STOPPFrail (Screening Tool of Older Persons’ Prescriptions in Frail adults with a limited life expectancy) criteria: application to a representative population awaiting long-term nursing care

Abstract

Purpose

STOPPFrail criteria highlight instances of potentially inappropriate medications (PIMs) in frailer older adults with poor 1-year survival prognosis. The objectives of this study were to (i) determine the proportion of older adults requiring long-term nursing care in whom STOPPFrail criteria are applicable, (ii) measure the prevalence of STOPPFrail PIMs, and (iii) identify risk factors for PIMs in this cohort.

Methods

We retrospectively reviewed applications for long-term nursing care to nursing homes in the Cork area over a 6-month period. We recorded diagnoses, medications, functional status, cognitive ability, frailty status, and applied STOPPFrail criteria as appropriate.

Results

We reviewed 464 applications; 38 were excluded due to incomplete information and 274 patients (64.3%) met STOPPFrail eligibility criteria (median age 83 years (IQR 77.25–88); 233 (54.7%) female). Those STOPPFrail eligible were prescribed 2194 medications (mean 8, (SD 4)), of which 828 (37.7%) were PIMs. At least one PIM was identified in 250 eligible patients (91.2%). The median number of PIMs was 3 (IQR 2–4), the most common being (i) medications without clear indication identified in 47.0% (n = 129) of patients, (ii) long-term high-dose proton pump inhibitors in 31.4% (n = 86), and (iii) statins in 29.6% (n = 81). For every additional medication prescribed, the odds of identifying a PIM increased by 58% (odds ratio 1.58, 95% CI 1.32–1.89, p < 0.001).

Conclusion

Almost 65% of patients awaiting long-term care are eligible for the application of STOPPFrail criteria with over 90% prescribed at least one PIM. Transition to nursing home care represents an opportunity to review therapeutic appropriateness and goals of prescribed medications.

http://bit.ly/2ThpXvi

Analysis of allele-specific expression of seven candidate genes involved in lipid metabolism in pig skeletal muscle and fat tissues reveals allelic imbalance of ACACA , LEP , SCD , and TNF

Abstract

Analysis of allele-specific expression may help to elucidate the genetic architecture of complex traits including fat deposition in pigs. Here, we used pyrosequencing to investigate the allele proportions of candidate genes (ACACA, ADIPOR1, FASN, LEP, ME1, SCD, and TNF) involved in regulation of lipid metabolism in two fat deposits (subcutaneous and visceral fat) and longissimus dorsi muscle of pigs representing Polish Large White, Polish Landrace, Duroc, and Pietrain breeds. We detected differential allelic expression of ACACA, LEP, SCD, and TNF in all tissues analyzed. To search for putative cis-regulatory elements involved in allele-specific expression, we quantified the methylation level within CpG islands located in 5′-flanking regions of ACACA and SCD. Comparison between samples showing markedly disproportionate allelic expression and control groups with similar levels of both alleles did not reveal significant differences. We also assessed the association of rs321308225 (c.*195C>A) an SNP located in the 3′UTR of ACACA with its allelic expression in Polish Landrace pigs, but it was not significant. We conclude that allelic imbalance occurs frequently in regard to genes involved in regulation of lipid deposition in pigs, and further studies are necessary to identify cis-regulatory elements affecting ACACA, LEP, SCD, and TNF expression in porcine fat tissues and skeletal muscle.

http://bit.ly/2B1NGZq

Diversifying selection signatures among divergently selected subpopulations of Polish Red cattle

Abstract

Polish Red cattle is one of the few indigenous breeds of European red cattle which is characterized by several desired features, such as high disease resistance, good health, longevity, good fertility, and high nutritional value of milk. Currently, Polish Red cattle population is a subject of two independent breeding programs: (i) improvement program and (ii) genetic resources conservation program. The aim of the improvement program is the genetic progress in terms of milk production and body conformation traits, while the conservation program mainly focuses on protection of the genetic resources of Polish Red cattle and preservation of the existing, original gene pool. By the analysis of F_ST genetic distances across genome-wide SNP panel, we detected diversifying selection signatures among these two subpopulations and indicated (among others) the significance of DGAT1 and FGF2 genes for milk production traits in these cattle. We also found that among genes being presumably under selection in terms of milk production, there are genes responsible, for example, for mammary gland development (e.g., SOSTDC1, PYGO2, MED1, and CCND1) and immune system response (e.g., IL10RA, IL12B, and IL21). The most important finding of this study is that the most pronounced genetic differences between the analyzed populations were associated with β-defensin genes (e.g., DEFB1, DEFB4A, DEFB5, DEFB7, DEFB10, DEFB13, EBD, BNBD-6, and LAP) located within so-called bovine cluster D on BTA27. The β-defensins are expressed mainly in the mammary gland and are antimicrobial peptides against the Gram-negative and Gram-positive bacteria, viruses, and other unicellular parasites. This suggests that antimicrobial resistance of mammary gland is of high importance during selection towards increased milk production and that genes responsible for this process are selected together with increasing levels of productivity.

http://bit.ly/2TfEFmK

Diffuse and patchy intra-myocardial fat deposition in left ventricle: unclassified cardiomyopathy in an obese woman without pathological condition

Abstract

Fat deposition in the left ventricle in patients without proven myocardial diseases has not been sufficiently investigated. In this paper, a case of diffuse and patchy intramyocardial fat deposition in the left ventricular myocardium in a patient with no cardiac disease history has been detected by cardiac magnetic resonance imaging (CMRI). Such a finding would not be considered a usual cardiomyopathy and further studies are needed to investigate its prevalence, pathophysiological mechanisms, and prognosis.

http://bit.ly/2HA6Hry

Both operator and heat treatment determine the centring ability of Reciproc® files in vitro

Abstract

Objectives

To determine the shaping ability of reciprocating files without/with post-manufacturing heat treatment (Reciproc®/Reciproc blue®, VDW) when used by six operators of similar level of experience.

Materials and methods

Plastic training blocs with curved root canals (5 mm radius, 55° angle) were mounted in a dental manikin. Each operator prepared six specimens with each instrument system using the file sizes R25, R40 and R50 consecutively. Specimens were photographed, and deviations from the centre of the canal were measured at intervals of 0.5 mm and averaged for the apical, middle and coronal part of the canal. Data were tested for significance using the Mann-Whitney U test and two-way ANOVA with instrument systems and operators serving as factors.

Results

Deviations were observed towards the outer curvature in the apical and coronal and to the inner curvature in the middle segment of the canal. They were larger after using larger size instruments and were smaller when using Reciproc blue® compared to Reciproc®. Significant differences among operators were observed in the middle (all sizes) and coronal part of the canals (only sizes R25 und R40). Coronally, interaction between the main factors was significant as well.

Conclusions

Post-manufacturing heat treatment significantly improved shaping ability of the reciprocating file system Reciproc®. The observed differences among operators suggest the possibility of further improvement by providing specific training for prospective users.

Clinical relevance

Maintenance of root canal curvature may be improved by using post-manufacturing heat-treated instruments, but specific training should be recommended as well.

http://bit.ly/2WjvfbS

Topical pimecrolimus versus betamethasone for oral lichen planus: a randomized clinical trial

Abstract

Objectives

Oral lichen plans (OLP) is a potentially malignant inflammatory mucocutaneous disease. CD133 is an investigated surface marker for cancer stem-like cells (CSCs) that may be involved in tumor initiation in head and neck carcinomas. We compared short-term clinical effectiveness of topical pimecrolimus as selective inflammatory cytokine release inhibitor with betamethasone cream for erosive/atrophic OLP and investigated the influence of this therapy on CD133 expression.

Material and methods

Thirty patients were randomly assigned into two equal groups to receive topical pimecrolimus (group I) or betamethasone (group II) four times daily for 4 weeks. A marker lesion in each patient were assessed at baseline using clinical score (CS) and visual analog scale (VAS) then at 1, 2, and 4 weeks and after 4 weeks of treatment-free period. CD133 expression was detected in pre- and post-treatment immunostained sections.

Results

Both drugs showed a reduction in CS, VAS, and CD133 expressions after treatment termination (p < 0.001). Pimecrolimus-treated lesions showed significant higher 1st week reduction in severity (33.1% (22.2)), pain score (57.53% (14.27)), less recurrence in follow-up period and less CD133 expression by the end of the 1st 4 weeks compared with betamethasone.

Conclusion

Pimecrolimus showed earlier clinical response and less recurrence rate compared with standard topical corticosteroid in symptomatic OLP lesions, and both treatment reduced CD133-positive CSC population.

Clinical relevance

The study proved the benefits of topical pimecrolimus in early management of painful lesions of OLP and its ability to inhibit CSCs, suggesting a possible role in reducing risk of malignant transformation.

http://bit.ly/2RbPjZT

Relationship between erosive tooth wear and beverage consumption among a group of schoolchildren in Mexico City

Abstract

Objective

To assess the association between erosive tooth wear (ETW) and consumption of different kinds of beverages in a group of schoolchildren 11–14 years old in Mexico City.

Methods

Cross-sectional study in a sample of students (n = 512) in Mexico City. The Basic Erosive Wear Examination (BEWE) was used to quantify ETW. Beverage consumption (BC) was determined using a frequency questionnaire; beverages included pure water, natural fruit juices, milk, hot beverages, and soft drinks. Ordinal logistic regression model was used to evaluate the association between the presence of ETW and BC.

Results

In total, 45.7% of the schoolchildren showed an initial loss of surface texture (BEWE = 1) and 18.2% a distinct defect involving loss of dental tissue (BEWE ≥ 2) in at least one tooth. For each glass (350 ml) of milk/week, the odds of not having erosive wear (BEWE = 0) versus having an initial loss of surface texture (BEWE = 1) or of having an initial loss of surface texture versus the presence of a defect involving the loss of dental tissue (BEWE ≥ 2) decreased 4% (OR = 0.96, 95% CI 0.93–0.99, p = 0.008); for each portion of sweet carbonated beverage consumed (350 ml), the odds increased 3% (OR = 1.03, 95% CI 1.001–1.07, p = 0.046).

Conclusion

The intake of milk and milk-based products could be a dietary means of helping prevent ETW, especially if their consumption could replace sweet carbonated drink consumption.

Clinical relevance

Knowing the impact of beverage consumption on ETW helps to provide suitable recommendations for the prevention and control of ETW in order to promote tooth longevity.

http://bit.ly/2RgVSKt

2-Methacryloyloxyethyl phosphorylcholine (MPC)-polymer suppresses an increase of oral bacteria: a single-blind, crossover clinical trial

Abstract

Objectives

The biocompatible 2-methacryloyloxyethyl phosphorylcholine (MPC)-polymers, which mimic a biomembrane, reduce protein adsorption and bacterial adhesion and inhibit cell attachment. The aim of this study is to clarify whether MPC-polymer can suppress the bacterial adherence in oral cavity by a crossover design. We also investigated the number of Fusobacterium nucleatum, which is the key bacterium forming dental plaque, in clinical samples.

