Πέμπτη 27 Ιουλίου 2017
Association Between Plasma Proprotein Convertase Subtilisin/Kexin Type 9 and the Presence of Metabolic Syndrome in a Predominantly Rural-Based Sub-Saharan African Population
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2tOwvcn
Incidence and risk of cardiotoxicity in cancer patients treated with targeted therapies
Source:Cancer Treatment Reviews
Author(s): Matteo Santoni, Federico Guerra, Alessandro Conti, Alessandra Lucarelli, Silvia Rinaldi, Laura Belvederesi, Alessandro Capucci, Rossana Berardi
BackgroundCardiotoxicityis a serious side effect of molecularly targeted agents. The purpose of this study was to evaluate the incidence and Relative Risk (RR) of developing all-grade and high-grade cardiotoxicity in patients with solid tumors receiving targeted agents through a revised meta-analysis of available clinical trials.MethodsThe scientific literature regarding cardiotoxicity was extensively analyzed using MEDLINE, PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL). Eligible studies were selected according to PRISMA statement. Summary incidence, RR, and 95% CIs were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies.ResultsOur search yielded a total of 4998 clinical studies; of them, 31 trials were finally considered for this meta-analysis. A total of 28538 patients were included; 7995 of these patients had breast cancer (28%), 6151 (22%) prostate cancer and 14392 (50%) were treated for other malignancies. The highest RR of high-grade events was observed with Vandetanib (RR=7.71, 95% CI 1.04–56.99), followed by Ramucirumab (RR=5.0) and Aflibercept (RR=4.1). Grouping by drug category, the highest incidence of high-grade cardiotoxicity was shown by anti-VEGFR-TKIs (RR 5.62, 95% CI 1.49–21.24) and anti-VEGF mAbs/VEGF-trap (RR 1.82, 95% CI 1.24–2.69). Grouping by tumor type, the highest incidence of cardiotoxicity was observed in thyroid cancer (8%), followed by gastric cancer (4%).ConclusionsTreatment with targeted agents in cancer patients is correlated with a significant increase in the risk of cardiotoxicity. Frequent clinical monitoring should be emphasized when using these and newer biological agents.
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Genomic characterization of an extensively-drug resistance Salmonella enterica serotype Indiana strain harboring blaNDM-1 gene isolated from a chicken carcass in China
Source:Microbiological Research
Author(s): Wei Wang, Zixin Peng, Zulqarnain Baloch, Yujie Hu, Jin Xu, Wenhui Zhang, Séamus Fanning, Fengqin Li
ObjectivesThe objective of this study was to genetically characterize the antimicrobial resistance mechanisms of Salmonella enterica serotype Indiana C629 isolated from a chicken carcass in China in 2014.MethodsAntimicrobial susceptibility against a panel of 23 antimicrobial agents was carried out on Salmonella enterica serotype Indiana C629 and assessed according to CLSI standards. Whole-genome sequencing of this isolate was conducted to obtain the complete genome of S. Indiana.ResultsSalmonella Indiana C629 expressed an XDR phenotype being resistant to more than 20 antimicrobial agents, including imipenem and meropenem. From the analysis of the resistance mechanisms, two mutations were identified in subunit A of DNA gyrase within the quinolone resistance determining region, in addition to the acquisition of mobile efflux pumps encoding oqxA/B/R. Additionally, four beta-lactamases resistance genes (blaCTX-M-65, blaTEM-1, blaOXA-1, and blaNDM-1), five aminoglycosides resistance genes (aac(3)-IV, aac(6′)-Ib-cr, aadA2, aadA5, and aph(4)-Ia), two phenicol resistance genes (catB3 and floR), and five trimethoprim/sulfamethoxazole resistance genes (sul1/2/3 and dfrA12/17) were also identified. A total of 191 virulence genes were identified. Among them, 57 belonged to type-three secretion system (T3SS) encoding genes, 55 belonged to fimbrial adherence encoding genes, and 39 belonged to flagella-encoding genesConclusionsThis study demonstrated that multi-resistance mechanisms consistent with an XDR-phenotype, along with various virulence encoding genes of a S. Indiana strain in China These findings highlight the importance of cooperation among different sectors in order to monitor the spread of resistant pathogens among food animal, foods of animal origin and human beings that might further take measures to protect consumers' health.
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The participation of oxidative stress in the pathogenesis of bronchial asthma
Publication date: October 2017
Source:Biomedicine & Pharmacotherapy, Volume 94
Author(s): Paulina Kleniewska, Rafał Pawliczak
Reactive oxygen species are produced during oxygen reduction and are characterized by high reactivity. They participate in many important physiological processes, but if produced in high concentrations they lead to oxidative stress development and disturb pro-oxidative/anti-oxidative balance towards the oxidation reaction – leading to damage of lipids, proteins, carbohydrates or nucleic acids. Asthma is a chronic inflammatory disease of the airways of various pathogenesis and clinical symptoms, prevalence in recent years has increased significantly. Recently published literature point out the involvement of reactive oxygen species in the pathogenesis of asthma. Changes in the protein and lipid oxidation lead, among others, to pathological changes in the respiratory epithelial cells, an increase in vascular permeability, mucus overproduction, smooth muscle contraction or airway hyperresponsiveness (AHR).The aim of this study is to present the current state of knowledge on the influence of oxidative stress parameters on asthma development.
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Cadmium chloride–induced testicular toxicity in male wistar rats; prophylactic effect of quercetin, and assessment of testicular recovery following cadmium chloride withdrawal
Publication date: October 2017
Source:Biomedicine & Pharmacotherapy, Volume 94
Author(s): Victor U. Nna, Godwin A. Ujah, Mahaneem Mohamed, Kingsley B. Etim, Benedict O. Igba, Ele R. Augustine, Eme E. Osim
This study assessed the effect of quercetin (QE) on cadmium chloride (CdCl2) − induced testicular toxicity, as well as the effect of withdrawal of CdCl2 treatment on same. Thirty male Wistar rats aged 10 weeks old and weighing 270–300g were assigned into 5 groups and used for this study. Rats in groups 1–4 were administered vehicle, CdCl2 (5mg/kg bwt), CdCl2+QE (5mg/kg bwt and 20mg/kg bwt, respectively) or QE (20mg/kg bwt) orally for 4 weeks. Group 5 rats received CdCl2, with 4 weeks recovery period. Results showed that cadmium accumulated in serum, testis and epididymis, decreased body weight, testicular and epididymal weights, sperm count, motility and viability. Cadmium decreased serum concentrations of reproductive hormones, but increased testicular glucose, lactate and lactate dehydrogenase activity. Cadmium decreased testicular enzymatic (superoxide dismutase, catalase and glutathione peroxidase) and non-enzymatic (glutathione, vitamins C and E) antioxidants, and increased malondialdehyde and hydrogen peroxide. Cadmium down-regulated Bcl-2 protein, up-regulated Bax protein, increased Bax/Bcl-2 ratio and cleaved caspase-3 activity. Histopathology of the testis showed decreased Johnsen's score and Leydig cell count. These negative effects were attenuated by QE administration, while withdrawal of CdCl2 did not appreciably reverse toxicity. We conclude that QE better protected the testis from CdCl2 toxicity than withdrawal of CdCl2 administration.
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The impact of supplementation with dietary fibres on weight loss: a systematic review of randomised controlled trials
Publication date: Available online 27 July 2017
Source:Bioactive Carbohydrates and Dietary Fibre
Author(s): Kia Yong Chew, Iain A Brownlee
The prevalence of excess body weight has significantly increased, with recent estimates suggesting 1.9 billion people are overweight or obese worldwide. While intake of dietary fibre (mainly from plant-based foods) is associated with improved weight management over time, it is uncertain whether dietary fibre isolates will benefit weight loss. The present study aimed to systematically assess the current evidence that dietary fibre supplementation can impact on weight loss in overweight adults. Blinded, randomised-controlled trials were retrieved from Scopus and Cochrane Central Register of Controlled Trials databases. Studies with free-living, overweight adult participants and fibre supplementation in various forms (i.e. as pills, capsules or powder mix formats) were included. A total of 32 trials were identified that met these criteria. Meta-analysis of statistically pooled data for chitosan (n=6) found significant increases in weight loss (effect size −0.42, 95% confidence interval: −0.81 to −0.03, P<0.001) in treatment groups compared with control groups. For glucomannan (n=5), non-significant difference was found (effect size −0.58, 95% confidence interval: −1.52 to 0.35, P<0.001). Risk of bias within included studies appeared to be low with mean scores of >3 on the Jadad scale and 13 studies scoring the highest possible value. Evidence on the potential impact of supplementation with other fibre types on weight loss was limited by a low number of studies and varied methodological approaches. Further research is recommended to explore these underlying issues to improve the paucity of evidence. A number of elements of study design should also be carefully considered in future work.
Graphical abstract
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Once upon a (slow) time in the land of recurrent neuronal networks…
Source:Current Opinion in Neurobiology, Volume 46
Author(s): Chengcheng Huang, Brent Doiron
The brain must both react quickly to new inputs as well as store a memory of past activity. This requires biology that operates over a vast range of time scales. Fast time scales are determined by the kinetics of synaptic conductances and ionic channels; however, the mechanics of slow time scales are more complicated. In this opinion article we review two distinct network-based mechanisms that impart slow time scales in recurrently coupled neuronal networks. The first is in strongly coupled networks where the time scale of the internally generated fluctuations diverges at the transition between stable and chaotic firing rate activity. The second is in networks with finitely many members where noise-induced transitions between metastable states appear as a slow time scale in the ongoing network firing activity. We discuss these mechanisms with an emphasis on their similarities and differences.
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Acquired pachydermatoglyphia: the cutaneous manifestation of pulmonary tumours
Description
A 74-year-old man with active smoking habits presented to the emergency department with a 2-month history of weight loss (20% of previous body mass), dyspnoea and night sweats. Physical examination showed clinical signs of respiratory distress, significant cachexia and thickened velvety palms with pronounced folds (figure 1). The laboratory results revealed leucocytosis of 15 700 cells/µl, thrombocytosis of 547 000/µl and elevated C reactive protein of 6.65 mg/dL. A posteroanterior chest radiograph showed a right pleural effusion and consolidation suggestive of pneumonia.
Figure 1
Thickened velvety palms with pronounced folds consistent with acquired pachydermatoglyphia.
