Azacitidine-induced Sweet syndrome: Two unusual clinical presentations

http://ift.tt/2xN88IY

Treatment of Hailey–Hailey disease with botulinum toxin

http://ift.tt/2ywggl3

Azacitidine-induced Sweet syndrome: Two unusual clinical presentations

http://ift.tt/2xN88IY

Treatment of Hailey–Hailey disease with botulinum toxin

http://ift.tt/2ywggl3

Plasmacytoid dendritic cells drive acute exacerbations of asthma

Publication date: Available online 17 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Aikaterini-Dimitra Chairakaki, Maria-Ioanna Saridaki, Katerina Pyrillou, Marios-Angelos Mouratis, Ourania Koltsida, Ross P. Walton, Nathan W. Bartlett, Athanasios Stavropoulos, Louis Boon, Nikoletta Rovina, Nikolaos G. Papadopoulos, Sebastian L. Johnston, Evangelos Andreakos
BackgroundAlthough acute exacerbations, mostly triggered by viruses, account for the majority of hospitalizations in asthma, there is still very little known about the pathophysiological mechanisms involved. Plasmacytoid DCs (pDCs), prominent cells of antiviral immunity, exhibit pro-inflammatory or tolerogenic functions depending on the context, yet their involvement in asthma exacerbations remains unexplored.ObjectivesWe sought to investigate the role of pDCs in allergic airway inflammation and acute exacerbations of asthma.MethodsAnimal models of allergic airway disease (AAD) and virus-induced AAD exacerbations were employed to dissect pDC function in vivo and unwind potential mechanisms involved. Sputum from asthma patients with stable disease or acute exacerbations was further studied to determine pDC presence and correlation with inflammation.Results: pDCs were key mediators of the immuno-inflammatory cascade that drives asthma exacerbations. In animal models of AAD and RV-induced AAD exacerbations, pDCs were recruited to the lung during inflammation and migrated to the draining lymph nodes to boost Th2-mediated effector responses. Accordingly, pDC depletion post-allergen challenge or during RV infection abrogated exacerbation of inflammation and disease. Central to this process was IL-25, induced by allergen challenge or RV infection that conditioned pDCs for pro-inflammatory function. Consistently, in asthma patients pDCs were markedly increased during exacerbations, and correlated with the severity of inflammation and the risk for asthmatic attacks.ConclusionsOur studies uncover a previously unsuspected role of pDCs in asthma exacerbations with potential diagnostic and prognostic implications. They also propose the therapeutic targeting of pDCs and IL-25 for the treatment of acute asthma.

Graphical abstract

http://ift.tt/2x5pdOL

A United Kingdom single centre review of the impact of extended waiting times in Early-Onset Scoliosis: the effect of a delay to surgical treatment of greater than 12 months.

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Morgan Jones, Matthew P. Newton Ede, Jwalant Metha, Adrian Gardner, Jonathan B. Spilsbury, David Marks




http://ift.tt/2yuAKZC

The Oxford 5 year observational study on 35 patients with Magnetically Controlled Growing Rods (MCGR)

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Adil Ahmad, Thejasvi Subramanian, Pavlos Panteliadis, James Wilson-Macdonald, Dominique Rothenfluh, Colin Nnadi




http://ift.tt/2ywa6kw

Editorial Board

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6





http://ift.tt/2yuz3eE

Comparison of Complications and unplanned OR visits between Magnetically Controlled Growing Rods and Vertical Expandable Prosthetic Titanium Rib

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Benjamin Roye, Chun Wai Hung, Hiroko Matsumoto, Megan Campbell, David P. Roye, Michael Vitale




http://ift.tt/2ywcAjf

Instructions for Authors

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6





http://ift.tt/2yvXWqA

Reliability of spino-pelvic and thoracic measurements with the EOS in patients with magnetically controlled growing rods in-situ

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Peter Obid, Karen Yiu, Kenny Kwan, Kenneth M.C. Cheung, Jason Pui Yin Cheung




http://ift.tt/2ywK9l7

Table of Contents

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6





http://ift.tt/2yvlmMC

Utilization and Reliability of Intraoperative Neuromonitoring in Vertebral Column Resections for Severe Early-Onset Scoliosis

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Anna McClung, Gregory Mundis, Jeff Pawelek, Sumeet Garg, Burt Yaszay, Oheneba Boachie-Adjei, James O. Sanders, Paul Sponseller, Francisco Javier Sánchez Pérez-Grueso, William Lavelle, John Emans, Charles Johnston, Behrooz Akbarnia




http://ift.tt/2yvW2HL

Prevalence of Vitamin D Deficiency in Pediatric Patients With Scoliosis Preparing for Spinal Surgery

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Theresa Mayes, Jennifer M. Anadio, Peter F. Sturm
BackgroundEstablishing prevalence of vitamin D deficiency in elective scoliosis surgery may impact clinical outcomes. The objectives of this study were to document vitamin D status of patients with scoliosis preparing for surgical intervention in order to establish frequency of deficiency and determine characteristics influencing levels.MethodsRecords were queried for patients with scoliosis diagnosis who underwent posterior spinal fusion or initial growing rod placement and had serum vitamin 25 hydroxyvitamin D (D25) recorded in the preoperative period. Demographic data (gender, age, body mass index [BMI], race, scoliosis type, spine surgery procedure, and season of the year) were extracted. Chi-square analysis and multivariate modeling were used to evaluate deficiency status among various demographic categories and determine the demographic factors impacting D25.ResultsA total of 217 patients with a mean age of 13.6 ± 3.6 years had vitamin D levels drawn a mean of 38.7 ± 20.6 days prior to surgery. The majority of the sample presented with a diagnosis of idiopathic scoliosis (n = 126), and most patients were scheduled for spinal fusion surgery (n = 192). Nearly 75% of the study population (n = 162) demonstrated D25 values below normal. African Americans presented with greater risk of deficiency (p < .0002) compared to Caucasians, as did patients preparing for spinal fusion versus growing rod placement (p < .03). Severe hypovitaminosis D was more common in winter than any other season (p < .005). Patients with neuromuscular scoliosis demonstrated significantly higher D25 levels over the idiopathic diagnosis type (p < .0002). Gender, BMI, and age did not impact D25.ConclusionLow D25 levels are reported in pediatric patients with scoliosis preparing for corrective spinal surgery. Population subsets most at risk for deficiency in this limited study include African American children, those presenting for spinal fusion surgery, and patients admitted in winter season.



http://ift.tt/2yuAJow

Rod lengthening with the magnetically controlled growing rod: factors influencing rod slippage and reduced gains during distractions

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Jason Pui Yin Cheung, Karen Yiu, Dino Samartzis, Kenny Kwan, James Tan, Kenneth M.C. Cheung




http://ift.tt/2ywdxrx

A Case-Control Study of Body Composition, Prevalence, and Curve Severity of the Patients With Adolescent Idiopathic Scoliosis in the East Part of China

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Yu Zheng, Yini Dang, Yan Yang, Ning Sun, Tao Wang, Huabo Li, Lijie Zhang, Chengqi He, M.S. Wong
ObjectiveThe purpose of the study is to investigate the characteristics of prevalence and curve severity in patients with adolescent idiopathic scoliosis (AIS) and the body composition alterations between the patients with AIS and healthy controls.MethodsInformation on the study sample was obtained from a screening database. The AIS cohort was paired with an age- and gender-matched healthy cohort. The stratification of BMI and curve severity was conducted according to the criteria developed by the US Centers for Disease Control and Prevention and the Scoliosis Research Society. The prevalence and curve severity of the patients with AIS were investigated. Multigroup comparison of body composition parameters was conducted according to BMI between the patients with AIS and healthy controls.ResultsA total of 1,202 patients with AIS and an age- and gender-matched cohort were recruited from local schools. The underweight cases had the highest prevalence of AIS and significantly higher Cobb angle compared with the other three BMI subgroups. Although the patients with AIS had lower body weight, body fat mass, percentage of body fat, and fat-free mass compared with healthy controls, converse results were observed in the underweight cases after stratification according to BMI.ConclusionBased on the sporadic body composition of the patients with AIS observed in the current study, it is predictable that the pathophysiological alterations may be different before and after the onset of scoliosis. Well-designed human or animal studies for underweight patients would be helpful to reveal the mechanisms of pathophysiological alterations and better predict the development of AIS.



http://ift.tt/2yuPRCl

Masthead

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6





http://ift.tt/2ywgIzB

Is Preoperative Fibrinogen Testing Associated With Total Blood Loss in Adolescent Idiopathic Scoliosis Correction?

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Matthew J. Geck, Devender Singh, Holly Gunn, John K. Stokes, Eeric Truumees
Study DesignRetrospective analysis.ObjectiveThis study sought to investigate the potential association between preoperative fibrinogen, bleeding, and transfusion requirements in adolescent idiopathic scoliosis (AIS) corrections.Summary of Background DataBlood loss after major spinal reconstruction increases the risks and costs of surgery. Preoperative fibrinogen levels may predict intra- and postoperative blood loss.MethodsData were collected from clinic charts and hospital medical records of all 110 of a single surgeon's consecutive AIS patients undergoing greater than three-level deformity correction surgeries from January 2011 to December 2013. Pearson test was used to investigate the correlation between bleeding and clinical variables, with level of significance set at α = 0.05.ResultsMean total bleeding volume was 488 (±356) mL. Overall, mean preoperative fibrinogen concentration was 188.6 ± 32.8 mg/dL. Preoperative platelet counts, prothrombin time (PT), and activated partial thromboplastin time (aPTT) did not correlate significantly with preoperative fibrinogen concentration (p > .05). Both packed red cells (PRC) and packed red blood cells (PRBC) correlated significantly with preoperative fibrinogen (p < .05). The correlation between PRC and preoperative fibrinogen was −0.042. There was a negative correlation between PRBC and preoperative fibrinogen (r = −0.46). Overall mean thromboelastography (TEG) values were within normal range in both males and females and both had comparable TEG parameter values. All the TEG variables (G, K, and Angle) correlated significantly with preoperative fibrinogen (p < .05) but not with total blood volume (p > .05). The correlation coefficient between these TEG variables and preoperative fibrinogen were 0.51, 0.59, and 0.54, respectively. The total bleeding volume and % estimated blood volume correlated significantly with both PRC (r = 0.352, r = 0.376; p < .05) and PRBC (r = 0.621, r = 0.614; p < .05).ConclusionsIn our cohort undergoing correction of AIS, preoperative fibrinogen levels exhibited a significant negative logarithmic correlation with total blood loss. TEG variables also correlated significantly with preoperative fibrinogen levels. Efforts should be made to incorporate this measure in perioperative blood management program for AIS corrections.Level of EvidenceLevel IV.



http://ift.tt/2ywwFEo

Early Onset Scoliosis: Results of Cotrel Mehta Casting from a Single Institution

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Kim Hammerberg, Jennifer Schottler




http://ift.tt/2yu9mLl

When Does Intraoperative Blood Loss Occur During Pediatric Scoliosis Correction?

