Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry

Abstract

Introduction

Infective endocarditis (IE) still carries high morbidity and mortality and frequently requires surgery. The benefit of mitral valve repair (MVr) in the setting of IE is yet to be proven. The goal of this study was to assess the results of MVr in patients with IE after a minimum follow-up of 1 year.

Methods

This study is based on a Spanish nationwide prospective registry that included patients operated on for native mitral valve IE. The collaborating Institutions pooled their pre-, peri-, and postoperative data into the database of the GAMES group [Grupo de Apoyo al Manejo de la EndocarditiS (Group for support and management of infective endocarditis)].

Results

Data from 27 hospitals were recorded and 3524 cases of active IE identified between 2008 and 2016. There were 1513 cases of mitral IE, of which 898 involved native valves. Of these, 437 patients underwent surgical treatment, and 369 completed the 1-year follow-up. The valve was repaired in 68 cases (18.4%). Preoperative groups were comparable (EuroSCORE MVr 7.7 vs MVR 8.0; p = ns). Mortality in the repair group was inferior to that in the replacement group (16.2% vs 27.2%, p = 0.058). At 1 year, mortality remained higher in the replacement group: 3.7% vs 2.9%. Relapse of the infection was slightly more frequent in the repair group (7.1% vs 3.7%; p = ns), although this did not lead to higher rates of reintervention (MVr/MVR: 2.9% vs 4.9%).

Conclusion

MVr is an attractive option for specific patients with IE and does not seem to negatively impact on relapses.

http://bit.ly/2U7RQ9n

Glasdegib: First Global Approval

Abstract

Glasdegib (DAURISMO™) is an oral inhibitor of the Hedgehog signalling pathway, the activation of which is associated with a number of malignancies. It has been developed by Pfizer and was approved in November 2018 in the USA for use in combination with low-dose cytarabine for the treatment of newly-diagnosed acute myeloid leukaemia (AML) in patients aged ≥ 75 years or those who have comorbidities that preclude use of intensive induction chemotherapy. Glasdegib is the first Hedgehog pathway inhibitor to be approved for AML in the USA. It received orphan designation for the treatment of AML in the USA in June 2017 and in the EU in October 2017, and for the treatment of myelodysplastic syndrome (MDS) in the USA in October 2017. It is also undergoing clinical development for use in select haematological and other malignancies, including MDS, in various countries worldwide. This article summarizes the milestones in the development of glasdegib leading to its use in combination with low-dose cytarabine for the treatment of newly-diagnosed AML in patients aged ≥ 75 years or those who have comorbidities that preclude use of intensive induction chemotherapy.

http://bit.ly/2Hn3MSZ

Next Steps for Measures of Physical Activity During Pregnancy

http://bit.ly/2szWpNT

Autologous haematopoietic stem cell transplantation (AHSCT) in autoimmune disease adult patients in France: analysis of the long-term outcome from the French Society for Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)

Abstract

Introduction

The use of autologous haematopoietic stem cell transplantation (AHSCT) in autoimmune disease (AD) patients has increased progressively worldwide. We retrospectively analysed the long-term outcome of AHSCT for AD reported to the French Society for Bone Marrow Transplantation and Cellular Therapy (SFGM-TC).

Method

All French AD patients (≥ 18 years at transplant) with a first AHSCT between 1997 and 2013 were included. Primary data were derived from the European Society for Blood and Marrow Transplantation (EBMT) registry, and additional data were obtained through a specific questionnaire designed for the study. Primary end-point was overall survival (OS). Secondary end points were progression-free survival (PFS) and non-relapse mortality (NRM).

Results

Ninety-four AD patients were included, of whom 71% suffered from rheumatologic diseases (n = 67, including 56 systemic sclerosis (SSc)), 16% from neurological disease (n = 15, including 14 multiple sclerosis (MS)) and 13% from various other AD (n = 12). After a median (interquartile range, IQR) follow-up of 83 months (38–130), OS at 5 and 10 years were 77% (95% CI 68.5–86.2) and 64% (95% CI 51.7–76.3), and for PFS 51% (95% CI 40.4–61.6) and 44% (95% CI 32.8–55.3), respectively. Overall, NRM was 8.7% (95% CI 4.0–15.5) at day 100, 9.8% (95% CI 4.8–16.9) at 5 years and 13.6% (95% CI 6.9–22.5) at 10 years.

Conclusions

This first SFGM-TC retrospective report shows long-term benefit of AHSCT in AD patients with acceptable toxicity.

http://bit.ly/2Cy0Pt7

Change in PsAID-12 scores in patients continuing or discontinuing anti-TNF treatments in psoriatic arthritis: results from the HUR-BIO biologic registry

Abstract

Objective

Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID-12) has been developed to be used in psoriatic arthritis in daily practice. The aim of the present study was to assess the change values of PsAID-12 in PsA patients continuing or discontinuing anti-TNF treatment.