The patient was given antibiotics and submitted to pleural effusion drainage for symptomatic relief. A skin biopsy of the palms was obtained and the histopathological examination identified signs of hyperkeratosis, acanthosis and papillomatosis consistent with acquired pachydermatoglyphia (figure 2).
Figure 2
Skin biopsy consistent with acquired...
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Bacteraemia and liver abscess due to Fusobacterium necrophorum
Fusobacterium necrophorum is the oropharyngeal pathogen usually associated with Lemierre's syndrome, a pharyngeal infection which evolves to sepsis, septic emboli and thrombophlebitis of the adjacent neck vessels. It is an uncommon causative bacteria of a liver abscess, and an extensive workup should, therefore, be performed in order to rule out potential sources of the infection. This case report describes the workup that led to the diagnosis of a colorectal carcinoma, which was deemed to be the source of the Fusobacterium bacteraemia.
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Hiatal hernia mimicking heart problems
Description
A 73-year-old man presented to the emergency department with symptoms of acute coronary syndrome. Findings on examination were dyspnoea, chest tightness and a burning sensation behind the sternum.
On admission, 3 hours after the onset of symptoms, his 12-lead ECG showed a left bundle branch block. Cardiac enzymes revealed only marginally elevated creatine kinase, aspartate transaminase and lactate dehydrogenase levels; however, troponin I (<0.04 ng/mL) was increased to 17 and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) to 1472 pg/mL (73 year normal range: 10–220 pg/mL). Though the consulting cardiologist determined coronary angiography to be unnecessary at the time, the patient was promptly sent to the intensive care unit (ICU) for monitoring and for quick intervention, if needed.
At that time, further information was gathered from the patient and his family. Apparently, the symptoms had started during lunch. The patient had experienced these symptoms several times in the preceding months; this time, however, the...
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Postoperative gluteal compartment syndrome following microsurgical free-flap hand reconstruction: the importance of early recognition and treatment
Compartment syndrome, a surgical emergency, is caused by an increase in pressure within a closed osseofascial space, often due to trauma. This causes a decrease in tissue perfusion and ultimately tissue necrosis and multiorgan failure if not treated in a timely fashion. Gluteal compartment syndrome is a rare variant and often caused by a period of immobilisation secondary to intoxication with alcohol or drugs or during long operations, typically in the supine position. We report on a case of gluteal compartment syndrome developing in a patient postoperatively following a long microsurgical procedure to a hand, which has not been documented before. Although rare, we highlight the clinical course and diagnostic criteria, which are essential for early identification and treatment.
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Adjunctive extracorporeal carbon dioxide removal in refractory status asthmaticus
Status asthmaticus (SA) is a life-threatening disorder. Severe respiratory failure may require extracorporeal membrane oxygenation (ECMO). Previous reports have demonstrated utility of ECMO in SA in various patients with varying success. A 25-year-old man was admitted with status asthmatics and severe hypercapnic respiratory failure. Despite tailored ventilator therapies, such as pressure control ventilation and maximal pharmacological therapy, including general anaesthesia, the patientâ™s condition deteriorated rapidly. Veno-venous ECMO (VV-ECMO) was provided for respiratory support. The patientâ™s clinical condition improved over the following 72âhours and was discharged from the intensive care unit on day 3. This case report demonstrates the successful use of VV-ECMO in a patient with severe respiratory failure due to SA, who failed to respond to maximal therapy. This case adds support to a growing body of literature that shows that ECMO can be used with success for refractory status asthmaticus.
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Intraparotid ductal ectasia: rare cause of parotid swelling
A 41-year-old patient was hospitalised for a chronic right parotid mass. A cervical ultrasound revealed a cystic mass of the parotid. Cervical MRI found a ductal ectasia of the parotid and submandibular glands associated with a retention cyst of the right parotid. He had a right total parotidectomy. Histopathological examination of the lesion revealed a multilocular cystic mass with a diffuse glandular ectasia of salivary ducts. The patient had an uneventful postoperative course without any recurrence of symptoms.
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Gamna-Gandy nodules of the spleen and asplenism in SLE: a novel association?
Description
We present a case of a 53-year-old woman who presented to the emergency room with acute abdominal pain, fever and haemodynamic and respiratory instability and was admitted to the intensive care unit with fulminant septic shock with multiorgan failure. CT imaging of the abdomen showed no gross abnormalities, initial laboratory results are presented in table 1.
Table 1
Laboratory test results
ParameterValueReference valueUnitCRP96<10mg/LESR7<20mm/hourHb8.07.0–9.2mmol/LHt0.400.32–0.44L/LMCV9582–89fLWBC6.5http://ift.tt/2eRQxw0
Reversible Holmesa{euro}™ tremor due to spontaneous intracranial hypotension
Holmes' tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes' tremor. We present a 23-year-old woman who presented with unilateral Holmes' tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH). She was managed conservatively and had a total clinical and radiological recovery. The brain sagging with the consequent distortion of the midbrain and diencephalon was responsible for this clinical presentation. SIH may be considered as one of the reversible causes of Holmes' tremor.
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Androgenic alopecia: an entity to consider in adolescence
Description
A 15-year-old healthy adolescent girl went to her physician consultation because she was preoccupied with progressive thinning of her hair since 11 years old. In the last year, she noticed an aggravation, with an excessive hair loss. She does not have hirsutism, acne, asthenia, menstrual irregularities or weight variations. In her family history, she reported that her mother had 'excessive hair loss after pregnancy' and her maternal aunt has alopecia of unknown aetiology. At physical examination it was observed diffuse reduction of capillary thickness and density at the frontal scalp area (figure 1) and vertex (figure 2). Rare black dots were present and the pull test was negative. The analytical study including blood count, iron kinetics, thyroid function and hormonal study had no alterations. The pelvic and adrenal gland's ultrasound were normal. At dermatology consultation, scalp biopsy revealed findings compatible with androgenic alopecia. She started treatment...
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Extramacular dome-shaped elevation: a novel finding in a case of high myopia
Description
Dome-shaped macula (DSM) is an elevation at the macula seen in about 5%–10% cases of high myopia, usually within a posterior staphyloma, caused by localised inward scleral and choroidal convexity.1 It may lead to visual deterioration when associated with serous foveal detachment (44% cases).2 3 Herein, we describe a similar but 'Extramacular dome-shaped elevation (EDSE)' associated with a large retinal hole.
A 23-year-old myopic female patient was referred to our clinic for pre refractive surgery fundus screening. She had a history of diminution of vision in the left eye more than the right eye since childhood and was using myopic glasses for the same. Best-corrected visual acuity on Snellen chart was 20/20 in the right eye and 20/200 in the left eye. Lower acuity in the left eye was attributed to anisometropic amblyopia as her refractive error was –6.75 D sphere...
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Directly observed therapy for clozapine with concomitant methadone prescription: a method for improving adherence and outcome
A young male presented with many years of delusions and hallucinations, with concurrent heroin use and subsequent amphetamine uses. There were no depressive or manic symptoms and psychotic symptoms prior to the amphetamine use. After the trials of two atypical antipsychotics and later clozapine due to treatment resistance, adherence and functionality were poor and there was still persistent drug use. As a result, a long acting injectable adjunct was commenced, but only minimal effects were observed. However after initiation of directly observed treatment of clozapine with methadone, there has been functional and clinical response and drug use has ceased.
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Accidental hypothermic cardiac arrest and rapid mediastinal warming with pleural lavage: a survivor after 3.5 hours of manual CPR
A 30-year-old man suffered post-traumatic hypothermic cardiac arrest. On arrival in the emergency department, rectal core temperature was 23°C. Manual cardiopulmonary resuscitation (CPR) was continued as no mechanical chest compression device was available, and active and passive rewarming was undertaken. Bilateral thoracostomies confirmed good lung inflation. Defibrillation and intravenous epinephrine were discontinued until core temperature was elevated above 30°C. Extracorporeal rewarming was unavailable. When no increase in rectal temperature was achieved after 90 min, an alternative oesophageal probe confirmed mediastinal temperature as 23°C. Bilateral chest drain insertion, followed by microwave-heated saline pleural lavage, rapidly raised the oesophageal temperature above 30°C with subsequent successful defibrillation, initially to pulseless electrical activity and finally return of spontaneous circulation 3.5 hours after the commencement of CPR. The patient recovered fully and was discharged without neurological deficit. Rapid mediastinal warming with pleural lavage should be considered in units with no access to extracorporeal rewarming service.
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A perforated caecal volvulus in the foramen of Winslow
The aim of this report is to discuss with high-quality images, a case of a caecal volvulus herniating through the foramen of Winslow with signs of perforation.
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IPL vs PDL in treatment of facial erythema: A split-face study
Summary
Background
Lasers and noncoherent intense pulse light sources effectively treat vascular lesions. Intense pulsed light (IPL), a nonablative treatment for photorejuvenation, uses a flashlamp which emits noncoherent light between 400 and 1400 nm. The light may be filtered to target a specific chromophore. The pulsed dye laser (PDL), at 595 nm, has been the historical standard of care in the treatment of facial erythema. We sought to determine whether IPL may be used in lieu of PDL in reducing facial erythema.
Objectives
To determine whether IPL may be used to treat facial erythema with equal efficacy as PDL used at nonpurpuric settings.
Methods
Prospective investigation of a cohort of 15 subjects with unwanted bilateral facial erythema. Subjects presented for two treatments with an IPL (BBL™ BroadBand Light; Sciton, Palo Alto, CA) to one half of the face and PDL (Cynergy™; Cynosure, Westford, MA) to the other half.
Results
Patients with facial erythema may be successfully treated with IPL or PDL.
Conclusions
Intense pulsed light and pulsed dye laser with nonpurpuric settings were equally effective in reducing facial erythema.
http://ift.tt/2v4drWP
IPL vs PDL in treatment of facial erythema: A split-face study
Summary
Background
Lasers and noncoherent intense pulse light sources effectively treat vascular lesions. Intense pulsed light (IPL), a nonablative treatment for photorejuvenation, uses a flashlamp which emits noncoherent light between 400 and 1400 nm. The light may be filtered to target a specific chromophore. The pulsed dye laser (PDL), at 595 nm, has been the historical standard of care in the treatment of facial erythema. We sought to determine whether IPL may be used in lieu of PDL in reducing facial erythema.
