Head and Neck Diseases by Alexandros G.Sfakianakis: 01/30/17

Δευτέρα 30 Ιανουαρίου 2017

Pigmented apocrine hamartoma of the vulva: a case report

Abstract

We herein report a patient who clinically presented with a pigmented, flat plaque in the vulvar area. Histological examination showed a benign lesion mainly composed of tubular and cystic glands with apocrine differentiation. The most striking histological feature was the deposition of finely granular melanin pigment both in the epithelial cells and in the luminal surface of the glands. In addition, Melan-A immunostaining demonstrated the presence of numerous melanocytes within the lesion suggesting that the pigment deposition was secondary to colonization of the lesion by melanocytes. We therefore diagnosed this lesion as 'pigmented apocrine hamartoma'. To the best of our knowledge only three cases of pigmented apocrine hamartoma have been reported in the literature so far.

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A Pediatric Case of Cowden Syndrome with Graves’ Disease

Cowden syndrome (CS) is a rare dominantly inherited multisystem disorder, characterized by an extraordinary malignant potential. In 80% of cases, the human tumor suppressor gene phosphatase and tensin homolog (PTEN) is mutated. We present a case of a 17-year-old boy with genetically confirmed CS and Graves' disease (GD). At the age of 15, he presented with intention tremor, palpitations, and marked anxiety. On examination, he had macrocephaly, coarse facies, slight prognathism, facial trichilemmomas, abdominal keratoses, leg hemangioma, and a diffusely enlarged thyroid gland. He started antithyroid drug (ATD) therapy with methimazole and, after a 2-year treatment period without achieving a remission status, a total thyroidectomy was performed. Diagnosis and management of CS should be multidisciplinary. Thyroid disease is frequent, but its management has yet to be fully defined. The authors present a case report of a pediatric patient with CS and GD and discuss treatment options.

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Osteopathic Manipulative Treatment Limits Chronic Constipation in a Child with Pitt-Hopkins Syndrome

Pitt-Hopkins Syndrome (PTHS) is a rare genetic disorder caused by insufficient expression of the TCF4 gene. Children with PTHS typically present with gastrointestinal disorders and early severe chronic constipation is frequently found (75%). Here we describe the case of a PTHS male 10-year-old patient with chronic constipation in whom Osteopathic Manipulative Treatment (OMT) resulted in improved bowel functions, as assessed by the diary, the QPGS-Form A Section C questionnaire, and the Paediatric Bristol Stool Form Scale. The authors suggested that OMT may be a valid tool to improve the defecation frequency and reduce enema administration in PTHS patients.

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Meretoja’s Syndrome: Lattice Corneal Dystrophy, Gelsolin Type

Lattice corneal dystrophy gelsolin type was first described in 1969 by Jouko Meretoja, a Finnish ophthalmologist. It is caused by an autosomal dominant mutation in gelsolin gene resulting in unstable protein fragments and amyloid deposition in various organs. The age of onset is usually after the third decade of life and typical diagnostic triad includes progressive bilateral facial paralysis, loose skin, and lattice corneal dystrophy. We report a case of a 53-year-old female patient referred to our Department of Ophthalmology by severe dry eye and incomplete eyelid closure. She had severe bilateral facial paresis, significant orbicularis, and perioral sagging as well as hypoesthesia of extremities and was diagnosed with Meretoja's syndrome at the age of 50, confirmed by the presence of gelsolin mutation. At our observation she had bilateral diminished tear film break-up time and Schirmer test, diffuse keratitis, corneal opacification, and neovascularization in the left eye. She was treated with preservative-free lubricants and topical cyclosporine, associated with nocturnal complete occlusion of both eyes, and underwent placement of lacrimal punctal plugs. Ocular symptoms are the first to appear and our role as ophthalmologists is essential for the diagnosis, treatment, and monitoring of ocular alterations in these patients.

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A Giant Lumbar Pseudomeningocele in a Patient with Neurofibromatosis Type 1: A Case Report

This is a rare case of giant lumbar pseudomeningocele with intra-abdominal extension in patient with neurofibromatosis type 1 (NF1). The patient's clinical course is retrospectively reviewed. A 34-year-old female affected by NF1 was referred to our institution for persistent low back pain and MRI diagnosis of pseudomeningocele located at L3 level with paravertebral extension. From the first surgical procedure by a posterior approach until the relapse of the pseudomeningocele documented by MRI, the patient underwent two subsequent posterior surgical procedures to repair the dural sac defect with fat graft and fibrin glue. One month after the third operation, the abdominal MRI showed a giant intra-abdominal pseudomeningocele causing compression of visceral structures. The patient was asymptomatic. The pseudomeningocele was treated with an anterior abdominal approach and the use of the acellular dermal matrix (ADM) sutured directly on the dural defect on the anterolateral wall of the spinal canal. After six months of follow-up the MRI showed no relapse of the pseudomeningocele. Our case highlights the possible use of ADM as an effective and safe alternative to the traditional fat graft to repair challenging and large dural defects.

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Non-invasive Identification of Vulnerable Atherosclerotic Plaques Using Texture Analysis in Ultrasound Carotid Elastography: An In Vivo Feasibility Study Validated by Magnetic Resonance Imaging

Publication date: Available online 30 January 2017
Source:Ultrasound in Medicine & Biology
Author(s): Chengwu Huang, Qiong He, Manwei Huang, Lingyun Huang, Xihai Zhao, Chun Yuan, Jianwen Luo
The aims of this study were to quantify the textural information of strain rate images in ultrasound carotid elastography and evaluate the feasibility of using the textural features in discriminating stable and vulnerable plaques with magnetic resonance imaging as an in vivo reference. Ultrasound radiofrequency data were acquired in 80 carotid plaques from 52 patients, mainly in the longitudinal imaging view, and axial strain rate images were estimated with an ultrasound carotid elastography technique based on an optical flow algorithm. Four textural features of strain rate images—contrast, homogeneity, correlation and angular second moment—were derived based on the gray-level co-occurrence matrix in plaque regions to quantify the deformation distribution pattern. Conventional elastographic indices based on the magnitude of the absolute strain rate, such as the maximum, mean, median, standard deviation and 99th percentile of the axial strain rate, were also obtained for comparison. Composition measurement with magnetic resonance imaging identified 30 plaques as vulnerable and the other 50 as stable. The four textural features, as well as the magnitude of strain rate images, significantly differed between the two groups of plaques. The best performing features for plaque classification were found to be the contrast and 99th percentile of the absolute strain rate, with a comparative area under the receiver operating characteristic curve of 0.81; a slightly higher maximum accuracy of plaque classification can be achieved by the textural feature of contrast (83.8% vs. 81.3%). The results indicate that the use of texture analysis in plaque classification is feasible and that larger local deformations and higher level of complexity in deformation patterns (associated with the elastic or stiffness heterogeneity of plaque tissues) are more likely to occur in vulnerable plaques.

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Can an Educational Intervention Improve Iodine Nutrition Status in Pregnant Women? A Randomized Controlled Trial

Thyroid , Vol. 0, No. 0.

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Chromatin dynamics during the cell cycle at centromeres

During the cell cycle, the centromeres of chromosomes have important roles and face key challenges, such as mediating successful chromosome segregation during mitosis and faithfully propagating their chromatin state to daughter chromosomes during S phase. This Review describes cell cycle-related features of centromeres, focusing on the nature and dynamics of centromeric chromatin, how it is intricately regulated and the potential implications for disease when these processes are disrupted.

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Genetic variation: Giving context to phenotype prediction

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Non-coding RNA: Pri-miRNA processing: structure is key

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Technique: SMiLE-seq illuminates transcription factor motifs

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Evolving health care through personal genomics

The advent of genomic technologies is changing health care systems, with genomic data increasingly being applied to guide individual patient care. In this Essay, Rehm discusses how genomics is becoming an essential part of clinical care and the existing challenges that must be surmounted to take full advantage of personal genomic information.

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Rapid malachite green degradation using Fe73.5Si13.5B9Cu1Nb3 metallic glass for activation of persulfate under UV–Vis light

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): S.X. Liang, Z. Jia, W.C. Zhang, W.M. Wang, L.C. Zhang
In this work, it is the first time to report that Fe73.5Si13.5B9Cu1Nb3 metallic glass having unique atomic structure was employed for activation of persulfate under UV–Vis light. The investigation evaluated the importance of influencing parameters, including dye concentration, persulfate concentration, ribbon dosage and light intensity, on malachite green (MG) dye degradation. The results reveal that 100% dye color removal with a reaction rate of k=0.0849min⁻¹ could be achieved within 30min under specific parameters control. In addition, surface decay behavior of the catalyst also plays a significant effect on the reusability and sustainability. The inclusion of Nb atom in Fe73.5Si13.5B9Cu1Nb3 promotes enrichment of Si atom on the ribbon surface, causing the formation of Si and Nb oxides to further improve the surface stability on both of free and roller-contacted surfaces. The precipitations on reused ribbon surface are confirmed as α-Fe, iron oxide and Si, Nb oxides, revealing a high potential of catalytic reusability for wastewater treatment. The present work will open a new gate for further realizing the high performance of industrial water treatment using metallic glass.

Graphical abstract

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Sol-gel hot injection synthesis of ZnO nanoparticles into a porous silica matrix and reaction mechanism

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Ahmed Barhoum, Guy Van Assche, Hubert Rahier, Manuel Fleisch, Sara Bals, Marie-Paule Delplancked, Frederic Leroux, Detlef Bahnemann
Despite the enormous interest in the properties and applications of porous silica matrix, only a few attempts have been reported to deposit metal and metal oxide nanoparticles (NPs) inside the porous silica matrix. We report a simple approach (i.e. sol-gel hot injection) for insitu synthesis of ZnO NPs inside a porous silica matrix. Control of the Zn:Si molar ratio, reaction temperature, pH value, and annealing temperature permits formation of ZnO NPs (≤10nm) inside a porous silica particles, without additives or organic solvents. Results revealed that a solid state reaction inside the ZnO/SiO2 nanocomposites occurs with increasing the annealing temperature. The reaction of ZnO NPs with SiO2 matrix was insignificant up to approximately 500°C. However, ZnO NPs react strongly with the silica matrix when the nanocomposites are annealed at temperatures above 700°C. Extensive annealing of the ZnO/SiO2 nanocomposite at 900°C yields 3D structures made of 500nm rod-like, 5–7μm tube-like and 3–5μm needle-like Zn2SiO4 crystals. A possible mechanism for forming ZnO NPs inside porous silica matrix and phase transformation of the ZnO/SiO2 nanocomposites into 3D architectures of Zn2SiO4 are carefully discussed.

