Phase 1 and pharmacokinetic study of LY3007113, a p38 MAPK inhibitor, in patients with advanced cancer

Summary

Background The signaling protein p38 mitogen-activated protein kinase (MAPK) regulates the tumor cell microenvironment, modulating cell survival, migration, and invasion. This phase 1 study evaluated the safety of p38 MAPK inhibitor LY3007113 in patients with advanced cancer to establish a recommended phase 2 dose. Methods In part A (dose escalation), LY3007113 was administered orally every 12 h (Q12H) at doses ranging from 20 mg to 200 mg daily on a 28-day cycle until the maximum tolerated dose (MTD) was reached. In part B (dose confirmation), patients received MTD. Safety, pharmacokinetics, pharmacodynamics, and tumor response data were evaluated. Results MTD was 30 mg Q12H. The most frequent treatment-related adverse events (>10%) were tremor, rash, stomatitis, increased blood creatine phosphokinase, and fatigue. Grade ≥ 3 treatment-related adverse events included upper gastrointestinal haemorrhage and increased hepatic enzyme, both occurring at 40 mg Q12H and considered dose-limiting toxicities. LY3007113 exhibited an approximately dose-proportional increase in exposure and time-independent pharmacokinetics after repeated dosing. Maximal inhibition (80%) of primary biomarker MAPK-activated protein kinase 2 in peripheral blood mononuclear cells was not reached, and sustained minimal inhibition (60%) was not maintained for 6 h after dosing to achieve a biologically effective dose (BED). The best overall response in part B was stable disease in 3 of 27 patients. Conclusions The recommended phase 2 dosage of LY3007113 was 30 mg Q12H. Three patients continued treatment after the first radiographic assessment, and the BED was not achieved. Further clinical development of this compound is not planned as toxicity precluded achieving a biologically effective dose.

http://ift.tt/2zUu1w8

Proximal total splenic artery embolization for refractory hepatic encephalopathy

Abstract

A Japanese woman with a history of Kasai operation for biliary atresia had living-donor liver transplantation at the age of 22. The first episode of refractory HE and late cellular rejection was treated by a high dose of methylprednisolone. The second episode of refractory HE was treated by balloon-occluded retrograde transvenous obliteration for a spleno-renal shunt. However, the third episode of refractory HE occurred 11 years after liver transplantation. The liver cirrhosis and hypersplenism were present with a Child–Pugh score of C-10. Although portal vein flow was hepatopetal, superior mesenteric vein flow regurgitated. We performed proximal total splenic artery embolization (TSAE). Superior mesenteric vein flow changed to a hepatopetal direction and she became clear. At a year after proximal TSAE, her spleen volume had decreased to 589 mL (20% decrease) on computed tomography. She is well and has a Child–Pugh score of 8 without overt HE. We report the first case of refractory HE treated by proximal TSAE that is a possible less invasive treatment option for a selected patient.

http://ift.tt/2zSb2lL

Simple linear brainstem MRI measurements in the differential diagnosis of progressive supranuclear palsy from the parkinsonian variant of multiple system atrophy

Abstract

Differential diagnosis of progressive supranuclear palsy (PSP) and the parkinsonian variant of multiple system atrophy (MSA-P) from Parkinson's disease (PD) can be difficult, particularly in atypical cases or early in the disease course. The Magnetic Resonance Parkinsonism Index (MRPI) utilizes linear and surface (planimetry) measurements and has been proposed as a dual MRI biomarker, with high values indicative of PSP and low values of MSA. The aim of this study was to examine the utility of simple linear MRI brainstem measurements, without the use of MRI planimetry, in the diagnosis of patients with Parkinsonism and compare them to the MRPI. A total of 51 patients (PSP: 24, MSA-P: 9, PD: 18) and 15 healthy controls were included. Simple linear MRI distances of brainstem structures were measured. These included midbrain and pons diameters as well as superior cerebellar peduncle (SCP) and middle cerebellar peduncle (MCP) widths. All relevant indices, including ratios and products, were also calculated. The SCP by midbrain product (SCP × midbrain) provided improved sensitivity (100 vs. 91%) and identical specificity (98%) for the diagnosis of PSP, compared to the MRPI. Neither the MRPI nor any of the linear measurements were able to discriminate MSA-P from PD. The SCP by midbrain product is a novel, potent MRI biomarker for PSP.

http://ift.tt/2ANWF1K

Simple linear brainstem MRI measurements in the differential diagnosis of progressive supranuclear palsy from the parkinsonian variant of multiple system atrophy

Abstract

Differential diagnosis of progressive supranuclear palsy (PSP) and the parkinsonian variant of multiple system atrophy (MSA-P) from Parkinson's disease (PD) can be difficult, particularly in atypical cases or early in the disease course. The Magnetic Resonance Parkinsonism Index (MRPI) utilizes linear and surface (planimetry) measurements and has been proposed as a dual MRI biomarker, with high values indicative of PSP and low values of MSA. The aim of this study was to examine the utility of simple linear MRI brainstem measurements, without the use of MRI planimetry, in the diagnosis of patients with Parkinsonism and compare them to the MRPI. A total of 51 patients (PSP: 24, MSA-P: 9, PD: 18) and 15 healthy controls were included. Simple linear MRI distances of brainstem structures were measured. These included midbrain and pons diameters as well as superior cerebellar peduncle (SCP) and middle cerebellar peduncle (MCP) widths. All relevant indices, including ratios and products, were also calculated. The SCP by midbrain product (SCP × midbrain) provided improved sensitivity (100 vs. 91%) and identical specificity (98%) for the diagnosis of PSP, compared to the MRPI. Neither the MRPI nor any of the linear measurements were able to discriminate MSA-P from PD. The SCP by midbrain product is a novel, potent MRI biomarker for PSP.

http://ift.tt/2ANWF1K

The interrelation of osteoarthritis and diabetes mellitus: considering the potential role of interleukin-10 and in vitro models for further analysis

Abstract

Introduction

Today, not only the existence of an interrelation between obesity/adipositas and osteoarthritis (OA) but also the association of OA and diabetes mellitus (DM) are widely recognized. Nevertheless, shared influence factors facilitating OA development in DM patients still remain speculative up until now. To supplement the analysis of clinical data, appropriate in vitro models could help to identify shared pathogenetic pathways. Informative in vitro studies could later be complemented by in vivo data obtained from suitable animal models.

Materials and methods

Therefore, this detailed review of available literature was undertaken to discuss and compare the results of currently published in vitro studies focusing on the interrelation between OA, the metabolic syndrome and DM and to propose models to further study the molecular pathways.

Results

The survey of literature presented here supports the hypothesis that the pathogenesis of OA in DM is based on imbalanced molecular pathways with a putative crucial role of antiinflammatory cytokines such as IL-10.

Conclusion

Future development of versatile micro-scaled in vitro models such as combining DM and OA on chip could allow the identification of common pathogenetic pathways and might help to develop novel therapeutic strategies.

http://ift.tt/2kfCFON

Tackling heterogeneous concept drift with the Self-Adjusting Memory (SAM)

Abstract

Data mining in non-stationary data streams is particularly relevant in the context of Internet of Things and Big Data. Its challenges arise from fundamentally different drift types violating assumptions of data independence or stationarity. Available methods often struggle with certain forms of drift or require unavailable a priori task knowledge. We propose the Self-Adjusting Memory (SAM) model for the k-nearest-neighbor (kNN) algorithm. SAM-kNN can deal with heterogeneous concept drift, i.e., different drift types and rates, using biologically inspired memory models and their coordination. Its basic idea is to have dedicated models for current and former concepts used according to the demands of the given situation. It can be easily applied in practice without meta parameter optimization. We conduct an extensive evaluation on various benchmarks, consisting of artificial streams with known drift characteristics and real-world datasets. We explicitly add new benchmarks enabling a precise performance analysis on multiple types of drift. Highly competitive results throughout all experiments underline the robustness of SAM-kNN as well as its capability to handle heterogeneous concept drift. Knowledge about drift characteristics in streaming data is not only crucial for a precise algorithm evaluation, but it also facilitates the choice of an appropriate algorithm on real-world applications. Therefore, we additionally propose two tests, able to determine the type and strength of drift. We extract the drift characteristics of all utilized datasets and use it for our analysis of the SAM in relation to other methods.

http://ift.tt/2kdwSJA

The effectiveness of vibrational stimulus to accelerate orthodontic tooth movement: a systematic review

Abstract

Background

In recent years, it has been a hot research topic to accelerate orthodontic tooth movement (OTM) through vibration. This review was therefore aimed to systematically evaluate the available evidences on the efficacy of vibrational stimulus to accelerate OTM.

Methods

Randomized controlled trials and controlled clinical trials that evaluated the efficacy of vibration on OTM acceleration were searched through electronic and manual search. Two review authors independently conducted the study inclusion, quality assessment and data extraction. The quality of synthesized evidence was assessed according to GRADE system.

Results

Eight clinical trials were included in this systematic review. Four studies found that vibration did not enhance the rate of OTM during alignment phase. Two studies revealed that the use of vibratory stimulation accelerated canine retraction. No deleterious effects including pain perceptions and root resorptions were reported.

Conclusions

Within the limitations of this review, weak evidence indicates that vibrational stimulus is effective for accelerating canine retraction but not for alignment. The effects of vibration on pain intensity and root resorption during orthodontic treatment are inconclusive. Future high-quality clinical trials are needed before warranting recommendations to clinical application.

http://ift.tt/2i3G8vj

Evidence of the efficacy and safety of house dust mite subcutaneous immunotherapy in elderly allergic rhinitis patients: a randomized, double-blind placebo-controlled trial

Allergen specific immunotherapy (AIT) in elderly patients is controversial, and there is still little evidence supporting the safety and efficacy of this treatment in this population. The study objective was t...

http://ift.tt/2nhyy5P

Endosymbiont CLS-HI plays a role in reproduction and development of Haemaphysalis longicornis

Abstract

Coxiella-like endosymbiont (CLS-Hl) is a primary endosymbiont of Haemaphysalis longicornis. CLS-Hl infects tick special tissues and its prevalence is 100% in ovaries and Malpighian tubules. Tetracycline was injected into females, which then fed on rabbits also treated with tetracycline. The densities of CLS-Hl were measured by semi-quantitative PCR. CLS-Hl densities in ovaries and Malpighian tubes of H. longicornis had significant effects on engorged weight, feeding time, number of eggs, oviposition period, and hatching period. These findings suggested that CLS-Hl plays a role in the reproduction and development of H. longicornis.

http://ift.tt/2j64dCF

3.0T MRI for long-term observation of lung nodules post cryoablation: a pilot study

Abstract

Background

The purpose of this study was to use serial magnetic resonance imaging (MRI) examinations to observe changes in malignant lung tumors over time post-cryoablation.

Methods

The study protocol was approved by Institutional Review Board, and written informed consent was obtained from each participant in accordance with the Declaration of Helsinki. Patients with primary or metastatic lung tumors eligible for cryoablation were included in this prospective study. Cryoablation was performed according to standard procedures. Unenhanced and dynamic contrast-enhanced MRI scans were performed pre-cryoablation and at 1 day, 1 week, and 3-, 6-, and 12 months after cryoablation. At each time point, the signal intensity of the ablated zone on both T₁WI and T₂WI images, and volume and characteristics of the ablation zone were examined, and changes over time analyzed.

