Gd-DTPA-induced dynamic metabonomic changes in rat biofluids

Publication date: December 2017
Source:Magnetic Resonance Imaging, Volume 44
Author(s): Chuanling Wan, Youyang Zhan, Rong Xue, Yijie Wu, Xiaojing Li, Fengkui Pei
ObjectivesThe purposes of this study were (1) to detect the dynamic metabonomic changes induced by gadopentetate dimeglumine (Gd-DTPA) and (2) to investigate the potential metabolic disturbances associated with the pathogenesis of nephrogenic systemic fibrosis (NSF) at the early stage.MethodsA nuclear magnetic resonance (NMR)-based metabolomics approach was used to investigate the urinary and serum metabolic changes induced by a single tail vein injection of Gd-DTPA (dosed at 2 and 5mmol/kg body weight) in rats. Urine and serum samples were collected on days 1, 2 and 7 after dosing.ResultsMetabolic responses of rats to Gd-DTPA administration were systematic involving changes in lipid metabolism, glucose metabolism, TCA cycle, amino acid metabolism and gut microbiota functions. Urinary and serum metabonomic recovery could be observed in both the 2 and 5mmol/kg body weight group, but the metabolic effects of high-dosed (5mmol/kg body weight) Gd-DTPA lasted longer. It is worth noting that hyperlipidemia was observed after Gd-DTPA injection, and nicotinate might play a role in the subsequent self-recovery of lipid metabolism. The disturbance of tyrosine, glutamate and gut microbiota metabolism might associate with the progression of NSF.ConclusionThese findings offered essential information about the metabolic changes induced by Gd-DTPA, and could be potentially important for investigating the pathogenesis of NSF at the early stage. Moreover, the recovery of rats administrated with Gd-DTPA may have implications in the treatment of early stage NSF.



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PCB dechlorination hotspots and reductive dehalogenase genes in sediments from a contaminated wastewater lagoon

Abstract

Polychlorinated biphenyls (PCBs) are a class of persistent organic pollutants that are distributed worldwide. Although industrial PCB production has stopped, legacy contamination can be traced to several different commercial mixtures (e.g., Aroclors in the USA). Despite their persistence, PCBs are subject to naturally occurring biodegradation processes, although the microbes and enzymes involved are poorly understood. The biodegradation potential of PCB-contaminated sediments in a wastewater lagoon located in Virginia (USA) was studied. Total PCB concentrations in sediments ranged from 6.34 to 12,700 mg/kg. PCB congener profiles in sediment sample were similar to Aroclor 1248; however, PCB congener profiles at several locations showed evidence of dechlorination. The sediment microbial community structure varied among samples but was dominated by Proteobacteria and Firmicutes. The relative abundance of putative dechlorinating Chloroflexi (including Dehalococcoides sp.) was 0.01–0.19% among the sediment samples, with Dehalococcoides sp. representing 0.6–14.8% of this group. Other possible PCB dechlorinators present included the Clostridia and the Geobacteraceae. A PCR survey for potential PCB reductive dehalogenase genes (RDases) yielded 11 sequences related to RDase genes in PCB-respiring Dehalococcoides mccartyi strain CG5 and PCB-dechlorinating D. mccartyi strain CBDB1. This is the first study to retrieve potential PCB RDase genes from unenriched PCB-contaminated sediments.

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Environmental hazard assessment by the Ecoscore system to discriminate PAH-polluted soils

Abstract

A bioassay battery-integrated index was applied to different soils sampled from a former coke factory, with the aim to evaluate the discriminating capacity of the Ecoscore system (ES) to assess the environmental hazard of PAH-polluted soils. Two soils from a former coke factory, polluted with polycyclic aromatic hydrocarbons (PAHs), were evaluated for their ecotoxicity to terrestrial and aquatic organisms and their genotoxicity. These soils have been already presented in a previous paper but data have been reanalyzed for the present article in an endeavor to standardize the ES. One soil was sampled in the untreated site and the second underwent a windrow treatment. While these soils had a similar total concentrations of US-EPA 16PAHs (around 3000 mg kg⁻¹), different ecoscores were obtained when subjected to a set of solid- and liquid-phase bioassays measuring acute, chronic, and genotoxic effects. The total PAH content of the soil is not a pertinent parameter to assess soil pollution hazards contrary to the ES. ES is a robust method to classify soils according to their toxicity level. Four levels of toxicity have been defined: no (ecoscore = 0), weak (0 < ecoscore ≤33), moderate (33 < ecoscore ≤67), and strong toxicity (67 < ecoscore ≤ 100). The combination of chemical and toxicological data highlights the relationship between three-ring PAHs and acute ecotoxicity. Conversely, chronic effects of water extracts on algal growth could be explained by high molecular weight PAHs, such as five- and six-ring PAHs.

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Distribution of serum levels of persistent organic pollutants, heterocyclic aromatic amine theoretical intake and nutritional cofactors in a semi-rural island population

Abstract

Persistent organic pollutant (POP) exposure is strongly associated with negative health effects in humans. Heterocyclic aromatic amines (HAAs) are formed during high temperature cooking of foods (i.e. meat and fish). Human exposure to HAA is through food consumption and from similar food groups to POPs. A study of serum samples for POPs in a non-occupational exposed population (n = 149, age range 18–80 years, recruited in 2012) and comparison with estimated HAA daily intake calculations based on food diaries were undertaken. Three different age groups (group 1, 18–29 years; group 2, 30–44 years; and group 3, 45–80 years) were used to explore possible relationships between POP levels present in blood, HAA intake and nutritional cofactors. Significant differences (p < 0.05) between groups (1 and 3) for POP levels were found for p,p′-DDE, polychlorinated biphenyl (PCB) 153, PCB 138 and the sum of PCBs. A similar trend was found between groups 2 and 3 for PCB 153 and sum of PCBs. Significant differences were found between groups 1 and 3 and groups 2 and 3 for HAA intake., i.e. HAA intake was lowest in those of middle age, which may well reflect a different pathway of human exposure between HAA and POPs through the diet preferences.

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Advances in the Role of Drug-Induced Sleep Endoscopy in Investigating Sleep Apnea

Abstract

Purpose of Review

Our aim is to highlight the current advances and the role of drug-induced sleep endoscopy (DISE) in investigating sleep apnea.

Recent Findings

Since drug-induced sleep is not necessarily identical to natural sleep, proper level of sedation is important. When using propofol, clinically useful determinations of airway obstruction seem to occur at medium sedation, which is most probably achieved with a blood propofol concentration of 3.2 μg/ml. Historically, recommendations were to perform DISE in the worse sleeping position, which is almost always the supine position. In positional dependent obstructive sleep apnea (POSA), evaluation of the upper airway in lateral position becomes more important and can be mimicked by lateral head rotation alone. Simulation bites and systems as the matrix provide higher accuracy to simulate the possible effect of oral appliance therapy (OAT) compared to manual jaw thrust. When evaluating awake examination versus DISE for surgical decision making, a modification was made in 50% after DISE. Multilevel surgery was performed less after preoperative DISE screening (8 versus 59.5%) and surgical success rate was increased (86 versus 51.4%).

Summary

Drug-induced sleep endoscopy can be used for assessment of the upper airway in patients diagnosed with OSA and is essential to determine site-specific treatment and individual patient management. Management of OSA is slowly moving away from CPAP treatment only, and evidence is rising that assessment with DISE changes surgical and non-surgical treatment planning and increases treatment outcome.

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Mineralization-defects are comparable in fluorotic impacted human teeth and fluorotic mouse incisors

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Rozita Jalali, Franck Guy, Samaneh Ghazanfari, Don Lyaruu, Leo van Ruijven, Pamela DenBesten, Stefania Martignon, Gina Castiblanco, Antonius L.J.J. Bronckers
ObjectiveFluoride excess of 0.05–0.07mgF/kgbw/day in water or food additives like salt is the principal cause of endemic dental fluorosis. How fluoride causes these defects is not clear yet. Recent studies in rodents suggest that development of enamel fluorosis is associated with insufficient neutralization of protons released during the formation of hypermineralized lines.DesignHere we examined whether hypermineralization could also be assessed by MicroCT in developing molar enamel of humans exposed to fluoride.ResultMicro-CT analysis of hypomineralized enamel from human fluorotic molars graded by the Thylstrup–Fejerskov (TF) Index as III–IV showed weak hypermineralized lines and hypermineralized patches not seen in TF-I/II grade enamel. The mesio-distal sides of these molar teeth were significantly smaller (∼18%, p=0.02) than in TF-I/II teeth.ConclusionThe patterns of changes observed in human fluorotic teeth were similar to those in fluorotic rodent incisors. The data are consistent with the hypothesis that also in developing human teeth fluoride-stimulated local acidification of enamel could be a mechanism for developing fluorotic enamel.



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In Response.

No abstract available

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In Response: Concerns With Rate of Rise of Carbon Dioxide During Apnea With Buccal Oxygenation.

No abstract available

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The Subtleties of Language as a Reason for Failure to Follow Preoperative Fasting Guidelines: The Differences Between Restricting, Allowing, and Encouraging.

No abstract available

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Core Temperature Monitoring in Obstetric Spinal Anesthesia Using an Ingestible Telemetric Sensor.

BACKGROUND: Perioperative hypothermia may affect maternal and neonatal outcomes after obstetric spinal anesthesia. Core temperature is often poorly monitored during spinal anesthesia, due to the lack of an accurate noninvasive core temperature monitor. The aim of this study was to describe core temperature changes and temperature recovery during spinal anesthesia for elective cesarean delivery. We expected that obstetric spinal anesthesia would be associated with a clinically relevant thermoregulatory insult (core temperature decrease >1.0[degrees]C). METHODS: A descriptive study was conducted in 28 women. An ingestible telemetric temperature sensor was used to record core temperature over time (measured every 10 seconds). The primary outcome was the maximum core temperature decrease after spinal anesthetic injection. The secondary outcomes were lowest absolute core temperature, time to lowest temperature, time to recovery of core temperature, hypothermic exposure (degree-hours below 37.0[degrees]C), and the time-weighted hypothermic exposure (median number of degrees below 37.0[degrees]C per hour). Basic descriptive statistics, median spline smooth, and integration of the area below the 37.0[degrees]C line of the temperature-over-time curve were utilized to analyze the data. RESULTS: Intestinal temperature decreased by a mean (standard deviation) of 1.30[degrees]C (0.31); 99% confidence interval (CI), 1.14 to 1.46 after spinal anesthetic injection. The median (interquartile range [IQR]) time to temperature nadir was 0.96 (0.73-1.32) hours (95% CI, 0.88-1.22). Fourteen of the 28 participants experienced intestinal temperatures below 36.0[degrees]C after spinal injection. Temperature was monitored for a minimum of 8 hours after spinal injection. In 8 of 28 participants, intestinal temperature did not recover to baseline during the monitored period. A median (IQR) of 4.59 (3.38-5.92) hours (95% CI, 3.45-5.90) was required for recovery to baseline intestinal temperature in the remaining 20 patients. Participants experienced a median (IQR) of 1.97 (1.00-2.68) degree-hours of hypothermic exposure (95% CI, 1.23-2.45). The median (IQR) number of degrees below 37.0[degrees]C per hour was 0.45 (0.35-0.60) (95% CI, 0.36-0.58). CONCLUSIONS: During cesarean delivery under spinal anesthesia, women experienced a rapid decrease in core temperature. Using an intestinal telemetric sensor, the perioperative thermal insult and recovery were documented with high resolution. Fifty percent of participants in this study became hypothermic. Although the surgical procedure is typically of short duration, women undergoing spinal anesthesia for cesarean delivery experience significant hypothermic exposure and compromised thermoregulation for several hours. (C) 2017 International Anesthesia Research Society

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Respiratory Outcomes in Preterm Infants: From Infancy Through Adulthood.

