Editorial Board

https://ift.tt/2pQESz8

Microanatomical Nerve Architecture of 6 Mammalian Species: Is Trans-Species Translational Anatomic Extrapolation Valid?

Background and Objectives Various animal models have historically been used to study iatrogenic nerve injury during performance of conduction nerve blocks. Our aims were to compare the microstructures of nerves in commonly used species to those of humans and to explore the validity of the extrapolating these findings to humans. Methods High-resolution, light-microscopic images were obtained from cross sections of sciatic nerves at their bifurcation from fresh rat, rabbit, pig, sheep, dog, and human cadavers. Various microanatomical characteristics were measured and compared between the species. P

https://ift.tt/2pSsIpB

Application of precision medicine to the treatment of anaphylaxis

Purpose of review Recognize the presentation of anaphylaxis for prompt management and treatment and to provide tools for the diagnosis of the underlying cause(s) and set up a long-term treatment to prevent recurrence of anaphylaxis. Recent findings The recent description of phenotypes provides new insight and understanding into the mechanisms and causes of anaphylaxis through a better understanding of endotypes and biomarkers for broad clinical use. Summary Anaphylaxis is the most severe hypersensitivity reaction and can lead to death. Epinephrine is the first-line treatment of anaphylaxis and it is life-saving. Patients with first-line therapy-induced anaphylaxis are candidates for desensitization to increase their quality of life and life expectancy. Desensitization is a breakthrough novel treatment for patients with anaphylaxis in need of first-line therapy, including chemotherapy, mAbs, aspirin and others. Ultrarush with venom immunotherapy should be considered in patients who present with life-threatening anaphylaxis after Hymenoptera sting with evidence of IgE-mediated mechanisms. Food desensitization is currently being expanded to provide increased safety to adults and children with food-induced anaphylaxis. Correspondence to Mariana Castells, MD, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, The Building for Transformative Medicine, 5th floor, Room 5002N, 60 Fenwood Road, Boston, MA 02115, USA. Tel: +1 617 525 1265; fax: +1 617 525 1310; e-mail: mcastells@bwh.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2J6qegf

Avenues for research in food allergy prevention: unheeded ideas from the epidemiology

No abstract available

https://ift.tt/2pShPUN

How to diagnose food allergy

Purpose of review To assess the recent studies that focus on specific immunoglobulin E (sIgE) testing and basophil activation test (BAT) for diagnosing IgE-mediated food allergies. Recent findings The sIgE to allergen extract or component can predict reactivity to food. The cutoff value based on the positive predictive value (PPV) of sIgE can be considered whenever deciding whether oral food challenge (OFC) is required to diagnose hen's egg, cow's milk, wheat, peanut, and cashew nut allergy. However, PPV varies depending on the patients' background, OFC methodology, challenge foods, and assay methodology. Component-resolved diagnostics (CRD) has been used for food allergy diagnosis. Ovomucoid and omega-5 gliadin are good diagnostic markers for heated egg and wheat allergy. More recently, CRD of peanut, tree nuts, and seed have been investigated. Ara h 2 showed the best diagnostic accuracy for peanut allergy; other storage proteins, such as Jug r 1 for walnut, Ana o 3 for cashew nut, Ses i 1 for sesame, and Fag e 3 for buckwheat, are also better markers than allergen extracts. Some studies suggested that BAT has superior specificity than skin prick test and sIgE testing. Summary The sIgE testing and BAT can improve diagnostic accuracy. CRD provides additional information that can help determine whether OFCs should be performed to diagnose food allergy. Correspondence to Sakura Sato, MD, Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan. Tel: +81 42 742 8311; fax: +81 42 742 5314; e-mail: s-satou@sagamihara-hosp.gr.jp Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2J5vOz7

How to predict and improve prognosis of food allergy

Purpose of review The prevalence of food allergy is increasing. More children are being diagnosed with food allergies, and it is taking longer to outgrow them, among those who develop tolerance. The aim of this review is to draw the profile of the persistent food allergic, so that prevention strategies can be developed and active treatment set up. Recent findings Many determinants are involved in food allergy prognosis: ethnicity and sex, type of food, innate immune system, eliciting dose, sensitization status and other biomarkers determination, gut microbiome composition, and the presence of comorbidities. Once identified, a persistent food allergy could be conveyed to active treatments, such as oral immunotherapy or the use of biologics, always taking into account their experimental nature. Summary A better understanding of prognostic factors and phenotypes of food allergy is crucial in decision-making when it comes to food allergy prevention and management. A good classification of the allergic patient allows to determine the degree of exclusion diets and the timing of the reintroduction of avoided food when possible. In the cases of persistent and severe food allergy, many promising interventions are emerging which could improve prognosis and quality of care. Correspondence to Lamia Dahdah, MD, University Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Piazza di Sant'Onofrio 4, Rome 00100, Vatican City, Italy. Tel: +39 046 6859 4777; fax: +39 046 6859 2020; e-mail: lamiaantanios.dahdah@opbg.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2pShNMF

Phenotypes/endotypes-driven treatment in asthma

Purpose of review Target therapy is the necessary step towards personalized medicine. The definition of asthma phenotypes and underlying mechanisms (endotypes) represent a key point in the development of new asthma treatments. Big data analysis, biomarker research and the availability of monoclonal antibodies, targeting specific cytokines is leading to the rapid evolution of knowledge. In this review, we sought to outline many of the recent advances in the field. Recent findings Several attempts have been made to identify asthma phenotypes, sometimes with contrasting results. More success has been obtained concerning the pathogenetic mechanism of specific asthma patterns with the consequent identification of biomarkers and development of effective ad hoc treatment. Summary We are in the middle of an extraordinary revolution of our mode of thinking about and approaching asthma. All the effort in the identification of clusters of patients with different disease clinical patterns, prognosis and response to treatment is closely linked to the identification of endotypes (Th2-low and Th2-high). This approach has allowed the development of the specific treatments (anti IgE, Anti IL5 and IL5R) that are now available and is leading to new ones. Correspondence to Angelica Tiotiu, MD, PhD, Pulmonology Department, CHRU Nancy, EA 3450 DevAH – Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, 9 Avenue de la Forêt de Haye, F- 54505 – Vandoeuvre-les-Nancy, France. Tel: +33 3 83 15 43 72; fax: +33 3 83 15 35 41; e-mail: a.tiotiu@chru-nancy.fr Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2J6hyq2

How to prevent food allergy during infancy: what has changed since 2013?

Purpose of review The purpose of this review is to summarize recent studies and emerging consensus guidelines regarding food allergy prevention in infants of the past 5 years. Recent findings Prior to 2013, the general consensus regarding prevention of food allergy in infants was to recommend delayed introduction or complete avoidance of commonly allergenic foods, such as milk, egg and peanut. However, in the past 5 years, several landmark studies have been conducted, particularly with peanut. The results of these studies have led to a paradigm shift from recommending delayed introduction to early introduction and frequent feeding of highly allergenic foods such as peanut, with hopes of achieving primary and secondary prevention of food allergy in infants. Summary Recent clinical trials have demonstrated that early introduction and frequent feeding, rather than delayed introduction or complete avoidance, of commonly allergenic foods plays a critical role in preventing food allergy in infants. More studies are required to risk-stratify infants by personal and family atopic history to tailor guidelines for groups with inherently different risks. The universal acceptance of the guidelines and their application outcome are still to be determined. Correspondence to Amal Assa'ad, MD, Professor of Pediatrics, Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Mail Location 2000, Cincinnati, OH 45229, USA. Tel: +1 513 636 6771; fax: +1 513 636 5835; e-mail: amal.assaad@cchmc.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2pShGRf

Current opinion in allergy and clinical immunology: a change in leadership

No abstract available

https://ift.tt/2J6WKi8

Point of Care Ultrasound in Trauma

Publication date: Available online 29 March 2018
Source:Seminars in Ultrasound, CT and MRI
Author(s): Timothy Gleeson, David Blehar
The use of point of care ultrasound (POCUS) in trauma is widespread. Focused Assessment with Sonography for Trauma (FAST) exam is a prototypical bedside exam used by the treating provider to quickly determine need for intervention and appropriate patient disposition. The role of bedside ultrasound in trauma, however, has expanded beyond the FAST exam. Advancements in diagnostics include contrast enhanced ultrasound (CEUS), thoracic, and musculoskeletal applications. Ultrasound is also an important tool for trauma providers for procedural guidance including vascular access and regional anesthesia. Its portability, affordability, and versatility have made ultrasound an invaluable tool in trauma management in resource-limited settings. In this review, we discuss these applications and the supporting evidence for POCUS in trauma.



https://ift.tt/2pPrzPm

Impairment of learning and memory performances induced by BPA: Evidences from the literature of a MoA mediated through an ED

Publication date: Available online 29 March 2018
Source:Molecular and Cellular Endocrinology
Author(s): Sakina Mhaouty-Kodja, Luc P. Belzunces, Marie-Chantal Canivenc, Henri Schroeder, Cécile Chevrier, Elodie Pasquier
Many rodent studies and a few non-human primate data report impairments of spatial and non-spatial memory induced by exposure to bisphenol A (BPA), which are associated with neural modifications, particularly in processes involved in synaptic plasticity. BPA-induced alterations involve disruption of the estrogenic pathway as established by reversal of BPA-induced effects with estrogenic receptor antagonist or by interference of BPA with administered estradiol in ovariectomised animals. Sex differences in hormonal impregnation during critical periods of development and their influence on maturation of learning and memory processes may explain the sexual dimorphism observed in BPA-induced effects in some studies. Altogether, these data highly support the plausibility that alteration of learning and memory and synaptic plasticity by BPA is essentially mediated by disturbance of the estrogenic pathways. As memory function in humans involves similar signaling pathways, this mode of action of BPA has the potential to alter human cognitive abilities.



https://ift.tt/2GDUwbv

A short synthesis of Dronedarone

Publication date: Available online 28 March 2018
Source:Bioorganic & Medicinal Chemistry
Author(s): Barbara Piotrkowska, Sven Nerdinger, Erwin Schreiner, Lovro Selič, Piotr P. Graczyk
A modification of the Nenitzescu reaction was used to obtain Dronedarone from quinonimine 15 and 1,3-diketone 18 (R=CH2CH2CH2NBu2) in a two-stage process in almost 55% overall yield. Our results represent significant improvement over other state-of-the-art methods as no extra steps for the decoration of the benzofuran core are required.