Graphical abstract

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Effects of processing routes on room temperature tensile strength and elongation for Inconel 718

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Yung-Ta Chen, An-Chou Yeh, Ming-Yen Li, Shih-Ming Kuo
For oil and gas industrial applications, materials of deep downhole drilling components are required to possess tensile strength over 1400MPa at room temperature. The present study demonstrates that processing design for Inconel 718 can widen the spectrum of its mechanical properties to meet the demand for ultra-high room temperature tensile strength. The range of room temperature tensile properties achieved in this study include tensile strength of 1785MPa in one end of spectrum, and large tensile strain over 40% in the other end. Furthermore, a well-balanced tensile property of 1430MPa with 18% tensile strain can be achieved by minimizing the formation of pre-aging δ precipitates through direct aging process. The strengthening mechanisms and the trade-off between tensile strength and ductility have been investigated and discussed.

Graphical abstract

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Preparation of pH-sensitive core-shell organic corrosion inhibitor and its release behavior in simulated concrete pore solutions

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Yangyang Zhu, Yuwei Ma, Qijun Yu, Jiangxiong Wei, Jie Hu
In this paper, core-shell organic corrosion inhibitors (COCI) based on poly(ethylene oxide)-b-polystyrene (PEO-b-PS) copolymers were successfully prepared. The release process of benzotriazole (BTA) reserved in COCI was investigated by UV spectrophotometry in deionized water and simulated concrete pore (SCP) solutions with different pH values, and the size and morphology of COCI were determined by dynamic light scattering measurements and SEM combined with EDS before and after the release process. The release amount of BTA was slightly higher (9%) in deionized water with lower pH values, which was related to the higher protonation degree of oxygen groups in PEO moieties and less compact structure of COCI at lower pH environment. In SCP solutions, the pH sensitivity of BTA release process was more pronounced, evidenced by 5 times lower release amount of BTA in SCP solution with a pH value of 13, compared to SCP solutions with pH values lower than 11. The most plausible reason is that in SCP solution with a pH value of 13, the existence of Ca²⁺ and high alkaline environment are beneficial for the agglomeration of COCI and formation of Na-rich layer around COCI, hindering the diffusion rate and subsequently release process of the reserved BTA.

Graphical abstract

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Mechanical properties and dynamic constitutive model of 42CrMo steel

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Zhiwu Zhu, Yesen Lu, Qijun Xie, Dingyuan Li, Ning Gao
42CrMo steel used in high-speed train axles withstands complex loading conditions. To study the mechanical properties and the stress-strain relationship of 42CrMo steel, it was subjected to quasi-static and dynamic compression experiments. Experiments at eight different strain rates, ranging from 10⁻³ to 4500s⁻¹, demonstrate that it exhibits rate-dependent plastic behavior, thermal softening, and work-hardening behaviors. The dislocation theory explains the deformation mechanism of 42CrMo steel. Furthermore, a new constitutive model, which includes the thermal softening effect, based on the Zerilli–Armstrong constitutive model, is proposed to describe the dynamic mechanical behavior of 42CrMo steel. The model results are in good agreement with the experimental data, demonstrating that the proposed constitutive model describes the mechanical behavior of 42CrMo steel at various strain rates very well.

Graphical abstract

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Effect of Ni addition on the wettability and microstructure of Sn2.5Ag0.7Cu0.1RE solder alloy

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Yaoli Wang, Guangxin Wang, Kexing Song, Keke Zhang
In order to study the effect of Ni addition on the wettability and microstructure of Sn2.5Ag0.7Cu0.1RE solder alloy, samples of 7compositions were prepared with Ni content ranging from 0 to 0.5% and contents of other alloying elements (Ag, Cu and RE) being kept the same. Results obtained have shown that the wettability of Sn2.5Ag0.7Cu0.1RE can be largely improved by adding 0.1% Ni in the alloy, and Sn2.5Ag0.7Cu0.1RE0.1Ni exhibits a better wettability than the commercially used Sn3.8Ag0.7Cu alloy. The wetting angle measured on Cu substrate is clearly larger than that measured on Cu wire, which is considering the "static" and "dynamic" natures of the two testing procedures. In addition, Ni has been found to be able to reduce the volume fraction of primary Sn, increase the ratio of eutectic structure and form a much finer eutectic microstructure from a three-dimensional view of the microstructure after deep-etching. Moreover, Ni shows a clear impact on the interface between Cu substrate and solder alloy. Compared to the solder alloy without Ni, adding 0.1% Ni leads to a relative flatter and thinner interface. For the solder alloy with 0.5% Ni, micro-cracks are observed at the interface.

Graphical abstract

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A comprehensive microstructural analysis of Al–WC micro- and nano-composites prepared by spark plasma sintering

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Amir Pakdel, Agnieszka Witecka, Gaulthier Rydzek, Dayangku Noorfazidah Awang Shri
There have been many investigations on metal matrix microcomposites produced by conventional casting routes; however, in the past decade, the focus has shifted more toward nanocomposites produced via solid state routes. To have a realistic view of performance prediction and optimum design of such composites, in this work Al matrix composites (AMCs) reinforced with WC microparticles, nanoparticles, and bimodal micro-/nano-particles were prepared by spark plasma sintering. The effects of particle size and concentration, and process variables (i.e. sintering temperature, duration, and pressure) on the evolution of microstructure, density and hardness of the composites were studied comprehensively. Full densification of AMCs with high particle concentration was problematic because of ceramic cluster formations in the microstructure. This effect was more emphasized in AMCs containing nanoparticles. AMCs with microparticles were more easily densified, but their hardness benefits were inferior. On the other hand, the mixture of micro- and nano-particles in Al-WC bimodal composites led to better matrix reinforcement integrity and an overall improvement in the microstructural properties. Finally, increasing the sintering temperature improved the microstructural features and hardness of the composites (more enhanced in high wt.% samples), but sintering duration and pressure did not have a big impact on the composite properties.

Graphical abstract

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Can an Educational Intervention Improve Iodine Nutrition Status in Pregnant Women? A Randomized Controlled Trial

Thyroid , Vol. 0, No. 0.

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Reduction of Radiation Dosage in Visualization of Paranasal Sinuses in Daily Routine

Background. Preoperative imaging of the nose and paranasal sinus is standard in otorhinolaryngology. Previous studies on phantoms demonstrated the potential for dose reduction of cone beam computed tomography (CBCT) by varying the application parameters. Methodology. Based on previous studies, the standard protocol of paranasal sinus imaging by CBCT was altered. One hundred and fifty examinations using the old protocol (01/2010–01/2011, high dosage) and 150 examinations using the new protocol (09/2012–09/2013, low dosage) were evaluated and compared for the visibility of 17 anatomical structures, the Lund-Mackay Score, and technical parameters. Results. Alteration of the protocol resulted in a significant reduction in dosage (6.64 mGy versus 2.88 mGy). Both groups showed the same amount of pathology (Lund-Mackay Score: versus ; ). There was a significant better visibility of the anatomical structures (all visible = 1, nothing visible = 4) (results: 1.25 versus 1.17; ) in the low-dosage group. Conclusion. Despite a significant reduction in the applied dosage, reliable visualization of the bony anatomy of the anterior skull base is possible by CBCT. This demonstrates the need for the discussion of the required clinical imaging quality.

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Reduction of Radiation Dosage in Visualization of Paranasal Sinuses in Daily Routine

Associations Between Adiposity and Metabolic Syndrome Over Time: The Healthy Twin Study

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Mindfulness within psychological interventions for the treatment of dermatologic diseases

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Ustekinumab for the treatment of acrodermatitis continua of Hallopeau refractory to anti-TNF agents

Abstract

Acrodermatitis continua of Hallopeau (ACH) is a variant of pustular psoriasis that is often very difficult to treat. Almost all anti-psoriatic agents have been used in the treatment of ACH. Ustekinumab, a fully human monoclonal antibody of the IgG1 class, is directed to the shared p40 subunit of cytokines IL-12 and IL-23. Herein, we present our experience of ustekinumab use in a 50-year-old man who was resistant to anti-tumor necrosis factor-α agents. Though initial therapy with ustekinumab achieved a sustained response in our patient, after a seven months of interruption, retreatment resulted in a slower and poorer response than the initial regimen. Both responses of our patient reflects: (i) the recalcitrant chronic nature of ACH in some patients, (ii) the value of ustekinumab in ACH treatment, (iii) the fact that, as with other biologics, a loss of response may also occur with ustekinumab when the treatment is interrupted. All these data provides evidence for the fact that the course of ACH is unpredictable and possibly indicate that concerning current biologics used in the treatment of ACH, we have still failed to hit the target we aimed for.

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Mindfulness within psychological interventions for the treatment of dermatologic diseases

http://ift.tt/2jxuib5

Ustekinumab for the treatment of acrodermatitis continua of Hallopeau refractory to anti-TNF agents

Abstract

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Exhaled nitric oxide or FEF25%–75% Balancing diagnostic value with efficacy despite evidentiary uncertainty

We appreciate the comments1,2 on our recent publication investigating the value of exhaled nitric oxide (FeNO) in predicting the outcome of a methacholine challenge (MCH) in adults with respiratory symptoms presenting to a tertiary care center.3 Despite our hypothesis not being confirmed, the performance profile of FeNO (inexpensive, point of care, information predicting treatment response) makes this testing modality attractive compared with MCH testing (more expensive, logistically more cumbersome, helpful primarily when the result is negative).

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Control measures in asthma: one size likely does not fit all

Despite great advances in our understanding and treatment of asthma, significant morbidity and mortality persist. Recent statistics have reported 1.8 million emergency department visits and 3,651 deaths from asthma in the United States.1,2 Although the greatest lability occurs in those with severe asthma, a recent study from the United Kingdom found that only 39% of patients who died of asthma were previously labeled as having severe asthma.3 All these findings speak to the need for better measurements of asthma control.