No abstract available

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Reducing Mortality in Acute Kidney Injury.

No abstract available

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Cervical mass as the first clinical manifestation of unsuspected metastatic seminoma

The authors reported a case of a 27‐year‐old man with a nontender left neck mass that had grown quite rapidly within few weeks. FNAB and CT were not consistent to establish the definite diagnosis. After excisional biopsy, the histopathological examination and the immunohistochemical study of the specimen revealed a cervical metastasis of seminoma. The patient was treated with chemotherapy with a complete clinical remission. This uncommon case-report can represent a great diagnostic and therapeutic challenge and should be considered in the differential diagnosis of every cervical masses occurring in young males patients.

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Does CT help in predicting preepiglottic space invasion in laryngeal carcinoma?

Evaluating preepiglottic space involvement in laryngeal cancer by CT may lead misinterpretation. We sought to understand the causes of misinterpretation in evaluating the preepiglottic space by CT and assessed the effects of misinterpretation in treatment plans of patients with laryngeal squamous cell carcinomas.

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Correlation of soft palate length with velum obstruction and severity of obstructive sleep apnea syndrome

Our aim in this study was to analyze whether soft palate length and velum obstruction during sleep are correlated and to determine the effects of related parameters on obstructive sleep apnea syndrome (OSAS) severity. We used computed tomography to measure soft palate length and drug-induced sleep endoscopy (DISE) to evaluate velum obstruction severity. Patients also underwent polysomnography (PSG) for evaluation of OSAS severity.

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Clinical course of incidental parathyroidectomy: Single center experience

Thyroidectomy is a very common surgical procedure. Regardless of surgeon experience, incidental parathyroidectomy is a complication of thyroidectomy. The aim of this study was to identify the clinical course of incidental parathyroidectomies after thyroidectomy.

http://ift.tt/2wCuNZr

Cervical mass as the first clinical manifestation of unsuspected metastatic seminoma

The authors reported a case of a 27‐year‐old man with a nontender left neck mass that had grown quite rapidly within few weeks. FNAB and CT were not consistent to establish the definite diagnosis. After excisional biopsy, the histopathological examination and the immunohistochemical study of the specimen revealed a cervical metastasis of seminoma. The patient was treated with chemotherapy with a complete clinical remission. This uncommon case-report can represent a great diagnostic and therapeutic challenge and should be considered in the differential diagnosis of every cervical masses occurring in young males patients.

http://ift.tt/2vrsBp4

Does CT help in predicting preepiglottic space invasion in laryngeal carcinoma?

Evaluating preepiglottic space involvement in laryngeal cancer by CT may lead misinterpretation. We sought to understand the causes of misinterpretation in evaluating the preepiglottic space by CT and assessed the effects of misinterpretation in treatment plans of patients with laryngeal squamous cell carcinomas.

http://ift.tt/2wCQVT8

Correlation of soft palate length with velum obstruction and severity of obstructive sleep apnea syndrome

Our aim in this study was to analyze whether soft palate length and velum obstruction during sleep are correlated and to determine the effects of related parameters on obstructive sleep apnea syndrome (OSAS) severity. We used computed tomography to measure soft palate length and drug-induced sleep endoscopy (DISE) to evaluate velum obstruction severity. Patients also underwent polysomnography (PSG) for evaluation of OSAS severity.

http://ift.tt/2vrE7kb

Clinical course of incidental parathyroidectomy: Single center experience

Thyroidectomy is a very common surgical procedure. Regardless of surgeon experience, incidental parathyroidectomy is a complication of thyroidectomy. The aim of this study was to identify the clinical course of incidental parathyroidectomies after thyroidectomy.

http://ift.tt/2wCuNZr

Commentary on Some Recent Theses Relevant to Combating Aging: August 2017

Rejuvenation Research , Vol. 0, No. 0.


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Necrotic mucosal CD30-positive ulcer on the oral mucosa: a self-healing lymphoma

We report the case of a peripheral mucosal lymphoma that developed in the oral cavity and had a self-limiting course.

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Postoperative complications after head and neck operations that require free tissue transfer- prevalence, morbidity, and cost

To understand and reduce the impact of postoperative complications, we studied 568 patients who had had operations over 72 months in our hospital. Multivariate analysis indicated that factors indicative of coexisting conditions (including activated systemic inflammation) and the complexity of the operation are primary determinants of postoperative complications. The enhanced recovery after surgery (ERAS) care pathway did not have an effect on their occurrence or severity. Systematic study of patients' toleration of major head and neck operations is required, as optimal perioperative care pathways remain elusive.

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Hearing Health USA and Belsono Partner to Remove Stigma of Hearing Aids

​Two national hearing heath center networks, Hearing Health USA and Belsono Hearing Centers, are partnering for the #FlauntYourHearingAids campaign to encourage an open dialogue about hearing loss and hearing aid use by showing that anyone can be affected but not limited by hearing loss. The campaign will feature a combination of visual materials and informational articles highlighting people doing amazing things while wearing their hearing aids. From now until the end of September, hearing aid users are invited to submit photos of themselves or their loved ones flaunting their hearing aids for a chance to be featured on the two companies' website and social media pages. Those interested in participating can submit their photos on Twitter, Facebook, and Instagram with the hashtag #FlauntYourHearingAids, or upload them to the websites of Hearing Health USA and Belsono (http://bit.ly/2vW4nok; http://bit.ly/2vVElRW). 

Published: 8/11/2017 12:10:00 PM

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A Limited Submuscular Direct-to-Implant Technique Utilizing AlloMax

Background: This study evaluates a novel limited submuscular direct-to-implant technique utilizing AlloMax where only the upper few centimeters of the implant is covered by the pectoralis, whereas the majority of the implant including the middle and lower poles are covered by acellular dermal matrix. Methods: The pectoralis muscle is released off its inferior and inferior-medial origins and allowed to retract superiorly. Two sheets of AlloMax (6 × 16 cm) are sutured together and secured to the inframammary fold, serratus fascia, and the superiorly retracted pectoralis. Thirty-seven breasts in 19 consecutive patients with follow-up at 6 months were reviewed. Results: Nineteen consecutive patients with 37 reconstructed breasts were studied. Average age was 50 years, average BMI was 24.3. Ptosis ranged from grade 0–III, and average cup size was B (range, A–DDD). Early minor complications included 1 seroma, 3 minor postoperative hematomas managed conservatively, and 3 minor wound healing problems. Three breasts experienced mastectomy skin flap necrosis and were managed with local excision. There were no cases of postoperative infection, red breast, grade III/IV capsular contractures, or implant loss. A single patient complained of animation postoperatively. One patient desired fat grafting for rippling. Conclusions: The limited submuscular direct-to-implant technique utilizing AlloMax appears to be safe with a low complication rate at 6 months. This technique minimizes the action of the pectoralis on the implant, reducing animation deformities but still providing muscle coverage of the upper limit of the implant. Visible rippling is reduced, and a vascularized bed remains for fat grafting of the upper pole if required.

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The Supra-Inframammary Fold Approach to Breast Augmentation: Avoiding a Double Bubble

Background: The inframammary incision for breast augmentation is commonly made at or below the existing inframammary fold (IMF) in an effort to keep the scar in the crease. In recent studies, surgeons inferiorly relocate the IMF, center the implant at nipple level, and attempt to secure the new IMF with sutures. The fascial attachments (also called ligaments) holding the IMF are released, risking a bottoming-out deformity or a double bubble. Methods: This retrospective study evaluated 160 consecutive women undergoing primary subpectoral breast augmentation. An incision was made 0.5–1.0 cm above the IMF. Dissection proceeded directly to the pectoralis margin, preserving IMF fascial attachments. The pectoralis origin was released from the lower sternum. Surveys were administered to obtain patient-reported outcome data. Ninety-eight patients (61%) participated. Results: Implants often appear high on the chest at early follow-up appointments but gradually settle. One patient (0.6%) developed a double bubble. No reoperations were needed for implant malposition. One patient had a mild animation deformity. There were no cases of symmastia. The mean result rating was 9.1/10. Four percent of surveyed patients found their implants too high; 8% found them too low. Ninety-two patients (94%) reported that their scars were well-hidden. Ninety-six women (98%) said that they would redo the surgery. Conclusions: A supra-IMF approach anticipates the normal descent of implants after augmentation. Scars remain hidden both in standing and supine positions. This method reduces the short-term risk of reoperation for implant malposition or a double bubble.

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Patient- and Physician-Reported Satisfaction With Systemic Lupus Erythematosus Treatment in US Clinical Practice

Publication date: Available online 10 August 2017
Source:Clinical Therapeutics
Author(s): Katie Pascoe, Steve Lobosco, David Bell, Ben Hoskin, David J. Chang, Bonnie Pobiner, Sulabha Ramachandran
PurposeThis two-part study comprised two descriptive, cross-sectional surveys to evaluate treatment satisfaction among patients with systemic lupus erythematosus (SLE) and their physicians from US clinical practices. The Lupus Plus Project (LPP; part one) involved belimumab-containing regimens; the Disease Specific Program (DSP; part two) included all treatments and was designed to build on the body of evidence from part one.MethodsThe LPP recruited patients receiving belimumab, and comprised 2 paper questionnaires: a patient self-completion questionnaire (PSC) and a patient record form (PRF) completed by the physician. The DSP enrolled patients with SLE receiving any treatment and comprised four parts: a PSC, a PRF completed by the physician after patient consultation, face-to-face physician interviews, and a workload form completed by the physicians to indicate their total SLE patient workload. The key objective of this study was to assess physician and patient satisfaction with current treatment.FindingsFrom the PSCs, data regarding patient-reported satisfaction with current treatment were available for 263 patients who were receiving belimumab combination therapy (LPP) and 250 patients who were receiving non-belimumab treatment (DSP). The majority of patients (belimumab, 86.3% [227/263]; non-belimumab, 78.4% [196/250]) responded positively (at least "somewhat satisfied") when asked about current treatment satisfaction, as did physicians (belimumab, 82.9% [311/375]; non-belimumab, 74.3% [326/439]). In multivariate analysis, factors most strongly associated with patient-reported satisfaction for patients receiving belimumab were patient-reported improvements in leisure activities since taking belimumab (odds ratio [OR] = 4.66), physician-reported improvements in fatigue (OR = 3.72), patient-reported improvements in general symptoms (OR = 3.02), and pain/achiness (OR = 2.71). Physician satisfaction was associated with clinical outcome such as improvements in pain/achiness (OR = 6.16), fatigue (OR = 3.76), and patient-reported satisfaction with treatment frequency (OR = 3.91). In patients receiving other SLE treatments, dosing frequency of current treatment (OR = 3.64) and a reduction in fatigue severity (OR = 3.61) were most strongly associated with patient-reported satisfaction; physician satisfaction was most strongly associated with a reduction in fatigue (OR = 6.22) and current remission status (OR = 6.05).ImplicationsWhen considering SLE treatment satisfaction patients tend to consider impact on daily functioning, whereas physicians take into account a wider range of clinical outcomes; however, both strongly consider improvements in fatigue. These surveys provide insights into treatment satisfaction among prescribers and patients with SLE. GSK-ClinicalStudyRegister.com identifiers: GSK study 202146 [HO 15-15509] and 205086 [HO 15-16709].



