Source:Clinical Neurophysiology
Author(s): Jürgen Kayser
https://ift.tt/2z4Id5p
Δευτέρα 2 Ιουλίου 2018
Craig Emery Tenke, 1950–2017
Source:Clinical Neurophysiology
Author(s): Jürgen Kayser
https://ift.tt/2z4Id5p
Correction to: Genetic aberrations of the K-ras proto-oncogene in bladder cancer in relation to pesticide exposure
The original publication of this paper contains a mistake. Line 6 in the abstract, line should read "One hundred patients were diagnosed with bladder cancer and two hundred controls attended the outpatient clinic;"
https://ift.tt/2tXejdR
Biofilm architecture on different substrates of an Oculatella subterranea (Cyanobacteria) strain isolated from Pompeii archaeological site (Italy)
Abstract
The Cyanobacterium Oculatella subterranea Zammit, Billi, Albertano inhabits hypogea and stone caves and is a pioneer of different stone substrata. In this study, a strain isolated from the House of Marco Castricio (Archaeological Park of Pompeii, Italy) was identified by a polyphasic approach and used for an in vitro colonization test to verify the influence of the substrate on the biofilm architecture. Fine structure of O. subterranea microbial mats was revealed as well as filaments orientation toward light source. This aim has been achieved through confocal laser scanner microscope microscopy and computer image analysis. Moreover, bioreceptivity of five different substrates, commonly retrieved in archaeological sites of Campania, was assessed for O. subterranea. Our results show that the three-dimensional structure of O. subterranea microbial mats is poorly affected by physical and geochemical features of substrates: in fact, the porous architecture of its biofilm was preserved, independently of the materials. On the other hand, the area/perimeter ratio relative to the O. subterranea growth on tuff, brick, and porphyry showed significant differences, indicating dissimilar levels of bioreceptivity of the three substrates.
https://ift.tt/2lQcKe5
Evaluation and Diagnosis of Salivary Gland Neoplasms
Publication date: Available online 2 July 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Erica Jackson Mayland, Anna M. Pou
Salivary gland tumors are an uncommon heterogeneous group of neoplasms that vary in their anatomic site, histology and biologic behavior. Pleomorphic adenoma is the most common benign tumor and mucoepidermoid and adenoid cystic carcinoma are the most common malignant tumors. Evaluation and diagnosis of these tumors includes not only a complete history and head and neck exam, but also biopsy and imaging of the tumors. Controversy remains regarding the necessity and type of biopsy to be performed and the usefulness of imaging. This manuscript describes the utility of different diagnostic procedures in evaluating salivary gland neoplasms.
https://ift.tt/2IMrljJ
Cognitive impairment and morphological changes after radiation therapy in brain tumors: A review
Source:Radiotherapy and Oncology
Author(s): Julian Jacob, Thomas Durand, Loïc Feuvret, Jean-Jacques Mazeron, Jean-Yves Delattre, Khê Hoang-Xuan, Dimitri Psimaras, Hassen Douzane, Monica Ribeiro, Laurent Capelle, Alexandre Carpentier, Damien Ricard, Philippe Maingon
Life expectancy of patients treated for brain tumors has lengthened due to the therapeutic improvements. Cognitive impairment has been described following brain radiotherapy, but the mechanisms leading to this adverse event remain mostly unknown.Technical evolutions aim at enhancing the therapeutic ratio. Sparing of the healthy tissues has been improved using various approaches; however, few dose constraints have been established regarding brain structures associated with cognitive functions.The aims of this literature review are to report the main brain areas involved in cognitive adverse effects induced by radiotherapy as described in literature, to better understand brain radiosensitivity and to describe potential future improvements.
https://ift.tt/2KASk6P
Predicting the pathological response to neoadjuvant chemoradiation using untargeted metabolomics in locally advanced rectal cancer
Publication date: Available online 2 July 2018
Source:Radiotherapy and Oncology
Author(s): Huixun Jia, Xiaotao Shen, Yun Guan, Meimei Xu, Jia Tu, Miao Mo, Li Xie, Jing Yuan, Zhen Zhang, Sanjun Cai, Ji Zhu, ZhengJiang Zhu
PurposeThe present study aimed to identify a panel of potential metabolite biomarkers to predict tumor response to neoadjuvant chemo-radiation therapy (NCRT) in locally advanced rectal cancer (LARC).Experimental designLiquid chromatography–mass spectrometry (LC–MS)-based untargeted metabolomics was used to profile human serum samples (n = 106) from LARC patients treated with NCRT. The samples were collected from Fudan University Shanghai Cancer Center (FUSCC) from July 2014 to January 2016. Statistical methods, such as partial least squares (PLS) and Wilcoxon rank-sum test, were used to identify discriminative metabolites between NCRT-sensitive and NCRT-resistant patients according to their tumor regression grade (TRG). This trial is registered with Clinical Trials.gov, number NCT03149978.ResultsA panel of metabolites was selected as potential predictive biomarkers of pathological response to NCRT. A total of 4810 metabolic peaks were detected, and 57 significantly dysregulated peaks were identified. These 57 metabolic peaks were used to differentiate patients using PLS in a dataset containing NCRT-sensitive (n = 56) and NCRT-resistant (n = 49) patients. The combination of 57 metabolic peaks had AUC values of 0.88, 0.81 and 0.84 in the prediction models using PLS, random forest, and support vector machine, respectively, suggesting that metabolomics has the potential ability to predict responses to NCRT. Furthermore, 15 metabolite biomarkers were identified and used to construct a logistic regression model and explore dysregulated metabolic pathways using untargeted metabolic profiling and data mining approaches.ConclusionsA panel of metabolites has been identified to facilitate the prediction of tumor response to NCRT in LARC, which is promising for the generation of personalized treatment strategies for LARC patients.
https://ift.tt/2INIs4r
Sounds enhance visual completion processes
Source:NeuroImage, Volume 179
Author(s): Ruxandra I. Tivadar, Chrysa Retsa, Nora Turoman, Pawel J. Matusz, Micah M. Murray
Everyday vision includes the detection of stimuli, figure-ground segregation, as well as object localization and recognition. Such processes must often surmount impoverished or noisy conditions; borders are perceived despite occlusion or absent contrast gradients. These illusory contours (ICs) are an example of so-called mid-level vision, with an event-related potential (ERP) correlate at ∼100–150 ms post-stimulus onset and originating within lateral-occipital cortices (the ICeffect). Presently, visual completion processes supporting IC perception are considered exclusively visual; any influence from other sensory modalities is currently unknown. It is now well-established that multisensory processes can influence both low-level vision (e.g. detection) as well as higher-level object recognition. By contrast, it is unknown if mid-level vision exhibits multisensory benefits and, if so, through what mechanisms. We hypothesized that sounds would impact the ICeffect. We recorded 128-channel ERPs from 17 healthy, sighted participants who viewed ICs or no-contour (NC) counterparts either in the presence or absence of task-irrelevant sounds. The ICeffect was enhanced by sounds and resulted in the recruitment of a distinct configuration of active brain areas over the 70–170 ms post-stimulus period. IC-related source-level activity within the lateral occipital cortex (LOC), inferior parietal lobe (IPL), as well as primary visual cortex (V1) were enhanced by sounds. Moreover, the activity in these regions was correlated when sounds were present, but not when absent. Results from a control experiment, which employed amodal variants of the stimuli, suggested that sounds impact the perceived brightness of the IC rather than shape formation per se. We provide the first demonstration that multisensory processes augment mid-level vision and everyday visual completion processes, and that one of the mechanisms is brightness enhancement. These results have important implications for the design of treatments and/or visual aids for low-vision patients.
https://ift.tt/2tRUwgs
Similarity in functional brain architecture between rest and specific task modes: A model of genetic and environmental contributions to episodic memory
Source:NeuroImage, Volume 179
Author(s): Raluca Petrican, Brian T. Levine
The ability to keep a mental record of specific past events, dubbed episodic memory (EM), is key to lifespan adaptation. Nonetheless, the neural mechanisms underlying its typical inter-individual variability remain poorly understood. To address this issue, we tested whether individual differences in EM could be predicted from levels of functional brain re-organization between rest and task modes relevant to the transformation of perceptual information into mental representations (relational processing, meaning extraction, online maintenance versus updating of bound perceptual features). To probe the trait specificity of our model, we included three additional core mental functions, processing speed, abstract reasoning, and cognitive control. Finally, we investigated the extent to which our proposed model reflected genetic versus environmental contributions to EM variability. Hypotheses were tested by applying graph theoretical analysis and structural equation modeling to resting state and task fMRI data from two samples of participants in the Human Connectome Project (Sample 1: N = 338 unrelated individuals; Sample 2: N = 268 monozygotic vs. dizygotic twins [134 same-sex pairs]). Levels of functional brain reorganization between rest and the scrutinized task modes, particularly relational processing and online maintenance of bound perceptual features, contributed substantially to variations in both EM and abstract reasoning (but not in cognitive control or processing speed) among the younger adults in our sample, implying a substantial neurofunctional overlap, at least during this life stage. Similarity in functional organization between rest and each of the scrutinized task modes drew on distinguishable neural resources and showed differential susceptibility to genetic versus environmental influences. Our results suggest that variability on complex traits, such as EM, is supported by neural mechanisms comprising multiple components, each reflecting a distinct pattern of genetic versus environmental contributions and whose relative importance may vary across typical versus psychopathological development.
https://ift.tt/2z35rsX
Are We Ready to Bell The Cat?: A Call for Cardiologists to Embrace Glucose-Lowering Therapies Proven to Improve Cardiovascular Outcomes.
Author: Nassif, Michael E. MD; Kosiborod, Mikhail MD
Page: 4-6
https://ift.tt/2NlGnjS
Pathways to Cardiorenal Complications in Type 2 Diabetes Mellitus: A Need to Rethink.
Author: Sattar, Naveed MD, PhD; McGuire, Darren K. MD, MHSc
Page: 7-9
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Circulation Global Rounds.
Author: Armstrong, Paul W. MD; Hill, Joseph A. MD, PhD
Page: 10-11
https://ift.tt/2tNlea4
Trends in Hospitalizations and Survival of Acute Decompensated Heart Failure in Four US Communities (2005-2014): ARIC Study Community Surveillance.
Author: Chang, Patricia P. MD, MHS; Wruck, Lisa M. PhD; Shahar, Eyal MD, MPH; Rossi, Joseph S. MD, MSCI; Loehr, Laura R. MD, PhD; Russell, Stuart D. MD; Agarwal, Sunil K. MD, MPH, PhD; Konety, Suma H. MD; Rodriguez, Carlos J. MD, MPH; Rosamond, Wayne D. PhD, MS
Page: 12-24
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Heart Failure Epidemic: It's Complicated[horizontal ellipsis].
