low dose) for sleep? Publication date: Available online 18 November 2019Source: Medical HypothesesAuthor(s): S. Schreiber, C.G. PickAbstractThe efficacy of each antidepressant available has been found equal to that of amitriptyline in double-blind studies. However, a few of them are being prescribed (at under-therapeutic doses) for sleep, in non-depressed persons, when there are relative contraindications for sedative-hypnotics. Following previous studies regarding the antinociceptive mechanisms of various antidepressants,... ScienceDirect Publication: Medical Hypotheses Mon Nov 18, 2019 13:20 Pulsed electromagnetic field (PEMF): A potential adjuvant treatment for infected nonunion Publication date: Available online 18 November 2019Source: Medical HypothesesAuthor(s): Xu-sheng Qiu, Xu-gang Li, Yi-xin ChenAbstractInfected nonunion is still a challenge for orthopaedic surgeons. The goal of treatment is to eliminate infection and achieve bone union. Surgery is the only effective method currently. However, it is invasive and the results are still unsatisfactory. Therefore, Seeking a noninvasive and effective method to resolve infected nonunion is necessary. Pulsed electromagnetic... ScienceDirect Publication: Medical Hypotheses Mon Nov 18, 2019 13:20 Pre-conceptional Folic Acid Supplementation: A possible Cause for the Increasing Rates of Ankyloglossia Publication date: Available online 18 November 2019Source: Medical HypothesesAuthor(s): Yona Amitai, Helen Shental, Luba Atkins-Manelis, Gideon Koren, Chen Stein ZamirAbstractBackgroundThere is an increasing awareness to ankyloglossia (tongue-tie) in infants, with marked increase in its report in the medical literature. Some reports indicate increase in prevalence. Whether the increase ankyloglossia rate is a real phenomenon or merely reflects increased awareness and reports has to be determined.... ScienceDirect Publication: Medical Hypotheses Mon Nov 18, 2019 13:20 An innate brainstem self-other system involving orienting, affective responding, and polyvalent relational seeking: some clinical implications for a "Deep Brain Reorienting" trauma psychotherapy approach Publication date: Available online 18 November 2019Source: Medical HypothesesAuthor(s): F.M. Corrigan, J. Christie-SandsAbstractUnderlying any complex relational intersubjectivity there is an inherent urge to connect, to have proximity, to engage in an experience of interpersonal contact. The hypothesis set out here is that this most basic urge to connect is dependent on circuits based in three main components: the midbrain superior colliculi (SC), the midbrain periaqueductal gray (PAG), and the... ScienceDirect Publication: Medical Hypotheses Mon Nov 18, 2019 13:20 Comment on "A thermodynamic approach to the problem of consciousness" Publication date: Available online 18 November 2019Source: Medical HypothesesAuthor(s): Seyedsaeid Ahmadvand, Bijan Peik, Babak AzarfarAbstractRecently, Beshkar has published a paper on the nature of qualia. His argument is based on several assumptions leading to a conjecture that qualia have a negentropic nature and so as consciousness. The assumptions are: 1) quale (singular of qualia) is the building block of consciousness and thus they are equivalent, 2) qualia and consciousness are both subjective... ScienceDirect Publication: Medical Hypotheses Mon Nov 18, 2019 13:20 Proposal for a New Diagnosis for U.S. Diplomats in Havana, Cuba, Experiencing Vestibular and Neurological Symptoms Publication date: Available online 18 November 2019Source: Medical HypothesesAuthor(s): Mehdi Abouzari, Khodayar Goshtasbi, Brooke Sarna, Harrison W. Lin, Hamid R. DjalilianAbstractBetween 2016 and 2017, several U.S. diplomats in Havana, Cuba, experienced perplexing vestibular and neurological symptoms attributed to an unknown source. They presented with significant vestibular and headache symptoms similar to individuals who experience vestibular migraine (VM). As such, we hypothesize that VM may... ScienceDirect Publication: Medical Hypotheses Mon Nov 18, 2019 13:20 GLP 1 Receptor agonists, glycemic variability, oxidative stress and acute coronary syndrome Publication date: Available online 18 November 2019Source: Medical HypothesesAuthor(s): Maria Isabel del Olmo García, Juan Francisco Merino-TorresAbstractGlycemic variability (GV) has been recently described as an independent cardiovascular risk factor in patients with acute coronary syndrome (ACS). Also, new findings suggest that GV plays an important role in the development of complications related to impaired glucose metabolism and oxidative stress. On the other hand, although treatment for diabetes... ScienceDirect Publication: Medical Hypotheses Mon Nov 18, 2019 13:20 Application of breast cancer diagnosis based on a combination of convolutional neural networks, ridge regression and linear discriminant analysis using invasive breast cancer images processed with autoencoders Publication date: Available online 18 November 2019Source: Medical HypothesesAuthor(s): Mesut Toğaçar, Burhan Ergen, Zafer CömertAbstractInvasive ductal carcinoma cancer, which invades the breast tissues by destroying the milk channels, is the most common type of breast cancer in women. Approximately, 80% of breast cancer patients have invasive ductal carcinoma and roughly 66.6% of these patients are older than 55 years. This situation points out a powerful relationship between the type of breast... ScienceDirect Publication: Medical Hypotheses Mon Nov 18, 2019 13:20 Mark above section as read  Disease Markers Plasma Fibrin Clot Properties Are Unfavorably Altered in Women following Venous Thromboembolism Associated with Combined Hormonal Contraception The use of hormonal contraception is associated with an increased risk of venous thromboembolism (VTE). Unfavorably altered fibrin clot phenotype has been reported in patients following unprovoked VTE who are at risk of recurrences. It remains unknown whether fibrin clot characteristics in women with contraception-related VTE differ from those in unprovoked VTE. We studied three age-matched groups of women: (1) after contraception-related VTE, () (2) after unprovoked VTE (), and (3) controls ().... Disease Markers Mon Nov 18, 2019 13:05 Circulating MicroRNAs as Prognostic Molecular Biomarkers in Human Head and Neck Cancer: A Systematic Review and Meta-Analysis Background. Circulating microRNAs (miRNAs) are potential molecular biomarkers for cancer detection; however, little is known about their prognostic role in head and neck cancer. This current study is aimed at evaluating the role of novel miRNAs in the survival of head and neck cancer patients. Materials and Methods. We performed a systematic literature search using online databases for articles published between December 2006 and February 2019. A meta-analysis was conducted to assess the correlation... Disease Markers Mon Nov 18, 2019 11:05 Mark above section as read
ESR statement on new approaches to undergraduate teaching in RadiologyAbstract Medical education is evolving and electronic learning (e-Learning) strategies have now become an essential asset in radiology education. Radiology education is a significant part of the undergraduate medical curriculum and the use of e-Learning in radiology teaching in medical schools is on the rise. If coupled with clinical decision support systems, e-Learning can be a practical way of teaching students clinical decision...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke Intensive therapy to lower serum lipid levels with the use of statins is recommended after transient ischemic attack (TIA) or ischemic stroke of atherosclerotic origin. These recommendations are based on the results of the Stroke Prevention by Aggressive Reduction in Cholesterol Level (SPARCL)… NEJM : Research Mon Nov 18, 2019 02:00 Mark above section as read  Upper respiratory tract infection Effectiveness of adjunctive nebulized antibiotics in critically ill patients with respiratory tract infections. Related ArticlesEffectiveness of adjunctive nebulized antibiotics in critically ill patients with respiratory tract infections. Eur J Clin Microbiol Infect Dis. 2019 Nov 16;: Authors: Leache L, Aquerreta I, Aldaz A, Monedero P, Idoate A, Ortega A Abstract The purpose of the study was to analyze the effectiveness of adding nebulized antibiotics to systemic antimicrobials in critically ill patients with respiratory tract infections (pneumonia or tracheobronchitis)... Upper respiratory tract infection Mon Nov 18, 2019 18:47 Fatality of Staphylococcus aureus infections in a Greek university hospital: role of inappropriate empiric treatment, methicillin resistance, and toxin genes' presence. Related ArticlesFatality of Staphylococcus aureus infections in a Greek university hospital: role of inappropriate empiric treatment, methicillin resistance, and toxin genes' presence. Eur J Clin Microbiol Infect Dis. 2019 Nov 16;: Authors: Katsarou I, Paraskevopoulou NM, Papadimitriou-Olivgeris M, Giormezis N, Militsopoulou M, Kolonitsiou F, Marangos M, Anastassiou ED, Spiliopoulou I Abstract The aim of the present study was to identify predictors of... Upper respiratory tract infection Mon Nov 18, 2019 18:47 Evaluation of the efficacy of Lactobacillus plantarum HEAL9 and Lactobacillus paracasei 8700:2 on aspects of common cold infections in children attending day care: a randomised, double-blind, placebo-controlled clinical study. Related ArticlesEvaluation of the efficacy of Lactobacillus plantarum HEAL9 and Lactobacillus paracasei 8700:2 on aspects of common cold infections in children attending day care: a randomised, double-blind, placebo-controlled clinical study. Eur J Nutr. 2019 Nov 16;: Authors: Lazou Ahrén I, Berggren A, Teixeira C, Martinsson Niskanen T, Larsson N Abstract BACKGROUND: The combination of Lactobacillus plantarum HEAL9 and Lactobacillus paracasei 8700:2... Upper respiratory tract infection Mon Nov 18, 2019 18:47 Complex rhinobronchial dystrophy and immunodeficiency: Chance association or exceptional congenital syndrome? Related ArticlesComplex rhinobronchial dystrophy and immunodeficiency: Chance association or exceptional congenital syndrome? Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Nov 13;: Authors: Migueres N, de Blay F, Braun JJ Abstract INTRODUCTION: We report a case of an exceptional syndromic association of apparently congenital rhinobronchial dystrophy associated with congenital anosmia and common variable immunodeficiency in a twelve-year-old girl. ... Upper respiratory tract infection Mon Nov 18, 2019 18:47 Procalcitonin: Where Are We Now? Related ArticlesProcalcitonin: Where Are We Now? Crit Care Clin. 2020 Jan;36(1):23-40 Authors: Hamade B, Huang DT Abstract Procalcitonin is a biomarker that is generally elevated in bacterial infections. This review describes a conceptual framework for biomarkers using lessons from the history of troponin, applies this framework to procalcitonin with a review of observational studies and randomized trials in and out of the intensive care unit, and concludes... Upper respiratory tract infection Mon Nov 18, 2019 18:47 Mark above section as read  Human homeostasis Dynamics of interaction and effects of microplastics on planarian tissue regeneration and cellular homeostasis. Related ArticlesDynamics of interaction and effects of microplastics on planarian tissue regeneration and cellular homeostasis. Aquat Toxicol. 2019 Nov 09;218:105354 Authors: Gambino G, Falleni A, Nigro M, Salvetti A, Cecchettini A, Ippolito C, Guidi P, Rossi L Abstract Increasing microplastics pollution of marine and terrestrial water is a concerning issue for ecosystems and human health. Nevertheless, the interaction of microplastics with freshwater... Human homeostasis Mon Nov 18, 2019 18:44 Repeated ethanol exposure influences key enzymes in cholesterol and lipid homeostasis via the AMPK pathway in the rat prefrontal cortex. Related ArticlesRepeated ethanol exposure influences key enzymes in cholesterol and lipid homeostasis via the AMPK pathway in the rat prefrontal cortex. Alcohol. 2019 Nov 14;: Authors: Xu S, Jeong SJ, Li G, Koo JW, Kang UG Abstract Cholesterol homeostasis has been proposed to be implicated in the development of addiction. However, the effects of ethanol on cholesterol homeostasis within the brain are not well understood. One of the most important regulators... Human homeostasis Mon Nov 18, 2019 18:44 Changes of skin electrical potential in acupoints from Ren Mai and Du Mai conduits during Qigong practice: Documentation of a clinical phenomenon. Related ArticlesChanges of skin electrical potential in acupoints from Ren Mai and Du Mai conduits during Qigong practice: Documentation of a clinical phenomenon. J Bodyw Mov Ther. 2019 Oct;23(4):713-720 Authors: Matos LC, Machado J, Greten HJ, Monteiro FJ Abstract Qigong is a therapeutic method of traditional Chinese medicine (TCM) that combines slow, soft movements and postures with breath control and a special mental state of 'awareness'. TCM holds... Human homeostasis Mon Nov 18, 2019 18:44 Mark above section as read  Nature Chemistry A review and critique of academic lab safety research Nature Chemistry, Published online: 18 November 2019; doi:10.1038/s41557-019-0375-xDespite the regular occurrence of high-profile accidents leading to serious injuries or deaths among lab personnel, the state of academic lab safety research has languished. Existing studies in this area are summarized and critiqued in this Review and suggestions are made for future research directions. Nature Chemistry Mon Nov 18, 2019 02:00 Alkenyl boost for Catellani Nature Chemistry, Published online: 18 November 2019; doi:10.1038/s41557-019-0361-3The Catellani reaction is a multi-component cascade sequence, catalysed by palladium and norbornene, which typically uses aromatic starting materials. Now, through the use of a modified norbornene co-catalyst, the scope of this reaction has been extended to alkenyl reagents, enabling the preparation of all-carbon tetrasubstituted olefins. Nature Chemistry Mon Nov 18, 2019 02:00 Modular and regioselective synthesis of all-carbon tetrasubstituted olefins enabled by an alkenyl Catellani reaction Nature Chemistry, Published online: 18 November 2019; doi:10.1038/s41557-019-0358-yAll-carbon tetrasubstituted olefins are challenging to prepare in a regio- and stereocontrolled fashion. Now, using an amide-substituted norbornene as a co-catalyst, alkenyl halide- or triflate-mediated palladium/norbornene (Pd/NBE) catalysis has been demonstrated, providing an efficient strategy for modular and regioselective construction of all-carbon tetrasubstituted olefins. Nature Chemistry Mon Nov 18, 2019 02:00 Iron(<span class="small-caps">ii</span>) coordination complexes with panchromatic absorption and nanosecond charge-transfer excited state lifetimes Nature Chemistry, Published online: 18 November 2019; doi:10.1038/s41557-019-0357-zReplacing rare elements in benchmark photosensitizers with iron would facilitate the large-scale implementation of solar energy conversion, but iron complexes generally do not exhibit sufficiently long-lived photoexcited states. Now, it has been shown that iron(ii) complexes with carefully designed ligands can absorb broadly across the visible light spectrum and have charge-transfer excited states with nanosecond lifetimes. Nature Chemistry Mon Nov 18, 2019 02:00 Mark above section as read  Case Reports in Pathology Intestinal Adenocarcinoma Arising from a Mature Cystic Teratoma Mature cystic teratomas are the most common ovarian germ cell tumour and account for 10–20% of all ovarian neoplasms. Malignant transformation of mature cystic teratomas is rare and has an incidence rate of less than 1%. The most common malignancy are squamous cell carcinomas. Here we present the case of an intestinal adenocarcinoma which is an exceedingly rare malignant entity arising within a mature cystic teratoma. Clinical presentation, imaging and histopathological diagnosis are discussed and... Case Reports in Pathology Mon Nov 18, 2019 18:05 Mark above section as read  Clinical Chemistry and Laboratory Medicine (CCLM) A more accurate prediction to rule in and rule out pre-eclampsia using the sFlt-1/PlGF ratio and NT-proBNP as biomarkers Journal Name: Clinical Chemistry and Laboratory Medicine (CCLM)Issue: Ahead of print Clinical Chemistry and Laboratory Medicine (CCLM) Mon Nov 18, 2019 18:04 Impact of delta check time intervals on error detection capability Journal Name: Clinical Chemistry and Laboratory Medicine (CCLM)Issue: Ahead of print Clinical Chemistry and Laboratory Medicine (CCLM) Mon Nov 18, 2019 18:04 Mark above section as read  Journal of Neuroscience Methods Measuring emotion recognition by people with Parkinson's disease using eye-tracking with dynamic facial expressions Publication date: Available online 17 November 2019Source: Journal of Neuroscience MethodsAuthor(s): Judith Bek, Ellen Poliakoff, Karen LanderAbstractBackgroundMotion is an important cue to emotion recognition, and it has been suggested that we recognize emotions via internal simulation of others' expressions. There is a reduction of facial expression in Parkinson's disease (PD), which may influence the ability to use motion to recognise emotions in others. However, the majority of previous work... Journal of Neuroscience Methods Mon Nov 18, 2019 17:49 Mark above section as read  Psychophysiology Evaluative conditioning affects the subsequent acquisition of differential fear conditioning as indexed by electrodermal responding and stimulus evaluations Abstract It is currently unclear whether the acquisition of negative stimulus valence in evaluative and fear conditioning paradigms is interrelated or independent. The present study used a transfer paradigm to address this question. Three groups of participants were trained in a picture‐picture evaluative conditioning paradigm before completing acquisition of differential fear conditioning using graphical shapes as conditional stimuli (CSs). In group congruent, the shape used as CS+ (paired with... Psychophysiology Sun Nov 17, 2019 22:00 The mindful attention and awareness scale is associated with lower levels of high‐frequency heart rate variability in a laboratory context Abstract Trait mindfulness has been associated with well‐being. A key component of trait mindfulness is intentional attention and awareness which is most commonly measured by the Mindful Attention and Awareness Scale (MAAS). This study investigated the relationship between the MAAS and cardiovascular (HF‐HRV, heart rate) reactivity to two laboratory stressors that evoked different patterns of change in heart rate (HR). One stressor (viewing a video of a surgery) evoked HR deceleration while the... Psychophysiology Sun Nov 17, 2019 19:54 Pupillometric investigation into the speed‐accuracy trade‐off in a visuo‐motor aiming task Abstract Convergent lines of evidence suggest that fluctuations in the size of the pupil may be associated with the trade‐off between the speed (adrenergic, sympathetic) and accuracy (cholinergic, parasympathetic) of behavior across a variety of task contexts. Here, we explored whether pupil size was related to this trade‐off during a visuospatial motor aiming task. Participants were shown visual targets at random locations on a screen and were instructed and incentivized to move a computer mouse‐controlled... Psychophysiology Sun Nov 17, 2019 19:48 Mark above section as read  האקדמיה ללשון העברית סטודנט או סטודנטית לתמיכה באתר האקדמיה האקדמיה ללשון העברית מחפשתסטודנט או סטודנטית לתמיכה באתר האקדמיה תיאור התפקיד תמיכה טכנית בהפעלת אתר האקדמיה, הזנת שוטפת של תכנים, סיוע לעורך התוכן, איתור תקלות ועבודה מול אנשי מערכות המידע. דרישות התפקיד היכרות בסיסית עם HTML, CSS, JavaScript ותוכנות Office. ידע וניסיון ב-wordpress – יתרון ידע ב-PHP – יתרון יכולת למידה גבוהה יוזמה ועצמאות שליטה בתוכנות עריכה של גרפיקה, שמע ווידאו – יתרון היקף העבודה עד 120 שעות בחודש מקום העבודה בקריית האוניברסיטה, גבעת רם, ירושלים שכר סטודנט לפי תנאי... האקדמיה ללשון העברית Mon Nov 18, 2019 15:59 Mark above section as read  Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Αιφνίδιος καρδιακός θάνατος: Η εξέταση που εντοπίζει τα άτομα υψηλού κινδύνου Ο αιφνίδιος καρδιακός θάνατος πλήττει περίπου 220.000 ενήλικες στις ΗΠΑ ετησίως, οι περισσότεροι από τους οποίους δεν έχουν κανένα προηγούμενο καρδιακό σύμπτωμα. Εντοπίζοντας σπάνια γονίδια που αυξάνουν τον κίνδυνο αιφνίδιου καρδιακού θανάτου ερευνητές από το Γενικό Νοσοκομείο της Μασαχουσέτης, το Ινστιτούτο Broad του MIT και το Χάρβαρντ μπορούν πλέον να αποφανθούν για το ποια άτομα θα μπορούσαν να ωφεληθούν από στρατηγικές πρόληψης πριν την εμφάνιση συμπτωμάτων. Σύμφωνα με τα ευρήματα που παρουσιάστηκαν... Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Mon Nov 18, 2019 14:08 Καρδιά: Τελικά πόσο αναγκαία είναι τα stent και σε ποιους ασθενείς Πολλοί ασθενείς με σοβαρή αλλά σταθερή καρδιοπάθεια που συνήθως υποβάλλονται σε αγγειοπλαστική με εμφύτευση stent για την αντιμετώπιση της αθηροσκλήρωσης, έχουν εξίσου καλή πορεία και με τη λήψη της σωστής φαρμακευτικής αγωγής και τις ανάλογες αλλαγές στον τρόπο ζωής, σύμφωνα με νέα μεγάλη μελέτη που παρουσιάστηκε στο ετήσιο συνέδριο της Αμερικανικής Καρδιολογικής Εταιρείας. Ουσιαστικά η μελέτη ISCHEMIA ανατρέπει τη μέχρι τώρα ιατρική πρακτική της τοποθέτησης stent σε καρδιοπαθείς που θεωρούνται... Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Mon Nov 18, 2019 13:44 Η ανακάλυψη που θα σας εξασφαλίσει έναν καλό ύπνο Αν και ο ύπνος είναι καθοριστικής σημασίας για τον οργανισμό όλων των έμβιων όντων, οι γενετικοί μηχανισμοί που τον ρυθμίζουν παραμένουν ακόμα ασαφείς. Επιστήμονες, όμως, από το Ινστιτούτο Τεχνολογίας της Καλιφόρνια (Caltech) εντόπισαν σε πειραματικό μοντέλο, στο ψάρι-ζέβρα (Danio rerio), ένα γενετικό μονοπάτι απαραίτητο για τον καλό ύπνο, το οποίο φαίνεται να ρυθμίζει και τον ύπνο στον ανθρώπινο οργανισμό. Το μονοπάτι αυτό ρυθμίζει τα επίπεδα ενός συγκεκριμένου νευρικού συστατικού που κάποια μέρα... Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Mon Nov 18, 2019 13:31 Σύστημα προβλέπει τον κίνδυνο θανάτου πριν από τους γιατρούς Ένα νέο πρόγραμμα τεχνητής νοημοσύνης μπορεί να εξετάσει ηλεκτροκαρδιογραφήματα και να εντοπίσει τους ασθενείς με καρδιακή αρρυθμία (κολπική μαρμαρυγή) που κινδυνεύουν από πρόωρο θάνατο μέσα στο επόμενο έτος, κάνοντας προβλέψεις καλύτερα και από καρδιολόγους. Η κολπική μαρμαρυγή σχετίζεται με αυξημένο κίνδυνο εμφράγματος και εγκεφαλικού επεισοδίου. Οι ερευνητές του Ιατρικού Κέντρου Geisinger της Πενσιλβάνια, που έκαναν δύο σχετικές ανακοινώσεις στο ετήσιο συνέδριο της Αμερικανικής Καρδιολογικής... Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Mon Nov 18, 2019 10:00 Η τεχνική που σας βοηθά να κάνετε λιγότερα λάθη Αν είστε από αυτούς που ξεχνούν εύκολα ή κάνουν πολλά λάθη όταν βιάζονται, ο διαλογισμός ίσως να σας βοηθήσει να γίνετε λιγότερο… επιρρεπής στα κακώς κείμενα της καθημερινότητας, υποστηρίζει μία έρευνα του Πανεπιστημίου του Michigan που δημοσιεύθηκε στο Brain Sciences, η μεγαλύτερη του είδους της μέχρι σήμερα. Η έρευνα εξέτασε το πώς ο ανοιχτός, καθοδηγούμενος διαλογισμός που επικεντρώνεται στην αντίληψη των συναισθημάτων, των σκέψεων και των αισθήσεων καθώς αυτά απελευθερώνονται από το μυαλό και... Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Mon Nov 18, 2019 09:30 Η κατάσταση που τριπλασιάζει τον κίνδυνο για την καρδιά Οι μοναχικοί ασθενείς με καρδιακά προβλήματα είναι πιο πιθανό να πεθάνουν εντός ενός χρόνου αφότου νοσηλευτούν. Σε αυτό το συμπέρασμα κατέληξε ερευνητική ομάδα του Πανεπιστημιακού Νοσοκομείου της Κοπεγχάγης σε δημοσίευση που έκανε στο Heart. Οι γυναίκες που ήταν μόνες είχαν τρεις φορές περισσότερες πιθανότητες να πεθάνουν 12 μήνες μετά τη νοσηλεία τους, ενώ ο κίνδυνος για τους άνδρες που ήταν μόνοι ήταν διπλάσιος. Η ερευνητική ομάδα εξέτασε τα αποτελέσματα που προέκυψαν εντός ενός έτους μετά από... Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Mon Nov 18, 2019 09:20 Σύνδρομο Χρόνιας Κόπωσης: Το φάρμακο που θα σας ανακουφίσει Ερευνητές ανακάλυψαν ότι η δραστική ουσία ναλτρεξόνη αποκαθιστά σε μεγάλο βαθμό τη λειτουργία των ελαττωματικών υποδοχέων που σχετίζονται με την μυαλγική εγκεφαλομυελίτιδα, γνωστή ως Σύνδρομο Χρόνιας Κόπωσης, σύμφωνα με τη σχετική δημοσίευση στο Frontiers in Immunology. Οι επιστήμονες από το Εθνικό Κέντρο Νευροανοσολογίας και Αναδυόμενων Παθήσεων (NCNED) του Πανεπιστημίου Griffith είναι οι πρώτοι στον κόσμο που αναπτύσσουν το σύστημα gold standard (η καλύτερη υπάρχουσα μέθοδος), ευρύτερα γνωστό... Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Mon Nov 18, 2019 08:50 Νέο πειραματικό εμβόλιο υπόσχεται καλύτερη αντιμετώπιση του καρκίνου Μια πρόδρομη μορφή δενδριτικών κυττάρων φαίνεται πως αποτελεί έναν αποδοτικό και αποτελεσματικό τρόπο ενεργοποίησης του ανοσοποιητικού συστήματος έτσι ώστε να καταπολεμήσει τους καρκινικούς όγκους, σύμφωνα με μια μελέτη που πραγματοποιήθηκε σε ζωικά και κυτταρικά μοντέλα από ερευνητές του Αντικαρκινικού Ινστιτούτου του Πανεπιστημίου Duke. Όπως περιγράφεται στη σχετική δημοσίευση στο Journal of Clinical Investigation, τα ευρήματα παρέχουν μια εναλλακτική έναντι του εμβολίου των δενδριτικών κυττάρων,... Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Mon Nov 18, 2019 08:15 Άνοια: Ποιοι διατρέχουν τριπλάσιο κίνδυνο Οι άνθρωποι που δεν μπορούν να διαβάσουν ή να γράψουν λόγω αναλφαβητισμού, αντιμετωπίζουν σχεδόν τριπλάσιο κίνδυνο να εμφανίσουν άνοια κάποια στιγμή στη ζωή τους, σύμφωνα με μια νέα αμερικανική επιστημονική έρευνα. Οι ερευνητές, με επικεφαλής την Δρ. Jennifer Manly του Ιατρικού Κολεγίου του Πανεπιστημίου Κολούμπια της Νέας Υόρκης, που έκαναν τη σχετική δημοσίευση στο Neurology της Αμερικανικής Ακαδημίας Νευρολογίας, μελέτησαν 983 ανθρώπους άνω των 65 ετών, από τους οποίους οι 237 ήταν αναλφάβητοι... Επιστημονικές Εξελίξεις – ygeiamou | Το αξιόπιστο site για την Υγεία, τη Διατροφή και την Ευεξία Mon Nov 18, 2019 08:02 Mark above section as read  Latest Results for Sports Medicine Sports Injury Prevention is Complex: We Need to Invest in Better Processes, Not Singular Solutions Abstract In recent years, an understanding has developed that sports injuries are the emergent outcomes of complex, dynamic systems. Thus, the influence of local contextual factors on injury outcomes is increasingly being acknowledged. These realisations place injury prevention research at a crossroads. Currently, injury prevention researchers develop universally applicable injury prevention solutions, but the adoption of these solutions in practice is low. This occurs because... Latest Results for Sports Medicine Mon Nov 18, 2019 02:00 Mark above section as read  Mediators of Inflammation The Ubiquitin-Specific Protease 18 Promotes Hepatitis C Virus Production by Increasing Viral Infectivity Background and Aims. Ubiquitin-specific protease 18 (USP18) is involved in immunoregulation and response to interferon- (IFN-) based treatment in patients chronically infected with hepatitis C virus (HCV). We investigated whether and how its upregulation alters HCV infection. Methods. Overexpression of wild-type (USP18 WT) or catalytically inactive mutant (USP18 C64S) USP18 was examined for effects on HCV replication in the absence and presence of IFNα or IFNλ using both the HCV-infective model and... Mediators of Inflammation Mon Nov 18, 2019 17:05 Interleukin-17: Potential Target for Chronic Wounds Chronic wounds exhibit persistent inflammation with markedly delayed healing. The significant burden of chronic wounds, which are often resistant to standard therapy, prompts further research on novel therapies. Since the interleukin-17 family has been implicated as a group of proinflammatory cytokines in immune-mediated diseases in the gut and connective tissue, as well as inflammatory skin conditions, we consider here if it may contribute to the pathogenesis of chronic wounds. In this review, we... Mediators of Inflammation Mon Nov 18, 2019 16:05 Could Increased Expression of Hsp27, an "Anti-Inflammatory" Chaperone, Contribute to the Monocyte-Derived Dendritic Cell Bias towards Tolerance Induction in Breast Cancer Patients? Dendritic cells (DCs) are the most efficient antigen-presenting cells and link the innate immune sensing of the environment to the initiation of adaptive immune responses, which may be directed to either acceptance or elimination of the recognized antigen. In cancer patients, though DCs would be expected to present tumor antigens to T lymphocytes and induce tumor-eliminating responses, this is frequently not the case. The complex tumor microenvironment subverts the immune response, blocks some effector... Mediators of Inflammation Mon Nov 18, 2019 13:05 Mark above section as read  Experimental Physiology Stimulation of autophagy improves vascular function in the mesenteric arteries of type 2 diabetic mice New Findings What is the central question of this study? Impaired autophagy has been reported to be involved in type 2 diabetes. However, role of autophagy in vascular dysfunction in type 2 diabetes remains unanswered. What is the main finding and its importance? The main findings of this study are autophagy is decreased in the mesenteric arteries of type 2 diabetic mice and stimulation of autophagy using rapamycin and trehalose improves vascular function, which is associated with normalization... Experimental Physiology Sun Nov 17, 2019 15:13 Mark above section as read  ScienceDirect Publication: Photodiagnosis and Photodynamic Therapy Choriocapillary vascular density in central serous chorioretinopathy complicated by choroidal neovascularization Publication date: Available online 17 November 2019Source: Photodiagnosis and Photodynamic TherapyAuthor(s): Gilda Cennamo, Chiara Comune, Federica Mirra, Pasquale Napolitano, Daniela Montorio, Giuseppe de CrecchioABSTRACTBackgroundTo evaluate choriocapillary vascular density (CVD) in eyes with central serous chorioretinopathy (CSC) complicated by choroidal neovascularization (CNV), at baseline and after intravitreal injections (IVR) of Ranibizumab, using optical coherence tomography angiography... ScienceDirect Publication: Photodiagnosis and Photodynamic Therapy Mon Nov 18, 2019 17:00 Mark above section as read  Magnetic Resonance Imaging Coil-Combined Split Slice-GRAPPA for Simultaneous Multi-Slice Diffusion MRI Publication date: Available online 18 November 2019Source: Magnetic Resonance ImagingAuthor(s): SK. HashemizadehKolowri, Rong-Rong Chen, Ganesh Adluru, Leslie Ying, Edward VR. DiBellaAbstractObjective: To develop a kernel optimization method called coil-combined split slice-GRAPPA (CC-SSG) to improve the accuracy of the reconstructed coil-combined images for simultaneous multi-slice (SMS) diffusion weighted imaging (DWI) data.Methods: The CC-SSG method optimizes the tuning parameters in the k-space... Magnetic Resonance Imaging Mon Nov 18, 2019 16:42 Accelerated dynamic contrast enhanced MRI based on region of interest compressed sensing Publication date: Available online 18 November 2019Source: Magnetic Resonance ImagingAuthor(s): Amaresha Shridhar Konar, Nithin N. Vajuvalli, Rashmi Rao, Divya Jain, D.R. Ramesh Babu, Sairam GeethanathAbstractMagnetic Resonance Imaging (MRI) provides excellent soft tissue contrast with one significant limitation of slow data acquisition. Dynamic Contrast Enhanced MRI (DCE-MRI) is one of the widely employed techniques to estimate tumor tissue physiological parameters using contrast agents. DCE-MRI... Magnetic Resonance Imaging Mon Nov 18, 2019 16:42 Mark above section as read  American Journal of Otolaryngology Relationship between inflammation and the severity of Recurrent Respiratory Papillomatosis Publication date: Available online 18 November 2019Source: American Journal of OtolaryngologyAuthor(s): Vivian Narana Ribeiro El Achkar, Andressa Duarte, Román Carlos, Jorge Esquiche León, Alfredo Ribeiro-Silva, Shirley Shizue Nagata Pignatari, Estela KaminagakuraAbstractObjectiveTo characterize inflammatory cells in Recurrent Respiratory Papillomatosis (RRP) and to correlate it with severity using the Derkay laryngoscopic scale.Materials and methodsThe data and biopsies from 36 patients with Juvenile... American Journal of Otolaryngology Mon Nov 18, 2019 16:19 Mark above section as read  Case Reports in Medicine Benign Subcutaneous Nodules and Hypereosinophilic Syndrome: A Rare Presentation of an Uncommon Entity A 40-year-old gentleman presented with a history of multiple swellings involving his face, scalp, left axilla, back, and right thigh for the past 8 years. For the last 6 months, he developed intermittent low-grade fever, anorexia, weight loss, and gradually worsening breathlessness. On evaluation, the patient was found to have abnormally elevated absolute eosinophil count. Workup for the etiology of eosinophilia was unrewarding. All investigations related to an underlying myeloproliferative disorder... Case Reports in Medicine Mon Nov 18, 2019 13:05 Mark above section as read  Experimental Brain Research Pro- and antisaccade task-switching: response suppression—and not vector inversion—contributes to a task-set inertia Abstract Alternating between different tasks represents an executive function essential to activities of daily living. In the oculomotor literature, reaction times (RT) for a 'standard' and stimulus-driven (SD) prosaccade (i.e., saccade to target at target onset) are increased when preceded by a 'non-standard' antisaccade (i.e., saccade mirror-symmetrical to target at target onset), whereas the converse switch does not elicit an RT cost. The prosaccade switch-cost has been attributed... Experimental Brain Research Mon Nov 18, 2019 02:00 Neural mechanism of selective finger movement independent of synergistic movement Abstract Muscle synergy is important for simplifying functional movement, which constitutes spatiotemporal patterns of activity across muscles. To execute selective finger movements that are independent of synergistic movement patterns, we hypothesized that inhibitory neural activity is necessary to suppress enslaved finger movement caused by synergist muscles. To test this hypothesis, we focused on a pair of synergist muscles used in the hand opening movement, namely the index... Experimental Brain Research Mon Nov 18, 2019 02:00 Mark above section as read  Alcohol ALCOHOL; +33 new citations 33 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results: ALCOHOL These pubmed results were generated on 2019/11/18PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites. Alcohol Mon Nov 18, 2019 15:53 ALCOHOL; +33 new citations 33 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results: ALCOHOL These pubmed results were generated on 2019/11/18PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites. Alcohol Mon Nov 18, 2019 13:52 Mark above section as read  European Journal of Neuroscience Myelin and oligodendrocyte lineage cell dysfunctions: New players in the etiology and treatment of depression and stress‐related disorders Abstract Depressive disorders are complex, multifactorial disorders that have been traditionally attributed exclusively to neuronal abnormalities. However, recent studies have increased our understanding of the contribution of glial cells – and particularly of oligodendroglia – to the pathogenesis and treatment outcome of depression and stress‐related disorders. This review scrutinizes recent studies focusing on the neurosupportive functions exerted by myelin and oligodendrocyte lineage cells and... European Journal of Neuroscience Sun Nov 17, 2019 20:19 Mark above section as read  NeuroImage Task-induced brain connectivity promotes the detection of individual differences in brain-behavior relationships Publication date: Available online 18 November 2019Source: NeuroImageAuthor(s): Rongtao Jiang, Nianming Zuo, Judith M. Ford, Shile Qi, Dongmei Zhi, Chuanjun Zhuo, Yong Xu, Zening Fu, Juan Bustillo, Jessica A. Turner, Vince D. Calhoun, Jing SuiAbstractAlthough both resting and task-induced functional connectivity (FC) have been used to characterize the human brain and cognitive abilities, the potential of task-induced FCs in individualized prediction for out-of-scanner cognitive traits remains largely... NeuroImage Mon Nov 18, 2019 15:42 Effective connectivity modulations related to win and loss outcomes Publication date: Available online 17 November 2019Source: NeuroImageAuthor(s): Frederik Van de Steen, Ruth M. Krebs, Nigel Colenbier, Hannes Almgren, Daniele MarinazzoAbstractPrevious studies have characterized the brain regions involved in encoding monetary reward and punishment outcomes. The question of how this information is integrated across brain regions has received less attention. Here, we investigated changes in effective connectivity related to the processing of positive and negative monetary... NeuroImage Mon Nov 18, 2019 15:42 Mark above section as read  ClinicalTrials Hip Arthroscopy Versus Total Hip Arthroplasty RCT Condition:   Hip OsteoarthritisInterventions:   Procedure: Hip Arthroscopy;   Procedure: Total Hip ArthroplastySponsor:   Western University, CanadaNot yet recruiting ClinicalTrials Mon Nov 18, 2019 15:24 A Phase II Study on Adjuvant Vaccination With Dendritic Cells Loaded With Autologous Tumor Homogenate in Resected Stage IV Rare Cancers. Conditions:   Head Neck Tumors;   Neuroendocrine Tumors;   Soft Tissue Sarcoma;   Rare Cancer;   VaccinationInterventions:   Biological: Autologous DC vaccine;   Drug: Interleukin-2Sponsor:   Istituto Scientifico Romagnolo per lo Studio e la cura dei TumoriNot yet recruiting ClinicalTrials Mon Nov 18, 2019 15:24 A Drug-Drug Interaction Study of CYP3A4 Inhibition and Pan-CYP Induction on APX001 Condition:   Fungal InfectionInterventions:   Drug: APX001;   Drug: Itraconazole;   Drug: RifampinSponsor:   Amplyx PharmaceuticalsRecruiting ClinicalTrials Mon Nov 18, 2019 15:24 Oral Pathology Asynchronous Telementoring Pilot Study Condition:   Oral CancerIntervention:   Device: intraoral camerasSponsor:   NYU Langone HealthNot yet recruiting ClinicalTrials Mon Nov 18, 2019 15:24 Mark above section as read  International journal of basic and clinical endocrinology A randomized trial comparing health-related quality-of-life and utility measures between routine fine-needle aspiration cytology (FNAC) and surveillance alone in patients with thyroid incidentaloma measuring 1–2 cm Abstract Purpose To present the impact of treatment on health-related quality-of-life (HRQOL) and health utility measures from the randomized controlled trial (ClinicalTrials.gov Identifier: NCT02398721) that investigated the FNAC versus watchful surveillance in patients with incidental benign thyroid nodules. Methods Health utility and HRQOL were evaluated... International journal of basic and clinical endocrinology Mon Nov 18, 2019 02:00 Interobserver agreement and efficacy of consensus reading in Kwak-, EU-, and ACR-thyroid imaging recording and data systems and ATA guidelines for the ultrasound risk stratification of thyroid nodules Abstract Purpose To investigate the interobserver agreement (IA) and the impact of consensus reading using four risk stratification systems for thyroid nodules (TN). Methods Four experienced specialists independently rated US images of 80 TN according to the Kwak-TIRADS, EU-TIRADS, ACR TI-RADS, and ATA Guidelines. The cases were randomly extracted from a... International journal of basic and clinical endocrinology Mon Nov 18, 2019 02:00 Mark above section as read  ScienceDirect Publication: Annals of Allergy, Asthma & Immunology Skin Testing with Ultraheat Treated (UHT) Cow's Milk in Children with Cow's Milk Allergy. Publication date: Available online 18 November 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Bella Shadur, Andrew Fong, Betina Altavilla, Rebecca Anne Saad, Brynn Kevin Wainstein ScienceDirect Publication: Annals of Allergy, Asthma & Immunology Mon Nov 18, 2019 15:13 Decades of Poor Availability of Epinephrine Auto-Injectors – Global Problems in Need of Global Solutions Publication date: Available online 18 November 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Susan Waserman, Ernie Avilla, Laurie Harada, Joni Huang, Monika Kastner ScienceDirect Publication: Annals of Allergy, Asthma & Immunology Mon Nov 18, 2019 15:13 Mark above section as read  Allergy Drug‐induced IgG‐neutrophil‐mediated anaphylaxis in humans: uncovered! Abstract Seminal work by Oettgen et al.1 in the early 90's revealed the existence of alternative pathways of anaphylaxis (non IgE‐mediated) in IgE‐deficient mice. These are mediated by IgG‐immune complexes which, depending on their nature, signal on a number of myeloid cells including macrophages/monocytes, basophils, mast cells and neutrophils. While extensively characterized in mice, conclusive evidence of the existence of alternative pathways of anaphylaxis in humans have remained elusive. Allergy Sun Nov 17, 2019 20:04 Mark above section as read  oral surg oral med A nodule in the palatal mucosa. Related ArticlesA nodule in the palatal mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 May 30;: Authors: Pontes HAR, de Souza LL, Rodrigues-Fernandes CI, Fernandes LA, Santos VL, de Souza ABC, de Carvalho VL, Khan W, de Almeida OP, Fonseca FP, Pontes FSC PMID: 31734141 [PubMed - as supplied by publisher] oral surg oral med Mon Nov 18, 2019 15:12 Mark above section as read  Critical Reviews in Oncology/Hematology (open access) Revisiting the impact of lifestyle on colorectal cancer risk in a gender perspective Publication date: Available online 18 November 2019Source: Critical Reviews in Oncology/HematologyAuthor(s): Lucia Conti, Manuela Del Cornò, Sandra GessaniAbstractColorectal cancer (CRC) is a leading cause of cancer-related mortality in the world. Patterns and trends in CRC incidence and mortality correlate with increasing adoption of Western lifestyles and with the overweight/obesity epidemic. Both genetic background and a range of modifiable environmental/lifestyle factors play a role in CRC etiology.... Critical Reviews in Oncology/Hematology (open access) Mon Nov 18, 2019 15:11 Mark above section as read  Journal of Cancer Research and Clinical Oncology Oncogenic potential of nucleoporins in non-hematological cancers: recent update beyond chromosome translocation and gene fusion Abstract Introduction The nuclear pore complex is comprised of approximately 30 proteins named nucleoporins (Nups) and tightly regulates nucleocytoplasmic transport of macromolecules across the nuclear membrane. Genetic alterations in many NUP genes are associated with many human maladies, such as neurological disease, autoimmune disorders and cancer. Methods ... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 Modified DHAP regimen in the salvage treatment of refractory or relapsed lymphomas Abstract Background The combination of dexamethasone, high-dose cytarabine, and cisplatin (DHAP) is an established salvage regimen for lymphoma patients. We hypothesized that a modified administration schedule for cisplatin and cytarabine results in lower toxicity and improved efficacy. Methods We retrospectively analysed 119 patients with relapsed... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 A systematic review of treatment outcomes in localised and metastatic spermatocytic tumors of the testis Abstract Introduction Because spermatocytic tumors of the testis are rare, only limited evidence exists regarding the malignant potential and the optimal management of localized and metastatic disease. Materials and methods We performed a systematic review through MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 Vimentin expression in circulating tumor cells (CTCs) associated with liver metastases predicts poor progression-free survival in patients with advanced lung cancer Abstract Objective To investigate the presence of vimentin expression in CTCs and its clinical relevance in patients with advanced lung cancer. Methods Peripheral blood was obtained from 61 treatment-naive patients with advanced lung cancer. Subtraction enrichment and immunostaining-fluorescence in situ hybridization (SE-iFISH) platform was... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 Brain metastasis as exclusion criteria in clinical trials involving extensive-stage small cell lung cancer Abstract Background The American Society of Clinical Oncology and Friends of Cancer Research submitted recommendations to the FDA to reduce barriers in clinical trial participation. They proposed the removal of several specific exclusion criteria, including brain metastasis. Clinical trials involving small cell lung cancer (SCLC) have varying exclusion criteria regarding brain metastasis. ... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 The efficacy and toxicity of the CHG priming regimen (low-dose cytarabine, homoharringtonine, and G-CSF) in higher risk MDS patients relapsed or refractory to decitabine Abstract Purpose Myelodysplastic syndromes (MDSs) refractory or relapsed after hypomethylating agents (HMAs) remain a therapeutic challenge. The CHG regimen has been demonstrated to be effective in initially treating higher risk MDS. The current study evaluated the efficacy and toxicity of the CHG regimen in patients who were resistant to decitabine. Methods ... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 Prognostic value and clinicopathological roles of phenotypes of tumour-associated macrophages in colorectal cancer Abstract Background The role of tumour-associated macrophages (TAMs) in predicting the prognosis of colorectal cancer (CRC) remains controversial. This is especially so because the prognostic significance and clinicopathological relevance of different subtypes of TAMs in the immune microenvironment of CRC have not yet been established. Objective ... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 Tumor-infiltrating lymphocytes and CD8 + T cells predict survival of triple-negative breast cancer Abstract Purpose Tumor inflammatory response was evaluated as a prognostic feature in triple-negative breast cancer (TNBC) and compared with the clinical prognosticators of breast cancer and selected biomarkers of cancer cell proliferation. Methods TNBC patients (n = 179) with complete clinical data and up to 18-year follow-up were obtained... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 Radiomics for diagnosis of dual-phenotype hepatocellular carcinoma using Gd-EOB-DTPA-enhanced MRI and patient prognosis Abstract Purpose To describe the clinical characteristics and outcomes of patients with dual-phenotype hepatocellular carcinoma (DPHCC) and investigate the use of radiomics to establish an image-based signature for preoperative differential diagnosis. Methods This study included 50 patients with a postoperative pathological diagnosis of DPHCC... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 Therapeutic delivery of microRNA-143 by cationic lipoplexes for non-small cell lung cancer treatment in vivo Abstract Purpose Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related deaths worldwide and new improvements are urgently needed. Several miRNA-targeted therapeutics have reached clinical development. MicroRNA-143 (miR-143) was found to significantly suppress the migration and invasion of NSCLC. It might be of great potential for NSCLC treatment. However, the therapeutic effect of miR-143 against NSCLC in... Journal of Cancer Research and Clinical Oncology Mon Nov 18, 2019 15:08 Mark above section as read  radiol anat Anatomy and white matter connections of the lateral occipital cortex. Related ArticlesAnatomy and white matter connections of the lateral occipital cortex. Surg Radiol Anat. 2019 Nov 16;: Authors: Palejwala AH, O'Connor KP, Pelargos P, Briggs RG, Milton CK, Conner AK, Milligan TM, O'Donoghue DL, Glenn CA, Sughrue ME Abstract PURPOSE: White matter tracts link different regions of the brain, and the known functions of those interconnected regions may offer clues about the roles that white matter tracts play in information... radiol anat Mon Nov 18, 2019 14:50 Mark above section as read  Surgical and Radiologic Anatomy Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. A systematic review of cadaveric studies Abstract Introduction The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Easy to access and at proximity to the hand, the palmaris longus tendon is considered as the optimal tendon source for hand reconstructive surgery. However, and besides its inconsistency, the size of the palmaris longus tendon is reported to show variability. The aim of this study is to look for the surgical adequacy... Surgical and Radiologic Anatomy Mon Nov 18, 2019 02:00 Mark above section as read  Alcohol and Homeostasis Mark above section as read  Radiation Molecular Biology. Meetings Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Radiation Molecular Biology. Mon Nov 18, 2019 14:43 In Reply to Gultekin and Yildiz Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Jérôme Doyen, Danny Jazmati, Dirk Geismar, Sabine Frisch, Stefanie Schulze Schleithoff, Xavier Vermeren, Monika Scheer, Christoph Blasé, Stephan Tippelt, Beate Timmermann Radiation Molecular Biology. Mon Nov 18, 2019 14:43 In Regard to Doyen et al Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Melis Gultekin, Ferah Yildiz Radiation Molecular Biology. Mon Nov 18, 2019 14:43 In Reply to Braunstein Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Samantha M. Buszek, Simona F. Shaitelman Radiation Molecular Biology. Mon Nov 18, 2019 14:43 In Regard to Buszek et al Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Lior Z. Braunstein Radiation Molecular Biology. Mon Nov 18, 2019 14:43 In Reply to Khosla et al Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Youlia M. Kirova, Geoffroy Boulle, Brigitte De La Lande, Alain Fourquet Radiation Molecular Biology. Mon Nov 18, 2019 14:43 In Regard to Boulle et al Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Divya Khosla, Rakesh Kapoor, Ritesh Kumar Radiation Molecular Biology. Mon Nov 18, 2019 14:43 Erratum to Fady B. Geara, MD, PhD; Ritsuko Komaki, MD; Susan L. Tucker, PhD; Penny Perkins, PhD; Elizabeth L. Travis, PhD; James D. Cox, MD. 2149 Determinants of Lung Fibrosis After Chemoradiation for Small Cell Carcinoma of the Lung: Evidence for Inherent Interindividual Variation. <em>Int J Radiat Oncol Biol Phys</em> 1996;36(suppl):350. Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Radiation Molecular Biology. Mon Nov 18, 2019 14:43 Don't Get Stuck on the Shoulder: Radiation Oncologists Should Get Into the CAR With T-Cell Therapies Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): John P. Plastaras, Elise A. Chong, Stephen J. Schuster Radiation Molecular Biology. Mon Nov 18, 2019 14:43 What Would I Want Done for My Mother? Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Jonathan P.S. Knisely Radiation Molecular Biology. Mon Nov 18, 2019 14:43 Offer Hypofractionated SRS… If Her Performance Status Is Good Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): John P. Kirkpatrick, Peter E. FecciThis article is a Gray Zone opinion that will be published at a later dateThe full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy. Radiation Molecular Biology. Mon Nov 18, 2019 14:43 The Choice of Postoperative Stereotactic Radiosurgery After Resection of an Isolated Brain Metastasis Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Matthew J. Shepard, Jason P. Sheehan Radiation Molecular Biology. Mon Nov 18, 2019 14:43 Radiation Therapy for Surgically Resected Brain Metastasis: What Is Your Approach? Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Richard Li, Nayana Vora Radiation Molecular Biology. Mon Nov 18, 2019 14:43 Implementation of New Biology-Based Radiation Therapy Technology: When Is It Ready So "Perfect Makes Practice?" Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): C. Norman Coleman, Mansoor M. Ahmed Radiation Molecular Biology. Mon Nov 18, 2019 14:43 Using Multiparametric Magnetic Resonance Imaging to Shift Prostate Cancer Diagnosis Toward Clinically Significant Disease and Minimize Overdiagnosis (and Overtreatment) Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Ann Henry Radiation Molecular Biology. Mon Nov 18, 2019 14:43 Issue Highlights Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Radiation Molecular Biology. Mon Nov 18, 2019 14:43 Erratum to: Lee AW, Ng WT, Pan JJ, et al. International Guideline on Dose Prioritization and Acceptance Criteria in Radiation Therapy Planning for Nasopharyngeal Carcinoma. <em>Int J Radiat Oncol Biol Phys</em> 2019;105:567-580 Publication date: 1 December 2019Source: International Journal of Radiation Oncology*Biology*Physics, Volume 105, Issue 5Author(s): Radiation Molecular Biology. Mon Nov 18, 2019 14:43 Mark above section as read
A Comparison of Two LDL Cholesterol Targets after Ischemic StrokeIntensive therapy to lower serum lipid levels with the use of statins is recommended after transient ischemic attack (TIA) or ischemic stroke of atherosclerotic origin. These recommendations are based on the results of the Stroke Prevention by Aggressive Reduction in Cholesterol Level (SPARCL)…NEJM : ResearchMon Nov 18, 2019 02:00Mark above section as read Upper respiratory tract infectionEffectiveness of adjunctive nebulized antibiotics...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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 bioRxiv Subject Collection: Evolutionary Biology, Chromosome painting does not support a sex chromosome turnover in Lacerta agilis Linnaeus, 1758 [NEW RESULTS] Reptiles show a remarkable diversity of sex determination mechanisms and sex chromosome systems, derived from different autosomal pairs. The origin of the ZW sex chromosomes of Lacerta agilis, a widespread Eurasian lizard species, is a matter of discussion: is it a small macrochromosome from the 11-18 group, common to all lacertids, or this species has unique ZW pair derived from the large chromosome 5. Using independent molecular cytogenetic methods, we investigated the karyotype of L. agilis exigua... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Dynamics of genetic variation in Transcription Factors and its implications for the evolution of regulatory networks in Bacteria [NEW RESULTS] The evolution of bacterial regulatory networks has largely been explained at macroevolutionary scales through lateral gene transfer and gene duplication. Transcription factors (TF) have been found to be less conserved across species than their target genes (TG). This would be expected if TFs accumulate mutations faster than TGs. This hypothesis is supported by several lab evolution studies which found TFs, especially global regulators, to be frequently mutated. Despite these studies, the contribution... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Selective sweeps under dominance and inbreeding [NEW RESULTS] A major research goal in evolutionary genetics is to uncover loci experiencing positive selection. One approach involves finding 'selective sweeps' patterns, which can either be 'hard sweeps' formed by de novo mutation, or 'soft sweeps' arising from recurrent mutation or existing standing variation. Existing theory generally assumes outcrossing populations, and it is unclear how dominance affects soft sweeps. We consider how arbitrary dominance and inbreeding via self-fertilisation affect hard and... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Rates of molecular evolution predict intraspecies genetic diversity [NEW RESULTS] Because the evolution of modern humans from early mammals has been a continuous process, human genetic diversity at the molecular level should reflect mammalian genetic diversity. To test this prediction, we contrasted the proportion of segregating sites, q, in human data from the 1000 Genome Project with phylogenetic trees of genes in 96 mammalian genomes ranging from human to platypus. The evolvability of a gene in the human population was found to be positively correlated with the long-term molecular... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Approximating the coalescent under facultative sex [NEW RESULTS] Genome studies of facultative sexual species are providing insight into the evolutionary consequences of mixed reproductive modes. However, it is unclear if the evolutionary history of facultative sexuals' genomes can be captured by standard population genetic models; in particular, whether they can be approximated by Wright-Fisher dynamics while assuming a rescaled effective population size Ne. Here, I determine when the gene genealogies of diploid facultative sexuals, which can either reproduce... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Chromosome painting does not support a sex chromosome turnover in Lacerta agilis Linnaeus, 1758 [NEW RESULTS] Reptiles show a remarkable diversity of sex determination mechanisms and sex chromosome systems, derived from different autosomal pairs. The origin of the ZW sex chromosomes of Lacerta agilis, a widespread Eurasian lizard species, is a matter of discussion: is it a small macrochromosome from the 11-18 group, common to all lacertids, or this species has unique ZW pair derived from the large chromosome 5. Using independent molecular cytogenetic methods, we investigated the karyotype of L. agilis exigua... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Recombination, variance in genetic relatedness, and selection against introgressed DNA [NEW RESULTS] The genomic proportion that two relatives share identically by descent - their genetic relatedness - can vary depending on the patterns of recombination and segregation in their pedigree. Here, we calculate the precise connection between genome-wide genetic shuffling and variance in genetic relatedness. For the relationships of grandparent-grandoffspring and siblings, the variance in genetic relatedness is a simple decreasing function of[r] , the average proportion of locus pairs that recombine in... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Counting the paternal founders of Austroasiatic speakers associated with the language dispersal in South Asia [NEW RESULTS] The phylogenetic analysis of Y chromosomal haplogroup O2a-M95 was crucial to determine the nested structure of South Asian branches within the larger tree, predominantly present in East and Southeast Asia. However, it had previously been unclear how many founders brought the haplogroup O2a-M95 to South Asia. On the basis of the updated Y chromosomal tree for haplogroup O2a-M95, we analysed 1,437 male samples from South Asia for various downstream markers, carefully selected from the extant phylogenetic... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Evidence for mutation-order speciation in an Australian wildflower [NEW RESULTS] In a number of animal species, divergent natural selection has repeatedly and independently driven the evolution of reproductive isolation between populations adapted to contrasting, but not to similar environments. This process is known as parallel ecological speciation, and examples in plants are enigmatically rare. Here, we perform a comprehensive test of the ecological speciation hypothesis in an Australian wildflower where parapatric populations found in coastal sand dunes (Dune ecotype) and... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Muller's Ratchet and the Long-Term Fate of Chromosomal Inversions [NEW RESULTS] Chromosomal inversions contribute widely to adaptation and speciation, yet they present a unique evolutionary puzzle as both their allelic content and frequency evolve in a feedback loop. In this simulation study, we quantified the role of the allelic content in determining the long-term fate of the inversion. Recessive deleterious mutations accumulated rapidly on both arrangements with most of them being private to a given arrangement. The emerging overdominance led to maintenance of the inversion... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Divergence in hormone signalling links local adaptation and hybrid failure [NEW RESULTS] Natural selection is a major driver for the origins of adaptations and new species. Whether or not the processes driving adaptation and speciation share a molecular basis remains largely unknown. Here, we show that divergence in hormone signalling contributed to the evolution of complex adaptations and intrinsic reproductive isolation in the Australian wildflower Senecio lautus. We provide evidence that differences in the auxin pathway, a hormone required for plant growth and development, has led... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Replicated anthropogenic hybridisations reveal parallel patterns of admixture in marine mussels. [NEW RESULTS] Human-mediated transport creates secondary contacts between genetically differentiated lineages, bringing new opportunities for gene exchange. When similar introductions occur in different places, they provide informally replicated experiments for studying hybridisation. We here examined 4279 Mytilus mussels, sampled in Europe and genotyped with 77 ancestry informative markers. We identified a type of introduced mussels, called 'dock mussels', associated with port habitats and displaying a particular... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Longer is not always better: Optimizing barcode length for large-scale species discovery and identification [NEW RESULTS] New techniques for the species-level sorting of millions of specimens are needed in order to accelerate species discovery, determine how many species live on earth, and develop efficient biomonitoring techniques. These sorting methods should be reliable, scalable and cost-effective, as well as being largely insensitive to low-quality genomic DNA, given that this is usually all that can be obtained from museum specimens. Mini-barcodes seem to satisfy these criteria, but it is unclear how well they... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Translational readthrough goes unseen by natural selection [NEW RESULTS] Occasionally during protein synthesis, the ribosome bypasses the stop codon and continues translation to the next stop codon in frame. This error is called translational readthrough (TR). Earlier research suggest that TR is a relatively common error, in several taxa, yet the evolutionary relevance of this translational error is still unclear. By analysing ribosome profiling data, we have conducted species comparisons between yeasts to infer conservation of TR between orthologs. Moreover, we infer... bioRxiv Subject Collection: Evolutionary Biology Mon Nov 18, 2019 02:00 Mark above section as read  Latest Results for Sleep and Breathing Association between body mass index and effectiveness of continuous positive airway pressure in patients with obstructive sleep apnea: a retrospective study Abstract Purpose Ineffective use of continuous positive airway pressure (CPAP) therapy can result in inconvenience and additional costs in patients with obstructive sleep apnea (OSA). This study investigated the predictive value of body mass index (BMI) to assess the efficacy of CPAP in patients with OSA. Methods Data were extracted from a retrospective study... Latest Results for Sleep and Breathing Mon Nov 18, 2019 02:00 Mark above section as read  Journal of Voice Tongue Edema Secondary to Suspension Laryngoscopy Suspension microlaryngoscopy (SML) is generally a safe, same-day procedure. Complications have been linked to prolonged operative time and substantial force applied to the tongue. This report of two cases describes marked tongue edema following SML, a complication not yet reported in the literature. Journal of Voice Mon Nov 18, 2019 02:00 Mark above section as read  Journal of Medical Case Reports - Latest Articles Spontaneous disappearance and recurrence of impending macular hole: a case report There have been several reports of spontaneous closure and reopening of a macular hole, however, in most of those cases, it was observed in eyes post vitrectomy. Here, we report a case of multiple episodes of ... Journal of Medical Case Reports - Latest Articles Sun Nov 17, 2019 02:00 Mark above section as read  The Journal of Immunology current issue Top Reads [TOP READS] The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Low-Dose IL-2 Therapy in Transplantation, Autoimmunity, and Inflammatory Diseases [TRANSLATING IMMUNOLOGY] Regulatory T cells (Tregs) play a central role in the induction and maintenance of immune homeostasis and self-tolerance. Tregs constantly express the high-affinity receptor to IL-2. IL-2 is a pleiotropic cytokine and a key survival factor for Tregs. It maintains Tregs' suppressive function by promoting Foxp3 expression and subsequent production of immunoregulatory cytokines. Administration of low-dose IL-2 is shown to be a promising approach to prevent allograft rejection and to treat autoimmune... The Journal of Immunology current issue Mon Nov 18, 2019 23:00 A Dynamic Variation of Pulmonary ACE2 Is Required to Modulate Neutrophilic Inflammation in Response to Pseudomonas aeruginosa Lung Infection in Mice [INNATE IMMUNITY AND INFLAMMATION] Key PointsPseudomonas bacterial lung infection leads to pulmonary ACE2 dynamic variation. The ACE2 dynamic alteration is critical in regulating neutrophilic lung inflammation. ACE2 modulates IL-17–mediated neutrophil influx by impacting STAT3 activity. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Inflammasomes: Their Role in Normal and Complicated Pregnancies [BRIEF REVIEWS] Inflammasomes are cytoplasmic multiprotein complexes that coordinate inflammatory responses, including those that take place during pregnancy. Inflammasomes and their downstream mediators caspase-1 and IL-1β are expressed by gestational tissues (e.g., the placenta and chorioamniotic membranes) during normal pregnancy. Yet, only the activation of the NLRP3 inflammasome in the chorioamniotic membranes has been partially implicated in the sterile inflammatory process of term parturition. In vivo and... The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Multiple Signaling Pathways Involved in Human Dendritic Cell Maturation Are Affected by the Fungal Quorum-Sensing Molecule Farnesol [INFECTIOUS DISEASE AND HOST RESPONSE] Key PointsFOH promotes CD1d expression in human DC via activation of PPAR, RARα, and p38 MAPK. FOH modulates cytokine release through nuclear receptors, MAPK, and NF-B pathways. FOH diminishes human DC capacity to activate iNKT, Th1, and FOXP3+ regulatory T cells. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Cutting Edge: TCR Signal Strength Regulates Acetyl-CoA Metabolism via AKT [CUTTING EDGE] Key PointsTCR signal strength regulates acetyl-CoA metabolism. Weak TCR signals promote phosphorylation of citrate synthase via Akt. TCR signal strength differentially regulates acetyl-lysine containing proteins. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Uhrf1-Mediated Tnf-{alpha} Gene Methylation Controls Proinflammatory Macrophages in Experimental Colitis Resembling Inflammatory Bowel Disease [MUCOSAL IMMUNOLOGY] Key PointsUhrf1-mediated DNA methylation represses Tnf-α expression in macrophages. Uhrf1 deficiency augments Tnf-α expression, resulting in aggravated colitis. Tnf-α triggers macrophage activation through destabilizing Uhrf1 protein. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Inhibition of Allergic Reactivity through Targeting Fc{varepsilon}RI-Bound IgE with Humanized Low-Affinity Antibodies [ALLERGY AND OTHER HYPERSENSITIVITIES] Key PointsLARI inhibits allergic reactivity while displaying an excellent safety profile. LARI blunts allergic responses via multiple mechanisms at multiple steps. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Role of IL-15 Signaling in the Pathogenesis of Simian Immunodeficiency Virus Infection in Rhesus Macaques [INFECTIOUS DISEASE AND HOST RESPONSE] Key PointsAnti–IL-15 depletes NK cells and disrupts TEM homeostasis in SIV-infected RM. IL-15 inhibition does not alter SIV replication dynamics or CD4+ T cell depletion. IL-15 inhibition does accelerate reactivation of an oncogenic -herpesvirus. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Malt1 Protease Deficiency in Mice Disrupts Immune Homeostasis at Environmental Barriers and Drives Systemic T Cell-Mediated Autoimmunity [AUTOIMMUNITY] Key PointsAutoreactive T cells drive the lethal disease in Malt1PD mice. Malt1PD mice display B cell hyperactivation to environmental Ags. IPEX-like disease occurs in Malt1PD mice despite in vitro Treg suppressive activity. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Long-Term Microgliosis Driven by Acute Systemic Inflammation [INNATE IMMUNITY AND INFLAMMATION] Key PointsEarly monocyte infiltration causes long-term microgliosis in sepsis. Brain microglia self-proliferate during severe sepsis. Microglia proliferation is associated with local M-CSF. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 cAMP Response Element Modulator {alpha} Induces Dual Specificity Protein Phosphatase 4 to Promote Effector T Cells in Juvenile-Onset Lupus [AUTOIMMUNITY] Key PointsCREMα induces DUSP4 phosphatase expression in CD4+ T cells. DUSP4 promotes IL-17A and reduces IL-2 production by effector T cells. The CREMα/DUSP4 axis is involved in the pathophysiology of SLE. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Ubc9 Interacts with and SUMOylates the TCR Adaptor SLP-76 for NFAT Transcription in T Cells [MOLECULAR AND STRUCTURAL IMMUNOLOGY] Key PointsUbc9 interacts with and SUMOylates the immune adaptor SLP-76 in T cells. Synergy of SLP-76–Ubc9 on IL-2 transcription is SLP-76 SUMOylation dependent. SLP-76 SUMOylation is required for Ubc9-NFAT complex assembly for IL-2 transcription. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Functional Characterization of CD11c+ Age-Associated B Cells as Memory B Cells [AUTOIMMUNITY] Key PointsCD11c+ ABCs exhibit functional characteristics of MBCs. ABCs express polyreactive B cell receptors binding diverse self-antigens. Adoptively transferred ABCs contribute to rapid recall responses to viral Ags. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Dendritic Cells Control Regulatory T Cell Function Required for Maintenance of Intestinal Tissue Homeostasis [MUCOSAL IMMUNOLOGY] Key PointsInhibitory receptors are upregulated on peripheral Tregs of DC-deficient mice. Tregs from DC-deficient mice are functionally impaired. Tregs require DCs for inhibition of T cell transfer-induced colitis. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 UBASH3A Regulates the Synthesis and Dynamics of TCR-CD3 Complexes [AUTOIMMUNITY] Key PointsUBASH3A interacts with the TCR–CD3 complex and regulates its turnover. UBASH3A facilitates the downmodulation of cell-surface TCR–CD3 upon TCR engagement. UBASH3A binds to CBL-B, another T1D-associated protein that inhibits T cell function. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 MR1-Independent Activation of Human Mucosal-Associated Invariant T Cells by Mycobacteria [IMMUNOTHERAPY AND VACCINES] Key PointsMAIT cells comprise half the CD8 T cell IFN- response to BCG in blood. Frequencies of MAIT cells were not sustainably modulated by BCG vaccination. Innate cytokines mediate BCG-induced MAIT cell responses in whole blood. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 TNF-Induced Interstitial Lung Disease in a Murine Arthritis Model: Accumulation of Activated Monocytes, Conventional Dendritic Cells, and CD21+/CD23- B Cell Follicles Is Prevented with Anti-TNF Therapy [AUTOIMMUNITY] Key PointsTNF-Tg mice develop NSIP-like lung disease with increased cDC2 and macrophages. Anti-TNF therapy modulates prefibrotic ILD in TNF-Tg mice. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 The IL-12- and IL-23-Dependent NK Cell Response Is Essential for Protective Immunity against Secondary Toxoplasma gondii Infection [INFECTIOUS DISEASE AND HOST RESPONSE] Key PointsNK cells are required for immune control of secondary T. gondii infection. NK cells do not develop intrinsic memory-like features during T. gondii infection. Secondary NK cell responses depend upon IL-12 and IL-23. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Regulatory T Cell Transmigration and Intravascular Migration Undergo Mechanistically Distinct Regulation at Different Phases of the Inflammatory Response [IMMUNE REGULATION] Key PointsRegulatory T cells can undergo extensive intravascular crawling in skin vessels. Mechanisms of regulatory T cell transmigration can be modulated dynamically. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 The TL1A-DR3 Axis Selectively Drives Effector Functions in Human MAIT Cells [INNATE IMMUNITY AND INFLAMMATION] Key PointsDR3 is highly expressed on human MAIT cells. DR3 ligand TL1A licenses innate TNF-α production and boosts polyfunctionality. TL1A equally augments TCR-dependent MAIT cell effector functions. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 RELM{alpha} Licenses Macrophages for Damage-Associated Molecular Pattern Activation to Instigate Pulmonary Vascular Remodeling [IMMUNE REGULATION] Key PointsRELMα (hResistin) activates pulmonary macrophages in PAH patients and hypoxic mice. RELMα (hResistin) induces HMGB1 acetylation by suppressing Sirt1 in macrophages. The RELMα–HMGB1 axis causes macrophage-mediated PASMC proliferation. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Glycogen Synthase Kinase 3{beta} Regulates Antiviral Responses of TLR3 via TRAF2-Src Axis [INNATE IMMUNITY AND INFLAMMATION] Key PointsGSK3β interacts with Src tyrosine kinase. Src positively regulates antiviral immune response. Src undergoes K63-linked ubiquitination by TRAF2. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 TLR2 Stimulation Increases Cellular Metabolism in CD8+ T Cells and Thereby Enhances CD8+ T Cell Activation, Function, and Antiviral Activity [IMMUNE REGULATION] Key PointsTLR2 directly regulates the anti-CD3–activated CD8+ T cells independently on APCs. Bioenergy metabolism is important for TLR2-mediated enhancement of CD8+ T cells. TLR2 enhances the antiviral CD8+ T cell response and the efficacy of HBV vaccine. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Exercise Promotes Resolution of Acute Inflammation by Catecholamine-Mediated Stimulation of Resolvin D1 Biosynthesis [INNATE IMMUNITY AND INFLAMMATION] Key PointsExercise enhances resolution of acute inflammation and RvD1 biosynthesis. Epinephrine stimulates macrophage production of RvD1 through α1-AR. α1-AR blockade in vivo abrogates exercise-enhanced resolution. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Downregulation of MHC Class II by Ubiquitination Is Required for the Migration of CD206+ Dendritic Cells to Skin-Draining Lymph Nodes [IMMUNE REGULATION] Key PointsMHCII molecule upregulation is not required for the development of skin moDCs. Skin CD206+ moDCs do not migrate to LNs in the absence of MHCII ubiquitination. GM-CSF restores the migration of skin moDCs by upregulating CCR7 and IRF4. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Recognition of Lewis X by Anti-Lex Monoclonal Antibody IG5F6 [MOLECULAR AND STRUCTURAL IMMUNOLOGY] Key PointsRecognition of monomeric Lex by IG5F6 using a panel of Lex analogues was studied. Anti-Lex mAbs bind in different ways; the hydrophobic patch of β-d-Gal is essential. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Folliculin Interacting Protein 1 Maintains Metabolic Homeostasis during B Cell Development by Modulating AMPK, mTORC1, and TFE3 [IMMUNE SYSTEM DEVELOPMENT] Key PointsFnip1 is required for pre–B cell development/survival independent of p53 and Bcl-xL. Fnip1 is required for optimal inhibition of mTORC1 in response to amino acid restriction. Fnip1 regulates TFE3 nuclear translocation and lysosome biogenesis in pre–B cells. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Pharyngeal Immunity in Early Vertebrates Provides Functional and Evolutionary Insight into Mucosal Homeostasis [MUCOSAL IMMUNOLOGY] Key PointsA mucosally associated lymphoid tissue is identified in teleost pharyngeal cavity. Trout pharyngeal bacteria are mainly coated with secretory IgT. Teleost IgT plays a vital role in protecting the PC from invading pathogens. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Ancient BCMA-like Genes Herald B Cell Regulation in Lampreys [IMMUNOGENETICS] Key PointsTwo lamprey BCMA-like receptors interact with a single lamprey BAFF protein. BCMAL1 and BCMAL2 genes are differentially expressed during VLRB cell stimulation. BAFF-based mechanisms for B cell regulation appeared early in vertebrate evolution. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 STAT3-Induced Wnt5a Provides Chronic Lymphocytic Leukemia Cells with Survival Advantage [TUMOR IMMUNOLOGY] Key PointsSTAT3 induces the expression of Wnt5a in CLL cells. Wnt5a provides CLL cells with survival advantage. The Journal of Immunology current issue Mon Nov 18, 2019 23:00 Mark above section as read  Evolutionary Biology News -- ScienceDaily Researchers clear the path for 'designer' plants A team of researchers has found a way to identify gene regulatory elements that could help produce 'designer' plants and lead to improvements in food crops at a critical time. Evolutionary Biology News -- ScienceDaily Mon Nov 18, 2019 21:03 Mark above section as read  Medgadget Launch of Index At-Home Biological Age Test: Interview with Dr. Morgan Levine, Yale School of Medicine and Head of Bioinformatics at Elysium Health Elysium Health, a life sciences company selling health products with a particular focus on interventions that target fundamental processes of aging, has developed the Index at-home biological age test. The company claims that the test allows users to determine their biological age at home, and provides science-backed healthy living recommendations that may be able to impact overall health. Aging is the largest risk-factor for a huge array of diseases and health issues, and, indeed, mortality.... Medgadget Mon Nov 18, 2019 22:48 Optical Coherence Tomography Finally Used to Measure Cartilage Health Optical coherence tomography (OCT) is an imaging modality that provides a micron-level look at the tissues being examined. It is used in ophthalmology to assess the eyes and for imaging the interior of arteries to help with atherectomies. Although OCT has significant potential to help clinicians evaluate the health of tissues, it has proven difficult to use deep within the body. Now, researchers at Duke University have managed to equip a rigid borescope, the kind used to look inside joints... Medgadget Mon Nov 18, 2019 21:09 FDA Clears First Duodenoscope with Disposable Business End Pentax Medical won FDA clearance for its ED34-i10T2 duodenoscope that features a disposable elevator end piece, making it easier to guarantee that the scope is properly sterilized between patients. This is the first scope of its kind, although we recently covered the clearance of ScopeSeal, a disposable device that snaps over a scope's business end to keep it clean. Thanks to a disposable end piece, there are fewer parts to process when sterilizing the new ED34-i10T2 duodenoscope.... Medgadget Mon Nov 18, 2019 19:27 Mark above section as read  Latest Results for European Biophysics Journal In-cell structural dynamics of an EGF receptor during ligand-induced dimer–oligomer transition Abstract The epidermal growth factor receptor (EGFR) is a membrane protein that regulates cell proliferation, differentiation and survival, and is a drug target for cancer therapy. Ligand-induced activation of the EGFR kinase is generally regarded to require ligand-bound-dimers, while phosphorylation and down-stream signalling is modulated by oligomers. Recent work has unveiled changes in EGFR dynamics from ligand-induced dimerization in membranes extracted from cells, however,... Latest Results for European Biophysics Journal Mon Nov 18, 2019 02:00 Mark above section as read  Anthropology-News The Clinical Importance of Space in Sexual Health With ongoing attacks on reproductive rights and an ever-growing list of politicians, celebrities, and billionaires accused of sexual assault and harassment, we need more safe spaces, especially for individuals seeking access to sexual health care. In Toronto, calls for inclusivity and diversity in sexual health care services abound, marking a paradigmatic shift from earlier forms of sexual health care in the interwar and postwar periods, where public sexual health services existed primarily to prevent... Anthropology-News Mon Nov 18, 2019 22:30 Museum Anthropology at the 2019 AAA/CASCA Annual Meeting The Council for Museum Anthropology is looking forward to a vibrant AAA/CASCA program this year. All members (or those interested in joining) are encouraged to attend both the CMA business meeting (Friday, November 22 at 12:15 p.m.) and reception (Friday, November 22 at 8:00 p.m.). In addition, Aaron Glass, this year's winner of the CMA Michael Ames Award for Innovative Museum Anthropology, will be installing a complete panel version of the award-winning exhibit "The Story Box" at the Annual Meeting... Anthropology-News Mon Nov 18, 2019 20:30 Mark above section as read  European Journal of Surgical Oncology (EJSO) The impact of liver resection on survival for locally advanced intrahepatic cholangiocarcinoma tumors: A propensity score analysis Publication date: Available online 17 November 2019Source: European Journal of Surgical OncologyAuthor(s): M. Moustafa, E. Fasolo, D. Bassi, F.E. D'amico, E. Gringeri, Timothy M. Pawlik, U. CilloAbstractBackgroundAim of work was to investigate the prognostic impact of liver resection (LR) on locally advanced Intrahepatic Cholangiocarcinoma (IC) in comparison to alternative palliative chemotherapy (CTx).MethodA retrospective cohort study performed utilizing Surveillance, Epidemiology, and End Results... European Journal of Surgical Oncology (EJSO) Mon Nov 18, 2019 22:19 Mark above section as read  Journal of Cancer Education Establishing and Evaluating an ASCO Learning Cohort: a Longitudinal Project Assessing the Learning Needs and Behaviors of Oncology Professionals Abstract Background: In 2013, the American Society of Clinical Oncology (ASCO)'s Continuing Education Committee recommended establishing an interprofessional, longitudinal cohort pilot project. The main goals of the cohort were to gain feedback from oncology providers on how they use resources to address their learning needs and gain insights into the utility of different ASCO educational activities. ... Journal of Cancer Education Mon Nov 18, 2019 02:00 Mark above section as read  Routledge: Acta Linguistica Hafniensia: Table of Contents Enumerative there-clauses and there-clefts: specification and information structure . Routledge: Acta Linguistica Hafniensia: Table of Contents Mon Nov 18, 2019 13:33 Mark above section as read  Journal of Endocrinological Investigation Association between biochemical control and comorbidities in patients with acromegaly: an Italian longitudinal retrospective chart review study Abstract Purpose Achieving biochemical control (normalization of insulin-like growth factor-1 [IGF-1] and growth hormone [GH]) is a key goal in acromegaly management. However, IGF-1 and GH fluctuate over time. The true potential impact of time-varying biochemical control status on comorbidities is unclear and relies on multiple, longitudinal IGF-1 and GH measurements. This study assessed the association between time-varying biochemical... Journal of Endocrinological Investigation Mon Nov 18, 2019 02:00 Mark above section as read  Cancer Biology & Therapy: Table of Contents: Taylor and Francis MiR-133a-5p inhibits androgen receptor (AR)-induced proliferation in prostate cancer cells via targeting FUsed in Sarcoma (FUS) and AR . Cancer Biology & Therapy: Table of Contents: Taylor and Francis Mon Nov 18, 2019 08:09 Mark above section as read  Imaging A radiologic review of hoarse voice from anatomic and neurologic perspectives Abstract The differential diagnosis for hoarseness is extensive and includes a multitude of etiologies that span a large geographic area from the brainstem to the mediastinum. Therefore, localizing a causative lesion can be extremely difficult for clinicians and radiologists alike. In this review, we will first discuss the normal anatomy of the larynx and its innervation via the vagus and recurrent laryngeal nerves. We will then proceed with a guided tour of the various infectious/inflammatory,... Imaging Mon Nov 18, 2019 02:00 Mark above section as read  JoVE: Journal of Visualized Experiments Spatial Temporal Analysis of Fieldwise Flow in Microvasculature To quantify microvascular flow from high speed capillary flow image sequences, we developed STAFF (Spatial Temporal Analysis of Fieldwise Flow) software. Across the full image field and over time, STAFF evaluates flow velocities and generates a sequence of color-coded spatial maps for visualization and tabular output for quantitative analyses. JoVE: Journal of Visualized Experiments Mon Nov 18, 2019 21:00 Preparation of Mitochondria from Ovarian Cancer Tissues and Control Ovarian Tissues for Quantitative Proteomics Analysis This article presents a protocol of differential-speed centrifugation in combination with density gradient centrifugation to separate mitochondria from human ovarian cancer tissues and control ovarian tissues for quantitative proteomics analysis, resulting in a high-quality mitochondrial sample and high-throughput and high-reproducibility quantitative proteomics analysis of a human ovarian cancer mitochondrial proteome. JoVE: Journal of Visualized Experiments Mon Nov 18, 2019 20:00 Mark above section as read  Royal Society of Chemistry (Great Britain) Society for Analytical Chemistry Society of Public Analysts (Great Britain) Electrodeposition behavior of homoleptic transition metal acetonitrile complexes interrogated with piezoelectric gravimetry Analyst, 2019, Accepted ManuscriptDOI: 10.1039/C9AN01952A, PaperDavid Joseph Sconyers, James BlakemoreHomoleptic acetonitrile complexes of first-row transition metal ions are a common product of the detrimental speciation of coordination complexes and organometallic compounds. However, the electrochemical properties of such species are...The content of this RSS Feed (c) The Royal Society of Chemistry Royal Society of Chemistry (Great Britain) Society for Analytical Chemistry Society of Public Analysts (Great Britain) Mon Nov 18, 2019 02:00 Electrochemical aptamer-based sensor prepared by utilizing strong interaction between DNA aptamer and diamond Analyst, 2019, Accepted ManuscriptDOI: 10.1039/C9AN01976F, PaperKai Asai, Takashi Yamamoto, Shinichi Nagashima, Genki Ogata, Hiroshi Hibino, Yasuaki EinagaStable and continuous biosensing of electroactive species in vivo have been achieved by boron-doped diamond (BDD) electrodes owing to the outstanding electrochemical properties. However, the present problem of the biosensing...The content of this RSS Feed (c) The Royal Society of Chemistry Royal Society of Chemistry (Great Britain) Society for Analytical Chemistry Society of Public Analysts (Great Britain) Mon Nov 18, 2019 02:00 Rapid differentiation of Campylobacter jejuni cell wall mutants using Raman spectroscopy, SERS and mass spectrometry combined with chemometrics Analyst, 2019, Accepted ManuscriptDOI: 10.1039/C9AN02026H, PaperMalama Chisanga, Dennis Linton, Howbeer Muhamadali, David I. Ellis, Richard Kimber, Aleksandr Mironov, Royston GoodacreThe Gram-negative bacterial pathogen Campylobacter jejuni is a major cause of foodborne gastroenteritis worldwide. Rapid detection and identification of C. jejuni informs timely prescription of appropriate therapeutics and epidemiological investigations....The content of this RSS Feed (c) The Royal Society of Chemistry Royal Society of Chemistry (Great Britain) Society for Analytical Chemistry Society of Public Analysts (Great Britain) Mon Nov 18, 2019 02:00 Mark above section as read  OEM Online First The neglected millions: the global state of aquaculture workers occupational safety, health and well-being A scoping project was funded by the Food and Agriculture Organization in 2017 on the health and safety of aquaculture workers. This project developed a template covering basic types of aquaculture production, health and safety hazards and risks, and related data on injuries and occupational ill health, regulations, social welfare conditions, and labour and industry activity in the sector. Profiles using the template were then produced for key aquaculture regions and nations across the globe where... OEM Online First Mon Nov 18, 2019 19:00 Mark above section as read  Mucosal Immunology - Issue - nature.com science feeds IgA and the intestinal microbiota: the importance of being specific Mucosal Immunology, Published online: 18 November 2019; doi:10.1038/s41385-019-0227-4IgA and the intestinal microbiota: the importance of being specific Mucosal Immunology - Issue - nature.com science feeds Mon Nov 18, 2019 02:00 IgA and the intestinal microbiota: the importance of being specific Mucosal Immunology - Issue - nature.com science feeds Mon Nov 18, 2019 02:00 Mark above section as read  Strahlentherapie und Onkologie Durvalumab nach Radiochemotherapie beim lokal fortgeschrittenen inoperablen NSCLC – ein Sprung nach vorn Strahlentherapie und Onkologie Mon Nov 18, 2019 02:00 Prospective trial on telemonitoring of geriatric cancer patients using handheld devices Abstract Purpose and objective Randomized trials indicate that electronic or app-based assessment of patient-reported outcomes may improve outcomes in cancer patients. To analyze if an app-based follow-up would be accepted by elderly cancer patients, we conducted a single-center prospective feasibility study (NCT03196050). Materials and methods Cancer patients... Strahlentherapie und Onkologie Mon Nov 18, 2019 02:00 Mark above section as read  Hearing Research Contribution of spectral pinna cues for sound localization in children with congenital unilateral conductive hearing loss after hearing rehabilitation Publication date: Available online 17 November 2019Source: Hearing ResearchAuthor(s): Katharina Vogt, Jan-Willem Wasmann, A. John Van Opstal, Ad F.M. Snik, Martijn J.H. AgterbergAbstractCongenital unilateral conductive hearing loss (UCHL) jeopardizes directional hearing and speech perception in noisy conditions. Potentially, children with congenital UCHL can benefit from fitting a hearing device, such as a bone-conduction device (BCD). However, the literature reports limited benefit from fitting... Hearing Research Mon Nov 18, 2019 19:27 Mark above section as read  Pediatric Otorhinolaryngology Relation of Public Health Staffing To Follow-up After Newborn Hearing Screening IN THREE HEALTH DISTRICTS IN GEORGIA, 2009-2015 Publication date: Available online 18 November 2019Source: International Journal of Pediatric OtorhinolaryngologyAuthor(s): Kareem Al-Mulki, N. Wendell ToddAbstractObjectiveTo describe the association, or non-association, of public health district staffing (specifically, Early Hearing Detection and Intervention [EHDI] coordinator/navigator) and loss to follow-up in newborns who did not pass hearing screening in selected public health districts in Georgia, USA.MethodsBy Freedom of Information request,... Pediatric Otorhinolaryngology Mon Nov 18, 2019 19:10 Mark above section as read  Angewandte Chemie International Edition Self‐Assembled Gold Arrays That Allow Rectification by Nanoscale Selectivity Deposition of a monolayer nanoarray on the surface of a micrometer‐thick substrate is demonstrated, producing rectification characteristics at the nanoscale. The heterogeneity of the structure and the charge density are the two key factors affecting rectification. By altering the asymmetric electrolyte environment, the fabricated heterogeneous membrane can be used in energy conversion. Abstract The deposition of a monolayer nanoarray on the surface of a micrometer‐thick substrate is demonstrated,... Angewandte Chemie International Edition Mon Nov 18, 2019 19:04 Dodecatwistarene Imides with Zigzag‐Twisted Conformation for Organic Electronics 1D nonplanar graphene nanoribbons generally have three possible conformers: helical, zigzag, and mixed conformations. In this research, a novel kind of 1D nonplanar graphene nanoribbon, namely dodecatwistarene imides featuring twelve linearly fused benzene rings, was obtained by bottom‐up synthesis of palladium‐catalyzed Stille coupling and C‐H activation. Single‐crystal X‐ray diffraction analyses revealed that it displays a zigzag‐twisted conformation caused by steric hindrance between imide groups... Angewandte Chemie International Edition Mon Nov 18, 2019 19:04 Lessons in Strain and Stability: Enantioselective Synthesis of (+)‐[5]‐Ladderanoic Acid A game of strain: The synthesis of highly strained natural products provides unexpected opportunities for the development of new reactions and strategies. In the synthesis of (+)‐[5]‐ladderanoic acid unexpected strain release driven transformations were uncovered, thus requiring a drastic revision of the synthetic design that ultimately led to the development of a novel stepwise cyclobutane assembly by an allylboration/Zweifel olefination sequence. Abstract The synthesis of structurally complex... Angewandte Chemie International Edition Mon Nov 18, 2019 19:04 Calcium Hydride Reduction of Polycyclic Aromatic Hydrocarbons A molecular calcium hydride effects the two electron reduction of polyaromatic hydrocarbons, including naphthalene (E0 = ‐3.1 V). Angewandte Chemie International Edition Mon Nov 18, 2019 16:19 A Supported Nickel Catalyst Stabilized by a Surface Digging Effect for Efficient Methane Oxidation A surface digging effect of supported Ni NPs on an amorphous N‐doped carbon is described, during which the surface‐loaded Ni NPs etch and sink into the carbon support underneath to prevent sintering. The sinking Ni NPs could be transformed into thermodynamically stable and active metal‐defect sites for activation of C−H bonds for methane oxidation by simply elevating temperature. Abstract A surface digging effect of supported Ni NPs on an amorphous N‐doped carbon is described, during which... Angewandte Chemie International Edition Mon Nov 18, 2019 15:53 Unconventional Route to Oxygen‐Vacancy‐Enabled Highly Efficient Electron Extraction and Transport in Perovskite Solar Cells The acid treatment of TiO2 weakens the bonding of octahedral chains in anatase TiO2, rendering the formation of amorphous TiO2 buffer layer on the surface of anatase TiO2. This amorphous TiO2 buffer layer contains rich oxygen vacancies, which increase the donor density of TiO2. Abstract The ability to effectively transfer photoexcited electrons and holes is an important endeavor toward achieving high‐efficiency solar energy conversion. Now, a simple yet robust acid‐treatment strategy is used... Angewandte Chemie International Edition Mon Nov 18, 2019 15:52 Ultrafast Condensation of Carbon Nitride on Electrodes with Exceptional Boosted Photocurrent and Electrochemiluminescence Ultrafast heating addresses the thermodynamic contradiction of precursor volatilization during polymerization and leads to strongly adhesive carbon nitride on electrodes with a gradient C‐rich texture. Charge separation and mobility are accelerated and a remarkable photocurrent and a record cathodic electrochemiluminescence efficiency are observed. Abstract Semiconducting polymeric carbon nitride (CN) has drawn wide attention ranging from photocatalysis to more recent biosensing owing to unique... Angewandte Chemie International Edition Mon Nov 18, 2019 15:50 An Unprecedented Kernel Growth Mode and the Layer‐Number‐Odevity‐Dependent Properties in Gold Nanoclusters The nanocluster Au56(TBBT)34 was synthesized. X‐ray crystallography revealed a defective kernel layer stacking mode different from that shared by a magic series of nanoclusters, Au28(TBBT)20, Au36(TBBT)24, Au44(TBBT)28, Au52(TBBT)32, and Au56(TBBT)34. Not only the size but also the odevity of the kernel layer number influences both polarity and photoluminescence of the metal nanoclusters. Abstract Kernel atoms of Au nanoclusters are packed layer‐by‐layer along the [001] direction with every... Angewandte Chemie International Edition Mon Nov 18, 2019 15:49 Thiophenylazobenzene: an Alternative Photoisomerization Controlled by Lone‐Pair⋅⋅⋅π Interaction My own way: Thiophenylazobenzene is a sulfur‐based azoheteroarene photoswitch with impressive fatigue resistance, photoisomerization efficiency, and highly selective photoconversion. Its (Z)‐isomer adopts an unusual orthogonal geometry stabilized by an intramolecular lone‐pair⋅⋅⋅π interaction governing the ultrafast photoisomerization, which requires a mechanism involving significant movement along the inversion reaction coordinate. Abstract Azoheteroarene photoswitches have attracted attention... Angewandte Chemie International Edition Mon Nov 18, 2019 15:49 Live‐Cell Localization Microscopy with a Fluorogenic and Self‐Blinking Tetrazine Probe Blink and you'll miss it: A rationally designed small‐molecule label comprising fluorogenic and self‐blinking features has been designed and synthesized for bioorthogonal chemistry and super‐resolution microscopy in living cells. Abstract Recent developments in fluorescence microscopy call for novel small‐molecule‐based labels with multiple functionalities to satisfy different experimental requirements. A current limitation in the advancement of live‐cell single‐molecule localization microscopy... Angewandte Chemie International Edition Mon Nov 18, 2019 14:37 Evolved Aliphatic Halogenases Enable Regiocomplementary C−H Functionalization of Pharmaceutically Relevant Beyond natural: A protein catalyst was engineered to perform selective halogenation of a fragment of martinelline, a pharmaceutically relevant non‐native substrate. Directed evolution of non‐heme iron halogenase WelO5* afforded a variant with an up to 400‐fold higher apparent k cat and a 290‐fold higher TTN for this target substrate than the wildtype enzyme while achieving high stereo‐ and regioselectivity (>99 %). Abstract Non‐heme iron halogenases are synthetically valuable biocatalysts... Angewandte Chemie International Edition Mon Nov 18, 2019 14:29 Carbene‐Catalyzed Enantioselective Aromatic N‐Nucleophilic Addition of Heteroarenes to Ketones Activation code: The aromatic nitrogen atoms of heteroarylaldehydes are activated by carbene catalysts to react with ketone electrophiles. A broad scope of cyclic N,O‐acetal products are afforded in good to excellent yields and optical purities. The reaction involves the formation of an aza‐fulvene acylazolium intermediate. Several products exhibit excellent antibacterial activities and are valuable in the development of novel agrichemicals. Abstract The aromatic nitrogen atoms of heteroarylaldehydes... Angewandte Chemie International Edition Mon Nov 18, 2019 14:29 Site‐Selective Alkoxylation of Benzylic C−H Bonds by Photoredox Catalysis Partner up: Photocatalysis offers a one‐step strategy to selectively functionalize the benzylic positions of electron‐rich arenes with alcohols. It merges the photoredox activation of arenes with copper(II)‐mediated oxidation of the resulting benzylic radicals, enabling the introduction of benzylic C−O bonds with high site selectivity, chemoselectivity, and functional‐group tolerance using only two equiv of the alcohol coupling partner. Abstract Methods that enable the direct C−H alkoxylation... Angewandte Chemie International Edition Mon Nov 18, 2019 14:27 Topochemical Synthesis of Two‐Dimensional Transition‐Metal Phosphides Using Phosphorene Templates Material gains: A general bottom‐up topochemical strategy has been developed to synthesize solution‐processable two‐dimensional transition‐metal phosphides, which exhibit semiconducting features and superior activity towards the oxygen evolution reaction. Notably, Co2P is a p‐type semiconductor, with a hole mobility of 20.8 cm2 V−1 s−1 at 300 K in field‐effect transistors. Abstract Transition‐metal phosphides (TMPs) have emerged as a fascinating class of narrow‐gap semiconductors and electrocatalysts.... Angewandte Chemie International Edition Mon Nov 18, 2019 14:27 The Structure of Sub‐nm Platinum Clusters at Elevated Temperatures Fast dynamic STEM combined with a spatio‐temporal image denoising algorithm is employed to explore the structure and stability of Pt clusters on carbon, which represents a highly relevant catalysis system. At room temperature, dynamic amorphous 2D structures are found, while above ≈300 °C, the clusters transform into a crystalline state. Abstract Little is known about metallic clusters consisting merely of a dozen of atoms or even less, despite of their importance in catalysis and crystal nucleation.... Angewandte Chemie International Edition Mon Nov 18, 2019 14:26 Palladium‐Catalyzed [2+2+1] Spiroannulation via Alkyne‐Directed Remote C−H Arylation and Subsequent Arene Dearomatization Easy as 1‐2‐3: A chemoselective Pd0‐catalyzed alkyne‐directed [2+2+1] spiroannulation of aryl iodides with bromophenol derivatives has been established for the assembly of spirocycle‐embedded polycyclic frameworks. This two‐component reaction proceeds via remote C−H cleavage, biaryl cross‐coupling, and arene dearomatization. Abstract Palladium‐catalyzed alkene‐directed cross‐coupling of aryl iodide with another aryl halide through C−H arylation opens a unique avenue for unsymmetrical biaryl‐derived... Angewandte Chemie International Edition Mon Nov 18, 2019 14:25 Discriminative Detection of Biothiols by Electron Paramagnetic Resonance Spectroscopy using a Methanethiosulfonate Trityl Probe It's a trap! The simultaneous detection and quantitation of multiple different biothiols in a single sample by EPR spectroscopy has been demonstrated using a technique termed EPR thiol‐trapping. This technique was used to monitor the efflux of glutathione and cysteine from HepG2 cells. Abstract Biothiols, such as glutathione (GSH), homocysteine (Hcy), and cysteine (Cys), coexist in biological systems with diverse biological roles. Thus, analytical techniques that can detect, quantify, and distinguish... Angewandte Chemie International Edition Mon Nov 18, 2019 14:24 Polar‐Functionalized, Crosslinkable, Self‐Healing, and Photoresponsive Polyolefins Going polar: An efficient route was reported to generate polar‐functionalized, crosslinkable, self‐healing, and photoresponsive polyolefins with thermoplastic, elastomeric, and thermosetting properties. Abstract The nonpolar nature of polyolefins is one of their biggest limitations. Now, an efficient route to generate polar‐functionalized, crosslinkable, self‐healing, photoresponsive polyolefins with thermoplastic, elastomeric, and thermosetting properties is reported. Tunable amounts of carboxylic... Angewandte Chemie International Edition Mon Nov 18, 2019 14:23 A Chiral Polycyclic Aromatic Hydrocarbon Monkey Saddle Based on a truxene a chiral monkey saddle shaped polyaromatic hydrocarbon (PAH) with three eight‐membered rings was accessible in only three synthetic steps. The enantiomers were separated by chiral HPLC and investigated photophysically. Abstract A contorted polycyclic aromatic hydrocarbon (PAH) in the shape of a monkey saddle has been synthesized in three steps from a readily available truxene precursor. The monkey saddle PAH is consisting of three five‐, seven six‐, and three eight‐membered... Angewandte Chemie International Edition Mon Nov 18, 2019 14:23 Electrochemistry Broadens the Scope of Flavin Photocatalysis: Photoelectrocatalytic Oxidation of Unactivated Alcohols Dynamic duo: The combination of electrochemistry and photochemistry allows the generation of highly reactive catalytic intermediates without the need for a chemical oxidant. This photoelectrocatalytic strategy thus accessed the elusive reactivity of flavins for oxidizing unactivated aliphatic alcohols. HAT=hydrogen‐atom transfer. Abstract Riboflavin‐derived photocatalysts have been extensively studied in the context of alcohol oxidation. However, to date, the scope of this catalytic methodology... Angewandte Chemie International Edition Mon Nov 18, 2019 14:20 Difluoro(aryl)(perfluoroalkyl)‐λ4‐sulfanes and Selanes: Missing Links of Trichloroisocyanuric Acid/Potassium Fluoride Chemistry The TCICA/KF approach to oxidative fluorination of heteroatoms has emerged as a surprisingly simple, safe, and versatile surrogate to classically challenging fluorination reactions. The mild syntheses of metastable difluoro(aryl)(perfluoroalkyl)‐λ4‐sulfanes and selanes is reported and preliminary evidence is provided that difluoro(aryl)(trifluoro‐methyl)‐λ4‐sulfanes may act as fluorinating reagents. Abstract The TCICA/KF approach to oxidative fluorination of heteroatoms has emerged as a surprisingly... Angewandte Chemie International Edition Mon Nov 18, 2019 14:19 Supramolecular Photothermal Effects: A Promising Mechanism for Efficient Thermal Conversion Bring the heat! Supramolecular assemblies provide an elegant way to fabricate organic photothermal materials with enhanced stability and photothermal conversion efficiency, which can be termed supramolecular photothermal effects. By elaborating the inherent mechanisms, the supramolecular photothermal effects are expected to greatly benefit the design of novel high‐efficiency photothermal materials and their applications in a variety of fields. Abstract Supramolecular assemblies have been very... Angewandte Chemie International Edition Mon Nov 18, 2019 14:19 Flexible Total Synthesis of 11‐Deoxylandomycins and Their non‐Natural Analogues by Way of Asymmetric Metal Catalysis A de novo first collective total synthesis of 11‐deoxylandomycins is reported. A signature step is featured by the Pd‐catalyzed asymmetric addition of alcohol to ene‐alkoxyallenes that assembles oligomeric 2,3,6‐trideoxyoligosaccharides. The unique feature of the protocol is illustrated by a flexible access to various natural 11‐deoxylandomycins as well as non‐natural analogues. Angewandte Chemie International Edition Mon Nov 18, 2019 13:55 Control of Intramolecular Hydrogen Bonding in a Conformation‐switchable Helical Spring Polymer by Solvent and Temperature A substituted poly(phenylacetylene) derivative with two hydroxymethyl groups at the meta position of the side phenyl ring (PPAHB) was examined as a conformation‐switchable helical spring polymer that responds to solvent and heat stimuli in a precisely controlled manner. The intramolecular hydrogen bonding that gives rise to the helical structure of the polymer was destroyed and regenerated by adjusting the hydrogen bonding strength (pKHB) values of various combinations of solvents or by varying the... Angewandte Chemie International Edition Sun Nov 17, 2019 20:49 Direct and Tandem Routes for the Copolymerization of Ethylene with Polar Functionalized Internal Olefins Transition metal‐catalyzed ethylene copolymerization with polar monomers is a highly challenging reaction. After decades of research, the scope of suitable comonomer substrates has expanded from special to fundamental polar monomers and, recently, to 1,1‐disubstituted ethylenes. In this contribution, we aim to describe a direct and tandem strategy to realize ethylene copolymerization with various 1,2‐disubstituted ethylenes. The direct route is sensitive to steric effects from both the comonomers... Angewandte Chemie International Edition Sun Nov 17, 2019 16:59 Stereodivergent Anion Binding Catalysis with Molecular Motors A photoresponsive chiral catalyst based on an oligotriazole‐functionalized unidirectional molecular motor has been developed for stereodivergent anion binding catalysis. The motor function controls the helical chirality of supramolecular assemblies with chloride anions, which by means of chirality transfer enables the enantioselective addition of a silyl ketene acetal nucleophile to oxocarbenium cations. Reversal of stereoselectivity (up to 142% Δee) was achieved through rotation of the motor core... Angewandte Chemie International Edition Sun Nov 17, 2019 16:58 Green Metal‐Free Photochemical Hydroacylation of Unactivated Olefins Direct alkylation of C(sp2)‐H bonds in order to convert an aldehyde into a ketone is a notorious transformation, due to the laborious challenge of the formation of ketyl or acyl radicals. Herein, we report a green, cheap, metal‐free and efficient method for the hydroacylation of olefins in water. This photochemical protocol utilizes phenylglyoxylic acid, a commercially available small organic molecule, as the photoinitiator, water as the solvent and household fluorescent lamps as the irradiation... Angewandte Chemie International Edition Sun Nov 17, 2019 16:48 Mark above section as read
 bioRxiv Subject Collection: Evolutionary Biology,Chromosome painting does not support a sex chromosome turnover in Lacerta agilis Linnaeus, 1758 [NEW RESULTS]Reptiles show a remarkable diversity of sex determination mechanisms and sex chromosome systems, derived from different autosomal pairs. The origin of the ZW sex chromosomes of Lacerta agilis, a widespread Eurasian lizard species, is a matter of discussion: is it a small macrochromosome from the 11-18 group, common to all lacertids, or this...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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NIR spectroscopic determination of urine components in spot urine: preliminary investigation towards optical point-of-care test Abstract Presently, there is no convenient method to measure 24-h urinary Na excretion, which is an important index of daily Na intake, and 24-h urine collection involves a complex process. However, the Na-to-creatinine ratio (NCR) in spot urine has the potential to evaluate 24-h Na excretion and is useful for point-of-care testing. Thus, this study aimed to realize a near-infrared spectroscopic system to assess NCR in spot urine: (1) We attempted to estimate Na concentration using... Latest Results for Medical 02:00 Novel transcutaneous sensor combining optical tcPO 2 and electrochemical tcPCO 2 monitoring with reflectance pulse oximetry Abstract This study investigated the accuracy, drift, and clinical usefulness of a new optical transcutaneous oxygen tension (tcPO2) measuring technique, combined with a conventional electrochemical transcutaneous carbon dioxide (tcPCO2) measurement and reflectance pulse oximetry in the novel transcutaneous OxiVenT™ Sensor. In vitro gas studies were performed to measure accuracy and drift of tcPO2 and tcPCO2. Clinical usefulness for tcPO2 and tcPCO2 monitoring was assessed in neonates.... Latest Results for Medical Mon Nov 18, 2019 02:00 Subject-specific finite element analysis of a lumbar cage produced by electron beam melting Abstract The aim of this study was the analysis of the mechanical behaviour of a partially porous lumbar custom-made cage by means of a subject-specific finite element analysis (FEA). The cage, made of Ti6Al4V ELI alloy, was produced via electron beam melting (EBM) process and surgically implanted in a female subject, 50 years old. The novelty of this study was the customized design of the cage and of its internal structure, which is impossible to obtain with the traditional production... Latest Results for Medical Mon Nov 18, 2019 02:00 Priority based health data monitoring with IEEE 802.11af technology in wireless medical sensor networks Abstract In this work, the IEEE 802.11af technology–based wireless sensor network for health data monitoring with priority classes is proposed. In IEEE 802.11af technology, a White Space Device (WSD), a Station (STA), and an Access Point (AP) communicate through television white spectrum opportunistically without causing any harmful interference to licensed` services. In the proposed network; WSDs, STA, and AP employ Frequency Division Multiple Access (FDMA) technique with the... Latest Results for Medical Mon Nov 18, 2019 02:00 Experimental validation of adaptive pedicle screws—a novel implant concept using shape memory alloys Abstract Pedicle screw fixation is a standard procedure in spine surgery. A secure anchoring in deficient (e.g., osteoporotic) bone or in a secondary supply after a revision is a major challenge. This study aimed to test the primary stability of a new self-expanding shape memory actuator screw concept with the traditional screw design. The actuator part braces itself against the osseous environment after implantation by heating to body temperature. Thirty screws and twenty-four... Latest Results for Medical Mon Nov 18, 2019 02:00 Mark above section as read  Cancers Cancers, Vol. 11, Pages 1815: Nucleocytoplasmic Shuttling of STATs. A Target for Intervention? Cancers, Vol. 11, Pages 1815: Nucleocytoplasmic Shuttling of STATs. A Target for Intervention? Cancers doi: 10.3390/cancers11111815 Authors: Sabrina Ernst Gerhard Müller-Newen Signal transducer and activator of transcription (STAT) proteins are transcription factors that in the latent state are located predominantly in the cytoplasm. Activation of STATs through phosphorylation of a single tyrosine residue results in nuclear translocation. The requirement of tyrosine phosphorylation... Cancers 02:00 Cancers, Vol. 11, Pages 1814: A Novel Calcium-Mediated EMT Pathway Controlled by Lipids: An Opportunity for Prostate Cancer Adjuvant Therapy Cancers, Vol. 11, Pages 1814: A Novel Calcium-Mediated EMT Pathway Controlled by Lipids: An Opportunity for Prostate Cancer Adjuvant Therapy Cancers doi: 10.3390/cancers11111814 Authors: Figiel Bery Chantôme Fontaine Pasqualin Maupoil Domingo Guibon Bruyère Potier-Cartereau Vandier Fromont Mahéo The composition of periprostatic adipose tissue (PPAT) has been shown to play a role in prostate cancer (PCa) progression. We recently reported... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1813: Evaluation of the Accuracy of Liquid-Based Oral Brush Cytology in Screening for Oral Squamous Cell Carcinoma Cancers, Vol. 11, Pages 1813: Evaluation of the Accuracy of Liquid-Based Oral Brush Cytology in Screening for Oral Squamous Cell Carcinoma Cancers doi: 10.3390/cancers11111813 Authors: Deuerling Gaida Neumann Remmerbach This study evaluates the accuracy of the results of liquid-based oral brush cytology and compares it to the histology and/or the clinical follow-ups of the respective patients. A total of 1352 exfoliated specimens were collected with an Orcellex brush from... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1812: Synergistic Autophagy Effect of miR-212-3p in Zoledronic Acid-Treated In Vitro and Orthotopic In Vivo Models and in Patient-Derived Osteosarcoma Cells Cancers, Vol. 11, Pages 1812: Synergistic Autophagy Effect of miR-212-3p in Zoledronic Acid-Treated In Vitro and Orthotopic In Vivo Models and in Patient-Derived Osteosarcoma Cells Cancers doi: 10.3390/cancers11111812 Authors: Ju Yeon Oh Eun Ho Kim Yeon-Joo Lee Sei Sai Sun Ha Lim Jang Woo Park Hye Kyung Chung Joon Kim Guillaume Vares Akihisa Takahashi Youn Kyoung Jeong Mi-Sook Kim Chang-Bae Kong Osteosarcoma (OS) originates from osteoid bone tissues... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1810: The Gasdermin E gene Potential as a Pan-Cancer Biomarker, While Discriminating between Different Tumor Types Cancers, Vol. 11, Pages 1810: The Gasdermin E gene Potential as a Pan-Cancer Biomarker, While Discriminating between Different Tumor Types Cancers doi: 10.3390/cancers11111810 Authors: Joe Ibrahim Ken Op de Beeck Erik Fransen Marc Peeters Guy Van Camp Due to the elevated rates of incidence and mortality of cancer, early and accurate detection is crucial for achieving optimal treatment. Molecular biomarkers remain important screening and detection tools, especially in light... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1809: Bulk and Single-Cell Next-Generation Sequencing: Individualizing Treatment for Colorectal Cancer Cancers, Vol. 11, Pages 1809: Bulk and Single-Cell Next-Generation Sequencing: Individualizing Treatment for Colorectal Cancer Cancers doi: 10.3390/cancers11111809 Authors: Ioannis D. Kyrochristos Demosthenes E. Ziogas Anna Goussia Georgios K. Glantzounis Dimitrios H. Roukos The increasing incidence combined with constant rates of early diagnosis and mortality of colorectal cancer (CRC) over the past decade worldwide, as well as minor overall survival improvements in the... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1808: hENT1 Testing in Pancreatic Ductal Adenocarcinoma: Are We Ready? A Multimodal Evaluation of hENT1 Status Cancers, Vol. 11, Pages 1808: hENT1 Testing in Pancreatic Ductal Adenocarcinoma: Are We Ready? A Multimodal Evaluation of hENT1 Status Cancers doi: 10.3390/cancers11111808 Authors: Jerome Raffenne Remy Nicolle Francesco Puleo Delphine Le Corre Camille Boyez Raphael Marechal Jean François Emile Peter Demetter Armelle Bardier Pierre Laurent-Puig Louis de Mestier Valerie Paradis Anne Couvelard Jean Luc VanLathem John R. MacKey Jean-Baptiste Bachet... Cancers Mon Nov 18, 2019 02:00 Cancers, Vol. 11, Pages 1811: Mitigating Effect of 1-Palmitoyl-2-Linoleoyl-3-Acetyl-Rac-Glycerol (PLAG) on a Murine Model of 5-Fluorouracil-Induced Hematological Toxicity Cancers, Vol. 11, Pages 1811: Mitigating Effect of 1-Palmitoyl-2-Linoleoyl-3-Acetyl-Rac-Glycerol (PLAG) on a Murine Model of 5-Fluorouracil-Induced Hematological Toxicity Cancers doi: 10.3390/cancers11111811 Authors: Jinseon Jeong Yong-Jae Kim Do Young Lee Ki-Young Sohn Sun Young Yoon Jae Wha Kim 5-Fluorouracil (5-FU) is an antimetabolite chemotherapy widely used for the treatment of various cancers. However, many cancer patients experience hematological side effects following... Cancers Mon Nov 18, 2019 02:00 Mark above section as read  BioMed Research International Assessment of Corneal Pachymetry Distribution and Morphologic Changes in Subclinical Keratoconus with Normal Biomechanics Purpose. To investigate the pachymetry distribution of central cornea and morphologic changes in subclinical keratoconus with normal biomechanics and determine their potential benefit for the screening of very early keratoconus. Methods. This retrospective comparative study was performed in 33 clinically unaffected eyes with normal topography and biomechanics from 33 keratoconus patients with very asymmetric ectasia (VAE-NTB; Corvis Biomechanical Index defined) and 70 truly normal eyes from 70 age-matched... BioMed Research International 07:05 PSO-LocBact: A Consensus Method for Optimizing Multiple Classifier Results for Predicting the Subcellular Localization of Bacterial Proteins Several computational approaches for predicting subcellular localization have been developed and proposed. These approaches provide diverse performance because of their different combinations of protein features, training datasets, training strategies, and computational machine learning algorithms. In some cases, these tools may yield inconsistent and conflicting prediction results. It is important to consider such conflicting or contradictory predictions from multiple prediction programs during... BioMed Research International 05:05 Mining TCGA Database for Tumor Microenvironment-Related Genes of Prognostic Value in Hepatocellular Carcinoma Hepatocellular carcinoma (HCC) is one of the most common and lethal malignancies. Recent studies reveal that tumor microenvironment (TME) components significantly affect HCC growth and progression, particularly the infiltrating stromal and immune cells. Thus, mining of TME-related biomarkers is crucial to improve the survival of patients with HCC. Public access of The Cancer Genome Atlas (TCGA) database allows convenient performance of gene expression-based analysis of big data, which contributes... BioMed Research International 05:05 Musculoskeletal Factors and Geriatric Syndromes Related to the Absence of Musculoskeletal Degenerative Disease in Elderly People Aged over 70 Years Purpose. To investigate factors with a significant relationship with the absence of musculoskeletal disease (MSD: osteoporosis, knee osteoarthritis (K-OA), and lumbar spondylosis (L-OA)) in elderly people ≥70 years old. Methods. The subjects were 279 people (134 males, 145 females, mean age: 75.2 years) who attended an annual health checkup and were prospectively included in the study. Osteoporosis was defined as %YAM ≤70%, K-OA as Kellgren–Lawrence grade ≥2, and L-OA as osteophytes of Nathan class... BioMed Research International Mon Nov 18, 2019 15:30 Mitochondrial D-loop Sequence Variability in Three Native Insular Griffon Vulture (Gyps fulvus) Populations from the Mediterranean Basin The islands of Sardinia, Crete, and Cyprus are hosting the last native insular griffon populations in the Mediterranean basin. Their states have been evaluated from "vulnerable" to "critically endangered". The sequence analysis of molecular markers, particularly the mtDNA D-loop region, provides useful information in studying the evolution of closely related taxa and the conservation of endangered species. Therefore, a study of D-loop region sequence was carried out to estimate the genetic diversity... BioMed Research International Mon Nov 18, 2019 10:05 Gut Microbiome of Chinese Forest Musk Deer Examined across Gender and Age Animal gut microbiota begins to colonize after birth and is functionally indispensable for maintaining the health of the host. It has been reported that gender and age influence the composition of the intestinal microbiome. However, the effects of gender and age on the intestinal microorganism of forest musk deer (FMD) remain unclear. The aim of this study was to establish the relationship between the structure and composition of fecal microbiota of male and female forest musk deer with age. Here,... BioMed Research International Mon Nov 18, 2019 10:05 Mark above section as read  Journal of Adolescent and Young Adult Oncology "It Made Me the Person I Am Today…": Survivors of Childhood, Adolescent, and Young Adult Cancer Reflect on Their Experiences Journal of Adolescent and Young Adult Oncology, Ahead of Print. Journal of Adolescent and Young Adult Oncology Mon Nov 18, 2019 10:00 Mark above section as read  liebertpub1 The Long-Term Outcome of Treatment for Graves' Hyperthyroidism Thyroid, Volume 29, Issue 11, Page 1545-1557, November 2019. liebertpub1 Thu Nov 14, 2019 10:00 Future Meetings Thyroid, Volume 29, Issue 11, Page 1708-1709, November 2019. liebertpub1 Thu Nov 14, 2019 10:00 Mitogen-Activated Protein Kinase Pathway Inhibition for Redifferentiation of Radioiodine Refractory Differentiated Thyroid Cancer: An Evolving Protocol Thyroid, Volume 29, Issue 11, Page 1634-1645, November 2019. liebertpub1 Thu Nov 14, 2019 10:00 A Phase 2 Study of Pembrolizumab Combined with Chemoradiotherapy as Initial Treatment for Anaplastic Thyroid Cancer Thyroid, Volume 29, Issue 11, Page 1615-1622, November 2019. liebertpub1 Thu Nov 14, 2019 10:00 A Novel ALK Fusion in Pediatric Medullary Thyroid Carcinoma Thyroid, Volume 29, Issue 11, Page 1704-1707, November 2019. liebertpub1 Thu Nov 14, 2019 10:00 Mark above section as read  Chemical Senses Metal-containing Particulate Matter and Associated Reduced Olfactory Identification Ability in Children from an Area of High Atmospheric Exposure in Mexico City AbstractAir pollution has been linked to poor olfactory function in human adults. Among pollutants, particulate matter (PM) is especially relevant, as it may contain toxic metal ions that can reach the brain via olfactory pathways. Our purpose was to investigate the relation between atmospheric PM and olfactory identification performance in children. Using a validated method, we tested the olfactory identification performance of 120 children, 6–12 years old, from two locations in Mexico City; a focal... Chemical Senses 02:00 Mark above section as read  RNA In Advance Alternative Splicing Coupled with Transcript Degradation Modulates OAS1g Antiviral Activity [Report] At the heart of an innate immune response lies a tightly regulated gene expression program. This precise regulation is crucial because small changes can shift the balance from protective to destructive immunity. Here we identify a frequently used alternative splice site in the gene oligoadenylate synthetase 1g (Oas1g), a key component of the 2-5A antiviral system. Usage of this splice site leads to the generation of a transcript subject to decay, and removal of the site leads to increased expression... RNA In Advance Mon Nov 18, 2019 23:24 Mark above section as read  Clinical Cancer Research Online First Articles Capecitabine and temozolomide versus FOLFIRI in RAS mutated, MGMT methylated metastatic colorectal cancer Purpose To determine whether second-line therapy with capecitabine and temozolomide was superior to irinotecan, leucovorin and fluorouracil (FOLFIRI) in patients with RAS mutated, MGMT methylated metastatic colorectal cancer. Experimental design In this randomized, phase 2 trial, we enrolled patients with RAS mutated, MGMT methylated mCRC after failure of oxaliplatin-based regimen. Patients with centrally confirmed MGMT methylation were stratified by first-line progression-free survival and prior... Clinical Cancer Research Online First Articles Mon Nov 18, 2019 16:38 Mark above section as read  Cancer TRIP13 promotes the cell proliferation, migration and invasion of glioblastoma through the FBXW7/c-MYC axis British Journal of Cancer, Published online: 19 November 2019; doi:10.1038/s41416-019-0633-0TRIP13 promotes the cell proliferation, migration and invasion of glioblastoma through the FBXW7/c-MYC axis Cancer 02:00 TRIP13 promotes the cell proliferation, migration and invasion of glioblastoma through the FBXW7/c-MYC axis Cancer 01:08 Mark above section as read  Oncogenesis - nature.com science feeds Long non-coding RNA GAS5 acts as proliferation "brakes" in CD133+ cells responsible for tumor recurrence Oncogenesis, Published online: 18 November 2019; doi:10.1038/s41389-019-0177-4Long non-coding RNA GAS5 acts as proliferation "brakes" in CD133+ cells responsible for tumor recurrence Oncogenesis - nature.com science feeds Mon Nov 18, 2019 02:00 Long non-coding RNA GAS5 acts as proliferation "brakes" in CD133+ cells responsible for tumor recurrence Oncogenesis - nature.com science feeds Mon Nov 18, 2019 02:00 Mark above section as read  Journal of the American Chemical Society: Latest Articles (ACS Publications) [ASAP] Time-Dependent Pulses of Lithium Ions in Cascaded Signaling and Out-of-Equilibrium (Supra)molecular Logic Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b10763 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 [ASAP] Selective Separation of Polyaromatic Hydrocarbons by Phase Transfer of Coordination Cages Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b10741 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 [ASAP] Olefin Metathesis in Confined Geometries: A Biomimetic Approach toward Selective Macrocyclization Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b08776 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 [ASAP] The Effect of Ring Expansion in Thienobenzo[<italic toggle="yes">b</italic>]indacenodithiophene Polymers for Organic Field-Effect Transistors Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b09367 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 [ASAP] The Bioorthogonal Isonitrile–Chlorooxime Ligation Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b07632 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 [ASAP] Excision of 5-Carboxylcytosine by Thymine DNA Glycosylase Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b10376 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 [ASAP] Enantioselective Olefin Hydrocyanation without Cyanide Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b10875 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 [ASAP] Synthesis, Characterization, and Electrochemical Applications of Chiral Imprinted Mesoporous Ni Surfaces Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b10507 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 [ASAP] Highly Selective and Catalytic Generation of Acyclic Quaternary Carbon Stereocenters via Functionalization of 1,3-Dienes with CO<sub>2</sub> Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b09721 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 [ASAP] Inorganic Phototropism in Electrodeposition of Se–Te Journal of the American Chemical SocietyDOI: 10.1021/jacs.9b10579 Journal of the American Chemical Society: Latest Articles (ACS Publications) Mon Nov 18, 2019 07:00 Mark above section as read  Experimental and Clinical Endocrinology & Diabetes Molecular Mechanisms of Thyroid Hormone Transport by l-Type Amino Acid Transporter Exp Clin Endocrinol DiabetesDOI: 10.1055/a-1032-8369Thyroid hormones (TH) pass through the plasma membrane into the target cells via transporter proteins. Thyroid hormone transporters that have been identified until now belong to two different solute carrier (SLC) subfamilies i) the major facilitator superfamily (MFS) and ii) the amino acid polyamine-organocation (APC) superfamily. Both are comprised by 12 transmembrane helices, however with different structural topology. The TH transporter MCT8,... Experimental and Clinical Endocrinology & Diabetes Mon Nov 18, 2019 01:00 Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview Exp Clin Endocrinol DiabetesDOI: 10.1055/a-1038-3883Chronic obstructive pulmonary disease (COPD) is a common disease with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Apart from cigarette smoking, certain occupational and environmental exposures, low socioeconomic status and genetic factors may contribute to the pathogenesis of COPD. Comorbidities, e. g. diabetes mellitus (DM), can negatively affect quality of life, COPD outcomes and cardiovascular... Experimental and Clinical Endocrinology & Diabetes Mon Nov 18, 2019 01:00 Mark above section as read  Analytical Chemistry [ASAP] Sheathless Acoustic Fluorescence Activated Cell Sorting (aFACS) with High Cell Viability Analytical ChemistryDOI: 10.1021/acs.analchem.9b03021 Analytical Chemistry Mon Nov 18, 2019 07:00 [ASAP] Polyaniline Films as Electrochemical-Proton Pump for Acidification of Thin Layer Samples Analytical ChemistryDOI: 10.1021/acs.analchem.9b03402 Analytical Chemistry Mon Nov 18, 2019 07:00 [ASAP] Electrokinetically Driven Exosome Separation and Concentration Using Dielectrophoretic-Enhanced PDMS-Based Microfluidics Analytical ChemistryDOI: 10.1021/acs.analchem.9b03448 Analytical Chemistry Mon Nov 18, 2019 07:00 [ASAP] N-Doped Carbon As Peroxidase-Like Nanozymes for Total Antioxidant Capacity Assay Analytical ChemistryDOI: 10.1021/acs.analchem.9b04333 Analytical Chemistry Mon Nov 18, 2019 07:00 [ASAP] Faraday-Cage-Type Electrochemiluminescence Immunoassay: A Rise of Advanced Biosensing Strategy Analytical ChemistryDOI: 10.1021/acs.analchem.9b04503 Analytical Chemistry Mon Nov 18, 2019 07:00 [ASAP] Numerical Elucidation of Flow and Dispersion in Ordered Packed Beds: Nonspherical Polygons and the Effect of Particle Overlap on Chromatographic Performance Analytical ChemistryDOI: 10.1021/acs.analchem.9b03598 Analytical Chemistry Mon Nov 18, 2019 07:00 [ASAP] Highly Sensitive Colorimetric Detection of a Variety of Analytes via the Tyndall Effect Analytical ChemistryDOI: 10.1021/acs.analchem.9b03824 Analytical Chemistry Mon Nov 18, 2019 07:00 [ASAP] Fiber-Optic Chemical Sensors and Biosensors (2015–2019) Analytical ChemistryDOI: 10.1021/acs.analchem.9b04708 Analytical Chemistry Mon Nov 18, 2019 07:00 [ASAP] Target-Induced Cascade Amplification for Homogeneous Virus Detection Analytical ChemistryDOI: 10.1021/acs.analchem.9b03805 Analytical Chemistry Mon Nov 18, 2019 07:00 Mark above section as read  Sprache · Stimme · Gehör Logopädische Behandlung unilateraler Stimmlippenparalysen Sprache Stimme GehörDOI: 10.1055/a-0949-7863© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Full text Sprache · Stimme · Gehör Mon Nov 18, 2019 01:00 Mark above section as read  Laryngo-Rhino-Otologie Liebe Leserinnen und Leser der LRO, liebe Kolleginnen und Kollegen, Laryngo-Rhino-Otol 2019; 98: 755-755DOI: 10.1055/a-0954-7752© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Full text Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Freie Transplantate Laryngo-Rhino-Otol 2019; 98: 826-829DOI: 10.1055/a-0954-7877© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Full text Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Tonsillektomie bei Erwachsenen medizinisch und ökonomisch sinnvoll Laryngo-Rhino-Otol 2019; 98: 760-761DOI: 10.1055/a-0898-8562Tzelnick S et al. Long-Term Outcomes of Tonsillectomy for Recurrent Tonsillitis in Adults. Laryngoscope 2019; 9999: 1–4. doi:10.1002/lary.27928 Ein Cochrane Review von 2014 beantwortete die Frage nach der Effektivität von Tonsillektomien bei Erwachsenen nicht abschließend, sprach aber für einen positiven Einfluss auf die Lebensqualität. Die retrospektive Studie aus Israel belegt nun eine deutliche Reduktion der Tonsillitis-Episoden... Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Sialolithiasis: aktuelle Diagnostik und Therapie Laryngo-Rhino-Otol 2019; 98: 815-823DOI: 10.1055/a-0896-9572Die Sialolithiasis als eine der häufigsten Speicheldrüsenerkrankungen betrifft die Glandula submandibularis im Vergleich zur Glandula parotis deutlich häufiger. Im Verlauf der Erkrankung kommt es in vielen Fällen zu rezidivierenden Sialadenitiden. Durch verbesserte Diagnostik besteht neben der Submandibulektomie auch die Möglichkeit einer drüsenerhaltenden Therapie, z. B. mittels Miniaturendoskopie (Sialendoskopie).[...]© Georg Thieme Verlag... Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Tinnitus oftmals mit temporomandibulärer Dysfunktion assoziiert Laryngo-Rhino-Otol 2019; 98: 761-761DOI: 10.1055/a-0996-6580Omidvar S et al. Association Between Tinnitus and Temporomandibular Disorders: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2019; 128: 662–675 Tinnitus ist eines der häufigsten otologischen Symptome bei Patienten mit Kiefergelenkserkrankungen. Iranische Ärzte durchsuchten die Literatur, um den möglichen Zusammenhang zwischen Tinnitus und der temporomandibulären Dysfunktion (TMD) darzustellen. ... Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Rheumatologische Erkrankungen und Schlaf – Schlafmedizinische Aspekte der Diagnostik und Therapie – Eine literaturbasierte Übersicht Laryngo-Rhino-Otol 2019; 98: 776-788DOI: 10.1055/a-0960-6616Ziel des auf einer PubMed-Recherche basierenden Übersichtsartikels ist es, die Schlafphysiologie und die pathophysiologischen Zusammenhänge von rheumatologischen Erkrankungen und primären sowie sekundären Schlafstörungen darzustellen. Dabei werden die somnologische Diagnostik und Therapie als ergänzende Verfahren in die rheumatologische Behandlungsstrategie eingebunden. Epidemiologie 70 % aller Rheumapatienten berichten über einen... Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Partielle Rekurrensparese – Parese des Ramus anterior Nervi laryngei inferioris (recurrentis) Laryngo-Rhino-Otol 2019; 98: 762-763DOI: 10.1055/a-0954-7785© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Full text Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Aus der Gutachtenpraxis: Isolierter Tinnitus bei einem Callcenter-Agenten – ein Arbeitsunfall? Laryngo-Rhino-Otol 2019; 98: 812-814DOI: 10.1055/a-0954-7807© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Full text Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Eosinophile Ösophagitis Update 2017: Neue Leitlinien der europäischen Studiengruppe EUREOS Laryngo-Rhino-Otol 2019; 98: 764-775DOI: 10.1055/a-0960-6553Die eosinophile Ösophagitis gilt heute als eine der häufigsten Erkrankungen der Speiseröhre und eine der häufigsten Ursachen für Dysphagie und Bolusobstruktion bei Kindern und Erwachsenen. Die zunehmende Bedeutung dieser Erkrankung und neue klinisch-wissenschaftliche Erkenntnisse erforderten eine Aktualisierung der bis dato existierenden internationalen Leitlinien. Die europäische Studiengruppe Eosinophile Ösophagitis (EUREOS) hat daher,... Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Fragen für die Facharztprüfung Laryngo-Rhino-Otol 2019; 98: 824-825DOI: 10.1055/a-0954-7819© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Full text Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Dakryolithen und iatrogene Fremdkörper als klassische Auslöser entzündlicher Pseudotumoren der ableitenden Tränenwege Laryngo-Rhino-Otol 2019; 98: 806-811DOI: 10.1055/a-0841-9713© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents  |  Full text Laryngo-Rhino-Otologie Mon Nov 18, 2019 01:00 Mark above section as read  G3: .Genes, Genomes, Genetics Mission - Online First Articles Transcription Profiles of Age-at-Maturity-Associated Genes Suggest Cell Fate Commitment Regulation as a Key Factor in the Atlantic Salmon Maturation Process Despite recent taxonomic diversification in studies linking genotype with phenotype, follow-up studies aimed at understanding the molecular processes of such genotype-phenotype associations remain rare. The age at which an individual reaches sexual maturity is an important fitness trait in many wild species. However, the molecular mechanisms regulating maturation timing processes remain obscure. A recent genome-wide association study in Atlantic salmon (Salmo salar) identified large-effect age-at-maturity-associated... G3: .Genes, Genomes, Genetics Mission - Online First Articles 00:34 Evolutionary Dynamics of the SKN-1 -> MED -> END-1,3 Regulatory Gene Cascade in Caenorhabditis Endoderm Specification Gene regulatory networks and their evolution are important in the study of animal development. In the nematode, Caenorhabditis elegans, the endoderm (gut) is generated from a single embryonic precursor, E. Gut is specified by the maternal factor SKN-1, which activates the MED -> END-1,3 -> ELT-2,7 cascade of GATA transcription factors. In this work, genome sequences from over two dozen species within the Caenorhabditis genus are used to identify MED and END-1,3 orthologues. Predictions are... G3: .Genes, Genomes, Genetics Mission - Online First Articles 00:34 Mark above section as read  European Journal of Nuclear Medicine and Molecular Imaging An aggressive functioning pituitary adenoma treated with peptide receptor radionuclide therapy European Journal of Nuclear Medicine and Molecular Imaging Mon Nov 18, 2019 02:00 The number of microspheres in Y90 radioembolization directly affects normal tissue radiation exposure Abstract Purpose In Y90 radioembolization, the number of microspheres infused varies by more than a factor of 20 over the shelf-life of the glass radioembolization device. We investigated the effect of the number of Y90 microspheres on normal liver tissue. Method Healthy pigs received lobar radioembolization with glass Y90 microspheres at 4, 8, 12, and 16... European Journal of Nuclear Medicine and Molecular Imaging Mon Nov 18, 2019 02:00 From metabolic connectivity to molecular connectivity: application to dopaminergic pathways Abstract Introduction This study aims to reveal the feasibility and potential of molecular connectivity based on neurotransmission in comparison with the metabolic connectivity with an application to dopaminergic pathways. For this purpose, we propose to compare the neurotransmission connectivity findings using 123I-FP-CIT SPECT and 18F-FDOPA PET with the metabolic connectivity findings using 18F-FDG PET. ... European Journal of Nuclear Medicine and Molecular Imaging Mon Nov 18, 2019 02:00 Zirconium-89 labelled rituximab PET-CT imaging of Graves' orbitopathy European Journal of Nuclear Medicine and Molecular Imaging Mon Nov 18, 2019 02:00 Letter to the Editor: 18 F-NaF not cited in the EANM practice guideline for PET/CT imaging in medullary thyroid carcinoma European Journal of Nuclear Medicine and Molecular Imaging Mon Nov 18, 2019 02:00 Mark above section as read  Annals of Allergy, Asthma & Immunology Skin Testing with Ultraheat Treated (UHT) Cow's Milk in Children with Cow's Milk Allergy. Cow's milk allergy is very common affecting between 2% and 3%, and in some reports up to 7%, of young infants and children1. It has been found that approximately 75% of cow's milk allergic children are able to tolerate heated cow's milk, such as in baked goods, while remaining reactive to unheated milk2-4. In addition, regular consumption of heated cow's milk may hasten the development of tolerance to unheated cow's milk in a proportion of cow's milk allergic children5. Annals of Allergy, Asthma & Immunology Mon Nov 18, 2019 02:00 Decades of Poor Availability of Epinephrine Auto-Injectors – Global Problems in Need of Global Solutions Guidelines recommend prompt use of intramuscular epinephrine as first-line treatment for anaphylaxis 1-5. Patients at-risk of anaphylaxis are generally couselled by medical professionals to carry epinephrine in the form of an epinephrine auto-injector (EAI) to treat a severe allergic reaction. Despite its critical role as a life-saving medication, availability of EAIs differs around the world. Shortages of EAIs have compounded this problem. Annals of Allergy, Asthma & Immunology Mon Nov 18, 2019 02:00 Mark above section as read  Oral Diseases MicroRNA‐21 Promotes Orthodontic Tooth Movement by Modulating the RANKL/OPG Balance in T Cells Abstract Objectives The present study was designed to investigate the effects of microRNA‐21 (miR‐21) on orthodontic tooth movement. Methods The orthodontic tooth movement model was established in C57BL/6 and miR‐21‐/‐ mice with or without implantation of activated T cells. Histological and histomorphometrical analyses were performed by hematoxylin‐eosin staining. Tartrate‐resistant acid phosphate staining was used to analyze the osteoclast numbers during tooth movement. Enzyme‐linked immunosorbent... Oral Diseases Mon Nov 18, 2019 16:06 Inhibitory effect of serotype a of Aggregatibacter actinomycetemcomitans on the increased destructive potential of serotype b Abstract Objective The serotype b of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) induces higher cytokine production in dendritic cells (DCs) compared with the other serotypes. However, this increased immuno‐stimulatory potential was modified when DCs were co‐infected with the other A. actinomycetemcomitans serotypes. This study aimed to analyze whether the production of interferon‐gamma (IFN‐γ), C‐reactive protein (CRP), matrix metalloproteinase (MMP)‐2, and MMP‐9, as well... Oral Diseases Mon Nov 18, 2019 15:36 Mark above section as read  RNA current issue Identification of human genetic variants controlling circular RNA expression [ARTICLE] Circular RNAs (circRNAs) are abundant in eukaryotic transcriptomes and have been linked to various human disorders. However, understanding genetic control of circular RNA expression is in the early stages. Here we present the first integrated analysis of circRNAs and genome sequence variation from lymphoblastoid cell lines of the 1000 Genomes Project. We identified thousands of circRNAs in the RNA-seq data and show their association with local single-nucleotide polymorphic sites, referred to as circQTLs,... RNA current issue Mon Nov 18, 2019 16:30 Broad regulation of gene isoform expression by Wnt signaling in cancer [ARTICLE] Differential gene isoform expression is a ubiquitous mechanism to enhance proteome diversity and maintain cell homeostasis. Mechanisms such as splicing that drive gene isoform variability are highly dynamic and responsive to changes in cell signaling pathways. Wnt/β-catenin signaling has profound effects on cell activity and cell fate and is known to modify several splicing events by altering the expression of individual splicing factors. However, a global assessment of how extensively Wnt signaling... RNA current issue Mon Nov 18, 2019 16:30 On the emergence of structural complexity in RNA replicators [BIOINFORMATICS] The RNA world hypothesis relies on the ability of ribonucleic acids to spontaneously acquire complex structures capable of supporting essential biological functions. Multiple sophisticated evolutionary models have been proposed for their emergence, but they often assume specific conditions. In this work, we explore a simple and parsimonious scenario describing the emergence of complex molecular structures at the early stages of life. We show that at specific GC content regimes, an undirected replication... RNA current issue Mon Nov 18, 2019 16:30 RNA: Reviewers for Volume 25, 2019 [REVIEWER INDEX] RNA current issue Mon Nov 18, 2019 16:30 Genetic robustness of let-7 miRNA sequence-structure pairs [BIOINFORMATICS] Genetic robustness, the preservation of evolved phenotypes against genotypic mutations, is one of the central concepts in evolution. In recent years a large body of work has focused on the origins, mechanisms, and consequences of robustness in a wide range of biological systems. In particular, research on ncRNAs studied the ability of sequences to maintain folded structures against single-point mutations. In these studies, the structure is merely a reference. However, recent work revealed evidence... RNA current issue Mon Nov 18, 2019 16:30 HNRNPH1-dependent splicing of a fusion oncogene reveals a targetable RNA G-quadruplex interaction [ARTICLE] The primary oncogenic event in ~85% of Ewing sarcomas is a chromosomal translocation that generates a fusion oncogene encoding an aberrant transcription factor. The exact genomic breakpoints within the translocated genes, EWSR1 and FLI1, vary; however, in EWSR1, breakpoints typically occur within introns 7 or 8. We previously found that in Ewing sarcoma cells harboring EWSR1 intron 8 breakpoints, the RNA-binding protein HNRNPH1 facilitates a splicing event that excludes EWSR1 exon 8 from the EWS–FLI1... RNA current issue Mon Nov 18, 2019 16:30 CRIP: predicting circRNA-RBP-binding sites using a codon-based encoding and hybrid deep neural networks [BIOINFORMATICS] Circular RNAs (circRNAs), with their crucial roles in gene regulation and disease development, have become rising stars in the RNA world. To understand the regulatory function of circRNAs, many studies focus on the interactions between circRNAs and RNA-binding proteins (RBPs). Recently, the abundant CLIP-seq experimental data has enabled the large-scale identification and analysis of circRNA–RBP interactions, whereas, as far as we know, no computational tool based on machine learning has been proposed... RNA current issue Mon Nov 18, 2019 16:30 Exon size and sequence conservation improves identification of splice-altering nucleotides [ARTICLE] Pre-mRNA splicing is regulated through multiple trans-acting splicing factors. These regulators interact with the pre-mRNA at intronic and exonic positions. Given that most exons are protein coding, the evolution of exons must be modulated by a combination of selective coding and splicing pressures. It has previously been demonstrated that selective splicing pressures are more easily deconvoluted when phylogenetic comparisons are made for exons of identical size, suggesting that exon size–filtered... RNA current issue Mon Nov 18, 2019 16:30 Evidence that the nadA motif is a bacterial riboswitch for the ubiquitous enzyme cofactor NAD+ [REPORT] The nadA motif is a riboswitch candidate present in various Acidobacteria species that was previously identified by bioinformatic analysis of bacterial DNA data sets. More than 100 unique representatives have been identified exclusively upstream of nadA genes, which code for an enzyme in the biosynthetic pathway of the ubiquitous coenzyme NAD+. The architecture of nadA motif RNAs suggests they use structurally similar tandem ligand-binding aptamer domains to control translation initiation. Biochemical... RNA current issue Mon Nov 18, 2019 16:30 Jonathan R. Warner (1936-2019)--pioneer of ribosome biosynthesis [OBITUARY] RNA current issue Mon Nov 18, 2019 16:30 A structure-based model for the prediction of protein-RNA binding affinity [ARTICLE] Protein–RNA recognition is highly affinity-driven and regulates a wide array of cellular functions. In this study, we have curated a binding affinity data set of 40 protein–RNA complexes, for which at least one unbound partner is available in the docking benchmark. The data set covers a wide affinity range of eight orders of magnitude as well as four different structural classes. On average, we find the complexes with single-stranded RNA have the highest affinity, whereas the complexes with the duplex... RNA current issue Mon Nov 18, 2019 16:30 Circular code motifs in the ribosome: a missing link in the evolution of translation? [ARTICLE] The origin of the genetic code remains enigmatic five decades after it was elucidated, although there is growing evidence that the code coevolved progressively with the ribosome. A number of primordial codes were proposed as ancestors of the modern genetic code, including comma-free codes such as the RRY, RNY, or GNC codes (R = G or A, Y = C or T, N = any nucleotide), and the X circular code, an error-correcting code that also allows identification and maintenance of the reading frame. It was demonstrated... RNA current issue Mon Nov 18, 2019 16:30 Interplay between substrate recognition, 5' end tRNA processing and methylation activity of human mitochondrial RNase P [ARTICLE] Human mitochondrial ribonuclease P (mtRNase P) is an essential three-protein complex that catalyzes the 5' end maturation of mitochondrial precursor tRNAs (pre-tRNAs). Mitochondrial RNase P Protein 3 (MRPP3), a protein-only RNase P (PRORP), is the nuclease component of the mtRNase P complex and requires a two-protein S-adenosyl-methionine (SAM)-dependent methyltransferase MRPP1/2 subcomplex to function. Dysfunction of mtRNase P is linked to several human mitochondrial diseases, such as mitochondrial... RNA current issue Mon Nov 18, 2019 16:30 Coding regions affect mRNA stability in human cells [ARTICLE] A new paradigm has emerged that coding regions can regulate mRNA stability in model organisms. Here, due to differences in cognate tRNA abundance, synonymous codons are translated at different speeds, and slow codons then stimulate mRNA decay. To ask if this phenomenon also occurs in humans, we isolated RNA stability effects due to coding regions using the human ORFeome collection. We find that many open reading frame (ORF) characteristics, such as length and secondary structure, fail to provide... RNA current issue Mon Nov 18, 2019 16:30 Local translation of yeast ERG4 mRNA at the endoplasmic reticulum requires the brefeldin A resistance protein Bfr1 [ARTICLE] Brefeldin A resistance factor 1 (Bfr1p) is a nonessential RNA-binding protein and multicopy suppressor of brefeldin A sensitivity in Saccharomyces cerevisiae. Deletion of BFR1 leads to multiple defects, including altered cell shape and size, change in ploidy, induction of P-bodies and chromosomal missegregation. Bfr1p has been shown to associate with polysomes, binds to several hundred mRNAs, and can target some of them to P-bodies. Although this implies a role of Bfr1p in translational control of... RNA current issue Mon Nov 18, 2019 16:30 Thermodynamic examination of pH and magnesium effect on U6 RNA internal loop [ARTICLE] U6 RNA contains a 1 x 2-nt internal loop that folds and unfold during spliceosomal assembly and activation. The 1 x 2 loop consists of a C67•A79 base pair that forms an additional hydrogen bond upon protonation, C67•A+79, and uracil (U80) that coordinates the catalytically essential magnesium ions. We designed a series of RNA and DNA constructs with a 1 x 2 loop sequence contained in the ISL, and its modifications, to measure the thermodynamic effects of protonation and magnesium binding using UV-visible... RNA current issue Mon Nov 18, 2019 16:30 Biophysical characterizations of the recognition of the AAUAAA polyadenylation signal [ARTICLE] Most eukaryotic messenger RNA precursors must undergo 3'-end cleavage and polyadenylation for maturation. We and others recently reported the structure of the AAUAAA polyadenylation signal (PAS) in complex with the protein factors CPSF-30, WDR33, and CPSF-160, revealing the molecular mechanism for this recognition. Here we have characterized in detail the interactions between the PAS RNA and the protein factors using fluorescence polarization experiments. Our studies show that AAUAAA is recognized... RNA current issue Mon Nov 18, 2019 16:30 RNA detection with high specificity and sensitivity using nested fluorogenic Mango NASBA [METHOD] There is a pressing need for nucleic acid–based assays that are capable of rapidly and reliably detecting pathogenic organisms. Many of the techniques available for the detection of pathogenic RNA possess one or more limiting factors that make the detection of low-copy RNA challenging. Although RT-PCR is the most commonly used method for detecting pathogen-related RNA, it requires expensive thermocycling equipment and is comparatively slow. Isothermal methods promise procedural simplicity but have... RNA current issue Mon Nov 18, 2019 16:30 The long noncoding RNA NEAT1_1 is seemingly dispensable for normal tissue homeostasis and cancer cell growth [ARTICLE] NEAT1 is one of the most studied lncRNAs, in part because its silencing in mice causes defects in mammary gland development and corpus luteum formation and protects them from skin cancer development. Moreover, depleting NEAT1 in established cancer cell lines reduces growth and sensitizes cells to DNA damaging agents. However, NEAT1 produces two isoforms and because the short isoform, NEAT1_1, completely overlaps the 5' part of the long NEAT1_2 isoform; the respective contributions of each of the... RNA current issue Mon Nov 18, 2019 16:30 RNA: Author Index for Volume 25, 2019 [AUTHOR INDEX] RNA current issue Mon Nov 18, 2019 16:30 Mark above section as read
NIR spectroscopic determination of urine components in spot urine: preliminary investigation towards optical point-of-care testAbstract Presently, there is no convenient method to measure 24-h urinary Na excretion, which is an important index of daily Na intake, and 24-h urine collection involves a complex process. However, the Na-to-creatinine ratio (NCR) in spot urine has the potential to evaluate 24-h Na excretion and is useful for point-of-care testing. Thus, this study aimed to realize a near-infrared...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Liver alterations in anorexia nervosa are not caused by insulin resistance AbstractBackground Liver dysfunction has been widely reported in connection with anorexia nervosa (AN) but the pathogenesis of these alterations has never been fully understood despite reported theories about the presence of insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). The aim of this study is to investigate if hypertransaminasemia in AN is linked to IR and NAFLD.Methods Anthropometric data and laboratory exams of 34 patients and 34 controls were analyzed, including alanine-aminotransferase, aspartate-aminotransferase and homeostatic model assessment of insulin resistance (HOMA-IR) index. All subjects also underwent magnetic resonance imaging (MRI), ultrasonography (US), and transient elastography (TE).Results Evidence of increased alanine aminotransferase in AN patients was confirmed in our sample together with a lower HOMA-IR index compared to controls. Positive results in US appeared in 16 patients vs none in controls (p = 0.0007); patients with liver parenchyma abnormalities in US were not different than normal-US patients in any of the studied variables. Only one patient showed non-alcoholic fatty liver disease in MRI while abnormal TE was found in four patients and never in controls.Conclusions Liver damage suggested by increased serum liver enzymes cannot be due to liver steatosis but potentially to a different liver disease (not identified by MRI) or to an early liver fibrosis not associated with an insulin-resistant status. Association between long boarding time in the emergency department and hospital mortality: a single-center propensity score-based analysis Abstract Once diagnostic work-up and first therapy are completed in patients visiting the emergency department (ED), boarding them within the ED until an in-hospital bed became available is a common practice in busy hospitals. Whether this practice may harm the patients remains a debate. We sought to determine whether an ED boarding time longer than 4 h places the patients at increased risk of in-hospital death. This retrospective, propensity score-matched analysis and propensity score-based inverse probability weighting analysis was conducted in an adult ED in a single, academic, 1136-bed hospital in France. All patients hospitalized via the adult ED from January 1, 2013 to March 31, 2018 were included. Hospital mortality (primary outcome) and hospital length of stay (LOS) were assessed in (1) a matched cohort (1:1 matching of ED visits with or without ED boarding time longer than 4 h but similar propensity score to experience an ED boarding time longer than 4 h); and (2) the whole study cohort. Sensitivity analysis to unmeasured confounding and analyses in pre-specified cohorts of patients were conducted. Among 68,632 included ED visits, 17,271 (25.2%) had an ED boarding time longer than 4 h. Conditional logistic regression performed on a 10,581 pair-matched cohort, and generalized estimating equations with adjustment on confounders and stabilized propensity score-based inverse probability weighting applied on the whole cohort showed a significantly increased risk of hospital death in patients experiencing an ED boarding time longer than 4 h: odds ratio (OR) of 1.13 (95% confidence interval [95% CI] 1.05–1.22), P = 0.001; and OR of 1.12 (95% CI 1.03–1.22), P = 0.007, respectively. Sensitivity analyses showed that these findings might be robust to unmeasured confounding. Hospital LOS was significantly longer in patients exposed to ED boarding time longer than 4 h: median difference 2 days (95% CI 1–2) (P < 0.001) in matched analysis and mean difference 1.15 days (95% CI 1.02–1.28) (P < 0.001) in multivariable unmatched analysis. In this single-center propensity score-based cohort analysis, patients experiencing an ED boarding time longer than 4 h before being transferred to an in-patient bed were at increased risk of hospital death. Risk stratification of patients with chest pain or anginal equivalents in the emergency department Abstract We studied whether previously developed cardiac risk scores—including history, ECG, age, risk factors, and troponin (HEART); Thrombolysis in Myocardial Infarction (TIMI); Global Registry of Acute Coronary Events (GRACE); and Emergency Department Assessment of Chest Pain (EDACS)—could be applied to predict major adverse cardiac events (MACE) in patients with possible coronary artery disease, including anginal equivalents. Patients with chest pain or anginal equivalents who underwent coronary computed tomographic angiography were included. The primary outcome was 30-day MACE. We compared the cardiac risk scores by the area under the receiver-operating characteristic curves (AUC). The primary outcome occurred in 200 patients (16.0%) of the 1247 patients included. For the prediction of MACE, the AUC of the HEART score (0.765) was superior to those of the TIMI (0.726), GRACE (0.612), and EDACS (0.631) scores. Among patients identified by each score as being at low risk, the MACE rate was the lowest for the HEART score (5.7%), followed by the TIMI (8.8%), EDACS (11.2%), and GRACE (12.2%) scores. At a sensitivity level of a < 2% rate of misses, the negative predictive value of the HEART score (1.0) outperformed those of the GRACE (0.932) and EDACS (0.964). The HEART score appeared to be more predictive of MACEs than the TIMI, GRACE, and EDACS in patients with chest pain or anginal equivalents. However, previously suggested cutoff could not safely identify low-risk patients for early discharge because of the unacceptably high rate of missed MACEs. A double-edged sword: e-cigarettes, and other electronic nicotine delivery systems (ENDS): reply Is delayed cardioversion the better approach in recent-onset atrial fibrillation? No Abstract Symptomatic atrial fibrillation (AF) is a common cause of emergency department (ED) referrals. In case of hemodynamic stability, the choice to either perform early cardioversion (pharmacologic or electrical) or to prescribe rate-lowering drugs and differ any attempts to restore sinus rhythm (i.e., wait-and-see approach) has been widely debated. Results of the recent Rate Control versus Electrical Cardioversion Trial 7-Acute Cardioversion versus Wait and See (RACE 7 ACWAS) have been considered a strong argument in favor of the wait-and-see approach. In this debate, we discuss several issues that would support early cardioversion, ranging from patients' satisfaction and costs to concerns about safety. Furthermore, the wait-and-see approach may translate into a missed opportunity to encourage widespread use of a "pill-in-the-pocket" home treatment: this underused option could allow rapid solving of many AF episodes, potentially avoiding future ED referrals. Our opinion is that a delayed cardioversion may introduce unneeded complications in the straightforward management of a common clinical problem. Therefore, early cardioversion should continue to be the preferred option because of its proven efficacy, safety and convenience. Correction to: Incidence of hyperkalemia in the emergency department: a 10-year retrospective study In the original publication of the article, the 3rd author name was swapped. The correct author name should read as Damien Masson. Treatment with ferric carboxymaltose in stable patients with severe iron deficiency anemia in the emergency department Abstract The AABB Choosing Wisely Campaign recommends "don't transfuse for iron deficiency without hemodynamic instability". However, the management of iron deficiency anemia (IDA) in the emergency department (ED) is heterogeneous and patients are often over-transfused. Intravenous iron is effective in correcting anemia and new formulations, including ferric carboxymaltose (FCM), allow the administration of high doses with low immunogenicity. The aim of this retrospective study was to analyze the management of hemodynamically stable patients aged 18–55 years with severe IDA (hemoglobin < 8 g/dL), who presented to the ED from January 2014 to July 2018. Patients who received FCM (FCM1) and those who did not receive FCM (FCM0) were compared. Efficacy and safety of FCM at follow-up were evaluated. Seventy-one subjects fulfilled the inclusion criteria (FCM0 n = 48; FCM1 n = 23). The mean Hb at admission was 6.6 g/dL. 40% in the FCM0 and 13% in FCM1 were transfused (p = 0.02). 21% of FCM0 patients were admitted to the ward, while all FCM1 were discharged (p = 0.02). Within 2 weeks, the Hb increase was 2.8 ± 1 g/dL in the FCM1 group. Sixteen FCM1 patients were evaluated at 52 ± 28 days (median 42, range 27–122): the average Hb increase was 5.3 ± 1.4 g/dL. In summary, we showed that FCM administration in the ED in hemodynamically stable patients was associated with fewer transfusions and hospital admissions compared to the FCM0 group; moreover, it succeeded in safely, effectively and rapidly increasing Hb levels after discharge from the ED. Further studies are needed to develop recommendations for IDA in the ED and to identify transfusion thresholds for non-hospitalized patients. A double-edged sword: E-cigarettes, and other electronic nicotine delivery systems (ENDS) Presence of air in the inferior vena cava: an uncommon radiologic presentation of emphysematous pyelonephritis Two different techniques of ultrasound-guided peripheral venous catheter placement versus the traditional approach in the pre-hospital emergency setting: a randomized study Abstract We performed a randomized pre-hospital clinical study to compare two different techniques of ultrasound-guided peripheral venous catheter (PVC) insertion and the conventional cannulation technique in the pre-hospital emergency setting, with a specific focus on the procedural success rate and the time required to introduce PVC. This pre-hospital prospective controlled randomized clinical trial allocated patients treated by emergency medical service to undergo PVC insertion fully controlled by ultrasound (ultrasound guidance of the PVC tip until it penetrates the lumen, group A), PVC insertion partially controlled by ultrasound (target vein identification only, group B) or to receive PVC without any ultrasound guidance (group C). The study outcomes were monitored until the patient was admitted to the hospital. A total of 300 adult patients were enrolled. The success of the first attempt (group A: 88%, group B: 94%, group C: 76%, p < 0.001) and overall success rate (A: 99%, B: 99%, C: 90%, p < 0.001) were significantly higher in the group A, followed by group B when compared to group C. The number of attempts was significantly lower (A: 1.18 ± 0.54, B: 1.05 ± 0.22, C: 1.22 ± 0.57, p < 0.001) and the time required for the procedure shorter (A: 75.3 ± 60.6, B: 43.5 ± 26.0, C: 82.3 ± 100.9 s, p < 0.001) in group B compared to groups A and C. Both techniques of ultrasound-guided PVC placement were associated with higher success rates than the conventional method. However, PVC insertion partially controlled by ultrasound was superior to full ultrasound guidance in terms of time and number of cannulation attempts required.
