Immunological classification of renal cell carcinoma patients based on phenotypic analysis of immune check-point molecules

Abstract

Objectives

To clarify comprehensive immunological signature patterns of tumour tissue-infiltrating lymphocytes in patients with renal cell carcinoma and show its clinical significance.

Materials and methods

We investigated the surface marker expressions of tumour tissue-infiltrating lymphocytes quantitatively and classified them based on their functional populations. We extracted 109 sets of tumour tissue-infiltrating lymphocytes from 80 patients who underwent surgical resection of renal cell carcinoma, of which 44 tumour tissue-infiltrating lymphocytes were multiply extracted from 15 patients. Each tumour tissue-infiltrating lymphocyte was characterised on the basis of functional T-cell populations using ten surface marker expressions measured by flow cytometry.

Results

All sets of the tumour tissue-infiltrating lymphocytes were classified into three groups, which correlated significantly with Fuhrman grade (OR 0.253, 95% CI 0.094–0.678, P = 0.006). Importantly, both overall metastasis-free survival (HR 0.449, 95% CI 0.243–0.832, P = 0.011) and recurrence-free survival (HR 0.475, 95% CI 0.238–0.948, P = 0.035) of the patients with the higher marker expressions were significantly inferior to those of the patients with the lower marker expressions by multivariate analysis. Six specific genes for this classification identified by microarray analysis verified our results using the TCGA KIRC data set. In addition, we discovered the presence of intra-tumoural diversity in the classification of 3 (20%) of the 15 patients.

Conclusions

This study showed that the presence of classable diversity in the immunological signature of tumour tissue-infiltrating lymphocytes correlated with prognosis and tumour aggressiveness that was observed even within individual tumours in some patients with renal cell carcinoma.

http://ift.tt/2kj7j9s

Abnormal Structural Brain Connectome in Individuals with Preclinical Alzheimer’s Disease

Abstract

Alzheimer's disease has a long preclinical phase during which amyloid pathology and neurodegeneration accumulate in the brain without producing overt cognitive deficits. It is currently unclear whether these early disease stages are associated with a progressive disruption in the communication between brain regions that subsequently leads to cognitive decline and dementia. In this study we assessed the organization of structural networks in cognitively normal (CN) individuals harboring amyloid pathology (A+N−), neurodegeneration (A−N+), or both (A+N+) from the prospective and longitudinal Swedish BioFINDER study. We combined graph theory with diffusion tensor imaging to investigate integration, segregation, and centrality measures in the brain connectome in the previous groups. At baseline, our findings revealed a disrupted network topology characterized by longer paths, lower efficiency, increased clustering and modularity in CN A−N+ and CN A+N+, but not in CN A+N−. After 2 years, CN A+N+ showed significant abnormalities in all global network measures, whereas CN A−N+ only showed abnormalities in the global efficiency. Network connectivity and organization were associated with memory in CN A+N+ individuals. Altogether, our findings suggest that amyloid pathology is not sufficient to disrupt structural network topology, whereas neurodegeneration is.

http://ift.tt/2fFYWzw

Intraoperative naloxone reduces remifentanil-induced postoperative hyperalgesia but not pain: a randomized controlled trial

Abstract

Background

Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone.

Methods

Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml⁻¹ remifentanil with 0.05 μg kg⁻¹ h⁻¹ naloxone in the high-remifentanil with naloxone group, and 4 or 1 ng ml⁻¹ remifentanil with a placebo in the high- or low-remifentanil groups, respectively. We measured the pain thresholds (primary outcome) to mechanical stimuli using von Frey filaments and incidence of hyperalgesia on the peri-incisional area 24 h after surgery. We also measured pain intensity, analgesic consumptions and adverse events up to 48 h after surgery.

Results

The pain threshold presented as von Frey numbers [median (interquartile range)] was significantly lower in the high-remifentanil group (n=31) than in the high-remifentanil with naloxone (n=30) and the low-remifentanil (n=30) groups [3.63 (3.22–3.84) vs 3.84 (3.76–4.00) vs 3.80 (3.69–4.08), P=0.011]. The incidence of hyperalgesia was also higher in the high-remifentanil group than in the other groups [21/31 vs 10/30 vs 9/30, P=0.005]. Postoperative pain intensity, analgesic consumptions and adverse events were similar between groups.

Conclusions

The intraoperative use of low-dose naloxone combined with high-dose remifentanil reduced postoperative hyperalgesia but not pain.

Clinical trial registration

NCT02856087.

http://ift.tt/2xbFMwE

Intraoperative naloxone reduces remifentanil-induced postoperative hyperalgesia but not pain: a randomized controlled trial

Abstract

Background

Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone.

Methods

Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml⁻¹ remifentanil with 0.05 μg kg⁻¹ h⁻¹ naloxone in the high-remifentanil with naloxone group, and 4 or 1 ng ml⁻¹ remifentanil with a placebo in the high- or low-remifentanil groups, respectively. We measured the pain thresholds (primary outcome) to mechanical stimuli using von Frey filaments and incidence of hyperalgesia on the peri-incisional area 24 h after surgery. We also measured pain intensity, analgesic consumptions and adverse events up to 48 h after surgery.

Results

The pain threshold presented as von Frey numbers [median (interquartile range)] was significantly lower in the high-remifentanil group (n=31) than in the high-remifentanil with naloxone (n=30) and the low-remifentanil (n=30) groups [3.63 (3.22–3.84) vs 3.84 (3.76–4.00) vs 3.80 (3.69–4.08), P=0.011]. The incidence of hyperalgesia was also higher in the high-remifentanil group than in the other groups [21/31 vs 10/30 vs 9/30, P=0.005]. Postoperative pain intensity, analgesic consumptions and adverse events were similar between groups.

Conclusions

The intraoperative use of low-dose naloxone combined with high-dose remifentanil reduced postoperative hyperalgesia but not pain.

Clinical trial registration

NCT02856087.

http://ift.tt/2xbFMwE

Biochemical and histopathological changes of subacute cadmium intoxication in male rats

Abstract

Biochemical and histopathological effects of subacute intoxication of rats with cadmium (Cd) were studied in rats. Twenty adult healthy male albino rats were randomly divided into two duplicate groups (five rats in each cage); (1) control group where rats were provided with standard diet and water ad-libitum, (2) Cd group where rats were subjected to freshly prepared Cd chloride solution (CdCl2) 200 mg/l in drinking water daily for 8 weeks, the whole duration of experiment. Blood samples were obtained after 4 weeks, via retro-orbital bleeding for separation of serum. Five rats were killed, each sacrifice by decapitation for collection of kidneys and heart. Disturbed renal and cardiac functions were achieved after 4 weeks as indicated by the increase of most biochemical parameters measured in the serum, renal, and cardiac tissues. Histopathological examination of kidneys and hearts showed pathological alterations in Cd-intoxicated rats after 4 and 8 weeks with hematoxylin and eosin (H&E) and Masson trichrome stains. It was concluded that subacute exposure of rats to Cd (200 mg/l) in drinking water daily induced glomerular shrinkage, focal renal, and cardiac fibrosis at 4 and 8 weeks.

http://ift.tt/2fMHkpu

Effect of the 5α-reductase enzyme inhibitor dutasteride in the brain of intact and parkinsonian mice

Publication date: Available online 2 October 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Nadhir Litim, Marc Morissette, Donatella Caruso, Roberto C. Melcangi, Thérèse Di Paolo
Dutasteride is a 5alpha-reductase inhibitor in clinical use to treat endocrine conditions. The present study investigated the neuroprotective mechanisms of action of dutasteride in intact and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-lesioned mice using a low dose of MPTP not affecting motor activity modeling early stages of Parkinson's disease (PD). We hypothesized that dutasteride neuroprotection is due to altered steroids levels. Dutasteride pre-treatment prevented loss of striatal dopamine (DA) and its metabolite DOPAC. Dutasteride decreased effects of MPTP on striatal dopamine transporter (DAT), vesicular monoamine transporter 2 (VMAT2) and D2 DA receptor specific binding while D1 receptor specific binding remained unchanged. Dutasteride enhanced DAT specific binding and the glycosylated form of DAT in intact mice. MPTP-lesioned mice had plasma and brain testosterone and dihydrotestosterone levels lower than control mice whereas progesterone and its metabolites (dihydroprogesterone, isopregnanolone and tetrahydroprogesterone) pathway showed increases. Dutasteride treatment by inhibiting transformation of progesterone and testosterone to its metabolites elevated plasma and brain concentrations of testosterone compared to MPTP mice and decreased DHT levels in intact mice. Plasma and brain estradiol levels were low and remained unchanged by MPTP and/or dutasteride treatment. Dutasteride treatment did not affect striatal phosphorylation of Akt and its downstream substrate GSK3β as well as phosphorylation of ERK1/2 in intact and MPTP lesioned MPTP mice. Striatal glial fibrillary acidic protein (GFAP) levels were markedly elevated in MPTP compared to control mice and dutasteride reduced GFAP levels in MPTP mice. Treatment with dutasteride post-lesion left unchanged striatal DA levels. These results suggest dutasteride as promising drug for PD neuroprotection.

Graphical abstract

http://ift.tt/2xQz2S4

Yield-scaled N2O emissions were effectively reduced by biochar amendment of sandy loam soil under maize - wheat rotation in the North China Plain

Publication date: December 2017
Source:Atmospheric Environment, Volume 170
Author(s): Yuhui Niu, Zengming Chen, Christoph Müller, Monhammad M. Zaman, Donggill Kim, Hongyan Yu, Weixin Ding
It is increasingly recognized that the addition of biochar to soil has potential to mitigate climate change and increase soil fertility by enhancing carbon (C) storage. However, the effect of biochar on yield and nitrous oxide (N2O) emissions from upland fields remains unclear. In this study, a one-year field experiment was conducted in an area of calcareous fluvo-aquic soil to assess and quantify the effect of maize straw biochar in reducing N2O loss during 2014–2015 in the North China Plain. Eight treatments were designed as follows: no nitrogen (N) fertilizer (control, CK); biochar application at rates of 3 (B3), 6 (B6) and 12 (B12) t ha⁻¹; chemical fertilizer (NPK) application at 200 kg N ha⁻¹ (F); and fertilizer plus biochar application at rates of 3 (FB3), 6 (FB6) and 12 (FB12) t ha⁻¹. Crop yield, N2O fluxes, soil mineral N concentrations, and soil auxiliary parameters were measured following the application of treatments during each season. During the maize growing season, N2O emission was 0.57 kg N2O-N ha⁻¹ under CK treatment, and increased to 0.88, 0.93 and 1.10 kg N2O-N ha⁻¹ under B3, B6 and B12, respectively. In contrast, N2O emissions were significantly reduced by 31.4–39.9% (P < 0.05) under FB treatments compared with F, and the N2O emission factor of the applied N was reduced from 1.36% under F to 0.71–0.85% under FB. There was also a significant interaction effect of fertilizer and biochar on N2O emissions (P < 0.01). During the wheat growing season, biochar had no effect on N2O emissions regardless of the fertilizer regime. Biochar application did not affect maize yield; however, a significant increase in wheat yield of 16.6–25.9% (P < 0.05) was observed without N fertilization. Nevertheless, a reduction in wheat yield was measured at a biochar rate of 12 t ha⁻¹ with fertilization. Overall, under maize cropping, N2O emissions per unit yield of grain, biomass, grain N and biomass N (yield-scaled N2O emissions) were significantly reduced by 32.4–39.9% under FB compared with F treatment, regardless of the biochar application rate. Biochar did not affect yield-scaled N2O emissions in wheat. Decreased soil bulk density with biochar is suggested to reduce the denitrification potential and N2O emissions; while increased retention capacity of fertilizer N in biochar-added soil decreased wheat growth and yield. These findings suggest that N fertilization plus biochar application at 3 t ha⁻¹ is a practical strategy for reducing yield-scaled N2O emissions from maize fields in the North China Plain.

