Simulation and analysis of XCO 2 in North China based on high accuracy surface modeling

Abstract

As an important cause of global warming, CO₂ concentrations and their changes have aroused worldwide concern. Establishing explicit understanding of the spatial and temporal distributions of CO₂ concentrations at regional scale is a crucial technical problem for climate change research. High accuracy surface modeling (HASM) is employed in this paper using the output of the CO₂ concentrations from weather research and forecasting-chemistry (WRF-CHEM) as the driving fields, and the greenhouse gases observing satellite (GOSAT) retrieval XCO₂ data as the accuracy control conditions to obtain high accuracy XCO₂ fields. WRF-CHEM is an atmospheric chemical transport model designed for regional studies of CO₂ concentrations. Verified by ground- and space-based observations, WRF-CHEM has a limited ability to simulate the conditions of CO₂ concentrations. After conducting HASM, we obtain a higher accuracy distribution of the CO₂ in North China than those calculated using the classical Kriging and inverse distance weighted (IDW) interpolation methods, which were often used in past studies. The cross-validation also shows that the averaging mean absolute error (MAE) of the results from HASM is 1.12 ppmv, and the averaging root mean square error (RMSE) is 1.41 ppmv, both of which are lower than those of the Kriging and IDW methods. This study also analyses the space-time distributions and variations of the XCO₂ from the HASM results. This analysis shows that in February and March, there was the high value zone in the southern region of study area relating to heating in the winter and the dense population. The XCO₂ concentration decreased by the end of the heating period and during the growing period of April and May, and only some relatively high value zones continued to exist.

https://ift.tt/2zX46Eh

Prediction of long-term heavy metal leaching from dredged marine sediment applied inland as a construction material

Abstract

Column leaching studies have been suggested as a reference for site-specific prediction of the long-term leaching characteristics of trace constituents in granular materials used as construction materials. In this study, the concept of the long-term leaching prediction using column studies is applied for dredged marine sediment impacted by heavy metals. The column studies show tailing of the liquid to solid ratio-dependent heavy metal leaching for sediment after heavy metal treatment by acid washing. A dual-mode first-order decay model, applied for the first time in this study for column leaching studies, is able to reproduce the leaching characteristics observed. A procedure for long-term leaching prediction using the dual-mode model is developed and applied to a virtual field scenario for which the sediment is beneficially used as a construction material. The prediction results show that by more accurately reproducing the column study results, the dual-mode model generally predicts greater long-term heavy metal loading to the underlying soil layer and longer duration of leaching than the single-mode model. The heavy metal leaching observed in the columns does not show any correlation with the sequential extraction procedure and toxicity characteristic leaching procedure (TCLP) results, suggesting that the column leaching test should be considered to be independent of such batch test procedures.

https://ift.tt/2Lsvcb6

Modeling nitrous oxide emissions from rough fescue grassland soils subjected to long-term grazing of different intensities using the Soil and Water Assessment Tool (SWAT)

Abstract

Given the rising nitrous oxide (N₂O) concentration in the atmosphere, it has become increasingly important to identify hot spots and hot moments of N₂O emissions. With field measurements often failing to capture the spatiotemporal dynamics of N₂O emissions, estimating them with modeling tools has become an attractive alternative. Therefore, we incorporated several semi-empirical equations to estimate N₂O emissions with the Soil and Water Assessment Tool from nitrification and denitrification processes in soil. We then used the model to simulate soil moisture and the N₂O flux from grassland soils subjected to long-term grazing (> 60 years) at different intensities in Alberta, Canada. Sensitivity analysis showed that parameters controlling the N₂O flux from nitrification were most sensitive. On average, the accuracy of N₂O emission simulations were found to be satisfactory, as indicated by the selected goodness-of-fit statistics and predictive uncertainty band, while the model simulated the soil moisture with slightly higher accuracy. As expected, emissions were higher from the plots with greater grazing intensity. Scenario analysis showed that the N₂O emissions with the recommended fertilizer rate would dominate the emissions from the projected wetter and warmer future. The combined effects of fertilization and wetter and warmer climate scenarios would increase the current N₂O emission levels by more than sixfold, which would be comparable to current emission levels from agricultural soils in similar regions.

https://ift.tt/2uSHpLK

Theoretical analysis of pollutant mixing zone considering lateral distribution of flow velocity and diffusion coefficient

Abstract

Theoretical formulae have shown significant advantages in describing the characteristic geometric scales of the pollutant mixing zone (PMZ) formed by offshore pollutant discharged by a single general form. They, however, fail to predict the influence of the lateral inhomogeneity of the river flow because constant flow velocity and the lateral diffusion coefficient are assumed during the derivation. The realistic flow velocity in a river is fitted by an exponential law in this study and the lateral diffusion coefficient is proposed to have the same form. Similar idea has been used in previous studies on the vertical dispersion of scalar in the lower atmosphere. Pollutant discharged from a steady onshore point source into a wide straight open channel is examined to characterize the concentration taking into consideration of these lateral variations. Theoretical formulae describing the maximum length, maximum width and its corresponding longitudinal position, as well as the area of the PMZ are derived. A non-dimensional standard curve equation for the isoconcentration boundary of PMZ is also obtained. The results show that the shape of the dimensionless standard curve of PMZ depends only on the exponential constants in the exponential laws. The exponential profiles that fit the near-shore velocity give good prediction, while the ones that match the entire lateral range up to the center of the river underpredict the PMZ significantly. These findings are of great importance for practitioners to characterize the geometry of the PMZ in rivers and for water quality modeling.

https://ift.tt/2LtJ70j

Pitfalls in anaphylaxis

Purpose of review Anaphylaxis is an acute medical emergency characterized by sudden presentation of life-threatening respiratory and cardiovascular symptoms. Rapid diagnosis of anaphylaxis is crucial to implement an appropriate treatment and management plan. However, mistakes in the diagnosis of anaphylaxis may occur because of the limited time during which the diagnosis must be made, the stressful environment of the emergency room, the often aspecific or incomplete clinical features of early anaphylaxis and the lack of useful laboratory markers. Recent findings Several disorders may mimick anaphylaxis and cause wrong or delayed diagnosis increasing chances of fatal outcomes. In addition, certain clinical situations, like general anesthesia, may complicate detection of early signs of anaphylaxis. Drugs like beta-blockers, angiotensin converting enzyme-inhibitors, antihistamines or steroids may hide or blunt initial clinical manifestations of anaphylaxis. Summary A careful evaluation of clinical signs in all organs is mandatory to quickly establish and confirm a diagnosis of anaphylaxis. Alternative diagnosis should be considered, particularly in the case of unresponsive patients. Avoiding pitfalls in anaphylaxis diagnosis will help to establish rapidly effective treatments and would further reduce the rate of fatal events. Correspondence to Massimo Triggiani, MD, PhD, Division of Allergy and Clinical Immunology University of Salerno, Via S. Allende Baronissi, Fisciano, Salerno, Italy. Tel: +39 089 965056; fax: +39 089 965056; e-mail: mtriggiani@unisa.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2uR91ko

The effects of three types of environmental regulation on energy consumption—evidence from China

Abstract

Based on panel data from 1997 to 2015 in China, in this paper, the direct and indirect effects of three types of environmental regulation on energy consumption are explored with the 2SLS and system GMM method. The main conclusions of this study are as follows: (1) the effects of three types of environmental regulation on energy consumption are quite varied. The cost effect of the economical environmental regulation is significant in the direct path. However, the phenomenon of "Green Paradox" emerges in legal and supervised types of environmental regulation. The "rebound effect" of energy, which led to a new energy demand, is greater than the energy conservation generated by technological innovation in the indirect path, which is embodied as a suppression effect. (2) The legal and supervised types of environmental regulation in the eastern, central, and western regions have a Green Paradox and rebound effect on energy consumption. By contrast, the economical environmental regulation shows an opposite performance. (3) The counterfactual simulation results indicate that the net effects of three types of environmental regulation on energy consumption are different. Based on the findings, some corresponding policy implications are provided.

https://ift.tt/2mBf352

Perinatal maternal negative life events as risk factors of atopic dermatitis in female offspring

Prenatal maternal stress has been suggested as a factor that promotes the development of allergic diseases in the offspring.1 Maternal stress includes recognition of stressors (perceived stress) such as anxiety and depression and environmental stressors such as negative life events (NLEs): bereavement, loss of her or husband's job, separation, or divorce.1 Recently, we reported that prenatal maternal stress influenced the development of atopic dermatitis (AD) in offspring from two independent birth cohort study.

https://ift.tt/2uVhp2r

Serial FLT PET imaging to discriminate between true progression and pseudoprogression in patients with newly diagnosed glioblastoma: a long-term follow-up study

Abstract

Purpose

Response evaluation in patients with glioblastoma after chemoradiotherapy is challenging due to progressive, contrast-enhancing lesions on MRI that do not reflect true tumour progression. In this study, we prospectively evaluated the ability of the PET tracer ¹⁸F-fluorothymidine (FLT), a tracer reflecting proliferative activity, to discriminate between true progression and pseudoprogression in newly diagnosed glioblastoma patients treated with chemoradiotherapy.