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Redirect Health Offers Affordable Healthcare Alternative to Drive Forward Small Businesses

Redirect Health makes healthcare a smart advantage for businesses, allowing them to easily and affordably recruit and retain employees in a way their competitors cannot. They believe America is driven forward by small businesses – the people who work for them, and the families who rely on them to be successful.

Today, the healthcare experience isn't always that great. In fact, it can be downright daunting and overwhelming to navigate. Getting the care they need when they want it is getting more and more difficult. The mission of Redirect Health is to help employers create healthcare plans that are affordable, comply with Obamacare and take great care of their people.

The American Sleep and Breathing Academy (ASBA) CEO, David Gergen, said Redirect Health saved his business thousands of dollars. With over 80 employees at Gergen's Sleep Appliance Lab and Gergen's Orthodontic Lab, his health care costs were reduced by over half of what they were prior. In turn, he spread the news and many dentists are now turning to Redirect Health for their healthcare solutions.

To learn more about Redirect Health, visit RedirectHealth.com

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Letter regarding “Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review”

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Hyaluronan-mediated mononuclear leukocyte binding to gingival fibroblasts

Abstract

Objectives

Binding of mononuclear leukocytes to hyaluronan cable structures is a well-known pathomechanism in several chronic inflammatory diseases, but has not yet described for chronic oral inflammations. The aim of this study was to evaluate if and how binding of mononuclear leukocytes to pathologic hyaluronan cable structures can be induced in human gingival fibroblasts.

Material and methods

Experiments were performed with human gingival fibroblasts and peripheral blood mononuclear cells (PBMCs) from three healthy blood donors. Gingival fibroblasts were stimulated with (1) tunicamycin, (2) polyinosinic/polycytidylic acid (Poly:IC), and (3) lipopolysaccharides (LPS) to simulate (1) ER stress and (2) viral and (3) bacterial infections, respectively. Fibroblasts were then co-incubated with PBMCs, and the number of bound and fluorescently labeled PBMCs was assessed using a fluorescence reader and microscopy. For data analysis, a linear mixed model was used.

Results

Hyaluronan-mediated binding of PBMCs to gingival fibroblasts was increased by tunicamycin and Poly(I:C) but not by LPS. Hyaluronidase treatment and co-incubation with hyaluronan transport inhibitors reduced this binding.

Conclusions

Results suggest that hyaluronan-mediated binding of blood cells might play a role in oral inflammations. A potential superior role of viruses needs to be confirmed in further clinical studies.

Clinical relevance

The linkage between pathological hyaluronan matrices and oral infections opens up potential applications of hyaluronan transport inhibitors in the treatment of chronic oral inflammations.

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Beck’s cognitive theory and the response style theory of depression in adolescents with and without mild to borderline intellectual disability

Publication date: October 2017
Source:Research in Developmental Disabilities, Volume 69
Author(s): Martine M. Weeland, Karin S. Nijhof, R. Otten, Ignace P.R. Vermaes, Jan K. Buitelaar
AimThis study tests the validity of Beck's cognitive theory and Nolen-Hoeksema's response style theory of depression in adolescents with and without MBID.MethodsThe relationship between negative cognitive errors (Beck), response styles (Nolen-Hoeksema) and depressive symptoms was examined in 135 adolescents using linear regression.ResultsThe cognitive error 'underestimation of the ability to cope' was more prevalent among adolescents with MBID than among adolescents with average intelligence. This was the only negative cognitive error that predicted depressive symptoms. There were no differences between groups in the prevalence of the three response styles. In line with the theory, ruminating was positively and problem-solving was negatively related to depressive symptoms. Distractive response styles were not related to depressive symptoms. The relationship between response styles, cognitive errors and depressive symptoms were similar for both groups.ConclusionThe main premises of both theories of depression are equally applicable to adolescents with and without MBID. The cognitive error 'Underestimation of the ability to cope' poses a specific risk factor for developing a depression for adolescents with MBID and requires special attention in treatment and prevention of depression.What this paper adds?Despite the high prevalence of depression among adolescents with MBID, little is known about the etiology and cognitive processes that play a role in the development of depression in this group. The current paper fills this gap in research by examining the core tenets of two important theories on the etiology of depression (Beck's cognitive theory and Nolen-Hoeksema's response style theory) in a clinical sample of adolescents with and without MBID. This paper demonstrated that the theories are equally applicable to adolescents with MBID, as to adolescents with average intellectual ability. However, the cognitive bias 'underestimation of the ability to cope' was the only cognitive error related to depressive symptoms, and was much more prevalent among adolescents with MBID than among adolescents with average intellectual ability. This suggests that underestimating one's coping skills may be a unique risk factor for depression among adolescents with MBID. This knowledge is important in understanding the causes and perpetuating mechanisms of depression in adolescents with MBID, and for the development of prevention- and treatment programs for adolescents with MBID.



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Plasticizers and bisphenol A, in packaged foods sold in the Tunisian markets: study of their acute in vivo toxicity and their environmental fate

Abstract

Today, processed and packaged foods are considered as among the major sources of human exposure to plasticizers and bisphenol which migrate from plastic packing. In the present study, a wide range of food products sold on the Tunisian market such as grain and grain products, milk and dairy products, fats and oil, drink, fish, and sweets have been analyzed firstly in order to identify the presence of phthalates and bisphenol. Then, the identified chemical molecules were studied for their environmental fate and tested in vivo for its toxicity in mice models. The food products analyzed using GC-MS/MS indicated the presence of the benzyl butyl phthalate (BBP), dibutyl phthalate (DBP), bis(2-ethylhexyl) phthalate (DEHP), diisodecyl phthalate (DiDP), diisononyl phthalate (DiNP), and 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINC) and which using UPLC-MS/MS demonstrated the presence of bisphenol A of all food products. However, compared to other phthalates, BBP was found at high concentrations in the puff pastry (123 mg/kg), milk (2.59 mg/kg), butter (1.5 mg/kg), yogurt (2.23 mg/kg), oil (6.94 mg/kg), water (0.57 mg/kg), candy 1 (2.35 mg/kg), candy 2 (0.81 mg/kg), orange juice (1.25 mg/kg), peach juice (1.26 mg/kg), fruit juices (0.4 mg/kg), and chocolate (0.884 mg/kg). The obtained data in vivo clearly showed that the acute administration of BBP caused hepatic and renal damage as demonstrated by an increase in biochemical parameters as well as the activities of plasma marker enzymes such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase, blood urea nitrogen, glucose, urea, creatinine, and uric acid when compared to the control group. By the same occurrence, the histopathological study revealed that BBP strongly modified the structure of hepatic and renal tissues. In addition, the plasticizers and BBP will therefore discharge via wastewater treatment plants in aquatic system and could reach marine organisms such as fish. We have followed the fate of BBP in bream Sparus aurata. In fact, chemical analysis showed the contamination of wild S. aurata by BBP from Sousse Coast (1.5 mg/kg) and wild S. aurata from Monastir Coast (0.33 mg/kg).

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Successful long-term extracorporeal membrane oxygenation for invasive pulmonary aspergillosis: a case report

Extracorporeal membrane oxygenation is an established life-saving procedure for severe acute respiratory failure due to various causes. In general, the duration of extracorporeal membrane oxygenation ranges fr...

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Simultaneous addition of zero-valent iron and activated carbon on enhanced mesophilic anaerobic digestion of waste-activated sludge

Abstract

The performance of biogas generation and sludge degradation was studied under different zero-valent iron/activated carbon (ZVI/AC) ratios in detail in mesophilic anaerobic digestion of sludge. A good enhancement of methane production was obtained at the 10:1 ZVI/AC ratio, and the cumulative methane production was 132.1 mL/g VS, 37.6% higher than the blank. The methane content at the 10:1 ZVI/AC ratio reached 68.8%, which was higher than the blank (55.2%) and the sludge-added AC alone (59.6%). For sludge degradation, the removal efficiencies of total chemical oxygen demand (TCOD), proteins, and polysaccharides were all the highest at the 10:1 ZVI/AC ratio. The concentration of available phosphorus (AP) decreased after anaerobic digestion process. On the other hand, the concentrations of available nitrogen (AN) and available potassium (AK) increased after the anaerobic digestion process and showed a gradually decreasing trend with increasing ZVI/AC ratio. The concentrations of AN and AK were 2303.1–4200.3 and 274.7–388.3 mg/kg, showing a potential for land utilization.

http://ift.tt/2vYqfP9

Degradation of 5,5-diphenylhydantoin by chlorination and UV/chlorination: kinetics, transformation by-products, and toxicity assessment

Abstract

This study investigated the reaction kinetics and mechanism of the degradation of 5,5-diphenylhydantoin (DPH) during conventional chlorination and UV/chlorination. DPH is one of the antiepileptic drugs, which has frequently been detected in the aquatic environment. For chlorination, the second-order rate constant for the reaction between DPH and free active chlorine (FAC) was determined at pH 5 to 8. At pH 6 to 8, the efficiency of chlorination in the removal of DPH was found to be dominated by the reaction involving hypochlorous acid (HOCl). The result also showed that anionic species of DPH was more reactive toward FAC as compared with neutral DPH. For UV/chlorination, the effect of FAC dosage and pH on the degradation of DPH was evaluated. UV/chlorination is a more effective method for removing DPH as compared with conventional chlorination and UV irradiation. The DPH degradation rate was found to increase with increasing FAC concentration. On the other hand, the degradation of DPH was found to be more favorable under the acidic condition. Based on the identified transformation by-products, DPH was found to be degraded through the reaction at imidazolidine-2,4-dione moiety of DPH for both chlorination and UV/chlorination. Toxicity study on the chlorination and UV/chlorination-treated DPH solutions suggested that UV/chlorination is a more efficient method for reducing the toxicity of DPH.

http://ift.tt/2uyH5jQ

Successful long-term extracorporeal membrane oxygenation for invasive pulmonary aspergillosis: a case report

Extracorporeal membrane oxygenation is an established life-saving procedure for severe acute respiratory failure due to various causes. In general, the duration of extracorporeal membrane oxygenation ranges fr...

http://ift.tt/2wQug5t

How do red and infrared low-level lasers affect folliculogenesis cycle in rat’s ovary tissue in comparison with clomiphene under in vivo condition

Abstract

Folliculogenesis is a cycle that produces the majority of oocyte. Any disruption to this cycle leads to ovulation diseases, like polycystic ovarian syndrome (PCOS). Treatments include drugs and surgery; lasers have also been used complementarily. Meanwhile, still there is no definite treatment for PCOS. This study investigated the photo-bio stimulation effect of near-infrared and red low-level laser on producing follicles and compared the result with result of using common drug, clomiphene. Therefore, the aim of this study was to propose the use of lasers autonomously treatment. So, there was one question: how do lasers affect folliculogenesis cycle in rat's ovary tissue? In this study, 28 rats were assigned to four groups as follows: control (CT), clomiphene drug (D), red laser (RL), and near-infrared laser (NIRL). Afterwards, 14 rats of RL and NIRL groups received laser on the first 2 days of estrous cycle, each 6 days, for 48 days. During treatment period, each rat received energy density of 5 J/cm². Seven rats in D group received clomiphene. After the experiment, lasers' effects at two wavelengths of 630 and 810 nm groups have been investigated and compared with clomiphene and CT groups. Producing different follicles to complement folliculogenesis cycle increased in NIRL and RL groups, but this increase was significant only in the NIRL group. This indicates that NIRL increases ovarian activity to produce oocyte that certainly can be used in future studies for finding a cure to ovarian negligence to produce more oocyte and treat diseases caused by it like PCOS.

http://ift.tt/2uwyaUk

Dysphagia and Speech-Language Pathology Involvement Following Chemical Ingestion Injury: A Review of 44 Cases Admitted to a Quaternary Australian Hospital (2008–2012)

Purpose

This study aimed to explore the clinical characteristics of an adult chemical ingestion population and examine the course of return to oral intake post injury and speech-language pathologist (SLP) involvement during the initial acute-care admission.

