Publication date: Available online 31 March 2017
Source:Clinical Imaging
Author(s): Jiyeon Baik, Seung Ho Kim, Yedaun Lee, Jung-Hee Yoon
PurposeTo compare the lesion conspicuity and diagnostic performance of three imaging data sets (T2WI, combined T2WI and DWI [combined DWI], contrast-enhanced (CE)-T1WI) in assessing perianal fistulas.MethodsTwo radiologists with 7 and 15years of experience assessed 28 fistulas from 24 patients in each image set.ResultsThe lesion conspicuity was improved for only one reader after reading the combined DWI (P=0.0039) and CE-T1WI (P=0.0215). The accuracy was stationary for fistula type (reader 1, all 93%; reader 2, all 89%) or for direction of internal opening (96% for all sets; 92% for CE-T1WI).ConclusionAlthough combined DWI and CE-T1WI might improve fistula conspicuity, they showed comparable diagnostic performance to T2WI.
http://ift.tt/2oJoRsO
Παρασκευή 31 Μαρτίου 2017
Comparison of T2-weighted imaging, diffusion-weighted imaging and contrast-enhanced T1-weighted MR imaging for evaluating perianal fistulas
A fluorescent glycosyl-imprinted polymer for pH and temperature regulated sensing of target glycopeptide antibiotic
Publication date: 15 August 2017
Source:Biosensors and Bioelectronics, Volume 94
Author(s): Kuncai Chen, Rong He, Xiaoyan Luo, Pengzhe Qin, Lei Tan, Youwen Tang, Zhicong Yang
This paper demonstrates a new strategy for developing a fluorescent glycosyl-imprinted polymer for pH and temperature regulated sensing of target glycopeptide antibiotic. The technique provides amino modified Mn-doped ZnS QDs as fluorescent supports, 4-vinylphenylbronic acid as a covalent monomer, N-isopropyl acrylamide as a thermo-responsive monomer in combination with acrylamide as a non-covalent monomer, and glycosyl moiety of a glycopeptide antibiotic as a template to produce fluorescent molecularly imprinted polymer (FMIP) in aqueous solution. The FMIP can alter its functional moieties and structure with pH and temperature stimulation. This allows recognition of target molecules through control of pH and temperature. The fluorescence intensity of the FMIP was enhanced gradually as the concentration of telavancin increased, and showed selective recognition toward the target glycopeptide antibiotic preferentially among other antibiotics. Using the FMIP as a sensing material, good linear correlations were obtained over the concentration range of 3.0–300.0μg/L and with a low limit of detection of 1.0μg/L. The analysis results of telavancin in real samples were consistent with that obtained by liquid chromatography tandem mass spectrometry.
http://ift.tt/2nsRYAe
Zn vacancy formation, Zn evaporation and decomposition of ZnSb at elevated temperatures: Influence on the microstructure and the electrical properties
Publication date: 5 July 2017
Source:Journal of Alloys and Compounds, Volume 710
Author(s): Xin Song, Matthias Schrade, Nahum Masó, Terje G. Finstad
The influence of annealing on the microstructure and electrical properties of undoped polycrystalline ZnSb samples has been investigated by different experimental techniques. In situ XRD in an argon atmosphere showed that ZnSb powders decompose at 300 °C, which is attributed to Zn evaporation. In situ SEM in a moist atmosphere showed fast surface deterioration at 450 °C and above, reflecting decomposition of ZnSb and the formation of metallic Sb precipitates. The rate of Zn loss in a reducing atmosphere was determined by thermogravimetry and related to the Zn partial vapor pressure. The increase of the hole carrier concentration of ZnSb measured at room temperature after heat treatment was correlated with Zn evaporation at elevated temperature. The carrier concentration after annealing at 400 °C is consistent with an activation energy for Zn vacancy formation of 0.4 eV and a maximum Zn deficiency x of Zn1-xSb of 1 × 10−3.
http://ift.tt/2nK6VRe
Synthesis and characterization of Zn-Ti layered double hydroxide intercalated with cinnamic acid for cosmetic application
Publication date: August 2017
Source:Journal of Physics and Chemistry of Solids, Volume 107
Author(s): Yong Li, Liping Tang, Xinxu Ma, Xinrui Wang, Wei Zhou, Dongsheng Bai
The use of sunscreen is recently growing and their efficacy and safety must be taken into account since they are applied on the skin frequently. In this work, an organic ultraviolet (UV) ray absorbent, cinnamic acid (CA) was intercalated into Zn-Ti layered double hydroxide (LDH) by anion-exchange reaction. ZnTi-CA-LDH, a new type of host-guest UV-blocking material has been synthesized. Detailed structural and surface morphology of ZnTi-CA-LDH were characterized by XRD, FT-IR, SEM and TEM. ZnTi-CA-LDH exhibits a superior UV blocking ability compared to pure CA and ZnTi-CO3-LDH. The thermal stability of the intercalated ZnTi-CA-LDH was investigated by TG-DTA, which showed that the thermostability of CA was markedly enhanced after intercalation into ZnTi-CO3-LDH. The EPR data showed greatly decreased photocatalytic activity compared to common inorganic UV blocking agents TiO2 and ZnO. Furthermore, the sample was formulated in a sunscreen cream to study the matrix protective effect towards UV rays.
http://ift.tt/2nsLVff
Structural, elastic and electronic properties of B2-type modified by ternary additions FeAl-based intermetallics: First-principles study
Publication date: 5 July 2017
Source:Journal of Alloys and Compounds, Volume 710
Author(s): Yibing Zheng, Fen Wang, Taotao Ai, Chuang Li
The structural, elastic and electronic properties of FeAl (B2) intermetallics modified by ternary additions have been investigated by first-principles calculations based on density functional theory (DFT). The calculations of the formation enthalpy indicate that Al atoms are more easily replaced by the alloying elements X (X = V, Sc, Mn, Si, Mg, Co, Zr, Cu, Zn, Nb, Cr, Mo, W, Ti, Ni). The ratio of the bulk modulus to shear modulus B/G and Poisson's ratio v show that the FeAl-Cr, FeAl-Ti, and FeAl-Co systems are ductile materials and FeAl-Co (B/G = 1.92, v = 0.28) is the most ductile phase among these alloy phases. The electronic structure calculations indicate that the doping by Cr, Ti and Co may lead to the charge redistribution, the weakening of the Al-Al interaction, and strengthening of the Fe-Fe and Fe-Al interactions. It can be concluded that Cr, Ti and Co form the most stable FeAl-based intermetallics.
http://ift.tt/2nJZkC1
Ethical Considerations for Successfully Navigating the Research Process
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Lauri Byerley, Helen Lane, Mary-Jon Ludy, Mara Z. Vitolins, Ellen Anderson, Kathleen Niedert, Karin Pennington, Jimin Yang, Jenica K. Abram
http://ift.tt/2mXBFiI
Cytokine Expression Profile as Predictive Surrogate Biomarkers for Clinical Events in the Field of Solid Organ Transplantation
The morbidity and mortality after solid organ transplantation leads to poor outcomes in the long-term graft survival. There are many sources increasing bad outcomes within the post-transplant period reducing the quality of recipient´s life, such as rejection episodes, opportunistic infections as well as immunosuppression related morbidity. A complete understanding on the immune system responses against the allo-graft remains unknown. Recently, some pro-inflammatory cytokines, such as IFN-γ and IL-17, as well as IL-2, have been proposed as surrogate biomarkers able to predict the appearance of clinical event episodes. In this review we summarize the latest findings regarding the immune function monitoring in solid organ transplantation as well as the most common techniques (ELISPOT, ELISA and Flow Cytometry) that have been widely used across different clinical laboratories.
http://ift.tt/2nGCUjf
A randomized, single-blinded trial of a tripeptide/hexapeptide healing regimen following laser resurfacing of the face
Summary
Background
A topical healing system containing a combination of active ingredients including a tripeptide and hexapeptide (TriHex Technology™) has been found to stimulate neoelastogenesis and neocollagenesis.
Objective
Evaluate the use of the tripeptide/hexapeptide topical system following fractionated CO2 laser resurfacing compared to a bland ointment and cream.
Patients/Methods
In this single-blinded, randomized study, 15 female subjects aged 45-70 years underwent laser resurfacing of the face. Subjects were randomized to use of the tripeptide/hexapeptide system (n=10) or a bland dimethicone-based ointment and petrolatum-based cream (n=5) from 3 weeks pre- until 12 weeks postprocedure. A blinded investigator graded erythema, edema, crusting, exudation, and healing on postprocedure days 1, 3, 4, 7, 28, and 84. A photodamage/wrinkle scale was completed on days 28 and 84. Subjects performed symptomatology grading on days 1 through 14 and completed self-assessments at days 28 and 84.
Results
Data from 14 subjects were analyzed. Blinded-investigator-rated healing was better for the tripeptide/hexapeptide system, reaching statistical significance at day 7. The tripeptide/hexapeptide group demonstrated less erythema and exudation during the first postprocedure week, reaching significance at day 3. On days 1 through 14, subjects using the tripeptide/hexapeptide system reported less tenderness and burning/stinging, also reaching significance on day 3. At day 84, subjects using the tripeptide/hexapeptide system reported higher satisfaction and were more likely to recommend the treatment to others.