Graphical abstract

http://ift.tt/2xUloyS

Carbon dioxide emissions from lakes and reservoirs of China: A regional estimate based on the calculated pCO2

Publication date: December 2017
Source:Atmospheric Environment, Volume 170
Author(s): Zhidan Wen, Kaishan Song, Yingxin Shang, Chong Fang, Lin Li, Lili Lv, Xianguo Lv, Lijiang Chen
The role of inland water in CO2 exchange with the atmosphere was evaluated on the basis of calculated partial pressure of CO2 (pCO2) from sampling of 207 lakes and 84 reservoirs across China in late summer. The results suggested that almost 60% of these water bodies were supersaturated with CO2 with respect to atmosphere, and the collected reservoirs samples exhibited higher mean pCO2 than lakes. The mean pCO2 in fresh water lakes was about 3.5 times of the value in saline lakes. The lakes and reservoirs were divided into five groups (Inner Mongolia -Xinjiang plateau region, Tibetan Plateau region, Northeastern plain and mountainous region, Yunnan- Guizhou Plateau region, and Eastern plain region). The Yunnan- Guizhou Plateau region showed the highest pCO2 compared with other regions, most likely due to the typical karst landforms, karst processes may promote aqueous CO2 concentration, and karstification has a significant effect on the capture of atmospheric CO2. Inner Mongolia-Xinjiang plateau and Tibetan Plateau region reserviors showed negative CO2 flux to atmosphere, other waters in this study all supersaturated with CO2 with respect to the atmosphere. A which We analyzed the relationship between pCO2 and environmental variables, and results showed that some indicators had correlations with pCO2 in individual region such as total phosphorus, dissolved organic matter, and total suspended solids, but the relationship could not be observed with all surveyed waters. This indicated that it might be much more effective in a smaller regional scale than the broadened scale when the environmental factors were used as the predictor of pCO2 in lakes. Therefore, the common algorithm that extrapolates CO2 concentration or emission flux from the study region to a wider scale might not be accurate because of the changes in the environmental and water quality conditions.



http://ift.tt/2xUaoSf

Assessment of long-term and large-scale even-odd license plate controlled plan effects on urban air quality and its implication

Publication date: December 2017
Source:Atmospheric Environment, Volume 170
Author(s): Suping Zhao, Ye Yu, Dahe Qin, Daiying Yin, Jianjun He
To solve traffic congestion and to improve urban air quality, long-lasting and large-scale even-odd license plate controlled plan was implemented by local government during 20 November to 26 December 2016 in urban Lanzhou, a semi-arid valley city of northwest China. The traffic control measures provided an invaluable opportunity to evaluate its effects on urban air quality in less developed cities of northwest China. Based on measured simultaneously air pollutants and meteorological parameters, the abatement of traffic-related pollutants induced by the implemented control measures such as CO, PM2.5 and PM10 (the particulate matter with diameter less than 2.5 μm and 10 μm) concentrations were firstly quantified by comparing the air quality data in urban areas with those in rural areas (uncontrolled zones). The concentrations of CO, NO2 from motor vehicles and fine particulate matter (PM2.5) were shown to have significant decreases of 15%–23% during traffic control period from those measured before control period with hourly maximum CO, PM2.5, and NO2/SO2 reduction of 43%, 35% and 141.4%, respectively. The influence of the control measures on AQI (air quality index) and ozone was less as compared to its effect on other air pollutants. Therefore, to alleviate serious winter haze pollution in China and to protect human health, the stringent long-term and large-scale even-odd license plate controlled plan should be implemented aperiodically in urban areas, especially for the periods with poor diffusion conditions.



http://ift.tt/2yU47nY

Food in synchrony with melatonin and corticosterone relieves constant light disturbed metabolism

Circadian disruption is associated with metabolic disturbances such as hepatic steatosis (HS), obesity and type 2 diabetes. We hypothesized that HS, resulting from constant light (LL) exposure is due to an inconsistency between signals related to food intake and endocrine-driven suprachiasmatic nucleus (SCN) outputs. Indeed, exposing rats to LL induced locomotor, food intake and hormone arrhythmicity together with the development of HS. We investigated whether providing temporal signals such as 12-h food availability or driving a corticosterone plus melatonin rhythm could restore rhythmicity and prevent the metabolic disturbances under LL conditions in male rats. Discrete metabolic improvements under these separate treatments stimulated us to investigate whether the combination of hormone treatment together with mealtime restriction (12-h food during four weeks) could prevent the metabolic alterations. LL exposed arrhythmic rats, received daily administration of corticosterone (2.5 µg/kg) and melatonin (2.5 mg/kg) in synchrony or out of synchrony with their 12-h meal. HS and other metabolic alterations were importantly ameliorated in LL-exposed rats receiving hormonal treatment in synchrony with 12-h restricted mealtime, while treatment out of phase with meal time did not. Interestingly, liver bile acids, a major indication for HS, were only normalized when animals received hormones in synchrony with food indicating that disrupted bile acid metabolism might be an important mechanism for the HS induction under LL conditions. We conclude that food-elicited signals, as well as hormonal signals, are necessary for liver synchronization and that HS arises when there is conflict between food intake and the normal pattern of melatonin and corticosterone.

http://ift.tt/2g5lp9V

Eplerenone prevented obesity-induced inflammasome activation and glucose intolerance

Obesity-associated activation of the renin-angiotensin-aldosterone system is implicated in the pathogenesis of insulin resistance; however, influences of mineralocorticoid receptor (MR) inhibition remain unclear. Therefore, we aimed to clarify the anti-inflammatory mechanisms of MR inhibition using eplerenone, a selective MR antagonist, in C57BL/6 mice fed a high-fat diet (HFD) for 12 weeks. Eplerenone prevented excessive body weight gain and fat accumulation, ameliorated glucose intolerance and insulin resistance and enhanced energy metabolism. In the epididymal white adipose tissue (eWAT), eplerenone prevented obesity-induced accumulation of F4/80⁺CD11c⁺CD206^–-M1-adipose tissue macrophage (ATM) and reduction of F4/80⁺CD11c^–CD206⁺-M2-ATM. Interestingly, M1-macrophage exhibited lower expression levels of MR, compared with M2-macrophage, in the ATM of eWAT and in vitro-polarized bone marrow-derived macrophages (BMDM). Importantly, eplerenone and MR knockdown attenuated the increase in the expression levels of proIl1b, Il6 and Tnfa, in the eWAT and liver of HFD-fed mice and LPS-stimulated BMDM. Moreover, eplerenone suppressed IL1b secretion from eWAT of HFD-fed mice. To reveal the anti-inflammatory mechanism, we investigated the involvement of NLRP3-inflammasome activation, a key process of IL1b overproduction. Eplerenone suppressed the expression of the inflammasome components, Nlrp3 and Caspase1, in the eWAT and liver. Concerning the second triggering factors, ROS production and ATP- and nigericin-induced IL1b secretion were suppressed by eplerenone in the LPS-primed BMDM. These results indicate that eplerenone inhibited both the priming and triggering signals that promote NLRP3-inflammasome activation. Therefore, we consider MR to be a crucial target to prevent metabolic disorders by suppressing inflammasome-mediated chronic inflammation in the adipose tissue and liver under obese conditions.

http://ift.tt/2wtVz5B

Role of in-situ simulation for training in healthcare: opportunities and challenges.

Purpose of review: Simulation has now been acknowledged as an important part of training in healthcare, and most academic hospitals have a dedicated simulation center. In-situ simulation occurs in patient care units with scenarios involving healthcare professionals in their actual working environment. The purpose of this review is to describe the process of putting together the components of in-situ simulation for training programs and to review outcomes studied, and challenges with this approach. Recent findings: In-situ simulation has been used to 'test-drive' new centers, train personnel in new procedures in existing centers, for recertification training and to uncover latent threats in clinical care areas. It has also emerged as an attractive alternative to traditional simulations for institutions that do not have their own simulation center. Summary: In-situ simulation can be used to improve reliability and safety especially in areas of high risk, and in high-stress environments. It is also a reasonable and attractive alternative for programs that want to conduct interdisciplinary simulations for their trainees and faculty, and for those who do not have access to a fully functional simulation center. Further research needs to be done in assessing effectiveness of training using this method and the effect of such training on clinical outcomes. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2xORwCd

NonOperating Room Anesthesia: distancing from invasive surgery, embracing the era of interventional medicine.

No abstract available

http://ift.tt/2yEtYzo

Recent advances of simulation in obstetric anesthesia.

Purpose of review: Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories. Recent findings: Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees. Low- and high-fidelity simulation devices for the learning and practicing neuraxial and non-neuraxial procedures have been described, and both are equally effective. The use of checklists in obstetric emergencies has become common as and post-scenario debriefing techniques have improved. Although participant task performance improves, whether participants retain learned skills or whether simulation improves patient outcomes has not yet been established. Tools to assess teamwork during simulation have been developed, but none have been rigorously validated. In-situ vs. offsite simulations do not differ in effectiveness. Summary: Simulation allows for practice of tasks and teamwork in a controlled manner. There is little data whether simulation improves patient outcomes and metrics to predict the long-term retention of skills by simulation participants have not been developed. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2xQun2w

Evaluation of fibroblast growth factor activity exerted by placental extract used as a cosmetic ingredient

Summary

Background

The biological activities claimed for placental extract (PE) in its medical and cosmetic applications are largely assumed to be the combined effects of its various signaling molecules and nutritional constituents. But there are considerable uncertainties about this assumption.

Aims

To determine the specific biological activity of PE at a molecular level.

Methods

Fibroblast growth factor (FGF) activity was assessed based on the ability to induce proliferation of FGF receptor (FGFR)-overexpressing BaF3 cells.

Results

Porcine PE (PPE), an ingredient in numerous cosmetics, activated proliferation of BaF3 cells overexpressing FGFR subtypes 1c, 2c, 2b, 3c, or 4, that is, all the major FGFR subtypes. The effect was suppressed largely or partially when the cells were treated with a FGFR inhibitor PD173074, and the FGFR-negative BaF3 parent cells exhibited minimal growth promotion as compared to the FGFR-expressing BaF3 cells. The high (>10 kDa) and low (<3 kDa) molecular weight fractions of PPE were effective activators of FGFR signaling. PPE was found to contain sulfated glycosaminoglycans, including heparin/heparan sulfate and chondroitin sulfate, which serve as both structural stabilizers of FGFs and indispensable cofactors for FGF-FGFR signaling.