Method

A retrospective chart review of adults admitted to a quaternary hospital for the treatment of an acute chemical ingestion injury between 2008 and 2012 was conducted.

Results

Forty-four adults (23 men, 21 women) were identified as receiving treatment for ingestion injury, of whom 18 (40.91%) required altered oral intake. Of those requiring altered oral intake, 50% were referred to SLPs. Individuals requiring altered oral intake were significantly (p < .05) older, more likely to be men, and present with more severe injuries requiring longer ICU and hospital admissions following intentional chemical ingestions than those who were able to commence a normal oral diet without any alteration or nonoral supplementation. By discharge, 15.91% (n = 7) of the total cohort had not resumed normal oral intake.

Conclusions

Return to oral intake post chemical ingestion injury can be protracted and complex. Referrals to SLPs were limited. These data may aid prognostic insight as well as provide (a) collateral information to assist discharge planning and follow-up and (b) background for evaluating the potential for SLP involvement.

http://article/doi/10.1044/2017_AJSLP-16-0075/2648978/Dysphagia-and-SpeechLanguage-Pathology-Involvement

Optimaler Resektionsrand für die brusterhaltende Operation und Ganzbrustbestrahlung beim duktalen Carcinoma in situ

http://ift.tt/2fyK3SY

Evaluación de la capacidad formativa del libro del residente de Otorrinolaringología español (FORMIR) como portafolio electrónico

Publication date: Available online 10 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Juan Manuel Maza Solano, Gustavo Benavente Bermudo, Francisco José Estrada Molina, Jesús Ambrosiani Fernández, Serafín Sánchez Gómez
Introducción y objetivosEvaluar la capacidad formativa del libro del residente español como portafolio electrónico para alcanzar los objetivos de aprendizaje de los MIR de Otorrinolaringología (ORL).MétodosSe realizó una investigación cualitativa multimétodo de características tranversal, temporal y de orientación retrospectiva sobre los MIR de ORL mediante un cuestionario estructurado y una entrevista semiestructurada, sobre la aplicación informática web FORMIR.ResultadosParticiparon el 56,5% de los MIR de ORL de alguno de los 63 hospitales españoles acreditados para impartir formación en ORL entre 2009 y 2012. Los resultados obtenidos demostraron que los MIR de ORL que utilizaban el portafolio electrónico eran capaces de autoguiar mejor su aprendizaje, conocían mejor sus objetivos de aprendizaje, cumplían más eficientemente el programa de formación, identificaban más claramente las causas de sus carencias en el aprendizaje y consideraban que FORMIR como portafolio electrónico constituía una herramienta formativa idónea para sustituir al libro del residente en formato papel.ConclusionesLos MIR de ORL apreciaban de forma muy relevante las prestaciones formativas de FORMIR como portafolio electrónico, especialmente su interfaz, el feedback numérico y automático sobre la adquisición de competencias, su capacidad de almacenamiento de evidencias y su capacidad de visualizarse como logbook de la Unión Europea de Médicos Especialistas o como un curriculum vitae estándar. Este feedback automático facilita el aprendizaje autoguiado. Todo esto hace de FORMIR una herramienta formativa y evaluativa que supera las prestaciones y aceptación de instrumentos similares puestos a disposición de los residentes, que no dudan en proponerlo como el libro del residente más idóneo para facilitar su formación especializada.Backgroundand objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents.MethodsA multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website.ResultsA 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009-2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format.ConclusionsThe ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training.



http://ift.tt/2vuIoBS

Arteria lusoria: A rare cause of tracheal compression

Publication date: Available online 10 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Ana Nóbrega-Pinto, Isabel Carvalho, Cecília Almeida-Sousa




http://ift.tt/2vMMR5l

Seudotumor inflamatorio subglótico en un niño de 3 años

Publication date: Available online 10 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Javier Cervera Escario, Sara Sirvent Cerdá, Saturnino Santos Santos, Adolfo Sequeiros González




http://ift.tt/2uy9Mxt

Primary tuberculosis of the nasal septum: The non-ulcerated form presenting as septal thickening

Publication date: Available online 10 August 2017
Source:Acta Otorrinolaringológica Española
Author(s): Neeraj Aggarwal, Mainak Dutta, Ramanuj Sinha




http://ift.tt/2vMDqD5

Crowdsourcing Samples in Cognitive Science

Publication date: Available online 10 August 2017
Source:Trends in Cognitive Sciences
Author(s): Neil Stewart, Jesse Chandler, Gabriele Paolacci
Crowdsourcing data collection from research participants recruited from online labor markets is now common in cognitive science. We review who is in the crowd and who can be reached by the average laboratory. We discuss reproducibility and review some recent methodological innovations for online experiments. We consider the design of research studies and arising ethical issues. We review how to code experiments for the web, what is known about video and audio presentation, and the measurement of reaction times. We close with comments about the high levels of experience of many participants and an emerging tragedy of the commons.



http://ift.tt/2uNIX7I

New hybrid nanocomposite of copper terephthalate MOF-graphene oxide: synthesis, characterization and application as adsorbents for toxic metal ion removal from Sungun acid mine drainage

Abstract

The application of a hybrid Cu(tpa).GO (Cu(tpa) copper terephthalate metal organic framework, GO graphene oxide) composite as a new adsorbent for the removal of toxic metal ions was reported. New hybrid nanocomposite with excellent dispersibility and stability was successfully fabricated by the simple and effective ultrasonication method. The synthesized composite was characterized by scanning electron microscopy (SEM), UV-Vis and Fourier-transform infrared (FT-IR) techniques. The characterization results concluded that the binding mechanism of the Cu(tpa) and GO was related to both π−π packing and hydrogen bonding. For scrutinizing the sorption activity, the prepared adsorbents were assessed for the removal of Mn²⁺, Cu²⁺, Zn²⁺, Cd²⁺, Pb²⁺ and Fe³⁺ metal ions from aqueous synthetic solution and also acid mine drainage (AMD) wastewater. The sorption experiments demonstrated that the removal efficiency was significantly improved by modified hybrid Cu(tpa).GO composite, owing to the significant number of active binding sites and unique structure formed based on π-conjugated networks. Also, it was shown that the adsorption reaction was mainly attributed to the chemical interactions between metal ions and the surface functional groups. Moreover, kinetic and adsorption studies clarified that the adsorption process onto the Cu(tpa).GO follows a pseudo-second-order kinetics and fits the Langmuir and Freundlich adsorption models. Holistically, the results of this research represent that applying Cu(tpa).GO can be remarked as an effective adsorbent with high possibility at conventional water treatment.

http://ift.tt/2vXLGQ5

Variation in soil aggregate–size distribution affects the dissipation of polycyclic aromatic hydrocarbons in long-term field-contaminated soils

Abstract

Soil organic matter (SOM) is the main adsorbent for polycyclic aromatic hydrocarbons (PAHs) and the principal aggregating agent for soil aggregation that can affect PAH bioavailability and bioaccessibility in soils. The objective of this study was to analyze the relationship between PAH dissipation and variation in soil aggregate–size distribution in two field-contaminated soils with different soil organic C (SOC) content (Anthrosols, 1.41% SOC; Phaeozems, 8.51% SOC) in phytoremediation with alfalfa. The results showed that there were significant reductions of 10.2 and 15.4% of the total PAHs in unplanted and planted treatments, respectively, for Anthrosols. However, there was no significant reduction of total PAHs in either unplanted or planted treatment for Phaeozems. For Anthrosols, mass percentages of coarse sand and fine sand were significantly reduced while coarse silt and fine silt were significantly increased for the planted soil compared to the initial soil (p < 0.05). For Phaeozems, there was no significant variation in aggregate–size distribution among different treatments except that coarse silt in planted and unplanted soil was slightly reduced. The main reason for the dissipation of PAHs in Anthrosols could be that macroaggregates were broken into microaggregates, which made some trapped PAHs become bioaccessible to soil microorganisms.

http://ift.tt/2vXT1iA

Functionalized hydrothermal carbon derived from waste pomelo peel as solid-phase extractant for the removal of uranyl from aqueous solution

Abstract

To develop a high-performance solid-phase extractant for the separation of uranyl f, pomelo peel, a kind of waste biomass, has been employed as carbon source to prepare carbonaceous matrix through low-temperature hydrothermal carbonization (200 °C, 24 h). After being oxidized by Hummers method, the prepared hydrothermal carbon matrix was functionalized with carboxyl and phenolic hydroxyl groups (1.75 mmol g⁻¹). The relevant characterizations and batch studies had demonstrated that the obtained carbon material possessed excellent affinity toward uranyl (436.4 mg g⁻¹) and the sorption process was a spontaneous, endothermic and rapid chemisorption. The selective sorption of U(VI) from the simulated nuclear effluent demonstrated that the sorbent displayed a desirable selectivity (56.14% at pH = 4.5) for the U(VI) ions over the other 11 competitive cations from the simulated industrial nuclear effluent. The proposed synthetic strategy in the present work had turned out to be effective and practical, which provides a novel approach to prepare functional materials for the recovery and separation of uranyl or other heavy metals from aqueous environment.

http://ift.tt/2uxZL39

The influence of particle size and feedstock of biochar on the accumulation of Cd, Zn, Pb, and As by Brassica chinensis L.

