Head and Neck Diseases by Alexandros G.Sfakianakis: 04/26/18

Πέμπτη 26 Απριλίου 2018

Biochemical responses of the Protaetia brevitarsis Lewis larvae to subchronic copper exposure

Abstract

Copper (Cu) is one of the most commonly detected heavy metals in livestock manure pollution. Protaetia brevitarsis Lewis larvae are widely used in the decomposition of livestock manure. During decomposition, heavy metals in livestock manure can accumulate in P. brevitarsis larvae and affect normal growth and reproduction. Therefore, this research focused on characterizing the toxic effects of Cu to P. brevitarsis Lewis larvae. Larvae were exposed to Cu concentrations of 0, 100, 200, 400, and 800 mg kg⁻¹ in edible fungi residue for 7, 14, 21, and 28 days. Results showed that the soluble protein content was markedly increased in 200 and 400 mg kg⁻¹ treatment groups on day 28. Compared to the control group, superoxide dismutase (SOD) and glutathione S-transferase (GST) activities were significantly stimulated on day 7 and then decreased as exposure length was increased (e.g., after 14, 21, and 28 days). Catalase (CAT) activity was also significantly increased after 7 days of exposure. Malondialdehyde (MDA) levels were markedly increased in the 100, 200, and 400 mg kg⁻¹ treatment groups on day 7. However, as time and Cu concentration were increased, MDA levels gradually decreased. These results indicate that Cu has biochemical effects on P. brevitarsis Lewis larvae, and both time and dose affect this biochemical response.

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American Thyroid Association Guidelines and Statements: Past, Present, and Future

Thyroid, Ahead of Print.

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Over- and Under-Treatment of Hypothyroidism Is Associated with Excess Mortality: A Register-Based Cohort Study

Thyroid, Ahead of Print.

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Synthesis of In2Se3 homojunction photocatalyst with α and γ phases for efficient photocatalytic performance

Publication date: 5 August 2018
Source:Materials & Design, Volume 151
Author(s): Ruimiao Wang, Jun Wan, Jia Jia, Wenhua Xue, Xiaoyun Hu, Enzhou Liu, Jun Fan
Herein, novel γ-In2Se3 nanoparticle/α-In2Se3 nanosheet (In2Se3 NPS) homojunctions were constructed by a facile solvothermal method and applied to photocatalytic H2 production from water splitting and removel of Cr(VI) pollutant for the first time. The photocatalytic H2 evolution rate and Cr(VI) removal rate can reach 1347.6 μmol/(g·h) and 94.9% in 10 min without any co-catalyst over optimal In2Se3 NPS, which is 4.34 and 4.12 times higher than that of pure γ-phase In2Se3 nanoparticles. The characterizations of valence band X-ray photoelectron spectroscopy and Mott-Schottky measurement prove that the In2Se3 NPS homojunction establishes a staggered band alignment to promote the separation and transfer of photogenerated charge carriers. Meanwhile, the hybrid nanoparticle/ nanosheet structure with appropriate proportion, uniform distribution and intimate contact can boost the light trapping and provide more electron trapping sites, resulting in active photocatalytic performance. This work not only enrich In2Se3-based semiconductor nanomaterials with a simple synthetic route, but also provide a new sight in design homojunction for efficient photocatalytic applications.

Graphical abstract

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Stress induced martensite variants revealed by in situ high resolution electron backscatter diffraction (HR-EBSD)

Publication date: 5 August 2018
Source:Materials & Design, Volume 151
Author(s): A. Arabi-Hashemi, Y. Guo, J. Michler, D. Casari, C. Leinenbach, X. Maeder
In situ HR-EBSD during FeMnSi-based micro-pillar compression is used to correlate phase transformations and its underlying stresses. A simple experimental configuration containing two grains, one grain boundary and a uniaxial compression causes complex stress fields. Two out of three differently orientated stress induced martensite variants are expected to form due to high Schmid factors. To reveal the origin of growth of the third variant with a low Schmid factor, we calculate global stress maps and local resolved shear stress maps based on HR-EBSD measurements. Localized shear stresses at the grain boundary are identified to cause the growth of the not expected near grain boundary variant.

Graphical abstract

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3D-printed biodegradable gyroid scaffolds for tissue engineering applications

Publication date: 5 August 2018
Source:Materials & Design, Volume 151
Author(s): Loïc Germain, Carlos A. Fuentes, Aart W. van Vuure, Anne des Rieux, Christine Dupont-Gillain
Fused deposition modeling (FDM), a low-cost and easy-to-use additive manufacturing technique, was used to produce poly(lactic acid) (PLA) gyroid scaffolds. Such morphology was selected for its spring shape, high porosity leading to good nutrient and waste diffusion, and favorable mechanical properties. Printing parameters were optimized and the need of a support material to improve printing was evidenced. The gyroid was compared to the common strut-based structure. Scaffold porosity was measured by micro-CT, and mechanical properties were determined by compression tests, taking into account the effect of geometry, printing resolution, and PLA crystallinity. The impact of scaffold geometry and crystallinity on its degradation was studied in vitro. Porosity of the gyroid structure was 71%, as expected from the printing model. The compression tests showed an isotropic behavior for the gyroid, in contrast with the strut-based scaffold. Upon aging in physiological conditions, gyroid scaffolds retained their integrity during 64 weeks, while control scaffolds lost struts starting from week 33, in a way that depended on crystallinity and printing resolution. Based on these results, the gyroid design is proposed as a suitable mesh architecture for tissue engineering scaffolds that can be elaborated using FDM techniques, to produce low-cost and personalized implants.

Graphical abstract

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Design of Fe3O4@SiO2@mSiO2-organosilane carbon dots nanoparticles: Synthesis and fluorescence red-shift properties with concentration dependence

Publication date: 5 August 2018
Source:Materials & Design, Volume 151
Author(s): Xiaolei Li, Wei Wang, Qianli Li, Han Lin, Yue Xu, Lin Zhuang
Organosilane-functionalized carbon dots (SiCDs) immobilized silica composite nanoparticles (Fe3O4@SiO2@mSiO2-SiCDs) with dually emissive properties have been prepared by a modified sol-gel method. Such Fe3O4@SiO2@mSiO2-SiCDs nanoparticles solution exhibits blue light emission with a maximum wavelength of 470 nm at lower concentrations, and red-shifts to yellow-green light emission with maximum wavelength of 565 nm at higher concentrations, which is different with traditional carbon dots composite materials displaying strong emission only in the blue-light region. The SiCDs are immobilized in the outer mesoporous silica layer by covalent bonds via proper blending ration, which enables the nanoparticles solution to possess excellent fluorescence stability. The Fe3O4@SiO2@mSiO2-SiCDs nanoparticles show good stability, high surface area (483.19 m²/g), high saturation magnetization (22.1 emu/g) and low remanence (0.217 emu/g). When the concentration of nanoparticles solution is increased, the distance between the nanoparticles decreases and exhibits the concentration-mediated scattering phenomena, which result in the red-shift of fluorescent peaks. The specific structure of the Fe3O4@SiO2@mSiO2-SiCDs nanoparticles and the concentration-mediated scattering phenomena play key roles in the red-shift appearing.

Graphical abstract

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Calcium phosphate coated 3D printed porous titanium with nanoscale surface modification for orthopedic and dental applications

Publication date: 5 August 2018
Source:Materials & Design, Volume 151
Author(s): Susmita Bose, Dishary Banerjee, Anish Shivaram, Solaiman Tarafder, Amit Bandyopadhyay
This study aims to improve the interfacial bonding between the osseous host tissue and the implant surface through the application of doped calcium phosphate (CaP) coating on 3D printed porous titanium. Porous titanium (Ti) cylinders with 25% volume porosity were fabricated using Laser Engineered Net Shaping (LENS™), a commercial 3D printing technique. The surface of these 3D printed cylinders was modified by growing TiO2 nanotubes first, followed by a coating with Sr²⁺ and Si⁴⁺ doped bioactive CaP ceramic in simulated body fluid (SBF). Doped CaP coated implants were hypothesized to show enhanced early stage bone tissue integration. Biological properties of these implants were investigated in vivo using a rat distal femur model after 4 and 10 weeks. CaP coated porous Ti implants have enhanced tissue ingrowth as was evident from the CT scan analysis, push out test results, and the histological analysis compared to porous implants with or without surface modification via titania nanotubes. Increased osteoid-like new bone formation and accelerated mineralization were revealed inside the CaP coated porous implants. It is envisioned that such an approach of adding a bioactive doped CaP layer on porous Ti surface can reduce healing time by enhancing early stage osseointegration in vivo.

Graphical abstract

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Preparation of the Secretory Recombinant ALV-J gp85 Protein Using Pichia pastoris and Its Immunoprotection as Vaccine Antigen Combining with CpG-ODN Adjuvant

Viral Immunology, Ahead of Print.

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Development of Fe/Nb-based solar photocatalysts for water treatment: impact of different synthesis routes on materials properties

Abstract

Semiconductors based on Fe/Nb oxides can present both solar sensitivity and high catalytic activity. However, there is still a lack regarding the comparison between different routes to produce Fe/Nb-based solar photocatalysts and the evaluation of the impact of the synthesis operating conditions on the material properties. In this work, Fe/Nb₂O₅ ratio, type of precipitating agent, presence/absence of washing stage, and temperature of calcination were verified to be the most relevant parameters in the synthesis by the co-precipitation method. These factors led to remarkable differences in the properties and performance of the photocatalysts produced by each distinct synthesis route. Composition, iron species present in the materials, crystallinity characteristics, and pH of the catalysts were affected, leading to different photocatalytic activities under UV-Vis light. Due to their characteristics, the synthesized materials are potential photocatalysts for application in solar processes.

Graphical abstract

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Clinical and psychological features of children and adolescents diagnosed with avoidant/restrictive food intake disorder in a pediatric tertiary care eating disorder program: a descriptive study

Abstract

Background

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder first described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) [American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2013]. Patients with ARFID do not fear gaining weight or have body image distortions. ARFID involves a persistent disturbance in feeding and eating that results in an inability to meet nutritional and/or energy needs with one of the following: weight loss or failure to achieve appropriate weight gain, nutritional deficiency, dependence on enteral feeding or nutritional supplements and significant interference with psychosocial functioning. To date, studies on patients with ARFID have retrospectively applied the DSM-5 diagnostic criteria for ARFID to reclassify patients diagnosed with DSM-IV eating disorders.

