Head and Neck Diseases by Alexandros G.Sfakianakis: 10/14/17

Σάββατο 14 Οκτωβρίου 2017

Kinetics of imidazolium-based ionic liquids degradation in aqueous solution by Fenton oxidation

Abstract

In the last few years, several works dealing with Fenton oxidation of ionic liquids (ILs) have proved the capability of this technology for their degradation, achieving complete ILs removal and non-toxic effluents. Nevertheless, very little is known about the kinetics of this process, crucial for its potential application. In this work, the effect of several operating conditions, including reaction temperature (50–90 °C), catalyst load (10–50 mg L⁻¹ Fe³⁺), initial IL concentration (100–2000 mg L⁻¹), and hydrogen peroxide dose (10–200% of the stoichiometric amount for the complete IL mineralization) on 1-butyl-3-methylimidazolium chloride ([C₄mim]Cl) oxidation has been investigated. Under the optimum operating conditions (T = 90 °C; [Fe³⁺]₀ = 50 mg L⁻¹; [H₂O₂]₀ = 100% of the stoichiometric amount), the complete removal of [C₄mim]Cl (1000 mg L⁻¹) was achieved at 1.5-min reaction time. From the experimental results, a potential kinetic model capable to describe the removal of imidazolium-based ILs by Fenton oxidation has been developed. By fitting the proposed model to the experimental data, the orders of the reaction with respect to IL initial concentration, Fe³⁺ amount and H₂O₂ dose were found to be close to 1, with an apparent activation energy of 43.3 kJ mol⁻¹. The model resulted in a reasonable fit within the wide range of operating conditions tested in this work.

http://ift.tt/2yqhRsC

Heterogeneous electro-Fenton catalyst for 1-butylpyridinium chloride degradation

Abstract

The application of the electro-Fenton process for organic compound mineralisation has been widely reported over the past years. However, operational problems related to the use of soluble iron salt as a homogeneous catalyst involve the development of novel catalysts that are able to operate in a wide pH range. For this purpose, polyvinyl alcohol-alginate beads, containing goethite as iron, were synthesised and evaluated as heterogeneous electro-Fenton catalyst for 1-butylpyridinium chloride mineralisation. The influence of catalyst dosage and pH solution on ionic liquid degradation was analysed, achieving almost total oxidation after 60 min under optimal conditions (2 g/L catalyst concentration and pH 3). The results showed good catalyst stability and reusability, although its effectiveness decreases slightly after three successive cycles. Furthermore, a plausible mineralisation pathway was proposed based on the oxidation byproducts determined by chromatographic techniques. Finally, the Microtox® test revealed notable detoxification after treatment which demonstrates high catalyst ability for pyridinium-based ionic liquid degradation by the electro-Fenton process.

http://ift.tt/2gjYUkM

Effect and mechanism of microwave-activated ultraviolet-advanced oxidation technology for adsorbent regeneration

Abstract

To decrease the secondary pollution of volatile organic compounds (VOCs) during adsorbent regeneration by microwave, electrodeless lamp was added in the microwave field to oxidize VOCs in the gas phase. Ultraviolet has a significant improvement on mineralization of VOCs generated from adsorbate during adsorbent regeneration. However, the mechanism and main influence factors on the degradation of VOCs are not clear. The effect of microwave power, regeneration time, airflow rate, and humidity content on the mineralization of adsorbed tetracycline during adsorbent regeneration was studied. Ozone concentration and ultraviolet irradiation intensity were also measured to analyze the mechanism of the microwave-ultraviolet adsorbent regeneration method. Although the electrodeless lamp adsorbed microwave and competed with the regenerated adsorbent, the mineralization percentage of tetracycline increased about 10% with the presence of electrodeless lamp at the same microwave power supply. Besides, humidity content also takes an important role on enhancing the mineralization of tetracycline. The mineralization of tetracycline in the microwave-ultraviolet field consists of three major parts: pyrolysis, ozone oxidation, and free radical oxidation. More than 50% adsorbed tetracycline can be oxidized into H₂O and CO₂ during regeneration in 5 min. These results support the potential use of electrodeless lamp to treat VOCs in the gas phase to decrease the risk of secondary pollution during adsorbent regeneration.

http://ift.tt/2yqhFJU

Mosquito oviposition deterrents

Abstract

Mosquitoes are well-known vectors of disease and threaten the health of millions of people annually. While synthetic insecticides have been relied on to combat these diseases, insecticide resistance and environmental concerns have directed attention towards novel and more targeted mosquitocides derived from botanicals. Research on the activity of botanical derivatives has focused on mosquito larvae and adults with little attention given to their potential as oviposition deterrents against gravid female mosquitoes. This review explores the influence of chemical and biological factors on deterrence and examines issues relating to environmental persistence and non-target effects. With very few discoveries of new insecticide pathways, the answer to effective mosquito control may well reside within other ancient plant-based organisms that have co-resided and evolved with this ubiquitous pest.

http://ift.tt/2gkKCjQ

Macrophytes as potential biomonitors in peri-urban wetlands of the Middle Parana River (Argentina)

Abstract

The aims of this study were to measure the concentrations of nutrients and pollutants in peri-urban wetlands, to analyze the plant morphology of the most representative macrophyte species, and to determine their potential use as biomonitors. Four wetlands in the Middle Paraná River floodplain evidencing contamination or anthropogenic impact were studied. The studied species were Typha domingensis Pers., Eichhornia crassipes (Mart.) Solms., Alternanthera philoxeroides (Mart.) Griseb., and Pistia stratiotes L. Besides, the same plant species from an uncontaminated wetland considered as control were studied. A. philoxeroides showed the highest total phosphorus (TP) concentration in leaves throughout the study, while the other species showed a higher TP concentration in roots than in leaves. Since metal concentration in A. philoxeroides tissues was always higher than in sediment, further studies focused on its phytoremediation capacity should be carried out. T. domingensis exhibited the highest Zn concentrations in roots followed by Pb, and E. crassipes presented the highest values of Pb concentrations in roots. The aerial part height of the plants from peri-urban wetlands was significantly higher than that of the plants from the control, while the root length was significantly lower. The root length of P. stratiotes showed a negative correlation with soluble reactive phosphorus (SRP) concentration in water. All the root anatomical parameters of T. domingensis and E. crassipes showed a positive correlation with nitrate and ammonium concentrations in water. The studied macrophytes evidenced a high tolerance, enabling them to grow and survive in peri-urban wetlands that receive pollution from different sources. The use of aquatic and wetland plants as contaminant bioindicators and bioaccumulators in the Middle Paraná River floodplain is completely feasible.

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A bibliometric analysis of research on haze during 2000–2016

Abstract

As one of the bibliometric analysis tools, CiteSpace software was applied to quantitatively and visually evaluate global scientific documents of research on haze from 2000 to 2016. Five thousand six hundred six documents from the Science Citation Index Expanded (SCI-Expanded) and Social Science Citation Index (SSCI) of the Web of Science database were statistically analyzed and examined. The distributions on authorship, countries/territories, institutes, and keywords were generated. The amount of publications has increased nearly for the past 17 years. The most productive author was Li J. with 46 articles. The publications on haze research were primarily originated from the USA, China, Germany, and France. By synthetically analyzing the keywords, the dominant hot spots of haze research could be concluded as "aerosol," "atmosphere," "particle," "PM_2.5,"and "air quality."

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Interaction mechanisms between polycyclic aromatic hydrocarbons (PAHs) and organic soil washing agents

Abstract

Understanding interaction mechanisms between polycyclic aromatic hydrocarbons (PAHs) and soil-washing agents can help in choosing efficient agents which are able to desorb and solubilize PAHs. This study investigated interaction mechanisms between pyrene and four washing agents including: two dissolved organic matters (DOM) F-DOM and CRC-DOM, and two commercial bio-based surfactants BBE-1000 and Supersolv using fluorescence spectroscopy combined with multivariate curve resolution alternating regression (MCR-AR). The efficiencies of these washing agents in removing PAHs from the soil were tested in a soil washing experiment. Pyrene showed π-π interactions with F-DOM and no interaction with CRC-DOM. This could be attributed to the more aromatic structures in F-DOM compared to CRC-DOM. The two DOMs were inefficient in soil washing which might be attributed to the relatively weak effect of π-π interactions in releasing PAHs from the soil. Interaction mechanisms between pyrene and the bio-based surfactants were elucidated with MCR-AR, which resolved three spectroscopically active species from pyrene emission spectra as a function of pyrene and bio-based surfactants concentrations. These species resembled pyrene emission in a polar and nonpolar microenvironment, respectively and of an excimer. Concentration profiles retrieved by the model for the three species showed that, below the critical micelle concentration (CMC), Supersolv created more nonpolar interactions with pyrene compared to BBE-1000. In soil washing, Supersolv showed the highest efficiency in extracting PAHs from the soil. This highlighted the importance of nonpolar interactions in desorbing PAHs from soils, which could then be solubilized in micelles. This study demonstrated the potential of fluorescence spectroscopy combined with the MCR-AR model for selecting efficient soil-washing agents.

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Use of Supplementary Patient Education Material Increases Treatment Adherence and Satisfaction Among Acne Patients Receiving Adapalene 0.1%/Benzoyl Peroxide 2.5% Gel in Primary Care Clinics: A Multicenter, Randomized, Controlled Clinical Study

Abstract

Introduction

Poor adherence to acne treatment may lead to unnecessary treatments, increased healthcare costs, and reduced quality of life (QoL). This multicenter study evaluated the effect of supplementary patient education material (SEM) (a short video, information card, and additional information available online) on treatment adherence and satisfaction among acne patients treated with the fixed-dose combination adapalene 0.1%/benzoyl peroxide 2.5% gel (A/BPO) in primary care clinics versus (1) standard-of-care patient education (SOCPE) (package insert and oral instruction) and (2) SOCPE plus more frequent clinic visits.

Methods

Subjects with acne were randomized to receive once-daily A/BPO for 12 weeks plus (1) SEM in addition to SOCPE; (2) SOCPE only with two additional visits; or (3) SOCPE only. Other assessments included a subject appreciation questionnaire, a physician questionnaire, and safety.