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Stevens-Johnson syndrome and toxic epidermal necrolysis

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN or Lyell disease) are rare diseases that cause acute destruction of the epithelium of the skin and mucous membrane by a violent immune response. SJS, TEN, and SJS-TEN overlap are considered variants in a spectrum of disease severity. SJS involves epidermal detachment of less than 10% of total body surface area, TEN involves epidermal detachment of more than 30% of total body surface area, and SJS-TEN overlap involves epidermal detachment of 10% to 29% of total body surface area.

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Instructions for Authors

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Guidelines for the prevention of peanut allergy in the United States

Allergists-immunologists are frequently consulted for specific recommendations regarding when to introduce solid foods to infants at risks for food allergy. While they had been given evidence from the literature for the lack of benefit from a delay in the introduction of allergenic foods, there was no evidence for lack of harm, let alone a benefit, for their early introduction. Results from the prospective randomized clinical trial that evaluated the preventive role of early introduction of peanut in the diet of infants at risk for peanut allergy (known as the Learning Early About Peanut Allergy [LEAP] study)1 have recently been published.

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Environmental control measures for the management of atopy

With the increasing prevalence of allergic airway disease in recent years, efforts have focused on the importance of environmental control measures to decrease morbidity and improve quality of life in the allergic population. Once allergy and asthma have been established, allergen abatement is an important aspect of managing the atopic population. We review current evidence of the role of environmental control and abatement measures for common allergens including furry animals, rodents, cockroach, dust mite, and mold.

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Book Review

Climate change is the defining challenge of our century, and this book considers its effects on aeroallergens and allergic diseases. These effects range from the geographic distribution of allergenic species of plants and molds to the allergenicity of the pollen grains and spores themselves. Also addressed are increased aeroallergen production, lengthening of allergy seasons, and interactions with air pollution. The remaining sections describe the effects on allergic disease incidence and clinical presentations.

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Information for Readers

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Asthma Yardstick

Current asthma guidelines recommend a control-based approach to management that involves assessment of impairment and risk followed by implementation of treatment strategies individualized according to the patient's needs and preferences. The fact that many patients still experience severe symptoms that negatively affect quality of life suggests that asthma control remains an objective to be achieved. Tools are available to help patients (and families) manage the day-to-day and short-term variability in asthma symptoms; however, when and how to implement a sustained step-up in therapy is less clear.

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Exhaled nitric oxide or FEF25%–75% Balancing diagnostic value with efficacy despite evidentiary uncertainty

Exhaled nitric oxide's ability to predict methacholine challenge

I read with interest the article "Evaluation of Exhaled Nitric Oxide's Ability to Predict Methacholine Challenge in Adults With Nonobstructive Spirometry" by Nickels and Lim, recently published on Annals of Allergy, Asthma, and Immunology.1 Their study, which was retrospectively conducted and selected patients who performed fractional exhaled nitric oxide (FeNO) and methacholine bronchial challenge within 2 weeks of each other, found that FeNO had a nonbrilliant ability to predict the outcome of a methacholine challenge, despite patients with positive methacholine challenge result having signficantly higher levels of FeNO.

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Control measures in asthma: one size likely does not fit all

Editorial Board

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Stevens-Johnson syndrome and toxic epidermal necrolysis

Fractional exhaled nitric oxide, methacholine, or forced expiratory flow between 25% and 75%

Nickels and Lim1 retrospectively evaluated 774 adults who underwent methacholine challenge and fractional exhaled nitric oxide (FeNO) measurement. They reported that approximately 16% of tested individuals had positive methacholine challenge results (ie, bronchial hyperreactivity [BHR]) and that FeNO values were higher in those with BHR. A receiver operating characteristic curve revealed an area under the curve of 0.57, suggesting a poor association between FeNO and methacholine outcomes. Therefore, the authors concluded that in corticosteroid-naive pulmonary patients with normal forced expiratory volume in 1 second values, FeNO poorly predicts the outcome of a methacholine challenge.

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Instructions for Authors

http://ift.tt/2kb69Jq

Guidelines for the prevention of peanut allergy in the United States

Environmental control measures for the management of atopy

Book Review

Information for Readers

http://ift.tt/2kJ6H98

Asthma Yardstick

http://ift.tt/2kJltg5

Exhaled nitric oxide's ability to predict methacholine challenge

Editorial Board

http://ift.tt/2kJmtkG

Fractional exhaled nitric oxide, methacholine, or forced expiratory flow between 25% and 75%

A causal role for hyperinsulinemia in obesity

Insulin modulates the biochemical pathways controlling lipid uptake, lipolysis and lipogenesis at multiple levels. Elevated insulin levels are associated with obesity, and conversely, dietary and pharmacological manipulations that reduce insulin have occasionally been reported to cause weight loss. However, the causal role of insulin hypersecretion in the development of mammalian obesity remained controversial in the absence of direct loss-of-function experiments. Here, we discuss theoretical considerations around the causal role of excess insulin for obesity, as well as recent studies employing mice that are genetically incapable of the rapid and sustained hyperinsulinemia that normally accompanies a high-fat diet. We also discuss new evidence demonstrating that modest reductions in circulating insulin prevent weight gain, with sustained effects that can persist after insulin levels normalize. Importantly, evidence from long-term studies reveals that a modest reduction in circulating insulin is not associated with impaired glucose homeostasis, meaning that body weight and lipid homeostasis are actually more sensitive to small changes in circulating insulin than glucose homeostasis in these models. Collectively, the evidence from new studies on genetic loss-of-function models forces a re-evaluation of current paradigms related to obesity, insulin resistance and diabetes. The potential for translation of these findings to humans is briefly discussed.

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Exogenous thyroxine improves glucose intolerance in insulin-resistant rats

Both hypothyroidism and hyperthyroidism are associated with glucose intolerance, calling into question the contribution of thyroid hormones (TH) on glucose regulation. TH analogues and derivatives may be effective treatment options for glucose intolerance and insulin resistance (IR), but their potential glucoregulatory effects during conditions of impaired metabolism are not well described. To assess the effects of thyroxine (T₄) on glucose intolerance in a model of insulin resistance, an oral glucose tolerance test (oGTT) was performed on three groups of rats (n = 8): (1) lean, Long Evans Tokushima Otsuka (LETO), (2) obese, Otsuka Long Evans Tokushima Fatty (OLETF) and (3) OLETF + T₄ (8.0 µg/100 g BM/day x 5 weeks). T₄ attenuated glucose intolerance by 15% and decreased IR index (IRI) by 34% in T₄-treated OLETF compared to untreated OLETF despite a 31% decrease in muscle Glut4 mRNA expression. T₄ increased the mRNA expressions of muscle monocarboxylate transporter 10 (Mct10), deiodinase type 2 (Di2), sirtuin 1 (Sirt1) and uncoupling protein 2 (Ucp2) by 1.8-, 2.2-, 2.7- and 1.4-fold, respectively, compared to OLETF. Activation of AMP-activated protein kinase (AMPK) and insulin receptor were not significantly altered suggesting that the improvements in glucose intolerance and IR were independent of enhanced insulin-mediated signaling. The results suggest that T₄ treatment increased the influx of T₄ in skeletal muscle and, with an increase of DI2, increased the availability of the biologically active T₃ to upregulate key factors such SIRT1 and UCP2 involved in cellular metabolism and glucose homeostasis.

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Predictive value of [ 18 F]-fluoride PET for monitoring bone remodeling in patients with orthopedic conditions treated with a Taylor spatial frame

Abstract

Purpose

The Taylor Spatial Frame (TSF) is used to correct orthopedic conditions such as correction osteotomies in delayed fracture healing and pseudarthrosis. Long-term TSF-treatments are common and may lead to complications. Current conventional radiological methods are often unsatisfactory for therapy monitoring. Hence, an imaging technique capable of quantifying bone healing progression would be advantageous.

Methods

A cohort of 24 patients with different orthopedic conditions, pseudarthrosis (n = 10), deformities subjected to correction osteotomy (n = 9), and fracture (n = 5) underwent dynamic [¹⁸F]-fluoride (Na¹⁸F) PET/CT at 8 weeks and 4 months, respectively, after application of a TSF. Parametric images, corresponding to the net transport rate of [¹⁸F]-fluoride from plasma to bone, K _i were calculated. The ratio of the maximum K _i at PET scan 2 and 1 ( \( {\overline{K}}_{i, \max } \) ) as well as the ratio of the maximum Standard Uptake Value at PET scan 2 and 1 ( \( {\overline{SUV}}_{\max } \) ) were calculated for each individual. Different treatment end-points were scored, and the overall treatment outcome score was compared with the osteoblastic activity progression as scored with \( {\overline{K}}_{i, \max } \) or \( {\overline{SUV}}_{\max } \) .

Results

\( {\overline{K}}_{i, \max } \) and \( {\overline{SUV}}_{\max } \) were not correlated within each orthopedic group (p > 0.1 for all groups), nor for the pooled population (p = 0.12). The distribution of \( {\overline{K}}_{i, \max } \) was found significantly different among the different orthopedic groups (p = 0.0046) -also for \( {\overline{SUV}}_{\max } \) (p = 0.022). The positive and negative treatment predictive values for \( {\overline{K}}_{i, \max } \) were 66.7 % and 77.8 %, respectively. Corresponding values for \( {\overline{SUV}}_{\max } \) were 25 % and 33.3 %

Conclusions

The \( {\overline{K}}_{i, \max } \) obtained from dynamic [¹⁸F]-fluoride-PET imaging is a promising predictive factor to evaluate changes in bone healing in response to TSF treatment.

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On the accuracy and reproducibility of a novel probabilistic atlas-based generation for calculation of head attenuation maps on integrated PET/MR scanners

Abstract

Purpose

To propose an MR-based method for generating continuous-valued head attenuation maps and to assess its accuracy and reproducibility. Demonstrating that novel MR-based photon attenuation correction methods are both accurate and reproducible is essential prior to using them routinely in research and clinical studies on integrated PET/MR scanners.

