Enhanced Microalgal Growth and Effluent Quality in Tertiary Treatment of Livestock Wastewater Using a Sequencing Batch Reactor

Abstract

Effect of harvesting and hydraulic retention time (HRT) on the performance of a sequencing batch reactor (SBR), growing a green alga Botoryococcus braunii, was investigated. In this continuous tertiary treatment, relieving limitations of light, inorganic carbon, nitrogen, and phosphorous can make photoautotrophy active through the rapid fixation of the building blocks into microalgal biomass together with heterotrophy promoted by organics and self-shading effect. Analysis of the results reveals that the control over CO₂ supply and the extension of solid retention time (SRT) are the keys to maintaining higher biomass productivity and better treatability in the mixotrophic SBR. Among HRTs tested, the shortest HRT of 2 days could demonstrate the best removal efficiencies of ammonia (98.8%) and total phosphorus (96.2%) while keeping the highest specific growth rate of 0.23 day⁻¹. Those results provide understanding on the impact of settling sequence, which extends SRT to 5~7 days and prevents significant limitations of light and essential building blocks. With the interplay between photoautotrophic and heterotrophic metabolisms of microalgae, this study identifies how the mixotrophic SBR perform resource recovery during tertiary treatment of livestock wastewater, and how limitation is associated with the effluent quality in the SBR.

http://ift.tt/2wWcS3d

Conditioning of Synthetic Sludge and Anaerobically Digested Sludge Using Chitosan, Organic Polyelectrolytes and Inorganic Metal Cations to Enhance Sludge Dewaterability

Abstract

Anaerobic digestion (AD) and dewatering are the most common and widely applied sludge treatment methods in wastewater treatment plants (WWTPs). However, sludge dewatering has been recognised as one of the most expensive and least understood processes. Therefore, this study investigated the dewatering performance of synthetic sludge in comparison with anaerobically digested sludge when conditioned with chitosan, organic polyelectrolytes and inorganic metal cations. Capillary suction time (CST), turbidity, electrical conductivity, zeta potential, cake solids content and particle size were used to assess sludge dewatering performance and to determine the optimum conditioner dose. The effectiveness of sludge conditioning was evaluated by batch experiments using a series of 250-mL jar test beakers. Both synthetic sludge and AD sludge exhibited similar trend but little different extent of dewaterability when conditioned with low molecular weight (MW) chitosan. The low MW and medium MW chitosans, commercial cationic polyelectrolytes and trivalent metal cations (Al³⁺, Fe³⁺) demonstrated as effective conditioning agents with good sludge dewaterability. When assessing the dewaterability measurement parameters using synthetic sludge, the optimal dosage was found at the range of 15 to 20 g-chitosan/kg-dry sludge where the values of CST, turbidity and cake solids content were attained between 6.6 and 11.0 s, 35.4–40.6 NTU, and 24.3–25.3%, respectively. The application of cationic polyelectrolytes and trivalent metal cations generally improved the sludge dewaterability via charge neutralisation and polymer bridging. This study also demonstrated that less complex chemically controlled synthetic sludge can be used for studying the final properties of complex real digested sludge.

http://ift.tt/2xBTDZP

Recombinant rabies virus expressing IL-15 enhances immunogenicity through promoting the activation of dendritic cells in mice

Abstract

Rabies remains a public health threat that kills approximately 59,000 people worldwide each year, most of which are from the developing countries of Africa and Asia where dog rabies are endemic. Therefore, developing an affordable and efficacious vaccine is crucial for rabies control in these countries. Interleukin (IL)-15, an immunoregulatory cytokine, is a pluripotent molecule with therapeutic potential, which targets many cell types and links the innate and adaptive immune system. In this study, IL-15 gene was cloned and inserted into the genome of a recombinant rabies virus (RABV) strain LBNSE (designated as LBNSE-IL15), and the effect of over-expression of IL-15 on the immunogenicity of RABV was investigated. It was found that mice vaccinated with LBNSE-IL15 could induce significantly higher level of virus-neutralizing antibody (VNA) than those immunized with LBNSE, resulting in the higher protection after challenge. Further investigation was performed to find out the possible role of IL-15 plays in the process of antibody induction, and it was found that LBNSE-IL15 could enhance the maturation of dendritic cells (DCs) in immunized mice. Furthermore, the mice immunized with LBNSE-IL15 could promote the T_FH cells differentiation and the generation of germinal center B cells and plasma cells. Together, these data indicated that IL-15 could be a potential adjuvant in enhancing the immunogenicity of RABV, contributing to the development of more-efficacious rabies vaccines.

http://ift.tt/2vvSWE1

Synthesis and property investigation of poly(arylene ether)s with pendant cyclohexyl units

Abstract

A series of poly(arylene ether)s with pendant cyclohexyl units had been prepared by solution polycondensation of 4,4′-cyclohexane-1,1′-diyldiphenol (CHDP) and 4,4′-difluorobenzophenone (DFBP) (or 4,4′-difluorodiphenylsulfone (DFDPS)). The inherent viscosities of obtained poly(arylene ether)s were in the range of 0.49–0.97 dLg⁻¹. They were found to have high glass transition temperatures (T_g) of 158–208 °C, and good thermal stability with 5% weight-loss temperature (T_5%) of 442–484 °C. The tensile test and dynamic mechanical analysis results indicate the good mechanical properties of poly(arylene ether)s. Their Young's Mdoulus were found to be 2.2–2.3 GPa, tensile strengths were 81.0–97.7 MPa, storage mdoulus were over 1.5 GPa even near glass transition temperature. The complex viscosities of the resultant polymers melt maintained a narrow range of 308–313 Pas at 260 °C or 2700–4600 Pas at 340 °C during the testing time. That indicates the resultant resins have good melt flowability and stability. In addition, these poly(arylene ether)s were found to have good solubility in various solvents such as CHCl₃, THF, NMP, DMAc, DMI, etc., and have good optical transmittance (>80%) at 450 nm. It suggests that the obtained poly(arylene ether)s not only can be processed by melt method, but also can be applied with solution method easily, and can be applied to tough and transparent films.

http://ift.tt/2vvQYmU

Erratum to: The effect of a performance-based intra-procedural checklist on a simulated emergency laparoscopic task in novice surgeons

http://ift.tt/2eIG4Qm

Erratum to: EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction

http://ift.tt/2guNWbR

Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas

Abstract

Background

This study aimed to determine the feasibility of the extracapsular enucleation method for giant liver hemangiomas by infrahepatic inferior vena cava (IVC) clamping and the Pringle maneuver to control intraoperative bleeding under laparoscopic hepatectomy.

Methods

From January 2012 to January 2016, 36 patients underwent laparoscopic extracapsular enucleation of giant liver hemangiomas. Patients were divided into two groups: infrahepatic IVC clamping + Pringle maneuvers group (IVCP group, n = 15) and the Pringle maneuvers group (Pringle group, n = 21). Operative parameters, postoperative laboratory tests, and morbidity and mortality were analyzed.

Results

The mean size of liver hemangiomas was 13.3 cm (range 10–25 cm). Infrahepatic IVC clamping + the Pringle maneuvers with laparoscopic extracapsular enucleation significantly reduced intraoperative blood loss (586.7 vs 315.3 mL, p < 0.001) and transfusion rates (23.8 vs 6.7%, p = 0.001), compared with the Pringle maneuver alone. The gallbladder was retained in both groups. The mean arterial pressure (MAP) in Pringle group remained virtually stable before and after clamping of hepatic portal, while it was significantly decreased after IVC clamping in IVCP group than that pre-clamping (p < 0.001). The heart rate of all patients was significantly increased after clamping when compared to pre-clamping heart rates (p < 0.001). Once vascular occlusion was released, MAP returned to normal levels within a few minutes. There were no significant differences in postoperative complications between two groups. The vascular occlusion techniques in both groups had no serious effect on postoperative of hepatic and renal function.

Conclusions

Extracapsular enucleation with infrahepatic IVC clamping + the Pringle maneuver is a safe and effective surgical treatment to control bleeding for giant liver hemangiomas in laparoscopic hepatectomy.

http://ift.tt/2eIG2rO

The SmartOR: a distributed sensor network to improve operating room efficiency

Abstract

Background

Despite the significant expense of OR time, best practice achieves only 70% efficiency. Compounding this problem is a lack of real-time data. Most current OR utilization programs require manual data entry. Automated systems require installation and maintenance of expensive tracking hardware throughout the institution. This study developed an inexpensive, automated OR utilization system and analyzed data from multiple operating rooms.

Study design

OR activity was deconstructed into four room states. A sensor network was then developed to automatically capture these states using only three sensors, a local wireless network, and a data capture computer. Two systems were then installed into two ORs, recordings captured 24/7. The SmartOR recorded the following events: any room activity, patient entry/exit time, anesthesia time, laparoscopy time, room turnover time, and time of preoperative patient identification by the surgeon.

Results

From November 2014 to December 2015, data on 1003 cases were collected. The mean turnover time was 36 min, and 38% of cases met the institutional goal of ≤30 min. Data analysis also identified outlier cases (>1 SD from mean) in the domains of time from patient entry into the OR to intubation (11% of cases) and time from extubation to patient exiting the OR (11% of cases). Time from surgeon identification of patient to scheduled procedure start time was 11 min (institution bylaws require 20 min before scheduled start time), yet OR teams required 22 min on average to bring a patient into the room after surgeon identification.

Conclusion

The SmartOR automatically and reliably captures data on OR room state and, in real time, identifies outlier cases that may be examined closer to improve efficiency. As no manual entry is required, the data are indisputable and allow OR teams to maintain a patient-centric focus.

http://ift.tt/2gswqFn

Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers

Abstract

Background and study aims

Precut sphincterotomy increases the success of deep biliary cannulation, but the method fails at the initial ERCP in 5–12% of cases. Although other invasive strategies are often used to access the bile duct, a second ERCP may be effective and safe. We evaluated the efficacy, safety, and factors related to a second ERCP after failed cannulation using a precut sphincterotomy.

Patients and methods

We reviewed all patients that underwent an ERCP with native papilla from 2006 to 2014 at two tertiary institutions. Efficacy was based on the cannulation rate of the second ERCP, and safety was assessed in terms of adverse events.

Results

We identified 112 patients with failed cannulation after precut, and a second ERCP was performed in 72 (64.3%). Median time between procedures was 7 days (IQR 5–11). Deep cannulation was achieved in 54 cases (75%). The only factor associated with cannulation failure was an ERCP within 4 days after the initial precut (cannulation success 44.4 vs. 79.4% after 4 days, p = 0.026). Adverse events were recorded after the first ERCP in 13 of 112 patients (11.8%): delayed bleeding in four, pancreatitis in five, and perforation in four. After the second ERCP, three of 72 patients (4.2%) presented adverse events: two delayed bleeding and one pancreatitis.