Conclusions

These results indicate that PPE is capable of evoking FGF signaling in cells via FGFRs. Given that recombinant FGFs have proven useful for medical/cosmetic purposes, our results suggest that the medical/cosmetic utility of PPE is provided at least partly through the activation of FGF signaling in epidermal, dermal, and subdermal tissues.

http://ift.tt/2fFJnry

Evaluation of fibroblast growth factor activity exerted by placental extract used as a cosmetic ingredient

Summary

Background

The biological activities claimed for placental extract (PE) in its medical and cosmetic applications are largely assumed to be the combined effects of its various signaling molecules and nutritional constituents. But there are considerable uncertainties about this assumption.

Aims

To determine the specific biological activity of PE at a molecular level.

Methods

Fibroblast growth factor (FGF) activity was assessed based on the ability to induce proliferation of FGF receptor (FGFR)-overexpressing BaF3 cells.

Results

Porcine PE (PPE), an ingredient in numerous cosmetics, activated proliferation of BaF3 cells overexpressing FGFR subtypes 1c, 2c, 2b, 3c, or 4, that is, all the major FGFR subtypes. The effect was suppressed largely or partially when the cells were treated with a FGFR inhibitor PD173074, and the FGFR-negative BaF3 parent cells exhibited minimal growth promotion as compared to the FGFR-expressing BaF3 cells. The high (>10 kDa) and low (<3 kDa) molecular weight fractions of PPE were effective activators of FGFR signaling. PPE was found to contain sulfated glycosaminoglycans, including heparin/heparan sulfate and chondroitin sulfate, which serve as both structural stabilizers of FGFs and indispensable cofactors for FGF-FGFR signaling.

Conclusions

These results indicate that PPE is capable of evoking FGF signaling in cells via FGFRs. Given that recombinant FGFs have proven useful for medical/cosmetic purposes, our results suggest that the medical/cosmetic utility of PPE is provided at least partly through the activation of FGF signaling in epidermal, dermal, and subdermal tissues.

http://ift.tt/2fFJnry

Is Load-Induced Ventricular Hypertrophy Ever Compensatory?.

Author: Schiattarella, Gabriele G. MD; Hill, Theodore M.; Hill, Joseph A. MD, PhD

Page: 1273-1275

http://ift.tt/2fFmV1J

Subclinical Atrial Fibrillation in Older Patients.

Author: Healey, Jeff S. MD, MSc; Alings, Marco MD; Ha, Andrew MD; Leong-Sit, Peter MD; Birnie, David H. MD; de Graaf, Jacob J. MD; Freericks, Michel MD; Verma, Atul MD; Wang, Jia PhD; Leong, Darryl MD; Dokainish, Hisham MD; Philippon, Francois MD; Barake, Walid MD; McIntyre, William F. MD; Simek, Kim BSc; Hill, Michael D. MD; Mehta, Shamir R. MD, MSc; Carlson, Mark MD; Smeele, Frank MD; Pandey, A. Shekhar MD; Connolly, Stuart J. MD; on behalf of the ASSERT-II Investigators

Page: 1276-1283

http://ift.tt/2xbBq8S

Seek and Ye Shall Find Subclinical Atrial Fibrillation in High-Risk Elderly Patients.

Author: Wijesurendra, Rohan S. MA, MRCP; Casadei, Barbara MD, DPhil, FRCP, FMedSci

Page: 1284-1287

http://ift.tt/2fFn0m3

Dynamic Edematous Response of the Human Heart to Myocardial Infarction: Implications for Assessing Myocardial Area at Risk and Salvage.

Author: Fernandez-Jimenez, Rodrigo MD *; Barreiro-Perez, Manuel MD, PhD *; Martin-Garcia, Ana MD, PhD *; Sanchez-Gonzalez, Javier PhD; Aguero, Jaume MD, PhD; Galan-Arriola, Carlos DVM; Garcia-Prieto, Jaime BSc; Diaz-Pelaez, Elena MD; Vara, Pedro DCS; Martinez, Irene DCS; Zamarro, Ivan DCS; Garde, Beatriz BPharm; Sanz, Javier MD; Fuster, Valentin MD PhD; Sanchez, Pedro L. MD, PhD; Ibanez, Borja MD, PhD

Page: 1288-1300

http://ift.tt/2xbnX0X

Time-Varying Edema Requires Cautious Interpretation of Myocardium at Risk and Infarct Size by All Imaging Methods.

Author: Arai, Andrew E. MD

Page: 1301-1303

http://ift.tt/2fHmkwt

Randomized Comparison of Ridaforolimus- and Zotarolimus-Eluting Coronary Stents in Patients With Coronary Artery Disease: Primary Results From the BIONICS Trial (BioNIR Ridaforolimus-Eluting Coronary Stent System in Coronary Stenosis).

Author: Kandzari, David E. MD; Smits, Pieter C. MD; Love, Michael P. MD; Ben-Yehuda, Ori MD; Banai, Shmuel MD; Robinson, Simon D. MD; Jonas, Michael MD; Kornowski, Ran MD; Bagur, Rodrigo MD, PhD; Iniguez, Andres MD, PhD; Danenberg, Haim MD; Feldman, Robert MD; Jauhar, Rajiv MD; Chandna, Harish MD; Parikh, Manish MD; Perlman, Gidon Y. MD, MSc; Balcells, Mercedes PhD; Markham, Peter MSc; Ozan, Melek Ozgu MSc; Genereux, Philippe MD; Edelman, Elazer R. MD, PhD; Leon, Martin B. MD; Stone, Gregg W. MD

Page: 1304-1314

http://ift.tt/2xbnVWT

Kruppel-Like Factor 4 Regulation of Cholesterol-25-Hydroxylase and Liver X Receptor Mitigates Atherosclerosis Susceptibility.

Author: Li, Zhao BS *; Martin, Marcy BS *; Zhang, Jin BS; Huang, Hsi-Yuan PhD; Bai, Liang PhD; Zhang, Jiao MD; Kang, Jian PhD; He, Ming MD, PhD; Li, Jie BS; Maurya, Mano R. PhD; Gupta, Shakti PhD; Zhou, Guangjin PhD; Sangwung, Panjamaporn PhD; Xu, Yong-Jiang PhD; Lei, Ting PhD; Huang, Hsien-Da PhD; Jain, Mohit MD; Jain, Mukesh K. MD; Subramaniam, Shankar PhD; Shyy, John Y.-J. PhD

Page: 1315-1330

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Current Practice of State-of-the-Art Surgical Coronary Revascularization.

Author: Head, Stuart J. MD, PhD; Milojevic, Milan MD, MSc; Taggart, David P. MD, PhD; Puskas, John D. MD

Page: 1331-1345

http://ift.tt/2xbnVpR

Hypoplastic Left Heart Syndrome With Intact or Restrictive Atrial Septum: A Report From the International Fetal Cardiac Intervention Registry.

Author: Jantzen, David W. MD; Moon-Grady, Anita J. MD; Morris, Shaine A. MD, MPH; Armstrong, Aimee K. MD; Berg, Christoph MD; Dangel, Joanna MD, PhD; Fifer, Carlen G. MD; Frommelt, Michele MD; Gembruch, Ulrich MD; Herberg, Ulrike MD; Jaeggi, Edgar MD; Kontopoulos, Eftichia V. MD, PhD; Marshall, Audrey C. MD; Miller, Owen; Oberhoffer, Renate MD, PhD; Oepkes, Dick MD, PhD; Pedra, Carlos A. MD, PhD; Pedra, Simone R. MD, PhD; Peralta, Fabio MD; Quintero, Ruben A. MD; Ryan, Greg MB; Gelehrter, Sarah K. MD

Page: 1346-1349

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Importance of Routine Antihuman/Leukocyte Antibody Monitoring: De Novo Donor Specific Antibodies Are Associated With Rejection and Allograft Vasculopathy After Heart Transplantation.

Author: Wong, Ka L. MBBS; Taner, Timucin MD, PhD; Smith, Byron H. PhD; Kushwaha, Sudhir S. MD; Edwards, Brooks S. MD; Gandhi, Manish J. MD; Kremers, Walter K. PhD; Daly, Richard C. MD; Pereira, Naveen L. MD

Page: 1350-1352

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Letter by Ma et al Regarding Article, "Depression Treatment and 1-Year Mortality After Acute Myocardial Infarction: Insights From the TRIUMPH Registry (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status)".

Author: Ma, Lei-Lei MD; Kong, Fei-Juan MD; Ge, Jun-Bo MD

Page: 1353-1354

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Response by Smolderen et al to Letter Regarding Article, "Depression Treatment and 1-Year Mortality After Acute Myocardial Infarction: Insights From the TRIUMPH Registry (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status)".

Author: Smolderen, Kim G. E.; Gosch, Kensey G.; Buchanan, Donna M.; Spertus, John A.

Page: 1355-1356

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Letter by Fukunaga and Rao Regarding Article, "Transcatheter Treatment of Severe Tricuspid Regurgitation With the Edge-to-Edge MitraClip Technique".

Author: Fukunaga, Naoto MD; Rao, Vivek MD, PhD

Page: 1357-1358

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Should We Stop Thinking About Inhibition? Searching for Individual and Age Differences in Inhibition Ability.

Author: Rey-Mermet, Alodie; Gade, Miriam; Oberauer, Klaus

DOI: 10.1037/xlm0000450

Publication Date: POST AUTHOR CORRECTIONS, 28 September 2017

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Morphological Effects in Visual Word Recognition: Children, Adolescents, and Adults.

Author: Dawson, Nicola; Rastle, Kathleen; Ricketts, Jessie

DOI: 10.1037/xlm0000485

Publication Date: POST AUTHOR CORRECTIONS, 28 September 2017

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Novel immunologic mechanisms in eosinophilic esophagitis

Julie M Caldwell | Misu Paul | Marc E Rothenberg

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The dichotomy between low frequency and delta waves in human sleep: A reappraisal

Publication date: Available online 2 October 2017
Source:Journal of Neuroscience Methods
Author(s): Jean-Pol Lanquart, Pasquale Nardone, Philippe Hubain, Gwénolé Loas, Paul Linkowski
BackgroundWe present the results of an analysis of the low frequency (LF) (0.25–1Hz) and delta (1–4Hz) waves during human sleep. Our objective was to investigate whether LF and delta waves should be considered as separate entities.MethodsThe slow-wave electroencephalogram (EEG) activity of 2 sets of 10 young, healthy volunteers was analysed utilising the rarely-used Lomb-Scargle periodogram. This method has advantages over the more commonly-used Fast Fourier Transform analysis.ResultsDuring the night, the frequencies of the most powerful waves are concentrated in the 0.5–2Hz range and show a continuous tendency to shift towards slower frequencies during sleep.Comparison with existing methodsWhen considering the frequency dynamics of slow-wave activity below 3Hz, the unifying theory of LF and delta waves is more parsimonious than the idea that there is a different origin and regulation for the two sub-bands.ConclusionsThe unifying theory of LF and delta waves is the simplest explanation for the slow-wave activity of the EEG below 3Hz. This finding is important for the clinical use of slow-wave activity.