Methods

We recruited patients from the Hacettepe University biological database (HUR-BIO). Overall, 70 PsA patients had PsAID-12 score before the initiation of the first anti-TNF treatment. Stopping or switching the anti-TNF treatment due to inefficacy was definitely considered a negative response. Changes were evaluated by the comparison with the baseline PsAID-12 score in compliance with the favorable and unfavorable responses to anti-TNF treatments. The standardized response mean (SRM) was used for determining the response.

Results

Seventy (78.6% female) patients were analyzed and their mean age was 45.5 years (12.0 years). The mean follow-up duration was 18.3 months (12.6 months). At baseline, the mean PsAID-12 score was 6.6 (1.5). Physicians stopped or switched the treatment in 28 patients (40.0%) due to the inefficacy of anti-TNF treatment. The ΔPsAID-12 score was 0.25 (1.71) in the patients discontinuing anti-TNF treatment and 3.52 (2.31) in the patients continuing their anti-TNF treatment (p < 0.001). The SRM scores higher for PsAID-12, particularly in the well response to anti-TNF treatments.

Conclusion

A decrease of 3.5 units in PsAID-12 score shows a favorable response to anti-TNF treatment. Changes in PsAID-12 score had well discrimination capacity for anti-TNF treatments.

http://bit.ly/2RBhc2x

A 12-Week Maintenance Therapy with a New Prepared Viscous Budesonide in Pediatric Eosinophilic Esophagitis

Abstract

Background

A new prepared oral viscous budesonide (PVB) has been effective in inducing clinical and histological remission in pediatric eosinophilic esophagitis (EoE).

Aims

To evaluate the efficacy of a 12-week maintenance therapy on clinical, endoscopic, and histological remission using half of the dose used in the induction therapy.

Methods

We prospectively enrolled pediatric patients with active EoE. After 12 weeks of induction therapy with PVB (< 150 cm: 2 mg/day; ≥ 150 cm: 4 mg/day) patients received a maintenance dose of half of the dose used in the induction therapy (1 mg or 2 mg) for another 12 weeks. A 12-week follow-up was then performed in all patients after the end of therapy. Endoscopy was performed at weeks 0, 12, 24, and 36. Symptoms, endoscopy, and histology scores were also calculated. Serum cortisol was evaluated during the treatment period.

Results

We enrolled 20 children (15 males; median age 10 years; range 4–17). After the 12-week induction therapy 18 patients (90%) were in remission, with a significant decrease in the median peak of eosinophil count/HPF as well as a marked reduction in clinical, endoscopic, and histological scores (p < 0.01). At the end of the maintenance therapy (week 24), 17 patients (85%) were still in remission, while there were only 9 at week 36 (45%). No significant changes in cortisol levels were observed during the study period.

Conclusions

The 12-week maintenance treatment with the half the dose of PVB was effective in sustaining remission at week 24; however, no reduction in the rate of relapse after suspension of treatment occurred.

http://bit.ly/2Mn5VwT

A Mathematical Model for the Action of High-Frequency Currents on Biological Tissues

An analysis of the actions of high-frequency currents on biological tissues is presented and an applied mathematical model of electrosurgical actions is proposed for studying coagulation by correlation with the parameters of the high-frequency generator at the moment of tissue coagulation.

http://bit.ly/2MpgFuU

Free Cortisol Is a More Accurate Marker for Adrenal Function and Does Not Correlate with Renal Function in Cirrhosis

Abstract

Background

The accuracy of diagnosis and clinical implications of the hepatoadrenal syndrome, as currently diagnosed using total cortisol, remain to be validated.

Aim

The aim of this study was to assess adrenal function using free cortisol in stable cirrhosis and study the potential implications of any abnormalities for renal and/or cardiac function.

Methods

Sixty-one stable consecutively enrolled patients with cirrhosis underwent assessment of adrenal function using the low-dose short Synacthen test, renal function by ⁵¹Cr-EDTA glomerular filtration rate (GFR), and cardiac function by two-dimensional echocardiography.

Results

Eleven patients (18%) had total peak cortisol (PC) < 500 nmol/L, but no patient had free PC < 33 nmol/L indicating that diagnosis of AI using total cortisol is not confirmed using free cortisol. Free cortisol did not correlate with GFR or parameters of cardiac function. Patients with higher Child–Pugh class had progressively lower free cortisol. Patients with low GFR < 60 mL/min (N = 22) had more frequently grade II–III diastolic dysfunction (66.7% vs. 17.6%; p = 0.005) and had higher Child–Pugh and MELD score compared to those with normal GFR.

Conclusions

Diagnosis of AI using total cortisol is not confirmed using free cortisol and is thus considered unreliable in cirrhosis. Free cortisol is not associated with renal or cardiac dysfunction. Lower free cortisol in more advanced stages of liver disease might be secondary to decreased synthesis due to lower cholesterol levels. Irrespective of free cortisol, parameters of cardiac dysfunction are associated with renal impairment supporting the cardio–renal hypothesis.

http://bit.ly/2Mn5Zg7

Characteristics of Intestinal Myoelectrical and Motor Activities in Diet-Induced Obese Rats: Obesity and Motility

Abstract

Background

Gastrointestinal motility has been reported to be altered in obesity. However, it is unknown whether intestinal myoelectrical activity (IMA) is also changed in obesity.