Results

A total of 26 nodules in 23 patients were included in the study. The mean patient age was 53.7 ± 13.6 years, and 57.7% were males. Ablation zone volume increased to 1 week after the procedure, and then returned to baseline by 3 months. Cavitation post-cryoablation was found in 34.6% (9/26) of the nodules 1 month after treatment. Two types of time-signal intensity curves post-cryoablation were found: a straight line representing no definite enhancement from 1-day to 1-month, and an inflow curve representing mild delayed enhancement from month 3 to month 12. Local progression was associated with an incomplete hypointense rim around the ablation zone and absence of cavitation post-treatment.

Conclusions

Characteristic changes are present on MRI after cryoablation of lung tumors. A complete hypointense rim and cavitation may be signs of adequate treatment and that local tumor progression is less likely.

http://ift.tt/2i7zcgO

Report on the 2nd European Tissue Repair Society summer school, Brussels, Sept 11–12th, 2017

http://ift.tt/2Aw5ZXu

Scientific Abstracts 8th Phoenix Fetal Cardiology Symposium October 27–31, 2017

http://ift.tt/2iw1NQX

Acute Pulmonary Vasodilator Testing and Long-Term Clinical Course in Segmental Pulmonary Vascular Disease

Abstract

Results of acute pulmonary vasodilator testing (AVT) and the outcome of medical therapy have not been described in patients with segmental pulmonary vascular disease (SPVD). We sought to compare the pulmonary vasodilatory effects of oxygen, oxygen with nitric oxide, and diltiazem, and to describe the clinical course of patients with SPVD and pulmonary hypertension. A retrospective review of 16 patients with pulmonary hypertension and SPVD involving 2–3 major lung segments who underwent AVT between January 2000 and December 2015 was performed. Baseline hemodynamic measurements were obtained with patients breathing ≤ 30% oxygen. AVT was performed using 100% oxygen, 100% oxygen with 20 ppm nitric oxide, 21–35% oxygen, and 21–35% oxygen with intravenous diltiazem. The events associated with their long-term care were described. Nine of 16 patients were acutely responsive during AVT using the Sitbon criteria. The change in mean pulmonary artery pressure with oxygen or oxygen with nitric oxide (19 ± 12 mmHg) was significantly greater than the change with diltiazem (7 ± 5 mmHg). Pulmonary vasodilator therapy was initiated or escalated after AVT in 12 patients. Five patients subsequently experienced a decrease in mean pulmonary artery pressure or normalization in B-type natriuretic peptide. Three patients experienced adverse events associated with therapy. The actuarial survival was 94% over a period of 1–20 years. This study suggests that AVT can be used to identify patients with SPVD who are reactive to oxygen, oxygen with nitric oxide, and diltiazem. Clinical improvement was temporally associated with pulmonary vasodilator therapy in some patients with few adverse effects.

http://ift.tt/2AvEf5q

Specific Energy Requirements in Electrokinetic Remediation

Abstract

Understanding the scaling-up process is essential for the application of the electrokinetic remediation at field scale, as the technique is site-specific and dependent on the target contaminants. In this paper, a generalized and easy-to-use model is presented for the prediction of the energy requirements at different scales. The mathematical model includes the definition of a specific energy parameter for each mobilized metal, obtained from the relationship between the amount of metal mobilized and the maximum that can be mobilized. The results indicate that the specific energy requirements for the removal of each target contaminant can be predicted as the process is scaled-up.

http://ift.tt/2iyHPVr

Capillary Hysteresis in Neutrally Wettable Fibrous Media: A Pore Network Study of a Fuel Cell Electrode

Abstract

Hysteresis in the saturation versus capillary pressure curves of neutrally wettable fibrous media was simulated with a random pore network model using a Voronoi diagram approach. The network was calibrated to fit experimental air-water capillary pressure data collected for carbon fibre paper commonly used as a gas diffusion layer in fuel cells. These materials exhibit unusually strong capillary hysteresis, to the extent that water injection and withdrawal occur at positive and negative capillary pressures, respectively. Without the need to invoke contact angle hysteresis, this capillary behaviour is re-produced when using a pore-scale model based on the curvature of a meniscus passing through the centre of a toroid. The classic Washburn relation was shown to produce erroneous results, and its use is not recommended when modelling fibrous media. The important effect of saturation distribution on the effective diffusivity of the medium was also investigated for both water injection and withdrawal cases. The findings have bearing on the understanding of both capillarity in fibrous media and fuel cell design.

http://ift.tt/2AsaClD

Management of horizontal duodenal perforation: a report of three cases and review of literature

Abstract

Background

Perforation of the horizontal duodenum is very rare due to the presence in retroperitoneal space. It depicts an unusual clinical picture and is difficult to diagnose, leading to increased morbidity and mortality. The treatment strategies are usually varied and based on small series of cases, literature reviews, and expert opinions.

Case presentation

Here, we presented three cases of horizontal duodenal perforation in three different clinical processes. The first case, a 30-year-old male patient, presented with abdominal pain and hematemesis after experiencing a physical assault on the previous day. Computed tomography (CT) scan showed rupture of the horizontal duodenum. It was repaired by side-to-side duodenojejunostomy. Postoperatively, he had anastomotic leakage, disseminated intravascular coagulation, and pulmonary failure and recovered after a long hospital stay. The second case, an 81-year-old female, had duodenal perforation with endoscopic coagulation of the bleeding diverticulum. Segmental resection of the duodenum and side-to-side duodenojejunostomy were performed. Postoperatively, there was slight anastomotic leakage, but surgical intervention was not needed. The third case, an 89-year-old female, was a patient with obstructive jaundice due to pancreas head carcinoma, who developed perforation of the horizontal duodenum during endoscopic retrograde cholangiopancreatography (ERCP). After unsuccessful conservative management, duodenojejunostomy at the perforated site and gastric bypass were performed. The postoperative course was uneventful.

Conclusion

Early suspicion and investigation is necessary for cases of abdominal injuries. CT scan is the investigation of choice. The management options should be based on the clinical condition of the patient, comorbidities, surgical expertise, existing guidelines, and available resources.

http://ift.tt/2AmuzYq

Prognostic Implication of Inflammation-based Prognostic Scores in Patients with Intrahepatic Cholangiocarcinoma Treated with First-line Gemcitabine plus Cisplatin

Summary

Background We aimed to comprehensively evaluate the prognostic value of inflammation-based prognostic scores, including the modified Glasgow Prognostic Score (mGPS), neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR), exclusively in patients with advanced intrahepatic cholangiocarcinoma (iCCA). Methods Between May 2010 and April 2015, 305 patients with histologically documented unresectable or metastatic iCCA were treated with first-line gemcitabine plus cisplatin (GemCis). Among these, 257 patients had complete data for inflammation-based prognostic scores and were included. Results Median age was 59 (range: 27–78) years, and 158 patients (61.5%) were males. High mGPS was independently associated with poor progression-free survival (PFS; mGPS ≥1 vs. 0: median, 3.9 vs. 5.5 months; P = 0.001) and overall survival (OS; mGPS ≥1 vs. 0; median, 6.9 vs. 14.1 months; P = 0.002) in the multivariate analysis. Regarding high NLR (> median) and PLR (> median), although a potential association existed with poor PFS or OS in the univariate analysis, these did not remain as significant in the multivariate analyses. Conclusion The current study suggests that mGPS might be the relevant prognostic index that could stratify the survival outcomes of patients with unresectable or metastatic iCCA who received first-line GemCis.

http://ift.tt/2i6NgHv

Preservative-Free Prostaglandin Analogs and Prostaglandin/Timolol Fixed Combinations in the Treatment of Glaucoma: Efficacy, Safety and Potential Advantages

Abstract

Glaucoma therapy-related ocular surface disease (OSD) is a serious pathology with a broad spectrum of insidious clinical presentations and complex pathogenesis that undermines long-term glaucoma care. Preservatives, especially benzalkonium chloride (BAK), contained in topical intraocular pressure-lowering medications frequently cause or aggravate OSD in glaucoma. Management of these patients is challenging, and to date often empirical due to the scarcity of controlled long-term clinical trials. Most of the available data are extracted from case series and retrospective analysis. Preservative-free prostaglandins and prostaglandin/timolol fixed combinations are novel options developed to remove the harmful impact of preservatives, especially BAK, upon ocular tissues. Based on what is currently known on the value of preservative-free antiglaucoma therapies it is tempting to speculate how these new therapies may affect the future medical management of all glaucoma patients. This article provides a comprehensive and critical review of the current literature on preservative-free prostaglandins and preservative-free prostaglandin/timolol fixed combinations.

http://ift.tt/2zDQCso

Prognostic Implication of Inflammation-based Prognostic Scores in Patients with Intrahepatic Cholangiocarcinoma Treated with First-line Gemcitabine plus Cisplatin

Summary

Background We aimed to comprehensively evaluate the prognostic value of inflammation-based prognostic scores, including the modified Glasgow Prognostic Score (mGPS), neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR), exclusively in patients with advanced intrahepatic cholangiocarcinoma (iCCA). Methods Between May 2010 and April 2015, 305 patients with histologically documented unresectable or metastatic iCCA were treated with first-line gemcitabine plus cisplatin (GemCis). Among these, 257 patients had complete data for inflammation-based prognostic scores and were included. Results Median age was 59 (range: 27–78) years, and 158 patients (61.5%) were males. High mGPS was independently associated with poor progression-free survival (PFS; mGPS ≥1 vs. 0: median, 3.9 vs. 5.5 months; P = 0.001) and overall survival (OS; mGPS ≥1 vs. 0; median, 6.9 vs. 14.1 months; P = 0.002) in the multivariate analysis. Regarding high NLR (> median) and PLR (> median), although a potential association existed with poor PFS or OS in the univariate analysis, these did not remain as significant in the multivariate analyses. Conclusion The current study suggests that mGPS might be the relevant prognostic index that could stratify the survival outcomes of patients with unresectable or metastatic iCCA who received first-line GemCis.

http://ift.tt/2i6NgHv

Liver Function Tests “Gone Viral”: Acute Hepatitis of Uncertain Cause

http://ift.tt/2jz089F

Paradoxic eczema in infants after heart transplantation

Abstract

New-onset psoriasis in patients receiving tumor necrosis factor inhibitors is well recognized in children and adults. We describe three children who underwent cardiac transplantation and developed an analogous form of paradoxic eczema occurring 2-48 months after starting systemic tacrolimus, a drug widely used topically to treat eczema. Anecdotal reports and our experience suggest that tacrolimus taper with alternative systemic antirejection immunosuppressant may lead to skin clearance. Pending additional insight, treatment should include optimizing skin barrier function, minimizing microbial and allergic triggers, and coordinating care to choose the best-tolerated systemic immunosuppressant regimen at the lowest effective dose.

http://ift.tt/2AuxOj3

COMT genotype and non-recovery after a whiplash injury in a Northern European population

Abstract

Background

The COMT (Catechol-O-Methyl Transferase) gene may influence a person's vulnerability to develop long-term pain and some COMT single nucleotide polymorphisms (SNPs) may associate with patterns of acute or chronic pain. Many patients with whiplash-associated disorders (WADs) suffer from long-term pain and other related symptoms, but it is less known if genetic factors play a role in the recovery process. The primary aim of this study was to evaluate whether self-reported non-recovery, including pain, was related to COMT genotype in patients with WAD. The secondary aim was to investigate whether or not background factors, including mental health, were related to genotype and non-recovery.

