Improved Quantitative Dynamic Range of Time-of-Flight Mass Spectrometry by Simultaneously Waveform-Averaging and Ion-Counting Data Acquisition

Abstract

Two different types of data acquisition methods, "averaging mode" and "ion-counting mode", have been used in a time-of-flight (TOF) mass spectrometry. The most common method is an averaging mode that sums waveform signals obtained from each flight cycle. While it is possible to process many ions arriving at the same TOF in one flight cycle, low-abundance ions are difficult to measure because ion signals are overwhelmed by noises from the detection system. An ion-counting mode is suitable for the detection of such low-concentration ions, but counting loss occurs when two or more ions arrive at the detector within the dead time of the acquisition system. In this study, we introduce a technique that combines two methods to measure target ions with a high concentration difference, i.e., averaging mode and ion-counting mode are used simultaneously for high abundant and trace ions, respectively. By processing waveforms concurrently during data acquisition, one can choose to analyze either or both types of data to achieve a highly quantitative mass spectrum over a wide range of sample concentrations. The result of the argon isotope analysis shows that this method provides a more accurate determination of the isotope ratio compared to averaging mode alone at one-twentieth of the analysis time required by ion-counting alone.

Graphical Abstract

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https://ift.tt/2qZzbAy

Analysis of Sulfate Patterns in Glycosaminoglycan Oligosaccharides by MS n Coupled to Infrared Ion Spectroscopy: the Case of GalNAc4S and GalNAc6S

Abstract

We report distinctive spectroscopic fingerprints of the monosaccharide standards GalNAc4S and GalNAc6S by coupling mass spectrometry and ion spectroscopy in the 3-μm range. The disaccharide standards CSA and CSC are used to demonstrate the applicability of a novel approach for the analysis of sulfate position in GalNAc-containing glycosaminoglycans. This approach was then used for the analysis of a sample containing CSA and CSC disaccharides. Finally, we discuss the generalization of the coupling of mass spectrometry with ion spectroscopy for the structural analysis of glycosaminoglycans on a tetrasaccharide from dermatan sulfate source.

Graphical abstract

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https://ift.tt/2vV6bOW

Fabrication and Testing of Electrospun Polyurethane Blended with Chitosan Nanoparticles for Vascular Graft Applications

Abstract

In this study, a small vascular graft based on polyurethane (PU) blended with chitosan (Ch) nanoparticles was fabricated using electrospinning technique. Initially, the chitosan nanoparticles were synthesized using ionic gelation method. UV–Vis spectrophotometer confirmed the presence of synthesized Ch nanoparticles by exhibiting absorption peak at 288 nm and the Fourier-transform infrared spectroscopy (FTIR) analysis confirmed the existence of the chitosan. Further, the synthesized Ch nanoparticles showed size diameter in the range of 134 ± 58 nm as measured using ImageJ. In the electrospun PU/chitosan graft, the fiber diameter and pore size diameter was found to be reduced compared to the pure PU owing to incorporation of chitosan into PU matrix. The FTIR spectrum revealed the presence of chitosan in the prepared nanocomposite membrane by the formation of the hydrogen bond and peak shift of CH and NH stretching. Moreover, the contact angle measurements revealed that the prepared graft showed decreased contact angle indicating hydrophilic nature compared to the pristine PU. The cytocompatibility studies revealed the non-toxic behavior of the fabricated graft. Hence, the prepared graft exhibiting significant physiochemical and non-toxic properties may be a plausible candidate for cardiovascular graft applications.

https://ift.tt/2HtiDLj

Medikamentöse Therapie der asymptomatischen Hyperurikämie

Zusammenfassung

Eine medikamentöse Therapie der asymptomatischen Hyperurikämie kann zum derzeitigen Zeitpunkt nicht empfohlen werden, da keine randomisierten Leitlinien und randomisierten kontrollierten Studien vorliegen. Es besteht auch kein Konsens, ab wann eine Therapie eingeleitet werden sollte. Außerdem sind die Nebenwirkungen einer Therapie zu bedenken.

https://ift.tt/2HxlCOT

Medikamentöse Therapie der asymptomatischen Hyperurikämie

Zusammenfassung

In letzter Zeit häufen sich die Zeichen für einen Paradigmenwechsel in Bezug auf medikamentöse Harnsäuresenkung. Gerade bei Patienten mit arterieller Hypertonie, koronarer Herzerkrankung oder renaler Insuffizienz finden sich in Studien zunehmend Hinweise, dass eine medikamentöse Intervention bei hohen Harnsäurespiegeln in Betracht gezogen werden sollte.

https://ift.tt/2I32fhF

Cyclin-dependent kinase 4/6 inhibitors in hormone receptor-positive early breast cancer: preliminary results and ongoing studies

Abstract

The cyclin D-cyclin-dependent kinase (CDK) 4/6-inhibitors (CDK4/6i) induce cell cycle arrest in the G1 phase what eventually can prevent the proliferation of cancer cells. The CDK4/6i have changed the landscape of treatment options for ER-positive, HER2-negative metastatic breast cancer. Currently, palbociclib, ribociclib, and abemaciclib are approved by the US Food and Drug Administration in this setting. This success encouraged the researchers to examine CDK4/6i activity in (neo)adjuvant setting. In this review, clinical data to date and ongoing clinical trials with palbociclib, ribociclib, and abemaciclib in the early breast cancer are discussed. A literature search of these topics was carried out using PubMed and data reported at international oncology meetings and clinicaltrials.gov were included. Currently, we have the early promising data from Phase II clinical trials of CDK4/6i efficacy in the neoadjuvant setting in women with HR-positive breast cancer. Moreover, there are numerous studies that are in progress today in (neo)adjuvant setting.

https://ift.tt/2r1I0K9

New structural dynamics of isolated waves via the coupled nonlinear Maccari’s system with complex structure

Abstract

In this study, the modified exp \((-\phi (\eta ))\) -expansion function method is utilized in acquiring some new results to the coupled nonlinear Maccari's system. The Maccari's system is a nonlinear model that describes the dynamics of isolated waves, confined in a small part of space, in various fields such as hydrodynamic, plasma physics and nonlinear optics. We construct some new results with a complex structure to this model, such as; the trigonometric and hyperbolic function solutions. Under the suitable choice of the values of parameters, we plot the 2D, 3D and the contour graphs to some of the obtained solutions in this study. We observed that our results may be helpful in detecting the movement of an isolated wave in a small space to some practical physical problems.

https://ift.tt/2r2UQaM

Work Engagement, Burnout and Personal Accomplishments Among Social Workers: A Comparison Between Those Working in Children and Adults’ Services in England

Abstract

Social workers (SWs) provide emotional and practical support to vulnerable service users who are likely to suffer from emotional trauma and mental health conditions. Stress and burnout levels are reported to be high among SWs, however, little is known about their relationships with different characteristics. The current article utilises unique and large dataset (n = 3786) on SWs working in adults and children's services to examine factors associated with burnout. Employing job-demand/resources model and structural equations modelling, we highlight the varying significant impact of work-engagement, administrative support and work experience as moderating factors to burnout across adult and children service specialism in this sample.

https://ift.tt/2vUpus2

Editorial of the “ionic liquids and biomolecules” special issue

https://ift.tt/2vQYZDy

Ionic liquids: a brief history

Abstract

There is no doubt that ionic liquids have become a major subject of study for modern chemistry. We have become used to ever more publications in the field each year, although there is some evidence that this is beginning to plateau at approximately 3500 papers each year. They have been the subject of several major reviews and books, dealing with different applications and aspects of their behaviours. In this article, I will show a little of how interest in ionic liquids grew and developed.

https://ift.tt/2r1nhG2

Data Literacy in der Medizin

Zusammenfassung

Hintergrund

Die digitale Transformation des Gesundheitssystems verändert den Beruf des Arztes. Data Literacy wird hierbei als eine der führenden Zukunftskompetenzen erachtet, findet jedoch derzeit weder in den implementierten Curricula des Medizinstudiums noch in den aktuell laufenden Reformprozessen (Masterplan Medizinstudium 2020 und Nationaler Kompetenzbasierter Lernzielkatalog) Beachtung.

Ziel

Der Beitrag möchte zum einen die Aspekte beleuchten, die im Begriff der Data Literacy im medizinischen Kontext gebündelt werden. Zum andern wird ein Lehrkonzept vorgestellt, das Data Literacy im Zeichen der digitalen Transformation erstmals im Medizinstudium abbildet.

Material und Methoden

Das Blended-Learning-Curriculum „Medizin im digitalen Zeitalter" adressiert in 5 Modulen den diversen Transformationsprozess der Medizin von digitaler Kommunikation über Smart Devices und medizinische Apps, Telemedizin, virtuelle/augmentierte und robotische Chirurgie bis hin zu individualisierter Medizin und Big Data. Diese Arbeit stellt Konzept und Erfahrungen der erstmaligen Implementierung des 5. Moduls dar, welches transdisziplinär und integrativ den Aspekt Data Literacy erläutert.

Ergebnisse

Die Evaluation des Kurskonzepts erfolgte sowohl qualitativ als auch quantitativ und demonstriert einen Kompetenzgewinn in den Bereichen Wissen und Fertigkeiten sowie eine differenziertere Haltung nach Kursabschluss.

Schlussfolgerungen

Die curriculare Integration von Data Literacy ist eine transdisziplinäre und longitudinale Aufgabe. Bei der Entwicklung dieser Curricula sollten die hohe Geschwindigkeit des Veränderungsprozesses der digitalen Transformation beachtet und die curriculare Anpassung im Sinne eines Agility by Design bereits bei der Konzeption adressiert werden.

https://ift.tt/2vTsTas

E-Health-Angebote in der Onkologie

Zusammenfassung

Hintergrund

Die krankheits- und behandlungsbedingten Belastungen von Krebserkrankungen gehen in der Regel mit deutlichen Beeinträchtigungen der Lebensqualität der Betroffenen einher. Durch die starke Verbreitung des Internets in deutschen Haushalten stellen onkologische E‑Health-Angebote eine schnelle und einfach zugängliche mögliche Quelle der Unterstützung für Patienten und Angehörige dar. Angebote für Behandler umfassen z. B. Informationsportale, die Behandler auf die Bedürfnisse von Krebspatienten vorbereiten. Die Zukunft von onkologischen E‑Health Angeboten scheint in der Entwicklung von Angeboten für das Smartphone zu liegen.

Ziel

Die Autoren beschreiben E‑Health-Angebote in der Onkologie, v. a. hinsichtlich Form und Inhalt, Inanspruchnahme und Wirksamkeit.