Abstract

Biochar produced from rice straw (RC) and maize stalk (MC) was amended to the heavy metal-contaminated soil to investigate the effects of different biochar feedstock and particle size (fine, moderate, coarse) on the accumulation of Cd, Zn, Pb, and As in Brassica chinensis L. (Chinese cabbage). The concentrations of Cd, Zn, and Pb in shoot were decreased by up to 57, 75, and 63%, respectively, after biochar addition (4%). Only MC decreased As concentration in B. chinensis L. shoots by up to 61%. Biochar treatments significantly decreased NH₄NO₃-extractable concentrations of Cd, Zn, and Pb in soil by 47–62, 33–66, and 38–71%, respectively, yet increased that of As by up to 147%. Amendment of RC was more effective on immobilizing Cd, Zn, and Pb, but mobilizing soil As, than MC. A decrease in biochar particle size greatly contributed to the immobilization of Cd, Zn, and Pb in soil and thereby the reduction of their accumulations in B. chinensis L. shoots, especially RC. Increases in soil pH and extractable P induced by biochar addition contributed to the sequestration of Cd, Zn, and Pb and the mobilization of As. Shoot biomass, root biomass, and root system of B. chinensis L. were enhanced with biochar amendments, especially RC. This study indicates that biochar addition could potentially decrease Cd, Zn, Pb, and As accumulations in B. chinensis L., and simultaneously increase its yield. A decrease in biochar particle size is favorable to improve the immobilization of heavy metals (except As). The reduction in Cd, Zn, Pb, and As levels in B. chinensis L. shoots by biochar amendment could be mainly attributed to a function of heavy metal mobility in soil, plant translocation factor, and root uptake.

http://ift.tt/2vXnltI

Effects of PBM in different energy densities and irradiance on maintaining cell viability and proliferation of pulp fibroblasts from human primary teeth

Abstract

This study aimed to compare the effects of photobiomodulation (PBM) in different energy densities and irradiances on maintaining cell viability, and proliferation of pulp fibroblasts from human primary teeth (HPF) were cultured in DMEM and used between the fourth and eighth passages. Then, HPF were irradiated with the following different energy densities: 1.25 J/cm² (a), 2.50 J/cm² (b), 3.75 J/cm² (c), 5.00 J/cm² (d), and 6.25 J/cm² (e); but varying either the time of irradiation (groups 1a–1e) or the output power (groups 2a–2e). Positive (groups 1f and 2f) and negative controls (groups 1g and 2g), respectively, comprised non-irradiated cells grown in regular nutritional conditions (10% fetal bovine serum [FBS]) and under nutritional deficit (1% FBS). Cell viability and proliferation were respectively assessed through MTT and crystal violet (CV) assays at 24, 48, and 72 h after irradiation. Statistical analysis was performed by two-way ANOVA, followed by Tukey test (P < 0.05). The negative controls showed significantly lower viability in relation to most of the corresponding subgroups, both for MTT and CV assays. For both assays, the intragroup comparison showed that the periods of 24 h exhibited lower viability than the periods of 48 and 72 h for most of the subgroups, except the negative controls with lower viability. The different irradiation protocols (equal energy densities applied with different irradiances) showed no statistically significant differences on cell viability and proliferation at the evaluated periods. The proposed PBM in different energy densities and irradiance did not affect the viability and proliferation of pulp fibroblasts from human primary teeth.

http://ift.tt/2wPBhDv

Télédermatologie unissant deux hôpitaux : deux ans d’expérience

Publication date: Available online 10 August 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Bertin, A. Diakite, B. Carton, C. Wozniak, S. Nathanson, S. Monnier, C. Sin, M.-A. Dommergues, J. Parigot, F. Moreau, M.-L. Sigal, P. Foucaud, A. Greder, E. Mahé
IntroductionLa télédermatologie est en plein essor. La pénurie de dermatologues rend difficile l'accès de certaines structures hospitalières à des avis dermatologiques. Nous présentons notre expérience unissant un centre expert, le service de dermatologie du centre hospitalier Victor-Dupouy d'Argenteuil, à toutes les structures médicales rattachées au centre hospitalier André-Mignot (CHV) de Versailles : 2 unités sanitaires de centres pénitentiaires (UCSA), les services traditionnels et les urgences.Matériel et méthodesLa télédermatologie, sous la forme de télé-expertises, a été déployée aux UCSA du CHV en novembre 2013. Cette expertise s'est ensuite étendue en juin 2014 au service de médecine interne et du CHV, et en décembre 2014 à l'ensemble des services du CHV y compris les urgences. Les règles de télédermatologie et éthiques ont été respectées. Si tous dossiers pouvaient être déposés par les UCSA, seuls les dossiers urgents ou difficiles pouvaient être déposés par les autres services du CHV.RésultatsEn 26 mois, 347 requêtes ont été déposées, 231 par les centres pénitentiaires et 116 par le CHV. Aucun refus de patient d'utiliser la télé-expertise n'a été exprimé. La qualité des informations et photographies était considérée comme bonne ou excellente dans plus de 95 % des cas. La réponse était donnée dans les 3heures dans plus de 50 % des cas et dans tous les cas dans les 24heures (jours ouvrables). L'analyse des pathologies diagnostiquées illustre la grande diversité des pathologies rencontrées en dermatologie, avec des spécificités propres aux différentes structures.ConclusionL'exemple détaillé ici illustre la possibilité de développer une telle plate-forme inter-hospitalière. Elle ne répond pas encore aux demandes adressées aux dermatologues par des patients ou par d'autres dermatologues. Son acceptabilité a été considérée comme excellente par les patients (aucun refus), par les demandeurs et par le centre expert.BackgroundTeledermatology is currently booming. Due to the shortage of dermatologists in hospitals access to dermatological consultations is very limited in some hospitals. We present our experience of collaboration between an expert center, the dermatology department of the Victor-Dupouy Hospital Centre in Argenteuil, and all medical structures under the André-Mignot Hospital in Versailles (CHV), including 2 prison medical centers (UCSA), traditional departments and emergency department.Patients and methodsTeledermatology, developed in the form of tele-expertise, began at the UCSA in November 2013. This expertise was then extended in June 2014 to the Internal Medicine department of CHV, and in December 2014 to all departments, including the emergency department. The rules and ethics of teledermatology were strictly adhered to. While UCSA could file all expertise dossiers, only urgent or difficult cases could be filed by other CHV departments.ResultsIn 26 months, 347 expertise requests were filed: 231 by prisons and 116 by the other departments of the CHV. No patients refused teledermatology. The quality of information and photographs was considered good or excellent in over 95% of cases. A response was given within 3hours in more than 50% of cases and in all cases within 24hours (on working days). Analysis of diseases diagnosed illustrates the wide variety of conditions encountered in dermatology, with different structures having their own specific features.ConclusionOur example illustrates the possibility of developing such an inter-hospital platform. However, it does not yet cater for requests made by patients to dermatologists, by dermatologists to dermatologists, or by dermatologists to the hospital teledermatology department. Acceptability was considered excellent by patients (with no refusals), physicians at the CHV, and the expert center.



http://ift.tt/2wPEGSN

Télédermatologie unissant deux hôpitaux : deux ans d’expérience

Publication date: Available online 10 August 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Bertin, A. Diakite, B. Carton, C. Wozniak, S. Nathanson, S. Monnier, C. Sin, M.-A. Dommergues, J. Parigot, F. Moreau, M.-L. Sigal, P. Foucaud, A. Greder, E. Mahé
IntroductionLa télédermatologie est en plein essor. La pénurie de dermatologues rend difficile l'accès de certaines structures hospitalières à des avis dermatologiques. Nous présentons notre expérience unissant un centre expert, le service de dermatologie du centre hospitalier Victor-Dupouy d'Argenteuil, à toutes les structures médicales rattachées au centre hospitalier André-Mignot (CHV) de Versailles : 2 unités sanitaires de centres pénitentiaires (UCSA), les services traditionnels et les urgences.Matériel et méthodesLa télédermatologie, sous la forme de télé-expertises, a été déployée aux UCSA du CHV en novembre 2013. Cette expertise s'est ensuite étendue en juin 2014 au service de médecine interne et du CHV, et en décembre 2014 à l'ensemble des services du CHV y compris les urgences. Les règles de télédermatologie et éthiques ont été respectées. Si tous dossiers pouvaient être déposés par les UCSA, seuls les dossiers urgents ou difficiles pouvaient être déposés par les autres services du CHV.RésultatsEn 26 mois, 347 requêtes ont été déposées, 231 par les centres pénitentiaires et 116 par le CHV. Aucun refus de patient d'utiliser la télé-expertise n'a été exprimé. La qualité des informations et photographies était considérée comme bonne ou excellente dans plus de 95 % des cas. La réponse était donnée dans les 3heures dans plus de 50 % des cas et dans tous les cas dans les 24heures (jours ouvrables). L'analyse des pathologies diagnostiquées illustre la grande diversité des pathologies rencontrées en dermatologie, avec des spécificités propres aux différentes structures.ConclusionL'exemple détaillé ici illustre la possibilité de développer une telle plate-forme inter-hospitalière. Elle ne répond pas encore aux demandes adressées aux dermatologues par des patients ou par d'autres dermatologues. Son acceptabilité a été considérée comme excellente par les patients (aucun refus), par les demandeurs et par le centre expert.BackgroundTeledermatology is currently booming. Due to the shortage of dermatologists in hospitals access to dermatological consultations is very limited in some hospitals. We present our experience of collaboration between an expert center, the dermatology department of the Victor-Dupouy Hospital Centre in Argenteuil, and all medical structures under the André-Mignot Hospital in Versailles (CHV), including 2 prison medical centers (UCSA), traditional departments and emergency department.Patients and methodsTeledermatology, developed in the form of tele-expertise, began at the UCSA in November 2013. This expertise was then extended in June 2014 to the Internal Medicine department of CHV, and in December 2014 to all departments, including the emergency department. The rules and ethics of teledermatology were strictly adhered to. While UCSA could file all expertise dossiers, only urgent or difficult cases could be filed by other CHV departments.ResultsIn 26 months, 347 expertise requests were filed: 231 by prisons and 116 by the other departments of the CHV. No patients refused teledermatology. The quality of information and photographs was considered good or excellent in over 95% of cases. A response was given within 3hours in more than 50% of cases and in all cases within 24hours (on working days). Analysis of diseases diagnosed illustrates the wide variety of conditions encountered in dermatology, with different structures having their own specific features.ConclusionOur example illustrates the possibility of developing such an inter-hospital platform. However, it does not yet cater for requests made by patients to dermatologists, by dermatologists to dermatologists, or by dermatologists to the hospital teledermatology department. Acceptability was considered excellent by patients (with no refusals), physicians at the CHV, and the expert center.



http://ift.tt/2wPEGSN

Nanoparticle-releasing nanofiber composites for enhanced in vivo vaginal retention

Publication date: November 2017
Source:Biomaterials, Volume 144
Author(s): Emily A. Krogstad, Renuka Ramanathan, Christina Nhan, John C. Kraft, Anna K. Blakney, Shijie Cao, Rodney J.Y. Ho, Kim A. Woodrow
Current approaches for topical vaginal administration of nanoparticles result in poor retention and extensive leakage. To overcome these challenges, we developed a nanoparticle-releasing nanofiber delivery platform and evaluated its ability to improve nanoparticle retention in a murine model. We individually tailored two components of this drug delivery system for optimal interaction with mucus, designing (1) mucoadhesive fibers for better retention in the vaginal tract, and (2) PEGylated nanoparticles that diffuse quickly through mucus. We hypothesized that this novel dual-functioning (mucoadhesive/mucus–penetrating) composite material would provide enhanced retention of nanoparticles in the vaginal mucosa. Equivalent doses of fluorescent nanoparticles were vaginally administered to mice in either water (aqueous suspension) or fiber composites, and fluorescent content was quantified in cervicovaginal mucus and vaginal tissue at time points from 24 h to 7d. We also fabricated composite fibers containing etravirine-loaded nanoparticles and evaluated the pharmacokinetics over 7d. We found that our composite materials provided approximately 30-fold greater retention of nanoparticles in the reproductive tract at 24 h compared to aqueous suspensions. Compared to nanoparticles in aqueous suspension, the nanoparticles in fiber composites exhibited sustained and higher etravirine concentrations after 24 h and up to 7d, demonstrating the capabilities of this new delivery platform to sustain nanoparticle release out to 3d and drug retention out to one week after a single administration. This is the first report of nanoparticle-releasing fibers for vaginal drug delivery, as well as the first study of a single delivery system that combines two components uniquely engineered for complementary interactions with mucus.