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Sean Wahlquist, Montri Wongworawat, Scott Nelson
BackgroundThe purpose of our study was to assess the relationship between amount of blood loss and surgical stage in pediatric patients undergoing posterior spinal fusion for deformity correction to determine: (1) when the highest rate of blood loss occurred; (2) what percentage of total blood loss occurred during deformity correction and closure; and (3) how to predict remaining blood loss during a procedure. Blood loss following exposure and placement of the final pedicle screw is often underestimated, which may result in lack of sufficient blood product availability. Knowledge of the rate of blood loss plays an important role in intraoperative decision making, facilitating communication with the anesthesia team, and improving patient safety.MethodsClinical records were reviewed for all patients 9 to 18 years of age who underwent index spinal fusion surgery with pedicle screw constructs for deformity correction of greater than 4 levels by a single surgeon from April 2013 to July 2015. All patients received tranexamic acid prophylactically. Exclusion criteria included vertebral column resections, cell saver use, cases complicated by signal loss on monitoring, and incomplete records. Sixty-two of 99 patients met criteria and were included in data analysis. The surgery was divided into four stages: exposure, screw/anchor placement, corrective procedures (reduction, osteotomies), and closure. Normalized blood loss (NBL) was calculated by adjusting actual blood loss for patient weight and number of levels fused. Demographic factors of age, sex, weight/BMI, diagnosis, preoperative Cobb angle, and number of levels fused were accounted for and autoregressive moving average was used to assess whether NBL varied significantly at different stages of the procedure.ResultsNBL during reduction and closure (1.69) was significantly greater than NBL during exposure and screw placement (1.49) (p < .040). The rate of blood loss was also highest during reduction/deformity correction procedures than exposure (p < .001), anchor placement (p = .010), and closure (p < .010). At the time of placement of the final pedicle screw, 47% of the total blood loss for the case had occurred.ConclusionsRate of blood loss varies during pediatric posterior spinal deformity correction surgery, with the highest rates occurring during the reduction portion of the operation. Just over half of the total EBL occurs during the reduction and closure stages of surgery requiring the surgical team to plan accordingly. Additional studies investigating modifiable factors affecting blood loss during the later stages of scoliosis surgery are warranted.



http://ift.tt/2yw8ojg

Early Onset Scoliosis within the 22q11.2 Deletion Syndrome (22q11.2DS)

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Jelle Homans, Vyaas Baldew, Tom Schlösser, Moyo Kruyt, René Castelein




http://ift.tt/2ysVH77

The Effect of Two Attending Surgeons on Patients With Large-Curve Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Liam Bosch, Carla Boan, Miranda Falk, Greg R. White, M. Wade Shrader
Study DesignRetrospective, chart review.ObjectivesThe objective of this study is to investigate the impact of using two surgeons for posterior spinal fusion (PSF) in patients with AIS with large-magnitude curves (greater than 70°).Summary of Background DataPrevious studies have shown that intraoperative risk factors can be reduced by having two surgeons operate simultaneously.MethodsA retrospective chart review identified 47 patients between January 1, 2009, and December 31, 2014, who underwent a posterior spinal fusion (PSF) with AIS with large-magnitude curves (greater than 70°). Patients with large-magnitude curves due to neuromuscular diseases or any defined pathology other than idiopathic scoliosis were excluded, as well as patients with kyphotic or kyphoscoliotic curves.ResultsThere was no statistical difference between the total operative time, anesthesia time, estimated blood loss (EBL), %EBL, and blood transfusion units. Total operative time for the two-surgeon group and single-surgeon group was 212.11 and 238.07 minutes, respectively (p = .078). The two-surgeon group averaged 0.26 blood transfusion units versus 0.39 units for the single-surgeon group (p = .50). Average hospital length of stay was decreased in the two-surgeon group (5.16 vs. 6.82 days, p = .002).ConclusionsThe use of two surgeons for PSF for AIS has previously been shown to decrease operative time and blood loss, factors that are correlated with prolonged hospital stay and increased risk of both neurologic and nonneurologic complications. However, in this study, the technique of having two experienced orthopedic spine surgeons work simultaneously to perform pedicle screw–only posterior spinal fusion on large-magnitude AIS curves greater than 70° did not improve blood loss or operative time. Further study needs to continue to identify ways to minimize complications for patients who undergo spinal fusion.Level of EvidenceLevel III, retrospective, comparative study.



http://ift.tt/2yvVXUt

Posterior Vertebral Column Resection (PVCR) for Congenital Thoracic Lordoscoliosis in children under age of 10 with minimum 5 years follow-up

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Cem Sever, Sinan Kahraman, Selhan Karadereler, Lim Sze Wei, Tunay Sanli, Meric Enercan, Azmi Hamzaoglu




http://ift.tt/2yvyDVu

Postoperative Spine Dressing Changes Are Unnecessary

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Ravi S. Bains, Mayur Kardile, Lance K. Mitsunaga, Sukhraj Bains, Nirmal Singh, Cary Idler
IntroductionThere is minimal literature regarding when dressing changes should be performed. We present the dressing change protocol adopted by our institution. The purpose of this study was to provide an update of our experience with this dressing change protocol over a 15-year period.MethodsEffective January 2005, we implemented our universal protocol of no dressing changes for five days after surgery. Reviewing a health system administrative database, all spine surgery cases involving instrumentation performed at our institution were captured. Surgical site infection (SSI) cases: superficial, deep, and organ space as defined by the Centers for Disease Control and Prevention (CDC), were identified by reviewing an infection control database. Fisher exact test was used to compare SSI rates in all instrumented fusion cases from January 1999 to December 2004 (prior to implementation of the dressing change protocol) to those from January 2005 to December 2013 (after the protocol was initiated).ResultsA total of 8,631 instrumented spine fusions were performed at a single institution from 1999 to 2013. Overall, after instituting our universal no-dressing-change protocol, SSI rates for all cervical, thoracic, and lumbar instrumented cases combined decreased from 3.9% (97/2473) to 0.93% (57/6158) (p < .0001). The reduction in SSI rates was most significant for posterior cervical and posterior lumbar surgeries. After our dressing change protocol was implemented, we saw an improvement in SSI rates for posterior cervical instrumented cases from 3.2% (6/186) to 0.50% (4/815) (p = .0041). Posterior lumbar instrumented fusion SSI rates dropped from 5.5% (65/1179) to 1.1% (32/2890) (p < .0001).ConclusionDressing changes in the immediate postoperative period are not necessary. Applying a sterile dressing in the operating room may serve as a barrier to nosocomial pathogens during hospitalization. Our data suggest this dressing change protocol may lead to reduced SSI risk. Leaving the original postoperative surgical dressing intact is safe, simple, and cost-effective.



http://ift.tt/2ywdsEf

Quantifying the ′Law of Diminishing Returns′ in Magnetically Controlled Growing Rods

Publication date: November 2017
Source:Spine Deformity, Volume 5, Issue 6
Author(s): Adil Ahmad, Thejasvi Subramanian, Pavlos Panteliadis, James Wilson-Macdonald, Dominique Rothenfluh, Colin Nnadi




http://ift.tt/2yuEpqt

Dynamic Risk Stratification in Stage I Papillary Thyroid Cancer Patients Younger Than 45 Years of Age

Thyroid , Vol. 0, No. 0.


http://ift.tt/2gpDKlp

Rebuttal to Smith and Janssen

Thyroid , Vol. 0, No. 0.


http://ift.tt/2gp97wm

Dynamic Risk Stratification in Stage I Papillary Thyroid Cancer Patients Younger Than 45 Years of Age

Thyroid , Vol. 0, No. 0.


http://ift.tt/2gpDKlp

Rebuttal to Smith and Janssen

Thyroid , Vol. 0, No. 0.


http://ift.tt/2gp97wm

Extensive nail changes in a toddler with multisystemic Langerhans cell histiocytosis

Abstract

Langerhans cell histiocytosis (LCH) is a multisystem disorder involving various organs. Nail changes in LCH are extremely rare. We present this case report of extensive nail changes in an 18-month-old child with multisystem LCH.

http://ift.tt/2yvzw1T

Methotrexate treatment in a case of juvenile pityriasis rubra pilaris

Abstract

An 8-year-old boy who was initially diagnosed with plaque psoriasis failed management with topical therapies and skin biopsy confirmed the suspected diagnosis of juvenile pityriasis rubra pilaris (PRP). Pityriasis rubra pilaris is a rare inflammatory disorder of the skin characterized by follicular keratotic papules coalescing into plaques, along with palmoplantar keratoderma. Treatment modalities include topical and systemic therapies, although previous studies have not shown much benefit with methotrexate in children. We present a case in which methotrexate led to significant improvement of the skin findings in a child with type IV juvenile pityriasis rubra pilaris.

http://ift.tt/2xMPOQp

Phytochemistry, pharmacology, quality control and future research of Forsythia suspensa (Thunb.) Vahl: A review

Publication date: 10 January 2018
Source:Journal of Ethnopharmacology, Volume 210
Author(s): Zhaoyi Wang, Qing Xia, Xin Liu, Wenxue Liu, Wanzhen Huang, Xue Mei, Jun Luo, Mingxu Shan, Zhiqiang Ma, Ruichao Lin
Ethnopharmacological relevanceForsythiae Fructus (called Lianqiao in Chinese), the fruit of Forsythia suspensa (Thunb.) Vahl, is utilized as a common traditional medicine in China, Japan and Korea. It is traditionally used to treat pyrexia, inflammation, gonorrhea, carbuncle and erysipelas. Depending on the different harvest time, Forsythiae Fructus can be classified into two forms, namely Qingqiao and Laoqiao. The greenish fruits that start to ripen are collected as Qingqiao, while the yellow fruits that are fully ripe are collected as Laoqiao. Both are applied to medical use. This review aims to provide a systematic summary of F. suspensa (Forsythia suspensa (Thunb.) Vahl) and to reveal the correlation between the traditional uses and pharmacological activities so as to offer inspiration for future research.Materials and methodsAll corresponding information about F. suspensa was searched by Scifinder and obtained from scientific databases including Springer, Science Direct, Wiley, Pubmed and China Knowledge Resource Integrated (CNKI). Local dissertations and books were searched as well.ResultsAccording to classical Chinese herbal texts and Chinese Pharmacopoeia, Forsythiae Fructus dominantly displays heat-clearing and detoxifying effects in TCM prescriptions. In modern research, more than 230 compounds were separated and identified from F. suspensa. 211 Of them were isolated from fruits. Lignans and phenylethanoid glycosides are considered as the characteristic and active constituents of this herb, such as forsythiaside, phillyrin, rutin and phillygenin. They exhibited anti-inflammatory, antioxidant, antibacterial, anti-virus, anti-cancer and anti-allergy effects, etc. Currently, there is no report on the toxicity of Forsythiae Fructus, despite slight toxicity of forsythiaside reported in local publications. Compared to Laoqiao, Qingqiao contains higher levels of forsythiaside, forsythoside C, cornoside, rutin, phillyrin, gallic acid and chlorogenic acid and lower levels of rengyol, β-glucose and S-suspensaside methyl ether.ConclusionHeat-clearing actions of Forsythiae Fructus are based on the anti-inflammatory and antioxidant properties of lignans and phenylethanoid glycosides. Detoxifying effects attribute to the antibacterial, antiviral and anti-cancer activities of Forsythiae Fructus. And traditional Chinese medicine (TCM) characteristics of Forsythiae Fructus (bitter flavor, slightly cold nature and lung meridian) supported its strong anti-inflammatory effects. In addition, the remarkable anti-inflammatory and antioxidant capacities of Forsythiae Fructus contribute to its anti-cancer and neuroprotective activities. The higher proportion of lignans and phenylethanoid glycosides in Qingqiao than Laoqiao might explain the better antioxidant ability of Qingqiao and more frequent uses of Qingqiao in TCM prescriptions. For future research, more in vivo experiments and clinical studies are encouraged to further clarify the relation between traditional uses and modern applications. Regarding to Qingqiao and Laoqiao, they remain to be differentiated by all-round quality control methods, and the chemical compositions and clinical effects between them should be compared.