Graphical abstract

https://ift.tt/2J6OMp6

BRADYKININ-POTENTIATING PEPTIDE-10C, AN ARGININOSUCCINATE SYNTHETASE ACTIVATOR, PROTECTS AGAINST H2O2-INDUCED OXIDATIVE STRESS IN SH-SY5Y NEUROBLASTOMA CELLS

Publication date: Available online 29 March 2018
Source:Peptides
Author(s): Samyr Machado Querobino, César Augusto João Ribeiro, Carlos Alberto-Silva
Bradykinin-potentiating peptides (BPPs – 5a, 7a, 9a, 10c, 11e, and 12b) of Bothrops jararaca (Bj) were described as argininosuccinate synthase (AsS) activators, improving L-arginine availability. Agmatine and polyamines, which are L-arginine metabolism products, have neuroprotective properties. Here, we investigated the neuroprotective effects of low molecular mass fraction from Bj venom (LMMF) and two synthetic BPPs (BPP-10c, <ENWPHPQIPP; BPP-12b, <EWGRPPGPPIPP) in the SH-SY5Y cell line against H2O2-induced oxidative stress. The neuroprotective effects against H2O2-induced were analyzed by reactive oxygen species (ROS – DCFH) production; lipid peroxidation (TBARS); intracellular GSH; AsS, iNOS, and NF-kB expressions; nitrite levels (Griess); mitochondrial membrane potential (TMRM); and antioxidant activity (DPPH). Analysis of variance followed by Tukey's post hoc test were calculated for statistical comparisons. Pre-treatment with both BPPs significantly reduced cell death induced by H2O2, but BPP-10c showed higher protective capacity than BPP-12b. LMMF pretreatment was unable to prevent the reduction of cell viability caused by H2O2. The neuroprotective mechanism of BPP-10c against oxidative stress was investigated. BPP-10c reduced ROS generation and lipid peroxidation in relation to cells treated only with H2O2. BBP-10c increased AsS expression and was not neuroprotective in the presence of MDLA, a specific inhibitor of AsS. BPP-10c reduced iNOS expression and nitrate levels but decreased NF-kB expression. Furthermore, BPP-10c protected the mitochondrial membrane against oxidation. Overall, we demonstrated for the first time neuroprotective mechanisms of BPPs against oxidative stress, opening new perspectives to the study and application of these peptides for the treatment of neurodegenerative diseases.



https://ift.tt/2J4Z6Ox

Treatment of Radiation and Cisplatin Induced Toxicities With Tempol

Conditions:   Mucositis;   Nephrotoxicity;   Ototoxicity
Interventions:   Drug: Tempol;   Drug: Placebo Solution
Sponsors:   Matrix Biomed, Inc.;   University of Maryland
Not yet recruiting

https://ift.tt/2E58XA8

Postoperative aRCH With Cisplatin Versus aRCH With Cisplatin and Pembrolizumab in Locally Advanced Head and Neck Squamous Cell Carcinoma

Condition:   HNSCC
Interventions:   Drug: Pembrolizumab 25 MG/1 ML Intravenous Solution [KEYTRUDA];   Other: adjuvant radiochemotherapy
Sponsor:   University of Leipzig
Not yet recruiting

https://ift.tt/2GVMpVn

Evaluation of an Oral Care Programme for Head and Neck Cancer Patients

Condition:   Head and Neck Cancer
Intervention:   Procedure: Oral care programme
Sponsors:   Göteborg University;   Ryhov County Hospital;   FUTURUM, Academy of Health and Science;   Swedish Cancer Foundation
Recruiting

https://ift.tt/2GXCO0D

The Inclined Position in Case of Respiratory Discomfort in the One Year Less Infant : Study on the Profits and the Risks in the Home

Conditions:   Obstruction, Airway;   Sudden; Death, Infant
Intervention:   Other: Questionnaires
Sponsor:   Hospices Civils de Lyon
Not yet recruiting

https://ift.tt/2E3IToV

Effect of Epley, Semont Maneuvers and Brandt–Daroff Exercise on Quality of Life in Patients with Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo (PSCBPPV)

Abstract

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause in patients with vertigo (Pereira et al. in Braz J Otorhinolaryngol (Impr) 76(6):704–708, 2010; Dix and Hallpike in Ann Otol Rhinol Laryngol 6:987–1016, 1952). Posterior Semicircular Canal BPPV (PSCBPPV) has more incidence and prevalence then Lateral, and Anterior Semicircular Canal BPPV (Alghwiri et al. in Arch Phys Med Rehabil 93:1822–1831, 2012). Quality of life (QoL) is significantly impaired by vertigo (Sargent et al. in Otol Neurotol 22:205–209, 2001; World Health Organization in International classification of functioning, disability and health, World Health Organization, Geneva, 2001). To study the effect and compare Epley, Semont maneuvers and Brandt–Daroff Exercise on QoL in patients with PSCBPPV. 90 individuals with unilateral PSCBPPV were selected based on positive Dix–Hallpike test. 3 groups Epley, Semont, and Brandt–Daroff were formed and 30 individuals were selected in each group randomly. Dix–Hallpike test and Vestibular Activities and Participation (VAP) Scale based on International Classification of Functioning were administered before and after Epley, Semont maneuvers, and Brandt–Daroff Exercise to fulfill the aim. VAP Scale results revealed significant difference between pre and post treatment score in all 3 groups, suggestive of positive effect on QoL in patients with PSCBPPV. Improvements in VAP Score between 3 groups were compared and significant difference was observed. Dix–Hallpike test results revealed that 90, 73.33, and 50% patients improved in Epely, Semont, and Brandt–Daroff group respectively. Epely maneuver found to be the best choice and then Semont and Brandt–Daroff should be least preferred in treatment of patients with PSCBPPV.

https://ift.tt/2GCZ41Y

Treatment of Radiation and Cisplatin Induced Toxicities With Tempol

Conditions:   Mucositis;   Nephrotoxicity;   Ototoxicity
Interventions:   Drug: Tempol;   Drug: Placebo Solution
Sponsors:   Matrix Biomed, Inc.;   University of Maryland
Not yet recruiting

https://ift.tt/2E58XA8

Postoperative aRCH With Cisplatin Versus aRCH With Cisplatin and Pembrolizumab in Locally Advanced Head and Neck Squamous Cell Carcinoma

Condition:   HNSCC
Interventions:   Drug: Pembrolizumab 25 MG/1 ML Intravenous Solution [KEYTRUDA];   Other: adjuvant radiochemotherapy
Sponsor:   University of Leipzig
Not yet recruiting

https://ift.tt/2GVMpVn

Proton Beam Therapy in the Treatment of Esophageal Cancer

Conditions:   Esophagus Cancer;   Esophageal Cancer;   Cancer of the Esophagus
Interventions:   Radiation: Proton beam therapy;   Other: Patient-Reported Outcome Measures
Sponsor:   Washington University School of Medicine
Not yet recruiting

https://ift.tt/2uw4YNH

Evaluation of an Oral Care Programme for Head and Neck Cancer Patients

Condition:   Head and Neck Cancer
Intervention:   Procedure: Oral care programme
Sponsors:   Göteborg University;   Ryhov County Hospital;   FUTURUM, Academy of Health and Science;   Swedish Cancer Foundation
Recruiting

https://ift.tt/2GXCO0D

The Inclined Position in Case of Respiratory Discomfort in the One Year Less Infant : Study on the Profits and the Risks in the Home

Conditions:   Obstruction, Airway;   Sudden; Death, Infant
Intervention:   Other: Questionnaires
Sponsor:   Hospices Civils de Lyon
Not yet recruiting

https://ift.tt/2E3IToV

External beam radiation therapy to hepatocellular carcinoma involving inferior vena cava and/or right atrium: A meta-analysis and systemic review

Publication date: Available online 29 March 2018
Source:Radiotherapy and Oncology
Author(s): Chai Hong Rim, Chul Yong Kim, Dae Sik Yang, Won Sup Yoon
PurposeHepatocellular carcinoma (HCC) involving inferior vena cava (IVC) and/or right atrium (RA) is a very rare but serious disease. The objective of this meta-analysis was to assess efficacy and safety of external beam radiotherapy (EBRT) for HCC involving IVC and/or RA.Materials and methodsSystematic search of Pubmed, MEDLINE, EMBASE, and Cochrane library published was performed. Primary endpoints were 1-year overall survival (OS) rate and 2-year OS rates. Secondary endpoints were response rate, local control (LC) rate, and grade ≥3 toxicities. According to heterogeneity evaluated with Cochran Q test and I² statistics, meta-analysis was performed using either random or fixed model.ResultsA total of 8 studies and 9 cohorts were included, encompassing 164 patients. Pooled 1- and 2-year OS rates were 53.6% (95% CI: 45.7–61.3%) and 36.9% (95% CI: 27.2–42.4%), respectively. Pooled response rate and LC rate were 59.2% (95% CI: 39.0–76.7%) and 83.8% (95% CI: 78.8–97.1%), respectively. Only one study reported 2 grade ≥3 toxicities, an esophageal rupture and a pulmonary embolism cases. The overall rate of possible grade ≥3 complications was 1.2% (2 of 164).ConclusionsEBRT is a feasible and safe option to palliate HCC with IVC and/or RA invasion.



https://ift.tt/2E5OBqA

Influence of deformable image registration on 4D dose simulation for extracranial SBRT: A multi-registration framework study

Publication date: Available online 29 March 2018
Source:Radiotherapy and Oncology
Author(s): Nik Mogadas, Thilo Sothmann, Tobias Knopp, Tobias Gauer, Cordula Petersen, René Werner
Background and purposeTo evaluate the influence of deformable image registration approaches on correspondence model-based 4D dose simulation in extracranial SBRT by means of open source deformable image registration (DIR) frameworks.Material and methodsEstablished DIR algorithms of six different open source DIR frameworks were considered and registration accuracy evaluated using freely available 4D image data. Furthermore, correspondence models (regression-based correlation of external breathing signal measurements and internal structure motion field) were built and model accuracy evaluated. Finally, the DIR algorithms were applied for motion field estimation in radiotherapy planning 4D CT data of five lung and five liver lesion patients, correspondence model formation, and model-based 4D dose simulation. Deviations between the original, statically planned and the 4D-simulated VMAT dose distributions were analyzed and correlated to DIR accuracy differences.ResultsRegistration errors varied among the DIR approaches, with lower DIR accuracy translating into lower correspondence modeling accuracy. Yet, for lung metastases, indices of 4D-simulated dose distributions widely agreed, irrespective of DIR accuracy differences. In contrast, liver metastases 4D dose simulation results strongly vary for the different DIR approaches.ConclusionsEspecially in treatment areas with low image contrast (e.g. the liver), DIR-based 4D dose simulation results strongly depend on the applied DIR algorithm, drawing resulting dose simulations and indices questionable.



https://ift.tt/2GWyxu7

Radiotherapy quality assurance for the RTOG 0834/EORTC 26053-22054/NCIC CTG CEC.1/CATNON intergroup trial “concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic glioma”: Individual case review analysis

Publication date: Available online 29 March 2018
Source:Radiotherapy and Oncology
Author(s): André N. Abrunhosa-Branquinho, Raquel Bar-Deroma, Sandra Collette, Enrico Clementel, Yan Liu, Coen W. Hurkmans, Loïc Feuvret, Karen Van Beek, Martin van den Bent, Brigitta G. Baumert, Damien C. Weber
BackgroundThe EORTC phase III 26053-22054/ RTOG 0834/NCIC CTG CEC.1/CATNON intergroup trial was designed to evaluate the impact on concurrent and adjuvant temozolomide chemotherapy in newly diagnosed non-1p/19q deleted anaplastic gliomas. The primary endpoint was overall survival.We report the results of retrospective individual case reviews (ICRs) for the first patient randomized per institution to detect the compliance with the study protocol.Material and methodsSixty-nine institutions were required to submit the radiotherapy plan of their first randomized patient. Full digital datasets uploaded to the EORTC server were assessed by three independent and blinded reviewers through the EORTC radiotherapy quality assurance platform.ResultsSixty-two (90%) of sixty-nine ICRs were received and assessable. Of the 62 cases, 22 were evaluated as per protocol (35.5%), 11 as acceptable variation (17.7%) and 29 were classified as unacceptable variations (46.8%). Most common unacceptable variations were related to the PTV dose (n = 19, 31%) and delineation (n = 17, 27%) processes.ConclusionsThe ICR analysis showed a significant number of unacceptable variations with potential impact on tumor control and/or toxicity profile. Prospective ICRs are encouraged for future studies to prevent and correct protocol violations before start of treatment.