Methods

Continuous-valued linear attenuation coefficient maps ("μ-maps") were generated by combining atlases that provided the prior probability of voxel positions belonging to a certain tissue class (air, soft tissue, or bone) and an MR intensity-based likelihood classifier to produce posterior probability maps of tissue classes. These probabilities were used as weights to generate the μ-maps. The accuracy of this probabilistic atlas-based continuous-valued μ-map ("PAC-map") generation method was assessed by calculating the voxel-wise absolute relative change (RC) between the MR-based and scaled CT-based attenuation-corrected PET images. To assess reproducibility, we performed pair-wise comparisons of the RC values obtained from the PET images reconstructed using the μ-maps generated from the data acquired at three time points.

Results

The proposed method produced continuous-valued μ-maps that qualitatively reflected the variable anatomy in patients with brain tumor and agreed well with the scaled CT-based μ-maps. The absolute RC comparing the resulting PET volumes was 1.76 ± 2.33 %, quantitatively demonstrating that the method is accurate. Additionally, we also showed that the method is highly reproducible, the mean RC value for the PET images reconstructed using the μ-maps obtained at the three visits being 0.65 ± 0.95 %.

Conclusion

Accurate and highly reproducible continuous-valued head μ-maps can be generated from MR data using a probabilistic atlas-based approach.

http://ift.tt/2klcPad

In Vivo Spiking Dynamics of Intra- and Extratelencephalic Projection Neurons in Rat Motor Cortex

<span class="paragraphSection"><div class="boxTitle">Abstract</div>In motor cortex, 2 types of deep layer pyramidal cells send their axons to other areas: intratelencephalic (IT)-type neurons specifically project bilaterally to the cerebral cortex and striatum, whereas neurons of the extratelencephalic (ET)-type, termed conventionally pyramidal tract-type, project ipsilaterally to the thalamus and other areas. Although they have totally different synaptic and membrane potential properties in vitro, little is known about the differences between them in ongoing spiking dynamics in vivo. We identified IT-type and ET-type neurons, as well as fast-spiking-type interneurons, using novel multineuronal analysis based on optogenetically evoked spike collision along their axons in behaving/resting rats expressing channelrhodopsin-2 (<span style="font-style:italic;">Multi-Linc</span> method). We found "postspike suppression" (~100 ms) as a characteristic of ET-type neurons in spike auto-correlograms, and it remained constant independent of behavioral conditions in functionally different ET-type neurons. Postspike suppression followed even solitary spikes, and spike bursts significantly extended its duration. We also observed relatively strong spike synchrony in pairs containing IT-type neurons. Thus, spiking dynamics in IT-type and ET-type neurons may be optimized differently for precise and coordinated motor control.</span>

http://ift.tt/2kaZpeq

Mirroring in the Human Brain: Deciphering the Spatial-Temporal Patterns of the Human Mirror Neuron System

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Embodied theories of cognition emphasize the central role of sensorimotor transformations in the representation of others' actions. Support for these theories is derived from the discovery of the mirror neuron system (MNS) in primates, from noninvasive techniques in humans, and from a limited number of intracranial studies. To understand the neural dynamics of the human MNS, more studies with precise spatial and temporal resolutions are essential. We used electrocorticography to define activation patterns in sensorimotor, parietal and/or frontal neuronal populations, during a viewing and grasping task. Our results show robust high gamma activation for both conditions in classic MNS sites. Furthermore, we provide novel evidence for 2 different populations of neurons: sites that were only active for viewing and grasping ("pure mirroring") and sites that were also active between viewing and grasping, and perhaps serve a more general attentional role. Lastly, a subgroup of parietal electrodes showed earlier peaks than all other regions. These results highlight the complexity of spatial-temporal patterns within the MNS and provide a critical link between single-unit research in monkeys and noninvasive techniques in human.</span>

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Integrins are required for tissue organization and restriction of neurogenesis in regenerating planarians [RESEARCH ARTICLE]

Florian Seebeck, Martin März, Anna-Wiebke Meyer, Hanna Reuter, Matthias C. Vogg, Martin Stehling, Karina Mildner, Dagmar Zeuschner, Franziska Rabert, and Kerstin Bartscherer

Tissue regeneration depends on proliferative cells and on cues that regulate cell division, differentiation, patterning and the restriction of these processes once regeneration is complete. In planarians, flatworms with high regenerative potential, muscle cells express some of these instructive cues. Here we show that members of the Integrin family of adhesion molecules are required for the integrity of regenerating tissues, including the musculature. Remarkably, in regenerating β1-integrin RNAi planarians, we detected increased numbers of mitotic cells and progenitor cell types, as well as a reduced ability of stem cells and lineage restricted progenitor cells to accumulate at wound sites. These animals also formed ectopic spheroid structures of neural identity in regenerating heads. Interestingly, those polarized assemblies comprised a variety of neural cells and underwent continuous growth. Our study indicates that Integrin-mediated cell adhesion is required for the regenerative formation of organized tissues and for restricting neurogenesis during planarian regeneration.

http://ift.tt/2kaWlz6

Health Services Research in Improving the Delivery of Care for Patients with Cardiovascular Diseases: Moving From Observation to Innovation to Action.

Author: Maddox, Thomas M. MD, MSc; Ho, P. Michael MD, PhD

Page: 403-405

http://ift.tt/2jxplit

Next-Generation Sequencing in Cardiovascular Disease: Present Clinical Applications and the Horizon of Precision Medicine.

Author: Parikh, Victoria N. MD; Ashley, Euan A. FRCP, DPhil

Page: 406-409

http://ift.tt/2kllcCZ

Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation: Analysis of a Large, Prospective, Multicenter, International Registry.

Author: Lazam, Siham MS; Vanoverschelde, Jean-Louis MD, PhD; Tribouilloy, Christophe MD, PhD; Grigioni, Francesco MD, PhD; Suri, Rakesh M. MD, PhD; Avierinos, Jean-Francois MD; Meester, Christophe de PhD; Barbieri, Andrea MD; Rusinaru, Dan MD, PhD; Russo, Antonio MD; Pasquet, Agnes MD, PhD; Michelena, Hector I. MD; Huebner, Marianne PhD; Maalouf, Joseph MD; Clavel, Marie-Annick DVM, PhD; Szymanski, Catherine MD, PhD; Enriquez-Sarano, Maurice MD; On behalf of the MIDA (Mitral Regurgitation International Database) Investigators

Page: 410-422

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Valve Repair: A Durable Surgical Option in Degenerative Mitral Regurgitation.

Author: Prendergast, Bernard D. DM; De Bonis, Michele MD

Page: 423-425

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Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults: The Atherosclerosis Risk in Communities Study.

Author: Shah, Amil M. MD, MPH; Claggett, Brian PhD; Kitzman, Dalane MD; Biering-Sorensen, Tor MD, PhD; Jensen, Jan Skov MD, PhD, DMSc; Cheng, Susan MD; Matsushita, Kunihiro MD, PhD; Konety, Suma MD; Folsom, Aaron R. MD, MPH; Mosley, Thomas H. PhD; Wright, Jacqueline D. DrPH; Heiss, Gerardo MD, PhD; Solomon, Scott D. MD

Page: 426-439

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Impact of Computed Tomography Perfusion Imaging on the Response to Tenecteplase in Ischemic Stroke: Analysis of 2 Randomized Controlled Trials.

Author: Bivard, Andrew PhD; Huang, Xuya; McElduff, Patrick PhD; Levi, Christopher R.; Campbell, Bruce C.V.; Cheripelli, Bharath Kumar; Kalladka, Dheeraj; Moreton, Fiona Catherine; Ford, Ian PhD; Bladin, Christopher F.; Davis, Stephen M.; Donnan, Geoffrey A.; Muir, Keith W. MD; Parsons, Mark W.

Page: 440-448

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Discovery and Validation of Agonistic Angiotensin Receptor Autoantibodies as Biomarkers of Adverse Outcomes.

Author: Abadir, Peter M. MD; Jain, Alka PhD; Powell, Laura J. BS; Xue, Qian-Li PhD; Tian, Jing MS; Hamilton, Robert G. PhD, DABMLI; Bennett, David A. MD; Finucane, Thomas MD; Walston, Jeremy D. MD; Fedarko, Neal S. PhD

Page: 449-459

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Plasma Metabolomics Implicates Modified Transfer RNAs and Altered Bioenergetics in the Outcomes of Pulmonary Arterial Hypertension.

Author: Rhodes, Christopher J. PhD; Ghataorhe, Pavandeep BM, BCh; Wharton, John PhD; Rue-Albrecht, Kevin C. PhD; Hadinnapola, Charaka BM, BCh; Watson, Geoffrey BM, BCh; Bleda, Marta PhD; Haimel, Matthias BSc; Coghlan, Gerry MD; Corris, Paul A. MD; Howard, Luke S. DPhil; Kiely, David G. MD; Peacock, Andrew J. MD; Pepke-Zaba, Joanna PhD; Toshner, Mark R. MD; Wort, S. John PhD; Gibbs, J. Simon R. MD; Lawrie, Allan PhD; Graf, Stefan PhD; Morrell, Nicholas W. MD; Wilkins, Martin R. MD

Page: 460-475

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The Role of Efferocytosis in Atherosclerosis.

Author: Kojima, Yoko MD, PhD; Weissman, Irving L. MD; Leeper, Nicholas J. MD

Page: 476-489

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Abnormal ECG, Seizures, and Associated Neurological Deficits.

Author: Reiffel, James A. MD

Page: 490-491

http://ift.tt/2kliuNM

Linear rheology of carbon black filled polystyrene

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Yihu Song, Yeqiang Tan, Qiang Zheng
Filling can cause polymer melt to undergo a so-called fluid-to-solid transition usually assigned to filler networking effect and heterogeneously retarded polymer dynamics while theories developed nowadays could not account for the several important aspects involving in the reinforcement and dissipation of the composites including the influence of molecular weight of the matrix. Herein linear dynamic rheological behaviors of carbon black filled polystyrene (PS) was investigated, disclosing significantly influences of weight-averaged molecular weight (Mw) of PS on the reinforcement and dissipation in and beyond the hydrodynamics regime. Attempts to create rheological master curves in hydrodynamics regime, taking account for both dynamics retardation in bulk polymer phase and strain amplification effect induced by filler, disclose time-concentration superpositions. The viscoelastic contributions from the dynamically retarded polymer phase and the viscoelastic "filler phase" are thus evaluated.