Liver alterations in anorexia nervosa are not caused by insulin resistanceAbstractBackgroundLiver dysfunction has been widely reported in connection with anorexia nervosa (AN) but the pathogenesis of these alterations has never been fully understood despite reported theories about the presence of insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). The aim of this study is to investigate if hypertransaminasemia in AN is linked to IR and NAFLD.MethodsAnthropometric data and laboratory...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
09:19
Real-Time Audiovisual Feedback Training Improves Cardiopulmonary Resuscitation Performance: A Controlled Study Objective The aim of the study was to quantitatively measure the effect of teaching cardiopulmonary resuscitation (CPR) using a real-time audiovisual feedback manikin system on first-year medical student's CPR performance. Methods This is a prospective, manikin-based intervention study, including 2 consecutive classes of medical school students enlisted to a mandatory first aid course. One class (control group) was taught using manikin-based standard CPR education models. The second class (intervention group) was taught similarly, but with the addition of real-time CPR quality feedback provided by the manikins. Students' performance was assessed using a standardized Objective Structured Clinical Examination scenario, during which no real-time feedback was provided. Critical CPR parameters were measured including compression depth, chest recoil, ventilation volume, and "hands-off" time. Results A total of 201 participants were included in the study, 106 in the control group and 95 in the intervention group. Baseline demographic characteristics and previous medical knowledge were similar for the 2 groups. A significant improvement was observed for all primary study outcomes in favor of the real-time feedback group for median (interquartile range) chest compression fraction [57 (52.75%–60%) vs. 49 (43%–55%), P < 0.001], compressions with adequate depth [66.5 (19.5%–95.25%) vs. 0 (0%–12%), P < 0.001], ventilations with adequate volume [68.5 (33%–89%) vs. 37 (0%–70%), P < 0.00], and a simulator-derived composite "total CPR score" [39 (24%–61.25%) vs. 13 (3.5%–22%), P < 0.001]. In multiple regression analysis, the real-time feedback group's performance was significantly better than the control group in all primary outcomes, adjusting for participant's characteristics of age, sex, and body mass index. Conclusions The use of audiovisual feedback techniques to teach CPR improves skill acquisition with significant improvement in crucial prognosis-improving parameters, as tested in a "no-feedback" test scenario. Reprints: Ron Eshel, BSc, Ben-Gurion University of the Negev, Ha'machtarot 20 A Ra'anana, Israel (e-mail: Ron.Eshel@gmail.com). The authors declare no conflict of interest. Neither Laerdal nor any other commercial company revised, altered, or influenced the study protocol or this article at any stage. This study was conducted as part of the requirements for graduation from the medical school of the Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.simulationinhealthcare.com). © 2019 Society for Simulation in Healthcare Evaluation of the Patterns of Learning in the Labor Cervical Examination Objective The aim of the study was to evaluate patterns of skill acquisition in the labor cervical examination in novice providers, such as the change in accuracy and overestimation and underestimation over time and the impact of dilation and effacement on accuracy. Methods In this descriptive longitudinal study, medical students each performed 120 simulated cervical examinations. Accuracy and how often students overestimated and underestimated dilation and effacement during was determined for each set of 10 repetitions. Accuracy data were grouped and compared by dilation (1–3, 4–6, and 7–10 cm) and effacement (90%, 75%, 50%, and 25%). Results Student accuracy in dilation significantly improved throughout the course of the study (P < 0.001). At the beginning of the study, students more often overestimated dilation, but this decreased over time (P < 0.001). In addition, the accuracy of the students' estimations was 84%, 62%, and 52% for dilations of 1–3, 4–6, and 7–10 cm, respectively (P < 0.001). Student accuracy in effacement significantly improved throughout the course of the study (P < 0.001). At the beginning of the study, students more often overestimated effacement, but as training progressed, more students tended to overestimate and underestimate equally often (P < 0.001). In addition, accuracy of the students' estimations was 93%, 88%, 81%, and 35% for effacements of 90%, 75%, 50%, and 25%, respectively (P < 0.001). Conclusions Knowing that students tend to overestimate cervical dilation and effacement early in training and that cervices of high dilation and low effacement are more difficult to assess will be helpful in designing more efficient cervical examination training regimens. Reprints: Joshua F. Nitsche, MD, PhD, Division of Maternal Fetal Medicine, Department of OB/GYN, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157 (e-mail: jnitsche@wakehealth.edu). The authors declare no conflict of interest. An abstract of this article was presented at the annual meeting of the Association for Professors of Gynecology and Obstetrics/Council on Resident Education in Obstetrics and Gynecology, National Harbor, MD, February 28 to March 3, 2018. © 2019 Society for Simulation in Healthcare Clinical Impact of the Introduction of Pediatric Intussusception Air Enema Reduction Technology in a Low- to Middle-Income Country Using Low-Cost Simulation-Based Medical Education Introduction Pediatric intussusception is a common cause of bowel obstruction in infants. Air enema (AE) reduction is routine first-line management in many countries; however, there is a high rate of operative intervention in low- and middle-income countries. The aims of the study were to use simulation-based medical education with an intussusception simulator to introduce AE reduction to Myanmar and to assess its effect on provider behaviors and the resulting clinical care. Methods Clinical evaluation was conducted by comparing clinical outcomes data for children with intussusception 12 months before implementation with that from 12 months subsequent to implementation. These included the following: AE success rates, recurrence rates, length of stay, intestinal resection, and operative intervention rates. An educational workshop was developed that used a low-cost mannequin to facilitate practice at the reduction of intussusception using AE. Curriculum evaluation was performed through 5-point rating scale self-assessment in several domains. Data analysis was performed with Mann-Whitney U test, Student t test, or Wilcoxon signed-ranks test as appropriate; a P value of less than 0.05 was considered to be significant. Results After implementation, there was a significant reduction in the overall operative intervention rates [82.5% (85/103) vs. 58.7% (44/75), P = 0.006]. Intestinal resection rates increased [15.3% (13/85) vs. 35.9% (14/39), P = 0.02]. The success rate with attempted AE reduction was 94.4% (34/36), with a recurrence rate of 5.6% (2/36). The simulation-based medical education workshop was completed by 25 local participants. There was a significant difference in the confidence of performing (1.9 vs. 3.6, P ≤ 0.0001) or assisting (2.8 vs. 3.7, P = 0.018) an AE reduction before and after the workshop. Conclusions Simulation-based educational techniques can be successfully applied in a low- and middle-income country to facilitate the safe introduction of new equipment and techniques with significant beneficial impact on provider behaviors and the resulting clinical care. Reprints: Ramesh Mark Nataraja, MBBS BSc (Hons), GCCS (Hons), GDipSurgEd FRCSEd (Paed.Surg), FFSTEd, FRACS (Paeds), Department of Paediatric Surgery, Monash Children's Hospital, Monash University, 246 Clayton Rd, Clayton, Melbourne, Australia, 3168 (e-mail: ram.nataraja@monashhealth.org). The authors declare no conflict of interest. Supported by the Australian Government and the Royal Australasian College of Surgeons. © 2019 Society for Simulation in Healthcare A Conceptual Framework for the Development of Debriefing Skills: A Journey of Discovery, Growth, and Maturity Summary Statement Despite the critical importance of debriefing in simulation-based education, existing literature offers little guidance on how debriefing skills develop over time. An elaboration of the trajectory through which debriefing expertise evolves would help inform educators looking to enhance their skills. In this article, we present a new conceptual framework for the development of debriefing skills based on a modification of Dreyfus and Dreyfus' model of skill development. For each of the 3 stages of debriefing skill development—discovery, growth, and maturity, we highlight characteristics of debriefers, requisite knowledge, and key skills. We propose how faculty development experiences map to each stage of debriefing skill development. We hope the new conceptual framework will advance the art and science of debriefing by shaping future faculty development initiatives, research, and innovation in debriefing. Reprints: Adam Cheng, MD, FRCPC, University of Calgary, KidSim-ASPIRE Research Program, Alberta Children's Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, Canada T3B 6A8 (e-mail: chenger@me.com). A.C., V.G., and M.M. are faculty for the Debriefing Academy, which runs debriefing courses for healthcare professionals. M.K. is faculty at the Simulation Center of the University Hospital and the Debriefing Academy, both providing debriefing faculty development training. W.E. receives salary support from the Center for Medical Simulation and the Debriefing Academy to teach on simulation educator courses; he also receives per diem honorarium from PAEDSIM e.V. to teach on simulation educator courses in Germany. K.B. is faculty at the NYC Health + Hospitals/Simulation Center, which provides debriefing faculty development training. © 2019 Society for Simulation in Healthcare "It's Not an Acting Job… Don't Underestimate What a Simulated Patient Does": A Qualitative Study Exploring the Perspectives of Simulated Patients in Health Professions Education Introduction Simulated patients (SPs) are individuals who have learned to realistically portray patient roles in health professional education. Program recommendations are increasing for simulation programs, and as key stakeholders, SPs' perspectives seem underrepresented. The aim of the study was to explore the experiences, perspectives, and practices of SPs to gain insights on topics of importance to SPs and inform program recommendations. Methods An interpretivist research paradigm and qualitative design were adopted. Eighteen SPs participated in 2 focus groups that were audio recorded, transcribed, and deidentified. Three researchers completed inductive thematic analysis. Institutional ethical approval was obtained. Results Three themes represented the different elements of SP practice: becoming and being a SP, preparing for a SP role, and performing a SP role. Simulated patients identify as educated specialists with unique responsibilities and attributes. Simulated patients are committed to representing the perspectives of real patients, while simultaneously supporting learners and educators. Simulated patients can feel unprepared to perform a role but have innovated responsive strategies. Conclusions Simulated patients considered 3 primary aspects to their practice and shared ways that they might be well supported. Simulated patients represent a community of practice, characterized by mutual engagement, joint enterprise, and a shared repertoire. Ongoing SP input in SP programs may benefit SPs and lead to higher-quality educational experiences for learners. Reprints: Shane A. Pritchard, BPhysio, Department of Physiotherapy, Monash University, PO Box 527, Frankston, Victoria, Australia 3199 (e-mail: shane.pritchard@gmail.com). The authors declare no conflict of interest. Supported by funding from Health Workforce Australia (CTR12-010) and an Australian Government Research Training Program (RTP) scholarship. © 2019 Society for Simulation in Healthcare Benefits and Limitations of Transurethral Resection of the Prostate Training With a Novel Virtual Reality Simulator Purpose Profound endourological skills are required for optimal postoperative outcome parameters after transurethral resection of the prostate (TURP). We investigated the Karl Storz (Tuttlingen, Germany) UroTrainer for virtual simulation training of the TURP. Materials and Methods Twenty urologists underwent a virtual reality (VR) TURP training. After a needs analysis, performance scores and self-rated surgical skills were compared before and after the curriculum, the realism of the simulator was assessed, and the optimal level of experience for VR training was evaluated. Statistical testing was done with SPSS 25. Results Forty percent of participants indicated frequent intraoperative overload during real-life TURP and 80% indicated that VR training might be beneficial for endourological skills development, underlining the need to advance classical endourological training. For the complete cohort, overall VR performance scores (P = 0.022) and completeness of resection (P < 0.001) significantly improved. Self-rated parameters including identification of anatomical structures (P = 0.046), sparing the sphincter (P = 0.002), and handling of the resectoscope (P = 0.033) became significantly better during the VR curriculum. Participants indicated progress regarding handling of the resectoscope (70%), bleeding control (55%), and finding the correct resection depth (50%). Although overall realism and handling of the resectoscope was good, virtual bleeding control and correct tissue feedback should be improved in future VR simulators. Seventy percent of participants indicated 10 to 50 virtual TURP cases to be optimal and 80% junior residents to be the key target group for VR TURP training. Conclusions There is a need to improve training the TURP and VR simulators might be a valuable supplement, especially for urologists beginning with the endourological desobstruction of the prostate. Reprints: Gerald B. Schulz, MD, Department of Urology, Ludwig-Maximilians-University Marchioninistr, 15, 81377 Munich, Germany (e-mail: gerald.schulz@med.uni-muenchen.de). The authors declare no conflict of interest. F.J. and A.K. share the last authorship. The authors state that the study was performed in complete accordance with the local ethical requirements. The internal review board exempted the study protocol of ethical review. No patients or animals were involved within this study. © 2019 Society for Simulation in Healthcare Medical Student Skill Retention After Cardiopulmonary Resuscitation Training: A Cross-sectional Simulation Study Introduction The retention of cardiopulmonary resuscitation skills and the ideal frequency of retraining remain unanswered. This study investigated the retention of cardiopulmonary resuscitation skills by medical students for up to 42 months after training. Methods In a cross-sectional study, 205 medical students received 10 hours of training in basic life support in 3 practical classes, during their first semester at school. Then, they were divided into 4 groups, according to the time elapsed since the training: 73 after 1 month, 55 after 18 months, 41 after 30 months, and 36 after 42 months. Nineteen cardiopulmonary resuscitation skills and 8 potential technical errors were evaluated by mannequin-based simulation and reviewed using filming. Results The mean retention of the skills was 90% after 1 month, 74% after 18 months, 62% after 30 months, and 61% after 42 months (P < 0.001). The depth of chest compressions had the greatest retention over time (87.8%), with no significant differences among groups. Compressions performed greater than 120 per minute were less likely to be done with adequate depth. Ventilation showed a progressive decrease in retention from 93% (n = 68) after 1 month to 19% (n = 7) after 42 months (P < 0.001). All 205 students were able to turn the automated external defibrillator on and deliver the shock. Conclusions The depth of chest compressions and the use of an automated external defibrillator were the skills with the highest retention over time. Based on a skills retention prediction curve, we suggest that 18 to 24 months as the minimum retraining interval to maintain at least 70% of skills. Reprints: Rafael Saad, MD, PhD, Dr. Arnaldo Ave, 455, Room 1210, Sao Paulo, Brazil (e-mail: rafaelsaad89@gmail.com). Supported by School of Medicine, University of Sao Paulo. The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.simulationinhealthcare.com). © 2019 Society for Simulation in Healthcare Learning Impacts of Pretraining Video-Assisted Debriefing With Simulated Errors or Trainees' Errors in Medical Students in Basic Life Support Training: A Randomized Controlled Trial Background Previous studies demonstrated that pretraining video-assisted debriefing (VAD) with trainees' errors (TE) videotaped in a skills pretest improved skill learning of basic life support (BLS). However, conducting a pretest and preparing TE video examples is resource intensive. Exposing individual trainee's errors to peers might be a threat to learners' psychological safety. We hypothesized pretraining VAD with simulated errors (SE, performed by actors) might have the same beneficial effect on skills learning as pretraining VAD with TE, but avoid drawbacks of TE. Methods Three hundred twenty-two third-year medical students were randomized into 3 groups (the control [C], TE, SE). A videotaped BLS skills pretest was conducted in 3 groups. Then, group C received traditional training with concurrent feedback. Video-assisted debriefing with TE in the pretest or SE was delivered in groups TE or SE, respectively, followed by BLS training without any feedback. Basic life support skills were retested 1 week later (posttest). Students completed a survey to express their preference to TE or SE for VAD in the future. Results Higher BLS skills scores were observed in groups TE (85.7 ± 7.0) and SE (86.8 ± 7.5) in the posttest, compared with group C (68.7 ± 13.3, P < 0.001). No skills difference was observed between group TE and SE in the posttest. More trainees (65.8%) preferred SE for VAD. Conclusions Pretraining VAD with SE had an equivalent beneficial effect as VAD with TE on BLS skills learning in medical students. More trainees preferred SE for VAD with regard to psychological safety. Reprints: Hong Xiao, MD, Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, PR China (e-mail: 619526767@qq.com). The authors declare no conflict of interest. Supported by the following research grants: National Key R&D Program of China (2018YFC2001800); a Medical Education Research Grant from Medical Education Committee of Chinese Medical Association and Medical Education Association of High Education Society of China in 2018 (2018-N07004); and a Key Project of Innovation in New Centurial High Education in Sichuan University in 2017 (SCU8052). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.simulationinhealthcare.com). © 2019 Society for Simulation in Healthcare Evaluating Best Methods for Crisis Resource Management Education: Didactic Teaching or Noncontextual Active Learning Introduction Health care training traditionally focuses on medical knowledge; however, this is not the only component of successful patient management. Nontechnical skills, such as crisis resource management (CRM), have significant impact on patient care. This study examines whether there is a difference in CRM skills taught by traditional lecture in comparison with low-fidelity simulation consisting of noncontextual learning through team problem-solving activities. Methods Two groups of multidisciplinary preclinical students were taught CRM through lecture or noncontextual active learning. Both groups were given a cardiopulmonary resuscitation simulation and clinical performance assessed by basic life support (BLS) checklist and CRM skills by Ottawa Global Rating Scale. The groups were reassessed at 4 months. A third group, who received no CRM education, served as a control group. Results The mean BLS scores after CRM education were 18.9 and 24.9 with mean Ottawa Global Rating Scale (GRS) scores of 22.4 and 29.1 in the didactic teaching and noncontextual groups, respectively. The difference between intervention groups was significant for BLS (P = 0.02) and Ottawa GRS (P = 0.03) score. At 4-month follow-up, there was no statistically significant difference in BLS (P = 1.0) or Ottawa GRS score (P = 0.55) between intervention groups. In comparison with the control group, there was a marginally significant difference in Ottawa GRS score (P = 0.06) at 4-month follow-up. Conclusions Noncontextual active learning of CRM using low-fidelity simulation results in improved CRM performance in comparison with didactic teaching. The benefits of CRM education do not seem to be sustained after one education session, suggesting the need for continued education and practice of skills to improve retention. Reprints: Sandy Widder, MD FRCSC, Department of Surgery, University of Alberta Hospital, 8440-112 St NW, 2D4.27 Walter C MacKenzie Health Sciences Centre, Edmonton, AB T6G 2B7, Canada (e-mail: Sandy.Widder2@albertahealthservices.ca). The authors declare no conflict of interest. © 2019 Society for Simulation in Healthcare Educational Interventions to Enhance Situation Awareness: A Systematic Review and Meta-analysis Summary Statement We conducted a systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals' situation awareness (SA). We searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library. Articles that reported a targeted SA intervention or a broader intervention incorporating SA, and an objective outcome measure of SA were included. Thirty-nine articles were eligible for inclusion, of these 4 reported targeted SA interventions. Simulation-based education (SBE) was the most prevalent educational modality (31 articles). Meta-analysis of trial designs (19 articles) yielded a pooled moderate effect size of 0.61 (95% confidence interval = 0.17 to 1.06, P = 0.007, I2 = 42%) in favor of SBE as compared with other modalities and a nonsignificant moderate effect in favor of additional nontechnical skills training (effect size = 0.54, 95% confidence interval = 0.18 to 1.26, P = 0.14, I2 = 63%). Though constrained by the number of articles eligible for inclusion, our results suggest that in comparison with other modalities, SBE yields better SA outcomes. Reprints: Nuala Walshe, RN, MTLHE, School of Nursing and Midwifery, Brookfield Health Science Complex, University College Cork, Cork T12 K8AF, Ireland (e-mail: n.walshe@ucc.ie). The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.simulationinhealthcare.com). © 2019 Society for Simulation in Healthcare
Real-Time Audiovisual Feedback Training Improves Cardiopulmonary Resuscitation Performance: A Controlled StudyObjective The aim of the study was to quantitatively measure the effect of teaching cardiopulmonary resuscitation (CPR) using a real-time audiovisual feedback manikin system on first-year medical student's CPR performance. Methods This is a prospective, manikin-based intervention study, including 2 consecutive classes of medical school students enlisted to a mandatory first aid course. One...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Real-Time Audiovisual Feedback Training Improves Cardiopulmonary Resuscitation Performance: A Controlled Study Objective The aim of the study was to quantitatively measure the effect of teaching cardiopulmonary resuscitation (CPR) using a real-time audiovisual feedback manikin system on first-year medical student's CPR performance. Methods This is a prospective, manikin-based intervention study, including 2 consecutive classes of medical school students enlisted to a mandatory first aid course. One class (control group) was taught using manikin-based standard CPR education models. The second class (intervention group) was taught similarly, but with the addition of real-time CPR quality feedback provided by the manikins. Students' performance was assessed using a standardized Objective Structured Clinical Examination scenario, during which no real-time feedback was provided. Critical CPR parameters were measured including compression depth, chest recoil, ventilation volume, and "hands-off" time. Results A total of 201 participants were included in the study, 106 in the control group and 95 in the intervention group. Baseline demographic characteristics and previous medical knowledge were similar for the 2 groups. A significant improvement was observed for all primary study outcomes in favor of the real-time feedback group for median (interquartile range) chest compression fraction [57 (52.75%–60%) vs. 49 (43%–55%), P < 0.001], compressions with adequate depth [66.5 (19.5%–95.25%) vs. 0 (0%–12%), P < 0.001], ventilations with adequate volume [68.5 (33%–89%) vs. 37 (0%–70%), P < 0.00], and a simulator-derived composite "total CPR score" [39 (24%–61.25%) vs. 13 (3.5%–22%), P < 0.001]. In multiple regression analysis, the real-time feedback group's performance was significantly better than the control group in all primary outcomes, adjusting for participant's characteristics of age, sex, and body mass index. Conclusions The use of audiovisual feedback techniques to teach CPR improves skill acquisition with significant improvement in crucial prognosis-improving parameters, as tested in a "no-feedback" test scenario. Reprints: Ron Eshel, BSc, Ben-Gurion University of the Negev, Ha'machtarot 20 A Ra'anana, Israel (e-mail: Ron.Eshel@gmail.com). The authors declare no conflict of interest. Neither Laerdal nor any other commercial company revised, altered, or influenced the study protocol or this article at any stage. This study was conducted as part of the requirements for graduation from the medical school of the Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.simulationinhealthcare.com). © 2019 Society for Simulation in Healthcare Evaluation of the Patterns of Learning in the Labor Cervical Examination Objective The aim of the study was to evaluate patterns of skill acquisition in the labor cervical examination in novice providers, such as the change in accuracy and overestimation and underestimation over time and the impact of dilation and effacement on accuracy. Methods In this descriptive longitudinal study, medical students each performed 120 simulated cervical examinations. Accuracy and how often students overestimated and underestimated dilation and effacement during was determined for each set of 10 repetitions. Accuracy data were grouped and compared by dilation (1–3, 4–6, and 7–10 cm) and effacement (90%, 75%, 50%, and 25%). Results Student accuracy in dilation significantly improved throughout the course of the study (P < 0.001). At the beginning of the study, students more often overestimated dilation, but this decreased over time (P < 0.001). In addition, the accuracy of the students' estimations was 84%, 62%, and 52% for dilations of 1–3, 4–6, and 7–10 cm, respectively (P < 0.001). Student accuracy in effacement significantly improved throughout the course of the study (P < 0.001). At the beginning of the study, students more often overestimated effacement, but as training progressed, more students tended to overestimate and underestimate equally often (P < 0.001). In addition, accuracy of the students' estimations was 93%, 88%, 81%, and 35% for effacements of 90%, 75%, 50%, and 25%, respectively (P < 0.001). Conclusions Knowing that students tend to overestimate cervical dilation and effacement early in training and that cervices of high dilation and low effacement are more difficult to assess will be helpful in designing more efficient cervical examination training regimens. Reprints: Joshua F. Nitsche, MD, PhD, Division of Maternal Fetal Medicine, Department of OB/GYN, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157 (e-mail: jnitsche@wakehealth.edu). The authors declare no conflict of interest. An abstract of this article was presented at the annual meeting of the Association for Professors of Gynecology and Obstetrics/Council on Resident Education in Obstetrics and Gynecology, National Harbor, MD, February 28 to March 3, 2018. © 2019 Society for Simulation in Healthcare Clinical Impact of the Introduction of Pediatric Intussusception Air Enema Reduction Technology in a Low- to Middle-Income Country Using Low-Cost Simulation-Based Medical Education Introduction Pediatric intussusception is a common cause of bowel obstruction in infants. Air enema (AE) reduction is routine first-line management in many countries; however, there is a high rate of operative intervention in low- and middle-income countries. The aims of the study were to use simulation-based medical education with an intussusception simulator to introduce AE reduction to Myanmar and to assess its effect on provider behaviors and the resulting clinical care. Methods Clinical evaluation was conducted by comparing clinical outcomes data for children with intussusception 12 months before implementation with that from 12 months subsequent to implementation. These included the following: AE success rates, recurrence rates, length of stay, intestinal resection, and operative intervention rates. An educational workshop was developed that used a low-cost mannequin to facilitate practice at the reduction of intussusception using AE. Curriculum evaluation was performed through 5-point rating scale self-assessment in several domains. Data analysis was performed with Mann-Whitney U test, Student t test, or Wilcoxon signed-ranks test as appropriate; a P value of less than 0.05 was considered to be significant. Results After implementation, there was a significant reduction in the overall operative intervention rates [82.5% (85/103) vs. 58.7% (44/75), P = 0.006]. Intestinal resection rates increased [15.3% (13/85) vs. 35.9% (14/39), P = 0.02]. The success rate with attempted AE reduction was 94.4% (34/36), with a recurrence rate of 5.6% (2/36). The simulation-based medical education workshop was completed by 25 local participants. There was a significant difference in the confidence of performing (1.9 vs. 3.6, P ≤ 0.0001) or assisting (2.8 vs. 3.7, P = 0.018) an AE reduction before and after the workshop. Conclusions Simulation-based educational techniques can be successfully applied in a low- and middle-income country to facilitate the safe introduction of new equipment and techniques with significant beneficial impact on provider behaviors and the resulting clinical care. Reprints: Ramesh Mark Nataraja, MBBS BSc (Hons), GCCS (Hons), GDipSurgEd FRCSEd (Paed.Surg), FFSTEd, FRACS (Paeds), Department of Paediatric Surgery, Monash Children's Hospital, Monash University, 246 Clayton Rd, Clayton, Melbourne, Australia, 3168 (e-mail: ram.nataraja@monashhealth.org). The authors declare no conflict of interest. Supported by the Australian Government and the Royal Australasian College of Surgeons. © 2019 Society for Simulation in Healthcare A Conceptual Framework for the Development of Debriefing Skills: A Journey of Discovery, Growth, and Maturity Summary Statement Despite the critical importance of debriefing in simulation-based education, existing literature offers little guidance on how debriefing skills develop over time. An elaboration of the trajectory through which debriefing expertise evolves would help inform educators looking to enhance their skills. In this article, we present a new conceptual framework for the development of debriefing skills based on a modification of Dreyfus and Dreyfus' model of skill development. For each of the 3 stages of debriefing skill development—discovery, growth, and maturity, we highlight characteristics of debriefers, requisite knowledge, and key skills. We propose how faculty development experiences map to each stage of debriefing skill development. We hope the new conceptual framework will advance the art and science of debriefing by shaping future faculty development initiatives, research, and innovation in debriefing. Reprints: Adam Cheng, MD, FRCPC, University of Calgary, KidSim-ASPIRE Research Program, Alberta Children's Hospital, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, Canada T3B 6A8 (e-mail: chenger@me.com). A.C., V.G., and M.M. are faculty for the Debriefing Academy, which runs debriefing courses for healthcare professionals. M.K. is faculty at the Simulation Center of the University Hospital and the Debriefing Academy, both providing debriefing faculty development training. W.E. receives salary support from the Center for Medical Simulation and the Debriefing Academy to teach on simulation educator courses; he also receives per diem honorarium from PAEDSIM e.V. to teach on simulation educator courses in Germany. K.B. is faculty at the NYC Health + Hospitals/Simulation Center, which provides debriefing faculty development training. © 2019 Society for Simulation in Healthcare "It's Not an Acting Job… Don't Underestimate What a Simulated Patient Does": A Qualitative Study Exploring the Perspectives of Simulated Patients in Health Professions Education Introduction Simulated patients (SPs) are individuals who have learned to realistically portray patient roles in health professional education. Program recommendations are increasing for simulation programs, and as key stakeholders, SPs' perspectives seem underrepresented. The aim of the study was to explore the experiences, perspectives, and practices of SPs to gain insights on topics of importance to SPs and inform program recommendations. Methods An interpretivist research paradigm and qualitative design were adopted. Eighteen SPs participated in 2 focus groups that were audio recorded, transcribed, and deidentified. Three researchers completed inductive thematic analysis. Institutional ethical approval was obtained. Results Three themes represented the different elements of SP practice: becoming and being a SP, preparing for a SP role, and performing a SP role. Simulated patients identify as educated specialists with unique responsibilities and attributes. Simulated patients are committed to representing the perspectives of real patients, while simultaneously supporting learners and educators. Simulated patients can feel unprepared to perform a role but have innovated responsive strategies. Conclusions Simulated patients considered 3 primary aspects to their practice and shared ways that they might be well supported. Simulated patients represent a community of practice, characterized by mutual engagement, joint enterprise, and a shared repertoire. Ongoing SP input in SP programs may benefit SPs and lead to higher-quality educational experiences for learners. Reprints: Shane A. Pritchard, BPhysio, Department of Physiotherapy, Monash University, PO Box 527, Frankston, Victoria, Australia 3199 (e-mail: shane.pritchard@gmail.com). The authors declare no conflict of interest. Supported by funding from Health Workforce Australia (CTR12-010) and an Australian Government Research Training Program (RTP) scholarship. © 2019 Society for Simulation in Healthcare Benefits and Limitations of Transurethral Resection of the Prostate Training With a Novel Virtual Reality Simulator Purpose Profound endourological skills are required for optimal postoperative outcome parameters after transurethral resection of the prostate (TURP). We investigated the Karl Storz (Tuttlingen, Germany) UroTrainer for virtual simulation training of the TURP. Materials and Methods Twenty urologists underwent a virtual reality (VR) TURP training. After a needs analysis, performance scores and self-rated surgical skills were compared before and after the curriculum, the realism of the simulator was assessed, and the optimal level of experience for VR training was evaluated. Statistical testing was done with SPSS 25. Results Forty percent of participants indicated frequent intraoperative overload during real-life TURP and 80% indicated that VR training might be beneficial for endourological skills development, underlining the need to advance classical endourological training. For the complete cohort, overall VR performance scores (P = 0.022) and completeness of resection (P < 0.001) significantly improved. Self-rated parameters including identification of anatomical structures (P = 0.046), sparing the sphincter (P = 0.002), and handling of the resectoscope (P = 0.033) became significantly better during the VR curriculum. Participants indicated progress regarding handling of the resectoscope (70%), bleeding control (55%), and finding the correct resection depth (50%). Although overall realism and handling of the resectoscope was good, virtual bleeding control and correct tissue feedback should be improved in future VR simulators. Seventy percent of participants indicated 10 to 50 virtual TURP cases to be optimal and 80% junior residents to be the key target group for VR TURP training. Conclusions There is a need to improve training the TURP and VR simulators might be a valuable supplement, especially for urologists beginning with the endourological desobstruction of the prostate. Reprints: Gerald B. Schulz, MD, Department of Urology, Ludwig-Maximilians-University Marchioninistr, 15, 81377 Munich, Germany (e-mail: gerald.schulz@med.uni-muenchen.de). The authors declare no conflict of interest. F.J. and A.K. share the last authorship. The authors state that the study was performed in complete accordance with the local ethical requirements. The internal review board exempted the study protocol of ethical review. No patients or animals were involved within this study. © 2019 Society for Simulation in Healthcare Medical Student Skill Retention After Cardiopulmonary Resuscitation Training: A Cross-sectional Simulation Study Introduction The retention of cardiopulmonary resuscitation skills and the ideal frequency of retraining remain unanswered. This study investigated the retention of cardiopulmonary resuscitation skills by medical students for up to 42 months after training. Methods In a cross-sectional study, 205 medical students received 10 hours of training in basic life support in 3 practical classes, during their first semester at school. Then, they were divided into 4 groups, according to the time elapsed since the training: 73 after 1 month, 55 after 18 months, 41 after 30 months, and 36 after 42 months. Nineteen cardiopulmonary resuscitation skills and 8 potential technical errors were evaluated by mannequin-based simulation and reviewed using filming. Results The mean retention of the skills was 90% after 1 month, 74% after 18 months, 62% after 30 months, and 61% after 42 months (P < 0.001). The depth of chest compressions had the greatest retention over time (87.8%), with no significant differences among groups. Compressions performed greater than 120 per minute were less likely to be done with adequate depth. Ventilation showed a progressive decrease in retention from 93% (n = 68) after 1 month to 19% (n = 7) after 42 months (P < 0.001). All 205 students were able to turn the automated external defibrillator on and deliver the shock. Conclusions The depth of chest compressions and the use of an automated external defibrillator were the skills with the highest retention over time. Based on a skills retention prediction curve, we suggest that 18 to 24 months as the minimum retraining interval to maintain at least 70% of skills. Reprints: Rafael Saad, MD, PhD, Dr. Arnaldo Ave, 455, Room 1210, Sao Paulo, Brazil (e-mail: rafaelsaad89@gmail.com). Supported by School of Medicine, University of Sao Paulo. The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.simulationinhealthcare.com). © 2019 Society for Simulation in Healthcare Learning Impacts of Pretraining Video-Assisted Debriefing With Simulated Errors or Trainees' Errors in Medical Students in Basic Life Support Training: A Randomized Controlled Trial Background Previous studies demonstrated that pretraining video-assisted debriefing (VAD) with trainees' errors (TE) videotaped in a skills pretest improved skill learning of basic life support (BLS). However, conducting a pretest and preparing TE video examples is resource intensive. Exposing individual trainee's errors to peers might be a threat to learners' psychological safety. We hypothesized pretraining VAD with simulated errors (SE, performed by actors) might have the same beneficial effect on skills learning as pretraining VAD with TE, but avoid drawbacks of TE. Methods Three hundred twenty-two third-year medical students were randomized into 3 groups (the control [C], TE, SE). A videotaped BLS skills pretest was conducted in 3 groups. Then, group C received traditional training with concurrent feedback. Video-assisted debriefing with TE in the pretest or SE was delivered in groups TE or SE, respectively, followed by BLS training without any feedback. Basic life support skills were retested 1 week later (posttest). Students completed a survey to express their preference to TE or SE for VAD in the future. Results Higher BLS skills scores were observed in groups TE (85.7 ± 7.0) and SE (86.8 ± 7.5) in the posttest, compared with group C (68.7 ± 13.3, P < 0.001). No skills difference was observed between group TE and SE in the posttest. More trainees (65.8%) preferred SE for VAD. Conclusions Pretraining VAD with SE had an equivalent beneficial effect as VAD with TE on BLS skills learning in medical students. More trainees preferred SE for VAD with regard to psychological safety. Reprints: Hong Xiao, MD, Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, PR China (e-mail: 619526767@qq.com). The authors declare no conflict of interest. Supported by the following research grants: National Key R&D Program of China (2018YFC2001800); a Medical Education Research Grant from Medical Education Committee of Chinese Medical Association and Medical Education Association of High Education Society of China in 2018 (2018-N07004); and a Key Project of Innovation in New Centurial High Education in Sichuan University in 2017 (SCU8052). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.simulationinhealthcare.com). © 2019 Society for Simulation in Healthcare Evaluating Best Methods for Crisis Resource Management Education: Didactic Teaching or Noncontextual Active Learning Introduction Health care training traditionally focuses on medical knowledge; however, this is not the only component of successful patient management. Nontechnical skills, such as crisis resource management (CRM), have significant impact on patient care. This study examines whether there is a difference in CRM skills taught by traditional lecture in comparison with low-fidelity simulation consisting of noncontextual learning through team problem-solving activities. Methods Two groups of multidisciplinary preclinical students were taught CRM through lecture or noncontextual active learning. Both groups were given a cardiopulmonary resuscitation simulation and clinical performance assessed by basic life support (BLS) checklist and CRM skills by Ottawa Global Rating Scale. The groups were reassessed at 4 months. A third group, who received no CRM education, served as a control group. Results The mean BLS scores after CRM education were 18.9 and 24.9 with mean Ottawa Global Rating Scale (GRS) scores of 22.4 and 29.1 in the didactic teaching and noncontextual groups, respectively. The difference between intervention groups was significant for BLS (P = 0.02) and Ottawa GRS (P = 0.03) score. At 4-month follow-up, there was no statistically significant difference in BLS (P = 1.0) or Ottawa GRS score (P = 0.55) between intervention groups. In comparison with the control group, there was a marginally significant difference in Ottawa GRS score (P = 0.06) at 4-month follow-up. Conclusions Noncontextual active learning of CRM using low-fidelity simulation results in improved CRM performance in comparison with didactic teaching. The benefits of CRM education do not seem to be sustained after one education session, suggesting the need for continued education and practice of skills to improve retention. Reprints: Sandy Widder, MD FRCSC, Department of Surgery, University of Alberta Hospital, 8440-112 St NW, 2D4.27 Walter C MacKenzie Health Sciences Centre, Edmonton, AB T6G 2B7, Canada (e-mail: Sandy.Widder2@albertahealthservices.ca). The authors declare no conflict of interest. © 2019 Society for Simulation in Healthcare Educational Interventions to Enhance Situation Awareness: A Systematic Review and Meta-analysis Summary Statement We conducted a systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals' situation awareness (SA). We searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library. Articles that reported a targeted SA intervention or a broader intervention incorporating SA, and an objective outcome measure of SA were included. Thirty-nine articles were eligible for inclusion, of these 4 reported targeted SA interventions. Simulation-based education (SBE) was the most prevalent educational modality (31 articles). Meta-analysis of trial designs (19 articles) yielded a pooled moderate effect size of 0.61 (95% confidence interval = 0.17 to 1.06, P = 0.007, I2 = 42%) in favor of SBE as compared with other modalities and a nonsignificant moderate effect in favor of additional nontechnical skills training (effect size = 0.54, 95% confidence interval = 0.18 to 1.26, P = 0.14, I2 = 63%). Though constrained by the number of articles eligible for inclusion, our results suggest that in comparison with other modalities, SBE yields better SA outcomes. Reprints: Nuala Walshe, RN, MTLHE, School of Nursing and Midwifery, Brookfield Health Science Complex, University College Cork, Cork T12 K8AF, Ireland (e-mail: n.walshe@ucc.ie). The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.simulationinhealthcare.com). © 2019 Society for Simulation in Healthcare
Real-Time Audiovisual Feedback Training Improves Cardiopulmonary Resuscitation Performance: A Controlled StudyObjective The aim of the study was to quantitatively measure the effect of teaching cardiopulmonary resuscitation (CPR) using a real-time audiovisual feedback manikin system on first-year medical student's CPR performance. Methods This is a prospective, manikin-based intervention study, including 2 consecutive classes of medical school students enlisted to a mandatory first aid course. One...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Awareness and practice of zinc therapy in diarrheal management among under-five caregivers in Enugu State, Nigeria Joshua I Ugwu, Ikechukwu E Ezeagu, Madu D Ibegbu International Journal of Medicine and Health Development 2019 24(2):63-69 Background: Acute diarrhea remains one of the leading causes of under -five years of age (u-5) childhood deaths in Nigeria. Use of zinc (Zn) sulfate monohydrate with low-osmolality oral rehydration solution (ORS) therapy reduces both the duration and severity of the diarrhea episodes in children. There has been little progress in the widespread introduction and adoption of ORS plus Zn sulfate (ORS+Zn) therapy in Nigeria. Aims and Objectives: The aim of this study was to assess the level of awareness and practice of ORS+Zn therapy among u-5 caregivers. Materials and Methods: Two local government areas, each representing urban and rural settings, were randomly selected. Awareness and practice of ORS+Zn therapy by 386 caregivers was assessed using a semi-structured interviewer-administered questionnaire. Frequency and percentages were used for categorical data and the influence of sociodemography was analyzed by using Pearson's correlation method. Results: Awareness and practice of Zn therapy was higher among the caregivers in the urban setting, who seems to be more exposed to information on the efficacy of ORS+Zn therapy (p < 0.05). Caregivers of u-5 children living in the rural settings were deficient in information on the use of ORS and Zn salts in the management of child diarrhea. In summary, of the 386 caregivers, 123 (62%) indicated awareness of Zn salt, and of these only 39 (10%) practiced Zn salt treatment. Level of education seems to influence awareness and practice positively in the urban setting (p < 0.05). Economic status underscored by employment type, clinic visits, and health campaigns influenced positively the adoption of ORS+Zn therapy in the rural and urban communities (p < 0.05). Tertiary education, which is the highest level of education, showed a positive association with awareness and practice of ORS+Zn treatment in both study areas (p < 0.05). One hundred and ninety-nine caregivers (52%) of all the respondents still preferred to treat child diarrhea with ORS with antibiotics adjuvant. Conclusion: Practice of ORS+Zn therapy is low and seems to be influenced by level of education, awareness, and location and availability. Advocacy and sensitization programs should be intensified, and intake of food rich in Zn and Zn supplement should be promoted in infant-feeding practices. Investigating the level of awareness and extent of financial risk protection among the population in Enugu state, southeast Nigeria Chijioke Okoli, Eric Obikeze, Charles Ezenduka, Ejikeme Arodiwe, Ogbonnia Ochonma, Obinna Onwujekwe International Journal of Medicine and Health Development 2019 24(2):70-77 Objective: The study investigated the level of awareness and extent of financial risk protection among the population in Enugu state, southeast Nigeria. Materials and Methods: A mixed-method approach involving cross-sectional quantitative and qualitative methods was adopted for data collection and analysis. The study was conducted in two purposively selected urban and rural local government settings in Enugu North and East senatorial zones, respectively. Results: The quantitative results show that most of the respondents (77.1%) were women and 80.2% were married. Slightly above a quarter of the respondents (25.6%) were self-employed, whereas 29.1% were main income earners. Out-of-pocket (OOP) dominates payment mechanisms (94.9%), whereas more than half (54.4%) of the respondents went to patent medicine dealers for treatment in the last one month. Logistic regression shows overall significance in use of prepayment mechanisms with χ2 = 56.57 and P = 0.001. More so, finding indicates that 55.9% of respondents have heard of prepayment mechanisms mainly from television (30.4%) and radio program (20.2%), while 89.5% has not used any prepayment mechanism in the State. Conclusion: OOP still dominates payment mechanism in Enugu state. Although over half of the respondents (55.9%) have heard of prepayment mechanisms, approximately 90% has not used any prepayment mechanism in the State. This calls for policy that will ensure moving away from OOP payment to prepayment mechanism through health system strengthening and awareness creation for the populace. Comparative study of six-month and eight-month treatment of new smear positive tuberculosis cases at a tertiary health facility in Enugu, South-Eastern Nigeria Babatunde I Omotowo, Ijeoma Itanyi, Edmund O Ndibuagu, Chuka C Agunwa, Ikechukwu E Obi, Arthur C Idoko, Anne C Ndu International Journal of Medicine and Health Development 2019 24(2):78-84 Introduction: Factors that affect tuberculosis (TB) treatment outcomes are important and should be investigated to achieve the targets of TB control program. Aims and Objectives: The aim of this study was to compare treatment outcomes of new smear positive TB patients treated for six months with those treated for eight months. Materials and Methods: A retrospective study of 600 new smear-positive TB patients was carried out. The data were analyzed using Stata version 22 (SPSS Inc., Chicago, Illinois, USA), and the values of P < 0.05 were considered statistically significant. Binary logistic regression was used to identify factors that influenced treatment outcomes. Results: Overall, a higher proportion of patients (78.6%) who were treated for six months had successful treatment outcomes as compared with those treated for eight months 64.4% (P = < 0.001, OR = 2.03, CI = 1.41–2.91). After adjusting for confounders, sex (P = 0.040, AOR = 0.65, CI = 0.44–0.98), treatment duration (P < 0.001, AOR = 2.27, CI = 1.53–3.39), and pretreatment weight (P = 0.007, AOR = 1.28, CI = 1.07–1.52) independently predicted treatment outcome. Conclusion: The treatment success rate was better among the patients treated for six-month duration than those treated for eight-month duration. The current six-month regimen recommended by WHO should be maintained. Loss to follow-up and TB/HIV coinfection management should be improved. A need for specialized education in pediatric radiography in Nigeria Odira C Ewuzie International Journal of Medicine and Health Development 2019 24(2):85-88 Introduction: Pediatrics is a vast field with many facets. The importance of having dedicated specialists trained in the treatment and care of pediatric patients has long been recognized. It is necessary to determine if the profession of radiography is making similar progress in improving on the pediatric radiography services offered in the country. Objective: The objective of this study was to establish if there was a perceived need for specialized pediatric radiographic education in Nigeria. Subjects and Methods: This was a descriptive cross-sectional survey, which accessed radiographers' take on the need for specialized education in pediatric imaging. A Google Form link was distributed through various Nigerian radiographers' WhatsApp groups, inviting interested radiographers to participate in stating their opinions on the need for specialized pediatric radiographic education in the country and other related questions. Data were analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results were presented using tables and charts. Results: Seventy-six radiographers working in 25 states across the federation participated in the online survey. A total of 90.8% of the respondents stated there was a need for specialized radiographic education in pediatric imaging, and 64.5% felt that this education or training opportunities for radiographers was inadequate. Only 43.4% were comfortable performing pediatric imaging. Conclusion: Majority of the radiography departments in Nigeria do not have dedicated equipment or staff for pediatric radiography. Undergoing specialized pediatric imaging training will benefit radiographers who are keen on improving the radiography services offered to pediatric patients. Second-phase delay in accessing major elective surgeries from a public tertiary health institution in Nigeria: The role of financial constraints Ikenna I Nnabugwu, Fredrick O Ugwumba, Jude K Ede International Journal of Medicine and Health Development 2019 24(2):89-94 Background: Many factors contribute to second-phase delay in accessing surgical care electively especially in low-income settings. The aim of this study was to evaluate second-phase delay in elective surgical care in a tertiary hospital. Materials and Methods: This study is a hospital-based cross-sectional survey conducted at a tertiary health institution in Nigeria from February to September 2017. Sampling units were households that accessed major elective surgical operation from the general surgery and urology units of the institution for an adult member (≥18 years of age) of the household. Analysis was performed using the Statistical Package for Social Sciences software version 20.0 (IBM SPSS Inc, Chicago, USA). Results: In total, 495 households representing same number of patients participated in the study. Second-phase interval was within one month in 16.2% of households. It was delayed 2–6 months in 55.2% of households, 6–12 months in 16.2% of households, and more than 12 months in 12.5% of households. Financial constraint was reported as reason for the observed second-phase interval in 54.7% of households with 93.4% of these households delayed for longer than one month and 38.0% for more than six months. Financial constraint was significantly more prevalent among larger households (OR 7.64; 95%CI 1.89–30.78; P < 0.01) and households in the lower wealth quartiles (OR 0.73; 95%CI 0.55–0.97; P = 0.03). Few households (7.1%) accessed health insurance for the prescribed major surgery and only 8.6% of those insured households reported financial constraints. Conclusion: Longer second-phase delay attributable to financial constraints is prevalent among larger households comprising mostly children, households in the lower socioeconomic quartiles, and uninsured households. Entry points into a Nigerian medical school at the graduate and undergraduate levels: A three-year prospective and retrospective comparison of performances at the first MBBS professional examinations Ed Nwobodo, Uchechukwu Dimkpa, Chidiebere Ugwu, Ugochukwu B Anyaehie International Journal of Medicine and Health Development 2019 24(2):95-99 Background: It is alleged that there is a mismatch between candidates' performance in University Matriculation Examination (UME) and their subsequent academic achievement in medical schools in Nigeria. Aim: The present study compares the performance of medical students admitted via Direct Entry (DE) module and that of UME using their 1st professional examination. Methodology: A total of 343 undergraduate medical students of College of Medicine, Nnamdi Azikiwe University, Nnewi, Anambra state, Nigeria were used for this study. 270 of the students were admitted through UME, while 73 were admitted through DE modes of admission. The results of the 1st MBBS examinations taken in the years 2014 to 2017 were collated, analyzed and compared between the two groups of students. Results: The rate of success in 1st MBBS examination was greater in the DE students (74%) compared with the UME students (44.1%). The failure rate was higher in the UME entrants (55.9%) compared with the direct entrants (26%). The frequency of withdrawals in the group with UME (n = 28) was greater than that of the group with DE (n = 0). Chi square test of association indicated significant (p < 0.001) association between performance of students in 1st MBBS examination and the mode of admission. Logistic regression test shows that the odds of failure were against students with UME module than those with DE. Conclusion: The present study indicates that the admission module of DE with previous degree increases the chances of academic success in medical education in Nigeria. This suggests the need for a review of the mode of admission into medical schools to favour students that have a previous degree. Prospective analysis of extremity gunshot injuries treated in a Nigerian regional trauma center Omolade A Lasebikan, Njoku I Omoke, Ndubuisi O Onyemaechi, Emmanuel C Iyidobi, Wilson I Anetekhai International Journal of Medicine and Health Development 2019 24(2):100-106 Background: Extremity gunshot injuries are a common cause of morbidity and mortality in our environment. They pose a management challenge because of the complex soft tissue and bony injuries. Objectives: The objectives of this study was to determine the pattern and treatment outcomes of these injuries in our setting. Materials and Methods: This was a prospective study of extremity gunshot injuries treated at National Orthopaedic Hospital, Enugu, Nigeria over a 12-month period. Results: Fifty-five patients were studied, with a mean age of 36.9 ± 13.39 years and a male-to-female ratio of 8.2:1. The two top causes of gunshot injuries were armed robbery (41; 74.5%) and assaults/communal clash (6; 10.9%), and the most common type of gun was the rifle (21; 38.2%). Gunshot fracture was the commonest type of injury among the patients (39, 70.9%). Only 34.5.1% of our patients presented to hospital within the first 6h. Secondary wound closure was the commonest method of wound cover. Majority of the gunshot fractures were treated non-operatively. The duration of hospitalization ranged from 2 days to 13 weeks with a mean duration of 4.9 weeks. Late presentation, presence of fracture, and wound infection were associated with prolonged hospital stay. Outcome of treatment was good in 80% of patients and the mortality rate was 1.8%. Conclusion: The young adult males are more involved in extremity gunshot injuries. The fracture rate of these injuries is high with associated increased morbidity. Effective control measures aimed at reducing the incidence of gunshot injuries will reduce the negative socioeconomic impact of these injuries. Unregulated drug use and consequences in the Nigerian health sector Chinwe L Onyekonwu, Chijioke G Onyekonwu, Emmanuel O Ugwu International Journal of Medicine and Health Development 2019 24(2):107-113 Background: The Nigerian health system is bedeviled with poor regulatory services, frequent interruption of services as a result of disharmony among different cadres of health-care providers, inadequate manpower, poor management and leadership, and poor access to care due to non-enrollment in health insurance. Health-care spending is often catastrophic in most cases as payment is usually out of pocket for most service users. This has led to proliferation and patronage of unlicensed and unregulated health-care providers. Some patients are able to afford out of pocket payment but often meet suboptimal functioning services when they present to the hospitals which are also bedeviled by inadequate manpower and health-care facilities. Others who cannot afford the payments first patronize quacks and present later to the hospitals, sometimes with complications and attendant increase in morbidity and mortality. Aims and Objectives: The aim of this study was to highlight some problems that may arise as a result of unregulated drug use in the Nigerian populace and the role of an efficient health system with improved health insurance access, in curbing these problems. Materials and Methods: The reality of the Nigerian Health Care System as it stands today was highlighted and objectives of the National Health Insurance Scheme at inception cited. Three clinical cases of complications arising from poor access to health care and drug use regulation were described. Conclusion: Access to health care in Nigeria has remained poor and mostly out of pocket despite the goal of the National Health Insurance Scheme to provide health care at reduced costs. Patronage of unlicensed health-care providers remains high due to poor access to health care, poverty, and illiteracy with untoward effects on affected individuals. There is an urgent need to scale up access to health insurance across all sectors and ensure efficient service delivery through regular monitoring by appropriate regulatory agencies and constant education of the populace to discourage patronage of quack health-care providers. Carbamazepine-associated urinary incontinence: A case report and literature review Jamir P Rissardo, Ana L Fornari Caprara International Journal of Medicine and Health Development 2019 24(2):114-117 Carbamazepine (CBZ) is an anticonvulsant approved for the management of many neurological and psychiatric disorders. We present a case of an adult male with epilepsy who reported new seizures, and the dose of CBZ administered was 1600mg daily. CBZ dose was increased to 1800mg daily. The subject complained of urinary incontinence without dysuria that started after the CBZ dose increase. It was associated with urgency, hesitancy, dribbling of urine, and poor stream. Laboratory tests were within normal limits. He admitted dry mouth, flushing, constipation, and accommodation paralysis starting after CBZ increase. Assuming that these symptoms were an adverse drug reaction, CBZ was withdrawn and valproate was started. The individual had full recovery within four weeks. To the best of our knowledge, only two case reports of similar nature are available, but this is the first one to be reported with young male adult. Emphasizing on the need of preparedness and antibiotics supply for the containment of the plague outbreak Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava International Journal of Medicine and Health Development 2019 24(2):118-119
Awareness and practice of zinc therapy in diarrheal management among under-five caregivers in Enugu State, NigeriaJoshua I Ugwu, Ikechukwu E Ezeagu, Madu D IbegbuInternational Journal of Medicine and Health Development 2019 24(2):63-69Background: Acute diarrhea remains one of the leading causes of under -five years of age (u-5) childhood deaths in Nigeria. Use of zinc (Zn) sulfate monohydrate with low-osmolality oral rehydration solution (ORS) therapy reduces both the duration and severity of the...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Achieving the Lowest Effective Antipsychotic Dose for Patients with Remitted Psychosis: A Proposed Guided Dose-Reduction Algorithm Abstract Continuing antipsychotic treatment in patients with schizophrenia under clinical remission remains controversial. Even though the mainstream opinion declares an outweighed balance against medication discontinuation, recent reviews and critiques suggest that some patients may remain symptom free and well functioning after stopping antipsychotics, but few predictors can identify who can try medication discontinuation, whilst no guidelines exist for reducing medication to reach the lowest effective dose safely. Analyzing the findings from studies employing different methodologies, adopting evidence from pharmacodynamic research, and observing dose reduction in stable patients, as well as taking inspiration from the metaphor of the Cantor set in natural philosophy, we introduce an alternative solution and propose a guided dose-reduction algorithm that follows a set of clear precautions and instructions. The algorithm recommends only a fraction (no more than 25%) of the dosage to be reduced at a time, with at least a 6-month stabilization period required before reducing another 25% of the dose. Patients are empowered to actively participate in decision making when they are ready for further dose tapering, or should they retreat to a previous dosage if warning signs of a relapse re-emerge. An intermittent or irregular dosing schedule can be used to adapt this algorithm to real-world practice. Our preliminary findings suggest that patients with remitted psychosis can do well along this path. We anticipate that this approach can help optimize the risk–benefit ratio and instill a hope in patients with schizophrenia that they can maintain in stable remission under a lower antipsychotic dose without an increased risk of relapse. Acknowledgement to Referees Adverse Events Associated with Melatonin for the Treatment of Primary or Secondary Sleep Disorders: A Systematic Review AbstractBackground Melatonin is widely available either on prescription for the treatment of sleep disorders or as an over-the-counter dietary supplement. Melatonin has also recently been licensed in the UK for the short-term treatment of jetlag. Little is known about the potential for adverse events (AEs), in particular AEs resulting from long-term use. Concern has been raised over the possible risks of exposure in certain populations including pre-adolescent children and patients with epilepsy or asthma.Objectives The aim of this systematic review was to assess the evidence for AEs associated with short-term and longer-term melatonin treatment for sleep disorders.Methods A literature search of the PubMed/Medline database and Google Scholar was conducted to identify randomised, placebo-controlled trials (RCTs) of exogenous melatonin administered for primary or secondary sleep disorders. Studies were included if they reported on both the types and frequencies of AEs. Studies of pre-term infants, studies of < 1 week in duration or involving single doses of melatonin and studies in languages other than English were excluded. Findings from open-label studies that raised concerns relating to AE reports in patients were also examined. Studies were assessed for quality of reporting against the Consolidated Standards of Reporting Trials (CONSORT) checklist and for risk of bias against the Cochrane Collaboration risk-of-bias criteria.Results 37 RCTs met criteria for inclusion. Daily melatonin doses ranged from 0.15 mg to 12 mg. Subjects were monitored for up to 29 weeks, but most studies were of much shorter duration (4 weeks or less). The most frequently reported AEs were daytime sleepiness (1.66%), headache (0.74%), other sleep-related AEs (0.74%), dizziness (0.74%) and hypothermia (0.62%). Very few AEs considered to be serious or of clinical significance were reported. These included agitation, fatigue, mood swings, nightmares, skin irritation and palpitations. Most AEs either resolved spontaneously within a few days with no adjustment in melatonin, or immediately upon withdrawal of treatment. Melatonin was generally regarded as safe and well tolerated. Many studies predated publication of the CONSORT checklist and consequently did not conform closely to the guidelines. Similarly, only eight studies were judged 'good' overall with respect to the Cochrane risk-of-bias criteria. Of the remaining papers, 16 were considered 'fair' and 13 'poor' but publication of almost half of the papers preceded that of the earliest version of the guidelines.Conclusion Few, generally mild to moderate, AEs were associated with exogenous melatonin. No AEs that were life threatening or of major clinical significance were identified. The scarcity of evidence from long-term RCTs, however, limits the conclusions regarding the safety of continuous melatonin therapy over extended periods. There are insufficient robust data to allow a meaningful appraisal of concerns that melatonin may result in more clinically significant adverse effects in potentially at-risk populations. Future studies should be designed to comply with appropriate quality standards for RCTs, which most past studies have not. Fingolimod Increases Brain-Derived Neurotrophic Factor Level Secretion from Circulating T Cells of Patients with Multiple Sclerosis AbstractBackground The pathophysiology of multiple sclerosis involves an autoimmune and a neurodegenerative mechanism. Central nervous system-infiltrating immune cells in multiple sclerosis also possess a neuroprotective activity through secretion of neurotrophins, such as brain-derived neurotrophic factor. Fingolimod was shown to slow the progression of disability and loss of brain volume.Objective The objective of this study was to explore whether fingolimod induces secretion of neurotrophins by immune cells.Methods Blood was drawn from 21 patients before the initiation of treatment with fingolimod and at 6 and 12 months of follow-up. The levels of the neurotrophic factors brain-derived neurotrophic factor, glial cell-derived neurotrophic factor, β-nerve growth factor, neurotrophin-3, neurotrophin-4, basic fibroblast growth factor, epidermal growth factor, and vascular endothelial growth factor were screened in the supernatants of separated T cells and monocyte cultures using a customized, multiplex enzyme-linked immunosorbent assay. Brain-derived neurotrophic factor levels were further validated by a specific enzyme-linked immunosorbent assay.Results Treatment with fingolimod significantly increased brain-derived neurotrophic factor secretion from T cells. A specific enzyme-linked immunosorbent assay confirmed these results in the supernatant of T cells after 6 and 12 months of therapy.Conclusions T cells that reach the bloodstream of fingolimod-treated patients with multiple sclerosis may contribute to the neuroprotective effect of this therapy by increased secretion of brain-derived neurotrophic factor. This mechanism of action of fingolimod in patients with multiple sclerosis has not been previously reported. An Update on Vitamin D and Disease Activity in Multiple Sclerosis Abstract Vitamin D and its main active metabolite 1,25-dihydroxyvitamin D serve a crucial role in maintenance of a healthy calcium metabolism, yet have additional roles in immune and central nervous system cell homeostasis. Serum levels of 25-hydroxyvitamin D are a biomarker of future disease activity in patients with early relapsing–remitting multiple sclerosis (RRMS), and vitamin D supplementation in patients with low circulating 25-dihydroxyvitamin D levels has been anticipated as a potential efficacious treatment strategy. The results of the first large randomized clinical trials (RCTs), the SOLAR and CHOLINE studies, have now been published. The SOLAR study compared 14,000 IU of vitamin D3 (cholecalciferol) per day with placebo for 48 weeks in 232 randomized patients, whereas CHOLINE compared vitamin D3 100,000 IU every other week with placebo for 96 weeks in 129 randomized patients. All patients in both studies also used interferon-β-1a. None of the studies met their primary endpoints, which were no evidence of disease activity (NEDA-3) at 48 weeks in SOLAR and annualized relapse rate at 96 weeks in CHOLINE. Both studies did, however, suggest modest effects on secondary endpoints. Thus, vitamin D reduced the number of new or enlarging lesions and new T2 lesions in SOLAR, and the annualized relapse rate and number of new T1 lesions, volume of hypointense T1 lesions, and disability progression in the 90 patients who completed 96 weeks' follow-up in CHOLINE. We conclude that none of the RCTs on vitamin supplementation in MS have met their primary clinical endpoint in the intention to treat cohorts. This contrasts the observation studies, where each 25 nmol/l increase in 25-hydroxyvitamin D levels were associated with 14–34% reduced relapse risk and 15–50% reduced risk of new lesions on magnetic resonnance imaging. This discrepancy may have several explanations, including confounding and reverse causality in the observational studies. The power calculations of the RCTs have been based on the observational studies, and the RCTs may have been underpowered to detect less prominent yet important effects of vitamin D supplementation. Although the effect of vitamin D supplementation is uncertain and less pronounced than suggested by observational studies, current evidence still support that people with MS should avoid vitamin D insufficiency, and preferentially aim for vitamin D levels around 100 nmol/L or somewhat higher. Ischemic and Thrombotic Events Associated with Concomitant Xa-inhibiting Direct Oral Anticoagulants and Antiepileptic Drugs: Analysis of the FDA Adverse Event Reporting System (FAERS) AbstractIntroduction Factor Xa-inhibiting direct oral anticoagulants (FXa-DOACs) undergo hepatic metabolism via cytochrome P-450 (CYP450). Concomitant use of rifampicin, an inducer of these enzymes, with FXa-DOACs, has been shown to decrease FXa-DOAC concentrations in healthy subjects. Several common antiepileptic drugs (AEDs) are known to induce CYP450 enzymes as well. However, little is known regarding the impact of this potential interaction on treatment outcomes with FXa-DOACs.Methods We analyzed adverse event cases submitted to the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) from January 2013 to December 2018. We compared the proportion of cases reporting thromboembolic and ischemic adverse events (TAIAEs) with the concomitant use of FXa-DOACs and enzyme-inducing AEDs to the proportion of cases with FXa-DOACs and other AEDs.Results During this period, 9693 adverse event cases reported concomitant use of FXa-DOACs and AEDs. Almost all reports (> 99%) involved the use of rivaroxaban or apixaban. Compared with other AEDs, enzyme-inducing AEDs were associated with an 86% increase in the odds of reporting TAIAEs [reporting odds ratio (ROR) 1.86, 95% confidence interval (CI) 1.61–2.15; p < 0.0001]. In secondary separate analyses of rivaroxaban and apixaban, enzyme-inducing AEDs were similarly associated with increased reporting of a TAIAE (ROR 1.79, 95% CI 1.50–2.12, and ROR 1.88, 95% CI 1.41–2.48, respectively).Conclusion Using real world data, we observed an increase in the odds of reporting anticoagulation treatment failure among patients treated with FXa-DOACs and concomitant enzyme-inducing AEDs compared to those treated with other AEDs. Risk Factors Associated with the Occurrence of Neonatal Opioid Withdrawal Syndrome: A Review Abstract In a number of countries, the prevalence of neonatal opioid withdrawal syndrome (NOWS) is increasing. While NOWS is ultimately the result of opioid exposure in utero, a wide range of risk factors have been associated with the prevalence of NOWS, extending beyond just drug exposure. This article reviews the available literature on factors associated with the incidence of NOWS in opioid-exposed neonates. A range of risk factors have been associated with NOWS, including features of neonatal drug exposure, maternal and neonatal characteristics, aspects of labor and delivery, and genetics. Increased length of gestation and higher birth weight were consistently associated with an increased risk of NOWS, while breast feeding and 'rooming-in' were associated with a reduced risk of NOWS. Additionally, several genetic factors have also been associated with NOWS severity. There is conflicting evidence on the association between NOWS and other risk factors including opioid dose, neonate sex, and the use of some medications during pregnancy. This may be in part attributable to differences in how NOWS is diagnosed and the variety of methodologies across studies. While a large number of risk factors associated with NOWS are non-modifiable, encouraging pregnant women to reduce other drug use (including smoking), breast feed their child, and the judicious use of medications during pregnancy may help reduce the prevalence of NOWS. The presence or absence of NOWS in an opioid-exposed neonate is associated with a wide range of factors. Some of these modifiable risk factors may be potential targets for the primary prevention of NOWS. Recent Advances in Pharmacotherapy for Episodic Migraine Abstract In 2018, three calcitonin gene-related peptide (CGRP) pathway monoclonal antibodies, erenumab, fremanezumab and galcanezumab, were approved in various parts of the world, including Europe and the US, and another, eptinezumab, is pending, for the prevention of migraine. In this article, episodic migraine treatment is reviewed, although these medicines are approved and are just as effective for chronic migraine. These new medicines usher a new phase in the preventive management of migraine with migraine-specific treatments. Data from phase III trials of CGRP pathway monoclonal antibodies have shown they are efficacious, with adverse effect rates comparable to placebo. The combination of clear efficacy and excellent tolerability will be welcome in an area where poor adherence to current preventives is common. Rimegepant, ubrogepant and lasmiditan are migraine-specific acute therapies yet to be approved by regulators. Phase III data for the respective CGRP receptor antagonists, the gepants, and the serotonin 5-HT1F receptor agonist, the ditan, have been positive and free of cardiovascular adverse effects. These medicines are not vasoconstrictors. When approved, they could meet the acute therapy demand of patients with cardiovascular risk factors where triptans are contraindicated. Beyond this, gepants will see the most disruptive development in migraine management in generations with medicines that can have both acute and preventive effects, the latter evidenced by data from the discontinued drug telcagepant and the early-phase drug atogepant. Moreover, one can expect no risk of medication overuse syndromes with gepants since the more patients take, the less migraines they have. During the next years, as experience with monoclonal antibodies grows in clinical practice, we can expect an evolution in migraine management to take shape. Clinicians will be able to offer treatment patients want rather than trying to fit migraineurs into therapeutic boxes for their management. Despite pessimistic susurrations of a largely addlepated form, many patients, and physicians, will welcome new options, and the challenges of new treatment paradigms, with optimism. Targeting Iron Dyshomeostasis for Treatment of Neurodegenerative Disorders Abstract While iron has an important role in the normal functioning of the brain owing to its involvement in several physiological processes, dyshomeostasis has been found in many neurodegenerative disorders, as evidenced by both histopathological and imaging studies. Although the exact causes have remained elusive, the fact that altered iron levels have been found in disparate diseases suggests that iron may contribute to their development and/or progression. As such, the processes involved in iron dyshomeostasis may represent novel therapeutic targets. There are, however, many questions about the exact interplay between neurodegeneration and altered iron homeostasis. Some insight can be gained by considering the parallels with respect to what occurs in healthy aging, which is also characterized by increased iron throughout many regions in the brain along with progressive neurodegeneration. Nevertheless, the exact mechanisms of iron-mediated damage are likely disease specific to a certain degree, given that iron plays a crucial role in many disparate biological processes, which are not always affected in the same way across different neurodegenerative disorders. Moreover, it is not even entirely clear yet whether iron actually has a causative role in all of the diseases where altered iron levels have been noted. For example, there is strong evidence of iron dyshomeostasis leading to neurodegeneration in Parkinson's disease, but there is still some question as to whether changes in iron levels are merely an epiphenomenon in multiple sclerosis. Recent advances in neuroimaging now offer the possibility to detect and monitor iron levels in vivo, which allows for an improved understanding of both the temporal and spatial dynamics of iron changes and associated neurodegeneration compared to post-mortem studies. In this regard, iron-based imaging will likely play an important role in the development of therapeutic approaches aimed at addressing altered iron dynamics in neurodegenerative diseases. Currently, the bulk of such therapies have focused on chelating excess iron. Although there is some evidence that these treatment options may yield some benefit, they are not without their own limitations. They are generally effective at reducing brain iron levels, as assessed by imaging, but clinical benefits are more modest. New drugs that specifically target iron-related pathological processes may offer the possibility to prevent, or at the least, slow down irreversible neurodegeneration, which represents an unmet therapeutic target. The Potential Therapeutic Capacity of Inhibiting the Brain Renin–Angiotensin System in the Treatment of Co-Morbid Conditions in Epilepsy Abstract Epilepsy is one of the most prevalent neurological diseases and although numerous novel anticonvulsants have been approved, the proportion of patients who are refractory to medical treatment of seizures and have progressive co-morbidities such as cognitive impairment and depression remains at about 20–30%. In the last decade, extensive research has identified a therapeutic capacity of the components of the brain renin–angiotensin system (RAS) in seizure- and epilepsy-related phenomena. Alleviating the activity of RAS in the central nervous system is considered to be a potential adjuvant strategy for the treatment of numerous detrimental consequences of epileptogenesis. One of the main advantages of RAS is associated with its modulatory influence on different neurotransmitter systems, thereby exerting a fine-tuning control mechanism for brain excitability. The most recent scientific findings regarding the involvement of the components of brain RAS show that angiotensin II (Ang II), angiotensin-converting enzyme (ACE), Ang II type 1 (AT1) and type 2 (AT2) receptors are involved in the control of epilepsy and its accompanying complications, and therefore they are currently of therapeutic interest in the treatment of this disease. However, data on the role of different components of brain RAS on co-morbid conditions in epilepsy, including hypertension, are insufficient. Experimental and clinical findings related to the involvement of Ang II, ACE, AT1, and AT2 receptors in the control of epilepsy and accompanying complications may point to new therapeutic opportunities and adjuvants for the treatment of common co-morbid conditions of epilepsy.
Achieving the Lowest Effective Antipsychotic Dose for Patients with Remitted Psychosis: A Proposed Guided Dose-Reduction AlgorithmAbstractContinuing antipsychotic treatment in patients with schizophrenia under clinical remission remains controversial. Even though the mainstream opinion declares an outweighed balance against medication discontinuation, recent reviews and critiques suggest that some patients may remain symptom free and well functioning after stopping antipsychotics, but few predictors...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Patient-Reported Outcomes in Adult Idiopathic Inflammatory Myopathies AbstractPurpose of Review Idiopathic inflammatory myopathies (IIM) have considerable impact on patient symptoms and quality of life. We have reviewed the evolution of patient-centered care and use of patient-reported outcome measures (PROMs) for adults with IIM.Recent Findings Use of PROMs in myositis care and research is limited, although the importance of incorporation into routine practice and trials has become increasingly recognized. Several key domains/measures have been identified including the patient global assessment of disease activity, physical function as measured by the health assessment questionnaire-disability index (HAQ-DI), Short Form Health Survey-36 (SF-36), or the Patient-Reported Outcome Measurement Information System ® (PROMIS®) in adult IIM. Data are limited for these instruments concerning their reliability, content and construct validity, and responsiveness.Summary Incorporation of the patient perspective into clinical care and research may be used to address the unmet/unaddressed needs of the patient living with myositis. Several ongoing projects aim to bring validated PROMs to the IIM community. "Mobile Health" for the Management of Spondyloarthritis and Its Application in China AbstractPurpose of the Review Spondyloarthritis (SpA) is a group of inflammatory diseases characterized by inflammation in the spine, peripheral joints, and entheses that usually start at the prime of one's life and lead to impaired physical function and reduced quality of life. Ankylosing spondylitis (AS) is prototype of SpA. This article reviews the opportunities and challenges of using mobile health (mHealth) in managing SpA, and report some of our experiences using a mHealth solution for management of SpA patients and performing related research in China.Recent Findings The recent rapid development of mobile communications and the common use of intelligent electronic devices have led to the increasing application of mHealth for chronic disease management by healthcare providers and patients alike. This is a promising new technology that can help mitigate limitations in time and space for patient management, promote easier communication between patients and their healthcare providers, reduce medical expenses, and optimize medical services. We have developed a smartphone-based mHealth SpA management system (SpAMS) that also helps the patients to monitor, manage, and share information on their disease with their physician at regular intervals.Summary There is a shift from a paternalistic model of healthcare to more personalized healthcare in which disease management is conducted by the patient together with their healthcare providers. The increasing utility of mHealth is expected to benefit disease management, promote patient–doctor communication, reduce medical expenses, and optimize medical services. Chlamydia -Induced Reactive Arthritis: Disappearing Entity or Lack of Research? AbstractPurpose of Review Recent studies regarding the frequency of Chlamydia-induced reactive arthritis (ReA) are reviewed, with a focus on the question of whether the entity is in fact disappearing or whether it is simply being underdiagnosed/underreported. Epidemiological reports indicate diversity in the frequency of Chlamydia-associated ReA in various parts of the world, with evidence of declining incidence in some regions.Recent Findings The hypothesis that early effective treatment with antibiotics prevents the manifestation of Chlamydia-associated ReA requires further investigation.Summary For clinicians, it is important to remember that ReA secondary to Lymphogranuloma venereum (LGV) serovars L1–L3 of C. trachomatis is probably underestimated due to a limited awareness of this condition, the re-emergence in Western countries of LGV overall, and the present increasingly rare classical inguinal presentation. Understanding the Cryoglobulinemias AbstractPurpose of the Review Cryoglobulins are immunoglobulins with the ability to precipitate at temperatures <37 °C. They are related to hematological disorders, infections [especially hepatitis C virus (HCV)], and autoimmune diseases. In this article, the state of the art on Cryoglobulinemic Vasculitis (CV), in a helpful and schematic way, with a special focus on HCV related Mixed Cryoglobulinemia treatment are reviewed.Recent Findings Direct – acting antivirals (DAA) against HCV have emerged as an important key in HCV treatment to related Cryoglobulinemic Vasculitis, and should be kept in mind as the initial treatment in non–severe manifestations. On the other hand, a recent consensus panel has published their recommendations for treatment in severe and life threatening manifestations of Mixed Cryoglobulinemias.Summary HCV-Cryoglobulinemic vasculitis is the most frequent form of CV. There are new treatment options in HCV-CV with DAA, with an important number of patients achieving complete response and sustained virologic response (SVR). In cases of severe forms of CV, treatment with Rituximab and PLEX are options. The lack of data on maintenance therapy could impulse future studies in this setting. Qigong and Musculoskeletal Pain AbstractPurpose of Review Musculoskeletal pain is a widespread symptom that commonly produces considerable disability, particularly in later life. This brief review strove to summarize and critically review the recent research base concerning the use of Qigong as a possible strategy for alleviating longstanding or chronic musculoskeletal pain states.Methods Research reports and literature reviews specifically focusing on Qigong and its impact on various forms of musculoskeletal pain between 2015 and 2019 were sought and analyzed, along with related data.Results Collectively, these data reveal that while more research is indicated, Qigong practice may help to attenuate pain in varying degrees among adults with different forms of chronic pain with few side-effects.Conclusion More research is needed to ensure health professionals working with adults who have chronic unrelenting musculoskeletal pain may safely recommend these exercises as one possible remedy for reducing intractable musculoskeletal pain. The Pathogenesis of Ankylosing Spondylitis: an Update AbstractPurpose of Review Ankylosing spondyloarthritis (AS) is a chronic inflammatory disease that involves the axial joints and entheses. Extra-spinal manifestations such as anterior uveitis, psoriasis, and colitis also occur frequently. This review on the pathogenesis of AS includes an update on the recent discoveries within the field.Recent Findings HLA-B*27 is still considered of major importance in the pathogenesis, and it has recently been shown to profoundly affect the gut microbiome and its metabolites and the handling of bacteria during infection. Biochemical and biophysical properties of HLA-B*27 influence its ability to misfold, to induce an endoplasmic reticulum stress response, and to promote autophagy/unfolded protein responses (UPR). HLA-B*27 free heavy chains may induce inflammation through T cells, NK cells, and myeloid cells. Induction of UPR genes results in release of tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), IL-23, and interferon-γ and increase in T helper (Th) 17 cells. Several other HLA-B and non-B molecules have been associated with AS, although their role in the pathogenesis is unknown.Summary Genotypes of endoplasmic reticulum aminopeptidases (ERAP) 1 and 2 have been associated with alterations in the antigenic pool expressed by HLA-B*27 molecules. In the gut, innate immune cells type 3 (ILC3) influence T cell expression of IL-17 and IL-22. Gamma-delta (γ/δ) T cells are induced by IL-23 to produce IL-17. IL-7 induces mucosa-associated invariant T (MAIT) cells to produce IL-17. Besides the microbiome, zonulin may be important through its effects on the permeability of tight junctions in the intestinal epithelial barrier. Clinical Insights into Diffuse Alveolar Hemorrhage in Antiphospholipid Syndrome AbstractPurpose of Review Diffuse alveolar hemorrhage (DAH) is a rare but devastating manifestation of antiphospholipid syndrome (APS) patients with or without other systemic autoimmune diseases. Data regarding diagnosis and treatment are limited to case series. We review diagnostic and therapeutic strategies employed in APS patients with DAH and discuss our experience in managing these complex patients.Recent Findings Pulmonary capillaritis likely contributes to the pathogenesis, however is only observed in half of the biopsies. Corticosteroids induce remission in the majority of patients, however almost half recur and require a steroid-sparing immunosuppressive to maintain remission. Cyclophosphamide- or rituximab-based regimens achieve the highest remission rates (50%); other strategies include intravenous immunoglobulin, plasmapheresis, mycophenolate mofetil, and/or azathioprine.Summary Given the rarity of DAH in APS, treatment is guided by interdisciplinary experience. Why certain patients achieve full remission with corticosteroids while others require immunosuppressive agents is unknown; future research should focus on the pathophysiology and optimal management. Transitional Care in Rheumatology: a Review of the Literature from the Past 5 Years AbstractPurpose of Review Effective transitional care for adolescents and young adults (AYA) with rheumatic musculoskeletal disease (RMD) is fundamental to rheumatology care provision. Here we review the recent evidence from the literature on transition in rheumatology and debate why universal implementation has yet to be recognised.Recent Findings Evidence of need for transitional care continues to be reported. The triphasic nature of transitional care remains poorly recognised, and the third phase following transfer to adult rheumatology is particularly under-researched in spite of the recognition of the age-related trajectories of transition skill development during young adulthood. Several rheumatology-specific transitional care interventions have now been evaluated but the search for valid measures including outcome continues. Finally, the need to study transition at a health system level is increasingly recognised.Summary Future research in this area should consider the developmental trajectories of AYA as well as the social-ecological model of transition readiness, which focuses on the interactions between AYA, caregivers and providers (and the systems they are part of) as these are the likely targets of any intervention to improve health transitions. Orbital Vasculitides–Differential Diagnosis AbstractPurpose of Review The orbit is subject to a variety of vascular insults that manifest with both specific and nonspecific patterns of vision compromise. The aim of the following review is to highlight the ophthalmic clinical features of systemic vasculitides that most frequently involve the orbit and differentiate them from the most common non-vasculitic orbital disorders.Recent Findings New studies continue to explore the autoimmune nature of vasculitic disease and seek to determine optimal use of newer therapies such as biologic agents.Summary The pattern of ocular involvement in the context of clinical history allows the knowledgeable physician to distill a differential diagnosis into a specific or likely cause. Establishing a diagnosis in a timely fashion allows for a custom-tailored approach to therapy. Novel Developments in Primary Immunodeficiencies (PID)—a Rheumatological Perspective AbstractPurpose of Review The purpose of this review is to provide an overview of the most relevant new disorders, disease entities, or disease phenotypes of primary immune deficiency disorders (PID) for the interested rheumatologist, using the new phenotypic classification by the IUIS (International Union of Immunological Societies) as practical guide.Recent Findings Newly recognized disorders of immune dysregulation with underlying mutations in genes pertaining to the function of regulatory T cells (e.g., CTLA-4, LRBA, or BACH2) are characterized by multiple autoimmune diseases—mostly autoimmune cytopenia—combined with an increased susceptibility to infections due to hypogammaglobulinemia. On the other hand, new mutations (e.g., in NF-kB1, PI3Kδ, PI3KR1, PKCδ) leading to the clinical picture of CVID (common variable immmune deficiency) have been shown to increasingly associate with autoimmune diseases.Summary The mutual association of autoimmune diseases with PID warrants increased awareness of immunodeficiencies when diagnosing autoimmune diseases with a possible need to initiate appropriate genetic tests.
Patient-Reported Outcomes in Adult Idiopathic Inflammatory MyopathiesAbstractPurpose of ReviewIdiopathic inflammatory myopathies (IIM) have considerable impact on patient symptoms and quality of life. We have reviewed the evolution of patient-centered care and use of patient-reported outcome measures (PROMs) for adults with IIM.Recent FindingsUse of PROMs in myositis care and research is limited, although the importance of incorporation into routine practice and trials has become increasingly recognized....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Predictors and prevalence of bipolar disorders in patients with a major depressive disorder Reda M Ismail, Hala T Mohamed, Rania A Hamed, Sherif A Helal Egyptian Journal of Psychiatry 2019 40(3):127-136 Introduction Onset of bipolar disorder (BD) involves a major depressive episode (MDE) in approximately half of type-I (BD-I) patients and three-quarters of those diagnosed with type-II (BD-II). Aim To detect the soft signs and the predictors of BD in patients with a MDE. Participants and methods A sample of 500 patients was solicited fulfilling the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for a current MDE. Patients were given the HCL-32-R2 questionnaire to assess the presence of manic/hypomanic symptoms; those scoring less than 14 were considered bipolar. We also examined whether demographics, psychiatric history, clinical characteristics, and the incidence of comorbid conditions differed significantly between patients with BD and unipolar disorder. Results A number of factors were highly predictive of bipolarity, including age at illness onset, family history of bipolarity, seasonality, mixed state, manic switch, mood irritability, and mood reactivity. Of the comorbidities examined, thyroid disorders, cardiovascular disorders, generalized anxiety disorder, presence of psychotic features, and borderline personality disorder occurred at a higher rate in patients with BDs than in those with unipolar disorders. Conclusion A number of factors in the patient's psychiatric history as well as clinical aspects of the episode itself may signal an increased likelihood of bipolarity. Schizophrenia symptom dimensions in correlation to patients' demographic and clinical characteristics Samah Rabei, Haitham Osama ElBoraie, Nesrin Elsaadouni, Mohamed Ezzat Elhadidy Egyptian Journal of Psychiatry 2019 40(3):137-140 Background Schizophrenia symptom dimensions could vary with clinical and demographic variables. Materials and methods A total of 100 patients with schizophrenia were diagnosed based on the Diagnostic and statistical manual criteria of the American Psychiatric association. Positive and negative symptom scale was used to assess schizophrenia symptoms. The search for possible correlations between dimensions and demographic and clinical variables was done by Pearson correlation coefficient. Results and conclusion Symptom dimensions showed a correlation with age, onset, duration, hospitalization, compliance to medication, duration without treatment, and family history of schizophrenia. Intercorrelation of symptom dimensions in patients with schizophrenia Nesrin Elsaadouni, Haitham Elboraie, Samah Rabei, Ahmed Elboraie Egyptian Journal of Psychiatry 2019 40(3):141-146 Background The heterogeneity of schizophrenia symptoms is well documented. The positive and negative distinction is limited to cover the entire spectrum of schizophrenia phenomenology. Aim The aim of the study is to find out the major symptom dimensions of phenomenology in a sample of schizophrenic patients. Materials and methods We recruited 100 schizophrenic patients. Diagnosis was based on diagnostic and statistical manual criteria. Positive and negative symptoms scale was used to assess schizophrenia symptoms. Patients' scores were subjected to factor analysis with varimax rotation. Internal consistency was determined by the use of Cronbach's α. Results Five dimensions (factors) were produced: negative, excitement, positive, depressive, and cognitive dimensions. Internal consistency was quite satisfactory. Psychosocial aspects and personality dimensions among a sample of patients with irritable bowel syndrome Hala M Abd Elaziz, Reda M Ismail, Hala T Mohammed, Shimaa Y Abd Elaziz Egyptian Journal of Psychiatry 2019 40(3):147-154 Background Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract, a burden to society through total direct costs, reduced social functioning, and quality of life impairment. Aim The aim of the study was to determine the associated psychosocial risk factors and personality traits in a sample of IBS patients. Participants and methods A total of 100 patients of IBS were recruited from the Gastroenterology and Internal Medicine Outpatient Clinics Departments at Al Zahraa University Hospital during the period from January 2018 to August 2018 and 100 apparently healthy participants as the control group (aged 18–45 years) were subjected to clinical psychiatric assessment, Eysenck's Personality Questionnaire, Stressor life events questionnaire, and Structured Clinical Interview for DSM-IV Axis I. Results The total number of cases was 100 [25 (25%) men and 75 (75%) women] with a mean age of 34.18±6.4 years; there was statistical significance regarding age, sex, marital status, and high significance in family history of IBS, education, employment; 51% had long duration of illness of more than 5 years. High neuroticism score was detected in 63% of the patients versus (VS) 20% of the control group and 52% of the patients had low extroversion VS 16% in the control group. There was high statistical significance in family, economic, social, emotional, health, and personal stressors. Moreover, 66% of the patients had psychiatric comorbidity, high statistical significance with generalized anxiety disorder and hypochondriasis, and statistical significance with somatization, dysthymic disorder, mixed anxiety depression, and panic disorder. Conclusion In this study, we found that IBS was associated with significant psychological distress and psychiatric comorbidities as psychosocial factors, so good assessment and early recognition will permit early intervention to improve outcome of the IBS and quality of life. Effect of adult attention-deficit hyperactivity on disability and quality of life of bipolar patients Amira A Fouad, Heba A Fouad, Shimaa I Amin Egyptian Journal of Psychiatry 2019 40(3):155-161 Background Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disease, usually first diagnosed during childhood or adolescence. A significant portion (∼50–65%) of ADHD symptoms persist into adulthood. Adult ADHD and bipolar disorder (BD) are common comorbid psychiatric conditions. Comorbidity between BD and adult ADHD has been reported in both ADHD and BD cases. Aim To determine the effect of comorbid adult ADHD on disability and quality of life of patients with bipolar disorder. Patients and methods This is a cross-sectional study that was done at the Psychiatric Department in the Zagazig University Hospitals, Sharkia Governorate, Egypt, during the period from May to November, 2017. One hundred and two euthymic patients with Diagnostic and statistical manual of mental disorders, 4th ed. − text revision diagnosis of BD I were selected by simple random probability sampling from the patients with bipolar disorder who came for follow-up and to receive their medications from psychiatric outpatient clinic. Results The mean age of the participants ranged from 18 to 40 years, and 51% were female. Patients with bipolar disorder with adult ADHD had more disability in work, social life, and family life than patients with pure bipolar disorder. Moreover, patients with bipolar disorder without adult ADHD had significant better quality of life in all domains as reflected by higher scores in WHO quality-of-life scale than patients with adult ADHD. Conclusion Adult ADHD is a frequent comorbid disorder in patients with BD. Adult ADHD comorbidity negatively affects functioning and quality of life of patients with BD. Psychiatric aspects of children who witness domestic violence Zeinab Gomma, El Sayed Saleh, Yomna Rizk, Dalia Asfour Egyptian Journal of Psychiatry 2019 40(3):162-169 Background The presence of domestic violence witnessed by children leads to development of different mental disorders of childhood. Objectives This study was aimed to assess the prevalence of psychiatric disorders in children who witness domestic violence. Patients and methods A community-based case–control study was designed to assess the prevalence of psychiatric disorder in children who witness domestic violence of both sexes aged 6–18 years old with different socioeconomic classes. Tools of measurement used in the current study were Hurt, Insulted, Threatened with Harm and Screamed tool; socioeconomic scale by El-Gilany; symptoms check list (SCL-90); and Structured Clinical Interview for DSM-IV Childhood Diagnoses for child's interview. Results The most common disorders among children witness domestic violence is conduct disorder (15%), major depressive disorder (10%), and attention-deficit hyperactive disorder (8.3%). Children who are not affected among studied families (cases) represented 33.3%. There was a statistically significant difference among cases that witness domestic violence and controls who did not witness it regarding additional signs, loss of appetite, insomniac problems, death ideas, aggressive symptom, and reactive sensitivity symptoms reported as well as global stress indices measured by SCL-90. The most common reason for domestic violence was the financial reasons. Fathers are more responsible for most of the violence incidents. Conclusions Ignoring of suffering and the long duration spent with domestic violent atmosphere without seeking help increase the risk for psychiatric disorder in those children. So legal empowerment and aid projects are essential in raising awareness to influence cultural change and put an end to domestic violence.
Predictors and prevalence of bipolar disorders in patients with a major depressive disorderReda M Ismail, Hala T Mohamed, Rania A Hamed, Sherif A HelalEgyptian Journal of Psychiatry 2019 40(3):127-136Introduction Onset of bipolar disorder (BD) involves a major depressive episode (MDE) in approximately half of type-I (BD-I) patients and three-quarters of those diagnosed with type-II (BD-II). Aim To detect the soft signs and the predictors of BD in patients with a MDE. Participants and methods A sample...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Information for CME Credit—Adherence to Cervical Cancer Screening Guidelines Among Women Aged 66–68 Years in a Large Community-Based Practice Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Ettinger de Cuba SA, Bovell-Ammon AR, Cook JT, et al. SNAP, young children's health, and family food security and healthcare access. Am J Prev Med. 2019;57(4)525–532 Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): U.S. Immigration Law Enforcement Practices and Health Inequities Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Paul J. Fleming, Nicole L. Novak, William D. Lopez Expanding Diabetes Prevention: Obstacles and Potential Solutions Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Michael Bergman The Obesity Parenting Intervention Scale: Factorial Validity and Invariance Among Head Start Parents Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Roger Figueroa, Jaclyn A. Saltzman, Alyssa Aftosmes-Tobio, Kirsten K. Davison IntroductionObesity affects 15.7% of U.S. preschoolers, with higher rates among low-income and Spanish-speaking populations. Food, physical activity, and sleep parenting practices, referred to collectively as obesity-related parenting practices, are linked with children's risk of obesity and are a common target in family-based obesity interventions. Yet, there is no brief, validated measure of obesity-related parenting practices that is appropriate for use in intervention studies and for diverse audiences. This study tests the factorial validity of a brief measure of obesity-related parenting and measurement invariance of the English and Spanish versions of the scale, as well as among mothers and fathers. MethodsParents of children enrolled in Head Start (n=578; 500 mothers and 78 fathers) completed a brief survey of food (7 items), physical activity (5 items), and sleep parenting (3 items) in fall of 2017 and 2018. Scale items were drawn from existing measures and the evidence base, initially drafted in English, and then translated to Spanish. One parent per family completed the scale independently in English (n=448) or Spanish (n=130). A confirmatory factor analysis framework was adopted to test a 3-factor model for the total sample. Multi-group structural equation modeling was used to assess measurement invariance of the scale by the language of administration (English or Spanish) and among mothers and fathers separately. ResultsResults supported a 3-factor model of obesity parenting with a single factor each for food, physical activity, and sleep parenting. There was statistically significant measurement invariance across all groups (p<0.05). Internal consistency was adequate across factors (α=0.65−0.80). ConclusionsThis brief obesity-parenting scale demonstrates adequate factorial validity in English and Spanish and among mothers and fathers. This measure has been integrated into an intervention, and future work will test sensitivity to change. A Methodologic Systematic Review of Mobile Health Behavior Change Randomized Trials Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Theodora Oikonomidi, Alexandre Vivot, Viet-Thi Tran, Carolina Riveros, Elisabeth Robin, Philippe Ravaud ContextMobile health helps providers offer accessible, affordable, tailored behavior change interventions. However, research assessing mobile health interventions may feature methodologic shortcomings and poor reporting. This review aims to summarize the characteristics, methods, and intervention reporting of RCTs evaluating mobile health behavior change interventions. Evidence acquisitionThis was a methodologic systematic review of RCTs assessing mobile health behavior change interventions published in PubMed from January 1, 2014 to January 1, 2018, in journals with the upper half of Impact Factors (Clarivate Analytics). Three reviewers independently extracted sample characteristics. Primary outcomes were classified as patient-important or not using definitions from the literature. Any non–patient-important outcomes were then reclassified by a panel of 3 patients. Intervention reporting was assessed by the mobile health Evidence Reporting and Assessment checklist. Data were analyzed in December 2018. Evidence synthesisMost of the 231 included RCTs assessed text messaging (51%) or smartphone app (28%) interventions aiming to change nutrition and physical activity (36%) or treatment adherence (25%). Only 8% of RCTs had a patient-important primary outcome, follow-up of ≥6 months, and intent-to-treat analysis. Most primary outcomes were behavioral measures (60%). Follow-up was <3 months in 29% of RCTs. Regarding reporting, 12 of the 16 checklist items were reported in less than half of RCTs (e.g., usability/content testing, 32%; data security, 13%). ConclusionsReports of RCTs assessing mobile health behavior change interventions lack information that would be useful for providers, including reporting of long-term intervention impact on patient-important primary outcomes and information needed for intervention replicability. Firearm Storage Practices and Risk Perceptions Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Amanda I. Mauri, Julia A. Wolfson, Deborah Azrael, Matthew Miller IntroductionDuring the past 2 decades, gun owners have become more likely to store household firearms loaded and unlocked, and believe that guns make homes safer rather than more dangerous. MethodsSelf-reported household firearm storage practices were described among 2,001 gun owners in relation to whether they report that firearms make homes (1) safer, (2) more dangerous, or (3) it depends. Data were from a probability-based online survey administered in 2015 (completion rate, 55%) and analyzed in 2018. ResultsNearly 60% of gun owners said that guns make homes safer (57.6%, 95% CI=55.1%, 60.1%), 39.9% (95% CI=37.4%, 42.5%) said that it depends (on other factors), and 2.5% (95% CI=1.8%, 3.4%) said that guns make homes more dangerous. A higher proportion of gun owners who reported that they believe guns increase household safety said that they store household firearms loaded and unlocked (39.2%, 95% CI=35.9%, 42.6%), compared with those who thought guns make the home either more dangerous (3.7%, 95% CI=1.3%, 10.1%) or those who thought the effect of guns on household safety depends on additional factors (17.5%, 95% CI=14.7%, 20.7%). ConclusionsGun owners who are most likely to assert categorically that firearms in the home make homes safer are, as a group, far more likely to store guns in their home loaded and unlocked. Drone and Other Hobbyist Aircraft Injuries Seen in U.S. Emergency Departments, 2010–2017 Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Jack A. Johnson, Megan R. Svach, Lawrence H. Brown IntroductionRecreational radio-controlled hobbyist aircraft—particularly "drones"—have become increasingly popular in the last decade. The purpose of this study is to describe injuries associated with hobbyist drones and compare them with injuries associated with other hobbyist aircraft. MethodsIn this 2018 cross-sectional analysis of National Electronic Injury Surveillance System data for 2010–2017, case narrative fields were searched to identify emergency department visits related to hobbyist aircraft injuries. The incidence of hobbyist aircraft injuries was estimated, and summary statistics, chi-square tests, and t-tests were used to describe and compare the demographic and clinical characteristics of drone and other hobbyist aircraft-related cases. ResultsAn estimated 12,842 hobbyist aircraft injuries presented to U.S. emergency departments during 2010–2017. An increased incidence attributable to drone-related injuries emerged in 2015. Overall, most injuries involved male patients aged 50 years on average. Propeller injuries were the leading mechanism. An estimated 270 patients required hospital admission. Patients injured by drones were younger (mean, 34 years vs 58 years; p<0.001) and more likely to be female than patients injured by hobbyist planes. Drone-related injuries were more likely than plane-related injuries to result from blunt trauma (e.g., being struck or falling during aircraft retrieval; 40.5% vs 7.9%, p<0.001). Helicopter-related injuries more closely resembled drone-related injuries than plane-related injuries. ConclusionsHobbyist aircraft-related injuries are increasing, particularly drone-related injuries. Tailored injury prevention measures and product safety materials are needed to address all hobbyist aircraft-related injuries, with a particular focus on drone-related injury prevention measures. Predicting Opioid Overdose Deaths Using Prescription Drug Monitoring Program Data Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Lindsey M. Ferris, Brendan Saloner, Noa Krawczyk, Kristen E. Schneider, Molly P. Jarman, Kate Jackson, B. Casey Lyons, Matthew D. Eisenberg, Tom M. Richards, Klaus W. Lemke, Jonathan P. Weiner IntroductionPrescription Drug Monitoring Program data can provide insights into a patient's likelihood of an opioid overdose, yet clinicians and public health officials lack indicators to identify individuals at highest risk accurately. A predictive model was developed and validated using Prescription Drug Monitoring Program prescription histories to identify those at risk for fatal overdose because of any opioid or illicit opioids. MethodsFrom December 2018 to July 2019, a retrospective cohort analysis was performed on Maryland residents aged 18–80 years with a filled opioid prescription (n=565,175) from January to June 2016. Fatal opioid overdoses were identified from the Office of the Chief Medical Examiner and were linked at the person-level with Prescription Drug Monitoring Program data. Split-half technique was used to develop and validate a multivariate logistic regression with a 6-month lookback period and assessed model calibration and discrimination. ResultsPredictors of any opioid-related fatal overdose included male sex, age 65–80 years, Medicaid, Medicare, 1 or more long-acting opioid fills, 1 or more buprenorphine fills, 2 to 3 and 4 or more short-acting schedule II opioid fills, opioid days' supply ≥91 days, average morphine milligram equivalent daily dose, 2 or more benzodiazepine fills, and 1 or more muscle relaxant fills. Model discrimination for the validation cohort was good (area under the curve: any, 0.81; illicit, 0.77). ConclusionsA model for predicting fatal opioid overdoses was developed using Prescription Drug Monitoring Program data. Given the recent national epidemic of deaths involving heroin and fentanyl, it is noteworthy that the model performed equally well in identifying those at risk for overdose deaths from both illicit and prescription opioids. The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): J. Travis Donahoe, Edward C. Norton, Michael R. Elliott, Andrea R. Titus, Lucie Kalousová, Nancy L. Fleischer IntroductionThis study sought to empirically evaluate whether the Medicaid expansion under the Affordable Care Act increased smoking cessation among low-income childless adult smokers. MethodsThe effects of the Medicaid expansion on smoking quit attempts and the probability of 30- and 90-day smoking cessation were evaluated using logistic regression and data from the 2010–2011 and 2014–2015 waves of the Tobacco Use Supplement to the Current Population Survey. Using boosted logistic regression, the Tobacco Use Supplement was restricted to an analytic sample composed of childless adults with high probability of being <138% of the federal poverty level. Propensity score weighting was used to compare changes in smoking cessation among a sample of current and past smokers in states that expanded Medicaid with a control sample of current and past smokers in states that did not expand Medicaid with similar sociodemographic characteristics and smoking histories. This study additionally controlled for state socioeconomic trends, welfare policies, and tobacco control policies. Analysis was conducted between January 2018 and June 2019. ResultsAfter weighting by propensity score and adjusting for state socioeconomic trends, welfare policies, and tobacco control policies, the Medicaid expansion was not associated with increases in smoking quit attempts or smoking cessation. ConclusionsThe Medicaid expansion did not appear to improve smoking cessation, despite extending health insurance eligibility to 2.3 million low-income smokers. Greater commitments to reducing barriers to cessation benefits and increasing smoking cessation in state Medicaid programs are needed to reduce smoking in low-income populations.
Information for CME Credit—Adherence to Cervical Cancer Screening Guidelines Among Women Aged 66–68 Years in a Large Community-Based PracticePublication date: December 2019Source: American Journal of Preventive Medicine, Volume 57, Issue 6Author(s):Ettinger de Cuba SA, Bovell-Ammon AR, Cook JT, et al. SNAP, young children's health, and family food security and healthcare access. Am J Prev Med. 2019;57(4)525–532Publication date: December 2019Source: American Journal of Preventive Medicine, Volume...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Multicellular growth of the Basidiomycota phytopathogen fungus Sporisorium reilianum induced by acid conditions Abstract Fungi are considered model organisms for the analysis of important phenomena of eukaryotes. For example, some of them have been described as models to understand the phenomenon of multicellularity acquisition by different unicellular organisms phylogenetically distant. Interestingly, in this work, we describe the multicellular development in the model fungus S. reilianum. We observed that Sporisorium reilianum, a Basidiomycota cereal pathogen that at neutral pH grows with a yeast-like morphology during its saprophytic haploid stage, when incubated at acid pH grew in the form of multicellular clusters. The multicellularity observed in S. reilianum was of clonal type, where buds of "stem" cells growing as yeasts remain joined by their cell wall septa, after cytokinesis. The elaboration and analysis of a regulatory network of S. reilianum showed that the putative zinc finger transcription factor CBQ73544.1 regulates a number of genes involved in cell cycle, cellular division, signal transduction pathways, and biogenesis of cell wall. Interestingly, homologous of these genes have been found to be regulated during Saccharomyces cerevisiae multicellular growth. In adddition, some of these genes were found to be negatively regulated during multicellularity of S. reilianum. With these data, we suggest that S. reilianum is an interesting model for the study of multicellular development. Combination of mass spectrometry and DNA sequencing for detection of antibiotic resistance in diagnostic laboratories Abstract In the last two decades, microbiology laboratories have radically changed by the introduction of novel technologies, like Next-Generation Sequencing (NGS) and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Nevertheless, emergence of antibiotic-resistant microorganisms represents a global threat of current medicine, being responsible for increasing mortality and health-care direct and indirect costs. In addition, the identification of antibiotic-resistant microorganisms, like OXA-48 carbapenemase-producing Enterobacteriaceae, has been changeling for clinical microbiology laboratories. Even the cost of NGS technology and MALDI-TOF MS equipment is relatively high, both technologies are increasingly used in diagnostic and research protocols. Therefore, the aim of this review is to present applications of these technologies used in clinical microbiology, especially in detection of antibiotic resistance and its surveillance, and to propose a combinatory approach of MALDI-TOF MS and NGS for the investigation of microbial associated infections. Assessing the intestinal carriage rates of vancomycin-resistant enterococci (VRE) at a tertiary care hospital in Hungary Abstract Excessive use of antibiotics contributes to the selection of resistant bacteria and intestinal colonization with multiresistant pathogens poses a risk factor for subsequent infections. The present study assessed vancomycin-resistant enterococci (VRE) carriage rates in patients admitted to our tertiary care hospital. Stool samples sent for routine culturing were screened with vancomycin containing solid or broth enrichment media. VRE isolates were identified with matrix-assisted laser desorption/ionization-time of flight mass spectrometry and antibiotic susceptibilities were tested by E-test. Vancomycin resistance genes were detected by polymerase chain reaction. Medical records of carriers were examined for suspected risk factors for colonization. Altogether 3025 stool specimens were analyzed. Solid media identified a VRE carriage rate of 2.2% while broth enrichment detected 5.8%. Seventy percent of the isolates were Enterococcus faecium. VanB genotype was detected in 38.2%, VanA in 37.3%, VanC1 in 22.6%, and VanC2 in 1.9%. All VRE were sensitive to linezolid, daptomycin, and tigecycline. Collective risk factors for carriage were diabetes, normal flora absence, Clostridioides difficile positivity, longer hospital stay, and advanced age. 78.5% of the carriers received antibiotic therapy which was metronidazole in most cases (47.3%). We recommend regular screening of risk groups such as patients with diabetes, history of recent hospitalization, or former C. difficile infection as an imperative step for preventing VRE dissemination. Atypical URA5 gene restriction fragment length polymorphism banding profile in Cryptococcus neoformans strains Abstract URA5-RFLP is one of the most widely used genotyping methods relating to Cryptococcus neoformans and C. gattii consensus genotype nomenclature. In order to identify a molecular type, this method uses a visual comparison of digested PCR products of tested and reference strains, therefore any anomaly in RFLP patterns of studied isolates makes recognition difficult or impossible. This report describes a strain of VNIV type showing an atypical URA5-RFLP pattern as well as a group of AD hybrids displaying the same anomaly. The atypical RFLP pattern is the result of a point mutation and emergence of a new restriction site. Emergence of the allele presenting a new banding pattern may lead to misidentification using the URA5-RFLP technique; the results of this study as well as the literature data may suggest the spread of the allele in the environment. Production of pyruvic acid from glycerol by Yarrowia lipolytica Abstract The aim of the study was to screen Yarrowia lipolytica strains for keto acid production and determine optimal conditions for pyruvic acid biosynthesis from glycerol by the best producer. The analyzed parameters were thiamine concentration, medium pH, stirring speed, and substrate concentration. The screening was performed in flask cultures, whereas pyruvic acid production was carried out in 5-L stirred-tank reactor with 2 L of working volume. In total, 24 Y. lipolytica strains were compared for their abilities to produce pyruvic and α-ketoglutaric acids. The total concentration of both acids ranged from 0.1 to 15.03 g/L. Ten strains were selected for keto acid biosynthesis in bioreactor. The Y. lipolytica SKO 6 strain was identified as the best producer of pyruvic acid. In the selected conditions (thiamine concentration 1.5 μg/L, pH 4.0, stirring speed 800 rpm, 150 g/L of glycerol), the strain Y. lipolytica SKO 6 produced 99.3 g/L of pyruvic acid, with process yield of 0.63 g/g and volumetric production rate of 1.18 g/L/h. Higher titer of pyruvic acid was obtained during fed-batch culture with 200 g/L of glycerol, reaching 125.8 g/L from pure glycerol (yield 0.68 g/g) and 124.4 g/L from crude glycerol (yield 0.62 g/g). Results obtained for the strain Y. lipolytica SKO 6 proved the suitability of microbial production of pyruvic acid at industrial scale. Characterization of Salmonella Typhimurium and its monophasic variant 1,4, [5],12:i:- isolated from different sources Abstract In order to characterize the most commonly detected Salmonella serotypes, we tested 124 isolates of S. Typhimurium and 89 isolates of the monophasic variant of S. Typhimurium (S. 1,4, [5],12:i:-) for their antimicrobial susceptibility by means of the Kirby–Bauer disk-diffusion method, and for the detection of 19 genes (four Phage Markers (g13, Sieb, eat, g8), ten prophage-related virulence genes (gipA, gtgB, nanH, gogB, grvA, sopE, sspH1, sspH2, sodC1, gtgE), and five plasmid-borne virulence genes (spvC, pefA, mig5, rcK, srgA)) by means of PCR-based assays. A total of 213 strains were analyzed from, humans (n = 122), animals (n = 25), food (n = 46), and irrigation water (n = 20). S. Typhimurium isolates showed higher variability, in both their resistance profiles and molecular typing, than S. 1,4, [5],12:i:-. Strains from irrigation water displayed significantly higher susceptibility to antibiotics than those from the other sources. Resistance to ampicillin, streptomycin, sulfonamide, and tetracycline was the most commonly detected resistance profile (R-type), being in serovar S. 1,4, [5],12:i:-, frequently associated to resistance to other antimicrobials. Significant differences in genetic profiles in the two abovementioned Salmonella serotypes were found. None of the plasmid-borne virulence genes investigated were detected in S. 1,4, [5],12:i:- isolates, while those genes, characterized 37.9% of the S. Typhimurium strains. Differences in the prevalence of some molecular targets between the two Salmonella serotypes deserve further study. Importantly, the grvA gene was found exclusively in S. Typhimurium strains, whereas sopE, sodC, gtgB, and gipA were mainly detected, with a statistically significant difference, in S. 1,4, [5],12:i:- isolates. Metabolic profiling of Fusarium oxysporum f. sp. conglutinans race 2 in dual cultures with biocontrol agents Bacillus amyloliquefaciens , Pseudomonas aeruginosa , and Trichoderma harzianum Abstract There are increasing efforts to identify biocontrol-active microbial metabolites in order to improve strategies for biocontrol of phytopathogens. In this work, Fusarium oxysporum f. sp. conglutinans was confronted with three different biocontrol agents: Trichoderma harzianum, Bacillus amyloliquefaciens, and Pseudomonas aeruginosa in dual culture bioassays. Metabolites produced during the microbial interactions were screened by a matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS). T. harzianum exhibited the strongest inhibition of growth of F. oxysporum resulting in overlay of the pathogen colony with its mycelium. Recorded metabolite profiles suggested a direct attack of F. oxysporum mycelium by T. harzianum and B. amyloliquefaciens by means of membrane-attacking peptaibols and a set of antimicrobial lipopeptides and siderophores, respectively. The direct mode of the biocontrol activity of T. harzianum and B. amyloliquefaciens corresponded to their ability to suppress F. oxysporum production of mycotoxin beauvericin suggesting that this ability is not specific only for Trichoderma species. In the case of P. aeruginosa, siderophores pyoverdine E/D and two rhamnolipids were produced as major bacterial metabolites; the rhamnolipid production was blocked by F. oxysporum. The results showed that this type of biocontrol activity was the least effective against F. oxysporum. The effective application of MALDI-MS profiling to the screening of nonvolatile microbial metabolites produced during the interaction of the phytopathogen and the biocontrol microorganisms was demonstrated. The acid phosphatase Pho5 of Saccharomyces cerevisiae is not involved in polyphosphate breakdown Abstract Inorganic polyphosphate is involved in architecture and functioning of yeast cell wall. The strain of Saccharomyces cerevisiae constitutively overexpressing acid phosphatase Pho5 was constructed for studying the Pho5 properties and its possible participation in polyphosphate metabolism. The parent strain was transformed by the vector carrying the PHO5 gene under a strong constitutive promoter of glyceraldehyde-3-phosphate dehydrogenase of S. cerevisiae. The culture liquid and biomass of transformant strain contained approximately equal total acid phosphatase activity. The levels of acid phosphatase activity associated with the cell wall and culture liquid increased in the transformant strain compared to the parent strain ~ 10- and 20-fold, respectively. The Pho5 preparation (specific activity of 46 U/mg protein and yield of 95 U/L) was obtained from culture liquid of overproducing strain. The overproducing strain had no changes in polyphosphate level. The activity of Pho5 with long-chained polyP was negligible. We concluded that Pho5 is not involved in polyphosphate metabolism. Purified Pho5 showed a similar activity with p-nitrophenylphosphate, ATP, ADP, glycerophosphate, and glucose-6-phosphate. The substrate specificity of Pho5 and its extracellular localization suggest its function: the hydrolysis of organic compounds with phosphoester bonds at phosphate limitation. The influence of N and S poles of static magnetic field (SMF) on Candida albicans hyphal formation and antifungal activity of amphotericin B Abstract Due to the increasing number of Candida albicans' infections and the resistance of this pathogenic fungus to drugs, new therapeutic strategies are sought. One of such strategies may be the use of static magnetic field (SMF). C. albicans cultures were subjected to static magnetic field of the induction 0.5 T in the presence of fluconazole and amphotericin B. We identified a reduction of C. albicans hyphal length. Also, a statistically significant additional effect on the viability of C. albicans was revealed when SMF was combined with the antimycotic drug amphotericin B. The synergistic effect of this antimycotic and SMF may be due to the fact that amphotericin B binds to ergosterol in plasma membrane and SMF similarly to MF could influence domain orientation in plasma membrane (PM). Community structures and comparison of nosZ and 16S rRNA genes from culturable denitrifying bacteria Abstract The objectives of this study were (i) to isolate and characterize of cultivable denitrifying bacteria using classic microbiological and molecular methods, (ii) to compare of 16S rRNA and nosZ genes as molecular markers, (iii) to determine bacterial community structure and diversity in soil samples using single-strand conformation polymorphism (SSCP) analysis. In this study, 49 bacterial isolates were cultivated and phylogenetic analyses grouped them into two phyla: Proteobacteria (37 species) and Firmicutes (12 species). Our study showed that the nosZ functional gen could be used to identify denitrifying bacteria abundance in environment but could not be used to identify pure bacterial cultures. In addition, the bacterial community structure showed significant differences among the various soil types. Phylogenetic analysis of community structure indicated that 51 clones could be divided into 2 phylotypes. Uncultured bacteria (80.4%) and Gammaproteobacteria (19.6%) were the dominant components of the soil bacterial community. For 16S rRNA, PCR products of 49 bacteria were obtained with 27F-1492R primer pairs. For nosZ, PCR products were obtained with primers 1F-1R (259 bp), 2F-2R (267 bp), and F-1622R (453 bp) of 39 bacteria that the single nosZ band provided on the agarose gel. The bacterial 16S rRNA gene clone library was dominated by Gammaproteobacteria and Bacilli. The nosZ clone sequences did not represent the bacteria from which they were obtained but were found to be closer to the environmental clones. Our study showed that the nosZ functional gene could be used to identify denitrification abundance in environment but could not be used to identify pure bacterial cultures. It was also found that the nosZ sequences showed uncultured denitrifier species.
Multicellular growth of the Basidiomycota phytopathogen fungus Sporisorium reilianum induced by acid conditionsAbstractFungi are considered model organisms for the analysis of important phenomena of eukaryotes. For example, some of them have been described as models to understand the phenomenon of multicellularity acquisition by different unicellular organisms phylogenetically distant. Interestingly, in this work, we describe the multicellular development in the model fungus S. reilianum. We observed...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Spatiotemporal clustering of suicides in the US from 1999 to 2016: a spatial epidemiological approach AbstractPurpose This study aims to describe and characterize the spatial and temporal clustering patterns of suicide in the ten states with the greatest suicide burden in the United States from 1999 to 2016.Methods All suicide deaths from January 1, 1999 to December 31, 2016 in the United States were identified using data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset. The ten states with the highest age-adjusted suicide rates were Montana, Alaska, Wyoming, New Mexico, Nevada, Utah, Idaho, Colorado, Arizona, and Oklahoma. A spatiotemporal scan statistic using a discrete Poisson model was employed to retrospectively detect spatiotemporal suicide clusters.Results From 1999 to 2016, a total of 649,843 suicides were recorded in the United States. Nineteen statistically significant spatiotemporal suicide mortality clusters were identified in the states with the greatest suicide rates, and 13.53% of the suicide cases within these states clustered spatiotemporally. The risk ratio of the clusters ranged from 1.45 to 3.64 (p < 0.001). All states had at least one cluster, with three clusters spanning multiple states, and four clusters were found in Arizona. While there was no clear secular trend in the average size of suicide clusters, the number of clusters increased from 1999 to 2016.Conclusions Hot spots for suicidal behavior in the United States warrant public health intervention and continued surveillance. As suicide rates in the US continue to increase annually, public health efforts could be maximized by focusing on regions with substantial clustering. Predictive factors for changes in quality of life among children and adolescents in youth welfare institutions AbstractPurpose Children and adolescents living in youth welfare institutions often have a below average quality of life (QoL), for reasons that include developmental difficulties, history of traumatic experiences, and mental disorders. Youth welfare measures are needed that would have a positive impact, but there is a lack of longitudinal research on which measures are most effective. This study investigated what factors are associated with an improvement in QoL during residential stay.Methods Residents of youth care facilities in Switzerland and their professional caregivers completed questionnaires that addressed QoL, psychopathology, and experience of traumatic events at two time points. In addition, information regarding mental disorders was obtained through structured clinical interviews. Analyses were conducted on the data obtained from 204 respondents aged 11–18 years. Comparisons with a school sample were conducted.Results Compared to a school sample, a majority of participants rated their QoL equal, whereas their caregivers rated it as lower. Factors predictive of a poorer QoL were high levels of internalizing and externalizing psychopathology, presence of co-morbidities, and female gender. At the second assessment, the caregivers reported a small improvement, which was associated with reductions in both internalizing and externalizing psychopathology.Conclusions The finding that a reduction in severity of psychopathology may result in an improvement in QoL underlines the importance of providing professional support for mentally ill residents of youth welfare institutions. Further research is needed to determine the causality of this association. Depressive symptoms, suicidal ideation, and mental health care-seeking in central Mozambique AbstractPurpose There is scant research on depressive symptoms (DS), suicidal ideation (SI), and mental health care-seeking in Mozambique.Methods Generalized estimating equations were used to assess factors associated with DS, SI, and mental health care-seeking among 3080 individuals interviewed in a representative household survey in Sofala and Manica provinces, Mozambique.Results 19% (CI 17–21%) of respondents reported DS in the past year and 17% (CI 15–18%) lifetime SI. Overall, only 10% (CI 8–11%) of respondents ever sought any care for mental illness, though 26% (CI 23–29%) of those reporting DS and/or SI sought care. 90% of those who sought care for DS received treatment; however, only 46% of those who sought care for SI received treatment. Factors associated with DS and SI include: female gender, divorced/separated, widowed, and > 55 years old. Respondents in the bottom wealth quintile reported lower DS, while those in upper wealth quintiles reported higher prevalence of SI. Individuals with DS or SI had significantly elevated measures of disability—especially in doing household chores, work/school activities, standing for long periods, and walking long distances. Factors associated with care-seeking include: female gender, rural residence, divorced/separated, and > 45 years old. Individuals in lower wealth quintiles and with no religious affiliation had lower odds of seeking care.Conclusions DS and SI are prevalent in central Mozambique and treatment gaps are high (68% and 89%, respectively). An urgent need exists for demand- and supply-side interventions to optimize the delivery of comprehensive community-based mental healthcare in Mozambique. Factors associated with discontinuation of antidepressant treatment after a single prescription among patients aged 55 or over: evidence from English primary care AbstractPurpose Antidepressants are frequently prescribed to older people with depression but little is known on predictors of discontinuation in this population. We, therefore, investigated factors associated with early discontinuation of antidepressants in older adults with new diagnoses or symptoms of depression in English primary care.Methods Data from a nationally representative cohort of patients aged 55 and over were used to evaluate the association between discontinuation of antidepressant medication after a single prescription and potential explanatory variables, including socio-demographic factors, polypharmacy and age-related problems such as dementia.Results Overall, during the study period we observed 34,715 new courses of antidepressant treatment initiated after recorded symptoms or diagnoses of depression. Antidepressant discontinuation after a single prescription was more common in people with depressive symptoms (32%) than in those with diagnosed depression (21.6%). In those diagnosed with depression and in women with depressive symptoms we found that, after adjusting for confounders, the odds of early discontinuation significantly increased after age 65 with a peak at around age 80 and then either levelled or reduced thereafter. Early discontinuation was also significantly less common in people with dementia and in those with diagnosed depression living in more rural areas.Conclusions Early discontinuation of antidepressants increases in the post-retirement years and is higher in those with no formal diagnosis of depression, those without dementia and those with diagnosed depression living in urban areas. Alternative treatment strategies, such as non-drug therapies, or more active patient follow-up should be further considered in these circumstances. Physical activity of people with mental disorders compared to the general population: a systematic review of longitudinal cohort studies AbstractPurpose We investigated if (a) people with lower physical activity have an increased risk of subsequent mental disorders (compared to those with higher physical activity); and (b) people with mental disorders have reduced subsequent physical activity (compared to those without mental disorders).Methods A systematic review of population-based longitudinal studies examining physical activity and mental disorders was conducted. Mental disorders were defined by International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. The results were described in a narrative summary.Results Twenty-two studies were included. The majority (19) examined mood disorders and physical activity. Only two studies found consistent association between lower physical activity and a reduced risk of subsequent mental disorders. One study found the bidirectional association between physical activity and major depression. Twelve studies found mixed results (i.e., no consistency in direction and significance of the findings), and seven studies found no association between the variables of interest.Conclusions There is a lack of consistent evidence linking physical activity to be either a risk factor or consequence of mental disorders.PROSPERO registration ID CRD42017071737. Concurrent use of benzodiazepines, antidepressants, and opioid analgesics with zolpidem and risk for suicide: a case–control and case–crossover study AbstractPurpose To evaluate whether the concurrent use of benzodiazepines, antidepressants, and opioid analgesics with zolpidem increases the risk of suicide or triggers suicide compared with the use of zolpidem alone.Methods We conducted a case–control and case–crossover study using the Korean National Health Insurance Service-National Sample Cohort database. Cases were older than 20 years with a suicide record (International Codes of Disease 10th Revision codes: X-60-X84 and Y87.0 intentional self-harm) between January 1, 2004, and December 31, 2013. For case–control design, ten controls were matched to each case by age, sex, index year, region, income, and health insurance type. For case–crossover analysis, we set hazard period to 60 days and assigned five corresponding sets of control periods of equal length. Exposure was assessed during 60 days before suicide for combinations of benzodiazepines, antidepressants, opioid analgesics with zolpidem against zolpidem alone. We conducted a conditional logistic regression to estimate odds ratios (ORs) and their 95% confidence intervals (CIs).Results In the case–control study, the risk of suicide was 2.80-fold higher in cases taking benzodiazepines and antidepressants with zolpidem than in those taking zolpidem alone (adjusted OR [aOR], 2.80; 95% CI, 1.38–5.70). However, in the case–crossover study, suicide risk showed no significant difference (crude OR [cOR], 0.92; 95% CI, 0.55–1.52) and was underpowered.Conclusions The results of the traditional case–control study confirmed that the concurrent use of benzodiazepines and antidepressants with zolpidem was associated with an increased risk of suicide compared with the use of zolpidem alone. However, there was no significant difference in the magnitude of risk in the within-person comparison design. Barriers and predictors of medication use for childhood ADHD: findings from a UK population-representative cohort AbstractPurpose Little is known about sociodemographic and clinical factors that predict and act as barriers to ADHD medication independently of symptom severity. We examined the proportion of children using medication for ADHD, age of initiation of medication, and predictors of medication use in a population-representative cohort.Methods Data from the Millennium Cohort Study on child ADHD, medication use for ADHD at age 14 (in 2014–2015) and child, parent and sociodemographic variables were collated. Logistic regression models were used to identify factors that predict medication use for ADHD (the main outcome measure), adjusting for symptom severity at age seven.Results The weighted prevalence of ADHD was 3.97% (N = 11,708). 45.57% of children with ADHD (N = 305) were taking medication. The median age at initiation was 9 years (range 3–14). Male gender (AOR 3.66, 95% CI 1.75, 7.66) and conduct problems at age seven (AOR 1.24 95% CI 1.04, 1.47) and 14 predicted medication use at age 14 after adjusting for symptom severity.Conclusions Our study is the first to assess predictors of medication whist adjusting for ADHD symptom severity. Girls with ADHD were less likely to be prescribed medication, even when they displayed similar ADHD symptom levels to boys. Conduct problems also predicted medication independently of ADHD symptoms. ADHD may be more often medicated in boys because clinicians may think a prototypical ADHD child is male, and perhaps conduct problems make boys more disruptive in the classroom, leading to boys being more often treated. The role of neuroticism in self-harm and suicidal ideation: results from two UK population-based cohorts AbstractBackground Self-harm is common, debilitating and associated with completed suicide and increased all-cause mortality, but there is uncertainty about its causal risk factors, limiting risk assessment and effective management. Neuroticism is a stable personality trait associated with self-harm and suicidal ideation, and correlated with coping styles, but its value as an independent predictor of these outcomes is disputed.Methods Prior history of hospital-treated self-harm was obtained by record-linkage to administrative health data in Generation Scotland:Scottish Family Health Study (N = 15,798; self-harm cases = 339) and by a self-report variable in UK Biobank (N = 35,227; self-harm cases = 772). Neuroticism in both cohorts was measured using the Eysenck Personality Questionnaire-Short Form. Associations of neuroticism with self-harm were tested using multivariable regression following adjustment for age, sex, cognitive ability, educational attainment, socioeconomic deprivation, and relationship status. A subset of GS:SFHS was followed-up with suicidal ideation elicited by self-report (n = 3342, suicidal ideation cases = 158) and coping styles measured by the Coping Inventory for Stressful Situations. The relationship of neuroticism to suicidal ideation, and the role of coping style, was then investigated using multivariable logistic regression.Results Neuroticism was positively associated with hospital-associated self-harm in GS:SFHS (per EPQ-SF unit odds ratio 1.2 95% credible interval 1.1–1.2, pFDR 0.0003) and UKB (per EPQ-SF unit odds ratio 1.1 95% confidence interval 1.1–1.2, pFDR 9.8 × 10−17). Neuroticism, and the neuroticism-correlated coping style, emotion-oriented coping (EoC), were also associated with suicidal ideation in multivariable models.Conclusions Neuroticism is an independent predictor of hospital-treated self-harm risk. Neuroticism and emotion-orientated coping styles are also predictive of suicidal ideation. Suicide mortality follow-up of the Swiss National Cohort (1990–2014): sex-specific risk estimates by occupational socio-economic group in working-age population AbstractPurpose To identify occupations and socio-economic groups with detrimental or protective effect on suicide mortality.Methods For every occupation and economic activity/industry, we computed directly age-standardized mortality rates (DSRs) using the age structure of the European population (2010) and standardized mortality ratios (SMRs) for suicide using national cause-specific mortality rates. We further stratified analyses by socio-economic variables, job-skill level, and by three calendar periods (1990–1998/1999–2006/2007–2014).Results The study sample comprised 5,834,618 participants (94,918,456 person-years). The highest DSRs were observed among unemployed/job-seeking group, in agricultural, fishery and related male workers, and in health and social activities female workers. The lowest DSRs were observed in real estate and renting, research and development, IT and other business activities in men and in agriculture, hunting and forestry industry in women. A consistent reduction in DSRs across three calendar periods was observed in men. In female corporate managers, DSRs increased over the 2007–2014 period compared with 1999–2006. Compared to general working-age population, unemployed/job-seeking people, manufacturing labourers, personal care and related workers, and motor vehicle drivers of both sexes were identified at risk of suicide. Moreover, an excess of suicide was observed among male material recording and transport clerks; nursing and midwife-associated professionals; and agricultural workers as well as among female writers and performing artists.Conclusions The findings suggest the detrimental effect of low socioeconomic positions, including unemployment, with respect to suicide mortality and a relationship between suicide and poor psychosocial working conditions in elementary occupations. Sex-specific results need further investigation. Identifying typologies among persons admitted to hospital for non-fatal intentional self-harm in Victoria, Australia AbstractPurpose The aim of this study was to determine whether people who have been hospitalised as the result of non-fatal self-harm form meaningful groups based on mechanism of injury, and demographic and mental health-related factors.Methods A retrospective analysis of 18,103 hospital admissions for self-harm in Victoria, Australia over the 3-year period 2014/2015–2016/2017 recorded on the Victorian Admitted Episodes Dataset (VAED). The VAED records all hospital admissions in public and private hospitals in Victoria. The primary analysis used a two-step method of cluster analysis. Initial analysis determined two distinct groups, one composed of individuals who had a recorded mental illness diagnosis and one composed of individuals with no recorded mental illness diagnosis. Subsequent cluster analysis identified four subgroups within each of the initial two groups.Results Within the diagnosed mental illness subgroups, each subgroup was characterised by a particular mental disorder or a combination of disorders. Within the no diagnosis of mental illness groups, the youngest group was also the most homogenous (all females who self-poisoned), the oldest group had a high proportion of rural/regional residents, the group with the highest proportion of males also had the highest proportion of people who used cutting as the method of self-harm, and the group with the highest proportion of metropolitan residents also had the highest proportion of people who were married.Conclusions Preventative interventions need to take into account that those who are admitted to hospital for self-harm are a heterogeneous group.
