A novel adaptive output feedback control for DC–DC boost converter using immersion and invariance observer

Abstract

This paper presents a class of novel adaptive output feedback controller for DC–DC boost converter with global exponential stability. In addition, the control input constraint is considered in stability analysis. The proposed adaptive control scheme is constructed to estimate input voltage and inductor current using output voltage and control signal information. In order to estimate unavailable state and parameter, immersion and invariance technique is employed. The effectiveness of the proposed method is investigated via experimental test and the practical results endorse the efficiency of this adaptive controller.

http://bit.ly/2Rf2YPX

Posttraumatic Arterial Priapism Treated with Superselective Embolization: Our Clinical Experience and a Review of the Literature

Abstract

Introduction

To present 12 cases of arterial priapism treated by superselective embolization and propose our management algorithm for this condition.

Methods

Between February 2013 and May 2018, 12 cases of arterial priapism caused by blunt trauma were treated by superselective embolization. The mean age of patients was 36 years (25–47 years). All of the patients had normal sexual capability before priapism (IIEF-5 scores 24–25). All patients were treated with superselective embolization after more than 3 weeks of simple conservative treatment had failed. All cases but one used a gelatin sponge as embolic agent. A microcoil was added in one case in which the gelatin sponge failed to occlude the pseudoaneurysm. After superselective embolization, ice pack and "observation" treatments continued. The sexual capability of the patients was evaluated by IIEF-5 scores at 6 months and 12 months postoperatively.

Results

The mean follow-up period was 27.2 months (13–48 months). Three patients achieved complete detumescence immediately. Nine cases needed 2–17 days to return to a flaccid nonpainful state. No patient underwent a second embolization. The time needed to improve erectile function was from 7 days to 4 months. There has been no recurrence. Eleven patients treated with gelatin sponge have normal erectile function, while one patient treated with additional microcoil embolization had mild erectile dysfunction.

Conclusion

Superselective embolization of the fistula is an effective option for arterial priapism. Absorbable agents should be used. Superselective arterial embolization should be considered after 3 weeks of conservative treatment. Patients should undergo another 3 weeks of "observation" treatment before repeated intervention.

http://bit.ly/2G3OQXS

Prevalence and correlates of dual tobacco use in cancer survivors

Abstract

Purpose

Tobacco use in cancer survivors remains a significant problem, however, the use of non-cigarette tobacco products (NCTPs) in this population is less understood. This study examined prevalence and correlates of tobacco use among cancer survivors who were never, current, and former cigarette users. Tobacco-related behaviors and quitting attitudes were compared between survivors dually using cigarettes and electronic cigarettes (ECs) and cigarette-only users.

Methods

In this cross-sectional study, patients at Mid-South cancer centers (n = 629; 50.4% never, 17.8% current, and 31.8% former cigarette users) responded to an anonymous questionnaire about tobacco-related behaviors and quitting attitudes.

Results

Among current cigarette users, 27.7% reported using two or more tobacco products. Most commonly, 15.2% of cigarettes users were using ECs. Compared to cigarette only use, dual use of tobacco products was associated with male gender (p < 0.0001), being single (p = 0.009), and a lung cancer diagnosis (p < 0.0001). Dual users of cigarettes and ECs were more likely to report a readiness to quit cigarettes within 6 months (p = 0.0317) and that a physician recommended ECs as a quit resource (p = 0.0361) compared to cigarette-only users.

Conclusions

Results suggest that using more than one tobacco product is common among cancer survivor cigarette users. Dual use of cigarettes and ECs was associated with an increased readiness for cigarette cessation and a physician recommendation of ECs. Targeting potential dual use of tobacco products, particularly cigarettes and ECs, might be beneficial for cigarette cessation among cancer survivors.

http://bit.ly/2MAHwEm

Rapid increase in endometrial cancer incidence and ethnic differences in New Zealand

Abstract

Purpose

Endometrial cancer accounts for 3.9% of all female cancers globally, and its incidence appears to be increasing in women under 40 years of age. This paper investigated ethnic-specific trends in endometrial cancer across different age groups in New Zealand.

Methods

Women who were diagnosed with endometrial cancer between 1996 and 2012 were identified from the New Zealand Cancer Registry. Annual age-standardized incidence and mortality rates were calculated for each ethnicity (Māori, Pacific, and non-Māori non-Pacific) in four age groups (< 40, 40–49, 50–74, and 75 +). The estimates were adjusted for hysterectomy. Joinpoint regression analysis was used to assess trends over time and annual percentage changes (APCs) were estimated.

Results

Between 1996 and 2012, age-standardized incidence rates increased in all women and significantly in the < 40, 40–49, and 50–74 age groups (APC 9.22, 3.56, and 1.65 respectively). Incidence rates were highest in Pacific women and increased most rapidly in those under 50 years of age (APC 9.36). Conversely, age-standardized mortality rates decreased in all women and significantly in the 50–74 and 75 + age groups (APC − 5.25 and − 5.06 respectively), with the highest rate observed in Pacific women.

Conclusion

Pacific women had the highest incidence of endometrial cancer and the trend was increasing, particularly in young women. This could be attributed, at least in part, to a high and increasing rate of obesity in these women and should be explored in future research.

http://bit.ly/2sLfjBu

Body mass index modifies bladder cancer risk associated with low estrogen exposure among Egyptian women after menopause

Abstract

Purpose

Investigators have reported inconsistent findings regarding associations between body mass index (BMI) and bladder cancer risk, and they have postulated that sex steroids mediate such associations. We assessed the impact of BMI on the relationship between bladder cancer risk and combinations of age at first childbirth, parity, and age at menopause, among Egyptian women.

Methods

We used data from our multicenter case–control study of 419 cases and 786 controls in logistic regression models to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of such associations.

Results

Age > 18 years at first childbirth and parity ≤ 6 were significantly associated with bladder cancer risk, which was higher when both factors (AOR = 2.31, 95% CI = 1.55–3.43) and age at menopause < 45 years (AOR = 3.51, 95% CI = 1.88–6.55) were present. Early menopause was associated with higher bladder cancer risk in obese (AOR = 2.90, 95% CI = 1.40–5.98) but not normal weight women (AOR = 0.98, 95% CI = 0.58–1.65; P_interaction = 0.11), and the risk was greatest when both first childbirth at age > 18 years and parity ≤ 6 were present (AOR = 7.60, 95% CI = 1.84–31.35); however, overweight and obesity were associated with significantly lower bladder cancer risk (AOR = 0.59, 95% CI = 0.43–0.81, and AOR = 0.26, 95% CI = 0.18–0.38, respectively).

Conclusion

Body mass index appears to modify bladder cancer risk in Egyptian women after menopause by slightly enhancing the risk associated with low estrogen exposure among the obese only. Longitudinal studies of the BMI role in bladder malignancy in this distinctive population are required.

http://bit.ly/2MAHOuW

Biography—Stephanie Tucker

http://bit.ly/2HzLPAX

Mucin glycoproteins block apoptosis; promote invasion, proliferation, and migration; and cause chemoresistance through diverse pathways in epithelial cancers

Abstract

Overexpression of mucin glycoproteins has been demonstrated in many epithelial-derived cancers. The significance of this overexpression remains uncertain. The aim of this paper was to define the association of mucin glycoproteins with apoptosis, cell growth, invasion, migration, adhesion, and clonogenicity in vitro as well as tumor growth, tumorigenicity, and metastasis in vivo in epithelial-derived cancers by performing a systematic review of all published data. A systematic review of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was performed to identify all papers that evaluated the association between mucin glycoproteins with apoptosis, cell growth, invasion, migration, adhesion, and clonogenicity in vitro as well as tumor growth, tumorigenicity, and metastasis in vivo in epithelial-derived cancers. PRISMA guidelines were adhered to. Results of individual studies were extracted and pooled together based on the organ in which the cancer was derived from. The initial search revealed 2031 papers, of which 90 were deemed eligible for inclusion in the study. The studies included details on MUC1, MUC2, MUC4, MUC5AC, MUC5B, MUC13, and MUC16. The majority of studies evaluated MUC1. MUC1 overexpression was consistently associated with resistance to apoptosis and resistance to chemotherapy. There was also evidence that overexpression of MUC2, MUC4, MUC5AC, MUC5B, MUC13, and MUC16 conferred resistance to apoptosis in epithelial-derived cancers. The overexpression of mucin glycoproteins is associated with resistance to apoptosis in numerous epithelial cancers. They cause resistance through diverse signaling pathways. Targeting the expression of mucin glycoproteins represents a potential therapeutic target in the treatment of epithelial-derived cancers.