Conclusion
Postresurfacing use of a tripeptide/hexapeptide system proved effective and well-tolerated. Subject satisfaction was greater among those using this system, which may indicate an improved patient experience following laser resurfacing.
http://ift.tt/2olJvTv
Current advances in the development of natural meniscus scaffolds: innovative approaches to decellularization and recellularization
Abstract
The increasing rate of injuries to the meniscus indicates the urgent need to develop effective repair strategies. Irreparably damaged menisci can be replaced and meniscus allografts represent the treatment of choice; however, they have several limitations, including availability and compatibility. Another approach is the use of artificial implants but their chondroprotective activities are still not proved clinically. In this situation, tissue engineering offers alternative natural decellularized extracellular matrix (ECM) scaffolds, which have shown biomechanical properties comparable to those of native menisci and are characterized by low immunogenicity and promising regenerative potential. In this article, we present an overview of meniscus decellularization methods and discuss their relative merits. In addition, we comparatively evaluate cell types used to repopulate decellularized scaffolds and analyze the biocompatibility of the existing experimental models. At present, acellular ECM hydrogels, as well as slices and powders, have been explored, which seems to be promising for partial meniscus regeneration. However, their inferior biomechanical properties (compressive and tensile stiffness) compared to natural menisci should be improved. Although an optimal decellularized meniscus scaffold still needs to be developed and thoroughly validated for its regenerative potential in vivo, we believe that decellularized ECM scaffolds are the future biomaterials for successful structural and functional replacement of menisci.
http://ift.tt/2nphhCB
Polycyclic aromatic hydrocarbons and polychlorinated biphenyls in soils of Mayabeque, Cuba
Abstract
Cuba is a country in transition with a considerable potential for economic growth. Soils are recipients and integrators of chemical pollution, a frequent negative side effect of increasing industrial activities. Therefore, we established a soil monitoring network to monitor polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) in soils of Mayabeque, a Cuban province southeast of Havana. Concentrations of the sum of the 16 US EPA PAHs and of the seven IRMM PCBs in soils from 39 locations ranged from 20 to 106 μg kg−1 and from 1.1 to 7.6 μg kg−1, respectively. While such concentrations can be considered as low overall, they were in several cases correlated with the distance of sampling sites to presumed major emission sources, with some of the concomitantly investigated source diagnostic PAH ratios, and with black carbon content. The presented data adds to the limited information on soil pollution in the Caribbean region and serves as a reference time point before the onset of a possible further industrial development in Cuba. It also forms the basis to set up and adapt national environmental standards.
http://ift.tt/2mXpl24
Characteristic comparison of heavy metal contamination between road-deposited and roof-deposited sediments in suburban area
Abstract
Surface-deposited sediment in urban area is an essential environmental medium for assessing heavy metal contamination. A total of 10 sampling trips were conducted to collect road-deposited and roof-deposited sediments for the comparison of nickel (Ni), copper (Cu), cadmium (Cd), lead (Pb), zinc (Zn), and chromium (Cr) contamination characteristics. Results indicated that roof sediment appeared to have a finer size distribution than road sediments. Roof sediment indicated higher metal concentration and lower surface loading than road sediment. The impact of particle size on heavy metal contamination was quantified by using the developed pioneering term of finer particle effect factor; it differed according to surface types and grain size fraction. Particles in individual grain size fraction showed different contribution to the surface loading for bulk sediments. No consistent trend was found for the grain size fraction loading along with grain size for the studied heavy metals for road sediments. In contrast, an asymmetric "W" trend was observed for the roof sediments, and it had the following results: Fraction of <63 and 250–500 μm showed higher loading, while fraction of 90–125 and >850 μm indicated the smaller loading. Findings above facilitated the appropriate management practice selection for the treatment of surface-deposited sediments.
http://ift.tt/2nGtNiR
The problem of dephosphorization using waste recycling
Abstract
The article considers optimizing methods for wastewater treatment systems. Nutrients (nitrogen and phosphorus) are discharged from the river basin of the northwest Russia. Disruption of ecological safety and healthy state of water basins takes place when excess amount of nitrogen and phosphorus is discharged from wastewater. This results in eutrophication that is increased growth of seaweeds and, therefore, in ecological system disruption. The cities of the northwest region are short of funds for renovation of water treatment systems. However, the new solution lies in improvement of biological water treatment system by means of chemical injection. The main research task is implementation of methods for enhanced biological phosphorus removal from domestic sewage. The problem of recycling and ecological safety of rivers within the northwest of Russia and the Baltic Sea is not solved completely. That is why for wastewater dephosphorization, the authors suggest using sulfuric acid production waste at chemical plant "Ammophos," Cherepovets (ferrous sulfate FeSO4·7H2O and phosphogypsum СаSO4·Р2О5), as reagents. The advantage of these reagents is their low cost. The authors show the efficiency of the new optimal reagent's combination. Filtering the wastewater through sand filters after secondary settlers increases the total phosphorus removal efficiency up to 90%. The high effect of all types of phosphorus and total nitrogen removal from wastewater can be resulted from the features of micelle creation during coagulation.
http://ift.tt/2mXhD7Y
Effects of applying biosolids to soils on the adsorption and bioavailability of 17α-ethinylestradiol and triclosan in wheat plants
Abstract
Biosolids contain inorganic and organic contaminants, including pharmaceutical and personal care products (PPCPs) that have accounted for a series of emerging contaminants, such as triclosan (TCS) and the hormone 17α-ethinylestradiol (EE2). The general aim of this study was to evaluate the effects of biosolid application on EE2 and TCS adsorption and bioavailability in soils through testing with wheat plants. For the bioavailability study, sand and two soils, Lampa and Lo Prado, were used. The sand and soils were treated using two biosolid application rates (0 and 90 mg ha−1), and the EE2 and TCS concentrations in the biosolids were determined as 0.54 ± 0.06 and 8.31 ± 0.19 mg kg−1, respectively. The concentration observed in wheat plants indicated that EE2 and TCS are mainly concentrated in the roots rather than in the shoots. Furthermore, the bioavailability of the compounds in plants depends on the properties of the contaminants and the soil. Adsorption studies showed that increasing the soil organic matter content increases the adsorption of TCS and EE2 on these substrates and that both compounds follow the Freundlich adsorption model. The desorption procedure indicated that availability for both TCS and EE2 depended on the soil type because TCS and EE2 were small in the Lampa soil with and without biosolid application and TCS increased by nearly 50% in the Lo Prado soil. The Lo Prado soil had an acidic pH (5.9) and the Lampa soil had a neutral pH of 7.3, and the organic carbon content was smaller.
http://ift.tt/2nGjCuk
Spatial distribution of atmospheric PAHs and their genotoxicity in petrochemical industrialized Lanzhou valley, northwest China
Abstract
The present study investigated the spatial and seasonal variations and sources of 16 priority polycyclic aromatic hydrocarbons (PAHs) in Lanzhou, a petrochemical industrialized and the capital city of Gansu province, northwest China. The human health risks to these PAHs were assessed using an in vitro genotoxic bioassay technique. Associations among direct genotoxic potency, atmospheric PAH concentrations, and potential carcinogen risks were examined. Due to high PAH emissions from fossil fuel combustion and petrochemical industries, considerable higher PAH levels in the atmosphere were observed in Xigu district, a suburb featured by heavy petrochemical industry, compared with those collected at downtown and rural sampling sites. Ambient PAH levels at all sampling sites during the wintertime were higher than that in the summertime due to the winter domestic heating. BaP equivalent (BaPeq) concentrations in winter (41 ng/m3) and summer (28 ng/m3) exceeded the China's new national daily BaPeq standard. The average excess inhalation cancer risks (ECR) due to human exposure to PAHs during winter and summer sampling periods were 45–3540 cancer cases and 31–2451 cases per million people, respectively. The average ECR in the industrial area of Lanzhou valley was 1.97 (winter) and 1.88 times (summer) higher than that in other sampling areas. The higher ECR in the industrial area was resulted primarily by industrial activities and insufficient emission control measures. Extracts from passive air samples in genotoxicity SOS/umu test demonstrated that the genotoxic effect of atmospheric PAHs in Lanzhou was seasonal dependent. PAH air samples collected in winter showed more statistically significant genotoxicity, as manifested by a strong correlation between in vitro genotoxicity and atmospheric PAH concentrations. This indicates that the local residents were under higher potential cancer risk through the inhalation of ambient PAH air concentrations in Lanzhou valley during the wintertime.
http://ift.tt/2oj2QED
Effectiveness of carbon dioxide against different developmental stages of Cadra cautella and Tribolium castaneum
Abstract
Methyl bromide is an excellent fumigant but has been banned because it has high potential for depleting the ozone layer which leads to many environmental and human health hazard issues. In this connection, effectiveness of carbon dioxide (CO2, 99.9%) was studied as an alternative to methyl bromide under various exposure timings, 25 ± 1 °C, against different developmental stages of the almond moth, Cadra cautella, and red flour beetle, Tribolium castaneum. In case of C. cautella, the LT99 against adult, pupa, and larval stages was achieved after 37.5, 78.1, and 99.9 h of CO2 application, respectively. While for T. castaneum, the LT99 values were obtained after exposure timings of 29.3, 153.9, and 78.4 h against adult, pupa, and larval stages, respectively. Adults were very susceptible; in contrast, pupae and larvae were more tolerant. The susceptibility order was observed as follows: T. castaneum adult > C. cautella adult > C. cautella pupae > T. castaneum larvae > C. cautella larvae > T. castaneum pupae. This study could be useful in developing the management strategies to prevent stored dates from C. cautella and T. castaneum infestation.
http://ift.tt/2nmnkYx
Subsurface cadmium loss from a stony soil—effect of cow urine application
Abstract
Cadmium (Cd) losses in subsurface flow from stony soils that have received cow urine are potentially important, but poorly understood. This study investigated Cd loss from a soil under a winter dairy-grazed forage crop that was grazed either conventionally (24 h) or with restricted grazing (6 h). This provided an opportunity to test the hypothesis that urine inputs could increase Cd concentrations in drainage. It was thought this would be a result of cow urine either (i) enhancing dissolved organic carbon (DOC) concentrations via an increase in soil pH, resulting in the formation of soluble Cd-organic carbon complexes and, or (ii) greater inputs of chloride (Cl) via cow urine, promoting the formation of soluble Cd-Cl complexes. Cadmium concentrations in subsurface flow were generally low, with a spike above the water quality guidelines for a month after the 24-h grazing. Cadmium fluxes were on average 0.30 g Cd ha−1 year−1 (0.27–0.32 g Cd ha−1 year−1), in line with previous estimates for agricultural soils. The mean Cd concentration in drainage from the 24-h grazed plots was significantly higher (P < 0.05) than 6-h plots. No increase in DOC concentrations between the treatments was found. However, Cl concentrations in drainage were significantly higher (P < 0.001) from the 24-h than the 6-h grazed treatment plots, and positively correlated with Cd concentrations, and therefore, a possible mechanism increasing Cd mobility in soil. Further study is warranted to confirm the mechanisms involved and quantities of Cd lost from other systems.
http://ift.tt/2oiQsEI
Microbial profiles of a drinking water resource based on different 16S rRNA V regions during a heavy cyanobacterial bloom in Lake Taihu, China
Abstract
Understanding of the bacterial community structure in drinking water resources helps to enhance the security of municipal water supplies. In this study, bacterial communities were surveyed in water and sediment during a heavy cyanobacterial bloom in a drinking water resource of Lake Taihu, China. A total of 325,317 high-quality sequences were obtained from different 16S ribosomal RNA (rRNA) regions (V3, V4, and V6) using the Miseq sequencing platform. A notable difference was shown between the water and sediment samples, as predominated by Cyanobacteria, Proteobacteria, and Actinobacteria in the water and Proteobacteria, Chloroflexi, and Verrucomicrobia in the sediment, respectively. The LD12 family dominated the water surface and was tightly associated with related indicators of cyanobacterial propagation, indicating involvement in the massive proliferation of cyanobacterial blooms. Alternatively, the genus Nitrospira dominated the sediment samples, which indicates that nitrite oxidation was very active in the sediment. Although pathogenic bacteria were not detected in a large amount, some genera such as Mycobacterium, Acinetobacter, and Legionella were still identified but in very low abundance. In addition, the effects of different V regions on bacterial diversity survey were evaluated. Overall, V4 and V3 were proven to be more promising V regions for bacterial diversity survey in water and sediment samples during heavy water blooms in Lake Taihu, respectively. As longer, cheaper, and faster DNA sequencing technologies become more accessible, we expect that bacterial community structures based on 16S rRNA amplicons as an indicator could be used alongside with physical and chemical indicators, to conduct comprehensive assessments for drinking water resource management.
