Voice outcomes for early laryngeal cancer.

Purpose of review: Treatment options for early laryngeal cancer are well established with good local control and 5-year survival. The commonest treatments are radiotherapy or transoral laser microsurgery (TLM). There are advantages and disadvantages of the different modalities, but debate continues regarding the voice outcomes posttreatment. This review will focus on early glottic carcinoma and voice outcomes following the different treatments. Recent findings: TLM and radiotherapy are both likely to affect voice quality, but the extent of voice change depends on different factors. These factors can be divided into patient, tumour and treatment factors. Recent meta-analyses data show similar voice outcomes for either modality in the treatment of early glottic carcinoma. However, larger tumours and those involving the anterior commissure are associated with worse voice outcomes. Summary: There are various considerations for the patient and clinician before deciding on the preferred treatment for early glottic carcinoma. Although both TLM and radiotherapy will affect voice outcomes, the recent meta-analyses show similar voice outcomes for either modality in the treatment of early glottic carcinoma. There are numerous variables in the published studies hindering direct comparisons. These include heterogeneous patient groups, different treatment standardization and methods of voice analysis. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2m9leLS

Social and quality of life impact using a voice prosthesis after laryngectomy.

Purpose of review: This review is intended to give an up-to-date overview of key developments in the evidence base relating specifically to the social and quality of life (QOL) impact of using a voice prosthesis, with reflections on the impact on clinical practice. Recent findings: Recent studies have shed light on the role of social support on psychological adjustment after laryngectomy, developing the existing evidence base on psychological sequelae. Investigations into the relationship between voice intensity/intelligibility and voice handicap/QOL may suggest a relationship for some patients, and current tools for measuring these constructs are evaluated. Recent qualitative research on the lived experience and social impact of using a voice prosthesis is presented. Summary: Little research is currently available exploring the impact of using a voice prosthesis on social participation, which is reflected in the dearth of participation-focused interventions for laryngectomy patients. Further research on the lived experience of tracheoesophageal speech is required to understand this phenomenon and develop appropriate interventions for enhancing communication, participation and QOL with a voice prosthesis after laryngectomy. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mHJ8RM

Dysphagia management in tracheostomized patients: where are we now?.

Purpose of review: Tracheostomized patients are medically complex and vulnerable. International attention is now focused on improving the safety and quality of their care. This review summarizes recent evidence in hot-topic areas pertinent to speech and language therapy (SLT) intervention for dysphagia management in tracheostomized patients. Recent findings: The management of tracheostomized patients requires a truly multidisciplinary team (MDT) approach. Without this, patients remain tracheostomized and hospitalized for longer and have slower access to MDT members. Patterns of SLT intervention are variable across the United Kingdom, and further work to achieve consensus on best practice is required. Instrumental evaluation of swallowing provides vital information and can facilitate well tolerated oral feeding even prior to cuff deflation. A systematic review suggests that sensitivity of blue-dye testing is poor, but studies are methodologically flawed. The need for tracheostomy-specific quality of life measures is being addressed by the development of a questionnaire. Summary: In this review, the main research themes relevant to speech and language therapists (SLTs) working with tracheostomized patients are discussed. This patient group poses significant challenges to robust study design. However, recent advances in uniting MDT members globally to improve standards of care are encouraging. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2m9u2Be

Voice and swallowing outcomes for adults undergoing reconstructive surgery for laryngotracheal stenosis.

Purpose of review: Adult laryngotracheal stenosis is a rare, multifactorial condition which carries a significant physical and psychosocial burden. Surgical approaches have developed in recent years, however, voice and swallowing function can be affected prior to treatment, in the immediate postoperative phase, and as an ongoing consequence of the condition and surgical intervention. In this study we discuss: the nature of the problem; surgical interventions to address airway disorders; optimal patterns of care to maximize voice and swallowing outcomes. Recent findings: Studies in this field are limited and focused on surgical outcomes and airway status with voice and swallowing a secondary consideration. Retrospective studies of swallowing have focused on factors such as the duration of dysphagia symptoms following airway surgery and made comparisons between type of surgery, use of stent, and length of swallowing problems. The literature suggests that patients are likely to return to their preoperative diet. There has been a focus on voice outcomes following cricotracheal resection which results in a postoperative decrease in the fundamental frequency. However, study comparisons are limited by the use of inconsistent outcome measures (for both voice and swallowing) which are often not validated, with heterogeneous groups and varying surgical techniques. Summary: The limited literature suggests that swallowing function is more likely to recover to presurgical status than voice function. Further prospective studies incorporating consistent instrumental, clinician, and patient-reported outcome measurement are required to understand the nature and extent of dysphagia and dysphonia resulting from this condition and its treatment. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mHBdny

The use of practice guidelines in the management of pediatric cases of Acute Otitis Media in Amman, Jordan

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Lubna Khreesha, Ali Bacharouch, R. Alexander Blackwood, Mohammed Alkhoujah, Mohamad R. Issa
ObjectivesThe widespread emergence of antimicrobial resistance has led many healthcare institutions to adopt more conservative antibiotic prescription practice guidelines for the treatment of acute otitis media (AOM). Little is known about the awareness and use of such guidelines by physicians in Jordan. Our aim was to pilot an anonymous survey instrument that would assess AOM treatment trends as well as awareness of and adherence to practice guidelines in Amman. By qualitatively assessing the management of AOM we could illuminate possible disparities in treatment trends, evaluate variability in practice guideline adherence, and help focus efforts of future educational programs that pertain to pediatric AOM management.MethodsA total of 71 practicing physicians were anonymously surveyed in Amman, Jordan. The survey assessed awareness of and adherence to practice guidelines by prompting responses to hypothetical AOM cases. Differences in performance between various physician groups were noted.ResultsIn total, participants answered 61.2% of the questions correctly. It was found that trainees would prescribe more appropriate antibiotics relative to attending physicians (p = 0.008). It was found that medical physicians followed guidelines more appropriately relative to ENT surgeons (64.2% of questions answered correctly vs. 58.1% of questions answered correctly; p = 0.015) and that physicians who report adhering to guidelines all/most of the time followed guidelines more appropriately relative to those who report adhering only sometimes or never (64.0% of questions answered correctly vs. 58.0% of questions answered correctly; p = 0.011). Also, cases that dealt with children were the most difficult for participants to diagnose as compared with cases that dealt with adults.ConclusionWe conducted the first known qualitative analysis of otitis media practices in Amman and found numerous shortcomings in AOM guideline familiarity. Awareness of practice guidelines can lead to more appropriate AOM management, but there is variability between groups in guideline familiarity and utilization. Interventions that promote more conservative antibiotic prescriptions could be targeted towards groups that prescribe antibiotics less appropriately relative to their colleagues e.g. attending physicians and ENT surgeons. Interventions could also target physicians who manage pediatric AOM cases as participants had the most difficulty in properly diagnosing cases that involved children and infants.



http://ift.tt/2mOdsdP

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

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Mats Eriksson, Ulrica Nilsson, Ann-Cathrine Bramhagen, Ewa Idvall, Elisabeth Ericsson
ObjectivesTonsil 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.MethodsIn total, 238 children (4–12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery.Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items.ResultsDaily life activities (sleeping, eating and playing), physical symptoms (e.g., headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period.The TE-girls showed higher scores than the boys regarding stomach ache, defecation and dizziness.Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states.Postoperative recovery improved from day 1–10 in all surgical groups. The TE-group showed lower recovery compared to the TT-group (p < 0.01–0.001) in most items.ConclusionThe goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative morbidity and a quicker return to normal activity compared to TE.



http://ift.tt/2m6FqNl

Foreign body aspiration in children: Focus on the impact of delayed treatment

Publication date: Available online 9 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Xiaoxi Chen, Chunlin Zhang
ObjectiveThis study aims to analyze the impact of delayed treatment of foreign body aspiration (FBA) in children.Materials and methodsIn this study, we retrospectively reviewed 220 children who were diagnosed with FBA through rigid bronchoscopy from January 2010 to May 2016 in our hospital. The time elapsed between aspiration event and arrival at our hospital exceeded 24h was considered to have a delayed treatment. The occurrence rate of complications at admission, operation time and hospitalization time were compared between the delayed treatment group and non-delayed treatment group.ResultsA total of 220 children diagnosed with FBA by rigid bronchoscopy were enrolled in this study, including 138(62.7%) boys and 82(37.3%) girls. The median age was 20 months. Only 102 (46.4%) cases came to our hospital within 24h. The remaining 118 (53.6%) cases had a delayed treatment. The occurrence rate of complication at admission was significantly higher in the delayed treatment group than in the non-delayed treatment group (80.5% vs. 52.9%, P<0.01). Delayed treatment group also had significantly longer operation time and hospitalization time than non-delayed treatment group (median operation time: 18min vs. 10min; median hospitalization time: 4d vs. 3d; both P<0.01). In multivariate analysis, delayed treatment remained an independent risk factor for longer operation time (HR 2.47, 95% CI 1.13-5.44, P=0.02) and longer hospitalization time (HR 2.19, 95% CI 1.23-3.88, P<0.01).ConclusionDelayed treatment of FBA is not only related to higher occurrence rate of complication but also associated with longer operation and hospitalization time.



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Anti-angiogenic treatment for breast cancer?

Publication date: Available online 9 March 2017
Source:Cancer Treatment Reviews
Author(s): Johannes Pieter van Netten, Stephen Hoption Cann, Ian Thornton, Rory P. Finegan, Chris Maxwell




http://ift.tt/2m6xQCw

The role of drug-drug interactions in prostate cancer treatment: focus on abiraterone acetate/prednisone and enzalutamide

Publication date: Available online 9 March 2017
Source:Cancer Treatment Reviews
Author(s): Marzia Del Re, Stefano Fogli, Lisa Derosa, Francesco Massari, Paul De Souza, Stefania Crucitta, Sergio Bracarda, Daniele Santini, Romano Danesi
Elderly patients with cancer may have comorbidities, each requiring additional pharmacologic treatment. Therefore, the occurrence of pharmacokinetic (PK) and pharmacodynamic (PD) interactions is very likely, and the risk of adverse reactions (ADRs), due to the narrow therapeutic window of anticancer drugs, is increased. Drug-drug interactions (DDIs) may occur in prostate cancer patients due to inhibition by abiraterone of liver cytochrome P450 (CYP)-dependent enzymes CYP2C8 and 2D6, which are involved in the metabolism of approximately 25% of all drugs, and induction by enzalutamide of CYP3A4, 2C9 and 2C19, which metabolize up to 50% of medications. Therefore, abiraterone may increase plasma levels of CYP2D6 substrates, including amitriptyline, oxycodone and risperidone, as well as of CYP2C8 substrates including amiodarone and carbamazepine. Since enzalutamide is extensively metabolized by CYP2C8, its plasma levels are likely to be raised if coadministered with strong CYP2C8 inhibitors such as gemfibrozil or pioglitazone. Inducers of CYP2C8 (i.e., rifampin) may reduce the effectiveness of enzalutamide and hence should be avoided. Enzalutamide may decrease plasma levels of CYP3A4, 2C9 and 2C19 substrates including disopiramide, quetiapine, quinidine and warfarin. Growing awareness of the importance of DDIs in cancer patients is now reflected in the variety of web-based sources offering information and guidance. However, the evaluation of the clinical relevance of DDIs is the result of a comprehensive evaluation of many factors, including therapeutic index, amplitude of therapeutic range and presence of comorbidities, requiring a specific expertise in clinical pharmacology.