https://ift.tt/2E6QQd8

Economic data for particle therapy: Dealing with different needs in a heterogeneous landscape

Publication date: Available online 29 March 2018
Source:Radiotherapy and Oncology
Author(s): Yolande Lievens, Klaus Nagels
BackgroundIn the light of scarce resources to be allocated for cancer care and a steady stream of costly innovations in all modalities applied to treat cancer, particle therapy needs to demonstrate its cost-utility balance to allow its positioning in the context of competing modalities. In the continuous evolving particle therapy landscape, the timely availability of appropriate economic data is crucial.MethodsEconomic data collection and compilation for particle therapy needs to follow health economic standards. Costing related analyses particularly need attention as clinical outcome data follow international standards to provide comparability. Among others, perspective, time horizons and cost categories are critical.ResultsIn this report from the "Health Economics Work Package" of the European Particle Therapy Network, the approaches commonly applied in health economic assessments are described and tailored to the specific needs of particle therapy. Data collection for cost calculation, economic evaluation and budget impact analysis are discussed.ConclusionThe presented data are intended to serve as a guidance for economic data collection, bearing in mind that in each specific case, the heterogeneous requirements of national health systems will need to be considered and assessments adapted accordingly.



https://ift.tt/2H0xo53

Effect of Epley, Semont Maneuvers and Brandt–Daroff Exercise on Quality of Life in Patients with Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo (PSCBPPV)

Abstract

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause in patients with vertigo (Pereira et al. in Braz J Otorhinolaryngol (Impr) 76(6):704–708, 2010; Dix and Hallpike in Ann Otol Rhinol Laryngol 6:987–1016, 1952). Posterior Semicircular Canal BPPV (PSCBPPV) has more incidence and prevalence then Lateral, and Anterior Semicircular Canal BPPV (Alghwiri et al. in Arch Phys Med Rehabil 93:1822–1831, 2012). Quality of life (QoL) is significantly impaired by vertigo (Sargent et al. in Otol Neurotol 22:205–209, 2001; World Health Organization in International classification of functioning, disability and health, World Health Organization, Geneva, 2001). To study the effect and compare Epley, Semont maneuvers and Brandt–Daroff Exercise on QoL in patients with PSCBPPV. 90 individuals with unilateral PSCBPPV were selected based on positive Dix–Hallpike test. 3 groups Epley, Semont, and Brandt–Daroff were formed and 30 individuals were selected in each group randomly. Dix–Hallpike test and Vestibular Activities and Participation (VAP) Scale based on International Classification of Functioning were administered before and after Epley, Semont maneuvers, and Brandt–Daroff Exercise to fulfill the aim. VAP Scale results revealed significant difference between pre and post treatment score in all 3 groups, suggestive of positive effect on QoL in patients with PSCBPPV. Improvements in VAP Score between 3 groups were compared and significant difference was observed. Dix–Hallpike test results revealed that 90, 73.33, and 50% patients improved in Epely, Semont, and Brandt–Daroff group respectively. Epely maneuver found to be the best choice and then Semont and Brandt–Daroff should be least preferred in treatment of patients with PSCBPPV.

https://ift.tt/2GCZ41Y

Use of the Ion AmpliSeq Cancer Hotspot Panel in clinical molecular pathology laboratories for analysis of solid tumours: with emphasis on validation with relevant single molecular pathology tests and the Oncomine Focus Assay

Publication date: Available online 29 March 2018
Source:Pathology - Research and Practice
Author(s): Ahwon Lee, Sung-Hak Lee, Chan Kwon Jung, Gyungsin Park, Kyo Young Lee, Hyun Joo Choi, Ki Ouk Min, Tae Jung Kim, Eun Jung Lee, Youn Soo Lee
Targeted application of next-generation sequencing (NGS) technology allows detection of specific mutations that can provide treatment opportunities for cancer patients. We evaluated the applicability of the Ion AmpliSeq Cancer Hotspot Panel V2 (CHV2) using formalin-fixed, paraffin-embedded (FFPE) tissue of clinical specimens.Thirty-five FFPE tumour samples with known mutational status were collected from four different hospitals and sequenced with CHV2 using an Ion Chef System and Ion S5 XL system. Out of 35 cases, seven were sequenced with Oncomine focus Assay Panel for comparison. For the limit of detection test, we used an FFPE reference standard, a cell line that included an engineered 50% EGFR T790 M in an RKO cell line background. Coverage analysis results including number of mapped reads, on target percent, mean depth, and uniformity were not different according to hospitals. Sensitivity for mutation detection down to 3% was demonstrated. NGS results showed 100% concordance with the results from single molecular pathology tests Assay in 30 cases with 24 known positive mutations and 14 known negative mutations, and another NGS panel of the Oncomine focus in seven cases.The CHV2 NGS test for solid tumours using Ion chef system and S5 XL system in clinical molecular pathology laboratories for analysis of solid tumours could be routinely used and could replace some single molecular pathology tests after a stringent and thorough validation process.



https://ift.tt/2Icvuxt

Development of a plug-type IMS-MS instrument and its applications in resolving problems existing in in-situ detection of illicit drugs and explosives by IMS

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Zhenxia Du, Tangqiang Sun, Jianan Zhao, Di Wang, Zhongxia Zhang, Wenlian Yu
Ion mobility spectrometry (IMS) which acts as a rapid analysis technique is widely used in the field detection of illicit drugs and explosives. Due to limited separation abilities of the pint-sized IMS challenges and problems still exist regarding high false positive and false negative responses due to the interference of the matrix. In addition, the gas-phase ion chemistry and special phenomena in the IMS spectra, such one substance showing two peaks, were not identified unambiguously. In order to explain or resolve these questions, in this paper, an ion mobility spectrometry was coupled to a mass spectrometry (IMS-MS). A commercial IMS is embedded in a custom-built ion chamber shell was attached to the mass spectrometer. The faraday plate of IMS was fabricated with a hole for the ions to passing through to the mass spectrometer. The ion transmission efficiency of IMS-MS was optimized by optimizing the various parameters, especially the distance between the faraday plate and the cone of mass spectrum. This design keeps the integrity of the two original instruments and the mass spectrometry still works with multimode ionization source (i.e., IMS-MS, ESI-MS, APCI-MS modes). The illicit drugs and explosive samples were analyzed by the IMS-MS with ⁶³Ni source. The results showed that the IMS-MS is of high sensitivity. The ionization mechanism of the illicit drug and explosive samples with ⁶³Ni source were systematically studied. In addition, the interferent which interfered the detection of cocaine was identified as dibutyl phthalate (DBP) by this platform. The reason why the acetone solution of amphetamine showed two peaks was explained.

Graphical abstract

https://ift.tt/2E6mirT

Reliable determination of new lipid peroxidation compounds as potential early Alzheimer Disease biomarkers

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Ana García-Blanco, Carmen Peña-Bautista, Camille Oger, Claire Vigor, Jean-Marie Galano, Thierry Durand, Nuria Martín-Ibáñez, Miguel Baquero, Máximo Vento, Consuelo Cháfer-Pericás
Lipid peroxidation plays an important role in Alzheimer Disease, so corresponding metabolites found in urine samples could be potential biomarkers. The aim of this work is to develop a reliable ultra-performance liquid chromatography-tandem mass spectrometry analytical method to determine a new set of lipid peroxidation compounds in urine samples.Excellent sensitivity was achieved with limits of detection between 0.08 and 17 nmol L⁻¹, which renders this method suitable to monitor analytes concentrations in real samples. The method's precision was satisfactory with coefficients of variation around 5–17% (intra-day) and 8–19% (inter-day). The accuracy of the method was assessed by analysis of spiked urine samples obtaining recoveries between 70% and 120% for most of the analytes. The utility of the described method was tested by analyzing urine samples from patients early diagnosed with mild cognitive impairment or mild dementia Alzheimer Disease following the clinical standard criteria. As preliminary results, some analytes (17(RS)−10-epi-SC-Δ¹⁵−11-dihomo-IsoF, PGE2) and total parameters (Neuroprostanes, Isoprostanes, Isofurans) show differences between the control and the clinical groups. So, these analytes could be potential early Alzheimer Disease biomarkers assessing the patients' pro-oxidant condition.

Graphical abstract

https://ift.tt/2GWzbI3

Development of a new pH assisted homogeneous liquid-liquid microextraction by a solvent with switchable hydrophilicity: Application for GC-MS determination of methamphetamine

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Siamak Kiani Shahvandi, Mohammad Hossein Banitaba, Hamid Ahmar
In this study, a new method based on homogeneous liquid–phase microextraction was developed for the determination of methamphetamine (MA) in urine samples. Dipropylamine (DPA), as a solvent with switchable hydrophilicity, was used as the extraction solvent and can be miscible/immiscible based on variable pH values of the aqueous sample solution. The effects of operational extraction parameters such as DPA volume, temperature, the amount of added acid and base solutions, and NaCl content of the sample were investigated. Under optimal conditions the preconcentration factor, limit of detection and linearity of the method were achieved in the ranges of 98.8, 1.5 µgL⁻¹ and 5–1500 µgL⁻¹, respectively. Also, within-run precision, between-run precision and robustness of the method were investigated. Finally, the proposed method was successfully applied to the analysis of MA in urine sample.

Graphical abstract

https://ift.tt/2GX6fjg

Confinement of carbon dots localizing to the ultrathin layered double hydroxides toward simultaneous triple-mode bioimaging and photothermal therapy

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Yangziwan Weng, Shanyue Guan, Heng Lu, Xiangmin Meng, Abdessamad. Y. Kaassis, Xiaoxue Ren, Xiaozhong Qu, Chenghua Sun, Zheng Xie, Shuyun Zhou
It is a great challenge to develop multifunctional nanocarriers for cancer diagnosis and therapy. Herein, versatile CDs/ICG-uLDHs nanovehicles for triple-modal fluorescence/photoacoustic/two-photon bioimaging and effective photothermal therapy were prepared via a facile self-assembly of red emission carbon dots (CDs), indocyanine green (ICG) with the ultrathin layered double hydroxides (uLDHs). Due to the J-aggregates of ICG constructed in the self-assembly process, CDs/ICG-uLDHs was able to stabilize the photothermal agent ICG and enhanced its photothermal efficiency. Furthermore, the unique confinement effect of uLDHs has extended the fluorescence lifetime of CDs in favor of bioimaging. Considering the excellent in vitro and in vivo phototherapeutics and multimodal imaging effects, this work provides a promising platform for the construction of multifunctional theranostic nanocarrier system for the cancer treatment.