Diskussion/Schlussfolgerung

In der Literatur ist eine große Anzahl von Studien zu finden, die Prozess und Outcome von E‑Health-Interventionen evaluieren. Jedoch wird weiterhin ein Bedarf für gut designte höherwertige RCTs (randomisierte kontrollierte Studien) konstatiert, unter anderem um genauere Aussagen zur Wirksamkeit der Angebote treffen zu können. Häufig berichtete Probleme der E‑Health-Angebote sind hohe Dropout-Raten und ein Nachhohlbedarf bei der bisher weitgehend fehlenden Implementierung der in Studien erprobten Ansätze in die Versorgungspraxis. Das Einbeziehen von potenziellen Zielgruppen in den Entwicklungsprozess der Angebote könnte hilfreich sein, um das Auftreten von hohen Dropout-Raten und Usability-Problemen zu vermindern und sicherzustellen, dass die Angebote dem Bedarf der Patienten entsprechen.

https://ift.tt/2HQKGDL

Serum brain-derived neurotrophic factor level and exercise tolerance complement each other in predicting the prognosis of patients with heart failure

Abstract

Brain-derived neurotropic factor (BDNF) is a myokine that plays a key role in regulating survival, growth, and maintenance of neurons. We investigated whether the serum BDNF level at discharge could predict the prognosis in patients with heart failure (HF). Furthermore, we aimed to examine the relationship between this myokine and exercise tolerance. We prospectively enrolled 94 patients who were hospitalized for worsening HF and had cardiac rehabilitation. At discharge, the serum BDNF level of all patients was measured using a commercial ELISA kit and they underwent a cardiopulmonary exercise test to measure peak oxygen uptake (peak VO₂). Correlation was not observed between BDNF and peak VO₂. Kaplan–Meier analysis demonstrated that cardiac death or rehospitalization owing to worsening HF was significantly higher in the low BDNF group (p = 0.023). The combination of peak VO₂ and BDNF levels led to the identification of subgroups with significantly different probabilities of events (p = 0.005). In particular, in the low BDNF and low peak VO₂ group, the frequency of rehospitalization within half a year after discharge was much higher than that in other groups. Multivariate analysis found BDNF as an independent factor of adverse events (hazard ratio 0.956; 95% confidence interval 0.911–0.999; p = 0.046). The serum BDNF level at discharge may be a useful biomarker of the prognosis in patients with HF. Furthermore, combining BDNF and peak VO₂ may be useful for predicting early cardiac events.

https://ift.tt/2HtUzbk

Sinusbodenelevation

Zusammenfassung

Hintergrund

Der klassischen Sinusbodenelevation und ihren Modifikationen kommt in der Versorgung des atrophen posterioren Oberkiefers eine zentrale Bedeutung zu. Erstmals berichtete Tatum 1977 über eine neue Operationsmethode zur Verbesserung der vertikalen Knochenhöhe im Sinusboden, 1980 veröffentlichten Boyne u. James den lateralen Zugang mittels Antrotomie in Verbindung mit einer Sinusbodenelevation. Zur Kompensation des Volumendefekts im Rahmen der Sinusbodenelevation wurden autologer Knochen, Knochenersatzmaterial und Kombinationen dieser Materialen eingesetzt.

Methoden

Die häufig schwierige anatomische Situation im distalen Oberkiefer wird durch die Pneumatisation des Sinusbodens in Kombination mit einer Alveolarfortsatzatrophie definiert. Die vertikale Problematik kann zudem mit einem horizontalen Knochenverlust vergesellschaftet sein. Diese Kombinationsdefekte verlangen umfassende Kenntnisse in der Planung und Durchführung augmentativer Maßnahmen. Der Erfolg der Gesamtbehandlung wird auch wesentlich durch die prothetische Konzeption bestimmt. Aus den statisch funktionellen und ästhetischen Planungsdaten ergeben sich die optimale Implantatposition und somit die notwendigen augmentativen Maßnahmen („backward planning"). In vielen Fällen sind die Planung und Durchführung einer Sinusbodenaugmentation nur auf der Basis einer digitalen Volumentomographie oder Computertomographie möglich. Exakte Kenntnisse der Anatomie und Physiologie des Mittelgesichtes sowie der absoluten und relativen Kontraindikationen auch auf Hals-Nasen-Ohren-ärztlichem Gebiet sind wichtige Voraussetzungen für eine erfolgreiche Gesamtstrategie.

https://ift.tt/2FiASNz

Modeling and analysis of a new locomotion control neural networks

Abstract

Experimental data have shown that inherent bursting of the neuron plays an important role in the generation of rhythmic movements in spinal networks. Based on the mechanism that the spinal neurons of a lamprey generate this inherent bursting, this paper builds a simplified inherent bursting neuron model. A new locomotion control neural network is built that takes advantage of this neuron model and its performance is analyzed mathematically and by numerical simulation. From these analyses, it is found that the new control networks have no restriction on their topological structure for generating the oscillatory outputs. If a network is used to control the motion of bionic robots or build the model of the vertebrate spinal circuitry, its topological structure can be constructed using the unit burst generator model proposed by Grillner. The networks can also be easily switched between oscillatory and non-oscillatory output. Additionally, inactivity and saturation properties of the new networks can also be developed, which will be helpful to increase the motor flexibility and environmental adaptability of bionic robots.

https://ift.tt/2KbZmMh

Clinical characteristics of two cohorts of infantile spasms: response to pyridoxine or topiramate monotherapy

Abstract

Background

Infantile spasms (IS) was an epileptic disease with varied treatment widely among clinicians. Here, we aimed to compare and analyze the clinical characteristics of IS response to pyridoxine or topiramate monotherapy (TPM control IS).

Methods

The clinical manifestations, treatment processes and outcomes were analyzed in 11 pyridoxine responsive IS and 17 TPM-control IS.

Results

Of the 11 patients with pyridoxine responsive IS, nine were cryptogenic/idiopathic. Age of seizure onset was 5.36 ± 1.48 months. Spasms were controlled within a week in most of the patients. At the last follow-up, EEG returned to normal in 8. Psychomotor development was normal in 6, mild delay in 3, severe delay in 2. Of the 17 patients with TPM-control IS, 10 were cryptogenic/idiopathic. The age of seizure onset was 5.58 ± 2.09 months. All patients were controlled within a month. At the last follow-up, EEG was normal in 10. Psychomotor development was normal in 8, mild delay in 5, severe delay in 4. Genetic analysis did not show any meaningful results.

Conclusions

The clinical characteristics and disease courses of pyridoxine responsive IS and TPM-control IS were similar, which possibly clued for a same pathogenic mechanism. Pyridoxine should be tried first in all IS patients, even in symptomatic cases. If patients were not responsive to pyridoxine, TPM could be tried.

https://ift.tt/2HsTIrf

Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients

Abstract

Background

Current recommendations for hernia treatment suggest applying techniques aimed at reducing postoperative pain in patients experiencing intense preoperative pain. However, there is still no reliable stratification method of preoperative pain, its circumstances, intensity and frequency, and the current assessments of hernia symptoms are performed by means of a subjective evaluation. The aim of this work is to discuss preoperative pain before hernia repair and determine its nature depending on the type and length of hernia persistence and the patient's age.

Materials and methods

The data from 1647 patients before inguinal hernia repairs (2010–2017) were registered prospectively in the National Hernia Repair Register (demographic data, pain score and influence on everyday activities).

Results

The most common symptom upon admission was pain (949 patients at rest; 57.6% and 1561 at physical activity; 94.8%). A significant influence of hernia persistence on the pain occurrence and intensity was not observed between patients with hernia < 12-months (60.8%;VAS5.0) and > 5-years (58.3%;VAS5.4) (p = 0.068). The occurrence and intensity of pain was significantly higher patients < 40-years (63.7%;VAS5.4) than patients > 60-years (54.3%;VAS4.8) (p = 0.008).

Conclusions

While pain at rest is not a significant problem, undertaking physical activities may intensify pain and increase the number of patients suffering from it. Preoperative assessment of pain may help determine the group of younger patients who could benefit the most from inguinal hernia repair. New indications for prompter admission for treatment should be planned in future studies of patients showing pain at rest for possible prevention of postoperative neuropathy.

https://ift.tt/2Juy42t

Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes

Abstract

Purpose

To compare the perioperative outcomes of initial, consecutive robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair (IHR) cases with consecutive open cases completed by the same surgeons.

Methods

Multicenter, retrospective, comparative study of perioperative results from open and robotic IHR using standard univariate and multivariate regression analyses for propensity score matched (1:1) cohorts.

Results

Seven general surgeons at six institutions contributed 602 consecutive open IHR and 652 consecutive R-TAPP IHR cases. Baseline patient characteristics in the unmatched groups were similar with the exception of previous abdominal surgery and all baseline characteristics were comparable in the matched cohorts. In matched analyses, postoperative complications prior to discharge were comparable. However, from post discharge through 30 days, fewer patients experienced complications in the R-TAPP group than in the open group [4.3% vs 7.7% (p = 0.047)]. The R-TAPP group had no reoperations post discharge through 30 days of follow-up compared with five patients (1.1%) in the open group (p = 0.062), respectively. Multivariate logistic regression analysis which demonstrated patient age > 65 years and the open approach were risk factors for complications within 30 days post discharge in the matched group [age > 65 years: odds ratio (OR) = 3.33 (95% CI 1.89, 5.87; p < 0.0001); open approach: OR = 1.89 (95% CI 1.05, 3.38; p = 0.031)].

Conclusions

In this matched analysis, R-TAPP provides similar postoperative complications prior to discharge and a lower rate of postoperative complications through 30 days compared to open repair. R-TAPP is a promising and reproducible approach, and may facilitate adoption of minimally invasive repairs of inguinal hernias.

https://ift.tt/2KdeGbg

Blind method regarding the effect of dexmedetomidine on CRBD

https://ift.tt/2Kiwx0z

Atraumatic tension hemothorax associated with ruptured aneurysm of intercostal artery–azygous fistula: a case report

Abstract

Atraumatic tension hemothorax is extremely rare. We report a case of 62-year-old woman presented with obstructive and hypovolemic shock status by tension hemothorax due to ruptured aneurysm of congenital intercostal artery–azygous fistula. Contrast-enhanced computed tomography and aortography revealed an aberrant 12th intercostal artery flowing into the aneurysm with a fistula draining into the azygous vein and the rupture of aneurysm. Our experience indicates that the rupture of congenital arteriovenous fistulas (AVFs) of systemic circulation in the thoracic cavity might cause not only hypovolemic shock but also atraumatic tension hemothorax. Surgery following preoperative endovascular embolization offers a feasible treatment strategy for ruptured aneurysms associated with AVFs.

https://ift.tt/2JoYMth

Author’s Reply to Cheung et al. Comment on: “Endurance Performance is Influenced by Perceptions of Pain and Temperature: Theory, Applications and Safety Considerations”

https://ift.tt/2I0Kpfa

Comment on: “Endurance Performance is Influenced by Perceptions of Pain and Temperature: Theory, Applications and Safety Considerations”

https://ift.tt/2Fj3kin

Molecular Cloning and Identification of the 2′–5′ Oligoadenylate Synthetase 2 Gene in Chinese Domestic Pigs Through Bioinformatics Analysis, and Determination of Its Antiviral Activity Against Porcine Reproductive and Respiratory Syndrome Virus Infection