Objectives
To determine whether IPL may be used to treat facial erythema with equal efficacy as PDL used at nonpurpuric settings.
Methods
Prospective investigation of a cohort of 15 subjects with unwanted bilateral facial erythema. Subjects presented for two treatments with an IPL (BBL™ BroadBand Light; Sciton, Palo Alto, CA) to one half of the face and PDL (Cynergy™; Cynosure, Westford, MA) to the other half.
Results
Patients with facial erythema may be successfully treated with IPL or PDL.
Conclusions
Intense pulsed light and pulsed dye laser with nonpurpuric settings were equally effective in reducing facial erythema.
http://ift.tt/2v4drWP
Alterations in the steroid biosynthetic pathways in the human prefrontal cortex in mood disorders: a postmortem study
Abstract
Altered levels of steroids have been reported in the brain, cerebral spinal fluid and plasma of patients with mood disorders. Neuroimaging studies have reported both functional and structural alterations in mood disorders, for instance in the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC). In order to determine whether the endogenous production of steroids is altered in the ACC and DLPFC of patients with major depressive disorder (MDD) or bipolar disorder (BPD), quantitative real-time PCR was performed to detect mRNA expression level of key enzymes in the steroid biosynthetic pathways. In MDD, a significant decrease in mRNA level of cytochrome P450 17A1 (CYP17A1, synthesizing C19 ketosteroids) in the ACC and a significant increase in mRNA levels of hydroxysteroid sulfotransferase 2A (SULT2A1, catalyzing the sulphate conjugation of dehydroepiandrosterone (DHEA)) were observed in the DLPFC, suggesting alterations in DHEA and its sulfate metabolite DHEAS levels. Decreased intensity and distribution of CYP17A1 immunohistochemical staining was found in the ACC of MDD patients. Interestingly, there was a significant positive correlation between the mRNA levels of CYP17A1 and tyrosine-related kinase B (TrkB) full length isoform. In a unique postmortem human brain slice culture paradigm, BDNF mRNA expression was found to be significantly increased following incubation with DHEA. Together, these data indicate a close relationship between DHEA and BDNF-TrkB pathways in depression. Furthermore, in the DLPFC, higher mRNA levels of 11β-hydroxysteroid dehydrogenase-1 (HSD11B1, reducing cortisone to the active hormone cortisol) and steroidogenic acute regulatory protein (STAR, facilitating the shuttle of cholesterol through the intermembrane space) were found in the MDD patients and BPD patients, respectively. In conclusion, this study suggests the presence of a disturbance in the endogenous synthesis of DHEA and DHEAS in mood disorders, which has a close relationship with BDNF-TrkB signaling. This article is protected by copyright. All rights reserved.
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Resting state functional connectivity correlates of emotional awareness
Source:NeuroImage, Volume 159
Author(s): Ryan Smith, Anna Alkozei, Jennifer Bao, Courtney Smith, Richard D. Lane, William D.S. Killgore
Multiple neuroimaging studies have now linked emotional awareness (EA), as measured by the Levels of Emotional Awareness Scale (LEAS), with activation in regions of neural networks associated with both conceptualization (i.e., default mode network [DMN] regions) and interoception (i.e., salience network [SN] regions) – consistent with the definition of EA as one's ability to appropriately recognize, conceptualize, and articulate the emotions of self and other in fine-grained, differentiated ways. However, no study has yet tested the hypothesis that greater LEAS scores are associated with greater resting state functional connectivity (FC) within these networks. Twenty-six adults (13 female) underwent resting state functional magnetic resonance imaging, and also completed the LEAS. Using pre-defined functional ROIs from the DMN and SN, we observed that LEAS scores were significantly positively correlated with FC between several regions of both of these networks, even when controlling for differences in general intelligence (IQ). These results suggest that higher EA may be associated with more efficient information exchange between brain regions involved in both interoception- and conceptualization-based processing, which could plausibly contribute to more differentiated bodily feelings and more fine-grained conceptualization of those feelings.
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A Plea to Faculty: Rethink Student Writing Assignments.
Author: Kennedy, Maureen Shawn MA, RN, FAAN; Barnsteiner, Jane PhD, RN, FAAN
Page: 7
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Low-Income Adults Report Better Health, Other Benefits, with the ACA.
Author: Sofer, Dalia
Page: 14
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U.S. Life Expectancy Varies Depending on County of Birth.
Author: Zolot, Joan PA
Page: 15
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NewsCAP: Interventions in EDs may prevent future suicide attempts and deaths.
Author:
Page: 15
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NewsCAP: The ACP updates treatment recommendations for low bone density and osteoporosis.
Author:
Page: 15
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Study Highlights the Need for Continuing Postapproval Drug Monitoring.
Author: Stockwell, Serena
Page: 16
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NewsCAP: Higher U.S. county poverty concentration is associated with higher rates of fatal child abuse.
Author:
Page: 16
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New CDC Guideline for the Prevention of Surgical Site Infection.
Author: Todd, Betsy MPH, RN, CIC
Page: 17
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Sucrose as Analgesia in Neonates Undergoing Painful Procedures.
Author: Matsuda, Erin DNP, RN, CPNP
Page: 21
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New Approvals in Cancer Treatment.
Author: Aschenbrenner, Diane S. MS, RN
Page: 22
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Relational containment: exploring the effect of family-based treatment for anorexia on familial relationships
Abstract
Background
The aim of this research was to investigate the process of familial relationship change for adolescents with anorexia nervosa and their parents, who participated in Family-Based Treatment (FBT).
Method
A Constructionist grounded theory design was employed with purposive sampling. Sixteen young people between 12 and 18 years with a good outcome in FBT and twenty-eight of their parents participated. Young people and their parents took part in separate interviews at the end of treatment. Each interview was transcribed and analysed to identify a unifying phenomenon across the data to elicit a theory that explained the data and then integrated into existing theory.
Results
Prior to treatment families' experienced significant conflict, disconnection and isolation. The FBT structure, therapist direction, and the specialist medical setting created a process of relational containment. This enabled parents to trust the process of FBT and develop confidence in their executive role in the family. In turn this allowed the adolescent with anorexia nervosa to trust their parents, feel more secure and gradually engage in the treatment process themselves. Improvements in closeness, communication and adolescent sense of self were reported after FBT.
Conclusions
These findings illuminate a possible mechanism of change in FBT. It underscores the importance of parental management of eating disorder symptoms at the commencement of treatment to enable increased parental confidence. Meaningful changes occurred for the adolescents' that aided normal developmental and relational processes, an important aspect of recovery.
Trial registration
Australian Clinical Trials Register number: ACTRN012607000009415
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A 12-week supervised exercise therapy program for young adults with a meniscal tear: Program development and feasibility study
Publication date: Available online 27 July 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Søren T. Skou, Jonas B. Thorlund
ObjectiveTo describe the development and feasibility of an exercise therapy program for treatment of young adults (18–40 years of age) with a meniscal tear.MethodsResearchers and experienced physical therapists developed a 12-week supervised neuromuscular and strengthening exercise therapy program based on clinical expertise and available evidence. Six patients (age range 22–39 years) considered eligible for meniscal surgery by an orthopedic surgeon underwent the program. Patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) and evaluated the program during a semi-structured qualitative interview. Feedback from patients was included to finalize the exercise therapy program.ResultsMedian improvements (Range) in KOOS subscales were 15 (0–33) for Pain, 11 (−11 to 50) for Symptoms, 16 (3–37) for Function in daily living, 23 (10–45) for Function in sport and recreation, and 9 (−6 to 31) for Quality of life. The patients found the program relevant and effective with only a few short-lasting adverse events and important clinical improvements after four to ten weeks. Physical therapist supervision was considered important. No patients wanted surgery up to 6 month after the exercise therapy program.ConclusionA neuromuscular and strengthening exercise therapy program was feasible and showed important improvement in a small group of young adults with meniscal tears.
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Cysteamine prevents vascular leakage through inhibiting transglutaminase in diabetic retina
Cysteamine (an aminothiol), which is derived from coenzyme A degradation and metabolized into taurine, has beneficial effects against cystinosis and neurodegenerative diseases; however, its role in diabetic complications is unknown. Thus, we sought to determine the preventive effect of cysteamine against hyperglycemia-induced vascular leakage in the retinas of diabetic mice. Cysteamine and ethanolamine, the sulfhydryl group-free cysteamine analogue, inhibited vascular endothelial growth factor (VEGF)-induced stress fiber formation and vascular endothelial (VE)-cadherin disruption in endothelial cells which play a critical role in modulating endothelial permeability. Intravitreal injection of the amine compounds prevented hyperglycemia-induced vascular leakage in the retinas of streptozotocin-induced diabetic mice. We then investigated the potential roles of reactive oxygen species (ROS) and transglutaminase (TGase) in the cysteamine prevention of VEGF-induced vascular leakage. Cysteamine, but not ethanolamine, inhibited VEGF-induced ROS generation in endothelial cells and diabetic retinas. In contrast, VEGF-induced TGase activation was prevented by both cysteamine and ethanolamine. Our findings suggest that cysteamine protects against vascular leakage through inhibiting VEGF-induced TGase activation rather than ROS generation in diabetic retinas.
http://ift.tt/2vcYHpF
Maternal modifiers of the infant gut microbiota: metabolic consequences
Transmission of metabolic diseases from mother to child is multifactorial and includes genetic, epigenetic, and environmental influences. Evidence in rodents, humans and non-human primates support the scientific premise that exposure to maternal obesity or high-fat diet during pregnancy creates a long-lasting metabolic signature on the infant innate immune system and the juvenile microbiota which predisposes the offspring to obesity and metabolic diseases. In neonates, gastrointestinal microbes introduced through the mother are noted for their ability to serve as direct inducers/regulators of the infant immune system. Neonates have a limited capacity to initiate an immune response. Thus, disruption of microbial colonization during the early neonatal period results in disrupted postnatal immune responses that highlight the neonatal period as a critical developmental window. Although the mechanisms are poorly understood, increasing evidence suggests that maternal obesity or poor diet influences the development and modulation of the infant liver and other end-organs through direct communication via the portal system, metabolite production, alterations in gut barrier integrity, and the hematopoietic immune cell axis. This review will focus on how maternal obesity and dietary intake influence the composition of the infant gut microbiota and how an imbalance or maladaptation in the microbiota, including changes in early pioneering microbes, might contribute to the programming of offspring metabolism with special emphasis on mechanisms that promote chronic inflammation in the liver. Comprehension of these pathways and mechanisms will elucidate our understanding of developmental programming, and may expand the avenue of opportunities for novel therapeutics.