Aims

The aim of this study was to characterize intestinal myoelectrical and motility activities in the fasting state, during feeding, and postprandial state after various test meals in diet-induced obese (DIO) rats in comparison with regular rats.

Methods

IMA was recorded in the fasting, feeding, and postprandial states in DIO and regular rats. Regular laboratory chow, high-fat solid food, and high-fat liquid food were used to test IMA responses to different meals.

Results

(1) The intestinal slow waves in the DIO rats were not different from those in normal rats in the fasting or postprandial state. Neither intestinal transit nor the number of intestinal contractions per minute was altered in DIO rats although gastric emptying was accelerated. (2) Both DIO rats and normal rats showed altered IMA during the first minute of feeding (cephalic stimulation). (3) The intestinal slow waves in both DIO rats and regular rats were impaired slightly but significantly after intake of a high-fat meal.

Conclusions

Our study demonstrates that intestinal myoelectrical activity is not altered in DIO rats and its postprandial responses to various meals are not altered either. High-fat meals induce intestinal dysrhythmia but do not have a chronic impact on intestinal slow waves in DIO rats.

http://bit.ly/2sBt45y

Healthcare Providers Underestimate Patients’ Glucocorticoid Use in Crohn’s Disease

Abstract

Background

One of the therapy goals for Crohn's disease (CD) is glucocorticoid-free remission. Studies have shown care setting-specific variations in inflammatory bowel disease (IBD) management.

Aims

The principal objective of this study was to assess concordance between patient-reported and physician-reported outcomes in two different care settings (IBD centers and community practices).

Methods

Data of overall and long-term (≥ 3 months) glucocorticoid, immunosuppressant, and biologics use in participants ≥ 18 years old with a confirmed diagnosis of CD were collected. HCPs were grouped by IBD centers and community practices. Quality of life (using EuroQol 5D [EQ-5D]) and work/activity days lost were assessed. Agreement between patients' and HCPs' responses to survey questions was tested using kappa statistics.

Results

Data from 812 patients were examined. Significantly more patients versus HCPs reported oral glucocorticoid use (25.9% vs. 20.8%, κ = 0.735, P < 0.0001). Long-term use of oral glucocorticoids was similar for patients versus HCPs (67.7% vs. 63.8%, κ = 0.598, P = 0.53). Immunosuppressant use was 52.4% vs. 51.1% (κ = 0.784) and biologics use was 49.5% vs. 47.0% (κ = 0.909) for patients vs. HCPs. Patients and HCPs reported greater rates of symptom improvement with vs without biologic therapy (patients: 33.3% vs 16.8%; HCPs: 29.3% vs 13.5%, both P < 0.001). Patients with versus without routine follow-up were less likely to be treated with long-term glucocorticoid monotherapy (10.3% vs. 20.7%, P < 0.01) and had fewer lost work/activity days (5 vs. 8 days, P < 0.05).

Conclusions

Patients reported more oral glucocorticoid use than physicians thought. Routine follow-up and higher rates of biologic use are associated with improvement in disease symptoms and general health among patients with CD.

http://bit.ly/2sBsHIc

Fragility of Life: Recurrent Intestinal Perforation Due to Vascular Ehlers–Danlos Syndrome

http://bit.ly/2MneSGk

Adherence to Two Large-Bore Intravenous Lines in Acute Gastrointestinal Bleeding Is Low

Abstract

Background

While the available literature recommends placement of two large-bore intravenous (2LBIV) lines in every patient presenting with acute GIB, the adherence and impact of this recommendation have never before been reported.

Aims

We designed a quality improvement project to assess whether the patients presenting to our institution with acute GIB have appropriate intravenous (IV) access or not.

Methods

We conducted a prospective, observational study, of all patients presenting to our emergency department with overt GIB over a 2-month period. Data analysis was performed, and based on the results, an intervention plan was developed and executed. Post-intervention data collection was done over a 3-month period. Our interventions included physician and nursing education, placing posters in the emergency department, and creation of an order set in the electronic medical record system.

Results

A total of 46 patients were in the pre-intervention group, and 71 patients were in the post-intervention group. The presence of 2LBIV lines in the pre-intervention group was only 19.5%, which improved to 36.6% in the post-intervention group (p = 0.049). Factors associated with placement of 2LBIV lines were being in the post-intervention group and admission to the intensive care unit.