Abstract

An interferon-mediated antiviral protein, 2′–5′ oligoadenylate synthetase 2, plays an important role in the antiviral response of interferons. In this study, 2′–5′ oligoadenylate synthetase 2 genes were cloned from Chinese domestic pigs. Bioinformatics analysis revealed that the 2024-bp long open reading fame encodes 707 amino acids. There are two conserved regions in this protein: the nucleotidyltransferase domain, and the 2′–5′ oligoadenylate synthetase domain (OAS). Genetic evolution analysis showed that the 2′–5′ oligoadenylate synthetase 2 gene in domestic pigs is closely related to that of cattle. There are multiple antigenic sites, no signal peptide, and no transmembrane region in the gene, which is predicted to be a hydrophilic protein. Secondary structures were found to be mainly alpha helix-based; its tertiary structure is close to that of humans and cattle, but not that of mice. Tissue distribution results indicated that this protein is distributed in multiple organs, with high distribution in the liver; it is mainly localized in the cytoplasm. PRRSV infection, interferon-beta, and Poly(I: C) treatment all promoted 2′–5′ oligoadenylate synthetase 2 gene expression. Overexpression and RNA silencing of porcine OAS2 inhibited and promoted PRRSV replication in cells, respectively. The inhibitory effect of porcine OAS2 was mainly dependent on RNase L, similar to what was predicted. This study has laid the foundation for future antiviral studies in pig, and provided a new way of preventing and treating PRRSV in the future.

https://ift.tt/2qZPTyA

Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges

Abstract

The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a "plumb line" to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying  reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.

https://ift.tt/2r2mC7i

Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature

Abstract

Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.

https://ift.tt/2vUqzjc

An improved method of locality-sensitive hashing for scalable instance matching

Abstract

In this study, we propose a scalable approach for automatically identifying similar candidate instance pairs in very large datasets. Efficient candidate pair generation is an essential to many computational problems involving calculation of instance similarities. Calculating similarities of instances with a large number of properties and efficiently matching a large number of similar instances in a scalable way are two significant bottlenecks of candidate instance pair generation. In our approach, we utilize locality-sensitive hashing (LSH) technique to greatly improve the scalability of candidate instance pair generation. Based on the candidate similarity threshold, our algorithm automatically discovers the optimum number of hash functions in each band in LSH. Moreover, we evaluated the scalability of our approach and its effectiveness in instance matching task using real-world very large datasets.

https://ift.tt/2FjjqZb

A systematic wavelet-based exploratory analysis of climatic variables

Abstract

Nonstationarity and time scale dependence are essential features of the climate system that may be dealt with simultaneously using wavelet analysis. In this study, we present a systematic analysis of a set of climate system variables, which include both natural and anthropogenic contributions, using wavelet-based exploratory methods. The tools of the continuous wavelet transform, the wavelet spectrum, coherence, and phase offer a comprehensive assessment of the characteristic modes of variability of climate system forcings and of the scale-based relationships of anthropogenic and natural climate variables with global surface temperature. Shorter-term variations in global surface temperature are associated with internally generated natural climate variability and external climate forcings, while longer-term variations are strongly related to human-induced changes only. In this respect, a long-term component of the net radiative forcing of human activities longer than 30 years displays a statistically significant relationship with global warming and cooling periods identified in the climate change literature.

https://ift.tt/2HtE5Qe

Leveraging sUAS for Infrastructure Network Exploration and Failure Isolation

Abstract

Large-scale infrastructures are prone to simultaneous faults when struck by a natural or man-made event. The current operating procedure followed by many utilities needs improvement, both in terms of monitoring performance and time to repair. Motivated by the recent technological progress on small Unmanned Aerial Systems (sUAS), we propose a practical framework to integrate the monitoring capabilities of sUAS into standard utility repair operations. A key aspect of our framework is the use of monitoring locations for sUAS-based inspection of failures within a certain spatial zone (called a localization set). This set is defined based on the alerts from fixed sensors or customer calls. The positioning of monitoring locations is subject to several factors such as sUAS platform, network topology, and airspace restrictions. We formulate the problem of minimizing the maximum time to respond to all failures by routing repair vehicles to various localization sets and exploring these sets using sUAS. The formulation admits a natural decomposition into two sub-problems: the sUAS Network Exploration Problem (SNEP); and the Repair Vehicle Routing Problem (RVRP). Standard solvers can be used to solve the RVRP in a scalable manner; however, solving the SNEP for each localization set can be computationally challenging. To address this limitation, we propose a set cover based heuristic to approximately solve the SNEP. We implement the overall framework on a benchmark network.

https://ift.tt/2JrIijZ

Enriched Environment Elicits Proangiogenic Mechanisms After Focal Cerebral Ischemia

Abstract

Brain has limited capacity for spontaneous recovery of lost function after stroke. Exposure to enriched environment (EE) can facilitate functional recovery, but mechanisms underlying this effect are poorly understood. Here, we used a middle cerebral artery occlusion (MCAO) model to investigate the impact of EE on angiogenesis in the post-ischemic brain in adult male Sprague Dawley rats, and examined whether blood-borne factors may contribute. Compared with standard cage (SC), exposure to EE was associated with greater improvement in neurological function, higher peri-infarct vascular density, and higher chronic post-ischemic cerebral blood flow assessed by laser speckle imaging. The effect persisted for at least 28 days. EE also enhanced the expression of hepatocyte growth factor in the peri-ischemic cortex when measured 15 days after MCAO. Interestingly, serum from rats exposed to EE after MCAO showed elevated levels of hepatocyte growth factor, and plasma or serum from rats exposed to EE after MCAO enhanced the survival and proliferation of cultured endothelial cells, in vitro, when compared with control plasma or serum from SC group after MCAO. Together, our data suggest that exposure to EE promotes angiogenesis in the ischemic brain that may in part be mediated by blood-borne factors.

https://ift.tt/2Fj2CBz

Investigating species boundaries using DNA and morphology in the mite Tyrophagus curvipenis (Acari: Acaridae), an emerging invasive pest, with a molecular phylogeny of the genus Tyrophagus

Abstract

Mites of the genus Tyrophagus (Acari: Acaridae) are among the most widespread and common mites, inhabiting diverse natural and anthropogenic habitats. Some species are pests of agricultural products and stored food and/or live in house dust, causing allergies to humans. We sequenced 1.2 kb of the mitochondrial COI gene for 38 individuals belonging to seven species of Tyrophagus, including T. curvipenis, T. putrescentiae, T. fanetzhangorum, T. longior, T. perniciosus, and T. cf. similis. Molecular phylogenetic analyses (1) recovered two major clades corresponding to the presence or absence of eyespots, and (2) separated all included morphological species. Tyrophagus curvipenis and T. putrescentiae had the lowest between-species genetic distances (range, mean ± SD): 14.20–16.30, 15.17 ± 0.40 (K2P). The highest within-species variation was found in T. putrescentiae 0.00–4.33, 1.78 ± 1.44 (K2P). In this species, we recovered two distinct groups; however, no geographical or ecological dissimilarities were observed between them. Based on our analyses, we document important morphological differences between T. curvipenis and T. putrescentiae. For the first time, we record the occurrence of T. curvipenis in the New World and suggest that it may be an emerging pest as it is currently spreading in agricultural produce.

https://ift.tt/2JtUoJz

HER2 genomic amplification in circulating tumor DNA and estrogen receptor positivity predict primary resistance to trastuzumab emtansine (T-DM1) in patients with HER2-positive metastatic breast cancer

Abstract

Background

Trastuzumab emtansine (T-DM1) is approved for the treatment of patients with human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer (ABC), and has high efficacy. However, some patients exhibit primary resistance to T-DM1, and thus methods that can predict resistance in clinical practice are needed. Genomic analysis of circulating tumor DNA (ctDNA) in plasma is a non-invasive and reproducible method. This study aimed to predict primary resistance to T-DM1 by combining genomic analysis of ctDNA and other clinicopathological features of patients with HER2-positive ABC.

Methods

The study population comprised 34 patients with HER2-positive ABC who had been treated with T-DM1. Correlations between clinicopathological characteristics of patients and primary resistance to T-DM1 were examined, and HER2 gene copy number and PIK3CA gene mutations were analyzed using plasma ctDNA samples obtained from 16 patients before T-DM1 administration.

Results

Among the 34 patients, nine (26.5%) had progressive disease at the first efficacy analysis; these patients were considered to have primary resistance to T-DM1. No significant difference was found in the rate of primary resistance to T-DM1 between groups. Among 16 patients whose ctDNA was analyzed, four showed primary resistance to T-DM1. These four patients showed negative HER2 gene amplification in ctDNA and were ER-positive and/or PR-positive by immunohistochemistry.

Conclusions

HER2 gene amplification in ctDNA and ER and PR status may predict primary resistance to T-DM1. A liquid biopsy before the initiation of T-DM1 treatment could be a non-invasive way to predict whether a patient would exhibit primary resistance to T-DM1.

https://ift.tt/2HvAFbE

Changes in the ADC of diffusion-weighted MRI with the oscillating gradient spin-echo (OGSE) sequence due to differences in substrate viscosities

Abstract

Purpose

Compared with the conventional pulsed gradient spin-echo (PGSE) sequence, diffusion-weighted imaging (DWI) with the oscillating gradient spin-echo (OGSE) sequence can shorten the diffusion time by changing the frequency. The purpose was to investigate whether n-alkanes are suitable as isotropic phantoms for estimating the diffusion coefficient with the OGSE sequence.

Materials and methods

We investigated changes in the apparent diffusion coefficient (ADC) due to differences in the viscosities of nine n-alkane phantoms with different numbers of carbon atoms from C₈H₁₈ to C₁₆H₃₄ using OGSE and PGSE sequences at 21 °C. Effective diffusion times of 4.3, 5.1, 6.5, 9.3, 20, 40, and 60 ms were used. The T₂ relaxation times of each n-alkane phantom were measured using quantitative synthetic magnetic resonance imaging (MRI). Circular regions of interest were placed manually within the alkane phantoms on ADC and T₂ maps.

Results

In each alkane phantom, changes in mean ADC values were almost constant with changes in diffusion times. Viscosities and ADC values showed inverse proportionality, as expected theoretically.