http://bit.ly/2S8OyVL

Current progress in the inflammatory background of angiogenesis in gynecological cancers

Abstract

A tumor growth depends on the potency of the tumor to support itself with nutrients and oxygen. The development of a vascular network within the tumor is key to its survival. The permanent contest between the tumor and its host involves tumor cells on one side and an immunological system and tissue stroma on the other. The angiogenesis is not only a specialty of the tumor, but it also depends on this complex multidirectional interaction. The most common gynecological cancers, cervical, endometrial and ovarian carcinoma are good examples for studying this problem. In this review, we aim to show that an inflammatory response against a tumor can be reverted into an undesirable process leading to the development of a vascular network within the tumor and, subsequently, further growth of the tumor and progression of a disease. Therefore, a key for tumor management should be searched within the immunological system, rather than focused on cell cycle and anti-angiogenic treatment only.

http://bit.ly/2MElArW

MiR-19a mediates the negative regulation of the NF-κB pathway in lipopolysaccharide-induced endometritis by targeting TBK1

Abstract

Objective

In both humans and animals, endometritis is severe inflammation of the uterus, and it causes great economic losses in dairy cow production. MicroRNAs have been reported to play an important role in various inflammatory diseases. However, the regulatory mechanisms of miR-19a in endometritis remain unclear. Thus, the aims of this study are to investigate the role of miR-19a in a mouse model of lipopolysaccharide (LPS)-induced endometritis and elucidate the possible mechanisms in bovine endometrial epithelial cells (bEECs).

Methods and results

Histological analysis showed that LPS induced severe pathological changes, suggesting that the endometritis mouse model was well established. The qPCR assay indicated that miR-19a expression in the uterine tissues of mice with endometritis and in bEECs with LPS stimulation was significantly reduced. The overexpression of miR-19a significantly decreased the expression of inflammatory cytokines (TNF-α, IL-6 and IL-1β) and the phosphorylation of NF-κB p65 and IκBα. Similar results were also obtained following the knockdown of TBK1. Furthermore, a dual luciferase reporter assay further validated that miR-19a inhibited TBK1 expression by binding directly to the 3′-UTR of TBK1.

Conclusion

We demonstrated that miR-19a has anti-inflammatory effects and mediates the negative regulation of the NF-κB Pathway in LPS-induced endometritis by targeting TBK1.

http://bit.ly/2sPoIYF

Nifuroxazide induces apoptosis, inhibits cell migration and invasion in osteosarcoma

Summary

Osteosarcoma is the most common primary malignancy of bone and characterized by an appendicular primary tumor with a high rate of metastasis to the lungs. Unfortunately, there is no effective strategy to treat osteosarcoma in current clinical practice. In this study, the anticancer effects and potential mechanisms of nifuroxazide, an oral nitrofuran antibiotic, on two osteosarcoma cell lines were investigated. The results of the antiproliferative activity in vitro showed that nifuroxazide inhibited cell proliferation of UMR106 and MG63 cells in a dose- and time-dependent manner. Interestingly, nifuroxazide showed low toxicity to non-tumor cells (HEK 293 T). In addition, ROS-mitochondrial mediated apoptosis was observed after treatment of nifuroxazide. Moreover, nifuroxazide could significantly inhibit osteosarcoma cells migration and invasion via p-Stat3, MMP-2 and MMP-9 mediated signaling pathway. Taken together, our results suggested that nifuroxazide could be a promising agent for osteosarcoma treatment by inhibiting cell proliferation, inducing cell apoptosis and impairing cell migration and invasion.

http://bit.ly/2MtUinN

The antitumor efficacy of monomeric disintegrin obtustatin in S-180 sarcoma mouse model

Summary

Obtustatin, isolated from the Levantine Viper snake venom (Macrovipera lebetina obtusa -MLO), is the shortest known monomeric disintegrin shown to specifically inhibit the binding of the α1β1 integrin to collagen IV. Its oncostatic effect is due to the inhibition of angiogenesis, likely through α1β1 integrin inhibition in endothelial cells. To explore the therapeutic potential of obtustatin, we studied its effect in S-180 sarcoma-bearing mice model in vivo as well as in human dermal microvascular endothelial cells (HMVEC-D) in vitro, and tested anti-angiogenic activity in vivo using the chick embryo chorioallantoic membrane assay (CAM assay). Our in vivo results show that obtustatin inhibits tumour growth by 33%. The expression of vascular endothelial growth factor (VEGF) increased after treatment with obtustatin, but the level of expression of caspase 8 did not change. In addition, our results demonstrate that obtustatin inhibits FGF2-induced angiogenesis in the CAM assay. Our in vitro results show that obtustatin does not exhibit cytotoxic activity in HMVEC-D cells in comparison to in vivo results. Thus, our findings disclose that obtustatin might be a potential candidate for the treatment of sarcoma in vivo with low toxicity.

http://bit.ly/2FUXnfD

Einseitige schmerzhafte Schwellung der Leiste nach ungeschütztem Geschlechtsverkehr

http://bit.ly/2HyjI4V

Raynaud-Phänomen

Zusammenfassung

Das Raynaud-Phänomen (RP) ist eine häufige akrale Durchblutungsstörung bei der es durch eine pathologische Kontraktion kleiner arterieller Gefäße zu einem schmerzhaften Abblassen einzelner Akren (am häufigsten der Finger) kommt. Bei dem häufigen sog. primären RP liegt lediglich eine funktionelle Störung des Gefäßtonus vor, beim seltenen sekundären RP kommen zusätzlich strukturelle Änderungen im Bereich der Gefäße hinzu. Die Kenntnis dieser Erkrankung ist für den Dermatologen wichtig, da das sekundäre RP mit dem Vorliegen oder der Entwicklung schwerwiegender Grunderkrankungen, insbesondere einer systemischen Sklerose, assoziiert sein kann. Das diagnostische Vorgehen sowie die wichtigsten therapeutischen Ansätze werden in diesem Überblick zusammengefasst.

http://bit.ly/2SbT2v4

Current perspectives of cancer-associated fibroblast in therapeutic resistance: potential mechanism and future strategy

Abstract

The goal of cancer eradication has been overshadowed despite the continuous improvement in research and generation of novel cancer therapeutic drugs. One of the undeniable existing problems is drug resistance due to which the paradigm of killing all cancer cells is ineffective. Tumor microenvironment plays a crucial role in inducing drug resistance besides cancer development and progression. Recently, many efforts have been devoted to understand the role of tumor microenvironment in cancer drug resistance as it provides the shelter, nutrition, and paracrine niche for cancer cells. Cancer-associated fibroblasts (CAFs), one major component of tumor microenvironment, reside in symbiotic relationship with cancer cells, supporting them to survive from cancer drugs. The present review summarizes the recent understandings in the role of CAFs in drug resistance in various tumors. Acknowledging the fact that drug resistance depends not only upon cancer cells but also upon the microenvironment niche could guide us to formulate novel cancer drugs and provide the optimal cancer treatment.

http://bit.ly/2HwUwMo

The Effect of Respiration on Breast Measurement Using Three-dimensional Breast Imaging

Abstract

Background

Three-dimensional (3D) imaging offers new opportunities to enable objective and quantitative analysis of the breast. Unlike scanning of rigid objects, respiration may be one of the factors that can influence the measurement of breast when using 3D imaging. In this study, we aimed to investigate how the different respiratory phases affect 3D morphologic and volumetric evaluations of the breast.

Methods

We performed preoperative 3D breast imaging at the end of expiration (EE) and the end of inspiration (EI). We repeated scans on each respiratory phase, taking four scans in total (EE1, EE2 and EI1, EI2). Using Geomagic Studio 12 software, measurements from the different respiratory phases (EE1 and EI1) were compared for differences in the linear distances of breast. Breast volumetric change error (BVCE) was measured between EE1 and EE2 (R1) and between EI1 and EI2 (R2). A multilevel model was used to analyze the difference of linear-distances parameters between EE1 and EI1 and a paired sample t-test was used to analyze the difference between R1 and R2.

Results

Our study included 13 Chinese women (26 breasts) with a mean age of 32.6 ± 6.3 years. Compared with EI, EE showed a longer sternal notch to the level of the inframammary fold and shorter nipple to midline (p < 0.05). During EI, breast projection increased by 0.23 cm (95% CI − 0.39, − 0.08) and breast base width increased by 0.27 cm (95% CI − 0.46, − 0.09). The position of the nipple moved by 0.18 cm (95% CI − 0.34, − 0.03) laterally, 0.41 cm (95% CI 0.18, 0.64) cranially, and 0.71 cm (95% CI − 0.92, − 0.51) anteriorly. Although there was no significant difference in BVCE between EE and EI, the result seen with EE appeared to be more consistent.