Methods

A total of 133 patients with neck pain after a whiplash trauma were included. Background factors were collected and blood samples were taken during the acute phase after the accident. DNA was isolated from blood and used to genotype the SNPs rs6269, rs4633, rs4818 and rs4680 in the COMT gene; additionally haplotypes were estimated and haplogenotypes inferred. The patients were followed up after 12 months and asked to rate their recovery including pain, mental health and quality of life.

Results

The overall reported non-recovery rate at 12 months was 44% with no significant differences in distribution of the COMT haplotypes. High levels of self-reported pain (OR 7.2) and anxiety (OR 4.4) after the accident were associated with non-recovery, but not related to the haplotypes. None of the other background factors were related to the haplotypes or non-recovery.

Conclusion

No association between self-reported non-recovery or pain levels and COMT haplotypes in patients with acute whiplash injuries could be detected. Independent replications are necessary to discard the hypothesis that COMT haplotypes do not influence non-recovery or pain levels in patients with acute whiplash injuries. High levels of initial pain and anxiety were associated with non-recovery, thereby confirming previously published reports.

http://ift.tt/2AtxwZV

Single versus double row suture anchor fixation for greater tuberosity fractures – a biomechanical study

Abstract

Background

Fractures of the humeral greater tuberosity (GT) are a frequent injury progressively treated with arthroscopic suture anchor repair. Yet, no biomechanical study has been performed comparing fixation strength of arthroscopic single- (SR) vs. double row (DR) fixation.

Methods

Standardized fractures of the greater tuberosity were created in 12 fresh frozen proximal humeri. After random assignation to the SR or DR group the fixed humeri were tested applying cyclic loading to the supraspinatus and infraspinatus tendon. Load to failure and fragment displacement were assessed by means of an electrodynamic material testing machine using an optical tracking system.

Results

Load to failure values were higher in the DR group (649 N; ±176) than in the SR group (490 N; ±145) however without statistical significance (p = .12). In greater tuberosity displacement of 3–5 mm surgical treatment is recommended. The fixing constructs in this study did not reach displacement landmarks of 3 or 5 mm before construct failure as shown in previous studies. Thus the applied traction force (N) at 1 mm displacement was analyzed. In the SR group the load at 1 mm displacement was 277 N; ±46 compared to 260 N; ±62 in the DR group (p = .65).

Conclusion

The results suggest that both techniques are viable options for refixation of greater tuberosity fractures.

Level of Evidence: Laboratory study.

http://ift.tt/2itdg3t

Diaphragm and Intercostal Muscle Activity after Mid-Cervical Spinal Cord Contusion in the Rat

Journal of Neurotrauma , Vol. 0, No. 0.


http://ift.tt/2zUMB7a

Diaphragm and Intercostal Muscle Activity after Mid-Cervical Spinal Cord Contusion in the Rat

Journal of Neurotrauma , Vol. 0, No. 0.


http://ift.tt/2zUMB7a

Editorial Board

Publication date: December 2017
Source:Dental Materials, Volume 33, Issue 12





http://ift.tt/2ivh6Ji

Detection of Bacteria Colonizing Titanium Spinal Implants in Children

Surgical Infections , Vol. 0, No. 0.


http://ift.tt/2j5yjX3

Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study

Abstract

Background

The benefits of physical activity in persons with Multiple Sclerosis (MS) are considerable. Knowledge about factors that correlate to physical activity is helpful in order to develop successful strategies to increase physical activity in persons with MS. Previous studies have focused on correlates to physical activity in MS, however falls self-efficacy, social support and enjoyment of physical activity are not much studied, as well as if the correlates differ with regard to disease severity. The aim of the study was to examine associations between physical activity and age, gender, employment, having children living at home, education, disease type, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, social support and enjoyment of physical activity in a sample of persons with MS and in subgroups with regard to disease severity.

Methods

This is a cross-sectional survey study including Swedish community living adults with MS, 287 persons, response rate 58.2%. The survey included standardized self-reported scales measuring physical activity, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, and social support. Physical activity was measured by the Physical Activity Disability Survey – Revised.

Results

Multiple regression analyzes showed that 59% (F(6,3) = 64.9, p = 0.000) of the variation in physical activity was explained by having less severe disease (β = −0.30), being employed (β = 0.26), having high falls self-efficacy (β = 0.20), having high self-efficacy for physical activity (β = 0.17), and enjoying physical activity (β = 0.11). In persons with moderate/severe MS, self-efficacy for physical activity explained physical activity.

Conclusions

Consistent with previous research in persons with MS in other countries this study shows that disease severity, employment and self-efficacy for physical activity are important for physical activity. Additional important factors were falls self-efficacy and enjoyment. More research is needed to confirm this and the subgroup differences.

http://ift.tt/2Bq5cEB

Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study

Abstract

Background

The benefits of physical activity in persons with Multiple Sclerosis (MS) are considerable. Knowledge about factors that correlate to physical activity is helpful in order to develop successful strategies to increase physical activity in persons with MS. Previous studies have focused on correlates to physical activity in MS, however falls self-efficacy, social support and enjoyment of physical activity are not much studied, as well as if the correlates differ with regard to disease severity. The aim of the study was to examine associations between physical activity and age, gender, employment, having children living at home, education, disease type, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, social support and enjoyment of physical activity in a sample of persons with MS and in subgroups with regard to disease severity.

Methods

This is a cross-sectional survey study including Swedish community living adults with MS, 287 persons, response rate 58.2%. The survey included standardized self-reported scales measuring physical activity, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, and social support. Physical activity was measured by the Physical Activity Disability Survey – Revised.

Results

Multiple regression analyzes showed that 59% (F(6,3) = 64.9, p = 0.000) of the variation in physical activity was explained by having less severe disease (β = −0.30), being employed (β = 0.26), having high falls self-efficacy (β = 0.20), having high self-efficacy for physical activity (β = 0.17), and enjoying physical activity (β = 0.11). In persons with moderate/severe MS, self-efficacy for physical activity explained physical activity.

Conclusions

Consistent with previous research in persons with MS in other countries this study shows that disease severity, employment and self-efficacy for physical activity are important for physical activity. Additional important factors were falls self-efficacy and enjoyment. More research is needed to confirm this and the subgroup differences.

http://ift.tt/2Bq5cEB

Lymphographic-Like Technique for the Treatment of Microcystic Lymphatic Malformation Components of <3 mm [HEAD & NECK]

BACKGROUND AND PURPOSE:

The treatment of microcystic lymphatic malformations remains challenging. Our aim was to describe the lymphographic-like technique, a new technique of slow bleomycin infusion for the treatment of microcyst components of <3 mm, performed at our institution.

MATERIALS AND METHODS:

A retrospective analysis of a prospectively collected lymphatic malformation data base was performed. Patients with at least 1 microcystic lymphatic malformation component demonstrated on MR imaging treated by lymphographic-like technique bleomycin infusion were included in the study. Patient interviews and MR imaging were performed to assess subjective and objective (microcystic lymphatic malformation size decrease of >30%) clinical improvement, respectively. Patients were reviewed 3 months after each sclerotherapy session. Lymphographic-like technique safety and efficacy were assessed.

RESULTS:

Between January 2012 and July 2016, sixteen patients (5 males, 11 females; mean age, 15 years; range, 1–47 years) underwent the bleomycin lymphographic-like technique for microcystic lymphatic malformations. Sixty sclerotherapy sessions were performed, with a mean of 4 sessions per patient (range, 1–8 sessions) and a mean follow-up of 26 months (range, 5–58 months). We observed no major and 3 minor complications: 1 eyelid infection, 1 case of severe postprocedural nausea and vomiting, and 1 case of skin discoloration. One patient was lost to follow-up. Overall MR imaging objective improvement was observed in 5/16 (31%) patients; overall improvement of clinical symptoms was obtained in 93% of treated patients.

CONCLUSIONS:

The bleomycin lymphographic-like technique for microcystic lymphatic malformations is safe and feasible with objective improvement in about one-third of patients. MR signal intensity changes after the lymphographic-like technique are associated with subjective improvement of the patient's symptoms.

http://ift.tt/2AlRvaf

CT Attenuation Analysis of Carotid Intraplaque Hemorrhage [EXTRACRANIAL VASCULAR]

BACKGROUND AND PURPOSE:

Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation to identify features that allow for confirming or ruling out the intraplaque hemorrhage.

MATERIALS AND METHODS:

This retrospective study included 91 patients (67 men; median age, 65 ± 7 years; age range, 41–83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013. Histopathologic analysis was performed for the tissue characterization and identification of intraplaque hemorrhage. Two observers assessed the plaque's attenuation values by using an ROI (≥ 1 and ≤2 mm²). Receiver operating characteristic curve, Mann-Whitney, and Wilcoxon analyses were performed.

RESULTS:

A total of 169 slices were assessed (59 intraplaque hemorrhage, 63 lipid-rich necrotic core, and 47 fibrous); the average values of the intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue were 17.475 Hounsfield units (HU) and 18.407 HU, 39.476 HU and 48.048 HU, and 91.66 HU and 93.128 HU, respectively, before and after the administration of contrast medium. The Mann-Whitney test showed a statistically significant difference of HU values both in basal and after the administration of contrast material phase. Receiver operating characteristic analysis showed a statistical association between intraplaque hemorrhage and low HU values, and a threshold of 25 HU demonstrated the presence of intraplaque hemorrhage with a sensitivity and specificity of 93.22% and 92.73%, respectively. The Wilcoxon test showed that the attenuation of the plaque before and after administration of contrast material is different (intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue had P values of .006, .0001, and .018, respectively).

CONCLUSIONS:

The results of this preliminary study suggest that CT can be used to identify the presence of intraplaque hemorrhage according to the attenuation. A threshold of 25 HU in the volume acquired after the administration of contrast medium is associated with an optimal sensitivity and specificity. Special care should be given to the correct identification of the ROI.

http://ift.tt/2AhcCN8

John Nash and the Organization of Stroke Care [PRACTICE PERSPECTIVES]

SUMMARY:

The concept of Nash equilibrium, developed by John Forbes Nash Jr, states that an equilibrium in noncooperative games is reached when each player takes the best action for himself or herself, taking into account the actions of the other players. We apply this concept to the provision of endovascular thrombectomy in the treatment of acute ischemic stroke and suggest that collaboration among hospitals in a health care jurisdiction could result in practices such as shared call pools for neurointervention teams, leading to better patient care through streamlined systems.

http://ift.tt/2AnLaek

Influences for Gender Disparity in Academic Neuroradiology [ACADEMIC PERSPECTIVES]

BACKGROUND AND PURPOSE:

There has been extensive interest in promoting gender equality within radiology, a predominately male field. In this study, our aim was to quantify gender representation in neuroradiology faculty rankings and determine any related factors that may contribute to any such disparity.

