Sleep in Patients with Chronic Migraine

Abstract

Purpose of Review

The biological and pathophysiological interaction between sleep and chronic migraine (CM) remains to be fully elucidated. In this article, we provide a narrative review of the literature on sleep disturbance and CM, highlighting recent advances in sleep research and insights into mechanisms that could mediate a role of sleep disturbances in migraine chronification. We discuss the potential for cognitive-behavioral insomnia therapy (CBTi) as an intervention for CM with comorbid insomnia. Finally, we propose a model of the mechanisms underlying the interactions among sleep physiology, maladaptive migraine-coping behaviors, and coexisting factors which contribute to sleep disturbances in CM based on conceptual models used in sleep research.

Recent Findings

Insomnia is the most common sleep complaint among patients with CM. CM patients experience more frequent and severe insomnia symptoms than patients with episodic migraine (EM). It has been suggested that sleep disturbances may predispose individuals to migraine attacks, which may affect the pain-processing trigeminovascular system and thus play a role in migraine progression. Encouraging but limited evidence suggests that management of insomnia via behavioral sleep therapy may reverse CM to EM and possibly prevent migraine chronification.

Summary

Migraine has a complex relationship with sleep. The use of objective sleep study such as polysomnographic microstructural sleep analysis and actigraphy could help connect sleep disturbances and processes related to CM. Future longitudinal studies should examine whether effective behavioral treatments such as CBTi can reverse migraine chronification.

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CORRIGENDUM

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Table of Contents

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Editorial Board

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CORRIGENDUM

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CORRIGENDUM

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Table of Contents

http://ift.tt/2uxOBL7

Editorial Board

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Sleep in Patients with Chronic Migraine

Abstract

Purpose of Review

The biological and pathophysiological interaction between sleep and chronic migraine (CM) remains to be fully elucidated. In this article, we provide a narrative review of the literature on sleep disturbance and CM, highlighting recent advances in sleep research and insights into mechanisms that could mediate a role of sleep disturbances in migraine chronification. We discuss the potential for cognitive-behavioral insomnia therapy (CBTi) as an intervention for CM with comorbid insomnia. Finally, we propose a model of the mechanisms underlying the interactions among sleep physiology, maladaptive migraine-coping behaviors, and coexisting factors which contribute to sleep disturbances in CM based on conceptual models used in sleep research.

Recent Findings

Insomnia is the most common sleep complaint among patients with CM. CM patients experience more frequent and severe insomnia symptoms than patients with episodic migraine (EM). It has been suggested that sleep disturbances may predispose individuals to migraine attacks, which may affect the pain-processing trigeminovascular system and thus play a role in migraine progression. Encouraging but limited evidence suggests that management of insomnia via behavioral sleep therapy may reverse CM to EM and possibly prevent migraine chronification.

Summary

Migraine has a complex relationship with sleep. The use of objective sleep study such as polysomnographic microstructural sleep analysis and actigraphy could help connect sleep disturbances and processes related to CM. Future longitudinal studies should examine whether effective behavioral treatments such as CBTi can reverse migraine chronification.

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CORRIGENDUM

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Doing Mastoidectomy Along with Tympanic Membrane Repair Reduces the Need for Revision Procedures: A Prospective Study

Abstract

To determine the role of cortical mastoidectomy on the results of tympanoplsty in tubotympanic type of chronic suppurative otitis media. A prospective, observational, interventional study was conducted from a period of October 2006–October 2008. This included 40 patients of either sex in the age group of 15–45 years having tubotympanic type of CSOM. Tympanoplasty with mastoidectomy was done in all the patients and they were followed up for graft acceptance and hearing impairment for 5 years to see the long term results. Per-operatively, the antrum was involved in 17, aditus in 11 and middle ear in 8 patients. Incus was necrosed in 10 cases and malleus and incus were absent in a single case. Mucoid discharge was found in the middle ear in 12 out of 40 patients. Mucoid discharge ears had antral mucosal hypertrophy in 100%, blocked aditus in 75% and middle ear mucosal hypertrophy in 58% cases; ossicular necrosis in 75% cases. 90% of the cases had graft accepted. In dry ears, graft take up rate was 89% and in ears with mucoid discharge it was 92%. Average air–bone–gap reduced to 13.90 dB as compared to average air–bone–gap (Av. AB Gap1) preoperatively of 38.62 dB. After 5 years, 83.5% patients had >10 dB improvement in hearing. We recommend opening of the mastoid if on inspection of middle ear one finds mucoid type of discharge.

http://ift.tt/2vFY73E

Doing Mastoidectomy Along with Tympanic Membrane Repair Reduces the Need for Revision Procedures: A Prospective Study

Abstract

To determine the role of cortical mastoidectomy on the results of tympanoplsty in tubotympanic type of chronic suppurative otitis media. A prospective, observational, interventional study was conducted from a period of October 2006–October 2008. This included 40 patients of either sex in the age group of 15–45 years having tubotympanic type of CSOM. Tympanoplasty with mastoidectomy was done in all the patients and they were followed up for graft acceptance and hearing impairment for 5 years to see the long term results. Per-operatively, the antrum was involved in 17, aditus in 11 and middle ear in 8 patients. Incus was necrosed in 10 cases and malleus and incus were absent in a single case. Mucoid discharge was found in the middle ear in 12 out of 40 patients. Mucoid discharge ears had antral mucosal hypertrophy in 100%, blocked aditus in 75% and middle ear mucosal hypertrophy in 58% cases; ossicular necrosis in 75% cases. 90% of the cases had graft accepted. In dry ears, graft take up rate was 89% and in ears with mucoid discharge it was 92%. Average air–bone–gap reduced to 13.90 dB as compared to average air–bone–gap (Av. AB Gap1) preoperatively of 38.62 dB. After 5 years, 83.5% patients had >10 dB improvement in hearing. We recommend opening of the mastoid if on inspection of middle ear one finds mucoid type of discharge.

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Connectivity Neurofeedback Training Can Differentially Change Functional Connectivity and Cognitive Performance

Abstract

Advances in functional magnetic resonance imaging have made it possible to provide real-time feedback on brain activity. Neurofeedback has been applied to therapeutic interventions for psychiatric disorders. Since many studies have shown that most psychiatric disorders exhibit abnormal brain networks, a novel experimental paradigm named connectivity neurofeedback, which can directly modulate a brain network, has emerged as a promising approach to treat psychiatric disorders. Here, we investigated the hypothesis that connectivity neurofeedback can induce the aimed direction of change in functional connectivity, and the differential change in cognitive performance according to the direction of change in connectivity. We selected the connectivity between the left primary motor cortex and the left lateral parietal cortex as the target. Subjects were divided into 2 groups, in which only the direction of change (an increase or a decrease in correlation) in the experimentally manipulated connectivity differed between the groups. As a result, subjects successfully induced the expected connectivity changes in either of the 2 directions. Furthermore, cognitive performance significantly and differentially changed from preneurofeedback to postneurofeedback training between the 2 groups. These findings indicate that connectivity neurofeedback can induce the aimed direction of change in connectivity and also a differential change in cognitive performance.

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Contributions of Parietal Cortex to the Working Memory of an Obstacle Acquired Visually or Tactilely in the Locomoting Cat

Abstract

A working memory of obstacles is essential for navigating complex, cluttered terrain. In quadrupeds, it has been proposed that parietal cortical areas related to movement planning and working memory may be important for guiding the hindlegs over an obstacle previously cleared by the forelegs. To test this hypothesis, parietal areas 5 and 7 were reversibly deactivated in walking cats. The working memory of an obstacle was assessed in both a visually dependent and tactilely dependent paradigm. Reversible bilateral deactivation of area 5, but not area 7, altered hindleg stepping in a manner indicating that the animals did not recall the obstacle over which their forelegs had stepped. Similar deficits were observed when area 5 deactivation was restricted to the delay during which obstacle memory must be maintained. Furthermore, partial memory recovery observed when area 5 function was deactivated and restored within this maintenance period suggests that the deactivation may suppress, but not eliminate, the working memory of an obstacle. As area 5 deactivations incurred similar memory deficits in both visual and tactile obstacle working memory paradigms, parietal area 5 is critical for maintaining the working memory of an obstacle acquired via vision or touch that is used to modify stepping for avoidance.

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Complex disease: From non-coding risk variant to biological mechanism in CAD

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Epigenetics: Getting instructions from mum

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Traditional or regenerative periodontal surgery?—a comparison of the publications between two periodontal journals over time

Abstract

Objectives

The objective is to compare the amount and content of publications regarding traditional or regenerative periodontal surgery in the years 1982/1983 and 2012/2013 in two leading periodontal journals of North America and Europe.

Material and methods

The search was carried out in the Journal of Periodontology and Journal of Clinical Periodontology. Four reviewers screened the articles and allocated the topics with respect to periodontal surgery. The distribution of articles with respect to traditional or regenerative periodontal surgery was then compared between the journals and the respective time periods.

Results

Out of 1084 screened articles, 145 articles were included. Articles with periodontal surgery content amounted to 18% for the first time period and to 11% for the second time period. In the years 1982/1983, 7% of articles in the Journal of Periodontology and 8% in the Journal of Clinical Periodontology referred to traditional periodontal surgery, while 8% (Journal of Periodontology) and 5% (Journal of Clinical Periodontology) examined regenerative periodontal surgery. The distribution changed 30 years later, with 1% (Journal of Periodontology) and 3% (Journal of Clinical Periodontology) traditional periodontal surgery and 7% and 6% regenerative periodontal surgery content.

Conclusion

While the clinical need for traditional periodontal surgery remained, research in this important field decreased. Publications rather tended to focus on adjunctive regenerative measures.

Clinical relevance

Periodontal surgery with adjunctive regenerative measures is an established and well-documented clinical procedure. However, with respect to the dominance of horizontal bone loss in periodontally diseased patients, there is a need for ongoing research with focus on traditional periodontal surgery.

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The 7-factor Hybrid Model of DSM-5 PTSD Symptoms and Alcohol Consumption and Consequences in a National Sample of Trauma-Exposed Veterans

Publication date: Available online 6 August 2017
Source:Journal of Anxiety Disorders
Author(s): Meredith Claycomb Erwin, Ruby Charak, Tory A. Durham, Cherie Armour, Xin Lv, Steven M. Southwick, Jon D. Elhai, Robert H. Pietrzak
The purpose of the present study was to investigate associations between the 7-factor hybrid model of DSM-5 posttraumatic stress disorder (PTSD) symptoms, which includes intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal symptoms, and alcohol consumption and consequences. A nationally representative sample of 916 trauma-exposed U.S. military veterans were administered the Trauma History Screen, PTSD Checklist-5, and Alcohol Use Disorders Identification Test. Confirmatory factor analyses were conducted to determine associations between the 7-factor hybrid model of PTSD symptoms, and alcohol consumption and consequences. Results revealed that lifetime dysphoric arousal (r=0.31), negative affect (r=0.30), and anhedonia (r=0.29) symptom clusters were most strongly associated with past-year alcohol consequences. No significant associations were observed for alcohol consumption. While the cross-sectional study design does not allow one to ascertain causative associations between PTSD factors and alcohol consumption and consequences, results generally align with the self-medication hypothesis, as PTSD factors reflecting internalizing were most strongly related to alcohol-related consequences. These results underscore the importance of assessing for alcohol use problems in veterans who score highly on PTSD symptoms reflecting internalizing symptomatology.