Graphical abstract

http://ift.tt/2grFoDc

Curcumol induces cell cycle arrest in colon cancer cells via reactive oxygen species and Akt/ GSK3β/cyclin D1 pathway

Publication date: 10 January 2018
Source:Journal of Ethnopharmacology, Volume 210
Author(s): Juan Wang, Xu-mei Li, Zhun Bai, Bi-xia Chi, Yan Wei, Xu Chen
Ethnopharmacological relevanceCurcuma kwangsiensis S. G. Lee & C. F. Liang (Guangxi ezhu, in Chinese) belongs to the Zingiberaceae family, has been used as a traditionally Chinese medicine nearly 2000 year. Curcumol is one of the guaiane-type sesquiterpenoid hemiketal isolated from medicine plant Curcuma kwangsiensis S. G. Lee & C. F. Liang, which has been reported possesses anti-cancer effects. Our previous study found that the most contribution to inhibit nasopharyngeal carcinoma cell growth was curcumol.Aim of the studyTo assess the effect of curcumol on cell cycle arrest against human colon cancer cells (CRC) cells (LoVo and SW480) and explore its mechanism in vitro and in vivo.Materials and methodsCurcumol was dissolved in absolute ethyl alcohol. The concentration of absolute ethyl alcohol in the control group or in experimental samples was always 1/500 (v/v) of the final medium volume. LoVo and SW480 cells were treated with different concentrations of curcumol (0, 53, 106, 212 and 424μM). And then the cell cycle of each group was examined by flow cytometry. The protein levels of PI3K, p-Akt, cyclin D1, cyclin E, CDK2, CDK4 and GSK3β were determined by Western blot. The mRNA expression of PI3K, Akt, cyclin D1, CDK4, P27, p21, and P16 in the treated cells were analyzed by real-time RT-PCR. In addition, the antitumor activity of curcumol was evaluated in nude mice bearing orthotopic tumor implants.ResultsCurcumol induced cell cycle arrest in G1/S phase. RT-qPCR and Western blot data showed that curcumol enhanced the expression of GSK3β, P27, p21 and P16, and decreased the levels of PI3K, phosphorylated Akt (p-Akt), cyclin D1, CDK4, cyclin E and CDK2. Furthermore, curcumol induced reactive oxygen species (ROS) generation in LoVo cells, and ROS scavenger N-acetylcysteine (NAC) significantly reversed curcumol-induced cell growth inhibition. Besides, curcumol also prevented the growth of human colon cancer cells xenografts in nude mouse, accompanied by the reduction of PI3K, Akt, cyclin D1, CDK4, cycln E and significant increase of GSK3β.ConclusionsCurcumol caused cell cycle arrest at the G0/G1 phase by ROS production and Akt/ GSK3β/cyclin D1 pathways inactivation, indicating the potential of curcumol in the prevention of colon cancer carcinogenesis.

Graphical abstract

http://ift.tt/2gr9Ayl

Antitussive, antispasmodic, bronchodilating and cardiac inotropic effects of the essential oil from Blepharocalyx salicifolius leaves

Publication date: 10 January 2018
Source:Journal of Ethnopharmacology, Volume 210
Author(s): Jehison Jiménez Hernández, María Inés Ragone, Patricia Bonazzola, Arnaldo L. Bandoni, Alicia E. Consolini
Ethnopharmacology relevanceBlepharocalyx salicifolius (Kunth) O. Berg (Myrtaceae) is a tree native to Argentina and Uruguay that grows and is cultivated along the riverside of the Rio de la Plata. The leaves of this plant species, locally known as "anacahuita" are used in South America to prepare infusions for the empiric treatment of cough and bronchospasm, as well as diarrhoea and other intestinal disorders. Although previous phytochemical studies have been performed with the essential oil extracted from Blepharocalyx salicifolius, pharmacological evidence supporting its traditional use is still lacking.Aim of the studyTo experimentally evaluate the pharmacological properties of Blepharocalyx salicifolius based on its traditional use. The studies were performed with tincture (T-Bs) and essential oil (EO-Bs) prepared from its leaves, in isolated rat trachea, intestine and heart preparations.MethodsThe ex-vivo effects of T-Bs and EO-Bs were evaluated with the agonists carbachol (CCh) and calcium chloride (Ca²⁺) in the contractile concentration-response curves (CRC) of the isolated intestine. The muscle relaxant effect of EO-Bs was evaluated in the isolated trachea and compared with the effect achieved with papaverine as a positive control. The T-Bs and EO-Bs cardiac effects were analysed by perfusion of an isolated rat heart before a period of ischemia/reperfusion (stunning model). The antitussive effect of both T-Bs and EO-Bs was evaluated in mice exposed to ammonia using codeine as a positive control.ResultsBoth T-Bs and EO-Bs induced a non-competitive inhibition of the CCh-CRC in the rat intestine, with IC50 values of 170.3±48.5µg T-Bs/mL (n = 6) and 5.9±1.6µg EO-Bs/mL (n = 6), respectively. EO-Bs also inhibited non-competitively the Ca²⁺-CRC, with IC50 value of 1.8±0.3µg EO-Bs/mL (n = 8). A similar effect was obtained with the main active component of the EO-Bs 1,8-cineole. In isolated trachea, EO-Bs induced the relaxation of the CCh-contracted tissue (1.7±0.2µg EO-Bs/mL, n = 11) up to a maximal relaxation that was 1.9 times higher than that of papaverine. In the isolated heart, EO-Bs induced a poor negative inotropic response, and did not improve the contractile and energetic recovery after ischemia and reperfusion. In the mouse cough model, EO-Bs (90mg/Kg) was as effective as codeine (30mg/Kg) in reducing cough frequency.ConclusionsThe results indicate that the preparations from Blepharocalyx salicifolius leaves were effective as central antitussive, bronchodilating and antispasmodic agents, suggestive of a mechanism associated with the inhibition of Ca²⁺ influx into smooth muscle. The EO-Bs displayed only a poor ability to reduce cardiac inotropism, and was devoid of any cardioprotective properties. Thus, the present study validates the traditional use of this South American plant for asthma, cough and bronchospasm, shedding new light into its potency and putative mechanism of action.

Graphical abstract

http://ift.tt/2gqRrQY

Latent Autoimmune Diabetes in Adults in North Indian Region: Assessment of β-Cell Function, Metabolic and Immunological Features

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2gr8Adz

Alternaria alternata (Fr.) Keissl with mutation G143A in the Cyt b gene is the source of a difficult-to-control allergen

Abstract

The saprotrophic fungus Alternaria alternata is widespread in the agro-environment and produces more than ten allergenic proteins, mostly protein Alt a 1. The frequency of the Alt a 1 gene was analyzed in a group of A. alternata isolates from winter wheat kernels obtained in Poland, and the effectiveness of various fungicides targeting the pathogen was evaluated. The Alt a 1 gene was identified in four of the seven tested isolates. A. alternata colonized 35.67% kernels on average, but its frequency increased in stored grain where the presence of epiphytes was noted on 23.09 to 51.38% kernels, and endophytes—in 26.21 to 42.01% of kernels. The efficacy of field-applied fungicides did not exceed 50%, despite the fact that A. alternata is highly sensitive to propiconazole, fenpropimorph, and tebuconazole under in vitro conditions. The analyzed isolates were characterized by limited sensitivity to azoxystrobin (EC₅₀ ranged from 0.505 to 1.350 μg cm⁻³) due to a mutation at codon 143 of the CYT b gene, responsible for resistance to quinone outside inhibitor fungicides, which was noted in all isolates. The spread of A. alternata can be effectively controlled with suitable fungicides and by monitoring the prevalence of pathogenic isolates in the environment.

http://ift.tt/2xQ4y5I

Plasmacytoid dendritic cells drive acute exacerbations of asthma

Although acute exacerbations, mostly triggered by viruses, account for the majority of hospitalizations in asthma, there is still very little known about the pathophysiological mechanisms involved. Plasmacytoid DCs (pDCs), prominent cells of antiviral immunity, exhibit pro-inflammatory or tolerogenic functions depending on the context, yet their involvement in asthma exacerbations remains unexplored.

http://ift.tt/2gr7f6w

Multi-site lymphatic venous anastomosis using echography to detect suitable subcutaneous vein in severe lymphedema patients

The method of lymphatic venous anastomosis (LVA), including its indications or pre-operative examinations, has not been established. The purpose of this study is to reveal the possible application of pre-operative echography in surgical LVA outcome.

http://ift.tt/2yvLubJ

Three-stage folded forehead flap for nasal reconstruction: objective and subjective measurements of aesthetic and functional outcomes.

This three-stage folded forehead flap (FFF) proved to be a simple and readily available method of lining replacement. To date, no clinical trial has evaluated the outcomes of the FFF the nose shape and function.

http://ift.tt/2xMa2Ka

Investigating the pros and cons of browns gas and varying EGR on combustion, performance, and emission characteristics of diesel engine

Abstract

The significance of mileage to the fruitful operation of a trucking organization cannot be downplayed. Fuel is one of the biggest variable expenses in a trucking wander. An attempt is made in this research to improve the combustion efficiency of a diesel engine for better fuel economy by introducing hydroxy gas which is also called browns gas or HHO gas in the suction line, without compromising performance and emission. Brown's gas facilitates the air-fuel mixture to ignite faster and efficient combustion. By considering safety and handling issues in automobiles, HHO gas generation by electrolysis of water in the presence of sodium bicarbonate electrolytes (NaHCO₃) and usage was explored in this research work over compressed pure hydrogen, due to generation and capacity of immaculate hydrogen as of now confines the application in diesel engine operation. Brown's gas was utilized as a supplementary fuel in a single-cylinder, four-stroke compression ignition (CI) engine. Experiments were carried out on a constant speed engine at 1500 rpm, result shows at constant HHO flow rate of 0.73 liter per minute (LPM), brake specific fuel consumption (BSFC) decreases by 7% at idle load to 16% at full load, and increases brake thermal efficiency (BTE) by 8.9% at minimum load to 19.7% at full load. In the dual fuel (diesel +HHO) operation, CO emissions decreases by 19.4, 64.3, and 34.6% at 25, 50, and 75% load, respectively, and unburned hydrocarbon (UHC) emissions decreased by 11.3% at minimum load to 33.5% at maximum load at the expense of NO_x emission increases by 1.79% at 75% load and 1.76% at full load than neat diesel operation. The negative impact of an increase in NO_x is reduced by adding EGR. It was evidenced in this experimental work that the use of Brown's gas with EGR in the dual fuel mode in a diesel engine improves the fuel efficiency, performance, and reduces the exhaust emissions.

http://ift.tt/2yxPCbS

Determination of element composition and extraterrestrial material occurrence in moss and lichen samples from King George Island (Antarctica) using reactor neutron activation analysis and SEM microscopy

Abstract

Seven lichens (Usnea antarctica and U. aurantiacoatra) and nine moss samples (Sanionia uncinata) collected in King George Island were analyzed using instrumental neutron activation analysis, and concentration of major and trace elements was calculated. For some elements, the concentrations observed in moss samples were higher than corresponding values reported from other sites in the Antarctica, but in the lichens, these were in the same range of concentrations. Scanning electron microscopy (SEM) and statistical analysis showed large influence of volcanic-origin particles. Also, the interplanetary cosmic particles (ICP) were observed in investigated samples, as mosses and lichens are good collectors of ICP and micrometeorites.

http://ift.tt/2gqxfPa

Adsorption and desorption for dynamics transport of hexavalent chromium (Cr(VI)) in soil column