Methods

FLT PET and MRI scans were performed before and 4 weeks after chemoradiotherapy. MRI scans were also performed after three cycles of adjuvant temozolomide. Pseudoprogression was defined as progressive disease on MRI after chemoradiotherapy with stabilisation or reduction of contrast-enhanced lesions after three cycles of temozolomide, and was compared with the disease course during long-term follow-up. Changes in maximum standardized uptake value (SUV_max) and tumour-to-normal uptake ratios were calculated for FLT and are presented as the mean SUV_max for multiple lesions.

Results

Between 2009 and 2012, 30 patients were included. Of 24 evaluable patients, 7 showed pseudoprogression and 7 had true progression as defined by MRI response. FLT PET parameters did not significantly differ between patients with true progression and pseudoprogression defined by MRI. The correlation between change in SUV_max and survival (p = 0.059) almost reached the standard level of statistical significance. Lower baseline FLT PET uptake was significantly correlated with improved survival (p = 0.022).

Conclusion

Baseline FLT uptake appears to be predictive of overall survival. Furthermore, changes in SUV_max over time showed a tendency to be associated with improved survival. However, further studies are necessary to investigate the ability of FLT PET imaging to discriminate between true progression and pseudoprogression in patients with glioblastoma.

https://ift.tt/2O8GuQn

Retentive characteristics of individual and prefabricated polyvinylsiloxane overdenture attachments: alternative treatment options for geriatric patients

Abstract

Objectives

Stud attachments are often too adhesive and too susceptible to damage for use in geriatric patients, especially when implants are angulated. This study aimed to evaluate alternative anchoring systems comprising individual and prefabricated polyvinylsiloxane (PVS) attachments.

Materials and methods

A total of 182 specimens with individual PVS (IPVS) attachments (Shore hardness [SH] 25, SH50, SH65], prefabricated PVS (PPVS) attachments (SM green, yellow, and red), and Locator attachments (LR blue) were fabricated (n = 7 per group). Retention force was measured using the following parameters: insertion/removal (100, 200, 500, 1000, and 5000 cycles), thermal undulation (10,000 cycles at 5–55 °C; one implant per specimen), implant angulation (0°, 5°, and 10° convergence and divergence; two implants per specimen), and artificial saliva.

Results

Insertion/removal and thermal undulation caused no changes in retention force in SM green and IPVS subgroups; conversely, LR blue, SM red, and SM yellow attachments exhibited significant decreases in retention force of up to 66% (all P ≤ 0.001). Implant angulation produced relevant changes in retention force only in LR blue attachments. Artificial saliva caused a general decrease in retention force.

Conclusions

Retention force of low-retentive PVS attachments proved to be comparatively immune to dislocation and thermal undulation, as well as to implant angulation up to 10°.

Clinical relevance

Low-retentive PVS attachments could be a treatment option if reduced denture retention is required and/or if angulated implants are in place. Clinical studies are necessary to evaluate the materials' durability under oral conditions.

https://ift.tt/2uGeonh

Untreated congenital hypothyroidism due to loss to follow-up: developing preventive strategies through quality improvement

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


https://ift.tt/2mvGAVo

Next-generation sequencing as a second-tier diagnostic test for newborn screening

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


https://ift.tt/2v1niv9

Thoracic Superior Duct Cyst: An Incidental Finding

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): Regina María Sánchez Jiménez, Francisca Velázquez Marín

https://ift.tt/2La4Db8

Carotid Canal Bone Erosion. Gradenigo's Syndrome

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): Aina Brunet-Garcia, M. Virginia Barrios-Crispi, Marta Faubel-Serra

https://ift.tt/2LGGZ2s

Primary tuberculosis of the nasal septum: The non-ulcerated form presenting as septal thickening

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): Neeraj Aggarwal, Mainak Dutta, Ramanuj Sinha

https://ift.tt/2LbIkSy

Recommendations on the Use of Neuromonitoring in Thyroid and Parathyroid Surgery

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): José Luis Pardal-Refoyo, Pablo Parente-Arias, Marta María Arroyo-Domingo, Juan Manuel Maza-Solano, José Granell-Navarro, Jesús María Martínez-Salazar, Ramón Moreno-Luna, Elvylins Vargas-Yglesias

Abstract

Introduction

Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary.

Objective

To develop a support document for guidance on the use of IONM in TPTS.

Method

Work group consensus through systematic review and the Delphi method.

Results

Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications.

Conclusions

IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.

Resumen

Introducción

La cirugía de tiroides y paratiroides (CTPT) se asocia a riesgo de lesión del nervio laríngeo recurrente, nervio laríngeo superior y cambios en la voz. La neuromonitorización intraoperatoria (NMIO), intermitente o continua, en CTPT evalúa el estado funcional de los nervios laríngeos y se utiliza progresivamente con más frecuencia. Esto obliga a adoptar puntos de acuerdo en los aspectos más controvertidos.

Objetivo

Elaborar un documento de ayuda para orientar en la utilización de la NMIO en CTPT.

Método

Consenso en grupo de trabajo mediante revisión sistemática y método Delphi.

Resultados

Se identificaron 7 secciones sobre las que se establecieron puntos de acuerdo: indicaciones, equipo, técnica (parámetros de programación y registro), conducta en pérdida de señal, laringoscopia, voz e implicaciones legales.

Conclusiones

La NMIO ayuda en la localización e identificación del nervio laríngeo recurrente, ayuda durante su disección, informa sobre su estado funcional al finalizar la cirugía y permite tomar decisiones en caso de pérdida de señal en el primer lado operado en una tiroidectomía bilateral programada o si había parálisis contralateral previa. La precisión de la NMIO depende de variables como la técnica realizada, la tecnología utilizada y la formación para la correcta ejecución de la técnica e interpretación de la señal. El documento presentado es un punto de inicio para futuros acuerdos en CTPT en cada una de las secciones de consenso.

https://ift.tt/2JJkqrV

Predictors of locoregional recurrence in early stage buccal cancer with pathologically clear surgical margins and negative neck

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): Shakeel Uz Zaman, Shakil Aqil, Mohammad Ahsan Sulaiman

Abstract

Objective

To identify the significant predictors of locoregional recurrence in early stage squamous cell carcinoma (SCC) of buccal mucosa with pathologically clear surgical margins and negative neck.

Method

Seventy-three patients who underwent per oral wide excision and supraomohyoid neck dissection for early stage buccal SCC with clear surgical margins (>5 mm margins each) and negative neck (N0) were included. None of the patients received postoperative radiotherapy or chemotherapy. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence.

Results

Recurrence was observed in 22 of 73 (30%) cases. Twelve had local, seven had regional and three developed locoregional recurrences. Both univariate and multivariate analyses demonstrated that lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) were independent predictors affecting locoregional control.

Conclusion

Lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) significantly increased the locoregional recurrence rate in early stage buccal SCC with clear surgical margins and negative nodal status. Adjuvant treatment with either radiation or chemoradiation should be considered when one or both of these factors present.

Resumen

Objetivo

Identificar los predictores significativos de recidiva locorregional en el carcinoma de células escamosas (CCS) en estadios iniciales de la mucosa buccal, con los márgenes quirúrgicos patológico libres y el cuello negativo.

Método

Se incluyeron en el estudio 73 pacientes sometidos a extirpación tumoral y disección supraomoioidea de cuello con cáncer bucal en estadios iniciales con márgenes quirúrgicos libres (margen de 5 mm cada uno) y cuello negativo (N0). Ninguno de los pacientes recibió radioterapia postoperatoria o quimioterapia. Se utilizaron análisis univariantes y multivariantes para identificar los factores predictivos independientes de recidiva locorregional.

Resultados

La recidiva se observó en 22 de 73 casos (30%). Doce tenían recidivas locales, 7 regionales y 3 desarrollaron recidivas locorregionales. Tanto los análisis univariantes como multivariantes demostraron que la invasión linfovascular (LVI) y la invasión muscular no T4 (non-T4MI) fueron predictores independientes que afectaron al control locorregional.