Results

Ninety-seven subjects were enrolled. At baseline, most (87.6%) had mild to moderate acne. Better adherence was observed in the A/BPO + SEM group compared with A/BPO + more visits or A/BPO alone [mean 63.1%, 48.2% (p = 0.0206), and 56.5%, respectively]. The A/BPO + SEM group had more subjects with greater than 75% adherence (45%, 30.4%, and 25%, respectively). According to the subject appreciation questionnaire, the SEM was more helpful to adhere to treatment (56.7%) versus more visits (32.3%) and A/BPO alone (15.2%), better use the product (70%, 61.3%, and 54.5%, respectively), and better manage skin irritation (53.3%, 48.4%, and 36.4%, respectively). All physicians were satisfied with the SEM and 90% would consider using it in their practice. Safety assessment showed fewer treatment-related adverse events in the A/BPO + SEM group.

Conclusion

Use of the SEM may increase adherence of acne patients treated with once-daily A/BPO gel in primary care, consequently improving treatment and QoL in the long term.

Funding

Nestle Skin Health-Galderma R&D.

Trial Registration

ClinicalTrials.gov Identifier: NCT02307266.

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Staphylococcus lugdunensis Infections of the Skin and Soft Tissue: A Case Series and Review

Abstract

Introduction

Staphylococcus lugdunensis (S. lugdunensis) is a coagulase-negative, Gram-positive bacterium that can be isolated as a component of normal skin flora in humans. However, more recently, it has also been documented as a culprit in skin and soft tissue infections. We describe the clinical features of five individuals with S. lugdunensis-associated skin infections. We review the characteristics of other patients that were previously described with this organism as the causative agent of skin infection.

Methods

Staphylococcus lugdunensis was correlated with the development of significant skin and soft tissue infections in five patients. The Pubmed database was used to search for the following terms: "abscess," "cellulitis," "cutaneous," "lugdunensis," "paronychia," "skin," "soft," "staphylococcus," and "tissue." The relevant and reference papers generated by the search were reviewed.

Results

One woman and four men developed S. lugdunensis-related skin infections from February 19, 2015 to May 30, 2017. The patients' ages at the onset of the infection ranged from 30 to 82 years; the median age was 70 years. Four patients were older than 65 years. The back was the most common location for the infection, followed by digits. The infection presented as cystic lesions with cellulitis or periungual abscesses. The lesions were incised or spontaneously ruptured. Patients were empirically treated with oral antibiotics; if necessary, the management was adjusted based on the culture-derived sensitivities of the organisms. The infections resolved within 10–30 days after commencing treatment.

Conclusion

Staphylococcus lugdunensis has previously been considered as a nonpathogenic organism and to be a component of normal skin flora. However, S. lugdunensis can result in significant skin and soft tissue infections, perhaps more frequently in older individuals. Its antibiotic sensitivities appear to be similar to those of methicillin-susceptible Staphylococcus aureus.

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Periodontitis: from Infection to Inflammation

Abstract

Purpose of the Review

The purpose of this study is to discuss the current understanding of periodontitis causation.

Recent Findings

The understanding of periodontitis as a monocausal infection has hindered the investigation of other potential causes that influence periodontitis morbidity and does not reflect the complexity of periodontitis etiology. Still today, the periodontal literature frequently defines periodontitis as an infection, whereas other potential causes of periodontitis, like smoking, which seems to be causally related to periodontitis, are typically called modifying or susceptibility factors. Instead of addressing the complexity of periodontitis, the field has narrowed its focus trying to find the most important bacteria or gene. Distal causes of periodontitis and interaction between constellations of causes at multiple levels have been commonly neglected.

Summary

Understanding periodontitis as a group of signs and symptoms characterized by inflammatory destruction of the periodontium would provide a better frame for future etiological research.

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Imaging in Rheumatology: An Update

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Giuseppe Guglielmi

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Practical Pediatric Imaging

Publication date: July 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 4
Author(s): Edward Y. Lee

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Copyright

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6

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Computed Tomography and MR Imaging in Crystalline-Induced Arthropathies

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Constantinus Franciscus Buckens, Maaike P. Terra, Mario Maas

Teaser

Crystalline-induced arthropathies impose substantial morbidity but can be challenging to diagnose, especially in early phases. The most common crystalline arthropathies are gout (monosodium urate deposition), calcium pyrophosphate dihydrate deposition, and hydroxyapatite deposition disease. Computed tomography (CT) and MR imaging provide 3-dimensional information on osseous structures, periarticular soft tissue, and tophi with superior spatial resolution. Dual-source CT (dual-energy CT [DECT]) offers the further advantage of selectively identifying crystalline deposits. CT, MR imaging, and DECT can be of value in problematic cases and can potentially be used for disease monitoring. Further research is necessary to elucidate their added value.

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Contributors

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5

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Conventional Radiology in Crystal Arthritis

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Thibaut Jacques, Paul Michelin, Sammy Badr, Michelangelo Nasuto, Guillaume Lefebvre, Neal Larkman, Anne Cotten

Teaser

This article reviews the main radiographic features of crystal deposition diseases. Gout is linked to monosodium urate crystals. Classic radiographic features include subcutaneous tophi, large and well-circumscribed paraarticular bone erosions, and exuberant bone hyperostosis. Calcium pyrophosphate deposition (CPPD) can involve numerous structures, such as hyaline cartilages, fibrocartilages, or tendons. CPPD arthropathy involves joints usually spared by osteoarthritis. Basic calcium phosphate deposits are periarticular or intraarticular. Periarticular calcifications are amorphous, dense, and round or oval with well-limited borders, and most are asymptomatic. When resorbing, they become cloudy and less dense with an ill-defined shape and can migrate into adjacent structures.

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CME Accreditation Page

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6

http://ift.tt/2gjMXMj

Imaging in Osteoarthritis

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Daichi Hayashi, Frank W. Roemer, Mohamed Jarraya, Ali Guermazi

Teaser

With technologic advances and the availability of sophisticated computer software and analytical strategies, imaging plays an increasingly important role in understanding the disease process of osteoarthritis (OA). Radiography has limitations in that it can visualize only limited features of OA, such as osteophytes and joint space narrowing, but remains the most commonly used modality for establishing an imaging-based diagnosis of OA. This article describes the roles and limitations of different imaging modalities and discusses the optimum imaging protocol, imaging diagnostic criteria of OA, differential diagnoses, and what the referring physician needs to know.

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Imaging and Cancer Screening

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Dushyant V. Sahani

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Imaging and Cancer Screening

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Dushyant V. Sahani

http://ift.tt/2gjdzNj

CME Accreditation Page

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5

http://ift.tt/2ypaSQH

Screening for Breast Cancer

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Bethany L. Niell, Phoebe E. Freer, Robert Jared Weinfurtner, Elizabeth Kagan Arleo, Jennifer S. Drukteinis

Teaser

The goal of screening is to detect breast cancers when still curable to decrease breast cancer–specific mortality. Breast cancer screening in the United States is routinely performed with mammography, supplemental digital breast tomosynthesis, ultrasound, and/or MR imaging. This article aims to review the most commonly used breast imaging modalities for screening, discuss how often and when to begin screening with specific imaging modalities, and examine the pros and cons of screening. By the article's end, the reader will be better equipped to have informed discussions with patients and medical professionals regarding the benefits and disadvantages of breast cancer screening.

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Conventional Radiology in Rheumatoid Arthritis

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Eva Llopis, Herman M. Kroon, Jose Acosta, Johan L. Bloem

Teaser

In clinical practice, the conventional radiography is still the radiologic method for the diagnosis of rheumatoid arthritis (RA). Moreover, it provides a quick overview of the symptomatic joints to narrow the differential diagnosis and to evaluate progression. RA is a polyarticular disease with bilateral and symmetric involvement of the peripheral joints, especially small joints, and less frequently, the cervical spine. The radiologic features are soft tissue swelling, periarticular osteoporosis, erosions, loss of joint space, and in advanced disease, osteolysis and typical subluxations or deformities, such as ulnar deviation.

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Lung Cancer Screening

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Florian J. Fintelmann, Ravi V. Gottumukkala, Shaunagh McDermott, Matthew D. Gilman, Inga T. Lennes, Jo-Anne O. Shepard

Teaser

This article explains the rationale of lung cancer screening with low-dose computed tomography and provides a practical approach to all relevant aspects of a lung cancer screening program. Imaging protocols, patient eligibility criteria, facility readiness, and reimbursement criteria are addressed step by step. Diagnostic criteria and Lung-RADS (Lung Computed Tomography Screening Reporting and Data System) nodule management pathways are illustrated with examples. Pearls and pitfalls for interpretation of lung cancer screening low-dose chest computed tomography are discussed.

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Computed Tomography and MR Imaging in Rheumatoid Arthritis

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Antonio Barile, Francesco Arrigoni, Federico Bruno, Giuseppe Guglielmi, Marcello Zappia, Alfonso Reginelli, Piero Ruscitti, Paola Cipriani, Roberto Giacomelli, Luca Brunese, Carlo Masciocchi

Teaser

The clinical diagnosis of rheumatoid arthritis is supported by imaging findings. MR imaging, in particular, can allow an early diagnosis to determine a target therapy that can stop or at least slow the disease progression.

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Imaging and Screening for Colorectal Cancer with CT Colonography

Publication date: November 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 6
Author(s): Perry J. Pickhardt

Teaser

Despite being readily preventable, colorectal cancer ranks second behind only lung cancer in overall mortality. However, this situation could be reversed if screening tests that effectively detect advanced adenomas and early cancers were broadly applied. Computed tomographic colonography (CTC) reflects an ideal balance of minimal invasiveness with high-level performance, assuming all facets of the examination are appropriately addressed. Unfortunately, this promising screening test remains grossly underused. This article details the technical and interpretive approaches used by one successful CTC screening program.

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Imaging of Myopathies

Publication date: September 2017
Source:Radiologic Clinics of North America, Volume 55, Issue 5
Author(s): Lukas Filli, Sebastian Winklhofer, Gustav Andreisek, Filippo Del Grande

Teaser

This article clarifies the current role of MR imaging in the assessment of myopathies. Typical MR imaging findings are discussed for different forms of myopathies, including idiopathic inflammatory myopathies, muscular dystrophies, and congenital myopathies. The last section deals with advanced MR imaging techniques and their potential role in further characterization of muscular disease.