Materials and methods

This study was a randomized, placebo-controlled, single-blind, crossover study, with two treatment periods separated by a 2-week washout period. We conducted clinical trial with 20 healthy subjects to evaluate the effect of 5% MPC-polymer mouthwash after 5 h on oral microflora. PBS was used as a control. The bacterial number in the gargling sample before and after intervention was counted by an electronic bacterial counter and a culture method. DNA amounts of total bacteria and F. nucleatum were examined by q-PCR.

Results

The numbers of total bacteria and oral streptcocci after 5 h of 5% MPC-polymer treatment significantly decreased, compared to the control group. Moreover, the DNA amounts of total bacteria and F. nucleatum significantly decreased by 5% MPC-polymer mouthwash.

Conclusions

We suggest that MPC-polymer coating in the oral cavity may suppress the oral bacterial adherence.

Clinical relevance

MPC-polymer can be a potent compound for the control of oral microflora to prevent oral infection.

http://bit.ly/2WiYlb4

The effect of intraosseous local anesthesia of 4% articaine with 1:100,000 epinephrine on pulpal blood flow and pulpal anesthesia of mandibular molars and canines

Abstract

Objectives

The aim of this study was to determine the effect of intraosseous (IO) anesthesia with 4% articaine and 1:100,000 epinephrine on pulpal blood flow (PBF) and pulpal anesthesia of mandibular first molars and canines in human subjects.

Materials and methods

Ten healthy volunteers with intact mandibular first molar and canine were given an osteocentral technique of IO injection using the Quick Sleeper 5 system and 4% articaine with 1:100,000 epinephrine at distal site of mandibular first molar. The PBF was monitored by a laser Doppler flowmeter (LDF). Pulpal anesthesia was assessed with an electric pulp tester (EPT).

Results

IO injection caused a decrease in PBF in molars from 6.31 ± 3.85 perfusion units (P.U.) before injection to 2.51 ± 2.53 P.U. 1 min after injection (P < 0.001). The percentage reduction in PBF was 60% after 1 min and PBF returned back to the baseline after 45 min. No significant reduction in PBF was observed in the canines (P = 0.212). For pulpal anesthesia in the molars, the mean onset was 2.40 ± 0.84 min and the mean duration was 38 ± 16.19 min. In the canines, there was a decrease in the sensitivity to EPT but complete pulpal anesthesia was not achieved.

Conclusions

IO injection distal to mandibular first molar caused a decrease in PBF and successful pulpal anesthesia in first molar, but not in canine. Both PBF and EPT readings returned to normal, suggesting that pulpal ischemia may not occur.

Clinical relevance

IO anesthesia is safe to use as a primary technique in teeth with normal pulp.

http://bit.ly/2WkmTRe

Structural and histological differences between connective tissue grafts harvested from the lateral palatal mucosa or from the tuberosity area

Abstract

Summary

Tuberosity grafts had a greater percentage of lamina propria and lower percentage of submucosa when compared to lateral palate grafts.

Objective

The study aims to understand the differences in the structural composition of soft tissue autografts harvested from the lateral palate or the tuberosity.

Material and methods

Patients were randomly allocated to receive autografts harvested either from palatal or tuberosity sites to augment horizontal volume deficiencies around single-tooth implants. Tissue biopsies were analyzed for histological and histo-morphometric analysis. Picro-sirius red stain was used to evaluate collagen 1 and 3. Also, immuno-histochemical analysis was performed against MMP1, MMP2, cytokeratin-10, cytokeratin-13, and lysine hydroxylase-2.

Results

Twenty specimens were harvested from 9 subjects in the lateral palate group (PG) and 11 subjects in the tuberosity group (TG). The percentage of lamina propria represented 51.08% in the PG group and 72.79% in the TG group, while the area of submucosa was minimal in the TG group representing 4.89% of the total sample vs 25.75% in the PG. The total area of COL-1 and 3 in the TG was 1.19 ± 0.57 and 0.72 ± 0.44 mm², respectively, while in the PG, the corresponding values were 1.4 ± 0.7 and 1.04 ± 0.5 mm². The immuno-histochemical analysis generally showed a higher expression of LLH-2, MMP2, CYT-10, and CYT-13 in the TG when compared with the PG.

Conclusion

Tuberosity grafts had a greater percentage of lamina propria and lower percentage of submucosa. The collagen content in the lamina propria was similar for both groups while the immuno-histochemical profile showed differences in the antibody expression of the epithelial cells.

Clinical relevance

Tuberosity grafts had more lamina propria and less submocusa, which may be beneficial for volume augmentation.

http://bit.ly/2Rd8dj2

In vitro evaluation by quantitative real-time PCR and culturing of the effectiveness of disinfection of multispecies biofilms in root canals by two irrigation systems

Abstract

Objectives

The purpose of this in vitro study was by using quantitative real-time PCR and culturing to determine the effectiveness of two irrigation and cleaning systems in removing multispecies oral biofilms from root canals.

Material and methods

Twenty extracted human molars were instrumented to size #15/.02 and then cleaned with the GentleWave (GW) System. The teeth were autoclaved to provide the same sterile baseline. The molars were filled with mixed plaque suspended in BHI and centrifuged to inoculate the biofilms. After 2 weeks of incubation, the teeth were randomly divided into two treatment groups. In GW group (26 canals), the teeth were further instrumented to size #15/04, and in PiezoFlow (PF) group (30 canals) to #35/.04. The teeth were then cleaned either with GW System or ProUltra PiezoFlow Active Ultrasonic System using 3% sodium hypochlorite NaOCl, 8% EDTA, and sterile water as irrigants. Samples (S1, S2, and S3) for bacterial cultures were taken from 13 canals before and after instrumentation and after final cleaning. Quantitative real-time PCR was performed from all 56 canals, and universal bacterial, one genus, and one species-specific primers were used to determine the presence of microorganisms in samples from root canals before and after instrumentation and after final cleaning. Statistical analyses were performed using the Mann-Whitney U test with the significance level set at P < 0.05.

Results

Bacterial culturing from the canal samples revealed strong reduction of bacteria from S1 to S2 in both groups after instrumentation and irrigation with water only. No growth was detected in any of the S3 samples after cleaning in either group. A highly significant reduction in bacterial DNA was recorded by qPCR for both groups (P < 0.001). GW System showed more constant and a significantly higher reduction of total microbial DNA (P = 0.007), Enterococcus faecalis DNA (P = 0.011) and Streptococcus spp. DNA (P = 0.029) than the Ultrasonic System. The amount of residual microbial DNA calculated as an average of residual DNA in each individual canal in PF group was 1.99% and in GW group 0.09%.

Conclusions

While both systems demonstrated a highly effective reduction of intracanal bacterial DNA, the final total amount and variation in the number of residual bacterial DNA was significantly smaller in the GW group.

Clinical relevance

Elimination of microbes from the infected root canal system is regarded as the key for long-term clinical success. While both GentleWave and Ultrasonic Systems used with NaOCl and EDTA demonstrated a highly effective reduction of intracanal bacterial DNA; GW produced higher reduction and better predictability.

http://bit.ly/2Riba1E

PEKK-made indirect temporary crowns and bridges: a clinical pilot study

Abstract

Objectives

The aim of the present study was to find out whether the high-performance polymer PEKK is an equivalent alternative compared to cobalt chrome (CoCr)-made restorations, regarding to biocompatibility, stability, and comfort.

Materials and methods

Twenty-two patients (m, 10; f, 12) who were indicated for a long-term temporary-fixed restoration were included. They were randomized through a lottery procedure into two groups: the first group was restored with veneered PEKK-made crowns and bridges (Pekkton ivory), while the second group was restored with veneered CoCr crowns. Clinical parameters (plaque index (PI), probing depth (PD), fracture, and chipping) were documented in a period of 3–5 months from the insertion of restoration. Furthermore, every patient completed the OHIP-14 questionnaire. An exchange of the restorations from the first to the alternative material was performed after a period of 3–5 months.

Results

All patients showed an improvement of the oral hygiene and probing depth after insertion of the temporary restorations. However, there were no significant differences between PEKK and CoCr-made restorations (P > 0.05). There was no chipping after 5 months for both kinds of materials. There was a noticeable reduction of pain and discomfort of patients after insertion of temporary restorations. However, there were no significant differences between the two materials (P > 0.05).

Conclusions

PEKK-made temporary restorations offer a good and stable alternative to CoCr-made restorations. They have a high aesthetical advantage over CoCr restoration.

Clinical relevance

Esthetic and price-efficient temporary crowns can be offered for the patient during periodontal therapy to improve its success, in particular by improving the oral hygiene.

http://bit.ly/2WiY7Rg

Quality Assurance in Interventional Radiology: Intra-procedural Care

Abstract

Purpose of Review

To highlight elements that potentially improve the quality of patient care during the Interventional Radiology procedure.

Recent Findings

The success of an interventional radiology procedure is not merely dependent on the skill of the operator. Many other factors considerably influence the safety and therefore the outcome of the procedure. The following elements are discussed in depth: universal protocol, preprocedural checklist, physical environment, communication during the procedure, preventing infection, planning and executing the procedure, and radiation safety.

Summary

Incorporating systems of safety and back-up plans during the procedure is essential in guaranteeing favorable results and decreasing complications.

http://bit.ly/2CKgyFO

A systematic review and novel classification of listing tools to improve medication in older people

Abstract

Purpose

Suboptimal drugs therapy is a threat to older people, and listing tools providing guidance are developed to address this problem.

Methods

A systematic review was performed to identify and analyze such tools published until February 2018. A novel categorization was developed to separate patient-in-focus listing approaches (PILA) providing disease-related positive and negative guidance from drug-oriented, mostly negative listing approaches (DOLA, DOLA+: with disease specification).

Results

In total, 76 tools were identified; only 9 were classified as PILA, 26 as DOLA, and 38 as DOLA+. Three DOLA(+) only address dementia. Most tools were developed in Europe or the USA and address community-dwellers. Thirty-two utilized a Delphi process, and only 10 provide a scoring system. Twenty tools utilize a questionnaire but no structured guidance or answers. Importantly, only 12 interventional clinical trials were identified reporting not only medication quality measures, but also clinical endpoints (e.g. falls, adverse drug reactions, hospitalization). For PILA, 4 trials showed positive, one negative clinical effects of a controlled intervention, for DOLA(+) 1 was positive, 7 negative (Fisher's exact test p < 0.05).

Discussion

An abundance of listing tools has been created. DOLAs that may be applied without intricate patient knowledge prevail over PILAs by sevenfold; unfortunately their clinical validation seems to be far less successful than that of patient-initiated approaches.

Conclusion

Drug therapy in older people has to be tailored to their individual, very divergent needs; tools requiring detailed medical knowledge about the patient as the starting point for medication optimization provide the best support.

http://bit.ly/2ThtPg6

A systematic review and meta-analysis of microbial contamination of parenteral medication prepared in a clinical versus pharmacy environment

Abstract

Purpose

Preparation of parenteral medication in hospitals is a complex process with a risk of microbial contamination of the product, especially when inappropriately prepared. Contaminated parenteral medications can cause severe complications to patients and increase morbidity in hospitals. The aim of this literature review is to systematically evaluate the contamination rate of parenteral medications in hospitals prepared in a pharmacy environment and a clinical environment.