Conclusion

The ADC values of alkanes do not depend on diffusion times. The n-alkanes can be useful phantoms for assessing the accuracy of clinical protocols of DWI with the OGSE sequence.

https://ift.tt/2vMtaf7

A smoothed monotonic regression via L2 regularization

Abstract

Monotonic regression is a standard method for extracting a monotone function from non-monotonic data, and it is used in many applications. However, a known drawback of this method is that its fitted response is a piecewise constant function, while practical response functions are often required to be continuous. The method proposed in this paper achieves monotonicity and smoothness of the regression by introducing an L2 regularization term. In order to achieve a low computational complexity and at the same time to provide a high predictive power of the method, we introduce a probabilistically motivated approach for selecting the regularization parameters. In addition, we present a technique for correcting inconsistencies on the boundary. We show that the complexity of the proposed method is \(O(n^2)\) . Our simulations demonstrate that when the data are large and the expected response is a complicated function (which is typical in machine learning applications) or when there is a change point in the response, the proposed method has a higher predictive power than many of the existing methods.

https://ift.tt/2vSrCQY

Conventional repair of total anomalous venous drainage without primary sutureless technique: surgical tips to prevent pulmonary vein obstruction

Abstract

Objectives

Although primary sutureless technique for total anomalous pulmonary venous drainage has been introduced to reduce postoperative pulmonary vein obstruction (PVO), controversy still exists about superiority of the procedure between the conventional repair and primary sutureless technique at the initial repair. In our unit, the conventional repair has been consistently used based on four important surgical policies: (1) mark incision lines between 2 chambers to gain anatomically natural alignment, (2) place precise stitches by "intima-to-intima" using monofilament suture, (3) adequate orifice size should be guaranteed in greater than expected mitral valve size, (4) do not hesitate to undertake a redo additional anastomosis by a different approach when an echocardiography shows the velocity more than 1.5 m/s. This study aims to evaluate mid-term outcome of the conventional repair for total anomalous pulmonary venous drainage.

Methods

Between 2004 and 2016, consecutive 15 patients who underwent the conventional repair without the primary sutureless technique were included in this study. Survival, Freedom from reoperation, and PVO were retrospectively reviewed.

Results

Mean follow-up period was 4.6 ± 3.7 years. Except for one patient who died of uncontrollable pleural effusion, all other patients survived with 5-year survival rate of 93.3%. For the 14 survivors, there was no PVO, nor reoperation.

Conclusions

Following these policies, the mid-term outcome of the conventional total anomalous pulmonary venous drainage repair was excellent without the primary sutureless technique showing no obstruction. The conventional repair can be safely applied at the initial operation when the morphological condition allows for it.

https://ift.tt/2r0ml4V

Analysis of radiological parameters associated with decreased fractional anisotropy values on diffusion tensor imaging in patients with lumbar spinal stenosis

Abstract

Purpose

Previous studies have indicated that decreased fractional anisotropy (FA) values on diffusion tensor imaging (DTI) are well correlated with the symptoms of nerve root compression. The aim of our study is to determine primary radiological parameters associated with decreased FA values in patients with lumbar spinal stenosis involving single L5 nerve root.

Methods

Patients confirmed with single L5 nerve root compression by transforaminal nerve root blocks were included in this study. FA values of L5 nerve roots on both symptomatic and asymptomatic side were obtained. Conventional radiological parameters, such as disc height, degenerative scoliosis, dural sac cross-sectional area (DSCSA), foraminal height (FH), hypertrophic facet joint degeneration (HFJD), sagittal rotation (SR), sedimentation sign, sagittal translation and traction spur were measured. Correlation and regression analyses were performed between the radiological parameters and FA values of the symptomatic L5 nerve roots. A predictive regression equation was established.

Results

Twenty-one patients were included in this study. FA values were significantly lower at the symptomatic side comparing to the asymptomatic side (0.263 ± 0.069 vs. 0.334 ± 0.080, P = 0.038). DSCSA, FH, HFJD, and SR were significantly correlated with the decreased FA values, with r = 0.518, 0.443, 0.472 and − 0.910, respectively (P < 0.05). DSCSA and SR were found to be the primary radiological parameters related to the decreased FA values, and the regression equation is FA = − 0.012 × SR + 0.002 × DSCSA.

Conclusions

DSCSA and SR were primary contributors to decreased FA values in LSS patients involving single L5 nerve root, indicating that central canal decompression and segmental stability should be the first considerations in preoperative planning of these patients.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

https://ift.tt/2HNQgXL

Patterns and Trends of the Pesticide Pollution of the Shallow Nile Delta Aquifer (Egypt)

Abstract

Two hundred forty-nine groundwater samples collected from 55 irrigation water supply wells in Al-Mahala Al-Kubra, Samannoud, and Al-Santa districts of the Gharbiya Governorate (Egypt) during a monitoring survey carried out in January, June, and in November in 3 years (2013–2015). The prime objective was to document, for the first time, the status and sustained trends in the concentrations of pesticides in the shallow Nile Delta aquifer. The non-parametric Mann–Kendall and Thiel–Sen trend statistical tests were applied for detection and estimation of trends and their magnitude. Violation of standards clarified emergence of methyl parathion (98.1%), endrin (97.9%), endosulfan sulfate (96.5%), dieldrin (55.3%), atrazine (42.3%), and simazine (40.4%), in decreasing order of abundances. Malathion obeyed the permissible limits (900 μg L⁻¹) in all samples. Methyl parathion showed an average rate of deterioration (μg L⁻¹ year⁻¹) of 0.82 that was largest in Al-Santa (1.0) followed by Al-Mahala Al-Kubra (0.63). Malathion proved the second largest rate emerging in Al-Mahala Al-Kubra (0.67) followed by Al-Santa (0.65). Endosulfan sulfate came third in deterioration rate (av. 0.37) followed by endrin (av. 0.32), atrazine (av. 0.32), dieldrin (av. 0.25), and simazine (av. 0.23). Groundwater improvements of pesticide contents propagated faster eastward and northward associated with larger surface water recharge rates from dense complex irrigation canals through thicker topmost silty clay layer and thicker peat layers inter-bedded in the sediments. For sustainable agriculture to alleviate negative impacts on groundwater resources and the environment, the use of ecofriendly bio-degradable or quickly deactivated pesticides along with awareness of farmers with the health hazards and the protective measures while handling pesticides are strongly recommended.

https://ift.tt/2HZHi7j

Parametric Study on Formation Flying Effectiveness for a Blended-Wing UAV

Abstract

This paper investigates aerodynamic performance improvements of formation flight at transonic speeds for a medium size Unmanned Aerial Vehicle (UAV). The metric for assessing the aerodynamic improvement of formation flight is the computed drag. The total drag for each formation configuration is compared with a single UAV, where a final drag reduction percentage is estimated. The evaluation of the aerodynamic performance is conducted by employing an in-house Computational Fluid Dynamics (CFD) solver, grid generation and post processing tools. For critical understanding of the tendency of the formation efficiency depending on main parameters, broad formation configurations are analysed. The parameterisation includes number of aircraft, proximity and formation shape. Full realisation of the benefit predicted would need to be proven in the real world, but there is sufficient confidence to suggest that it exist: the empirical parametric analysis suggests that formation flight can improves aerodynamic performance and formation configuration greatly influence the degree of improvement.

https://ift.tt/2r2q94G

Essential Elements of Early Post Discharge Care of Patients with Heart Failure

Abstract

Purpose of Review

Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis. It can also provide opportunities for medication reconciliation and optimization, consideration of device-based therapies, appropriate management of comorbidities, identification of individual barriers to care, and a discussion of goals of care based on prognosis.

Recent Findings

Recent studies suggest that attention to detail regarding patient comorbidities, barriers to care, optimization of both diuretic and neurohormonal therapies, and assessment of prognosis improve patient outcomes. Despite the fact that the transition period appears to be an optimal time to address these issues in a comprehensive manner, most patients are not referred to programs specializing in this approach post hospital discharge.

Summary

The objective of this review is to provide an outline for early post discharge care that allows clinicians and other health care providers to care for these heart failure patients in a manner that is both firmly rooted in the guidelines and patient-centered. Data regarding which intervention is most likely to confer benefit to which subset of patients with this disease is lacking and warrants further study.

https://ift.tt/2Hv85Ho

Halving the volume of AnaConDa: initial clinical experience with a new small-volume anaesthetic reflector in critically ill patients—a quality improvement project

Abstract

AnaConDa-100 ml (ACD-100, Sedana Medical, Uppsala, Sweden) is well established for inhalation sedation in the intensive care unit. But because of its large dead space, the system can retain carbon dioxide (CO₂) and increase ventilatory demands. We therefore evaluated whether AnaConDa-50 ml (ACD-50), a device with half the internal volume, reduces CO₂ retention and ventilatory demands during sedation of invasively ventilated, critically ill patients. Ten patients participated in this cross-over protocol. After sedation with isoflurane via ACD-100 for 24 h, the 5-h observation period started. During the first hour, ACD-100 was used; for the next 2 h, ACD-50; and for the last 2 h, ACD-100 was used again. Sedation was titrated to Richmond Agitation and Sedation Scale (RASS) score − 3 to − 4 and a processed electroencephalogram (Narcotrend Index, Narcotrend-Gruppe, Hannover, Germany) was recorded. Minute ventilation, CO₂ elimination, and isoflurane consumption were compared. All patients were deeply sedated (Narcotrend Index, mean ± SD: 38 ± 10; RASS scores − 3 to − 5) and breathed spontaneously with pressure support throughout the observation period. Infusion rates of isoflurane and opioid, either remifentanil or sufentanil, as well as ventilator settings were unchanged. Minute ventilation and end-tidal CO₂ were significantly reduced with the ACD-50, respiratory rate remained unchanged, and tidal volume decreased by 66 ± 43 ml. End-tidal isoflurane concentrations were also slightly reduced while haemodynamic measures remained constant. The ACD-50 reduces the tidal volume needed to eliminate carbon dioxide without augmenting isoflurane consumption.

https://ift.tt/2I0ytKh

Announcements

https://ift.tt/2HRavUk

Efficacy of two types of palliative sedation therapy defined using intervention protocols: proportional vs. deep sedation

Abstract

Purpose

This study investigated the effect of two types of palliative sedation defined using intervention protocols: proportional and deep sedation.

Methods

We retrospectively analyzed prospectively recorded data of consecutive cancer patients who received the continuous infusion of midazolam in a palliative care unit. Attending physicians chose the sedation protocol based on each patient's wish, symptom severity, prognosis, and refractoriness of suffering. The primary endpoint was a treatment goal achievement at 4 h: in proportional sedation, the achievement of symptom relief (Support Team Assessment Schedule (STAS) ≤ 1) and absence of agitation (modified Richmond Agitation-Sedation Scale (RASS) ≤ 0) and in deep sedation, the achievement of deep sedation (RASS ≤ − 4). Secondary endpoints included mean scores of STAS and RASS, deep sedation as a result, and adverse events.

Results

Among 398 patients who died during the period, 32 received proportional and 18 received deep sedation. The treatment goal achievement rate was 68.8% (22/32, 95% confidence interval 52.7–84.9) in the proportional sedation group vs. 83.3% (15/18, 66.1–100) in the deep sedation group. STAS decreased from 3.8 to 0.8 with proportional sedation at 4 h vs. 3.7 to 0.3 with deep sedation; RASS decreased from + 1.2 to − 1.7 vs. + 1.4 to − 3.7, respectively. Deep sedation was needed as a result in 31.3% (10/32) of the proportional sedation group. No fatal events that were considered as probably or definitely related to the intervention occurred.

