An analysis of knowledge-based planning for stereotactic body radiation therapy of the spine

Publication date: Available online 2 March 2017
Source:Practical Radiation Oncology
Author(s): Joseph J. Foy, Robin Marsh, Randall K. Ten Haken, Kelly C. Younge, Matthew Schipper, Yilun Sun, Dawn Owen, Martha M. Matuszak
PurposePlanning for spine stereotactic body radiation therapy (SBRT) is time consuming and differences in planner experience and technique result in discrepancies in plan quality between facilities. Here, knowledge-based planning (KBP) is analyzed in order to determine if it may be effective in improving the quality and efficiency of spine SBRT planning.MethodsThirty-eight spine SBRT cases were collected from the XXX database and inverse planned to deliver three 10-Gy fractions to the PTV. These plans were used to train a knowledge-based model (Model A) using RapidPlan (Varian Medical Systems). The model was evaluated for outliers and validated in ten independent cases. Each of these cases was manually planned in order to compare the quality of the model-generated plans with the manual plans. In order to further test the robustness of the software, two additional models (Models B and C) were created with intentional outliers due to inconsistent contouring.ResultsUsing Models A, B, and C, all 10 generated plans met all dose objectives for modeled organs-at-risk (OARs) (spinal cord, cord PRV, and esophagus) without user intervention. The target coverage and OAR dose sparing was improved or equivalent to manual planning by an expert dosimetrist. However, manually created plans typically required 1–1.5hours to produce and model-generated plans required only 10–15minutes with minimal human intervention in order to meet all dose objectives.ConclusionThe plans produced by RapidPlan were found to be of improved or similar clinical quality as the manually created plans in terms of normal tissue objectives and PTV dose coverage and could be produced in a fraction of the time. RapidPlan is a robust technique that can improve planning efficiency in spine SBRT while maintaining or potentially improving plan quality and standardization across planners and centers.



http://ift.tt/2lWC56Z

Bean peptides have higher in silico binding affinities than ezetimibe for the N-terminal domain of cholesterol receptor Niemann-Pick C1 Like-1

Publication date: Available online 1 March 2017
Source:Peptides
Author(s): Luis M. Real Hernandez, Elvira Gonzalez de Mejia
Niemann-Pick C1 like-1 (NPC1L1) mediates cholesterol absorption at the apical membrane of enterocytes through a yet unknown mechanism. Bean, pea, and lentil proteins are naturally hydrolyzed during digestion to produce peptides. The potential for pulse peptides to have high binding affinities for NPC1L1 has not been determined. In this study , in silico binding affinities and interactions were determined between the N-terminal domain of NPC1L1 and 14pulse peptides (5≥ amino acids) derived through pepsin-pancreatin digestion. Peptides were docked in triplicate to the N-terminal domain using docking program AutoDock Vina, and results were compared to those of ezetimibe, a prescribed NPC1L1 inhibitor. Three black bean peptides (−7.2 to −7.0kcal/mol) and the cowpea bean dipeptide Lys-Asp (−7.0kcal/mol) had higher binding affinities than ezetimibe (−6.6kcal/mol) for the N-terminal domain of NPC1L1. Lentil and pea peptides studied did not have high binding affinities. The common bean peptide Tyr-Ala-Ala-Ala-Thr (−7.2kcal/mol), which can be produced from black or navy bean proteins, had the highest binding affinity. Ezetimibe and peptides with high binding affinities for the N-terminal domain are expected to interact at different locations of the N-terminal domain. All high affinity black bean peptides are expected to have van der Waals interactions with SER130, PHE136, and LEU236 and a conventional hydrogen bond with GLU238 of NPC1L1. Due to their high affinity for the N-terminal domain of NPC1L1, black and cowpea bean peptides produced in the digestive track have the potential to disrupt interactions between NPC1L1 and membrane proteins that lead to cholesterol absorption.



http://ift.tt/2mNQ50p

Genetics of Congenital Adrenal Hyperplasia

Publication date: Available online 1 March 2017
Source:Endocrinology and Metabolism Clinics of North America
Author(s): Fady Hannah-Shmouni, Wuyan Chen, Deborah P. Merke

Teaser

Congenital adrenal hyperplasia (CAH) refers to a group of autosomal recessive disorders due to single-gene defects in the various enzymes required for cortisol biosynthesis. CAH represents a continuous phenotypic spectrum with more than 95% of all cases caused by 21-hydroxylase deficiency. Genotyping is an important tool in confirming the diagnosis or carrier state, provides prognostic information on disease severity, and is essential for genetic counseling. In this article, the authors provide an in-depth discussion on the genetics of CAH, including genetic diagnosis, molecular analysis, genotype-phenotype relationships, and counseling of patients and their families.


http://ift.tt/2lBAkcQ

Trace element composition of smolt scales from Atlantic salmon (Salmo salar L.), geographic variation between hatcheries

Publication date: June 2017
Source:Fisheries Research, Volume 190
Author(s): Belinda Flem, Vidar Moen, Tor Erik Finne, Hildegunn Viljugrein, Anja Bråthen Kristoffersen
The escape of farmed Atlantic salmon is a problem for the Norwegian aquaculture industry. Escapes in all phases of the life cycle of the farmed fish create situations unwanted by authorities and industry, as well as with those depending on the wild Atlantic salmon for commercial or recreational fishing. As a contribution to develop a dependable and feasible method of linking escaped salmon to their hatchery, the chemical variation of 12 elements in sclerites of scale from smolt from hatcheries located all along the coast have been analysed by laser ablation inductively coupled plasma mass spectroscopy (LA-ICP-MS). The survey comprised data on B, Ba, Fe, K, Mg, Mn, Na, Pb, S, Sr, U and Zn in 1347 scales from 24 groups of smolt collected from 18 hatcheries, the largest survey with regard to statistical and geographical variation conducted to date. A majority vote between the result of four different classification methods (linear discriminant analysis, Naïve Bayes, k-nearest neighbour and random forest) misplaced only 55 scales (4%) to group of origin. Sr and Ba are the two most important elements for group separation. Without Sr, the success of correct hatchery classification is reduced from 95.8% to 92.2%, and to 93.4% without Ba.Chemical composition (same elements as in sclerites, except for S and U) of local floodplains' sediments revealed elevated levels of Pb coinciding with most of the hatcheries where Pb in sclerites was above detection limit.The other elements incorporated in the hydroxyapatite layer (HAP-layer) analysed for this study seems shifted by water treatment done in the hatcheries. Scale chemistry may provide a powerful tool to determine the origin of escaped farmed Atlantic salmon. However, further investigations should be performed before this method can be implemented in the Norwegian salmon management, particularly on two topics. These are the stability of trace elements incorporated in the HAP-layer after change of water environment, and whether the elemental profile from the freshwater hatchery is still recognizable after the salmon has spent more than 2 years in sea.



http://ift.tt/2mNGPJI

Sonochemical synthesis and characterization of microrod to nanoparticle of new mixed-ligand zinc(II) fumarate metal-organic polymer

Publication date: July 2017
Source:Ultrasonics Sonochemistry, Volume 37
Author(s): Payam Abdolalian, Ali Morsali, Giuseppe Bruno
Micro and nano-structures of a new mixed-ligand Zn(II) fumarate metal-organic polymer, {[Zn(tptz)(fum)].DMF}n (1), (tptz=2,4,6-tris(2-pyridyl)-s-triazine, fum=fumarate, DMF=N,N-dimethylforamide), were synthesized by sonochemical method. These new micro and nano-structures were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), IR spectroscopy and elemental analyses. Compound 1 was structurally characterized by single-crystal X-ray diffraction and consists of the primary unit of [Zn(tptz)(fum)]. Self assembly between the units of [Zn(tptz)(fum)] from Zn–O bonds results in the formation of a one-dimensional zinc(II) coordination polymer. The Zn^II-ion in compound 1 has ZnO2N3 coordination sphere with a trigonal bipyramidal molecular geometry. Compound 1 was synthesized by ultrasound irradiation under different concentrations and times. The microrods structure of compound 1 with increasing of concentration and ultrasound radiation time were synthesized as nanoparticles structure successfully. So ultrasound radiation change morphology from microrods to nanoparticles.



http://ift.tt/2lfwycN

Evaluation of the bioaccessible gastric and intestinal fractions of heavy metals in contaminated soils by means of a simple bioaccessibility extraction test

Publication date: June 2017
Source:Chemosphere, Volume 176
Author(s): C. Jorge Mendoza, R. Tatiana Garrido, R. Cristian Quilodrán, C. Matías Segovia, A. José Parada
A study is made to evaluate the bioaccessibility of heavy metals in contaminated soils through a simple bioaccessibility extraction test (SBET), applied to the analysis of both the gastric and intestinal phases. Soils with high metal content of the Mapocho, Cachapoal, and Rancagua series were studied; they are located in suburban areas of large cities in the central valley of Chile. The bioaccessible concentrations of Cd, Cr, Cu, Ni, Pb, and Zn were related to the main physicochemical characteristics of the soils and to the chemical forms obtained by sequential extraction.The elements Cd, Cu, Ni, and Zn are distributed in the soils between the exchangeable fractions, bound to oxides, to organic matter, and in the residual fraction. On the other hand, Cr and Pb are found mainly in the fractions bound to organic matter and in the residual fraction. The three soils have a high Cu content, (640–2060 mg/kg), in the order Cachapoal > Rancagua > Mapocho. The SBET test allowed establishing a different bioaccessibility for the elements in the soil. Cu was notoriously bioaccessible in both the gastric and intestinal phases in the three soils, reaching more than 50% in the Cachapoal and Rancagua soils. The other elements, regardless of the soil, were bioaccessible only in one of the phases, more frequently in the gastric phase. The multiple correlation study indicates that the metal forms have a higher incidence than the soil's physicochemical factors on the extractability to evaluate the human oral bioaccessibility of the metals.



http://ift.tt/2mNXywp

The off-stoichiometry effect on the optical properties of water-soluble copper indium zinc sulfide quantum dots

Publication date: 15 June 2017
Source:Journal of Colloid and Interface Science, Volume 496
Author(s): Yanqiao Xu, Ting Chen, Xiaobo Hu, Wan Jiang, Lianjun Wang, Weihui Jiang, Jianmin Liu
CuInZnS quantum dots (CIZS QDs) were prepared via reflux method in aqueous solution using CuCl2·2H2O, InCl3·4H2O, Zn(OAc)2·2H2O and Na2S·9H2O as raw materials, l-glutathione (GSH) and sodiumcitrate (SC) as stabilizing agents, respectively. The effects of off-stoichiometry (Cu/In and Zn/Cu ratios) on the crystal structure and morphology were systematically studied by means of X-ray diffraction (XRD) and high-resolution transmission electron microscope (HRTEM), and the relative optical properties were also investigated by absorption and fluorescence spectra. The as-prepared water-dispersible CIZS QDs were around 3–4nm and possessed the tetragonal chalcopyrite crystal structure. The photoluminescence (PL) intensity of QDs was significantly increased with decreasing the Cu/In ratio. Compared with the Cu/In ratio variation, changing Zn/Cu ratio was an effective strategy to realize a more uniform irradiation and a wide range of emission wavelength tunability.