Conclusions

The results of this study demonstrate that there was no difference in breast volume results when patients are in the expiratory or inspiratory state during 3D breast imaging. This study, however, holds potential benefits to both surgical practice as well as the 3D imaging industry.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

http://bit.ly/2FN3of1

Reply to Commentaries on: Opinions on the “Trick” Technique to Reposition the NAC in Female-to-Male Transexuals

http://bit.ly/2FWFltj

Measuring Projection of Nasal Tip with Syringe in Rhinoplasty

Abstract

Preoperative and intraoperative assessments are very important for surgeons to plan or regulate tip projection. But how to measure the tip projection is a difficult problem even with a ruler or on full-size pictures. In this paper, the author introduces a method to measure the nasal tip projection with a remodeled syringe.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266.

http://bit.ly/2FW5Pew

“Dual-Knot Fixation” Technique for Better Stabilization of the Extended Columellar Strut Graft with the Anterior Nasal Spine

Abstract

Introduction

Extended columellar strut graft (ecsg.) is one of the most crucial cartilage tissues used especially in secondary rhinoplasties. Stabilization of an ecsg. with the anterior nasal spine (ans.) is very important. Regular suture placement is the most common practice. Nevertheless, this kind of suture fixation may result in sliding of the ecsg. through either side of the ans. Suture placement like the figure of eight may prevent sliding of the ecsg. to sides. However, the figure of eight suture forces the graft to turn around during its fixation.

Method

I have tried to solve these two problems with a simple still better suture technique. After passing the suture through the hole of the ans., a stabilization knot is tied over the spine tip. Then passing the suture through the lower end of the ecsg. and fixating it with a second knot named as the "fixation knot" results in very good stabilization and prevents both side sliding and rotation of the graft. This stabilization technique can be called "dual-knot fixation" (dkf.). Opening a small notch at the lower tip of the graft may help to hide the "stabilization knot" inside the graft which will help to obscure the tiny space between the cartilage and the bone, and thus the bonding process between the graft and spine would be better.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

http://bit.ly/2FW5NmU

Erratum zu: Dermatofiller in der ästhetischen Medizin – ein Überblick

Erratum zu:

MKG-Chirurg 2018

http://bit.ly/2sNhxjF

In Tab. 3 „Gebräuchliche Fillerpräparate" wurde angegeben, dass für die Produkte Juvéderm Ultra, Voluma, Volift und Volbella keine Zulassung der Food and Drug Administration (FDA) vorläge. Diese Aussage ist falsch. Alle …

http://bit.ly/2MxhPEo

Putting Implementation Science into Practice: Lessons from the Creation of the National Maternal and Child Health Workforce Development Center

Abstract

Purpose This article describes how implementation science informed the design of a national training and technical assistance (TA) center, and how implementation best practices have been used to improve the quality of training and technical assistance services offered to states/jurisdictions. Description An existing tool, based on the Implementation Drivers Framework (in: Fixsen et al., Implementation research: a synthesis of the literature, University of South Florida, The National Implementation Research Network, Tampa, 2005), was adapted to assess efforts of the National MCH Workforce Development Center (the Center) against known implementation best practices. Staff identified specific examples of effective practice and gaps for inclusion in this article. Assessment Using implementation science to establish, assess and improve Center practice was both feasible and practical, requiring intentionality, dedicated time, and staff committed to deepening their understanding of implementation science. The Implementation Drivers framework proved useful for creating a shared approach to analysis and identification of opportunities for improvement of Center practice. Conclusion Policymakers and funding agencies should consider how training and technical assistance programs demonstrate knowledge and use of implementation science best practices among other evidence based practices in their work. Increasing attention to the use of implementation science can contribute to a higher quality of service among technical assistance centers, with the long term goal of improving outcomes for training and assistance recipients and the communities they serve. Establishing the link between customer satisfaction and quality of technical assistance, on the one hand, and long term outcomes, on the other, remains a challenge and an area of focus and learning for the Center.

http://bit.ly/2DyPWt0

The Role of Parents’ Nativity in Shaping Differential Risks of Food Insecurity Among US First Graders

Abstract

Objectives Food insecurity remains a problem in the US, especially for children in immigrant families. We developed a novel measure of parental nativity and incorporated school effects to advance knowledge from prior studies. Methods Using hierarchical logistic models and data from the Early Childhood Longitudinal Study-2011 Kindergarten Cohort, we examined how parental nativity and race/ethnicity, and school characteristics influence household food insecurity among a nationally representative sample of US first-graders in 2012. Results After adjusting for potential confounders, children without any US-born parents had a higher likelihood of household food insecurity than children with two US-born parents or one foreign-born/one US-born parent. Attending a Title 1 school was associated with food insecurity independent of household socioeconomic status. Conclusions for Practice Results suggest that providers should take special care to screen for food insecurity among children with only immigrant parents and that Title 1 schools have a potentially important role to play in reducing food insecurity.

http://bit.ly/2FXhs52

Understanding the Family Impact of Autism Spectrum Disorder in a Racially and Ethnically Diverse Sample: Findings from the National Survey of Children with Special Health Care Needs

Abstract

Objectives Caregivers of children with autism spectrum disorder (ASD) experience stress at greater rates than caregivers of other children with developmental conditions. Little is known about how families from different racial and ethnic backgrounds report family impact beyond individual stressors associated with caregiving. This paper aims to examine differences in family impact variables among caregivers of ASD children from different racial/ethnic backgrounds. Methods Using data from the 2005–2006 and 2009–2010 National Survey of Children with Special Health Care Needs, this retrospective, cross-sectional study examined family impact among caregivers of children with ASD. Family impact was defined as financial impact, time spent caregiving, and work impact variables and evaluated in five racial/ethnicity groups: white, non-Hispanic; any race, English-speaking Hispanic; any race, Spanish-speaking Hispanic; black, non-Hispanic; and other race, non-Hispanic respondents (n = 5115). Multivariate logistic regression was used to analyze the association of race and ethnicity with family impact variables while controlling for child and family covariates. Results Significant differences were found between race/ethnicity groups of caregivers on financial spending of more than $500 per year on care and providing more than 11 h a week on direct child care. No significant differences were observed in job impact variables between race/ethnicity groups. Conclusions for Practice Racial/ethnic differences exist in providing and spending more on direct care, but they do not necessarily represent disparities. More research is needed to fully understand if family impact is affected by cultural differences in care provided for children with ASD.

http://bit.ly/2RYa4g4

MCH Workforce Capacity: Maximizing Opportunities Afforded by a Changing Public Health System

Abstract

Objectives A skilled workforce is essential to advancing maternal and child health (MCH) in a rapidly changing public health system. Little is known about the MCH workforce's existing capacity to maximize opportunities afforded by ongoing change. We assessed MCH workforce capacity in three areas: Systems Integration, Evidence-Based Decision-Making, and Change Management/Adaptive Leadership. We then examined associations between workforce capacity and modifiable workforce development strategies/resources. Methods Data are from the Public Health Workforce Interests and Needs Survey (PH WINS). The present study was limited to employees working in MCH programs (weighted N = 3062). Workforce capacity was operationalized as self-reported awareness of public health trends and proficiency to perform related skills in the three areas. Survey-weighted generalized estimating equations were used to fit logistic regression models accounting for employee clustering within states. Results While awareness of public health trends was low, the majority of employees (> 70% in each area) reported proficiency to perform skills related to these trends. Capacity was lowest in Systems Integration. Employee engagement in academic partnerships and higher state contributions to MCH program budgets were the strategies/resources most consistently associated with higher capacity. Workplace support was the strongest correlate of capacity in Change Management/Adaptive Leadership. Conclusions for Practice Although employees lacked familiarity with specific public health trends, they were proficient in skills needed to engage in related work. Still, areas for improvement remain. Results provide a baseline against which future training efforts can be evaluated. Academic partnerships and MCH program funding may be useful to prioritize in the context of health transformation.

http://bit.ly/2Dq5eQu

Next Steps for Measures of Physical Activity During Pregnancy

http://bit.ly/2szWpNT

Independent evolution of complex development in animals and plants: deep homology and lateral gene transfer