Conclusion

The relatively simple and cost-effective intervention of placing 2LBIV lines is not often executed. We suggest that specific mention of 2LBIV placement in guidelines from national gastroenterology societies might improve compliance in this aspect.

http://bit.ly/2sBsXqE

Expression of Demethylase Genes, FTO and ALKBH1 , Is Associated with Prognosis of Gastric Cancer

Abstract

Background

Reversible N⁶-methyladenosine (m⁶A) modifications in messenger RNAs can be categorized under the field of "RNA epigenetics." However, the potential role of m⁶A-related genes in gastric cancer (GC) prognosis has not been systematically researched.

Aims

This study was aimed at providing insights into the prognostic role of m⁶A-related gene expression, at both mRNA and protein levels.

Methods

Kaplan–Meier (KM) plotter database and The Cancer Genome Atlas (TCGA) database were used to explore the prognostic significance of individual m⁶A-related genes in overall survival (OS) and progression-free survival at the mRNA level. For independent validation, the protein level of genes significantly associated with prognosis in both databases was further detected in 450 paired GC and corresponding adjacent non-tumor tissues using tissue microarray (TMA)-based immunohistochemistry (IHC). The relationship between the FTO and ALKBH1 expression and the clinicopathological characteristics was explored.

Results

Among nine m⁶A-related genes, aberrantly high mRNA expression of FTO and ALKBH1 was associated with poor OS in the KM and TCGA cohorts. However, the TMA-IHC indicated that protein expression of FTO and ALKBH1 was markedly downregulated in GC tissues. A lower protein level of ALKBH1 was closely correlated with larger tumor sizes (≥ 5 cm) and more advanced TNM stages, while lower FTO protein expression was associated with shorter OS in GC patients.

Conclusions

Aberrant expression of demethylase genes, FTO and ALKBH1, has a distinct prognostic value in GC patients, indicating that FTO and ALKBH1 may play vital roles in GC progression and metastasis.

http://bit.ly/2MjH50R

Pre-transplant ALBI Grade 3 Is Associated with Increased Mortality After Liver Transplantation

Abstract

Background

Although MELD score is a reliable tool for estimating mortality in the waiting list, criteria for preoperative prediction of survival after liver transplantation (LT) are lacking. ALBI score was validated as a prognostic marker for hepatocellular carcinoma patients undergoing transarterial chemoembolization, hepatic resection, and sorafenib treatment but not for LT outcomes yet. This study aimed to evaluate ALBI score as a prognostic factor in LT.

Methods

This is a single-center analysis of patients undergoing LT between October 2001 and June 2017. Primary endpoint was overall post-LT mortality. Secondary endpoint was 90-day mortality.

Results

Of all 301 patients included in this study, 185 (61.5%) were males. The median age was 54.1 ± 11.3 years. Univariate and multivariate analysis revealed that ALBI grade 3 (HR 1.836, 95% CI 1.154–2.921, p = 0.010), low serum albumin (HR 0.628, 95% CI 0.441–0.893, p = 0.010), black race (HR 2.431, 95% CI 1.160–5.092, p = 0.019), and elevated body mass index (HR 1.061, 95% CI 1.022–1.102, p = 0.002) all were associated with decreased overall survival following LT. Patients with both ALBI grade 3 (n = 25) and calculated MELD score ≥ 25 had the lowest overall survival (p < 0.001).

Discussion

ALBI grade 3 was related to lower post-LT survival and can be utilized as a tool for risk stratification in LT.

http://bit.ly/2sBsS6k

Biomarkers for Acute Respiratory Distress syndrome and prospects for personalised medicine

Abstract

Acute lung injury (ALI) affects over 10% of patients hospitalised in critical care, with acute respiratory distress syndrome (ARDS) being the most severe form of ALI and having a mortality rate in the region of 40%. There has been slow but incremental progress in identification of biomarkers that contribute to the pathophysiology of ARDS, have utility in diagnosis and monitoring, and that are potential therapeutic targets (Calfee CS, Delucchi K, Parsons PE, Thompson BT, Ware LB, Matthay MA, Thompson T, Ware LB, Matthay MA, Lancet Respir Med 2014, 2:611–-620). However, a major issue is that ARDS is such a heterogeneous, multi-factorial, end-stage condition that the strategies for "lumping and splitting" are critical (Prescott HC, Calfee CS, Thompson BT, Angus DC, Liu VX, Am J Respir Crit Care Med 2016, 194:147–-155). Nevertheless, sequencing of the human genome, the availability of improved methods for analysis of transcription to mRNA (gene expression), and development of sensitive immunoassays has allowed the application of network biology to ARDS, with these biomarkers offering potential for personalised or precision medicine (Sweeney TE, Khatri P, Toward precision medicine Crit Care Med; 2017 45:934-939).