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Food addiction and substance addiction in women: Common clinical characteristics

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Raven Hardy, Negar Fani, Tanja Jovanovic, Vasiliki Michopoulos
Food addiction is characterized by poorly controlled intake of highly-palatable, calorically-dense, foods. While previous studies indicate that risk factors for food addiction are similar to substance use disorders (SUD), these studies have looked at food addiction and SUD in independent samples, limiting the ability to directly compare food addiction to SUD. The present study was conducted to assess rates of posttraumatic stress disorder (PTSD), depression, childhood and adult trauma exposure, as well as presence and severity of emotion dysregulation, in a sample of women (N = 229) who either meet criteria for no addiction, food addiction only or SUD only. The prevalence of food addiction was 18.3% and the prevalence of SUD was 30.6% in this sample. Women with food addiction and women with SUD endorsed more depression and PTSD symptoms when compared with individuals with no addiction. Individuals with food addiction and SUD had higher total emotion dysregulation scores, specifically with difficulties in goal directed behaviors, non-acceptance of emotional responses, impulse control, limited access to emotion regulation strategies, and lack of emotional clarity, when compared to individuals with no addiction (all p's < 0.05). There were no differences in PTSD and depression symptoms and emotion dysregulation scores between food addiction and SUD groups (all p > 0.05). However, women with SUD endorsed higher levels of total childhood (p < 0.01) and adulthood trauma (p < 0.01) as compared with women with no addiction or food addiction. These results suggest that women with food addiction and those with SUD share similar psychological characteristics and risk factors, with the exception of trauma histories. These findings have implications for the detection of risk for and treatment of these disorders.



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Urinary biomarker CXCL10, identifying site specific allograft inflammation in renal transplantation.

No abstract available

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Long-term effects of pancreas transplantation on diabetic retinopathy and incidence and predictive risk factors for early worsening.

Background: Limited data are available regarding the long-term effects of pancreas transplantation on the progression of diabetic retinopathy (DR) and the incidence of and associated risk factors for early worsening of DR. Methods: Patients who underwent successful pancreas transplantation between January 2007 and October 2015 and were followed for >= 1 year were consecutively enrolled. Variables regarding demographic, systemic, metabolic, and surgical factors were reviewed for each patient. DR progression was defined as i) development or aggravation of macular edema requiring intravitreal injections and/or ii) progression of DR severity requiring panretinal photocoagulation (PRP) and/or pars planar vitrectomy (PPV). Early worsening was defined as progression within 1 year of posttransplant. Results: Three hundred and 3 eyes of 153 patients were included in the analysis. At the pretransplant ocular evaluation, 221 eyes (72.9 %) showed advanced DR with history of PRP and/or PPV. During a mean follow-up period of 4.2 years, 62 eyes (20.5%) experienced DR progression, and early worsening was noted in 57 eyes (18.8%). DR with recent PRP within pretransplant 1 year and pancreas transplant alone were significant risk factors for early worsening. Conclusions: In 4 out 5 patients who received pancreas transplant, the degree of DR remained stable over time after transplantation. Meanwhile, early worsening of DR could occur in patients at risk, particularly within the first posttransplant year. We suggest that physicians should have a high index of suspicion and carefully monitor for early worsening of DR, and timely manage possible ocular deterioration. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Marked decrease in urgent listing for liver transplantation over time: evolution of characteristics and outcomes of Status-1 liver transplantation.

Background: Approximately 5% of liver transplants annually are performed urgently with "status-1" designation. This study aims to determine if the demand, characteristics and outcome for status-1 liver transplantation has changed over time. Methods: We utilized the Scientific Registry of Transplant Patients (2003-2015) to characterize 2352 adult patients who underwent 2408 status-1 liver transplants and compared them between Era1 (2003-6/2009) and Era2 (7/2009 -2015). Results: Overall, there were fewer liver transplants performed with the Status-1 designation in Era2 than Era1 (1099 vs 1309). Although the number of urgent liver transplants was relatively constant with successive years, the proportion transplanted with Status-1 designation decreased markedly over time. Era2 patients were older (43.2 vs 41.7 years, p=0.01) and less likely be ABO-incompatible (1.1% vs 2.4%, p=0.01) or re-transplant (77 vs 124, p=0.03). In terms of disease etiology, the largest group was "ALF, nonspecified" (43.4%). There was no difference in proportion with drug-induced liver injury (DILI), but the subset of herbal/dietary supplements increased in Era2 (1.3% vs 0.46 %, p=0.04). Survival was increased in Era2 in the overall cohort and for patients with autoimmune disease (p

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Role of human CD200 overexpression in pig-to-human xenogeneic immune response compared with human CD47 overexpression.

Background: Macrophages play important roles in xenograft rejection. Here, we investigated whether overexpression of human CD200 or CD47 in porcine endothelial cells (PEC) can suppress macrophages activation in xenogeneic immune responses. Methods: PECs and human macrophages were incubated together, harvested and analyzed for in vitro macrophage phagocytic and cytotoxicity activity, and cytokine release. Next, PEC were injected into renal subcapsular space of humanized mice. On day 10 posttransplantation, we analyzed xenograft survival and perigraft inflammatory cell infiltrations in PEC-to-humanized mouse transplantation. Results: PECs highly expressing human CD200, CD47, or both CD47/CD200 were established by lentiviral vector transduction. Both CD200 and CD47 suppressed in vitro macrophage phagocytic and cytotoxic activity against PECs; decreased TNF-[alpha], IL-1[beta], and IL-6 secretion; and increased IL-10 secretion. However, simultaneous overexpression of CD200 and CD47 did not show additive effects. Next, PECs were transplanted into NSG mice, and human monocytes and lymphocytes were adoptively transferred 1 day after xenotransplantation. PEC xenograft cell death and apoptosis were decreased in the CD200-PEC and CD47/CD200-PEC groups. Perigraft infiltration of human T cells was suppressed by CD47; CD200 suppressed infiltration of human macrophages to a greater extent than CD47; and the CD47/CD200-PEC group exhibited the lowest level of leukocyte infiltration. In summary, overexpression of CD200 in PECs suppressed xenogeneic activation of human macrophages and improved survival of PEC xenografts in humanized mice; however, co-expression of CD200 and CD47 did not show additive effects. Conclusions: Therefore, overexpression of human CD200 in donor pigs could constitute a promising strategy for overcoming xenograft rejection. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Coexistence of Bilirubin >=10 mg/dL and Prothrombin Time-International Normalized Ratio >=1.6 on Day 7: A Strong Predictor of Early Graft Loss after Living Donor Liver Transplantation.

Background: Early allograft dysfunction (EAD) defined by serum total bilirubin (TB) >=10 mg/dL or prothrombin time-international normalized ratio (PT-INR) >=1.6 on postoperative day 7 (POD7) or aminotransferase >2000 IU/L within the first week, is associated with early graft loss after deceased-donor liver transplantation. We aimed to determine the prognostic impact of the EAD definition in living-donor liver transplantation (LDLT). Methods: We analyzed the validity of the EAD definition and its impact on early graft survival in 260 adult recipients who underwent primary LDLT. Results: Eighty-four (32.3%) patients met the EAD criteria; 59 (22.7%) and 46 (17.7%) patients had TB >=10 mg/dL and PT-INR >=1.6 on POD7, respectively, and 22 (8.5%) patients satisfied both criteria. Graft survival differed significantly when stratified according to TB >=10 mg/dL and PT-INR >=1.6 (p=1.6 resulted in higher graft mortality (RR=3.87, p<.0001 at rr="2.97," p as did tb>=10 mg/dL (RR=1.89, p=0.027 at 90-day; RR=1.91, p=0.006 at 180-day). Coexistence of TB >=10 mg/dL and PT-INR >=1.6 was strongly associated with early graft loss (59.1%, RR=6.97 at 90-day; 68.2%, RR=5.75 at 180-day). In Cox regression analysis, PT-INR >=1.6 and TB >=10 mg/dL on POD7 were significant risk factors for early graft loss (hazard ratio =4.10 [95% CI: 2.35-7.18], p=10 mg/dL and/or PT-INR >=1.6 on POD7 predicted early graft loss after LDLT, and their coexistence worsened patient outcomes. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Performance and Interpretation Training of Transthoracic Echocardiography in Resource-Limited Settings

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The Importance of Breakfast in Atherosclerosis Disease: Insights From the PESA Study

AbstractBackground

Daily habits, including the number and quality of eating occasions, are potential targets for primary prevention strategies with large health impacts. Skipping breakfast is considered a frequent and unhealthy habit associated with an increased cardiovascular (CV) risk.

Objectives

The study sought to explore the association between different breakfast patterns and CV risk factors and the presence, distribution, and extension of subclinical atherosclerosis.

Methods

Cross-sectional analysis was performed within the PESA (Progression of Early Subclinical Atherosclerosis) study, a prospective cohort of asymptomatic (free of CV events at baseline) adults 40 to 54 years of age. Lifestyle and multivascular imaging data along with clinical covariates were collected from 4,052 participants. Multivariate logistic regression models were used in the analysis.

Results

Three patterns of breakfast consumption were studied: high-energy breakfast, when contributing to >20% of total daily energy intake (27% of the population); low-energy breakfast, when contributing between 5% and 20% of total daily energy intake (70% of the population); and skipping breakfast, when consuming <5% of total daily energy (3% of the population). Independent of the presence of traditional and dietary CV risk factors, and compared with high-energy breakfast, habitual skipping breakfast was associated with a higher prevalence of noncoronary (odds ratio: 1.55; 95% confidence interval: 0.97 to 2.46) and generalized (odds ratio: 2.57; 95% confidence interval: 1.54 to 4.31) atherosclerosis.

Conclusion

Skipping breakfast is associated with an increased odds of prevalent noncoronary and generalized atherosclerosis independently of the presence of conventional CV risk factors. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318)

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Hearty Breakfast for Healthier Arteries

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Predicting Risk in ACS: Taking the Long-Term View

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Preterm Birth and Risk of Heart Failure Up to Early Adulthood

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JACC Instructions for Authors

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Limitations of Treating Heart Rate as the Primary Outcome Determinant in Older Adults

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Palliative Care in Heart Failure: Rationale, Evidence, and Future Priorities

Abstract

Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course.

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Pulmonary Artery Pressure-Guided Management of Patients With Heart Failure and Reduced Ejection Fraction

AbstractBackground

Despite increased use of guideline-directed medical therapy (GDMT), some patients with heart failure and reduced ejection fraction (HFrEF) remain at high risk for hospitalization and mortality. Remote monitoring of pulmonary artery (PA) pressures provides clinicians with actionable information to help further optimize medications and improve outcomes.

Objectives

CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients trial) analyzed PA pressure-guided heart failure (HF) management in patients with HFrEF based on their ability to tolerate GDMT.

Methods

CHAMPION enrolled 550 patients with chronic HF regardless of left ventricular ejection fraction. A pre-specified sub-group analysis compared HF hospitalization and mortality rates between treatment and control groups in HFrEF patients (left ventricular ejection fraction ≤40%). Post hoc analyses in patients who tolerated GDMT were also performed. Hospitalizations and mortality were assessed using Andersen-Gill and Cox proportional hazards models.