http://ift.tt/2nofUDS
Characteristics and mechanisms of nickel adsorption on biochars produced from wheat straw pellets and rice husk
Abstract
The adsorption characteristics and mechanisms of Ni2+ on four-standard biochars produced from wheat straw pellets (WSP550, WSP700) and rice husk (RH550, RH700) at 550 and 700 °C, respectively, were investigated. The kinetic results show that the adsorption of Ni2+ on the biochars reached an equilibrium within 5 min. The increase of the solid to liquid ratio resulted in an increase of Ni2+ removal percentage but a decrease of the adsorbed amount of Ni2+ per weight unit of biochar. The Ni2+ removal percentage increased with the increasing of initial solution pH values at the range of 2–4, was relatively constant at the pH range of 4–8, and significantly increased to ≥98% at pH 9 and stayed constantly at the pH range of 9–10. The calculated maximum adsorption capacities of Ni2+ for the biochars follow the order of WSP700 > WSP550 > RH700 > RH550. Both cation exchange capacity and pH of biochar can be a good indicator of the maximum adsorption capacity for Ni2+ showing a positively linear and exponential relationship, respectively. This study also suggests that a carefully controlled standardised production procedure can make it reliable to compare the adsorption capacities between different biochars and investigate the mechanisms involved.
http://ift.tt/2noh9Dl
Biosensor for detection of dissolved chromium in potable water: A review
Source:Biosensors and Bioelectronics, Volume 94
Author(s): Puja Biswas, Abhinav Kumar Karn, P. Balasubramanian, Paresh G. Kale
The unprecedented deterioration rate of the environmental quality due to rapid urbanization and industrialization causes a severe global health concern to both ecosystem and humanity. Heavy metals are ubiquitous in nature and being used extensively in industrial processes, the exposure to excessive levels could alter the biochemical cycles of living systems. Hence the environmental monitoring through rapid and specific detection of heavy metal contamination in potable water is of paramount importance. Various standard analytical techniques and sensors are used for the detection of heavy metals include spectroscopy and chromatographic methods along with electrochemical, optical waveguide and polymer based sensors. However, the mentioned techniques lack the point of care application as it demands huge capital cost as well as the attention of expert personnel for sample preparation and operation. Recent advancements in the synergetic interaction among biotechnology and microelectronics have advocated the biosensor technology for a wide array of applications due to its characteristic features of sensitivity and selectivity. This review paper has outlined the overview of chromium toxicity, conventional analytical techniques along with a particular emphasis on electrochemical based biosensors for chromium detection in potable water. This article emphasized porous silicon as a host material for enzyme immobilization and elaborated the working principle, mechanism, kinetics of an enzyme-based biosensor for chromium detection. The significant characteristics such as pore size, thickness, and porosity make the porous silicon suitable for enzyme entrapment. Further, several schemes on porous silicon-based immobilized enzyme biosensors for the detection of chromium in potable water are proposed.
http://ift.tt/2mXf6L0
Multi-atlas pancreas segmentation: Atlas selection based on vessel structure
Publication date: Available online 31 March 2017
Source:Medical Image Analysis
Author(s): Ken'ichi Karasawa, Masahiro Oda, Takayuki Kitasaka, Kazunari Misawa, Michitaka Fujiwara, Chengwen Chu, Guoyan Zheng, Daniel Rueckert, Kensaku Mori
Automated organ segmentation from medical images is an indispensable component for clinical applications such as computer-aided diagnosis (CAD) and computer-assisted surgery (CAS). We utilize a multi-atlas segmentation scheme, which has recently been used in different approaches in the literature to achieve more accurate and robust segmentation of anatomical structures in computed tomography (CT) volume data. Among abdominal organs, the pancreas has large inter-patient variability in its position, size and shape. Moreover, the CT intensity of the pancreas closely resembles adjacent tissues, rendering its segmentation a challenging task. Due to this, conventional intensity-based atlas selection for pancreas segmentation often fails to select atlases that are similar in pancreas position and shape to those of the unlabeled target volume. In this paper, we propose a new atlas selection strategy based on vessel structure around the pancreatic tissue and demonstrate its application to a multi-atlas pancreas segmentation. Our method utilizes vessel structure around the pancreas to select atlases with high pancreatic resemblance to the unlabeled volume. Also, we investigate two types of applications of the vessel structure information to the atlas selection. Our segmentations were evaluated on 150 abdominal contrast-enhanced CT volumes. The experimental results showed that our approach can segment the pancreas with an average Jaccard index of 66.3% and an average Dice overlap coefficient of 78.5%.
Graphical abstract
http://ift.tt/2ojPecg
Incidental spade-shaped FDG uptake in the left ventricular apex suggests apical hypertrophic cardiomyopathy
Abstract
Purpose
Apical wall thickening with an "ace-of-spades" configuration is a unique sign of apical hypertrophic cardiomyopathy (AHCM). We investigated spade-shaped FDG uptake around the left ventricular apex (SSUA) incidentally found in routine oncological FDG PET.
Methods
Cases showing SSUA were selected based on retrospective review. The pattern or intensity of SSUA was compared with the results of electrocardiogram (ECG), echocardiography, and stress myocardial perfusion SPECT. The diagnosis of ACHM was based on the presence of giant negative T wave in ECG, thickness of spade-shaped hypertrophy in the apex in echocardiography, and increased tracer uptake in the apex in rest SPECT.
Results
Among the 34 patients in 36 PET scans showing SSUA, SSUA was weak in 17 and intense in 17. There were isolated SSUA (n = 29) and SSUA with diffuse or other focal left ventricular uptake (n = 5). Three patients with the latter uptake pattern turned out to have coexistence of AHCM and asymmetric septal hypertrophy. Of the 16 SSUA-positive patients who underwent echocardiography, 13 (81%) were diagnosed as AHCM and the remaining 3 were regarded as borderline AHCM (apical wall thickness, 14–15 mm). There were 16 patients with SSUA who also underwent PET scans after the study period among which 11 (69%) had persistent SSUA in the follow-up PET. In the remaining 5, follow-up PET scans showed diffuse left ventricular uptake and SSUA was barely visible. The intensity of SSUA was significantly or marginally associated with giant negative T wave (p < 0.01), apical asynergy (p = 0.08), and impaired coronary flow reserve (p < 0.05). There were no other factors correlated with the pattern or intensity of SSUA.
Conclusion
SSUA incidentally found in oncological FDG PET appeared to be associated with AHCM, especially in ischemic conditions. The moderate repeatability of SSUA was probably due to obscurity by physiological uptake.
http://ift.tt/2nG1uB6
What more can we learn about sleep education programs in young people?
It has been clearly documented in the paediatric and sleep medicine literature and in recognised bodies [1-3], that sleep health has become an important public health issue and more importantly that young people worldwide face challenges in achieving and maintaining enough sleep. Increasing awareness about the importance of sleep, the effects of poor sleep heath and preventative and/or treatment modalities for improving sleep health have been largely delivered through school based sleep education programs which have been reviewed and critiqued over recent years [4-6].
http://ift.tt/2nFS74a
Ludwik Bierkowski and the early days of general anaesthesia in the Polish soil in February 1847
Ludwik Bierkowski belonged to the elite of surgeons of the first half of the 19th century. Educated in an excellent German university, Bierkowski had in-depth and comprehensive knowledge, a wide range of practical skills and was continuously eager to search for new solutions. He introduced cotton wool for wound dressings, experimentally determined the conditions of blood transfusions and published two outstanding anatomo-surgical atlases, which ranks him among the leading physicians of those days. Moreover, he was the first to use ether for effective general anaesthesia in the Polish lands, the procedure that changed the course of the history of medicine. Bierkowski performed ether anaesthesia in less than four months after the first world and in less than two months after the first European demonstration, which rates him among the most modern surgeons of those times. This year we celebrate the 170th anniversary of this event.
http://ift.tt/2mX8qwt
Effect of universal chlorhexidine decolonisation on the infection rate in intensive care patients
BACKGROUND: Healthcare-associated infections (HAIs), particularly intensive care unit-acquired infections (HAI-ICU), are an important cause of morbidity and mortality in hospitals. Most of these infections are caused by multidrugresistant organisms. The results of recent studies have suggested that daily bathing with chlorhexidine (CHX)-universal decolonisation can prevent ICU infections. The purpose of the study was to determine the influence of CHX bathing on the rate and type of HAI-ICU in critically ill patients.
METHODS: This observational study, conducted in a mixed, 16-bed tertiary ICU, compared the following three 3-month periods: I) pre-intervention (traditional soap-water bathing), II) intervention (bathing with 2% CHX clothes), and III) post-intervention (soap-water bathing). The type and rate of HAI-ICU were registered according to the European Centre for Disease Prevention and Control (ECDC) guidelines.
RESULTS: A total of 272 patients were included in the study. During the intervention period, the total infection rate was significantly lower than in the pre-intervention period (12.7% vs 22.2%, respectively). Significant decreases in the rate and density of catheter-related infections (CRI) were observed during the intervention period. A decrease in the isolation rate of multidrug-resistant bacteria was also observed during the intervention and post-intervention periods.
CONCLUSIONS: Daily bathing of ICU patients with chlorhexidine-impregnated clothes significantly decreased the rate of HAI-ICU and the acquisition of CRI. This simple hygienic approach can be an important adjunctive intervention with the capability of reducing the burden of healthcare-associated infections in ICUs.
http://ift.tt/2nsC5ty
Methods of pain assessment in adult intensive care unit patients — Polish version of the CPOT (Critical Care Pain Observation Tool) and BPS (Behavioral Pain Scale)
Many patients treated in the intensive care unit (ICU) experience pain that is a source of suffering and leaves a longterm imprint (chronic pain, post-traumatic stress disorder). Nearly 30% of patients experience pain at rest, while the percentage increases to 50% during nursing procedures. Pain in ICU patients can be divided into four categories: continuous ICU treatment-related pain/discomfort, acute illness-related pain, intermittent procedural pain and pre-existing chronic pain present before ICU admission. As daily nursing procedures and interventions performed in the ICU may be a potential source of pain, it is crucial to use simple pain monitoring tools. The assessment of pain intensity in ICU patients remains an everyday challenge for clinicians, especially in sedated, intubated and mechanically ventilated patients. Regular assessment of pain intensity leads to improved outcome and better quality of life of patients in the ICU and after discharge from ICU. The gold standard in pain evaluation is patient self-reporting, which is not always possible. Current research shows that the two tools best validated for patients unable to self-report pain are the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT). Although international guidelines recommend the use of validated tools for pain evaluation, they underline the need for translation into a given language. The authors of this publication obtained an official agreement from the authors of the two behavioral scales — CPOT and BPS — for translation into Polish. Validation of these tools in the Polish population will aid their wider use in pain assessment in ICUs in Poland.
http://ift.tt/2mWWYAW
Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy
BACKGROUND: Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared.