Methods

A literature search of PubMed and EMBASE from 2000 to 2018 was performed. Two different environments where preparation may be carried out were defined. Point estimates and 95% confidence intervals for contamination rates were calculated for each environment of medication preparation. The meta-analysis was performed using a random effects model.

Results

The contamination rates in the clinical environment (n = 13 studies) varied between 1.09 and 20.70%. In the pharmacy environment (n = 5), all contamination rates were 0.00% except for one study (0.66%). The point estimates (random effect model) for the overall contamination rate of doses prepared in the clinical environment was 7.47% (5.16–9.79%), and 0.08% for doses prepared in the pharmacy environment. The point estimates (random effect model) for the overall contamination rate of doses prepared by nursing/ medical staff was 7.85% (5.18–10.53%), and 0.08% for doses prepared by pharmacy staff.

Conclusions

Significantly higher contamination rates were found for the preparation of parenteral medication in the clinical environment compared to pharmacy environment. In accordance with recent guidance, the almost 100-fold higher changes of contamination when reconstitution is performed in the clinical environment should urge hospitals to review their reconstitution process and apply risk-reducing measures to improve patient safety of parenteral therapy.

http://bit.ly/2UewOWw

Pesticide Dissipation and Enzyme Activities in Ungrassed and Grassed Biomixtures, Composed of Winery Wastes, Used in Biobed Bioremediation Systems

Abstract

The biomixture composition and the presence of a grass layer in a biobed bioremediation system can improve the performance of these systems to minimize pesticide point-source contamination. In this study, a novel biomixture composed with organic wastes from vineyards and wine industries (vermicompost of winery wastes and vine shoots) and top soil (W) was elaborated. The impact of three pesticides, commonly used in vineyards, on its microbial activity and on the development of turfgrass was determined in a short-term experiment. Moreover, the dissipation of the assayed pesticides was evaluated to stablish their distribution patterns between the turfgrass and the biomixture. For comparison, the original biomixture composed with top soil, peat, and straw (P) was also studied. After 15 days of pesticide application, the development of the turfgrass in both biomixtures was similar. However, the oxidoreductases (dehydrogenase and ortho-diphenol oxidase) and the hydrolytic (FDA and β-glucosidase) enzyme activities were greater in W-biomixture than in P-biomixture. The dissipation of metalaxyl and imidacloprid recorded in the W-biomixtures was significantly greater than in the P-biomixtures. The pesticide dissipation in W-biomixtures followed the same order of their octanol water partition coefficients. Except for tebuconazole, the lower biological activity in the P-biomixture would explain the limited pesticide dissipation. In the grassed biomixtures, most (> 83%) of the non-dissipated imidacloprid and tebuconazole remained in the biomixtures, while metalaxyl was rapidly translocated to the aerial part of the turfgrass. Our results show the potential capability of the novel biomixture as an alternative to the original one in a biobed.

http://bit.ly/2HzOpGX

Biological effects of acid-eroded MTA Repair HP and ProRoot MTA on human periodontal ligament stem cells

Abstract

Objective

The aim of this study was to analyze the biological effects of MTA Repair HP and ProRoot MTA on human periodontal ligament stem cells (hPDLSCs) after exposure to acidic and neutral environments.

Materials and methods

Discs of each material (n = 30) were exposed to phosphate buffered saline (pH = 7.4) or butyric acid (pH = 5.2) for 7 days, and biological testing was carried out in vitro on hPDLSCs. Cell viability and apoptosis assays were performed using eluates of each root-end filling material. To evaluate cell attachment to the different materials, hPDLSCs were directly seeded onto the material surfaces and analyzed by scanning electron microscopy. The chemical composition of the root-end filling materials was determined by energy-dispersive x-ray and eluates were analyzed by inductively coupled plasma-mass spectrometry. Statistical differences were assessed by ANOVA and Tukey test (p < 0.05).

Results

Under an acidic environment, both materials displayed similar ion release abilities, with the increased release of Si and Ca ions. Substantial changes in microstructure were observed for both materials after exposure to acidic pH. In addition, material exposure to an acidic environment showed a similar degree of cell adherence, and, surprisingly, MTA Repair HP exhibited higher cell viability rates at pH 5.2 than ProRoot MTA.

Conclusions

Exposure to an acidic environment promoted Si and Ca ion release from ProRoot MTA and MTA Repair HP. Moreover, we observed optimal biological properties of ProRoot MTA and MTA Repair HP in terms of cell viability, cell death, and cell attachment in both environments.

Clinical relevance

These results may suggest that MTA Repair HP and ProRoot exhibited optimal biological properties in terms of cell viability, cell death and cell attachment in acidic environment, being considered as materials for root-end filling and perforations.

http://bit.ly/2Rg8GRi

Adsorption of As(V) from Water over a Hydroxyl-Alumina Modified Paddy Husk Ash Surface and Its Sludge Immobilization

Abstract

Arsenic (As) is considered as one of the most hazardous elements found in the groundwater. It is present in water in both arsenate (As(V)) and arsenite (As(III)) forms. On exposure for a considerable length of time to water having As concentration above the maximum permissible limit of 10 μg/L, there is a serious threat of developing various health problems including cancer. There is frequent reporting about the development of different newer methods for the removal of arsenic from water. In this present approach, a low-cost product namely modified paddy husk ash (PHA) was used as an adsorbent for the adsorption of arsenic from water. The adsorbent is important from the point of its easy availability in the tropical paddy producing countries. For improved removal efficiency and disposal of spent adsorbent, the surface of the PHA was activated with an aluminum oligomeric solution called as hydroxyl-alumina. To understand the process, various techniques such as XRD, SEM–EDS, particle size determination, and zeta potential measurements were used and the effects like variation of adsorbent dose, pH, initial arsenic concentration, and contact time were studied. The Freundlich adsorption isotherm and pseudo-second-order kinetic models were found to be the best fitted adsorption isotherm and kinetic data models respectively thereby confirming the adsorption as a multilayer chemisorption process. Finally, the issue of disposal of the spent sludge through the successful formation of cement clinkers was studied.

http://bit.ly/2Hujzzu

A new rule-based knowledge extraction approach for imbalanced datasets

Abstract

Classification consists of extracting a classifier from large datasets. A dataset is imbalanced if it contains more instances in one class compared to the others. An imbalanced dataset contains majority instances and minority ones. It is worth noting that classical learning algorithms have a bias toward majority instances. If classification is applied to imbalanced datasets, it is called partial classification. Its approaches are generally based on sampling methods or algorithmic methods. In this paper, we propose a new hybrid approach using a three-phase-rule-based extraction process. Initially, the first classifier is extracted; it contains classification rules representing only majority instances. Then, we delete the majority instances, which are well classified by these rules, to produce a balanced dataset. The deleted majority instances are replaced by the extracted classification rules, which prevent any information loss. Subsequently, our algorithm is applied to the obtained balanced dataset to produce the second classifier which contains rules that represent both majority and minority instances. Finally, we add the rules of the first classifier to the second classifier to obtain the final classifier, which will be post-processed. Our approach has been tested on several imbalanced binary datasets. The obtained results show its efficiency compared to other results.

http://bit.ly/2S56fpo

Prognostic significance of pretreatment plasma D-dimer levels in patients with spinal chordoma: a retrospective cohort study

Abstract

Purpose

Plasma D-dimer levels, a marker of hypercoagulation, have not only been used as an indicator for cascaded reaction in the coagulation process but are also reported to be an underlying biomarker in several types of cancers. This retrospective cohort study was designed to evaluate the prognostic value of preoperative plasma D-dimer level in patients with spinal chordoma.

Methods

We enrolled 224 patients who underwent surgery for spinal chordoma between 2002 and 2015 at Changzheng Orthopedic Oncology Center. Preoperative clinical parameters were recorded and evaluated by univariate and multivariate Cox regression models. The correlation between preoperative plasma D-dimer levels and survival was assessed using the Kaplan–Meier method.

Results

The optimal cutoff value of pretreatment D-dimer was 840 μg/L determined by X-tile. DFS (disease-free survival) was 64.7% and OS (overall survival) was 75% in the cohort. Multivariate Cox regression model identified D-dimer level as an independent prognostic factor of DFS and OS, as well as treatment history, preoperative Karnofsky Performance Scale, preoperative Frankel score, pathology classification and adjuvant radiotherapy (p < 0.05). In addition, D-dimer level may also be an effective supplement for defining tumor Enneking staging (p < 0.05).

Conclusions

Higher pretreatment plasma D-dimer level was associated with a poor prognosis in chordoma and could be used as an independent prognostic factor for the survival of the patients with spinal chordoma. With supplementation of D-dimer level, Enneking stage may be more able to accurate stratify individualized risk and determine clinical management.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

http://bit.ly/2ROdkuZ

Systematic Review and Meta-analysis of the Change in Ghrelin Levels After Roux-en-Y Gastric Bypass

Abstract

Background

Roux-en-Y gastric bypass (RYGB) is considered effective for weight loss and for treatment of many obesity-related metabolic diseases. Ghrelin is an essential orexigenic peptide that plays an indispensable role in controlling body weight and energy homeostasis of post-operative patients. This systematic review and meta-analysis aimed to investigate changes in the level of fasting total ghrelin following RYGB.

Methods

A systematic literature search of PubMed, EMBASE, and the Cochrane Library until April 2018 with keywords "ghrelin" and "gastric bypass" was performed in accordance with the MOOSE guidelines and PRISMA statement. Three reviewers independently selected the studies and extracted data. Quality assessment of the included studies was undergone. A random effects model was employed to calculate overall effect sizes. Subgroup analyses and meta-regression were subsequently performed.

Results

Sixteen studies with 325 patients were included. We found ghrelin levels had an increasing tendency (SMD = 0.30; 95% CI = 0.04 to 0.57) despite moderate heterogeneity (I² = 58%). Subsequent subgroup analysis indicated that ghrelin levels decreased (SMD = − 0.49; 95% CI = − 0.98 to 0.00) in the short term (≤ 3 months) and increased (SMD = 0.46; 95% CI = 0.22 to 0.69) in the long term (> 3 months) after RYGB. Meta-regression showed that gastric pouch volume, alimentary limb length and biliopancreatic limb length were not associated with changes in ghrelin levels.

Conclusion

Fasting total ghrelin levels decreased in the short term (≤ 3 months) and increased in the long term (> 3 months) after RYGB.

http://bit.ly/2DylVJA

Examining the impact of small bowel resection procedure timing in patients with blunt traumatic injury: a propensity-matched analysis

Abstract

Objective

The purpose of this study was to evaluate the impact of the timing of small bowel resection in small bowel injury on patients' outcomes.