Results

In 456 patients with HFrEF, HF hospitalization rates were 28% lower in the treatment group than in the control group (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.59 to 0.88; p = 0.0013), with a strong trend for 32% lower mortality (HR: 0.68; 95% CI: 0.45 to 1.02; p = 0.06). A 445-patient subset received at least 1 GDMT (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, or beta-blocker) at baseline; these patients had 33% lower HF hospitalization rates (HR: 0.67; 95% CI: 0.54 to 0.82; p = 0.0002) and 47% lower mortality (HR: 0.63; 95% CI: 0.41 to 0.96, p = 0.0293) than controls. Compared with controls, patients receiving both components of optimal GDMT (n = 337) had 43% lower HF hospitalizations (HR: 0.57; 95% CI: 0.45 to 0.74; p < 0.0001) and 57% lower mortality (HR: 0.43; 95% CI: 0.24 to 0.76; p = 0.0026).

Conclusions

PA pressure-guided HF management reduces morbidity and mortality in patients with HFrEF on GDMT, underscoring the important synergy of addressing hemodynamic and neurohormonal targets of HF therapy. (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients [CHAMPION]; NCT00531661)

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Innovating Toward High-Value Cardiovascular Care

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(Re)Discovering the Neurohormonal and Hemodynamic Duality of Heart Failure

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Submaximal Blood Pressure Responses to Exercise in Young Adulthood and Long-Term Cardiovascular Health

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Clinical Outcomes Following the Ross Procedure in Adults: A 25-Year Longitudinal Study

AbstractBackground

Very few reports of long-term outcomes of patients who underwent the Ross procedure have been published.

Objectives

The authors reviewed their 25-year experience with the Ross procedure with the aim of defining very–long-term survival and factors associated with Ross-related failure.

Methods

Between January 1990 and December 2014, the Ross procedure was performed in 310 adults (mean age 40.8 years) at a single institution. All patients were prospectively added to a dedicated cardiac surgery registry. Complete post-operative clinical examination and history were obtained, and transthoracic echocardiography was performed according to a standardized protocol. There was no loss to follow-up. Median follow-up was 15.1 years and up to 25 years.

Results

Bicuspid aortic valve was diagnosed in 227 patients (73.2%), and the most common indication for surgery was aortic stenosis (n = 225 [72.6%]). Freedom from any Ross-related reintervention was 92.9% and 70.1% at 10 and 20 years, respectively. Independent risk factors for pulmonary autograft degeneration were pre-operative large aortic annulus (hazard ratio: 1.1; p = 0.01), pre-operative aortic insufficiency (hazard ratio: 2.7; p = 0.002), and concomitant replacement of the ascending aorta (hazard ratio: 7.7; p = 0.0003). There were 4 hospital deaths (1.3%), and overall survival at 10 and 20 years was 94.1% and 83.6%, respectively. Long-term survival was not significantly different in patients who required Ross-related reintervention (log-rank p = 0.70). However, compared with the general population, survival was significantly lower in patients following the Ross procedure when matched on age and sex (p < 0.0001).

Conclusions

The Ross procedure was associated with excellent long-term valvular outcomes and survival, regardless of the need for reintervention. Adults presenting with aortic insufficiency or a dilated aortic annulus or ascending aorta were at greater risk for reintervention. Unlike previous reports, long-term survival was lower in Ross patients compared with matched subjects.

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Reply: Preterm Birth and Risk of Heart Failure in Childhood and Early Adulthood

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The Ross Outlasts its Critics and Competition

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Monocyte and macrophage immunometabolism in atherosclerosis

Abstract

Atherosclerosis is characterized by chronic low grade inflammation of arteries that results in the development of lipid dense plaques. Chronic inflammation induced by Western-type diet is associated with the risk of developing atherosclerosis, and new insights shed light on the importance of metabolic and functional reprogramming in monocytes and macrophages for progression of atherosclerosis. This review aims to provide an overview of our current understanding into how the metabolic reprogramming of glucose, cholesterol, fatty acid, and amino acid metabolism in macrophages contributes to inflammation during atherosclerosis. Recent insights suggest that transcriptional and epigenetic adaptation within innate immune cells (termed trained immunity) play an important role in the pathogenesis of atherosclerosis. We propose that metabolic changes induced by pro-atherogenic lipoproteins partly mediate these changes in trained macrophages. Finally, we discuss the possibility of manipulating cellular metabolism of immune cells for targeted therapeutic intervention against atherosclerosis.

http://ift.tt/2ykg49x

The prospective evaluation of risk factors and clinical influence of carbapenem resistance in children with gram-negative bacteria infection

Publication date: Available online 2 October 2017
Source:American Journal of Infection Control
Author(s): Zumrut Sahbudak Bal, Nur Bekmezci, Mehmet Soylu, Semra Sen, Gulhadiye Avcu, Sohret Aydemir, Fadil Vardar
BackgroundCarbapenem-resistant gram-negative (CRGN) infections have been increasing in recent years and associated with significant morbidity, mortality, and health care costs. The aim of this study was to evaluate the epidemiologic and clinical risk characteristics, risk factors, and outcome of CRGN infections and to compare with carbapenem-sensitive gram-negative (CSGN) infections in children.MethodsNewly diagnosed CRGN infections in hospitalized children younger than age 18 years were prospectively recorded and all patients infected with a CSGN pathogen in the same unit within 48 hours of diagnosis were included in a control group between April 1, 2014, and December 31, 2014.ResultsTwenty-seven patients with CRGN infections and 28 patients with CSGN infections were enrolled in this study. Ventilator-associated pneumonia was the most common type of infection in both groups. Prior exposure to carbapenems (relative risk [RR], 11.368; 95% confidence interval [CI], 1.311-98.589), prolonged hospitalization (RR, 5.100; 95% CI, 1.601-16.242) were found to be independent risk factors for acquiring CRGN infections. Septic shock was significantly more frequent in the CRGN group (RR, 9.450; 95% CI, 1.075-83.065). The in-hospital mortality was higher in the CRGN group (RR, 7.647; 95% CI, 1.488-39.290).ConclusionsPrior carbapenem exposure and prolonged hospitalization are the most important risk factors for acquiring CRGN infections in our hospital. This study demonstrated, similar to previous reports, that carbapenem resistance increases morbidity, mortality, and health care costs.



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Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review

Publication date: Available online 2 October 2017
Source:American Journal of Infection Control
Author(s): Danielle J. Durant
BackgroundCatheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-acquired conditions and no longer reimbursable from Medicare as of 2008. Nurse-driven protocols (NDPs), which provide a medically approved rubric for professional nurses to make autonomous care decisions, can facilitate appropriate catheter use and timely removal, as advised in the Centers for Disease Control and Prevention's 2009 CAUTI prevention guidelines. However, little attempt has been made to systematically evaluate their effect on clinical outcomes.MethodsA systematic review of studies published in the United States since 2006 was performed, following guidelines from the Institute of Medicine. Sources included CINAHL, Medline, professional agencies, hand-searching, and expert consultation. Clinical predictors and prevalence of CAUTI were examined and synthesized qualitatively; heterogeneity of outcomes made a statistical meta-analysis inappropriate.ResultsTwenty-nine studies were found eligible for inclusion. All used a case-control (pre-post) approach, and all reported reductions in clinical predictors of CAUTI, particularly indwelling-urinary catheter utilization and CAUTI rates. However, the number of CAUTIs remained unchanged in 1 study. A formal quality assessment revealed a high risk of bias; included studies met an average of 4.9 out of 11 quality indicators. Specifically, many did not use standardized measures.ConclusionsNDPs appear to have a positive impact on the clinical predictors and prevalence of CAUTI. However, this review identified need for improving the study design of quality improvement projects conducted within the patient care setting.



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Preventing new sensitization and asthma onset by allergen immunotherapy: the current evidence.

Purpose of review: Specific allergen immunotherapy is considered a key candidate for a successful preventive intervention in atopic diseases. The strong association of atopic manifestations such as rhinitis and asthma with atopic sensitizations (specific serum IgE) provide a rationale for early intervention in childhood and adolescence. Recent findings: Currently, the documentation of the disease-modifying intervention effects is limited to the secondary prevention of asthma symptoms in children with allergic rhinoconjunctivitis. These effects appear to be rather allergen specific than nonspecific. Summary: Documentation on disease modification including a reduction of asthma symptoms in children, particularly with grass pollen tablets has become quite robust. It is not clear up to now, if the new onset of allergic sensitizations can be modified. So far data on primary prevention are not conclusive. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Approaches to the removal of T-lymphocytes to minimize graft-versus-host disease in patients with primary immunodeficiencies who do not have a matched sibling donor.

Purpose of review: Since the advent of T-lymphocyte depletion in hematopoietic stem cell transplantation (HSCT) for primary immunodeficiency, survival following this procedure has remained poor compared to results when using matched sibling or matched unrelated donors, over the last 40 years. However, three new techniques are radically altering the approach to HSCT for those with no matched donor, particularly those with primary immunodeficiencies which are not severe combined immunodeficiency. Recent findings: Three main techniques of T-lymphocyte depletion are altering donor choice for patients with primary immunodeficiencies and have improved transplant survival for primary immunodeficiencies to over 90%, equivalent to that for matched sibling and matched unrelated donor transplants. CD3+ T cell receptor (TCR)[alpha][beta]+ CD19+ depletion, CD45RA depletion and use of posttransplant cyclophosphamide give similar overall survival of 90%, although viral reactivation remains a concern. Further modification of CD3+ TCR[alpha][beta]+ CD19+ depletion by adding back inducible caspase-9 suicide gene-modified CD3+ TCR[alpha][beta]+ T-lymphocytes may further improve outcomes for patients with systemic viral infection. Summary: Over the last 5 years, the outcomes of HSCT using new T-lymphocyte depletion methods have improved to the extent that they are equivalent to outcomes of matched sibling donors and may be preferred in the absence of a fully matched sibling donor, over an unrelated donor to reduce the risk of graft versus host disease. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Critical appraisal of the unmet needs in the treatment of chronic spontaneous urticaria with omalizumab: an Italian perspective.

