Endocannabinoid-Dependent Long-Term Potentiation of Synaptic Transmission at Rat Barrel Cortex

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Brain-derived neurotrophic factor (BDNF) plays a critical role in modulating plasticity in sensory cortices. Indeed, a BDNF-dependent long-term potentiation (LTP) at distal basal excitatory synapses of Layer 5 pyramidal neurons (L5PNs) has been demonstrated in disinhibited rat barrel cortex slices. Although it is well established that this LTP requires the pairing of excitatory postsynaptic potentials (PSPs) with Ca²⁺ spikes, its induction when synaptic inhibition is working remains unexplored. Here we show that low-frequency stimulation at basal dendrites of L5PNs is able to trigger a PSP followed by an action potential (AP) and a slow depolarization (termed PSP-Ca²⁺ response) in thalamocortical slices without blocking synaptic inhibition. We demonstrate that AP barrage-mediated release of endocannabinoids (eCBs) from the recorded L5PNs induces PSP-Ca²⁺ response facilitation and BDNF-dependent LTP. Indeed, this LTP requires the type 1 cannabinoid receptors activation, is prevented by postsynaptic intracellular 1,2-bis(2-aminophenoxy) ethane-<span style="font-style:italic;">N</span>,<span style="font-style:italic;">N</span>,<span style="font-style:italic;">N</span>,<span style="font-style:italic;">N</span>′-tetraacetic acid (BAPTA) or the anandamide membrane transporter inhibitor AM404, and only occurs in L5PNs neurons showing depolarization-induced suppression of inhibition. Additionally, electrical stimulation at the posteromedial thalamic nucleus induced similar response and LTP. These results reveal a novel form of eCB-dependent LTP at L5PNs that could be relevant in the processing of sensory information in the barrel cortex.</span>

http://ift.tt/2mrvu5Q

Characterization of White Matter Tracts by Diffusion MR Tractography in Cat and Ferret that Have Similar Gyral Patterns

<span class="paragraphSection"><div class="boxTitle">Abstract</div>The developmental relationships between gyral structures and white matter tracts have long been debated, but it is still difficult to discern whether they influence each other's development or are causally related. To explore this topic, this study used cats and ferrets as models for species that share similar gyral folding patterns and imaged with diffusion magnetic resonance imaging to compare white matter innervations in homologous gyri and other brain regions. Adult cat and ferret brains were analyzed via diffusion spectrum imaging tractography and homologous regions of interest were compared. Although similar genetic lineage and gyral structures would suggest analogous white matter tracts, tractography reveals significantly differing white matter connectivity in both the visual and auditory cortices. Similarities in connectivity were concentrated primarily in the highly conserved cerebellar region. These results correlate well with existing histological and functional studies of both species. Our results indicate that, while the 2 species may share similar gyral structures, they utilize different white matter connectivity; suggesting that while species may share similar gyral structures, they can develop different underlying white matter connectivity.</span>

http://ift.tt/2lxnWup

Variations in Acetylcholinesterase Activity within Human Cortical Pyramidal Neurons Across Age and Cognitive Trajectories

<span class="paragraphSection"><div class="boxTitle">Abstract</div>We described an extensive network of cortical pyramidal neurons in the human brain with abundant acetylcholinesterase (AChE) activity. Emergence of these neurons during childhood/adolescence, attainment of highest density in early adulthood, and virtual absence in other species led us to hypothesize involvement of AChE within these neurons in higher cortical functions. The current study quantified the density and staining intensity of these neurons using histochemical procedures. Few faintly stained AChE-positive cortical pyramidal neurons were observed in children/adolescents. These neurons attained their highest density and staining intensity in young adulthood. Compared with the young adult group, brains of cognitively normal elderly displayed no significant change in numerical density but a significant decrease in staining intensity of AChE-positive cortical pyramidal neurons. Brains of elderly above age 80 with unusually preserved memory performance (SuperAgers) showed significantly lower staining intensity and density of these neurons when compared with same-age peers. Conceivably, low levels of AChE activity could enhance the impact of acetylcholine on pyramidal neurons to counterbalance other involutional factors that mediate the decline of memory capacity during average aging. We cannot yet tell if elderly with superior memory capacity have constitutively low neuronal AChE levels or if this feature reflects adaptive neuroplasticity.</span>

http://ift.tt/2mryoHF

Mirroring the Social Aspects of Speech and Actions: The Role of the Insula

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Action and speech may take different forms, being expressed, for example, gently or rudely. These aspects of social communication, named vitality forms, have been little studied in neuroscience. In the present functional magnetic resonance imaging study, we investigated the role of insula in processing action and speech vitality forms. In speech runs, participants were asked to listen or imaging themselves to pronounce action verbs gently or rudely. In action runs, they were asked to observe or imaging themselves to perform actions gently or rudely. The results showed that, relative to controls, there was an activation of the dorso-central insula in both tasks of speech and action runs. The insula sector specific for action vitality form was located slightly more dorsally than that of speech with a large overlap of their activations. The psycho-physiological interaction analysis showed that the insular sector involved in action vitality forms processing is connected with the left hemisphere areas controlling arm actions, whereas the sector involved in speech vitality forms processing is linked with right hemisphere areas related to speech prosody. We conclude that the central part of the insula is a key region for vitality forms processing regardless of the modality by which they are conveyed or expressed.</span>

http://ift.tt/2lxjfk2

A Critical Role of Inhibition in Temporal Processing Maturation in the Primary Auditory Cortex

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Faithful representation of sound envelopes in primary auditory cortex (A1) is vital for temporal processing and perception of natural sounds. However, the emergence of cortical temporal processing mechanisms during development remains poorly understood. Although cortical inhibition has been proposed to play an important role in this process, direct in-vivo evidence has been lacking. Using loose-patch recordings in rat A1 immediately after hearing onset, we found that stimulus-following ability in fast-spiking neurons was significantly better than in regular-spiking (RS) neurons. In-vivo whole-cell recordings of RS neurons revealed that inhibition in the developing A1 demonstrated much weaker adaptation to repetitive stimuli than in adult A1. Furthermore, inhibitory synaptic inputs were of longer duration than observed in vitro and in adults. Early in development, overlap of the prolonged inhibition evoked by 2 closely following stimuli disrupted the classical temporal sequence between excitation and inhibition, resulting in slower following capacity. During maturation, inhibitory duration gradually shortened accompanied by an improving temporal following ability of RS neurons. Both inhibitory duration and stimulus-following ability demonstrated exposure-based plasticity. These results demonstrate the role of inhibition in setting the pace for experience-dependent maturation of temporal processing in the auditory cortex.</span>

http://ift.tt/2mrJa0P

Relapsing bullous amyloidosis of the oral mucosa and acquired cutis laxa in a patient with multiple myeloma: a rare triple association

Summary

It is well known that primary systemic amyloidosis [light chain (AL) amyloidosis] is associated with hidden dyscrasia or multiple myeloma. Acquired cutis laxa (cutis laxa acquisita; CLA) has also been described in patients with plasma cell dyscrasias, including multiple myeloma. We report a case in which haemorrhagic oral bullae were the first sign of an undiagnosed primary systemic amyloidosis related to multiple myeloma IgG-λ and previously diagnosed CLA. There is only one report in literature of this rare triple association; however, in that case the patient did not have oral mucosal involvement or bullous amyloidosis.

http://ift.tt/2lVaC3E

A novel mutation in the RSPO4 gene in a patient with autosomal recessive anonychia

Summary

The Wnt signalling pathway is a major pathway involved in the embryogenic development of the various organs of the body. Appropriate signalling in this pathway relies on the proper functioning of several proteins including the R-spondin family of proteins. Deactivating mutations in R-spondin 4 are associated with anonychia. We present the case of a 26-year-old man presenting with anonychia of the 20 nails, which had been present since birth. Using genetic studies, we identified a novel nonsense mutation, c.164-165TC>AA, characterized by two consecutive mismatch bases. To our knowledge, this mutation is the first to be reported in R-spondin 4 in a Lebanese population. Evaluating new patients with anonychia provides fruitful clinical and molecular findings.

http://ift.tt/2lStbav

Otophyma in Morbihan disease

http://ift.tt/2lV2noz

Lentigo maligna successfully treated with combination therapy of topical tazarotene and imiquimod

http://ift.tt/2lolx48

Effectiveness of omalizumab in a case of urticarial vasculitis

Summary

Urticarial vasculitis (UV) is a mainly leucocytoclastic vasculitis with urticarial plaques. Treating these patients is challenging as the available treatments have poor efficacy. Oral corticosteroids are considered the first-line treatment, but H1 antihistamines, dapsone, colchicine, antimalarials, ciclosporin and antileucotrienes have all been tried also. However, because of their adverse effects and/or lack of efficacy, new agents are still needed. Omalizumab, an anti-IgE antibody, shows efficacy in chronic spontaneous urticaria, and might also be a good treatment for angio-oedema and urticarial vasculitis. To our knowledge, there have been only seven relevant case reports published in the English literature. We add a new case of severe chronic recurrent urticarial vasculitis refractory to all of the drugs mentioned above. We started the patient on subcutaneous omalizumab 300 mg every 4 weeks, which produced clinical improvement within the first month and total remission in the fifth month. The patient has remained stable for 23 months, and follow-up is ongoing.

http://ift.tt/2lSgqwJ

Relapsing bullous amyloidosis of the oral mucosa and acquired cutis laxa in a patient with multiple myeloma: a rare triple association

Summary

It is well known that primary systemic amyloidosis [light chain (AL) amyloidosis] is associated with hidden dyscrasia or multiple myeloma. Acquired cutis laxa (cutis laxa acquisita; CLA) has also been described in patients with plasma cell dyscrasias, including multiple myeloma. We report a case in which haemorrhagic oral bullae were the first sign of an undiagnosed primary systemic amyloidosis related to multiple myeloma IgG-λ and previously diagnosed CLA. There is only one report in literature of this rare triple association; however, in that case the patient did not have oral mucosal involvement or bullous amyloidosis.

http://ift.tt/2lVaC3E

A novel mutation in the RSPO4 gene in a patient with autosomal recessive anonychia

Summary

The Wnt signalling pathway is a major pathway involved in the embryogenic development of the various organs of the body. Appropriate signalling in this pathway relies on the proper functioning of several proteins including the R-spondin family of proteins. Deactivating mutations in R-spondin 4 are associated with anonychia. We present the case of a 26-year-old man presenting with anonychia of the 20 nails, which had been present since birth. Using genetic studies, we identified a novel nonsense mutation, c.164-165TC>AA, characterized by two consecutive mismatch bases. To our knowledge, this mutation is the first to be reported in R-spondin 4 in a Lebanese population. Evaluating new patients with anonychia provides fruitful clinical and molecular findings.

