Source:Acta Otorrinolaringológica Española
Author(s): Regina María Sánchez Jiménez, Francisca Velázquez Marín
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Δευτέρα 23 Οκτωβρίου 2017
Quiste del conducto torácico superior: un hallazgo incidental
Source:Acta Otorrinolaringológica Española
Author(s): Regina María Sánchez Jiménez, Francisca Velázquez Marín
http://ift.tt/2laDR5T
Subtotal Parathyroidectomy and Relocation of the Parathyroid Remnant for Renal Hyperparathyroidism: modification of a traditional operation
Abstract
Background
We describe a modification of the conventional subtotal parathyroidectomy operation where the parathyroid gland(s) remnant is repositioned with intact vascular supply to a plane superficial to the infrahyoid strap muscles and immediately under the skin incision. This technique called Subtotal Parathyroidectomy and Remnant Relocation (SPARE) retains all the metabolic advantages of the conventional operation with the added advantage of easier identification of a recurrent hyperplastic remnant if re-exploration becomes necessary.
Methods
In the SPARE technique, four parathyroid glands were identified and the quality of each gland and the length of each vascular pedicle to the parathyroid glands were assessed. The optimal parathyroid gland was relocated to a plane superficial to the strap muscles. The remainder of the glands were removed.
Results
In total, 30 patients with hyperparathyroidism secondary to renal failure (HSRF) underwent parathyroidectomy with the SPARE technique. The mean age was 53.1±12.5 years and median follow-up was 17.1 months (range 1-78.9 months). There were no recurrent laryngeal nerve (RLN) injuries or hematomas. The pre- and post-operative value for corrected calcium and PTH were 158.4±109.4 pmol/L and 11.4±12.1 pmol/L, respectively (p < 0.05). Three recurrences were noted (10.0%), with a mean time to recurrence of 15.3±6.6 months. One patient had excision of the remnant parathyroid glands performed under local anaesthetic (29 min); one had re-exploration performed under general anaesthetic (81 min), and one was managed medically.
Conclusion
We described a novel parathyroidectomy technique for patients with HSRF, which provides the advantages of conventional subtotal parathyroidectomy while mitigating the challenges of thyroid bed re-exploration when recurrences arise.
http://ift.tt/2xiKN2y
Subtotal Parathyroidectomy and Relocation of the Parathyroid Remnant for Renal Hyperparathyroidism: modification of a traditional operation
Abstract
Background
We describe a modification of the conventional subtotal parathyroidectomy operation where the parathyroid gland(s) remnant is repositioned with intact vascular supply to a plane superficial to the infrahyoid strap muscles and immediately under the skin incision. This technique called Subtotal Parathyroidectomy and Remnant Relocation (SPARE) retains all the metabolic advantages of the conventional operation with the added advantage of easier identification of a recurrent hyperplastic remnant if re-exploration becomes necessary.
Methods
In the SPARE technique, four parathyroid glands were identified and the quality of each gland and the length of each vascular pedicle to the parathyroid glands were assessed. The optimal parathyroid gland was relocated to a plane superficial to the strap muscles. The remainder of the glands were removed.
Results
In total, 30 patients with hyperparathyroidism secondary to renal failure (HSRF) underwent parathyroidectomy with the SPARE technique. The mean age was 53.1±12.5 years and median follow-up was 17.1 months (range 1-78.9 months). There were no recurrent laryngeal nerve (RLN) injuries or hematomas. The pre- and post-operative value for corrected calcium and PTH were 158.4±109.4 pmol/L and 11.4±12.1 pmol/L, respectively (p < 0.05). Three recurrences were noted (10.0%), with a mean time to recurrence of 15.3±6.6 months. One patient had excision of the remnant parathyroid glands performed under local anaesthetic (29 min); one had re-exploration performed under general anaesthetic (81 min), and one was managed medically.
Conclusion
We described a novel parathyroidectomy technique for patients with HSRF, which provides the advantages of conventional subtotal parathyroidectomy while mitigating the challenges of thyroid bed re-exploration when recurrences arise.
http://ift.tt/2xiKN2y
Normative prosthodontic care need: does it impact the daily life of young Saudis with high level of oral diseases? A cross sectional study
Abstract
Background
Assessing the need for prosthodontic care previously included older age groups. There is less information about younger populations who may need this care because of high disease levels. The aim of this study was to assess the normative need for prosthodontic care in a young Saudi population with high oral disease levels, the associated factors and its impact on daily life.
Methods
A cross sectional study included Saudi adults in the Eastern Province in 2016. A questionnaire was used to assess personal background (confounders), risk factors affecting oral diseases (exposures) and the impact of oral problems on daily life. A clinical examination assessed tooth loss, the presence of prosthodontic appliances, the presence of untreated decay and need for periodontal care. Directed acyclic graphs identified the confounders to be included in regression models with separate outcomes: normative need for prosthodontic care (binary logistic model) and impact on 6 daily life aspects (ordinal regression models).
Results
Complete data were available for 574/ 700 = 82% and 46.7% needed prosthodontic care with 2 lost teeth on average among adults of mean age = 33.2 years. The confounders controlled for the need for prosthodontic care included socioeconomic status (SES), dental visits last year and health insurance. The confounders for the impact on daily life included age and SES. In adjusted models, normative need for prosthodontic care was significantly associated with untreated decay (OR = 2.09, 95% C.I. = 1.37, 3.19). The impact on daily life was not significantly associated with prosthodontic care need but with untreated decay, especially sleeplessness (regression coefficient = 0.53, 95% C.I. = 0.02, 1.04) and dropping daily activities (regression coefficient = 0.79, 95% C.I. = 0.13, 1.46). In addition, the need for periodontal care was associated with food avoidance (regression coefficient = 0.73, 95% C.I. = 0.28, 1.18).
Conclusions
In Saudi adults in the Eastern Province, there was a considerable normative need for prosthodontic care due to untreated decay. The impact on daily life was related to the underlying oral diseases rather than the need for prosthodontic care itself.
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Ischemia and reperfusion by retrograde flow: experimental comparative study
Resumo Contexto Isquemia crítica de membro inferior sem leito distal tem opções restritas para tratamento. Desviar o fluxo de maneira retrógrada através da circulação venosa é alternativa amparada em evidências de inúmeros trabalhos publicados. Objetivos Comparar o comportamento de variáveis clínicas e laboratoriais em extremidades de suínos submetidas a isquemia e a isquemia com reperfusão por circulação retrógrada entre si e em relação e a um grupo controle. Métodos Dez suínos foram separados em dois grupos. No grupo 1 (n=5), controle, avaliaram-se padrões fisiológicos de variáveis como fluxo ao Doppler, temperatura, gasometria, lactato, creatinoquinase (CK) e pressão arterial. No grupo 2 (n=5), após um período médio de isquemia de 27 minutos e 30 segundos, consequente à interrupção do fluxo nas artérias femorais, os animais foram submetidos a arterialização venosa no membro posterior esquerdo e a manutenção da isquemia no direito. As variáveis foram analisadas separadamente durante momentos 0, 2, 3, 4 e 6 horas após a reperfusão para efeito de comparação entre si e com o grupo controle. Resultados A análise das variáveis mostrou, em ambos os procedimentos, queda de BE e pO2, com elevação significativa de lactato e CK em relação ao grupo controle. Nos membros isquêmicos arterializados, encontramos fluxo ao Doppler e maiores pressões arteriais e temperaturas quando comparadas ao membro em isquemia. Conclusões A análise comparativa das extremidades em isquemia e isquemia arterializada mostrou, em relação ao grupo controle, um quadro de acidose metabólica, com significativo aumento de lactato e CK, que sugerem dano celular e sinais de reperfusão retrógrada nas extremidades arterializadas.
Abstract Background There are few options for treating critical ischemia in limbs with no distal patency. Diverting flow through the venous circulation is an option supported by evidence from numerous published studies. Objectives To compare the behavior of clinical and laboratory variables between the hind limbs of pigs subjected to ischemia and to ischemia with reperfusion by retrograde circulation and between these intervention groups and a control group. Methods Ten pigs were divided into 2 groups. In group 1 (n=5), controls, patterns of physiological variables such as flow according to Doppler ultrasound, temperature, blood gas analysis results, lactate, creatine kinase, and blood pressure were evaluated. In group 2 (n=5), after an initial ischemia period with mean duration of 27 minutes and 30 seconds, provoked by interrupting flow through the femoral arteries, the animals were subjected to venous arterialization of the left hind limb while the right hind limb was maintained in ischemia. Variables were analyzed separately for each hind leg at 0, 2, 3, 4, and 6 hours after reperfusion and compared against each other and the control group. Results Analysis of variables from both procedures showed decreases in BE and PO2 and significant increases in lactate and creatine kinase, in relation to the control group. In arterialized ischemic limbs, we observed flow on Doppler ultrasound, and arterial pressures and temperatures were higher than in the ischemic limbs. Conclusions Comparative analysis of the extremities in ischemia and arterialized ischemia showed, in relation to the control group, metabolic acidosis with significant increases in lactate and creatine kinase, suggesting cellular damage, and there were signs of retrograde reperfusion in arterialized extremities.
http://ift.tt/2yNTwgT
Handmade model for peripheral vascular access training
Resumo Contexto O acesso vascular é o procedimento mais comum realizado entre pacientes hospitalizados. Assim, na tentativa de minimizar complicações e aliar conhecimento técnico ao conhecimento teórico, os modelos de simulação são capazes de oferecer um ambiente seguro para profissionais em formação e evitar os dilemas éticos de treinamento direto em pacientes. Com esse objetivo, surgiram diversos manequins de treinamento, mas devido ao seu alto custo eles não são acessíveis a todos, e com frequência os profissionais em formação da área da saúde realizam procedimentos sem que tenham um treinamento prévio. Objetivo Desenvolver um modelo de ensino e treinamento de acesso vascular periférico, utilizando um modelo de baixo custo para fins educacionais. Método Para reproduzir a via periférica de acesso, utilizou-se um macarrão de polietileno com equipos de infusão, com uma extremidade em fundo cego e a outra conectada a duas bolsas de 500 mL de soro fisiológico acrescido de corante. A bolsa foi instalada em um suporte metálico. Resultado O formato sugerido para o modelo apresentou semelhança com a anatomia do antebraço simplificada. O modelo se mostrou prático na punção e, devido à sua extensão, tem-se a possibilidade de puncionar diversas vezes o mesmo modelo, facilitando o treinamento. Conclusão O modelo proposto permite o treinamento de acesso vascular periférico, sendo uma alternativa de baixo custo que pode ser utilizada para fins educacionais.
Abstract Background Vascular access is the procedure performed with greatest frequency in hospitalized patients. Simulation models are intended to minimize complications and combine technical and theoretical knowledge, offering a safe environment for training health professionals that avoids the ethical dilemmas of conducting initial training with patients. Many different training dolls have been developed to achieve this objective, but their high cost means they are not universally available, and it is common for unqualified health professionals to perform procedures on patients with no previous practice. Objective To develop a low-cost educational model for teaching and training peripheral vascular access. Method Peripheral access routes were reproduced using a polyethylene foam noodle and infusion kits, each with one extremity sealed off and the other connected to one of two 500 mL packs of saline, dyed red or blue. The packs were hung on a metal stand. Results The structure chosen for the model was similar to a simplified version of the anatomy of the forearm. The model proved to be practical for puncture and, because of its length, the same model can be punctured multiple times, facilitating training. Conclusions The model proposed here enables training of peripheral vascular access and is a low-cost option that can be used for educational purposes.
http://ift.tt/2yIbA9P
Do we know how to prescribe venous thromboembolism prophylaxis to hospitalized patients?