Purpose of review: The humanized anti-IgE antibody omalizumab has been available for patients with chronic spontaneous urticaria (CSU) in Italy since 2015. This review summarizes the unresolved issues and unmet therapeutic needs associated with omalizumab and discusses practical recommendations for its use in the management of CSU. Recent findings: Although modern second-generation H1-antihistamines are the standard of care for patients with CSU, adjunctive treatments (including omalizumab) may be required for effective control of symptoms in many patients. Evidence from clinical trials and experience from daily clinical practice suggest that the use of omalizumab in patients with CSU who have inadequate response to H1-antihistamines remains challenging. Summary: Based on current international guidelines, omalizumab labelling information and our experience in clinical practice, we provide treatment recommendations regarding the use of omalizumab in patients with CSU. These include: optimal treatment duration, the use of concomitant antihistamine therapy, the definition and management of disease relapse after treatment, and the management of patients with late or no response to treatment. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Nasal Soft Tissue Change Following Bimaxillary Orthognathic Surgery

Objective: The purpose of this study is to identify the correlation between maxillary movement and nasal soft tissue changes on three-dimensional reconstructed cone beam computed tomography (CBCT) images after Le Fort I osteotomy. Materials and Methods: The authors also investigate the long-term change of alar base width (ABW) to determine the effect of cinch suture. The authors retrospectively studied 52 subjects (14 males and 38 females) who were treated by bimaxillary orthognathic surgery including Le Fort I osteotomy and mandibular ramus surgery. The landmarks and planes were established on three-dimensional reconstructed CBCT images. The authors measured each parameters preoperatively, 1 month postoperatively, and 1 year postoperatively. Results: There was no significant correlation between the horizontal movement of A-point and the widening of ABW (P 

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Differential Diagnosis of Intramuscular Schwannoma of the Craniocervical Region

Abstract: Schwannomas in the head and neck are a relatively common condition. However, intramuscular schwannomas in the craniocervical region are extremely rare. The preoperative consideration of schwannomas is very important to preserve adjacent circulation and nerve function during the surgery in this area. Moreover, the treatment and preoperative evaluation of this condition is not firmly established in the past literatures. The authors successfully managed the intramuscular schwannoma in the craniocervical region, and provide the differential diagnoses with appropriate treatments.

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Dissemination of Information: From the Stone Age to the Social Media of Facebook

No abstract available

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Mean Platelet Volume, Red Cell Distribution Width, and Neutrophil-to-Lymphocyte Ratio Before and After Surgery in Patients With Carotid Body Tumors

Objective: Carotid body tumors (CBTs) are rare hypervascular benign tumors that originate from the paraganglia at the carotid bifurcation. The red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and mean platelet volume (MPV) may serve as markers in inflammatory, cardiovascular, and neoplastic diseases. However, their prognostic value in CBTs is unknown. The purpose of this study was to assess the leukocyte count, MPV, RDW, and NLR before and after surgery in patients with CBTs. Methods: This retrospective trial included data from 80 patients with CBTs and 65 age-matched healthy controls. The leukocyte, neutrophil, lymphocyte and platelet counts, RDW, and MPV were extracted and NLR was calculated from the complete blood count results of participants. Results: The leukocyte and neutrophil counts as well as RDW levels were significantly increased in patients with CBTs compared with healthy controls (P = 0.005, P = 0.003, and P = 0.026; respectively). Patients with CBTs had lower lymphocytes counts (P = 0.241) and higher NLRs (P = 0.054); however, the difference was statistically insignificant. Moreover, no statistically significant difference was detected between groups in terms of platelet counts and MPV levels. Furthermore, the leukocyte count, platelet numbers, MPV, RDW, and NLR levels in patients with CBTs were not statistically significant after surgery (all; P > 0.05). Conclusion: This is the first study that documents the increased RDW levels and leukocyte count in patients with CBTs. The combined use of RDW and the leukocyte count along with other clinical assessments can be used as a biomarker for CBTs. Further clinical trials with larger cases series are required to determine the actual predictive roles of these systemic biomarkers.

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Stimuli-Responsive Biomaterials: Next Wave

No abstract available

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Review of “Alopecia Following Bicoronal Incisions” by Kadakia S, Badhey A, Ashai S, Lee TS, Ducic Y in JAMA Facial Plast Surg 19: 220–224, 2017

No abstract available

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Postoperative Changes After Closed Reduction of Nasal Fracture

Abstract: Nasal bone fracture is the most common facial fracture; however, surgery does not guarantee reduction and complications, such as undercorrection, overcorrection, and deviation, may occur. By analyzing findings of computed tomography (CT) immediately and at 3 months postoperatively, we evaluated the accuracy of reduction and long-term changes to the nasal bone. Patients with pure nasal bone fracture were evaluated from January 1, 2010 to December 31, 2011. First, we categorized fracture types according to the Stranc-Robertson classification system, using preoperative CT findings (ie, F1, F2, L1, and L2). We categorized each result of reduction by immediate postoperative CT scan findings as "Excellent," "Good," "Fair," and "Poor," with "Excellent" and "Good" ratings being considered a "Success." We evaluated changes to the nasal bone at 3 months after reduction, using the same grade. A total of 128 patients were analyzed. The results of patients in the F1 group were better than those of other patients immediately postoperatively, whereas those of the L2 group were worse. The overall success rate was 49.2% (58/118). At 3 months postoperatively, 33 cases exhibited an improvement to a higher grade, whereas 25 cases improved from an unacceptable outcome to a successful outcome, with the overall success rate being 70.3% (83/118). Immediately postoperative CT scans can be helpful for surgeons in determining whether a secondary adjustment is necessary. Incompletely reduced nasal bone showed spontaneous improvement in bony arrangement according to our study, so simple observation could be a choice.

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Evaluation of Protraction Face-Mask Therapy on the Craniofacial and Upper Airway Morphology in Unilateral Cleft Lip and Palate

Introduction: The aim of the authors' study was to evaluate the effects of protraction face-mask therapy on the craniofacial and upper airway morphology in patients with unilateral cleft lip and palate (UCLP). Methods: Twenty-three growing UCLP patients (mean age: 8.3 + 2.4) were enrolled in the study group. Protraction face-mask in combination with Hyrax appliance was applied for the correction of anterior crossbite and maxillary insufficiency. Twenty-six patients with maxillary retrusion (mean age: 8.1 + 2.5) were evaluated as the control group. The pharyngeal airway morphology was assessed via the area measurements of upper airway structures on the lateral cephalometric radiographs. Results: The upper airway morphology was similar compared with the control group subjects at the beginning of the treatment. The pharyngeal airway area was increased significantly following the maxillary expansion and protraction. Nasopharyngeal area increased and the oropharyngeal area decreased significantly. There was an increase in the sagittal and vertical dimensions after the protraction therapy. Conclusion: The pharyngeal morphology in both UCLP patients and control group patients was similarly improved with the protraction face-mask therapy.

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Osseous Flap of Galea and Periosteum Filled With Mesenchymal Stem Cells, Platelet-Rich Plasma, Bone Dust, and Hyaluronic Acid

Abstract: Reconstructive surgery to craniofacial deformities caused by tumor ressections, traumas or congenital malformation are frequent in medicine practice. It aims to provide the patients with better quality of life and functional improvement of speech, breathing, chewing, and swallowing. Many are the techniques described in the literature to recover bone defects. This study evaluated a vascularized galeal and periosteum flap in rabbits, which could possibly substitute the bone graft in reconstructive surgery, especially for facial defects. It involved rabbits, divided into 12 groups, submitted to a surgical procedure to construct the galea and periosteum cranial flap filled with fragments of cranial bone, platelet-rich plasma, mesenchimal stem cells, and hyaluronic acid. The evaluation methods included image examinations and histological analysis. The results demonstrated bone formation with the use of platelet-rich plasma, mesenchimal stem cells, and bone fragments. The use of several enrichment materials of osseous cellular stimulation improved the quality and bone tissue organization. The more enrichment factor used, the better the tissue quality result was. Much research should be done to improve the methods and to analyze if results in human have the same bone formation as it happened in rabbits.

http://ift.tt/2yT2Z46

Effect of Suturation Plus Surgicel Application on Post-Tonsillectomy Bleeding and Pain

Objective: The aim of this study was to evaluate the effect of suturation (tonsillary fossa closure) plus Surgicel application on postoperative bleeding and pain after tonsillectomies performed using a classical dissection method. Study Design: A prospective, randomized, double-blind, clinical trial was performed on 760 patients undergoing tonsillectomy or adenotonsillectomy during a 5-year period. Methods: After excluding patients with hemorrhagic disorder, chronic disease, and peritonsillar abscess, both tonsils were removed via classic dissection technique (cold knife or blunt dissection) and then electrocauterized for hemostasis. The tonsillar fossa randomly assigned to the treatment protocol (Group 1) was closed by sutures, following Surgicel application. The other side was unaltered and acted as the control (Group 2). Pain was evaluated every day for 10 days postoperatively, and bleeding was reported at any time. Results: A total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years (mean age 13.46 ± 7.98) were included in the study. Bleeding was observed in 31 patients: 8 from Group 1; and 23 from Group 2 (95% confidence interval [CI], P 

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Formation of the Philtral Column Using a Dermal Graft in Secondary Unilateral Cleft Lip

Introduction: The philtral column has an important aesthetic significance and is especially important in patients with cleft lip. If the integrity of the philtrum cannot be preserved in patients of unilateral clefts, these patients will have profound abnormalities in their facial musculature. The purpose of this study was to analyze the effects of dermal grafting on the philtral column in patients with a unilateral alveolar cleft. Methods: The authors retrospectively studied dermal grafts performed in Konkuk University Medical Center between January 2009 and January 2015. A total of 26 patients with unilateral cleft lip were included in this study; the authors measured philtral symmetry based on differences in convexity and angle using clinical photos. Additionally, panel evaluation was performed. Results: Of 26 patients enrolled, 21 completed follow-up and had adequate photographs. Five patients who were lost to follow-up were excluded. The difference in convexity decreased from 0.25 to 0.15 (P

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Olfactory Dysfunction Associated With Neuro-Behçet Disease

Introduction: Neurologic involvement associated with Behçet disease (BD) is defined as a different entity: Neuro-Behçet disease (NBD). Behçet disease presents with olfactory dysfunction. It is not known whether this is the consequence of mucosal involvement or neurologic involvement. Objective: The aim of this study was to investigate whether olfactory dysfunction was further aggravated as the result of neurologic involvement. Methods: Sixteen patients diagnosed with NBD and 16 healthy control patients with similar demographic characteristics were recruited as the healthy control group. Expanded Disability Status Scale (EDSS) scoring was used for quantification of neurological disability. All diagnoses were confirmed and categorized with magnetic resonance imaging studies in all patients individually: parenchymal or nonparenchymal. A well-established test of orthonasal olfaction developed at the CCCRC was used. Correlation analysis was carried out. Results: The mean CCCRC score of NBD patients was 4.60 out of 7, and this group was diagnosed to be moderately hyposmic, whereas the average score of the control group was 6.5; the difference was significant (P 

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Analysis of Orbital Volume Measurements Following Reduction and Internal Fixation Using Absorbable Mesh Plates and Screws for Patients With Orbital Floor Blowout Fractures

Introduction: Hinge-shaped fractures are common type of orbital floor blowout fractures, for which reduction and internal fixation is ideal. Nonetheless, orbital floor reconstruction using alloplastic materials without reducing the number of bone fragments is the most frequently used procedure. Therefore, this study analyzed and compared the outcomes between open reduction and internal fixation using absorbable mesh plates and screws, and orbital floor reconstruction, by measuring the orbital volume before and after surgery. Method: Among patients with orbital floor blowout fractures, this study was conducted on 28 patients who underwent open reduction and internal fixation, and 27 patients who underwent orbital floor reconstruction from December 2008 to September 2015. The mechanism of injury, ophthalmic symptoms before and after surgery, and the degree of enophthalmos were examined; subsequently, the volumes of the affected and unaffected sides were measured before and after surgery based on computed tomography images. This study compared the degree of recovery in the correction rate of the orbital volume, ophthalmic symptoms, and enophthalmos between the 2 groups. Result: The patients who underwent open reduction and internal fixation, and the patients who underwent orbital floor reconstruction showed average correction rates of 100.36% and 105.24%, respectively. Open reduction and internal fixation showed statistically, significantly superior treatment outcomes compared with orbital floor reconstruction. The ophthalmic symptoms and incidence of enophthalmos completely resolved in both groups. Conclusion: For orbital floor blowout fractures, open reduction and internal fixation using absorbable mesh plates and screws was a feasible alternative to orbital floor reconstruction.