Graphical abstract

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Complex interplay of short- and long-chain branching on thermal and rheological properties of ethylene/α-olefin copolymers made by metallocene catalysts with oscillating ligand structure

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Mostafa Ahmadi, Faezeh Rezaei, Seyed Mohammad Mahdi Mortazavi, Mehdi Entezam, Florian J. Stadler
Unbridged oscillatory metallocenes are prone to produce heterogeneous chain microstructure, for instance, giving rise to elastomeric polypropylene. Here, we use the bis(2-phenylindenyl)ZrCl2/MAO catalyst system, featuring oscillating ligands, to copolymerize ethylene with several α-olefins. Through investigation of chain microstructure, thermal and rheological properties, we show that the complex behavior of these materials can be justified by considering a catalyst with dual active center having different comonomer affinities. This behavior is consistent with the proposed mechanism of fast oscillating ligands, becoming locked upon proximity of cocatalyst counteranion, leading to diverse stereo- and comonomer selectivity. The unlocked, oscillating active center with lower comonomer response gives rise to mostly linear chains and is not affected by the presence of comonomer, while the locked one creates long chain branched chains, whose frequency decreases by introduction of comonomer. Copolymer samples exhibited bimodal MWD, dual crystallization mechanisms, and low frequency plateau modulus, specifically at higher comonomer levels. It was concluded that the overall behavior is determined by complex interplay of SCB and LCB, which leads to thermorheological complexity as well as phase separation.

Graphical abstract

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Wilhelmy balance characterization beyond contact angles: Differentiating leaching from nanosurface reorganization and optimizing surface modification

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Chenyu Wang, Sithara Nair, Kenneth J. Wynne
Over and above measurements of contact angles, this article provides examples from our work that emphasize unexpected wetting behavior using the Wilhelmy Plate (WP) method. These findings either would not have been noticed by conventional sessile drop methods or might have been dismissed due to deviations associated with measurements or sample-to-sample variations in surface composition. The examples chosen for this article include: (1) Wilhelmy plate force distance curves providing a sensitive measure for the detection of leaching or diffusion of species from polydimethylsiloxane elastomeric coatings, (2) A Dynamic Contact Angle (DCA) investigation of a polyurethane to establish whether changes in CAs vs immersion time were due to leaching of substances that changed the surface tension of water or to nanosurface reorganization of polymer chains, (3) Changing network formation conditions that give low or high receding contact angles (θR) and "sticky or slippery" wetting of water drops on a widely used Sylgard 184 silicone coating as well as the impact of θR on ice adhesion and (4) Polymer surface modification for introducing special functionality via a modifier is shown to depend on a balance of miscibility and immiscibility that resulted in an unexpected "more is less" dependence on concentration for a fluorous modifier and a condensation cured silicone.

Graphical abstract

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Branching analysis of star-shaped polybutadienes by temperature gradient interaction chromatography-triple detection

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Hyojoon Lee, Jinseok Yang, Taihyun Chang
Size exclusion chromatography (SEC) coupled with triple detection (TD) method is widely used for branching analysis of polymers. However, there is an inherent limitation of SEC-TD method that SEC separates polymers according their hydrodynamic size. The SEC resolution of branched polymers is not high since the hydrodynamic size of branched polymers does not change as much as linear polymers with molecular weight (MW), let alone the serious band-broadening in SEC. As a solution of the problem, we propose temperature gradient interaction chromatography (TGIC)-TD method taking advantage of TGIC's characteristics of separating branched polymers according to their MW with much higher resolution than SEC. The potential of the method was demonstrated using regular star-shaped polybutadienes prepared by anionic polymerization. They are characterized by both SEC-TD and TGIC-TD methods. Detailed analysis of branch distribution is possible for narrow MW fractions in TGIC-TD while SEC-TD only provides with average branch number for SEC fractions.

Graphical abstract

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One-step enzymatic synthesis of poly(p-dioxanone-co-butylene-co-succinate) copolyesters with well-defined structure and enhanced degradability

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Wu-Cheng Nie, Hai-Chun Dang, Xiu-Li Wang, Fei Song, Yu-Zhong Wang
In this work, we present a mild one-step enzymatic-catalyzed copolymerization of diethyl succinate, 1,4-butanediol and p-dioxanone (PDO) to synthesize poly(p-dioxanone-co-butylene-co-succinate) copolyesters. Their chemical structure, triad distributions, and molecular weight of the copolyesters are characterized by ¹H NMR, ¹³C NMR and GPC. All copolyesters have narrow molecular weight polydispersity (1.3–1.5) and higher molecular weight (Mw) values (23700–33200 g mol⁻¹), which are well controlled by varying the amount of PDO units from 9 to 30 mol%. NMR, DSC, and XRD results show that copolyesters are semicrystalline random copolyesters and thermal properties depended on their composition. Furthermore, the degradation rate of the poly(p-dioxanone-co-butylene-co-succinate) are enhanced compared to PBS.

Graphical abstract

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Adhesion of blended polymer films

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Christopher Staszel, Suman Sinha-Ray, Alexander L. Yarin, Behnam Pourdeyhimi
In this work, the adhesion energies of two dissimilar polymer films after thermal bonding are studied. The films were formed from the emulsions of polycaprolactone (PCL) and nylon-6 (N6) spin-coated onto metal substrates. After that, the solidified blend polymer films on the metal substrates were faced with additional PCL films on metal substrates and thermally bonded to them. The surface structure of blend films was elucidated prior to thermal bonding by staining them using Rhodamine B. The dye stained only N6 leaving PCL undyed and the exposed structure was analyzed using digital photography, which revealed the surface concentration of PCL, as well as the N6 and PCL distributions over the surfaces. It was discovered that PCL-N6 domains would remain partially mixed, influencing the adhesion energy measured.

Graphical abstract

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Strain sensing behaviors of epoxy nanocomposites with carbon nanotubes under cyclic deformation

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Xiaohan Cao, Xiangdong Wei, Guojie Li, Chao Hu, Kun Dai, Jiang Guo, Guoqiang Zheng, Chuntai Liu, Changyu Shen, Zhanhu Guo
The strain sensing behavior of multi-walled carbon nanotubes (MWCNT)/epoxy (EP) conductive composites subjected to tensile strain was studied in detail. With increasing the load to rupture, the responsivity (ΔR/R0, R0 is the original resistance, ΔR is instantaneous change in resistance) increased in a linear fashion and then began to decrease at a critical strain (εc), which was remarkably different from the thermoplastic conductive composites only with a monotonic increase of the responsivity. It was attributed to the decrease of the nanotube contact points, the increase in the gaps before εc, and the reorientation and violent alignment of nanotubes in the zones of high local deformation (after εc). In addition, when the extension-retraction cycles were applied, the values of max ΔR/R0 showed a distinct tendency with different strains around the εc. These behaviors were attributed to the competition of network destruction and reconstruction during the cyclic deformation. The mechanism of this unique sensing behavior was proposed as well.

Graphical abstract

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Crystal structures and phase transition behavior of Poly(nonamethylene terephthalamide) and its model compounds

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Hiroko Yamamoto, Kohji Tashiro, Kiyotaka Ishino, Masahide Takahashi, Ryokei Endo, Mitsunori Asada, Yaqi Li, Katsuyoshi Katsube, Takahiro Ishii
The crystal structure and phase transition behavior of poly(nonamethylene terephthalamide) (PA9T, -[CO-C6H4-CONH-(CH2)9-NH]n-) and its related model compounds (ATm,C6H5-CONH-(CH2)m-NHCO-C6H5 (m = 7–12)) have been investigated by carrying out the temperature dependent measurements of wide-angle X-ray diffraction (WAXD), small-angle X-ray scattering (SAXS) and infrared spectra along with the DSC measurement. The crystal structure of PA9T at room temperature was determined by analyzing the X-ray diffraction diagram measured for the uniaxially-oriented sample. The nonamethylene segmental part takes the zigzag conformation, which was supported by the quantitative analysis of the methylene progression bands observed in the infrared spectra. The temperature dependence of WAXD, SAXS and infrared spectra of PA9T revealed the existence of the 2-staged order-to-disorder phase transitions: at room temperature this polymer exists as phase I, the crystal structure of which was analyzed as mentioned above. In the relatively low and wide temperature region (190–270 °C for the unoriented sample), phase I transforms to phase II, in which the methylene conformation is disordered, the aromatic amide part is slightly rotated and the intermolecular hydrogen bonds become weaker but the hydrogen bonds are still kept alive. In the temperature region immediately below the melting point (270–310 °C for the unoriented sample), the phase II is melted once and recrystallizes into phase III, where the intermolecular hydrogen bonds are mostly broken in addition to the further disordering of the methylene segments and aromatic amide groups. The thus-occurring violent thermal motions cause a remarkable increase of the long period in this transition region. The molecular chains are still highly oriented and so the phase III may be assumed to be in a kind of liquid crystalline state. The crystal structural changes detected in these phase transitions of PA9T were confirmed by the analysis of the X-ray diffraction and IR spectral data collected for the low molecular-weight model compounds.

Graphical abstract

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Diverse morphological formations and lamellar dimensions of poly(ε-caprolactone) crystals in the monolayers grafted onto solid substrates

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Takayuki Ikehara, Toshiyuki Kataoka
Poly(ε-caprolactone) (PCL) chains grafted onto Si substrates, namely PCL brushes, exhibited diverse structures such as dendrites, branched linear crystals, and curved crystals with dendrites when they were isothermally crystallized from melts. The crystallization was possible over a wide range of temperature. The discussion on the lamellar thickness of the dendrites indicated that the equilibrium melting point, Tm^°, in a grafted layer was higher than the values reported for bulk-crystallized PCL and that the surface free energy of the fold surfaces of lamellae was within the range reported so for. The value of Tm^° implied that the conformational entropy is reduced in the grafted layers than in bulk. The grafted layers were prepared using a novel "grafting-to" method, where the middle parts of the polymer molecules, instead of the chain ends, are reacted to silanized Si substrates.