MATERIALS AND METHODS:

We evaluated the academic and administrative faculty members of neuroradiology divisions for all on-line listed programs in the US and Canada. After excluding programs that did not fulfill our selection criteria, we generated a short list of 85 US and 8 Canadian programs. We found 465 faculty members who met the inclusion criteria for our study. We used Elsevier's SCOPUS for gathering the data pertaining to the publications, H-index, citations, and tenure of the productivity of each faculty member.

RESULTS:

Gender disparity was insignificant when analyzing academic ranks. There are more men working in neuroimaging relative to women (² = 0.46; P = .79). However, gender disparity was highly significant for leadership positions in neuroradiology (² = 6.76; P = .009). The median H-index was higher among male faculty members (17.5) versus female faculty members (9). Female faculty members have odds of 0.84 compared with male faculty members of having a higher H-index, adjusting for publications, citations, academic ranks, leadership ranks, and interaction between gender and publications and gender and citations (9).

CONCLUSIONS:

Neuroradiology faculty members follow the same male predominance seen in many other specialties of medicine. In this study, issues such as mentoring, role models, opportunities to engage in leadership/research activities, funding opportunities, and mindfulness regarding research productivity are explored.

http://ift.tt/2AifhWA

Reproducibility of Deep Gray Matter Atrophy Rate Measurement in a Large Multicenter Dataset [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Precise in vivo measurement of deep GM volume change is a highly demanded prerequisite for an adequate evaluation of disease progression and new treatments. However, quantitative data on the reproducibility of deep GM structure volumetry are not yet available. In this paper we aim to investigate this reproducibility using a large multicenter dataset.

MATERIALS AND METHODS:

We have assessed the reproducibility of 2 automated segmentation software packages (FreeSurfer and the FMRIB Integrated Registration and Segmentation Tool) by quantifying the volume changes of deep GM structures by using back-to-back MR imaging scans from the Alzheimer Disease Neuroimaging Initiative's multicenter dataset. Five hundred sixty-two subjects with scans at baseline and 1 year were included. Reproducibility was investigated in the bilateral caudate nucleus, putamen, amygdala, globus pallidus, and thalamus by carrying out descriptives as well as multilevel and variance component analysis.

RESULTS:

Median absolute back-to-back differences varied between GM structures, ranging from 59.6–156.4 μL for volume change, and 1.26%–8.63% for percentage volume change. FreeSurfer had a better performance for the outcome of longitudinal volume change for the bilateral amygdala, putamen, left caudate nucleus (P < .005), and right thalamus (P < .001). For longitudinal percentage volume change, Freesurfer performed better for the left amygdala, bilateral caudate nucleus, and left putamen (P < .001). Smaller limits of agreement were found for FreeSurfer for both outcomes for all GM structures except the globus pallidus. Our results showed that back-to-back differences in 1-year percentage volume change were approximately 1.5–3.5 times larger than the mean measured 1-year volume change of those structures.

CONCLUSIONS:

Longitudinal deep GM atrophy measures should be interpreted with caution. Furthermore, deep GM atrophy measurement techniques require substantially improved reproducibility, specifically when aiming for personalized medicine.

http://ift.tt/2AmbYM9

Alphabet Soup: Sagittal Balance Correction Osteotomies of the Spine--What Radiologists Should Know [REVIEW ARTICLE]

SUMMARY:

Global sagittal malalignment has been demonstrated to have correlation with clinical symptoms and is a key component to be restored in adult spinal deformity. In this article, various types of sagittal balance-correction osteotomies are reviewed primarily on the basis of the 3 most commonly used procedures: Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection. Familiarity with the expected imaging appearance and commonly encountered complications seen on postoperative imaging studies following correction osteotomies is crucial for accurate image interpretation.

http://ift.tt/2AivOKd

Time for a Time Window Extension: Insights from Late Presenters in the ESCAPE Trial [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

The safety and efficacy of endovascular therapy for large-artery stroke in the extended time window is not yet well-established. We performed a subgroup analysis on subjects enrolled within an extended time window in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial.

MATERIALS AND METHODS:

Fifty-nine of 315 subjects (33 in the intervention group and 26 in the control group) were randomized in the ESCAPE trial between 5.5 and 12 hours after last seen healthy (likely to have groin puncture administered 6 hours after that). Treatment effect sizes for all relevant outcomes (90-day mRS shift, mRS 0–2, mRS 0–1, and 24-hour NIHSS scores and intracerebral hemorrhage) were reported using unadjusted and adjusted analyses.

RESULTS:

There was no evidence of treatment heterogeneity between subjects in the early and late windows. Treatment effect favoring intervention was seen across all clinical outcomes in the extended time window (absolute risk difference of 19.3% for mRS 0–2 at 90 days). There were more asymptomatic intracerebral hemorrhage events within the intervention arm (48.5% versus 11.5%, P = .004) but no difference in symptomatic intracerebral hemorrhage.

CONCLUSIONS:

Patients with an extended time window could potentially benefit from endovascular treatment. Ongoing randomized controlled trials using imaging to identify late presenters with favorable brain physiology will help cement the paradigm of using time windows to select the population for acute imaging and imaging to select individual patients for therapy.

http://ift.tt/2AlRp2n

MR Imaging Characteristics Associate with Tumor-Associated Macrophages in Glioblastoma and Provide an Improved Signature for Survival Prognostication [ADULT BRAIN]

BACKGROUND AND PURPOSE:

In glioblastoma, tumor-associated macrophages have tumor-promoting properties. This study determined whether routine MR imaging features could predict molecular subtypes of glioblastoma that differ in the content of tumor-associated macrophages.

MATERIALS AND METHODS:

Seven internally derived MR imaging features were assessed in 180 patients, and 25 features from the Visually AcceSAble Rembrandt Images feature set were assessed in 164 patients. Glioblastomas were divided into subtypes based on the telomere maintenance mechanism: alternative lengthening of telomeres positive (ALT+) and negative (ALT–) and the content of tumor-associated macrophages (with [M+] or without [M–] a high content of macrophages). The 3 most frequent subtypes (ALT+/M–, ALT–/M+, and ALT–/M–) were correlated with MR imaging features and clinical parameters. The fourth group (ALT+/M+) did not have enough cases for correlation with MR imaging features.

RESULTS:

Tumors with a regular margin and those lacking a fungating margin, an expansive T1/FLAIR ratio, and reduced ependymal extension were more frequent in the subgroup of ALT+/M– (P < .05). Radiologic necrosis, lack of cystic component (by both criteria), and extensive peritumoral edema were more frequent in ALT–/M+ tumors (P < .05). Multivariate testing with a Cox regression analysis found the cystic imaging feature was additive to tumor subtype, and O6-methylguanine methyltransferase (MGMT) status to predict improved patient survival (P < .05).

CONCLUSIONS:

Glioblastomas with tumor-associated macrophages are associated with routine MR imaging features consistent with these tumors being more aggressive. Inclusion of cystic change with molecular subtypes and MGMT status provided a better estimate of survival.

http://ift.tt/2AkxaEx

A pilot study with early adolescents: dealing with diet, tobacco and air pollution using practical experiences and biological markers

Abstract

Background

Tobacco use and the Western diet are two of the most important and investigated topics in relation to adolescents' health. In addition, air pollution is a crucial subject for future generations. School is a key social environment that should promote healthy behaviors in children and adolescents. In this field many different programs have been conducted, with mixed results and effectiveness. Research data suggest that comprehensive and multicomponent approaches may have a greater effect on tobacco use and diet, especially when integrated into a community-wide approach.

Methods

The present work describes a multi-area pilot study called "La Scuola della Salute" (the School of Health) with a focus on the methodological aspects of the intervention. In our study we assessed different web-based and practical experiences related to adolescents' smoking and dietary behaviors and awareness of smoke-related air pollution. Furthermore, to make adolescents more conscious of smoking and dietary behaviors, we conducted experiential workshops that addressed smoking and environmental pollution, food education, and lifestyle. Teachers and school administrators were involved in the project.

Results

At baseline we investigated dietary habits, tobacco use, and individual and social characteristics by means of lifestyle questionnaires. In addition, we collected anthropometric parameters and performance indicators such as exhaled carbon monoxide and urinary fructose to assess smoking and nutrition habits. At the end of the intervention lifestyle questionnaire and biological markers were collected again: knowledge about these topics was significantly improved, and the urinary fructose was able to estimate the levels of obesity in the classes.

Conclusions

The integrated approach, combined with the use of biological markers, could be an innovative approach to the promotion of healthy lifestyles among adolescents, but further research is needed.

http://ift.tt/2jAsr7q

Efficacy of Rebamipide in Organic and Functional Dyspepsia: A Systematic Review and Meta-Analysis

Abstract

Objective

The role of gastritis in dyspepsia remains controversial. We aimed to examine the efficacy of rebamipide, a gastric mucosal protective agent, in both organic and functional dyspepsia.

Design

A systematic review and meta-analysis was performed. The following databases were searched using the keywords ("rebamipide" OR "gastroprotective agent*" OR "mucosta") AND ("dyspepsia" OR "indigestion" OR "gastrointestinal symptoms"): PubMed, Wed of Science, Embase, CINAHL, Cochrane Clinical Trials Register. The primary outcome was dyspepsia or upper GI symptom score improvement. Pooled analysis of the main outcome data were presented as risk ratio (RR) for dichotomous data and standardized mean difference (SMD) for continuous data.

Results

From an initial 248 records, 17 randomised controlled trial (RCT) publications involving 2170 subjects (1224 rebamipide, 946 placebo/control) were included in the final analysis. Twelve RCTs were conducted in subjects with organic dyspepsia (peptic ulcer disease, reflux esophagitis or NSAID-induced gastropathy) and five RCTs were conducted in patients with functional dyspepsia (FD). Overall, dyspepsia symptom improvement was significantly better with rebamipide compared to placebo/control drug (RR 0.77, 95% CI = 0.64–0.93; SMD −0.46, 95% CI = −0.83 to −0.09). Significant symptom improvement was observed both in pooled RR and SMD in subjects with organic dyspepsia (RR 0.72, 95% CI = 0.61–0.86; SMD −0.23, 95% CI = −0.4 to −0.07), while symptom improvement in FD was observed in pooled SMD but not RR (SMD −0.62, 95% CI = −1.16 to −0.08; RR 1.01, 95% CI = 0.71–1.45).

Conclusion

Rebamipide is effective in organic dyspepsia and may improve symptoms in functional dyspepsia.

http://ift.tt/2isXZzA

Impact of Bacterial Translocation on Hepatopulmonary Syndrome: A Prospective Observational Study

Abstract

Background/Aims

Hepatopulmonary syndrome (HPS) is characterized by a defect in oxygenation induced by pulmonary vascular dilatation in cirrhosis. While severe HPS is responsible for a high rate of mortality, the prevalence and pathophysiology of HPS are not fully elucidated. We evaluated the prevalence and pathophysiology of HPS in patients with cirrhosis.