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Hard tissue debris removal from the mesial root canal system of mandibular molars with ultrasonically and laser-activated irrigation: a micro-computed tomography study

Abstract

This study is to investigate the efficacy of different irrigant activation techniques on removal of accumulated hard tissue debris (AHTD) in mesial roots of human mandibular molars. Extracted human mandibular molars with an isthmus between the mesial root canals were selected based on micro-CT (μCT) scans. The mesial canals were instrumented to an apical diameter ISO30 using ProTaper rotary files. Teeth were randomly assigned to three irrigant activation groups (n = 10): ultrasonically activated irrigation (UAI) using a size 20 Irrisafe for 3 × 20 s, laser-activated irrigation (LAI) with an Er:YAG laser (2940 nm) and plain 300 μm fiber tip inside the canal (20 mJ, 20 Hz, 3 × 20 s), and laser-activated irrigation with identical parameters with a 400 μm photon-induced photoacoustic streaming (PIPS) tip held at the canal entrance. All teeth were scanned with μCT before and after instrumentation and after irrigant activation. After reconstruction and image processing, the canal system volume filled with hard tissue debris before and after irrigant activation was calculated. Changes in hard tissue debris volumes were compared between groups using one-way ANOVA. The percentage volume of hard tissue debris (vol%) was significantly lower after irrigant activation in all groups. Although the lowest debris values were observed in the laser groups, no significant differences in the vol% of accumulated hard tissue debris after activation were observed between groups. Accumulated hard tissue debris was reduced significantly in all activation groups. Ultrasonically and laser-activated irrigation regimens performed similarly in this respect. None of the tested methods was able to render the root canal systems free of debris.

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In vivo and in vitro control activity of plant essential oils against three strains of Aspergillus niger

Abstract

Contamination of environment and food from the prevalent spores and mycotoxins of Aspergillus niger has led to several diseases in humans and other animals. The present study investigated the control activity of plant essential oils against three strains of A. niger. In the elaborate assays done through microdilution plate assay and agar disk diffusion assay in the lab condition and in vivo assay on the stored wheat grains, the essential oil of Thymus vulgaris depicted overall superior efficacy. In microdilution plate assay, the oil of Anethum graveolens showed best fungistatic activity, while best fungicidal activity was depicted by Syzygium aromaticum oil. The oil of T. vulgaris showed moderate control efficacy against A. niger strains with its antifungal activity resulting mainly due to killing of microorganism rather than growth inhibition. In agar disk diffusion assay, T. vulgaris oil with a zone of inhibition (ZOI) of 23.3–61.1% was the most effective fungicide. The in vivo assay to evaluate the protection efficacy of oils for stored wheat grains against A. niger (AN1) revealed T. vulgaris (90.5–100%) to be the best control agent, followed by the oil of S. aromaticum (61.9–100%). The GC–MS analysis of T. vulgaris oil indicated the presence of thymol (39.11%), γ-terpinene (19.73%), o-cymene (17.21%), and β-pinene (5.38%) as major oil components. Phytotoxic effects of the oils on wheat seeds showed no significant phytotoxic effect of oils in terms of seed germination or seedling growth. The results of the study demonstrated control potentiality of essential oils for the protection of stored wheat against A. niger with prospect for development of eco-friendly antifungal products.

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Investigation of different ethylenediamine- N , N ′-disuccinic acid-enhanced washing configurations for remediation of a Cu-contaminated soil: process kinetics and efficiency comparison between single-stage and multi-stage configurations

Abstract

A comparison of Cu extraction yields for three different ethylenediamine-N,N′-disuccinic acid (EDDS)-enhanced washing configurations was performed on a Cu-contaminated soil. Batch experiments were used to simulate a single-stage continuous stirred tank reactor (CSTR) and a multi-stage (side feeding and counter-current) reactor. Single-stage CSTR conditions were simulated for various EDDS:(Cu + Cd + Pb + Co + Ni + Zn) molar ratio (EDDS:M ratio) (from 1 to 30) and liquid to soil (L/S) ratio (from 15 to 45). The highest Cu extraction yield (≃56%) was achieved with EDDS:M = 30. In contrast, a Cu extraction yield decrease was observed with increasing L/S ratio with highest extracted Cu achievement (≃48%) for L/S = 15. Side feeding configuration was tested in four experimental conditions through different fractionation mode of EDDS dose and treatment time at each washing step. Results from the four tests showed all enhanced Cu extraction (maximum values from ≃43 to ≃51%) achieved at lower treatment time and lower EDDS:M molar ratio compared to CSTR configuration with L/S = 25 and EDDS:M = 10. The counter-current washing was carried out through two washing flows achieving a process performance enhancement with 27% increase of extracted Cu compared to single-stage CSTR configuration. Higher Cu extraction percentage (36.8%) was observed in the first washing phase than in the second one (24.7%).

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Adolescent Mental Health: An Overlooked and Forgotten Issue

In our society, mental health is often overlooked instead of being taken seriously, and when it comes to adolescents, the situation is even worse. The very idea that adolescents could be mentally ill is still ...

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Endoscopic Treatment of Sphenoid Sinus Mucocele: Case Report and Surgical Considerations

Introduction. The paranasal sinuses mucoceles are benign expansive cystic lesions that occur rarely in the sphenoid sinus and contain mucous material enclosed by cylindrical pseudostratified epithelium. Objective. To report one case of sphenoid sinus mucocele that occurred with headache and was submitted to surgical treatment through endonasal endoscopy approach. Case Report. 59-year-old male patient with history of increasing frontoorbital, bilateral, fluctuating headache and exophthalmos. There was no other associated clinical abnormality. Computed Tomography (CT) and Magnetic Resonance Image (MRI) scans confirmed an expansive mass of sphenoid sinus, suggesting mucocele. The patient was submitted to endonasal endoscopic surgery with posterior ethmoidotomy, large sphenoidotomy, and marsupialization of the lesion. Conclusion. Mucoceles of the sphenoid sinus are a very rare condition with variable clinical and radiological presentation. Surgical treatment is absolutely indicated and early treatment avoids visual damage that can be permanent. Endonasal endoscopic approach with drainage and marsupialization of sphenoid sinus, using a transnasal corridor, is a safe and effective treatment modality.

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Endoscopic Treatment of Sphenoid Sinus Mucocele: Case Report and Surgical Considerations

Introduction. The paranasal sinuses mucoceles are benign expansive cystic lesions that occur rarely in the sphenoid sinus and contain mucous material enclosed by cylindrical pseudostratified epithelium. Objective. To report one case of sphenoid sinus mucocele that occurred with headache and was submitted to surgical treatment through endonasal endoscopy approach. Case Report. 59-year-old male patient with history of increasing frontoorbital, bilateral, fluctuating headache and exophthalmos. There was no other associated clinical abnormality. Computed Tomography (CT) and Magnetic Resonance Image (MRI) scans confirmed an expansive mass of sphenoid sinus, suggesting mucocele. The patient was submitted to endonasal endoscopic surgery with posterior ethmoidotomy, large sphenoidotomy, and marsupialization of the lesion. Conclusion. Mucoceles of the sphenoid sinus are a very rare condition with variable clinical and radiological presentation. Surgical treatment is absolutely indicated and early treatment avoids visual damage that can be permanent. Endonasal endoscopic approach with drainage and marsupialization of sphenoid sinus, using a transnasal corridor, is a safe and effective treatment modality.

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Investigations on (C6H9N2)2[MIIBr4] halogenometallate complexes with MII = Co, Cu and Zn: Crystal structure, thermal behavior and magnetic properties

Publication date: 5 December 2017
Source:Journal of Alloys and Compounds, Volume 726
Author(s): Souad Dgachi, Assila Maatar Ben Salah, Mark M. Turnbull, Thierry Bataille, Houcine Naïli
Three complexes with the general formula (C6H9N2)2[M^IIBr4] with M^II = Cu (1), Co (2) and Zn (3) have been grown by the slow evaporation method at room temperature. These compounds were subjected to the following characterization techniques: single crystal X-ray diffraction, thermal analysis (ATG-TD), In situ X-ray powder diffraction and temperature dependent magnetic susceptibility measurements. The crystals of (C6H9N2)2[CuBr4] belong to the triclinic P1¯ space group, whereas (C6H9N2)2[CoBr4] and (C6H9N2)2[ZnBr4] crystallize in the orthorhombic system with the Pbcn space group. Molecular structures of the three coordination compounds consist of [MBr4]^2- anions and 2-amino-6-methylpyridinium cations linked together via non-covalent interactions including hydrogen bonding, π···π stacking and halogen···halogen interactions which lead to three-dimensional supramolecular architecture. The thermal decomposition of the copper compound reveals the slow crystallization of CuBr at 130 °C. Both compounds 1 and 2 exhibit weak antiferromagnetic interactions.

Graphical abstract

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National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy: Two-Stage Implant-Based Breast Reconstruction

J reconstr Microsurg
DOI: 10.1055/s-0037-1604389

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

Article in Thieme eJournals:
Table of contents  |  Full text

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Digital breast Tomosynthesis vacuum assisted biopsy for Tomosynthesis-detected Sonographically occult lesions

Publication date: Available online 5 August 2017
Source:Clinical Imaging
Author(s): Nikki S. Ariaratnam, Sherrill T. Little, Markus A. Whitley, Kristy Ferguson
PurposeTo assess the utility and pathological results from DBT VAB for lesions occult on 2D mammography and breast ultrasound (US).Materials and methodsA retrospective review of 1116 consecutive stereotactic biopsies was performed over 27months. DBT VAB was performed for 38 non-calcified lesions which were solely detected using DBT. Imaging findings and pathology results were reviewed.ResultsPathologic findings were malignant in 8 of 38 lesions [masses (5) and distortion (3)]. High-risk findings found in 14 lesions.ConclusionDBT VAB is easily performed and the majority of cases yield actionable pathologies. Therefore, perform DBT VAB primarily when available.



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Anti-glomerular basement membrane glomerulonephritis following nintedanib for idiopathic pulmonary fibrosis: a case report

We report a previously unrecognized and unreported case of a patient with anti-glomerular basement membrane glomerulonephritis following nintedanib, an orally active small molecule tyrosine kinase inhibitor.