Graphical abstract

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Preparation of amorphous nanocomposites with quick heat triggered shape memory behavior

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Masoud Babaahmadi, Mohammad Sabzi, Gholam Reza Mahdavinia, Mohsen Keramati
The aim of this work was to prepare shape memory materials from poly(vinyl acetate) (PVAc), a low-cost commercial polymer, through the simple solution mixing method without need for complex synthetic routes. However, neat PVAc with inherent low strength and modulus exhibited inappropriate shape memory behavior. Therefore, stiff graphene nanoplatelets were incorporated within the PVAc matrix to improve its thermomechanical properties. Transmission electron microscopy (TEM) observations showed that graphene nanoplatelets built up a dense 3D network throughout PVAc. Furthermore, tensile and dynamic mechanical analysis (DMA) results demonstrated that the strength and modulus of PVAc were noticeably enhanced by introducing graphene nanoplatelets. DMA revealed that the PVAc/graphene nanocomposites possess excellent shape memory properties, as the fixation ratio (Rf) and recovery ratio (Rr) could be as high as 99.8 and 98.2%, respectively, and the original shape recovery time was ∼5 s. The remarkable improvement in the shape memory properties of nanocomposites was correlated to great stored elastic strain energy in nanocomposites providing a high driving force for subsequent quick and almost complete shape recovery. In addition, enhanced heat transfer rate in the presence of graphene network can also account for high speed thermal actuation of the developed nanocomposites.

Graphical abstract

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Ixekizumab: A Review in Moderate to Severe Plaque Psoriasis

Abstract

Ixekizumab (Taltz^®) is a subcutaneously administered, humanized anti-interleukin-17A monoclonal antibody indicated for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy (USA and EU) or phototherapy (USA). In the phase 3 UNCOVER trials in this patient population, ixekizumab was superior to placebo or etanercept in terms of the proportion of patients achieving a ≥75% reduction from baseline in the Psoriasis Area and Severity Index and in those achieving a static Physician Global Assessment score of 0 or 1, after 12 weeks of induction treatment. Clinical responses to ixekizumab were seen as early as week 1. Patients receiving ixekizumab also reported improvements in health-related quality of life, itching, and work productivity. Clinical responses to ixekizumab were sustained during additional 48 weeks of maintenance treatment. Ixekizumab was generally well tolerated and exhibited low immunogenicity in the UNCOVER trials during up to 60 weeks of therapy. Currently available data indicate that ixekizumab is an effective and generally well tolerated treatment option for patients with moderate to severe plaque psoriasis. It has the potential advantage of one maintenance dose for every 4 weeks.

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Breathing parameters associated to two different external nasal dilator strips in endurance athletes

The aim of the study was to investigate and compare the effects of two different external nasal dilator strips (ENDS) on nasal respiratory flow, maximal oxygen uptake (VO2max), nasal VO2max, time to exhaustion and subjective nasal obstruction in adult triathletes participating in exhaustive, controlled physical exercise tests.

http://ift.tt/2jPuweP

Development skills of children born premature with low and very low birth weight

RESUMO Objetivo Comparar o desempenho de crianças nascidas prematuras de baixo peso (BP) e muito baixo peso (MBP) com crianças nascidas a termo na faixa etária de um a três anos, quanto ao desenvolvimento infantil, nos domínios motor grosso; motor fino adaptativo; pessoal-social; e linguagem. Método Estudo de coorte transversal. A amostra foi constituída por 150 crianças nascidas prematuras (grupo experimental) e a termo (grupo comparativo), divididas em oito grupos, quanto ao peso (baixo peso: abaixo de 2500 gramas e muito baixo peso: abaixo de 1500 gramas) e faixa etária (de 12 a 24 e de 25 a 36 meses). Os grupos comparativos foram pareados aos experimentais quanto ao gênero, idade cronológica e nível socioeconômico. A avaliação constou da aplicação do protocolo de anamnese, classificação socioeconômica e do Teste de Screening de Desenvolvimento Denver-II (TSDD-II). Foi realizado o cálculo da idade corrigida para as crianças prematuras de idade até 24 meses. Utilizou-se análise estatística descritiva e o Teste "t" Student. Resultados Na comparação entre os grupos de prematuros e nascidos a termo, houve diferença estatisticamente significante para todos os domínios avaliados. Conclusão O desempenho de crianças nascidas prematuras foi inferior quando comparado ao desempenho de crianças nascidas a termo, nos domínios motor grosso, motor fino adaptativo, pessoal-social e linguagem. Neste estudo, os grupos de prematuros obtiveram desempenho distintos, ou seja, no mesmo grupo existiram desempenhos normativo, na média e abaixo.

ABSTRACT Purpose To compare the performance of children born premature with low birth weight (LBW) and very low birth-weight (VLBW) with that of children born at term, within the age range of one to three years, regarding child development in the gross motor, fine motor-adaptive, personal-social and language domains. Methods This is a cross-sectional study in a cohort of 150 infants born premature (experimental group) and at term (control group) divided into eight groups with respect to weight (low birth weight: <2500 grams and very low birth weight: <1500 grams) and age range (aged 12 to 24 and 25 to 36 months). The control groups were paired with the experimental groups as for gender, chronological age, and socioeconomic level. Assessment comprised the application of anamnesis protocol, socioeconomic classification, and Denver Developmental Screening Test (DDST-II). Corrected age was calculated for premature children up to 24 months of age. Descriptive statistical analysis and the Student's t-test were used. Results No statistically significant difference was found in the comparison between the groups of infants born premature and at term for all domains evaluated. Conclusion The performance of infants born premature was lower than that of infants born at term regarding the gross motor, fine motor-adaptive, personal-social and language domains. In this study, the preterm groups presented different performances, i.e., normative, average, and below average performances were observed within the same group.

http://ift.tt/2kaI7OS

Breathing parameters associated to two different external nasal dilator strips in endurance athletes

Evaluation of bone resorption in fibula and deep circumflex iliac artery flaps following dental implantation: A three-year follow-up study

Long-term results of dental implant treatment in fibula free and deep circumflex iliac artery (DCIA) free flaps are scarce. The purpose of this study was to assess and compare peri-implant bone resorption of vascularized bone flaps treated with dental implants. A total of 28 patients, 14 fibula and 14 DCIA flaps, respectively, underwent reconstruction of the lower and upper jaw by the use of vascularized bone flaps and were treated with dental implants. Peri-implant bone resorption was measured using digital panographs up to 3 years.

http://ift.tt/2klrthA

Endovascular management of iatrogenic cervical internal carotid artery pseudoaneurysm in a 9-year-old child: Case report and literature review.

Extracranial internal carotid artery (ICA) pseudoaneurysms are uncommon in the pediatric population and are usually secondary to direct trauma to the vessel. Treatment options include surgery (ligation), anticoagulation therapy and endovascular treatment. Endovascular covered stents have shown good results in adult populations, resulting in occlusion of the aneurysm and preservation of the artery without significant complications. However, there have been only limited reports in the literature reporting endovascular carotid stent placement in the pediatric population.

http://ift.tt/2kaAbwO

A national survey of knowledge, attitude and practices among pediatricians towards newborn hearing screening in India

Pediatricians have a key role in ensuring that infant has undergone hearing screening and required follow-up. Attempts in various countries and centers have been made at exploring their knowledge, attitude and practices towards universal newborn hearing screening. In India, such a program is at its preliminary stage, and hence a need was felt to study this aspect in pediatricians working in India.

http://ift.tt/2josu9r

The development of dendritic cell vaccine-based immunotherapies for glioblastoma

Abstract

In this review, we focus on the biologic advantages of dendritic cell-based vaccinations as a therapeutic strategy for cancer as well as preclinical and emerging clinical data associated with such approaches for glioblastoma patients.

http://ift.tt/2kNtJuU

Trauma associated sleep disorder: a parasomnia induced by trauma

Nightmares and disruptive nocturnal behaviors that develop after traumatic experiences have long been recognized as having different clinical characteristics that overlap with other established parasomnia diagnoses. The inciting experience is typically in the setting of extreme traumatic stress coupled with periods of sleep disruption and/or deprivation. The limited number of laboratory documented cases and symptomatic overlap with REM sleep behavior disorder (RBD) and posttraumatic stress disorder (PTSD) have contributed to difficulties in identifying what is a unique parasomnia.

http://ift.tt/2kNRXVW

Low Yield of Chest Radiography in General Inpatients and Outpatients with “Positive PPD” Results in a Country with Low Prevalence of TB

Publication date: Available online 30 January 2017
Source:Academic Radiology
Author(s): Ronald L. Eisenberg, Benedikt H. Heidinger
Rationale and ObjectivesThe purpose of this study was to assess the frequency and spectrum of abnormalities on routine screening chest radiographs among inpatients and outpatients with "positive purified protein derivative (PPD)" in a large tertiary care academic medical center in a country with low prevalence of tuberculosis (TB).Materials and MethodsThe reports of all chest radiographs of general inpatients and outpatients referred for positive PPD (2010–2014) were evaluated for the frequency of evidence of active or latent TB and the spectrum of imaging findings. The results of additional chest radiographs and computed tomography scans were recorded, as were additional relevant clinical histories and symptoms.ResultsOf the 2518 patients who underwent chest radiography for positive PPD, the radiographs were normal in 91.3%. The vast majority of the abnormal radiographs demonstrated findings consistent with old tuberculous disease. There were three cases (0.1%) of active TB, all of which were either recent immigrants from an endemic area or had other relevant histories or clinical symptoms suggestive of the disease.ConclusionsUniversal chest radiography in general inpatient and outpatient populations referred for positive PPD is of low yield for detecting active disease in a country with low prevalence of TB.