Author: Roger, Veronique L. MD, MPH
Page: 25-28
https://ift.tt/2tPH6S4
Long-Term Outcomes of Hypertrophic Cardiomyopathy Diagnosed During Childhood: Results From a National Population-Based Study.
Author: Alexander, Peta M.A. MBBS; Nugent, Alan W. MBBS; Daubeney, Piers E.F. DM; Lee, Katherine J. PhD; Sleeper, Lynn A. ScD; Schuster, Tibor PhD; Turner, Christian MBBS; Davis, Andrew M. MBBS; Semsarian, Chris MBBS, PhD, MPH; Colan, Steven D. MD; Robertson, Terry MBBS; Ramsay, James MBBS; Justo, Robert MBBS; Sholler, Gary F. MBBS; King, Ingrid; Weintraub, Robert G. MBBS; On behalf of the National Australian Childhood Cardiomyopathy Study
Page: 29-36
https://ift.tt/2u07Cro
Oral Anticoagulation in Very Elderly Patients With Atrial Fibrillation: A Nationwide Cohort Study.
Author: Chao, Tze-Fan MD; Liu, Chia-Jen MD; Lin, Yenn-Jiang MD; Chang, Shih-Lin MD; Lo, Li-Wei MD; Hu, Yu-Feng MD; Tuan, Ta-Chuan MD; Liao, Jo-Nan MD; Chung, Fa-Po MD; Chen, Tzeng-Ji MD; Lip, Gregory Y.H. MD ,*; Chen, Shih-Ann MD ,,*
Page: 37-47
https://ift.tt/2Nmwh1Z
Novel Adipokine, FAM19A5, Inhibits Neointima Formation After Injury Through Sphingosine-1-Phosphate Receptor 2.
Author: Wang, Yingbao BS ,*; Chen, Dixin PhD ,,*; Zhang, Yan PhD ,*; Wang, Pingzhang PhD; Zheng, Can BS; Zhang, Songyang PhD; Yu, Bing BS; Zhang, Lu PhD; Zhao, Guizhen PhD; Ma, Baihui BS; Cai, Zeyu BS; Xie, Nan PhD; Huang, Shiyang BS; Liu, Ziyi PhD; Mo, Xiaoning PhD; Guan, Youfei MD, PhD; Wang, Xian MD, PhD; Fu, Yi MBBS, PhD; Ma, Dalong MD, PhD; Wang, Ying MD, PhD; Kong, Wei MD, PhD
Page: 48-63
https://ift.tt/2tWWtYl
Understanding Obesity-Related Cardiovascular Disease: It's All About Balance.
Author: Zarzour, Abdalrahman MD; Kim, Ha Won PhD; Weintraub, Neal L. MD
Page: 64-66
https://ift.tt/2Nmw4Mf
Bmal1 in Perivascular Adipose Tissue Regulates Resting-Phase Blood Pressure Through Transcriptional Regulation of Angiotensinogen.
Author: Chang, Lin MD, PhD; Xiong, Wenhao MD; Zhao, Xiangjie MS; Fan, Yanbo MD, PhD; Guo, Yanhong MD, PhD; Garcia-Barrio, Minerva PhD; Zhang, Jifeng PhD; Jiang, Zhisheng MD, PhD; Lin, Jiandie D. PhD; Chen, Y. Eugene MD, PhD
Page: 67-79
https://ift.tt/2u0KdWG
Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies.
Author: Anand, Inder S. MD, DPhil (Oxon); Gupta, Pankaj MD
Page: 80-98
https://ift.tt/2NlHakS
Wearable Defibrillator Trial Has Mixed Result.
Author: Kuehn, Bridget M.
Page: 99-100
https://ift.tt/2z4tp6P
The Right-Sided ECG for the Right Diagnosis.
Author: Teigeler, Todd L. MD; Ellenbogen, Kenneth A. MD; Padala, Santosh K. MD
Page: 107-109
https://ift.tt/2zbNCbg
Hypogonadism as a Reversible Cause of Torsades de Pointes in Men.
Author: Salem, Joe-Elie MD, PhD; Waintraub, Xavier MD; Courtillot, Carine MD; Shaffer, Christian M. BS; Gandjbakhch, Estelle MD, PhD; Maupain, Carole MD; Moslehi, Javid J. MD; Badilini, Fabio PhD; Haroche, Julien MD, PhD; Gougis, Paul MD; Fressart, Veronique MD, PhD; Glazer, Andrew M. PhD; Hidden-Lucet, Francoise MD; Touraine, Philippe MD, PhD; Lebrun-Vignes, Benedicte MD; Roden, Dan M. MD; Bachelot, Anne MD, PhD; Funck-Brentano, Christian MD, PhD; Bretagne, Marie; Dureau, Pauline; Saque, Valentin; Zarhrate-Ghoul, Aida; Bourguignon, Clement; Leban, Monique; Grouthier, Virginie; Vaglio, Martino
Page: 110-113
https://ift.tt/2tPfaOq
Letter by Yang et al Regarding Article, "Accelerometer-Measured Physical Activity and Sedentary Behavior in Relation to All-Cause Mortality: The Women's Health Study".
Author: Yang, Yi MPH; Lynch, Brigid M. PhD; van Roekel, Eline H. PhD
Page: 114-115
https://ift.tt/2z4rUpn
Response by Lee et al to Letter Regarding Article, "Accelerometer-Measured Physical Activity and Sedentary Behavior in Relation to All-Cause Mortality: The Women's Health Study".
Author: Lee, I-Min MBBS, ScD; Shiroma, Eric J. ScD; Buring, Julie E. ScD
Page: 116-117
https://ift.tt/2tOfihb
Letter by Voicu et al Regarding Article, "Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients Without ST-Segment-Elevation Myocardial Infarction After Cardiac Arrest".
Author: Voicu, Sebastian MD, PhD; Megarbane, Bruno MD, PhD; Sideris, Georgios MD, PhD
Page: 118-119
https://ift.tt/2tX57pR
Response by Bascom and Seder to Letter Regarding Article, "Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients Without ST-Segment-Elevation Myocardial Infarction After Cardiac Arrest".
Author: Bascom, Karen E. MBChB; Seder, David B. MD
Page: 120-121
https://ift.tt/2Njxszr
Effects of inorganic ions on the photolysis of propranolol in FA solution
Abstract
Photolysis of the widely used beta-blocker propranolol (PRO) was investigated in the presence of fulvic acid (FA) and inorganic ions under simulated solar irradiation. PRO undergoes direct photolysis proceeding mainly via degradation of the triplet excited state, 3PRO*. FA and inorganic ions inhibited photolysis of PRO in the order of FA > Fe3+ > Cl− > Ca2+ > Mg2+ > NO3− > K+. An antagonistic effect between FA and inorganic ions toward the suppression of PRO photolysis was exhibited. The binding behaviors of PRO, FA, and inorganic ions were examined through fluorescence quenching experiments, which showed that inorganic ions affected the binding between FA and PRO through competing for the binding sites of FA or PRO. The correlation analysis demonstrated a positive correlation between the binding constant (KOC) of FA-PRO and the inhibition rate of FA on PRO photolysis. The observed rate constants of photolysis (kobs) have opposite correlations with the concentration of singlet oxygen (1O2). These findings strongly suggest that inorganic ions decrease the inhibition effect of FA on PRO photolysis via restraining the complexation of FA-PRO and production of 1O2.
https://ift.tt/2tYDrkh
Imaging of chemokine receptor CXCR4 expression in culprit and nonculprit coronary atherosclerotic plaque using motion-corrected [ 68 Ga]pentixafor PET/CT
Abstract
Purpose
The chemokine receptor CXCR4 is a promising target for molecular imaging of CXCR4+ cell types, e.g. inflammatory cells, in cardiovascular diseases. We speculated that a specific CXCR4 ligand, [68Ga]pentixafor, along with novel techniques for motion correction, would facilitate the in vivo characterization of CXCR4 expression in small culprit and nonculprit coronary atherosclerotic lesions after acute myocardial infarction by motion-corrected targeted PET/CT.
Methods
CXCR4 expression was analysed ex vivo in separately obtained arterial wall specimens. [68Ga]Pentixafor PET/CT was performed in 37 patients after stent-based reperfusion for a first acute ST-segment elevation myocardial infarction. List-mode PET data were reconstructed to five different datasets using cardiac and/or respiratory gating. Guided by CT for localization, the PET signals of culprit and various groups of nonculprit coronary lesions were analysed and compared.
Results
Ex vivo, CXCR4 was upregulated in atherosclerotic lesions, and mainly colocalized with CD68+ inflammatory cells. In vivo, elevated CXCR4 expression was detected in culprit and nonculprit lesions, and the strongest CXCR4 PET signal (median SUVmax 1.96; interquartile range, IQR, 1.55–2.31) was observed in culprit coronary artery lesions. Stented nonculprit lesions (median SUVmax 1.45, IQR 1.23–1.88; P = 0.048) and hot spots in naive remote coronary segments (median SUVmax 1.34, IQR 1.23–1.74; P = 0.0005) showed significantly lower levels of CXCR4 expression. Dual cardiac/respiratory gating provided the strongest CXCR4 PET signal and the highest lesion detectability.
Conclusion
We demonstrated the basic feasibility of motion-corrected targeted PET/CT imaging of CXCR4 expression in coronary artery lesions, which was triggered by vessel wall inflammation but also by stent-induced injury. This novel methodology may serve as a platform for future diagnostic and therapeutic clinical studies targeting the biology of coronary atherosclerotic plaque.
https://ift.tt/2KvemIL
Frequency and amplitude modulation of resting-state fMRI signals and their functional relevance in normal aging
Publication date: October 2018
Source:Neurobiology of Aging, Volume 70
Author(s): Albert C. Yang, Shih-Jen Tsai, Ching-Po Lin, Chung-Kang Peng, Norden E. Huang
The intrinsic composition and functional relevance of resting-state blood oxygen level–dependent signals are fundamental in research using functional magnetic resonance imaging (fMRI). Using the Hilbert–Huang Transform to estimate high-resolution time-frequency spectra, we investigated the instantaneous frequency and amplitude modulation of resting-state fMRI signals, as well as their functional relevance in a large normal-aging cohort (n = 420, age = 21–89 years). We evaluated the cognitive function of each participant and recorded respiratory signals during fMRI scans. The results showed that the Hilbert–Huang Transform effectively categorized resting-state fMRI power spectra into high (0.087–0.2 Hz), low (0.045–0.087 Hz), and very-low (≤0.045 Hz) frequency bands. The high-frequency power was associated with respiratory activity, and the low-frequency power was associated with cognitive function. Furthermore, within the cognition-related low-frequency band (0.045–0.087 Hz), we discovered that aging was associated with the increased frequency modulation and reduced amplitude modulation of the resting-state fMRI signal. These aging-related changes in frequency and amplitude modulation of resting-state fMRI signals were unaccounted for by the loss of gray matter volume and were consistently identified in the default mode and salience network. These findings indicate that resting-state fMRI signal modulations are dynamic during the normal aging process. In summary, our results refined the functionally related blood oxygen level–dependent frequency band in a considerably narrow band at a low-frequency range (0.045–0.087 Hz) and challenged the current method of resting-fMRI preprocessing by using low-frequency filters with a relatively wide range below 0.1 Hz.