Conclusión

La LVI y la non-T4MI aumentaron significativamente la tasa de recurrencia locorregional en el CCS bucal precoz con márgenes quirúrgicos libres y estado nodal negativo. El tratamiento adyuvante con radiación o quimiorradiación debe considerarse cuando se presentan uno o ambos de estos factores.

https://ift.tt/2LbIj0W

Vertigo and Dizziness in Hospital: Attendance, Flow and Characteristics of Patients

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): Carmen Bécares Martínez, Marta M. Arroyo Domingo, Aurora López Llames, Jaime Marco Algarra, María M. Morales Suárez-Varela

Abstract

Introduction and objectives

Vertigo and dizziness as symptoms are frequent in the population. They are present in a wide range of pathologies and it is usually difficult to make an accurate diagnosis. The general objective of this study is to obtain the information to evaluate vertigo and dizziness in the hospital setting. The specific objectives are: to estimate the burden of these symptoms at the hospital; to study patients' conditions and to detail the flow of these patients inside the hospital.

Methods

Observational descriptive study. We made a search of the referral proposals made in 2011 and 2012 to the hospital because of vertigo symptoms. The patients' demographic and clinical characteristics, and the administrative details of the referrals were analysed.

Results

A total of 558 proposals were analysed corresponding to 494 patients. Vertigo accounted for 0.5% of all referrals made from Primary Care to the hospital. Sixty-three percent of the sample were women; the average age was 58 years. Eighty-eight percent of the patients were evaluated by Otorhinolaryngology, 24% by Neurology. Thirty point eight percent consulted on 3 or more occasions for the symptom. Sixteen percent were assessed for psychiatric conditions in the hospital.

Conclusions

Vertigo as a symptom is a significant burden in the hospital setting. The patients who suffer it consult on several occasions and are assessed by different specialties. This implies in some cases an excessive and ineffective flow of patients. In our setting, otorhinolaryngology is the main department to treat vertigo and dizziness patients.

Resumen

Introducción y objetivos

Los síntomas de vértigo y mareo son frecuentes en la población, se presentan como manifestación de un amplio abanico de enfermedades y habitualmente es difícil realizar un diagnóstico de certeza. El objetivo general de este estudio es obtener la información para evaluar estos síntomas en el entorno hospitalario. Los objetivos específicos son: estimar el peso global que representan estos síntomas en las derivaciones al hospital; conocer las características de los pacientes derivados y detallar el flujo de las consultas.

Métodos

Estudio descriptivo observacional. Se buscaron las propuestas de consulta realizadas en 2011 y 2012 al hospital por el síntoma de vértigo. Se analizaron características demográficas y clínicas de los pacientes, y administrativas de las derivaciones.

Resultados

Se analizaron un total de 558 propuestas correspondientes a 494 pacientes. El vértigo supuso el 0,5% del total de las derivaciones realizadas desde Atención Primaria al hospital. El 63% de la muestra han sido mujeres, con una edad media de 58 años. El 88% de los pacientes fue valorado por Otorrinolaringología y el 24% por Neurología. Un 30,8% consultó en 3 o más ocasiones por el síntoma. El 16% fue valorado por enfermedad psiquiátrica en el hospital.

Conclusiones

El vértigo como síntoma supone una carga significativa en el ámbito hospitalario. Los pacientes que lo presentan consultan en múltiples ocasiones y son valorados en distintas especialidades. En ciertos casos, el flujo de pacientes puede resultar excesivamente dinámico e ineficaz. En nuestro entorno, Otorrinolaringología es el principal receptor de pacientes con síntomas de vértigo y mareo.

https://ift.tt/2JJ6NZF

Analysis of Audiometric Relapse-Free Survival in Patients With Immune-Mediated Hearing Loss Exclusively Treated With Corticosteroids

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): Nieves Mata-Castro, Raimon García-Chilleron, Javier Gavilanes-Plasencia, Rafael Ramírez-Camacho, Alfredo García-Fernández, José Ramón García-Berrocal

Abstract

Objective

To describe the results in terms of audiometric relapse-free survival and relapse rate in immunomediated hearing loss patients treated exclusively with corticosteroids.

Method

Retrospective study of patients with audiometric relapses, monitored from 1995 to 2014, in two centres of the Community of Madrid.

Results

We evaluated 31 patients with a mean age of 48.52 years (14.67 SD), of which 61.3% were women. Most hearing loss was fluctuating (48.4%). Only 16.1% of patients had systemic autoimmune disease. There is a moderate positive correlation between the sex variable and the systemic involvement variable (Spearman's correlation coefficient = 0.356): specifically, between being female and systemic disease. The relative incidence rate of relapse in the first year was 2.01 relapses/year with a 95% CI (1.32–2.92). The mean survival time of the event (audiometric relapse) was 5.25 months (SD 0.756). With multivariate analysis, the only variable that achieved statistical significance was age, with a hazard ratio of 1.032 (95% CI; 1.001–1.063, P = .043).

Conclusions

Immune-mediated disease of the inner ear is a chronic disease with relapses. Half of the patients with immunomediated hearing loss treated exclusively with corticosteroids relapse before 6 months of follow-up. In addition, if a patient has not relapsed, they are more likely to relapse as each year passes. Analysis of the audiometric relapse-free survival will enable the effect of future treatments to be compared and their capacity to reduce the rhythm of relapses.

Resumen

Objetivo

Describir los resultados en términos de supervivencia libre de recaída audiométrica y el ritmo de recaída en pacientes con hipoacusia inmunomediada tratados exclusivamente con corticoides.

Método

Estudio retrospectivo de pacientes, con recaídas audiométricas, en seguimiento desde 1995 hasta 2014, en 2 centros de la Comunidad de Madrid.

Resultados

Se evaluaron 31 pacientes con una media de edad de 48,52 años (14,67 DE) de los cuales el 61,3% fueron mujeres. La mayoría de las hipoacusias fueron fluctuantes (48,4%). Solo el 16,1% de los pacientes presentaban enfermedad autoinmune sistémica. Existe una correlación positiva moderada entre ser mujer y presentar afectación sistémica (coeficiente de correlación de Spearman = 0,356). La tasa relativa de incidencia de recaída en el primer año en nuestra serie fue de 2,01 recaídas/año con un IC95% (1,32-2,92). El tiempo de supervivencia medio del evento (recaída audiométrica) fue de 5,25 meses (DE 0,756). Con el análisis multivariante, la única variable que consiguió significación estadística fue la edad, con una hazard ratio de 1,032 (IC95%; 1,001-1,063, p = 0,043)

Conclusiones

La enfermedad inmunomediada del oído interno es una enfermedad crónica con recaídas. La mitad de los pacientes tratados exclusivamente con corticoides recaen antes de los 6 meses de seguimiento. Además, si un paciente no ha presentado recaída, tiene más riesgo de recaer cada año que pasa. El análisis de la supervivencia libre de recaída audiométrica permitirá comparar el efecto de tratamientos futuros y su capacidad para reducir el ritmo de recaídas.

https://ift.tt/2La5cSi

Importance of neoadjuvant chemotherapy in olfactory neuroblastoma treatment: Series report and literature review

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): Ricardo Bartel, Xavier Gonzalez-Compta, Enric Cisa, Francesc Cruellas, Alberto Torres, Aleix Rovira, Manel Manos

Abstract

Introduction and objectives

Olfactory neuroblastoma (ONB) is a rare entity that constitutes less than 5% of nasosinusal malignancies. Mainstream treatment consists in surgical resection +/− adjuvant radiotherapy. By exposing results observed with apparition of new therapeutic options as neoadjuvant chemotherapy, the objective is to evaluate a series and a review of the current literature.

Methods

A retrospective review was conducted including patients diagnosed and followed-up for ONB from 2008 to 2015 in our institution.

Results

9 patients were included. Mean follow-up of 52.5 months (range 10–107). Kadish stage: A, 1 patient (11.1%) treated with endoscopic surgery; B, 2 patients (22.2%) treated with endoscopic surgery (one of them received adjuvant radiotherapy); C, 6 patients (66.7%), 4 patients presented intracranial extension and were treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. The other 2 patients presented isolated orbital extension, treated with radical surgery (endoscopic or craniofacial resection) plus radiotherapy. The 5-year disease free and overall survival observed was 88.9%.

Conclusion

Neoadjuvant chemotherapy could be an effective treatment for tumor reduction, improving surgical resection and reducing its complications.

Resumen

Introducción y objetivos

Elneuroblastoma olfatorio es una entidad rara que se corresponde con menos del 5% de las neoplasias nasosinusales. El tratamiento principal consiste en la resección quirúrgica ± radioterapia adyuvante. El objetivo es evaluar la sobrevida en una serie de casos y la literatura actual, mostrando resultados observados con la aparición de nuevas opciones terapéuticas como la quimioterapia neoadyuvante.

Métodos

Se realizó un estudio retrospectivo incluyendo pacientes tratados y seguidos en nuestro centro desde 2008 a 2015.