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Denosumab as a potential treatment alternative for patients suffering from diffuse sclerosing osteomyelitis of the mandible—a rapid communication

Diffuse sclerosing osteomyelitis (DSO) is a rare disease of the jaw bone. Its treatment is challenging. Different medical and surgical treatment protocols have been proposed; however, none of these treatment protocols produce reliable results. Recently, ibandronate administration has been attempted as a treatment alternative in acute cases of DSO. Due to the similar antiresorptive effect, we sought to explore the application of the human monoclonal antibody to the receptor activator of nuclear factor kappaB ligand (RANKL), denosumab, in the treatment of DSO.

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Influence of Ginkgo Biloba extract (EGb 761) on expression of IL-1 Beta, IL-6, TNF-alfa, HSP-70, HSF-1 and COX-2 after noise exposure in the rat cochlea

The objective of this study was to investigate the influence of Ginkgo Biloba in early treatment of noise induced hearing loss on expression of IL-6, IL-1 Beta, TNF-alfa, HSP-70, HSF-1 and COX-2 in the rat cochlea.

http://ift.tt/2gaFxqK

Influence of Ginkgo Biloba extract (EGb 761) on expression of IL-1 Beta, IL-6, TNF-alfa, HSP-70, HSF-1 and COX-2 after noise exposure in the rat cochlea

Effect of V–Y plasty on lip lengthening and treatment of gummy smile

The aim of this study was to assess the effect of isolated V–Y plasty on lip lengthening and the treatment of gummy smile. An isolated V–Y plasty was performed on 14 patients with a gummy smile. In each case, measurements of upper lip length and gingival display were recorded from posed-smile photographs taken preoperatively and at 1, 3, and 6 months postoperatively. Gingival display decreased significantly and lip length increased significantly over all intervals investigated. Applying this technique after Le Fort I surgery may be beneficial; however, as with other injection or surgical lip lengthening methods, its stand-alone application should be questioned.

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Intraoperative anaphylaxis to bacitracin during scleral buckle surgery

A 63-year-old man with a history of retinal detachment in the right eye repaired by scleral buckle presented with decreased peripheral vision in the left eye and was found to have a macula-sparing retinal detachment in the left eye, for which urgent repair by scleral buckle was recommended. The patient did not take any routine outpatient medications. Preoperative evaluation revealed no history of anesthetic complications, and he denied any drug allergies. He did not receive any preoperative prophylactic antibiotics.

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Crowdsourcing dermatology: DataDerm, big data analytics, and machine learning technology

"There is art in 'big data'… in the seductive potential of its exponential, uncontrolled, ungraspable growth to improve our lives… and, ultimately, truly personal medicine."1

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Gender Differences in Indoor Tanning Habits and Location

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Beyond the triad: inheritance, mucocutaneous phenotype, and mortality in a cohort of patients with dyskeratosis congenita

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Risk of Melanoma in Patients With Multiple Myeloma: A SEER Population-based Study

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The NPF/Corrona Psoriasis Registry: A New Collaborative Approach to Post-approval Registries

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“Allergen of the Year” alkyl glucoside is an ingredient in top-selling sunscreens and facial moisturizers

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Liquid nitrogen cryotherapy for chronic recalcitrant interdigital candidiasis of toe-spaces – an uncontrolled pilot study

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Pathogenetic insights from quantification of the cerebriform connective tissue nevus in Proteus syndrome

Plantar cerebriform connective tissue nevus (CCTN) size increases in children with Proteus syndrome, but not in adults.The presence and growth of a plantar CCTN are affected by age of the patient and extent of the precursor lesion.Knowledge of CCTN growth patterns may be useful for predicting the rate of expansion and eventual extent of sole involvement.

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Economic and sustainable management of wastes from rice industry: combating the potential threats

Abstract

Rice is one of the imperative staple foods, particularly in the developing countries. The exponential boom in human population has resulted in the continuous expansion in the rice industry in order to meet the food demands. The various stages of paddy processing release huge quantity of solid wastes, mainly rice husk, rice husk ash and liquid wastes in the form of rice industry wastewater. The discharge of the rice industry wastewater imparts a substantial threat to the aquatic bodies and the nearby surrounding and, thus, consequently demands eco-benign treatment plan. As a result, different strategies are needed to enhance the effluent quality and minimize the operational cost of the treatment process. Therefore, efficient technological approach targeting the minimization of pollution as well as assuring the economic prosperity should be implemented. In this review article, several aspects related to the rice industry discussing the significant challenges involved in the generation of both solid and liquid wastes, mitigation experiments and future prospects have been meticulously elaborated. Furthermore, the article also focuses on the various processes utilized for reducing the pollution load and promoting the practice of reuse and recycle of waste rather than the discharge action for the sake of sustainability and the emergence of novel techniques for the generation of energy and value-added products.

http://ift.tt/2kO11ie

Biological and analytical techniques used for detection of polyaromatic hydrocarbons

Abstract

Polycyclic aromatic hydrocarbons contain two or more fused benzene rings that are considered as cosmo-pollutants ubiquitously found in the environment. The identification and monitoring of polycyclic aromatic hydrocarbons (PAHs) are of great interests for rapid and on-site detection. Therefore, many analytical and biological techniques have been proposed for the qualitative and quantitative assessments of PAHs. Non-biological analytical techniques such as infrared, Raman, and fluorescence spectroscopies are commonly exploited as non-destructive techniques while gas chromatography (GC) and high-performance liquid chromatography (HPLC) with multiple detectors are extensively employed for the separation and detection of an analyte. Even though spectroscopy and chromatography are more accurate, convenient, and feasible techniques, often, these methods are expensive and sophisticated which require high maintenance cost. On the other hand, biological approaches, i.e., immunoassay, PCR, and microarray, offer comprehensive high-throughput specificity and sensitivity for a similar analyte. Biosensor- and immunoassay-mediated detections of PAHs have opened up new avenues in terms of low cost, rapid determination, and higher sensitivity. In this review, we have discussed the strengths and limitations of biological and analytical techniques that were explored for precise evaluation and were trusted at both the legislation and research levels.

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Cytokine profile changes in gingival crevicular fluid after placement different brackets types

Publication date: January 2018
Source:Archives of Oral Biology, Volume 85
Author(s): Ana Zilda Nazar Bergamo, Paulo Nelson-Filho, Cássio do Nascimento, Renato Corrêa Viana Casarin, Márcio Zaffalon Casati, Marcela Cristina Damião Andrucioli, Érika Calvano Kuchler, Daniele Lucca Longo, Léa Assed Bezerra da Silva, Mírian Aiko Nakane Matsumoto
ObjectiveThe aim of this study was to examine the relationship between bracket design and ratio of five proinflammatory cytokine, in gingival crevicular fluid (GCF), and bacterial adhesion without tooth movement influence.DesignThe sample was comprised of 20 participants, aged 11 to 15 years old (mean age: 13.3 years±1.03). A conventional Gemini™ metallic bracket and two self-ligating brackets, In-Ovation^®R and SmartClip™, were bonded to the maxillary incisors and canines. GCF was collected using a standard filter paper strip before and 60days after bonding. The cytokine levels (IL-12, IL-1α, IL-1β, IL-6 and TNF-α) were performed by the LUMINEX assay. The levels of the red and orange bacterial complexes were analyzed by the Checkerboard DNA-DNA hybridization. The data of cytokine and bacterial complexes were carried out using the non-parametric tests at 5% of significance level.ResultsIncreased cytokine levels were observed. However, only the SmartClip™ group showed a significantly increased level of TNF-α (p=0.046). The SmartClip™ brackets group presented higher levels of red complex bacteria.ConclusionsThe bracket design affected cytokine levels and bacterial adhesion since it was observed that the proinflammatory cytokines released in GCF to the SmartClip™ group showed an increase in the TNF-α levels associated with higher bacterial levels, which possibly represents greater inflammatory potential. Thereby, the bracket design should be considered in patients with risk of periodontal disease and root resorption.

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Multiple complex somatosensory systems in mature rat molars defined by immunohistochemistry

Publication date: January 2018
Source:Archives of Oral Biology, Volume 85
Author(s): Margaret R. Byers, Leanne M. Cornel
ObjectiveIntradental sensory receptors trigger painful sensations and unperceived mechanosensitivity, but the receptor bases for those functions are only partly defined. We present new evidence here concerning complex endings of myelinated axons in rat molars.DesignWe sectioned mature rat jaws in sagittal and transverse planes to analyze neural immunoreactivity (IR) for parvalbumin, peripherin, neurofilament protein, neurotrophin receptors, synaptophysin, calcitonin gene-related peptide (CGRP), or mas-related g-protein-receptor-d (Mrgprd).ResultsWe found two complex sensory systems in mature rat molar dentin that labeled with neurofilament protein-IR, plus either parvalbumin-IR or peripherin-IR. The parvalbumin-IR system made extensively branched, beaded endings focused into dentin throughout each pulp horn. The peripherin-IR system primarily made unbeaded, fork-shaped dentinal endings scattered throughout crown including cervical regions. Both of these systems differed from neuropeptide CGRP-IR. In molar pulp we found peripherin- and parvalbumin-IR layered endings, either near special horizontal plexus arrays or in small coiled endings near tangled plexus, each with specific foci for specific pulp horns. Parvalbumin-IR nerve fibers had Aβ axons (5–7μm diameter), while peripherin-IR axons were thinner Aδ size (2–5μm). Mechano-nociceptive Mrgprd-IR was only found in peripherin-IR axons.ConclusionsComplex somatosensory receptors in rat molars include two types of dentinal endings that both differ from CGRP-IR endings, and at least two newly defined types of pulpal endings. The PV-IR neurons with their widely branched, synaptophysin-rich, intradentinal beaded endings are good candidates for endodontic non-nociceptive, low threshold, unperceived mechanoreceptors. The complex molar dentinal and pulpal sensory systems were not found in rat incisors.

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Extending the service life of existing dental restorations with esthetic and functional limitations

Publication date: Available online 14 October 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Malin Strasding, Vincent Fehmer, Bjarni E. Pjetursson, Irena Sailer
Adhesive cementation is a useful procedure not only for cementing restorations onto teeth but also for attaching new ceramic restorations to existing restorations to improve their esthetics and/or function. This clinical report presents a technique for modifying an existing nonsatisfactory implant-supported fixed dental prosthesis by means of adhesively cemented veneers and onlays bonded to the pre-existing metal–ceramic surface with resin cement. This modification may avoid the replacement of the fixed dental prosthesis, reducing both treatment costs and time while fulfilling the patient's demands.