http://ift.tt/2w51yx3
A photoclickable peptide microarray platform for facile and rapid screening of 3-D tissue microenvironments
Publication date: October 2017
Source:Biomaterials, Volume 143
Author(s): Sadhana Sharma, Michael Floren, Yonghui Ding, Kurt R. Stenmark, Wei Tan, Stephanie J. Bryant
Microarrays are powerful experimental tools for high-throughput screening of cellular behavior in multivariate microenvironments. Here, we present a new, facile and rapid screening method for probing cellular behavior in 3D tissue microenvironments. This method utilizes a photoclickable peptide microarray platform developed using electrospun fibrous poly(ethylene glycol) hydrogels and microarray contact printing. We investigated the utility of this platform with five different peptide motifs and ten cell types including stem, terminally differentiated, cancer or immune cells that were from either primary origin or cell lines and from different species. We validated the capabilities of this platform to screen arrays consisting of multiple peptide motifs and concentrations for selectivity to cellular adhesion and morphology. Moreover, this platform is amenable to controlled spatial presentation of peptides. We show that by leveraging the differential attachment affinities for two cell types to two different peptides, this platform can also be used to investigate cell-cell interactions through miniature co-culture peptide arrays. Our fibrous peptide microarray platform enables high-throughput screening of 3D tissue microenvironments in a facile and rapid manner to investigate cell-matrix interactions and cell-cell signaling and to identify optimal tissue microenvironments for cell-based therapies.
Graphical abstract
http://ift.tt/2uCSUYY
Red blood cell membrane-camouflaged melanin nanoparticles for enhanced photothermal therapy
Source:Biomaterials, Volume 143
Author(s): Qin Jiang, Zimiao Luo, Yongzhi Men, Peng Yang, Haibao Peng, Ranran Guo, Ye Tian, Zhiqing Pang, Wuli Yang
Photothermal therapy (PTT) has represented a promising noninvasive approach for cancer treatment in recent years. However, there still remain challenges in developing non-toxic and biodegradable biomaterials with high photothermal efficiency in vivo. Herein, we explored natural melanin nanoparticles extracted from living cuttlefish as effective photothermal agents and developed red blood cell (RBC) membrane-camouflaged melanin (Melanin@RBC) nanoparticles as a platform for in vivo antitumor PTT. The as-obtained natural melanin nanoparticles demonstrated strong absorption at NIR region, higher photothermal conversion efficiency (∼40%) than synthesized melanin-like polydopamine nanoparticles (∼29%), as well as favorable biocompatibility and biodegradability. It was shown that RBC membrane coating on melanin nanoparticles retained their excellent photothermal property, enhanced their blood retention and effectively improved their accumulation at tumor sites. With the guidance of their inherited photoacoustic imaging capability, optimal accumulation of Melanin@RBC at tumors was achieved around 4 h post intravenous injection. Upon irradiation by an 808-nm laser, the developed Melanin@RBC nanoparticles exhibited significantly higher PTT efficacy than that of bare melanin nanoparticles in A549 tumor-bearing mice. Given that both melanin nanoparticles and RBC membrane are native biomaterials, the developed Melanin@RBC platform could have great potential in clinics for anticancer PTT.
http://ift.tt/2uCZVZu
Chemomechanically engineered 3D organotypic platforms of bladder cancer dormancy and reactivation
Source:Biomaterials, Volume 142
Author(s): Taraka Sai Pavan Grandhi, Thrimoorthy Potta, Rajeshwar Nitiyanandan, Indrani Deshpande, Kaushal Rege
Tumors undergo periods of dormancy followed by reactivation leading to metastatic disease. Arrest in the G0/G1 phase of the cell cycle and resistance to chemotherapeutic drugs are key hallmarks of dormant tumor cells. Here, we describe a 3D platform of bladder cancer cell dormancy and reactivation facilitated by a novel aminoglycoside-derived hydrogel, Amikagel. These 3D dormant tumor microenvironments (3D-DTMs) were arrested in the G0/G1 phase and were highly resistant to anti-proliferative drugs. Inhibition of targets in the cellular protein production machinery led to induction of endoplasmic reticulum (ER) stress and complete ablation of 3D-DTMs. Nanoparticle-mediated calcium delivery significantly accelerated ER stress-mediated 3D-DTM death. Transfer of 3D-DTMs onto weaker and adhesive Amikagels resulted in selective reactivation of a sub-population of N-cadherin deficient cells from dormancy. Whole-transcriptome analyses further indicated key biochemical differences between dormant and proliferative cancer cells. Taken together, our results indicate that 3D bladder cancer microenvironments of dormancy and reactivation can facilitate fundamental advances and novel drug discovery in cancer.
http://ift.tt/2uHoXoU
Photocatalytic degradation of polypropylene film using TiO2-based nanomaterials under solar irradiation
Publication date: 5 November 2017
Source:Materials & Design, Volume 133
Author(s): Rajni Verma, Sachchidanand Singh, M.K. Dalai, M. Saravanan, Ved V. Agrawal, Avanish Kumar Srivastava
The aim of this research is the reduction of environmental pollution by degrading polypropylene (PP) film in an eco-friendly way via TiO2-based nanomaterials (NMs) under solar irradiation. PP was mingled with TiO2-based NMs; TiO2 nanoparticles (NPs) and its nanocomposite, (TiO2-reduced Graphene Oxide: TiO2-rGO) individually by a facile solution casting technique to comparatively study its photodegradation before and after 130h of solar irradiation in triplicate manner. The photocatalytic degradation of PP, by TiO2-based NMs, is affirmed by various advanced characterization tools such as XRD, FT-IR, FE-SEM and ToF-SIMS. XRD depicts the phase transformation. FT-IR confirms the appearance of carbonyl group with higher carbonyl index leading to efficient photodegradation of PP by TiO2-rGO nanocomposite as compared to TiO2 NPs. Microstructural investigation by FE-SEM reveals the augmented degradation of PP matrix on the surface of TiO2-rGO nanocomposite through the formation of cavity (diameter: ~500nm) at the interface. The prominent peaks in ToF-SIMS affirm generation of Reactive Oxygen Species (ROS) followed by photodegradation. The mechanism of enhancement of photocatalytic degradation by TiO2-rGO nanocomposite has also been presented in detail. The obtained degraded fragments of PP, thus, are biodegradable and facilitate to reduce the environmental pollution by this eco-friendly route.
Graphical abstract
http://ift.tt/2u3quUj
Preparation and characterization of thermally crosslinked poly(vinyl alcohol)/feather keratin nanofiber scaffolds
Publication date: 5 November 2017
Source:Materials & Design, Volume 133
Author(s): Yussef Esparza, Aman Ullah, Yaman Boluk, Jianping Wu
Electrospun keratin nanofiber fabricated with non-toxic solvents and crosslinking reagents are promising scaffolds for tissue engineering applications. Keratin from chicken feathers was solubilized in aqueous alkaline conditions and electrospun using aqueous poly(vinyl alcohol)(PVA)/citric acid solution as electrospinning polymer aid. Keratin/PVA nanofibers were successfully prepared containing 10, 20 and 30% keratin to PVA mass ratio. The increase in keratin concentration from 0 to 20% resulted in decreased viscosity of keratin/PVA solutions leading to a reduction in the fiber diameter from 565nm in to 274nm. Further decrease in viscosity with 30% keratin resulted in beads-on-fiber type of morphology. Nanofibers were thermally cross-linked through esterification reaction between carbonyl groups in citric acid and hydroxyl groups in PVA. Cross-linked nanofibers maintained their morphology and pore structure after soaking in water. The incorporation of keratin in PVA nanofiber was confirmed by FTIR and XPS results. Proliferation of fibroblasts after 14days was higher in scaffolds containing 20% keratin which was attributed to the superior biological properties of keratin and higher surface area to volume ratio compared to 30% keratin/PVA scaffolds. Safer extraction, electrospinning and crosslinking conditions of keratin/PVA nanofiber are important for potential uses in tissue engineering.
Graphical abstract
http://ift.tt/2u3bmX0
Surgical considerations and safety of cochlear implantation in otitis media with effusion
Source:Auris Nasus Larynx
Author(s): Rasit Cevizci, Alper Dilci, Fatih Celenk, Recep Karamert, Yildirim Bayazit
ObjectiveTo evaluate the effects of otitis media with effusion on surgical parameters, patient safety, perioperative and postoperative complications.MethodsTotal 890 children who underwent cochlear implantation between 2006 and 2015 were included. The ages ranged from 12 months to 63 months (mean: 32 months). The patients were divided into two groups according to the presence or absence of otitis media with effusion; otitis media with effusion group and non-otitis media group.ResultsOf 890 children, 105 had otitis media with effusion prior to surgery. In non-otitis media with group, there were 785 children. The average duration of surgery was 60min (ranged from 28 to 75min) in non-otitis media group, and 90min (ranged from 50 to 135min) in otitis media with effusion group (p<0.05). Granulation tissue and edematous middle ear and mastoid mucosa were observed in all cases of otitis media with effusion during the surgery. There was no significant difference between the complications of groups with or without otitis media with effusion (p>0.05). In 5 of 105 patients, there was a ventilation tube inserted before cochlear implantation, which did not change the outcome of implantation.ConclusionThere is no need for surgical treatment for otitis media with effusion before implantation since otitis media with effusion does not increase the risks associated with cochlear implantation. Operation duration is longer in the presence of otitis media with effusion. However, otitis media with effusion leads to intraoperative difficulties like longer operation duration, bleeding, visualization of the round window membrane, cleansing the middle ear granulations as well as mastoid and petrous air cells.
http://ift.tt/2v3TU8S
Abdominoplasty with Lymphatic Microsurgery for Patients with Secondary Lower Extremity Lymphedema.