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Anti-glomerular basement membrane glomerulonephritis following nintedanib for idiopathic pulmonary fibrosis: a case report

We report a previously unrecognized and unreported case of a patient with anti-glomerular basement membrane glomerulonephritis following nintedanib, an orally active small molecule tyrosine kinase inhibitor.

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Proteome profiling of s-nitrosylated synaptosomal proteins by isobaric mass tags

Publication date: Available online 5 August 2017
Source:Journal of Neuroscience Methods
Author(s): Teodora Stella Wijasa, Marc Sylvester, Nahal Brocke-Ahmadinejad, Markus P. Kummer, Frederic Brosseron, Volkmar Gieselmann, Michael T. Heneka

Graphical abstract

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High content analysis of phagocytic activity and cell morphology with PuntoMorph

Publication date: Available online 5 August 2017
Source:Journal of Neuroscience Methods
Author(s): Hassan Al-Ali, Han Gao, Camilla Dalby-Hansen, Vanessa Ann Peters, Yan Shi, Roberta Brambilla
BackgroundPhagocytosis is essential for maintenance of normal homeostasis and healthy tissue. As such, it is a therapeutic target for a wide range of clinical applications. The development of phenotypic screens targeting phagocytosis has lagged behind, however, due to the difficulties associated with image-based quantification of phagocytic activity.New methodWe present a robust algorithm and cell-based assay system for high content analysis of phagocytic activity. The method utilizes fluorescently labeled beads as a phagocytic substrate with defined physical properties. The algorithm employs statistical modeling to determine the mean fluorescence of individual beads within each image, and uses the information to conduct an accurate count of phagocytosed beads. In addition, the algorithm conducts detailed and sophisticated analysis of cellular morphology, making it a standalone tool for high content screening.ResultsWe tested our assay system using microglial cultures. Our results recapitulated previous findings on the effects of microglial stimulation on cell morphology and phagocytic activity. Moreover, our cell-level analysis revealed that the two phenotypes associated with microglial activation, specifically cell body hypertrophy and increased phagocytic activity, are not highly correlated. This novel finding suggests the two phenotypes may be under the control of distinct signaling pathways.Comparison with existing methodsWe demonstrate that our assay system outperforms preexisting methods for quantifying phagocytic activity in multiple dimensions including speed, accuracy, and resolution.ConclusionsWe provide a framework to facilitate the development of high content assays suitable for drug screening. For convenience, we implemented our algorithm in a standalone software package, PuntoMorph.



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Functional overestimation due to spatial smoothing of fMRI data

Publication date: Available online 5 August 2017
Source:Journal of Neuroscience Methods
Author(s): Peng Liu, Vince Calhoun, Zikuan Chen
BackgroundPearson correlation (simply correlation) is a basic technique for neuroimage function analysis. It has been observed that the spatial smoothing may cause functional overestimation, which however remains a lack of complete understanding. Herein, we present a theoretical explanation from the perspective of correlation scale invariance.New MethodsFor a task-evoked spatiotemporal functional dataset, we can extract the functional spatial map by calculating the temporal correlations (tcorr) of voxel timecourses against the task timecourse. From the relationship between image noise level (changed through spatial smoothing) and the tcorr map calculation, we show that the spatial smoothing causes a noise reduction, which in turn smooths the tcorr map and leads to a spatial expansion on neuroactivity blob estimation.ResultsThrough numerical simulations and subject experiments, we show that the spatial smoothing of fMRI data may overestimate activation spots in the correlation functional map. Our results suggest a small spatial smoothing (with a smoothing kernel with a full width at half maximum (FWHM) of no more than two voxels) on fMRI data processing for correlation-based functional mappingComparison with existing methodsIn extreme noiselessness, the correlation of scale-invariance property defines a meaningless binary tcorr map. In reality, a functional activity blob in a tcorr map is shaped due to the spoilage of image noise on correlative responses. We may reduce data noise level by smoothing processing, which poses a smoothing effect on correlation. This logic allows us to understand the noise dependence and the smoothing effect of correlation-based fMRI data analysis.

Graphical abstract

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A comparison of weekly paclitaxel and cetuximab with the EXTREME regimen in the treatment of recurrent/metastatic squamous cell head and neck carcinoma

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Kenji Nakano, Shoko Marshall, Shinichiro Taira, Yukiko Sato, Junichi Tomomatsu, Toru Sasaki, Wataru Shimbashi, Hirofumi Fukushima, Hiroyuki Yonekawa, Hiroki Mitani, Kazuyoshi Kawabata, Shunji Takahashi
BackgroundThe effectiveness of the combination chemotherapy of weekly paclitaxel and cetuximab has not yet been compared to that of the current standard regimen, EXTREME (combination of 5-fluorouracil, cisplatin and cetuximab).MethodsWe retrospectively reviewed the clinical records of R/M SCCHN patients who received cetuximab-containing chemotherapy as a first-line therapy; from these, patients receiving a weekly paclitaxel and cetuximab regimen (cohort A) and the EXTREME regimen (cohort B) were extracted. The responses, prognoses and adverse events of these two cohorts were evaluated.ResultsA total of 86 patients were included (cohort A, 49; cohort B, 36). Patients with histories of platinum-based chemotherapy were more frequently given the cohort A treatment. Though the response rates were similar in the two cohorts (45% in cohort A and 51% in cohort B; p=0.83), the progression-free survival (PFS) was significantly more favorable in cohort A by the log-rank test (6.0monthsvs 5.0months; p=0.027). In the Cox-regression hazard analyses, male gender (hazard ratio [HR]=2.1, p=0.010), older age (≥ 70 yo) (HR=5.0, p=0.018), PS 0 (HR=2.2, p=0.027), no history of platinum chemotherapy (HR=3.2, p=0.003) and the presence of a tracheostomy (HR=2.3, p=0.039) were favorable factors within cohort A.ConclusionIn selected R/M SCCHN patients, the combination of weekly paclitaxel and cetuximab could be the better treatment option than the EXTREME regimen.



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The difficult management of radio-incuced head and neck sarcomas

Publication date: Available online 5 August 2017
Source:Oral Oncology
Author(s): Valentina Terenzi, Andrea Cassoni, Marco Della Monaca, Giulia Di Benedetto, Paolo Priore, Andrea Battisti, Valentino Valentini




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The dynamic imprint of word learning on the dorsal language pathway

Publication date: 1 October 2017
Source:NeuroImage, Volume 159
Author(s): María-Ángeles Palomar-García, Ana Sanjuán, Elisenda Bueichekú, Noelia Ventura-Campos, César Ávila
According to Hickok and Poeppel (2007), the acquisition of new vocabulary rests on the dorsal language pathway connecting auditory and motor areas. The present study tested this hypothesis longitudinally by measuring BOLD signal changes during a verbal repetition task and modulation of resting state functional connectivity (rs-FC) in the dorsal stream. Thirty-five healthy participants, divided into trained and control groups, completed fMRI sessions on days 1, 10, and 24. Between days 1 and 10, the trained group learned 84 new pseudowords associated with 84 native words. Task-related fMRI results showed a reduced activity in the IFG and STG while processing the learned vocabulary after training, returning to initial values two weeks later. Moreover, rs-fMRI analysis showed stronger rs-FC between the IFG and STG in the trained group than in the control group after learning, especially on day 24. These neural changes were more evident in participants with a larger vocabulary. Discussion focuses on the prominent role of the dorsal stream in vocabulary acquisition. Even when their meaning was known, newly learned words were again processed through the dorsal stream two weeks after learning, with the increase in rs-FC between auditory and motor areas being a relevant long-term imprint of vocabulary learning.



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New Recommendations of the IFCN: from scalp EEG to electrical brain imaging

Publication date: Available online 5 August 2017
Source:Clinical Neurophysiology
Author(s): Louis Maillard, Georgia Ramantani




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Idiopathic intracranial hypertension: ocular vestibular evoked myogenic potentials as a new evaluation tool

Publication date: Available online 5 August 2017
Source:Clinical Neurophysiology
Author(s): Robert Gürkov, Luis Wittwer, Guillaume Speierer, René Müri, Georgios Mantokoudis, Roger Kalla




http://ift.tt/2vtTp8F

A smoking-related background helps moderate smokers to focus: An Event-Related Potential study using a Go-NoGo Task

Publication date: Available online 5 August 2017
Source:Clinical Neurophysiology
Author(s): Sandrine Detandt, Ariane Bazan, Elisa Schröder, Giulia Olyff, Hendrik Kajosch, Paul Verbanck, Salvatore Campanella
ObjectiveCognitive impairment is a major component in addiction. However, research has been inconclusive as to whether this is also the case for smokers. The present study aims at providing electrophysiological clue for altered inhibitory control in smokers and at investigating whether reduced inhibition was more pronounced during exposure to a smoking cue.MethodsERPs were recorded during a visual Go-NoGo task performed by 18 smokers and 23 controls, in which either a frequent Go signal (letter "M") or a rare No-Go signal ("letter W") were superimposed on three different long-lasting background contexts: black-neutral, smoking-related and non smoking-related.Results1) Smokers performed worse and had an earlier NoGo-N2 latency as compared to controls and independently of context, suggesting a general inhibition impairment; 2) With smoking-related backgrounds specifically, smokers made fewer mistakes than they did in other contexts and displayed a larger NoGo P3 amplitude.ConclusionThese data might suggest that background cues related to addiction may help smokers to be more accurate in an inhibition task.SignificanceOur results show the classical inhibitory impairment in smokers as compared to non-smokers. However, our data also suggest that a smoking-related background may bolster the inhibitory ability of smokers specifically.



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Recombinant Calponin of human filariid Brugia malayi: Secondary structure and immunoprophylactic potential

Publication date: Available online 5 August 2017
Source:Vaccine
Author(s): Shiv K. Verma, Ashish Arora, P. Kalpana Murthy
In the search for potential vaccine candidates for the control of human lymphatic filariasis, we recently identified calponin-like protein, that regulates actin/myosin interactions, in a proinflammatory fraction F8 (45.24–48.64kDa) of Brugia malayi adult worms. In the present study, the gene was cloned, expressed, and the recombinant Calponin of B. malayi (r-ClpBm) was prepared and characterized. r-ClpBm bears homology with OV9M of Onchocerca volvulus, a non-lymphatic filariid that causes loss of vision and cutaneous pathology. r-ClpBm was found to be a ∼45kDa protein that folds into a predominantly α-helix conformation. The protective efficacy of r-ClpBm against B. malayi infection in Mastomys coucha was investigated by assessing the course of microfilaraemia and adult worm burden in the host immunized with r-ClpBm and subsequently infected with infective third stage larvae (L3). Expression of the Calponin was detected in all life stages (microfilariae, L3, L4, L5 and adults) of the parasite and immunization with r-ClpBm partially protected M. coucha against establishment of infection as inferred by ∼42% inhibition in parasite burden. Upregulated cellular proliferation, TNF-α, IFN-γ, IL-1β, IL-4, nitric oxide (NO) release, expression of iNOS, and specific IgG, IgG1 and IgG2b in immunized animals correlated with parasitological findings. r-ClpBm immunization caused degranulation in majority of mast cells indicating possible involvement of mast cell products in reducing the parasite survival. It appears that complex mechanisms including Th1, Th2, NO and mast cells are involved in the clearance of infection. To the best of our knowledge this is the first report on cloning, expression of the gene and purification of r-ClpBm, determination of its secondary structure and its ability to partially prevent establishment of B. malayi infection. Thus, r-ClpBm may further be studied and developed in combination with other protective molecules of B. malayi as a component of potential filarial cocktail vaccine candidate.