Methods

A descriptive retrospective chart review was completed on patients less than 18-years diagnosed with ARFID after a comprehensive eating disorder assessment between May 2013 and March 2016. The data collected included demographics, anthropometrics, historical information, clinical features, co-morbid diagnoses, need for inpatient hospitalization and psychometric measures.

Results

Three hundred and sixty-nine patients were assessed for an eating disorder between May 2013 and March 2016. Of these, 31 (8.4%) received a DSM-5 diagnosis of ARFID. A full chart review was performed on 28 (90.3%) patients. Weight loss or failure to achieve appropriate weight gain was the reason for diagnosis in 96.4% (27/28). All of our patients had 2 or more physical symptoms at the time of diagnosis and 16 (57.1%) had a co-morbid psychiatric disorder. Twenty (71.4%) reported a specific trigger for their eating disturbance. Admission for inpatient hospitalization occurred in 57.1% (16/28) of patients. Thirteen (46.4%) patients had been previously assessed by another specialist for their eating disturbance. None of the patients had elevated scores on commonly used psychometric tests used to assess eating disorders.

Conclusion

This is the first study to retrospectively determine the incidence of ARFID in children and adolescents using the DSM-5 diagnostic criteria at assessment. The clinical presentation of patients with ARFID is complex with multiple physical symptoms and comorbid psychiatric disorders. Commonly used pediatric eating disorder psychometric measures are not specific for making a diagnosis of ARFID, and may not be sensitive as assessment tools.

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Bulk deposition of base cationic nutrients in China's forests: Annual rates and spatial characteristics

Publication date: July 2018
Source:Atmospheric Environment, Volume 184
Author(s): Enzai Du, Wim de Vries, Steven McNulty, Mark E. Fenn
Base cations, such as potassium (K⁺), calcium (Ca²⁺) and magnesium (Mg²⁺), are essential nutrients for plant growth and their atmospheric inputs can buffer the effect of acid deposition by nitrogen (N) and sulphur (S) compounds. However, the spatial variation in atmospheric deposition of these base cationic nutrients is less understood compared with N and S deposition. By synthesizing bulk deposition data for K⁺, Ca²⁺ and Mg²⁺, we assessed their annual rates and spatial characteristics at 34 forested sites across China. Our synthesis showed relatively high levels of bulk deposition of base cationic nutrients in China's forests, being an order of magnitude higher than in the USA and Europe. On average, K⁺, Ca²⁺ and Mg²⁺ accounted for 13%, 72% and 15% of the bulk deposition of base cationic nutrients, respectively. Surprisingly, base cation deposition was lower at sites near semi-arid regions compared with sites in eastern and southern China, which were far from semi-arid regions. Moreover, elevated base cation deposition was associated with urban hotspots, exhibiting a significant power-law increase with closer distance to the nearest large cities. We estimated that on average base cationic nutrients neutralized a significant proportion (76%) of the potential acid load due to acid deposition. Our findings suggest that in China there is considerable anthropogenic alteration of the regional cycling of base cationic nutrients, which plays an important role in counteracting the risk of soil acidification and base cation depletion in forest ecosystems, especially in the southern regions.

Graphical abstract

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Artificial neural network model for ozone concentration estimation and Monte Carlo analysis

Publication date: July 2018
Source:Atmospheric Environment, Volume 184
Author(s): Meng Gao, Liting Yin, Jicai Ning
Air pollution in urban atmosphere directly affects public-health; therefore, it is very essential to predict air pollutant concentrations. Air quality is a complex function of emissions, meteorology and topography, and artificial neural networks (ANNs) provide a sound framework for relating these variables. In this study, we investigated the feasibility of using ANN model with meteorological parameters as input variables to predict ozone concentration in the urban area of Jinan, a metropolis in Northern China. We firstly found that the architecture of network of neurons had little effect on the predicting capability of ANN model. A parsimonious ANN model with 6 routinely monitored meteorological parameters and one temporal covariate (the category of day, i.e. working day, legal holiday and regular weekend) as input variables was identified, where the 7 input variables were selected following the forward selection procedure. Compared with the benchmarking ANN model with 9 meteorological and photochemical parameters as input variables, the predicting capability of the parsimonious ANN model was acceptable. Its predicting capability was also verified in term of warming success ratio during the pollution episodes. Finally, uncertainty and sensitivity analysis were also performed based on Monte Carlo simulations (MCS). It was concluded that the ANN could properly predict the ambient ozone level. Maximum temperature, atmospheric pressure, sunshine duration and maximum wind speed were identified as the predominate input variables significantly influencing the prediction of ambient ozone concentrations.

Graphical abstract

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Paget's disease of the male breast: case report and a point of view from actual literature.

Paget's disease of the male breast: case report and a point of view from actual literature.

G Chir. 2018 Mar-Apr;39(2):114-117

Authors: Vergine M, Musella A, Gulotta E, Frusone F, De Luca A, Maceli F, Libia A, Benedetti Panici P, Monti M

Abstract
INTRODUCTION: Paget disease of the nipple in man is a very rare breast cancer, and there are not standard procedures or guidelines. In any cases, a Paget's disease could hide an invasive ductal breast cancer.
CASE DESCRIPTION: We report the case of a 77-years old man affected by Alzheimer's disease, who presented to our attention because of an ulcerated palpable mass in the right nipple. A biopsy of the lesion showed "intra-epidermic proliferation of epitelioid cells, associated with linfo-plasmacellular infiltration of superficial dermis, compatible with Paget's disease (pTis)". We discussed the case in the multidisciplinary meeting and decided to subject the patient to surgery, so a right mastectomy plus sentinel lymph node biopsy (SLNB) were performed. Histo-pathological examination revealed "invasive ductal carcinoma of the breast, associated with a small component of in situ ductal carcinoma and Paget's disease of the nipple with superficial ulceration". Resection margins were free. Sentinel lymph node was negative. Biological features were as follows: ER 95%, PR 60%, Her-2/neu 1+, Ki-67 35%. The patient was discharged in the third post-operative day in good conditions. In the following weeks the patient's healing process was good and free of complications.
CONCLUSIONS: Clinical recognition of Paget's disease is very important also in man, because it can be the alarm bell for an underlying invasive ductal breast cancer, often more aggressive than in woman.

PMID: 29694313 [PubMed - in process]

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A case of peduncolated Brunner's gland hamartoma.

A case of peduncolated Brunner's gland hamartoma.

G Chir. 2018 Mar-Apr;39(2):111-113

Authors: Tornambè A, Tornambè G

Abstract
AIM: To report a case of Brunner's gland hamartoma (BGH) in patient treated with surgical resection.
CASE REPORT: A 73 years old male patient that was admitted with melena. The preoperative investigations suggested a suspected duodenal large polypoidal mass. A local resection was performed. Surgical resection is actually considered the best treatment for this lesion.
DISCUSSION: Brunner's glands were first described by Brunner in 1688. Hamartoma designates an excessive focal overgrowth of mature normal cells and tissues, composed of identical cellular elements. Most patients with Brunner's gland hamartoma are asymptomatic or have nonspecific complaints.
CONCLUSION: BHG is a rare tumor arising from the Brunner's gland of the duodenum, considered entirely benign, although there have been occasionally reports of malignant foci inside.

PMID: 29694312 [PubMed - in process]

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Primary abdominal wall endometriosis: presentation of rarely seen two cases.

Primary abdominal wall endometriosis: presentation of rarely seen two cases.

G Chir. 2018 Mar-Apr;39(2):107-110

Authors: Ferhatoglu MF, Senol K

Abstract
Abdominal wall endometriosis is a pathology which usually develops after preceding surgeries on the surgical incision line and shows clinical manifestation especially during menstrual cycle. However, primary abdominal wall endometriosis is seen very rarely and it is a condition developing without a previous history of surgery. In this paper, we aimed to provide a contribution to the theories of pathogenesis of the disease by presenting two cases of primary abdominal wall endometriosis in two patients without previous history of surgery.

PMID: 29694311 [PubMed - in process]

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Superior vena cava syndrome due to central port catheter thrombosis: a real life-threatening condition.

Superior vena cava syndrome due to central port catheter thrombosis: a real life-threatening condition.

G Chir. 2018 Mar-Apr;39(2):101-106

Authors: Lianos GD, Hasemaki N, Tzima E, Vangelis G, Tselios A, Mpailis I, Lekkas E

Abstract
Superior vena cava syndrome (SVCS) represents undoubtedly a rare life-threatening condition. Herein, we present a rare case of a 69-year-old woman, with a history of hepatic flexure tumor and an indwelling central venous port, presenting with acute signs and symptoms of SVCS due to thrombosis of the catheter. The patient was treated with intravenous anticoagulation and fibrinolytic therapy and showed regression of symptoms. It is reported that central venous catheters are routinely used in clinical practice mainly in oncological cases for chemotherapy, parenteral nutrition or dialysis. However, complications related to implantation technique, care, or maintenance of these catheters may arise. High index of suspicion for SVCS should always arise when a patient presents with common symptoms and long-term central catheters, in order to avoid unfavorable outcomes. Local thrombolysis appears to be a safe and effective therapy for port catheter-associated thrombosis.

PMID: 29694310 [PubMed - in process]

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Malakoplakia of the large intestine: an incidental extremely rare finding.

Malakoplakia of the large intestine: an incidental extremely rare finding.

G Chir. 2018 Mar-Apr;39(2):97-100

Authors: Koutserimpas C, Ioannidis A, Demonakou M, Siaperas P, Skarpas A, Velimezis G, Karanikas I

Abstract
Malakoplakia is a rare inflammatory disease, most commonly found in the urinary tract. It appears be related to a functional deficiency of macrophages, resulting in an inability to destroy digested bacteria and it is associated with various conditions that cause immunodeficiency. A rare case of malakoplakia of the colon in a healthy 68-year old male is presented. The patient underwent emergency surgery with colon resection and an end stoma with closure of the distal bowel (Hartmann's procedure), due to incarcerated ventral hernia and sigmoid-colon rupture. He underwent reversal of the Hartmann's procedure four months after the initial operation. The histological examination from the anastomotic rings revealed Michaelis-Gutmann bodies that are pathognomonic of malakoplakia. He received per os ciprofloxacin, bethanecol and ascorbic acid for 12 months. Follow-up endoscopy did not exhibit any signs of the disease. A case of a healthy patient presenting with malakoplakia without any underlying disease that causes immunodeficiency is extremely rare. Treatment of malakoplakia involves the eradication of microorganisms. Cholinergic agonists, such as bethanechol and ascorbic acid, as well as antimicrobial treatment with trimpethoprim/sulphamethoxazol and rifampicin are most commonly being used. Long-term antimicrobial treatment has been reported (6 months to 3 years).