Conclusions

A second ERCP after failure of initial biliary cannulation following precut appears to be safe and effective. A second ERCP should be delayed at least 4 days if feasible.

http://ift.tt/2gtMV43

Increased identification of parathyroid glands using near infrared light during thyroid and parathyroid surgery

Abstract

Background

Parathyroid gland (PG) identification during thyroid and parathyroid surgery is challenging. Accidental parathyroidectomy increases the rate of postoperative hypocalcaemia. Recently, autofluorescence with near infrared light (NIRL) has been described for PG visualization. The aim of this study is to analyze the increased rate of visualization of PGs with the use of NIRL compared to white light (WL).

Materials and methods

All patients undergoing thyroid and parathyroid surgery were included in this study. PGs were identified with both NIRL and WL by experienced head and neck surgeons. The number of PGs identified with NIRL and WL were compared. The identification of PGs was correlated to age, sex, and histopathological diagnosis.

Results

Seventy-four patients were included in the study. The mean age was 48.4 (SD ±13.5) years old. Mean PG fluorescence intensity (47.60) was significantly higher compared to the thyroid gland (22.32) and background (9.27) (p < 0.0001). The mean number of PGs identified with NIRL and WL were 3.7 and 2.5 PG, respectively (p < 0.001). The difference in the number of PGs identified with NIRL and WL and fluorescence intensity was not related to age, sex, or histopathological diagnosis, with the exception of the diagnosis of thyroiditis, in which there was a significant increase in the number of PGs visualized with NIRL (p = 0.026).

Conclusion

The use of NIRL for PG visualization significantly increased the number of PGs identified during thyroid and parathyroid surgery, and the differences in fluorescent intensity among PGs, thyroid glands, and background were not affected by age, sex, and histopathological diagnosis.

http://ift.tt/2grVBYG

Compositional analysis of multi-element magnetic nanoparticles with a combined NMR and TEM approach

Abstract

The increasing interest in nanoscale materials goes hand in hand with the challenge to reliably characterize the chemical compositions and structural features of nanosized objects in order to relate those to their physical properties. Despite efforts, the analysis of the chemical composition of individual multi-element nanoparticles remains challenging—from the technical point of view as well as from the point of view of measurement statistics. Here, we demonstrate that zero-field solid-state nuclear magnetic resonance (NMR) complements local, single particle transmission electron microscopy (TEM) studies with information on a large assembly of chemically complex nanoparticles. The combination of both experimental techniques gives information on the local composition and structure and provides an excellent measurement statistic through the corresponding NMR ensemble measurement. This analytical approach is applicable to many kinds of magnetic materials and therefore may prove very versatile in the future research of particulate magnetic nanomaterials.

http://ift.tt/2wlWYNR

Do Male Patients Benefit from Laparoscopic Adjustable Gastric Banding More than Female Patients? A Retrospective Cohort Study

Abstract

Background

Clinical trials in the field of bariatrics, and specifically laparoscopic adjustable gastric banding (LAGB), have frequently been gender imbalanced, with males representing only 20% of examinees. Long-term gender-oriented results, and specifically quality of life (QOL) parameters, have not been addressed sufficiently. The aim of our study was to examine the long-term gender association with outcome of LAGB including the impact on QOL.

Methods

A retrospective cohort study of patients who underwent LAGB between 2006 and 2014 by a single surgeon was conducted. Data were collected from the hospital registry and a telephone interview that included a standardized questionnaire. Outcomes including BMI reduction, evolution of comorbidities, complications, reoperations, and QOL were compared according to the Bariatric Analysis and Reporting Outcome System (BAROS).

Results

Included were 114 males and 127 females, with a mean age of 38.2 years at surgery, and an average post-surgery follow-up of 6.5 years. Similar BMI reduction (p = 0.68) and perioperative complication rates (p = 0.99) were observed. Males had a greater improvement in comorbidities (p < 0.001), less band slippage (p = 0.006), underwent fewer reoperations (p = 0.02), and reported higher QOL scores (p = 0.02) than females. The total BAROS score was significantly higher for males than females (p < 0.001).

Conclusions

LAGB surgery results in better outcomes for male than female patients as measured by the BAROS, despite a similar BMI reduction. Gender-specific outcomes should be taken into consideration in optimizing patient selection and preoperative patient counseling.

http://ift.tt/2vNVpVv

Controlled synthesis of random, block-random and gradient styrene, methyl methacrylate and acrylonitrile Terpolymers via Nitroxide-mediated free radical polymerization

Abstract

Different types of the styrene − methyl methacrylate −acrylonitrile terpolymers were synthesized according to the recently proposed concept of the living nitroxide-mediated terpolymerization. Random azeotropic and gradient terpolymers were prepared using the living TEMPO-mediated polymerization. Block random terpolymer was obtained via the living terpolymerization initiated by macro-alkoxyamine polystyrene-SG1. In all systems, terpolymerization proceeds in the living manner even in the presence of TEMPO. Upon complete polymerization at high conversions of monomers, the molecular weight of terpolymers linearly increases with the monomer conversion. The resultant terpolymers were characterized by the methods of turbidimetric titration, GPC, DSC, and TGA, and their characteristics were compared with their non-living analogs synthesized by the conventional radical polymerization. The effect of the macromolecular structure on the thermal stability of the terpolymers was studied.

http://ift.tt/2eIvGIg

Pancreas sparing duodenectomy for duodenal trauma

Abstract

Background

Although blunt abdominal trauma is frequently encountered, isolated duodenal injury is relatively uncommon. The management of such patients is challenging and various surgical procedures are described for their management.

Methods

Two patients presented to our emergency department with isolated duodenal injuries (transection and devascularisation) secondary to blunt abdominal trauma.

Results

Both patients underwent exploratory laparotomy, revealing transection of the duodenum along with proximal devascularization and detachment of mesentery at duodeno-jejunal junction without any other intra-abdominal injury (especially pancreas, colon, vena cava) for which pancreas-sparing duodenectomy (infra-ampullary) was performed.

Conclusion

Pancreas-sparing duodenectomy is a valuable tool in the management of duodenal trauma, allowing the surgeon (and the patient) to avoid the complications of major surgical resections.

http://ift.tt/2emMeFp

Exophytic gastrointestinal stromal tumor of the stomach. Report of two cases

Abstract

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Most GISTs occur in the stomach (60-70%). Their diagnosis is established immunohistochemically and reveals that the tumor cells are immunoreactive for the antigens CD117 and CD34. The infiltration of the adjacent organs, the large tumor size (>5cm) and the mitosis count of the cells (>5/50 CHPFs) are typical characteristics of GIST malignancy. GISTs rarely infiltrate adjacent organs and usually push them back. The clinical behaviour of GISTs is highly variable and tumor size mitotic rate and location are prognostic determinants.

The biologic behaviour of GIST is variable. The majority were previously thought to be benign due to their characteristically bland histopathologic features. However, it is becoming increasingly clear that with long follow-up, virtually all GISTs have the potential for malignant behaviour, even those 2 cm or less with bland histologic features. Thus, it is not appropriate to define any GIST as "benign" per se.

We present two cases of exophytic gastric GIST which were recently treated successfully in our Clinic with "wedge" gastric resection. The margins were negative and there was neither rupture of the tumor, nor spillage.

http://ift.tt/2iMXGzh

Our case reports a component of acute care surgery

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Gastric outlet obstruction with perforation. A rare presentation of left-sided adult Morgagni hernia

Abstract

Adult presentation of congenital diaphragmatic hernia (CDH) is rare. Out of the three varieties of CDH, Morgagni hernia is the rarest of all. Though most of them are asymptomatic and may be incidentally detected, they may also present in the emergency setting with respiratory or gastrointestinal features like obstruction or strangulation. Gastric outlet obstruction is a rare manifestation of adult Morgagni hernia. We present a case of adult left-sided Morgagni hernia with features of gastric outlet obstruction complicated with perforation.

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The anatomy of a surgeon

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Coexistence of Hashimoto’s thyroiditis and papillary thyroid carcinoma

Abstract

Aim

The coexistence of Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) has been a widely debated issue. In view of the current controversy, as well as the high prevalence of both diseases, the objective of the present paper is to evaluate the association between them and to propose the proper therapeutic management.

Methods

We herein review previous pertinent literature on the subject of concomitant HT and PTC, with respect to epidemiology, clinical presentation, carcinogenesis, and appropriate treatment.

Results

Studies to date establish 6.5-43.8% of patients with PTC and coexisting HT, while 11-58.3% of all HT patients will develop PTC. Coexistence of the diseases is significantly related to younger women. Malignant lesions tend to be microcarcinomas, at times multifocal (13.5-44%) and occasionally metastasising to the central cervical compartment (10.8-49%). Mostly, patients have a good prognosis with total thyroidectomy, accompanied by central compartment node dissection in cases with nodal involvement. Many issues, including molecular biological characteristics of carcinogenesis in Hashimoto's thyroiditis, remain to be clarified and further studies need to be undertaken.

Conclusions

The close relationship between HT and PTC lends credence to the hypothesis that autoimmune thyroiditis is a predisposing factor to the development of thyroid carcinoma but patients tend to have favorable clinicopathological characteristics and long recurrence-free survival. A careful surveillance of these patients is required for an early detection of malignant lesions, which should constitute indication for radical surgical treatment.

http://ift.tt/2iKxnte

Use of idarucizumab for dabigatran reversal in patients with non-valvular atrial fibrillation undergoing emergency surgical repair of strangulated femoral hernia

Abstract

Non-vitamin-K oral anticoagulants (NOACs) are approved for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) and dabigatran exetilate, a direct thrombin inhibitor, was the first one to be approved. While anticoagulated, patients can experience serious perioperative bleeding so idarucizumab, a specific for dabigatran reversal agent was developed, in order to remove anticoagulant action and restore normal haemostasis. We report a case of a 61-year-old woman with history of NVAF on dabigatran, presented to the emergency department with a strangulated right femoral hernia causing small bowel obstruction, where idarucizumab was administered before surgery. The patient had received her last dose of dabigatran 4 hours before presenting to the emergency department and her activated partial thromboplastin time was over the upper limit of reference. Surgery followed about one hour after the administration of idarucizumab and surgeon reported normal perioperative haemostasis. The patient had a normal recovery, received parenteral anticoagulation until her hospital discharge when she was advised to restart dabigatran. To our knowledge, this is the first case of successful reversal of anticoagulation, with the use of idarucizumab, to a patient in need for an emergency surgery, in Greece.

http://ift.tt/2emRgkZ

Intestinal obstruction in appendicitis: A retrospective cohort study

Abstract

Background

Appendicitis as a cause of intestinal obstruction is an infrequent condition. The purpose of this study was to define the incidence and frequency of intestinal obstruction, according to the classification of intestinal obstruction secondary to appendicitis, and to characterise their severity.