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Estrogen Receptor Alpha and Beta Regulate Actin Polymerization and Spatial Memory through an SRC-1/mTORC2-Dependent Pathway in the Hippocampus of Female Mice

Publication date: Available online 5 August 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Yangang Zhao, Li He, Yuanyuan Zhang, Jikai Zhao, Zhi Liu, Fangzhou Xing, Mengying Liu, Ziqi Feng, Wei Li, Jiqiang Zhang
Aging-related decline of estrogens, especially 17β-estradiol (E2), has been shown to play an important role in the impairment of learning and memory in dementias, such as Alzheimer's disease (AD), but the underlying molecular mechanisms are poorly understood. In this study, we first demonstrated decreases in E2 signaling (aromatase, classic estrogen receptor ERα and ERβ and their coactivator SRC-1), mTORC2 signaling (Rictor and phospho-AKTser473) and actin polymerization (phospho-Cofilin, Profilin-1 and the F-actin/G-actin ratio) in the hippocampus of old female mice compared with those levels detected in the adult hippocampus. We then showed that ERα and ERβ antagonists induced a significant decrease in SRC-1, mTORC2 signaling, actin polymerization, and CA1 spine density, as well as impairments of learning and memory; however, ovariectomy-induced changes of these parameters could be significantly reversed by treatment with ER agonists. We further showed that expression of SRC-1, mTORC2 signaling and actin polymerization could be upregulated by E2 treatment, and the effects of E2 were blocked by the ER antagonists but mimicked by the agonists. We also showed that the lentivirus-mediated SRC-1 knockdown significantly inhibited the agonist-activated mTORC2 signaling and actin polymerization, and the lentivirus-mediated Rictor knockdown also significantly inhibited the agonist-activated actin polymerization. Finally, we demonstrated that the ERα and ERβ antagonists induced a disruption in actin polymerization and an impairment of spatial memory, which were rescued by activation of mTORC2. Taken together, the above results clearly demonstrated an mTORC2-dependent regulation of actin polymerization that contributed to the effects of ERα and ERβ on spatial learning, which may provide a novel target for the prevention and treatment of E2-related dementia in the aged population.

Graphical abstract

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3D/2D Registration with Superabundant Vessel Reconstruction for Cardiac Resynchronization Therapy

Publication date: Available online 5 August 2017
Source:Medical Image Analysis
Author(s): Daniel Toth, Maria Panayiotou, Alexander Brost, Jonathan M. Behar, Christopher A. Rinaldi, Kawal S. Rhode, Peter Mountney
A key component of image guided interventions is the registration of pre-operative and intra-operative images. Classical registration approaches rely on cross-modality information; however, in modalities such as MRI and X-ray there may not be sufficient cross-modality information. This paper proposes a fundamentally different registration approach which uses adjacent anatomical structures with superabundant vessel reconstruction and dynamic outlier rejection. In the targeted clinical scenario of cardiac resynchronization therapy (CRT) delivery, preoperative, non contrast-enhanced, MRI is registered to intraoperative, contrasted X-ray fluoroscopy. The adjacent anatomical structures are the left ventricle (LV) from MRI and the coronary veins reconstructed from two contrast-enhanced X-ray images. The novel concept of superabundant vessel reconstruction is introduced to bypass the standard reconstruction problem of establishing one-to-one correspondences. Furthermore, a new dynamic outlier rejection method is proposed, to enable globally optimal point set registration. The proposed approach has been qualitatively and quantitatively evaluated on phantom, clinical CT angiography with ground truth and clinical CRT data. A novel evaluation method is proposed for clinical CRT data based on previously implanted artificial aortic and mitral valves. The registration accuracy in 3D was 2.94 mm for the aortic and 3.86 mm for the mitral valve. The results are below the required accuracy identified by clinical partners to be the half-segment size (16.35 mm) of a standard American Heart Association (AHA) 16 segment model of the LV.

Graphical abstract

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Understanding the role of primary tumour localisation in colorectal cancer treatment and outcomes

Publication date: October 2017
Source:European Journal of Cancer, Volume 84
Author(s): Sebastian Stintzing, Sabine Tejpar, Peter Gibbs, Lars Thiebach, Heinz-Josef Lenz
Metastatic colorectal carcinoma (mCRC) is a heterogeneous disease with differing outcomes and clinical responses and poor prognosis. CRCs can be characterised by their primary tumour location within the colon. The left-sided colon, derived from the hindgut, includes the distal third of the transverse colon, splenic flexure, descending colon, sigmoid colon and rectum. The right-sided colon, derived from the midgut, includes the proximal two-thirds of the transverse colon, ascending colon and caecum. Sometimes, the rectum is described separately, despite originating from the hindgut, and in many clinical series, the left-sided colon includes only tumours within and distal to the splenic flexure. Differences in the microbiome, clinical characteristics and chromosomal and molecular characteristics have been reported between the right and left side of the colon, regardless of how this is defined. There is now strong evidence from clinical studies in patients with mCRC for the prognostic effect of primary tumour location. The impact of primary colonic tumour location on response to treatment is now under investigation in a large number of clinical studies in patients with mCRC.In this review, we summarise the microbiome, clinical, chromosomal and molecular differences associated with the primary location of CRC. We present an overview of the proven prognostic impact of primary tumour location for patients with mCRC and discuss emerging data for the predictive impact of primary tumour location on clinical outcome.



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Application of a mathematical model for ergonomics in lean manufacturing

Publication date: October 2017
Source:Data in Brief, Volume 14
Author(s): Lucia Botti, Cristina Mora, Alberto Regattieri
The data presented in this article are related to the research article "Integrating ergonomics and lean manufacturing principles in a hybrid assembly line" (Botti et al., 2017) [1]. The results refer to the application of the mathematical model for the design of lean processes in hybrid assembly lines, meeting both the lean principles and the ergonomic requirements for safe assembly work. Data show that the success of a lean strategy is possible when ergonomics of workers is a parameter of the assembly process design.



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Editorial Board

Publication date: September 2017
Source:Dental Materials, Volume 33, Issue 9





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Aging of 3Y-TZP dental zirconia and yttrium depletion

Publication date: Available online 5 August 2017
Source:Dental Materials
Author(s): P. Pandoleon, E. Kontonasaki, N. Kantiranis, N. Pliatsikas, P. Patsalas, L. Papadopoulou, T. Zorba, K.M. Paraskevopoulos, P. Koidis
ObjectiveYttrium-stabilized zirconia is susceptible to low temperature degradation after interaction with water. Various mechanisms by which water molecules destabilize the tetragonal phase have been proposed, while the concept of yttrium depletion by the incorporation of hydroxyl ions in the crystalline structure either through the formation of YOH/ZrOH bonds or small α-Y(OH)3 crystallites, is prevailing. The present study was performed to investigate the surface alterations on a 3Y-TZP dental ceramic during the process of in-vitro aging and to further explore the yttrium depletion mechanism that occurs upon interaction with water.MethodsSurface structural changes of zirconia specimens where investigated before and after in-vitro aging with X-ray diffraction analysis, Fourier-transformed infrared spectroscopy, X-ray photoelectron spectroscopy, fluorescence microscopy and scanning electron microscopy.ResultsHigh luminescence generated from the non-aged specimen was explained by the high amount of oxygen vacancies. The phase transformation from the t-ZrO2 to the m-ZrO2 phase after aging was accompanied by a significant loss of yttrium, a clear decrease of oxygen vacancies and a profound decrease of luminescence. Surface oxygen vacancies either migrated into the inner of the specimens or/and/engaged oxygen from the ZrO2 and formed the metallic phase of Y2O3 on the surface after aging.SignificanceAn "ideal" amount of oxygen vacancies that could stabilize the tetragonal phase in Y-TZP zirconia ceramics, without compromising esthetics and LTD resistance, is still a matter of further research and different susceptibilities to LTD among various dental zirconia ceramics are based on the amount of oxygen vacancies that can be annihilated by water molecules.



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Drp1 regulates mitochondrial morphology and cell proliferation in cutaneous squamous cell carcinoma

Publication date: Available online 5 August 2017
Source:Journal of Dermatological Science
Author(s): Shinya Kitamura, Teruki Yanagi, Keisuke Imafuku, Hiroo Hata, Riichiro Abe, Hiroshi Shimizu
BackgroundDynamin-related protein 1 (Drp1) mediates mitochondrial fission. Recently, several studies have shown that Drp1 plays an important role in some cancers. However, little is known about Drp1 in cutaneous squamous cell carcinoma (SCC).ObjectiveTo investigate the role of Drp1 in the tumorigenesis of cutaneous SCCs.Methods and resultsWe investigated cell proliferation, cell cycle, mitochondrial morphology, and MAPK signaling pathway using cutaneous SCC A431 and DJM1 cells that were transfected with shRNA vectors targeting Drp1. The Drp1 gene-knockdown SCC cells showed lower cell proliferation than scramble-control cells, as assessed by direct cell counting and clonogenic assays. DNA content analysis showed Drp1 knockdown to cause G2/M arrest. Morphologically, the depletion of Drp1 resulted in an elongated, hyper-fused mitochondrial network. The MEK inhibitor PD325901 suppressed cell proliferation, as well as inhibiting the phosphorylation of ERK^1/2 and Drp1^Ser616. Also, PD325901 caused the dysregulation of the mitochondrial network. In tumor xenografts of DJM1 cells, the knockdown of Drp1 suppressed tumor growth in vivo, and clinically, the expression levels of Drp1 were higher in cutaneous SCCs than in normal epidermis, and correlated positively with the advanced clinical stages.ConclusionOur results reveal a crucial function for Drp1 in regulating tumor growth, mitochondrial morphology, and cell cycle in cutaneous SCC, suggesting that Drp1 could be a novel target for skin tumor therapies.