Graphical abstract

https://ift.tt/2GXYZ6U

Solid phase microextraction method using a novel polystyrene oleic acid imidazole polymer in micropipette tip of syringe system for speciation and determination of antimony in environmental and food samples

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Abdul Haleem Panhwar, Mustafa Tuzen, Baki Hazer, Tasneem Gul Kazi
A simple, rapid and sensitive solid phase microextraction method was used for the speciation of inorganic antimony (Sb) by using a novel synthesized polymeric material in micropipette tip of syringe system. In present methodology, the specie of Sb (III) made hydrophobic complex with diethyl dithiocarbamate (DDTC) at pH 5.5 and subsequently adsorbed on polystyrene oleic acid imidazole polymer (POIP), whereas Sb(V) did not made complex and adsorbed on the polymer, remained in aqueous solutions. The strategy of multivariate was carried out to screen out the different variables and assessed the optimum values of their experimental values for the extraction efficiency of analyte. Then the analyte was sorbed on the polymer in micropipette tip of syringe system was quantitatively eluted by different types of acids at different levels for 2–6 aspirating/dispensing cycles. The extracted Sb(III) ions with modifiers were directed into the graphite furnace atomic absorption spectrometry for analysis. The limit of detection (LOD), limit of quantification (LOQ) and preconcentration factor (PF) for Sb(III) was found to be 6 ng L⁻¹, 20 ng L⁻¹ and 100. The RSD value was found to be 4.2%. The standard addition method and certified reference materials were checked for accuracy and validity of method. The developed method was effectively applied for the determination of total and inorganic species of Sb(III) and Sb(V) in different types of water samples, whereas only total Sb was determined in acid digested soil, Tuna fish, rice, spinach, black tea, mixed fruit juice and ice tea samples.

Graphical abstract

https://ift.tt/2uwP8lJ

Molecularly imprinted polymer for determination of lumefantrine in human plasma through chemometric-assisted solid-phase extraction and liquid chromatography

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Pedro Henrique Reis da Silva, Melina Luiza Vieira Diniz, Gerson Antônio Pianetti, Isabela da Costa César, Maria Elisa Scarpelli Ribeiro e Silva, Roberto Fernando de Souza Freitas, Ricardo Geraldo de Sousa, Christian Fernandes
Lumefantrine is the first-choice treatment of Falciparum uncomplicated malaria. Recent findings of resistance to lumefantrine has brought attention for the importance of therapeutic monitoring, since exposure to subtherapeutic doses of antimalarials after administration is a major cause of selection of resistant parasites. Therefore, this study focused on the development of innovative, selective, less expensive and stable molecularly imprinted polymers (MIPs) for solid-phase extraction (SPE) of lumefantrine from human plasma to be used in drug monitoring. Polymers were synthesized by precipitation polymerization and chemometric tools (Box-Behnken design and surface response methodology) were employed for rational optimization of synthetic parameters. Optimum conditions were achieved with 2-vinylpyridine as monomer, ethylene glycol dimethacrylate as crosslinker and toluene as porogen, at molar ratio of 1:6:30 of template/monomer/crosslinker and azo-bisisobutyronitrile as initiator at 65 °C. The MIP obtained was characterized and exhibited high thermal stability, adequate surface morphology and porosity characteristics and high binding properties, with high affinity (adsorption capacity of 977.83 μg g⁻¹) and selectivity (imprinting factor of 2.44; and selectivity factor of 1.48 and selectivity constant of 1.44 compared with halofantrine). Doehlert matrix and fractional designs were satisfactorily used for development and optimization of a MISPE-HPLC-UV method for determination of lumefantrine. The method fulfilled all validation parameters, with recoveries ranging from 83.68% to 85.42%, and was applied for quantitation of the drug in plasma from two healthy volunteers, with results of 1407.89 and 1271.35 ng mL⁻¹, respectively. Therefore, the MISPE-HPLC-UV method optimized through chemometrics provided a rapid, highly selective, less expensive and reproducible approach for lumefantrine drug monitoring.

Graphical abstract

https://ift.tt/2E5QYK2

Cyanine-based NIR fluorescent probe for monitoring H2S and imaging in living cells and in vivo

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Jiacheng Xiong, Lili Xia, Qili Huang, Jinxin Huang, Yueqing Gu, Peng Wang
As a critical gaseous signaling molecule, H2S is involved in various biological processes. To deeper study the physiological and pathological roles of H2S, convenient and efficient detection techniques for endogenous H2S in vivo are still in urgent demand. Herein, we reported a new turn-on Near-infrared (NIR) fluorescence probe NIR-H2S based on thiolysis reactions for detection of H2S. The probe possessed many excellent properties including high sensitivity and selectivity, good cell-membrane permeability, and low cytotoxicity. In vitro, NIR-H2S showed a 58-fold fluorescence enhancement when reacted with H2S in a buffer and displayed a good linear relationship (r = 0.9925) in a rather wide concentration range of H2S (0–500 μM). Furthermore, NIR-H2S was successfully employed in monitoring endogenous H2S induced by D-Cys in living cancer cells and mice. These results indicated that NIR-H2S had great potentiality in detecting cellular H2S in living animals and being applied to cancer diagnosis.

Graphical abstract

https://ift.tt/2uBHeb0

Synthesis of a novel Au nanoparticles decorated Ni-MOF/Ni/NiO nanocomposite and electrocatalytic performance for the detection of glucose in human serum

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Jingyuan Chen, Qin Xu, Yun Shu, Xiaoya Hu
A nonenzymatic glucose electrochemical sensor was constructed based on Au nanoparticles (AuNPs) decorated Ni metal-organic-framework (MOF)/Ni/NiO nanocomposite. Ni-MOF/Ni/NiO nanocomposite was synthesized by one-step calcination of Ni-MOF. Then AuNPs were loaded onto the Ni-based nanocomposites' surface through electrostatic adsorption. Through characterization by transmission electron microscopy (TEM), high resolution TEM (HRTEM) and energy disperse spectroscopy (EDS) mapping, it is found that the AuNPs were well distributed on the surface of Ni-based nanocomposite. Cyclic voltammetric (CV) study showed the electrocatalytic activity of Au-Ni nanocomposite was highly improved after loading AuNPs onto it. Amperometric study demonstrated that the Au-Ni nanocomposites modified glassy carbon electrode (GCE) exhibited a high sensitivity of 2133.5 mA M⁻¹ cm⁻² and a wide linear range (0.4–900 μM) toward the oxidation of glucose with a detection limit as low as 0.1 μM. Moreover, the reproducibility, selectivity and stability of the sensor all exhibited outstanding performance. We applied the as-fabricated high performance sensor to measure the glucose levels in human serum and obtained satisfactory results. It is believed that AuNPs decorated Ni MOF/Ni/NiO nanocomposite provides a new platform for developing highly performance electrochemical sensors in practical applications.

Graphical abstract

https://ift.tt/2E6Bqp5

Silver nanoparticles-embedded nanopaper as a colorimetric chiral sensing platform

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Erhan Zor
Paper-based sensors open new avenue to produce simple, rapid, inexpensive and single-use analytical devices for a wide application fields involving medical diagnosis, food analysis and environmental monitoring. In this study, a new optical sensing platform for enantioselective recognition of chiral analytes was introduced by using in-situ synthesized silver nanoparticles-embedded transparent nanopaper. To this aim, nanopaper was obtained by environment-friendly approach using bacterial cellulose made of nanofibers and silver nanoparticles were embedded within nanopaper by an in-situ generation method. The chiral recognition capability of AgNPs was operated in both solution phase and nanopaper for the tested enantiomers. AgNPs showed a discriminative sensing response toward D-cysteine with a LOD value of 4.88 µM. The principle of optical sensing is the selective interaction of the inherently chiral AgNPs with enantiomers causing to aggregation of AgNPs to display a significant colour change from yellow to purple-brown in both aqueous phase and nanopaper. As for practical use, the obtained plasmonic nanopaper was punched into circular pieces and put on wax-printed PET film to produce disposable two-dimensional cuvette which could be inserted in an ordinary spectrophotometer. The enantiomeric percentage of D-cysteine was successfully determined by the fabricated nanopaper-based cuvettes.

Graphical abstract

https://ift.tt/2GWB2MW

Direct-immersion single-drop microextraction and in-drop stirring microextraction for the determination of nanomolar concentrations of lead using automated Lab-In-Syringe technique

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Ivana H. Šrámková, Burkhard Horstkotte, Kateřina Fikarová, Hana Sklenářová, Petr Solich
Two operational modes for Lab-In-Syringe automation of direct-immersion single-drop microextraction have been developed and critically compared using lead in drinking water as the model analyte. Dithizone was used in the presence of masking additives as a sensitive chromogenic complexing reagent. The analytical procedure was carried out inside the void of an automatic syringe pump. Normal pump orientation was used to study extraction in a floating drop of a toluene-hexanol mixture. Placing the syringe upside-down allowed the use of a denser-than-water drop of chloroform for the extraction. A magnetic stirring bar was placed inside the syringe for homogenous mixing of the aqueous phase and enabled in-drop stirring in the second configuration while resulting in enhanced extraction efficiency. The use of a syringe as the extraction chamber allowed drop confinement and support by gravitational differences in the syringe inlet. Keeping the stirring rates low, problems related to solvent dispersion such as droplet collection were avoided. With a drop volume of 60 µL, limits of detection of 75 nmol L⁻¹ and 23 nmol L⁻¹ were achieved for the floating drop extraction and the in-drop stirring approaches, respectively. Both methods were characterized by repeatability with RSD typically below 5%, quantitative analyte recoveries, and analyte selectivity achieved by interference masking. Operational differences were critically compared. The proposed methods permitted the routine determination of lead in drinking water to be achieved in less than 6 min.

Graphical abstract

https://ift.tt/2E6f1IC

Highly selective detection of p-nitrophenol using fluorescence assay based on boron, nitrogen co-doped carbon dots

Publication date: 1 July 2018
Source:Talanta, Volume 184
Author(s): Na Xiao, Shi Gang Liu, Shi Mo, Na Li, Yan Jun Ju, Yu Ling, Nian Bing Li, Hong Qun Luo
p-Nitrophenol (p-NP) contaminants seriously endanger environmental and living beings health, hence to establish a sensitive and selective method is of great importance for the determination of p-NP. In this work, boron and nitrogen co-doped carbon dots (B,N-CDs) were synthesized by one-step hydrothermal method using 3-aminophenylboronic acid as the sole precursor. The product was characterized through high-resolution transmission electron microscopy, fluorescence spectroscopy, UV–visible absorption spectroscopy, X-ray photoelectron spectroscopy, and Fourier transform infrared spectroscopy. Without any functionalized modification, B,N-CDs can be directly applied as a 'turn-off' fluorescent probe for rapid, highly selective, and sensitive detection of p-NP. The fluorescent sensor based on the B,N-CDs exhibited a broad linear response to the concentration of p-NP in the range of 0.5 − 60 μM and 60 − 200 μM, respectively, and provided a detection limit of 0.2 μM. It was found that only the absorption spectrum of p-NP has a wide overlap with the fluorescence excitation and emission spectra of B,N-CDs compared to those of other representative analogues. The response mechanism was due to the inner filter effect and the formation of dynamic covalent B-O bonds between B,N-CDs and p-NP, which endowed the sensing platform with the rapid response and high selectivity to p-NP. Finally, the sensor showed the practicability of p-NP determination in environmental water samples.