Methods

A retrospective cohort study analysing all patients operated on for intestinal obstruction secondary to appendicitis within a 15-year period was designed. Continuous and categorical variables including age, gender, time interval between onset of symptoms and diagnosis, C-reactive protein and white blood cells values, type of intestinal obstruction and WSES Sepsis Severity Score, were included.

Results

During the period of study 3626 patients were operated on for appendicitis and 44 cases had associated intestinal obstruction (1.2%). According to the classification of intestinal obstruction in appendicitis, most patients had a mechanical ileus with strangulation (48%) and a WSES Sepsis Severity Score of 3 or less points (77%).

Conclusions

The incidence of intestinal obstruction in appendicitis was higher than expected. These patients have a severe inflammatory response with a WSES Sepsis Severity Score of 3 points. According to the classification of intestinal obstruction in appendicitis, most patients had a mechanical obstruction with strangulation.

http://ift.tt/2iLSpI6

Current concepts on GIST

http://ift.tt/2emRrx1

The inaugural letter

http://ift.tt/2iKxbKw

Gallstone obstructing the duodenum. Report of two cases of Bouveret’s syndrome

Abstract

Bouveret's syndrome is the obstruction of the duodenum due to a gallstone. It is a rare condition, known for over a century that continues to confound emergency room physicians and surgeons to this day. We present two cases of Bouveret's syndrome. The first is a 63-year-old female patient with a 4 cm gallstone obstructing the third part of the duodenum. The patient underwent prompt surgery and the gallstone was removed through the jejunum. The other patient's course, an 88–year-old male, was more complicated. After fluid resuscitation and an attempt at endoscopic removal, a gallstone obstructing the first part of the duodenum was surgically removed through a gastrotomy. Both patients recovered fully and were discharged. Both cases presented many dilemmas and challenges from the diagnosis to the final management.

http://ift.tt/2emQTHm

Acute surgical abdomen as presentation of undiagnosed midgut malrotation in adults

Abstract

Aim-Background

Acute presentation in adulthood of the indolent developmental midgut malformations constitutes a diagnostic problem and emergent surgery may result to an operative surprise.

Methods

In the last five years two women (case I: 46 years, case II: 88 years) and two men (case III: 42 years, case IV: 50 years) underwent urgent laparotomy for acute abdomen due to bowel obstruction (all cases) and peritonitis (cases II, III). Right colon volvulus in cases I, II and IV, ileocolonic intussusception in case II, gaseous distension of bowel loops and abdominal abscess in case III, and enlargement of the entire colon and megasigmoid in case IV were revealed by preoperative imaging. Symptoms of severe abdominal pain, abdominal distension with tenderness, vomiting and complete constipation were evident in all cases. At surgery, features of malrotation, mainly lack of fixation of the right colon which was volvulised, were found in all cases. Right-sided small intestine and Meckel's diverticulum abscess were found in case III, and an incompletely volvulised megasigmoid coexisted in case IV. We performed resection of peritoneal bands, right hemicolectomy with ileotransversostomy in cases I, II and IV, and enterectomy and right colon fixation in case III. A Hartmann's sigmoidectomy completed the operation in case IV.

Results

All cases had uneventful outcome, except for some delay in wound healing in a diabetic patient. Histology revealed ischaemia in all segments excised, ileocolonic intussusception associated with a caecal adenocarcinoma in case II, and inflammed Meckel's diverticulum in case III.

Conclusions

Adult bowel malrotation complicated with right colon volvulus and/or ileocolonic intussusception requires emergent surgery.

http://ift.tt/2iLV0li

Pathological findings in 377 patients with differentiated thyroid cancer in a single centre

Abstract

Aim-Background

The purpose of this study is to review the pathology findings of 377 patients diagnosed with differentiated thyroid cancer (DTC) in a single centre over a period of six years.

Methods

Retrospective review of all total and near-total thyroidectomies (TT and NTT) performed in a single institution. Clinical records were accessed for patient demographic data and clinical characteristics. Patients with a histopathologic diagnosis of DTC were grouped in incidental DTC and non-incidental DTC groups and TNM staging was used.

Results

1465 thyroidectomies were included. The M:F ratio was 1:2.9. 377/1465 patients had a histologic diagnosis of DTC (26%). T1b group (n=227) had a statistically significant higher number of cases, where tumor invaded the capsule, tumor extending extrathyroidally, tumor invading the blood vessels compared to T1a group (n=64) (p=0.001 for all three variables). T1a group had a statistically significant higher number of papillary conventional variant of DTC and more unifocal tumors (p=0.045 and p=0.004 respectively). In the non-incidental DTC group (n=79), there were 29 patients (37%) in T1a category and 16 of them had a unifocal papillary DTC.

Conclusions

16/79 of patients (20%) operated for DTC had a subcetrimetric, unifocal papillary DTC. According to the 2106 American Thyroid Association (ATA) Management Guidelines, these patients could potentially have been treated with a lobectomy alone. Patients in T1b category present more aggressive histologic features and should undergo multi-disciplinary team discussion to decide optimal surgical treatment.

http://ift.tt/2emGUSp

Perfusion magnetic resonance imaging in pediatric brain tumors

Abstract

Purpose

The use of DSC-MR imaging in pediatric neuroradiology is gradually growing. However, the number of studies listed in the literature remains limited. We propose to assess the perfusion and permeability parameters in pediatric brain tumor grading.

Methods

Thirty children with a brain tumor having benefited from a DSC-MR perfusion sequence have been retrospectively explored. Relative CBF and CBV were computed on the ROI with the largest lesion coverage. Assessment of the lesion's permeability was also performed through the semi-quantitative PSR parameter and the K2 model-based parameter on the whole-lesion ROI and a reduced ROI drawn on the permeability maps. A statistical comparison of high- and low-grade groups (HG, LG) as well as a ROC analysis was performed on the histogram-based parameters.

Results

Our results showed a statistically significant difference between LG and HG groups for mean rCBV (p < 10^-3), rCBF (p < 10^-3), and for PSR (p = 0.03) but not for the K2 factor (p = 0.5). However, the ratio K2/PSR was shown to be a strong discriminating factor between the two groups of lesions (p < 10^-3). For rCBV and rCBF indicators, high values of ROC AUC were obtained (> 0.9) and mean value thresholds were observed at 1.07 and 1.03, respectively. For K2/PSR in the reduced area, AUC was also superior to 0.9.

Conclusions

The implementation of a dynamic T2* perfusion sequence provided reliable results using an objective whole-lesion ROI. Perfusion parameters as well as a new permeability indicator could efficiently discriminate high-grade from low-grade lesions in the pediatric population.

http://ift.tt/2gs8JwK

MWCNT/Hectorite hybrid filled acrylonitrile butadiene rubber/ ethylene-co-vinyl acetate blend nanocomposites: preparation and properties

Abstract

Multiwalled carbon nanotube/hectorite hybrid filler (HMH) was prepared by simple dry grinding method. It was subsequently used for the reinforcement of technologically compatible acrylonitrile butadiene rubber (NBR)/ ethylene-co-vinyl acetate (EVA) blend through solution intercalation method. Analysis of the prepared blend nanocomposites confirms homogeneous dispersion of the constituent fillers in the polymer matrix and significant interaction between two types of constituent fillers. Mechanical properties of NBR/EVA blend are significantly improved with HMH content up to 4 wt.% followed by reversion. Maximum improvement observed in tensile strength, elongation at break and toughness are 106%, 37% and 171% respectively without significant rise in Young's modulus. Results also show best dynamic mechanical and dielectric response at 4 wt.% and 3 wt.% HMH content respectively. Enhanced mechanical, dynamic mechanical and dielectric properties of the blend nanocomposites attained may be attributed to fair degree of compatibility between the two polymer matrices, homogeneous dispersion of fillers and improved polymer-filler interaction.

http://ift.tt/2emvgqI

HSV-2 encephalitis presenting as multifocal ischemic stroke

http://ift.tt/2iLgPBq

Reproducibility of the Pleth Variability Index in premature infants

Abstract

The aim was to assess the reproducibility of the Pleth Variability Index (PVI), developed for non-invasive monitoring of peripheral perfusion, in preterm neonates below 32 weeks of gestational age. Three PVI measurements were consecutively performed in stable, comfortable preterm neonates in the first 48 h of life. On each occasion, pulse oximeter sensors were attached to two different limbs for 5 min. Reproducibility was assessed with the intra-class correlation coefficient (ICC) and Bland–Altman analysis. A total of 25 preterm neonates were included. Inter-limb comparison showed fair to moderate ICC's with 95%-confidence intervals (95%-CI). Left hand–right hand ICC = 0.498, 95%-CI (0.119–0.753); right foot–right hand ICC = 0.314 (−0.088–0.644); right foot–left foot ICC = 0.315 (−0.089–0.628). Intra-limb comparison showed fair to moderate ICC for right foot–right foot ICC = 0.380 (−0.014–0.677); and good ICC for right hand–right hand ICC = 0.646 (0.194–0.852). Bland–Altman plots showed moderate reproducibility of measurements between different limbs and of the same limb in consecutive time periods, with large biases and wide limits of agreement. The findings from this study indicate that PVI measurement is poorly reproducible when measured on different limbs and on the same limb in stable and comfortable preterm neonates.

http://ift.tt/2eIavWK

Real-time multi-scale parallel compressive tracking

Abstract

Robust visual tracking is a challenging problem because the appearance of a target may rapidly change due to significant variations in the object's motion and the surrounding illumination. In this paper, a novel robust visual tracking algorithm is proposed based on an existing compressive tracking method. The proposed algorithm adopts multiple naive Bayes classifiers, each trained under a different scale condition, to realize online parallel multi-scale classification. Further, each classifier was initialized by randomly generating different types of Haar-like features. By doing so, the robustness of the feature classification can be improved to obtain more accurate tracking results. To enhance the real-time performance of the visual tracking system, the formula of the naive Bayes classifier is studied and simplified to speed up the processing speed of parallel multi-scale feature classification. After acceleration via formula simplification and parallel implementation, the proposed visual tracking algorithm can reach a tracking performance of approximately 45 frames per second (fps) when dealing with images of 642 × 352 pixels on a popular Intel Core i5-3230M platform. The experimental results show that the proposed algorithm outperforms state-of-the-art visual tracking methods on challenging videos in terms of success rate, tracking accuracy, and visual comparison.

http://ift.tt/2xAQQ2Q

Deep-learning-based automatic computer-aided diagnosis system for diabetic retinopathy

Abstract

The high-pace rise in advanced computing and imaging systems has given rise to a new research dimension called computer-aided diagnosis (CAD) system for various biomedical purposes. CAD-based diabetic retinopathy (DR) can be of paramount significance to enable early disease detection and diagnosis decision. Considering the robustness of deep neural networks (DNNs) to solve highly intricate classification problems, in this paper, AlexNet DNN, which functions on the basis of convolutional neural network (CNN), has been applied to enable an optimal DR CAD solution. The DR model applies a multilevel optimization measure that incorporates pre-processing, adaptive-learning-based Gaussian mixture model (GMM)-based concept region segmentation, connected component-analysis-based region of interest (ROI) localization, AlexNet DNN-based highly dimensional feature extraction, principle component analysis (PCA)- and linear discriminant analysis (LDA)-based feature selection, and support-vector-machine-based classification to ensure optimal five-class DR classification. The simulation results with standard KAGGLE fundus datasets reveal that the proposed AlexNet DNN-based DR exhibits a better performance with LDA feature selection, where it exhibits a DR classification accuracy of 97.93% with FC7 features, whereas with PCA, it shows 95.26% accuracy. Comparative analysis with spatial invariant feature transform (SIFT) technique (accuracy—94.40%) based DR feature extraction also confirms that AlexNet DNN-based DR outperforms SIFT-based DR.

http://ift.tt/2wVz7pP

The treatment of desmoid tumors associated with familial adenomatous polyposis: the results of a Japanese multicenter observational study

Abstract

Purpose

Familial adenomatous polyposis (FAP)-associated desmoid tumor (DT) is sometimes life threatening. However, the optimal treatment for DTs has not been established. The aim of this study was to analyze the outcomes of surgical and pharmacological treatments for DT in Japanese FAP patients.