Resumo Contexto Embora preconizada, a profilaxia de tromboembolismo venoso (TEV) deixa de ser realizada sistematicamente em pacientes internados. Objetivo Verificar se os pacientes hospitalizados recebem a prescrição correta da profilaxia de TEV do médico responsável por sua internação, conforme sua categoria de risco. Métodos Estudo transversal com análise de prontuários de pacientes internados no Hospital Santa Casa de Misericórdia de Curitiba, PR, entre 20 de março e 25 de maio de 2015. Excluíram-se os pacientes em uso de anticoagulantes ou com sangramento ativo. Analisou-se gênero, idade, tipo de cobertura de saúde, especialidade responsável pelo paciente e fatores de risco dos pacientes para classificá-los em alto, moderado ou baixo risco para TEV. Comparou-se o uso ou não da profilaxia entre as prescrições das especialidades clínicas e cirúrgicas, pacientes internados pelo Sistema Único de Saúde (SUS) e por convênios e de acordo com seu risco para TEV. Resultados Dos 78 pacientes avaliados, oito preencheram os critérios de exclusão. Dos 70 pacientes elegíveis (média etária 56,9 anos; 41 homens; 62 cobertos pelo SUS), 31 eram tratados por clínicos e 39 por cirurgiões. Apenas 46 (65,71%) pacientes receberam profilaxia para TEV. Dentre os pacientes clínicos, 29 (93,5%) receberam profilaxia, contra 17 (43,6%) do grupo cirúrgico (p < 0,001). Pacientes clínicos de moderado e alto risco receberam mais profilaxia que os cirúrgicos (p < 0,001 e p = 0,002). Não houve diferenças quanto à cobertura de saúde (SUS versus convênios médicos). Conclusões No Hospital Santa Casa de Misericórdia de Curitiba, pacientes cirúrgicos estão menos protegidos de eventos tromboembólicos em relação aos clínicos.
Abstract Background Although prophylaxis to prevent venous thromboembolism is recommended, it is rarely systematically performed in hospitalized patients. Objective To investigate whether hospitalized patients are given the correct VTE prophylaxis prescription by the physician responsible for them while in hospital, analyzed by risk category. Methods This was a cross-sectional study based on analysis of medical records for patients admitted to the Hospital Santa Casa de Misericórdia, Curitiba, PR, Brazil, from March 20 to May 25, 2015. Patients on anticoagulants or with active bleeding were excluded. The following variables were analyzed: sex, age, type of healthcare coverage, specialty responsible for the patient, and patients' risk factors to classify them as at high, moderate, or low risk of VTE. Use or not of prophylaxis was compared across prescriptions made by clinical and surgical specialties, between patients treated on the Brazilian National Health Service (SUS - Sistema Único de Saúde) and private health insurance, and according to patients' risk of VTE. Results Eight of the 78 patients assessed met exclusion criteria. The remaining 70 eligible patients had a mean age of 56.9 years, 41 were male, 62 were treated on the SUS, 31 were treated by clinicians, and 39 were treated by surgeons. Just 46 (65.71%) patients were given prophylaxis for VTE. Among the clinical patients, 29 (93.5%) were given prophylaxis, against 17 (43.6%) in the surgical group (p < 0.001). Moderate and high risk clinical patients were more likely to be given prophylaxis than surgical patients (p < 0.001 and p = 0.002). There were no differences with relation to type of healthcare coverage (SUS vs. private healthcare). Conclusions At the Hospital Santa Casa de Misericórdia in Curitiba, surgical patients are less well protected from thromboembolic events than clinical patients.
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Adolescents: behavior and cardiovascular risk
Resumo Contexto Os benefícios para a saúde decorrentes da prática regular de atividade física estão bem documentados. Entretanto, são raros os estudos associando essa prática ao comportamento sedentário e ao risco cardiovascular em adolescentes. Objetivos Pretende-se avaliar a prática de atividade física, o comportamento sedentário e a associação com o risco cardiovascular mensurado pelo escore Pathobiological Determinants of Atherosclerosis in Youth (PDAY). Métodos Estudo transversal desenvolvido nas escolas públicas estaduais de Campina Grande, PB, Brasil, com 576 adolescentes de 15 a 19 anos, incluindo variáveis socioeconômicas, demográficas, de estilo de vida e clínicas. Os dados foram coletados através de formulário validado, antropometria, aferição da pressão arterial e exames laboratoriais. Foram utilizadas medidas descritivas, teste do qui-quadrado de Pearson e regressão logística binomial. Trabalhou-se com o SPSS 22.0 se adotou intervalo de confiança de 95%. Resultados A idade média foi de 16,8 anos. A maioria dos adolescentes era do sexo feminino (66,8%), não branco (78.7%) e pertencente às classes C, D e (69,1%). Quanto ao sedentarismo e à insuficiência de atividade física, as prevalências foram de 78,1% e 60,2%, respectivamente. De acordo com o escore PDAY, 10,4% dos adolescentes apresentaram alto risco cardiovascular; 31,8% risco intermediário; e 57,8%, risco baixo. Verificou-se que PDAY esteve associado ao sexo e à adiposidade abdominal. Conclusões Ficou comprovado que adiposidade abdominal e sexo masculino representam importantes fatores de risco cardiovascular em adolescentes. Considerando-se a presença de um fator de risco modificável, medidas preventivas voltadas ao estilo de vida são essenciais.
Abstract Background The health benefits of regular physical activity are well documented. However, there are few studies associating this practice with sedentary behavior and cardiovascular risk in adolescents. Objectives To evaluate physical activity levels and sedentary behavior and their associations with cardiovascular risk using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score Methods A cross-sectional study carried out in state-owned public schools in Campina Grande, PB, Brazil, with 576 adolescents aged 15 to 19 years, investigating socioeconomic; demographic; lifestyle; and clinical variables. Data were collected using a validated form covering anthropometry data; blood pressure measurements; and laboratory tests. Data were analyzed using descriptive statistics, Pearson's chi-square test, and binomial logistic regression using SPSS 22.0 and adopting a 95% confidence interval. Results Mean age was 16.8 years. The majority of the adolescents were female (66.8%); non-white (78.7%); and belonged to socioeconomic classes C, D and E (69.1%). The prevalence rates of sedentary behavior and physical inactivity were 78.1% and 60.2%, respectively. According to the PDAY score, 10.4% of adolescents were at high cardiovascular risk and 31.8% and 57.8% were at intermediate risk and low risk, respectively. PDAY scores were associated with sex and abdominal adiposity. Conclusions It was found that abdominal fat and being male were important cardiovascular risk factors in adolescents. Considering that modifiable risk factors were present, preventive measures aimed at lifestyle changes are essential.
http://ift.tt/2yIbuPv
Changes in lower extremity blood flow during advancing phases of pregnancy and the effects of special footwear
Abstract Background During pregnancy, a number of changes affecting venous blood flow occur in the circulatory system, such as reduced vein wall tension or increased exposure to collagen fibers. These factors may cause blood stagnation, swelling of the legs, or endothelial damage and consequently lead to development of venous disease. Objectives The aim of this study is to evaluate the effect of special footwear designed to improve blood circulation in the feet on venous blood flow changes observed during advancing phases of pregnancy. Methods Thirty healthy pregnant women participated in this study at 25, 30, and 35 weeks of gestation. Participants were allocated at random to an experimental group (n = 15) which was provided with the special footwear, or a control group (n = 15). At each data collection session, Doppler measurements of peak systolic blood flow velocity and cross-sectional area of the right popliteal vein were performed using a MySonoU6 ultrasound machine with a linear transducer (Samsung Medison). The differences were compared using Cohen's d test to calculate effect size. Results With advancing phases of pregnancy, peak systolic velocity in the popliteal vein decreased significantly in the control group, whereas it increased significantly in the experimental group. No significant change in cross-sectional area was observed in any of the groups. Conclusions Findings in the experimental group demonstrated that wearing the footwear tested may prevent venous blood velocity from reducing during advanced phases of pregnancy. Nevertheless, there is a need for further investigation of the beneficial effect on venous flow of the footwear tested and its application.
Resumo Contexto Durante a gravidez, uma série de mudanças que afetam o fluxo venoso ocorrem no sistema circulatório, tais como menor tensão da parede venosa ou aumento da exposição a fibras de colágeno. Esses fatores podem causar estagnação sanguínea, inchaço das pernas ou dano endotelial e, consequentemente, levar ao desenvolvimento de doença venosa. Objetivos O objetivo deste estudo foi avaliar o efeito do uso de calçados especiais projetados para melhorar a circulação sanguínea dos pés sobre as mudanças no fluxo venoso observadas nas fases avançadas da gravidez. Métodos Trinta gestantes saudáveis participaram deste estudo às 25, 30 e 35 semanas de gestação. As participantes foram aleatoriamente designadas a um grupo experimental (n = 15) que recebeu calçados especiais, ou um grupo controle (n = 15). A cada sessão de coleta de dados, foram obtidas medidas Doppler do pico de velocidade do fluxo sanguíneo sistólico e da área transversal da veia poplítea direita, utilizando-se um aparelho de ultrassom MySonoU6 com transdutor linear (Samsung Medison). As diferenças foram comparadas utilizando-se o teste d de Cohen para calcular o tamanho do efeito. Resultados Nas fases avançadas da gravidez, o pico da velocidade sistólica na veia poplítea diminuiu significativamente no grupo controle, porém aumentou significativamente no grupo experimental. Não houve mudanças significativas na área transversal da veia poplítea em nenhum dos grupos. Conclusões Os achados do grupo experimental demonstraram que o uso dos calçados especiais testados pode evitar que a velocidade do fluxo venoso diminua nas fases avançadas da gravidez. No entanto, mais estudos são necessários para investigar os efeitos benéficos sobre o fluxo venoso do uso dos calçados testados e suas aplicações.
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The influence of low- and high-energy-density intravenous laser ablation on the saphenofemoral junction, with 1470-nm laser
Resumo Contexto Faz-se importante o conhecimento técnico dos ajustes de potência e de densidade de energia linear endovenosa (linear endovenous energy density, LEED) adequados para atingir o objetivo final da termoablação endovenosa (endovenous laser ablation, EVLA). Objetivos Avaliar a influência de diferentes LEEDs em termos de patência e presença de refluxo, bem como determinar a evolução clínica. Métodos Foram incluídas 60 veias safenas magnas (VSM). Os pacientes foram randomizados em dois grupos: EVLA com baixa potência (7 W e LEED de 20-40 J/cm) e com alta potência (15 W e LEED de 80-100 J/cm). O acompanhamento com eco-Doppler e escore de severidade clínica venoso (VCSS) foi realizado nos intervalos de 3-5 dias, 30 dias, 180 dias e 1 ano após o procedimento. Resultados Dezoito pacientes (29 membros) tratados com 7W de potência e 13 pacientes (23 membros) com 15 W completaram o estudo. Não houve diferença significativa considerando idade, tempo de cirurgia e o uso de analgésicos, lateralidade, gênero e presença de comorbidades. O LEED médio foi de 33,54 J/cm no grupo de 7 W e de 88,66 J/cm no de 15 W. Ambos apresentaram melhora no VCSS, redução significativa dos diâmetros da JSF e ausência de diferença significativa quanto ao aumento do comprimento do coto da VSM e de refluxo após o tratamento. Conclusões A utilização de maior densidade de energia mostrou-se mais efetiva em relação à estabilização do comprimento do coto da VSM e do refluxo em 6 meses. Fazem-se necessários estudos com um período de acompanhamento maior para fundamentar essa hipótese.