Graphical abstract

https://ift.tt/2GVIxUl

Cervical myelopathy after high-voltage electrical burn of the head: Report of an unusual case

Shri Ram Sharma, Masaraf Hussain, Hibo Hibong

Annals of Indian Academy of Neurology 2018 21(1):76-79

High-voltage electrical injuries are uncommonly reported and may predispose to both immediate and delayed neurologic complications. We present a case of 27-year-old male who experienced a high-voltage electrical burn of the head resulting in quadriparesis. High-voltage electrocution injuries are a serious problem with potential for immediate, delayed, and long-term neurologic sequelae. The existing literature regarding effective treatment of neurologic complications is limited. Multidisciplinary management and long-term follow up are required.

https://ift.tt/2J5JpXw

As I Sign in…

Vinay Goyal

Annals of Indian Academy of Neurology 2018 21(1):1-1



https://ift.tt/2J0OS1H

Preventing “neurophobia”: Remodeling neurology education for 21st-century medical students through effective pedagogical strategies for “neurophilia”

Bhaskara P Shelley, Thomas V Chacko, Balakrishnan R Nair

Annals of Indian Academy of Neurology 2018 21(1):9-18

Neurology has a reputation, particularly as a complex "head-to-toe" discipline for undergraduate medical students. Neurophobia syndrome, a global phenomenon, fundamentally stems from pedagogical deficiencies during the undergraduate curriculum, the lack of vertical integration between basic neurosciences and clinical bedside neurology, the lack of clinical reasoning exercises, cognitive heuristics, and clinical problem-solving, errors in diagnostic competence, and hyposkilia. This ultimately results in poor clinical competence and proficiency in clinical neurology and causes attrition in nurturing a passion for learning the neurology discipline. This article explores plausible factors that contribute to the genesis of neurophobia and multifaceted strategies to nurture interest in neurosciences and provide possible solutions to demystify neurology education, especially the need for evidence-based educational interventions. Remodeling neurology education through effective pedagogical strategies and remedial measures, and using the Miller's pyramid, would provide a framework for assessing clinical competence in clinical bedside neurology. Technology-enhanced education and digital classrooms would undoubtedly stamp out neurophobia in medical students of the 21st century. It will not frighten off another generation of nonneurologist physicians to empower them to hone expertise in order to tackle the increasing burden of neurological disorders in India. Furthermore, promoting neurophilia would facilitate the next generation of medical students in pursuing career options in neurology which would be quintessential not only in closing India's looming neurologist workforce gap but also in fostering interest in research imperatives in the next generation of medical students.

https://ift.tt/2pPRmqM

A viral polymyositis masquerade: Life-threatening case of juvenile dermatomyositis complicated by systemic capillary leak syndrome

Bhaskara P Shelley, Shrijeet Chakraborti

Annals of Indian Academy of Neurology 2018 21(1):70-74

This is a case report of an 8-year-old boy who developed an atypical, rare subphenotype of autoimmune inflammatory acute juvenile dermatomyositis (JDM), initially masquerading as viral polymyositis (PM)-like presentation, that was complicated by a hitherto unreported fulminant, life-threatening pediatric systemic capillary leak syndrome (SCLS). We highlight the close differential between viral PM and JDM, the baffling clinical syndromic constellation of hypotension with hemoconcentration – a "shock"-like syndrome, hypoalbuminemia without albuminuria, and generalized edema with the atypical JDM presentation, and stress crucial need to implement early aggressive, multipronged immunomodulatory treatment along with intensive fluid resuscitation which saved the life, this patient from a stormy, and turbulent 4-week clinical illness. This is the first published case description in the current literature of the association of an aggressive subphenotype of JDM and life-threatening pediatric SCLS. This report opens the Pandora's Box to explore the genetic and pathomechanisms of both disorders.

https://ift.tt/2J5Jyu2

Edgar adrian and patrick merton: Names blurred with the passage of time

Kalyan B Bhattacharyya

Annals of Indian Academy of Neurology 2018 21(1):19-23

Edgar Douglas Adrian and Patrick Anthony Merton are two supreme neurophysiologists from England in the last century whose names are almost forgotten these days. Adrian's work on all-or-none phenomenon in nerve and muscle excitability ushered in a new era and Merton's servo theory of muscular movement and muscle fatigue added a new dimension to the understanding of stretch reflex and deep tendon reflexes. Both of them trained and worked at Trinity College, Cambridge and both were elected as Fellow of the Royal Society and Adrian in addition, was awarded the Nobel Prize in 1932 along with Charles Scott Sherrington.

https://ift.tt/2pPcLQM

Cysts in White Matter: A Novel Neuroimaging Finding in Infantile GM1 Gangliosidosis

Mahesh Kamate

Annals of Indian Academy of Neurology 2018 21(1):82-83



https://ift.tt/2J6w5BV

Determinants of remission in medically treated carpal tunnel syndrome: Study from Central India

Ajoy Sodani, Raunak Dani, Mukesh Dube, Dinesh Choukesey, Sunil Athale

Annals of Indian Academy of Neurology 2018 21(1):29-34

Background: The factors associated with the spontaneous remission (SR) of symptoms in carpal tunnel syndrome (CTS) are not well known. Objectives: To look for determinants of SR in medically treated, electrophysiologically proven patients of CTS. Methods: We revisited the medical records and nerve conduction study data of 130 hands with CTS and divided them into two groups as per the absence or persistence of the symptoms when contacted after a median time lapse of 3 years following the diagnosis. Results: SR occurred in 46.1% of the hands. Higher odds of SR were linked with female gender, symptoms restriction to lateral fingers, symptom duration <10 months, mildly delayed median motor and sensory distal latencies, and median sensory amplitude >20 μV. We developed a seven-point scale, on which a score of ≥4 had a strong association (odds ratio 4.31) with SR. Discussion and Conclusion: No single risk factor, standalone, can predict SR in patients with CTS, which could lead to an invasive treatment (Surgery or local injection) to them. We propose that patients scoring ≥4 on our 7 point scale should be treated medically for the initial 10 months after the symptom onset.

https://ift.tt/2pQWif3

Value of motor nerve conduction studies in the diagnosis of idiopathic tarsal tunnel syndrome: A single-center prospective observational study from India

Ajoy Sodani, Mukesh Dube, Rahul Jain

Annals of Indian Academy of Neurology 2018 21(1):35-41

Background: Nerve conduction studies are considered to be the gold standard for diagnosing secondary tarsal tunnel syndrome (s TTS), but their utility in the diagnosis of idiopathic tarsal tunnel syndrome (i TTS) is largely unknown. Objective: We sought to investigate the value of motor nerve conductions studies (MNCS) in the diagnosis of clinically suspected i TTS. Materials and Methods: Twenty-six (52 limbs) adult patients of clinically suspected i TTS were subjected to motor nerve conductions of posterior tibial nerve, and its branches and motor conduction parameters were compared with those of 45 healthy controls. Results: Symptoms were bilateral in 70% (P = 0.02), with heel pain in 95% of symptomatic limbs. MNCS was abnormal in 32 (80%) of symptomatic limbs and 8 (66.6%) of asymptomatic limbs (P = 0.004). Out of electrophysiologically abnormal nerves (n = 67), the pathological process could be identified in all the nerves with abnormal MNCS (P = 0.02). Probable demyelination was seen in 58.2% of the electrophysiologically abnormal nerves. Discussion: The present study shows that i TTS are gender and Body Mass Index neutral with bilateral symptoms being common. Tinel's sign was inconsistent. Heel pain did not correlate with abnormal inferior calcaneal nerve conductions. Motor nerve conduction study was abnormal in a significant number of symptomatic limbs. "Probable demyelination" was more frequent in symptomatic limbs. Conclusion: MNCS is significantly abnormal in symptomatic limbs of subjects with i TTS. Demyelination is slightly more common than axonopathy in i TTS. With a sensitivity of 80% and specificity of 33.3%, MNCS seems to be useful as a screening tool in clinically suspected i TTS. This study is Level II: Lesser quality randomized controlled trial or prospective comparative study.

https://ift.tt/2pNxX9Y

The Spectrum of Autonomic Dysfunction in Myasthenic Crisis

Rohit Ninan Benjamin, Sanjith Aaron, Ajith Sivadasan, Suresh Devasahayam, Amalan Sebastin, Mathew Alexander

Annals of Indian Academy of Neurology 2018 21(1):42-48

Background: Autoimmune autonomic dysfunction is described in Myasthenia Gravis. In myasthenic crisis, the spectrum of autonomic dysfunction is hitherto uncharacterized. Objective: The objective of this study is to describe the spectrum of autonomic dysfunction in myasthenic crises using the composite autonomic symptom scale 31 (COMPASS 31) autonomic symptom questionnaire and power spectral analysis of heart rate variability (HRV), which is a simple way of estimating general autonomic dysfunction. Methods: Adult patients with myasthenic crisis from January 1, 2014 to March 15, 2015, were prospectively included in this study. The COMPASS 31 questionnaire for symptoms of autonomic dysfunction and power spectral analysis of HRV were assessed. These were compared with the patient's demographic and clinical parameters and with previous literature. IRB approval was obtained. Results: Sixteen patients were included (M:F 3:1). 15/16 patents (93%) had autonomic dysfunction on COMPASS 31 questionnaire. The domains of involvement were gastrointestinal (80%), orthostatic (67.7%), pupillomotor (67.7%); sudomotor (33.3%), and vasomotor (13.3%). Parasympathetic dysfunction predominance was suggested by the symptom profile. HRV analysis showed a low frequency (LF) spectral shift suggesting slowed parasympathetic responsiveness (LF normalized unit (nu): high frequency [HF] nu mean 8.35, standard deviation ± 5.4, 95% confidence interval 2.2–12.5), which significantly exceeded the mean LF nu: HF nu ratios of the majority of previously reported noncrises myasthenic populations. Conclusions: Myasthenic crisis has autonomic dysfunction involving multiple organ systems. Increased latency of parasympathetic reflexes is suggested. A comprehensive management protocol addressing different autonomic domains is required for holistic patient care.

https://ift.tt/2pVAfUL

Uncommon anatomical variant – Types artery of percheron infarcts: Clinical-radiological correlations

T Harisuthan, Anirudh Vilas Kulkarni, Gigy Varkey Kuruttukulam

Annals of Indian Academy of Neurology 2018 21(1):80-81



https://ift.tt/2J5lZBt

Pseudo-subarachnoid hemorrhage sign

Ramnath Santosh Ramanathan

Annals of Indian Academy of Neurology 2018 21(1):83-84



https://ift.tt/2J2rCjE

Phrenic nerve conduction study in the early stage of guillain–barre syndrome as a predictor of respiratory failure

Barun Kumar Sen, Alak Pandit

Annals of Indian Academy of Neurology 2018 21(1):57-61

Background: Guillain-Barré syndrome (GBS) has unpredictable clinical course with severe complication of respiratory failure. Objective: To identify clinical profiles and electrophysiological study particularly non-invasive Phrenic nerve conduction study in patients of early GBS to predict respiratory failure. Methods: 64 adult (age≥18yrs) patients of early GBS (onset ≤ 14 days) during the study period from January 2014 to October 2015 were evaluated by clinical profiles of age, gender, antecedent infection, time to peak disability, single breath counts, cranial nerve involvement, autonomic dysfunction and non-invasive Phrenic nerve conduction study. Patients with predisposition factors of polyneuropathy like diabetes mellitus, hypothyroidism, vitamin deficiency, renal failure were excluded. Results: Among 64 patients abnormal phrenic nerve conduction study was seen in 65.62% cases (42/64) and 45.23% (19/42) of them developed respiratory failure. Phrenic nerve sum latency, amplitude, duration and area were abnormal in those who developed respiratory failure and they had sum of phrenic nerve latency >28 msec, sum of CMAP amplitude <300 μV, sum of CMAP duration >50 msec and sum of area < 4 mVmS. None with normal phrenic nerve study developed respiratory failure. It was found that age, gender, preceding infection, autonomic involvement and types of GB syndrome had no influence on development of respiratory failure (p>0.05). Rapid disease progression to peak disability, more severe disease, shorter single breath counts and cranial nerve involvement were seen more often in patients with respiratory failure. Conclusion: Abnormal Phrenic nerve conduction study in the early Guillain-Barré syndrome might be of great value independently in predicting impending respiratory failure.

https://ift.tt/2pPBapF

The Kids Are Not Alright.