http://ift.tt/2lStbav

Otophyma in Morbihan disease

http://ift.tt/2lV2noz

Lentigo maligna successfully treated with combination therapy of topical tazarotene and imiquimod

http://ift.tt/2lolx48

Effectiveness of omalizumab in a case of urticarial vasculitis

Summary

Urticarial vasculitis (UV) is a mainly leucocytoclastic vasculitis with urticarial plaques. Treating these patients is challenging as the available treatments have poor efficacy. Oral corticosteroids are considered the first-line treatment, but H1 antihistamines, dapsone, colchicine, antimalarials, ciclosporin and antileucotrienes have all been tried also. However, because of their adverse effects and/or lack of efficacy, new agents are still needed. Omalizumab, an anti-IgE antibody, shows efficacy in chronic spontaneous urticaria, and might also be a good treatment for angio-oedema and urticarial vasculitis. To our knowledge, there have been only seven relevant case reports published in the English literature. We add a new case of severe chronic recurrent urticarial vasculitis refractory to all of the drugs mentioned above. We started the patient on subcutaneous omalizumab 300 mg every 4 weeks, which produced clinical improvement within the first month and total remission in the fifth month. The patient has remained stable for 23 months, and follow-up is ongoing.

http://ift.tt/2lSgqwJ

Management of pinna of haematoma study (MaPHaeS): a multicentre retrospective observational study

Abstract

Objectives

To assess current variation in the management of pinna haematoma (PH) and its effect on outcomes.

Design

Multicentre retrospective observational record-based study.

Setting

Eleven hospitals around the UK.

Participants

Eighty-three patients above the age of 16 with PH.

Outcome Measures

The primary outcome measure was recurrence rate of PH over a six-month period post treatment, assessed by treatment type (scalpel incision vs. needle aspiration). Secondary outcome measures assessed the impact of other factors on recurrence, infection and cosmetic complications of PH over a period of six months.

Results

After adjusting for confounding factors, involvement of the whole ear, and management within an operating theatre were associated with a lower rate of recurrence of pinna haematoma. The drainage technique, suspected aetiology, choice of post-drainage management, grade and specialty of practitioner performing drainage, the use of intra-auricular antibiotic injection and hospital admission did not affect the rate of haematoma recurrence, infection or cosmetic complications.

Conclusions

Where possible PH should be drained in an operating theatre. Multi-centre randomized-controlled trials are required to further investigate the impact of drainage technique and post drainage management on outcome.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mrTvKf

Management of pinna of haematoma study (MaPHaeS): a multicentre retrospective observational study

Abstract

Objectives

To assess current variation in the management of pinna haematoma (PH) and its effect on outcomes.

Design

Multicentre retrospective observational record-based study.

Setting

Eleven hospitals around the UK.

Participants

Eighty-three patients above the age of 16 with PH.

Outcome Measures

The primary outcome measure was recurrence rate of PH over a six-month period post treatment, assessed by treatment type (scalpel incision vs. needle aspiration). Secondary outcome measures assessed the impact of other factors on recurrence, infection and cosmetic complications of PH over a period of six months.

Results

After adjusting for confounding factors, involvement of the whole ear, and management within an operating theatre were associated with a lower rate of recurrence of pinna haematoma. The drainage technique, suspected aetiology, choice of post-drainage management, grade and specialty of practitioner performing drainage, the use of intra-auricular antibiotic injection and hospital admission did not affect the rate of haematoma recurrence, infection or cosmetic complications.

Conclusions

Where possible PH should be drained in an operating theatre. Multi-centre randomized-controlled trials are required to further investigate the impact of drainage technique and post drainage management on outcome.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mrTvKf

Poor Safety and Tolerability Hamper Reaching a Potentially Therapeutic Dose in the Use of Thalidomide for Alzheimer’s Disease: Results from a Double-Blind, Placebo-Controlled Trial

Introduction: To date there is no cure for Alzheimer's disease (AD). After amyloid beta immunotherapies have failed to meet primary endpoints of slowing cognitive decline in AD subjects, the inhibition of the beta-secretase BACE1 appears as a promising therapeutic approach. Pre-clinical data obtained in APP23 mice suggested that the anti-cancer drug thalidomide decreases brainBACE1 and Aβ levels. This prompted us to develop an NIH-supported Phase IIa clinical trial to test the potential of thalidomide for AD. We hypothesized that thalidomide can decrease or stabilize brain amyloid deposits, which would result in slower cognitive decline in drug- versus placebo-treated subjects. <p></p> Methods: This was a 24-week, randomized, double-blind, placebo-controlled, parallel group study with escalating dose regimen of thalidomide with a target dose of 400mg daily in patients with mild to moderate AD. The primary outcome measures were tolerability and cognitive performance assessed by a battery of tests. <p></p> Results: A total of 185 subjects have been pre-screened, out of which25 were randomized. Mean age of the sample at baseline was 73.64 (±7.20) years; mean education was 14.24 (±2.3) years; mean MMSE score was 21.00 (±5.32); and mean GDS score was 2.76 (±2.28).Among the 25 participants, 14 (56%) terminated early due to adverse events, dramatically decreasing the power of the study. In addition, those who completed the study (44%) never reached the estimated therapeutic dose of 400 mg/day thalidomide because of reported adverse events. The cognitive data showed no difference between the treated and placebo groups at the end of the trial. <p></p> Conclusion: This study demonstrates AD patients have poor tolerability for thalidomide, and are unable to reach a therapeutic dose felt to be sufficient to have effects on BACE1. Because of poor tolerability, this study failed to demonstrate a beneficial effect on cognition. <p></p>

http://ift.tt/2mDio2a

Follicular lymphoma transforming into diffuse large B-cell lymphoma in spleen: Simultaneous appearance of both on 18F-FDG PET/CT and histology

Publication date: May–June 2017
Source:Clinical Imaging, Volume 43
Author(s): William Makis, Anthony Ciarallo, Tina Petrogiannis-Haliotis, Arthur Rosenberg, Stephan Probst
Low grade lymphoma may transform into a more aggressive lymphoma and this transformation is usually associated with a poor outcome. A 65year old man presented with two metabolically active splenic lesions on a staging [18F] fluoro-2-deoxy-d-glucose (¹⁸F–FDG) positron emission tomography/computed tomography (PET/CT). Histologic evaluation post splenectomy confirmed the presence of two clonally related lymphomas: a follicular lymphoma (FL) and a diffuse large B-cell lymphoma (DLBCL). Molecular genetic studies confirmed that the DLBCL lesions arose from a pre-existing FL. We present the ¹⁸F–FDG PET/CT imaging characteristics of both lymphoma types which were simultaneously present in the spleen.



http://ift.tt/2lo7T15

Direct resin composite restorations for fractured maxillary teeth and diastema closure: A 7 years retrospective evaluation of survival and influencing factors

Publication date: Available online 28 February 2017
Source:Dental Materials
Author(s): Edina Lempel, Bálint Viktor Lovász, Réka Meszarics, Sára Jeges, Ákos Tóth, József Szalma
ObjectivesThis retrospective study evaluated the survival rate of anterior direct resin based composite (RBC) build-ups in vital teeth made of microhybrid and nanofill RBC materials and the influence of bruxism, beverage consumption and smoking on the long-term performance of restorations.MethodsPatients receiving anterior restoration between 2006 and 2011, with the diagnosis of fracture or diastema, were selected. A total of 65 adult patients (mean age: 25.2) with 163 restorations (78 Filtek Supreme XT and 85 Enamel Plus HFO) were evaluated using the USPHS criteria. Data were analyzed with Fisher's Exact Test, Extended Cox-regression analysis and Kaplan–Meier method.ResultsMean observation period was 7.2 (±1.4) years and the mean annual failure rate for this period was 1.43%. The reasons of failures included restoration fracture and color mismatch. Nanofill restorations had significantly higher rate of color mismatch (p=0.002), microhybrids more frequently failed in fracture of restoration (p=0.034). The overall difference in potential hazard of using Enamel Plus HFO or Filtek Supreme XT was not significant (p=0.704). Chipping or fracture of the restoration was more frequent in the first year after placement (p=0.036), while beverage consumption was significantly correlated with discoloration of the restorations (p=0.005).SignificanceThe application of direct RBC restorations provides an excellent treatment option for fractured teeth and for closing diastemas. The overall survival rate was 88.34% up to 10 years. Microhybrid and nanofill RBC restorations showed similar survival rates, however nanofills discolored at a higher rate, meanwhile chipping of the restoration occurred frequently with microhybrids.



http://ift.tt/2lo4VcT

Cytotoxicity and genotoxicity of a low-shrinkage monomer and monoacylphosphine oxide photoinitiator: Comparative analyses of individual toxicity and combination effects in mixtures

Publication date: Available online 28 February 2017
Source:Dental Materials
Author(s): Dragica Manojlovic, Miroslav D. Dramićanin, Vesna Miletic, Dragana Mitić-Ćulafić, Bojana Jovanović, Biljana Nikolić
ObjectiveTo compare cytotoxicity and genotoxicity of novel urethane-based monomer FIT-852 and monoacylphosphine oxide photoinitiator (Lucirin TPO) with conventional Bisphenol A-glycidyl-methacrylate (BisGMA) and triethylene glycol dimethacrylate (TEGDMA) monomers and camphorquinone (CQ)/amine photoinitiator system, respectively. Moreover, we quantified and analyzed the combinatorial effects of individual substances in resin-based mixtures concerning the nature of the combinatorial effects.MethodsCytotoxic and genotoxic effects of BisGMA, FIT, TEGDMA, CQ, DMAEMA and TPO and their combined toxicity in four clinically relevant mixtures (FIT/TPO, FIT/CQ, BisGMA/TPO, BisGMA/CQ) were tested on human fetal lung fibroblasts MRC-5 using MTT and Comet assays. We assessed combination effects of monomers and photoinitiators on overall toxicity from the measured concentration-effect relationships. Combination index (CI) was calculated on the basis of the median-effect equation derived from the mass-action law principle.ResultsIndividual substances showed decreasing cytotoxic effects in the following order: BisGMA>TPO>FIT>CQ>DMAEMA>TEGDMA. Experimental mixtures showed decreasing cytotoxic effects in the order BisGMA/TPO>BisGMA/CQ>FIT/CQ>FIT/TPO. FIT-based mixtures exhibited antagonistic cytotoxic effects between components while BisGMA-based mixtures demonstrated synergistic effects at ED50. TPO amplified both antagonistic and synergistic cytotoxic effects in mixtures. Pure substances showed genotoxicity in the following order: TPO>BisGMA>FIT>CQ>TEGDMA. We did not detect the genotoxic potential of DMAEMA. The rank of genotoxic concentrations of the mixtures was: BisGMA/TPO>BisGMA/CQ>FIT/CQ>FIT/TPO.SignificanceLower cytotoxicity and genotoxicity of FIT than BisGMA suggests its greater biocompatibility. Conversely, photoinitiator TPO was significantly more cytotoxic and genotoxic than both CQ and DMAEMA. CI values showed that components of FIT-based mixtures exhibit an antagonistic cytotoxic effect, while compontents of BisGMA-based mixtures show synergism.