METHODS: This prospective, randomized, clinical study included 109 patients (ASA grades I–III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy. Block onset time, duration, and effectiveness on the Lovett rating scale were assessed.
RESULTS: There was no statistically significant intergroup difference in duration of block performance, irrespective of the technique (P = 0.232). Onset time of complete warmth sensation loss (P < 0.001) and muscle strength abolition (P < 0.001) was significantly longer and mean Lovett rating scale score distribution was significantly higher in the N group than in the other groups (P < 0.001). These findings show a statistically significant correlation between the performance of the used block technique and the necessity of conversion to general anesthesia because of insufficient block in the N group (58.54%) than in the U (24.44%) and NU (19.57%) groups.
CONCLUSIONS: Peripheral nerve stimulator-confirmed needle placement is not necessary to ensure effectiveness of ultrasound-guided blocks, which is expressed as a lack of necessity of conversion to general anesthesia. Nevertheless, the dual guidance technique is recommended to reduce the risk of complications and might be considered the regional anesthesia of choice for shoulder surgery.
http://ift.tt/2nszHTy
Comparison of anaesthetic gas consumption and stability of anaesthesia using automatic and manual control over the course of anaesthesia
BACKGROUND: The automatic control module of end-tidal volatile agents (EtC) was designed to reduce the consumption of anaesthetic gases, increase the stability of general anaesthesia and reduce the need for adjustments in the settings of the anaesthesia machine. The aim of this study was to verify these hypotheses.
METHODS: The course of general anaesthesia with the use of the EtC module was analysed for haemodynamic stability, depth of anaesthesia, end-expiratory concentration of anaesthetic, number of ventilator key presses, fentanyl supply, consumption of volatile agents and anaesthesia and operation times. These data were compared with the data obtained during general anaesthesia controlled manually and were processed with statistical tests.
RESULTS: Seventy-four patients underwent general anaesthesia for scheduled operations. Group AUTO-ET (n = 35) was anaesthetized with EtC, and group MANUAL-ET (n = 39) was controlled manually. Both populations presented similar anaesthesia stability. No differences were noted in the time of anaesthesia, saturation up to MAC 1.0 or awakening. Data revealed no differences in mean EtAA or the fentanyl dose. The AUTO-ET group exhibited fewer key presses per minute, 0.0603 min-1, whereas the MANUAL-ET exhibited a value of 0.0842 min-1; P = 0.001. The automatic group consumed more anaesthetic and oxygen per minute (sevoflurane 0.1171 mL min-1; IQR: 0.0503; oxygen 1.8286 mL min-1, IQR: 1,3751) than MANUAL-ET (sevoflurane 0.0824 mL min-1, IQR: 0.0305; oxygen 1,288 mL min-1, IQR: 0,6517) (P = 0.0028 and P = 0.0171, respectively).
CONCLUSION: Both methods are equally stable and safe for patients. The consumption of volatile agents was significantly increased in the AUTO-ET group. EtC considerably reduces the number of key presses.
http://ift.tt/2mX8V9H
Is the change of percutaneous oxygen pressure available to judge the effects of brachial plexus block?
BACKGROUND: To know the objective methods of the effects of the brachial plexus block, we studied the changes in percutaneous oxygen pressure (tcPO2) with the hypothesis that tcPO2 increases significantly on the blocked arm in comparison with the non-blocked arm, a phenomenon which is connected with vasodilation following the brachial plexus block.
METHODS: Fifteen patients scheduled for upper extremity surgery, aged 20 to 70 years, with ASA physical status I or II were included. Before anaesthesia, the electrodes used to measure tcPO2 were put on the radial side of the forearm and upper arm of both the right and left sides (a total of 4 electrodes). Oxygen at 6 L min-1 was administered by a facial mask. Once midazolam 1–2 mg and fentanyl 50 μg had been administered intravenously, a propofol infusion was started at a dose of 2 mg kg-1 h-1. The interscalene block was performed by means of a nerve stimulator, using 20 mL of 1% lidocaine solution combined with 20 mL of 0.75% ropivacaine solution. TcPO2 was measured just before the block and 30 minutes after the block.
RESULTS: TcPO2 in both forearm and upper arm significantly increased after the block in both sides namely, blocked and non-blocked. No difference was observed in tcPO2 between the blocked side and non-blocked side.
CONCLUSION: Changes of tcPO2 are not useful in order to assess the effects of the interscalene block under oxygen administration.
http://ift.tt/2nstS8P
Local anaesthesia with analgosedation in patients qualified for transcatheter aortic valve implantation (TAVI): first institute’s results and experiments
BACKGROUND: The authors present their own experience of the treatment of patients qualified for transcatheter aortic valve implantation (TAVI) carried out in a modern hybrid operating room. The objective of the present study was to demonstrate the initial results of conducting anaesthesia in high-risk patients qualified for the TAVI procedure (transcatheter aortic valve implantation). In addition, the authors' aim was also to point out to the special challenges of an anaesthesiologist conducting local anaesthesia in such a type of procedures and to evaluate the safety and efficacy of the TAVI procedure conducted under remifentanil analgosedation.
METHODS: A retrospective analysis included patients treated during the period from September 2015, when local anaesthesia for the transcatheter aortic valve implantation was used for the first time at our centre, up to February 2016. The studied population consisted of 11 patients treated for severe aortic valve stenosis. The mean age of patients was 80 ± 7 years. Three patients were men (27%) and eight were women (73%). The study included all subsequent patients (n = 11), treated in our centre, for whom it was decided to perform TAVI under local anaesthesia.
RESULTS: The total hospital mortality rate was 0%. All procedures were performed in a hybrid operating room. Despite the complications observed in the described group, the hospital mortality rate during TAVI was 0%. All patients, after 12 ± 5 days of treatment, left the hospital in a good neurological condition, which was assessed based on the CPC-1 (Cerebra Performance Categories Scale) and GCS-15 (Glasgow Coma Scale) scales. With an ejection fraction of the left ventricle of 53 ± 11%, the transcatheter aortic valve was successfully implanted.
CONCLUSIONS: Percutaneous aortic valve implantation can be successfully conducted under remifentanil analgosedation. TAVI procedures should be performed in the conditions of a modern, well-equipped hybrid room. The aim of the anaesthesiologist should consist of conducting the least invasive anaesthesia/analgesia, bearing in mind the safety and comfort of the patient.
http://ift.tt/2mXmvdd
Nasogastric tube insertion in anaesthetized patients: a comprehensive review
Nasogastric tubes (NGT) still remain the easiest and the best way for gastrointestinal tract access. There are various indications for the insertion of a nasogastric tube in anaesthetized and critically ill patients. Although many techniques have been introduced to facilitate nasogastric tube insertion using anatomic landmarks and a group of devices, there is no consensus on a standard method. Moreover, there are different methods for the assessment of the correct placement of a nasogastric tube. In addition to these challenges in insertion and assessment methods, there are varieties of major life-threatening and minor complications to be addressed. Thus, selecting the most appropriate approach requires enough knowledge in this area, considering patient condition and clinical factors, as well as the practitioners' sufficient education and experience, along with skill in performance. This is a comprehensive review of the literature evidence on different methods for nasogastric tube insertion, on the assessment of correct placement and the evaluation of complications, in addition to an approach to the effect of education on the quality of routine practice and patients' outcome.
http://ift.tt/2nsuBXG
Design and evaluation of a phospholipase D based drug delivery strategy of novel phosphatidyl-prodrug
Source:Biomaterials, Volume 131
Author(s): Xinyi Tao, Ning Jia, Nenghui Cheng, Yuhong Ren, Xuni Cao, Min Liu, Dongzhi Wei, Feng-Qing Wang
A strategy is proposed to design a safe and simple amphiphilic prodrug delivery system, based on the elevated expression of phospholipase D (PLD) in cancer cells. The method utilizes the transphosphatidylation ability of bacterial PLD on alcohol groups and the hydrolysis activity of overexpressed PLD on phospholipids in cancer cells. Doxorubicin (DOX) was selected as a test drug, and the phosphatidyl-doxorubicin (PX) was synthesized by bacterial PLD. The PX prodrug could be readily self-assembled to nanoparticles with uniform size and was stable during storage and circulation. The pharmacokinetics and biodistribution investigations indicated DOX could be selectively released from PX in cancer cells triggered by the local overexpressed PLD, and PX could significantly prolong the half-life of DOX in the tumors and decrease the distribution in heart and kidney. Moreover, the PX prodrug enhanced cellular uptake in MCF-7/ADR cells, demonstrating it could reverse the multi-drug resistance. Consequently, the prodrug displayed favorable anticancer efficacy in the MCF-7/ADR xenograft model without the cardiotoxicity and nephrotoxicity of DOX. The results demonstrated that phosphatidyl modification method can be used as an efficient strategy to develop a promising nanoscale drug delivery system for some drugs.
http://ift.tt/2mVQvpV
Whole Exome Sequencing Identified a Novel Frameshift Mutation in SDR9C7 underlying Autosomal Recessive Congenital Ichthyosis in a Pakistani Family
Abstract
Autosomal Recessive Congenital Ichthyosis (ARCI) is a group of cornification disorders (prevalence 1:200,000) broadly divided into three classes namely Harlequin Ichthyosis (HI; OMIM#242500), Lamellar Ichthyosis (LI; OMIM#242304) and Congenital Ichthyosiform Erythroderma (CIE; OMIM#242100). ARCI clinical features include generalized scaling, hypohidrosis and palmo-plantar hyperlinearity although presentation and severity may vary significantly. A large number of affected individuals present with collodion membrane at birth. HI is the most severe and fatal form of the disease and the neonates are born covered with thick, hard, armor-like plates of cornified skin. The classic form of LI present with dark brown, plate-like scales with no erythroderma and CIE with fine and white scales adjoining generalized erythema. Affected individuals with severe involvement can have ectropion, eclabium, scarring alopecia and palmoplantar keratoderma. Currently, ten genes are reported in association with different ARCI phenotypes: TGM1, ALOX12B, ALOXE3, ABCA12, CYP4F22, NIPAL4, LIPN, CERS3, PNPLA1 and SDR9C71,2,3. Here we report a novel frameshift mutation in SDR9C7 (short-chain dehydrogenase/reductase family 9C member 7) underlying ARCI in a consanguineous Pakistani family.