Author: Kennedy, Maureen Shawn MA, RN, FAAN

Page: 7

https://ift.tt/2J632i2

An Exodus of Bedside Nurses.

Author: Branthover, Jean BSN, RN

Page: 10

https://ift.tt/2pRnXwk

An Exodus of Bedside Nurses.

Author: W., Cynthia via Facebook

Page: 10

https://ift.tt/2J5Bp8T

An Exodus of Bedside Nurses.

Author: P., Jessi via Facebook

Page: 10

https://ift.tt/2pPAEYL

An Exodus of Bedside Nurses.

Author: R., Susan via Facebook

Page: 10

https://ift.tt/2J6YEiz

Short-Term Medical Missions: Toward an Ethical Approach.

Author: Matlick, Garrett Logan BSN, RN

Page: 11

https://ift.tt/2pRnHxm

HHS Division to Enforce 'Conscience and Religious Freedom'.

Author: Sofer, Dalia

Page: 12

https://ift.tt/2J6YwQ7

Mandatory Parental Counseling Reduces Vaccine Exemptions.

Author: Zolot, Joan PA

Page: 13

https://ift.tt/2pRnESc

NewsCAP: Updated guidelines for treating nausea and vomiting during pregnancy.

Author:

Page: 13

https://ift.tt/2pRI3qn

Among Other Industrialized Countries, the United States Has Highest Childhood Mortality Rate.

Author: Stockwell, Serena

Page: 14

https://ift.tt/2J7iwCa

NewsCAP: DEA gives NPs the authority to treat opioid use disorder.

Author:

Page: 14

https://ift.tt/2pT487V

Duration of Postoperative Opioid Use Predicts Misuse More Than Dosage.

Author: Mechcatie, Elizabeth MA, BSN

Page: 15

https://ift.tt/2J6ve4b

NewsCAP: On the horizon: a blood test for identifying solid organ tumors and their origin.

Author:

Page: 15

https://ift.tt/2pRHZqD

NewsCAP: The best age for one-time HIV screening is 25 years.

Author:

Page: 15

https://ift.tt/2J375M9

Hysterectomy Associated with Long-Term Health Risks.

Author: Potera, Carol

Page: 16

https://ift.tt/2pSc49B

The Value of Simulation in Nursing Education.

Author: Sofer, Dalia

Page: 17-18

https://ift.tt/2J2fj74

AJN On the Cover.

Author: Szulecki, Diane Editor

Page: 19

https://ift.tt/2pPAyQT

Toward universal influenza virus vaccines: from natural infection to vaccination strategy

Chen Zhao | Jianqing Xu

https://ift.tt/2GXlXLp

Particulate matter on two Prunus spp. decreases survival and performance of the folivorous beetle Gonioctena quinquepunctata

Abstract

Woody plants growing along streets and construction sites play an important role in removing harmful particulate matter (PM). Researchers rarely consider the impact of different types and size fractions of PM deposited on the leaves on insect folivores. We determined differences in the accumulation of cement and roadside PM on the leaves of two Prunus species (P. padus and P. serotina) with different leaf surface structures. We also determined the effect of PM on the beetle Gonioctena quinquepunctata, the main pest of these plants. Saplings were artificially dusted in greenhouses and leaves were utilised for larval and adult insect stages feeding in laboratory conditions. Road PM accumulated in greater amounts than did cement PM, regardless of plant species. For both PM sources, P. padus accumulated twofold more than did P. serotina. Insect survival was negatively affected by PM pollution; however, neither Prunus species nor PM source variant significantly affected masses of larvae and pupae, duration of larval and pupal development or relative growth rates. The experiment showed strong negative influences of PM were noted only for adult insects, due to the grazing period being longer than that in larvae. The mass of adult insects and the efficiency of conversion of ingested food (ECI) were lower for insects exposed to PM than those for control insects. Insects compensated for lower ECI by eating a greater total amount of food (TFE). Adult insects gained significantly higher mass when fed with P. serotina than with P. padus. The effect of PM on analysed plant metabolites was insignificant. Only Prunus sp. and date of collection affected the level of condensed tannins and total phenols. Our results indicate that, when investigating the effect of the host plant on folivore performance, the accumulation of PM, as well as its type and quantity, should be taken into account.

https://ift.tt/2GkUXEd

Cardiotoxic effects of chemotherapy: A review of both cytotoxic and molecular targeted oncology therapies and their effect on the cardiovascular system

Publication date: Available online 29 March 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Hani M Babiker, Ali McBride, Michael Newton, Leigh M. Boehmer, Adrienne Goeller Drucker, Mollie Gowan, Manouchkathe Cassagnol, Todd D. Camenisch, Faiz Anwer, James M. Hollands
Cardiotoxic effects of chemotherapy and targeted drugs are ubiquitous and challenging in the field of oncology therapeutics. The broad spectrum of toxicities ranging from ischemic, hypertensive, cardiomyopathic, and arrhythmic complications can present as a significant challenge for clinicians treating cancer patients. If early diagnosis and intervention of cardiotoxic complications is missed, this can lead to delay or abrogation of planned treatment, which can potentially culminate to significant morbidity due to not only the cardiotoxic complications but also the progression of cancer. Hence, full knowledge of cardiovascular complications of chemotherapeutic agents, essential diagnostics tests to order, and appropriate management is paramount to oncologist, oncology pharmacists, and scientific clinical investigators. The aforementioned is particularly true in the current oncology era of plenteous early clinical trials studying several pathway/molecular-targeting agents with an increased cardiotoxic potential and the rapid expedited approval of those drugs by the FDA. Herein, we present a review discussing cardiotoxic effects of drugs and guidelines for management of the toxicities to assist the medical field in general managing patients with cancer.



https://ift.tt/2E9vmfS

EpiTools, A software suite for presurgical brain mapping in epilepsy: Intracerebral EEG.

Publication date: Available online 29 March 2018
Source:Journal of Neuroscience Methods
Author(s): S. Medina Villalon, R. Paz, N. Roehri, S. Lagarde, F. Pizzo, B. Colombet, F. Bartolomei, R. Carron, C.-G. Bénar
BackgroundIn pharmacoresistant epilepsy, exploration with depth electrodes can be needed to precisely define the epileptogenic zone. Accurate location of these electrodes is thus essential for the interpretation of Stereotaxic EEG (SEEG) signals. As SEEG analysis increasingly relies on signal processing, it is crucial to make a link between these results and patient's anatomy.Our aims were thus to develop a suite of software tools, called "EpiTools", able to i) precisely and automatically localize the position of each SEEG contact and ii) display the results of signal analysis in each patient's anatomy.New MethodThe first tool, GARDEL (GUI for Automatic Registration and Depth Electrode Localization), is able to automatically localize SEEG contacts and to label each contact according to a pre-specified nomenclature (for instance that of FreeSurfer or MarsAtlas). The second tool, 3Dviewer, enables to visualize in the 3D anatomy of the patient the origin of signal processing results such as rate of biomarkers, connectivity graphs or Epileptogenicity Index.ResultsGARDEL was validated in 30 patients by clinicians and proved to be highly reliable to determine within the patient's individual anatomy the actual location of contacts.Comparison with Existing MethodsGARDEL is a fully automatic electrode localization tool needing limited user interaction (only for electrode naming or contact correction). The 3Dviewer is able to read signal processing results and to display them in link with patient's anatomy.ConclusionEpiTools can help speeding up the interpretation of SEEG data and improving its precision.



https://ift.tt/2pTaNPp

Genome Sequencing Analysis of Liver Cancer for Precision Medicine

Publication date: Available online 29 March 2018
Source:Seminars in Cancer Biology
Author(s): Hidewaki Nakagawa, Masashi Fujita, Akihiro Fujimoto
Liver cancer is the third leading cause of cancer-related death worldwide. Some thousands of liver cancer genome have been sequenced globally so far and most of driver genes/mutations with high frequency are established in liver cancer, including Wnt/β-catenin pathway, TP53/cell-cycle pathways, telomere maintenance, and chromatin regulators. HBV integration into cancer-related genes is also a driver event in hepatocarcinogenesis. These genes are affected by structural variants, copy-number alterations and virus integrations as well as point mutations. Etiological factors of liver cancer is most understood among common cancers, such as hepatitis, aflatoxin, alcohol, and metabolic diseases, and mutational signatures of liver cancer can provide evidence of the association between specific etiological factors and mutational signatures. Molecular classifications based on somatic mutations profiles, RNA expression profiles, and DNA methylation profiles are related with patient prognosis. For precision medicine, several actionable mutations with solid evidence such as targets of multi-kinase inhibitors is observed in liver cancer, but there is few molecular target therapy so far. It is possible that rare actionable mutations in liver cancer can guide other specific molecular therapy and immune therapy



https://ift.tt/2pQ6nK1

Optimization of photo-Fenton process for the treatment of prednisolone

Abstract

Prednisolone is a widely prescribed synthetic glucocorticoid and stated to be toxic to a number of non-target aquatic organisms. Its extensive consumption generates environmental concern due to its detection in wastewater samples at concentrations ranged from ng/L to μg/L that requests the application of suitable degradation processes. Regarding the actual treatment options, advanced oxidation processes (AOPs) are presented as a viable alternative. In this work, the comparison in terms of pollutant removal and energetic efficiencies, between different AOPs such as Fenton (F), photo-Fenton (UV/F), photolysis (UV), and hydrogen peroxide/photolysis (UV/H₂O₂), was carried out. Light diode emission (LED) was the selected source to provide the UV radiation. The UV/F process revealed the best performance, reaching high levels of both degradation and mineralization with low energy consumption. Its optimization was conducted and the operational parameters were iron and H₂O₂ concentrations and the working volume. Using the response surface methodology with the Box-Behnken design, the effect of independent variables and their interactions on the process response were effectively evaluated. Different responses were analyzed taking into account the prednisolone removal (TOC and drug abatements) and the energy consumptions associated. The obtained model showed an improvement of the UV/F process when treating smaller volumes and when adding high concentrations of H₂O₂ and Fe²⁺. The validation of this model was successfully carried out, having only 5% of discrepancy between the model and the experimental results. Finally, the performance of the process when having a real wastewater matrix was also tested, achieving complete mineralization and detoxification after 8 h. In addition, prednisolone degradation products were identified. Finally, the obtained low energy permitted to confirm the viability of the process.