Conclusion

The two types of intervention protocol well reflected the treatment intention and expected outcomes. Further, large-scale cohort studies are promising.

https://ift.tt/2HTjRiu

Predictors of analgesic efficacy of neurolytic celiac plexus block in patients with unresectable pancreatic cancer: the importance of timing

Abstract

Background

Neurolytic celiac plexus block (NCPB) is a safe and effective method for reducing abdominal cancer pain. However, the analgesic efficacy of NCPB is not always guaranteed. The aim of this retrospective study was to identify predictors for the analgesic efficacy of NCPB in patients with unresectable pancreatic cancer.

Methods

Patients with unresectable pancreatic cancer who underwent NCPB from 2006 to 2015 were enrolled. Good analgesia after NCPB was defined as ≥ 50% reduction in pain score at day 30. Patient demographics, cancer characteristics, and pain-related factors were evaluated using a logistic regression analysis to identify predictors for good analgesia after NCPB. Additionally, survival outcomes were compared between patients with poor and good analgesia after NCPB.

Results

A total of 112 patients satisfied the study protocol requirements. Forty-seven patients (41.9%) showed good analgesia after NCPB. Better performance status, lower serum CA 19-9 level, shorter pain duration, and lower opioid dose were observed in patients with good analgesia after NCPB. Good performance status (ECOG performance status 1 vs. 2 or 3, OR = 2.737, 95% CI = 1.149 to 6.518, P = 0.023) and low daily opioid use (< 150 vs. ≥ 150 mg, OR = 2.813, 95% CI = 1.159 to 6.831, P = 0.022) before NCPB were independent predictors of good analgesia after NCPB. The median survival was significantly lower for patients with poor analgesia after NCPB (68 vs. 150 days, P < 0.001).

Conclusion

NCPB should be offered early to selected patients to improve its analgesic efficacy in advance of deterioration from disease and pain in this population.

https://ift.tt/2JqYEte

Response to letter to the editor

https://ift.tt/2HR8FTe

Sexual health in patients with hematological malignancies: a neglected issue

Abstract

Current evidence, although limited, outlines that sexual dysfunction may represent a prominent part of the symptom burden experienced by the patients with hematologic malignancies (HM). However, despite their presumed negative effects on quality of life (QoL), sexual health is not typically considered in the QoL assessment of HM patients. In addition, very few studies have been conducted in this area. Therefore, it would be important to further investigate how newer drugs developed in recent years for patients with HM, including targeted therapies and impact on sexual health, and how this influence overall patients' QoL outcomes.

https://ift.tt/2HxXQT3

The views of patients with metastatic prostate cancer towards physical activity: a qualitative exploration

Abstract

Purpose

Patients with metastatic cancer can experience debilitating symptoms, which may influence attitudes towards and engagement in physical activity. This study aimed to examine the attitudes of patients living with metastatic prostate cancer towards physical activity.

Materials and methods

Semi-structured interviews were completed with male patients living with metastatic prostate cancer. Interviews included eight questions related to patients' attitudes towards physical activity. Content analysis was conducted on the transcribed interview data. Twenty men with metastatic prostate cancer (mean age 71 ± 8.5 years; body mass index 30.19 ± 5.37 kg/cm²) and associated bone metastases (55% with > 2 regions affected) participated in the study.

Results

Men's views towards physical activity were coded into the following major themes: (1) barriers to physical activity, (2) benefits of physical activity, (3) a reduction in physical activity levels post diagnosis and (4) social support for physical activity. Symptoms of metastatic prostate cancer and treatment side effects including pain and fatigue negatively influenced activity participation. In addition, many generic barriers to physical activity were described such as bad weather and a lack of suitable facilities for exercising in rural areas.

Conclusion

Men living with metastatic prostate cancer have unique needs regarding physical activity related to symptoms of both their cancer and cancer treatment. There is a need to increase prompts that encourage those with metastatic prostate cancer to maintain/increase physical activity levels post diagnosis. Given the individualised needs of this patient group, referral to a cancer exercise specialist should be considered for prescription of tailored physical activity programmes.

Trial registration

Clinicaltrials.gov NLM Identifier: NCT02453139

https://ift.tt/2qWd0u2

Chemotherapy-induced nausea and vomiting (CINV) in patients with advanced lung cancer during the first-line treatment: assessment by physicians, nurses, and patients from an Italian multicenter survey

Abstract

Purpose

Chemotherapy-induced nausea and vomiting (CINV) still represents a common side-effect of chemotherapy, and often, its perception differs between patients and healthcare professionals. The aim of this study was to evaluate the agreement on the perception of CINV and other items among clinicians, patients, and nurses.

Methods

This observational prospective study was part of an evaluation program promoted by the Women Against Lung Cancer in Europe (WALCE) Onlus. From August 2015 to February 2016, a survey was administered in 11 oncologic institutions to 188 stage IV lung cancer patients and to their oncologists and nurses during first-line chemotherapy. Our survey investigated 11 aspects: anxiety, mood, weakness, appetite, nausea, vomiting, pain, drowsiness, breath, general condition, and trust in treatments. These items were assessed through Numerical Rating Scale at four consecutive evaluations: at T0 (immediately prior to the first cycle), at T1 (immediately prior to the second cycle), at T2 (immediately prior to the third cycle), and at T3 (immediately prior to the fourth cycle). Clinician versus patient (CvP), nurse versus patient (NvP), and clinician versus nurse (CvN) agreements were estimated applying Weighted Cohen's kappa. A multivariate logistic model and generalized equation estimates were applied to evaluate factors possibly influencing CINV development.

Results

The incidence of patients reporting CINV varied from 40% at T0 to 71% at T3. Both CvP and NvP agreement on the investigated items were mainly moderate, slightly increasing over time, and becoming substantial for some items, in particular for NvP. Pre-chemotherapy anxiety in its mild, moderate, and severe manifestations, as well as mild, moderate, and severe anxiety experienced after chemotherapy start, exposed patients to a higher risk of anticipatory and acute/delayed CINV, respectively.

Conclusions

Despite clinical staff awareness of patients' status and perceptions, CINV still represents a clinical problem. This study confirms that particular attention should be paid to anxiety due to its key role in CINV development.

https://ift.tt/2qYFHam

Associations among physical symptoms, fear of cancer recurrence, and emotional well-being among Chinese American breast cancer survivors: a path model

Abstract

Purpose

Most existing studies on fear of cancer recurrence (FCR) are exploratory without theoretical underpinnings and have been conducted among non-Hispanic Whites. Based on theoretical models, we hypothesized that more physical symptoms (pain and fatigue) would be associated with higher FCR, which, in turn would be related to lower emotional well-being among Chinese American breast cancer survivors.

Methods

Participants were 77 Chinese American women who were diagnosed with breast cancer of stages 0–III. A cross-sectional path analysis was conducted with a bootstrapping method.

Results

The final model showed that indirect paths from pain interference to emotional well-being and from fatigue to emotional well-being via FCR were significant. That is, higher levels of pain interference and fatigue were associated with higher FCR, which was further related to lower emotional well-being.

Conclusions

To our best knowledge, this is the first theory-driven study that investigates FCR experiences among Chinese American breast cancer survivors. Our study might provide a more comprehensive understanding of FCR as it simultaneously shows predictors and a psychological consequence of FCR. Results need to be replicated in large, racially/ethnically diverse samples and longitudinal studies.

https://ift.tt/2r2SCHw

Bismuth adjuvant and adverse effects of chemotherapy: issues with statistical analyses

https://ift.tt/2HxXvjf

Vitamin “G”arden: a qualitative study exploring perception/s of horticultural therapy on a palliative care ward

Abstract

Purpose

In a palliative care setting, the preservation of quality of life is of particular importance. Horticultural therapy (HT) is reported as an excellent way to improve physical as well as psychological well-being, reduce levels of anxiety and depression, and promote social interaction. The use of horticultural interventions in palliative care has not yet been explored. The aim of this study was to explore the effects of HT in patients and team members on a palliative care ward.

Methods

This study was based on a qualitative methodology, comprising 20 semistructured interviews with 15 advanced cancer patients participating in HT and with 5 members of the palliative care team. Interviews were analyzed using NVivo 10 software based on thematic analysis.

Results

The results revealed the following themes: (1) well-being, (2) variation of clinical routine, (3) creation, and (4) building relationships. Patients experienced positive stimulation through HT, were distracted from daily clinical routines, enjoyed creative work, and were able to build relationships with other patients. HT was also welcomed by the members of the palliative care team. Thirty-six percent of the patients did not meet the inclusion criteria, and 45% could not participate in the second or third HT session.

Conclusions

Our study showed that the availability of HT was highly appreciated by the patients as well as by the palliative care team. Nevertheless, the dropout rate was high, and therefore, it might be more feasible to integrate green spaces into palliative care wards.

https://ift.tt/2HT2iPo

Administrating docetaxel, doxorubicin, and cyclophosphamide as a neoadjuvant treatment may decrease lymphedema risk in breast cancer patients

https://ift.tt/2Js8yLi

Diagnostic-driven antifungal approach in neutropenic patients at high risk for chronic disseminated candidiasis: preliminary observations on the role of 1,3-β-D-glucan antigenemia and multiphasic contrast-enhanced computed tomography

https://ift.tt/2HT2iim

Sleep disturbance among Chinese breast cancer survivors living in the USA

Abstract

Purpose

Emerging evidence suggests Chinese breast cancer survivors, a largely understudied population, are at increased risk of sleep disturbance which can have significant impacts on quality of life and other important outcomes. This study aims to describe sleep disturbance among Chinese breast cancer survivors and to examine demographic and clinical correlates as well as psychosocial correlates of sleep disturbance.

Methods

Data from 80 Chinese breast cancer survivors in the USA completed the Chinese version of the Pittsburgh Sleep Quality Index as well as measures of quality of life, depressive symptoms, and perceived stress. Participants also completed measures of demographic factors and acculturation.

Results

Two thirds (66%) of survivors experienced elevated sleep disturbance. Approximately half (49%) reported sleep efficiency, the percentage of time in bed that is spent asleep, that was below the recommended cutoff. Compared to those without sleep disturbance, those with sleep disturbance had worse quality of life, more depressive symptoms, and more perceived stress (ps ≤ .01).

Conclusions

This study is among the first to examine sleep disturbance among any Asian cancer population in the USA. Findings indicate Chinese breast cancer survivors may experience significant disparities in sleep disturbance relative to non-Hispanic Whites and suggest an urgent need for interventions to address sleep disturbance among Chinese breast cancer survivors.

https://ift.tt/2Hw1nBg

Transfusion practice patterns in patients with anemia receiving myelosuppressive chemotherapy for nonmyeloid cancer: results from a prospective observational study

Abstract

Purpose

The decision to prescribe packed red blood cell (PRBC) transfusions in patients with chemotherapy-induced anemia (CIA) includes assessment of clinical features such as the patient's cancer type and treatment regimen, severity of anemia symptoms, and presence of comorbidities. We examined contemporary transfusion practices in patients with nonmyeloid cancer and CIA.