Spatiotemporal clustering of suicides in the US from 1999 to 2016: a spatial epidemiological approachAbstractPurposeThis study aims to describe and characterize the spatial and temporal clustering patterns of suicide in the ten states with the greatest suicide burden in the United States from 1999 to 2016.MethodsAll suicide deaths from January 1, 1999 to December 31, 2016 in the United States were identified using data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Information for CME Credit—Adherence to Cervical Cancer Screening Guidelines Among Women Aged 66–68 Years in a Large Community-Based Practice Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Ettinger de Cuba SA, Bovell-Ammon AR, Cook JT, et al. SNAP, young children's health, and family food security and healthcare access. Am J Prev Med. 2019;57(4)525–532 Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): U.S. Immigration Law Enforcement Practices and Health Inequities Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Paul J. Fleming, Nicole L. Novak, William D. Lopez Expanding Diabetes Prevention: Obstacles and Potential Solutions Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Michael Bergman The Obesity Parenting Intervention Scale: Factorial Validity and Invariance Among Head Start Parents Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Roger Figueroa, Jaclyn A. Saltzman, Alyssa Aftosmes-Tobio, Kirsten K. Davison IntroductionObesity affects 15.7% of U.S. preschoolers, with higher rates among low-income and Spanish-speaking populations. Food, physical activity, and sleep parenting practices, referred to collectively as obesity-related parenting practices, are linked with children's risk of obesity and are a common target in family-based obesity interventions. Yet, there is no brief, validated measure of obesity-related parenting practices that is appropriate for use in intervention studies and for diverse audiences. This study tests the factorial validity of a brief measure of obesity-related parenting and measurement invariance of the English and Spanish versions of the scale, as well as among mothers and fathers. MethodsParents of children enrolled in Head Start (n=578; 500 mothers and 78 fathers) completed a brief survey of food (7 items), physical activity (5 items), and sleep parenting (3 items) in fall of 2017 and 2018. Scale items were drawn from existing measures and the evidence base, initially drafted in English, and then translated to Spanish. One parent per family completed the scale independently in English (n=448) or Spanish (n=130). A confirmatory factor analysis framework was adopted to test a 3-factor model for the total sample. Multi-group structural equation modeling was used to assess measurement invariance of the scale by the language of administration (English or Spanish) and among mothers and fathers separately. ResultsResults supported a 3-factor model of obesity parenting with a single factor each for food, physical activity, and sleep parenting. There was statistically significant measurement invariance across all groups (p<0.05). Internal consistency was adequate across factors (α=0.65−0.80). ConclusionsThis brief obesity-parenting scale demonstrates adequate factorial validity in English and Spanish and among mothers and fathers. This measure has been integrated into an intervention, and future work will test sensitivity to change. A Methodologic Systematic Review of Mobile Health Behavior Change Randomized Trials Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Theodora Oikonomidi, Alexandre Vivot, Viet-Thi Tran, Carolina Riveros, Elisabeth Robin, Philippe Ravaud ContextMobile health helps providers offer accessible, affordable, tailored behavior change interventions. However, research assessing mobile health interventions may feature methodologic shortcomings and poor reporting. This review aims to summarize the characteristics, methods, and intervention reporting of RCTs evaluating mobile health behavior change interventions. Evidence acquisitionThis was a methodologic systematic review of RCTs assessing mobile health behavior change interventions published in PubMed from January 1, 2014 to January 1, 2018, in journals with the upper half of Impact Factors (Clarivate Analytics). Three reviewers independently extracted sample characteristics. Primary outcomes were classified as patient-important or not using definitions from the literature. Any non–patient-important outcomes were then reclassified by a panel of 3 patients. Intervention reporting was assessed by the mobile health Evidence Reporting and Assessment checklist. Data were analyzed in December 2018. Evidence synthesisMost of the 231 included RCTs assessed text messaging (51%) or smartphone app (28%) interventions aiming to change nutrition and physical activity (36%) or treatment adherence (25%). Only 8% of RCTs had a patient-important primary outcome, follow-up of ≥6 months, and intent-to-treat analysis. Most primary outcomes were behavioral measures (60%). Follow-up was <3 months in 29% of RCTs. Regarding reporting, 12 of the 16 checklist items were reported in less than half of RCTs (e.g., usability/content testing, 32%; data security, 13%). ConclusionsReports of RCTs assessing mobile health behavior change interventions lack information that would be useful for providers, including reporting of long-term intervention impact on patient-important primary outcomes and information needed for intervention replicability. Firearm Storage Practices and Risk Perceptions Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Amanda I. Mauri, Julia A. Wolfson, Deborah Azrael, Matthew Miller IntroductionDuring the past 2 decades, gun owners have become more likely to store household firearms loaded and unlocked, and believe that guns make homes safer rather than more dangerous. MethodsSelf-reported household firearm storage practices were described among 2,001 gun owners in relation to whether they report that firearms make homes (1) safer, (2) more dangerous, or (3) it depends. Data were from a probability-based online survey administered in 2015 (completion rate, 55%) and analyzed in 2018. ResultsNearly 60% of gun owners said that guns make homes safer (57.6%, 95% CI=55.1%, 60.1%), 39.9% (95% CI=37.4%, 42.5%) said that it depends (on other factors), and 2.5% (95% CI=1.8%, 3.4%) said that guns make homes more dangerous. A higher proportion of gun owners who reported that they believe guns increase household safety said that they store household firearms loaded and unlocked (39.2%, 95% CI=35.9%, 42.6%), compared with those who thought guns make the home either more dangerous (3.7%, 95% CI=1.3%, 10.1%) or those who thought the effect of guns on household safety depends on additional factors (17.5%, 95% CI=14.7%, 20.7%). ConclusionsGun owners who are most likely to assert categorically that firearms in the home make homes safer are, as a group, far more likely to store guns in their home loaded and unlocked. Drone and Other Hobbyist Aircraft Injuries Seen in U.S. Emergency Departments, 2010–2017 Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Jack A. Johnson, Megan R. Svach, Lawrence H. Brown IntroductionRecreational radio-controlled hobbyist aircraft—particularly "drones"—have become increasingly popular in the last decade. The purpose of this study is to describe injuries associated with hobbyist drones and compare them with injuries associated with other hobbyist aircraft. MethodsIn this 2018 cross-sectional analysis of National Electronic Injury Surveillance System data for 2010–2017, case narrative fields were searched to identify emergency department visits related to hobbyist aircraft injuries. The incidence of hobbyist aircraft injuries was estimated, and summary statistics, chi-square tests, and t-tests were used to describe and compare the demographic and clinical characteristics of drone and other hobbyist aircraft-related cases. ResultsAn estimated 12,842 hobbyist aircraft injuries presented to U.S. emergency departments during 2010–2017. An increased incidence attributable to drone-related injuries emerged in 2015. Overall, most injuries involved male patients aged 50 years on average. Propeller injuries were the leading mechanism. An estimated 270 patients required hospital admission. Patients injured by drones were younger (mean, 34 years vs 58 years; p<0.001) and more likely to be female than patients injured by hobbyist planes. Drone-related injuries were more likely than plane-related injuries to result from blunt trauma (e.g., being struck or falling during aircraft retrieval; 40.5% vs 7.9%, p<0.001). Helicopter-related injuries more closely resembled drone-related injuries than plane-related injuries. ConclusionsHobbyist aircraft-related injuries are increasing, particularly drone-related injuries. Tailored injury prevention measures and product safety materials are needed to address all hobbyist aircraft-related injuries, with a particular focus on drone-related injury prevention measures. Predicting Opioid Overdose Deaths Using Prescription Drug Monitoring Program Data Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): Lindsey M. Ferris, Brendan Saloner, Noa Krawczyk, Kristen E. Schneider, Molly P. Jarman, Kate Jackson, B. Casey Lyons, Matthew D. Eisenberg, Tom M. Richards, Klaus W. Lemke, Jonathan P. Weiner IntroductionPrescription Drug Monitoring Program data can provide insights into a patient's likelihood of an opioid overdose, yet clinicians and public health officials lack indicators to identify individuals at highest risk accurately. A predictive model was developed and validated using Prescription Drug Monitoring Program prescription histories to identify those at risk for fatal overdose because of any opioid or illicit opioids. MethodsFrom December 2018 to July 2019, a retrospective cohort analysis was performed on Maryland residents aged 18–80 years with a filled opioid prescription (n=565,175) from January to June 2016. Fatal opioid overdoses were identified from the Office of the Chief Medical Examiner and were linked at the person-level with Prescription Drug Monitoring Program data. Split-half technique was used to develop and validate a multivariate logistic regression with a 6-month lookback period and assessed model calibration and discrimination. ResultsPredictors of any opioid-related fatal overdose included male sex, age 65–80 years, Medicaid, Medicare, 1 or more long-acting opioid fills, 1 or more buprenorphine fills, 2 to 3 and 4 or more short-acting schedule II opioid fills, opioid days' supply ≥91 days, average morphine milligram equivalent daily dose, 2 or more benzodiazepine fills, and 1 or more muscle relaxant fills. Model discrimination for the validation cohort was good (area under the curve: any, 0.81; illicit, 0.77). ConclusionsA model for predicting fatal opioid overdoses was developed using Prescription Drug Monitoring Program data. Given the recent national epidemic of deaths involving heroin and fentanyl, it is noteworthy that the model performed equally well in identifying those at risk for overdose deaths from both illicit and prescription opioids. The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers Publication date: December 2019 Source: American Journal of Preventive Medicine, Volume 57, Issue 6 Author(s): J. Travis Donahoe, Edward C. Norton, Michael R. Elliott, Andrea R. Titus, Lucie Kalousová, Nancy L. Fleischer IntroductionThis study sought to empirically evaluate whether the Medicaid expansion under the Affordable Care Act increased smoking cessation among low-income childless adult smokers. MethodsThe effects of the Medicaid expansion on smoking quit attempts and the probability of 30- and 90-day smoking cessation were evaluated using logistic regression and data from the 2010–2011 and 2014–2015 waves of the Tobacco Use Supplement to the Current Population Survey. Using boosted logistic regression, the Tobacco Use Supplement was restricted to an analytic sample composed of childless adults with high probability of being <138% of the federal poverty level. Propensity score weighting was used to compare changes in smoking cessation among a sample of current and past smokers in states that expanded Medicaid with a control sample of current and past smokers in states that did not expand Medicaid with similar sociodemographic characteristics and smoking histories. This study additionally controlled for state socioeconomic trends, welfare policies, and tobacco control policies. Analysis was conducted between January 2018 and June 2019. ResultsAfter weighting by propensity score and adjusting for state socioeconomic trends, welfare policies, and tobacco control policies, the Medicaid expansion was not associated with increases in smoking quit attempts or smoking cessation. ConclusionsThe Medicaid expansion did not appear to improve smoking cessation, despite extending health insurance eligibility to 2.3 million low-income smokers. Greater commitments to reducing barriers to cessation benefits and increasing smoking cessation in state Medicaid programs are needed to reduce smoking in low-income populations.
Information for CME Credit—Adherence to Cervical Cancer Screening Guidelines Among Women Aged 66–68 Years in a Large Community-Based PracticePublication date: December 2019Source: American Journal of Preventive Medicine, Volume 57, Issue 6Author(s):Ettinger de Cuba SA, Bovell-Ammon AR, Cook JT, et al. SNAP, young children's health, and family food security and healthcare access. Am J Prev Med. 2019;57(4)525–532Publication date: December 2019Source: American Journal of Preventive Medicine, Volume...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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STrategically Acquired Gradient Echo (STAGE) imaging, part III: Technical advances and clinical applications of a rapid multi-contrast multi-parametric brain imaging method Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): E. Mark Haacke, Yongsheng Chen, David Utriainen, Bo Wu, Yu Wang, Shuang Xia, Naying He, Chunyan Zhang, Xiao Wang, M. Marcella Lagana, Yu Luo, Ali Fatemi, Saifeng Liu, Sara Gharabaghi, Dongmei Wu, Sean K. Sethi, Feng Huang, Taotao Sun, Feifei Qu, Brijesh K. Yadav Abstract One major thrust in radiology today is image standardization with a focus on rapidly acquired quantitative multi-contrast information. This is critical for multi-center trials, for the collection of big data and for the use of artificial intelligence in evaluating the data. Strategically acquired gradient echo (STAGE) imaging is one such method that can provide 8 qualitative and 7 quantitative pieces of information in 5 min or less at 3 T. STAGE provides qualitative images in the form of proton density weighted images, T1 weighted images, T2* weighted images and simulated double inversion recovery (DIR) images. STAGE also provides quantitative data in the form of proton spin density, T1, T2* and susceptibility maps as well as segmentation of white matter, gray matter and cerebrospinal fluid. STAGE uses vendors' product gradient echo sequences. It can be applied from 0.35 T to 7 T across all manufacturers producing similar results in contrast and quantification of the data. In this paper, we discuss the strengths and weaknesses of STAGE, demonstrate its contrast-to-noise (CNR) behavior relative to a large clinical data set and introduce a few new image contrasts derived from STAGE, including DIR images and a new concept referred to as true susceptibility weighted imaging (tSWI) linked to fluid attenuated inversion recovery (FLAIR) or tSWI-FLAIR for the evaluation of multiple sclerosis lesions. The robustness of STAGE T1 mapping was tested using the NIST/NIH phantom, while the reproducibility was tested by scanning a given individual ten times in one session and the same subject scanned once a week over a 12-week period. Assessment of the CNR for the enhanced T1W image (T1WE) showed a significantly better contrast between gray matter and white matter than conventional T1W images in both patients with Parkinson's disease and healthy controls. We also present some clinical cases using STAGE imaging in patients with stroke, metastasis, multiple sclerosis and a fetus with ventriculomegaly. Overall, STAGE is a comprehensive protocol that provides the clinician with numerous qualitative and quantitative images. An evaluation of the reproducibility of 1H-MRS GABA and GSH levels acquired in healthy volunteers with J-difference editing sequences at varying echo times Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): James J. Prisciandaro, Mark Mikkelsen, Muhammad G. Saleh, Richard A.E. Edden Abstract Recent advances in J-difference-edited proton magnetic resonance spectroscopy (1H MRS) data acquisition and processing have led to the development of Hadamard Encoding and Reconstruction of MEGA-Edited Spectroscopy (HERMES) techniques, which enable the simultaneous measurement of ɣ-aminobutyric acid (GABA), the primary inhibitory amino acid neurotransmitter in the central nervous system, and of glutathione (GSH), the most abundant antioxidant in living tissue, at the commonly available magnetic field strength of 3 T. However, the reproducibility of brain levels of GABA and GSH measured across multiple scans in human subjects using HERMES remains to be established. In the present study, twelve healthy volunteers completed two consecutive HERMES scans of the dorsal anterior cingulate cortex (dACC) to assess the test-retest reproducibility of the technique for GABA and GSH measurements at TE = 80 ms. Eleven of the twelve participants additionally completed two consecutive MEGA-PRESS scans at TE = 120 ms, with editing pulses configured for GSH acquisition, to compare the reliability of GSH in the same voxel measured using the standard MEGA-PRESS at TE = 120 ms. The primary findings of study were that, 1) the coefficient of variation (CV) of measuring GABA with HERMES was 16.7%, which is in agreement with the reliability we previously reported for measuring GABA using MEGA-PRESS; and 2) the reliability of measuring GSH with MEGA-PRESS at TE = 120 ms was more than twice as high as that for measuring the antioxidant with HERMES at TE = 80 ms (CV = 7.3% vs. 19.0% respectively). These findings suggest that HERMES and MEGA-PRESS offer similar reliabilities for measuring GABA, while MEGA-PRESS at TE = 120 ms is more reliable for measuring GSH relative to HERMES at TE = 80 ms. In-situ observation for natural gas hydrate in porous medium: Water performance and formation characteristic Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): Lunxiang Zhang, Mingrui Sun, Lingjie Sun, Tao Yu, Yongchen Song, Jiafei Zhao, Lei Yang, Hongsheng Dong Abstract Extensive efforts have been made regarding gas hydrate sample reconstruction in the laboratory for a better understanding and development of natural gas resources. Magnetic resonance imaging (MRI) is a useful method for directly observing the reconstruction of methane hydrate, yet relevant studies remain limited. In this study, a 9.4-T 400-MHz MRI instrument was employed to investigate CH4 hydrate formation in porous media involving various initial water saturation levels and sand diameters. Pressure histories and MRI signal variations were monitored to discuss the process of CH4 hydrate growth, and the three main formation stages of induction, rapid growth, and slow formation were determined. Furthermore, the liquid water performance in MRI micro-images was analyzed to predict the characteristics of CH4 hydrate formation. The results indicated that CH4 hydrate formed in a spatially and temporally random manner and that pore plugging occurred owing to the residual water encased in grown hydrate. Additionally, phase saturations, water conversion percentages, and formation rates were defined to evaluate the effect of sand diameter and initial water saturation on CH4 hydrate formation. With the reduction in the diameter of quartz glass beads from 400 μm to 100 μm, the average hydrate formation rate increased from 0.0010 min−1 to 0.0034 min−1, respectively. When the initial water saturation decreased to the optimized value (0.22 in this study), the water conversion percentage and hydrate saturation increased. Non-contrast enhanced diagnosis of acute myocarditis based on the 17-segment heart model using 2D-feature tracking magnetic resonance imaging Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): Mona Salehi Ravesh, Matthias Eden, Patrick Langguth, Tim-Christian Piesch, Johanna Karolin Lehmann, Annett Lebenatus, David Hauttemann, Joachim Graessner, Norbert Frey, Olav Jansen, Marcus Both Abstract PurposeThe aim of this study was to investigate the diagnostic value of myocardial deformation analysis based on the 17-segment heart model using non-contrast enhanced (CE) 2D tissue feature tracking (2D-FT) technique. Material and methodsSeventy patients with suspected myocarditis underwent a cardiovascular magnetic resonance (CMR) examination at 1.5 Tesla. A contrast-agent-free part of this CMR protocol was additionally performed in forty healthy volunteers (HV). Besides standard CMR data sets, 2D-FT derived segmental and global longitudinal, radial, and circumferential deformation parameters were analyzed. The 2D-FT results were compared to the combined findings from CMR imaging and endomyocardial biopsy (EMB). ResultsPatients were assigned to three groups depending on their ejection fraction (EF) (<40%, 40–55%, ≥55%). Compared to HV, impaired EF (<55%) was significantly correlated to reduced segmental and global strain and strain rate values. The circumferential deformation analysis was more sensitive to myocardial changes than longitudinal and radial analysis. The segmental strain/strain rate had an accuracy of 84.3%/70.0% for the diagnosis of an acute myocarditis, stated by EMB and CMR in 42 of 70 patients. In patients with preserved EF, acute myocarditis could be ruled out using only segmental strain analysis with a negative predictive value of 87.5%. ConclusionIn patients with suspected myocarditis, the deformation analysis based on the 17-segment heart model provides valuable information about functional myocardial inhomogeneity. This quantitative approach could be used in addition to the clinical standard CMR protocol and represents a promising tool in the framework of a prospective automatized multiparametric CMR imaging analysis. MRF-ZOOM for the unbalanced steady-state free precession (ubSSFP) magnetic resonance fingerprinting Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): Ze Wang, Di Cui, Jian Zhang, Ed.X. Wu, Edward S. Hui Abstract In magnetic resonance fingerprinting (MRF), tissue parameters are determined by finding the best-match to the acquired MR signal from a predefined signal dictionary. This dictionary searching (DS) process is generally performed in an exhaustive manner, which requires a large predefined dictionary and long searching time. A fast MRF DS algorithm, MRF-ZOOM, was recently proposed based on DS objective function optimization. As a proof-of-concept study, MRF-ZOOM was only tested with one of the earliest MRF sequences but not with the recently more popular unbalanced steady state free precession MRF sequence (MRF-ubSSFP, or MRF-FISP). Meanwhile noise effects on MRF and MRF-ZOOM have not been examined. The purpose of this study was to address these open questions and to verify whether MRF-ZOOM can be combined with a dictionary-compression based method to gain further speed. Numerical simulations were performed to evaluate the DS objective function properties, noise effects on MRF, and to compare MRF-ZOOM with other methods in terms of speed and accuracy. In-vivo experiments were performed as well. Evaluation results showed that premises of MRF-ZOOM held for MRF-FISP; noise did not affect MRF-ZOOM more than the conventional MRF method; when SNR ≥ 1, MRF quantification yielded accurate results. Dictionary compression introduced quantification errors more to T2 quantification. MRF-ZOOM was thousands of times faster than the conventional MRF method. Combining MRF-ZOOM with dictionary compression showed no benefit in terms of fitting speed. In conclusion, MRF-ZOOM is valid for MRF- FISP, and can remarkably save MRF dictionary generation and searching time without sacrificing matching accuracy. Tsallis-Entropy Segmentation through MRF and Alzheimer anatomic reference for Brain Magnetic Resonance Parcellation Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): Mehran Azimbagirad, Fabrício H. Simozo, Antonio C.S. Senra Filho, Luiz O. Murta Junior Abstract Quantifying the intracranial tissue volume changes in magnetic resonance imaging (MRI) assists specialists to analyze the effects of natural or pathological changes. Since these changes can be subtle, the accuracy of the automatic compartmentalization method is always criticized by specialists. We propose and then evaluate an automatic segmentation method based on modified q-entropy (Mqe) through a modified Markov Random Field (MMRF) enhanced by Alzheimer anatomic reference (AAR) to provide a high accuracy brain tissues parcellation approach (Mqe-MMRF). We underwent two strategies to evaluate Mqe-MMRF; a simulation of different levels of noise and non-uniformity effect on MRI data (7 subjects) and a set of twenty MRI data available from MRBrainS13 as patient brain tissue segmentation challenge. We accessed eleven quality metrics compared to reference tissues delineations to evaluate Mqe-MMRF. MRI segmentation scores decreased by only 4.6% on quality metrics after noise and non-uniformity simulations of 40% and 9%, respectively. We found significant mean improvements in the metrics of the five training subjects, for whole-brain 0.86%, White Matter 3.20%, Gray Matter 3.99%, and Cerebrospinal Fluid 4.16% (p-values < 0.02) when Mqe-MMRF compared to the other reference methods. We also processed the Mqe-MMRF on 15 evaluation subjects group from MRBrainS13 online challenge, and the results held a higher rank than the reference tools; FreeSurfer, SPM, and FSL. Since the proposed method improved the precision of brain segmentation, specifically, for GM, and thus one can use it in quantitative and morphological brain studies. Graphical abstract The correlation of fractional anisotropy parameters with Ki-67 index, and the clinical implication in grading of non-enhancing gliomas and neuronal-glial tumors Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): Xiang Liu, Wei Tian, Balasubramanya Kolar, Mahlon D. Johnson, Michael T Milano, Haihui Jiang, Song Lin, Dongmei Li, Nimish A. Mohile, Yan M. Li, Kevin A. Walter, Sven Ekholm, Henry Z Wang Abstract PurposeTo investigate the correlation between the FA parameters and Ki-67 labeling index, and their diagnostic performance in grading supratentorial non-enhancing gliomas and neuronal-glial tumors (GNGT). MethodsThis institutional review board-approved, Health Insurance Portability and Accountability (HIPAA) compliant retrospective study enrolled 35 patients, including 19 with low grade GNGT and 16 with high grade GNGT. The mean FA, maximal FA and mean maximal FA values derived from diffusion tensor imaging were measured. The correlation between the FA parameters and the Ki-67 labeling index was assessed by Spearman rank test. The receiver operating characteristic curve analysis and multivariate logistic regression analysis were performed to detect the optimal imaging parameters in grading GNGT. ResultsThe three FA parameters of low grade GNGT were significantly lower than the high grade GNGT (p < 0.001). The mean FA, maximal FA and mean maximal FA had significant positive correlation with Ki-67 labeling index (p = 0.001, p < 0.001, p < 0.001 respectively). The maximal FA showed a higher sensitivity and specificity in grading of non-enhancing GNGT with specificity of 78.9%, sensitivity of 100.0%, respectively. ConclusionsThe FA parameters correlated with Ki-67 labeling index, and were useful surrogates in preoperative grading supratentorial non-enhancing GNGT. Generation of human thalamus atlases from 7 T data and application to intrathalamic nuclei segmentation in clinical 3 T T1-weighted images Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): Yuan Liu, Pierre-François D'Haese, Allen T. Newton, Benoit M. Dawant Abstract The thalamus serves as the central relay station for the brain. It processes and relays sensory and motor signals between different subcortical regions and the cerebral cortex and it can be divided into several neuronal clusters referred to as nuclei. Each of these can possibly be subdivided into sub-nuclei. Accurate and reliable identification of thalamic nuclei is important for surgical interventions and neuroanatomical studies. This is however a challenging task because the small size of the nuclei and the lack of contrast over the thalamus region in clinically acquired images does not permit the visualization of their boundaries. A number of methods have been developed for thalamus parcellation but the vast majority of these relies on diffusion imaging or functional imaging. The low resolution of these images only permit localizing the largest nuclei. In this work we propose a method to segment smaller nuclei. We first present a protocol to build histological-like atlases from a series of high-field (7 Tesla) MR images acquired with different pulse sequences that each permits to visualize the boundaries of a subset of the nuclei. We use this protocol to scan 9 subjects and we manually delineate 23 thalamic nuclei following the Morel atlas naming convention for each of these subjects. Manual contours for the nuclei are subsequently utilized to create statistical shape models. With these data, we compare four methods for the segmentation of thalamic nuclei in 3 T images we have also acquired for the 9 subjects included in the study: (1) single atlas, (2) multi atlas, (3) statistical shape, and (4) hierarchical statistical shape in which thalamic nuclei are hierarchically fitted to the images, starting from the largest ones. Results of a leave-one-out validation study conducted on the nine image sets we have acquired show that the multi atlas approach improves upon the single atlas approach for most nuclei. Segmentations obtained with the hierarchical statistical shape model yield the highest accuracy, with dice coefficients ranging from 0.53 to 0.90, mean surface errors from 0.27 mm to 0.64 mm, and maximum surface errors from 1.31 mm to 2.52 mm for all nuclei averaged across test cases. This suggests the feasibility of using such approach for localizing thalamic substructures in clinically acquired MR volumes. It may have a direct impact on surgeries such as Deep Brain Stimulation procedures that require the implantation of stimulating electrodes in specific thalamic nuclei. Quantitative ferumoxytol-enhanced MRI in pregnancy: A feasibility study in the nonhuman primate Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): Ante Zhu, Scott B. Reeder, Kevin M. Johnson, Sydney M. Nguyen, Sean B. Fain, Ian M. Bird, Thaddeus G. Golos, Oliver Wieben, Dinesh M. Shah, Diego Hernando Abstract ObjectivesTo assess the feasibility of ferumoxytol-enhanced MRI in pregnancy with a nonhuman primate model. Materials and methodsIn this prospective study, eleven pregnant rhesus macaques at day 98 ± 5 of gestation were divided into three groups, untreated control (UC) (n = 3), saline control (SC) (n = 4) and interleukin 1 beta (IL-1β) treated (IT) (n = 4), which were administered with either saline or IL-1β into the amniotic fluid. All animals were imaged at multiple time points before and after ferumoxytol administration (4 mg/kg). Longitudinal R2* and susceptibility of tissues were obtained using region-of-interest analysis and the longitudinal changes were assessed using linear mixed models and Student's t-test. ResultsIn fetuses, a slope of 0.3 s−1/day (P = 0.008), 0.00 ppm/day (P = 0.699) and − 0.2 s−1/day (P = 0.023) was observed in liver R2*, liver susceptibility, and lung R2*, respectively. In placentas, R2* and susceptibility increased immediately after ferumoxytol administration (P < 0.001) and decreased to baseline within two days. The mean change from baseline showed no significant difference between the SC group and the IT group at all scan time points. In maternal livers, R2* increased immediately after ferumoxytol administration, further increased at one-day, and then decreased but remained elevated (P < 0.001). The mean change from baseline showed no significant difference between the SC group and the IT group at all scan time points. ConclusionsThis work demonstrates the feasibility of quantitative ferumoxytol-enhanced MRI to measure dynamics of ferumoxytol delivery and washout in the placenta. Stable MRI measurements indicated no evidence of iron deposition in fetal tissues of nonhuman primates after maternal ferumoxytol exposure. Evaluation of B0-correction of relative CBF maps using tagging distance dependent Z-spectrum (TADDZ) Publication date: January 2020 Source: Magnetic Resonance Imaging, Volume 65 Author(s): Frederick C. Damen, Rong-Wen Tain, Riya Thomas, Weigo Li, Leon Tai, Kejia Cai Abstract Arterial spin labeling (ASL) MRI, based on endogenous contrast from blood water, is used in research and diagnosis of cerebral vascular conditions. However, artifacts due to imperfect imaging conditions such as B0-inhomogeneity (ΔB0) could lead to variations in the quantification of relative cerebral blood flow (CBF). In this study, we evaluate a new approach using tagging distance dependent Z-spectrum (TADDZ) data, similar to the ΔB0 corrections in the chemical exchange saturation transfer (CEST) experiments, to remove the imaging plane B0 inhomogeneity induced CBF artifacts in ASL MRI. Our results indicate that imaging-plane B0-inhomogeneity can lead to variations and errors in the relative CBF maps especially under small tagging distances. Along with an acquired B0 map, TADDZ data helps to eliminate B0-inhomogeneity induced artifacts in the resulting relative CBF maps. We demonstrated the effective use of TADDZ data to reduce variation while subjected to systematic changes in ΔB0. In addition, TADDZ corrected ASL MRI, with improved consistency, was shown to outperform conventional ASL MRI by differentiating the subtle CBF difference in Alzheimer's disease (AD) mice brains with different APOE genotypes.
STrategically Acquired Gradient Echo (STAGE) imaging, part III: Technical advances and clinical applications of a rapid multi-contrast multi-parametric brain imaging methodPublication date: January 2020Source: Magnetic Resonance Imaging, Volume 65Author(s): E. Mark Haacke, Yongsheng Chen, David Utriainen, Bo Wu, Yu Wang, Shuang Xia, Naying He, Chunyan Zhang, Xiao Wang, M. Marcella Lagana, Yu Luo, Ali Fatemi, Saifeng Liu, Sara Gharabaghi, Dongmei Wu, Sean K. Sethi, Feng Huang, Taotao Sun, Feifei Qu,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Thyroidology and public health: Challenges within the medical profession Sanjay Kalra Thyroid Research and Practice 2019 16(3):93-94 Assessment of serum midkine level in benign and malignant thyroid nodules. Can midkine be a marker of thyroid malignancy? Nermin Ahmed Sheriba, Maram Mohamed Mahdy, Rana Hashem Ibrahim Elattary, Maha Mohamed El-Nabarawy Thyroid Research and Practice 2019 16(3):95-99 Background: Thyroid nodules are a common clinical problem. The prevalence of malignancy in thyroid nodules is currently about 5%–15%. Fine-needle aspiration biopsy (FNAB) has improved the preoperative prediction of malignancy, but still has disadvantages including operator variability and nondiagnostic reports. Midkine (MK) is a novel heparin-binding growth factor; MK levels have been proposed as indicative of malignancy in numerous tumors. MK overexpression in thyroid cancer has been reported to be in correlation with clinicopathological features of the tumor, hypothesizing that MK might play a role as a biomarker for diagnosis and more aggressive behavior of thyroid cancer. Aim: The aim of this study is to evaluate the value of serum MK (SMK) as a marker of malignancy in patients with nodular thyroid disease. Patients and Methods: The current study included 75 individuals with age ranging from 25 to 80 years divided into 25 with malignant thyroid nodule (Group A), 25 with benign thyroid nodule (Group B), and 25 healthy individuals as a control group (Group C). Free triiodothyronine, free thyroxin, thyroid-stimulating hormone, and SMK levels were assessed. Individuals with thyroid nodules were submitted for neck ultrasonography and FNAB. Results: On comparing the three studied groups, a high statistically significant difference in plasma MK levels was found (P < 0.001), being higher in Group A (malignant nodule) with a mean of 1.127 ± 0.527 than Group B (benign nodule) with a mean of 0.536 ± 0.301 with P < 0.001* and also higher in Group A (malignant nodule) with a mean of 1.127 ± 0.527 than Group C (control) with a mean of 0.366 ± 0.230 with P < 0.001*. There was significant difference regarding MK levels, with thyroid nodule contour being higher in thyroid nodule with irregular contour than thyroid nodule with regular contour (P < 0.001*) and calcification being higher in microcalcification than macrocalcification (P = 0.006*). There was high statistically significant difference regarding the level of MK between papillary carcinoma and follicular carcinoma (P < 0.001*). Conclusions: SMK might be the indicator of malignant thyroid cytopathology, suggesting that MK might serve as a novel biomarker in the assessment of thyroid nodules. The present study explored the usefulness of MK as a biomarker in the differentiation between benign and malignant thyroid nodules in samples from serum. Morphological variations of the thyroid gland: An insight on embryological and clinicoanatomical considerations Honnegowda Thittamaranahalli Muguregowda, G Krishna, KG Prakash Thyroid Research and Practice 2019 16(3):100-104 Background: The thyroid gland, a highly vascular endocrine gland, is composed of two lateral lobes connected by isthmus. A wide range of morphological alterations of the thyroid gland such as hypoplasia, ectopy to hemiagenesis, and genesis are common because of disturbed embryogenesis. The significance of diagnosing such extensions of the thyroid gland is crucial. It may alter the normal anatomical relationship of the thyroid gland with other adjacent cervical structures. Further, it may be confused with a tumor mass on magnetic resonance imaging and scintillation scans. Methods: The primary aim is to study the thyroid gland for gross anatomical variations (weight, height, and breadth) and secondarily to document the morphometric and congenital/developmental variation gross of the thyroid gland in 65 cadavers from the coastal belt of South India. The glands were according to the various age groups of the cadavers. Results: The mean thyroid weight was 26.01 ± 7.14 g. In males, it was 26.59 ± 6.96 g, whereas in females, it was 20.93 ± 8.98 g. The pyramidal lobe was present in 35 (53.8%), and the presence of the levator glandulae thyroideae was noted in 25 (38.48%) of male cadavers. Agenesis of the isthmus was found in 20 (30.76%). However, the accessory thyroid tissue was found in only one female cadaver. Conclusions: Our morphometric study on cadaveric thyroid glands highlights individual and ethnic variations. Knowledge of various developmental anomalies and unusual variations of the thyroid gland is of paramount importance to differentiate it from other pathologies such as autonomous thyroid nodule and thyroiditis. Role of nuclear grooves in the cytological diagnosis of papillary carcinoma thyroid Archana S Bhat, Lisa Varma, Hilda Fernandes, CS Jayaprakash Thyroid Research and Practice 2019 16(3):105-107 Introduction: It is well known that nuclear grooves play a major role in the diagnosis of papillary carcinoma thyroid (PCT). Furthermore, grooves are found in many nonneoplastic lesions of thyroid. Aims: The aim of this study is to calculate the percentage of nuclear grooves in histopathologically proven cases of papillary carcinoma and nonneoplastic lesions (Hashimoto's thyroiditis and colloid goiter). Materials and Methods: This retrospective study was carried out by reviewing the data and cytology smears of 21 histopathologically confirmed cases of PCT and 10 cases each of Hashimoto's thyroiditis and colloid goiter. The percentage of nuclear grooves was calculated in oil immersion by counting 100–500 cells depending on the cellularity. Results: The percentage of nuclear grooving ranged from 15% to 85% in the papillary carcinoma cases. Greater than 20% nuclear grooves were observed in 19 (90.4%) of the cases. Nuclear crowding and overlapping, pale chromatin, nuclear grooves, nuclear enlargement, and prominent nucleoli were seen in all (100%) cases. Intranuclear cytoplasmic pseudoinclusions were seen in only 5 (23.8%) of the cases. Histiocytes, metaplastic cells, and multinucleated giant cells were seen in 12 (57.1%), 10 (47.6%), and 6 (28.5%) of the cases. The percentage of nuclear grooves in nonneoplastic cases overall observed was <10%. The sensitivity and specificity of grooves for PCT at ≥20% were 90.5% and 100%, respectively. Conclusion: Whenever in doubt, a diagnosis of papillary carcinoma can be offered confidently by this semiquantitative approach for grooves in combination with other features. Iodine nutrition status in Graves' disease: A single-center study from Bangladesh Md Abu Jar Gaffar, A B. M. Kamrul-Hasan, Afsar Ahammed, Muhammad Abul Hasanat, Md Fariduddin Thyroid Research and Practice 2019 16(3):108-112 Context: An increase in occurrence of Graves' disease (GD) has been reported in many countries after the introduction of the salt iodization program. Aims: To observe iodine nutrition status in GD. Settings and Design: Cross-sectional observational study conducted in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from May 2013 to September 2014. Methods and Material: This study included 140 GD patients (55 newly detected, 85 already under treatment). Urinary iodine concentration (UIC) was measured in spot urine sample following wet digestion method. The iodine nutrition status was categorized according to the internationally recommended cutoffs of UIC (excessive: ≥300 μg/L, more than optimal: 200-299 μg/L, optimal: 100-199 μg/L, deficiency: <100 μg/L). Results: The median UIC in subjects with Graves' disease was 96.69 μg/L. 21.2% of the study subjects had iodine status to be considered as more than optimal or excessive, 25.7% had optimal iodine level, and more than half (51.4%) had iodine deficiency. The mean UIC were similar in newly diagnosed and treated groups, and among subjects with different thyroid functional status. UIC did not differ among male and female subjects and among subjects from different socioeconomic groups. UIC showed no correlations with age, socioeconomic condition, the family history of thyroid disease, TSH, FT4, and thyroid function status of the study participants. Conclusions: Effective monitoring of salt iodization program is needed to prevent iodine-excess related increase in the prevalence of Graves' disease. Prognostic efficacy of thyroid profile with sequential organ failure assessment score in predicting mortality in intensive care unit patients Arvind Mishra, Rohin Saini, Madhukar Mittal, Dandu Himanshu, Kamlesh Kumar Gupta, Abbas Ali Mahdi Thyroid Research and Practice 2019 16(3):113-120 Introduction and Objectives: Thyroid hormone changes in critically ill patients are commonly observed phenomenon. This is known as sick euthyroid syndrome. Sequential organ faillure assessment (SOFA) score is used to track and determine the extent of a person's organ function or its rate of failure. We performed a prospective observation study to analyze the prognostic rather than diagnostic efficacy of thyroid function test (TFT) (T3, T4, thyroid-stimulating hormone [TSH], free triiodothyronine [fT3], and free thyroxine [fT4]) in unselected critically ill patients and compare the prognostic efficacy of fT3, fT4, TSH, T3, and T4 with SOFAS in predicting mortality in critically ill patients. Materials and Methods: We studied a sample of unselected 338 patients admitted in the intensive care unit (ICU) and measured their TFT, routine biochemical parameters within 48 h of admission along with SOFA scores and assessed their individual and combined efficacy in predicting mortality. All patients with known thyroid illness were excluded from this study. Results: There were 200 survivors and 138 nonsurvivors, the nonsurvivors had higher SOFAS score and lower free T3 levels and lower T3 levels compared to survivors. ICU survival was predicted using SOFAS score alone and a combination of TFT with SOFA score. Conclusions: In critically ill patients with higher SOFA score, lower values of serum fT3 and T3 levels were clinically significantly associated with mortality and free T3 have additional powers to improve predictive ability to SOFAS in predicting mortality in ICU patients. Severe hypothyroidism-associated acute renal failure – A case series from North India and review of literature Namrata S Rao, Abhilash Chandra, Kiran Preet Malhotra Thyroid Research and Practice 2019 16(3):121-127 Background: Several cases of complete or partially reversible renal failure have been reported in association with severe hypothyroidism, which have responded to thyroxine replacement. However, its risk factors, pathology, pathophysiology, and time of recovery remain unclear. Aim: We report our experience with 31 cases of renal failure in association with severe hypothyroidism, from a goiter-endemic belt in North India, along with a review of existing literature. Materials and Methods: We retrieved cases presenting to our centre, from August 2013 to April 2018 and collected information regarding clinical presentation, laboratory parameters including renal and thyroid function tests, creating kinase, urinary findings and follow-up data pertaining to time and extent of renal function recovery. In three cases, renal biopsies were also done, and these were reviewed by a pathologist. Results: In our study, females slightly outnumber males. More than one-third of patients were known hypothyroid and had defaulted on medications. The severity of serum thyroid-stimulating hormone and CK elevation were not associated with the severity of renal failure or its extent or time of recovery. Older age, coexistence of diabetes mellitus and/or hypertension, higher serum creatinine at presentation, and urinary abnormalities (proteinuria and/or active sediments) correlated significantly with lack of complete renal recovery. All the three biopsies revealed significant tubulointerstitial fibrosis. Conclusions: Thyroid function tests should be performed in the evaluation of unexplained renal failure, even in cases with underlying chronic kidney disease. It is also an important preventable cause of renal failure in known hypothyroid patients. A case-based approach to aggressive variants of papillary thyroid carcinoma with literature review Joseph Antoine Flordelis Chatto, Annette Laurente Salillas Thyroid Research and Practice 2019 16(3):128-136 Papillary thyroid caarcinoma (PTC) is the most common thyroid and endocrine malignancy. Although considered to be indolent, aggressive variants have been identified, including the Tall Cell (TCV), Columnar Cell (CCV), Hobnail (HPTC) and Solid Variants (SVPTC). The objective of this study is to pre-operatively recognize the cytologic features of these variants. Four cases with final diagnoses of TCV, CCV, HPTC and SVPTC were reviewed and compared with Fine Needle Aspiration Biopsy (FNAB) smears. The first case is a 44-year-old female diagnosed with TCV pre-operatively through FNAB and was confirmed through tissue biopsy showing malignant glands in papillary formation with greater than 50% of tall cells. The second patient is a 54-year-old female with CCV showing stratified columnar cells with cytoplasmic supranuclear and subnuclear vacuoles. Third is a 57-year-old female with HPTC exhibiting eccentrically-located nuclei imparting a hobnail appearance with cellular dyscohesiveness. The fourth case is a 59-year-old female diagnosed with SVPTC showing predominantly solid sheets surrounded by thin, delicate fibrous stroma. They all have nuclear features of PTC. TCV, CCV, HPTC and SVPTC are related to extrathyroidal extension, angiolymphatic invasion, positive surgical margin and lymph node metastasis. FNAB is an important tool to recognize these variants preoperatively and plan for amore comprehensive management. Extensive squamous metaplasia in papillary carcinoma of the thyroid: A potential diagnostic pitfall Subhash Yadav, Rajiv Kumar, Munita Bal, Asawari Patil Thyroid Research and Practice 2019 16(3):137-139 It is a rare event to find squamous cells in the thyroid gland. Squamous metaplasia (SM) of the thyroid follicular epithelium is one of such conditions. SM can occur in association with nonneoplastic as well as neoplastic thyroid lesions. Here, we report a case of papillary carcinoma of the thyroid in a 26-year-old female showing extensive SM. On immunohistochemistry, squamous as well as papillary carcinoma component expresses CK7 and thyroglobulin. High molecular weight cytokeratin and p63 were positive in only in the squamous area, while TTF-1 was negative in these cells. Extensive SM in the thyroid can be misinterpreted as primary or metastatic squamous cell carcinoma. Further, the tumor may be mislabeled as collision tumors of thyroid. As it might lead to therapeutic implications, the distinction of SM in thyroid is necessary. Diagnostic issue and caveats of immunoreactivity for Ki67 in hyalinizing trabecular neoplasm with a review of literature Veer Karuna, Priya Gupta, Mamta Gupta, Kriti Grover Thyroid Research and Practice 2019 16(3):140-143 Few benign and malignant tumors of thyroid lesion share many histological features, including papillary and trabecular pattern, hyalinized stroma, calcification, nuclear grooving, and nuclear inclusion. The lesions those have these common features are hyalinizing trabecular tumor, papillary thyroid carcinoma, medullary carcinoma, paraganglioma, trabecular follicular adenoma (TFA), and poorly differentiated tumor (PDT). These tumors are derived from thyroid follicular cell except PDT and paraganglioma. Hyalinized trabecular tumor and TFA are rare tumors. Due to these common features, they create a diagnostic pitfall for a false-positive or false-negative diagnosis. Therefore, histopathological and immunohistochemical studies are needed to make a definite diagnosis. The present case describes a relatively rare thyroid tumor – hyalinizing trabecular tumor – with its varied morphological features creating diagnostic difficulties and role of immunohistochemistry in formulating definitive diagnosis.
Thyroidology and public health: Challenges within the medical professionSanjay KalraThyroid Research and Practice 2019 16(3):93-94Assessment of serum midkine level in benign and malignant thyroid nodules. Can midkine be a marker of thyroid malignancy?Nermin Ahmed Sheriba, Maram Mohamed Mahdy, Rana Hashem Ibrahim Elattary, Maha Mohamed El-NabarawyThyroid Research and Practice 2019 16(3):95-99Background: Thyroid nodules are a common clinical problem. The prevalence of malignancy in thyroid nodules...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Statistical need of the hour Sanjeev Kumar Jain, Nidhi Sharma, Sonika Sharma Acta Medica International 2019 6(2):51-52 Impact of CD40 gene polymorphism on coronary artery disease in an Indian population: A pilot study Sapna Singh, Manisha Naithani, Sarama Saha Acta Medica International 2019 6(2):53-57 Context: Coronary artery disease (CAD) is number one killer in India. CD40/CD40 L may have crucial contribution in the development of CAD because of its dual prothrombotic and proinflammatory role. However, no study has been conducted to observe the effect of CD40 gene polymorphism on CAD in Indian populations. Aims: To determine the allelic frequency of CD40 gene and its influence on Indian individuals having unstable chest pain and cardiac muscle infarction which are variants of CAD. Settings and Design: A clinic-based observational study was conducted in Maulana Azad Medical College. Eighty angiographically proven patients of CAD and fifty healthy individuals registered for this study. Materials and Methods: Polymerase chain reaction and restriction fragment length polymorphism were used for studying CD40 gene polymorphism. Statistical Analysis Used: Frequency distribution of genotype was analyzed by standard Chi-square test using SPSS software version 21. Results: The C and T allele frequencies were 71.25% and 28.75%, respectively, in diseased individuals. Significant difference was observed among patients with CAD and healthy references regarding distribution of genotypes (χ2 = 10, P = 0.007) although allele frequencies (χ2 = 2.94, P = 0.09) of CD40 gene did not show any significance. The presence of C allele augmented the chance of having CADs compared to the wild type (odds ratio: 1.13; 95% confidence interval: 0.687–1.887). Conclusions: Important correlation was noted between rs1883832 C/T polymorphism of CD40 gene and risk of development of CADs among Indian populations. Oxidative stress and biomarker of tumor necrosis factor-alpha, malondialdehyde, and ferric reducing antioxidant power in hypertension Manish Kumar Verma, Anoop Jaiswal, Preeti Sharma, Pradeep Kumar, Anand Narayan Singh Acta Medica International 2019 6(2):58-64 Background: Concurrent with the imbalance of oxidizing agents and antioxidants, high blood pressure (BP) is a major physical condition burden in the current scenario. Tumor necrosis factor-alpha (TNF-α) plays a vital role in the pathogenesis of hypertension (HTN). TNF-α inhibitor improves clinical symptoms; however, their outcome on high BP has not been investigated. We investigated the inflammatory marker TNF-α, malondialdehyde (MDA), and ferric reducing antioxidant power (FRAP) in hypertensive patients. We measured BP randomly using an ambulatory observe in hypertensive patients. Measured systolic BP was 140 mmHg and/or diastolic BP was 90 mmHg were considered hypertensive. Materials and Methods: A total of 60 cases were considered in the study involving 30 hypertensive patients and 30 normal controls (30). Measurements of serum concentrations of TNF-α, MDA, and FRAP in HTN patients were done in both the groups. Results: Serum TNF-α was found to be remarkably increased in study participants as compared to the normal group (r = 0.32,P < 0.0001*). Serum MDA was also raised in hypertensive as compared to the control group (r = 0.99**,P < 0.0001*), whereas serum FRAP was found to be decreased in the hypertensive group in comparison to the healthy controls (r = 0.23,P < 0.0001*). Conclusions: It is concluded that high BP leads to the generation of oxidative stress with a remarkable elevation of TNF-α and MDA levels. The indicates decrease level of Ferric Reducing Antioxidant Power (FRAP) and suggest a possible role of oxidative stress in the pathophysiology of hypertension. Assessment of vital respiratory indices of petrol pump workers of Kathmandu Rajan Pandit Acta Medica International 2019 6(2):65-67 Introduction: Petrol pump is a place where workers are exposed to both fuel vapor and the vehicular exhaust fumes. Automobile exhaust, a complex mixture of different gasses such as sulfur dioxide, carbon dioxide, carbon monoxide, nitrogen dioxide, and particulate matter, has an adverse impact on the respiratory system. The present cross-sectional study, therefore, has been designed to determine the few vital respiratory indices of petrol pump workers. Methods: Forty nonsmoker petrol pump workers and other forty participants, as a control group from the same locality, were considered in this study. All inclusion and exclusion criteria were followed. After participants were familiarized with spiro-excel (PC bases) spirometer, they were asked to perform maneuver – a forced expiratory following full inspiration – until they could duplicate the maneuvers successfully on three consecutive attempts. Parameters such as forced vital capacity (FVC), forced expiratory volume in the 1st s (FEV1), FEV1/FVC (%), peak expiratory flow rate (PEFR), and forced expiratory flow at 25%–75% (FEF25%–75%) were recorded in sitting position preceded by 5-min rest, and the best values of three attempts were considered for data analysis using SPSS 16.0 version, and t-test (P < 0.05) was used for statistical analysis. Results: The mean ± standard deviation values of FVC, FEV1, FEV1/FVC (%), FEF25%–75%, and PEFR for petrol pump workers versus control groups were 3.44 ± 0.23 versus 3.94 ± 0.25 L, 2.64 ± 0.20 versus 3.24 ± 0.29 L, 77.11% ± 0.08% versus 82.61% ± 0.09%, 4.36 ± 0.37 versus 5.58 ± 0.36 L/s, and 6.35 ± 0.27 versus 7.62 ± 0.45 L/s, respectively. Conclusion: The significant decrease in FVC, FEV1, FEV1/FVC (%), FEF25%–75%, and PEFR in this study showed that long-term exposure to gasoline fumes/products leads to inflicted changes in lungs functions and could result to obstructive lung disease. Clinical profile and maternal depression and anxiety in children and adolescents with intellectual disability: A study from outpatient child psychiatry Bilal Ahmad Bhat, Shabir Ahmad Dar, Wasim Qadir, Mudassir Hassan Pandith Acta Medica International 2019 6(2):68-73 Background: With prevalence between 1% and 3%, intellectual disability (ID) not only affects the children and adolescents with this disability but also the caregivers, particularly the mothers. Aims: The aim was to study the clinical profile of children and adolescents with ID along with the prevalence of depressive and anxiety disorders in their mothers. Settings and Design: Cross-sectional descriptive study was conducted in Outpatient child psychiatry clinic. Methodology: Children and adolescents diagnosed with ID by a psychiatrist and clinical psychologist where subjected to a semi-structured questionnaire to record the sociodemographic status, antenatal history, perinatal history, and developmental history, presenting complaints, current behavioral problems, and medical history. Psychiatric comorbidity in the study participants and depression and anxiety disorders in their mothers was also assessed. Results: With the mean age of 8.68 years ± 2.63, majority (81.2%) belonged to the age group of 6–12 years with predominance of boys (60%). Antenatal factors were present in about 18%, whereas perinatal factors were present in about 48%. Delayed developmental history was present in 75%. Psychiatric comorbidity was present in about 32%, whereas current behavioral problems were present in about 47%. Majority (about 71%) had mild ID. Maternal depression and anxiety disorders were present in about 70%. Statistical Analysis: Descriptive analysis was performed with the Statistical Package for the Social Sciences. Conclusion: High rates of antenatal and perinatal factors with a history of developmental delay in a significant number of children and adolescents with ID were found. Mild ID predominated. Behavioral problems, psychiatric comorbidity, and medical comorbidity were frequently observed. Maternal depression and anxiety were also very high. Prevalence of different types of sphenoid sinus pneumatization in the Indian population: A noncontrast computed tomography-based study Abdul Haseeb Wani, Arshed Hussain Parry, Imza Feroz, Naseer Ahmad Choh, Tariq A Gojwari Acta Medica International 2019 6(2):74-77 Background: Trans-sphenoidal approach for various surgical interventions of sella and suprasellar pathologies is fraught with the risk of injuring vital neurovascular structures which lie nearby. Preoperative knowledge of the pattern of sphenoid sinus pneumatisation is of paramount importance to anticipate and simultaneously undertake appropriate precautions to avert any complication. Objective: To determine the prevalence of different types of sphenoid sinus pneumatisation in our population. Materials and Methods: NCCT head images of 613 patients were analysed retrospectively to determine the type of sphenoid sinus pneumatisation. Individuals in the age range of 20 to 75 years were included in the study. Individuals with age less than 20 years (pneumatisation incomplete), previous surgery involving skull base/sphenoid sinus and trauma causing hemo-sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. Results: The age range of evaluated patients was 20 to 75 years with mean age of 45.67 years of which 368 (60.03%) were males and 245 (39.97%) were females. There was no significant statistical difference in the prevalence of various types of sphenoid sinus pneumatisation between male and female subjects (P-value >0.05). The commonest type of sphenoid sinus pneumatisation was post-sellar type (82.71%) followed by sellar (14.68%) and pre-sellar (2.45%) type. Conchal type was extremely rare. Conclusions: Preoperative computed tomographic (CT) evaluation of sellar region is a requisite whenever trans-sphenoidal surgery is contemplated to determine the location and extent of sphenoid sinus walls to shorten operative time and to minimize morbid consequences. Determination of the gallbladder wall thickness in patients with cholecystitis and cholelithiasis by ultrasonography in North Indian population Vishram Singh, Durgesh Singh, Ashutosh Tandon, Yogesh Yadav, Richa Tiwari Acta Medica International 2019 6(2):78-81 Objective: The objective of the study was to determine the gallbladder (GB) wall thickness in patients with cholecystitis and cholelithiasis with the help of ultrasonography in North Indian population for the estimation of epidemiology. Aim: The aim was to estimate epidemiology of the GB wall thickness in patients with cholecystitis and cholelithiasis by ultrasonography in North Indian population. Materials and Methods: This was a hospital-based case–control study. Patients with cholecystitis and cholelithiasis of age between 15 and 70 years of either sex were included in the study. The GB wall thickness was determined in the fasting state. A total of 50 samples, 36 cases (with diseased bladder) and 14 controls (with normal bladder) were included in the study. Results: More than one-third of cases (38.9%) were between 30 and 40 years. The mean age of cases and controls was 42.22 ± 12.81 and 35.43 ± 11.85 years, respectively. More than one-third of both cases (36.1%) and controls (35.7%) were males. The GB wall thickness was significantly (P = 0.005) higher among the cases (4.06 ± 2.28 mm) than that of controls (2.22 ± 0.67 mm). Full distention of the GB was in more than half of both cases (69.4%) and controls (57.1%). Partial distended was in 11.1% of cases and in 21.4% of controls. Contracted (8.3%) and overdistended (2.8%) were only seen among cases. The GB wall thickness of ≥3 mm was among 66.7% of patients and in 14.3% of controls. The GB wall thickness of <3 mm was 92% lower in cases compared to controls (odds ratio = 0.08, 95% confidence interval = 0.01–0.43, P = 0.001). Conclusion: During ultrasonography, a higher degree of the GB wall thickness was found in patients with cholecystitis and cholelithiasis as compared to the control group. Role of a noninvasive stool-based molecular test in screening and early detection of colorectal cancers Khalid Ahmad Al-Sindi, Mulazim Hussain Bukhari, Mohmed Ali Al-Hamar Acta Medica International 2019 6(2):82-88 Background: Colonoscopy is considered the gold standard for most currently established screening programs for colorectal carcinoma (CRC), but due to its invasive nature, there were several emerging needs for the use of a substitutive, sensitive, non-invasive triaging modalities, such as utilizing immunochromatographic fecal occult blood tests (IFOBT) or molecular stool based tests such as Glycolytic M2-Pyruvate Kinase (M2-PK). Objectives: Firstly, to evaluate the sensitivity of a molecular stool based (M2PK) test, as a non-invasive, screening modality for detecting CRC and other colorectal disease (CRD). Secondary, to insight the current prevalence of CRC precursors in the Kingdom of Bahrain and recommend a customized age of enrollment in National Screening Program for CRC, once established and Thirdly, to compare the sensitivity of this fecal tumor marker based M2-PK test, as a potential replacement for the currently used IFOB test, in an attempt to promote for the need to establish a National Screening Program for Colorectal Cancer (NSPCC) based on such molecular based test or a similar platform in the kingdom, much comparable to the currently established international screening programs. Design: Prospective, cross sectional study. Duration and Place of Study: July 2012-December 2016, King Hamad University Hospital (KHUH), Bahrain. Sample Size: 2,100 (Based on Bahrain Population statistics: 1,248.348. Materials and Methods: The stool samples were collected shortly after launching a nationwide public awareness campaign against CRD in all major governmental and private sector hospitals and clinics. Out of the intended 2100 target samples, 1074 individuals managed to go through the well-structured distributed questioner and have been selected according to the inclusion/exclusion criteria and submitted their stools' samples for the detection of any CRD. A combined (molecular M2-PK and IFOBT) stool tests were used to detect any CRD in all examined stool samples. A total of 105 M2-PK' positive and 85 M2-PK'negative individuals underwent a subsequent specialist consultation and a fast track colonoscopy. Results: Out of the intended 2100 study sample, 1552 Participants were obtained during the study period and out of those, 1199 have been selected based on the inclusion and exclusion criteria. The no-show selected participants were 624 and only 575 individuals have submitted their Stool samples along with fully completed questioners. Out of those 575, only 287 stool samples were positive with M2-PK test, while 197 of the same stool samples were positive with IFOBT. Among these positive cases, only 105 of participants agreed after their medical consultation to undergo for full colonoscopies and biopsies for microscopic examination. These 105 successful full colonoscopies reveled 85 (81%) individuals negative for any neoplastic lesion and only 20 individuals (19%) showed neoplastic lesion. These 20 neoplastic findings included, 17 (85%) adenomatous polyps, 02 (10%), adenocarcinomas, and 01 (5%) was neuroendocrine carcinoma. The 17 adenomatous polyps were 09 tubular adenomas, 01 villous adenoma, and 07 tubulovillous adenomas. The colonoscopy findings in those (85) negative cases for neoplastic lesion were (6) hemorrhoids, (13) hyperplastic polyps, (10) normal mucosae with normal biopsies, (9) diverticulosis, (1) angiodysplasia, (1) inflammatory bowel disease and (1) solitary rectal ulcer. Conclusion: The screening of CRC by Stool Based molecular test such M2-PK showed high sensitivity for the detection of neoplastic Colorectal lesions compared to IFOBT. The study also found that stool based molecular (M2-PK) test, is a rapid, non-invasive, and convenient technique, which can be used as a platform for a forthcoming CRC National Screening Program in the Kingdom of Bahrain. Functional reach test: Establishing the reference value in healthy adults of Gujarat, India Vyoma Bharat Dani, Riki Shah, Rima Sheth Acta Medica International 2019 6(2):89-92 Context: Functional reach test (FRT) is a quick and simple, single-task dynamic test to measure the balance of an individual during functional task and is considered to be a predictor of fall in older adults. There is a lack of availability of data from a large population-based study, especially in India. Aim: The aim of the present study is to establish the reference value for FRT in healthy adults of Gujarat, India. Materials and Methods: It was a cross-sectional, observational study. Five hundred and twenty-one healthy individuals, aged 40–70 years, were recruited based on convenience sampling. All the participants were made to perform FRT in a controlled environment in community. Three readings of the actual test were obtained and averaged. Results: Data were analyzed with mean, standard deviation, confidence intervals (confidence interval 95%), and Pearson's correlation coefficient (r) with α = 0.05 by the age groups (40–50, 51–60, 61–70 years) and gender. The mean FRT value for healthy adults of Gujarat (age 40–70 years) was found to be 34.94 ± 3.9 cm and 33.43 ± 3.69 cm for males and females, respectively. It also showed significant negative correlation with weight and body mass index and also demonstrated age-related decline for both male and female participants. Conclusion: The reference value for FRT in healthy adults was found to be 34.18 (±3.79) cm. These large population-based data can be used as a reference with a specific age group considering due variability with regards to age, sex, anthropometric measures, genetics, and geographical changes. Robotic-assisted radical adrenalectomy for large adrenocortical carcinoma Altaf Khan, Vinit Kumar Singh, Muhammed A P. Manzoor, M Mujeeburahiman, Nischith Dsouza Acta Medica International 2019 6(2):93-95 Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy with poor prognosis. Laparoscopic adrenalectomy has been a favorite surgical approach for the treatment of adrenal masses. The use of robotic-assisted surgery is the latest development for minimally invasive surgical management of adrenal masses. Here, we describe a rare case of ACC in a 51-year-old male patient who presented with pain in the lumbar region, and robot-assisted laparoscopic radical adrenalectomy was successfully performed transperitoneally with the assistance of the da Vinci robotic system. We also discuss the summary of clinical features of ACC. Robot-assisted laparoscopic adrenalectomy is safe, is easier with lesser blood loss, and is comfortable to the patient due to its low complication rates. The patient improved after tumor removal.
Statistical need of the hourSanjeev Kumar Jain, Nidhi Sharma, Sonika SharmaActa Medica International 2019 6(2):51-52Impact of CD40 gene polymorphism on coronary artery disease in an Indian population: A pilot studySapna Singh, Manisha Naithani, Sarama SahaActa Medica International 2019 6(2):53-57Context: Coronary artery disease (CAD) is number one killer in India. CD40/CD40 L may have crucial contribution in the development of CAD because of its dual prothrombotic and proinflammatory role. However,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Standard safety policy: a retrospect of the Korean chicken egg crisis in 2017 Abstract On August 14, 2017, a report released by the Ministry of Agriculture, Food, and Rural Affairs confirmed the presence of pesticides in chicken eggs in South Korea. The literature has identified various causes for the crisis, such as the lack of criteria for permissible amounts of residual pesticides, and dichotomized management and supervision systems. This study investigated current laws and enactments relevant to South Korea's 2017 crisis of pesticide-contaminated eggs, seeking to extract applicable safety standards. Of the 12 laws directly related to eggs, eight contained a combined total of 19 safety standards. The main problems of these standards include the lack of criteria to regulate permissible amounts of residual pesticides, the lack of standardized countermeasures against residual chemicals, conflicting standards between higher-ranking and lower-ranking legal norms, and confusing misuse of terminology. It is suggested that these problems in egg-related safety standards can be addressed by South Korea adopting the internationally recognized Codex Alimentarius standard, with strengthened application of stricter administrative measures exceeding the Maximum Residue Levels in the field, using unified terminology. Thus, the present study aims to investigate the 2017 crisis to extract safety standards from the law and analyze related problems. The study also makes suggestions to improve applicable safety standards in the hope of preventing the recurrence of similar crises. PAGIF method to verify animal species in dairy products: improved separation performance, sensitivity and efficiency Abstract Over more than 20 years, isoelectric focusing (IEF) in a polyacrylamide gel (PAGIF) has been the only official method in Germany to verify the animal species in dairy products, including cheese. The method remains valid until now, using the analytical standards and the detection and quantification limits of that time. With the introduction of faster, cheaper and more sensitive methods, the PAGIF is in danger to lose importance in food control. Therefore, based on the § 64 method(s) of the German Food and Feed Code (LFGB), the pH gradient has been optimized, on the one hand, to sharpen the protein bands and thus to improve the detection limit (cow's milk: 0.1%, previously 1%) and on the other hand, to make it possible to analyze simultaneously several animal species, such as cow, sheep, goat and buffalo in one single gel. By condensing the workflow and improving the original performance data, the revised PAGIF will continue to be the official method in food control alongside new analytical methods. Prevalence of Salmonella spp. in Egyptian dairy products: molecular, antimicrobial profiles and a reduction trial using d -tryptophan Abstract The study aims to determine the prevalence and serotypes of Salmonella spp. in milk and dairy products sold on Egyptian markets, characterize their virulence-associated genes, and assess their antimicrobial profile. Furthermore, d-tryptophan was used as a new approach for controlling the growth of Salmonella in combination with heat stress. A total of 125 samples (raw market milk, bulk tank milk, Kareish cheese, white soft cheese, and small scale ice cream, 25 each) were used for assessing the prevalence of Salmonella spp. Nine Salmonella isolates with different serotypes were recovered from bulk tank milk (4/9; 44.44%) and Kariesh cheese (5/9; 55.55%), respectively. Antimicrobial susceptibility testing indicated that all isolates were resistant to streptomycin and erythromycin. PCR analysis revealed that 100%, 66.67% and 88.89% of the obtained isolates possessed invA, avrA and stn genes, respectively. d-Tryptophan (40 mM) in combination with heat stress had a significant inhibitory effect on Salmonella enterica subsp. enterica serovar Typhimurium (S. Typhimurium) added to control milk samples. The results indicate insufficient hygienic measures adopted during handling by dairies in Egypt. Therefore, strict hygienic approaches are recommended during milking, processing and distribution of dairy products in Egypt. A synergistic effect of d-tryptophan and heat stress is considered as a promising tool for controlling growth of Salmonella in milk. Stichprobenplanung in der Lebensmittelüberwachung: Reduktion des notwendigen Stichprobenumfangs durch Pooling Zusammenfassung Es wird ein Verfahren zur Berechnung des notwendigen Stichprobenumfangs in einem Pooling-Design zur Ermittlung des Substanzgehalts in Lebensmitteln beschrieben. Mit diesem kann die Poolgröße und die Anzahl notwendiger Messungen zur Bestimmung eines Mittelwerts mit einer vorgegebenen Konfidenzintervallbreite berechnet werden. Wie stark sich die Anzahl analytischer Messungen durch Pooling mehrerer Proben in einer Sammelprobe reduzieren lässt, hängt dabei von der Relation zwischen biologischer Varianz (Variation zwischen Proben unterschiedlichen Ursprungs) und technischer Varianz (Variation zwischen Wiederholungsmessungen) ab. Die Anwendung der Methode wird am Beispiel der Bestimmung von Dioxinen und polychlorierten Biphenylen (PCB) in Hühnereiern erläutert, kann jedoch auf andere Kontaminanten und Lebensmittel übertragen werden. Toy swords revisited: identification of additional odour-active contaminants Abstract Odorants related to offensive odours in three children's toy swords were identified and characterized by human sensory and chemical analyses. Samples were initially evaluated by a trained sensory panel. Panellists reported unpleasant smells in all samples that were dominated by mothball-like, phenolic and rubber-like notes and additionally almond-like and fatty notes. The odorants from the samples were then extracted using dichloromethane and subsequent solvent-assisted flavour evaporation distillation. Enriched distillates were then analysed by means of single and two-dimensional gas chromatography–mass spectrometry/olfactometry. An additional screening analysis for polycyclic aromatic hydrocarbons was also performed on all samples. The most predominant odorants identified in the samples were naphthalene, 1- and 2-methylnaphthalene and diverse dimethylnaphthalene isomers with gasoline-like smells. Acetophenone, with an almond-like, flowery smell, was also detected. Furthermore, the phenolic/leather-like smelling substances 3-ethylphenol, 3-hydroxyacetophenone, and 3-methoxyacetophenone were identified in one sample. Characteristics of enterotoxin-producing methicillin-resistant Staphylococcus aureus strains isolated from meat in Tehran, Iran Abstract In this study, we investigated the clonality, antibiotic susceptibility and presence of different enterotoxin genes among 49 methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from 131 fresh raw meat samples in Tehran, Iran during 2016. 47% of beef, 30% of chicken and 27% of turkey samples were MRSA positive. PhenePlate (PhP typing) revealed the presence of 12 PhP types consisting of five common types and seven single types, and 86% of the strains harbored staphylococcal cassette chromosome mec (SCCmec) type III and type 3 cassette chromosome recombinases (ccr). Moreover, SCCmec type IVa was positive in all isolates with SGA prophage types. High level resistance to ciprofloxacin, erythromycin, tobramycin and kanamycin was also observed. The rate of resistance to most of the antibiotics tested was higher in chicken samples compared to other meat samples. Out of eleven different enterotoxin genes found, sea, sek and seq were the dominant genes in all strains. Our results illustrate the presence and persistence of highly resistant clonal groups of enterotoxin-producing MRSA in meat samples. These isolates had PhP and SCCmec types and prophage patterns which were similar to the clinical isolates previously reported in Iran, supporting the notion of dissemination of the MRSA in the hospital, community, as well food products in Iran.
Standard safety policy: a retrospect of the Korean chicken egg crisis in 2017AbstractOn August 14, 2017, a report released by the Ministry of Agriculture, Food, and Rural Affairs confirmed the presence of pesticides in chicken eggs in South Korea. The literature has identified various causes for the crisis, such as the lack of criteria for permissible amounts of residual pesticides, and dichotomized management and supervision systems. This study investigated current laws and enactments relevant to...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
09:12
Understanding high ε-poly- l -lysine production by Streptomyces albulus using pH shock strategy in the level of transcriptomics Abstract ε-Poly-l-lysine (ε-PL) is a natural food preservative, which exhibits antimicrobial activity against a wide spectra of microorganisms. The production of ε-PL was significantly enhanced by pH shock in our previous study, but the underlying mechanism is poorly understood. According to transcriptional and physiological analyses in this study, the mprA/B and pepD signal transduction system was first proved to be presented and activated in Streptomyces albulus M-Z18 by pH shock, which positively regulated the transcription of ε-PL synthetase (Pls) gene and enhanced the Pls activity during fermentation. Furthermore, pH shock changed the ratio of unsaturation to saturation fatty acid in the membrane through up-regulating the transcription of fatty acid desaturase genes (SAZ_RS14940, SAZ_RS14945). In addition, pH shock also enhanced the transcription of cytochrome c oxidase (SAZ_RS15070, SAZ_RS15075), ferredoxin reductase (SAZ_RS34975) and iron sulfur protein (SAZ_RS31410) genes, and finally resulted in the improvement of cell respiratory activity. As a result, pH shock was considered to influence a wide range of proteins including regulators, fatty acid desaturase, respiratory chain component, and ATP-binding cassette transporter during fermentation. These combined influences might contribute to enhanced ε-PL productivity with pH shock. Adaptive mechanism of Acidithiobacillus thiooxidans CCTCC M 2012104 under stress during bioleaching of low-grade chalcopyrite based on physiological and comparative transcriptomic analysis Abstract Acidithiobacillus thiooxidans (A. thiooxidans) is often used for sulfur-bearing ores bioleaching, but its adaptive mechanism to harsh environments remains unclear. Here, we explored the adaptive mechanism of A. thiooxidans in the process of low-grade chalcopyrite bioleaching based on the physiology and comparative transcriptome analysis. It was indicated that A. thiooxidans maintains intracellular pH homeostasis by regulating unsaturated fatty acids, especially cyclopropane fatty acids, intracellular ATP, amino acid metabolism, and antioxidant factors. Comparative transcriptome analysis indicated that the key genes involved in sulfur oxidation, sor and soxABXYZ, were significantly up-regulated, generating more energy to resist extreme environmental stress by more active sulfur metabolism. Confocal laser scanning microscope analysis found that down-regulation of flagellar-related genes was likely to promote the biofilm formation. System-level understanding of leaching microorganisms under extreme stress can contribute to the evolution of these extremophiles via genetic engineering modification work, which further improves bioleaching in future. Enhanced production of heterologous proteins via engineering the cell surface of Bacillus licheniformis Abstract Cell surface engineering was proven as the efficient strategy for enhanced production of target metabolites. In this study, we want to improve the yield of target protein by engineering cell surface in Bacillus licheniformis. First, our results confirmed that deletions of d-alanyl-lipoteichoic acid synthetase gene dltD, cardiolipin synthase gene clsA and CDP-diacylglycerol-serine O-phosphatidyltransferase gene pssA were not conducive to cell growth, and the biomass of gene deletion strains were, respectively, decreased by 10.54 ± 1.43%, 14.17 ± 1.51%, and 17.55 ± 1.28%, while the concentrations of total extracellular proteins were improved, due to the increases of cell surface net negative charge and cell membrane permeability. In addition, the activities of target proteins, nattokinase, and α-amylase were also improved significantly in gene deletion strains. Furthermore, the triplicate gene (dltD, clsA, and pssA) deletion strain was constructed, which further led to the 45.71 ± 2.43% increase of cell surface net negative charge and 26.45 ± 2.31% increase of cell membrane permeability, and the activities of nattokinase and α-amylase reached 37.15 ± 0.89 FU/mL and 305.3 ± 8.4 U/mL, increased by 46.09 ± 3.51% and 96.34 ± 7.24%, respectively. Taken together, our results confirmed that cell surface engineering via deleting dltD, clsA, and pssA is an efficient strategy for enhanced production of target proteins, and this research provided a promising host strain of B. licheniformis for efficient protein expression. Identification and characterization of the ZRT, IRT-like protein (ZIP) family genes reveal their involvement in growth and kojic acid production in Aspergillus oryzae Abstract The ZRT, IRT-like protein (ZIP) family exists in many species and plays an important role in many biological processes, but little is known about ZIP genes in Aspergillus oryzae. Here, 10 ZIP genes in A. oryzae were identified and these were classified into four groups based on phylogenetic analysis. The structures of these AoZip genes were determined, which indicated a great divergence of AoZip members from different groups. Synteny analysis revealed that AoZip7, AoZip8, and AoZip10 are conserved among Aspergillus species. We also found that the promoter regions of AoZip2, AoZip7, AoZip8, and AoZip10 contain multiple conserved response elements. Expression analysis revealed that AoZips exhibited different expression patterns in response to different metal treatments. Moreover, overexpression and RNA-interference (RNAi) of AoZip2 led to a decrease in mycelium growth diameter and inhibited conidia formation. AoZip2 overexpression and RNAi strains showed distinct sensitivity to severely Zn/Mn-depleted stress. In addition, kojic acid production was markedly lower in AoZip2 overexpression and RNAi strains than in the control strains, and the expression of kojA, kojR, and kojT was down-regulated in AoZip2 overexpression and RNAi strains. This study provides new insights into our understanding of ZIP genes and lays a foundation for further investigation of their roles in Aspergillus oryzae. The expression, secretion and activity of the aspartic protease MpAPr1 in Metschnikowia pulcherrima IWBT Y1123 Abstract Protease-secreting yeasts have broad biotechnological potential for application to various industrial processes, including winemaking. However, this activity is influenced by the yeast response to environmental factors such as nitrogen and protein sources, as are found in grape juice. In this study, the wine-relevant yeast Metschnikowia pulcherrima IWBT Y1123, with known protease-secreting ability, was subjected to different nitrogen-containing compounds to monitor their impact on protease secretion and activity. Protease activity increased above basal levels for haemoglobin-containing treatments, indicating an inductive influence of proteins. On the other hand, treatments containing both haemoglobin and assimilable nitrogen sources led to a delayed increase in protease activity and protein degradation, suggesting a nitrogen catabolite repression mechanism at work. Protease activity and expression were furthermore evaluated in grape juice, which revealed increased expression and activity levels over time as promising results for further investigations into the impact of this yeast on wine properties. Redirecting the lipid metabolism of the yeast Starmerella bombicola from glycolipid to fatty acid production Abstract Free fatty acids are basic oleochemicals implemented in a range of applications including surfactants, lubricants, paints, plastics, and cosmetics. Microbial fatty acid biosynthesis has gained much attention as it provides a sustainable alternative for petrol- and plant oil-derived chemicals. The yeast Starmerella bombicola is a microbial cell factory that naturally employs its powerful lipid metabolism for the production of the biodetergents sophorolipids (> 300 g/L). However, in this study we exploit the lipidic potential of S. bombicola and convert it from the glycolipid production platform into a free fatty acid cell factory. We used several metabolic engineering strategies to promote extracellular fatty acid accumulation which include blocking competing pathways (sophorolipid biosynthesis and β-oxidation) and preventing free fatty acid activation. The best producing mutant (Δcyp52m1Δfaa1Δmfe2) secreted 0.933 g/L (± 0.04) free fatty acids with a majority of C18:1 (43.8%) followed by C18:0 and C16:0 (40.0 and 13.2%, respectively). Interestingly, deletion of SbFaa1 in a strain still producing sophorolipids also resulted in 25% increased de novo sophorolipid synthesis (P = 0.0089) and when oil was supplemented to the same strain, a 50% increase in sophorolipid production was observed compared to the wild type (P = 0.03). We believe that our work is pivotal for the further development and exploration of S. bombicola as a platform for synthesis of environmentally friendly oleochemicals. Microbial production of O -methylated flavanones from methylated phenylpropanoic acids in engineered Escherichia coli Abstract Methylated flavonoids possess improved bioactivities compared to their unmethylated counterparts. In this study, for the efficient production of O-methylated flavonoids from simple methylated phenylpropanoic acids, a recombinant Escherichia coli strain expressing 4-coumarate:coenzyme A ligase (4CL) from Oryza sativa and chalcone synthase (CHS) from Hordeum vulgare was constructed; this strain produced significant amount of homoeriodictyol (~ 52 mg/L) as well as a few amount of hesperetin (0.4 mg/L), respectively, from ferulic acid and 4-methylcaffeic acid. This demonstrates, for the first time, that the scarce but valuable methylated flavanones can be successfully produced from methylated phenylpropanoic acids in a microbial host via an artificial biosynthetic pathway consisting of 4CL and CHS that can accept O-methylated precursors. Beneficial mutations for carotenoid production identified from laboratory-evolved Saccharomyces cerevisiae Abstract Adaptive laboratory evolution (ALE) is a powerful tool used to increase strain fitness in the presence of environmental stressors. If production and strain fitness can be coupled, ALE can be used to increase product formation. In earlier work, carotenoids hyperproducing mutants were obtained using an ALE strategy. Here, de novo mutations were identified in hyperproducers, and reconstructed mutants were explored to determine the exact impact of each mutation on production and tolerance. A single mutation in YMRCTy1-3 conferred increased carotenoid production, and when combined with other beneficial mutations led to further increased β-carotene production. Findings also suggest that the ALE strategy selected for mutations that confer increased carotenoid production as primary phenotype. Raman spectroscopy analysis and total lipid quantification revealed positive correlation between increased lipid content and increased β-carotene production. Finally, we demonstrated that the best combinations of mutations identified for β-carotene production were also beneficial for production of lycopene. Efficient production of glutathione with multi-pathway engineering in Corynebacterium glutamicum Abstract Glutathione is a bioactive tripeptide composed of glycine, l-cysteine, and l-glutamate, and has been widely used in pharmaceutical, food, and healthy products. The current metabolic studies of glutathione were mainly focused on the native producing strains with precursor amino acid supplementation. In the present work, Corynebacterium glutamicum, a workhorse for industrial production of a series of amino acids, was engineered to produce glutathione. First, the introduction of glutathione synthetase gene gshF from Streptococcus agalactiae fulfilled the ability of glutathione production in C. glutamicum and revealed that l-cysteine was the limiting factor. Then, considering the inherent capability of l-glutamate synthesis and the availability of external addition of low-cost glycine, l-cysteine biosynthesis was enhanced using a varieties of pathway engineering methods, such as disrupting the degradation pathways of l-cysteine and l-serine, and removing the repressor responsible for sulfur metabolism. Finally, the simultaneously introduction of gshF and enhancement of cysteine formation enabled C. glutamicum strain to produce glutathione greatly. Without external addition of l-cysteine and l-glutamate, 756 mg/L glutathione was produced. This is first time to demonstrate the potential of the glutathione non-producing strain C. glutamicum for glutathione production and provide a novel strategy to construct glutathione-producing strains. Biological functions of nirS in Pseudomonas aeruginosa ATCC 9027 under aerobic conditions Abstract Through our previous study, we found an up-regulation in the expression of nitrite reductase (nirS) in the isothiazolone-resistant strain of Pseudomonas aeruginosa. However, the definitive molecular role of nirS in ascribing the resistance remained elusive. In the present study, the nirS gene was deleted from the chromosome of P. aeruginosa ATCC 9027 and the resulting phenotypic changes of ΔnirS were studied alongside the wild-type (WT) strain under aerobic conditions. The results demonstrated a decline in the formations of biofilms but not planktonic growth by ΔnirS as compared to WT, especially in the presence of benzisothiazolinone (BIT). Meanwhile, the deletion of nirS impaired swimming motility of P. aeruginosa under the stress of BIT. To assess the influence of nirS on the transcriptome of P. aeruginosa, RNA-seq experiments comparing the ΔnirS with WT were also performed. A total of 694 genes were found to be differentially expressed in ΔnirS, of which 192 were up-regulated, while 502 were down-regulated. In addition, these differently expressed genes were noted to significantly enrich the carbon metabolism along with glyoxylate and dicarboxylate metabolisms. Meanwhile, results from RT-PCR suggested the contribution of mexEF-oprN to the development of BIT resistance by ΔnirS. Further, c-di-GMP was less in ΔnirS than in WT, as revealed by HPLC. Taken together, our results confirm that nirS of P. aeruginosa ATCC 9027 plays a role in BIT resistance along with biofilm formation and further affects several metabolic patterns under aerobic conditions.
Understanding high ε-poly- l -lysine production by Streptomyces albulus using pH shock strategy in the level of transcriptomicsAbstractε-Poly-l-lysine (ε-PL) is a natural food preservative, which exhibits antimicrobial activity against a wide spectra of microorganisms. The production of ε-PL was significantly enhanced by pH shock in our previous study, but the underlying mechanism is poorly understood. According to transcriptional and physiological analyses in this study, the mprA/B and pepD signal...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
09:11
Deoxyribonucleic Acid Repair Activity Is Associated with Healed Coronary Plaque Rupture by Optical Coherence Tomography Abstract Deoxyribonucleic acid (DNA) damage and repair signaling cascades are related to the development of atherosclerosis. Pathological studies have demonstrated that healed coronary plaque rupture (HCPR) contributes to plaque progression and predisposes to sudden ischemic cardiac death. The objective of this study is to investigate the relationship between HCPR detected by optical coherence tomography (OCT) and DNA ligase. Forty-two patients with both OCT and DNA ligase were prospectively enrolled. The population included patients with stable angina pectoris (SA) and non-ST-elevation myocardial infarction (NSTEMI). It was found that the prevalence of HCPR was greater in subjects with higher DNA ligase activity (correlation coefficient 0.36, p = 0.019). The presence of HCPR in patients with NSTEMI was greater than in patients with SA per OCT analysis; however, there was no statistical difference in this limited population (22.53% versus 12.83%, respectively, p = 0.116). DNA repair activity by DNA ligase was associated with HCPR in advanced coronary artery plaque by OCT. Amyloid Cardiomyopathy in the Rare Transthyretin Tyr78Phe Mutation Abstract Tyr78Phe is a rare pathogenic transthyretin (TTR) mutation. Few previous reports described a late-onset hereditary transthyretin-related amyloidosis (ATTR-m) form with a variable phenotype, mainly dominated by neurological manifestations. We describe the case of a 69-year-old male with massive but asymptomatic cardiac infiltration and only subclinical neurological involvement, and review the literature to depict characteristics of the Tyr78Phe TTR mutation. Application of Proteomics Profiling for Biomarker Discovery in Hypertrophic Cardiomyopathy Abstract High-throughput proteomics profiling has never been applied to discover biomarkers in patients with hypertrophic cardiomyopathy (HCM). The objective was to identify plasma protein biomarkers that can distinguish HCM from controls. We performed a case-control study of patients with HCM (n = 15) and controls (n = 22). We carried out plasma proteomics profiling of 1129 proteins using the SOMAscan assay. We used the sparse partial least squares discriminant analysis to identify 50 most discriminant proteins. We also determined the area under the curve (AUC) of the receiver operating characteristic curve using the Monte Carlo cross validation with balanced subsampling. The average AUC was 0.94 (95% confidence interval, 0.82–1.00) and the discriminative accuracy was 89%. In HCM, 13 out of the 50 proteins correlated with troponin I and 12 with New York Heart Association class. Proteomics profiling can be used to elucidate protein biomarkers that distinguish HCM from controls. Oxidized HDL, as a Novel Biomarker for Calcific Aortic Valve Disease, Promotes the Calcification of Aortic Valve Interstitial Cells Abstract Calcific aortic valve disease (CAVD) is characterized by progressive mineralization of the aortic valve. Lipid infiltration and oxidative stress are the driving forces for the initiation and development of this disease. However, it remains unknown whether oxidized high-density lipoprotein (ox-HDL) plays a role in the mineralization of aortic valve interstitial cells (AVICs). Serum ox-HDL levels were determined in 168 severe CAVD patients and 168 age- and gender-matched non-CAVD controls. Results showed that ox-HDL concentrations were significantly increased in CAVD compared with the control group (131.52 ± 30.96 ng/mL vs. 112.58 ± 32.20 ng/mL, P < 0.001) and were correlated with CAVD severity. Multivariable logistic regression revealed that ox-HDL levels were independently associated with CAVD after adjusting for the incidence of coronary artery disease (CAD) (odds ratio 1.019, 95% CI 1.012–1.027, P < 0.001) or atherosclerotic risk factors (odds ratio 1.027, 95% CI 1.017–1.037, P < 0.001). Chronic ox-HDL stimulation of AVICs increased alkaline phosphatase activity (ALP) and calcium deposits in AVICs in vitro. Mechanistic studies further showed that ox-HDL upregulated several osteogenic factors, including BMP-2, Runx2, and Msx2 expressions in AVICs. This is the first study to demonstrate a relationship between increased ox-HDL concentration and CAVD incidence. Exercise Attenuates Acute β-Adrenergic Overactivation – Induced Cardiac Fibrosis by Modulating Cytokines Abstract During acute sympathetic stress, the overactivation of β-adrenergic receptors (β-ARs) causes cardiac fibrosis by triggering inflammation and cytokine expression. It is unknown whether exercise training inhibits acute β-AR overactivation–induced cytokine expression and cardiac injury. Here, we report that running exercise inhibited cardiac fibrosis and improved cardiac function in mice treated with isoproterenol (ISO), a β-AR agonist. A cytokine antibody array revealed that running exercise prevented most of the changes in cytokine expression induced by ISO. Specifically, ISO-induced upregulation of 18 cytokines was prevented by running exercise. A Kyoto encyclopedia of genes and genomes analysis of these cytokines revealed that Hedgehog and RAP1 signaling pathways were involved in the regulation of cytokine expression by exercise. The changes in the expression of some cytokines that were prevented by exercise were verified by an enzyme-linked immunosorbent assay and real-time PCR. In conclusion, running exercise prevented the cytokine expression changes after acute β-AR overactivation and therefore attenuated cardiac fibrosis. Acute sympathetic stress is an important risk factor for the patients with cardiovascular diseases, and the present study revealed that exercise training can prevent against the upregulation of cytokines and the subsequent cardiac injury induced by acute sympathetic stress, suggesting that exercise training may be beneficial for cardiovascular patients who are in risk of acute sympathetic stress. This finding provides a theoretical basis for the application of exercise training in patients who may suffer from acute sympathetic stress. 3D Myocardial Scar Prediction Model Derived from Multimodality Analysis of Electromechanical Mapping and Magnetic Resonance Imaging Abstract Many cardiac catheter interventions require accurate discrimination between healthy and infarcted myocardia. The gold standard for infarct imaging is late gadolinium–enhanced MRI (LGE-MRI), but during cardiac procedures electroanatomical or electromechanical mapping (EAM or EMM, respectively) is usually employed. We aimed to improve the ability of EMM to identify myocardial infarction by combining multiple EMM parameters in a statistical model. From a porcine infarction model, 3D electromechanical maps were 3D registered to LGE-MRI. A multivariable mixed-effects logistic regression model was fitted to predict the presence of infarct based on EMM parameters. Furthermore, we correlated feature-tracking strain parameters to EMM measures of local mechanical deformation. We registered 787 EMM points from 13 animals to the corresponding MRI locations. The mean registration error was 2.5 ± 1.16 mm. Our model showed a strong ability to predict the presence of infarction (C-statistic = 0.85). Strain parameters were only weakly correlated to EMM measures. The model is accurate in discriminating infarcted from healthy myocardium. Unipolar and bipolar voltages were the strongest predictors. Early Wave Reflection and Pulse Wave Velocity Are Associated with Diastolic Dysfunction in Rheumatoid Arthritis Abstract Rheumatoid arthritis (RA) impacts arterial and diastolic function. This study examined whether arterial properties can determine diastolic function in RA. In 173 RA patients, arterial function measures including carotid femoral pulse wave velocity (PWV), central systolic and pulse pressure, pulse pressure amplification, and the magnitude and timing of the forward and reflected waves were measured using applanation tonometry. Diastolic function parameters including the ratio of early-to-late transmitral velocity (E/A) and ratio of E to the mean of the lateral and septal wall myocardial tissue lengthening (e') were measured using echocardiography. The timing of the reflected wave was associated with E/A; PWV was related to E/e'. The timing of the reflected wave, forward wave magnitude, and pulse pressure amplification were associated with impaired relaxation; PWV was related to increased left ventricular (LV) filling pressure. Early wave reflection and PWV are associated with LV-impaired relaxation and increased filling pressure, respectively, in RA. Prevalence of Cardiac Amyloidosis in Patients with Carpal Tunnel Syndrome Abstract Carpal tunnel syndrome (CTS) is a common finding among patients with cardiac amyloidosis. We sought to determine the prevalence of cardiac amyloidosis in patients who had undergone CTS surgery. From 2005 to 2014, 308 patients ≥ 60 years underwent CTS surgery. Of these, 233 (76%) agreed to participate in the study and 101 (73 ± 8 years; 68% females) showed left ventricular hypertrophy (LVH) ≥ 12 mm and underwent additional studies to diagnose AL and ATTR amyloidosis. Based on complementary studies, three patients were diagnosed with cardiac amyloidosis (two wild-type ATTR and one AL). The three patients showed bilateral CTS with no occupational risk factors. Prevalence of cardiac amyloidosis in the overall cohort was only 1.2% (3/233), but among patients with LVH and bilateral CTS, the prevalence was 5.5% (3/55) and 13.6% (3/22) if cases with an occupational risk factor were excluded. Cardiac amyloidosis should be excluded in the presence of bilateral CTS and particularly if an occupational risk factor is absent. The Influence of Aortic Valve Obstruction on the Hyperemic Intracoronary Physiology: Difference Between Resting Pd/Pa and FFR in Aortic Stenosis Abstract The reliability of fractional flow reserve (FFR) in aortic stenosis (AS) has been questioned because of the uncertain response to vasodilators. A retrospective multicenter cohort of 114 AS patients who underwent coronary physiology assessment was compared with 154 controls before and after propensity matching adjustment. The difference between resting distal coronary vs aortic pressure ratio (Pd/Pa) and FFR (ΔPd/Pa-FFR) was tested against the severity of AS. ΔPd/Pa-FFR was not influenced by the severity of AS in terms of aortic valve area (r = − 0.02, p = 0.83) and gradient (r = − 0.05, p = 0.64) or by the left ventricle hypertrophy (r = − 0.03, p = 0.88). Conversely, ΔPd/Pa-FFR was influenced by the presence of diabetes (r = − 0.24, p = 0.005), peripheral vascular disease (r = − 0.16, p = 0.047), and chronic kidney disease (r = − 0.19, p = 0.03). No significant difference was observed in the ΔPd/Pa-FFR between patients with AS and matched controls. Further studies are warranted to validate the FFR-guided revascularization in patients with AS. Curcumin Induces Endothelium-Dependent Relaxation by Activating Endothelial TRPV4 Channels Abstract It is well-known that curcumin, as a plant substance, has vascular protective effects. TRPV4 (transient receptor potential vanilloid 4) is a highly Ca2+-selective channel in vascular endothelium. In our study, fluorescent Ca2+ imaging in mesenteric arterial endothelial cells (MAECs) and overexpressed TRPV4 human embryonic kidney (HEK293) cells showed that curcumin dose-dependently stimulated Ca2+ influx. Whole-cell patch clamp proved that curcumin stimulated the TRPV4-mediated currents in TRPV4-HEK293 cells. The TRPV4-specific blocker HC067047 markedly decreased the whole-cell current. Molecular modeling and docking showed that the binding site of curcumin and TRPV4 was mainly in the amino acid sequence LYS340-LEU349 of TRPV4 protein. Furthermore, curcumin dose-dependently induced the endothelium-dependent vessel dilatation in small mesenteric arteries. Therefore, our results demonstrated that curcumin stimulates Ca2+ entry in endothelial cells and improves endothelium-dependent vessel relaxation by activating TRPV4 channels. Moreover, we identified the specific binding sites of curcumin and TRPV4, thereby highlighting its potential therapeutic target of cardiovascular diseases.
Deoxyribonucleic Acid Repair Activity Is Associated with Healed Coronary Plaque Rupture by Optical Coherence TomographyAbstractDeoxyribonucleic acid (DNA) damage and repair signaling cascades are related to the development of atherosclerosis. Pathological studies have demonstrated that healed coronary plaque rupture (HCPR) contributes to plaque progression and predisposes to sudden ischemic cardiac death. The objective of this study is to investigate the relationship between HCPR detected by optical...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
09:11
Metastatic pheochromocytoma and paraganglioma: Management of endocrine manifestations, surgery and ablative procedures, and systemic therapies Publication date: Available online 24 October 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): Sina Jasim, Camilo Jimenez Metastatic pheochromocytomas and paragangliomas (MPPGs) are rare neuroendocrine tumors. Most patients present with advanced disease that is associated with manifestations of catecholamine release. Surgical resection of the primary tumor and ablative therapies of metastases—whenever possible—may improve clinical outcomes and, perhaps, lengthen the patient's overall survival. Significant steps in understanding the genetic alterations linked to MPPGs and scientific progress made on cancers that share a similar pathogenesis are leading to the recognition of potential systemic therapeutic options. Data derived from clinical trials evaluating targeted therapies such as tyrosine kinase inhibitors, radiopharmaceuticals, immunotherapy, and combinations of these will likely improve the outcomes of patients with advanced and progressive MPPGs. Exemplary of this success is the recent approval in the United States of the high-specific-activity iodine131 meta-iodine-benzylguanidine (MIBG) for patients with unresectable and progressive MPPGs that express the noradrenaline transporter. This review will discuss the therapeutic approaches for patients with MPPGs. Pheochromocytoma: An approach to diagnosis Publication date: Available online 22 October 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): Emilia Sbardella, Ashley B. Grossman Pheochromocytomas are rare neuroendocrine chromaffin-derived tumors that arise within the adrenal medulla. They are usually benign, but if not diagnosed or if left untreated, they can have devastating consequences. Clinical consideration of the diagnosis is paramount, as they may have protean manifestations, and a high index of suspicion is essential if serious consequences are to be avoided. An accurate biochemical diagnosis is crucial for the management of these patients: either plasma or urinary metanephrines are both highly sensitive and specific if correctly employed, but knowledge of pre- and post-analytic interference is essential. Diagnostic imaging with cross-sectional CT and/or MRI offers high sensitivity in their detection, but lack specificity. The introduction of PET/CT/MR has led to a dramatic improvement in the localization of both pheochromocytomas and paragangliomas, together with the increasing availability of new functional imaging radionuclides. Optimal investigation and accurate diagnosis is best achieved at 'centers of excellence' with expert multidisciplinary teams. Disease monitoring of patients with pheochromocytoma or paraganglioma by biomarkers and imaging studies Publication date: Available online 21 October 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): Florentine Schreiner, Felix Beuschlein Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors, a large proportion of which secrete catecholamines. PPGL are associated with a high cardiovascular morbidity and come with a risk of malignancy. The therapy of choice is surgical resection. Nevertheless, PPGL are associated with a lifelong risk of tumor persistence or recurrence. Currently, there are no clinical, biochemical, histopathological or imaging characteristics, which can predict or exclude malignant behavior or tumor recurrence. Therefore, long-term follow-up is recommended even after apparent complete surgical removal. Early detection of recurrence is essential to reduce cardiovascular morbidity and mortality due to catecholamine secretion, to prevent morbidity by mass effects of paraganglioma (PGL) or by metastatic spread of disease. Due to the rarity of these tumors, no prospective data on long-term surveillance exist. In fact, current recommendations are based on retrospective analyses, expert opinions and case studies. The aim of this review is to provide an overview on the current state of knowledge with regard to known factors that increase the risk of recurrence and might impact disease monitoring as well as the available possibilities for biochemical and imaging follow-up. Based on this overview, we aim to propose a practical approach for a patient-oriented follow-up after surgical removal of a PPGL. Autoimmune polyglandular diseases Publication date: Available online 4 October 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): George J. Kahaly, Lara Frommer Autoimmune polyglandular diseases (APD) are defined as the presence of two autoimmune –induced endocrine failures. With respect to the significant morbidity and potential mortality of APD, the diagnostic objective is to detect APD at an early stage, with the advantage of less frequent complications, effective therapy and better prognosis. This requires that patients at risk be regularly screened for subclinical endocrinopathies prior to clinical manifestation. Regarding the time interval between manifestation of first and further endocrinopathies, regular and long-term follow-up is warranted. Quality of life and psychosocial status are poor in APD patients and involved relatives. Familial clustering is high in patients with APD. Considering the high incidence of one or more endocrinopathies in first-degree relatives of patients with APD, family members should be regularly screened since they may also develop autoimmune endocrinopathies. Multidisciplinary management of these multiplex families in specialized centers is warranted. Modern endocrine surgery – Striving for a better quality of life Publication date: Available online 28 September 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): Henning Dralle, Frank Weber Value of ileus-prophylactic surgery for metastatic neuroendocrine midgut tumours Publication date: Available online 25 September 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): Frank Weber, Henning Dralle Neuroendocrine tumours of the small intestine (SINET) are a rare disease. However, a rising incidence rate and excellent long-term survival, even in the setting of metastatic disease lead to a high prevalence of SINET of up to 11/100.000. At the time of diagnosis, most patients already suffer from metastatic disease. About one third of patients demonstrate localized or regional metastatic disease at time of presentation. For those patients the indication for curative surgery is not debated and 10-year cancer specific survival of almost 90% can be achieved. Due to major limitations of existing studies actually there is no sufficient evidence in favour of ileus-prophylactic palliative surgery for metastatic SINET. Until now the available evidence favouring an ileus-prophylactic palliative small bowel resection for stage IV SI-NET must be weighed against available high-level evidence from randomized trials that showed long-term survival under systemic therapy. Importantly, there is not a single study that indicates surgery for a symptomatic patient should be postponed. Because the majority of patients are symptomatic at the time of diagnosis, the rationale for an ileus-prophylactic palliative surgery is to operate before progression of mesenteric tumour mass and desmoplasia takes place and before intestinal obstruction and ischaemia occurs. To what extent a prophylactic palliative small bowel resection will provide a survival benefit in a situation where the mesenteric tumour mass cannot be resected radically is not clearly addressed by the current level of evidence. Insights into the autoimmune aspect of premature ovarian insufficiency Publication date: Available online 16 September 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): Kassem Sharif, Abdulla Watad, Charlie Bridgewood, Darja Kanduc, Howard Amital, Yehuda Shoenfeld Premature ovarian insufficiency (POI) refers to a continuum of decreasing ovarian function in women before the age of 40. To date, the cause of POI in the majority of cases remain unresolved. Many cases has been linked to genetic, toxic, infections, enzymatic and iatrogenic causes. A key function of the immune system is to identify and differentiate "self" and "non self" i.e. tolerance. Loss of self-tolerance results in an immune response against self-tissues and thus autoimmunity. Various investigations have highlighted the role of autoimmunity and its pertinence to POI. Several potential immune antigenic targets in the ovary have been reported to be involved in autoantibody induced autoimmune attack. The presence of lymphocytic oöphorits in ovarian samples of patients with POI provides histopathological evidence of autoimmune ovarian involvement. Finally, POI is strongly associated with other autoimmune conditions including for instance Addison disease, autoimmune polyglandular syndrome (APS) −1, APS-4, hypothyroidism, and diabetes mellitus among other autoimmune diseases. Taken together, these lines of evidence provide strong basis that support the role of autoimmunity as a potential cause of disease etiopathogenesis. Continuing research is increasingly providing more insight into the complex disease process. The aim of this review is to summarize the current literature related to the autoimmune nature of POI. Exacerbations of autoimmune diseases during pregnancy and postpartum Publication date: Available online 11 September 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): Vânia Vieira Borba, Gisele Zandman-Goddard, Yehuda Shoenfeld Autoimmune diseases represent a complex heterogeneous group of disorders that occur as a results of immune homeostasis dysregulation and loss of self-tolerance. Interestingly, more than 80% of the cases are found among women at reproductive age. Normal pregnancy is associated with remarkable changes in the immune and endocrine signaling required to tolerate and support the development and survival of the placenta and the semi-allogenic fetus in the hostile maternal immune system environment. Gravidity and postpartum represent an extremely challenge period, and likewise the general population, women suffering from autoimmune disorders attempt pregnancy. Effective preconception counseling and subsequent gestation and postpartum follow-up are crucial for improving mother and child outcomes. This comprehensive review provides information about the different pathways modulating autoimmune diseases activity and severity, such as the influence hormones, microbiome, infections, vaccines, among others, as well as updated recommendations were needed, in order to offer those women better medical care and life quality. Autoimmune diseases and pregnancy Publication date: Available online 11 September 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): Angela Tincani, Cecilia Nalli, Jamilya Khizroeva, Victoria Bitsadze, Andrea Lojacono, Laura Andreoli, Yehuda Shoenfeld, Alexander Makatsariya Pregnancy in autoimmune diseases remains an argument of debate. In last years great improvements were done and with the correct medical support women with disease such as Systemic Lupus Erythematosus or Antiphospholipid Syndrome can afford a pregnancy and have healthy babies. The starting point is a good counselling. Women should be informed about risks that can occur taking some medications while pregnant and, on the other hand, that there are medications that can be safety assumed during pregnancy. Furthermore, there are known maternal risks factor such as the presence of antiphospholipid antibodies or anti-Ro/SSA antibodies that must be carefully manage by both rheumatologists and obstetrics. In addition, also disease activity during pregnancy can represent an issue. For all these reason, a multidisciplinary approach is mandatory in order to give our patients an optimal medical support, before, during and after pregnancy. Prolactin and autoimmunity: The hormone as an inflammatory cytokine Publication date: Available online 11 September 2019 Source: Best Practice & Research Clinical Endocrinology & Metabolism Author(s): Vânia Vieira Borba, Gisele Zandman-Goddard, Yehuda Shoenfeld Nowadays, more than 80 autoimmune disorders are recognized, in which an aberrant immune response against different organs and tissues plays a crucial role. Hormonal homeostasis has great influence in achieving competent and healthy immune system function. Prolactin has a bioactive function acting as a hormone and a cytokine. It influences the immune system modulation, mainly inhibiting the negative selection of autoreactive B lymphocytes. Hyperprolactinemia has been detected in many patients with different autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, multiple sclerosis, autoimmune thyroid disease, systemic sclerosis, among others, and its believed to play a crucial role in disease pathogenesis. A direct correlation between prolactin levels and disease activity was not clear. Genetic factors may have a role in humans as in animal models. Dopamine agonists have proven to offer clinical benefits among autoimmune patients and represent a promising therapy to be explored. In this review, the authors attempt to provide a critical overview on the role of prolactin in the immune system, exploring its contribution to the development of autoimmune diseases.
Metastatic pheochromocytoma and paraganglioma: Management of endocrine manifestations, surgery and ablative procedures, and systemic therapiesPublication date: Available online 24 October 2019Source: Best Practice & Research Clinical Endocrinology & MetabolismAuthor(s): Sina Jasim, Camilo JimenezMetastatic pheochromocytomas and paragangliomas (MPPGs) are rare neuroendocrine tumors. Most patients present with advanced disease that is associated with manifestations of catecholamine release....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
09:10
The utility of thromboelastography and tranexamic acid in plasminogen activator inhibitor deficiency during pregnancy: a rare case report Complete plasminogen activator inhibitor-1 (PAI-1) deficiency is a very rare genetic disorder that is associated with an increased risk of bleeding diathesis. Patients with PAI-1 deficiency are also known to be at increased risk for massive postpartum hemorrhage. We discuss one such rare case of PAI-1 deficiency in a young pregnant patient at 22 weeks of gestation with history of prolonged bleeding. Tranexamic acid was administered for menorrhagia and resumed later for labor and continued into the postpartum period since antifibrinolytics have been the mainstay in the management of PAI-1 deficiency. The patient delivered a healthy infant at 39 weeks. As PAI-1 deficiency causes increased fibrinolysis, the patient's coagulation panel was monitored by performing serial thromboelastograms to monitor for any increase in fibrinolysis. We believe that thromboelastograms might be a useful tool in the monitoring and management of fibrinolytic conditions such as PAI-1 deficiency. Correspondence to Nitya Prabhakaran, MD, Resident, Post Graduate Year 4, Pathology and Anatomic Sciences, Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, M263 Medical School Building, One Hospital Drive, Columbia, MO 65212, USA Tel: +1 573 882 1201; e-mail: prabhakarann@health.missouri.edu Received 29 May, 2019 Revised 21 October, 2019 Accepted 25 October, 2019 Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved. von Willebrand factor alloantibodies in type 3 von Willebrand disease The development of neutralizing antibodies is a rare complication of von Willebrand disease treatment. In major surgical procedures for severe forms of the disease, the recognition of ineffective therapy and alternative treatment protocols are lifesaving. We report the case of a 6-year-old girl with type 3 von Willebrand disease in whom inhibitors were sought due to ineffective haemostasis together with lower than expected von Willebrand factor (VWF) recoveries after a surgical procedure. Replacement therapy first with recombinant factor VIIa and then with high doses of recombinant factor VIII in continuous infusion successfully stopped the bleeding. A high level of anti-VWF antibodies was determined by the immunological method. A frameshift mutation associated with premature termination codon (c.2435delC, p.Pro812ArgfsTer31) was determined in our patient. Although the reports on association of this mutation with inhibitor risk are inconsistent, it represents an evidence-based diagnostic and management practice in recognition of high-risk VWF genotype. Correspondence to Barbara Faganel Kotnik, MD, PhD, Department of Haematology and Oncology, University Medical Centre Ljubljana, University Children's Hospital, Bohoričeva 20, 1000 Ljubljana, Slovenia. Tel: +386 1 522 9215; fax: +386 1 522 4038; e-mail: barbara.faganel@kclj.si Received 16 May, 2019 Revised 22 August, 2019 Accepted 26 September, 2019 Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved. Evaluation of biomarkers for monitoring thrombogenic potential of FXaI16L A zymogen-like activated factor X variant (FXaI16L) is being developed for treating acute bleeding conditions. Activated factor V is an essential cofactor to FXaI16L for activating prothrombin to thrombin. Thrombi/emboli formation was observed microscopically in FXaI16L toxicity studies in animals. The objective of this research was to evaluate candidate biomarkers for FXaI16L-induced thrombi/emboli formation to inform safety monitoring and dose-escalation decisions in FXaI16L clinical trials. Effects of intravenous FXaI16L administration on platelets, fibrinogen, activated partial thromboplastin time (aPTT), prothrombin time (PT), D-dimer, tissue factor pathway inhibitor, thrombin : antithrombin complex, antithrombin, and factor V, and protein C (PC) activities were evaluated in mice, rats, and monkeys. Mice had endogenous factor V activity 10× that of monkeys and were overly sensitive to FXaI16L-induced thrombi/emboli formation. In monkeys, decreases in fibrinogen and prolongation in aPTT and PT emerged as potential biomarkers for impending FXaI16L-induced thrombi/emboli formation, based on association of changes with microscopically observable thrombi/emboli (0–97 thrombi/emboli per monkey). PC decreases, measured by a clot-based assay, were also observed. A similar reduction in PC activity, when measured by clot-based assay, was observed in a phase 1 clinical trial. However, an in-vitro experiment with human plasma spiked with increasing concentrations of FXaI16L indicated dose-dependent FXaI16L-induced interference with clot-based assays and no depletion of PC or S by FXaI16L in non-clot-based assays. Nonclinical biomarker studies identified fibrinogen, aPTT and PT as potential biomarkers for monitoring the clinical safety of FXaI16L. Results of clot-based assays with FXaI16L treatment should be interpreted with caution. Correspondence to Michael W. Bolt, PhD, DABT, Drug Safety Research and Development, Pfizer Inc, 1 Portland St, Cambridge, MA 02139, USA Tel: +1 617 674 6408; e-mail: Michael.Bolt@Pfizer.com Received 3 May, 2019 Revised 27 August, 2019 Accepted 26 September, 2019 Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved. Congenital afibrinogenemia in a patient with vascular abnormalities and a novel variant: clinical-molecular description and literature review The objective is to report a patient with congenital afibrinogenemia and vascular abnormalities and also review the clinical and molecular issues. The female proband, diagnosed with congenital afibrinogenemia, was admitted at a hospital due to a hemorrhagic shock. Angiotomography revealed ectasias from ascending branch to the abdominal aorta, with multiple calcifications and atheroma. Clinical exome identified a homozygous novel pathogenic variant in FGG gene. In our review the main symptom, at diagnosis, was umbilical cord bleeding and the degree of clinical involvement varied from asymptomatic to severe. The FGA gene was the most affected and possible hot spots were observed. Variants considered as loss of function were the most frequent. The association of vascular abnormalities in a patient with congenital afibrinogenemia alerts for a closer follow-up of vascular issues in these patients. Correspondence to Luiza A. Virmond, Clinical Genetics Department, Universidade Federal de São Paulo, Rua Botucatu, 394, Vila Clementino, São Paulo 04023-061, SP, Brazil E-mail: virmondluiza@gmail.com Received 2 August, 2019 Accepted 15 October, 2019 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.bloodcoagulation.com). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.bloodcoagulation.com). Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved. An obscure case of using apixaban anti-Xa levels in a morbidly obese patient who was nil per os with enterocutaneous fistula Apixaban anti-Xa levels have been introduced to monitor apixaban activity. Presented is a fundamental use of anti-Xa monitoring in questionable absorption in enterocutaneous fistula. A 57-year-old morbidly obese male (150 kg, BMI 42.5) presented to the emergency department with deep venous thromboses and pulmonary embolisms. He also had high-output enterocutaneous fistula managed with an abdominal collection device, total parental nutrition therapy, and nil per os status. He was able to take some oral (PO) medications; however, he reported finding whole capsules in his collection device. He refused enoxaparin injections for venous thromboembolism treatment. The decision was made to load with apixaban therapy with anti-Xa monitoring. After two 10-mg doses, peak apixaban anti-Xa level was 146 ng/ml which fell within on-therapy levels in the AMPLIFY study, prothrombin time 18 s, partial thromboplastin time 35.5 s, international normalized ration 1.5. Monitoring was an important factor in this patient with questionable absorption and further complicated by his morbid obesity which has not been adequately studied in clinical trials. Correspondence to Jennifer L. Cole, PharmD, BCPS, BCCCP, Clinical Pharmacy Specialist, Veterans Healthcare System of the Ozarks, Department of Pharmacy, 1100 North College Avenue, Fayetteville, AR 72703, USA Tel: +1 479 444 4020; e-mail: Jennifer.cole@va.gov Received 24 June, 2019 Revised 15 August, 2019 Accepted 6 October, 2019 Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved. Investigating the influence of LCT rs3754689 polymorphism on inhibitor development in Iranian and Afghan patients with severe hemophilia A Development of alloantibodies against factor VIII (FVIII) in patients with severe hemophilia A is the main complication of FVIII replacement therapy. There are many studies indicating several genetic factors associated with inhibitor development. A recent study showed that there is a correlation between the risk of inhibitor development and LCT rs3754689 polymorphism among Italian hemophilia A patients. The aim of this study was to speculate whether LCT rs3754689 polymorphism is correlated to inhibitor development in Afghan and Iranian patients. In addition, we assessed the association of F8 gene mutations and inhibitor development in Iranian patients. This case–control study was conducted on 33 severe hemophilia A patients with inhibitor and 119 samples without inhibitor. Genotyping was performed by Sanger sequencing, inverse and multiplex PCR. According to the obtained data, we found a significant correlation between LCT rs3754689 polymorphism and the risk of inhibitor development in Afghan patients (observed risk, 0.11; 95% confidence interval, 0.01–0.88; P = 0.012). Among Iranian patients, rs3754689 polymorphism showed no significant association with inhibitor development against FVIII (P > 0.05). However, we found a significant correlation between the risk of inhibitor formation and large deletions and nonsense mutations in F8 gene among Iranian patients (observed risk, 7.25; 95% confidence interval, 1.93–27.18; P = 0.003). Lack of association of rs3754689 polymorphism in Iranian population shows the various effects of genetic markers in different populations. More studies in different ethnicities or larger sample sizes are recommended. Correspondence to Sirous Zeinali, Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran; Dr Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran; Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran E-mail: zeinali@kawsar.ir Received 18 June, 2019 Revised 29 August, 2019 Accepted 26 September, 2019 Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved. Thrombin generation test with the calibrated automated thrombogram and anticoagulant activity of Mentha crispa Evaluate the in-vitro effect of Mentha crispa extract on blood coagulation, compare the conventional coagulometric tests with thrombin generation test (TGT), and study the qualitative micromolecular composition of M. crispa. Extract of M. crispa was incubated with plasma and used in the coagulometric tests: prothrombin and activated partial thromboplastin times, fibrinogen, and TGT. A phytochemical prospection was performed to evaluate the chemical composition of this extract. The extract was efficient in prolonging prothrombin time and activated partial thromboplastin time, and reducing fibrinogen levels and TGT parameters, indicating that the extract of M. crispa inhibited the intrinsic and extrinsic pathways of blood coagulation. The results obtained in TGT are in agreement with the results of conventional coagulometric tests and the in-vitro anticoagulant activity of M. crispa suggests that its use by patients using oral anticoagulants deserves caution. Correspondence to Paula M. Leite, Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil. Tel: +55 31 3409 6936; fax: +55 31 3409 6935; e-mail: paulamleite02@gmail.com; ORCID ID 0000-0002-8499-5791 Received 27 June, 2019 Revised 13 September, 2019 Accepted 26 September, 2019 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.bloodcoagulation.com). Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
The utility of thromboelastography and tranexamic acid in plasminogen activator inhibitor deficiency during pregnancy: a rare case reportComplete plasminogen activator inhibitor-1 (PAI-1) deficiency is a very rare genetic disorder that is associated with an increased risk of bleeding diathesis. Patients with PAI-1 deficiency are also known to be at increased risk for massive postpartum hemorrhage. We discuss one such rare case of PAI-1 deficiency in a young pregnant patient at 22 weeks of gestation...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
09:10
Effects of combined nicotine and caffeine on the rat skeletal muscles: A histological and immunohistochemical study Faizah Alotaibi, Seham K Abounasef, Heba Fikry Journal of Microscopy and Ultrastructure 2019 7(4):147-152 Background: Nicotine and caffeine are pharmacologically active substances that consumed widely in the whole world. Most of the nicotine users also consume caffeine. Smokers tend to drink more coffee than nonsmokers. It is important to characterize these substances with regard to their effects on the histological and immunohistological structure. Objectives: The objective of the study is to assess the impact of combined administration of nicotine and caffeine on histological structure of the skeletal muscle tissue in the adult male Wistar rats. Materials and Methods: Twenty adult male Wistar rats with an average weight of 200–250 g were randomly divided into four equal groups: control, nicotine, caffeine, and combined (nicotine + caffeine). The diaphragm muscle was processed and stained with hematoxylin and eosin (H and E) stain, histochemically by periodic acid–Schiff (PAS) and immunohistochemically by anti-CD68 antibodies. Results: After injected nicotine, thick basement membrane with apparent increase in the positive CD68 macrophages inbetween the diaphragm muscle fibers. After injected caffeine, there was an apparent accumulation of mononuclear cells around some fibers with decrease in the PAS positive fibers. Combined injected (nicotine + caffeine) group, some fibers exhibited deep acidophilic cytoplasm with flat peripheral nuclei and apparent increase of the CD68 positive cells. There was an increase in PAS positive material around fibers appearing as a thick basement membrane. Conclusions: The present study proved that caffeine and nicotine either taken alone or in combination have many negative impacts on the active type of skeletal muscles like diaphragm leading to degenerative changes that may affect their function. Effect of suramin on renal proximal tubular cells damage induced by cisplatin in rats (histological and immunohistochemical study) Eman Ali El-Kordy Journal of Microscopy and Ultrastructure 2019 7(4):153-164 Background: Renal toxicity is the most common complication of cispaltin therapy that has broad-spectrum antitumor activity against a variety of human solid tumor. Suramin, a Food and Drug Administration-approved old drug is a polysulfonated compound of napthylurea originally designed to treat trypanosomiasis. Aim: The current work aimed to investigate the possible protective effect of different doses of suramin against cisplatin-induced renal proximal tubular cells (RPTCs) damage. Material and Methods: Fifty adult male rats were used and divided into five equal groups. Group I served as a control, group II received suramin alone (10 mg/kg). Groups III, IV and V were administered cisplatin once (5 mg/kg, intraperitoneally) alone or combined with low dosage suramin (5 mg/kg) or high dosage suramin (10 mg/kg) once intravenously respectively. Results: Compared with control rats, cisplatin administration caused proximal tubules damage, RPTCs vacuolation with pyknotic nuclei, loss of brush border and widespread caspase-3 immunostaining. Cisplatin-induced RPTCs toxicity was further confirmed morphometrically (a significantly decreased proximal tubular epithelium height and increased mean number of caspase-3-immunopositive cells). These changes were accompanied by biochemical alteration manifested as a significant increase of blood urea nitrogen and serum creatinine. Simultaneous administration of high-dose but not low-dose suramin to the cisplatin-treated rats improved the deleterious morphological and morphometrical effects on RPTCs and restored the aforementioned biochemical parameters to control values. Conclusion: In conclusion suramin in a dose dependant manner protects RPTCs from damage induced by cisplatin. Protective effect of pomegranate (Punica granatum) extract against diabetic changes in adult male rat liver: Histological study Khadija A Faddladdeen, Ahlam Abdulaziz Ojaimi Journal of Microscopy and Ultrastructure 2019 7(4):165-170 Background: Diabetes mellitus could be result from disorders in insulin secretion or receptors, characterized by hyperglycemia. Natural antioxidants including pomegranate have hypoglycemic effect. Aim of the Work: The present research was designed to evaluate the possible protective role of pomegranate peel extract (PPE) against diabetic-induced hepatic complication. Materials and Methods: Forty-eight male Wistar rats, weighed 200–250 g and aged 3 months, were sorted into four groups: Group 1: Used as control, Group 2: Normal rats received PPE (200 mg/kg bw/day) given orally for 11 consecutive weeks. Group 3: Streptozotocin (STZ)-diabetic rats, injected with 55 mg/kg bw of STZ, and Group 4: Normal rats received PPE for 11 weeks and then rats were injected with STZ (55 mg/kg/bw). Effectiveness of the PPE was assessed by measuring serum glucose and histopathology of liver tissue. Liver enzymes were also assayed. PPE was found to control diabetic hyperglycemia and decrease in body weight. Histological examination showed that pretreatment with PPE provided preservation against diabetes-induced hepatic histological changes (necrotic and apoptosis). Result: Alanine aminotransferase, alanine phosphatase, and aspartate aminotransferase levels were significantly elevated in Group 3 diabetics and decreased in Group 4 which confirmed histological finding. Conclusion: This study confirmed the hypothesized possible protective effect of PPE against diabetic-induced histological and functional alteration of rat liver and advised its use by diabetic patients. The possible protective role of barley seeds on the spleen after administration of glucocorticoids in adult albino rats: A histological and immunohistochemical study Manal M Shehata, Heba M Saad Eldien, Fatma Y Meligy, Shadha Y Bahaidarh Journal of Microscopy and Ultrastructure 2019 7(4):171-180 Background: Glucocorticoids (GCs) are the main treatment strategy in many autoimmune disease and inflammatory diseases; however, they have immunosuppressive effect on many organs. The barley seeds contain many antioxidant compounds, which may improve the antioxidant status and related physiological functions. Our aim in this work is to evaluate the possible protective role of barley seeds on some immune cells in the spleen against immunosuppressive effect of GCs in adult albino rats. Materials and Methods: Forty-five adult albino rats were equally divided into 3 groups. Group I: normal vehicle control (n = 15), Group II: steroid-treated animals (n = 15), and Group III: steroid/barley-treated group (n = 15). Specimens from spleen were processed for light and electron microscopy. Results: In steroid-treated group, the histological changes in white and red pulp were in the form of loss of architecture and wide empty spaces among the cells. Most of the cells showed degenerative change, dilatation of blood sinusoids, and deposition of fibrinoid material among the cells of the RP. However, multiple lysosomal bodies were observed in both dendritic and macrophage cells. These changes are improved in steroid/barley-treated group in the form of increasing the number and size of the lymphatic follicles. Most of the splenic cells regained normal structure. Dendritic cell marker CD86 and macrophage marker CD68 expression are increased. Conclusion: Barley protects the spleen tissues from steroid-induced structural changes; this could be mediated through its antioxidant effects, so barely is recommended as a healthy diet in patients consuming steroids. The spermatozoal ultrastructure of the Chinese mitten crab (Eriocheir Sinensis) Jie Zeng, Shasha Peng, Shengwei Zhong, Hui Zhang Journal of Microscopy and Ultrastructure 2019 7(4):181-184 Background: The Chinese mitten crab (Eriocheir sinensis) is an economically important aquatic species in China. The artificial breeding crabs are also increasing in number day by day. However, knowledge about spermatozoal organization of the crab is still very limited. Aims and Objectives: In the present study, the spermatozoal ultrastructure of the E. sinensis is illustrated for improving artificial breeding technique. Materials and Methods: The spermatozoa are observed by light microscopy and transmission electron microscopy. Results: Spermatozoa are located in the lumen of seminiferous tubules. The spermatocytes and spermatids are observed in the wall of seminiferous tubules. The spermatophores are both present in the lumen of vas deferens and seminal vesicles. A mature spermatozoon consists of a central electron dense acrosome and a peripheral electron lucent nucleus within structures-organelles complex. The acrosome is divided into three zones, including inner acrosome zone, outer acrosome zone and zonal texture. The centre of acrosome is the perforatorium within parallel arranged perforatorial tubules along vertical axis. The highest electron dense operculum surrounds the head side of perforatorium. Conclusion: The ultrastructure of spermatozoa of E. sinensis is illustrated. In particular, the outermost part of the acrosome appears as concentric circles and is described as zonal texture. Cardiogenic differentiation of murine bone marrow-derived mesenchymal stem cells by 5-azacytidine: A follow-up In vitro study Heba E. M. Sharaf Eldin, Marwa A. A. Ibrahim, Amany M. I. Mousa, Hala G Metwaly, Nadia F.E. Abo-Hassan Journal of Microscopy and Ultrastructure 2019 7(4):185-193 Background: Cell-based therapy is a promising tool in the management of myocardial infarction. Aim of the Work: The aim of this study is to examine the in vitro potential differentiation of murine bone marrow (BM)-derived stem cells into cardiomyocytes using 5-azacytidine after 1, 3, and 5 weeks and follow it up after 8 weeks. Materials and Methods: BM-derived mesenchymal stem cells (MSCs) were extracted from the bones of adult albino rats. MSCs were induced with 10 μM 5-azacytidine for 24 h. The cells were examined after 1, 3, 5, and 8 weeks. Cell characterization with immunocytochemistry for detection of CD105, desmin, and T-troponin and transmission electron microscopy was performed. Results: The 5-azacytidine-induced MSCs showed light and electron microscopic histological characteristics resembling cardiomyocytes and progressively expressed the cardiac muscle-specific markers over the 1st, 3rd, and 5th weeks, yet by the 8th week, these parameters were significantly downregulated. Conclusion: Prolonged survival of 5-azacytidine-induced MSCs in culture beyond the 8th week resulted in loss of the newly acquired cardiomyocyte characteristics. It is not recommended to prolong the maintenance of 5-azacytidine-induced MSCs in culture on the hope of increasing its cardiogenic potentiality beyond 5 weeks. Lipsticks: The microbial cellar: An original study K Siya, Jubin Thomas, RB Vinod Kumar, Ajish M Saji, Amal K Iype, S Akhil Journal of Microscopy and Ultrastructure 2019 7(4):194-197 Background: Microbial contamination of cosmetics products is of incredible significance since it will not only cause significant health hazardous but also act as a potential source of infections. Contamination will cause spoilage of the item and when pathogenic they become a genuine threat for its users. Aim: To evaluate the bacterial contamination in regularly used lipsticks. Objectives: To identify the pathogenic organism present in the lipsticks.To understand the potential complications of the organisms identified. Comparing the microbial count in used and new lipsticks. Increased copy number of anaplastic lymphoma kinase gene signal in lung carcinomas: Is it significant? Saumya Shukla, Nuzhat Husain, Kiran Preet Malhotra, Vandana Tiwari Journal of Microscopy and Ultrastructure 2019 7(4):198-200 The anaplastic lymphoma kinase gene re-arrangement which is present in 3-5% cases of non small cell lung cancer is a somatic gene re-arrangement. The gold standard for the identification of this gene re-arrangement is fluorescence in situ hybridization. Many variant hybridization patterns have been documented. We present a case of polysomy of ALK gene in the absence of ALK gene re-arrangement in a 45 year old female who presented with brain metastasis. This is a rare case of polysomy of ALK gene reported in a non small cell lung carcinoma. It may be indicative of a worse prognosis and may predict high metastatic potential in these tumors.