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Intraductal Papillary Mucinous Neoplasms of the Pancreas

Publication date: Available online 30 January 2017
Source:Academic Radiology
Author(s): Wanbo Xu, Xiaojin Liu, Jiawen Zhang, Li Yang
Rationale and ObjectivesIntraductal papillary mucinous neoplasms (IPMNs) are precancerous lesions of the pancreas. Computed tomography (CT) has been recommended to screen the malignant potential of IPMNs. However, data evaluating the use of CT to differentiate categories of IPMN based on disease progression are limited. This study aimed to explore the correlation between CT characteristics and pathology in IPMN associated with invasive carcinoma.Materials and MethodsA total of 31 patients with intraductal papillary mucinous carcinoma (IPMC) treated at one local regional hospital in Shanghai, China, were enrolled in this study. Patients were divided into two groups based on invasion component and characterized as follows: group A, an invasive component of less than 50% (IPMC-I); and group B, with invasion of 50% or greater and defined as pancreatic ductal adenocarcinoma associated with IPMN (PDAC-IPMN). First, we analyzed the imaging information of the 31 patients retrospectively. Then, we compared the imaging differences between the two groups.ResultsFifteen patients with IPMC-1 and 16 patients with PDAC-IPMN were identified. There was no statistically significant difference in sex, age, lesion location, radiologic type, tumor size, mural nodule size, and lymphatic metastasis between the two groups. However, the arterial increased CT values were significantly different between the two groups (P < .01), with values of 29.2 ± 12.4 HU for group A and 14.2 ± 8.8 HU for group B. The venous increased CT values were 44.6 ± 12.0 HU for group A and 28.4 ± 12.3 HU for group B, and these were significantly different between the two groups (P < .01). In group A, 13 cases (86.7%) were classified as T1 or T2 stage, and in group B, eight cases (50.0%) were classified as T1 and T2 stage. There was a statistically significant difference in tumor classification between group A and group B patients (P < .05).ConclusionsIPMC-I and PDAC-IPMN have different characteristics in CT imaging, and we demonstrated that CT scans based on blood supply and lymphatic metastasis could be used to evaluate and potentially screen for variation in IPMC disease outcomes.

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Professional Social Networking in Radiology: Who Is There and What Are They Doing?

Publication date: Available online 30 January 2017
Source:Academic Radiology
Author(s): Sumir S. Patel, C. Matthew Hawkins, James V. Rawson, Jenny K. Hoang
Rationale and ObjectivesAlthough it is perceived that the use of social media professionally is increasing among radiologists, little is known about the habits and demographics of this subspecialty. This study aims to compare radiologists who use social networking for professional purposes to those who do not with regard to their characteristics, habits, and attitudes.Materials and MethodsRadiologists were invited by e-mail and through posts on social networks to participate in a survey on the use of social media platforms. Questions included type of user, pattern of use, and benefits and barriers. Professional users and professional nonusers were compared.ResultsOne hundred eighty-six radiologists responded. One hundred ten (59.1%) used social networking for professional purposes, 34 (18.2%) for personal-use only, and 42 (22.6%) denied using social media. LinkedIn was the most common platform among all professional users, and Twitter was the most commonly used platform among highly active professional users. Trainees comprised 52 out of 110 (47.3%) professional social networking users compared to 18 out of 76 (23.7%) nonusers (P < 0.01). A subgroup analysis on Twitter use for professional purposes revealed a significant gender difference: 15 out of 66 (22.7%) professional Twitter users were female compared to 48 out of 120 (40.0%) non-Twitter users (P < 0.05). The greatest barrier to professional social media use for nonusers was confidentiality.ConclusionNearly 60% of radiologist respondents use social networking for professional purposes. Radiology is likely to see growth in the role of social networking in the coming years as nearly half of professional users are radiology trainees. Twitter use for professional purposes among radiologists was disproportionately male. It is important to be cognizant of gender imbalance and to improve visibility of female leaders on social networking.

http://ift.tt/2kNYvni

Development and Assessment of a Novel Task Trainer and Targeting Tasks for Ultrasound-guided Invasive Procedures

Publication date: Available online 30 January 2017
Source:Academic Radiology
Author(s): Joshua F. Nitsche, Kristina M. Shumard, Brian C. Brost
Rationale and ObjectivesThe American Institute of Ultrasound in Medicine (AIUM) recommends that all providers performing ultrasound-guided invasive procedures be competent in a core set of guidance skills common to all ultrasound-guided procedures, including in-plane and out-of-plane needle guidance and needle imaging optimization techniques such as probe translation, rotation, and heel-toe standoff. To allow for the practice and assessment of these core skills, we have created a novel task trainer and set of targeting tasks, and sought to obtain validity evidence in the content and response process domains for this training and assessment system according to the Standards for Educational and Psychological Testing.Materials and MethodsWe have constructed an ultrasound-guided invasive procedure training system and five targeting tasks that focused on the needle guidance skills outlined by the AIUM. All tasks were performed by obstetrics and gynecology or maternal-fetal medicine physicians with and without experience in ultrasound-guided invasive procedures during a series of simulation workshops. All participants completed a survey regarding the trainer's and the tasks' usefulness in the training of inexperienced physicians.ResultsThe physicians who completed the tasks had favorable views of task trainer and curriculum. The targeting curriculum was felt to allow practice of all of the core guidance skills outlined by the AIUM. The average response provided for all of the tasks was 4.0 or greater, with half of the items having an average response of 4.5 or higher.ConclusionsWe have constructed a task trainer that incorporates all of the core skills outlined by the AIUM. All five tasks received very favorable reviews from both experienced and inexperienced providers. Taken together, our findings suggest they have strong content and response process validity evidence.

http://ift.tt/2kM5KQI

Rapid vivid-coloured dreaming induced by cerebral radiotherapy

A 59 year-old male presented with ptosis and a pink subconjunctival mass. CT scan showed a corresponding diffuse thickening. Biopsy revealed a B-cell lymphoid tumour. Staging investigations were otherwise negative.

http://ift.tt/2jozanG

Measuring Quality of Life in Pediatric Paradoxical Vocal Fold Motion Using the SF-36v2

Paradoxical vocal fold motion (PVFM) consists of intermittent adduction of the vocal folds during inspiration, resulting in stridor and worsened by anxiety and stress. The purpose of this study was to assess the impact of PVFM on quality of life in our pediatric patient population.

http://ift.tt/2jPkytE

Evidence for a role of eosinophils in blister formation in bullous pemphigoid

Abstract

Background

Bullous pemphigoid (BP) is an autoimmune bullous disease of the skin characterized by subepidermal blister formation due to tissue-bound and circulating autoantibodies to the hemidesmosomal antigens BP180 and BP230. Although eosinophils and their toxic mediators are found abundantly in BP lesions, their role in blister formation has remained unclear.

Objective

To investigate the role of eosinophils in the pathogenesis of BP with a specific focus on blister formation and to define conditions inducing dermal-epidermal separation (DES).

Methods

In an ex vivo human model of BP, normal human skin cryosections were incubated with purified human peripheral blood eosinophils with or without activation in the presence or absence of BP autoantibodies, brefeldin A, diphenyleneiodonium (DPI), DNase, or blocking F(ab')₂ fragments to CD16, CD18, CD32 and CD64. DES was assessed by light microscopy studies and quantified using Fiji software.

Results

Following activation with IL-5 and in the presence of BP autoantibodies, eosinophils induced separation along the dermal-epidermal junction of ex vivo skin. DES was significantly reduced by blocking any of the following: Fcγ receptor binding (p=0.048), eosinophil adhesion (p=0.046), reactive oxygen species (ROS) production (p=0.002), degranulation (p<0.0001), or eosinophil extracellular trap (EET) formation (p=0.048).

Conclusions

Our results provide evidence that IL-5-activated eosinophils directly contribute to BP blister formation in the presence of BP autoantibodies. DES by IL-5-activated eosinophils depends on adhesion and Fcγ receptor activation, requires elevated ROS production and degranulation, and involves EET formation. Thus, targeting eosinophils may be a promising therapeutic approach for BP.

http://ift.tt/2kkUrym

Evidence for a role of eosinophils in blister formation in bullous pemphigoid

Abstract

Background

Objective

To investigate the role of eosinophils in the pathogenesis of BP with a specific focus on blister formation and to define conditions inducing dermal-epidermal separation (DES).

Methods

Results

Conclusions

http://ift.tt/2kkUrym

Regulation of antimicrobial resistance by extracytoplasmic function (ECF) sigma factors

Publication date: Available online 30 January 2017
Source:Microbes and Infection
Author(s): Emily C. Woods, Shonna M. McBride
Extracytoplasmic function (ECF) sigma factors are a subfamily of σ⁷⁰ sigma factors that activate genes involved in stress-response functions. In many bacteria, ECF sigma factors regulate resistance to antimicrobial compounds. This review will summarize the ECF sigma factors that regulate antimicrobial resistance in model organisms and clinically relevant pathogens.

http://ift.tt/2kLW3BR

Adult Atopic Dermatitis with Comorbid Atopic Disease is Associated with Increased Risk of Infections: A Population-Based Cross-Sectional Study

Abstract

Introduction

Atopic dermatitis (AD) is related to other atopic diseases asthma and allergic rhinitis. It is known that those with asthma or allergic rhinitis have impaired immune responses that may predispose them to infections. This study sought to determine whether adult AD is associated with systemic infections, and whether association is strengthened in those with AD plus another atopic disease.

Methods

This cross-sectional study obtained information from adults in the 2010 and the 2012 National Health Interview Survey (NHIS). The primary exposure was history of AD without or with an additional atopic disease, asthma or allergic rhinitis. Self-reported systemic infections were the primary outcomes. Survey logistic regression was performed and adjusted odds ratios (aOR) reported.

Results

AD in NHIS 2010 was associated with increased risk of sinusitis [aOR (95% CIs): 1.65 (1.42, 1.91), P < 0.001], head or chest cold [1.31 (1.12, 1.52), P < 0.001], and gastrointestinal illness [2.39 (1.97, 2.89), P < 0.001], and in NHIS 2012, pneumonia/influenza [1.73 (1.54, 1.95), P < 0.001], strep throat/tonsillitis [1.72 (1.54, 1.92), P < 0.001], sinusitis [1.77 (1.54, 2.02), P < 0.001], head or chest cold [1.49 (1.33, 1.67), P < 0.001], and infectious disease [2.66 (2.20, 3.21), P < 0.001]. An increase in atopic disease mirrored an increase in number of infectious outcomes and was statistically significant in the combined dataset (P < 0.001).

Conclusion

The associations between AD and AD plus another atopic disease with systemic infections suggest that an underlying immune defect may be contributing to microbial susceptibility. Further studies are warranted to understand the burden of infectious disease in this population.

http://ift.tt/2kkmu0j

Low-dose carperitide (α-human A-type natriuretic peptide) alleviates hemoglobin concentration decrease during prolonged oral surgery: a randomized controlled study

Abstract

Purpose

Surgical injury stimulates the renin–angiotensin–aldosterone system (RAAS) and causes antidiuresis, leading to postoperative oliguria. Carperitide (α-human A-type natriuretic peptide) is a cardiac peptide hormone secreted from the atrium. This peptide hormone enhances diuresis by suppressing the RAAS. In our experience, carperitide alleviates decreased hemoglobin (Hb) concentration during elective surgery. In the current study, we investigated the relationship between low-dose carperitide (0.01 µg/kg/min) and Hb concentration during oral surgery.