Abstract

The evolution of multicellularity is a premier example of phenotypic convergence: simple multicellularity evolved independently many times, and complex multicellular phenotypes are found in several distant groups. Furthermore, both animal and plant lineages have independently reached extreme levels of morphological, functional, and developmental complexity. This study explores the genetic basis for the parallel evolution of complex multicellularity and development in the animal and green plant (i.e., green algae and land plants) lineages. Specifically, the study (i) identifies the SAND domain—a DNA-binding domain with important roles in the regulation of cell proliferation and differentiation, as unique to animals, green algae, and land plants; and (ii) suggests that the parallel deployment of this ancestral domain in similar regulatory roles could have contributed to the independent evolution of complex development in these distant groups. Given the deep animal-green plant divergence, the limited distribution of the SAND domain is best explained by invoking a lateral gene transfer (LGT) event from a green alga to an early metazoan. The presence of a sequence motif specifically shared by a family of SAND-containing transcription factors involved in the evolution of complex multicellularity in volvocine algae and two types of SAND proteins that emerged early in the evolution of animals is consistent with this scenario. Overall, these findings imply that (i) in addition to be involved in the evolution of similar phenotypes, deep homologous sequences can also contribute to shaping parallel evolutionary trajectories in distant lineages, and (ii) LGT could provide an additional source of latent homologous sequences that can be deployed in analogous roles and affect the evolutionary potentials of distantly related groups.

http://bit.ly/2CLB3BT

A task and performance analysis of endoscopic submucosal dissection (ESD) surgery

Abstract

Background

ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries.

Methods

We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons.

Results

The average time of the marking, injection, and circumferential cutting phases are 203.4 (σ: 205.46), 83.5 (σ: 49.92), 908.4 s. (σ: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (σ: 908.43). We also performed correlation analysis (Pearson's test) among the performance scores of the tasks. There is a moderate positive correlation (R = 0.528, p = 0.0355) between marking scores and total scores, a strong positive correlation (R = 0.7879, p = 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (R = 0.7095, p = 0.0021) between circumferential cutting and submucosal dissection and marking scores.

Conclusions

We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator.

Graphical abstract

http://bit.ly/2DB4DeV

Thoracoscopic truncal vagotomy versus surgical revision of the gastrojejunal anastomosis for recalcitrant marginal ulcers

Abstract

Introduction

Marginal ulcer is a common complication following Roux-en-Y gastric bypass with incidence rates between 1 and 16%. Most marginal ulcers resolve with medical management and lifestyle changes, but in the rare case of a non-healing marginal ulcer there are few treatment options. Revision of the gastrojejunal (GJ) anastomosis carries significant morbidity with complication rates ranging from 10 to 50%. Thoracoscopic truncal vagotomy (TTV) may be a safer alternative with decreased operative times. The purpose of this study is to evaluate the safety and effectiveness of TTV in comparison to GJ revision for treatment of recalcitrant marginal ulcers.

Methods

A retrospective chart review of patients who required surgical intervention for non-healing marginal ulcers was performed from 1 September 2012 to 1 September 2017. All underwent medical therapy along with lifestyle changes prior to intervention and had preoperative EGD that demonstrated a recalcitrant marginal ulcer. Revision of the GJ anastomosis or TTV was performed. Data collected included operative time, ulcer recurrence, morbidity rate, and mortality rate.

Results

Twenty patients were identified who underwent either GJ revision (n = 13) or TTV (n = 7). There were no 30-day mortalities in either group. Mean operative time was significantly lower in the TTV group in comparison to GJ revision (95.7 ± 16 vs. 227.5 ± 89 min, respectively, p = 0.0022). Recurrence of ulcer was not significant between groups and occurred following two GJ revisions (15%) and one TTV (14%). Complication rates were not significantly different with 62% in the GJ revision group and 57% in the TTV group. Approximately 38% (5/13) of GJ revisions and 28% (2/7) of TTV patients experienced complications with Clavien–Dindo scores > 3. There was no difference in postoperative symptoms between both groups.

Conclusions

Our results demonstrate that thoracoscopic vagotomy may be a better alternative with decreased operative times and similar effectiveness. However, further prospective observational studies with a larger patient population would be beneficial to evaluate complication rates and ulcer recurrence rates between groups.

http://bit.ly/2G1PvsB

Closed Facebook™ groups and CME credit: a new format for continuing medical education

Abstract

Background

The International Hernia Collaboration (IHC) is a closed Facebook™ group that allows international surgeons to post clinical questions and exchange transparent feedback with the intent to optimize patient outcomes. Despite the educational value of closed FB groups, CME credits have not been available to members. To determine feasibility of and user interest in earning CME credit through social media, the IHC piloted a series of expert lectures followed by an interactive Facebook Live session as a novel pathway offering CME credit.

Methods

Nine monthly lectures and Facebook Live sessions were presented. CME credit was offered for the final seven lectures. Participation in the form of views, comments, and likes was quantified by a Facebook analytics service and an engagement score, defined as [(the number of comments × 2) + (the number of reactions)], was calculated for each lecture and Facebook Live session. CME credit was obtained through a two-question quiz.

Results

Of 5400 + Facebook members of the IHC, an average of 1116 (20.4 ± 4.0%) viewed the live session event following each lecture (n = 9 events). The average Facebook engagement score for Facebook Live was 259 ± 75, a significant difference with the average Facebook engagement score on the IHC (40.8) over the same time period (p < 0.001). On average, 16 users [range 8–35, (n = 7 events)] claimed CME credit for each educational series.

Conclusions

Closed Facebook groups can be a useful media to offer educational content and CME credit. The pilot IHC Lecture and Facebook Live series offering CME credit resulted in significantly more engagement amongst its members compared to other posts during the same time period. A small portion of participants qualified for CME credit. Future social media educational series may increase participants qualifying for CME by streamlining the interface to obtain CME credit.

http://bit.ly/2FP66AJ

Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors

Abstract

Background

Duodenum-preserving total pancreatic head resection (DPPHRt) is an accepted alternative surgical procedure for benign or low-grade malignant tumors of the pancreatic head by preserving the duodenum with its intact blood supply from the pancreatic duodenal arterial arcade. This study describes our experience in laparoscopic DPPHRt (LDPPHRt). To our knowledge, this is the first description of this novel minimally invasive operation.

Methods

From August 2016 to May 2017, all consecutive patients who underwent LDPPHRt for pancreatic head lesions at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital in Guangzhou, China were enrolled into this retrospective study.

Results

There were ten women and two men. The average age was 37.3 years (range 8–61 years). The average diameter of the pancreatic head lesions on pre-operative CT/MR was 3.7 cm (range 2–4.8 cm). All the LDPPHRt procedures were performed successfully. There was no peri-operative death. The average operative time was 272.5 min (range 210–320 min). The average blood loss was 215 ml (range 50–450 ml). Post-operative complications included pancreatic fistula grade B (two patients, or 16.7%) and biliary fistula (two patients, or 16.7%). All the complications responded well to conservative treatment. The mean post-operative hospital stay was 11.5 days (range 6–25 days).

Conclusions

LDPPHRt provided a minimally invasive approach with good organ-preservation for benign or low-grade malignant tumors of the pancreatic head. The long-term oncological outcomes, and the exocrine and endocrine pancreatic functions after this operation require further studies.

http://bit.ly/2G3jWij

EUS-guided irreversible electroporation using endoscopic needle-electrode in porcine pancreas

Abstract

Background

Endoscopic irreversible electroporation (IRE) can be performed using a flexible, thin, needle-shaped electrode for an endoscopic ultrasound (EUS)-guided procedure. This study aimed to evaluate the feasibility and efficacy of performing EUS-guided IRE with endoscopic needle-electrode in porcine pancreas.

Methods

Experimental endoscopic IRE on the pancreas were performed by EUS-guided approach in three pigs and compared with surgical approach in three pigs. The animals were killed after 24 h and their pancreases collected.

Results

IRE ablation using endoscopic needle-electrode was successful technically in EUS-guided approaches for the pancreas. Immediately following IRE, the ablated pancreatic tissue showed no gross change except focal hemorrhage. H&E staining presented a well-demarcated ablation site measuring 1.0–1.5 cm in diameter in the pancreas. TUNEL immunohistochemistry showed diffuse cell death along the puncture site 24 h after IRE. No complication was observed in pigs after endoscopic IRE ablation.