Effects of combined nicotine and caffeine on the rat skeletal muscles: A histological and immunohistochemical studyFaizah Alotaibi, Seham K Abounasef, Heba FikryJournal of Microscopy and Ultrastructure 2019 7(4):147-152Background: Nicotine and caffeine are pharmacologically active substances that consumed widely in the whole world. Most of the nicotine users also consume caffeine. Smokers tend to drink more coffee than nonsmokers. It is important to characterize these substances with regard to their...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Comparing Nonopioids Versus Opioids for Acute Pain in the Emergency Department: A Literature Review Background: Pain is the most common reason for patient visits in the emergency department (ED). Opioids have been long considered the standard of care for acute pain in the ED. Because of the opioid crisis, investigation and implementation of novel practices to manage pain is needed. The use of various nonopioids has been suggested as a plausible alternative to opioids, with emerging literature to support its use for acute pain in the ED. Study Question: To evaluate the safety, efficacy, opioid-sparing effects of nonopioids in patients who present with acute pain in the ED. Data Sources: We systematically searched PubMed and EMBASE (July 1970 to January 2019). Study Design: Randomized controlled trials that evaluated nonopioids versus opioids in the ED were eligible. The clinical outcomes measured were change in pain scores compared with baseline, the incidence of adverse events, and use of rescue analgesia. Results: Twenty-five randomized controlled trials that evaluated the use of nonopioids in 2323 patients [acetaminophen (APAP) (n = 651), diclofenac (n = 547), ketamine (n = 272), ketorolac (n = 225), lidocaine (n = 219), ibuprofen (n = 162), ibuprofen & APAP (n = 162), hydroxyzine & dihydroergotamine (n = 85)] met inclusion criteria. Four trials found significant greater reductions in pain scores, favoring nonopioids. In all trials, the duration of pain relief provided by nonopioids was not sustained over an extended period. Eighteen trials reported no significant differences in reduction of pain scores. Two trials reported improved pain reduction with opioids and one trial reported noninferiority. Conclusions: Evidence from primary literature suggests that nonopioids could be a feasible alternative to opioids for management of acute pain in the ED as it is effective, safe, and decreases the need for rescue analgesia. Address for correspondence: Assistant Director of Pharmacy, Mount Sinai Queens, Long Island City, Queens NY, 25–10 30th Avenue, Long Island City, NY 11102. E-mail: billy.sin@mountsinai.org The authors have no conflicts of interest to declare. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.americantherapeutics.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Acetazolamide-Associated Hyperosmolar Hyperglycemic Nonketotic Syndrome No abstract available Carfilzomib-Induced Pulmonary Hypertension No abstract available Inappropriate Use of Aztreonam Background: Aztreonam is not a preferred empiric antibiotic because of variable susceptibilities compared with alternative agents. In addition, it has no Gram-positive activity, necessitating coadministration with vancomycin when used empirically, and is more costly when compared with other Gram-negative active agents. Aztreonam is often given to patients with a reported penicillin allergy without further investigation into the reaction or other relevant allergy information. Study Question: How frequently is aztreonam being used inappropriately? Study Design: We conducted a retrospective chart review at an academic medical center to assess the appropriateness of our aztreonam use. Measures and Outcomes: Our primary outcome was frequency of appropriate aztreonam use, based on a true IgE-mediated allergy reported for each patient. We evaluated whether the patients had tolerated a beta-lactam in the past, and what the reported allergic reaction was. Results: We included 165 patients and found that 46.7% of our aztreonam use was inappropriate, based on previous use of a beta-lactam, or no documentation of an IgE-mediated response. Of the patients with a documented beta-lactam allergy, 63 (38.2%) patients had no allergy manifestation listed, and 37 (22.4%) patients had a non–IgE-mediated allergy manifestation. Of the total population, 61 (37%) patients had tolerated a beta-lactam in the past. Conclusions: Aztreonam should be avoided, except in the case of a true IgE-mediated allergic reaction. Our goal was to reduce the inappropriate use of aztreonam at our institution by one or more of the following: educating providers, reviewing aztreonam orders, requiring answering of order questions, or requiring an indication for use. Penicillin skin testing and desensitization are options as well. Address for correspondence: 600 S 43rd Street, 108T, Philadelphia, PA 19104. E-mail: mking3509@gmail.com L. Rose is on the speakers' bureau for Allergan. M. King is on the speakers' bureau for Tetraphase. The remaining authors have no conflicts of interest to declare. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Hundred Years of Insulin Therapy: Purified Early Insulins Background: The discovery of insulin has changed dramatically the outcome of patients with type 1 diabetes, giving them the possibility to survive. This is of particular concern due to the fact that type 1 diabetes most frequently occurs in children who were destined to die in ketoacidosis coma. Areas of Uncertainty: From insulin discovery to the availability of human insulin and human insulin analogs to be used in diabetes therapy, a series of problems have arisen as the difficulty of insulin purifications, the animal insulin used by the first researches were in fact contaminated by proteins, fats, and other impurities, and the presence of side effects such as allergy, antibodies generation, and lipoatrophy. Data Source Literature: Data strictly related to the argument have been searched in Pub Med and used. Results: Starting from insulin discovery in 1921 to nowadays, significant efforts have been made by a series of researches to purify animal insulin, discover the molecular structure of human insulin, and develop methods to synthetize human insulin and then insulin analogs. Conclusions: The history of insulin discovery here reported is fascinating; insulin is a hormone, a product of biotechnology, a field of research that saved and save the life of many diabetic patients. Address for correspondence: E-mail: annunziata.lapolla@unipd.it The authors have no conflicts of interest to declare. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Examining the Causes and Consequences of Increasing Insulin Costs With Prospective Interventions No abstract available Paliperidone-Associated Priapism in an Autistic Child No abstract available Cefepime-Associated Myoclonic Seizures No abstract available Angioedema in an Immunocompromised Patient No abstract available Insulin Therapy and Diabetic Pregnancy Background: A good metabolic control before conception and throughout pregnancy with diabetes decreases the risk of short- and long-term adverse outcomes of the mothers and their offsprings. Insulin treatment remains the gold standard treatment recommended for any type of diabetes. New technologies including new insulins and insulin analogues, continuous subcutaneous insulin infusion without and with sensors, the low-glucose predictive suspension function, and closed-loop systems that persistently and automatically self-adjust according to patients' continuous glucose monitoring readings have expanded the offer to clinicians for achieving tight glucose control. Areas of Uncertainty: Unsafe effects of insulin and insulin analogues in pregnancy with diabetes could be linked with changes in insulin immunogenicity, teratogenicity, and mitogenicity. Second-generation insulin analogues need to be tested and proven. Effectiveness and safety of new insulin delivery systems in real life of diabetic women in pregnancy need further confirmations. Sources: MEDLINE, EMBASE, Web of Science, Cochrane Library, randomized controlled trials, systematic review and meta-analysis, observational prospective and retrospective studies, case series reports for the most recent insulin analogues, published in English impacted journals, and consensus statements from scientific societies I excluded 60 from 221 papers as not suitable for the purpose of the subject. Results: Subcutaneous insulin infusion can be safely used during pregnancy and delivery of well-trained women. Sensors are increasingly accurate tools that improve the efficacy and safety of integrated systems' functioning. Continuous glucose monitoring provides metrics ("time in range" time in "hypoglycemia" and in "hyperglycemia," glucose variability, average glucose levels in different time intervals) used as a guide to diabetes management; these new metrics are object of discussion in special populations. Randomized controlled trials have shown that sensor-augmented pump therapy improves pregnancy outcomes in women with type 1 diabetes. Closed-loop insulin delivery provides better glycemic control than sensor-augmented pump therapy during pregnancy, before, and after delivery. Conclusion: Second-generation insulin analogues and newer insulin infusion systems that automatically self-adjust according to patients continuous glucose monitor readings are important tools improving the treatment and quality of life of these women. Multi-institutional and disciplinary teams are working to develop and evaluate a pregnancy-specific artificial pancreas. Address for correspondence: Professor of Endocrinology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psycology, "Sapienza" University of Rome, via di Grottarossa, 1035, CAP 00189, Rome, Italy. E-mail: angela.napoli@uniroma1.it Grant from Medtronic to "Clinical and Molecular Department" of "Sapienza" University, Rome. The author has no conflicts of interest to declare. Clinical Trials Identifier: NCT03761615. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Comparing Nonopioids Versus Opioids for Acute Pain in the Emergency Department: A Literature ReviewBackground: Pain is the most common reason for patient visits in the emergency department (ED). Opioids have been long considered the standard of care for acute pain in the ED. Because of the opioid crisis, investigation and implementation of novel practices to manage pain is needed. The use of various nonopioids has been suggested as a plausible alternative to opioids, with emerging literature to support...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Clostridium difficile Infection in Children Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Ana M. Alvarez, Mobeen H. Rathore Nonoccupational Postexposure Prophylaxis and Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention in Adolescents and Young Adults Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Diane M. Straub, Tanya L. Kowalczyk Mullins Resurgence of Syphilis Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Joseph A. Puccio, Aileen Cannon, Kalyani Derasari, Rodney Friend Pediatric Multiple Sclerosis: A Review Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Megan M. Langille, Alice Rutatangwa, Carla Francisco Cerebral Palsy: Diagnosis, Epidemiology, Genetics, and Clinical Update Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Abimbola Michael-Asalu, Genevieve Taylor, Heather Campbell, Latashia-Lika Lelea, Russell S. Kirby Updates on Hypertension and New Guidelines Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Pamela S. Singer Tall Stature in Children Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Alexander K.C. Leung, Alexander A.C. Leung, Kam Lun Hon Review of Narcolepsy and Other Common Sleep Disorders in Children Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Sagarika Nallu, Giselle Y. Guerrero, Jaclyn Lewis-Croswell, Lara M. Wittine Feeding Issues in Young Children Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Melissa Harada, Nelly Amariglio, Hope Wills, Irene Koolwijk The Essentials of Essential Oils Publication date: August 2019 Source: Advances in Pediatrics, Volume 66 Author(s): Rebecca M. Plant, Lisa Dinh, Shaara Argo, Monica Shah
Clostridium difficile Infection in ChildrenPublication date: August 2019Source: Advances in Pediatrics, Volume 66Author(s): Ana M. Alvarez, Mobeen H. RathoreNonoccupational Postexposure Prophylaxis and Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention in Adolescents and Young AdultsPublication date: August 2019Source: Advances in Pediatrics, Volume 66Author(s): Diane M. Straub, Tanya L. Kowalczyk MullinsResurgence of SyphilisPublication date: August 2019Source: Advances in Pediatrics,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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What's new in emergencies, trauma and shock? Using queuing theory to optimize the emergency department triage process Leon D Sanchez, Joshua W Joseph Journal of Emergencies, Trauma, and Shock 2019 12(4):225-226 Gunshot wounds – From Lebanon, via Syria, to the streets of your city! Timothy Craig Hardcastle Journal of Emergencies, Trauma, and Shock 2019 12(4):227-228 The 2019 WACEM and academic college of emergency experts india position paper on developing the academic department of space medicine in India – The time has come! Vivek Chauhan, Sagar Galwankar, Kishore K Deepak, Anant Mohan, Randeep Guleria, Sanjeev Bhoi, Praveen Aggarwal Journal of Emergencies, Trauma, and Shock 2019 12(4):229-231 The 2019 WACEM expert document on the framework for setting up a simulation centre Fatimah Lateef, Shanqing Yin, Madhavi Suppiah Journal of Emergencies, Trauma, and Shock 2019 12(4):232-242 Almost every institution and academic medical center has its own simulation center today. It seems to have become a prerequisite and is incorporated into the guidelines of setting up new centers as well as in the upgrading and enhancement plans of existing institutions. In considering this, it is critical to consider the needs and demands of the healthcare population and staff the center will be serving. Setting up a simulation center is not an endeavor to be undertaken lightly. It entails a sustainable commitment in terms of political will, professional, educational and financial commitments. On the other hand, setting up a simulation center can be the most worthwhile and rewarding experience if the objectives and goals are met and effective learning occurs. The latter is an important element to be considered in the step toward nurturing an effective healthcare practitioner. In this paper, the principle author, who is the Director of the SingHealth Duke NUS Institute of Medical Simulation (SIMS) in Singapore, shares her views and experience of leading a world-class simulation facility. She has been involved in SIMS from its conception and is a strong advocate of medical education and lifelong learning. At the end of this paper, she shares a Checklist which puts together all the important considerations for anyone or any institution what is looking at setting up a simulation facility, a simulation-based training program, or even upgrading and upscaling their current simulation centre. The 2019 WACEM expert document on hybrid simulation for transforming health-care simulation through "mixing and matching" Fatimah Lateef, Xin Yi Too Journal of Emergencies, Trauma, and Shock 2019 12(4):243-247 With the multitude of options available under the umbrella of "simulation" today, we have a larger repertoire of choices in our educational journey and outreach. These provide a platform for us to really transform health-care simulation from the traditional, unimodality simulation, to more complex, high fidelity, integrated, and engaging multimodality techniques. The main thrust must be to enhance clinical decision-making in patient care, to solve real-world clinical problems. Hybrid simulation (HS) utilizes at least two different simulation modalities, whereby combining them will enable one type of simulation modality to enhance the other, with the proper alignment, coordination, and interfacing between the modalities. Although the term is often used interchangeably, HS is slightly different from multimodality simulation. The latter refers to the use of multiple types of simulation in the same scenario or place. The main objectives for using HS have to be as follows: (1) for the acquisition of knowledge and skills by the best combination of methodologies, (2) for clinical performance improvement at all levels of care through the creation of as close as possible to real-world situation and problems, (3) to be able to sustain motivation and passion of our spectrum learners in their educational continuum, and (4) to provide a rich, exciting, and stimulating learning platform and environment, which can trigger deep learning and understanding. This article will also share some examples and cases utilizing HS in transforming health-care simulation. Utility of point-of-care lung ultrasound for initial assessment of acute respiratory distress syndrome patients in the emergency department A Sanjan, S Vimal Krishnan, Siju V Abraham, Babu Urumese Palatty Journal of Emergencies, Trauma, and Shock 2019 12(4):248-253 Aim: Lung ultrasound (LUS) has been extensively used in the evaluation of acute respiratory distress syndrome (ARDS) in the critical care setting. In our study, we aim to assess the utility of point-of-care ultrasound (POCUS)-LUS in the initial assessment of ARDS patients presenting to the emergency department (ED). Subjects and Methods: We evaluated a prospective convenience sample of 73 adult patients presenting to the ED. The bedside LUS was performed by the trained emergency physician on patients with undifferentiated dyspnea with a clinical diagnosis of ARDS according to the Berlin's criteria. The four major LUS findings were examined on structured 12-zone LUS. The observed profile consisted of A lines, well-separated B lines, coalescent B lines, and consolidation among patients who were clinically diagnosed as ARDS. These LUS findings may vary depending on the severity of ARDS. The findings were analyzed using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY, USA). Results: Of the 73 study individuals, majority were male 46 (63%). The distributions of study individuals were as follows: 27% – mild ARDS, 37% – moderate ARDS, and 36% – severe ARDS. Coalescent B lines are present in about 70.4% and 92.3% of moderate and severe ARDS patients, respectively. Consolidations are predominantly present in moderate (100%) and severe (92.3%) ARDS. Conclusion: LUS in the initial assessment of patients' with ARDS yielded significant findings in the three clinically designated categories. This study opens up the possibility of using POCUS as an adjunct in the initial assessment of ARDS patient in the ED. Is emergency department thoracotomy effective in trauma resuscitation? The retrospective study of the emergency department thoracotomy in trauma patients at thammasat university hospital, Thailand Amonpon Kanlerd, Nattida Sapsamarn, Karikarn Auksornchart Journal of Emergencies, Trauma, and Shock 2019 12(4):254-259 Introduction: The survival rate after the emergency department thoracotomy (EDT) in trauma patients varies from the previous study as 1.6% in blunt injury and 11.2% in penetrating injury. Most of the data came from Europe, the US, South Africa, and Japan. This study aims to identify the success of EDT of trauma patients at Thammasat University Hospital, Thailand, and to evaluate the effectiveness of EDT. This study may be representative data for Southeast Asia. Materials and Methods: This retrospective review of 21 consecutive EDT cases which performed by our staffs and chief of general surgery residents between June 2009 and July 2016. Age, gender, injury mechanisms, injury sites, patient transport methods, initial vital signs, fluids and blood component requirements, resuscitation times, laboratory results, and injury severity scores were all analyzed. Results: Of the 21 EDT cases, one patient was excluded due to being a nontraumatic case. The remaining twenty patients were primarily young (mean 36.5 years), male (85%), suffering from blunt injuries (75%), of which 45% were predominantly thoracic injuries. Most of the patients presented without any sign of life (75%), and the total time for resuscitation was 43.5 ± 19.6 min. Seven patients (35%) had the return of spontaneous circulation (ROSC) and were successful in being brought to the operating room. Unfortunately, all patients passed away within 24 h of the operation. Conclusions: The ROSC rate of EDT in this study was 35%, but with no survival benefit. Therefore, we cannot guarantee that EDT serves as an effective life-saving procedure. However, EDT may play a significant role in treating extremis injured patients. Neutrophil gelatinase-associated lipocalin as an early diagnostic biomarker of acute kidney injury in snake bite Subramanian Senthilkumaran, Ponniah Thirumalaikolundusubramanian, Namasivayam Elangovan Journal of Emergencies, Trauma, and Shock 2019 12(4):260-262 Background: Snakebite envenomation is a major public health problem in the developing world, and the effects of viper envenomation on renal tissues leading to acute kidney injury (AKI) are well known. However, the usefulness of neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker to detect AKI in viper envenomation cases were not studied much. Aims and Objectives: The present study was undertaken to find out plasma NGAL levels and assess its usefulness among the hospitalized Viperidae group of snakebite victims in predicting acute kidney injury. Materials and Methods: The plasma NGAL level was estimated within 6–8 h of all the 184 cases of viper bites along with other laboratory parameters. Results: It was elevated much before the elevation of serum creatinine levels, irrespective of the age, gender, and bite to hospital time. The sensitivity and specificity was 99.37 and 96.15, respectively. Elevated plasma NGAL levels in viper bite helped not only to detect AKI early but also assisted to plan for appropriate intervention. Conclusion: It is suggested to include estimation of plasma NGAL in the point of care testing, especially in emergency settings handling snakebite cases. However, more studies are recommended to find out its serial levels in snakebite cases following different kinds of snake envenomation with different clinical and laboratory manifestations in different age groups and gender belonging to different population so as to arrive at valid conclusions. Last breath in the emergency department Aakriti Jain, Noella Nathaniel Sase, Anne Rhea Mathew, Immanuel Judson Paul, Paul Prabhakar Abhilash Kundavaram, Priya Ganesan Journal of Emergencies, Trauma, and Shock 2019 12(4):263-267 Background: Early and aggressive time to intervention has been shown to increase the odds of survival and decrease mortality in critically ill patients. Since emergency medicine is a nascent specialty in India, a review and assessment of the mortality profile in the Emergency Department (ED) would help improve the quality of care. Aims: The aim of the study is to determine the mortality profile and causes of preventable deaths at large ED in South India. Methods: This retrospective chart review was conducted between January and December 2017. Patients admitted with Triage priority 1 and priority 2 of our ED, who died, despite treatment, were recruited in the study. Two ED consultants blinded from each other, independently audited all the charts to determine preventable and nonpreventable causes of death. Results: There were a total of 69,369 patients during the study period who presented to the ED. Despite resuscitation 189 (0.7%) died, the mortality rate was 2.43%. Cardiac-related (32%) and sepsis-related (31%) causes were the most common cause of death, 23.8% were due to preventable causes and 16.9% of which were due to inappropriate management. In patients with sepsis, the odds of death due to preventable causes were significantly high (odds ratio 4.31, 95% confidence intervals: 1.96–9.47; P < 0.001). Conclusions: Cardiac- and sepsis-related causes of death, together accounted for most of the mortality. In patients with sepsis, the odds of death due to preventable causes were more than four times higher than those without preventable causes. Application of queuing theory to optimize the triage process in a tertiary emergency care ("ER") department Atilio Moreno-Carrillo, Lina María �vila Arenas, Julián Andrés Fonseca, Camilo Andrés Caicedo, Sandra Verónica Tovar, Oscar Mauricio Muñoz-Velandia Journal of Emergencies, Trauma, and Shock 2019 12(4):268-273 Context: Time from triage to patient care is usually evaluated, but time elapsed between the arrival of patient to emergency room (ER) and triage (pretriage) is not usually measured. Aims: The present study evaluates how the application of the queuing (or "waiting line") theory in the triage process can generate effective strategies to improve patient care in the ER. Settings and Design: A "before-and-after" study was conducted in the ER of the Hospital Universitario San Ignacio, a tertiary emergency care in Bogotá, Colombia. Subjects and Methods: The pretriage time was evaluated, and queuing theory was applied to the evaluation; according to the results, the number and distribution of the necessary nursing personnel were determined. Statistical Analysis Used: The change in waiting times was compared using a paired t-test. Results: In a first 7 months evaluation period, 89,898 patient visits were considered, with an average pretriage time of 22.15 min. According to the arrival distribution by hours and days of the week and considering the results of the calculations made using queuing theory, the number of nurses needed in the service per hour was determined for each day of the week, and schedule changes were implemented without increasing staff. In a second similar evaluation period, 94,497 patient visits were considered demonstrating a reduction of the pretriage time to 7.5 min (mean difference 14.64 min, 95% confidence interval 14.42–14.85, P < 0.001). Conclusions: The use of queuing theory in the planning of the daily personnel requirements in the triage area of ER can reduce the pretriage time by 65% without incurring additional cost.
What's new in emergencies, trauma and shock? Using queuing theory to optimize the emergency department triage processLeon D Sanchez, Joshua W JosephJournal of Emergencies, Trauma, and Shock 2019 12(4):225-226Gunshot wounds – From Lebanon, via Syria, to the streets of your city!Timothy Craig HardcastleJournal of Emergencies, Trauma, and Shock 2019 12(4):227-228The 2019 WACEM and academic college of emergency experts india position paper on developing the academic department of space medicine in India...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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The human kindness curriculum: An innovative preclinical initiative to highlight kindness and empathy in medicine Johanna Shapiro, Julie Youm, Aaron Kheriaty, Tiffany Pham, Yanjun Chen, Ralph Clayma Education for Health 2019 32(2):53-61 Background: Prior studies have shown a marked drop in empathy among students during their third (clinical) year of medical school. Curricula developed to address this problem have varied greatly in content and have not always been subjected to validated measures of impact. Methods: In 2015, we initiated a Human Kindness (HK) curriculum for the initial 2 years of medical school. This mandatory 12-h curriculum (6 h/year) included an innovative series of lectures and patient interactions with regard to compassion and empathy in the clinical setting. Both quantitative (Jefferson Scale of Empathy [JSE]) and qualitative data were collected prospectively to evaluate the impact of the HK curriculum. Results: In the initial Pilot Year, neither 1st (Group 1) nor 2nd (Group 2) year medical students showed pre-post changes in JSE scores. Substantial changes were made to the curriculum based on faculty and student evaluations. In the following Implementation Year, both the new 1st (Group 3) and the now 2nd year (Group 4) students, who previously experienced the Pilot Year, showed significant improvements in post-course JSE scores; this improvement remained valid across subanalyses of gender, age, and student career focus (e.g., internal medicine, surgery, etc.). Despite the disappointingly flat initial Pilot Year JSE scores, the 3rd year students (Group 2) who experienced only the Pilot Year of the curriculum (i.e., 2nd year students at the time of the Pilot Year) had subsequent JSE scores that did not show the typical decline associated with the clinical years. Students generally evaluated the HK curriculum positively and rated it as being important to their medical education and development as a physician. Discussion: A required preclinical curriculum focused on HK resulted in significant improvements in medical student empathy; this improvement was maintained during the 1st clinical year of training. Approaches of anatomy teaching for seriously resource-deprived countries: A literature review Ana Yoe-Cheng Chang Chan, Olle ten Cate, Eugène J. F. M. Custers, Maarten S van Leeuwen, Ronald L. A. W. Bleys Education for Health 2019 32(2):62-74 Background: Teaching anatomy is an important but expensive part of the medical curriculum, potentially more than many countries can afford. In the search for efficient methods, cost-effectiveness is of utmost importance for such countries. The aim of this contribution is to provide a review of the literature on anatomy teaching methods, evaluating these for feasibility in resource-deprived countries. Methods: A literature review was carried out to identify distinct approaches to anatomy teaching published in the period 2000–2014, using the databases of PubMed, Wiley Online Library, Elsevier, HINARI, Springer, and ERIC. The approaches found were compared against their conceptual, operational, technical, and economic feasibility and Mayer's principles of effective instruction. Results: Our search yielded 432 papers that met the inclusion criteria. We identified 14 methods of teaching anatomy. Based on their conceptual feasibility, dissection and technology enhanced learning approaches appeared to have more benefits than others. Dissection has, besides benefits, many specific drawbacks. Lectures and peer teaching showed better technical and economic feasibility. Educational platforms, radiological imaging, and lectures showed the highest operational feasibility. Dissection and surgery were found to be less feasible with regard to operational, technical, and economic characteristics. Discussion: Based on our findings, the most important recommendations for anatomy teaching in seriously resource-deprived countries include a combination of complementary strategies in 3 different moments, lecturing at the beginning, using virtual learning environment (for self-study), and at the end, using demonstration through prosected specimens and radiological imaging. This provides reasonable insights in anatomy through both dead and living human bodies and their virtual representations. Evaluation of the educator's portfolio as a tool for self-reflection: Faculty perceptions Saee Deshpande, Suresh Chari, Usha Radke, Tapasya Karemore Education for Health 2019 32(2):75-78 Background: Preparing a teaching portfolio to document educational expertise has shown to be useful for both promotion and to stimulate faculty development. This article describes a study of the effectiveness of the Educator's Portfolio (EP) as a stimulus for faculty reflection about educational practice. Methods: A sensitizing session of thirty faculty from medical, dental, and physiotherapy colleges on the same campus was conducted; faculty members were asked to complete and submit their EPs. Out of 30 members, 25 responded (83%). Semi-structured interviews of 25 faculties who prepared EPs were conducted, and a qualitative content analysis of the resulting protocols was completed to determine how the EP development process had promoted their reflection on education. Results: All the 25 faculty members indicated that reflection about education had occurred. Four categories of reflection emerged, namely, (a) lack of understanding regarding how to categorize their work; (b) lack of evidence of the effectiveness of educational activities; (c) reformulating educational practice; and (d) source of motivation and self-regulation. Discussion: The findings indicate that EP preparation serves as a tool for reflection on educational practice, which promotes faculty development. Engaging family medicine residents in research training: An innovative research skills program in Israel Christina Solbach-Sabbach, Tamar Adar, Mordechai Alperin, Khaled Karkabi, Inbar Levkovich Education for Health 2019 32(2):79-83 Background: The importance of medical research in developing academic and clinical excellence is widely acknowledged. Obstacles hindering research in primary care include negative attitudes, lack of dedicated time, funding shortages, and a relative paucity of mentors. Residency is the appropriate stage for developing research skills and encouraging research performance. In this article, we describe an intensive research training program offered at the family medicine (FM) Department, Technion Faculty of Medicine in Haifa, Israel. The program aims to engage residents in FM in constructing a research protocol to provide them with a positive experience, help them to overcome barriers, and enhance their research performance. Methods: Learning is achieved through a course design that includes the following six components: (1) course website: a platform for online collaborative learning; (2) inverted classroom: theory is learned through website video lectures and presentations during resident's own time according to a guided schedule, while weekly classroom sessions are dedicated to step-by-step implementation of theory, group discussion, and individual mentoring; (3) Peer feedback; (4) personal mentoring; (5) presentation of the protocol to peers and senior department staff at the end of the course; and (6) evaluation of protocol presentation and engagement during the research course as well as possibilities for further development. Results: Five teams of residents went on to conduct full research projects. Their studies have been presented at seven national and three international conferences, and one has been published. The outcomes of these studies have been useful in FM practices and have inspired residents to continue scholarly work in our department. Discussion: Innovation in teaching methods enhances engagement in learning research skills among residents and may encourage them to conduct research in primary care. Charting a successful course: The academic and clinical success committee's impact on student success Chris Diem, Angela Hairrell Education for Health 2019 32(2):84-86 Background: The road from prematriculation to graduation looks different for each student at each institution. To successfully complete the curriculum, students must often overcome difficulties, both academic and nonacademic. Up to 15% of 3rd-year medical students in the United States are still struggling on the major components of their clerkships and 11% in their 4th year. While there is an established need for medical school remediation, there is little evidence supporting what specifically works across the board. These deficiencies often do not go away on their own and with the need to educate all students, the guidance provided by multiple stakeholders (i.e., administration, staff, faculty, and clinicians) would be necessary to chart a course of success for these students. Methods: The Academic and Clinical Success Committee (ACSC) at the Texas A and M University College of Medicine provides a venue to review individual students and provide input, resources, and support on a timely basis. This is a necessary ingredient in guiding the students facing academic and clinical challenges toward successful completion of graduation requirements. Results: Since its incorporation, the work of the ACSC has contributed to a decrease in failures on consecutive block examinations, a decreased failure rate on Step 2 clinical skills (CS), and increased capacity to help students at risk of failing Step 1 to not do so. Discussion: In this brief report, we illustrate how we developed the ACSC, the impact and levels of success it has had on students, and challenges we have faced. Checking in on check-out: Survey of Learning Priorities in Primary Care Residency Teaching Clinics Yvonne N Covin, Shannon Scielzo, Lynne Kirk, Blake Barker Education for Health 2019 32(2):87-90 Background: Despite focus on increasing the quality of ambulatory education training, few studies have examined residents' perceptions of learning during case discussions with their preceptors (i.e., "check-out"). The objective of this study was to assess the difference between residents' and preceptors' perceptions of behaviors that should occur during check-out discussions. Methods: We conducted a cross-sectional survey of categorical internal medicine and family medicine residents and preceptors. The survey was distributed electronically and assessed 20 components of the check-out discussion. Results: Of 38 preceptors, 22 (61%) completed the survey. Of 172 residents, 82 (48%) completed the survey. For residents, we identified discrepancies in desired and perceived check-out behaviors. Specifically, utilizing a dependent sample t-test, residents felt that all 20 areas needed additional teaching during check-out (P < 0.05). Preceptors believed that demonstrating physical examination skills in the patient room during check-out was significantly more important than did residents (P = 0.01). Increasing years of preceptor experience did not statistically relate to their valuation of components important to residents. Discussion: Our research highlighted a major deficiency in training in the check-out process, with residents desiring more patient management education in all components. Moreover, faculty and residents do not necessarily agree with what is an important focus in the "teachable moment." Our results serve as a training needs assessment for future faculty development seminars and highlight the need to consider resident learning needs in general. Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study Victor Mogre, Fred C. J. Stevens, Paul A Aryee, Anthony Amalba, Albert J. J. A. Scherpbier Education for Health 2019 32(2):91-94 Background: Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students' perspectives on health professionals' nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting. Methods: Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process. Results: Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health-care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors' advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient. Discussion: Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients. Developing an objective structured clinical examination in comprehensive geriatric assessment – A pilot study Michael Vassallo, Joseph Grey, Anthony Hemsley, Liliana Chris, Stuart G Parker Education for Health 2019 32(2):95-98 Background: Acquiring medical competencies alone does not necessarily lead to the delivery of quality clinical care. Many UK training programs are soon to be based on the curricula of entrustable professional capabilities (EPCs). These are tasks carried out in practice requiring proficiency in several competencies for quality practice. Assessments to evaluate EPCs for independent practice are needed. Comprehensive geriatric assessment (CGA) is an EPC in geriatric medicine. We describe the development of an assessment of CGA as an example of examining EPCs. Methods: A CGA station was introduced in the Diploma in Geriatric Medicine clinical examination. Candidates rotate through four stations: three single competency-based stations (history, communication/ethics and physical examination) and an EPC-based station in CGA. Results: One hundred and seventy-eight (female: 96 [53.9%]) candidates took it. There was a weak but significantly positive correlation between the score at CGA and the total score in the other stations (r = 0.46; P < 0.001). Most candidates passing the station passed the examination. Correlation with other stations similarly showed weak significant correlations (Station 1: r = 0.38; P < 0.001, Station 3: r = 0.28; P < 0.001, and Station 4: r = 0.37; P < 0.001). There was 61.4% (kappa: 0.61; P = 0.000) agreement between examiners whether a candidate passed or failed. Agreement was higher for the other stations, i.e. Station 1 (kappa: 0.85; P < 0.001), Station 3 (kappa: 0.72; P < 0.001), and Station 4 (kappa: 0.85; P < 0.001). Discussion: Performance on the station correlated positively with overall performance, suggesting that it has discriminatory value in differentiating candidates with varying ability and the more able candidates pass the examination. A Report from the 2017 Sino-US Medical Education Symposium in Wuhan, China Rimas Vincas Lukas, Ivy Jiang, Jonathan Lio, Brian Cooper, Hongmei Dong, Jingyi Fan, Renslow Sherer Education for Health 2019 32(2):99-100
The human kindness curriculum: An innovative preclinical initiative to highlight kindness and empathy in medicineJohanna Shapiro, Julie Youm, Aaron Kheriaty, Tiffany Pham, Yanjun Chen, Ralph ClaymaEducation for Health 2019 32(2):53-61Background: Prior studies have shown a marked drop in empathy among students during their third (clinical) year of medical school. Curricula developed to address this problem have varied greatly in content and have not always been subjected to validated measures of impact....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Global oral health: A proposal for a change of picture Gerhard K Seeberger Indian Journal of Dental Research 2019 30(4):483-485 Oral health, universal health coverage, and dental research SM Balaji Indian Journal of Dental Research 2019 30(4):486-486 Randomized clinical trial of four adhesion strategies: A 42 month study Maristela Dutra-Correa, Vanessa Harumi Kiyan, Marcia Tonetti Ciaramicoli, Vanessa Pecorari, Flávia Pires Rodrigues, Cintia Helena Coury Saraceni Indian Journal of Dental Research 2019 30(4):487-495 Context: The adhesives clinical effectiveness has been extensively reported for noncarious cervical lesions (NCCLs). However, there is a lack of information about the adhesive systems strategies and their effect on NCCL restoration longevity. Aims: This study aims to evaluate a 42-month performance of four dentin adhesive systems used for the restorative treatment of NCCLs. Settings and Design: NCCLs were randomly divided into four groups: (1) Scotchbond multi-purpose (MP); 2: Single bond plus (SB); 3: Scotchbond SE (SE); and 4: Easy bond (EB). Subjects and Methods: NCCLs (125) were randomly distributed: (1) MP; (2) SB; (3) SE; and (4) EB and were restored with a nanofilled resin-composite, evaluated along 18-36-42 months. Statistical Analysis Used: Kruskal–Wallis test: Comparison among the adhesive systems in each period. Friedman analysis: Comparison along the periods. Kaplan–Meier: Survival analysis. Results: Baseline and 42-month retention (RET) rates (%) were 100/100 for MP; 100/94.74 for SB; 100/87.5 for SE; and 100/100 for EB. The cumulative failure percentage was 9.52% for MP, 9.52% SB, 15.8% SE, and 10% EB. Restorations survival was not dependent on the used adhesive type. Marginal adaptation (MA) was similar to each group, but EB presented noticeable marginal deterioration. Wear was noticed in the 3-step etch-and-rinse (MP) restorations evaluated after 42 months. For the EB, baseline and 18-month wear evaluation were statistically similar. After 36 and 42 months, wear was also similar for EB. Conclusions: Adhesive systems showed similar performance within most important adhesive bonding efficiency achievement parameters: RET, MA, interfacial staining, recurrent caries, and postoperative sensitivity evaluated during 42 months. The incisive papilla as a guide to maxillary anterior teeth position for complete dentures Rosalin Kar, Niranjan Mishra, Debashish Pati, Krishna Gopal Birmiwal, Aparna Gupta, Subhrajit Raut Indian Journal of Dental Research 2019 30(4):496-499 Context: The incisive papilla as a guide for complete dentures. Aims: To evaluate incisive papilla as a guide to maxillary anterior teeth position for complete dentures. Settings and Design: To measure the linear distances from the incisive papilla to the maxillary central incisors in Odia population and compare it to other ethnic groups. Subjects and Methods: The subjects were selected following inclusion & exclusion criteria. The impressions of maxillary & mandibular arches were taken and poured with die stone to produce the cast. The incisive papilla & incisors were marked on casts with a pencil. The photographs of casts were traced on an acetate tracing paper. The anterior-most points of maxillary incisors, anterior, middle & posterior-most points of incisive papillae were marked on the tracing as A, I1,M, I2 respectively. The A to M and A to I2 distances were measured, analysed and compared with Caucasians, Southern Chinese, and Dravidians. Statistical Analysis: Independent sample "t" test and Analysis of Variance followed by the post-hoc Bonferroni test were used. Results: A sample of 100 subjects in the age group of 20 to 40 years with was selected. The A to M measurements of Odia population differed significantly from Caucasians but were similar to Southern Chinese population. The A to I2 measurements of Odia population differed significantly from Caucasians & Dravidians but were similar to Southern Chinese. Conclusion: The linear measurements from incisive papilla to maxillary incisors of the Odia population are similar to that of Southern Chinese but differ significantly from Caucasians and Dravidians. Prevalence of precancerous lesions in an adult population Benley George, Shibu T Sebastian, Rino R Soman, Vinod M Mulamoottil, Minimol K Johny Indian Journal of Dental Research 2019 30(4):500-505 Objectives: The present study aimed to identify the prevalence of precancerous lesions among an adult population in Kerala, India. Materials and Methods: A dental screening camp was organized in each district at two locations for two consecutive days to draw maximum participation of the community. All adult subject's attending the camp were initially screened for precancerous lesions using conventional light. An initial oral screening was done by two public health dentists and suspected cases were subjected to Identafi Oral cancer screening device and followed by histopathological evaluation. Results: The prevalence of oral precancerous lesions in the adult population of Kerala was 4.4%. Most of the lesions were associated with the use of tobacco followed by alcohol and spicy foods. Conclusion: The oral cancer detection device is an aid in detection of oral precancerous lesions. Efficacy of a mouthwash containing essential oils and curcumin as an adjunct to nonsurgical periodontal therapy among rheumatoid arthritis patients with chronic periodontitis: A randomized controlled trial Divvi Anusha, Preetha Elizabeth Chaly, Mohammed Junaid, JE Nijesh, K Shivashankar, Shyam Sivasamy Indian Journal of Dental Research 2019 30(4):506-511 Purpose: The purpose of this study was to assess the efficacy of mouthwash containing essential oils and curcumin (MEC) as an adjunct to nonsurgical periodontal therapy on the disease activity of rheumatoid arthritis (RA) among RA patients with chronic periodontitis (CP). Materials and Methods: A triple-blinded controlled trial was conducted among 45 female RA patients with CP randomized into three treatment groups as follows: Group A: scaling and root planing (SRP) with 0.2% chlorhexidine mouthwash as an adjunct (n = 15), Group B: SRP with MEC as an adjunct (n = 15), and Group C: SRP alone (n = 15). RA disease activity was assessed using erythrocyte sedimentation rate, serum C-reactive protein, serum anti-citrullinated protein antibody, and serum rheumatoid factor. Periodontal disease activity was assessed using plaque index, clinical attachment level (CAL), and pocket depth (PD). All parameters were recorded at baseline and 6 weeks thereafter. Data were assessed using one-way ANOVA and paired t-test. Results: A significant reduction in periodontal and RA disease activity parameters was observed from baseline to 6 weeks following intervention (P < 0.05). The highest percentage of mean reduction in plaque index and RA parameters from baseline to 6 weeks was observed in Group B followed by Groups A and C. The highest percentage of mean reduction in PD and CAL was observed in Group A followed by Groups B and C (P < 0.001). Conclusion: This study reveals that MEC as an adjunct to SRP is effective in reducing the disease activity of RA and CP, thereby warranting the use of the same. Comparative efficacy of analgesic gel phonophoresis and ultrasound in the treatment of temporomandibular joint disorders Sankar Narayanan Ramakrishnan, Nalini Aswath Indian Journal of Dental Research 2019 30(4):512-515 Aim: The aim of this study is to determine the efficacy of phonophoresis in patients with temporomandibular disorders. Objective: To prove that phonophoresis could be an effective treatment modality in in patients with temporomandibular disorders. Procedure: Fifty patients diagnosed clinically and radiographically as temporomandibular disorder were randomly assigned into either of the two groups, namely, (Group A) plain ultrasound and (Group B) phonophoresis. Acoustic gel containing no pharmacological agent was applied in the ultrasound group, whereas a gel containing aceclofenac was applied in the phonophoresis group. Each group was treated three times a week for 2 weeks. The assessment of pain and inflammation both before and after treatment were done using the visual analog scale (VAS) and Creactive protein (CRP). Results: Intergroup comparison was done and analyzed statistically using independent ttest. Intragroup comparison was done using paired ttest. A significant difference in VAS scores and CRP levels before and after treatment were seen within both ultrasound phonophoresis PH groups. No significant difference was noted statistically between ultrasound and phonophoresis group. Conclusion: The results of this study suggests that though plain ultrasound as well as phonophoresis with aceclofenac gel are effective in the management of temporomandibular disorders. Phonophoresis was found be slightly superior as evident in VAS scores and CRP levels though not statistically significant. Clinico-pathological correlations of odontogenic tumors: Some critical observations based on a 20 year institutional study and a comprehensive review of literature Shaheen Syed, Karla M Carvalho, Anita Spadigam, Anita Dhupar Indian Journal of Dental Research 2019 30(4):516-520 Context: Odontogenic tumors (OTs) represent a rare subset of pathologies of the oral and maxillofacial region. The classification of OTs has undergone several changes over the years due to a lack of uniform international identification criteria. The histomorphological similarity and the many variations in behavioral patterns elaborated by these lesions warrant research. Aims: Using the update from the fourth edition of the World Health Organisation Classification of Head and Neck Tumors (2017), this dental institution carried out an epidemiological study on OTs in the state of Goa (India) and compared the data obtained with similar studies on OTs done within India. Materials and Methods: The clinical and pathological data of OTs from August 1996 to December 2016 was retrieved from the oral and maxillofacial pathology department archives, belonging to the lone dental college and hospital in the state of Goa, India. Demographic data such as frequency, age, gender, and site along with pathological subtype was analysed. Statistical Analysis Used: Descriptive analysis (i.e. frequency of age, gender, and location), Chi-Square Test and Fischer Exact test. Results: The relative frequency of OTs was 2.61% of all oral biopsied specimens. The most common OT encountered was ameloblastoma (57.9%). The posterior aspect of the mandible was the most favored site (77.2%). The frequency of OTs decreased after the fourth decade. An overall marginal male predilection (55%) was seen. Conclusions: This study contributes to the establishment of a comprehensive loco-regional epidemiological database on OTs in India, aiding research on their aetio-pathogenesis and diagnosis. Periodontal health status among HIV-seropositive pregnant women Narendra Dev Jampani, Ravi Kiran Sunkavilli, Vajra Madhuri Songa, Lahari Buggapati, Srinivasa Reddy Pathagunti Indian Journal of Dental Research 2019 30(4):521-526 Aims and Objective: Routine oral health care is essential for those living with HIV (human immunodeficiency virus) infection, especially in pregnant women. Hormonal changes during pregnancy, immunosupression in HIV along with bacterial load in periodontal infections strongly influence the pregnancy outcomes. The aim of this study was to evaluate the periodontal health status in HIV seropositive pregnant women in Andhra Pradesh, India. Materials and Methods: This study includes a sample of 90 divided into three groups; HIV seropositive pregnant women (group PH; n = 30), HIV seropositive nonpregnant women (group H; n = 30), and healthy pregnant women without HIV infection (group P; n = 30). Clinical examination includes the recording of probing depths (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and periodontal screening and recording index (PSR) were assessed in three groups. Statistical analysis was done by Mann–Whitney U-test and Wilcoxon paired test using the software SPSS version 17. Results: Clinical parameters do not show any significant variation between the three groups. But slightly higher mean PD and CAL levels was observed in HIV seropositive pregnant and nonpregnant women compared with healthy pregnant women without HIV infection. About 13% of severe gingivitis cases were observed in HIV seropositive pregnant group compared with 6% in HIV seropositive and 3% in healthy pregnant group. Conclusions: Presence of slightly higher percentage of severe gingivitis in HIV seropositive pregnant women strengthens the fact of extra need for preventive oral health services during the prenatal period and provides recommendations for promoting maternal oral health in regional antiretroviral therapy centers in India. Salivary flow rate, pH and buffering capacity in patients undergoing fixed orthodontic treatment – A prospective study V Anu, PD Madan Kumar, M Shivakumar Indian Journal of Dental Research 2019 30(4):527-530 Background: Human saliva has got many important functions like lubrication of the oral tissues, making oral functions like speech, mastication and deglutition possible and also protecting teeth and oral mucosal surfaces in different ways. Dental Caries is one of the common complications in patients undergoing orthodontic treatment. Subjects with impaired saliva flow rate often show high caries incidence. A low flow rate combined with a low or moderate buffer effect clearly indicates poor salivary resistance against microbial attack. Aim: To investigate the changes in stimulated and unstimulated salivary flow rate, pH and buffer capacity in patients undergoing therapy with fixed orthodontic appliances. Materials and Methods: Salivary flow rate, pH and buffering capacity of 20 patients who underwent fixed orthodontic treatment at Department of Orthodontics, Ragas Dental College and Hospital, Chennai were examined using GC saliva check buffer kit. The procedure was carried out during the initiation of orthodontic treatment and subsequently, one month and six months after the placement of appliance. Results: Results showed there was a significant increase in the salivary flow rate one month and six months after placement of fixed appliance while pH and buffering capacity showed no significant changes. Conclusion: Salivary flow rate increases significantly during fixed orthodontic treatment. Salivary pH and buffering capacity showed no significant changes suggesting that they are not sole factors for demineralization in orthodontic patients.
Global oral health: A proposal for a change of pictureGerhard K SeebergerIndian Journal of Dental Research 2019 30(4):483-485Oral health, universal health coverage, and dental researchSM BalajiIndian Journal of Dental Research 2019 30(4):486-486Randomized clinical trial of four adhesion strategies: A 42 month studyMaristela Dutra-Correa, Vanessa Harumi Kiyan, Marcia Tonetti Ciaramicoli, Vanessa Pecorari, Flávia Pires Rodrigues, Cintia Helena Coury SaraceniIndian Journal of Dental Research 2019 30(4):487-495Context:...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Metagenomic next-generation sequencing in clinical microbiology Jobin John Jacob, Balaji Veeraraghavan, Karthick Vasudevan Indian Journal of Medical Microbiology 2019 37(2):133-140 Pneumococcal conjugate vaccine rollout in India: Expectations and challenges Rosemol Varghese, Balaji Veeraraghavan, Yuvraj Jeyaraman, Girish Kumar, Narendra Kumar Arora, S Balasubramanian Indian Journal of Medical Microbiology 2019 37(2):141-146 India is one among the four Asian countries with the greatest number of deaths due to pneumococcal infection among children under 5 years. pneumococcal conjugate vaccine (PCV) has been introduced in a phased manner in five major Indian states. Ambiguity remains in choosing the appropriate type of PCV and optimum schedule with maximum effectiveness specific for each country. Here, we discuss the evidences with respect to serotype coverage, immunogenicity, reactogenicity and dosage schedule for introduction of PCV13 in India. In addition, the expected PCV impact and the challenges are detailed. PCV13 is expected to provide >75% serotype coverage for invasive pneumococcal disease (IPD) serotypes in Indian children combined with the replacement by nonvaccine serotypes which is unpredictable due to lack of complete data. Nasopharyngeal (NP) surveillance is easy, feasible and can replace IPD surveillance in resource-poor settings. Continuous IPD as well as NP surveillance in all the regions are necessary to assess the impact of PCV in India. Current strategy for local- to global-level molecular epidemiological characterisation of global antimicrobial resistance surveillance system pathogens Dhiviya Prabaa Muthuirulandi Sethuvel, Naveen Kumar Devanga Ragupathi, Yamuna Devi Bakthavatchalam, Saranya Vijayakumar, Rosemol Varghese, Chaitra Shankar, Jobin John Jacob, Karthick Vasudevan, Divyaa Elangovan, Veeraraghavan Balaji Indian Journal of Medical Microbiology 2019 37(2):147-162 The prime goal of molecular epidemiology is to identify the origin and evolution of pathogens, which can potentially influence the public health worldwide. Traditional methods provide limited information which is not sufficient for outbreak investigation and studying transmission dynamics. The recent advancement of next-generation sequencing had a major impact on molecular epidemiological studies. Currently, whole-genome sequencing (WGS) has become the gold standard typing method, especially for clinically significant pathogens. Here, we aimed to describe the application of appropriate molecular typing methods for global antimicrobial resistance surveillance system pathogens based on the level of discrimination and epidemiological settings. This shows that sequence-based methods such as multi-locus sequence typing (MLST) are widely used due to cost-effectiveness and database accessibility. However, WGS is the only method of choice for studying Escherichia coli and Shigella spp. WGS is shown to have higher discrimination than other methods in typing Klebsiella pneumoniae, Acinetobacter baumannii and Salmonella spp. due to its changing accessory genome content. For Gram positives such as Streptococcus pneumoniae, WGS would be preferable to understand the evolution of the strains. Similarly, for Staphylococcus aureus, combination of MLST, staphylococcal protein A or SCCmec typing along with WGS could be the choice for epidemiological typing of hospital- and community-acquired strains. This review highlights that combinations of different typing methods should be used to get complete information since no one standalone method is sufficient to study the varying genome diversity. Experience of Indian association of medical microbiology external quality assurance scheme centre, New Delhi: Challenges and quality assessment of clinical microbiology laboratories Chand Wattal, Jaswinder Kaur Oberoi, Neeraj Goel, Sanghamitra Datta, Reena Raveendran, KJ Prasad Indian Journal of Medical Microbiology 2019 37(2):163-172 Introduction: EQAS program at New Delhi under IAMM was started in January 2014 across North and North east regions of India with 217 participants, which grew up to 540 by 2018. Materials and Methods: In 2014, 4 analytes per year were sent for 3 exercises, i.e. smear culture and serology. 2018 onwards PT analytes were increased from 4 to 12 and comparative performance of techniques analysed. Results: Out of the 22 smears sent for gram staining, ZN staining, Kinyoun staining and Albert staining, completely correct results ranged between 29.55% - 79.9%, 94.3% - 99.2%, 35.5% & 93.8%, respectively. Correct results for culture isolate identification & susceptibility testing and serology exercises varied between 70 & 92.4% and 73.1 & 98.59%, respectively. In the year 2018, 470 responses were received for bacterial culture identification & antibiotic susceptibility testing out of which manual and automated systems were used by 54% & 46% and 52.5% & 47.5% participants, respectively. Techniques used in BBV assays for HBsAg, HCV & HIV found all methods like ELISA, ELFA, CLIA and Card Test performing similarly. The major challenges in running the EQA program included requirement of large amount of specimens for PT item preparation, stability in hot and humid conditions and timely delivery of PT challenges in remote parts of the country. Conclusion: A large number of the participating laboratories (77%) had an overall score of >80% for all exercises, demonstrating acceptable baseline performance of EQAS registered laboratories. However, continued EQAS participation could further improve the quality of results. RNA-seq analysis reveals resistome genes and signalling pathway associated with vancomycin-intermediate Staphylococcus aureus Devika Subramanian, Jeyakumar Natarajan Indian Journal of Medical Microbiology 2019 37(2):173-185 Context: Vancomycin-intermediate Staphylococcus aureus remains one of the most prevalent multidrug-resistant pathogens causing healthcare infections that are difficult to treat. Aims: This study uses a comprehensive computational analysis to systematically investigate various gene expression profiles of resistant and sensitive S. aureus strains on exposure to antibiotics. Settings and Design: The transcriptional changes leading to the development of multiple antibiotic resistance were examined by an integrative analysis of nine differential expression experiments under selected conditions of vancomycin-intermediate and -sensitive strains for four different antibiotics using publicly available RNA-Seq datasets. Materials and Methods: For each antibiotic, three experimental conditions for expression analysis were selected to identify those genes that are particularly involved in the development of resistance. The results were further scrutinised to generate a resistome that can be analysed for their role in the development or adaptation to antibiotic resistance. Results: The 99 genes in the resistome are then compiled to create a multiple drug resistome of 25 known and novel genes identified to play a part in antibiotic resistance. The inclusion of agr genes and associated virulence factors in the identified resistome supports the role of agr quorum sensing system in multiple drug resistance. In addition, enrichment analysis also identified the kyoto encyclopedia of genes and genomes (KEGG) pathways – quorum sensing and two-component system pathways – in the resistome gene set. Conclusion: Further studies on understanding the role of the identified molecular targets such as SAA6008_00181, SAA6008_01127, agrA, agrC and coa in adapting to the pressure of antibiotics at sub-inhibitory concentrations can help in learning the molecular mechanisms causing resistance to the pathogens as well as finding other potential therapeutics. Clinico-microbiological analysis of toxigenic clostridium difficile from hospitalised patients in a tertiary care hospital, Mangalore, Karnataka, India Sherin Justin, Beena Antony Indian Journal of Medical Microbiology 2019 37(2):186-191 Purpose: Prevalence of Clostridium difficile, an anaerobic, Gram-positive, spore-forming bacillus, is very much underestimated in India. The present study was intended to assess the burden of toxigenic C. difficile in hospitalised patients with clinically significant diarrhoea and analysis of their clinical picture. Materials and Methods: This cross-sectional study was conducted in a tertiary care teaching hospital, South India, from January 2012 to December 2014. Stool samples were collected consecutively from 563 inpatients from various wards. The prevalence of toxigenic C. difficile was determined by toxigenic culture and a two-step algorithm. The clinical spectrum of these patients was also analysed. Associated pathogens were identified using standard procedures. Statistical analysis was done by frequency, percentage, Chi-square test and z-test. Results: Out of the 563 stool samples analysed, the prevalence of toxigenic C. difficile was 12.79% and that of non-toxigenic C. difficile was 10.83%. The prevalence of toxigenic C. difficile among oncology patients was highly significant (HS). Antibiotic treatment, prolonged hospital stay and underlying diseases/conditions were the risk factors which were HS, and fever was the significant clinical feature among the patients. Escherichia coli was the predominant associated pathogen isolated (18.47%). Conclusion: The presence of toxigenic C. difficile in our locality is a matter of concern. Constant supervision, appropriate treatment and preventive measures are crucial in controlling C. difficile infection. Assessment of efficacy of palm polymerase chain reaction with microscopy, rapid diagnostic test and conventional polymerase chain reaction for diagnosis of malaria Paras Mahale, Rajas Warke, Mira Ramaiya, Deepa Balasubramanian, Suvin Shetty, Ranjit Mankeshwar, Abhay Chowdhary Indian Journal of Medical Microbiology 2019 37(2):192-197 Purpose: Sensitive, specific, rapid and cost-effective technique for malaria diagnosis is need of the hour. Microscopy has been the gold standard for malaria diagnosis, but its interpersonnel variability and lack of sensitivity make it subjective test. Conventional polymerase chain reaction (cPCR) has proven to be sensitive technique, but costly and time-consuming. Considering these factors, we have compared microscopy and cPCR with newly derives ultra-fast, portable PCR machine called Palm PCR. Materials and Methods: Palm PCR is arranged with three heat blocks precisely made for three stages of PCR cycles with 34 min for 1100 bp Plasmodium genus outer primer to amplify and 10 min each for Plasmodium falciparum and Plasmodium vivax inner primers of 120 bp and 205 bp, respectively. A total of 191 suspected samples were processed and evaluated using receiver operating characteristic (ROC) curve analysis. Results: The area under ROC curve analysis for Palm PCR with reference standard microscopy for P. falciparum, P. vivax and Plasmodium was 0.8969, 0.9121 and 0.9116, respectively, and with reference standard cPCR was 1.0 for all of them. ROC curve area close of suggests that Palm PCR can be as significant as cPCR in malaria diagnosis. In fact, ultra-rapid amplification with same precision makes Palm PCR better technique than cPCR. Conclusion: Palm PCR is sensitive, rapid and works on battery with simple laboratory facility requirements. Portable electrophoresis and transilluminator combined with Palm PCR could be implemented as an important diagnostic tool in resource-limited and rural areas. Similar studies with wider parameters in rural areas will help us evaluate and maybe establish Palm PCR as PCR platform of choice for such specific set-ups. An emerging threat of ceftriaxone-resistant non-typhoidal salmonella in South India: Incidence and molecular profile Agila Kumari Pragasam, Shalini Anandan, James John, Ayyanraj Neeravi, Vignesh Narasimman, Dhiviya Prabaa Muthuirulandi Sethuvel, Divyaa Elangovan, Balaji Veeraraghavan Indian Journal of Medical Microbiology 2019 37(2):198-202 Background: Non-typhoidal Salmonella (NTS) infection is a serious public health problem globally. Although NTS infections are self-limited, antimicrobial therapy is recommended for severe infections and immunocompromised patients. Antimicrobial resistance (AMR) in these pathogens further limits its therapeutic options. Here, we report an incidence of ceftriaxone resistance in NTS over the past 9 years in a southern Indian region. Materials and Methods: Molecular mechanisms of resistance in ceftriaxone-resistant NTS have been tested by both phenotypic and molecular methods. Minimum inhibitory concentration was determined by the E-test and broth microdilution method. AMR gene markers of β-lactamases such as AmpCs (blaMOX, blaCMY, blaDHA, blaFOX, blaACC and blaACT) and extended-spectrum β-lactamases (ESBLs) (blaSHV, blaTEM, blaVEB, blaPER, blaCTXM-1like,blaCTXM-2like, blaCTXM-8like, blaCTXM-9like and blaCTXM-25like) were screened. The presence of IncH12 and IncI1 plasmid was also analysed. Results: The study reports a 5% prevalence of ceftriaxone resistance in NTS. The most common serogroup was Salmonella Group B followed by Salmonella Group E and Salmonella group C1/C2. The occurrence of blaCTX-M-1, blaTEM, blaCMY and blaSHV genes was observed in 54%, 54%, 48% and 3% of the isolates, respectively. Interestingly, few isolates carried dual resistance genes (ESBLs and AmpCs). IncH12 and IncI1 plasmid was identified in isolates carrying ESBL and AmpC genes, respectively. Conclusion: This study shows that ceftriaxone resistance is mainly mediated by β-lactamases such as ESBL and AmpC. As the incidence of ceftriaxone resistance is rising gradually over the years, it is imperative to monitor the AMR in this species. Review of a 7-year record of the bacteriological profile of airway secretions of children with cystic fibrosis in North India Vikas Gautam, Parinitha Kaza, Joseph L Mathew, Varpreet Kaur, Megha Sharma, Pallab Ray Indian Journal of Medical Microbiology 2019 37(2):203-209 Background: Cystic fibrosis (CF) is now a recognised entity in India, with prevalence rates between 1/10,000 and 1/50,000. However, no data were available with regard to the profile of respiratory pathogens in the Indian setting. Materials and Methods: The records of respiratory secretion bacterial cultures of children with CF in a tertiary care hospital in North India from January 2010 to December 2016 were reviewed. Culture data were evaluated; the organisms were noted and their antimicrobial susceptibilities were analysed. The microbiological profile and antimicrobial susceptibility pattern of CF patients were evaluated. Results: A total of 445 samples from 146 children were processed, of which 246 (55%) samples showed bacterial growth. Mixed infections 48 (19.5%) were common in older children. Children aged 3–6 months (62.5%) showed the highest culture positivity. The most commonly isolated organisms were Pseudomonas aeruginosa (52.6%) and Staphylococcus aureus. Children with initial cultures positive for P. aeruginosa had 55% of their subsequent cultures showing polymicrobial infections. P. aeruginosa was most susceptible to ciprofloxacin (89%) and piperacillin-tazobactum (88%). Among the staphylococcal isolates, 38% were methicillin-resistant S. aureus (MRSA). The percentage of MRSA increased from 66% in 2010 to 75% in 2012, followed by a decline to 24% in 2016. Conclusions: The pattern of airway colonisation in the Indian setting is different from the Caucasian population, and P. aeruginosa and Burkholderia cepacia complex appear early. Colonisation with P. aeruginosa benefits from therapy. In case of infection, care must be taken while initiating empiric therapy. It should be based on local antibiograms to prevent the emergence of resistant microbes. Characterisation of virulence genes associated with pathogenicity in Klebsiella pneumoniae PA Remya, M Shanthi, Uma Sekar Indian Journal of Medical Microbiology 2019 37(2):210-218 Purpose: This study was undertaken to characterise the virulence factors in clinical strains of Klebsiella pneumoniae and analyse their association with various infections caused and also to determine the association between virulence factors and antimicrobial resistance profile. Materials and Methods: A total number of 370 clinically significant, non-duplicate isolates of K. pneumoniae isolated from both hospitalised patients and patients attending clinics were included in this study. Polymerase chain reaction (PCR) was carried out for the detection of various virulence genes such as mucoviscosity-associated gene A (magA), gene associated with allantoin metabolism (allS), Klebsiella ferric iron uptake(Kfu), capsule-associated gene A (K2A), regulator of mucoid phenotype A (rmpA), enterobactin (entB), yersiniabactin (YbtS), aerobactin, Fimbrial adhesin (FimH) and uridine-diphosphate galacturonate 4-epimerase (uge). Antimicrobial susceptibility testing and PCR-based detection of beta-lactamase-encoding genes such as extended-spectrum beta-lactamases, AmpCs and carbapenemases were performed. Univariate analysis was done to find the association between virulence genes and mortality. Results: The siderophore, entB, was present in most (90.5%) of the isolates. Of the 370 isolates, 345 carried multiple virulence genes; 15 harboured single virulence genes and 10 did not harbour any of the studied virulence genes. The most common combination of occurrence was entB and FimH. A mortality rate of 12.75% (38/298) was observed among hospitalised patients. None of the virulence genes had any significant association with mortality. Conclusion: Pathogenic K. pneumoniae can harbour single to multiple virulence genes. Invasive infection with even a single virulence gene-harbouring K. pneumoniae can lead to poor outcomes. Both multidrug-resistant (MDR) and non-MDR K. pneumoniae can harbour a variety of virulence genes. None of the virulence genes have a significant association with mortality.
Metagenomic next-generation sequencing in clinical microbiologyJobin John Jacob, Balaji Veeraraghavan, Karthick VasudevanIndian Journal of Medical Microbiology 2019 37(2):133-140Pneumococcal conjugate vaccine rollout in India: Expectations and challengesRosemol Varghese, Balaji Veeraraghavan, Yuvraj Jeyaraman, Girish Kumar, Narendra Kumar Arora, S BalasubramanianIndian Journal of Medical Microbiology 2019 37(2):141-146India is one among the four Asian countries with the greatest number of deaths...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Family Care Rituals in the ICU to Reduce Symptoms of Post-Traumatic Stress Disorder in Family Members—A Multicenter, Multinational, Before-and-After Intervention Trial Objectives: To assess the feasibility and efficacy of implementing "Family Care Rituals" as a means of engaging family members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress-related symptoms in family members. Design: Prospective, before-and-after intervention evaluation. Setting: Two U.S. academic medical ICU's, and one Italian academic medical/surgical ICU. Subjects: Family members of patients who had an attending predicted ICU mortality of greater than 30% within the first 24 hours of admission. Interventions: A novel intervention titled "Family Care Rituals" during which, following a baseline observation period, family members enrolled in the intervention phase were given an informational booklet outlining opportunities for engagement in care of the patient during their ICU stay. Measurements and Main Results: Primary outcome was symptoms of post-traumatic stress disorder in family members 90 days after patient death or ICU discharge. Secondary outcomes included symptoms of depression, anxiety, and family satisfaction. At 90-day follow-up, 131 of 226 family members (58.0%) responded preintervention and 129 of 226 family members (57.1%) responded postintervention. Symptoms of post-traumatic stress disorder were significantly higher preintervention than postintervention (39.2% vs 27.1%; unadjusted odds ratio, 0.58; p = 0.046). There was no significant difference in symptoms of depression (26.5% vs 25.2%; unadjusted odds ratio, 0.93; p = 0.818), anxiety (41.0% vs 45.5%; unadjusted odds ratio, 1.20; p = 0.234), or mean satisfaction scores (85.1 vs 89.0; unadjusted odds ratio, 3.85; p = 0.052) preintervention versus postintervention 90 days after patient death or ICU discharge. Conclusions: Offering opportunities such as family care rituals for family members to be involved with providing care for family members in the ICU was associated with reduced symptoms of post-traumatic stress disorder. This intervention may lessen the burden of stress-related symptoms in family members of ICU patients. This research was completed at following institutions: Rhode Island Hospital, Rush Medical Center, Azienda Ospedaliero-Universitaria Careggi. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). The James M Cox Foundation provide support for this trial in the form of grant funding for study coordination, travel, supplies, and statistical analysis. Dr. Amass's institution received funding from the National Heart, Lung, and Blood Institute (grant T32 HL134625), and he received support for article research from the National Institutes of Health. Drs. Amass's, OMahoney's, Caine's, and Palmisciano's institutions received funding from the James M. Cox Foundation. Dr. Villa received funding from Baxter and Pall. Dr. OMahoney received support for article research from the Family Foundation Grant. Ms. McFadden, Mr. Walsh, Ms. Caine, and Ms. Palmisciano received support for article research from James M. Cox Foundation. Dr. De Gaudio's institution received funding from MSD Italia and Pall, and he received funding from Baxter. The remaining authors have disclosed that they do not have any potential conflicts of interest. Address requests for reprints to: Timothy H. Amass, MD, ScM, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine. Department of Veterans Affairs, Eastern Colorado Health System. 1700 N. Wheeling Street, Office F2-266, Denver, CO 80045 E-mail: tim.amass@gmail.com Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Alive and Ventilator Free: A Hierarchical, Composite Outcome for Clinical Trials in the Acute Respiratory Distress Syndrome Objectives: Survival from acute respiratory distress syndrome is improving, and outcomes beyond mortality may be important for testing new treatments. The "ventilator-free days" score, is an established composite that equates ventilation on day 28 to death. A hierarchical outcome treating death as a worse than prolonged ventilation would enhance face validity, but performance characteristics and reporting of such an outcome are unknown. We therefore evaluated the performance of a novel hierarchical composite endpoint, the Alive and Ventilator Free score. Design: Using data from four Acute Respiratory Distress Syndrome Network clinical trials, we compared Alive and Ventilator Free to the ventilator-free days score. Alive and Ventilator Free compares each patient with every other patient in a win-lose-tie for each comparison. Duration of mechanical ventilation is only compared if both patients survived. We evaluated power of Alive and Ventilator Free versus ventilator-free days score under various circumstances. Setting: ICUs within the Acute Respiratory Distress Syndrome Network. Patients: Individuals enrolled in four Acute Respiratory Distress Syndrome Network trials. Interventions: None for this analysis. Measurements and Main Results: Within the four trials (n = 2,410 patients), Alive and Ventilator Free and ventilator-free days score had similar power, with Alive and Ventilator Free slightly more powerful when a mortality difference was present, and ventilator-free days score slightly more powerful with a difference in duration of mechanical ventilation. Alive and Ventilator Free less often found in favor of treatments that increased mortality and increased days free of ventilation among survivors. Conclusions: A hierarchical composite endpoint, Alive and Ventilator Free, preserves statistical power while improving face validity. Alive and Ventilator Free is less prone to favor a treatment with discordant effects on survival and days free of ventilation. This general approach can support complex outcome hierarchies with multiple constituent outcomes. Approaches to interpretation of differences in Alive and Ventilator Free are also presented. Drs. Novack, Beitler, and Brown were involved in drafting the work. Drs. Yitshak-Sade, Thompson, Schoenfeld, Rubenfeld, and Talmor were involved in critical revision for important intellectual content. Drs. Novack, Beitler, Yitshak-Sade, and Brown were involved in statistical analysis. All authors were involved in substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. All authors were involved in final approval of the version to be published. All authors were involved in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Supported, in part, by grant from the National Institutes of Health. Dr. Novack received funding from Cardiomed Consultants LLC. Drs. Beitler's and Schoenfeld's institution received funding from the National Institutes of Health (NIH). Drs. Beitler, Thompson, Schoenfeld, and Brown received support for article research from the NIH. Dr. Thompson's institution received funding from the National Heart, Lung, and Blood Institute (NHLBI) and Department of Defense; reports consulting for Bayer, Boehringer Ingelheim, and GlaxoSmithKline; and authorship for UpToDate, all outside the submitted work. Drs. Talmor (1UM1HL108724) and Beitler (K23HL133489) received funding from NHLBI. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: Samuel.Brown@imail.org Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Neuroprognostication Practices in Postcardiac Arrest Patients: An International Survey of Critical Care Providers Objectives: To characterize approaches to neurologic outcome prediction by practitioners who assess prognosis in unconscious cardiac arrest individuals, and assess compliance to available guidelines. Design: International cross-sectional study. Setting: We administered a web-based survey to members of Neurocritical Care Society, Society of Critical Care Medicine, and American Academy of Neurology who manage unconscious cardiac arrest patients to characterize practitioner demographics and current neuroprognostic practice patterns. Subjects: Physicians that are members of aforementioned societies who care for successfully resuscitated cardiac arrest individuals. Interventions: Not applicable. Measurements and Main Results: A total of 762 physicians from 22 countries responses were obtained. A significant proportion of respondents used absent corneal reflexes (33.5%) and absent pupillary reflexes (36.2%) at 24 hours, which is earlier than the recommended 72 hours in the standard guidelines. Certain components of the neurologic examination may be overvalued, such as absent motor response or extensor posturing, which 87% of respondents considered being very or critically important prognostic indicators. Respondents continue to rely on myoclonic status epilepticus and neuroimaging, which were favored over median nerve somatosensory evoked potentials for prognostication, although the latter has been demonstrated to have a higher predictive value. Regarding definitive recommendations based on poor neurologic prognosis, most physicians seem to wait until the postarrest timepoints proposed by current guidelines, but up to 25% use premature time windows. Conclusions: Neuroprognostic approaches to hypoxic-ischemic encephalopathy vary among physicians and are often not consistent with current guidelines. The overall inconsistency in approaches and deviation from evidence-based recommendations are concerning in this disease state where mortality is so integrally related to outcome prediction. Drs. Maciel and Barden contributed equally for this article and shared first authorship. This study was conducted at Yale University School of Medicine. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Dr. Maciel received funding from Claude D. Pepper Older Americans Independence Center Junior Scholar award that supports preclinical studies of mechanisms of secondary brain injury in a rodent cardiac arrest model. Dr. Dhakar received funding from Adamas Pharmaceuticals and research support from Marinus Pharmaceuticals and UCB Biopharma for clinical trials. Dr. Greer's institution received funding from National Institutes of Neurological Disorders and Stroke/National Institutes of Health, he received funding form medical-legal consultation, and he serves as Editor-in-Chief of Seminars in Neurology and has received compensation for medico-legal consultation. The remaining authors have disclosed that they do not have any potential conflicts of interest. ORCID 0000-0002-8763-5839 (to Dr. Maciel), ORCID 0000-0002-4901-4177 (to Dr. Barden), ORCID 0000-0002-7325-1148 (to Dr. Youn), ORCID 0000-0001-9275-2784 (to Dr. Dhakar), and ORCID 0000-0002-2026-8333 (to Dr. Gree). For information regarding this article, E-mail: carolina.maciel@neurology.ufl.edu Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Effect of Best Practice Advisories on Sedation Protocol Compliance and Drug-Related Hazardous Condition Mitigation Among Critical Care Patients Objectives: To determine whether best practice advisories improved sedation protocol compliance and could mitigate potential propofol-related hazardous conditions. Design: Retrospective observational cohort study. Setting: Two adult ICUs at two academic medical centers that share the same sedation protocol. Patients: Adults 18 years old or older admitted to the ICU between January 1, 2016, and January 31, 2018, who received a continuous infusion of propofol. Interventions: Two concurrent best practice advisories built in the electronic health record as a clinical decision support tool to enforce protocol compliance with triglyceride and lipase level monitoring and mitigate propofol-related hazardous conditions. Measurements and Main Results: The primary outcomes were baseline and day 3 compliance with triglyceride and lipase laboratory monitoring per protocol and time to discontinuation of propofol in the setting of triglyceride and/or lipase levels exceeding protocol cutoffs. A total of 1,394 patients were included in the study cohort (n = 700 in the pre–best practice advisory group; n = 694 in the post–best practice advisory group). In inverse probability weighted regression analyses, implementing the best practice advisory was associated with a 56.6% (95% CI, 52.6–60.9) absolute increase and a 173% relative increase (risk ratio, 2.73; 95% CI, 2.45–3.04) in baseline laboratory monitoring. The best practice advisory was associated with a 34.0% (95% CI, 20.9–47.1) absolute increase and a 74% (95% CI, 1.39–2.19) relative increase in day 3 laboratory monitoring after inverse probability weighted analyses. Among patients with laboratory values exceeding protocol cutoffs, implementation of the best practice advisory resulted in providers discontinuing propofol an average of 16.6 hours (95% CI, 4.8–28.3) sooner than pre–best practice advisory. Findings from alternate analyses using interrupted time series were consistent with the inverse probability weighted analyses. Conclusions: Best practice advisories can be effectively used in ICUs to improve sedation protocol compliance and may mitigate potential propofol-related hazardous conditions. Best practice advisories should undergo continuous quality assurance and optimizations to maximize clinical utility and minimize alert fatigue. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Dr. Zullo is supported by award 5K12HS022998 from the Agency for Healthcare Research and Quality. He is supported, in part, by a research grant from Sanofi Pasteur to Brown University on unrelated work that aims to understand the epidemiology of infections in long-term care facilities. He is also supported by a Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship in Health Services Research and Development. Dr. Amass' institution received funding from National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (grant number: T32HL134625), and the Brown University Respiratory Research Training Program, and he received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: rgreene1@lifespan.org Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Formyl Peptide Receptor-1 Blockade Prevents Receptor Regulation by Mitochondrial Danger-Associated Molecular Patterns and Preserves Neutrophil Function After Trauma Objectives: Trauma predisposes to systemic sterile inflammation (systemic inflammatory response syndrome) as well as infection, but the mechanisms linking injury to infection are poorly understood. Mitochondrial debris contains formyl peptides. These bind formyl peptide receptor-1, trafficking neutrophils to wounds, initiating systemic inflammatory response syndrome, and wound healing. Bacterial formyl peptides, however, also attract neutrophils via formyl peptide receptor-1. Thus, mitochondrial formyl peptides might suppress neutrophils antimicrobial function. Also, formyl peptide receptor-1 blockade used to mitigate systemic inflammatory response syndrome might predispose to sepsis. We examined how mitochondrial formyl peptides impact neutrophils functions contributing to antimicrobial responses and how formyl peptide receptor-1 antagonists affect those functions. Design: Prospective study of human and murine neutrophils and clinical cohort analysis. Setting: University research laboratory and level 1 trauma center. Patients: Trauma patients, volunteer controls. Animal Subjects: C57Bl/6, formyl peptide receptor-1, and formyl peptide receptor-2 knockout mice. Interventions: Human and murine neutrophils functions were activated with autologous mitochondrial debris, mitochondrial formyl peptides, or bacterial formyl peptides followed by chemokines or leukotrienes. The experiments were repeated using formyl peptide receptor-1 antagonist cyclosporin H, "designer" human formyl peptide receptor-1 antagonists (POL7178 and POL7200), or anti-formyl peptide receptor-1 antibodies. Mouse injury/lung infection model was used to evaluate effect of formyl peptide receptor-1 inhibition. Measurements and Main Results: Human neutrophils cytosolic calcium, chemotaxis, reactive oxygen species production, and phagocytosis were studied before and after exposure to mitochondrial debris, mitochondrial formyl peptides, and bacterial formyl peptides. Mitochondrial formyl peptide and bacterial formyl peptides had similar effects on neutrophils. Responses to chemokines and leukotrienes were suppressed by prior exposure to formyl peptides. POL7200 and POL7178 were specific antagonists of human formyl peptide receptor-1 and more effective than cyclosporin H or anti-formyl peptide receptor-1 antibodies. Formyl peptides inhibited mouse neutrophils responses to chemokines only if formyl peptide receptor-1 was present. Formyl peptide receptor-1 blockade did not inhibit neutrophils bacterial phagocytosis or reactive oxygen species production. Cyclosporin H increased bacterial clearance in lungs after injury. Conclusions: Formyl peptides both activate and desensitize neutrophils. Formyl peptide receptor-1 blockade prevents desensitization, potentially both diminishing systemic inflammatory response syndrome and protecting the host against secondary infection after tissue trauma or primary infection. This work was performed at Beth Israel Deaconess Medical Center. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Supported, in part, by Department of Defense Focused Program Award W81XWH-16-1-0464 (Drs. Yaffe, Otterbein, and Hauser) and National Institute of Allergy Infectious Diseases grant 1R03AI35346-01 (Dr. Itagaki). Dr. Itagaki has a grant from National Institute of Allergy and Infectious Diseases/National Institutes of Health (NIH), 1R03AI135346-01. Drs. Itagaki, Kaczmarek, Wang, Gong, Gao, and Otterbein received support for article research from the NIH. Dr. Yaffe's institution received funding from Department of Defense (DoD); he received funding from The American Association for the Advancement of Science Science Signaling and Applied Biomath; and he received support for article research from the DoD. Drs. Wang, Gong, and Gao disclosed government work. Dr. Otterbein received funding from HillHurst Biopharmaceuticals (stock options). Drs. Hauser and Otterbein share a grant from DoD, W81XWH-16-1-0464. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: kitagaki@bidmc.harvard.edu; cjhauser@bidmc.harvard.edu Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Corticosteroids as Adjunctive Therapy in the Treatment of Influenza: An Updated Cochrane Systematic Review and Meta-analysis Objectives: Corticosteroids may be beneficial in sepsis, but uncertainty remains over their effects in severe influenza. This systematic review updates the current evidence regarding corticosteroids in the treatment of influenza and examines the effect of dose on outcome. Data Sources: Electronic databases (MEDLINE, EMBASE, CINAHL, LILACS, CENTRAL, and Web of Science) and trial registries were searched to October 2018 for randomized controlled trials, quasi-experimental designs, and observational cohort studies reporting corticosteroid versus no corticosteroid treatment in individuals with influenza. Study Selection and Data Extraction: Two researchers independently assessed studies for inclusion. Risk of bias was assessed using the Cochrane Risk of Bias tool (randomized controlled trials) or Newcastle-Ottawa Scale (observational studies). Where appropriate, we estimated the effect of corticosteroids by random-effects meta-analyses using the generic inverse variance method. Meta-regression analysis was used to assess the association of corticosteroid dose and mortality. Data Synthesis: We identified 30 eligible studies, all observational apart from one randomized controlled trial. Twenty-one observational studies were included in the meta-analysis of mortality, which suggested an adverse association with corticosteroid therapy (odds ratio, 3.90; 95% CI, 2.31–6.60; 15 studies; adjusted hazard ratio, 1.49; 95% CI, 1.09–2.02; six studies). Risk of bias assessment was consistent with potential confounding by indication. Pooled analysis of seven studies showed increased odds of hospital-acquired infection in people treated with corticosteroids (unadjusted odds ratio, 2.74; 95% CI, 1.51–4.95). Meta-regression of the effect of dose on mortality did not reveal an association, but reported doses of corticosteroids in included studies were high (mostly > 40 mg methylprednisolone [or equivalent] per day). Conclusions: Corticosteroid treatment in influenza is associated with increased mortality and hospital-acquired infection, but the evidence relates mainly to high corticosteroid doses and is of low quality with potential confounding by indication a major concern. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Supported, in part, by grants from National Institute for Health Research Nottingham Biomedical Research Centre, (Nottingham University Hospitals National Health Service Trust and University of Nottingham), Nottingham, United Kingdom. This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2019; issue 2, DOI: 10.1002/14651858.CD010406. (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review. Dr. Lansbury disclosed that this work is part of an ongoing program undertaken by the Nottingham Biomedical Research Centre funded by the National Institute for Health Research (NIHR); she is the Head of the World Health Organization Collaborating Centre for Pandemic Influenza and Research at the University of Nottingham, which has a grant from the World Health Organization to provide technical assistance for the prevention and control of seasonal influenza; she has salary support funded by the NIHR; and she received support for article research from the NIHR. Dr. Rodrigo received salaries funded, in part, by an unrestricted grant from Pfizer and the NIHR. Professor Leonardi-Bee disclosed that she was a coapplicant on an educational grant from Hoffmann-La Roche to carry out research in the area of pandemic influenza. Hoffmann-La Roche did not support any aspects of this work. She also undertook consultancy work for the U.K. Food Standards Agency in 2013–2015 and for a Breast Milk Substitute manufacturer in 2017 to help them design a healthcare claim trial. Professor Nguyen-Van-Tam's institution received funding from the NIHR. He disclosed that the University of Nottingham Health Protection Research Group currently holds an unrestricted educational grant for influenza research from F. Hoffmann-La Roche, but this did not support any aspect of this work. He also disclosed that he is a former employee of SmithKline Beecham plc (now GlaxoSmithKline), Roche Products, and Aventis-Pasteur MSD (now Sanofi-Pasteur MSD), all prior to 2005, with no outstanding pecuniary interests by way of shareholdings, share options, or accrued pension rights. He is currently on secondment to the Department of Health and Social Care (U.K. government); he received support for article research from NIHR, Nottingham Biomedical Research Centre; and he disclosed off-label product use of corticosteroids. Professor Lim's institution received funding from NIHR Biomedical Research Centre and Pfizer (unrestricted investigator-initiated research grant for pneumococcal pneumonia) and the NIHR (corticosteroids in pandemic influenza clinical trial). This work was performed at the University of Nottingham, Nottingham, United Kingdom. Address requests for reprints to: Louise E. Lansbury, MBBS, PhD, Department of Epidemiology and Public Health, University of Nottingham, Room B104 Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, United Kingdom. E-mail: louise.lansbury@nottingham.ac.uk Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Suppression of Superoxide-Hydrogen Peroxide Production at Site IQ of Mitochondrial Complex I Attenuates Myocardial Stunning and Improves Postcardiac Arrest Outcomes Objectives: Cardiogenic shock following cardiopulmonary resuscitation for sudden cardiac arrest is common, occurring even in the absence of acute coronary artery occlusion, and contributes to high rates of postcardiopulmonary resuscitation mortality. The pathophysiology of this shock is unclear, and effective therapies for improving clinical outcomes are lacking. Design: Laboratory investigation. Setting: University laboratory. Subjects: C57BL/6 adult female mice. Interventions: Anesthetized and ventilated adult female C57BL/6 wild-type mice underwent a 4, 8, 12, or 16-minute potassium chloride-induced cardiac arrest followed by 90 seconds of cardiopulmonary resuscitation. Mice were then blindly randomized to a single IV injection of vehicle (phosphate-buffered saline) or suppressor of site IQ electron leak, an inhibitor of superoxide production by complex I of the mitochondrial electron transport chain. Suppressor of site IQ electron leak and vehicle were administered during cardiopulmonary resuscitation. Measurements and Main Results: Using a murine model of asystolic cardiac arrest, we discovered that duration of cardiac arrest prior to cardiopulmonary resuscitation determined postresuscitation success rates, degree of neurologic injury, and severity of myocardial dysfunction. Post-cardiopulmonary resuscitation cardiac dysfunction was not associated with myocardial necrosis, apoptosis, inflammation, or mitochondrial permeability transition pore opening. Furthermore, left ventricular function recovered within 72 hours of cardiopulmonary resuscitation, indicative of myocardial stunning. Postcardiopulmonary resuscitation, the myocardium exhibited increased reactive oxygen species and evidence of mitochondrial injury, specifically reperfusion-induced reactive oxygen species generation at electron transport chain complex I. Suppressor of site IQ electron leak, which inhibits complex I-dependent reactive oxygen species generation by suppression of site IQ electron leak, decreased myocardial reactive oxygen species generation and improved postcardiopulmonary resuscitation myocardial function, neurologic outcomes, and survival. Conclusions: The severity of cardiogenic shock following asystolic cardiac arrest is dependent on the length of cardiac arrest prior to cardiopulmonary resuscitation and is mediated by myocardial stunning resulting from mitochondrial electron transport chain complex I dysfunction. A novel pharmacologic agent targeting this mechanism, suppressor of site IQ electron leak, represents a potential, practical therapy for improving sudden cardiac arrest resuscitation outcomes. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Supported, in part, by National Institutes of Health RO1HL133675 (to Dr. Sharp). Dr. Archer is supported by the Canadian Institutes of Health Research, The Henderson Foundation, and the Queen's Cardiopulmonary Unit. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: wsharp@medicine.bsd.uchicago.edu This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Net Ultrafiltration Prescription and Practice Among Critically Ill Patients Receiving Renal Replacement Therapy: A Multinational Survey of Critical Care Practitioners Objectives: To assess the attitudes of practitioners with respect to net ultrafiltration prescription and practice among critically ill patients with acute kidney injury treated with renal replacement therapy. Design: Multinational internet-assisted survey. Setting: Critical care practitioners involved with 14 societies in 80 countries. Subjects: Intensivists, nephrologists, advanced practice providers, ICU and dialysis nurses. Intervention: A cross-sectional survey. Measurement and Main Results: Of 2,567 practitioners who initiated the survey, 1,569 (61.1%) completed the survey. Most practitioners were intensivists (72.7%) with a median duration of 13.2 years of practice (interquartile range, 7.2–22.0 yr). Two third of practitioners (71.0%; regional range, 55.0–95.5%) reported using continuous renal replacement therapy with a net ultrafiltration rate prescription of median 80.0 mL/hr (interquartile range, 49.0–111.0 mL/hr) for hemodynamically unstable and a maximal rate of 299.0 mL/hr (interquartile range, 200.0–365.0 mL/hr) for hemodynamically stable patients, with regional variation. Only a third of practitioners (31.5%; range, 13.7–47.8%) assessed hourly net fluid balance during continuous renal replacement therapy. Hemodynamic instability was reported in 20% (range, 20–38%) of patients and practitioners decreased the rate of fluid removal (70.3%); started or increased the dose of a vasopressor (51.5%); completely stopped fluid removal (35.8%); and administered a fluid bolus (31.6%), with significant regional variation. Compared with physicians, nurses were most likely to report patient intolerance to net ultrafiltration (73.4% vs 81.3%; p = 0.002), frequent interruptions (40.4% vs 54.5%; p < 0.001), and unavailability of trained staff (11.9% vs 15.6%; p = 0.04), whereas physicians reported unavailability of dialysis machines (14.3% vs 6.1%; p < 0.001) and costs associated with treatment as barriers (12.1% vs 3.0%; p < 0.001) with significant regional variation. Conclusions: Our study provides new knowledge about the presence and extent of international practice variation in net ultrafiltration. We also identified barriers and specific targets for quality improvement initiatives. Our data reflect the need for evidence-based practice guidelines for net ultrafiltration. Dr. Murugan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, and involved in drafting of the article, statistical analysis, and study supervision. Drs. Murugan, Ostermann, Peng, Puttarajappa, Weisbord, Palevsky, Kellum, and Bellomo were involved in study concept and design. Drs. Murugan, Ostermann, Peng, Kitamura, Romagnoli, Di Lullo, Srisawat, Todi, Bellomo, and Ronco were involved in acquisition of data. Drs. Murugan, Ostermann, Weisbord, Palevsky, Kellum, Bellomo, and Ronco were involved in analysis and interpretation of data. Drs. Murugan, Ostermann, Peng, and Kitamura were involved in administrative, technical, or material support. All authors were involved in critical revision of the article for important intellectual content. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Dr. Murugan received grant funding from the National Institute of Diabetes and Digestive and Kidney Diseases and Bioporto and funding from AM Pharma and La Jolla unrelated to this study. Dr. Romagnoli received funding from Baxter, MSD, and Masimo. Dr. Hoste's institution received funding from AM Pharma and Sopachem. Dr. Bagshaw received funding from Baxter. Dr. Weisbord received funding from Saghmos Therapeutics. Drs. Weisbord and Palevsky disclosed government work. Dr. Palevsky's institution received funding from Dascena, and he received funding from Baxter, Novartis, and GE Healthcare. Dr. Kellum received funding from Baxter (grant and consulting) and NxStage (consulting). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: muruganr@upmc.edu Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Conditional Survival With Increasing Duration of ICU Admission: An Observational Study of Three Intensive Care Databases Objectives: Prolonged admissions to an ICU are associated with high resource utilization and personal cost to the patient. Previous reports suggest increasing length of stay may be associated with poor outcomes. Conditional survival represents the probability of future survival after a defined period of treatment on an ICU providing a description of how prognosis evolves over time. Our objective was to describe conditional survival as length of ICU stay increased. Design: Retrospective observational cohort study of three large intensive care databases. Setting: Three intensive care databases, two in the United States (Medical Information Mart for Intensive Care III and electronic ICU) and one in United Kingdom (Post Intensive Care Risk-Adjusted Alerting and Monitoring). Patients: Index admissions to intensive care for patients 18 years or older. Interventions: None. Measurements and Main Results: A total of 11,648, 38,532, and 165,125 index admissions were analyzed from Post Intensive Care Risk-Adjusted Alerting and Monitoring, Medical Information Mart for Intensive Care III and electronic ICU databases respectively. In all three cohorts, conditional survival declined over the first 5–10 days after ICU admission and changed little thereafter. In patients greater than or equal to 75 years old conditional survival continued to decline with increasing length of stay. Conclusions: After an initial period of 5–10 days, probability of future survival does not decrease with increasing length of stay in unselected patients admitted to ICUs. These findings were consistent between the three populations and suggest that a prolonged admission to an ICU is not a reason for a pessimism in younger patients but may indicate a poor prognosis in the older population. Drs. Marshall, Young, and Watkinson designed the study. Drs. Marshall and Hatch and Mr. Gerry conducted the analysis. All authors were responsible for interpreting the data and drafting of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). This publication has been made possible through access to a research database that was created with support from the Health Innovation Challenge Fund (HICF-0510-006; WT-094951), a parallel funding partnership between the Department of Health and Wellcome Trust. Access was granted by the owners of the research database, the University of Oxford Critical Care Research Group. Dr. Young's institution received funding from Health Innovation Challenge Fund (joint venture of Wellcome Trust and U.K. Department of Health. Dr. Watkinson's institution received funding from Drayson Health and National Institute for Health Research (NIHR) Biomedical Research Center, Oxford, and he received funding from Drayson Health. Dr. Hatch is funded by an NIHR Academic Clinical Fellowship. Gerry is funded by an NIHR Doctoral Fellowship (DRF-2016-09-073). Dr. Watkinson has developed an electronic observations application for which Drayson Health (now Sensyne Health) has purchased a sole license. The company has a research agreement with the University of Oxford and pay personal fees. No other authors have financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years, nor other relationships or activities that could appear to have influenced the submitted work. Dr. Marshall has disclosed that he does not have any potential conflicts of interest. For information regarding this article, E-mail: dominic.marshall@bath.edu This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Investigating Swallowing and Tracheostomy Following Critical Illness: A Scoping Review Objectives: Tracheostomy and dysphagia often coexist during critical illness; however, given the patient's medical complexity, understanding the evidence to optimize swallowing assessment and intervention is challenging. The objective of this scoping review is to describe and explore the literature surrounding swallowing and tracheostomy in the acute care setting. Data Sources: Eight electronic databases were searched from inception to May 2017 inclusive, using a search strategy designed by an information scientist. We conducted manual searching of 10 journals, nine gray literature repositories, and forward and backward citation chasing. Study Selection: Two blinded reviewers determined eligibility according to inclusion criteria: English-language studies reporting on swallowing or dysphagia in adults (≥ 17 yr old) who had undergone tracheostomy placement while in acute care. Patients with head and/or neck cancer diagnoses were excluded. Data Extraction: We extracted data using a form designed a priori and conducted descriptive analyses. Data Synthesis: We identified 6,396 citations, of which 725 articles were reviewed and 85 (N) met inclusion criteria. We stratified studies according to content domains with some featuring in multiple categories: dysphagia frequency (n = 38), swallowing physiology (n = 27), risk factors (n = 31), interventions (n = 21), and assessment comparisons (n = 12) and by patient etiology. Sample sizes (with tracheostomy) ranged from 10 to 3,320, and dysphagia frequency ranged from 11% to 93% in studies with consecutive sampling. Study design, sampling method, assessment methods, and interpretation approach varied significantly across studies. Conclusions: The evidence base surrounding this subject is diverse, complicated by heterogeneous patient selection methods, design, and reporting. We suggest ways the evidence base may be developed. This work was performed at the School of Audiology and Speech Sciences, University of British Columbia; University of Alberta Hospitals, Edmonton, AB, Canada. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccmjournal). Supported, in part, by Dr. Skoretz' School of Audiology and Speech Sciences startup funds from the University of British Columbia's (UBC) Faculty of Medicine and UBC's student Work Learn program. Dr. Dawson's institution received funding from Queen Elizabeth Hospital Birmingham Charities. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: sskoretz@audiospeech.ubc.ca Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Family Care Rituals in the ICU to Reduce Symptoms of Post-Traumatic Stress Disorder in Family Members—A Multicenter, Multinational, Before-and-After Intervention TrialObjectives: To assess the feasibility and efficacy of implementing "Family Care Rituals" as a means of engaging family members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress-related symptoms in family members. Design: Prospective, before-and-after intervention evaluation. Setting:...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Where are such teachers? A legend, an icon, and a role model! Shridhar Dwivedi Indian Journal of Medical Specialities 2019 10(4):179-183 Clinicodemographic profiling of zika outbreak in Jaipur, Rajasthan Raman Sharma, Madhulata Agarwal, Mayank Gupta, Ruchi Singh, Sunil Kumar Mahavar, Rajni Sharma, Deepa Meena Indian Journal of Medical Specialities 2019 10(4):184-189 Background: The 2018 postmonsoon outbreak of Zika virus infection, in a localized pocket of city of Jaipur, Rajasthan, so far the largest in India, alarmed the health authorities to optimize surveillance and measures. Hence, a community-based study to analyze the clinicodemographic profile was conducted to gain better understanding of its squeal. This study aimed to analyze the clinicodemographic profile of this new entrant viral infection. Methods: The study was designed as a community-based observational study. 1,488,870 people in vicinity of the index case were surveyed clinically from October to November 2018. A total of 1925 febrile individuals including pregnant ones in various trimesters of their pregnancy were screened for Zika infection by reverse-transcriptase-polymerase-chain-reaction (RT-PCR). Among these, 153 were RT-PCR positive and 111 cases consenting for the study were included and data collected were analyzed using SPSS 16 software. Results: The mean age of the study population was 27.51 years (95% confidence interval = 24.78–30.25), 53% of the patients were females. Out of 59 Zika-positive females, 27 (46%) were pregnant; 12 (44.4%) were in first trimester and 9 (33%) and 6 (22.2%) in second and third trimester, respectively. The incubation period ranged from 2 to 10 days, the most common symptom being low grade fever in 82%, followed by myalgia in 64.9% and arthralgia in rheumatoid distribution in 55.9%. On examination, a widely distributed blanching maculopapular rash was seen in 28.8%; nonpurulent conjunctivitis differentiating it from dengue was seen in 16.2%. Conclusions: Although Zika, a commonly prevalent virus in dengue endemic belts, yet unknown to our territory, usually causes a mild febrile illness, it can be a cause of intense apprehension to many if infection occurs in the first trimester of pregnancy. Formulating guidelines to tackle Zika pregnancy is a daunting task and needs collaboration across the globe to carry out future research and to get the knowhow. Prevalence of obesity in Iranian children: Systematic review and meta-analysis Moloud Fakhri, Diana Sarokhani, Mandana Sarokhani, Ali Hasanpour Dehkordi, Leila Jouybari Indian Journal of Medical Specialities 2019 10(4):190-200 Background of the Study: Childhood obesity, in addition to the likelihood of its continuation in adulthood, is associated with an increase in mortality and various diseases. Purpose of the Study: This meta-analytic study aimed at determining the prevalence of obesity among Iranian children. Methodology: Two researchers independently searched national and international databases using MeSH, Scopus, PubMed, Science Direct, Web of Science, Springer, Magiran, Iranmedex, SID, Medlib, and the Google Scholar search engine. The heterogeneity between studies was evaluated using the I2 index. Data were analyzed using STATA software. This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Among 93 studies with a sample size of 3,845,768, the prevalence of obesity in Iranian children was 7% (girls 8% and boys 10%), and the prevalence of overweight was 12% (girls 17% and boys 15%). The incidence rate of obesity in children was 13% based on US centers for disease control and prevention (CDC) 2000 reference, 11% on international obesity task force (IOTF) reference, 9% on World Health Organization reference, 9% on Iranian reference, 5% on CDC reference, and 3% on national center for health statistics (NCHS) reference. Meta-regression diagram also showed that the prevalence of obesity in children was not dependent on sample size. However, the prevalence of obesity declined during the years 1999–2016, which was statistically significant. Conclusion: The prevalence of obesity in Iranian children was less than of their overweight. On the other hand, the prevalence of childhood obesity in girls was lower than that of boys, and the prevalence of child overweight among girls was higher than that of boys. Factors affecting quality of sleep in hospitalized patients: A cross-sectional survey in a tertiary care hospital Ovine Loyster D souza, Irene T. R. Alvares, Manjeshwar Shrinath Baliga Indian Journal of Medical Specialities 2019 10(4):201-206 Background: Sleep is very important for humans and more so to hospitalized patients. Alterations in the normal sleep pattern have negative impact on the medical conditions, mental health, cognitive performance and recovery of the hospitalized individuals. The primary aim of this study was to assess the quality of sleep among hospitalized patients and to find the correlation between the factors affecting sleep and sleep quality. The secondary objective was to understand the quality of sleep in people admitted for surgical and medical treatment. Methods: In this cross-sectional study, the hospitalized patients were examined. Sleeping habits of 100 inpatients of surgical and clinical wards were assessed through the Pittsburgh Sleep Quality Index (PSQI). A self-designed questionnaire was also used to ascertain the factors affecting the sleep. Content validity and test–retest reliability were evaluated. The data obtained were analyzed by the statistical methods of frequency, percentage, and Chi-square. Results: The cross-sectional study showed that the mean score for PSQI was 7.58 ± 3.14 and that 69% of the patients had poor sleep as inferred from the global PSQI >5 scores. Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication, and attitude toward the overall atmosphere and interior of wards has caused deviation in scores. Conclusion: Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality. Seroprevalence of hepatitis B infection among pregnant women in Southern Odisha Neha Samal, Sanghamitra Padhi, Laxmi Burman Indian Journal of Medical Specialities 2019 10(4):207-209 Background: Hepatitis B virus (HBV) infection continues to be a life- threatening health problem throughout world, infecting more than two billion people. While blood transfusion and unsafe therapeutic injection continue to be major risk factors, the role of vertical transmission remains under- estimated. Hence, this study was done to find out the prevalence of HBV infection and associated risk factors among healthy pregnant ladies in Southern Odisha. The present study was a prospective, observational study conducted, in the department of Microbiology, with collaboration of department of Obstetrics and Gynecology of MKCG Medical college from 1st March 2017 to 28th Feb 2018. Methodology: After collection of three to four millilitre of venous blood from the clients, sera was separated by centrifugation. They were then tested for Hepatitis B surface antigen (HBsAg) by Enzyme linked Immunsorbent assay (ELISA). Serological status of the subjects and correlation with their socio-economic characteristic was noted using a preset proforma. Babies born to HBsAg positive ladies were administered Hepatitis B vaccine and immunoglobulin. Results: Total 3,230 in non-duplicating serum samples were screened among which 150 (4.64%) were tested positive for HBsAg. Ladies with multiple sexual partners (57. 14%) followed by intravenous drug users (7.88%) were mostly positive for HBsAg. Conclusion: Exposure to risky social behavioural pattern, lack of awareness could be suggested as possible means of acquiring the infection. Immunization is the most effective and only way of preventing development of chronic carrier state. Hence all neonates were administered with hepatitis B vaccine and 0.5 ml of hepatitis B immunoglobulin within 12 hours of birth. Adoption and validation of the adolescent stress questionnaire for Indian high school students Ovine Loyster D Souza, Sucharitha Suresh, Manjeshwar Shrinath Baliga Indian Journal of Medical Specialities 2019 10(4):210-218 Introduction: Adolescent stress questionnaire (ASQ) – a 58-item inventory covering broad range of adolescent distress was developed and validated for Australian adolescents. The present study reports a modification of the ASQ for the Indian context. Methodology: Initially, a focus groups study was carried out with 8 adolescents and 8 experts to understand the relevance of the subject and domain contents of ASQ using the original ASQ. Later content validation was done by the experts in the field for the modified ASQ. The modified version was administered to (n = 20) adolescents for pilot testing. In the next stage, the scale was given to 153 adolescents and readministered to the same samples after 1 week. Statistical analysis was done to ascertain the internal consistency, component factor, and test–retest reliability as per the standard analysis. Results: During stage one, 38 questions were retained which were more relevant to Indian context. The internal consistency of 6 subscales was ≥8 and measuring 0.89 for overall questionnaire. The test–retest reliability measured 0.96 for the overall scale (P < 0.0001) for each domain. During the confirmatory factor analysis, above half (20 of 38) of the items confirmed high correlations with their component scale, with factor loadings P < 0.5. Conclusion: The modified ASQ had acceptable internal consistency and test–retest reliability. Further testing with adolescent students living in other parts is recommended to provide a more complete assessment of the questionnaire. Absent inferior venacava and anti phospholipid antibody syndrome: Compounding risk factor for deep vein thrombosis and recurrent pregnancy loss Aruna Nigam, Nidhi Gupta, Abhinav Jain, Arima Nigam Indian Journal of Medical Specialities 2019 10(4):219-221 The spectrum of congenital anomalies of the inferior vena cava (IVC) has been well described in the literature, but the absence of IVC is a rare occurrence. Most of these patients remain asymptomatic, and the age of presentation depends on the development of deep-venous thrombosis. A young female presented to us with irregular bleeding per vaginum and recurrent pregnancy loss. A thorough general examination of the female patient revealed dilated veins over the abdomen and lower limbs. Investigations of recurrent pregnancy loss led to the diagnosis of antiphospholipid antibody syndrome and computed tomography venography to find out the cause of dilated veins lead to the diagnosis of absent IVC. Both these factors, i.e., absent IVC and the presence of autoimmune antibodies, have compounded the risk factor of thrombosis and management challenging which is discussed. Area postrema syndrome: A lesser known variant of neuromyelitis optica spectrum disorder Gaurav Kumar Mittal, Shilpa Sekhar, John Jacob Mathew, Jennifer Singhdev Indian Journal of Medical Specialities 2019 10(4):222-224 One of the most specific presentations of neuromyelitis optica spectrum disorders (NMOSDs) is area postrema syndrome (APS). Although NMOSDs are now being increasingly encountered, APS is rarely reported in literature. With the emergence of the ever-expanding spectrum of neuromyelitis optica (NMO) comes various challenges in the prompt recognition, confirmation, and swift initiation of the therapy. Although with the new consensus criteria of the International Panel of NMO Diagnosis 2015, the earlier challenges of diagnosis have been removed to a great extent, still there is a long road ahead in the widespread dissemination of the current knowledge of NMOSD among health-care professionals in India. We hereby report a case of APS in a young female with endeavor to increase the awareness of this peculiar kind of presentation from India. Idiopathic hepatic granulomatosis: A challenging case of fever of unknown origin Ashutosh Garg, Vivek Pal Singh, Jai Khullar, Afreen Khan Indian Journal of Medical Specialities 2019 10(4):225-228 For any physician, fever of unknown origin (FUO) is an enigmatic problem, while being equally frustrating. It tests the limits of patience of both the physician and the patient. While the majority of such cases end up being of infective etiology, the rest are attributable to noninfectious inflammatory disorders (NIIDs) and neoplasms. Among the NIIDs, most turn out to be connective tissue disorders (CTDs). CTDs are commonly known to have granulomas on histopathology. However, hepatic granulomas are rarely encountered. We present a case of FUO in an elderly urban North Indian businessman who after thorough workup was diagnosed with idiopathic hepatic granulomatous disease. Response to disease-modifying therapy was rewarding. Cortical blindness in posterior reversible encephalopathy syndrome in postpartum eclampsia Sonakshi Singhal, Amit Baheti, Kirti Singh, Sourya Acharya, Neema Acharya Indian Journal of Medical Specialities 2019 10(4):229-230
Where are such teachers? A legend, an icon, and a role model!Shridhar DwivediIndian Journal of Medical Specialities 2019 10(4):179-183Clinicodemographic profiling of zika outbreak in Jaipur, RajasthanRaman Sharma, Madhulata Agarwal, Mayank Gupta, Ruchi Singh, Sunil Kumar Mahavar, Rajni Sharma, Deepa MeenaIndian Journal of Medical Specialities 2019 10(4):184-189Background: The 2018 postmonsoon outbreak of Zika virus infection, in a localized pocket of city of Jaipur, Rajasthan, so far the largest...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Relationship between inflammation and the severity of Recurrent Respiratory Papillomatosis Vivian Narana Ribeiro El Achkar, Andressa Duarte, Román Carlos, Jorge Esquiche León, ... Estela KaminagakuraIn Press, Journal Pre-proof, Available online 18 November 2019Purchase PDF Article preview Abstract Abstract Objective To characterize inflammatory cells in Recurrent Respiratory Papillomatosis (RRP) and to correlate it with severity using the Derkay laryngoscopic scale. Materials and methods The data and biopsies from 36 patients with Juvenile (JRRP) and 56 patients with Adult (ARRP) were collected and analyzed under light microscopy. The patients were separated into groups according to the Derkay index: ≥20 for the most severe and < 20 for the less severe cases. Immunohistochemical analysis using CD3, CD4, CD8, CD15, CD20, CD68, FoxP3 and MUM-1 antibodies was performed, and the inflammatory cells were quantified. All the clinicopathological characteristics and the results of the immunohistochemical analysis were compared among the groups proposed using the Chi-Square test and correlated through the Spearman correlation test. Results The ARRP showed significantly higher quantities of CD3+, CD8+ and MUM1+ cells (p < .05) than the JRRP samples. The presence of CD15+ cells showed positive correlation with the Derkay index (p < .05), while the MUM-1+ cells showed an inverse correlation (p = .01). Conclusion There are differences between the inflammatory cells population in the juvenile and adult groups and it can be related to disease severity. select article An association between marijuana use and tinnitusResearch articleAbstract onlyAn association between marijuana use and tinnitus Z. Jason Qian, Jennifer C. AlyonoIn Press, Corrected Proof, Available online 13 November 2019Purchase PDF Article preview Abstract Abstract Objective While some advocates have argued for marijuana as a treatment for tinnitus, the relationship between marijuana use and tinnitus is unknown. The objective of this study was to evaluate associations between marijuana use and the prevalence, severity, and rate of occurrence of tinnitus. Study design Cross-sectional analysis of nationally representative data. Setting National Health and Nutrition Examination Survey 2011–2012. Subjects and methods Statistical analysis was performed on data collected from 2705 non-institutionalized adults aged 20–69 who underwent audiometric testing and were administered questionnaires about hearing, drug use, current health status, and medical history. Results The use of marijuana at least once per month for the previous 12 months was significantly associated with experiencing tinnitus during that 12-month month (X2(1) = 19.41, p < 0.001). Subjects who used marijuana were more likely to experience tinnitus after accounting for covariables including age, gender, audiometric hearing loss, noise exposure history, depression, anxiety, smoking, salicylate use, cardiovascular disease, hypertension, and diabetes (OR = 1.75, 95% CI 1.02–3.01, p = 0.043). There were no associations between the severity or frequency of tinnitus occurrence and the quantity or frequency of marijuana use. Use of other substances such as alcohol, cocaine, methamphetamine, and heroin was not associated with tinnitus. Conclusion Regular marijuana use is associated with prevalent tinnitus. However, no dose response between marijuana use and tinnitus was observed. The relationship between marijuana use and tinnitus is complex and is likely modulated by psychosocial factors. select article Investigation of vitamin D levels in patients with Sudden Sensory-Neural Hearing Loss and its effect on treatmentResearch articleAbstract onlyInvestigation of vitamin D levels in patients with Sudden Sensory-Neural Hearing Loss and its effect on treatment Hossein Ghazavi, Amir-Abbas Kargoshai, Mohammad Jamshidi-koohsariIn Press, Corrected Proof, Available online 12 November 2019Purchase PDF Article preview Abstract Abstract Background Due to high prevalence of vitamin D deficiency and the possible association with Sudden Sensory-Neural Hearing Loss (SSNHL) finding the main causes and appropriate treatments are highly essential. This study aimed to investigate vitamin D levels in patients suffering SSNHL and its effect on response to treatment. Materials and methods This cross-sectional study was performed on two groups of case (34 SSNHL patients) and control (34 healthy subjects without risk of hearing loss). All patient information such as age, sex, audiogram illustration of hearing frequency and the level of vitamin D were recorded at baseline. Patients with SSNHL received routine treatments such as 10 days of 1 mg/kg/day steroid and the response or lack of complete response to treatment was recorded and analyzed according to the audiometry. Results Vitamin D level in SSNHL group with a mean of 19.28 ± 9.56 ng/ml was significantly less than the control group (25.71 ± 11.21 ng/ml; P value < 0.001). After treatment, 76.5% were completely recovered and 23.5% did not recover completely. Factors such as age, sex and level of initial hearing loss did not have a significant effect on the response to treatment, but the level of vitamin D in these patients had a significant relationship with the response to treatment (P value = 0.004); so that all patients with sufficient vitamin D level had completely recovered, versus 87.5% of patients with vitamin D deficiency and 12.5% of insufficient vitamin D had no response to treatment. Conclusion According to the results of the present study, the prevalence of vitamin D deficiency in patients with SSNHL was more than healthy people. SSNHL patients with deficient vitamin D had the highest percentage of no response to treatment. select article Osteoradionecrosis of the mandible: Why not to be more aggressive in earlier stage?CorrespondenceNo accessOsteoradionecrosis of the mandible: Why not to be more aggressive in earlier stage? Nidal F. AL DeekIn Press, Journal Pre-proof, Available online 12 November 2019Purchase PDF select article Impact of perforation size and predictive factors for successful pediatric gelfoam myringoplastyResearch articleAbstract onlyImpact of perforation size and predictive factors for successful pediatric gelfoam myringoplasty Elizabeth O. Shay, Janki Shah, Blake Smith, Samantha AnneIn Press, Corrected Proof, Available online 12 November 2019Purchase PDF Article preview Abstract Abstract Objectives Rates of success with pediatric myringoplasty range from 35 to 95%. The objective of this study is to evaluate the impact of perforation size on successful closure of the tympanic membrane (TM) after gelfoam myringoplasty. We also aim to identify variables that affect perforation closure rates and define predictive factors for successful TM closure. Methods A retrospective chart review of all patients that underwent gelfoam myringoplasty by a single surgeon from August 2008 through January 2015 was performed. Results One hundred fifty-nine patients met inclusion criteria and underwent a total of 219 procedures. Overall, gelfoam myringoplasty had an 83.1% rate of successful closure. Average perforation size was 15.31%. Classification tree analysis separated our cohort into three groups based on perforation size: Group 1 (<16.25%) had a 91% closure rate, group 2 (16.25% to <31.25%) had a 66.0% closure rate and group 3 (≥31.25%) had a 30.0% closure rate. Smaller perforations (P ≤0.001) were associated with increased success rates. Other factors associated with successful closure of the TM included younger age at the time of myringoplasty (P ≤0.001), fewer number of prior tympanostomy tubes (P = 0.016), and lesser duration of tube retention (P = 0.003). Conclusion Gelfoam myringoplasty provides good overall TM closure rates and may be considered as a potential first-line option for repair of perforations, including those involving up to 40% of the TM. Younger patients with smaller perforations, fewer sets of tubes, shorter length of tube retention are more likely to have successful closure of the tympanic membrane. select article Echinacea can help with Azithromycin in prevention of recurrent tonsillitis in childrenResearch articleAbstract onlyEchinacea can help with Azithromycin in prevention of recurrent tonsillitis in children Osama G. Abdel-Naby AwadIn Press, Journal Pre-proof, Available online 12 November 2019Purchase PDF Article preview Abstract Abstract Purpose Recurrent tonsillitis in children is a common disease affecting children quality of life and extends to their families. The aim of this study was to assess the effect of combined use of oral Azithromycin (AZT) plus Echinacea compared to exclusive use of AZT in children with recurrent tonsillitis. Material and methods A prospective comparative study including three groups of children with recurrent tonsillitis. Group 1: (100 patients) had no prophylactic treatment. Group 2 (100 patients) received [60 mg/kg] prophylactic dose of AZT divided as (10 mg/kg/day) over 6 consecutive days every month for 6 consecutive months. Group 3 (100 patients) received AZT as in group 2 plus commercially available Echinacea in a dose of 5 ml oral suspension; 3 times daily for 10 consecutive days every month for 6 consecutive months. Number of tonsillitis attacks and severity of tonsillitis symptoms were assessed and compared in different groups. Results Group 2 and group 3 had significant less number of tonsillitis attacks and severity of assessed symptoms during 6 months of prophylactic treatment with significant better results in group 3 (i.e. AZT plus Echinacea) compared to group 2 (I.e. AZT alone). However; there was no significant difference in patients with any prophylaxis. Conclusion The combined use of Echinacea with Azithromycin produced favorable outcome than Azithromycin alone in pediatric patients with recurrent tonsillitis. select article Surgical management of Eagle syndrome: A 17-year experience with open and ransoral robotic styloidectomyResearch articleAbstract onlySurgical management of Eagle syndrome: A 17-year experience with open and ransoral robotic styloidectomy Thomas H. Fitzpatrick, Benjamin D. Lovin, Marcus J. Magister, Joshua D. Waltonen, ... Christopher A. SullivanIn Press, Journal Pre-proof, Available online 12 November 2019Purchase PDF Article preview Abstract Abstract Eagle Syndrome (ES) is a rare disorder that can present with symptoms ranging from globus sensation to otalgia that is attributed to an elongated styloid process and/or calcified stylohyoid ligament. No standardized treatment algorithm exists, and although various surgical approaches have been described, data on the use of transoral robotic surgery (TORS) in this population is limited. To investigate the utility of TORS in the treatment of ES, a retrospective review in 19 ES patients was carried out at a single academic, tertiary medical center between 2000 and 2017. Nineteen patients underwent twenty-one styloid resections: 6 performed via TORS and 15 via transcervical approach. Across all patients, 90% reported some degree of lasting improvement in symptoms while 55% reported significant improvement. When TORS was compared to transcervical resection, there was no difference in the subjective rate of "meaningful" (83 vs. 57%) versus rate of "non-meaningful" symptom improvement (17 vs. 43%) (p = .35). There was a trend towards less estimated blood loss (EBL), operative time, and post-operative length of stay (LOS) with TORS versus transcervical cases (9.2 mL vs. 30.0 mL, 98 vs. 156 min, and 0.7 vs. 1.2 days); however, these did not reach statistical significance (p = .11, 0.13, and 0.42, respectively). Three patients (14% of total) experienced complications associated with an open approach, as compared to none with TORS. In select patients, TORS styloidectomy is a reasonable surgical alternative to traditional transoral and transcervical techniques as it provides similar symptom improvement, and reduced length of stay, blood loss, and operative time. select article Estimated versus actual; The accuracy of accounting for blood loss during endoscopic sinus surgeryResearch articleAbstract onlyEstimated versus actual; The accuracy of accounting for blood loss during endoscopic sinus surgery Michael J. EliasonIn Press, Corrected Proof, Available online 11 November 2019Purchase PDF Article preview Abstract Abstract Purpose Endoscopic sinus surgery (ESS) is the mainstay for chronic inflammatory and neoplastic sinonasal process and as a result many modalities have been studied to minimize blood loss and patient morbidity and to maximize intraoperative visualization. However, often conclusions of actual blood loss are based on surgeons' estimations without ever actually assessing the accuracy of these estimations. The objective of this study was to determine the accuracy of intraoperative blood loss estimates by attending otolaryngology surgeons among patients undergoing ESS. Materials and methods After obtaining institutional review board approval, data were collected on six surgeons performing ESS at a military academic medical center for 21 surgical cases. Specifically, both hourly and end-of-case total "estimated" (EBL) and "calculated actual" (ABL) blood loss values were recorded and compared statistically. Surgeons were blinded to the results until after all data were collected. Results The difference between mean EBL and ABL was 62.5 ml and was statistically significant (p = .007, Power 86.2%). EBL lagged ABL for both hourly intervals during a surgical case and the total end-of-surgery values. Conclusion The surgeons studied had EBL that were statistically significantly less than ABL both at hourly intervals during the surgery and at the conclusion of the case. As a result there exists potential for adverse consequences in clinical care and in efforts in medical research/advancement. select article The role of molecular testing in the diagnosis of medullary thyroid cancer: A case report of oncocytic medullary thyroid carcinoma and review of the literatureCase reportAbstract onlyThe role of molecular testing in the diagnosis of medullary thyroid cancer: A case report of oncocytic medullary thyroid carcinoma and review of the literature Sarah L. Spaulding, Rebecca Ho, Sedef Everest, Raymond L. ChaiIn Press, Corrected Proof, Available online 11 November 2019Purchase PDF Article preview Abstract Abstract Background Medullary thyroid carcinoma (MTC) is a somewhat rare, particularly aggressive form of thyroid cancer. The authors present what we believe to be the first case of MTC diagnosed solely on the basis of molecular testing, as well as a review of the literature concerning this topic and oncocytic variants of MTC. Case description A 30-year-old female patient with a 1.1 cm thyroid nodule underwent a fine-needle aspiration biopsy showing a Bethesda IV Hurthle cell neoplasm. Molecular testing of the specimen identified a RET M918 T mutation. The patient underwent a total thyroidectomy and bilateral central neck dissection. Initial pathologic analysis yielded a diagnosis of Hurthle cell adenoma. Based on the patient's known RET mutation, immunohistochemistry for calcitonin was performed and yielded a positive result. The final diagnosis was amended to an oncocytic variant of medullary thyroid carcinoma. Discussion Had this patient undergone fine-needle aspiration (FNA) biopsy without molecular testing or serum calcitonin measurement, the patient's disease would have been diagnosed as a Hurthle cell adenoma. Despite the lack of characteristic features of malignancy and the rarity of oncocytic MTC, the diagnostic pitfall in this oncocytic lesion was avoided due to molecular testing at the time of FNA biopsy. Conclusion This case draws attention to the unique clinical value of molecular testing in the diagnosis of MTC. The authors believe this case supports the consideration for molecular testing to prevent missed diagnoses in cases of rare benign-appearing disease. select article Cerumen impaction was composed of abnormal exfoliation of keratinocytes that was correlated with infectionResearch articleAbstract onlyCerumen impaction was composed of abnormal exfoliation of keratinocytes that was correlated with infection Shoude Zhang, Mao Jin, Guojin Zhou, Yuejiao ZhangIn Press, Corrected Proof, Available online 7 November 2019Purchase PDF Article preview Abstract Abstract Objective This study investigated the exact composition and tried to be helpful in explaining the etiologic mechanism of cerumen impaction in the external auditory canal (EAC). Methods A hundred impacted cerumen samples and 15 normal cerumen samples were collected by manual removal and divided into 2 groups. All samples were examined via microbial culture, hematoxylin–eosin staining, periodic acid–Schiff staining, and fungal fluorescent staining. Results Eighty-eight patients in group 1 were in the habit of using cotton buds. Forty-seven impacted cerumen samples tested positive for microbes, while only 1 sample of normal cerumen tested positive for microbes (p < .05). The most commonly isolated bacterium and fungus was Staphylococcus aureus and Aspergillus terreus respectively. All cerumen samples were composed of exfoliated keratinocytes and microorganisms assessed via pathologic examination. However, unlike normal cerumen, impacted cerumen contained nucleated keratinocytes and infiltrated neutrophils. Recurrent impaction was found only among patients who tested mold culture-positive. Conclusion Impacted cerumen is composed of abnormal exfoliated keratinocytes that was correlated with microbial-induced neutrophil-mediated inflammation. Mold infection is highly correlated with recurrent cerumen impaction. Microbial culture of removed impacted cerumen is strongly recommended. Ear cleaning with cotton buds, particularly when the EAC is wet might be one of the important causes of cerumen impaction which is need further studied. Level of evidence 2b. select article Risk factors for post-tonsillectomy hemorrhage in adult population: Does smoking history have an impact?Research articleNo accessRisk factors for post-tonsillectomy hemorrhage in adult population: Does smoking history have an impact? Nurullah Seyhun, Senem Kurt Dizdar, Alican Çoktur, Merve Ekici Bektaş, ... Suat TurgutIn Press, Corrected Proof, Available online 6 November 2019Purchase PDF select article Endoscopic repair of cribriform plate cerebrospinal fluid leaks: An easy and reproducible technique sparing the middle turbinateResearch articleAbstract onlyEndoscopic repair of cribriform plate cerebrospinal fluid leaks: An easy and reproducible technique sparing the middle turbinate Christopher J. Ito, Nelson May, Stilianos KountakisIn Press, Corrected Proof, Available online 1 November 2019Purchase PDF Article preview Abstract Abstract Objective The purpose of this study was to evaluate the outcomes of patients with cribriform cerebrospinal fluid leaks undergoing endoscopic repair with an easy and reproducible middle turbinate-sparing technique. Material and methods Date was obtained by retrospective chart review and includes a description of the technique with technical pearls and contraindications to the approach. Results We report 17 patients who underwent repair of cribriform cerebrospinal fluid leaks with a middle turbinate-sparing technique with 100% success rate at a mean follow up of 38 months. One patient complained of hyposmia. There were no other complications. Conclusions The endoscopic middle turbinate-sparing approach to repair cribriform cerebrospinal fluid leaks using a free mucosal graft is easy, effective, and reproducible. select article Orbital complication of acute ethmoiditis: A Tunisian paediatric cross sectional studyResearch articleAbstract onlyOrbital complication of acute ethmoiditis: A Tunisian paediatric cross sectional study Asma Ben Mabrouk, Selmen Wannes, Mehdi Hasnaoui, Amina Werdani, ... Bahri MahjoubIn Press, Corrected Proof, Available online 31 October 2019Purchase PDF Article preview Abstract Abstract Objective The anatomical and developmental particularities of sinus cavities in paediatric population lead acute ethmoiditis to be the earliest form of sinusitis in children. Orbital complications are frequent and could lead to visual and neurological impairment. This study investigated the clinical, biological and radiological features of orbital complications. We identified the predictive factors of severe ophthalmological lesions and/or associated cerebral complications of acute ethmoiditis. Design and methods This cross sectional study included all patients identified as having orbital extension of acute ethmoiditis in the database of a single academic paediatric care centre over a period of 14 years. All orbital and cerebral Scans of the included patients were reviewed and the cohort was classified using Chandler's classification as having less severe lesions (Chandler's 1 and 2) or more serious lesions (Chandler's 3, 4 and 5). Results In total, 16 patients (12 girls and 4 boys) were included among 39 consecutives cases of ethmoiditis recessed with a complication rate of 41%. Average consultation delay was 4.88 days. The mean age was 4.37 years. Fever was objectified in 13 cases (81%). Six patients (37.5%) had exophthalmos. Orbital extension spectrum was: stage I (n = 4, 25%), stage II (n = 4, 25%), stage III (n = 6, 37.5%), stage IV (n = 1, 6.5%), stage V (n = 1, 6.5%) and intra cranial extension was associated in two cases. Univariate analysis showed that fever, exophthalmos, ophthalmoplegia, positive CRP, age and white blood cells count were not associated with more severe lesions in the CT scan. Initially, all children received intravenous antibiotic treatment. Association of multiple antibiotics was prescribed in 75% of the cases. With 21.07 days ± 5.51 days as a total treatment duration. Only Four patients underwent surgical treatment. Conclusion Orbital complications of ethmoiditis are frequent. No clinical or biological criteria seem to predict the severity of orbital lesions. Both orbital and brain CT scan could help detect eventual complications on time to adapt antibiotic treatment and eventually bring forward surgical intervention. select article Alternative techniques in cochlear implant surgery: Subtotal petrosectomyCase reportAbstract onlyAlternative techniques in cochlear implant surgery: Subtotal petrosectomy Santiago Hernández, Juan C. Ospina, Elisa Gutiérrez-Gómez, María Teresa Rodríguez-Ruiz, Juan G. TrujilloIn Press, Corrected Proof, Available online 31 October 2019Purchase PDF Article preview Abstract Abstract Objectives To report and analyze three cases of subtotal petrosectomy (SP) in cochlear implant surgery at our institution, and establish the indications, surgical technique and complications encountered. Materials and method A retrospective descriptive study is proposed, analyzing a series of three clinical cases of subtotal petrosectomy as surgical technique for cochlear implant surgery at San Ignacio University Hospital (Bogotá, Colombia) from year 2004 to 2019. Results A total of three cases of subtotal petrosectomy as surgical technique in cochlear implant candidates were analyzed. The indications were the presence of a wide mastoid cavity after canal wall down mastoidectomy, extrusion of the electrode into the external auditory canal with a wide mastoid cavity and erosion of the posterior wall of the ear canal, and the presence of cholesteatoma in a cophotic ear with previous surgery. The ear canal was defunctionalized in all three cases; in two of them with obliteration of the Eustachian tube and in none of the cases the mastoid was obliterated. There was a single complication associated with the procedure corresponding to a small retention cholesteatoma in the skin of the obliterated duct sac, that didn't required surgical intervention. Conclusion Subtotal petrosectomy is a surgical alternative for cochlear implant surgery in patients with chronic ear pathology, wide cavities or cochlear implant extrusion, not associated to significant complications. select article Submental flap practice patterns and perceived outcomes: A survey of 212 AHNS surgeonsResearch articleAbstract onlySubmental flap practice patterns and perceived outcomes: A survey of 212 AHNS surgeons Liyang Tang, Andrew T. Day, Rebecca Lee, Eli Gordin, ... Jeremy D. RichmonIn Press, Corrected Proof, Available online 30 October 2019Purchase PDF Article preview Abstract Abstract Objectives To describe American Head and Neck Society (AHNS) surgeon submental flap (SMF) practice patterns and to evaluate variables associated with SMF complications. Methods The design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between 11/11/16 and 12/31/16. Surgeon demographics, training, practice patterns and techniques were characterized and evaluated for associations with frequency of SMF complications. Results Among 212 AHNS surgeons, 108 (50.9%) reported performing SMFs, of whom 86 provided complete responses. Most surgeons who performed the SMF routinely reconstructed oral cavity defects with the flap (86.1%, n = 74). Thirty-seven surgeons (43.0%) experienced "very few" complications with the SMF. Surgeons who practiced in the United States versus internationally (p = 0.003), performed more total career SMFs (p = 0.02), and routinely reconstructed parotid and oropharyngeal defects (p = 0.04 and p < 0.001) with SMFs were more frequently perceived to have "very few" complications. SMF surgeons reported more perceived complications with the SMF compared to pectoralis major (p = 0.001) and radial forearm free flaps (p = 0.01). However, similar perceived complications were reported between all three flaps when surgeons performed >30 SMF. Among 94 surgeons not performing SMFs, 71.3% had interest in a SMF training course. Conclusions Practice patterns of surgeons performing SMFs are diverse, although most use the flap for oral cavity reconstruction. While 43% of surgeons performing the SMF reported "very few" complications, overall complication rates with the SMF were higher compared to other flaps, potentially due to limited experience with the SMF. Increased training opportunities in SMF harvest and inset are indicated. select article Clinical significance of head shake movement in three planes in individuals with dizzinessResearch articleAbstract onlyClinical significance of head shake movement in three planes in individuals with dizziness Büşra Altın, Songül AksoyIn Press, Corrected Proof, Available online 30 October 2019Purchase PDF Article preview Abstract Abstract Purpose This study aims to evaluate the efficacy of head shake movement on three head movement planes (yaw, pitch and, roll) in patients with dizziness despite normal vestibular test results. Materials and methods Twenty individuals aged between 20 and 51 years with complaints of dizziness were included in the study, and their results were compared with the results from twenty age- and gender-matched controls. Participants were assessed using the Sensory Organization Test, Head Shake-Sensory Organization Test which is based on the modification of the Sensory Organization Test on the yaw, pitch, and roll planes, videonystagmography, caloric test, and Dizziness Handicap Inventory. Results Significant differences were found in the yaw (p = 0.007), pitch (p < 0.001), and roll (p = 0.002) planes between the study and control groups of the Head Shake-Sensory Organization Test-5 scores. There were no statistically significant differences between the two groups of the Head Shake-Sensory Organization Test-2 scores in the yaw (p = 0.448), pitch (p = 0.213), and roll (p = 0.531) planes. When the sensitivity and specificity of Head Shake-Sensory Organization Test-5 conditions were examined, the highest specificity was observed in the pitch plane (100%), followed by the yaw (95%) and roll plane (95%). Conclusion Dynamic head movements are an important parameter for the evaluation of balance performance. The head shake modification could be used effectively in three-movement planes in individuals with dizziness. select article Therapeutic effects of metformin for noise induced hearing lossResearch articleAbstract onlyTherapeutic effects of metformin for noise induced hearing loss Özge Gedik, Remzi Doğan, Mehmet Ali Babademez, Ersin Karataş, ... Orhan ÖzturanIn Press, Corrected Proof, Available online 30 October 2019Purchase PDF Article preview Abstract Abstract Objective This study aimed to investigate the healing effect of metformin on noise induced hearing loss (NIHL) by measuring audiological, biochemical and histological parameters. Materials and methods 32 rats were divided into four groups (Group 1: Noise, Group 2: Noise + Metformin, Grup 3: Metformin, Grup 4: Control). Broadband noise was applied to Group 1 and Group 2 after basal measurements. Measuring audiological (distortion product otoacoustic emission (DPOAE) and Auditory Brainstem Response (ABR)), biochemical (total antioxidant status (TAS), total oxidant status (TOS), oxidative status index (OSI), DNA damage, IL-1 beta, IL-6, TNF alfa, HSF-1 and COX-2) and histological parameters. Results Group 2 had significant decreases in ABR thresholds on day 7 and day 14 compared to day 1. DPOAE values of Group 2 on the 7th and 14th days were significantly higher than the post-noise levels. DNA damage, TOS and OSI values of Group 1 were significantly higher than the other groups. The Cox-2 value of Group 1 was higher than all other groups. The HSF-1 value of Group 2 was significantly higher than that of Group 1. In terms of IL-1 Beta, IL-6 and TNF-alpha values, there was no significant difference between groups 2, 3 and 4 and these values were significantly lower than group 1. In histopathological results of our study, no significant difference was found between the groups being exposed to noise and the control group. Conclusion This study showed that early period of Metformin treatment has therapeutic effect on NIHL. select article Assessment of post-operative healing following endoscopic, transnasal, transsphenoidal pituitary surgery without formal sellar graftingResearch articleAbstract onlyAssessment of post-operative healing following endoscopic, transnasal, transsphenoidal pituitary surgery without formal sellar grafting Danny Jandali, Sarah Shearer, Richard Byrne, Peter Papagiannopoulos, ... Pete S. BatraIn Press, Journal Pre-proof, Available online 29 October 2019Purchase PDF Article preview Abstract Abstract Introduction Multiple options exist for sellar reconstruction after endoscopic transnasal, transsphenoidal surgery (TSS) including free mucosa, fat, bone and synthetic materials. The objective of this study was to assess healing and mucosalization of the sellar face following TSS without formal sellar grafting or reconstruction. Methods Single institution retrospective chart review was conducted for patients undergoing TSS without intraoperative CSF leaks between January 2014 and March 2017 at Rush University Medical Center. No formal sellar reconstruction was performed for the entire patient group. Follow-up endoscopic data and clinical notes were coded for time to mucosalization of the sella as well as degree of abnormal mucosal healing, epistaxis, crusting and scarring. Results 83 patients were included in this study. Mean time to mucosalization was 119 days (range, 17 to 402 days). Incidence of abnormal mucosal healing, epistaxis, crusting and scarring increased from the first to the second postoperative visit but trended down by the third visit. Nasal crusting was the most common finding, followed by abnormal mucosal healing. Chi square analysis showed smoking to be associated with prolonged time to full mucosalization of the sella. Two patients (2.4%) had post-operative CSF leaks requiring lumbar drain placement. Conclusion Adequate sellar healing is achievable in all cases without formal grafting or reconstruction after TSS. Great care must be exercised given the small inherent risk of unmasking a subclinical intraoperative CSF leak. Patients should be followed closely endoscopically during the first four months after TSS to minimize the impact of crusting. select article The effect of transcutaneous electrical nerve stimulation (TENS) on chronic subjective tinnitusResearch articleAbstract onlyThe effect of transcutaneous electrical nerve stimulation (TENS) on chronic subjective tinnitus Belgin Tutar, Sevgi Atar, Güler Berkiten, Onur Üstün, ... Yavuz UyarIn Press, Corrected Proof, Available online 29 October 2019Purchase PDF Article preview Abstract Abstract Objectives Chronic Subjective Tinnitus is a very highly prevalent disorder worldwide. There is no definitive treatment. The aim of this study is to investigate the efficacy of transcutaneous electrical nerve stimulation (TENS) applied to the auricula for treating tinnitus using the Depression Anxiety Stress Scales (DASS) and Tinnitus Handicap Inventory (THI). Methods The 60 patients were randomly divided into 3 groups of 20 patients. The first group (A) had one ear stimulated with TENS, and the second group (B) had both ears stimulated. Group C (placebo group) received no electrical or sound stimulation. All group patients received total of 10 sessions with a maximum of 4 days between the sessions. Results The THI and DASS scores decreased significantly after the treatment (p < 0.05). A significant difference was also observed between the groups after treatment (p < 0.05). While there was no difference between group A and B, it was shown that group C's post-treatment score was significantly higher than those of both groups (p < 0.05.) Conclusion It is important to note that TENS has a therapeutic effect on subjective chronic tinnitus as well as a placebo effect. select article An update on autoimmune inner ear disease: A systematic review of pharmacotherapyReview articleAbstract onlyAn update on autoimmune inner ear disease: A systematic review of pharmacotherapy David Strum, Sunny Kim, Timothy Shim, Ashkan MonfaredIn Press, Corrected Proof, Available online 28 October 2019Purchase PDF
Relationship between inflammation and the severity of Recurrent Respiratory PapillomatosisVivian Narana Ribeiro El Achkar, Andressa Duarte, Román Carlos, Jorge Esquiche León, ... Estela KaminagakuraIn Press, Journal Pre-proof, Available online 18 November 2019Purchase PDFArticle previewAbstractAbstractObjectiveTo characterize inflammatory cells in Recurrent Respiratory Papillomatosis (RRP) and to correlate it with severity using the Derkay laryngoscopic scale.Materials and methodsThe data and biopsies...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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The impact of using three-dimensional digital models of human embryos in the biomedical curriculum Publication date: January 2020 Source: Annals of Anatomy - Anatomischer Anzeiger, Volume 227 Author(s): Nora Chekrouni, Roeland P. Kleipool, Bernadette S. de Bakker Abstract BackgroundKnowledge of embryonic development is essential to understand the positioning of organs in the human body. Unfortunately, (bio)medical students have to struggle with textbooks that use static, two-dimensional (2D) schematics to grasp the intricate three-dimensional (3D) morphogenesis of the developing human body. To facilitate embryology education on an understandable and scientific level, a 3D Atlas of Human Embryology (3D Atlas) was created (Science, 2016), encompassing 14 interactive 3D-PDFs of various stages of human embryonic development (freely available from http://www.3datlasofhumanembryology.com). This study examined whether the use of the 3D atlas has added educational value and improves the students learning experience. MethodsThe 3D atlas was introduced and integrated in lectures and practical classes of an existing embryology course at our university for first year biomedical students. By means of a questionnaire the use of the 3D atlas was evaluated. The outcomes in written examinations was compared between cohorts that followed the course before and after integration of the 3D atlas. ResultsOur results showed that the 3D Atlas significantly improves students' understanding of human embryology, reflected in significant higher test scores for new students. Furthermore, the 3D atlas also significantly improved repeaters' test scores. ConclusionsThe results indicate that the3D Atlas of Human Embryology facilitates students' learning experience as a resource to support embryology lectures. Students appreciated the use of the 3D atlas in practical classes and liked its interactive aspect. Interestingly, the students also appreciated the physical hand-painted embryological models that were used in addition to the digital 3D atlas during practical classes. The 3D Atlas of Human Embryology has proven to be a valuable resource in addition to the existing resources to teach the intricate developmental processes of human embryology, especially in a blended learning curriculum. Onset of calciotropic receptors during the initiation of mandibular/alveolar bone formation Publication date: January 2020 Source: Annals of Anatomy - Anatomischer Anzeiger, Volume 227 Author(s): Jan Bobek, Veronika Oralova, Herve Lesot, Adela Kratochvilova, Jaroslav Doubek, Eva Matalova Abstract Mandibular/alveolar (m/a) bone, as a component of the periodontal apparatus, allows for the proper tooth anchorage and function of dentition. Bone formation around the tooth germs starts prenatally and, in the mouse model, the mesenchymal condensation turns into a complex vascularized bone (containing osteo-blasts, -cytes, -clasts) within only two days. This very short but critical period is characterized by synchronized cellular and molecular events. The m/a bone, as others, is subjected to endocrine regulations. This not only requires vasculature to allow the circulation of active molecules (ligands), but also the expression of corresponding cell receptors to define target tissues. This contribution aimed at following the dynamics of calciotropic receptors´ expression during morphological transformation of a mesenchymal condensation into the initial m/a bone structure. Receptors for all three calciotropic systemic regulators: parathormone, calcitonin and activated vitamin D (calcitriol), were localized on serial histological sections using immunochemistry and their relative expression was quantified by q-PCR. The onset of calciotropic receptors was followed along with bone cell differentiation (as checked using osteocalcin, sclerostin, RANK and TRAP) and vascularization (CD31) during mouse prenatal/embryonic (E) days 13–15 and 18. Additionally, the timing of calciotropic receptor appearance was compared with that of estrogen receptors (ESR1, ESR2). PTH receptor (PTH1r) appeared in the bone already at E13, when the first osteocalcin-positive cells were detected within the mesenchymal condensation forming the bone anlage. At this stage, blood vessels were only lining the condensation. At E14, the osteoblasts started to express the receptor for activated vitamin D (VDR). At this stage, the vasculature just penetrated the forming bone. On the same day, the first TRAP-positive (but not yet multinucleated) osteoclastic cells were identified. However, calcitonin receptor was detected only one day later. The first Sost-positive osteocytes, present at E15, were PTH1r and VDR positive. ESR1 almost copied the expression pattern of PTH1r, and ESR2 appearance was similar with VDR with a significant increase between E15 and E18. This report focuses on the in vivo situation and links morphological transformation of the mesenchymal cell condensation into a bone structure with dynamics of cell differentiation/maturation, vascularization and onset of receptors for calciotropic endocrine signalling in developing m/a bone. Long-term treatment with naproxen changes the chemical coding of the porcine intramural duodenum neurons Publication date: January 2020 Source: Annals of Anatomy - Anatomischer Anzeiger, Volume 227 Author(s): Marta Czajkowska, Andrzej Rychlik, Jarosław Całka Abstract Due to numerous therapeutic applications and high availability, non-steroidal anti-inflammatory drugs (NSAIDs) are the most widely used drugs worldwide. However, long-term use of these drugs can lead to damage to the gastrointestinal mucosa. The enteric nervous system (ENS), which is part of the autonomic nervous system, controls most aspects of gastrointestinal activity. Enteric neurons are characterized by considerable chemical plasticity and the appearance of a pathological factor results in a change in the synthesis of neurotransmitters. The purpose of this study was to determine the effects of naproxen on expression of biologically active substances by intramural neurons supplying the porcine duodenum. The study was performed on eight immature pigs of the Pietrain x Duroc race (approximately 20 kg of body weight). The animals were divided into two groups - a control (C group) and an experimental group (N group). Group C (n = 4) consisted of animals which received empty gelatine capsules. Group N (n = 4) was composed of pigs who received naproxen orally for 28 days, approximately one hour before feeding. After this time, animals from both groups were euthanized. Frozen sections (14 μm thickness) were then prepared from the collected duodenum and subjected to double immunofluorescence staining. Antibodies against the neuronal marker PGP 9.5 and against vasoactive intestinal polypeptide (VIP), substance P (SP), neuronal nitric oxide synthase (nNOS), galanin (GAL), pituitary adenylate cyclase-activating polypeptide (PACAP) and cocaine- and amphetamine- regulated transcript peptide (CART) were used as primary antibodies. The polyclonal donkey anti-rabbit, anti-mouse and anti-guinea pig IgG antibodies - Alexa Fluor 488 and 546 - were also used for staining. Analysis of the results obtained with a fluorescence microscope showed a significant increase in the number of nNOS-, VIP-, GAL-, PACAP- and CART-immunoreactive ganglionated neurons and a decrease in the number of SP-positive neurons in the myenteric and submucosal plexuses of the porcine duodenum. The obtained results indicate the participation of enteric neurotransmitters in the neuronal duodenal response to naproxen-induced inflammation. In vitro postovulatory oocyte aging affects H3K9 trimethylation in two-cell embryos after IVF Publication date: January 2020 Source: Annals of Anatomy - Anatomischer Anzeiger, Volume 227 Author(s): Theresa Petri, Debora Dankert, Hannah Demond, Gunther Wennemuth, Bernhard Horsthemke, Ruth Grümmer Abstract BackgroundThe physiological time axis of oocyte maturation comprises highly sensitive processes. A prolonged time span between ovulation and fertilization may impair oocyte developmental competence and subsequent embryo development, possibly due to epigenetic modifications. Since post-translational histone modifications can modify chromatin activity, and trimethylation of H3K9 (H3K9me3) has been shown to increase in the murine oocyte during maturation, here the effect of postovulatory oocyte aging on H3K9me3 was analyzed. MethodsThe competence of murine oocytes which were aged for 2, 4, 6 and 8 h in vitro after oocyte retrieval to develop to the two-cell and blastocyst stage was determined. Degree of H3K9me3 was analyzed in the postovulatory aged oocytes as well as in the resulting two-cell embryos after IVF. ResultsThe current study shows that postovulatory aging of oocytes for up to eight hours after oocyte retrieval exhibited no effect on two-cell embryo and blastocyst rate; however, changes in H3K9me3 in the resulting two-cell embryos were observed. ConclusionProlonged postovulatory oocyte aging leads to epigenetic modifications of H3K9. Such modifications may affect the developmental capacity of embryos at post-implantation developmental stages. Anatomical study and clinical application of medial sural artery perforator flap for oral cavity reconstruction Publication date: January 2020 Source: Annals of Anatomy - Anatomischer Anzeiger, Volume 227 Author(s): Qiu-wangyue Sun, Peng-fei Gao, Chen-xing Wang, Xiao-meng Song, Xu Ding, huai-qi Li, He-ming Wu, Cheng Jie, Yu-nong Wu, Ye Yuan, jin-hai Ye Abstract The present study aims to provide anatomical evidence for clinical application of the medial sural artery perforator (MSAP) flap. The current study investigated the vascular anatomy of the flap, evaluated the postoperative appearance and function of the donor and recipient sites, and investigate the clinical value in reconstruction of oral cavity. Six lower limbs of Chinese adult cadavers were microsurgically dissected. The locations and courses of the medial sural artery perforators were identified and recorded, which provided an anatomical basis for clinical application. Then, 16 clinical cases employing this flap were evaluated, ranging from 3 × 4 cm to 6 × 8 cm, and were employed for defects in the oral cavity region. Sixteen clinical cases with intraoral soft tissue defects, which included four clinical cases with inner cheek defects, were successfully followed up for 10–47 months (24 months on average). The donor site function, contour of recipient site and oral function recovery were evaluated as acceptable or better in cases with intraoral soft tissue defect, which were further verifying the value of clinical application of MSAP in repairing oral cavity defects. Moreover, two typical clinical cases were described in detail. To conclude, the MSAP flap is a favorable choice for small- to medium-size defects based on minor donor site morbidity, satisfactory oral function recovery, perforator stability and adaptation of the pedicle for anastomosis in the oral cavity region. Location of the myoneural junction of the inferior oblique muscle: An anatomic study Publication date: January 2020 Source: Annals of Anatomy - Anatomischer Anzeiger, Volume 227 Author(s): Marian Grace Ana-Magadia, Ma. Regina Paula Valencia, Munekazu Naito, Takashi Nakano, Hidetaka Miyazaki, Hirohiko Kakizaki, Yasuhiro Takahashi Abstract PurposeTo examine both the horizontal and vertical locations of the myoneural junction of the inferior oblique muscle (IOM) in reference to the ala nasi, IOM origin, and inferior orbital rim. Materials and MethodsFifty-six orbits from 56 Japanese cadavers (15 male and 41 female cadavers; average age at time of death, 86.5 ± 9.4 years) were used in this experimental anatomical study. The inter-alae-nasi distance and the horizontal distances from the ipsilateral ala nasi to the IOM origin (ala-nasi-origin distance) and to the myoneural junction (ala-nasi-junction distance) were measured. The horizontal distance from the IOM origin to the myoneural junction (origin-junction distance) was calculated by subtraction of the ala-nasi-origin distance from the ala-nasi-junction distance. The vertical distance from the inferior orbital rim to the myoneural junction (rim-junction distance) was also measured. ResultsThe ala-nasi-junction, origin-junction, and rim-junction distances were 12.2 ± 3.2 mm, 10.6 ± 3.2 mm, and 3.4 ± 1.0 mm, respectively. Males had a longer inter-alae-nasi distance than females (P < 0.001), although the other distances did not show statistically significant sex-related difference (P > 0.050). The ala-nasi-junction distance tended to be negatively correlated with the inter-alae-nasi distance (r = −0.222, P = 0.050). ConclusionsThe ala-nasi-junction distance can be affected by the inter-alae-nasi distance, which was found to be longer in males. Therefore, the IOM origin and the inferior orbital rim can be considered as more practical and reliable reference points to predict the location of the myoneural junction during the posterior inferior orbitotomy, irrespective of sex. Virtual Special Issue „Human lymph vessels" Publication date: Available online 13 November 2019 Source: Annals of Anatomy - Anatomischer Anzeiger Author(s): Erich Brenner Transient connection or origin of the inferior pharyngeal constrictor during fetal development: a study using human fetal sagittal sections Publication date: Available online 11 November 2019 Source: Annals of Anatomy - Anatomischer Anzeiger Author(s): Shogo Hayashi, Hidetomo Hirouchi, Gen Murakami, Jőrg Wilting, Jose Francisco Rodríguez-Vázquez, Ji Jyun Kim Summary The inferior pharyngeal constrictor (IPC) originates from the thyroid and cricoid cartilages and inserts to the pharyngeal raphe. In serial sagittal sections of 37 embryos and fetuses at 6-15 weeks (crown rump length 15-115 mm), we found 1) the IPC connecting to the sternothyroideus and thyrohyoideus muscles (16 fetuses at 6-11 weeks) or 2) the cricothyroideus muscle (6 fetuses at 12-15 weeks) in addition to the usual cricoid origin. These aberrant connections were most likely to be transient origins of the IPC not from a hard tissue but nearby striated muscles. In four of the latter six specimens, a tendinous band from the IPC inferior end connected to the cricothyroideus muscle to provide a digastric muscle-like appearance. These aberrant connections with nearby muscles seemed to become separated by a growing protrusion of the thyroid cartilage. Therefore, these aberrant origins were, even if developed, most likely to be "corrected" to the adult morphology during midterm or late prenatal period. The aberrant or transient origin of the IPC seemed to result from a discrepancy in growth of the cartilage and muscles. Such a discrepancy in growth seems to resemble the IPC wrapping around the superior cornu of thyroid cartilage. In addition, a final or adult-like morphology was found in two of the present 37 fetal specimens. It seemed to suggest a significant redundancy in growth rate of the laryngeal structures. Establishment of a glioblastoma in vitro (in)complete resection dual co-culture model suitable for drug testing Publication date: Available online 11 November 2019 Source: Annals of Anatomy - Anatomischer Anzeiger Author(s): Christina Schmitt, Vivian Adamski, Florian Rasch, Rainer Adelung, Ralph Lucius, Michael Synowitz, Kirsten Hattermann, Janka Held-Feindt Summary BackgroundThe treatment of glioblastomas (GBM) is still a clinical challenge. Current GBM therapeutic plans focus on the development of new strategies for local drug administration in the tumor cavity to realize an efficient long-term treatment with small side-effects. Here, different amounts of residual GBM cells and healthy brain cells define the microenvironment of the tumor cavity after individual surgical GBM resection (complete or incomplete). MethodsWe evaluated available in vivo data and determined the required amounts and numerical ratios of GBM and healthy brain cells for our in vitro (in)complete resection dual co-culture model. We applied a generic two-drug treatment [temozolomide (TMZ) in combination with AT101, followed by single AT101 treatment] strategy and analyzed the results in comparison with appropriate mono-culture systems to prove the applicability of our model. ResultsWe established a suitable GBM dual co-culture model, mimicking the complete and incomplete resection in vitro, giving stable and reliable results on drug testing. Both dual co-culture conditions protectively influenced on cell death and growth rates of primary GBMs when treated with TMZ + AT101/AT101, although the treatment strategy per se was still efficient. Cell death of astrocytes correlated with amounts of increasing GBM cell numbers in the incomplete resection model upon drug treatment, and probably GBM-released chemokine and cytokines were involved in this interplay. ConclusionsOur results suggest that this dual co-culture model provides a biologically relevant platform for the discovery and compound screening of local GBM treatment strategies. Sexual dimorphism of maxillary sinuses in children and adolescents – a retrospective CT study Publication date: Available online 11 November 2019 Source: Annals of Anatomy - Anatomischer Anzeiger Author(s): Agnieszka Przystańska, Artur Rewekant, Alicja Sroka, Tomasz Gedrange, Michał Ekkert, Katarzyna Jończyk-Potoczna, Agata Czajka-Jakubowska Summary BackgroundIn the postnatal period, some sexual dimorphism is observed from the moment of birth, but it is most pronounced from puberty. The aim of the study based on CT images was to assess possible sexual dimorphism of the maxillary sinus in children aged 0-18. MethodsThe retrospective analysis of CT images of the head (assessed as normal by radiologists) of 170 patients aged 0 - 18 (85 females and 85 males) was performed. The maxillary sinuses of every patient were bilaterally measured in three planes. Three diameters were obtained: maximum transverse (horizontal) diameter (the maxillary sinus width, MSW); maximum vertical diameter (the maxillary sinus height, MSH) and maximum antero-posterior diameter (maxillary sinus length, MSL). The automatic CT image segmentation algorithm was used (Syngo Via for Oncology, Siemens) to establish maxillary sinus volume (MSV). The coefficient of variation used in the study allowed the biological variation between sexes to be observed. Results and conclusionsThe sexual dimorphism of maxillary sinus parameters is variable and depends on the phase of ontogenesis. All investigated parameters of maxillary sinuses are larger in males at 2-3 years (except for the length, which is larger in females by the end of three years, between six and nine years and after 15 years). The sexual dimorphism is less evident during the first year of age, and the most evident between 15 and 16 years. During the first two years, females are dominant with all parameters being larger than in males. The maxillary sinus length is developmentally the most stable parameter of maxillary sinuses, because throughout the investigated ontogenesis, the sexual differences are very similar. The most evident sexual dimorphism is observed in the volume of the maxillary sinus.