Abstract Background It is important to acquire technical knowledge about the power and linear endovenous energy density (LEED) settings needed to achieve the ultimate goal of endovenous laser ablation (EVLA). Objectives To evaluate the influence of different LEEDs in terms of patency and presence of reflux and to determine clinical outcomes. Methods Sixty great saphenous veins (GSVs) were included. Patients were randomized into 2 groups, low-power EVLA (7 W and LEED of 20-40 J/cm) and high-power EVLA (15 W and LEED of 80-100 J/cm). Patients were followed-up with duplex ultrasound and calculation of venous clinical severity score (VCSS) at 3-5 days, 30 days, 180 days, and 1 year after the procedure. Results 18 patients (29 limbs) treated with 7 W of laser power and 13 patients (23 limbs) treated with 15 W of laser power completed the study. There was no significant difference regarding age, operating time, use of analgesics, laterality, sex, or presence of comorbidities. Mean LEED was 33.54 J/cm in the 7-W group and 88.66 J/cm in the 15-W group. Both groups exhibited improvements in VCSS and significant reductions in SFJ diameters, and there were no significant difference in increase of length of the GSV stump or rates of reflux after treatment. Conclusions The higher energy density setting was more effective for stabilizing the length of the GSV stump and was associated with a lower incidence of reflux at 6 months. Further studies with a longer follow-up period are required to substantiate this hypothesis.
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Regional incidence of venous thromboembolism in Brazil
Resumo Contexto Vários estudos realizados em climas temperados sugerem que há uma variação na incidência de tromboembolismo venoso (TEV) de acordo com as estações climáticas. Entretanto, nenhum estudo foi feito comparando áreas de clima semiárido com áreas de clima temperado. Objetivos Analisar se existe correlação entre a incidência do TEV em áreas de clima semiárido e de clima temperado no Brasil. Métodos Foi feito um levantamento de dados retrospectivos de pacientes com diagnóstico de TEV no Sistema Único de Saúde de janeiro de 2011 a dezembro de 2014 provenientes dos seguintes estados com clima semiáridos: Alagoas, Ceará, Maranhão, Paraíba, Pernambuco, Piauí e Rio Grande do Norte, localizados na Região Nordeste do Brasil; e dos seguintes estados com clima temperado: Paraná, Santa Catarina e Rio Grande do Sul, localizados na Região Sul do Brasil. Os dados de variação climática foram obtidos do Instituto Nacional de Meteorologia e os dados populacionais do Instituto Brasileiro de Geografia e Estatística. Resultados Houve correlação significativa na incidência de casos de TEV em regiões de temperaturas mais baixas (p < 0,001). A Região Sul apresentou temperaturas significativamente menores que as da Região Nordeste (p < 0,001) e apresentou número significativamente maior de casos de TEV do que a Região Nordeste (p < 0,001). Conclusão Há mais casos de TEV em regiões de clima temperado, onde as temperaturas são mais baixas. No entanto, pouco ainda é conhecido na literatura sobre a flutuação sazonal e a incidência de TEV. Sendo assim, mais estudos são necessários nessa área.
Abstract Background Several studies conducted in areas with temperate climates have suggested that the incidence of venous thromboembolism (VTE) varies depending on seasonal climatic fluctuations. However, no studies have been conducted comparing areas with semi-arid climate with areas with temperate climates. Objectives To analyze whether there is a correlation between the incidence of VTE in areas with semi-arid climates and areas with temperate climates in Brazil. Methods Retrospective data were acquired for patients diagnosed with VTE from January 2011 to December 2014 from the Brazilian National Health Service for the following Brazilian states that have semi-arid climates: Alagoas, Ceará, Maranhão, Paraíba, Pernambuco, Piauí, and Rio Grande do Norte (all located in the Northeast Region of Brazil); and the following states with temperate climates: Paraná, Santa Catarina, and Rio Grande do Sul (all located in the South Region of Brazil). Data on climatic variation were obtained from the National Meteorological Institute and population data were obtained from the Brazilian Institute of Geography and Statistics. Results There was a significant correlation in the incidence of VTE cases in areas with lower temperatures (p < 0.001). The South Region exhibited significantly lower temperatures than the Northeast Region (p < 0.001) and had a significantly higher number of cases of VTE than the Northeast Region (p < 0.001). Conclusions There are more cases of VTE in areas with temperate climates, where temperatures are lower. However, there is still little information in the literature on seasonal fluctuations and incidence of VTE. More studies of this subject are needed.
http://ift.tt/2yMsVR7
Prevalence of incidental pulmonary thromboembolism in cancer patients: retrospective analysis at a large center
Resumo Contexto Devido à maior aplicação de exames de imagem rotineiros, especialmente nos pacientes com neoplasia para controle da doença, vem aumentando o diagnóstico de tromboembolismo pulmonar (TEP) incidental, importante fator de morbimortalidade associado. Objetivo Identificar os casos de TEP incidental em pacientes oncológicos submetidos a tomografia computadorizada (TC) de tórax, correlacionando aspectos clínicos e fatores de risco associados. Métodos Estudo retrospectivo de todos os episódios de TEP ocorridos de janeiro de 2013 a junho de 2016, com seleção dos pacientes oncológicos e divisão deles em dois grupos: com suspeita clínica e sem suspeita clínica (incidentais) de embolia pulmonar. Resultados Foram avaliados 468 pacientes com TEP no período citado. Destes, 23,1% eram oncológicos, entre os quais 44,4% apresentaram achado incidental de embolia pulmonar na TC de tórax. Não houve diferença estatística entre os grupos para sexo, idade e tabagismo. Quanto à procedência, 58,3% dos pacientes sem suspeita clínica eram de origem ambulatorial e 41,7% com suspeita de TEP vinham do pronto-socorro (p < 0,001). As neoplasias mais prevalentes foram de pulmão (17,6%), intestino (15,7%) e mama (13,0%). Aqueles com achado incidental apresentaram significativamente mais metástases, sem diferença entre os grupos para realização de quimioterapia, radioterapia ou cirurgia recente. Quanto aos sintomas apresentados, 41,9% daqueles sem suspeita clínica tinham queixas sugestivas de TEP quando realizaram o exame. Conclusão TEP incidental é frequente em pacientes oncológicos, especialmente naqueles provenientes de seguimento ambulatorial e em estágios avançados da doença. Sintomas sugestivos de TEP estavam presentes em pacientes sem suspeita clínica ao realizarem a TC de tórax.
Abstract Background Increased use of routine imaging exams has led to higher rates of incidental diagnosis of pulmonary thromboembolism (PTE), especially for management of disease in cancer patients, among whom it is an important factor in associated morbidity and mortality. Objective To identify cases of incidental PTE in cancer patients examined with computed tomography (CT) of the thorax, correlating clinical features and associated risk factors. Methods This is a retrospective study of all episodes of PTE diagnosed between January 2013 and June 2016, selecting cases involving cancer patients and dividing them into two subsets: those with clinical suspicion and those without clinical suspicion of pulmonary embolism (incidental cases). Results At total of 468 patients had PTE during the period investigated and 23.1% of them were cancer patients, 44.4% of whom exhibited pulmonary embolism as an incidental finding of a chest CT. There was no statistical difference between the two subsets in terms of sex, age, or smoking. In terms of patients' admission status, 58.3% of the patients without clinical suspicion were outpatients and 41.7% of those with suspicion of PTE were admitted via the emergency room (p < 0.001). The most common cancer sites were lung (17.6%), intestine (15.7%), and breast (13.0%). Patients whose PTE were diagnosed incidentally exhibited a significantly greater rate of metastases, while there were no differences between the groups in terms of chemotherapy, radiotherapy, or recent surgery. Analysis of symptoms revealed that 41.9% of patients without clinical suspicion had complaints suggestive of PTE when they underwent the CT examination. Conclusions Incidental PTE is common among cancer patients, especially those in outpatients follow-up and in advanced stages of the disease. Patients without clinical suspicion also had symptoms suggestive of PTE when they presented for chest CT.
http://ift.tt/2yIoyoc
Impact of ultrasound-guided polidocanol foam sclerotherapy in patients with venous ulcers
Resumo Contexto A escleroterapia com espuma de polidocanol guiada por ultrassom tem sido utilizada no tratamento de pacientes com úlceras venosas. É um procedimento minimamente invasivo e de fácil execução, porém apresenta taxas de recidiva elevadas. Objetivos Relatar a evolução a curto e médio prazo de pacientes com úlcera venosa tratados com escleroterapia com espuma de polidocanol guiada por ultrassom. Métodos Foram reavaliados 19 pacientes submetidos ao tratamento de escleroterapia com espuma de polidocanol guiada por ultrassom no período de janeiro de 2013 a dezembro de 2014. Foram analisados tempo de cicatrização da úlcera, melhora de sintomas clínicos, recanalização das veias tratadas, recidiva dos sintomas e da úlcera venosa. Resultados Foram analisados 15 pacientes do sexo feminino (78,9%) e quatro do sexo masculino (21,1%). A média geral de idade foi de 53 anos. O tempo de seguimento dos pacientes variou de 448 dias a 1.276 dias (média de 791 dias). O tempo médio de presença das úlceras foi de 53 meses. Na avaliação pós-procedimento, foram observadas recanalização total em 15,7%, recanalização parcial em 21% e oclusão em 47,3% das veias tratadas. Apenas em um caso foi observada recidiva da úlcera. Pela avaliação das médias do Venous Clinical Severity Score (VCSS), houve diferença significativa antes e após o procedimento, com variação entre os grupos de 11,2 (p < 0,01). Conclusões A escleroterapia por espuma guiada por ultrassom apresenta altas taxas de sucesso terapêutico, com índices de cicatrização de úlceras venosas elevados.
Abstract Background Ultrasound-guided polidocanol foam sclerotherapy is used to treat patients with venous ulcers. It is a minimally invasive procedure and is simple to perform, but it has high relapse rates. Objectives To report short to medium term results in patients with venous ulcers treated using ultrasound-guided polidocanol foam sclerotherapy. Methods A sample of 19 patients who had been treated with ultrasound-guided polidocanol foam sclerotherapy between January 2013 and December 2014 were followed-up. Time taken for ulcers to heal, improvement of clinical symptoms, recanalization of treated veins, and relapse of symptoms and of venous ulcers were analyzed. Results Fifteen of the patients analyzed were female (78.9%) and four were male (21.1%). Overall mean age was 53 years. Follow-up times ranged from 448 days to 1,276 days (mean of 791 days). The mean duration of active ulcers was 53 months. At postoperative follow-up assessments, total recanalization was observed in 15.7%, partial recanalization in 21%, and occlusion in 47.3% of the veins that had been treated. There was only one case of ulcer relapse. Analysis of mean Venous Clinical Severity Scores (VCSS) revealed a significant difference from before to after the procedure, with a variation of 11.2 (p < 0.01). Conclusions Ultrasound-guided foam sclerotherapy has high rates of therapeutic success and achieves high rates of venous ulcer healing.
http://ift.tt/2yM4GTk
Abdominal aortic pseudoaneurysm as a complication of chronic pancreatitis: case report
Resumo A pancreatite crônica é uma enfermidade associada a diversas complicações vasculares, como pseudocisto hemorrágico, trombose do sistema venoso portal e formações varicosas e pseudoaneurismáticas. O pseudoaneurisma de aorta abdominal secundário à pancreatite crônica é uma complicação rara, de difícil suspeição clínica, que requer tratamento complexo. A fisiopatologia dessa condição envolve a corrosão enzimática tecidual após a liberação e ativação de enzimas exócrinas proteolíticas das células acinares do pâncreas. O presente estudo relata o caso de um paciente de 52 anos, etilista crônico, internado com dor abdominal difusa, cuja propedêutica revelou se tratar de um pseudoaneurisma em aorta infrarrenal. Optou-se pelo tratamento cirúrgico convencional, levando-se em consideração a idade, as condições clínicas do paciente e a disponibilidade de endopróteses compatíveis com o diâmetro da aorta.