Methods

This study was performed using data from patients included in the National Trauma Data Bank (2007–2010) who sustained blunt injuries and underwent a small bowel resection (SBR) within 24 h of arrival to the hospital. The patients' characteristics and outcomes were compared between two groups: SBR within 4 h (Group 1) and SBR between 4 and 24 h (Group 2) using Chi-square, Fisher exact, and Wilcoxon rank-sum tests. However, in an attempt to better balance the groups, propensity score matching was performed using baseline characteristics and a follow-up paired analysis was performed using McNemar, Stuart-Maxwell, and Wilcoxon signed-rank tests.

Results

A total of 1774 patients qualified for the study. Of those, 1,292 (72.8%) patients underwent SBR within 4 h and 482 (27.2%) underwent SBR between 4 and 24 h after arrival. There were significant baseline differences between the two groups regarding Injury Severity Score (ISS) [Median (IQR)19 (10, 29) vs 14 (9, 25), P < 0.001], Glasgow Coma Scale (GCS) [15 (13, 15) vs 15 (15, 15), P < 0.001] and the proportion of patients with an initial systolic blood pressure (SBP) < 90 mmHg (18.3% vs 8.7%, P < 0.001). Given these clear differences, 482 patients from each group were pair-matched using propensity score matching on age, sex, race, ISS, GCS, and SBP. After matching, there were no significant differences observed in the matching variables, patient mortality rate (8.3% vs 7.9%, P = 0.90), or discharge disposition (home with no services: 63.1% vs 64.9%, P = 0.90); however, there was a significantly shorter hospital length of stay for those patients in Group 1 compared to Group 2 [9 (6, 15) vs 10 (7, 19), P = 0.03].

Conclusion

More than 70% of the patient cases examined underwent SBR within 4 h of hospital arrival. However, there were no significant differences identified in the mortality rate or the discharge disposition regardless of the timing of the SBR (≤ 4 vs > 4–24 h). However, the patients whose SBR was performed within 4 h of arrival had a lower hospital length of stay when compared with those whose procedure was delayed.

http://bit.ly/2COU32y

Measurement and Quantification of Diffusion-Induced Compositional Variations in Absence of Convective Mixing at Reservoir Conditions

Abstract

We present numerical and experimental investigation on the existence of diffusion-induced compositional variations in a reservoir fluid in the absence of convective mixing. New pressure-decay experimental data are presented for ethane in contact with stock tank oil, and the values of diffusivity and solubility parameters are obtained by using the one-dimensional transient diffusion model and integral-based regression method. We show the variation in oil composition through composition-height measurements at the end of the experiment. Finally, the diffusion model with estimated parameters is used to predict the compositional variations, where comparisons show excellent agreement with the measurements, validating the parameter estimation technique and quantifying the compositional variations in the oil phase caused by diffusion.

http://bit.ly/2S6rTcQ

The links between the gut microbiome and non-alcoholic fatty liver disease (NAFLD)

Abstract

NAFLD is currently the main cause of chronic liver disease in developed countries, and the number of NAFLD patients is growing worldwide. NAFLD often has similar symptoms to other metabolic disorders, including type 2 diabetes and obesity. Recently, the role of the gut microbiota in the pathophysiology of many diseases has been revealed. Regarding NAFLD, experiments using gut microbiota transplants to germ-free animal models showed that fatty liver disease development is determined by gut bacteria. Moreover, the perturbation of the composition of the gut microbiota has been observed in patients suffering from NAFLD. Numerous mechanisms relating the gut microbiome to NAFLD have been proposed, including the dysbiosis-induced dysregulation of gut endothelial barrier function that allows for the translocation of bacterial components and leads to hepatic inflammation. In addition, the various metabolites produced by the gut microbiota may impact the liver and thus modulate NAFLD susceptibility. Therefore, the manipulation of the gut microbiome by probiotics, prebiotics or synbiotics was shown to improve liver phenotype in NAFLD patients as well as in rodent models. Hence, further knowledge about the interactions among dysbiosis, environmental factors, and diet and their impacts on the gut–liver axis can improve the treatment of this life-threatening liver disease and its related disorders.

http://bit.ly/2sKe5qf

A crash course in sequencing for a microbiologist

Abstract

For the last 40 years, "Sanger sequencing" allowed to unveil crucial secrets of life. However, this method of sequencing has been time-consuming, laborious and remains expensive even today. Human Genome Project was a huge impulse to improve sequencing technologies, and unprecedented financial and human effort prompted the development of cheaper high-throughput technologies and strategies called next-generation sequencing (NGS) or whole genome sequencing (WGS). This review will discuss applications of high-throughput methods to study bacteria in a much broader context than simply their genomes. The major goal of next-generation sequencing for a microbiologist is not really resolving another circular genomic sequence. NGS started its infancy from basic structural and functional genomics, to mature into the molecular taxonomy, phylogenetic and advanced comparative genomics. Today, the use of NGS expended capabilities of diagnostic microbiology and epidemiology. The use of RNA sequencing techniques allows studying in detail the complex regulatory processes in the bacterial cells. Finally, NGS is a key technique to study the organization of the bacterial life—from complex communities to single cells. The major challenge in understanding genomic and transcriptomic data lies today in combining it with other sources of global data such as proteome and metabolome, which hopefully will lead to the reconstruction of regulatory networks within bacterial cells that allow communicating with the environment (signalome and interactome) and virtual cell reconstruction.

http://bit.ly/2MEt3ax

Oncoplastic breast surgery combining partial mastectomy with immediate breast reshaping using multiple local flaps for a patient with slim body

Abstract

Oncoplastic breast surgery (OBS), which combines the concepts of oncologic and plastic surgery, is becoming more common worldwide. We report the results of OBS in a Japanese patient with early breast cancer located on the outer lower quadrant area. We performed OBS combining partial mastectomy with immediate breast reshaping using multiple adipofascial cutaneous flaps and free dermal fat graft because she refused any other OBS. We selected three local flaps to repair the defect. Perioperative and postoperative complications were not seen. The cosmetic findings 3 years after surgery were not excellent, but the patient was satisfied with the results. OBS combining partial mastectomy with immediate breast reshaping using a combination of several flaps was successfully performed in a patient with early breast cancer.

http://bit.ly/2HxZtEq

3, 3′-Diindolylmethane-encapsulated chitosan nanoparticles accelerate molecular events during chemical carcinogen-induced mammary cancer in Sprague Dawley rats

Abstract

Background

3, 3′-Diindolylmethane (DIM) is a dietary indole compound; its medical application was limited because of poor bioavailability, unsatisfying dispersity, and rapid metabolism. To conquer this problem, nanoformulation of DIM was synthesized and investigated its mechanism-based chemotherapeutic potential.

Methods

7,12-Dimethylbenz(a)anthracene (DMBA) 25 mg/kg b.wt initiated mammary carcinogenesis in rats, the investigational tumor model that closely resembles human mammary cancer. Rats had accessed after 8 weeks of tumor formation, DIM 10 mg/kg b.wt. and DIM@CS-NP 0.5 mg/kg b.wt. were administrated orally for 8 weeks.

Results

The treatment with DIM@CS-NP 0.5 mg/kg b.wt. on DMBA-induced tumor-bearing rats was down-regulated Cyclin D1, Bcl-2 expression, and up-regulated proapoptotic proteins such as Bax, p53, Cytochrome-C, Caspase-9, and Caspase-3 as compared to DIM 10 mg/kg b.wt. In addition, the mRNA expressions of Cyclin D1, Bcl-2 decreased and increased Bax, p53 expression, in immunohistochemical analysis decreased expressions of Cyclin D1 and PCNA in the treatment of DIM@CS-NP 0.5 mg/kg b.wt. compared to DIM 10 mg/kg b.wt. Histological analysis of tumor tissues shows abnormal in collagen deposition in with Masson's trichrome (MT) and Picrosirius red (PR) staining, the treatment of DIM@CS-NP 0.5 mg/kg b.wt. reduced the collagen deposition as compared to DIM 10 mg/kg b.wt.

Conclusion

Our results clearly provide evidence that DIM@CS-NP exerts chemotherapeutic effect than DIM in DMBA model of mammary cancer by hold back anomalous tumor cell proliferation and inducing apoptosis to intervene through alterations of up-regulated and down-regulated molecules. Taken together, the data provide new evidence for mechanism action of DIM@CS-NP on mammary cancer.

http://bit.ly/2S4ZMe6

Detection measures for visual inspection of X-ray images of passenger baggage

Abstract

In visual inspection tasks, such as airport security and medical screening, researchers often use the detection measures d' or A' to analyze detection performance independent of response tendency. However, recent studies that manipulated the frequency of targets (target prevalence) indicate that d_a with a slope parameter of 0.6 is more valid for such tasks than d' or A'. We investigated the validity of detection measures (d', A', and d_a) using two experiments. In the first experiment, 31 security officers completed a simulated X-ray baggage inspection task while response tendency was manipulated directly through instruction. The participants knew half of the prohibited items used in the study from training, whereas the other half were novel, thereby establishing two levels of task difficulty. The results demonstrated that for both levels, d' and A' decreased when the criterion became more liberal, whereas d_a with a slope parameter of 0.6 remained constant. Eye-tracking data indicated that manipulating response tendency affected the decision component of the inspection task rather than search errors. In the second experiment, 124 security officers completed another simulated X-ray baggage inspection task. Receiver operating characteristic (ROC) curves based on confidence ratings provided further support for d_a, and the estimated slope parameter was 0.5. Consistent with previous findings, our results imply that d' and A' are not valid measures of detection performance in X-ray image inspection. We recommend always calculating d_a with a slope parameter of 0.5 in addition to d' to avoid potentially wrong conclusions if ROC curves are not available.

http://bit.ly/2sMmGZm

Attentional resources contribute to the perceptual learning of talker idiosyncrasies in audiovisual speech

Abstract

To recognize audiovisual speech, listeners evaluate and combine information obtained from the auditory and visual modalities. Listeners also use information from one modality to adjust their phonetic categories to a talker's idiosyncrasy encountered in the other modality. In this study, we examined whether the outcome of this cross-modal recalibration relies on attentional resources. In a standard recalibration experiment in Experiment 1, participants heard an ambiguous sound, disambiguated by the accompanying visual speech as either /p/ or /t/. Participants' primary task was to attend to the audiovisual speech while either monitoring a tone sequence for a target tone or ignoring the tones. Listeners subsequently categorized the steps of an auditory /p/–/t/ continuum more often in line with their exposure. The aftereffect of phonetic recalibration was reduced, but not eliminated, by attentional load during exposure. In Experiment 2, participants saw an ambiguous visual speech gesture that was disambiguated auditorily as either /p/ or /t/. At test, listeners categorized the steps of a visual /p/–/t/ continuum more often in line with the prior exposure. Imposing load in the auditory modality during exposure did not reduce the aftereffect of this type of cross-modal phonetic recalibration. Together, these results suggest that auditory attentional resources are needed for the processing of auditory speech and/or for the shifting of auditory phonetic category boundaries. Listeners thus need to dedicate attentional resources in order to accommodate talker idiosyncrasies in audiovisual speech.