Graphical abstract

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Incidental Findings on Pediatric Abdominal Magnetic Resonance Angiography

Publication date: Available online 9 March 2017
Source:Academic Radiology
Author(s): Nattinee Leelakanok, Matthew A. Zapala, Emily A. Edwards, Andrew S. Phelps, John D. Mackenzie, Jesse Courtier
Rationale and ObjectivesAbdominal magnetic resonance angiography (MRA) has gained favor in pediatric patients owing to its lack of ionizing radiation and noninvasive nature. Reports exist regarding incidental findings on body MRA in adult patients. However, the incidental findings in pediatric abdominal MRA have not been previously reported. Our study aims to determine the frequencies, characteristics, and categories of incidental findings in pediatric patients undergoing abdominal MRA.Materials and MethodsRetrospective study was performed in 78 consecutive contrast-enhanced abdominal MRA of patients between ages 0 and 20 years over a 7-year time period. The presence of incidental vascular and extravascular findings was noted. Reports were categorized in consensus by two radiologists as no incidental finding (group A), normal or normal variants or nonsignificant incidental common findings (group B), or abnormal incidental findings (group C). Group C was reviewed to determine whether additional management was performed.ResultsA total of 40 boys and 38 girls (51%:49%) were reported, with a mean age of 12.3 years (standard deviation ±5.6 years, range 7 days to 20 years). Three most common indications for MRA were renal artery stenosis (24.4%), vasculitis (21.8%), and suspected intra-abdominal venous thrombosis (14.1%). We identified a total of 92 incidental findings in 50 of 78 patients; 60 findings in 29 patients in group B, and 32 findings in 21 patients in group C. Atelectasis at the lung bases was the most common incidental finding in group B (14 of 78 patients). The most common findings in group C were ascites, scoliosis, and splenomegaly. There were three abnormal incidental findings that led to causative workup and/or further management (moderate ascites, pericardial and pleural effusion, and venous malformation). The remaining cases with abnormal findings received treatment of their primary conditions only.ConclusionsPediatric abdominal MRA revealed a large number of incidental findings. The large majority were findings without clinical significance. Basal lung atelectasis was the most common overall incidental and nonsignificant finding, whereas ascites was the most common abnormal incidental finding. Although not all abnormal incidental findings affected management, appropriate identification and communication of relevant findings would improve patient care.



http://ift.tt/2mHrKwc

Dosimetric Analysis of Liver Toxicity Post Liver Metastasis Stereotactic Body Radiotherapy

Publication date: Available online 9 March 2017
Source:Practical Radiation Oncology
Author(s): A. Barry, A. McPartlin, P. Lindsay, L. Wang, J Brierley, J Kim, J Ringash, R Wong, R Dinniwell, T. Craig, L.A. Dawson
PurposeThe aim of this study is to describe the incidence and type of liver toxicity seen following liver metastases stereotactic body radiotherapy (SBRT) and the corresponding clinical and dosimetric factors associated with toxicity.Methods and MaterialsBetween 2002 and 2009, 81 evaluable patients with liver metastases were treated on two prospective studies assessing SBRT, with prescription doses based on the effective liver volume irradiated evaluated. Toxicity was defined as grade≥2 classic or non-classic radiation induced liver disease (RILD). Specific toxicity endpoints evaluated were worsening transaminases and albumin levels, within 3months of SBRT.ResultsSeventy percent of patients had colorectal carcinoma, 55% had extra-hepatic disease, 1 patient had Hepatitis B and 54% had received prior chemotherapy. Baseline transaminases were elevated at CTCAE V4.0 grade 1, 2 and 3 levels in 33 (41%), 2 (2%) and 0 (0%) of patients. The mean prescription dose was 43Gy (27.7 – 60Gy) in 6 fractions. The mean liver (minus GTV) dose (MLD) was 16Gy (3–25.6Gy) in 6 fractions. No classic or non-classical ≥ grade 2 RILD was observed. Within 3months of SBRT, 49 (61%) patients had worsening of grade of transaminase and 23 (28%) patients had a reduction in albumin, all transient (majority grade≤2 toxicity) without subsequent clinical toxicity. Seventeen patients exceeded QUANTEC MLD guidelines (≤20Gy), 13 (76%) of whom had worsening of transaminase grade. On multivariate analysis, worsening of liver enzymes was more likely in patients with higher doses to the spared 700cc of liver (p=0.026), and reduction of albumin was more likely with higher effective liver volume (OR 1.53 (1.08, 2.16)) p=0.016).ConclusionLiver metastases SBRT is safe with a low risk of transient biochemical liver toxicity, more likely in patients with a higher effective liver volume and higher doses to the spared uninvolved liver volume.



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Outcomes and Toxicity following High-Dose Radiation Therapy in 15 Fractions for Non-Small Cell Lung Cancer

Publication date: Available online 9 March 2017
Source:Practical Radiation Oncology
Author(s): Penny Fang, Cameron W. Swanick, Todd A. Pezzi, Zhongxing Liao, James Welsh, Steven H. Lin, Daniel R. Gomez
Background and PurposeAccelerated hypofractionated radiation therapy (AHRT) is increasingly used for select lung cancer patients. We evaluated clinical outcomes and predictors of pulmonary/esophageal toxicity in patients treated with ≥52.5Gy in 15 fractions.Material and MethodsWe evaluated 229 patients treated with RT doses ≥52.5Gy in 15 fractions for non-small cell lung cancer from January 2009–January 2016. Toxicity was scored using Common Terminology Criteria for Adverse Events, v4.0. Univariate and multivariate logistic regression was used to identify predictors of toxicity. Overall survival (OS), progression-free survival (PFS), and local control (LC) were estimated using Kaplan–Meier method. Predictors of clinical outcome were modeled using Cox proportional hazards regression.ResultsMedian follow-up was 7months. Forty-two patients (19%) developed grade≥2 pneumonitis, and nine (4%) grade≥3 esophagitis. In multivariate analysis, age>75years (OR2.56, 95%CI 1.24–5.25, P=0.01) and lung V10≥32% were associated with grade≥2 pneumonitis (OR2.79, 95%CI 1.39–5.79, P=0.005). On univariate analysis, esophagus mean dose ≥17Gy (OR10.14, 95%CI 1.82–189.8, P=0.006), GTV size ≥71cm3 (P=0.002) and PTV size ≥409cm3 (P=0.02) were associated with development of grade≥3 esophagitis. In patients with stage II/III disease (n=73), median LC was not reached, median OS 14months, and median PFS 6months.ConclusionsAHRT in 15 fractions can be safe and effective. Consideration for using AHRT with immunotherapy and sequential chemotherapy for improved out-of-radiation field and distant control is warranted.



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Persistent nasal carriers of Acinetobacter baumannii in long-term-care facilities

Publication date: Available online 9 March 2017
Source:American Journal of Infection Control
Author(s): Ming-Li Liou, Kuan-Hsueh Chen, Hui-Ling Yeh, Chun-Yi Lai, Chang-Hua Chen
BackgroundAcinetobacter baumannii and Staphylococcus aureus have persisted as 2 major pathogens worldwide.AimWe designed a prevalence study to investigate the prevalence of nasal carriage of S aureus and A baumannii in long-term-care facilities (LCTFs) and their collaborative community hospitals. In addition, we aimed to clarify persistent or nonpersistent carriage of the 2 organisms among residents of LTCFs.MethodsWe performed a prevalence study concerning nasal carriers of A baumannii and S aureus in 3 LTCFs and 1 collaborative community hospital.ResultsSeventy subjects were enrolled and clustered into 3 groups: the elderly sick group (n = 24), the elderly healthy group (n = 33), and the healthy health care worker group (n = 13). Nasal samples were collected, and the nuc and mecA genes of S aureus and the blaOXA gene of A baumannii were analyzed by polymerase chain reaction. Among the 3 groups, the rate of nasal carriage of S aureus was approximately 0%-15%. However, the rate for A baumannii was approximately 54%-92%. Notably, the persistent carrier rate of A baumannii in the elderly sick group was 83.3% (20 out of 24) despite a 12.5% (3 out of 24) rate of carbapenem-resistant A baumannii.ConclusionsWe emphasized that the persistent nasal carriage of A baumannii in LTCFs could be another portal of exit to cause A baumannii infection in Taiwan.



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A New Keystone Flap “Plus” Design: Case Series and Analysis of Follow-Up

The original keystone island flap, originally described by Behan (1), is a surgical technique used after the removal of skin cancer in order to close skin defects. It is essentially two end-to-side V-Y flaps based on fasciocutaneous perforators, offering both the robust vascularity of perforator flaps and the relative ease and speed of local tissue rearrangement (2). Some authors (3, 4) highlight the advantages of this technique. Other authors applied their own modifications improving the technique (5).

http://ift.tt/2m99Jnt

Failure to Diagnose an Incompetent Cervix,Premature Birth Lawsuits,Universal Cervical Length Screening,καθ' έξιν αποβολές, ανεπάρκεια τραχήλου,. πρόωρος τοκετός ... νομικό πλαίσιο−αστική−ποινική ευθύνη στη μαιευτική− γυναικολογία

http://emergencymedicinesfakianakis.blogspot.com/2017/03/premature-birth-lawsuitsuniversal.html

Every expectant mother hopes that her pregnancy will go full-term and that she will have a healthy baby to take home from the hospital. The unborn baby continues to grow throughout the entire pregnancy, and it has the best chance at being healthy when born after 37 weeks of pregnancy.

Unfortunately, 1 out of every 10 births in the U.S.—or an estimated 380,000 babies each year – are delivered too soon, often with devastating, life-changing results.

There are many factors that can contribute to a baby being born prematurely, and some are simply unavoidable in nature. However, there are some premature births that can be prevented, and may in fact be caused by a doctor's deviation from the accepted standard of care.

Some of our many multi-million-dollar recoveries have involved:

Injuries from premature delivery due to the failure to place a cervical cerclage for cervical incompetence or insufficiency

The failure to properly manage preeclampsia and delayed delivery, resulting in placental abruption and fetal bradycardia

Injuries suffered as a result of medication errors in neonatal intensive care units, or NICUs

Injuries from the failure to address non-reassuring fetal heart tracings

There are numerous causes for a premature birth, and doctors must be aware of them in order to appropriately care for expectant mothers. These are just some of the causes:

Women with a history of a second trimester miscarriage or a previous premature delivery

Women who are found to have a short cervix (a condition where the cervix is not the length that it should be) during a routine sonogram

Women with recurrent urinary tract infections

Women with diabetes – gestational or pre-gestational

Women with hypertension, which can result in preeclampsia

African American women, who, regardless of age or other conditions, are naturally at greater risk for delivering premature babies

Women with vaginal infections or sexually transmitted diseases

Because there are many things that can cause a baby to be born early, a doctor needs to ask the right questions of the expectant mother. Failure of the doctor to recognize, properly monitor and/or treat any of the factors mentioned can certainly rise to the level of negligence and malpractice. If this has occured to your baby, you should speak with an experienced premature birth attorney.