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Staphylococcus aureus from atopic dermatitis skin alters cytokine production triggered by monocyte-derived Langerhans cell

Publication date: Available online 5 August 2017
Source:Journal of Dermatological Science
Author(s): Kazumasa Iwamoto, Masaya Moriwaki, Yoshie Niitsu, Masachika Saino, Shunsuke Takahagi, Junzo Hisatsune, Motoyuki Sugai, Michihiro Hide
BackgroundAtopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. The skin of patients with AD presents as a disbalance of the microbiome with a strong colonization by Staphylococcus aureus, which positively correlates with the severity of the disease. However, the effect of colonized S. aureus on the skin immune system has not been fully elucidated.ObjectiveThe aim of this study is to explore whether S. aureus isolated from AD skin is able to skew T cell responses via Langerhans cells (LC) as compared to a standard strain of S. aureus and S. epidermidis.MethodsWe prepared monocyte-derived LC (MoLC) from healthy controls and patients with AD, and stimulated MoLC with a standard strain of S. aureus NCTC8325, S. aureus TF3378 isolated from AD skin, or S. epidermidis. Stimulated MoLC were co-cultured with autologous CD4^pos T cells and then T cell responses were analyzed by T cell polarization assays, cytokine analysis and real-time PCR.ResultsMoLC stimulated by S. aureus TF3378 induced significantly high and rapid proliferation of T cells as compared to those by S. aureus NCTC8325 and S. epidermidis. Cytokine productions from T cells cultured with S. aureus TF3378 − stimulated MoLC showed significantly high amounts of IL-2 and less IFN-γ production with imbalanced Th1/Th2 (decreased TBX21/GATA3 ratio) mRNA expression. The T cell proliferation with increased IL-2 production via S. aureus TF3378 − stimulated MoLC was diminished by treatment of proteinase K.ConclusionS. aureus TF3378 on AD skin can skew T cell responses via LC toward imbalanced Th1/Th2 skin immunity.



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Portable near infrared spectroscopy applied to quality control of Brazilian coffee

Publication date: 1 January 2018
Source:Talanta, Volume 176
Author(s): Radigya M. Correia, Flavia Tosato, Eloilson Domingos, Rayza R.T. Rodrigues, Luiz Felipe M. Aquino, Paulo R. Filgueiras, Valdemar Lacerda, Wanderson Romão
The use of portable micro-spectrometers such as a micro near infrared region (microNIR) spectrometer is a promising technique for solving analytical problems in several areas of science. This work evaluated the potential of microNIR in quality control of Arabica coffee. Arabica coffee has a high commercial value product, motivating the development of analytical methods with high sensitivity and accuracy for detection of its adulteration. Herein, microNIR was successfully used to determine the quality of Arabica coffee by identification and quantification of adulterations such as Robusta coffee (in different roasting levels), as well as corn, peels, and sticks. MicroNIR was combined with multivariate calibration by partial least squares (PLS) and principal component analysis (PCA). A total of 125 blends were produced, containing thirteen different concentrations of the adulterants (corn and peels/sticks, and the Robusta coffee) ranging from 1 to 100wt%. Developed PCA and PLS models were also applied to monitor the quality of sixteen commercial coffee samples. The results obtained using microNIR proved the ability of the method to be efficient and capable in the prediction of adulterations with minimum quantification levels (LOQs of 5–8wt%), being able to be applied to quality control of commercial coffee samples. Therefore, microNIR can reduce and simplify the time of analysis and sample preparation step, as well as to guarantee the efficiency of real-time data acquisition owing to its portability.

Graphical abstract

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Simultaneous determination of designer benzodiazepines in human serum using non-aqueous capillary electrophoresis – Tandem mass spectrometry with successive multiple ionic – Polymer layer coated capillary

Publication date: 1 January 2018
Source:Talanta, Volume 176
Author(s): Martin Švidrnoch, Barbora Boráňová, Jana Tomková, Peter Ondra, Vítězslav Maier
A novel non-aqueous capillary electrophoresis - tandem mass spectrometry method for the simultaneous separation, identification and quantification of nine designer benzodiazepines (bentazepam, etizolam, deschloroetizolam, diclazepam, flubromazepam, flubromazolam, nimetazepam, phenazepam, and pyrazolam) was developed. A non-aqueous running electrolyte consisting of 25mM ammonium acetate with 100mM trifluoroacetic acid in acetonitrile was used. The separation was carried out using a semipermanent coated capillary (successive multiple ionic-polymer coating) with a strong anodic electroosmotic flow at a negative separation voltage within twelve minutes. Electrospray ionization with a triple quadrupole mass spectrometry was utilized for the identification and quantification of selected designer benzodiazepines in a positive ionization mode. The developed method was validated and applied on the analysis of spiked serum sample following a simple liquid-liquid extraction. The LODs of the designer benzodiazepines were between 1.5 and 15.0ngmL⁻¹.

Graphical abstract

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The outcomes of glucose abnormalities in chronic hepatitis C patients receiving interferon-free direct antiviral agents

Publication date: Available online 5 August 2017
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Jee-Fu Huang, Chung-Feng Huang, Ming-Lun Yeh, Chia-Yen Dai, Meng-Hsuan Hsieh, Jeng-Fu Yang, Ching-I. Huang, Yi-Hung Lin, Po-Cheng Liang, Zu-Yau Lin, Shinn-Chern Chen, Ming-Lung Yu, Wan-Long Chuang
Direct-acting antiviral agents (DAAs) have been widely used for chronic hepatitis C (CHC) treatment recently. The characteristics of glucose abnormalities after DAAs therapy however, remain elusive. We aimed to elucidate the mutual impact between treatment response and parameters of glucose abnormalities after DAAs therapy in CHC patients. CHC patients who received DAAs therapy were recruited. The primary outcome measurements were their insulin resistance (IR) and beta-cell function assessed by the homeostasis model assessment (HOMA) method before treatment and at end-of-follow-up (EOF). Sixty-five CHC patients (19 males, mean age = 59.8 ± 10.3 years) were consecutively enrolled. They included 47 (72.3%) patients of genotype-1 infection. The treatment regimens among patients were sofosbuvir in 30 patients, paritaprevir-ritonavir/ombitasvir/dasabuvir in 23 patients, and asunaprevir/daclatasvir in 12 patients respectively. The overall sustained virological response rate was 98.5%. The mean IR at EOF was 2.6 ± 1.8, which was not significantly different from baseline level (2.7 ± 2.9, P = 0.75). There was a significant improvement of beta-cell function at EOF compared to baseline (107.7 ± 86.8 to 86.7 ± 44.5, P = 0.05). The amelioration of beta-cell function at EOF was significantly observed among 23 patients of high baseline IR (166.7 ± 111.3 of baseline vs 105.7 ± 48.2 of EOF, P = 0.04). Six (60%) of the 10 pre-diabetic patients at baseline achieved a normoglycemic state at EOF. Successful eradication of HCV by DAAs might improve glucose abnormalities in CHC patients, particularly among those who had high IR.



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Vonoprazan treatment improves gastrointestinal symptoms in patients with gastroesophageal reflux disease

Publication date: Available online 5 August 2017
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Satoshi Shinozaki, Hiroyuki Osawa, Yoshikazu Hayashi, Hirotsugu Sakamoto, Yoshimasa Miura, Alan Kawarai Lefor, Hironori Yamamoto
The effects of vonoprazan, a new potassium-competitive acid blocker, on gastroesophageal reflux disease (GERD) symptom are not fully elucidated. The aim of this study is to determine the effect of vonoprazan on GERD and associated gastrointestinal symptoms. We retrospectively reviewed 88 Helicobacter pylori negative patients with GERD treated with vonoprazan 10 mg daily. Symptoms were evaluated using the Izumo scale, which reflects quality of life related to various abdominal symptoms. The rates of improvement and resolution of GERD symptoms were 86% (76/88) and 57% (50/88), respectively. Improvement and resolution in patients with erosive esophagitis was higher than in those with non-erosive reflux disease (91% vs 83%, p = 0.260 and 71% vs 47%, p = 0.025, respectively). We attempted to identify factors which predict the effects of vonoprazan. Multivariate analysis identified advanced age (≥60-year-old) (odds ratio [OR] 7.281, 95% confidence interval [CI] 2.056–25.776, p = 0.002), obesity (BMI ≥ 24) (OR 3.342, 95%CI 1.124–9.940, p = 0.030) and erosive esophagitis (OR 4.368, 95%CI 1.281–14.895, p = 0.018) as positive predictors of resolution of GERD symptoms. Alcohol use (OR 0.131, 95%CI 0.027–0.632, p = 0.011) and history of H. pylori eradication (OR 0.171, 95%CI 0.041–0.718, p = 0.015) were identified as negative predictors. Vonoprazan also improved epigastric pain (73%), postprandial distress (60%), constipation (58%) and diarrhea (52%) in patients with GERD. In conclusion, vonoprazan 10 mg daily is effective in improving GERD symptoms. Advanced age, obesity, erosive esophagitis, alcohol use and history of H. pylori eradication influence the resolution of GERD symptoms. Treatment with vonoprazan favorably affects gastrointestinal symptoms in patients with GERD.



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The Volume of Three-Dimensional Cultures of Cancer Cells In Vitro Influences Transcriptional Profile Differences and Similarities with Monolayer Cultures and Xenografted Tumors

Publication date: September 2017
Source:Neoplasia, Volume 19, Issue 9
Author(s): Erwin R. Boghaert, Xin Lu, Paul E. Hessler, Thomas P. McGonigal, Anatol Oleksijew, Michael J. Mitten, Kelly Foster-Duke, Jonathan A. Hickson, Vitor E. Santo, Catarina Brito, Tamar Uziel, Kedar S. Vaidya
Improving the congruity of preclinical models with cancer as it is manifested in humans is a potential way to mitigate the high attrition rate of new cancer therapies in the clinic. In this regard, three-dimensional (3D) tumor cultures in vitro have recently regained interest as they have been acclaimed to have higher similarity to tumors in vivo than to cells grown in monolayers (2D). To identify cancer functions that are active in 3D rather than in 2D cultures, we compared the transcriptional profiles (TPs) of two non-small cell lung carcinoma cell lines, NCI-H1650 and EBC-1 grown in both conditions to the TP of xenografted tumors. Because confluence, diameter or volume can hypothetically alter TPs, we made intra- and inter-culture comparisons using samples with defined dimensions. As projected by Ingenuity Pathway Analysis (IPA), a limited number of signal transduction pathways operational in vivo were better represented by 3D than by 2D cultures in vitro. Growth of 2D and 3D cultures as well as xenografts induced major changes in the TPs of these 3 modes of culturing. Alterations of transcriptional network activation that were predicted to evolve similarly during progression of 3D cultures and xenografts involved the following functions: hypoxia, proliferation, cell cycle progression, angiogenesis, cell adhesion, and interleukin activation. Direct comparison of TPs of 3D cultures and xenografts to monolayer cultures yielded up-regulation of networks involved in hypoxia, TGF and Wnt signaling as well as regulation of epithelial mesenchymal transition. Differences in TP of 2D and 3D cancer cell cultures are subject to progression of the cultures. The emulation of the predicted cell functions in vivo is therefore not only determined by the type of culture in vitro but also by the confluence or diameter of the 2D or 3D cultures, respectively. Consequently, the successful implementation of 3D models will require phenotypic characterization to verify the relevance of applying these models for drug development.