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Restoring masticatory function in a patient with severe microstomia using rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis

Publication date: Available online 14 October 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Ibrahim Tulunoglu, Meng Huan Lee, Mohammed Louay Taifur, Ozlem Tulunoglu
This clinical report describes the use of rapid prototyped mesh in a complete swing-lock prosthesis to restore masticatory function in an edentulous patient with severe microstomia and perioral scar tissue after an industrial hot tar accident.

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Marginal discrepancy dimensions of single unit metal crowns fabricated by using CAD-CAM–milled acrylate resin polymer blocks or a conventional waxing technique

Publication date: Available online 14 October 2017
Source:The Journal of Prosthetic Dentistry
Author(s): David Lalande, Jeffrey A. Hodd, John S. Brousseau, Van Ramos, Daniel Dunham, Frederick Rueggeberg
Statement of problemBecause crowns with open margins are a well-known problem and can lead to complications, it is important to assess the accuracy of margins resulting from the use of a new technique. Currently, data regarding the marginal fit of computer-aided design and computer-aided manufacturing (CAD-CAM) technology to fabricate a complete gold crown (CGC) from a castable acrylate resin polymer block are lacking.PurposeThe purpose of this in vitro study was to compare marginal discrepancy widths of CGCs fabricated by using either conventional hand waxing or acrylate resin polymer blocks generated by using CAD-CAM technology.Material and methodsA plastic model of a first mandibular molar was prepared by using a 1-mm, rounded chamfer margin on the entire circumference of the tooth. The master die was duplicated 30 times, and 15 wax patterns were fabricated by using a manual waxing technique, and 15 were fabricated by using CAD-CAM technology. All patterns were invested and cast, and resulting CGCs were cemented on their respective die by using resin-modified glass ionomer cement. The specimens were then embedded in acrylic resin and sectioned buccolingually. The buccal and lingual marginal discrepancies of each sectioned portion were measured by using microscopy at ×50 magnification. Data were subjected to repeated measures 2-way ANOVA, by using the Tukey post hoc pairwise comparison test (α=.05).ResultsThe factor of "technique" had no significant influence on marginal discrepancy measurement (P=.431), but a significant effect of "margin location" (P=.019) was noted. The confounding combination of factors was found to be significantly lower marginal discrepancy dimensions of the lingual margin discrepancy than on the buccal side by using CAD-CAM technology.ConclusionsThe marginal discrepancy of CAD-CAM acrylate resin crowns was not significantly different from those made with a conventional manual method; however, lingual margin discrepancies present from CAD-CAM–prepared crowns were significantly less than those measured on the respective buccal surface.

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Effect of thickness and surface modifications on flexural strength of monolithic zirconia

Publication date: Available online 14 October 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Fusun Ozer, Andrew Naden, Volkan Turp, Francis Mante, Deniz Sen, Markus B. Blatz
Statement of problemA recommended minimum thickness for monolithic zirconia restorations has not been reported. Assessing a proper thickness that has the necessary load-bearing capacity but also conserves dental hard tissues is essential.PurposeThe purpose of this in vitro study was to evaluate the effect of thickness and surface modifications on monolithic zirconia after simulated masticatory stresses.Material and methodsMonolithic zirconia disks (10 mm in diameter) were fabricated with 1.3 mm and 0.8 mm thicknesses. For each thickness, 21 disks were fabricated. The specimens of each group were further divided into 3 subgroups (n=7) according to the surface treatments applied: untreated (control), airborne-particle abrasion with 50-μm Al2O3 particles at a pressure of 400 kPa at 10 mm, and grinding with a diamond rotary instrument followed by polishing. The biaxial flexure strength was determined by using a piston-on-3-balls technique in a universal testing machine. Flexural loading was applied with a 1.4-mm diameter steel cylinder, centered on the disk, at a crosshead speed of 0.5 mm/min until fracture occurred. X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses were performed. The data were statistically analyzed with 2-way ANOVA, Tamhane T2, 1-way ANOVA, and Student t tests (α=.05).ResultsThe 1.3-mm specimens had significantly higher flexural strength than the 0.8-mm specimens (P<.05). Airborne-particle abrasion significantly increased the flexural strength (P<.05). Grinding and polishing did not affect the flexural strength of the specimens (P>.05).ConclusionsThe mean flexural strength of 0.8-mm and 1.3-mm thick monolithic zirconia was greater than reported masticatory forces. Airborne-particle abrasion increased the flexural strength of monolithic zirconia. Grinding did not affect flexural strength if subsequently polished.

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Outer Membrane Protein OmpB Methylation May Mediate Bacterial Virulence

Publication date: Available online 13 October 2017
Source:Trends in Biochemical Sciences
Author(s): David C.H. Yang, Amila H. Abeykoon, Bok-Eum Choi, Wei-Mei Ching, P. Boon Chock
Methylation of outer membrane proteins (OMPs) has been implicated in bacterial virulence. Lysine methylation in rickettsial OmpB is correlated with rickettsial virulence, and N- and O-methylations are also observed in virulence-relevant OMPs from several pathogenic bacteria that cause typhus, leptospirosis, tuberculosis, and anaplasmosis. We summarize recent findings on the structure of methylated OmpB, biochemical characterization, and crystal structures of OmpB methyltransferases. Native rickettsial OmpB purified from highly virulent strains contains multiple clusters of trimethyllysine, in contrast with mostly monomethyllysine, and no trimethyllysine is found in an avirulent strain. Crystal structure of the methyltransferases reveals mechanistic insights for catalysis, and a working model is discussed for this unusual post-translational modification.

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ATA 2017 Abstracts Available Online

We are pleased to provide complimentary access to the conference program and meeting abstracts for the 87th Annual Meeting of the American Thyroid Association, October 18-21, 2017 in Victoria, British Columbia. The Abstracts are available now on the Thyroid website:

87th Annual Meeting of the American Thyroid Association Abstracts
Abstract Author Index
Short Call Abstracts
Short Call Author Abstract Index

The post ATA 2017 Abstracts Available Online appeared first on American Thyroid Association.

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ATA 2017 Abstracts Available Online

87th Annual Meeting of the American Thyroid Association Abstracts
Abstract Author Index
Short Call Abstracts
Short Call Author Abstract Index

The post ATA 2017 Abstracts Available Online appeared first on American Thyroid Association.

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Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis

Publication date: Available online 14 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Sterre A.S. Hamann, Jenny Giang, Marianne G.R. De Maeseneer, Tamar E.C. Nijsten, Renate R. van den Bos
ObjectivesThe most frequently used treatment options for great saphenous vein incompetence are high ligation with stripping (HL+S), endovenous thermal ablation (EVTA), mainly consisting of endovenous laser ablation (EVLA) or radiofrequency ablation, and ultrasound guided foam sclerotherapy (UGFS). The objective of this systematic review and meta-analysis was to compare the long-term efficacy of these different treatment modalities.MethodsA systematic literature search was performed. Randomised controlled trials (RCTs) with follow-up ≥ 5 years were included. Pooled proportions of anatomical success, which was the primary outcome, rate of recurrent reflux at the saphenofemoral junction (SFJ), and mean difference in venous clinical severity score (VCSS) were compared using a z test or Student t test. Quality of life data were assessed and described.ResultsThree RCTs and 10 follow-up studies of RCTs were included of which 12 were pooled in the meta-analysis. In total, 611 legs were treated with EVLA, 549 with HL+S, 121 with UGFS, and 114 with HL+EVLA. UGFS had significantly lower pooled anatomical success rates than HL+S, EVLA, and EVLA with high ligation: 34% (95% CI 26–44) versus 83% (95% CI 72–90), 88% (95% CI 82–92), and 88% (95% CI 17–100) respectively; p ≤ .001. The pooled recurrent reflux rate at the SFJ was significantly lower for HL+S than UGFS (12%, 95% CI 7–20, vs. 29%, 95% CI 21–38; p ≤ .001) and EVLA (12%, 95% CI 7–20, vs. 22%, 95% CI 14–32; p = .038). VCSS scores were pooled for EVLA and HL+S, which showed similar improvements.ConclusionEVLA and HL+S show higher success rates than UGFS 5 years after GSV treatment. Recurrent reflux rates at the SFJ were significantly lower in HL+S than UGFS and EVLA. VCSS scores were similar between EVLA and HL+S.

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Data on the chemical properties of commercial fish sauce products

Publication date: Available online 14 October 2017
Source:Data in Brief
Author(s): Mitsutoshi Nakano, Yoshimasa Sagane, Ryosuke Koizumi, Yozo Nakazawa, Masao Yamazaki, Toshihiro Watanabe, Katsumi Takano, Hiroaki Sato
This data article reports on the chemical properties of commercial fish sauce products associated with the fish sauce taste and flavor. All products were analyzed in triplicate. Dried solid content was analyzed by moisture analyzer. Fish sauce salinity was determined by a salt meter. pH was measured using a pH meter. The acidity was determined using a titration assay. Amino nitrogen and total nitrogen were evaluated using a titration assay and Combustion-type nitrogen analyzer, respectively.The analyzed products originated from Japan, Thailand, Vietnam, China, the Philippines, and Italy. Data on the chemical properties of the products are provided in table format in the current article.

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Dataset on antioxidant metabolites and enzymes activities of freshly harvested sweet cherries (Prunus avium L.) of Campania accessions

Publication date: Available online 14 October 2017
Source:Data in Brief
Author(s): Antonio Mirto, Federica Iannuzzi, Petronia Carillo, Loredana F. Ciarmiello, Pasqualina Woodrow, Amodio Fuggi
In this article, we reported the original data obtained by the study of metabolites and enzymes involved in sweet cherry antioxidant system. We measured hydrogen peroxide (H2O2) and malondialdehyde (MDA), which are indicator of oxidative stress. Moreover, we measured the concentration of reduced and oxidized ascorbate and glutathione that are involved in ROS detoxification together with phenolics, anthocyanins and tocopherols. Among antioxidant enzymes, we analyzed the activities of ascorbate peroxidase (APX; EC 1.11.1.11), and the soluble and bound forms of polyphenol oxidase (PPO; EC 1.10.3.1) and guaiacol peroxidase (POD; EC 1.11.1.7). The data reported in this paper are related to the research article "Metabolic characterization and antioxidant activity in sweet cherry (Prunus avium L.) Campania accessions", authored by Mirto et al. (2018) [1].