This article is protected by copyright. All rights reserved.
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Scaling of rotational inertia of primate mandibles
Source:Journal of Human Evolution, Volume 106
Author(s): Callum F. Ross, Jose Iriarte-Diaz, Ellen Platts, Treva Walsh, Liam Heins, Geoffrey E. Gerstner, Andrea B. Taylor
The relative importance of pendulum mechanics and muscle mechanics in chewing dynamics has implications for understanding the optimality criteria driving the evolution of primate feeding systems. The Spring Model (Ross et al., 2009b), which modeled the primate chewing system as a forced mass-spring system, predicted that chew cycle time would increase faster than was actually observed. We hypothesized that if mandibular momentum plays an important role in chewing dynamics, more accurate estimates of the rotational inertia of the mandible would improve the accuracy with which the Spring Model predicts the scaling of primate chew cycle period. However, if mass-related momentum effects are of negligible importance in the scaling of primate chew cycle period, this hypothesis would be falsified. We also predicted that greater "robusticity" of anthropoid mandibles compared with prosimians would be associated with higher moments of inertia. From computed tomography scans, we estimated the scaling of the moment of inertia (Ij) of the mandibles of thirty-one species of primates, including 22 anthropoid and nine prosimian species, separating Ij into the moment about a transverse axis through the center of mass (Ixx) and the moment of the center of mass about plausible axes of rotation. We found that across primates Ij increases with positive allometry relative to jaw length, primarily due to positive allometry of jaw mass and Ixx, and that anthropoid mandibles have greater rotational inertia compared with prosimian mandibles of similar length. Positive allometry of Ij of primate mandibles actually lowers the predictive ability of the Spring Model, suggesting that scaling of primate chew cycle period, and chewing dynamics in general, are more strongly influenced by factors other than scaling of inertial properties of the mandible, such as the dynamic properties of the jaw muscles and neural control. Differences in cycle period scaling between chewing and locomotion systems reinforce the suggestion that displacement and force control are more important in the design of feeding systems than energetics and speed.
http://ift.tt/2oIzGv2
Editorial Board
Source:Journal of Human Evolution, Volume 105
http://ift.tt/2oIEyk1
Anterior dental microwear textures show habitat-driven variability in Neandertal behavior
Source:Journal of Human Evolution, Volume 105
Author(s): Kristin L. Krueger, Peter S. Ungar, Debbie Guatelli-Steinberg, Jean-Jacques Hublin, Alejandro Pérez-Pérez, Erik Trinkaus, John C. Willman
The causes of Neandertal anterior tooth wear patterns, including labial rounding, labial scratches, and differential anterior-posterior wear, have been debated for decades. The most common explanation is the "stuff-and-cut" hypothesis, which describes Neandertals clamping down on a piece of meat and slicing a portion close to their lips. "Stuff-and-cut" has been accepted as a general aspect of Neandertal behavior without fully assessing its variability. This study analyzes anterior dental microwear textures across habitats, locations, and time intervals to discern possible variation in Neandertal anterior tooth-use behavior.Forty-five Neandertals from 24 sites were analyzed, represented by high-resolution replicas of permanent anterior teeth. The labial surface was scanned for antemortem microwear using a white-light confocal profiler. The resultant 3D-point clouds, representing 204 × 276 μm for each specimen, were uploaded into SSFA software packages for texture characterization. Statistical analyses, including MANOVAs, ANOVAs, and pairwise comparisons, were completed on ranked microwear data. Neandertal descriptive statistics were also compared to 10 bioarchaeological samples of known or inferred dietary and behavioral regimes.The Neandertal sample varied significantly by habitat, suggesting this factor was a principal driving force for differences in Neandertal anterior tooth-use behaviors. The Neandertals from open habitats showed significantly lower anisotropy and higher textural fill volume than those inhabiting more closed, forested environments. The texture signature from the open-habitat Neandertals was most similar to that of the Ipiutak and Nunavut, who used their anterior teeth for intense clamping and grasping behaviors related to hide preparation. Those in more closed habitats were most similar to the Arikara, who did not participate in non-dietary behaviors. These Neandertal individuals had a broad range of texture values consistent with non-dietary and dietary behaviors, suggesting they varied more in anterior tooth-use behaviors and exploited a wider variety of plant and animal resources than did those from open habitats.
http://ift.tt/2nTWpHn
The Evolving Role of Checkpoint Inhibitors in the Management of Gastroesophageal Cancer
Source:Hematology/Oncology Clinics of North America
Author(s): Adrian G. Murphy, Ronan J. Kelly
Teaser
The connection between inflammation and malignancy has long been recognized in gastric and esophageal cancers. Given the considerable success of immune checkpoint inhibitors in other tumor types, for example, lung cancer and melanoma, much attention is being paid to furthering their role in gastric and esophageal cancers. The Cancer Genome Atlas has provided further details of the molecular heterogeneity of these tumors, which may help predict responsiveness to immune checkpoint inhibitors. This article discusses the rationale for investigating these agents in gastroesophageal cancer and summarizes the relevant clinical trial data and ongoing studies.http://ift.tt/2mWOQ3D
Morbidity of the Free Fibula Flap Reconstruction in Head and Neck Malignancies
J reconstr Microsurg
DOI: 10.1055/s-0037-1601421
Thieme Medical Publishers, Inc. 333 Seventh Avenue, New York, NY 10001, USA
Article in Thieme eJournals:
Table of contents | Full text
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Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction
J reconstr Microsurg
DOI: 10.1055/s-0037-1601422
Background The anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane. Methods Retrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded. Results A total of 25 patients underwent suprafascial (n = 14) or super-thin (n = 11) ALT flap reconstruction for primarily lower extremity wounds (n = 19), with an average age and body mass index of 53.8 years and 26.3 kg/m2, respectively. Follow-up was 6.3 months. Comorbidities included smoking (n = 7), diabetes (n = 8), peripheral vascular disease (n = 6), and hypertension (n = 8). The presence of hardware (n = 9), trauma (n = 10), and chronic infection (n = 12) were common risk factors. Average flap size was 8.2 × 21.5 cm, with 64% (n = 16) taken on one perforator. Forty-eight percent (n = 12) were end-to-side anastomoses and 62% (n = 13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% (n = 6) complication rate. There were no partial or complete flap losses. Conclusion The ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.
[...]
Thieme Medical Publishers, Inc. 333 Seventh Avenue, New York, NY 10001, USA
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Aqueous extract from leaf of Artocarpus altilis provides cardio-protection from isoproterenol induced myocardial damage in rats: Negative chronotropic and inotropic effects
Publication date: 5 May 2017
Source:Journal of Ethnopharmacology, Volume 203
Author(s): Chukwuemeka Nwokocha, Javier Palacios, Mario J. Simirgiotis, Jemesha Thomas, Magdalene Nwokocha, Lauriann Young, Rory Thompson, Fredi Cifuentes, Adrian Paredes, Rupika Delgoda
Ethnopharmacological relevanceThe leaves of Artocarpus altilis (Parkinson ex F.A.Zorn, Fosberg) (Moraceae) are used in the management of hypertension; this study assessed the cardio-protective effects of the leaf extract on isoproterenol (ISO) induced myocardial damage in rats.Material and methodsTwenty (20) adult male Sprague-Dawley rats (175–230g) were divided into 5 groups. Group 1 (Control), 2 (AA) received 50mg/Kg Artocarpus altilis (AA) only; 3 (ISO) received 85mg/Kg ISO only; 4 (ISO+AA/50) and 5 (ISO+AA/100) received 50 and 100mg/Kg AA respectively for 6 days, after induced with ISO twice (85mg/Kg) at a 24-h period. Blood pressure readings were taken before and after the administering of ISO using the tail cuff method. ECG was performed on anaesthetized rats. Cardiac contractility was measured in isolated right atrial muscles. Assessment of myocardial infarct (MI) size, heart/body weight ratio, biochemical, hematological and histo-morphological parameters were conducted at the end of seven days. An aqueous extract from leaves of A. altilis was analyzed for organic compounds using UHPLC mass spectrometry.ResultsISO induced myocardial damage through an elevation of the heart rate (HR), infarct size and ECG distortions. Treatment with AA significantly (p˂0.05) reduced heart/body weight ratio (49%), MI (96%), HR (27%), sympathovagal imbalance (36%) and serum cardiac biomarkers (AST, LDH, HDL, triglycerides and CCK) caused by ISO. AA decreased the beat frequency of isolated right atrium (11%) cause by ISO, an action similar to propranolol (beta-adrenergic antagonist; 20%), but showed no significant changes in the QTc intervals of the ECG (suggesting no cardio-toxic drug-herb interactions), Thirty nine compounds were detected using high resolution LC-MS analysis (HPLC-Orbitrap-APCI-MS) in the extract. Pure compounds, as gallic acid and rutin, presented a higher negative chronotropic effect, similar to propranolol.ConclusionOral administration of aqueous extract of Artocarpus artilis has cardio-protective functions in myocardial injury, in part, by decreasing the HR, reduced contractility and infarct size. These findings may explain the cardio-protective use of A. altilis in traditional medicine.
Graphical abstract
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IL-17A and IL-22 producing neutrophils in psoriatic skin
Abstract
The pro-inflammatory cytokine IL-17 is recognized as playing an important role in the pathogenesis of psoriasis, an inflammatory skin disease, and the relevance of the IL-23/IL-17 axis is underlined by the recent clinical efficacy of treatments targeting this axis 1.
This article is protected by copyright. All rights reserved.
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Structural transitions in torsionally constrained DNA and their dependence on solution electrostatics
Publication date: Available online 30 March 2017
Source:Acta Biomaterialia
Author(s): Jaspreet Singh, Prashant K. Purohit
Experimental studies on single molecules of DNA have reported a rich variety of structural transitions, including coexistence of three phases, in a torsionally constrained molecule. A comprehensive knowledge of these structural transitions is useful for unraveling the in vivo and in vitro behavior of DNA. Our objective is to understand the structural transitions in a torsionally constrained DNA molecule when it is pulled using optical or magnetic tweezers. We use foundational concepts from the Zimm-Bragg helix-coil transition theory and merge them with ideas from the theory of fluctuating elastic rods to model the mechanics of DNA. We also account for the electrostatic interactions between the ions and the negatively charged phosphate backbone of DNA. Using our model, we calculate the force and torque corresponding to the overstretching transition characterized by a 70% jump in the contour length of the molecule and examine the effect of salt concentration on this transition. We also deduce conditions under which the co-existence of B-, S- and P-DNA is possible. We examine how the cooperativity parameter for each transition affects the force-extension curve or torque-rotation curve. We attempt to rationalize the non-monotonic dependence of external work done on the ion concentration by connecting it to the electrostatic dependence of the interfacial energy between two phases of DNA. Our theoretical results are in agreement with multiple experiments documented in the literature and they generate falsifiable predictions that can be tested in new experiments.Statement of SignificanceThe overarching objective of this paper is to explore the implications of variation in ion concentration on the structural transitions driven by external forces in a torsionally constrained DNA molecule. A comprehensive understanding of the phase behavior of torsionally constrained DNA is useful because DNA in cells is tightly packaged and is acted upon by molecular machines in different ionic environments. We examine the mechanics of the overstretching transition, characterized by a 70% jump in contour length, wherein a mixture of B- and S-DNA converts into a mixture of S- and P-DNA through a triple point in the phase diagram. Our results are corroborated by experimental data at every step and we make predictions that are experimentally verifiable.