Expectant mothers should give their doctors as much information as they can about their medical history, but they may not be aware of all of the things that can contribute to premature birth. Consequently, a doctor must be prepared to ask pertinent questions to have all of the information needed to lower the chances of an early birth. If a doctor neglects to ask thorough questions and fails to act appropriately once the information is obtained and a baby is born premature as a result, it could be a case of malpractice and the mother may have grounds for a premature birth lawsuit.

When a premature birth does occur, there are many medical complications that can affect the child, and there is a higher risk of serious disability or death the earlier the baby is born. Some problems that a baby born too early may face include:

Breathing problems

Difficulty feeding

Increased risk of severe infection

Neurological problems

Cerebral palsy

Delayed development

Vision and hearing impairment

Determining whether or not a premature birth could have been prevented can be complicated, so it is imperative that you have both legal and medical experts to help and support you. 

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

6948891480

alsfakia@gmail.com

Permanent prostate brachytherapy pubic arch evaluation with diagnostic MRI

Publication date: Available online 9 March 2017
Source:Brachytherapy
Author(s): Geoffrey V. Martin, Thomas J. Pugh, Usama Mahmood, Rajat J. Kudchadker, Jihong Wang, Teresa L. Bruno, Tharakeswara Bathala, Steven J. Frank
PurposePubic arch interference (PAI), when it occurs, is often a limiting factor for patients pursuing brachytherapy treatment of prostate cancer. Pre-brachytherapy pubic arch evaluation is often performed by CT or transrectal ultrasound (TRUS), but MRI has increasingly replaced these modalities for prostate cancer evaluation. The purpose of this study was to determine if staging MRI could be used to evaluate PAI and compare it with these other imaging methods.Methods and MaterialsForty-one consecutive patients undergoing brachytherapy evaluation had pelvic MRI-, CT-, and TRUS-based brachytherapy simulation. Pubic arch overlap on T2-weighted MRI and CT was determined by contouring the prostate gland on its largest axial slice and superimposing this contour onto the pubic arch bones. The largest degree of overlap of the prostate gland on MRI and CT was used to predict the existence of PAI as determined by TRUS-based simulation. The correlation between prostate contour overlap was also compared between MRI and CT.ResultsNineteen patients (48%) exhibited PAI on TRUS brachytherapy simulation evaluation. The average (±standard error) amount of prostate contour overlap on the pubic arch on CT was 2.9 ± 0.6 mm and on MRI was 2.0 ± 0.6 mm (linear correlation, R, of 0.783, p < 0.001). CT and MRI were equally predictive of PAI on TRUS evaluation (area under the curve = 0.75).ConclusionPre-brachytherapy pubic arch assessment with diagnostic MRI provides similar predictability of PAI compared with CT, potentially obviating the need for additional pre-brachytherapy CT in the setting of staging MRI.



http://ift.tt/2mrUybu

Assessment of clinical and radiologic differences between small and large adrenal pheochromocytomas

Publication date: Available online 10 March 2017
Source:Clinical Imaging
Author(s): Dong Won Kim, Seong Kuk Yoon, Sang Hyeon Kim, Eun Ju Kang, Hee Jin Kwon
ObjectiveTo evaluate differences in clinical and radiologic features of small and large pheochromocytomas.Materials and methodsThis study included 39 patients with adrenal pheochromocytomas. Several clinical and radiologic features were statistically analyzed and compared between small and large pheochromocytomas.ResultsNo significant differences were found in clinical features between them. Small pheochromocytomas had more relatively homogeneous attenuation although large pheochromocytomas had more cystic or necrotic changes.ConclusionsPheochromocytomas tend to have different CT imaging features mimicking other tumors according to the size of the tumors. However, clinical features, CT imaging characteristics, and radioisotope activity are not different between small and large pheochromocytomas.



http://ift.tt/2m6lwlB

Use of hepatobiliary phase images in Gd-EOB-DTPA-enhanced MRI of breast cancer hepatic metastasis to predict response to chemotherapy

Publication date: Available online 9 March 2017
Source:Clinical Imaging
Author(s): Hyun Ji Lee, Chang Hee Lee, Jeong Woo Kim, Yang Shin Park, Jongmee Lee, Kyeong Ah Kim
ObjectivesTo determine the prognostic value of Gd-EOB-DTPA MRI findings of liver metastasis from breast cancer.Methods29 metastatic lesions from 12 breast cancer patients who received chemotherapy were retrospectively reviewed. We evaluated hepatobiliary phase of the lesions and classified them as a "target" or "non-target" appearance. The relationship of appearance or SI ratio with tumor response was analyzed.ResultsA non-target appearance was more frequent in disease control group than in non-control group [14/18 (77.8%) vs. 4/18 (22.2%)], and it was associated with a better response [p=0.048].ConclusionHBP analysis may be useful to predict the response to chemotherapy and survival.



http://ift.tt/2mNGHxb

Unusual ultrasound appearance of small bowel intussusception and secondary bowel obstruction in a child with Peutz-Jeghers syndrome

Publication date: Available online 9 March 2017
Source:Clinical Imaging
Author(s): Lei Wu, Ramesh S. Iyer, George T. Drugas, A. Luana Stanescu
Small bowel intussusception (SBI) in pediatric patients resolves spontaneously in the majority of cases. Pathologic small bowel intussusception with a lead point is rare in children. Ultrasound (US) is the preferred initial imaging study for the diagnosis of intussusception. We report a case of long-segment SBI and secondary bowel obstruction caused by a large hamartomatous polyp.This case emphasizes unique, atypical ultrasound findings that may be encountered in small bowel intussusception, with correlative radiographic, CT (computed tomography) and intra-operative findings. Increased awareness of these atypical imaging features can lead to early diagnosis and decrease the risk of potential complications including mesenteric venous thrombosis, bowel ischemia and necrosis.



http://ift.tt/2m67joS

Contrast-enhanced ultrasound and computed tomography findings of granulomatosis with polyangiitis presenting with multiple intrarenal microaneurysms: A case report

Publication date: Available online 9 March 2017
Source:Clinical Imaging
Author(s): Youe Ree Kim, Young Hwan Lee, Jong-Ho Lee, Kwon-Ha Yoon
Granulomatosis with polyangiitis (GPA) is a systemic disorder that affects small- and medium- sized vessels in many organs. Although the kidneys are the second most commonly involved organ in patients with GPA, its manifestation as multiple intrarenal aneurysms is rare. We report an unusual manifestation of GPA with multiple intrarenal microaneurysms, as demonstrated by contrast-enhanced ultrasound and computed tomography.



http://ift.tt/2mNSjjW

Neocortical and hippocampal TREM2 protein levels during the progression of Alzheimer’s disease

Publication date: Available online 9 March 2017
Source:Neurobiology of Aging
Author(s): Sylvia E. Perez, Muhammad Nadeem, Bin He, Jennifer C. Miguel, Michael H. Malek-Ahmadi, Kewei Chen, Elliott J. Mufson
Heterozygous TREM2 mutations are an Alzheimer's disease (AD) risk factor. Non-mutated TREM2 dysregulation occurs in AD brain. Whether TREM2 is altered in prodromal AD remains unknown. Western blotting was used to determine levels of TREM2 (∼ 25 kDa) and Iba1 in the frontal cortex and TREM2 in the hippocampus from people who died with an ante-mortem clinical diagnosis of non- and mild-cognitive impairment, mild/moderate AD (mAD) and severe AD (sAD). Immunohistochemistry defined the relationship between amyloid and Iba1 profiles. PCR analysis revealed that all subjects did not carry the most common R47H TREM2 variant. TREM2 was significantly upregulated in sAD frontal cortex, but stable in hippocampus. Frontal TREM2 mRNA and protein level patterns were similar, but not significantly different. Iba1 immunopositive microglia counts increased significantly in frontal cortex containing plaques in sAD. TREM2 and Iba1 levels were not associated with plaques, tangles, neuropathological criteria or cognitive performance. Frontal cortex TREM2 upregulation is a late event and may not play a major role early in the pathogenesis of the disease.



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Engineering intravaginal vaccines to overcome mucosal and epithelial barriers

Publication date: June 2017
Source:Biomaterials, Volume 128
Author(s): Zhonghua Ji, Zhaolu Xie, Zhirong Zhang, Tao Gong, Xun Sun
The mucosal surface of the vagina is a primary human immunodeficiency virus (HIV) entry portal, making it an attractive site for HIV vaccination. However, HIV vaccines based on recombinant adenovirus (rAd) do not efficiently cross the mucus layers or underlying epithelium of the vagina. Here we designed nanocomplexes of rAd particles coated with (1) the polyethylene glycol derivative APS to provide a hydrophilic surface that would prevent entrapment in the hydrophobic mucus, and (2) the cell-penetrating peptide TAT to improve transduction efficiency. The optimized rAd-TAT-APS nanocomplexes could achieve the balance of effective mucus-penetrating and cellular transduction. Intravaginal delivery of rAd-TAT-APS encoding HIVgag p24 into mice strongly enhanced HIVgag-specific systemic and mucosal immune responses. This rAd-TAT-APS system may allow effective vaginal delivery of vaccines against HIV and other infectious agents.



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Islet encapsulation with polyphenol coatings decreases pro-inflammatory chemokine synthesis and T cell trafficking

Publication date: June 2017
Source:Biomaterials, Volume 128
Author(s): Dana Pham-Hua, Lindsey E. Padgett, Bing Xue, Brian Anderson, Michael Zeiger, Jessie M. Barra, Maigen Bethea, Chad S. Hunter, Veronika Kozlovskaya, Eugenia Kharlampieva, Hubert M. Tse
Type 1 Diabetes (T1D) is a chronic pro-inflammatory autoimmune disease consisting of islet-infiltrating leukocytes involved in pancreatic β-cell lysis. One promising treatment for T1D is islet transplantation; however, clinical application is constrained due to limited islet availability, adverse effects of immunosuppressants, and declining graft survival. Islet encapsulation may provide an immunoprotective barrier to preserve islet function and prevent immune-mediated rejection after transplantation. We previously demonstrated that a novel cytoprotective nanothin multilayer coating for islet encapsulation consisting of tannic acid (TA), an immunomodulatory antioxidant, and poly(N-vinylpyrrolidone) (PVPON), was efficacious in dampening in vitro immune responses involved in transplant rejection and preserving in vitro islet function. However, the ability of (PVPON/TA) to maintain islet function in vivo and reverse diabetes has not been tested. Recent evidence has demonstrated that modulation of redox status can affect pro-inflammatory immune responses. Therefore, we hypothesized that transplanted (PVPON/TA)-encapsulated islets can restore euglycemia to diabetic mice and provide an immunoprotective barrier. Our results demonstrate that (PVPON/TA) nanothin coatings can significantly decrease in vitro chemokine synthesis and diabetogenic T cell migration. Importantly, (PVPON/TA)-encapsulated islets restored euglycemia after transplantation into diabetic mice. Our results demonstrate that (PVPON/TA)-encapsulated islets may suppress immune responses and enhance islet allograft acceptance in patients with T1D.