http://bit.ly/2Mvhnqe

Object-based biased competition during covert spatial orienting

Abstract

Biased-competition models assert that spatial attention facilitates visual perception by biasing competitive interactions in favor of relevant input. In line with this view, past work has shown that the benefits of covert spatial attention are greatest when targets must compete with interfering stimuli. Here we propose a boundary condition for the resolution of interference via exogenous attention: Attention resolves visual interference between targets and distractors, but only when they can be individuated into distinct representations. Thus, we propose that biased competition may be object-based. We replicated previous observations of larger attention effects when targets were flanked by irrelevant distractors (interference-present displays) than when targets were presented alone (interference-absent displays). Critically, we then showed that this amplification of cueing effects in the presence of interference is eliminated when strong crowding hampers individuation of the targets and distractors. Likewise, when targets were embedded within a noise mask that did not evoke the percept of an individuated distractor, the attention effects were equivalent across noise and lone-target displays. Thus, we conclude that exogenous spatial attention resolves interference in an object-based fashion that depends on the perception of individuated targets and distractors.

http://bit.ly/2sNbMmo

Can we perceive two colors at the same time? A direct test of Huang and Pashler’s (2007) Boolean map theory of visual attention

Abstract

Can observers access two spatially separated color targets (e.g., red and green) at the same time (i.e., in parallel)? According to the Boolean map theory of visual attention (Huang & Pashler, Psychological Review, 114(3), 599–631, 2007), access to two different features that belong to the same dimension (e.g., red and green targets) is limited and therefore can be held only in a serial fashion. The current study proposes a strong test of the Boolean map theory of attention through the application of two of the most rigorous stochastic approaches to response times modeling—the system factorial technology (Townsend & Nozawa, 1995) and the logical rule models (Fifić, Little, & Nosofsky, Psychological Review, 117, 309–348, 2010). These approaches allowed identification of serial, parallel, and coactive architectures in the processing of multicolor targets. The results showed that multiple-color targets are processed serially when observers are required to process all the targets in the display (i.e., an exhaustive stopping rule), and in parallel or coactively when observers can terminate the search when one of the targets is found (i.e., self-terminating stopping rule). These results are generally inconsistent with predictions of the Boolean map theory. They highlight the role of stopping rules in multicolor visual search, as well as the flexibility of the attentional system in shifting between processing architectures.

http://bit.ly/2Mykii2

ZURÜCKGEZOGEN: Organisation evidenzbasierter „investigator initiated trials“

http://bit.ly/2G4oAfE

PsrA Regulator Connects Cell Physiology and Class 1 Integron Integrase Gene Expression Through the Regulation of lexA Gene Expression in Pseudomonas spp.

Abstract

Pseudomonas aeruginosa, which is a clinically important representative of Pseudomonas spp., has been recognized as causative agent of severe nosocomial infections worldwide. An increase in antibiotic resistance of P. aeruginosa clinical strains could be attributed to their capacity to acquire resistance through mobile genetic elements such as mobile integrons that are present in one-half of multidrug-resistant P. aeruginosa strains. Mobile class 1 integrons are recognized as genetic elements involved in the rapid dissemination of multiple genes encoding for antibiotic resistance. The LexA protein is a major repressor of integrase transcription, but differences in transcription regulation among bacterial species have also been noted. In this study, the promoter activity of class 1 integron integrase gene (intI1) and its variant lacking the LexA binding site in Pseudomonas putida WCS358 wild type, ΔrpoS and ΔpsrA was analysed. The results show that the activity of the intI1 gene promoter decreased in the rpoS and psrA mutants in the stationary phase of growth compared to the wild type, which indicates the role of RpoS and PsrA proteins in the positive regulation of integrase transcription. Additionally, it was determined that the activity of the lexA gene promoter decreased in ΔrpoS and ΔpsrA, and thus, we propose that PsrA indirectly regulates the intI1 gene promoter activity through regulation of lexA gene expression in co-operation with some additional regulators. In this study, intI1 gene expression was shown to be controlled by two major stress response (SOS and RpoS) regulons, which indicates that integrase has evolved to use both systems to sense the cell status.

http://bit.ly/2HwbZEp

Effects of Different Carbon Sources on Enzyme Production and Ultrastructure of Cellulosimicrobium cellulans

Abstract

The secretomes of the strain Cellulosimicrobium cellulans F16 grown on different carbon sources were analyzed by zymography, and the subcellular surface structures were extensively studied by electron microscope. The exo-cellulase and xylanase systems were sparse when cells were grown on soluble oligosaccharides, but were significantly increased when grown on complex and water-insoluble polysaccharides, such as Avicel, corn cob, and birchwood xylan. The cellulosome-like protuberant structures were clearly observed on the cell surfaces of strain F16 grown on cellulose, with diameters of 15–20 nm. Fibrous structures that connected the adjacent cells can be seen under microscope. Moreover, protuberances that adsorbed the cell to cellulose were also observed. As the adhesion of Cellulosimicrobium cellulans cells onto cellulose surfaces occurs via thick bacterial curdlan-type exopolysaccharides (EPS), such surface layer is potentially important in the digestion of insoluble substrates such as cellulose or hemicellulose, and the previously reported xylanosomes are part of such complex glycocalyx layer on the surface of the bacterial cell.

http://bit.ly/2S6gZUs

An Operable, Portable, and Disposable Ultrathin Endoscope for Evaluation of the Upper Gastrointestinal Tract

Abstract

Background and Aims

A prototype of a disposable endoscope (DE) with easy viewing of the esophagus has been developed. The aim of this study was to develop a new version of DE with improved functionality and to assess the feasibility of DE as a screening tool for upper gastrointestinal diseases compared with conventional endoscopes.

Methods

Diagnostic accuracy and maneuverability of DE were evaluated by comparing endoscopy using DE with conventional endoscopy. Different examiners performed DE endoscopy and conventional endoscopy in a randomized order, blinded to the results. Examiners were asked to respond to a questionnaire about ease of handling and observation using DE in preformed result sheets. Tolerability of DE was also evaluated. Non-sedated participants were asked to respond to a questionnaire about the convenience and satisfaction with DE endoscopy on a nine-point Likert scale.

Results

The overall ease of insertion and handling of DE was excellent. The new device enabled observation and evaluation of the entire esophagus with a good agreement between DE endoscopy and conventional endoscopy in terms of endoscopic diagnosis (Kappa value; hiatal hernia; 0.910, reflux esophagitis; 0.949, Barrett's esophagus, 1.000). Participants suggested that they were more comfortable with DE endoscopy than with conventional endoscopy with a lower symptom score (p = 0.030).

Conclusion

The new DE enabled easy observation of the entire esophagus owing to its improved maneuverability, and its diagnostic ability of esophageal diseases was comparable to that of conventional endoscopes. Non-sedated esophagoscopy with this disposable device potentially has widespread applications in outpatient clinics and areas without endoscopic facilities.

http://bit.ly/2WlUElg

Early Postoperative Anti-TNF Therapy Does Not Increase Complications Following Abdominal Surgery in Crohn’s Disease

Abstract

Background

The impact of postoperative anti-TNF therapy on infectious complications following Crohn's disease surgery remains controversial. Use of anti-TNF therapy 2–4 weeks postoperatively appears safe, but safety of use within 2 weeks is unknown.

Aims

We sought to evaluate the effect of anti-TNF therapy initiated within 2 weeks of abdominal surgery in patients with Crohn's disease.

Methods

We conducted a retrospective review of adult Crohn's disease patients undergoing abdominal surgery between 2004 and 2011. Infectious and non-infectious complications were compared between patients exposed to anti-TNF therapy within 2 weeks or between 2 and 4 weeks postoperatively and to those without exposure using chi-squared and regression analysis.

Results

Three hundred thirty-one abdominal surgeries were included; 241 were without anti-TNF exposure, 46 received postoperative anti-TNF within 2 weeks of surgery, and 44 received anti-TNF therapy 2–4 weeks after surgery. Patients who received anti-TNF therapy within 2 weeks of surgery, those initiated between 2 and 4 weeks of surgery, and those who did not receive anti-TNF therapy within 4 weeks of surgery had no significant difference in rates of infectious complications (22%, 32%, 33%, p = 0.332). Rates of non-infectious complications (4%, 9%, 14%, p = 0.143), mortality (0%, 0%, 3%, p = 0.105), hospital readmission (17%, 16%, 15%, p = 0.940), and reoperation (11%, 11%, 16%, p = 0.563) were also similar between groups.

Conclusions

Use of early anti-TNF therapy within 2 weeks or between 2 and 4 weeks following abdominal surgery did not increase risk of postoperative surgical infections in Crohn's patients.

http://bit.ly/2RcbTSd

Laryngopharyngeal Reflux: Weak Acid and Weaker Correlations

http://bit.ly/2WhcxBr

Safety of Cold Snare Polypectomy in Patients Receiving Treatment with Antithrombotic Agents

Abstract

Background

With the aging of the population and rising incidence of thromboembolic events, the clinical use of antithrombotic agents is also increasing. There are few reports yet on the management of antithrombotic agent use in patients undergoing cold snare polypectomy (CSP).

Aims

The aim of this study was to evaluate whether continued administration of antithrombotic agents in patients undergoing CSP would be associated with an increased rate of delayed post-polypectomy bleeding (DPPB).

Methods

A total of 1177 colorectal polyps in 501 patients were resected at Omori Red Cross Hospital between October 2017 and March 2018. The polyps were divided into two groups depending on whether the patients received antithrombotic agent treatment or not: the antithrombotic group (911 polyps) and the no-antithrombotic group (266 polyps).

Results

Among the 1177 polyp resections, there was no case of DPPB, including in the antithrombotic group. Immediate bleeding occurred in a total of 63 (5.4%) cases. Polyp location in the rectum (OR (95% CI) 2.64 (1.223–5.679); p = 0.013), polyp size ≥ 6 mm (OR (95% CI) 4.64 (2.719–7.933); p < 0.001), polypoid growth pattern (OR (95% CI) 2.78 (1.607–4.793); p < 0.001), and antithrombotic agent use (OR (95% CI) 2.98 (1.715–5.183); p < 0.001) were identified as significant risk factors of immediate bleeding.

Conclusions

Continued use of antithrombotic agents does not increase the risk of DPPB, even in those receiving multiple antithrombotic agents. Thus, it is safe to perform CSP even in multiple agent users. Prospective, randomized studies are necessary to confirm our results.

http://bit.ly/2RfZRXI

Musculoskeletal Injuries Are Commonly Reported Among Gastroenterology Trainees: Results of a National Survey

Abstract

Background

Endoscopy-related musculoskeletal injuries are increasingly recognized among gastroenterologists. While injury rates and risk factors have been studied among practicing gastroenterologists, little is known about rates among trainees during fellowship.