PMID: 29694309 [PubMed - in process]

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Severe neurological complication following adjustable gastric banding.

Severe neurological complication following adjustable gastric banding.

G Chir. 2018 Mar-Apr;39(2):92-96

Authors: Martines G, Musa N, Aquilino F, Capuano P

Abstract
AIM: In the last years with the increase of bariatric surgery, first of all as a result of new indications, a rise in the incidence of nutrient-related complications has been observed. Currently little is known about the impact of post-bariatric malnutrition and neurological complications. Wernicke's encephalopathy is a severe neurological syndrome which occurs as a result of thiamine deficiency. Wernicke-Korsakoff syndrome must be considered a serious neurological complication of bariatric surgery with significant morbidity and mortality, with rapidly progressing neurological symptoms, and must be treated immediately.
CASE REPORT: We report the case of a 35 years-old male patient, affected by morbid obesity, anxious-depressive syndrome and alcohol use disorder, who after adjustable gastric banding implanted in another hospital developed a severe malnutrition and neurological syndrome. The patient showed poor adherence to the follow-up and to the dietary indications and after all, we needed to place a PEG for enteral nutrition in order to resolve the malnutrition condition and the neurological syndrome. Our experience emphasizes that preoperative selection and assessment of a patient's nutritional status according to guidelines, is required to identify potential problems, and that bariatric surgeons or physicians caring for patient who have undergone bariatric surgery should be familiar with the constellation of nutritional and neurological disorder that may occur after surgery.
CONCLUSION: We want to remark the importance of preoperative selection of the patients, the follow-up and the cooperation between patient and physician in order to obtain the best result and avoid severe complications.

PMID: 29694308 [PubMed - in process]

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Laparoscopic cholecystectomy for acute cholecystitis: are intended operative approach, timing and outcome affected by BMI? A multicenter retrospective study.

Laparoscopic cholecystectomy for acute cholecystitis: are intended operative approach, timing and outcome affected by BMI? A multicenter retrospective study.

G Chir. 2018 Mar-Apr;39(2):87-91

Authors: Lauro A, Vaccari S, Cervellera M, Casella G, D'Andrea V, Di Matteo FM, Panarese A, Santoro A, Cirocchi R, Tonini V

Abstract
BACKGROUND: Laparoscopy is the gold-standard for cholecystectomy after acute cholecystitis, but the issue is controversial in obese subjects.
PATIENTS AND METHODS: We reviewed 464 patients operated for acute cholecystitis (59 open and 405 laparoscopic) over the last five years at St Orsola University Hospital-Bologna and Umberto I University Hospital-Rome, comparing retrospectively: 1) BMI < 30 (397 patients) and BMI =/> 30 (67 patients) and moreover 2) BMI < 25 (207 patients) and BMI =/> 25 (257 patients).
RESULTS: In the first comparison, obese patients showed higher cardiovascular co-morbidity (61.1% vs 44.5%, p=0.01), worse symptoms (Murphy's sign positive in 92.5% vs 80.8%, p=0.02; fever >38.5°C in 88.0% vs 76.0 %, p=0.02) and significant radiologic imaging (95.5% vs 85.1%, p=0.01) of acute cholecystitis. Laparoscopy was used in 83.6% of obese patients vs 87.9% without any difference, and operative time or conversion rate were similar. According to Tokyo Guidelines 2013, the number of patients who underwent surgery within 3 days or after 6 weeks was similar without statistical difference between the two groups. Hospital stay, morbidity and mortality were similar. Complications were seen in 25.4% of obese patients vs 15.9% (p= 0.03), mainly represented by wound infections. The second comparison did show no difference between two groups BMI =/>25 and BMI < 25.
CONCLUSIONS: Our retrospective multicenter study showed no difference related to intended operative approach, timing and outcome in higher BMI versus lower BMI patients operated for acute cholecystitis.

PMID: 29694307 [PubMed - in process]

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The use of local anesthesia to perform lower limb revascularization in the fragile patient with critical limb ischemia.

The use of local anesthesia to perform lower limb revascularization in the fragile patient with critical limb ischemia.

G Chir. 2018 Mar-Apr;39(2):77-81

Authors: Kontopodis N, Papaioannou A, Tavlas E, Papadopoulos G, Lioudaki S, Tzirakis K, Ioannou CV

Abstract
Patients with critical limb ischemia are usually compromised, frequently making administration of general or regional anesthesia problematic. We treated 3 fragile patients presenting contraindications to undertake traditional anesthetic techniques for lower limb revascularization, in whom local anesthesia with conscious sedation was used to complete the operation. An axillo-bifemoral, a unilateral axillo-femoral and a femoro-femoral bypass were performed. Procedure was uneventful in all three cases despite the coexistence of specific surgical challenges (distal anastomosis at the profunda in two cases, redo surgery and scarred groin in the third). Surgical revascularization under local anesthesia may be considered in selected high risk patients.

PMID: 29694305 [PubMed - in process]

https://ift.tt/2I0vgKR

Cluster analysis of microclimate data to optimize the number of sensors for the assessment of indoor environment within museums

Abstract

For the first time, the cluster analysis (k-means) has been applied on long time series of temperature and relative humidity measurements to identify the thermo-hygrometric features in a museum. Based on ASHRAE (2011) classification, 84% of time all rooms in the Napoleonic Museum in Rome (case study) were found in the class of control B. This result was obtained by analyzing all recorded data in 10 rooms of the museum as well as using the cluster aggregation. The use of objective-oriented methodology allows to achieve an acceptable knowledge of the microclimate in case of multi-room buildings, reducing computations with large amounts of collected data and time-consuming in redundant elaborations. The cluster analysis enables to reduce the number of the sensors in microclimate monitoring programs within museums, provided that the representativeness of the instrument location is known, and professional conservators have assessed that the artifacts are well preserved.

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Editorial Board and Contents

Publication date: May 2018
Source:Trends in Immunology, Volume 39, Issue 5

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Cell Biology of T Cell Receptor Expression and Regulation

Annual Review of Immunology, Volume 36, Issue 1, Page 103-125, April 2018.

https://ift.tt/2HtVWGN

Immune Responses to Retroviruses

Annual Review of Immunology, Volume 36, Issue 1, Page 193-220, April 2018.

https://ift.tt/2r4bMNi

Autophagy and Inflammation

Annual Review of Immunology, Volume 36, Issue 1, Page 73-101, April 2018.

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Regulation of the Cell Biology of Antigen Cross-Presentation

Annual Review of Immunology, Volume 36, Issue 1, Page 717-753, April 2018.

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Self-Reactive B Cells in the Germinal Center Reaction

Annual Review of Immunology, Volume 36, Issue 1, Page 339-357, April 2018.

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Immune Responses in the Liver

Annual Review of Immunology, Volume 36, Issue 1, Page 247-277, April 2018.

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The Formation and Function of Granulomas

Annual Review of Immunology, Volume 36, Issue 1, Page 639-665, April 2018.

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The Immune Response to Mycobacterium tuberculosis in HIV-1-Coinfected Persons

Annual Review of Immunology, Volume 36, Issue 1, Page 603-638, April 2018.

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Human T Cell Leukemia Virus Type 1: Persistence and Pathogenesis

Annual Review of Immunology, Volume 36, Issue 1, Page 43-71, April 2018.

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Genetics of Natural Killer Cells in Human Health, Disease, and Survival

Annual Review of Immunology, Volume 36, Issue 1, Page 519-548, April 2018.

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Evolution of Alternative Adaptive Immune Systems in Vertebrates

Annual Review of Immunology, Volume 36, Issue 1, Page 19-42, April 2018.

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Connections Between Metabolism and Epigenetics in Programming Cellular Differentiation

Annual Review of Immunology, Volume 36, Issue 1, Page 221-246, April 2018.

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Rebooting Human Immunology

Annual Review of Immunology, Volume 36, Issue 1, Page 843-864, April 2018.

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Exploiting Nanobodies’ Singular Traits

Annual Review of Immunology, Volume 36, Issue 1, Page 695-715, April 2018.

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Immune Response to Dengue and Zika

Annual Review of Immunology, Volume 36, Issue 1, Page 279-308, April 2018.

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What Nurses Do.

Author: Kennedy, Maureen Shawn MA, RN, FAAN

Page: 7

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Independent Practice by APRNs.

Author: Korbecka, Alicja M. RN

Page: 13

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Saving the Safety Net.

Author: Thompson, Earl nursing student

Page: 13

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Death with Dignity.

Author: S., Jackie via Facebook

Page: 13

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Report: Nursing Homes Are Overmedicating People with Dementia.

Author: Stockwell, Serena

Page: 14

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NewsCAP: Updates to adult and child immunization schedules are issued for 2018.

Author:

Page: 15

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Young Single Mothers Benefit from the Affordable Care Act.

Author: Sofer, Dalia

Page: 16

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NewsCAP: New AHA guidelines include extending time to treatment for ischemic stroke.

Author:

Page: 16

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NewsCAP: Asymptomatic women with no known risk of ovarian cancer do not benefit from screening for the disease.

Author:

Page: 17

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NewsCAP: The FDA approves a blood test to aid assessment after head injury.

Author:

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AJN On the Cover.

Author: Szulecki, Diane Editor

Page: 18

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Reports of Anaphylaxis with an Antiemetic.