Graphical abstract

http://ift.tt/2vTNrxN

Viscosupplementation for hip osteoarthritis: a systematic review and meta-analysis of the efficacy for pain, disability and adverse events

Publication date: Available online 11 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Victor Figueiredo Leite, João Eduardo Daud Amadera, Anna Maria Buehler
ObjectiveTo assess the efficacy of viscosupplementation (HA) in hip osteoarthritis (OA) pain, disability and adverse events.Data SourcesPubmed, EMBASE, Cochrane Library, ClinicalTrials.gov database and specific journals up to March 2017.Study SelectionRandomized controlled trials comparing HA with any other intra-articular injection.Data ExtractionPerformed according to Cochrane/GRADE criteria. Two authors extracted data, assessed risk of bias and quality of evidence. Random-effects meta-analysis was conducted. Protocol registered on PROSPERO under CRD42015017312Data SynthesisEight RCTs were retrieved (n=807): four comparing HA to placebo (PBO); three with platelet-rich plasma (PRP), three with methylprednisolone (MPA), and one mepivacaine (MPV). Some RCTs had three arms. There is VERY LOW evidence that HA is not superior to PBO in pain at 3 months (SMD=-0.06 [95% CI -0.38; 0.25], p=0.69), and HIGH evidence that is not superior in adverse events (RR=1.21 [95%CI 0.79; 1.86], p=0.38).There is LOW evidence that HA is not superior to PRP for pain at 1 month. There is VERY LOW evidence that HA is not superior to PRP for pain at 6 and 12 months (mean difference in VAS in cm= -0.05 [95%CI -0.81, 0.71]; 1.0 [95%CI -1.5, 3.50]; 0.81 [95%CI -1.11, 2.73], respectively).There is HIGH evidence that HA is no different from MPA for pain at 1 month (SMD=0.02 [95% CI -0.18; 0.22], p=0.85). There is LOW evidence HA is no different from MPA for OMERACT-OARSI responders index at 1 month (RR=0.44 [95%CI 0.10; 1.95], p=0.28; There is HIGH evidence HA is no different from MPA for adverse events (RR=1.21 [95%CI 0.79; 1.87], p=0.38).ConclusionsWe do not recommend viscosupplementation for hip OA. Compared to placebo, data shows scarce evidence of its efficacy up to 3 months, and suggests no difference at 6 months. However, future RCTs could present HA as an alternative to MPA for short-term symptom relief.



http://ift.tt/2wPXjWx

Predictors of survival in head and neck mucosal melanoma

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Matthew Q. Schmidt, John David, Emi J. Yoshida, Kevin Scher, Alain Mita, Stephen L. Shiao, Allen S. Ho, Zachary S. Zumsteg
ObjectivesTo evaluate hospital-based data of head and neck mucosal melanoma patients in order to identify predictors of survival.Materials and methodsThe National Cancer Data Base was used to identify 1368 patients with head and neck mucosal melanoma diagnosed between the years of 2004 and 2012. The Kaplan-Meier method was utilized to estimate overall survival, and multivariate Cox regression analyses were performed to assess the impact of covariates on survival after adjusting for confounding variables.ResultsMedian follow-up was 55.2months. Median survival of all patients was 29.3months, and the 5-year survival was 27.4%. After adjusting for other prognostic factors in multivariate analysis, paranasal sinus location [hazard ratio (HR)=1.54, 95% Confidence Interval (CI)=1.30–1.82, P<0.001)] and the use of radiotherapy alone for definitive local treatment (HR=2.27, 95% CI=1.72–2.98, P<0.001) were associated with worse survival. Similar results were seen in the subgroup of patients with complete clinical staging information. In terms of patterns of care, the use of combined surgery and radiotherapy as the primary local treatment modality has significant increased from 2004 and 2012 (P=0.03).ConclusionOutcomes in mucosal melanoma of the head and neck remain suboptimal, despite increased use of multimodality local therapy, likely due to the high risk of distant metastases. Mucosal melanomas arising from the paranasal sinuses have particularly poor prognosis. Novel therapeutic paradigms for head and neck mucosal melanoma, incorporating systemic therapies to decrease the risk of distant relapse, should be pursued in clinical trials.



http://ift.tt/2fyMo08

Incidence of facial nerve sacrifice in parotidectomy for primary and metastatic malignancies

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Brian Swendseid, Shawn Li, Jason Thuener, Rod Rezaee, Pierre Lavertu, Nicole Fowler, Chad Zender
IntroductionThe parotid gland may become involved by primary parotid malignancies and secondarily by metastases from other primary sites. Surgical resection of these tumors can be technically challenging due to the intimate relationship of the parotid gland and the facial nerve. The primary aim of this project was to determine the incidence of facial nerve sacrifice in parotidectomy for primary and secondary malignancies of the parotid.MethodsA retrospective chart review of was performed. Patients who received parotidectomy with final pathology consistent with a malignant neoplasm were included. The primary outcome studied was necessity for facial nerve sacrifice. Co-variates included preoperative facial nerve function, preoperative pain, superficial versus total parotidectomy and pathologic diagnosis. Univariate analysis was performed using student t-test to determine odds ratios.ResultsWe identified 75 patients who had a parotidectomy for a malignant process in our review. 30 patients had facial nerve sacrifice: 14 total and 16 partial sacrifices. Patients were more likely to require facial nerve sacrifice when they presented with preoperative facial nerve dysfunction [100% vs 19.6%, p=0.0006, OR 154.3, CI (8.66–2750.9)], pre-op pain [76.5% vs. 29.3%, p=0.001, OR 7.84, CI (2.23–27.50)], and required excision of both superficial and deep lobes of the parotid gland [64.9% vs 15.8%, p=0.0001, OR 9.85, CI (3.27–29.66)].ConclusionOur data illustrates that many patients with normal facial nerve function, even in the setting of malignancy, can have their facial nerve preserved. Pain, deep lobe involvement and preoperative facial nerve dysfunction are associated with an increased risk of needing at least partial facial nerve sacrifice in the setting of parotid gland malignancies.



http://ift.tt/2hRTbCN

Population Estimates, Health Care Characteristics, and Material Hardship Experiences of U.S. Children With Parent-Reported Speech-Language Difficulties: Evidence From Three Nationally Representative Surveys

Purpose

To provide estimates for the prevalence of parent-reported speech-language difficulties in U.S. children, and to describe the levels of health care access and material hardship in this population.

Method

We tabulated descriptive and bivariate statistics using cross-sectional data from the 2007 and 2011/2012 iterations of the National Survey of Children's Health, the 2005/2006 and 2009/2010 iterations of the National Survey of Children with Special Health Care Needs, and the 2004 and 2008 panels of the Survey of Income and Program Participation.

Results

Prevalence estimates ranged from 1.8% to 5.0%, with data from two of the three surveys preliminarily indicating increased prevalence in recent years. The largest health care challenge was in accessing care coordination, with 49%–56% of children with parent-reported speech-language difficulties lacking full access. Children with parent-reported speech-language difficulties were more likely than peers without any indications of speech-language difficulties to live in households experiencing each measured material hardship and participating in each measured public benefit program (e.g., 20%–22% experiencing food insecurity, compared to 11%–14% of their peers without any indications of speech-language difficulties).

Conclusions

We found mixed preliminary evidence to suggest that the prevalence of parent-reported speech-language difficulties among children may be rising. These children face heightened levels of material hardship and barriers in accessing health care.

http://article/doi/10.1044/2017_LSHSS-16-0072/2648977/Population-Estimates-Health-Care-Characteristics

'Minimum intervention' – MI inspiring future oral healthcare?

British Dental Journal 223, 133 (2017). doi:10.1038/sj.bdj.2017.644

Author: Avijit Banerjee

http://ift.tt/2hRdT5H

Everything you need in vibrant colours

British Dental Journal 223, 232 (2017). doi:10.1038/sj.bdj.2017.682

http://ift.tt/2hRLv3C

Primary dental care: Heresy, dam it!

British Dental Journal 223, 137 (2017). doi:10.1038/sj.bdj.2017.646

Author: R. Shamash

http://ift.tt/2hRe54Y

Minimum intervention children's dentistry – the starting point for a lifetime of oral health

British Dental Journal 223, 205 (2017). doi:10.1038/sj.bdj.2017.671

Authors: N. P. Innes & D. J. Manton

http://ift.tt/2hRdTCM

Dental history: Wartime dentists

British Dental Journal 223, 138 (2017). doi:10.1038/sj.bdj.2017.647

Author: P. Sherwin

http://ift.tt/2hRdLmM

Catch a glimpse of the future

British Dental Journal 223, 231 (2017). doi:10.1038/sj.bdj.2017.678

http://ift.tt/2hRdHn2

Occupational health: Accessing services

British Dental Journal 223, 138 (2017). doi:10.1038/sj.bdj.2017.648

Authors: R. McMullan, B. Hendron & M. Donaldson

http://ift.tt/2hRKyIy

Risk management: An upstream approach

British Dental Journal 223, 138 (2017). doi:10.1038/sj.bdj.2017.649

Author: R. Rattan

http://ift.tt/2hQYp1J

Increased levels of dissolved titanium are associated with peri-implantitis – a cross-sectional study

British Dental Journal 223, 203 (2017). doi:10.1038/sj.bdj.2017.669

http://ift.tt/2hRK8ls

Alternative sugars: Xylitol

British Dental Journal 223, 141 (2017). doi:10.1038/sj.bdj.2017.650

Elaine Gardner, British Dietetic Association (BDA) Spokesperson, presents part 1 in our brand new series of columns on sugar and sugar alternatives.

http://ift.tt/2hRK5pM

A guide to building 'MI' oral healthcare practice

British Dental Journal 223, 223 (2017). doi:10.1038/sj.bdj.2017.673

Authors: B. Dawett, B. Atkins & A. Banerjee

http://ift.tt/2hRJYdQ

CEREC: An open, complete CAD/CAM system with smart software

British Dental Journal 223, 230 (2017). doi:10.1038/sj.bdj.2017.689

http://ift.tt/2hQXVIX

Prolonged breastfeeding can cause caries

British Dental Journal 223, 142 (2017). doi:10.1038/sj.bdj.2017.652

http://ift.tt/2hR02wu

A toothbrush which looks as smart as it performs

British Dental Journal 223, 232 (2017). doi:10.1038/sj.bdj.2017.680

http://ift.tt/2hSdal3

BDJ Team now accepts manuscript submissions

British Dental Journal 223, 142 (2017). doi:10.1038/sj.bdj.2017.653

http://ift.tt/2wQ04qY

Safe cabinetry

British Dental Journal 223, 233 (2017). doi:10.1038/sj.bdj.2017.684

http://ift.tt/2wPPDUs

A Comparison of Two Endoscopic Posterior Cordotomy Techniques: Laser Cordotomy vs Diathermy Assisted Cordotomy

Abstract

Objectives

To compare respiratory function, swallowing and voice quality of bilateral abductor vocal fold paralysis (BAVFP) patients undergoing laser and diathermy assisted posterior cordotomy.