Aims

This study analyzes the prevalence of endoscopy-related overuse injuries and risk factors for injuries among a national sample of gastroenterology (GI) fellows. We also surveyed GI fellowship program directors and fellows about perceptions of overuse injuries during GI training.

Methods

We distributed a 29-item electronic survey to GI fellows at accredited programs in the USA in April 2016. Survey items included demographic information, questions pertaining to injuries, and level of agreement on the importance of ergonomics training in GI fellowship. Additionally, we distributed a 7-item electronic survey to fellowship program directors evaluating perception of overuse injuries and prevention during fellowship training. Fisher's exact test determined factors associated with sustaining an injury.

Results

An estimated 1509 fellows received the survey. Eleven percent (n = 165) of gastroenterology fellows completed the survey. Twenty percent reported having a musculoskeletal injury. Female gender was the only factor associated with a higher rate of reported injury (p < 0.01). The most common injuries reported were thumb and other hand-related pain (n = 28 [64%]).

Conclusions

Musculoskeletal injuries may affect up to 20% of GI fellows. Female fellows more frequently report injuries and may be at particularly high risk which has not been found in previously reported surveys of practicing gastroenterologists. Standardized curricula on ergonomic considerations and injury prevention are needed to enhance GI fellowship training and reduce injury rates.

http://bit.ly/2WlnWA7

Empagliflozin for the Treatment of Nonalcoholic Steatohepatitis in Patients with Type 2 Diabetes Mellitus

Abstract

Background and Aims

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of drugs that lower glucose by inducing renal glycosuria. We aimed to explore whether SGLT2 inhibitor added to the usual care for patients with type 2 diabetes mellitus (T2DM) and biopsy-proven nonalcoholic steatohepatitis (NASH) will benefit NASH histology.

Methods

In this investigator-initiated, single-arm, open-label, pilot study, nine biopsy-proven NASH patients with T2DM were given empagliflozin 25 mg daily for 24 weeks. Liver biopsy was repeated at the end of treatment. The histological outcomes were compared with the placebo group of a previous 48-week clinical trial.

Results

There was a significant reduction in body mass index (median change, Δ = −0.7 kg per m², p = 0.011), waist circumference (Δ = −3 cm, p = 0.033), systolic blood pressure (Δ = −9 mmHg, p = 0.024), diastolic blood pressure (Δ = −6 mmHg, p = 0.033), fasting blood glucose (Δ = −1.7 mmol/L, p = 0.008), total cholesterol (Δ = −0.5 mmol/L, p = 0.011), gamma glutamyl transpeptidase (Δ = −19 U/L, p = 0.013), volumetric liver fat fraction (Δ = −7.8%, p = 0.017), steatosis (Δ = −1, p = 0.014), ballooning (Δ = −1, p = 0.034), and fibrosis (Δ = 0, p = 0.046). All histological components either remained unchanged or improved, except in one patient who had worsening ballooning. Empagliflozin resulted in significantly greater improvements in steatosis (67% vs. 26%, p = 0.025), ballooning (78% vs. 34%, p = 0.024), and fibrosis (44% vs. 6%, p = 0.008) compared with historical placebo.

Conclusion

This pilot study provides primary histological evidence that empagliflozin may be useful for the treatment of NASH. This preliminary finding should prompt larger clinical trials to assess the effectiveness of empagliflozin and other SGLT2 inhibitors for the treatment of NASH in T2DM patients.

Trial registry number ClincialTrials.gov number, NCT02964715.

http://bit.ly/2RioW4F

Recommendations on the Diagnosis and Initial Management of Acute Variceal Bleeding and Hepatorenal Syndrome in Patients with Cirrhosis

Abstract

Cirrhosis is a serious and life-threatening condition which imposes a significant socioeconomic burden on affected individuals and healthcare systems. Cirrhosis can result in portal hypertension, which may lead to major complications, including acute variceal bleeding and hepatorenal syndrome. Without prompt treatment, these complications may be life-threatening. Over the past 2 decades, new treatment modalities and treatment strategies have been introduced, which have improved patients' prognosis, but the initial management of these severe complications continues to present a challenge. The present recommendations aim to increase clinicians' knowledge on the importance of early diagnosis and treatment, and to provide evidence-based management strategies to potentially, further improve patient outcomes. Special attention was given to the role of terlipressin. A comprehensive non-systematic literature search was undertaken to evaluate the evidence for the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis. Recommendations on the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis have been developed based on the best available evidence and the expert opinion of the consensus panel following a comprehensive review of the available clinical data. Prompt identification and timely treatment of acute variceal bleeding and hepatorenal syndrome are essential to reduce the burden.

http://bit.ly/2WjsR4Q

Qualitätsindikatoren bei der Therapie der Analfisteln

Zusammenfassung

Analfisteln stellen ein häufiges proktologisches Krankheitsbild dar und können mit einem Perianalabszess assoziiert auftreten. Die Ätiologie wird durch eine kryptoglanduläre Infektion im Intersphinktärraum bestimmt. Die Therapie der Analfistel ist chirurgisch. Oberstes Ziel der Fistelchirurgie bleibt die Heilung, wobei der „Erfolg" von verschiedenen Faktoren abhängt, u. a. Erfahrung des Chirurgen, Art der Fistel, Beteiligung des Schließmuskels, Art des Operationsverfahrens sowie patientenassoziierte Faktoren. Bei der chirurgischen Therapie der komplexen Analfistel stehen verschiedene operative Verfahren zur Verfügung: die Fistelspaltung mit Schließmuskelrekonstruktion, plastische Verfahren (z. B. Mukosa-Flap, Muskel-Mukosa-Flap) sowie sog. „sphinktererhaltende" Verfahren wie LIFT („ligation of intersphincteric fistula tract"), VAAFT („video-assisted anal fistula treatment"), die Verwendung eines Plugs, von Kollagen oder Fibrinkleber als auch Laserverfahren oder der Clip. Auf der Suche nach geeigneten Qualitätsindikatoren in der analen Fistelchirurgie besteht ein Spannungsfeld zwischen Heilung einerseits und dem Kontinenzerhalt andererseits. Identifiziert man potenzielle Qualitätsindikatoren, sind sowohl die Grundsätze der Analfistelchirurgie zu beachten als auch die entsprechende Patientenselektion bzw. Verfahrenswahl von entscheidender Bedeutung, um hohe Heilungsraten zu erreichen, ohne beträchtliche Kontinenzstörungen oder hohe Revisionsraten wegen eines Abszesses oder Rezidivs zu induzieren. Vor dem Hintergrund der vorliegenden Literatur und Leitlinien bestehen in der Bewertung von Qualitätsindikatoren erhebliche Unterschiede hinsichtlich Patientenselektion, Ätiologie der Analfistel, Dauer der Nachbeobachtung und Heterogenität der Therapieregime, die eine definitive Bewertung erschweren, welche chirurgische Therapie die beste bei der komplexen Analfistel darstellt.

http://bit.ly/2FPvqGO

Work Stress and Satisfaction with Leadership Among Nurses Encountering Patient Aggression in Psychiatric Care: A Cross-Sectional Survey Study

Abstract

We examined the associations between work stress (job strain, effort-reward imbalance), perceived job insecurity, workplace social capital, satisfaction with leadership and working hours in relation to the likelihood of encountering patient aggression (overall exposure, assaults on ward property, mental abuse, physical assaults). We conducted a cross-sectional survey for nurses (N = 923) in 84 psychiatric units. Both work stress indicators were associated higher odds for different types of patient aggression. Poorer satisfaction with leadership was associated with higher odds for overall exposure to patient aggression. These findings were robust to adjustment for several nurse and work characteristics, and unit size.

http://bit.ly/2Tgo2Hm

Spatial patterns of climate–growth relationships across species distribution as a forest management tool in Moncayo Natural Park (Spain)

Abstract

Forests exhibit strategies to cope with climate change; however, the rate of the changes on forests can be slower than the actual changes in environmental conditions. Forest management policies, such as assisted migration, may help forests to adapt their species distribution to changing climate conditions. Nonetheless, it certainly requires a better knowledge of climate influences on trees to ensure the success of specific management actions. In this study, we apply dendroclimatological methods to investigate the growth response of the main forest species present in Moncayo Natural Park to climate to assess their current relationship and to model these responses over the potential distribution of each species across the study area. Our results revealed large differences in the response of beech, pine and Pyrenean oak to prevailing climate factors and indicated species-specific patterns of climate sensitivity. The general importance of summer conditions for tree growth was confirmed. In addition, we found directional trends in correlation with specific climate factors along spatial gradients; these results are consistent with the autoecology of the studied species. Based on these findings, we present a new model approach that can serve as a key tool for forest managers to design forest communities that are more stable during climatic change.

http://bit.ly/2S6dpcR

Big data challenges in genome informatics

Abstract

In recent years, we have witnessed a big data explosion in genomics, thanks to the improvement in high-throughput technologies at drastically decreasing costs. We are entering the era of millions of available genomes. Notably, each genome can be composed of billions of nucleotides stored as plain text files in gigabytes (GBs). It is undeniable that those genome data impose unprecedented data challenges for us. In this article, we briefly discuss the big data challenges associated with genomics in recent years.

http://bit.ly/2TauCix

Stems cells, big data and compendium-based analyses for identifying cell types, signalling pathways and gene regulatory networks

Abstract

Identification of new drug and cell therapy targets for disease treatment will be facilitated by a detailed molecular understanding of normal and disease development. Human pluripotent stem cells can provide a large in vitro source of human cell types and, in a growing number of instances, also three-dimensional multicellular tissues called organoids. The application of stem cell technology to discovery and development of new therapies will be aided by detailed molecular characterisation of cell identity, cell signalling pathways and target gene networks. Big data or 'omics' techniques—particularly transcriptomics and proteomics—facilitate cell and tissue characterisation using thousands to tens-of-thousands of genes or proteins. These gene and protein profiles are analysed using existing and/or emergent bioinformatics methods, including a growing number of methods that compare sample profiles against compendia of reference samples. This review assesses how compendium-based analyses can aid the application of stem cell technology for new therapy development. This includes via robust definition of differentiated stem cell identity, as well as elucidation of complex signalling pathways and target gene networks involved in normal and diseased states.

http://bit.ly/2B5rv4w

Outcomes and associated ethical considerations of long-run pediatric ECMO at a single center institution

Abstract

Purpose

Survival of neonatal and pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) ≥ 21 days has not been well described. We hypothesized that patients would have poor survival and increased long-term complications.

Methods

Retrospective, single center, review and case analysis. Tertiary-care university children's hospital including neonatal, pediatric and cardiac intensive care units. After institutional review board approval, the charts of all patients < 18 years of age undergoing ECMO for ≥ 21 continuous days were performed, and they were compared to comparative patients undergoing shorter runs. Overall survival, incidence of complications, and post-discharge recovery were recorded.

Results

Overall survival was 36% in patients undergoing ≥ 21 days of ECMO (N = 14). 5/8 patients with cardiopulmonary failure from acquired etiologies survived versus 0/6 patients with congenital anomalies. 1/5 survivors achieved complete recovery with no neurologic deficits. The remaining survivors suffer from multiple medical and neurodevelopmental morbidities.