https://ift.tt/2NjRIkw
The effects of cerebral amyloid angiopathy on integrity of the blood-brain barrier
Publication date: October 2018
Source:Neurobiology of Aging, Volume 70
Author(s): Shino Magaki, Zhaoyi Tang, Spencer Tung, Christopher K. Williams, Darrick Lo, William H. Yong, Negar Khanlou, Harry V. Vinters
Cerebral amyloid angiopathy (CAA), in which amyloid accumulates predominantly in the walls of arterioles and capillaries, is seen in most patients with Alzheimer disease (AD) and may contribute to compromise of blood-brain barrier (BBB) function seen in AD. We investigated the effects of CAA on BBB integrity by examining the expression of the endothelial marker CD31, basement membrane protein collagen IV (COL4), tight junction protein claudin-5, and fibrinogen, a marker of BBB leakage, by immunohistochemistry in the occipital cortex of autopsy brains with AD and capillary CAA (CAA type 1; n = 8), AD with noncapillary CAA (CAA type 2; n = 10), and AD without CAA (n = 7) compared with elderly controls (n = 10). Given the difference in pathogenesis of capillary and noncapillary CAA, we hypothesize that features of BBB breakdown are observed only in capillary CAA. We found decreased expression of CD31 in AD subjects with CAA types 1 and 2 compared with AD without CAA and an increase in COL4 in AD without CAA compared with controls. Furthermore, there was increased immunoreactivity for fibrinogen in AD with CAA type 1 compared with controls. These findings suggest that capillary CAA is associated with morphologic and possibly physiologic alterations of the neurovascular unit and increased BBB permeability in AD.
https://ift.tt/2tYfOby
Acute psychosocial stress in mid-aged male rats causes hyperthermia, cognitive decline, and increased deep sleep power, but does not alter deep sleep duration
Publication date: October 2018
Source:Neurobiology of Aging, Volume 70
Author(s): Kendra Hargis, Heather M. Buechel, Jelena Popovic, Eric M. Blalock
Aging is associated with altered sleep architecture and worsened hippocampus-dependent cognition, highly prevalent clinical conditions that detract from quality of life for the elderly. Interestingly, exposure to psychosocial stress causes similar responses in young subjects, suggesting that age itself may act as a stressor. In prior work, we demonstrated that young animals show loss of deep sleep, deficits in cognition, and elevated body temperature after acute stress exposure, whereas aged animals are hyporesponsive on these measures. However, it is unclear if these age-altered stress responses occur in parallel over the course of aging. To address this, here we repeated the experiment in mid-aged animals. We hypothesized that mid-aged stress responses would be intermediate between those of young and aged subjects. Sixteen mid-aged (12 months) male F344 rats were implanted with EEG/EMG emitters to monitor sleep architecture and body temperature, and were trained on the Morris water maze for 3 days. On the fourth day, half of the subjects were restrained for 3 hours immediately before the water maze probe trial. Sleep architecture and body temperature were measured during the ensuing inactive period, and on the following day, endpoint measures were taken. Restrained mid-aged animals showed resistance to deep sleep loss, but demonstrated stress-induced water maze probe trial performance deficits as well as postrestraint hyperthermia. Taken in the context of prior work, these data suggest that age-related loss of sleep architecture stress sensitivity may precede both cognitive and body temperature–related stress insensitivity.
https://ift.tt/2tNLEZd
Thyroid Peroxidase Antibody is Associated with Plasma Homocysteine Levels in Patients with Graves’ Disease
Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0643-4692
Purpose Homocysteine is associated with cardiovascular, inflammation and autoimmune diseases. Previous studies have shown that thyroid peroxidase antibody is associated with homocysteine levels in hypothyroidism. The relationship between thyroid antibodies and homocysteine in hyperthyroidism remains unclear. In this study, we aimed to investigate the association of thyroid antibodies with homocysteine in patients with Graves' disease. Methods This was a cross-sectional study including 478 Graves' disease patients who were consecutively admitted and underwent radioiodine therapy. Homocysteine, thyroid hormones, thyroid antibodies, glucose and lipids were measured. Results Patients with homocysteine levels above the median were older and had unfavorable metabolic parameters compared to patients with homocysteine levels below the median. Thyroglobulin antibody or thyroid peroxidase antibody was associated with homocysteine levels (β=0.56, 95%CI 0.03-1.08, p=0.04; β=0.75, 95%CI 0.23-1.27, p=0.005). The relationship between thyroid peroxidase antibody and homocysteine remained significant when additionally adjusting for free triiodothyronine (β=0.76, 95%CI 0.24-1.28, p=0.004). The presence of a homocysteine level above the median increased significantly with increasing thyroid peroxidase antibody quartiles in the logistic regression (OR=1.74, 95%CI 1.27-2.39, P for trend=0.001). Homocysteine levels increased significantly with increasing thyroid peroxidase antibody quartiles (p=0.005). Thyroid peroxidase antibody had no significant effect on other traditional cardiovascular risk factors. Conclusions Thyroid peroxidase antibody is independently and positively associated with homocysteine levels in patients with Graves' disease. Thyroid peroxidase antibody may be associated with the cardiovascular risk of patients with Graves' disease through its effect on homocysteine.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Expenditures Of Metabolic Diseases – An Estimation on National Health Care Expenditures of Diabetes and Obesity, Hungary 2013
Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0630-0318
Background Obesity could be considered as the main consequence of unhealthy nutrition, responsible for many pathological alterations in human. Obese patients usually need more health care services. The aim of the study was to estimate the financial expenditures of health care provisions in Hungary, related to obesity and diabetes, as its main pathological consequence. Methods Data of the Hungarian National Health Insurance Fund (NHIF) were collected for 2013, regarding finances of secondary care, hospital services, reimbursement for medications and healing aids of diabetic patients together with selected morbidities linked to obesity, based on the codes of the International Classification of Diseases (ICD) and calculated their population prevalence on the population-attributable fraction (PAF). Results Financial data regarding diabetes care resulted in a 40,311 Million HUF (129 Million EUR) national fund expenses, beside a 7,173 Million HUF (23 Million EUR) contribution from patients. Estimated total health care expenditures related to obesity were 58,986 Million HUF (188 Million EUR) and the financial contribution of patients was calculated as 25,316 Million HUF (81 Million EUR). These data represent a 5.2% and 9.3% of the whole national health services, 16% and 30% of the whole drug-reimbursement budgets, respectively. Conclusions Although expenditures for some obesity related pathologies analyzed in this paper represent 0.28% of the national GDP, considering other morbidities and other patient's expenses, the real ratio could be between 0.5–1%. The increasing number of overweight and obese persons requires more focus in public health, higher awareness in the society and more governmental support.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Neuro-Endocrine Recovery After Pituitary Apoplexy: Prolactin as a Predictive Factor
Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0640-2915
Objective Pituitary apoplexy is a serious medical complication of a pre-existing pituitary adenoma characterized by a variety of clinical symptoms ranging from mild headache to neurologically impaired and finally comatose patients. Management options are surgery or conservative treatment (e. g., with dexamethasone). Surgery is commonly performed in case of severe acute neurological and visual symptoms. However, prospective studies demonstrating a benefit of surgery over conservative treatment in terms of visual, neurological and even endocrine outcomes are lacking. Decision making is still controversial, and recommendations for surgery are based on low evidence grades and focus on visual impairment. Endocrine function and especially markers identifying patients with potential for pituitary recovery after surgery are not well described in the literature. Patients and Design We analysed data from 24 patients (m:f/16:8) with a median age of 64 yrs (38 to 83yrs) that underwent surgery for pituitary apoplexy regardless of time from symptom onset. Apoplexies were necrotic in 14 cases and haemorrhagic in 10 cases. Results Preoperatively, 7 patients (29.2%) showed complete anterior pituitary insufficiency, 16 patients (66.6%) had partial anterior pituitary insufficiency and one patient (4.17%) had normal pituitary functions. Persistent panhypopituitarism was found in 7 patients (29.2%), whereas an overall improvement of pituitary function was noted in 13 (57.1%) patients. Preoperative prolactin (PRL) levels were significantly associated with recovery of endocrine functions, whereas specifically all patients with preoperative PRL levels of at least 8.8 ng/ml recovered partially or fully. Time to surgery (0–7 days vs. 1–4 weeks vs.>4 weeks) was not significantly associated with outcome. Conclusions Our data emphasize that normal and high preoperative PRL levels are associated with better endocrine outcome after surgery. We conclude that patients benefit from surgical intervention even after delayed diagnosis with the serum PRL levels is being a valid biomarker for clinical decision making.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Rehabilitation in Germany 2004–2016 A Multicenter Analysis Over a Period of 13 Years in Children and Adolescents with Diabetes Mellitus
Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0594-9311
In the treatment of children/adolescents with diabetes medical rehabilitation plays an important role. It was the aim of the survey to analyze trends in the number of patients admitted to rehabilitation, the quality of diabetes care, the incidence of acute complications, risk factors for cardiovascular co-morbidities like lipids and blood pressure and the familial status nationwide and over a period of 13 years. Methods: Currently seven hospitals offer in-patient rehabilitation for children/adolescents with diabetes in Germany. Six hospitals participated in the survey. All children/adolescents (n=7.163) who participated in an in-patient rehabilitation 01/01/2004-31/12/2016 were included. Clinical/familial data were assessed: age, sex, family situation, type/duration of diabetes, insulin dosage, self-monitoring, acute complications, height, body weight, blood pressure and laboratory parameters. For collecting and storage of data the computer software DPV® (Diabetes-Patienten-Verlaufsdokumentation, University of Ulm, Germany) was used. Statistical analyses were performed using the programme SAS (Statistical Analysis Software 9.4, SAS Institute Inc, Cary, North Carolina, USA). Results: During the study period 7.163 patients took part in 10.987 in-patient rehabilitation procedures. The yearly number of patients participating in rehabilitation remained stable. There was no change in the quality of diabetes control (HbA1c: p=0.30, fasting blood glucose: p=0.80). The incidence of severe hypoglycaemia decreased (p<0.001). The incidence of ketacidosis remained stable (p=0.18). The frequency of blood glucose self-monitoring increased (p<0.001). The same was true for patients treated with CSII (p<0.001), whereas the numbers of patients treated with CT or ICT decreased (both p<0.001). There was no change in patients' total insulin dose (p=0.01). There was a decrease of the number of patients living with both parents (p<0.001), the percentage of children/adolescents living with mother or father alone increased (p<0.001). The percentage of children/adolescents living in mixed cultural families or having a background of immigration increased (p<0.001). Conclusions: There is a change in medical rehabilitation: The number is stable, the proportion of patients using CSII increased, the number of patients living with single parents and the percentage of patients from culturally mixed families increased also.