Conclusion

EUS-guided IRE ablation was feasible and effective for pancreas using the newly developed device.

http://bit.ly/2FP63F3

Regression of intestinal metaplasia following magnetic sphincter augmentation device placement

Abstract

Background

Intestinal metaplasia represents an esophageal mucosal transformation due to uncontrolled gastroesophageal reflux disease. Fundoplication has been shown to lead to regression of disease. Magnetic sphincter augmentation is an alternative to fundoplication that effectively treats reflux disease. Initially, patients with intestinal metaplasia were not considered candidates for device placement, so outcomes in these patients are unknown.

Methods

A retrospective review of all patients who underwent magnetic sphincter augmentation device placement between 2007 and 2017 was performed. All patients underwent pre-operative endoscopic evaluation and were categorized as having ultra-short segment (less than 1 cm), short-segment (1–3 cm), or long-segment (greater than or equal to 3 cm) disease. To be included in the study, pathologic examination demonstrating columnar mucosa with goblet cells was required.

Results

There were 86 patients with biopsy-proven non-dysplastic intestinal metaplasia. 35 patients had ultra-short segment, 37 patients had short-segment, and 14 patients had long-segment disease. At a median follow-up of 1.2 years, 67/86 (78%) patients completed endoscopic follow-up. 48/67 (71.6%) patients had regression of intestinal metaplasia. There was no progression to dysplasia or carcinoma. Patients with abnormal post-operative DeMeester scores were less likely to have regression of disease. Regression was more likely in the ultra-short segment (82.8%) and short-segment (73.3%) groups compared to the long-segment group (25.0%).

Conclusions

Magnetic sphincter augmentation is effective in achieving regression of intestinal metaplasia. Longer-term follow-up is needed to assess durability of effect and make meaningful comparisons to fundoplication.

http://bit.ly/2G0G3G6

Outcome of endoscopic small-bore naso-jejunal tube stenting in early postoperative jejunal limb obstruction after gastrectomy

Abstract

Background

Early postoperative jejunal limb obstruction is a rare complication following gastric surgery with jejunal reconstruction. The condition is mainly attributed to kinking of the jejunal limbs, gastrojejunal or jejunojejunal anastomosis. There has been currently limited information regarding the safety and efficacy of endoscopic treatment in patients with early postoperative jejunal obstruction. We aimed to investigate outcome of endoscopic small-bore naso-jejunal (N-J) tube stenting across the obstructed segment in patients with uncomplicated early postoperative partial jejunal limb obstruction.

Methods

All patients diagnosed of jejunal limb obstruction within 8 weeks after gastric-related surgery were reviewed. Patients with malignant obstruction, complete closed loop obstruction, sepsis, instability, intestinal strangulation, or perforation were excluded. All patients underwent endoscopic dekinking and stenting for 2 weeks with an N-J tube using 16-French single lumen plastic nasogastric tube across the obstruction segment after failed conservative therapy. Successful N-J tube placement across the obstruction point was confirmed by contrast study. Complications, technical, and clinical success were evaluated.

Results

Twenty-one patients met the criteria. The primary operations were 7 partial gastrectomies with Billroth-II reconstruction, 7 total or partial gastrectomies with Roux-en-Y reconstruction and 4 Whipple's operations, 2 bypass procedures, and 1 proximal gastrectomy. Most common site of obstruction was jejunojejunal anastomosis and gastrojejunal anastomosis following Roux-en-Y and Billroth-II reconstruction, respectively. Endoscopic N-J tube placement was technically successful in 20 out of 21 patients (95%). One patient had aspirated pneumonia. There was no procedure-related mortality. After N-J tube removal, clinical success was demonstrated in 19 out of 20 patients (95%) at the median duration of 6 months. One patient underwent reoperation due to repeated tube dislodgement.

Conclusions

Endoscopic stenting with a 16-F naso-jejunal tube across the angulated segment is safe and effective for treatment of patients with uncomplicated early postoperative partial jejunal limb obstruction following gastric surgery with jejunal reconstruction.

http://bit.ly/2FP61wV

Implementation of 3D printed superior mesenteric vascular models for surgical planning and/or navigation in right colectomy with extended D3 mesenterectomy: comparison of virtual and physical models to the anatomy found at surgery

Abstract

Background

Three-dimensional (3D) printing technology has recently been well approved as an emerging technology in various fields of medical education and practice; e.g., there are numerous studies evaluating 3D printouts of solid organs. Complex surgery such as extended mesenterectomy imposes a need to analyze also the accuracy of 3D printouts of more mobile and complex structures like the diversity of vascular arborization within the central mesentery. The objective of this study was to evaluate the linear dimensional anatomy landmark differences of the superior mesenteric artery and vein between (1) 3D virtual models, (2) 3D printouts, and (3) peroperative measurements.

Methods

The study included 22 patients from the ongoing prospective multicenter trial "Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic MDCT Angiography," with preoperative CT and peroperative measurements. The patients were operated in Norway between January 2016 and 2017. Their CT datasets underwent 3D volume rendering and segmentation, and the virtual 3D model produced was then exported for stereolithography 3D printing.

Results

Four parameters were measured: distance between the origins of the ileocolic and the middle colic artery, distance between the termination of the gastrocolic trunk and the ileocolic vein, and the calibers of the middle colic and ileocolic arteries. The inter-arterial distance has proven a strong correlation between all the three modalities implied (Pearson's coefficient 0.968, 0.956, 0.779, respectively), while inter-venous distances showed a weak correlation between peroperative measurements and both virtual and physical models.

Conclusion

This study showed acceptable dimensional inter-arterial correlations between 3D printed models, 3D virtual models and authentic soft tissue anatomy of the central mesenteric vessels, and weaker inter-venous correlations between all the models, reflecting the highly variable nature of veins in situ.

http://bit.ly/2G1PpBf

Surgical techniques for advanced transverse colon cancer using the pincer approach of the transverse mesocolon

Abstract

Background

Laparoscopic surgery for colorectal cancer, not only early cancer but also advanced cancer, has become standardized by some randomized controlled studies. However, cases involving advanced transverse colon cancer were excluded from these studies due to the technical difficulty of the surgery. Hence, laparoscopic surgery for advanced transverse colon cancer is still a theme that we need to overcome. To solve these issues, it is necessary to establish a standardized approach and surgical technique.

Surgical techniques

The advantage of our method, which approaches from both sides of the transverse mesocolon, is that it is easier to achieve hemostasis when active bleeding occurs because this approach provides space for ligating and sealing. This allows the surgeon to perform lymphadenectomy around the superior mesenteric artery and vein.

Conclusions

We introduced the usefulness of the "Pincer approach of the transverse mesocolon" to standardize laparoscopic surgery for advanced transverse colon cancer.

http://bit.ly/2FRq6mk

Colorectal endoscopic submucosal dissection using novel articulating devices: a comparative study in a live porcine model

Abstract

Background and aims

Colonic endoscopic submucosal dissection (ESD) is time-consuming and bears a high risk of perforation. The aim of the present study was to compare the safety and efficacy between novel articulating devices and conventional ESD in live porcine colon models.

Methods

Thirty ESDs in ten pigs were carried out at three different locations (15, 25, and 35 cm from the anus) by the conventional method (n = 15) and by the new method (n = 15). Procedure times, adverse events (perforation, bleeding), and damage to the muscular layer were recorded, and the ESD time per unit area of the specimens was calculated.

Results

The perforation rate using the conventional method was 6.7% (1/15), whereas that using the new method was 0.0%. The number of sites of muscular damage was significantly lower in the new than conventional method (6 vs. 37, respectively; P = 0.024). The mean procedure time was significantly shorter in the new than conventional method (4.6 ± 2.0 vs. 7.0 ± 4.1 min/cm², respectively; P = 0.042).

Conclusions

Use of the new ESD method allows for reduced adverse events and a shortened resection time.

http://bit.ly/2G1Pmp3

New experience of endoscopic papillectomy for ampullary neoplasms

Abstract

Aim

To establish the clinical value of endoscopic papillectomy for duodenal papillary tumor based on endoscopic and clinical characteristics.

Patients and methods

This single-center, retrospective study included 110 patients with duodenal papillary tumor who underwent endoscopic papillectomy between January 2006 and April 2017 at the gastrointestinal endoscopic center of the Chinese PLA General Hospital. Clinical data, postoperative pathology, procedure-related complications, and therapeutic outcomes were analyzed.