Methods

Key inclusion criteria were age ≥ 18 years with nonmyeloid cancer, receiving first/second-line myelosuppressive chemotherapy, baseline hemoglobin (Hb) ≤ 10.0 g/dL, and planned to receive ≥ 1 PRBC transfusions. Exclusion criteria were receipt of erythropoiesis-stimulating agents within 8 weeks of screening and/or chronic renal insufficiency. Data were collected from patients' medical records, laboratory values, and physician/provider questionnaires. Proportion of patients for each clinical consideration leading to a decision to prescribe a PRBC transfusion and 95% exact binomial confidence intervals were determined.

Results

The study enrolled 154 patients at 18 sites in USA; 147 (95.5%) received a PRBC transfusion. Fatigue was the most common symptom affecting the decision to prescribe a PRBC transfusion (101 [69.2%] patients). Of the three reasons selected as primary considerations for prescribing a PRBC transfusion, anemia symptoms (106 [72.1%] patients) was the most frequently reported, followed by Hb value (37 [25.2%] patients) and medical history (4 [2.7%] patients).

Conclusions

In this study, the primary consideration for prescribing a PRBC transfusion was anemia symptoms in 72.1% of patients, with only 25.2% of patients prescribed a transfusion based exclusively on Hb value. Results indicate that clinical judgment and patient symptoms, not just Hb value, were used in decisions to prescribe PRBC transfusions.

https://ift.tt/2HPlfCx

Stenotrophomonas maltophilia bacteremia and pneumonia at a tertiary-care oncology center: a review of 16 years

Abstract

Purpose

The aim of this study was to describe the clinical characteristics and antimicrobial patterns of Stenotrophomonas maltophilia bloodstream infections (BSI) and pneumonia episodes in patients with cancer.

Methods

Patients with S. maltophilia BSI or pneumonia admitted from 1 Jan. 2000 to 31 Dec. 2016 were identified at the Instituto Nacional de Cancerología (INCan), a tertiary-care oncology hospital in Mexico City.

Results

During the study period, there were 171 isolates identified. The mean age of the whole group was 46.9 ± 17.4 years; 99 (57.9%) were women. There were 95 BSI: 64 ambulatory catheter-related BSI (CRBSI), 20 nosocomial CRBSI, and 11 secondary BSI. Mortality was higher in nosocomial CRBSI (40%) vs. that in ambulatory CRBSI (7.8%) (p = 0.001). There were 76 pneumonia episodes; all were nosocomial acquired; 46 (60.5%) ventilator-associated. From all the group, nine strains (5.2%) were resistant to sulfamethoxazole/trimethoprim/(SMX/TMP). At the first month, 54 patients (31.6%) have died, 38 due to pneumonia (70%) and 16 due to BSI (30%, p < 0.001). Multivariate analysis showed that removal of central venous catheter was associated with a favorable outcome in patients with bacteremia. For patients with pneumonia, age ≥ 65 years and inappropriate antimicrobial treatment were risk factors associated with 30-day mortality.

Conclusions

S. maltophilia related with ambulatory CRBSI have a better prognosis than other sources of BSI. Older patients with pneumonia who do not receive appropriate antibiotics have higher mortality. SMX/TMP is still the antibiotic of choice.

https://ift.tt/2HsnQPC

Digestive toxicities after palliative three-dimensional conformal radiation therapy (3D-CRT) for cervico-thoracic spinal metastases

Abstract

Objective

The palliative treatment for cervico-thoracic spinal metastases is based on a three-dimensional conformal radiation therapy (3D-CRT). Digestive toxicities are common and cause a clinical impact frequently underestimated in patients. We performed a retrospective study of digestive side effects occurring after palliative 3D-CRT for cervico-thoracic spinal metastases.

Patients and methods

All patients receiving palliative 3D-CRT at Jean Bernard Center from January 2013 to December 2014 for spinal metastases between the 5th cervical vertebra (C5) and the 12th thoracic vertebra (T12) were eligible. Three-dimensional conformal RT was delivered by a linear accelerator (CLINAC, Varian). Premedication to prevent digestive toxicities was not used. Adverse events ("esophagitis" and "nausea and/or vomiting") were evaluated according to the NCI-CTCae (version 4).

Results

From January 2013 to December 2014, 128 patients met the study criteria. The median age was 68.6 years [31.8; 88.6]. Most patients (84.4%) received 30 Gy in 10 fractions. The median overall time of treatment was 13 days [3–33]. Forty patients (31.3%) suffered from grade ≥ 2 of "esophagitis" (35 grade 2 (27.4%) and 5 grade 3 (3.9%)). Eight patients (6.3%) suffered from grade ≥ 2 of "nausea and/or vomiting" (6 grade 2 (4.7%), 1 grade 3 (0.8%), and 1 grade 4 (0.8%)).

Conclusion

The high incidence of moderate to severe digestive toxicities after palliative 3D-CRT for cervico-thoracic spinal metastases led to consider static or dynamic intensity-modulated radiation therapy (IMRT) to reduce the dose to organ at risk (the esophagus and stomach). Dosimetric studies and implementation in the clinic should be the next steps.

https://ift.tt/2qXuCGU

Influence of family on expected benefits of complementary and alternative medicine (CAM) in cancer patients

Abstract

Background

Cancer patients often use complementary and alternative medicine (CAM) based on recommendations from family. However, the relationship between family endorsement of CAM and the patient's expectation of its benefits has never been quantified.

Methods

Between 2010 and 2011, we conducted a cross-sectional survey study among patients with a diagnosis of cancer recruited from thoracic, breast, and gastrointestinal medical oncology clinics at a single academic cancer center. We performed multivariate linear regression analyses to evaluate the relationship between perceived family endorsement of and expected benefits from CAM, adjusting for covariates.

Results

Among the 962 participants, 303 (31.3%) reported family endorsement of CAM use. Younger patients and those who had college or higher education were more likely to report family endorsement (both p < 0.05). Patients with family support had expectation scores that were 15.9 higher than patients without family support (coefficient 15.9, 95% CI 13.5, 18.2, p < 0.001). Participants with family encouragement of CAM use were also more likely to expect CAM to cure their cancer (12 vs. 37%) and prolong their life (24 vs. 61%). These relationships remained highly significant after adjusting for covariates).

Conclusions

Family endorsement of CAM use is strongly associated with patient expectation of its clinical efficacy, including expectations for cure and improved survival. These findings underscore the importance of including family in counseling and education on CAM use in order to achieve realistic patient expectations, maximize benefits, and avoid potential medical adverse effects through herb-drug interactions or rejections of conventional care.

https://ift.tt/2Hrc4ca

An investigation into the nutritional status of patients receiving an Enhanced Recovery After Surgery (ERAS) protocol versus standard care following Oesophagectomy

Abstract

Purpose

Enhanced Recovery After Surgery (ERAS) protocols have been effectively expanded to various surgical specialities including oesophagectomy. Despite nutrition being a key component, actual nutrition outcomes and specific guidelines are lacking. This cohort comparison study aims to compare nutritional status and adherence during implementation of a standardised post-operative nutritional support protocol, as part of ERAS, compared to those who received usual care.

Methods

Two groups of patients undergoing resection of oesophageal cancer were studied. Group 1 (n = 17) underwent oesophagectomy between Oct 2014 and Nov 2016 during implementation of an ERAS protocol. Patients in group 2 (n = 16) underwent oesophagectomy between Jan 2011 and Dec 2012 prior to the implementation of ERAS. Demographic, nutritional status, dietary intake and adherence data were collected. Ordinal data was analysed using independent t tests, and categorical data using chi-square tests.

Results

There was no significant difference in nutrition status, dietary intake or length of stay following implementation of an ERAS protocol. Malnutrition remained prevalent in both groups at day 42 post surgery (n = 10, 83% usual care; and n = 9, 60% ERAS). A significant difference was demonstrated in adherence with earlier initiation of oral free fluids (p <0.008), transition to soft diet (p <0.004) and continuation of jejunostomy feeds on discharge (p <0.000) for the ERAS group.

Conclusion

A standardised post-operative nutrition protocol, within an ERAS framework, results in earlier transition to oral intake; however, malnutrition remains prevalent post surgery. Further large-scale studies are warranted to examine individualised decision-making regarding nutrition support within an ERAS protocol.

https://ift.tt/2Jsz0o0

Transfusion practices at end of life for hematopoietic stem cell transplant patients

Abstract

Purpose

Limited data exist regarding transfusion practices at end of life (EOL) for hematopoietic stem cell transplant (HSCT) patients. The purpose of this study was to examine red blood cell (RBC) and platelet transfusion practices in HSCT patients who enrolled or did not enroll in hospice.

Methods

This was a single-center, retrospective chart review in deceased HSCT patients. The primary objective was to determine the mean difference between the last transfusion and death in HSCT patients (n = 116) who enrolled or did not enroll in hospice.

Results

Sixteen (14%) and 100 (86%) patients were enrolled in hospice and not enrolled in hospice, respectively. Hospice patients observed a larger mean difference between death and last transfusion (45.9 ± 66.7 vs. 14.6 ± 48.1 days, p < 0.0001). A higher amount of platelet, but not RBC, transfusions occurred in patients not enrolled in hospice (p = 0.04). The last transfusion that occurred more than 96 h before death was observed in 12 (75%) and 22 (22%) in hospice and non-hospice patients, respectively. For HSCT patients not enrolled in hospice, 17 patients received a transfusion on the same day of death and 31 patients received the last transfusion 24 h before death.

Conclusions

Blood transfusion practices differed in HSCT patients enrolled and not enrolled in hospice. For most patients not enrolled in hospice, the last transfusion occurred 24 h before death. Future efforts should explore if limited access to blood products is a barrier to hospice enrollment for HSCT patients.

https://ift.tt/2HUJq2N

Applying pre-participation exercise screening to breast cancer survivors: a cross-sectional study

Abstract

Purpose

Clinical guidelines recommend that breast cancer (BrCa) survivors be prescribed exercise. However, clinicians often do not prescribe exercise citing the presence of multiple health issues found among cancer survivors. No study has examined the proportion of BrCa survivors that can be prescribed a community/home-based unsupervised exercise program safely and independently, without further medical investigations or supervision.

Methods

Participants included BrCa survivors who received treatment at a university healthcare system between 2009 and 2014. We applied previously identified published guidelines for health conditions that may impede BrCa survivors from completing a community/home-based exercise program. Logistic regression models were used to quantify the magnitude of the association between demographic and clinical characteristics and the ability to perform community/home-based exercise.

Results

Among 667 BrCa survivors, 65 to 75% was classified as able to complete community/home-based exercise as recommended by the clinical guidelines. Older age, black race, treatment with chemotherapy, and treatment with radiation were associated with the potential need for further medical evaluation prior to starting exercise.