Methods

A total of 142 patients with cirrhosis who underwent saline-agitated contrast echocardiography were enrolled in this prospective observational study. HPS was defined by positive findings on contrast echocardiography, cirrhosis, and the presence of an oxygenation defect (alveolar–arterial oxygen gradient > 15 mmHg). HPS grades from 0 to 3 were assigned based on the density and spatial distribution of microbubbles in the left ventricle. The primary endpoint was the prevalence of HPS. The secondary endpoints included clinical characteristics and levels of lipopolysaccharide (LPS), LPS-binding protein (LBP), nitric oxide, and endothelin-1 in HPS.

Results

Fifty-nine patients (41.5%) were diagnosed with HPS (grade 1: 24, grade 2: 23, and grade 3: 12 patients). The mean levels of LPS (0.36 ± 0.02, 1.02 ± 0.18, 2.86 ± 0.77, and 6.56 ± 1.46 EU/mL, p < 0.001) and LBP (7026 ± 3336, 11,445 ± 1247, 11,947 ± 1164, and 13,791 ± 2032 ng/mL, p = 0.045) were found to be increased according to HPS grade (negative, grade 1–3). Endothelin-1 levels were significantly elevated according to HPS grade (1.83 ± 0.17, 2.62 ± 0.22, 3.69 ± 0.28, and 4.29 ± 0.34 pg/mL, p < 0.001), demonstrating a significant difference between each grade (p < 0.05).

Conclusions

HPS is a common complication with a prevalence of 41.5% in patients with cirrhosis. Bacterial translocation and portal pulmonary vascular dilatation are key mechanism involved in the progression of HPS.

http://ift.tt/2AvitPu

Effect of Intraoral Mechanical Cleaning Techniques on Bond Strength of Cast Crowns to Metal Cores

Abstract

Purpose

To evaluate the effect of cleaning of metal cores from provisional cement, using an intraoral airborne-particle abrasion method, on the bond strength of permanent resin cement with cast crowns to cores.

Materials and Methods

Thirty stainless steel models of a standard complete crown tooth preparation were fabricated. Thirty Type III gold crowns were fabricated. Each cast crown corresponded to one stainless steel crown preparation model. All crowns were cemented with noneugenol zinc oxide cement and stored for 7 days at 37°C. All crowns were debonded, and the cement was cleaned with airborne-particle abrasion using 50 μm aluminum oxide at 4.1 bar (0.41 MPa) followed by ultrasonic cleaning. Based on the mechanical cleaning technique of the remaining provisional cement on surfaces of cast cores, specimens were equally divided into 3 groups: hand cleaning (HC) with a dental excavator, hand cleaning followed by polishing using a brush and pumice (BP), and hand cleaning followed by intraoral airborne-particle abrasion (APA). All crowns were then cemented to their corresponding cores using universal resin cement. All crowns were stored for 7 days at 37°C. An Instron universal testing machine was used to record the bond strength of crowns.

Results

Airborne-particle abrasion method for intraoral mechanical cleaning revealed a statistically significantly higher bond strength compared to the other two methods.

Conclusions

When comparing the three methods of provisional cement cleaning from metal cores, airborne-particle abrasion resulted in the highest bond strength for cast crowns.

http://ift.tt/2j5FSg6

A Digital Approach to Retrofitting a Post and Core Restoration to an Existing Crown

Abstract

One problem that may arise in full-coverage restorations is clinical crown fracture. Fracture of an endodontically treated and crowned tooth in the esthetic zone may be embarrassing to both the patient and clinician. If a completely sound margin and at least 2 mm of coronal structure remain, a fractured tooth may possibly be retreated by a repair. Several methods have been introduced to reproduce the original contour of the tooth for retrofitting an existing crown. If an existing crown is used as a template, excessive core material may remain over the margin, as loading the proper amount of core material is difficult, and making vent holes on the existing crown is not feasible. This article presents a repair technique to reuse an existing crown with computer-aided design and computer-aided manufacturing (CAD/CAM) technology. By using a milled poly(methylmethacrylate) matrix, the mentioned limitations are eliminated, and the original contour of the tooth can be effectively restored with minimal intervention. As an existing crown is reused, the issues of additional time and cost for repreparation, reimpression, and new crown are eliminated.

http://ift.tt/2Bnu5AL

Marginal and Internal Fit of CAD/CAM Crowns Fabricated Over Reverse Tapered Preparations

Abstract

Purpose

Intraoral digital scanning can accurately record single abutment tooth preparations despite their geometry, and the algorithms of the CAD software can be set to manage different abutment forms. The purpose of this in vitro study was to evaluate the marginal and internal fit of CAD/CAM zirconia crowns fabricated over conventional and reverse-tapered preparations.

Materials and Methods

Crown preparations with known total occlusal convergence (TOC) angles (–8°, –4°, 0°, 8°, 12°, 16°, and 22°) were digitally created from a maxillary left central incisor and printed in acrylic resin. Next, casts were scanned with a TRIOS intraoral scanner, and crowns were designed with KaVo multiCAD software using default parameters (50 μm cement space) on abutments with positive TOC angles, whereas reverse-tapered abutments (negative TOC angles) were digitally blocked out at 0° and had an extra mesiodistal gap set to 50 μm. Then, zirconia crowns were fabricated, and their marginal and internal discrepancies were recorded with the silicone replica technique. All replicas were examined under a stereomicroscope at 50× magnification. Collected data were analyzed with one-way ANOVA and post hoc Tukey test for marginal fit. For the axial and incisal fit, measured values did not follow a normal distribution; therefore, the Kruskal-Wallis and the Dunn/Bonferroni multiple comparison tests were applied (p = 0.05).

Results

The mean marginal fit of –8° crowns (58.2 ± 6.0 μm) was statistically different (p < 0.0001) from all the remaining crowns (range 42.1-47.3 μm). Also, the internal fit was statistically significant when comparing crowns fabricated over abutments with positive and negative TOC angles (p < 0.0001). The largest median axial discrepancies were found in the –8° (165.5 μm) and –4° (130.8 μm) groups; however, when evaluating the incisal fit, they showed the smallest discrepancies (67.3 and 81.8 μm, respectively).

Conclusions

Under the conditions of this study, the marginal and internal fit of zirconia crowns fabricated over inverse-tapered preparations is within clinically accepted values.

http://ift.tt/2j6paNL

A population-level study examining discontinuation of statins in older people with dementia

http://ift.tt/2zDqlL0

Modeling and Evaluating the Performance of River Sediment on Immobilizing Arsenic from Hydrothermally Altered Rock in Laboratory Column Experiments with Hydrus-1D

Abstract

Large volumes of excavated rock are produced as a result of road and railway tunnel construction in Hokkaido, Japan. Due to the geological condition of this region, these rocks have often undergone hydrothermal alterations, causing them to contain elevated amounts of hazardous elements including arsenic (As). Therefore, these excavated rocks are potentially hazardous waste, and proper disposal methods are required. In this article, performance of unsaturated river sediment on immobilizing As from hydrothermally altered rock is evaluated using laboratory column experiments and Hydrus-1D. The results reveal that the river sediment significantly reduces As migration. Arsenic retarded by river sediment was observed in three patterns. The first was an adsorption onto minerals originally contained in the river sediment. The next pattern was a combination of reduction of As generation by oxidation of As bearing-minerals, irreversible adsorption, and adsorption onto newly precipitated Fe oxy-hydroxide/oxide. The last pattern led to a further depletion of As leached from the rock layer due to a shift in the majority of the As generation mechanism from dissolution to oxidation in combination with a low concentration of oxygen in the rock layer. These patterns were satisfactorily evaluated by a Hydrus-1D model with reversible and irreversible adsorptions. The information from this work is effective in designing and establishing a reasonable technique for the disposal of hydrothermally altered rocks.

http://ift.tt/2iv60E9

Multimodal molecular 3D imaging for the tumoral volumetric distribution assessment of folate-based biosensors

Abstract

The aim of this study was to characterize the in vivo volumetric distribution of three folate-based biosensors by different imaging modalities (X-ray, fluorescence, Cerenkov luminescence, and radioisotopic imaging) through the development of a tridimensional image reconstruction algorithm. The preclinical and multimodal Xtreme imaging system, with a Multimodal Animal Rotation System (MARS), was used to acquire bidimensional images, which were processed to obtain the tridimensional reconstruction. Images of mice at different times (biosensor distribution) were simultaneously obtained from the four imaging modalities. The filtered back projection and inverse Radon transformation were used as main image-processing techniques. The algorithm developed in Matlab was able to calculate the volumetric profiles of ^99mTc-Folate-Bombesin (radioisotopic image), ¹⁷⁷Lu-Folate-Bombesin (Cerenkov image), and FolateRSense™ 680 (fluorescence image) in tumors and kidneys of mice, and no significant differences were detected in the volumetric quantifications among measurement techniques. The imaging tridimensional reconstruction algorithm can be easily extrapolated to different 2D acquisition-type images. This characteristic flexibility of the algorithm developed in this study is a remarkable advantage in comparison to similar reconstruction methods.

http://ift.tt/2Aw02tE

Clinical, morphologic, and demographic characteristics of bipartite patella in patients referred to Iranian academic clinics

Abstract

In a descriptive cross-sectional study, we evaluated clinical, morphologic, and demographic characteristics of bipartite patella (BP) in 20 patients referred to clinics affiliated to Iran University of Medical Sciences from 2011 to 2015. Simple radiography, computerized topography scanning, and magnetic resonance imaging characteristics of BP plus demographic data include age, gender, co-morbidities, and side of involvement were recorded. Male to female ratio was 17:3 (5.6) with total mean age of 39.1 ± 13.4 years. Sixteen patients (80%) had unilateral involvement, and among them right- and left-side involvements were seen in 11 and 5 patients, respectively. The BP position included superolateral (8 patients, 40%), lateral (5 patients, 25%), and inferomedial (7 patients, 35%). Knee pain, joint stiffness, and decrease the motion range were seen in 13 (65%), 7 (35%), and 11 (55%) patients, respectively. Chondromalacia (7 patients, 35%) and bone marrow edema (7 patients, 35%) were the most common co-morbidities. The mean diameter of the cartilage that covered the segment in right and left sides were 8.92 ± 3.63 and 9.01 ± 2.22 mm, respectively (P > 0.05). The right and left sides distance of segment to patella were 2.50 ± 0.86 and 3.17 ± 1.45 mm, respectively (P > 0.05). No significant associations were detected between age, gender, decrease the motion range, pain, and joint stiffness with sides of involvement (P > 0.05). Just patients with bone marrow edema had significant higher diameter of cartilage that covered the segment in comparison to patients without bone marrow edema (P = 0.010). In summary, higher percentage of male, existence of pain, and decrease the motion range plus superolateral position of the bipartite segment were noticeable which must be considered in the future research.

http://ift.tt/2AMykJX

Effects of Transcranial Direct Current Stimulation of Rat Cerebral Structures on Pentylenetetrazole-Induced Seizures

In rats with a kindling syndrome induced by injections of pentylenetetrazole (PTZ, 30.0 mg/kg, i.p., for three weeks), the latent periods of seizures induced by test doses of PTZ (30 mg/kg) were, on average, 37.5% greater than those in the control (P < 0.05) after transcranial direct current stimulation (TDCS, 600 μA, 15.0 min, cathode on the skull surface) oriented to the cerebellar cortex. Such stimulation prevented initiation of generalized clonico-tonic seizures; the duration of ictal discharges in brain structures decreased, on average, by 42.1% (P < 0.02). The latent periods of acute PTZ-induced (60.0 mg/kg) seizures in rats that were not subjected to the kindling procedure were 33.5% longer after TDCS (P < 0.05) than those in the control. Similar stimulation focused on the frontal cerebral cortex prevented the development of generalized seizures in 50% of the kindling rats (P < 0.05).