Abstract Chronic pancreatitis can be complicated by several vascular disorders, such as bleeding pseudocysts, thrombosis of the venous portal system, varicosities, and pseudoaneurysms. Pseudoaneurysm of the abdominal aorta secondary to chronic pancreatitis is a rare complication. It is a challenging clinical situation, demanding a high degree of clinical suspicion, and requires complex therapeutic procedures. The pathophysiology of this condition involves interstitial liberation and activation of enzymes from the exocrine pancreatic glands and subsequent digestion of the surrounding tissues. In the present case report, we describe a 52-year-old patient complaining of diffuse abdominal pains. Clinical investigation revealed chronic alcoholism and imaging examinations showed a pseudoaneurysm of the infrarenal aorta. We decided to perform conventional surgical treatment after considering the patient's age and clinical status and the endoprostheses available at our hospital with diameters compatible with the patient's aorta.
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Abnormal origin of posterior circumflex humeral artery and subscapular artery: case report and review of the literature
Abstract The subscapular, anterior circumflex, and posterior circumflex arteries arise from the third part of the axillary artery. During dissection of the right upper limb of the cadaver of a 70-year-old male, a common trunk was observed arising from the third part of the axillary artery which, after traveling for 0.5 cm, bifurcated into subscapular and posterior circumflex humeral arteries. The common trunk was crossed anteriorly by the radial nerve. The medial nerve was formed by medial and lateral roots on the medial side of the third part of the axillary artery, remaining medial to the brachial artery up to the cubital fossa and then following its usual course thereafter. Awareness of the vascular variations observed in the present case is important when conducting surgical procedures in the axilla, for radiologists interpreting angiographs, and for anatomy-pathologists studying rare findings.
Resumo As artérias subescapular, circunflexa anterior e circunflexa posterior se originam da terceira parte da artéria axilar. Durante a dissecção de membro superior direito de um cadáver humano com 70 anos de idade, do sexo masculino, um tronco comum foi observado originando-se da terceira parte da artéria axilar, após um percurso de 0,5 cm, bifurcando-se em artéria subescapular e artéria circunflexa posterior do húmero. O tronco comum era cruzado anteriormente pelo nervo radial. O nervo medial era formado por raízes medial e lateral, no lado medial da terceira parte da artéria axilar, permanecendo em posição medial à artéria braquial até a fossa cubital e seguindo seu curso usual a partir de então. Conhecimento das variações vasculares observadas neste caso é importante ao executar procedimentos cirúrgicos na axila, para radiologistas que interpretam radiografias, e também para anatomo-patologistas que estudam achados raros.
http://ift.tt/2yMzZNz
Stanford B aortic dissection: case report and literature review
Resumo O complexo tratamento de dissecção da aorta ainda apresenta controvérsias devido à gravidade do caso e à necessidade de individualização da terapêutica. A gravidade relaciona-se ao difícil diagnóstico pelas queixas inespecíficas e pelas graves complicações inerentes à evolução da doença (ruptura aórtica, síndrome de má perfusão, dissecção retrógrada, dor ou hipertensão refratária). Este relato apresenta um homem de 61 anos, tabagista e hipertenso mal controlado, que evoluiu para dissecção aórtica de tipo B de Stanford. Foi abordado através de técnica endovascular com uso de endoprótese com stent para tratamento do caso após falha do tratamento medicamentoso. O tratamento endovascular mostrou-se uma ferramenta eficaz para o tratamento definitivo, com boa taxa de sobrevida ao final do primeiro ano após o procedimento.
Abstract Complex treatment of aortic dissection is still a controversial subject because of the severity of these cases and the need to treat on a case-by-case basis. Severity is related to the difficulty of diagnosis caused by nonspecific complaints and by the serious complications inherent to disease progression (aortic rupture, hypoperfusion syndrome, retrograde dissection, refractory hypertension or pain). This article reports the case of a 61-year-old male smoker with poorly controlled hypertension who suffered a Stanford type B aortic dissection. After drug-based treatment failed, the patient was treated using endovascular techniques to place an endoprosthesis with stenting. Endovascular treatment is proving to be an effective tool for definitive treatment, with a good survival rate at the end of the first year after the procedure.
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Bilateral low origin of testicular artery: a case report
Abstract The testicular artery is frequently subjected to radiographic imaging techniques such as angiography for diagnosis and treatment of conditions like epididymitis, testicular torsion, tumor, hematoma, and hydrocele and in cases of undescended testis. Radiologists and surgeons should therefore be aware of testicular artery variants. Although there are numerous studies and case reports that mention testicular artery variants, this is probably the first case, reporting a bilateral low origin of the testicular artery and discussing its probable embryological etiology.
Resumo A artéria testicular é frequentemente examinada por técnicas de imagem como angiografia, para o diagnóstico e tratamento de condições como epididimite, torsão testicular, tumor, hematoma e hidrocele, e também em casos de criptorquidia. Sendo assim, radiologistas e cirurgiões devem estar cientes de variantes anatômicas da artéria testicular. Embora numerosos estudos e relatos de caso mencionem variantes da artéria testicular, este provavelmente é o primeiro caso a descrever origem bilateral baixa da artéria testicular e a discutir sua provável etiologia embriológica.
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Low-cost vascular anastomosis training: the surgeon goes to market
Resumo Anastomoses vasculares são procedimentos comuns realizados por grande parte dos cirurgiões e cujo treinamento ocorre principalmente em seres humanos, contrariando os princípios éticos vigentes. Esse fato se deve, sobretudo, à carência e ao alto custo relacionados aos atuais modelos de treinamento. Assim, este estudo visa avaliar a viabilidade de três vegetais para a realização de anastomoses vasculares. Foram utilizadas cinco unidades de cebolinha, vagem e feijão-verde. Em cada uma tentou-se realizar uma anastomose término-terminal. Conseguiu-se a realização da anastomose apenas na vagem e no feijão-verde. Contudo, por apresentar uma menor espessura, o feijão-verde assemelhou-se mais aos vasos humanos.
Abstract Vascular anastomoses are common procedures and are performed by most surgeons. Training is primarily conducted in human beings, which violates current ethical principles. This is because current training models are expensive and in short supply. This study was designed to investigate the feasibility of three vegetable models of vascular anastomosis. Five units each of scallions, green beans, and yardlong beans were used. An end-to-end anastomosis was attempted with each specimen. Anastomoses were only successful in green beans and yardlong beans. Since they are narrower, the yardlong beans are the most similar to human vessels.
http://ift.tt/2yIaQ4x
Lymphatic malformation with acquired Horner syndrome in an infant
An infantpresented with right upper eyelid ptosis and was subsequently diagnosed with acquired Horner syndrome. Further evaluation revealed a right-sided cervicothoracic lymphatic malformation. At 13 weeks of age, the child underwent percutaneous intracystic sclerotherapy with a mixture of sodium tetradecyl sulphate and ethanol. Twenty-one weeks after initial treatment, ophthalmic examination showed complete resolution of the blepharoptosis and pupillary miosis. Percutaneous sclerotherapy not only effectively treated the space-occupying lymphatic malformation but also reversed the Horner syndrome that was presumably induced by neural tension (more likely) or compression.
http://ift.tt/2zLDQsC
Leiomyosarcoma presenting as 'idiopathic unilateral lower limb lymphoedema
A 74-year-old woman presented with an 8-year history of unilateral swelling of her right lower limb, which was thought to be 'idiopathic' lymphoedema until she noticed a painless swelling in her right groin. Physical examination showed a painless, non-pulsatile, deep-seated mass in her right proximal thigh with significant lymphoedema distally. MRI scan showed a large mass at her right inguinal region, involving the common femoral vein. Histological examination on complete excision revealed leiomyosarcoma. It is important to exclude proximal obstructive lesion before making a diagnosis of unilateral idiopathic lower limb lymphoedema.
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Rhomboencephalosynapsis
Description
A baby boy was born to healthy, unrelated parents at 34 weeks gestation by caesarean section in view of an antenatal ultrasound diagnosis of hydrocephalus. Mother had a previous miscarriage at 13 weeks gestation of a twin pregnancy. At birth, the boy weighed 2.47 kg, was well and did not require resuscitation. Pregnancy was unremarkable with no significant events. At birth, a large head circumference was noted, but fontanelles were soft. The Apgar score was 9 at 1 and 10 min, baby had a good cry and was moving all four limbs. A CT scan of brain was done at 1-day old which showed obstructive hydrocephalus at the level of the cerebral aqueduct. A ventriculoperitoneal (VP) shunt was inserted at 1-week old. The boy showed slow development over the subsequent years, he never suffered from seizures, however required growth hormone therapy. A small atrial septal defect was noted on echocardiogram. An...
http://ift.tt/2zK4CRY
Measurement of bone mineral density as an efficacy marker in denosumab treatment of giant cell tumour of bone
Three patients with giant cell tumour of bone (GCTB) in the lower extremity, where the only surgical treatment options were amputation or severe weakening of the bone, were treated with denosumab (D-mab) to strengthen the bone mass in the tumour. In order to quantify changes in bone mineral density (BMD) in the GCTB lesion during D-mab treatment, we did repeated dual-energy X-ray absorptiometry (DXA) scans. The patients underwent operation after 3, 4 and 8 months of D-mab treatment, respectively. The tumours in all three patients responded markedly to D-mab, and up to 50% BMD increase was observed. There was almost no BMD change in the control scans in the hip and spine of the same patients. DXA scans provide no information about local tumour response, but may be of value in evaluation of the time and size of the D-mab response in GCTB, and thereby aid in finding the best timing for surgery.
http://ift.tt/2xkcacB
Giant mediastinal parathyroid adenoma presenting as bilateral brown tumour of mandible: a rare presentation of primary hyperparathyroidism
Hyperparathyroidism (HPT) is becoming increasingly common endocrinopathy in clinical practice. Nowadays, it is mostly diagnosed in subclinical or early clinical stage. Bony involvement in HPT has seen significant fall in incidence. Brown tumour of bone is exceptionally rare as a first manifestation of primary HPT (PHPT). Its radiological and histopathological features may be mistaken for other bony pathologies. If possibility of underlying HPT is overlooked the disease is bound to recur after surgery adding to morbidity of the patient. Here we present a case of bilateral brown tumour of mandible which was mistakenly treated as giant cell granuloma by surgical curettage. That the patient was harbouring an ectopic parathyroid adenoma with hypercalcemia causing non-specific symptoms was missed by the referring physician. This led to recurrence of the lesion. On subsequent evaluation, a giant mediastinal parathyroid adenoma causing PHPT was detected at our centre and was removed via mini sternotomy approach.
http://ift.tt/2zLDKBg
Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms
Severe carcinoid syndrome and carcinoid heart disease in neuroendocrine tumours can have a significant impact on a patient's quality of life and are a major cause of morbidity and mortality. We present a novel approach to managing a patient with medically uncontrollable carcinoid syndrome. Inferior and superior vena cava placement of transcatheter heart valves has been used to treat patients with right heart failure due to severe tricuspid and pulmonary regurgitation. However, this procedure has not been attempted to specifically reduce hormone secretion, primarily from the liver, in order to control carcinoid syndrome symptoms. We attempted this procedure in a patient with severe carcinoid disease and tricuspid regurgitation as a bridge to later definitive therapy. The procedure was technically successful, but did not improve carcinoid symptoms. The possible reasons for the failure are discussed here.
http://ift.tt/2xjSkOy
Birt-Hogg-Dube syndrome: awareness is important!