Conclusion

ECMO support for ≥ 21 days is associated with poor survival, particularly in neonates with congenital anomalies. Long-term outcomes for survivors ought to be carefully weighed and discussed with parents given the high incidence of neurologic morbidities in this population.

http://bit.ly/2RgkpQa

Dynamic Change in Enzyme Activity and Bacterial Community with long-term rice Cultivation in Mudflats

Abstract

Bacteria play an important role in the reclamation of mudflats. However, little is known about the effects of long-term rice cultivation on bacterial communities in mudflats. In this study, the bacterial community in mudflats with long-term rice cultivation was evaluated using Illumina MiSeq sequencing of the bacterial 16S rRNA genes. We found that the soil enzyme activity in mudflat soil demonstrated an overall increasing trend with an increase in rice planting years, while polyphenol oxidase activity decreased. There were significant differences in the microbial community composition between mudflat and paddy soil. There were high proportions of Proteobacteria and Bacteroidetes in mudflat soil, while the predominant phyla in paddy soil were Proteobacteria, Chloroflexi, and Acidobacteria. The dominant taxa were significantly correlated with electrical conductivity, organic matter, and total nitrogen. In addition, the proportion of Fe- and S-related bacteria in paddy soil was much higher than that of mudflat soil, including Anaeromyxobacter, Geobacter, Thiobacillus, Clostridium, and GOUTA19. Furthermore, the proportion of some nitrogen cycle-related bacteria (e.g., Nitrospira, Steroidobacter, Rhodoplanes) and some carbohydrate-degrading bacteria (e.g., Anaerolinea, Candidatus Solibacter) also increased with long-term rice cultivation in mudflat soil. These key microbial players are involved in the biogeochemical C, N, S, and Fe cycles of mudflat paddy soil during mudflat reclamation by rice cultivation. In short, the orderly succession of the bacterial community changed with the change of soil physical–chemical properties during long-term rice cultivation. In addition, key microbial players have a beneficial ecological function in enhancing soil fertility.

http://bit.ly/2HvjtaX

Revisiting the disabilities of the arm, shoulder and hand (DASH) and QuickDASH in rheumatoid arthritis

Abstract

Background

Limitations in upper limb functioning are common in Musculoskeletal disorders and the Disabilities of the Arm, Shoulder and Hand scale (DASH) has gained widespread use in this context. However, various concerns have been raised about its construct validity and so this study seeks to examine this and other psychometric aspects of both the DASH and QuickDASH from a modern test theory perspective.

Methods

Participants in the study were eligible if they had a confirmed diagnosis of Rheumatoid Arthritis (RA). They were mailed a questionnaire booklet which included the DASH. Construct validity was examined by fit to the Rasch measurement model. The degree of precision of both the DASH and QuickDASH were considered through their Standard Error of Measurement (SEM).

Results

Three hundred and thirty-seven subjects with confirmed RA took part, with a mean age of 62.0 years (SD12.1); 73.6% (n = 252) were female. The median standardized score on the DASH was 33 (IQR 17.5–55.0). Significant misfit of the DASH and QuickDASH was observed but, after accommodating local dependency among items in a two-testlet solution, satisfactory fit was obtained, supporting the unidimensionality of the total sets and the sufficiency of the raw (ordinal or standardized) scores.

Conclusion

Having accommodated local response dependency in the DASH and QuickDASH item sets, their total scores are shown to be valid, given they satisfy the Rasch model assumptions. The Rasch transformation should be used whenever all items are used to calculate a change score, or to apply parametric statistics within an RA population.

Significance and innovations

• Most previous modern psychometric analyses of both the DASH and QuickDASH have failed to fully address the effect of a breach of the local independence assumption upon construct validity.

• Accommodating this problem by creating 'super items' or testlets, removes this effect and shows that both versions of the scale are valid and unidimensional, as applied with a bi-factor equivalent solution to an RA population.

• The Standard Error of Measurement of a scale can be biased by failing to take into account the local dependency in the data which inflates reliability and thus making the SEM appear better (i.e. smaller) than the true value without bias.

http://bit.ly/2RfEndE

Latent Semantic Analysis Discriminates Children with Developmental Language Disorder (DLD) from Children with Typical Language Development

Abstract

Computer based analyses offer a possibility for objective methods to assess semantic-linguistic quality of narratives at the text level. The aim of the present study is to investigate whether a semantic language impairment index (SELIMI) based on latent semantic analysis (LSA) can discriminate between children with developmental language disorder (DLD) and children with typical language development. Spoken narratives from 54 children with DLD and 54 age matched controls with typical language development were summarized in a semantic representation generated using LSA. A statistical model was trained to discriminate between children with DLD and children with typical language development, given the semantic vector representing each individual child's narrative. The results show that SELIMI could distinguish between children with DLD and children with typical language development significantly better than chance and thus has a potential to complement traditional analyses focussed on form or on the word level.

http://bit.ly/2G01sPt

Big data: the elements of good questions, open data, and powerful software

http://bit.ly/2HxJ4A5

Seeded growth of gold nanoparticles in aqueous solution of cationic gemini surfactants with different spacer length: influences of molecular and aggregate structures

Abstract

It is well known that surfactants play a vital role in aqueous-phase synthesis of gold nanoparticles (GNPs). However, to date, it remains challenging to fully elucidate the roles of surfactants, especially for the correlation between the molecular and aggregate structure of the employed surfactant and the structures of the resulting GNPs. In the study, the synthesis of GNPs in aqueous solution of a series of cationic gemini surfactants with different spacer length (12-s-12, s = 0, 2, 4, 6, 8, 10, and 12) has been investigated. A remarkable spacer length-dependent morphological evolution of nanorod→nanostar→nanoplate→spherical nanoparticle has been observed. The results show that the gemini surfactants can form the electrostatic complexes with Au^I ions, and the complexes further self-assemble into the various aggregates of different sizes, which greatly alters the migration dynamics of Au^I and eventually influences the growth kinetics of GNPs. The overall growth rate of the GNPs is determined by the combination of the monomer-Au^I molecular weight, the size of aggregates, and the local concentration of Au^I in the aggregates. Besides, the gemini surfactants with different spacer length could selectively anchor on various facets of GNPs, thus acting as the capping agents to direct the formation of the shaped GNPs. It is believed that the cationic gemini surfactants with different spacer length provide an excellent choice to control the growth kinetics and final morphology of GNPs, and this study provides new insights in surfactant-assisted synthesis of GNPs.

Graphical abstract

http://bit.ly/2CO1F5o

Changes in stair ascent biomechanics two to eight years after ACL reconstruction are associated with patient-reported outcomes

Publication date: March 2019

Source: Gait & Posture, Volume 69

Author(s): Arielle G. Fischer, Jennifer C. Erhart-Hledik, Constance R. Chu, Jessica L. Asay, Thomas P. Andriacchi

Abstract

Background

Anterior cruciate ligament (ACL) injury is often followed by quadriceps deficits that are apparent with gait analysis. The deficit frequently remains after ACL reconstruction (ACLR). As such, evaluation of ACLR patients could be enhanced by a simple method to detect quadriceps deficits. Analyzing forward trunk flexion during stair ascent has been suggested as an assessment of quadriceps function that can be visualized with relatively simple instrumentation.

Aim

The purpose of this study was to determine if trunk flexion angle (TFA) during stair ascent is associated with quadriceps function (as measured by the peak knee flexion moment (KFM)) at 2 and 8 years post-ACLR and if changes are associated with patient-reported outcomes (PRO).

Methods

Fourteen subjects with unilateral primary ACLR performed three stair-ascending trials at two-time periods: 2 years (baseline) and 8 years (follow-up) post-ACLR. Paired Student t-tests determined differences in KFM and TFA. Associations between KFM, TFA, and PRO were determined through Pearson correlations.

Results

Peak KFM during stair ascent significantly increased from baseline to follow-up (p = 0.01). Though there was no significant difference in TFA (p = 0.84) compared to baseline, 50% of subjects showed decreases in TFA. Further, subjects with reduced TFA during stair ascent at follow-up had significantly increased peak KFM (p = 0.029) and improvements in PRO (p = 0.001).

Discussion

The results suggest that TFA during stair ascent can provide a simple method to assess changes in quadriceps function and pain over time following ACLR. Further analysis is needed to draw conclusions between knee osteoarthritis development and increases in TFA.

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

Changes in stair ascent biomechanics two to eight years after ACL reconstruction are associated with patient-reported outcomes

Publication date: March 2019

Source: Gait & Posture, Volume 69

Author(s): Arielle G. Fischer, Jennifer C. Erhart-Hledik, Constance R. Chu, Jessica L. Asay, Thomas P. Andriacchi

Abstract

Background

Anterior cruciate ligament (ACL) injury is often followed by quadriceps deficits that are apparent with gait analysis. The deficit frequently remains after ACL reconstruction (ACLR). As such, evaluation of ACLR patients could be enhanced by a simple method to detect quadriceps deficits. Analyzing forward trunk flexion during stair ascent has been suggested as an assessment of quadriceps function that can be visualized with relatively simple instrumentation.

Aim

The purpose of this study was to determine if trunk flexion angle (TFA) during stair ascent is associated with quadriceps function (as measured by the peak knee flexion moment (KFM)) at 2 and 8 years post-ACLR and if changes are associated with patient-reported outcomes (PRO).

Methods

Fourteen subjects with unilateral primary ACLR performed three stair-ascending trials at two-time periods: 2 years (baseline) and 8 years (follow-up) post-ACLR. Paired Student t-tests determined differences in KFM and TFA. Associations between KFM, TFA, and PRO were determined through Pearson correlations.

Results

Peak KFM during stair ascent significantly increased from baseline to follow-up (p = 0.01). Though there was no significant difference in TFA (p = 0.84) compared to baseline, 50% of subjects showed decreases in TFA. Further, subjects with reduced TFA during stair ascent at follow-up had significantly increased peak KFM (p = 0.029) and improvements in PRO (p = 0.001).

Discussion

The results suggest that TFA during stair ascent can provide a simple method to assess changes in quadriceps function and pain over time following ACLR. Further analysis is needed to draw conclusions between knee osteoarthritis development and increases in TFA.

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

Changes in stair ascent biomechanics two to eight years after ACL reconstruction are associated with patient-reported outcomes

Publication date: March 2019

Source: Gait & Posture, Volume 69

Author(s): Arielle G. Fischer, Jennifer C. Erhart-Hledik, Constance R. Chu, Jessica L. Asay, Thomas P. Andriacchi

Abstract

Background

Anterior cruciate ligament (ACL) injury is often followed by quadriceps deficits that are apparent with gait analysis. The deficit frequently remains after ACL reconstruction (ACLR). As such, evaluation of ACLR patients could be enhanced by a simple method to detect quadriceps deficits. Analyzing forward trunk flexion during stair ascent has been suggested as an assessment of quadriceps function that can be visualized with relatively simple instrumentation.