Author: Aschenbrenner,, Diane S. MS, RN

Page: 23

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At What Cost to Clinical Trial Enrollment? A Retrospective Study of Patient Travel Burden in Cancer Clinical Trials

AbstractBackground.Recent literature suggests that living in a rural setting may be associated with adverse cancer outcomes. This study examines the burden of travel from home to cancer center for clinical trial (CT) enrollees.Materials and Methods.Patients from the University of California San Francisco Clinical Trial Management System database who enrolled in a cancer CT for a breast, genitourinary, or gastrointestinal malignancy between 1993 and 2014 were included. Cancer type, household zip code, race/ethnicity, phase of study, study sponsor, and year of signed consent were exported. Distance traveled from home to center was calculated using a GoogleMaps application programming interface. The relationships of distance with phase of CT, household income, and race/ethnicity were examined.Results.A total of 1,600 patients were enrolled in breast (55.8%), genitourinary (29.4%), or gastrointestinal (14.9%) cancer CTs. The overall median unidirectional distance traveled from home to study site was 25.8 miles (interquartile range [IQR] 11.5–75.3). Of the trial sponsors examined, principal investigator (56.4%), industry (22.2%), cooperative group (11.6%), and National Institutes of Health (NIH; 9.8%), the longest distance traveled was for NIH‐sponsored trials, with a median of 39.4 miles (p < .001). Phase I (8.4%) studies had the longest distance traveled, with a median of 41.2 miles (IQR 14.5–101.0 miles; p = .001). White patients (83%) traveled longer compared with black patients (4.4%), with median distances of 29.9 and 13.9 miles, respectively (p < .001). Patients from lower‐income areas (n = 799) traveled longer distances compared with patients from higher‐income areas (n = 773; 58.3 vs. 17.8 miles, respectively; p < .001). A multivariable linear model where log10 (distance) was the outcome and adjusting for the exported variables and income revealed that cancer type, year of consent, race/ethnicity, and income were significantly associated with distance traveled.Conclusion.This study found that the burden of travel is highest among patients enrolled in NIH‐sponsored trials, phase I studies, or living in low‐income areas. These data suggest that travel burden for cancer CT participants may be significant.Implications for Practice.This study is one of the first to measure travel distance for patients in cancer clinical trials using a real‐world GoogleMaps calculator. Out‐of‐pocket expenses such as travel are not typically covered by health care payers; therefore, patients may face considerable cost to attend each study visit. Using a single‐center clinical trials enrollment database, this study found that the burden of travel is highest for patients enrolled in National Institutes of Health‐sponsored trials and phase I studies, as well as for patients living in low‐income areas. Results suggest that a significant proportion of patients enrolled in clinical trials face a substantial travel burden.

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Representation of Minorities and Elderly Patients in Multiple Myeloma Clinical Trials

AbstractMultiple myeloma (MM) occurs in all races, but the incidence in non‐Hispanic black patients (NHBs) is two to three times higher than in non‐Hispanic white patients (NHWs). We determined the representation of minorities and elderly patients in MM clinical trials. Enrollment data from all therapeutic trials reported in ClinicalTrials.gov from 2000 to 2016 were analyzed. Enrollment fraction (EF) was defined as the number of trial enrollees divided by the 2014 MM prevalence. Participation in MM clinical trials varied significantly across racial and ethnic groups; NHWs were more likely to be enrolled in clinical trials (EF 0.18%) than NHBs (EF 0.06%, p < .0001) and Hispanic patients (EF 0.04%, p < .0001). The median age of trial participants was 62 years, with 7,956 participants (66%) being less than 65 years of age. Collaborations between investigators, sponsors, and the community are necessary to increase access to clinical trials to our minority and elderly patients.

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Monoclonal Antibodies and Multiple Myeloma: All in All It's Just Another Brick in the Wall?

https://ift.tt/2FjSc4Q

Comprehensive Molecular Characterization of Young Chinese Patients with Lung Adenocarcinoma Identified a Distinctive Genetic Profile

AbstractBackground.Occurrence at a younger age has been demonstrated to be associated with a distinct biology in non‐small cell lung cancer. However, genomics and clinical characteristics among younger patients with lung adenocarcinoma remain to be determined. Here we studied the potentially targetable genetic alterations by next‐generation sequencing (NGS) assay in young Chinese patients with lung adenocarcinoma.Materials and Methods.Seventy‐one surgically resected lung adenocarcinoma tissue samples from patients aged less than 45 years were collected with informed consent from all patients. Targeted NGS assays were used to identify actionable genetic alterations in the cancer tissues. Additionally, the genomic and clinicopathologic characteristics of 106 patients with lung adenocarcinoma who received NGS testing over the same period were analyzed retrospectively.Results.The frequencies of targetable genetic alterations in 177 patients with lung adenocarcinoma were analyzed by defined age categories, which unveiled a distinctive molecular profile in the younger group, aged less than 45 years. Notably, higher frequency of ALK and HER2 genetic alterations were associated with young age. However, a reverse trend was observed for KRAS, STK11 and EGFR exon 20 mutations, which were more frequently identified in the older group, aged more than 46 years. Furthermore, concurrent EGFR/TP53 mutations were much more prevalent in the younger patients (81.6% vs. 46.8%), which might have a poor response to treatment with epidermal growth factor receptor tyrosine kinase inhibitor.Conclusion.In this study, NGS assay revealed a distinctive genetic profile in younger patients with adenocarcinoma. High frequency of concurrent EGFR/TP53 mutations was found in the younger patients, which especially warranted personalized treatment in this population.Implications for Practice.Further investigation is needed to understand the genomics and clinical characteristics of young patients with lung adenocarcinoma. In the present study, hybrid capture‐based next‐generation sequencing assays were used to identify targeted genetic alterations in young lung adenocarcinoma patients. Young patients with lung adenocarcinoma, aged less than 45 years, harbored a higher frequency of ALK and HER2 genetic alterations compared with patients aged more than 46 years. Dramatically, concurrent EGFR/TP53 mutations were much more prevalent in younger patients, which had a poor response to treatment with epidermal growth factor receptor kinase inhibitor. These results reveal a distinctive genetic profile in younger patients with adenocarcinoma, which might improve the treatment of this subpopulation.

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Spontaneous pneumomediastinum, pneumothorax, pneumorrhachis, pneumoretroperitoneum, surgical emphysema.

Spontaneous pneumomediastinum, pneumothorax, pneumorrhachis, pneumoretroperitoneum, surgical emphysema.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):132-133

Authors: Shilpa B, Sudhir R, Mohan MVTK, Koppula V

PMID: 29692541 [PubMed]

https://ift.tt/2FmLJ98

Sonographic features of invasive ductal breast carcinomas predictive of malignancy grade.

Sonographic features of invasive ductal breast carcinomas predictive of malignancy grade.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):123-131

Authors: Gupta K, Kumaresan M, Venkatesan B, Chandra T, Patil A, Menon M

Abstract
Context: Assessment of individual sonographic features provides vital clues about the biological behavior of breast masses and can assist in determining histological grade of malignancy and thereby prognosis.
Aims: Assessment of individual sonographic features of biopsy proven invasive ductal breast carcinomas as predictors of malignancy grade.
Settings and Design: A retrospective analysis of sonographic findings of 103 biopsy proven invasive ductal breast carcinomas.
Materials and Methods: Tumor characteristics on gray-scale ultrasound and color flow were assessed using American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) Atlas Fifth Edition. The sonographic findings of masses were individually correlated with their histopathologic grades.
Statistical Analysis Used: Chi square test, ordinal regression, and Goodman and Kruskal tau test.
Results: Breast mass showing reversal/lack of diastolic flow has a high probability of belonging to histological high grade tumor (β 1.566, P 0.0001). The masses with abrupt interface boundary are more likely grade 3 (β 1.524, P 0.001) in comparison to masses with echogenic halos. The suspicious calcifications present in and outside the mass is a finding associated with histologically high grade tumors. The invasive ductal carcinomas (IDCs) with complex solid and cystic echotexture are more likely to be of high histological grade (β 1.146, P 0.04) as compared to masses with hypoechoic echotexture.
Conclusions: Certain ultrasound features are associated with tumor grade on histopathology. If the radiologist is cognizant of these sonographic features, ultrasound can be a potent modality for predicting histopathological grade of IDCs of the breast, especially in settings where advanced tests such as receptor and molecular analyses are limited.

PMID: 29692540 [PubMed]

https://ift.tt/2I1ONdX

Comparing the diagnostic efficacy of full field digital mammography with digital breast tomosynthesis using BIRADS score in a tertiary cancer care hospital.

Comparing the diagnostic efficacy of full field digital mammography with digital breast tomosynthesis using BIRADS score in a tertiary cancer care hospital.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):115-122

Authors: Singla D, Chaturvedi AK, Aggarwal A, Rao SA, Hazarika D, Mahawar V

Abstract
Introduction: Breast cancer is one of the leading cancers in females worldwide, and its incidence has been rising at an exponential pace in the last 10 years even in India. Mammography has been the mainstay for detection of breast cancer over decades and has gradually advanced from screen film to full-field digital mammography. Recently, tomosynthesis has evolved as an advanced imaging investigation for early diagnosis of breast lesions in both diagnostic and screening settings.
Aim of Study: To compare and evaluate the impact of digital breast tomosynthesis (DBT) compared to full-field digital mammography (FFDM) in the interpretation of BIRADS score in both diagnostic and screening settings.
Settings and Design: A 1-year prospective longitudinal study was conducted in the Department of Radio-diagnosis in our institute using Hologic Selenia Dimensions for mammography as well as tomosynthesis.
Materials and Methods: One hundred women known or suspected (opportunistic screening) for breast cancer were evaluated either with FFDM alone or both FFDM and DBT. Sensitivity, specificity, positive predictive value, negative predictive value, and P value were used to assess the various diagnostic criteria in our study.
Results: Addition of DBT to FFDM results in a statistically significant increase in the sensitivity, specificity, and positive predictive value, and a statistically significant decrease in the false positive rates. Similar results were noted in both diagnostic and screening cases. It was observed that, in most cases, i.e. a total of 47, DBT did not change the BIRADS scoring; however, its addition increased the diagnostic confidence. BIRADS was upgraded and downgraded in 14 and 31 cases, respectively, with the addition of DBT to FFDM. New lesions were seen with addition of DBT to FFDM in 8 cases.
Conclusion: Addition of DBT to FFDM results in increase in sensitivity, specificity, positive predictive value, and a statistically significant decrease in false positive rates in both diagnostic and screening cases. As addition of tomosynthesis results in a significant decrease in recall rate, it should be added, at least, in all screening mammography programs.

PMID: 29692539 [PubMed]

https://ift.tt/2FkGV4j

Orphan disease: Cherubism, optic atrophy, and short stature.