http://ift.tt/2Aslik1

Control of the Functionality of the Brachial Plexus during Robot-Assisted Transaxillary Thyroid Surgery

At present, such a type of endoscopic surgery as robot-assisted transaxillary thyroidectomy has become available. In this case, traumatization of the brachial plexus is a rare but possible complication. For the control of the function of the brachial plexus during the above operation we used monitoring of somatosensory evoked potentials (SSEPs) induced by stimulation of the median nerve. Fifteen patients (14 women and one man) were included in this study. All interventions were robot-assisted transaxillary thyroidectomies using the daVinci SI Surgical System. We found that such surgery induced mild but significant increases in the latency of the cortical N20 potential, especially when the tissue was tensioned by the autostatic retractor. The latency prolongation was a valuable signal given to the surgeon, followed by repositioning or loosening of the retractor. In the examined group, no significant decreases in the amplitude of the N20 potential were observed. We conclude that SSEP monitoring during robotic thyroid surgery is an available and safe method providing valuable information on the functional integrity of somatosensory pathways during surgical maneuvers.

http://ift.tt/2ivJJGA

Effects of a Propolis Extract on the Viability of and Levels of Cytoskeletal and Regulatory Proteins in Rat Brain Astrocytes: an In Vitro Study

A potential for the use of propolis in preventive and therapeutic purposes has been acknowledged, but little attention has been paid to estimation of possible propolis cytotoxicity with respect to astrocytes. We tried to estimate how a propolis ethanol extract (PEE) affects rat brain astrocytes in vitro and also to uncover crucial molecular targets of the PEE action. Primary astrocytes were exposed to PEE in doses of 10, 25, or 100 μg/ml for 24 h, and then the cell viability was monitored by MTT assay. Levels of glial fibrillary acidic protein (GFAP), transcriptional nuclear factor-κB (NF-κB), poly(ADPribose) polymerase (PARP), and angiostatins were measured using Western blot to identify the molecular mechanisms underlying cell responses to PEE. The PEE treatment exerted a dose-dependent cytotoxic effect on cultured astrocytes. The PEE modulated astrocyte signaling pathways through inducing the expression of NF-κB and PARP. At the same time, the PEE stimulated GFAP synthesis and fibrillogenesis, which was indicative for activation of astrocytes preceding their suppression. The PEE significantly increased the production of angiostatin isoforms by astrocytes, thus contributing to an antiangiogenic potential of these cells. In summary, our results indicated that exposure to the PEE exerts certain cytotoxic effects on astrocytes in a dose-dependent manner; these effects are realized through modulation of cytoskeleton rearrangements and pro-apoptotic signaling pathways. A widely available, safe, and inexpensive substance, propolis, and its components and derivatives may be used in the prevention and treatment of neuronal impairments, including malignant tumors and neurodegenerative disorders associated with excessive astrocytic activation.

http://ift.tt/2AsxPEl

Effects of Beta-Adrenergic Blockade on Diabetes-Induced Neurobehavioral Alterations in Mice

Neurobehavioral activities were estimated in three groups of male albino mice using the open field, elevated plus maze, light/dark board, and hole-board tests. The control group included intact animals, while alloxan-induced diabetes was evoked in the other two groups (single i.p. injection of 120 mg/kg alloxan). In the third group, a nonspecific beta-adrenoreceptor antagonist, propranolol, was i.p. injected (40 mg/kg) before the induction of diabetes. In diabetic mice, all neurobehavioral indices tested in the four above-mentioned tests were significantly (P< 0.05) smaller than those in the control group. The frequencies of rearings and grooming episodes in the open field, number of entries into the open arms and time spent in these arms in the elevated plus maze test, and number of head dips in the hole-board test demonstrated the most intense drops (more than twofold). Pretreatment with propranolol provided significant (P < 0.05) normalization of all neurobehavioral indices in diabetic mice; such normalization with respect to the locomotion intensity, frequency of grooming, time spent in the open arms, and both indices in the light/dark board was nearly complete. Thus, diabetes in the animal model used is accompanied by the development of the state of abnormally high anxiety. The activity of the betaadrenergic system is noticeably involved in the formation of this state; pharmacological blocking of beta-adrenoreceptors provides significant anxiolytic effects.

http://ift.tt/2iuZ1v9

Expression of Vascular Endothelial Growth Factor after Transfection of Human Neural Stem Cells with the Lentiviral Vector Encoding the VEGF165 Gene

We examined the expression of vascular endothelial growth factor (VEGF) and characteristics of human neural stem cells after transfection with the lentiviral vector encoding the VEGF 165 gene. The latter gene was amplified from the human breast cancer cell line MCF-7 using RT-PCR; then the target gene was cloned into the pCDH–CMV–MCS-EF1-copGFP, a lentiviral expressing plasmid. After transformation, enzyme digestion led to a correct length of the VEGF165 gene, and DNA sequencing analysis confirmed that the VEGF165 gene sequence was exactly the same as that reported by the GeneBank. Then, the recombinant lentivirus produced by 293T cells and packaging plasmids were transfected into fourthpassage human neural stem cells (NSCs). One week after transfection with pCDH-VEGF165, NSCs expressed VEGF stably, and their proliferation ability significantly increased. Furthermore, human NSCs kept their characteristics and multiple differentiation activity after transfection. Our results indicate that human NSCs can express vascular endothelial growth factor highly and stably via transfection with the lentiviral vector encoding the VEGF165 gene, which may be useful for future research on function recovery after stroke.

http://ift.tt/2Asl7oR

Expression of Calcium-Binding Proteins, Calbindin D28k and Calretinin, in the Frog Taste Receptor Structures

Considering that information on the expression of calcium-binding proteins (CaBPs) in different cells of the taste receptors is rather limited, we investigated the distribution of such proteins, calbindin D28k (CB) and calretinin (CR), in the taste disc (TD) of the frog Lithobates catesbeianus. Western blot analysis revealed that CB and CR are expressed in cells of the fungiform papillae. CB-immunoreactive (ir) and CR-ir cell somata were located in the middle layer of the TD. Most CB-ir and CR-ir cells possessed one rod-shaped apical process and one basal process; in some cells there were several extended basal processes. Apical processes of CR-ir cells were thinner than those of CB-ir units, and CR-ir nerve fibers were ramified in the lamina propria directly below the TD. Most CR-ir fiber branches surrounded the TD; however, some penetrated this region, with both types of branches approaching the surface. CB and CR immunoreactivities did not co-occur in TD cells. In the TDs examined, the number of CB-ir cells was significantly greater than that of CR-ir units. Our observations suggest that CB-ir and CR-ir cells in the frog TD correspond to type-II and type-III cells, respectively.

http://ift.tt/2iuYIjZ

Hysteresis in EMG Activity of Muscles of the Human Upper Limb at Rotations of the Isometric Effort Vector

We studied the dynamics of EMG activity of muscles of the human upper limb under conditions of changes in the direction of a vector of the isometric effort created by the hand. Averaged EMG activities of seven muscles of the shoulder and shoulder girdle at nine combinations of the angles in the shoulder and elbow joints were evaluated. Mean values of the angles of the maximum activity (AMAs) of the muscle during slow counterclockwise and clockwise rotations of the above-mentioned vector were compared. A significant dependence of the AMA in a considerable part of the muscles on the direction of the target trajectory hodograph by the vector of the generated effort was observed; this dependence is, most likely, due to the manifestations of hysteresis in the activity of the examined muscles. In the case where the analysis was performed in more detail, AMA values for the mm. triceps brachii, pectoralis major, and deltoideus pars scapularis were significantly greater at clockwise rotation, while those for the m. brachioradialis demonstrated an opposite trend.

http://ift.tt/2AvTtHw

Proteasome-mediated degradation of collagen III by cortisol in amnion fibroblasts

Rupture of fetal membranes (ROM) can initiate parturition at both term and preterm. Collagen III in the compact layer of the amnion contributes to the tensile strength of fetal membranes. However, the upstream signals triggering collagen III degradation remain mostly elusive. In this study we investigated the role of cortisol regenerated by 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) in collagen III degradation in human amnion fibroblasts with an aim to seek novel targets for the prevention of preterm premature ROM (PPROM)-elicited preterm birth. Human amnion tissue and cultured amnion tissue explants and amnion fibroblasts were used to study the regulation of collagen III, which is composed of three identical collagen 3A1 chains (COL3A1), by cortisol. Cortisol decreased COL3A1 protein but not mRNA abundance in a concentration-dependent manner. Cortisone also decreased COL3A1 protein, which was blocked by 11β-HSD1 inhibition. The reduction in COL3A1 protein by cortisol was not affected by a transcription inhibitor but further enhanced by a translation inhibitor. Autophagic pathway inhibitor chloroquine or siRNA-mediated knock-down of ATG7, an essential protein for autophagy failed to block cortisol-induced reduction in COL3A1 protein abundance, whereas proteasome pathway inhibitors MG132 and bortezomib significantly attenuated cortisol-induced reduction in COL3A1 protein abundance. Moreover, cortisol increased COL3A1 ubiquitination and the reduction of COL3A1 protein by cortisol was blocked by PYR-41, a ubiquitin-activating enzyme inhibitor. Conclusively, cortisol regenerated in amnion fibroblasts may be associated with rupture of fetal membranes at parturition by reducing collagen III protein abundance through a ubiquitin-proteasome pathway.

http://ift.tt/2iuGi2M

Congratulations Shannon O’Donnell, Diane Guerrero, Irina Potapova, and Shannon Doolittle, Student Success Fee Funding Recipients!

SLHS wants to congratulate the following recipients of the 2017-2018 Student Success Fee Academic Related Program.  This program provides students an opportunity to become engaged and involved in their education outside their academic courses.  Successful student proposals focus on academic enhancement, high impact practices, colloquia etc.

Undergraduate:

Shannon O'Donnell (Faculty Sponsor: Peter Torre):  Excellence in SLHS Student Research

The goal for this proposed project is directly in line with the San Diego State University mission to have students, at all levels, be involved in research. This proposal is requesting travel support for students to independently present at a national conference.

MA Program:

Diane Guerrero (Faculty Sponsor: Sonja Pruitt-Lord):  Speech Language Pathology CSHA Convention

Funds are requested to support 20 undergraduate, graduate and doctoral students in attending the 2018 CSHA Convention being held in Sacramento, CA, March 22-25, 2018. Funds will be used to pay for student registration, airfare, and hotel costs.

SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders:

Irina Potapova (Faculty Sponsor: Sonja Pruitt-Lord):  Fourth Annual Speech, Language and Hearing Awareness and Information Day (SAID)

Professional development events for students in Speech, Language and Hearing Sciences and peers in related fields (e.g., Education, Public Health, Physical Therapy). The project includes a professional mentoring event and our fourth annual Speech, Language and Hearing Awareness and Information Day.