Background: Patients with secondary lower extremity lymphedema (LEL) often develop suprapubic lymphedema. We developed a novel surgical method of shaping the lower abdomen and debulking suprapubic lymphedema with simultaneous reconstruction of lymphatic flow in case of LEL. Methods: A skin incision in a fleur-de-lis pattern was performed for horizontal and vertical abdominal skin and fat resection. A caudal-based isosceles triangular flap was created on the central suprapubic region to reduce wound tension at the intersection of the horizontal and vertical incisions. After resection and debulking of the suprapubic region, a lymphaticovenular anastomosis (LVA) between the efferent lymphatic vessel of the groin node and the superficial inferior epigastric vein was created or vascularized lymph node transfer (LNT) to the groin region was performed to restore lymphatic flow. LVA and LNT were also performed at the lower extremities to improve LEL. Perioperative change in limb volume was evaluated using the LEL index, and lymphatic function was evaluated by lymphoscintigraphy. Results: Simultaneous abdominoplasty and reconstructive lymphatic microsurgery were performed in 11 patients. The LEL index improved perioperatively, with a significant difference (p
http://ift.tt/2uEL8vR
http://ift.tt/2uEL8vR
"Sural nerve splitting in reverse sural artery perforator flap: Anatomical study in 40 cadaver legs".
Background: The reverse sural artery perforator flap (RSAPF) has been widely used in reconstructions of the lower extremity. However, along with the high rate of flap necrosis, sural nerve (SN) injury is one of the most frequent complications. This cadaveric study investigated a simple SN preservation technique during RSAPF. Methods: Anatomic dissection of the sural nerve was performed on 40 lower legs, from 20 cadavers, to investigate the pattern of SN distribution. The points where the lateral sural cutaneous (LSCN) and medial sural cutaneous (MSCN) nerves penetrate the deep fascia were measured. The converging point of these nerves into the SN was also recorded. Further, the SN was split until no tethering was observed, during flap transposition, to simulate SN-sparing RSAPF. Results: Twenty-nine legs (72.5%) showed the LSCN and MSCN converging to become the SN (combined pattern); 7 (17.5%) and 4 legs (10.0%) demonstrated the diminished and parallel types, respectively. The distances between the lateral malleolus and the fascia-penetrating point of the LSCN and MSCN were 29.9 +/- 3.3 cm and 18.8 +/- 5.6 cm, respectively. In the combined type, the point of the LSCN and MSCN convergence was 13.6 +/- 4.2 cm from the lateral malleolus. Nerve splitting was successfully performed in all combined cases, without injuring the nerve fascicles. Conclusions: The MSCN enters the deep fascia significantly more distally than does the LSCN. Further, using nerve splitting, the MSCN can be kept intact during RSAPF in cases demonstrating the combined type of SN. (C)2017American Society of Plastic Surgeons
http://ift.tt/2v01Nwv
http://ift.tt/2v01Nwv
"Does the Organization of Plastic Surgery Units into Independent Departments Affect Academic Productivity?".
Background: There is an increased push for plastic surgery units in the United States to become independent departments administered autonomously rather than as divisions of a multispecialty surgery department. The purpose of this research was to determine if there are any quantifiable differences in the academic performance of departments versus divisions. Methods: Using a list of the plastic surgery units affiliated with The American Council of Academic Plastic Surgeons (ACAPS), unit websites were queried for departmental status and to obtain a list of affiliated faculty. Academic productivity was then quantified using the SCOPUS database. National Institute of Health (NIH) funding was determined through the Research Portfolio Online Reporting Tools database. Results: Plastic surgery departments were comparable to divisions in academic productivity, evidenced by a similar number of publications per faculty (38.9 versus 38.7; p=0.94), number of citations per faculty (692 versus 761; p=0.64), H-indices (9.9 versus 9.9; p=0.99), and NIH grants (3.25 versus 2.84; p=0.80), including RO1 grants (1.33 versus 0.84; p=0.53). There was a trend for departments to have a more equitable male to female ratio (2.8 versus 4.1; p=0.06), and departments trained a greater number of integrated plastic surgery residents (9.0 versus 5.28; p=0.03). Conclusions: This study demonstrates that the academic performance of independent plastic surgery departments is generally similar to divisions, but with nuanced distinctions. (C)2017American Society of Plastic Surgeons
http://ift.tt/2uZGKtT
http://ift.tt/2uZGKtT
Upper lip reconstruction.
Reconstruction of an aesthetically acceptable and functional upper lip requires a careful consideration of the transverse and vertical soft tissue, muscle and skin, deficiency. This review focuses on the reconstructive aspects of the upper lip. The functional anatomy of the upper lip is considerably complex and includes paired muscles in addition to the orbicularis, elevators of both the upper lip and commissure. The muscular action of facial expression recruits different sets of these paired muscles. Unlike the aesthetic uniform appearance of the lower lip commissure to commissure, the upper lip aesthetics can be divided into a central, the philtrum unit, and a lateral upper lip unit. The lateral unit can be further subdivided into medial and lateral elements, the medial more fixed and less mobile due to attachments superiorly at the alar sill and base. Reconstruction of the philtrum is best accomplished with an Abbe flap. Methods to reconstruct the lateral unit hinge on location, medial vs. lateral, and defect size. A conceptual approach to successful reconstruction of upper lip defects entails the use of a classification based on the aesthetic unit, appropriate selection of the reconstructive option for a particular defect driven by location and size, and careful consideration given to a final result in harmony both transversely and vertically with the lower lip and the remainder of the midface. (C)2017American Society of Plastic Surgeons
http://ift.tt/2uERR8Y
http://ift.tt/2uERR8Y
Denervated muscle fibers induce mitochondrial peroxide generation in neighboring innervated fibers: Role in muscle aging
Publication date: November 2017
Source:Free Radical Biology and Medicine, Volume 112
Author(s): Natalie Pollock, Caroline A. Staunton, Aphrodite Vasilaki, Anne McArdle, Malcolm J. Jackson
Disruption of neuromuscular junctions and denervation of some muscle fibers occurs in ageing skeletal muscle and contribute to loss of muscle mass and function. Aging is associated with mitochondrial dysfunction and loss of redox homeostasis potentially occurs through increased mitochondrial generation of reactive oxygen species (ROS). No specific link between increased mitochondrial ROS generation and denervation has been defined in muscle ageing. To address this, we have examined the effect of experimental denervation of all fibers, or only a proportion of the fibers, in the mouse tibialis anterior (TA) muscle on muscle mitochondrial peroxide generation. Transection of the peroneal nerve of mice caused loss of pre-synaptic axons within 1–3 days with no significant morphological changes in post-synaptic structures up to 10 days post-surgery when decreased TA mass and fiber size were apparent. Mitochondria in the denervated muscle showed increased peroxide generation by 3 days post-transection. Use of electron transport chain (ETC) substrates and inhibitors of specific pathways indicated that the ETC was unlikely to contribute to increased ROS generation, but monoamine oxidase B, NADPH oxidase and phospholipase enzymes were implicated. Transection of one of the 3 branches of the peroneal nerve caused denervation of some TA muscle fibers while others retained innervation, but increased mitochondrial peroxide generation occurred in both denervated and innervated fibers. Thus the presence of recently denervated fibers leads to increased ROS generation by mitochondria in neighboring innervated fibers providing a novel explanation for the increased mitochondrial oxidative stress and damage seen with aging in skeletal muscles.
Graphical abstract
http://ift.tt/2tNKoHT
Chronic hyper-leptinemia induces insulin signaling disruption in adipocytes: Implications of NOS2
Publication date: November 2017
Source:Free Radical Biology and Medicine, Volume 112
Author(s): Abhishek Gupta, Muheeb Beg, Durgesh Kumar, Kripa Shankar, Salil Varshney, Sujith Rajan, Ankita Srivastava, Kalpana Singh, Satyendra Sonkar, Abbas Ali Mahdi, Madhu Dikshit, Anil Nilkanth Gaikwad
Leptin, following its discovery, has developed a formidable interest in the scientific community to delineate its contribution towards overall metabolic homeostasis. Contradictory reports have been published on leptin administration effects on whole body insulin sensitivity. Following late reports, we surveyed human serum leptin levels along with other metabolic parameters including BMI and HOMA-IR. We found a positive correlation between leptin levels and insulin resistance parameters. Considering the presence of the long form of leptin receptor on adipocytes, we explored the effects of chronic physiological hyper-leptinemic exposure on adipocyte insulin sensitivity. Chronic leptin (50ng/ml) treatment in 3T3-L1 adipocytes decreased insulin-induced phosphorylation of nodal insulin signaling proteins along with reduced glucose uptake. Metabolic flux studies indicated mitochondrial dysfunction and reduced oxygen consumption rate. Leptin treatment also increased both cellular and mitochondrial superoxide levels concomitant to increased expression of nitric oxide synthase-2 (NOS2). Further, pharmacological depletion of NOS2 reversed leptin mediated effects on insulin signaling. In-vivo implantation of leptin osmotic pumps in C57BL/6 mice also decreased insulin responsiveness. Interestingly, these effects were lacking in NOS2 knockout strain. In conclusion, our studies put forward a potential link between leptin and adipocyte insulin responsiveness in an NOS2 dependent manner.
Graphical abstract
http://ift.tt/2tOqxIr
Curcumin modulates endothelial permeability and monocyte transendothelial migration by affecting endothelial cell dynamics
Publication date: November 2017
Source:Free Radical Biology and Medicine, Volume 112
Author(s): Laurent-Emmanuel Monfoulet, Sylvie Mercier, Dominique Bayle, Radu Tamaian, Nicolas Barber-Chamoux, Christine Morand, Dragan Milenkovic
Curcumin is a phenolic compound that exhibits beneficial properties for cardiometabolic health. We previously showed that curcumin reduced the infiltration of immune cells into the vascular wall and prevented atherosclerosis development in mice. This study aimed to investigate the effect of curcumin on monocyte adhesion and transendothelial migration (TEM) and to decipher the underlying mechanisms of these actions.Human umbilical vein endothelial cells (HUVECs) were exposed to curcumin (0.5–1μM) for 3h prior to their activation by Tumor Necrosis Factor alpha (TNF-α). Endothelial permeability, monocyte adhesion and transendothelial migration assays were conducted under static condition and shear stress that mimics blood flow. We further investigated the impact of curcumin on signaling pathways and on the expression of genes using macroarrays.Pre-exposure of endothelial cells to curcumin reduced monocyte adhesion and their transendothelial migration in both static and shear stress conditions. Curcumin also prevented changes in both endothelial permeability and the area of HUVECs when induced by TNF-α. We showed that curcumin modulated the expression of 15 genes involved in the control of cytoskeleton and endothelial junction dynamic. Finally, we showed that curcumin inhibited NF-κB signaling likely through an antagonist interplay with several kinases as suggested by molecular docking analysis.Our findings demonstrate the ability of curcumin to reduce monocyte TEM through a multimodal regulation of the endothelial cell dynamics with a potential benefit on the vascular endothelial function barrier.