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Tolerability, usability and acceptability of dissolving microneedle patch administration in human subjects

Publication date: June 2017
Source:Biomaterials, Volume 128
Author(s): Jaya Arya, Sebastien Henry, Haripriya Kalluri, Devin V. McAllister, Winston P. Pewin, Mark R. Prausnitz
To support translation of microneedle patches from pre-clinical development into clinical trials, this study examined the effect of microneedle patch application on local skin reactions, reliability of use and acceptability to patients. Placebo patches containing dissolving microneedles were administered to fifteen human participants. Microneedle patches were well tolerated in the skin with no pain or swelling and only mild erythema localized to the site of patch administration that resolved fully within seven days. Microneedle patches could be administered by hand without the need of an applicator and delivery efficiencies were similar for investigator-administration and self-administration. Microneedle patch administration was not considered painful and the large majority of subjects were somewhat or fully confident that they self-administered patches correctly. Microneedle patches were overwhelmingly preferred over conventional needle and syringe injection. Altogether, these results demonstrate that dissolving microneedle patches were well tolerated, easily usable and strongly accepted by human subjects, which will facilitate further clinical translation of this technology.



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TANTIGEN: a comprehensive database of tumor T cell antigens

Abstract

Tumor T cell antigens are both diagnostically and therapeutically valuable molecules. A large number of new peptides are examined as potential tumor epitopes each year, yet there is no infrastructure for storing and accessing the results of these experiments. We have retroactively cataloged more than 1000 tumor peptides from 368 different proteins, and implemented a web-accessible infrastructure for storing and accessing these experimental results. All peptides in TANTIGEN are labeled as one of the four categories: (1) peptides measured in vitro to bind the HLA, but not reported to elicit either in vivo or in vitro T cell response, (2) peptides found to bind the HLA and to elicit an in vitro T cell response, (3) peptides shown to elicit in vivo tumor rejection, and (4) peptides processed and naturally presented as defined by physical detection. In addition to T cell response, we also annotate peptides that are naturally processed HLA binders, e.g., peptides eluted from HLA in mass spectrometry studies. TANTIGEN provides a rich data resource for tumor-associated epitope and neoepitope discovery studies and is freely available at http://ift.tt/2mrs5D0 or http://ift.tt/2mpnNds (mirror).

http://ift.tt/2mrDLWc

Murine Th17 cells utilize IL-2 receptor gamma chain cytokines but are resistant to cytokine withdrawal-induced apoptosis

Abstract

Adoptive cellular therapy (ACT) with the Th17 subset of CD4⁺ T cells can cure established melanoma in preclinical models and holds promise for treating human cancer. However, little is known about the growth factors necessary for optimal engraftment and anti-tumor activity of Th17 cells. Due to the central role of IL-2 receptor gamma chain (IL2Rγ-chain) cytokines (IL-2, IL-7, and IL-15) in the activity and persistence of many T cell subsets after adoptive transfer, we hypothesized that these cytokines are important for Th17 cells. We found that Th17 cells proliferated in response to IL-2, IL-7, and IL-15 in vitro. However, in contrast to many other T cell subsets, including conventionally activated CD8⁺ T cells, we found that Th17 cells were resistant to apoptosis in the absence of IL2Rγ-chain cytokines. To determine whether Th17 cells utilize IL2Rγ-chain cytokines in vivo, we tracked Th17 cell engraftment after adoptive transfer with or without cytokine depletion. Depletion of IL-7 and/or IL-2 decreased initial engraftment, while depletion of IL-15 did not. Supplementation of IL-2 increased initial Th17 engraftment. To assess the clinical relevance of these findings, we treated melanoma-bearing mice with Th17 cell adoptive transfer and concurrent cytokine depletion or supplementation. We found that simultaneous depletion of IL-2 and IL-7 decreased therapeutic efficacy, depletion of IL-15 had no effect, and IL-2 supplementation increased therapeutic efficacy. Our results show that Th17 cells are responsive to IL2Rγ-chain cytokines, and provide insight into the application of these cytokines for Th17-based therapeutic strategies.

http://ift.tt/2mpnWO8

Acoustic Context Alters Vowel Categorization in Perception of Noise-Vocoded Speech

Abstract

Normal-hearing listeners' speech perception is widely influenced by spectral contrast effects (SCEs), where perception of a given sound is biased away from stable spectral properties of preceding sounds. Despite this influence, it is not clear how these contrast effects affect speech perception for cochlear implant (CI) users whose spectral resolution is notoriously poor. This knowledge is important for understanding how CIs might better encode key spectral properties of the listening environment. Here, SCEs were measured in normal-hearing listeners using noise-vocoded speech to simulate poor spectral resolution. Listeners heard a noise-vocoded sentence where low-F₁ (100–400 Hz) or high-F₁ (550–850 Hz) frequency regions were amplified to encourage "eh" (/ɛ/) or "ih" (/ɪ/) responses to the following target vowel, respectively. This was done by filtering with +20 dB (experiment 1a) or +5 dB gain (experiment 1b) or filtering using 100 % of the difference between spectral envelopes of /ɛ/ and /ɪ/ endpoint vowels (experiment 2a) or only 25 % of this difference (experiment 2b). SCEs influenced identification of noise-vocoded vowels in each experiment at every level of spectral resolution. In every case but one, SCE magnitudes exceeded those reported for full-spectrum speech, particularly when spectral peaks in the preceding sentence were large (+20 dB gain, 100 % of the spectral envelope difference). Even when spectral resolution was insufficient for accurate vowel recognition, SCEs were still evident. Results are suggestive of SCEs influencing CI users' speech perception as well, encouraging further investigation of CI users' sensitivity to acoustic context.

http://ift.tt/2m8EDMU

Verrucarin A and roridin E produced on spinach by Myrothecium verrucaria under different temperatures and CO 2 levels

Abstract

The behavior of Myrothecium verrucaria, artificially inoculated on spinach, was studied under seven different temperature conditions (from 5 to 35 °C) and under eight different combinations of temperature and CO₂ concentration (14–30 °C and 775–870 or 1550–1650 mg/m³). The isolate used for this study was growing well on spinach, and the mycotoxins verrucarin A and roridin E were produced under all tested temperature and CO₂ conditions. The maximum levels of verrucarin A (18.59 ng/g) and roridin E (49.62 ng/g) were found at a temperature of 26–30 °C and a CO₂ level of 1550–1650 mg/m³. Rises in temperature as well as in temperature and CO₂ concentrations had a significant effect by increasing Myrothecium leaf spots on spinach. The biosynthesis of verrucarin A was significantly increased at the highest temperature (35 °C), while roridin E was influenced by the CO₂ concentration. These results show that a positive correlation between climate condition and macrocyclic trichothecene production is possible. However, because of the ability of M. verrucaria to produce mycotoxins, an increase in temperature could induce the spread of M. verrucaria in temperate regions; this pathogen may gain importance in the future.

http://ift.tt/2nl1chp

Withdrawing ASV therapy in clinical practice: trials and tribulations

On May 13, 2015, prior to publication of the results of the SERVE-HF Study,1 a field safety notice was issued identifying an increase in the risk of cardiovascular death (hazard ratio 1.34 [95% CI 1.09-1.65] P=0.006) in patients with symptomatic chronic heart failure (HF) with left ventricular ejection fraction (LVEF) ≤ 45% being treated with Adaptive Servo-ventilation (ASV). Three recommendations were made: physicians should identify and reassess all patients with symptomatic HF with reduced EF (HFrEF) currently being treated with ASV "with the aim of urgently stopping" such therapy.

http://ift.tt/2mNxuVD

Risk of developing obstructive sleep apnea among women with polycystic ovarian syndrome: a nationwide longitudinal follow-up study

Previous cross-sectional studies have suggested a comorbid relationship between polycystic ovarian syndrome (PCOS) and obstructive sleep apnea (OSA). However, the temporal association between these two distinct diseases has not yet been investigated.

http://ift.tt/2m6dCZt

Natural course and potential prognostic factors for sleep-disordered breathing in multiple system atrophy

/Background: Multiple system atrophy (MSA) frequently results in the development of sleep-disordered breathing (SDB). Few reports have described the natural course of this phenomenon. The aim of the present study was to determine the natural course of SDB and prognostic factors associated with such conditions in MSA.

http://ift.tt/2n5LmLJ

The Transient Receptor Potential Melastatin 7 Channel Regulates Pancreatic Cancer Cell Invasion through the Hsp90α/uPA/MMP2 pathway

Publication date: April 2017
Source:Neoplasia, Volume 19, Issue 4
Author(s): Pierre Rybarczyk, Alison Vanlaeys, Bertrand Brassart, Isabelle Dhennin-Duthille, Denis Chatelain, Henri Sevestre, Halima Ouadid-Ahidouch, Mathieu Gautier
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a very poor prognosis. There is an urgent need to better understand the molecular mechanisms that regulate PDAC cell aggressiveness. The transient receptor potential melastatin 7 (TRPM7) is a nonselective cationic channel that mainly conducts Ca²⁺ and Mg²⁺. TRPM7 is overexpressed in numerous malignancies including PDAC. In the present study, we used the PANC-1 and MIA PaCa-2 cell lines to specifically assess the role of TRPM7 in cell invasion and matrix metalloproteinase secretion. We show that TRPM7 regulates Mg²⁺ homeostasis and constitutive cation entry in both PDAC cell lines. Moreover, cell invasion is strongly reduced by TRPM7 silencing without affecting the cell viability. Conditioned media were further studied, by gel zymography, to detect matrix metalloproteinase (MMP) secretion in PDAC cells. Our results show that MMP-2, urokinase plasminogen activator (uPA), and heat-shock protein 90α (Hsp90α) secretions are significantly decreased in TRPM7-deficient PDAC cells. Moreover, TRPM7 expression in human PDAC lymph node metastasis is correlated to the channel expression in primary tumor. Taken together, our results show that TRPM7 is involved in PDAC cell invasion through regulation of Hsp90α/uPA/MMP-2 proteolytic axis, confirming that this channel could be a promising biomarker and possibly a target for PDAC metastasis therapy.



http://ift.tt/2nccaGG

Reactivating p53 and Inducing Tumor Apoptosis (RITA) Enhances the Response of RITA-Sensitive Colorectal Cancer Cells to Chemotherapeutic Agents 5-Fluorouracil and Oxaliplatin