Resultados

Dentro del estudio fueron incluidos 9 pacientes. El seguimiento medio fue de 52,5 meses (rango 10-107). Estadio Kadish: A) un paciente (11,1%) fue tratado con resección endoscópica; B) 2 pacientes (22,2%) tratados con resección endoscópica (uno de ellos recibió radioterapia adyuvante); C) 6 pacientes (66,7%), de los cuales 4 presentaron extensión intracraneal y fueron tratados con quimioterapia neoadyuvante, cirugía y radioterapia adyuvante. Los otros 2 pacientes presentaron invasión intraorbitaria aislada, tratados con cirugía radical y radioterapia adyuvante. La sobrevida y periodo libre de enfermedad a 5 años fue del 88,9%.

Conclusión

La quimioterapia neoadyuvante puede ser un tratamiento efectivo para la reducción del tamaño tumoral, mejorando la resección quirúrgica y reduciendo sus complicaciones.

https://ift.tt/2LGGGEQ

Efficacy of Particle Repositioning Manoeuvres in Benign Positional Paroxysmal Vertigo: A Revision of 176 Cases Treated in a Tertiary Care Centre

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): Claudio Carnevale, Diego J. Arancibia-Tagle, Elena Rizzo-Riera, Guillermo Til-Perez, Pedro L. Sarría-Echegaray, Julio J. Rama-Lopez, Santiago Quer-Canut, German Fermin-Gamero, Manuel D. Tomas-Barberan

Abstract

Introduction and objectives

Benign paroxysmal positional vertigo is the most common peripheral vertigo disease. The aim of this paper is to review the results obtained with the different specific particle repositioning manoeuvres, evaluating the possible risk factors linked to a poorer prognosis.

Methods

One hundred and seventy-six patients with a diagnosis of benign paroxysmal positional vertigo were reviewed retrospectively, of whom 150 had vertigo of the posterior canal, 20 had vertigo of the horizontal canal, 3 had vertigo of the superior canal, and 3 had a double vertigo. The Epley manoeuvre was used to treat the posterior and superior canals, and Lempert manoeuvre was used to treat the horizontal canal. An imaging study by nuclear magnetic resonance with gadolin was always used in refractory cases.

Results

The Epley manoeuvre showed an efficacy of 74.6 and 100% at first attempt for posterior and superior canals respectively. The efficacy of the Lempert manoeuvre for the horizontal canal was 72.72% in the patients with canalolithiasis, and 58.33% in the patients with cupulolithiasis. The treatment of patients with more than one affected canal and a history of surgery in the previous month was more difficult.

Conclusions

Particle repositioning manoeuvres show a very high success rate, allowing better results in the treatment of the posterior canal. We need more studies to confirm the suspicion that surgery may be a factor of poorer prognosis.

Resumen

Introducción y objetivos

El vértigo posicional paroxístico benigno es la entidad más frecuente dentro de los vértigos de origen periférico. El objetivo del siguiente trabajo es revisar los resultados obtenidos con las diferentes maniobras de reposicionamiento canalicular específicas para cada tipo de canal semicircular afectado, evaluando posibles factores de riesgo relacionados con un peor pronóstico.

Métodos

Se han revisado retrospectivamente 176 pacientes diagnosticados de vértigo posicional paroxístico benigno en nuestro centro, de los cuales 150 tenían vértigo del canal semicircular posterior, 20 del horizontal, 3 del superior y 3 multicanal. Se ha usado la maniobra de Epley para el tratamiento del canal posterior y del superior y la maniobra de Lempert para el tratamiento del horizontal. En los casos refractarios se ha realizado siempre un estudio de imagen cerebral con resonancia.

Resultados

La maniobra de Epley ha mostrado una eficacia al primer intento del 74,6% para el canal posterior y del 100% para el superior. La eficacia de la maniobra de Lempert para el canal horizontal ha sido del 72,72% en los casos de canalolitiasis y del 58,33% en los de cupulolitiasis. Más complicado ha sido el tratamiento de los pacientes con más de un canal afectado y con antecedente quirúrgico en el mes previo.

Conclusiones

Las maniobras de reposicionamiento canalicular permiten alcanzar una tasa de éxito muy alta, obteniendo mejores resultados en el tratamiento del canal posterior. Hacen falta más estudios para confirmar la sospecha de que la cirugía previa pueda ser un factor de peor pronóstico.

https://ift.tt/2LdST7t

Evaluation of the Training Capacity of the Spanish Resident Book of Otolaryngology (FORMIR) as an Electronic Portfolio

Publication date: July–August 2018

Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 4

Author(s): Juan Manuel Maza Solano, Gustavo Benavente Bermudo, Francisco José Estrada Molina, Jesús Ambrosiani Fernández, Serafín Sánchez Gómez

Abstract

Background

and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents.

Methods

A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website.

Results

A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009 and 2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format.

Conclusions

The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training.

Resumen

Introducción y objetivos

Evaluar la capacidad formativa del libro del residente español como portafolio electrónico para alcanzar los objetivos de aprendizaje de los MIR de Otorrinolaringología (ORL).

Métodos

Se realizó una investigación cualitativa multimétodo de características tranversal, temporal y de orientación retrospectiva sobre los MIR de ORL mediante un cuestionario estructurado y una entrevista semiestructurada, sobre la aplicación informática web FORMIR.

Resultados

Participaron el 56,5% de los MIR de ORL de alguno de los 63 hospitales españoles acreditados para impartir formación en ORL entre 2009 y 2012. Los resultados obtenidos demostraron que los MIR de ORL que utilizaban el portafolio electrónico eran capaces de autoguiar mejor su aprendizaje, conocían mejor sus objetivos de aprendizaje, cumplían más eficientemente el programa de formación, identificaban más claramente las causas de sus carencias en el aprendizaje y consideraban que FORMIR como portafolio electrónico constituía una herramienta formativa idónea para sustituir al libro del residente en formato papel.

Conclusiones

Los MIR de ORL apreciaban de forma muy relevante las prestaciones formativas de FORMIR como portafolio electrónico, especialmente su interfaz, el feedback numérico y automático sobre la adquisición de competencias, su capacidad de almacenamiento de evidencias y su capacidad de visualizarse como logbook de la Unión Europea de Médicos Especialistas o como un curriculum vitae estándar. Este feedback automático facilita el aprendizaje autoguiado. Todo esto hace de FORMIR una herramienta formativa y evaluativa que supera las prestaciones y aceptación de instrumentos similares puestos a disposición de los residentes, que no dudan en proponerlo como el libro del residente más idóneo para facilitar su formación especializada.

https://ift.tt/2LBQ5gM

Angiokératome circonscrit naeviforme

Publication date: Available online 21 July 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): H. Kasssem Youssef, E. Backobi, C. Michel

https://ift.tt/2zZA2bh

Evaluation of neuregulin-1's neuroprotection against ischemic injury in rats using diffusion tensor imaging

Publication date: November 2018

Source: Magnetic Resonance Imaging, Volume 53

Author(s): Silun Wang, Yonggang Li, Ramesh Paudyal, Byron D. Ford, Xiaodong Zhang

Abstract

Stroke is a devastating neurovascular disorder that results in damage to neurons and white matter tracts. It has been previously demonstrated that neuregulin-1 (NRG-1) protects neurons from ischemic injury following stroke. Here, diffusion tensor imaging (DTI) was utilized to characterize the effects of NRG-1 treatment on cererbral infarction and integrity of white matter after ischemic insult using a permanent middle celebral artery occlusion (pMCAo) rat model. In the present study, sixteen Sprague-Dawley rats underwent pMCAo surgery and received either a single intra-arterial bolus (20 μg/kg) dose of NRG-1 or saline immediately prior to pMCAo. MRI including T2-weighted imaging and DTI was performed in the first 3 h post stroke, and repeated 48 h later. It is found that the stroke infarction was significantly reduced in the NRG-1 treated group. Also, NRG-1 prevented the reduction of fractional anisotropy (FA) in white matter tracts of fornix and corpus callosum (CC), indicating its protection of CC and fornix white matter bundles from ischemia insult. As a conclusion, the present DTI results demonstrate that NRG-1 has significantly neuroprotective effects in both cerebral cortex and white matter including corpus callosum and fornix during acute stroke. In particular, NRG-1 is more effective on stroke lesion with mild ischemia. As CC and fornix white matter bundles play critical roles in transcallosal connectivity and hippocampal projections respectively in the central nervous system, the findings could provide complementary information for better understanding the biological mechanism of NRG-1's neuroprotection in ischemic tissues and neurobehavioral effects.

https://ift.tt/2mvEaGq

An Empirical Study of the Maximum Degree of Undersampling in Compressed Sensing for T2*-weighted MRI