http://ift.tt/2mrujmU

Evaluation of dental adhesive systems incorporating an antibacterial monomer eugenyl methacrylate (EgMA) for endodontic restorations

Publication date: Available online 27 February 2017
Source:Dental Materials
Author(s): A. Almaroof, S.A. Niazi, L. Rojo, F. Mannocci, S. Deb
ObjectiveThe purpose of this study was to incorporate EgMA, an antibacterial monomer into two commercial dental adhesive systems for their application in endodontic restoration with the aim to disinfect the root canal space before curing and to inhibit bacterial growth on their surfaces after being cured.MethodsEgMA monomer was added at 20%wt. into the formulation of the single-component self-etch, Clearfil Universal Bond™ (CUB) and into the catalyst and the adhesive components of the total-etch Adper Scotchbond-multipurpose™ (SBMP) adhesive systems. The degree of conversion (DC) was calculated from FTIR spectra, glass transition temperature (Tg) determined by DSC, water sorption and solubility were measured gravimetrically, and surface free energy (SFE) via contact angle measurements. The bonding performance to coronal and middle root canal dentin was assessed through push-out bond strength after filling the canals with a composite core material and the surface integrity was observed using SEM and confocal laser scanning microscopy (CLSM). The standard agar diffusion test (ADT) was used to identify the sensitivity of three endodontically pathogenic bacteria, Enterococcus faecalis, Streptococcus mutans and Propionibacterium acnes to uncured EgMA modified adhesives. Multispecies biofilm model from these strains was grown on the disc surface of cured adhesives and investigated using quantitative microbial culture and CLSM with live/dead staining. MTT assay was also used to determine the cytotoxicity of these adhesives.ResultsThe incorporation of EgMA lowered polymerization exotherm and enhanced the hydrophobic character of these adhesives, without changing the DC and Tg in comparison to the controls (without EgMA). The total push-out bond strengths of the EgMA-containing adhesives were not significantly different from those of the controls (p>0.05). The modification of self-etch adhesive system enhanced the bond strength in the middle region of the roots canal. SEM of debonded specimens and CLSM examination showed the integrity of the resin-dentin interfaces. For all three bacteria tested, the sizes of the inhibition zones produced by uncured EgMA modified adhesives were significantly greater (p<0.05) than those of the controls. The results of biofilm inhibition tests showed less CFU for total bacteria on bonding agents with EgMA compared to the control materials (p<0.05). The modification at 20% monomer concentration had no adverse effects on cytocompatibility of both adhesives tested.SignificanceThe inclusion of EgMA endows dental adhesives with effective antibacterial effects without influencing their curing properties, bonding ability to root canal dentin, and cytotoxicity against human gingival fibroblasts, indicating the usefulness of their application in endodontic restorations.



http://ift.tt/2lo5UJP

Effect of monomer type on the CC degree of conversion, water sorption and solubility, and color stability of model dental composites

Publication date: Available online 27 February 2017
Source:Dental Materials
Author(s): Andrea Soares Q.S. Fonseca, Allana Dutra Labruna Moreira, Pedro Paulo A.C. de Albuquerque, Lívia Rodrigues de Menezes, Carmem S. Pfeifer, Luis Felipe J. Schneider
ObjectiveThis study has investigated the influence of BisGMA, BisEMA, BisEMA 30, and two UDMA-based monomers (UDMA and Fit 852), with TEGDMA as co-monomer, on the degree of conversion, water sorption, water solubility, and optical properties of experimental dental composites.MethodsMaterials were formulated at 70/30 molar rations using BisGMA, BisEMA, BisEMA 30, UDMA or FIT 852, as base monomers, combined with TEGDMA. 60wt% of silanated-glass particles was added. Degree of conversion (DC) and polymerization kinetics were monitored using Fourier-transformed infrared spectroscopy in the near-IR range. Water sorption (Wsp) and solubility (Wsl) were assessed using mass variation after 60days water storage. Color was evaluated using a digital spectrophotometer, applying the CIELab parameters 24h after dry storage and 60days after water immersion to calculate ΔE values. All data were analyzed using ANOVA and Tukey's test (pre-set alpha=0.05).ResultsThe BisGMA-based co-monomer mixture presented the lowest DC (62±1%), whereas BisEMA 30 had the highest DC value (95±2%). The highest Wsp was observed for BisEMA 30 (12.2±0.8%), and the lowest for BisEMA (0.4±0.1%). BisEMA has shown the lowest Wsl (0.03±0.01%) and BisEMA 30 the highest one (0.97±0.1%). The ΔE values showed that BisEMA 30 (7.3 color units) and Fit 852 (3.8 color units) altered the color stability providing ΔE>3.3, which is considered clinically unacceptable.ConclusionsThe chemical composition and structure of the base monomer influenced the degree of conversion, water sorption, water solubility, and color stability. Considering the overall results, it is possible to state that the base monomer BisEMA mixed with the co-monomer TEGDMA presented the best performance in terms of all the parameters tested.SignificanceThe resin matrix composition might influence physical property degradation processes and color stability of dental resin composites. Formulations based on BisEMA seem most promising for materials' development.



http://ift.tt/2mry0sI

Laryngopharyngeal Reflux in Children with Chronic Otitis Media with Effusion

http://sfaki.blogspot.com/2017/02/laryngopharyngeal-reflux-in-children.html

Children aged 7-10 years of age with OME underwent 24-hour multichannel intraluminal impedance pH-metry. The upper pH sensor was situated 1 cm above the upper esophageal sphincter, and the lower pH sensor was placed 3-5 cm above the lower esophageal sphincter. Parents were asked to complete the gastroesophageal reflux assessment of symptoms in a pediatrics questionnaire.

Twenty-eight children were enrolled; LPR was detected in 19 (67.9%) children. The criteria of the LPR diagnosis was the presence of at least one supraesophageal episode with a pH < 5.0 and a change in the pH value measured from the initial level at the upper sensor of > 0.2. In total, 64 episodes were observed. Assessment of all LPR episodes showed the presence of 246 episodes in the entire study. A considerable predominance of weakly acidic episodes (87.8%) was noted; there were 6.5% acidic episodes, and weakly alkaline episodes reached 5.7%. Pathological GER was noted in 10 (35.7%) subjects. Acid GER was detected in 8 children, 2 of whom demonstrated non-acidic reflux. In the LPR-negative patients, no pathological GER was confirmed with the exception of a single case of non-acidic reflux.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Low-grade intraductal carcinoma (low-grade cribriform cystadenocarcinoma) with tumor-associated lymphoid proliferation of parotid gland

Publication date: Available online 28 February 2017
Source:Pathology - Research and Practice
Author(s): Toshimitsu Nishijima, Hidetaka Yamamoto, Takafumi Nakano, Yui Hatanaka, Ken-ichi Taguchi, Muneyuki Masuda, Yoshinao Oda
We report a rare case of low-grade intraductal carcinoma with tumor-associated lymphoid proliferation (TALP) in the parotid gland of a 75-year-old woman. Grossly, the tumor was solid and cystic. Histologically, the tumor consisted of a papillary-cystic, micropapillary, or focally cribriform proliferations of epithelial cells with low-grade cytological atypia. The interspaces between the epithelial components were filled with prominent lymphoid stroma and lymphoid follicles, superficially mimicking Warthin tumor. The neoplastic epithelial cells were positive for S100 protein by immunohistochemical staining. There was an attenuated layer of myoepithelial cells all around the epithelial components, indicating a non-invasive (in situ) nature. Although TALP is a rare finding in intraductal carcinoma, it should be considered as a histological variation of this kind of tumor. The relationship between intraductal carcinoma, low-grade cribriform cystadenocarcinoma, low-grade salivary duct carcinoma, and salivary duct carcinoma in situ is also discussed in this report.



http://ift.tt/2mJ6ByL

Genomic profiling of esophageal squamous cell carcinoma (ESCC) − basis for precision medicine

Publication date: Available online 28 February 2017
Source:Pathology - Research and Practice
Author(s): Jung Wook Yang, Yoon-La Choi
PurposePreparing for precision medicine, we surveyed genomic alterations in esophageal squamous cell carcinoma (ESCC) and identified candidate therapeutic targets by genomic profiling using next-generation sequencing (NGS).Materials and methodsSingle-nucleotide variations, indels, and copy number variations in 80 genes were evaluated by targeted deep sequencing in 24 surgically resected ESCC specimens. Immunohistochemistry analyses and silver in situ hybridization for ERBB2 (HER2) were conducted to verify the NGS results. Associations between clinicopathological factors and detected genomic alterations were estimated.ResultsThe mean coverage of sequencing of the tumor tissues from 24 patients was 464.8X with 85.1% over 100X. We detected a total of 115 genetic alterations and more than one genetic alteration was detected in most patients (23/24, 95.8%). Genes with genetic alterations detected in more than 20% of cases included TP53 (20/24, 83%), NOTCH1 (7/24, 29%), and MTOR (6/24, 25%). Amplification of 7 genes was detected in 8 cases. Genes showing amplification included AKT2 (1/24, 4.2%), EGFR (2/24, 8.3%), ERBB2 (HER2; 1/24, 4.2%), FGFR1 (1/24, 4.2%), KRAS (1/24, 4.2%), MDM2 (1/24, 4.2%), and PIK3CA (1/24, 4.2%). The ERBB2 alteration was confirmed by immunohistochemistry and silver in situ hybridization. Patients with NF1 and ARID1A mutations were younger than the patients without the mutations. (p=0.024 and 0.014, respectively). NOTCH1 mutation and EGFR genetic alteration were associated with a larger tumor size (p=0.019) and lesser invasion depth (p=0.005), respectively.ConclusionThis study revealed the genetic profiles of ESCC, which may provide a foundation for the development of novel targeted therapy and precision medicine.