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Incidence and identification of risk factors for trastuzumab-induced cardiotoxicity in breast cancer patients: an audit of a single "real-world" setting.

Related Articles

Incidence and identification of risk factors for trastuzumab-induced cardiotoxicity in breast cancer patients: an audit of a single "real-world" setting.

Med Oncol. 2017 Sep;34(9):154

Authors: Tang GH, Acuna SA, Sevick L, Yan AT, Brezden-Masley C

Abstract
Management of human epidermal growth factor receptor-2-positive (HER2+) breast cancer patients includes the combination of adjuvant chemotherapy and trastuzumab. A meta-analysis reported that <5% of HER2+ breast cancer patients will develop trastuzumab-induced cardiotoxicity (TIC). Observational data suggest that incidence is much higher. We aimed to determine the incidence, time to development, and risk factors associated with TIC among less selected patients. A retrospective cohort study was carried out in 160 HER2+ breast cancer patients who received adjuvant chemotherapy with trastuzumab from January 2006 to June 2014 at St. Michael's Hospital, Toronto, Canada. Patient demographics, cardiovascular history, and TIC were recorded. TIC was defined as symptomatic (heart failure) or asymptomatic [decline in left ventricular ejection fraction (LVEF) by ≥10% or LVEF ≤ 50%]. Of the 160 patients [median age 52 (IQR 45-60), 48.1% on anthracycline-based chemotherapy], 34 patients (21.3%) experienced TIC (median follow-up 55.4 months). The median time to development of TIC was 28.5 weeks during trastuzumab therapy. Those with TIC were more likely to have undergone a mastectomy (52.9 vs. 33.3%, p = 0.04). However, after adjusting for anthracycline-based chemotherapy, and radiotherapy, mastectomy was not independently associated with TIC (HR 2.02; 95% CI 0.88-4.63). The incidence of TIC is higher in our "real-world" population compared to clinical trial data. The median time to development of TIC was 28 weeks after trastuzumab initiation, approximately the 10th treatment of trastuzumab. Timely identification and management of patients is important to avoid irreversible cardiac toxicity and improve breast cancer survival.

PMID: 28779423 [PubMed - in process]

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Thermo-switchable pressure-sensitive adhesives with strong tunable adhesion towards substrate surfaces of different hydrophilicity

Publication date: 8 September 2017
Source:Polymer, Volume 125
Author(s): Kermen A. Bovaldinova, Mikhail M. Feldstein, Natalia E. Sherstneva, Alexander P. Moscalets, Alexei R. Khokhlov
Short-chain oligomeric poly(ethylene glycols), PEGs, are capable of forming supramolecular hydrogen-bonded stoichiometric network complexes with stimuli-responsive polymer such as N-substituted high molecular weight polyamide, poly(N-isopropyl acrylamide), PNIPAM, demonstrating Lower Critical Solution Temperature (LCST) in aqueous solutions. H-bonding occurs through interaction of PEG terminal hydroxyl groups with complementary amide groups in the PNIPAM monomer units. The complexes combine high cohesive strength (due to H-bond crosslinking of long-chain macromolecules) with large free volume (resulting from telechelic structure and essential length of PEG chains). Combination of these factors is the necessary condition of pressure sensitive adhesion. "Smart" pressure-sensitive adhesives (PSAs) adhere towards the hydrophilic substrates at room temperature and detach reversibly at the temperatures above LCST, while their behavior towards hydrophobic substrates follows opposite pattern. As contact angle measurements have shown, at room temperatures the thermo-switchable PSAs have low contact angle with water, which becomes large at temperatures above LCST. Under temperature elevation, the complex turns hydrophobic inside out and loses hydrophilicity, similarly to the complexes of another «smart» polyamide, poly-N-vinyl caprolactam (PVCL), with PEG-400. Evident correlation has been observed between the strength of hydrogen bonding and molecular structures of both the PVCL – PEG and PNIPAM – PEG PSA complexes and their adhesion.

Graphical abstract

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Fe3O4 nanoparticle-embedded polystyrene composite particles fabricated via a Shirasu porous glass membrane technique and their magnetorheology

Publication date: 8 September 2017
Source:Polymer, Volume 125
Author(s): Chun Yan Gao, Min Wook Kim, Dong Hun Bae, Yu Zhen Dong, Shang Hao Piao, Hyoung Jin Choi
We synthesized Fe3O4/polystyrene (PS) composite nanoparticles via a Shirasu porous glass (SPG) membrane emulsification technique and examined their magnetorheological (MR) properties under external magnetic field strengths. The SPG method was adopted for achieving a narrow size distribution of the product nanoparticles containing magnetite. The structure and morphology of the samples were analyzed by transmission electron microscopy and their thermal characteristics were evaluated by thermogravimetric analysis. The MR behavior of a Fe3O4/PS composite-based MR fluid dispersed in silicone oil was examined by a rotational rheometer under an extra magnetic field strength. The experimental results obtained from both the steady shear and dynamic oscillation tests showed that the fluid exhibited a typical MR behavior under an applied magnetic field.

Graphical abstract

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“A new physical aspect for elastic-viscous transition and velocity jump in fracture of rubbers”

Publication date: 8 September 2017
Source:Polymer, Volume 125
Author(s): Y. Fukahori, K. Sakulkaew, J.J.C. Busfield
The elastic-viscous transition of tear fracture of rubber consists of three different fracture zones, the elastic-brittle fracture zone, the viscous-ductile fracture zone and the intermediate transition zone accompanied with stick-slip motion and a corresponding velocity jump at a constant strain energy release rate. Following the previous paper where the fundamental concept named the elastic-viscous transition for the velocity jump was newly introduced, here in addition the authors propose another new physical concept for the mechanism of the elastic-viscous transition in comparison with the phase transition of water. The vibrational energy caused by the stick-slip motion converted from the external strain energy works as a driving force for the velocity jump, being similar to the situation when the latent heat converted from an external heating source causes a volume jump in the phase transition of water.The greatly increased vibrational energy might be consumed to accelerate the ductile fracture of the newly induced fraction of the glassy state in the transition process from the rubbery to glassy state around the glass transition region, resulting in the velocity jump at the elastic-viscous transition. It is the purpose of this paper to answer the essential question why the abrupt and significant velocity change occurs under circumstances where the input strain energy release rate is kept constant.

Graphical abstract

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Vacuum induced dehydration of swollen poly(methoxy diethylene glycol acrylate) and polystyrene-block-poly(methoxy diethylene glycol acrylate)-block-polystyrene films probed by in-situ neutron reflectivity

Publication date: 25 August 2017
Source:Polymer, Volume 124
Author(s): Qi Zhong, Ezzeldin Metwalli, Monika Rawolle, Gunar Kaune, Achille M. Bivigou-Koumba, André Laschewsky, Christine M. Papadakis, Robert Cubitt, Jiping Wang, Peter Müller-Buschbaum
The isothermal vacuum-induced dehydration of thin films made of poly(methoxy diethylene glycol acrylate) (PMDEGA), which were swollen under ambient conditions, is studied. The dehydration behavior of the homopolymer film as well as of a nanostructured film of the amphiphilic triblock copolymer polystyrene-block-poly(methoxy diethylene glycol acrylate)-block-polystyrene, abbreviated as PS-b-PMDEGA-b-PS, are probed, and compared to the thermally induced dehydration behavior of such thin thermo-responsive films when they pass through their LCST-type coil-to globule collapse transition. The dehydration kinetics is followed by in-situ neutron reflectivity measurements. Contrast results from the use of deuterated water. Water content and film thickness are significantly reduced during the process, which can be explained by Schott second order kinetics theory for both films. The water content of the dehydrated equilibrium state from this model is very close to the residual water content obtained from the final static measurements, indicating that residual water still remains in the film even after prolonged exposure to the vacuum. In the PS-b-PMDEGA-b-PS film that shows micro-phase separation, the hydrophobic PS domains modify the dehydration process by hindering the water removal, and thus retarding dehydration by about 30%. Whereas residual water remains tightly bound in the PMDEGA domains, water is completely removed from the PS domains of the block copolymer film.

Graphical abstract

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Surface texturing of electrospun fibres by photoembossing using pulsed laser interference holography and its effects on endothelial cell adhesion

Publication date: 8 September 2017
Source:Polymer, Volume 125
Author(s): Nanayaa F. Hughes-Brittain, Lin Qiu, Olivier T. Picot, Wen Wang, Ton Peijs, Cees W.M. Bastiaansen
Electrospun fibres are nowadays extensively studied for biomedical applications such as tissue engineering and drug delivery. Here, fibres for such applications are electrospun from photopolymer blends using a volatile solvent. The obtained nonwoven fibre mats were textured using a photoembossing technique that uses the interference of two coherent UV laser beams followed by a thermal development step. AFM measurements revealed that the patterned exposure using pulsed laser interference holography resulted in a surface texture on the fibres. The effect of temperature and UV dosage on fibre texturing was studied and was similar to results seen in photoembossed films. Fibronectin and cell adhesion was evaluated on textured fibres of 1 μm diameter with relief structures of 60 nm height and 2 μm pitch. Initial results did not seem to indicate improved cell adhesion for photoembossed fibres compared to their non-embossed counterparts.

Graphical abstract

http://ift.tt/2wwsq9D

Flexible polydimethylsiloxane/multi-walled carbon nanotubes membranous metacomposites with negative permittivity

Publication date: 8 September 2017
Source:Polymer, Volume 125
Author(s): Kai Sun, Peitao Xie, Zhongyang Wang, Tongming Su, Qian Shao, JongEun Ryu, Xihua Zhang, Jiang Guo, Akash Shankar, Jianfeng Li, Runhua Fan, Dapeng Cao, Zhanhu Guo
Metacomposites with negative electromagnetic parameters can be promising substitute for periodic metamaterials. In this paper, we devoted to fabricating flexible metacomposite films, which have great potential applications in the field of wearable cloaks, sensing, perfect absorption and stretchable electronic devices. The conductivity and the complex permittivity were investigated in flexible polydimethylsiloxane (PDMS)/multi-walled carbon nanotubes (MWCNTs) membranous nanocomposites, which were fabricated via in-situ polymerization process. With the increase of conductive one-dimension carbon nanotubes concentration, there was a percolation transition observed in conduction due to the formation of continuous networks. The dielectric dispersion behavior was also analyzed in the spectra of complex permittivity. It is indicated that the conduction and polarization make a combined effect on the dielectric loss in flexible PDMS/MWCNTs composites. The negative permittivity with a dielectric resonance was obtained, and was attributed to the induced electric dipoles.