Biomarker panels have potential applications in molecular phenotyping for identifying patients at risk of developing ARDS, diagnosis of ARDS, risk stratification and monitoring. Two subphenotypes of ARDS have been identified on the basis of blood biomarkers: hypo-inflammatory and hyper-inflammatory. The hyper-inflammatory subphenotype is associated with shock, metabolic acidosis and worst clinical outcomes. Biomarkers of particular interest have included interleukins (IL-6 and IL-8), interferon gamma (IFN-γ), surfactant proteins (SPD and SPB), von Willebrand factor antigen, angiopoietin 1/2 and plasminogen activator inhibitor-1 (PAI-1). In terms of gene expression (mRNA) in blood there have been found to be increases in neutrophil-related genes in sepsis-induced and influenza-induced ARDS, but whole blood expression does not give a robust diagnostic test for ARDS.

Despite improvements in management of ARDS on the critical care unit, this complex disease continues to be a major life-threatening event. Clinical trials of β₂-agonists, statins, surfactants and keratinocyte growth factor (KGF) have been disappointing. In addition, monoclonal antibodies (anti-TNF) and TNFR fusion protein have also been unconvincing. However, there have been major advances in methods of mechanical ventilation, a neuromuscular blocker (cisatracurium besilate) has shown some benefit, and stem cell therapy is being developed. In the future, by understanding the role of biomarkers in the pathophysiology of ARDS and lung injury, it is hoped that this will provide rational therapeutic targets and ultimately improve clinical care (Seymour CW, Gomez H, Chang CH, Clermont G, Kellum JA, Kennedy J, Yende S, Angus DC, Crit Care 2017, 21:257).

http://bit.ly/2Mnb1cm

A Mobile Medical Thermostatic Unit Based on the Ranque–Hilsch Vortex Effect

The paper describes the possibility of application of the vortex effect in a mobile thermostatic unit. The structural diagram of the unit and the results of tests are presented. It is shown that the technological efficiency of the Ranque–Hilsch vortex tube used in the unit can be increased by forced cooling of the tube housing or solely its hot flow outlet.

http://bit.ly/2sBsLYs

Plasma Glow Discharge as a Tool for the Dissection and Coagulation of Biological Tissues

We present here the results of studies of the mechanism of plasma formation and the kinetics of plasma glow discharge required for making electrosurgical instruments with controllable plasma temperature. Numerical data on the energy parameters of the high-frequency current required for stable heating of the plasma glow discharge at atmospheric pressure are presented. Scientifically based technical solutions for creating prototype high-quality electrosurgical instruments with controlled-temperature low-temperature plasma glow discharge are described. The value of using a single technical platform based on a modular design for the main functional elements of high-frequency electrosurgical instruments with biological tissue dissection and coagulation modes based on temperature-controllable plasma glow discharge is assessed.

http://bit.ly/2syPAfu

Channel Rotor Calculation for a Centrifugal Blood Pump

A test model of a centrifugal pump with constant cross-section channels in the rotor was developed using 3D computer simulation. The channels are shaped as a logarithmic spiral. The geometry of the flow channel providing optimal flow in the nominal operating mode (flow, 5 L/min; pressure drop, 100 mm Hg) was calculated. In addition, pump operation conditions in the extracorporeal membrane oxygenation (ECMO) mode were considered. The main requirements imposed on the developed test model were those of meeting the allowable shear stress threshold and minimizing the stagnation and flow recirculation zones.

http://bit.ly/2MpgCPK

Use of Neural Network-Based Deep Learning Techniques for the Diagnostics of Skin Diseases

Melanoma is one of the most dangerous types of cancer. The accuracy of visual diagnosis of melanoma directly depends on the experience and specialty of the physician. Current development of image processing and machine learning technologies allows systems based on artificial neural convolutional networks to be created, these being better than humans in object classification tasks, including the diagnostics of malignant skin neoplasms. Presented here is an algorithm for the early diagnostics of melanoma based on artificial deep convolutional neural networks. This algorithm can discriminate benign and malignant skin tumors with an accuracy of at least 91% by examination of dermatoscopy images.

http://bit.ly/2sxeT1A

A History of the Discovery of the Hoorweg–Weiss–Lapicque Law

First quantitative studies of the effect of electricity on excitable biological tissues forming the basis of the Hoorweg–Weiss–Lapicque law are described. The contribution of each researcher to the discovery is delineated and the practical significance of the Hoorweg–Weiss–Lapicque law is explained.

http://bit.ly/2MjMgxO

The Hub of an External Fixation Device for Early Mobilization of the Wrist in the Treatment of Distal Radial Epimetaphyseal Fractures

A mobilization hub inserted into an external fixator was developed for the treatment of fractures of the distal epimetaphysis of the radius bone. The hub was designed in a three-dimensional solid-body modeling system. Experimental prototypes were made of ABS plastic by 3D printing. Cadaver experiments showed that with the device carrying the mobilization hub, the range of movements was not statistically significantly different from the range of passive movements in the intact joint. The X-ray-transparent material used for the hub provides unimpeded visualization of the fracture site and wrist joint. Single use of the hub is proposed, as it can be made using inexpensive plastic and 3D printing, while batch production is by pressure casting.

http://bit.ly/2sCXwwk

Studies of the Electrochemical Properties of Thin-Film Materials for Coating Cardiac Stimulator Electrodes