Graphical abstract
http://ift.tt/2nTPPAx
Radiology Abroad
Source:Academic Radiology
Author(s): Neda I. Sedora Román, Teodora Bochnakova
ObjectiveThe purpose of this article is to share our experience conducting a global health outreach initiative in the Radiology Department of the Georgetown Public Hospital in Guyana alongside RAD-AID, a nonprofit organization whose mission is to increase the availability of medical imaging services in developing countries.ConclusionThe collaboration between RAD-AID and the Guyanese Ministry of Health has resulted in significant strides for radiology, including the introduction of new resources such as updated sonography and, for the first time, computed tomography for the public sector. In addition, collaboration with the Georgetown Public Hospital has strengthened the clinical management of patients and radiological education of health-care workers in Guyana.
http://ift.tt/2mWNdD2
Rational Design of Charged Peptides that Self-Assemble into Robust Nanofibers as Immune-Functional Scaffolds
Publication date: Available online 30 March 2017
Source:Acta Biomaterialia
Author(s): Hangyu Zhang, Jaehyung Park, Yonghou Jiang, Kim A. Woodrow
Self-assembling peptides programed by sequence design to form predefined nanostructures are useful for a variety of biomedical applications. However, assemblies of classic ionic self-complementary peptides are unstable in neutral pH, while charged peptide hydrogels have low mechanical strength. Here, we report on the rational design of a self-assembling peptide system with optimized charge distribution and density for bioscaffold development. Our designer peptides employs a sequence pattern that undergoes salt triggered self-assembly into β-sheet rich cationic nanofibers in the full pH range (pH 0 to 14). Our peptides form nanofibrils in physiological condition at a minimum concentration that is significantly lower than has been reported for self-assembly of comparable peptides. The robust fiber-forming ability of our peptides results in the rapid formation of hydrogels in physiological conditions with strong mechanical strength. Moreover, fiber structure is maintained even upon dense conjugation with a model bioactive cargo OVA257-264 peptide. Nanofibers carrying OVA257-264 significantly enhanced CD8+ T cell activation in vitro. Subcutaneous immunization of our peptide fiber vaccine also elicited robust CD8+ T cell activation and proliferation in vivo. Our self-assembling peptides are expected to provide a versatile platform to construct diverse biomaterials.Statement of SignificanceThis work is an attempt of rational design of materials from molecular level for targeted properties and an exploration in molecular self-assembly. Current widely studied self-assembling peptides do not have stable nanofiber structures and form weak hydrogels under physiological conditions. To address this issue, we develop charged self-assembling peptides with a novel sequence pattern for strong fiber-forming ability under physiological conditions. Our designer peptides can undergo salt-triggered self-assembly into nanofibers that are ultrastable in extreme pH (0 to 14) and dilute solutions, and into hydrogels with strong mechanical strength. Upon conjugation with a model bioactive cargo, our self-assembled peptides exhibit great potential as bioscaffolds for multiple applications.
Graphical abstract
http://ift.tt/2nTYzqp
Digital image correlation-aided mechanical characterization of the anteromedial and posterolateral bundles of the anterior cruciate ligament
Publication date: Available online 30 March 2017
Source:Acta Biomaterialia
Author(s): Kaitlyn Mallett, Ellen M. Arruda
The anterior cruciate ligament (ACL) is one of the most commonly injured soft tissue structures in the articular knee joint, often requiring invasive surgery for patients to restore pre-injury knee kinematics. There is a pressing need to understand the role of the ACL in knee function, in order to select proper replacements. Digital image correlation (DIC), a non-contact full field displacement measurement technique, is an established tool for evaluating non-biological materials. The application of DIC to soft tissues has been in the nascent stages, largely due to patterning challenges of such materials. The ACL is notoriously difficult to mechanically characterize, due to the complex geometry of its two bundles and their insertions. This paper examines the use of DIC to determine the tensile mechanical properties of the AM and PL bundles of ovine ACLs in a well-known loading state. Homogenous loading in the mid-substance of the bundles provides for accurate development of stress/strain curves using DIC. Animal to animal variability is reduced, and the bundles are stiffer than previously thought when tissue-level strains are accurately measured.Statement of SignificanceThe anterior cruciate ligament (ACL), a major stabilizing ligament of the articular knee joint, is one of the most commonly injured soft tissue structures in the knee. Often, invasive surgery is required to restore pre-injury knee kinematics, and there are several long-term consequences of ACL reconstructions, including early-onset osteoarthritis. The role of the ACL in knee stability and motion has received much attention in the biomechanics community. This paper examines the use of a non-contact full-field displacement measurement technique, digital image correlation, to determine the tensile mechanical properties of the ACL. The focus of this work is to investigate the intrinsic mechanical properties of the ACL, as new knowledge in these areas will aid clinicians in selecting ACL replacements.
Graphical abstract
http://ift.tt/2nTSWsq
Applications and theory of electrokinetic enrichment in micro-nanofluidic chips
Abstract
This review reports the progress on the recent development of electrokinetic enrichment in micro-nanofluidic chips. The governing equations of electrokinetic enrichment in micro-nanofluidic chips are given. Various enrichment applications including protein analysis, DNA analysis, bacteria analysis, viruses analysis and cell analysis are illustrated and discussed. The advantages and difficulties of each enrichment method are expatiated. This paper will provide a particularly convenient and valuable reference to those who intend to research the electrokinetic enrichment based on micro-nanofluidic chips.
http://ift.tt/2oj9cUn
Delayed prosthetic breast reconstruction without the use of acellular dermal matrix
Abstract
Background
Since the widespread adoption of acellular dermal matrices (ADM) in immediate breast reconstruction, many surgeons have applied the same techniques to delayed reconstruction. To counteract this trend, we present a method of performing delayed prosthetic breast reconstruction without the use of ADM. This approach produces excellent aesthetic outcomes while eliminating the cost of relatively expensive ADM.
Methods
A retrospective review was performed on patients who underwent delayed implant-based breast reconstruction without ADM at a single institution between 2001 and 2013.
Results
A total of 31 patients met inclusion criteria. In our cohort, radiation therapy was performed on 14 patients (45%). Expanders were filled intraoperatively to a median volume of 150 cm3, and median permanent implant size was 500 cm3. Operative time averaged 62 minutes for unilateral expander insertion and 92 minutes for bilateral insertion. After expander placement, complications requiring reoperation occurred in five patients (16%), of which four (75%) had prior radiation therapy. Permanent implants were placed in 29 patients (94%), and six of these patients (21%) underwent additional procedures. Thirteen patients without prior radiation (76%) and eight patients with prior radiation (57%) did not undergo any unplanned surgical interventions during the reconstructive process.
Conclusions
Our study shows delayed breast reconstruction can be successfully performed without ADM. Since delayed reconstruction is generally performed less frequently than immediate reconstruction, plastic surgeons are advised to critically review their techniques, as the operation should be approached differently. While ADM may have specific benefits in immediate reconstruction, those benefits do not directly translate in delayed reconstruction.
Level of Evidence: Level IV, risk/ prognostic study.
http://ift.tt/2ooxlGh
Effects of root debridement and adjunctive photodynamic therapy in residual pockets of patients on supportive periodontal therapy: a randomized split-mouth trial
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Edwin X. Goh, Kai Soo Tan, Yiong Huak Chan, Lum Peng Lim
BackgroundThe study aims to compare the effects of adjunctive photodynamic therapy (PDT) with scaling and root debridement alone on periodontal parameters and inflammatory cytokines in residual pockets of patients undergoing maintenance therapy.Methods27 subjects, each with at least 2 residual pockets ≥5mm, were recruited for this randomized, split-mouth controlled trial, providing total of 72 sites. Probing pocket depth (PPD), recession, clinical attachment loss (CAL), plaque and bleeding on probing of all sites were examined at baseline, 3 and 6 months. Gingival crevicular fluids (GCFs) were collected to determine levels of IL-1β, IL-6, IL-8, TNF-α and MMP-8 via enzyme-linked immunosorbent assay. At baseline, all sites received subgingival instrumentation and polishing. In addition, test sites received a single application of PDT using Fotosan® with toluidine blue O solution photosensitizer. At 3 and 6 months, site level analysis was performed for changes in clinical parameters and cytokine level.ResultsBased on mixed model analysis, at 3 months, test sites showed significant reduction in CAL (p=0.016) and PPD (p=0.027) (from 6.14±0.28mm to 5.49±0.20mm and 5.42±0.16mm to 4.65±0.18mm respectively) compared to control sites (from 6.32±0.24mm to 6.08±0.17mm and 5.32±0.13mm to 5.15±0.15mm respectively). At 6 months, these differences were no longer significant (p=0.510). Adjunctive PDT did not offer additional reduction in levels of GCF cytokines.ConclusionsA single application of PDT to residual pockets provided a modest improvement of CAL and PPD over 3 months. Application of adjunctive PDT may lead to faster resolution of residual pockets and may be recommended for periodontal patients with slower healing capacity.
http://ift.tt/2okyH8m
Synergism between PKCδ regulators hypericin and rottlerin enhances apoptosis in U87 MG glioma cells after light stimulation
Publication date: Available online 31 March 2017
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Matus Misuth, Denis Horvath, Pavol Miskovsky, Veronika Huntosova
BackgroundGliomas belong to the most infiltrative types of tumors. Photodynamic therapy (PDT) can be applied to regulate glioma cell proliferation. The inhibitors of PKCs are very promising drugs that can mediate glioma cells apoptosis in PDT. Hypericin is one of PKCs regulators, and thanks to its physicochemical properties it can be used in PDT. Rottlerin is also considered to be the PKCδ inhibitor. Its implementation in PDT may significantly influence glioma cells response to PDT.MethodsThe viability of U87 MG glioma cells in the presence of rottlerin and hypericin was assessed by MTT assay and flow cytometry in the absence and presence of light. The flow cytometric data were analyzed through Shannon entropy. The oxidative stress and immunocytochemistry of PKCδ and phosphorylated Bcl-2 (the regulators of apoptosis) were observed using fluorescence microscopy.ResultsA pretreatment of glioma cells with rottlerin before hypericin induced PDT led to significant increase in apoptosis accompanied by the decrease of intracellular oxidative stress and increase of phosphorylated Bcl-2 in the cytoplasm of U87 MG cells.ConclusionsIn conclusion, we assume that the synergism between rottlerin and hypericin leads firstly to activation of rescue mechanisms in the glioma cells, but finally this cooperation triggers apoptosis rather than necrosis.