Orphan disease: Cherubism, optic atrophy, and short stature.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):111-114

Authors: Jeevanandham B, Ramachandran R, Dhanapal V, Subramanian I, Sai V

Abstract
A 12-year-old female presented with complaints of progressive visual impairment in both her eyes. On clinical examination, she was short for her age and her ophthalmoscopic examination revealed bilateral optic atrophy. Computed tomography of the patient revealed multiple expansile lytic lesions of mandible suggesting cherubism. The optic atrophy was confirmed on magnetic resonance imaging, which additionally revealed bilateral retrocerebellar arachnoid cysts. This association of cherubism with optic atrophy and short stature was grouped as orphan disease by National Institutes of Health and only one case was reported in the literature so far.

PMID: 29692538 [PubMed]

https://ift.tt/2I2hO9k

Brown fat necrosis with calcifications in the newborn: Risk factors, radiographic findings, and clinical course.

Brown fat necrosis with calcifications in the newborn: Risk factors, radiographic findings, and clinical course.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):107-110

Authors: Golden ET, Dickson P, Simoneaux S

Abstract
Objective: To describe the radiographic appearance of subclinical calcified brown fat necrosis and the associated clinical and laboratory findings.
Materials and Methods: Picture Archiving and Communications Sytem (PACS) was searched using keywords "soft tissue calcification" and "chest." The clinical record was searched for prior cardiac surgery, bypass, Extracorporeal Membrane Oxygentation (ECMO) and prostaglandin use. Age when calcifications were first detected, location, resolution, and associated laboratory abnormalities were recorded.
Results: Nine patients were identified. None had skin lesions. All patients had congenital heart disease and had experienced cardiac/respiratory arrest and/or severe hypotension 1-6 weeks before soft tissue calcifications occurred. Calcifications resolved by 9 weeks to 5 months in 3 patients. The remaining were either deceased or lacked follow-up imaging. Renal ultrasound was performed in all but 1 patient. Nephrocalcinosis was only seen in 1 patient.
Conclusion: Brown fat necrosis is subclinical, diagnosed on plain film, and likely self-limited. It occurs in term and preterm infants who have undergone significant systemic stress and carries a poor prognosis.

PMID: 29692537 [PubMed]

https://ift.tt/2Flv6Lc

Performance of quantitative CT parameters in assessment of disease severity in COPD: A prospective study.

Performance of quantitative CT parameters in assessment of disease severity in COPD: A prospective study.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):99-106

Authors: Kumar I, Verma A, Jain A, Agarwal SK

Abstract
Background: Both emphysematous destruction of lung parenchyma and airway remodeling is thought to contribute to airflow limitation in cases of chronic obstructive pulmonary disease (COPD).
Objective: To evaluate the value of quantitative computed tomography (QCT) parameters of emphysema and airway disease with disease severity in patients with COPD.
Materials and Methods: We prospectively studied 50 patients with COPD, which included nonsmokers and patients with different degrees of cumulative smoking exposure. Three QCT parameters namely LAA% (low attenuation area percentage), WA% (Wall area percentage), and pi10 were calculated as per the standard technique. Forced expiratory volume in 1 s (FEV1), BODE score, and MMRC dyspnea scale were used as measures of disease severity.
Results: FEV1 was inversely and significantly associated with all three QCT parameters. Receiver operated characteristic curves in prediction of GOLD class 3 COPD yielded cut-off values of 12.2, 61.45, and 3.5 for LAA%, WA%, and pi10, respectively, with high sensitivities and specificities. In multiple linear regression model, however, only LAA% proved to be significantly associated with FEV1, BODE, and dyspnea.
Conclusion: QCT indices of both emphysema and airway disease influence FEV1, dyspnea, and BODE score in patients with COPD. Emphysema, however, appears to be more closely related to disease severity.

PMID: 29692536 [PubMed]

https://ift.tt/2I2AFAZ

t-PA power-pulse spray with rheolytic mechanical thrombectomy using cross-sectional image-guided portal vein access for single setting treatment of subacute superior mesenteric vein thrombosis.

t-PA power-pulse spray with rheolytic mechanical thrombectomy using cross-sectional image-guided portal vein access for single setting treatment of subacute superior mesenteric vein thrombosis.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):93-98

Authors: Syed MI, Gallagher RM, Ahmed RS, Shaikh A, Roberto E, Patel S

Abstract
Background: Isolated superior mesenteric vein (SMV) thrombosis is a rare but potentially fatal condition if untreated. Current treatments include transjugular or transhepatic approaches for rheolytic mechanical thrombectomy and subsequent infusions of thrombolytics. Tissue plasminogen activator (t-PA) power-pulse spray can provide benefit in a single setting without thrombolytic infusions. Computed tomography (CT) guidance for portal vein access is underutilized in this setting.
Materials and Methods: Case 1 discusses acute SMV thrombosis treated with rheolytic mechanical thrombectomy alone using ultrasound guidance for portal vein access. Case 2 discusses subacute SMV thrombosis treated with the addition of t-PA power-pulse spray to the rheolytic mechanical thrombectomy, using CT guidance for portal vein access.
Results: With rheolytic mechanical thrombectomy alone, the patient in Case 1 had significant improvement in abdominal pain. Follow-up CT demonstrated no residual SMV thrombosis and the patient continued to do well in long-term follow-up. With the addition of t-PA power-pulse spray to rheolytic mechanical thrombectomy, the patient in Case 2 with subacute SMV thrombosis dramatically improved postprocedure with resolution of abdominal pain. Follow-up imaging demonstrated patency to the SMV and partial resolution of thrombus. The patient continued to do well at 2-year follow-up.
Conclusions: Adding t-PA power-pulse spray to rheolytic mechanical thrombectomy can provide benefit in a single setting versus mechanical thrombectomy alone and prevent the need for subsequent infusions of thrombolytic therapy. CT guidance is a useful alternative of localization for portal vein access via the transhepatic route that is nonoperator-dependent and helpful in the case of obese patients.

PMID: 29692535 [PubMed]

https://ift.tt/2Fk2fXP

Analysis of the time course of changes in imaging findings of small arteries embolized with the N-Butyl cyanoacrylate-lipiodol mixture.

Analysis of the time course of changes in imaging findings of small arteries embolized with the N-Butyl cyanoacrylate-lipiodol mixture.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):81-84

Authors: Tokue H, Tokue A, Tsushima Y

Abstract
Background: There are no reports analyzing imaging findings of arteries embolized with N-butyl cyanoacrylate (NBCA)-Lipiodol. To evaluate the time course of changes in the imaging findings of small arteries embolized with NBCA-Lipiodol.
Materials and Methods: Selective transcatheter arterial embolization procedures via the inferior phrenic artery (right IPA, n = 25; left IPA, n = 5) were performed in 30 patients (25 males, 5 females; mean age 63 years, range: 45-78) at our institution. The NBCA-Lipiodol mixture was used as an embolic agent. The ratio of NBCA to Lipiodol was 1:4 (Group-A, n = 16) or 1:8 (Group-B, n = 14).We retrospectively reviewed the computed tomography (CT) findings and outcomes of small arteries embolized with the NBCA-Lipiodol mixture. The residual lipiodol was compared between Group-A and Group-B. The Student's t-test and Chi-square test were used for statistical analyses. In addition, the residual lipiodol rate was calculated using the Kaplan-Meier method and compared using the log-rank test.
Results: The mean observation period was 264 ± 84 days (range: 104-425). Lipiodol completely disappeared in 20 arteries (66%) during follow-up. Recanalization of arterial flow was not seen in CT images, even when Lipiodol disappeared. Group-B showed a shorter period of progression to disappearance of Lipiodol than Group-A (P < 0.05). On follow up, the rate of residual Lipiodol in Group-A was higher than that in Group-B (P < 0.05).
Conclusion: Residual Lipiodol was expected to gradually disappear. Lipiodol disappeared early when the density of NBCA was low in the NBCA-Lipiodol mixture. Further evaluations of various arteries and ratios of NBCA to Lipiodol are needed.

PMID: 29692533 [PubMed]

https://ift.tt/2FoaceA

Emphysematous osteomyelitis: Report of two cases and review of literature.

Emphysematous osteomyelitis: Report of two cases and review of literature.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):78-80

Authors: Khanduri S, Singh M, Goyal A, Singh S

Abstract
Emphysematous osteomyelitis is a rare condition characterized by the presence of intraosseous gas. A prompt diagnosis is required for this disease to expedite management as it is a potentially fatal condition. Many comorbidities, such as malignancy, diabetes mellitus, alcohol abuse, Crohn's disease, and other etiologies causing immunosuppression, predispose to this condition. The causative organisms are generally anaerobes or members of Enterobacteriaceae family; however, the infection can be mono or polymicrobial. We report two cases affected with emphysematous osteomyelitis due to varied underlying comorbidities. The purpose of this study is to (a) emphasize the importance of computed tomography in diagnosing emphysematous osteomyelitis and (b) to highlight an unusual location of this rare pathology.

PMID: 29692532 [PubMed]

https://ift.tt/2I3cdQc

Can MRI diffusion-weighted imaging identify postoperative residual/recurrent soft-tissue sarcomas?

Can MRI diffusion-weighted imaging identify postoperative residual/recurrent soft-tissue sarcomas?

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):70-77

Authors: ElDaly MM, Moustafa AFI, Abdel-Meguid SMS, Shokry AM, El Wahab NA

Abstract
Purpose: The aim of this study was to evaluate contrast-enhanced magnetic resonance imaging (CE-MRI) and quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping in the detection of recurrent/residual postoperative soft tissue sarcomas.
Materials and Methods: This study included 36 patients; 27 patients had postoperative recurrent/residual soft tissue sarcomas and 9 patients had postoperative and treatment-related changes (inflammation/fibrosis). The DWI was obtained with 3 b values including 0, 400, and 800 s/mm2. Calculation of the ADC value of the lesion was done via placing the region of interest (ROI) to include the largest area of the lesion. ADC values were compared to histopathology.
Results: Our results showed that including CE-MRI improved the diagnostic accuracy and sensitivity in recurrence detection compared to conventional non-enhanced sequences. However, it showed low specificity (55.56%) with a high false-positive rate that may lead to an unnecessary biopsy of a mass such as region of postoperative scar tissue.
Conclusion: The joint use of gadolinium-enhanced MRI and quantitative DWI with ADC mapping offer added value in the detection of recurrent/residual postoperative soft tissue sarcoma. This combined use increased both the diagnostic sensitivity and specificity with a cut-off average ADC value for detecting nonmyxoid recurrent/residual lesions ≤1.3 × 10-3 mm2/s (100% specificity and 90.48% sensitivity). Our results showed limited value of DWI with ADC mapping in assessing myxoid sarcomatous tumor recurrences.