Methods

We retrospectively reviewed the data of 303 patients who underwent colectomy for FAP between 2000 and 2012. We analyzed 41 patients with DTs in which the location was apparent. The selection of treatment for intra-abdominal DTs was also evaluated according to Church's classification.

Results

Surgery was frequently used to treat extra-abdominal DTs. Multimodal treatments, including surgery, and the administration of non-steroidal anti-inflammatory drugs, hormonal therapy, and chemotherapy were widely used for intra-abdominal DTs. The most effective pharmacological treatment was cytotoxic chemotherapy, which was associated with a response rate of 45.5% and a disease control rate of 72.7%. After a median follow-up period of 53.0 months, the 5-year DT-specific survival rate in patients with stage IV disease was 71.4%; in contrast, the rate in patients with other stages was 100%. Four-stage IV patients died of DT due to uncontrollable rapid progression. No cytotoxic chemotherapy was administered; however, incomplete resection was performed in three cases.

Conclusion

Our findings will provide clues that may help physicians in selecting the optimal strategy for this rare disease.

http://ift.tt/2xPOf4L

Successful therapy switch from eculizumab to mycophenolate mofetil in a girl with DEAP-HUS

http://ift.tt/2wlJlOT

Cyclic Degradation Behavior of $$ \langle 001 \rangle $$ ⟨ 001 ⟩ -Oriented Fe–Mn–Al–Ni Single Crystals in Tension

Abstract

In the present study, functional fatigue behavior of a near 〈001〉-oriented Fe–Mn–Al–Ni single crystal was investigated under tensile load. An incremental strain test up to 3.5% strain and cyclic tests up to 25 cycles revealed rapid pseudoelastic degradation. Progressive microstructural degradation was studied by in situ scanning electron microscopy. The results show a partially inhibited reactivation of previously formed martensite and proceeding activation of untransformed areas in subsequent cycles. The preferentially formed martensite variants were identified by means of Schmid factor calculation and the Kurdjumov–Sachs relationship. Post mortem transmission electron microscopy investigations shed light on the prevailing degradation mechanisms. Different types of dislocations were found promoting the progressive degradation during cyclic loading.

http://ift.tt/2gs2Nnr

Challenges and Barriers to Identifying Pain in the Special Education Classroom: A Review

Abstract

Although special education professionals are primarily responsible for the well-being of students with intellectual and developmental disabilities (IDD), these professionals often lack training in determining whether a child with IDD is experiencing pain. Pain that is not assessed or managed restricts student access to learning. This systematic review describes potential challenges or barriers to adequate pain assessment in the special education classroom. The review methods yielded 36 sources. Five themes emerged following summative content analysis. These themes point to a critical need to identify special educators' current practices related to pain. Understanding these practices will inform research and development for a needed training program for special educators related to pain occurrence, identification, and assessment in students with IDD.

http://ift.tt/2glXBOl

Green clubs in building block climate change regimes

Abstract

Climate change is the consequence of a market failure, with private actors' incentives misaligned on a global scale and across multiple generations. Government policies to address climate change remain inadequate and the near term prospects are suspect. Analysts have turned their attention to finding alternative approaches to reducing greenhouse gas emissions. Green clubs offer a potential institutional mechanism for reducing greenhouse gas emissions, but to be effective they must be designed to fit their circumstances. An effective green club solves a market or quasi-market failure among firms and their stakeholders. Focusing on the market and nonmarket strategic imperatives for green clubs identifies several important considerations for improving the effectiveness of green clubs. Green clubs addressing climate change are more likely to be effective if they provide potential participants with a private benefit they are unable to achieve through other means and when the private benefits participants receive are tightly linked to the environmental benefits the club produces. Analyzing green clubs through this lens suggests that environmental certification club goods are more promising candidates than environmental technology club goods.

http://ift.tt/2esDUY7

Incomplete cooperation and co-benefits: deepening climate cooperation with a proliferation of small agreements

Abstract

Case study and model results lend some optimism for the potential of small coalitions with partially excludable public goods to substantially deepen international cooperation on energy and climate issues. Drawing motivation from other issue areas in international relations ranging from nuclear non-proliferation, transboundary air pollution and liberalized trade, we use an evolutionary-game-theoretic model to analyze regimes that yield domestic incentives to contribute to public goods provision (co-benefits). Co-benefits may be limited, but can create a nucleus for formation of coalitions that grow while deepening provision of global public goods. The Climate and Clean Air Coalition (CCAC) is a prime example of an agreement that employs partially excludable club benefits to deepen cooperation on non-CO₂ greenhouse gases. Our game-theoretic results support two important insights for the building blocks approach to addressing climate change: sustained cooperation in club agreements is possible even when public goods are not entirely excludable and some members of the population free-ride; and second, cooperation in small club configurations yields larger non-excludable public goods benefits than cooperation in more inclusive forums. This paper lends positive support that a proliferation of small agreements under a building blocks approach at the UNFCCC may be more effective (not just more likely) for deepening climate change cooperation than a fully inclusive approach.

http://ift.tt/2glZr1w

Mixed reality ultrasound guidance system: a case study in system development and a cautionary tale

Abstract

Purpose

Real-time ultrasound has become a crucial aspect of several image-guided interventions. One of the main constraints of such an approach is the difficulty in interpretability of the limited field of view of the image, a problem that has recently been addressed using mixed reality, such as augmented reality and augmented virtuality. The growing popularity and maturity of mixed reality has led to a series of informal guidelines to direct development of new systems and to facilitate regulatory approval. However, the goals of mixed reality image guidance systems and the guidelines for their development have not been thoroughly discussed. The purpose of this paper is to identify and critically examine development guidelines in the context of a mixed reality ultrasound guidance system through a case study.

Methods

A mixed reality ultrasound guidance system tailored to central line insertions was developed in close collaboration with an expert user. This system outperformed ultrasound-only guidance in a novice user study and has obtained clearance for clinical use in humans. A phantom study with 25 experienced physicians was carried out to compare the performance of the mixed reality ultrasound system against conventional ultrasound-only guidance. Despite the previous promising results, there was no statistically significant difference between the two systems.

Results

Guidelines for developing mixed reality image guidance systems cannot be applied indiscriminately. Each design decision, no matter how well justified, should be the subject of scientific and technical investigation. Iterative and small-scale evaluation can readily unearth issues and previously unknown or implicit system requirements.

Conclusions

We recommend a wary eye in development of mixed reality ultrasound image guidance systems emphasizing small-scale iterative evaluation alongside system development. Ultimately, we recommend that the image-guided intervention community furthers and deepens this discussion into best practices in developing image-guided interventions.

http://ift.tt/2glZk66

A method for going from 2D laparoscope to 3D acquisition of surface landmarks by a novel computer vision approach

Abstract

Purpose

This paper presents a method to use the Smart Trocars—our new surgical instrument recognition system—or any accurate localization system of surgical instrument for acquiring intraoperative surface data. Complex laparoscopic surgeries need a proper guidance system which requires registering the preoperative data from a CT or MRI scan to the intraoperative patient state. The Smart Trocar can be used to localize the instruments when it comes to contact with the soft tissue surface.

Method

Two successive views through the laparoscope at different angles with the 3D localization of a fixed tool at one single location using the Smart Trocars can point out visible features during the surgery and acquire their location in 3D to provide a depth map in the region of interest. In other words, our method transforms a standard laparoscope system into a system with three-dimensional registration capability.

Result

This method was initially tested on a simulation for uncertainty assessment and then on a rigid model for verification with an accuracy within 2 mm distance. In addition, an in vivo experiment on pig model was also conducted to investigate how the method might be used during a physiologic respiratory cycle.

Conclusion

This method can be applied in a large number of surgical applications as a guidance system on its own or in conjunction with other navigation techniques. Our work encourages further testing with realistic surgical applications in the near future.

http://ift.tt/2esIOVf

Breast cancer cell nuclei classification in histopathology images using deep neural networks

Abstract

Purpose

Cell nuclei classification in breast cancer histopathology images plays an important role in effective diagnose since breast cancer can often be characterized by its expression in cell nuclei. However, due to the small and variant sizes of cell nuclei, and heavy noise in histopathology images, traditional machine learning methods cannot achieve desirable recognition accuracy. To address this challenge, this paper aims to present a novel deep neural network which performs representation learning and cell nuclei recognition in an end-to-end manner.

Methods

The proposed model hierarchically maps raw medical images into a latent space in which robustness is achieved by employing a stacked denoising autoencoder. A supervised classifier is further developed to improve the discrimination of the model by maximizing inter-subject separability in the latent space. The proposed method involves a cascade model which jointly learns a set of nonlinear mappings and a classifier from the given raw medical images. Such an on-the-shelf learning strategy makes obtaining discriminative features possible, thus leading to better recognition performance.

Results

Extensive experiments with benign and malignant breast cancer datasets are conducted to verify the effectiveness of the proposed method. Better performance was obtained when compared with other feature extraction methods, and higher recognition rate was achieved when compared with other seven classification methods.