Graphical abstract

http://ift.tt/2lfEF9i

Synthesis, crystal structure, and luminescent properties of two coordination polymers based on 1,4-phenylenediacetic acid

Publication date: 5 June 2017
Source:Journal of Molecular Structure, Volume 1137
Author(s): Meili Zhang, Yixia Ren, Zhenzhen Ma, Lei Qiao
Two coordination polymers, [Zn(pda)(bib)]n (1) and [Cd(pda)0.5(bib)Cl]n (2)]. (H2pda = 1,4-phenylenediacetic acid, bib = 1,2-bis(imidazol-1-ylmethyl)benzene), have been synthesized by using Zn(II)/Cd(II) salts with two flexible ligands pda and bib under hydrothermal conditions. Their structures have been characterized by elemental analysis, IR spectroscopy, single-crystal X-ray crystallography and powder X-ray diffraction (PXRD) analysis. Due to the coordination geometry around the metal ions and the diverse coordination modes of the flexible ligands, the obtained complex show diverse structures. In the structure of 1, a pair of bib ligands connect two Zn(II) atoms give rise a 22-membered ring, which is further extended by pda ligands in bidentate coordination mode leading a ring-containing 2D layer. In 2, bib ligands join [Cd2Cl2]²⁺ dimmers generate 1D polymeric ribbon, the pda ligands further extend such ribbon forming a 2D layer network containing rectangular windows, which discovers the effect of the central metal ions on the formation of metal–organic frameworks. In additional, luminescent properties of two complexes have also been studied, they could be potential fluorescence materials.

Graphical abstract

http://ift.tt/2lfxqyg

Synthesis, characterization, spectral, thermal analysis and computational studies of thiamine complexes

Publication date: 5 June 2017
Source:Journal of Molecular Structure, Volume 1137
Author(s): Mamdouh S. Masoud, Doaa A. Ghareeb, Shahenda Sh. Ahmed
Thiamine metal complexes were synthesized and characterized by elemental analysis, IR, electronic spectra, magnetic susceptibility, ESR spectra of Cu(II) complex and EDX for structural investigation of the complexes to know their geometries and mode of bonding. All the manganese, iron, copper, zinc, tungsten and mercury complexes are with octahedral geometry, while cobalt and nickel complexes are with tetrahedral geometry. The selenium and palladium complexes are with square planner geometry, while vanadium complex with stoichiometry (2:1) is with square pyramidal geometry. The thermal properties of the complexes were examined. The kinetic thermodynamic parameters were estimated from the TGA and DTA curves. Molecular modeling of the ligand and its complexes was performed using PC computer to give extra spot lights on the bonding properties of these compounds. Some theoretical studies were carried out to obtain the charges, bond lengths, bond angles and dihedral angles, energies of highest occupied molecular orbital (EHOMO), energies of lowest unoccupied molecular orbital (ELUMO), the separation energy (ΔE), chemical potential, electronegativity, hardness, softness, ionization potential and electron affinity of the studied ligand and its complexes. Correlation analysis was done to explore the relationships between some different parameters of the studied complexes.



http://ift.tt/2lfxxde

High performance and prospective application of xanthate-modified thiourea chitosan sponge-combined Pseudomonas putida and Talaromyces amestolkiae biomass for Pb(II) removal from wastewater

Publication date: June 2017
Source:Bioresource Technology, Volume 233
Author(s): Nana Wang, Xingjian Xu, Haiyan Li, Quanying Wang, Lizhu Yuan, Hongwen Yu
Biosorption using microbes has been proved to be an efficient technology to remove heavy metals from wastewater, whereas the imperfections in mechanical property and separation limit their practical application. In this study, Pseudomonas putida I3 and Talaromyces amestolkiae Pb respectively combined with xanthate-modified thiourea chitosan sponge (PXTCS and TXTCS) were synthesized to investigate the Pb(II) removal ability from solutions. The prepared biosorbents possessed a three-dimensional macroporous structure convenient for separation. Experimental data indicated their biosorption behaviors well followed the pseudo-second-order kinetics and Langmuir isotherm model. The maximum biosorption capacities of PXTCS and TXTCS were 232.03 and 241.61mgg⁻¹ with 40% P. putida I3 and 15% T. amestolkiae Pb, respectively. For the effects of co-existing metal ions on Pb(II) biosorption, the promoting degree followed the sequence: Zn(II)>Na(I)≈K(I)>Ca(II)>Mg(II)≈Al(III)≫Cd(II)>Fe(III). Both prepared biosorbents were effective in removing heavy metals from simulated industrial effluents containing various trace-level heavy metals or high concentration Pb(II).

Graphical abstract

http://ift.tt/2mO1sW4

The Lymphatic Anatomy of the Lower Eyelid and Conjunctiva and Correlation with Postoperative Chemosis and Edema

The lower eyelid and conjunctiva are drained by interconnecting superficial and deep lymphatic systems of the face. The superficial system is vulnerable to damage in incisions and dissection in the infraorbital area. The deep system is vulnerable to damage in dissection around the orbicularis retaining ligament and the zygomaticocutaneous ligaments. The authors suggest that concurrent damage to both the superficial and deep lymphatic systems, especially laterally, may be responsible for postoperative chemosis and edema.

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

6948891480

alsfakia@gmail.com

Abstracts

http://ift.tt/2lYDOXD

The genetics of brain function and psychophysiology: an introduction to the special issue

Publication date: Available online 1 March 2017
Source:International Journal of Psychophysiology
Author(s): Andrey P. Anokhin




http://ift.tt/2mNwXQ8

Acoustic Behavior of Halobacterium salinarum Gas Vesicles in the High-Frequency Range: Experiments and Modeling

Publication date: Available online 1 March 2017
Source:Ultrasound in Medicine & Biology
Author(s): Emmanuel Cherin, Johan M. Melis, Raymond W. Bourdeau, Melissa Yin, Dennis M. Kochmann, F. Stuart Foster, Mikhail G. Shapiro
Gas vesicles (GVs) are a new and unique class of biologically derived ultrasound contrast agents with sub-micron size whose acoustic properties have not been fully elucidated. In this study, we investigated the acoustic collapse pressure and behavior of Halobacterium salinarum gas vesicles at transmit center frequencies ranging from 12.5 to 27.5 MHz. The acoustic collapse pressure was found to be above 550 kPa at all frequencies, nine-fold higher than the critical pressure observed under hydrostatic conditions. We illustrate that gas vesicles behave non-linearly when exposed to ultrasound at incident pressure ranging from 160 kPa to the collapse pressure and generate second harmonic amplitudes of −2 to −6 dB below the fundamental in media with viscosities ranging from 0.89 to 8 mPa·s. Simulations performed using a Rayleigh–Plesset-type model accounting for buckling and a dynamic finite-element analysis suggest that buckling is the mechanism behind the generation of harmonics. We found good agreement between the level of second harmonic relative to the fundamental measured at 20 MHz and the Rayleigh–Plesset model predictions. Finite-element simulations extended these findings to a non-spherical geometry, confirmed that the acoustic buckling pressure corresponds to the critical pressure under hydrostatic conditions and support the hypothesis of limited gas flow across the GV shell during the compression phase in the frequency range investigated. From simulations, estimates of GV bandwidth-limited scattering indicate that a single GV has a scattering cross section comparable to that of a red blood cell. These findings will inform the development of GV-based contrast agents and pulse sequences to optimize their detection with ultrasound.



http://ift.tt/2lWdfUR

Mutation analysis of CTNNB1 gene and the ras pathway genes KRAS, NRAS, BRAF, and PIK3CA in eyelid sebaceous carcinomas

Publication date: Available online 1 March 2017
Source:Pathology - Research and Practice
Author(s): Mi Jung Kwon, Eun Sook Nam, Seong Jin Cho, Hye-Rim Park, Soo Kee Min, Jinwon Seo, Ji-Young Choe
Sebaceous carcinoma (SC) represents a rare, aggressive eyelid malignancy with poor prognosis and is a possible component of Muir-Torre syndrome. However, genetic features as driver mutations or potential therapeutic targets are not fully elucidated. Recent a few studies have shown that SCs have concurrently multiple mutations including RAS/RAF/MAPK and PI3K/Akt pathways via next-generation sequencing in western population. Because we recently demonstrated absence of KRAS mutations in Korean eyelid SCs, we extended our previous study to the analysis of NRAS, BRAF, PIK3CA, and CTNNB1 mutations, and the examination of related protein expressions in 15 eyelid SCs.Repeated molecular analysis by peptide nucleic acid-mediated PCR clamping method, PNA clamping-assisted fluorescence melting curve analysis, and direct sequencing revealed that all eyelid SCs had wild type alleles of NRAS, BRAF, and PIK3CA in hotspot exon locations. Only silent mutations in the CTNNB1 gene (p.Q61Q) were identified. Using immunohistochemistry and microsatellite instability analysis, they harbored all intact mismatch repair gene proteins with microsatellite stability. Membranous and cytoplasmic β-catenin staining was found in all tumors, whereas the one third of those tumors showed cyclin D1 overexpression, of which 40% and 80% showed p53 expression and p16 expression, respectively.The lack of KRAS, NRAS, BRAF, and PIK3CA mutation in our study may suggest that a subset of eyelid SCs is unlike that of eyelid SCs of western countries. The mismatch repair gene proteins and microsatellite instability analysis as a screening test for Muir-Torre syndrome may be limited in the Korean eyelid SCs.



http://ift.tt/2lW3gPg

Influence of third molars in mandibular fractures. Part 2: mandibular condyle—a meta-analysis

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and VHL, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 13 studies were included in the systematic review and 11 in the meta-analysis. In terms of the risk of bias analysis, six studies presented ≤6 stars in the Newcastle–Ottawa scale assessment.

http://ift.tt/2lusPmU

Papilla and alveolar crest levels in immediate versus delayed single-tooth zirconia implants

The aim of this study was to determine the correlation between the papilla deficit and the distance between the bone crest at the neighbouring tooth and the contact point of the clinical crown (distance 4) for immediate and delayed zirconia implants. This prospective observational study included 78 patients with 82 implants investigated at the 1-year follow-up. Patients received single-unit zirconia implants (Straumann PURE Ceramic Implant with ZLA surface) that were placed using either the delayed (group A) or immediate (group B) protocol after tooth extraction.

http://ift.tt/2mbpGMT

Papillary carcinoma in struma ovarii

http://ift.tt/2mNsQUa

A rare case of spontaneous Cushing disease remission induced by pituitary apoplexy

http://ift.tt/2lfg6Jq

The mystery of puberty initiation: genetics and epigenetics of idiopathic central precocious puberty (ICPP)