PMID: 29692531 [PubMed]

https://ift.tt/2HsoyAh

Primary presentation of Jeune's syndrome as gastric motility disorder in an infant: A case report.

Primary presentation of Jeune's syndrome as gastric motility disorder in an infant: A case report.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):65-69

Authors: Katyan A, Grover SB, Rajani H, Bagga D, Antil N

Abstract
We report a case of a 4-week-old female neonate with Jeune's asphyxiating thoracic dystrophy (JATD) and coexistent situs anomaly, primarily presenting as gastric motility disorder. The child presented with abdominal distension and nonbilious vomiting since birth with failure to thrive. However, skeletal survey revealed JATD. Upper gastrointestinal contrast study showed situs inversus with delayed gastric emptying. Pyloric biopsy and intraoperative antro-duodenal manometry confirmed association of gastric motility disorder. Awareness of the unusual possibility of primary presentation of Jeune syndrome as gastric motility disorder will improve the management approach in such infants.

PMID: 29692530 [PubMed]

https://ift.tt/2I18mD4

Portal vein thrombosis after donor liver biopsy: Case report.

Portal vein thrombosis after donor liver biopsy: Case report.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):61-64

Authors: Bashir S, Mittal K, Khisti R, Yadav A, Mukund A, Pamecha V

Abstract
Percutaneous plugged liver biopsy is a safe procedure with a low complication rate. Portal vein thrombosis has not been reported after percutaneous liver biopsy in the literature. We present a case of portal vein thrombosis after percutaneous plugged liver biopsy in a voluntary liver donor, which was subsequently treated with catheter-directed percutaneous transhepatic thrombolysis. In future, healthy patients undergoing liver biopsies are expected to increase for donor evaluation. More refinements of technique and hardware in the future may further decrease the rate of complications. However, if they occur, they need to be recognized and managed at the earliest.

PMID: 29692529 [PubMed]

https://ift.tt/2JwzNUK

Comparative diagnostic test accuracy of post-esophagectomy water-soluble computed tomography and fluoroscopic swallow studies: A meta-analysis.

Comparative diagnostic test accuracy of post-esophagectomy water-soluble computed tomography and fluoroscopic swallow studies: A meta-analysis.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):55-60

Authors: Murray TE, Morrin M

Abstract
Aims: Both fluoroscopic water-soluble contrast swallow (FWSCS) and CT water-soluble contrast swallow (CTWSCS) are widely performed as a routine in the post-esophagectomy patient to assess for anastomotic leak. Several prospective studies have compared FWSCS and CTWSCS; however, no synthesis of the data exists.
Materials and Methods: Systematic review and meta-analysis of diagnostic test accuracy studies comparing FWSCS and CTWSCS in the adult patient following esophagectomy for malignancy was performed in accordance with PRISMA guidelines.
Results: Three diagnostic test accuracy studies met the inclusion criteria, directly comparing FWSCS and CTWSCS in 185 patients. FWSCS demonstrated high specificity (98%), but low sensitivity (64%). CTWSCS can be categorized as normal, mediastinal gas without contrast leak, or leakage of oral contrast. Visible leakage of oral contrast demonstrated high specificity (98%) but low sensitivity (56%). The presence of mediastinal gas increased sensitivity (84%), but reduced specificity (85%). The higher sensitivity of CTWSCS over FWSCS failed to reach significance (P = 0.125).
Conclusion: CTWSCS shares the high specificity of FWSCS. Its higher sensitivity increases its utility as a rule-out test in the postoperative period. Additional factors that may influence decision-making are described.

PMID: 29692528 [PubMed]

https://ift.tt/2KiO60n

Gangrenous cholecystitis: Analysis of imaging findings in histopathologically confirmed cases.

Gangrenous cholecystitis: Analysis of imaging findings in histopathologically confirmed cases.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):49-54

Authors: Sureka B, Rastogi A, Mukund A, Thapar S, Bhadoria AS, Chattopadhyay TK

Abstract
Purpose: To study the imaging findings in gangrenous acute cholecystitis.
Materials and Methods: Retrospective analysis of imaging findings in 31 histopathologically confirmed cases of gangrenous cholecystitis was done. The following imaging findings were analyzed: wall thickness, gallbladder distension, intraluminal membranes, mural striation, edema, wall enhancement, gallstones, gas, pericholecystic fluid, stranding, hemorrhage, hyperaemia in adjacent liver, mucosal/wall irregularity, complications.
Statistical Analysis: Appropriate statistical tests were used using SPSS.22.0 software. The two proportions were compared using Chi-square or Fisher exact test and two means were compared using student t test.
Results: Mean gallbladder wall thickening was 6 ± 1.93 mm. Gallstones, mural edema, mural striation, pericholecystic fluid, intraluminal membranes, gas were seen in 30, 27, 18, 20, 14 and 3 cases respectively. The mean short-axis distension of gallbladder lumen was 4.24 ± 0.91 cm. Gallbladder wall enhancement was studied in only 10 cases. Complete absence of enhancement was seen in 1, focal decreased enhancement in 8 cases. Mucosal/wall irregularity was seen in 28 cases. 74.2% cases had ≥4 cm gallbladder distension. Intraluminal membranes were present in 14 cases with mean short-axis distension of 4.6 cm and absent in 17 (P = 0.041), in 11 cases with mural striation (P = 0.036). Mean wall thickening was 6.69mm in patients with intraluminal membranes and 5.46 mm with absence of membranes (P = .078).
Conclusion: Presence of more than one of these findings - gallbladder distension (short axis diameter of ≥4 cm), intraluminal membranes, mural striation, absent or decreased enhancement of gallbladder wall suggest high probability of gangrenous change in acute cholecystitis.

PMID: 29692527 [PubMed]

https://ift.tt/2JwKFSN

Hernia uteri inguinalis in ovotesticular disorder of sexual differentiation: A rare complication and role of imaging.

Hernia uteri inguinalis in ovotesticular disorder of sexual differentiation: A rare complication and role of imaging.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):41-44

Authors: Ponnatapura J

Abstract
Neonate with ambiguous genitalia can cause great apprehension for the family as well as for healthcare providers. We report a rare complication of delayed diagnosis of hernia uteri inguinalis in ovotesticular disorder of sexual differentiation (DSD) in 20-year-old male patient who presented with pain and swelling in left inguinal region since 1 month. He had a past surgical history of repair of hypospadias 10 years back. On imaging, the left inguinal hernia sac contained nonfunctioning uterus and one ovary in the left scrotal sac and one testis in the right scrotal sac. Further investigation confirmed genotypically female (46XX) with negative sex determining region-Y gene on fluorescence in situ hybridization. The patient was given psychiatric counseling and wished to remain as male. The left inguinal hernia was repaired with excision of nonfunctioning uterus, ovary, and fallopian tube. Hernia uteri inguinalis is rare complication seen in DSD with only three cases being reported worldwide thus far, including our case.

PMID: 29692525 [PubMed]

https://ift.tt/2JwAz4i

Different etiologies of an unusual disease: Colouterine fistula - Report of two cases.

Different etiologies of an unusual disease: Colouterine fistula - Report of two cases.

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):37-40

Authors: Aggarwal R, Indiran V, Maduraimuthu P

Abstract
Colouterine fistula is an extremely rare condition, as the uterus is a thick, muscular organ. Here, we present two different etiologies for this rare condition-diverticulitis and malignancy. A 77-year-old female with colouterine fistula due to diverticulitis presented with complaints of lower abdominal pain localized particularly in the left iliac fossa and fever. Another case was of 73-year-old female with colouterine fistula due to malignancy who presented with abdominal pain, blood in stools, and whitish discharge from vagina. Both cases were evaluated with contrast-enhanced computed tomography (CECT). The presence of air and fluid within the uterus on ultrasound or CT scan, prompts the possibility of colouterine fistula with CECT providing accurate preoperative assessment.

PMID: 29692524 [PubMed]

https://ift.tt/2KhPSiD

Comparison of MDCT, MRI and MRI with diffusion-weighted imaging in evaluation of focal renal lesions: The defender, challenger, and winner!

Comparison of MDCT, MRI and MRI with diffusion-weighted imaging in evaluation of focal renal lesions: The defender, challenger, and winner!

Indian J Radiol Imaging. 2018 Jan-Mar;28(1):27-36

Authors: Goyal A, Sharma R, Bhalla AS, Gamanagatti S, Seth A

Abstract
Purpose: To compare the diagnostic performance of multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and MRI with diffusion-weighted imaging (DWI) in the characterization of focal renal lesions. We also compared MDCT and MRI in the staging of renal cell carcinoma (RCC).
Materials and Methods: One hundred and twenty adult patients underwent MDCT (40-row and 128-row scanners), MRI (at 1.5 T), and DWI (at b-values of 0 and 500 s/mm2) for characterization of 225 renal lesions. There were 65 malignant neoplasms (44 RCCs), 25 benign neoplasms, 25 abscesses, 45 pseudotumors, 15 hemorrhagic cysts, and 50 benign cysts. A composite gold standard including histology, typical imaging criteria, and follow-up imaging was employed. To determine the diagnostic performance of imaging modalities, area-under-curve (AUC) was calculated by receiver-operating-characteristic analysis and compared. Fisher's exact test was used to compare the diagnostic accuracies and confidence levels with MDCT, MRI, and MRI + DWI. Cross-tabulation was used to assess the precision of MDCT and MRI in RCC staging.
Results: AUC for MDCT (0.834) and MRI (0.841) in the classification of benign and malignant lesions were within corresponding 95% confidence interval (CI) (P = 0.88) whereas MRI + DWI had significantly better performance (AUC 0.968, P = 0.0002 and 0.0004, respectively). Both CT and MRI had low specificity (66.9% and 68.8%, respectively), which increased substantially with DWI (93.8%) owing to correct diagnosis of pseudotumors. MRI was superior to CT in diagnosing necrotic RCC and hemorrhagic cysts. MRI + DWI had the highest accuracy (94.2%) in assigning the definitive diagnosis and 97.6% lesions were diagnosed with very high confidence, significantly better than CT and MRI. Both CT and MRI had the same accuracy (86.1%) in RCC staging and evaluation of intravascular thrombi.
Conclusions: Characterization of renal lesions was most accurate with MRI + DWI. The latter is also the most suitable modality in diagnosing pseudotumors and evaluating patients with renal dysfunction. CT and MRI were equivalent in RCC staging.