The frequency characteristics of the admittances of a series of candidate materials for coating pacemaker electrode poles were studied. A method for assessing the properties of current transfer from an electrode connected to a source of stimulatory impulses to tissues is described. The main factors influencing decreases in the effectiveness of this transfer are identified. Potential physical vapor deposition technologies for depositing coatings, followed by alloying of films with metal ion beams, which increase the production of charged particles on the surfaces of the poles, are presented.

http://bit.ly/2MiXdQa

An Experimental Study of the Specific Features of Laser Radiation Propagation through the Optical System of the Human Eye and the Optic Nerve

The results of studies of the process of low-intensity laser radiation propagation through human optic pathways are presented. It is shown that the optic nerve can be modeled as a fiber optic cable rather than a coaxial electric cable.

http://bit.ly/2sDvwsi

Measurements of Ion Beam Composition in the Temporary Radiobiology Facility at the Institute for High Energy Physics

A detector consisting of four p-i-n silicon pad structures of size 6 × 6 mm² and thickness 300 μm was developed for the rapid monitoring of carbon ion beam quality at the Temporary Radiobiology Facility at the Institute for High Energy Physics (TRBF IHEP) by measuring event-by-event energy release on passage of charged particles (ions) through it. This articles describes the detector design and the method used for identifying contaminants in the beam of carbon nuclei. The charge composition of the ion beam of the TRBF IHEP calculated using the amplitude spectra of signals from the p-i-n structures is presented.

http://bit.ly/2Mk0E9s

Electrical Stimulation of Human Connective Tissue Cells on Layers of Composite Structures with a Nanocarbon Framework

A technique for electrical stimulation of growth of connective tissue cells on composite structures with a nanocarbon framework was developed. Cells were stimulated with pulsed electric signal (amplitude, 200 mV; pulse duration, 2.5 ms) for 5 h. A study of the effect of the electrical stimulation on the viability of cells showed an increase in the proliferative activity and in the density of cells adhering to the surface of composite structure layers. The aspect ratio for the cell structure subjected to the electrical stimulation was 1.4 times greater than for nonstimulated cells. The developed technique can be used in tissue engineering, an important branch of regenerative medicine.

http://bit.ly/2sFmvil

Multi-segment foot models and their use in clinical populations

Publication date: March 2019

Source: Gait & Posture, Volume 69

Author(s): Alberto Leardini, Paolo Caravaggi, Tim Theologis, Julie Stebbins

Abstract

Background

Many multi-segment foot models based on skin-markers have been proposed for in-vivo kinematic analysis of foot joints. It remains unclear whether these models have developed far enough to be useful in clinical populations. The present paper aims at reviewing these models, by discussing major methodological issues, and analyzing relevant clinical applications.

Research question

Can multi-segment foot models be used in clinical populations?

Methods

Pubmed and Google Scholar were used as the main search engines to perform an extensive literature search of papers reporting definition, validation or application studies of multi-segment foot models. The search keywords were the following: 'multisegment'; 'foot'; 'model'; 'kinematics', 'joints' and 'gait'.

Results

More than 100 papers published between 1991 and 2018 were identified and included in the review. These studies either described a technique or reported a clinical application of one of nearly 40 models which differed according to the number of segments, bony landmarks, marker set, definition of anatomical frames, and convention for calculation of joint rotations. Only a few of these models have undergone robust validation studies. Clinical application papers divided by type of assessment revealed that the large majority of studies were a cross-sectional comparison of a pathological group to a control population.

Significance

This review suggests that there is sufficient evidence that multi-segment foot models may be successfully applied in clinical populations. Analysis of the currently available models allows users to better identify the most suitable protocol for specific clinical applications. However new models require thorough validation and assessment before being used to support clinical decisions.

from #Audiology via ola Kala on Inoreader http://bit.ly/2CvsTgW

Multi-segment foot models and their use in clinical populations

Publication date: March 2019

Source: Gait & Posture, Volume 69

Author(s): Alberto Leardini, Paolo Caravaggi, Tim Theologis, Julie Stebbins

Abstract

Background

Many multi-segment foot models based on skin-markers have been proposed for in-vivo kinematic analysis of foot joints. It remains unclear whether these models have developed far enough to be useful in clinical populations. The present paper aims at reviewing these models, by discussing major methodological issues, and analyzing relevant clinical applications.

Research question

Can multi-segment foot models be used in clinical populations?

Methods

Pubmed and Google Scholar were used as the main search engines to perform an extensive literature search of papers reporting definition, validation or application studies of multi-segment foot models. The search keywords were the following: ‘multisegment’; ‘foot’; ‘model’; ‘kinematics’, ‘joints’ and ‘gait’.

Results

More than 100 papers published between 1991 and 2018 were identified and included in the review. These studies either described a technique or reported a clinical application of one of nearly 40 models which differed according to the number of segments, bony landmarks, marker set, definition of anatomical frames, and convention for calculation of joint rotations. Only a few of these models have undergone robust validation studies. Clinical application papers divided by type of assessment revealed that the large majority of studies were a cross-sectional comparison of a pathological group to a control population.