Publication date: Available online 21 July 2018

Source: Magnetic Resonance Imaging

Author(s): Carole Lazarus, Pierre Weiss, Alexandre Vignaud, Philippe Ciuciu

Abstract

Magnetic Resonance Imaging (MRI) is one of the most dynamic and safe imaging modalities used in clinical routine today. Yet, one major limitation to this technique resides in its long acquisition times. Over the last decade, Compressed Sensing (CS) has been increasingly used to address this issue and offers to shorten MR scans by reconstructing images from undersampled Fourier data. Nevertheless, a quantitative guide on the degree of acceleration applicable to a given acquisition scenario is still lacking today, leading in practice to a trial-and-error approach in the selection of the appropriate undersampling factor. In this study, we shortly point out the existing theoretical sampling results in CS and their limitations which motivate the focus of this work: an empirical and quantitative analysis of the maximum degree of undersampling allowed by CS in the specific context of T2*-weighted MRI. We make use of a generic method based on retrospective undersampling to quantitatively deduce the maximum acceleration factor R_max which preserves a desired image quality as a function of the image resolution and the available signal-to-noise ratio~(SNR). Our results quantify how larger acceleration factors can be applied to higher resolution images as long as a minimum SNR is guaranteed. In practice however, the maximum acceleration factor for a given resolution appears to be constrained by the available SNR inherent to the considered acquisition. Our analysis enables to take this a priori knowledge into account, allowing to derive a sequence-specific maximum acceleration factor adapted to the intrinsic SNR of any MR pipeline. These results obtained on an analytical T2*-weighted phantom image were corroborated by prospective experiments performed on MR data collected with radial trajectories on a 7 Tesla scanner with the same contrast. The proposed framework allows to study other sequence weightings and therefore better optimize sequences when accelerated using CS.

https://ift.tt/2zW4Mtz

Robust Estimation of the Apparent Diffusion Coefficient Invariant to Acquisition Noise and Physiological Motion

Publication date: Available online 21 July 2018

Source: Magnetic Resonance Imaging

Author(s): Santiago Sanz-Estébanez, Tomasz Pieciak, Carlos Alberola-López, Santiago Aja-Fernández

Abstract

Purpose:

In this work we have proposed a methodology for the estimation of the apparent diffusion coefficient in the body from multiple breath hold diffusion weighted images, which is robust to two preeminent confounding factors: noise and motion during acquisition.

Methods:

We have extended a method for the joint groupwise multimodal registration and apparent diffusion coefficient estimation, previously proposed by the authors, in order to correct the bias that arises from the non-Gaussianity of the data and the registration procedure.

Results:

Results show that the proposed methodology provides a statistically significant improvement both in robustness for displacement fields calculation and in terms of accuracy for the apparent diffusion coefficient estimation as compared with traditional sequential approaches. Reproducibility has also been measured on real data in terms of the distribution of apparent diffusion coefficient differences obtained from different b-values subsets.

Conclusions:

Our proposal has shown to be able to effectively correct the estimation bias by introducing additional computationally light procedures to the original method, thus providing robust apparent diffusion coefficient maps in the liver and allowing an accurate and reproducible analysis of the tissue.

https://ift.tt/2mz4q2J

A Machine-learning Framework for Automatic Reference-free Quality Assessment in MRI

Publication date: Available online 21 July 2018

Source: Magnetic Resonance Imaging

Author(s): T. Küstner, S. Gatidis, A. Liebgott, M. Schwartz, L. Mauch, P. Martirosian, H. Schmidt, NF. Schwenzer, K. Nikolaou, F. Bamberg, B. Yang, F. Schick

Abstract

Magnetic resonance (MR) imaging offers a wide variety of imaging techniques. A large amount of data is created per examination which needs to be checked for sufficient quality in order to derive a meaningful diagnosis. This is a manual process and therefore time- and cost-intensive. Any imaging artifacts originating from scanner hardware, signal processing or induced by the patient may reduce the image quality and complicate the diagnosis or any image post-processing. Therefore, the assessment or the ensurance of sufficient image quality in an automated manner is of high interest. Usually no reference image is available or difficult to define. Therefore, classical reference-based approaches are not applicable. Model observers mimicking the human observers (HO) can assist in this task. Thus, we propose a new machine-learning-based reference-free MR image quality assessment framework which is trained on HO-derived labels to assess MR image quality immediately after each acquisition. We include the concept of active learning and present an efficient blinded reading platform to reduce the effort in the HO labeling procedure. Derived image features and the applied classifiers (support-vector-machine, deep neural network) are investigated for a cohort of 250 patients. The MR image quality assessment framework can achieve a high test accuracy of 93.7% for estimating quality classes on a 5-point Likert-scale. The proposed MR image quality assessment framework is able to provide an accurate and efficient quality estimation which can be used as a prospective quality assurance including automatic acquisition adaptation or guided MR scanner operation, and/or as a retrospective quality assessment including support of diagnostic decisions or quality control in cohort studies.

Graphical Abstract

https://ift.tt/2uRvWMp

High BIS and low rSO 2 during CPB: seizure?

https://ift.tt/2LEutjI

Primary immunodeficiency disorder caused by phosphoinositide 3-kinase delta (PI3Kδ) deficiency

Publication date: Available online 21 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Georgios Sogkas, Mykola Fedchenko, Akshay Dhingra, Alexandra Jablonka, Reinhold E. Schmidt, Faranaz Atschekzei

Short summary

First publication on human PI3Kδ deficiency. Two patients carrying novel homozygous loss-of-function mutation in PIK3CD, resulting in PI3Kδ deficiency, developed a primary immunodeficiency disorder characterized by hypogammaglobulinemia and inflammatory bowel disease.

https://ift.tt/2uSTHUy

Trans- and inter-generational epigenetic inheritance in allergic diseases

Publication date: Available online 21 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Toril Mørkve Knudsen, Faisal I. Rezwan, Yu Jiang, Wilfried Karmaus, Cecilie Svanes, John W. Holloway

ABSTRACT

It has become clear that early life (including in utero exposures), is a key window of vulnerability where environmental exposures can alter developmental trajectories and initiate allergic disease development. However, recent evidence suggests that there may be additional windows of vulnerability to environmental exposures in the parental generation before conception, or even in previous generations. There is evidence suggesting that information of prior exposures can be transferred across generations, and experimental animal models suggest that such transmission may be conveyed through epigenetic mechanisms. While the molecular mechanisms of inter- and trans-generation epigenetic transmission have yet to be determined, the realisation that environment before conception may alter risks of allergic diseases, has profound implications for the development of public health interventions to prevent disease. Future research in both experimental models and in multigenerational human cohorts is needed to better understand the role of inter- and trans-generational effects in asthma and allergic disease. This will provide the knowledge basis for a new approach to efficient intervention strategies aimed at reducing the major public health challenge of these conditions.

https://ift.tt/2mzStKc

Socioeconomics of Atopic Dermatitis-Can We Afford New Treatments?

Publication date: Available online 21 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Michael S. Blaiss

https://ift.tt/2O5jphj

Perinatal maternal negative life events as risk factors of atopic dermatitis in female offspring

Publication date: Available online 21 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Jisun Yoon, Eun Mi Kim, Mi Young Lee, Sungsu Jung, Hyun-Ju Cho, Yeongho Kim, Yean Jung Choi, Eun Lee, Song-I Yang, So-Yeon Lee, Jeong Rim Lee, Yejin Yi, Soo-Jong Hong

https://ift.tt/2NyRa9s

Differences in egg and milk food challenge outcomes based on tolerance to the baked form

Publication date: Available online 21 July 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Peter Capucilli, Antonella Cianferoni, Joel Fiedler, Laura Gober, Nicholas Pawlowski, Gita Ram, Rushani Saltzman, Jonathan M. Spergel, Jennifer Heimall

Abstract

Background

Previous studies suggest inclusion of baked egg and milk in the diet of egg or cow's milk (CM) allergic children may positively impact native tolerance. Differences in native food reactivity based on historical baked tolerance, however, is not fully understood. Objective: To assess differences in native egg and CM oral food challenge (OFC) outcomes based on presenting history of tolerance and exposure to these foods in the baked form.

Methods

Retrospective review of all egg and CM OFCs at The Children's Hospital of Philadelphia, Philadelphia, PA, over 4 years (n=580). History of baked ingestion was compared to OFC pass rate, eliciting dose, epinephrine use, reaction classification and recent skin test or specific IgE level.