http://ift.tt/2lUYQXk

Organic contaminants and heavy metals in indoor dust from e-waste recycling, rural, and urban areas in South China: Spatial characteristics and implications for human exposure

Publication date: June 2017
Source:Ecotoxicology and Environmental Safety, Volume 140
Author(s): Chun-Tao He, Xiao-Bo Zheng, Xiao Yan, Jing Zheng, Mei-Huan Wang, Xiao Tan, Lin Qiao, She-Jun Chen, Zhong-Yi Yang, Bi-Xian Mai
The concentrations of several organic contaminants (OCs) and heavy metals were measured in indoor dust from e-waste recycling, rural, and urban areas in South China to illustrate the spatial characteristics of these pollutants and to further evaluate human exposure risks. The median concentrations of polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), decabromodiphenyl ethane (DBDPE), and dechlorane plus (DPs) were 38.6–3560, 2360–30,100, 665–2720, and 19.5–1860ng/g, while the median concentrations of Cd, Pb, Cu, Cr, and Zn were 2.46–40.4, 206–1380, 217- 1200, 25.3–134, and 176–212μg/g in indoor dust. The levels of all pollutants, except Zn, in dust from the e-waste recycling area were significantly higher than those from the other areas. Cd, Pb, and most OCs exhibited similar pollution patterns in the three areas, indicating that e-waste recycling activities are the major pollution source. In contrast, Cu, Cr, Zn, and penta-BDE are likely derived from household products in the rural and urban areas. The highest estimated daily intakes (EDIs) of PCBs, PBDEs, DBDPE, and DPs were 0.15–163, 3.97–1470, 1.26–169, and 0.11–134ng/kg bw/day for toddlers and adults. The highest EDIs of BDE 209 and Pb in toddlers in the e-waste recycling area were 16% and 18 times higher than the reference doses, indicating the high exposure risk of these pollutants in the e-waste recycling area.

Graphical abstract

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Two 3D Zinc(II) coordination frameworks constructed from pyrazine-2,3-dicarboxylate and 1,2-bis(4-pyridyl)ethylene

Publication date: 5 June 2017
Source:Journal of Molecular Structure, Volume 1137
Author(s): Güneş Günay Sezer, Okan Zafer Yeşilel, Orhan Büyükgüngör
Two 3D coordination polymers, {[Zn(μ3-pzdc)(μ-dpeten)0.5]∙3H2O}n (1) and [Zn(μ3-pzdc)(μ-dpeten)0.5]n (2) (H2pzdc = pyrazine-2,3-dicarboxylic acid and dpeten = 1,2-bis(4-pyridyl)ethylene) have been synthesized by hydrothermal methods and structurally characterized by elemental analysis, IR spectroscopy, single-crystal and powder X-ray diffraction. In complex 1, each pzdc ligand bridges three Zn(II) ions through forming two-dimensional layers. The adjacent 2D layers are further connected by dpeten ligand to generate a novel 3D framework containing one-dimensional large porous channel. It displays a 5-connected bnn hexagonal topology with point symbol {4⁶.6⁴}. Although the complex 2 was obtained under the same reaction conditions together with complex 1, it exhibits 3D→3D a 2-fold interpenetration network with 6-connected pcu α-Po primitive cubic topology with point symbol {4¹².6³}. The adjacent three Zn(II) ions are linked by tridentate bridging pzdc ligands to form a 2D layer structure. The 2D layers are further bridged by dpeten ligand to form a 3D pillar-layered network. Moreover, thermal and photoluminescent properties of complexes 1 and 2 have also been studied.



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Rising incidence of oral tongue cancer among white men and women in the United States, 1973–2012

Cancers of the oral cavity and pharynx have traditionally been considered a single etiologic entity. However, recent studies show significant differences in the etiology and epidemiology for individual anatomic sites [1–3]. Reduction in smoking in the United States has resulted in significant declines in the incidence of most oral cavity cancers, including lip, gum, floor of mouth, hard palate, buccal mucosa, and vestibule cancers [4–8]. In contrast, the incidence of oral tongue cancers (anterior 2/3 of the tongue) has reportedly increased in recent years [7–12].

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Complications following transoral robotic surgery (TORS): A detailed institutional review of complications

Since FDA approval of transoral robotic surgery (TORS), the publication of TORS related complications has not equaled reports of oncological outcomes. It is important to know the incidence and severity of complications associated with TORS when counseling patients regarding modality of treatment especially when nonsurgical treatment options are available. The introduction of the da Vinci robot (Intuitive Surgical Inc, Sunnyvale, CA, USA) was initially developed in urology and cardiac surgical specialties.

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Clonal analysis as a prognostic factor in multiple oral squamous cell carcinoma

Despite improved functional outcomes due to advances in radiotherapy, chemotherapy, surgical and imaging techniques, the survival rate in Oral Squamous Cell Carcinoma (OSCC) has only marginally improved over the past two decades [1]. The incidence of second neoplastic manifestations after treatment for OSCC ranges from 10% to 34% and contributes to the majority of cancer-related deaths [2].

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JAAA CEU Program.

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JAAA CEU Program.

J Am Acad Audiol. 2017 Feb;28(2):170-171

Authors:

PMID: 28240984 [PubMed - in process]

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Validation of a Computer-Administered Version of the Digits-in-Noise Test for Hearing Screening in the United States.

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Validation of a Computer-Administered Version of the Digits-in-Noise Test for Hearing Screening in the United States.

J Am Acad Audiol. 2017 Feb;28(2):161-169

Authors: Folmer RL, Vachhani J, McMillan GP, Watson C, Kidd GR, Feeney MP

Abstract
BACKGROUND: The sooner people receive treatment for hearing loss (HL), the quicker they are able to recognize speech and to master hearing aid technology. Unfortunately, a majority of people with HL wait until their impairments have progressed from moderate to severe levels before seeking auditory rehabilitation. To increase the number of individuals with HL who pursue and receive auditory rehabilitation, it is necessary to improve methods for identifying and informing these people via widely accessible hearing screening procedures. Screening for HL is the first in a chain of events that must take place to increase the number of patients who enter the hearing health-care system. New methods for hearing screening should be readily accessible through a common medium (e.g., telephone or computer) and should be relatively easy and quick for people to self-administer.
PURPOSE: The purpose of this study was to assess a digits-in-noise (DIN) hearing screening test that was delivered via personal computer.
RESEARCH DESIGN: Participants completed the Hearing Handicap Inventory for Adults (HHIA) questionnaire, audiometric testing in a sound booth, and computerized DIN testing. During the DIN test, sequences of three spoken digits were presented in noise via headphones at varying signal-to-noise ratios (SNRs). Participants entered each three-digit sequence they heard using an on-screen keypad.
STUDY SAMPLE: Forty adults (16 females, 24 males) participated in the study, of whom 20 had normal hearing and 20 had HL (pure-tone average [PTA] thresholds for 0.5, 1, 2, and 4 kHz >25 dB HL).
DATA COLLECTION AND ANALYSIS: DIN SNR and PTA data were analyzed and compared for each ear tested. Receiver operating characteristic curves based on these data were plotted. A measure of overall accuracy of a screening test is the area under the receiver operating characteristic curve (AUC). This measures the average true positive rate across false positives at varying DIN SNR cutoffs. Larger values of the AUC indicate, on average, more accurate screening tests. HHIA responses were analyzed and compared to PTA and DIN SNR results using Pearson correlation statistics.
RESULTS: HHIA scores were positively correlated with audiometric PTA and DIN SNR results (p < 0.001 for all correlations). For an HL criterion of one or more frequencies from 0.25 to 8 kHz >25 dB HL, the AUC for the DIN test was 0.95. When a criterion of hearling level was set at one or more frequencies from 0.25 to 8 kHz >20 dB HL, the AUC for the DIN test was 0.96.
CONCLUSIONS: The computer version of the DIN test demonstrated excellent sensitivity and specificity for our sample of 40 participants. AUC results (≥0.95) suggest that this DIN test administered via computer should be very useful for adult hearing screening.

PMID: 28240983 [PubMed - in process]

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Inner Ear Excitation in Normal and Postmastoidectomy Participants by Fluid Stimulation in the Absence of Air- and Bone-Conduction Mechanisms.

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Inner Ear Excitation in Normal and Postmastoidectomy Participants by Fluid Stimulation in the Absence of Air- and Bone-Conduction Mechanisms.

J Am Acad Audiol. 2017 Feb;28(2):152-160

Authors: Ronen O, Geal-Dor M, Kaufmann-Yehezkely M, Perez R, Chordekar S, Adelman C, Sohmer H

Abstract
BACKGROUND: Hearing can be induced not only by airborne sounds (air conduction [AC]) and by the induction of skull vibrations by a bone vibrator (osseous bone conduction [BC]), but also by inducing vibrations of the soft tissues of the head, neck, and thorax. This hearing mode is called soft tissue conduction (STC) or nonosseous BC.
PURPOSE: This study was designed to gain insight into the mechanism of STC auditory stimulation.
RESEARCH DESIGN: Fluid was applied to the external auditory canal in normal participants and to the mastoidectomy common cavity in post-radical mastoidectomy patients. A rod coupled to a clinical bone vibrator, immersed in the fluid, delivered auditory frequency vibratory stimuli to the fluid. The stimulating rod was in contact with the fluid only. Thresholds were assessed in response to the fluid stimulation.
STUDY SAMPLE: Eight ears in eight normal participants and eight ears in seven post-radical mastoidectomy patients were studied.
DATA COLLECTION AND ANALYSIS: Thresholds to AC, BC, and fluid stimulation were assessed. The postmastoidectomy patients were older than the normal participants, with underlying sensorineural hearing loss (SNHL). Therefore, the thresholds to the fluid stimulation in each participant were corrected by subtracting his BC threshold, which expresses any underlying SNHL.
RESULTS: Hearing thresholds were obtained in each participant, in both groups in response to the fluid stimulation at 1.0 and 2.0 kHz. The fluid thresholds, corrected by subtracting the BC thresholds, did not differ between the groups at 1.0 kHz. However, at 2.0 kHz the corrected fluid thresholds in the mastoidectomy patients were 10 dB lower (better) than in the normal participants.
CONCLUSIONS: Since the corrected fluid thresholds at 1.0 kHz did not differ between the groups, the response to fluid stimulation in the normal participants at least at 1.0 kHz was probably not due to vibrations of the tympanic membrane and of the ossicular chain induced by the fluid stimulation, since these structures were absent in the mastoidectomy patients. In addition, the fluid in the external canal (normal participants) and the absence of the tympanic membrane and the ossicular chain (mastoidectomy patients) induced a conductive hearing loss (threshold elevation to air-conducted sounds coming from the bone vibrator), so that AC mechanisms were probably not involved in the thresholds to the fluid stimulation. In addition, as a result of the acoustic impedance mismatch between the fluid and skull bone, the audio-frequency vibrations induced in the fluid at threshold would probably not lead to vibrations of the bony wall of the meatus, so that hearing by osseous BC is not likely. Therefore, it seems that the thresholds to the fluid stimulation, in the absence of AC and of osseous BC, represent an example of STC, which is an additional mode of auditory stimulation in which the cochlea is activated by fluid pressures transmitted along a series of soft tissues, reaching and exciting the inner ear directly. STC can explain the mechanism of several auditory phenomena.