Significance

This review suggests that there is sufficient evidence that multi-segment foot models may be successfully applied in clinical populations. Analysis of the currently available models allows users to better identify the most suitable protocol for specific clinical applications. However new models require thorough validation and assessment before being used to support clinical decisions.

from #Audiology via ola Kala on Inoreader http://bit.ly/2CvsTgW
via IFTTT

Multi-segment foot models and their use in clinical populations

Publication date: March 2019

Source: Gait & Posture, Volume 69

Author(s): Alberto Leardini, Paolo Caravaggi, Tim Theologis, Julie Stebbins

Abstract

Background

Many multi-segment foot models based on skin-markers have been proposed for in-vivo kinematic analysis of foot joints. It remains unclear whether these models have developed far enough to be useful in clinical populations. The present paper aims at reviewing these models, by discussing major methodological issues, and analyzing relevant clinical applications.

Research question

Can multi-segment foot models be used in clinical populations?

Methods

Pubmed and Google Scholar were used as the main search engines to perform an extensive literature search of papers reporting definition, validation or application studies of multi-segment foot models. The search keywords were the following: ‘multisegment’; ‘foot’; ‘model’; ‘kinematics’, ‘joints’ and ‘gait’.

Results

More than 100 papers published between 1991 and 2018 were identified and included in the review. These studies either described a technique or reported a clinical application of one of nearly 40 models which differed according to the number of segments, bony landmarks, marker set, definition of anatomical frames, and convention for calculation of joint rotations. Only a few of these models have undergone robust validation studies. Clinical application papers divided by type of assessment revealed that the large majority of studies were a cross-sectional comparison of a pathological group to a control population.

Significance

This review suggests that there is sufficient evidence that multi-segment foot models may be successfully applied in clinical populations. Analysis of the currently available models allows users to better identify the most suitable protocol for specific clinical applications. However new models require thorough validation and assessment before being used to support clinical decisions.

from #Audiology via ola Kala on Inoreader http://bit.ly/2CvsTgW
via IFTTT

Post-harvesting dynamics of the deadwood profile: the case of lowland beech-oak coppice-with-standards set-aside stands in France

Abstract

In most European temperate forests, the heavy harvesting of low-quality wood for energy, a low minimum harvest diameter and a short rotation period, result in the limited deadwood resources. However, areas are being set aside in managed forests to restore deadwood levels. Coppice-with-standards is a silvicultural method characterized by periodic logging which clear-cuts coppice trees and removes some standard trees. We studied the deadwood profile (i.e., both amount and diversity) in oak-beech coppice-with-standards over time-since-the-last-harvest in order to evaluate how long it takes to recover significantly high amounts and diversity of deadwood substrates. A total of 282 circular 500-m² plots were set up in 24 forests in southwestern France. We sampled five time-since-harvest classes within 80 years of the time elapsed since the last harvest. At the plot level, we used Generalized Linear Mixed Models to compare both deadwood volume and diversity among time classes. Diversity was also compared within time classes through accumulation curves. Deadwood legacies were very scarce after harvesting, both for volume and diversity. It took more than 70 years for deadwood amounts to become significantly higher than just after harvest; deadwood diversity was significantly higher only 30–50 years after harvesting due to quick snag recruitment. Crown deadwood, a particularly specialized resource rarely recorded, provided roughly 10–20% of the total deadwood amount throughout the study period and should be systematically recorded in further studies. Time-since-the-last-harvest was the best explanatory variable for both deadwood volume and diversity. We therefore recommend installing permanent set-aside areas to ensure deadwood conservation.

http://bit.ly/2FBSzfF

ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ,ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ,ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ

Οπισθωτιαία
Εφαρμόζονται πίσω από το αυτί και συνδέονται με το κατάλληλο εκμαγείο

Ενδοκαναλικά
Αθέατα,Είναι μικρότερα σε μέγεθος και εφαρμόζονται μέσα στον ακουστικό πόρο.

Καθαρή και διαυγή μετάδοση της φωνής των συνομιλούντων
Έξυπνη φραγή των θορύβων

Άριστη ποιοτική ενίσχυση και απόδοση του ήχου,εύκολα στη χρήση,άνετα στην εφαρμογή,όμορφα για καλύτερη αισθητική όσο αφορά το μέγεθος και την εξωτερική εμφάνιση,χωρίς καμμία ιδιαίτερη συντήρηση.