SDSU/UCSD Joint Doctoral Program in Audiology:

Shannon Doolittle (Faculty Sponsor: Laura Dreisbach-Hawe):  Speech, Language, and Hearing Sciences Guest Speaker Event

Since 2003, the Student Academy of Audiology has invited internationally-recognized speakers to present their leading research to students of all levels, faculty, and professional members of the community through the generous support of IRA funds provided by the College of Health and Human Sciences.

 

http://ift.tt/2Ai5uji

Challenge and Yield of Enrolling Racially and Ethnically Diverse Patient Populations in Low Event Rate Clinical Trials [Original Contributions]

Background and Purpose—We report patient enrollment and retention by race and ethnicity in the CREST (Carotid Revascularization Endarterectomy versus Stent Trial) and assess potential effect modification by race/ethnicity. In addition, we discuss the challenge of detecting differences in study outcomes when subgroups are small and the event rate is low.Methods—We compared 2502 patients by race, ethnicity, baseline characteristics, and primary outcome (any periprocedural stroke, death, or myocardial infarction and subsequent ipsilateral stroke up to 10 years).Results—Two hundred forty (9.7%) patients were minority by race (6.1%) or ethnicity (3.6%); 109 patients (4.4%) were black, 32 (1.3%) Asian, 2332 (93.4%) white, 11 (0.4%) other, and 18 (0.7%) unknown. Ninety (3.6%) were Hispanic, 2377 (95%) non-Hispanic, and 35 (1.4%) unknown. The rate of the primary end point for all patients was 10.9%±0.9% at 10 years and did not differ by race or ethnicity (Pinter>0.24).Conclusions—The proportion of minorities recruited to CREST was below their representation in the general population, and retention of minority patients was lower than for whites. Primary outcomes did not differ by race or ethnicity. However, in CREST (like other studies), the lack of evidence of a racial/ethnic difference in the treatment effect should be interpreted with caution because of low statistical power to detect such a difference.Clinical Trial Registration—URL: http://ift.tt/PmpYKN. Unique identifier: NCT00004732.

http://ift.tt/2AofLsy

DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) Mismatch in Thrombectomy Candidates [Brief Reports]

Background and Purpose—We aimed to study the intrarater and interrater agreement of clinicians attributing DWI-ASPECTS (Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging–Fluid Attenuated Inversion Recovery) mismatch in patients with acute ischemic stroke referred for mechanical thrombectomy.Methods—Eighteen raters independently scored anonymized magnetic resonance imaging scans of 30 participants from a multicentre thrombectomy trial, in 2 different reading sessions. Agreement was measured using Fleiss κ and Cohen κ statistics.Results—Interrater agreement for DWI-ASPECTS was slight (κ=0.17 [0.14–0.21]). Four raters (22.2%) had a substantial (or higher) intrarater agreement. Dichotomization of the DWI-ASPECTS (0–5 versus 6–10 or 0–6 versus 7–10) increased the interrater agreement to a substantial level (κ=0.62 [0.48–0.75] and 0.68 [0.55–0.79], respectively) and more raters reached a substantial (or higher) intrarater agreement (17/18 raters [94.4%]). Interrater agreement for DWI-FLAIR mismatch was moderate (κ=0.43 [0.33–0.57]); 11 raters (61.1%) reached a substantial (or higher) intrarater agreement.Conclusions—Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0–5 versus 0–6 or 0–6 versus 7–10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial.

http://ift.tt/2AjZXJ0

Statin Treatment in Patients With Intracerebral Hemorrhage [Comments and Opinions]

http://ift.tt/2AnsEmH

Long-Term Effect of Pravastatin on Carotid Intima-Media Complex Thickness [Original Contributions]

Background and Purpose—The effect of statins on progression of carotid intima–media complex thickness (IMT) has been shown exclusively in nonstroke Western patients. This study aimed to determine the effect of low-dose pravastatin on carotid IMT in Japanese patients with noncardioembolic ischemic stroke.Methods—This is a substudy of the J-STARS trial (Japan Statin Treatment Against Recurrent Stroke), a multicenter, randomized, open-label, parallel-group trial to examine whether pravastatin reduces stroke recurrence. Patients were randomized to receive pravastatin (10 mg daily, usual dose in Japan; pravastatin group) or not to receive any statins (control group). The primary outcome was IMT change of the common carotid artery for a 5-year observation period. IMT change was compared using mixed-effects models for repeated measures.Results—Of 864 patients registered in this substudy, 71 without baseline ultrasonography were excluded, and 388 were randomly assigned to the pravastatin group and 405 to the control group. Baseline characteristics were not significantly different, except National Institute of Health Stroke Scale scores (median, 0 [interquartile range, 0–2] versus 1 [interquartile range, 0–2]; P=0.019) between the 2 groups. Baseline IMT (mean±SD) was 0.887±0.155 mm in the pravastatin group and 0.887±0.152 mm in the control group (P=0.99). The annual change in the IMT at 5-year visit was significantly reduced in the pravastatin group as compared with that in the control group (0.021±0.116 versus 0.040±0.118 mm; P=0.010).Conclusions—The usual Japanese dose of pravastatin significantly reduced the progression of carotid IMT at 5 years in patients with noncardioembolic stroke.Clinical Trial Registration—URL: http://ift.tt/PmpYKN. Unique identifier: NCT00361530.

http://ift.tt/2AjZTZM

Clinical Thyroidology High-Impact Articles

FREE ACCESS through December 14, 2017.
Read Now:

Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration
Stephanie A. Fish 

Are Wider TSH Cutoffs for Reflex Testing of Free T4 Feasible, Safe and Cost-Effective?
Jacques Orgiazzi 

Punctate Echogenic Foci on Thyroid Ultrasound Do Not Necessarily Represent Calcifications on Histopathology
Martin Biermann 

Significant Variations of Thyroid Testing in the U.S. Argue for Improved Standardization of Practice Patterns
Angela M. Leung 

The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.

http://ift.tt/2iuNGv4

Intermedin 1–53 Protects Cardiac Fibroblasts by Inhibiting NLRP3 Inflammasome Activation During Sepsis

Abstract

Sepsis is a disease that occurs as a result of systemic inflammatory response syndrome (SIRS) in response to an infection, contributing to multiple organ dysfunction and a high mortality rate. Interleukin-lβ (IL-1β) is a cytokine that plays critical roles in inflammation and cardiac dysfunction during severe sepsis. Intermedin_1–53 (IMD_1–53) has been recently discovered to possess potential endogenous anti-inflammatory and strong cardiovascular protective effects. To investigate whether IMD_1–53 can inhibit the NLRP3/caspase-1/IL-1β pathway to alleviate cardiac injury and rescue heart function, sepsis was induced in vivo by caecal ligation and puncture (CLP) surgery, and lipopolysaccharides were used as septic stressors for cardiac fibroblasts (CFs) in vitro. The expressions of IMD_1–53 receptors in sepsis rat heart were increased. After IMD_1–53 treatment, inflammation caused by sepsis in vivo was greatly reduced, as shown by the downregulation of apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), nucleotide-binding domain and leucine-rich repeat containing family, pyrin containing 3 (NLRP3), pro-IL-1β, caspase 1, and nuclear translocation of nuclear factor-κB (NF-kB) protein levels. In addition, cardiac function was significantly improved and mean arterial blood pressure (MABP) increased by 34.8% (P < 0.05) which almost back to normal. Surprisingly, IMD_1–53 inhibited cell apoptosis, as caspase 3 activity and Bax expression was significantly reduced in the heart upon IMD_1–53 treatment. IMD_1–53 abolished the upregulation of ASC, NLRP3, and caspase 1 protein levels in CFs induced by lipopolysaccharide (LPS). IMD_1–53 increased cell survival rates and inhibited IL-1β production in the cell culture medium. IMD_1–53 can protect against inflammation and heart injury during sepsis via attenuating the NLRP3/caspase-1/IL-1β pathway.

http://ift.tt/2iuSmAV

Citation for the 2016 BAOMS Surgery Prize - Kathleen Fan

The BAOMS Surgery Prize is awarded by the association to the fellow who in their first 10 years of consultant practice has made a major contribution to Oral and Maxillofacial Surgery.

http://ift.tt/2itoo0c

In reference to “Central nervous system anomalies in craniofacial microsomia: a systematic review”

We read with interest the in-depth review by Renkema and colleagues on central nervous system (CNS) involvement in patients affected by craniofacial microsomia1. In this article, the authors clearly showed that CNS abnormalities are commonly detected (2–69%), thus confirming that malformations in craniofacial microsomia go far beyond isolated skeletal abnormalities. The authors also underlined the need to investigate further the true prevalence rate of CNS involvement through the performance of dedicated studies, and attributed the wide range of CNS abnormality detection rates to selection bias, as patients with neurological symptoms are more likely to undergo neuroimaging studies.

http://ift.tt/2AwvI2p

Anaesthetic efficacy of 4% articaine compared with 2% mepivacaine: a randomized, double-blind, crossover clinical trial

The aim of this study was to evaluate the clinical efficacy of 4% articaine (Ar4) compared to 2% mepivacaine (Me2), both in combination with 1:100,000 epinephrine, in a unique soft tissue model. This was a randomized, double-blind, crossover clinical trial. The anaesthetic was applied to the lower lip using a computerized local delivery system. The following were evaluated: blood flow, thermal sensation, pressure and proprioception, extent of anaesthesia, gradual elimination, and the final duration of the effect of the anaesthesia.

http://ift.tt/2iuME1X

Earwax MD Now Available in Canada

Eosera (https://earcaremd.com/) has made Earwax MD available in Canada through Amazon.ca, the first foreign market the company has brought its product to. On Amazon.ca, the product is available in a kit that includes a 15 mL bottle and rinsing bulb. Amazon Prime members can get Earwax MD with free shipping on Amazon.ca. The topical cerumen-dissolving drop has been stocked in CVS stores across the United States since August, and has been part of the U.S. Amazon Exclusives program since April 2017.

Elyse Dickerson, co-founder and CEO of Eosera, said they founded Eosera to develop solutions for unmet healthcare needs that would have a global impact, and since launching Earwax MD on Amazon.com in April, they have received considerable interest from Canadian consumers, audiologists, ENTs and other health care professionals. "We are thrilled to enter Canada on Amazon.ca, so that from the start, we are available to all Canadians," Dickerson said. "We are working towards a larger distribution channel in Canada, and anticipate availability in retail stores and additional distributors in the future."

Published: 11/30/2017 3:52:00 PM

http://ift.tt/2AmZTpU

Mesenteric cyst: an uncommon cause of acute abdomen

http://ift.tt/2njQ7Ce

Perioperative albumin ratio is associated with post-operative pancreatic fistula

Background

Despite improvements in surgical techniques and perioperative management, post-operative pancreatic fistula (POPF) remains a serious complication after pancreaticoduodenectomy (PD). The aim of this study was to evaluate the role of perioperative clinical variables of patients, including albumin level, in predicting pancreatic fistula.

Methods

A total of 86 patients underwent PD for pancreas cancer between 2011 and 2017 at our institution. We prospectively investigated the relation between patient's characteristics and the incidence of clinically relevant (CR)-POPF. Perioperative albumin ratio was defined as post-operative day 1 (POD1) albumin level/preoperative albumin level.