Birt-Hogg-Dubé (BHD) is a rare syndrome of inherited renal cell carcinomas, characterised by cutaneous lesions and pulmonary cysts and pneumothorax in a vast majority of the patients. Awareness of this syndrome is important in order to refer patients for genetic counselling and personalised follow-up as soon as possible. We describe a case of a 30-year-old female referred to our institution due to incidental discovery of solid bilateral renal masses. Renal biopsies were consistent with chromophobe tumour, and bilateral nephrectomy was performed. Gross examination revealed deformed kidneys with 28 brown and solid lesions, size variable between 0.1 and 6 cm, histologically corresponding to renal cell carcinomas, chromophobe type. Genetic test was required that showed a c.573delGAinsT frameshift mutation in heterozigosity at the folliculin gene, consistent with BHD diagnosis.
http://ift.tt/2zLDGS2
Idiopathic catastrophic thrombosis with happy ending
A 59-year-old male patient suffered three life-threatening instent thromboses after an initial resuscitation due to an ST-segment elevation myocardial infarction of the anterior cardiac wall. With a high-risk profile for heparin-induced thrombocytopenia (HIT), he was placed on argatroban after the second reinfarction. Under this apparently appropriate treatment, a third reinfarction occurred, and the patient had to undergo high-risk cardiac bypass surgery. Later on, a deep vein thrombosis and an intracardiac thrombus formed. Despite a positive screening test for HIT and a single positive result in the heparin-induced platelet aggregation test, we are not convinced that HIT was the only underlying cause for this 'catastrophic thrombotic syndrome'. We speculate that a massive generation of thrombin, reflected in consistently high D dimers and the need of copious amounts of a direct thrombin inhibitor, triggered the set of events. With this case report, we want to raise awareness for cardiac complications in patients with complex clotting disorders and share our experience in the diagnostic and therapeutic management of such an unusual scenario.
http://ift.tt/2xj1UkS
Neuroendocrine tumour in pancreatic dorsal agenesis: a rare association
Pancreatic dorsal agenesis (PDA) is a rare congenital anomaly, usually asymptomatic, that can present with abdominal pain, pancreatitis, diabetes mellitus and jaundice. Pancreatic tumours in PDA background are extremely rare, and when they occur are mainly pancreatic ductal adenocarcinoma. We present a case of a 48-year-old female patient with incidental detection of a 26x20 mm nodular lesion of the cephalic pancreas on ultrasound. Surgery was performed and gross examination revealed PDA with a tumour developed around the Wirsung duct. Histology showed a neuroendocrine tumour G1 with neural and vascular invasion. Two and half years later, the patient is alive and without tumour relapse. Awareness of the association of PDA and pancreatic tumours is fundamental in order to develop personalised follow-up programmes.
http://ift.tt/2zLDClg
Adverse reaction with suvorexant for insomnia: acute worsening of depression with emergence of suicidal thoughts
A 59-year-old woman on daily peritoneal dialysis for end-stage renal failure received care at an outpatient psychiatric clinic for her diagnoses that include major depressive disorder, generalised anxiety disorder and insomnia disorder. Although there was partial improvement in the patient's mood and anxiety symptoms with antidepressant treatment, insomnia remained a persistent complaint despite adequate trials of different sleep medications. The novel hypnotic, suvorexant (Belsomra, Merck & Co.) was then initiated at the recommended bedtime dose of 10 mg and was followed by a 15 mg dose the following night. Within an hour after taking her second suvorexant dose, the severity of patient's depression symptoms worsened and was accompanied by new onset of suicidal thoughts.
http://ift.tt/2xhMygh
Case of tumoral calcinosis on images: a rare clinicopathological entity
Description
We are presenting a case of tumoral calcinosis (TC) diagnosed on histopathology with characteristic X-ray, CT and MRI images. We acknowledge that although radiological and pathological descriptions are suggested as diagnostic criteria, mostly the term TC is saved for the condition caused by hereditary metabolic dysfunction of phosphate regulation associated with massive periarticular masses. Our patient had a normal phosphate. On review of literature, normophosphatemic TC has also been described.1
An 81-year-old Caucasian woman presented with left wrist pain and swelling, which first began approximately 3–4 years ago. As per patient, she saw her physician regarding this 1 year ago and was diagnosed with gout. Physical examination showed 4x3 cm left-sided volar ulnar wrist mass (figure 1).
Figure 1
Patient's picture showing swelling on the left wrist.
The patient's vital signs and rest of the examination were within normal limits....
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Metastatic meningioma: a rare cause of mediastinal lymphadenopathy.
Description
A 69-year-old man with known, stable atypical meningioma of the brain diagnosed 5 years previously presented with severe shortness of breath. The patient had previously been treated with surgery and radiotherapy to the brain. Chest X-ray revealed bulky mediastinal lymphadenopathy (figure 1). CT (figure 2) confirmed mediastinal and upper abdominal lymphadenopathy in addition to multiple pulmonary emboli. The patient underwent an endoscopic ultrasound and fine-needle aspiration (EUS-FNA), an established technique that enables prompt cytological sampling and assessment.1
Figure 1
Chest X-ray.
Figure 2
Contrast-enhanced CT image showing adenopathy at the level of the aortic arch.
The EUS-FNA preparations showed sheets and clusters of bland, polygonal epithelioid cells (figure 3). These demonstrated strong immunohistochemical positivity (figure 4) for epithelial membrane antigen. The final immunopanel was strongly supportive...
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Olfactory nerve hypertrophy: a clue to the presence of ipsilateral megalencephaly
Description
A boy aged 4 years presented with refractory focal seizures since 9 months of age. The seizures involved the left side of the body and consisted of clonic movements with frequent generalisation. MRI brain showed abnormal area with poor grey-white differentiation involving the right frontal lobe, especially the basifrontal region and the temporal lobe (figure 1A,B) suggesting the presence of a frontotemporal developmental malformation. Interestingly olfactory nerve hypertrophy was also noted on the same side (figure 1C,D). Video-electroencephalogram study demonstrated concurrence of the interictal (figure 2A) and ictal data (figure 2B) with the MRI defined abnormality. An 18-fluoro-2-deoxy-D-glucose positron emission tomography/CT of the brain showed severe right frontotemporal hypometabolism. The boy underwent a disconnection procedure involving the right frontal lobe sparing the motor cortex and the temporal lobe. Histopathology of the abnormal brain obtained during the surgery showed large...
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Necrotising pneumonia following influenza due to PVL-negative Staphylococcus aureus in a 64-year-old woman
Description
A 64-year-old immunocompetent woman presented to our institution during the 2016–2017 influenza A(H3N2) epidemic for cough and fever. She presented 10 days ago with an influenza syndrome, treated with ibuprofen 400 mg/day for 7 days. As the fever continued, with blood-streaked sputum, amoxicillin with clavulanic acid was prescribed for 3 days and then ceftriaxone (1 g/day). She had elevated transaminases and C reactive protein (184 mg/L). A chest X-ray was performed, showing a left pneumonia (figure 1A), and the patient was admitted in the infectious disease unit. There was no respiratory failure. Amphoric breath sound was heard at the top of the right lung. Antibiotics were modified, as levofloxacine (500 mg twice daily) was added to cefotaxime (1 g/8 hours). A CT scan of the chest was performed (figure 1B,C), showing a bifocal pneumonia involving the upper right and lower left lobes, and excavated bilateral nodules. The bronchoalveolar lavage showed a positive influenza...
http://ift.tt/2xiIUCT
Correction: Out of the blue--finger ischaemia and occult colorectal cancer
Schattner A. Out of the blue finger ischaemia and occult colorectal cancer. BMJ Case Rep 2017 (Epub ahead of print 8 Mar 2017). doi:10.1136/bcr-2016-218779
The correct title of the article is: Out of the blue—finger ischaemia and occult colorectal cancer.
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Heart irradiation reduces microvascular density and accumulation of HSPA1 in mice
Abstract
Purpose
Improvement of radiotherapy techniques reduces the exposure of normal tissues to ionizing radiation. However, the risk of radiation-related late effects remains elevated. In the present study, we investigated long-term effects of radiation on heart muscle morphology.
Materials and methods
We established a mouse model to study microvascular density (MVD), deposition of collagen fibers, and changes in accumulation of heat shock 70 kDa protein 1 (HSPA1) in irradiated heart tissue. Hearts of C57BL/6 mice received a single dose of X‑ray radiation in the range 0.2–16 Gy. Analyses were performed 20, 40, and 60 weeks after irradiation.
Results
Reduction in MD was revealed as a long-term effect observed 20–60 weeks after irradiation. Moreover, a significant and dose-dependent increase in accumulation of HSPA1, both cytoplasmic and nuclear, was observed in heart tissues collected 20 weeks after irradiation. We also noticed an increase in collagen deposition in hearts treated with higher doses.
Conclusions
This study shows that some changes induced by radiation in the heart tissue, such as reduction in microvessel density, increase in collagen deposition, and accumulation of HSPA1, are observed as long-term effects which might be associated with late radiation cardiotoxicity.
http://ift.tt/2z33Gen
Double fluorescent labelling of a bipolar epithelial cell in vitro: The outer hair cell
Publication date: 1 January 2018
Source:Journal of Neuroscience Methods, Volume 293
Author(s): Csaba Harasztosi, Entcho Klenske, Susanne Badum, Emese Harasztosi, Anthony W. Gummer
BackgroundFluorescence membrane markers are efficient tools for visualizing the dynamics of membrane recycling processes in living cells. The outer hair cell (OHC) − a bipolar epithelial cell in the cochlea − possesses endocytic activity at both its apical and basal poles. The best visual overview of transcytosis in the OHC is achieved when the cell is isolated, so that both the apical and the basal poles are in the same focal plane to allow confocal imaging. Until now, fluorescent markers were applied to the extracellular environment of isolated OHCs without distinguishing the apical and basal poles. The drawback of that configuration is that apicobasal and basoapical vesicle traffic labelled at the opposite poles cannot be visualized independently because the same fluorescent marker has access to both poles.New methodA double-barrel, capillary perfusion system was developed to independently stain either one pole or both the apical and the basal poles of isolated OHCs using different types of fluorescence membrane markers.ResultsProducing laminar fluid flow, the double-barrel perfusor allows investigation of the dynamics of apicobasal and basoapical vesicle traffic independently and/or simultaneously in the same OHC.Comparison with existing methodThis method offers a unique option for investigating bidirectional vesicle traffic in bipolar epithelial cells, which is superior to other already established labelling techniques.ConclusionsThe double-barrel perfusion system, suitable for selectively staining a longitudinal section of the plasma membrane of an isolated bipolar epithelial cell, opens new possibilities for investigating cell labelling and intracellular vesicle traffic.