Abstract

Batch experiments have been carried out to study the adsorption of heavy metals in soils, and the migration and transformation of hexavalent chromium (Cr(VI)) in the soil of a vegetable base were studied by dynamic adsorption and desorption soil column experiments. The aim of this study was to investigate the effect of initial concentration and pH value on the adsorption process of Cr(VI). Breakthrough curve were used to evaluate the capacity of Cr(VI) adsorption in soil columns. The results show that the higher the initial concentration, the worse the adsorption capacity of Cr(VI). The adsorption of Cr(VI) was strongly sensitive to pH value. The capacity of Cr(VI) adsorption is maximized at very low pH value. This may be due to changes in pH that cause a series of complex reactions in Cr(VI). In a strongly acidic environment, the reaction of Cr(VI) with hydrogen ions is accompanied by the formation of Cr³⁺, which reacts with the soil free iron-aluminum oxide to produce hydroxide in the soil. The results of the desorption experiments indicate that Cr(VI) is more likely to leach from this soil, but if the eluent is a strong acid solution, the leaching process will be slow and persistent. During the experiment, the pH value of the effluent was in the range of 7–8.5, which tends to the original pH value of the soil. It is indicating that the soil has a strong buffer on the acid liquid. The program CXTFIT was used to fit the breakthrough curve to estimate parameters. The results of the calculation of the dispersion coefficient (D) can be obtained by this program. The two-site model fit the breakthrough curve data of Cr(VI) well, and the parameters calculated by the CXTFIT can be used to explain the behavior of Cr(VI) migration and transformation in soil columns. When pH = 2, the retardation factor (R) reach at 79.71 while the value of the R is generally around 10 in other experiments. The partitioning coefficient β shows that more than half of the adsorption sites are instantaneous in this adsorption process and non-equilibrium affects the Cr(VI) transport process in this soil.

http://ift.tt/2yxEOdy

Assessment of filtration efficiency and physiological responses of selected plant species to indoor air pollutants (toluene and 2-ethylhexanol) under chamber conditions

Abstract

Three common plant species (Dieffenbachia maculata, Spathiphyllum wallisii, and Asparagus densiflorus) were tested against their capacity to remove the air pollutants toluene (20.0 mg m⁻³) and 2-ethylhexanol (14.6 mg m⁻³) under light or under dark in chamber experiments of 48-h duration. Results revealed only limited pollutant filtration capabilities and indicate that aerial plant parts of the tested species are only of limited value for indoor air quality improvement. The removal rate constant ranged for toluene from 3.4 to 5.7 L h⁻¹ m⁻² leaf area with no significant differences between plant species or light conditions (light/dark). The values for 2-ethylhexanol were somewhat lower, fluctuating around 2 L h⁻¹ m⁻² leaf area for all plant species tested, whereas differences between light and dark were observed for two of the three species. In addition to pollutant removal, CO₂ fixation/respiration and transpiration as well as quantum yield were evaluated. These physiological characteristics seem to have no major impact on the VOC removal rate constant. Exposure to toluene or 2-ethylhexanol revealed no or only minor effects on D. maculata and S. wallisii. In contrast, a decrease in quantum yield and CO₂ fixation was observed for A. densiflorus when exposed to 2-ethylhexanol or toluene under light, indicating phytotoxic effects in this species.

http://ift.tt/2gqtnOc

Breast Reduction: Decreasing Complications and Improving Long-Term Aesthetic Results with Parenchymal Sutures

Background: The inverted T/keyhole pattern is commonly used for large breast reductions. This technique relies on the breast skin to retain the shape. With the passage of time "fallout" (pseudoptosis) occurs impairing the cosmetic result. A technique is described that uses parenchymal sutures and inframammary fold (IMF) reinforcement sutures to maintain the intraoperative shape. Methods: A retrospective study of 25 consecutive patients (50 breasts) where the IMF was reinforced and parenchymal sutures were inserted. The patients were followed up and the nipple to notch and nipple to IMF distance was measured and compared with that marked preoperatively and set intraoperatively. Complications, especially T junction breakdown, were also recorded. Results: The mean age was 38 years (range, 16–62 years) with a mean follow-up of 12 months. The mean body mass index was 31 (range, 22–41). The mean mass of tissue excised was 925 g (range, 340–1,800 g) per side. The distance from the suprasternal notch to the nipple remained unchanged. The distance from the nipple to the IMF remained the same as that marked preoperatively except in 3 patients who developed pseudoptosis. Only 3 patients had wound dehiscence. Conclusion: Parenchymal and superficial fascial system sutures combined with IMF reinforcement contributes to maintaining the aesthetic result and decreasing complications, in weight stable patients.

http://ift.tt/2zf3Efk

Castillo Morales Appliance Therapy in the treatment of drooling children

To evaluate the efficacy of Castillo Morales Appliance Therapy (CMAT) in reducing the severity and frequency of problematic drooling in children.

http://ift.tt/2yylqgq

Epidemiological characteristics of pediatric epistaxis presenting to the emergency department

Investigate the epidemiological characteristics of pediatric epistaxis in the emergency department setting.

http://ift.tt/2gqLZ0B

Targeted next generation sequencing identified a novel mutation in MYO7A causing Usher syndrome type 1 in an Iranian consanguineous pedigree

Usher syndrome (USH) is characterized by congenital hearing loss and retinitis pigmentosa (RP) with a later onset. It is an autosomal recessive trait with clinical and genetic heterogeneity which makes the molecular diagnosis much difficult. In this study, we introduce a pedigree with two affected members with USH type 1 and represent a cost and time effective approach for genetic diagnosis of USH as a genetically heterogeneous disorder.

http://ift.tt/2yxlcpX

Incidence and factors associated with revision adenoidectomy: A retrospective study

Adenoidectomy is one of the most commonly performed pediatric operations worldwide. There are a proportion of children who require revision adenoidectomy. Yet there is little in the literature about the incidence, associated factors and etiology of adenoidal regrowth. The aim of this retrospective cohort study was to determine incidence and factors associated with revision adenoidectomy.

http://ift.tt/2gpd6cn

Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients

To determine factors associated with post-tracheotomy hospital readmission within 30 days of discharge.

http://ift.tt/2yxJ399

Relationship between empathic processing and drinking behavior in project MATCH

Publication date: February 2018
Source:Addictive Behaviors, Volume 77
Author(s): Charles S.H. Robinson, Kathryn Fokas, Katie Witkiewitz
IntroductionFamily relationships, social connectedness and a greater network of supportive others each predict better drinking outcomes among individuals with alcohol use disorder (AUD). The association between social factors and drinking may be related to the ability of individuals to take the perspectives of others' mental and emotional states, defined as empathic processing (EP). As such, it may be the case that EP is associated with social support (SS) and drinking behavior among individuals with AUD, yet few prior studies have attempted to define EP in an AUD sample.MethodsThe current study was a secondary data analysis of Project MATCH (N=1726) using structural equation modeling to model EP as a latent factor. The study also sought to test the baseline associations between EP, SS, and drinking behavior, as well as sex differences in the associations between EP, SS, and drinking. It was hypothesized that EP would be positively associated with SS and negatively associated with drinking behavior.ResultsResults suggested adequate model fit of the EP construct. Structural equation models indicated significant associations between EP, SS, and both drinking consequences and percent drinking days, but only for males. Males reported significantly lower EP and SS from friends, but more SS from family, compared to females. EP was not related to drinking among females.ConclusionsThe current study validated a model of EP in a treatment-seeking sample of individuals with alcohol use disorder. Future work may consider EP as a treatment-modifiable risk factor for drinking frequency and consequences in males.



http://ift.tt/2ytvrcP

Alcohol expectancies longitudinally predict drinking and the alcohol myopia effects of relief, self-inflation, and excess

Publication date: February 2018
Source:Addictive Behaviors, Volume 77
Author(s): Andrew Lac, Nathaniel Brack
IntroductionAlcohol myopia theory posits that alcohol consumption attenuates information processing capacity, and that expectancy beliefs together with intake level are responsible for experiences in myopic effects (relief, self-inflation, and excess).MethodsAdults (N=413) averaging 36.39 (SD=13.02) years of age completed the Comprehensive Effects of Alcohol questionnaire at baseline, followed by alcohol use measures (frequency and quantity) and the Alcohol Myopia Scale one month later. Three structural equation models based on differing construct manifestations of alcohol expectancies served to longitudinally forecast alcohol use and myopia.ResultsIn Model 1, overall expectancy predicted greater alcohol use and higher levels of all three myopic effects. In Model 2, specifying separate positive and negative expectancy factors, positive but not negative expectancy predicted greater use. Furthermore, positive expectancy and use explained higher myopic relief and higher self-inflation, whereas positive expectancy, negative expectancy, and use explained higher myopic excess. In Model 3, the seven specific expectancy subscales (sociability, tension reduction, liquid courage, sexuality, cognitive and behavioral impairment, risk and aggression, and self-perception) were simultaneously specified as predictors. Tension reduction expectancy, sexuality expectancy, and use contributed to higher myopic relief; sexuality expectancy and use explained higher myopic self-inflation; and risk and aggression expectancy and use accounted for higher myopic excess. Across all three predictive models, the total variance explained ranged from 12 to 19% for alcohol use, 50 to 51% for relief, 29 to 34% for self-inflation, and 32 to 35% for excess.ConclusionsFindings support that the type of alcohol myopia experienced is a concurrent function of self-fulfilling alcohol prophecies and drinking levels. The interpreted measurement manifestation of expectancy yielded different prevention implications.



http://ift.tt/2x3upmx

Extraction of mandibular third molars: proposal of a new scale of difficulty

We evaluated the accuracy of a new scale of surgical difficulty for the extraction of impacted mandibular third molars, which includes consideration of previously underestimated variables. Two hundred patients with impacted third molars were enrolled, and a preoperative clinical and radiographic assessment of difficulty was made by an oral surgeon using the new index. Five oral surgeons with similar degrees of experience then evaluated the surgical difficulty during operation. The kappa test and weighted kappa were used to evaluate the level of agreement between the preoperative and postoperative evaluations.

http://ift.tt/2ij1Lek

The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: a systematic review

Inadequate sleep is highly prevalent and known to decline both physical- and mental health. Literature suggests that altered functioning of the hypothalamic-pituitary-adrenal (HPA) axis might underlie this association. This assumption is mainly based on changes in basal neuroendocrine activity and it is of equal importance to elucidate whether sleep may also influence HPA stress responsiveness. The present review provides a complete outline of recent human studies that have investigated how different aspects of sleep influence cortisol reactivity to laboratory stress.

http://ift.tt/2ySR6y4

Inherited and acquired clinical phenotypes associated with neuroendocrine tumors.