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© Georg Thieme Verlag KG Stuttgart · New York
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Prevalence and risk factors for helicobacter pylori infection in gastroduodenal diseases in Kano, Nigeria
African Journal of Medical and Health Sciences 2018 17(1):41-46
Background: Helicobacter pylori (H. pylori) has been well noted as a causative agent of many diseases in the gastrointestinal (GI) tract notably, gastritis, peptic ulcer disease, and gastric adenocarcinoma. Determining the burden and the risk factors for acquiring this infection may be crucial to containing it and its sequelae in Kano, Nigeria. Methodology: The study was cross-sectional in design. Questionnaires were administered in dyspeptic patients to obtain the relevant clinical, and sociodemographic data. Upper GI endoscopy was performed in the patients, and gastric biopsy specimens were taken and sent to the histopathology laboratory for assessment and H. pylori identification. Results: Of the 306 participants, 136 (44.4%) were males, while 170 (55.6%) were females, with male: female ratio of 1:1.3. The ages of the participants ranged from 18 to 84 years with a mean of 41.2 ± 15.3 years. Of the 306 samples, 250 (81.7%) were positive for H. pylori. This gives H. pylori prevalence of 81.7%. Only 4 (1.3%) of the participants belonged to the higher social class, out of which 25% had positive H. pylori, while 230 (75.2%) participants belonged to the lower socioeconomic class with 87.8% H. pylori prevalence. The lower social class had a significant association (P < 0.0001) with increased H. pylori infection. A total of 290 subjects (94.8%) shared a room with three or more other siblings in childhood, out of which 233 (80.3%) had H. pylori. Only 80 subjects (26.1%) used pipe-borne water in childhood, while 226 (73.9%) sourced their water from either well, pond or stream during childhood. Conclusion: This study showed a high prevalence of H. pylori in Kano, and low socioeconomic status, unclean water source, overcrowding, and cigarette smoking were significant risk factors for H. pylori infection.
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The effect of bacterial colonization of the embryo transfer catheter on Outcome of In vitro Fertilization–Embryo transfer treatment
African Journal of Medical and Health Sciences 2018 17(1):7-13
Background: In vitro fertilization–embryo transfer (IVF − ET) has become a core treatment method for managing infertility. Bacterial contamination of the ET catheter may affect outcome, but there is still no consensus of evidence. Objectives: This study aims to assess the effect of bacterial colonization of the ET catheter tip on the clinical pregnancy rate in an IVF–ET treatment. Methods: An analytical cross-sectional study among women undergoing IVF–ET treatment was undertaken. The patients selected had both cervical swab and the tip of the ET catheter cultured. The patients were grouped into positive (bacterial isolated) and negative (no bacterial isolated) based on the culture result. The clinical pregnancy rate (primary outcome) between the two groups was compared. Results: A total of 80 patients were selected. In 34 patients (42.25%), the cervical culture was positive, while 46 patients (57.50%) had negative cervical culture. Catheter tip culture was positive in 27 patients (33.75%) and negative in 53 patients (66.25%). The predominant microorganisms isolated were Escherichia coli (23.75%), Staphylococcus spp. (18.75%), and Streptococcus spp. (15.00%). The clinical pregnancy rate was 26.25%. The significant factors affecting clinical pregnancy were the age of the patient (P = 0.044), duration of infertility (P = 0.01), and culture result (P = 0.03). Conclusion: Bacterial colonization of the ET catheter tip is associated with a reduction in the clinical pregnancy rate. Utility of routine cervical swab; microscopy, culture, and sensitivity at recruitment of patients for IVF–ET treatment is highlighted.
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Nutritional status of perinatally HIV-infected children on antiretroviral therapy from a resource-poor rural South African community
African Journal of Medical and Health Sciences 2018 17(1):1-6
Objective: In Sub-Saharan Africa, millions of children are suffering from HIV and coexisting child undernutrition. Despite efforts to curb the spread of HIV through the availability of treatment and various nutritional programmes, it has been argued that undernutrition remains highly prevalent in rural areas. The objective of this study was to describe the prevalence and psychosocial factors influencing the nutritional status in the sample of rural-based HIV-infected children on antiretroviral therapy. Materials and Methods: Anthropometric and home environment data were collected from 152 perinatally HIV-infected children on antiretroviral therapy who lived with their primary caregivers in a rural Eastern Cape community. Results: More than half of the sample of children had inadequate nutritional status. The prevalence of stunting particularly was high (36.2%), while 12% were underweight and only 2.7% presented with wasting. Coexisting poor quality home-environment (P < 0.01) added to this burden. Younger age children who lived with a younger biological caregiver were found to present more with stunting than older age children (χ2 [n = 152] = 14.79, P = 0.005), but no significant differences were observed for underweight or wasting. Conclusion: It is important in a context such as South Africa, with the double burden of HIV infection and poverty, that all efforts be directed at alleviating undernutrition. Early pediatric HIV management should not only focus on the provision of treatment but should also prioritize the quality of care of HIV-positive children in the home to improve on their nutritional health.
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Prevalence and antibiogram pattern of Salmonella enterica serotypes in Garhwal Region: First report from foothills of himalayas
African Journal of Medical and Health Sciences 2018 17(1):14-19
Introduction: Enteric fever, caused by Salmonella enterica subsp. enterica serotype Typhi and Paratyphi, is endemic in India with an incidence of 102–2219/100,000 populations. The definitive diagnosis of enteric fever in patients with compatible clinical picture is isolation of Salmonellae from blood, bone marrow, stool or urine, and demonstration of four-fold rise in antibody titer to both O and H antigen of the organism between acute and convalescent-phase sera. Aim: The aim of the study was to study the prevalence of various serotypes of S. enterica and their antibiogram in foot hills of Himalayas. Materials and Methods: During February 2012–January 2013, all clinically suspected patients were screened for enteric fever by Widal tube agglutination test. For the isolation of etiology, venous blood, stool and urine specimen were obtained from patients with antibody titer of ≥80 and 160 for anti-O agglutinin and anti-H agglutinin of Salmonella typhi, respectively, and ≥20 for anti-H agglutinin of S. paratyphi A and S. paratyphi B. Characterization and antibiogram determination of the isolates was done by conventional microbiological methods including Kirby–Bauer's disc diffusion technique. Result: Among 1173 suspected cases, 373 showed a high titer of antibodies against O (≥80), H (≥160), AH (≥20), and BH (≥20) antigens. A total of 81 isolates were obtained from 76 patients (29 from blood and 49 from stool and three from urine), of which 54 were identified as Salmonella typhi, 20 as Paratyphi A and seven as Paratyphi B. Extended-spectrum beta-lactamase production was observed in four isolates of S. typhi. Ciprofloxacin followed by co-trimoxazole was resistant to 46.5 and 36.5% of the isolates, respectively. Conclusion: This report indicates a significant percentage of drug resistance in S. enterica serotypes in Garhwal region. Periodic monitoring of the antibiogram pattern along with the implementation of strict antibiotic policies and patient education is needed.
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Diagnostic reference levels for mammography examinations in North Eastern Nigeria
African Journal of Medical and Health Sciences 2018 17(1):54-59
Background: Diagnostic reference levels (DRLs) plays an important role in health-care delivery and radiation safety of patients. This study was carried out as part of a comprehensive project to establish DRLs for the radiological examinations for the first time in North Eastern Nigeria. Objective of the Study: The aim is to establish DRL for mammography examination in North Eastern Nigeria and to compare it with other established works. Materials and Methods: This study is a prospective cross-sectional study conducted in two university teaching hospitals in North Eastern Nigeria. Sixty patients were recruited for the study. Thermoluminescent dosimeter (TLD) chips were exposed for craniocaudal (CC) and mediolateral examinations to record the entrance skin dose (ESD). TLD readings were obtained at the Center for Energy Research and Training Zaria, Kaduna State, Nigeria. Dance formula was used to convert ESD to mean glandular dose (MGD). Student's t-test was used to determine the relationship between the mean ESD obtained in the two centers and Pearson's correlation was used to determine the relationship between the MGD and anthropotechnical parameters. Statistical significance was set at P < 0.05. Results: The total MGD for this study was 0.31 ± 0.05 mGy and 0.69 ± 0.11 mGy for CC and mediolateral oblique (MLO), respectively. DRL was 0.63 mGy and 1.04 mGy for CC and MLO, respectively. There was no statistically significant relationship (P > 0.05) between the MGD and anthropotechnical parameters. The DRL in this work were higher when compared with international established work. Conclusion: There is need for optimization of our radiology practice in North Eastern Nigeria and most centers in Nigeria.
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Musculoskeletal tumors of the extremities: Challenges and outcome of management in a Nigeria Tertiary Hospital
African Journal of Medical and Health Sciences 2018 17(1):20-25
Background: Patients with musculoskeletal tumors in developing countries often present late to the hospital and this poses serious challenges to the management, especially for malignant tumors. This study aims to highlight the various types of musculoskeletal extremity tumors seen in a Nigerian tertiary health center during the study period, the challenges encountered in managing them, and the outcome of the management. Materials and Methods: A prospective study in which all consenting patients with musculoskeletal extremity tumors who presented to the center from April 2015 to March 2017 were recruited. Results: Seventy-two patients were managed during the study period. The mean age was 22.1 ± 4.5 years and the age group most affected was the 11–20 years group, n = 22 (30.6%). Male-to-female ratio was 1.6:1. The femur was the most commonly involved bone. Forty tumors were benign while 32 were malignant tumors. Osteochondroma was the most common benign tumor while osteosarcoma was the most common malignant tumor. The challenges encountered during the management were a late presentation, poverty, and traditional bonesetter intervention before the presentation. Patients with benign tumor had excision with good outcome in all. Twenty (62.5%) of the patients with a malignant tumor had the ablative procedure, two of these 20 patients died within 6 months of treatment, while 12 (37.5%) of the patients with malignant tumor refused the treatment. Conclusion: Management of musculoskeletal extremity tumors is highly challenging in this part of the country, especially the malignant types, due to the challenges mentioned. There is a need for more awareness about the disease, the Government should subsidize the cost of management of this disease, and more specialty training of personnel is necessary for appropriate management of the diseases.