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The management of first-line biologic therapy failures in rheumatoid arthritis: Current practice and future perspectives

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Ennio Giulio Favalli, Maria Gabriella Raimondo, Andrea Becciolini, Chiara Crotti, Martina Biggioggero, Roberto Caporali
The introduction of biologic disease–modifying anti-rheumatic drugs (bDMARDs) has dramatically changed the management of rheumatoid arthritis (RA). However, in a real-life setting about 30–40%.of bDMARD treated patients experience drug discontinuation because of either inefficacy or adverse events. According to international recommendations, to date the best strategy for managing first-line bDMARD failures has not been defined yet and available data (especially on TNF inhibitors [TNFis]) seem to drive toward a personalized approach for the individual patient. Some TNFi partial responders may benefit from optimization of concomitant methotrexate therapy or from switching to a different concomitant sDMARD such as leflunomide. Conversely, apart from infliximab, TNFi dose escalation seems to be poor efficacious and poor cost-effective compared with alternative strategies. Albeit counterintuitive, the use of a second TNFi after the failure of the first-one (cycling strategy) is supported by clear evidences and has become widespread in the 2000s as the result of the limited alternative options till the introduction of bDMARDs with a mechanism of action other than TNF blockade. Nowadays, the use of abatacept, rituximab, tocilizumab, or JAK inhibitors as second-line agent (swapping strategy) is strongly supported by RCTs and real-life experiences. In the absence of head-to-head trials directly comparing these two strategies, meta-analyses of separated RCTs failed to find significant differences in favor of one or another choice. However, results from most observational studies, including well designed prospective pragmatic randomised analyses, demonstrated the superiority of swapping over cycling approach, whereas only few studies reported a comparable effectiveness. In this review, we aimed to critically analyze all the potential therapeutic options for the treatment of first-line bDMARD failures in order to provide a comprehensive overview of available strategies to be applied in clinical practice.

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New Insights in the Pathogenesis of Immunoglobulin A Vasculitis (Henoch-Schönlein Purpura)

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Marieke H. Heineke, Aranka V. Ballering, Agnès Jamin, Sanae Ben Mkaddem, Renato C. Monteiro, Marjolein Van Egmond
Immunoglobulin A vasculitis (IgAV), also referred to as Henoch-Schönlein purpura, is the most common form of childhood vasculitis. The pathogenesis of IgAV is still largely unknown. The disease is characterized by IgA1-immune deposits, complement factors and neutrophil infiltration, which is accompanied with vascular inflammation. Incidence of IgAV is twice as high during fall and winter, suggesting an environmental trigger associated to climate. Symptoms can resolve without intervention, but some patients develop glomerulonephritis with features similar to IgA nephropathy that include hematuria, proteinuria and IgA deposition in the glomerulus. Ultimately, this can lead to end-stage renal disease. In IgA nephropathy immune complexes containing galactose-deficient (Gd-)IgA1 are found and thought to play a role in pathogenesis. Although Gd-IgA1 complexes are also present in patients with IgAV with nephritis, their role in IgAV is disputed. Alternatively, it is has been proposed that in IgAV IgA1 antibodies are generated against endothelial cells. We anticipate that such IgA complexes can activate neutrophils via the IgA Fc receptor FcαRI (CD89), thereby inducing neutrophil migration and activation, which ultimately causes tissue damage in IgAV. In this Review, we discuss the putative role of IgA, IgA receptors, neutrophils and other factors such as infections, genetics and the complement system in the pathogenesis of IgA vasculitis.

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The effects of add-on exenatide to insulin on glycemic variability and hypoglycemia in patients with type 1 diabetes mellitus

Abstract

Objective

To investigate the effect of add-on exenatide to insulin on glycemic excursion and the counter-regulatory hormone in response to hypoglycemia in patients with type 1 diabetes mellitus (T1DM).

Methods

30 patients with T1DM were recruited and randomly assigned to exenatide + insulin-treated group (group 1, n = 15) or insulin-only-treated group (group 2, n = 15) for 4 weeks. All patients had continuous glucose monitor system (CGMS) applied at before (week-0) and after (week-4) treatment to evaluate the glycemic variability. All patients had an arginine-stimulated test at before and after treatment. Six patients from each group also had hypoglycemic clamp test to assess counter-regulatory hormone level.

Results

Patients in the exenatide group had significant reductions in body weight, body mass index (BMI), total insulin dose, bolus insulin dose, fructosamine, and glycemic excursion after 4 weeks' treatment. Compared with patients in group 2, the mean amplitude of glycemic excursion (MAGE) and coefficient of variation (CV) of exenatide group decreased significantly. Similarly, a significant decrease of glucagon (GLC) in the arginine-stimulated test was found in group 1. No significant changes of GLC, growth hormone (GH), cortisol (COR), epinephrine (E), and norepinephrine (NE) were found in both groups during hypoglycemia clamp test. However, patients who had residual islet function in group 1 showed an upward trend of basic C-peptide (C-P) and GLC during the hypoglycemia period.

Conclusion

Although exenatide could inhibit glucagon secretion during euglycemia or hyperglycemia in patients with T1DM, it has no effect on GLC and counter-regulatory hormones during hypoglycemia clamp in patients with no functional residual islet test.

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The management of first-line biologic therapy failures in rheumatoid arthritis: Current practice and future perspectives

HLA-DRB1 alleles and juvenile idiopathic arthritis: Diagnostic clues emerging from a meta-analysis

Publication date: Available online 14 October 2017
Source:Autoimmunity Reviews
Author(s): Annalisa De Silvestri, Cristina Capittini, Dimitri Poddighe, Gian Luigi Marseglia, Luca Mascaretti, Elena Bevilacqua, Annamaria Pasi, Miryam Martinetti, Carmine Tinelli
Juvenile Idiopathic Arthritis (JIA) is characterized with a variable pattern of articular involvement and systemic symptoms and, thus, it has been classified in several subtypes. Genetic predisposition to JIA is mainly due to HLA class II molecules (HLA-DRB1, HLA-DPB1), although HLA class I molecules and non-HLA genes have been implicated, too. Here, we carried out a meta-analysis on selected studies designed to assess HLA genetic background of JIA patients, compared to healthy controls and, particularly, we focused our attention on HLA-DRB1. In summary, our meta-analysis showed four main findings regarding HLA-DRB1 locus as a genetic factor of JIA: i) HLA-DRB1*08 is a strong factor predisposing to JIA, both for oligo-articular and poly-articular forms (oJIA > pJIA); ii) HLA-DRB1*01 and HLA-DRB1*04 may be involved in the genetic predisposition of Rheumatoid Factor (RF) positive forms of JIA; iii) HLA-DRB1*11 was confirmed to be predisposing to oligo-articular JIA; iv) HLA-DRB1*04 was confirmed to have a role in systemic JIA. Importantly, the positivity for the RF seems to select the JIA clinical subset with the strongest immunogenetic similarities with the adult form of rheumatoid arthritis.

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New Insights in the Pathogenesis of Immunoglobulin A Vasculitis (Henoch-Schönlein Purpura)

Inferential language use by youth with Down syndrome during narration

Publication date: December 2017
Source:Research in Developmental Disabilities, Volume 71
Author(s): Shealyn A. Ashby, Marie Moore Channell, Leonard Abbeduto
We examined inferential language use by youth with Down syndrome (DS) in the context of narrative storytelling relative to younger typically developing (TD) children and same-aged peers with fragile X syndrome (FXS) matched on nonverbal cognitive ability level. Participants' narratives were coded for the use of different types of inferential language. Participants with DS used proportionately less inferential language overall relative to their counterparts with TD or FXS, although mean length of utterance accounted for group differences observed for the DS-TD group comparison only. Patterns of inferential language use varied across inferential subtypes and across participant groups, with mean length of utterance playing a significant role in group differences. These findings suggest potential syndrome specificity to the DS phenotype regarding impairments in inferential language use that can be partially explained by level of expressive syntactic ability and should be considered in future research. Clinical interventions within the DS population, therefore, should target to some extent the use of inferential language and complex sentence structure.

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Difference or delay? A comparison of Bayley-III Cognition item scores of young children with and without developmental disabilities

Publication date: December 2017
Source:Research in Developmental Disabilities, Volume 71
Author(s): Linda Visser, Carla Vlaskamp, Cornelius Emde, Selma A.J. Ruiter, Marieke E. Timmerman
The "difference or delay paradigm" focuses on the question of whether children with developmental disabilities (DD) develop in a way that is only delayed, compared to typically developing children, or also qualitatively different. The current study aimed to examine whether qualitative differences exist in cognitive development of young children with and without DD on the basis of item scores on the Dutch Bayley-III Cognition scale. Differential item functioning was identified for 15 of the 91 items. The presence of DD was related to a higher number of Guttman errors, hinting at more deviation in the order of skill development. An interaction between group (i.e., with or without DD) and developmental quotient appeared to predict the number of Guttman errors. DD was related to a higher number of Guttman errors for the whole range of developmental quotients; children with DD with a small developmental quotient had the highest number. Combined, the results mean that qualitative differences in development are not to be excluded, especially in cases of severe developmental disabilities. When using the Bayley-III in daily practice, the possibility needs to be taken into account that the instruments' assumption of a fixed order in skill development does not hold.

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Adaptation of the MABC-2 Test (Age Band 2) for children with low vision

Publication date: December 2017
Source:Research in Developmental Disabilities, Volume 71
Author(s): Hanne Alves Bakke, Silvia Wanick Sarinho, Maria Teresa Cattuzzo
BackgroundThe tools used to assess motor performance in children with low vision often have no validity and reliability data concerning this population and use non-standardized modifications. Adaptations of these tools could help to identify motor problems and mitigate their effects.AimTo assess aspects of validity and reliability in an adaptation of the Movement ABC-2 Test (MABC-2) for children with low vision.Methods and proceduresThe research was undertaken in two stages: 1) application of the original MABC-2 to 10 children with low vision, adaptation and pilot test; 2) administration and re-administration of the adapted MABC-2 in 30 children with low vision. Inter-rater reliability and test-retest reliability were assessed with an intraclass correlation coefficient and Kappa index; internal consistency was assessed with Cronbach's alpha.Outcomes and resultsSubstantial to almost perfect inter-rater reliability was found between the component standard scores and a reasonable to excellent concordance rate in the classification of movement difficulty. The adapted tool has moderate internal consistency.Conclusions and implicationsThe adapted MABC-2 Test has improved the assessment of motor performance in children with low vision.