The impact of using three-dimensional digital models of human embryos in the biomedical curriculumPublication date: January 2020Source: Annals of Anatomy - Anatomischer Anzeiger, Volume 227Author(s): Nora Chekrouni, Roeland P. Kleipool, Bernadette S. de BakkerAbstractBackgroundKnowledge of embryonic development is essential to understand the positioning of organs in the human body. Unfortunately, (bio)medical students have to struggle with textbooks that use static, two-dimensional (2D) schematics...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Conservative vs. preservative management of chronic kidney disease: similarities and distinctions Purpose of review Dialysis has been the prevailing treatment paradigm in advanced chronic kidney disease (CKD) for patients ineligible for or unlikely to receive kidney transplantation. As dialysis may neither offer survival benefit nor improved quality of life in certain groups, there has been increasing interest in conservative management as an alternative approach. Recent findings Experts and workgroups suggest the main goals of conservative management are to optimize quality of life, treat symptoms of end-stage renal disease without dialysis or transplant, and improve survival and cardiovascular health. Given the implications of preserved kidney function on clinical outcomes, preservative management has been proposed as an integral component of conservative management. Growing evidence suggests the survival benefit of dialysis vs. conservative management without dialysis is marginal or even reversed in certain subpopulations (elderly, multimorbid, cardiovascular disease). Limited data suggest that conservative and preservative management is associated with equivalent to more favorable trajectories of health-related quality of life and symptom burden over time as opposed to dialysis. Summary Whereas existing data suggest conservative management is a viable patient-centered treatment strategy, further research is needed to determine the comparative effectiveness of preservative kidney management vs. dialysis or palliative management, as well as which patient subgroups will most benefit from these treatment strategies. Correspondence to Connie M. Rhee, MD, MSc, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California, Irvine, School of Medicine, 101 The City Drive South, City Tower, Suite 400, Orange, CA 92868, USA. Tel: +1 714 456 5142; fax: +1 714 456 6034; e-mail: crhee1@uci.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Novel options for failing allograft in kidney transplanted patients to avoid or defer dialysis therapy Purpose of review Despite improvement in short-term renal allograft survival in recent years, renal transplant recipients (RTR) have poorer long-term allograft outcomes. Allograft function slowly declines with periods of stable function similar to natural progression of chronic kidney disease in nontransplant population. Nearly all RTR transitions to failing renal allograft (FRG) period and require transition to dialysis. Conservative chronic kidney disease management before transition to end-stage renal disease is an increasingly important topic; however, there is limited data in RTR regarding how to delay dialysis initiation with conservative management. Recent findings Since immunological and nonimmunological factors unique to RTR contribute to decline in allograft function, therapies to slow progression of FRG should take both sets of factors into account. Renal replacement therapy either incremental dialysis or rekidney transplantation should be explored. This required taking benefits and risks of continuing immunosuppressive medications into account when allograft nephrectomy may be necessary. Summary FRG may benefit from various interventions to slow progression of worsening allograft function. Until there are stronger evidence to guide interventions to preserve renal function, extrapolating evidence from nontransplant patients and clinical judgment are necessary. The goal is to provide individualized care for conservative management of RTR with FRG. Correspondence to Kamyar Kalantar-Zadeh, MD, MPH, PhD, Professor and Chief, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA. Tel: +1 714 456 5142; e-mail: kkz@hs.uci.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Perspiration interventions for conservative management of kidney disease and uremia Purpose of review There has been an increasing interest in developing novel technologies to treat patients with chronic kidney disease as evidenced by KidneyX, the public–private partnership between government and industry. Perhaps a simple technology for treating kidney failure would be to utilize perspiration. It is a physiological process, and when used properly it might not be an unpleasant experience. This review will explore the current state of knowledge regarding perspiration therapy in the setting of far advanced kidney failure. Recent findings A literature review using the PubMed database was conducted between 1 April 2019 and 3 September 2019. Search terms are shown in Table 1. Major themes of the results include diaphoresis therapy for patients with chronic kidney disease, excessive perspiration causing kidney disease, analysis of sweat to diagnose cystic fibrosis, and analysis of sweat to replenish lost electrolytes. This review will focus on intentional perspiration for the treatment of patients with end-stage renal disease (ESRD). Studies have shown that perspiration, or sweat-based therapies, can provide some of the most important currently recognized therapeutic goals in treating ESRD. These goals include decreased interdialytic weight gain, reduced serum potassium levels, and benefits to cardiovascular status. Research has shed light on some of the mechanisms, both molecular and clinical, that may be involved in induced perspiration therapy in ESRD. Summary There is a long history of humans using perspiration for both recreation and therapy. Perspiration therapy for ESRD experienced a surge in the United States in the 1960s but does not have much modern momentum. With the continued growth of the ESRD population worldwide this could be considered an appropriate time to conduct more research into this promising therapy. Correspondence to Raymond W. Keller, DO, Third Kidney, Inc., 546 Pool St, Biddeford, ME 04005, USA. Tel: +1 207 929 0576; e-mail: raykeller@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Preventing a nonexistent entity: the curious case of contrast and acute kidney injury Purpose of review In recent years, doubt has been cast on the existence of contrast-induced acute kidney injury. The skepticism has stemmed from observational studies from large administrative healthcare databases. Although they correctly call that contrast-induced acute kidney injury is less common than previously thought, they cannot completely exclude selection bias. Recent findings Though less common than previously thought, contrast-induced acute kidney injury still exists. The only prophylactic method that remains valid is that of isotonic volume expansion, which is still deemed beneficial in high-risk patients. N-acetylcysteine and sodium bicarbonate are ineffective and their use should be abandoned. Summary Contrast-induced kidney injury should be defined based on clinical grounds, not merely on biochemical numbers. More research to validate a clinical definition is necessary in order to accurately re-examine its incidence. Correspondence to Swapnil Hiremath, MD, MPH, 1967 Riverside Dr, Ottawa, ON, Canada K1H7W9. Tel: +1 6137388400 x82762; fax: +1 6137388337; e-mail: shiremath@toh.ca Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Intestinal dialysis for conservative management of Uremia Purpose of review Renal replacement therapies, such as hemodialysis are invasive and impose significant financial burden as well as burden on quality of life. Conservative and 'gentler' forms of renal replacement therapy for the frail and palliative care patient is an unmet medical need. Recent findings The treatment of uremia using the gut as a substitute for the kidney has been proposed but is not practiced widely because of proven lack of long-term mortality benefit coupled with complications like edema and hyperchloremia. Mounting evidence showed that endotoxins from gastrointestinal tract are a major source of chronic inflammation in chronic kidney disease (CKD). The high load of nitrogenous waste elimination through the bowel could potentially serve as an alternative modality to remove uremic wastes especially in people who opt for conservative management for end-stage renal disease with some recent studies in Iran and China showing promising benefits in uremia. Summary In this review, we will discuss the history, recent evidence and potential of these therapies and their implications in CKD for conservative and easy management of uremia. Correspondence to Subodh J. Saggi, MD, MPH, Renal Division, Department of Medicine, State University of New York Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA. Tel: +1 718 270 1584/+1 718 270 2848; e-mail: subodh.saggi@downstate.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Charcoal for the management of pruritus and uremic toxins in patients with chronic kidney disease Purpose of review Pruritus is an important, prevalent but often neglected symptom in patients with advanced chronic kidney disease (CKD) or on dialysis. This review addresses the use of activated charcoal and its analogs in the treatment of uremic pruritus, which can be a sign of uremic toxicity. Recent findings When common causes are corrected and dialysis efficiency is optimized, pruritus is mainly ascribed to the retention of middle and protein-bound molecules, of which indoxyl sulfate and p-cresyl sulfate are the best studied. While hemodialysis and hemodiafiltration are of limited use, activated charcoal and its analogs offer interesting alternatives. Oral preparations are associated with symptom improvement and a better metabolic pattern, probably via a combination of absorption and modification of the intestinal microbiota. Large studies, in well phenotyped populations, are needed. Hemoperfusion, commonly used in poisoning and intoxication, could be an interesting alternative in hemodialysis patients. The treatment has proved promising in some preliminary and small studies; more research is now needed to test its validity. Summary Oral activated charcoal and hemoperfusion can be proposed to patients with severe refractory pruritus based on positive, albeit scattered evidence. They also contribute to reducing uremic toxins. Research on their implementation associated with well established treatments is needed to understand whether they can be used as 'uremic detoxifiers'. Correspondence to Adamasco Cupisti, MD, Professor of Nephrology, Department of Clinical and Experimental Medicine, Università di Pisa, Via Roma 67, 56126 Pisa, Italy. Tel: +00 39 50 997291; e-mail: adamasco.cupisti@med.unipi.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Microbiome modulation to correct uremic toxins and to preserve kidney functions Purpose of review The association between dysbiosis and CKD is well established. This review focuses on the current understanding of microbiome, in normal individuals and CKD patients, in order to hypothesize how to correct uremic toxins levels and preserve the renal function and reduce associated comorbidities. Here we discuss our current opinion on microbiome modulation in order to manage the CKD-associated dysbiosis. Recent findings Emerging evidence confirms the role of gut microbiome in the progression of CKD. In this scenario, the need is felt to set up multifaceted approaches for dysbiosis management. Among many strategies able to improve gut wellness, a crucial approach is represented by the functional nutrition. At the same time, drug-based treatments show significant results in microbiome modulation. Furthermore, we examine here the potentialities of fecal microbiome transplantation (FMT) in CKD, an approach currently applied in Clostridium difficile infection. Summary The gut microbiome plays a pivotal role in the pathophysiology of CKD. The vicious cycle triggered by kidney function decline leads to gut dysbiosis. Considering the gut microbiome as a therapeutic target in CKD, multiple approaches aimed at its modulation should be envisioned to preserve kidney function. Dietary interventions and pharmacological strategies are able to improve microbiome dysbiosis, oxidative stress and fibrosis. Additionally, FMT could represent a promising novel therapy in the management of CKD-associated dysbiosis. Correspondance to Loreto Gesualdo, Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy. Tel: +39 0805594041; e-mail: loreto.gesualdo@uniba.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Renoprotective effects of sodium-glucose cotransporter-2 inhibitors and underlying mechanisms Purpose of review Emerging data have demonstrated that sodium-glucose cotransporter-2 (SGLT2) inhibitors prevent cardiovascular events, especially heart failure-associated endpoints. Cardiovascular outcome trials have also suggested their renoprotective effects. One large clinical trial investigated renal primary endpoints and demonstrated that SGLT2 inhibitors slowed the progression of diabetic kidney disease (DKD). This review summarizes clinical trial data on renal outcomes and discusses potential underlying mechanisms. Recent findings The EMPA-REG, CANVAS, and DECLARE-TIMI 58 studies revealed that SGLT2 inhibitors reduce the risk of cardiovascular events and concomitantly suggested that these drugs slow the progression of kidney disease in type 2 diabetes. The CREDENCE trial on patients with high-risk type 2 diabetes and chronic kidney disease demonstrated that canagliflozin treatment reduced the relative risk of a composite outcome, including end-stage kidney disease, serum creatinine doubling, and renal/cardiovascular death, by 30% in these patients. Animal experiments revealed that oxidative stress, inflammation, fibrosis, and tubuloglomerular feedback are underlying renoprotective mechanisms behind SGLT2 inhibitors. Summary Recent clinical trials have established the renoprotective effects of SGLT2 inhibitors. Further investigations on mechanisms of these renoprotective effects will provide deeper insights and understanding of pathogenetic properties of DKD. Correspondence to Naoki Kashihara, MD, PhD, Department of Nephrology and Hypertension, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. Tel: +81 86 462 1111; fax: +81 86 462 1199; e-mail: kashinao@med.kawasaki-m.ac.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Novel dietary and pharmacologic approaches for acid–base modulation to preserve kidney function and manage uremia Purpose of review We review mechanisms for chronic kidney disease (CKD) progression that might be addressed with nonpharmacologic and novel pharmacologic interventions as strategies by which to slow or even prevent CKD progression. Recent findings Evolving data support the contribution of the broad spectrum of disorders of acid (H+) accumulation, which we refer to as 'H+ stress', to CKD progression. Recent studies support that amelioration of H+ stress, including spectra of H+ accumulation that are insufficient to cause metabolic acidosis, is kidney-protective. In addition, gut-derived toxins appear to contribute to CKD progression and to the well described increased cardiovascular disease (CVD) risk in patients with CKD. Dietary and novel pharmacologic interventions hold promise as strategies to slow CKD progression through reducing levels of these gut-derived toxins. In addition, oxidative stress appears to mediate CKD progression and contributing factors like diet and cigarette smoking can exacerbate oxidative stress. Dietary changes and smoking cessation hold promise to favorably affect CKD progression by reducing kidney oxidative stress. Summary The urgent need to add to the traditional armamentarium of blood pressure control and antiangiotensin II pharmacologic therapy for kidney protection has led to investigations into additional kidney-protective strategies. Acid stress, a disordered gut microbiome, and oxidative stress each appear to contribute to CKD progression and can be potentially addressed by nonpharmacologic and novel pharmacologic interventions. Correspondence to Donald E. Wesson, MD, Baylor Scott and White Health and Wellness Center, Texas A&M Health Sciences Center College of Medicine, 4500 Spring Avenue, Dallas, TX 75216, USA. Tel: +1 214 865 3064; fax: +1 214 865 3070; e-mail: Donald.wesson@BSWHealth.org Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Novel therapeutic approaches in chronic kidney disease and uremia management No abstract available
Conservative vs. preservative management of chronic kidney disease: similarities and distinctionsPurpose of review Dialysis has been the prevailing treatment paradigm in advanced chronic kidney disease (CKD) for patients ineligible for or unlikely to receive kidney transplantation. As dialysis may neither offer survival benefit nor improved quality of life in certain groups, there has been increasing interest in conservative management as an alternative approach. Recent findings Experts and workgroups...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Antimicrobial activity and phytochemical screening of Ocimum americanum L extracts against pathogenic microorganisms Publication date: Available online 23 October 2019 Source: Acta Ecologica Sinica Author(s): Vidhya E, Vijayakumar S, Rajalakshmi S, Kalaiselvi S, Pandiyan P Abstract The aim of the present study is to assess the antimicrobial activities of various leaf extracts of Ocimum americanum were tested against pathogenic microorganisms. Preparation of different extracts viz., aqueous, acetone, ethyl acetate and methanol through soxhlet extraction method. Various extracts were investigated against MTCC strains of Bacillus cereus, Clostridium penfrigens, Klebsilla pnemoniae, Salmonella paratyphi, Candida albicans and Aspergillus niger by agar well diffusion and disc diffusion methods. Minimum inhibitory concentration (MIC), Minimum Bactericidal/Fungicindal Concentration (MBC/MFC) were determined through micro dilution method. Elucidation of phytochemicals and functional groups were observed by HPLC and FT-IR respectively. Ethyl acetate leaf extract of O.americanum showed significant antimicrobial activity against the all tested pathogens in agar well diffusion method in which B.cereus (17 mm) was observed high zone of inhibition. Whereas lowest inhibition was observed in aqueous extract against C.pentrigens (7 mm). The ranges of MIC values from 0.78 μg/ml to 50 μg/ml and MBC/MFC 1.56 μg/ml to 50 μg/ml were observed. Phytochemicals such as alkaloids, steroids, saponins, flavonoids, tannins, terepenes, phenolic compounds cardiac glycosides were detected. Saponinns, flavonoids, tannins, phenolic compounds were observed in only ethyl acetate leaf extracts. Functional group of the leaf extracts was exhibited by FTIR and HPLC analysis of the ethyl acetate leaf extract was elutated at six peaks. Based on the results we concluded that ethyl acetate leaf extract of O.americanum has proved to be potentially effective than the other extracts. Therefore, ethyl acetate leaf extract of O.americanum could act as antimicrobial agent and further studies are recommended for isolation of compounds and toxicological studies. Different response of Alyssum montanum and Helianthus annuus to cadmium bioaccumulation mediated by the endophyte fungus Serendipita indica Publication date: Available online 23 October 2019 Source: Acta Ecologica Sinica Author(s): Saleh Shahabivand, Azar Parvaneh, Ali Asghar Aliloo Abstract Environmental pollution by heavy metals is a severe issue worldwide. Microbe-assisted phytoremediation is a safe, inexpensive, and promising strategy in refinement of metal-polluted regions. Current in vitro work was installed to study effects of the endophytic fungus Serendipita indica on some physiological traits and cadmium (Cd) bioaccumulation of Alyssum montanum and Helianthus annuus seedlings grown in MS medium, under varying levels of Cd (0, 20, 40 and 60 mg Cd/l medium). Even though Cd stress induced phyto-toxicity in both tested species, but a significant improvement was found in biomass accumulation, photosynthetic pigments content, and chlorophyll fluorescence indicators in inoculated seedlings by S. indica under different doses of Cd in media. The non-infected A. montanum plantlets accumulated more Cd in shoot than root, and illustrated the properties of an accumulator species as evidenced by translocation factor (TF) and bioaccumulation factor of shoot (BFS) higher than 1. Contrary to this, un-colonized H. annuus seedlings had higher amount of Cd in root than shoot and showed a phyto-stabilizer feature, as evidenced by TF˂1 and bioaccumulation factor of root (BFR) higher than 1. Presence of S. indica significantly enhanced Cd accumulation in root, while it noticeably diminished Cd amounts of shoot in both A. montanum and H. annuus seedlings, so that inoculated plants had higher values for BFR against lower values for BFS and TF, in compare to non-inoculated ones. These findings indicated that S. indica can be considered as a bio-fertilizer to improve the physiological characteristics of tested species under Cd stress, as well as a bio-stabilizer of Cd in the roots of A. montanum and H. annuus in the regions exposed to toxic levels of Cd. Integrated use of plant residues, phosphorus and beneficial microbes improve hybrid maize productivity in semiarid climates Publication date: October 2019 Source: Acta Ecologica Sinica, Volume 39, Issue 5 Author(s): Asif Iqbal, Amanullah, Meizhen Song, Zahir Shah, Madeeha Alamzeb, Mazhar Iqbal Abstract Phosphorus unavailability and lack of organic matter in calcareous soils under semiarid climates are the major reasons for low crop productivity. A field experiment was conducted at The Agronomy Research Farm of The University of Agriculture Peshawar (semiarid climate), during summer 2015. The objective of the research was to investigate the effect of plant residues, organic and inorganic phosphorus management on improving yield and yield components of hybrid maize (CS-200) with (+) and without (−) phosphate solubilizing bacteria. The experiment was laid out in randomized complete block design with split plot arrangement, using three replications. A combination of plant residues and phosphorus sources were used as mainplot factor, and phosphate solubilizing bacteria were used as a subplot factor. The results revealed that plant residues, phosphorus sources and phosphate solubilizing bacteria significantly affected all parameters under study except number of plants at harvest. Application of legume residues (Faba bean) increased ear length (22.9 cm), grains row−1 (46) and ear−1 (419), 1000 grains weight (365 g), grain yield (6175 kg ha−1) and shelling percentage (83) as compared to paper mulberry and garlic residues. Phosphorus application at the higher rate of 120 kg ha−1 from inorganic source (single super phosphate) was superior in terms of higher ear length (24.4 cm), number of grains row−1 (48) and ear−1 (455), 1000 grains weight (380 g), grain yield (6558 kg ha−1), harvest index (42.7%) and shelling percentage (83%) than the lower rate of phosphorus (60 kg P ha−1). Inoculation of maize seeds with beneficial microbes (phosphate solubilizing bacteria) significantly increased ear length (22.9 cm), number of grains row−1 (45) and ear−1 (413), 1000 grains weight (364 g), grain yield (6237 kg ha−1), harvest index (41.8%) and shelling percentage (82) than without seed inoculation. On the basis of our results from this study, we concluded that application of faba bean residues, 120 kg P ha−1 as single super phosphate along with seed inoculation with phosphate solubilizing bacteria could improve yield and yield components of hybrid maize under semiarid climates. Ethnobotanical survey of medicinal plants in Thanjavur and its surrounding (Tamil Nadu - India) Publication date: October 2019 Source: Acta Ecologica Sinica, Volume 39, Issue 5 Author(s): S. Rajalakshmi, S. Vijayakumar, P. Arulmozhi Abstract The present study aims to document data about the traditional uses of plants in health-care trainers among the local peoples of areas which may lead to natural drug invention development. There is urgency in recording such data for ethnobotanical studies using many statistical calculations were applied. Totally, 137 informants were selected from 8 villages by their traditional knowledge about medicinal plants. The collected specimens were statistically analyzed by Frequency citation (FC), Relative frequency citation (RFC), Use values (UV), Relative importance (RI), Cultural index (CI), Frequency index (FI) and Pearson correlation Co-efficient. Totally, 85 medicinal plants belonging to 73 families were documented through traditional people of Thanjavur for the treatment of 17 different ailments in which paste based herbal medicine is highly used (30%). Among the families, Acanthaceae, Euphorbiaceae and Malvaceae are dominant species with each five, Solanaceae with four species, Amaranthaceae, Apiaceae, Convulcacaeae, Aizoaceae, Apocynaceae, Lamiaceae and Rubiaceae with each three species and Capparaceae, Lythraceae, Anacardiaceae are recorded each two species and remaining families were one species respectively. In this quantitative ethnobotanical analysis, the high use values were recorded as Solanum trilobatum (1.31), Thespesia populnea (1.30), Cissus quadrangularis (1.26), Trianthema portulacastrum (1.76), and Hygrophila auriculata. Phyllanthus niruri showed high RI values than other plants. Pearson correlation coefficient between RFC and UV was 0.802 with P-value <1%. From this study, we can recommend that statistically proved medicinal plants like Solanum trilobatum, Thespesia populnea, Cissus quadrangularis, Trianthema portulacastrum, Hygrophila auriculata, Phyllanthus niruri and Achyranthes aspera were also needed for further investigation on pharmacologically which leads to natural drug invention development. Floristic composition and biological spectrum of Keran - a remote valley of northwestern Himalaya Publication date: October 2019 Source: Acta Ecologica Sinica, Volume 39, Issue 5 Author(s): Shiekh Marifatul Haq, Akhtar H. Malik, Anzar A. Khuroo, Irfan Rashid Abstract The Himalayas are one of the youngest and richest ecosystems on earth with a variety of species and forest types due to the varying altitude, topographic, and climatic conditions. The present study was aimed to investigate the floristic composition and biological spectrum of Keran valley, a region nestled in the northwestern frontiers of Himalayan biodiversity hotspot. Floristically, a total of 183 species were recorded, out of which 55 were aliens. Herbaceous growth form was dominant (67%) and therophytes were the dominant (37%) life form. Likewise, mesophylls (34%) followed by nanophylls (29%) and microphylls (27%) were major leaf size categories; and the simple leaf lamina type was recorded in majority of the species (65%). Almost 1/3rd of the total species pool was growing in the forest habitats, while as the 2/3rd occur within the rest 9 habitat types which were largely human-modified. The vegetation phenology observed during different seasons revealed that most of the species were dominant in summer season (37%), followed by spring (29%), autumn (21%) and winter (13%). The present study provides baseline information on the plant diversity in this hitherto unexplored region of northwestern Himalaya. Floristic diversity along altitudinal gradient under Betula utilis in North Western Himalayas of Kashmir, India Publication date: October 2019 Source: Acta Ecologica Sinica, Volume 39, Issue 5 Author(s): Naseer A. Mir, T.H. Masoodi, Syed Maqbool Geelani, Akhlaq Amin Wani, Gowher N. Parrey, Javeed Ahmad Mugloo Abstract A study on community structure was carried out along three altitudinal gradients viz., Lower (3000–3200m), Middle (3200–3400m) and upper (3400–3600m) asl in Sindh Forest Division (Sonamarg) and Tangmarg Forest Divisions (Gulmarg) in sub alpine zone of North Western Kashmir Himalayas, India. The floristic structure revealed that Betula stands at Sonamarg forests supported 48 species belonging to 26 families on South Eastern aspect and 53 species belonging to 28 families on South Western aspect, whereas Gulmarg forest was represented by 54 species of 28 families. The overall community structure of Betula stands depicted that Asteraceae, Poaceae, Rosaceae and Lamiaceae were the dominant families in these timberline forests. The dispersion showed that 65.48% species were contagiously distributed, 25.67 and 8.85% species showed random and regular distribution. Betula utilis shared the top niche with the dominance of 61.56 and 76.27% on SE and SW aspect at Sonamarg, and 71.81% at Gulmarg. Species richness decreased with elevation and species diversity of the forest was relatively low, the decrease in these parameter with increasing altitude can be directly related to high grazing pressure, harsh climatic conditions, topography and snow, which covers these areas for longer times especially during the growing season. Screening the antimicrobial potential of twelve medicinal plants against venereal diseases causing pathogens Publication date: October 2019 Source: Acta Ecologica Sinica, Volume 39, Issue 5 Author(s): J.E. Morvin Yabesh, S. Vijayakumar, P. Arulmozhi, S. Rajalakshmi Abstract The antimicrobial potential of selected ethnomedicinal plants in traditional healers of Silent valley, Palakkad district of Kerala, India against venereal diseases causing pathogens. Twelve medicinal plants and their parts were collected from the various places of Silent Valley, Kerala, India. These plant parts were dried and mixed with different kinds of solvents respectively hexane, chloroform, methanol and water. In this study, six microbial strains were selected, in which five bacterial and a fungal strain. Among the bacterial strains, two strains were gram positive and three strains for gram negative bacteria. Totally, twelve medicinal plant parts mixed with various solvents were treated against the selected pathogenic organisms. Among them, methanolic extract of A. occidentate, C. indica, H. rosa-sinensis and M. oleifera exhibited excellent antibacterial activity than other parts of plants and standard drugs. As well as, methanolic extract of H. rosa-sinensis showed good antifungal activity against C. albicans. While,the least inhibition was noted with aqueous extract of C. indica against S. aureus. The MIC ranges from 0.78μg/ml to 50μg/ml and MBC/MFC 1.52μg/ml to 50μg/ml. The methanolic flower extract of H. rosa-sinensis has showed effective zone of inhibition against all the pathogens, particularly N. gonorrhoeae (30 mm) and C. albicans (26mm), than other extracts and standard drugs. Therefore, we concluded that, flower extract had potential therapeutic activity against venereal diseases. This research will be helpful to discover the new therapeutic drug molecule in Pharmaceutical sectors. Effect of seaweed liquid fertilizer on yield and quality of Capsicum annum L. Publication date: October 2019 Source: Acta Ecologica Sinica, Volume 39, Issue 5 Author(s): S. Vijayakumar, S. Durgadevi, P. Arulmozhi, S. Rajalakshmi, T. Gopalakrishnan, N. Parameswari Abstract In the present study, intensive investigation was made on the effect of seaweed liquid fertilizer (SLF) of Codium decorticatum on the seed germination yield biochemical and pigment characteristic of Capsium annum under laboratory conditions and in pots. Different concentrations such as 10%, 20%, 30%, 40% and 50% of SLF were prepared using distilled water. The seeds were soaked in 10 h for each SLF concentration then placed in separate Petri plates. Similarly, water soaked seeds were used as controls. Application of a lower concentration (20%) of SLF Showed maximum seed germination, fresh weight, dry weight, root and shoot length, number of branches, leaf area, number of pods and content of total chlorophyll, chl a, and chl b, protein, carbohydrate and lipids were observed. Therefore, the results of the present study suggested that the SLF of C. decortianum could serve as an alternative bio-fertilizer as is eco-friendly, cost-effective, deliver substantial economic and environmental benefits to farmer. Modelling of plant species richness along altitudinal gradient: Asalem Watershed basin, temperate deciduous forests in northern Iran Publication date: October 2019 Source: Acta Ecologica Sinica, Volume 39, Issue 5 Author(s): Hassan Pourbabaei, Ali Salehi, Sepide Sadat Ebrahimi, Fazel khodaparasrt Abstract Among the various topographical factors, effects of altitudinal factor on species diversity, richness, composition and biological functions patterns are considerable. This study was done to investigate plant species richness along altitudinal gradient in the Asalem watershed basin, northern forests of Iran. For these purpose, 13 altitudinal transects were established from 100 to 2500 m, according to altitude ranges within 200 m intervals. Data collection was done in 216 circular plots of 1000-m2 area with a distance of 150 m from each other. In total, 576species of 325 genus and 96 families were recorded. The highest number of species was belonged to Asteracese، Fabaceae and Lamiaceae families. The results indicated that forbs with 414 species belong to54 families and ferns with 31 species belong to10 families were the largest and smallest group of plants in study area respectively. In herbaceous layer, the mean number of species was increased along altitudinal gradients (P ≤ 0.005). The lowest and highest value of species number was belonged to 500 and 2500 m altitudes, respectively. Generally, there was a gradual decline of species number at 100 to 500 m. Fitted models indicated that variation patterns at altitudinal gradients were significant and the proposed polynomial model had a high conformity with changes of species richness. The lowest value of species number in woody layer was belonged to 1900 m altitude and 2100 m had the highest value. Three peak points were recorded at the beginning, middle and the end of gradient, respectively. Sinusoidal models showed a correlation between species richness and altitudinal changes by high coefficient of determination. Results of β –diversity indicated that species change rate was fixed at 700 m altitude, but it was decreased by increasing altitude. Fluctuations of β diversity were followed of the sinusoidal models. In the study area, destructive factors including road construction, tourism and over-exploitation are a serious threat for the ecosystem and this study can be considerable to develop targeted strategies for conservation of plant diversity. In addition, study of habitat conditions in each altitudinal gradients is necessary to reconstruction stands with low species diversity and appropriate species selection to establish stands with high density. Dominant control of climate variations over land-use change on net primary productivity under different urbanization intensities in Beijing, China Publication date: October 2019 Source: Acta Ecologica Sinica, Volume 39, Issue 5 Author(s): Yuhong Tian, Weilin Huang, Xiuchen Wu, C.Y. Jim, Xinpan Wang, Yiqing Liu Abstract Climate variations and land-use change induced by rapid urbanization can lead to crucial impacts on ecosystem Net Primary Productivity (NPP), especially in regions with intensive human activity. However, the relative contributions of land-use change and climate variations to NPP changes under different urbanization intensities are still a topic of debate. This study reports on a case study in Beijing, which is undergoing rapid urbanization, to estimate the effects of land-use change and climate variations on NPP in regions with diverse urbanization intensities in recent decades using remote-sensing data and the Carnegie-Ames-Stanford Approach (CASA) model. The results reveal obvious land-use changes in Beijing, showing an increase in both built-up and forested areas in the two inner, highly urbanized regions and a dramatic conversion from built-up area and grassy bush to forest in the two outer, less urbanized regions. Factorial experiments were performed to estimate the contributions of land-use change and climate variations to NPP changes for different regions and land-use types. An increasing trend in regional NPP was observed with decreasing urbanization intensity in all experiments. However, the increment in NPP between 2002 and 2009 tended to decrease with decreasing urbanization intensity in most experiments. Climate variation was the dominant factor in increasing NPP in the study region during 2002–2009, with a mean contribution of ∼89.5% over different regions and land-use types. However, land-use change contributed to a certain extent to NPP changes for specific land-use types (e.g., ∼28.1% for forests) in regions of intensive urbanization. Eco-engineering approaches such as increasing vegetation cover, especially forest, in built-up areas and reforestation and afforestation in non-built-up areas may be useful in mitigating the impacts of urbanization on NPP, especially in intensively urbanized regions.
Antimicrobial activity and phytochemical screening of Ocimum americanum L extracts against pathogenic microorganismsPublication date: Available online 23 October 2019Source: Acta Ecologica SinicaAuthor(s): Vidhya E, Vijayakumar S, Rajalakshmi S, Kalaiselvi S, Pandiyan PAbstractThe aim of the present study is to assess the antimicrobial activities of various leaf extracts of Ocimum americanum were tested against pathogenic microorganisms. Preparation of different extracts viz., aqueous, acetone, ethyl...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Sphingadienes show therapeutic efficacy in neuroblastoma in vitro and in vivo by targeting the AKT signaling pathway The authors would like to note an omission of disclosure in this paper. Author JDS is cofounder, equity-holder, and consultant of GILTRx Therapeutics. Correction to: Inhibitory effects of tea polyphenols by targeting cyclooxygenase-2 through regulation of nuclear factor kappa B, Akt and p53 in rat mammary tumors The authors regret to inform that there were unknowing errors in figures. The corrected images are given below. These figures are not affecting the results and conclusion of the manuscript. Hence, the text in original paper remains unchanged. Axitinib pharmacologic therapeutic monitoring reveals severe under-exposure despite titration in patients with metastatic renal cell carcinoma Summary Introduction New therapeutic strategies combining axitinib and immune checkpoint blockers are ongoing in metastatic renal cell carcinoma (mRCC). These strategies do not consider the pharmacokinetic variability of axitinib. We aimed to describe the risk of axitinib under-exposure using routine pharmacologic therapeutic monitoring (PTM). Methods We analyzed axitinib dosage in nine patients with mRCC. Routine axitinib concentration measurements were centralized at Henri Mondor University Hospital (Créteil, France) using a validated method. The primary objective was to describe the evolution of Cmax dosages (1 to 6 h after oral intake) during routine axitinib titration. Results Nine patients with available Cmax axitinib dosages were included. Four out of the nine patients had axitinib titration and Cmax dosages were performed before and after titration. All but one corrected their plasma axitinib exposure after titration, suggesting of a titration success. The last patient was monitored in the Henri Mondor Hospital routine PTM program and a pharmacokinetic profiling was performed after controlled oral intake. Results suggested a poor axitinib absorption. This patient experienced early tumor progression as best response. Conclusion We report a patient with significant axitinib under-exposure, possibly due to a poor absorption. PTM should be evaluated and considered in drug developments evaluating combination therapies based on axitinib. Delineation of proapoptotic signaling of anthracene-shelled M 2 L 4 metallacapsules and their synergistic activity with curcumin in cisplatin-sensitive and resistant tumor cell lines Summary Since the introduction of cisplatin into clinical practice a few decades ago, the topic of metal-based drugs has expanded significantly. Recent examples emphasize on metallosupramolecules as an emerging class of compounds with diverse properties. They can trigger unique cellular events in malignant cells or serve as molecular hosts for various biologically active compounds, including anticancer agents. The anthracene-shelled M2L4 coordination nanocapsules under research have already proved very high anticancer potency with remarkable selectivity and lack of cross-resistance. In this study, we provide an oncopharmacological evaluation of the Pt(II)- and Pd(II)-clipped M2L4 nanocapsules; we report a thorough analysis of their synergistic effects in combined treatments with the pleiotropic anticancer agent curcumin. We examined changes in cellular expression of several apoptosis-related proteins in a panel of tumor cell lines with different chemosensitivity towards cisplatin, i.e. HT-29, HL-60 and its resistant strains HL-60/CDDP and HL-60/Dox, in order to assess the molecular mechanisms of their antitumor activity The results of the immunoassay concluded activation of the mitochondrial apoptotic pathway in all the screened tumor lines. A prevalent modulation of the extrinsic apoptotic signaling cascade was observed in the chemoresistant variants. Curcumin interactions of the tested compounds were estimated against the cisplatin-refractory cell line HT-29 via the Chou-Talalay method (CTM), whereby the palladium species yielded superior synergistic activity as compared to their platinum analogues. Synergistic effect and reduced toxicity by intratumoral injection of cytarabine-loaded hyaluronic acid hydrogel conjugates combined with radiotherapy on lung cancer Summary The aim of this study was to explore the synergistic anti-tumor effects of cytarabine hyaluronic acid-tyramine (Ara-HA-Tyr) hydrogel conjugates and radiotherapy (RT) in the Lewis lung cancer (LLC) xenograft model, and the mechanisms involved. The radiotherapy sensitization ratio (SER) of 0.5 μg cytarabine (Ara-C) was 1.619 in the LLC cells. Ara-HA-Tyr was prepared by encapsulating Ara-C into hyaluronic acid-tyramine (HA-Tyr) conjugates. The hydrogels were formed through the oxidative coupling of tyramines by hydrogen peroxide (H2O2) and horseradish peroxidase (HRP). Mice engrafted with the LLC cells were given intra-tumoral injections of saline, Ara-C or Ara-HA-Tyr, with or without RT. The combination of Ara-HA-Tyr and RT increased survival compared to free Ara-C and RT (p < 0.05), and prolonged tumor growth delay (TGD). Furthermore, the RT + Ara-HA-Tyr combination therapy significantly reduced 18F-FDG uptake, induced cell cycle arrest at G2/M-phase, increased apoptosis and histone H2AX phosphorylation (γ-H2AX), and decreased the proliferation index (Ki67) in tumor cells compared to either monotherapy. Taken together, Ara-C encapsulated with HA-Tyr effectively sensitized tumor xenografts to RT and showed significantly less systemic toxicity. Graphical abstract In this work, Ara-C encapsulated with hyaluronic acid–tyramine conjugates (HA–Tyr) was prepared and used to investigate its synergistic anti-tumor efficacy by combination with radiotherapy in the Lewis lung cancer xenograft model. The synergistic mechanism may be related to tumor cell cycle redistribution, apoptosis and expression of histone H2AX phosphorylation. Clinical outcomes of advanced stage cancer patients treated with sequential immunotherapy in phase 1 clinical trials Summary Background Given the increasing number of available immunotherapeutic agents, more patients are presenting after failing immunotherapy in need of new treatment options. In this study, we investigated the clinical outcomes of patients treated with sequential immunotherapy. Methods We performed a retrospective review of 90 advanced stage cancer patients treated on immunotherapy-based phase 1 clinical trials at Winship Cancer Institute from 2009 to 2017. We included 49 patients with an immune checkpoint inhibitor (ICI)-indicated histology. Patients were analyzed based on whether they had received prior ICI. Clinical outcomes were overall survival (OS), progression-free survival (PFS), and clinical benefit (best response of complete response, partial response, or stable disease). Univariate analysis (UVA) and multivariate analysis (MVA) were performed using Cox proportional hazard or logistic regression model. Covariates included age, liver metastases, number of prior lines of therapy, histology, and Royal Marsden Hospital (RMH) risk group. Results The most common histologies were melanoma (61%) and lung/head and neck cancers (37%). More than half of patients (n = 27, 55%) received at least one ICI prior to trial enrollment: ten received anti-PD-1, two received anti-CTLA-4, five received anti-PD-1/CTLA-4 combination, and ten received multiple ICI. In MVA, ICI-naïve patients had significantly longer OS (HR: 0.22, CI: 0.07–0.70, p = 0.010) and trended towards higher chance of CB (HR: 2.52, CI: 0.49–12.97, p = 0.268). Patients who received prior ICI had substantially shorter median OS (10.9 vs 24.3 months, p = 0.046) and PFS (2.8 vs. 5.1 months, p = 0.380) than ICI-naïve patients per Kaplan-Meier estimation. Within the ICI-naïve group, 78% (7 of 9) of patients who received prior interleukin (IL-2) or interferon gamma (IFNγ) experienced disease control for at least 6 months, compared to a disease control rate of 15% (2 of 13) in patients who had received chemotherapy, targeted therapy, or no prior treatment. Conclusions ICI-naïve patients may experience improved clinical outcomes on immunotherapy-based phase 1 clinical trials than patients who have received prior ICI. This may be particularly true for patients who received prior IL-2 or IFNγ. Further development of immunotherapy combination therapies is needed to improve clinical outcomes of these patients. These results should be validated in a larger study. Increased DKC1 expression in glioma and its significance in tumor cell proliferation, migration and invasion Summary The dyskeratosis congenita 1 (DKC1) gene is located on the X chromosome at Xq28. Dyskerin encoded by the DKC1 gene is associated with the formation of certain small RNAs and the telomerase activity. Inherited mutations in DKC1 inactivate the dyskerin and causes dyskeratosis congenital, which is characterized by skin defects, hematopoiesis failure, and increased susceptibility to cancer. DKC1 reportedly up-regulates in several human cancers, including renal cell carcinoma and prostate cancer. Dyskerin is deregulated in B-chronic lymphocytic leukemia and breast carcinomas, but its expression and function in glioma have hardly been investigated. Hence, we were prompted to collect tissue samples and implement cell experiments. Our study reveals that DKC1 expression is significantly increased in the pathological tissues of glioma compared with that in normal tissues. The increased staining of DKC1 is related to the World Health Organization stages of tumors. DKC1 knockdown also significantly inhibits glioma cell growth by altering the expression of cell cycle-relative molecules to arrest at the G1 phase. In the transwell chamber, DKC1 knockdown glioma cells exhibit low motility. Consistent with classic oncogenic pathways, N-cadherin, HIF-1α, and MMP2 expression levels are lower compared with those of the control group. Therefore, DKC1 up-regulation in gliomas is common and necessary for extensive tumor growth. The phenotype of glioma cell lines after DKC1 down-regulation suggests its use as a valuable clinical treatment strategy. A high-throughput drug screen identifies auranofin as a potential sensitizer of cisplatin in small cell lung cancer Summary Small cell lung cancer (SCLC) is a highly lethal malignancy with the 5-year survival rate of less than 7%. Chemotherapy-resistance is a major challenge for SCLC treatment in clinic. In the study, we developed a high-throughput drug screen strategy to identify new drugs that can enhance the sensitivity of chemo-drug cisplatin in SCLC. This screen identified auranofin, a US Food and Drug Administration (FDA)-approved drug used therapeutically for rheumatoid arthritis, as a sensitizer of cisplatin. Further study validated that auranofin synergistically enhanced the anti-tumor activity of cisplatin in chemo-resistant SCLC cells, which was accompanied by the enhanced induction of cell cycle arrest and apoptosis. The synergistic action of auranofin and cisplatin was through ROS overproduction, thereby leading to mitochondrial dysfunction and DNA damage. Furthermore, in vivo study demonstrated that the combination treatment of auranofin and cisplatin dramatically inhibited tumor growth in SCLC. Therefore, our study provides a rational basis for further clinical study to test whether auranofin could enhance the sensitivity of cisplatin-based therapy in SCLC patients. LEF1-AS1 contributes to proliferation and invasion through regulating miR-544a/ FOXP1 axis in lung cancer Summary Long non-coding RNAs (lncRNAs) are increasingly recognized as important regulators in tumor development. This study aims to investigate the potential role oflncRNALEF1-AS1, in the progression of lung cancer. Quantitative real-time PCR (qRT-PCR) and western blot assays showed that LEF1-AS1 was upregulated while miR-544a was downregulated in lung cancer specimens and cells. Overexpression of LEF1-AS1 led to the enhancement of cell proliferation and invasion, revealed by CCK-8 assay and transwell assay. A negative correlation was found between LEF1-AS1 and miR-544a. BLAST analysis and dual-luciferase assay confirmed that FOXP1 is a downstream effector of miR-544a. Therefore, the LEF1-AS1/miR-544a/FOXP1 axis is an important contributor to lung cancer progression. Collectively, our novel data uncovers a new mechanism that governs tumor progression in lung cancer and provides new targets that may be used for disease monitoring and therapeutic intervention of lung cancer. Discovery and anticancer evaluation of a formononetin derivative against gastric cancer SGC7901 cells Summary Background Gastric cancer (GC) is the second most common cause of cancer-related death worldwide. Novel anticancer drugs against gastric cancer are urgently needed. Methods Compound 10 was designed and synthesized via a molecular hybridization strategy based on the natural product formononetin. It was evaluated for their antiproliferative activity against three gastric cancer cell lines (SGC7901, MKN45 and MGC803). Results Derivative 10 displayed potently antiproliferative activity with an IC50 value of 1.07 μM against SGC7901 cells. Derivative 10 could inhibit the growth and migration against gastric cancer SGC7901 cells through the Wnt/β-Catenin and AKT/mTOR pathways. From the in vivo expremints, it could effectively inhibited SGC7901 xenograft tumor growth in vivo without significant loss of the body weight. Conclusion Derivative 10 is an novel antitumor agent with potential for further clinical applications to treat gastric cancer. Graphical abstract
Sphingadienes show therapeutic efficacy in neuroblastoma in vitro and in vivo by targeting the AKT signaling pathwayThe authors would like to note an omission of disclosure in this paper. Author JDS is cofounder, equity-holder, and consultant of GILTRx Therapeutics.Correction to: Inhibitory effects of tea polyphenols by targeting cyclooxygenase-2 through regulation of nuclear factor kappa B, Akt and p53 in rat mammary tumorsThe authors regret to inform that there were unknowing errors in figures....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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A Narrative Literature Review of the Identity Negotiation of Bilingual Students Who are Labelled ESL Abstract English as a second language or ESL instruction is said to be for students who have moved to the United States (or Canada) from another country and temporarily need assistance in learning the English language. However, statistically, a vast majority of ESL students in the United States were born in the US and are US citizens. When students are labelled as ESL and placed in this tract of alternative education, there is an othering process going on. This narrative literature review questions how do these ESL students negotiate their own identity. It is shown that ESL students are socialized into a deficit model, placed in classrooms where the discourse is hegemonic and are placed in location of constant power play where the system is set up against them. Correction to: Subject Advisers' Perception of Curriculum Delivery in the Intermediate Phase in South Africa In the original publication of the article, the authors' institution name was published incorrectly. The correct institution name is given in this Correction. What are the Qualities of Good Citizenship in Post-genocide Rwanda? High School Teachers Speak Through a Q-Methodological Approach Abstract Teachers play a crucial role in the political socialization of adolescents. Using Q-Methodology, we explored high school teachers' conceptions of good citizenship in post-genocide Rwanda. Teachers ranked 50 statements, describing a 'good citizen', on a 9-column grid, anchored by 'least important citizenship behaviour' and 'most important citizenship behaviour'. The four perspectives that emerged viewed good citizenship as (a) being mindful or considerate of the 1994 genocide perpetrated against the Tutsi and promoting unity as well as reconciliation among Rwandans; (b) being morally upright and demonstrating a strong sense of patriotism; (c) being politically enthusiastic; and (d) promoting justice. The study argues for a shift towards more critical forms of citizenship. It also advocates the reinforcement of democratic and participatory skills among teachers. The Data of Deviance: Disintegrative Shaming and Exclusion in Queensland Schools Abstract It is the purpose of this study to determine the extent to which the implementation of the Positive Behaviour for Learning (PBL) model and its focus on data-driven behaviour management has impacted on exclusion rates in Queensland public schools and, as such, the commitment of Queensland public schools to reintegration of students with behavioural issues. Using the open source data on student exclusion rates and the reasons for exclusion, it is possible to determine shifting patterns over the last 10 years. In doing so, it has been possible to identify how the approach to exclusion in Queensland public schools has changed in the period since the introduction of the OneSchool data aggregation software. An analysis of exclusion data shows that while long-term suspensions have decreased over the last 10 years, the rate of short-term suspension and exclusion has increased. There has been a particular increase in disciplinary absences related to conduct issues like refusal to participate in class, rather than more serious violations like physical violence or drug use. Using Braithwaite's reintegrative shaming model as a framework to analyse this behavioural exclusion data indicates that an over-reliance on exclusion is steering Queensland schools away from the principles of restorative justice, and has a negative impact on student outcomes. Implications of the Legalization of Marijuana in Canada Affecting Educational Policy Abstract This research attempts to explore the implications of Bill C-45: The Cannabis Act and how this could influence educational policy in schools. The researchers sought the perspectives of multiple stakeholders involved in education, specifically their views on mitigating the transition, and other topics such as attitudes towards policy change, drug testing, and the impacts on students and teachers. This research includes components of qualitative research, statistical analysis, and review of academic literature and policy. The qualitative research portion was undertaken through in-person interviews with three teachers, four principals, and a board of education trustee in a large city in Western Canada. The statistical analysis portion of the investigation was conducted through a survey distributed to a sample of 384 people of the general public over the age of 18. This article focuses on three of the five predominate themes found in the research: (i) sustainable approaches to educating stakeholders about cannabis following legalization, (ii) comparison of views for and against drug testing between educators and the general public, and (iii) the nature of consumption does matter. There will inevitably be countless implications to follow based upon this political shift in Canada that will directly and indirectly affect stakeholders in education. Findings addressing these perceived impacts and considerations can help educational professionals mitigate the possible negative consequences of Bill C-45. Disarming Privilege to Achieve Equitable School Communities: A Spiritually-Attuned School Leadership Response to Our Storied Lives Abstract This conceptual paper addresses the nature of white male privilege within school administration and how that privilege, through an examination and clarification of equity as justice, can be checked, interrogated and possibly moderated by a reflection on the spiritual nature of leading for democratic change. Conditioning Tendency Among Preschool and Primary School Children: Cross-Sectional Research Abstract The present study aims to understand children's behavior within classroom settings in terms of conditioning theories. It was designed based on grounded theory. Data were collected through participant observation and 98 children whose ages varied between 6 and 10 years were observed. Data were inductively analyzed. Findings indicated that kindergarteners and first graders tend toward classical conditioning and need more teacher control to adjust to classroom settings, whereas children aged from 9 to 10 years behave based on operant conditioning. It is proposed that differences in conditioning stem from teachers' classroom management strategies, and cognitive development. A Dialogue of Shared Discoveries on Immigration: A Duoethnography of International Students in Canada Abstract International students are believed to contribute significantly in education and research as they bring a rich variety of perspectives, experiences, and languages. International students are frequently categorized into one homogenous group; however, this categorization dishonours their complex intersectional diversity and background that provides cultural capital. There is a need to understand the many manifestations of the complex and intersectional diversity in the backgrounds of international students. These students have many different reasons to immigrate to developed countries and undertake a rigorous academic program, including pursuing high academic goals, gaining personal knowledge, developing research skills, and widening employment opportunities. Using a duoethnographic dialogical approach, this article focuses on the experiences of two female international PhD students, one from Nigeria and the other from Costa Rica as they embark on a journey of shared self-discoveries on their mobility to Canada. Our paper takes a broad perspective on the processes behind mobility coming from different cultures and nationalities that meet in Canada. Some of our findings include the impact of background when transitioning to a new country, the role of reflective dialogue when questioning the source of our cultural assumptions and ethical judgments. In addition, we find that duoethnography has a strong effect to re-story our own narratives and perspectives. Finally, this dialogue allows us to broaden how we come to understand and extract meaning from our experiences as international students. Second Language Reading from an Hegelian Perspective Abstract Second language research has traditionally been characterized by the cognitive perspective which focuses on how the individual processes language. There has been an emerging trend over the past few decades on taking into consideration the social influences on second language learning based on diverse theoretical frameworks. Research on second language reading is no exception. Hegel points out the unique features of publicity, persistence over time, resistance to negation, universality and objectivity of the written form. These features enable the written form to perform some social and collective functions such as cultural preservation and enforcement of contracts that cannot be replaced by the spoken form. Hegel's philosophy also suggests that reading in a second language is qualitatively different from reading in a first language, and second language reading is an enculturation process. Hegel's accounts on these three aspects of second language reading provide new insights to both theories and practice of the teaching of second language reading. Why on Earth Would Some People Reject Democracy? An Autoethnographic Reflection on Education and Democracy in Egypt Abstract In 2013, thousands of Egyptians protested in the streets of Cairo in an effort to overthrow the country's first democratically elected president only 1 year after he took office. Some of my acquaintances participated in those protests, chanting "we do not want democracy." Several observers tried to analyze and understand this strange phenomenon of declining democracy after many Egyptians had waited so many years for it. However, using an autoethnographic method, I argue that any analysis of this phenomenon that does not include curriculum and education is inadequate. This autoethnographic essay argues that Egypt's curriculum and its schooling system are fundamental factors that contributed to this phenomenon. Fundamentally, this paper discusses the theoretical and practical relationship between curriculum and democracy from an autoethnographic perspective by assessing the nature of this relationship both in democratic societies and in Egypt. Furthermore, an overview of the Egyptian educational system is provided to answer the basic question of this paper: why would some people reject democracy?
A Narrative Literature Review of the Identity Negotiation of Bilingual Students Who are Labelled ESLAbstractEnglish as a second language or ESL instruction is said to be for students who have moved to the United States (or Canada) from another country and temporarily need assistance in learning the English language. However, statistically, a vast majority of ESL students in the United States were born in the US and are US citizens. When students are labelled as ESL and placed in this tract of alternative...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:54
Genetic analysis of resistance to bacterial leaf spot in the heirloom lettuce cultivar Reine des Glaces Abstract Bacterial leaf spot (BLS) is a disease that affects lettuce (Lactuca sativa L.) worldwide. The disease is caused by the bacterium Xanthomonas campestris pathovar vitians (Xcv), which exclusively infects lettuce and is particularly devastating in warm humid climates. Reine des Glaces (RG), an old Batavia-type cultivar, exhibited an uninvestigated partial resistance to Xcv. Quantitative trait loci (QTLs) were analyzed using two recombinant inbred line (RIL) populations derived from RG × Eruption and RG × Delsay using three isolates collected in California and Canada, each representing a different race, and an isolate collected in France. A major QTL was identified in linkage group 2 in both populations; additional, minor QTLs were also detected in other linkage groups. The major QTL collocates with the Xanthomonas resistance 1 (Xar1) and Xanthomonas campestris vitians resistance (Xcvr) genes that had previously been identified using RIL populations derived from Salinas 88 × La Brillante and PI 358001-1 × Tall Guzmaine. RG provides another resistance resource for combating BLS using data provided by this study for marker-assisted selection. Current understanding of genetic and molecular basis of cold tolerance in rice Abstract Rice (Oryza sativa L.) is one of the most important crops worldwide, but its growth and production can be severely affected by climate change. As a tropical species, rice is in general vulnerable to the adverse effects of low temperature. To cope with or adapt to cold stress condition, rice has evolved elaborate regulatory mechanisms under both natural and artificial selection. Over the past few decades, intensive research efforts have been focused on abiotic stress biology in rice with genetic, genomic, and molecular strategies, disclosing a series of potential genetic determinants and mechanisms controlling cold stress tolerance. Here, we review cold tolerance (CT)-related quantitative trait loci (QTLs) identified by linkage and association mapping, together with key genes involved in cold sensing, signaling, and response. More importantly, recent studies have shown that CT-related QTLs/genes can be employed in genomic breeding aiming at developing cold-tolerant rice. Overall, the recent research progresses in understanding the complex genetic and molecular mechanisms of CT provide a substantial basis for CT improvement in rice. Dissecting the genetic architecture of important traits that enhance wild germplasm resource usage in modern maize breeding Abstract Domestication and improvement of maize (Zea mays L.) from ~ 10,000 years ago has produced remarkable alterations from its wild ancestor, teosinte. To investigate the genetic basis of changes in plant and inflorescence traits, we developed a teosinte–maize intermated population. More than 200 common quantitative trait loci (QTLs) and 44 QTL clusters were identified underlying 13 vegetative and reproductive traits. Among them, few common QTLs with major effects were observed, which supported previous hypotheses that a small number of major loci can explain a large portion of phenotypic changes during domestication. Additionally, we found many moderate or minor QTLs that might have critical roles in shaping plant architecture and enhancing grain yield of modern maize. Although maize has better performance for the traits studied here, teosinte still harbored desirable alleles in some of the common QTLs. Furthermore, we integrated multiple datasets and predicted candidate genes underlying these QTLs. This study elucidates the genetic basis of these vegetative and reproductive traits in maize and teosinte, and suggests the possibility of improving maize by teosinte re-domestication using a small number of loci. Peptidomics-based study reveals that GAPEP1, a novel small peptide derived from pathogenesis-related (PR) protein of cotton, enhances fungal disease resistance Abstract Peptides play important roles in many important biological processes. For instance, plant antimicrobial peptides, which are essential components of innate immunity and exert rapid defense response, have a broad activity against pathogenic bacteria, fungi, enveloped viruses, and parasites. Verticillium wilt, caused by the soil-borne fungus Verticillium dahliae, is a destructive vascular disease in plants. In this study, we used mass spectrometry approach to detect and characterize important peptides, especially antimicrobial peptides from roots of Gossypium arboretum and to evaluate their inhibitory activities against phytopathogenic fungi. We have identified a novel small peptide, GAPEP1, which is derived from the N-terminal of Pathogenesis-related protein STH-2 protein and upregulated by V. dahliae inoculation. GAPEP1 is localized in the nucleus and cell membrane. Plants with exogenous treatment or overexpressing GAPEP1 both exhibited enhanced disease resistance as compared with the control group. Our results provide the cotton endogenous peptides library that could potentially be used to develop natural, targeted, and environmentally friendly strategies to enhance the resistance of Gossypium species against biotic attackers. Transcriptome analysis reveals genes commonly responding to multiple abiotic stresses in rapeseed Abstract Rapeseed production is limited by abiotic stresses such as drought, salinity, and low temperature. Evidences suggest that common stress response genes are shared by multiple stresses. To study how rapeseed responds to abiotic stresses at transcriptional level and identify genes that regulate multiple abiotic stress tolerance, we investigated transcriptional dynamics of the rapeseed treated by abscisic acid (ABA), salt, dehydration, and cold stresses at two different time points, respectively. A total of 30,908 differentially expressed genes (DEGs) under 4 abiotic stresses were identified. There were 2568 upregulated and 4376 downregulated DEGs (2-fold change) commonly shared by four stresses. Analysis of the DEGs identified significantly enriched gene ontology biological processes under multiple stress conditions. The commonly shared DEGs included 225 upregulated and 294 downregulated transcription factors belonging to 35 and 40 different families, respectively. The representative mostly upregulated and downregulated DEGs at each time point of abiotic stress treatment were presented. We identified a list of core abiotic stress genes commonly regulated by four stresses, which mainly included ERD15, RAB18, LEA14, and transcription factors belonging to ERF, bZIP, and MYBR1 families. The findings of shared abiotic stress responsive genes may help develop strategies for breeding rapeseed varieties with improved tolerance to multiple abiotic stresses. Basmati rice lines development carrying multiple bacterial blight resistance genes pyramided using the marker-assisted backcross breeding approach Abstract Basmati rice is treated as one of the world's best rice due to its extra-long grain and unique aroma,. Over the last decade, Pakistan has earned more than US$2 billion through basmati export. Unfortunately, basmati rice is being threatened with bacterial leaf blight (BLB) disease that leads to poor production and quality. We attempted pyramiding of BLB genes through marker-assisted backcross breeding using Super Basmati as the recipient and IRBB60 as the donor parent. BLB resistance genes Xa4, xa5, and Xa21 were used for introgression. Molecular markers MP1 and MP2, RM122, and pTA248 were used for Xa4, xa5, and Xa21 genes respectively for foreground selection. The 85 SSR polymorphic molecular markers were used for background selection, which showed a more than 90% recurrent parent genome recovery. Phenotypic traits for grain dimensions were also considered while selecting backcross female parents from BC1F1 to BC5F1, which resulted in saving the resources from background selection before the selfing of backcrossed lines. Multiple lines carrying BLB resistance genes combinations Xa4 + xa5 and Xa4 + xa5 + Xa21 were developed. The BC5F4 uniform lines showed resistance against BLB disease at hotspot locations. One of the developed lines, PKBB15–116, which has a yield advantage of more than 10%, tolerant to lodging, and has basmati quality. These pyramided lines in basmati background will also be helpful for breeders to incorporate resistance genes in a shorter period of time, in order to develop new basmati rice varieties in future. An update on molecular mechanism of disease resistance genes and their application for genetic improvement of rice Abstract Multiple pathogens cause rice various diseases affecting its yield and quality. Pyramiding resistance genes or quantitative traits loci into rice cultivars to enhance their resistance is an operable and optimal strategy for rice genetic improvement. New technologies and methods accelerate the identification and cloning of the resistance genes from landraces, domesticated and wild rice germplasm accessions. Some of these superior resistance genes have been successfully pyramided into diverse rice cultivars worldwide based on molecular marker-assisted selection. The underlying molecular mechanisms of some resistance genes have been uncovered which support their stacking into rice cultivars in a proper manner. The genetically improved rice lines show broad spectrum and durable resistance to different pathogens, which can greatly contribute to high yield and outstanding quality of rice cultivars. This paper summarizes the cloned major resistance genes, elucidates the underlying molecular mechanisms, and proposes the operable strategies to use these genes for rice genetic improvement. Genetic variation analysis of field isolates of clubroot and their responses to Brassica napus lines containing resistant genes CRb and PbBa8.1 and their combination in homozygous and heterozygous state Abstract Brassica napus is one of the most important oilseed crops in the world and Plasmodiophora brassicae is a serious threat causing yield reduction. CRb and PbBa8.1 resistance genes are known to be highly effective against P. brassicae race 4. Here, we combined two clubroot resistance (CR) genes through marker-assisted selection (MAS) and developed CR homozygous lines. The CR parental and pyramided lines were crossed with genetically male sterile (GMS) plants to generate heterozygous lines. In order to confirm their differences on resistance, the parental and generated lines were inoculated with 9 P. brassicae field isolates in the greenhouse and resistant test also evaluated in different naturally infested fields. The CR pyramiding lines exhibited high levels of resistance to the most isolates than line containing any single resistance gene; comparatively, the homozygous lines demonstrated a higher resistance than the heterozygous. The genetic variation among P. brassicae isolates was analyzed through simple sequence repeat (SSR) marker and significant divergences were recorded among the 9 tested field isolates and the result was consistent with data acquired from the greenhouse and natural field experiments. This study will certainly provide a novel molecular strategy for the breeding of the durable CR B. napus varieties in future breeding programs. Multi-environments and multi-models association mapping identified candidate genes of lint percentage and seed index in Gossypium hirsutum L. Abstract Upland cotton (Gossypium hirsutum L.) accounts most of the natural fiber production worldwide. Lint percentage (LP) and seed index (SI) are important components of cotton fiber yield, which is a constant breeding goal of cotton. So, the loci underpinning LP and SI should be extensively dissected. Here, one single-locus and four multi-locus genome-wide association study (GWAS) models were employed to detect candidate loci for lint percentage and seed index under seven environments with 196 upland cotton accessions and 41,815 single nucleotide polymorphism (SNP) markers. Totally, 39 and 45 significant quantitative trait locus (QTL) were identified in at least two environments or two models, including 24 previously reported QTLs and six pleiotropic QTLs. Referred to the genome and gene expression database of TM-1, 614 candidate genes were detected for lint percentage and seed index, including 103 genes preferentially expressed in fiber or ovule. The gene Gh_A10G0378, functioned in potassium ion transport, was considered to be related to lint percentage. Collectively, the associated markers and promising genes detected herein will help to elucidate the genetic architecture of lint percentage and facilitate fiber yield improvement in cotton. Genome-wide association analysis in tetraploid potato reveals four QTLs for protein content Abstract Valorisation of tuber protein is relevant for the potato starch industry to create added-value and reduce impact on the environment. Hence, protein content has emerged as a key quality trait for innovative potato breeders. In this study, we estimated trait heritability, explored the relationship between protein content and tuber under-water weight (UWW), inferred haplotypes underlying quantitative trait loci (QTLs) and pinpointed candidate genes. We used a panel of varieties (N = 277) that was genotyped using the SolSTW 20 K Infinium single-nucleotide polymorphism (SNP) marker array. Protein content data were collected from multiple environments and years. Our genome-wide association study (GWAS) identified QTLs on chromosomes 3, 5, 7 and 12. Alleles of StCDF1 (maturity) were associated with QTLs found on chromosome 5. The QTLs on chromosomes 7 and 12 are presented here for the first time, whereas those on chromosomes 3 and 5 co-localized with loci reported in earlier studies. The candidate genes underlying the QTLs proposed here are relevant for functional studies. This study provides resources for genomics-enabled breeding for protein content in potato.
Genetic analysis of resistance to bacterial leaf spot in the heirloom lettuce cultivar Reine des GlacesAbstractBacterial leaf spot (BLS) is a disease that affects lettuce (Lactuca sativa L.) worldwide. The disease is caused by the bacterium Xanthomonas campestris pathovar vitians (Xcv), which exclusively infects lettuce and is particularly devastating in warm humid climates. Reine des Glaces (RG), an old Batavia-type cultivar, exhibited an uninvestigated partial resistance to Xcv. Quantitative trait...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:54
Who Burns out More? Comparison of Burnout Levels Between Teachers and Physicians in the Czech Republic Abstract Despite burnout being considered primarily a syndrome related to medical professionals, it is now known that it affects a wider range of professions as well. It is seen as a state of complete physical, emotional, and cognitive depletion. In physicians, not only can burnout lead to work-related absenteeism but also it may affect their patients while teachers' burnout may affect the mental well-being of their students. This study explored whether teachers have higher or comparable rates of burnout with the burnout rates of physicians. Furthermore, we compared them to the norms we established in the Czech Republic in the previous year. Cross-sectional data collection was utilized through a combination of multiple questionnaires. The questionnaires analyzed for the purpose of this study were the SMBM and BDI-II. Regardless of gender, physicians suffer from significantly higher burnout symptomatology when compared with teachers. These differences were found to be statistically significant. Furthermore, significant differences were also found between males with depressive symptomatology. We did not observe this difference in females. Our results suggest that, although burnout is a syndrome that appears regardless of profession, its manifestation can be quite different depending on the type of job. Overall, higher levels of burnout were found among female teachers compared with their male counterparts; between physicians, the situation was reversed; burnout affected more males than females. In all categories, more females were within the norm of Czech population. Nonetheless, the risk of burnout should not be underestimated in either of these professions. Chalmers' Principle of Organizational Invariance Makes Consciousness Fundamental but Meaningless Spectator of Its Own Drama Abstract The principles of classical physics, including deterministic dynamics and observability of physical states, are incompatible with the existence of unobservable conscious minds that possess free will. Attempts to directly accommodate consciousness in a classical world lead to philosophical paradoxes such as causally ineffective consciousness and possibility of alternate worlds in which functional brain isomorphs behave identically but lack conscious experiences. Here, we show that because Chalmers' principle of organizational invariance is based on a deficient nineteenth century classical physics, it is inherently flawed and implies evolutionary inexplicable epiphenomenal consciousness. Consequently, if consciousness is a fundamental ingredient of physical reality, no psychophysical laws such as Chalmers' principle of organizational invariance are needed to establish correspondence between conscious experiences and brain function. Quantum mechanics is the most successful and only modern physical theory capable of naturally accommodating consciousness without violation of physical laws. Twin Loss in the Uterus: Neurodevelopmental Impairment and Reduced Resilience? Abstract Spontaneous loss of a twin most often occurs in the first trimester. This phenomenon is called vanishing twin. Foetuses are especially vulnerable to various stress-related factors. As a result, twin loss in the uterus can produce deep and long-lasting consequences on mental health and may increase the risk of a variety of disease states in the surviving twin. In addition, twin loss may generate strong non-conscious stress that creates epigenetic alterations that impair the brain's development endocrine and inflammatory substances produced by perturbed signalling pathways. These altered signalling pathways may generate lasting dysfunctions in various areas of the limbic system, predisposing the surviving twin to psychological and emotional problems later in life. We also hypothesise that specific cfDNA and other substances from the dead twin during its reabsorption may affect the surviving twin's neurodevelopmental and emotional (e.g. resilience) development. 5-Methoxy- N,N -dimethyltryptamine: An Ego-Dissolving Endogenous Neurochemical Catalyst of Creativity Abstract 5-Methoxy-N,N-dimethyltryptamine (acronymized as 5-MeO-DMT) is sui generis among the numerous naturally occurring psychoactive substances due to its unparalleled ego-dissolving effects which can culminate in a state of nondual consciousness that is phenomenologically similar to transformative peak experiences described in various ancient contemplative traditions (e.g., Advaita Vedānta, Mahāyāna Buddhism, inter alia). The enigmatic molecule is endogenous to the human brain and has profound psychological effects which are hitherto only very poorly understood due to the absence of scientifically controlled human experimental trials. Its exact neuronal receptor binding profile is a matter of ongoing research; however, empirical evidence indicates that its remarkable psychoactivity is partially mediated via agonism of the 5-HT1A/2A (serotonin) receptor subtypes. Anthropological/ethnopharmacological evidence indicates that various cultures utilized 5-MeO-DMT containing plants for medicinal, psychological, and spiritual purposes for millennia. We propose that this naturally occurring serotonergic compound could be fruitfully utilized as a neurochemical research tool with the potential to significantly advance our understanding of the psychological and neuronal processes which underpin cognition and creativity (e.g., downregulation of the default mode network, increased global functional connectivity, neuroplasticity, σ1 receptor interactions, etc.). An eclectic interdisciplinary perspective is adopted, and we present converging evidence from a plurality of sources in support of our conjecture. Specifically, we argue that 5-MeO-DMT has significant neuropsychopharmacological potential due to its incommensurable capacity to completely disintegrate self-referential cognitive/neuronal processes (viz., ego death). The importance of unbiased systematic scientific research on naturally occurring endogenous psychoactive compounds is discussed from a Jamesian radical empiricism perspective, and potential scenarios of abuse are addressed, particularly in the context of neuroethics, cybernetic manipulation, and military research on torture. Assessment of Theory of Mind in Adults: Beyond False Belief Tasks Abstract Theory of Mind, or the ability to attribute mental states to the self and others, forms the foundation of social cognitive processes or social cognition. Since its conception in 1978, the construct has been enjoying increasing attention from researchers and it has been widely studied in the context of autism spectrum disorder. This paper tries to review the issues surrounding the assessment of the construct. Theory of Mind (ToM) assessment goes almost synonymously with false belief tests. And assessing ToM with false belief tasks did not pose a problem because the construct had traditionally been studied mostly, if not exclusively on children. This paper discusses the danger of testing theory of mind with false belief tasks only and the serious necessity to study the construct in the adult population. The paper also discusses why the construct needs to be assessed in a culture-specific manner, the problems with the existing recent tools that have been developed to measure the construct, the complexity of simulating real social stimuli, and the subtleties around the construct that is to be taken care of while developing assessment measures. Isomorphism: Abstract and Concrete Representations Abstract Looking at concrete representations of mathematical problems from an isomorphic perspective, this article suggests that every concrete representation of a mathematical concept is understood by reference to an underlying abstract representation in the mind of the comprehender. The complex form of every abstract representation of a problem is created by the gradual development of its elementary form. Throughout the process of cognitive development, new features are added to the elementary form of abstract representation, which leads to gradual formation of a fully developed abstract representation in the mind. Every developed abstract representation of a problem is the underlying source for understanding an infinite number of concrete isomorphic representations. Deep or abstract representations of a problem are shared by the concrete realizations or concrete forms of that problem. In other words, concrete representations of a problem are the realizations of a single abstract representation. This discussion is extended to mind-brain relationship and the possible isomorphism that could exist between mind and brain. The Dorsolateral Prefrontal Cortex, the Apathetic Syndrome, and Free Will Abstract The prefrontal cortex is deputed to higher functions, such as behavior and personality. It includes three regions: ventromedial, orbitofrontal, and dorsolateral. Each of them has a function. Devising, programming, and planning are all conditions related to the dorsolateral cortex, also responsible for rational content and decision. Damage to this region results in apathetic syndrome, a condition that causes loss of interest, initiative, and attention, and in the most severe cases leads to a lethargic state. It is also known as a form of secondary depression, the so-called pseudo-depression syndrome, according to Karl Kleist or apathetic-abulic-akinetic syndrome, according to Alexander Luria. The prefrontal dorsolateral syndrome is responsible for the reduction or abolition of free will. Free will is an expression of individual freedom. It allows the human being to have and express own opinions as well as to respect those of others. Free will is related to moral sense, a binomial which directs the individual towards a proper social conduct. In this review, we describe the effects of the pseudo-depression syndrome on free will, of which we treat both the anatomical site and the social aspect. ADHD and Time Perception: Findings and Treatments Abstract This mini review aims to explore the intricate connection between ADHD and time perception along with some new findings on new treatments to manage ADHD symptoms. The topic of time perception is addressed from a variety of perspectives and with an understanding that although differences in time perception are not listed among the primary symptoms of the disorder, they are of the utmost importance to understand the condition and possibly new treatment plans. We also review some of the new findings on ADHD and time perception, and look at the usefulness of certain psychometric tools like the Zimbardo Time Perspective Inventory recent research into educational video games and apps for managing the disorder. Analysis of Differential Expression of Neurotransmitter Receptors with TNF-a Treatment in Rat Primary Hypothalamic Cell Abstract In this study, tumor necrosis factor-alpha (TNF-α) was incubated to primary hypothalamic cell culture of rat as an important inflammatory cytokine and the effect of TNF-α to neurotransmitter receptors of the hypothalamus in vitro by real-time fluorescence quantitative PCR with PCR array for researching the effect of TNF-α to neuroendocrine system was analyzed. The result showed that the expression level of Avpr1a, Gabrr1, Grin1, Htr4, and Tspo 5 genes was obviously up and the other Adrb2, Cckbr, Chrm5, Chrna6, Gabra5, Gabra6, Grm8, Htr2c, Htr3a, Sstr1, and Tacr1 11 genes were down. Especially, Grin1 and Tacr1 were affected obviously, increased 3.12 and decreased 2.76, respectively. So, TNF-α can modulate the expression of many receptors of neurotransmitters of the hypothalamus by the special cell signal transduction pathways and alter the responsibility and exciting of these neurons to neurotransmitters corresponding. Furthermore, these changes can affect many hormone secretion of the hypothalamus and affect neuroendocrine function of rat. On Minds that Interpret Quantum Mechanics: a Tribute to Henry Stapp Abstract This essay describes what an anthropologist has learned from his ethnographic research with physicists who are engaged in quantum physics interpretation, including Henry Stapp. I argue that meta-physical considerations about "mind" among physicists often obscure the possibility of empirical research on concrete and individual minds and the role they play in quantum interpretation. Therefore, the philosophical rigor of quantum interpretation could benefit if individual interpreters could find an interest in discovering a manner of analyzing their own style of interpretation such that their own style would be communicable with others as a topic of conversation, rather than simply repeated dogmatically and argumentatively. Such considerations would require greater empirical attention to human thought itself, such that "mind" becomes less abstract and mystified, and thus more knowable and self-conscious.
Who Burns out More? Comparison of Burnout Levels Between Teachers and Physicians in the Czech RepublicAbstractDespite burnout being considered primarily a syndrome related to medical professionals, it is now known that it affects a wider range of professions as well. It is seen as a state of complete physical, emotional, and cognitive depletion. In physicians, not only can burnout lead to work-related absenteeism but also it may affect their patients while teachers' burnout may affect the mental...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:53
Introduction: New Perspectives on Philosophical Thought Experiments The e-mail address of the second author was incorrectly published in the original article. The author's correct e-mail address is given in this correction. Scientific Counterpublics: In Defense of the Environmental Scientist as Public Intellectual Abstract Global warming and climate change pose a significant threat to the livelihoods of future generations. Although there is a consensus among qualified climate scientists who believe that scientific evidence supports anthropogenic climate change (ACC) theories, this has not translated into public understanding or trust in these theories. In this essay, I trace policy debates in the United States during the 1970s and 1980s concerning the link between CFC pollution and ozone depletion. Based on a rich tradition of counterpublic scholarship and empirical success of ozone scientists, I argue that a rhetorical defense of global warming science in the form of counterpublic intellectualism may help environmental advocates overcome public disbelief in ACC theories. Thought Experiments in Philosophy: A Neo-Kantian and Experimentalist Point of View Abstract The paper addresses the question of the nature and limits of philosophical thought experiments. On the one hand, experimental philosophers are right to claim that we need much more laboratory work in order to have more reliable thought experiments, but on the other hand a naturalism that is too radical is incapable of clarifying the peculiarity of thought experiments in philosophy. Starting from a historico-critical reconstruction of Kant's concept of the "experiments of pure reason", this paper outlines an account of thought experiments in philosophy that tries to reconcile the thesis of a principled difference between scientific and philosophical TEs with the position of a methodological naturalism that does not admit any difference in kind between the methods of science and of philosophy. Giving Reasons Does Not Always Amount to Arguing Abstract Both because of the vagueness of the word 'give' when speaking about giving reasons, and because we lack an adequate definition of 'reasons', there is a harmful ambiguity in the expression 'giving reasons'. Particularly, straightforwardly identifying argumentation with reasons giving would make of virtually any interplay a piece of argumentation. Besides, if we adopt the mainstream definition of reasons as "considerations that count in favour of doing or believing something", then only good argumentation would count as argumentation. In this paper, I defend a qualified characterization of argumentation as reasons giving that is shown to be fruitful for shedding light on the practice of giving reasons, and an inferentialist conception of reasons that makes room for speaking of "bad reasons" and, consequently, makes it possible to talk of argumentation as reasons giving even if we are talking about bad argumentation. Argumentative Virtues as Conduits for Reason's Causal Efficacy: Why the Practice of Giving Reasons Requires that We Practice Hearing Reasons Abstract Psychological and neuroscientific data suggest that a great deal, perhaps even most, of our reasoning turns out to be rationalizing. The reasons we give for our positions are seldom either the real reasons or the effective causes of why we have those positions. We are not as rational as we like to think. A second, no less disheartening observation is that while we may be very effective when it comes to giving reasons, we are not that good at getting reasons. We are not as reasons-responsive as we like to think. Reasoning and argumentation are, on this view, charades without effect. This paper begins by identifying a range of theoretical responses to the idea that reasoning and argumentation have little casual role in our thoughts and actions, and, consequently, that humans are not the reasons-giving, reasons-responsive agents that we imagine ourselves to be. The responses fall into three categories: challenging the data and their interpretations; making peace with the loss of autonomy that is implied; and seeking ways to expand the causal footprint of reasoning and argumentation, e.g., by developing argumentative virtues. There are indeed possibilities for becoming more rational and more reasons-responsive, so the reports of our demise as the rational animal are greatly exaggerated. Thought Experiments and Actual Causation Abstract Philosophical works on actual causation make wide use of thought experiments. The principal aim of this paper is to show how thought experiments are used in the contemporary debate over actual causation and to discuss their role in relation to formal approaches in terms of causal models. I claim that a recourse to thought experiments is not something old fashioned or superseded by abstract models, but it is useful to interpret abstract models themselves and to use our intuitions to judge the results of the model. Recent research on actual causation has stressed the importance of integrating formal models with some notion of normality; I suggest that thought experiments can be useful in eliciting intuitions where normality is not intended in a statistical sense. The first expository part (1–3) gives a short presentation of the notion of actual causation, summarising some typical problems of counterfactual approaches and how they are treated in causal and structural models. The second part (4–7) focuses on the problems of model isomorphism and criticises some radical ideas opposing the role of thought experiments, claiming that they may also be of use in evaluating formal models. Subjectivity, Multiple Drafts and the Inconceivability of Zombies and the Inverted Spectrum in this World Abstract Proponents of the hard problem of consciousness argue that the zombie and inverted spectrum thought experiments demonstrate that consciousness cannot be physical. They present scenarios designed to demonstrate that it is conceivable that a physical replica of someone can have radically different or no conscious experiences, that such an experience-less replica is possible and therefore that materialism is false. I will argue that once one understands the limitations that the physics of this world puts on cognitive systems, zombies and the inverted spectrum are not conceivable. Reasons Abstract The temptation to look for the "purely normative essence" of argument stems from the understandable ambition to distinguish rational persuasion from mere persuasion. But in seeking a purely normative notion of argument it is easy to overlook—or actually deny—that rational persuasion is a kind of persuasion. The burden of this essay is to show that the concept of reason from which our interest in argument derives can only exist and have normative force as a kind of persuasion, that is, as something (also) causal. Introduction: New Perspectives on Philosophical Thought Experiments The Pragmatic Force of Making an Argument Abstract Making arguments makes reasons apparent. Sometimes those reasons may affect audiences' relationships to claims (e.g., accept, adhere). But an over-emphasis on audience effects encouraged by functionalist theories of argumentation distracts attention from other things that making arguments can accomplish. We advance the normative pragmatic program on argumentation through two case studies of how early advocates for women's suffrage in the U.S. made reasons apparent in order to show that what they were doing wasn't ridiculous. While it might be possible to identify this as a new function of argumentation, we encourage instead attention to a more important question: explaining how all the diverse uses of argument have pragmatic force.
Introduction: New Perspectives on Philosophical Thought ExperimentsThe e-mail address of the second author was incorrectly published in the original article. The author's correct e-mail address is given in this correction.Scientific Counterpublics: In Defense of the Environmental Scientist as Public IntellectualAbstractGlobal warming and climate change pose a significant threat to the livelihoods of future generations. Although there is a consensus among qualified climate scientists who believe that...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:53
Associations Between Depression Literacy and Help-Seeking Behavior for Mental Health Services Among High School Students Abstract Despite the growth in school-based mental health services (SBMHS), rates of mental health help-seeking among adolescents remain low, especially for ethnic minority youth. This study examined factors associated with adolescents' help-seeking of mental health services among a sample of 369 racially diverse high school students (age M = 15.5 years, SD = 0.72, 81.3% were ethnic minorities). We examined the relationships among mental health literacy for depression, knowledge barriers related to services and providers, perceived stigmatization by others, emotional/behavioral difficulties, and actual help-seeking behavior. Logistic regression results showed that adolescents with higher mental health literacy for depression and more emotional/behavioral difficulties are more likely to report seeking help in general and from providers outside of school specifically, but not for services inside of school alone. Asian-American students were less likely to seek help than Caucasian peers. It is important to promote mental health literacy to encourage help-seeking among high school students. Leveraging Technology to Facilitate Teachers' Use of a Targeted Classroom Intervention: Evaluation of the Daily Report Card.Online (DRC.O) System Abstract Historically, teachers' uptake and implementation of empirically supported classroom interventions have involved substantial face-to-face consultation. However, most schools do not have the resources to provide this intensive level of support and many teachers may not need it. Thus, evaluation of alternative supports is warranted. In this pilot study, we evaluated the feasibility and effectiveness of an interactive web-based technology [i.e., the Daily Report Card.Online (DRC.O)] designed to facilitate teachers' use of the DRC with minimal external support and examined individual teacher characteristics associated with DRC use. Elementary school teachers (N = 54) were given access to the DRC.O Web site and asked to use it to implement a DRC with one child. With regard to implementation, 16% were short-term adopters (less than 1 month) and 39% were long-term adopters (1–7 months of use). On average, short-term adopters adhered to 37% of data entry procedures, whereas long-term adopters adhered to 74% of data entry procedures. Higher teacher stress was associated with shorter use and lower adherence. Web site analytics revealed that, on average, long-term adopters completed all steps of DRC development in less than 1 h and spent only 3 min per day engaged in data entry for progress monitoring. The magnitude of change in student target behaviors and Strengths and Difficulties Questionnaire scores was moderate to large. These results reveal the feasibility and promise of the DRC.O and generate hypotheses for future research. Implications for additional evaluation of technology-driven implementation supports for teachers are discussed. Effectiveness Trial of Brief Indicated Cognitive-Behavioral Group Depression Prevention in French-Canadian Secondary Schools Abstract Most adolescent depression prevention programs have been tested in the USA and other Anglo-Saxon countries. Their effects in other contexts are less clear. We conducted a pilot trial aimed at testing the effectiveness of the Blues program, a brief indicated cognitive-behavioral (CB) group program to prevent depression originally developed in the USA, in French-Canadian secondary schools. CB group facilitators were endogenous school clinicians. A total of 74 students (mean age= 15.50; 66% female) with elevated depressive symptoms were randomized to CB group (n = 37) or educational brochure control (n = 37). Participants completed diagnostic interviews and surveys at pretest, posttest, and 6-month follow-up. Results showed that CB group had a large, statistically significant effect on MDD onset at 6-month follow-up. CB group also had a positive effect on depressive symptoms, intermediate outcomes (pleasant activities, negative thoughts), and one secondary outcome (improved interaction with parents) at posttest. These effects were not maintained at follow-up. This trial replicates results from a previous US effectiveness trial. The clinically meaningful effects of brief indicated CB group prevention, at least with regard to the prevention of MDD onset, hold in French-Canadian students when the intervention is implemented by school clinicians. Work is still needed to augment and maintain CB effects in real-world practice. "Lost in Transition": A Systematic Mixed Studies Review of Problems and Needs Associated with School Reintegration After Psychiatric Hospitalization Abstract The purpose of this review was to identify the problems and needs associated with school reintegration after psychiatric hospitalization. Principles outlined by the Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre) for systematic mixed studies reviews were used to search 14 electronic databases with all possible literature from inception to September 2017. Quality was appraised by two sets of two independent reviewers using an adapted version of the Mixed Methods Appraisal Tool. Fourteen studies met the inclusion criteria. The key themes revolve around the different systems of the bioecological model: the youth ontosystem, microsystems (family, school) and mesosystems (family–hospital, family–school, school–hospital). Predominant emergent themes of each system converged toward a better communication, collaboration and coordination among all concerned actors. Many problems seem to alter school reintegration after psychiatric hospitalization and different needs are still required to be met. Future research directions and implications for intervention are discussed. Loneliness and Personality Profiles Involved in Bullying Victimization and Aggressive Behavior Abstract Bullying is a worrisome reality due to its harmful consequences. Although many constructs have been associated with bullying victimization and aggressive behavior, its relationship both with loneliness and personality has received little attention. The main objective of this study is to identify differences in bullying victimization and aggressive behavior scores based on a typology of personality and loneliness profiles. Six hundred and four middle school students (54% female) from the province of León (Spain), aged between 12 and 15 (Mage = 13.3 ± 1.12), completed the Eysenck Junior Personality Inventory, the Loneliness Scales, the Bullying Victimization Scale, and the Short Aggression Questionnaire. Correlations, linear regressions, and latent profile analysis (LPA) were performed. Age (β = − 0.90, p < 0.001), peer loneliness (β = 0.70, p < 0.001), isolation (β = 0.18, p < 0.001), neuroticism (β = 0.06, p = 0.048), and psychoticism (β = 0.06, p = 0.026) predicted bullying victimization. Moreover, the LPA distinguished five distinct profiles based on the loneliness and personality subscales. The disruptive and peer-alienated profiles obtained the highest scores in bullying victimization, and the former also had the highest aggression scores. Loneliness and personality are closely linked to victimization and aggressive behavior. It is crucial for health and school communities to identify and address these vulnerabilities for the prevention of bullying victimization and aggression. Multi-tiered Approaches to Trauma-Informed Care in Schools: A Systematic Review Abstract Childhood trauma can adversely impact academic performance, classroom behaviour, and student relationships. Research has gradually explored integrated approaches to care for traumatised students in schools. Increasingly, research has pointed to implementation of multi-tiered programs to trauma-informed care for traumatised students in schools. However, evaluations of these programs are limited and no systematic review of the existing evidence has been conducted. The aim of this research was to be the first systematic review to explore evidence on multi-tiered, trauma-informed approaches to address trauma in schools. Results of this systematic review yielded 13 published and unpublished studies. Findings indicated that further research, guided by empirical evidence of the effectiveness of multi-tiered and trauma-sensitive approaches in schools, is required. Recommendations for research in the area of trauma-sensitive, multi-tiered care in schools are provided. Benefits of a Highly Entitative Class for Adolescents' Psychological Well-Being in School Abstract Previous studies of the protective factors for adolescents' psychological well-being in school have focused on the emotional relationships under the classroom climate. In contrast, the present study focused on the structural relationships among students. To investigate this issue, we examined the effects of class entitativity, that is, the extent that a class is a coherent group rather than a number of students, on students' attitudes about themselves, their peers, and the whole class. A total of 408 adolescents completed measures of perceived class entitativity (i.e., homogeneity and interaction among students), self-efficacy, peer trust, and identification with the class. The results of a structural equation model analysis indicated that class entitativity was positively correlated with students' self-efficacy and their identification with the class, which were in turn correlated with students' trust of their peers. Further analysis revealed that homogeneity was positively associated with students' self-efficacy, while higher level of interaction was associated with stronger identification with the class. These findings highlight the essential role of structural relationships between students in their psychological well-being and have implications for student-oriented practices in schools. Efficacy of a Combined Approach to Tier 2 Social-Emotional and Behavioral Intervention and the Moderating Effects of Function Abstract Systematic literature reviews have supported the effectiveness of behavioral Tier 2 interventions, with research being particularly plentiful in relation to Check-In/Check-Out (CICO) and social skills training (SST). Though findings indicate either approach is effective in isolation, a recent study suggested these approaches might be particularly effective when integrated. The purpose of the current study was to build upon this initial single-case design study with a larger sample within a randomized controlled trial. Participants included 91 elementary students who had been identified as being at risk of social-emotional and behavioral difficulties. Students were randomized into three intervention conditions: CICO only, SST only, and CICO + SST. Prior to intervention, information was collected regarding the function of student problem behavior and the extent of social skill deficits. Systematic direct observation data were then completed at pre- and post-test regarding student positive and negative social engagement. Multivariate general linear models were then conducted, with pre-test scores serving as covariates and intervention group and behavioral function serving as fixed factors. Results indicated that implementation of CICO, SST, and a combined CICO + SST was functionally related to a reduction in negative social engagement. Follow-up post hoc tests indicated that after adjusting for pre-test responding, the difference between conditions in effectiveness was moderated by behavioral function. Specifically, SST was less effective for students whose behavior functioned to escape social and academic situations. No such differences were noted between students whose behavior functioned to attain adult or peer attention. Implications for practice, methodological limitations, and directions for future research are reviewed. Child Maltreatment Knowledge and Responses Among Teachers: A Training Needs Assessment Abstract Knowledge gaps, false beliefs, and limited skills with regard to child maltreatment are commonly found among teachers, despite their vital role in the lives of maltreated children. In Canada, little has been done to develop training or other supports for teachers around detecting and responding to child maltreatment. This study conducted a multi-informant assessment of teachers' child maltreatment training needs, as well as identified factors that may influence teachers' training participation and use of maltreatment-related knowledge and skills. We gathered qualitative information from three informant groups in one Canadian city, namely 19 school social workers, 9 child welfare practitioners, and 21 foster caregivers. Participants shared their experiences when working with teachers to support maltreated children, as well as their beliefs about gaps in teachers' maltreatment-related knowledge and skills. Participants were also asked about factors that might influence the delivery of child maltreatment training to teachers and teachers' responses to maltreatment-related behaviour at school. Findings showed consensus across all three participant groups that child maltreatment training for teachers is currently inadequate. Participants identified gaps in knowledge and skills among teachers in the detection and reporting of suspected maltreatment, as well as in their use of trauma-sensitive classroom strategies. Findings also highlighted multi-level factors that may affect teachers' decision-making and actions in response to child maltreatment, especially school- (e.g. inadequate educational resources) and teacher-level influences (e.g. teacher overburden). Recommendations for teacher training, implications for school staff and other professionals, and future directions for research are discussed. How Do Parent Psychopathology and Family Income Impact Treatment Gains in a School-Based Intervention for Trauma? Abstract The current study examined the impacts of parent psychopathology and family socioeconomic status on symptom reduction for children participating in Bounce Back, a school-based intervention for elementary students exposed to trauma. Participants in this study were 52 first through fourth graders (Mage= 7.76; 65% male) who were predominately Latinx (82%). Schools were randomly assigned to immediate treatment or waitlist control. Children whose parents reported higher socioeconomic status showed steeper declines in symptoms compared to lower socioeconomic status. Further, children of parents who endorsed high PTSD symptoms reported attenuated treatment effects, whereas children of parents who endorsed high hostility reported enhanced treatment effects. Although Bounce Back is an effective intervention for reducing PTSD symptoms and improving coping skills among children exposed to trauma and other ongoing stressors, treatment gains are attenuated for children from families with low socioeconomic status, and parent psychopathology also impacts treatment effects. The effectiveness of Bounce Back may vary based on socioeconomic status and parent psychopathology. Future research should examine methods of tailoring Bounce Back for children coping with economic stress and parent psychopathology.
Associations Between Depression Literacy and Help-Seeking Behavior for Mental Health Services Among High School StudentsAbstractDespite the growth in school-based mental health services (SBMHS), rates of mental health help-seeking among adolescents remain low, especially for ethnic minority youth. This study examined factors associated with adolescents' help-seeking of mental health services among a sample of 369 racially diverse high school students (age M = 15.5 years, SD = 0.72, 81.3% were ethnic...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Frau Univ. Lekt. DDr. Irmgard Simma mit dem Professorentitel ausgezeichnet DGfAN Ärzte für Akupunktur Nachruf auf Medizinalrat Dr. Gerhart Feucht Chinesische Ernährungstherapie bei Fluor vaginalis Vergessen wir die Männer nicht 15. Festspielgespräche zur Ganzheitsmedizin DÄGfA Editorial Qigongtherapie in der Frauenheilkunde
Frau Univ. Lekt. DDr. Irmgard Simma mit dem Professorentitel ausgezeichnetDGfANÄrzte für AkupunkturNachruf auf Medizinalrat Dr. Gerhart FeuchtChinesische Ernährungstherapie bei Fluor vaginalisVergessen wir die Männer nicht15. Festspielgespräche zur GanzheitsmedizinDÄGfAEditorialQigongtherapie in der Frauenheilkunde
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:52
Religious Attendance and the Social Support Trajectories of Older Mexican Americans Abstract In this paper, we directly assessed the extent to which the association between religious attendance and the social support trajectories of older Mexican Americans is due to selection (spurious) processes related to personality, health status, and health behavior. We employed seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (1993–2010) to examine the association between religious attendance and perceived social support trajectories (n = 2479). We used growth mixture modeling to estimate latent classes of social support trajectories and multivariate multinomial logistic regression models to predict membership in the social support trajectory classes. Growth mixture estimates revealed three classes of social support trajectories: high, moderate, and low. Multinomial logistic regression estimates showed that the odds of membership in the low support trajectory class (versus the high social support trajectory class) were lower for respondents who attended religious services yearly, monthly, weekly, and more than weekly than for respondents who never attend religious services. Religious attendance could not distinguish between membership in the moderate and high support trajectory classes. These results persisted with adjustments for age, gender, immigrant status, language proficiency, education, income, religious affiliation, marital status, living arrangements, contact with family/friends, secular group memberships, self-esteem, smoking, heavy drinking, depression, cognitive functioning, and physical mobility. We conclude that the association between religious attendance and the social support trajectories of older Mexican Americans is primarily driven by processes related to social integration, not selection. Do Income Supplemental Programs for Older Adults' Help Reduce Primary Caregiver Burden? Evidence from Mexico Abstract In countries such as Mexico without formal public long-term care policies, informal care becomes the main source of support for older adults. Alternative social programs, such as supplemental income programs, for older adults could alleviate caregiver burden, especially if supplemental income were to be used for paid care or to compensate non-paid family caregivers. This work is the first to analyze the effects of a supplemental income program for older adults on primary caregiver burden. To identify how such a program might affect caregiver burden, we analyze rich panel data on 433 adults 70 years and older in two communities, one receiving a supplemental income program and the other not, in Yucatan, Mexico. Data were collected in 2008 and 2009 among treatment and control groups before and 6 months after program introduction. We employ a difference-in-differences approach. In our sample, most care is provided by non-paid female caregivers. We find that individuals in both the treatment and control groups received fewer hours of care over time. The decrease was lower for older adults who received the supplemental income, but the difference with those who did not was not statistically significant. We also observe few changes on caregiving burden; even after program introduction, more than 98% of caregivers remained unpaid and the same primary caregiver remained. Altogether, our work suggests supplemental income programs have negligible effects on caregiving, making evident the urgent need for other strategies to support non-paid caregivers who bear most of the burden for old-age care in Mexico. Characteristics and Consequences of Family Support in Latino Dementia Care Abstract The purpose of this study is to explore variations in family support for Latino dementia caregivers and describe the role of the family in dementia caregiver stress processes. Content analysis is utilized with themes derived inductively from 16 in-depth interviews with Latino caregivers recruited in California from 2002 to 2004. Three types of family support are described: extensive (instrumental and emotional support from family, n = 3), limited (instrumental support from one family member, n = 7), and lacking (no support from family, n = 6). Most caregivers report limited support, high risk for burnout and distress, and that dementia-related neuropsychiatric symptoms are obstacles to family unity. Caregivers with extensive support report a larger family size, adaptable family members, help outside of the family, and formalized processes for spreading caregiving duties across multiple persons. Culturally competent interventions should take into consideration diversity in Latino dementia care by (a) providing psychoeducation on problem solving and communication skills to multiple family members, particularly with respect to the nature of dementia and neuropsychiatric symptoms, and by (b) assisting caregivers in managing family tensions — including, when appropriate, employing tactics to mobilize family support. Community Gerontology Model for Healthy Aging Developed in Mexico Framed in Resilience and Generativity Abstract Background: The aims of this paper are to present the evolutionary development of the Community Model of Healthy Aging (CMHA) and to show the main results of the community gerontology studies framed in each of the stages of the CMHA. Method: The study employs a qualitative community-based participatory research approach. We also measured several biochemical parameters, social support networks, and indicators of physical and cognitive functioning. Results: We identified three stages in the development of the CMHA. The first stage was informative (CMHA-I, 1994-2000) with more than 70% of the older adults participating in self-care programs for health. The second stage was formative (CMHA-F, 2001-2015) with more than 80% of older adults participating in self-care, mutual aid, and self-management programs. The third stage was emancipatory (CMHA-E, 2016-2018). In this last stage, we added resilience and generativity as basic elements to strengthen and enhance human capacities during aging, and more than 90% of older adults made optimal use of social support networks as a key strategy. Conclusion: Our findings suggest that the addition of resilience and generativity in the CMHA contributed to the active participation of older adults in the maintenance of functioning and the prevention and control of diseases linked to aging. Overcoming a Bad Day: a Qualitative Look into the Dementia Caregiving Experiences of Mexican-Origin Women in East Los Angeles Abstract The number of Latinos with Alzheimer's disease (AD) is projected to more than double by 2030. Yet, the current literature is lagging on Alzheimer's caregiving among Latinos. This study explores how Mexican origin women experience dementia caregiving, and the coping strategies they use to manage their caregiving situations. Nine women were identified as caregivers of a family member with AD or dementia from a larger study on caregiving. Interviews with them were collected and subsequently analyzed using a modified grounded theory approach to reduce the data to identify thematic content. All but one participant described caregiving as "tiring," "wearing," or "hard." They reported suffering from stress, insomnia, nervousness, migraines, and/or depression because of their caregiving experiences. Participants engaged in various coping strategies to help combat the perceived negative consequences of their caregiving experiences. The most commonly reported strategies were various forms of distraction, and meditation or prayer. The Mexican origin women in this study experience faced two types of interpersonal challenges related to dementia caregiving: changes in the care receiver's personality and behaviors, and physical care needs. They engaged in various coping to strategies to address the difficulties of their situation. This study provides formative research for identifying research questions and topics of examination in the future. Aging and the Hidden Costs of Going Home to Mexico Abstract Data from the Mexican Census reveal that between 2005 and 2015, nearly two million migrants returned voluntarily to Mexico from the United States. Currently, high rates of voluntary-return migration to Mexico continue at the same time that migration flows to the U.S. steadily decline. This return migration trend presents serious challenges for Mexico, a country that has long struggled to satisfy the health care demands of its population. However, little is known about return migrants' health care needs. In this study, we examine the health risk profiles and healthcare utilization for Mexican return migrants and the non-migrant population. We examine how these outcomes are affected by both the migration and return migration experience of the returnee population, while paying close attention to age-group differences. We employ inverse probability weighting regression adjustment (IPWRA) and logistic regression analysis of a sample of 348,450 respondents from the 2014 National Survey of Demographic Dynamics (ENADID) to test for differences in health conditions between those Mexican return migrants and non-migrants. We then turn to the Survey of Migration at Mexico's Northern Border (EMIF Norte, for its Spanish acronym) for the 2014–2017 period to further assess whether certain characteristics linked to aging and the migration experience influence the prevalence of chronic health conditions, and health insurance coverage among 17,258 returned migrants. Findings reveal that compared to non-migrants, returnees are more likely to be physically impaired. These poor health outcomes are influenced by the migration and return migration experience and vary by age group and duration of residence, the time that has elapsed since returning to Mexico. We do not find an association between return migration and mental or emotional distress. Policy implications are discussed in light of immigration reform and restrictions on eligibility for health insurance coverage for older adults in Mexico. Coping Strategies Utilized by Middle-Aged and Older Latino Caregivers of Loved Ones with Alzheimer's Disease and Related Dementia Abstract We aimed to explore the coping strategies utilized by Latino caregivers of people with Alzheimer's disease or related dementia (ADRD). We conducted 16 semi-structured interviews with Latinos family caregivers. The interviews explored the caregivers' experiences utilizing coping strategies. Coping strategies were identified based on a direct content analysis of the interviews. Participants were 50 to 75 years old, majority female, and from Mexico. The most common coping strategies adopted were: rationalization, social interactions, physical activity, and leisure activities. Other strategies used included avoidance, keeping busy, self-care, and spirituality or faith. Strategies such as using social interactions and spirituality and faith may be rooted in Latino cultural values such as familismo and fatalismo. The possible origin from cultural values might make some of the coping strategies more prevalent or effective in Latinos. Effective interventions aiming to reduce stress in Latino caregivers should prioritize culturally relevant problem-focused coping strategies. Differences within Differences: Gender Inequalities in Caregiving Intensity Vary by Race and Ethnicity in Informal Caregivers Abstract Among the 50+ million informal caregivers in the US, substantial gender, racial/ethnic, and socioeconomic disparities in caregiving intensity are well-documented. However, those disparities may be more nuanced: gender disparities in caregiving intensity may vary by race/ethnicity (White, Black, and Hispanic) and socioeconomic status (SES). We used data from the 2011 National Study of Caregiving and applied generalized linear models to estimate associations between three measures of caregiver intensity (ADLs, IADLs, and hours caregiving/month) and the three sociodemographic factors with their interaction terms. Black female caregivers provided significantly higher levels of care than White females and males for both IADL caregiving and hours/month spent caregiving. Black caregivers spent an average of 28.5 more hours/month (95%CI 1.7–45.2) caregiving than White caregivers. These findings highlight the need to understand the complex disparities within population subgroups and how intersections between gender, race/ethnicity, and SES can be used to develop effective policies to reduce disparities and improve caregiver quality-of-life. Family-Centred Interventions for Elder Abuse: a Narrative Review Abstract Information about elder abuse has not only been sparse due to factors such as underreporting or lack of standardized research, but also in defining elder abuse. However elder abuse is commonly understood to be a single/repeated act, or lack of appropriate action, occurring within any relationship which embodies an expectation of trust, which causes harm or distress to elderly individual. In elder abuse, the relationship of trust usually entails the family, as it family members who are noted to be the most likely perpetrators of elder abuse With the increased prevalence of elder abuse in developed countries and a proclivity towards individualized interventions, this narrative review sought to explore family-centered interventions used to address elder abuse by using a RE-AIM framework. Environmental Challenges in the Home for Ageing Societies: a Comparison of Sweden and Japan Abstract Sweden and Japan are developed welfare countries facing serious societal and public health challenges due to demographic ageing. The objective of the present study was to provide a background to environmental challenges in the home, related to demographic ageing. Specific aims were to compare: 1) demography and household composition 2) physical housing stocks 3) indoor accidents and 4) housing adaptations between the two countries. Descriptive analyses were conducted using secondary data sources. Demographic ageing is projected to accelerate faster in Japan compared to Sweden, with overall lower fertility rates expected in Japan. In 2050, 39% of the Japanese population is projected to be aged 65 years or older, compared to 23% of the Swedish population. The Swedish ordinary housing stock was markedly older than the Japanese housing stock, with almost 80% of the dwellings built before 1980, while in Japan about 65% were built after 1980. High occurrences of fatal indoor accidents were noted in both countries, but for different reasons. In Sweden, falls was the dominant cause of fatal accidents among older people, while in Japan, in addition to falls, drowning and suffocation caused most of the fatal accidents. Housing adaptations were less frequent in Japan compared to Sweden, and the procedure for evaluating, granting and carrying out housing adaptations appeared to be more complicated in Japan. To decrease the occurrence of indoor accidents, identifying and removing "risk barriers" could be instrumental. In both countries, large-scale efforts are imperative to improve the housing situation for the ageing population.
Religious Attendance and the Social Support Trajectories of Older Mexican AmericansAbstractIn this paper, we directly assessed the extent to which the association between religious attendance and the social support trajectories of older Mexican Americans is due to selection (spurious) processes related to personality, health status, and health behavior. We employed seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (1993–2010) to examine the association...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Effect of quality-switched laser exposure in patients with history of edible gold consumption Abstract Injectable gold is known to deposit in the dermis for life, and such patients are at risk of developing chrysiasis post-laser exposure. It is unknown if patients with history of edible gold consumption would develop a similar reaction after quality-switched laser exposure. Our aim is to assess if patients with history of edible gold consumption develop chrysiasis after quality-switched laser exposure. This is a proof of concept pilot study conducted between September 2017 and September 2018 at two dermatology clinics in Riyadh, Saudi Arabia. Adult patients who have history of edible gold consumption were recruited to receive a spot test with different quality-switched lasers in a hidden, non-sun-exposed skin site. The test area was photographed before, immediately after, and 10 min after laser exposure. The test area was examined by two independent investigators for the development of chrysiasis. A total of 10 patients (five male and five female) were enrolled. The mean age was 31.7 years. Forty percent of subjects consumed edible gold more than once, and the duration of last intake ranged from 3 weeks to 3 months. Chocolate was the main source of edible gold. All participants had no chrysiasis reaction post-quality-switched laser exposure. Contrary to our hypothesis, all participants with history of short-term edible gold consumption did not develop chrysiasis after quality-switched laser exposure. Further controlled studies including more patients with longer duration and higher frequency of edible gold consumption are needed. Combination laser therapy as a non-surgical method for treating congenital melanocytic nevi from cosmetically sensitive locations on the body Photobiomodulation-induced analgesia in experimental temporomandibular disorder involves central inhibition of fractalkine Abstract Temporomandibular disorder (TMD) is a collective term that encompasses a set of clinical problems that affect the masticatory muscles, the temporomandibular joint, and associated structures. Despite their high clinical prevalence, the mechanisms of chronic craniofacial muscle pain are not yet well understood. Treatments for TMD pain relief and control should be minimally invasive, reversible, and conservative. Photobiomodulation (PBM) is a promising option once it is known to inhibit inflammatory response and to relief painful symptoms. Herein, the effects of PBM (660 nm, 30 mW, 16 J/cm2, 0.2 cm2, 15 s in a continuous frequency) on the pain sensitivity of rats submitted to an experimental model of TMD induced by CFA was evaluated. Experimental TMD was induced in rats by the injection of complete Freund's adjuvant (CFA) injection into the masseter muscle. Nociceptive behavior was evaluated by electronic von Frey before CFA and after 1 h, 3 h, 6 h, and 24 h and 7, 14, and 21 days after PBM treatment. Inflammatory infiltrate was evaluated by histology of the masseter muscle and fractalkine expression was evaluated by immunohistochemistry of the trigeminal ganglia. PBM reversed the mechanical hypersensitivity of the animals by inhibiting the local inflammatory response, observed by the decrease of the inflammatory infiltrate in the masseter muscle of rats and by a central inhibition of fractalkine observed in the trigeminal ganglion. These data provide new insights into the mechanisms involved in the effects of photobiomodulation therapy emphasizing its therapeutic potential in the treatment of TMD. Early intervention with pulse dye and CO 2 ablative fractional lasers to improve cutaneous scarring post-lumpectomy: a randomized controlled trial on the impact of intervention on final cosmesis Abstract Light-based modalities appear to be effective for ameliorating surgical scar appearance; however, protocols for achieving such outcomes have yet to be established. We studied the safety and efficacy of a combination of pulsed dye laser (PDL) and fractional ablative CO2 laser (FACL) for the attenuation of post-lumpectomy scarring. We conducted a prospective, evaluator-blinded, comparative split-scar study in post-lumpectomy patients. One-half of the scar was treated with three sessions of 595-nm PDL and FACL at 1-month intervals, starting within 6 weeks after suture removal. The entire scar was also treated with standard moisturizers and silicone gels. Six months after the last treatment, the two halves of the scar were assessed by three uninvolved physicians who used the Observer Scar Assessment Scale as well as by the patients who used the Patient and Observer Scar Assessment Scale. Eighteen female patients (mean age, 51.3 years) with a mean scar length of 7.8 cm completed the treatment and follow-up. Six months after the last treatment, both the physician evaluators and the patients noted significant improvements for all assessed scar parameters in the laser-treated scar area compared with the untreated scar area. The treatment was well tolerated, and no remarkable adverse events were reported. All 18 participants were satisfied with the treated scar areas. A combination PDL and FACL protocol starting up to 6 weeks after suture removal is a safe and effective method for the attenuation of post-lumpectomy scar formation. Topical and intradermal delivery of PpIX precursors for photodynamic therapy with intense pulsed light on porcine skin model Abstract In order to purposely decrease the time of the photodynamic therapy (PDT) sessions, this study evaluated the effects of PDT using topical and intradermal delivery of two protoporphyrin (PpIX) precursors with intense pulsed light (IPL) as irradiation source. This study was performed on porcine skin model, using an IPL commercial device (Intense Pulse Light, HKS801). IPL effect on different administration methods of two PpIX precursors (ALA and MAL) was investigated: a topical cream application and an intradermal application using a needle-free, high-pressure injection system. Fluorescence investigation showed that PpIX distribution by needle-free injection was more homogeneous than that by cream, suggesting that a shorter drug-light interval in PDT protocols is possible. The damage induced by IPL-PDT assessed by histological analysis mostly shows modifications in collagens fibers and inflammation signals, both expected for PDT. This study suggested an alternative protocol for the PDT treatment, possibility half of the incubation time and with just 3 min of irradiation, making the IPL-PDT, even more, promising for the clinical treatment. Application of temporal correlation algorithm to interpret laser Doppler perfusion imaging A randomized, investigator-blinded, controlled, split-scalp study of the efficacy and safety of a 1550-nm fractional erbium-glass laser, used in combination with topical 5% minoxidil versus 5% minoxidil alone, for the treatment of androgenetic alopecia Abstract Fractional 1550-nm erbium-glass (Er:Glass) laser therapy is effective in inducing hair regrowth. Combining fractional Er:Glass laser therapy with topical minoxidil may yield therapeutic benefits for patients with androgenetic alopecia (AGA). To compare the efficacy and safety of fractional Er:Glass laser used in combination with topical 5% minoxidil versus 5% minoxidil alone for the treatment of male AGA, 30 men with AGA were randomized to 24 weeks of split-scalp treatment using fractional Er:Glass laser and 5% minoxidil on one side (combined therapy) or 5% minoxidil alone on the other side (monotherapy). The primary outcome was the difference in hair density and diameter, from baseline, between two treatment sides, at week 24. The secondary outcome was a global photographic assessment, evaluated by two dermatologists and the participants. Adverse events were evaluated. Twenty-nine participants completed the 24-week study period. Combination therapy provided significantly superior results for both the primary and secondary outcomes (all p < 0.05). No serious adverse events were identified for either treatment. In conclusion, combination therapy, consisting of fractional Er:Glass laser and topical minoxidil, is a promising treatment option for AGA. Laser-induced photothermolysis and the formation of effective routes for transdermal drug delivery are possible mechanisms. clinicaltrials.in.th, identifier TCTR20160912001 Label-free diagnosis of lung cancer with tissue-slice surface-enhanced Raman spectroscopy and statistical analysis Abstract Despite the rapid development of medical science, the diagnosis of lung cancer is still quite challenging. Due to the ultrahigh detection sensitivity of surface-enhanced Raman spectroscopy (SERS), SERS has a broad application prospect in biomedicine, especially in the field of tumor blood detection. Although Raman spectroscopy can diagnose lung cancer through tissue slices, its weak cross sections are problematic. In this study, silver nanoparticles (AgNPs) were added to the surface of lung tissue slices to enhance the Raman scattering signals of biomolecules. The electromagnetic field distribution of AgNPs prepared was simulated using the COMSOL software. SERS obtained from the slices reflected the difference in biochemical molecules between normal (n = 23) and cancerous (n = 23) lung tissues. Principal component-linear discriminate analysis (PCA-LDA) was utilized to classify lung cancer and healthy lung tissues. The receiver operating characteristic curve gave the sensitivity (95.7%) and specificity (95.7%) of the PCA-LDA method. This study sheds new light on the general applicability of SERS analysis of tissue slices in clinical trials. Different photodynamic effects of blue light with and without riboflavin on methicillin-resistant Staphylococcus aureus (MRSA) and human keratinocytes in vitro Abstract Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of infections in humans. Photodynamic therapy using blue light (450 nm) could possibly be used to reduce MRSA on different human tissue surfaces without killing the human cells. It could be less harmful than 300–400 nm light or common disinfectants. We applied blue light ± riboflavin (RF) to MRSA and keratinocytes, in an in vitro liquid layer model, and compared the effect to elimination using common disinfection fluids. MRSA dilutions (8 × 105/mL) in wells were exposed to blue light (450 nm) ± RF at four separate doses (15, 30, 56, and 84 J/cm2). Treated samples were cultivated on blood agar plates and the colony forming units (CFU) determined. Adherent human cells were cultivated (1 × 104/mL) and treated in the same way. The cell activity was then measured by Cell Titer Blue assay after 24- and 48-h growth. The tested disinfectants were chlorhexidine and hydrogen peroxide. Blue light alone (84 J/cm2) eliminated 70% of MRSA. This dose and riboflavin eradicated 99–100% of MRSA. Keratinocytes were not affected by blue light alone at any dose. A dose of 30 J/cm2 in riboflavin solution inactivated keratinocytes completely. Disinfectants inactivated all cells. Blue light alone at 450 nm can eliminate MRSA without inactivation of human keratinocytes. Hence, a high dose of blue light could perhaps be used to treat bacterial infections without loss of human skin cells. Photodynamic therapy using riboflavin and blue light should be explored further as it may perhaps be possible to exploit in treatment of skin diseases associated with keratinocyte hyperproliferation. Fractional carbon dioxide laser and topical tioconazole in the treatment of fingernail onychomycosis Abstract Onychomycosis is a common chronic-resistant nail disease. Traditional treatment has its limitations and side effects. This study aimed to evaluate the role of fractional CO2 laser and topical tioconazole 28% nail lacquer in the treatment of fingernail onychomycosis, as sole treatment modalities and in combination. Thirty patients with culture-proven onychomycosis were included and randomly divided into three equal groups. Laser group received six fractional carbon dioxide (CO2) laser sessions at monthly intervals; topical group received topical tioconazole 28% nail lacquer twice daily for 6 months, and combined group received six fractional CO2 laser sessions at monthly intervals with topical tioconazole twice daily for 6 months. Treatment outcome was evaluated through physician's evaluation of improvement using onychomycosis severity index score (OSI), patients' satisfaction, side effect evaluation, and mycological culture (assessed after the end of treatment). At the end of treatment, both laser and combined groups showed significantly better degrees of improvement (P = 0.036, 0.024, respectively) and patient's satisfaction (P = 0.046, 0.003, respectively) in comparison with topical group. Mycological clearance in fungal cultures was significantly higher in combined group than topical group after the end of treatment (P = 0.007). Fractional CO2 laser is a safe and effective treatment modality for onychomycosis. Its efficacy approximates that of fractional CO2 laser combined with topical tioconazole 28% nail lacquer and surpasses that of topical tioconazole 28% monotherapy. It is expected to be an excellent choice for patients in whom systemic antifungals are contraindicated or who are unresponsive or intolerant to topical antifungals.
Effect of quality-switched laser exposure in patients with history of edible gold consumptionAbstractInjectable gold is known to deposit in the dermis for life, and such patients are at risk of developing chrysiasis post-laser exposure. It is unknown if patients with history of edible gold consumption would develop a similar reaction after quality-switched laser exposure. Our aim is to assess if patients with history of edible gold consumption develop chrysiasis after quality-switched laser exposure....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:51
Adult Granulosa Cell Tumor of Ovary: Clinical Study of 10 Cases AbstractPurpose To evaluate the clinicopathological entities of adult granulosa cell tumor of ovary.Method A retrospective analysis of ten cases of adult granulosa cell tumor of ovary managed in a tertiary care center (VPS Lakeshore hospital, Kochi) from 2004 to 2018.Results Ten cases were identified to have adult granulosa cell tumor (GCT). Mean age was 45.3 years (range 31–63 years). Irregular cycles, palpable mass and pain abdomen were presenting complains. Palpable abdomino-pelvic mass was present in 7 (70%). Only one case had preoperative rise in serum Ca125 level. Serum inhibin analysis was done in postoperative period only, and one case had raised inhibin. Out of ten cases, 6 underwent laparoscopic surgery for adnexal mass and diagnosis of GCT was made in the final histopathology report. Five of them underwent completion surgery later on. Adjuvant chemotherapy was given in three of the cases. Total of 7 cases (70%) had recurrence. Pelvis was common site of recurrence, and mean duration of recurrence was 5.08 years (24–132 months). Mean disease-free period was 3.97 years (6–132 months). There were four mortalities. The longest follow-up duration for single case till the date was 13 years with recurrence in between.Conclusion Granulosa cell tumor of ovary is rare form of ovarian malignancy. Stage is the important prognostic factor. It has good prognosis compared to epithelial ovarian neoplasm. It is difficult to predict preoperatively. Care should be taken to prevent spillage while dealing with adnexal mass which occurs commonly in minimal access surgery and mini-laparotomy. Addition of Etoricoxib During Concurrent Chemo-radiation of Cervical Cancer Patients Could Result in Faster Resolution of Gross Disease: A Prospective Single-Institution Study AbstractObjective A prospective study was conducted to assess the effect of adding COX-2 inhibitor Etoricoxib during concurrent chemo-radiotherapy schedule of cervical cancer patients on tumour response and acute toxicities.Materials and Methods Forty patients of carcinoma cervix [mostly locally advanced] were treated using external beam radiotherapy (EBRT) [telecobalt, 45 Gy/20F/5F per week] concurrent with weekly cisplatin- or cisplatin + paclitaxel-based chemotherapy. Low-dose-rate (LDR) intracavitary brachytherapy (ICBT) 30 Gy to point A was delivered in between EBRT fractions in a single setting. Patients were prospectively allocated either to receive Etoricoxib 90 mg OD during the entire course of chemo-radiation [arm A] or not [arm B]. Weekly assessment with clinical evaluation and routine blood tests were done during the course of treatment, with pre-ICBT clinical evaluation taken into consideration for disease response comparison between arms.Results When evaluated clinically before intracavitary brachytherapy procedure, the gross disease was found to have regressed more in the arm receiving Etoricoxib [p = 0.042]. Acute grade-3 toxicities ranged between 5 and 15% for patients who received Etoricoxib and 10–15% for those who did not. Difference in toxicities was not statistically significant.Conclusion Addition of COX-2 inhibitor [Etoricoxib] during concurrent chemo-radiation results in a faster response of the primary disease in locally advanced cervical cancer patients, without a significant difference in acute toxicities. A Suggested Strategy to Reduce Stump Carcinoma After Performing "Obligatory" Subtotal Hysterectomy Patterns of First Relapse and Outcome in Patients with Locally Advanced Cervical Cancer After Radiochemotherapy: A Single Institutional Experience AbstractPurpose Radiochemotherapy followed by brachytherapy is the standard treatment in locally advanced cervical cancer. The aim of this study was to evaluate the patterns of first relapse, the treatment given and its outcome.Methods This is a retrospective analysis of electronic records of locally advanced cervical cancer patients treated in prospective trials from 2003 to 2014.Results Out of 1388 patients, relapse was seen in 316 (23%). Relapse was seen as—pelvic: 105 (7.6%), distant: 136 (10%), and both: 75 (5.4%). Local, regional, paraaortic and systemic relapses were seen in 148 (10.8%), 65 (4.7%), 102 (7.4%) and 163 (11.8%) patients, respectively. Post-relapse, 201/316 (63.6%) received palliative care alone. Treatment in the form of concurrent or sequential chemo-radiotherapy, surgery, stereotactic body radiotherapy and reirradiation using brachytherapy was received by 15 (4.7%), 7 (2.2%), 1 (0.3%) and 1(0.3%) patients, respectively; 65 (20.6%) received palliative chemotherapy, and 28 (8.9%) received palliative radiotherapy. Median post-relapse survival was 7 months (95% CI 5.9–8.1); and in those who received treatment versus supportive care was 10 (95% CI 7.0–13.0) versus 5 (95% CI 3.9–6.1) months (p < 0.001). The proportion of patients with > 1-year post-relapse survival was 85.7% in surgery, 66.7% in concurrent or sequential chemotherapy plus radiation, 32.3% in palliative chemotherapy, 14.3% in palliative radiotherapy and 13.4% in supportive care.Conclusion Distant failure is the predominant pattern of relapse seen in patients undergoing radiochemotherapy for locally advanced cervical cancer. Well-selected single-site relapses treated with surgery or chemotherapy plus radiation can have good post-relapse survival. Challenges in Detection and Management of Pre-invasive Glandular Lesions of the Cervix Abstract Despite the success of cervical screening, we continue to see an increase in pre-invasive glandular lesions, and subsequent adenocarcinomas of the cervix. Atypical glandular cells are reported in approximately 0.17–0.6% of cervical cytology samples; up to one-third have underlying pathology that requires further treatment. Glandular lesions of the cervix present unique diagnostic and therapeutic challenges. Colposcopy is often less reliable for assessment of glandular lesions. The role of HPV testing and ECC in diagnosis and surveillance is unclear. Conventional belief is that cold knife conization is superior to LEEP for management of adenocarcinoma in situ (AIS); however, more recent reviews suggest the procedures are oncologically equivalent so long as margins are interpretable and negative. As many young women with AIS desire fertility preservation, evidence on oncologic and obstetric outcomes following conservative management is emerging. The purpose of this review is to discuss some of the common challenges, from a clinician's perspective, around detection and management of pre-invasive lesions of the cervix. Editorial Technical Aspects of Endosurgical Extraperitoneal Aortic Lymph Node Dissection in Gynaecologic Oncology AbstractIntroduction Laparoscopic aortic node dissection can be performed using extraperitoneal techniques. The surgical technique has been made much easier by the development of multifunction instruments, combining sophisticated bipolar thermal fusion and sharp incision, or using harmonic hemostasis. These instruments improve ergonomy, and may reduce the lymphocyst formation rate, the more frequent complication of extraperitoneal lymph node dissection. Robotic assistance is feasible and safe, but that does not provide significant improvement in perioperative outcomes. Laparoscopic or robot-assisted single port has been used by several investigators, which led to the same conclusions. Interestingly, the left lateral extraperitoneal approach can be extended to the left pelvic sidewall, allowing to resect suspicious nodes, sentinel nodes or to complete left pelvic lymph node dissection.Materials and Methods In this paper, a review of the technical aspects including surgical steps, instrumentation, and comparative studies of perioperative outcomes has been carried out. A PubMed search was carried out from the year 1995, including the terms "extraperitoneal" "aortic" "lymph node dissection". Comparative studies investigating the benefits of the extraperitoneal approach compared to the transperitoneal approach were carefully screened. One animal randomized study and one clinical randomized study are available, along with meta-analyses or reviews of retrospective comparative studies.Results No difference was observed in terms of duration of the surgery, blood loss, postoperative complications, hospital stay, and node yield. The extraperitoneal technique overall generates less adhesions, and the intraoperative complication rate is significantly lower than in the transperitoneal approach. The proportion of patients in whom the operation can be satisfactorily completed by this approach is over 90%. The advantages of the extraperitoneal approach are more in obese patients, in relation to the absence of interference of the bowel loops in the operative field, and a higher feasibility.Conclusion The extraperitoneal endosurgical approach is an indispensable tool which must be mastered by gynaecologic oncologists. Extraperitoneal aortic lymph node dissection can be used as a staging procedure, or a part of a full endoscopic operation encompassing intraperitoneal steps like omentectomy and hysterectomy in the surgical staging of endometrial and ovarian cancer. Surgery for Cervical Cancer: Perspectives from Low- and Middle-Income Countries AbstractPurpose This review and opinion provides a very brief overview of current thinking about surgery for cervical cancer. The aim is to add the perspectives of gynaecologic oncologists working in low- and middle-income countries and consider where these may differ from the oft-quoted perspectives of professionals in high-income settings.Methods This article firstly explores aspects of cervical cancer and its treatment that differ between low- and middle-income countries (LMICs) and high-income countries. Secondly, newer developments in the surgical management of primary and recurrent cervical cancers are considered. Lastly, it is discussed where and why perspectives from LMIC may be different from the 'global standard'.Results The reader will be challenged to rethink the applicability of widely published current opinions to all areas in the world. It is acknowledged that LMIC represents a large spectrum over multiple continents and that considerations will not apply to all settings. Some developments may be detrimental to countries without disease control, while other concepts offer hope and innovation.Conclusion Different conditions in LMIC and the solutions found by health professionals working there, must be noted by the wide fraternity as a contribution to science. Adherence to global guidelines should not be expected. Making of a Gynecologic Oncologist Abstract It takes a special person to be a gynecologic oncologist, requiring special surgical skills, empathy and knowledge of female cancer. American Board of Obstetrics and Gynecology started a division of subspecialty in gynecology oncology in 1974 to train gynecologic oncologists in taking care of women with gynecologic malignancies. The curriculum was developed for candidates in training, and institutes were selected based on their expertise and availability of surgical, chemotherapy and radiation specialists following their board certification in obstetrics and gynecology. This article specifies all the current requirements and what it takes to be a gynecological oncologist for a person who is certified in obstetrics and gynecology and fits the criteria to become a gynecologic oncologist. Review of the Outcomes of Ovarian Cancer Treated with Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy Abstract Ovarian, fallopian tube and primary peritoneal carcinomas (OVCA) most commonly present in advanced stages and despite aggressive surgical resection and chemotherapy will likely recur. Although OVCA can recur in the liver, chest or brain, it most commonly recurs within the peritoneal cavity. Peritoneal spread is problematic and often results in bowel obstruction and the inability to maintain nutritional goals. Given the lethality of peritoneal disease as well as the difficulty in treating this recurrence pattern, novel tactics to treat peritoneal dissemination have been a focus of research in OVCA. Heated intraperitoneal chemotherapy (HIPEC) has been well studied and is utilized to treat appendiceal malignancies, which similarly involve the peritoneum. HIPEC has been shown to improve survival and decrease the risk of peritoneal recurrence in patients with appendiceal malignancies. This technique has also been shown to improve outcomes in patients with peritoneal metastases due to colorectal cancers and gastric cancers. Over the past three decades, HIPEC has been used to treat OVCA with mixed results. The aim of this paper is to review the use of HIPEC in the treatment of OVCA in the upfront and recurrent setting.
Adult Granulosa Cell Tumor of Ovary: Clinical Study of 10 CasesAbstractPurposeTo evaluate the clinicopathological entities of adult granulosa cell tumor of ovary.MethodA retrospective analysis of ten cases of adult granulosa cell tumor of ovary managed in a tertiary care center (VPS Lakeshore hospital, Kochi) from 2004 to 2018.ResultsTen cases were identified to have adult granulosa cell tumor (GCT). Mean age was 45.3 years (range 31–63 years). Irregular cycles, palpable mass and pain abdomen were...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:51
Association of daily physical activity with cognition and mood disorders in treatment-naive patients with early-stage Parkinson's disease Abstract To determine the association of daily physical activity with cognition, mood disorders, and olfactory function in treatment-naive patients with early-stage Parkinson's disease (PD). The study subjects were 52 treatment-naive patients with early-stage PD (< 80 years). Daily physical activity was measured using a wearable sensor with a built-in triaxial accelerometer, and its association with cognition [mini-mental state examination (MMSE), clock-drawing test (CDT), frontal assessment battery (FAB), and behavioral assessment of the dysexecutive syndrome (BADS)], depressive symptoms [Beck Depression Inventory-Second Edition (BDI-II)], apathy [Starkstein Apathy Scale (AS)], and olfactory function [Odor Stick Identification Test for the Japanese (OSIT-J)] was analyzed using multiple linear regression after adjustment for age, sex, and education status. The daily physical activity (0.42 ± 0.11 m/s2) of the PD group was significantly lower than that of healthy controls (p < 0.001). Moreover, the daily physical activity of the PD group was significantly associated with FAB (β = 0.337, p = 0.027) and BADS (β = 0.374, p = 0.017) scores, but not with MMSE, CDT, BDI-II, AS, and OSIT-J scores. The daily physical activity is significantly reduced in treatment-naive patients with early-stage PD, and the low activity correlates with frontal/executive function. Macular ganglion-cell-complex layer thinning and optic nerve integrity in drug-naïve Parkinson's disease Abstract To reveal the macular inner retinal change linked to axonal degeneration in Parkinson's disease (PD), we performed macular optical coherence tomography scan and diffusion tensor imaging of the retrobulbar optic nerve on both eyes of 36 drug-naïve PD patients. Thicknesses of inner retinal layers were automatically measured, and correlation analysis was conducted between the retinal thickness and diffusion parameters of the optic nerve. PD patients showed thinning of the inner retinal layers compared to control data. Thicknesses of the ganglion cell and inner plexiform layers were both correlated positively with fractional anisotropy and negatively with diffusivity indices of ipsilateral optic nerve (FDR-adjusted p < 0.05). This study revealed a novel in vivo connection between macular parafoveal ganglion cell change and integrity in the retrobulbar optic nerve in drug-naïve PD. Molecular determinants of behavioral changes induced by neonatal ketamine and dexmedetomidine application Abstract Ketamine (KET), an anesthetic, analgesic, and a sedative N-methyl-d-aspartate (NMDA) receptor antagonist agent, exposure during neonatal period may lead to learning impairment, behavioral abnormalities, and cognitive decline in the later years of life. In recent studies, it has been reported that sedative-acting α2 agonist dexmedetomidine (DEX), which is commonly used in clinical practice with KET, has neuroprotective effects and prevents the undesirable effects of anesthesia. To elucidate the underlying mechanisms of these actions, we investigated the interaction between NMDA receptors α2 adrenoceptor and adulthood behaviors in neonatally KET and/or DEX administrated mice. Balb/c male mice were administrated with saline, KET (75 mg/kg), DEX (10 µg/kg), or KET + DEX (75 mg/kg + 10 µg/kg) on postnatal day 7. During adulthood (8–10 weeks old) mice were subjected to elevated plus maze, open field, and Morris water maze tests. After behavioral tests, hippocampus samples were extracted for mRNA expression studies of NMDAR subunits (GluN1, GluN2A, and GluN2B) and α2 adrenoceptor subunits (α2A, α2B, and α2C) by real-time PCR. Ketamine increased horizontal and vertical locomotor activity (p < 0.01) and impaired spatial learning-memory (p < 0.05). DEX increased anxiety-like behavior (p < 0.01), but did not affect spatial learning-memory and locomotor activity. KET + DEX impaired spatial learning-memory (p < 0.01), increased horizontal locomotor activity (p < 0.01), and anxiety-like behavior (p < 0.05). Our study implies that DEX cannot prevent the adverse effects of KET, on spatial learning-memory, and locomotor activity. In addition to this, it can be thought that during brain development, there is an interaction between NMDAR and α2 adrenoceptor systems. Mesenchymal stem cells inhibited the inflammation and oxidative stress in LPS-activated microglial cells through AMPK pathway Abstract Microglia are the resident mononuclear immune cells of the central nervous system (CNS) and the activation of microglia contributes to the production of excessive neurotoxic factors. In particular, the overproduction of neurotoxic factors has critical effects on the development of brain injuries and neurodegenerative diseases. The human bone marrow-derived mesenchymal stem cells (hBM-MSCs) have blossomed into an effective approach with great potential for the treatment of neurodegenerative diseases and gliomas. The present study aimed to investigate the mechanism behind the therapeutic effect of hBM-MSCs on the activation of microglia in vitro. Specifically, the hBM-MSCs significantly inhibited the proliferation of lipopolysaccharide-activated microglial cells (LPS)-activated microglial cells. Additionally, we investigated whether the adenosine-monophosphate-activated protein kinase signaling (AMPK) pathway was involved in this process. Our data demonstrated that hBM-MSCs significantly increased the phosphorylated AMPK in LPS-activated microglial cells. In addition, our study indicated the inhibitory effect of hBM-MSCs on the pro-inflammatory mediators and oxidative stress by the AMPK pathway in LPS-activated microglial cells. These results could shed light on the understanding of the molecular basis for the inhibition of hBM-MSCs on LPS-activated microglial cells and provide a molecular mechanism for the hBM-MSCs implication in brain injuries and neurodegenerative diseases. Association between cognitive performance and SYT1 -rs2251214 among women with cocaine use disorder Abstract The SNP rs2251214 of the SYT1 gene was recently associated with externalizing phenotypes, including ADHD and cocaine use disorder (CUD). Here, we investigated whether SYT1-rs2251214 could also be implicated with cognitive performance variations among women with CUD. Results showed that G homozygous (n = 146) have lower cognitive performance in the Stroop, Trail Making and Matrix Reasoning tests compared with A-allele carriers (n = 64), suggesting that rs2251214 may influence the severity of cognitive impairments in CUD. Vitamin D rise enhances blood perfusion in patients with multiple sclerosis Abstract The chemical structure of vitamin D resembles steroids and anabolics. Following activation by enzymatic hydroxylation, vitamin D enhances numerous body functions. We determined 25-hydroxy-vitamin D, number of erythrocytes, haematocrit, mean corpuscular haemoglobin and mean corpuscular volume in 97 patients with multiple sclerosis initially and 6 months later. Patients with deficient levels of 25-hydroxyvitamin D (< 30 ng/mL) were advised to perform vitamin D supplementation and received a prescription of a vitamin D formulation. Six months later we observed a rise of 25-OH-vitamin D, as to be expected, and a modified constellation of blood parameters such as elevation of mean corpuscular haemoglobin concentration and fall of mean corpuscular volume. Mean corpuscular haemoglobin and number of erythrocytes remained stable. The haematocrit went down. We suggest that vitamin D elevation may be beneficial in disorders characterised by chronic neuroinflammation and neurodegeneration, since changes of blood perfusion parameters may enhance cellular tissue oxygenation. Comparing lanbotulinumtoxinA (Hengli ® ) with onabotulinumtoxinA (Botox ® ) and incobotulinumtoxinA (Xeomin ® ) in the mouse hemidiaphragm assay Abstract LanbotulinumtoxinA (LAN) is manufactured and registered in China since 1994. Despite its widespread use in China and its increasing use in other Asian countries and in South America, it is not yet well known elsewhere. We wanted to compare its potency labelling using the mouse diaphragm assay (MDA), an isolated muscle model for botulinum toxin (BT) potency measurements, which is superior to clinical tests and which was recently refined as an alternative batch release assay for BT manufacturing. We also wanted to estimate LAN manufacturing quality by testing its inter-batch potency consistency. Potencies of 20, 60 and 100 MU of LAN, onabotulinumtoxinA (ONA) and incobotulinumtoxinA (INCO) were measured by the inversely related paresis time (PT) in the MDA. The PT (M ± SD) of all doses of LAN, ONA and INCO was 90.4 ± 27.0 min, 114.9 ± 46.5 min and 94.3 ± 29.9 min, respectively. Statistical analysis demonstrated indistinguishable potency labelling of LAN and INCO, but revealed a slightly lower potency of ONA compared to LAN and INCO. PT of LAN batch 1 and LAN batch 2 was 86.9 ± 21.2 min and 94.0 ± 32.8 min, respectively (no statistically significant difference), suggesting an adequate LAN manufacturing consistency. The MDA is an appropriate instrument for potency testing of BT drugs, including new ones currently under development. Our results allow comparing therapeutic effects, adverse effects and economics of LAN, ONA and INCO. They also suggest adequate manufacturing consistency of LAN. Theta burst stimulation for the treatment of obsessive–compulsive disorder: a pilot study Abstract A non-negligible part of patients with obsessive–compulsive disorder (OCD) experiences inadequate response to pharmacological and cognitive therapies. Therefore, new approaches are required to overcome this problem. The present pilot study estimates the capacity of theta burst stimulation (TBS) in reducing OCD symptoms, also focusing on the neurophysiological basis of TBS aftereffects. Ten patients with OCD who were unsatisfactorily responsive to the pharmacological and neuropsychological treatment, participated to the present randomized crossover pilot study, in which they were subjected to a real or sham intermittent TBS (iTBS) paradigm over the left dorsolateral prefrontal cortex (L-DLPFC) as add-on treatment. They were randomly assigned to a real or sham iTBS in a 1:1 allocation ratio. Patients received the TBS treatment every morning, 5 days a week for 1 month, and were clinically and electrophysiologically evaluated (EEG phase synchronization and coherence) before, immediately after (T0), and one (T1), three (T3) and six (T6) months after the end of the TBS treatment. Then, each patient was subjected to the alternative treatment (that was not practiced before), and followed up to 6 months. We found that all the patients improved in OCD symptomatology up to T1, while four among them improved up to T3. These patients were those showing a more extensive reshape of frontal areas phase synchronization and frontoparietal coherence compared to the other participants. Our pilot study suggests that iTBS over L-DLPFC may represent a feasible approach to improve OCD symptoms. The efficacy of iTBS seems to depend on the extent of frontal and frontoparietal connectivity modulation. Covariation bias in depression - a predictor of treatment response? Abstract Covariation bias, defined as an overestimation of the relationship between fear-relevant stimuli and aversive consequences, is a well-investigated cognitive bias in anxiety disorders. As patients with affective disorders also show biased information processing, the aim of the present study was to investigate whether depressed patients also display a covariation bias between negative stimuli and aversive consequences. Covariation estimates of 62 inpatients with a current severe depressive episode were assessed at admission (n = 31) or after 6 weeks of treatment (n = 31) and were compared in a between-group design with 31 age- and sex-matched healthy controls. All participants showed a covariation bias for the relationship between negative stimuli and aversive consequences. Moreover, covariation bias at admission was significantly associated with various clinician- and self-reported dimensional measures of treatment response assessed 6 weeks later (Global Assessment of Functioning, Clinical Global Impression Scale, and Beck Depression Inventory), i.e., patients with a stronger bias showed greater impairment after 6 weeks of treatment. Categorical analyses revealed that overall, treatment non-responders—but not responders—were characterized by a covariation bias. The naturalistic study design without standardized pharmacological and psychotherapeutic treatments is a central limitation. We conclude that the covariation bias may constitute a possible marker in the field of emotional information processing in the search for effective predictors of therapy outcome. High ultrasensitive serum C-reactive protein may be related to freezing of gait in Parkinson's disease patients Abstract C-reactive protein (CRP) is a biomarker of systemic inflammation that has been linked to accelerated decline in walking speed in older adults. The aim of the present study was to compare the CRP levels of PD patients with vs patients without freezing of gait (FOG). Patients and controls participating in the COPPADIS-2015 study that performed blood extraction for determining molecular serum biomarkers were included. Patients with FOG were identified as those with a score of 1 or greater on item-3 of the Freezing of Gait Questionnaire (FOG-Q). Immunoassay was used for determining ultrasensitive CRP (US-CRP) level (mg/dL). In the PD group (n = 225; 61.8 ± 9.5 years old, 61.8% males), 32% of the patients presented FOG but none in the control group (n = 65; 60.3 ± 6.1 years old, 56.9% males) (p < 0.0001). Differences in US-CRP level were significant in patients with FOG vs patients without FOG and vs controls (0.31 ± 0.52 vs 0.16 ± 0.21 vs 0.21 ± 0.22; p = 0.04). Significant differences were also observed between patients with vs without FOG (p = 0.001) but not between patients and controls (p = 0.163). US-CRP level was related to FOG (OR = 4.369; 95% CI 1.105–17.275; p = 0.036) along with H&Y (OR = 2.974; 95% CI 1.113–7.943; p = 0.030) and non-motor symptoms burden (NMSS total score; OR = 1.017; 95% CI 1.005–1.029; p = 0.006) after adjusting for age, gender, disease duration, equivalent daily levodopa dose, number of non-antiparkinsonian drugs per day, motor fluctuations, cognition, motor phenotype, and chronic use of anti-inflammatory drugs. The present study suggests that serum US-CRP level is related to FOG in PD patients. Inflammation could be linked to FOG development.