Graphical abstract
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Functional brain connectivity in resting-state fMRI using phase and magnitude data
Publication date: 1 January 2018
Source:Journal of Neuroscience Methods, Volume 293
Author(s): Zikuan Chen, Arvind Caprihan, Eswar Damaraju, Srinivas Rachakonda, Vince Calhoun
BackgroundThe output of BOLD fMRI consists of a pair of magnitude and phase components. While the magnitude data has been widely accepted for brain function analysis, we can also make use of the phase data (unwrapped) since this is a good representation of the internal magnetic field. In this work, we discuss the use of fMRI phase data for brain function analysis.New methodsThe fMRI phase data taken from 100 subjects are preprocessed using standard SPM approaches. Group independent component analysis (ICA) is applied to the magnitude and phase data separately. We then compare the spatial patterns for both magnitude and phase data using an empirical spatial smoothing procedure. We also evaluate the magnitude and phase functional network connectivity (FC) matrices.ResultsWe observed the positive/negative correlation-balanced functional connectivity in phase data, which is distinct from the positive correlation prevalence in magnitude data. The phase FC (pFC) structure is quite different from the magnitude FC (mFC) in functional clusters (on-diagonal blocks or cliques) and inter-cluster couplings (off-diagonal blocks).Comparison with existingMethods since both the magnitude and phase data of the fMRI signals are generated from the same magnetic source, either can be useful for brain function analysis from different perspective (per different measurements). Herein, we report on making use of resting-state fMRI phase data for brain functional analysis in comparison with magnitude data. This exploration in phase fMRI may provide a new arena for more comprehensive brain function analysis.
Graphical abstract
http://ift.tt/2z2cEIS
Corrigendum to “Promoting child-initiated social-communication in children with autism: Son-rise program intervention effects” [J. Commun. Disord. 46/5–6 (2013) 495–506]
Source:Journal of Communication Disorders
Author(s): Kat Houghton, Julia Schuchard, Charlie Lewis, Cynthia K. Thompson
http://ift.tt/2xillKG
Biofilm formation is determinant in tomato rhizosphere colonization by Bacillus velezensis FZB42
Abstract
In this work, the behavior in tomato rhizosphere of Bacillus velezensis FZB42 was analyzed taking into account the surfactin production, the use of tomato roots exudate as substrates, and the biofilm formation. B. velezensis FZB42 and B. amyloliquefaciens S499 have a similar capability to colonize tomato rhizosphere. Little difference in this colonization was observed with surfactin non producing B. velezensis FZB42 mutant strains. B. velezensis is able to grow in the presence of root exudate and used preferentially sucrose, maltose, glutamic, and malic acids as carbon sources. A mutant enable to produce exopolysaccharide (EPS-) was constructed to demonstrate the main importance of biofilm formation on rhizosphere colonization. This mutant had completely lost its ability to form biofilm whatever the substrate present in the culture medium and was unable to efficiently colonize tomato rhizosphere.
http://ift.tt/2zz2E5R
Combined effects of binary antibiotic mixture on growth, microcystin production, and extracellular release of Microcystis aeruginosa : application of response surface methodology
Abstract
The interactive effects of binary antibiotic mixtures of spiramycin (SP) and ampicillin (AMP) on Microcystis aeruginosa (MA) in terms of growth as well as microcystin production and extracellular release were investigated through the response surface methodology (RSM). SP with higher 50 and 5% effective concentrations in MA growth was more toxic to MA than AMP. RSM model for toxic unit approach suggested that the combined toxicity of SP and AMP varied from synergism to antagonism with SP/AMP mixture ratio decreasing from reversed equitoxic ratio (5:1) to equitoxic ratio (1:5). Deviations from the prediction of concentration addition (CA) and independent action (IA) model further indicated that combined toxicity of target antibiotics mixed in equivalent ratio (1:1) varied from synergism to antagonism with increasing total dose of SP and AMP. With the increase of SP/AMP mixture ratio, combined effect of mixed antibiotics on MA growth changed from stimulation to inhibition due to the variation of the combined toxicity and the increasing proportion of higher toxic component (SP) in the mixture. The mixture of target antibiotics at their environmentally relevant concentrations with increased total dose and SP/AMP mixture ratio stimulated intracellular microcystin synthesis and facilitated MA cell lysis, thus leading to the increase of microcystin productivity and extracellular release.
http://ift.tt/2h2UwUF
Isolation and characterization of culturable bacteria present in the spent nuclear fuel pool water
Abstract
A spent nuclear fuel (SNF) pool is a key facility for safe management of nuclear waste, where spent nuclear fuel rods are stored in a water pool. The spent fuel rods carry a significant amount of radioactivity; they are either recycled or stored for further processing. Pool water acts as a heat sink as well as a shield against the radiation present in spent/burned fuel rods. The water used in these pools is filtered by an ultra-filtration process which makes certain the purity of water. As the life span of these pools is approximately 20 to 40 years, the maintenance of pure water is a big challenge. A number of researchers have shown the presence of bacterial communities in this ultrapure water. The bacterial types present in SNF pool water is of increasing interest for their potential bioremediation applications for radioactive waste. The present study showed the isolation of six bacterial species in the SNF pool water samples, which had significant radio-tolerance (D10 value 248 Gy to 2 kGy) and also biofilm-forming capabilities. These strains were also investigated for their heavy metal removal capacity. Maximum biofilm-mediated heavy metal (Co and Ni) removal (up to 3.8 μg/mg of biomass) was observed by three isolates (FPB1, FPB4, and FPB6). The ability of these bacterial isolates to survive in radioactive environments can be of great interest for remediation of radioactive contaminants.
http://ift.tt/2zxw70e
Prokaryotic community profiling of local algae wastewaters using advanced 16S rRNA gene sequencing
Abstract
Algae biomass-fed wastewaters are a promising source of lipid and bioenergy manufacture, revealing substantial end-product investment returns. However, wastewaters would contain lytic pathogens carrying drug resistance detrimental to algae yield and environmental safety. This study was conducted to simultaneously decipher through high-throughput advanced Illumina 16S ribosomal RNA (rRNA) gene sequencing, the cultivable and uncultivable bacterial community profile found in a single sample that was directly recovered from the local wastewater systems. Samples were collected from two previously documented sources including anaerobically digested (AD) municipal wastewater and swine wastewater with algae namely Chlorella spp. in addition to control samples, swine wastewater, and municipal wastewater without algae. Results indicated the presence of a significant level of Bacteria in all samples with an average of approximately 95.49% followed by Archaea 2.34%, in local wastewaters designed for algae cultivation. Taxonomic genus identification indicated the presence of Calothrix, Pseudomonas, and Clostridium as the most prevalent strains in both local municipal and swine wastewater samples containing algae with an average of 17.37, 12.19, and 7.84%, respectively. Interestingly, swine wastewater without algae displayed the lowest level of Pseudomonas strains < 0.1%. The abundance of some Pseudomonas species in wastewaters containing algae indicates potential coexistence between these strains and algae microenvironment, suggesting further investigations. This finding was particularly relevant for the earlier documented adverse effects of some nosocomial Pseudomonas strains on algae growth and their multidrug resistance potential, requiring the development of targeted bioremediation with regard to the beneficial flora.
http://ift.tt/2i0n3d6
Macroinvertebrate communities in riverine systems of buffer areas of protected wildland, rangeland and city areas: implications for conservation of riverine systems on urbanising watersheds
Abstract
Riverine systems in developing countries continue to be degraded by anthropogenic pressures such as urbanisation. The responses of biota in watersheds surrounding a drainage divide may provide critical information that is required to protect the ecological condition of riverine systems. This study assessed the spatial variation of selected environmental variables together with macroinvertebrate communities in upper reaches of riverine systems across different land use categories of the Bulawayo region. Based on an a priori selection criterion, studied sites were grouped following an urban-wastewater disturbance gradient comprising of (i) heavily polluted city sites, (ii) moderately disturbed rangeland sites and (iii) less disturbed sites of the buffer areas of protected wildland. Most of the studied environmental variables and the macroinvertebrate community assemblages were significantly (ANOVA, p < 0.05) different and degraded within the city areas. In this study, the variance of environmental variables known to be associated with organic pollution like increased nutrients, embeddedness by particulates, salinity, COD, conductivity, turbidity and reduced dissolved oxygen was found to be related with the variation of macroinvertebrate communities across the studied sites. Besides affirming the effectiveness of macroinvertebrate-based bioassessment approaches, the results of our study demonstrate that an aggressive riverine protection policy that prohibits the discharge of poor-quality urban effluents and preservation of the less disturbed riverine systems needs to be part of the larger urban planning and regulatory framework in urbanising watersheds.
http://ift.tt/2gxJOEZ
Relay cropping of wheat ( Triticum aestivum L.) in cotton ( Gossypium hirsutum L.) improves the profitability of cotton-wheat cropping system in Punjab, Pakistan
Abstract
Delayed sowing of wheat (Triticum aestivum L.) in cotton-based system reduces the productivity and profitability of the cotton-wheat cropping system. In this scenario, relay cropping of wheat in standing cotton might be a viable option to ensure the timely wheat sowing with simultaneous improvement in wheat yields and system profitability. This 2-year study (2012–2013 and 2013–2014) aimed to evaluate the influence of sowing dates and relay cropping combined with different management techniques of cotton sticks on the wheat yield, soil physical properties, and the profitability of the cotton-wheat system. The experiment consisted of five treatments viz. (S1) sowing of wheat at the 7th of November by conventional tillage (two disc harrows + one rotavator + two plankings) after the removal of cotton sticks, (S2) sowing of wheat at the 7th of November by conventional tillage (two disc harrows + two plankings) after the incorporation of cotton sticks in the field with a rotavator, (S3) sowing of wheat at the 7th of November as relay crop in standing cotton with broadcast method, (S4) sowing of wheat at the 15th of December by conventional tillage (two disc harrows + one rotavator + two plankings) after the removal of cotton sticks, and (S5) sowing of wheat at the 15th of December by conventional tillage (two disc harrows + two plankings) after the incorporation of cotton sticks in the field with a rotavator. The highest seed cotton yield was observed in the S5 treatment which was statistically similar with the S3 and S4 treatments; seed cotton yield in the S1 and S2 treatments has been the lowest in both years of experimentation. However, the S2 treatment produced substantially higher root length, biological yield, and grain yield of wheat than the other treatments. The lower soil bulk density at 0–10-cm depth was recorded in the S2 treatment which was statistically similar with the S5 treatment during both years of experimentation. The volumetric water contents, net benefit, and benefit-cost ratio were the highest in the S3 treatment during both years of experimentation. Thus, relay cropping of wheat in standing cotton might be a viable option to improve the soil physical environment and profitability of the cotton-wheat cropping system.
http://ift.tt/2i0sQiZ
Assessing watercourse quality: challenges in implementing European and Swiss legal frameworks
Abstract
Hydro-climatic changes and the increasing release of pollutants into rivers by human activities tend to affect the quality of watercourses, to alter aquatic ecosystems and to reduce the amount of useable water. The ecological and chemical states of rivers and their evolution is thus of growing concern. In Europe and Switzerland, water policies are progressively shifting towards a holistic approach of river systems. The European Commission notably established a framework to highlight rivers' ecological deficits and to enhance regional or local water management plans. In Switzerland, a similar framework is currently under development. In this paper, both procedures are compared and implemented in a Swiss catchment dominated by agricultural activities. The aim is to define the challenges that still need to be addressed to assess and sustain river health. The hydromorphological, ecological, and ecotoxicological quality of the river was evaluated. Both frameworks highlighted the fact that no section of the river can currently be classified as being in a good environmental state and that the state deteriorates as tributaries and wastewater discharge flow into the main riverbed. Chemical issues and water quality changes due to hydro-climatic variations and management strategies were also pinpointed. Both frameworks are thus useful tools to survey changes in rivers quality in space and over time. However, challenges remain regarding the appropriate strategies to monitor and analyze chemicals, the definition of target values and conditions, the evaluation and integration of human-induced pressures, and the overall evaluation of the state of a river. The development of integrated indicators or of ecosystem services approaches is considered as a potential solution to explore river health and to define efficient restoration measures by water managers.