PMID: 28240982 [PubMed - in process]

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Potential Benefits of an Integrated Electric-Acoustic Sound Processor with Children: A Preliminary Report.

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Potential Benefits of an Integrated Electric-Acoustic Sound Processor with Children: A Preliminary Report.

J Am Acad Audiol. 2017 Feb;28(2):127-140

Authors: Wolfe J, Neumann S, Schafer E, Marsh M, Wood M, Baker RS

Abstract
BACKGROUND: A number of published studies have demonstrated the benefits of electric-acoustic stimulation (EAS) over conventional electric stimulation for adults with functional low-frequency acoustic hearing and severe-to-profound high-frequency hearing loss. These benefits potentially include better speech recognition in quiet and in noise, better localization, improvements in sound quality, better music appreciation and aptitude, and better pitch recognition. There is, however, a paucity of published reports describing the potential benefits and limitations of EAS for children with functional low-frequency acoustic hearing and severe-to-profound high-frequency hearing loss.
PURPOSE: The objective of this study was to explore the potential benefits of EAS for children.
RESEARCH DESIGN: A repeated measures design was used to evaluate performance differences obtained with EAS stimulation versus acoustic- and electric-only stimulation.
STUDY SAMPLE: Seven users of Cochlear Nucleus Hybrid, Nucleus 24 Freedom, CI512, and CI422 implants were included in the study.
DATA COLLECTION AND ANALYSIS: Sentence recognition (assayed using the pediatric version of the AzBio sentence recognition test) was evaluated in quiet and at three fixed signal-to-noise ratios (SNR) (0, +5, and +10 dB). Functional hearing performance was also evaluated with the use of questionnaires, including the comparative version of the Speech, Spatial, and Qualities, the Listening Inventory for Education Revised, and the Children's Home Inventory for Listening Difficulties.
RESULTS: Speech recognition in noise was typically better with EAS compared to participants' performance with acoustic- and electric-only stimulation, particularly when evaluated at the less favorable SNR. Additionally, in real-world situations, children generally preferred to use EAS compared to electric-only stimulation. Also, the participants' classroom teachers observed better hearing performance in the classroom with the use of EAS.
CONCLUSIONS: Use of EAS provided better speech recognition in quiet and in noise when compared to performance obtained with use of acoustic- and electric-only stimulation, and children responded favorably to the use of EAS implemented in an integrated sound processor for real-world use.

PMID: 28240980 [PubMed - in process]

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Does Language Matter When Using a Graphical Method for Calculating the Speech Intelligibility Index?

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Does Language Matter When Using a Graphical Method for Calculating the Speech Intelligibility Index?

J Am Acad Audiol. 2017 Feb;28(2):119-126

Authors: Jin IK, Kates JM, Arehart KH

Abstract
BACKGROUND: Graphical methods for calculating the speech intelligibility index (SII), such as the count-the-dot audiogram, are useful tools in quantifying how much weighted audibility is restored when amplification is used for individuals with hearing loss. The band-importance function (BIF), which is an important component of the SII, depends on the language. Thus, language may affect the prediction of weighted audibility using the graphical SII.
PURPOSE: The purpose of this study was to apply language-specific BIFs to develop and compare graphical SIIs for English, Korean, and Mandarin.
RESEARCH DESIGN: The graphical SIIs were developed and compared using a research design that applied and analyzed existing datasets.
DATA COLLECTION AND ANALYSIS: Language-specific BIFs and dynamic ranges were used to derive graphical SIIs for English, Korean, and Mandarin. SII predictions were compared by calculating the language-specific predictions for the same audiometric configurations.
RESULTS: The graphical SIIs for English, Korean, and Mandarin yielded different unaided and aided predictions for the same audiogram configurations.
CONCLUSIONS: A graphical SII helps patients easily understand their weighted audibility for unaided and aided conditions; thus, it is a useful counseling tool in the clinic. The most accurate graphical SII's will, however, be based on a patient's spoken language.

PMID: 28240979 [PubMed - in process]

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Evaluation of the Self-Fitting Process with a Commercially Available Hearing Aid.

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Evaluation of the Self-Fitting Process with a Commercially Available Hearing Aid.

J Am Acad Audiol. 2017 Feb;28(2):109-118

Authors: Convery E, Keidser G, Seeto M, McLelland M

Abstract
BACKGROUND: Hearing aids and personal sound amplification products that are designed to be self-fitted by the user at home are becoming increasingly available in the online marketplace. While these devices are often marketed as a low-cost alternative to traditional hearing health-care, little is known about people's ability to successfully use and manage them. Previous research into the individual components of a simulated self-fitting procedure has been undertaken, but no study has evaluated performance of the procedure as a whole using a commercial product.
PURPOSE: To evaluate the ability of a group of adults with a hearing loss to set up a pair of commercially available self-fitting hearing aids for their own use and to investigate factors associated with a successful outcome.
RESEARCH DESIGN: An interventional study that used regression analysis to identify potential contributors to the outcome.
STUDY SAMPLE: Forty adults with mild to moderately severe hearing loss participated in the study: 20 current hearing aid users (the "experienced" group) and 20 with no previous amplification experience (the "new" group). Twenty-four participants attended with partners, who were present to offer assistance with the study task as needed.
DATA COLLECTION AND ANALYSIS: Participants followed a set of written, illustrated instructions to perform a multistep self-fitting procedure with a commercially available self-fitting hearing aid, with optional assistance from a lay partner. Standardized measures of cognitive function, health literacy, locus of control, hearing aid self-efficacy, and manual dexterity were collected. Statistical analysis was performed to examine the proportion of participants in each group who successfully performed the self-fitting procedure, factors that predicted successful completion of the task, and the contributions of partners to the outcome.
RESULTS: Fifty-five percent of participants were able to successfully perform the self-fitting procedure. Although the same success rate was observed for both experienced and new participants, the majority of the errors relating to the hearing test and the fine-tuning tasks were made by the experienced participants, while all of the errors associated with physically customizing the hearing aids and most of the insertion errors were made by the new participants. Although the majority of partners assisted in the self-fitting task, their contributions did not significantly influence the outcome. Further, no characteristic or combination of characteristics reliably predicted which participants would be successful at the self-fitting task.
CONCLUSIONS: Although the majority of participants were able to complete the self-fitting task without error, the provision of knowledgeable support by trained personnel, rather than a fellow layperson, would most certainly increase the proportion of users who are able to achieve success. Refinements to the instructions and the physical design of the hearing aid may also serve to improve the success rate. Further evaluation of the range of self-fitting hearing aids that are now on the market should be undertaken.

PMID: 28240978 [PubMed - in process]

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Build a Better Hearing Assessment and the Patients Will Beat a Path to Your Clinic.

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Build a Better Hearing Assessment and the Patients Will Beat a Path to Your Clinic.

J Am Acad Audiol. 2017 Feb;28(2):108

Authors: McCaslin DL

PMID: 28240977 [PubMed - in process]

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An Update on Lower Lid Blepharoplasty

Seminars in Plastic Surgery 2017; 31: 046-050
DOI: 10.1055/s-0037-1598632

Aging changes to the lower eyelids and midface include pseudoherniated orbital fat, tear trough deformity, lid laxity, and dermatochalasis. Surgical repair often aims at treating redundant skin or orbital fat malposition with a lower eyelid blepharoplasty. Either a transcutaneous or transconjunctival approach may be used, though recent trends have favored the transconjunctival technique if procedures require more than simple skin excision. In manipulating the inferior orbital fat pads, a surgeon has many options including excision, repositioning, or augmentation with synthetic dermal filler, autologous fat grafts, or acellular dermal allografts. The authors review and detail indications, preoperative evaluation, techniques, and complications of lower lid blepharoplasty.
[...]

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Oculofacial Plastic and Reconstructive Surgery

Seminars in Plastic Surgery 2017; 31: 003-004
DOI: 10.1055/s-0037-1598630

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Pediatric Blepharoptosis

Seminars in Plastic Surgery 2017; 31: 058-064
DOI: 10.1055/s-0037-1598631

Congenital blepharoptosis, caused by levator muscle dysgenesis, presents at birth and may lead to disturbed visual development and function. Other causes of ptosis in pediatric patients can be myogenic, neurogenic, mechanical, or traumatic. Timely correction is, therefore, critical, and careful preoperative planning and intraoperative considerations are crucial to achieve optimal outcomes and minimize potential complications. The various surgical techniques, including the frontalis suspension or sling, levator resection and advancement, Müller's muscle conjunctival resection (the Putterman procedure), and modified Fasanella-Servat procedure are each associated with distinct indications, benefits, and drawbacks, necessitating a unique tailored approach to each surgical candidate.
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Orbital Fracture Repair

Seminars in Plastic Surgery 2017; 31: 031-039
DOI: 10.1055/s-0037-1598191

Orbital fractures are very common after facial trauma. The assessment of a patient with a suspected orbital wall injury includes a detailed oculofacial examination as well as radiologic imaging. Surgical repair with or without an implant may be indicated for diplopia, enophthalmos, or both. Cicatricial eyelid malposition is an iatrogenic complication commonly due to poor orbitotomy technique. Optimal repair involves direct exposure of the perimeter of the fractures' site through surgical planes that minimally scar the eyelids. A wide variety of implant options exist; however, thin, pliable, nonadherent materials such as nylon foil may offer several advantages. The authors describe the evaluation and management of orbital wall fractures.
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Intermediate-Acting Nondepolarizing Neuromuscular Blocking Agents and Risk of Postoperative 30-Day Morbidity and Mortality, and Long-term Survival.