Conclusions

We propose an end-to-end DNN model for cell nuclei and non-nuclei classification of histopathology images. It demonstrates that the proposed method can achieve promising performance in cell nuclei classification, and the proposed method is suitable for the cell nuclei classification task.

http://ift.tt/2glWWwl

Inhaled anesthetic agent sedation in the ICU and trace gas concentrations: a review

Abstract

There is a growing interest in the use of volatile anesthetics for inhalational sedation of adult critically ill patients in the ICU. Its safety and efficacy has been demonstrated in various studies and technical equipment such as the anaesthetic conserving device (AnaConDa™; Sedana Medical, Uppsala, Sweden) or the MIRUS™ system (Pall Medical, Dreieich, Germany) have significantly simplified the application of volatile anesthetics in the ICU. However, the personnel's exposure to waste anesthetic gas during daily work is possibly disadvantageous, because there is still uncertainty about potential health risks. The fact that average threshold limit concentrations for isoflurane, sevoflurane and desflurane either differ significantly between countries or are not even defined at all, leads to raising concerns among ICU staff. In this review, benefits, risks, and technical aspects of inhalational sedation in the ICU are discussed. Further, the potential health effects of occupational long-term low-concentration agent exposure, the staffs' exposure levels in clinical practice, and strategies to minimize the individual gas exposure are reviewed.

http://ift.tt/2esHWjy

Current situation in gynecological oncology training in Spain: where we are and where we want to go

Abstract

Background

It is important to know what a young gynecologic oncologist perceives as a need to achieve a good training in gynecologic oncology.

Objective

This study aims to evaluate the level of training in gynecologic oncology in Spain.

Methods

A Web-based anonymous questionnaire was sent via e-mail to Spanish trainees listed in European Network of Young Gynecological Oncology (ENYGO). The survey was developed in four sections: (1) general training in gynecologic oncology, (2) distribution of current clinical activity, (3) surgical training, and (4) perspective future gynecologic oncology. It contained 51 questions, with multiple-choice answers that had to be answered by the ENYGO members.

Results

The questionnaire was sent to 64 people listed in the ENYGO database. Of these, 37 members responded (response rate of 58%). Overall, more training in surgery is necessary, to perform radical oncological surgeries. It is claimed a sub-specialty recognition, to ensure an equalitarian and homogeneous training.

http://ift.tt/2glNyZA

Role of sentinel node in differentiated thyroid cancer: a prospective study comparing patent blue injection technique, lymphoscintigraphy and the combined technique

Abstract

Purpose

The purpose of the present study was to evaluate the feasibility and reproducibility of the sentinel lymph node (SLNs) biopsy in differentiated thyroid cancer using patent blue injection, lymphoscintigraphy and the combined techniques.

Methods

Between January 2011 and January 2013, 82 consecutive patients were enrolled in our prospective multicentre study. Inclusion criteria were 18 years of age, preoperative diagnosis of differentiated thyroid carcinoma, no evidence of lymph node enlargement and multifocal neoplasm. To investigate the benefits of each procedure, all patients underwent total thyroidectomy plus central compartment lymphadenectomy, and in all cases, the SLN was identified via one of three techniques using the same protocol.

Results

Lymphoscintigraphy was used in five patients, patent blue injection was used in 40 patients, and a combined technique was used in 40 patients to identify sentinel lymph nodes (SLN). SLNs were identified in 61 cases. In the patent blue injection technique, the sensitivity, specificity and false negative rates were 88.9, 94.4 and 3.8%, respectively. In the lymphoscintigraphy technique, the percentages of sensitivity and specificity were 100%, and the percentage false negative was 0%. For the combined techniques, the corresponding values were, respectively, 69.2, 90, and 17.4%. Metastases were detected in nine cases of lateral-cervical nodes, ipsilateral tumour metastases were observed in eight cases, and contralateral tumour metastasis was observed in one case.

Conclusion

Additional well-designed randomized studies are needed to validate and further optimize the SLN biopsy in patients with differentiated thyroid cancer.

http://ift.tt/2esHKk7

Tailoring plasmonic properties of metal nanoparticle-embedded dielectric thin films: the sandwich method of preparation

Abstract

Tailoring of plasmonic properties of metal nanoparticle-embedded dielectric thin films are very crucial for many thin film-based applications. We, herein, investigate the various ways of tuning the plasmonic positions of gold nanoparticles (AuNPs)-embedded indium oxide thin films (Au:IO) through a sequence-specific sandwich method. The sandwich method is a four-step process involving deposition of In₂O₃ film by magnetron sputtering in first and fourth steps, thermal evaporation of Au on to In₂O₃ film in second and annealing of Au/In₂O₃ film in the third step. The Au:IO films were characterized by x-ray diffraction, spectrophotometry and transmission electron microscopy. The size and shape of the embedded nanoparticles were found from Rutherford back-scattering spectrometry. Based on dynamic Maxwell Garnett theory, the observed plasmon resonance position was ascribed to the oblate shape of AuNPs formed in sandwich method. Finally, through experimental data, it was shown that the plasmon resonance position of Au:IO thin films can be tuned by ~ 125 nm. The method shown here can be used to tune the plasmon resonance position over the entire range of visible region for the thin films made from other combinations of metal-dielectric pair.

http://ift.tt/2gs0TTO

Termination of nanoscale zero-valent iron reactivity by addition of bromate as a reducing reactivity competitor

Abstract

Remediation of contaminated groundwater by nanoscale zero-valent iron (nZVI) is widely becoming a leading environmentally friendly solution throughout the globe. Since a wide range of various nZVI-containing materials have been developed for effective remediation, it is necessary to determine an appropriate way to terminate the reactivity of any nZVI-containing material for a practical experimental procedure. In this study, bimetallic Ni/Fe-NPs were prepared to enhance overall reduction kinetics owing to the catalytic reactivity of nickel on the surface of nZVI. We have tested several chemical strategies in order to terminate nZVI reactivity without altering the concentration of volatile compounds in the solution. The strategies include surface passivation in alkaline conditions by addition of carbonate, and consumption of nZVI by a reaction competitor. Four halogenated chemicals, trichloroethylene, 1,1,1-trichloroethane, atrazine, and 4-chlorophenol, were selected and tested as model groundwater contaminants. Addition of carbonate to passivate the nZVI surface was not effective for trichloroethylene. Nitrate and then bromate were applied to competitively consume nZVI by their faster reduction kinetics. Bromate proved to be more effective than nitrate, subsequently terminating nZVI reactivity for all four of the tested halogenated compounds. Furthermore, the suggested termination method using bromate was successfully applied to obtain trichloroethylene reduction kinetics. Herein, we report the simple and effective method to terminate the reactivity of nZVI by addition of a reducing reactivity competitor.

http://ift.tt/2eGBUsa

Structural and metabolic changes in the traumatically injured rat brain: high-resolution in vivo proton magnetic resonance spectroscopy at 7 T

Abstract

Purpose

The understanding of microstructural and metabolic changes in the post-traumatic brain injury is the key to brain damage suppression and repair in clinics.

Methods

Ten female Wistar rats were traumatically injured in the brain CA1 region and above the cortex. Next, diffusion tensor magnetic resonance imaging (DTI) and proton magnetic resonance spectroscopy (¹H MRS) were used to analyze the microstructural and metabolic changes in the brain within the following 2 weeks.

Results

Anisotropy fraction (FA) and axial diffusivity (AD) of the corpus callosum (CC) began to decrease significantly at day 1, whereas radial diffusivity (RD) significantly increased immediately after injury, reflecting the loss of white matter integrity. Compared with day 3, RD decreased significantly at day 7, implicating the angioedema reduction. In the hippocampus, FA significantly increased at day 7; the choline-containing compounds (Cho) and myo-inositol (MI) remarkably increased at day 7 compared with those at day 3, indicating the proliferation of astrocytes and radial glial cells after day 7. No significant differences between DTI and ¹H MRS parameters were observed between day 1 and day 3.

Conclusion

Day 1–3 after traumatic brain injury (TBI) may serve as a relatively appropriate time window for treatment planning and the following nerve repair.

http://ift.tt/2vtHCbB

Determination of ochratoxin A in tissues of wild boar ( Sus scrofa L.) by enzymatic digestion (ED) coupled to high-performance liquid chromatography with a fluorescence detector (HPLC-FLD)

Abstract

Ochratoxin A (OTA) is a secondary toxic metabolite synthesized by Aspergillus or Penicillium species, which can contaminate various crops. The International Agency for Research on Cancer (IARC) classified OTA as a group 2B possible human carcinogen. The aim of the present study was to assess OTA concentrations in tissues of wild boar (Sus scrofa L.) from Tuscany (Italy). Over a period of 2 years, samples of muscle, liver, and kidney from 48 wild boars were collected and concentrations of OTA were determined by enzymatic digestion (ED) coupled to high-performance liquid chromatography with a fluorescence detector (HPLC-FLD). The highest concentrations of OTA were found in the kidneys of the 48 wild boars analyzed. No difference in concentrations was found based on years of collection and sex while a significantly higher OTA concentration was found in the kidney of the young wild boars with respect to the adult one. Monitoring the quality of meat destined for transformation is a priority in order to decrease the possibility of toxin carry-over to humans. The present study showed that contamination of wild boar meat products by OTA represents a potential emerging source of OTA.

http://ift.tt/2wL3cbi

Improving Naming Abilities Among Healthy Young-Old Adults Using Transcranial Direct Current Stimulation

Abstract

Transcranial direct current stimulation (tDCS) is a noninvasive tool to facilitate brain plasticity and enhance language abilities. Our study aims to search for a potential beneficial influence of tDCS on a cognitive linguistic task of naming which found to decline during aging. A group of fifteen healthy old adults \((\hbox {M}= 64.93 \pm 5.09\,\hbox {years})\) were tested in naming 50 pictures of objects. Each subject participated in two sessions spanning on a one week period. One session included active tDCS stimulation and the other sham-placebo like stimulation. Subjects were blinded to stimulation type. During the active stimulation a bilateral protocol of anodal tDCS to the left Inferior Frontal Gyrus (IFG) combined with cathodal tDCS to the right IFG was delivered. Half of participants received active stimulation at the first session and sham at the second and half received the stimulations at the opposite order. Naming reaction time was measured at baseline, after active tDCS stimulation and after sham. 10 min of bilateral tDCS stimulation which was given after sham (training) was found to reduce naming reaction time among healthy adult subjects. These findings support the cooperative model (Weems and Reggia in Brain Lang 89:554–568, 2004) and point on strong interhemispheric connections during naming processing. It is also demonstrate the advantage of training to intensify the therapeutic effect of tDCS. Our results pinpoint on a potential tool to facilitate naming among aging people.

http://ift.tt/2xz6Rq8

Adjuvant-Loaded Spiky Gold Nanoparticles for Activation of Innate Immune Cells

Abstract

Introduction

Gold nanoparticles are versatile carriers for delivery of biomacromolecules. Here, we have developed spiky gold nanoparticles (SGNPs) that can efficiently deliver immunostimulatory agents.

Objectives

Our goal was to develop a platform technology for co-delivery of multiple adjuvant molecules for synergistic stimulation and maturation of innate immune cells.