http://ift.tt/2gyoWNF
Effect of zero-valent iron and trivalent iron on UASB rapid start-up
Abstract
In order to realize the rapid start-up of upflow anaerobic sludge blanket (UASB) reactor, the iron ion in different valence state was added to UASB. The results indicated that the start-up time of R3 (FeCl3) was 48 h faster than that of R2 (zero-valent iron (ZVI)). It was because the FeCl3 could rapidly promote granulation of sludge as a flocculant. However, ZVI released Fe2+ through corrosion slowly, and then the Fe2+ increased start-up speed by enhancing enzyme activity and enriching methanogens. In addition, the ZVI and FeCl3 could promote hydrolysis acidification and strengthen the decomposition of long-chain fatty acids. The detection of iron ions showed that iron ions mainly existed in the sludge. Because the high concentration of Fe2+ could inhibit anaerobic bacteria activity, excess Fe3+ could be changed into iron hydroxide precipitation to hinder the mass transfer process of anaerobic bacteria under the alkaline condition. The FeCl3 was suitable to be added at the initial stage of UASB start-up, and the ZVI was more fitted to be used in the middle stage of reactor start-up to improve the redox ability.
http://ift.tt/2i0sN6N
210 Po and 210 Pb bioaccumulation and possible related dose assessment in parasol mushroom ( Macrolepiota procera )
Abstract
Presented are results of a study on accumulation and distribution of 210Po and 210Pb in the fruitbodies of parasol mushroom (Macrolepiota procera) and risk to human consumer due to exposure from highly radiotoxic decay particles emitted by both radionuclides. Mushrooms were collected from 16 forested places in central and northern regions of Poland. Activity concentrations of 210Po and 210Pb were determined after radiochemical separation of nuclides and subsequent measurement using validated method and alpha spectrometer. Results showed on spatially heterogeneous distribution of the 210Po and 210Po activity concentrations in M. procera and two interpolation maps were prepared. Activity concentrations of nuclides in dried caps of M. procera were in the range from 3.38 ± 0.41 to 16.70 ± 0.33 Bq∙210Po ∙kg−1 and from 5.11 ± 0.21 to 13.42 ± 0.30 Bq∙210Pb ∙kg−1. Consumption of M. procera foraged in central and northern Poland should not contribute significantly to the annual effective radiation doses from 210Po and 210Pb due to amount of both nuclides accumulated by fungus in caps.
http://ift.tt/2gyWSKf
Photocatalytic degradation of organic pollutant aldicarb by non-metal-doped nanotitania: synthesis and characterization
Abstract
The current study focused on pollution control by titania through photocatalytic degradation of aldicarb pesticide in aqueous medium. Titania, which is an efficient photocatalyst, can bring about degradation of aqueous organic pollutants under UV and visible light irradiation. Here, we prepared titania by sol-gel method from titanium tetraisopropoxide and doped non-metals like N and S from sources such as urea and thiourea, respectively. The prepared catalyst was characterized by XRD, UV-Vis.DRS, TEM, XPS, etc. Photocatalytic activity of the catalyst was evaluated from extend of degradation of aldicarb pesticide by measuring its concentration with the help of HPLC. It was found that the modified catalyst showed better photocatalytic degradation than pure titania in visible light.
http://ift.tt/2i0sM2J
Multivariate curve resolution of organic pollution patterns in mangrove forest sediment from Qeshm Island and Khamir Port—Persian Gulf, Iran
Abstract
Straight-chain alkanes (n-alkanes) have been proposed as biomarkers to assess petroleum pollution sources in marine environments. In this work, three sampling sites were selected along Iranian-protected mangrove forests in the Persian Gulf. Sample sites were chosen to represent different compositions and sources of n-alkanes in surface sediments (0–5 cm) from different locations in the Khamir Port, in the middle part of the Gulf, and in the Qeshm Island. Samples were analyzed by gas chromatography-mass spectrometry (GC–MS), and the obtained n-alkanes concentrations were analyzed by principal component analysis (PCA) and multivariate curve resolution alternating least squares (MCR-ALS) to deduce their possible sources and distribution patterns. Results revealed that n-alkanes have a dominant biogenic source in marginal Qeshm Island stations, which changed from biogenic to petrogenic sources in the Khamir Port areas. Sediment samples from the Khamir Port showed the significant presence of oil pollution due to transportation. These samples are being exposed to basic Persian Gulf currents entering from the Hormuz Strait causing oil pollution spread over the entire Gulf area. Sediment samples of the Middle Part stations located between two other sites show a combined condition of the two previous sections, with petrogenic and biogenic contributions. The present study demonstrates that the Hara Protected Area was already contaminated by background oil pollution as a result of continuous oil spills and war conflicts in the Persian Gulf.
Additionally, the MCR-ALS method is shown to be a powerful chemometric tool for the investigation, resolution, identification, and description of pollution patterns distributed over a particular geographical area and environmental compartment. They can be used as well as parameters like unresolved to resolved ratio (U/R), pristane to phytane (Pr/Ph), n-C17/Pr, n-C18/Ph, and unresolved complex mixture (UCM) to assess petroleum pollution sources in the sediments.
http://ift.tt/2gyPkqQ
Corn industrial wastewater (nejayote): a promising substrate in Mexico for methane production in a coupled system (APCR-UASB)
Abstract
In Mexico, the corn tortilla is a food of great economic importance. Corn tortilla production generates about 1500–2000 m3 of wastewater per 600 tons of processed corn. Although this wastewater (also known as nejayote) has a high organic matter content, few studies in Mexico have analyzed its treatment. This study presents fresh data on the potential methane production capacity of nejayote in a two-phase anaerobic digestion system using an Anaerobic-Packed Column Reactor (APCR) to optimize the acidogenic phase and an up-flow anaerobic sludge blanket (UASB) reactor to enhance the methanogenic process. Results indicate that day 8 was ideal to couple the APCR to the UASB reactor. This allowed for a 19-day treatment that yielded 96% COD removal and generated a biogas containing 84% methane. The methane yield was 282 L kg−1 of CODremoved. Thus, two-phase anaerobic digestion is an efficient process to treat nejayote; furthermore, this study demonstrated the possibility of using an industrial application by coupling the APCR to the UASB reactor system, in order to assess its feasibility for biomethane generation as a sustainable bioenergy source.
http://ift.tt/2i0sJnz
Occurrence of multi-class surfactants in urban wastewater: contribution of a healthcare facility to the pollution transported into the sewerage system
Abstract
Healthcare facility discharges, by their nature, are often considered as non-domestic effluent, which can provide significant pollution comparatively to other domestic sources. In this context, a total of 12 monthly sampling campaigns were collected from a healthcare facility as well as the output of a sewerage system of Site Pilote de Bellecombe (SIPIBEL) observatory. This study focuses more specifically on 12 surfactants and biocides: four anionics, four cationic, two non-ionic, one zwitterionic, and one dispersive agent, among the most commonly used commercial surfactants. Particular attention was also provided to routine wastewater quality parameters. Both effluents were heavily contaminated by most anionic surfactants; they displayed median concentrations up to 1 to 2 mg/L for linear alkylbenzene sulfonates and between 10 and 100 μg/L for other sodium sulfate congeners (lauryl and laureth). Overall, for the majority of surfactants, the healthcare facility contribution to the total flux reaching the wastewater treatment plant ranges between 5 and 9%.
http://ift.tt/2gzT9MD
Environmental impact assessment of municipal solid waste management options using life cycle assessment: a case study
Abstract
The goal of this study is to use life cycle assessment (LCA) tool to assess possible environmental impacts of different municipal solid waste management (MSWM) scenarios on various impact categories for the study area Dhanbad City, India. The scenarios included in the present study are collection and transportation (denoted as S1); baseline scenario consisting of recycling, open burning, open dumping, and finally unsanitary landfilling without energy recovery (denoted by S2); composting and landfilling (denoted by S3); and recycling and composting followed by landfilling of inert waste without energy recovery (denoted by S4). One ton of municipal solid waste (MSW) was selected as the functional unit. The primary data were collected through sampling, surveys, and literatures. Background data were obtained from Eco-invent data of SimaPro 8.1 libraries. The scenarios were compared using the CML 2 baseline 2000 method, and the results indicated that the scenario S1 had the highest impact on marine aquatic ecotoxicity (1.86E + 04 kg 1,4-DB eq.) and abiotic depletion (2.09E + 02 kg Sb eq.). S2 had the highest impact on global warming potential (9.42E + 03 kg CO2 eq.), acidification (1.15E + 01 kg SO2 eq.), eutrophication (2.63E + 00 kg PO43− eq.), photochemical oxidation (2.12E + 00 kg C2H4 eq.), and human toxicity (2.25E + 01 kg 1,4-DB eq.). However, S3 had the highest impact on abiotic depletion (fossil fuels) (2.71E + 02 MJ), fresh water aquatic ecotoxicity (6.54E + 00 kg 1,4-DB eq.), terrestrial ecotoxicity (3.36E − 02 kg 1,4-DB eq.), and ozone layer depletion (2.73E − 06 kg CFC-11 eq.). But S4 did not have the highest impact on any of the environmental impact categories due to recycling of packaging waste and landfilling of inert waste. Landfilling without energy recovery of mixed solid waste was found as the worst disposal alternative. The scenario S4 was found as the most environmentally suitable technology for the study area and recommended that S4 should be considered for strategic planning of MSWM for the study area.
http://ift.tt/2i0sHfr
Purification of Hg 0 from flue gas by wet oxidation method and its mechanism: a review
Abstract
The vast majority of Hg2+ can be removed while elemental mercury (Hg0) can hardly be removed due to its characteristic of high volatility and insolubility in water. Till now, how to oxidize Hg0 to Hg2+ is the key for the purification of Hg0, especially when there are others pollutants, such as HCl, SO2, and NOx. In this review, the method and mechanism of Hg0 purification from flue gas by H2O2, KMnO4, NaClO2, and O3 are reviewed comprehensively. It is concluded that the oxidation of Hg0 mainly depends on the electronic supply efficiency from the solution. The Fenton reagent, composed of H2O2 and metal cations, is superior to O3 and the solution of KMnO4 and NaClO2. Moreover, HCl, SO2, and NOx in the flue gas can influence the oxidation and purification mechanism of Hg0. It is found that HCl in flue gas had obvious auxo-action on the oxidation of mercury, and SO2 and NOx have different effects on the oxidation of Hg0 with the change of compositions and concentration of pollutants in the flue gas. In general, SO2 and NOx can slightly promote the oxidation of Hg0 due to the synergistic effect.