Purpose of review: Overview of neuroendocrine neoplasms in the context of their associations with primary and secondary immunodeficiency states. Recent findings: Malignancies of neuroendocrine origin are well known to be associated with hereditary syndromes, including multiple endocrine neoplasia type 1, von Hippel-Lindau syndrome, neurofibromatosis type 1, and tuberous sclerosis. This review includes the X-linked form of hyper-IgM syndrome (XHIGM), due to mutations in the CD40Ligand gene (CD40LG), as an additional inherited disorder with susceptibility to such malignancies, and discusses neuroendocrine tumors (NETs) arising in other immunocompromised states. Of all primary immune deficiency diseases, NETs appear to be unique to XHIGM patients. Outcomes for XHIGM patients with NETs is poor, and the mechanism behind this association remains unclear. In secondary immune deficiency states, NET occurrences were primarily in patients with HIV or AIDS, the autoimmune disease systemic lupus erythematosus and solid organ transplant recipients. Gastroenteropancreatic NETs were most frequent in XHIGM patients, whereas nongastroenteropancreatic-NETs, like Merkel cell carcinoma and small-cell lung carcinoma, affected HIV/AIDS patients. Possible mechanisms as to the nature of these associations are discussed, including chronic infections and inflammation, and CD40-CD40L interactions. Many questions remain, and further studies are needed to clarify the predisposition of patients with XHIGM to the development of NETs. Given that many of these patients present late in their disease state and have poor outcomes, it is imperative to keep a high index of suspicion at the advent of early signs and symptoms. Regular monitoring with laboratory or imaging studies, including tumor markers, may be warranted, for which further studies are needed. Summary: Of all primary immunodeficiency diseases, NETs appear to be unique to XHIGM, and the mechanism behind this association remains unclear. Outcome for XHIGM patients with NETs is poor, and it is imperative to keep a high index of suspicion at the advent of early signs and symptoms. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gq1pSD

An update on gain-of-function mutations in primary immunodeficiency diseases.

Purpose of review: Most primary immunodeficiencies described since 1952 were associated with loss-of-function defects. With the advent and popularization of unbiased next-generation sequencing diagnostic approaches followed by functional validation techniques, many gain-of-function mutations leading to immunodeficiency have also been identified. This review highlights the updates on pathophysiology mechanisms and new therapeutic approaches involving primary immunodeficiencies because of gain-of-function mutations. Recent findings: The more recent developments related to gain-of-function primary immunodeficiencies mostly involving increased infection susceptibility but also immune dysregulation and autoimmunity, were reviewed. Updates regarding pathophysiology mechanisms, different mutation types, clinical features, laboratory markers, current and potential new treatments on patients with caspase recruitment domain family member 11, signal transducer and activator of transcription 1, signal transducer and activator of transcription 3, phosphatidylinositol-4,5-biphosphate 3-kinase catalytic 110, phosphatidylinositol-4,5-biphosphate 3-kinase regulatory subunit 1, chemokine C-X-C motif receptor 4, sterile [alpha] motif domain containing 9-like, and nuclear factor [kappa]-B subunit 2 gain-of-function mutations are reviewed for each disease. Summary: With the identification of gain-of-function mutations as a cause of immunodeficiency, new genetic pathophysiology mechanisms unveiled and new-targeted therapeutic approaches can be explored as potential rescue treatments for these diseases. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ywnF4a

Anticholinergics for asthma: a long history.

Purpose of review: To provide a fast overview about the introduction and development of anticholinergic drugs in Western medicine to their current indications particularly in asthma. Recent findings: Although short-acting muscarinic antagonists have been positioned in the last 15 years for the treatment of adults and children with moderate-to-severe acute asthma in the emergency setting (reducing the risk of hospital admissions and improving lung function), a growing body of evidence has recently emerged that positions the long-acting muscarinic anticholinergic tiotropium bromide as add-on therapy to at least inhaled corticosteroids (ICS) maintenance therapy in adults, adolescents, and children with symptomatic asthma. Thus, the addition of tiotropium bromide to ICS alone or ICS and another controller was associated with significant improvements in spirometric measures and asthma control, and a significantly decrease in the rate of asthma exacerbations. Summary: Short-acting muscarinic antagonists and tiotropium bromide have a well established role in the treatment of different phases of asthma. Further data are needed to provide more evidence on other selective long-acting muscarinic antagonists in addition to tiotropium as potential treatment options. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gq8bYX

Secular trends in height, weight and body mass index of primary school children in Turkey between 1993 and 2016

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://ift.tt/2yRFdbW

Effects of 1-year growth hormone replacement therapy on thyroid volume and function of the children and adolescents with idiopathic growth hormone deficiency

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://ift.tt/2hNdwWT

Early-onset severe obesity due to complete deletion of the leptin gene in a boy

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


http://ift.tt/2yRcnbD

Proposal of a Budget-Friendly Camera Holder for Endoscopic Ear Surgery.

Endoscopic ear surgery (EES) is increasingly a preferred technique in otologic society. It offers excellent visualization of the anatomical structures directly and behind the corners with variable angled telescopes. It also provides reduced operative morbidity due to being able to perform surgical interventions with less invasive approaches. Operative preparation and setup time and cost of endoscopy system are less expensive compared with surgical microscopes. On the other hand, the main disadvantage of EES is that the surgery has to be performed with 1 single hand. It is certainly restrictive for an ear surgeon who has been operating with 2 hands under otologic microscopic views for years and certainly requires a learning period and perseverance. Holding the endoscope by a second surgeon is not executable because of insufficient surgical space. Endoscope/camera holders have been developed for those who need the comfort and convenience afforded by double-handed microscopic ear surgery. An ideal endoscope holder should be easy-to-set up, easily controlled, providing a variety of angled views, allowing the surgeon to operate with 2 hands and, budget-friendly. In this article, a commercially available 11-inch magic arm camera holder is proposed by the authors to be used in EES due to its versatile, convenient, and budget-friendly features. It allows 2-handed EES through existing technology and is affordable for surgeons looking for a low-cost and practical solution. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zvFrSY

Surgical Treatment of Dentofacial Deformities Caused by Juvenile Idiopathic Arthritis.

The purpose of our retrospective study was to evaluate the results of orthognathic treatment, distraction osteogenesis, and/or prosthetic reconstruction of the temporomandibular joints in patients with juvenile idiopathic arthritis (JIA). Twelve patients with severely affected temporomandibular joints (TMJs) and reduced ramus height were treated with mandibular advancement with orthognathic surgery (11) and additional bilateral or unilateral mandibular ramus distraction (3) or additional bilateral or unilateral prosthetic reconstruction of the TMJ (3). One patient was treated surgically with bilateral TMJ prosthetic reconstruction only. The patients were followed up clinically and radiologically with emphasis on healing, TMJ function, stability of the occlusion, skeletal stability, and facial appearance for an average of 2.3 years after the final surgery. The mean mandibular advancement was 10.1 mm. The mean relapse at pogonion was 2.1 mm, which represents 20.8% of the surgical advancement. The occlusion was stable in 11/12 patients. The TMJ function was good and the facial esthetics improved in all patients. Orthognathic treatment and mandibular ramus distraction osteogenesis provide beneficial lengthening of the mandibular body in JIA patients with asymptomatic and stabile condyles. In adult patients with relapse of the disease or postoperative condylar relapse prosthetic total joint replacement is a reliable and safe alternative. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zw95rs

The Role of Preoperative Imaging in the Management of Nonsyndromic Lambdoid Craniosynostosis.

Background: The necessity of imaging for patients with craniosynostosis is controversial. Lambdoid synostosis is known to be associated with additional anomalies, but the role of imaging in this setting has not been established. The purpose of this study was to evaluate the impact of preoperative imaging on intraoperative and postoperative management among patients undergoing operative intervention for lambdoid craniosynostosis. Methods: A retrospective review of patients undergoing cranial vault remodeling for lambdoid craniosynostosis between January 2006 and 2014 was conducted. Patient demographics, age at computed tomography scan, age at surgery, results of the radiologic evaluation, operative technique, and modification of the diagnosis following the radiologic studies were analyzed. A pediatric neuroradiology and the surgical team interpreted the radiographs. The primary outcome was change in intraoperative or postoperative management based on imaging results. Results: A total of 11 patients were diagnosed with lambdoid synostosis. Of these patients, 81.8% had abnormalities on imaging relevant to operative planning. The most common anomalies were Chiari I malformation (45%) and venous anomalies of the posterior fossa (36%). Preoperative imaging altered the management of 9 (81.8%) patients. Closer follow-up was required for 6 patients (54%). Suboccipital decompression was performed in 4 patients (36%). Venous anomalies were found in 4 patients (36%). The diagnosis was changed from positional plagiocephaly to lambdoid synostosis in 2 patients (18%). Conclusions: Given the frequency and significance of radiographic abnormalities in the setting of lamboid synostosis, preoperative imaging should be considered during the operative planning phase as it can affect postoperative and intraoperative management. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zvNdMM

Long-Term Effects of Bone Morphogenetic Protein-2-Loaded Calcium Phosphate on Maxillary Sinus Lift Surgery for Delayed and Simultaneous Dental Implantation.

Maxillary sinus lift surgery (MSLS) is considered to be a useful treatment method for patients with atrophic alveolar bone. Choosing a suitable surgical procedure to simultaneously decrease graft absorption and obtain long-term survival of dental implants is still a challenge. In this study, 20 patients received MSLS with graft of bone morphogenetic protein 2 (BMP2)-loaded calcium phosphate. Dental implants were placed simultaneously in 10 patients receiving MSLS (1-stage group), and in 10 patients receiving dental implants with a 3 to 6 months delay (2-stage group). The effects were evaluated based on clinical and radiographic examination during a 4 to 5 years follow-up. The results showed that only 1 perforation of the maxillary sinus mucosa was observed in 1-stage group, and was patched with a collagen membrane. An average bone gain of 6.8 mm was observed, and all implants exhibited no looseness, peri-implantitis, or fracture, all of which were stable during the follow-up and exhibited nice dental function during a 4 to 5 years follow-up. The loss of peri-implant bone height was 1.12 +/- 0.47 and 1.10 +/- 0.39 mm, the probing depth of periodontal pocket was 1.79 +/- 0.62 and 1.81 +/- 0.71 mm, the sulcular bleeding index was 1.63 +/- 0.47 and 1.72 +/- 0.54 in 1-stage group and 2-stage group, respectively, and no significant differences existed between these 2 groups. These findings implied that BMP2-loaded calcium phosphate may be a suitable material for MSLS, especially for patients with minimal bone height. Clinicians can use the 1- or 2-stage technique based on clinical condition, patients' choice and clinicians' experience. In patients where implants cannot be stabilized for patients with minimal bone height, 2-stage surgery may be more suitable. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zvN5gg

The Pantheon Variant of the Classic Cathedral Dome Procedure for Parieto-Occipital Skull Deformities.

Objective: To describe a new technique for the reconstruction of parieto-occipital skull deformities. Methods and Results: The technique is a variant of the previously described "cathedral dome procedure" used for frontal skull deformities. The authors apply the same principle of remodeling by making meridional slat craniotomies surrounding the depressed dome of the posterior skull deformity, followed by "green-stick fracture-reshaping" of the meridional slats to elevate and support the excised depressed dome. The authors present an illustrative patient with a follow-up of 2 years and an excellent cosmetic result. Conclusion: The authors introduce a new operative technique for the reconstruction of parieto-occipital skull deformities with excellent long-term results. The freshly reconstructed occiput resembles the dome of the pantheon in Rome, Italy, whose unique features inspired us to name this procedure the "Pantheon" variant of the cathedral dome operation. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zgOg2k

Clinical Evaluation of Standardized Fronto-Orbital Advancement for Correction of Isolated Trigonocephaly.

Corrective surgery of trigonocephaly is a major challenge, owing to the complex development of the craniofacial skull. Although reports on the clinical success of standardized fronto-orbital advancement have been promising, there is a lack of studies, assessing this method. Hence, the aim of our study was to evaluate the clinical outcome of a standardized fronto-orbital advancement procedure for correction of isolated nonsyndromic trigonocephaly, in our patient cohort. The retrospective study included 30 patients from 2008 to 2015. Inclusion criteria were treatment-naive children with isolated nonsyndromic trigonocephaly, being treated with standardized frontoorbital advancement in our department. We considered postoperative complications and the Whitaker Score to evaluate the success of the clinical outcome. Surgery was performed at a mean age of 9.3 months. The mean operation time was 153 minutes. All patients were assigned I according to the Whitaker score. One patient suffered from a small inconsequential subdural hematoma. Another patient suffered from dural tears, which were identified and treated intraoperatively. No major complications occurred within our patient cohort. The standardized fronto-orbital advancement is a safe and successful method, as it is associated with a high morphological outcome and low complication rate. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zvMXgM

Proof of Concept Study for the Design, Manufacturing, and Testing of a Patient-Specific Shape Memory Device for Treatment of Unicoronal Craniosynostosis.