Publication date: April 2017
Source:Neoplasia, Volume 19, Issue 4
Author(s): Armin Wiegering, Niels Matthes, Bettina Mühling, Monika Koospal, Anne Quenzer, Stephanie Peter, Christoph-Thomas Germer, Michael Linnebacher, Christoph Otto
Colorectal carcinoma (CRC) is the most common cancer of the gastrointestinal tract with frequently dysregulated intracellular signaling pathways, including p53 signaling. The mainstay of chemotherapy treatment of CRC is 5-fluorouracil (5FU) and oxaliplatin. The two anticancer drugs mediate their therapeutic effect via DNA damage-triggered signaling. The small molecule reactivating p53 and inducing tumor apoptosis (RITA) is described as an activator of wild-type and reactivator of mutant p53 function, resulting in elevated levels of p53 protein, cell growth arrest, and cell death. Additionally, it has been shown that RITA can induce DNA damage signaling. It is expected that the therapeutic benefits of 5FU and oxaliplatin can be increased by enhancing DNA damage signaling pathways. Therefore, we highlighted the antiproliferative response of RITA alone and in combination with 5FU or oxaliplatin in human CRC cells. A panel of long-term established CRC cell lines (n=9) including p53 wild-type, p53 mutant, and p53 null and primary patient-derived, low-passage cell lines (n=5) with different p53 protein status were used for this study. A substantial number of CRC cells with pronounced sensitivity to RITA (IC50<3.0 μmol/l) were identified within established (4/9) and primary patient-derived (2/5) CRC cell lines harboring wild-type or mutant p53 protein. Sensitivity to RITA appeared independent of p53 status and was associated with an increase in antiproliferative response to 5FU and oxaliplatin, a transcriptional increase of p53 targets p21 and NOXA, and a decrease in MYC mRNA. The effect of RITA as an inducer of DNA damage was shown by a strong elevation of phosphorylated histone variant H2A.X, which was restricted to RITA-sensitive cells. Our data underline the primary effect of RITA, inducing DNA damage, and demonstrate the differential antiproliferative effect of RITA to CRC cells independent of p53 protein status. We found a substantial number of RITA-sensitive CRC cells within both panels of established CRC cell lines and primary patient-derived CRC cell lines (6/14) that provide a rationale for combining RITA with 5FU or oxaliplatin to enhance the antiproliferative response to both chemotherapeutic agents.



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Noninvasive Bioluminescence Imaging of AKT Kinase Activity in Subcutaneous and Orthotopic NSCLC Xenografts: Correlation of AKT Activity with Tumor Growth Kinetics

Publication date: April 2017
Source:Neoplasia, Volume 19, Issue 4
Author(s): Karina Suchowski, Thomas Pöschinger, Alnawaz Rehemtulla, Michael Stürzl, Werner Scheuer
Aberrant signaling through the AKT kinase mediates oncogenic phenotypes including cell proliferation, survival, and therapeutic resistance. Here, we utilize a bioluminescence reporter for AKT kinase activity (BAR) to noninvasively assess the therapeutic efficacy of the EGFR inhibitor erlotinib in KRAS-mutated lung cancer therapy. A549 non–small cell lung cancer cell line, engineered to express BAR, enabled the evaluation of compounds targeting the EGFR/PI3K/AKT pathway in vitro as well as in mouse models. We found that erlotinib treatment of resistant A549 subcutaneous and orthotopic xenografts resulted in significant AKT inhibition as determined by an 8- to 13-fold (P < .0001) increase in reporter activity 3 hours after erlotinib (100 mg/kg) administration compared to the control. This was confirmed by a 25% (P < .0001) decrease in pAKT ex vivo and a decrease in tumor growth. Treatment of the orthotopic xenograft with varying doses of erlotinib (25, 50, and 100 mg/kg) revealed a dose- and time-dependent increase in reporter activity (10-, 12-, and 23-fold). Correspondingly, a decrease in phospho-AKT levels (0%, 16%, and 28%, respectively) and a decrease in the AKT dependent proliferation marker PCNA (0%, 50%, and 50%) were observed. We applied μ-CT imaging for noninvasive longitudinal quantification of lung tumor load which revealed a corresponding decrease in tumor growth in a dose-dependent manner. These findings demonstrate the utility of BAR to noninvasively monitor AKT activity in preclinical studies in response to AKT modulating agents. These results also demonstrate that BAR can be applied to study drug dosing, drug combinations, and treatment efficacy in orthotopic mouse lung tumor models.



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Emergency cricothyrotomy: temporary measure or definitive airway? A systematic review.

Related Articles

Emergency cricothyrotomy: temporary measure or definitive airway? A systematic review.

Rev Col Bras Cir. 2016 Dec;43(6):493-499

Authors: Macêdo MB, Guimarães RB, Ribeiro SM, Sousa KM

Abstract
Being a fast and safe method in the hands of well trained professionals in both prehospital and intrahospital care, Cricothyrotomy has been broadly recommended as the initial surgical airway in the scenario "can't intubate, can't ventilate", and is particularly useful when the obstruction level is above or at the glottis. Its prolonged permanence, however, is an endless source of controversy. In this review we evaluate the complications of cricothyrotomy and the need of its routine conversion to tracheotomy through a search on PubMed, LILACS and SciELO electronic databases with no restriction to the year or language of the publication. In total, we identified 791 references, retrieved 20 full text articles, and included nine studies in our review. The incidence of short-term complications ranged from zero to 31.6%, and the long-term complications, from zero to 7.86%. Subglotic stenosis was the main long-term reported complication, even though it was quite infrequent, occurring only in 2.9 to 5%. The frequency of conversion to tracheostomy varied from zero to 100%. Although a small frequency of long-term complications was found for emergency cricothyrotomy, the studies' low level of evidence does not allow the recommendation of routine use of cricothyrotomy as a secure definitive airway.

PMID: 28273224 [PubMed - in process]

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Foreign body aspiration in children: Focus on the impact of delayed treatment

This study aims to analyze the impact of delayed treatment of foreign body aspiration (FBA) in children.

http://ift.tt/2lJpup4

Close surgical margin after conservative parotidectomy in early stage low-/intermediate-grade parotid carcinoma: Outcome of watch and wait policy

Patients with early-stage primary parotid carcinoma have a good chance of recovery and normal function of 7th nerve when treated solely by surgery. Is such cases the surgeon must decide whether to perform radical procedure or to preserve facial nerve [1]. Excision of the nerve, regardless of various reconstruction techniques, is associated with a severe aesthetic and functional defect. On the other hand, positive surgical margin is an independent negative factor [2,3]. In the case of a positive margin it is necessary to carry out a radical procedure (frequently with excision of 7th nerve) and/or radiotherapy.

http://ift.tt/2n5EXQE

Our auditory results using the Vibrant Soundbridge on the long process of the incus: 20 years of data

Publication date: Available online 9 March 2017
Source:Auris Nasus Larynx
Author(s): Anaïs Grégoire, Jean-Philippe Van Damme, Chantal Gilain, Benoit Bihin, Pierre Garin
ObjectiveAfter 20 years of experience with different types of middle ear implants, we analyzed our database about the Vibrant Soundbridge (VSB) to know the rate of complications, the effect on the residual hearing and the audiometric gain in our center.MethodThe study was retrospective and included all VSB implants bound to the long process of the incus in our tertiary medical center between january 1999 and february 2015. We observed the effect of surgery on residual hearing by comparing bone and air conduction thresholds before and after implantation. The functional results of the implant were quantified by measuring, at several post-operative intervals, the thresholds with the VSB in pure tone audiometry and speech audiometry, in quiet and in noise.Results53 VSB were implanted in 46 patients aged between 22 and 81 years old (average 53.9). 48 patients (90%) suffered from a sensorineural hearing loss, and 5 patients from a mixed hearing loss due to an otosclerosis (but only 3 of them have undergone stapedotomy). There were no major complications (e.g. facial palsy, dead ear or postoperative infection). The placement of the implant created an insignificant deterioration of the air conduction thresholds (5,6 dB HL) and bone conduction thresholds (2.2 dB HL) at 6 weeks post-implantation. The bone conduction thresholds increased by 4.7 dB HL 2.5 years after surgery in comparison with the preoperative results, which is also considered clinically insignificant. With the implant turned on, the pure tone audiometry thresholds in open field, in quiet, were significantly improved (gain of 13.9 dB on average on frequencies from 250 to 8000 Hz), particularly at frequencies of 1000, 2000 and 4000 Hz as the average gain on these frequencies amounted to 19.4 dB. The speech intelligibility in a cocktail party noise was also improved by 18.3% on average at 6, 52 and 104 weeks post-implantation.ConclusionThe Vibrant Soundbridge with the electromagnetic vibrator fixed to the long process of the incus is a safe active middle ear implant with no major complications; it has no significant impact on the residual hearing. The VSB is particularly suitable for patients who are unable to wear conventional hearing aids due to anatomical or infectious problems in the external ear canal, or in case of poor audiometric results with conventional hearing aids. The VSB brings significant hearing gain, as it is particularly efficient in frequencies for the speech range and higher, resulting especially in better speech intelligibility in noisy environments.



http://ift.tt/2m68hSd

The clinical manifestations of vestibular migraine: A review

Publication date: Available online 9 March 2017
Source:Auris Nasus Larynx
Author(s): Ashley P. O'Connell Ferster, Adrian J. Priesol, Huseyin Isildak
ObjectivesTo provide an overview of vestibular migraines presentation, pathology, and diagnosis, as well as an update on current diagnostic criteria.MethodsA review of the most recent literature on vestibular migraines was performed.ResultsVestibular migraine is a process with significant impact on the quality of life for those afflicted with the disease, with attacks of spontaneous or positional vertigo and migraine symptoms lasting several minutes to 72h. Inner ear disease can co-exist with migraine and the vestibular symptoms occurring with vestibular migraine can mimic inner ear disorders providing a challenge for clinicians in establishing diagnosis. Recent diagnostic criteria for vestibular migraine proposed by a joint committee of the Bárány Society and the International Headache Society provide an important standard for clinical diagnosis and research endeavor.ConclusionVestibular migraine is a challenging disease process to both diagnose and treat. Proper diagnosis and treatment requires a thorough understanding of the current literature.



http://ift.tt/2mNw79z

Comparing performance of Fastrach ILMA vs flexible bronchoscope for awake intubation

In the recent article by Hanna et al. [1] comparing the performance of Fastrach intubating laryngeal mask airway (ILMA) and flexible bronchoscopy (FB) for awake intubation in patients with difficult airways, they showed that the Fastrach ILMA compared to the FB provided a higher first-pass success rate (95% vs 58%) and a shorter mean time to intubation (92 vs 246s). Given that awake intubation is a cornerstone for safe management of predicted or known difficult airways, their findings have potential implications.

http://ift.tt/2mpoaER

Targeting BMI1+ Cancer Stem Cells Overcomes Chemoresistance and Inhibits Metastases in Squamous Cell Carcinoma

Publication date: Available online 9 March 2017
Source:Cell Stem Cell
Author(s): Demeng Chen, Mansi Wu, Yang Li, Insoon Chang, Quan Yuan, Mari Ekimyan-Salvo, Peng Deng, Bo Yu, Yongxin Yu, Jiaqiang Dong, John M. Szymanski, Sivakumar Ramadoss, Jiong Li, Cun-Yu Wang
Squamous cell carcinoma in the head and neck (HNSCC) is a common yet poorly understood cancer, with adverse clinical outcomes due to treatment resistance, recurrence, and metastasis. Putative cancer stem cells (CSCs) have been identified in HNSCC, and BMI1 expression has been linked to these phenotypes, but optimal treatment strategies to overcome chemotherapeutic resistance and eliminate metastases have not yet been identified. Here we show through lineage tracing and genetic ablation that BMI1⁺ CSCs mediate invasive growth and cervical lymph node metastasis in a mouse model of HNSCC. This model and primary human HNSCC samples contain highly tumorigenic, invasive, and cisplatin-resistant BMI1⁺ CSCs, which exhibit increased AP-1 activity that drives invasive growth and metastasis of HNSCC. Inhibiting AP-1 or BMI1 sensitized tumors to cisplatin-based chemotherapy, and it eliminated lymph node metastases by targeting CSCs and the tumor bulk, suggesting potential regimens to overcome resistance to treatments and eradicate HNSCC metastasis.