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Data-driven heterogeneity in mathematical learning disabilities based on the triple code model

Publication date: December 2017
Source:Research in Developmental Disabilities, Volume 71
Author(s): Christian Peake, Juan E. Jiménez, Cristina Rodríguez
Many classifications of heterogeneity in mathematical learning disabilities (MLD) have been proposed over the past four decades, however no empirical research has been conducted until recently, and none of the classifications are derived from Triple Code Model (TCM) postulates. The TCM proposes MLD as a heterogeneous disorder, with two distinguishable profiles: a representational subtype and a verbal subtype. A sample of elementary school 3rd to 6th graders was divided into two age cohorts (3rd − 4th grades, and 5th − 6th grades). Using data-driven strategies, based on the cognitive classification variables predicted by the TCM, our sample of children with MLD clustered as expected: a group with representational deficits and a group with number-fact retrieval deficits. In the younger group, a spatial subtype also emerged, while in both cohorts a non-specific cluster was produced whose profile could not be explained by this theoretical approach.

Graphical abstract

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Novel genetic loci associated HLA-B*08:01 positive myasthenia gravis

Publication date: Available online 14 October 2017
Source:Journal of Autoimmunity
Author(s): Jezabel Varade, Ning Wang, Che Kang Lim, Tao Zhang, Yuanwei Zhang, Xiaomin Liu, Fredrik Piehl, Ritva Matell, Hongzhi Cao, Xun Xu, Lennart Hammarström
ObjectiveTo identify potential causative markers involved in the development of early-onset myasthenia gravis (EOMG) in the MHC and non-MHC regions that may interact with the HLA-B*08:01 allele.MethodsWe analyzed 583 MG patients and identified 5 patients homozygous for the disease-associated ancestral haplotype 8.1 (HLA-A*01:01, B*08:01, DRB1*03:01, DQB1*02:01). We also analyzed more than 9000 controls and selected 24 for further investigation. We subsequently conducted a fine mapping analysis through high-throughput sequencing of the MHC region (from upstream of the GPα5 gene to downstream of the ZBTB9 gene). For the interaction analysis we analyzed a total of 150,090 SNPs equally distributed throughout the genome in the individuals that were homozygous for the main susceptibility HLA allele HLA-B*08:01 and investigated the expression of the genes located close to the observed susceptibility variants.ResultsThe overall coverage of the 4.79 Mb MHC region ranged between 96.57% and 97.41%. We identified 705 new variants in the MHC region (673 SNPs and 32 InDels). However, no significant differences were found between patients and controls within the MHC region of the ancestral 8.1 haplotype. As the susceptibility gene is considered to be located close to the HLA-B locus, complete sequencing of the surrounding 200 kb was carried out in the 5 patients and 24 controls. No significant differences where observed, suggesting that the HLA-B molecule itself is the susceptibility factor for EOMG.We also observed two new susceptibility loci specific for MG HLA*08:01 patients (P < 3.33 × 10⁻⁷). These loci map to an intronic OVCH1 variant (rs10492374; P = 1.90 × 10⁻⁸) and a 5′ downstream CNPY2 variant (rs10783780; P = 3.33 × 10⁻⁷) on chromosome 12. Individuals heterozygous for GA*rs10492374 showed an increased expression of the OVCH1 gene. The rs10783780 genotypes were not associated with CNPY2 mRNA levels, but the MG HLA*08:01 patients present a lower expression of this gene than the healthy controls.ConclusionOur results showed that when we control for the influence of the ancestral haplotype 8.1, no polymorphism was demonstrated to be associated with EOMG development within the MHC region suggesting that the HLA-B*08:01 allele is the unique genetic factor within the HLA region responsible for EOMG development in patients who carry the ancestral haplotype 8.1. Our study also identified two novel polymorphisms as risk factors for MG HLA-B*08:01 positive patients which regulate the expression of the OVCH1 and CNYP2 genes.

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Impaired anti-inflammatory activity of PPARγ in the salivary epithelia of Sjögren's syndrome patients imposed by intrinsic NF-κB activation

Publication date: Available online 14 October 2017
Source:Journal of Autoimmunity
Author(s): Aigli G. Vakrakou, Alexandros Polyzos, Efstathia K. Kapsogeorgou, Dimitris Thanos, Menelaos N. Manoussakis
Sjögren's syndrome (SS) patients manifest inflammation in the salivary glands (SG) and evidence of persistent intrinsic activation of ductal SG epithelial cells (SGEC), demonstrable in non-neoplastic SGEC lines derived from patients (SS-SGEC). The peroxisome-proliferator-activated receptor-γ (PPARγ) mediates important anti-inflammatory activities in epithelial cells. Herein, the comparative analysis of SG biopsies and SGEC lines obtained from SS patients and controls had revealed constitutively reduced PPARγ expression, transcriptional activity and anti-inflammatory function in the ductal epithelia of SS patients that were associated with cell-autonomously activated NF-κB and IL-1β pathways. Transcriptome profiling analysis revealed several differentially expressed proinflammatory and metabolism-related gene sets in SS-SGEC lines. These aberrations largely correlated with the severity of histopathologic lesions, the disease activity and the occurrence of adverse manifestations in SS patients studied, a fact which corroborates the key role of the persistently-activated epithelia in the pathogenesis of both local and systemic features of this disease. The treatment of control SGEC lines with PPARγ agonists was found to diminish the NF-κB activation and apoptosis induced by proinflammatory agents. In addition, the in-vitro application of PPARγ agonists and pharmacologic inhibitors of IL-1β and NF-κB had significant beneficial effects on SS-SGEC lines, such as the restoration of PPARγ functions and the reduction of their intrinsic activation, a fact which may advocate the future clinical study of the above agents as therapeutic modalities for SS.

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Clinical Application of Contrast-Enhanced Ultrasound Using High-Frequency Linear Probe in the Detection of Small Colorectal Liver Metastases

Publication date: Available online 14 October 2017
Source:Ultrasound in Medicine & Biology
Author(s): Si Qin, Yao Chen, Xiao-yin Liu, Wen-jie Cheng, Jun-li Yu, Wen-jing Zhang, Qing-ling Jiang, Yi-min Wang, Yan-ling Wen, Guang-jian Liu
To compare the performance of contrast-enhanced ultrasound (CEUS) using high-frequency linear and convex probes in the detection of small colorectal liver metastases (CRLMs). A total of 85 patients with 143 small CRLMs were evaluated. High-frequency ultrasound (US) and CEUS detected significantly more superficial lesions within 60 mm below the skin than a convex probe (p < 0.05). The detection rate decreased in the chemotherapy group, especially when using a convex probe for US (p < 0.05). By combining convex and linear probes, detection rates of US and CEUS were significantly higher than that of a convex or a linear probe alone (p < 0.05). High-frequency US and CEUS helped to improve detection of small CRLMs and reduce the influence of chemotherapy. For patients with a high risk of CRLMs and those after chemotherapy, we recommend first scanning the liver by using a convex probe and subsequently screening the surface area of the liver and suspicious small lesions by using a linear probe.

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Spatio-Temporal Flow and Wall Shear Stress Mapping Based on Incoherent Ensemble-Correlation of Ultrafast Contrast Enhanced Ultrasound Images

Publication date: Available online 13 October 2017
Source:Ultrasound in Medicine & Biology
Author(s): Chee Hau Leow, Meng-Xing Tang
In this study, a technique for high-frame-rate ultrasound imaging velocimetry (UIV) is extended first to provide more robust quantitative flow velocity mapping using ensemble correlation of images without coherent compounding, and second to generate spatio-temporal wall shear stress (WSS) distribution. A simulation model, which couples the ultrasound simulator with analytical flow solution, was implemented to evaluate its accuracy. It is shown that the proposed approach can reduce errors in velocity estimation by up to 10-fold in comparison with the coherent correlation approach. Mean errors (ME) of 3.2% and 8.6% were estimated under a steady flow condition, while 3.0% and 10.6% were found under a pulsatile condition for the velocity and wall shear rate (WSR) measurement, respectively. Appropriate filter parameters were selected to constrain the velocity profiles before WSR estimations and the effects of incorrect wall tracking were quantified under a controlled environment. Although accurate wall tracking is found to be critical in WSR measurement (as a 200 µm deviation from the wall may yield up to a 60% error), this can be mitigated by HFR imaging (of up to 10 kHz) with contrast agents, which allow for improved differentiation of the wall-fluid boundaries. In vitro investigations on two carotid bifurcation phantoms, normal and diseased, were conducted, and their relative differences in terms of the flow patterns and WSR distribution were demonstrated. It is shown that high-frame-rate UIV technique can be a non-invasive tool to measure quantitatively the spatio-temporal velocity and WSS distribution.