Treatment of unicoronal craniosynostosis is a surgically challenging problem, due to the involvement of coronal suture and cranial base, with complex asymmetries of the calvarium and orbit. Several techniques for correction have been described, including surgical bony remodeling, early strip craniotomy with orthotic helmet remodeling and distraction. Current distraction devices provide unidirectional forces and have had very limited success. Nitinol is a shape memory alloy that can be programmed to the shape of a patient-specific anatomy by means of thermal treatment. In this work, a methodology to produce a nitinol patient-specific distractor is presented: computer tomography images of a 16-month-old patient with unicoronal craniosynostosis were processed to create a 3-dimensional model of his skull and define the ideal shape postsurgery. A mesh was produced from a nitinol sheet, formed to the ideal skull shape and heat treated to be malleable at room temperature. The mesh was afterward deformed to be attached to a rapid prototyped plastic skull, replica of the patient initial anatomy. The mesh/skull construct was placed in hot water to activate the mesh shape memory property: the deformed plastic skull was computed tomography scanned for comparison of its shape with the initial anatomy and with the desired shape, showing that the nitinol mesh had been able to distract the plastic skull to a shape close to the desired one. The shape-memory properties of nitinol allow for the design and production of patient-specific devices able to deliver complex, preprogrammable shape changes. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2zfxi4p

Evaluation of mean transit time of aerosols from the area of origin to the Arctic with 210Pb/210Po daily monitoring data

Publication date: Available online 17 October 2017
Source:Journal of Environmental Radioactivity
Author(s): Weihua Zhang, Baki Sadi, Christopher Rinaldo, Jing Chen, Norman Spencer, Kurt Ungar
In this study, the activity concentrations of ²¹⁰Pb and ²¹⁰Po on the 22 daily air filter samples, collected at CTBT Yellowknife station from September 2015 to April 2016, were analysed. To estimate the time scale of atmospheric long-range transport aerosol bearing ²¹⁰Pb in the Arctic during winter, the mean transit time of aerosol bearing ²¹⁰Pb from its origin was determined based on the activity ratios of ²¹⁰Po/²¹⁰Pb and the parent-progeny decay/ingrowth equation. The activity ratios of ²¹⁰Po/²¹⁰Pb varied between 0.06 and 0.21 with a median value of 0.11. The aerosol mean transit time based the activity ratio of ²¹⁰Po/²¹⁰Pb suggests longer mean transit time of ²¹⁰Pb aerosols in winter (12 d) than in autumn (3.7 d) and spring (2.9 d).Four years ²¹⁰Pb and ²¹²Pb monitoring results and meteorological conditions at the Yellowknife station indicate that the ²¹²Pb activity is mostly of local origin, and that ²¹⁰Pb aerosol in wintertime are mainly from outside of the Arctic regions in common with other pollutants and sources contributing to the Arctic. The activity concentration ratios of ²¹⁰Pb and ²¹²Pb have a relatively constant value in summer with a significant peak observed in winter, centered in the month of February. Comparison of the ²¹⁰Pb/²¹²Pb activity ratios and the estimated mean ²¹⁰Pb transit time, the mean aerosol transit times were real reflection of the atmosphere transport characteristics, which can be used as a radio-chronometer for the transport of air masses to the Arctic region.



http://ift.tt/2yvcFmV

Functionalized polyethylene fibers for the selective capture of palladium ions from aqueous solution

Publication date: 1 March 2018
Source:Applied Surface Science, Volume 433
Author(s): Li-juan Pang, Rong Li, Jiang-tao Hu, Lin-juan Zhang, Ming-xing Zhang, Chen-guang Yang, Guo-zhong Wu
An innovative ultrahigh molecular weight polyethylene (UHMWPE) fibrous adsorbent was successfully synthesized via radiation grafting and applied to the selective capture of palladium ions from dilute aqueous solutions. The influence of the pH, initial Pd(II) concentration, and temperature on the adsorption performance was examined in a batch adsorption experiment. Pd K-edge extended X-ray absorption fine structure (EXAFS) spectra indicated that Pd(II) was immobilized on the adsorbent surface via a ligand exchange reaction that formed a stable UHMWPE-PMDA-Pd complex. Although the concentrations of coexisting ions (Cu(II), Zn(II), Cr(VI), Fe(III), and Ni(II)) in the solution were much higher than that of Pd(II), the adsorption capacity for Pd(II) of the as-prepared absorbent was significantly greater than that for other metal ions. Kinetic studies showed good correlation with the pseudo-second-order model. The maximum capacity for Pd(II) adsorption was approximately 221.8mg·g⁻¹ at 298K. The adsorption behavior conformed to the Langmuir isotherm model. Thermodynamic studies revealed that the adsorption of Pd(II) was a feasible, spontaneous, and endothermic process.

Graphical abstract

http://ift.tt/2yuIgDS

Structural characterization and antimicrobial activities of transition metal complexes of a hydrazone ligand

Publication date: 15 February 2018
Source:Journal of Molecular Structure, Volume 1154
Author(s): Raghavendra P. Bakale, Ganesh N. Naik, Shrinath S. Machakanur, Chandrashekhar V. Mangannavar, Iranna S. Muchchandi, Kalagouda B. Gudasi
A hydrazone ligand has been synthesized by the condensation of 2-nitrobenzaldehyde and hydralazine, and its Co(II), Ni(II), Cu(II) and Zn(II) complexes have been reported. Structural characterization of the ligand and its metal complexes has been performed by various spectroscopic [IR, NMR, UV–Vis, Mass], thermal and other physicochemical methods. The structure of the ligand and its Ni(II) complex has been characterized by single crystal X-ray diffraction studies. All the synthesized compounds have been screened for in vitro antimicrobial activity. The antibacterial activity is tested against Gram-positive strains Enterococcus faecalis, Streptococcus mutans and Staphylococcus aureus and Gram-negative strains Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae using ciprofloxacin as the reference standard. Antifungal activity is tested against Candida albicans, Aspergillus fumigatus and Aspergillus niger using ketoconazole as the reference standard. The minimum inhibitory concentration (MIC) was determined for test compounds as well as for reference standard. Ligand, Cu(II) and Zn(II) complexes have shown excellent activity against Candida albicans.

Graphical abstract

http://ift.tt/2kVcz3j

Coordination-organometallic hybrid materials based on the trinuclear M(II)-Ru(II) (M=Ni and Zn) complexes: Synthesis, structural characterization, luminescence and electrochemical properties

Publication date: 15 February 2018
Source:Journal of Molecular Structure, Volume 1154
Author(s): S.B. Pawal, S.R. Lolage, S.S. Chavan
A new series of trinuclear complexes of the type Ni[R-C6H4NCH(O)C6H3CCRu(dppe)2Cl]2 (1a-c) and Zn[RC6H4NCH(O)C6H3CCRu(dppe)2Cl]2 (2a-c) have been prepared from the reaction of trans-[RuCl(dppe)2CCC6H3(OH)(CHO)] (1) with aniline, 4-nitroaniline and 4-methoxyaniline (R1-3) in presence of nickel acetate and zinc acetate in CH2Cl2/MeOH (1:1) mixture. The structural properties of the complexes have been characterized by elemental analyses and spectroscopic techniques viz. FTIR, UV-Visible, ¹H NMR and ³¹P NMR spectral studies. The crystal structure and morphology of the hybrid complexes was investigated with the help of X-ray powder diffraction (XRPD), Scanning electron microscopy (SEM) and Transmission electron microscopy (TEM). The thermal properties of 1a-c and 2a-c were studied by thermogravimetric (TG) analysis. The electrochemical behaviour of the complexes reveals that all complexes displayed a quasireversible redox behaviour corresponding to Ru(II)/Ru(III) and Ni(II)/Ni(III) couples for 1a-c and only Ru(II)/Ru(III) couple for 2a-c. All complexes are emissive in solution at room temperature revealing the influence of substituents and solvent polarity on emission properties of the complexes.

Graphical abstract

http://ift.tt/2kWy6J4

Preremedial assessment of the municipal landfill pollution impact on soil and shallow groundwater in Subotica, Serbia

Publication date: 15 February 2018
Source:Science of The Total Environment, Volume 615
Author(s): Dejan Krčmar, Slaven Tenodi, Nenad Grba, Djurdja Kerkez, Malcolm Watson, Srdjan Rončević, Božo Dalmacija
Most regional municipal solid waste landfills in Serbia are operated without control of landfill leachate and gas or with no regard for implementation of national and European legislation. For the first time in Serbia, groundwater and soil at a landfill were subject to systematic annual monitoring according to national, European legislation and adopted methodologies. Characterisation of the groundwater and soil samples from the landfill included ten metals (Fe, Mn, As, Zn, Cd, Pb, Ni, Cr, Cu and Hg), 16 EPA PAHs, nutrients and certain physicochemical parameters, in order to assess the risks such poorly controlled landfills pose to the environment. This impact assessment was performed using specially adapted pollution indices: LWPI, the Single factor pollution index and the Nemerow index for groundwater, and geo-accumulation index, ecological risk factor and selected rations of PAHs for soil. The data analysis included multivariate statistical methods (factor analysis of principal component analysis (PCA/FA)) in order to assess the extent of the contaminants detected in the groundwater and soil samples.The pollution indices (LWPI: 3.56–8.89; Nemerow index: 2.02–3.78) indicate the quality of the groundwater at the landfill is degrading over time, with PAH16, TOC, Cr, Cu, Pb and Zn as the substances of greatest concern. Heavy metals Hg (Igeo≤3.14), Pb (Igeo≤2.22), Cr (Igeo≤3.31) and Cu (Igeo≤2.16) represent the worst soil contamination. Hg has moderate (52.9) to very high (530.0) potential ecological risk, demonstrating the long-term potential effects of bioaccumulation and biomagnification.The results of this work indicate that Cr and Cu should possibly be added to the EU Watch List of emerging substances. This proposition is substantiated by relevant state and alike environmental information from nations in the region. This study demonstrates the need to develop a model for prioritization of landfill closure and remediation based on environmental risk assessment.