PMID: 29692523 [PubMed]

https://ift.tt/2Jykuef

Antibody-based vaccine strategies against intracellular pathogens

Arturo Casadevall

https://ift.tt/2vSxdGU

Lymphatic endothelial progenitor cells: origins and roles in lymphangiogenesis

Jan Kazenwadel | Natasha L Harvey

https://ift.tt/2vSxd9S

Improving the signal detection accuracy of functional Magnetic Resonance Imaging

Publication date: 1 August 2018
Source:NeuroImage, Volume 176
Author(s): Niels Janssen, Juan A. Hernández-Cabrera, Laura Ezama Foronda
A major drawback of functional Magnetic Resonance Imaging (fMRI) concerns the lack of detection accuracy of the measured signal. Although this limitation stems in part from the neuro-vascular nature of the fMRI signal, it also reflects particular methodological decisions in the fMRI data analysis pathway. Here we show that the signal detection accuracy of fMRI is affected by the specific way in which whole-brain volumes are created from individually acquired brain slices, and by the method of statistically extracting signals from the sampled data. To address these limitations, we propose a new framework for fMRI data analysis. The new framework creates whole-brain volumes from individual brain slices that are all acquired at the same point in time relative to a presented stimulus. These whole-brain volumes contain minimal temporal distortions, and are available at a high temporal resolution. In addition, statistical signal extraction occurred on the basis of a non-standard time point-by-time point approach. We evaluated the detection accuracy of the extracted signal in the standard and new framework with simulated and real-world fMRI data. The new slice-based data-analytic framework yields greatly improved signal detection accuracy of fMRI signals.

https://ift.tt/2HPAyv4

Multi-voxel pattern classification differentiates personally experienced event memories from secondhand event knowledge

Publication date: 1 August 2018
Source:NeuroImage, Volume 176
Author(s): Tiffany E. Chow, Andrew J. Westphal, Jesse Rissman
Studies of autobiographical memory retrieval often use photographs to probe participants' memories for past events. Recent neuroimaging work has shown that viewing photographs depicting events from one's own life evokes a characteristic pattern of brain activity across a network of frontal, parietal, and medial temporal lobe regions that can be readily distinguished from brain activity associated with viewing photographs from someone else's life (Rissman, Chow, Reggente, and Wagner, 2016). However, it is unclear whether the neural signatures associated with remembering a personally experienced event are distinct from those associated with recognizing previously encountered photographs of an event. The present experiment used a novel functional magnetic resonance imaging (fMRI) paradigm to investigate putative differences in brain activity patterns associated with these distinct expressions of memory retrieval. Eighteen participants wore necklace-mounted digital cameras to capture events from their everyday lives over the course of three weeks. One week later, participants underwent fMRI scanning, where on each trial they viewed a sequence of photographs depicting either an event from their own life or from another participant's life and judged their memory for this event. Importantly, half of the trials featured photographic sequences that had been shown to participants during a laboratory session administered the previous day. Multi-voxel pattern analyses assessed the sensitivity of two brain networks of interest—as identified by a meta-analysis of prior autobiographical and laboratory-based memory retrieval studies—to the original source of the photographs (own life or other's life) and their experiential history as stimuli (previewed or non-previewed). The classification analyses revealed a striking dissociation: activity patterns within the autobiographical memory network were significantly more diagnostic than those within the laboratory-based network as to whether photographs depicted one's own personal experience (regardless of whether they had been previously seen), whereas activity patterns within the laboratory-based memory network were significantly more diagnostic than those within the autobiographical memory network as to whether photographs had been previewed (regardless of whether they were from the participant's own life). These results, also apparent in whole-brain searchlight classifications, provide evidence for dissociable patterns of activation across two putative memory networks as a function of whether real-world photographs trigger the retrieval of firsthand experiences or secondhand event knowledge.

https://ift.tt/2HzGZPs

Correction of eyelid retraction using a half-thickness tarsal flap for lengthening of the eyelid following ptosis surgery

Abstract

Various surgical procedures for correction of upper eyelid retraction have been reported, many of which have had favorable results. However, most of these reports are concerned with the correction of upper eyelid retraction in patients with thyroid ophthalmopathy, and few have focused on upper eyelid retraction caused by overcorrection during ptosis surgery. Corrective surgery for upper eyelid retraction resulting from ptosis surgery is often difficult because of the extensive irregular contracture caused by scar tissue. However, as this is a repeat surgery following ptosis surgery, it is important to ensure good postoperative evaluation indices, particularly favorable symmetry, appropriate palpebral fissure width, appropriate crease height, and natural-looking parabolic eyelid margins. Here, we report the lengthening of the upper eyelids using a half-thickness tarsal flap to address upper eyelid retraction secondary to ptosis surgery. By using a half-thickness tarsal flap, the anatomy of the levator insertion onto the tarsal plate is retained, so that good eyelid contour can be obtained, and the results are quantitatively reproducible. Therefore, this technique can be considered for the treatment of upper eyelid retraction and has a potentially wide range of applications.

Level of Evidence: Level V, therapeutic study.

https://ift.tt/2HySWVG

Antituberculosis drug isoniazid degraded by electro-Fenton and photoelectro-Fenton processes using a boron-doped diamond anode and a carbon-PTFE air-diffusion cathode

Abstract

Solutions with 0.65 mM of the antituberculosis drug isoniazid (INH) in 0.050 M Na₂SO₄ at pH 3.0 were treated by electro-Fenton (EF) and UVA photoelectro-Fenton (PEF) processes using a cell with a BDD anode and a carbon-PTFE air-diffusion cathode. The influence of current density on degradation, mineralization rate, and current efficiency has been thoroughly evaluated in EF. The effect of the metallic catalyst (Fe²⁺ or Fe³⁺) and the formation of products like short-chain linear aliphatic carboxylic acids were assessed in PEF. Two consecutive pseudo-first-order kinetic regions were found using Fe²⁺ as catalyst. In the first region, at short time, the drug was rapidly oxidized by ^●OH, whereas in the second region, at longer time, a resulting Fe(III)-INH complex was much more slowly removed by oxidants. INH disappeared completely at 300 min by EF, attaining 88 and 94% mineralization at 66.6 and 100 mA cm⁻², respectively. Isonicotinamide and its hydroxylated derivative were identified as aromatic products of INH by GC-MS and oxalic, oxamic, and formic acids were quantified by ion-exclusion HPLC. The PEF treatment of a real wastewater polluted with the drug led to slower INH and TOC abatements because of the parallel destruction of its natural organic matter content.

https://ift.tt/2HtSPyI

Dictionary-based monitoring of premature ventricular contractions: An ultra-low-cost point-of-care service

Publication date: Available online 26 April 2018
Source:Artificial Intelligence in Medicine
Author(s): S. Chandra Bollepalli, S. Sastry Challa, Laxminarayana Anumandla, Soumya Jana
While cardiovascular diseases (CVDs) are prevalent across economic strata, the economically disadvantaged population is disproportionately affected due to the high cost of traditional CVD management, involving consultations, testing and monitoring at medical facilities. Accordingly, developing an ultra-low-cost alternative, affordable even to groups at the bottom of the economic pyramid, has emerged as a societal imperative. Against this backdrop, we propose an inexpensive yet accurate home-based electrocardiogram (ECG) monitoring service. Specifically, we seek to provide point-of-care monitoring of premature ventricular contractions (PVCs), high frequency of which could indicate the onset of potentially fatal arrhythmia. Note that the first-generation telecardiology system acquires the ECG, transmits it to a professional diagnostic center without processing, and nearly achieves the diagnostic accuracy of a bedside setup. In the process, such a system incurs high bandwidth cost and requires the physicians to process the entire record for diagnosis. To reduce cost, current telecardiology systems compress data before transmitting. However, the burden on physicians remains undiminished. In this context, we develop a dictionary-based algorithm that reduces not only the overall bandwidth requirement, but also the physicians workload by localizing anomalous beats. Specifically, we detect anomalous beats with high sensitivity and only those beats are then transmitted. In fact, we further compress those beats using class-specific dictionaries subject to suitable reconstruction/diagnostic fidelity. Finally, using Monte Carlo cross validation on MIT/BIH arrhythmia database, we evaluate the performance of the proposed system. In particular, with a sensitivity target of at most one undetected PVC in one hundred beats, and a percentage root mean squared difference less than 9% (a clinically acceptable level of fidelity), we achieved about 99.15% reduction in bandwidth cost, equivalent to 118-fold savings over first-generation telecardiology. In the process, the professional workload is reduced by at least 85.9% for noncritical cases. Our algorithm also outperforms known algorithms under certain measures in the telecardiological context.