Abstract

Puberty is a major developmental stage. Damaging mutations, considered as "mistakes of nature", have contributed to the unraveling of the networks implicated in the normal initiation of puberty. Genes involved in the abnormal hypothalamic–pituitary–gonadal (HPG) axis development, in the normosmic idiopathic hypogonadotropic hypogonadism (nIHH), in the X-linked or autosomal forms of Kallmann syndrome and in precocious puberty have been identified (GNRH1, GNRHR, KISS1, GPR54, FGFR1, FGF8, PROK2, PROKR2, TAC3, TACR3, KAL1, PROK2, PROKR2, CHD7, LEP, LEPR, PC1, DAX1, SF-1, HESX-1, LHX3, PROP-1). Most of them were found to play critical roles in HPG axis development and regulation, the embryonic GnRH neuronal migration and secretion, the regulation and action of the hypothalamic GnRH. However, the specific neural and molecular mechanisms triggering GnRH secretion remain one of the scientific enigmas. Although GnRH neurons are probably capable of autonomously generating oscillations, many gonadal steroid-dependent and -independent mechanisms have also been proposed. It is now well proven that the secretion of GnRH is regulated by kisspeptin as well as by permissive or opposing signals mediated by neurokinin B and dynorphin. These three supra-GnRH regulators compose the kisspeptin-neurokinin B-dynorphin neuronal (KNDy) system, a key player in pubertal onset and progression. Moreover, an ongoing increasing number of inhibitory, stimulatory and permissive networks acting upstream on GnRH neurons, such as GABA, NPY, LIN28B, MKRN3 and others integrate diverse hormonal and peripheral signals and have been proposed as the "gate-keepers" of puberty, while epigenetic modifications play also an important role in puberty initiation.

http://ift.tt/2mNI0Zy

A modified intraoral and extraoral approach osteotomy for the prominent mandibular angle

A prominent mandibular angle (PMA) is a relatively common condition in Asians, and surgeons typically use the intraoral approach to treat it. However, the approach can have many drawbacks due to the limited operative field and view. The procedures of the osteotomy are not easily performed, and an exact resection is difficult. In addition, major complications can occur readily. This article presents a modified osteotomy method for the PMA that avoids these disadvantages and makes the procedure easier to execute.

http://ift.tt/2mHODgX

Correction of tuberous breast deformity: a retrospective study comparing lipofilling versus breast implant augmentation

Breast implants and more recently autologous fat grafting are the two most common treatments used to correct tuberous breast deformity (TBD). Post-surgical quality of life between the two techniques is not well demonstrated. The purpose of this study is to compare satisfaction and health-related quality of life in patients affected of TBD between these two techniques.All TBD patients operated between January 2008 and May 2015 were retrospectively identified and only those treated with implants or lipofilling were included.

http://ift.tt/2mgAolS

Engineered microenvironments for synergistic VEGF – Integrin signalling during vascularization

Publication date: May 2017
Source:Biomaterials, Volume 126
Author(s): Vladimíra Moulisová, Cristina Gonzalez-García, Marco Cantini, Aleixandre Rodrigo-Navarro, Jessica Weaver, Mercedes Costell, Roser Sabater i Serra, Matthew J. Dalby, Andrés J. García, Manuel Salmerón-Sánchez
We have engineered polymer-based microenvironments that promote vasculogenesis both in vitro and in vivo through synergistic integrin-growth factor receptor signalling. Poly(ethyl acrylate) (PEA) triggers spontaneous organization of fibronectin (FN) into nanonetworks which provide availability of critical binding domains. Importantly, the growth factor binding (FNIII12-14) and integrin binding (FNIII9-10) regions are simultaneously available on FN fibrils assembled on PEA. This material platform promotes synergistic integrin/VEGF signalling which is highly effective for vascularization events in vitro with low concentrations of VEGF. VEGF specifically binds to FN fibrils on PEA compared to control polymers (poly(methyl acrylate), PMA) where FN remains in a globular conformation and integrin/GF binding domains are not simultaneously available. The vasculogenic response of human endothelial cells seeded on these synergistic interfaces (VEGF bound to FN assembled on PEA) was significantly improved compared to soluble administration of VEGF at higher doses. Early onset of VEGF signalling (PLCγ1 phosphorylation) and both integrin and VEGF signalling (ERK1/2 phosphorylation) were increased only when VEGF was bound to FN nanonetworks on PEA, while soluble VEGF did not influence early signalling. Experiments with mutant FN molecules with impaired integrin binding site (FN-RGE) confirmed the role of the integrin binding site of FN on the vasculogenic response via combined integrin/VEGF signalling. In vivo experiments using 3D scaffolds coated with FN and VEGF implanted in the murine fat pad demonstrated pro-vascularization signalling by enhanced formation of new tissue inside scaffold pores. PEA-driven organization of FN promotes efficient presentation of VEGF to promote vascularization in regenerative medicine applications.

Graphical abstract

http://ift.tt/2mHNqWX

Impact of caries and dental fluorosis on oral health-related quality of life: a cross-sectional study in schoolchildren receiving water naturally fluoridated at above-optimal levels

Abstract

Purpose

The purpose of this study was to evaluate the impact of caries and fluorosis on oral health-related quality of life (OHRQoL) among schoolchildren living in areas with high concentrations of fluoride in water.

Methods

Five hundred and twenty-four schoolchildren (8–12 year olds) residing in rural communities in central Mexico were examined for oral hygiene, caries (International Caries Detection and Assessment System, ICDAS II), and fluorosis (Thylstrup and Fejerskov Index, TFI). OHRQoL was evaluated with the Child Perceptions Questionnaire for two age groups (CPQ_8–10 and CPQ_11–14). Generalized structural equation models were constructed for data analysis.

Results

Overall prevalence of caries was 88.5% and fluorosis 46.9%. In the group of 8–10 year olds, 48% of the children had advanced carious lesions in primary or permanent teeth (ICDAS ≥4), 22.6% had moderate/severe fluorosis, and 59.9% of children had an impact on OHRQoL. Schoolchildren with ICDAS ≥4 were more likely [OR = 1.75, (95% CI 1.34–2.28)] to suffer a negative impact on OHRQoL. In the group of 11–12 year olds, 19.9% of children had advanced carious lesions and 23.2% showed moderate/severe fluorosis; 67.3% of children reported had an impact on OHRQoL. Children 11–12 year olds with fluorosis (TFI ≥4) [OR = 2.39 (95% CI 2.12–2.69)], caries (ICDAS ≥4) [OR = 2.18 (95% CI 2.13–2.24)], and low brushing frequency [OR = 2.04 (95% CI 1.21–3.44)] were more likely to have deterioration on OHRQoL.

Conclusion

A negative impact on OHRQoL was observed in children with caries and fluorosis.

Clinical relevance

Deterioration on OHRQoL found in children as a sequel of caries and fluorosis should be considered when designing health policies leading to prevention and effective health promotion programs and incorporated to clinical guidelines for timely dental treatment.

http://ift.tt/2lYCEvc

Idiopathic avascular necrosis associated with humoral deficiency

The prevalence of avascular necrosis (AVN) of the femoral head is unknown, but estimates indicate that the incidence is between 10,000 and 20,000 new cases a year, with a smaller fraction of those being idiopathic.1 Idiopathic AVN has been associated with a variety of autoimmune conditions, including systemic lupus erythematosus and antiphospholipid syndrome.2 It has also been associated with infections and immunodeficiencies, such as human immunodeficiency virus (HIV).3 It has never been described in association with a functional humoral deficiency.

http://ift.tt/2mgzupp

Evaluation of the risk of infection associated with subcutaneous allergen immunotherapy

Questions have recently been raised by regulatory bodies in the United States regarding a potential risk of infections related to subcutaneous allergen immunotherapy (SCIT) injections. In response to a fungal meningitis outbreak from contaminated, compounded injectable medications, the US Food and Drug Administration endorsed the US Pharmacopeia's Pharmaceutical Compounding—Sterility Preparations guidelines as the standard for pharmaceutical compounding in 2013.1 An exemption was granted to allergen extracts as long as they addressed specific procedures that were feasible in an office setting.

http://ift.tt/2mHFdlz

Idiopathic avascular necrosis associated with humoral deficiency

The prevalence of avascular necrosis (AVN) of the femoral head is unknown, but estimates indicate that the incidence is between 10,000 and 20,000 new cases a year, with a smaller fraction of those being idiopathic.1 Idiopathic AVN has been associated with a variety of autoimmune conditions, including systemic lupus erythematosus and antiphospholipid syndrome.2 It has also been associated with infections and immunodeficiencies, such as human immunodeficiency virus (HIV).3 It has never been described in association with a functional humoral deficiency.

http://ift.tt/2mgzupp

Evaluation of the risk of infection associated with subcutaneous allergen immunotherapy

Questions have recently been raised by regulatory bodies in the United States regarding a potential risk of infections related to subcutaneous allergen immunotherapy (SCIT) injections. In response to a fungal meningitis outbreak from contaminated, compounded injectable medications, the US Food and Drug Administration endorsed the US Pharmacopeia's Pharmaceutical Compounding—Sterility Preparations guidelines as the standard for pharmaceutical compounding in 2013.1 An exemption was granted to allergen extracts as long as they addressed specific procedures that were feasible in an office setting.

http://ift.tt/2mHFdlz

Editorial Board

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2





http://ift.tt/2lf6ZII

Instructions for Authors

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2





http://ift.tt/2mNpQqZ

2016 SRS Presidential Address

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): David W. Polly, James W. Ogilvie, Catherine Mills Davis




http://ift.tt/2mNzAkU

Table of Contents

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2





http://ift.tt/2lf5hqZ

Art Is Long, Life Is Short: Lessons Learned in the Life of a Spine Surgeon

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Behrooz A. Akbarnia




http://ift.tt/2lf6Xk4

Masthead

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2





http://ift.tt/2mNA7TT

Report of the 2016 SRS Traveling Fellowship

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Brice Ilharreborde, Bangping Qian, Kota Watanabe, Keith D. Luk




http://ift.tt/2lf6NJC

Influence of Sequential Ponte Osteotomies on the Human Thoracic Spine With a Rib Cage

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Erin M. Mannen, Paul M. Arnold, John T. Anderson, Elizabeth A. Friis
Study DesignBiomechanical cadaveric study.ObjectivesThe purpose of this study was to determine the change in range of motion (ROM) of the human thoracic spine and rib cage due to sequential Ponte osteotomies (POs).Summary of Background DataPOs are often performed in deformity correction surgeries to provide flexibility in the sagittal plane at an estimated correction potential of 5° per PO, but no studies have evaluated the biomechanical impact of the procedure on a cadaveric model with an intact rib cage.MethodsSeven human thoracic cadavers with intact rib cages were loaded with pure moments in flexion, extension, axial rotation, and lateral bending for five conditions: intact, PO at T9–T10, PO at T8–T9, PO at T7–T8, and PO at T6–T7. Motion of T1, T6, and T10 were measured, and overall (T1–T12) and regional (T6–T10) ROMs were reported for each mode of bending at each condition.ResultsPOs increased ROM in flexion both overall (T1–T12) and regionally (T6–T10), although the magnitude of the increase was marginal (<1°/PO). No significant differences were found in axial rotation or lateral bending.ConclusionsPOs may increase sagittal correction potential before fusion in patients with hyperkyphosis, though more work should be done to determine the magnitude of the changes.Level of EvidenceLevel V.



http://ift.tt/2mNmiVF

Current Evidence Regarding Diagnostic Imaging Methods for Pediatric Lumbar Spondylolysis: A Report From the Scoliosis Research Society Evidence-Based Medicine Committee