Methods

SGNPs were synthesized by a seed-mediated, surfactant-free synthesis method and incorporated with polyinosinic-polycytidylic acid (pIC) and DNA oligonucleotide containing unmethylated CpG motif (CpG) by an electrostatic layer-by-layer approach. Adjuvant-loaded SGNP nano-complexes were examined for their biophysical and biochemical properties and studied for immune activation using bone marrow-derived dendritic cells (BMDCs).

Results

We have synthesized SGNPs with branched nano-spikes layered with pIC and/or CpG. Adjuvant-loaded SGNP nano-complexes promoted cellular uptake of the adjuvants. Importantly, we achieved spatio-temporal control over co-delivery of pIC and CpG via SGNPs, which produced synergistic enhancement in cytokine release (IL-6, TNF-α) and upregulation of co-stimulatory markers (CD40, CD80, CD86) in BMDCs, compared with pIC, CpG, or their admixtures.

Conclusion

SGNPs serve as a versatile delivery platform that allows flexible and on-demand cargo fabrication for strong activation of innate immune cells.

http://ift.tt/2xyDvbr

Molecular dynamics study on structure stability, lattice variation, and melting behavior of silver nanoparticles

Abstract

Molecular dynamics simulation is used to comparatively investigate the structure stability, lattice variation, and surface energy of Ag nanoparticles. It is revealed that the most stable structure of shapes transformed from an octahedron to a cuboctahedron with the cluster size increasing, and the energetically larger lattice contraction of particles should have higher surface energy. Simulation also shows that the cubic shapes have contributed highly to the lattice contractions of particles, and the lattice constants of octahedral shapes are the nearest to bulk Ag. In addition, a systematic work on the melting behavior of polyhedral shapes is carried out by shape factor, and the surface energy-dependent shape evolution of Ag particles is revealed. The present results agree well with experimental observations in the literature, and provide a deep understanding of the different physical and chemical properties of Ag nanoparticles.

http://ift.tt/2vFyT1R

Pharmacokinetics of Cromolyn and Ibuprofen in Healthy Elderly Volunteers

Abstract

Background and Objectives

The combination of cromolyn and ibuprofen is being investigated as a treatment for early Alzheimer's disease (AD). This study investigated the pharmacokinetics, safety, and tolerability of cromolyn and ibuprofen co-administration in healthy elderly adult volunteers.

Methods

In this open-labeled study, 26 subjects, aged 55–75 years, received co-administration of inhaled cromolyn (single dose 17.1 mg; double dose 34.2 mg total) and oral ibuprofen (single dose 10 mg; double dose 20 mg total). Blood sampling was performed for 6 h after co-administration in all subjects; cerebrospinal fluid (CSF) was collected in three to four subjects per cohort for 4 h following co-administration. Safety parameters, including adverse events (AEs), were monitored throughout the study.

Results

For cromolyn, the mean (±SD) maximum observed concentration (C _max) in plasma was 46.69 ± 32.97 and 96.75 ± 46.22 ng/ml after single- and double-dose inhalation, respectively [time to C _max (t _max) ~22 min for each; terminal elimination half-life (t _½) ~1.8 h for each]. For ibuprofen, the plasma C _max was 1090.98 ± 474.64 ng/ml and 2062.96 ± 655.13 ng/ml after single- and double-dose oral administration, respectively (t _max ~1.6–1.8 h; t _½ ~1.9 h for each). For cromolyn, the CSF C _max was 0.24 ± 0.08 ng/ml at 3.72 ± 0.70 h after single-dose administration and 0.34 ± 0.17 ng/ml at 3.45 ± 0.95 h after double-dose administration, and for ibuprofen, the CSF C _max was 3.94 ± 1.29 ng/ml at 2.55 ± 0.96 h after single-dose administration and 8.93 ± 3.29 ng/ml at 3.15 ± 1.05 h after double-dose administration. Three (12%) subjects reported mild or moderate AEs which were unlikely to be related to study drug.

Conclusions

The combination of cromolyn and ibuprofen was safe and well tolerated. The concentrations of cromolyn and ibuprofen observed in the CSF are considered sufficient to titrate the estimated daily amyloid production and the associated inflammatory response in patients with AD.

http://ift.tt/2wjUgbT

Changes in transcranial motor evoked potentials during hemorrhage are associated with increased serum propofol concentrations

Abstract

Transcranial motor evoked potentials (TcMEPs) monitor the integrity of the spinal cord during spine surgery. Propofol-based anesthesia is favored in order to enhance TcMEP quality. During intraoperative hemorrhage, TcMEP amplitudes may be reduced. The serum concentration of propofol may increase during hemorrhage. No study has determined whether changes in TcMEPs due to hemorrhage are related to changes in propofol blood levels. We monitored TcMEPs, mean arterial pressure (MAP), and cardiac output (CO) and hemoglobin in pigs (n = 6) undergoing controlled progressive hemorrhage during a standardized anesthetic with infusions of propofol, ketamine, and fentanyl. We recorded TcMEPs from the rectus femoris (RF) and tibialis anterior (TA) muscles bilaterally. A pulmonary artery catheter was placed to measure CO. Progressive hemorrhage of 10% blood volume increments was done until TcMEP amplitude decreased by >60% from baseline. Serum propofol levels were also measured following removal of each 10% blood volume increment. TcMEP responses were elicited every 3 min using constant stimulation parameters. We removed between 20 and 50% of total blood volume in order to achieve the >60% reduction in TcMEP amplitude. MAP and CO decreased significantly from baseline. At maximum hemorrhage, TcMEP amplitude decreased in the RF and TA by an average of 73 and 62% respectively from baseline (P < 0.01). Serum propofol levels varied greatly among animals at baseline (range 410–1720 ng/mL) and increased in each animal during hemorrhage. The mean propofol concentration rose from 1190 ± 530 to 2483 ± 968 ng/mL (P < 0.01). The increased propofol concentration correlated with decreased CO. Multivariate analysis using hierarchical linear models indicated that the decline of TcMEP amplitude was primarily associated with rising propofol concentrations, but was also independently affected by reduced CO. We believe that the decrease in blood volume and CO during hemorrhage increased the serum concentration of propofol by reducing the volume of distribution and/or rate of hepatic metabolism of the drug. Despite wide acceptance of propofol as the preferred anesthetic when using TcMEPs, intravenous anesthetics are vulnerable to altered pharmacokinetics during conditions of hemorrhage and could contribute to false-positive TcMEP changes.

http://ift.tt/2iJk9gn

Calcitonin gene-related peptide antagonism and cluster headache: an emerging new treatment

Abstract

Calcitonin gene-related peptide (CGRP) is a key signaling molecule involved in migraine pathophysiology. Efficacy of CGRP monoclonal antibodies and antagonists in migraine treatment has fueled an increasing interest in the prospect of treating cluster headache (CH) with CGRP antagonism. The exact role of CGRP and its mechanism of action in CH have not been fully clarified. A search for original studies and randomized controlled trials (RCTs) published in English was performed in PubMed and in ClinicalTrials.gov. The search term used was "cluster headache and calcitonin gene related peptide" and "primary headaches and calcitonin gene related peptide." Reference lists of identified articles were also searched for additional relevant papers. Human experimental studies have reported elevated plasma CGRP levels during both spontaneous and glyceryl trinitrate-induced cluster attacks. CGRP may play an important role in cluster headache pathophysiology. More refined human studies are warranted with regard to assay validation and using larger sample sizes. The results from RCTs may reveal the therapeutic potential of CGRP monoclonal antibodies and antagonists for cluster headache treatment.

http://ift.tt/2x688qL

Inter-observer agreement among pathologists in grading the pathological response to neoadjuvant chemotherapy in breast cancer

Abstract

Background

The degree of pathological response to neoadjuvant chemotherapy (NAC) was correlated with the prognosis in breast cancer. There are few studies published on inter-observer variability in the assessment of pathological responses among pathologists.

Methods

We collected 64 surgically resected specimens from patients who had received NAC. Three pathologists assessed the pathological responses and classified them into 7 grades according to grading system of the Japanese Breast Cancer Society. The levels of concordance among pathologists were categorized into 3 classes: full concordance (all pathologists gave the same grade), partial concordance (two of them gave the same grade), and discordance (all three gave different grades). The inter-observer agreement among pathologists was estimated using the percentage concordance and Cohen's kappa statistics.

Results

Full concordance, partial concordance, and discordance were seen in 28 (43%), 33 (52%), and 3 (5%) specimens, respectively. In most of partial concordance specimens (30 out of 33), the pathological response grades differed by only one level. The kappa value was 0.59. The concordance rate with regard to pCR was 97%.

Conclusions

Most of the judgments among pathologists differed within one level, but there is room for improving harmonization in the assessment of pathological responses.

http://ift.tt/2wiTA6s

Use of low-dose radioiodine ablation for Graves’ orbitopathy: results of a pilot, perspective study in a small series of patients

Abstract

Objective

Elimination of thyroid antigens by total thyroid ablation (TTA), namely, thyroidectomy followed by radioiodine, may be beneficial for Graves' Orbitopathy (GO). TTA is usually performed with a ¹³¹I dose of 30 mCi. In Italy, this dose must be followed by a 24-h protected hospitalization, with increase in the waiting lists. In contrast, a 15 mCi dose can be given without hospitalization and with lower costs. Here, we investigated whether a lower dose of radioiodine can be used to ablate thyroid remnants in patients with GO, after thyroidectomy.

Methods

The study was performed in two small groups of consecutive thyroidectomized patients (six patients per group) with Graves' hyperthyroidism and GO. Patients underwent ablation with either 15 or 30 mCi of ¹³¹I following treatment with recombinant human TSH (rhTSH). The primary outcome was rhTSH-stimulated serum thyroglobulin (Tg) at 6 months. The secondary outcome was baseline Tg at 6 months.

Results

Baseline Tg and rhTSH-stimulated Tg after at 6 months did not differ between two groups, suggesting a similar extent of ablation. rhTSH-stimulated Tg was reduced significantly compared with rhTSH-stimulated Tg at ablation in both groups. GO outcome following treatment with intravenous glucocorticoids did not differ between the two groups.

Conclusions

Our findings may provide a preliminary basis for the use of a 15 mCi dose of radioiodine upon rhTSH stimulation in thyroidectomized patients with Graves' hyperthyroidism and GO.

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Recurrent and metastatic congenital mesoblastic nephroma: where does the evidence stand?

Abstract

Purpose

Fifty years ago, Bolande described Congenital Mesoblastic Nephroma (CMN) as a benign lesion. Unexpected aggressive clinical behaviors prompted a sub-classification based on histology. Recent molecular genetic evidence has identified the aggressive cellular variant to be the renal manifestation of congenital infantile fibrosarcoma. We submit a reappraisal and analysis of the available literature on recurrent and metastatic CMN.