Design

Prospective study.

Setting

Tertiary academic hospital.

Participants

Thirty patients were included in the study (Group 1 and 2, 15 patients each). Mean age was 53±14.27 years with a range of 31-78 years (12 (40%) male, 18 (60%) female).

Main outcome measures

Sufficient airway, complications, FEV1, FEV1/FVC, PEF, voice quality VAS, fundamental frequency, jitter, shimmer, NHR, APQ and PPQ scores.

Results

A sufficient laryngeal airway was achieved in all patients. Six patients (20%) developed postoperative granulation tissue (two in group 1 and four in group 2).

There was a statistically significant improvement in FEV1, FEV1/FVC and PEF measurements at the postoperative sixth month compared to preoperative measurements in both of the groups (p<0.05).

Preoperative median voice quality VAS scores in groups 1 and 2 were 8 (IQR=1) and 8 (IQR=3) respectively. Postoperative sixth month voice quality VAS scores in groups 1 and 2 were 6 (IQR=1) and 6 (IQR=0) respectively. Postoperative VAS scores were significantly lower in both groups (p<0.05).

The postoperative changes in fundamental frequency, NHR, jitter, shimmer, APQ and PPQ were not statistically significant in both of the groups (p>0.05).

Conclusions

Laser and diathermy assisted posterior cordotomy are both minimaly invasive, effective techniques with a long-term sufficient laryngeal airway. Despite lower quality of voice VAS scores, objective acoustic outcomes were not significantly lower in both of the groups.

This article is protected by copyright. All rights reserved.

http://ift.tt/2vqdc8f

The SIGN 104 guideline (2014) for topical antibiotic prophylaxis during grommet insertion: misguided?

Abstract

We write to express both concern and surprise at the updated SIGN (Scottish Intercollegiate guidelines network) guideline 104 (2014) for antibiotic prophylaxis [1]. The original SIGN guideline 104 (2008)[2] recommended the use of a single dose of prophylactic topical antibiotic during grommet insertion based on 3 RCT's one of which showed no difference in outcome in the use of antibiotic and saline drops. Two of the 3 studies used Ciprofloxacin and Ofloxacin, neither of which is licensed for use in the United Kingdom.

This article is protected by copyright. All rights reserved.

http://ift.tt/2wAWTnH

Comparison of robotic and coblation tongue base resection for obstructive sleep apnea

Abstract

Objectives

To compare the efficacy and safety of transoral robotic surgery (TORS) with endoscope-guided coblation tongue base resection.

Design

Retrospective case-control study.

Setting

University-based tertiary care medical center.

Participants

OSA patients who underwent endoscope-guided tongue base coblation resection or TORS in combination with lateral pharyngoplasty at a single institution in South Korea between April 2013 and December 2016 were investigated. Forty-five patients who had moderate to severe OSA with tongue base collapse and a minimum follow-up period of 6 months with postoperative polysomnography (PSG) were enrolled in this study.

Main outcome measures

All patients underwent pre- and postoperative (at least 4 months after surgery) overnight PSG. Available information on results of the PSG, Epworth Sleepiness Scale, and complications of the TORS and coblation groups were compared.

Results

Postoperative PSG studies showed improved sleep quality for most patients. The mean postoperative apnea-hypopnea index (AHI) was reduced significantly from 45.0 to 17.0 events/h (p < 0.0001) in the TORS group and from 45.6 to 16.2 events/h (p < 0.0001) in the coblation group. The mean rates of improvement (AHI reduction > 50%) were 75.0% in TORS patients and 62.1% in coblation patients; the difference was not significant. Less frequent postoperative morbidity, including bleeding, taste dysfunction, and foreign body sensation, were recorded in TORS patients.

Conclusions

Both the coblation and TORS groups showed similar surgical outcomes, TORS achieved PSG results non-inferior to and complication rates comparable to coblation.

This article is protected by copyright. All rights reserved.

http://ift.tt/2vq26A5

A Comparison of Two Endoscopic Posterior Cordotomy Techniques: Laser Cordotomy vs Diathermy Assisted Cordotomy

Abstract

Objectives

To compare respiratory function, swallowing and voice quality of bilateral abductor vocal fold paralysis (BAVFP) patients undergoing laser and diathermy assisted posterior cordotomy.

Design

Prospective study.

Setting

Tertiary academic hospital.

Participants

Thirty patients were included in the study (Group 1 and 2, 15 patients each). Mean age was 53±14.27 years with a range of 31-78 years (12 (40%) male, 18 (60%) female).

Main outcome measures

Sufficient airway, complications, FEV1, FEV1/FVC, PEF, voice quality VAS, fundamental frequency, jitter, shimmer, NHR, APQ and PPQ scores.

Results

A sufficient laryngeal airway was achieved in all patients. Six patients (20%) developed postoperative granulation tissue (two in group 1 and four in group 2).

There was a statistically significant improvement in FEV1, FEV1/FVC and PEF measurements at the postoperative sixth month compared to preoperative measurements in both of the groups (p<0.05).

Preoperative median voice quality VAS scores in groups 1 and 2 were 8 (IQR=1) and 8 (IQR=3) respectively. Postoperative sixth month voice quality VAS scores in groups 1 and 2 were 6 (IQR=1) and 6 (IQR=0) respectively. Postoperative VAS scores were significantly lower in both groups (p<0.05).

The postoperative changes in fundamental frequency, NHR, jitter, shimmer, APQ and PPQ were not statistically significant in both of the groups (p>0.05).

Conclusions

Laser and diathermy assisted posterior cordotomy are both minimaly invasive, effective techniques with a long-term sufficient laryngeal airway. Despite lower quality of voice VAS scores, objective acoustic outcomes were not significantly lower in both of the groups.

This article is protected by copyright. All rights reserved.

http://ift.tt/2vqdc8f

The SIGN 104 guideline (2014) for topical antibiotic prophylaxis during grommet insertion: misguided?

Abstract

We write to express both concern and surprise at the updated SIGN (Scottish Intercollegiate guidelines network) guideline 104 (2014) for antibiotic prophylaxis [1]. The original SIGN guideline 104 (2008)[2] recommended the use of a single dose of prophylactic topical antibiotic during grommet insertion based on 3 RCT's one of which showed no difference in outcome in the use of antibiotic and saline drops. Two of the 3 studies used Ciprofloxacin and Ofloxacin, neither of which is licensed for use in the United Kingdom.

This article is protected by copyright. All rights reserved.

http://ift.tt/2wAWTnH

Comparison of robotic and coblation tongue base resection for obstructive sleep apnea

Abstract

Objectives

To compare the efficacy and safety of transoral robotic surgery (TORS) with endoscope-guided coblation tongue base resection.

Design

Retrospective case-control study.

Setting

University-based tertiary care medical center.

Participants

OSA patients who underwent endoscope-guided tongue base coblation resection or TORS in combination with lateral pharyngoplasty at a single institution in South Korea between April 2013 and December 2016 were investigated. Forty-five patients who had moderate to severe OSA with tongue base collapse and a minimum follow-up period of 6 months with postoperative polysomnography (PSG) were enrolled in this study.

Main outcome measures

All patients underwent pre- and postoperative (at least 4 months after surgery) overnight PSG. Available information on results of the PSG, Epworth Sleepiness Scale, and complications of the TORS and coblation groups were compared.

Results

Postoperative PSG studies showed improved sleep quality for most patients. The mean postoperative apnea-hypopnea index (AHI) was reduced significantly from 45.0 to 17.0 events/h (p < 0.0001) in the TORS group and from 45.6 to 16.2 events/h (p < 0.0001) in the coblation group. The mean rates of improvement (AHI reduction > 50%) were 75.0% in TORS patients and 62.1% in coblation patients; the difference was not significant. Less frequent postoperative morbidity, including bleeding, taste dysfunction, and foreign body sensation, were recorded in TORS patients.

Conclusions

Both the coblation and TORS groups showed similar surgical outcomes, TORS achieved PSG results non-inferior to and complication rates comparable to coblation.

This article is protected by copyright. All rights reserved.

http://ift.tt/2vq26A5

Epithelioid Malignant Mesothelioma Metastatic to the Skin: A Case Report and Review of the Literature

Mesothelioma is a rare form of cancer arising from a monolayer of mesothelial cells that form the lining of the internal body cavities and organs, with the vast majority of cases arising from the pleura (65-80%), less commonly from the peritoneum (10-30%), and rarely from the pericardium and tunica vaginalis testis (1-2%).

http://ift.tt/2vXek4b

Immunohistochemistry reveals an increased proportion of MYC-positive cells in subcutaneous panniculitis-like T-cell lymphoma compared with lupus panniculitis

Background

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a malignant primary cutaneous T-cell lymphoma that shares significant clinical, histopathologic, and immunophenotypic overlap with lupus erythematosus panniculitis (LEP).

Methods

We performed immunohistochemistry for the MYC oncoprotein on 23 cases of SPTCL (one CD8 negative) and 12 cases of LEP to evaluate if there are quantitative or qualitative differences in protein expression of this marker in these entities.

Results

In SPTCL cases, the percentage of all cells that were c-Myc positive ranged from 0.8% to 16%, with a mean of 5.0% and a median of 4.4%. In contrast, in the LEP cases, the percentage of c-Myc positive cells in the cases ranged from 0.34% to 3.7%, averaged 1.4%, and the median was 0.8%. The difference between the means of these two diagnostic categories was statistically significant. Fluorescence in situ hybridization performed on 4 cases of SPTCL with a relatively high level of MYC immunohistochemical staining, however, failed to demonstrate evidence of MYC rearrangement or amplification.