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Incidence and pattern of dog bite injuries treated in the emergency room of a teaching hospital South East Nigeria
African Journal of Medical and Health Sciences 2018 17(1):35-40
Background: Dog bite injury treated in the emergency room varies from and within subregions in pattern and potential risk of transmission of rabies. This variation has implications in its morbidity and mortality. The aim of this study was to determine the incidence and pattern of dog bite injuries treated in a teaching hospital emergency room setting of a developing country. Patients and Methods: This was a retrospective study of the entire patients with dog bite injury treated in the emergency room of Federal Teaching Hospital Abakaliki from January 2006 to December 2015. Results: Dog bite injury necessitated visit in 74 patients with an incidence of 2 per 1000 emergency room attendances, and a male to female ratio of 1:1.1. The mean age of the patients was 25.5 ± 1.87 years, and peak age group incidence was 5–9 years. Lower extremity was involved in 77.5% of the injuries, and buttock was the predominant site of injury in 0–4 years old. Fifty-one (68.9%) owned dogs and 23 (31.1%) stray dogs were involved in the attack. There was unprovoked attack in 81.1% of cases, and 51 (68.9%) sustained Grade II injury. Twenty-eight (37.8%) of the dogs had anti-rabies vaccination. Fifty-four (73%) patients had no prehospital care while 64 (86.5%) received postexposure anti-rabies vaccine. Majority of the patients 73 (98.7%) recovered fully. One (1.4%) patient that presented with clinical rabies self-discharged against medical advice. Conclusion: The incidence of dog bite injury is within worldwide range though the female gender bias is unprecedented. We recommend preventive strategies based on the observed pattern and improvement in the rate of prehospital care and higher coverage of anti-rabies vaccination of dogs.
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Lead in potable water sources in Anambra State, South East, Nigeria
African Journal of Medical and Health Sciences 2018 17(1):26-30
Introduction: Due to lack of treated water supply in major cities and settlements in Anambra state, Nigeria, majority of the population obtain potable water directly from boreholes, streams, sachet, harvested rain, and well water sources. Lead-laden potable water may be a major cause of mortality and morbidity in Anambra state, Nigeria. Objective: This study was conducted to determine the presence of lead in potable water sources in Anambra state, Nigeria. Materials and Methods: Water samples were systematically collected from 81 water sampling sites in different senatorial zones of the state. Lead was estimated in the water samples using Varian AA240 atomic absorption spectrophotometer. Results: The mean levels of lead in the water samples in all the senatorial zones of the state were higher than the maximum contaminant limit (0.01 mg/L) set by the World Health Organization (WHO). The mean level of lead in harvested rain, sachet, and stream waters (0.34 ± 0.23, 0.37 ± 0.08, and 0.23 ± 0.06 mg/L, respectively) was higher in Anambra South senatorial zone compared to the WHO maximum contaminant limit. Furthermore, Anambra South has higher (P < 0.001) mean lead level compared to the North and Central senatorial zones. Conclusion: This study reveals significantly high lead levels in potable water sources in Anambra state, Nigeria. The water samples should be well treated to remove this harmful toxic heavy metal which is very dangerous to health.
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Work-Related respiratory symptoms and cardiopulmonary function impairment of factory workers in a cement company in South-West Nigeria
African Journal of Medical and Health Sciences 2018 17(1):47-53
Background: Cement factory workers are exposed to dangerous cement dust while at workplace especially in the developing countries where little or no safety standards are followed. This study investigated the work-related respiratory symptoms and cardiopulmonary functions' impairment in cement factory workers in South-West, Nigeria. Materials and Methods: Seventy cement exposed workers and 70 age-matched unexposed individuals participated in this cross-sectional study. A self-administered questionnaire was used to assess their sociodemographic characteristics, clinical details, and respiratory symptoms. Selected cardiopulmonary parameters of participants were measured. Data were analyzed using the Statistical Package for Social Sciences version 20.0. Independent t-test was used to compare the selected cardiopulmonary parameters of the two groups. Results: The mean age of cement-exposed group was 31.57 ± 8.32 years, and the unexposed group was 31.50 ± 8.57 years. The prevalence of respiratory symptoms among the cement-exposed group were as follows: 71.4% for cough, 45.7% for phlegm, 67.1% for wheeze, 38.6% for breathlessness, and 48.6% for chest tightness while those for the unexposed group were as follows: 50% for cough, 15.7% for phlegm, 5.7% for wheeze, 2.9% for breathlessness, and 7.1% for chest tightness. There were significant differences between the mean values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1)/FVC ratio, peak expiratory flow rate, systolic blood pressure, and diastolic blood pressure (P < 0.05) of the cement-exposed group and those of the unexposed group. Conclusion: Respiratory symptoms were higher among cement factory workers than the age-matched unexposed individuals. FVC, FEV1, FEV1/FVC ratio, and peak expiratory flow rate were reduced while blood pressure was increased in cement factory workers.
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Anesthesia for emergency cesarean section: A comparison of spinal versus general anesthesia on maternal and neonatal outcomes
African Journal of Medical and Health Sciences 2018 17(1):31-34
Background: Despite the relative safety of cesarean section (CS), increasing CS rate is a cause for concern to obstetricians and anesthetists because of the attendant increased health risk one of which is the risk of anesthesia. The choice of anesthesia for cesarean section depends on the indication for the surgery, the urgency of intervention required, the maternal and/or fetal status, and the patient's desires. Despite the paradigm shift toward spinal anesthesia, general anesthesia is still commonly administered in our facility for some specific indications. Objective: This study was aimed to evaluate the maternal and neonatal outcomes in patients who had emergency CS under spinal anesthesia compared with those who had general anesthesia. Materials and Methods: This was a retrospective study comparing the obstetric outcome of patients who had emergency CS under spinal anesthesia compared with those who had the surgery under general anesthesia. Data analysis was done using statistical Epi Info version 7.2.1. Results: The most common indication for surgery in the spinal group was cephalopelvic disproportion while that for the general anesthesia group was antepartum hemorrhage/placenta previa. Patients who had spinal anesthesia had less intraoperative blood loss compared with those who had general anesthesia (814 ± 124 vs. 842 ± 324; P = 0.0007). There was a significant difference in the intraoperative blood loss >1000 ml among women who had spinal anesthesia relative to women who had general anesthesia (odds ratio [OR]: 0.6832, 95% confidence interval [CI]: 0.3390–0.9779; P = 0.0005). Spinal anesthesia was associated with a reduced risk of having a 1st-min Apgar score <7 (OR: 0.6096, 95% CI: 0.4066–0.9140; P = 0.016). There was no significant difference in the 5th-min Apgar score in both groups. There was also no significant difference in the number of neonates admitted into the Intensive Care Units. The maternal and perinatal mortality was not different in both groups. Conclusion: Spinal anesthesia was associated with reduced risk of blood loss and reduced risk of low Apgar score in the 1st min. There was no difference in the 5th-min Apgar score and maternal and neonatal mortality.
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A 10-Year review of ultrasonographic findings of scrotal diseases in Ibadan, South Western, Nigeria
African Journal of Medical and Health Sciences 2018 17(1):60-65
Introduction: Despite the importance of a thorough clinical evaluation, ultrasonography has emerged as the mainstay of imaging of the scrotum and its contents. Differentiation of testicular lesions and that of adjacent scrotum and content is usually difficult clinically. Scrotal ultrasound (SUSS) is highly sensitive in the detection of intrascrotal abnormalities and in differentiating testicular from paratesticular lesions. SUSS accurately determines the location and nature of palpable lesions and reveals nonpalpable scrotal masses. The aim of this study is to report the various indications for SUSS in this setting and to describe the sonographic findings in these patients. Materials and Methods: A retrospective and descriptive study carried out to evaluate scrotal ultrasound scans performed on 442 patients referred for various clinical indications from the clinics and units of the University College Hospital, to the Radiology department of the same hospital which serves as referral center in Ibadan, and the South-Western Nigeria; over a 10 year period from January 2006 to December 2015, a tertiary health Institution. Results: The mean age of the study population was 36.13 years ± standard deviation 15.88 years. Most of the patients (57.1%) were within the age group of 30 and 49 years. The leading clinical indication for ultrasound referral was infertility/infertility related issues in 56.1% of the total patients. Testicular masses were clinically detected and required SUSS for confirmation in 4.5% of the study population. On USS, the average testicular volume in adults with normal study was 16.38 cm3 and 15.99 cm3 on the right and left side, respectively. The most common USS findings were varicocele (29.4%), this was bilateral in more than half of the cases. Hydrocele was the second most common finding in 18.78% and often bilateral. Testicular masses were seen in 11.1% and were cystic in nature in more than half of the study population. Conclusion: Infertility/infertility related diagnosis were the most frequent indications for testicular ultrasound in adults in our environment. We recommend SUSS as a routine investigation in suspected scrotal/testicular pathologies.
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Four Japanese Patients with Congenital Nephrogenic Diabetes Insipidus due to the AVPR2 Mutations
Almost 90% of nephrogenic diabetes insipidus (NDI) is caused by mutations in the arginine vasopressin receptor 2 gene (AVPR2) on the X chromosome. Herein, we reported clinical and biochemical parameters in four cases of three unrelated Japanese families and analyzed the status of the AVPR2. Two of the four patients had poor weight gain. However, in the male and female sibling cases, neither had poor weight gain while toddlers, but in the male sibling, episodes of recurrent fever, polyuria, and polydipsia led to the diagnosis of NDI at 4 years of age. Analysis of AVPR2 identified two nonsense mutations (c.299_300insA; p.K100KfsX91 and c.296G > A; p.W99X) and one missense mutation (c.316C > T; p.R106C). These mutations were previously reported. The patient with c.316C > T; p.R106C had milder symptoms consistent with previous reports. Of the familial cases, the sister was diagnosed as having NDI, but a skewed X-inactivation pattern in her peripheral blood lymphocytes was not identified. In conclusion, our study expands the spectrum of phenotypes and characterized mutations in AVPR2 in NDI.
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Caso infrecuente de feocromocitoma vesical positivo en la SPECT/TC con 123I-MIBG, pero negativo en la PET/TC con 68Ga-DOTA-TOC
Publication date: Available online 2 July 2018
Source:Revista Española de Medicina Nuclear e Imagen Molecular
Author(s): A.S. Kroiss, C. Uprimny, R. Pichler, R.W. Gasser, I.J. Virgolini
El feocromocitoma es poco frecuente, y se enmarca en el grupo de los tumores neuroendocrinos. Dichos tumores pueden encontrarse en cualquier parte, desde el cuello a la pelvis, asociados a los ganglios simpáticos. La imagen morfológica, como en el caso de la TC, aporta un detalle anatómico excelente y una elevada sensibilidad, pero carece de especificidad, dado que pueden producirse dificultades a la hora de distinguir entre los tumores derivados del sistema nervioso simpático y otros tipos de tumores. A diferencia de la imagen anatómica, la imagen funcional (PET con 123I-MIBG, 68Ga-DOTA-TOC) aporta una alta sensibilidad y especificidad para la detección de tumores neuroendocrinos.La detección precoz de feocromocitoma es esencial y tiene repercusiones importantes en el tratamiento y el pronóstico.Este caso clínico describe la importancia del papel de la imagen anatómica y funcional en un paciente con tumor neuroendocrino de origen inusual.Pheochromocytoma (PHEO) is rare and belongs to the group of neuroendocrine tumours (NETs). These tumours can be found anywhere from the neck to the pelvis associated with sympathetic ganglia. Morphological imaging, for example CT, provides excellent anatomical detail and high sensitivity but lacks specificity as difficulties may occur when distinguishing between tumours derived from the sympathetic nervous system and other tumour entities. In contrast to anatomical imaging, functional imaging (123I-MIBG, 68Ga-DOTA-TOC PET) provides high sensitivity and specificity in detecting NETs.Early detection of PHEO is crucial and has a major effect on treatment and prognosis.This case report describes the important role of anatomical and functional imaging in a patient with a neuroendocrine tumour of unusual origin.