Graphical abstract

Teaser

Chen et al. show that BMI1⁺ CSCs drive invasive growth and cervical lymph node metastasis in squamous cell carcinoma. BMI1⁺ CSCs have increased AP-1 activity and are chemotherapy resistant, and combination therapy that targets BMI1⁺ CSCs and the tumor bulk yields better outcomes and effectively eliminates metastasis.


http://ift.tt/2mpjoqZ

PRC2 Facilitates the Regulatory Topology Required for Poised Enhancer Function during Pluripotent Stem Cell Differentiation

Publication date: Available online 9 March 2017
Source:Cell Stem Cell
Author(s): Sara Cruz-Molina, Patricia Respuela, Christina Tebartz, Petros Kolovos, Milos Nikolic, Raquel Fueyo, Wilfred F.J. van Ijcken, Frank Grosveld, Peter Frommolt, Hisham Bazzi, Alvaro Rada-Iglesias
Poised enhancers marked by H3K27me3 in pluripotent stem cells have been implicated in the establishment of somatic expression programs during embryonic stem cell (ESC) differentiation. However, the functional relevance and mechanism of action of poised enhancers remain unknown. Using CRISPR/Cas9 technology to engineer precise genetic deletions, we demonstrate that poised enhancers are necessary for the induction of major anterior neural regulators. Interestingly, circularized chromosome conformation capture sequencing (4C-seq) shows that poised enhancers already establish physical interactions with their target genes in ESCs in a polycomb repressive complex 2 (PRC2)-dependent manner. Loss of PRC2 does not activate poised enhancers or induce their putative target genes in undifferentiated ESCs; however, loss of PRC2 in differentiating ESCs severely and specifically compromises the induction of major anterior neural genes representing poised enhancer targets. Overall, our work illuminates an unexpected function for polycomb proteins in facilitating neural induction by endowing major anterior neural loci with a permissive regulatory topology.

Graphical abstract

Teaser

Cruz-Molina et al. demonstrate that pluripotent-associated poised enhancers are necessary for the induction of anterior neural genes. Poised enhancers physically interact with their target genes in embryonic stem cells in a PRC2-dependent manner. Thus, polycomb proteins might facilitate neural induction by providing anterior neural loci with a permissive regulatory topology.


http://ift.tt/2mpuX1q

Mex3a Marks a Slowly Dividing Subpopulation of Lgr5+ Intestinal Stem Cells

Publication date: Available online 9 March 2017
Source:Cell Stem Cell
Author(s): Francisco M. Barriga, Elisa Montagni, Miyeko Mana, Maria Mendez-Lago, Xavier Hernando-Momblona, Marta Sevillano, Amy Guillaumet-Adkins, Gustavo Rodriguez-Esteban, Simon J.A. Buczacki, Marta Gut, Holger Heyn, Douglas J. Winton, Omer H. Yilmaz, Camille Stephan-Otto Attolini, Ivo Gut, Eduard Batlle
Highly proliferative Lgr5+ stem cells maintain the intestinal epithelium and are thought to be largely homogeneous. Although quiescent intestinal stem cell (ISC) populations have been described, the identity and features of such a population remain controversial. Here we report unanticipated heterogeneity within the Lgr5+ ISC pool. We found that expression of the RNA-binding protein Mex3a labels a slowly cycling subpopulation of Lgr5+ ISCs that contribute to all intestinal lineages with distinct kinetics. Single-cell transcriptome profiling revealed that Lgr5+ cells adopt two discrete states, one of which is defined by a Mex3a expression program and relatively low levels of proliferation genes. During homeostasis, Mex3a+ cells continually shift into the rapidly dividing, self-renewing ISC pool. Chemotherapy and radiation preferentially target rapidly dividing Lgr5+ cells but spare the Mex3a-high/Lgr5+ population, helping to promote regeneration of the intestinal epithelium following toxic insults. Thus, Mex3a defines a reserve-like ISC population within the Lgr5+ compartment.

Graphical abstract

Teaser

Lgr5+ intestinal stem cells are considered to be a homogeneous and rapidly proliferating population. Barriga et al. show that the RNA binding protein Mex3a defines a subset of slowly proliferating Lgr5+ cells that contribute to all intestinal lineages with slow kinetics, are resistant to chemotherapy, and support intestinal regeneration.


http://ift.tt/2mpl7wz

New in vivo model to analyse the expression of angiogenic genes in the borders of a cleft lip

Defects in the fusion of facial buds can result from an anomaly in tissue development or apoptosis, or both. Our working hypothesis was that anomalies in the development of tissues could be caused by a genetic angiogenic defect. Our main objective was to design a reproducible experimental model to study the expression of angiogenic genes in the borders of cleft lips with or without cleft palate. We therefore prospectively studied seven non-syndromic patients, three with a cleft lip (2 right, 1 left), and four with a cleft lip and palate (1 bilateral, 2 right, 1 left), with no CGH (comparative genomic hybridisation) array, who had primary operations to repair their clefts.

http://ift.tt/2m65aJM

Stimuli-responsive shell cross-linked micelles from amphiphilic four-arm star copolymers as potential nanocarriers for “pH/redox-triggered” anticancer drug release

Publication date: 7 April 2017
Source:Polymer, Volume 114
Author(s): Di Xiong, Na Yao, Huawei Gu, Jufang Wang, Lijuan Zhang
A novel amphiphilic four-arm star copolymer [poly(ε-caprolactone)-b-poly(poly(ethylene glycol) methyl ether methacrylate-co-p-(2-methacryloxyethoxy) benzaldehyde)]4 [4-AS-PCL-P(PEGMA-co-MAEBA)] was designed and synthesized by a combination of ring-opening polymerization (ROP) and continuous activators regenerated by electron transfer atom transfer radical polymerization (ARGET ATRP). Stimuli-responsive cross-linked micelles (SCMs) were prepared by crosslinking the shell structure of the self-assembled micelles from star copolymers. The SCMs could be de-cross-linked under low pH and redox conditions. After loading with the anticancer drug camptothecin (CPT), the SCMs displayed a good stability against extensive dilution and a slow sustained drug release at pH 7.4 with 15% in 24 h, while a fast release (54%) was observed at pH 5.0 and 10 mM DTT. Confocal microscopy studies and MTT assays revealed that the CPT-loaded SCMs showed a good uptake property and a high cytotoxicity against HepG2 tumor cells. The pH/redox dual stimuli-responsive cross-linked micelles are proposed to be a highly promising platform for the intracellular delivery of insoluble chemotherapeutics for cancer therapy.

Graphical abstract

http://ift.tt/2nl4aTf

Novel endodontic sealers induce cell cytotoxicity and apoptosis in a dose-dependent behavior and favorable response in mice subcutaneous tissue

Abstract

Objectives

The objective of the present study is to evaluate the in vitro cytotoxicity and in vivo biocompatibility of two novel endodontic sealers: RealSeal XT1 and Sealapex Xpress on the subcutaneous connective tissue of mice.

Materials and methods

The cytotoxicity was assessed by cell viability using the MTT assay (one-way ANOVA), trypan blue test (Mann-Whitney) and cell apoptosis by flow cytometer. For the subcutaneous study, polyethylene tubes filled with the sealers were implanted in 70 BALB/c mice: 6 experimental groups (n = 10/group) and 2 control groups with empty tubes (n = 5/group). At the end of experimental periods (7, 21, and 63 days), the tissue was removed and histotechnically processed. Angioblastic proliferation and edema (Fisher's exact test) were evaluated, besides thickness measurement (μm) of the reactionary granulomatous tissue and neutrophil counts (Kruskal-Wallis and Dunn's post test; Mann-Whitney) (α = 0.05).

Results

MTT assay, trypan blue, and analysis of apoptotic cells showed a dose-dependent direct effect: the more diluted the sealer, the less cytotoxic. Regarding the angioblastic proliferation and edema, difference between the sealers at 7 and 63 days occurred (p < 0.05). Both endodontic sealers initially promoted perimaterial tissue reaction as a foreign body granuloma and thus stimulated favorable tissue responses.

Conclusions

Both sealers showed a dose-dependent effect and promoted satisfactory subcutaneous tissue response; the sealer Sealapex Xpress was less cytotoxic and more biocompatible than RealSeal XT.

Clinical relevance

The step of root canal filling during endodontic treatment is highly important for the preservation of the periapical tissue integrity. Subcutaneous reaction to endodontic sealers enables scientific basis for clinical use.

http://ift.tt/2m5Ttmv

Root canal morphology and variations in mandibular second molar teeth of an Indian population: an in vivo cone-beam computed tomography analysis

Abstract

Objectives

This study aims to investigate the root canal morphology of permanent mandibular second molars of an Indian population in vivo using cone-beam computed tomography (CBCT) images.

Methods

CBCT images (n = 983; males = 489, females = 494) of untreated, completely developed permanent mandibular second molar teeth were examined. CBCT scans were acquired as part of diagnosis and treatment planning for treatments unrelated to the present study. The number of roots and root canals were recorded. Canal configuration was classified based on Vertucci's and Fan's classifications.

Results

The most common configuration was two-root (79.35%) and three-root canals (53.50%). The incidence of three-rooted molars was 7.53%, whereas 13.12% of the studied teeth studied have fused roots with C-shaped canals. The predominant canal morphology in the mesial roots was Vertucci's type IV (45.17%), followed by type II (32.55%), type I (7.23%), type V (1.02%), and type III (0.91%). The distal root in contrast showed type I (61.14%) as the predominant canal configuration, followed by type II (18.21%) and type IV (7.53%). The incidence of three-rooted molars was higher in males (n = 55; 5.59%) than in females (n = 19; 1.94%) (p < 0.01). The canals in the extra roots exhibited type I (100%) root canal morphology. In teeth with C-shaped root canal (13.12%), the variations in the coronal, middle, and apical third ranged from C1 to C4.

Conclusions

Root canal systems of the mesial roots of mandibular second molars of the study population demonstrated a high degree of variability. While three roots were rare, there was a sexual predisposition. Fused roots with C-shaped canals were rare and demonstrated significant variations from the coronal to apical third.