Graphical abstract
http://ift.tt/2oj7Nx6
A systematic review of coping among heterosexual female IPV survivors in the United States with a focus on the conceptualization and measurement of coping
Source:Aggression and Violent Behavior
Author(s): Cynthia Fraga Rizo, Ashley Givens, Brianna Lombardi
Intimate partner violence (IPV) is a significant stressor associated with numerous negative consequences. Many IPV researchers have sought to understand survivors' experiences and to identify malleable factors that can enhance survivor well-being by focusing on survivors' coping efforts. To develop a better understanding of how coping has been conceptualized and measured in the context of U.S.-based research with heterosexual female IPV survivors, we conducted a systematic review of 48 research articles examining IPV and coping among this population. Additionally, the review assesses the state of this literature in terms of methodological strengths and limitations as well as what is known about these survivors' coping efforts. Review findings suggest that coping is a complex construct that has been conceptualized and measured in diverse ways. Findings also demonstrate that heterosexual, female survivors engage in various coping strategies and help-seeking behaviors, and some effort has been made to examine: (a) the relationship between coping and mental health, (b) the relationship between coping and other constructs (e.g., decision to leave an abusive partner, revictimization), and (c) differences in coping across diverse groups of survivors. Recommendations for future research are offered in light of review findings.
http://ift.tt/2oqACou
From “real rape” to real justice: A systematic review of police officers' rape myth beliefs
Source:Aggression and Violent Behavior
Author(s): Kayleigh A. Parratt, Afroditi Pina
This systematic review examined 18 documents that contained information about rape myths/cognitions of police officers with the goal of identifying the factors that influence police officers' beliefs of rape. Past research on sexual offence processing decisions has rarely considered the characteristics of police officers as active participants in the legal decision making process (Alderden & Ullman, 2012); meaning that the factors that directly influence police officers' rape myths and the implications these may have on rape victims' experiences when reporting to the police remain unclear. The current review systematically examines the literature on police officers' rape myth beliefs, and evaluates the current available research regarding, decision-making, victim credibility, police training and experiences, and police gender. It concludes by providing recommendations for policy makers in terms of best practice, continual police training and development and improving rape victims' reporting experiences.
http://ift.tt/2oqQIP3
Umbilical Cord Blood Androgen Levels in Girls and Boys Assessed by Gas Chromatography-Tandem Mass Spectrometry
Publication date: Available online 31 March 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Anna-Carin Lundell, Henrik Ryberg, Liesbeth Vandenput, Anna Rudin, Claes Ohlsson, Åsa Tivesten
Androgen exposure of the fetus during gestation plays an important role in human physiology and pathophysiology, but assessment of androgens, in particular dihydrotestosterone (DHT), in human umbilical cord blood is technically challenging. The aim of this study was to assess umbilical cord androgen levels, including DHT, at birth by a highly sensitive assay, and study their association with sex of the infant, sex-hormone-binding globulin (SHBG) levels, and gestational age at delivery. Swedish infants (27 girls, 26 boys) were recruited at maternity care clinics in Southern Sweden. Umbilical cord blood levels of dehydroepiandrosterone (DHEA), androstenedione, testosterone and DHT at delivery were assessed by a gas chromatography-tandem mass spectrometry assay. Cord blood levels of DHT were 2.4-fold higher in boys (median 27.8pg/mL) than in girls (11.5pg/mL), while the sex difference was less pronounced for testosterone (1.3-fold higher in boys) and non-significant for DHEA and androstenedione. Gestational age at delivery associated inversely with DHT levels in boys and with DHEA levels in girls. There was a strong inverse correlation between SHBG and DHEA in both sexes, while there were no associations between SHBG and testosterone or DHT levels. In conclusion, using state of the art technology, we report that there is a pronounced sexual dimorphism in human umbilical cord blood DHT levels. The possibility to assess a complete androgen profile in human cord blood opens up for future increased understanding of the biological impact of the fetal androgen milieu.
http://ift.tt/2nTHdtG
Imatinib discontinuation in chronic myeloid leukaemia patients with undetectable BCR-ABL transcript level: A systematic review and a meta-analysis
Source:European Journal of Cancer, Volume 77
Author(s): Leonardo Campiotti, Matteo Basilio Suter, Luigina Guasti, Rocco Piazza, Carlo Gambacorti-Passerini, Anna Maria Grandi, Alessandro Squizzato
PurposeTyrosine kinase inhibitors (TKIs) are the cornerstones of treatment for patients with chronic myeloid leukaemia (CML). In recent years, several studies were conducted to evaluate the safety of TKIs discontinuation. We performed a systematic review of the literature to determine the incidence of CML relapse, to identify possible factors relapse rates and to evaluate the long-term safety in CML patients with stable undetectable BCR-ABL transcript level who discontinued TKIs.DesignStudies evaluating TKIs discontinuation in CML patients with undetectable BCR-ABL transcript level were identified by electronic search of MEDLINE and EMBASE database until May 2015. Weighted mean proportion and 95% confidence intervals (CIs) of CML relapse was calculated using a fixed-effects and a random-effects model. Statistical heterogeneity was evaluated using the I2 statistic.ResultsFifteen cohort studies, for a total of 509 patients, were included. Nine studies were at low-risk of bias. All 15 studies included only patients on imatinib. Overall weighted mean molecular relapse rate of CML was 51% (95% CI 44–58%; I2 = 55). Weighted mean molecular relapse rate at 6-month follow-up was 41% (95% CI 32–51%; I2 = 78). Eighty percent of molecular relapses occurred in the first 6 months. All 509 patients were alive at 2-year follow-up and only one patient (0.8%, 95% CI 0.2–1.8%; I2 = 0) has progressed to a blastic crisis.ConclusionsOur findings suggest that imatinib discontinuation is feasible for the majority of CML patients with stable undetectable BCR-ABL transcript level. Approximately 50% of patients remain therapy-free after imatinib discontinuation. Restarting TKIs therapy was followed by a very high rate of molecular response, with no deaths 2 years after discontinuation.
http://ift.tt/2ojg4RB
European Organisation for Research and Treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome – Update 2017
Source:European Journal of Cancer, Volume 77
Author(s): Franz Trautinger, Johanna Eder, Chalid Assaf, Martine Bagot, Antonio Cozzio, Reinhard Dummer, Robert Gniadecki, Claus-Detlev Klemke, Pablo L. Ortiz-Romero, Evangelia Papadavid, Nicola Pimpinelli, Pietro Quaglino, Annamari Ranki, Julia Scarisbrick, Rudolf Stadler, Liisa Väkevä, Maarten H. Vermeer, Sean Whittaker, Rein Willemze, Robert Knobler
In order to provide a common standard for the treatment of mycosis fungoides (MF) and Sézary syndrome (SS), the European Organisation for Research and Treatment of Cancer–Cutaneous Lymphoma Task Force (EORTC-CLTF) published in 2006 its consensus recommendations for the stage-adapted selection of management options for these neoplasms. Since then, the understanding of the pathophysiology and epidemiology of MF/SS has advanced, the staging system has been revised, new outcome data have been published and novel treatment options have been introduced. The purpose of the present document is to update the original recommendations bearing in mind that there are still only a limited number of controlled studies to support treatment decisions for MF/SS and that often treatment is determined by institutional experience and availability.This consensus on treatment recommendations was established among the authors through a series of consecutive consultations in writing and a round of discussion. Recommended treatment options are presented according to disease stage, whenever possible categorised into first- and second-line options and supported with levels of evidence as devised by the Oxford Centre for Evidence-Based Medicine (OCEBM).Skin-directed therapies are still the most appropriate option for early-stage MF, and most patients can look forward to a normal life expectancy. For patients with advanced disease, prognosis is still grim, and only for a highly selected subset of patients, prolonged survival can be achieved with allogeneic stem cell transplantation (alloSCT). There is a high need for the development and investigation in controlled clinical trials of treatment options that are based on our increasing understanding of the molecular pathology of MF/SS.
http://ift.tt/2oIr4og
Giant cell tumour of bone in the denosumab era
Source:European Journal of Cancer, Volume 77
Author(s): Lizz van der Heijden, P.D. Sander Dijkstra, Jean-Yves Blay, Hans Gelderblom
Giant cell tumour of bone (GCTB) is an intermediate locally aggressive primary bone tumour, occurring mostly at the meta-epiphysis of long bones. Overexpression of receptor activator of nuclear factor kappa-B ligand (RANKL) by mononuclear neoplastic stromal cells promotes recruitment of numerous reactive multinucleated osteoclast-like giant cells, causing lacunar bone resorption. Preferential treatment is curettage with local adjuvants such as phenol, alcohol or liquid nitrogen. The remaining cavity may be filled with bone graft or polymethylmethacrylate (PMMA) bone cement; benefits of the latter are a lower risk of recurrence, possibility of direct weight bearing and early radiographic detection of recurrences. Reported recurrence rates are comparable for the different local adjuvants (27–31%). Factors increasing the local recurrence risk include soft tissue extension and anatomically difficult localisations such as the sacrum. When joint salvage is impossible, en-bloc resection and endoprosthetic joint replacement may be performed. Local tumour control on the one hand and maintenance of a functional native joint and quality of life on the other hand are the main pillars of surgical treatment for this disease. Current knowledge and development in the fields of imaging, functional biology and systemic therapy are forcing us into a paradigm shift from a purely surgical approach towards a multidisciplinary approach. Systemic therapy with denosumab (RANKL inhibitor) or zoledronic acid (bisphosphonates) blocks, respectively inhibits, bone resorption by osteoclast-like giant cells. After use of zoledronic acid, stabilisation of local and metastatic disease has been reported, although the level of evidence is low. Denosumab is more extensively studied in two prospective trials, and appears effective for the optimisation of surgical treatment. Denosumab should be considered in the standard multidisciplinary treatment of advanced GCTB (e.g. cortical destruction, soft tissue extension, joint involvement or sacral localisation) to facilitate surgery at a later stage, and thereby aiming at immediate local control. Even though several questions concerning optimal treatment dose, duration and interval and drug safety remain unanswered, denosumab is among the most effective drug therapies in oncology.