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In vitro inhalation/ingestion bioaccessibility, health risks, and source appointment of airborne particle-bound elements trapped in room air conditioner filters
Abstract
The airborne particle-bound elements (Ca, Fe, Al, Mg, K, Na, Zn, Mn, P, Pb, Cu, Sr, Ti, Ba, Cr, Ni, As, Sb, Cd, Co, and V) trapped in room air conditioners' filters (filter dusts) during recirculating indoor air from different types of rooms were analyzed, and the objectives of this study were to assess the potential sources of those elements and their potential health risks via inhalation/ingestion exposure. Main crustal elements such as Ca, Fe, Al, Mg, and K with an average value of 60.6, 17.9, 11.3, 7.58, and 6.90 mg g−1, respectively, are the preponderant elements, and the mean values of main toxic elements were 2230, 344, 508, 85.7, 71.5, 36.0, 8.02, and 16.9 mg kg−1 for Zn, Cu, Pb, Cr, Ni, As, Cd, and Sb, respectively. The enrichment factors indicated the significant enrichment of Cd, Pb, Cr, Cu, Sb, and Zn in the filter dusts. Four potential sources with the contributions of 33.5, 29.1, 22.6, and 14.8%, respectively, were identified by absolute principal component scores-multiple linear regression analysis (APCS-MLR). Enrichment factor and APCS-MLR model reveal the outdoor input of toxic elements. In vitro inhalation and ingestion bioaccessibility of toxic elements showed elemental and in vitro procedure dependence. There are potential carcinogenic risks via ingestion exposure and no non-carcinogenic risks to both children and adults based on bioaccessible contents of toxic elements. This study reveals the potential health risks posed by the particle-bound elements.
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Optimization of preparation of monolithic carbon foam from rice husk char for benzene leakage emergency
Abstract
In the aim of BTEX leakage emergency, monolithic carbon foam (MCF) was designed and prepared via a simple method. Rice husk char (RHC) was chosen as raw material, polyurethane sponge (PUS) was used as sacrificed template to form inner channel, and corn starch and ZnO were employed as binder and reinforcing filler, respectively. The optimized preparation parameter was determined by adopting of Taguchi experimental design method. Both MCF-RHC and MCF-CAC were made from RHC and commercial activated carbon (CAC) under the same condition, and three reported monolithic carbon adsorbents were selected for comparative study with MCFs. The surface and structural properties were characterized by XRD, SEM, and N2 adsorption/desorption isotherm analyses. XRD analysis results reveal that MCF-RHC was the composites of carbon, SiO2, and ZnO, and MCF-RHC and MCF-CAC have good potential in organic adsorption. Hierarchical structure of MCF was constructed by inner macro-channel from burning up of PUS and micro- and meso-pores from resultant carbon composite, and these inner macro-channels play a more important role in benzene rapid adsorption. Specific surface area of MCF-RHC was 465.5 m2 g−1, which included micro- and meso-pores, which mainly come from RHC during the carbonization process. Adsorption kinetics study demonstrated that the benzene equilibrium uptake of MCF-RHC and MCF-CAC was similar, and both of data well fitted the pseudo-second-order kinetic model. However, MCF-RHC has the ability to absorb benzene more quickly, which meets the demand of absorbent utilizing in benzene leakage emergency.
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Recurrent FPIES to wheat after multiple tolerant exposures in a male infant
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated reaction to food that typically presents in infancy and manifests as repetitive vomiting, lethargy and hypotension 1 to 4 hours after ingestion, occasionally followed by delayed diarrhea. Due to lack of a diagnostic biomarker, oral food challenge (OFC) remains the gold standard for diagnosis of FPIES and to monitor for resolution. Supervised introduction of high-risk foods has also been recommended given the high rate of cross-reactivity of some foods.
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Autonomic imbalance in cardiac surgery: a potential determinant of the failure in remote ischemic preconditioning
Source:Medical Hypotheses
Author(s): Abraham I.J. Gajardo, Lukas Karachon, Pablo Bustamante, Pablo Repullo, Marcelo Llancaqueo, Gina Sánchez, Ramón Rodrigo
Remote ischemic preconditioning (RIPC) is a cardioprotective strategy against myocardial damage by ischemia-reperfusion. Many in-vivo and ex-vivo animal researches have demonstrated that RIPC decreases significantly the ischemia-reperfusion myocardial damage, by up to 58% in isolated rat heart. Cardiac artery bypass graft surgery (CABG) is a clinical model of myocardial ischemia-reperfusion and a clinical potential application to RIPC. However, although RIPC has shown successful results in experimental studies, clinical trials on CABG have failed to demonstrate a benefit of RIPC in humans. Strikingly, the main proposed factors associated with this translational failure also impair the balance of the autonomic nervous system (ANS), which has shown to play a key role in RIPC cardioprotection in animal models. Comorbidities, chronic pharmacological treatment and anesthesic drugs - common conditions in CABG patients - cause an ANS imbalance through parasympathetic activity decrement. On the other hand, ANS and specially the parasympathetic branch are essentials to get cardioprotection by RIPC in animal models. Consequently, we propose that ANS imbalance in CABG patients would explain the failure of RIPC clinical trials. Whether our hypothesis is true, many patients could be benefited by RIPC: a cheap, simple and virtually broad-available cardioprotective maneuver. In this paper we discuss the evidence that support this hypothesis and its clinical implications.
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Ferulic acid may target MyD88-mediated pro-inflammatory signaling – Implications for the health protection afforded by whole grains, anthocyanins, and coffee
Source:Medical Hypotheses, Volume 118
Author(s): Mark F. McCarty, Simon B. Iloki Assanga
Higher dietary intakes of anthocyanins have been linked epidemiologically to decreased risk for metabolic syndrome, type 2 diabetes and cardiovascular events; clinical trials and rodent studies evaluating ingestion of anthocyanin-rich extracts confirm favorable effects of these agents on endothelial function and metabolic syndrome. However, these benefits of anthocyanins are lost in rats whose gut microbiome has been eliminated with antibiotic treatment – pointing to bacterial metabolites of anthocyanins as the likely protective agents. A human pharmacokinetic assessment of orally administered cyanidin-3-O-glucoside, a prominent anthocyanin, has revealed that, whereas this compound is minimally absorbed, ferulic acid (FA) is one of its primary metabolites that appears in plasma. FA is a strong antioxidant and phase 2 inducer that has exerted marked anti-inflammatory effects in a number of rodent and cell culture studies; in particular, FA is highly protective in rodent models of diet-induced weight gain and metabolic syndrome. FA, a precursor for lignan synthesis, is widely distributed in plant-based whole foods, mostly in conjugated form; whole grains are a notable source. Coffee ingestion boosts plasma FA owing to gastrointestinal metabolism of chlorogenic acid. Hence, it is reasonable to suspect that FA mediates some of the broad health benefits that have been associated epidemiologically with frequent consumption of whole grains, anthocyanins, coffee, and unrefined plant-based foods. The molecular basis of the anti-inflammatory effects of FA may have been clarified by a recent study demonstrating that FA can target the adaptor protein MyD88; this plays an essential role in pro-inflammatory signaling by most toll-like receptors and interleukin-1β. If feasible oral intakes of FA can indeed down-regulate MyD88-dependent signaling, favorable effects of FA on neurodegeneration, hypothalamic inflammation, weight gain, adipocyte and beta cell function, adiponectin secretion, vascular health, and cartilage and bone integrity can be predicted. Since FA is well tolerated, safe, and natural, it may have great potential as a protective nutraceutical, and clinical trials evaluating its effects are needed.
https://ift.tt/2lNvYRj
Financial instability and CO 2 emissions: the case of Saudi Arabia
Abstract
This study aims to investigate the nexus between financial instability and CO2 emissions within the multivariate framework in Saudi Arabia's economy over 1971–2016. Autoregressive Distributed Lag (ARDL) model is used to estimate long-run dynamics followed by Vector Error Correction Model (VECM) to detect the direction of causality. The result of the study reveals that financial instability has an insignificant impact on CO2 emissions. However, electricity consumption has an adverse impact on environmental quality by producing a huge amount of CO2 emissions in the atmosphere. The coefficients of oil and non-oil GDPs also suggest that both oil and non-oil GDPs contribute to producing a massive amount of CO2 emissions. Bi-directional causality is observed among all the core variables of the study. Moreover, the reliability and validity are confirmed by applying several diagnostic tests. This study provides novel findings which not only help to advance the existing literature but can be a particular interest to the country's policymakers regarding financial sector and its role in environmental degradation.
https://ift.tt/2KGefJQ
Unusual case of primary spontaneous hemopneumothorax in a young man with atypical tension pneumothorax: a case report
Spontaneous life-threatening hemopneumothorax is an atypical but treatable entity of unexpected circulatory collapse in young patients, affecting 0.5–11.6% of patients with primary spontaneous pneumothorax. Sp...
https://ift.tt/2lR6yCw
Intraoperative thermal safety of endoscopic ear surgery utilizing a holder
Despite the ever-growing popularity of endoscopic ear surgery (EES), there are still concerns regarding the potential thermal risk associated with the use of light sources and also questions raised about the thermal safety of extended stationary applications of endoscopes with holders that allow the use of both hands in the middle ear. The temperature changes witnessed during EES when using different calipers on static endoscopes fitted with camera holders during true operations were measured, and effects of varying light source intensities, as well as the cooling effect of irrigation and suction, were investigated.