Results

A total of 23 patients (26.7%) developed CR-POPF. At univariate analysis POPF correlated with soft pancreas (P = 0.045), low POD1 albumin (P = 0.02), POD1 and POD3 amylase levels in drainage fluid (P = 0.003 and P = 0.014, respectively) and perioperative albumin ratio (0.58 ± 0.10 versus 0.69 ± 0.12 in patients without POPF; P = 0.003). No significant correlations with POPF were demonstrated for surgical time, serum amylase levels and preoperative albumin levels. At multivariate analysis POD3 amylase level in drainage fluid and perioperative albumin ratio were the only significant independent parameters (P = 0.027 and P = 0.047, respectively).

Conclusions

Perioperative albumin ratio can predict POPF after PD.

http://ift.tt/2zErbai

How I do hanging manoeuvres to facilitate portal vein resection during pancreaticoduodenectomy for borderline tumours

http://ift.tt/2nhEGLu

Utero-cutaneous fistula following Caesarean section

http://ift.tt/2zF5Hdu

Oesophageal adenocarcinoma associated with a right-sided aortic arch

http://ift.tt/2nnD6rx

Metastatic prostate cancer incidence in Australia after amendment to prostate-specific antigen screening guidelines

Background

To compare the incidence of newly diagnosed metastatic prostate cancer at an Australian facility pre- and post-publication of the United States Preventive Services Task Force (USPSTF) guidelines and subsequent amendment of the Royal Australian College of General Practitioners Preventive Activities in General Practice guidelines.

Methods

A retrospective analysis was undertaken by patients with newly diagnosed prostate cancer following transrectal ultrasound-guided biopsy between 2009 and 2014. Patients were divided into two even groups based on whether they had undergone their transrectal ultrasound biopsy pre- (2009–2011) or post- (2013–2014) publication of USPSTF guidelines. Metastatic disease was determined by computed tomography chest, abdomen, pelvis as well as nuclear medicine bone scan. A comparison in the incidence of newly diagnosed metastatic prostate cancer was made.

Results

A total of 130 patients were allocated into each group. In the pre-USPSTF group, 23 out of 130 patients had newly diagnosed metastatic prostatic cancer (17.7%). In the post-USPSTF group, 41 out of 130 (31.5%) had newly diagnosed metastatic prostate cancer (P < 0.05). The mean and median prostate-specific antigen was 15.9 and 9.4 (pre-guideline group) and 33.0 and 9.8 (post-guideline group), respectively (P = 0.02). The post-guidelines group had a higher incidence of low-grade disease (Gleason <7), a decreased incidence of intermediate grade disease (Gleason 7) and a relatively unchanged incidence in high-risk disease (Gleason >7).

Conclusion

The incidence of newly diagnosed metastatic prostate cancer nearly doubled in patients referred to our Urology Department post-release of the USPSTF guidelines.

http://ift.tt/2zDWyS9

Radical gastric cancer surgery results in widespread upregulation of pro-tumourigenic intraperitoneal cytokines

Background

Radical surgical resection is the mainstay of curative treatment for oesophagogastric malignancy. However, survival and recurrence rates remain poor. Theoretical data suggests that the inflammatory response to surgery can promote tumour recurrence. The local and systemic inflammatory response to radical oesophagogastric cancer surgery has not been fully characterized. We aimed to measure this response, particularly factors associated with tumour implantation.

Methods

Consecutive patients undergoing radical junctional or gastric cancer resection over 12 months were recruited. Repeated serum and adipose tissue were collected intra-operatively. Adipose tissue was collected adjacent and remote to the tumour, and cytokine messenger RNA (mRNA) expression was measured. Post-operatively, daily serum was collected for 7 days, and analysed for inflammatory cell profile and cytokine concentration.

Results

There were nine patients recruited (67.1 ± 2.1 years). mRNA expression of interleukin-6 (IL-6), CC-chemokine ligand-2 and IL-1β increased in adipose tissue intra-operatively (P < 0.05), equally both adjacent and remote from the tumour site. Serum IL-6 concentration increased from 23.3 pg/mL to 161.8 pg/mL intra-operatively (P < 0.05) before falling steadily to 35.7 pg/mL post-operatively (P < 0.05). Serum tumour necrosis factor-α was elevated throughout, and IL-1β levels were unaffected. Leukocyte and neutrophil populations increased, while T-cell and dendritic cell populations decreased intra-operatively (P < 0.05).

Conclusion

Radical surgery dramatically upregulates the expression of pro-tumourigenic cytokines in the peritoneum. There is also a marked systemic immune and inflammatory response to surgery, including downregulation of T-cell and dendritic cell populations. This offers two potential pathways that may facilitate tumour progression – local inflammation promoting peritoneal adherence and implantation, and secondary suppression of immunosurveillance due to circulating inflammatory response.

http://ift.tt/2nkzw16

Factors influencing lymph node skip metastasis in colorectal cancer: a retrospective study

Background

The risk factors for lymph node skip metastasis (LNSM) have not been thoroughly clarified in patients with advanced colorectal cancer (CRC). This study aimed to identify the risk factors for LNSM in CRC patients who underwent laparoscopic radical resection with D3 lymphadenectomy.

Methods

This retrospective cohort study included a total of 167 consecutive patients who underwent laparoscopic radical resection with D3 lymphadenectomy for CRC between April 2005 and June 2017. The patients were sorted into the LNSM-positive (skip+ group) and LNSM-negative (skip− group) groups. Logistic regression was used to identify the risk factors for LNSM.

Results

Compared with the skip− group, the frequency of tumour size <5 cm, pT1-2 stage, and pN1 stage were significantly higher in the skip+ group (tumour size <5 cm: 68.8 versus 46.7%, P = 0.025; pT1-2 stage: 18.8 versus 4.4%, P = 0.012; pN1 stage: 78.1 versus 57.0%, P = 0.028), respectively. Multivariate logistic regression analysis revealed that pT1-2 stage (odds ratio (OR) = 4.3, 95% confidence interval (CI): 1.1–16.6, P = 0.034) and pN1 stage (OR = 2.6, 95% CI: 1.1–6.8, P = 0.047) were independent risk factors for LNSM.

Conclusions

pT1-2 stage and pN1 stage are significantly associated with LNSM. Radical D3 lymphadenectomy should remain standard practice for CRC.

http://ift.tt/2zEYgTG

Gastric Gastrointestinal Stromal Tumors (GIST): a Case Series and Current State of the Art in the Workup and Treatment of This Rare Disease

http://ift.tt/2nghBsg

Application of Zeolites for Sustainable Agriculture: a Review on Water and Nutrient Retention

Abstract

Developing urbanization, water shortage, watercourse pollution, and demands for more food due to population growth require a more efficient water irrigation and fertilizer application. Retaining nutrients and water in agricultural soils brings about higher crop yields and prevents pollution of water courses. Among different solutions, zeolites, which are environmental friendly, ubiquitous, and inexpensive, have been extensively employed in agricultural activities. These minerals are considered as soil conditioners to improve soil physical and chemical properties including infiltration rate, saturated hydraulic conductivity (K _s), water holding capacity (WHC), and cation exchange capacity (CEC). Natural and surface-modified zeolites can efficiently hold water and nutrients including ammonium (NH₄⁺), nitrate (NO₃⁻) and phosphate (PO₄³⁻), potassium (K⁺), and sulfate (SO₄²⁻) in their unique porous structures. Their application as slow-release fertilizers (SRFs) are reported as well. Therefore, zeolite application can improve both water use efficiency (WUE) and nutrient use efficiency (NUE) in agricultural activities and consequently can reduce the potential of surface and groundwater pollution. This review paper summarizes findings in the literature about the impact of zeolite applications on water and nutrient retention in the agriculture. Furthermore, it explores benefits and drawbacks of zeolite applications in this regard.

Graphical Abstract

ᅟ

http://ift.tt/2jB7Xvs

Voice Profile Recovery and Quality of Life Changes After Microdirect Laryngoscopy in Three Categories of Glottis Lesions: Benign, Precancerous, and Malignant

The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF).

http://ift.tt/2BvP4C9

Non-destructive monitoring of ethylene vinyl acetate crosslinking in PV-modules by luminescence spectroscopy

Abstract

This work reports on the prospects of using luminescence spectroscopy as a non-destructive method for the characterization of ethylene vinyl acetate copolymer (EVA) crosslinking in photovoltaic (PV) modules. Luminescence has the potential to be easily applied in-line for monitoring purposes, e.g. during manufacturing. We investigate the correlation of luminescence, Raman spectroscopy and differential scanning calorimetry with the EVA crosslinking. We show that all these methods, including the luminescence method, show a good correlation with the hold time during the lamination process. Furthermore, time-dependent luminescence measurements are introduced. These make use of the fact that the luminescence decreases upon the ultraviolet irradiation during the measurement. In contrast to steady-state luminescence, this facilitates measurements that are inherently less dependent on possible interfering signal artifacts, as these may occur in industrial PV modules due to other components of the PV module.

http://ift.tt/2kciJwc

Strength retention and moisture resistant properties of citric acid modified thermoplastic starch resins

Abstract

The strength retention and moisture resistant properties of thermoplastic starch (TPS) resins were significantly enhanced by modifying with proper amounts of citric acid (CA) (i.e. TPS₁₀₀CA_x specimens) or by melt-blending with poly(lactic acid) (PLA) (i.e. (TPS₁₀₀CA_0.1)_xPLA_y specimens). In contrast to the distinguished retrogradation effect found for all conditioned TPS specimens, one can barely find any recrystallized starch crystals in TPS₁₀₀CA_x and/or (TPS₁₀₀CA_0.1)_xPLA_y specimens maintained at 20 °C/50% RH for less than 42 days. The tensile/impact strength retention values of properly prepared conditioned TPS₁₀₀CA_0.1 and (TPS₁₀₀CA_0.1)₃₀PLA₇₀ specimens were equivalent to 1.5 MPa/0.28 KJ/m² and 41.8 MPa/1.63 KJ/m², respectively, which were more than 4/4 times and 105/23 times higher than those of corresponding TPS specimens maintained at 20 °C/50% RH for 70 days. In comparison with conditioned TPS specimens, significantly less and shorter drawn debris were found on the fracture surfaces of the corresponding conditioned TPS₁₀₀CA_0.1 and (TPS₁₀₀CA_0.1)₃₀PLA₇₀ specimens with the same amounts of conditioned time. As revealed by Fourier transform infrared spectroscopy, Solid-state ¹³C Nuclear Magnetic Resonance analyses, disruption of intra and interhydrogen-bondings within starch molecules did occur after addition of small amounts of CA during the modification processes of TPS₁₀₀CA_x specimens. The relatively unchanged in retrogradation effect, significantly less drawn debris and considerable improvement in moisture resistant and/or strength retention properties of the conditioned TPS₁₀₀CA_x and/or (TPS₁₀₀CA_0.1)_xPLA_y specimens is most likely due to the efficient hydrogen-bonding CA molecules with the moisture-absorbing hydroxyl (free or hydrogen-bonded) of starch molecules that prohibits moisture absorption during their conditioning processes.

http://ift.tt/2As8gTR