BACKGROUND: Nondepolarizing neuromuscular blocking drugs (NNMBDs) are commonly used as an adjunct to general anesthesia. Residual blockade is common, but its potential adverse effects are incompletely known. This study was designed to assess the association between NNMBD use with or without neostigmine reversal and postoperative morbidity and mortality. METHODS: This is a retrospective observational study of 11,355 adult patients undergoing general anesthesia for noncardiac surgery at 5 Veterans Health Administration (VA) hospitals. Of those, 8984 received NNMBDs, and 7047 received reversal with neostigmine. The primary outcome was a composite of respiratory complications (failure to wean from the ventilator, reintubation, or pneumonia), which was "yes" if a patient had any of the 3 component events and "no" if they had none. Secondary outcomes were nonrespiratory complications, 30-day and long-term all-cause mortality. We adjusted for differences in patient risk using propensity matched (PM) followed by assessment of the association of interest by logistic regression between the matched pairs as our primary analysis and multivariable logistic regression (MLR) as a sensitivity analysis. RESULTS: Our primary aim was to assess the adverse outcomes in the patients who had received NNMBDs with and without neostigmine. Administration of an NNMBD without neostigmine reversal compared with NNMBD with neostigmine reversal was associated with increased odds of respiratory complications (PM odds ratio [OR], 1.75 [95% confidence interval [CI], 1.23-2.50]; MLR OR, 1.71 [CI, 1.24-2.37]) and a marginal increase in 30-day mortality (PM OR, 1.83 [CI, 0.99-3.37]; MLR OR, 1.78 [CI, 1.02-3.13]). However, there were no statistically significant associations with nonrespiratory complications or long-term mortality. Patients who were administered an NNMBD followed by neostigmine had no differences in outcomes compared with patients who had general anesthesia without an NNMBD. CONCLUSIONS: The use of NNMBDs without neostigmine reversal was associated with increased odds of our composite respiratory outcome compared with patients reversed with neostigmine. Based on these data, we conclude that reversal of NNMBDs should become a standard practice if extubation is planned. (C) 2017 International Anesthesia Research Society

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Clinical Evaluation of Blepharoptosis: Distinguishing Age-Related Ptosis from Masquerade Conditions

Seminars in Plastic Surgery 2017; 31: 005-016
DOI: 10.1055/s-0037-1598188

Aponeurotic ptosis accounts for the majority of acquired ptosis encountered in clinical practice. Other types of ptosis include traumatic, mechanical, neurogenic, and myogenic. In addition to true ptosis, some patients present with pseudoptosis caused by globe dystopia, globe asymmetry, ocular misalignment, or retraction of the contralateral lid. It is particularly important for the clinician to rule out neurologic causes of ptosis such as dysfunction of the third cranial nerve, Horner's syndrome, and myasthenia gravis, as these conditions can be associated with significant systemic morbidity and mortality. A thorough history and physical examination is necessary to evaluate each patient presenting with a complaint of ptosis. Correctly identifying the cause of the patient's complaint allows the ptosis surgeon to plan for appropriate surgical repair when indicated and to defer surgery when observation or additional clinical evaluation is warranted.
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Safety of Large-Volume, Same-Day Oral Bowel Preparations During Deep Sedation: A Prospective Observational Study.

BACKGROUND: Colonoscopy quality is directly related to the bowel preparation. It is well established that bowel preparations are improved when at least part of the laxative is ingested on the day of the procedure. However, there is concern that this can result in higher gastric residual volumes (GRV) and increase the risk of pulmonary aspiration. The aim of this study is to evaluate GRV and gastric pH in patients who received day-before bowel preparation versus those ingesting their laxative on the day of colonoscopy under anesthesiologist-directed propofol deep sedation. METHODS: This is a prospective observational study for patients undergoing same-day upper endoscopy and colonoscopy. All included patients had large-volume polyethylene glycol lavage preparation and received propofol sedation. Gastric fluid was collected during the upper endoscopy for volume and pH measurement. RESULTS: The study included 428 patients with 56% receiving same-day laxative preparation and the remainder evening-before preparation. Mean +/- SD GRV was 18.1 +/- 10.2 mL, 16.3 +/- 16.5 mL in each of these preparation groups, respectively (P = .69). GRV >= 25 mL or higher than expected GRV adjusted by weight (0.4 mL/kg) were also not different among the study groups (P = .90 and P = .87, respectively). Evaluating GRV based on time since last ingestion of preparation (3-5, 5-7, >7 hours) did not result in any differences (P = .56). Gastric pH was also similar between the bowel preparation groups (P = .23), with mean +/- SD of 2.5 +/- 1.4 for evening-before and 2.5 +/- 1.3 for the same-day preparation. There were more inadequate bowel preparations in day before bowel preparations (P = .001). CONCLUSIONS: A large-volume bowel preparation regimen finished on the day of colonoscopy as close as 3 hours before the procedure results in no increase in GRV or decrease in gastric pH. (C) 2017 International Anesthesia Research Society

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Cross-Disciplinary Perceptions of Structured Interprofessional Rounds in Promoting Teamwork Within an Academic Tertiary Care Obstetric Unit.

BACKGROUND: In 2005, physician and nursing leaders at Brigham and Women's Hospital initiated structured interprofessional rounds (SIPRs) on the labor and delivery (L&D) suite to improve team communication. We performed a cross-sectional analysis of providers' perceptions of SIPRs and their effectiveness in improving teamwork. We hypothesized that on average, providers would perceive SIPRs as being effective in promoting teamwork, but ratings would differ among professional groups. METHODS: After a factor analysis and internal consistency assessment, a 19-item paper-based questionnaire was used to evaluate providers' perceptions using a 5-point Likert scale. Respondents included L&D nurses, midwives, obstetricians, and anesthesiologists who participate in SIPRs. The primary aim was to evaluate the providers' perceptions of SIPRs and their association with professional roles. The outcome was total response score for each provider, ranging from 19 to 95; perception of SIPRs as being effective in promoting teamwork was defined as having a total response score of >66.5 (mean score, >3.5 per question). A univariable linear regression model was performed, followed by a multivariable analysis adjusting for predictors that modified the outcome; predictors included years of professional practice, years of experience on the L&D suite, number of clinical work hours worked weekly, and principal shift assignment among nurses. The associations between these predictors and providers' perceptions were assessed as a secondary aim. RESULTS: A total of 234 practitioners responded (100% response rate). The mean total response score (SD) for all providers was 73.3 (9.5). After multivariable adjustment, the mean total response scores were significantly higher for obstetric providers than for anesthesia ([DELTA] mean, 6.5, 95% CI, 0.3, 12.7 P = .036) and midwifery ([DELTA] mean, 12.5, 95% CI, 2.0, 23.0, P = .009) providers. Providers scored significantly lower if they worked >60 clinical hours per week compared with

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A Randomized Crossover Study Comparing Cervical Spine Motion During Intubation Between Two Lightwand Intubation Techniques in Patients With Simulated Cervical Immobilization: Laryngoscope-Assisted Versus Conventional Lightwand Intubation.

BACKGROUND: In patients with cervical immobilization, jaw thrust can cause cervical spine movement. Concurrent use of a laryngoscope may facilitate lightwand intubation, allowing midline placement and free movement of the lightwand in the oral cavity without jaw thrust. We compared the effects of laryngoscope-assisted lightwand intubation (LALI) versus conventional lightwand intubation (CLI) on cervical spine motion during intubation in patients with simulated cervical immobilization. METHODS: In this randomized crossover study, the cervical spine angle was measured before and during intubation at the occiput-C1, C1-C2, and C2-C5 segments in 20 patients with simulated cervical immobilization who underwent intubation using both the LALI and CLI techniques. Cervical spine motion was defined as the change from baseline in angle measured at each cervical segment during intubation. RESULTS: Cervical spine motion at the occiput-C1 segment was 5.6[degrees] (4.3) and 9.3[degrees] (4.5) when we used the LALI and CLI techniques, respectively (mean difference [98.33% CI]; -3.8[degrees] [-7.2 to -0.3]; P = .007). At other cervical segments, it was not significantly different between the 2 techniques (-0.1[degrees] [-2.6 to 2.5]; P = .911 in the C1-C2 segment and -0.2[degrees] [-2.8 to 2.5]; P = .795 in the C2-C5 segment). CONCLUSIONS: The LALI technique produces less upper cervical spine motion during intubation than the CLI technique in patients with simulated cervical immobilization. (C) 2017 International Anesthesia Research Society

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Nonsurgical Rejuvenation of the Eyelids with Hyaluronic Acid Gel Injections

Seminars in Plastic Surgery 2017; 31: 017-021
DOI: 10.1055/s-0037-1598189

There has been an increased recognition for the role volume deflation plays in the aging periorbital area, and as such, rejuvenation strategies to augment and restore volume have developed and evolved. Hyaluronic acid fillers provide an efficient option for volume augmentation with good efficacy, longevity, and safety. An understanding of the changes in the upper and lower periocular area due to aging, the meticulous identification of focal hollows, and the precise delivery of filler to these areas can smooth contours and restore a rejuvenated periorbital area.
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Anesthetic Management for Percutaneous Minimally Invasive Fetoscopic Surgery of Spina Bifida Aperta: A Retrospective, Descriptive Report of Clinical Experience.

Minimally invasive fetoscopic surgery for spina bifida aperta is a new therapeutic approach to preserve neurologic function by protecting exposed neural tissue. The anesthetic management is of paramount importance for the success of the procedure. Therefore, our protocol was developed with particular attention to safe and adequate maternal and fetal anesthesia, sufficient uterine relaxation as well as prevention of pulmonary edema, placental abruption, and spontaneous labor. As illustrated by this retrospective analysis of 61 cases, these goals can be reliably achieved. The clinical protocol is presented as a supplemental digital content to this manuscript (Supplemental Digital Content 1, http://ift.tt/2lx03TC). (C) 2017 International Anesthesia Research Society

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Orbital Decompression for Thyroid Eye Disease

Seminars in Plastic Surgery 2017; 31: 040-045
DOI: 10.1055/s-0037-1598192

Although most cases of thyroid eye disease (TED) can be managed medically, some refractory or severe cases are treated surgically with orbital decompression. Due to a lack of randomized controlled trials comparing surgical techniques for orbital decompression, none have been deemed superior. Thus, each case of TED is managed based on patient characteristics and surgeon experience. Surgical considerations include the extent of bony wall removal, the surgical approach, the choice of incision, and the use of fat decompression. Outcomes vary based on surgical indications and techniques; hence, vision can improve or worsen after the surgery.
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The Role of NR2B-CREB-miR212/132-CRTC1-CREB Signal Network in Pain Regulation In Vitro and In Vivo.