https://ift.tt/2GF5DRr

Perfusión tejido-músculo evaluada mediante protocolo de un día de gammagrafía reposo-dipiramidol con 99mTc-MIBI en pacientes no diabéticos y diabéticos

Publication date: Available online 28 March 2018
Source:Revista Española de Medicina Nuclear e Imagen Molecular
Author(s): N. Manevska, S. Stojanoski, D. Pop Gjorceva, L. Todorovska, M. Vavlukis, V. Majstorov
ObjetivoDeterminar la reserva de perfusión en miembros inferiores utilizando el método de gammagrafía de perfusión (protocolo de un día) con ^99mTc-MIBI (reposo-dipiridamol) en la evaluación diagnóstica de la enfermedad arterial periférica (EAP) en pacientes con y sin diabetes mellitus (DM).Material y métodosRealizamos gammagrafía de perfusión tejido-músculo (TMPS) de miembros inferiores, mediante el protocolo de un día de reposo-dipiridamol con ^99mTc-MIBI en 24 pacientes, divididos en dos grupos, según la presencia de diabetes: pacientes con DM (Dp) 13/24 (54%), 2 varones y 9 mujeres, de edad 63±13 años, y pacientes sin DM (NDp) 11/24 (46%), 3 varones y 10 mujeres, de edad 61±14 años.ResultadosEn la fase dinámica del estudio en reposo, el tiempo de actividad máxima (Tmax), en la fase arterial temprana, de la región de la pantorrilla, estaba significativamente retrasado en Dp con respecto a NDp, con menor acumulación de radiotrazador en el 1^er minuto (85-87% en Dp vs. 89-90% en NDp, ns). 4/11 pacientes de NDp (36,4%) y 7/13 de Dp (53,8%) registraron un valor patológico del índice inter-extremidad de la pantorrilla en el estudio de estrés. La reserva de perfusión (RP) de los muslos (MI, MD) y las pantorrillas (PI, PD) calculada mediante la fórmula «(ROI estrés-ROI reposo) x 100%/ROI reposo», fue significativamente menor en Dp: MI: 28±19% vs. 43±24% en NDp, p<0,05; MD: 27±17% vs. 40±25% en NDp, p<0,05; PI: 22±15% vs. 36±15% en NDp, p<0,01; PD: 25±15% vs. 38±14% in NDp, p<0,01.ConclusiónEste protocolo de un día (reposo-dipiridamol con ^99mTc-MIBI) de gammagrafía de perfusión de miembros inferiores se considera un procedimiento útil para la valoración de los pacientes con EAP, especialmente en su forma asintomática. La TMPS de miembros inferiores en nuestro estudio indicó que la reserva de perfusión en pacientes con DM fue significativamente menor, en comparación con los pacientes sin diabetes.AimTo determine the perfusion reserve of the lower limbs using the method ^99mTc-MIBI (rest-dipyridamole) perfusion scintigraphy (one-day protocol) in the diagnostic evaluation of peripheral artery disease (PAD) in patients with and without diabetes mellitus (DM).Material and methodsWe performed tissue-muscle perfusion scintigraphy (TMPS) of the lower limbs, through one-day rest-dipyridamole protocol with ^99mTc-MIBI in 24 patients, divided in two groups according to the presence of diabetes – patients with DM (Dp) 13/24 (54%), 2 males and 9 female patients, age 63±13 years and patients without DM (NDp) 11/24 (46%), 3 males and 10 females, age 61±14 years.ResultsIn the dynamic phase of the rest study, the time of maximum activity (Tmax), in the early arterial phase, of the calf region was significantly prolonged in Dp compared to NDp, with lower accumulation of the radiotracer in the 1st minute (85%/87% in Dp vs. 89%/90% in NDp, ns). 4/11 of NDp (36.4%) and 7/13 of Dp (53.8%) registered pathological value of the inter-extremity index of the calves in the stress study. Perfusion reserve (PR) of the thighs (LT, RT) and calves (LC, RC) calculated with the formula "(ROI stress−ROI rest)×100%/ROI rest", was significantly lower in Dp: LT: 28±19% vs. 43±24% in NDp, p<0.05; RT: 27±17% vs. 40±25% in NDp, p<0.05; LC: 22±15% vs. 36±15% in NDp, p<0.01; RC: 25±15% vs. 38±14% in NDp, p<0.01.ConclusionThis one-day protocol (rest-dipyridamole with ^99mTc-MIBI) of perfusion scintigraphy of lower limbs is considered as a useful procedure in PAD assessment, especially the asymptomatic form. TMPS of the lower limbs in our study indicated that perfusion reserve in patients with DM was significantly lower, compared to the patients without diabetes.



https://ift.tt/2GjTKgx

99mTc-HMPAO SPECT cerebral en la monitorización de la terapia de vasculitis

Publication date: Available online 28 March 2018
Source:Revista Española de Medicina Nuclear e Imagen Molecular
Author(s): V. Frantellizzi, M. Morreale, M. Pontico, A. Francia, F.M. Drudi, A. Farcomeni, M. Liberatore
ObjetivoEl sistema nervioso central (SNC) puede estar afectado en una variedad de enfermedades inflamatorias de los vasos sanguíneos, generalmente conocidas como vasculitis. El diagnóstico clínico de dicha afectación en etapas tempranas es difícil, ya que un leve deterioro cognitivo puede ser el único síntoma. Se planteó la hipótesis de que la SPECT de perfusion cerebral podría mostrar la afectación del SNC y podría servir para controlar el curso de la enfermedad. El propósito de este estudio fue evaluar si y cuándo una mejora de la perfusión cerebral puede ser registrada por SPECT durante el seguimiento de estas enfermedades.Material y métodosDieciocho pacientes afectados por Lupus eritematoso sistémico (LES), 22 por vasculitis indiferenciada (VI), 5 por la enfermedad de Behcet (EB) y 5 por el síndrome de Sjogren Primario (SSp) se incluyeron en este estudio prospectivo. Se realizó una SPECT de perfusión cerebral con ^99mTc-HMPAO antes del tratamiento, y se repitió durante el seguimiento a diferentes intervalos de tiempo. El análisis de imagen se realizó en 10 áreas cerebrales utilizando un software específico.ResultadosEn los pacientes con LES no se encontró una mejora significativa de la perfusión cerebral. Por el contrario, en la VI la captación cerebral del trazador comenzó a mejorar significativamente desde el vigésimo cuarto mes (18/22 pacientes). Los pacientes con EB mostraron una mejora de los hallazgos gammagráficos (5/5 pacientes), mientras que sólo se obtuvo un resultado similar en dos de los pacientes con SSp.ConclusionesEn conclusión, el SPECT cerebral parece ser capaz de monitorizar la enfermedad en VI, evaluando cuándo se puede registrar una mejoría de la perfusión cerebral. En los pacientes con LES, esta técnica gammagráfica no ha encontrado una mejoría significativa en la perfusión del SNC.ObjectiveThe central nervous system (CNS) may be involved in a variety of inflammatory diseases of the blood vessels, generally known as vasculitis. The clinical diagnosis of such involvement in early stages is difficult, since a mild cognitive impairment can be the only symptom. It was hypothesized that brain-perfusion SPECT would be able to reveal CNS involvement and to monitor the course of the disease. The purpose of this study was assess if and when an improvement of cerebral perfusion can be registered by SPECT during the follow-up of these diseases.Material and methodsEighteen patients affected by Systemic Lupus Erythematosus (SLE), 22 by undifferentiated vasculitis (UV), 5 by Behcet's disease (BD) and 5 by primary Sjogren's Syndrome (pSS) were enrolled in this prospective study. A ^99mTc-HMPAO brain perfusion SPECT was performed before the treatment and was repeated during the follow-up at different time intervals. Image analysis was performed on 10 cerebral areas using a specific software.ResultsIn the SLE patients, no significant improvement of brain perfusion was found. On the contrary, in the UV the cerebral uptake of the tracer significantly improved from the twenty-fourth month (18/22 patients). Patients with BD showed an improvement of scintigraphic findings (5/5 patients), while a similar result was obtained only in 2 of the patients with pSS.ConclusionsIn conclusion, brain SPECT seems to be able to monitor the disease in UV, indicating the moment when an improvement of the cerebral perfusion is achieved. In SLE patients this scintigraphic technique did not show a significant improvement in CNS perfusion.



https://ift.tt/2GFHLNK

Spectral fitting approach for the determination of enrichment and contamination factors in mining sediments using laser-induced breakdown spectroscopy

Abstract

Monitoring of pollution index values in sediments is crucial in assessing the environmental impacts of toxic metals in a given location. These indices are typically acquired using elaborate and tedious calibration curve-dependent techniques such as (inductively coupled plasma – optical emission spectroscopy) ICP-OES and (atomic absorption spectroscopy) AAS. In this study, laser-induced breakdown spectroscopy (LIBS) was used as a simple and fast alternative method for estimating enrichment factor (EF) and contamination factor (CF) of the sediment samples obtained from selected mining sites. Quantitative analyses of three metal targets (Cd, Pb, and Zn) were done using a calibration-free LIBS method based on the Boltzmann population distribution. Both the EF and CF values calculated from classical ICP-OES method provided significantly high correspondence with the respective EF (R² = 0.8862–0.9770, p < 0.01–0.05) and CF (R² = 0.9454–0.9714, p < 0.01) obtained from the developed LIBS method. The intensity-based LIBS approach identified samples AC2 and CCC as the ones with the highest and lowest pollution index values, respectively. The same observation was seen using the concentration-based ICP-OES technique which showed good correlation between the two methods. The correlation results showed the potential of the curve-fitting LIBS analysis in evaluating the level of metal contamination in an area without the preparation of matrix-matched calibration curves.

https://ift.tt/2uvOwwL

A comparative evaluation of spectrophotometric intracutaneous analysis and laser doppler imaging in the assessment of adult and paediatric burn injuries

Clinical assessment of mid dermal burns can be challenging. Currently, Laser Doppler Imaging is the gold standard adjunct in the assessment of burn injuries. Whilst Laser Doppler Imaging has demonstrated reliable accuracy, it poses various limitations in everyday use including cost and ease of use. In comparison, Spectrophotometric Intracutaneous Analysis is a relatively cheaper technique which can be carried out using a modified digital camera which enables easy image acquisition. We aim to compare the accuracy of the two modalities in the assessment of mid-dermal burn injuries.

https://ift.tt/2GjoL8r

Tissue expansion in cranioplasty - a collaborative approach for all involved for improved outcomes?

The use of tissue expanders is well established in plastic surgery. However, there are currently no clear indications for tissue expansion as an adjunct to cranioplasty. We present a series of nine patients who underwent tissue expansion prior to cranioplasty after removal of an infected bone flap and/or radiotherapy. Family members of 8 patients were taught how to undertake expansion at home. Two patients experienced exposure and infection of the expander. Post-operatively two patients developed an infection of their cranioplasty implant which was removed.

https://ift.tt/2uvOd55

Butterfly cartilage tympanoplasty outcomes: A single-institution experience and literature review

In 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort.

https://ift.tt/2GmYL81

Tube patency: Is there a difference following otic drop administration?