Graphical abstract

http://ift.tt/2kWJPr5

Second-harmonic generation of ZnO nanoparticles synthesized by laser ablation of solids in liquids

Publication date: 1 February 2018
Source:Optics & Laser Technology, Volume 99
Author(s): Israel Rocha-Mendoza, Santiago Camacho-López, Yryx Y. Luna-Palacios, Yasmín Esqueda-Barrón, Miguel A. Camacho-López, Marco Camacho-López, Guillermo Aguilar
We report the synthesis of small zinc oxide nanoparticles (ZnO NPs) based colloidal suspensions and the study of second-harmonic generation from aggregated ZnO NPs deposited on glass substrates. The colloidal suspensions were obtained using the laser ablation of solids in liquids technique, ablating a Zn solid target immersed in acetone as the liquid medium, with ns-laser pulses (1064nm) of a Nd-YAG laser. The per pulse laser fluence, the laser repetition rate frequency and the ablation time were kept constant. The absorption evolution of the obtained suspensions was optically characterized through absorption spectroscopy until stabilization. Raman spectroscopy, SEM and HRTEM were used to provide evidence of the ZnO NPs structure. HRTEM results showed that 5–8nm spheroids ZnO NPs were obtained. Strong second-harmonic signal is obtained from random ZnO monocrystalline NPs and from aggregated ZnO NPs, suggesting that the high efficiency of the nonlinear process may not depend on the NPs size or aggregation state.



http://ift.tt/2kWJJzJ

Delafloxacin an Effective Option for Acute Bacterial Skin Infections

Delafloxacin is non-inferior to vancomycin plus aztreonam for treating acute bacterial skin and skin-structure infections (ABSSSI), according to a new phase 3 trial.
Reuters Health Information

http://ift.tt/2xOnHVX

Clinical profile of silent growth hormone pituitary adenomas; higher recurrence rate compared to silent gonadotroph pituitary tumors, a large single center experience

Abstract

Purpose

Study and comparison of characteristics of silent growth hormone adenomas (SGHA), silent corticotroph adenomas (SCA), and silent gonadotroph adenomas (SGA) in a single institution cohort of surgically treated pituitary adenomas.

Methods

Retrospective analysis of SGHA surgically resected over 10 years: SGHA was defined as no clinical or biochemical evidence of acromegaly and positive GH immunostaining.

Results

Of 814 pituitary surgeries; 2.1% (n = 17) were SGHA, 4.5% (n = 37) SCA, and 18.9% (n = 70/371; 2011–2016) SGA. Mean age at SGHA diagnosis was 43 years, with a large female predominance (82%). Mean tumor size and cavernous/sphenoid sinus invasiveness for SGHA, SCA, and SGA were 1.5 ± 1.0 cm and 25%, 2.5 ± 1.2 cm and 43%, 2.9 ± 2.0 cm and 41%, respectively (tumor size p = 0.009, SGHA vs. SGA, and invasion p; not-significant). During mean follow-up of 3.9 years, two patients (11%) developed elevated insulin-like growth factor-1 and five patients (29%) required a second surgery for tumor recurrence. Rate of surgical reintervention was similar to SCA (31%), but higher than SGA (10%) (p = 0.035, SGHA vs. SGA), and 18% underwent radiation therapy, similar to SCA (19%, p; not-significant) but higher than SGA (2.9%, p = 0.018).

Conclusion

This is the largest single center study characterizing SGHA behavior with SGA and SCA control groups in a cohort of surgically resected pituitary adenomas. SGHA present mostly in young females, and should be closely followed due to their higher likelihood of recurrence and potential of progression to clinical acromegaly. We propose that a complete hormonal staining panel be routinely performed for all pituitary adenomas.

http://ift.tt/2xLSBcn

Inherited and acquired clinical phenotypes associated with neuroendocrine tumors.

Purpose of review: Overview of neuroendocrine neoplasms in the context of their associations with primary and secondary immunodeficiency states. Recent findings: Malignancies of neuroendocrine origin are well known to be associated with hereditary syndromes, including multiple endocrine neoplasia type 1, von Hippel-Lindau syndrome, neurofibromatosis type 1, and tuberous sclerosis. This review includes the X-linked form of hyper-IgM syndrome (XHIGM), due to mutations in the CD40Ligand gene (CD40LG), as an additional inherited disorder with susceptibility to such malignancies, and discusses neuroendocrine tumors (NETs) arising in other immunocompromised states. Of all primary immune deficiency diseases, NETs appear to be unique to XHIGM patients. Outcomes for XHIGM patients with NETs is poor, and the mechanism behind this association remains unclear. In secondary immune deficiency states, NET occurrences were primarily in patients with HIV or AIDS, the autoimmune disease systemic lupus erythematosus and solid organ transplant recipients. Gastroenteropancreatic NETs were most frequent in XHIGM patients, whereas nongastroenteropancreatic-NETs, like Merkel cell carcinoma and small-cell lung carcinoma, affected HIV/AIDS patients. Possible mechanisms as to the nature of these associations are discussed, including chronic infections and inflammation, and CD40-CD40L interactions. Many questions remain, and further studies are needed to clarify the predisposition of patients with XHIGM to the development of NETs. Given that many of these patients present late in their disease state and have poor outcomes, it is imperative to keep a high index of suspicion at the advent of early signs and symptoms. Regular monitoring with laboratory or imaging studies, including tumor markers, may be warranted, for which further studies are needed. Summary: Of all primary immunodeficiency diseases, NETs appear to be unique to XHIGM, and the mechanism behind this association remains unclear. Outcome for XHIGM patients with NETs is poor, and it is imperative to keep a high index of suspicion at the advent of early signs and symptoms. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gq1pSD

An update on gain-of-function mutations in primary immunodeficiency diseases.

Purpose of review: Most primary immunodeficiencies described since 1952 were associated with loss-of-function defects. With the advent and popularization of unbiased next-generation sequencing diagnostic approaches followed by functional validation techniques, many gain-of-function mutations leading to immunodeficiency have also been identified. This review highlights the updates on pathophysiology mechanisms and new therapeutic approaches involving primary immunodeficiencies because of gain-of-function mutations. Recent findings: The more recent developments related to gain-of-function primary immunodeficiencies mostly involving increased infection susceptibility but also immune dysregulation and autoimmunity, were reviewed. Updates regarding pathophysiology mechanisms, different mutation types, clinical features, laboratory markers, current and potential new treatments on patients with caspase recruitment domain family member 11, signal transducer and activator of transcription 1, signal transducer and activator of transcription 3, phosphatidylinositol-4,5-biphosphate 3-kinase catalytic 110, phosphatidylinositol-4,5-biphosphate 3-kinase regulatory subunit 1, chemokine C-X-C motif receptor 4, sterile [alpha] motif domain containing 9-like, and nuclear factor [kappa]-B subunit 2 gain-of-function mutations are reviewed for each disease. Summary: With the identification of gain-of-function mutations as a cause of immunodeficiency, new genetic pathophysiology mechanisms unveiled and new-targeted therapeutic approaches can be explored as potential rescue treatments for these diseases. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ywnF4a

Anticholinergics for asthma: a long history.

Purpose of review: To provide a fast overview about the introduction and development of anticholinergic drugs in Western medicine to their current indications particularly in asthma. Recent findings: Although short-acting muscarinic antagonists have been positioned in the last 15 years for the treatment of adults and children with moderate-to-severe acute asthma in the emergency setting (reducing the risk of hospital admissions and improving lung function), a growing body of evidence has recently emerged that positions the long-acting muscarinic anticholinergic tiotropium bromide as add-on therapy to at least inhaled corticosteroids (ICS) maintenance therapy in adults, adolescents, and children with symptomatic asthma. Thus, the addition of tiotropium bromide to ICS alone or ICS and another controller was associated with significant improvements in spirometric measures and asthma control, and a significantly decrease in the rate of asthma exacerbations. Summary: Short-acting muscarinic antagonists and tiotropium bromide have a well established role in the treatment of different phases of asthma. Further data are needed to provide more evidence on other selective long-acting muscarinic antagonists in addition to tiotropium as potential treatment options. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gq8bYX

Inherited and acquired clinical phenotypes associated with neuroendocrine tumors.

Purpose of review: Overview of neuroendocrine neoplasms in the context of their associations with primary and secondary immunodeficiency states. Recent findings: Malignancies of neuroendocrine origin are well known to be associated with hereditary syndromes, including multiple endocrine neoplasia type 1, von Hippel-Lindau syndrome, neurofibromatosis type 1, and tuberous sclerosis. This review includes the X-linked form of hyper-IgM syndrome (XHIGM), due to mutations in the CD40Ligand gene (CD40LG), as an additional inherited disorder with susceptibility to such malignancies, and discusses neuroendocrine tumors (NETs) arising in other immunocompromised states. Of all primary immune deficiency diseases, NETs appear to be unique to XHIGM patients. Outcomes for XHIGM patients with NETs is poor, and the mechanism behind this association remains unclear. In secondary immune deficiency states, NET occurrences were primarily in patients with HIV or AIDS, the autoimmune disease systemic lupus erythematosus and solid organ transplant recipients. Gastroenteropancreatic NETs were most frequent in XHIGM patients, whereas nongastroenteropancreatic-NETs, like Merkel cell carcinoma and small-cell lung carcinoma, affected HIV/AIDS patients. Possible mechanisms as to the nature of these associations are discussed, including chronic infections and inflammation, and CD40-CD40L interactions. Many questions remain, and further studies are needed to clarify the predisposition of patients with XHIGM to the development of NETs. Given that many of these patients present late in their disease state and have poor outcomes, it is imperative to keep a high index of suspicion at the advent of early signs and symptoms. Regular monitoring with laboratory or imaging studies, including tumor markers, may be warranted, for which further studies are needed. Summary: Of all primary immunodeficiency diseases, NETs appear to be unique to XHIGM, and the mechanism behind this association remains unclear. Outcome for XHIGM patients with NETs is poor, and it is imperative to keep a high index of suspicion at the advent of early signs and symptoms. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gq1pSD

An update on gain-of-function mutations in primary immunodeficiency diseases.

Purpose of review: Most primary immunodeficiencies described since 1952 were associated with loss-of-function defects. With the advent and popularization of unbiased next-generation sequencing diagnostic approaches followed by functional validation techniques, many gain-of-function mutations leading to immunodeficiency have also been identified. This review highlights the updates on pathophysiology mechanisms and new therapeutic approaches involving primary immunodeficiencies because of gain-of-function mutations. Recent findings: The more recent developments related to gain-of-function primary immunodeficiencies mostly involving increased infection susceptibility but also immune dysregulation and autoimmunity, were reviewed. Updates regarding pathophysiology mechanisms, different mutation types, clinical features, laboratory markers, current and potential new treatments on patients with caspase recruitment domain family member 11, signal transducer and activator of transcription 1, signal transducer and activator of transcription 3, phosphatidylinositol-4,5-biphosphate 3-kinase catalytic 110, phosphatidylinositol-4,5-biphosphate 3-kinase regulatory subunit 1, chemokine C-X-C motif receptor 4, sterile [alpha] motif domain containing 9-like, and nuclear factor [kappa]-B subunit 2 gain-of-function mutations are reviewed for each disease. Summary: With the identification of gain-of-function mutations as a cause of immunodeficiency, new genetic pathophysiology mechanisms unveiled and new-targeted therapeutic approaches can be explored as potential rescue treatments for these diseases. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ywnF4a

Anticholinergics for asthma: a long history.

Purpose of review: To provide a fast overview about the introduction and development of anticholinergic drugs in Western medicine to their current indications particularly in asthma. Recent findings: Although short-acting muscarinic antagonists have been positioned in the last 15 years for the treatment of adults and children with moderate-to-severe acute asthma in the emergency setting (reducing the risk of hospital admissions and improving lung function), a growing body of evidence has recently emerged that positions the long-acting muscarinic anticholinergic tiotropium bromide as add-on therapy to at least inhaled corticosteroids (ICS) maintenance therapy in adults, adolescents, and children with symptomatic asthma. Thus, the addition of tiotropium bromide to ICS alone or ICS and another controller was associated with significant improvements in spirometric measures and asthma control, and a significantly decrease in the rate of asthma exacerbations. Summary: Short-acting muscarinic antagonists and tiotropium bromide have a well established role in the treatment of different phases of asthma. Further data are needed to provide more evidence on other selective long-acting muscarinic antagonists in addition to tiotropium as potential treatment options. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gq8bYX

Clinical profile of silent growth hormone pituitary adenomas; higher recurrence rate compared to silent gonadotroph pituitary tumors, a large single center experience

Abstract

Purpose

Study and comparison of characteristics of silent growth hormone adenomas (SGHA), silent corticotroph adenomas (SCA), and silent gonadotroph adenomas (SGA) in a single institution cohort of surgically treated pituitary adenomas.