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Charles G.T. Ledonio, Douglas C. Burton, Charles H. Crawford, Robert Shay Bess, Jacob M. Buchowski, Serena S. Hu, Baron S.H. Lonner, David W. Polly, Justin S. Smith, James O. Sanders
BackgroundSpondylolysis is common among the pediatric population, yet no formal systematic literature review regarding diagnostic imaging has been performed. The Scoliosis Research Society (SRS) requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis.MethodsLiterature was searched professionally and citations retrieved. Abstracts were reviewed and analyzed by the SRS Evidence-Based Medicine Committee. Level I studies were considered to provide Good Evidence for the clinical question. Level II or III studies were considered Fair Evidence. Level IV studies were considered Poor Evidence. From 947 abstracts, 383 full texts reviewed. Best available evidence for the questions of diagnostic methods was provided by 27 studies: no Level I sensitivity/specificity studies, five Level II and two Level III evidence, and 19 Level IV evidence.ResultsPain with hyperextension in athletes is the most widely reported finding in history and physical examination. Plain radiography is considered a first-line diagnostic test for suspected spondylolysis, but validation evidence is lacking. There is consistent Level II and III evidence that pars defects are detected by advanced imaging in 32% to 44% of adolescents with spondylolysis based on history and physical. Level III evidence that single-photon emission computed tomography (SPECT) is superior to planar bone scan and plain radiographs but limited by high rates of false-positive and false-negative results and by high radiation dose. Computed tomography (CT) is considered the gold standard and most accurate modality for detecting the bony defect and assessment of osseous healing but exposes the pediatric patient to ionizing radiation. Magnetic resonance imaging (MRI) is reported to be as accurate as CT and useful in detecting early stress reactions of the pars without a fracture.ConclusionPlain radiographs are widely used as screening tools for pediatric spondylolysis. CT scan is considered the gold standard but exposes the patient to a significant amount of ionizing radiation. Evidence is fair and promising that MRI is comparable to CT.



http://ift.tt/2lf83fV

Scoliosis and the Social Media: Facebook as a Means of Information Exchange

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Jonathan P. Ng, Nadim Tarazi, Damien P. Byrne, Joseph F. Baker, John P. McCabe
Background ContextOver the last decade, the emergence of social networking websites such as Facebook have revolutionized information dissemination and broadened opportunities to engage in discussions. In particular, having been widely adopted in the younger generation, the use of this medium has become more prevalent in health disorders such as scoliosis in the adolescent population. However, the quality of information on Facebook is unregulated and variable, which may mislead patients in their decision making.PurposeTo document the various types of information available and assess the quality of information on Facebook discussion boards using recognized scoring systems.Study DesignTo evaluate the quality of information on the social network.Patient SampleA search for the keyword "scoliosis" on Facebook was performed and the first 100 pages generated were reviewed.Outcomes MeasuredSCSS and DISCERN score.MethodsContent analysis was performed on discussion boards and personal blogs. Two independent examiners evaluated each site according to scoliosis-specific content score (SCSS) and the DISCERN criteria, both previously used instruments to judge the quality of information on the Internet pertaining to scoliosis. The SCSS range from 0 to 32 (higher score better) and the DISCERN 16 to 80 (higher score better).ResultsOf the 100 sites reviewed, 33 were discussion boards and personal blogs. Of these, the overall average SCSS was 5.7 (SD 5.8, range 0–20) and the DISCERN was 22.5 (SD 7.6, range 16–45), indicating that using general scoring systems the quality of information provided was overall poor.ConclusionUsing recognized scoring systems to analyze Facebook pages used as discussion forums or blogs, we showed that the quality in general was poor. For modern practices to adapt to an era of information exchange via the social network, the orthopedic community should develop ways to incorporate the social media in future patient education.



http://ift.tt/2mNk5t5

Can Postoperative Radiographs Accurately Identify Screw Misplacements?

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Vishal Sarwahi, Saankritya Ayan, Terry Amaral, Stephen Wendolowski, Rachel Gecelter, Yungtai Lo, Beverly Thornhill
Study DesignRetrospective case series.ObjectiveThe objective of this study was to determine the safety of postoperative radiographs to assess screw placement.Summary of Background DataPreviously defined criteria are frequently employed to determine pedicle screw placement on intraoperative supine radiographs. Postoperatively, radiographs are typically used as a precursor to identify screws of concern, and a computed tomographic (CT) is typically ordered to confirm screw safety.MethodsFirst, available postoperative PA and lateral radiographs were reviewed by 6 independently blinded observers. Screw misplacement was assessed using previously defined criteria. A musculoskeletal radiologist assessed all CT scans for screw placement. Pedicle screw position was classified either as acceptable or misplaced. Misplacements were subclassified as medial, lateral, or anterior.ResultsOne hundred four patients with scoliosis or kyphosis underwent posterior spinal fusion and had postoperative CT scan available were included. In total, 2,034 thoracic and lumbar screws were evaluated. On CT scan, 1,772 screws were found to be acceptable, 142 were laterally misplaced, 30 medially, and 90 anteriorly. Of the 30 medially placed screws, 80% to 87% screws were believed to be in positions other than medial, with a median of 73% (63% to 92%) of these screws presumed to be in normal position. Similarly, of the 142 screws placed laterally, 49% to 81% screws were identified in positions other than lateral, with a median of 77% (59% to 96%) of these screws felt to be in normal position. Of the 90 anteriorly misplaced screws, 16% to 87% screws were identified in positions other than anterior, with 72% (20% to 98%) identified as normal. The criteria produced a median 52% sensitivity, 70% specificity, and 68% accuracy across the 6 observers.ConclusionRadiograph is a poor diagnostic modality for observing screw position.Level of EvidenceLevel IV.



http://ift.tt/2lfcBTF

Prognosis of Significant Intraoperative Neurophysiologic Monitoring Events in Severe Spinal Deformity Surgery

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Benjamin T. Bjerke, Daniel M. Zuchelli, Venu M. Nemani, Ronald G. Emerson, Han Jo Kim, Oheneba Boachie-Adjei
BackgroundIntraoperative neurophysiologic monitoring has become a standard tool for mitigating neurologic injury during spinal deformity surgery. Significant monitoring changes during deformity correction are relatively uncommon. This study characterizes precipitating factors for neurologic injury and relates significant events and postoperative neurologic prognosis.MethodsAll spinal deformity surgeries at a West African hospital over a 12-month period were reviewed. Patients were included if complete operative reports, monitoring data, and postoperative neurologic examinations were available for review. Surgical and systemic triggers of monitoring events were recorded and neurologic status was followed for 6 weeks postoperatively.ResultsEighty-eight patients met inclusion criteria. The average age was 14 years (3–28). The average kyphosis was 108° (54°–176°) and average scoliosis was 100° (48°–177°). There were 44 separate neurologic events in 34 patients (39%). The most common triggers were traction or positioning (16), posterior column osteotomies/vertebral column resections (9/1), and distraction, corrective maneuvers, or implant placement (12). On surgery completion, 100% (12/12) of events from non-osteotomy-related surgical procedures, 75% (12/16) of events from traction or positioning resolved; however, 0% (0/10) of events from osteotomies resolved completely. Eight percent (7/88) had new neurologic deficits postoperatively, all with intraoperative monitoring changes. In 6 of these 7 patients, the event was attributed to an osteotomy; in 1 patient the cause was not determined. At 6-week follow-up, all patients had some preserved motor function bilaterally with the ability to walk (ASIA D/E) or recovered completely.ConclusionsIntraoperative signal changes were most frequently from traction or positioning. However, the most common cause of persistent neurologic deterioration and the only cause of postoperative neurologic deficit was the performance of osteotomies. Unlike traction- or instrument-related correction, osteotomies produce irreversible changes, from canal intrusion or sudden localized deformity change. The incidence of postoperative neurologic deficit is very low when the inciting cause is reversed; however, osteotomy-related events are irreversible, with a high incidence of associated lasting neurologic injury.



http://ift.tt/2mNiMuo

MRI Screening in Operative Scheuermann Kyphosis: Is it Necessary?

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Baron S. Lonner, Courtney S. Toombs, Michael Mechlin, Gina Ciavarra, Suken A. Shah, Amer F. Samdani, Paul Sponseller, Harry L. Shufflebarger, Randal R. Betz, Burt Yaszay, Peter O. Newton
Study DesignPatients with preoperative spine magnetic resonance imaging (MRI) studies from a prospective multicenter study of operative adolescent Scheuermann kyphosis (SK).ObjectivesTo investigate the usefulness of MRI screening in operative planning for SK surgeries.Summary of Background DataNeural axis abnormalities in operative SK have not been previously studied with MRI screening, despite its use.MethodsOne orthopedic surgeon and two radiologists evaluated all images retrospectively. Radiographs were evaluated for kyphosis apex and magnitude. MRIs were evaluated for spinal cord abnormalities, epidural lipomatosis, location and number of vertebral wedging, Schmorl nodes and posterior disc herniations, frequency of spondylolysis, etc. The relationship of these pathologies to the kyphosis apex was explored. This group was compared to a surgical SK group without preoperative MRIs.ResultsEighty-six patients with MRIs, mean age 16.3 years, 64% male, and a mean preoperative kyphosis of 75.9° were evaluated. There were 17 spinal cord abnormalities. Low-lying conus was found in 2 patients, and syrinx in 15 (no Chiari malformations). Epidural lipomatosis was found in 49 patients, average of 5.7 levels. Anterior vertebral wedging occurred in all (mean 4.7 levels). Posterior disc herniations averaged 5.2 levels/patient and 1.8 levels caudad to the apex. Spondylolysis was reported in 8.1%. Four cases (4.7%) had the operative plan changed as a result of the preoperative MRI: two due to neural compression, one due to disc herniation and one due to a spinal cord draped over the apex. Thirty-one patients did not receive an MRI; there were no significant differences between the two groups. The rate of postoperative neurologic change was 3.5% in the MRI group and 3.2% in the no-MRI group.ConclusionsBased on 4.7% of cases requiring a change in the operative plan as a result of preoperative MRI, the authors recommend considering performing screening MRI in operative SK patients.



http://ift.tt/2lf6K0o

Benign Natural History of Spondylolysis in Adolescence With Midterm Follow-Up

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Ted Sousa, David L. Skaggs, Priscella Chan, Kent T. Yamaguchi, Jerald Borgella, Christopher Lee, Jeffrey Sawyer, Alice Moisan, John M. Flynn, Melissa Gunderson, M. Timothy Hresko, Pierre D'Hemecourt, Lindsay M. Andras
Study DesignRetrospective chart review.ObjectivesTo use the Micheli Functional Scale to assess adolescent patients with spondylolysis treated conservatively at midterm follow-up.Summary of BackgroundSpondylolysis is a common source of back pain for adolescents and is generally managed with bracing and physical therapy. There is little data regarding the results of conservative management of spondylolysis over time.MethodsFour major academic pediatric institutions performed a retrospective chart review of patients from 5 to 21 years of age with the initial diagnosis of spondylolysis. Inclusion criteria were patients who initially underwent conservative management and had a minimum of 2 years' follow-up. The patients were contacted and asked to complete the Micheli Functional Scale Survey.ResultsA total of 295 patients with the diagnosis of spondylolysis were identified and contacted. Sixty-one subjects with spondylolysis completed the follow-up survey. Sixty of 61 respondents (98%) answered questions regarding their current pain level. Thirty-five of 60 (58.3%) reported no pain (0/10) and 47/60 (78%) rated their pain at 3 or less, whereas 22% (13/60) rated their pain as 4 or higher. There was no correlation with pain ratings on the follow-up survey and radiographic healing at initial management.Of the 61 patients, 50 returned to sports (82%), 8 did not return (13%), and 5 returned to most but not all of their sports (8%). No correlation was observed between radiographic healing and return to sports (p = .4885).ConclusionUsing a validated functional scale, this study demonstrated that with conservative management of spondylolysis a majority of patients at an average of 8 years out self-report a return to sports (90%), though many reported continued pain (42%) and interference with activities (67%). There was no correlation observed between radiographic evidence of healing and pain or return to sports with a mean follow-up of 8 years.Level of EvidenceMulticenter retrospective case series.