Association of daily physical activity with cognition and mood disorders in treatment-naive patients with early-stage Parkinson's diseaseAbstractTo determine the association of daily physical activity with cognition, mood disorders, and olfactory function in treatment-naive patients with early-stage Parkinson's disease (PD). The study subjects were 52 treatment-naive patients with early-stage PD (< 80 years). Daily physical activity was measured using a wearable sensor with a built-in triaxial...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Diagnosis of coronary artery disease in patients with atrial fibrillation using low tube voltage coronary CT angiography with isotonic low-concentration contrast agent Abstract This prospective study evaluated the image quality and accuracy of coronary computed tomography angiography (CCTA) for diagnosing coronary artery disease (CAD) in patients with atrial fibrillation (AF), in which CCTA used adaptive iterative dose reduction (AIDR) with a low tube voltage and low concentration of isotonic contrast agent. Sixty-eight consecutive patients with AF and suspected CAD were equally and randomly apportioned to two groups and underwent CCTA. In the experimental group, the contrast agent was iodixanol (270 mg I/mL), patients were scanned with 100 kV, and reconstruction was by AIDR. In the conventional scanning (control) group, the contrast agent was iopromide (370 mg I/mL), patients were scanned with 120 kV, and reconstruction was by filtered back projection. The image quality, effective radiation dose (E), and total iodine intake of the groups were compared. Thirty-nine patients with coronary artery stenosis later were given invasive coronary angiography (ICA). The groups were similar with regard to mean CT value, noise, and signal-to-noise and contrast-to-noise ratios. The figure of merit of the experimental group was significantly higher than that of the control group, while the E and total iodine were significantly lower. Using ICA as the diagnostic reference, the groups shared similar sensitivity, specificity, and false positive and false negative rates for diagnosing coronary artery stenosis. For determining CAD in patients with AF, CCTA with isotonic low-concentration contrast agent and low-voltage scanning is a feasible alternative that improves accuracy and reduces radiation dose and iodine intake. Denoising and artefact removal for transthoracic echocardiographic imaging in congenital heart disease: utility of diagnosis specific deep learning algorithms Abstract Deep learning (DL) algorithms are increasingly used in cardiac imaging. We aimed to investigate the utility of DL algorithms in de-noising transthoracic echocardiographic images and removing acoustic shadowing artefacts specifically in patients with congenital heart disease (CHD). In addition, the performance of DL algorithms trained on CHD samples was compared to models trained entirely on structurally normal hearts. Deep neural network based autoencoders were built for denoising and removal of acoustic shadowing artefacts based on routine echocardiographic apical 4-chamber views and performance was assessed by visual assessment and quantifying cross entropy. 267 subjects (94 TGA and atrial switch and 39 with ccTGA, 10 Ebstein anomaly, 9 with uncorrected AVSD and 115 normal controls; 56.9% male, age 38.9 ± 15.6 years) with routine transthoracic examinations were included. The autoencoders significantly enhanced image quality across diagnostic subgroups (p < 0.005 for all). Models trained on congenital heart samples performed significantly better when exposed to examples from congenital heart disease patients. Our study demonstrates the potential of autoencoders for denoising and artefact removal in patients with congenital heart disease and structurally normal hearts. While models trained entirely on samples from structurally normal hearts perform reasonably in CHD, our data illustrates the value of dedicated image augmentation systems trained specifically on CHD samples. Novel mesh-derived right ventricular free wall longitudinal strain analysis by intraoperative three-dimensional transoesophageal speckle-tracking echocardiography: a comparison with conventional parameters Abstract Longitudinal right ventricular (RV) function is substantial and might be reflected by free wall longitudinal strain (FWLS). Software solutions for FWLS analysis by two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) are available, but data on validation are sparse. In this study, a novel method for FWLS analysis on 3D meshes ("mesh surface", MS-FWLS,) was tested for feasibility and compared to available parameters. 80 patients undergoing left-sided cardiac valve surgery with intraoperative TEE were included retrospectively. 2D-FWLS, 3D-derived (3Dd)-FWLS (assessed in optimized four-chamber views after volume analysis) and MS-FWLS were measured and compared to conventional parameters (3Dd-TAPSE, FAC and RVEF). The mean FWLS values did not differ significantly between methods (− 19.0 ± 6.1%, − 20.0 ± 7.3%, − 19.5 ± 7.3% for 2D-, 3Dd- and MS-FWLS, respectively). No significant differences in the mean FWLS between patients with normal or increased pulmonary artery pressures as well as normal or reduced left ventricular ejection fraction were observed. Agreement was best between 3Dd- and MS-FWLS (r = 0.89, bias = − 1.0%, LOA ± 6.9%). Conventional echocardiographic parameters yielded poorer intermodality agreement. In patients with discrepant results between 2D- and 3Dd-FWLS, 3Dd-FWLS and MS-FWLS yielded similar results (r = 0.82, bias = − 0.3%, LOA ± 8.6%), while 2D-FWLS and MS-FWLS did not. Intra- and interobserver variabilities of strain analyses were low. MS-FWLS might represent a promising method to overcome artefacts associated with 2D analysis. Its prognostic relevance needs to be investigated in prospective studies. Evaluation of left atrial volume and function in patients with coronary slow flow phenomenon using real-time three-dimensional echocardiography Abstract This study aimed to evaluate the left atrial (LA) volume and phasic functions using real-time three-dimensional echocardiography (RT3DE) in coronary slow flow phenomenon (CSFP) patients with preserved left ventricular ejection fraction (LVEF). 56 patients with CSFP (36 males, 20 females) and 48 controls with normal coronary flow (27 males, 21 females) were prospectively enrolled. Comprehensive transthoracic echocardiographic examination and RT3DE for the assessment of LA dynamics were performed in all participants. LA maximum, minimum, and pre-atrial contraction volumes (LAV-max, LAV-min, and LAV-preA) were obtained for every subject. Conventional echocardiographic parameters, except for isovolumetric relaxation time and transmitral deceleration time, did not differ in two groups. RT3DE demonstrated higher LAV-max, LAV-min, LAV-preA, indexed LAV-max (LAVi-max), LA total emptying volume, and LA active emptying volume and fraction for CSFP patients compared with controls (all P < 0.05). In addition, LA total emptying fraction and LA passive emptying fraction were found to be lower in CSFP patients than in controls (all P < 0.05). Moreover, there were positive correlations between mean thrombolysis in myocardial infarction frame count values and LAV-max, LAV-min, LAV-preA, LAVi-max, and LA total and active emptying volumes. CSFP was associated with enlarged LA volumes, impaired LA reservoir and conduit function and enhanced contractile function. Evaluation of LA dynamics using RT3DE could facilitate recognition of subtle myocardial alterations related with CSFP. Patients with high left ventricular filling pressure may be missed applying 2016 echo guidelines: a pilot study Abstract 2016 guidelines for the echographic evaluation of left ventricular filling pressure (LVFP) proposed a single algorithm with limited number of criteria (E/A ratio, tricuspid regurgitation velocity, left atrial volume index and average E/e′) mainly related to left atrial pressure. Pulmonary venous flow analysis, evaluating more specifically left ventricular end diastolic pressure (LVEDP) has been withdrawn. We aim to evaluate the proportion of patients diagnosed with normal LVFP according to 2016 recommendations, despite an abnormal pulmonary venous flow profile suggesting high LVEDP. We prospectively studied patients with stable ischemic cardiomyopathy and aortic stenosis, before cardiac surgery. Extensive echocardiography was performed including pulmonary and mitral A wave durations. We included 76 patients (mean age 72 ± 10 years, 78% were men), 37 (49%) with aortic stenosis and 22 (29%) with ischemic cardiomyopathy. Mean left ventricular ejection fraction was 67 ± 11%. Applying recommendations, 58 patients had normal LVFP and 15 patients had high LVFP. Among the 58 patients with normal LVFP, 26 patients had Apd–Amd duration > 30 ms highly suggestive of high LVEDP. These patients had higher LV mass (112 ± 30 g/m2 vs. 86 ± 20 g/m2, p = 0.004) and shorter A wave duration (120 ± 13.6 ms vs. 132 ± 16.5 ms, p = 0.006) as compared to the remaining 15 patients with concordant evaluation (normal LVFP and normal Apd–Amd). In the present study, we found that 26/58 patients with low LVFP according to the 2016 recommendations had Apd–Amd suggestive of high LVEDP. Pulmonary venous flow should be added to the algorithm, particularly in patients with unexplained symptom, high LV mass or truncated mitral A wave. Diagnostic and prognostic value of cardiac magnetic resonance in acute myocarditis: a systematic review and meta-analysis Abstract While diagnostic criteria were elaborated for acute myocarditis using cardiac magnetic resonance (CMR) in 2009, studies have since examined the yield of traditional and novel CMR parameters to achieve greater accuracy and to predict clinical outcomes. The purpose of this systematic review and meta-analysis was to determine the diagnostic and prognostic value of CMR parameters for acute myocarditis. MEDLINE and EMBASE were systematically searched for original studies that reported CMR parameters in adult patients suspected of acute myocarditis. Each CMR parameter's binary prevalence, mean value and standard deviation were extracted. Parameters were meta-analyzed using a random-effects model to generate standardized mean differences. After screening 1492 abstracts, 53 studies were included encompassing 2823 myocarditis patients and 803 controls. Pooled standardized mean differences between myocarditis patients and controls were: T2 mapping time 2.26 (95% CI 1.50–3.02), extracellular volume 1.64 (95% CI 0.87–2.42), LGE percentage 1.30 (95% CI 0.95–1.64), T1 mapping time 1.18 (95% CI 0.35–2.01), T2 ratio 1.17 (95% CI 0.80–1.54), and EGE ratio 0.93 (95% CI 0.66–1.19). Prolonged T1 mapping time had the highest sensitivity (82%), pericardial effusion had the highest specificity (99%). Baseline LV dysfunction and the presence of LGE were predictive of major adverse cardiac events. The results support integration of parametric mapping criteria in the diagnostic criteria for myocarditis. The presence of baseline LV dysfunction and LGE predict patients at higher risk of adverse events. Impact of lesion angle on optical coherence tomography findings and clinical outcomes after drug-eluting stent implantation in curved vessels Abstract Tortuous coronary lesions are associated with adverse outcomes after implantation of bare metal or first-generation drug-eluting stents (DESs). We investigated the impact of lesion angle on vessel wall injuries and stent apposition as assessed by optical coherence tomography (OCT) after second- and newer-generation DES implantation. We investigated 95 de novo lesions treated with a single DES (62 platinum-chromium everolimus-eluting stents and 33 bioresorbable-polymer sirolimus-eluting stents). Post-intervention OCT findings were compared between angled lesions (≥ 45°; n = 33) and non-angled lesions (< 45°; n = 62). The 12-month clinical outcomes were also compared between the groups. Cross-sectional OCT analysis revealed that compared to non-angled lesions, angled ones had a significantly higher incidence of intra-stent dissection around the centre of the angle (19.7% vs. 10.8%, p = 0.01) and incomplete stent apposition (ISA) in the distal and proximal sub-segments (10.0% vs. 4.1%, p = 0.002; 15.3% vs. 7.9%, p < 0.001, respectively). Strut-based analysis also showed that angled lesions demonstrated a higher rate of malapposed strut in the distal and proximal sub-segments (3.0% vs. 0.9%, p < 0.001; 4.3% vs. 1.8%, p < 0.001, respectively). The 12 month clinical outcomes were comparable between the groups. Compared to non-angled lesions, angled coronary lesions were associated with a higher incidence of intra-stent dissection and ISA on post-intervention OCT after implantation of second- and newer-generation DESs. Impact of two formulas to calculate percentage diameter stenosis of coronary lesions: from stenosis models (phantom lesion model) to actual clinical lesions Abstract Percentage diameter stenosis (%DS) by angiography is still commonly used to determine luminal obstruction of coronary artery disease (CAD) lesions. While visual estimation of %DS is widespread, because of high inter-operator variability, quantitative coronary arteriography (QCA) analysis is the gold standard. There are two %DS formulas: %DS1 averages the proximal and distal reference vessel diameter (RVD); %DS2 interpolates the RVD. This study aims to evaluate the difference between %DS assessed by QCA in two datasets, phantom lesion models and CAD patients. Ten phantom lesion models (PLMs) and 354 CAD lesions from the FIRST trial were assessed by QCA. In the latter, two scenarios were assessed: Scenario A (worst view), the most common approach in the clinical setting; and Scenario B (average of two complementary views), the standard core-laboratory analysis. In the PLMs, %DS1 and %DS2 mean ± standard deviation (median) was 58.5 ± 21.7 (61.6) and 58.7 ± 21.6 (61.8), respectively, with a signed difference of − 0.2% ± 0.3% (− 0.1%). In Scenario A, the mean %DS1 was 43.8 ± 9.1 (43.3) and 44.0 ± 9.1 (42 .9) in %DS2. In Scenario B, the mean %DS1 was 45.3 ± 8.8 (45.1) and 45.5 ± 9.0 (45.1) in %DS2. The signed difference was − 0.2% ± 2.4% (0.0%) and − 0.2% ± 2.1% (0.0%) in Scenario A and B, respectively. These differences between formulas ranged from − 1.2 to 0.5% for the phantom cases compared to − 17.7% to 7.7% in Scenario A and to − 15.5% to 7.1% in Scenario B. Although the overall means of the formulas provide similar results, significant lesion-level differences are observed. The use of the worst view versus the average of two views provided similar results. Subclinical left ventricular dysfunction assessed by two-dimensional speckle tracking echocardiography in asymptomatic patients with carotid stenosis Abstract The relationship between subclinical left ventricular (LV) dysfunction and atherosclerosis may have been underestimated in the past, which might be responsible for the high incidence of premature death in individuals with carotid stenosis. We sought to evaluate the underlying myocardial dysfunction in asymptomatic carotid stenosis patients using speckle tracking echocardiography (STE). Fifty patients with carotid stenosis ≥ 50% and a preserved LV ejection fraction (LVEF), and 45 controls without carotid stenosis who were matched in terms of vascular comorbidities were enrolled. All participants underwent carotid ultrasound and echocardiographic examination. The global LV longitudinal strain (GLS) was measured using STE. Compared with the control group, the e' of the mitral annular velocity and GLS were decreased in asymptomatic carotid stenosis patients (p < 0.05), however, the LVEF was well preserved. Based on a predefined cutoff for subclinical LV systolic dysfunction that was defined at a GLS <  − 18%, this dysfunction was detected in 22 patients with carotid stenosis (44%) and in 10 patients in the control group (22%) (p < 0.05). The GLS was negatively correlated with the levels of low-density lipoprotein cholesterol (r =  − 0.356, p < 0.05) and triglyceride (r =  − 0.396, p < 0.05). In conclusion, LV diastolic and systolic functioning were significantly decreased in patients with asymptomatic carotid stenosis, and dyslipidemia likely contributed to the subclinical LV dysfunction in these patients. Our findings indicated the importance of detecting LV subclinical dysfunction and early intervention in this patient population. Conservative gadolinium administration to patients with Duchenne muscular dystrophy: decreasing exposure, cost, and time, without change in medical management Abstract Cardiac MR (CMR) is increasingly used to assess for cardiac involvement in patients with Duchenne muscular dystrophy (DMD). The frequent use of gadolinium based contrast agents (GBCAs) has been called into question with reports of intracranial gadolinium deposition in patients receiving multiple administrations. We adopted a conservative GBCA administration policy, limiting the frequency of GBCA exposure in patients with previously documented late gadolinium enhancement. The aim of our study was to evaluate the clinical effects of this policy change. Data were retrospectively reviewed on 405 consecutive patients with DMD who underwent CMR evaluation. Patients were grouped into conservative GBCA administration or historical control. CMR reports were evaluated and clinical reports were reviewed to determine actionable changes. Ohio Medicaid reimbursements were used to estimate costs. A total of 187 patients comprised the conservative GBCA group and 218 patients the historical cohort. The conservative GBCA group had lower contrast administration rates (84% vs. 99%, p < 0.0001), shorter scan times (35.2 vs. 39.0 min, p < 0.0001), and lower estimated medical costs ($339 vs. $351/study). There was no change regarding the initial presence of first-time late gadolinium enhancement, and no difference in actionable change. Contrast administration substantially decreased 7 months post-policy change (65%) compared to the initial 7 months (96%, p < 0.0001). In the current era with unclear concern for intracranial gadolinium deposition, thoughtful GBCA administration is warranted in patients anticipated to undergo multiple CMRs. Our updated approach has resulted in fewer patients receiving contrast, shorter scan times, and less medical costs, without appreciable changes to patient management.
Diagnosis of coronary artery disease in patients with atrial fibrillation using low tube voltage coronary CT angiography with isotonic low-concentration contrast agentAbstractThis prospective study evaluated the image quality and accuracy of coronary computed tomography angiography (CCTA) for diagnosing coronary artery disease (CAD) in patients with atrial fibrillation (AF), in which CCTA used adaptive iterative dose reduction (AIDR) with a low tube voltage and low concentration of isotonic contrast...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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The Explanatory Role of Basic Psychological Need Experiences in the Relation between Dependency, Self-Criticism and Psychopathology in Adolescence Abstract According to Blatt's theory on personality development, adolescents with high levels of self-criticism and dependency are more vulnerable to diverse types of psychopathology. However, relatively little is known about intervening processes involved in this personality-based vulnerability. The goal of this study is to examine, on the basis of Self-Determination Theory, the explanatory role of the psychological needs for autonomy, competence, and relatedness in associations between self-criticism and dependency on the one hand and adolescents' internalizing and externalizing problems on the other hand. In this cross-sectional and multi-informant study, 284 adolescents (58,5% female; mean age = 14.15; SD = .93) and their parents reported about the adolescent's internalizing and externalizing problems. Adolescents also completed measures assessing self-criticism, dependency, and psychological needs experiences. Data were analyzed using structural equation modeling. Self-criticism and dependency were significantly related to higher levels of both internalizing and externalizing problems, with psychological need frustration fully mediating these associations. This study suggests that psychological need frustration is an important explanatory mechanism in personality-related vulnerability for adolescent psychopathology. More generally, it provides further evidence for the integration between two major theoretical approaches in the domain of adolescent development and psychopathology. Moderated Mediation of the Link between Parent-Adolescent Conflict and Adolescent Risk-Taking: the Role of Physiological Regulation and Hostile Behavior in an Experimentally Controlled Investigation Abstract Compared to childhood and adulthood, adolescence is a time of greater risk-taking behavior, potentially resulting in serious consequences. Theories of adolescent brain development highlight the imbalance between neural circuitry for reward vs. regulation. Although this imbalance may make adolescents more vulnerable to impaired decision-making in the context of heightened arousal, not all adolescents exhibit problematic risk behavior, suggesting other factors are involved. Relatedly, parent-adolescent conflict increases in mid-adolescence, and is linked to negative outcomes like substance use related risk-taking. However, the mechanism by which parent-adolescent conflict and risk-taking are linked is still unknown. Therefore, we investigated this association using a multi-method experimental design. Parent-adolescent dyads were randomly assigned to complete a discussion task together on the topic of either the adolescent's dream vacation or an adolescent-identified conflict topic. During the task, adolescent peripheral psychophysiology was measured for later calculation of heart rate variability (HRV), an index of self-regulation. Immediately after the discussion task, adolescents completed a performance-based measure of risk-taking propensity that indexes real-world risk behaviors. We hypothesized that parent-adolescent conflict would predict greater adolescent risk-taking propensity, and that increased behavioral arousal in the context of conflict, coupled with impaired self-regulation, would explain this link. Results indicated no direct effect of parent-adolescent conflict on adolescent risk-taking propensity. However, there was a significant conditional indirect effect: lower HRV, indexing worse regulatory ability, mediated the relation between conflict and risk-taking propensity but only for adolescents exhibiting behavioral arousal during the discussion task. We discuss implications for understanding adolescent risk-taking behavior. Cognitive Styles in Preschool-Age Children: Associations with Depression Risk and Evidence of Stability Abstract Evidence suggests cognitive styles are associated with depression; however, little research has examined cognitive styles in early childhood. Using developmentally appropriate, stress-inducing laboratory paradigms to assess young children's cognitive vulnerability, the current study assessed negative and positive cognitive styles, their concurrent associations with well-established risk factors for depression in early childhood, and their stability from early to middle childhood. Participants included 173 preschool-aged children and their parents. Cognitive styles were assessed by coding children's negative and positive self-referent and non-self-referent verbalizations and assistance-seeking verbalizations during stress-inducing laboratory tasks during early childhood (Wave 1; ages 3–5) and middle childhood (Wave 2; ages 6–10). Children's Wave 1 verbalizations were concurrently associated with exposure to maternal depression, child negative and positive temperamental emotionality, and child externalizing psychopathology. Assistance-seeking verbalizations demonstrated homotypic continuity from Wave 1 to Wave 2, and both assistance-seeking verbalizations and negative non-self-referent verbalizations at Wave 1 predicted increases in negative self-referent verbalizations from Wave 1 to Wave 2. Findings suggest that cognitive styles can be observed in young children when using an ecologically valid assessment and are linked to risk factors for depression. Further research is warranted to elucidate the development of cognitive vulnerability in young children, which may inform prevention and early interventions targeting cognitive risk for depression. Emotion Sensitivity of the Error-Related Negativity in Hoarding Individuals Abstract Emerging research suggests that hoarding individuals display atypical activation in their anterior cingulate cortex (ACC). Hemodynamic studies have found a biphasic pattern of ACC activity in hoarding individuals that appears sensitive to possession-related decision-making. Electrophysiological studies suggest that hoarding individuals display a blunted error-related negativity (ERN); an event-related potential originating from the ACC that indexes error-detection. These neural abnormalities may reflect an error sensitivity in hoarding individuals as they acquire and discard, however it may also reflect the hyper-emotionality often reported by individuals who hoard. The present study aimed to examine the emotional sensitivity of the error-related negativity in hoarding individuals outside a possession-related context. Seventeen hoarding individuals and 16 healthy controls underwent continuous electroencephalography (EEG) as they completed Go/No-Go (GNGT) tasks design to elicit the ERN. Identical GNGT tasks were completed both before and after watching a negative mood induction video, and self-reported distress was measured throughout. Neither group displayed any neural effect of the negative mood induction, however the hoarding group displayed a pattern of blunted ERN consistent with previous research. This study provides additional evidence that hoarding individuals display blunted indices of error-detection outside possession-related decision-making. Future research could explore if this reflects a pathophysiology shared with other psychiatric disorders that feature a blunted ERN, and if error-detection is also abnormal as hoarding individuals acquire and discard their possessions. A Psychometric Evaluation of the Revised Childhood Anxiety Sensitivity Index (CASI-R) in a Child and Adolescent Sample Abstract The multifactorial nature of anxiety sensitivity (AS) in children has been assessed almost solely with the Childhood Anxiety Sensitivity Index (CASI; Silverman et al. Journal of Clinical Child Psychology, 20(2), 162–168, 1991); however, multiple studies have suggested that the item content of the CASI is too limited to adequately assess multiple AS factors in youth. Here we examined the psychometric properties of the Revised Childhood Anxiety Sensitivity Index (CASI-R; Muris Behaviour Research and Therapy, 40, 299–311, 2002), developed to assess a higher-order global AS factor and four lower-order factors. In a non-clinical sample of youth aged 8–14 we (a) examined the psychometric properties of the CASI-R, comparing findings for children aged 11 and younger with those aged 12 and older, (b) evaluated and compared the internal consistency of the four-factor CASI-R and the three- and four-factor CASI, and (c) examined and compared the convergent validity of the CASI and CASI-R subscales with child-reported anxiety symptoms. Reliability estimates for the CASI-R total, Cardiovascular, and Respiratory scales were high for all youth; the Cognitive Dyscontrol and Publicly Observable Reactions scales yielded low estimates of internal consistency for the younger group. Compared to the parallel CASI scales, these CASI-R scales demonstrated stronger internal consistency in both the older and younger groups. Comparatively larger correlations between the CASI-R physical and cognitive scales with symptoms of panic and between the CASI-R social scale and symptoms of social anxiety were observed. These findings suggest continued use and examination of the CASI-R in child and adolescent non-clinical and clinical samples to comprehensively assess the AS construct in youth. Differences and Similarities in how Psychopathic Traits Predict Attachment Insecurity in Females and Males Abstract We examined whether there are differential associations between latent psychopathy (Interpersonal, Affective, Lifestyle, Antisocial) and adult attachment anxiety and avoidance factors, and if sex moderated the associations in a large sample of young adults (n = 590). Participants completed the Self-Report Psychopathy-Short Form (SRP-SF) and the Experiences in Close Relationships (ECR) attachment scale. Based on norms from the SRP Manual (Paulhus et al. 2017), 19.1% reported an elevated SRP total score (T-score = 60). Multiple group structural equation modeling (MGSEM) was conducted with item factor loadings and thresholds constrained to be equal across male and female subsamples. The MGSEM results indicated excellent model fit (CFI = .95; RMSEA = .04), thus providing evidence of strong invariance and assurance of equvalence of measurement across sex. The pattern of SEM results across males and females revealed both similar and differential relations between specific psychopathy and attachment factors. For both sexes, the Affective psychopathy factor had a significant effect on Avoidant attachment (Males, β = .48; Females, β = .48). In contrast, for males, the Avoidant attachment factor was linked with the Lifestyle factor (β = .47), while for females, the Antisocial factor had a negative effect on Avoidant attachment (β = −.23). The findings highlight both similarities and differences across sex regarding the associations between psychopathic trait domains and disturbances in adult attachment consistent with previous studies. Discussion of this pattern of results and their implications for further understanding of psychopathic traits in males versus females are provided. Distinguishing SCT Symptoms from ADHD in Children: Internal and External Validity in Turkish Culture Abstract In this study, our aim was to evaluate the internal and external validity of Sluggish Cognitive Tempo (SCT) and to determine if it is an independent factor from Attention Deficit Hyperactivity Disorder (ADHD) in Turkish children, like in other cultures. Two hundred sixty-one children (6–12 years of age) who applied to Ankara University Child and Adolescent Psychiatry outpatient clinics and diagnosed with ADHD recruited the study. All children were evaluated with the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version which is a semi-structured diagnostic interview (K-SADS-PL) for ADHD diagnosis. Child Behavior Checklist for ages 6–18, The Barkley's Child SCT Ratings Scale, SNAP-IV Parent and Teacher Scale, and Sociodemographic Information Form were enrolled by the parents and teachers of the children. Our results demonstrated that SCT symptoms formed two distinct but interrelated factors (Sluggish and Daydreaming) separate from those for ADHD. Due to regression analyses, higher levels of SCT predicted higher levels of ADHD-IN (Inattentive) and internalizing symptoms including anxiety-depression, social problems, and social withdrawal. These findings distinguished SCT cases from ADHD-IN in Turkish children. Results also indicated that ADHD- IN symptoms are risk factors for lower academic achievement while SCT symptoms haven't such an effect. Our study is the first which demonstrates SCT's construct validity relative to ADHD-IN by parental and teacher ratings in Turkey. Similar findings with Turkish children to the findings with children from other cultures would increase our confidence in the transcultural generalizability of SCT's internal-external validity. Interrelations among Biologically Relevant Personality Traits, Emotion Regulation Strategies, and Clinical Symptoms Abstract Biologically relevant personality traits of weak inhibitory control (disinhibition) and threat sensitivity confer vulnerability to various clinical problems. Difficulties with emotion regulation have also been studied extensively in relation to risk for and maintenance of psychopathology. However, it remains unclear how emotion regulation strategies interface with dispositional vulnerabilities in affecting clinical symptomatology. The current study provided an initial examination of the roles of disinhibition, threat sensitivity, and use of key emotion regulation strategies (cognitive reappraisal, expressive suppression) in the occurrence of distress-related symptoms (i.e., depressivity, anxiousness, and borderline personality features). Analyses revealed that trait disinhibition and lowered use of cognitive reappraisal were related to each form of distress symptomatology, with the predictive relationship for disinhibition accounting entirely for that of reappraisal. This finding suggests that deficient top-down control capacity (i.e., disinhibition) is integral to failures in the use of an adaptive but cognitively demanding regulation strategy (i.e., reappraisal). By contrast, threat sensitivity was related both to anxiousness and use of expressive suppression, with the latter two variables unrelated to one another. Anxious individuals may avoid emotionally evocative situations, negating the downstream need to engage in the maladaptive strategy of expressive suppression. Despite certain study limitations (a cross-sectional, self-report design; modest sample size), the current study yielded evidence in line with study hypotheses, indicating a pivotal role for dispositional traits in associations between cognitive-behavioral processes and clinical problems. Motives for Nonsuicidal Self-Injury in Individuals with Lifetime Depressive Disorders and Posttraumatic Stress Disorder Abstract Although researchers have identified a number of factors that may motivate individuals to engage in nonsuicidal self-injury (NSSI), few studies have examined whether motives for NSSI differ as a function of psychiatric diagnosis. Therefore, the goal of the present study was to examine motives for lifetime NSSI among individuals with a history of psychiatric disorders associated with elevated rates of NSSI: depressive disorders and posttraumatic stress disorder (PTSD). Young adults (N = 139) with a history of NSSI completed several diagnostic interviews and questionnaires, including a measure of lifetime NSSI motives. Results demonstrated that participants with (vs. without) a lifetime depressive disorder reported significantly lower levels of interpersonal influence motives for NSSI, and participants with (vs. without) lifetime PTSD reported significantly higher levels of emotional relief and feeling generation motives. Further, results revealed a significant interaction between lifetime depressive disorders and PTSD for interpersonal communication motives; specifically, whereas participants with lifetime diagnoses of both a depressive disorder and PTSD did not differ significantly in reported interpersonal communication motives from participants with neither diagnosis, those with lifetime PTSD but without a lifetime depressive disorder reported significantly higher levels of interpersonal communication motives than those without either diagnosis. Results suggest that a history of depression and PTSD (alone and in combination) may be associated with different motives for NSSI. Schizotypy from the Perspective of the DSM-5 Alternative Model of Personality Traits: a Study on a Sample of 1056 Italian Adult University Students Abstract To assess the relationships between schizotypy measures and DSM-5 Alternative Model of Personality Disorders (AMPD) traits, 1056 (69.4% female; mean age = 23.30 years) University students, were administered the Italian translation of the Schizotypal Personality Questionnaire (SPQ), Schizotypal Personality Scale (STA), Schizotypy Scale (SS), and Personality Inventory for DSM-5 (PID-5). Exploratory structural equation modeling (ESEM) suggested that the SPQ, STA, and SS Schizofrenism scale total scores may represent primary measures of schizotypy/Schizotypal personality disorder (PD), whereas the SS anhedonia (AH) total score represent an index of the general anhedonia level. MAMBAC, MAXCOV, and LMode taxometric analyses showed that both schizotypy and anhedonia constructs had a dimensional distribution (all comparison curve fit index values<.40). Bayesian confirmatory factor analysis (CFA) supported a two-factor model of SPQ, STA, SS SZ and SS AH scale total scores. Hierarchical regression analyses showed that DSM-5 AMPD traits that were hypothesized to define the Schizotypal PD profile (i.e., Cognitive and Perceptual Dysregulation, Unusual Beliefs and Experiences, Eccentricity, Restricted Affectivity, Withdrawal, and Suspiciousness), as well as the additional specifiers (i.e., Anxiousness, and Depressivity) explained 66.0% of the systematic variance in the schizotypy factor scale scores. Our findings suggested that schizotypy could be represented as a continuously-distributed latent variable which may be effectively described in terms of a coherent system of dysfunctional personality traits.
The Explanatory Role of Basic Psychological Need Experiences in the Relation between Dependency, Self-Criticism and Psychopathology in AdolescenceAbstractAccording to Blatt's theory on personality development, adolescents with high levels of self-criticism and dependency are more vulnerable to diverse types of psychopathology. However, relatively little is known about intervening processes involved in this personality-based vulnerability. The goal of this study is to examine, on the basis of Self-Determination...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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A multi-institutional analysis of clinical outcomes and patterns of care of 1p/19q codeleted oligodendrogliomas treated with adjuvant or salvage radiation therapy AbstractPurpose Practice patterns vary for adjuvant treatment of 1p/19q-codeleted oligodendroglioma patients. This study evaluates the outcomes of adjuvant (aRT) versus salvage radiation therapy (sRT) in a multi-institutional cohort.Methods Oligodendroglioma patients with confirmed 1p/19q codeletion who were treated with RT with or without chemotherapy from 2000 to 2017 at four tertiary centers were retrospectively reviewed. Overall survival (OS), post-RT progression-free survival (PFS), freedom-from-RT (FFRT), and radiation necrosis (RN) rates were determined using Kaplan–Meier analyses. OS1/PFS1 were defined from the initial surgery. OS2/PFS2 were defined from the RT start-date. Multivariable analyses (MVAs) of prognostic factors for OS and PFS were performed with Cox regression.Results One hundred eighty-six patients were identified: 124(67%) received aRT and 62(33%) received sRT; of sRT patients, 58% were observed after surgery while 42% received chemotherapy without aRT. The median time from initial diagnosis to sRT was 61 months, and 74% had reoperations before sRT. sRT had longer OS1 than aRT (94% vs. 69% at 10 years, p = 0.03) and PFS1 (10-year PFS of 80% vs. 68%, p = 0.03), though sRT was not associated with significantly different OS1/PFS1 on MVAs. Chemotherapy did not delay sRT compared to observation and had worse PFS2 (42% vs. 79% at 5 years, p = 0.08). Higher RT dose was not associated with improved clinical outcomes but was associated with higher symptomatic RN rate (15% vs. 0% at 2 years, p = 0.003).Conclusions Delaying RT for selected oligodendroglioma patients appears safe. Adjuvant chemotherapy does not delay sRT longer than observation and may be associated with worse PFS after RT. EGFR gene amplification in monocentric and multicentric glioblastoma Radiation chronotherapy—clinical impact of treatment time-of-day: a systematic review AbstractPurpose Many brain tumor patients suffer from radiation-induced toxicities. Chronotherapy is a treatment modality that utilizes circadian rhythms to optimize the effect on tumor while minimizing negative outcomes on healthy tissue. This review aims to systematically examine the literature on the application of a radiation chronotherapeutic for all cancers and determine the possible advantages of incorporating a circadian-based fixed time-of-day for radiotherapy into CNS cancers.Methods A systematic review of the literature was conducted in two electronic databases from inception to February 1, 2019. Primary research manuscripts were screened for those related to adult human subjects exposed to ionizing radiation using the chronotherapy technique.Results Nine manuscripts were included in the review from 79 eligible articles. Three were prospective randomized trails and 6 were retrospective reviews. This survey revealed that overall survival and tumor control do not have consistent effects with only 60% and 55.5% of paper which included the variables having some significance, respectively. Treatment symptoms were the primary endpoint for both the prospective trials and were examined in 3 of the retrospective reviews; effects were observed in sensitive tissue for all 5 studies including mucosal linings and skin basal layer.Conclusions Existing literature suggests that the application of radiation chronotherapy may reduce negative symptom outcome within highly proliferative tissues. Further examination of radiation chronotherapy in well-designed prospective trials and studies in brain tumor patients are merited. Analysis of CDKN2A gene alterations in recurrent and non-recurrent meningioma AbstractPurpose Assessment of the risk of recurrence is essential to determine the therapeutic strategy of meningioma treatment. Many relapsing or aggressive meningiomas show elevated mitotic and/or Ki67 indices, reflecting cell cycle deregulation. As CDKN2A is a key tumor suppressor gene involved in cell cycle control, we investigated whether CDKN2A alterations may be involved in tumor recurrence.Methods We carried out a comparative analysis of 17 recurrent and 13 non-recurrent meningiomas. CDKN2A single nucleotide variations (SNVs), deletions, methylation status of the promotor, and p16 expression were investigated. Results were correlated with the recurrent or non-recurrent status and clinicopathological data.Results We identified a CDKN2A SNV (NM_000077, exon2, c.G442A, p.Ala148Thr) in five meningiomas that was significantly associated with recurrence (p = 0.03). This mutation, confirmed by Sanger sequencing and referenced in the COSMIC database in various cancers, has not been reported in meningioma. The presence of one of the three following CDKN2A alterations—p.(Ala148Thr) mutation, whole homozygous or heterozygous gene loss, or promotor methylation > 8%—was observed in 13 of the 17 relapsing meningiomas and was strongly associated with recurrence (p < 0.0001) and a Ki67 labeling index > 7% (p = 0.004).Conclusion We report an undescribed p.(Ala148Thr) CDKN2A mutation in meningioma that was only present in relapsing tumors. In our series, CDKN2A gene alterations were only found in recurrent meningiomas. However, our results need to be evaluated on a larger series to ensure that these CDKN2A alterations can be used as biomarkers of recurrence in meningioma. Hypofractionated radiotherapy with temozolomide in diffuse intrinsic pontine gliomas: a randomized controlled trial AbstractIntroduction Diffuse intrinsic pontine glioma (DIPG) is the most common form of brainstem glioma. The present study was performed to assess if hypofractionated radiotherapy completed in < 3 weeks with temozolomide improves survival in DIPG.Material and methods The present study is a phase II open label randomized trial. The study included newly diagnosed patients with DIPG. Patients in arm A received conventional fractionated RT of 60 Gy in 30 fractions over 6 weeks while patients in arm B received hypo-fractionated radiotherapy of 39 Gy in 13 fractions over 2.6 weeks along with concurrent Temozolomide (TMZ) 75 mg/m2 from day 1 to day 17 followed by adjuvant TMZ for six cycles. The survival analysis was performed with modified intention to treat analysis.Results A total of 35 patients were randomized. 33 patients were evaluable. 93% (n = 14) of patients in the conventional arm completed treatment while only 17% (n = 3) of the children could complete planned course of treatment in the experimental arm. The median overall survival (OS) was 11 months (95% CI − 7.5 to 14.5 months) in the conventional arm and 12 months (95% CI − 10.5 to 13.5 months) in the experimental arm (p = 0.208). 28% (n = 5) patients in the experimental arm developed grade 3 or 4 hematological toxicity.Conclusion The above study shows that hypofractionated radiotherapy with concurrent and adjuvant temozolomide does not improve OS and has higher hematological toxicity. Conventional radiotherapy remains the standard of care. Treatment-induced lesions in newly diagnosed glioblastoma patients undergoing chemoradiotherapy and heat-shock protein vaccine therapy AbstractObjectives Treatment-induced lesions represent a great challenge in neuro-oncology. The aims of this study were (i) to characterize treatment induced lesions in glioblastoma patients treated with chemoradiotherapy and heat-shock protein (HSP) vaccine and (ii) to evaluate the diagnostic accuracy of diffusion weighted imaging for differentiation between treatment-induced lesions and tumor progression.Methods Twenty-seven patients with newly diagnosed glioblastoma treated with HSP vaccine and chemoradiotherapy were included. Serial magnetic resonance imaging evaluation was performed to detect treatment-induced lesions and assess their growth. Quantitative analysis of the apparent diffusion coefficient (ADC) was performed to discriminate treatment-induced lesions from tumor progression. Mann–Whitney U-test and receiver operating characteristic (ROC) curves were used for analysis.Results Thirty-three percent of patients developed treatment-induced lesions. Five treatment-related lesions appeared between end of radiotherapy and the first vaccine administration; 4 lesions within the first 4 months from vaccine initiation and 1 at 3.5 years. Three patients with pathology proven treatment-induced lesions showed a biphasic growth pattern progressed shortly after. ADC ratio between the peripheral enhancing rim and central necrosis showed an accuracy of 0.84 (95% CI 0.63–1) for differentiation between progression and treatment-induced lesions.Conclusion Our findings do not support the iRANO recommendation of a 6-month time window in which progressive disease should not be declared after immunotherapy initiation. A biphasic growth pattern of pathologically proven treatment-induced lesions was associated with a dismal prognosis. The presence of lower ADC values in the central necrotic portion of the lesions compared to the enhancing rim shows high specificity for detection of treatment-induced lesions. Delay in diagnosing patients with right-sided glioblastoma induced by hemispheric-specific clinical presentation AbstractPurpose Cognitive functions are differentially represented in brain hemispheres. Aphasia is an "easy to recognize" symptom of diseases affecting the left side. In contrast, lesions in the right hemisphere cause subtle neuropsychological deficits such as neglect and anosognosia. We evaluated whether right-sided malignant brain tumors are on average larger at the time of first diagnosis as compared to left-sided tumors, and extrapolated the delay in diagnosing right-sided tumors compared to the left side.Methods All first-ever diagnosed glioblastoma (GBM) patients between 2005 and 2012 were identified using our hospital-based prospective research registry. Baseline data, information on initial clinical presentation and imaging findings (including tumor volume) were collected. Extrapolation of time since tumor initiation was based on an established gompertzian growth model.Results We included 173 patients. Mean age of the study population was 58 ± 13 years. Tumors located in the right hemisphere (n = 96) were larger as compared to tumors located in the left hemisphere (n = 77) (median 36.4 mL [interquartile range 13.0–56.0; minimum 0.2, maximum 140.0] vs. 17.2 mL [7.7–45.1 mL; 0.4, 105.2]; p = 0.011). Right-sided tumors grew longer than left-sided tumors (378 ± 95 days vs. 341 ± 74 days; p = 0.006). Initial neuropsychological symptoms differed depending on the affected hemisphere.Conclusion Right-hemispheric symptoms appear to be less clinically conspicuous resulting in a delayed diagnosis of GBM, which might be improved by raising awareness for the corresponding neuropsychological deficits. Whether our findings have prognostic implications needs to be evaluated in future studies. Microscopic brain invasion in meningiomas previously classified as WHO grade I is not associated with patient outcome AbstractPurpose For meningiomas, the 2016 revision of the WHO classification introduced brain invasion per se as a sufficient condition to classify as grade II. We analyzed whether meningiomas previously graded as WHO grade I differ in prognosis depending on the presence of microscopic brain invasion.Methods A consecutive series of patients with intracranial meningioma WHO grade I (± brain invasion) at two neurosurgical departments was analyzed retrospectively. Cox regression models on progression-free survival (PFS) and Kaplan–Meier survival estimates were performed.Results 875 adult patients were included. Histological diagnosis of brain invasion was confirmed in 28 patients. Median follow-up was 73 months. In univariate and multivariate models, gross total resection gained favorable prognostic influence for PFS (p < 0.001, HR: 0.237, CI 0.170–0.382). 170 patients with the brain/meningioma interface present in histopathological specimen were separately analyzed as a subgroup. Importantly, presence of brain invasion did not reach significance for PFS, even in the subgroup with available specimen of brain/meningioma interface (p = 0.787, HR: 0.852, CI 0.268–2.710 and p = 0.811, HR: 0.848, CI 0.222–3.246, respectively). Patients with and without brain invasion did not differ in terms of age, tumor location and extent of resection, but were more likely to receive radiotherapy (p = 0.03) of tumor remnants. However, subgroup analysis of non-irradiated tumors revealed no prognostic influence of brain invasion (p = 0.749, HR: 0.772, CI 0.158–3.767).Conclusions In this bi-institutional series, brain invasion was frequent among meningiomas WHO grade I when brain/meningioma interface was available for histology (16.5%). However, brain invasion did not impact early recurrence. Fractionated stereotactic radiosurgery for malignant gliomas: comparison with single session stereotactic radiosurgery AbstractPurpose Stereotactic radiosurgery (SRS) is feasible for malignant glioma; however, delivering the optimal radiation dose with sufficient large-volume coverage is a major concern. We aimed to investigate the clinical efficacy and safety of fractionated SRS (fSRS) versus single-session SRS (sSRS) for malignant gliomas.Methods We retrospectively reviewed 58 malignant glioma patients who underwent gamma knife SRS from January 2015 to December 2018. Forty-one underwent sSRS, and 17 underwent fSRS. Median dose for fSRS was 28 Gy (range 24–35 Gy), with a median dose of 6 Gy per fraction (range 5–7 Gy). Patients received 4 or 5 fractions on consecutive days. Median dose for sSRS was 18 Gy (range 11–25 Gy), with a median isodose of 50% (range 50–65%). Mean target volumes were 5.9 and 19.3 cc for sSRS and fSRS, respectively (p < 0.001, two-sided t test).Results After SRS, median progression-free survival (PFS) was 4.5 and 4.6 months (p = 0.58), and median overall survival (OS) was 12.7 and 12.6 months for sSRS and fSRS (p = 0.41), respectively (log-rank test). The incidence of clinically significant radiation necrosis was 20.5% (8/39) and 18.8% (3/16) for sSRS and fSRS, respectively (p = 1, Fisher's exact test).Conclusion fSRS for malignant glioma conferred local control and survival comparable with conventional sSRS. The radiation necrosis incidence was comparable between groups when a parallel biological effective dose was administered to the larger target volumes in the fSRS group. fSRS can be a better alternative to sSRS if re-irradiation is considered for large malignant gliomas. Weak MGMT gene promoter methylation confers a clinically significant survival benefit in patients with newly diagnosed glioblastoma: a retrospective cohort study AbstractIntroduction Quantitative methylation specific PCR (qMSP) is a frequently used technique to assess MGMT gene promoter methylation in glioblastoma patients. The optimal technical cut-off value to distinguish methylated from unmethylated samples is nevertheless still undetermined. In literature, a "grey zone" of diagnostic uncertainty has been described.Methods We performed a retrospective analysis of newly diagnosed glioblastoma patients treated according to the Stupp protocol. Epidemiological data were gathered from the individual patient files. MGMT gene promoter methylation status was determined on stored tumour samples using qMSP. A strong, weak or absent promoter methylation was determined based on Cq values (quantification value) of the MGMT and ACTB primers as well as a positive control sample.Results In total, 181 patient files were reviewed and included for statistical analysis. MGMT promoter hypermethylation was detected in 38.7% of glioblastoma patients. The median overall survival of unmethylated and strongly methylated patients was 10.1 months and 19.7 months respectively. Furthermore, 11% of the total patient cohort had a weak MGMT gene promoter methylation. The median OS in this subgroup was 15.4 months, significantly better compared to the unmethylated cohort (P < 0.001). Multivariate Cox regression analysis showed weak MGMT promoter methylation as an independent prognostic parameter for overall survival.Conclusion Glioblastoma patients with weak promoter methylation show a statistically significant longer overall survival when compared to clearly unmethylated patients. Patients with grey zone qMSP test results should receive additional molecular analysis in future to further direct individual therapy strategies.
A multi-institutional analysis of clinical outcomes and patterns of care of 1p/19q codeleted oligodendrogliomas treated with adjuvant or salvage radiation therapyAbstractPurposePractice patterns vary for adjuvant treatment of 1p/19q-codeleted oligodendroglioma patients. This study evaluates the outcomes of adjuvant (aRT) versus salvage radiation therapy (sRT) in a multi-institutional cohort.MethodsOligodendroglioma patients with confirmed 1p/19q codeletion who were treated with RT with or without...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Estimated prevalence of ulcerative colitis and Crohn's disease in Japan in 2014: an analysis of a nationwide survey AbstractBackground Almost a quarter century has passed since the first nationwide survey on ulcerative colitis (UC) and Crohn's disease (CD) was conducted in Japan. In this study, we used a nationwide survey to estimate the number of patients and prevalence of these diseases in Japan in 2014.Methods We conducted a mail-based survey targeting hospitals to estimate the annual numbers of patients with UC and CD in 2014. Respondents were asked to report the numbers of patients who met specific diagnostic criteria for these two conditions. A stratified random sampling method was used, and a total of 3712 departments (internal medicine, surgery, pediatrics, and pediatric surgery) were selected for analysis. The overall and sex-specific annual numbers of UC and CD patients were estimated. The corresponding prevalence rates per 100,000 population were calculated by dividing the number of patients with each disease by the mid-year population of Japan in 2014.Results The overall survey response rate was 56.7% (2016 departments). The estimated numbers of patients with UC and CD were 219,685 (95% confidence interval: 183,968–255,403) and 70,700 (56,702–84,699), respectively. The annual prevalence rates of UC and CD per 100,000 population were 172.9 (men: 192.3; women: 154.5) and 55.6 (men: 79.5; women: 33.1), respectively. These numbers are almost tenfold increase in comparing the previous survey (22,300 in UC and 7,400 in CD). The male-to-female ratios were 1.24 for UC and 2.40 for CD, and the UC-to-CD ratio was 3.11.Conclusions The prevalence of UC and CD in Japan has risen substantially over the past two decades, and their disease burden requires further examination. Nonalcoholic fatty liver disease is associated with lower hepatitis B viral load and antiviral response in pediatric population AbstractBackground The interaction between nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis B infection (CBI) was unclear. We aimed to investigate the association between NAFLD and CBI and the effect of NAFLD on response to antiviral therapy in pediatric population.Methods All children aged 0–18 years with liver biopsy-proven NAFLD, CBI, and co-existing NAFLD and CBI were consecutively collected. Children with co-existing CBI and NAFLD were considered as cases and n:m matched with simple NAFLD and simple CBI patients in the same cohort, respectively. In longitude study, the role of NAFLD in antiviral response was further analyzed in children with CBI who received antiviral treatment. Logistic or Cox regression models were used appropriately for analysis.Results 765 subjects were finally enrolled with 62 co-existing patients, 560 CBI patients, and 143 NAFLD patients. Multivariate analysis showed that HBV DNA level was negatively associated with NAFLD in CBI children (OR 0.376, 95% CI 0.173–0.818). Conversely, the severity of steatosis and levels of serum lipid profile were found to be inversely associated with CBI in NAFLD subjects. Then, in longitude study, we found that HBsAg loss at 96 weeks of antiviral treatment was independently associated with NAFLD (aHR 3.245, 95% CI 1.288–8.176).Conclusions An inverse association between CBI and NAFLD reciprocally existed in pediatric population. In longitude study, HBsAg loss was associated with NAFLD at week 96 of antiviral therapy. A novel urinary microRNA biomarker panel for detecting gastric cancer AbstractBackground Gastric cancer (GC) is one of the most common causes of cancer deaths worldwide; however, reliable and non-invasive screening methods for GC are not established. Therefore, we conducted this study to develop a biomarker for GC detection, consisting of urinary microRNAs (miRNAs).Methods We matched 306 participants by age and sex [153 pairs consisting of patients with GC and healthy controls (HCs)], then randomly divided them across three groups: (1) the discovery cohort (4 pairs); (2) the training cohort (95 pairs); and (3) the validation cohort (54 pairs).Results There were 22 urinary miRNAs with significantly aberrant expressions between the two groups in the discovery cohort. Upon multivariate analysis of the training cohort, urinary expression levels of miR-6807-5p and miR-6856-5p were significantly independent biomarkers for diagnosis of GC, in addition to Helicobacter pylori (H. pylori) status. A diagnostic panel that combined these 2 miRNAs and H. pylori status distinguished between HC and GC samples with an area under the curve (AUC) = 0.736. In the validation cohort, urinary miR-6807-5p and miR-6856-5p showed significantly higher expression levels in the GC group, and the combination biomarker panel of miR-6807-5p, miR-6856-5p, and H. pylori status also showed excellent performance (AUC = 0.885). In addition, this biomarker panel could distinguish between HC and stage I GC patients with an AUC = 0.748. Urinary expression levels of miR-6807-5p and miR-6856-5p significantly decreased to undetectable level after curative resection of GC.Conclusions This novel biomarker panel enables early and non-invasive detection of GC. Familial pancreatic cancer risk: a population-based study in Utah AbstractIntroduction Pancreas adenocarcinoma (PC) has an undefined hereditary component. We quantified the familial risk of PC among relatives of patients diagnosed with PC and stratified it based on anatomic location of PC and age and sex of the proband.Methods This is a retrospective, population-based, case–control study of PC diagnosed in Utah between 1980 and 2011. The Utah population database and cancer registry were used to identify index patients with PC. The risk of PC in first-degree relatives (FDRs), second-degree relatives (SDRs), and first cousins (FCs) of probands was compared with randomly selected sex- and age-matched population controls.Results A total of 4,095 patients and 40,933 controls were identified. The relative risk (RR) of PC was 1.76 (95% CI 1.35–2.29) in FDRs, 1.42 (95% CI 1.18–1.7) in SDRs and 1.08 (95% CI 0.95–1.23) in FCs of probands compared to relatives of PC-free controls. The RR were elevated in FDRs (1.96, 95% CI 1.45–2.65), SDRs (1.54, 95% CI 1.19–1.98) and FCs (1.18, 95% CI 1.0–1.64) of female probands. Among probands diagnosed as < 65 years, RR was 2.12 (95% CI 1.37–3.28) in FDRs, 1.94 (95% CI 1.44–2.62) in SDRs, and 1.28 (95% CI 1.0–1.64) in FCs. Overall, the RR for PC was elevated in FDRs regardless of the anatomic location of PC.Discussion There is an increased risk of PC in FDR and more distant relatives of patients with PC. Relatives of female patients with PC and patients diagnosed at age < 65 years are at a significantly increased risk of PC. Cost-utility analysis of a 'vonoprazan-first' strategy versus 'esomeprazole- or rabeprazole-first' strategy in GERD AbstractBackground Gastroesophageal reflux disease (GERD) can be treated using a vonoprazan-first strategy (first-line treatment with vonoprazan), or esomeprazole-first/rabeprazole-first strategies (first-line treatment with proton-pump inhibitors [PPIs], esomeprazole/rabeprazole, followed by a switch to vonoprazan). This cost-utility analysis used long-term simulation modeling to evaluate the cost-effectiveness of a vonoprazan-first strategy compared with the esomeprazole-first and rabeprazole-first strategies.Methods A Markov simulation model was developed to evaluate the cost-effectiveness of vonoprazan-first, esomeprazole-first, and rabeprazole-first strategies, comprising healing and maintenance therapies, over 5 years (4-week cycles). Healing therapy began with the administration of a normal dose of drug per real-world practice. If patients were not healed endoscopically, either a longer duration of healing therapy was provided (vonoprazan), the dose was increased (rabeprazole), or patients were switched to vonoprazan (immediately for esomeprazole, and after dose-escalation for rabeprazole, respectively). Healed patients received maintenance (lower/same dose as healing therapy). Recurrence resulted in re-challenge with healing therapy. Transition probabilities were derived from the results of indirect comparisons (network meta-analysis) and costs calculated from the Japanese payer perspective. Outcomes were defined as quality-adjusted life years (QALYs), with utilities based on published values.Results Expected costs of the vonoprazan-, esomeprazole-, and rabeprazole-first strategies were ¥36,194, ¥76,719, and ¥41,105, respectively, over 5 years. QALY gains for vonoprazan-first strategy versus the esomeprazole- and rabeprazole-first strategies were 0.014 and 0.003, respectively. Both estimated incremental cost-effectiveness ratios were dominant and robust to two sensitivity analyses.Conclusions Vonoprazan-first strategy increased QALYs and appeared to be cost-effective for GERD patients compared with the esomeprazole- or rabeprazole-first strategies. Effects of proton pump inhibitor use on risk of Clostridium difficile infection: a hospital cohort study AbstractBackground Although there are several studies on the association between use of proton pump inhibitors (PPIs) and increased Clostridium difficile infection (CDI) risk, detailed studies analyzing the effects of PPI use on CDI risk are lacking. The present study investigated the association of the dose, duration, and types of PPIs with CDI risk.Methods A single-center, cohort study was conducted on patients admitted to a hospital. The exposed cohort comprised patients who were prescribed PPIs at least once during the study period, and a control cohort was prepared by randomly assigning an index date to patients who did not use PPIs ensuring the same distribution of index dates as in the exposed cohort and matching sex, age, hospitalization period, and date of admission.Results PPI use increased the risk of CDI by 1.8-fold [95% confidence interval (CI) 1.5–2.2]. CDI risk increased by 1.8-fold with esomeprazole (95% CI 1.4–2.2) and 2.0-fold with pantoprazole (95% CI 1.5–2.8). Patients who used a high dose had a higher risk than those who used a medium dose [adjusted hazard ratio (HR) 2.0 vs 1.3]. The risk of CDI increased 4.2-fold when the PPI exposure period was 6 days or shorter than 6 days.Conclusions Our study showed that PPI use was associated with an increased risk of developing CDI and the risk of CDI was dose dependent. Therefore, PPIs should only be used at proper doses and only for the necessary indications to avoid CDI risk. Epitope peptides of Helicobacter pylori CagA antibodies from sera by whole-peptide mapping AbstractBackground Helicobacter pylori CagA has been found to be immuno-dominant protein and utilized for the diagnosis of the infection with cagA-positive strains. It is important to characterize the peptide epitopes capable of detecting serum anti-CagA antibodies to understand CagA immunogenicity.Methods Sera from 171 Japanese patients were subjected for the epitope mapping study. Eighty seven peptides were designed from the CagA consensus sequence and were used for ELISA protocol to test the serum samples. The reacting anti-CagA IgG amounts to specific peptides were measured and compared.Results The study revealed a strong reactivity of two peptides (c7-NNTEPIYAQVNKKKAGQAT and c8-AGQATSPEEPIYAQVAKKV) in H. pylori-infected group. Interestingly, these two peptides contained the well-known EPIYA-A and EPIYA-B region, respectively, which are two out of three CagA phosphorylation domains. Tyrosine-phosphorylation of these peptides reduced their reactivity in most sera. Moreover, additional peptides' mapping and chimeric-peptides' experiments indicated that the amino acids (QV and KK) accommodated in right-side flanking regions of both EPIYA-motifs were essential for their strong reactivity, whereas the third EPIYA-motif containing peptide (c12-GRSASPEPIYATIDFDEA) with differing flanking amino acids was not reactive in most cases.Conclusions Our results suggest that the amino acid sequences constituted in the two reactive peptides are the important immunogenic regions of CagA which would be useful to develop next-generation peptide-based diagnostic assays. Clinical impact of different cut-off values in high-resolution manometry systems on diagnosing esophageal motility disorders AbstractBackground The values of the parameters in the Chicago classification measured by a high-resolution manometry (HRM) system with the Unisensor catheter (Starlet) are significantly different from those measured by the ManoScan. The contraction vigor is categorized by values of the distal contractile integral (DCI) in the Chicago classification v3.0; however, reference values of the DCI in the Starlet and the clinical impact of the different reference values in the Starlet and ManoScan on diagnosing esophageal motility disorders are not known.Methods We evaluated data from a previous report in which ManoScan and Starlet were compared in the same subjects. The DCI values in each system were compared and reference DCI values were calculated. Moreover, diagnoses assessed by Starlet using reference values in ManoScan were compared with those using calculated reference values and those assessed by ManoScan.Results There was a significant positive correlation between the DCI values measured by ManoScan and those measured by Starlet (r = 0.80, p < 0.01). Based on a linear functional relationship considering measurement errors, the reference DCI values for diagnosing failed, weak and hypercontractile contraction vigor were calculated as 590.6, 1011.3 and 10,085.8 mmHg-s-cm, respectively, in the Starlet. Therefore, the proposed reference values in the Starlet were 500, 1000 and 10,000 mmHg-s-cm, respectively. When the reference values in the ManoScan were used in the Starlet data, approximately 30% of subjects were diagnosed inappropriately. This issue was resolved using the proposed reference values in the Starlet.Conclusion Recognizing systemic differences in HRM systems is important. REFLECT—a phase 3 trial comparing efficacy and safety of lenvatinib to sorafenib for the treatment of unresectable hepatocellular carcinoma: an analysis of Japanese subset AbstractBackground A phase 3, multinational, randomized, non-inferiority trial (REFLECT) compared the efficacy and safety of lenvatinib (LEN) and sorafenib (SOR) in patients with unresectable hepatocellular carcinoma (uHCC). LEN had an effect on overall survival (OS) compared to SOR, statistically confirmed by non-inferiority [OS: median = 13.6 months vs. 12.3 months; hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.79–1.06], and demonstrated statistically significant improvements in progression-free survival (PFS) and the objective response rate (ORR) in the overall population. The results of a subset analysis that evaluated the efficacy and safety of LEN and SOR in the Japanese population are reported.Methods The intent-to-treat population enrolled in Japan was analyzed.Results Of 954 patients in the overall population, 168 Japanese patients were assigned to the LEN arm (N = 81) or the SOR arm (N = 87). Median OS was 17.6 months for LEN vs. 17.8 months for SOR (HR 0.90; 95% CI 0.62–1.29). LEN showed statistically significant improvements over SOR in PFS (7.2 months vs. 4.6 months) and ORR (29.6% vs. 6.9%). The relative dose intensity of LEN and SOR in the Japanese population was lower than in the overall population. Frequently observed, related adverse events included palmar-plantar erythrodysaesthesia syndrome (PPES), hypertension, decreased appetite, and proteinuria in the LEN arm, and PPES, hypertension, diarrhea, and alopecia in the SOR arm.Conclusions The efficacy and safety of LEN in the Japanese population were similar to those in the overall population of REFLECT. With manageable adverse events, LEN is a new treatment option for Japanese patients with uHCC.Trial registration ID ClinicalTrials.gov. No. NCT01761266. Steeper steps and pledge for inevitable responsibilities
Estimated prevalence of ulcerative colitis and Crohn's disease in Japan in 2014: an analysis of a nationwide surveyAbstractBackgroundAlmost a quarter century has passed since the first nationwide survey on ulcerative colitis (UC) and Crohn's disease (CD) was conducted in Japan. In this study, we used a nationwide survey to estimate the number of patients and prevalence of these diseases in Japan in 2014.MethodsWe conducted a mail-based survey targeting hospitals to estimate the annual numbers of...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Public Solicitation and The Canadian Media: Two Cases of Living Liver Donation, Two Different Stories Background . Two stories of public solicitation for living liver donors received substantial Canadian media attention in 2015: The Wagner family, with twin toddlers, each needing transplants, and Eugene Melnyk, wealthy owner of a professional hockey team. This study compared the print media coverage of these 2 stories to understand how public solicitation was portrayed and whether coverage differed depending on the individual making the plea. Methods. We conducted a content analysis on 155 relevant Canadian newspaper articles published between January 1, 2015 and December 31, 2016. Articles were analyzed for their description of public solicitation, benefits and issues associated with public solicitation, and overall tone with respect to public solicitation. Results. The foregrounding of public solicitation and associated ethical issues featured heavily in articles focused on Melnyk but were largely absent when discussing the Wagner family. The fairness of Melnyk's solicitation was the most prominent ethical issue raised. Laws and policies surrounding public solicitation also featured in the Melnyk story but not in articles focused on the Wagners. Public solicitation was portrayed more negatively in the Melnyk articles, but overall, was portrayed positively in relation to both Melnyk and the Wagner family. Conclusions. Public solicitation was generally portrayed as a positive phenomenon in Canadian print media, yet there were stark differences in how these cases were presented. The Wagner story was largely portrayed as a human-interest piece about a family in dire circumstances, whereas Melnyk's wealth, status, and influence raised questions of the fairness of his transplant. Published online 15 November, 2019. Received 4 September 2019. Revision received 18 September 2019. Accepted 19 September 2019. Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.transplantationdirect.com). Supported by Genome Canada and Genome Alberta: Precision Medicine Applying Precision Medicine Technologies in Canada to Prevent Antibody Mediated Rejection and Premature Kidney Transplant Loss (CanPREVENT AMR) and Canadian Institutes of Health Research and the Kidney Foundation of Canada: The Canadian National Transplant Research Program: Increasing Donation and Improving Transplantation Outcomes. A.R.M., M.T., T.C. designed the study. A.R.M. compiled and analyzed the data with assistance from M.T., A.R.M., and M.T. wrote the initial drafts of the article. A.R.M., M.T., and T.C. edited, revised, and contributed to the final version of the article. The authors declare no conflicts of interest. Correspondence: Maeghan Toews, LLM, Adelaide Law School Room 2.05 Ligertwood Bldg University of Adelaide, N Trc Adelaide SA 5005, Australia. (maeghan.toews@adelaide.edu.au). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. © 2019 The Authors. Published by Wolters Kluwer Health, Inc. Whole Body CT Imaging in Deceased Donor Screening for Malignancies Background. In most western countries, the median donor age is increasing. The incidence of malignancies in older populations is increasing as well. To prevent donor-derived malignancies we evaluated radiologic donor screening in a retrospective donor cohort. Methods. This study analyzes the efficacy of a preoperative computed tomography (CT) scan on detecting malignancies. All deceased organ donors in the Netherlands between January 2013 and December 2017 were included. Donor reports were analyzed to identify malignancies detected before or during organ procurement. Findings between donor screening with or without CT-scan were compared. Results. Chest or abdominal CT-scans were performed in 17% and 18% of the 1644 reported donors respectively. Screening by chest CT-scan versus radiograph resulted in 1.5% and 0.0% detected thoracic malignancies respectively. During procurement no thoracic malignancies were found in patients screened by chest CT compared with 0.2% malignancies in the radiograph group. Screening by abdominal CT-scan resulted in 0.0% malignancies, compared with 0.2% in the abdominal ultrasound group. During procurement 1.0% and 1.3% malignancies were found in the abdominal CT-scan and ultrasound groups, respectively. Conclusions. Screening by CT-scan decreased the perioperative detection of tumors by 30%. A preoperative CT-scan may be helpful by providing additional information on (aberrant) anatomy to the procuring or transplanting surgeon. In conclusion, donor screening by CT-scan could decrease the risk of donor-derived malignancies and prevents unnecessary procurements per year in the Netherlands. Published online 15 November, 2019. Received 5 September 2019. Accepted 29 September 2019. The authors declare no funding or conflicts of interest. Author contributions A.E.B., I.P.J.A., and J.W.M. participated in research design. J.W.M. participated in data collection. A.E.B., R.A.P., and J.W.M. participated in data analysis. All authors participated in construction and critical revision of the article. Correspondence: J.W. Mensink, MD, Department of Surgery, Division of Transplantation, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. (j.w.mensink@hotmail.com). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. © 2019 The Authors. Published by Wolters Kluwer Health, Inc. Comparison of a Behavioral Versus an Educational Weight Management Intervention After Renal Transplantation: A Randomized Controlled Trial Background. In the first year following renal transplantation, preventing weight gain to minimize overweight or obesity is particularly important. The aim of this study is to test the effect of an 8-month behavioral intervention BMI and physical activity. Methods. This randomized controlled study included 123 adult kidney or kidney-pancreas recipients. Patients were randomized to usual (1 educational session, then weight self-monitoring) and intervention care (usual care plus 7–8 counseling sessions). Alongside weight, body composition, and physical activity, satisfaction and perceptions regarding care were measured at weeks 2–6 (baseline), then at months 8 and 12. Results. Both groups reported comparably high satisfaction. The intervention group (IG) reported more chronic care-related activities. In patients with BMIs ≥ 18.5, mean weight gain (from baseline) was unexpectedly low in both groups: at month 8, +0.04 kg/m2 in IG patients and +0.14 kg/m2 in the control group (P = 0.590), and respectively, +0.03 kg/m2 and +0.19 kg/m2 at month 12 (P = 0.454). Both groups were physically active, walking averages of 10 807 (IG) and 11 093 (control group) steps per day at month 8 (P = 0.823), and respectively 9773 and 11 217 at month 12 (P = 0.195). Conclusions. The behavioral intervention had high patient acceptance and supported patients in maintaining their weight, but had no superior effect on a single educational session. Further research is needed to assess patient weight gain risk profiles to stratify the intervention. Published online 15 November, 2019. Received 5 July 2019. Accepted 26 July 2019. Trial registration number: NCT02282124 (ClinicalTrials.gov) G.S-M. performed the writing of the article, designing the study, and study management. P.Z. performed the co-writing of the article and development and provision of the intervention. N.G. performed the co-writing of the article and statistical analysis. P.W. performed the co-designing and implementation of intervention in clinical practice and critical revision of article. T.F.M. performed the critical revision of article R.W. performed the implementation of study in clinical practice. L.H. performed the data management. T.F. is the second senior author and performed the co-designing of the study and intervention and critical revision of article. R.S. performed the co-designing of the study and the intervention and critical revision of article. T.F. and R.S. are both senior author. The authors declare no conflicts of interest. Supported by an unrestricted grant from Astellas Pharma Switzerland, Novartis Pharma Switzerland, and the Béatrice Ederer-Weber Stiftung Switzerland. Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.transplantationdirect.com). Correspondence: Gabriela Schmid-Mohler, PhD, RN, Center of Clinical Nursing Science, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. (gabriela.schmid@usz.ch). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. © 2019 The Authors. Published by Wolters Kluwer Health, Inc. Insights Into the Experience of Liver Transplant Recipients With Alcoholic Liver Disease: A Descriptive Qualitative Study Background. Alcoholic liver disease (ALD) due to alcohol use disorder (AUD) is the primary cause of liver transplantation (LT) in the United States. Studies have found that LT recipients experience a range of physical and emotional difficulties posttransplantation including return to alcohol use, depression, and anxiety. The aim of this study is to better understand the experiences of LT recipients with ALD because they recovered posttransplant to inform the development of a patient-centered intervention to assist patients during recovery. Methods. Using qualitative methods, researchers conducted semi-structured interviews with 16 ALD LT recipients. The primary topics of the interview were physical recovery, mental health, substance use including alcohol and tobacco use, and financial experiences. Common patient themes were identified and coded. Results. Within the domain of physical health, patients stressed that undergoing LT was a near-death experience, they were helpless, changes in weight influenced their perception of their illness, and they have ongoing medical problems. In the domain of mental health, patients described cognitive impairments during their initial recovery, difficulty in processing the emotions of having a terminal condition, ongoing depression, anxiety, and irritability. The patients also described their perception of having AUD, the last time they used alcohol and their attitude to AUD treatment posttransplant. Patients also described their reliance on one member of their social support network for practical assistance during their recovery and identified one member of their medical team as being of particular importance in providing emotional as well as medical support during recovery. Conclusions. The patient's description of their lived experience during the months following transplant informed the development of a patient-centered intervention that colocates behavioral health components with medical treatment that helps broaden their social network while addressing topics that emerged from this study. Published online 15 November, 2019. Received 29 January 2019. Revision received 20 September 2019. Accepted 21 September 2019. The authors declare no conflicts of interest. This work was supported by Agency for Healthcare Research and Quality #5R24HS022135-04/PI. M.H. conducted interviews and participated in creating coding scheme, coding transcripts, and writing the preliminary draft of the article. M.L.M. participated in research design and creating coding scheme, conducted interviews, participated in coding transcripts, and contributed to major editing of the draft. M.T. and J.L.M. and M.C. participated in research design, reviewed coding scheme, and reviewed and edited the article. P.S. conceptualized the study and provided oversight of research design, participated in creating coding scheme and writing preliminary draft of the article, and reviewed and substantially edited the final article. Correspondence: Martin Hochheimer, MSW, University of Maryland School of Social Work, 525 W Redwood St, Baltimore, MD 21201. (mhochheimer@ssw.umaryland.edu). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. © 2019 The Authors. Published by Wolters Kluwer Health, Inc. Evaluation of Intrahepatic Lactate/Pyruvate Ratio As a Marker for Ischemic Complications Early After Liver Transplantation—A Clinical Study Background. Lactate/pyruvate ratio has been introduced as a sensitive marker for ischemia in the transplanted liver. In the present study, we aimed to evaluate lactate/pyruvate ratio measured in the liver by microdialysis as a marker for ischemic complications early after liver transplantation. Methods. Forty-five patients undergoing liver transplantation were included in the study. A microdialysis catheter was placed in the liver graft directly following liver transplantation and the metabolites lactate and pyruvate measured for up to 6 days and the lactate/pyruvate ratio calculated. The association between increased intrahepatic lactate/pyruvate ratio and ischemic complications was studied. Results. One of 45 patients developed hepatic arterial thrombosis. Forty-four events with increased lactate/pyruvate ratio were identified in 24 patients. In none of the 24 patients that had a raised lactate/pyruvate ratio could we detect occurrence of any ischemic complication. In the patient that did have hepatic arterial thrombosis, the lactate/pyruvate ratio did not show a significant prolonged rise. Conclusions. An increase in the intrahepatic lactate/pyruvate ratio is not necessarily indicative of ischemic complications and is thus not a reliable marker for monitoring of clinically significant ischemia in the liver early after transplantation. Published online 15 November, 2019. Received 7 June 2016. Revision received 16 September 2019. Accepted 25 September 2019. A.v.P. involved in collection and analyzing of data and writing article. M.A.D.S. involved in analyzing of data and writing article. O.R. involved in writing article. G.N. involved in study design, collection and analyzing of data, and writing article This work was supported by CMA Microdialysis AB, Stockholm, Sweden. Pregraduate School of Clinical Science, Karolinska Institute. The authors declare no conflicts of interest. Correspondence: Anna von Platen, MD, Division of Transplantation Surgery, CLINTEC, Karolinska Institute, Karolinska University Hospital Huddinge F82, 141 86 Stockholm, Sweden. (annavonplaten@sll.se). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. © 2019 The Authors. Published by Wolters Kluwer Health, Inc.
Public Solicitation and The Canadian Media: Two Cases of Living Liver Donation, Two Different StoriesBackground . Two stories of public solicitation for living liver donors received substantial Canadian media attention in 2015: The Wagner family, with twin toddlers, each needing transplants, and Eugene Melnyk, wealthy owner of a professional hockey team. This study compared the print media coverage of these 2 stories to understand how public solicitation was portrayed and whether coverage differed...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Airway Epithelial Hepcidin Coordinates Lung Macrophages and Immunity Against Bacterial Pneumonia Background: Hepcidin is a liver-derived master regulator of iron metabolism through its molecular target ferroportin, the only known mammalian iron exporter. Accumulated evidence has shown the important roles of hepatic hepcidin in host defense and infections. Hepcidin is also expressed by airway epithelial cells. However, the function of epithelial hepcidin during bacterial pneumonia remains unknown. Methods: Pneumonia was induced in hepcidin-1-deficient and wild-type mice using the most common bacterial agents, and the effects of hepcidin on survival, bacterial burden, iron status, and macrophage phagocytosis after bacterial pneumonia were assessed. Results: Hepcidin levels decreased in airway epithelium during common pneumonia, while lung macrophage-derived ferroportin levels and pulmonary iron concentrations increased. Lack of hepcidin in the airway epithelium worsened the outcomes of pneumonia. Manipulation of hepcidin level in the airway epithelium in mice with macrophage-specific ferroportin deletion did not affect the progress of pneumonia. Increased pulmonary iron concentration not only facilitated bacterial growth but also led to the defective phagocytic function of lung macrophages via activation of RhoA GTPase through oxidation of RhoGDI. Furthermore, enhancing the hepcidin level in the airway epithelium rescued mice from lethal bacterial pneumonia. Conclusions: These findings identify an uncharacterized important role of airway epithelial hepcidin in protection against bacterial pneumonia and provide the basis for novel alternative therapeutic strategies for combatting bacterial pneumonia in future translational research. Address reprint requests to QiXing Chen, PhD, Clinical Research Center, Children's Hospital, School of Medicine, Zhejiang University, BinSheng Road 3333, 310052 Hangzhou, China. E-mail: qixingchen@zju.edu.cn; Co-correspondence: XiangMing Fang, MD, Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, QingChun Road 79, 310003 Hangzhou, China. E-mail: xmfang@zju.edu.cn. Received 23 August, 2019 Revised 13 September, 2019 Accepted 23 October, 2019 This work was supported by programs from the National Natural Science Foundation of China (grant numbers 81871543, 81571872, and 81701947) and Zhejiang Provincial Natural Science Foundation of China (grant number LY18H150001). The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.shockjournal.com). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 © 2019 by the Shock Society Variability of Microcirculatory Measurements in Critically ill Patients Introduction: monitoring the microcirculation may be helpful in guiding resuscitation in patients with circulatory shock. Sublingual side-stream dark field imaging camera's allow for non-invasive, bedside evaluation of the microcirculation, although their use in clinical practice has not yet been validated. The GlycoCheck system automatically analyzes these images to determine glycocalyx thickness, red blood cell filling percentage and vessel density. Although GlycoCheck has been used to study microcirculation in critically ill patients, little is known about the reproducibility of measurements in this population. Materials and Methods: a total of 60 critically ill patients were studied. Three consecutive microcirculation measurements were performed with the GlycoCheck system in fourty of these patients by one of two experienced observers. Twenty patients were assessed by both observers. Intra- and interobserver variability were assessed using intra-class correlation coefficients (ICC's). Results: ICC's of single measurements were poor for glycocalyx thickness and good for filling percentage and vessel density. Reproducibility could be substantially increased for all parameters when three consecutive measurements were performed and averaged. Discussion: GlycoCheck can be used to study microcirculation. However, to obtain reliable results three consecutive measurements should be performed and averaged. The variation of the measurements currently hampers the clinical application in individual patients. Address reprint requests to Martine E. Bol, MSc, P. Debyelaan 25, 6229 HX Maastricht, PO Box 5800. E-mail: martine.bol@mumc.nl Received 14 August, 2019 Revised 5 September, 2019 Accepted 19 October, 2019 D. Beurskens received funding from an unrestricted grant (2014/01) from the Coenraad Hemker Foundation. Conflicts of Interest and Source of Funding: There are no conflicts of interest. © 2019 by the Shock Society Should Albumin Be Considered For Prehospital Resuscitation in Austere Environments? A Prospective Randomized Survival Study in Rabbits Background: The new guidelines for prehospital care of combat casualties in shock recommend administration of whole blood or blood components to increase blood pressure to a permissible hypotensive level (i.e., hypotensive resuscitation, HR). We investigated if 2hrs of HR using limited volumes of whole blood, plasma or albumin would lead to full recovery and long-term survival of rabbits subjected to severe hemorrhagic shock (HS). Methods: Following instrumentation, laparotomy was performed on IV-anesthetized spontaneously breathing NZW rabbits (3.0–3.5 kg). Next, ∼40% of rabbits' blood volume was removed producing HS (MAP∼20 mmHg). 15 min later, rabbits were resuscitated with a limited volume (12.5 ml/kg) of rabbit whole blood (FWB), rabbit fresh frozen plasma (FFP), or 5% human albumin (ALB) to a target pressure (MAP) of 60 mmHg (n=8/grp) and monitored for 2hrs. Liver bleeding time was measured at baseline and 10 min after HR. Subsequently, animals were fully resuscitated (blood + LR), surgically repaired, and recovered for 8 days. An untreated group (n = 6) was also included. Results: Following HS, lactate and base deficit levels were increased to 9.2 ± 0.3 and 12.2 ± 2.5 mM respectively with no difference among groups. A lower volume of FWB volume was required to reach the target MAP (p < 0.05 vs. ALB) but MAP declined during the HR period (p < 0.01 vs. ALB). FWB provided higher hematocrit and platelets but it did not reduce lactate level faster than other fluids. Beside higher fibrinogen, no differences were found in hemostatic or resuscitative effects of FFP vs. ALB. Bleeding time was prolonged with ALB and FFP fluids but unchanged with FWB. Untreated rabbits died during shock or shortly after. All treated rabbits except one recovered and lived for 8 days with normal blood tests and similar tissue histology. Conclusions: Two hours of HR using a limited volume of FWB, FFP or ALB led to full recovery and long-term survival of rabbits subjected to HS. Apart from bleeding time, no clinically significant differences were found among the three fluids. Five percent human albumin solutions are isotonic, iso-oncotic, ready-to-use, stable, and compatible with all blood types and should be considered for prehospital resuscitation where blood products are not available or not accepted. Address reprint requests to Bijan S. Kheirabadi, PhD, 3650 Chambers Pass, BHT2, Bldg. 3610, Fort Sam Houston, TX 78234. E-mail: Bijan.s.kheirabadi.civ@mail.mil Received 29 August, 2019 Revised 13 September, 2019 Accepted 29 October, 2019 This work was funded solely by the US Army Medical Research and Development Command. Disclaimer: The opinions or assertions expressed herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Department of Defense. DISCLOSURE: The authors have no conflict of interest to report. This manuscript is not an endorsement of any commercial products by the authors or the U.S. Army. The funding for this work was provided solely by the US Army Medical Research and Development Command. © 2019 by the Shock Society The Prognostic Value of Presepsin For Sepsis in Abdominal Surgery: A Prospective Study Introduction: Rapid diagnosis accompanied by appropriate treatment is essential in the therapy of sepsis. However, there is no blood marker available, which reliably predicts sepsis and associated mortality. Therefore, the aim of the present study was to evaluate presepsin and endotoxin in comparison with established blood markers in patients undergoing emergency visceral surgery for abdominal infection. Patients and Methods: This prospective study included 31 patients with abdominal infection undergoing emergency surgery between March and August 2014. The Sepsis-2 and Sepsis-3 definitions of sepsis were used. Blood markers (presepsin, endotoxin, C-reactive protein, procalcitonin (PCT), interleukin 6 (IL-6), white blood count) were analyzed preoperatively and correlated with the clinical course and mortality. Additionally, a combination of the three markers, which performed best, was tested. Results: Twenty patients (64.5%) in the analyzed cohort developed sepsis from an abdominal focus according to the latest sepsis definition. Out of the analyzed blood markers, presepsin exhibited the highest area under the curve, sensitivity, and specificity for the prediction of the development of sepsis. Moreover, presepsin had the highest predictive value for mortality as opposed to both endotoxin and previously established blood markers (i.e., PCT, IL-6). The multimarker approach, which included PCT, IL-6, and presepsin, showed no additional predictive value over presepsin alone. Conclusion: The present study suggests that presepsin is a novel predictor of sepsis and mortality from sepsis in patients undergoing surgery for intra-abdominal infections. The findings of the present study should be validated in a larger cohort. Address reprint requests to Martin K. Angele, MD, FACS, Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany. E-mail: martin.angele@med.uni-muenchen.de Received 13 May, 2019 Revised 17 July, 2019 Accepted 29 October, 2019 FB and SS contributed equally to this work. The authors report no conflicts of interest. © 2019 by the Shock Society Plasma miR-370-3p As a Biomarker of Sepsis-Associated Encephalopathy, The Transcriptomic Profiling Analysis of Microrna-Arrays From Mouse Brains The diagnosis of sepsis-associated encephalopathy (SAE), an alteration of conscious from sepsis, is difficult due to the similarity to altered states of conscious that occur from other causes. Transcriptomic analyses between mouse-brains at 24 h after cecal ligation and puncture (CLP) (SAE brain as evaluated by SHIRPA score) and at 120 h post-CLP (survivor) were performed to discover the SAE biomarker. Then, candidate microRNAs (miRs) were validated in mouse and patient samples. As such, increased miR-370-3p in SAE mouse-brains (compared with recovery phase) was demonstrated by transcriptomic miR-profiling and was highly expressed in brain (but not other organs) of 24h-post-CLP mice. Plasma miR-370-3p also increased in CLP but was non-detectable in bilateral-nephrectomy (BiNx, a representative model of acute uremic encephalopathy) despite blood brain barrier permeability defect (determined by plasma s100β and Evan blue dye assay) in both conditions. In parallel, high plasma miR-370-3p was demonstrated in patients with SAE (but not sepsis alone or uremia) suggesting the specificity toward SAE. The association among TNF-α, miR-370-3p and brain apoptosis was demonstrated by i) high serum TNF-α and increased brain apoptosis in SAE mice, ii) TNF-α (but not other cytokines) activated miR-370-3p expression in PC-12 neuron cell and iii) increased cell apoptosis in miR-370-3p transfected PC-12 after incubation with TNF-α. In conclusion, miR-370-3p increased in brain and plasma of SAE mice but not uremic encephalopathy. Perhaps, TNF-α enhances cell susceptibility toward brain apoptosis in SAE, in part, through miR-370-3p induction in neuron. Our pilot-results in patients with SAE supported the possibility that plasma miR-370-3p is an interesting SAE biomarker candidate. Further studies are warranted. Address reprint requests to Asada Leelahavanichkul, Immunology Unit, Department of Microbiology, Chulalongkorn University, Bangkok 10330, Thailand. E-mail: aleelahavanit@gmail.com Received 10 August, 2019 Revised 29 August, 2019 Accepted 24 October, 2019 Declarations: Ethics approval and consent to participate: This project was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University, which waived the need for informed consent, as the study was observational and performed for routine follow-up (IRB 113/60). Consent for publication: Not applicable Availability of data and material: Not applicable Funding: This work was supported by Thailand Government Fund (RSA-6080023), Thailand Research Fund (RES_61_202_30_022), National Research Council of Thailand (Graduate studies) and Ratchadaphiseksomphot Endowment Fund 2017 (76001-HR). Authors' contributions: Not applicable Conflicts of interest: None Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.shockjournal.com). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.shockjournal.com). © 2019 by the Shock Society CA1 Hippocampal Pyramidal Cells in Rats, resuscitated from 8 minutes of Ventricular Fibrillation Cardiac Arrest, recover after 20 weeks of Survival: A Retrospective Pilot Study Purpose: The CA1 region of the hippocampus is specifically vulnerable to global ischemia. We hypothesized that histopathological outcome in a ventricular fibrillation cardiac arrest (VFCA) rat model depends on the time point of the examination. Methods: Male Sprague-Dawley rats were put into VFCA for 8 min, received chest compressions for 2 min and were defibrillated to achieve return of spontaneous circulation. Animals surviving for 80 min, 14 days and 140 days were compared to controls. Viable neurons were counted in a 500 μm sector of the CA1 region and layer thickness measured. Microglia cells and astrocytes were counted in a 250x300 μm2 aspect. Results: Control and 80 min surviving animals had similar numbers of pyramidal neurons in the CA1 region. In 14 and 140 days survivors neuron numbers and layer thickness were severely diminished compared to controls (p < 0.001). Two thirds of the 140 days survivors showed significantly more viable neurons than the last third. Microglia was increased in 14 days survivors compared to controls and 140 days survivors, while astrocytes increased in 14 days and 140 days survivors compared to controls (p < 0.001). 140 days survivors had significantly higher astrocyte counts compared to 14 days survivors. Conclusions: The amount and type of brain lesions present after global ischemia depend on the survival time. A consistent reduction in pyramidal cells in the CA1 region was present in all animals 14 days after VFCA, but in two-thirds of animals a repopulation of pyramidal cells seems to have taken place after 140 days. Address reprint requests to Wolfgang Weihs, DMV, Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20,6D, 1090 Vienna, Austria. E-mail: wolfgang.weihs@meduniwien.ac.at. Received 8 August, 2019 Revised 28 August, 2019 Accepted 16 October, 2019 Ethics approval and consent to participate: The experimental protocol was approved by the responsible Animal Care and Use Committee (GZ 0064.11/3b/2011). Experiments were conducted in compliance with EU regulations for animal experimentation and in accordance with ARRIVE guidelines [41]. In this study brain lesions of an 8 min VFCA rat model were analyzed. Consent for publication: Not applicable. Availability of data and material: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: None of the authors has any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, his/her work. Funding: The study was made possible through the generous financial support of the Austrian Science Fund (FWF) [P 24824–824]. The Austrian Science Fund had no involvement in the development of the study design, in the collection, analysis or interpretation of data, in the writing of the report or in the decision to submit the article for publication. The Austrian Science Fund (FWF) requires all project leaders and FWF workers to make their publications freely available through open access. Authors' contributions: WW, substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; performance of research (histological examination), drafting of the article, its critical revision; writing of the paper and final approval of the version to be published. AW, FE, IM, performance of research (resuscitation model),acquisition and interpretation of data; EL, CS, CC, performance of research (resuscitation model), AK, UT, assistance with histological examination, BB, immunohistochemical stainings, HH Statistics, MH, AT, substantial contributions to conception and design, AK, responsible veterinarian for animal keeping and housing SH, histological examination, drafting of the article, all co-authors, critical revision of the article as to important intellectual content; and final approval of the version to be published. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.shockjournal.com). This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 © 2019 by the Shock Society Association Between Perfusate Oxygenation and Acute Lung Injury in Tetralogy of Fallot Surgery Purpose: Little is known regarding precise estimates of the association between perfusate oxygenation (PpO2) and acute lung injury (ALI) following tetralogy of Fallot repair. The objective is to investigate PpO2 and the risk of ALI following tetralogy of Fallot repair in pediatric patients. Methods: We conducted a nested case-control study within a prospective Chinese TedaICH cohort including 134 ALI patients aged 1 month to 18 years undergoing complete repair of tetralogy of Fallot, and each was matched to 2 controls. We selected the highest PpO2 during aortic crossclamp as the exposure. Conditional logistic regression was used to quantify the association between PpO2 and overall ALI risk by covariates of interest. We identified and integrated the risk covariates to build ALI nomograms and internally validated the nomograms using bootstrapping. Results: After adjusting for covariates, continuously and categorically higher PpO2 values were associated with ALI risk (all p < 0.05), especially for those with a z-score of pulmonary annulus < -4.0 (p = 0.002), McGoon ratio < 1.5 (p = 0.029), and major aortopulmonary collateral arteries (p = 0.005), despite no statistical heterogeneity (all p interaction >0.05). Younger age, lower oxyhemoglobin saturation, untreated minor aortopulmonary collateral arteries, transannular patch, larger transpulmonary gradient, major transfusion, and longer cardiopulmonary bypass time were independent risk factors for ALI (all p < 0.05). Combining the PpO2 nomogram provided further risk discriminative information on ALI diagnosis compared with the covariate-based nomogram alone in the training cohort (AUC 0.865, 95% CI [0.828 to 0.903] vs 0.869 [0.832 to 0.906], respectively) with no statistical significance (p = 0.445). Conclusions: The findings suggested an association between high PpO2 and ALI risk, and more importance should be attached to independent risk factors for ALI. Address reprint requests to Zhi-gang Liu, MD, PhD, Department of Cardiovascular Surgery, Graduate School, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, P.R China. E-mail: liuzgtich@sina.com, Yong-feng Shao, MD, PhD, Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210038, P.R China. E-mail: yfshaojph@sina.com, Hong Liu, MD, PhD, Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210038, P.R China. E-mail: dr.hongliu@foxmail.com Received 26 August, 2019 Revised 23 September, 2019 Accepted 25 October, 2019 Funding/Support: The research was supported by Fundamental Research Funds for the Central Universities (No.3332018189) and National Clinical Key Specialty Construction Projects of China. Conflict of interest: The authors have no conflict of interests. ClinicalTrials.gov: NCT03568357. © 2019 by the Shock Society Resuscitation Fluids in Septic Shock: A Network Meta-Analysis of Randomized Controlled Trials The aim of this study was to assess the efficacy and safety of various resuscitation fluids in septic shock by adopting a network meta-analysis (NMA). Randomized controlled trials (RCTs) comparing resuscitation fluids in septic shock were carried out by retrieving electronic databases. NMAs of 28-day mortality, 90-day mortality, incidence of acute kidney injury (AKI), and the need for renal replacement therapy (RRT) were conducted using the STATA 15.0 software. Probability-based ranking and surface under cumulative ranking (SUCRA) were performed to identify the optimal resuscitation fluid. Inconsistencies were evaluated by node-splitting analysis and a loop-specific approach. Furthermore, publication bias was analyzed by funnel plots. A total of 13 RCTs were enrolled in the analysis. The NMA results revealed that no significant differences were detected in the outcomes of 28-day mortality and 90-day mortality among various resuscitation fluids. The SUCRAs (the first indicates the best) of 28-day mortality showed that the hypertonic sodium chloride/hydroxyethyl starch 40 solution ranked the highest (93.8%), followed by the balanced solution (BS) (69.6%), and albumin (61.9%). On the other hand, the SUCRAs of 90-day mortality revealed that gelatin (GEL) ranked the highest (75.1%), followed by BS (55.1%), and NS (52.4%). The NMA results of AKI demonstrated that high-molecular-weight hydroxyethyl starch (H-HES) was associated with increased risk of AKI in comparison with GEL, BS, and L-HES. The SUCRAs of AKI showed that GEL ranked the highest (74.4%), followed by NS (64.9%), and BS (58.3%). In addition, the NMA results of RRT revealed that H-HES was associated with an increased need for RRT in comparison with BS and NS, and L-HES was associated with increased need of RRT in comparison with BS. The SUCRAs of RRT revealed that NS ranked the highest (91.6%), followed by BS (74.4%) and L-HES (36.1%). No significant inconsistencies were shown by the node-splitting analysis and no publication bias was demonstrated in the funnel plots. In conclusion, BS was determined as the preferred resuscitation fluid for septic shock. Moreover, the use of GEL requires further evaluation. H-HES was associated with a significant risk of AKI and RRT, whereas L-HES with an increased need for RRT compared with BS. Thus, both resuscitation fluids should be avoided for septic shock. Address reprint requests to Liangming Liu, State Key Laboratory of Trauma, Burns, and Combined Injury, Department 2, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China. E-mail: liangmingliu@yahoo.com. Co-correspondence: Tao Li, PhD, MD, State Key Laboratory of Trauma, Burns, and Combined Injury, Department 2, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China. E-mail: lt200132@163.com. Received 11 August, 2019 Revised 16 September, 2019 Accepted 16 October, 2019 This work was supported by the Military Key Projects (Grant No. AWS16J032). The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.shockjournal.com). © 2019 by the Shock Society Shock, not Blood Pressure or Shock, Determines the need for Thoracic Damage Control Following Penetrating Trauma Background: Damage control laparotomy has increased survival for critically injured patient with penetrating abdominal trauma. There has been a slower adoption of a damage control strategy for thoracic trauma despite the considerable mortality associated with emergent thoracotomy for patients in profound shock. We postulated admission physiology, not blood pressure or shock index, would identify patients who would benefit from thoracic damage control. Study Design: Retrospective trauma registry review from 2002 to 2017 at a busy, urban trauma center. 301 patients with penetrating thoracic trauma operated on within 6 hours of admission were identified. Of those 66 (21.9%) required thoracic damage control and comprise the study population. Results: Compared to the non-damage control group, the 66 damage control patients had significantly higher ISS, chest AIS, lactate and base deficit, and lower pH and temperature. In addition, the DCTS group had significantly more gunshot wounds, transfusions, concomitant laparotomies, vasoactive infusions, and shorter time to the operating room. Notably, however, there were no significant differences in admission systolic blood pressure or shock index between the groups. Once normal physiology was restored, chest closure was performed 1.7 (0.7) days after the index operation. Mortality for thoracic damage was 15.2%, significantly higher than the 4.3% in the non-damage control group. Over two-thirds of damage control deaths occurred prior to chest closure. Conclusions: Mortality in this series of severely injured, profoundly physiologically altered patients undergoing thoracic damage control is substantially lower than previously reported. Rather than relying on blood pressure and shock index, early recognition of shock identifies patients in whom thoracic damage control is beneficial. Address reprint requests to James V. O'Connor, MD, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201. E-mail: james.oconnor@som.umaryland.edu Received 30 August, 2019 Revised 18 September, 2019 Accepted 24 October, 2019 The authors report no conflicts of interest. © 2019 by the Shock Society Toll like receptor 2 and 9 expression on circulating neutrophils is associated with increased mortality in critically ill patients Background: Toll-like receptors (TLRs) play an important role in inflammatory processes in critically ill patients by binding to pathogen-associated molecular patterns and danger-associated molecular patterns (DAMPs). Whether neutrophil or monocyte TLR expression patterns are associated with outcome in critical illness is unknown. Objectives: To answer this question, we conducted a prospective, observational study including 215 consecutive patients admitted to a medical ICU at a tertiary care center. Methods: Blood was drawn at admission and expression of TLR-2, TLR-4, and TLR-9 on neutrophils and monocytes were analyzed by flow cytometry. Results: Median Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 19, and 30-day mortality was 26%. TLR-2 expression on neutrophils was associated with APACHE II, Simplified Acute Physiology Score II, and Sepsis-related Organ Failure Assessment score. TLR-2 (P < 0.001) and TLR-9 (P < 0.05) expression on neutrophils was significantly higher in nonsurvivors. In contrast, neutrophil TLR-4 expression and monocyte TLR expression were not associated with survival. Neutrophil TLR-2 (OR 3.8; 95% CI 1.4–10.2; P < 0.05) and TLR-9 (OR 4.0; 95% CI 2.0–8.1; P < 0.001) expression in the third tertile predicted mortality independent from APACHE II, serum lactate, serum creatinine, and procalcitonin, respectively. Conclusion: We provide evidence for prognostic properties of neutrophil TLR-2 and TLR-9 expression regarding 30-day mortality in unselected critically ill patients, independent from baseline clinical characteristics, and laboratory values. These findings suggest that specific TLR-dependent activation of the innate immune system via neutrophils possibly caused by cell damage and release of otherwise intracellular components may play a significant role in the pathophysiology of critical illness. Address reprint requests to Walter S. Speidl, MD, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria. E-mail: Walter.Speidl@meduniwien.ac.at Received 7 August, 2019 Revised 28 August, 2019 Accepted 7 October, 2019 Conflicts of interest: the authors declare no conflict of interest. Availability of materials and data: The datasets generated during and/or analyzed during the present study are available from the corresponding author on reasonable request. Author contributions: K.A.K. and W.S.S. designed the study and were involved in data analysis and interpretation. A.N., K.H., J.W., and G.H. were strongly involved in analysis and interpretation of data. D.F.D., C.Z., M.K., and S.P.K. were strongly involved in data acquisition. M.L., K.A.K., and W.S.S. drafted the manuscript. D.F.D., C.Z., M.K., S.P.K., A.N., K.H., J.W., and G.H. critically revised the manuscript. All authors gave final approval of the version submitted. Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Competing interests: All authors declare no competing interests. © 2019 by the Shock Society
Airway Epithelial Hepcidin Coordinates Lung Macrophages and Immunity Against Bacterial PneumoniaBackground: Hepcidin is a liver-derived master regulator of iron metabolism through its molecular target ferroportin, the only known mammalian iron exporter. Accumulated evidence has shown the important roles of hepatic hepcidin in host defense and infections. Hepcidin is also expressed by airway epithelial cells. However, the function of epithelial hepcidin during bacterial pneumonia remains unknown....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Water Quality Assessment and Variation Trends Analysis of the Min River Sea-Entry Section, China Abstract In order to further understand the status of the water quality of Min River's sea-entry section, the index systems for water environmental quality assessment was built based on twenty evaluation parameters including dissolved oxygen (DO), permanganate index (CODMn), chemical oxygen demand (CODCr), biochemical oxygen demand (BOD5), ammonia (NH3-N), total phosphorus (TP), and total nitrogen (TN). Water environmental quality of Min River's sea-entry section in 2015–2017 was evaluated by utilizing the entire-array-polygon synthesis illustration method, accompanied by the time-dependent trend analysis. The results demonstrated that the water environmental quality of Min River's sea-entry section was between the levels I and II of the Environmental Quality Standards for Surface Water (EQSSW, GB3838-2002) in 2015–2017, indicating a generally good water quality. The water quality was affected by both natural factors (such as temperature, rainfall, and runoff) and human factors and had a tendency to deteriorate at the duration of 2015–2017. The research results are of great significance for further understanding of the discharge of pollutants from the Min River basin and will be a strong support for the scientific decision-making of marine management in Fujian Province. Influence of Heavy Metals on Seed Germination and Seedling Growth of Wheat, Pea, and Tomato Abstract Experiments were conducted under lead (Pb), cadmium (Cd), and copper (Cu) exposure to observe germination and seedling growth of wheat (Triticum aestivum L), pea (Pisum sativum), and tomato (Solanum lycopersicum L.). Metals were applied in five concentrations (20, 65, 110, 175, and 220 ppm) and Hoagland solution was used to feed the seedlings. Irrespective of the tested crop seeds, copper revealed maximum effect (51.2%) on germination followed by lead (47.5%) and cadmium (35.3%). Tomato seeds were most sensitive in germination stage followed by pea and wheat. In seedling stage, tomato also showed highest sensitivity to both Cd and Cu. However, pea seedlings showed higher tolerance to Pb and wheat seedlings had the highest tolerance to both Cu and Cd. Toxicity and tolerance of metals was found to vary with crops and growth stages. Higher transfer of metals (Pb, Cd, and Cu) in wheat seedling indicates higher risk of food chain contamination when grown in polluted soil. Higher mobility and uptake of Cd in tomato and wheat seedlings even under lower concentration of exposure needs further study. Paracetamol Degradation Performance and Mechanisms Using Microwave-Assisted Heat-Activated Persulfate in Solutions Abstract A microwave (MW) heat-activated the persulfate (PS) process was employed to treat paracetamol (PAM) in wastewater, and the powder-activated carbon (PAC) be used is used as a catalyst to accelerate this reaction process. The PAM added (100 mg) to the solution was nearly completely removed within 70 min, and the PH, temperature, PAC, and PS dosage have great influence on the degradation process; the total organic carbon (TOC) removal rate reached 98%. The PAC1 still had a good catalytic effect after being reused six times. The radical mechanism was investigated to determine the type of dominant active species involved in PAM degradation. Sulfate radicals (\( {\mathrm{SO}}_4^{-\bullet } \)) were the dominant oxidizing agent for PAM degradation under acidic conditions. The degradation mechanism was proposed based on the PAM degradation intermediates, which were identified using ultra-high-performance liquid chromatography coupled with linear trap quadrupole orbitrap mass spectrometry. Three types of possible reaction pathways for PAM were identified as follows: including hydroxylation of the benzene ring, amine group oxidation at the benzene ring, and amine (HN–C=O) functional group N–C bond cleavage. A Chemical Time Bomb: Future Risks of Microplastics Abstract Despite the controversy, the ecological risk of microplastics research has increased sharply from only one in 1966 to 495 in 2018, according to Web of Science with microplastics as keyword. To date, an upward trend of global microplastics mass emission was confirmed by many environmental scientists. The ocean is the ultimate destination of land-based microplastics sources; therefore, most of efforts were concentrated on microplastics in aquatic environment. In this brief article, the global release of microplastics and flux into the ocean in the recent decade were estimated roughly. The plastics fragmentation in the marine environment only accounted for 22% of total microplastics release (assuming defined emission rate per capita and fragmentation rate of plastics). Future research is needed for microplastics generation and retention in the terrestrial system, especially indoor environments. The accumulated microplastics over the environmental self-purification capacity certainly increases stress for the marine, freshwater and terrestrial ecosystem. The Effect of Temperature Oscillations and Sediment Texture on Fecal Indicator Bacteria Survival in Sediments Abstract Fecal indicator bacteria (FIB) inhabiting stream sediments have become a concern with regard to recreational and irrigation water quality. Sediments contain higher concentrations of E. coli and other FIB than the overlying water column. The objective of this work was to evaluate the effect of temperature oscillations on the populations of both E. coli and enterococci in sediments and the water column. The study was conducted in a microcosm system with flow-through chambers representing a small stream with two different sediment textures. Bovine manure was freshly collected and mixed with both clayey and sandy sediment. Temperatures within the chambers oscillated from 17° to 28 °C which is representative of a diurnal summer temperature range for Maryland; the control chambers were kept at 22 °C. The effect of temperature oscillations differed depending on the sediment texture. Bacterial populations in the sandy sediment immediately increased before net die-off began. Conversely, in the chambers with the clayey sediments, there was no immediate increase in concentrations in the oscillation chambers as compared to the controls. There were significantly higher populations of both E. coli and enterococci within the oscillation sandy texture chambers compared to the control constant temperature chambers; that was not the case in the clayey sediment chambers. The die-off rates in the sandy sediments were greater than those in the clayey sediments; in the latter, bacteria populations remained almost constant throughout the experiment. Temperature oscillations should be simulated in experiments designed to estimate and compare inactivation rates for fecal indicator bacteria in sediments for future inferences on microbial water quality. Spatial and Temporal Evolution Characteristics of Drought in Yunnan Province from 1969 to 2018 Based on SPI/SPEI Abstract The objective of this article is to describe the effect of precipitation and temperature on the drought characteristics of Yunnan province in China. The rainfall and temperature data from 10 national meteorological stations in Yunnan province during 1969 to 2018 were used to investigate the spatial and temporal evolution of drought in Yunnan province and the difference of drought index based on Standardized Precipitation Index (SPI) and Standardized Precipitation Evapotranspiration Index (SPEI) at nearly 50a different time scales. The results showed that Yunnan province had a frequent alternation of drought and flood, and the larger the time scale, the gentler the SPI and SPEI changes. The recent 50a drought mainly occurred in 1980–1982, 1988–1990, 2003–2007, and 2010–2015, and there was continuous drought and the duration was prolonged. The changes of SPI and SPEI showed a downward trend in different seasons. The linear slopes of SPI and SPEI in spring, summer, autumn, and winter were − 0.0064, − 0.0088, − 0.0057 and − 0.0.0111, respectively, and the drought trend was the most serious in winter. Continuous spring drought occurred in 2009–2010 and 2012–2014. The SPEI values in 2009–2010 and 2012–2014 were − 0.80, − 0.64, − 0.75, − 1.23, and − 1.17, respectively. The spatial distribution of drought frequency in Yunnan province was greatly different, and its distribution rule was more in the north and east, less in the south and west. The drought frequency in Zhaotong (northeast Yunnan) was the highest at 36.53%, the drought frequency in Deqin and Lijiang (northwest Yunnan) were 33.11% and 33.28%, and the drought frequency in Kunming (central Yunnan) Lincang, Lancang, and Simao (southwest Yunnan) were 29.35%, 30.73%, 32.77%, and 28.35%, respectively. This study provided a scientific basis for revealing the spatial and temporal variation rules, evolution trends, regional drought, and drought impact assessment and risk management of drought in Yunnan province. Soil Heavy Metal(loid) Pollution and Phytoremediation Potential of Native Plants on a Former Gold Mine in Ghana Abstract This study investigated the soil pollution level and evaluated the phytoremediation potential of 25 native plant species on a former gold mine-tailing site in Ghana. Plant shoots and associated soil samples were collected from a tailing deposition site and analyzed for total element concentration of As, Hg, Pb, and Cu. Soil metal(loid) content, bioaccumulation factor (BAFshoots), and hyperaccumulator thresholds were also determined to assess the current soil pollution level and phytoextraction potential. The concentration of As and Hg in the soil was above international risk thresholds, while that of Pb and Cu were below those thresholds. None of the investigated plant species reached absolute hyperaccumulator standard concentrations. Bioavailability of sampled metal(loid)s in the soil was generally low due to high pH, organic matter, and clay content. However, for Cu, relatively high bioaccumulation values (BAFshoots > 1) were found for 12 plant species, indicating the potential for selective heavy-metal extraction via phytoremediation by those plants. The high levels of As at the study site constitute an environmental and health risk but there is the potential for phytoextraction of Cu (e.g., Aspilia africana) and reclamation by afforestation using Leucaena leucocephala and Senna siamea. Role of AM Fungi in the Uptake and Accumulation of Cd and Ni by Luffa aegyptiaca Abstract Sponge gourd (Luffa aegyptiaca) was grown in pots with and without inoculation with two arbuscular mycorrhizal (AM) fungi, viz., Glomus macrocarpum and Glomus monosporum singly and in combination. Seven-day-old plants were treated with 18.9 μg Cd g−1 soil and 155.4 μg Ni g−1 soil alone and in combination. At 90 days old stage, dry weight of root, shoot, and fruit; uptake of heavy metals in root, stem, leaves, and fruits; percent mycorrhizal root colonization; and spore number in the root zone were determined. When applied singly, the uptake of Cd and Ni in host plants was enhanced more effectively by G. monosporum than G. macrocarpum. The larger proportion of Cd uptake in uninoculated host was retained in the roots but in inoculated plants (with both Glomus sp.), major amounts of the Cd were translocated to the above ground parts including fruits. The leaves were the main sinks of Ni in inoculated plants. The overall tissue burden of both heavy metals in the host was enhanced relatively more effectively on association with G. monosporum as compared with G. macrocarpum. The uptake of Cd was relatively higher in plants treated with both the metals and both the AM fungi. Despite the relatively higher uptake of both the heavy metals in inoculated plants, the host dry weight was significantly higher compared with uninoculated plants. The percent mycorrhizal root colonization of the host by both AM fungi was higher in plants grown without either of the heavy metals. The combined application of both the heavy metals reduced the spore density in the root zone soil of host. The results show that the AM fungi enhanced the uptake of Cd and Ni by the host but alleviated the toxicity by promoting plant growth. The Azo Dye Degradation and Differences Between the Two Anodes on the Microbial Community in a Double-Anode Microbial Fuel Cell Abstract The anode configuration determined the performance of power generation and contaminant removal in microbial fuel cell (MFC). In this study, double anodes were constructed along an up-flow MFC for mitigating the suppression of refractory organic azo dye Reactive Brilliant Red X-3B and increasing the power output. Results revealed that high concentration of X-3B suppressed the power generation of MFC. The maximum power density decreased from 0.413 to 0.161 W/m3, and the inner resistance rose from 448 to 698 Ω. However, double anodes weakened the suppression of X-3B to the current generation. Compared with single anode, the attenuation of MFC current decreased from 48 to 40%. Meanwhile, the X-3B removal efficiency in double-anode MFC was 19.81% higher compared with a single-anode condition when the X-3B was 1000 mg/L. The degradation pathway analysis indicated that aromatic amines formation and further oxidation were achieved sequentially in the MFC. Furthermore, microbial communities in the lower and upper anodes were analyzed, revealing that the microorganisms in the lower anode were more inclined to degrade the pollutant, whereas those in the upper anode were more inclined to generate electricity. This double-anode structure showed the potential for large concentration range of azo dye removal and the current recovery in real textile wastewater. Removal of Cu and Zn from Aqueous Solutions by Selected Tree Leaves with Phytoremediation Potential Abstract In this study, some different selected plant leaves grown in Jordan such as Citrus limon (Rutaceae), Ceratonia siliqua L., Olea europaea (Oleaceae), Washingtonia filifera, and Myoporum (Myoporaceae) were examined for removal of copper (Cu) and zinc (Zn) ions from aqueous solutions. Cu and Zn were analyzed by atomic absorption spectrometry. A pH S-2 acidometer was used for determining the acidity of leaves solution system. Our findings showed the plants leaves were relatively efficient for removal of Cu and Zn compared to activated carbon. Removal of a 5 mg/L aqueous metal solution of Cu and Zn was treated with 2.5 g oven-dried plant in a 50 mL deionized water. The removal of Cu and Zn was expressed in terms of a time function ranged between 0 and 192 hours of contact time. The uptake of Cu and Zn by plant leaves was arranged in the following order: Cu: Activated carbon > Washingtonia filifera > Ceratonia siliqua L. > Olea europaea (Oleaceae) > Myoporum (Myoporaceae) > Citrus limon (Rutaceae) Zn: Activated carbon > Olea europaea (Oleaceae) > Citrus limon (Rutaceae) > Ceratonia siliqua L. > Washingtonia filifera > Myoporum (Myoporaceae)
Water Quality Assessment and Variation Trends Analysis of the Min River Sea-Entry Section, ChinaAbstractIn order to further understand the status of the water quality of Min River's sea-entry section, the index systems for water environmental quality assessment was built based on twenty evaluation parameters including dissolved oxygen (DO), permanganate index (CODMn), chemical oxygen demand (CODCr), biochemical oxygen demand (BOD5), ammonia (NH3-N), total phosphorus (TP), and total nitrogen (TN)....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Julia Dahlvik (2018): Inside Asylum Bureaucracy: Organizing Refugee Status Determination in Austria Mayer, Stefanie (2018): Politik der Differenzen. Ethnisierung, Rassismen und Antirassismus im weißen feministischen Aktivismus in Wien Zwischen Statuskrise und Autonomiebegehren: Solo-Selbstständigkeit als generationstypische Bearbeitung des Wandels von Arbeit und Biografie Zusammenfassung Der vorliegende Beitrag untersucht soloselbstständige Erwerbstätigkeit aus einer biografieanalytischen und generationalen Perspektive. Anhand einer Einzelfallanalyse wird nachgezeichnet, welche Anforderungen an die biografische Selbstgestaltung die Solo-Selbstständigkeit als individualisiertes Muster der Lebensführung stellt. Die Frage nach den Möglichkeiten und Normierungen des biografischen Handelns führt in einem weiteren Analyseschritt zu einer Betrachtung des Generationszusammenhangs der Interviewten, dem Milieu der akademischen Kulturberufe sowie dem marktlichen Bewährungskontext der Tätigkeit. Erkennbar wird ein generationsspezifisches Individuationsbegehren, welches auf der Erfahrung wohlfahrtsstaatlicher Sicherung fußt und auf die Erosion eines Bildungs- und Aufstiegsversprechens trifft. In der Folge konstituiert eine spannungsreiche Verknüpfung von Selbstentfaltung und Statusunklarheit die Auseinandersetzung mit der sozialen Institution Biografie. Solo-Selbstständigkeit zeigt sich somit als ein hochgradig individualisiertes Erwerbsmuster, dessen Anschlussfähigkeit für das Projekt des „authentischen Selbst" erst vor dem Hintergrund generationsspezifischer Erfahrungen gewährter und entzogener Wohlfahrtsstaatlichkeit plausibel wird. „Alltagsgeschichte" als Exploration kleiner Lebenswelten Zusammenfassung Elizabeth T. Spira hat mit ihrem ganz eigenen Blick interessante Betrachtungsweisen zur österreichischen Gesellschaft und Alltagskultur geliefert. Anlässlich ihres Todes wird deshalb an ihre Leistungen als Sozialreporterin erinnert, auf soziologisch relevante Aspekte verwiesen und ihre Arbeit kritisch gewürdigt. Darüber hinaus werden zu diesem Anlass die Verbindungen und Abgrenzungen zwischen Sozialreportage und (Teilen der) Soziologie thematisiert. Anhand der Liebesg'schichten und Heiratssachen, vor allem aber der Alltagsgeschichten wird geprüft, inwiefern für die Soziologie und die Frage nach dem Zugang zur sozialen Wirklichkeit von den Arbeiten Spiras Impulse und Denkanstöße ausgehen können. Digitale Gesundheit: Was ändert sich für den Gesundheitsbegriff? Zusammenfassung Dieser Beitrag untersucht, wie sich mit der Entwicklung digitaler Gesundheitstechnologien das Verständnis von Krankheit und Gesundheit ändert. Digitale Technologien sind in einem bedeutsamen Sinn transgressiv. Sie gehen über die kurative und präventive Medizin hinaus und überschreiten die Grenzen zu einer wunscherfüllenden Medizin, die nach Verbesserung und Optimierung des menschlichen Körpers und seiner Leistungsfähigkeit sucht. Vor allem ist digitale Medizin eine Vision. Nicht, was es bereits gibt, sondern was möglich sein könnte, wird mit diesem Begriff in Verbindung gebracht. Digitale Medizin gibt ein Versprechen ab: Wenn es gelingt, medizinisches Wissen und gesundheitsbezogene Daten umfassend zu integrieren, wird es möglich, Krankheiten besser zu heilen, ja sogar ihr Auftreten zu verhindern. In Form eines medizinischen Avatars gießt sich diese Vision in eine konkrete technologische Gestalt. Ein solcher digitaler Zwilling stellt ein Abbild aller physiologischen und psychischen Vorgänge bereit, auf dessen Basis gesundheitsbezogene Prozessabläufe simuliert und therapeutische Maßnahmen evaluiert werden können. Aufgabe sozialwissenschaftlicher Reflexion ist es nun, im Sinne eines Vision Assessments die Implikationen neuer Technologien zu diskutieren, bevor sie Realität geworden sind. Besonders bedeutsam sind im diskutierten Zusammenhang die technologisch vermittelten Möglichkeiten eines lückenlosen Monitorings und einer umfassenden Simulation. Durch digitale Gesundheitstechnologien ändert sich nicht nur der Interventionsmodus medizinischen Handelns, sondern auch das, was wir autonomes Subjekt nennen. Gesundheit wird zu einer quantifizierbaren Zielvorgabe und zu einer Optimierungspraxis. Letztlich befördert dies die Ökonomisierung des Sozialen und verändert in tiefgreifender Weise, wie wir uns verhalten, um unsere Gesundheit zu erhalten, Krankheiten heilen oder präventiv verhindern. Im Feld der Verschwörungstheorien – Interaktionsregeln und kollektive Identitäten einer verschwörungstheoretischen Bewegung Zusammenfassung Trotz der steigenden politischen Bedeutung von Verschwörungstheorien gibt es bislang keine qualitativen soziologischen Auseinandersetzungen mit diesem Phänomen. Der vorliegende Beitrag versucht, diese Forschungslücke anhand von qualitativen Interviews mit Mitgliedern einer verschwörungstheoretischen Bewegung zu schließen. Dabei steht die Frage im Zentrum, wie Teilnehmerinnen dieser Bewegung mit internen inhaltlichen Differenzen umgehen und aller Heterogenität zum Trotz eine kollektive Identität ausbilden. Dabei zeigt sich, dass inhaltliche Differenzen ausgeklammert oder ignoriert werden. Während Verschwörungstheoretikerinnen von der Öffentlichkeit zumeist wörtlich, aber nicht ernst genommen werden, verhält es sich im Feld der Verschwörungstheorien umgekehrt. Verschwörungstheorien werden ernst, aber nicht wörtlich genommen. Die kollektive Identität der untersuchten Bewegung ergibt sich nicht aus einem geteilten Glauben an bestimmte Theorien, sondern aus einer kollektiven Opposition zur hegemonialen Wissensproduktion sowie dem gemeinsamen Zelebrieren herrschaftskritischer Lebensstile. Proving the world more imaginary? Abstract Sustainability research has set itself the double-challenge of uncovering the complexity of a globally, locally and historically unsustainable development path, and of contributing to a search process for more sustainable development paths for humanity. A small number of researchers involved in this area have suggested "that maybe the challenge of sustainability isn't to prove the world more real […] but to prove the world more imaginary" (Robinson as quoted in Taylor 2012, n. p.). Taking up this invocation of the imaginary, the article investigates some imaginaries and imagination of sustainability at play in sustainability research. Four relatively distinct approaches to sustainability research are identified, characterized and differentiated: "triple bottom-line", "sustainability transformation", "holistic healing/biophilia", and "culture of qualitative complexity". They each develop a specific focus, are nourished by partly different imaginaries and develop their imaginations in distinct directions. In this article, imagination is understood as an individual and social, perceptive and creative process by which we shape realities in our encounters with the world; whereas the imaginary is understood as a deep symbolic matrix that enables our access to the world. Imaginaries are not just made up and imposed on the world by the humans, but the result of an imaginative encounter with the human and other-than-human world. Focused attention on imagination and imaginaries not only allows to observe the area of sustainability research through a differentiating perspective that helps understand certain contrasting and/or shared features across different approaches to sustainability research. This focused attention also bears a potentially instrumental value for inter- and transdisciplinary sustainability research itself, because it encourages sustainability researchers to further reflect on the importance, modalities and different framings of creative and reflective approaches to futures-oriented research agendas. The creative exercise of the imagination is not only at the core of "anticipatory competences" (Wiek et al. 2011, p. 7) for sustainability, but also at the core of percipience to nature-culture's dynamic complexity. In this respect, sustainability research needs to develop its self-reflexivity beyond discourse-rational approaches to narratives, with a deeper understanding of both embodied cognition and of culture. Reflection on, and radically imaginative work with both dominant and alternative imaginaries that sustainability researchers operate from, such as the four imaginaries discussed in this article, are a precondition to any movement beyond institutional path-dependency to a globally unsustainable development. Social imaginaries and the limits of differential meaning Abstract Elaborating on theories of the social imaginary, this contribution addresses the shortcomings of a differential conception of meaning, which is widespread in the social and cultural sciences. After a brief literature review, a preliminary concept of the social imaginary and its sociological relevance will be outlined drawing on the works of Taylor and others. The theoretical argument of this article, the fundamental difference and complementarity between the differential logic of the symbolic and the fuzzy logic of the imaginary, will be developed in a discussion of structuralism and one of its most fervent critics: Castoriadis. The latter developed his account of the social imaginary as a critique of Marxist reductionism, of the structuralist analysis of language and totemism, and of "ensemblistic-identitarian logic" in general. The implications of Castoriadis' "imaginary significations"—a "magma" of meaning not exhausted by the differential order of signs—will be demonstrated discussing two contemporary sociological theories informed by structuralism as well as poststructuralism: Luhmann's system theory and the cultural sociology of Alexander and Smith. The social imaginary, as a reservoir of meaning and condition for the emergence of new meanings, not only illuminates the blind spots in these theories, but also has the potential to transform our thinking about culture and society. Das Imaginäre der Praxis Zusammenfassung Gegenwärtige Praxistheorie tendiert, so der Ausgangspunkt des Artikels, zu einem Ordnungsbias. Sie sieht letztlich keinen systematischen Ort für das Denken und Aufspüren von Momenten vor, die sich dem Gelingen von Praktiken entziehen oder widersetzen. Entsprechend thematisiert sie Probleme nahezu ausschließlich als interne Vollzugsprobleme, nicht aber als in Praktiken bearbeitete Bezugsprobleme. Mit Castoriadis' Begriff des Imaginären als einer schöpferischen Kraft, die sich in einem Andersmachen entfalten kann, bringen wir demgegenüber ein Beobachtungskonzept in die Praxistheorien ein, das es der praxeologischen Analyse erlaubt, aufzuspüren und zur Sprache zu bringen, was eine gegebene Ordnung auf etwas hin überschreitet, das in ihr angelegt, aber (noch) nicht entfaltet ist. Exemplarisch wird der mit Castoriadis zu erringende wissenschaftliche Landgewinn an Gegenwartsdiagnosen angedeutet, einem historischen Typ der symbolischen Repräsentation von Gesellschaft, der Bezugsprobleme erzeugt, vor deren Sinnhorizont sich die symbolische Ordnung in der Moderne entwirft. Am empirischen Beispiel der gegenwartsdiagnostisch durch Umweltdiskurse informierten Praktiken eines Öko-Dorfes wird aufgewiesen, dass einem solchen Entwurf über Planungsrationalität hinaus stets auch ein Potential der Kritik innewohnt, das Alternativen zum Bestehenden eröffnet. Auf dieser theoretischen und empirischen Folie mündet der Artikel in eine (Selbst‑)Kritik gegenwärtiger Praxistheorie und einen Ausblick auf Praxiskonzeptionen, die dem Ordnungsbias zu entgehen versprechen. Theorien des gesellschaftlichen Imaginären Zusammenfassung Im Anschluss an Cornelius Castoriadis' Konzept der Gesellschaft als imaginäre Institution lotet der Beitrag das theoretische und gesellschaftsanalytische Potential der Kategorie des gesellschaftlichen Imaginären aus. Die These ist: „Gesellschaft" erscheint in dieser französischen Theorietradition als dreifach kontrafaktische Imagination: als vorgestellte Identität in der Zeit; als vorgestellte Einheit der Mitglieder; als Fundierung des Kollektivs im imaginären Außen oder dem gesellschaftlichen Grund. Eine solche Theorie interessiert sich für die Konstitution von Gesellschaften, indem sie diese nicht allein auf die Identitätsbildung via Differenz bezieht, sondern ebenso auf die Erfindung einer Identität in der Zeit und vor allem das fundierende Außen. Der Beitrag zielt auf eine umfassende Theorie der Gesellschaft als imaginärer Institution. Dazu bezieht er neben Castoriadis weitere Konzepte ein, klassische Traditionen (Émile Durkheim, Henri Bergson) und an Castoriadis anschließende, historisch-vergleichende Gesellschaftsanalysen (Marcel Gauchet, Claude Lefort). Schließlich wird das gegenwartsanalytische Potential einer solchen Theorie des gesellschaftlichen Imaginären angedeutet.