Graphical abstract

https://ift.tt/2vM1EhK

An intelligent algorithm for identification of optimum mix of demographic features for trust in medical centers in Iran

Publication date: Available online 26 April 2018
Source:Artificial Intelligence in Medicine
Author(s): R. Yazdanparast, S. Abdolhossein Zadeh, D. Dadras, A. Azadeh
Healthcare quality is affected by various factors including trust. Patients' trust to healthcare providers is one of the most important factors for treatment outcomes. The presented study identifies optimum mixture of patient demographic features with respect to trust in three large and busy medical centers in Tehran, Iran. The presented algorithm is composed of adaptive neuro-fuzzy inference system and statistical methods. It is used to deal with data and environmental uncertainty. The required data are collected from three large hospitals using standard questionnaires. The reliability and validity of the collected data is evaluated using Cronbach's Alpha, factor analysis and statistical tests. The results of this study indicate that middle age patients with low level of education and moderate illness severity and young patients with high level of education, moderate illness severity and moderate to weak financial status have the highest trust to the considered medical centers. To the best of our knowledge this the first study that investigates patient demographic features using adaptive neuro-fuzzy inference system in healthcare sector. Second, it is a practical approach for continuous improvement of trust features in medical centers. Third, it deals with the existing uncertainty through the unique neuro-fuzzy approach.

https://ift.tt/2r233vW

MuDeRN: Multi-category classification of breast histopathological image using deep residual networks

Publication date: Available online 26 April 2018
Source:Artificial Intelligence in Medicine
Author(s): Ziba Gandomkar, Patrick C. Brennan, Claudia Mello-Thoms
MotivationIdentifying carcinoma subtype can help to select appropriate treatment options and determining the subtype of benign lesions can be beneficial to estimate the patients' risk of developing cancer in the future. Pathologists' assessment of lesion subtypes is considered as the gold standard, however, sometimes strong disagreements among pathologists for distinction among lesion subtypes have been previously reported in the literature.ObjectiveTo propose a framework for classifying hematoxylin-eosin stained breast digital slides either as benign or cancer, and then categorizing cancer and benign cases into four different subtypes each.Materials and methodsWe used data from a publicly available database (BreakHis) of 81 patients where each patient had images at four magnification factors (×40, ×100, ×200, and ×400) available, for a total of 7786 images. The proposed framework, called MuDeRN (MUlti-category classification of breast histopathological image using DEep Residual Networks) consisted of two stages. In the first stage, for each magnification factor, a deep residual network (ResNet) with 152 layers has been trained for classifying patches from the images as benign or malignant. In the next stage, the images classified as malignant were subdivided into four cancer subcategories and those categorized as benign were classified into four subtypes. Finally, the diagnosis for each patient was made by combining outputs of ResNets' processed images in different magnification factors using a meta-decision tree.ResultsFor the malignant/benign classification of images, MuDeRN's first stage achieved correct classification rates (CCR) of 98.52%, 97.90%, 98.33%, and 97.66% in ×40, ×100, ×200, and ×400 magnification factors respectively. For eight-class categorization of images based on the output of MuDeRN's both stages, CCRs in four magnification factors were 95.40%, 94.90%, 95.70%, and 94.60%. Finally, for making patient-level diagnosis, MuDeRN achieved a CCR of 96.25% for eight-class categorization.ConclusionsMuDeRN can be helpful in the categorization of breast lesions.

https://ift.tt/2vRtEk7

Extended IgE profile based on an allergen macroarray: a novel tool for precision medicine in allergy diagnosis

Precision medicine (PM) is changing the scope of allergy diagnosis and treatment. An in vitro IgE assay, a prototype PM method, was developed in the sixties and has garnered increasing interest because of the ...

https://ift.tt/2HPvZ3U

The Battle Ground between Two Giants: Toe Transfer and Hand Allotransplantation

J reconstr Microsurg
DOI: 10.1055/s-0038-1639513

A few severe hand injuries represent a gray zone for the reconstructive surgeon, for which autologous tissue transfer and allotransplantation can yield satisfactory results, but not without downsides or morbidity.This article is written to address the dilemma of application of both techniques in those selected cases.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Abstract | Full text

https://ift.tt/2I4MuXK

Modeling the oxygen transport process under preferential flow effect in landfill

Abstract

Evaluation of oxygen distribution during aeration in landfill is significantly important to determine the design parameters of an injection well. A coupling model describing gas preferential transport in a landfill was developed, which linked the effect of advection–diffusion and oxidation reaction and mass exchange between the fracture and the matrix system. The quantitative simulation of the variation in gas distribution during vertical well aeration in short term was presented, combined with the typical cases in field site. The parameter sensitivity in the coupling model to gas transport was addressed. Simulation result of the oxygen and methane concentrations by using the dual advective–diffusive (DAD) model, which considered the immobile zone effect, was closer to the monitoring data than that by using single advective–diffusive model. The variation of the AR under aeration was presented with the key parameters to provide the theory evidence for gas well design in landfill. This study provided reference for the design of the gas injection well distribution in aerobic landfill.

https://ift.tt/2FjXDAV

High dimensional immune biomarkers demonstrate differences in phenotypes and endotypes in food allergy and asthma

Advances in high throughput technologies and big data analytics are rapidly increasing our understanding of the role of various immune cells and factors associated with atopic disease beyond the Th1/Th2 axis. Many children and adults with atopy can suffer from co-morbid conditions like having food allergy and chronic asthma, which can increase the risk of anaphylaxis and fatal reactions to a food allergen. Further understanding of the contributions and roles of the different immune cell subsets would be of great value in understanding the food allergy-asthma co-morbid clinical phenotype.

https://ift.tt/2I2lrMl

From the pages of allergywatch June 2018

Allergic contact dermatitis (ACD) is a common condition in children, and may become a recurrent and chronic problem. Patch testing is the standard for diagnosis of ACD. The authors review their center's 10-year experience with pediatric patch testing. From 2005 to 2015, 157 children and adolescents underwent patch testing at the authors' dermatology department. Test procedures followed North American Contact Dermatitis Group standards. The median patient age was 13 years; 58.6% were female. Symptoms were present for 6 months to 2 years in about one-third of patients, and longer than 2 years in nearly half.

https://ift.tt/2FkeFyS

MAGE-A antigens as targets for cancer immunotherapy

Publication date: Available online 26 April 2018
Source:Cancer Treatment Reviews
Author(s): Erik Schooten, Alessia Di Maggio, Paul M.P. van Bergen en Henegouwen, Marta M. Kijanka
Targeted anti-cancer therapies aim at reducing side effects while retaining their anti-cancer efficacy. Immunotherapies e.g. monoclonal antibodies, adoptive T cell therapy and cancer vaccines are used to combat cancer, but the number of available cancer specific targets is limited and new approaches are needed to generate more effective and patient tailored treatments. Unique cancer intracellular epitopes can be presented on the cell surface by MHC class I molecules, which can function as epitopes for targeted therapies. The intracellular MAGE proteins belong to a sub-class of Cancer Testis (CT) antigens which are expressed in germline cells and a wide variety of tumors of different histological origin. Evidence has emerged that their expression is linked to pro-tumorigenic activities like increased cell motility, resisting cell death, and tumor promoting inflammation. Intracellular MAGE proteins are processed by the proteasome and their peptides are presented by MHC class I molecules on the cell surface of cancer cells thereby making them ideal cancer specific antigens. Here we review the previous and ongoing (pre-) clinical studies on the use of surface expressed MAGE antigens for their employment in targeted anti-cancer therapies. We present and analyze study outcomes and discuss possible future directions and improvements for MAGE directed anti-cancer immunotherapies.

https://ift.tt/2I0TdSe

Untying the Gordion Knot of Targeting MET in Cancer

Publication date: Available online 26 April 2018
Source:Cancer Treatment Reviews
Author(s): Kanwal Raghav, Ann Marie Bailey, Jonathan M. Loree, Scott Kopetz, Vijaykumar Holla, Timothy Anthony Yap, Fang Wang, Ken Chen, Ravi Salgia, David Hong
Despite compelling evidence backing the crucial role of a dysregulated MET axis in cancer and a myriad of agents targeting this pathway in active clinical development, the therapeutic value of MET inhibition in cancer oncology remains to be established. Although a series of disappointing clinical trials, at first, lessened fervor for targeting this pathway, investigations continue unabated with a number of novel active compounds entering clinical trials. Suboptimal designs which lacked biomarker selection have been the main reason for these early failures and this has stimulated a more biomarker enriched approach lately. Fresh insights into the mechanics of diverse MET aberrations (amplifications and mutations) have allowed trial enrichment for appropriate patients in appropriate disease settings. Development of MET inhibition as a therapeutic strategy in cancer has been a lesson in itself reflecting the challenging opportunities enclosed in the genetic landscape of cancer. Here, we will review the status of MET targeted therapy in development as it stands today, discuss emerging paradigms in MET inhibition and theorize on concepts for future development. We venture to propose that in spite of early disappointments, the future of this therapeutic strategy is promising with use of appropriate predictive biomarker in the right clinical context.

https://ift.tt/2Flepzw

Exploding Head Syndrome as Aura of Migraine with Brainstem Aura: A Case Report.

Exploding Head Syndrome as Aura of Migraine with Brainstem Aura: A Case Report.

J Oral Facial Pain Headache. 2018 Spring;32(2):e34-e36

Authors: Rossi FH, Gonzalez E, Rossi EM, Tsakadze N

Abstract
This article reports a case of exploding head syndrome (EHS) as an aura of migraine with brainstem aura (MBA). A middle-aged man presented with intermittent episodes of a brief sensation of explosion in the head, visual flashing, vertigo, hearing loss, tinnitus, confusion, ataxia, dysarthria, and bilateral visual impairment followed by migraine headache. The condition was diagnosed as MBA. Explosive head sensation, sensory phenomena, and headaches improved over time with nortriptyline. This case shows that EHS can present as a primary aura symptom in patients with MBA.

PMID: 29694468 [PubMed - in process]

https://ift.tt/2KePCAM

Computer-Aided Design/Computer-Assisted Manufacture-Derived Needle Guide for Injection of Botulinum Toxin into the Lateral Pterygoid Muscle in Patients with Oromandibular Dystonia.

Computer-Aided Design/Computer-Assisted Manufacture-Derived Needle Guide for Injection of Botulinum Toxin into the Lateral Pterygoid Muscle in Patients with Oromandibular Dystonia.

J Oral Facial Pain Headache. 2018 Spring;32(2):e13-e21

Authors: Yoshida K

Abstract
AIMS: To evaluate the effectiveness and safety of botulinum toxin administration into the inferior head of the lateral pterygoid muscle of patients with jaw opening dystonia by using a computer-aided design/computer-assisted manufacture (CAD/CAM)-derived needle guide.
METHODS: A total of 17 patients with jaw opening dystonia were enrolled. After the patient's computed tomography (CT) scan was imported and fused with a scan of a plaster cast model of the maxilla, the optimal needle insertion site over the lateral pterygoid muscle was determined using the NobelClinician software. A total of 13 patients were injected both with and without the guide, and 4 patients underwent guided injection alone. The therapeutic effects of botulinum toxin injection and its associated complications were statistically compared between the guided and unguided procedures using paired t test.
RESULTS: Botulinum toxin therapy was performed 42 and 32 times with and without the guides, respectively. The needle was easily inserted without any complications in all procedures. There was a significant difference (P < .001) between the mean comprehensive improvements observed with (66.3%) and without (54.4%) the guides.
CONCLUSION: The findings suggest that the use of needle guides during the injection of botulinum toxin into the inferior head of the lateral pterygoid muscle is very useful for aiding the accurate and safe administration of botulinum toxin therapy for jaw opening dystonia.

PMID: 29694466 [PubMed - in process]

https://ift.tt/2vSlVT2

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Πέμπτη 26 Απριλίου 2018

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