Graphical abstract

http://ift.tt/2wwM3hw

Dynamic mechanical analysis and water vapour sorption of highly porous poly(methyl methacrylate)

Publication date: 8 September 2017
Source:Polymer, Volume 125
Author(s): Ángel Serrano-Aroca, Mar Llorens-Gámez
Highly porous poly(methyl methacrylate) (PMMA) with porosities ranging from 65 to 78% were synthesised at room temperature under UV light by the polymerisation in solution method with several cross-linker contents using ethylenglycol dimethacrylate. Bulk poly(methyl methacrylate) samples (non-porous) with the same cross-linker contents were also prepared as reference materials. The results of performing thermo-mechanical analysis, differential scanning calorimetry and water sorption isotherms showed that the mechanical performance and water sorption of highly porous PMMA depends on more on the microstructure (porosity) than on the material composition only in the glassy state. Furthermore, in this broad range of temperatures, the mechanical behaviour of highly porous PMMA, considered as a biphasic material composed of bulk PMMA and pores, can be perfectly predicted by Takayanagi's three-block model. For high water activities, surprisingly, water sorption decreased considerably in highly porous PMMA as compared with bulk PMMA due to the formation of water clusters.

Graphical abstract

http://ift.tt/2wwEvLO

Thiol-Michael ‘click’ hydrogels as an imageable packing material for cancer therapy

Publication date: 8 September 2017
Source:Polymer, Volume 125
Author(s): Nicholas G. Moon, Allison M. Pekkanen, Timothy E. Long, Timothy N. Showalter, Bruce Libby
Gynecological cancer treatment strategies commonly employ pelvic brachytherapy, a technique that temporarily locates radioactive materials in or near the source of the tumor. Despite numerous advances in brachytherapy treatment protocols, advances in the required vaginal packing materials lag significantly. This paper describes a packing material for vaginal brachytherapy based on a poly(ethylene glycol) (PEG)-based hydrogel. Commercially available oligomeric starting materials rapidly formed a hydrogel upon action of mild base (NaHCO3) through a thiol-Michael addition reaction. Tuning the base concentration enabled rapid formation of hydrogels with moduli sufficient for effective tissue displacement (>10 kPa). The poly(ethylene glycol) diacrylate oligomer molecular weight exerted minimal influence on the hydrogel modulus. The hydrogels absorbed up to four times their weight in water from the dry state. CT imaging demonstrated distinguishability between hydrogel, water, and metal medical tools. The hydrogels did not induce significant IL-8 upregulation or cytotoxicity when cultured against vaginal macrophage cells, suggesting lack of immunogenicity. Our findings support these hydrogels as ideal candidates for a packing material in pelvic brachytherapy applications.

Graphical abstract

http://ift.tt/2wwVr4S

Polytriazolium poly(ionic liquid) bearing triiodide anions: Synthesis, basic properties and electrochemical behaviors

Publication date: 25 August 2017
Source:Polymer, Volume 124
Author(s): Weiyi Zhang, Christoph Willa, Jian-Ke Sun, Ryan Guterman, Andreas Taubert, Jiayin Yuan
4-Methyl-1-vinyl-1,2,4-triazolium triiodide ionic liquid and its polymer poly(4-methyl-1-vinyl-1,2,4-triazolium) triiodide were prepared for the first time from their iodide precursors via the reaction of iodide (I⁻) with elemental iodine (I2). The change from iodide to triiodide (I3⁻) was found to introduce particular variations in the physical properties of these two compounds, including lower melting point/glass transition temperature and altered solubility. The compounds were characterized by single-crystal X-ray diffraction, elemental analysis, and their electrochemical properties examined in solution and in the solid-state. Compared with their iodide analogues, the triiodide salts exhibited lower electrical impedance and higher current in the cyclic voltammetry. We found that poly(4-methyl-1,2,4-triazolium triiodide) was proven to be a promising solid polymer electrolyte candidate.

Graphical abstract

http://ift.tt/2wwsmXr

Rigid, bio-based polyamides from galactaric acid derivatives with elevated glass transition temperatures and their characterization

Publication date: 25 August 2017
Source:Polymer, Volume 124
Author(s): Aleksandra A. Wróblewska, Katrien V. Bernaerts, Stefaan M.A. De Wildeman
A comparative study was prepared investigating the synthesis of polyamides using bio-based building blocks derived from sugar beet pulp, namely 2,3:4,5-di-O-methylene-galactarate (GalXH) and 2,3:4,5-di-O-isopropylidene-galactarate (GalXMe) derivatives. Two different approaches towards the synthesis of bio-based polyamides were evaluated: melt polycondensation and direct polycondensation in solution via the phosphorylation technique. The polymerization of GalXMe with diamines resulted in polymers with narrow dispersity whereas GalXH gives polyamides with broad dispersity. Kinetic studies were performed to understand the different behavior of GalXH and GalXMe during polycondensation. The GalX monomers were combined with linear, cycloaliphatic and aromatic diamines, which resulted in amorphous polyamides with glass transition temperatures between 50 °C–220 °C. The obtained polyamides were stable at elevated temperatures (i.e. above 300 °C). The hydrolytic stability of the acetal/ketal groups in the GalX polyamides in different acids (e.g. 5% citric acid, 90% formic acid) was investigated and revealed higher acid resistance of GalXH compared to that of GalXMe. Furthermore, the water absorption of the GalX copolymers was compared to commercial polyamide references.

Graphical abstract

http://ift.tt/2wwPgOa

Crystal reorganization of poly (butylene terephthalate)

Publication date: 25 August 2017
Source:Polymer, Volume 124
Author(s): Katalee Jariyavidyanont, René Androsch, Christoph Schick
The kinetics of isothermal melt-crystallization of poly (butylene terephthalate) (PBT) has been evaluated in a wide temperature range from below the glass transition temperature Tg to close to the equilibrium melting temperature, using fast scanning chip calorimetry. Analysis of heating scans recorded after pre-defined crystallization times permitted gaining valuable information about the effect of crystallization on the glass transition, the cold-crystallization kinetics and stability of crystals formed at the crystallization temperature and during heating. As one of the main conclusions, it is suggested that reorganization on heating involves melting of crystals without formation of a completely relaxed and isotropic melt (at the length scale of a crystal) but a non-isotropic cluster of chain segments which turn into a more stable crystal by a fast click- but not classical secondary nucleation/growth-mechanism.

Graphical abstract

http://ift.tt/2wweix4

B cell phenotypes, signaling and their roles in secretion of antibodies in systemic lupus erythematosus

Publication date: Available online 5 August 2017
Source:Clinical Immunology
Author(s): Yoshiya Tanaka, Satoshi Kubo, Shigeru Iwata, Maiko Yoshikawa, Shingo Nakayamada
B cells play a pivotal role in the initiation and perpetuation of SLE. Because SLE is molecularly and clinically heterogeneous, efficacious targeted therapy to clinical remission has not yet been established in SLE. We have found i) statistical clustering between Tfh cells and class-switched memory B cells and the upregulated transition from CXCR5⁺ IgM memory B cells to CXCR3⁺ class-switched memory B cells in SLE by 8-color flow cytometry, ii) the involvement of Syk, Btk and JAK in the activation and differentiation of B cells in SLE, iii) SLE patients was divided to 3 groups based on immunophenotypic analysis and statistical analysis and patients in the Tfh/class-switched B cell-dominant group were most refractory to conventional therapies although 3 groups had similar clinical features. Thus, novel therapies targeting Tfh-memory B cell interaction are anticipated in certain subpopulation of SLE patients, which leads to the precision medicine in SLE.



http://ift.tt/2wjhJrs

Re: ASTRO consensus guideline for oropharyngeal cancer

Publication date: Available online 5 August 2017
Source:Practical Radiation Oncology
Author(s): Gary V. Walker, Pierre Blanchard, Adam S. Garden




http://ift.tt/2uddQTJ

Response to ASTRO consensus guideline for oropharyngeal cancer

Publication date: Available online 5 August 2017
Source:Practical Radiation Oncology
Author(s): David J. Sher, David J. Adelstein, Gopal K. Bajaj, David M. Brizel, Ezra E. Cohen, Aditya Halthore, Louis B. Harrison, Charles Lu, Benjamin J. Moeller, Harry Quon, James W. Rocco, Erich M. Sturgis, Roy B. Tishler, Andy Trotti, John Waldron, Avraham Eisbruch




http://ift.tt/2vBYonD

The Technology of Processed Electroencephalogram Monitoring Devices for Assessment of Depth of Anesthesia.

Commercial brain function monitors for depth of anesthesia have been available for more than 2 decades; there are currently more than 10 devices on the market. Advances in this field are evidenced by updated versions of existing monitors, development of new monitors, and increasing research unveiling the mechanisms of anesthesia on the brain. Electroencephalography signal processing forms an integral part of the technology supporting the brain function monitors for derivation of a depth-of-anesthesia index. This article aims to provide a better understanding of the technology and functionality behind these monitors. This review will highlight the general design principles of these devices and the crucial stages in electroencephalography signal processing and classification, with a focus on the key mathematical techniques used in algorithm development for final derivation of the index representing anesthetic state. We will briefly discuss the advantages and limitations of this technology in the clinical setting as a tool in our repertoire used for optimizing individualized patient care. Also included is a table describing 10 available commercial depth-of-anesthesia monitors. (C) 2017 International Anesthesia Research Society

http://ift.tt/2vaPDhW

Atlas of Peripheral Regional Anesthesia Anatomy and Techniques, 3rd edition.

No abstract available

http://ift.tt/2vtAgUz

Perioperative Drill-Based Crisis Management.

No abstract available

http://ift.tt/2vaCCoy

Reduction in Operating Room Plasma Waste After Evidence-Based Quality Improvement Initiative.

Anesthesiologists request units of plasma in anticipation of transfusion. The amount of plasma transfused intraoperatively is less than that issued (requested, thawed, and sent). We presented institutional-specific data on plasma usage including anesthesiologist-specific ratios of plasma issued-to-transfused. In month-to-month comparisons from the year before the presentation (June-December 2015) to 7 months after (June-December 2016), plasma issued to the operating room was reduced from 434.9 +/- 81 to 327.3 +/- 65 units, a change of 107.6 units per month (95% confidence interval [CI], 22-193); plasma discarded by the blood bank was reduced from 109.7 +/- 48 units to 69.1 +/- 9 units, a change of 40.6 units per month (95% CI, 0.2-81); and plasma transfused went from 188.4 +/- 42 units to 160.7 +/- 52 units, a nonsignificant change of 27.7 units per month (95% CI, -27 to 83). (C) 2017 International Anesthesia Research Society

http://ift.tt/2vtOeFW

An Appraisal of the Carlisle-Stouffer-Fisher Method for Assessing Study Data Integrity and Fraud.