Methods

Retrospective analysis of SGHA surgically resected over 10 years: SGHA was defined as no clinical or biochemical evidence of acromegaly and positive GH immunostaining.

Results

Of 814 pituitary surgeries; 2.1% (n = 17) were SGHA, 4.5% (n = 37) SCA, and 18.9% (n = 70/371; 2011–2016) SGA. Mean age at SGHA diagnosis was 43 years, with a large female predominance (82%). Mean tumor size and cavernous/sphenoid sinus invasiveness for SGHA, SCA, and SGA were 1.5 ± 1.0 cm and 25%, 2.5 ± 1.2 cm and 43%, 2.9 ± 2.0 cm and 41%, respectively (tumor size p = 0.009, SGHA vs. SGA, and invasion p; not-significant). During mean follow-up of 3.9 years, two patients (11%) developed elevated insulin-like growth factor-1 and five patients (29%) required a second surgery for tumor recurrence. Rate of surgical reintervention was similar to SCA (31%), but higher than SGA (10%) (p = 0.035, SGHA vs. SGA), and 18% underwent radiation therapy, similar to SCA (19%, p; not-significant) but higher than SGA (2.9%, p = 0.018).

Conclusion

This is the largest single center study characterizing SGHA behavior with SGA and SCA control groups in a cohort of surgically resected pituitary adenomas. SGHA present mostly in young females, and should be closely followed due to their higher likelihood of recurrence and potential of progression to clinical acromegaly. We propose that a complete hormonal staining panel be routinely performed for all pituitary adenomas.

http://ift.tt/2xLSBcn

Optimal timing of dopamine agonist withdrawal in patients with hyperprolactinemia: a systematic review and meta-analysis

Abstract

Purpose

Dopamine agonists (DAs) are recommended as first-line treatment for patients with hyperprolactinemia. Generally, it is accepted that patients with hyperprolactinemia do not need lifelong medication, but the optimal timing for DA withdrawal has not been determined. The aim of this systematic review and meta-analysis is to assess the impact of DA withdrawal on the clinical outcomes of patients with hyperprolactinemia, and to explore possible factors affecting successful DA withdrawal.

Methods

The databases of PubMed, Cochrane and EMBASE were searched up to May 2016.

Results

The proportion of patients with persisting normoprolactinemia after DA withdrawal reached 36.6% in a random effects model (95% CI, 29.4–44.2%; I-squared: 82.5%). Data of stratified analysis showed that the success rate of drug withdrawal was high in patients using cabergoline (CAB) as the only treatment (41.2%; 95% CI 32.3–50.4%) and those using CAB over 24 months (48.7%; 95% CI 38.9–58.5%), especially in patients with idiopathic hyperprolactinemia (73.2%; 95% CI 55.6–87.7%). In addition, patients who received a low maintenance dose of CAB, and had a significant reduction in tumor size (over 50%) before withdrawal, were more likely to achieve success (51.5 and 49.4%, respectively).

Conclusion

The success rate of DA withdrawal has increased in recent years. Further, the success rate of CAB withdrawal was higher than that of bromocriptine, especially in patients with a duration of treatment longer than 24 months. Conclusively, the probability of success was higher in patients who received low-dose CAB maintenance treatment and those who achieved a significant reduction in tumor size before withdrawal.

http://ift.tt/2gggW3M

Antibacterial activity against cariogenic bacteria and cytotoxic and genotoxic potential of Anacardium occidentale L. and Anadenanthera macrocarpa (Benth.) Brenan extracts

Publication date: January 2018
Source:Archives of Oral Biology, Volume 85
Author(s): Josenildo Segundo Chaves de Araújo, Aline Rogéria Freire de Castilho, Andressa Brito Lira, Andréia Vieira Pereira, Tatiane Kelly Barbosa de Azevêdo, Edja Maria de Melo de Brito Costa, Maria do Socorro Vieira Pereira, Hilzeth Freire Luna Pessoa, Jozinete Vieira Pereira
ObjectivesThe present study aimed to assess the antibacterial activity against bacteria with cariogenic relevance, toxic and genotoxic potential of the plants Anacardium occidentale L. and Anadenanthera macrocarpa (Benth.) Bernam.DesignUsing a microdilution technique, the extracts were submitted to minimum inhibitory concentration (MIC) testing against Streptococcus mitis (ATCC 903), Streptococcus mutans (ATCC 25175), Streptococcus oralis (ATCC 10557), Streptococcus salivarius (ATCC 7073), Streptococcus sanguinis (ATCC 15300) and Streptococcus sobrinus (ATCC 27609). The toxicity of the extracts was then verified against eukaryotic cells. Additionally, a micronucleus assay was performed to investigate the potential mutagenic effects of the extracts on rat erythrocytes. The Student's t-test, Bonferroni test, and one-way ANOVA followed by Tukey's tests were used for statistical analysis, at a significance level of 5%.ResultsWhile the A. occidentale extract was able to inhibit all of the tested strains, with S. mutans and S. mitis being the most susceptible to that extract́s action, the A. macrocarpa did not show antimicrobial activity. Interestingly, the hemolytic, oxidant and antioxidant activities were slightly observed for either extract, even at high concentrations (1000mg/mL). The micronucleus assay showed no significant changes in the cells exposed to the extracts.ConclusionThe A. occidentale extract has potential as an antimicrobial agent with low eukaryotic cell toxicity or mutagenic activity. The A. macrocarpa extract, although absent of antibacterial activity might as well be a safe and effective phytotherapeutic alternative.



http://ift.tt/2zw0Zip

Optimal timing of dopamine agonist withdrawal in patients with hyperprolactinemia: a systematic review and meta-analysis

Abstract

Purpose

Dopamine agonists (DAs) are recommended as first-line treatment for patients with hyperprolactinemia. Generally, it is accepted that patients with hyperprolactinemia do not need lifelong medication, but the optimal timing for DA withdrawal has not been determined. The aim of this systematic review and meta-analysis is to assess the impact of DA withdrawal on the clinical outcomes of patients with hyperprolactinemia, and to explore possible factors affecting successful DA withdrawal.

Methods

The databases of PubMed, Cochrane and EMBASE were searched up to May 2016.

Results

The proportion of patients with persisting normoprolactinemia after DA withdrawal reached 36.6% in a random effects model (95% CI, 29.4–44.2%; I-squared: 82.5%). Data of stratified analysis showed that the success rate of drug withdrawal was high in patients using cabergoline (CAB) as the only treatment (41.2%; 95% CI 32.3–50.4%) and those using CAB over 24 months (48.7%; 95% CI 38.9–58.5%), especially in patients with idiopathic hyperprolactinemia (73.2%; 95% CI 55.6–87.7%). In addition, patients who received a low maintenance dose of CAB, and had a significant reduction in tumor size (over 50%) before withdrawal, were more likely to achieve success (51.5 and 49.4%, respectively).

Conclusion

The success rate of DA withdrawal has increased in recent years. Further, the success rate of CAB withdrawal was higher than that of bromocriptine, especially in patients with a duration of treatment longer than 24 months. Conclusively, the probability of success was higher in patients who received low-dose CAB maintenance treatment and those who achieved a significant reduction in tumor size before withdrawal.

http://ift.tt/2gggW3M

Expert Staff Training! ASBA Sleep Coordinator Specialist “Certification” on December 1-2, 2017

This is a MUST for the dental team members involved in Dental Sleep Medicine screening and treatment. This 2 day weekend course will give the educational requirements to achieve Dental Sleep Coordinator Specialists Certification with the American Sleep and Breathing Academy via Sleep Group Solutions Boot Camp.

As an added bonus, by bringing your staff to this boot camp you will be able to register them as ASBA Sleep Coordinator Members, receive $100 off at the Annual Sleep and Wellness Conference April 13-14, 2018 and access to the ASBA online educational module curriculum ($530 VALUE).

 

Register now 

 

Boot Camp Agenda:

• Become an integral part of the interdisciplinary dental sleep medicine team.
• This course is designed for the dental office auxiliary and clinical team members
• The Sleep Group Solutions Boot Camp, in association with the ASBA, is built around supporting dental team members involved in DSM screening and treatment. The program will provide a two-day, hands-on training dedicated to their particular roles in snoring and sleep apnea screening and treatment, as well as oral appliance therapy. The two-day program will focus on patient care, team coordination, case creation and presentation, marketing, insurance billing and collections.

http://ift.tt/2hMstIw

Experimental and numerical studies on impact behaviors of recycled aggregate concrete-filled steel tube after exposure to elevated temperature

Publication date: 15 December 2017
Source:Materials & Design, Volume 136
Author(s): Wengui Li, Zhiyu Luo, Chengqing Wu, Vivian W.Y. Tam, Wen Hui Duan, Surendra P. Shah
This study investigated the impact behaviors of recycled aggregate concrete-filled steel tube (RACFST) after exposed to elevated temperatures by experimental and numerical studies. The impact test on RACFST was conducted by a split Hopkinson pressure bar (SHPB) with 100mm-diameter. After the validation of finite element method simulation by the experimental results, parametric analysis were applied to analyze the effects of RAC strength, steel strength and steel ratio on the impact behaviors and deformation properties of the RACFSTs exposed to elevated temperatures ranging from 20°C, 200°C to 500°C and to 700°C. The results show that both the increases in RAC strength, steel strength and steel ratio significantly enhance the impact resistance of RACFST. However, when RAC strength deteriorates quickly after exposure to high temperature, the increase in RAC strength just slightly improves the impact properties of RACFST, especially after exposure to elevated temperatures higher than 500°C. In conclusion, increasing steel ratio is an effective way for improving the impact behaviors of RACFST, but resulting in higher cost for practical application. For the impact design of RACFST, steel strength and steel ratio are two essential factors in terms of impact behavior enhancement and cost efficiency.

Graphical abstract

http://ift.tt/2yo1cXh

Coefficient of thermal expansion of nanostructured tungsten based coatings assessed by substrate curvature method

Publication date: 5 January 2018
Source:Materials & Design, Volume 137
Author(s): E. Besozzi, D. Dellasega, A. Pezzoli, A. Mantegazza, M. Passoni, M.G. Beghi
The in plane coefficient of thermal expansion (CTE) and the residual stress of nanostructured W based coatings are extensively investigated. The CTE and the residual stresses are derived by means of an optimized ad-hoc developed experimental setup based on the detection of the substrate curvature by a laser system. The nanostructured coatings are deposited by Pulsed Laser Deposition. Thanks to its versatility, nanocrystalline W metallic coatings, ultra-nano-crystalline pure W and W-Tantalum coatings and amorphous-like W coatings are obtained. The correlation between the nanostructure, the residual stress and the CTE of the coatings are thus elucidated. We find that all the samples show a compressive residual state of stress that decreases as the structure goes from columnar nanocrystalline to amorphous-like. The CTE of all the coatings is higher than the one of the corresponding bulk W form. In particular, as the grain size shrinks, the CTE increases from 5.1 10⁻⁶ K⁻¹ for nanocrystalline W to 6.6 10⁻⁶ K⁻¹ in the ultra-nano-crystalline region. When dealing with amorphous W, the further increase of the CTE is attributed to a higher porosity degree of the samples. The CTE of the coatings is also investigated as function of materials stiffness: when stiffness decreases, the CTE increases.

Graphical abstract

http://ift.tt/2ynBXnT