Julia Dahlvik (2018): Inside Asylum Bureaucracy: Organizing Refugee Status Determination in AustriaMayer, Stefanie (2018): Politik der Differenzen. Ethnisierung, Rassismen und Antirassismus im weißen feministischen Aktivismus in WienZwischen Statuskrise und Autonomiebegehren: Solo-Selbstständigkeit als generationstypische Bearbeitung des Wandels von Arbeit und BiografieZusammenfassungDer vorliegende Beitrag untersucht soloselbstständige Erwerbstätigkeit aus einer biografieanalytischen und generationalen...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Electrode Array Type and Its Impact on Impedance Fluctuations and Loss of Residual Hearing in Cochlear Implantation Hypothesis/Objective: Determine variables associated with electrode impedance fluctuations and loss of residual hearing in cochlear implant (CI) recipients. Background: CI recipients with postoperative hearing preservation demonstrate superior speech perception with an electric-acoustic stimulation (EAS) device as compared with a CI-alone device. Maintaining superior speech perception over time relies on long-term hearing preservation; therefore, understanding variables that may contribute to loss of residual hearing is needed. Recent reports suggest a relationship between changes in electrode impedance and loss of residual hearing. The variables influencing this relationship have yet to be determined. Methods: Review of pediatric and adult CI cases from 2013 to 2016 who presented with preoperative residual hearing. Regression analysis was performed to evaluate effects of array type (lateral wall vs. perimodiolar), manufacturer, age at implantation, and preoperative hearing on impedance. The correlation between peak impedance change and change in low-frequency hearing was determined. Results: One hundred forty-six CI recipients presented with preoperative residual hearing. A multivariate regression analysis demonstrated a statistically significant association between preoperative hearing thresholds (p = 0.017), device manufacturer (p = 0.011), and array type (p = 0.038) on postoperative impedance changes. Hearing preservation rates and change in impedance differed by electrode array type. The association between peak impedance changes and loss of residual hearing differed between manufacturers (R2 = 0.208, p = 0.029 vs. R2 = 0.016, p = 0.609). Conclusion: Impedance fluctuation appears to be a marker for loss of residual hearing for specific electrode array types and manufacturers. Specific arrays may affect the cochlear microenvironment differently, with different effects on postoperative hearing preservation. Address correspondence and reprint requests to Kevin D. Brown, M.D., Ph.D., Associate Professor, Vice Chair of Outpatient Services, Chief of Division of Otology/Neurotology, Skull Base Surgery, Medical Director of Children's Cochlear Implant Center at UNC, 170 Manning Drive, CB#7070, Physicians Office Building, Rm G190A, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7070; E-mail: kevin_d_brown@med.unc.edu; Nicholas J. Thompson, M.D., University of North Carolina, Chapel Hill, NC; E-mail: nicholas.thompson@unchealth.unc.edu M.T.D. and L.R.P. are supported by a research grant from MED-EL; H.C.P., B.O.C., and K.D.B. serve on the Surgical Advisory Board for MED-EL. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company The Importance of the Temporal Bone 3T MR Imaging in the Diagnosis of Menière's Disease Background: The aim of this study was to evaluate endolymphatic hydrops using the 3T temporal bone magnetic resonance imaging (MRI), performed according to the chosen protocol, and determine whether it could be applied as an objective diagnostic tool for Menière's disease. Methods: 105 participants diagnosed with probable (n = 50) and definite (n = 55) Menière's disease were included in this prospective study at Vilnius University Hospital, Santaros Clinics. Audiometry, vestibular function tests, videonystagmography, and computer posturography were performed before MRI. The 3T MRI with gadolinium contrast was performed to evaluate the endolymphatic hydrops. Imaging protocol consisted of 3D-FLAIR and 3D T2DRIVE sequences. Vestibular endolymphatic sac was interpreted as enlarged if occupied more than 50% of the vestibular area. Results: 78.1% of subjects had abnormal MRI findings other than hydrops, and it was more than 90% (50/55) of patients in the definite MD group (p < 0.001). Changes in caloric test were observed in 63.8% of subjects in general, and in 76.4% of patients with a definite Menière's disease. The side of the endolymphatic hydrops observed on MR imaging corresponded to the clinical diagnosis of the Menière's disease based on the results of audiometry (p < 0.001) and unilateral weakness (p < 0.001). Endolymphatic hydrops on MRI and directional preponderance in caloric test were two independent predictors of the definite Menière's disease. Conclusions: Temporal bone 3T MRI with gadolinium contrast is clinically superior to confirm the diagnosis of Menière's disease. Grade II endolymphatic hydrops on MRI, directional preponderance, and unilateral weakness on caloric test were independent predictors for the definite Menière's disease. Address correspondence and reprint requests to Aistė Paškonienė, Centre of Ear, Nose and Throat Diseases, Vilnius University Hospital Santaros Clinics, Santariskiu str. 2, LT08661, Vilnius, Lithuania; E-mail: aiste.paskoniene@santa.lt The authors received no specific funding for this work. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company Comparison of Spontaneous Temporal Bone Cerebrospinal Fluid Leaks From the Middle and Posterior Fossa Objectives: To compare patients surgically managed for spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone arising from the middle cranial fossa (MCF) and posterior cranial fossa (PCF) and to describe the surgical management of posterior fossa CSF leaks. Study Design: Retrospective case review. Setting: Academic tertiary center. Patients: Adult patients presenting with spontaneous temporal bone CSF leaks undergoing operative repair between January 2010 and August 2018. Patients with a history of trauma, previous mastoid surgery, and iatrogenic CSF leaks were excluded. Intervention: Transmastoid or MCF CSF leak repair. Main Outcome Measures: Patient demographics, body mass index (BMI), comorbidities, presenting features, and lumbar puncture opening pressures were compared between groups and the management of the PCF CSF leaks described. Results: Forty-six patients (26 women, 20 men) were included. The mean age at the time of repair was 58.0 ± 12.9 years (±SD). The origin of the CSF leak was from the PCF in three patients and MCF in 43 patients. All three patients with PCF leaks presented with an acute history of meningitis compared with only seven (16%) in the MCF group. This difference was statistically significant (p = 0.01, Fisher's exact test). There were no statistically significant differences in age, sex, BMI, or lumbar puncture opening pressures. The PCF leaks were repaired using a transmastoid approach with multilayer closure of the bony defect and fat graft obliteration of the mastoid. Conclusions: Spontaneous CSF leaks arising from the PCF are rare and may present more commonly with meningitis. Identification requires careful review of imaging. Address correspondence and reprint requests to Andrew A. McCall, M.D., Eye and Ear Institute, Suite 500, 203 Lothrop Street, Pittsburgh, PA 15213; E-mail: mccallaa@upmc.edu Accepted for poster presentation at the American Neurotology Society Meeting at the Combined Otolaryngology Spring Meeting in Austin, TX on May 3–4, 2019. This material has never been published and is not currently under evaluation in any other peer-reviewed publication. Source of funding: None. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company Factors Associated With Facial Nerve Paresis Following Gamma Knife for Vestibular Schwannoma Objective: Evaluate the incidence of and potential contributory factors to facial nerve paresis and other cranial neuropathies (CN) following stereotactic radiosurgery with Gamma Knife (GK) for primary treatment of vestibular schwannoma (VS). Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Charts were reviewed for all adult patients receiving primary GK treatment for unilateral VS between 2005 and 2013. Patients with NF2 or previous surgery were excluded from analysis. Intervention: GK radiosurgery. Main Outcome Measures: The incidence of new-onset facial nerve paresis after primary GK treatment of VS was evaluated. Secondary endpoints included other cranial neuropathies. Results: One hundred thirty-three patients with VS received primary GK therapy. Posttreatment CN developed in 33 patients (24.8%). Twelve patients (9.0%) experienced trigeminal paresthesia, 11 (8.3%) developed sudden sensorineural hearing loss (SSNHL) requiring steroids, and seven (5.3%) demonstrated facial paresis. The mean maximum cochlear dose was 15.49 Gy in patients with facial paresis compared with 12.42 Gy in subjects without facial paresis (p = 0.032). Subjects with facial paresis were more likely to have a lateral tumor without fundal fluid on magnetic resonance imaging (MRI) (71%) compared with subjects without facial paresis (43%). Conclusions: In the treatment of VS with primary GK, maximum cochlear dose was significantly associated with facial paresis. Laterally extending tumors without fundal fluid on MRI experienced higher rates of facial paresis. These factors should be considered during GK treatment planning for VS. Address correspondence and reprint requests to Michael J. Ruckenstein, M.D., Department of Otolaryngology–Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, 5 Silverstein, Philadelphia, PA 19104; E-mail: Michael.ruckenstein@uphs.upenn.edu There are no financial disclosures to report. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company Systematic Review and Network Meta-analysis of Cognitive and/or Behavioral Therapies (CBT) for Tinnitus Objective: To evaluate the efficacy of cognitive and/or behavioral therapies in improving health-related quality of life (HRQOL), depression, and anxiety associated with tinnitus. Data Sources: EMBASE, MEDLINE, PubMed, PsycINFO, and the Cochrane Registry were used to identify English studies from database inception until February 2018. Study Selection: Randomized controlled trials (RCTs) comparing cognitive and/or behavioral therapies to one another or to waitlist controls for the treatment of tinnitus were included. Data Extraction: Quality and risk were assessed using GRADE and Cochrane's Risk of Bias tool respectively. Data Synthesis: Pairwise meta-analysis (12 RCTs: 1,144 patients) compared psychological interventions to waitlist controls. Outcomes were measured using standardized mean differences (SMDs) and 95% confidence intervals (CI). I2 and subgroup analyses were used to assess heterogeneity. Network meta-analysis (NMA) (19 RCTS: 1,543 patients) compared psychological therapies head-to-head. Treatment effects were presented by network diagrams, interval plots, and ranking diagrams indicating SMDs with 95% CI. Direct and indirect results were further assessed by inconsistency plots. Conclusions: Results are consistent with previously published guidelines indicating that CBT is an effective therapy for tinnitus. While guided self-administered forms of CBT had larger effect sizes (SMD: 3.44; 95% CI: −0.022, 7.09; I2: 99%) on tinnitus HRQOL, only face-to-face CBT was shown to make statistically significant improvements (SMD: 0.75; 95% CI: 0.53, 0.97; I2: 0%). Guided self-administered CBT had the highest likelihood of being ranked first in improving tinnitus HRQOL (75%), depression (83%), and anxiety (87%), though statistically insignificant. This NMA is the first of its kind in this therapeutic area and provides new insights on the effects of different forms of cognitive and/or behavioral therapies for tinnitus. Address correspondence and reprint requests to Brian D. Westerberg, M.D., F.R.C.S.C., M.H.S.c., Department of Otolaryngology-Head and Neck Surgery, St. Paul's Hospital, BC Rotary Hearing & Balance Clinic, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; E-mail: BWesterberg@providencehealth.bc.ca BDW and JL have paid travel expenses to attend cochlear implant conferences for educational and CME purposes from Med El, Cochlear, and Oticon. No financial support was received for the completion of this study. The authors disclose no conflicts of interest. Supplemental digital content is available in the text. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company Postoperative Healthcare Utilization of Elderly Adults After Cochlear Implantation Objective: To determine the association between geriatric age and postoperative healthcare utilization after cochlear implantation. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: : Older adults (>59 yr) who underwent unilateral cochlear implantation from 2009 until 2016. Intervention(s): : Standard electrode length cochlear implantation. Main Outcome Measure(s): : Postoperative surgical and audiological visit rate after cochlear implantation for those aged 60 to 69, 70 to 79, and 80+ years. Results: : Fifty-nine older adult patients were included in the study with a mean age of 71.5 ± 6.9 years (range, 60–88 yr), mean duration of hearing loss of 25.4 ± 19.6 years (range, 0.25–67 yr), and mean length of follow up of 37 ± 24.6 months (range, 6–107 mo). There was no significant difference in the mean number of surgical and audiological visits over both the first and second postoperative years between those aged 60 to 69, 70 to 79, and 80+ years. Additionally, on one-way multivariate analysis of covariance (MANCOVA), there was no significant difference in cumulative postoperative healthcare utilization measures between each age group, when controlling for postoperative AzBio scores, estimated household income, and driving distance to the hospital. Conclusions: Older geriatric adults do not have higher rates of postoperative healthcare utilization after cochlear implantation than their younger, geriatric hearing impaired counterparts, despite presumed higher rates of frailty and comorbidity. Address correspondence and reprint requests to Esther X. Vivas, Department of Otolaryngology, Emory University Hospital Midtown, Medical Office Tower, 11th Floor, Suite 1135, 550 Peachtree St NE, Atlanta, GA 30308; E-mail: evivas@emory.edu Disclosures and Support: none. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company Risks of Intracochlear Pressures From Laser Stapedotomy Hypothesis: Surgical manipulations during laser stapedotomy can produce intracochlear pressure changes comparable to pressures created by high-intensity acoustic stimuli. Background: New-onset sensorineural hearing loss is a known risk of stapes surgery and may result from pressure changes from laser use or other surgical manipulations. Here, we test the hypothesis that high sound pressure levels are generated in the cochlea during laser stapedotomy. Methods: Human cadaveric heads underwent mastoidectomy. Fiber-optic sensors were placed in scala tympani and vestibuli to measure intracochlear pressures during key steps in stapedotomy surgery, including cutting stapedius tendon, lasering of stapedial crurae, crural downfracture, and lasering of the footplate. Results: Key steps in laser stapedotomy produced high-intensity pressures in the cochlea. Pressure transients were comparable to intracochlear pressures measured in response to high intensity impulsive acoustic stimuli. Conclusion: Our results demonstrate that surgical manipulations during laser stapedotomy can create significant pressure changes within the cochlea, suggesting laser application should be minimized and alternatives to mechanical downfracture should be investigated. Results from this investigation suggest that intracochlear pressure transients from stapedotomy may be of sufficient magnitude to cause damage to the sensory epithelium and affirm the importance of limiting surgical traumatic exposures. Address correspondence and reprint requests to Nathaniel T. Greene, Ph.D., Department of Otolaryngology, University of Colorado School of Medicine, 12631 E. 17th Ave., Mail Stop B205, Aurora, CO 80045; E-mail: Nathaniel.Greene@CUAnschutz.edu Author contribution statement: E.M., R.M.B.H., S.P.G., and N.T.G. designed and performed the experiments; E.M., R.M.B.H., S.P.G., and N.T.G. reviewed data and provided interpretive analysis; E.M., R.M.B.H., and N.T.G. analyzed data and wrote the paper. All authors discussed the results and implications and commented on the manuscript at all stages. S.G. receives grant support from the NIH/NIDCD for work unrelated to this project and is on the scientific advisory boards for Applied Genetic Technologies Corporation and Roche. He is also a consultant for Cochlear Corporation and Sirocco Therapeutics. In addition, he is on the advisory board for the Cystic Fibrosis Foundation and receives research support without personal financial remuneration from Med-El Corporation. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company On the Relationship Between Menière's Disease and Endolymphatic Hydrops The relationship between Menière's disease and endolymphatic hydrops is ambiguous. On the one hand, the existence of cases of endolymphatic hydrops lacking the classic symptoms of Menière's disease has prompted the assertion that endolymphatic hydrops alone is insufficient to cause symptoms and drives the hypothesis that endolymphatic hydrops is a mere epiphenomenon. Yet, on the other hand, there is considerable evidence suggesting a relationship between the mechanical pressure effects of endolymphatic hydrops and resultant disordered auditory physiology and symptomatology. A critical appraisal of this topic is undertaken, including a review of key histopathologic data chiefly responsible for the epiphenomenon hypothesis. Overall, a case is made that A) the preponderance of available evidence suggests endolymphatic hydrops is likely responsible for some of the auditory symptoms of Menière's disease, particularly those that can be modulated by mechanical manipulation of the basilar membrane and cochlear microphonic; B) Menière's disease can be reasonably considered part of a larger spectrum of hydropic inner ear disease that also includes some cases that lack vertigo. C) The relationship with endolymphatic hydrops sufficiently robust to consider its presence a hallmark defining feature of Menière's disease and a sensible target for diagnostic detection. Address correspondence and reprint requests to Michael B. Gluth, M.D., Section of Otolaryngology–Head & Neck Surgery, The University of Chicago Medicine & Biological Sciences, 5841 S. Maryland Ave., Rm. E-103, MC 1035, Chicago, IL 60637; E-mail: mgluth1@surgery.bsd.uchicago.edu The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company Long-Term Stability and Functional Outcome of an Active Middle Ear Implant Regarding Different Coupling Sites Objectives: Indication and implantation of active middle ear implants (AMEI) are well established. Choice of the coupling site depends from the individual anatomical situation. Long-term stability of different coupling sites in terms of functional outcome and complications are rare and were investigated in this study. Design: Retrospective analysis of 41 consecutive patients (45 ears) with coupling of the AMEI at the incus, stapes, and round window. Analysis of preoperative, postoperative, and long-term results of pure-tone average, speech discrimination in quiet at 65 dB (German language Freiburg Monosyllabic Test) and noise (German language Oldenburger Sentence Test), rate of revision surgeries as well as explantations and the novel parameter patient years (py). Results: Mean of follow-up was 3.0 ± 1.7 years resulting in a total of 135.6 py. Bone conduction was stable in all patients pre- to postoperatively as well as preoperatively to the long-term. Round window patients had the broadest air-bone gap (31.4 ± 19.4 dB HL) benefitting the most from the AMEI (functional gain = 39.0 ± 12.8 dB HL). Regarding speech discrimination, incus patients performed the best both in quiet (77.7 ± 22.8%) and noise (3.4 ± 2.9 dB SNR). In terms of revision surgery and explantations, round window patients exhibited the highest rates (20%). Conclusions: Regarding all coupling sites, satisfying long-term stability results and comparable complication rates were reported with best performance of coupling to the incus. Implementation of patient years might be a novel parameter for the comparison of revisions and explantations. Address correspondence and reprint requests to Jennifer L. Spiegel, M.D., Marchioninistr. 15, 81377 Munich, Germany; E-mail: jennifer.spiegel@med.uni-muenchen.de Author contributions: J.L.S. analyzed data, and wrote the paper; L.K. collected and analyzed data; M.J., B.G.W., and M.C. conceptualized the study and provided critical revision; F.I. designed the experiments, collected and analyzed data, and wrote the paper. All authors discussed the results and implications and commented on the manuscript at all stages. This work was supported by the German Federal Ministry of Education and Health (BMBF) in the context of the foundation of the German Center for Vertigo and Balance Disorders (DSGZ) (grant number 01 EO 0901). The authors did not receive payment or support in kind for any aspect of the submitted work. The authors disclose no conflicts of interest. Supplemental digital content is available in the text. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company 3D-Printed Microneedles Create Precise Perforations in Human Round Window Membrane in Situ Hypothesis: Three-dimensional (3D)-printed microneedles can create precise holes on the scale of micrometers in the human round window membrane (HRWM). Background: An intact round window membrane is a barrier to delivery of therapeutic and diagnostic agents into the inner ear. Microperforation of the guinea pig round window membrane has been shown to overcome this barrier by enhancing diffusion 35-fold. In humans, the challenge is to design a microneedle that can precisely perforate the thicker HRWM without damage. Methods: Based on the thickness and mechanical properties of the HRWM, two microneedle designs were 3D-printed to perforate the HRWM from fresh frozen temporal bones in situ (n = 18 total perforations), simultaneously measuring force and displacement. Perforations were analyzed using confocal microscopy; microneedles were examined for deformity using scanning electron microscopy. Results: HRWM thickness was determined to be 60.1 ± 14.6 (SD) μm. Microneedles separated the collagen fibers and created slit-shaped perforations with the major axis equal to the microneedle shaft diameter. Microneedles needed to be displaced only minimally after making initial contact with the RWM to create a complete perforation, thus avoiding damage to intracochlear structures. The microneedles were durable and intact after use. Conclusion: 3D-printed microneedles can create precise perforations in the HRWM without damaging intracochlear structures. As such, they have many potential applications ranging from aspiration of cochlear fluids using a lumenized needle for diagnosis and creating portals for therapeutic delivery into the inner ear. Address correspondence and reprint requests to Anil K. Lalwani, M.D., Division of Otology, Neurotology, and Skull Base Surgery, Department of Otolaryngology—Head and Neck Surgery, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, Harkness Pavilion, 8th Floor, New York, NY 10032; E-mail: anil.lalwani@columbia.edu J.W.K. and A.K.L. are co-senior authors. Research was funded by the National Institutes of Health National Institute on Deafness and Other Communication Disorders with award number R01DC014547. Dr. A.K.L. is on the Medical Advisory Board of Advanced Bionics. The authors disclose no conflicts of interest. Supplemental digital content is available in the text. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://journals.lww.com/otology-neurotology). Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company
Electrode Array Type and Its Impact on Impedance Fluctuations and Loss of Residual Hearing in Cochlear ImplantationHypothesis/Objective: Determine variables associated with electrode impedance fluctuations and loss of residual hearing in cochlear implant (CI) recipients. Background: CI recipients with postoperative hearing preservation demonstrate superior speech perception with an electric-acoustic stimulation (EAS) device as compared with a CI-alone device. Maintaining superior speech perception...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Consensus and Controversies Between Pain and Addiction Experts on the Prevention, Diagnosis, and Management of Prescription Opioid Use Disorder Objectives: Prescription opioid use disorder (POUD) is an established public health crisis in many countries, and current evidence indicates it is a growing problem in Europe. Many specialists play a role, including pain and addiction medicine specialists, in the diagnosis and management of POUD, but neither group can fully address these patients' needs alone. The purpose of this consensus process was to bring together experts from pain and addiction medicine to examine the positions of both specialties. Methods: In all, 13 international pain medicine, addiction medicine, and addiction psychiatry experts convened a meeting to formulate a set of consensus statements on the diagnosis and management of POUD. The statements were further refined by a wider group of 22 European expert clinicians. At a second meeting of all 35 participants, a set of controversy statements was also developed to recognize some of the key areas of divergent opinion. Results/conclusions: There was a high level of agreement between pain and addiction specialists. Key themes that emerged were the need to strengthen interdisciplinary communication, a desire for greater education and training for clinicians in both specialties, and mutual acknowledgment of the importance of multidisciplinary management of POUD. The blurred line between poorly managed pain and POUD was also a subject of much discussion, reflecting the difficulties in defining and diagnosing this complex condition. Send correspondence to Mark Kraus, MD, and Kaitlin Pellicano, MD, 714 Chase Parkway, Waterbury, CT 06708. E-mail: MLK@wsmgct.com; pellicanomd@gmail.com Received 8 October, 2018 Accepted 20 August, 2019 Funding: The authors would like to acknowledge funding support from PharmaComMedia and Indivior for facilitating travel and honoraria for the participants to attend 2 meetings at which the consensus positions were developed. Indivior had no input in the proceedings of the meetings or in the work presented here. The authors have no conflicts of interest. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.journaladdictionmedicine.com). © 2019 American Society of Addiction Medicine A Light in the Darkness: Repetitive Transcranial Magnetic Stimulation (rTMS) to Treat the Hedonic Dysregulation of Addiction The present paper discusses the potential use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of addiction, within a conceptual framework that includes the "dark side" of addiction. New findings suggest that rTMS may rescue specific reward system dysfunction that underlies the pathophysiology of addiction by exposing widely under-recognized and untreated key clinical and psychopathological aspects of addictive disorders. Our paper sheds light on the relevance of these hidden dimensions for the development of effective treatment interventions. In particular, we argue that rTMS may have an impact on craving by reversing the allostatic load of hedonic dysregulation. Send correspondence to George F. Koob, PhD, National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Room 1209, MSC 6902, Bethesda, MD 20892-6902. E-mail: george.koob@nih.gov Received 28 February, 2019 Accepted 4 July, 2019 The authors report no conflicts of interest. © 2019 American Society of Addiction Medicine Opioid and Amphetamine Treatment Trends Among American Indians in the Great Plains Objectives: Traditionally underserved populations in the United States, particularly rural and American Indian/Alaska Native (AI/AN) communities, are disproportionately impacted by the opioid and amphetamine epidemics and have a higher risk for substance use disorders. AI/AN communities in the American Great Plains face exceptional health risks. We aim to describe recent trends in opioid and amphetamine treatment admissions for AI/ANs living in the Great Plains relative to that of the general population. Methods: We used data from the 2014 to 2016 Substance Abuse and Mental Health Services Administration (SAMHSA) Drug and Alcohol Services Information System (DASIS) Treatment Episode Data Set (TEDS) for Admissions. We extracted opioid and amphetamine treatment admissions for self-identified AI/AN and non-AI/AN patients living in the Great Plains: North Dakota, South Dakota, Nebraska, and Iowa. Average annual admission rates were calculated and compared from 2014 to 2016 for AI/AN versus non-AI/AN populations. Results: While opioid and amphetamine treatment admissions from 2014 to 2016 increased in both AI/AN (49 vs 80 per 10,000) and non-AI/AN (20 vs 26 per 10,000) populations, the rate of increase was significantly greater among AI/ANs (64% vs 32%; P < 0. 01). These trends are largely reflective of increased amphetamine use treatment admissions observed in both AI/AN and non-AI/AN populations. Conclusions: Treatment admissions for opioid and amphetamine use have increased from 2014 to 2016 for both AI/AN and non-AI/AN individuals in the Great Plains, driven largely by amphetamine use. AI/AN individuals were observed to seek care at a much higher rate. This increase in treatment admissions suggests increasing demand for services, which, in turn, necessitates greater investment of resources into AI/AN health facilities to address opioid and amphetamine use disorder in this underserved population. Send correspondence to Julian A. Mitton, MD, MPH, Massachusetts General Hospital, Division of General Internal Medicine, 100 Cambridge Street, 16th Floor, Boston, MA 02114. E-mail: jmitton@partners.org Received 13 May, 2019 Revised 23 September, 2019 Accepted 3 October, 2019 The authors report no conflicts of interest. © 2019 American Society of Addiction Medicine Screening, Brief Intervention, and Referral to Treatment for Prenatal Alcohol Use and Cigarette Smoking: A Survey of Academic and Community Health Care Providers Objectives: Prenatal alcohol and cigarette smoking are associated with numerous adverse pregnancy outcomes. Screening, Brief Intervention, and Referral to Treatment (SBIRT) represents a standardized approach; however, implementation in routine pregnancy care remains a challenge. The purpose of the study was to determine current practices, barriers to implementation, and education needs of healthcare providers utilizing SBIRT to address prenatal alcohol and cigarette smoking. Methods: We conducted a survey of 118 providers including family physicians, midwives, and obstetricians practicing at 2 Toronto hospitals: community-based teaching site and fully affiliated academic health sciences center. Results: The response rate was 79%. Almost all providers reported screening every pregnant woman for alcohol and smoking status. Brief intervention was offered by fewer providers. Education and supportive counseling were reported by a higher percentage of providers for prenatal cigarette smoking in comparison to alcohol use. Furthermore, up to 60% referred pregnant women to treatment programs for alcohol and cigarette smoking. A significantly higher number of community-based providers reported referring pregnant women to addiction treatment programs. Barriers to interventions included a perceived lack of appropriate resources, training, and clinical pathways. Conclusion: Healthcare providers report universal screening for prenatal alcohol and cigarette smoking; however, brief intervention and referral to treatment are more limited practices. There is a need for education of all providers regarding effective brief counseling strategies and referral to appropriate treatment resources. Development of clinical care pathways may also increase adoption of all components of SBIRT for prenatal alcohol use and cigarette smoking. Send correspondence to Alice Ordean, MD, St. Joseph's Health Centre, Family Medicine Clinic, 30 The Queensway, Toronto, ON M6R 1B5, Canada. E-mail: Alice.Ordean@unityhealth.to. Received 24 April, 2019 Accepted 17 September, 2019 Funding: This project was supported by grant funding from the University of Toronto Practice-Based Research Network (UTOPIAN), Department of Family and Community Medicine, University of Toronto. The funding source was not involved in study design, collection, analysis and interpretation of data nor in the preparation or submission of this manuscript for publication. Disclosure: Dr Ordean receives salary support for academic work from the Department of Family Medicine at St. Joseph's Health Centre. Dr Ordean has also received honoraria for presentations and development of educational materials relating to substance use in pregnancy. Dr Selby has received commercial funding/grants from Pfizer Inc., Bhasin Consulting Fund Inc., Shoppers Drug Mart, and the Patient-centered Outcomes Research Institute. Dr Selby has also received honorariums from Pfizer Canada Inc., and Bristol-Myers Squibb. Dr Selby has received consulting fees from Pfizer Canada Inc., Evidera Inc., Johnson & Johnson Group of Companies, Medcan Clinic, MedPlan Communications (who organized Pfizer Canada Inc. events), Miller Medical Communications, NVision Insight Group, Sun Life Financial, and Myelin & Associates. Dr Selby has also received drugs free/discounted for study through an open tender process from Pfizer Inc., Novartis, and Johnson & Johnson. Finally, Dr Selby receives salary support as a Clinician Scientist from the Centre for Addiction and Mental Health (CAMH) and the Department of Family & Community Medicine at the University of Toronto. Dr. Milena Forte and Ms. Erin Grennell have no conflict of interest to report. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 © 2019 American Society of Addiction Medicine Supporting the Use of Medications for Addiction Treatment in US Drug Courts: Opportunities for Health Professionals Drug courts are specialty courts that offer treatment services as alternatives to incarceration for defendants struggling with problems related to substance use. These courts have become major access points in the United States for the treatment of substance use disorders, but drug court participants often have limited access to medications for addiction treatment (MAT). A growing chorus of advocates and organizations have called for expanding access to MAT in drug courts, and health professionals may wonder how to join in these efforts. This article reviews practical ways in which individual health professionals might support access to MAT in drug courts, including working with drug courts, fighting public stigma against MAT, contributing to research on MAT in drug courts, and expanding addiction training among clinicians. Send correspondence to Nathaniel P. Morris, MD, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA. E-mail: npm@stanford.edu Received 30 April, 2019 Accepted 22 June, 2019 Disclosure: The authors declare no conflicts of interest. © 2019 American Society of Addiction Medicine Health Professionals Should be Involved in Shaping Substance Use Disorder Policy Health professionals should become actively involved in creating evidence based SUD policies as individuals; as members of advisory commissions; as advocates within professional associations and through participation in political campaigns as candidates, donors or activists. Send correspondence to David L Rosenbloom, PhD, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118. E-mail: drosenbloom@bu.edu Received 26 August, 2019 Accepted 17 September, 2019 Disclosure: The authors have no conflicts of interest to disclose. © 2019 American Society of Addiction Medicine Validity of Self-reported Cannabis Use Among Pregnant Females in Northern California Background: Most clinical and epidemiologic estimates of prenatal cannabis use are based on self-report, and the validity of self-reported cannabis use has not been examined in a large, representative population of pregnant women. We determined the validity of self-reported prenatal cannabis use and predictors of nondisclosure using data from Kaiser Permanente Northern California's (KPNC) healthcare system with universal prenatal cannabis screening during prenatal care. Methods: Validation study using data from 281,025 pregnancies in KPNC among females aged ≥11 years who completed a self-administered questionnaire on prenatal cannabis use and a cannabis urine toxicology test from 2009 to 2017. We calculated sensitivity, specificity, positive predictive value, and negative predictive value of self-reported prenatal cannabis use using urine toxicology testing as the criterion standard, and sensitivity of urine toxicology testing using self-reported use as the criterion standard. We compared sociodemographics of those who disclosed versus did not disclose prenatal cannabis use. Results: Urine toxicology testing identified more instances of prenatal cannabis use than self-report (4.9% vs 2.5%). Sensitivity of self-reported use was low (33.9%). Sensitivity of the toxicology test was higher (65.8%), with greater detection of self-reported daily (83.9%) and weekly (77.4%) than monthly or less use (54.1%). Older women, those of Hispanic race/ethnicity, and those with lower median neighborhood incomes were most likely to be misclassified as not using cannabis by self-reported screening. Conclusions: Given that many women choose not to disclose prenatal cannabis use, clinicians should educate all prenatal patients about the potential risks and advise them to quit cannabis use during pregnancy. Send correspondence to Kelly C. Young-Wolff, PhD, MPH, Research Scientist, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612. E-mail: Kelly.c.young-wolff@Kp.org Received 21 June, 2019 Accepted 1 September, 2019 All authors assisted in the conceptualization and design of the study. Young-Wolff and Sarovar conducted the literature searches and summaries of previous related work. Tucker and Sarovar extracted the data needed for the study and Sarovar and Alexeeff undertook the statistical analysis. Young-Wolff wrote the first draft of the manuscript, which was revised and edited by all authors. All authors contributed to and have approved the final manuscript. Funding: This study was supported by a NIH NIDA K01 Award (DA043604). The authors have no conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.journaladdictionmedicine.com). © 2019 American Society of Addiction Medicine A Multicenter, Randomized, Double-blind, Parallel, Placebo-controlled Clinical Study to Evaluate the Efficacy and Safety of a Nicotine Mint Lozenge (2 and 4 mg) in Smoking Cessation Objective: To evaluate the efficacy in smoking cessation and safety of 2 and 4 mg nicotine mint lozenges in Chinese adult smokers. Methods: This was a multicenter, randomized, stratified, double-blind, placebo-controlled, parallel-group study. The low-dependence stratum included 483 smokers (241 randomized to active 2 mg nicotine lozenge and 242 to placebo lozenge). The high-dependence stratum included 240 smokers (120 randomized to active 4 mg nicotine lozenge and 120 to placebo lozenge). The primary endpoint was successful smoking cessation at 6 weeks postquit, defined as continuous abstinence from smoking for the 28-day period up to and including the 6-week visit (verified by CO measurement). Cochran–Mantel–Haenszel tests were performed to compare quit rates between active nicotine and placebo separately for the high-dependence and low-dependence strata. Results: The primary analysis showed that in the low-dependence (2 mg) stratum, 59 subjects (24.5%) of 241 in the active nicotine group and 52 subjects (21.5%) of 242 in the placebo group were successful quitters (P = .3851). In the high-dependence (4 mg) stratum, 37 subjects (30.8%) of 120 in the active nicotine group and 24 subjects (20.2%) of 119 in the placebo group were successful quitters (P = .0565). Conclusions: The 4 mg nicotine lozenge provided a directionally significant improvement in smoking cessation rates compared with placebo in Chinese adult smokers with high nicotine dependence for the primary endpoint. The 2 mg nicotine lozenge provided higher, but nonsignificant, smoking cessation rates than placebo. Both nicotine lozenges were generally well tolerated in Chinese adult smokers. Send correspondence to Chen Wang, MD, PhD, China-Japan Friendship Hospital, 2 Yinghuayuan E St, Chaoyang Qu, Beijing, 100029, China. E-mail: cyh-birm@263.net Received 20 September, 2018 Accepted 28 April, 2019 Current affiliation: Accenture, Berwyn, PA, USA. On behalf of the following Principal Investigators: Chunxue Bai (Zhongshan Hospital Fudan University, Shanghai); Kejing Ying (Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou); Ping Chen (General Hospital of Shenyang Military District PLA, Shenyang); Qiang Li (Changhai Hospital, Second Medical Military University, Shanghai); Nanshan Zhong (The First Affiliated Hospital of Guangzhou Medical University, Guangzhou); Gengzhi Ge (The 2nd Hospital of Tainjin Medical University, Tianjin); Jiangtao Lin (China-Japan Friendship Hospital, Beijing); Baoyuan Chen (Tianjin Medical University General Hospital, Tianjin). This study was sponsored by Tianjin Sino-American SmithKline & French Laboratory Ltd. Medical writing assistance was provided by Peloton Advantage, LLC, an OPEN Health company, and was funded by GlaxoSmithKline Consumer Healthcare. GlaxoSmithKline Consumer Healthcare provided a full review of the article. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.journaladdictionmedicine.com). © 2019 American Society of Addiction Medicine Sustained-release Oral Hydromorphone for the Treatment of Opioid Use Disorder Objectives: In 2017, almost 50,000 Americans and over 4000 Canadians died from an opioid overdose. Accordingly, an urgent need exists to improve access to evidence-based treatment for opioid addiction, and also to develop and evaluate alternative treatment options for opioid use disorder (OUD). We present a case of a patient with OUD who was successfully switched and managed on oral hydromorphone after development of a prolonged QTc interval on methadone. Case: A 51-year-old man with longstanding polysubstance use presented to an urban hospital in Vancouver, Canada, for management of alcohol intoxication and hyponatremia. At the time of admission, the patient was stable on 100 mg of methadone daily, but was found to have a persistently elevated QTc (>550 milliseconds), putting him at increased risk for Torsades de Pointes. In an effort to find an alternative opioid agonist therapy for maintenance, a trial of slow-release oral morphine was attempted, but discontinued due to the development of myoclonus. Once-daily sustained-release oral hydromorphone was then started, which was found to manage cravings well without notable side effects. Discussion: The case presented offers promise for the use of once-daily sustained-release oral hydromorphone as a viable treatment option for patients with OUD for whom first-line therapies are not suitable or tolerated. This case report is the first to our knowledge to demonstrate the successful use of oral hydromorphone for treatment of opioid use disorder. Send correspondence to Seonaid Nolan, MD, Assistant Professor, University of British Columbia, Clinician Scientist, British Columbia Centre on Substance Use, 553B-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. E-mail: Seonaid.nolan@bccsu.ubc.ca Received 8 July, 2019 Accepted 22 September, 2019 Disclosure: S.N. is supported by a Michael Smith Foundation for Health Research Health Professional Investigator award. The other authors report no conflicts of interest. © 2019 American Society of Addiction Medicine Sexual Abuse and Future Mental Health Hospitalization in a Swedish National Sample of Men Who Use Opioids Objective: Experiences of trauma, specifically sexual abuse, have been linked to both mental health and substance use disorders. This study used 14 years of Swedish health registry data to select a sample of adult men who reported frequent opioid use and assessed if those with a self-reported history of sexual abuse had a higher likelihood of hospitalization for a mental health disorder. Methods: A Swedish longitudinal (2003–2017) registry study linked Addiction Severity Index (ASI) assessments completed with individuals who sought treatment for substance use disorders with data on hospitalizations for mental health disorders, and assessed associations with self-reported histories of sexual abuse among men who reported sustained and frequent use of opioids (n = 1862). Cox regression methods tested associations and controlled for age, and the 7 ASI composite scores: family and social relationships, employment, alcohol use, drug use, legal, physical health, and mental health. Results: The ASI composite score for mental health (hazard ratio [HR] 16.6, P < 0.001) and a history of sexual abuse (HR 1.93, P < 0.001) were associated with an elevated risk of future mental health hospitalization. Conclusion: Both the ASI composite scores for mental health and self-reported history of sexual abuse reflected complex needs among men who used opioids and increased risk for mental health hospitalization. Treatment providers should strive to provide integrated care and address the negative aspects of victimization. Send correspondence to Marcus Blom Nilsson, Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden. E-mail: Marcus.Blom.Nilsson@umu.se Received 11 February, 2019 Accepted 12 September, 2019 Funding: A grant from the Swedish Research Council for Health, Working Life and Welfare (Grant No. 2016–07213) supported the analysis and manuscript preparation. The contributing authors have no financial interests affecting this manuscript and certify that there are no conflicts of interest, including relationships and affiliations relevant to the subject matter or materials discussed in the manuscript. © 2019 American Society of Addiction Medicine
Consensus and Controversies Between Pain and Addiction Experts on the Prevention, Diagnosis, and Management of Prescription Opioid Use DisorderObjectives: Prescription opioid use disorder (POUD) is an established public health crisis in many countries, and current evidence indicates it is a growing problem in Europe. Many specialists play a role, including pain and addiction medicine specialists, in the diagnosis and management of POUD, but neither group can fully address these patients' needs alone....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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 Infectious Disease Management and Control with Povidone Iodine In the original publication, Figure 1 was incorrectly published. The correct figure is given here. Specific Varicella-Related Complications and Their Decrease in Hospitalized Children after the Introduction of General Varicella Vaccination: Results from a Multicenter Pediatric Hospital Surveillance Study in Bavaria (Germany) AbstractBackground Universal varicella vaccination (UVV) for children introduced in Germany in 2004 resulted in a significant overall decline of varicella-related hospitalizations (VRHs). We investigated the incidence of specific types of varicella-related complications (VRCs) in hospitalized children and the impact of UVV on VRCs during the first 7 years of UVV.Methods Children < 17 years of age hospitalized with an ICD-10-based (International Classification of Diseases, 10th Revision) discharge diagnosis of varicella were identified as VRH in pediatric hospitals in Bavaria by annual standardized data queries of the hospital databases (2005–2011). For each VRH, the hospitals reported basic demographic data, duration of hospital stay, all diagnostic and procedural codes, and outcome. VRCs were reported overall, per year, and by immune status. Complication rates were calculated as mean number per complication category per hospital and per year; VRC trends over time were assessed by linear regression.Results Between 78% (2005) and 61% (2011) of Bavarian hospitals participated and reported a total of 1263 VRHs. Specific VRCs were reported in 954 (76%) children. Complication rates per hospital and year decreased from 6.7 [95% confidence interval (CI): 5.1–8.3] in 2005 to 1.5 (95% CI: 0.8–2.3) in 2011, with the strongest reduction of 90% in children < 5 years of age from 5.3 (95% CI: 4.0–6.6) in 2005 to 0.5 (95% CI: 0.1–0.9) in 2011. Significant decreases were observed for children with upper respiratory tract (URT, by 97%), lower respiratory tract (LRT, by 90%), skin (by 81%), gastrointestinal (by 78%), and neurologic (by 65%) VRCs. Forty-eight children with VRCs were immunocompromised; their annual rate decreased by 87%.Discussion Corresponding to increasing varicella vaccination coverage in the population, the incidence of VRC decreased by 77% from 2005 to 2011, with the most substantial decrease in the target group for UVV.Conclusion Within 7 years, UVV in Germany led to a decrease of about 77% of all types of VRCs, with the highest reductions observed for VRCs of the respiratory tract. A Community-Based Survey to Assess Knowledge, Attitudes, Beliefs and Practices Regarding Herpes Zoster in an Urban Setting AbstractIntroduction In the USA, nearly one in three people will experience herpes zoster (HZ) in their lifetime. Underserved communities may be at even higher risk due to several factors, including access to healthcare, education, and co-morbid conditions. The purpose of this study was to investigate current knowledge, attitudes, beliefs and practices (KABP) relative to HZ and HZ vaccines in a large urban city.Methods A cross-sectional KABP survey was conducted via in-person interview among 381 participants aged ≥ 50 years in Detroit, MI, USA, from June to August 2018. Survey results were stratified into two groups [< 60 and ≥ 60 years of age (YO)] for comparison.Results Of the 381 participants, 373 reported their age (110 < 60 YO and 263 ≥ 60 YO). Overall, the majority of participants reported having heard of HZ and HZ vaccines. In addition, receiving a recommendation from a healthcare provider (37.5%) followed by gaining a better understanding of HZ vaccine (36.7%) and of HZ (29.9%) were leading factors that influenced participants' willingness to receive the vaccine. Of note, 65.5% of participants < 60 YO reported the belief that HZ is preventable versus only 53.2% in those ≥ 60 YO (p = 0.001).Conclusion Our findings underscore the need to educate patients in underserved communities about HZ as well as new HZ vaccine recommendations to improve vaccination rates and reduce the incidence of HZ and its associated sequelae. Immunological and Clinical Benefits of Maternal Immunization Against Pertussis: A Systematic Review Abstract Infants are vulnerable to pertussis infection particularly before initiation of pertussis vaccination. Maternal pertussis vaccination during pregnancy has been introduced in a number of countries in order to confer on young infants indirect protection from the disease through transplacental transfer of maternal antibodies. We reviewed the evidence on the immunogenicity and efficacy of maternal pertussis vaccination during pregnancy. A systematic search of PubMed/MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews, ProQuest, and Science Direct was undertaken to identify studies published between January 1995 and December 2018. This review was not specific to any particular pertussis vaccine but included applicable data on available pertussis vaccines administered to pregnant women. The search identified 40 publications for inclusion in this review. Vaccination during pregnancy elicited robust maternal immune responses against all vaccine antigens and resulted in high placental transfer of pertussis antibodies to the infant that persisted well beyond delivery. Vaccination during the second or early third trimesters was considered ideal for antibody quantity and functionality. Although blunting of immune responses to some antigens in the primary immunization series was documented in neonates born to women vaccinated during pregnancy, there was no apparent adverse effect on vaccine efficacy. Multiple studies conducted in diverse settings have confirmed the effectiveness of maternal pertussis vaccination during pregnancy in preventing pertussis in infants prior to receipt of their first primary vaccine dose and beyond. These findings collectively underscore the value of maternal pertussis vaccination during pregnancy in protecting vulnerable infants too young to be vaccinated. Funding Sanofi Pasteur. Plain Language Summary Plain language summary available for this article. Safety, Resistance, and Efficacy Results from a Phase IIIb Study of Conventional- and Double-Dose Oseltamivir Regimens for Treatment of Influenza in Immunocompromised Patients AbstractIntroduction Immunocompromised patients infected with influenza exhibit prolonged viral shedding and higher risk of resistance. Optimized treatment strategies are needed to reduce the risk of antiviral resistance. This phase IIIb, randomized, double-blind study (NCT00545532) evaluated conventional-dose or double-dose oseltamivir for the treatment of influenza in immunocompromised patients.Methods Patients with primary or secondary immunodeficiency and influenza infection were randomized 1:1 to receive conventional-dose oseltamivir (75 mg adolescents/adults [≥ 13 years]; 30–75 mg by body weight in children [1–12 years]) or double-dose oseltamivir (150 or 60–150 mg, respectively), twice daily for an extended period of 10 days. Nasal/throat swabs were taken for virology assessments at all study visits. Co-primary endpoints were safety/tolerability and viral resistance. Secondary endpoints included time to symptom alleviation (TTSA) and time to cessation of viral shedding (TTCVS).Results Of 228 patients enrolled between February 2008 and May 2017, 215 (199 adults) were evaluable for safety, 167 (151 adults) for efficacy, and 152 (138 adults) for resistance. Fewer patients experienced an adverse event (AE) in the conventional-dose group (50.5%) versus the double-dose group (59.1%). The most frequently reported AEs were nausea, diarrhea, vomiting, and headache. Fifteen patients had post-baseline resistance, more commonly in the conventional-dose group (n  = 12) than in the double-dose group (n  = 3). In adults, median TTSA was similar between arms, while median TTCVS was longer with conventional dosing.Conclusions Oseltamivir was well tolerated, with a trend toward better safety/tolerability for conventional dosing versus double dosing. Resistance rates were higher with conventional dosing in this immunocompromised patient population.Trial Registration ClinicalTrials.gov identifier: NCT00545532.Funding F. Hoffmann-La Roche Ltd. Use of Antifungals and Outcomes Among Inpatients at Risk of Invasive Aspergillosis or Mucormycosis in the USA: A Retrospective Cohort Study AbstractIntroduction Prophylaxis and treatment of invasive aspergillosis (IA) and mucormycosis (IM) within a real-world US inpatient setting is undocumented since the introduction of isavuconazole. This retrospective medical record review aimed to describe characteristics, triazole use, and outcomes among inpatients across the USA who initiated antifungal monotherapy (AFMT) as prophylaxis or treatment of IA/IM.Methods A convenience sample of US physicians abstracted data from randomly selected records of hospitalized patients aged ≥ 18 years initiating AFMT (amphotericin B, isavuconazole, voriconazole, or posaconazole) as prophylaxis or treatment of IA/IM between 2013 and 2017. Retrieved data included background characteristics, dosage and duration of AFMT, healthcare resource use, and survival. Characteristics and outcomes were compared (prophylaxis vs treatment) using Fisher's exact and one-way analysis of variance tests where applicable. Exploratory Kaplan–Meier analyses described overall and inpatient survival.Results Physicians (n = 23) retrieved 124 patient records (43 prophylaxis; 81 treatment). Median duration of first-line AFMT was 14 days (range 1–603 days) and 19 days (range 3–351 days) in the prophylaxis and treatment groups, respectively. One patient received second-line therapy. Median duration of hospitalization was 29 days (range 4–259 days) and 31 days (range 6–980 days) in the prophylaxis and treatment groups, respectively. Admission to intensive care occurred in 14% and 52% of patients in the prophylaxis and treatment groups, respectively. At the time of data retrieval, overall and inpatient survival rates in the prophylaxis group were 88% and 87%, respectively, and in the treatment group were 66% and 76%, respectively.Conclusions This study documented real-world prophylactic and therapeutic AFMT use for IA/IM and associated outcomes among hospitalized patients in the USA since approval of isavuconazole. IA/IM were associated with lengthy hospital stays commonly requiring intensive care. Prophylactic and therapeutic AFMT dosages and duration generally followed recommendations and switching between agents was rare.Funding Astellas Pharma Global Development, Inc., Northbrook, IL, USA. Incidence and Prevention of Invasive Meningococcal Disease in Global Mass Gathering Events AbstractIntroduction Mass gathering events involve close contact among large numbers of people in a specific location at the same time, an environment conducive to transmission of respiratory tract illnesses including invasive meningococcal disease (IMD). This report describes IMD incidence at mass gatherings over the past 10 years and discusses strategies to prevent IMD at such events.Methods A PubMed search was conducted in December 2018 using a search string intended to identify articles describing IMD at mass gatherings, including religious pilgrimages, sports events, jamborees, and refugee camps. The search was limited to articles in English published from 2008 to 2018. Articles were included if they described IMD incidence at a mass gathering event.Results A total of 127 articles were retrieved, of which 7 reported on IMD incidence at mass gatherings in the past 10 years. Specifically, in Saudi Arabia between 2002 and 2011, IMD occurred in 16 Hajj pilgrims and 1 Umrah pilgrim; serotypes involved were not reported. At a youth sports festival in Spain in 2008, 1 case of serogroup B IMD was reported among 1500 attendees. At the 2015 World Scout Jamboree in Japan, an outbreak of serogroup W IMD was identified in five scouts and one parent. At a refugee camp in Turkey, one case of serogroup B IMD was reported in a Syrian girl; four cases of serogroup X IMD occurred in an Italian refugee camp among refugees from Africa and Bangladesh. In 2017, a funeral in Liberia resulted in 13 identified cases of serogroup C IMD. Requiring meningococcal vaccination for mass gathering attendees and vaccinating refugees might have prevented these IMD cases.Conclusions Mass gathering events increase IMD risk among attendees and their close contacts. Vaccines preventing IMD caused by serogroups ACWY and B are available and should be recommended for mass gathering attendees.Funding Pfizer. Infectious Disease Management and Control with Povidone Iodine Abstract With reports of vancomycin-resistant enterococci recently emerging in hospital settings, renewed focus is turning to the importance of multifaceted infection prevention efforts. Careful compliance with established hygiene practices by healthcare workers together with effective antiseptic options is essential for the protection of patients from infectious agents. For over 60 years, povidone iodine (PVP-I) formulations have been shown to limit the impact and spread of infectious diseases with potent antiviral, antibacterial and antifungal effects. In addition to a lack of reported resistance, the benefits of PVP-I include an excellent safety profile and a broad spectrum of effect due to its multimodal action. Studies have shown that hand washing with PVP-I-based antiseptics is effective for the decontamination of skin, while PVP-I mouthwashes and gargles significantly reduce viral load in the oral cavity and the oropharynx. The importance of PVP-I has been emphasised by its inclusion in the World Health Organization's list of essential medicines, and high potency for virucidal activity has been observed against viruses of significant global concern, including hepatitis A and influenza, as well as the Middle-East Respiratory Syndrome and Sudden Acute Respiratory Syndrome coronaviruses. Together with its diverse applications in antimicrobial control, broad accessibility across the globe, and outstanding safety and tolerability profile, PVP-I offers an affordable, potent, and widely available antiseptic option. Funding Mundipharma Singapore Holding Pte Limited. Safety of Maternal Immunization Against Pertussis: A Systematic Review Abstract The WHO recommends vaccination of all children against pertussis. However, newborn infants remain vulnerable to infection. Pertussis vaccination during pregnancy has been introduced in several countries to protect newborns via transplacental transfer of maternal pertussis antibodies to the infant. We reviewed the impact of maternal pertussis vaccination on the health of pregnant women, the developing fetus, and health of the newborn. We searched PubMed/MEDLINE, EMBASE, Scopus (Elsevier), Cochrane Database of Systematic Reviews, ProQuest, and Science Direct to identify studies that assessed the safety of maternal pertussis vaccination. Twenty-seven English language publications published between January 1995 and December 2018 were included in this review. Pregnant women receiving pertussis vaccines did not have increased rates of systemic or local reactions. There were no safety concerns with repeat vaccination with other tetanus-containing vaccines or their concomitant administration with influenza vaccines. Maternal pertussis vaccination did not adversely affect pregnancy, birth or neonatal outcomes. This review confirms the safety of maternal pertussis vaccination during pregnancy.Funding Sanofi Pasteur.Plain Language Summary Plain language summary available for this article. The Intestinal Microbiota as a Reservoir and a Therapeutic Target to Fight Multi-Drug-Resistant Bacteria: A Narrative Review of the Literature Abstract The appearance and dissemination of antibiotic-resistant bacteria, particularly in specific closed environments such as intensive care units of acute care hospitals, have become a major health concern. The intestinal microbiota has various functions including host protection from overgrowth or colonization by unwanted bacteria. The exposure to antibiotics significantly reduces the bacterial density of intestinal microbiota leaving an ecologic void that can be occupied by potentially pathogenic and/or resistant bacteria frequently present in hospital settings. Consequently, the intestinal microbiota of inpatients acts as a major reservoir and plays a critical role in perpetuating the spread of resistant bacteria. There are novel innovative methods to protect the host microbiota during antibiotic treatment, but they do not offer a solution for already established colonization by resistant microorganisms. Fecal microbiota transfer (FMT) is a promising intervention to achieve this goal; however, controlled trials report lower success rates than initial retrospective studies, especially in case of gram negatives. The aim of the present article is to highlight the importance of the intestinal microbiota in the global spread of multi-drug-resistant (MDR) microorganisms and to review the recent advances to protect the human microbiota from the action of antibiotics as well as a critical discussion about the evidence of decolonization of MDR microorganisms by FMT.
 Infectious Disease Management and Control with Povidone IodineIn the original publication, Figure 1 was incorrectly published. The correct figure is given here.Specific Varicella-Related Complications and Their Decrease in Hospitalized Children after the Introduction of General Varicella Vaccination: Results from a Multicenter Pediatric Hospital Surveillance Study in Bavaria (Germany)AbstractBackgroundUniversal varicella vaccination (UVV) for children introduced in Germany in 2004 resulted in a...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Effects of a Self-Management with Peer Training Intervention on Academic Engagement for High School Students with Autism Spectrum Disorder Abstract Self-management interventions have been shown to improve behavioral, social, and academic outcomes across age-groups and settings; yet, a dearth of research exists on the impact of self-management interventions on academic engagement of high school students with autism spectrum disorder (ASD). The present study uses an ABAB withdrawal design to examine the effects of a self-management with peer trainer (SM + PT) intervention on the academic engagement of two high school students with ASD. The peer trainer in this study also had ASD. Additionally, the study examines the extent to which the peer trainer with ASD implemented a peer training session with fidelity and the social validity of the SM + PT intervention. Based on the What Works Clearinghouse Procedures and Standards Handbook guidelines (Institute of Education Sciences 2017), this study found moderate evidence for a causal relationship of the SM + PT intervention and academic engagement for both students. Data suggest that the peer trainer implemented the peer training component with fidelity. Social validity results suggest that the intervention was feasible, acceptable, and effective. Limitations include the presence of naturally occurring variations in the teacher-assigned tasks, school-imposed time constraints, and data outliers in both students' second baseline phases. Future research is needed to investigate the extent to which SM + PT interventions can be effectively implemented and generalized to more inclusive high school settings. Teaching Leisure Activities with Social Initiations Through Video Prompting Abstract Children with autism typically have a limited repertoire of activities they engage in during their free time and are often observed to engage in inappropriate or non-functional play. Previous research has suggested that deficits in leisure skills are not only a factor of the diagnosis, but also influenced by structural constraints such as lack of resources, support, and opportunity. This study used a multiple probe across participants design to assess the effects of video prompting and error correction on the acquisition of a leisure activity and social initiation for three children with autism. Results indicate that video prompting may be effective in increasing appropriate engagement in a leisure activity. However, findings are mixed concerning the use of video prompting to teach a social initiation. This study expands on previous research by systematically selecting a leisure activity to teach and by including a social component. Incorporating the Portable Operant Research and Teaching Laboratory into Undergraduate Introduction to Behavior Analysis Courses Abstract The use of operant chambers for research and teaching in behavior analysis is in decline due to the expense, maintenance, and ethical considerations of such complex mechanical apparati (Venneman and Knowles in Teach Psychol 32(1):66–68, 2005. https://doi.org/10.1207/s15328023top3201_13). Other technologies for testing and demonstrating behavioral principles have emerged in the pursuit of creating free operant paradigms that are accessible and effective for students and economical for institutions. One example is virtual programs that emulate the behavior of organisms such as CyberRat and Sniffy (Graham et al. in Behav Res Methods Instrum Comput 26(2):134–141, 1994. https://doi.org/10.3758/bf03204606; Ray in CyberRat (version 1.0), Brown & Benchmark, Madison, 1996; Behav Philos 39:203–301, 2011). Recently, a new instrument has been developed—the Portable Operant Research and Teaching Lab (PORTL; Rosales-Ruiz and Hunter in Operants 4:34–36, 2016). PORTL is a tabletop apparatus comprised of various objects and tools that enable students to experience and manage free operant situations. In addition to its instructional benefits, PORTL provides a setting for basic research to be completed quickly and ethically with human participants. The purpose of this paper is to outline how to incorporate PORTL into undergraduate behavior analysis courses. Several examples of how PORTL has been incorporated into such courses, including sample exercises, are provided as a model for other course instructors. Interdependent Group Contingencies Reduce Disruption in Alternative High School Classrooms Abstract Group contingencies have been indicated to be effective in reducing disruptive behavior and increasing academic engagement in school settings. Previous research has demonstrated their efficacy with a wide range of student ages, but there have been few studies with older students who engage in severe disruptive behavior. In the current study, we implemented an interdependent group contingency in three high school classrooms of students aged 14–19 years with histories of delinquency, emotional and behavioral disorder diagnoses, or both. Results indicated that interdependent group contingencies can be effective in reducing the disruptive classroom behavior of these students. Implications for future research and special considerations for this population are discussed. The Effects of the Concrete-Representational-Abstract Sequence for Students at Risk for Mathematics Failure Abstract Students who have difficulty with mathematics may have trouble understanding underlying concepts of numbers and operations. The concrete-representational-abstract (CRA) instructional sequence of instruction provides a way for teachers to help students gain meaning from numbers and the mathematical concepts those numbers represent. This study addresses evidence-based practices and applies CRA methods to instruction address concepts such as rounding, regrouping, and equivalent fractions. The purpose of this study was to investigate the effects of CRA instruction on the performance of elementary students across varied areas of need related to poor conceptual understanding and proficiency in completing tasks related to numbers and operations. The researchers implemented a multiple baseline across behaviors design for two students who were at risk for mathematics failure. A functional relation was found for CRA intervention and rounding, regrouping, and fraction concepts for the two students. Results and implications are discussed. Using Brief Experimental Analysis to Identify the Right Math Intervention at the Right Time Abstract Brief experimental analysis (BEA) is a methodology of rapidly implementing interventions and observing the effect each has on student performance. Extensive research exists demonstrating the utility of BEA in identifying effective reading interventions for students, but comparatively little research exists regarding BEA and mathematics. The current study utilized BEA procedures to identify an intervention targeting skill- or performance-based deficits that would be effective for remediating 4 middle school students' two-digit by two-digit multiplication skills. Each student had a clearly differentiated intervention identified by BEA as being most effective. Findings from the current study provide evidence for the utility of BEA in matching deficits with mathematics interventions and illustrate their sensitivity to changes in student performance. Exploring Procedural Manipulations to Enhance Student Performance on SAFMEDS in Undergraduate Introduction to Behavior Analysis Courses Abstract Research into the fluency-building tactic named Say All Fast Minute Every Day Shuffled (SAFMEDS) has implications for instruction at all academic levels. Several researchers have studied the effects of SAFMEDS in undergraduate courses; however, not all of the salient variables, or the relationships among variables, have been fully analyzed. The numerous procedural variations may pose specific challenges for college instructors who wish to implement SAFMEDS in their course design or for students who are attempting to use SAFMEDS on their own. We collected behavioral data across four semesters of undergraduate introductory behavior analysis courses. The effects of two procedural manipulations were evaluated in relation to undergraduate students' performance frequencies on weekly checkouts with two or four decks of see term/say definition SAFMEDS. The authors describe how SAFMEDS were implemented and modified over the course of four semesters of instruction. SAFMEDS' procedures were modified each semester based on student outcomes in the prior semester in an effort to improve our student outcomes and to assist other course instructors who might wish to utilize SAFMEDS in their university courses. An overview of the decision-making process and student outcomes allows for the authors to make recommendations for course instructors who employ SAFMEDS in their courses and suggestions for future research to improve our understanding of how SAFMEDS affect student performance. Effect of Task Sequence and Preference on On-Task Behavior Abstract This study compared effects of student choice of task sequence to two variations in teacher-manipulated task sequences on on-task behavior of elementary-aged students with disabilities. Researchers modified Call et al.'s (J Appl Behav Anal 42: 723–728, 2009) demand assessment to determine high-, moderate-, and low-probability tasks. Next, researchers applied the results from the demand assessment to inform teacher-manipulated variations in task sequences: a high- to low-probability task sequence and low- to high-probability task sequence. These sequences were then embedded in a visual activity schedule (VAS). Results of task sequence manipulation embedded in a VAS indicated slightly higher median percentages of on-task behavior for the high- to low-probability task sequence. Future directions for research based on these preliminary data are discussed. A Systematic and Quality Review of Parent-Implemented Language and Communication Interventions Conducted via Telepractice Abstract The purpose of this study was to systematically review the literature researching telepractice and parent-implemented language and communication interventions. A total of 12 studies met inclusion criteria and comprise the final study sample. A majority of the included articles were single-case research studies, and two were randomized controlled trials. We analyzed participant characteristics, intervention types, outcomes, and research quality in all 12 studies. All telepractice-based parent-implemented interventions reported improvements in parent and/or child outcomes. We evaluated the rigor of the studies against single-case research and group design quality indicators as well as What Works Clearinghouse standards. Of the 10 single-case research studies, one met single-case research design standards and six met standards with reservations, and of the two group design studies, only one met all quality indicators and standards. Results are discussed and future directions are provided. Effects of Response Cards on Fourth-Grade Students' Participation and Disruptive Behavior During Language Arts Lessons in an Inclusive Elementary Classroom Abstract Many teachers state that disruptive behavior in their classroom is one of their main challenges, and it often results in a loss of instructional time. Teachers also have difficulty in providing opportunities for their students to be actively engaged in their own learning. This study used an ABAB reversal design to investigate the effects of preprinted response cards on students' participation and disruptive behavior in a fourth-grade inclusive elementary classroom during language arts instruction. The findings of this study showed that the use of preprinted response cards resulted in increased participation for all five target students. Limitations of the study, areas for future research to investigate, and implications for practice are discussed.
Effects of a Self-Management with Peer Training Intervention on Academic Engagement for High School Students with Autism Spectrum DisorderAbstractSelf-management interventions have been shown to improve behavioral, social, and academic outcomes across age-groups and settings; yet, a dearth of research exists on the impact of self-management interventions on academic engagement of high school students with autism spectrum disorder (ASD). The present study uses an ABAB withdrawal design to examine...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:44
Neurosurgical Interventions for Neurotrauma in the Obstetric Population: A Systematic Review Trauma requiring neurosurgical intervention in the obstetric population is rare. Provision of care must include consideration for both maternal and fetal well-being, and conflicts may arise. Management strategies to reduce elevated maternal intracranial pressure (ICP) and provide adequate surgical exposure, for example, may compromise uteroplacental perfusion. There is scarce literature to guide anesthetic care and few resources summarizing management of these uncommon cases. We conducted a systematic literature search for English publications of neurosurgical interventions on obstetric patients following trauma. We searched MEDLINE, EMBASE, and Google Scholar from inception to May 1, 2019. We identified 18 cases from 13 publications including 9 case reports and 4 case series. Median Glasgow coma scale on presentation was 6, good maternal outcome occurred in 39% of cases, and good fetal outcome occurred in 67% of cases. Qualitative review of the articles suggests an initially low Glasgow coma scale on admission commonly resulted in worse maternal and fetal outcomes. Delivery occurred postneurosurgical intervention in the majority of viable fetuses. Few details were available regarding anesthetic management, and ICP management strategies varied widely. Our review identified only a small number of case reports and case series. Maternal outcomes were generally poor, although the majority of fetal outcomes were good. Although there seems to be a relationship between outcomes and severity of maternal injury on presentation, it is difficult to draw conclusions or make recommendations because of limited data on perioperative anesthetic and ICP management strategies. Regardless of gestational age, maternal supremacy must be upheld. Our results are limited by the quality of the available research and potential selection bias. Previous presentations of this work: oral and poster presentation at the American Society of Anesthesiologists (ASA) Annual Meeting. Additional poster presentation at the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Annual Meeting (October 2018; San Francisco, CA). The authors have no funding or conflicts of interest to disclose. Address correspondence to: Christie M. Addison, MD. E-mail: Christie.fitch@alumni.ubc.ca. Received May 10, 2019 Accepted October 15, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved JNA Is Looking Forward to 2020 and Beyond No abstract available Perceived Benefits and Barriers to a Career in Neuroanesthesiology: A Pilot Survey of Anesthesiology Clinicians Background: Despite advances in perioperative neuroscience, there is low interest among anesthesiology trainees to pursue subspecialty training in neuroanesthesiology. We conducted a pilot survey to assess attitudes about neuroanesthesiology fellowship training. Materials and Methods: A confidential survey was distributed to an international cohort of anesthesiology attendings and trainees between January 15, 2017 and February 26, 2017. Results: A total of 463 responses were received. Overall, 309 (67%), 30 (6%), 116 (25%), and 8 (2%) of respondents identified themselves as attendings, fellows, residents, and "other," respectively. In total, 390 (84%) of respondents were from the United States. Individuals typically pursue anesthesiology fellowship training because of interest in the subspecialty, acquisition of a special skill set, and the role of fellowship training in career planning and advancement. Overall, 64% of attendings, 56% of fellows, and 55% of residents favored accreditation of neuroanesthesiology fellowships, although opinion was divided regarding the role of accreditation in increasing interest in the specialty. Respondents believe that increased opportunities for research and greater exposure to neurocritical care and neurological monitoring methods would increase interest in neuroanesthesiology fellowship training. Perceived barriers to neuroanesthesiology fellowship training were perceptions that residency provides adequate training in neuroanesthesiology, that a unique skill set is not acquired, and that there are limited job opportunities available to those with neuroanesthesiology fellowship training. Conclusions: In this pilot survey, we identified several factors that trainees consider when deciding to undertake subspecialty training and barriers that might limit interest in pursuing neuroanesthesiology subspecialty training. Our findings may be used to guide curricular development and identify factors that might increase interest among trainees in pursuing neuroanesthesiology fellowship training. Presented in abstract form at the 45th Annual Meeting of the Society for Neuroscience in Anesthesiology and Critical Care in Boston, MA on October 20, 2017. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Shobana Rajan, MD. E-mail: shobanarajan5@gmail.com. Received June 26, 2019 Accepted September 16, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved Erector Spine Plane Block at the T12 Level may not Provide Good Postoperative Pain Relief Following Lumbosacral Spine Surgery No abstract available Reporting Quality Analysis of Randomized Controlled Trials in Journal of Neurosurgical Anesthesiology: A Methodological Assessment Background: Randomized controlled trials (RCTs) are considered to provide high levels of evidence to optimize decision-making for patient care, although there can be a risk bias in their design, conduct, and analysis. Quality assessment of RCTs is necessary to assess whether they provide reliable results with little bias. Materials and Methods: We assessed the reporting quality of RCTs published in the Journal of Neurosurgical Anesthesiology (JNA) between January 1, 2000 and December 31, 2017 using the Jadad scale, van Tulder scale, and Cochrane Collaboration Risk of Bias Tool (CCRBT). Results: We identified 130 RCTs and 570 original articles. Among the 130 RCTs, 92 (70.8%) presented an appropriate blinding method, and 70 (53.8%) described an appropriate allocation method. For the entire period, the percentages of high-quality reporting articles were 71.5%, 73.1%, and 13.8% in the Jadad scale, van Tulder scale, and CCRBT assessments, respectively. There was an improvement in the van Tulder scale over time (coefficients [95% confidence interval {CI}]=0.08 [0.01-0.15]; P=0.02). Appropriate reporting of allocation in the Jadad scale (coefficients [95% CI]=1.68 [1.28-2.07]; P<0.001) and van Tulder scale (coefficients [95% CI]=2.34 [1.97-2.70]; P<0.001), and reporting of blinding in the Jadad (coefficients [95% CI]=1.09 [0.66-1.52]; P<0.001) and van Tulder scores (coefficients [95% CI]=1.85 [1.45- 2.25]; P<0.001), were associated with high-quality reporting. Conclusions: The ratio of high-quality reporting RCTs in JNA was consistently high compared with other journals. Thorough consideration of allocation concealment during the peer review process can further improve the reporting quality of RCTs in JNA. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Kyu Nam Kim, MD, PhD. E-mail: vesicle100@naver.com. Received June 5, 2019 Accepted September 24, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved Assessment of Anesthesia Practice Patterns for Endovascular Therapy for Acute Ischemic Stroke: A Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Member Survey Background: The choice of general anesthesia (GA) or conscious sedation (CS) may impact neurological outcomes of patients undergoing endovascular therapy (EVT) for acute ischemic stroke (AIS). The aim of this survey was to describe the practice patterns of members of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) for anesthetic management of AIS. Methods: Following institutional review board approval, a 16-question online survey assessing anesthetic management of patients with AIS undergoing EVT was circulated to members of SNACC. Results: A total of 76 SNACC members from 52 institutions and 11 countries completed the survey (12.5% response rate). Overall, 33% of institutions reported dedicated neuroanesthesia teams for EVT. Patients treated with GA ranged from 5% to 100% between centers. In total 51% and 49% of centers in the United States reported preferentially providing GA and CS, respectively, compared with 34% and 66%, respectively, in European centers. Reported anesthetic induction agents are propofol (64%), etomidate (4%) and either medication (33%). For maintenance of GA, volatile anesthetic is used more often (54%) than propofol (16%). There was wide variation in medications used for CS. Arterial catheter placement was reported by 75% and 43% of respondents for patients undergoing GA and CS, respectively. Systolic blood pressure >140 mm Hg was targeted by 35.7% of respondents, with others targeting mean arterial pressure within 10%, 20% or 30% of baseline values. Phenylephrine and norepinephrine were the most commonly used vasopressors. Conclusions: There is wide variation in anesthesia technique and hemodynamic management during EVT for AIS, and no consensus on the choice of, or preferred medications for, GA or CS, or target blood pressure and management of hypotension during the procedure. C.P. and D.S. are members of the Editorial Board of the Journal of Neurosurgical Anesthesiology. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Deborah A. Rusy, MD, MBA. E-mail: darusy@wisc.edu. Received March 23, 2019 Accepted October 1, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved Anesthesia During Positive-pressure Myelogram: A New Role for Cerebral Oximetry Background: Positive-pressure myelogram (PPM) is an emerging radiologic study used to localize spinal dural defects. During PPM, cerebrospinal fluid pressure (CSFp) is increased by injecting saline with contrast into the cerebrospinal fluid. This has the potential to increase intracranial pressure and compromise cerebral perfusion. Methods: We performed a retrospective chart review and analysis of 11 patients. The aim was to describe the periprocedural anesthetic management of patients undergoing PPM. Results: All patients underwent PPM with general anesthesia and intra-arterial blood pressure and near-infrared spectroscopy monitoring of regional cerebral tissue oxygen saturation. Mean±SD maximum lumbar CSFp was 58±12 mm Hg. Upon intrathecal injection, mean systolic blood pressure increased from 115±21 to 142±32 mm Hg (P<0.001), diastolic blood pressure from 68±12 to 80±20 mm Hg (P≤0.001), and mean blood pressure from 87±10 to 98±14 mm Hg (P=0.02). Ten of 11 patients received blood pressure augmentation with phenylephrine to minimize the risk of reduced cerebral perfusion secondary to increased CSFp after intrathecal injection. The mean heart rate before and following injection was similar (68±15 vs. 70±15 bpm, respectively; P=0.16). There was a decrease in regional cerebral oxygen saturation after positioning from supine to prone position (79±10% to 74±9%, P=0.02) and a further decrease upon intrathecal injection (75±10% to 69±9%, P≤0.01). Conclusions: Systemic blood pressure increased following intrathecal injection during PPM, possibly due to a physiologic response to intracranial hypertension/reduced cerebral perfusion or administration of phenylephrine. Regional cerebral oxygen saturation decreased with the change to prone position and further decreased upon intrathecal injection. Cerebral near-infrared spectroscopy has a potential role to monitor the adequacy of cerebral perfusion and guide adjustment of systemic blood pressure during PPM. The authors have no conflicts of interest to disclose. Address correspondence to: Tasha L. Welch, MD. E-mail: welch.tasha@mayo.edu. Received May 14, 2019 Accepted August 20, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved Power and Challenges of Big Data: Why Clinical Researchers Should Not Be Ignored No abstract available Recent Preoperative Concussion and Postoperative Complications: A Retrospective Matched-cohort Study Background: Physiological alterations during the perianesthetic period may contribute to secondary neurocognitive injury after a concussion. Methods: Patients exposed to concussion and who received an anesthetic within 90 days were matched to unexposed patients without concussion. Intraoperative and postoperative events were compared. Subgroup analyses assessed relationships among patients with a concussion in the prior 30, 31 to 60, and 61 to 90 days and their respective unexposed matches. To facilitate identification of potential targets for further investigation, statistical comparisons are reported before, as well as after, correction for multiple comparisons. Results: Sixty concussion patients were matched to 176 unexposed patients. Before correction, 28.3% postconcussion versus 14.8% unexposed patients reported postanesthesia care unit pain score≥7 (P=0.02); 16.7% concussion versus 6.5% unexposed patients reported headache within 90 days of anesthesia (P=0.02) and 23.5% of patients who received surgery and anesthesia within 30 days of concussion experienced headache within 90 days of anesthesia compared with 7.1% in the unexposed group (P=0.01). Patients who experienced concussion and had anesthesia between 31 and 60 days after injury had a postanesthesia care unit Richmond Agitation and Sedation Scale score of −1.61±1.29 versus a score of −0.2±0.45 in unexposed patients (P=0.002). After adjusting the P-value threshold for multiple comparisons, the P-value for significance was instead 0.0016 for the overall cohort. Our study revealed no significant associations with application of adjusted significance thresholds. Conclusions: There were no differences in intraoperative and postoperative outcomes in patients with recent concussion compared with unexposed patients. Before correction for multiple comparisons, several potential targets for further investigation are identified. Well-powered studies are warranted. Presented in abstract form at the Annual Meeting of the Society for Neuroscience in Anesthesiology and Critical Care in San Francisco, CA, October 12, 2018. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Arnoley S. Abcejo, MD. E-mail: abcejo.arnoley@mayo.edu. Received March 5, 2019 Accepted September 19, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved Intraoperative Magnetic Resonance Imaging–induced Oropharyngeal Thermal Injury in a Patient With Acromegaly No abstract available
Neurosurgical Interventions for Neurotrauma in the Obstetric Population: A Systematic ReviewTrauma requiring neurosurgical intervention in the obstetric population is rare. Provision of care must include consideration for both maternal and fetal well-being, and conflicts may arise. Management strategies to reduce elevated maternal intracranial pressure (ICP) and provide adequate surgical exposure, for example, may compromise uteroplacental perfusion. There is scarce literature to guide anesthetic...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:43
Projets actuels de télémédecine dans le domaine du diabète Focus sur les projets de télésuivi 2.0 et sur l'expérience strasbourgeoise à travers le projet DIABETe Emmanuel Andrès, Laurent Meyer, Abrar-Ahmad Zulfiqar, Mohamed Hajjam, Samy Talha, Sylvie Ervé, Jawad Hajjam, Jean Doucet, Nathalie Jeandidier, Amir Hajjam El Hassani Il a été démontré que le contrôle intensif de la glycémie retarde ou prévient le développement de complications micro- et macrovasculaires liées au diabète. Toutefois, on estime que 43,2 à 55,6 % des adultes atteints de diabète de type 2 n'atteignent pas la cible de référence pour le contrôle glycémique (hémoglobine glyquée [HbA1c] < 7,0 %). En pratique, les principales causes de détérioration du diabète nécessitant une intervention médicale sont liées [...] » Lire la suite
Projets actuels de télémédecine dans le domaine du diabèteFocus sur les projets de télésuivi 2.0 et sur l'expérience strasbourgeoise à travers le projet DIABETeEmmanuel Andrès, Laurent Meyer, Abrar-Ahmad Zulfiqar, Mohamed Hajjam, Samy Talha, Sylvie Ervé, Jawad Hajjam, Jean Doucet, Nathalie Jeandidier, Amir Hajjam El Hassani Il a été démontré que le contrôle intensif de la glycémie retarde ou prévient le développement de complications micro- et macrovasculaires liées au diabète. Toutefois, on estime...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:43
Performative Compliance and the State–Corporate Structuring of Neglect in a Residential Care Home for Older People Abstract The abuse and neglect of older people in care homes is widespread across England, but current causative explanations are limited and frequently fail to highlight the economic and political factors underpinning poor care. Informed by social harm and state–corporate crime perspectives, this study uses ethnographic data gathered through a nine-month period of working in an older person's residential care home to show how neglect is embedded in working routines. Three aspects of care are interrogated to reveal the embedded nature of harm in the home; all reveal the rift between official, regulatory rules and informal working practices shaped by material constraints of the labor process. This article explores the role of regulatory regimes in actively legitimizing sectors, such as the residential care industry, even in the face of routine violence, by bureaucratically ensuring the appearance of compliance with formal rules. While the harms of contemporary institutionalized care for older people have its roots in material conditions, performative compliance through regulation guarantees that these injurious outcomes are concealed. This article contends that malpractice (and harm) can be explained with reference to conjoint state–corporate relationships and practices. Valeria Vegh Weis: Marxism and Criminology: A History of Criminal Selectivity The Electronic Monitoring of Offenders in Context: From Policy to Political Logics Abstract The electronic monitoring (EM) of offenders is a subject that has been researched widely within criminology. Theoretical engagement with this instrument has been limited, however. The criminological literature, in fact, has focused primarily on empirical assessments of EM's financial and technical aspects, as well as on the legal implications of EM and its impact on reoffending. Against this backdrop, this article provides a critical examination of EM, focussing on how policy construes this penal measure, using Scotland as an example. In addition, drawing on Foucault's notion of governmentality, this article explores and problematizes the political logics (neoliberal, nationalist and techno-communitarian) which inform EM policy in the context of Scotland. The final section shifts the focus from exposing the political milieu within which EM policy emerges to contesting its possible effects, thereby extending the political critique of EM policy. The overarching aim is to contribute toward a nuanced political assessment of EM, while presenting directions for future engagement with this subject. Systemic Endangerment: A Tale of Neoliberal "Slumcare" Abstract In this case study of neoliberal responsibilization (Garland 1996), I used grounded theory methods to explore practitioners' experiences of Therapeutic Crisis Intervention at a for-profit, violence-prevention, group home for troubled youth. While previous research has shown that responsibilization can create spaces for on-the-ground resistance to post-welfarism and the reemergence of rehabilitative practices, this study shows that it can also lead to irresponsibly dangerous practices. As a result of this analysis, I introduce the concept of "slumcare" to capture a broad array of egregiously substandard behavioral-healthcare interventions that are provided throughout the United States in the name of crime prevention. While systemic endangerment is just one illustration of "slumcare," I contend that three interrelated processes—priority corruption, a paper trail of propriety, and the evasion of criticism—explain how the neoliberal state enables a host of "slumcare practices"—including systemic endangerment—to persist beyond the walls of this particular site. Governance Through Diversion in Neoliberal Times and the Possibilities for Transformative Social Justice Abstract Over the last decade, the dramatic increase in the number of young people diverted from formal processing through the youth justice system in England and Wales, and the equally sharp drop in the rate of youth custody suggest that the neoliberal formula for the penal governance of young people who offend has been undergoing significant reshaping. This article draws on research which interrogates the changes that are currently taking place, particularly the proliferation of "out of court" community-based measures of diversion and offense resolution, to develop a more fine-tuned conceptualization of the complexities of neoliberal youth penality. We base our findings principally on England and Wales, although it is likely that our analysis is applicable in other settings. With the extensive reduction in the capacity of the state to exert direct measures of institutional and community-based coercion, we seek to identify other, less overt processes that also aspire to maintain order and reproduce social relations favorable to the neoliberal project. In lieu of ending on a purely pessimistic note, we conclude with a brief outline of the potential for alternative, progressive strategies that seek to challenge rather than simply modify or incorporate previous modes of regulation and control. How Contemporary Rehabilitation Fails Youth and Sabotages the American Juvenile Justice System: A Critique and Call for Change Abstract Long a cornerstone of the American juvenile justice system, the idea that youth can change, and merit chances to do so, has enjoyed new life after decades of punitive erosion. Unfortunately, the rehabilitation offered to youth is largely shortsighted and inadequate. In this article, I argue that the juvenile justice system embraces a "myopic model" of rehabilitation that loses touch with the social roots of youth problems and focuses too heavily on improving internal thoughts and behaviors through short-term "pills and programs" (Goshe 2019). By losing sight of the societal harms at the root of delinquent behaviors, the myopic model advances a limited and ultimately unsustainable model of change. In contrast, this article contends that robust rehabilitation treats the social and the personal as crucial to the rehabilitative equation and offers a pathway to meaningful change for youth and the juvenile justice system. Challenging the Logics of Reformism and Humanism in Juvenile Justice Rhetoric Abstract This article draws on contemporary policy discourse in order to advance claims about the intractable figure of the "bad" child in contemporary juvenile justice reforms in the United States (US). The article focuses in particular on the discourses of trauma and "brain science" to point to a form of neo-positivism that has arguably emerged and which challenges efforts to engage in systematic decarceration. The article also focuses on the idea of the "bad child" that persists in the commitment of some reformers to the necessity of confinement for some children. The article questions the extent to which new forms of positivism challenge our ability to leverage structural claims. Young People, Shadow Carceral Innovations, and the Reproduction of Inequality Abstract The rate of detention for juveniles in the United States (US) is half what it was 20 years ago, and arrest rates have declined as well. Scholars, however, have illuminated more subtle processes of criminalization, such as through school disciplinary practices and civil penalties for low-level infractions in the community. Recognizing the presence and importance of such "shadow measures" helps us to understand how the carceral state penetrates deeper into the lives of (young) people, even in the midst of emerging reforms that would seem to dull the sharpest edges of the US criminal justice system. In this article, we delineate some of the ways that "shadow measures" help to sustain and legitimate deep economic, social, and justice system inequalities in the present-day US. Specifically, we describe how several "shadow carceral innovations" in the school and community mark some young people as "dangerous," "high-risk," or "unsafe," and show how these experiences are measured and judged across a variety of institutions. Ultimately, we argue that these "shadow measures" structure the day-to-day lives of youth outside the workforce and the cellblock, functioning as a key mechanism for maintaining inequality in the second decade of this century. Illicit Drug Markets, Consumer Capitalism and the Rise of Social Media: A Toxic Trap for Young People Abstract This article explores young people's involvement in illicit drug markets in England. It focuses in particular on why young people become involved in illicit drug distribution, the extent to which their involvement is predicated on adults' use of threats and violence, and how young people frame the morality of drug dealing. The article's findings are based on a unique dataset generated by a six-month period of online social media platform analysis, alongside additional data drawn from periods of observation, focus groups and interviews with young people and professionals. In short, I argue that drug prohibition, consumer capitalism, severe levels of inequality, and emerging problems associated with the rise of online social media are combining to produce a toxic trap that is dragging tens of thousands of young people into street-level drug dealing. Considered in this context, the inadequacy of the UK government's response to some of the main harms associated with illicit drug markets is clear: children and young people will continue to be coerced and exploited until either drug markets are legalized and regulated, or they have realistic opportunities to pursue lives that offer genuine meaning, decent levels of income, and levels of status and respect that are comparable to those provided by drug distribution.
Performative Compliance and the State–Corporate Structuring of Neglect in a Residential Care Home for Older PeopleAbstractThe abuse and neglect of older people in care homes is widespread across England, but current causative explanations are limited and frequently fail to highlight the economic and political factors underpinning poor care. Informed by social harm and state–corporate crime perspectives, this study uses ethnographic data gathered through a nine-month period of working in an older...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:37
Distinct evolution of toll-like receptor signaling pathway genes in cetaceans AbstractBackground The relatively rapid spread and diversity of marine pathogens posed an initial and ongoing challenge for cetaceans (whales, dolphins, and porpoises), descendants of terrestrial mammals that transitioned from land to sea approximately 56 million years ago. Toll-like receptors (TLRs) play important roles in regulating immunity against pathogen infections by detecting specific molecular patterns and activating a wide range of downstream signaling pathways. The ever-increasing catalogue of mammalian genomes offers unprecedented opportunities to reveal genetic changes associated with evolutionary and ecological processes.Objective This study aimed to explore the molecular evolution of TLR signaling pathway genes in cetaceans.Methods Genes involved in the TLR signaling pathway were retrieved by BLAST searches using human coding sequences as queries. We tested each gene for positive selection along the cetacean branches using PAML and Hyphy. Physicochemical property changes of amino acids at all positively selected residues were assessed by TreeSAAP and visualized with WebLogo. Bovine and dolphin TLR4 was assessed using human embryonic kidney cell line HEK293, which lacks TLR4 and its co-receptor MD-2.Results We demonstrate that eight TLR signaling pathway genes are under positive selection in cetaceans. These include key genes in the response to Gram-negative bacteria: TLR4, CD14, and LY96 (MD-2). Moreover, 41 out of 65 positively selected sites were inferred to harbor substitution that dramatically changes the physicochemical properties of amino acids, with most of them situated in or adjacent to functional regions. We also found strong evidence that positive selection occurred in the lineage of the Yangtze finless porpoise, likely reflecting relatively recent adaptions to a freshwater milieu. Species-specific differences in TLR4 response were observed between cetacean and terrestrial species. Cetacean TLR4 was significantly less responsive to lipopolysaccharides from a terrestrial E. coli strain, possibly a reflection of the arms race of host–pathogen co-evolution faced by cetaceans in an aquatic environment.Conclusion This study provides further impetus for studies on the evolution and function of the cetacean immune system. A thiosemicarbazone derivative induces triple negative breast cancer cell apoptosis: possible role of miRNA-125a-5p and miRNA-181a-5p AbstractBackground Breast cancer, the most commonly diagnosed malignancy in women, accounts for the highest cancer-related deaths worldwide. Triple negative breast cancer (TNBC), lacking the expression of estrogen, progesterone and HER2 receptors, has an aggressive clinical phenotype and is susceptible to chemotherapy but not to hormonal or targeted immunotherapy. In an attempt to identify potent and selective anti-TNBC agents, a set of thiosemicarbazone derivatives were screened for their cytotoxic activity against MDA-MB 231 breast cancer cell line.Methods MTT assay was used to examine cell viability. P53 phosphorylation status, poly (ADP-ribose) polymerase (PARP) cleavage as well as Bcl2 and Bax protein levels were assessed by Western blot. Quantitative Real Time-PCR was carried out to characterize miRNAs expression levels.Results Combining Cisplatin + thiosemicarbazone compound 4 showed potent anti-TNBC potential. Cisplatin + compound 4 significantly enhanced p53 phosphorylation, induced Bax amount, reduced Bcl2 protein levels, enhanced PARP cleavage and modulated miRNAs expression profile in TNBCs, with a particular overexpression of miR-125a-5p and miR-181a-5p. Intriguingly, miR-125a-5p and miR-181a-5p could significantly downregulate BCL2 expression by binding to their target sites in the 3′UTR.Conclusions Collectively, our results demonstrate an anti-TNBC activity of Cisplatin + thiosemicarbazone compound 4 combination mediated via induction of apoptosis. Transcriptome analysis to characterize the genes related to gonad growth and fatty acid metabolism in the sea urchin Strongylocentrotus intermedius AbstractBackground Sea urchin gonads of both sexes, commonly termed "roe", are highly valued seafood delicacies, and Strongylocentrotus intermedius is considered one of the tastiest sea urchins. In order to produce high-quality gonads for consumption and clarify the mechanism of gonad growth and development of the sea urchin, more genetic information, especially at the transcriptome level, is needed.Objective A more thorough understanding of sea urchin gonad growth and development in both sexes could enable regulation of these processes at several stages with the aim of suppressing gametogenesis in order to produce high-quality gonads for consumption.Methods The adult sea urchins S. intermedius were cultured for 3 months, and were sampled for the gonadal transcriptome analysis which has been performed on the RNAs of three male and female adults of S. intermedius in each gonad development stage.Results Illumina sequencing raw sequence data was deposited in the NCBI Sequence Read Archive (SRA) database (PRJNA532998). It generated 560,196,356 raw reads and 548,956,944 clean reads were acquired, which were assembled into 107,850 transcripts with 44,124 genes. Comparative analysis showed the differentially expressed genes (DEGs) from 114 to 2566. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were used to determine the functional significance of these DEGs. We have selected 9 genes related to growth and 12 genes related to fatty acid biosynthesis and metabolism in sea urchin gonads.Conclusion These data for sea urchins were intended to provide markers for gonad growth and development that can be accumulated for use in aquaculture applications. Study on the differential gene expression of elm leaves fed on by Tetraneura akinire Sasaki AbstractBackground To study the essential molecular mechanism of gall formation is very important.Objective To investigate the differential gene expression in leaves fed on by Tetraneura akinire Sasaki and to provide a basis for the better understanding of the essential molecular mechanism of gall formation.Methods The infected leaves of the elm were divided into three periods: initial formation period (T2), growth and differentiation period (T3), and cracking period (T4). The untouched leaves were used as the control (T1). RNA-Seq was performed, and the high-quality sequences were mapped to the reference genome and the elm gene database to obtain the gene expression profiles. The expression level of each gene was calculated by the RPKM method. A combination of FDR ≤ 0.01 and the absolute value of |log2 ratio (T/CK)| ≥ 2 was used as the threshold to determine the significance of gene expression. Finally, GO and pathway enrichment analyses were used to identify the significantly enriched functional classification and metabolic pathways in DEGs.Results The results revealed that approximately 244 mRNAs were detected between T1 and T2, including 192 up-regulated and 52 down-regulated mRNAs; approximately 175 mRNAs were detected between T1 and T3, including 145 up-regulated and 30 down-regulated mRNAs; and approximately 372 mRNAs were detected between T1 and T4, including 360 up-regulated and 12 down-regulated mRNAs. Approximately 34 differentially expressed genes were identified by Venn analysis. Comparing the three infection periods to the control, there were 28 up-regulated and six down-regulated mRNAs. Additionally, 562 genes were used for cluster analysis, which revealed that the gene expression in T2 and T3 changed greatly. Genes related to cell proliferation and respiration, such as microtubulin and 6-phosphoric acid fructose kinase were mainly up-regulated during the T2 period. Genes encoding lipoxygenase, glutathione-S-transferase, superoxide dismutase and protease inhibitor were up-regulated during T2 and T3. Genes encoding lignocellulose synthase were up-regulated during T4, which suggests the reinforcement of the cell wall to improve the resistance to the damage of the Tetraneura akinire Sasaki.Conclusions The results showed that the feeding of Tetraneura akinire Sasaki caused the differential expression of elm genes and influenced cellular energy metabolism. These changes in physiological response and gene expression of the elm compose the physiological and molecular basis of the gall formation and may improve the resistance of elm to Tetraneura akinire Sasaki. A core set of microsatellite loci for yellow-throated marten, Martes flavigula : a case of inferences of family relationships AbstractBackground Microsatellite markers are an ideal molecular marker for population genetic studies such as population structure, pedigree, and kinship. The yellow-throated marten (Martes flavigula) is widely distributed in coniferous and deciduous forests of eastern Asia and plays the role of an indicator and umbrella species in South Korea, given the absence of top predators such as tiger and leopard.Objective The aim of our study was to establish a core set of microsatellite markers that could be used for a population genetics study on M. flavigula.Methods We characterized 21 di-motif microsatellites for M. flavigula by Illumina next-generation sequencing. We evaluated them for a population genetics study against five established criteria together with 33 previously developed microsatellites. We calculated relatedness values between individual yellow-throated martens in two groups that were suspected to be siblings using the selected core set of markers to confirm applicability.Results Twenty-three loci were determined as the core set of microsatellite markers. The probability of identity P(ID) and probability of identity between siblings P(ID)sib of the core set was estimated as 2−15 and 2.2−7, respectively. Relatedness values between individuals in the two groups of M. flavigula revealed that one of the pairs was sisters, confirming that the core set can be applied to kinship studies.Conclusion The developed microsatellite core set in this study is expected to contribute to studies on molecular ecology and population structure of M. flavigula. Comparative transcript profiling and cytological observation of the newly bred recessive genic male sterility non-heading Chinese cabbage ( Brassica rapa ssp. chinensis) line WS24-3A AbstractBackground WS24-3A is a newly bred non-heading Chinese cabbage genic male-sterile line, in which sterility is controlled by a recessive gene, designated as Bra2ms. WS24-3A has been used for hybrid breeding.Objective To reveal the underlying molecular mechanisms responsible for the sterility of WS24-3A.Methods Cytological observation of the process of sterile/fertile anther development was performed to determine the tissue and stage in which sterility occurs. Phenotyping and transcriptomic analyses were performed to identify differentially expressed genes (DEGs) between sterile and fertile flower buds at different stages.Results Cytological analysis revealed no tetrads at stage 7 or at later stages of anther development, and the degradation of callose was delayed. Abnormal meiocytes were surrounded by sustaining callose that degenerated gradually in WS24-3A. Comparative transcript profiling identified 3282 DEGs during three anther developmental stages, namely, pre-meiotic anther, meiotic anther, and anthers with single-celled pollen stage. The difference in DEG percentage between up-regulated and down-regulated at meiotic anther stage was obviously larger than at the other two stages; further, most DEGs are important for male meiosis, callose synthesis and dissolution, and tapetum development. Ten DEGs were found to be involved in anther and pollen development, which were analyzed by quantitative PCR.Conclusion Bra2ms affected gene expression in meiocytes and associated with callose synthesis, degradation and tapetum development. Our results provide clues to elucidate the molecular mechanism of genic male sterility in non-heading Chinese cabbage. A transcriptome analysis uncovers Panax notoginseng resistance to Fusarium solani induced by methyl jasmonate AbstractBackground Panax notoginseng is a famous Chinese herbal medicine, but the root rot disease mainly caused by Fusarium solani severely reduces the yield and quality of its medicinal materials.Objective The defense priming in P. notoginseng through exogenous application of signaling molecule will supply theoretical support for the exogenous regulation of disease resistance in P. notoginseng.Methods In this study, the exogenous application of methyl jasmonate (MeJA) increased P. notoginseng's resistance to F. solani. Furthermore, the P. notoginseng transcriptome during F. solani infection was investigated through next-generation sequencing to uncover the resistance mechanism of P. notogingseng induced by MeJA.Results The de novo assembly of transcriptome sequences produced 80,551 unigenes, and 36,771 of these unigenes were annotated by at least one database. A differentially expressed gene analysis revealed that a large number of genes related to terpenoid backbone biosynthesis, phenylalanine metabolism, and plant–pathogen interactions were predominantly up-regulated by MeJA. Moreover, jasmonic acid (JA) biosynthesis-related genes and the JA signaling pathway genes, such as linoleate 13S-lipoxygenase, allene oxide cyclase, allene oxide synthase, TIFY, defensin, and pathogenesis-related proteins, showed increased transcriptional levels after inoculation with F. solani. Notably, according to the gene expression analysis, JA and ethylene signaling pathways may act synergistically to positively regulate the defense responses of P. notoginseng to F. solani.Conclusion JA signaling appears to play a vital role in P. notoginseng responses to F. solani infection, which will be helpful in improving the disease resistance of P. notoginseng cultivars as well as in developing an environmentally friendly biological control method for root rot disease. Up-regulation of miR-27 extenuates lipopolysaccharide-induced injury in H9c2 cells via modulating ICAM1 expression AbstractBackground MiR-27 has been found to present an overt myocardial expression during cardiogenesis. However, whether miR-27 involves in myocarditis development and the possible molecular mechanism remain unknown. The purpose of this study was to investigate the biological characteristic of miR-27 in LPS-damaged H9c2 cells.Methods H9c2 cells were treated with lipopolysaccharide (LPS, 10 µg/ml) for 12 h to form cell injury. MiR-27 mimic and inhibitor were used to up-regulate or down-regulate miR-27 expression. MTT assay and flow cytometry analysis were conducted to test cell viability and apoptosis. The relative RNA expression level of miR-27 and intercellular adhesion molecule 1 (ICAM1) was determined by qRT-PCR. Luciferase reporter gene assay was utilized to confirm the interaction between miR-27 and ICAM1. Western blot was used to determine the protein expression levels.Results We observed that LPS treatment significantly decreased the level of miR-27 in H9c2 cells. Moreover, LPS exposure suppressed cell viability, promoted cell apoptosis and increased the relative expression of p-NF-κB p65/NF-κB p65 and p-IκBα/IκBα. Up-regulation of miR-27 increased cell proliferation and reduced cell apoptosis, while down-regulation of miR-27 suppressed cell growth and promoted cell apoptosis. ICAM1 was predicted and verified as a target of miR-27, and the expression of ICAM1 is negatively regulated by miR-27. The relative expression of p-NF-κB p65/NF-κB p65 and p-IκBα/IκBα was dramatically decreased by miR-27 mimic and increased by miR-27 inhibitor.Conclusion Our study illustrated that up-regulation of miR-27 exhibits a protective effect on LPS-damaged H9c2 cells, which may be achieved by regulating ICAM1 and NF-κB signaling. Integrated analysis of quantitative proteome and transcriptional profiles reveals abnormal gene expression and signal pathway in bladder cancer AbstractBackground Bladder cancer (BCa) is a tumor associated with high morbidity and mortality and its incidence is increasing worldwide. However, the pathogenesis of bladder cancer is not well understood.Objective To further illustrate the molecular mechanisms involved in the pathogenesis of BCa and identify potential therapeutic targets, we combined the transcriptomic analysis with RNA sequencing and tandem mass tags (TMT)-based proteomic methods to quantitatively screen the differentially expressed genes and proteins between bladder cancer tissues (BC) and adjacent normal tissues (AN).Results Transcriptome and proteome studies indicated 7094 differentially expressed genes (DEGs) and 596 differentially expressed proteins (DEPs) between BC and AN, respectively. GO enrichment analyses revealed that cell adhesion, calcium ion transport, and regulation of ATPase activity were highly enriched in BCa. Moreover, several key signaling pathway were identified as of relevance to BCa, in particular the ECM-receptor interaction, cell adhesion molecules (CAMs), and PPAR signaling pathway. Interestingly, 367 genes were shared by DEGs and DEPs, and a significant positive correlation between mRNA and translation profiles was found.Conclusion In summary, this joint analysis of transcript and protein profiles provides a comprehensive reference map of gene activity regarding the disease status of BCa. Analysis of differential gene expression in cold-tolerant vs. cold-sensitive varieties of snap bean ( Phaseolus vulgaris L.) in response to low temperature stress AbstractBackground Snap bean, Phaseolus vulgaris L., as a warm-season vegetable, low temperature stress seriously affect the yield and quality. At present, little is known about the genes and molecular regulation mechanism in cold response in snap bean exposed to low temperature.Objectives Our objectives were to identify the low temperature response genes in snap bean and to examine differences in the gene response between cold-tolerant and cold-sensitive genotypes.Methods We used two highly inbred snap bean lines in this study, the cold-tolerant line '120', and the cold-sensitive line '093'. The plants were grown to the three leaf and one heart stage and exposed to 4 °C low temperature. We used RNA sequencing (RNA-seq) to analyze the differences of gene expression.Results 988 and 874 cold-responsive genes were identified in 'T120 vs CK120' and 'T093 vs CK093' ('T' stands for low temperature treatment, and 'CK' stands for control at room temperature), respectively. Of these, 555 and 442 genes were unique to cold-stressed lines '120' and '093', respectively compared to the control. Our analysis of these differentially expressed genes indicates that Ca2+, ROS, and hormones act as signaling molecules that play important roles in low temperature response in P. vulgaris. Altering the expression of genes in these signaling pathways activates expression of downstream response genes which can interact with other signaling regulatory networks. This may maintained the balance of ROS and hormones, making line '120' more cold-tolerant than line '093'.Conclusion Our results provide a preliminarily understanding of the molecular basis of low temperature response in snap bean, and also establish a foundation for the future genetic improvement of cold sensitivity in snap bean by incorporating genes for cold tolerance.
Distinct evolution of toll-like receptor signaling pathway genes in cetaceansAbstractBackgroundThe relatively rapid spread and diversity of marine pathogens posed an initial and ongoing challenge for cetaceans (whales, dolphins, and porpoises), descendants of terrestrial mammals that transitioned from land to sea approximately 56 million years ago. Toll-like receptors (TLRs) play important roles in regulating immunity against pathogen infections by detecting specific molecular patterns and activating...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:36
Emodin Attenuates Severe Acute Pancreatitis via Antioxidant and Anti-inflammatory Activity Abstract There is no specific drug to treat severe acute pancreatitis (SAP), which induces substantial medical and social burden. Many studies have reported the beneficial effects of emodin against SAP in vivo and in vitro. However, the underlying mechanism has been unclear. This paper described the design and implementation of anti-inflammatory and antioxidant activity of emodin. Emodin restored the pathological damage of SAP and simultaneously decreased the high levels of serum amylase, lipase, TNF-α, and IL-18 in the peripheral blood of SAP rat. Emodin reversed reactive oxygen species (ROS) in neutrophils derived from SAP rat. The levels of voltage-dependent anion channel 1 (VDAC1), NOD-like receptor protein 3 (NLRP3), caspase-1, and IL-18 were examined to analyze the change of inflammasome-related mediators between SAP and emodin treatment. These findings suggest that emodin plays its protective role on SAP against oxidative stress and inflammasome signals. Characterization of Circular RNA and microRNA Profiles in Septic Myocardial Depression: a Lipopolysaccharide-Induced Rat Septic Shock Model Abstract Septic shock with heart dysfunction is common in intensive care units. However, the mechanism underlying myocardial depression is still unclear. Whether circular RNA (circRNA) or microRNA (miRNA) profiles differ between patients with and without myocardial depression is unknown. We generated a hypodynamic septic shock model induced by lipopolysaccharide (LPS) in adolescent rats. A total of 12 rats were utilized and heart tissue from each was collected. RNA sequencing was performed on left ventricular tissue. We focused on features of circRNAs and miRNAs, predicting their function by bioinformatic analysis and constructing circRNA-associated and miRNA-associated regulatory networks in heart tissue. We detected 851 circRNAs in heart samples, and 11 showed differential expression. A total of 639 annotated miRNAs and 91 novel miRNAs were explored including 78 showing differential expression between the two groups. We then constructed the most comprehensive circRNA-associated and miRNA-associated networks to explore their regulatory relationship in septic heart tissue, and demonstrated that different networks could potentially participate in and regulate the pathological process of sepsis. Furthermore, gene ontology term enrichment indicated miRNAs, and miRNA-mRNA networks could be associated with regulation and metabolic process, or influence cellular functions. The construction of regulator networks could improve the understanding of the basic molecular mechanisms underlying myocardial depression. It will be important for future investigations to ascertain the biological mechanisms present during the development of sepsis-induced myocardial depression to influence approaches to treatment. Potential Anti-Inflammatory Effect of Escitalopram in Iodoacetamide-Induced Colitis in Depressed Ovariectomized Rats: Role of α7-nAChR Abstract Escitalopram, a drug of choice in the treatment of depression, was recently shown to possess an anti-inflammatory activity. The aim of the present study was to elucidate the effect of escitalopram on peripheral inflammatory cascades in iodoacetamide-induced colitis associated with depressive behavior in ovariectomized rats. Moreover, the role of α-7 nicotinic acetylcholine receptor in mediating the anti-colitic effect of escitalopram was examined using a nicotinic receptor antagonist methyllycaconitine citrate. Colitis was induced by intracolonic injection of 4% iodoacetamide in ovariectomized rats. Escitalopram (10 mg/kg/day, i.p.) was then injected for 1 week and several parameters including macroscopic (colon mass index and ulcerative area), microscopic (histopathology and scoring), and biochemical (myeloperoxidase and tumor necrosis factor-α) were determined. Colitis induction in ovariectomized rats resulted in a marked increase in colon mass index, ulcerative area, histopathological scoring, myeloperoxidase activity and tumor necrosis factor-α levels. These effects were ameliorated by escitalopram, even in the presence of methyllycaconitine indicating that α-7 nicotinic acetylcholine receptor does not mediate the anti-inflammatory effect of escitalopram. The present study revealed the beneficial effect of escitalopram in iodoacetamide induced colitis in ovariectomized rats and suggests that it may represent a new therapeutic agent for the treatment of inflammatory bowel disease, especially in patients with or at high risk of depressive behavior. Inhibition of Fibroblast Growth Factor Receptor by AZD4547 Protects Against Inflammation in Septic Mice Abstract Sepsis is a life-threatening condition caused by the dysregulated host immune response to infection characterized by excessive secretion of inflammatory factors. AZD4547 is a selective inhibitor of fibroblast growth factor receptors that participates in the inflammatory response. The aim of this study was to investigate the inflammation-targeting effects and related molecular mechanisms of AZD4547 in sepsis using a cecal ligation and puncture model and RAW264.7 macrophages stimulated with lipopolysaccharide. AZD4547 improved the survival of CLP mice and exhibited a robust protective function against lung damage histologically. Pretreatment with AZD4547 significantly alleviated the expression of the pro-inflammatory factors IL-1β, IL-6, TNF-α, MMP9, and CXCL10 both in vivo and in vitro. In addition, AZD4547 suppressed the proliferative activity of macrophages in lung tissue and RAW264.7 macrophages. In addition, the LPS-induced phosphorylation of key proteins of NF-κB/MAPK/STAT3 pathways in RAW264.7 macrophages, such as p65, IκB-α, Erk1/2, JNK, and STAT3 proteins, could be inhibited by AZD4547 pretreatment. In conclusion, AZD4547 exerts a protective effect against excessive inflammatory damage in septic mice and may have the potential for use as an effective drug for the management of sepsis. The Role of Decidual PD-1 + Treg Cells in Adverse Pregnancy Outcomes due to Toxoplasma gondii Infection Abstract Toxoplasma gondii infection during pregnancy can result in adverse pregnancy outcomes. Previously, we have reported that these outcomes are associated with the impaired function of decidual Treg cells; however, the detailed mechanisms involved were unclear. It has been reported that the suppressive capacity of Treg cells is dependent on PD-1 expression. The present study explored the role of decidual PD-1+ Treg cell function in adverse pregnancy outcomes due to T. gondii infection. Toxoplasma gondii–infected pregnant mice were sacrificed on gestational day 14 and their pregnancy outcomes were observed. The expression of PD-1 on decidual Treg cells and expressions of Foxp3, CTLA-4, TGF-β, and IL-10 on decidual PD-1+ and PD-1− Treg cells were determined using flow cytometry. The results showed that the expression of PD-1 on decidual Treg cells was clearly higher in the T. gondii–infected mice than in the normal mice. Meanwhile, the expressions of Foxp3, CTLA-4, TGF-β, and IL-10 on decidual PD-1+ Treg cells were higher in the infected mice than in the normal mice. The expressions were higher in decidual PD1+ Treg cells than in PD-1− Treg cells in the infected mice. However, these expressions on PD-1− Treg cells did not significantly differ between the infected and normal mice. Nonetheless, the absolute percentages of decidual PD-1+ Treg cells decreased significantly in the infected mice compared with those in the normal mice. These results suggest that T. gondii infection mainly influences the function of decidual PD-1+ Treg cells, which would result in an insufficiently immunotolerant microenvironment and consequently in adverse pregnancy outcomes. Damage and Phenotype Change in PC12 Cells Induced by Lipopolysaccharide Can Be Inhibited by Antioxidants Through Reduced Cytoskeleton Protein Synthesis Abstract The present study investigated changes in cellular phenotype and oxidative stress during the inflammatory response in PC12 cells stimulated by lipopolysaccharide (LPS) and assessed the effects of minocycline, astragalus (AST), and baicalin on inflammation. PC12 cells were exposed to LPS with or without minocycline, AST, or baicalin. Cell viability was measured by a thiazolyl blue tetrazolium bromide (MTT) assay. Contrast and laser confocal microscopy were used to analyze changes in cellular phenotype and cytoskeleton synthesis. Western blotting tested the expression of α7nAChR and vimentin. Inhibitory ratio of superoxide dismutase (SOD) activity and leakage of lactate dehydrogenase (LDH) were detected to evaluate cellular oxidative stress. Results showed that LPS could attenuate PC12 cell viability in a time- and dose-dependent manner, which could be rescued by minocycline. In addition, minocycline could reverse PC12 cell phenotypic change and the synthesis of the mesenchymal cytoskeleton protein vimentin, both induced by LPS. During LPS-initiated inflammation, α7nAChR and vimentin expression were obviously inhibited by minocycline, AST, or baicalin. The inhibitory rate of SOD activity and LDH leakage in PC12 cells were increased by LPS and attenuated significantly when exposed to minocycline, AST, or baicalin. These findings suggest phenotype change, altered cytoskeleton protein synthesis, and oxidative stress are all involved in the inflammatory response in PC12 cells during which α7 nicotinic acetylcholine receptor (α7nAChR) is induced by LPS stimulation. Minocycline, AST, and baicalin have a protective effect against PC12 cell injury, acting as antioxidants and inhibitors of mesenchymal proteins. Investigation of Extracellular Matrix Protein Expression Dynamics Using Murine Models of Systemic Inflammation Abstract Extracellular matrix (ECM) proteins form the structural support for migration of leukocytes and provide multiple signals to assist in their functions during inflammatory conditions. Presence of pro-inflammatory mediators in the tissues results in the remodelling of matrices which could modify the functions of extravasated leukocytes. Previous reports have shown changes in the expression of ECM proteins during local inflammatory responses. In this study, we have investigated the time- and tissue-specific expression profile of key ECM proteins in systemic inflammation using lipopolysaccharide (LPS)-induced endotoxemia and cecal ligation and puncture (CLP) mouse models. The results show that compared to naïve tissues, within 12 h following CLP surgery, a 20–30-fold increase was observed in the expression of collagen-IV (Col-IV) transcripts in the mesentery tissues with a 2.4-fold increase in the protein by 24 h. However, Western blot band intensities indicated that vimentin and fibrinogen were remarkably expressed in more quantity compared to Col-IV. Secondly, in CLP group of mice, fibrinogen showed 6–40-fold increase in mRNA level in various tissues with about 2-fold increase in the protein level compared to respective naïve tissues. Similar studies in the LPS-injected mice showed up to 2–3 fold increase in the expression of Col-IV, fibrinogen and vimentin at protein level in the lungs. In such animals, although similar pattern was observed for fibrinogen in kidney and liver tissues, the mesentery showed prominent changes in Col-IV and vimentin mRNA compared to CLP. Further, bioinformatics analysis showed multiple pathways which could be associated with vimentin, Col-IV and fibrinogen under inflammatory conditions both in human and mouse. The current study will help in better understanding of possible signalling from ECM proteins in inflammatory microenvironment and may contribute in development of cell adhesion-based therapeutics. Role of JNK Signaling Pathway in Dexmedetomidine Post-Conditioning-Induced Reduction of the Inflammatory Response and Autophagy Effect of Focal Cerebral Ischemia Reperfusion Injury in Rats Abstract To investigate the effect of dexmedetomidine post-conditioning on the inflammatory response and autophagy effect of focal cerebral ischemia reperfusion injury in rats, and further to study its potential mechanisms. Water maze was conducted to evaluate spatial learning and memory ability of middle cerebral artery occlusion (MCAO) rats. TTC staining was used to observe the area of cerebral infarction. The expressions of inflammatory factors in serum were detected by ELISA. TUNEL assay, HE staining, and transmission electron microscopy were used to detect the apoptosis of neurons, neuro-cytopathic changes, and the formation of auto-phagosome in hippocampus CA1 region, respectively. The mRNA and protein expression of Beclin-1, Caspase-3, and light chain 3 (LC3) were detected by qRT-PCR and Western blot. Moreover, the activity of C-Jun N-terminal kinase (JNK) pathway was detected by Western blot. The escape latency (EL); cerebral infarction area ratio; positive apoptosis; neuron pathological changes; auto-phagosome numbers; inflammatory factor contents; mRNA and protein expressions of Beclin-1, Caspase-3 and LC3II/I; and the phosphorylation level of JNK were decreased, while the times across platform and the times stayed in the quadrant of the original platform were increased after dexmedetomidine treatment. However, the protective effect of dexmedetomidine on brain injury in MCAO rats was reversed by JNK pathway activator. Dexmedetomidine post-conditioning could improve learning and memory dysfunction caused by MCAO in rats and reduce the inflammatory response and autophagy effect. The mechanism may be related to inhibition of JNK pathway activation. Pleural Effusion IL-33/sST2 Levels and Effects of Low and High IL-33/sST2 Levels on Human Mesothelial Cell Adhesion and Migration Abstract Interleukin 33 (IL-33) is an alarmin with multiple roles in immunity and cell homeostasis, highly expressed in barrier sites, acting via the suppression of tumorigenicity 2 receptor (ST2). Production of IL-33 and soluble ST2 (sST2), a decoy receptor for IL-33, has been implicated in several pulmonary diseases, but both have been scarcely investigated in pleural diseases. The aim of this study was to determine the levels of IL-33 and sST2 in transudative (TrPEs), malignant (MPEs), and parapneumonic (PPEs) pleural effusions (PEs) and investigate the effect of PE fluids from each group with low and high IL-33/sST2 levels on MeT-5A cell adhesion and migration. IL-33 and sST2 pleural fluid levels were similar among TrPEs, MPEs, and PPEs. However, a significant correlation was found between IL-33 and LDH and in sST2 levels with lymphocyte counts in TrPEs. Additionally, in MPEs the levels of IL-33 correlated with the levels of sST2 and with the red blood cell counts. Furthermore, incubation of MeT-5A cells with MPEs and PPEs bearing low or high levels of IL-33/sST2 yielded significant differential effects on MeT-5A cell adhesion and migration. In MPEs, high IL-33/sST2 levels led to increased adhesion and migration of MeT-5A cells, while in PPEs the effect was the opposite, while no effect in both cell phenotypes was determined for TrPEs. These results reveal a clinical context dependent effect of the IL-33/sST2 axis in PEs. Immunomodulatory and Anti-Inflammatory Potential of Curcumin for the Treatment of Allergic Asthma: Effects on Expression Levels of Pro-inflammatory Cytokines and Aquaporins Abstract Curcumin is well known for possessing anti-inflammatory properties and for its beneficial effects in the treatment of asthma. Current study investigates the immunomodulatory and anti-inflammatory effects of curcumin using mouse model of ovalbumin-induced allergic asthma. BALB/c mice were immunized with ovalbumin on day 0 and 14 to induce allergic asthma. Animals were treated with two different doses of curcumin (20 mg/kg and 100 mg/kg) and methylprednisolone from day 21 to 28. Mice were also daily challenged intranasally with ovalbumin during treatment period, and all groups were sacrificed at day 28. Histopathological examination showed amelioration of allergic asthma in treated groups as evident by the attenuation of infiltration of inflammatory cells, goblet cell hyperplasia, alveolar thickening, and edema and vascular congestion. Curcumin significantly reduced total and differential leukocyte counts in both bronchoalveolar lavage fluid and blood. Reverse transcription polymerase chain reaction analysis showed significantly suppressed mRNA expression levels of IL-4 and IL-5 (pro-inflammatory cytokines), TNF-α, TGF-β (pro-fibrotic cytokines), eotaxin (chemokine), and heat shock protein 70 (marker of airway obstruction) in treated groups. Attenuation of these pro-inflammatory markers might have led to the suppression of airway inflammation. The expression levels of aquaporin-1 (AQP) and AQP-5 were found significantly elevated in experimental groups which might be responsible for reduction of pulmonary edema. In conclusion, curcumin significantly ameliorated allergic asthma. The anti-asthmatic effect might be attributed to the suppression of pro-inflammatory cytokines, and elevation of aquaporin expression levels, suggesting further studies and clinical trials to establish its candidature in the treatment of allergic asthma.
Emodin Attenuates Severe Acute Pancreatitis via Antioxidant and Anti-inflammatory ActivityAbstractThere is no specific drug to treat severe acute pancreatitis (SAP), which induces substantial medical and social burden. Many studies have reported the beneficial effects of emodin against SAP in vivo and in vitro. However, the underlying mechanism has been unclear. This paper described the design and implementation of anti-inflammatory and antioxidant activity of emodin. Emodin restored the pathological...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Response to the comments made by Möller, P., E. Rosenthal, E. and Siebert, C. to the paper "The Sdom evaporite formation in Israel and its relationship with the Messinian Salinity Crisis" by J. Charrach Abstract I thank the discussors for their critique of the above paper. In geology there are rarely any absolute models but working hypotheses, which will be modified with new data. The paper under discussion, Charrach (Carbonates Evaporites 33:727–766, 2018a), presents a very new large data set, which is multi-disciplinary and integrated the most recent research. The critique by Möller et al. (Carbonates Evaporites https://doi.org/10.1007/s13146-019-00486-3, 2019) and their paper of 2018 (Int J Earth Sci 107:2409–2431, 2018),  presents a computer simulation, which must be validated with field evidence and recent research in the area, and not based on assumptions, which have turned into facts over time. The discussors may be unfamiliar with the geological research that has been published over the last 20 years in the areas under consideration. Furthermore, the research on marine–non-marine evaporite formations is hardly considered in their discussion, yet much has been published. Comments on "The Sdom evaporite formation in Israel and its relationship with the Messinian Salinity Crisis" by J. Charrach Abstract According to J. Charrach, the Sdom formation is a major non-marine evaporite sequence deposited during the climax of the Mediterranean Salinity Crisis (MSC). Hydrochemical studies, however, reveal that the evaporites of the Sdom and Zemah stratigraphic columns dominantly originate from evaporated Tethys seawater mixed with some local drainage water. The formation of evaporites in the northern and southern Inland Sea lasted about 2 Ma, a period that could only be pre-Messinian, i.e., most probably Tortonian. Introductory editorial Abstract In order to understand the genesis of a carbonate (karst) aquifer from its initial stage to a fully developed karst system number of different methods have been developed over the last 50 years. Nevertheless, with the continued progress of new technologies developing, the groundwater genesis of the karst aquifer becoming more and more precisely defined. Still, more investigation, specific forums and scientific discussion as well as publications are necessary to improve the knowledge of groundwater genesis within carbonate aquifers, as a main step of karst groundwater protection and utilization. With increasing demands on water resources protection, water supply, urbanisation, construction of large dams, reservoirs, tunnels, railways, roads, mines, tailings and waste disposal structures also increase necessity for close co-operation of a wide spectrum of scientist in precise defining and modeling of groundwater genesis. Groundwater from carbonate aquifer as a rule have good physic-chemical characteristics, and inside of the carbonate rocks can accumulate a large quantities of groundwater, which are ideal for watersupply. On the other hand, they are characterized with high vulnerability to pollution, due to weak autopurification properties of the medium, and big variation in discharging. In order of properly using of karst natural resources, the good knowledge of the hydrogeological system genesis is necessary, meaning primarily on carbonate or evaporitic formation with well-developed dissolution porosity. In a case of defining of groundwater genesis of carbonat aquifer as well as protection, a large number of methodological approaches can be applied in order to define the recharge zone and connection between the underground and surface waters, the mean residence time, as well as groundwater interaction with the hostrock, which have influence on chemical composition and temperature regime of discharged water. This special thematic edition partly includes extended versions of the selected papers that will have been presented at the International Symposium KARST 2018, which deals with the above presented and discussed topics precisely through the works of a large number of world-renowned authors. A number of papers will be presented by invitation, and will directly refer to specific areas of karst exploration: hydrogeology, geomorphology, engineering geology, speleology, all relating to the sustainable use of karst waters as an essential natural resource. The papers will cover a wide range of recent scientific research that was carried out in karst terrains all over the world (China, USA, Canada, Russia, Iran, Peru, Turkey, Malaysia and many European countries). Microfacies and depositional environments of the Qom Formation in Barzok area, SW Kashan, Iran Abstract Qom Formation (Oligo-Miocene marine deposits of Middle Iran) in the southwestern Kashan was studied to determine its microfacies and depositional environments. Outcrops of the Qom Formation in the study area with 410 m, consist mainly of limestone, sandy limestone, shale and marl. Study section is unconformably underlain by the Eocene volcanic rocks and overlain by alluvium. Biogenic components of the Qom Formation comprise mainly of larger benthic foraminifera, coralline red algae and corals. Based on the presence of Nummulites spp. (Nummulites fichteli, Nummulites vascus, Nummulites cf. vascus, Nummulites sp.) throughout the study section, the Qom Formation is considered to be Rupelian in age. Microfacies analysis and field investigations on the study section led to recognition of six carbonate microfacies and two marl and shale facies. Two major depositional environments were identified in the study area including lagoon and open marine. Based on the recognized microfacies and field investigations, deposition of the Qom Formation in Barzok area took place on a carbonate ramp; besides, most of the carbonate parts of the study section are deposited in the open-marine settings. The high abundance of larger benthic foraminifera, coralline red algae and corals indicates that deposition took place in the tropical warm waters. Delineation of groundwater potential zones using remote sensing (RS), geographical information system (GIS) and analytic hierarchy process (AHP) techniques: a case study in the Leylia–Keynow watershed, southwest of Iran Abstract In this research, a standard methodology has been applied to delineate groundwater resource potential zonation based on integrated remote sensing (RS), geographic information system (GIS), and analytical hierarchy process (AHP) techniques in Leylia–Keynow watershed, southwest of Iran. A total of five sets of criteria/factors (including lineament density, rainfall, lithology, slope, and drainage density) believed to be influencing groundwater storage potential in the area were selected. Each criterion/factor was assigned appropriate weight based on Saaty's 9-point scale and the weights were normalized through the analytic hierarchy process (AHP). The process was integrated in the GIS environment to produce the groundwater potential prediction map for the area. The fi9-p groundwater prospect map obtained was classified as excellent potential, very good potential, good potential, moderate potential, and poor potential zone. The obtained results indicated that only 21% (122 km2) of the study area exhibit poor groundwater potential, whereas most of the regions (326 km2) in the research showed good to excellent groundwater potential. Also, about 24% (141 km2) was classified as having moderate groundwater potential. The good to excellent potential zones are characterized by the higher lineament density, higher rainfall, and lithology type such as limestone, whereas the poor to moderate groundwater potential zones are characterized by the lesser lineament density, lower rainfall, lithology type of shale and marl as well as shale and limestone. Based on the obtained evidences, the tectonic structures had an important role in fracturing and crushing of limestone units in the area and so are vital for karst and ground water sources development. The demarcation of groundwater potential zones in the Leylia–Keynow watershed will be helpful for future planning, development and management of the groundwater resources. Formation of $${\text {CaCO}}_3$$CaCO3 varieties from a carbonated aqueous solution Abstract Experimental studies have been conducted to clarify the paragenetic conditions of \({\text {CaCO}}_3\) varieties, calcite and aragonite formed from the same wall rock. In addition, the solubility dependence of calcite, aragonite, and limestone formed from limestone cave in \({\text {CO}}_2\)-saturated solutions was compared with the previous studies. First, the calcite and aragonite were powdered to below 200 meshes. In addition, the powders were, respectively, added into the \({\text {CO}}_2\)-saturated distilled water at 8, 13, 18, and \(22 \,^\circ {\text {C}}\) and were kept constant for 15 days. The amount of dissolved \({\text {CaCO}}_3\) was then measured. The solubility of aragonite was higher than that of calcite, and the solubility decreased exponentially with increasing temperature. Simultaneous production and growth of calcite and aragonite proceeded only when the saturation of aragonite was reached in aqueous carbonate solution. Conversely, when the dissolved amount of \({\text {CaCO}}_3\) has not been reached, calcite is only formed and grown. In these solutions, aragonite crystals dissolve and calcite crystals grow. The degree of saturation of aragonite can be reached by rapid evaporation of solvent, \({\text {CO}}_2\) gas degassing, and the presence of Mg. However, paragenesis of calcite and aragonite in natural caves can be explained by rapid evaporation of the solvent. A rapid evaporation of the solvent may occur at a place, where a small amount of karst solution flows and a large amount of air flows. In such places, paragenesis of calcite and aragonite is possible. Khuzestan plain continental sabkhas, southwest Iran Abstract Khuzestan Plain is part of the Zagros basin that is located in the southwest of Iran. So far, no comprehensive study has been carried out on these sabkha in Khuzestan plain. This research is the first study on these environments in Khuzestan plain. In this study, continental sabkha of Khuzestan have been divided into four groups: playa, sabkha of dried floodplains, sabkha of dried lagoons, sabkha of ephemeral saline lake (pans). A playa, called Maleh, four sabkha of dried floodplains, with the names of east Zohreh, east Jarrahi, west Jarrahi–east Karoon and west Karoon, two sabkha of dried lagoons, called Hor Al-Azim and Shadegan as well as five sabkha of ephemeral saline lakes were identified in this plain. A total of 87 specimens were collected from the continental sabkha sediments of Khuzestan which classified according Shepard (J Sediment Petrol 24:151–158, 1954). Silt and then clayey silt and sandy silt are the most abundant sediments of continental sabkha of Khuzestan. Origin of crystal dolomite and its reservoir formation mechanism in the Xixiangchi Formation, Upper Cambrian in Southeastern Sichuan basin Abstract This paper takes the thick and widely distributed crystal dolomite of Xixiangchi Formation, Upper Cambrian in Southeastern Sichuan basin as an example, the reservoir characteristics and main controlling factors of crystal dolomite have been analyzed systematically, and the genesis and reservoir formation mechanism of crystal dolomite have been discussed. It shows that the main reservoir rocks of crystal dolomite include powder crystalline dolomite and finely crystalline dolomites, and the intercrystal pores and dissolved intercrystal pores are the main reservoir spaces, with few dissolved vugs and fractures developed in the reservoir. The pore structure analysis shows that the throats of crystal dolomite reservoir are mainly lamellar, reflecting a good configuration between pores and throats, medium- low porosity and low permeability, representing typical porous-type reservoir. Dolomitization analysis indicates that the dolomitization occurred in the penecontemporaneous or early diagenetic stage. The degree of dolomitization decreased gradually from the top to the bottom in each sedimentary cycle, and distribution of dolomite in the study area shows that the content of dolomites decreases from the west to the east, which reflects the degree of dolomitization weakening eastward. Combined with the geochemical research of crystal dolomite, the C and O isotope data reflect the same characteristics of seawater during the late Cambrian. It indicates that the dolomitization might be related to the seepage-reflux of seawater in the early time. Recrystallization played an important role in the genesis of the crystal dolomite, because most of crystal dolomites remain residual granular texture. The intercrystal pores formed by seepage–reflux dolomitization acted as superior seepage channels for the reservoir transformation, and the recrystallization adjusted the previous pores and made them better, while the karstification was the key to the dissolved pore formation. Difference in the relationship between soil CO 2 concentration and the karst-related carbon cycle under different land use types in southwest China Abstract As an important driving force for karstification, soil CO2 has a close relation with karst-related carbon cycle. However, their relationship may be disturbed when H2SO4 and HNO3 participate in karstification. Here, soil CO2 and spring water samples were collected from two catchments to examine the dynamics of carbon under different land use types. The net CO2 consumption at the Baishuwan spring catchment (BSW; range 1.7–2.69 mmol/L, average of 2.21 mmol/L) was higher than it was at the Hougou spring catchment (HG; range − 0.63 to 0.02 mmol/L, average of − 0.24 mmol/L). Due to the participation of H2SO4 and HNO3, CO2 was released from bedrock and reduced net CO2 consumption when this portion of CO2 escaped from the water. With regard to soil CO2 concentration, a bidirectional gradient of CO2 concentration occurred at BSW, while alternating bidirectional and unidirectional gradients occurred at HG. However, the δ13C of soil CO2 could not confirm whether the vertical changes in soil CO2 concentration as well as net CO2 consumption were related to the CO2 released from bedrock to soil. With regard to seasonal changes, net CO2 consumption was consistent with soil CO2 concentration at BSW, while the reverse relationship was found at HG. These observations indicated that soil CO2 concentration was not the dominant factor controlling net CO2 consumption at HG, which was affected by H2SO4 and HNO3, and more CO2 escaped from the water due to the reduced water–rock reaction time in the rainy season. Some carbonate rocks utilized as a building material rocks, Egypt Abstract Studies of the geochemical, mineralogical, petrographical characteristics and the physicochemical properties were carried out on some carbonate rocks, so as to throw light on the possibility of utilizing them as a building stones. The dolomitic and dolostone rocks of Gebel Ataqa and Giran El-Ful quarries have been acquiring potential application in building and industry. Petrographically, the dolomite rocks of the Gebel Ataqa quarries are characterized by dolo-biomicrosparite and dolomitic limestone microfacies for Hassan Alaam quarry and dolosparite microfacies for Arab Contractors quarry, while those of Giran El-Ful (Abu Roash area) are mainly dolo-biomicite microfacies and dolostones. They are deposited in mixing zone environment. Mineralogically, XRD patterns indicate the dolomites of the Ataqa and Giran El-Ful quarries are non-stoichiometric. XRD with DTA revealed that the rocks of the three quarries are consisting mainly of dolomite (Ataqa quarries), calcite and ankarite (Abo Roash quarry), as the main constituents, besides quartz and halite as minor constituents. Geochemically, the normative dolomite contents in the studied rocks with an average ~ 90, ~ 35, and ~ 31% for Arab Contractors, Hassan Alaam and Giran El-Ful quarries; respectively. Thus, the dolomitization was more effective in the Cretaceous carbonates at Arab Contractors quarry than those in the Middle Eocene in Hassan Alaam and Giran El-Ful quarries. Arab Contractors have very high Mg content followed by Hassan Alaam, though impoverished in Na2O, K2O, Al2O3, Fe2O3, SO3, SiO2, TiO2, and Cl. Giran El-Ful quarry has very high Fe2O3 and MgO contents; on the other hand, poor in Na2O, K2O, Al2O3, SO3, SiO2, TiO2, and Cl. Sr contents indicate that the dolomite crystals were deposited in mixing zone environments. The total radioactivity measurements are ranging from 2 to 8 ppm for U and from 3 to 9 ppm for Th. The radioactivity measurements are approximately against to the background level of carbonates, and they are in the permissible limits for carbonates used in cement industries and as building stones. The dolomitic and dolostone rocks of the three quarries are proved chemically suitable for the industries relevant to crushed aggregates and lime production. Physically–mechanically examination revealed that the youngest carbonate deposits in the Middle Eocene (Hassan Alaam quarry) rocks have relatively low porosity, water absorption, and crushability, and highest compressive strength compared with those carbonate rocks of the two other quarries of Upper Cretaceous (Arab Contractors and Giran El-Ful). The petrographical, geochemical, and physical–mechanical observations recommended that the carbonates rocks of Hassan Alaam and Arab Contractors quarries in Gebel Ataqa area clearly can be used in the production of crushed aggregates to utilize in the concrete works. On the other hand, Giran El-Ful quarry can be used only in the mechanical sawing and in the production of limestone blocks.
Response to the comments made by Möller, P., E. Rosenthal, E. and Siebert, C. to the paper "The Sdom evaporite formation in Israel and its relationship with the Messinian Salinity Crisis" by J. CharrachAbstractI thank the discussors for their critique of the above paper. In geology there are rarely any absolute models but working hypotheses, which will be modified with new data. The paper under discussion, Charrach (Carbonates Evaporites 33:727–766, 2018a), presents a very new large data set, which...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:35
Which search are you on? Adapting to color while searching for shape Abstract Human observers adjust their attentional control settings when searching for a target in the presence of predictable changes in the target-defining feature dimension. We investigated whether observers also adapt to changes in a nondefining target dimension. According to feature integration theory, stimuli that are unique in their environment in a single feature dimension can be detected with little effort. In two experiments, we studied how observers searching for such singletons adapt their attentional control settings to a dynamical change in a nondefining target dimension. Participants searched for a shape singleton and freely chose between two targets in each trial. The two targets differed in color, and the ratio of distractors colored like each target varied dynamically across trials. A model-based analysis with a Bayesian estimation approach showed that participants adapted their target choices to the color ratio: They tended to select the target from the smaller color subset, and switched their preference both when the color ratio changed between gray and heterogeneous colors (Exp. 1) and when it changed between red and blue (Exp. 2). Participants thus tuned their attentional control settings toward color, although the target was defined by shape. We concluded that observers spontaneously adapted their behavior to changing regularities in the environment. Because adaptation was more pronounced when color homogeneity allowed for element grouping, we suggest that observers adapt to regularities that can be registered without attentional resources. They do so even if the changes are not relevant for accomplishing the task—a process presumably based on statistical learning. Configural superiority for varying contrast levels Abstract Observers can search for a target stimulus at a particular speed and accuracy. Adding an identical context to each stimulus can improve performance when the resulting stimuli form clearly discriminable configurations. This search advantage is known as the configural superiority effect (CSE). A recent study showed that embedding these stimuli in noise revealed lower contrast thresholds for part-stimuli compared to configural stimuli (Bratch et al., Journal of Experimental Psychology. Human Perception and Performance, 42(9), 1388–1398, 2016). This contrasts with the accuracy advantages traditionally associated with CSEs. In this study, we aimed to replicate the results of Bratch et al. and asked whether the benefit for part-stimuli held across the full psychometric function. Additionally, we tested whether embedding the stimuli in noise was crucial for obtaining their result and whether different contrast definitions affected the results. Furthermore, we used control stimuli that were more directly comparable. Our results showed a detection benefit for the Gestalt context stimuli in all conditions. Together, these results are in line with the literature on CSEs and do not seem to support the recent claim that Gestalts are processed less efficiently than part stimuli. Inspired by this, we sketch how contrast manipulations could be an additional tool to study how Gestalts are processed. An analysis of the processing of intramodal and intermodal time intervals Abstract In this 3-experiment study, the Weber fractions in the 300-ms and 900-ms duration ranges are obtained with 9 types of empty intervals resulting from the combinations of three types of signals for marking the beginning and end of the signals: auditory (A), visual (V), or tactile (T). There were three types of intramodal intervals (AA, TT, and VV) and 6 types of intermodal intervals (AT, AV, VA, VT, TA, and TV). The second marker is always the same during Experiments 1 (A), 2 (V), and 3 (T). With an uncertainty strategy where the first marker is 1 of 2 sensory signals being presented randomly from trial to trial, the study provides direct comparisons of the perceived length of the different marker-type intervals. The results reveal that the Weber fraction is nearly constant in the three types of intramodal intervals, but is clearly lower at 900 ms than at 300 ms in intermodal conditions. In several cases, the intramodal intervals are perceived as shorter than intermodal intervals, which is interpreted as an effect of the efficiency in detecting the second marker of an intramodal interval. There were no significant differences between the TA and VA intervals (Experiment 1) and between the AV and TV intervals (Experiment 2), but in Experiment 3, the AT intervals were perceived as longer than the VT intervals. The results are interpreted in terms of the generalized form of Weber's law, using the properties of the signals for explaining the additional nontemporal noise observed in the intermodal conditions. Flexible weighting of target features based on distractor context Abstract Models of attention posit that attentional priority is established by summing the saliency and relevancy signals from feature-selective maps. The dimension-weighting account further hypothesizes that information from each feature-selective map is weighted based on expectations of how informative each dimension will be. In the current studies, we investigated the question of whether attentional biases to the features of a conjunction target (color and orientation) differ when one dimension is expected to be more diagnostic of the target. In a series of color-orientation conjunction search tasks, observers saw an exact cue for the upcoming target, while the probability of distractors sharing a target feature in each dimension was manipulated. In one context, distractors were more likely to share the target color, and in another, distractors were more likely to share the target orientation. The results indicated that despite an overall bias toward color, attentional priority to each target feature was flexibly adjusted according to distractor context: RT and accuracy performance was better when the diagnostic feature was expected than unexpected. This occurred both when the distractor context was learned implicitly and explicitly. These results suggest that feature-based enhancement can occur selectively for the dimension expected to be most informative in distinguishing the target from distractors. Visual noise consisting of X-junctions has only a minimal adverse effect on object recognition Abstract In 1968, Guzman showed that the myriad of surfaces composing a highly complex and novel assemblage of volumes can readily be assigned to their appropriate volumes in terms of the constraints offered by the vertices of coterminating edges. Of particular importance was the L-vertex, produced by the cotermination of two contours, which provides strong evidence for the termination of a 2-D surface. An X-junction, formed by the crossing of two contours without a change of direction at the crossing, played no role in the segmentation of a scene. If the potency of noise elements to affect recognition performance reflects their relevancy to the segmentation of scenes, as was suggested by Guzman, gaps in an object's contours bounded by irrelevant X-junctions would be expected to have little or no adverse effect on shape-based object recognition, whereas gaps bounded by L-junctions would be expected to have a strong deleterious effect when they disrupt the smooth continuation of contours. Guzman's roles for the various vertices and junctions have never been put to systematic test with respect to human object recognition. By adding identical noise contours to line drawings of objects that produced either L-vertices or X-junctions, these shape features could be compared with respect to their disruption of object recognition. Guzman's insights that irrelevant L-vertices should be highly disruptive and irrelevant X-vertices would have only a minimal deleterious effect were confirmed. Interacting hands draw attention during scene observation Abstract In this study I examined the role of the hands in scene perception. In Experiment 1, eye movements during free observation of natural scenes were analyzed. Fixations to faces and hands were compared under several conditions, including scenes with and without faces, with and without hands, and without a person. The hands were either resting (e.g., lying on the knees) or interacting with objects (e.g., holding a bottle). Faces held an absolute attentional advantage, regardless of hand presence. Importantly, fixations to interacting hands were faster and more frequent than those to resting hands, suggesting attentional priority to interacting hands. The interacting-hand advantage could not be attributed to perceptual saliency or to the hand-owner (i.e., the depicted person) gaze being directed at the interacting hand. Experiment 2 confirmed the interacting-hand advantage in a visual search paradigm with more controlled stimuli. The present results indicate that the key to understanding the role of attention in person perception is the competitive interaction among objects such as faces, hands, and objects interacting with the person. The space contraction asymmetry in Michotte's launching effect Abstract Previous studies have found that, compared with noncausal events, spatial contraction exists between the causal object and the effect object due to the perceived causality. The present research aims to examine whether the causal object and the effect object have the same effect on spatial contraction. A modified launching effect, in which a bar bridges the spatial gap between the final position of the launcher and the initial position of the target, was adopted. Experiment 1 validates the absolute underestimation of the bar's length between the launcher and the target. Experiment 2a finds that in the direct launching effect, the perceived position of the bar's trailing edge that was contacted by the final launcher was displaced along the objects' direction of movement. Meanwhile, the perceived position of the bar's leading edge that was contacted by the initial target was displaced in opposite direction to the moving direction. The magnitude of the former's displacement was significantly larger than that of the latter, displaying a significant contraction asymmetry. Experiment 2b demonstrates that the contraction asymmetry did not result from the launcher remaining in contact with the edge of the bar. Experiment 3 indicates that contraction asymmetry showed a type of postdictive effect; that is, to some extent, this asymmetry depends on what happens after contact. In conclusion, the space between the causal object and effect object contracts asymmetrically in the launching effect, which implies that the causal object and effect object are perceived as shifting toward each other nonequidistantly in visual space. Dwelling on simple stimuli in visual search Abstract Research and theories on visual search often focus on visual guidance to explain differences in search. Guidance is the tuning of attention to target features and facilitates search because distractors that do not show target features can be more effectively ignored (skipping). As a general rule, the better the guidance is, the more efficient search is. Correspondingly, behavioral experiments often interpreted differences in efficiency as reflecting varying degrees of attentional guidance. But other factors such as the time spent on processing a distractor (dwelling) or multiple visits to the same stimulus in a search display (revisiting) are also involved in determining search efficiency. While there is some research showing that dwelling and revisiting modulate search times in addition to skipping, the corresponding studies used complex naturalistic and category-defined stimuli. The present study tests whether results from prior research can be generalized to more simple stimuli, where target-distractor similarity, a strong factor influencing search performance, can be manipulated in a detailed fashion. Thus, in the present study, simple stimuli with varying degrees of target-distractor similarity were used to deliver conclusive evidence for the contribution of dwelling and revisiting to search performance. The results have theoretical and methodological implications: They imply that visual search models should not treat dwelling and revisiting as constants across varying levels of search efficiency and that behavioral search experiments are equivocal with respect to the responsible processing mechanisms underlying more versus less efficient search. We also suggest that eye-tracking methods may be used to disentangle different search components such as skipping, dwelling, and revisiting. Comparable search efficiency for human and animal targets in the context of natural scenes Abstract In a previous series of studies, we have shown that search for human targets in the context of natural scenes is more efficient than search for mechanical targets. Here we asked whether this search advantage extends to other categories of biological objects. We used videos of natural scenes to directly contrast search efficiency for animal and human targets among biological or nonbiological distractors. In visual search arrays consisting of two, four, six, or eight videos, observers searched for animal targets among machine distractors, and vice versa (Exp. 1). Another group searched for animal targets among human distractors, and vice versa (Exp. 2). We measured search slope as a proxy for search efficiency, and complemented the slope with eye movement measurements (fixation duration on the target, as well as the proportion of first fixations landing on the target). In both experiments, we observed no differences in search slopes or proportions of first fixations between any of the target–distractor category pairs. With respect to fixation durations, we found shorter on-target fixations only for animal targets as compared to machine targets (Exp. 1). In summary, we did not find that the search advantage for human targets over mechanical targets extends to other biological objects. We also found no search advantage for detecting humans as compared to other biological objects. Overall, our pattern of findings suggests that search efficiency in natural scenes, as elsewhere, depends crucially on the specific target–distractor categories. Is it impossible to acquire absolute pitch in adulthood? Abstract Absolute pitch (AP) refers to the rare ability to name the pitch of a tone without external reference. It is widely believed to be only for the selected few with rare genetic makeup and early musical training during the critical period, and therefore acquiring AP in adulthood is impossible. Previous studies have not offered a strong test of the effect of training because of issues like small sample size and insufficient training. In three experiments, adults learned to name pitches in a computerized, gamified and personalized training protocol for 12 to 40 hours, with the number of pitches gradually increased from three to twelve. Across the three experiments, the training covered different octaves, timbre, and training environment (inside or outside laboratory). AP learning showed classic characteristics of perceptual learning, including generalization of learning dependent on the training stimuli, and sustained improvement for at least one to three months. 14% of the participants (6 out of 43) were able to name twelve pitches at 90% or above accuracy, comparable to that of 'AP possessors' as defined in the literature. Overall, AP continues to be learnable in adulthood, which challenges the view that AP development requires both rare genetic predisposition and learning within the critical period. The finding calls for reconsideration of the role of learning in the occurrence of AP, and pushes the field to pinpoint and explain the differences, if any, between the aspects of AP more trainable in adulthood and the aspects of AP that are potentially exclusive for the few exceptional AP possessors observed in the real world.
Which search are you on? Adapting to color while searching for shapeAbstractHuman observers adjust their attentional control settings when searching for a target in the presence of predictable changes in the target-defining feature dimension. We investigated whether observers also adapt to changes in a nondefining target dimension. According to feature integration theory, stimuli that are unique in their environment in a single feature dimension can be detected with little effort. In two experiments,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:35
It's Not About Ethical Dilemmas: A Survey of Bavarian Veterinary Officers' Opinions on Moral Challenges and an e-Learning Ethics Course Abstract The presented survey focused on moral challenges of Bavarian veterinary officers in their daily work and their expectations of an (e-learning) ethics module in their training program. The results suggest that Bavarian veterinary officers are confronted with morally challenging situations. However, they do not describe these challenges as dilemmas in which the veterinary officers do not know what the moral right choice would be. They are rather convinced to know what they should do from an ethical point of view but see difficulties with the realization as the crucial moral challenge of their profession. The participants in the study do not only expect ethics to help them to find a morally justified way of dealing with moral challenges, but also to gain a better understanding of essential conflicts. In regard to a possible e-learning course on ethics, most veterinary officers were skeptical or highly critical because, from their perspective, ethics needs personal exchange, promoting a dialogue with colleagues, and this is best possible in a classroom-based seminar. Therefore, according to the participants in the survey, if e-learning tools are used, this should only be in combination with classroom-based events. Genome Editing and Responsible Innovation, Can They Be Reconciled? Abstract Genome editing is revolutionising the field of genetics, which includes novel applications to food animals. Responsible research and innovation (RRI) has been advocated as a way of ensuring that a wider-range of stakeholders and publics are able to engage with new and emerging technologies to inform decision making from their perspectives and values. We posit that genome editing is now proceeding at such a fast rate, and in so many different directions, such as to overwhelm attempts to achieving a more reflective pace. An alternative location for reflection is during the much slower process of taking products from the lab to market. We suggest emphasising Responsible Innovation, putting the 'I' back into RRI, and encouraging companies to embrace an RRI approach. We review some previous attempts at developing industry-relevant frameworks for RRI. We then describe two examples of genome editing in livestock; hornless cattle and disease resistant pigs, and reflect on the sorts of questions that could be considered in these two genome editing examples. This paper seeks to take forward the discussion on RRI by extending it to bringing products to market in the context of genome edited livestock. Anthropodicy and the Fate of Humanity in the Anthropocene: From the Disenchantment of Evil to the Re-enchantment of Suffering Abstract The rise of a collective conscience of a new epoch, the Anthropocene, has brought to the fore scientists' predictions of irreversible damage done to the Earth's ecosystems within barely a decade. The passive attitude worldwide of placing the task of overcoming the evil consequences of human activity on specialized forums (e.g., national governments and international organizations) has already proved to be insufficient. In this context, Hamilton seeks to continue Becker's project of laying down the foundations of an "anthropodicy," seen as a humanistic science meant to bring a participatory dimension to the humanity's dealing with the degradation of the conditions of civilized life on Earth. Responsible Innovation for Life: Five Challenges Agriculture Offers for Responsible Innovation in Agriculture and Food, and the Necessity of an Ethics of Innovation Abstract In this special issue we will investigate, from the perspective of agricultural ethics (e.g. animal welfare, agricultural and food ethics, environmental ethics etc.) the potential to develop a Responsible Research and Innovation (RRI) approach to agriculture, and the limitations to such an enterprise. RRI is an emerging field in the European research and innovation (R&I) policy context that aims to balance economic, socio-cultural and environmental aspects in innovation processes. Because technological innovations can contribute significantly to the solution of societal challenges like climate change or food security, but can also have negative societal consequences, it is assumed that social and ethical aspects should be considered during the R&I process. For this reason, the emerging concept of RRI calls for ethical reflection on the nature, scope and applicability of responsibility and innovation in innovation practices in general, and the way social–ethical issues can be applied and addressed in agriculture. The Ethics of Biosurveillance Abstract Governments must keep agricultural systems free of pests that threaten agricultural production and international trade. Biosecurity surveillance already makes use of a wide range of technologies, such as insect traps and lures, geographic information systems, and diagnostic biochemical tests. The rise of cheap and usable surveillance technologies such as remotely piloted aircraft systems (RPAS) presents value conflicts not addressed in international biosurveillance guidelines. The costs of keeping agriculture pest-free include privacy violations and reduced autonomy for farmers. We argue that physical and digital privacy in the age of ubiquitous aerial and ground surveillance is a natural right to allow people to function freely on their land. Surveillance methods must be co-created and justified through using ethically defensible processes such as discourse theory, value-centred design and responsible innovation to forge a cooperative social contract between diverse stakeholders. We propose an ethical framework for biosurveillance activities that balances the collective benefits for food security with individual privacy: (1) establish the boundaries of a biosurveillance social contract; (2) justify surveillance operations for the farmers, researchers, industry, the public and regulators; (3) give decision makers a reasonable measure of control over their personal and agricultural data; and (4) choose surveillance methodologies that give the appropriate information. The benefits of incorporating an ethical framework for responsible biosurveillance innovation include increased participation and accumulated trust over time. Long term trust and cooperation will support food security, producing higher quality data overall and mitigating against anticipated information gaps that may emerge due to disrespecting landholder rights. Agricultural Innovation and the Role of Institutions: Lessons from the Game of Drones Abstract In 2015, observers argued that the fourth agricultural revolution had been initiated. This article focuses on one part of this high-tech revolution: the origin, development, applications, and user value of unmanned aerial systems (UAS). Institutional changes connected to the UAS innovation are analyzed, based on a Swedish case study. The methods included autoethnography. The theoretical frame was composed by four perspectives: innovation, institutions, sustainability, and ethics. UAS can help farmers cut costs and produce higher quantity with better quality, and also has environmental benefits. However, this promising innovation was exposed to institutional forces and suddenly became subordinated the Act of Camera Surveillance. This study illuminates how legislative institutions can inhibit responsible innovation. The study shows that different ethical perspectives can collide with each other. Biblical Gardens in Word Culture: Genesis and History Abstract For nearly 80 years Biblical gardens have been present in the natural and cultural landscape. The first gardens came into existence in the US. The idea to create such gardens spread from the US mainly across Europe, Australia and Israel. These gardens are being made all the time; recently we have observed their dynamic development. This study is to show the effects of the 20 years long scientific work to formulate the original genesis of the Biblical garden idea. The characteristics of 64 facilities situated in 14 countries has been presented for the first time so widely. This enabled us to show both the history of these gardens and how they are situated in the cultural and social context. The effect of various factors inspiring people of various professions to create Biblical gardens both near sacral buildings and within the secular areas has been evidenced. Biblical gardens exercise the principles of gardens of senses and learning gardens. And it is the highly developed semantic layer that makes them stand out. Ethical Concerns in Poultry Production: A German Consumer Survey About Dual Purpose Chickens Abstract The paper offers insights into the acceptability of ethical issues in poultry production and how this situation provides an opportunity to transform the prevailing system into a more sustainable one. The survey among German consumers reveals that killing day-old chicks is a well-known practice and is rated as "very problematic". In contrast, dual-purpose chickens are mostly unknown but are considered a positive alternative to killing day-old chicks (after the concept has been explained). Consumer clusters were identified regarding purchasing criteria for dual-purpose chickens, purchasing routines and socio-economic factors. Three of the five clusters—the perfectionists, idealists, and realists—turned out to be potential buyers. To develop a suitable marketing strategy, it is recommended that the added value of dual-purpose chickens be comprehensibly communicated. From a multi-level perspective, rearing dual-purpose chickens has a competitive disadvantage compared to system-compliant alternatives (in-ovo sexing, "lay hen brothers"). Through increasing external pressure, the different alternatives can jointly contribute to a regime shift. Entanglements of Water Management Abstract This review essay investigates Andrea Ballestero's A Future History of Water (Duke University Press, Durham, 2019), Jeremy Schmidt's Water: Abundance, Scarcity, and Security in the Age of Humanity (New York University Press, New York, 2017), and Wade Graham's Braided Waters: Environment and Society in Molokai, Hawai'i (University of California, Oakland, 2018) within the wider theme of water-human relationships. More specifically, these books provide insight into the human dimensions of water management as they explore the process of how water impacts and drives economic, social, and political change. By doing this, Ballestero, Schmidt, and Graham highlight water's agency and the vital role it plays in a variety of locations and situations. Broadly speaking, works like these help move water beyond discussions limited to ecological science, giving this resource a starring role in crucial discussions ranging from policy and economics to community development and social equity. In this regard, environmental issues are holistic matters that must engage cultural, economic, political, and religious dimensions as well as ecological issues. Collectively these books show that water's fluctuating nature dictates the structure of our world, permeating every issue from the daily to the global while reinforcing the need to look critically at this life-giving resource. Managing Socio-Ethical Challenges in the Development of Smart Farming: From a Fragmented to a Comprehensive Approach for Responsible Research and Innovation Abstract Smart farming (also referred to as digital farming, digital agriculture and precision agriculture) has largely been driven by productivity and efficiency aims, but there is an increasing awareness of potential socio-ethical challenges. The responsible research and innovation (RRI) approach aims to address such challenges but has had limited application in smart farming contexts. Using smart dairying research and development (R&D) in New Zealand (NZ) as a case study, we examine the extent to which principles of RRI have been applied in NZ smart dairying development and assess the broader lessons for RRI application in smart farming. We draw on insights from: a review of research on dairy technology use in NZ; interviews with smart dairying stakeholders; and the application of an analytical framework based on RRI dimensions. We conclude that smart dairying R&D and innovation activities have focused on technology development and on-farm use without considering socio-ethical implications and have excluded certain actors such as citizens and consumers. This indicates that readiness to enact RRI in this context is not yet optimal, and future RRI efforts require leadership by government or dairy sector organisations to fully embed RRI principles in the guidelines for large R&D project design (what has also been referred to as 'RRI maturity'). More broadly, enacting RRI in smart farming requires initial identification of RRI readiness in a given sector or country and devising a roadmap and coherent project portfolio to support capacity building for enacting RRI. Additionally, methods (such as RRI indicators) for operationalising RRI must be adapted to the context of the national or sectoral innovation system in which smart farming is being developed.