Data fabrication and scientific misconduct have been recently uncovered in the anesthesia literature, partly via the work of John Carlisle. In a recent article in Anaesthesia, Carlisle analyzed 5087 randomized clinical trials from anesthesia and general medicine journals from 2000 to 2015. He concluded that in about 6% of studies, data comparing randomized groups on baseline variables, before the given intervention, were either too similar or dissimilar compared to that expected by usual sampling variability under the null hypothesis. Carlisle used the Stouffer-Fisher method of combining P values in Table 1 (the conventional table reporting baseline patient characteristics) for each study, then calculated trial P values and assessed whether they followed a uniform distribution across studies. Extreme P values targeted studies as likely to contain data fabrication or errors. In this Statistical Grand Rounds article, we explain Carlisle's methods, highlight perceived limitations of the proposed approach, and offer recommendations. Our main findings are (1) independence was assumed between variables in a study, which is often false and would lead to "false positive" findings; (2) an "unusual" result from a trial cannot easily be concluded to represent fraud; (3) utilized cutoff values for determining extreme P values were arbitrary; (4) trials were analyzed as if simple randomization was used, introducing bias; (5) not all P values can be accurately generated from summary statistics in a Table 1, sometimes giving incorrect conclusions; (6) small numbers of P values to assess outlier status within studies is not reliable; (7) utilized method to assess deviations from expected distributions may stack the deck; (8) P values across trials assumed to be independent; (9) P value variability not accounted for; and (10) more detailed methods needed to understand exactly what was done. It is not yet known to what extent these concerns affect the accuracy of Carlisle's results. We recommend that Carlisle's methods be improved before widespread use (applying them to every manuscript submitted for publication). Furthermore, lack of data integrity and fraud should ideally be assessed using multiple simultaneous statistical methods to yield more confident results. More sophisticated methods are needed for nonrandomized trials, randomized trial data reported beyond Table 1, and combating growing fraudster sophistication. We encourage all authors to more carefully scrutinize their own reporting. Finally, we believe that reporting of suspected data fraud and integrity issues should be done more discretely and directly by the involved journal to protect honest authors from the stigma of being associated with potential fraud. (C) 2017 International Anesthesia Research Society

http://ift.tt/2vaxYXF

Mortality, Geriatric, and Nongeriatric Surgical Risk Factors Among the Eldest Old: A Prospective Observational Study.

BACKGROUND: Preoperative risk and postoperative outcomes among the elderly are the subject of extensive debate. However, the eldest old, that is, the fastest-growing and most vulnerable group, are insufficiently studied; even their mortality rate is unclear. This prospective observational study was performed with the aim of determining the mortality rate of this population and establishing which preoperative conditions were predictors of which postoperative outcomes. The study was undertaken between 2011 and 2015 in a major tertiary care university hospital. METHODS: All patients aged >=85 years undergoing any elective procedure during the study period were included. Patients were followed up for 30 days postoperatively. The preoperative conditions studied were demographic data, grade of surgical complexity (1-3), preoperative comorbidities, and some characteristically geriatric conditions (functional reserve, nutrition, cognitive status, polypharmacy, dependency, and frailty). The outcome measures were 30-day all-cause mortality (primary end point), morbidity, prolonged length of stay, and escalation of care in living conditions. RESULTS: Of 139 eligible patients, 127 completed follow-up. The 30-day mortality was 7.9%; 95% confidence interval (CI), 3.2-12.6. It had 3 predictors: malnutrition (odds ratio [OR], 15; 95% CI, 3-89), complexity 3 (OR, 9.1; CI, 2-52), and osteoporosis/osteoporotic fractures (OR, 14.7; CI, 2-126). Significant predictors for morbidity (40%) were ischemic heart disease (OR, 3.9; CI, 1-11) and complexity 3 (OR, 3.6; CI, 2-9), while a nonfrail phenotype (OR, 0.3; CI, 0.1-0.8) was found to be protective. Only 2 factors were found to be predictive of longer admissions, namely complexity 3 (OR, 4.4; CI, 2-10) and frailty (OR, 2.7; CI, 2-7). Finally, risk factors for escalation of care in living conditions were slow gait (a surrogate for frailty, OR, 2.5; CI, 1-6), complexity 3 (OR, 3.2; CI, 1-7), and hypertension (OR, 2.9; CI, 1-9). CONCLUSIONS: The eldest old is a distinct group with a considerable mortality rate and their own particular risk factors. Surgical complexity and certain geriatric variables (malnutrition and frailty), which are overlooked in American Society of Anesthesiologists and most other usual scores, are particularly relevant in this population. Inclusion of these factors along with appropriate comorbidities for risk stratification should guide better decision making for families and doctors alike and encourage preoperative optimization of patients. (C) 2017 International Anesthesia Research Society

http://ift.tt/2vue8cy

Perioperative Considerations for the Use of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes.

No abstract available

http://ift.tt/2vav4lS

Do advanced glycation end-products cause food allergy?.

Purpose of review: The aim of this study was to appraise the evidence relating to dietary advanced glycation end-products (AGEs), their influence on innate and adaptive immune responses and their possible role in the increasing rate of food allergy that is being observed globally. Recent findings: The western pattern of diet is high in both AGEs and their substrates and this has been increasing in the last 30 years. AGEs mimic alarmins such as S100 proteins and the high molecular group box 1 (HMBG1), binding to the Receptor for Advanced Glycation End Products (RAGE), which in turn influences innate and adaptive immune responses. AGEs can directly cause mast cell activation and degranulation. Population data from USA and Australia have correlates with the rise in food allergy and sources of AGEs in the diet and this is also reinforced by urban and regional data within countries. The function of the RAGE receptor is inter-twined with Toll-like receptor (TLR) signalling and vitamin D levels. Activation of the RAGE receptor results in loss of epithelial integrity. Animal models studies have shown that dietary compounds that reduce the formation of AGEs can protect from the development of food allergies; however, this has not been shown in humans. Summary: Dietary sources of AGEs and their substrates are a plausible contributor to the increasing prevalence of food allergy, which requires prospective evaluation in human populations. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2v8doqS

Component resolved diagnostics for hymenoptera venom allergy.

Purpose of review: Component-resolved diagnostics makes use of defined allergen molecules to analyse IgE-mediated sensitizations at a molecular level. Here, we review recent studies on the use of component-resolved diagnostics in the field of Hymenoptera venom allergy (HVA) and discuss its benefits and limitations. Recent findings: Component resolution in HVA has moved from single molecules to panels of allergens. Detection of specific immunoglobulin E (sigE) to marker and cross-reactive venom allergens has been reported to facilitate the discrimination between primary sensitization and cross-reactivity and thus, to provide a better rationale for prescribing venom immunotherapy (VIT), particularly in patients sensitized to both honeybee and vespid venom. Characterization of IgE reactivity to a broad panel of venom allergens has allowed the identification of different sensitization profiles that in honeybee venom allergy were associated with increased risks for side effects or treatment failure of VIT. In contrast, component resolution so far has failed to provide reliable markers for the discrimination of sensitizations to venoms of different members of Vespidae. Summary: Component-resolved diagnostics allows a better understanding of the complexity of sensitization and cross-reactivities in HVA. In addition, the enhanced resolution and precision may allow identification of biomarkers, which can be used for risk stratification in VIT. Knowledge about the molecular composition of different therapeutic preparations may enable the selection of appropriate preparations for VIT according to individual sensitization profiles, an approach consistent with the goals of personalized medicine. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2vrGp3p

Cadaveric Study of the Articular Branches of the Shoulder Joint.

Background and Objectives: This cadaveric study investigated the anatomic relationships of the articular branches of the suprascapular (SN), axillary (AN), and lateral pectoral nerves (LPN), which are potential targets for shoulder analgesia. Methods: Sixteen embalmed cadavers and 1 unembalmed cadaver, including 33 shoulders total, were dissected. Following dissections, fluoroscopic images were taken to propose an anatomical landmark to be used in shoulder articular branch blockade. Results: Thirty-three shoulders from 17 total cadavers were studied. In a series of 16 shoulders, 16 (100%) of 16 had an intact SN branch innervating the posterior head of the humerus and shoulder capsule. Suprascapular sensory branches coursed laterally from the spinoglenoid notch then toward the glenohumeral joint capsule posteriorly. Axillary nerve articular branches innervated the posterolateral head of the humerus and shoulder capsule in the same 16 (100%) of 16 shoulders. The AN gave branches ascending circumferentially from the quadrangular space to the posterolateral humerus, deep to the deltoid, and inserting at the inferior portion of the posterior joint capsule. In 4 previously dissected and 17 distinct shoulders, intact LPNs could be identified in 14 (67%) of 21 specimens. Of these, 12 (86%) of 14 had articular branches innervating the anterior shoulder joint, and 14 (100%) of 14 LPN articular branches were adjacent to acromial branches of the thoracoacromial blood vessels over the superior aspect of the coracoid process. Conclusions: Articular branches from the SN, AN, and LPN were identified. Articular branches of the SN and AN insert into the capsule overlying the glenohumeral joint posteriorly. Articular branches of the LPN exist and innervate a portion of the anterior shoulder joint. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2wiR7H7

Focused Cardiac Ultrasound for the Regional Anesthesiologist and Pain Specialist.

This article in our point-of-care ultrasound (PoCUS) series discusses the benefits of focused cardiac ultrasound (FoCUS) for the regional anesthesiologist and pain specialist. Focused cardiac US is an important tool for all anesthesiologists assessing patients with critical conditions such as shock and cardiac arrest. However, given that ultrasound-guided regional anesthesia is emerging as the new standard of care, there is an expanding role for ultrasound in the perioperative setting for regional anesthesiologists to help improve patient assessment and management. In addition to providing valuable insight into cardiac physiology (preload, afterload, and myocardial contractility), FoCUS can also be used either to assess patients at risk of complications related to regional anesthetic technique or to improve management of patients undergoing regional anesthesia care. Preoperatively, FoCUS can be used to assess patients for significant valvular disease, such as severe aortic stenosis or derangements in volume status before induction of neuraxial anesthesia. Intraoperatively, FoCUS can help differentiate among complications related to regional anesthesia, including high spinal or local anesthetic toxicity resulting in hemodynamic instability or cardiac arrest. Postoperatively, FoCUS can help diagnose and manage common yet life-threatening complications such as pulmonary embolism or derangements in volume status. In this article, we introduce to the regional anesthesiologist interested in learning FoCUS the basic views (subcostal 4-chamber, subcostal inferior vena cava, parasternal short axis, parasternal long axis, and apical 4-chamber), as well as the relevant sonoanatomy. We will also use the I-AIM (Indication, Acquisition, Interpretation, and Medical decision making) framework to describe the clinical circumstances where FoCUS can help identify and manage obvious pathology relevant to the regional anesthesiologist and pain specialist, specifically severe aortic stenosis, hypovolemia, local anesthetic systemic toxicity, and massive pulmonary embolism. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2v8S9Xy