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Reproductibilité de la mesure de la force et de l’endurance du quadriceps dans la BPCO

Publication date: Available online 13 October 2017
Source:Revue des Maladies Respiratoires
Author(s): M. Beaumont, G. Kerautret, L. Peran, R. Pichon, C. Le Ber, M. Cabillic
IntroductionLes patients atteints de BPCO ont fréquemment une altération de la force et de l'endurance des membres inférieurs et l'évaluation des quadriceps est recommandée dans cette pathologie. Le dynamomètre manuel est un instrument facile d'utilisation pour cette évaluation ; toutefois, la reproductibilité de ses mesures n'a pas été étudiée pour l'endurance. L'objectif de cette étude était d'évaluer la reproductibilité inter et intra-opérateur des mesures de force maximale volontaire et d'endurance des quadriceps avec un dynamomètre manuel chez des patients atteints de BPCO.MéthodeLes mesures de force maximale volontaire et d'endurance du quadriceps ont été effectuées en isométrique à l'aide d'un même dynamomètre manuel. Trois sessions de mesures séparées de 24 heures chacune ont été réalisées. Les reproductibilités intra- et interopérateurs ont été évaluées par le calcul du coefficient de corrélation intraclasse.RésultatsVingt et un patients ont été inclus. Les coefficients de corrélations intraclasses pour la force maximale volontaire en intra- et interopérateurs étaient compris entre 0,95 et 0,99. Concernant l'endurance, le coefficient pour la reproductibilité intra-opérateur était de 0,81. Les deux coefficients de corrélation intraclasse pour la reproductibilité interopérateurs étaient de 0,69 et 0,77.ConclusionLe dynamomètre permet une excellente reproductibilité de la force maximale volontaire et une reproductibilité correcte à excellente de l'endurance. Cet outil est utilisable pour l'évaluation en pratique courante du quadriceps dans la BPCO, en particulier au cours de la réhabilitation respiratoire.IntroductionPatients with COPD frequently have lower strength and endurance in their lower limbs compared to healthy subjects and evaluation of their quadriceps strength is recommended in practice. The handheld dynamometer has been validated and is easy to use for this measurement but its reproducibility has never been studied for endurance evaluation and only poorly for strength. The objective of this study was to estimate the inter and intra-operator reproducibility of maximal voluntary strength and endurance measurements of the quadriceps with a handheld dynamometer in patients with COPD.MethodsThe measurements of maximal voluntary strength and endurance were performed with a single handheld dynamometer using isometric contraction. Three measurement sessions were undertaken, separated by 24hours. The intra- and interoperator reproducibility were estimated by calculation of the intraclass correlation coefficient.ResultsOverall, 21 patients were included in the study. The intraclass correlation coefficient calculated for the maximal voluntary strength for intra and interoperator reliability ranged between 0.95 and 0.99. For endurance, the coefficient for intra-operator reliability was 0.81 and the two for interoperator reliability were 0.69 and 0.77.ConclusionThe handheld dynamometer allows an excellent inter and intra-operator reproducibility for the measurement of quadricipital maximal voluntary strength and a correct to excellent reproducibility for the measurement of quadricipital endurance. This tool may be used for the evaluation of quadriceps strength in clinical practice in COPD patients, particularly during rehabilitation.

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Le tatouage et le principe de dignité humaine

Publication date: Available online 12 October 2017
Source:Médecine & Droit
Author(s): Chloé Mitaine
Le tatouage est une pratique qui devient de plus en plus populaire dans notre société. Il implique nécessairement la notion de corps et de protection du corps. En effet, il dénature le corps humain puisqu'il le modifie. Ce faisant, il semble contrevenir au principe du respect de la dignité humaine. Or, dans le même temps, il respecte le principe de la libre disposition de son corps lorsque cette modification du corps est un acte désiré par la personne elle-même. L'opposition entre ces deux grands principes amène à se poser la question du rapport entre la dignité et le tatouage. La réponse est nuancée puisque le tatouage ne peut pas être considéré comme indigne en lui-même, alors que l'utilisation qui en est faite peut l'être.Tattooing is a practice that is becoming more and more popular in our society. It necessarily implies the notion of body and protection of the body. Indeed, it denatures the human body since it modifies it. In so doing, it appears to contravene the principle of respect for human dignity. At the same time, it respects the right to treat one's body as one pleases when this modification of the body is an act desired by the person himself. The contrast between these two main principles leads to the question of the relationship between dignity and tattooing. The answer is nuanced since the tattoo cannot be considered unworthy in itself, whereas the use made of it can be so considered.

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The Development of a Novel Perfused Cadaver Model With Dynamic Vital Sign Regulation and Real-World Scenarios to Teach Surgical Skills and Error Management

Publication date: Available online 14 October 2017
Source:Journal of Surgical Education
Author(s): Michael Minneti, Craig J. Baker, Maura E. Sullivan
AbstractThe landscape of graduate medical education has changed dramatically over the past decade and the traditional apprenticeship model has undergone scrutiny and modifications. The mandate of the 80-hour work-week, the introduction of integrated residency programs, increased global awareness about patient safety along with financial constraints have spurred changes in graduate educational practices. In addition, new technologies, more complex procedures, and a host of external constraints have changed where and how we teach technical and procedural skills. Simulation-based training has been embraced by the surgical community and has quickly become an essential component of most residency programs as a method to add efficacy to the traditional learning model.The purpose of this paper is twofold: (1) to describe the development of a perfused cadaver model with dynamic vital sign regulation, and (2) to assess the impact of a curriculum using this model and real world scenarios to teach surgical skills and error management. By providing a realistic training environment our aim is to enhance the acquisition of surgical skills and provide a more thorough assessment of resident performance.Twenty-six learners participated in the scenarios. Qualitative data showed that participants felt that the simulation model was realistic, and that participating in the scenarios helped them gain new knowledge, learn new surgical techniques and increase their confidence performing the skill in a clinical setting. Identifying the importance of both technical and nontechnical skills in surgical education has hastened the need for more realistic simulators and environments in which they are placed. Team members should be able to interact in ways that allow for a global display of their skills thus helping to provide a more comprehensive assessment by faculty and learners.

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How Does Level and Type of Experience Affect Measurement of Joint Range of Motion?

Publication date: Available online 14 October 2017
Source:Journal of Surgical Education
Author(s): Russell R. Russo, Matthew B. Burn, Sabir K. Ismaily, Brayden J. Gerrie, Shuyang Han, Jerry Alexander, Christopher Lenherr, Philip C. Noble, Joshua D. Harris, Patrick C. McCulloch
ObjectivesComparison of range of motion measurements by 3 types of investigators with different levels and types of training using three different measurement techniques. The study hypothesis was that the accuracy and precision of range of motion measurements would vary based on (1) the level and type of experience of the investigator and (2) the measurement technique used.Design/SettingDescriptive laboratory study.ParticipantsTen fresh frozen cadavers (20 upper and 20 lower extremities).InterventionsShoulder, elbow, hip, and knee motion were measured using 3 different measurement techniques (digital photography, goniometry, and visual estimation) by 3 groups of investigators (attending orthopedic surgeons, physical therapists, and residents). Accuracy was defined by the difference from the reference standard (motion capture analysis), whereas precision was defined by the proportion of measurements within either 5° or 10° of the reference standard. Analysis of variance, t-tests, and chi-squared tests were used.ResultsStatistically significant (p < 0.05) differences in accuracy were found for hip flexion, abduction, internal rotation, external rotation, and knee flexion. However, none of these differences met the authors' defined clinical significance (maximum difference 3°). Precision was significantly (p < 0.05) different for elbow extension, hip flexion, abduction, internal rotation, external rotation, and knee flexion.ConclusionThis study found that clinically accurate measurements of shoulder, elbow, hip, and knee motion are obtained regardless of technique used or the investigators' level and type of experience. Precision was equivalent for all shoulder motions, elbow flexion, and knee extension, but varied by as much as 7% to 28% between groups for all other motions.

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Graduating Surgical Residents Lack Competence in Critical Care Ultrasound

Publication date: Available online 14 October 2017
Source:Journal of Surgical Education
Author(s): Renuka Tripu, Margaret H. Lauerman, Daniel Haase, Syeda Fatima, Jacob Glaser, Cassandra Cardarelli, Thomas M. Scalea, Sarah Murthi
ObjectiveUltrasound provides accessible imaging for bedside diagnostics and procedural guidance, but may lead to misdiagnosis in untrained users. The main objective of this study was to determine observed and self-perceived competence with critical care ultrasound in graduated general surgery residents.DesignThe design of this study was a retrospective review. Ultrasound training program records were reviewed for number of prior ultrasound examinations performed, self-perceived competence, observed competence on faculty examinations, and intended future use of individual critical care ultrasound examinations.SettingThis study was undertaken at the R Adams Cowley Shock Trauma Center, which is a tertiary care center in Baltimore, MD.ParticipantsGraduated general surgery residents were identified at the beginning of their surgical critical care fellowship at our institution, and were included if they participated in our critical care ultrasound education program. Fifteen graduated general surgery residents were included.ResultsPrior ultrasound experience ranged from 100% for focused assessment of sonography for trauma (FAST) to 13.3% for advanced cardiac assessment. Self-perceived competence ranged from 46.7% with FAST to 0% for advanced cardiac assessment. Observed competence ranged from 20.0% for FAST examinations to 0% for basic cardiac assessment, advanced cardiac assessment, and inferior vena cava (IVC) assessment. All participants intended to use ultrasound in the future for FAST, pneumothorax detection and basic cardiac assessment, and 86.7% for IVC assessment and advanced cardiac assessment. Of participants with self-perceived competence, 28.6% had observed competence with FAST, 0% with IVC assessment, and 100% with pneumothorax detection.ConclusionsGraduated general surgery residents are not competent in multiple critical care ultrasound examinations despite universally planning to use critical care ultrasound in future practice. Current exposure to ultrasound in residency may give a false sense of competency with ultrasound use. A standardized ultrasound curriculum is an urgent need for general surgery training.

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Validation of a Novel Inverted Peg Transfer Task: Advancing Beyond the Regular Peg Transfer Task for Surgical Simulation-Based Assessment

Publication date: Available online 14 October 2017
Source:Journal of Surgical Education
Author(s): Amro M. Abdelrahman, Denny Yu, Bethany R. Lowndes, EeeLN H. Buckarma, Becca L. Gas, David R. Farley, Juliane Bingener, M. Susan Hallbeck
ObjectiveTo evaluate the validity of a novel inverted peg transfer (iPT) task for assessing laparoscopic skills of novices and experts and compare iPT to the regular PT (rPT) task to ensure surgical trainee acquisition of an adequate advanced laparoscopic skills level for safe laparoscopic practice in the operating room.DesignProspective crossover study.SettingMultidisciplinary simulation center and motion analysis laboratory, Mayo Clinic.ParticipantsNovices were medical students and surgical interns without laparoscopic experience. Experts were surgeons with at least 3 years of experience in laparoscopic surgery.MethodsThis was the first exposure to iPT for both groups. Completion time and performance metrics were recorded. A scoring rubric was used to calculate a normalized performance score between 0 and 100. Wilcoxon rank sum and Mann-Whitney tests were performed with α = 0.05. Receiver-operating characteristic curves were graphed for the 2 task scores to assess the tasks' sensitivity and specificity in differentiating laparoscopic experience level.Main Outcome MeasuresPerformance measures of completion time, transferred triangles, dropped triangles (errors), and the overall performance score on both tasks between- and within-subjects (i.e., novices and experts).ResultsThirty-six novices and eight experts participated. Both experts and novices had longer completion time and lower scores during iPT than rPT (p < 0.05). Within iPT, novice completion times were 144 seconds longer (p = 0.04), and performance score was 35 points lower than experts (p < 0.01). No differences between novices and experts were observed for completion time or performance scores (p > 0.05) for rPT. The iPT scores had a higher sensitivity and specificity than the rPT (area under the receiver-operating characteristic curve: iPT = 0.91; rPT = 0.69).ConclusionsiPT is a valid assessment of advanced laparoscopic skills for surgical trainees with higher specificity and sensitivity than rPT. As advanced minimally invasive surgery becomes more common, it is important that tasks such as iPT be included in surgical simulation curricula and training assessment.