Graphical abstract
http://ift.tt/2tNKqzv
IL-27 induces a pro-inflammatory response in human fetal membranes mediating preterm birth
Publication date: September 2017
Source:International Immunopharmacology, Volume 50
Author(s): Nanlin Yin, Hanbing Wang, Hua Zhang, Huisheng Ge, Bing Tan, Yu Yuan, Xiaofang Luo, David M. Olson, Philip N. Baker, Hongbo Qi
Inflammation at the maternal-fetal interface has been shown to be involved in the pathogenesis of preterm birth. Interleukin 27 (IL-27), a heterodimeric cytokine, is known to mediate an inflammatory response in some pregnancy complications. In this study, we aimed to determine whether IL-27 could induce an inflammatory reaction at the maternal-fetal interface that would mediate the onset of preterm birth. We found elevated expression of IL-27 in human peripheral serum and elevated expression of its specific receptor (wsx-1) on fetal membranes in cases of preterm birth. Moreover, the release of inflammatory markers (CXCL10, IFN-γ, MCP-1, IL-6, IL-1β and TNF-α), especially CXCL10, was markedly augmented upon stimulation of IL-27 in the fetal membranes. Additionally, IL-27 and IFN-γ cooperated to amplify the expression of CXCL10 in the fetal membranes. Moreover, the production of CXCL10 was increased in IL-27-treated fetal membrane through JNK, PI3K or Erk signaling pathways. Finally, MMP2 and MMP9 were activated by IL-27 in human fetal membranes, which may be related to the onset of preterm premature rupture of membranes (pPROM). In conclusion, for the first time, we reported that the aberrant expression of IL-27 could mediate an excessive inflammatory response in fetal membranes through the JNK, PI3K or Erk signaling pathways, which contributes to preterm birth.
http://ift.tt/2tI8Cio
Oncogenic signalling pathways in benign odontogenic cysts and tumours
Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Marina Gonçalves Diniz, Carolina Cavalieri Gomes, Sílvia Ferreira de Sousa, Guilherme Machado Xavier, Ricardo Santiago Gomez
The first step towards the prevention of cancer is to develop an in-depth understanding of tumourigenesis and the molecular basis of malignant transformation. What drives tumour initiation? Why do most benign tumours fail to metastasize? Oncogenic mutations, previously considered to be the hallmark drivers of cancers, are reported in benign cysts and tumours, including those that have an odontogenic origin. Despite the presence of such alterations, the vast majority of odontogenic lesions are benign and never progress to the stage of malignant transformation. As these lesions are likely to develop due to developmental defects, it is possible that they harbour quiet genomes. Now the question arises – do they result from DNA replication errors? Specific candidate genes have been sequenced in odontogenic lesions, revealing recurrent BRAF mutation in the case of ameloblastoma, KRAS mutation in adenomatoid odontogenic tumours, PTCH1 mutation in odontogenic keratocysts, and CTNNB1 (Beta-catenin) mutation in calcifying odontogenic cysts. Studies on these benign and rare entities might reveal important information about the tumorigenic process and the mechanisms that hinder/halt neoplastic progression. This is because the role of relatively common oncogenic mutations seems to be context dependent. In this review, each mutation signature of the odontogenic lesion and the affected signalling pathways are discussed in the context of tooth development and tumorigenesis. Furthermore, behavioural differences between different types of odontogenic lesions are explored and discussed based on the molecular alteration described. This review also includes the employment of molecular results for guiding therapeutic approaches towards odontogenic lesions.
http://ift.tt/2uHgySr
Risk factors of Lung Cancer in Non-smoker
Source:Current Problems in Cancer
Author(s): Nahid Akhtar, Jeena Gupta Bansal
Generally, the cause of lung cancer is attributed to tobacco smoking. But many of the new lung cancer cases have been reported in non-smokers. Apart from smoking; air pollution, environmental exposure, mutations and single nucleotide polymorphisms are known to be associated with lung cancer. Improper diet, alcohol consumption, marijuana smoking, estrogen, infections with HPV (human papillomavirus), HIV and Epstein-Barr virus are suggested to be linked with lung cancer but clear evidences to ascertain their relation is not available. This article provides a comprehensive review of various risk factors and the underlying molecular mechanisms responsible for increasing the incidence of lung cancer. The pathological, histological and genetic differences exist with lung cancer among smokers and non-smokers. A better understanding of the risk factors, differences in pathology and molecular features of lung cancer in smokers and non-smokers and the mode of action of various carcinogens will facilitate the prevention and management of lung cancer.
http://ift.tt/2uD0gf7
Rituximab desensitization in three patients with severe rituximab allergy
Source:Current Problems in Cancer
Author(s): Erman Öztürk, Leyla Pur Özyiğit, Ayşe Bilge Öztürk, Meltem Olga Akay, Mustafa Çetiner, Burhan Ferhanoğlu
Rituximab is a chimeric monoclonal antibody that targets CD20 positive B cells and has a positive effect on both overall and progression-free survival in B cell lymphoid malignancies. Combination rituximab with chemotherapy treatment provide survival improvement. Although rituximab is an important treatment option in hematological malignancies, the risk of allergic reactions is high. These reactions are usually IgE-mediated and can be varied in regards of severity from urticaria to anaphylaxis. It is an option to interrupt the treatment and ommit rituximab therapy who had allergic reactions. Drug desensitization is another option and successful results have been reported by applying desensitization to such reactions. Drug desensitization alters the immune response to induce a state of temporary clinical tolerance to the allergic drug by giving gradual increasing of doses of drug at fixed time intervals. Herein we present 3 cases successfully treated with rituximab desensitization. The cases were using rituximab with the diagnosis of Burkitt lymphoma, follicular lymphoma and marginal zone lymphoma, respectively. Two cases had grade 2, one case had grade 3 systemic allergic reaction with rituximab. There was no known allergy history in all three cases. All patients tolerated the desensitization protocol. The subsequent treatments of the patients were also given by desensitization protocol. A total of 12 desensitizations were administered to 3 cases. No severe or life-threating reactions were observed in subsequent applications. To date applying desensitization protocols ensure rituximab treatment safely. Rituximab desensitization can be performed at trained allergy centers and it may be an appropriate option for rituximab allergic patients.
http://ift.tt/2vOfDzG
Management of perioperative laryngospasm by French paediatric anaesthetists
Editor—Perioperative laryngospasm is a life-threating emergency in paediatric patients. A recent multicentre study of children undergoing surgery1 found a high rate of severe critical events during the perioperative period (5.2%), with an incidence of respiratory critical events of 3.1%. Laryngospasm was one of most frequent respiratory complications (0.2–6.7%). Its effective management requires appropriate diagnosis, followed by prompt and aggressive management. The use of a structured algorithm would lead to earlier recognition and better management.2 We undertook a survey in order to explore the practical management of laryngospasm by French paediatric anaesthetists.
http://ift.tt/2eRUPDu
http://ift.tt/2eRUPDu
Electroencephalography and delirium in the postoperative period
Abstract
Delirium commonly manifests in the postoperative period as a clinical syndrome resulting from acute brain dysfunction or encephalopathy. Delirium is characterized by acute and often fluctuating changes in attention and cognition. Emergence delirium typically presents and resolves within minutes to hours after termination of general anaesthesia. Postoperative delirium hours to days after an invasive procedure can herald poor outcomes. Easily recognized when patients are hyperactive or agitated, delirium often evades diagnosis as it most frequently presents with hypoactivity and somnolence. EEG offers objective measurements to complement clinical assessment of this complex fluctuating disorder. Although EEG features of delirium in the postoperative period remain incompletely characterized, a shift of EEG power into low frequencies is a typical finding shared among encephalopathies that manifest with delirium. In aggregate, existing data suggest that serial or continuous EEG in the postoperative period facilitates monitoring of delirium development and severity and assists in detecting epileptic aetiologies. Future studies are needed to clarify the precise EEG features that can reliably predict or diagnose delirium in the postoperative period, and to provide mechanistic insights into this pathologically diverse neurological disorder.http://ift.tt/2h7iPTH
Abstracts for Spring BJA Research Forum meeting, Royal College of Anaesthetists, London, 5th and 6th April 2017
(The authors of all the following abstracts have confirmed that their research received ethics committee approval or was conducted under the Animal (Scientific Procedures) Act (1986) or equivalent.)
http://ift.tt/2eRUO2o
http://ift.tt/2eRUO2o
Simulated emergency cricothyroid incision length
Editor—The revised 2015 Difficult Airway Society (DAS) guidelines for the 'unanticipated difficult airway' include a standardized approach to performance of emergency front-of-neck access in the 'can't intubate, can't oxygenate' (CICO) scenario.1 We have subsequently changed how we educate colleagues in the management of a CICO scenario using the surgical technique as part of our airway update days and on the Aintree Difficult Airway Management course.
http://ift.tt/2h6Wu92
http://ift.tt/2h6Wu92
Predicting postoperative brain function from the blood: is there a role for biomarkers?