Results

Endoscopic papillectomy was technically feasible in all patients, and was mainly performed by four experienced endoscopists. The primary success rate of endoscopic papillectomy for ampullary neoplasms was 78.2%. A total of 13 patients experienced recurrence during a mean follow-up period of 16.28 months (range 6–132 months), the predictive factors that were related to recurrence were complete resection (53.8% vs. 94.2%; P = 0.001), and final pathology findings (P = 0.001). Delayed hemorrhage, the most common procedure-related complication, occurred in 20% (22/110) of patients and was significantly related to intraoperative bleeding (P = 0.042). Pancreatitis was the second most common complication, which was closely related to intraoperative bleeding requiring intervention (P = 0.040) and larger tumor size (P = 0.044). Histology, type of resection, stent placement, sphincterotomy, and duration of procedure were not related to post-procedure hemorrhage or pancreatitis. Older age (63.7 ± 13.5 vs. 57.4 ± 12.2; P = 0.033), jaundice (47.8% vs. 13.8%; P = 0.001), endoscopic forceps biopsy diagnosis of high-grade intraepithelial neoplasia (82.6% vs. 14.9%; P = 0.001), tumor size ≥ 2 cm (60.9% vs. 34.5%; P = 0.022), and dilation of the bile duct (34.8% vs. 9.2%; P = 0.006) were clinical features for ampullary carcinoma. The rate of complete resection (52.2% vs. 92.0%; P = 0.001) and recurrence (34.8% vs. 6.8%; P = 0.001) were also related to the diagnosis of ampullary carcinoma at final pathology.

Conclusions

Endoscopic papillectomy is a feasible and reasonable option for both diagnosis and treatment of tumors of the duodenal papilla in properly selected patients.

http://bit.ly/2FQouJk

Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair

Abstract

Background

The increased incidence of anemia in patients with hiatal hernias (HH) and resolution of anemia after HH repair (HHR) have been clearly demonstrated. However, the implications of preoperative anemia on postoperative outcomes have not been well described. In this study, we aimed to identify the incidence of preoperative anemia in patients undergoing primary HHR at our institution and sought to determine whether preoperative anemia had an impact on postoperative outcomes.

Methods

Using our IRB-approved institutional HH database, we retrospectively identified patients undergoing primary HHR between January 2011 and April 2017 at our institution. We identified patients with anemia, defined as serum hemoglobin levels less than 13 mg/dL in men and 12 mg/dL in women, measured within two weeks prior to surgery, and compared this group to a cohort of patients with normal preoperative hemoglobin. Perioperative outcomes analyzed included estimated blood loss (EBL), operative time, perioperative blood transfusions, failed postoperative extubation, intensive care unit (ICU) admission, postoperative complications, length of stay (LOS), and 30-day readmission. Outcomes were compared by univariable and multivariable analyses, with significance set at p < 0.05.

Results

We identified 263 patients undergoing HHR. The median age was 66 years and most patients were female (78%, n = 206). Seventy patients (27%) were anemic. In unadjusted analyses, anemia was significantly associated with failed postoperative extubation (7 vs. 2%, p = 0.03), ICU admission (13 vs. 5%, p = 0.03), postoperative blood transfusions (9 vs. 0%, p < 0.01), and postoperative complications (41 vs. 18%, p < 0.01). On adjusted multivariable analysis, anemia was associated with 2.6-fold greater odds of postoperative complications (OR 2.57; 95% CI 1.36–4.86; p < 0.01).

Conclusions

In this study, anemia had a prevalence of 27% in patients undergoing primary HHR. Anemic patients had 2.6-fold greater odds of developing postoperative complications. Anemia is common in patients undergoing primary HHR and warrants consideration for treatment prior to elective repair.

http://bit.ly/2G1Pkxr

Long-term follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a prospective randomized comparative study of weight loss and remission of comorbidities

Abstract

Background

One-Anastomosis Gastric Bypass (OAGB) has exponentially increased in the last decade, as it is associated with very low complications, mortality, readmissions and reoperations rates, and shows excellent short- and long-term benefits of weight loss and resolution of comorbidities. The aim of this study was to compare the effect of SG, RYGB, and OAGB, on short- and long-term weight loss and comorbidities resolution.

Methods

A prospective randomized clinical study of all morbidly obese patients undergoing SG, RYGB, and OAGB, as primary bariatric procedures, was performed. Patients were randomly assigned into 3 groups: those patients undergoing SG, those ones undergoing RYGB and those ones undergoing OAGB. BMI, excess BMI loss (EBMIL) and remission of type 2 diabetes (T2DM), hypertension (HT), and dyslipidemia (DL) were assessed.

Results

600 patients were included in the study, 200 in each group. Follow-up rate at 5 years postoperatively was 91% in SG group, 92% in RYGB, and 90% in OAGB. OAGB achieves significantly greater EBMIL than RYGB and SG at 1, 2, and 5 years (p < 0.001, respectively). At 5 years, OAGB achieves significantly greater remission of T2DM (p = 0.027), HT (p = 0.006), and DL (p < 0.001) than RYGB and SG. RYGB did not show significant superiority than SG in short- and long-term remission of T2DM and HT, but achieves greater remission of DL (p < 0.001).

Conclusion

OAGB achieves superior mid- and long-term weight loss than RYGB and SG. There are no significant differences in weight loss between SG and RYGB at 1, 2, and 5 years. OAGB achieves better short- and long-term resolution rates of DM, HT, and DL than SG and RYGB. RYGB and SG obtain similar T2DM and HT remissions, but RYGB reaches significantly greater rates of DL remission. ClinicalTrials.gov Identifier: NCT03467646.

http://bit.ly/2FP5Wt7

Fluorescence lymphangiography-guided full-thickness oncologic gastric resection

Abstract

Background

We aimed to assess the feasibility of a novel hybrid endoscopic/laparoscopic non-exposed, full-thickness, single-wall gastric resection technique guided by a fluorescence lymphangiography to identify the lymphatic pathway and the sentinel node basin.

Methods

Eight large white pigs (4 acute and 4 survival models) were included. Indocyanine green was injected submucosally around a pseudo-tumor at four points (1 ml, 0.1 mg/ml). The lymphatic spreading pathway was identified by the means of near-infrared (NIR) laparoscopic camera, and the resection line was planned outside of the fluorescent signals, to include all the potential lymphatic channels. Lymph node (LN) dissection was performed at greater curvature side and the infrapyloric area preserving the infragastric artery for all pigs. At the lesser curvature, 3–4 branches of the gastric artery were preserved in all acute and in two survival (group A), while in the remaining animals, 1–2 branches were preserved (group B). Perfusion of the remaining stomach was examined by NIR angiography. The gastric motility and function were evaluated by the means of a dynamic MRI immediately after the procedure and repeated after 1 week in surviving animals.

Results

The hybrid full-thickness resection with bilateral sentinel LN basin dissection were successfully performed with no intra-operative or post-operative complications. The removed specimen was including all the area with florescent signal. The remaining stomach demonstrated a good perfusion at the NIR angiography. The dynamic MRI revealed a preserved emptying function in the acute animals and in the group A, and a loss of function in the group B.

Conclusions

Fluorescence-lymphangiography guided hybrid resection was feasible to remove a relatively large part of the stomach including the lymphatic spreading pathway and sentinel basin. The extent of dissection in the lesser curvature side can affect the post-operative function and further researches are warranted to optimize the concept.

http://bit.ly/2G1lmtv

A systematic review of the learning curve in robotic surgery: range and heterogeneity

Abstract

Background

With the rapid adoption of the robotic surgery, more and more learning curve (LC) papers are being published but there is no set definition of what should constitute a rigorous analysis and represent a true LC. A systematic review of the robotic surgical literature was undertaken to determine the range and heterogeneity of parameters reported in studies assessing the LC in robotic surgery.

Methods

The search was conducted in July 2017 in PubMed. All studies reporting a LC in robotic surgery were included. 268 (25%) of the identified studies met the inclusion criteria.

Results

102 (38%) studies did not define nor explicitly state the LC with appropriate evidence; 166 studies were considered for quantitative analysis. 46 different parameters of 6 different outcome domains were reported with a median of two parameters (1–8) and 1 domain (1–5) per study. Overall, three domains were only technical and three domains were both technical and clinical/patient-centered outcomes. The two most commonly reported domains were operative time [146 studies (88%)] and intraoperative outcomes [31 studies (19%)]. Postoperative outcomes [16 studies (9%)] and surgical success [11 studies (7%)] were reported infrequently. Purely technical outcomes were the most frequently used to assess LC [131 studies (79%)].