Conclusions

Our work demonstrates that MYC expression levels differ between these two histologic mimics and suggests that this important oncoprotein may play a role in the pathogenesis of SPTCL.

http://ift.tt/2uxzqm1

Metabolic Dysfunction in Parkinson’s Disease: Bioenergetics, Redox Homeostasis and Central Carbon Metabolism

Publication date: July 2017
Source:Brain Research Bulletin, Volume 133
Author(s): Annadurai Anandhan, Maria S. Jacome, Shulei Lei, Pablo Hernandez-Franco, Aglaia Pappa, Mihalis I. Panayiotidis, Robert Powers, Rodrigo Franco
The loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc) and the accumulation of protein inclusions (Lewy bodies) are the pathological hallmarks of Parkinson's disease (PD). PD is triggered by genetic alterations, environmental/occupational exposures and aging. However, the exact molecular mechanisms linking these PD risk factors to neuronal dysfunction are still unclear. Alterations in redox homeostasis and bioenergetics (energy failure) are thought to be central components of neurodegeneration that contribute to the impairment of important homeostatic processes in dopaminergic cells such as protein quality control mechanisms, neurotransmitter release/metabolism, axonal transport of vesicles and cell survival. Importantly, both bioenergetics and redox homeostasis are coupled to neuro-glial central carbon metabolism. We and others have recently established a link between the alterations in central carbon metabolism induced by PD risk factors, redox homeostasis and bioenergetics and their contribution to the survival/death of dopaminergic cells. In this review, we focus on the link between metabolic dysfunction, energy failure and redox imbalance in PD, making an emphasis in the contribution of central carbon (glucose) metabolism. The evidence summarized here strongly supports the consideration of PD as a disorder of cell metabolism.



http://ift.tt/2vM0TEs

IFC (Ed. Board)

Publication date: July 2017
Source:Brain Research Bulletin, Volume 133





http://ift.tt/2vucaGA

PERK as a hub of multiple pathogenic pathways leading to memory deficits and neurodegeneration in Alzheimer’s disease

Publication date: Available online 10 August 2017
Source:Brain Research Bulletin
Author(s): Masuo Ohno
Cell signaling in response to an array of diverse stress stimuli converges on the phosphorylation of eukaryotic initiation factor-2α (eIF2α). In the brain, eIF2α is a hub for controlling learning and memory function and for maintaining neuronal integrity in health and disease. Among four eIF2α kinases, PERK is emerging as a key regulator for memory impairments and neurodegeneration in Alzheimer's disease (AD). Genetic and pharmacological manipulations of PERK-eIF2α signaling have revealed that the overactivation of this pathway is not a mere consequence of the neurodegenerative process but play critical roles in AD pathogenesis and the occurrence of memory deficits. This review provides an overview of recent progress in animal model studies, which demonstrate that dysregulated PERK accounts for memory deficits and neurodegeneration not only as a detrimental mediator downstream of β-amyloidosis and tauopathy but also as an important regulator upstream of both pathogenic mechanisms in AD. A therapeutic perspective is also discussed, in which interventions targeting the PERK-eIF2α pathway are expected to provide multiple beneficial outcomes in AD, including enhanced mnemonic function, neuroprotection and disease modification.



http://ift.tt/2vMkZhL

Vertical distribution of soil extractable organic C and N contents and total C and N stocks in 78-year-old tree plantations in subtropical Australia

Abstract

Few studies have focused on the effects of long-term forest plantations on the soil profile of carbon (C) and nitrogen (N) stocks. In this study, we selected 78-year-old tree plantations that included three coniferous tree species (i.e., slash pine, hoop pine and kauri pine) and a Eucalyptus species in subtropical Australia. We measured soil extractable organic C (EOC) and N (EON) contents and total C and N stocks under different tree species on the forest floor and along a soil profile to 100 cm depth. The results showed that Eucalyptus had significantly higher soil EOC contents (3.3 Mg ha⁻¹) than the other tree species (EOC of 1.9–2.3 Mg ha⁻¹) and had significantly higher EON (156 kg ha⁻¹) contents than slash pine (107 kg ha⁻¹). Eucalyptus had significantly higher soil C (58.9 Mg ha⁻¹) and N (2.03 Mg ha⁻¹) stocks than the other tree species (22.3–27.6 Mg C ha⁻¹ and 0.71–1.23 Mg N ha⁻¹) at 0–100 cm depth. There were no differences in soil C stocks at the 0–100 cm depth among the coniferous tree species. Forest floor C stocks had stronger effects on mineral soil total N stocks than fine root biomass, whereas fine root biomass exerted stronger effects on soil total C stocks at the 0–100 cm depth than forest floor C and N stocks. Our results addressed large differences in soil C and N stocks under different tree species, which can provide useful information for local forest management practices in this region.

http://ift.tt/2fymxFr

Unresectable squamous cell carcinoma of upper trachea with long-term survival after concurrent chemoradiotherapy

Upper tracheal malignancies are rare, and long-term survival is even rarer, especially among the unresectable malignancies. A 66-year-old chronic smoker was diagnosed as a locally advanced, non-metastatic squamous cell carcinoma of the upper trachea. Being unresectable, he was treated with six cycles of concurrent weekly cisplatin and three-dimensional conformal radiotherapy to a dose of 60 Gy in 30 fractions over 6 weeks. Follow-up imaging at 6 and 12 months revealed no disease. Our patient is presently 36 months post-treatment and is disease free without tracheal necrosis, fistula or radiation pneumonitis but developed hypothyroidism and is presently euthyroid. Concurrent chemoradiotherapy appears safe up to 3 years at least without any necrosis and is effective in controlling local disease. Meticulous planning obviates the need for higher technology like motion management techniques or intensity-modulated radiotherapy.

http://ift.tt/2vpm9P8

Paraneoplastic mucous membrane pemphigoid with ocular and laryngeal involvement

A 73-year-old woman was treated 8 years previously for synchronous breast and uterine neoplasms. She presented with a severe sore throat, odynophagia, dysphonia, dyspnoea, ocular irritation and weight loss over the last 3 months. Physical examination revealed ulcerations in the oral cavity, posterior pharyngeal wall and supraglottic larynx, nasal crusting, bilateral conjunctivitis and three cutaneous blisters. A diagnosis of anti-laminin 5 mucous membrane pemphigoid was retained, based on skin biopsy, direct immunofluorescence and immunoprecipitation. A positron emission tomography (PET)-CT detected multiple adenopathies. Cytology revealed adenocarcinoma with an immunocytology compatible with a breast origin and this was considered as a late metastatic recurrence of her previous breast cancer. A treatment of prednisone, dapsone and hormonotherapy was introduced, but intravenous immunoglobulin and rituximab were added due to new mucosal lesions. Despite treatment, a posterior laryngeal scar and bilateral symblepharon were developed. After 3 years, the patient is still alive and reports a satisfactory quality of life.

http://ift.tt/2wBeX0P

Isolated intraductal variant of hepatocellular carcinoma

Description

A 70-year-old male teetotaller, with a history of chronic obstructive lung disease and hypertension, presented to the emergency department with a 2-day history of right upper quadrant pain and melaena. Investigations revealed total bilirubin 6.8 mg/dL, aspartate and alanine transaminases 88 and 122 IU/L, respectively, alkaline phosphatase 338 IU/L and gamma-glutamyl transpeptidase 223 IU/L. Tests for chronic hepatitis B, hepatitis C and HIV were negative. Serum alpha-fetoprotein was 22.8 ng/mL, whereas carcino-embryonic antigen (CEA), CA 19–9, prostate specific antigen and chromogranin levels were normal. Contrast CT of the abdomen revealed fatty liver with moderate dilation of bilateral intrahepatic biliary radicles (figure 1A) and dilated common bile duct (CBD) with hyperdense contents, without identifiable mass lesions in the liver or biliary tree. Upper gastrointestinal endoscopy revealed haemobilia, and cholangiogram showed normal calibre CBD with filling defects. Endoscopic intraductal ultrasound revealed focal thickening of segment three hepatic duct, and Spyglass cholangioscopy confirmed a...

http://ift.tt/2vqbZho

Bilateral painful tic convulsif

'Painful tic convulsif' (PTC) describes the coexistence of hemifacial spasm and trigeminal neuralgia. In this report, we describe a unique presentation of bilateral PTC in a man with bilateral hemifacial spasm and trigeminal neuralgia secondary to neurovascular conflict of all four cranial nerves. Following failed medical and radiofrequency therapy, microvascular decompression of three of the four involved nerves was performed, where the offending vessels were mobilised and Teflon used to prevent conflict recurrence. He continues to respond to Botox for right hemifacial spasm. Since surgery, he remains pain free bilaterally and spasm free on the left.

http://ift.tt/2wAWS39

Lenalidomide-associated arterial thrombosis in a patient with JAK2 positive atypical myeloproliferative neoplasm

Description

A 71-year-old woman, with a recent diagnosis of JAK2 positive atypical myeloproliferative neoplasm, presented to the emergency room (ER) for bilateral foot pain and purplish discolouration of her toes (figure 1). She started her first cancer treatment 3 weeks ago using lenalidomide with prednisone 20 mg daily. Venous thromboprophylaxis was not prescribed then due to anaemia and history of intracranial haemorrhage. ER work up included simple X-rays of her feet that were normal. Lower extremity ultrasound did not show any deep vein thrombosis, so she was discharged home. The patient did not have atrial fibrillation or hyperviscosity. No history of arterial thrombosis or smoking. Two weeks later, she was re-evaluated by her haematologist, and a hospital admission was arranged given worsening symptoms. Her physical exam now showed the purplish discolouration has progressed over both feet, associated with some toes turning black (figure 2). She had strong lower extremity...

http://ift.tt/2vpWx4F

Right hepatic artery 'caterpillar hump and dual cystic arteries: relevance of critical view of safety in a 'straightforward cholecystectomy

Description

A 60-year-old woman with unremarkable medical history, underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis. A four-port technique was performed. Initial exploration of Calot's triangle was carried out by upward traction of the fundus and lateral retraction of the Hartmann's pouch; after dissection of the peritoneum medially at the level of the infundibulum, two tubular structures entering the gallbladder were visible, as usually expected. However, to obtain a 'critical view of safety',1 dissection was continued by opening up the lateral aspect of the peritoneum; hepatobiliary triangle was dissected free of areolar tissue and the bottom of the gallbladder was dissected off the lower part of the liver bed. At this stage, an anatomical variation became evident (figure 1): the right hepatic artery made a 'caterpillar-like' loop inside Calot's triangle and two short cystic arteries reached the gallbladder. According to a recent review, among clinically...

http://ift.tt/2wAV0Y6

Therapeutic options for bleeding oesophageal varices: cyanoacrylate and balloon-occluded retrograde obliteration (BRTO)

A 56-year-old male with cirrhosis presented with acute bleeding from cardiofundal gastroesophageal varices (GOV) and was treated with endoscopic cyanoacrylate glue. Glue therapy achieved stabilisation of the patient in the emergent setting. Three months later, the patient suffered rebleeding. At that time, he underwent retreatment with balloon-occluded retrograde obliteration (BRTO), with no recurrence at a follow-up of 14 months.

Available treatments for bleeding GOV include methods to (a) directly obstruct the varices (endoscopic variceal ligation , sclerotherapy and cyanoacrylate glue, BRTO) or to (b) decrease portal pressure (surgical portacaval shunts; transportal intrahepatic portosystemic shunt). No precise guidelines are available regarding when to use which modality, and few centres have experience with all of them. This case report illustrates a setting in which both options of cyanoacrylate glue therapy and BRTO were used for acute gastric variceal bleeding.

http://ift.tt/2vqpP3q