Loss of consciousness upon exposure to general anaesthetics reflects the powerful influence of these drugs on brain physiology. While this phenomenon is usually transient and rapidly resolves upon discontinuation of drug administration, an overwhelming number of both clinical and experimental observations suggest that even relatively short periods of anaesthesia can trigger a myriad of biochemical pathways which, in turn, can give rise to temporary or even lasting changes in neurobehavioural and cognitive function after emergence from anaesthesia.1 Most of these functional alterations have been described as postoperative delirium or impaired cognitive performance and, therefore, have negative connotations. It is nevertheless important to note that exposure to anaesthetics can also improve both cognition and mood in some specific clinical states, such as in major depressive disorders. This context-dependent impact of anaesthetics on neuronal function probably reflects the major context-dependent modulatory influence of these drugs on neuronal plasticity.1
http://ift.tt/2h6Wshq
http://ift.tt/2h6Wshq
The Princes of Serendip
Abstracts from the BJA Research Forum Glasgow, November 10–11, 2016
(The authors of all the following abstracts have confirmed that their research received ethics committee approval or was conducted under the Animal (Scientific Procedures) Act (1986) or equivalent.)
http://ift.tt/2eRJsv6
http://ift.tt/2eRJsv6
Association between delirium and cognitive change after cardiac surgery
Abstract
Background. Previous studies provide inconsistent data on whether postoperative delirium (POD) is a risk factor for postoperative cognitive decline (POCD). We thus investigated the relationship between POD and cognitive change after cardiac surgery and assessed the relationship between preoperative cognitive domain scores and POD.Methods. Postoperative delirium was assessed with the Confusion Assessment Method (CAM) adapted for the intensive care unit and the conventional CAM accompanied by chart review. Cognitive function was assessed with a neuropsychological test battery before elective cardiac surgery and 1 month and 1 yr afterwards. Cognitive change was calculated using the Reliable Change Index (RCI). Multiple linear regression was used to adjust for confounding.Results. Of the 184 patients who completed baseline assessment, 23 (12.5%) developed POD. At 1 month, the decline in cognitive performance was worse in patients with POD [median composite RCI −1.00, interquartile range (IQR) −1.67 to 0.28] than in patients without POD (RCI −0.04, IQR −0.70 to 0.63, P=0.02). At 1 yr, both groups showed cognitive improvement on average compared with baseline (POD patients median composite RCI 0.25, IQR −0.42 to 1.31, vs non-POD patients RCI 0.92, IQR 0.18–1.53; P=0.08). Correction for differences in age and level of education did not change the results. Patients with POD performed less well than patients without POD on the preoperative Trailmaking test part A (P=0.03).Conclusions. Postoperative delirium is independently associated with cognitive decline 1 month after surgery, but cognitive performance generally recovers in 1 yr. Patients with a predisposition to POD can be identified before surgery by worse performance in an attention task.Clinical trial registration. NCT00293592.http://ift.tt/2eSNdAK
Management of perioperative laryngospasm by French paediatric anaesthetists
Editor—Perioperative laryngospasm is a life-threating emergency in paediatric patients. A recent multicentre study of children undergoing surgery1 found a high rate of severe critical events during the perioperative period (5.2%), with an incidence of respiratory critical events of 3.1%. Laryngospasm was one of most frequent respiratory complications (0.2–6.7%). Its effective management requires appropriate diagnosis, followed by prompt and aggressive management. The use of a structured algorithm would lead to earlier recognition and better management.2 We undertook a survey in order to explore the practical management of laryngospasm by French paediatric anaesthetists.
http://ift.tt/2eRUPDu
http://ift.tt/2eRUPDu
Electroencephalography and delirium in the postoperative period
Abstract
Delirium commonly manifests in the postoperative period as a clinical syndrome resulting from acute brain dysfunction or encephalopathy. Delirium is characterized by acute and often fluctuating changes in attention and cognition. Emergence delirium typically presents and resolves within minutes to hours after termination of general anaesthesia. Postoperative delirium hours to days after an invasive procedure can herald poor outcomes. Easily recognized when patients are hyperactive or agitated, delirium often evades diagnosis as it most frequently presents with hypoactivity and somnolence. EEG offers objective measurements to complement clinical assessment of this complex fluctuating disorder. Although EEG features of delirium in the postoperative period remain incompletely characterized, a shift of EEG power into low frequencies is a typical finding shared among encephalopathies that manifest with delirium. In aggregate, existing data suggest that serial or continuous EEG in the postoperative period facilitates monitoring of delirium development and severity and assists in detecting epileptic aetiologies. Future studies are needed to clarify the precise EEG features that can reliably predict or diagnose delirium in the postoperative period, and to provide mechanistic insights into this pathologically diverse neurological disorder.http://ift.tt/2h7iPTH
Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics
Abstract
Background: Despite evidence of high activity, the number of surgical procedures performed in UK hospitals, their cost and subsequent mortality remain unclear.Methods: Time-trend ecological study using hospital episode data from England, Scotland, Wales and Northern Ireland. The primary outcome was the number of in-hospital procedures, grouped using three increasingly specific categories of surgery. Secondary outcomes were all-cause mortality, length of hospital stay and healthcare costs according to standard National Health Service tariffs.Results: Between April 1, 2009 and March 31, 2014, 39 631 801 surgical patient episodes were recorded. There was an annual average of 7 926 360 procedures (inclusive category), 5 104 165 procedures (intermediate category) and 1 526 421 procedures (restrictive category). This equates to 12 537, 8073 and 2414 procedures per 100 000 population per year, respectively. On average there were 85 181 deaths (1.1%) within 30 days of a procedure each year, rising to 178 040 deaths (2.3%) after 90 days. Approximately 62.8% of all procedures were day cases. Median length of stay for in-patient procedures was 1.7 (1.3–2.0) days. The total cost of surgery over the 5 yr period was £54.6 billion ($104.4 billion), representing an average annual cost of £10.9 billion (inclusive), £9.5 billion (intermediate) and £5.6 billion (restrictive). For each category, the number of procedures increased each year, while mortality decreased. One-third of all mortalities in national death registers occurred within 90 days of a procedure (inclusive category).Conclusions: The number of surgical procedures in the UK varies widely according to definition. The number of procedures is slowly increasing whilst the number of deaths is decreasing.http://ift.tt/2h7d5cJ
How powerful is failure to rescue as a global metric? Not as powerful as a commitment to measurement
In a much-discussed study published in 2009, Dr Ghaferi and colleagues1 revived the concept, originally described in the early 1990s by Jeffrey Silber and colleagues,2 of 'failure to rescue'. Ghaferi and colleagues1 used a prospective, multicentre clinical registry organized by the American College of Surgeons (ACS-NSQIP) to rank hospitals by mortality quintiles. They then evaluated adverse events and noted that across the different mortality quintiles the risk of an adverse event was remarkably consistent. What differed with respect to mortality was not so much the likelihood of a complication, but the ability of a hospital to 'save' a patient who experienced a complication. Hospitals in the lowest mortality quintile had very similar rates of both minor and major complications to those in the highest mortality quintile, yet had half the rates of death. They concluded that 'failure to rescue' patients with complications in the higher mortality quintiles represented an opportunity for improvement; it was not the complications per se that killed patients, but the inability to quickly recognize and respond to their deterioration.
http://ift.tt/2eSfKGl
http://ift.tt/2eSfKGl
Simulated emergency cricothyroid incision length
Editor—The revised 2015 Difficult Airway Society (DAS) guidelines for the 'unanticipated difficult airway' include a standardized approach to performance of emergency front-of-neck access in the 'can't intubate, can't oxygenate' (CICO) scenario.1 We have subsequently changed how we educate colleagues in the management of a CICO scenario using the surgical technique as part of our airway update days and on the Aintree Difficult Airway Management course.
http://ift.tt/2h6Wu92
http://ift.tt/2h6Wu92
Effect of a 12-Week Aerobic Exercise Training on Serum Fetuin-A and Adipocytokine Levels in Type 2 Diabetes
Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-115904
Objective We aimed to evaluate the effect of 12-week aerobic exercise training on fetuin-A levels in type 2 diabetes mellitus and examine the relationships between fetuin-A and adipocytokine levels and cardiovascular risk factors. Methods The study included 32 patients with type 2 diabetes mellitus who were assigned to an exercise or a control group. The exercise group underwent 12 weeks of exercise (consisting of a 5-min warm-up, 60-min aerobic bicycle training performed at 70% of the maximal heart rate, a cool-down period, 5 times/week). Adiponectin, resistin, and fetuin-A serum levels were measured using enzyme-linked immunosorbent assay. Leptin serum levels were measured by a radioimmunoassay. Results Exercise for 12 weeks significantly reduced serum fetuin-A (643.1±109.4 to 448.7±92.5 μg/mL, P<0.05), leptin (11.9±7.2 to 8.6±5.7 ng/dL, P<0.05), and resistin (3.2±1.5 to 2.2±1.4 ng/mL, P<0.05) levels, but increased adiponectin (6.9±1.9 to 8.1±1.7 µg/mL, P<0.05) levels. In the exercise group, Δfetuin-A positively correlated with differences in weight (r=0.654, P=0.046), body mass index (r=0.725, P=0.002), waist circumference (r=0.898, P=0.013), and adiponectin levels (r=0.662, P=0.035). Conclusions Aerobic exercise significantly decreased serum fetuin-A levels in type 2 diabetes mellitus, which can be attributed to weight loss and related to increased adiponectin levels.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Delirium, what’s in a name?
Delirium has been known since ancient times. Hippocrates [460–370 Before Common Era (BCE)] may have been the first to describe the syndrome that he called 'phrenitis', marked by confusion and restlessness that fluctuated unpredictably and that was associated with physical illness.1 Many other names have been used, including acute mental status change, confusional state, confusion, acute brain dysfunction, brain failure, encephalopathy, postoperative psychosis and acute organic syndrome.1 Of these, the term delirium (derived from the Latin word delirare, deviate from a straight track) has gained acceptance. Besides a more uniform terminology, an important recent achievement includes publication of criteria to define delirium. Although criticized,23 the criteria of the Diagnostic and Statistical Manual of Mental Disorders (5th edition, DSM-5) have become standard.4 According to these criteria, a patient can be considered delirious when all items listed in Table 1 are present at the same time.4 In essence, this means that a patient has acutely developed disturbed attention with other cognitive deficits, which is not solely due to underlying dementia and is caused by a physical condition. Table 1Criteria for delirium according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)4
http://ift.tt/2h7oysD
- A. A disturbance in attention (i.e. reduced ability to direct, focus, sustain and shift attention) and awareness (reduced orientation to the environment).
- B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
- C. An additional disturbance in cognition (e.g. memory deficit, disorientation, language, visuospatial ability or perception).
- D. The disturbances in Criteria A and C are not better explained by another pre-existing, established or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.