Conclusions

The outcomes reported in studies assessing LC in robotic surgery are extremely heterogeneous and are most often technical indicators of surgical performance rather than clinical and patient-centered outcomes. There is no single outcome that best represents the surgical success. A standardized multi-outcome approach to assessing LC is recommended.

http://bit.ly/2FRnFQr

Robotic transanal minimally invasive surgery (TAMIS) with the newest robotic surgical platform: a multi-institutional North American experience

Abstract

Background

Transanal minimally invasive surgery (TAMIS) offers intra-luminal full-thickness excision of rectal neoplasia. Robotic TAMIS (RT) allows for greater versatility in motion while operating in the limited space of the rectum. We present our experience with this technique in practice using the DaVinci Xi™ platform.

Method

This is a multi-institutional retrospective analysis for patient undergoing Robotic TAMIS for resection of rectal lesions at two tertiary referral hospitals in the United States. Morbidity, mortality, anatomic measurement, and final pathology were analyzed.

Results

Thirty-four patients planned for Robotic TAMIS were identified. Average follow-up was 188 days. The average BMI was 29.5 ± 5.9. All patients had an American Society of Anesthesiologist (ASA) Class of 2 or greater and 21 (62%) were ASA 3 or greater. Rectal lesions located from 2 to 15 cm from the dentate line were successfully resected. Lesions up to 4.5 cm in the longest dimension were successfully resected. The average operative time was 100 ± 70 min, which correlated to a robotic console time of 76 ± 67 min. Patients were placed in Lithotomy in 32 (94%) cases and were prone in only 2 (6%) cases. There were no intraoperative complications or conversions to another technique. The only postoperative complication was a medically managed Clostridium difficile infection in 1 patient. Three patients were upstaged to T2 on final pathology and underwent successful formal resections. BMI was a statistically significant predictor of a longer operation.

Conclusions

With increased reach and operative range of motion, Robotic TAMIS is a safe and effective method for excising low-risk rectal neoplasia with a wide range of anatomical measurements. Higher BMI is a significant predictor of a longer and likely more challenging operation.

http://bit.ly/2G1lkln

Regenerating a ventricular cavity during left ventricular assist device implantation

Abstract

Ten months after an ineffective percutaneous coronary stent placement, a 53-year-old patient was rehospitalized with NYHA functional class IV congestive heart failure, ischemic heart disease and left ventricular aneurysm. Echocardiography revealed thrombus formation in the left ventricle with apical aneurysm. Even though left ventricular assist device (LVAD) implantation improves quality of patients' lives with an increase of its overall use, it becomes more complicated in the presence of ventricular thrombus. We decided to perform ventricular reconstruction with thrombus extraction concomitant to HeartMate 3™ LVAD implantation. The patient was recovered uneventfully, and discharged on postoperative day 14. This report shares the patient's case and the surgical procedure.

http://bit.ly/2G3igW3

Risk factors associated with 30-day mortality for out-of-center ECMO support: experience from the newly launched ECMO retrieval service

Abstract

Out-of-hospital extracorporeal membrane oxygenation (ECMO) implantation and ECMO transport have become a growing field useful for emergent treatment of heart or lung failure with increasing number of centers launching such service. This study was designed to present risk factors predicting 30-day mortality for patients receiving ECMO support in a newly launched ECMO retrieval service. From 01/2015 till 01/2017 28 consecutive patients received ECMO support in peripheral hospitals using a miniaturized portable Cardiohelp System^® (Maquet, Rastatt Germany) for heart, lung or heart/lung failure as a bridge-to-decision as a part of our newly launched ECMO retrieval service. Outcomes and predictors for 30-day mortality were presented. The mean age was 56 ± 15 (maximum 78) years. The mean ECMO support duration was 97 ± 100 h, whereas 11 patients (40%) were weaned off support and discharged from hospital. Presence of hemolysis (p = 0.041), renal failure (p = 0.016), lower platelet count before ECMO implantation (p = 0.001), and higher lactate 24 h after initiation of support (p = 0.006) were factors associated with 30-day mortality. Initial success of an ECMO retrieval service depends on logistic organization and clinical management. Taking into consideration highly deleterious effects of hemodynamic malperfusion of end organs, rapid initiation of ECMO support is a vital factor for survival. This is highlighted by predictive factors of early mortality that are associated with peripheral organ failure or complications.

http://bit.ly/2FRnp3V

Deployment of stent graft in an excessively higher position above the renal artery induces a flow channel to the aneurysm in chimney endovascular aortic aneurysm repair: an in vitro study

Abstract

We aimed to investigate the influences of the sealing length above the renal artery (RA) on gutter formation, non-apposed regions between the aortic wall, stent graft (SG), and chimney graft and incidence of flow channel to the aneurysm in chimney endovascular aortic aneurysm repair (Ch-EVAR) using a juxtarenal abdominal aortic aneurysm model. Neck diameter and length of the silicone model were 24 and 4 mm, respectively. In double Ch-EVAR configuration using Advanta V12, 12 combinations were tested three times with two sizes [28.5 (20%-oversize) and 31 (30%-oversize) mm] of Excluder SG, three sealing lengths above the RA (10, 20, and 30 mm), and two deployment positions (anatomical and cross-leg). Gutter area, non-apposed region, and flow channels to the aneurysm were analyzed using micro-computed tomography. Average gutter area and non-apposed region of 30%-oversize SG were significantly smaller than those of 20%-oversize SG (p = 0.05). Furthermore, the non-apposed region of 30%-oversize SG with a 30-mm sealing length was significantly larger than that of the other sealing lengths. For 20%-oversize SGs, flow channel to the aneurysm was observed, except for the anatomical deployment with the sealing length of 10 mm. For 30%-oversize SGs, flow channel was absent, except for the SG with a 30-mm sealing length in both deployment positions. These flow channels were frequently formed through a valley space, existing in the lower unibody above the two limbs. Our data indicated that the optimal sealing length should be chosen in consideration of the device design difference due to the device diameter in Ch-EVAR.

http://bit.ly/2G2FE5Z

Operative Therapie des frühen und fortgeschrittenen Ovarialkarzinoms

Zusammenfassung

Hintergrund

Die operative Therapie des Ovarialkarzinoms ist neben der systemischen Therapie ein grundlegender Pfeiler in der Behandlungsstrategie. Grundsätzlich hat die Operation eine duale Bedeutung: Sie dient zum einen als Grundlage des FIGO-Stagings und ist demnach die wichtigste diagnostische Methode. Andererseits hat sie unmittelbaren Einfluss auf die Prognose und ist Teil eines meist multimodalen und interdisziplinären Therapiekonzepts beim primären Ovarial‑, Tuben- und Peritonealkarzinom.

Ergebnisse

Während es sich in den frühen Stadien bis FIGO IIA mehrheitlich um Komplettierungs- sowie Staging-Operationen handelt, sollte das Ziel der Operation beim fortgeschrittenen Karzinom die maximale Tumorreduktion sein, häufig verbunden mit der Notwendigkeit multiviszeraler Eingriffe. Das operative Staging im Frühstadium bis FIGO IIA sollte adäquat sowie komplett durchgeführt werden und definierte Operationsschritte beinhalten. Da der verbleibende, makroskopisch sichtbare Tumorrest ein entscheidender Prognosefaktor für das Gesamtüberleben ist, sollte das Ziel der Operation im fortgeschrittenen Stadium immer eine makroskopische Komplettresektion sein. Bei Patientinnen mit fortgeschrittenem Ovarialkarzinom ab dem Stadium FIGO IIIC sollte bei klinisch unauffälligen Lymphknoten und einer makrokoskopischen Komplettresektion auf eine systematische pelvine und paraaortale Lymphonodektomie unbedingt verzichtet werden. Die primäre Operation gilt auch in der aktuellen interdisziplinär und interprofessionell abgestimmten S3-Leitlinie als Standardtherapie. Methoden wie PIPAC oder HIPEC sollten nicht außerhalb klinischer Studien zur Anwendung kommen.

Diskussion

Der postoperative Tumorrest ist der entscheidendste Prognosefaktor für das progressionsfreie und Gesamtüberleben. In den Frühstadien sollte ein adäquates Staging erfolgen, wohingegen in den häufigeren fortgeschrittenen Stadien multiviszerale Resektionen erforderlich sind, welche eine interdisziplinäre Zusammenarbeit erforderlich machen.

http://bit.ly/2FUgzuG

Robotic-assisted procedures in neurosurgery

http://bit.ly/2Se8vdQ

Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry

Abstract

Background

The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques.

Objective

To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes.

Methods

This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined.

Results

From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year.

Conclusions

In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.

http://bit.ly/2Hygq1z

In vivo demonstration of blood-brain barrier impairment in Moyamoya disease

Abstract

Background

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by fragile vascular system. Previous studies suggested that the blood-brain barrier (BBB) destabilizing cytokine angiopoietin-2 plays a critical role in increasing vascular plasticity and endothelial disintegration in MMD. The aim of this study was to assess cerebrovascular integrity in vivo in patients affected by MMD.