BACKGROUND: Chronic pain is a debilitating threat to human health, and its molecular mechanism remains undefined. Previous studies have illustrated a key role of cAMP response element-binding protein (CREB) in pain regulation; CREB-regulated transcription coactivator 1 (CRTC1) and microRNA212/132 (miR212/132) are also vital in synaptic plasticity. However, little is known about the interaction among these factors in pain condition. We conducted this experiment mainly to determine the crosstalk between CREB, CRTC1, and miR212/132 in vitro. Moreover, we explored the changes in hyperalgesia on chronic constrictive injury (CCI) mouse in vivo when given CREB-related adenovirus vectors, CRTC1-related adenovirus vectors, and miR212/132-locked nucleic acid (LNA). METHODS: We cultured primary neurons in the spinal cord of mouse embryos. Exogenous glutamate was added to cultured neurons to simulate in vivo pain process. Real-time quantitative polymerase chain reaction was used to determine changes of NR2B, CRTC1, CREB, and miR212/132 at the mRNA level; Western blot was used to detect p-NR2B, p-CREB, and CRTC1 at protein level. Von Frey cilia were used to study mechanical hyperalgesia in a murine model of CCI. CREB-miR (adenovirus vector interfering CREB gene), CREB-AD (adenovirus vector overexpressing CREB gene); CRTC1-miR (adenovirus vector interfering CRTC1 gene), CRTC1-AD (adenovirus vector overexpressing CRTC1 gene), and miR212/132-LNA were injected intrathecally. RESULTS: In vitro, 100 [mu]mol/L glutamate induced p-CREB and miR212/132-LNA. CRTC1 protein was downregulated by CREB-miR and miR212/132-LNA. CRTC1 mRNA was upregulated by CREB-AD and downregulated by CREB-miR and miR212-LNA. P-CREB was upregulated by CRTC1-AD and downregulated by miR212/132. CREB mRNA was upregulated by CRTC1-AD and downregulated by CRTC1-miR. MiR212/132 was upregulated by CRTC1-AD and CREB-AD; downregulated by CREB-miR. In vivo, CRTC1-miR, CREB-miR, and miR212/132-LNA increased paw withdrawal mechanical threshold in various degrees. CONCLUSIONS: The NR2B-CREB-miR212/132-CRTC1-CREB signal network plays an important role in the regulation of pain. Intervening with any molecule in this signal network would reduce pain perception. (C) 2017 International Anesthesia Research Society

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Ocular Adnexal Reconstruction for Cutaneous Periocular Malignancies

Seminars in Plastic Surgery 2017; 31: 022-030
DOI: 10.1055/s-0037-1598190

Although the majority of lesions present in the periocular region are benign, periocular cutaneous malignancies are certainly not uncommon and must be considered. The management of nonmelanoma cutaneous malignancies is predominately surgical with Mohs micrographic surgery or excision with frozen sections. The approach to reconstruction of the resulting defects depends on the defect location and size. When able, it is preferable to close lesions directly or with the recruitment of adjacent tissue in an effort to preserve the inherent anatomy. The eyelid's dynamic function is thus maintained, which is essential for optimal ocular surface protection. However, larger and more extensive defects will require complex reconstructions that are able to restore the necessary structural integrity to the eyelids. The authors review the various reconstruction approaches for defects of all sizes involving the periocular area including nonmarginal defects and defects of the lower and upper eyelids, as well as those of the medial canthal region.
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Prophylactic Phenylephrine Infusions to Reduce Severe Spinal Anesthesia Hypotension During Cesarean Delivery in a Resource-Constrained Environment.

Phenylephrine infusions are considered as standard management for obstetric spinal hypotension, but there remains reluctance to implement them in resource-limited contexts. This prospective, alternating intervention study of patients undergoing elective or urgent cesarean delivery under spinal anesthesia compared a vasopressor bolus strategy to fixed-rate, low-dose prophylactic phenylephrine infusion with supplemental boluses. The primary outcome was the incidence of severe hypotension (mean arterial pressure

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Douglas P. Marx, MD

Seminars in Plastic Surgery 2017; 31: 001-002
DOI: 10.1055/s-0037-1598629

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Upper Eyelid Blepharoplasty: Evaluation, Treatment, and Complication Minimization

Seminars in Plastic Surgery 2017; 31: 051-057
DOI: 10.1055/s-0037-1598628

Upper eyelid blepharoplasty is one of the most common procedures performed worldwide for both functional and cosmetic indications. There is a high rate of patient satisfaction; however, in this era of social media, patient expectations are higher than ever. Today's digitally savvy patients expect perfect outcomes with no complications and rapid recovery. To achieve optimal results, a careful preoperative evaluation and sound surgical technique is essential for minimizing complications. Here the authors review their approach to the management of the blepharoplasty patient.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Effect of Clopidogrel on Thrombus Formation in an Ex Vivo Parallel Plate Flow Chamber Model Cannot Be Reversed by Addition of Platelet Concentrates or vWF Concentrate.

BACKGROUND: Hemorrhage is the most important complication of antithrombotic therapy with P2Y12 receptor blockers. The administration of platelet concentrates (PCs) and von Willebrand factor (vWF) concentrates are common procedures to normalize impaired primary hemostasis in bleeding patients. We tested whether this strategy reverses the effect of clopidogrel using a parallel plate flow chamber model. METHODS: Whole blood from patients, who received a loading dose of clopidogrel with 600 mg and an ongoing dual antiplatelet therapy with 75 mg/d clopidogrel and 100 mg/d acetyl salicylic acid, compared with blood from healthy volunteers was examined in a collagen-coated parallel plate flow chamber. Blood was perfused by suction at a shear rate of 300/s, which is equivalent to 14 dynes/cm2 to resemble shear stress in conduit arteries. Platelet-covered area, individual thrombus size, and the average thrombus size were assessed morphometrically. The equivalent of 2 or 5 units of PC and/or 2 U/mL of vWF concentrate were used in an attempt to restore coagulation capacity in blood samples of clopidogrel-treated patients. RESULTS: In this model, clopidogrel reduced the increase of thrombus size. The equivalent of 2 U of PC or 2 U/mL of vWF alone did not show any significant changes in thrombus size. 5 U of PC increased thrombus size in clopidogrel-treated patients (P

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Game-based combined cognitive and neurofeedback training using focus pocus reduces symptom severity in children with diagnosed AD/HD and subclinical AD/HD

Publication date: Available online 28 February 2017
Source:International Journal of Psychophysiology
Author(s): Stuart J. Johnstone, Steven J. Roodenrys, Kirsten Johnson, Rebecca Bonfield, Susan J. Bennett
Previous studies report reductions in symptom severity after combined working memory (WM) and inhibitory control (IC) training in children with AD/HD. Based on theoretical accounts of the role of arousal/attention modulation problems in AD/HD, the current study examined the efficacy of combined WM, IC, and neurofeedback training in children with AD/HD and subclinical AD/HD. Using a randomized waitlist control design, 85 children were randomly allocated to a training or waitlist condition and completed pre- and post-training assessments of overt behavior, trained and untrained cognitive task performance, and resting and task-related EEG activity. The training group completed twenty-five sessions of training using Focus Pocus software at home over a 7 to 8-week period. Trainees improved at the trained tasks, while enjoyment and engagement declined across sessions. After training, AD/HD symptom severity was reduced in the AD/HD and subclinical groups according to parents, and in the former group only according to blinded teachers and significant-others. There were minor improvements in two of six near-transfer tasks, and evidence of far-transfer of training effects in four of five far-transfer tasks. Frontal region changes indicated normalization of atypical EEG features with reduced delta and increased alpha activity. It is concluded that technology developments provide an interesting a vehicle for delivering interventions and that, while further research is needed, combined WM, IC, and neurofeedback training can reduce AD/HD symptom severity in children with AD/HD and may also be beneficial to children with subclinical AD/HD.



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Enzymatic extraction and characterization of polysaccharide from Tuber aestivum

Publication date: Available online 28 February 2017
Source:Bioactive Carbohydrates and Dietary Fibre
Author(s): Devshri Bhotmange, Janne H. Wallenius, Rekha S. Singhal, Salem S. Shamekh
Tuber aestivum is one of the important edible mycorrhizal truffle having unique flavor and texture. It is known to contain approximately 5.23% of polysaccharide. The present work was focused on extraction and characterization of the polysaccharide from fruiting body of T. aestivum. The polysaccharide was extracted using complex enzymes viz. papain, trypsin and pectinase. Taguchi orthogonal array experimental design and response surface methodology were employed to optimize the factors involved in the extraction process. The optimal factors for the extraction of polysaccharide from T. aestivum were 1.0% trypsin, 2.0% pectinase, 1.0% papain, temperature 50°C, pH 6.0 and extraction time 90min. Under these optimum conditions the polysaccharide extraction yield was found to be 46.93% of total polysaccharide. Polysaccharide so obtained was characterized for its structure, chemical composition, thermal analysis and bioactivity. The monosaccharides present in the extracted polysaccharides were glucose (>90%), rhamnose, galactose and mannose. The polysaccharide extracted from T. aestivum possessed the significant in vitro antioxidant capability.

Graphical abstract

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Smart Earbuds: A Looming Threat to the Hearing Aid Market?

No abstract available

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Emotional Soundscapes of Life With Ménière's Disease

No abstract available

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World Hearing Day

No abstract available

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Online Reputation Management for a Busy Clinic

No abstract available

http://ift.tt/2mbxy17

Detecting Non-Organic Hearing Loss at CI Assessment

No abstract available

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Listen to the Brain to Suss Out Concussions

No abstract available

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P-E Fit Increases in Importance for Older Patients

No abstract available

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Benefits of Extended High-Frequency Audiometry for Everyone

No abstract available

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Promoting Hearing Health Care in Nepal

No abstract available

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Audiology Services for PSAP Users

No abstract available

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Symptom: Ear Blockage

No abstract available

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Trade Talk: A Q&A with Tucker Worster

No abstract available

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Hearing Conservation Through Partnership With Musicians

No abstract available

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Manufacturers News

No abstract available

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Brusterhaltende Therapie mit adjuvanter Radiotherapie des Mammakarzinoms besser als die Mastektomie?