http://ift.tt/2mNzvxC

Predictors of Health-Related Quality-of-Life After Complex Adult Spinal Deformity Surgery: A Scoli-RISK-1 Secondary Analysis

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Leah Y. Carreon, Steven D. Glassman, Christopher I. Shaffrey, Michael G. Fehlings, Benny Dahl, Christopher P. Ames, Yukihiro Matsuyama, Yong Qiu, Hossein Mehdian, Kenneth M.C. Cheung, Frank J. Schwab, Ferran Pellisé, Khaled M. Kebaish, Lawrence G. Lenke
Study DesignLongitudinal cohort.ObjectivesTo identify variables that predict 2-year Short Form-36 Physical Composite Summary Score (SF-36PCS) and the Scoliosis Research Society-22R (SRS22-R) Total score after surgery for complex adult spinal deformity.Summary of Background DataIncreasingly, treatment effectiveness is assessed by the extent to which the procedure improves a patient's health-related quality of life (HRQOL). This is especially true in patients with complex adult spinal deformity.MethodsThe data set from the Scoli-Risk-1 study was queried for patients with complete 2-year SF-36 and SRS-22R. Regression analysis was performed to determine predictors of 2-year SF-36PCS and SRS-22R Total scores. Factors included were sex, age, smoking status, body mass index, American Society of Anesthesiologists (ASA) grade, Lower Extremity Motor Score improvement, indication for surgery, preoperative and 2-year maximum coronal Cobb angles, number of prior spine surgeries, number of three-column osteotomies, number of surgical levels, number of surgical stages, lowest instrumented level, presence and type of neurologic complication, and number of reported serious adverse events.ResultsOf 272 cases enrolled, 206 (76%) cases were included in this analysis, 143 (69%) females, and mean age of 57.69 years. Factors that were significantly associated with of 2-year SF-36PCS were age (p < .001), ASA grade (p < .001), maximum preoperative Cobb angle (p = .007), number of three-column osteotomies (p = .049) and type of neurologic complication (p = .068). Factors predictive of 2-year SRS-22R Total scores were maximum preoperative Cobb angle (p = .001) and the number of serious adverse events (p = .071).ConclusionsFactors predictive of lower 2-year HRQOLs after surgery for complex adult spinal deformity were older age, higher ASA grade, larger preoperative Cobb angle, larger numbers of three-column osteotomies, and the occurrence of both neurologic and nonneurologic complications. Most of these factors are beyond the control of surgeons. Still, surgeons should medically optimize a patient prior to surgery to minimize the risk of complications and offer the best chance of improving a patient's quality of life.Level of EvidenceLevel II. Prospective cohort.



http://ift.tt/2lf6SwM

Timing of Complications Occurring Within 30 Days After Adult Spinal Deformity Surgery

Publication date: March 2017
Source:Spine Deformity, Volume 5, Issue 2
Author(s): Rafael De la Garza Ramos, C. Rory Goodwin, Peter G. Passias, Brian J. Neuman, Khaled M. Kebaish, Virginie Lafage, Frank Schwab, Daniel M. Sciubba
Study DesignCross-sectional study of a national surgical database.ObjectiveTo investigate the timing of complications after adult spinal deformity (ASD) surgery.Summary of Background DataThere is limited data on the range of days when complications after ASD surgery occur.MethodsThe American College of Surgeons National Surgical Quality Improvement database was reviewed for the years 2007–2013. Inclusion criteria were adult patients (over 21 years of age) who underwent spinal fusion for ASD. Ten unique complications occurring within 30 postoperative days were examined and the median day to diagnosis was recorded.ResultsA total of 1,250 patients met inclusion criteria with an overall complication rate of 13.5%. The median day of diagnosis (and interquartile range) for each complication was as follows: myocardial infarction (3.5, 1–5), pulmonary embolism (4, 2–16), reintubation (4.5, 1–11), pneumonia (6, 3–9), urinary tract infection (11, 5–15), sepsis (12, 6–18.5), deep vein thrombosis (12, 6–19), deep surgical site infection (SSI; 18.5, 13–23), superficial SSI (19, 13–24), and organ space SSI (21, 17–25). The three complications that were most commonly diagnosed before hospital discharge included pneumonia, reintubation, and myocardial infarction (diagnosed before discharge on more than 70% of cases). On the other hand, superficial, deep, and organ space infection were diagnosed in less than 40% of cases before patients left the hospital. On univariate analysis, predictors of complication occurrence included older age (p = .014), instrumentation of 7–12 levels (p = .034), and instrumentation of 13 or more levels (p = .035).ConclusionUnderstanding the timing of specific complications after adult spinal deformity surgery is important for both patients and clinicians. Efforts in prevention of such conditions should continue, as well as heightened awareness during the periods of highest risk.



http://ift.tt/2mNmeoT

Quality assurance guidelines for superficial hyperthermia clinical trials

Abstract

Quality assurance (QA) guidelines are essential to provide uniform execution of clinical trials with uniform quality hyperthermia treatments. This document outlines the requirements for appropriate QA of all current superficial heating equipment including electromagnetic (radiative and capacitive), ultrasound, and infrared heating techniques. Detailed instructions are provided how to characterize and document the performance of these hyperthermia applicators in order to apply reproducible hyperthermia treatments of uniform high quality. Earlier documents used specific absorption rate (SAR) to define and characterize applicator performance. In these QA guidelines, temperature rise is the leading parameter for characterization of applicator performance. The intention of this approach is that characterization can be achieved with affordable equipment and easy-to-implement procedures. These characteristics are essential to establish for each individual applicator the specific maximum size and depth of tumors that can be heated adequately. The guidelines in this document are supplemented with a second set of guidelines focusing on the clinical application. Both sets of guidelines were developed by the European Society for Hyperthermic Oncology (ESHO) Technical Committee with participation of senior Society of Thermal Medicine (STM) members and members of the Atzelsberg Circle.

http://ift.tt/2lYFxMJ

Consensus statement for the treatment of infantile haemangiomas with propranolol

Abstract

Although most infantile haemangiomas do not require treatment due to a natural history of spontaneous involution, some require early intervention. The Australasian Vascular Anomalies Network and the Australasian Paediatric Dermatology Network have developed a consensus statement for the treatment of infantile haemangiomas with oral propranolol. Infants with haemangiomas that are life threatening, at risk of ulceration, or at risk of causing a significant functional impairment, psychological impact or physical deformity should be treated early with oral propranolol. Oral propranolol is safe and effective and in most healthy infants oral propranolol can be started in an outpatient setting.

http://ift.tt/2lVXg9i

Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon

Abstract

Background/Objectives

There is little data on the profile and magnitude of scabies in sub-Saharan African prisons. The present study aimed to assess the prevalence and determinants of scabies in prisons of the west region of Cameroon.

Methods

We conducted a cross-sectional study from March to August 2014, and consecutively recruited volunteer detainees of three randomly selected prisons in the West Region of Cameroon. The diagnosis was based on clinical findings after assessment by two experienced and well-trained dermatologists.

Results

We enrolled 755 prisoners, 17 (2%) of whom were women. Their mean age was 32 ± 12 years. There were 242 cases (32%) of scabies, with significantly more cases in the most crowded prison (P < 0.0001). Men were significantly more affected than women (P = 0.004) and the prevalence of scabies significantly decreased when the level of education increased (P < 0.0001). In addition to a low level of education (adjusted odds ratio (aOR) 1.90; P < 0.0001), sharing clothes/bedding (aOR 2.72; P < 0.0001) and the number of detainees per cell > 10 (aOR 1.89; P = 0.002), but not age, duration of incarceration, number of baths/week and washing/week, were independent drivers of scabies occurrence.

Conclusion

Almost one-third of prisoners suffered from scabies in our prisons. A low educational level, the sharing of clothes/bedding and number of detainees/cell > 10 were independent determinants of the disease. Urgent measures must be undertaken to reduce the burden of scabies in our prisons.

http://ift.tt/2lVSp7P

Consensus statement for the treatment of infantile haemangiomas with propranolol

Abstract

Although most infantile haemangiomas do not require treatment due to a natural history of spontaneous involution, some require early intervention. The Australasian Vascular Anomalies Network and the Australasian Paediatric Dermatology Network have developed a consensus statement for the treatment of infantile haemangiomas with oral propranolol. Infants with haemangiomas that are life threatening, at risk of ulceration, or at risk of causing a significant functional impairment, psychological impact or physical deformity should be treated early with oral propranolol. Oral propranolol is safe and effective and in most healthy infants oral propranolol can be started in an outpatient setting.

http://ift.tt/2lVXg9i

Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon

Abstract

Background/Objectives

There is little data on the profile and magnitude of scabies in sub-Saharan African prisons. The present study aimed to assess the prevalence and determinants of scabies in prisons of the west region of Cameroon.

Methods

We conducted a cross-sectional study from March to August 2014, and consecutively recruited volunteer detainees of three randomly selected prisons in the West Region of Cameroon. The diagnosis was based on clinical findings after assessment by two experienced and well-trained dermatologists.

Results

We enrolled 755 prisoners, 17 (2%) of whom were women. Their mean age was 32 ± 12 years. There were 242 cases (32%) of scabies, with significantly more cases in the most crowded prison (P < 0.0001). Men were significantly more affected than women (P = 0.004) and the prevalence of scabies significantly decreased when the level of education increased (P < 0.0001). In addition to a low level of education (adjusted odds ratio (aOR) 1.90; P < 0.0001), sharing clothes/bedding (aOR 2.72; P < 0.0001) and the number of detainees per cell > 10 (aOR 1.89; P = 0.002), but not age, duration of incarceration, number of baths/week and washing/week, were independent drivers of scabies occurrence.