Aim

The purpose of this study was to determine if trunk flexion angle (TFA) during stair ascent is associated with quadriceps function (as measured by the peak knee flexion moment (KFM)) at 2 and 8 years post-ACLR and if changes are associated with patient-reported outcomes (PRO).

Methods

Fourteen subjects with unilateral primary ACLR performed three stair-ascending trials at two-time periods: 2 years (baseline) and 8 years (follow-up) post-ACLR. Paired Student t-tests determined differences in KFM and TFA. Associations between KFM, TFA, and PRO were determined through Pearson correlations.

Results

Peak KFM during stair ascent significantly increased from baseline to follow-up (p = 0.01). Though there was no significant difference in TFA (p = 0.84) compared to baseline, 50% of subjects showed decreases in TFA. Further, subjects with reduced TFA during stair ascent at follow-up had significantly increased peak KFM (p = 0.029) and improvements in PRO (p = 0.001).

Discussion

The results suggest that TFA during stair ascent can provide a simple method to assess changes in quadriceps function and pain over time following ACLR. Further analysis is needed to draw conclusions between knee osteoarthritis development and increases in TFA.

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

PP2ACα of Alveolar Macrophages Is a Novel Protective Factor for LPS-Induced Acute Respiratory Distress Syndrome

Abstract

Protein phosphatase 2A (PP2A) is one main serine/threonine phosphatase in eukaryotes, and its activation changes have been linked to modulation of numerous pathological processes, such as cancer, inflammation, fibrosis, and neurodegenerative diseases. Acute respiratory distress syndrome (ARDS), the major cause of respiratory failure, remains with limited therapies available up to now. Alveolar macrophages (AMs) are essential to innate immunity and host defense, participating in the pathogenesis of ARDS. As a result, AMs are considered as a potential therapeutic target for ARDS. In our study, we firstly found that PP2A activity was significantly decreased in the lipopolysaccharide (LPS)-stimulated AMs. Furthermore, adoptive transfer of AMs with enhanced PP2A enzyme activity that was improved by C2-ceramide prior to LPS exposure alleviated acute lung inflammation. Conversely, AM-specific ablation of PP2ACα exacerbated inflammatory responses to LPS. Mechanistically, PP2ACα negatively regulates LPS-induced cytokine secretion of AMs by NF-κB and MAPK pathways. Together, these findings provide the evidence to guide the development of novel therapeutic options targeting PP2ACα for ARDS/acute lung injury.

http://bit.ly/2RNa1o0

Water limitation can negate the effect of higher temperatures on forest carbon sequestration

Abstract

Climate change will bring about a consistent increase in temperatures. Annual precipitation rates are also expected to increase in boreal countries, but the seasonal distribution will be uneven, and several areas in the boreal zone will experience wetter winters and drier summers. This study uses the dynamic forest ecosystem model ForSAFE to estimate the combined effect of changes in temperature and precipitation on forest carbon stocks in Sweden. The model is used to simulate carbon stock changes in 544 productive forest sites from the Swedish National Forest Inventory. Forest carbon stocks under two alternative climate scenarios are compared to stocks under a hypothetical scenario of no climate change (baseline). Results show that lower water availability in the future can cause a significant reduction in tree carbon compared to a baseline scenario, particularly expressed in the southern and eastern parts of Sweden. In contrast, the north-western parts will experience an increase in tree carbon stocks. Results show also that summer precipitation is a better predictor of tree carbon reduction than annual precipitation. Finally, the change in soil carbon stock is less conspicuous than in tree carbon stock, showing no significant change in the north and a relatively small but consistent decline in the south. The study indicates that the prospect of higher water deficit caused by climate change cannot be ignored in future forest management planning.

http://bit.ly/2FNFHDi

Cost-effectiveness of Teriflunomide Compared to Interferon Beta-1b for Relapsing Multiple Sclerosis Patients in China

Abstract

Background and Objective

Teriflunomide is a once-daily oral immunomodulatory agent approved in 80 countries for the treatment of patients with relapsing multiple sclerosis (RMS). The study objective was to estimate the cost effectiveness of teriflunomide (14 mg tablet, daily) versus interferon beta-1b (250 mcg subcutaneous injection, every other day) among RMS patients from the Chinese healthcare system perspective.

Methods

A Markov model with annual cycles and a lifetime horizon was utilized to assess cost-effectiveness of teriflunomide in comparison with interferon beta-1b in RMS patients. Treatment effects, including 3-month confirmed disability worsening and annualized relapse rate, were derived from a network meta-analysis. Cost inputs included costs related to treatment acquisition, administration, monitoring, natural disease management through Expanded Disability Status Scale states, relapse treatment, and adverse event management. These costs were calculated as the product between unit costs from published sources and healthcare resource utilization patterns identified in a survey conducted among 11 neurologists across different areas in China. Health effects were expressed as quality-adjusted life years (QALYs) with costs in local currency (¥) and US dollars (US$), 2018.

Results

Teriflunomide dominated interferon beta-1b and was associated with lower total costs (teriflunomide ¥1,887,144 vs interferon beta-1b ¥2,061,393) and higher QALYs (teriflunomide 9.60 QALYs vs interferon beta-1b 8.88 QALYs). In probabilistic sensitivity analysis, teriflunomide was dominant in 62.2% of model runs.

Conclusion

Teriflunomide is a cost-effective therapy over a lifetime time horizon compared to interferon beta-1b in the treatment of RMS patients in China. Results should be interpreted with caution as head-to-head comparisons are not available.

http://bit.ly/2Ubd3yY

The Asian Lineage of Zika Virus: Transmission and Evolution in Asia and the Americas

Abstract

Since first isolation in 1947 from the Zika forest in Uganda, Zika virus (ZIKV) has been principally known as a benign agent associated with sporadic human infections in a restricted number of African countries. However, during 2015–2016, an Asian lineage of ZIKV caused an unprecedentedly large outbreak in the Americas and sizeable numbers of exported cases across the globe. In this review, we critically appraise the recent advances in molecular epidemiological studies of ZIKV performed to date, and we highlight the pivotal role played by genomic surveillance in elucidating the origins, dissemination and evolution of the Asian lineage of ZIKV in Asia and in the Americas.

http://bit.ly/2MtytF9

Cellular responses to proteostasis perturbations reveal non-optimal feedback in chaperone networks

Abstract

The proteostasis network (PN) comprises a plethora of proteins that are dedicated to aid in protein folding and maintenance; some with overlapping functions. Despite this, there are multiple pathophysiological states associated with depletion of chaperones. This is counter-intuitive, assuming cells have the ability to re-program transcriptional outputs in accordance with its proteostasic limitations. Here, we have used S. cerevisiae to understand how cells respond to different types of proteostasis impairments. We monitored the proteostasis status and transcriptome of single deletions of fourteen different Protein Quality Control (PQC) genes. In most cases, cellular response did not activate proteostasis components or pathways that could either complement the function of the missing PQC gene or restore proteostasis. Over-expression of alternate machineries could restore part of the proteostasis defect in two representative PQC gene deletion strains. We posit that S. cerevisiae inherently lacks the ability to sense and respond optimally to defects in proteostasis caused due to deletion of specific PQC components.

http://bit.ly/2sMTBNo

Link between the unfolded protein response and dysregulation of mitochondrial bioenergetics in Alzheimer’s disease

Abstract

Alzheimer's disease (AD) is a progressive neurodegenerative disorder affecting more than 47.5 million people worldwide. Metabolic impairments are common hallmarks of AD, and amyloid-β (Aβ) peptide and hyperphosphorylated tau protein—the two foremost histopathological signs of AD—have been implicated in mitochondrial dysfunction. Many neurodegenerative disorders, including AD, show excessive amounts of mis-/unfolded proteins leading to an activation of the unfolded protein response (UPR). In the present study, we aimed to characterize the link between ER stress and bioenergetics defects under normal condition (human SH-SY5Y neuroblastoma cells: control cells) or under pathological AD condition [SH-SY5Y cells overexpressing either the human amyloid precursor protein (APP) or mutant tau (P301L)]. More specifically, we measured UPR gene expression, cell viability, and bioenergetics parameters, such as ATP production and mitochondrial membrane potential (MMP) in basal condition and after an induced ER stress by thapsigargin. We detected highly activated UPR and dysregulated bioenergetics in basal condition in both AD cellular models. Strikingly, acute-induced ER stress increased the activity of the UPR in both AD cellular models, leading to up-regulation of apoptotic pathways, and further dysregulated mitochondrial function.

http://bit.ly/2MteDcU

The HMG box transcription factor HBP1: a cell cycle inhibitor at the crossroads of cancer signaling pathways

Abstract

HMG box protein 1 (HBP1) is a transcription factor and a potent cell cycle inhibitor in normal and cancer cells. HBP1 activates or represses the expression of different cell cycle genes (such as CDKN2A, CDKN1A, and CCND1) through direct DNA binding, cofactor recruitment, chromatin remodeling, or neutralization of other transcription factors. Among these are LEF1, TCF4, and MYC in the WNT/beta-catenin pathway. HBP1 also contributes to oncogenic RAS-induced senescence and terminal cell differentiation. Collectively, these activities suggest a tumor suppressor function. However, HBP1 is not listed among frequently mutated cancer driver genes. Nevertheless, HBP1 expression is lower in several tumor types relative to matched normal tissues. Several micro-RNAs, such as miR-155, miR-17-92, and miR-29a, dampen HBP1 expression in cancer cells of various origins. The phosphatidylinositol-3 kinase (PI3K)/AKT pathway also inhibits HBP1 transcription by preventing FOXO binding to the HBP1 promoter. In addition, AKT directly phosphorylates HBP1, thereby inhibiting its transcriptional activity. Taken together, these findings place HBP1 at the center of a network of micro-RNAs and oncoproteins that control cell proliferation. In this review, we discuss our current understanding of HBP1 function in human physiology and diseases.

http://bit.ly/2sLdZP5

The functional roles of exosomal long non-coding RNAs in cancer

Abstract

Exosomes are extracellular membranous vesicles that are secreted by various cell types. Exosomes have become indispensable facilitators in the exchange of information between cells. More importantly, exosomes perform a crucial role in a variety of diseases including cancers. Long non-coding RNAs (lncRNAs) are over 200 nucleotides long transcripts that exhibit no or limited protein-coding potentials. LncRNAs are an emerging group of regulatory RNAs and can be selectively packaged into exosomes. Exosomal lncRNAs play a central role in carcinogenesis and cancer progression by modulating tumor growth, metastasis, angiogenesis and chemoresistance. Moreover, exosomal lncRNAs function as messengers in cell-to-cell communication, and thus remodel the tumor microenvironment. Their function relevance in cancer biology hints at the possibility of employing exosomal lncRNAs as promising, non-invasive biomarkers for further cancer therapy. In this review, we provide an overview of current research on the functional roles of exosomal lncRNAs in cancer and discuss their potential clinical applications as diagnostic biomarkers and therapeutic targets for cancers.

http://bit.ly/2MxMKAp