Results

There were 115 egg and 70 CM positive challenges with most eliciting anaphylaxis. Children tolerating baked egg passed OFC more frequently (75%), compared to children who avoided baked egg (58%) (P=0.01) or never ingested egg (45%) (P<0.0001). For positive reactions, baked egg tolerant children reacted at higher eliciting doses of native egg (Median 3.0g, Range 0.125-15.75g) compared to those avoiding baked egg (Median 0.69g, Range 0.13-10.0g) (P=0.03) and those with no egg exposure (Median 0.88g, Range 0.13-13.88g) (P=0.01). Further, epinephrine use was lower in children tolerating baked egg (10%) compared to children avoiding baked egg (22%) (P=0.02) and compared to subjects who never ingested egg (32%) (P=0.0001). These differences were not observed for CM challenges.

Conclusion

Children who historically tolerated baked egg were less sensitive to native egg during OFC compared to children whose baked reactivity was largely unknown.

https://ift.tt/2O84cfh

Activity and clinical relevance of autotaxin and lysophosphatidic acid pathways in high-grade serous carcinoma

Abstract

The aim of this study was to analyze the expression, biological role and clinical relevance of autotaxin (ATX), the enzyme synthetizing lysophosphatidic acid (LPA), and LPA receptors (LPAR) in high-grade serous carcinoma (HGSC). mRNA expression by qRT-PCR of LPAR1-6 was analyzed in 155 HGSC specimens (88 effusions, 67 solid lesions). ATX mRNA expression was analyzed in 97 specimens. ATX, ERK, and AKT protein expression was studied by Western blotting. LPAR2 mRNA was overexpressed in HGSC cells in effusions compared to solid lesions, with opposite findings for LPAR3 and LPAR6 mRNA and ATX protein. Higher LPAR1 levels were significantly related to longer overall survival (OS) in pre-chemotherapy effusions (p = 0.027). Conversely, higher expression of LPAR1, LPAR2, and LPAR5 in post-chemotherapy effusions was significantly associated with shorter OS (p = 0.037, p = 0.025 and p = 0.021, respectively) and progression-free survival (PFS) (p < 0.001, p = 0.007 and p < 0.001, respectively) in univariate survival analysis. LPAR1 mRNA expression was an independent prognosticator of OS in patients with pre-chemotherapy effusions and PFS in patients with post-chemotherapy effusions (p = 0.013 both). In conclusion, LPAR mRNA and ATX protein levels are anatomic site-dependent in HGSC and the former are informative of disease outcome.

https://ift.tt/2uPbkVb

Immunoglobulin genes in Primates

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): David N. Olivieri, Francisco Gambón Deza

Abstract

Five classes of immunoglobulins are known to exist in mammals. The number of isotypes of classes G, E and A varies among species for unknown reasons. Here, a study of the presence of immunoglobulin genes in Primates was carried out from the genomes and transcriptomes deposited in the NCBI repository. For this, a machine learning application based upon neural networks was implemented that scans the genomes and identifies the exon sequences that encode the immunoglobulin CH domains. From these exons, the immunoglobulins that each species possess can be inferred. Also, the presence of sequences outside the IGHC locus was found which were produced by retrotranscription of RNA that are probably not viable. From this study, the distribution of immunoglobulin genes across primate orders is described in detail. In Prosimians, IgD genes are not found; in Platyrrhines, a gene is identified for each of the immunoglobulin classes but the IgD gene does not have the CH2 exon; in the Cercopithecidae family, a gene is detected for each class in the Colobinae family, while in Cercopithecidae the genes for IgG have been duplicated several times. In hominids, a greater number of duplications that include the genes that code for IgA and IgE are observed. These results indicate that from the appearance of the Cercopithecidae, there is an evolutionary instability in the Ig locus.

https://ift.tt/2zYo6Xa

Investigating vulnerability of ecological industrial symbiosis network based on automatic control theory

Abstract

System fluctuations of eco-industrial symbiosis network (EISN) organization due to disturbance are very similar to the controller adjustment in the automatic control theory. Thus, a methodology is proposed in this study to assess the vulnerability of EISN based on the automatic control theory. The results show that the regulator plays a key role to enhance the resilience of the network system to vulnerability. Therefore, it is imperative to strengthen the real-time regulation and control of EISN so that the system stability is improved. In order to further explore the impact of various regulations on the system vulnerability, the influence of system stability is simulated by means of proportional, differential, and integral control. A case study with Guigang eco-industrial park (EIP) was undertaken to test this model. The results showed that when the system was disturbed at different positions, the key nodes which had great influence on system vulnerability could be selected according to the magnitude of simulation curve. By changing the ratio coefficient of proportional, differential, and integral units to adjust the ecological chain network, the system's resilience to vulnerability can be enhanced. Firstly, if basic conditions of EISN organization remain unchanged, the integral control of the policy support and infrastructure sharing should be strengthened. Secondly, the differential regulation should be improved continuously for the technological innovation capability of key node enterprises. Finally, the key chain filling projects should be introduced for proportional control so that the chain network design can be optimized from the source.

https://ift.tt/2Lr59B8

Photocatalytic degradation of imidacloprid by Ag-ZnO composite

Abstract

The present study focused on exploring the potential of Ag-ZnO composites for complete mineralization of imidacloprid with the aim to sustain the pollutant free safe water supply. The composites were prepared by hydrothermal method and characterized by Scanning electron microscope (SEM), Energy dispersive X-ray crystallography (EDX), X-ray diffraction (XRD) and band gap measurements. These composites were used to study the UV irradiated degradation of imidacloprid while optimizing the process parameters such as time of UV irradiation, pH of medium, pesticide concentration and composite loading. The results of the study revealed an increase in photodegradation of imidacloprid by Ag-ZnO composites than pure ZnO. Temperature and catalyst loading had a positive effect on degradation efficiency, while an inverse relation was observed between pesticide concentration and degradation. Moreover, no harmful degradation products of imidacloprid were observed in GC-MS analyses that confirmed its complete mineralization.

https://ift.tt/2JGdQ5D

Anti-polysaccharide and anti-diphtheria protective antibodies after 13-valent pneumococcal conjugate vaccination in rheumatoid arthritis patients under immunosuppressive therapy

Publication date: Available online 21 July 2018

Source: Clinical Immunology

Author(s): Sara Caporuscio, Roberto Ieraci, Guido Valesini, Raffaela Teloni, Sabrina Mariotti, Francesca Romana Spinelli, Claudia Ferlito, Simonetta Salemi, Andrea Picchianti Diamanti, Giorgia Meneguzzi, Milica Markovic, Mayla Sgrulletti, Christina von Hunolstein, Luisa Ralli, Antonietta Pinto, Gerardo Salerno, Marco Canzoni, Maria Laura Sorgi, Bruno Laganà, Roberta Di Rosa

Abstract

Immunogenicity of 13-valent pneumococcal polysaccharide (PnPS) conjugate vaccine (PCV13) was evaluated in 38 rheumatoid arthritis patients under immunosuppressive treatment and 20 healthy controls (HC). Antibodies to all PnPS and diphtheria-toxin analogue conjugate protein were measured pre- (T0), 1 (T1), 6 (T2), 12 (T3) months post-immunization. Patients and HC had similar response to individual PnPS. Mean antibody levels to all PnPS but one doubled at T1 compared with T0, with T3 persistence for only 8-7/13 PnPS. Baseline antibody levels was inversely associated with the rate of responders at T1 (T1/T0≥2) to 11/13 PnPS. Few subjects reached protective IgG levels against some serotypes frequently isolated in Italian patients with invasive pneumococcal disease. Antibody response was not influenced by therapy, except the one to PS7F, which was reduced by tumor necrosis factor-α-inhibitors. Vaccination increased also anti-diphtheria IgG. Despite this study substantially confirmed the PCV13 immunogenicity in immunocompromised patients, it also revealed some limitations.

https://ift.tt/2JIxCgK

Assessment of vestibular function in elderly patients

Purpose of review Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT). Recent findings Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function. Summary The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population. Correspondence to Rachael Krager, Audiologist, UC Davis Medical Center, 2521 Stockton Blvd., 6th Floor, Sacramento, CA 95817, USA. E-mail: rkrager@ucdavis.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LofCgu

Advances in computer-aided design for bony free-flap reconstruction

Purpose of review The current article reviews the most recent publications of computer-assisted reconstruction using bony free flaps, emphasizing on comparative reports using these novel techniques. Recent findings Computer-aided reconstruction has shown some benefits in comparison with traditional techniques and some of the perceived limitations are currently being addressed in the latest reports. Still, there is a lack of appropriate comparative studies and unblinded measurements to establish solid conclusions. Summary Despite the application of new technologies showed encouraging results, it is premature to state that the traditional technique should be replaced by the modern approaches. Correspondence to Kevin Fung, MD, FRCS(C), FACS, Professor, Chair/Chief, Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, LHSC – Victoria Hospital, Room B3-427, 800 Commissioners Rd E, London, ON, Canada N6A 4G5. Tel: +1 519 685 8599; fax: +1 519 685 8567; e-mail: kevin.fung@lhsc.on.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2uTjoUG