Conclusion

Almost one-third of prisoners suffered from scabies in our prisons. A low educational level, the sharing of clothes/bedding and number of detainees/cell > 10 were independent determinants of the disease. Urgent measures must be undertaken to reduce the burden of scabies in our prisons.

http://ift.tt/2lVSp7P

Suction blistering the lesional skin of vitiligo patients reveals useful biomarkers of disease activity

Vitiligo is an autoimmune disease of the skin with limited treatment options; there is an urgent need to identify and validate biomarkers of disease activity to support vitiligo clinical studies.

http://ift.tt/2mNd5N2

Macrophage and osteoclast polarization in bisphosphonate associated necrosis and osteoradionecrosis

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a complication of antiresorptive therapy with nitrogen-containing bisphosphonates (BP). With various suggestions as to pathogenesis, the etiology of BRONJ is not sufficiently understood. Osteoclasts and their precursors, that is, macrophages, are the main target cells of BP. BP can repolarize regeneration- and healing-associated M2 macrophages towards the tissue destructive M1-type. The current study aims to elucidate differences in macrophage and osteoclast polarization in BRONJ, osteoradionecrosis (ORN) and healthy control specimens.

http://ift.tt/2mgmWOA

Gene expression profiling of circulating CD133+ cells of hepatocellular carcinoma patients associated with HCV infection

Publication date: Available online 1 March 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Abdel-Rahman N. Zekri, Enas R. El-Sisi, Zeinab F. Abdallah, Alaa El-Din Ismail Abd El-Motaleb, Ahmed Barakat Barakat
AimIdentifying the genetic expression profile of CD133⁺ cells from HCC patients compared to CD133⁺ cells from healthy volunteers that may contribute in hepatocarcinogenesis process.MethodCirculating CD133⁺ cells were sorted from the peripheral blood of HCC patients as well as from healthy volunteers using magnetic activated cell sorting. The differential expression profile of stem cell related genes was performed using the Stem Cell PCR profiling assay.ResultsData analysis of stem cells related genes in CD133⁺ cells of the HCC group compared to the control group showed that; CCND2, COL1A1, CTNNA1, DLL3, JAG1, KRT15, MYC, NOTCH2, T and TERT were up-regulated (fold change=80, 68.6, 6.67, 7.22, 3.8, 15.2, 14.5, 105.6, 26.6 and 99 respectively while only CD3D was down-regulated (fold change=0.055) in HCC patients. However, after application of Beferroni correction to adjust P-value; KRT15 was the only gene that was significantly over expressed in CD133⁺ cells of HCC compared to control group (P-value=0.012).ConclusionKRT15 can be used to differentiate between circulating CD133⁺ cells from HCC group control group. However, further study may be needed to confirm on the protein level.



http://ift.tt/2lBhToF

Prognostic significance of epithelial/stromal caveolin‐1 expression in prostatic hyperplasia, high grade prostatic intraepithelial hyperplasia and prostatic carcinoma and its correlation with microvessel density

Publication date: Available online 1 March 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Dareen A. Mohammed, Duaa S. Helal
Caveolin-1 may play a role in cancer development and progression. The aim was to record the expression and localization of caveolin-1 in benign prostatic hyperplasia (BPH), high grade prostatic intraepithelial neoplasia (HGPIN) and prostatic carcinoma (PCa). Microvessel density was evaluated with CD34 immunostain. Correlations with known prognostic factors of PCa were recorded. Immunohistochemical expression of caveolin-1 and the MVD was evaluated in 65 cases; BPH (25), HGPIN (20) and PCa (20). Stromal caveolin-1expression was significantly higher in BPH than HGPIN and PCca. There was significant inverse relation between stromal caveolin-1 expression and extension to lymph node and seminal vesicle in carcinoma cases. Epithelial caveolin-1 was significantly higher in carcinomas than in BPH and HGPIN. Epithelial expression in carcinoma was significantly associated with preoperative PSA, Gleason score and lymph node extension. MVD was significantly higher in PCa than in BPH and HGPIN. There were significant relations between MVD and preoperative PSA, Gleason score, lymph node and seminal vesicle extension. Stromal caveolin-1 was associated with low MVD while epithelial caveolin-1 with high MVD. Conclusions: Caveolin-1 plays an important role in prostatic carcinogenesis and metastasis. Stromal expression of caveolin-1 in PCa is lowered in relation to BPH and HGPIN. In PCa; stromal caveolin-1 was associated with good prognostic parameters. Epithelial caveolin-1 is significantly increased in PCa than BPH and HGPIN. It is associated with clinically aggressive disease. Caveolin-1 may play a role in angiogenesis.



http://ift.tt/2mvQ0Ch

Resurrection of whole liver radiotherapy—A case report

Publication date: Available online 1 March 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Sabeena Choudhary, Swarupa Mitra, Manoj Kumar Sharma, Pooja Khullar, Upasna Saxena
IntroductionThis is a case report of a patient of lymphoma with liver metastasis who had persistent pain and jaundice despite multiple lines of chemotherapy. She underwent palliative liver irradiation. This is an uncommon modality due to fear of radiation induced hepatitis. We reviewed literature available on the use of liver irradiation for palliation and concluded that it can be safely used with good results. A 33-year-old female with Non-Hodgkin's Lymphoma (NHL) presented with obstructive jaundice. She underwent stenting followed by chemotherapy. She was lost to follow up to later present with a progressively increasing right hypochondrial mass, pain and icterus. Ultrasound abdomen revealed massive hepatomegaly with hypodense lesions in both liver lobes and centring the porta with dilatation of biliary radicals. Despite multiple lines of chemotherapy and use of opioids, there was no symptomatic relief in pain, size of mass or any decrease in biochemical parameters. Then she was offered palliative radiation in the form of partial liver irradiation to a dose of 21Gy/7 fractions. She had >50% pain relief after 2 fractions and was off opioids by last fraction. Liver span reduced from 6cm to 1cm below costal margin in mid clavicular line. Radiologically 60% reduction in size of liver lesions was observed. Also, a decreasing trend in biochemical parameters was observed. Use of whole or partial liver irradiation is rare in clinical practice due to fear of radiation induced hepatitis by conventional techniques. Newer techniques of delivering radiation can highly improvise accuracy and permit further dose escalation.



http://ift.tt/2lBggau

Malignant peripheral nerve sheath tumor of the tongue with an unusual pattern of recurrence

Publication date: Available online 1 March 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Soumyajit Roy, Ajeet Kumar Gandhi, Bharti Devnani, Lavleen Singh, Bidhu Kalyan Mohanti
Malignant peripheral nerve sheath tumor (MPNST) of oral cavity is an extremely uncommon malignancy. Less than 15 cases have been reported since 1973 though none of them describes a distant metastasis. We present a rare case of MPNST of the tongue who presented with features of hypoglossal nerve palsy. Incisional biopsy showed a malignant spindle cell tumor in the sub-epithelial connective tissue. The tumor cells were immune-positive for S-100. He underwent surgery followed by adjuvant chemo-radiation. Later the disease recurred in the form of isolated pelvic bone metastasis. Palliative chemotherapy was offered to him. With this case report we intend to refer to such unusual presentation and pattern of recurrence in a MPNST of tongue.



http://ift.tt/2mvPhAW

Spectrum of fungal infection in head and neck cancer patients on chemoradiotherapy

Publication date: Available online 1 March 2017
Source:Journal of the Egyptian National Cancer Institute
Author(s): Gunjesh Kumar Singh, Malini R. Capoor, Deepthi Nair, K.T. Bhowmik
BackgroundRadiotherapy for head and neck cancers (HNC) causes alteration of oral mucosal barrier predisposing it to colonization and infection. Such infections often result in pain and burning sensation thus contributing to major morbidity.Objective1. To identify the fungi isolated from the patients undergoing radiotherapy for HNC.2. To determine their antifungal susceptibility and week of colonization.3. To find out association between oral fungal infection and severity of oral mucositis.Materials and methodsStudy was done on 50 patients of HNC treated with concurrent chemoradiotherapy. Three samples (throat, urine, blood) were collected for fungal culture and sensitivity. These samples were collected before the start of radiotherapy, during radiotherapy (2nd and 6th week) and post radiotherapy (10th week).ResultsOnly 49 patients were available for analysis. Fungal infection was found in 27/49 patients (55.10%) out of which Non-albicans Candida was isolated in 18/49 (36.73%) and Candida albicans in 9/49 (18.36%) cases. About 66.66% (18/27) isolates were sensitive to fluconazole. Maximum isolation of yeast was during 6th week of radiotherapy. All grade 4 and 71.42% of grade 3 oral mucositis were found in patients who were positive for fungal infection.ConclusionThe spectrum of fungal species in throat swab was: Non-albicans Candida and Candida albicans observed in 36.73% and 18.36% of patients respectively. Higher rate of fungal colonization and infection was found in patients with grade 3/4 oral mucositis. Prophylactic fluconazole in HNC patients on concurrent chemoradiotherapy has the potential to reduce emerging invasive fungal infection and its associated morbidity.



http://ift.tt/2lBi2YT

Sequential curing of thiol-acetoacetate-acrylate thermosets by latent Michael addition reactions

Publication date: 24 March 2017
Source:Polymer, Volume 113
Author(s): Ali Osman Konuray, Freddy Liendo, Xavier Fernández-Francos, Àngels Serra, Marco Sangermano, Xavier Ramis
Thiol-acetoacetate-acrylate ternary dual-curing thermosets were prepared by a sequential process consisting of thiol-Michael addition to acrylates at room temperature followed by Michael addition of acetoacetates to acrylates at moderately elevated temperature. The curing sequence can be controlled with the help of the different acidities of the protons on thiol and acetoacetate groups, the favorable pKa of the base used as catalyst and the self-limiting character of Michael additions. The latency of the curing steps can be regulated by selection of the right catalysts, temperature and curing conditions. The properties of the intermediate and final materials can be tuned by changing the structure of the monomers and the contribution of both Michael addition reactions.

Graphical abstract

http://ift.tt/2mvHcwf

In-situ orientation and crystal growth kinetics of P3HT in drop cast P3HT:PCBM films

Publication date: 24 March 2017
Source:Polymer, Volume 113
Author(s): Abul F. Huq, Ali Ammar, Abdullah M. Al-Enizi, Alamgir Karim
Effect of casting solvents on drop cast thin films of conductive conjugated polymers is largely studied by characterizing post processed films. However, the results have often been inconclusive due to the complexity of the in-situ evolution of structures. In this research we implement in-situ grazing incidence wide angle x-ray scattering (GIWAXS) approach to extracting morphological evolution information during film formation in model Poly(3-hexylthiophene) (P3HT): [6,6]-phenyl C61-butyric acid methyl ester (PCBM) blend films that have otherwise been widely studied. Casting solvents include chloroform, benzene and tetrahydrothiophene (THT), carefully selected for their relative solubilities of P3HT and PCBM. Individual casting solvent studies show that the casting solvents' solubility for P3HT and pure solvent boiling point, along with residual solvent content in the films have significant implications on final thin film morphology and crystallization of its constituent components. For example, the orientations of P3HT in P3HT:PCBM films, cast from different solvents, are largely affected by the individual solubilities of P3HT and PCBM, and substrate surface energy. On the other hand PCBM crystal growth from different PCBM solutions predominantly depends on the solubilities of PCBM in the solvents and boiling points of solvents. In this study we correlate and distinguish the drying behavior of the blend films with respect to the drying behavior of its constituent components. These results have important ramifications for controlling desired morphology for polymer electronics, such as organic photovoltaics (OPV), organic field effect transistor (OFET) and photo-detectors.