Ενδοωτιαίο Ακουστικό Βοήθημα με ελεγχόμενη ένταση,
Ενδοωτιαίο Ακουστικό Βοήθημα Υψηλής Πιστότητας,
Ενδοωτιαίο Ακουστικό Βοήθημα Δώρο Χαράς Σε Όσους Αγαπάτε και Φροντίζετε,
Ενδοωτιαίο Ακουστικό Βοήθημα με πιστοποίηση γνησιότητας και ποιότητας,
Ενδοωτιαίο Ακουστικό Βοήθημα υποαλλεργικά άριστης εφαρμογής,
Ενδοωτιαίο Ακουστικό Βοήθημα όμορφα μικρά αόρατα με άριστες αποδόσεις,
Ενδοωτιαίο Ακουστικό Βοήθημα όμορφα μικρά αόρατα με άριστες αποδόσεις για μεσαίες εως υψηλές βαρηκοΐες,
Ενδοωτιαίο Ακουστικό Βοήθημα Οδηγίες Χρήσης,

https://akoustika-ellas.blogspot.com/,
12 ή 14 άτοκες δόσεις
Δωρεάν μεταφορικά

Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με μπαταρία μακράς διάρκειας,

https://akoustika-ellas-2.blogspot.com/,
12 ή 14 άτοκες δόσεις
Δωρεάν μεταφορικά

Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με μπαταρία μακράς διάρκειας,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC Extra Low Noise,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC sound processing technology,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC Extra Low Noise με μπαταρία μακράς διάρκειας και γρήγορης φόρτισης,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με μπαταρία μακράς διάρκειας 12 εως 18 ωρών φόρτιση σε θύρα USB,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC Extra Low Noise με μπαταρία μακράς διάρκειας και γρήγορης φόρτισης 5γρ εύκολη χρήση,

https://akoustika-ellas1.blogspot.com/,
12 ή 14 άτοκες δόσεις
Δωρεάν μεταφορικά  

Can screening tools for potentially inappropriate prescriptions in older adults prevent serious adverse drug events?

Abstract

Purpose

The purpose of the study is to identify and explore risk factors of serious adverse drug events (SADE) and SADE-related admissions in acutely hospitalized multimorbid older adults and assess whether these could have been prevented by adherence to the prescription tools Screening Tool of Older Persons' Prescriptions (STOPP) and The Norwegian General Practice (NORGEP) criteria.

Methods

Cross-sectional study of acutely admitted patients to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, receiving home care services, and aged 75+, with ≥ 3 chronic diseases. Medications and information regarding the admission were retrieved from the referral letter and medical records, while an expert panel identified SADE using the Common Terminology Criteria for Adverse Events and SADE-related admissions.

Results

We included 232 patients. Mean (SD) age was 86 (5.7) years, 137 (59%) were female, 121 (52%) used 5–9 drugs whereas 65 (28%) used ≥ 10. We identified SADEs in 72 (31%) of the patients, and in 49 (68%) of these cases, the SADE was considered to cause the hospital admission. A low body mass index (BMI) and a high Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score were independent risk factors for SADEs. Among the SADEs identified, 32 (44%) and 11 (15%) were preventable by adherence to STOPP and NORGEP, respectively.

Conclusions

We found a high prevalence of SADE leading to hospitalization. Risk factors for SADE were high CIRS-G and low BMI. STOPP identified more SADEs than NORGEP, but adherence to the prescription tools could only to a limited degree prevent SADEs in this patient group.

http://bit.ly/2MlFg3I

Strategy for improving L-isoleucine production efficiency in Corynebacterium glutamicum

Abstract

As one of the three branched-chain amino acids essential for human body, L-isoleucine is widely used in food, medicine, and feed industries. At present, L-isoleucine is mainly produced by microbial fermentation, and the main production strain is Corynebacterium glutamicum. The biosynthetic pathway of L-isoleucine in C. glutamicum is complex, and the activity of key enzymes and the transcription of key genes in the pathway are strictly regulated. The intracellularly synthesized L-isoleucine is secreted by transporters, and the activity of the transporters is also regulated. These intricate regulatory mechanisms increase the difficulty to engineer the L-isoleucine-producing C. glutamicum. This article focuses on the mechanism of L-isoleucine biosynthesis, secretion, and regulation in C. glutamicum and reviews the various metabolic engineering strategies for improving L-isoleucine production efficiency in C. glutamicum.

http://bit.ly/2S28XMa

Boundary-integral representations for ship motions in regular waves

Abstract

Alternative boundary-integral representations of linear potential flow around a ship that travels at a constant speed in regular (time-harmonic) waves in deep water are considered. In particular, the Neumann–Michell (NM) boundary-integral representation of steady flow around a ship traveling in calm water is extended to ship motions in regular waves. This extension is straightforward, but points to a complicated and unresolved fundamental issue that is essentially related to the formulation of a linear flow model. Indeed, the NM boundary-integral flow representation for ship motions in regular waves given in the study suggests that the classical Neumann–Kelvin (NK) flow model may be inadequate at a ship waterline. Alternative NM boundary-integral representations of time-harmonic ship waves that are consistent with the previously given NM representation of ship waves in calm water, and yield Fourier–Kochin representations of ship waves that are well suited for numerical computations, are given.

http://bit.ly/2T4ItHh