Endogenous Bradykinin and BK1-5 during ACE Inhibitor-Associated Angioedema

Publication date: Available online 21 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Scott Hubers, Kevin Kohm, Shouzuo Wei, Chang Yu, Hui Nian, Ryan Grabert, Daniel J. Sexton, Nancy J. Brown

Capsule Summary

Bradykinin concentrations and the ratio of bradykinin to its stable metabolite BK1-5 (RPPGF) were significantly increased in patients presenting with angiotensin-converting enzyme (ACE) inhibitor-associated angioedema compared to ACE inhibitor-treated controls. Cleavage of high molecular weight kininogen was not increased in patients with ACE inhibitor-associated angioedema, indicating that increased bradykinin concentrations result from decreased degradation.

https://ift.tt/2LDanqi

Clinical and genetic differences between pustular psoriasis subtypes

Publication date: Available online 21 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Sophie Twelves, Alshimaa Mostafa, Nick Dand, Elias Burri, Katalin Farkas, Rosemary Wilson, Hywel L. Cooper, Alan D. Irvine, Hazel H. Oon, Külli Kingo, Sulev Köks, Ulrich Mrowietz, Luis Puig, Nick Reynolds, Eugene Sern-Ting Tan, Adrian Tanew, Kaspar Torz, Hannes Trattner, Mark Valentine, Shyamal Wahie

Abstract

Background

The term pustular psoriasis indicates a group of severe skin disorders characterised by eruptions of neutrophil-filled pustules. The disease, which often manifests with concurrent psoriasis vulgaris (PV), can have an acute systemic (generalised pustular psoriasis, GPP) or chronic localised presentation (palmoplantar pustulosis, PPP; acrodermatitis continua of Hallopeau, ACH). While mutations have been uncovered in IL36RN and AP1S3, the rarity of the disease has hindered the study of genotype-phenotype correlations.

Objective

We sought to characterise clinical and genetic features of pustular psoriasis through the analysis of an extended patient cohort.

Methods

We ascertained a dataset of unprecedented size, including 863 unrelated patients (251 GPP, 560 PPP, 28 ACH, 24 multiple diagnoses). We undertook mutation screening in 473 cases.

Results

PV concurrence was lowest in PPP (15.8% vs. 54.4% in GPP and 46.2% in ACH, P<0.0005 for both), whereas mean age of onset was earliest in GPP (31.0 years vs. 43.7 in PPP and 51.8 in ACH, P<0.0001 for both). The percentage of females was higher in PPP (77.0%) than GPP (62.5%) (P=5.8x10^-5). The same applied to the prevalence of smokers (79.8% vs 28.3%, P<10^-15). While AP1S3 alleles had similar frequency (0.03-0.05) across disease subtypes, IL36RN mutations were less common in PPP (0.03) than GPP (0.19) and ACH (0.16) (P=1.9x10^-14 and 0.002, respectively). Importantly, IL36RN disease alleles had a dose-dependent effect on age of onset, in all forms of pustular psoriasis (P=0.003).

Conclusions

The analysis of an unparalleled patient resource revealed key clinical and genetic differences between PPP and GPP.

Graphical abstract

https://ift.tt/2Ldk1DT

Basophil levels in PBMC population during childhood acute wheeze/asthma are associated with future exacerbations

Publication date: Available online 21 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jonatan Leffler, Anya C. Jones, Elysia M. Hollams, Franciska Prastanti, Peter N. Le Souëf, Patrick G. Holt, Anthony Bosco, Ingrid A. Laing, Deborah H. Strickland

Encapsulating summary

Our data suggest that a basophil level above 0.18% of the PBMC population during an acute respiratory exacerbation is associated with an increased risk for future exacerbations in children with asthma and/or wheeze.

https://ift.tt/2LAP4FP

Generating evidence to inform an update of asthma clinical practice guidelines: Perspectives from the National Heart, Lung, and Blood Institute

Publication date: Available online 21 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): George A. Mensah, James P. Kiley, Gary H. Gibbons

Asthma is the most prevalent chronic respiratory disease worldwide. Its increasing prevalence and evidence of suboptimal control require renewed efforts in the development and widespread implementation of clinical practice guidelines for prevention, treatment, and control. Given the rapidly changing landscape and evolving best practices for guideline development, the National Heart, Lung, and Blood Institute made a commitment to support rigorous systematic evidence reviews that frontline health care providers and stakeholders could use to create new or update existing guidelines. This article describes the protocols, key questions, methodology, and analytic framework to support the update of the 2007 National Asthma Education and Prevention Program Expert Panel Report 3 (EPR-3) on the diagnosis and management of asthma in adults and children. It also describes the expert panel's practical experience in managing asthmatic patients across the age and severity spectrum. The article explains the process for ensuring that the expert panel's deliberations are conducted in accordance with the Institute of Medicine's standards and recommendations for guideline development. The outcome of this ambitious effort will be an update of the EPR-3 asthma guidelines and publication of the key recommendation in the Journal of Allergy and Clinical Immunology. Importantly, several novel approaches will be explored and incorporated as appropriate to accelerate adoption and sustained implementation of the guidelines.

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Thirty-Day Acute Health Care Resource Utilization Following Outpatient Anterior Cruciate Ligament Surgery

Background and Objectives The need for hospital-based acute care following outpatient surgical procedures is expensive and measured as marker for quality. However, little information is available about events leading to emergency department visit or inpatient admission after ambulatory anterior cruciate ligament (ACL) surgery. Methods We studied adult patients who underwent outpatient ACL surgery in New York State between 2009 and 2013 using the Healthcare Cost and Utilization Project database. Emergency department visits and inpatient admissions within 30 days of surgery were identified by cross-matching 2 additional independent Healthcare Cost and Utilization Project databases. Results The final cohort included 26,873 subjects. We identified 1208 (3.90%; 95% confidence interval [CI], 3.6%–4.1%) secondary health care encounters of interest. The majority of these encounters were emergency department visits (951). The most common reasons were musculoskeletal pain (349 [28.9%]), any infection (122 [10.1%]), drug abuse (98 [8.1%]), wound infection (87 [7.2%]), deep venous thrombosis (77 [6.4%]), and psychotic events (54 [4.5%]). Patients operated on in high-volume surgical centers were less likely to require acute care (odds ratio, 0.47; P

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Global Health: Issues, Challenges, and Global Action

No abstract available

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The Future of Activated Clotting Time?

No abstract available

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Bubble Trouble: Venous Air Embolism in Endoscopic Retrograde Cholangiopancreatography

No abstract available

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The Stress Hormone Cortisol Enhances Interferon-υ–Mediated Proinflammatory Responses of Human Immune Cells

BACKGROUND: Cortisol is a prototypical human stress hormone essential for life, yet the precise role of cortisol in the human stress response to injury or infection is still uncertain. Glucocorticoids (GCs) such as cortisol are widely understood to suppress inflammation and immunity. However, recent research shows that GCs also induce delayed immune effects manifesting as immune stimulation. In this study, we show that cortisol enhances the immune-stimulating effects of a prototypical proinflammatory cytokine, interferon-υ (IFN-υ). We tested the hypothesis that cortisol enhances IFN-υ–mediated proinflammatory responses of human mononuclear phagocytes (monocyte/macrophages [MOs]) stimulated by bacterial endotoxin (lipopolysaccharide [LPS]). METHODS: Human MOs were cultured for 18 hours with or without IFN-υ and/or cortisol before LPS stimulation. MO differentiation factors granulocyte-macrophage colony stimulating factor (GM-CSF) or M-CSF were added to separate cultures. We also compared the inflammatory response with an acute, 4-hour MO incubation with IFN-υ plus cortisol and LPS to a delayed 18-hour incubation with cortisol before LPS exposure. MO activation was assessed by interleukin-6 (IL-6) release and by multiplex analysis of pro- and anti-inflammatory soluble mediators. RESULTS: After the 18-hour incubation, we observed that cortisol significantly increased LPS-stimulated IL-6 release from IFN-υ–treated undifferentiated MOs. In GM-CSF–pretreated MOs, cortisol increased IFN-υ–mediated IL-6 release by >4-fold and release of the immune stimulant IFN-α2 (IFN-α2) by >3-fold, while suppressing release of the anti-inflammatory mediator, IL-1 receptor antagonist to 15% of control. These results were reversed by either the GC receptor antagonist RU486 or by an IFN-υ receptor type 1 antibody antagonist. Cortisol alone increased expression of the IFN-υ receptor type 1 on undifferentiated and GM-CSF–treated MOs. In contrast, an acute 4-hour incubation of MOs with IFN-υ and cortisol showed classic suppression of the IL-6 response to LPS. CONCLUSIONS: These results reveal a surprisingly robust proinflammatory interaction between the human stress response hormone cortisol and the immune activating cytokine IFN-υ. The results support an emerging physiological model with an adaptive role for cortisol, wherein acute release of cortisol suppresses early proinflammatory responses but also primes immune cells for an augmented response to a subsequent immune challenge. These findings have broad clinical implications and provide an experimental framework to examine individual differences, mechanisms, and translational implications of cortisol-enhanced immune responses in humans.