Graphical abstract

http://ift.tt/2mvIlE4

Morphologies of spherical polyampholyte brushes: Effects of counterion valence and charged monomer sequence

Publication date: 24 March 2017
Source:Polymer, Volume 113
Author(s): Qianqian Cao, Hao You
We study the conformational behavior of spherical brushes composed of polyampholyte chains end-grafted onto spherical particles in the presence of monovalent and tetravalent counterions using molecular dynamics simulations. The overall net charge for each chain consisting of both positively and negatively charged segments is zero. The dependences of the structural properties of the brushes on the chain stiffness, grafting density and charge sequence along the chains are examined systemically. For the diblock brushes, our results indicate that increasing the chain rigidity leads to a significant effect of counterion valence and a reduced collapsing degree of the brushes. At high chain stiffness, the number of high-valent counterions trapped in the brushes is diminished compared to the cases with monovalent counterions, corresponding to lower osmotic pressure. For the flexible brushes, the short-range and electrostatic interactions depending on the charge sequence, determine the conformational transition of the brushes, whereas the effect of counterion valence becomes weaker. In the presence of high-valent counterions, the brushes which consist of polyampholyte chains with blocks of medium length, adopt a slightly stretched conformation owing to relatively strong electrostatic correlation between high-valent counterions and oppositely charged monomers.

Graphical abstract

http://ift.tt/2mvKXld

Multidimensional Assessment of the Effectiveness of Group Voice Therapy

Group voice therapy has been successfully used in patients with dysphonia, but there is little objectively documented evidence of its effects on voice quality and the self-perception of voice fatigue. The aim of this study was to investigate the effectiveness of group therapy in patients with functional dysphonia and minor anatomic vocal fold pathologies linked by appearance and history to voice use in an objective and multidimensional manner.

http://ift.tt/2mgD56R

Anatomic distribution of cervicofacial lymphatic malformations based on lymph node groups

Lymphatic malformations (LM) are rare benign congenital malformations of lymphatic vessels [1]. The incidence of head and neck LM is approximately 1 of every 2000 to 4000 live births [2]. These lesions typically present as soft, colorless masses that generally grow proportionally with the child. Approximately 90% of lesions are diagnosed by five years of age and can be subject to rapid growth with infection or trauma [3]. Symptoms are commonly related to the size of the malformation and encasement of adjacent structures.

http://ift.tt/2mvP01f

Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy

Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect.

http://ift.tt/2mNqswq

Syk expression and IgE-mediated histamine release in basophils as biomarkers for predicting the clinical efficacy of omalizumab

Omalizumab is a treatment for asthma that has a success rate of approximately 40% to 50%.1 Recent mechanistic studies have suggested that basophil behavior may explain some of the variability in response to therapy. First, the biological changes that occur during treatment with omalizumab have suggested that changes in basophil IgE-mediated reactivity occur faster than changes in the mast cell response.2,3 Other studies have shown that the IgE-mediated response of basophils results largely from limitations in the expression of the early required tyrosine kinase syk.

http://ift.tt/2mN4aei

Susceptibility to influenza virus infection of bronchial biopsies in asthma

Influenza causes significant morbidity and mortality, especially in patients with chronic lung diseases.1 Infection results in inflammatory cell influx and leads to either resolution or increased lung immunopathology and resulting morbidity,2 especially in patients with chronic airways diseases where viruses exacerbate inflammation and, subsequently, symptoms. Those with asthma are more susceptible to influenza and are, therefore, the most common population hospitalized, although, interestingly, they are less likely to develop severe disease or die than those without asthma.

http://ift.tt/2leW6qy

Human passive cutaneous anaphylaxis in the 21st century: Worth the risk?

"In 1921, Otto Carl W. Prausnitz (Giles) (1876-1963) identified what was later called 'reagin,' now known to be immunoglobulin E (IgE) antibody, found in higher quantities in the serum of allergic individuals than in nonallergic individuals. Prausnitz and his colleague, Heinz Küstner (1897-1963), discovered that a serum factor from an allergic patient (Küstner) could transfer skin-sensitizing properties to another individual (Prausnitz). Twenty-four hours after injecting serum from Küstner, who was allergic to fish, into Prausnitz's skin, they injected fish extract into the same area.

http://ift.tt/2lBmPK5

Plasma apolipoproteins and physical and cognitive health in very old individuals

Publication date: Available online 1 March 2017
Source:Neurobiology of Aging
Author(s): Julia Muenchhoff, Fei Song, Anne Poljak, John D. Crawford, Karen A. Mather, Nicole A. Kochan, Zixuan Yang, Julian N. Trollor, Simone Reppermund, Kate Maston, Adam Theobald, Susanne Kirchner-Adelhardt, John B. Kwok, Robyn L. Richmond, Mark McEvoy, John Attia, Peter W. Schofield, Henry Brodaty, Perminder S. Sachdev
Apolipoproteins play a crucial role in lipid metabolism with implications in cardiovascular disease, obesity, diabetes, Alzheimer's disease and longevity. We quantified seven apolipoproteins in plasma in 1067 individuals aged 56–105 using immunoassays and explored relationships with APOE polymorphism ε2/3/4, vascular health, frailty and cognition. ApoA1, ApoA2, ApoB, ApoC3, ApoE, ApoH and ApoJ decreased from midlife, although ApoE and ApoJ had U-shaped trends. Centenarians had the highest ApoE levels and the lowest frequency of APOE ε4 allele relative to younger groups. Apolipoprotein levels trended lower in APOE ε4 homo- and heterozygotes compared to non-carriers, with ApoE and ApoJ being significantly lower. Levels of all apolipoproteins except ApoH were higher in females. Sex- and age-related differences were apparent in the association of apolipoproteins with cognitive performance, as only women had significant negative associations of ApoB, ApoE, ApoH and ApoJ in mid-life, whereas associations at older age were non-significant or positive. Our findings suggest levels of some apolipoproteins, especially ApoE, are associated with lifespan and cognitive function in exceptionally long-lived individuals.



http://ift.tt/2mgwaut

CPAP Treatment Adherence in Women with Obstructive Sleep Apnea

Untreated obstructive sleep apnea (OSA) has numerous negative health-related consequences. Continuous positive airway pressure (CPAP) is generally considered the treatment of choice for OSA, but rates of nonadherence are high. It is believed that OSA is more prevalent among men; therefore understanding how OSA presents among women is limited and treatment adherence has received little research attention. For this study, 29 women were recruited from primary care offices. They completed a questionnaire battery and underwent a night of nocturnal polysomnography (PSG) followed by a visit with a sleep specialist. Women diagnosed with OSA were prescribed CPAP; 2 years later CPAP adherence was evaluated. Results show that approximately half the sample was adherent. There were no significant differences between adherent and nonadherent women on OSA severity; however CPAP adherent women had worse nocturnal and daytime functioning scores at the time of diagnosis. Moreover, when the seven nocturnal and daytime variables were used as predictors in a discriminant analysis, they could predict 87% of adherent and 93% of the nonadherent women. The single most important predictor was nonrefreshing sleep. We discuss the implications of the findings for identifying women in primary care with potential OSA and offer suggestions for enhancing treatment adherence.

http://ift.tt/2lBk63p

A Wandering Abdominal Mass in a Neonate: An Enteric Duplication Cyst Mimicking an Ovarian Cyst

Enteric duplication cysts are rare congenital anomalies that are prenatally diagnosed through antenatal ultrasonography (US). In female patients, however, attention must be paid since these formations might be confused with ovarian cysts. Herein, we present a case of a low birth weight female infant with an enteric duplication cyst. A cystic lesion was detected in the right abdomen of the fetus on antenatal US and magnetic resonance imaging (MRI). Serial US and MRI examinations performed after birth showed a single cyst that wandered from side to side in the abdomen; the initial diagnosis was thought to be an ovarian cyst. During laparotomy, however, it was found to be an enteric duplication cyst with volvulus. To our knowledge, there has been no report of an enteric duplication cyst presenting as a wandering abdominal mass. Our experience indicates that early intervention is necessary for patients who have a wandering abdominal mass to avoid complications and urgent surgery, whether it is an ovarian cyst or an enteric duplication cyst.

http://ift.tt/2mvqQE2

In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1597915

In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital floor and medial wall was successful in all the cases. Ten patients had bone grafting to the orbital floor, eight had it done onto medial wall, and 4 onto both floor and wall after reduction. The mean length of in situ rib bone graft was 40.9 mm (range, 20–70 mm), the mean width of these was 14.9 mm (range, 8–20 mm). The bone grafting was done by one leaf for 15 cases and two leafs for 7 cases in size of defects. The technique of in situ splitting of a rib bone graft for the repair of the orbital floor and medial wall is a simple and safe procedure, easily taking out the in situ splitting of a rib, and less pain in donor site. It has proved to be an optimal choice in craniofacial reconstruction, especially the defects of orbital floor and medial wall.
[...]

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

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2mvtvgY

Pancreas Transplantation Delays the Progression of Morphological, Morphometric and Ultrastructural Changes in Testes of Alloxan-Induced Diabetic Rats

Exp Clin Endocrinol Diabetes 2017; 125: 106-115
DOI: 10.1055/s-0042-122137

Aim: The aim of this study was to assess the effects of pancreas transplantation on the progression of testicular lesions in diabetic rats. Methods: Diabetic rats were subjected to pancreas transplantation and sacrificed after 6, 14, 26 and 50 weeks of follow-up, using non-diabetic and untreated diabetic rats as controls. Results: Successful pancreas transplantation corrected all of the metabolic changes observed in diabetic rats, including low levels of testosterone. The testicular mass was decreased, and the relative weight of the testes was high in diabetic rats. The seminiferous tubules of diabetic rats showed progressive atrophy of the germinal epithelium, with cytoplasmic vacuolization, detachment of germ cells to the tubular lumen and the appearance of giant cells. Leydig cells were abnormally distributed, and hyperplasia of Sertoli cells was observed. Sperm were not detectable within the tubular lumen in late follow-up. The diameter, total area, lumen area, and germinal epithelium area of the seminiferous tubules were low, and tubular density was high in diabetic rats. Ultrastructural changes were also observed in these rats, compromising the cytoplasm, organelles and cellular nuclei of the germ, Sertoli, and Leydig cells. The most frequent changes consisted of accumulation of lipid droplets and electron-dense dark material in the cell cytoplasm, cellular degeneration and apoptosis. Similar to non-diabetic rats, pancreas-transplanted rats showed progressive testicular lesions, but they were much less severe and occurred much later than in the untreated diabetic controls. Conclusion: Diabetes causes morphological and ultrastructural changes in rat testes, but the progression of lesions can be significantly delayed by successful pancreas transplantation, which may have a positive impact on male infertility due to diabetes.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2lewOZJ

Liver radiofrequency ablation as emergency treatment for a ruptured hepatocellular carcinoma: a case report

Hemoperitoneum is a possible complication of hepatocellular carcinoma that may require emergency surgery as an alternative to radiological locoregional therapies.

http://ift.tt/2ltJLdd

Theoretical Implications of Oxygenation in Limb Replant or Transplant

J reconstr Microsurg
DOI: 10.1055/s-0037-1599102

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

Article in Thieme eJournals:
Table of contents  |  Full text

http://ift.tt/2lAR6c1

Aging Effect on Categorical Perception of Mandarin Tones 2 and 3 and Thresholds of Pitch Contour Discrimination

Purpose

The purpose of the study was to examine the aging effect on the categorical perception of Mandarin Chinese Tone 2 (rising F0 pitch contour) and Tone 3 (falling-then-rising F0 pitch contour) as well as on the thresholds of pitch contour discrimination.