It's Not About Ethical Dilemmas: A Survey of Bavarian Veterinary Officers' Opinions on Moral Challenges and an e-Learning Ethics CourseAbstractThe presented survey focused on moral challenges of Bavarian veterinary officers in their daily work and their expectations of an (e-learning) ethics module in their training program. The results suggest that Bavarian veterinary officers are confronted with morally challenging situations. However, they do not describe these challenges as dilemmas in which...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:34
It's Not About Ethical Dilemmas: A Survey of Bavarian Veterinary Officers' Opinions on Moral Challenges and an e-Learning Ethics Course Abstract The presented survey focused on moral challenges of Bavarian veterinary officers in their daily work and their expectations of an (e-learning) ethics module in their training program. The results suggest that Bavarian veterinary officers are confronted with morally challenging situations. However, they do not describe these challenges as dilemmas in which the veterinary officers do not know what the moral right choice would be. They are rather convinced to know what they should do from an ethical point of view but see difficulties with the realization as the crucial moral challenge of their profession. The participants in the study do not only expect ethics to help them to find a morally justified way of dealing with moral challenges, but also to gain a better understanding of essential conflicts. In regard to a possible e-learning course on ethics, most veterinary officers were skeptical or highly critical because, from their perspective, ethics needs personal exchange, promoting a dialogue with colleagues, and this is best possible in a classroom-based seminar. Therefore, according to the participants in the survey, if e-learning tools are used, this should only be in combination with classroom-based events. Genome Editing and Responsible Innovation, Can They Be Reconciled? Abstract Genome editing is revolutionising the field of genetics, which includes novel applications to food animals. Responsible research and innovation (RRI) has been advocated as a way of ensuring that a wider-range of stakeholders and publics are able to engage with new and emerging technologies to inform decision making from their perspectives and values. We posit that genome editing is now proceeding at such a fast rate, and in so many different directions, such as to overwhelm attempts to achieving a more reflective pace. An alternative location for reflection is during the much slower process of taking products from the lab to market. We suggest emphasising Responsible Innovation, putting the 'I' back into RRI, and encouraging companies to embrace an RRI approach. We review some previous attempts at developing industry-relevant frameworks for RRI. We then describe two examples of genome editing in livestock; hornless cattle and disease resistant pigs, and reflect on the sorts of questions that could be considered in these two genome editing examples. This paper seeks to take forward the discussion on RRI by extending it to bringing products to market in the context of genome edited livestock. Anthropodicy and the Fate of Humanity in the Anthropocene: From the Disenchantment of Evil to the Re-enchantment of Suffering Abstract The rise of a collective conscience of a new epoch, the Anthropocene, has brought to the fore scientists' predictions of irreversible damage done to the Earth's ecosystems within barely a decade. The passive attitude worldwide of placing the task of overcoming the evil consequences of human activity on specialized forums (e.g., national governments and international organizations) has already proved to be insufficient. In this context, Hamilton seeks to continue Becker's project of laying down the foundations of an "anthropodicy," seen as a humanistic science meant to bring a participatory dimension to the humanity's dealing with the degradation of the conditions of civilized life on Earth. Responsible Innovation for Life: Five Challenges Agriculture Offers for Responsible Innovation in Agriculture and Food, and the Necessity of an Ethics of Innovation Abstract In this special issue we will investigate, from the perspective of agricultural ethics (e.g. animal welfare, agricultural and food ethics, environmental ethics etc.) the potential to develop a Responsible Research and Innovation (RRI) approach to agriculture, and the limitations to such an enterprise. RRI is an emerging field in the European research and innovation (R&I) policy context that aims to balance economic, socio-cultural and environmental aspects in innovation processes. Because technological innovations can contribute significantly to the solution of societal challenges like climate change or food security, but can also have negative societal consequences, it is assumed that social and ethical aspects should be considered during the R&I process. For this reason, the emerging concept of RRI calls for ethical reflection on the nature, scope and applicability of responsibility and innovation in innovation practices in general, and the way social–ethical issues can be applied and addressed in agriculture. The Ethics of Biosurveillance Abstract Governments must keep agricultural systems free of pests that threaten agricultural production and international trade. Biosecurity surveillance already makes use of a wide range of technologies, such as insect traps and lures, geographic information systems, and diagnostic biochemical tests. The rise of cheap and usable surveillance technologies such as remotely piloted aircraft systems (RPAS) presents value conflicts not addressed in international biosurveillance guidelines. The costs of keeping agriculture pest-free include privacy violations and reduced autonomy for farmers. We argue that physical and digital privacy in the age of ubiquitous aerial and ground surveillance is a natural right to allow people to function freely on their land. Surveillance methods must be co-created and justified through using ethically defensible processes such as discourse theory, value-centred design and responsible innovation to forge a cooperative social contract between diverse stakeholders. We propose an ethical framework for biosurveillance activities that balances the collective benefits for food security with individual privacy: (1) establish the boundaries of a biosurveillance social contract; (2) justify surveillance operations for the farmers, researchers, industry, the public and regulators; (3) give decision makers a reasonable measure of control over their personal and agricultural data; and (4) choose surveillance methodologies that give the appropriate information. The benefits of incorporating an ethical framework for responsible biosurveillance innovation include increased participation and accumulated trust over time. Long term trust and cooperation will support food security, producing higher quality data overall and mitigating against anticipated information gaps that may emerge due to disrespecting landholder rights. Agricultural Innovation and the Role of Institutions: Lessons from the Game of Drones Abstract In 2015, observers argued that the fourth agricultural revolution had been initiated. This article focuses on one part of this high-tech revolution: the origin, development, applications, and user value of unmanned aerial systems (UAS). Institutional changes connected to the UAS innovation are analyzed, based on a Swedish case study. The methods included autoethnography. The theoretical frame was composed by four perspectives: innovation, institutions, sustainability, and ethics. UAS can help farmers cut costs and produce higher quantity with better quality, and also has environmental benefits. However, this promising innovation was exposed to institutional forces and suddenly became subordinated the Act of Camera Surveillance. This study illuminates how legislative institutions can inhibit responsible innovation. The study shows that different ethical perspectives can collide with each other. Biblical Gardens in Word Culture: Genesis and History Abstract For nearly 80 years Biblical gardens have been present in the natural and cultural landscape. The first gardens came into existence in the US. The idea to create such gardens spread from the US mainly across Europe, Australia and Israel. These gardens are being made all the time; recently we have observed their dynamic development. This study is to show the effects of the 20 years long scientific work to formulate the original genesis of the Biblical garden idea. The characteristics of 64 facilities situated in 14 countries has been presented for the first time so widely. This enabled us to show both the history of these gardens and how they are situated in the cultural and social context. The effect of various factors inspiring people of various professions to create Biblical gardens both near sacral buildings and within the secular areas has been evidenced. Biblical gardens exercise the principles of gardens of senses and learning gardens. And it is the highly developed semantic layer that makes them stand out. Ethical Concerns in Poultry Production: A German Consumer Survey About Dual Purpose Chickens Abstract The paper offers insights into the acceptability of ethical issues in poultry production and how this situation provides an opportunity to transform the prevailing system into a more sustainable one. The survey among German consumers reveals that killing day-old chicks is a well-known practice and is rated as "very problematic". In contrast, dual-purpose chickens are mostly unknown but are considered a positive alternative to killing day-old chicks (after the concept has been explained). Consumer clusters were identified regarding purchasing criteria for dual-purpose chickens, purchasing routines and socio-economic factors. Three of the five clusters—the perfectionists, idealists, and realists—turned out to be potential buyers. To develop a suitable marketing strategy, it is recommended that the added value of dual-purpose chickens be comprehensibly communicated. From a multi-level perspective, rearing dual-purpose chickens has a competitive disadvantage compared to system-compliant alternatives (in-ovo sexing, "lay hen brothers"). Through increasing external pressure, the different alternatives can jointly contribute to a regime shift. Entanglements of Water Management Abstract This review essay investigates Andrea Ballestero's A Future History of Water (Duke University Press, Durham, 2019), Jeremy Schmidt's Water: Abundance, Scarcity, and Security in the Age of Humanity (New York University Press, New York, 2017), and Wade Graham's Braided Waters: Environment and Society in Molokai, Hawai'i (University of California, Oakland, 2018) within the wider theme of water-human relationships. More specifically, these books provide insight into the human dimensions of water management as they explore the process of how water impacts and drives economic, social, and political change. By doing this, Ballestero, Schmidt, and Graham highlight water's agency and the vital role it plays in a variety of locations and situations. Broadly speaking, works like these help move water beyond discussions limited to ecological science, giving this resource a starring role in crucial discussions ranging from policy and economics to community development and social equity. In this regard, environmental issues are holistic matters that must engage cultural, economic, political, and religious dimensions as well as ecological issues. Collectively these books show that water's fluctuating nature dictates the structure of our world, permeating every issue from the daily to the global while reinforcing the need to look critically at this life-giving resource. Managing Socio-Ethical Challenges in the Development of Smart Farming: From a Fragmented to a Comprehensive Approach for Responsible Research and Innovation Abstract Smart farming (also referred to as digital farming, digital agriculture and precision agriculture) has largely been driven by productivity and efficiency aims, but there is an increasing awareness of potential socio-ethical challenges. The responsible research and innovation (RRI) approach aims to address such challenges but has had limited application in smart farming contexts. Using smart dairying research and development (R&D) in New Zealand (NZ) as a case study, we examine the extent to which principles of RRI have been applied in NZ smart dairying development and assess the broader lessons for RRI application in smart farming. We draw on insights from: a review of research on dairy technology use in NZ; interviews with smart dairying stakeholders; and the application of an analytical framework based on RRI dimensions. We conclude that smart dairying R&D and innovation activities have focused on technology development and on-farm use without considering socio-ethical implications and have excluded certain actors such as citizens and consumers. This indicates that readiness to enact RRI in this context is not yet optimal, and future RRI efforts require leadership by government or dairy sector organisations to fully embed RRI principles in the guidelines for large R&D project design (what has also been referred to as 'RRI maturity'). More broadly, enacting RRI in smart farming requires initial identification of RRI readiness in a given sector or country and devising a roadmap and coherent project portfolio to support capacity building for enacting RRI. Additionally, methods (such as RRI indicators) for operationalising RRI must be adapted to the context of the national or sectoral innovation system in which smart farming is being developed.
It's Not About Ethical Dilemmas: A Survey of Bavarian Veterinary Officers' Opinions on Moral Challenges and an e-Learning Ethics CourseAbstractThe presented survey focused on moral challenges of Bavarian veterinary officers in their daily work and their expectations of an (e-learning) ethics module in their training program. The results suggest that Bavarian veterinary officers are confronted with morally challenging situations. However, they do not describe these challenges as dilemmas in which...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:33
Quantitative Assessment of Elagolix Enzyme-Transporter Interplay and Drug–Drug Interactions Using Physiologically Based Pharmacokinetic Modeling AbstractIntroduction Elagolix is approved for the management of moderate-to-severe pain associated with endometriosis. The aim of this analysis was to develop a physiologically based pharmacokinetic (PBPK) model that describes the enzyme-transporter interplay involved in the disposition of elagolix and to predict the magnitude of drug–drug interaction (DDI) potential of elagolix as an inhibitor of P-glycoprotein (P-gp) and inducer of cytochrome P450 (CYP) 3A4.Methods A PBPK model (SimCYP® version 15.0.86.0) was developed using elagolix data from in vitro, clinical PK and DDI studies. Data from DDI studies were used to quantify contributions of the uptake transporter organic anion transporting polypeptide (OATP) 1B1 and CYP3A4 in the disposition of elagolix, and to quantitatively assess the perpetrator potential of elagolix as a CYP3A4 inducer and P-gp inhibitor.Results After accounting for the interplay between elagolix metabolism by CYP3A4 and uptake by OATP1B1, the model-predicted PK parameters of elagolix along with the DDI AUC∞ and Cmax ratios, were within 1.5-fold of the observed data. Based on model simulations, elagolix 200 mg administered twice daily is a moderate inducer of CYP3A4 (approximately 56% reduction in midazolam AUC∞). Simulations of elagolix 150 mg administered once daily with digoxin predicted an increase in digoxin Cmax and AUC∞ by 68% and 19%, respectively.Conclusions A PBPK model of elagolix was developed, verified, and applied to characterize the disposition interplay between CYP3A4 and OATP1B1, and to predict the DDI potential of elagolix as a perpetrator under dosing conditions that were not tested clinically. PBPK model-based predictions were used to support labeling language for DDI recommendations of elagolix. Acknowledgement to Referees Fetal Physiologically Based Pharmacokinetic Models: Systems Information on Fetal Blood Components and Binding Proteins AbstractBackground Fetal blood and plasma volume and binding components are critical parameters in a fetal physiologically based pharmacokinetic model. To date, a comprehensive review of their changes during fetal development has not been reported.Objective The objective of this work was to collate and analyze physiological information on fetal blood and plasma volume and binding component data during development and to provide a mathematical description of these parameters that can be integrated within a fetal physiologically based pharmacokinetic model.Methods A comprehensive literature search was conducted on fetal blood and plasma volume and binding component parameters and their changes during growth from apparently healthy fetuses from uncomplicated pregnancies. Collated data were assessed, integrated, and analyzed to establish continuous mathematical functions describing their growth trends with fetal age and weight.Results Data were available from 14 studies for blood, ten studies for hematocrit, 12 studies for albumin, and four studies for alpha-1-acid glycoprotein, while plasma and red blood cell volumes were described based on blood and hematocrit data. Fetal physiologically based pharmacokinetic parameters, including blood, plasma and red blood cell volumes, hematocrit, serum albumin, and acid glycoprotein were quantified as a function of fetal age and weight. Variability around the mean parameters at different fetal ages was also investigated. The growth of each of these parameters was different (with respect to direction and monotonicity).Conclusions Despite the limitations identified in the availability of some values, the collected data presented in this article provide a useful resource for fetal physiologically based pharmacokinetic modeling. Potential applications include predicting xenobiotic exposure and risk assessment in the fetus following maternally administered drugs or unintended exposure to environmental toxicants. Setting the Dose of Checkpoint Inhibitors: The Role of Clinical Pharmacology Abstract Cancer immunotherapy is based on checkpoint inhibitors (CPIs) that significantly improve the clinical outcome of several malignant diseases. These inhibitors are monoclonal antibodies (mAbs) directed at cytotoxic T lymphocyte-associated protein 4 (CTLA-4), programmed cell death 1 (PD-1), or programmed death-ligand 1 (PD-L1), sharing most of the clinical pharmacokinetic characteristics of mAb targeted therapies, all of which differ from those of cytotoxics and small molecules. Establishing the labeled dose of mAbs, and particularly of the CPIs, represents a true challenge. This review therefore examines the main criteria used for dose selection, along with their limits. The relationships between CPI pharmacokinetic parameters and treatment outcome (efficacy and/or toxicity) differ somewhat among the various drugs, but general features can be identified. Nevertheless, the interpretation of these relationships remains quite controversial. A first interpretation asserts that inter-individual pharmacokinetic variability in clearance has an impact on outcome and should be taken into consideration for dosing individualization. The second considers that higher clearance values observed in some patients result from characteristics associated with poor predictive factors of efficacy. Finally, the schedule, and particularly its frequency of administration, merits rethinking. Correction to: Evidence-Based Design of Fixed-Dose Combinations: Principles and Application to Pediatric Anti-Tuberculosis Therapy In the online supplementary Population Pharmacokinetics of Blinatumomab in Pediatric and Adult Patients with Hematological Malignancies AbstractBackground and objectives Blinatumomab (BLINCYTO®) is a novel bispecific T cell engager (BiTE®) approved in the USA for the treatment of relapsed or refractory B cell precursor acute lymphoblastic leukemia (ALL) in children and adults, as well as minimal residual disease ALL in adults. This analysis characterized the population pharmacokinetics of intravenous blinatumomab in pediatric and adult patients.Methods A total of 2417 serum concentrations of blinatumomab from 674 patients, including adult (n = 628) and pediatric patients (n = 46), from eight clinical studies were analyzed. The impact of covariates on pharmacokinetic parameters were explored, and significant covariates were further evaluated using a simulation approach.Results Blinatumomab pharmacokinetics were described by a one-compartment linear model with first-order elimination, a clearance (CL) of 2.22 L/h, and a central volume of 5.98 L. A statistically significant effect of body surface area (BSA) on CL was observed. The smallest BSA of 0.37 m2 in the pediatric population was associated with a 63% reduction in blinatumomab systemic CL, relative to an adult patient with the median BSA (1.88 m2), supporting the use of BSA-based dosing in patients of lower bodyweight. The BSA effect was minimal, with a ≤ 25% change in CL over the range of BSA in adults, supporting no need for BSA-based dosing.Conclusions Blinatumomab pharmacokinetics were adequately described by a one-compartment linear model with first-order elimination. No covariates other than BSA on CL were identified as significant. BSA-based dosing should be considered for lightweight patients to minimize inter-subject variability in blinatumomab exposure. Clinical Pharmacokinetics and Pharmacodynamics of Etravirine: An Updated Review Abstract Etravirine is a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) for the treatment of human immunodeficiency virus type 1 infection. It is a potent inhibitor of HIV reverse transcriptase and retains activity against wild-type and most NNRTI-resistant HIV. The pharmacokinetic profile of etravirine and clinical data support twice-daily dosing, although once-daily dosing has been investigated in treatment-naïve and treatment-experienced persons. Despite similar pharmacokinetic and pharmacodynamic results compared with twice-daily dosing, larger studies are needed to fully support once-daily etravirine dosing in treatment-naïve individuals. Etravirine is reserved for use in third- or fourth-line antiretroviral treatment regimens, as recommended, for example, in treatment guidelines by the US Department of Health and Human Services—Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Etravirine exhibits the potential for bi-directional drug–drug interactions with other antiretrovirals and concomitant medications through its interactions with cytochrome P450 (CYP) isozymes: CYP3A4, CYP2C9, and CYP2C19. This review summarizes the pharmacokinetic and pharmacodynamic parameters of etravirine, with particular attention to information on drug–drug interactions and use in special patient populations, including children/adolescents, women, persons with organ dysfunction, and during pregnancy. Population Pharmacokinetics of Mycophenolic Acid Co-Administered with Tacrolimus in Corticosteroid-Free Adult Kidney Transplant Patients AbstractBackground and Objective Mycophenolic acid is commonly prescribed to adult kidney transplant recipients. Mycophenolic acid is extensively metabolized to mycophenolic acid-glucuronide (major metabolite) and mycophenolic acid-acyl-glucuronide (minor metabolite). We hypothesized that (1) adult kidney transplant patients on corticosteroid-free regimens exhibit unique mycophenolic acid population pharmacokinetics compared with patients receiving corticosteroid-based therapy, and (2) mycophenolic acid clearance is directly dependent on glucuronide metabolite formation.Methods Non-linear mixed-effects modeling was conducted with MonolixSuite-2018R1 (n = 27). Optimal pharmacokinetic models were selected based on objective function values, standard errors, and biological plausibility.Results Clinical demographic data were sex (female, 16), age (47 ± 13 years, mean ± standard deviation), weight (70 ± 16 kg), height (165 ± 9 cm), albumin (43 ± 4 g/L), serum creatinine (102 ± 27 µmol/L), estimated glomerular filtration rate (61 ± 16 mL/min/1.73 m2), mycophenolic acid dosage (1.4 ± 0.5 g/day, as mycophenolate mofetil), and tacrolimus dosage (5 ± 3 mg/day, immediate release). The population pharmacokinetics of mycophenolic acid can be described by a two-compartment first-order absorption with lag time, and a linear elimination structural model. The apparent oral clearance estimate in the final model (population mean, relative standard error) was 2.87 L/h, 42.3%, which is lower than that reported for similar patients on corticosteroid-based regimens (11.9–26.3 L/h). Other pharmacokinetic parameters were comparable to historical data obtained in corticosteroid-based patients. Both mycophenolic acid-acyl-glucuronide trough concentration and the area under the concentration–time curve ratio were significant covariates that reduced mycophenolic acid apparent oral clearance from 16.5 (base model) to 2.87 L/h. The model was evaluated based on bootstrapping, visual predictive checks, and diagnostic plots.Conclusions Our novel findings suggest the potential need to reduce mycophenolic acid dosage in subjects on corticosteroid-free regimens. Corticosteroid-free subjects may also be more sensitive to drug/gene interactions. Requirements to Establishing Confidence in Physiologically Based Pharmacokinetic (PBPK) Models and Overcoming Some of the Challenges to Meeting Them Abstract When scientifically well-founded, the mechanistic basis of physiologically based pharmacokinetic (PBPK) models can help reduce the uncertainty and increase confidence in extrapolations outside the studied scenarios or studied populations. However, it is not always possible to establish mechanistically credible PBPK models. Requirements to establishing confidence in PBPK models, and challenges to meeting these requirements, are presented in this article. Parameter non-identifiability is the most challenging among the barriers to establishing confidence in PBPK models. Using case examples of small molecule drugs, this article examines the use of hypothesis testing to overcome parameter non-identifiability issues, with the objective of enhancing confidence in the mechanistic basis of PBPK models and thereby improving the quality of predictions that are meant for internal decisions and regulatory submissions. When the mechanistic basis of a PBPK model cannot be established, we propose the use of simpler models or evidence-based approaches. Phenotyping of Human CYP450 Enzymes by Endobiotics: Current Knowledge and Methodological Approaches Abstract Drug response is subject to an important within- and between-individual variability owing, mainly, to pharmacokinetic and pharmacodynamic factors. Pharmacokinetics includes metabolism by cytochrome P450 (CYP450), major enzymes of phase I reactions that are responsible for the biotransformation of around 60% of the currently approved drugs. CYP450 activity and/or expression are influenced by multiple intrinsic and extrinsic factors, such as drug–drug interactions or genetic polymorphisms. Present phenotyping strategies with xenobiotics used to assess CYP450 activity could be replaced by less invasive procedures using endogenous CYP450 biomarkers. In this work, we review existing knowledge on endobiotics and their ability to characterise variability of the CYP1A2, CYP2C19, CYP2D6 and CYP3A enzymes in humans. To date, it appears that there is a lack of clinical data for the majority of the endogenous compounds described in the literature or some important limitations to allow their use in clinical practice. Additional studies are needed to fill the gap or to identify new candidates, in particular through the use of metabolomics. The use of multivariate models is also a very promising approach to enhance prediction by combining several endogenous phenotyping metrics and other covariates.
Quantitative Assessment of Elagolix Enzyme-Transporter Interplay and Drug–Drug Interactions Using Physiologically Based Pharmacokinetic ModelingAbstractIntroductionElagolix is approved for the management of moderate-to-severe pain associated with endometriosis. The aim of this analysis was to develop a physiologically based pharmacokinetic (PBPK) model that describes the enzyme-transporter interplay involved in the disposition of elagolix and to predict the magnitude of drug–drug interaction (DDI)...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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The Gut in MR Imaging: From the Upper to the Lower Digestive Tract Publication date: Available online 2 November 2019 Source: Magnetic Resonance Imaging Clinics of North America Author(s): Suresh K. Mukherji The Gut in MR Imaging: A Successful Story Publication date: Available online 2 November 2019 Source: Magnetic Resonance Imaging Clinics of North America Author(s): Andrea Laghi Radiographic/MR Imaging Correlation of Soft Tissues Publication date: November 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 4 Author(s): Filip M. Vanhoenacker, Frederik Bosmans Pitfalls in Pediatric Trauma and Microtrauma Publication date: November 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 4 Author(s): Sarah D. Bixby Anteroposterior Radiograph of the Ankle with Cross-Sectional Imaging Correlation Publication date: November 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 4 Author(s): Dana J. Lin, Erin F. Alaia, Ignacio Martín Rossi, Jonathan Zember, Zehava Sadka Rosenberg Joint Effusion and Bone Outlines of the Knee: Radiographic/MR Imaging Correlation Publication date: November 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 4 Author(s): Thibaut Jacques, Sammy Badr, Paul Michelin, Guillaume Lefebvre, Julien Dartus, Anne Cotten Conventional Radiography of the Hip Revisited: Correlation with Advanced Imaging Publication date: November 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 4 Author(s): Charbel Mourad, Patrick Omoumi, Jacques Malghem, Bruno C. Vande Berg Radiographic/MR Imaging Correlation of Paravertebral Ossifications in Ligaments and Bony Vertebral Outgrowths: Anatomy, Early Detection, and Clinical Impact Publication date: November 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 4 Author(s): Monique Reijnierse Radiographic/MR Imaging Correlation of Spinal Bony Outlines Publication date: November 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 4 Author(s): Timothy Woo, Prudencia N.M. Tyrrell, Antonello Leone, Francesco Pio Cafarelli, Giuseppe Guglielmi, Victor Cassar-Pullicino Radiographic/MR Imaging Correlation of the Wrist Publication date: November 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 4 Author(s): Thomas P. Moser, Adriana P. Martinez, Sooheib Andoulsi, Jérémy Jeantroux, Étienne Cardinal
The Gut in MR Imaging: From the Upper to the Lower Digestive TractPublication date: Available online 2 November 2019Source: Magnetic Resonance Imaging Clinics of North AmericaAuthor(s): Suresh K. MukherjiThe Gut in MR Imaging: A Successful StoryPublication date: Available online 2 November 2019Source: Magnetic Resonance Imaging Clinics of North AmericaAuthor(s): Andrea LaghiRadiographic/MR Imaging Correlation of Soft TissuesPublication date: November 2019Source: Magnetic Resonance Imaging Clinics...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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All Hands On Deck: Evolving Best Practices for Optimal Intraoperative Hand Hygiene No abstract available Hocus, PoCUS: OSA Diagnosis? No abstract available Descriptive Statistics in Medical Research No abstract available Hand Hygiene and Relearning Lessons From the Past No abstract available Untapped Potential of Dexmedetomidine No abstract available Perioperative Screening for Sleep Apnea: The New Frontier of Point-of-Care Ultrasound No abstract available Methadone: New Indications for an Old Drug? No abstract available Tranexamic Acid for Acute Hemorrhage: When Is Enough Evidence Enough? No abstract available Guidelines, Practice Parameters, and Consensus Statements in Anesthesiology No abstract available Methylprednisolone Does Not Reduce Acute Postoperative Pain After Cardiac Surgery: Subanalysis of a Randomized Clinical Trial BACKGROUND: Pain after cardiac surgery is largely treated with opioids, but their poor safety profile makes nonopioid medications attractive as part of multimodal pathways. Anti-inflammatory drugs reduce acute postoperative pain, but the role of steroids in reducing acute poststernotomy pain is unclear. We evaluated the association between the intraoperative administration of methylprednisolone and postoperative analgesia, defined as a composite of pain scores and opioid consumption, during the initial 24 hours after cardiac surgery. METHODS: We conducted a post hoc retrospective analysis of a large clinical trial in which adults having cardiac surgery were randomized 1:1 to receive 2 intraoperative doses of 250 mg IV methylprednisolone or placebo. Pain scores and opioid consumption were collected during the initial 24 hours after surgery. Methylprednisolone was considered to be associated with better pain control than placebo if proven noninferior (not worse) on both pain scores (defined a priori with delta of 1 point) and opioid consumption (delta of 20%) and superior to placebo in at least 1 of the 2 outcomes. This test was repeated in the opposite direction (testing whether placebo is better than methylprednisolone on postoperative pain management). RESULTS: Of 251 eligible patients, 127 received methylprednisolone and 124 received placebo. Methylprednisolone was noninferior to placebo on pain with difference in mean (CI) pain scores of −0.25 (−0.71 to 0.21); P < .001. However, methylprednisolone was not noninferior to placebo on opioid consumption (ratio of geometric means [CI]: 1.11 [0.64–1.91]; P = .37). Because methylprednisolone was not noninferior to placebo on both outcomes, we did not proceed to superiority testing based on the a priori stopping rules. Similar results were found when testing the opposite direction. CONCLUSIONS: In this post hoc analysis, we could not identify a beneficial analgesic effect after cardiac surgery associated with methylprednisolone administration. There are currently no data to suggest that methylprednisolone has significant analgesic benefit in adults having cardiac surgery.
All Hands On Deck: Evolving Best Practices for Optimal Intraoperative Hand HygieneNo abstract availableHocus, PoCUS: OSA Diagnosis?No abstract availableDescriptive Statistics in Medical ResearchNo abstract availableHand Hygiene and Relearning Lessons From the PastNo abstract availableUntapped Potential of DexmedetomidineNo abstract availablePerioperative Screening for Sleep Apnea: The New Frontier of Point-of-Care UltrasoundNo abstract availableMethadone: New Indications for an Old Drug?No abstract...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Refractory dependence on opioid analgesics No abstract available Itch sensitization? A systematic review of studies using quantitative sensory testing in patients with chronic itch As well established for patients with chronic pain, patients suffering from chronic itch also exhibit signs of peripheral and central sensitization. This has been linked to parallel neuroplastic sensitization processes. However, for chronic itch, sensitization has not yet been systematically assessed, studied, and hence validated. This review (Prospero CRD42016043002) summarizes and meta-analytically evaluates whether sensory aberrations including sensitization for itch occur in chronic itch. Databases PubMed, Embase, and Cochrane Library were searched for studies investigating somatosensory sensitivity assessment by quantitative sensory testing stimuli, including experimental cutaneous chemical pruritic provocations, in patients with chronic itch from skin/neurological conditions and compared with healthy controls. Outcomes were extracted for lesional and nonlesional skin, and risk of biases were assessed. Meta-analyses were performed when sufficient quantitative data were available. Of 4667 identified articles, 46 were included and 25 were eligible for meta-analyses. Patients (66% atopic dermatitis [AD]) were found more sensitive than the controls to histamine-evoked itch in lesional skin (standardized mean difference [SMD]: 0.66 confidence interval [CI]: 0.16-1.15), but not nonlesionally (SMD: −0.26 [CI: −0.58 to 0.06]). Cowhage did not evoke more itch in nonlesional skin of patients as compared to the controls (SMD: 0.38 [CI: −0.04 to 0.81]). For numerous other chemical provocations as well as for mechanical, thermal, and electrical stimulation paradigms, results were ambiguous or based on few studies. Patients with chronic itch are only robustly sensitized to various chemical pruritic stimuli when applied lesionally. More studies on somatosensory aberrations in chronic itch conditions other than AD are needed to establish whether sensitization is robustly present across chronic itch conditions. Conditioned pain modulation as a biomarker of chronic pain: a systematic review of its concurrent validity Conditioned pain modulation (CPM) is a promising psychophysical biomarker of central pain mechanisms because it significantly discriminates patients with chronic pain from healthy controls. Nevertheless, it is unclear in what extent CPM assessed experimentally is correlated with clinical manifestations of pain. To assess the concurrent validity of CPM, we performed a systematic review of the literature reporting correlations between CPM responses and pain intensity, disability, duration, and area in patients with different chronic pain conditions. We included 32 studies that altogether encompassed data from 1958 patients and provided 62 correlations. The majority of the results (69%) reported nonsignificant correlations between CPM efficiency and clinical manifestations of pain, whereas the remaining results showed a correlation between CPM reduction and worse clinical symptoms of pain. The modality of stimulation, the type of pain, and the stimulation site appear to be critical variables that influenced the pattern of results. Given that most of the studies were conducted with highly heterogeneous methodologies and unclear risk of bias, the findings highlight the need for future studies using standardized measures of clinical and experimental pain before considering CPM as a valid biomarker of pain. We discuss some guidelines to overcome the constraints in this promising line of research. A randomized pilot study to investigate the effect of opioids on immunomarkers using gene expression profiling during surgery Endogenous opioid peptides and exogenous opioids modulate immune function, and animal and human studies have shown that some have a depressant immunomodulatory effect. This is potentially of high clinical significance, eg, in cancer patients and surgery. The primary objective of this pilot study was to evaluate the effect of morphine and oxycodone on immune pathways associated with immunosuppression in gynecological laparotomy patients. Gene expression was analyzed in CD4+, CD8+, and natural killer (NK) cells using the 3′ Affymetrix microarray. Patients were randomized to receive morphine, oxycodone, or nonopioid "control" analgesia during and after surgery. Genes demonstrating differential expression were those with a ≥±2-fold difference and P-value ≤0.05 after analysis of variance. Cytometric bead array and NK cell degranulation assay were used to investigate changes in serum cytokine concentration and in NK cell cytotoxicity, respectively. Forty patients had satisfactory RNA which was hybridized to gene chips. Genes were identified (Partek Genomics Suite 6.6) at baseline, 2, 6, and 24 hours and were either ≥2-fold upregulated or downregulated from baseline. At 2 hours, a large number of genes were downregulated with morphine but not with control analgesia or oxycodone. Statistically significant increases in IL-6 concentrations were induced by morphine only; NK cell activity was suppressed with morphine, but maintained with oxycodone and epidural analgesia. Gene expression profiles suggest that at 2 hours, post incision morphine appeared to be immunosuppressive as compared to oxycodone and nonopioid control analgesia. Epidermal expression of human TRPM8, but not of TRPA1 ion channels, is associated with sensory responses to local skin cooling Human cold perception and nociception play an important role in persisting pain. However, species differences in the target temperature of thermosensitive ion channels expressed in peripheral nerve endings have fueled discussions about the mechanism of cold nociception in humans. Most frequently implicated thermosensors are members of the transient receptor potential (TRP) ion channel family TRPM8 and TRPA1. Regularly observed, distinct cold pain phenotype groups suggested the existence of interindividually differing molecular bases. In 28 subjects displaying either high or medium sensitivity to local cooling of the skin, the density at epidermal nerve fibers of TRPM8, but not that of TRPA1 expression, correlated significantly with the cold pain threshold. Moreover, reproducible grouping of the subjects, based on high or medium sensitivity to cooling, was reflected in an analogous grouping based on high or low TRPM8 expression at epidermal nerve fibers. The distribution of TRPM8 expression in epidermal nerve fibers provided an explanation for the previously observed (bi)modal distribution of human cold pain thresholds which was reproduced in this study. In the light of current controversies on the role of human TRPA1 ion channels in cold pain perception, the present observations demonstrating a lack of association of TRPA1 channel expression with cold sensitivity–related measures reinforce doubts about involvement of this channel in cold pain in humans. Since TRP inhibitors targeting TRPM8 and TRPA1 are currently entering clinical phases of drug development, the existence of known species differences, in particular in the function of TRPA1, emphasizes the increasing importance of new methods to directly approach the roles of TRPs in humans. Dermorphin [D-Arg2, Lys4] (1-4) amide inhibits below-level heat hypersensitivity in mice after contusive thoracic spinal cord injury Opioid use for chronic pain is limited by severe central adverse effects. We examined whether activating mu-opioid receptors (MORs) in the peripheral nervous system attenuates spinal cord injury (SCI) pain-like behavior in mice. We produced a contusive SCI at the T10 vertebral level and examined motor and sensory dysfunction for 6 weeks. At 6 weeks, we tested the effect of subcutaneous (s.c.) injection of dermorphin [D-Arg2, Lys4] (1-4) amide (DALDA), a peripherally acting MOR-preferring agonist, on mechanical and heat hypersensitivity. Basso mouse scale score was significantly decreased after SCI, and mice showed hypersensitivity to mechanical and heat stimulation at the hind paw beginning at 2 weeks, as indicated by increased paw withdrawal frequency to mechanical stimulation and decreased paw withdrawal latency to heat stimulation. In wild-type SCI mice, DALDA (1 mg/kg, s.c.) attenuated heat but not mechanical hypersensitivity. The effect was blocked by pretreatment with an intraperitoneal injection of methylnaltrexone (5 mg/kg), a peripherally restricted opioid receptor antagonist, and was also diminished in Pirt-MOR conditional knockout mice. DALDA did not adversely affect exploratory activity or induced preference to drug treatment in SCI mice. In vivo calcium imaging showed that DALDA (1, 10 mg/kg, s.c.) inhibited responses of small dorsal root ganglion neurons to noxious heat stimulation in Pirt-GCaMP6s mice after SCI. Western blot analysis showed upregulation of MOR in the lumbar spinal cord and sciatic nerves at 6 weeks after SCI. Our findings suggest that peripherally acting MOR agonist may inhibit heat hypersensitivity below the injury level with minimal adverse effects. Fatty acid suppression of glial activation prevents central neuropathic pain after spinal cord injury About half of patients with spinal cord injury (SCI) develop debilitating central neuropathic pain (CNP), with no effective treatments. Thus, effective, safe, and novel therapies are needed urgently. Previously, docosahexaenoic acid (DHA) was reported to confer neuroprotection in preclinical SCI models. However, its therapeutic potential on SCI-CNP remains to be elucidated. Here, we demonstrated for the first time that intravenous DHA administrations with 3-day intervals (250 nmol/kg; starting 30 minutes after injury and maintained for 6 weeks) effectively prevented SCI-CNP development in a clinically relevant rat contusion model. SCI-CNP was assessed by a novel sensory profiling approach combining evoked pain measures and pain-related ethologically relevant rodent behaviours (burrowing, thigmotaxis, and place/escape avoidance) to mimic those for measuring human (sensory, affective, cognitive, and spontaneous) pain. Strikingly, already established SCI-CNP could be abolished partially by similar DHA administrations, starting from the beginning of week 4 after injury and maintained for 4 weeks. At spinal (epicenter and L5 dorsal horns) and supraspinal (anterior cingulate cortex) levels, both treatment regimens potently suppressed microglial and astrocyte activation, which underpins SCI-CNP pathogenesis. Spinal microgliosis, a known hallmark associated with neuropathic pain behaviours, was reduced by DHA treatments. Finally, we revealed novel potential roles of peroxisome proliferator–activated and retinoid X receptors and docosahexaenoyl ethanolamide (DHA's metabolite) in mediating DHA's effects on microglial activation. Our findings, coupled with the excellent long-term clinical safety of DHA even in surgical and critically ill patients, suggest that systemic DHA treatment is a translatable, effective, safe, and novel approach for preventing and managing SCI-CNP. Motor simulation is disturbed when experiencing pain While the contribution of social processes to pain perception is well documented, surprisingly little is known about the influence of pain on social perception. In particular, an important question is how pain modulates the processing of other people's actions. To address this question, the current study tests, using automatic imitation, the hypothesis that pain interferes with motor simulation—that is, the processing of observed actions in the motor system. Participants in both experiments performed an automatic imitation task requiring them to abduct their index or little finger while they saw someone else performing either a congruent or incongruent action. Automatic imitation was measured in a pain-free context, a context where pain was coupled to the execution of a movement (experiment 1), and a context where pain occurred randomly (experiment 2). The results revealed that automatic imitation, indexed by slower responses on incongruent compared with congruent trials, was reduced when experiencing pain, both when pain was linked to movement execution and when it was not. Thus, the current study shows that pain leads to reduced motor processing of others' behavior and, as such, has important implications for understanding the social difficulties associated with pain. Brain dysfunction in chronic pain patients assessed by resting-state electroencephalography Chronic pain is a common and severely disabling disease whose treatment is often unsatisfactory. Insights into the brain mechanisms of chronic pain promise to advance the understanding of the underlying pathophysiology and might help to develop disease markers and novel treatments. Here, we systematically exploited the potential of electroencephalography to determine abnormalities of brain function during the resting state in chronic pain. To this end, we performed state-of-the-art analyses of oscillatory brain activity, brain connectivity, and brain networks in 101 patients of either sex suffering from chronic pain. The results show that global and local measures of brain activity did not differ between chronic pain patients and a healthy control group. However, we observed significantly increased connectivity at theta (4-8 Hz) and gamma (>60 Hz) frequencies in frontal brain areas as well as global network reorganization at gamma frequencies in chronic pain patients. Furthermore, a machine learning algorithm could differentiate between patients and healthy controls with an above-chance accuracy of 57%, mostly based on frontal connectivity. These results suggest that increased theta and gamma synchrony in frontal brain areas are involved in the pathophysiology of chronic pain. Although substantial challenges concerning the reproducibility of the findings and the accuracy, specificity, and validity of potential electroencephalography-based disease markers remain to be overcome, our study indicates that abnormal frontal synchrony at theta and gamma frequencies might be promising targets for noninvasive brain stimulation and/or neurofeedback approaches. Heme and sensory neuropathy: insights from novel mutations in the heme exporter feline leukemia virus subgroup C receptor 1 Hereditary sensory and autonomic neuropathies (HSANs) are a group of clinically and genetically heterogeneous disorders of the peripheral nervous system mainly characterized by impaired nociception and autonomic dysfunction. We previously identified heme metabolism as a novel pathway contributing to sensory neurons maintenance and nociception. Indeed, we reported mutations in the feline leukemia virus subgroup C receptor 1 (FLVCR1) gene in individuals affected by HSAN. FLVCR1 gene encodes for 2 heme export proteins, FLVCR1a (plasma membrane) and FLVCR1b (mitochondria), crucially involved in the regulation of cellular heme homeostasis. Here, we report on 2 additional patients carrying novel biallelic mutations in FLVCR1 translation initiation codon (c.2T>C; p.(Met1Thr) and c.3G>T; p.(Met1Ile)). We overexpressed the c.2T>C; p.(Met1Thr) mutant in human cell lines and we describe its impact on protein structure and function in comparison with other HSAN-related mutations. We found that the mutation interferes with translation in 2 different ways: by lowering levels of translation of wild-type protein and by inducing translation initiation from a downstream in-frame ATG, leading to the production of an N-terminal truncated protein that is retained in the endoplasmic reticulum. The impact of different kinds of mutations on FLVCR1a localization and structure was also described. The identification of novel FLVCR1 mutations in HSAN reinforces the crucial role of heme in sensory neuron maintenance and pain perception. Moreover, our in vitro findings demonstrate that heme export is not completely lost in HSAN patients, thus suggesting the possibility to improve FLVCR1 expression/activity for therapeutic purposes.
Refractory dependence on opioid analgesicsNo abstract availableItch sensitization? A systematic review of studies using quantitative sensory testing in patients with chronic itchAs well established for patients with chronic pain, patients suffering from chronic itch also exhibit signs of peripheral and central sensitization. This has been linked to parallel neuroplastic sensitization processes. However, for chronic itch, sensitization has not yet been systematically assessed, studied, and hence validated....
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Substance Use Disorders Among Industry Workers in Egypt Background and Objective: Substance abuse in the workplace is a major public health problem. The objectives of this study are to: (1) to determine the prevalence and associated risk factors of substance abuse, drug-related problems, and drug dependence among industrial workers; (2) to identify patients' views of the pros and cons of their drug use and their treatment readiness; and (3) to assess the severity of substance abuse according to the Addiction Severity Index (ASI) scale in substance users. Subjects and Methods: A total of 353 industrial workers from 5 factories in 10th of Ramadan city in Egypt were included in the study. The participants were interviewed to collect sociodemographic and clinical data using the Structural Clinical Interview for DSM-IV-Axis I (SCID-I), the Drug Use Disorder Identification Test (DUDIT), DUDIT-Extended version and the Addiction Severity Index (ASI). The participants were screened for drug abuse by urine analysis. Results: The prevalence rates of smoking and substance abuse were 27.6% and 18.3%, respectively. The most commonly abused drugs were tramadol (66.2%), cannabis (55.4%), and alcohol (38.5%). Compared with controls, smokers and substance users were more likely to be males and were older. Smokers were 7 times more likely to use substances. Substance dependence was associated with a younger age of substance use onset and alcohol abuse. Conclusions: Smoking and substance abuse are common among industrial workers. Tramadol and cannabis are the most commonly abused substances. Smoking, older age, and male sex are correlates of substance abuse. Alcohol abuse is associated with dependence. Familial Opioid Misuse and Family Cohesion: Impact on Family Communication and Well-being Objectives: This study aimed to understand family communication and overall well-being of young adults in the context of familial opioid misuse using the family systems framework. Methods: A cross-sectional, mixed-methods, online survey of young adults aged 18 to 30 years (n=137) was conducted. A cluster analysis was performed based on family organization and structural characteristics. MANCOVA was utilized to compare groups identified using the cluster analysis in terms of (1) family's belief about opioid misuse, (2) worry regarding opioid misuse, (3) family communication, and (4) overall well-being of young adults. Results: A cluster analysis resulted in three groups (group 1: no familial opioid misuse with high family cohesion; group 2: familial opioid misuse with moderate family cohesion; group 3: those with/without familial opioid misuse and low family cohesion). Group 3 had the lowest family communication compared to group 1 and group 2 (P<0.001 and P=0.001, respectively) and had lower overall well-being compared to group 1 (P=0.008). Group 2 had a higher worry score than group 1 (P<0.001). Qualitative analysis using Labov's narrative analysis elucidated that having someone misusing opioids with other substances (eg, alcohol) in the family can negatively impact the emotions of family members. Conclusions: Our findings indicated that family cohesion had a greater impact on family communication and overall well-being of young adults even in the presence of familial opioid misuse. This suggests that higher family cohesion may positively influence young adults to cope with issues related to familial opioid misuse. Pregabalin Does Not Reduce Opioid Withdrawal Symptoms: A Randomized Controlled Trial Background and Aim: Controlling the symptoms of opioid withdrawal syndrome is important for the treatment of opioid addiction. There is very limited evidence on the effectiveness of pregabalin on opioid withdrawal syndrome. The present study examines the effectiveness of pregabalin in reducing opioid withdrawal symptoms. Methods: This double-blind clinical-trial was conducted on noninjecting opioid users diagnosed with opioid dependence and referred to the Addiction Treatment Center of Khorshid Hospital in Isfahan, Iran, in 2015 and 2016. The patients were divided into intervention and control groups, and both groups received Buprenorphine for the routine management of opioid withdrawal syndrome. The intervention group additionally received 450 mg/d of pregabalin while the control group received placebos. Opioid withdrawal symptoms were evaluated using the Short Opioid Withdrawal Scale (SOWS). Data were analyzed in SPSS-20. Descriptive data were reported as mean±SD. The analytic data were analyzed using the repeated-measures ANOVA. The level of statistical significance was set at P-value<0.05. Results: The mean age was 41.58±10.09 in the intervention group and 44±8.87 years in the control group (P=0.47). None of the assessed signs and symptoms differed significantly between the 2 groups. Conclusions: The results did not show the superiority of the 450-mg/day pregabalin regimen versus the placebo for controlling the symptoms of opioid withdrawal syndrome. Further studies administering higher doses of pregabalin are recommended. The Effects of Repetitive Transcranial Magnetic Stimulation in Reducing Cocaine Craving and Use Given the scale and complexity of cocaine abuse in individual, social and public health terms, new forms of treatment are urgently needed. The therapeutic uses of Transcranial Magnetic Stimulation (TMS) for reducing consumption by those who abuse cocaine have been explored since 2003. This article reports an integrative review of seven trials carried out from 2007 to 2016, investigating the use of TMS on subjects abusing cocaine. The analysis was categorized into 5 different topics (1) area of intervention; (2) hemisphere; (3) number of pulses and intensity; (4) safety and adverse effects; and (5) other outcomes. Most of the trials found promising results of craving and/or use reduction with repetitive TMS (rTMS). Future interventions should consider the use of TMS as part of rehabilitation therapies. Game Addiction Scale for Adolescents: Arabic Version Validation Objectives: This study is aimed to translate the game addiction scale for adolescents into Arabic language and to test reliability and validity of the Arabic version. The game addiction scale for adolescents was developed to measure computer and video game addiction based on the criteria of pathological gambling in DSM-IV. Methods: The scale has been translated into Arabic. The English and Arabic versions were compared by psychiatry experts to ensure consistency and then they were administered to bilingual individuals who played computer and video games. Finally, the Arabic version was distributed among 50 school students, aged 10 to 19 years, who played computer and video games. Results and Conclusions: The data were collected from school students. The statistical analysis of the Arabic version of game addiction scale for adolescents showed that the Arabic/English validity was satisfactory, with proper internal consistency and reliability. Alcohol Consumption by Older People in Brazil: A Systematic Review of Population-based Studies Introduction: Given the rapid population aging taking place in countries like Brazil and in many other countries, understanding patterns of alcohol consumption by older people and the associated factors are important. Methods: The databases MEDLINE, Embase, and LILACS were searched for population-based studies on the prevalence of current alcohol consumption among Brazilians aged over 60. Results: Eight eligible studies were identified. Two studies reported data on binge drinking, with one national study finding a prevalence of 10.3%, while the other (male subjects only) found higher prevalences (27.1% and 13.7% at 2 sites). Heavy drinking was estimated in 4 studies with prevalences varying from 2.9% to 7.3%. Alcohol dependence was estimated in 3 studies, 1 used the DSM-IV diagnosis criteria and found a prevalence of 3.8%, while the other 2 used screening tools and found higher prevalences of 8.2% and 9.2%. Being male and younger were associated with several of the above patterns of alcohol consumption. Higher education was associated with binge and heavy drinking, and low education and socioeconomic status with alcohol dependence. Discussion/Conclusions: These findings show that in Brazil problems related to alcohol use by the elderly remain relatively unknown. There was a high heterogeneity of methodologies in the studies, making it difficult to summarize the findings and produce prevalence estimates for the different patterns of consumption. More homogenous studies using similar definitions of patterns of alcohol consumption are required to allow comparisons to be made between different Brazilian regions and other countries. Profile of Help-seeking Crack Cocaine Users in Brazil: A Comparison of 2 Cross-sectional Studies From 1997 and 2013 Objective: The purpose of this study was to compare the characteristics of treatment-seeking crack cocaine users in Brazil in 1996/1997 and 2012/2013. Methods: We analyzed data from 2 cross-sectional studies conducted 16 years apart. The first study (performed 1996-1997) included 133 crack users. The second study (performed 2012-2013) included 577 crack users. An interview based on the Intake Questionnaire and the Maudsley Addiction Profile was performed to examine sociodemographic characteristics and patterns of drug use. In both surveys, criminal and treatment history were collected. Results: The mean age of users increased from 27.3 years (SD=7.9) in 1997 to 30.8 years in 2013 (SD=7.7). The number of individuals with a high school diploma was >3 times higher in 2013, (11.7% vs. 38.9%). The mean time elapsed since first use was 3.9 years (SD=2.8) in 1997 versus 9.3 years (SD=5.8) in 2013. Other differences included higher unemployment and incarceration rates in the 1997 study. Conclusions: A change was detected in the profile of treatment-seeking crack cocaine users over the past 2 decades. Current patients appear to be older and use the drug more chronically, in addition to having a higher level of schooling and lower unemployment rates when compared with 1997 users. Clinic Payment Options as a Barrier to Accessing Medication-assisted Treatment for Opioid Use in Albuquerque, New Mexico Objectives: For patients with opioid addiction seeking treatment, an effective option is Medication-assisted Treatment (MAT). In Albuquerque, the city with the greatest number of people who use opioids in New Mexico, the demand for MAT exceeds the number of patients receiving treatment. The authors hypothesized that a primary factor in patients' ability to access treatment is clinic payment options, rather than the traditionally cited availability of providers. Methods: The authors conducted a survey assessing payment methods and corresponding availability in MAT programs for 53 of Albuquerque's ~70 providers. Results: The authors found a statistically significant (P<0.01) imbalance in treatment availability between insurance-accepting clinics (10.1% had ≥1 openings) and cash clinics (100% had ≥1 openings). Conclusions: These findings suggest that a lack of clinics accepting Medicaid and third party insurance may pose a significant treatment barrier. The authors thus conclude that more focus should be placed on increasing the number of clinicians and clinics accepting insurance.
Substance Use Disorders Among Industry Workers in EgyptBackground and Objective: Substance abuse in the workplace is a major public health problem. The objectives of this study are to: (1) to determine the prevalence and associated risk factors of substance abuse, drug-related problems, and drug dependence among industrial workers; (2) to identify patients' views of the pros and cons of their drug use and their treatment readiness; and (3) to assess the severity of substance abuse according to the...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Myeloid Neoplasia and Other Leukemias No abstract available Unusual Presentation of Myeloid Sarcoma in a Patient With Usher Syndrome A 45-year-old woman with Usher syndrome, associated congenital deafness, progressive blindness due to retinitis pigmentosa, and latent autoimmune diabetes presented to the emergency department with malaise, dizziness, and pelvic pain following removal of an intrauterine device. A posterior vaginal wall mass was found on examination. Laboratory values demonstrated anemia, thrombocytopenia, and an elevated white blood cell count, raising concern for infection and potential onset of diabetic ketoacidosis. This prompted a peripheral blood smear review, which showed 60% monocytic blasts. A subsequent vaginal mass biopsy showed a myeloid sarcoma. Molecular studies demonstrated an NPM1 mutation in exon 12 without FLT3 mutation or internal tandem duplication. While a diagnosis of acute myeloid leukemia with mutated NPM1 was considered, cytogenetics revealed a complex karyotype with evidence of clonal evolution, consistent with acute myeloid leukemia with myelodysplasia-related changes. In addition to an unusual presentation of myeloid sarcoma, this case posed significant questions regarding management and pursuit of hematopoietic stem cell transplantation. Usher syndrome is genetically and clinically heterogeneous. While it is not known to be associated with increased risk of malignancy, mutation of genes associated with Usher syndrome has been identified in acute leukemia. Our case raises the question as to whether potential germline predisposition should be considered in a patient with a previously unassociated congenital syndrome. Chronic Myelomonocytic Leukemia in a Patient With a Germline Predisposition and Short Telomeres Myeloid neoplasms with germline predisposition are an increasingly recognized category within the World Health Organization classification. Detection requires a high degree of suspicion, with mounting awareness of clinically silent phenotypes and heterogeneous presentations, challenging diagnostic and laboratory testing considerations, need for surveillance of disease progression, and unique concerns in donor selection for stem cell transplantation. We describe the case of a patient who presented as a teenager with thrombocytopenia and was later diagnosed with chronic myelomonocytic leukemia, with eventual transformation to acute myeloid leukemia, which has relapsed after stem cell transplantation. She was found to have short telomeres and a TERT mutation, in addition to numerous features suggestive of a germline predisposition syndrome. These findings have not been specifically associated with chronic myelomonocytic leukemia and raise interesting questions about the associations between myelodysplastic/myeloproliferative neoplasms, telomere biology disorders, and the roles of specific myeloid mutations as drivers of disease. Next-Generation Sequencing Analysis in Posttransplant Relapsed Acute Myeloid Leukemia Reveals Clonal Evolution and Donor-Derived Germline Variant Indicating Bone Marrow Chimerism The era of next-generation sequencing (NGS) has led to a deeper understanding of the genetic complexity and heterogeneity of this disease, in addition to revealing mechanisms of disease relapse. Clinical NGS is becoming routine in clinical practice in both solid organ and hematologic malignancies to identify molecular markers of disease that might assist with diagnosis, prognosis, and the treatment of cancer. These tumor-specific markers also enable treatment response monitoring, as they serve as clonal markers unique to the disease. Continuous molecular monitoring also allows identification of disease recurrence with potentially new actionable mutations. This practice is complicated in the setting of allogeneic bone marrow transplant, as the admixtures of donor and recipient DNA pose unique challenges to NGS interpretation. This case highlights the importance of systematic methodological interpretation of NGS results to better understand the clinical significance and impact of new mutations discovered posttransplant and reveals another potential application of NGS for bone marrow engraftment analysis. Unclassifiable Myelodysplastic/Myeloproliferative Neoplasm With Hypocellularity: A Classification Conundrum Myelodysplastic/myeloproliferative neoplasm (MPN), unclassifiable (MDS/MPN-U), has clinical and morphologic features of both myelodysplastic syndrome (MDS) and myeloproliferative neoplasms (MPNs), and does not meet diagnostic criteria for any other specific entity within MDS, MPN, or MPN, including therapy-related myeloid neoplasms, and cases evolving from a prior MDS or MPN. Diagnostic criteria for MDS/MPN-U include, among other specifications, a platelet count of greater than or equal to 450 × 10E9/L associated with bone marrow megakaryocytic proliferation. We present the case of a young adult patient with a several-year reported history of cytopenias, found to have thrombocytosis and 5% circulating blasts. Surprisingly, his bone marrow biopsy demonstrated hypocellularity (10%), with 5% to 10% blasts, myeloid hypoplasia, minimal fibrosis, and focal megakaryocytic dyspoiesis but no hyperplasia. The constellation of morphologic and clinical features presents a challenging differential diagnosis between MDS/MPN-U and MDS with excess blasts (as well as thrombocytosis). Molecular testing interestingly demonstrated an SF3B1 mutation, although no increased ring sideroblasts were found by iron staining. Cases such as these may prove instructive in refining our understanding of the MDS/MPN category, as well as its relationship to myelodysplasia and the complex molecular genetic landscape underlying myeloid neoplasia. Granulomatous Slack Skin T-Cell Lymphoma Manifesting as Ulcerative and Gangrenous Lesions With a Fatal Outcome: A Case Report and Review of the Literature Granulomatous slack skin is an extremely rare cutaneous T-cell lymphoma, which often pursues an indolent disease course. Clinically, it is characterized by areas of redundant and lax skin in flexural areas, with variable erythema. Histologic findings include granulomatous T-cell infiltrates with loss of elastic fibers and poikilodermic change. In this article, we report a patient with unusual rapidly progressive ulcerative and gangrenous skin lesions, leading to amputation and ultimately demise. We also review the literature on granulomatous slack skin with similarly aggressive clinical course and discuss the differential diagnosis. MYC Alteration by Chromothripsis Event in Aggressive High-Grade B-Cell Lymphoma Negative by Conventional Fluorescence In Situ Hybridization Analysis: A Case Report Double-hit and double-expressor phenotypes in lymphomas are characterized by activation of the expression of the MYC and BCL2 genes through diverse mechanisms including chromosomal translocations and amplifications. Herein, we report a high-grade B-cell lymphoma in a patient with evidence for a chromothripsis event (via chromosomal microarray methodology) at chromosome 8, resulting in a focal copy number gain of the MYC locus, not detected by conventional fluorescence in situ hybridization for MYC despite strong MYC expression by immunohistochemical analysis. Chromosome analysis from the biopsy was not successful because of an extensive tissue necrosis. Chromothripsis is suggested as another mechanism for the activation of MYC in non-Hodgkin lymphoma, resulting in aggressive disease course, and this case underscores the need for chromosomal microarray testing in select cases to identify aggressive biology. Unusual Cases of Hairy Cell Leukemia With Uncommon Immunophenotypes: A Diagnostic Challenge Hairy cell leukemia (HCL) is a rare indolent B-cell neoplasm with distinct morphologic and immunophenotypic features. Immunophenotypically, the neoplastic cells in HCL are strongly positive for B-cell markers, such as CD19, CD20, and CD22. They also characteristically express CD11c, CD25, CD103, and CD123, but lack CD5, CD10, and CD23. Uncommon immunophenotypes of HCL can pose diagnostic challenges. Here, we report 2 unusual cases of CD5-positive and CD10-positive HCL. Hairy Cell Leukemia Presenting as Presternal Soft Tissue Mass: A Case Report With Review of Literature Hairy cell leukemia (HCL) is an uncommon chronic lymphoproliferative disorder. Initial presentation frequently includes symptoms related to peripheral blood cytopenias. It can sometimes have atypical manifestations and can present at unusual sites. We report an unusual presentation of HCL as a presternal soft tissue mass in a 45-year-old man. His peripheral blood counts showed pancytopenia. There were no palpable lymph nodes or hepatosplenomegaly. CT-scan revealed a middle mediastinal mass with extension into the presternal soft tissue. Tissue core biopsy was taken and histopathologic findings confirmed the diagnosis of HCL. To our knowledge, this is the second reported case of HCL presenting as a presternal soft tissue mass. Although rare, HCL should be considered in the differential diagnosis of tumors involving extramedullary/extranodal sites including the soft tissue and bone, so the patient can get the utmost benefit for early diagnosis of a treatment responsive disease. Myeloid Sarcoma of the Urinary Bladder Associated With t(8;21): Case Report and Review of the Literature Myeloid sarcoma is a malignant neoplasm of myeloid lineage that occurs in extramedullary sites, frequently in patients with acute myeloid leukemia and other myeloproliferative and myelodysplastic syndromes. Myeloid sarcoma of the urinary bladder is exceptionally rare, and although the most common cytogenetic abnormality associated with this lesion is t(8;21)/RUNX-RUNX1T1, to the best of our knowledge, there are no previous reports of this in patients with bladder involvement. We report a case of a 30-year-old man with a urinary bladder mass, which was consistent with myeloid sarcoma with t(8;21). The importance of myeloid sarcoma of the bladder is that it could be misdiagnosed and must be differentiated from other poorly differentiated bladder tumors composed of round cells, mainly because it is a malignant neoplasm with a good response to treatment, which does not require surgery.
Myeloid Neoplasia and Other LeukemiasNo abstract availableUnusual Presentation of Myeloid Sarcoma in a Patient With Usher SyndromeA 45-year-old woman with Usher syndrome, associated congenital deafness, progressive blindness due to retinitis pigmentosa, and latent autoimmune diabetes presented to the emergency department with malaise, dizziness, and pelvic pain following removal of an intrauterine device. A posterior vaginal wall mass was found on examination. Laboratory values demonstrated anemia,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:31
Reversible Impaired Methotrexate Clearance After Platinum-Based Chemotherapy for Osteosarcoma Abstract: The authors present a case of an 18-year-old man with metastasized osteosarcoma, admitted for methotrexate (MTX) treatment combined with cisplatin and doxorubicin. During the first cycle, severe MTX toxicity was observed with increased MTX serum levels and delayed MTX clearance requiring rescue treatment with intensified leucovorin. In the following cycles, cisplatin and doxorubicin were discontinued, and MTX dose was reduced. The elimination half-life slowly improved over the following cycles suggesting a reversible cause responsible for reduced MTX clearance and toxicity during the first cycle. Cisplatin is well-known for its nephrotoxic effects and can induce reversible tubular injury. Previous treatment with cisplatin may well have been responsible for decreased MTX clearance, and combination treatment should be used with adequate monitoring of MTX levels. Other factors that may have contributed, such as urine alkalization, gene polymorphisms, and other drug–drug interactions are discussed. Generation and Validation of a Limited Sampling Strategy to Monitor Mycophenolic Acid Exposure in Children With Nephrotic Syndrome Background: Mycophenolate mofetil (MMF) plays an increasingly important role in the treatment of children with nephrotic syndrome, especially in steroid sparing protocols. Recent publications show the relationship of exposure to its active moiety mycophenolic acid (MPA) and clinical efficacy. Performance of full-time pharmacokinetic (PK) profiles, however, is inconvenient and laborious. Established limited sampling strategies (LSS) to estimate the area under the concentration (AUC) versus time curve of MPA (MPA-AUC) in pediatric renal transplant recipients cannot be easily transferred to children suffering from nephrotic syndrome, mainly because of the lack of concomitant immunosuppressive therapy. We therefore aimed for the generation and validation of a LSS to estimate MPA exposure to facilitate therapeutic drug monitoring in children with nephrotic syndrome. Methods: We performed 27 complete PK profiles in 23 children in remission [mean age (±SD):12.3 ± 4.26 years] to generate and validate an LSS. Sampling time points were before administration (C0) and 0.5, 1, 1.5, 2, 4, 6, 8, and 12 hours after the administration of MMF. MPA was measured by enzyme multiplied immunoassay technique. There was no concomitant treatment with calcineurin inhibitors. Results: Mean daily dose of MMF was 927 ± 209 mg/m2 of body surface area resulting in a mean MPA-AUC0-12 value of 59.2 ± 29.3 mg × h/L and a predose level of 3.03 ± 2.24 mg/L. Between-patient variability of dose-normalized MPA-AUC0-12 was high (coefficient of variation: 45.5%). Correlation of predose levels with the corresponding MPA-AUC0-12 was moderate (r2 = 0.59) in a subgroup of 18 patients (20 PK profiles, generation group). An algorithm based on 3 PK sampling time points during the first 2 hours after MMF dosing (estimated AUC0-12 = 8.7 + 4.63 × C0 + 1.90 × C1 + 1.52 × C2) was able to predict MPA-AUC with a low percentage prediction error (3.88%) and a good correlation of determination (r2 = 0.90). Validation of this algorithm in a randomized separate group of 6 patients (7 PK profiles, validation group) resulted in comparably good correlation (r2 = 0.95) and low percentage prediction error (5.57%). Conclusions: An abbreviated profile within the first 2 hours after MMF dosing gives a good estimate of MPA exposure in children with nephrotic syndrome and hence has the potential to optimize MMF therapy. Pharmacokinetics of Enteric-Coated Mycophenolate Sodium in Lupus Nephritis (POEMSLUN) Background: Mycophenolate mofetil or enteric-coated mycophenolate sodium (EC-MPS) and steroids are used for induction and maintenance therapy in severe lupus nephritis. Blood concentrations of mycophenolic acid (MPA), the active metabolite of these drugs, vary among patients with lupus nephritis. The objective of this study was to examine whether concentration-controlled (CC) dosing (through therapeutic drug monitoring) of EC-MPS results in a higher proportion of participants achieving target exposure of MPA compared with fixed-dosing (FD). An additional aim of the study was to evaluate the influence of CC dosing on clinical outcomes. Methods: Nineteen participants were randomly assigned either to the FD or CC group. All the participants were eligible to have free and total measurements of MPA over a period of 8–12 hours on 3 different occasions. Area under the concentration–time curve between 0 and 12 hours (AUC0-12) was calculated using noncompartmental methods. Dose of EC-MPS was titrated according to AUC0-12 in the CC group. Results: Thirty-two AUC0-12 measurements were obtained from 9 FD and 9 CC participants. Large inter-patient variability was observed in both groups but was more pronounced in the FD group. There were no significant differences between FD and CC participants in any pharmacokinetic parameters across the study visits, except for total C0 (FD 2.0 ± 0.3 mg/L versus CC 1.1 ± 0.3; P = 0.01) and dose-normalized C0 (FD 2.9 ± 0.2 mg/L/g versus CC 2.1 ± 0.7 mg/L/g; P = 0.04) at the second visit and total AUC0-12 (FD 66.6 ± 6.0 mg·h/L versus CC 35.2 ± 11.4 mg·h/L; P = 0.03) at the third visit. At the first study visit, 33.3% of the FD and 11.1% of the CC participants achieved the target area under the concentration–time curve (P = 0.58). From the second visit, none of the FD participants, compared with all the CC participants, achieved target AUC0-12 (P = 0.01). More CC participants achieved remission compared with FD participants (absolute difference of −22.2, 95% confidence interval JOURNAL/thdm/04.02/00007691-201912000-00003/math_3MM1/v/2019-11-14T070550Z/r/image-tiff 0.19 to 0.55; P = 0.62). The mean free MPA AUC0-12 was significantly lower in those who had complete remission. Conclusions: CC participants reached target AUC0-12 quicker. Larger studies are required to test clinical efficacy. Quality Assessment of Dried Blood Spots from Patients With Tuberculosis from 4 Countries Background: Dried blood spot (DBS) sampling is a blood collection tool that uses a finger prick to obtain a blood drop on a DBS card. It can be used for therapeutic drug monitoring, a method that uses blood drug concentrations to optimize individual treatment. DBS sampling is believed to be a simpler way of blood collection compared with venous sampling. The aim of this study was to evaluate the quality of DBSs from patients with tuberculosis all around the world based on quality indicators in a structured assessment procedure. Methods: Total 464 DBS cards were obtained from 4 countries: Bangladesh, Belarus, Indonesia, and Paraguay. The quality of the DBS cards was assessed using a checklist consisting of 19 questions divided into 4 categories: the integrity of the DBS materials, appropriate drying time, blood volume, and blood spot collection. Results: After examination, 859 of 1856 (46%) blood spots did not comply with present quality criteria. In 625 cases (34%), this was due to incorrect blood spot collection. The DBS cards from Bangladesh, Indonesia, and Paraguay seemed to be affected by air humidity, causing the blood spots not to dry appropriately. Conclusions: New tools to help obtain blood spots of sufficient quality are necessary and environmental specific recommendations to determine plasma concentration correctly. In addition, 3% of the DBS cards were rejected because the integrity of the materials suggesting that the quality of plastic ziplock bags currently used to protect the DBS cards against contamination and humidity may not be sufficient. Nonparametric Population Pharmacokinetic Modeling of Isoniazid in Colombian Patients With Tuberculosis Background: Isoniazid (INH) is a first-line antituberculosis (TB) agent with a pharmacokinetic profile characterized by high interindividual variation; however, population pharmacokinetic studies in patients with TB are scarce. The aim was to develop a population model for INH in Colombian patients with TB suitable for predicting drug exposure and assessing the probability of target attainment of pharmacodynamic goals. Methods: Ten hospitalized adult patients with TB undergoing INH treatment were recruited. After an 8-hour fasting, subjects took 300 mg of INH, and 10 samples were taken from 0 to 12 hours. INH was quantified by high-performance liquid chromatography–UV, and data were analyzed with the Pmetrics R package software. A Monte Carlo simulation with the model parameters was run to determine the probability of target attainment for optimal efficacy. Results: The best model included 2 compartments, first-order absorption (Ka), delayed absorption (Tlag), and linear clearance (CL). Median Tlag was 0.25 hours, 5.54 hour−1 for Ka, JOURNAL/thdm/04.02/00007691-201912000-00005/math_5MM1/v/2019-11-14T070550Z/r/image-tiff for CL, JOURNAL/thdm/04.02/00007691-201912000-00005/math_5MM2/v/2019-11-14T070550Z/r/image-tiff for the volume of the central compartment (Vc), 1.04 L/h for intercompartmental clearance (Q), and 788 L for the volume of the peripheral compartment (Vp). CL and Vc were allometrically scaled on basis of the normalized body weight. Conclusions: The Monte Carlo simulation indicated that 300 mg of INH per day is appropriate for Mycobacterium tuberculosis strains with minimal inhibitory concentration (MIC) up to 0.03 mg/L (target: area under the concentration–time curve/MIC >597); however, to cover strains with MIC up to 0.125 mg/L (80% of clinical isolates), a dose of 900 mg per day would be required. Comparison of the Area Under the Curve for Vancomycin Estimated Using Compartmental and Noncompartmental Methods in Adult Patients With Normal Renal Function Background: Vancomycin pharmacokinetics are best described using a 2-compartment model. However, 1-compartment population models are commonly used as the basis for dose prediction software. Therefore, the validity of using a 1-compartment model to guide vancomycin drug dosing was examined. Methods: Published plasma concentration–time data from adult subjects (n = 30) with stable renal function administered a single intravenous infusion of vancomycin were extracted from previous studies. The vancomycin area under the curve (AUC0–∞) was calculated for each subject using noncompartmental methods (AUCNCA) and by fitting 1- (AUC1CMT), 2- (AUC2CMT), and 3- (AUC3CMT) compartment infusion models. The optimal model fit was determined using the Akaike information criterion and visual inspection of the residual plots. The individual compartmental AUC0–∞ values from the 1- and 2-compartment models were compared with AUCNCA values using one-way repeated measures analysis of variance. Results: The mean (±SD) AUC estimates were similar for the different methods: AUCNCA 180 ± 86 mg·h/L, AUC1CMT 167 ± 79 mg·h/L, and AUC2CMT 183 ± 88 mg·h/L. Despite the overlapping AUC values, AUC2CMT and AUCNCA were significantly greater than AUC1CMT (P < 0.05). The 3-compartment model was excluded from the analysis because of the failure to converge in some instances. Conclusions: Dose prediction software using a 1-compartment model as the basis for Bayesian forecasting underestimates drug exposure (estimated as the AUC) by less than 10%. This is unlikely to be clinically significant with respect to dose adjustment. Therefore, a 1-compartment model may be sufficient to guide vancomycin dosing in adult patients with stable renal function. Linezolid Dosing in Patients With Liver Cirrhosis: Standard Dosing Risk Toxicity Background: Limited data regarding altered linezolid pharmacokinetics in patients with liver cirrhosis are available. The objective of this study was to evaluate the pharmacokinetics, efficacy and safety of linezolid in cirrhotic patients. Methods: A case–control 1:1 study of patients undergoing linezolid therapeutic drug monitoring was conducted between January 2015 and June 2017. Cases with liver cirrhosis were matched with controls by age, body weight, comorbidities, renal function, and intensive care unit (ICU) admission. Results: Fifty-two patients were included, 26 in each group. Patients with Child–Pugh Scores A, B, and C were 1 (3.8%), 13 (50.0%), and 12 (46.2%), respectively. Cases had higher median linezolid trough plasma concentrations than controls [20.6 (17.4) versus 2.7 (11.3); P < 0.001)] and more frequently achieved an optimal pharmacodynamic index [26 (100%) versus 16 (61.5%); P = 0.002]. In addition, potentially toxic concentrations and treatment discontinuation due to overexposure and hematological toxicity were also more frequently seen in cirrhotic patients. Overall clinical cure rate was high (67.4%), and in-hospital mortality was 28.8%. No differences in clinical outcomes were observed between both groups. Conclusions: Linezolid showed a high clinical cure rate. Nevertheless, plasma concentrations and treatment discontinuation due to hematological toxicity were higher in cirrhotic patients. Liver cirrhosis may influence linezolid pharmacokinetics and question the use of standard doses. Therapeutic drug monitoring of linezolid would be valuable in these patients. Pharmacokinetic/Pharmacodynamic Analysis of Voriconazole Against Candida spp. and Aspergillus spp. in Allogeneic Stem Cell Transplant Recipients Background: To evaluate the adequacy of different dosing regimens of voriconazole for the prophylaxis of invasive candidiasis and aspergillosis in adult allogeneic stem cell transplant recipients by means of population pharmacokinetic (PK) modelling and simulation. Methods: Allogeneic stem cell transplant recipients receiving voriconazole were included in this observational study. A population PK model was developed. Three oral voriconazole-dosing regimens were simulated: 200, 300, and 400 mg twice daily. The pharmacodynamic target was defined as fAUC0–24/0.7. A probability of target attainment ≥90% was considered optimal. The cumulative fraction of response was defined as the fraction of patients achieving the pharmacodynamic target when a population of simulated patients is matched with a simulated population of different Candida spp. and Aspergillus spp. The percentage of patients with trough plasma concentrations at steady state (Ctrough) within the reference range (1–5.5 mg/L) was also calculated. Results: A 2-compartment PK model was developed using data from 40 patients, which contributed 237 voriconazole plasma samples, including trough and maximum concentrations. Voriconazole 200, 300, and 400 mg twice daily achieved probability of target attainment ≥90% for minimal inhibitory concentration values ≤0.25, ≤0.38, and ≤0.50 mg/L, respectively. The cumulative fraction of response for A. niger, A. versicolor, and A. flavus increased >10% when increasing voriconazole dose from 200 to 400 mg twice daily (from 72.5% to 89.5% for A. niger; from 77.7% to 88.7% for A. versicolor; and from 82.4% to 94.9% for A flavus). The percentage of patients with Ctrough within the reference range increased 15% when voriconazole dose was increased from 200 to 300 mg twice daily. Conclusions: The PK simulations in this study suggest that transplant recipients on voriconazole prophylaxis against invasive candidiasis or aspergillosis are likely to achieve the target concentrations associated with the desired treatment outcomes if the maintenance dose is 200 mg twice daily. However, Aspergillus spp. with high minimal inhibitory concentrations could require higher maintenance doses. Chinese Patients With Heart Valve Replacement Do Not Benefit From Warfarin Pharmacogenetic Testing on Anticoagulation Outcomes Background: Genotype-guided warfarin dosing has been shown in some randomized trials to improve anticoagulation outcomes in individuals of European ancestry; yet, its utility in Chinese patients with heart valve replacement remains unresolved. Methods: A total of 2264 patients who underwent heart valve replacement at Wuhan Asia Heart Hospital were enrolled in this study. Patients were randomly divided into 2 groups, namely, a genotype-guided and a traditional clinically guided warfarin dosing group. In the genotype-guided group (n = 1134), genotyping for CYP2C9 and VKORC1 (−1639 G→A) was performed using TaqMan genotyping assay. Warfarin doses were predicted with the International Warfarin Pharmacogenetics Consortium algorithm. Patients in the control group (n = 1130) were clinically guided. The primary outcome was to compare the incidence of adverse events (major bleeding and thrombotic) during a 90-day follow-up period between 2 groups. Secondary objectives were to describe effects of the pharmacogenetic intervention on the first therapeutic-target-achieving time, the stable maintenance dose, and the hospitalization days. Results: A total of 2245 patients were included in the analysis. Forty-nine events occurred during follow-up. Genotype-guided dosing strategy did not result in a reduction in major bleeding (0.26% versus 0.63%; hazard ratio, 0.44; 95% confidence interval, 0.13–1.53; P = 0.20) and thrombotic events (0.89% versus 1.61%; hazard ratio, 0.56; 95% confidence interval, 0.27–1.17; P = 0.12) compared with clinical dosing group. Compared with traditional dosing, patients in the genotype-guided group reached their therapeutic international normalized ratio in a shorter time (3.8 ± 2.0 versus 4.4 ± 2.0 days, P < 0.001). There was no difference in hospitalization days (P = 0.28). Conclusions: Warfarin pharmacogenetic testing according to the International Warfarin Pharmacogenetics Consortium algorithm cannot improve anticoagulation outcomes in Chinese patients with heart valve replacement. Prednisolone Concentrations in Plasma (Total and Unbound) and Saliva of Adult Kidney Transplant Recipients Background: Prednisolone displays significant pharmacokinetic variability and exposure–outcome relationships in renal transplant recipients, suggesting a role for drug monitoring in some scenarios. It is highly protein-bound, and the free form is pharmacologically active but cumbersome to measure. Saliva concentrations might reflect free plasma prednisolone and present an alternative measurement. The aim of this study was to examine the correlation between total and free plasma and saliva prednisolone in adult renal transplant recipients. Methods: Total and free plasma and saliva prednisolone concentrations were measured in 20 patients receiving oral prednisolone 1–2 months after transplant, between pre-dose and 12 hours post-dose. Prednisolone was determined using high-performance liquid chromatography mass spectrometric detection. The Pearson coefficient was used to assess the association between plasma and salivary prednisolone concentrations and area under the concentration–time curves (AUC0–12). Results: When considering all time points, the total and free plasma prednisolone concentrations correlated well (r2 = 0.81), but there was poor correlation between saliva and free (r2 = 0.003) and total (r2 = 0.01) plasma concentrations. When concentrations before the maximum free prednisolone plasma value were excluded, the correlation between free plasma and saliva concentrations improved (r2 = 0.57). There was a moderate correlation between free and total plasma prednisolone AUC0–12 (r2 = 0.62) using all time points, but a poor correlation between free and total plasma prednisolone AUC0–12 and saliva AUC0–12 (r2 = 0.07; r2 = 0.17). Conclusions: Total and free plasma prednisolone measurements correlated poorly with saliva measurements; however, correlation improved when concentrations early in the dosing interval were excluded.
Reversible Impaired Methotrexate Clearance After Platinum-Based Chemotherapy for OsteosarcomaAbstract: The authors present a case of an 18-year-old man with metastasized osteosarcoma, admitted for methotrexate (MTX) treatment combined with cisplatin and doxorubicin. During the first cycle, severe MTX toxicity was observed with increased MTX serum levels and delayed MTX clearance requiring rescue treatment with intensified leucovorin. In the following cycles, cisplatin and doxorubicin were discontinued,...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:31
Candida Infections in Clinical Trials of Ixekizumab (Taltz), an Interleukin-17A Monoclonal Antibody, in Patients With Psoriasis or Psoriatic Arthritis Interleukin-17 mediates immunity against pathogens such as Candida. Ixekizumab, an anti-interleukin-17A antibody, showed efficacy treating psoriasis (PsO) and psoriatic arthritis (PsA). Detailed here are Candida infections from 11 PsO and three PsA ixekizumab studies. Overall, patients received 80-mg ixekizumab every 2 or 4 weeks for 12 weeks (PsO) or 24 weeks (PsA) and then every 4 weeks. Candida (high-level term), six Candida subcategories (oral, vulvovaginal, skin, esophageal, nail, and unspecific), and four fungal infections (esophagitis, oral, oropharyngitis, and vulvovaginal mycotic) were included. Patients were counted once per category for multiple events. Analysis included 5,689 patients with PsO (12,061.5 patient-years of exposure, median exposure = 883 days) and 1,118 patients with PsA (1,373.4 patient-years of exposure, median exposure = 309 days). Overall, Candida infections were low and occurred in 4.4% (PsO incidence rate = 2.1) and 3.1% (PsA incidence rate = 2.5); most were mild or moderate in severity. The average duration of moderate and mild Candida ranged from 33 to 105 days. Most Candida infections were single events, 74% and 91%, with median onset of 328 and 146 days for PsO and PsA, respectively. Five patients (four with PsO and one with PsA) were reported to have a severe infection. Oral, skin, and vulvovaginal Candida were the most frequently reported Candida infections. Leveraging Teledermatology for Patient Triage Nurses in outpatient settings face challenges balancing heavy patient caseloads while accommodating unplanned acute visits. Nurses also spend significant time triaging patients' symptoms on the telephone. Patients often find it difficult to accurately describe symptoms, and without accompanying images, unnecessary office visits are scheduled. Teledermatology, involving the exchange of digital images remotely between patient and provider, has shown promise in accurately triaging patients and decreasing unnecessary visits. At one outpatient dermatology site at a multisite comprehensive cancer center, a 6-month performance improvement initiative was conducted to evaluate the effectiveness of teledermatology using an electronic patient portal. Nurses instructed prescreened patients to send digital images via the portal. On the basis of image appearance and patients' symptoms, nurses provided assessment and education over the phone, and patients either kept their future appointments or came in for an earlier evaluation. More complex cases were escalated to the physician. This initiative reduced the number of unnecessary patient visits, which opened more visit slots for those with acute issues. Teledermatology improved overall efficiency of care, and patients and clinicians have reported satisfaction with the process. Safe and Effective Laser Hair Removal Treatments: A Literature Review for New Providers Objective The aim of this study was to review the current literature regarding safe and effective laser hair removal (LHR) treatments. Methods Significant and current studies (2008–2017) were retrieved through a series of searches conducted in CINAHL, Cochrane, and MEDLINE databases using Boolean terms/phrases. Pertinent results are explained in narrative form with supporting tables and figures. Results Today, there is a vast amount of current literature on the need for LHR treatments and on its side effects and comparative studies using various lasers on the market. There is an ongoing concern associated with the lack of standards and guidelines. Conclusion Practitioners interested in offering LHR within the primary care setting must verify that operating a Class 4 medical device is within their scope of practice. Despite the increased popularity of LHR treatments and the advancement of technology, there are limited up-to-date information on safe and effective treatment parameters and minimal information regarding the importance of patient education. More research is necessary to determine the efficacy of LHR treatments in both men and women of all ages and skin types. With no LHR guidelines in place, the best practice for LHR treatments is contained within this literature review using the most recent research available to date. Kava-Induced Ichthyosis Acquired ichthyosis is an uncommon finding in the outpatient dermatology clinic. This case portrays a presentation of ichthyosis induced by the medicinal drink, kava, which is becoming a more mainstream beverage in American culture. This case provides an overview of the clinical presentation of ichthyosis and a historical background on kava as well as recent studies on kava-induced ichthyosis or kava dermopathy. It also highlights the need to consider the use of herbal and alternative therapies when considering the underlying causes of skin disorders. White Plaques of the Posterior Buccal Mucosa Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of oral lichen planus. Scaled Papules in an HIV-Positive Patient Teledermatology is the term used to describe the provision of dermatologic medical services through telecommunication technology. The following is a teledermatology case of scaled papules in an HIV-positive patient. Diffuse Nonresolving Violaceous Plaques This is a case of a patient presenting with nonresolving violaceous plaques for over 12 years of duration. In addition to the skin findings, the patient notes progressive arthropathy and nail changes. A multiple-choice question is presented, and readers will be challenged to diagnose this patient based on the case presentation, symptoms, and patient history. An answer is given followed by a discussion of the diagnosis, clinical features, and therapeutic management. Use of 5-Fluorouracil "Chemowraps" as a Method of Field Therapy for Actinic Keratosis and Adjunctive Therapy for Squamous Cell Carcinoma Drugs are medications or substances that are used to modify physiologic responses and alleviate associated symptoms. In dermatology, medications and substances are utilized on a daily basis and include topical treatments to anesthetics in micrographic surgery to biologic-acting immunologic agents. The purposes of this section are to focus on drug, specifically how it works and how it is utilized, and to discuss routine alternatives (if available). In this column, we will focus on the uses, mechanism of action, adverse effects, and alternatives of 5-fluorouracil used in chemowraps for actinic keratoses and squamous cell carcinoma. Skin Test No abstract available
Candida Infections in Clinical Trials of Ixekizumab (Taltz), an Interleukin-17A Monoclonal Antibody, in Patients With Psoriasis or Psoriatic ArthritisInterleukin-17 mediates immunity against pathogens such as Candida. Ixekizumab, an anti-interleukin-17A antibody, showed efficacy treating psoriasis (PsO) and psoriatic arthritis (PsA). Detailed here are Candida infections from 11 PsO and three PsA ixekizumab studies. Overall, patients received 80-mg ixekizumab every 2 or 4 weeks for 12 weeks (PsO)...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:29
Arterialized Posterior Interosseous Nerve Graft for Digital Neuroma Painful neuromas are not uncommon following nerve injury, and are especially bothersome in the hand, with severe cases resulting in significant disability. Outcomes of neuroma surgery are unpredictable regardless of technique. It is recognized that optimal soft tissue environment influences nerve healing more than the specific nerve graft technique, and it is in this context, we present a novel technique of transferring a posterior interosseous nerve graft along with vascularized synovial and fat tissue based on a branch of the posterior interosseous artery to provide healthy soft tissue for nerve healing of neuroma in continuity about the hand and digits. Combined Pedicled Vascularized and Wedge Nonvascularized Bone Graft for Treating Scaphoid Waist Nonunion With Humpback Deformity Pedicled vascularized bone graft (VBG) is a useful method in treating the scaphoid fracture nonunion, especially when the avascular necrosis exists. Humpback deformity is an important issue that we have to correct it during the treatment. We describe a method by using combined wedge non-VBG to correct the nonunion deformity when treating scaphoid nonunion with pedicled VBG. The wedge bone graft was harvested just proximal to the 2,3 intercompartmental supraretinacular artery VBG and was used as an inlay at the volar site to correct the humpback deformity, whereas the VBG was set at the dorsal site for bone bridging and blood supply. We also present our results of 10 patients with scaphoid fracture nonunion and humpback deformity treated with this method. Bone healing was achieved and the lateral intrascaphoid angles could be improved in all the 10 patients. Functional outcomes, including the Visual Analog Pain Scale for pain during activity, grip strength, the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the modified Mayo Wrist Scores, were significantly improved. Fixation of a Type 3 Flexor Digitorum Avulsion Injury This article describes a novel technique for flexor digitorum profundus (FDP) avulsion injuries, useful for Leddy Packer type 3, 4, and 5 injuries. Multidirectional stability is achieved with combination pull-out suture, which neutralizes the deforming force of FDP, and cerclage wire, which holds the bone fragment in an anatomic position and provides interfragmentary compression. Traditional techniques such as interosseous wires, Kirschner wires, or plating risk fragment comminution and loss of reduction due to proximal pull of FDP as demonstrated in this case report of failed Kirschner-wire fixation. The technique presented here eliminates the risk of avulsion fragment comminution and provides stable fixation that allows for early mobilization. Steindler Flexorplasty: A Description of Current Technique and Case Series This year marks the 100th anniversary of Dr Steindler's original report of a proximal transfer of the flexor pronator mass to restore elbow flexion. The authors present their updated surgical technique to perform the Steindler flexorplasty. In this procedure, the flexor-pronator mass origin on the medial epicondyle is transferred proximally to the anterior humerus to restore elbow flexion. They also report a retrospective case series of patients from 2007 to 2017 who underwent a Steindler flexorplasty at their institution to restore elbow flexion. In the series, 8 of 9 patients achieved at least 90 degrees of active antigravity (M3) or greater elbow flexion. Outcomes following the Steindler flexorplasty have been reported in the literature over the course of the past 100 years. Although alternative techniques to improve elbow flexion have been developed and performed over the last century, this time tested procedure remains a powerful reconstructive option. Anteromedial Release for Posttraumatic Flexion-pronation Contracture of the Wrist: Surgical Technique Wrist stiffness can be a complication of trauma. A small percentage of patients fail to improve with nonoperative management and require operative intervention to regain range of motion and function. These group of patients can present with a soft tissue flexion-pronation contracture, which is hypothesized to be caused by capsular contraction of the distal radioulna joint, musculotendinous contracture of the flexor carpi ulnaris, contracture of the volar ulnar carpal ligaments and of the pronator quadratus muscle. This complication significantly restricts functional dart-thrower's range of motion and is highly disabling. A surgical option to manage this condition is release of pathologic structures with an anteromedial approach to the wrist. We describe a safe, effective, and reproducible technique to treat these patients. A Novel External Fixation Technique for Injuries of the Proximal Interphalangeal Joint Digital external fixation is often used for the management of complex injuries involving the proximal interphalangeal joint, including pilon fractures of the middle phalanx base and unstable fracture-dislocations. Several dynamic "homemade" constructs have been described which utilize only K-wires and rubber bands and allow early range of motion within the construct. Although these constructs are inexpensive and their application is fairly straightforward, their designs pose a few potential problems when the construct is stressed during rehabilitation efforts. These designs utilize a blocking K-wire which relies on pin-to-pin contact to maintain reduction and creates unnecessary friction that can impede motion and result in pin loosening in bone. Furthermore, rubber band rupture can occur and destabilizes the construct. Here we present a novel technique which utilizes only K-wires and K-wire caps, provides adequate joint distraction and stabilization throughout the arc of motion, and avoids the aforementioned pitfalls of existing designs. Triquetrum Excision in Radioscapholunate Arthrodesis for Posttraumatic Radiocarpal Osteoarthritis With Ulnar Impaction Syndrome Dependent on fracture type, concomitant carpal injuries, and operative treatment, distal radius fractures can lead to symptomatic radiocarpal osteoarthritis. In addition, radial shortening can cause ulnar impaction syndrome. Radiocarpal arthrodesis and ulnar shortening osteotomy are known and frequently applied surgical procedures for each of those pathologies. There are limited data concerning treatment options for a combined disorder. The presented technique in this article demonstrates that radioscapholunate arthrodesis with distal pole scaphoidectomy and total triquetrum excision successfully treats both symptomatic radiocarpal osteoarthritis and ulnar impaction syndrome without further surgery on the ulna. Extra-articular Corrective Osteotomy With Bone Grafting to Achieve Lengthening and Regain Alignment for Distal Radius Fracture Malunion Surgical correction of the distal radius fracture malunion is challenging because of the 3-dimensional deformity. We propose a method by using the Kapandji intrafocal pinning in corrective osteotomy for treatment of the distal radius fracture malunion to facilitate the alignment correction while using the bone graft to restore the radial length. The surgery was started with the osteotomy from a volar approach, and the osteotomy gap was expanded gradually. Then, allobone grafting was performed to maintain the corrected radial length. We used the Kapandji intrafocal pinning dorsally to provide dorsal supporting force and radially to correct the radial inclination. Finally, a volar plate was used to buttress and push the distal fragment to fit as to regain the correct volar tilt. We enrolled 10 patients of distal radius fracture malunion with a mean age of 59.3 years. All patients had bone healing within 3 months after surgery. The mean lengthened distance was 5 mm. The radial inclination and volar tilt could be corrected with improved functional results. Anatomic Considerations and Reconstruction of the Thumb Flexor Pulley System Disruption to the flexor pulley system of the thumb is an infrequent but devastating injury that can lead to significant compromise in both strength and function. Acute rupture leads to pain, weakness, reduced range of motion (ROM), and potential bowstringing of the flexor tendons. Conservative treatment with a pulley ring should be considered in all patients. However, failure of conservative treatment and bowstringing of the thumb are indications for operative intervention. Reconstruction of the oblique pulley system can be performed either in situ or using a free palmaris longus graft. Care should be taken to identify the neurovascular bundles to avoid compression during the reconstruction. Conscious sedation protocols augmented by ultrasound-guided sheath blocks allow the patient to actively and strongly contract the flexor pollicis longus tendon intraoperatively to appropriately tension the construct for optimal results. Rehabilitation should be performed in a stepwise manner beginning with early passive ROM, active ROM, and finally strengthening at around 8 weeks postoperative.
Arterialized Posterior Interosseous Nerve Graft for Digital NeuromaPainful neuromas are not uncommon following nerve injury, and are especially bothersome in the hand, with severe cases resulting in significant disability. Outcomes of neuroma surgery are unpredictable regardless of technique. It is recognized that optimal soft tissue environment influences nerve healing more than the specific nerve graft technique, and it is in this context, we present a novel technique of transferring a posterior...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:28
The Role of Positron Emission Tomography/Magnetic Resonance Imaging in Gynecological Malignancies Accurate oncological staging for early detection is of utmost importance in patient care and increasing the overall patient survival outcome. Hybrid imaging in the form of positron emission tomography (PET)/computed tomography has been successfully implemented in oncological imaging and, where available, has been used consistently in patients with gynecologic malignancies. The implementation of PET/magnetic resonance imaging (MRI) enables high-quality assessment of gynecological malignancies by combining the diagnostic advantages of metabolic information of PET along with the high-resolution anatomical and functional information from the MRI to provide precise information about staging, recurrence, and metastases. This article will review the various applications of PET/MRI in gynecological cancer. Ovarian Cancer Genetics and Implications for Imaging and Therapy Ovarian cancer is the second most common gynecologic malignancy in the United States. Ovarian cancer has a dismal prognosis when diagnosed at an advanced stage. Therapy for these cancers is determined not only by stage but also by their heterogeneous pathologic features, genetic mutations, and biology. In this review, we will discuss types of epithelial ovarian cancer, and their associated genetic mutations and the implications for imaging and treatment. Von Meyenburg Complex: Current Concepts and Imaging Misconceptions Von Meyenburg complexes, also known as biliary hamartomas, are ductal plate malformations that are usually diagnosed on imaging studies when there are multiple as small hepatic cysts. However, because of variations in histology, they actually have a wide spectrum of imaging appearances ranging from solid, to mixed solid and cystic, to cystic lesions. The objective of the review is to provide up-to-date information about the embryopathogenesis of von Meyenburg complexes, their imaging appearances, diagnostic pitfalls, and clinical significance. Combined Qualitative and Quantitative Assessment of Low-Attenuation Renal Lesions Improves Identification of Renal Malignancy on Noncontrast Computed Tomography Objective The objective of this study was to assess renal lesions measuring less than 20 Hounsfield units (HU) on noncontrast computed tomography (NCT). Methods Twenty-one (18.1%) of 116 consecutive pathologically proven renal cell carcinomas measured less than 20 HU on NCT and were compared with 40 confirmed benign cysts also measuring less than 20 HU. All lesions were assessed qualitatively (heterogeneous or homogenous) by 3 blinded readers and quantitatively with commercially available textural analysis software. Finally, a combined assessment was performed. Results Qualitative assessment performed well (sensitivity, 76%–90%; specificity, 70%–88%). Quantitative assessment revealed mean positive pixels as having the highest performance (area under the curve, 0.912; sensitivity, 90%; specificity, 80% at a cutoff value of 21). The combined assessment, using the mean positive pixel cutoff, improved the sensitivity (reader 1, 100%; reader 2, 95%; and reader 3, 95%). Conclusion Qualitative and quantitative assessments have relatively good performance, but the combination can nearly eliminate renal cell carcinomas being missed on NCT. Monoexponential and Biexponential Fitting of Diffusional Magnetic Resonance Imaging Signal Analysis for Prediction of Liver Fibrosis Severity Objective The objective of this study is to compare the value of monoexponential and biexponential approach to the diffusion-weighted magnetic resonance imaging signal in the prediction of the liver fibrosis. Methods Forty patients with hepatitis C were included. Quantification of the apparent diffusion coefficient (ADC) and pure molecular diffusion (D), pseudodiffusion (D*), and perfusion fraction (f) was performed using 9 b values (b = 0, 20, 50, 100, 200, 400, 600, 800, 1000 s/mm2). Results Significant fibrosis was found in 14 subjects. Monoexponentally derived ADC parameters were significantly correlated. Apparent diffusion coefficient calculated from all b values and ADC based on high b values were significantly related to the fibrosis grade (P < 0.02), and none of intravoxel incoherent motion parameters presented such an association. Apparent diffusion coefficient based on high b values was the best predictor of significant fibrosis with area under the curve of 0.81, sensitivity of 0.57, and specificity of 0.92. Conclusion Intravoxel incoherent motion parameters did not allow for prediction of the liver fibrosis. Apparent diffusion coefficient calculated based on high b values presents considerable specificity in predicting significant fibrosis. Imaging Features of Sclerosing Angiomatoid Nodular Transformation in Spleen Purpose The purpose of this study was to evaluate the features of sclerosing angiomatoid nodular transformation (SANT) in spleen on the imaging of computed tomography (CT) and magnetic resonance (MR). Materials and Methods From July 2006 to April 2017, 12 patients with SANT confirmed by pathology were evaluated in a retrospective study. Eight patients were with CT imaging only, 2 patients were with MR imaging only, and 2 patients were with both CT and MR. Three professional senior radiologists analyzed the imaging features on CT and MR. The main characteristic analysis included size, margin, density, signal intensity, and enhancement pattern. The significant enhancement was defined as the degree of enhancement of lesion that is higher than the surrounding spleen parenchyma, and the mild enhancement was defined as the degree of enhancement of lesion that is lower than the surrounding spleen parenchyma. Results All the 12 patients (5 men, 7 women; mean age, 45.8 years; age range, 21–62 years) presented as single lesion without special clinical symptoms. The range of lesions on diameter was from 25 to 80 mm. On CT images, 9 (90%) of 10 presented as hypodense in comparison with the parenchyma of spleen, 1 (10%) of 10 presented as isodense, and calcification was observed in 4 (40%) of 10 cases. On MR images, 4 (100%) of 4 manifested heterogeneous hypointensity on in-phase sequence and 3 (75%) of 4 performed as isointensity on out-of-phase sequence of T1-weighted. On the sequences of T2-weighted and diffusion-weighted image, 4 (100%) of 4 showed hypointensity. On CT and MR enhancement images, the number of significant enhancement and mild enhancement was 2 and 10, respectively. Seven (58%) of 12 showed progressive enhancement with the pattern of "spoke-wheel." Conclusions Imaging features on CT and MR have a high diagnostic value for SANT, especially when CT combined with MR examination. Whole-Body Computed Tomography Using Low-Dose Biphasic Injection Protocol With Adaptive Statistical Iterative Reconstruction V: Assessment of Dose Reduction and Image Quality in Trauma Patients Aim This study aimed to evaluate potential dose savings on a revised protocol for whole-body computed tomography and image quality after implementing Adaptive Statistical Iterative Reconstruction V (ASiR-V) algorism for trauma patients and compare it with routine protocol. Materials and Methods One hundred trauma patients were classified into 2 groups using 2 different scanning protocols. Group A (n = 50; age, 32.48 ± 8.09 years) underwent routine 3-phase protocol. Group B (n = 50; age, 35.94 ± 13.57 years) underwent biphasic injection protocol including unenhanced scan for the brain and cervical spines, followed by a 1-step acquisition of the thorax, abdomen, and pelvis. The ASiR-V level was kept at 50% for all examinations, and then studies were reconstructed at 0% ASiR-V level. Radiation dose, total acquisition time, and image count were compared between groups (A and B). Two radiologists independently graded image quality and artifacts between both groups and 2 ASiR-V levels (0 and 50%). Results The mean (±SD) dose-length product value for postcontrast scans in group A was 1602.3 ± 271.8 mGy · cm and higher when compared with group B (P < 0.001), which was 951.1 ± 359.6 mGy · cm. Biphasic injection protocol gave a dose reduction of 40.4% and reduced the total acquisition time by 11.4% and image count by 37.6%. There was no statistically significant difference between the image quality scores for both groups; however, group A scored higher grades (4.62 ± 0.56 and 4.56 ± 0.67). Similarly, the image quality scores for both ASiR-V levels in both groups were not significantly different. Conclusions Biphasic computed tomography protocol reduced radiation dose with maintenance of diagnostic accuracy and image quality after implementing ASiR-V algorism. Effective Radiation Dose Reduction in Computed Tomography With Iterative Reconstruction in Patients With Urinary Stone Purpose This study aimed to prospectively compare the image quality and visibility of urinary stone on computed tomographic (CT) images at multiple radiation exposure levels from the same patient reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE). Methods This study included 760 patients with urinary stone who underwent CT with simultaneous acquisition at 6 exposures per patient (100% filtered back projection, 75%, 50%, 37.5%, 25%, and 12.5% SAFIRE). Two radiologists independently assessed overall image quality, noise, and stone visibility by using a 5-point scale. Quantitative measurements, including the CT number, image noise, signal-to-noise ratio, contrast-to-noise ratio (CNR), and corresponding figure of merit (FOM), were compared for 100% versus 5 other radiation doses. Results Qualitative overall image quality, noise, and stone visibility according to the location were not inferior at 37.5% exposure compared with 100% exposure, except for the visualization of smaller stones <3 mm. The signal-to-noise ratio and CNR of CT images were increased at 50% exposure compared with 100% exposure. Computed tomographic images at 37.5% exposure reconstructed with SAFIRE had significantly more noise and a lower CNR compared with CT images reconstructed with filtered back projection, based on FOMnoise and FOMCNR. The size-specific dose estimation was 4.1 ± 0.8 mGy at 37.5% exposure. Conclusion Computed tomography performed at 37.5% exposure with SAFIRE may be diagnostically acceptable for the detection of clinically relevant stone. Nonhemorrhagic Adrenal Infarction in Pregnancy: Magnetic Resonance Imaging and Computed Tomography Evaluation We present the case of unilateral nonhemorrhagic adrenal infarct in a 29-week pregnant 21-year-old woman. The patient presented with right upper quadrant pain, nausea, and vomiting. Ultrasonography of the right upper quadrant and appendix was negative for pathology. Magnetic resonance imaging of the abdomen demonstrated a right nonhemorrhagic adrenal infarct, subsequently confirmed with limited computed tomography of the upper abdomen. This case discusses the clinical presentation and pertinent imaging findings of adrenal infarction in pregnancy. Gastric Hepatoid Adenocarcinoma: Differentiation From Gastric Adenocarcinoma With Dynamic Contrast-Enhanced Computed Tomographic Findings Purpose This study aimed to describe the computed tomographic (CT) findings of gastric hepatoid adenocarcinoma (GHA) and determine features distinguishing it from gastric adenocarcinoma (GA). Methods Computed tomographic images of pathologically verified GHA (n = 11) and GA (n = 38) were retrospectively reviewed. α-Fetoprotein (AFP), carcinoembryonic antigen (CEA), and CT findings were assessed in our study. Computed tomographic findings included the location, distribution, growth pattern, ulceration, thickness of gastric wall, enhancement pattern, and the ratio of lesion attenuation to aorta CT attenuation. Short diameter of the metastatic lymph nodes, mean short diameter of metastatic lymph nodes, and the ratio of the number of enlarged lymph node on CT to the number of metastatic lymph nodes pathologically were measured and calculated. Data were compared using the χ2 and Student t tests; significant CT criteria were identified using receiver operating characteristic curve. Results α-Fetoprotein, CEA, and CT findings, including the longest short diameter, the mean short diameter, the ratio of the number of enlarged lymph node on CT to the number of metastatic lymph nodes pathologically, the lesion in arterial phase minus portal venous phase, and the lesion/aorta ratio, were statistically significant predictors for the differentiation of GHA from GA (P < 0.05). When only the aforementioned CT findings were used as criteria, the sensitivity and specificity for diagnosing GHA were 82.86% and 90.91%, respectively. When AFP, CEA, and CT findings were used as criteria, sensitivity of 97.14% and specificity of 90.91% were achieved. Conclusions Elevated serum AFP level and CT findings could distinguish GHA and GA with a high degree of accuracy.
The Role of Positron Emission Tomography/Magnetic Resonance Imaging in Gynecological MalignanciesAccurate oncological staging for early detection is of utmost importance in patient care and increasing the overall patient survival outcome. Hybrid imaging in the form of positron emission tomography (PET)/computed tomography has been successfully implemented in oncological imaging and, where available, has been used consistently in patients with gynecologic malignancies. The implementation of PET/magnetic...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:28
Rare bleeding disorders and advances in gene therapy Rare bleeding disorders usually begin in childhood and manifest as varying degrees of bleeding, which can be life-threatening in severe cases. With the development of gene editing technology, it is expected that hereditary coagulation factor disorders will someday be fundamentally cured by gene therapy. On account of their rarity, comprehension of these diseases is essential for the application of new treatment strategies. We have compiled the features of some newly discovered mutations of prothrombin, factor VII, and factor X in recent years. In addition, this review introduces the advances and obstacles in gene therapy. Anticoagulant activity of krait, coral snake, and cobra neurotoxic venoms with diverse proteomes are inhibited by carbon monoxide Background A phenomena of interest is the in vitro anticoagulant effects of neurotoxins found in elapid venoms that kill by paralysis. These enzymes include phospholipase A2 (PLA2), and it has recently been demonstrated that carbon monoxide inhibits the PLA2-dependent neurotoxin contained in Mojave rattlesnake type A venom. The purpose of this investigation was to assess if the anticoagulant activity of elapid venoms containing PLA2 and/or three finger toxins could be inhibited by carbon monoxide. Methods Venoms collected from Bungarus multicinctus, Micrurus fulvius, and five Naja species were exposed to carbon monoxide via carbon monoxide releasing molecule-2 prior to placement into human plasma. Coagulation kinetics were assessed via thrombelastography. Results Compared with plasma without venom addition, all venoms had significant anticoagulant effects, with a 160-fold range of concentrations having similar anticoagulant effects in a species-specific manner. Carbon monoxide significantly inhibited the anticoagulant effect of all venoms tested, but inhibition was not complete in all cases. Conclusion Given that individual neurotoxin activity often depends on intact activity that includes anticoagulant action, it may be possible that carbon monoxide inhibits neurotoxicity. Future investigation is justified to assess such carbon monoxide mediated inhibition with purified neurotoxins in vitro and in vivo. Perioperative safety and haematostatic efficacy of a new bypassing agent pd-FVIIa/FX (Byclot) in haemophilia patients with high-responding type inhibitors The novel agent pd-FVIIa/FX is a 1 : 10 protein weight mixture of activated factor VII (FVIIa) and factor X (FX) derived from donated blood plasma. A phase III clinical trial of pd-FVIIa/FX revealed high efficacy for bleeding episodes in haemophilia patients with inhibitors. However, up to now, only one case of this new agent being used for surgery had been reported. The objective of this study is to evaluate the perioperative haemostatic efficacy and safety of pd-FVIIa/FX in haemophilia patients with inhibitors. We retrospectively reviewed 25 operation charts from 14 haemophilia patients with high-responding inhibitors using pd-FVIIa/FX during the perioperative period. Efficacy was evaluated by attending physicians and results divided into four groups (excellent, good, fair, and poor). The operation chart was provided by nine Japanese medical institutes with expertise in haemophilia management. Out of the total of 25 surgical procedures, 44% (11/25) were classified as major surgery and the remainders were minor surgeries. In all of the surgeries but one, rFVIIa and/or APCC were administered in combination or sequential method. In all cases except one, the haemostatic efficiency rate was judged as excellent or good by treating physicians for an overall efficacy rate of 96%. No thrombotic adverse effects were reported. This study's results suggest that both combination and sequential therapy of pd-FVIIa/FX and other bypassing agents are well tolerated and effective for the control of perioperative bleeding in haemophilia patients with high-responding inhibitors. Plasma phenotypes of protein S Lys196Glu and protein C Lys193del variants prevalent among young Japanese women Protein S Tokushima (p.Lys196Glu) and two protein C gene variants (p.Arg189Trp, p.Lys193del) are hereditary thrombophilia in Japanese and Chinese populations, respectively; however, their diagnosis by plasma analyses is difficult because of the type II deficiency phenotype. Three gene variant genotypes were examined in young Japanese women (n = 231). Plasma total protein S activity and total protein S antigen levels were measured using a total protein S assay system, protein C and protein S activities by clot-based methods, and protein C and free protein S antigen levels by latex agglutination methods. protein S Tokushima (p.Lys196Glu) and protein C p.Lys193del variants were prevalent among participants with allele frequencies of 1.08 and 0.86%, respectively, whereas any carrier of protein C p.Arg189Trp variant was not identified. The plasma phenotype of the type II deficiency of protein S Tokushima heterozygotes was demonstrated by decreased total protein S activity with a normal total protein S antigen level; however, the protein C activities of protein C p.Lys193del heterozygotes were within reference intervals, whereas their protein C antigen levels were elevated. We compared the diagnostic accuracy of the total protein S activity/total protein S antigen ratio for identifying protein S Tokushima heterozygotes with that of the clot-based protein S activity/free protein S antigen ratio and found that sensitivity and specificity of 100% each was only achieved by the former. Protein S Tokushima and protein C p.Lys193del are prevalent among young Japanese women, and a plasma analysis using the total protein S assay system is more accurate than the clot-based protein S activity/free protein S antigen ratio for diagnosing protein S Tokushima carriers. Mixing-based inhibitor screening in haemophilia A: challenges in interpretation Inhibitor development in haemophilia A patients is a dreaded complication of factor VIII (FVIII) replacement therapy. With increasing use of FVIII replacement therapy, there is an imperative need for cost-effective and standardized screening. To evaluate the efficacy of mixing-based inhibitor screening (MBIS) in the detection of FVIII inhibitors and to assess the best cut-off values for MBIS. Forty inhibitor positive and 40 inhibitor negative haemophilia A patients, diagnosed by standard criteria, with detailed clinical, haematological and on-demand treatment records were included. MBIS was evaluated in all 80 cases and a classical Bethesda assay and Nijmegen modification of Bethesda assay (NBA) were used as gold standards for inhibitor diagnosis. Classical Bethesda assay missed eight cases, most with low titres, which were confirmed by NBA. A systematic analysis of cut-offs for MBIS using a receiver operating characteristic curve fixed the cut-off at more than 5 s. MBIS detected 36 out of 40 inhibitor positive haemophilia A patients with a sensitivity, specificity, PPV and NPV of 90.0, 95, 94.7, 90.5%, respectively, whereas at the conventional cut-off of more than 10 s, MBIS detected only 25 of 40 cases with a low sensitivity of 62.5%. The likelihood ratio of a positive test was 11. The false-negative haemophilia A patients had low titres from 1.6 to 4.2 BU/ml. MBIS at a cut-off of 5 s can be considered as an effective screening test in low-resource situations. In clinical situations and in cases with clinical evidence of inhibitors we recommend that a direct NBA should be done. Congenital factor XI deficiency, complete genotype and phenotype of two Iranian families Congenital factor XI (FXI) deficiency is a mild trauma-related bleeding disorder with estimated worldwide prevalence of one per 1 million. The disorder is less frequent in Iran and a few studies have been performed on Iranian patients. In the current study, we assessed molecular, laboratory and clinical features of two Iranian patients with congenital FXI deficiency and their families. Clinical features and demographic data of the patients were assessed by the physician and a staff member trained specifically to deal with patients with bleeding disorders. FXI activity and antigen assays were performed for seven members of the two families and genotyping was performed by direct sequencing of all F11 gene exons and intron-exon boundaries as well as the untranslated regions. Five members of the two families were affected by FXI deficiency. Both patients experienced prolonged epistaxis, whereas other family members were asymptomatic. Two gene defects were observed in the patients and their families. Two disease-causing mutations were c.943G>A (p.Glu315Lys) missense and the four-nucleotide deletion (g.27849-27852del) in exon 15. The gene deletion was observed in homozygote state in the patient with severe FXI deficiency (FXI activity <1%) and heterozygote state in the parent, whereas the c.943G>A mutation was detected in heterozygote state and was accompanied by epistaxis in the patient. FXI deficiency is a mild bleeding disorder that is caused by heterogeneous molecular defects. Genetic analysis of a pedigree with hereditary coagulation factor XI deficiency To identify potential mutations of F11 gene in a family with hereditary coagulation factor XI (FXI) deficiency and explore the molecular pathogenesis. The FXI activity and FXI antigen were tested with clotting assay and ELISA, respectively. The FXI gene was amplified by PCR with direct sequencing. Three bioinformatics softwares were used to study the conservatism and harm of the mutation. The proband had a prolonged activated partial thromboplastin time (84.2 s), whose FXI activity and FXI antigen were 3.0 and 8.6%. Gene sequencing revealed that the propositus carried a heterozygous nonsense mutation c.738G>A in exon 7 resulting in a p.Trp228stop and deletions mutation c.1325delT in exon 12 resulting in a p.Leu424Cys. Two bioinformatics softwares all were indicated the mutation had affected the function of the protein. The c.738G>A heterozygous nonsense variation and the c.1325delT heterozygous deletion variation are associated with decreased FXI levels in this family, which is the first reported in the world. Severe acquired platelet dysfunction because of primary myelofibrosis with full functional and morphological recovery after allogeneic hematopoietic cell transplantation Primary myelofibrosis (PMF) is a clonal hematopoietic stem cell disorder characterized by fibrosis of the marrow cavity, marked megakaryocyte atypia and progressive cytopenias. Although thrombosis predominates, bleeding is the primary manifestation in up to 20% of patients and may be life-threatening. In this report, we document restoration of megakaryocyte and platelet structure and function in PMF after allogeneic hematopoietic cell transplantation (HCT). A 59-year-old man presented with recurrent episodes of postoperative bleeding preceding a diagnosis of primary myelofibrosis (PMF). Platelet aggregation and secretion studies showed abnormal responses to all agonists tested (epinephrine, ADP, arachidonic acid, U46619, collagen, ristocetin) despite the presence of thrombocytosis. After an allogeneic HCT, platelet morphology and function studies were all normal. The pathophysiology of platelet dysfunction in myeloid neoplasia is not well understood but, as highlighted in our report, restoration of platelet function by HCT supports a clonal process involving an early hematopoietic progenitor cell. Bernard–Soulier syndrome associated with 22q11.2 deletion and clinical features of DiGeorge/velocardiofacial syndrome Bernard–Soulier syndrome (BSS) is a rare autosomal recessive bleeding disorder caused by a defective function of glycoprotein (GP) Ib-V-IX complex. Among the genes encoding the 4 receptor subunits (GPIbα, GPIbβ, GPV and GPIX), the GPIbβ gene is located on chromosomes 22q11.2. We report a case of a girl with BSS associated with clinical features of 22q11.2 deletion syndrome (22q11.2DS) with phenotypic spectrum of DiGeorge syndrome/velocardiofacial syndrome. She has a history of life-long bleeding tendency, tetralogy of Fallot, hypothyroidism, mild facial dysmorphic signs and macrothrombocytopenia. The BBS and 22q11.2DS association could be explained by the fact that the constitutional hemizygosity of 22q11.2 may unmask an autosomal recessive disorder caused by alterations of the nondeleted GPIbβ allele. We suggest that all patients with 22q11.2DS and bleeding manifestations should be always tested for BSS. Argatroban to achieve therapeutic anticoagulation in two patients with acute thrombosis and heparin resistance We present two cases where argatroban was successfully used in patients with acute thrombosis requiring anticoagulant treatment where heparin resistance with unfractionated heparin had been encountered. The first case was a woman with abdominal arterial thrombosis, of unknown cause, treated with therapeutic low molecular weight heparin that developed pulmonary embolism despite therapeutic anticoagulation (and had evidence of heparin resistance on anti-Xa monitoring). The second patient had provoked abdominal arterial thrombosis from sepsis and could not attain therapeutic anticoagulation with intravenous unfractionated heparin. In both cases therapeutic anticoagulation was achieved with the use of argatroban, as a temporizing measure to treat the acute thrombotic event. Conventionally, argatroban has been described for use in heparin-induced thrombocytopenia. The use of argatroban is briefly discussed, especially in the context of heparin resistance where anticoagulation can be challenging. Further research using argatroban in heparin resistant patients could be justified.
Rare bleeding disorders and advances in gene therapyRare bleeding disorders usually begin in childhood and manifest as varying degrees of bleeding, which can be life-threatening in severe cases. With the development of gene editing technology, it is expected that hereditary coagulation factor disorders will someday be fundamentally cured by gene therapy. On account of their rarity, comprehension of these diseases is essential for the application of new treatment strategies. We have compiled the features...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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The impact of internet-delivered cognitive behavioural therapy for health anxiety on cyberchondria Publication date: January 2020 Source: Journal of Anxiety Disorders, Volume 69 Author(s): Jill M. Newby, Eoin McElroy Abstract Cyberchondria refers to an emotional-behavioural pattern whereby excessive online searches lead to increased anxiety about one's own health status. It has been shown to be associated with health anxiety, however it is unknown whether existing cognitive behavioural therapy (CBT) interventions targeting health anxiety also improve cyberchondria. This study aimed to determine whether internet-delivered cognitive behavioural therapy (iCBT) for severe health anxiety led to improvements in self-reported cyberchondria and whether improvements in cyberchondria were associated with improvements in health anxiety observed during treatment. Methods: We analysed secondary data from a randomised controlled trial (RCT) comparing an iCBT group (n = 41) to an active control group who underwent psychoeducation, monitoring and clinical support (n = 41) in health anxious patients with a DSM-5 diagnosis of Illness Anxiety Disorder and/or Somatic Symptom Disorder. The iCBT group showed a significantly greater reduction in cyberchondria compared to the control group, with large differences at post-treatment on the Cyberchondria Severity Scale Total scale (CSS; Hedges g = 1.09), and the Compulsion, Distress, Excessiveness subscales of the CSS (g's: 0.8–1.13). Mediation analyses showed improvements in health anxiety in the iCBT group were mediated by improvements in all of the CSS subscales, except for the Mistrust subscale. Conclusions: Internet CBT for health anxiety improves cyberchondria. Increased epoch-to-epoch parasympathetic cardiac regulation in participants with posttraumatic stress disorder compared to those with panic disorder and control participants Publication date: December 2019 Source: Journal of Anxiety Disorders, Volume 68 Author(s): Jonathan W. Reeves, Aaron J. Fisher, Steven H. Woodward Abstract BackgroundResearch on the link between respiratory sinus arrhythmia (RSA) and posttraumatic stress disorder (PTSD) has largely focused on average levels of RSA. However, given that rapid shifts in parasympathetic tone are necessary to maintain adaptive cardiac variability, the exclusive focus on these tonic estimates provides an incomplete quantification of parasympathetic cardiac regulation. MethodThe present study is a secondary analysis of previously published data. This analysis aimed to address this limitation by examining the dynamic regulatory effect of the parasympathetic nervous system on heart rate. As such, we examined epoch-to-epoch parasympathetic cardiac regulation – operationalized as the lagged relationship between RSA and heart rate (HR) across consecutive 30-s epochs – across a single night in participants with PTSD, panic disorder (PD), comorbid PTSD and PD (PTSD + PD), and healthy controls. Electrocardiogram and respiratory signals were continuously recorded from 23 participants with PTSD, 14 with PD, 16 with PTSD + PD, and 16 control participants over a single night of sleep in a laboratory setting. ResultsNo group differences in tonic RSA were observed; however, participants with PTSD only and PTSD + PD exhibited significantly greater epoch-to-epoch parasympathetic cardiac regulation over the night than those with PD only and control participants. Moreover, greater severity of hyperarousal symptoms was significantly associated with increased epoch-to-epoch parasympathetic cardiac regulation among participants with PTSD only and PTSD + PD. DiscussionThese data provide preliminary evidence for an upregulatory parasympathetic response to self-reported hyperarousal in participants with PTSD only and PTSD + PD reflected by increased epoch-to-epoch parasympathetic cardiac regulation. Predictors of treatment outcome in OCD: An interpersonal perspective Publication date: December 2019 Source: Journal of Anxiety Disorders, Volume 68 Author(s): Lee Tibi, Patricia van Oppen, Anton J.L.M. van Balkom, Merijn Eikelenboom, Paul M.G. Emmelkamp, Gideon E. Anholt Abstract Although effective treatments for obsessive compulsive disorder (OCD) are increasingly available, a considerable percentage of patients fails to respond or relapses. Predictors associated with improved outcome of OCD were identified. However, information on interpersonal determinants is lacking. This study investigated the contribution of attachment style and expressed emotion to the outcome of exposure and response prevention (ERP), while accounting for previously documented intrapersonal (i.e., symptom severity and personality pathology) predictors. Using logistic regression analyses and multi-level modeling, we examined predictors of treatment completion and outcome among 118 adult OCD patients who entered ERP. We assessed outcome at post treatment, and at four and 13 months from treatment completion. OCD baseline severity and fearful attachment style emerged as the main moderators of treatment outcome. Severe and fearfully attached patients were more likely to dropout prematurely. The improvement of fearful clients was attenuated throughout treatment and follow-up compared to non-fearful clients. However, their symptom worsening at the long-term was also mitigated. Severe OCD patients had a more rapid symptom reduction during treatment and at follow-up, compared to less severe clients. The findings suggest that both baseline OCD severity and fearful attachment style play a role in the long-term outcome of ERP. Changes in Dosing and Dose Timing of D-Cycloserine Explain Its Apparent Declining Efficacy for Augmenting Exposure Therapy for Anxiety-related Disorders: An Individual Participant-data Meta-analysis Publication date: December 2019 Source: Journal of Anxiety Disorders, Volume 68 Author(s): David Rosenfield, Jasper A.J. Smits, Stefan G. Hofmann, David Mataix-Cols, Lorena Fernández de la Cruz, Erik Andersson, Christian Rück, Benedetta Monzani, Ana Pérez-Vigil, Paolo Frumento, Michael Davis, Rianne A. de Kleine, JoAnn Difede, Boadie W. Dunlop, Lara J. Farrell, Daniel Geller, Maryrose Gerardi, Adam J. Guastella, Gert-Jan Hendriks, Matt G. Kushner ABSTRACT The apparent efficacy of d-cycloserine (DCS) for enhancing exposure treatment for anxiety disorders appears to have declined over the past 14 years. We examined whether variations in how DCS has been administered can account for this "declining effect". We also investigated the association between DCS administration characteristics and treatment outcome to find optimal dosing parameters. We conducted a secondary analysis of individual participant data obtained from 1047 participants in 21 studies testing the efficacy of DCS-augmented exposure treatments. Different outcome measures in different studies were harmonized to a 0-100 scale. Intent-to-treat analyses showed that, in participants randomized to DCS augmentation (n = 523), fewer DCS doses, later timing of DCS dose, and lower baseline severity appear to account for this decline effect. More DCS doses were related to better outcomes, but this advantage leveled-off at nine doses. Administering DCS more than 60 minutes before exposures was also related to better outcomes. These predictors were not significant in the placebo arm (n = 521). Results suggested that optimal DCS administration could increase pre-to-follow-up DCS effect size by 50%. In conclusion, the apparent declining effectiveness of DCS over time may be accounted for by how it has been administered. Optimal DCS administration may substantially improve outcomes. Registration: The analysis plan for this manuscript was registered on Open Science Framework (https://osf.io/c39p8/). Social problem solving in social anxiety disorder Publication date: December 2019 Source: Journal of Anxiety Disorders, Volume 68 Author(s): Mia Romano, David A. Moscovitch, Ruofan Ma, Jonathan D. Huppert Abstract Successful social problem solving requires both an adaptive orientation toward the problem and the necessary skills to generate relevant and effective solutions. Surprisingly few studies have examined social problem solving in the context of social anxiety. We examined social problem solving in 38 participants with social anxiety disorder (SAD) in comparison to 30 healthy control (HC) participants with no history of anxiety problems. Participants rated their problem solving attitudes and abilities (i.e., problem orientation) and then generated solutions to hypothetical interpersonal problems from both their own perspective and that of an objective other. These solutions were coded for effectiveness and relevance, as well as the degree to which the solution was active versus passive. Participants with SAD exhibited a more negative problem orientation than HC participants. Furthermore, although SAD and HC participants demonstrated no overall differences in generating relevant and effective solutions to interpersonal problems, utilizing a personal perspective facilitated the generation of more active solutions for HC participants, but less active solutions for those with SAD. Findings illuminate new research directions regarding social problem solving in social anxiety, with potential implications for applied intervention. Changes in trauma-potentiated startle, skin conductance, and heart rate within prolonged exposure therapy for PTSD in high and low treatment responders Publication date: December 2019 Source: Journal of Anxiety Disorders, Volume 68 Author(s): Jessica L. Maples-Keller, Sheila A.M. Rauch, Tanja Jovanovic, Carly W. Yasinski, Jessica Morgan Goodnight, Andrew Sherrill, Kathryn Black, Vasiliki Michopoulos, Boadie W. Dunlop, Barbara Olasov Rothbaum, Seth Davin Norrholm Abstract While exposure-based psychotherapy is recommended as a first-line treatment for posttraumatic stress disorder (PTSD) given strong evidence for its effectiveness, some patients fail to receive full benefit. Psychophysiological data may be important complementary indices for investigating variability in treatment response and changes over the course of treatment. The focus of the present investigation was to examine change in psychophysiological indices pre- to post-treatment and to investigate if changes differed for high versus low PTSD treatment responders. Participants included veterans with primary PTSD diagnoses who received a two-week intensive prolonged exposure (PE) treatment. Psychophysiological assessment included trauma-potentiated startle, heart rate, and skin conductance recordings during presentation of three standard virtual reality (VR)-based, trauma-relevant scenes presented through a head mounted display. Results indicate that 48.6% were classified as high treatment responders (≥50% reduction in PCL-5 from baseline). Trauma-potentiated startle was observed in all patients at pre-treatment, F = 13.58, p < .001, in that startle magnitude was increased during VR stimuli relative to baseline regardless of responder status. However, in high treatment responders, there was an interaction of VR with time, F = 14.10, p = .001; VR scenes did not potentiate startle post-treatment. Specifically, high treatment responders were less reactive to trauma stimuli following PE treatment. There was no effect of time in the low responder group. Heart rate reactivity data revealed a significant main effect of treatment, F = 45.7, p = .035, but no significant interaction with responder status. Skin conductance reactivity did not significantly change from pre to post-treatment. These results suggest that trauma-potentiated startle may represent an objective marker of fear- and anxiety-related symptom reduction that is sensitive to both traditional outpatient as well as intensive treatment approaches. But what will the results be?: Learning to tolerate uncertainty is associated with treatment-produced gains Publication date: December 2019 Source: Journal of Anxiety Disorders, Volume 68 Author(s): Sophie A. Palitz, Lara S. Rifkin, Lesley A. Norris, Mark Knepley, Nicole J. Fleischer, Laurence Steinberg, Philip C. Kendall Abstract The current study examined the association between changes in intolerance of uncertainty (IU) and treatment outcomes for anxious youth. Participants were youth ages 7 to 17 who received cognitive behavioral therapy for anxiety (N = 73). Youth and their primary caregivers completed a diagnostic interview and self- and parent-report measures at pre- and post-treatment, including the Intolerance of Uncertainty Scale for Children (IUS-C/P; Przeworski, 2006), the Coping Questionnaire (CQ-C/P; Kendall, 1994) and the Multidimensional Anxiety Scale for Children (MASC-C/P; March et al., 1997). Hierarchical regression analyses evaluated the role of change in IU (the IUS-C/P) in predicting changes in functional impairment, coping efficacy, and anxiety severity post-treatment, controlling for demographic variables (age and gender), and baseline levels of IU, anxiety severity, functional impairment, and coping efficacy. Results demonstrated that treatment was associated with improvements across child-, parent- and clinician-report, and decreased IU from pre- to post-treatment was associated with (a) decreased functional impairment, (b) increased coping efficacy and (c) decreased anxiety severity. The findings indicate that a greater reduction in IU over treatment is associated with better outcomes in children and adolescents with anxiety across informants, suggesting the possibility that an increased focus on IU during treatment for youth anxiety may improve treatment outcomes. Future research should assess the causality of this relationship. The association between prenatal maternal anxiety disorders and postpartum perceived and observed mother-infant relationship quality Publication date: December 2019 Source: Journal of Anxiety Disorders, Volume 68 Author(s): Selina Nath, Rebecca M. Pearson, Paul Moran, Susan Pawlby, Emma Molyneaux, Fiona L. Challacombe, Louise M. Howard Abstract IntroductionPrenatal maternal anxiety disorders have been associated with adverse outcomes in offspring including emotional, behavioral and cognitive problems. There is limited understanding of the mechanisms underpinning these associations, although one possible candidate is an impaired mother-infant relationship. The authors investigated whether prenatal anxiety disorders were associated with poorer postpartum mother-infant relationship quality, measured by maternal self-reported bonding and observed mother-infant interactions. MethodsA cohort of 454 pregnant women recruited from an inner-city maternity service in London (UK) were assessed for mental disorders using the Structured Clinical Interview for DSM-IV and followed up at mid-pregnancy and 3-months postpartum. Depressive symptoms were assessed at baseline and mid-pregnancy (using the Edinburgh Postnatal Depression Scale). At three months postpartum, women were assessed for self-reported bonding difficulties (using the Postpartum Bonding Questionnaire) and a subsample (n = 204) participated in video-recorded mother-infant interaction, coded using the Child-Adult Relationship Experimental Index by an independent rater. ResultsPrenatal anxiety disorders were associated with higher perceived bonding impairment, but not associated with observed poor mother-infant interaction quality. Higher levels of depressive symptoms were associated with lower maternal sensitivity. ConclusionsInterventions for anxiety disorders in the perinatal period could be tailored to address anxieties about mother-infant relationship and co-morbid depressive symptoms. Patient adherence to cognitive behavioural therapy for obsessive-compulsive disorder: A systematic review and meta-analysis Publication date: December 2019 Source: Journal of Anxiety Disorders, Volume 68 Author(s): Tamara Leeuwerik, Kate Cavanagh, Clara Strauss Abstract Whilst cognitive behavioural therapy (CBT) is the treatment of choice for obsessive-compulsive disorder (OCD), around half of the participants do not experience remission following treatment. As yet, there is no comprehensive systematic review of the extent to which patient non-adherence presents a challenge to the overall benefit of CBT for OCD. The aim of this systematic review and meta-analysis was to identify the magnitude, moderators and reasons for poor patient adherence to CBT for OCD in terms of: (1) treatment refusal, (2) treatment dropout, (3) session attendance/module completion, and (4) between-session CBT task adherence. Sociodemographic and clinical variables, treatment and study design characteristics were examined as moderators of adherence. The systematic search identified 123 studies including 5627 participants taking part in CBT or control conditions. A pooled rate of 15.6% of eligible patients refused CBT and a further 15.9% of treatment starters dropped out from treatment. Group CBT had significantly lower dropout rates than individually-delivered CBT. No other significant moderators were found. Most studies reported moderate to good adherence to between-session CBT tasks, which had a significant medium to large association with post-treatment OCD symptom reduction. Recommendations for enhanced measurement and reporting of patient adherence to CBT for OCD are made along with clinical implications of findings. Patterns and correlates of racial/ethnic disparities in posttraumatic stress disorder screening among recently separated veterans Publication date: December 2019 Source: Journal of Anxiety Disorders, Volume 68 Author(s): Juliette McClendon, Daniel Perkins, Laurel A. Copeland, Erin P. Finley, Dawne Vogt Abstract BackgroundDespite the high prevalence of posttraumatic stress disorder (PTSD) among military veterans, there is a lack of knowledge about racial/ethnic differences. The current study describes patterns and correlates of PTSD screening across race/ethnicity and gender in a sample of 9420 veterans recently separated from the military. Veterans who identified as White (n = 6222), Hispanic/Latinx (n = 1313), Black (n = 1027), Asian/Hawaiian/Pacific Islander (n = 420) and multiracial (n = 438) were included. MethodTrauma exposure and PTSD were assessed with the Primary Care PTSD Screen for DSM-5. Contextual factors examined included the intensity of ongoing stressful events, perceived social support, and sociodemographic variables (e.g., income). Weighted analyses were conducted to account for differential sample response rates. Regression analyses examining correlates of racial/ethnic differences in PTSD screening were stratified by gender. ResultsAmong men and women, positive PTSD screening rates were significantly elevated among Black, multiracial, and Hispanic/Latinx veterans compared with White veterans. Sociodemographics, trauma exposure, stress and social support accounted for elevated positive screening rates among all racial/ethnic groups except Black men and multiracial women. ConclusionsFindings suggest that Black, Hispanic/Latinx and multiracial veterans may be at higher risk for PTSD shortly following separation from the military. Contextual factors examined explain the excess risk among some, but not all, subgroups. Further specifying disparities in PTSD diagnostic rates and risk factors will enable targeted and tailored intervention among veteran subgroups.
The impact of internet-delivered cognitive behavioural therapy for health anxiety on cyberchondriaPublication date: January 2020Source: Journal of Anxiety Disorders, Volume 69Author(s): Jill M. Newby, Eoin McElroyAbstractCyberchondria refers to an emotional-behavioural pattern whereby excessive online searches lead to increased anxiety about one's own health status. It has been shown to be associated with health anxiety, however it is unknown whether existing cognitive behavioural therapy (CBT) interventions...
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
08:27
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com, Telephone consultation 11855 int 1193,
Die Fußballerhüfte Zusammenfassung Während Beschwerden und Verletzungen an Knie- und Sprunggelenk im...Die FußballerhüfteZusammenfassungWährend Beschwerden und Verletzungen an Knie- und Sprunggelenk im Fußball sehr präsent sind, wird dem Hüftgelenk bisher eine nur sehr geringe Aufmerksamkeit geschenkt. Beschwerden in diesem Bereich werden häufig auf pathologische Veränderungen in der Leistenregion zurückgeführt. Intraartikuläre Differenzialdiagnosen werden hingegen häufig nicht in Betracht gezogen....
Medicine by Alexandros G. Sfakianakis
Mon 

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