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Rashomon Effect and the Contradiction of Data, Practice, and Regulations

No abstract available

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Physics for Anesthesiologists: From Daily Life to the Operating Room

No abstract available

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Agreement Between Transesophageal Echocardiography and Thermodilution-Based Cardiac Output

No abstract available

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More on Fatigue Mitigation for Anesthesiology Residents

No abstract available

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The Costs and Costing of Regulatory Compliance

No abstract available

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Adding to Our Competitive Advantage: Making the Case for Teaching Communication and Professionalism

No abstract available

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Vascular Air Embolism and Endoscopy: Every Bubble Matters

No abstract available

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Perioperative Management in Robotic Surgery, 1st ed

No abstract available

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Treating Chronic Pain: Is Buprenorphine the (or Even an) Answer?

No abstract available

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In Response

No abstract available

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The Mythology of Plasma Transfusion

No abstract available

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Adjusting the Ventilator? Not Only Size Matters!

No abstract available

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Troubleshooting Technical Difficulties With Videolaryngoscope Use in Children: Initial Steps Toward Improving Tracheal Tube Passage

No abstract available

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Beyond Emergence: Understanding postoperative Cognitive Dysfunction (POCD)

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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Repeated Measures Designs and Analysis of Longitudinal Data: If at First You Do Not Succeed—Try, Try Again

Anesthesia, critical care, perioperative, and pain research often involves study designs in which the same outcome variable is repeatedly measured or observed over time on the same patients. Such repeatedly measured data are referred to as longitudinal data, and longitudinal study designs are commonly used to investigate changes in an outcome over time and to compare these changes among treatment groups. From a statistical perspective, longitudinal studies usually increase the precision of estimated treatment effects, thus increasing the power to detect such effects. Commonly used statistical techniques mostly assume independence of the observations or measurements. However, values repeatedly measured in the same individual will usually be more similar to each other than values of different individuals and ignoring the correlation between repeated measurements may lead to biased estimates as well as invalid P values and confidence intervals. Therefore, appropriate analysis of repeated-measures data requires specific statistical techniques. This tutorial reviews 3 classes of commonly used approaches for the analysis of longitudinal data. The first class uses summary statistics to condense the repeatedly measured information to a single number per subject, thus basically eliminating within-subject repeated measurements and allowing for a straightforward comparison of groups using standard statistical hypothesis tests. The second class is historically popular and comprises the repeated-measures analysis of variance type of analyses. However, strong assumptions that are seldom met in practice and low flexibility limit the usefulness of this approach. The third class comprises modern and flexible regression-based techniques that can be generalized to accommodate a wide range of outcome data including continuous, categorical, and count data. Such methods can be further divided into so-called "population-average statistical models" that focus on the specification of the mean response of the outcome estimated by generalized estimating equations, and "subject-specific models" that allow a full specification of the distribution of the outcome by using random effects to capture within-subject correlations. The choice as to which approach to choose partly depends on the aim of the research and the desired interpretation of the estimated effects (population-average versus subject-specific interpretation). This tutorial discusses aspects of the theoretical background for each technique, and with specific examples of studies published in Anesthesia & Analgesia, demonstrates how these techniques are used in practice.

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A 2018 Reference Guide to the Banff Classification of Renal Allograft Pathology

The Banff Classification of Allograft Pathology is an international consensus classification for the reporting of biopsies from solid organ transplants. Since its initial conception in 1991 for renal transplants, it has undergone review every 2 years, with attendant updated publications. The rapid expansion of knowledge in the field has led to numerous revisions of the classification. The resultant dispersal of relevant content makes it difficult for novices and experienced pathologists to faithfully apply the classification in routine diagnostic work and in clinical trials. This review shall provide a complete and simple illustrated reference guide of the Banff Classification of Kidney Allograft Pathology based on all publications including the 2017 update. It is intended as a concise desktop reference for pathologists and clinicians, providing definitions, Banff Lesion Scores and Banff Diagnostic Categories. An online website reference guide hosted by the Banff Foundation for Allograft Pathology (www.banfffoundation.org) is being developed, which will be updated with future refinement of the Banff Classification from 2019 onwards. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received 19 February 2018. Revision received 7 May 2018. Accepted 23 May 2018. Corresponding author: Jan U. Becker, MD, Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, 50937, Germany, Phone: +4922147898803, Fax: +492214786360, E-mail: janbecker@gmx.com Authors' contribution All authors contributed the discussion of the content, the collation of images and illustrations and to writing of the manuscript. Disclosure: The authors declare no conflicts of interest. Funding Dr. Roufosse's and Dr. Simmond's contribution to this research is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Alexandre Loupy is supported by a research grant ATIP AVENIR from the National French Institute of Research. Jan U. Becker is supported by the European Rare Kidney Disease Network (ERKNet); the content of this manuscript is the sole responsibility of the authors. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Transplant-free Survival in Chronic Liver Disease Presenting as Acute Liver Failure in Childhood

Background in adults, the absence of a preexisting chronic liver disease (CLD) is required to diagnose acute liver failure (ALF). The paediatric classification does not considered this aspect, thus previous studies pooled together children with ALF and children with unknown CLD presenting with acute hepatic decompensation (ALF-CLD). We aimed to compare prevalence, features and outcome of children with ALF-CLD to those with a proper ALF. Methods Patients admitted between 1996-2017 because of ALF defined by PALF criteria (raised transaminases, INR ≥2.0, no history of liver disease) were classified as ALF-CLD if diagnosed with autoimmune hepatitis (AIH), Wilson disease (WD), Budd-Chiari syndrome, HBV reactivation, inborn errors of metabolism (IEM). The others were classified as ALF. Results 74 children [median age 4 years, 1.0-8.8, M/F =36/38] with ALF were found ; 18 of

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Assessment of vestibular function in elderly patients

Purpose of review Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT). Recent findings Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function. Summary The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population. Correspondence to Rachael Krager, Audiologist, UC Davis Medical Center, 2521 Stockton Blvd., 6th Floor, Sacramento, CA 95817, USA. E-mail: rkrager@ucdavis.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Advances in computer-aided design for bony free-flap reconstruction

Purpose of review The current article reviews the most recent publications of computer-assisted reconstruction using bony free flaps, emphasizing on comparative reports using these novel techniques. Recent findings Computer-aided reconstruction has shown some benefits in comparison with traditional techniques and some of the perceived limitations are currently being addressed in the latest reports. Still, there is a lack of appropriate comparative studies and unblinded measurements to establish solid conclusions. Summary Despite the application of new technologies showed encouraging results, it is premature to state that the traditional technique should be replaced by the modern approaches. Correspondence to Kevin Fung, MD, FRCS(C), FACS, Professor, Chair/Chief, Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, LHSC – Victoria Hospital, Room B3-427, 800 Commissioners Rd E, London, ON, Canada N6A 4G5. Tel: +1 519 685 8599; fax: +1 519 685 8567; e-mail: kevin.fung@lhsc.on.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Mechanisms of acute and chronic pain after surgery: update from findings in experimental animal models

Purpose of review Management of postoperative pain is still a major issue and relevant mechanisms need to be investigated. In preclinical research, substantial progress has been made, for example, by establishing specific rodent models of postoperative pain. By reviewing most recent preclinical studies in animals related to postoperative, incisional pain, we outline the currently available surgical-related pain models, discuss assessment methods for pain-relevant behavior and their shortcomings to reflect the clinical situation, delineate some novel clinical-relevant mechanisms for postoperative pain, and point toward future needs. Recent findings Since the development of the first rodent model of postoperative, incisional pain almost 20 years ago, numerous variations and some procedure-specific models have been emerged including some conceivably relevant for investigating prolonged, chronic pain after surgery. Many mechanisms have been investigated by using these models; most recent studies focussed on endogenous descending inhibition and opioid-induced hyperalgesia. However, surgical models beyond the classical incision model have so far been used only in exceptional cases, and clinical relevant behavioral pain assays are still rarely utilized. Summary Pathophysiological mechanisms of pain after surgery are increasingly discovered, but utilization of pain behavior assays are only sparsely able to reflect clinical-relevant aspects of acute and chronic postoperative pain in patients. Correspondence to Esther Pogatzki-Zahn, Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany. Tel: +49 251 8347261; fax: +49 251 88704; e-mail: pogatzki@anit.uni-muenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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