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Reconstruction of Zygomaticomaxillary Buttress With Mandibular Ramus Bone Graft in Atrophic Maxillary Fracture

No abstract available

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Distraction of Fronto-Orbital Segment as a Nonvascularized Bone Graft in Craniosynostotic Patients

Abstract: Fronto-orbital advancement using distraction techniques involves the dura left attached to the osteotomized bone segment to avoid dead space formation and dural injury, whereas it is impossible to reshape the supraorbital bar and the frontal bone complex, when necessary. Our approach combines advantageous parts of conventional and distraction osteogenesis techniques as remodel and distract the supraorbital bar and frontal bone complex as a free bone graft. Twenty-seven patients either being syndromic and nonsyndromic craniosynostosis, with at least 3 years of follow-up were reviewed in this study. Mean age of the patients at the time of the operation was 23.44 ± 18.42 months and mean operative time was 4.96 ± 0.97 hours. Blood transfusion was required in all patients, with an average of 112.04 ± 44.60 mL. Amount of the distraction ranged 10 to 30 mm, a mean of 17.26 ± 4.71 mm for the right side and 18.15 ± 4.69 mm for the left side. Mean duration of consolidation was 98.26 ± 12.98 days and mean follow-up was 41.33 ± 22.92 months. In this study, result of internal distraction of fronto-orbital segment as a nonvascularized bone graft in craniosynostotic patients is reviewed to emphasize the efficacy of the nonvascularized bone graft distraction in management of craniosynostosis. Graft distraction after fronto-orbital and cranial vault remodeling appears to be safe and effective approach in correcting severe craniosynostosis deformities especially necessitating asymmetrical advancement.

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Secondary Palatal Elongation: Improvement in Speech Quality

Abstract: Cleft palate is one of the challenging problems in the field of craniofacial surgery. In particular, the conventional methods of bilateral and severe cleft palate repairs have failed to achieve normal speech. In most instances, secondary procedures such as pharyngoplasty and pharyngeal flap surgery are performed to improve speech. This study introduces secondary palatal elongation (SPE) as a new approach to cleft palate repair. The patients included usually had a short palate and unrepaired palatal muscles. The authors' procedure involved dissecting the previously repaired palatal mucosa and pushing back and cutting the nasal mucosa of the palate horizontally and further pushing it back. Then, 1 or 2 buccal mucosal flaps were used to repair the nasal mucosal defect of the palate. In case of unrepaired veloplasty from the primary surgery, the levator muscles were dissected and sutured together to perform veloplasty. The range of palatal elongation was 15 to 25 mm. Secondary palatal elongation has been performed on 17 patients since 2007 with a high rate of speech improvement. Based on this 9-year experience with performing SPE, SPE is a radical anatomic technique of palatal elongation as compared with pharyngoplasty and pharyngeal flap surgery. All 17 patients who underwent SPE showed improvement in speech, from very poor to poor speech and from normal to good speech.

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The Effect of External Approach Septoplasty on Olfactory Function

Objective: Septal deviation-induced nasal obstruction is frequently accompanied by hyposmia. The aim of this study was to evaluate the effect of external approach septoplasty on olfactory function. Methods: Thirty patients (23 males, 7 females) who had external approach septoplasty were included in the study. The age interval was 18 to 60 years (mean 33±12 years). All subjects had olfactory function and acoustic rhinometry tests in both the pre- and postoperative periods (mean interval 6 weeks ± 3 weeks). Olfactory function was determined by the "Sniffin Sticks" test. The minimum cross-sectional area from the nostril to 2.20 cm backward was referred to as MCA1, and the minimum cross-sectional area from 2.20 to 5.40 cm was referred to as MCA2, determined by acoustic rhinometry. Results: Olfactory threshold, discrimination, and identification function improved significantly after external approach septoplasty. A statistically significant difference was also detected between pre- and postoperative left MCA1 and left MCA2 of the nasal cavities. Postoperative hyposmic and anosmic patient improvement was statistically significant. Conclusion: External approach septoplasty has a beneficial effect on olfaction and this effect may be partly due to interactions between the increased perception of nasal air flow, as well as surgery-associated improvement in the internal nasal valve area.

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An Epithelioid Hemangioendothelioma of the Head and Neck

Abstract: An epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of the head and neck region, which carries a risk of recurrence and metastasis. Its etiology is still unclear. It frequently involves the lungs, liver, and bones. Rarely, it may manifest in other parts of the body. Pathologic immunohistochemical investigations are essential to make the definite diagnosis. As it is uncommon, there is no standardized protocol for the treatment of EHE. Herein, the authors report a rare patient with of an EHE localized in the head and neck region.

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Surgical Outcome of Simplified Horse-Shoe Technique With the Traditional Procedure in Children With Trigonocephaly

Abstract: Trigonocephaly is one of the most common types of craniosynostosis leading to triangular-shaped head and neurodevelopmental complications. Several surgical techniques have been suggested for its correction, but the newly suggested technique seems to have optimal outcomes compared with the traditional methods. Thus, the authors retrospectively evaluated the outcomes of the simplified horse-shoe technique with previous procedures performed on 169 children severe trigonocephaly during 1996 to 2015 at Mofid Hospital, Tehran, Iran. Demographic data of the patients and the surgical outcomes and complications and the need for reoperation were recorded and scored using the Whitaker system. The male-to-female ratio was 2.75:1. The mean ±  standard deviation age of all the patients at the time of surgery was 7.09 ± 7.5, 9.95 ± 7.71, 10.53 ± 6.57, and 10.59 ± 7.96 months for the traditional, horse-shoe, and simplified horse-shoe techniques, respectively. The total reoperation rate was 6.5% (4.7% in the traditional technique, 1.2% in the horse-shoe, and 0.6% in the simplified horse-shoe technique) (P 

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Is Horizontal Mattress Suturing More Effective Than Simple Interrupted Suturing on Postoperative Complications and Primary Wound Healing After Impacted Mandibular Third Molar Surgery?

Abstract: The aim of this clinical study was to compare the influence of 2 different suturing techniques on postoperative complications and wound healing after surgical extractions of impacted mandibular third molars. In this randomized split mouth study, 30 patients were examined in whom 60 consecutive surgical extractions of symmetrically positioned impacted mandibular third molars were performed. After the extractions, the surgical flaps were sutured with either the simple interrupted or horizontal mattress suturing technique. Postoperative swelling and trismus were recorded on the 2nd, 7th, and 10th days. Pain was recorded in a 7-day diary and wound dehiscence was recorded on the10th postoperative day. Statistical evaluation of data was made using Mann–Whitney U test and Pearson correlation. There were no statistical differences between the 2 suturing techniques in terms of postoperative pain, trismus, and swelling (P > 0.05). There was significantly less wound dehiscence in the horizontal mattress suturing group than in the simple interrupted suturing group (P: 0017). According to the results of this study, the horizontal mattress suturing technique is more effective than the simple interrupted suturing technique on wound healing after impacted mandibular third molar surgery, although it does not decrease the levels of pain, trismus, and swelling.

http://ift.tt/2xTNQ48

Attentional Modulation of Envelope-Following Responses at Lower (93–109 Hz) but Not Higher (217–233 Hz) Modulation Rates

Abstract

Directing attention to sounds of different frequencies allows listeners to perceive a sound of interest, like a talker, in a mixture. Whether cortically generated frequency-specific attention affects responses as low as the auditory brainstem is currently unclear. Participants attended to either a high- or low-frequency tone stream, which was presented simultaneously and tagged with different amplitude modulation (AM) rates. In a replication design, we showed that envelope-following responses (EFRs) were modulated by attention only when the stimulus AM rate was slow enough for the auditory cortex to track—and not for stimuli with faster AM rates, which are thought to reflect 'purer' brainstem sources. Thus, we found no evidence of frequency-specific attentional modulation that can be confidently attributed to brainstem generators. The results demonstrate that different neural populations contribute to EFRs at higher and lower rates, compatible with cortical contributions at lower rates. The results further demonstrate that stimulus AM rate can alter conclusions of EFR studies.

http://ift.tt/2hKbevj

Attentional Modulation of Envelope-Following Responses at Lower (93–109 Hz) but Not Higher (217–233 Hz) Modulation Rates

Abstract

Directing attention to sounds of different frequencies allows listeners to perceive a sound of interest, like a talker, in a mixture. Whether cortically generated frequency-specific attention affects responses as low as the auditory brainstem is currently unclear. Participants attended to either a high- or low-frequency tone stream, which was presented simultaneously and tagged with different amplitude modulation (AM) rates. In a replication design, we showed that envelope-following responses (EFRs) were modulated by attention only when the stimulus AM rate was slow enough for the auditory cortex to track—and not for stimuli with faster AM rates, which are thought to reflect 'purer' brainstem sources. Thus, we found no evidence of frequency-specific attentional modulation that can be confidently attributed to brainstem generators. The results demonstrate that different neural populations contribute to EFRs at higher and lower rates, compatible with cortical contributions at lower rates. The results further demonstrate that stimulus AM rate can alter conclusions of EFR studies.

http://ift.tt/2hKbevj

Colonization of the middle turbinate

Publication date: Available online 2 October 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Djian, A.-L. Gaultier, S. Chartier, O. Laccourreye




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Tolerable rates of visual field progression in a population-based sample of patients with glaucoma

Aims

To provide population-based data on the maximum tolerable rate of progression to avoid visual impairment (maxTRoP_VI) and blindness (maxTRoP_BL) from open-angle glaucoma (OAG).

Methods

Participants with OAG in the Thessaloniki Eye Study (cross-sectional, population-based study in a European population) were included in the analysis. Visual impairment was defined as mean deviation (MD) equal to or worse than –12 dB and blindness as MD equal to or worse than –24 dB. Additional thresholds for visual impairment were tested. For each participant maxTRoP_VI was defined as the rate of progression which would not lead to visual impairment during expected lifetime. MaxTRoP_BL was defined accordingly. Both parameters were calculated for each OAG subject using age, sex, MD and life expectancy data. The eye with the better MD per subject was included in the analysis.

Results

Among 135 subjects with OAG, 123 had reliable visual fields and were included in the analysis. The mean age was 73±6 years and the median MD was –3.65±5.28 dB. Among those, 69.1% would have a maxTRoP_VI slower than –1 dB/year and 18.7% would have a maxTRoP_VI between –1 and –2 dB/year. Also, 72.4% would have a maxTRoP_BL slower than –2 dB/year. For all tested thresholds for visual impairment, approximately 86% of the OAG study participants would not be able to tolerate a rate of progression equal to or faster than –2 dB/year.

Conclusions

The majority of patients with glaucoma in our study would have a maximum tolerable rate of progression slower than –1 dB/year in their better eye. Patient-tailored strategies to monitor the visual field are important, but raise the issue of feasibility with regard to the number of visual field tests needed.