Clinical relevance

Root canal morphology can demonstrate variations based on race and sex of patients. Clinicians must always consider the possible variations to ensure successful endodontic treatment.

http://ift.tt/2mNoH6s

Lipid parameters in obese and normal weight patients with or without chronic periodontitis

Abstract

Objective

The aim of this study was to evaluate the serum levels of lipids in patients with normal weight (NW) or obesity with or without chronic periodontitis (ChP).

Materials and methods

One hundred and sixty non-smoking patients without history of diabetes and/or cardiovascular events were allocated into one of the following groups: NW patients with periodontal health (NWH; n = 40), NW patients with ChP (NWChP; n = 40), obese patients with periodontal health (ObH; n = 40), and obese patients with ChP (ObChP; n = 40). Serum levels of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TRG) were estimated.

Results

After adjustments for gender and age, both NW groups presented lower levels of TRG than both obese groups (p < 0.05). The NWH group presented lower levels of LDL than both periodontitis groups (p < 0.05) and the lowest TC/HDL ratio when compared to the other groups (p < 0.05). Females from the NWH group exhibited higher levels of HDL and lower LDL/HDL ratio than females from the ObChP group (p < 0.05). Furthermore, individuals from the ObChP group were more likely to have levels of LDL ≥130 mg/dl and HDL ≤40 mg/dl, compared to those from the NWH group (p < 0.05).

Conclusions

ChP and obesity, jointly or individually, are associated with undesirable pro-atherogenic lipid profiles.

Clinical relevance

There is interest in identifying clinical conditions associated with dyslipidemia to improve preventive and treatment strategies. This study demonstrated that ChP, obesity, and the association of both conditions might be related to pro-atherogenic lipid profiles.

http://ift.tt/2m5Rwq4

Odontogenic differentiation potential of human dental pulp cells cultured on a calcium-aluminate enriched chitosan-collagen scaffold

Abstract

Objective

The study aims to evaluate the odontogenic potential of human dental pulp cells (HDPCs) in contact with an experimental porous chitosan-collagen scaffold (CHC) enriched or not with a mineral phase of calcium-aluminate (CHC-CA).

Material and methods

To assess the chemotactic effect of the materials, we placed HDPCs seeded on transwell membranes in intimate contact with the CHC or CHC-CA surface, and the cell migration was monitored for 48 h. Additionally, cells were seeded onto the material surface, and the viability and proliferation were evaluated at several time points. To assess the odontoblastic differentiation, we evaluated ALP activity, DSPP/DMP-1 gene expression, and mineralized matrix deposition. HDPCs cultured onto a polystyrene surface (monolayer) were used as negative control group.

Results

The experimental CHC-CA scaffold induced intense migration of HDPCs through transwell membranes, with cells attaching to and spreading on the material surface after 24-h incubation. Also, the HDPCs seeded onto the CHC-CA scaffold were capable of migrating inside it, remaining viable and featuring a proliferative rate more rapid than that of CHC and control groups at 7 and 14 days of cell culture. At long-term culture, cells in the CHC-CA scaffold featured the highest deposition of mineralized matrix and expression of odontoblastic markers (ALP activity and DSPP/DMP-1 gene expression).

Conclusions

According to the results, the CHC-CA scaffold is a bioactive and cytocompatible material capable of increasing the odontogenic potential of human pulp cells. Based on analysis of the positive data obtained in this study, one can suggest that the CHC-CA scaffold is an interesting future candidate for the treatment of exposed pulps.

Clinical relevance

The experimental scaffold composed by a chitosan-collagen matrix mineralized with calcium aluminate seems to be an interesting candidate for in vivo application as a cell-free approach to dentin tissue engineering, which may open a new perspective for the treatment of exposed pulp tissue.

http://ift.tt/2mNoG2o

Integrative Proteomics and Phosphoproteomics Profiling Reveals Dynamic Signaling Networks and Bioenergetics Pathways Underlying T Cell Activation

Publication date: Available online 9 March 2017
Source:Immunity
Author(s): Haiyan Tan, Kai Yang, Yuxin Li, Timothy I. Shaw, Yanyan Wang, Daniel Bastardo Blanco, Xusheng Wang, Ji-Hoon Cho, Hong Wang, Sherri Rankin, Cliff Guy, Junmin Peng, Hongbo Chi
The molecular circuits by which antigens activate quiescent T cells remain poorly understood. We combined temporal profiling of the whole proteome and phosphoproteome via multiplexed isobaric labeling proteomics technology, computational pipelines for integrating multi-omics datasets, and functional perturbation to systemically reconstruct regulatory networks underlying T cell activation. T cell receptors activated the T cell proteome and phosphoproteome with discrete kinetics, marked by early dynamics of phosphorylation and delayed ribosome biogenesis and mitochondrial activation. Systems biology analyses identified multiple functional modules, active kinases, transcription factors and connectivity between them, and mitochondrial pathways including mitoribosomes and complex IV. Genetic perturbation revealed physiological roles for mitochondrial enzyme COX10-mediated oxidative phosphorylation in T cell quiescence exit. Our multi-layer proteomics profiling, integrative network analysis, and functional studies define landscapes of the T cell proteome and phosphoproteome and reveal signaling and bioenergetics pathways that mediate lymphocyte exit from quiescence.

Graphical abstract

Teaser

Tan et al. apply multi-layer proteomic profiling and systems biology approaches to define T cell proteome and phosphoproteome landscapes, and they identify signaling networks and bioenergetics pathways that mediate T cell quiescence exit. These data establish the function and mechanisms of oxidative phosphorylation and mitochondrial activation in antigen-induced T cell responses.


http://ift.tt/2mGLAI3

Concentration-dependent alterations in gene expression induced by cadmium in Solanum lycopersicum

Abstract

Cadmium (Cd) toxicity in agricultural soil has received significant attention because of its higher transformation in the food chain and toxicity to humans. The aim of the present study was to develop sensitive and specific biomarkers for Cd stress. Therefore, transcriptional analyses were performed to investigate concentration-response characteristics of Cd responsive genes identified from a Solanum lycopersicum microarray. The results showed that the lowest observable adverse effect concentrations (LOAECs) of Cd to S. lycopersicum were 1 mg/kg for seed germination, 8 mg/kg for root dry weight, 8 mg/kg for root elongation, and 8 mg/kg for root morphology. Furthermore, the genes were differentially expressed even at the lowest Cd concentrations (0.5 mg/kg), indicating that the detection of Cd in soil at the molecular level is a highly sensitive method. Cd in soil was positively correlated with the expression of the F-box protein PP2-B15 (r = 0.809, p < 0.01) and zinc transporter 4 (r = 0.643, p < 0.01), indicating that these two genes could be selected as indicators of soil Cd contamination.

http://ift.tt/2mrGVt0

Iron-based adsorbent prepared from Litchi peel biomass via pyrolysis process for the removal of pharmaceutical pollutant from synthetic aqueous solution

Abstract

A porous iron-based adsorbent obtained from litchi peel via pyrolysis process was prepared in this work, in order to evaluate its adsorptive potential for the removal of a pharmaceutical dye (amaranth) from aqueous solution. The material was characterized by X-ray diffraction, nitrogen adsorption–desorption isotherms, and scanning electron microscopy. Several isotherm and kinetic models were tested aiming to represent the amaranth dye adsorption. The prepared sample presented magnetic property, and a mesoporous texture constituted of graphite and three iron-based phases. The adsorption kinetics of amaranth on the adsorbent followed the pseudo-second-order model, whereas the equilibrium data were in good agreement with the BET isotherm, being represented by a sigmoid-shaped adsorption isotherm. The maximum adsorption capacity for the amaranth dye was found to be 44.87 mg g⁻¹, demonstrating that the material prepared in this work showed to be a promising adsorbent for the removal of amaranth from aqueous solution.

http://ift.tt/2mppZl7

Amelioration of boron toxicity in sweet pepper as affected by calcium management under an elevated CO 2 concentration

Abstract

We investigated B tolerance in sweet pepper plants (Capsicum annuun L.) under an elevated CO₂ concentration, combined with the application of calcium as a nutrient management amelioration technique. The data show that high B affected the roots more than the aerial parts, since there was an increase in the shoot/root ratio, when plants were grown with high B levels; however, the impact was lessened when the plants were grown at elevated CO₂, since the root FW reduction caused by excess B was less marked at the high CO₂ concentration (30.9% less). Additionally, the high B concentration affected the membrane permeability of roots, which increased from 39 to 54% at ambient CO₂ concentration, and from 38 to 51% at elevated CO₂ concentration, producing a cation imbalance in plants, which was differentially affected by the CO₂ supply. The Ca surplus in the nutrient solution reduced the nutritional imbalance in sweet pepper plants produced by the high B concentration, at both CO₂ concentrations. The medium B concentration treatment (toxic according to the literature) did not result in any toxic effect. Hence, there is a need to review the literature on critical and toxic B levels taking into account increases in atmospheric CO₂.

http://ift.tt/2mrDuTb

Effect of foliar application of plant growth regulators on nitrous oxide (N 2 O) emission and grain yield in wheat

Abstract

Agricultural soils are the major source of global nitrous oxide (N₂O) emission, and more than two thirds of N₂O emission originate from soil. Recent studies have identified that green plants contribute to transport of N₂O to the atmosphere. We investigated the effects of foliar application of plant growth regulators (PGRs) and growth stimulating chemicals on N₂O emission and wheat grain yield for 2 years. The PGRs' abscisic acid (ABA) and cytozyme (20 mg L⁻¹), kinetin (10 and 20 mg L⁻¹) and wet tea extract (1:20 w/w) along with distilled water as control were sprayed on wheat canopy at the tillering and panicle initiation stages. Our results showed that cytozyme and tea extract enhanced the plant dry biomass over control. Kinetin (10 and 20 mg L⁻¹) and cytozyme increased the plant photosynthetic rate and photosynthate partitioning towards the developing grain. ABA (20 mg L⁻¹) and kinetin (10 and 20 mg L⁻¹) reduced the N₂O emission over control primarily through regulation of leaf growth, stomatal density and xylem vessel size. Leaf area, stomatal density and xylem vessel size were found to be associated with N₂O transport and emission. We concluded that use of ABA and kinetin can reduce N₂O emissions without any impact on wheat grain yield.

http://ift.tt/2mpoQu0

Withered on the stem: is bamboo a seasonally limiting resource for giant pandas?