http://ift.tt/2ojiLma
Regression of melanoma metastases and multiple non-melanoma skin cancers in xeroderma pigmentosum by the PD1-antibody pembrolizumab
Source:European Journal of Cancer, Volume 77
Author(s): Axel Hauschild, Julia Eichstaedt, Lena Möbus, Katharina Kähler, Michael Weichenthal, Thomas Schwarz, Stephan Weidinger
http://ift.tt/2oj3MZu
Macrophage activation syndrome: A new complication of checkpoint inhibitors
Source:European Journal of Cancer, Volume 77
Author(s): Nausicaa Malissen, Julie Lacotte, Aurélie Du-Thanh, Caroline Gaudy-Marqueste, Bernard Guillot, Jean-Jacques Grob
http://ift.tt/2oIbLMp
Drug-induced sleep endoscopy with target-controlled infusion using propofol and monitored depth of sedation to determine treatment strategies in obstructive sleep apnea
Abstract
Background
Drug-induced sleep endoscopy (DISE) has become an important diagnostic examination tool in the treatment decision process for surgical therapies in the treatment of obstructive sleep apnea (OSA). Currently, there is a variety of regimes for the performance of DISE, which renders comparison and assessment across results difficult. It remains unclear how the different regimes influence the findings of the examination and the resulting conclusions and treatment recommendations. This study aimed to investigate the correlation between increasing levels of sedation (i.e., light, medium, and deep) induced by propofol using a target-controlled infusion (TCI) pump, with the obstruction patterns at the levels of the velum, oropharynx, tongue base, and epiglottis (i.e., VOTE classification). A second goal was the establishment of a sufficient sedation level to enable a reliable decision regarding treatment recommendations.
Material and methods
Forty-three patients with OSA underwent a DISE procedure using propofol TCI. Three levels of sedation were defined, depending on entropy levels and assessment of sedation: light sedation, medium sedation, and deep sedation. The evaluation of the upper airway at each level, with increasing sedation, was documented using the VOTE classification. The elapsed time at which each assessment was performed was recorded.
Results
Upper airway changes occurred and were measured throughout the DISE procedure. Clinically useful determinations of airway closure occurred at medium sedation; this level of sedation was most probably achieved with a blood propofol concentration of 3.2 μg/ml. In all 43 patients, definite treatment decisions could be made at medium sedation level. Increasing sedation did not result in changes in the treatment decision.
Conclusions
Changes in upper airway collapse during DISE with propofol TCI occur at levels of medium sedation. Decisions regarding surgical treatment could be made at this level of sedation.
Clinical trial name
Upper Airway Collapse in Patients with Obstructive Sleep Apnea Syndrome by Drug Induced Sleep Endoscopy (URL: http://ift.tt/2mWIPDL)
Registration number
NCT02588300
http://ift.tt/2oqIuGC
FDG-PET predicts treatment efficacy and surgical outcome of pre-operative chemoradiation therapy for resectable and borderline resectable pancreatic cancer
Publication date: Available online 31 March 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Hirofumi Akita, Hidenori Takahashi, Hiroaki Ohigashi, Akira Tomokuni, Shogo Kobayashi, Keijiro Sugimura, Norikatsu Miyoshi, Jeong-Ho Moon, Masayoshi Yasui, Takeshi Omori, Hiroshi Miyata, Masayuki Ohue, Yoshihiko Fujiwara, Masahiko Yano, Osamu Ishikawa, Masato Sakon
BackgroundThe efficacy of neoadjuvant chemoradiotherapy (NACRT) for resectable and borderline resectable pancreatic cancer is important for predicting outcomes after radical surgery, but few clinical indicators predict outcome before resection. This study examined the utility of FDG-PET in predicting the efficacy of NACRT and outcome after radical surgery.MethodsEighty-three pancreatic cancer patients who underwent FDG-PET before and after NACRT and had positive standard uptake values (SUVs) before NACRT were enrolled in this study. Peri-operative clinical factors, including FDG-PET findings, were examined to predict the efficacy of NACRT and outcome after surgery.ResultsEvans grade I, IIA, IIB, III, and IV was determined in 11, 31, 27, 11, and 3 patients, respectively. The maximum SUVs after NACRT (post SUV-max) and tumor size were significantly decreased compared to pretreatment values (p<0.001 and p=0.007, respectively). The post SUV-max and regression index were significantly related to grade III/IV (p=0.04 and p<0.001, respectively), but only the regression index predicted NACRT efficacy (p=0.002). The AUC of the regression index for the detection of grade III/IV was 0.822, and 13 of 14 grade III/IV patients were picked up using 50% as the threshold (p<0.001). Patients with a regression index >50% had a significantly better prognosis after radical resection than patients with <50% (p=0.032). Regression index as well as pathological lymph node status and resectability status were independent prognostic factors in multivariate analysis (exp2.086, p=0.043).ConclusionThe regression index is potentially a good indicator of the efficacy of NACRT and outcome after radical resection for pancreatic cancer.
http://ift.tt/2nIpa9v
Citizenship, length of stay, and screening for breast, cervical, and colorectal cancer in women, 2000–2010
Abstract
Background
Two factors jointly account for significant gaps in access to health care among immigrants who are present in the U.S.—legal status, and length of residence. The objective of this study is to examine the association between citizenship and length of residence in the U.S. and cancer screening (breast, cervical, and colorectal) among women.
Methods
We analyzed 11 years (2000–2010) of consolidated data from the Medical Expenditure Panel Survey linked with the National Health Interview Survey. Multivariate analyses compared cancer screening among U.S.-born citizens (n = 58,484), immigrant citizens (n = 8,404), and immigrant non-citizens (n = 6,564).
Results
Immigrant non-citizens living in the U.S. for less than 5 years were less likely to receive guideline-concordant breast (OR = 0.68 [0.53–0.88]), cervical (OR = 0.65 [0.54–0.78]), and colorectal (OR = 0.31 [0.19–0.50]) cancer screening compared to U.S.-born citizens. Immigrant citizens and non-citizens living in the U.S. for 5 years or more had higher odds of being screened for breast and cervical cancer compared to U.S.-born citizens; (OR = 1.26 [1.13–1.41] and OR = 1.17 [1.06–1.29]) for immigrant citizens, (OR = 1.28 [1.13–1.45] and OR = 1.23 [1.09–1.38]) for non-citizens. Immigrant non-citizens living in the U.S. for 5 years or more had lower odds of being screened for colorectal cancer compared to U.S.-born citizens (OR = 0.76 [0.65–0.90]).
Conclusions
Based on these findings, duration mandates in immigration policy may indirectly influence future pathways to preventive health care and cancer disparities disproportionately affecting immigrant women. We suggest that limits of duration mandates be reevaluated, as they may offer pathways to preventive health care for this vulnerable population, and prevent future cancer disparities.
http://ift.tt/2nGY6aB
Of Cytometry, Stem Cells and Fountain of Youth
Abstract
Outlined are advances of cytometry applications to identify and sort stem cells, of laser scanning cytometry and ImageStream imaging instrumentation to further analyze morphometry of these cells, and of mass cytometry to classify a multitude of cellular markers in large cell populations. Reviewed are different types of stem cells, including potential candidates for cancer stem cells, with respect to their "stemness", and other characteristics. Appraised is further progress in identification and isolation of the "very small embryonic-like stem cells" (VSELs) and their autogenous transplantation for tissue repair and geroprotection. Also assessed is a function of hyaluronic acid, the major stem cells niche component, as a guardian and controller of stem cells. Briefly appraised are recent advances and challenges in the application of stem cells in regenerative medicine and oncology and their future role in different disciplines of medicine, including geriatrics.
http://ift.tt/2nnFJnS
Sphingosine-1-phosphate is involved in inflammatory reactions in patients with Graves’ orbitopathy
Abstract
Objective
Graves' orbitopathy (GO) is initiated by excessive amount of various inflammatory mediators produced by orbital fibroblasts. This study aimed to assess the crucial role of sphingosine-1-phosphate (S1P) in the inflammatory process of GO.
Methods
Orbital adipose/connective tissue samples were obtained from 10 GO patients and 10 normal control individuals during surgery. Primary orbital fibroblast culture was done. After the expression of S1P receptors and sphingosine kinase (SphK) was assessed with the treatment of interleukin (IL)-1β, we evaluated the expression of pro-inflammatory factors [intercellular adhesion molecule-1 (ICAM-1), cyclooxygenase-2 (COX-2) and IL-6] after treating S1P. S1P receptor antagonists and SphK 1 inhibitor were pretreated and the expression of the pro-inflammatory factors was assessed.
Results
IL-1β exacerbated the inflammatory process by enhancing the expression of S1P receptors and SphK in GO orbital fibroblasts. IL-1β also induced the expressions of ICAM-1, COX-2, and IL-6 in GO orbital fibroblasts, and these expressions were effectively inhibited by S1P receptor antagonists and SphK1 inhibitor.
Conclusion
S1P has an important role in the pathological inflammatory process of GO, which is mediated through the SphK1-S1P- S1P receptor pathway. SphK1 inhibitors and S1P receptors or antagonists could be potential approaches for controlling the inflammatory process of GO.
http://ift.tt/2nG3Npj
Overweight and Obesity in Children with Autism Spectrum Disorder (ASD): a Critical Review Investigating the Etiology, Development, and Maintenance of this Relationship
Abstract
Pediatric obesity is associated with negative health and psychosocial consequences. However, obesity may not uniformly affect all populations. Limited research has investigated the factors that contribute to the incidence and persistence of overweight and obesity among children with autism spectrum disorder (ASD). This review systematically examined the prevalence rate of overweight and obesity among children with ASD. The majority of studies suggest that children with ASD may be at a greater risk for excess weight gain compared to typically developing peers. Additionally, this review investigated potential contributing factors to the etiology and maintenance of obesity within this population. Research should continue to investigate excess weight gain in this population in order to adapt weight loss interventions for children with ASD.
http://ift.tt/2nrHvoD
Fly rounds: Validation and pilot of a novel epidemiologic tool to guide infection control response to an infestation of Sarcophagidae flies in a community hospital's perioperative department
Source:American Journal of Infection Control
Author(s): Jonathan M. Schouest, Leah Heinrich, Barbara Nicholas, Frederick Drach
During an outbreak of Sarcophagidae, or flesh flies, in a community hospital's perioperative department, the infection prevention and control (IPC) department developed, validated, and piloted a novel epidemiologic tool to track hourly fly prevalence by room. Interrater reliability of the tool was measured as 0.88 and hourly point prevalence counts were superimposed on floor plans to create heat maps. Such surveillance tools allowed more timely decision making in conjunction with the operations of the hospital incident command system.
http://ift.tt/2nnKayP