http://ift.tt/2gxtS5z
Existing forms and changes of nitrogen inside of horizontal subsurface constructed wetlands
Abstract
Horizontal zeolite subsurface constructed wetland system (HZCWs) and horizontal limestone subsurface constructed wetland system (HLCWs) were applied to the removal of nitrogen in lightly polluted wastewater, and the existing forms, changes, and removal mechanism of nitrogen in the constructed wetlands were analyzed. The results indicated that compared with HLCWs, HZCWs exhibited better nitrogen removal effect, and the maximum removal rates of ammonia nitrogen and total nitrogen could reach 96.97 ± 5.29 and 93.12 ± 3.35%, respectively. Besides, analysis of the removal effect on nitrogen in different existing forms on different substrate heights in the constructed wetlands showed that variation of nitrogen removal efficiency had certain regularities, which were related to the interior construction features of the wetland systems, and agreed with the regularities in the changes of the influential factors such as DO inside of the wetlands. In addition, degradation mechanism of pollutions was also analyzed, and the results indicated that the quantity of microorganisms and enzymes, including FDA, catalase, and urease, on the surface of the substrates had significant influence on the removal regularities and effects of the major pollutions in constructed wetlands.
http://ift.tt/2i0sDwd
Heavy metal and nutrient uptake in plants colonizing post-flotation copper tailings
Abstract
Copper ore mining and processing release hazardous post-flotation wastes that are difficult for remediation. The studied tailings were extremely rich in Cu (1800 mg kg−1) and contaminated with Co and Mn, and contained very little available forms of P, Fe, and Zn. The plants growing in tailings were distinctly enriched in Cu, Cd, Co, Ni, and Pb, and the concentration of copper achived the critical toxicity level in shoots of Cerastium arvense and Polygonum aviculare. The redundancy analysis demonstrated significant relationship between the concentration of available forms of studied elements in substrate and the chemical composition of plant shoots. Results of the principal component analysis enabled to distinguish groups of plants which significantly differed in the pattern of element accumulation. The grass species Agrostis stolonifera and Calamagrostis epigejos growing in the tailings accumulated significantly lower amounts of Cu, but they also had the lowest levels of P, Fe, and Zn in comparison to dicotyledonous. A. stolonifera occurred to be the most suitable species for phytostabilization of the tailings with regard to its low shoot Cu content and more efficient acquisition of limiting nutrients in relation to C. epigejos. The amendments improving texture, phosphorus fertilization, and the introduction of native leguminous species were recommended for application in the phytoremediation process of the tailings.
http://ift.tt/2gzT9w7
The impact of foreign direct investment on CO 2 emissions in Turkey: new evidence from cointegration and bootstrap causality analysis
Abstract
Pollution haven hypothesis (PHH), which is defined as foreign direct investment inducing a raising impact on the pollution level in the hosting country, is lately a subject of discussion in the field of economics. This study, within the scope of related discussion, aims to look into the potential impact of foreign direct investments on CO2 emission in Turkey in 1974–2013 period using environmental Kuznets curve (EKC) model. For this purpose, Maki (Econ Model 29(5):2011–2015, 2012) structural break cointegration test, Stock and Watson (Econometrica 61:783–820, 1993) dynamic ordinary least square estimator (DOLS), and Hacker and Hatemi-J (J Econ Stud 39(2):144–160, 2012) bootstrap test for causality method are used. Research results indicate the existence of a long-term balance relationship between FDI, economic growth, energy usage, and CO2 emission. As per this relationship, in Turkey, (1) the potential impact of FDI on CO2 emission is positive. This result shows that PHH is valid in Turkey. (2) Moreover, this is not a one-way relationship; the changes in CO2 emission also affect FDI entries. (3) The results also provide evidence for the existence of the EKC hypothesis in Turkey. Within the frame of related findings, the study concludes several polities and presents various suggestions.
http://ift.tt/2i0qiRN
Prevalence of Ideal Cardiovascular Health and Its Association with Cognitive Function in Older Adults: The Chilean National Health Survey (2009–2010)
Rejuvenation Research , Vol. 0, No. 0.
http://ift.tt/2z2lSoB
Response of Human Fetal Liver Progenitor Cell Types to Temperature and pH Stresses In Vitro
Rejuvenation Research , Vol. 0, No. 0.
http://ift.tt/2iudKpM
Improving Surgical Safety and Nontechnical Skills in Variable-Resource Contexts: A Novel Educational Curriculum
Publication date: Available online 23 October 2017
Source:Journal of Surgical Education
Author(s): Yihan Lin, John W. Scott, Sojung Yi, Kathryn K. Taylor, Georges Ntakiyiruta, Faustin Ntirenganya, Paulin Banguti, Steven Yule, Robert Riviello
ObjectiveA substantial proportion of adverse intraoperative events are attributed to failures in nontechnical skills. To strengthen these skills and improve surgical safety, the Non-Technical Skills for Surgeons (NOTSS) taxonomy was developed as a common framework. The NOTSS taxonomy was adapted for low- and middle-income countries, where variable resources pose a significant challenge to safe surgery. The NOTSS for variable-resource contexts (VRC) curriculum was developed and implemented in Rwanda, with the aim of enhancing knowledge and attitudes about nontechnical skills and promoting surgical safety.DesignThe NOTSS-VRC curriculum was developed through a rigorous process of integrating contextually appropriate values. It was implemented as a 1-day training course for surgical and anesthesia postgraduate trainees. The curriculum comprises lectures, videos, and group discussions. A pretraining and posttraining questionnaire was administered to compare knowledge and attitudes regarding nontechnical skills, and their potential to improve surgical safety.SettingThe setting of this study was in the tertiary teaching hospital of Kigali, Rwanda.ParticipantsParticipants were residents of the University of Kigali. A total of 55 residents participated from general surgery (31.4%), obstetrics (25.5%), anesthesia (17.6%), and other surgical specialties (25.5%).ResultsIn a paired analysis, understanding of NOTSS improved significantly (55.6% precourse, 80.9% postcourse, p<0.01). All residents reported that the course would improve their ability to provide safer patient care, and 97.4% believed developing nontechnical skills would improve patient outcomes.ConclusionsNontechnical skills must be highlighted in surgical training in low- and middle-income countries. The NOTSS-VRC curriculum can be implemented without additional technology or significant financial cost. Its deliberate design for resource-constrained settings allows it to be used both as an educational course and a quality improvement strategy. Our research demonstrates it is feasible to improve knowledge and attitudes about NOTSS through a 1-day course, and represents a novel approach to improving global surgical safety.
http://ift.tt/2i1nVhN
Pre-emptive Diclofenac Versus Ketoprofen as a Transdermal Drug Delivery System: How They Face
Abstract
Aim
To compare the analgesic efficacy of Diclofenac vis-a-vis Ketoprofen transdermal patch, in the management of immediate post-operative pain following orthognathic procedures.
Material and Method
A prospective, double-blinded, randomised controlled study was conducted among 50 subjects, between 2012 and 2015. These patients were diagnosed clinically and cephalometrically as skeletal and dental class II malocclusion and underwent bi-jaw surgical procedure. In total, 25 Diclofenac and 25 Ketoprofen transdermal patches, sealed in envelopes and numbered, were administered to subjects. The patches used, contained 100 mg of either Diclofenac or Ketoprofen and administered by a nurse prior to induction. Duration of analgesia, severity of pain using Visual Analog Scale, necessity of rescue analgesia (spontaneous pain > 5 on a 10-cm scale) and any other adverse effect associated with the drug were evaluated.
Results
Mean duration of analgesia was significantly higher in the Ketoprofen group (20 h), compared to Diclofenac group (13 h) (p = 0.001). Rescue analgesia was required in 12% of subjects who received Diclofenac patch, compared to 4% in Ketoprofen group. None of the subjects showed any allergic reactions.
Conclusion
The study was designed to evaluate the efficacy of transdermal patch in reduction of post-operative pain in subjects undergoing bi-jaw surgeries. Subjects in both groups were comfortable and returned to early function. However, Ketoprofen transdermal patch had an edge over the Diclofenac transdermal patch with respect to analgesic efficacy.
http://ift.tt/2gyqCa6
Re: “Assessing the Detection of Middle East Respiratory Syndrome Coronavirus IgG in Suspected and Proven Cases of Middle East Respiratory Syndrome Coronavirus Infection” by Alhetheel et al. (Viral Immunol 2017 [Epub ahead of print]; DOI: 10.1089/vim.2017.0091)
Viral Immunology , Vol. 0, No. 0.
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Tribute to Professor Dr. Abdel Moniem Tewfik Hussein
Source:Arab Journal of Gastroenterology, Volume 18, Issue 3
Author(s): Sherif Mohamed Abdel Fattah
http://ift.tt/2i0nN1R
Editorial Board
Source:Arab Journal of Gastroenterology, Volume 18, Issue 3
http://ift.tt/2gzPLkT
Neuronal LRP4 regulates synapse formation in the developing CNS [RESEARCH ARTICLE]
Andromachi Karakatsani, Nicolas Marichal, Severino Urban, Georgios Kalamakis, Alexander Ghanem, Anna Schick, Yina Zhang, Karl-Klaus Conzelmann, Markus A. Rüegg, Benedikt Berninger, Carmen Ruiz de Almodovar, Sergio Gascon, and Stephan Kröger
http://ift.tt/2yK3u0M
The low-density lipoprotein receptor-related protein 4 (LRP4) is critical in muscle fibers for the establishment of the neuromuscular junction. Here, we show that LRP4 is also expressed by embryonic cortical and hippocampal neurons, and that downregulation of LRP4 in these neurons reduced density of synapses and number of primary dendrites. Accordingly, overexpression of LRP4 in cultured neurons had the opposite effect inducing more but shorter primary dendrites with an increased number of spines. Transsynaptic tracing mediated by rabies virus revealed a reduced number of neurons presynaptic to cortical neurons in which LRP4 was knocked down. Moreover, neuron-specific knock down of LRP4 by in utero electroporation of LRP4 miRNA in vivo also resulted in neurons with fewer primary dendrites and a lower density of spines in the developing cortex and hippocampus. Collectively, our results demonstrate an essential and novel role of neuronal LRP4 in dendritic development and synaptogenesis in the CNS.
http://ift.tt/2yK3u0M
Motor neurons with limb-innervating character in the cervical spinal cord are sculpted by apoptosis based on the Hox code in chick embryo [RESEARCH ARTICLE]
Katsuki Mukaigasa, Chie Sakuma, Tomoaki Okada, Shunsaku Homma, Takako Shimada, Keiji Nishiyama, Noboru Sato, and Hiroyuki Yaginuma
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In the developing chick embryo, a certain population of motor neurons (MNs) in the non-limb-innervating cervical spinal cord undergoes apoptosis between embryonic days 4 and 5. However, the characteristics of these apoptotic MNs remain undefined. Here, by examining the spatiotemporal profiles of apoptosis and MN subtype marker expression in normal or apoptosis-inhibited chick embryos, we found that this apoptotic population is distinguishable by Foxp1 expression. When apoptosis was inhibited, the survived Foxp1+ MNs showed characteristics of lateral motor column (LMC) neurons, which are of a limb-innervating subtype, suggesting that cervical Foxp1+ MNs are the rostral continuation of LMC. Knock-down and misexpression of Foxp1 did not affect apoptosis progression, but revealed the role of Foxp1 in conferring LMC identity on the cervical MNs. Furthermore, ectopic expression of Hox genes that are normally expressed in the brachial region prevented apoptosis, and directed Foxp1+ MNs to LMC neurons at the cervical level. These results indicate that apoptosis in the cervical spinal cord plays a role in sculpting Foxp1+ MNs committed to LMC neurons, depending on the Hox expression pattern.
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