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Clinical relevance of the M1b and M1c descriptors from the proposed TNM 8 classification of lung cancer

Abstract

Objective

The TNM 8 lung cancer staging system reclassifies patients with a solitary extrathoracic metastasis as M1b and two or more extrathoracic metastases as M1c. This study investigates the clinical relevance of this change.

Methods

Advanced lung cancer patients were retrospectively restaged according to the TNM8 M1b and M1c classifiers. Overall survival was compared in M1b and M1c patients staged with and without PET-CT. We then summarized the TNM 8 staging classification and the relevant literature on the treatment of oligometastatic lung cancer.

Results

In all, 82 patients with metastatic lung cancer were reclassified according to the TNM 8: 14 had M1b and 58 had M1c disease. Those with M1b disease lived significantly longer than those with M1c disease (15.2 vs. 7.3 months, p = 0.0029). Among those with M1b disease, survival was the highest when M1b status was confirmed by PET-CT (21.4 vs. 7 months). M1c patients with 4 or less distant metastases had a trend to longer survival vs. M1c patients with 5 or more metastases (9.4 vs. 7.3 months), especially when PET-CT staging was used (13.9 months).

Conclusions

We confirmed the prognostic value of the M1b and M1c descriptors in a Western European tertiary care population. The use of PET-CT seems to increase the prognostic value of the M descriptor and may define an additional oligometastatic subgroup of M1c patients. Clinical trials investigating the treatment of patients with varying degrees of metastatic disease are needed and should be based on PET-CT staging.

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A 2-bp insertion (c.67_68insCC) in MC1R causes recessive white coat color in Bama miniature pigs

Publication date: Available online 28 February 2017
Source:Journal of Genetics and Genomics
Author(s): Qitao Jia, Chunwei Cao, Hai Tang, Ying Zhang, Qiantao Zheng, Xiao Wang, Rui Zhang, Xianlong Wang, Ailing Luo, Hong Wei, Anming Meng, Qi Zhou, Hongmei Wang, Jianguo Zhao




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Editorial Board

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3





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Improvement in the diagnosis of catheter-related bloodstream infections in a tertiary cancer center

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3
Author(s): Patrick Chaftari, Anne-Marie Chaftari, Javier Adachi, Ray Hachem, Sammy Raad, Elizabeth Natividad, Nora Oliver, Bena Ellickalputhenpura, Ying Jiang, Jeffrey Tarrand, Issam Raad
BackgroundIdentifying a central venous catheter (CVC) as the source of bacteremia requires drawing simultaneous blood cultures (BCs) from the CVC and peripheral site and correct labeling of the BC source. In our emergency center (EC), 52% of BCs collected from febrile cancer patients lacked source information, making the diagnosis and management of catheter-related bloodstream infections (CRBSIs) challenging.MethodsBetween January 2015 and June 2015, we conducted a quality improvement project in our EC aiming to increase the occurrence of simultaneous BC drawing with accurate source labeling by 10%.ResultsStaff education and monitoring increased average BC source labeling from a baseline of 48% to a much better rate of 70%. Label introduction led to increased source labeling to 94% by June 2015. This project had a significant influence in patients with a CVC and a positive BC because the physician is now able to determine whether the CVC is the source of the bacteremia in 88% of cases compared with 36% at baseline (P = .0003).ConclusionsEducation without an active intervention is usually not enough. Simple solutions such as label introduction can have significant influence on patient safety and care. Accurate diagnosis may guide clinicians at the bedside to appropriately manage CVCs in the setting of bacteremia, remove a CVC when indicated, and prevent unnecessary CVC removal with its potential safety and cost-effectiveness implications.



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APIC Masthead

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3





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Information for Readers

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3





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Information for Authors

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3





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Foam soap is not as effective as liquid soap in eliminating hand microbial flora

Publication date: Available online 28 February 2017
Source:American Journal of Infection Control
Author(s): Nicolette Dixon, Margie Morgan, Ozlem Equils
Foam soaps are aerosolized liquid soaps dispensed through a special pump mechanism. Currently there are no studies comparing liquid soap with foam soap in regard to efficacy of reducing hand microbial burden. In 3 separate experiments and with 2 different brands of foam soap, it was observed that nonantimicrobial foam soap was not as effective in reducing hand bacterial load as the liquid soap.



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Long-term care certificate program prepares facilities for regulatory changes

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3





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Table of Contents

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3





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National survey of practices to prevent health care-associated infections in Thailand: The role of prevention bundles

Publication date: Available online 28 February 2017
Source:American Journal of Infection Control
Author(s): Anucha Apisarnthanarak, David Ratz, M. Todd Greene, Thana Khawcharoenporn, David J. Weber, Sanjay Saint
BackgroundWe evaluated the practices used in Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP).MethodsFrom January 1, 2014-November 30, 2014, we surveyed all Thai hospitals with an intensive care unit and at least 250 beds. The use of prevention practices for CAUTI, CLABSI, and VAP was assessed. High compliance (≥75%) with all components of the CLABSI and VAP prevention bundles were determined. CAUTI, CLABSI, and VAP infection rates before and after implementing infection control practices are reported. Multivariable regression was used to examine associations between infection prevention bundle compliance and infection rate changes.ResultsOut of 245 eligible hospitals, 212 (86.5%) responded. A total of 120 (56.6%) and 115 hospitals (54.2%) reported ≥75% compliance for all components of the CLABSI and VAP prevention bundles, respectively, and 91 hospitals (42.9%) reported using ≥ 4 recommended CAUTI-prevention practices. High compliance with all of the CLABSI and VAP bundle components was associated with significant infection rate reductions (CLABSI, 38.3%; P < .001; VAP, 32.0%; P < .001). Hospitals regularly using ≥ 4 CAUTI-prevention practices did not have greater reductions in CAUTI (0.02%; P = .99).ConclusionsCompliance with practices to prevent hospital infections was suboptimal. Policies and interventions promoting bundled approaches may help reduce hospital infections for Thai hospitals.



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Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3
Author(s): Abhishek Deshpande, Jennifer L. Cadnum, Dennis Fertelli, Brett Sitzlar, Priyaleela Thota, Thriveen S. Mana, Annette Jencson, Heba Alhmidi, Sreelatha Koganti, Curtis J. Donskey
In a survey of 5 hospitals, we found that floors in patient rooms were frequently contaminated with pathogens and high-touch objects such as blood pressure cuffs and call buttons were often in contact with the floor. Contact with objects on floors frequently resulted in transfer of pathogens to hands.

Graphical abstract

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Surveillance culture for multidrug-resistant gram-negative bacteria: Performance in liver transplant recipients

Publication date: 1 March 2017
Source:American Journal of Infection Control, Volume 45, Issue 3
Author(s): Maristela Pinheiro Freire, Isabel Cristina Villela Soares Oshiro, Patrícia Rodrigues Bonazzi, Ligia Câmera Pierrotti, Larissa Marques de Oliveira, Anna Silva Machado, Inneke Marie Van Der Heijdenn, Flavia Rossi, Silvia Figueiredo Costa, Luiz Augusto Carneiro D'Albuquerque, Edson Abdala
BackgroundThe prevalence of infection with multidrug-resistant gram-negative bacteria (MDR-GNB) after solid-organ transplantation is increasing. Surveillance culture (SC) seems to be an important tool for MDR-GNB control. The goal of this study was to analyze the performance of SC for MDR-GNB among liver transplant (LT) recipients.MethodsThis was a prospective cohort study involving patients who underwent LT between November 2009 and November 2011. We screened patients for extended spectrum β-lactamase-producing Escherichia coli, extended spectrum β-lactamase-producing Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB). We collected SC samples immediately before LT and weekly thereafter, until hospital discharge. Samples were collected from the inguinal-rectal area, axilla, and throat. The performance of SC was evaluated through analysis of its sensitivity, negative predictive value, and accuracy.ResultsDuring the study period, 181 patients were evaluated and 4,110 SC samples were collected. The GNB most often identified was CRAB, in 45.9% of patients, followed by CRKP in 40.3%. For all microorganisms, the positivity rate was highest among the inguinal-rectal samples. If only samples collected from this area were considered, the SC would fail to identify 34.9% of the cases of CRAB colonization. The sensitivity of SC for CRKP was 92.5%. The performance of SC was poorest for CRAB (sensitivity, 80.6%).ConclusionsOur data indicate that SC is a sensitive tool to identify LT recipients colonized by MDR-GNB.



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Reasons for influenza vaccination underuse: A case-control study

Publication date: Available online 28 February 2017
Source:American Journal of Infection Control
Author(s): Scott S. Field




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In this issue

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The importance of nano-porosity in the stalk-derived biochar to the sorption of 17β-estradiol and retention of it in the greenhouse soil

Abstract

Natural estrogens in greenhouse soils with long-term manure application are becoming a potential threat to adjacent aquatic environment. Porous stalk biochar as a cost-effective adsorbent of estrogen has a strong potential to reduce their transportation from soil to waters. But the dominant adsorption mechanism of estrogen to stalk biochars and retention of estrogen by greenhouse soils amended with biochar are less well known. Element, function groups, total surface area (SA_total), nano-pores of stalk biochars, and chemical structure of 17β-estradiol (E2, length 1.20 nm, width 0.56 nm, thickness 0.48 nm) are integrated in research on E2 sorption behavior in three stalk-derived biochars produced from wheat straw (WS), rice straw (RS), and corn straw (CS), and greenhouse soils amended with optimal biochar. The three biochars had comparable H/C and (O + N)/C, while their aromatic carbon contents and total surface areas (SA_total) both varied as CS > WS > RS. However, WS had the highest sorption capacity (logK _oc), sorption affinity (K _f ), and strongest nonlinearity (n). Additionally, the variation of Langmuir maximum adsorption capacity (Q ⁰) was consistent with the trend for SA_1.2-20 (WS > RS > CS) but contrary to the trend for SA_total and SA_<1.2 (CS > WS > RS). These results indicate that pore-filling dominates the sorption of E2 by biochars and exhibits "sieving effect" and length-directionality-specific via H-bonding between –OH groups on the both ends of E2 in the length direction and polar groups on the inner surface of pores. After the addition of wheat straw biochar, the extent of increase in the sorption affinity for E2 in the soil with low OC content was higher than those in the soil with high OC content. Therefore, the effectiveness for the wheat straw biochar mitigating the risk of E2 in greenhouse soil depended on the compositions of soil, especially organic matter.

http://ift.tt/2mIMWia