- E. There is evidence from the history, physical examination or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e. due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple aetiologies.
http://ift.tt/2h7oysD
Topics for the national audit projects of the Royal College of Anaesthetists
Editor—Moppett and colleagues1 provide a very fair assessment of the value of the national audit projects (NAPs) performed in the UK during the last decade. However, I would question their statement that the choice of topics for the third and fourth projects performed by the Royal College of Anesthetists (NAP3 and NAP4) was 'in part serendipitous, as a result of the coincidence of the desires of the specialist societies (Pain and Difficult Airway) and the Royal College of Anaesthetists'. The subjects for both audits were discussed at meetings of College Council and, as a member of that group at the time, I remember no input from any society.
http://ift.tt/2h6B0sK
http://ift.tt/2h6B0sK
Hyperthyroidism in Patients with Graves’ Ophthalmopathy, and Thyroidal, Skeletal and Eye Muscle Specific Type 2 Deiodinase Enzyme Activities
Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-113831
Graves' ophthalmopathy is characterized by hyperthyroidism, which is associated with higher serum T3 levels than T4 due to deiodinase enzymes.The effect of Graves' patient's sera (n=52) with elevated thyroid hormone and TSH receptor or thyroid peroxidase antibody (anti-TPO) levels was investigated on thyroidal, skeletal and eye muscle type 2 deiodinase enzyme (DII) activities. DII activities were measured with 125I-T4 substrate, while thyroid hormone and antibody levels with immunoassays.In Graves' ophthalmopathy, sera with elevated FT4 or FT3 levels reduced DII activites remarkably in all tissue fractions. Thyroidal DII activities were lower than those using eye muscle fraction (0.6±0.22 vs 1.14±0.43 pmol/mg/min, P<0.006). Effect of sera with increased FT3 levels demonstrated also reduced DII activities in patients with Graves' ophthalmopathy after methimazole therapy compared to those who had no ophthalmopathy (2.88±2 vs 20.42±11.82 pmol/mg/min, P<0.006 for thyroidal fraction, 4.07±2.72 vs 29.22±15.46 pmol/mg/min, P<0.004 for skeletal muscle, 5.3±3.47 vs 37.87±18.82 pmol/mg/min, P<0.003 for eye muscle). Hyperthyroid sera with TSH receptor antibodies resulted in increased DII activities, while sera with anti-TPO antibodies were connected to lower DII activities in Graves' ophthalmopathy.In summary, the actions of hyperthyroid sera derived from patients with Graves' disease were tested on tissue-specific DII activities. Elevated FT4 level-induced DII inactivation is present in Graves' ophthalmopathy, which seems to be also present at the beginning of methimazole therapy. Stimulating TSH receptor antibiodies increased DII activities via their nongenomic effects using sera of hyperthyroid Graves' ophthalmopathy, but anti-TPO antibodies could influence DII activities via altering FT4 levels.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Postoperative delirium portends descent to dementia
Many elderly patients worry that their thinking will be impaired after surgery. Concerns include acute confusion in the days to weeks following surgery, as well as persistent cognitive deficits lasting months to years.1 Both postoperative delirium (POD) and delayed neurocognitive recovery lasting months after surgery are common in older adults, but reports of non-resolving cognitive decline or neurocognitive disorders (NCDs) are inconsistent.23 The acute onset inattention and disorganized thinking characteristic of POD often manifest between one and four days after surgery.4 Delayed neurocognitive recovery is a subtle NCD that typically lasts weeks to months following surgery. Although transient, both disorders can significantly impact recovery. Patients with POD have increased morbidity and mortality, longer Intensive Care Unit (ICU) stays, decreases in quality of life and are likely to be vulnerable to delayed neurocognitive recovery.56 While the pathophysiology of delirium remains unclear, it has been linked with NCDs and dementia in non-surgical patients,7 and several studies have suggested that POD may be a risk factor for non-resolving minor and even major NCD (or incident dementia).89 In this issue of the British Journal of Anaesthesia, the retrospective cohort studies by Sauër and colleagues10 and Sprung and colleagues11 investigate the association between POD and persistent NCDs; the conflicting results highlight the difficulties in studying postoperative cognition.
http://ift.tt/2h7oDNg
http://ift.tt/2h7oDNg
Experiences in Sensor-Augmented Pump Therapy in Families with two Children with Type 1 diabetes: A Qualitative Study
Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-110479
Background Caring for a child with type 1 diabetes is a tremendous challenge for a family. The aim of the study was to explore the experiences of transition to sensor-augmented pump therapy (SAP) in families with 2 affected children and the internal and external conditions which potentially impede or facilitate the adjustment process. Methods 5 families (9 parents, 8 children and adolescents) who used the SAP technology for 6 months were interviewed to describe their experiences. The interviews were analysed using thematic content analysis. Results Qualitative analysis of the transcribed interviews revealed that the adaptation process to SAP consisted of several phases and differed among families. There were benefits as well as hassles of using SAP with regard to managing the diabetes, and psychosocial issues: school and peer relations, as well as family relations. While parents clearly regarded the improved metabolic control and hypoglycaemic safety as the most important benefits of SAP, the hassles reported as most important covered a wide range, from technical problems of the system to family conflicts. On the whole, families rated the experience of using SAP as a positive one, with most recommending SAP to other families as long as they were willing to come to terms with the technology and commit to the work and time involved. Conclusion Sensor-augmented pump therapy can be extremely beneficial and a resource for families who care for more than one child with diabetes. During the adaptation process there is a great need of education and frequent follow-up e. g., by telemedical support.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Post-anaesthesia care unit delirium: incidence, risk factors and associated adverse outcomes
Delirium is a sudden disturbance in attention and orientation to the environment that develops over a short period of time and tends to fluctuate in severity during the course of the day.1 The acute confusional state of delirium occurs in 50–80% of critically ill patients and postoperatively (from the day after surgery onwards) in up to 54% of elective major non-cardiac surgical patients.1 It incurs a huge societal burden, because of, in part, a result of its association with increased morbidity and mortality; each additional day of delirium has been independently associated with a 10% increased risk of death.2 Increased morbidity contributes to prolonged hospital length of stay and significant financial implications: delirium is estimated to total $4–16 billion annually.3 Its association with long-term neuropsychological and cognitive deficits4–7 mandates a better understanding of the pathogenesis of delirium8 and the mechanisms underlying the prolonged disruption of cognitive processing.9 Despite these apparent strong associations, it remains unclear whether delirium identified in the post-anaesthetic care unit (PACU) or recovery unit is associated with similar outcomes. For anaesthetists, this is a critical question that remains unanswered. Indeed at least some of these events are of limited duration and hence it could be assumed they would be associated with less severe consequences. In this context, PACU delirium is differentiated from postoperative delirium as the latter occurs from the day after surgery onwards whereas the former occurs in the PACU on the day of surgery.
http://ift.tt/2eSfBCN
http://ift.tt/2eSfBCN
Approach affects injectate spread in ultrasound-guided thoracic paravertebral block: a cadaveric trial
Editor—Ultrasound-guided thoracic paravertebral block has made much progress, and various approaches have been developed in the past decade.1 However, the differences in local anaesthetic distribution patterns are unknown. We adopted two patterns of injections, namely the intercostal approach (IC approach)2 and the paralaminar in-plane approach (PL approach),34 and compared their injectate spreading patterns in three Thiel-embalmed human cadavers using a dye injection method.56 For the IC approach, a 6–13 MHz linear array transducer was placed at the T4, T5 and T9 intercostal levels to visualize the transverse process. An 18-gauge Tuohy needle was inserted from lateral to medial beside the probe to penetrate the internal intercostal membrane next to the tip of the transverse process. For the PL approach, the needle was inserted from medial to lateral using a 5–8 MHz microconvex array transducer to visualize the lateral edge of the vertebral lamina at the T6, T7 and T10 levels. We investigated five injections by the IC approach and four injections by the PL approach using 10 ml of dye of various colours. One injection in each group included real-time, direct observation of the distribution pattern after dissection via a pre-inserted catheter 2.5 cm beyond the needle tip. Paravertebral spread was confirmed in all procedures. In the IC approach group, dye covered the respective intercostal space and the adjacent paravertebral space (PVS) (Fig. 1A), consistent with previous reports.7 The injected dye in the PL approach group covered the more longitudinal and medial PVS rather than the lateral intercostal space (Fig. 1B).8 Real-time dye injections from the catheter showed that in the IC approach dye first spread to the respective intercostal level following PVS whereas in the PL approach dye first covered the area around the sympathetic trunk followed by the intercostal area.
http://ift.tt/2h7ezUf
http://ift.tt/2h7ezUf
Predicting postoperative brain function from the blood: is there a role for biomarkers?
Loss of consciousness upon exposure to general anaesthetics reflects the powerful influence of these drugs on brain physiology. While this phenomenon is usually transient and rapidly resolves upon discontinuation of drug administration, an overwhelming number of both clinical and experimental observations suggest that even relatively short periods of anaesthesia can trigger a myriad of biochemical pathways which, in turn, can give rise to temporary or even lasting changes in neurobehavioural and cognitive function after emergence from anaesthesia.1 Most of these functional alterations have been described as postoperative delirium or impaired cognitive performance and, therefore, have negative connotations. It is nevertheless important to note that exposure to anaesthetics can also improve both cognition and mood in some specific clinical states, such as in major depressive disorders. This context-dependent impact of anaesthetics on neuronal function probably reflects the major context-dependent modulatory influence of these drugs on neuronal plasticity.1
http://ift.tt/2h6Wshq
http://ift.tt/2h6Wshq
Nitric Oxide Plasma Level as a Barometer of Endothelial Dysfunction in Factory Workers
Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-110054
Objective Nitric oxide (NO) plays a key role in the regulation of vascular tone and is known as one of the key markers of endothelial dysfunction. We investigated the relationship between NO and risk factors of lifestyle-related disease in factory workers. Methods Our study included 877 factory workers presenting hypertension, dyslipidemia and type 2 diabetes. oxidated forms of NO, NO2-/NO3- (NOx) plasma concentrations were measured using a colorimetric method. Results NOx plasma levels in patients with lifestyle-related disease were significantly lower than those in the controls. The brachial-ankle pulse wave velocity (baPWV) measured in those patients was significantly greater than that of the controls. Multiple regression analysis revealed that LDL cholesterol was an independent risk factor for reducing NOx plasma concentrations. Interestingly, individuals with low NOx plasma concentrations were more likely to present type 2 diabetes compared to those with the highest plasma levels of NOx (odds ratio [OR] [95% confidence interval; CI]=3.65 [1.61–8.28], P=0.002, 2.67 [1.15–6.20], P=0.022, and 3.27 [1.43–7.48], P=0.005). Subjects with the lowest levels of plasma NOx were more likely to present dyslipidemia (OR [95% CI]=1.69 [1.13–2.53], P=0.01). Conclusion Endothelial function evaluated with plasma NOx may be indicative of lifestyle-related diseases independently from the vascular function assessed using baPWV.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2v472Lo
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