Conclusions

A large proportion of BrCa survivors can be prescribed community/home-based exercise program safely and independently, without further medical investigations or supervision. Future research will be needed to determine how to identify the subset of BrCa survivors that may benefit from medical evaluation prior to starting exercise in a manner that does not interrupt clinical oncology workflow. Approximately 35% of BrCa survivors may benefit from medical evaluation prior to starting community/home-based exercise.

https://ift.tt/2r61oF5

Convergent priorities and tensions: a qualitative study of the integration of complementary and alternative therapies with conventional cancer treatment

Abstract

Purpose

Demand for complementary and alternative medicine (CAM) is high among cancer patients. This, alongside growing evidence for the efficacy of some CAM therapies, is driving change within cancer centres, where evidence-based CAM therapies are increasingly provided alongside standard cancer treatments. In Australia, commitment to equitable access to healthcare is strong, and some cancer centres are now providing integrative services at no cost to the patient. This represents a significant shift in healthcare provision. This study aimed to examine health professional and patient dynamics in an integrated cancer service where CAM is provided at no cost to patients alongside standard cancer treatments. It specifically sought to understand what might drive or hinder further integration of CAM with standard treatment in the cancer context.

Methods

Qualitative interviews were undertaken with twenty key stakeholders—cancer patients, cancer nurses, and oncologists—who were delivering or receiving care in an Australian public hospital where acupuncture services are provided at no cost to patients alongside standard chemotherapy and radiation treatments.

Results

Findings point to key areas where the concerns and priorities of cancer patients, cancer nurses, and oncologists converge and diverge in ways that reflect core personal and professional interests regarding patient care needs, the evidence base for CAM efficacy and safety, and rising healthcare costs.

Conclusions

Understanding points of convergence and divergence could assist clinicians and service providers in negotiating ways forward for integrative cancer services.

https://ift.tt/2Hq1LFc

Imaging scoring systems for preoperative molecular diagnoses of lower-grade gliomas

Abstract

Recent advance in molecular characterization of gliomas showed that patient prognosis and/or tumor chemosensitivity correlate with certain molecular signatures; however, this information is available only after tumor resection. If molecular information is available by routine radiological examinations, surgical strategy as well as overall treatment strategy could be designed preoperatively.With the aim to establish an imaging scoring system for preoperative diagnosis of molecular status in lower-grade gliomas (WHO grade 2 or 3, LrGGs), we investigated 8 imaging features available on routine CT and MRI in 45 LGGs (discovery cohort) and compared them with the status of 1p/19q codeletion, IDH mutations, and MGMT promoter methylation. The scoring systems were established based on the imaging features significantly associated with each molecular signature, and were tested in the another 52 LrGGs (validation cohort).For prediction of 1p/19q codeletion, the scoring system is composed of calcification, indistinct tumor border on T1, paramagnetic susceptibility effect on T1, and cystic component on FLAIR. For prediction of MGMT promoter methylation, the scoring system is composed of indistinct tumor border, surface localization (FLAIR), and cystic component. The scoring system for prediction of IDH status was not established. The 1p/19q score ≥ 3 showed PPV of 96.2% and specificity of 98.1%, and the MGMT methylation score ≥ 2 showed PPV of 77.4% and specificity of 67.6% in the entire cohort.These scoring systems based on widely available imaging information may help to preoperatively design personalized treatment in patients with LrGG.

https://ift.tt/2HU36DJ

Inhibiting IL-2 signaling and the regulatory T-cell pathway using computationally designed peptides

Summary

Background Increased serum levels of soluble interleukin-2 (IL-2) receptor alpha (sIL-2Rα) are an indicator of poor prognosis in patients with B-cell non-Hodgkin lymphoma (NHL). By binding to IL-2, sIL-2Rα upregulates Foxp3 expression and induces the development of regulatory T (T_reg) cells. Methods To inhibit the binding of IL-2 to sIL-2Rα with the goal of suppressing the induction of Foxp3 and decreasing T_reg cell numbers, we developed peptides by structure-based computational design to disrupt the interaction between IL-2 and sIL-2Rα. Each peptide was screened using an enzyme-linked immunosorbent assay (ELISA), and 10 of 22 peptides showed variable capacity to inhibit IL-2/sIL-2Rα binding. Results We identified a lead candidate peptide, CMD178, which consistently reduced the expression of Foxp3 and STAT5 induced by IL-2/sIL-2Rα signaling. Furthermore, production of cytokines (IL-2/interferon gamma [IFN-γ]) and granules (perforin/granzyme B) was preserved in CD8⁺ T cells co-cultured with IL-2–stimulated CD4⁺ T cells that had been pretreated with CMD178 compared to CD8⁺ cells co-cultured with untreated IL-2–stimulated CD4⁺ T cells where it was inhibited. Conclusions We conclude that structure-based peptide design can be used to identify novel peptide inhibitors that block IL-2/sIL-2Rα signaling and inhibit T_reg cell development. We anticipate that these peptides will have therapeutic potential in B-cell NHL and other malignancies.

https://ift.tt/2KgD3ov

The relationship between adiposopathy and glucose-insulin homeostasis is not affected by moderate-intensity aerobic training in healthy women with obesity

Abstract

The contribution of adiposopathy to glucose-insulin homeostasis remains unclear. This longitudinal study examined the potential relationship between the adiponectin/leptin ratio (A/L, a marker of adiposopathy) and insulin resistance (IR: homeostasis model assessment (HOMA)), insulin sensitivity (IS: Matsuda), and insulin response to an oral glucose tolerance test before and after a 16-week walking program, in 29 physically inactive pre- and postmenopausal women with obesity (BMI, 29–35 kg/m²; age, 47–54 years). Anthropometry, body composition, VO₂max, and fasting lipid-lipoprotein and inflammatory profiles were assessed. A/L was unchanged after training (p = 0.15), despite decreased leptin levels (p < 0.05). While the Matsuda index tended to increase (p = 0.07), HOMA decreased (p < 0.05) and fasting insulin was reduced (p < 0.01) but insulin area under the curve (AUC) remained unchanged (p = 0.18) after training. Body fatness and VO₂max were improved (p < 0.05) while triacylglycerols increased and HDL-CHOL levels decreased after training (p < 0.05). At baseline, A/L was positively associated with VO₂max, HDL-CHOL levels, and Matsuda (0.37 < ρ < 0.56; p < 0.05) but negatively with body fatness, HOMA, insulin AUC, IL-6, and hs-CRP levels (− 0.41 < ρ < − 0.66; p < 0.05). After training, associations with fitness, HOMA, and inflammation were lost. Multiple regression analysis revealed A/L as an independent predictor of IR and IS, before training (partial R² = 0.10 and 0.22), although A/L did not predict the insulin AUC pre- or post-intervention. A significant correlation was found between training-induced changes to A/L and IS (r = 0.38; p < 0.05) but not with IR or insulin AUC. Although changes in the A/L ratio could not explain improvements to glucose-insulin homeostasis indices following training, a relationship with insulin sensitivity was revealed in healthy women with obesity.

https://ift.tt/2vMKlxa

Inhibiting IL-2 signaling and the regulatory T-cell pathway using computationally designed peptides

Summary

Background Increased serum levels of soluble interleukin-2 (IL-2) receptor alpha (sIL-2Rα) are an indicator of poor prognosis in patients with B-cell non-Hodgkin lymphoma (NHL). By binding to IL-2, sIL-2Rα upregulates Foxp3 expression and induces the development of regulatory T (T_reg) cells. Methods To inhibit the binding of IL-2 to sIL-2Rα with the goal of suppressing the induction of Foxp3 and decreasing T_reg cell numbers, we developed peptides by structure-based computational design to disrupt the interaction between IL-2 and sIL-2Rα. Each peptide was screened using an enzyme-linked immunosorbent assay (ELISA), and 10 of 22 peptides showed variable capacity to inhibit IL-2/sIL-2Rα binding. Results We identified a lead candidate peptide, CMD178, which consistently reduced the expression of Foxp3 and STAT5 induced by IL-2/sIL-2Rα signaling. Furthermore, production of cytokines (IL-2/interferon gamma [IFN-γ]) and granules (perforin/granzyme B) was preserved in CD8⁺ T cells co-cultured with IL-2–stimulated CD4⁺ T cells that had been pretreated with CMD178 compared to CD8⁺ cells co-cultured with untreated IL-2–stimulated CD4⁺ T cells where it was inhibited. Conclusions We conclude that structure-based peptide design can be used to identify novel peptide inhibitors that block IL-2/sIL-2Rα signaling and inhibit T_reg cell development. We anticipate that these peptides will have therapeutic potential in B-cell NHL and other malignancies.

https://ift.tt/2KgD3ov

Optimising the Bariatric Patients’ Outcome through Cardiac Rehabilitation Approach

Abstract

Bariatric surgery offers a therapeutic alternative with favourable weight management, cardiovascular, metabolic and functional outcomes. Bariatric individuals often have functional impairments pre-operatively that can be addressed to improve post-operative results and eventual functional independence. Multidisciplinary team offers the best approach to address peri-operative needs and sustainable weight loss thereafter. We exemplified the application of cardiac rehabilitation therapeutic model in managing two bariatric clients with specific bariatric-related challenges. Our approach focuses on adaptive physical activity, sustainable lifestyle changes to promote post-operative weight loss through education and problem solving as well as secondary prevention of cardiovascular disease. Putting emphasis on addressing physical and psychosocial barriers towards physical activity alongside nutritional aspects potentially confers sustained if not better outcomes on weight reduction and functional improvement.

https://ift.tt/2FicImn

An international survey on hybrid imaging: do technology advances preempt our training and education efforts?

Abstract

Background

Hybrid PET/CT and PET/MRI are increasingly important technologies in the evaluation of malignancy and require cooperation between radiologists and specialists in molecular imaging. The aim of our study was to probe the mindsets of radiological and nuclear medicine professionals in regard to current hybrid imaging practice and to assess relevant training aspirations and perceived shortfalls, particularly amongst young professionals. In this context, we initiated an international survey on "Hybrid Imaging Training".

Methods

An online survey was prepared on-line and launched on October-2, 2016. It was composed of 17 multiple-choice and open questions regarding the professional background, a perspective on hybrid imaging training efforts and lessons to be learned from disparate craft groups. The survey ran for 2 weeks. We report total responses per category and individual free-text responses.

Results

In total, 248 responses were collected with a mean age of all responders of (41 ± 11) y. Overall, 36% were within the target age range of (20–35) y. Across all responders, the majority (72%) commented on there being too few hybrid imaging experts in their country, whereas only 1% said that there were too many. Three quarters of the responders were in favour of a curriculum allowing sub-specialisation in hybrid imaging. With respect to reporting of hybrid imaging, confidence increased with age. The average rating across all responders on the level of cooperation among the two specialties suggested a low overall level of satisfaction. However, the survey feedback indicated the local (on-site) cooperation being somewhat better than the perceived cooperation between the relevant associations on a European level.