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Current Techniques of Teaching and Learning in Bariatric Surgical Procedures: A Systematic Review

Publication date: Available online 13 October 2017
Source:Journal of Surgical Education
Author(s): Mirjam Kaijser, Gabrielle van Ramshorst, Bart van Wagensveld, Jean-Pierre Pierie
ObjectiveThe gastric sleeve resection and gastric bypass are the 2 most commonly performed bariatric procedures. This article provides an overview of current teaching and learning methods of those techniques in resident and fellow training.DesignA database search was performed on Pubmed, Embase, and the Education Resources Information Center (ERIC) to identify the methods used to provide training in bariatric surgery worldwide. After exclusion based on titles and abstracts, full texts of the selected articles were assessed. Included articles were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.ResultsIn total, 2442 titles were identified and 14 full text articles met inclusion criteria. Four publications described an ex vivo training course, and 6 focused on at least 1 step of the gastric bypass procedure. Two randomized controlled trials (RCT) provided high-quality evidence on training aspects. Surgical coaching caused significant improvement of Bariatric Objective Structured Assessment of Technical Skills (BOSATS) scores (3.60 vs. 3.90, p = 0.017) and reduction of technical errors (18 vs. 10, p = 0.003). A preoperative warm-up increased global rating scales (GRS) scores on depth perception (p = 0.02), bimanual dexterity (p = 0.01), and efficiency of movements (p = 0.03).ConclusionStepwise education, surgical coaching, warming up, Internet-based knowledge modules, and ex vivo training courses are effective in relation to bariatric surgical training of residents and fellows, possibly shortening their learning curves.

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Resource Usage Implementing the Surgical Resident Prep Curriculum at a Single Institution

Publication date: Available online 14 October 2017
Source:Journal of Surgical Education
Author(s): Lily Owei, Chris Neylan, Rachel Kelz, Kristoffel R. Dumon, Steve R. Allen, Noel Williams, Daniel T. Dempsey, Carla Fisher
ObjectiveThe Resident Prep Curriculum (RPC), published in 2014 and developed as a collaboration of the American College of Surgeons, Association of Program Directors in Surgery, and the Association for Surgical Education, was designed to improve the quality and consistency of medical student preparation for surgical residency. We aim to assess the feasibility of and resource usage for implementation of this curriculum at our institution.DesignOur institution expanded upon a pre-existing 2-week surgical preparatory course, adding modules designed to meet the goals and objectives of the RPC. We performed an evaluation of the resources required for these additions, namely time, logistics and incremental cost.SettingThe course took place at the Perelman School of Medicine, which is a large, academic medical center affiliated with the Hospital of the University of Pennsylvania.ResultsOur course satisfied each of the six domains outlined in the RPC. In 2015, 22 students were enrolled in the course. It was run over a consecutive 4-week period in the spring of 2015, with 9 full and 9 half days. To meet the needs of the Curriculum, approximately 33 hours (38%) were spent in the classroom, 34 hours (39%) in a simulation center, and 20 hours (23%) in the anatomical laboratory. Seventy faculty-hours (from 5 disciplines) and 73 resident-hours (double-counting for cotaught modules) were required to support the course. Besides room availability, funding was required for certain aspects of the course such as cadavers, dedicated anatomy teaching, and the costs of supplies in the simulation center. There is also a cost associated with the use of the Penn Medicine Simulation Center. Taking these into account, the total cost of implementing the curriculum amounted to $30,627.10.ConclusionThe implementation of the RPC was feasible but relied heavily upon faculty/resident time. As a result of the success of this initiative, our medical school seeks to expand the idea across multiple specialties.

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Surgical Education Module Improves Operative Proficiency in Endoscopic Carpal Tunnel Release: A Blinded Randomized Controlled Trial of Trainees

Publication date: Available online 13 October 2017
Source:Journal of Surgical Education
Author(s): Steve J. Kempton, A. Neil Salyapongse, Jacqueline S. Israel, Benjamin A. Mandel
ObjectiveThe purpose of this study is to evaluate whether an interactive endoscopic carpal tunnel release (ECTR) surgical education module can improve knowledge of surgical indications and improve procedural competency.DesignAn ECTR education module was developed and trainees at various level of training were enrolled and randomized to surgical module and nonmodule (control) groups. Subjects were instructed that they would be the primary surgeon performing an ECTR. A written assessment was administered before and after module completion or independent case preparation to test comprehension of the procedure. The senior author evaluated each subject's intraoperative performance using a 5-point scoring system. Statistical analysis was performed using chi-square and paired t-tests.SettingThis study took place at a tertiary care hospital at the University of Wisconsin.ResultsIn all, 30 subjects were tested (15 surgical module and 15 nonmodule). There were no differences in prepreparation test scores between groups. Postpreparation test scores following use of the module were significantly higher compared to the nonmodule group. The average operation performance scores for the surgical module group and nonmodule group were 96% and 82%, respectively. The surgical module group performed significantly better on all operative steps except for dressing application. Surgical module subjects without prior ECTR experience (n = 7) had operative scores that were significantly higher than those for nonmodule subjects without previous ECTR experience (n = 8) (95% vs. 75%). There was no difference in operative scores between surgical module subjects with no prior experience (n = 7) and nonmodule subjects who had performed at least 1 prior case (n = 7) (95% vs. 89%).ConclusionsThe use of an ECTR surgical education module demonstrates a significant benefit in ECTR-naïve subjects. When compared to subjects with previous ECTR experience, ECTR-naïve subjects trained using the surgical module demonstrate better familiarity with the equipment and equivalent performance of the procedure.

http://ift.tt/2zndtJ2

Comparison of two coarse-grained models of cis-polyisoprene with and without pressure correction

Publication date: 9 November 2017
Source:Polymer, Volume 130
Author(s): Takahiro Ohkuma, Kurt Kremer
We investigate two coarse-grained models of a cis-polyisoprene melt. The bonded interactions which are used in both models are derived by Boltzmann inversion of the probability distributions of the bonded variables in a single chain simulation. The non-bonded interactions are derived by an iterative Boltzmann inversion method in the melt state with pressure correction in a model and without in the other model. In our mapping rule, two or three carbons are grouped into coarse-grained beads. The trade-off relationship between pressure and compressibility is observed in the coarse-grained models. Since the relaxation dynamics of the coarse-grained models are accelerated by the smoothed potentials, single numerical factors are introduced to rescale the time scale of the coarse-grained models, respectively. The factors of the two models are in the same order but the model with pressure correction displays larger acceleration than the other. It is found that the stress relaxation function near equilibrium and the nonlinear viscosity under steady shear are essentially the same between the two coarse-grained models in the rescaled time scales despite of their different equilibrium pressures. We also study the dependency of the rescaling factors on the chain length of the polymer. The rescaling factors increase with increasing the chain length and exponentially saturates to certain values around 100 monomers in chains.

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Effect of monomer sequence distribution on the CO2-philicity of a well-defined ternary copolymer: Poly(vinyl acetate-co-vinyl butyrate-co-vinyl butyl ether)

Publication date: 9 November 2017
Source:Polymer, Volume 130
Author(s): Zewen Zhu, Yongfei Zhang, Wei Jiang, Lu Sun, Lixin Dai, Gang Zhang, Jun Tang
The work aims to interpret the phase behavior of multi-polymers in super critical CO2 via a spatially dependent structural parameter, the monomer sequence distribution, rather than traditional statistical factors. Well-defined statistical copolymers based on three CO2-philic monomers, vinyl acetate, vinyl butyrate and vinyl butyl ether, were synthesized with reversible addition-fragmentation chain transfer free-radical polymerization by combining their kinetic behaviors and pairwise reactivity ratios into the Alfrey–Goldfinger–Skeist model. The corresponding cloud point pressures become nonlinear with the polymer composition and possess upper critical solution pressure behavior. Additionally, their diad and triad monomer sequence distributions were calculated by simple theoretical arithmetic. While analyzing the cloud point pressure measurements, we found that both the differences in composition and symmetrical structure of the monomer triads could impact the CO2-philicity of triads, which were close to the properties of the products, and thus, the variations in the triad sequence distribution could reasonably predict the phase behavior of the products.

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Surface roughness and bacterial adhesion on root dentin treated with diode laser and conventional desensitizing agents

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The treatments for dentin hypersensitivity (DH) may change the surface roughness of the root dentin, which can lead to biofilm accumulation, increasing the risk of root caries. The aim was to compare the surface roughness of root dentin after different treatments of DH and the biofilm formation on those surfaces. After initial surface roughness (Sa) assessment, 50 bovine root fragments received the following treatments (n = 10): G 1—no treatment; G2—5% sodium fluoride varnish; G3—professional application of a desensitizing dentifrice; G4—toothbrushing with a desensitizing dentifrice; and G5—diode laser application (908 nm; 1.5 W, 20 s). The Sa was reevaluated after treatments. Afterward, all samples were incubated in a suspension of Streptococcus mutans at 37 °C for 24 h. The colony-forming units (CFU) were counted using a stereoscope, and the results were expressed in CFU/mL. The one-way ANOVA and the Tukey's tests compared the roughness data and the results obtained on the bacterial adhesion test (α = 5%). G2 (2.3 ± 1.67%) showed similar Sa variation than G1 (0.25 ± 0.41%) and G5 (5.69 ± 0.99%), but different from group G3 (9.05 ± 2.39%). Group 4 showed the highest Sa variation (30.02 ± 3.83%; p < 0.05). Bacterial adhesion was higher in G4 (2208 ± 211.9), suggesting that bacterial growth is greater on rougher surfaces. The diode laser and the conventional treatments for DH may change the surface roughness of the root dentin, but only brushing with desensitizing dentifrice induced a higher bacteria accumulation on root dentin surface.

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Σάββατο 14 Οκτωβρίου 2017

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