Methods

An electronic search of PubMed, MEDLINE, EMBASE, and Scopus yielded 38 children with local recurrence and/or metastases.

Results

Of the 38 children with local recurrence and/or metastasis, 59% were girls. Median time to recurrence was 6 months (range 1–12 months). The commonest sites of metastases were the lung (39%) and liver (29%). Fifty percent of these children died of disease. The outcome of additional chemotherapy (p = 0.5) did not differ from that of surgery alone. The choice of chemotherapy did not influence the outcome (p = 0.6).

Conclusions

Recurrence and metastasis in cellular CMN are much more common than described earlier and carry a high mortality. Children with cellular and mixed CMN require close clinical and radiological follow-up for a minimum of 12 months after primary surgery. Surgery is the mainstay of the treatment of recurrent and metastatic lesions. Neoadjuvant chemotherapy is recommended only if the lesion is inoperable. Targeted therapy may be an option in treatment of refractory cases.

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How long will I have my ACE? The natural history of the antegrade continence enema stoma in idiopathic constipation

Abstract

Purpose

We aim to determine the natural history of the ACE in idiopathic constipation and factors predictive of closure.

Methods

A retrospective case-note review of all patients undergo ACE formation for idiopathic constipation Jan 2003–Mar 2016. Kaplan–Meier analysis was used to determine ACE survival and Cox's proportional hazard models to examine potential predictors of closure.

Results

29/84 (35%) ACEs were closed: 21/84 due to success and 8/84 due to failure. Median age of closure was 15.5 years (3.5–23.6). Median ACE survival was 77.0 months (95% CI 58.0–96.0). An ACE survival curve was derived from which we estimate that 5-year post-ACE, one-third of patients can expect to have had their ACE closed. Younger age at ACE was predictive of earlier closure (p = 0.023) and closure for success (p < 0.001). Neither patient sex (p = 0.546) nor presence of psychological comorbidities (p = 0.769) predicted likelihood of closure. Incontinence 6-week post-ACE was also associated with increased likelihood of closure (p = 0.042).

Conclusion

The ACE survival curve estimates the proportion of patients with idiopathic constipation who can expect closure (either due to success or failure) at certain timepoints. This may be useful for patient counseling. Younger age at ACE was associated with earlier closure (for success).

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Effects of capacity limits, memory loss, and sound type in change deafness

Abstract

Change deafness, the inability to notice changes to auditory scenes, has the potential to provide insights about sound perception in busy situations typical of everyday life. We determined the extent to which change deafness to sounds is due to the capacity of processing multiple sounds and the loss of memory for sounds over time. We also determined whether these processing limitations work differently for varying types of sounds within a scene. Auditory scenes composed of naturalistic sounds, spectrally dynamic unrecognizable sounds, tones, and noise rhythms were presented in a change-detection task. On each trial, two scenes were presented that were same or different. We manipulated the number of sounds within each scene to measure memory capacity and the silent interval between scenes to measure memory loss. For all sounds, change detection was worse as scene size increased, demonstrating the importance of capacity limits. Change detection to the natural sounds did not deteriorate much as the interval between scenes increased up to 2,000 ms, but it did deteriorate substantially with longer intervals. For artificial sounds, in contrast, change-detection performance suffered even for very short intervals. The results suggest that change detection is generally limited by capacity, regardless of sound type, but that auditory memory is more enduring for sounds with naturalistic acoustic structures.

http://ift.tt/2x5S0ph

How humans react to changing rewards during visual foraging

Abstract

Much is known about the speed and accuracy of search in single-target search tasks, but less attention has been devoted to understanding search in multiple-target foraging tasks. These tasks raise and answer important questions about how individuals decide to terminate searches in cases in which the number of targets in each display is unknown. Even when asked to find every target, individuals quit before exhaustively searching a display. Because a failure to notice targets can have profound effects (e.g., missing a malignant tumor in an X-ray), it is important to develop strategies that could limit such errors. Here, we explored the impact of different reward patterns on these failures. In the Neutral condition, reward for finding a target was constant over time. In the Increasing condition, reward increased for each successive target in a display, penalizing early departure from a display. In the Decreasing condition, reward decreased for each successive target in a display. The experimental results demonstrate that observers will forage for longer (and find more targets) when the value of successive targets increases (and the opposite when value decreases). The data indicate that observers were learning to utilize knowledge of the reward pattern and to forage optimally over the course of the experiment. Simulation results further revealed that human behavior could be modeled with a variant of Charnov's Marginal Value Theorem (MVT) (Charnov, 1976) that includes roles for reward and learning.

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Elongation of very Long-Chain (>C 24 ) Fatty Acids in Clarias gariepinus : Cloning, Functional Characterization and Tissue Expression of elovl4 Elongases

Abstract

Elongation of very long-chain fatty acid 4 (Elovl4) proteins participate in the biosynthesis of very long-chain (>C₂₄) saturated and polyunsaturated fatty acids (FA). Previous studies have shown that fish possess two different forms of Elovl4, termed Elovl4a and Elovl4b. The present study aimed to characterize both molecularly and functionally two elovl4 cDNA from the African catfish Clarias gariepinus. The results confirmed that C. gariepinus possessed two elovl4-like elongases with high homology to two previously characterized Elovl4 from Danio rerio, and thus they were termed accordingly as Elovl4a and Elovl4b. The C. gariepinus Elovl4a and Elovl4b have open reading frames (ORF) of 945 and 915 base pairs, respectively, encoding putative proteins of 314 and 304 amino acids, respectively. Functional characterization in yeast showed both Elovl4 enzymes have activity towards all the PUFA substrates assayed (18:4n-3, 18:3n-6, 20:5n-3, 20:4n-6, 22:5n-3, 22:4n-6 and 22:6n-3), producing elongated products of up to C₃₆. Moreover, the C. gariepinus Elovl4a and Elovl4b were able to elongate very long-chain saturated FA (VLC-SFA) as denoted by increased levels of 28:0 and longer FA in yeast transformed with elovl4 ORF compared to control yeast. These results confirmed that C. gariepinus Elovl4 play important roles in the biosynthesis of very long-chain FA. Tissue distribution analysis of elovl4 mRNAs showed both genes were widely expressed in all tissues analyzed, with high expression of elovl4a in pituitary and brain, whereas female gonad and pituitary had the highest expression levels for elovl4b.

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Applying Optimization Algorithms to Tuberculosis Antibiotic Treatment Regimens

Abstract

Introduction

Tuberculosis (TB), one of the most common infectious diseases, requires treatment with multiple antibiotics taken over at least 6 months. This long treatment often results in poor patient-adherence, which can lead to the emergence of multi-drug resistant TB. New antibiotic treatment strategies are sorely needed. New antibiotics are being developed or repurposed to treat TB, but as there are numerous potential antibiotics, dosing sizes and potential schedules, the regimen design space for new treatments is too large to search exhaustively. Here we propose a method that combines an agent-based multi-scale model capturing TB granuloma formation with algorithms for mathematical optimization to identify optimal TB treatment regimens.

Methods

We define two different single-antibiotic treatments to compare the efficiency and accuracy in predicting optimal treatment regimens of two optimization algorithms: genetic algorithms (GA) and surrogate-assisted optimization through radial basis function (RBF) networks. We also illustrate the use of RBF networks to optimize double-antibiotic treatments.

Results

We found that while GAs can locate optimal treatment regimens more accurately, RBF networks provide a more practical strategy to TB treatment optimization with fewer simulations, and successfully estimated optimal double-antibiotic treatment regimens.

Conclusions

Our results indicate surrogate-assisted optimization can locate optimal TB treatment regimens from a larger set of antibiotics, doses and schedules, and could be applied to solve optimization problems in other areas of research using systems biology approaches. Our findings have important implications for the treatment of diseases like TB that have lengthy protocols or for any disease that requires multiple drugs.

http://ift.tt/2wiZ7tY

The Automated Assessment of Postural Stability: Balance Detection Algorithm

Abstract

Impaired balance is a common indicator of mild traumatic brain injury, concussion and musculoskeletal injury. Given the clinical relevance of such injuries, especially in military settings, it is paramount to develop more accurate and reliable on-field evaluation tools. This work presents the design and implementation of the automated assessment of postural stability (AAPS) system, for on-field evaluations following concussion. The AAPS is a computer system, based on inexpensive off-the-shelf components and custom software, that aims to automatically and reliably evaluate balance deficits, by replicating a known on-field clinical test, namely, the Balance Error Scoring System (BESS). The AAPS main innovation is its balance error detection algorithm that has been designed to acquire data from a Microsoft Kinect^® sensor and convert them into clinically-relevant BESS scores, using the same detection criteria defined by the original BESS test. In order to assess the AAPS balance evaluation capability, a total of 15 healthy subjects (7 male, 8 female) were required to perform the BESS test, while simultaneously being tracked by a Kinect 2.0 sensor and a professional-grade motion capture system (Qualisys AB, Gothenburg, Sweden). High definition videos with BESS trials were scored off-line by three experienced observers for reference scores. AAPS performance was assessed by comparing the AAPS automated scores to those derived by three experienced observers. Our results show that the AAPS error detection algorithm presented here can accurately and precisely detect balance deficits with performance levels that are comparable to those of experienced medical personnel. Specifically, agreement levels between the AAPS algorithm and the human average BESS scores ranging between 87.9% (single-leg on foam) and 99.8% (double-leg on firm ground) were detected. Moreover, statistically significant differences in balance scores were not detected by an ANOVA test with alpha equal to 0.05. Despite some level of disagreement between human and AAPS-generated scores, the use of an automated system yields important advantages over currently available human-based alternatives. These results underscore the value of using the AAPS, that can be quickly deployed in the field and/or in outdoor settings with minimal set-up time. Finally, the AAPS can record multiple error types and their time course with extremely high temporal resolution. These features are not achievable by humans, who cannot keep track of multiple balance errors with such a high resolution. Together, these results suggest that computerized BESS calculation may provide more accurate and consistent measures of balance than those derived from human experts.

http://ift.tt/2wJqpuk

Population growth rate of dry bulb mite, Aceria tulipae (Acariformes: Eriophyidae), on agriculturally important plants and implications for its taxonomic status

Abstract

Dry bulb mite (DBM), Aceria tulipae, is an economically important mite with a worldwide distribution and a broad host range. As a generalist, it is the most important eriophyoid mite attacking bulbous plants such as garlic, onion and tulip. To date, DBM has been recorded on host plants belonging to the families Liliaceae, Amaryllidaceae, Melanthiaceae and Asparagaceae. However, a precise understanding of DBM host range is lacking as it is largely based on casual records of mites on plants, some of which may include accidental hosts. Moreover, the possible existence of cryptic species has not been considered. In this study the hypothesis that DBM may be a complex of distinct genetic lineages or cryptic species was tested by comparing the common barcode sequence marker mtDNA COI of specimens from several populations originating from the Netherlands and Poland. The population growth rate of DBM on seven agriculturally important plant species and on various parts of the garlic plant was also experimentally assessed in the laboratory. The results did not support the first hypothesis, and indicated that DBM populations originating from Poland and the Netherlands shared essentially the same genome. In addition, they indicated that DBM reached the highest population growth rate on leek and also displayed high growth rates on garlic, chive and red onion, whereas white onion and wheat were not colonized by the mites. Answering the question of whether DBM is a single polyphagous species rather than a complex of cryptic lineages is of particular importance since the misidentification of pests may lead to ineffective control strategies. Moreover, improved knowledge of DBM host range is essential for assessing risk to crops.