Conclusion

We consider these results to represent an appropriate cross-section of professional opinions of imaging experts across different demographic and hierarchical levels. Collectively they provide evidence supporting a need to address current shortfalls in developing hybrid imaging expertise through national educational plans, and, thus, contribute to helping improve patient care.

https://ift.tt/2HY7Fuc

Levetiracetam-induced rhabdomyolysis: the first Italian case

https://ift.tt/2HwETUQ

Risk factors and treatments for brain metastasis in patients with adenocarcinoma of the lung: a retrospective analysis of 373 patients

Abstract

Background

Risk factors and treatments for brain metastasis (BM) in patients with adenocarcinoma have not been fully profiled in previous studies because of the enrolment of patients with tumours of mixed histology. Thus, we specifically addressed the issue in patients with adenocarcinoma.

Methods

Clinical data for 373 patients with pathologically confirmed adenocarcinoma were studied retrospectively. Factors including age (≤60 vs. > 60), gender (male vs. female), stage at diagnosis, T status (T1–2 vs. T3–4), N status (N0–1 vs. N2–3), epidermal growth factor receptor (EGFR) mutation status (wild-type vs. mutant) and smoking status (never vs. current) were analyzed.

Results

In multivariate analysis, age (P = 0.006) and N status (P = 0.041) were independent risk factors for BM. In patients with BM, adding systemic therapy to local therapy improved median post-brain-metastasis survival (mPBMS) (P = 0.02). However, if stratification was conducted according to the recursive partitioning analysis (RPA) classification or graded prognostic assessment (GPA) scoring, only patients in RPA class II (P = 0.020) or with GPA score 1.5-2.5 (P = 0.032) could benefit from local plus systemic therapy. Those who received both pemetrexed and tyrosine kinase inhibitors (TKIs) as systemic therapies had a longer mPBMS than those who received TKIs alone, regardless of whether local therapy was applied. In patients with EGFR-sensitive mutations, TKIs therapy led to a longer mPBMS than conventional chemotherapy (P = 0.002).

Conclusions

Adenocarcinoma patients who were younger than 60 years of age and those with N2–3 disease have a significantly higher risk of BM. The addition of systemic therapy to local therapy can significantly prolong mPBMS, but the survival benefit confined in certain populations. Patients with opportunity to receive both pemetrexed and TKIs had the longest mPBMS.

https://ift.tt/2JsRcOi

Direct nanodrug delivery for tumor targeting subject to shear-augmented diffusion in blood flow

Abstract

The advent of multifunctional nanoparticle has enabled numerous innovative strategies in diagnostics, imaging, and cancer therapy. Despite the intense research efforts in developing new nanoparticles and surface bonding ligands, one major obstacle in achieving highly effective treatment, including minimizing detrimental side effects, is the inability to deliver drug-carrying nanoparticles from the injection point directly to the tumor site. The present study seeks to employ a direct nanodrug delivery methodology to feed multifunctional nanoparticles directly to tumor vasculatures, sparing healthy tissue. An important aspect to examine is how the interactions between such nanoparticles and relatively large red blood cells would affect the transport and delivery efficiency of nanodrugs. So, a novel computer simulation model has been developed to study nanoparticle transport in a representative human hepatic artery system, subject to shear-induced diffusion of nanoparticles due to hydrodynamic interactions with red blood cells. The particle-size effect was also evaluated by comparing the dynamics of nanoparticles with microspheres. Results from computer simulations under physiologically realistic conditions indicate that shear-induced diffusion has a significant effect on nanoparticle transport, even in large arteries. Nevertheless, as documented, direct nanodrug delivery to tumor-feeding hepatic artery branches is feasible.

Graphical abstract

Direct nanodrug delivery from injection point to tumor-feeding artery branch

https://ift.tt/2JsNu7s

ReShape Intragastric Balloon Complicated by Gastric Perforation and Peritonitis

Abstract

Background

Obesity is a growing global epidemic with tremendous financial burden and health care costs worldwide. Restrictive surgery has emerged as the definitive treatment option to combat morbid obesity and its associated comorbidities. The advent of endoscopy has new grounds in obesity with the introduction of inflatable balloon placed in the stomach that decreases satiety by volume restriction.

Materials and Methods

We report a first case of gastric perforation with peritonitis after ReShape intragastric balloon placement that needed emergent surgical intervention. Decision was made to proceed with exploratory laparotomy, device deflation, and removal with subsequent gastric defect repair.

Results

Postoperative period was uneventful, drain was removed on postoperative day 2, and patient tolerated diet and was discharged home subsequently. Biopsy of the perforation site demonstrated mild non-specific chronic gastritis.

Conclusion

In the modern era of minimal invasiveness, any new approach would roar popularity among patients and hence is of utmost importance for clinicians to be constantly educated on scientific research and innovations in their field.

https://ift.tt/2qZeO6k

Aortic remodeling in acute type A aortic dissection after frozen elephant trunk implantation

Abstract

Survivors at first intervention after acute type A aortic dissection often necessitate additional interventions to avoid dilation and rupture of the remaining thoraco-abdominal aorta. During the first-stage arch procedure, the attempt to treat the descending thoracic aorta with a stent graft could attenuate this phenomenon and reduce the need for further open or endovascular reinterventions. In this short review article, the frozen elephant trunk technique was tested as influencing factor of aortic remodeling during follow-up analysis. Late results from the identified studies suggested promising rates of false lumen thrombosis of the descending thoracic aorta (78–100%), suggesting that aortic remodeling is highly probable with this approach. However, a longer surveillance of the aortic diameters is still necessary to confirm this initial hypothesis.

https://ift.tt/2HY0nXm

Neurobehçet, multiple sclerosis or overlap syndrome? A case report

https://ift.tt/2KcLEsq

Tissue banking in Asia Pacific region: past, present and future

Abstract

Tissue banking in the Asia Pacific regions is driven by two main forces—firstly the International Atomic Energy Agency (IAEA) via Regional Co-operative Agreement projects and secondly by the Asia Pacific Association of Surgical Tissue Banking (APASTB). This overview is written in three sections: (1) History of tissue banking in individual country in the region. (2) History of APASTB. (3) History of IAEA programme in Asia Pacific region. The current status and future of the tissue banking programme in the region will be discussed.

https://ift.tt/2Hs707h

Interaction of preservation methods and radiation sterilization in human skin processing, with particular insight on the impact of the final water content and collagen disruption. Part I: process validation, water activity and collagen changes in tissues cryopreserved or processed using 50, 85 or 98% glycerol solutions

Abstract

Current regulatory requirements demand an in-depth understanding and validation of protocols used in tissue banking. The aim of this work was to characterize the quality of split thickness skin allografts cryopreserved or manufactured using highly concentrated solutions of glycerol (50, 85 or 98%), where tissue water activity (a_w), histology and birefringence changes were chosen as parameters. Consistent a_w outcomes validated the proposed processing protocols. While no significant changes in tissue quality were observed under bright-field microscopy or in collagen birefringence, in-process findings can be harnessed to fine-tune and optimize manufacturing outcomes in particular when further radiation sterilization is considered. Furthermore, exposing the tissues to 85% glycerol seems to derive the most efficient outcomes as far as a_w and control of microbiological growth.

https://ift.tt/2r2P5Jp

Grey Turner’s Sign

Abstract

Bluish discolouration of the flanks 24–48 h after an acute attack of pancreatitis is known as Grey Turner's sign. It is caused by subcutaneous haemorrhage from retroperitoneal blood vessels damaged by pancreatic enzymes released during an acute attack of pancreatitis. The image shows a classical presentation of Grey Turner's sign involving a large area of the left flank.

https://ift.tt/2Ff9rUY

Comparison of Early Morbidity and Mortality Between Sleeve Gastrectomy and Gastric Bypass in High-Risk Patients for Liver Disease: Analysis of American College of Surgeons National Surgical Quality Improvement Program

Abstract

Introduction

Chronic liver disease is prevalent in obese patients presenting for bariatric surgery and is associated with increased postoperative morbidity and mortality (M&M). There are no comparative studies on the safety of different types of bariatric operations in this subset of patients.

Objective

The aim of this study is to compare the 30-day postoperative M&M between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-Y-gastric bypass (LRYGB) in the subset of patients with a model of end-stage liver disease (MELD) score ≥ 8.

Methods

Data for LSG and LRYGB were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from years 2012 and 2013. MELD score was calculated using serum creatinine, bilirubin, INR, and sodium. Postoperative M&M were assessed in patients with a score ≥ 8 and compared for the type of operation. This was followed by analysis for MELD subcategories. Multiple logistic regression was performed to adjust for confounders.

Results

Out of 34,169, 9.8% of cases had MELD ≥ 8 and were included. Primary endpoint, 30-day M&M, was significantly lower post-LSG (9.5%) compared to LRYGB (14.7%); [AOR = 0.66(0.53, 0.83)]. Superficial wound infection, prolonged hospital stay, and unplanned readmission were more common in LRYGB. M&M post-LRYGB (30.6%) was significantly higher than LSG (15.7%) among MELD15-19 subgroup analysis.

Conclusion

LRYGB is associated with a higher postoperative risk than LSG in patients with MELD ≥ 8. The difference in postoperative complications between procedures was magnified with higher MELD. This suggests that LSG might be a safer option in morbidly obese patients with higher MELD scores, especially above 15.

https://ift.tt/2KeXBxV

Green Silver Nanoparticles for Enhancing the Phytoremediation of Soil and Water Contaminated by Fipronil and Degradation Products

Abstract

Fipronil has been associated with neurotoxicity, carcinogenicity, endocrine disruption, persistence in soil, and low uptake by plants and is a potential groundwater contaminant. Fipronil degradation by silver nanoparticles (AgNPs) from medicinal plant extracts was investigated in spiked water. Also, remediation capacity of soil contaminated by fipronil under the combined application of green AgNPs and phytoremediation was investigated. Brassica-AgNps, Ipomoea-AgNps, Camellia-AgNps, and Plantago-AgNps in water solution significantly reduced fipronil residues by 95.45, 90.15, 63.65, and 63.48%) during 2 days of treatment as compared with 18.42% in untreated water without AgNps. Fipronil amide and fipronil-desulfenyl metabolites were detected in water under the influence of AgNps. The contribution of Brassica-AgNps, Plantago-AgNps, Ipomoea-AgNps, and Camellia-AgNps to the dissipation of fipronil in the soil were 68.8, 54.64, 43.75, and 30.99%, respectively, compared with 10.14% by Plantago major alone through 6 days. Low uptake and translocation of fipronil by P. major roots and leaves were seen in flooded soil alone or under the influence of AgNps within 6 days of treatment. However, the resulting fipronil amide product accumulates in large quantities in P. major roots and leaves. These results show that AgNps and P. major play a major role for the remediation of fipronil contaminated water and in flooded soil, while P. major played an important role for remediation the polar break product, fipronil-amide as phytoremediation.

https://ift.tt/2Hu0sBj