https://ift.tt/2lOF0NV
Chronic Deafness Degrades Temporal Acuity in the Electrically Stimulated Auditory Pathway
Abstract
Electrical stimulation of the auditory nerve with a penetrating intraneural (IN) electrode in acutely deafened cats produces much more restricted spread of excitation than is obtained in that preparation with a conventional cochlear implant (CI) as reported by Middlebrooks and Snyder (J Assoc Res Otolaryngol 8:258–279, 2007). That suggests that a future auditory prosthesis employing IN stimulation might offer human patients greater frequency selectivity than is available with a present-day CI. Nevertheless, it is a concern that the electrical field produced by an IN electrode might be too restricted to produce adequate stimulation of the partially depopulated auditory nerve of a deaf patient. We evaluated this by testing responses to IN and CI stimulation in adult-deafened cats. Activation of the auditory pathway was monitored by recording from the central nucleus of the inferior colliculus (ICC). Cats deaf for 153–277 days exhibited a ~ 30 % loss of auditory nerve fibers compared to cats deaf for < 18 h. Contrary to our concern, measures of thresholds and dynamic ranges showed no significant deafness-related impairment of excitation by IN or CN stimulation. Surprisingly, however, temporal acuity decreased dramatically in these adult-deafened cats, as demonstrated by a marked decrease in the maximum rate of electrical cochlear stimulation to which ICC neurons synchronized to IN or CI stimulation. For instance, half of ICC neurons synchronized to IN stimulation up to 203 pulses per second (pps) in acute deafness, whereas that number dropped to 79 pps for chronic deafness. Such a loss of temporal acuity might contribute to the poor sensitivity to temporal fine structure that has been reported in human CI users. Seemingly, the degraded temporal acuity that we observed in cats was even worse than the fine-structure sensitivity of human CI users, suggesting that most patients experience some improvement of temporal acuity resulting from restoration of patterned auditory nerve stimulation by a CI.
https://ift.tt/2lNpMsH
Regulation on the toxicity of microcystin-LR target to protein phosphatase 1 by biotransformation pathway: effectiveness and mechanism
Abstract
Biotransformation was an important pathway to regulate the toxicity of microcystins (MCs) targeted to protein phosphatases (PPs). To explore the regulation effectiveness and mechanism, several typical biothiol transformation products originated from MCLR were prepared by nucleophilic addition reaction. The reduced inhibition effect of MCLR transformation products on PP1 was evaluated and compared with their original toxin. Though molecular simulation showed the introduced biothiols enhanced the total combination areas and energies for target complexes, the steric hindrance of introduced biothiols inhibited the combination between the key action sites (Mdha7 and Adda5 residues) and PP1. Furthermore, the introduced biothiols also weakened the hydrogen bonds for some key interaction sites and altered the ion bonds between PP1 and the two Mn2+ ions in the catalytic center. The discrepant regulation effect for biothiols on the toxicity of MCLR was closely related to above indexes and influenced by molecular sides.
https://ift.tt/2u0m2I5
A population-based epidemiological study of anaphylaxis using national big data in Korea: trends in age-specific prevalence and epinephrine use in 2010–2014
Previous reports on anaphylaxis in Asia are limited to relatively small-scale studies. We performed this study to identify the nationwide prevalence of anaphylaxis and epinephrine prescription rates by age gro...
https://ift.tt/2IJoIz6
Odorous emission reduction from a waste landfill with an optimal protection system based on fuzzy logic
Abstract
Effective landfill management and operation require an accurate evaluation of the occurrence and extent of odour emission events, which are among the main causes of resident complaints and concerns, in particular in densely urbanised areas. This paper proposes a fuzzy optimal protection system (FOPS) based on fuzzy logic to manage odour production from a municipal solid waste (MSW) landfill. The case study is a MSW landfill in an old quarry site located 6 km north-west of Naples city centre (Italy). The aim is to reduce the odour nuisance in the area surrounding the landfill where there are several sensitive receptors. FOPS is based on logical relationships between local atmospheric dynamics, number and intensity of odour pollution events detected by certain fixed receptors and odour emission rate via an optimal fuzzy approach. Such system allows to start, in real time, established mitigation actions required to further reduce the odorous emissions from the landfill itself (e.g. spraying of perfumed substances and activation of extraction wells), especially when weather conditions might not be favourable and cause by causing a higher odour perception. The fuzzy system was coupled with the air pollutant transport software CALPUFF to simulate the odour dispersion in the considered area taking into account both different odour emission rates and local weather conditions. FOPS results show that this approach can be very useful as, by measuring the odour concentrations, a significant reduction of the odour exceedances over the thresholds fixed, to minimise the olfactory harassment, was observed in the whole area studied.
https://ift.tt/2KC3ubr
CO 2 emission thresholds for inclusive human development in sub-Saharan Africa
Abstract
We provide policy-relevant critical masses beyond which, increasing CO2 emissions negatively affects inclusive human development. This study examines how increasing CO2 emissions affects inclusive human development in 44 sub-Saharan African countries for the period 2000–2012. The empirical evidence is based on fixed effects and Tobit regressions. In order to increase the policy relevance of this study, the dataset is decomposed into fundamental characteristics of inclusive development and environmental degradation based on income levels (low income versus (vs.) middle income); legal origins (English common law vs. French civil law); religious domination (Christianity vs. Islam); openness to sea (landlocked vs. coastal); resource-wealth (oil-rich vs. oil-poor) and political stability (stable vs. unstable). All computed thresholds are within policy range. Hence, above these thresholds, CO2 emissions negatively affect inclusive human development.
https://ift.tt/2MENdzQ
Biomonitoring of atmospheric particulate pollution via chemical composition and magnetic properties of roadside tree leaves
Abstract
Particulate matter (PM) is a main atmospheric pollution which threats human health and well-being. In this research, we chemically and magnetically analysed roadside tree leaves, collected from three tree species in two main roads (from two different cities) and a reference area, for 28 elements and the saturation isothermal remanent magnetisation. Comparison of unwashed and washed leaves revealed that deposited particles on the leaf surface contain various elements including Al, Ca, Fe, Mg, Mn, Na, Si, Ti, Ba, Co, Cr, Cu, Ni, Rb, V, Zn and Zr. Moreover, there was no significant difference between washed/unwashed leaves in Cl, K, P, S, As, Cd, Cs, Pb, Sn and Sr concentrations, which indicates tree leaves may not be a suitable biomonitor for these elements. Our results showed that site and tree species are important factors which affect atmospheric elements deposition. Among the three considered tree species, Chamaecyparis lawsoniana showed the highest potential for atmospheric particle accumulation. The PCA results revealed that Al, Fe, Ti, Co, Cr, Cu, Ni, Rb, Si, V, Zn and Zr indicated emissions from road traffic activities and soil dust; Ca, Mg and Na from sea salts and Mn and Sb from industrial activity. The biplot results showed that the site effect was much stronger than the species effect for all elements and saturation isothermal remanent magnetisation (SIRM) values. Moreover, elements from traffic, industrial activity and soil dust are significantly correlated with leaf SIRM indicating that leaf SIRM can be a suitable bioindicator of exposure to traffic-derived particles and soil dust, and not from sea salts. It is concluded that chemical composition and SIRM of urban tree leaves can serve as a good indicator of atmospheric PM pollution in Iran and anywhere else where the studied trees grow.
https://ift.tt/2KrBJTL
Fermented camel milk by Lactococcus lactis subsp. cremoris attenuates erythrocytes oxidative stress-induced hematological and immunological damage in CCl 4 -intoxicated mice
Abstract
Fermented camel by Lactococcus lactis subsp. cremoris has been recently discovered to protect against the toxic effect of carbon tetrachloride (CCl4), but its beneficial effects in the presence of oxidative stress in the erythrocytes have not been established. In the present study, 28 mice were randomly divided into four groups: control group; CCl4 group: intoxicated by a single intraperitoneal injection (ip) of CCl4; group FCM-LLC + CCl4: pretreated with FCM-LLC daily during 14 days, and received a single dose of CCl4. FCM-LLC group received FCM-LLC alone. The occurrence of oxidative stress in erythrocytes was evidenced by an increase in lipid peroxidation, protein carbonyl, and changes in antioxidant enzyme activities and non-enzymatic antioxidant. The oxidative injury induced by CCl4 in the erythrocytes was confirmed by modifications in hematological parameters and decreases in protein, albumin, and globulin content in the serum of intoxicated mice. Therefore, CCl4 caused a significant decrease in immunotoxic indices, including immunoglobulin G (IgG), immunoglobulin M (Ig M), and immunoglobulin A (IgA) levels, and an increase of inflammatory markers such as C-reactive protein (CRP) level. Meanwhile, FCM-LLC effectively restored the parameters cited above to near-normal values. It can be suggested that fermented camel milk could regulate deviant physiological effects induced by CCl4 which is due to its powerful antioxidant and immunomodulatory and anti-inflammatory capacity.
https://ift.tt/2MEMRt0
Reflection- and Distortion-Source Otoacoustic Emissions: Evidence for Increased Irregularity in the Human Cochlea During Aging
Abstract
Previous research on distortion product otoacoustic emission (DPOAE) components has hinted at possible differences in the effect of aging on the two basic types of OAEs: those generated by a reflection mechanism in the cochlea and those created by nonlinear distortion (Abdala and Dhar in J Assoc Res Otolaryngol 13:403–421, 2012). This initial work led to the hypothesis that micromechanical irregularity ("roughness") increases in the aging cochlea, perhaps as the result of natural tissue degradation. Increased roughness would boost the backscattering of traveling waves (i.e., reflection emissions) while minimally impacting DPOAEs. To study the relational effect of aging on both types of emissions and address our hypothesis of its origin, we measured reflection- and distortion-type OAEs in 77 human subjects aged 18–76 years. The stimulus-frequency OAE (SFOAE), a reflection emission, and the distortion component of the DPOAE, a nonlinear distortion emission, were recorded at multiple stimulus levels across a four-octave range in all ears. Although the levels of both OAE types decreased with age, the rate of decline in OAE level was consistently greater for DPOAEs than for SFOAEs; that is, SFOAEs are relatively preserved with advancing age. Multiple regression analyses and other controls indicate that aging per se, and not hearing loss, drives this effect. Furthermore, SFOAE generation was simulated using computational modeling to explore the origin of this result. Increasing the amount of mechanical irregularity with age produced an enhancement of SFOAE levels, providing support for the hypothesis that increased intra-cochlear roughness during aging may preserve SFOAE levels. The characteristic aging effect—relatively preserved reflection-emission levels combined with more markedly reduced distortion-emission levels—indicates that SFOAE magnitudes in elderly individuals depend on more than simply the gain of the cochlear amplifier. This relative pattern of OAE decline with age may provide a diagnostic marker for aging-related changes in the cochlea.
https://ift.tt/2lPPYTo
Fatal or Irreversible Bleeding and Ischemic Events With Rivaroxaban in Acute Coronary Syndrome
AbstractBackground
Net clinical outcome analyses of acute coronary syndrome (ACS) mingle fatal or irreversible events with survivable or reversible events that vary significantly in clinical impact.
ObjectivesA comparison of efficacy and safety limited to fatal or irreversible ischemic and adverse or seriously harmful events is one way to assess net clinical outcome and risk-benefit overall, given the fact that these events have a similar clinical impact.
MethodsIn the ATLAS ACS 2-TIMI 51 (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction) trial of rivaroxaban in the secondary prevention of events among patients with ACS treated with aspirin plus clopidogrel or ticlopidine (clopidogrel/ticlopidine) or aspirin alone, fatal and irreversible efficacy events including nonbleeding cardiovascular death, myocardial infarction, and ischemic stroke were compared to fatal or irreversible safety events, including fatal and intracranial bleeding.