Many surgeons instill peri-operative otic drops to maintain tube patency. A post-hoc analysis of three randomized, controlled studies involving a one-time administration of ciprofloxacin (OTO-201) given instead of otic drops perioperatively was conducted to evaluate tube patency in patients who did and did not receive otic drops as defined within the study protocol.

https://ift.tt/2GEXrRb

Editorial Board and Contents

Publication date: April 2018
Source:Trends in Immunology, Volume 39, Issue 4





http://bit.ly/2E4ygSU

Differential diagnoses of diaper dermatitis

Pediatric Dermatology, Volume 35, Issue S1, Page s10-s18, March/April 2018.


http://bit.ly/2GW2avw

Prevention and treatment of diaper dermatitis

Pediatric Dermatology, Volume 35, Issue S1, Page s19-s23, March/April 2018.


http://bit.ly/2E5eAy4

Issue Information ‐ Editorial Board

Pediatric Dermatology, Volume 35, Issue S1, Page s1-s1, March/April 2018.


http://bit.ly/2GUMKrE

Skin barrier in the neonate

Pediatric Dermatology, Volume 35, Issue S1, Page s5-s9, March/April 2018.


http://bit.ly/2uBoeJk

Subclassification of Bethesda Atypical and Follicular Neoplasm Categories According to Nuclear and Architectural Atypia Improves Discrimination of Thyroid Malignancy Risk

Thyroid, Ahead of Print.


http://bit.ly/2GZQGaJ

Neutrophils and redox stress in the pathogenesis of autoimmune disease

Publication date: Available online 29 March 2018
Source:Free Radical Biology and Medicine
Author(s): Laurence Glennon-Alty, Angela P Hackett, Elinor A Chapman, Helen L Wright
Polymorphonuclear leukocytes, or neutrophils, are specialist phagocytic cells of the innate immune system. Their primary role is host defence against micro-organisms, which they kill via phagocytosis, followed by release of reactive oxygen species (ROS) and proteolytic enzymes within the phagosome. ROS are generated via the action of the NADPH oxidase (also known as NOX2), in a process termed the 'Respiratory Burst'. This process consumes large amounts of oxygen, which is converted into the highly-reactive superoxide radical O2^- and H2O2. Subsequent activation of myeloperoxidase (MPO) generates secondary oxidants and chloroamines that are highly microbiocidal in nature, which together with proteases such as elastase and gelatinase provide a toxic intra-phagosomal environment able to kill a broad range of micro-organisms. However, under certain circumstances such as during an auto-immune response, neutrophils can be triggered to release ROS and proteases extracellularly causing damage to host tissues, modification of host proteins, lipids and DNA and dysregulation of oxidative homeostasis. This review describes the range of ROS species produced by human neutrophils with a focus on the implications of neutrophil redox products in autoimmune inflammation.

Graphical abstract

http://bit.ly/2GmGfwG

Redox regulation of cell proliferation: Bioinformatics and redox proteomics approaches to identify redox-sensitive cell cycle regulators

Publication date: Available online 29 March 2018
Source:Free Radical Biology and Medicine
Author(s): Christine H. Foyer, Michael Wilson, Megan Wright
Plant stem cells are the foundation of plant growth and development. The balance of quiescence and division is highly regulated, while ensuring that proliferating cells are protected from the adverse effects of environment fluctuations that may damage the genome. Redox regulation is important in both the activation of proliferation and arrest of the cell cycle upon perception of environmental stress. Within this context, reactive oxygen species serve as 'pro-life' signals with positive roles in the regulation of the cell cycle and survival. However, very little is known about the metabolic mechanisms and redox-sensitive proteins that influence cell cycle progression. We have identified cysteine residues on known cell cycle regulators in Arabidopsis that are potentially accessible, and could play a role in redox regulation, based on secondary structure and solvent accessibility likelihoods for each protein. We propose that redox regulation may function alongside other known posttranslational modifications to control the functions of core cell cycle regulators such as the retinoblastoma protein. Since our current understanding of how redox regulation is involved in cell cycle control is hindered by a lack of knowledge regarding both which residues are important and how modification of those residues alters protein function, we discuss how critical redox modifications can be mapped at the molecular level.

Graphical abstract

http://bit.ly/2GD0Qjv

Attenuation of TNF-induced neutrophil adhesion by simvastatin is associated with the inhibition of Rho-GTPase activity, p50 activity and morphological changes

Publication date: May 2018
Source:International Immunopharmacology, Volume 58
Author(s): Angélica Aparecida Antoniellis Silveira, Venina Marcela Dominical, Daiana Morelli Vital, Wilson Alves Ferreira, Fabio Trindade Maranhão Costa, Claudio C. Werneck, Fernando Ferreira Costa, Nicola Conran
Neutrophil adhesion to the vasculature in response to potent inflammatory stimuli, such as TNF-α (TNF), can contribute to atheroprogression amongst other pathophysiological mechanisms. Previous studies have shown that simvastatin, a statin with known pleiotropic anti-inflammatory properties, can partially abrogate the effects of TNF-induced neutrophil adhesion, in association with the modulation of β2-integrin expression. We aimed to further characterize the effects of this statin on neutrophil and leukocyte adhesive mechanisms in vitro and in vivo. A microfluidic assay confirmed the ability of simvastatin to inhibit TNF-induced human neutrophil adhesion to fibronectin ligand under conditions of shear stress, while intravital imaging microscopy demonstrated an abrogation of leukocyte recruitment by simvastatin in the microvasculature of mice that had received a TNF stimulus. This inhibition of neutrophil adhesion was accompanied by the inhibition of TNF-induced RhoA activity in human neutrophils, and alterations in cell morphology and β2-integrin activity. Additionally, TNF augmented the activity of the p50 NFκB subunit in human neutrophils and TNF-induced neutrophil adhesion and β2-integrin activity could be abolished using pharmacological inhibitors of NFκB translocation, BAY11-7082 and SC514. Accordingly, the TNF-induced elevation of neutrophil p50 activity was abolished by simvastatin. In conclusion, our data provide further evidence of the ability of simvastatin to inhibit neutrophil adhesive interactions in response to inflammatory stimuli, both in vivo and in vitro. Simvastatin appears to inhibit neutrophil adhesion by interfering in TNF-induced cytoskeletal rearrangements, in association with the inhibition of Rho A activity, NFκB translocation and, consequently, β2-integrin activity.



http://bit.ly/2J4bqyx

Tube patency: Is there a difference following otic drop administration?

Publication date: Available online 29 March 2018
Source:American Journal of Otolaryngology
Author(s): Joseph E. Dohar, Chung H. Lu
PurposeMany surgeons instill peri-operative otic drops to maintain tube patency. A post-hoc analysis of three randomized, controlled studies involving a one-time administration of ciprofloxacin (OTO-201) given instead of otic drops perioperatively was conducted to evaluate tube patency in patients who did and did not receive otic drops as defined within the study protocol.Materials and methodsPost-hoc, retrospective analysis from three prospective, randomized, double-blind trials, (Phase 1b study [n = 83] and two Phase 3 studies [n = 532]) which enrolled children with confirmed middle ear effusion on the day of tympanostomy tube surgery and then randomized to placebo/sham (tubes alone) or OTO-201 and studied over a 28-day observation period. Patients with observed otorrhea post-tube were provided otic drops in the studies. An analysis was performed on the combined studies to evaluate tube patency, determined by pneumatic otoscopy and tympanometry, at four defined study visits over 28 days after the initial tube placement.ResultsThe analysis included 591 total patients with similar baseline demographics across groups. Tube patency ranged from 87 to 95% for patients who received otic drops, and from 96 to 99% for patients who did not receive otic drops.ConclusionBased on a retrospective post-hoc analysis from three randomized controlled trials in nearly 600 patients, tympanostomy tube occlusion rates was not increased in patients who did not receive otic drops. From this analysis, occlusion is likely caused primarily by peri-operative otorrhea since patency rates approached 99% in the absence of this complication.



https://ift.tt/2pQJRjd

Editorial Board

Publication date: April 2018
Source:Autoimmunity Reviews, Volume 17, Issue 4





https://ift.tt/2If8X3b

Editorial Board

Publication date: April 2018
Source:Autoimmunity Reviews, Volume 17, Issue 4





https://ift.tt/2If8X3b

Anesthetics Influence Mortality in a Drosophila Model of Blunt Trauma With Traumatic Brain Injury

Background: Exposure to anesthetics is common in the majority of early survivors of life-threatening injuries. Whether and to what degree general anesthetics influence outcomes from major trauma is unknown. Potential confounding effects of general anesthetics on outcome measures are usually disregarded. We hypothesized that exposure to isoflurane or sevoflurane modulates the outcome from blunt trauma with traumatic brain injury (bTBI). Methods: We tested the hypothesis in a novel model of bTBI implemented in Drosophila melanogaster. Fruit flies of the standard laboratory strain w1118 were cultured under standard conditions. We titrated the severity of bTBI to a mortality index at 24 hours (MI24) of approximately 20% under control conditions. We administered standard doses of isoflurane and sevoflurane before, before and during, or after bTBI and measured the resulting MI24. We report the MI24 as mean ± standard deviation. Results: Isoflurane or sevoflurane administered for 2 hours before bTBI reduced the MI24 from 22.3 ± 2.6 to 10.4 ± 1.8 (P

https://ift.tt/2GET7S8

Database Quality and Access Issues Relevant to Research Using Anesthesia Information Management System Data

For this special article, we reviewed the computer code, used to extract the data, and the text of all 47 studies published between January 2006 and August 2017 using anesthesia information management system (AIMS) data from Thomas Jefferson University Hospital (TJUH). Data from this institution were used in the largest number (P = .0007) of papers describing the use of AIMS published in this time frame. The AIMS was replaced in April 2017, making this finite sample finite. The objective of the current article was to identify factors that made TJUH successful in publishing anesthesia informatics studies. We examined the structured query language used for each study to examine the extent to which databases outside of the AIMS were used. We examined data quality from the perspectives of completeness, correctness, concordance, plausibility, and currency. Our results were that most could not have been completed without external database sources (36/47, 76.6%; P = .0003 compared with 50%). The operating room management system was linked to the AIMS and was used significantly more frequently (26/36, 72%) than other external sources. Access to these external data sources was provided, allowing exploration of data quality. The TJUH AIMS used high-resolution timestamps (to the nearest 3 milliseconds) and created audit tables to track changes to clinical documentation. Automatic data were recorded at 1-minute intervals and were not editable; data cleaning occurred during analysis. Few paired events with an expected order were out of sequence. Although most data elements were of high quality, there were notable exceptions, such as frequent missing values for estimated blood loss, height, and weight. Some values were duplicated with different units, and others were stored in varying locations. Our conclusions are that linking the TJUH AIMS to the operating room management system was a critical step in enabling publication of multiple studies using AIMS data. Access to this and other external databases by analysts with a high degree of anesthesia domain knowledge was necessary to be able to assess the quality of the AIMS data and ensure that the data pulled for studies were appropriate. For anesthesia departments seeking to increase their academic productivity using their AIMS as a data source, our experiences may provide helpful guidance. Accepted for publication January 29, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Data from this study were presented, in part, at the 2017 Annual Meeting of the American Society of Anesthesiologists, October 21–25, 2017, Boston, MA. Reprints will not be available from the authors. Address correspondence to Richard H. Epstein, MD, Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, 1400 NW 12th Ave, Suite 3075, Miami, FL 33136. Address e-mail to repstein@med.miami.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2E5a42I