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Combination of measures of handgrip strength and red cell distribution width can predict in-hospital complications better than the ASA grade after hip fracture surgery in the elderly

Abstract

Background

Early detection of a high-risk patient following hip fracture surgery is of paramount clinical importance. American Society of Anesthesiologists (ASA) grading is an easy and efficient index in predicting a worse outcome. The red cell distribution width (RDW) and handgrip strength, are gaining interest as a prediction tool as well. Accordingly, the objective of this study was to investigate the potential association between ASA, RDW and grip strength and detect the effects of combining RDW and grip strength for predicting early complication after hip fracture surgery in the elderly.

Methods

Eighty-three consecutive patients operated with hip fracture surgeries were identified retrospectively. Age, gender, diagnosis, RDW, handgrip strength and ASA grade were recorded. Admission to the intensive care unit (ICU), length of ICU stay, transfer to other departments, in-hospital death, and readmission were investigated as early complications. Logistic regression analysis was applied to evaluate the estimates in predicting complications, and receiver operating characteristics curves were constructed to compare the estimates and decide which method is more accurate.

Results

After the surgery, 52% of the patients were admitted to the ICU. From the analyses, RDW and grip strength had no significant relation with each other. However, the ICU stay was correlated with RDW and grip strength but not for the ASA grade. A higher ASA grade and grip strength could independently predict ICU admission. The combination of RDW with grip strength outweighed the ASA grade in predictive ability.

Conclusions

The current study indicated that combining RDW and grip strength measures can be efficient and clinically relevant in predicting early postoperative complications after fragility hip fracture in the elderly. Due to the objectivity and availability of those two approaches, patient care, and functional outcomes are expected to be improved by adopting these measures in the clinical setting.

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Fibroma of tendon sheath around large joints: clinical characteristics and literature review

Abstract

Background

Fibroma of tendon sheath (FTS) is a benign tumor arising from the synovium of the tendon sheath that occurs mostly around small joints such as the fingers, hands, and wrist. However, FTS rarely arises around a large joint (knee, shoulder, elbow, and ankle) with intra-articular or extra-articular involvement. The clinical characteristics of FTS arising around a large joint are unclear. An additional 3 cases of FTS arising around a large joint are presented. Furthermore, the published cases and the present cases are reviewed with respect to their clinical characteristics and imaging and histopathology findings.

Methods

The 43 reported cases including the present 3 patients were summarized, and the patients' profiles, symptoms, sites and locations in the joint involved by FTS, magnetic resonance imaging (MRI) findings, surgical procedures, clinical courses, and cytogenetic analyses were reviewed.

Results

The average age of 26 cases was 40.9 years (range 13–69 years), and about 60% of the patients were male. About 10% of the patients had a past history of trauma to the knee joint. Of the present 3 cases, one case was extra-articular around the elbow joint, one case was extra-articular around the knee joint, and one case was intra-articular involving the knee joint. The common symptoms were pain (62.5%), swelling or palpable mass (54.2%), and limited range of motion of the involved joint (50%). The most commonly involved joint was the knee, with 32 cases (74.4%), followed by the elbow in 5 cases (11.6%), ankle in 4 (9.3%), and shoulder in 2 (4.7%). The tumor typically exhibited iso to low signal intensity on T1-weighted MRI. T2-weighted images showed various patterns, but mostly low signal intensity relative to muscle. The surgical margin was marginal resection in all cases. There were no recurrences after surgery. On chromosomal analysis, only the present Case 3 showed an abnormality.

Conclusions

A total of 43 FTS cases that occurred around large joints were summarized. The most common site was around the knee joint. In FTS cases around large joints, it is necessary to distinguish between various fibroblastic and/or fibrohistiocytic tumors.

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Biochemical and histological alterations induced by the smoke of allethrin based mosquito coil on mice model

Abstract

Background

Mosquito coil (MC) emits insecticide upon burning which provides limited protection against lethal mosquito borne diseases. However, apart from killing the insect, toxicities associated with the inhalation of these insecticides poses severe health hazards. However, the use of MC is increasing day by day in third world countries in particular but, yet to receive enough attention of both policy maker and general public. The current study was aimed to assess the MC smoke induced damage of pulmonary and hepatic tissues along with observing the alterations of several blood biochemical parameters in mice model.

Methods

A total of twenty four Swiss albino mice were allowed to inhale the smoke of allethrin based MC at different duration per day for 120 days. By the end of treatment period, blood sample was drawn from each mouse and blood biochemical parameters including alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen(BUN), serum total protein, cholesterol, low density lipoprotein (LDL) and triglyceride (TG) were analyzed. Intact lung and liver were collected for histological analysis using standard protocol.

Results

Biochemical study indicates elevated activity of two hepatic enzymes: ALT (89%), AST (85%), in comparison with the respective control. Increased level of some parameters of lipid profile including cholesterol (36%), LDL (48%) and triglyceride (30%) in smoke inhaled mice is the new finding of this study. On the contrary, the activity of serum total protein and BUN was decreased by 20% and 24%, respectively in inhaled mice. Pulmonary tissue of treated mice shows severe forms of emphysema and hyperplasia, especially in the peripheral region of lung, which is the hallmark of chronic obstructive pulmonary disease (COPD). Histological study of hepatic tissue shows apoptosis mediated damage of hepatocytes along with severe form of necrosis. Infiltration of Inflammatory cells was also observed in both of the organs.

Conclusion

Results from the present studies suggest that chronic exposure of allethrin based MC is responsible factor for severe health complications such as COPD due to the alterations of the key biochemical parameters of blood and histo-organization of lung and liver.

http://ift.tt/2vso0Eu

Automatic detection of new tumors and tumor burden evaluation in longitudinal liver CT scan studies

Abstract

Purpose

Radiological longitudinal follow-up of liver tumors in CT scans is the standard of care for disease progression assessment and for liver tumor therapy. Finding new tumors in the follow-up scan is essential to determine malignancy, to evaluate the total tumor burden, and to determine treatment efficacy. Since new tumors are typically small, they may be missed by examining radiologists.

Methods

We describe a new method for the automatic detection and segmentation of new tumors in longitudinal liver CT studies and for liver tumors burden quantification. Its inputs are the baseline and follow-up CT scans, the baseline tumors delineation, and a tumor appearance prior model. Its outputs are the new tumors segmentations in the follow-up scan, the tumor burden quantification in both scans, and the tumor burden change. Our method is the first comprehensive method that is explicitly designed to find new liver tumors. It integrates information from the scans, the baseline known tumors delineations, and a tumor appearance prior model in the form of a global convolutional neural network classifier. Unlike other deep learning-based methods, it does not require large tagged training sets.

Results

Our experimental results on 246 tumors, of which 97 were new tumors, from 37 longitudinal liver CT studies with radiologist approved ground-truth segmentations, yields a true positive new tumors detection rate of 86 versus 72% with stand-alone detection, and a tumor burden volume overlap error of 16%.

Conclusions

New tumors detection and tumor burden volumetry are important for diagnosis and treatment. Our new method enables a simplified radiologist-friendly workflow that is potentially more accurate and reliable than the existing one by automatically and accurately following known tumors and detecting new tumors in the follow-up scan.

http://ift.tt/2x4RLLf

Risk of depression, anxiety, and adjustment disorders in women with a suspected but unconfirmed diagnosis of breast or genital organ cancer in Germany

Abstract

Background

Breast cancer (BC) and genital organ cancers (GOC) are known to have a major impact on the quality of life of patients. The aim of this study was to analyze the risk of depression, anxiety, and adjustment disorders in women in Germany with a suspected but unconfirmed diagnosis of BC or GOC in their medical history.

Methods

This study included women who received a suspected diagnosis of BC or GOC and were followed between 2007 and 2015 (index date). These women were matched (1:1:1) by age to women with a confirmed diagnosis of BC or GOC and women without a cancer diagnosis. The main outcome measure of the study was the rate of depression, anxiety, and adjustment disorder diagnoses within 3 years of the index date.

Results

The present analysis included a total of 4,842 patients (mean age = 49.3 years). Within 3 years of the index date, 23.5% of women with a confirmed diagnosis of BC or GOC, 14.1% of those with a suspected diagnosis of BC or GOC, and 10.5% of those without a cancer diagnosis developed depression, anxiety, or an adjustment disorder (log-rank p value <0.001). Women with a suspected diagnosis of cancer were at a higher risk for these psychiatric conditions than those without a cancer diagnosis (BC and GOC: HR 1.32; BC: HR 1.21; GOC: HR 1.50).

Conclusion

A suspected diagnosis of BC or GOC in a woman's medical history is associated with an increased risk of developing depression, anxiety, and adjustment disorders.

http://ift.tt/2gozQJg

Long-term results of Birmingham hip resurfacing arthroplasty in Asian patients

Abstract

Several reports have shown good long-term results with the Birmingham hip resurfacing (BHR) arthroplasty, but little is known about the results in Asian countries where there is a high prevalence of osteonecrosis and developmental dysplasia of the hip, and many females with small femoral head sizes. Therefore, we retrospectively evaluated the long-term clinical results of the BHR in 112 Japanese patients (53 males and 59 females—130 hips) with an average age of 52 years. Implant survivorship was analyzed using the Kaplan–Meier method with the endpoint being revision for any reason. Factors such as sex, femoral component size, and type of hip disease were analyzed as predictors of implant survivorship. With a median follow-up of 12 years, six cases were revised (two for femoral component aseptic loosening, two for infection, one for cup aseptic loosening, and one for femoral neck fracture), and the overall survival rate was 96.5% (95% CI 90.9–98.7) at 10 years and 93.6% (95% CI 83.4–97.7) at 15 years. When septic revisions were excluded, the implant survival rate was 98.2% (95% CI 92.9–99.6) at 10 years and 95.3% (95% CI 83.9–98.7) at 15 years. Sex, femoral component size, and type of hip disease were not predictors of implant survivorship. In conclusion, good clinical results were obtained with the BHR at 10- and 15-year follow-up in Japanese patients who have different stature and types of hip diseases as compared with patients in Western countries.

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