Method

Three experiments of Mandarin tone perception were conducted for younger and older listeners with Mandarin Chinese as the native language. The first 2 experiments were in the categorical perception paradigm: tone identification and tone discrimination for a series of stimuli, the F0 contour of which systematically varied from Tone 2 to Tone 3. In the third experiment, the just-noticeable differences of pitch contour discrimination were measured for both groups.

Results

In the measures of categorical perception, older listeners showed significantly shallower slopes in the tone identification function and significantly smaller peakedness in the tone discrimination function compared with younger listeners. Moreover, the thresholds of pitch contour discrimination were significantly higher for older listeners than for younger listeners.

Conclusion

These results suggest that aging reduced the categoricality of Mandarin tone perception and worsened the psychoacoustic capacity to discriminate pitch contour changes, thereby possibly leading to older listeners' difficulty in identifying Tones 2 and 3.

http://ift.tt/2letJsx

Multicenter, randomized, open-label Phase II study comparing S-1 alternate-day oral therapy with the standard daily regimen as a first-line treatment in patients with unresectable advanced pancreatic cancer

Abstract

Purpose

Non-inferiority for overall survival (OS) following alternate-day treatment with the oral anticancer drug S-1 compared with standard daily treatment was assessed in Japanese patients with unresectable advanced pancreatic cancer in a multicenter, randomized, phase II study. This trial was registered at the UMIN Clinical Trials Registry (no. 000008604).

Methods

Chemotherapy-naïve patients with locally advanced or metastatic pancreatic cancer were randomly assigned 2:1 to treatment with alternate-day (twice daily on alternate days from days 1 through 42 of a 42-day cycle) or daily (twice daily on days 1 through 28 of a 42-day cycle) treatment with S-1. The primary endpoint was OS. Secondary endpoints were progression-free survival (PFS), time to treatment failure, response rate, quality of life assessments, and safety.

Results

A total of 190 patients were enrolled, of which 185 were included in the final analysis (alternate-day: 121; daily: 64). Median OS was 9.4 for the alternate-day group and 10.4 months for the daily group [hazard ratio (HR), 1.19; 95% credible interval, 0.86 to 1.64], indicating that non-inferiority of alternate-day treatment to daily treatment was not demonstrated. Median PFS was 3.0 for the alternate-day group and 4.2 months for the daily group (HR, 1.65; 95% credible interval, 1.20–2.29). The incidence of anorexia, fatigue, neutrophils, pigmentation, and pneumonitis was lower in alternate-day treatment compared with daily treatment.

Conclusion

S-1 for advanced pancreatic cancer should be taken daily as recommended, based on the decreased OS and PFS and marginal improvement in safety observed in the alternate-day group.

http://ift.tt/2lAN1EJ

Editorial Board

Publication date: March 2017
Source:Critical Reviews in Oncology/Hematology, Volume 111





http://ift.tt/2lesxVX

General and emotion-specific neural effects of ketamine during emotional memory formation

Publication date: 15 April 2017
Source:NeuroImage, Volume 150
Author(s): Benjamin Becker, Maria Steffens, Zhiying Zhao, Keith M. Kendrick, Claudia Neumann, Bernd Weber, Johannes Schultz, Mitul A. Mehta, Ulrich Ettinger, Rene Hurlemann
Animal studies suggest that N-methyl-D-aspartate receptor (NMDAR) dependent signalling in limbic and prefrontal regions is critically involved in both cognitive and emotional functions. In humans, ketamine-induced transient, and disorder associated chronic NMDAR hypofunction (i.e. in schizophrenia) has been associated with deficient performance in the domains of memory and higher-order emotional functioning, as well as altered neural activity in the underlying limbic-prefrontal circuits. To model the effects of NMDAR hypofunction on the integration of emotion and cognition the present pharmacological fMRI study applied the NMDAR antagonist ketamine (target plasma level=100ng/ml) to 21 healthy volunteers in a within-subject placebo-controlled crossover design during encoding of neutral, positive and negative pictures. Our results show that irrespective of emotion, ketamine suppressed parahippocampal and medial prefrontal activity. In contrast, ketamine selectively increased amygdala and orbitofrontal activity during successful encoding of negative stimuli. On the network level ketamine generally increased medial prefrontal-parahippocampal coupling while specifically decreasing amygdala-orbitofrontal interplay during encoding of negative stimuli. On the behavioural level, ketamine produced generally decreased memory performance and abolished the emotional enhancement of memory after a wash-out period of 5 days. The present findings suggest that ketamine produces general as well as valence-specific effects during emotional memory formation. The pattern partly overlaps with alterations previously observed in patients with schizophrenia.



http://ift.tt/2leB0IP

Fetal Imaging, Other Infectious Diseases Screening of Fetus With Zika Virus Infection and the Need for Long-Term Follow-Up

Publication date: Available online 1 March 2017
Source:Pediatric Neurology
Author(s): Juan Esteban Garcia-Robledo, Alfonso J. Rodriguez-Morales




http://ift.tt/2lAYJiv

GABAA receptor subtypes in the mouse brain: Regional mapping and diazepam receptor occupancy by in vivo [18F]flumazenil PET

Publication date: 15 April 2017
Source:NeuroImage, Volume 150
Author(s): Adrienne Müller Herde, Dietmar Benke, William T. Ralvenius, Linjing Mu, Roger Schibli, Hanns Ulrich Zeilhofer, Stefanie D. Krämer
Classical benzodiazepines, which are widely used as sedatives, anxiolytics and anticonvulsants, exert their therapeutic effects through interactions with heteropentameric GABAA receptors composed of two α, two β and one γ2 subunit. Their high affinity binding site is located at the interface between the γ2 and the adjacent α subunit. The α-subunit gene family consists of six members and receptors can be homomeric or mixed with respect to the α-subunits. Previous work has suggested that benzodiazepine binding site ligands with selectivity for individual GABAA receptor subtypes, as defined by the benzodiazepine-binding α subunit, may have fewer side effects and may even be effective in diseases, such as schizophrenia, autism or chronic pain, that do not respond well to classical benzodiazepines. The distributions of the individual α subunits across the CNS have been extensively characterized. However, as GABAA receptors may contain two different α subunits, the distribution of the subunits does not necessarily reflect the distribution of receptor subtypes with respect to benzodiazepine pharmacology. In the present study, we have used in vivo [¹⁸F]flumazenil PET and in vitro [³H]flumazenil autoradiography in combination with GABAA receptor point-mutated mice to characterize the distribution of the two most prevalent GABAA receptor subtypes (α1 and α2) throughout the mouse brain. The results were in agreement with published in vitro data. High levels of α2-containing receptors were found in brain regions of the neuronal network of anxiety. The α1/α2 subunit combinations were predictable from the individual subunit levels. In additional experiments, we explored in vivo [¹⁸F]flumazenil PET to determine the degree of receptor occupancy at GABAA receptor subtypes following oral administration of diazepam. The dose to occupy 50% of sensitive receptors, independent of the receptor subtype(s), was 1–2mg/kg, in agreement with published data from ex vivo studies with wild type mice. In conclusion, we have resolved the quantitative distribution of α1- and α2-containing homomeric and mixed GABAA receptors in vivo at the millimeter scale and demonstrate that the regional drug receptor occupancy in vivo at these GABAA receptor subtypes can be determined by [¹⁸F]flumazenil PET. Such information should be valuable for drug development programs aiming for subtype-selective benzodiazepine site ligands for new therapeutic indications.

Graphical abstract

http://ift.tt/2lesgT7

Involuntary orienting of attention to a sound desynchronizes the occipital alpha rhythm and improves visual perception

Publication date: 15 April 2017
Source:NeuroImage, Volume 150
Author(s): Wenfeng Feng, Viola S. Störmer, Antigona Martinez, John J. McDonald, Steven A. Hillyard
Directing attention voluntarily to the location of a visual target results in an amplitude reduction (desynchronization) of the occipital alpha rhythm (8–14Hz), which is predictive of improved perceptual processing of the target. Here we investigated whether modulations of the occipital alpha rhythm triggered by the involuntary orienting of attention to a salient but spatially non-predictive sound would similarly influence perception of a subsequent visual target. Target discrimination was more accurate when a sound preceded the target at the same location (validly cued trials) than when the sound was on the side opposite to the target (invalidly cued trials). This behavioral effect was accompanied by a sound-induced desynchronization of the alpha rhythm over the lateral occipital scalp. The magnitude of alpha desynchronization over the hemisphere contralateral to the sound predicted correct discriminations of validly cued targets but not of invalidly cued targets. These results support the conclusion that cue-induced alpha desynchronization over the occipital cortex is a manifestation of a general priming mechanism that improves visual processing and that this mechanism can be activated either by the voluntary or involuntary orienting of attention. Further, the observed pattern of alpha modulations preceding correct and incorrect discriminations of valid and invalid targets suggests that involuntary orienting to the non-predictive sound has a rapid and purely facilitatory influence on processing targets on the cued side, with no inhibitory influence on targets on the opposite side.



http://ift.tt/2lYq27y

Aflatoxins, discolouration and insect damage in dried cowpea and pigeon pea in Malawi and the effectiveness of flotation/washing operation in eliminating the aflatoxins

Abstract

Aflatoxin contamination and biodeterioration were examined in 302 samples of dry cowpeas and pigeon peas that were randomly purchased from 9 districts of the Southern Region of Malawi during July and November 2015. Further, the impact of flotation/washing on aflatoxin levels on the pulses was elucidated. Aflatoxin analyses involved immunoaffinity column (IAC) clean-up and HPLC quantification with fluorescence detection (FLD) while legume biodeterioration assessments were done by visual inspection. Aflatoxins were frequently detected in cowpea (24%, max., 66 μg/kg) and pigeon pea (22%, max., 80 μg/kg) samples that were collected in the month of July. Lower aflatoxin incidence of 15% in cowpeas (max., 470 μg/kg) and 14% in pigeon peas (max., 377 μg/kg) was recorded in the November collection. Overall, aflatoxin levels were significantly higher in the pulses that were collected in November. However, there were no significant differences in the total aflatoxin (aflatoxin B₁ (AFB₁) + AFB₂ + AFG₁ + AFG₂) levels between the two types of pulses. Remarkably, in 76.2% of the aflatoxin positive cowpea and in 41.7% of the aflatoxin positive pigeon pea samples, aflatoxin G₁ concentration exceeded aflatoxin B_1. Insect damage percentage averaged at 18.1 ± 18.2% (mean ± SD) in the cowpeas and 16.1 ± 19.4% in pigeon peas. Mean discolouration percentage (number of pulses) of the cowpeas and pigeon peas was found to be at 6.7 ± 4.9 and 8.7 ± 6.2%, respectively. Washing and discarding the buoyant fraction was highly efficient in reducing aflatoxin levels; only 5.2 ± 11.1% of the initial aflatoxin level was found in the cleaned samples. In conclusion, cowpeas and pigeon peas sold on the local market in Malawi may constitute a hazard especially if floatation/washing step is skipped.

http://ift.tt/2maFn6Q

Liver radiofrequency ablation as emergency treatment for a ruptured hepatocellular carcinoma: a case report

Hemoperitoneum is a possible complication of hepatocellular carcinoma that may require emergency surgery as an alternative to radiological locoregional therapies.

http://ift.tt/2ltJLdd