Methods

Patients (ASA-PS: I–II, 40–80 years old) undergoing oral maxillofacial surgery (duration of operation >8 h) were enrolled in this study. Patients were divided into two groups: the carperitide group received carperitide at 0.01 µg/kg/min and the control group received normal saline. Body fluid water [including total body water (TBW), extracellular water (ECW), and intracellular water (ICW)], urine volume, and chemical parameters such as Hb concentration, PaO₂, and serum electrolytes were evaluated every 2 h.

Results

In the carperitide group (n = 15), Hb decreased from 12.6 ± 1.1 to 10.8 ± 1.5 g/dl, while it decreased from 12.6 ± 1.4 to 9.5 ± 1.3 g/dl in the control group (n = 15) (p < 0.05). Urine volume (2557.3 ± 983.5 mL) in the carperitide group was significantly more than it was in the control group (1108.8 ± 586.4 mL; p < 0.001). There were no significant differences in clinical characteristics, body fluid water, PaO₂, and serum electrolytes between the two groups. In addition, there were no perioperative clinical respiratory and hemodynamic complications in the groups.

Conclusion

The Hb concentration in the group administered low-dose carperitide at 0.01 µg/kg/min remained higher than that in the control group during surgery. Administration of low-dose carperitide may therefore reduce the risk of blood transfusion during surgery.

http://ift.tt/2jMMrVY

A big thank you to our reviewers in the past year!

Exp Clin Endocrinol Diabetes 2017; 125: 1-3
DOI: 10.1055/s-0042-123975

Article in Thieme eJournals:
Table of contents | Full text

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Stereotactic body radiotherapy (SBRT) in recurrent or oligometastatic pancreatic cancer

Abstract

Background

Stereotactic body radiotherapy (SBRT) in pancreatic cancer can be limited by its proximity to organs at risk (OAR). In this analysis, we evaluated the toxicity and efficacy of two different treatment approaches in patients with locally recurrent or oligometastatic pancreatic cancer.

Materials and methods

According to the prescription method, patients were divided in two cohorts (C1 and C2). The planning target volume (PTV) was created through a 4 mm expansion of the internal target volume. In C2, a subvolume was additionally created, a simultaneous integrated protection (SIP), which is the overlap of the PTV with the planning risk volume of an OAR to which we prescribed a reduced dose.

Results

In all, 18 patients were treated (7 with local recurrences, 9 for oligometastases, 2 for both). Twelve of 23 lesions were treated without SIP (C1) and 11 with SIP (C2). The median follow-up was 12.8 months. Median overall survival (OS) was 13.2 (95% confidence interval [CI] 9.8–14.6) months. The OS rates at 6 and 12 months were 87 and 58%, respectively. Freedom from local progression for combined cohorts at 6 and 12 months was 93 and 67% (95% CI 15–36), respectively. Local control was not statistically different between the two groups. One patient in C2 experienced grade ≥3 acute toxicities and 1 patient in C1 experienced a grade ≥3 late toxicity.

Conclusion

The SIP approach is a useful prescription method for abdominal SBRT with a favorable toxicity profile which does not compromise local control and overall survival despite dose sacrifices in small subvolumes.

http://ift.tt/2jOr83B

Ultrastructural changes in peripheral arteries and nerves in diabetic ischemic lower limbs, by electron microscope

Publication date: Available online 30 January 2017
Source:Alexandria Journal of Medicine
Author(s): Mohamed E. Salem, Abdel-Azzem A. Ismael, Amr Salem, Tarek Salem
BackgroundThe results of "light and electron microscopic study" of the peripheral arteries and nerves biopsies in diabetic neuropathy comparing with biopsies of normal arteries and nerves of traumatic amputation as a control group.Aim of the workTo evaluate the "electron microscopic changes" in the peripheral small arteries and nerves in the diabetic ischemic lower limbs.Patients and methodsFrom January 2015 to June 2016 a total number of 20 patients with diabetic ischemic lower limbs (Diabetic patients group) compared with 20 non diabetic non ischemic persons as (Control group) who undergone traumatic lower limb amputation. All cases were subjected to complete history taking, complete clinical examination, and routine laboratory investigations. "Light and electron microscopic studies" of biopsies from the peripheral small arteries and nerves e.g. digital or posterior tibial arteries and nerves during amputation of diabetic gangrene of the toes, below knee, above knee amputation and from traumatic amputation of the control group.ResultsThe results of an "electron microscopic study" of diabetic peripheral arteries and nerves biopsies, 12 out of 20 cases showed thrombi in small vessels. In some small vessels, masses of fibrin were seen within the lumen. In other vessels, older thrombi were present. 17 out of 20 cases showed endothelial cells hyperplasia in some vessels. The degree of hyperplasia was sufficient to occlude the lumen of the vessels. Some vessels showed degenerate pericytes and endothelial cells which contained large lipid droplets. The peripheral nerves showed patchy demyelination, areas of degeneration and regeneration, areas of infarction and necrosis and collagen fibers deposition. Among the control group, no cases contained thrombi, degenerated vessels, degenerate pericytes or lipid droplets within the endothelial cells.ConclusionThe present study found that the diabetic microangiopathy is the main cause of diabetic neuropathy and diabetic foot lesions.

http://ift.tt/2kNqp30

Pyomyositis Is Not Only a Tropical Pathology: A Case Series

Primary pyomyositis has been thought to be endemic to tropical countries, and in fact often called "tropical pyomyositis", but this case series demonstrates that's not always the case.
Journal of Medical Case Reports

http://ift.tt/2kzkePW

Can You Have Your Cake and Eat It Too? The Sunlight D-lema

Can the negative health consequences of sun exposure be balanced with the benefits of sunlight as an important source of vitamin D and other beneficial photochemical processes?
The British Journal of Dermatology

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Reply to comments about ‘LMA-ProSeal™ insertion by novice doctors as affected by a 90 degree bend created by an intubating stylet: A randomized clinical trial’

To the Editor,

http://ift.tt/2kNBlxu

Low-skill flexible bronchoscopic intubation – Overcoming common pitfalls

To the Editor,

http://ift.tt/2kLHEpa

Clinical experiences of the continuous quadratus lumborum block via paramedian sagittal oblique approach

To the Editor:

http://ift.tt/2kNtLCV

Continuous serratus plane block in a patient with multiple rib fractures

A 63-year-old man with a medical history of obesity (BMI 32), complicated by chronic obstructive pulmonary disease, diabetes, and hypertension was admitted to the emergency department (ED) following a car accident. While in the ED, the patient was fully collaborative (GSC 15), hemodynamically stable, and visibly suffering from chest pain. Self-reported pain intensity originating mainly from the right side of the thorax was 9–10, as measured on the numeric rating scale (NRS).

http://ift.tt/2kLMgMd

A simple method to control the distal tip of nasotracheal tube using the surgical suture - A reply

We thank Yang et al. for their letter in response to our article "A novel method to control the distal tip of nasotracheal tube" [1]. Nasotracheal intubation is an established airway management technique in patients undergoing oral and maxilla-facial surgery. The most frequent complication of nasotracheal intubation is nasal mucosal trauma and the incidence of mild to severe epistaxis is reportedly to be about 35.3% when using a conventional tracheal tube (Rusch endotracheal tube) [2]. Yang et al.

http://ift.tt/2kNwRa0

Adapting the Toyota production model to teach systems-based practice to anesthesiology fellows

What does the Accreditation Council for Graduate Medical Education (ACGME) core competency in systems-based practice (SBP) mean for anesthesiologists? The broad ACGME definition of SBP is "an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value." They further refined the definition into 6 resident expectations known as milestones [1], and subsequent education expert consensus has provided additional operational definitions [2,3].

http://ift.tt/2kIeyUH

Esophageal Doppler monitoring with the Ambu® AuraGain™ laryngeal mask airway

To the Editor,

http://ift.tt/2jMFiVw

Effectiveness of antiangiogenic drugs in glioblastoma patients: a systematic review and meta-analysis of randomized clinical trials

Publication date: Available online 30 January 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Giuseppe Lombardi, Ardi Pambuku, Luisa Bellu, Miriam Farina, Della Puppa Alessandro, Denaro Luca, Vittorina Zagonel
Backgroundglioblastomas are highly vascularized tumors and various antiangiogenic drugs have been investigated in clinical trials showing unclear results. We performed a systematic review and a meta-analysis to clarify and evaluate their effectiveness in glioblastoma patients.Patients and methodswe searched relevant published and unpublished randomized clinical trials analyzing antiangiogenic drugs versus chemotherapy in glioblastoma patients from January 2006 to January 2016 in MEDLINE, WEB of SCIENCE, ASCO, ESMO and SNO databases.Resultsfourteen randomized clinical trials were identified (7 with bevacizumab, 2 cilengitide, 1 enzastaurin, 1 dasatinib, 1 vandetanib, 1 temsirolimus, 1 cediranib) were identified including 4330 patients. Antiangiogenic drugs showed no improvement in overall survival with a pooled HR of 1.00, a trend for an inferior outcome, in terms of overall survival, was observed in the group of patients receiving antiangiogenic drug alone compared to cytotoxic drug alone (HR=1.24, p=0.056). Bevacizumab did not improve overall survival. Twelve trials (4113 patients) were analyzed for progression-free survival. Among antiangiogenic drugs, only bevacizumab demonstrated an improvement of progression-free survival (HR=0.63, p<0.001), both alone (HR=0.60, p=0.003) or in combination to chemotherapy (HR=0.63; p<0.001), both as first-line treatment (HR=0.70, p<0.001) or in recurrent disease (HR=0.52, p<0.001).Conclusionsantiangiogenic drugs did not improve overall survival in glioblastoma patients, either as first or second-line treatment, and either as single agent or in combination with chemotherapy. Among antiangiogenic drugs, only bevacizumab improved progression-free survival regardless of treatment line, both as single agent or in combination with chemotherapy

http://ift.tt/2k9DUec

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Δευτέρα 30 Ιανουαρίου 2017

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