Abstract

In response to seasonal variation in quality and quantity of available plant biomass, herbivorous foragers may alternate among different plant resources to meet nutritional requirements. Giant pandas (Ailuropoda melanoleuca) are reliant almost exclusively on bamboo which appears omnipresent in most occupied habitat, but subtle temporal variation in bamboo quality may still govern foraging strategies, with population-level effects. In this paper, we investigated the possibility that temporal variation in the quality of this resource is involved in population regulation and examined pandas' adaptive foraging strategies in response to temporal variation in bamboo quality. Giant pandas in late winter and early spring consumed a less optimal diet in Foping Nature Reserve, as the availability of the most nutritious and preferred components and age classes of Bashania fargesii declined, suggesting that bamboo may be a seasonally limiting resource. Most panda mortalities and rescues occurred during the same period of seasonal food limitation. Our findings raised the possibility that while total bamboo biomass may not be a limiting factor, carrying capacity may be influenced by subtle seasonal variation in bamboo quality. We recommend that managers and policy-makers should consider more than just the quantity of bamboo in the understory and that carrying capacity estimates should be revised downward to reflect the fact that all bamboos are not equal.

http://ift.tt/2mrHYcn

Frequencies of erythrocyte nuclear abnormalities and of leucocytes in the fish Barbus peloponnesius correlate with a pollution gradient in the River Bregalnica (Macedonia)

Abstract

Integrated chemical and biomarker approaches were performed to estimate if there is ongoing toxicity in the River Bregalnica, namely connected with the presence of metals. The study was performed in water, sediment, and barbel (Barbus peloponnesius), collected in two seasons, from two suspected polluted and one reference zones. The water analyses revealed higher mean values in polluted sites for most of the examined physicochemical parameters. Metal concentrations (Zn, Cu, Cd, Mn, Pb, and Fe) in water were more or less constant, whereas in sediment, they were higher at the two polluted locations. Condition factor (CF), as a general health indicator, revealed better overall condition in barbel from the reference site. In general, blood parameters revealed higher values in the polluted localities. Irrespective of sex and/or season, the frequency of micronuclei (MN) and vacuolated nuclei (VN) were with higher rates in polluted sites. Similarly, the frequencies of the leucocytes (Le), binuclei (BN), and irregularly shaped nuclei (ISN) were also significantly increased in the polluted localities, but they seemed prone to be influenced by sex and/or season. However, strong positive correlations between blood biomarkers and most water physicochemical parameters and metal in sediment were estimated. Our data support that the River Bregalnica's lower course receives significant genotoxic pollution, likely via metal industry effluents, agricultural runoff, and domestic sewage, and reinforced the utility of MN and other nuclear abnormalities as sensitive and suitable biomarkers for genotoxicity when used in monitoring studies.

http://ift.tt/2mpipar

Using early life stages of marine animals to screen the toxicity of priority hazardous and noxious substances

Abstract

This study provides toxicity values for early life stages (ELS) of two phylogenetically distinct marine animal taxa, the sea urchin (Paracentrotus lividus), a deuterostome invertebrate, and the turbot (Scophthalmus maximus), a vertebrate (teleost), when challenged by six hazardous and noxious substances (HNS): aniline, butyl acrylate, m-cresol, cyclohexylbenzene, hexane and trichloroethylene. The aim of the study was to provide preliminary information on toxic effects of representative and relevant priority HNS to assess the risk posed by spills to marine habitats and therefore improve preparedness and the response at the operational level. Selection criteria to include each compound in the study were (1) inclusion in the HASREP (2005) list; (2) presence on the priority list established by Neuparth et al. (2011); (3) paucity of toxicological data (TOXnet and ECOTOX) for marine organisms; (4) behaviour in the water according to the categories defined by the European Behaviour classification system (GESAMP 2002), by selecting compounds with different behaviours in water; and (5) physicochemical and toxicological properties, where available, in order to anticipate the most toxic compounds. Aniline and m-cresol were the most toxic compounds with no observed apical effect concentration (NOAEC) values for sea urchin ranging between 0.01 and 0.1 mg/L, followed by butyl acrylate and cyclohexylbenzene with NOAECs ranging between 0.1 and 1.0 mg/L and trichloroethylene with NOAEC values that were in the range between 1 and 10 mg/L, reflecting their behaviour in water, mostly vapour pressure, but also solubility and log Kow. Hexane was toxic only for turbot embryos, due to its neurotoxic effects, and not for sea urchin larvae, at concentrations in the range between 1 and 10 mg/L. The concentrations tested were of the same order of magnitude for both species, and it was observed that sea urchin embryos (length of the longest arm) are more sensitive than turbot eggs larvae (hatching and cumulative mortality rates) to the HNS tested (except hexane). For this specific compound, concentrations up to 70 mg/L were tested in sea urchin larvae and no effects were observed on the length of the larvae. Both tests were found to be complementary depending on behaviour in water and toxicity target of the compounds analysed.

http://ift.tt/2mrIwis

Toxic effect of nonylphenol on the marine macroalgae Gracilaria lemaneiformis (Gracilariales, Rhodophyta): antioxidant system and antitumor activity

Abstract

The objective of the present work was to evaluate the toxic effect of nonylphenol (NP) on the antioxidant response and antitumor activity of Gracilaria lemaneiformis. An obvious oxidative damage was observed in this study. The thallus exposed to NP showed 1.2–2.0-fold increase in lipid peroxide and displayed a maximum level of 16.58 μmol g⁻¹ Fw on 0.6 mg L⁻¹ for 15-day exposure. The activities of antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT) enhanced significantly by 1.1–3.2-fold and subsequently diminished at the high concentrations and prolonged exposure. The results of DNA damage in comet assay also supported that NP was obviously toxic on G. lemaneiformis with increasing the percentage of tail DNA in a dose-dependent manner. Furthermore, the ethanol extract of G. lemaneiformis (EEGL) did exhibit antitumor potential against HepG-2 cells. While decreased in cell inhibition, ROS generation, apoptosis, and caspase-3 in HepG-2 cells treated with the EEGL were observed when G. lemaneiformis was exposed to NP for 15 days, and which were related to exposure concentration of NP. These suggested that NP has strongly toxic effect on the antitumor activity of G. lemaneiformis. The results revealed in this study imply that macroalgae can be useful biomarkers to evaluate marine pollutions.

http://ift.tt/2mpdiqB

Unique characteristics of algal dissolved organic matter and their association with membrane fouling behavior: a review

Abstract

Over the last several decades, the frequent occurrence of algal bloom in drinking water supplies, driven by increasing anthropogenic input and climate change, has posed serious problems for membrane filtration processes, resulting in reduced membrane permeability and increased energy consumption. It is essential to comprehensively understand the characteristics of algal dissolved organic matter (DOM) and the subsequent effects on the filtration processes for better insight into membrane fouling mitigation. Many studies have revealed that algal DOM has displayed unique characteristics distinguished from other sources of DOM with respect to the chemical composition, the structures, and the molecular weight distributions. Algal DOM is considered to be a major obstacle in understanding membrane fouling due to its complicated interactions among dissimilar algal DOM constituents as well as between algal DOM and membrane material matrices. The present review article summarizes (1) recent characterizing methods for algal DOM, (2) environmental factors affecting the characteristics of algal DOM, (3) the discrepancies between algal DOM and other sources of aquatic DOM, particularly terrestrial sources, and (4) potential fouling effects of algal DOM on membrane filtration processes and their associations with algal DOM characteristics. A broad understanding of algal DOM-driven membrane fouling can lead to breakthroughs in efficient membrane filtration processes to treat algal bloom water sources.

http://ift.tt/2mrGWNA

Precipitation and air temperature control the variations of dissolved organic matter along an altitudinal forest gradient, Gongga Mountains, China

Abstract

Dissolved organic carbon (DOC) and dissolved organic nitrogen (DON) contribute significantly to C and N cycling in forest ecosystems. Little information is available on the variations in the DOC and DON concentrations and depositions in bulk and stand precipitation within forests along an altitudinal gradient. To determine the temporal variations in the DOC and DON concentrations and depositions in different forests and the spatial variations along the elevation gradient, the DOC and DON concentrations and depositions were measured in bulk precipitation, throughfall, and stemflow within three forest types, i.e., broadleaf forest (BLF), broadleaf-coniferous forest (BCF), and coniferous forest (CF), during the wet season (May to October) on Gongga Mountain, China, in 2015. The concentrations of bulk precipitation in BLF, BCF, and CF were 3.92, 4.04, and 2.65 mg L⁻¹, respectively, for DOC and were 0.38, 0.26, and 0.29 mg L⁻¹, respectively, for DON. BCF had the highest DOC deposition both in bulk precipitation (45.12 kg ha⁻¹) and stand precipitation (98.52 kg ha⁻¹), whereas the highest DON deposition was in BLF (3.62 kg ha⁻¹ bulk precipitation and 4.11 kg ha⁻¹ stand precipitation) during the study period. The meteorological conditions of precipitation and air temperature significantly influenced the dissolved organic matter (DOM) depositions along the elevation gradient. The leaf area index did not show any correlation with DOM depositions during the growing season.

http://ift.tt/2mppCat

The death of the circulatory system diseases in China: provincial socioeconomic and environmental perspective

Abstract

Few studies have explored the association between circulatory system diseases (CSDs) and provincial socioeconomic and environmental factors from spatial perspective, although large literature have focused on CSD. The numbers of death of hypertension disease (HD), ischemic heart disease (IHD), and cerebrovascular disease (CVD) are investigated, and 14 representative socioeconomic and environmental factors are collected. Stepwise regression model (SRM) and geographically weighted regression model (GWRM) are applied to determine the spatial correlation between the number of death of those diseases and selected factors. The results are the following: (1) diseases exhibit a pattern of zonal distribution. Higher HD is mostly distributed in south district, whereas higher IHD and CVD are observed in the north area. (2) SO₂ emission amount (SO₂ EA) is significantly positively related with HD, while coal consumption (CC) and PM_2.5 are notably positively correlated with IHD and CVD. (3) A 10,000 tons increase in SO₂ EA results in three increases in the numbers of death of HD. For every 100 ten thousand tons (TTTs) increase in CC, the death of IHD and CVD increases by 11.1 and 15.7, while for every 1 μg/m³ increase in ambient PM_2.5 concentration, the numbers of death of IHD and CVD increase by 34.773 and 43.222, respectively. (4) Our findings show that there exist spatial differences for SO₂ EA, CC, and PM_2.5 influencing HD, IHD, and CVD. This study is expected to provide a reference for HD, IHD, and CVD control in different regions.

http://ift.tt/2mpoFyK

Slow-release formulations of the herbicide picloram by using Fe–Al pillared montmorillonite

Abstract

Slow-release formulations of the herbicide picloram (PCM, 4-amino-3,5,6-trichloropyridine-2-carboxylic acid) were designed based on its adsorption on pillared clays (pillared clays (PILCs)) for reducing the water-polluting risk derived from its use in conventional formulations. Fe–Al PILCs were synthesized by the reaction of Na⁺-montmorillonite (SWy-2) with base-hydrolyzed solutions of Fe and Al. The Fe/(Fe + Al) ratios used were 0.15 and 0.50. The PCM adsorption isotherms on Fe–Al PILCs were well fitted to Langmuir and Freundlich models. The PCM adsorption capacity depended on the Fe content in the PILCs. Slow-release formulations were prepared by enhanced adsorption of the herbicide from PCM-cyclodextrin (CD) complexes in solution. CDs were able to enhance up to 2.5-fold the solubility of PCM by the formation of inclusion complexes where the ring moiety of the herbicide was partially trapped within the CD cavity. Competitive adsorption of anions such as sulfate, phosphate, and chloride as well as the FTIR analysis of PCM-PILC complexes provided evidence of formation of inner sphere complexes of PCM-CD on Fe–Al PILCs. Release of the herbicide in a sandy soil was lower from Fe–Al PILC formulations relative to a PCM commercial formulation.

http://ift.tt/2mrIs2c