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Interlower and postlower eyelid retractor fat pads: a cadaveric microscopic study

Background

To report the histological microscopic anatomy of the interlower and postlower eyelid retractor (LER) fat pads.

Methods

In this experimental microscopic study, 31 exenterated orbits from 31 Japanese cadavers (19 right and 12 left; 15 male and 16 female; mean age of death, 81.0±8.8 years; range, 52–97 years) fixed in 10% buffered formalin were used. Masson trichrome was used to stain sagittal full sections of exenterated tissues. Microscopic examination of the lower eyelids was carried out.

Results

The exenterated orbits demonstrated the presence of the histological existence of inter-LER fat pad (80.6%) and post-LER fat pad (22.6%) in the lower eyelids. The inter-LER fat pad was thick and located between the anterior and posterior layers of the LER, where the blood vessels passed through in 18 specimens (72.0%). The post-LER pad was thin, subtle and located between the posterior layer of the LER and conjunctiva.

Conclusion

This study reports a novel finding of the inter-LER and post-LER fat pads. Awareness of these fat layers provides surgeons with additional anatomical detail of lower eyelid anatomy.

http://ift.tt/2hJ4DRL

Prevalence and incidence of non-arteritic anterior ischaemic optic neuropathy in South Korea: a nationwide population-based study

Aims

To determine the age and sex-specific prevalence and incidence of non-arteritic anterior ischaemic optic neuropathy (NAION) in South Korea.

Methods

This is a nationwide population-based study using data from the Korean national health claims database to identify patients with NAION using the registration programme database, which comprises ophthalmologist-confirmed NAION from 2011 through 2015. We evaluated prevalence and incidence rates using these data.

Results

Among 25 816 797 of entire population 40 years of age or older, 26 167 patients had NAION (47.8% men) during the 5-year study period. The prevalence in the general population 40 years of age or older was 102.87 (95% CI 95.22 to 110.53) per 100 000 people. In men, it was 111.10 (95% CI 101.19 to 121.02), and in women, it was 94.64 (95% CI 89.25 to 100.03) per 100 000 people. The prevalence increased with advancing age and peaked at 70–74 years in men and 65–69 years in women. The incidence in the general population 40 years of age or older was 11.35 (95% CI 10.37 to 12.33) per 100 000 person-years. In men, it was 14.89 (95% CI 12.26 to 16.91), and in women, it was 9.92 (95% CI 8.85 to 10.99) per 100 000 person-years. The incidence increased with advancing age and peaked at 80–84 years in men and 70–74 years in women.

Conclusions

The prevalence and incidence estimates of NAION are comparable with those of Caucasians. These detailed estimates could promote understanding of the disease's pathophysiology and allow for appropriate planning within the healthcare system.

http://ift.tt/2xOI5Tx

MicroRNA-20a-5p suppresses IL-17 production by targeting OSM and CCL1 in patients with Vogt-Koyanagi-Harada disease

Aim

To elucidate the role of microRNA-20a-5p (miR-20a-5p) in the pathogenesis of Vogt-Koyanagi-Harada (VKH) disease.

Methods

Quantitative real-time PCR was used to quantify miR-20a-5p expression in CD4⁺ T cells from patients with active VKH and normal controls. The promoter methylation status of miR-20a-5p was detected by bisulfite sequencing PCR. Targets were evaluated by a luciferase reporter assay. The functional effects of miR-20a-5p on CD4⁺ T cells from patients with active VKH were assessed by upregulation or downregulation of its expression using liposomes.

Results

The miR-20a-5p level was significantly decreased in CD4⁺ T cells from patients with active VKH as compared with normal controls. The two genes, oncostatin M (OSM) and C-C motif chemokine ligand 1 (CCL1), were identified as targets of miR-20a-5p. The upregulation of miR-20a-5p significantly suppressed interleukin 17 (IL-17) production in CD4⁺ T cells from patients with active VKH, whereas downregulation of miR-20a-5p exhibited an inverse effect. In addition, overexpression of OSM and CCL1 could rescue the effect of the upregulation of miR-20a-5p. Moreover, the level of miR-20a-5p was reduced in response to hypermethylation of the promoter. Further study showed that miR-20a-5p suppressed the activity of the phosphoinositide 3-kinase-AKT pathway.

Conclusions

Our findings indicate that downregulation of miR-20a-5p is caused by promoter hypermethylation. MiR-20a-5p could also suppress the production of IL-17 by targeting OSM and CCL1 production in CD4⁺ T cells in patients with active VKH.

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Choroidal neovascularisation triggered multiple evanescent white dot syndrome (MEWDS) in predisposed eyes

Background

Multiple evanescent white dot syndrome (MEWDS) is an inflammatory disease that can be associated with choroidalneovascularisation (CNV). However, few studies in the literature have described the occurrence of MEWDS in association with CNV. This paper discusses whether CNV can trigger MEWDS in a predisposed eye.

Methods

A retrospective multicentric case series of six eyes in six patients with acute onset of MEWDS and evidence of previous CNV was conducted between January 2015 and January 2017. All patients underwent ophthalmic examination including multimodal imaging at baseline and during follow-up.

Results

The mean age was 32.2±12.2 years. The majority of patients were women (5/1). In each case, MEWDS was diagnosed during a recurrence or occurrence of CNV secondary to choriocapillaritis, central serous chorioretinopathy or atrophic scar, presumably due to congenital toxoplasmosis. All patients were treated with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) with good anatomical and functional responses (mean gain of 0.3±0.31 logMAR). The mean duration of follow-up was 13.5±10.65 months.

Conclusion

This study highlights a sequence in the development of MEWDS, following the occurrence or recurrence of CNV. CNV may trigger MEWDS, possibly due to the proinflammatory environment created by the retinal tissue surrounding the CNV.

http://ift.tt/2xOBNmW

Differences in clinical ocular outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix: a systematic review of published literature

Background

Sporotrichosis is an implantation mycosis caused by Sporothrix species prevalent worldwide, which occasionally can also result in intraocular infection presenting as an exogenous or endogenous infection (disseminated sporotrichosis). Knowledge in its clinical recognition and management is limited.

Aims

To systematically review and analyse data from published literature with a view to comparing clinical outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix.

Methods

Case reports of intraocular sporotrichosis, published from 1960 to 2016, were retrieved from MEDLINE, Embase, Cochrane, LILACS and SciELO databases. The entire data set was divided into two patient groups: (1) exogenous endophthalmitis and (2) endogenous endophthalmitis. Primary outcomes were differences in ocular findings and clinical ocular outcomes between the two groups.

Results

From 16 publications retrieved, a total of 8 eyes of 8 patients with exogenous endophthalmitis and 13 eyes of 10 patients with endogenous endophthalmitis were identified. Compared with exogenous endophthalmitis, endogenous endophthalmitis was more common in patients infected with HIV (p=0.001) and those from hyperendemic areas (p=0.036). Anterior uveitis (p=0.015) and posterior uveitis (p=0.04) were more common in the exogenous and endogenous endophthalmitis groups, respectively. The majority of patients with endogenous endophthalmitis had partial or full clinical resolution of ocular lesions with systemic amphotericin B alone or in combination with an oral antifungal, whereas patients with exogenous endophthalmitis had poor outcomes with irreversible vision loss, enucleation and evisceration.

Conclusions

Anterior uveitis is more common in exogenous endophthalmitis with worse overall outcomes and complications, compared with endogenous endophthalmitis where posterior uveitis is the most common clinical manifestation, especially in patients infected with HIV and those from hyperendemic areas. Sporothrix infection should be included in the differential diagnosis for ocular inflammation, regardless of the presence or absence of autoimmune comorbidities and whether the patient resides in an endemic area or not. Ophthalmologists should consider intravitreal and systemic antifungal therapy for exogenous and endogenous endophthalmitis caused by Sporothrix.

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Retinal hemangioblastoma: prevalence, incidence and frequency of underlying von Hippel-Lindau disease

Background and aims

We aimed to determine the frequency of von Hippel-Lindau disease (vHL) as the underlying cause of retinal hemangioblastoma and to estimate retinal hemangioblastoma incidence and prevalence in a national cohort study.

Methods

Through the national patient register and vHL research database, we identified 81 patients diagnosed with a retinal hemangioblastoma in Denmark between 1977 and 2014. Consent was obtained for 54 living and 10 deceased patients with retinal hemangioblastoma. For each participant, we collected medical records and family information. Almost all (63 of 64) participants were or had previously been tested for mutations in the VHL gene.

Results

Overall, 84% of the participants (54 of the 64) had vHL. Compared with the non-vHL patients, the vHL patients had their first retinal hemangioblastoma at a younger age (22.5 vs 40 years), and were more likely to have an asymptomatic first hemangioblastoma (80% vs 20%). Overall, 76% (41 of 54) of the vHL patients had a family history of vHL, while none of the patients without vHL did. Despite the rarity of the disease, on average more than eight new tumours are diagnosed each year due to multiple tumour development in vHL patients. The estimated prevalence of patients with retinal hemangioblastoma was up to 1 in 73 080 individuals.

Conclusion

In the first national study in which almost all participants were genetically tested, vHL was the underlying cause of retinal hemangioblastoma in 84% of cases; more often than previously reported. We recommend that genetic and clinical vHL screening should be performed in all patients with retinal hemangioblastoma.

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Risk factors for extraophthalmic involvement and treatment outcomes in patients with IgG4-related ophthalmic disease

Background/aim

To analyse the clinical risk factors for extraophthalmic involvement and treatment outcomes in patients with IgG4-related ophthalmic disease (IgG4-ROD) in Korea.

Methods

We retrospectively reviewed medical records of 42 patients diagnosed with IgG4-ROD confirmed by a surgical biopsy during the 7-year period, between January 2009 and March 2015, at three tertiary referral centres in Korea. Data regarding patients' demographics, clinical characteristics and radiological findings were obtained. The relapse rate was compared between systemic steroids only and combined immunosuppressant therapy.

Results

The mean patient age was 55.2 years (male:female ratio, 1:1). Based on the primary orbital structure affected, the IgG4-RODs were classified as dacryoadenitis (52.4%), orbital soft tissue inflammation (21.4%), trigeminal nerve involvement (11.9%) and myositis (9.5%). Extraophthalmic involvement (n=21) was associated with bilateral involvement (p=0.004), longer symptom duration (p=0.033) and a higher serum IgG4 level (p=0.034). Initial treatment regimens included attentive observation (n=7), prednisolone alone (n=22) and prednisolone plus immunosuppressive agent (n=13). During follow-up (mean, 24 months), 13 patients (37.1%) experienced relapse. In the extraophthalmic involvement group, steroid therapy alone resulted in a significantly higher relapse rate than combined immunosuppressant treatment (p=0.028).

Conclusion

Bilateral involvement, longer symptom duration and higher IgG4 levels were significant risk factors for extraophthalmic involvement in Korean patients with IgG4-ROD. In patients with an extraophthalmic involvement, prednisolone combined with an immunosuppressive agent was more effective for preventing recurrence than prednisolone alone.

http://ift.tt/2hHQtQC