ResultsRivaroxaban, 2.5 mg orally twice per day, in patients treated with aspirin and clopidogrel/ticlopidine was associated with 115 (95% confidence interval [CI]: 18 to 212) fewer fatal or irreversible ischemic events (663 for placebo vs. 548 for therapy) and 10 (95% CI: –11 to 32) additional fatal or irreversible seriously harmful events (33 vs. 23 for placebo) per 10,000 patient-years of exposure. Taken together, there would be 105 (95% CI: 6 to 204) fatal or irreversible events prevented per 10,000 patient-years of exposure to rivaroxaban compared with placebo, with 11 (10 of 115) fatal or irreversible ischemic events prevented for each fatal or irreversible seriously harmful event caused. If only nonbleeding cardiovascular death is included as a fatal or irreversible event, then 95 events would be prevented per 10,000 patient-years of exposure in the group taking 2.5 mg orally twice per day.
ConclusionsBoth fatal or irreversible ischemia and bleeding are clinically significant events that can be compared to assess the net clinical outcomes associated with therapy. Rivaroxaban therapy at an oral dose of 2.5 mg twice daily in patients treated with aspirin and clopidogrel is associated with a net reduction in fatal or irreversible events. (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction [ATLAS ACS 2-TIMI 51]; NCT00809965)
https://ift.tt/2z44hxj
Global Prospective Safety Analysis of Rivaroxaban
AbstractBackground
The efficacy of direct oral anticoagulants (DOACs) for stroke prevention in patients with atrial fibrillation (AF) has been established in clinical trials. However, well-conducted, prospective, real-world observational studies of the safety and effectiveness of DOACs are needed.
ObjectivesThis study sought to assess the real-world safety profile of rivaroxaban through a pooled analysis of patients with AF enrolled in the XANTUS (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation) program worldwide.
MethodsA pre-planned pooled analysis of the XANTUS, XANAP (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation in Asia), and XANTUS-EL (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation in Latin America and EMEA Region) registries was performed. Patients with AF newly starting rivaroxaban for stroke prevention were followed for 1 year. Primary outcomes were treatment-emergent major bleeding, adverse events (AEs)/serious AEs, and all-cause death. Secondary outcomes included treatment-emergent thromboembolic events and nonmajor bleeding. Major outcomes were centrally adjudicated.
ResultsOverall, 11,121 patients were included (mean age 70.5 ± 10.5 years; female 42.9%). Comorbidities included heart failure (21.2%), hypertension (76.2%), and diabetes (22.3%). Event rates were: events/100 patient-years: major bleeding 1.7 (95% confidence interval [CI]: 1.5 to 2.0; lowest: Latin America 0.7; highest: Western Europe, Canada, and Israel 2.3); all-cause death 1.9 (95% CI: 1.6 to 2.2; lowest: Eastern Europe 1.5; highest: Latin America, Middle East, and Africa 2.7); and stroke or systemic embolism 1.0 (95% CI: 0.8 to 1.2; lowest: Latin America 0; highest: East Asia 1.8). One-year treatment persistence was 77.4% (lowest: East Asia 66.4%; highest: Eastern Europe 84.4%).
ConclusionsThis large, prospective, real-world analysis in 11,121 patients from 47 countries showed low bleeding and stroke rates in rivaroxaban-treated patients with AF, with low treatment discontinuation in different regions of the world. Results were broadly consistent across regions. (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation [XANTUS]; NCT01606995; Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation in Latin America and EMEA Region [XANTUS-EL]; NCT01800006; and Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation in Asia [XANAP]; NCT01750788)
https://ift.tt/2z66jNe
Association of IL-8 With Infarct Size and Clinical Outcomes in Patients With STEMI
AbstractBackground
Little is known about the role of interleukin (IL)-8 in patients with acute ST-segment elevation myocardial infarction (STEMI).
ObjectivesThe aims of this study were to evaluate, in STEMI patients, the temporal profile of IL-8 and possible associations with left ventricular (LV) function and remodeling, infarct size, microvascular obstruction, myocardial salvage, and future clinical events.
MethodsA total of 258 patients with STEMI were included. Blood samples were drawn before and immediately after percutaneous coronary intervention (PCI), at day 1, and after 4 months. Cardiac magnetic resonance imaging was performed in the acute phase and after 4 months. Clinical events were registered during 12 months' follow-up and all-cause mortality after median 70 months' follow-up.
ResultsPatients with IL-8 levels greater than the median measured both immediately after PCI and at day 1 had larger final infarct size, lower LV ejection fraction, larger increase in LV end-diastolic volume, and higher frequency of microvascular obstruction. After multivariate adjustment, high IL-8 levels at day 1 were associated with an increased risk of developing a large MI and having reduced LV ejection fraction at 4 months, also after adjustment for peak troponin value. Patients with IL-8 levels in the highest quartile measured at all sampling points were more likely to have a clinical event during the first 12 months after the MI and had lower overall survival during long-term follow-up.
ConclusionsHigh levels of circulating IL-8 were associated with large infarct size, impaired recovery of LV function, and adverse clinical outcome in patients with STEMI, suggesting IL-8 as a future therapeutic target based on its important role in post-infarction inflammation.
https://ift.tt/2NilkP7
Remnant-Like Particle Cholesterol, Low-Density Lipoprotein Triglycerides, and Incident Cardiovascular Disease
AbstractBackground
Hypertriglyceridemia is associated with increased remnant-like particle cholesterol (RLP-C) and triglycerides in low-density lipoprotein (LDL-TG). Recent studies have focused on atherogenicity of RLP-C, with few data on LDL-TG.
ObjectivesThe aim of this study was to examine associations of RLP-C and LDL-TG with incident cardiovascular disease (CVD) events and genetic variants in the ARIC (Atherosclerosis Risk In Communities) study.
MethodsFasting plasma RLP-C and LDL-TG levels were measured in 9,334 men and women without prevalent CVD. Participants were followed for incident CVD events (coronary heart disease and ischemic stroke) for up to 16 years. Associations between LDL-TG and RLP-C levels and genetic variants were assessed by whole-exome sequencing using single-variant analysis for common variants and gene-based burden tests for rare variants; both an unbiased and a candidate gene approach were explored.
ResultsRLP-C and LDL-TG levels were correlated with triglyceride levels (r = 0.85 and r = 0.64, p < 0.0001). In minimally adjusted analyses, RLP-C and LDL-TG were associated with CVD risk, but in models adjusted for traditional risk factors including lipids, only LDL-TG was associated with incident CHD (hazard ratio: 1.28; 95% confidence interval: 1.10 to 1.50) and stroke (hazard ratio: 1.47; 95% confidence interval: 1.13 to 1.92). A common APOE variant, rs7412, had the strongest association with LDL-TG and RLP-C (p < 5 x 10–8).
ConclusionsRLP-C and LDL-TG levels were predictive of CVD and associated with APOE variants. LDL-TG may represent a marker of dysfunctional remnant lipoprotein metabolism associated with increased CVD risk. Further research is needed to determine whether LDL-TG plays a causal role in CVD and may be a target for therapy.
https://ift.tt/2u0kJss
Neoplasia and the Heart: Pathological Review of Effects With Clinical and Radiological Correlation
Abstract
The intersection of oncological and cardiovascular diseases is an increasingly recognized phenomenon. This recognition has led to the emergence of cardio-oncology as a true subspecialty. This field is not simply limited to primary cardiac tumors or complications of chemotherapeutic medications. Rather, it also encompasses metastatic cardiovascular complications and secondary cardiovascular effects of the underlying neoplasia. This review will broadly cover primary and metastatic cardiac neoplasms, as well as secondary cardiovascular effects of extracardiac neoplasia (e.g., amyloidosis, carcinoid valvulopathy, and chemotherapeutic cardiotoxicities).
https://ift.tt/2tNNFox
Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction
AbstractBackground
Vasopressor agents could have certain specific effects in patients with cardiogenic shock (CS) after myocardial infarction, which may influence outcome. Although norepinephrine and epinephrine are currently the most commonly used agents, no randomized trial has compared their effects, and intervention data are lacking.
ObjectivesThe goal of this paper was to compare in a prospective, double-blind, multicenter, randomized study, the efficacy and safety of epinephrine and norepinephrine in patients with CS after acute myocardial infarction.
MethodsThe primary efficacy outcome was cardiac index evolution, and the primary safety outcome was the occurrence of refractory CS. Refractory CS was defined as CS with sustained hypotension, end-organ hypoperfusion and hyperlactatemia, and high inotrope and vasopressor doses.
ResultsFifty-seven patients were randomized into 2 study arms, epinephrine and norepinephrine. For the primary efficacy endpoint, cardiac index evolution was similar between the 2 groups (p = 0.43) from baseline (H0) to H72. For the main safety endpoint, the observed higher incidence of refractory shock in the epinephrine group (10 of 27 [37%] vs. norepinephrine 2 of 30 [7%]; p = 0.008) led to early termination of the study. Heart rate increased significantly with epinephrine from H2 to H24 while remaining unchanged with norepinephrine (p < 0.0001). Several metabolic changes were unfavorable to epinephrine compared with norepinephrine, including an increase in cardiac double product (p = 0.0002) and lactic acidosis from H2 to H24 (p < 0.0001).
ConclusionsIn patients with CS secondary to acute myocardial infarction, the use of epinephrine compared with norepinephrine was associated with similar effects on arterial pressure and cardiac index and a higher incidence of refractory shock. (Study Comparing the Efficacy and Tolerability of Epinephrine and Norepinephrine in Cardiogenic Shock [OptimaCC]; NCT01367743)
https://ift.tt/2tSBh5I
Naïve models of dietary splurges: Beliefs about caloric compensation and weight change following non-habitual overconsumption
Publication date: 1 September 2018
Source:Appetite, Volume 128
Author(s): Julia D. O'Brien, Rachel M. Kahn, Zachary Zenko, Jessica R. Fernandez, Dan Ariely
The mechanisms that lead to overeating and the consumption of tempting, unhealthy foods have been studied extensively, but the compensatory actions taken afterwards have not. Here we describe the naïve models individuals hold around dietary splurges (single bouts of overeating) and associated weight changes. Across six online experiments, we found that, following a hypothetical dietary splurge, participants did not plan to adequately adjust calorie consumption to account for the additional calories consumed (Studies 1 and 2), and this pattern was worse following hypothetical splurges characterized by a large amount of food consumed in a single bout (Study 3). Participants expected weight changes to happen faster than they do in reality (Study 4) and they expected that weight gained from a dietary splurge would disappear on its own without explicit compensation attempts through diet or exercise (Study 5). Similarly, participants expected that when compensation attempts were made through calorie restriction, the rate of weight loss would be faster following a dietary splurge compared to normal eating (Study 6). This research contributes novel data demonstrating an important mechanism that likely contributes to weight gain and failed weight loss attempts.
https://ift.tt/2u2CCHo
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