Methods

We retrospectively analyzed 11 patients that underwent bypass for MMD (MMD group), 11 patients that underwent bypass for atherosclerotic cerebrovascular disease (ACVD—control group I), and 5 patients that underwent clipping for unruptured aneurysms (non-ischemic—control group II). Sodium fluorescein (NaFL) extravasation was evaluated during videoangiography when checking for bypass patency. A grading system (0, +, ++, +++) was used to define the extent of extravasation. Frequency and intensity of leakage was compared among different groups.

Results

NaFL extravasation appeared in 10/11 (91%) patients with MMD and in 8/11 (73%) patients with ACVD during bypass procedures. Extravasation was observed in none of the patients undergoing clipping for unruptured aneurysms. Although both chronic ischemic patient groups showed a comparably high incidence of NaFL extravasation, the MMD group was characterized by a much greater intensity of NaFL extravasation (grade +++ in 82%) than the ACVD group (grade +++ in 27%, p < 0.05).

Conclusions

We demonstrate blood-brain barrier impairment in MMD patients for the first time in vivo. This may be due to mechanisms intrinsic to the unique pathology of MMD, probably explaining the higher association with hemorrhage and post-operative hyperperfusion.

http://bit.ly/2Sb62B1

Thank you list 2018

http://bit.ly/2HyTpvE

Stereotactic brain biopsy: evaluation of robot-assisted procedure in 60 patients

Abstract

Background

Frameless stereotactic biopsies, particularly robot-assisted procedures are increasing in neurosurgery centers. Results of these procedures should be at least equal to or greater than frame-based reference procedure. Evaluate robot-assisted technology is necessary in particular, when a team has chosen to switch from one to another method.

Objective

The objective of our prospective work was (i) to evaluate the success rate of contributive robotic-assisted biopsy in 60 patients, to report the morbidity and mortality associated with the procedure and (ii) to compare it with literature data.

Methods

We performed a prospective and descriptive study including 60 consecutive patients having had robotic-assisted stereotactic biopsy at the Rouen University Hospital, France. All patients had presurgical imaging before the procedure included Magnetic Resonance Imaging merged with Computed Tomography scan acquisition. Registration was mostly performed with a touch-free laser (57/60). A control Computed Tomography scan was always realized at day 0 or day 1 after surgery. Data collected were success rate, bleeding, clinical worsening, infection, and mortality.

Results

All the biopsies were considered as contributive and lead to the final diagnosis. In 41/60 patients (68%), the lesion was glial. Six in 60 patients (10%) had visible bleeding without clinical worsening related, 5/60 patients (8.5%) showed clinical impairment following surgery, which was permanent in 2 patients, and 1/60 patient presented generalized seizures. We did not report any infection and mortality.

Conclusion

Robot-assisted frameless surgery is efficient and provides a reasonable alternative to frame-based procedure. The operating time can be reduced, without increasing morbidity and mortality rates.

http://bit.ly/2S8kOIF

Neurosurgical treatment and outcome patterns of meningioma in Sweden: a nationwide registry-based study

Abstract

Background

Surgery is the main treatment modality for intracranial meningiomas, but data on short-term surgical outcome are limited. The aim of this Swedish nationwide registry-based study was to benchmark the 30-day complication rate in a cohort of meningioma patients using data from the Swedish brain tumor registry (SBTR). Furthermore, we investigated outcomes for asymptomatic patients.

Methods

Data were collected from the SBTR for all adults with histopathologically verified intracranial meningioma between 2009 and 2015. Patient symptoms, tumor characteristics, and complications within 30 days postoperatively were analyzed.

Results

In total, 2324 patients, with a mean age of 58.7 years (SD 13.5), underwent surgery for intracranial meningioma and 14.1% of the patients were asymptomatic before the intervention. The most common symptom prior to treatment was focal deficit, which occurred in 1450 patients (62.4%). Moreover, within 30 days after surgery, 344 patients (14.8%) developed new neurological deficits and new-onset seizures occurred in 105 patients (4.5%), while 8.3% of asymptomatic patients developed neurological deficit and 3.7% new-onset seizures. Due to complications, reoperations were performed in 120 patients (5.2%). The postoperative 30-day mortality in the whole cohort was 1.5%.

Conclusion

This study benchmarks the 30-day complication rate after meningioma surgery and provides outcome data in the highly relevant group of asymptomatic patients using data from the Swedish brain tumor registry. Since surgical decision-making is a careful consideration of short-term risk versus long-term benefit, this information may be useful for both caregivers and patients.

http://bit.ly/2HLSSXp

Association between medical academic genealogy and publication outcome: impact of unconscious bias on scientific objectivity

Abstract

Background

Our previous studies suggest that the training history of an investigator, termed "medical academic genealogy", influences the outcomes of that investigator's research. Here, we use meta-analysis and quantitative statistical modeling to determine whether such effects contribute to systematic bias in published conclusions.

Methods

A total of 108 articles were identified through a comprehensive search of the high-grade glioma (HGG) surgical resection literature. Analysis was performed on the 70 articles with sufficient data for meta-analysis. Pooled estimates were generated for key academic genealogies. Monte Carlo simulations were performed to determine whether the effects attributed to genealogy alone can arise due to chance alone.

Results

Meta-analysis of the HGG literature without consideration for academic medical genealogy revealed that gross total resection (GTR) was associated with a significant decrease in the odds ratio (OR) for the hazard of death after surgery for both anaplastic astrocytoma (AA) and glioblastoma (AA: log [OR] = − 0.04, 95% CI [− 0.07 to − 0.01]; glioblastoma log [OR] = − 0.36, 95% CI [− 0.44 to − 0.29]). For the glioblastoma literature, meta-analysis of articles contributed by members of a genealogy consisting of mostly radiation oncologists revealed no reduction in the hazard of death after GTR [log [OR] = − 0.16, 95% CI [− 0.41 to 0.09]. In contrast, meta-analysis of published articles contributed by members of a genealogy consisting of mostly neurosurgeons revealed that GTR was associated with a significant reduction in the hazard of death [log [OR] = − 0.29, 95% CI [− 0.40 to 0.18]. Monte Carlo simulation revealed that the observed discrepancy between the articles contributed by the members of these two genealogies was unlikely to arise by chance alone (p < 0.006).

Conclusions

Meta-analysis of articles contributed by authors belonging to the different medical academic genealogies yielded distinct and contradictory pooled point-estimates, suggesting that genealogy contributes to systematic bias in the published literature.

http://bit.ly/2S6QE8W

Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study

Abstract

Background

Cerebrospinal fluid (CSF) drainage or intracranial pressure (ICP) monitoring devices are life-saving devices. We examined the risk factors for infections related to them and assessed the effect of an infection control (IC) intervention.

Methods

A prospective observational study was conducted in the Neurosurgical Department of our hospital between 2014 and 2017. We included all consecutive patients undergoing CSF catheter insertions, including external ventricular drainage (EVD), lumbar drainage (LD), and ICP catheters. An IC intervention was implemented between March and August 2016. We examined risk factors for meningitis or ventriculitis, defined according to Healthcare-associated infections surveillance definitions, on univariate and multivariate analysis.

Results

A total of 232 patients with 437 drains (212 EVDs, 92 LDs, and 133 ICPs) were included. On univariate and multivariate analysis, the infection incidence was 13.7 per 1000 drain days (17.3/1000 before IC intervention, 7.9/1000 during, and 9.2/1000 after the intervention). Most episodes were caused by Gram-negative bacteria, and the most common pathogen was Acinetobacter baumanii. Risk factors for infection per patient included diabetes mellitus (p = 0.017), CSF leak (p = 0.032), drain opening (p = 0.027), and the duration of the drain in days (p = 0.035). Risk factors per catheter included drain opening (p < 0.001), drain days (p = 0.001), and the IC intervention period compared to before the intervention period (p = 0.037). When restricting the analysis to EVDs, drain days (p = 0.001) was the only significant risk factor.

Conclusions

Strict adherence to IC, shortening drain duration, and avoiding unnecessary opening and manipulation of the drains are crucial to preventing neurosurgical drain infections.

http://bit.ly/2HyTpf8

In response to letter to the editor “Statin use in patients undergoing carotid artery endarterectomy: still much to be uncovered”

http://bit.ly/2S4y4hF

Combined hormonal influence of cyproterone acetate and nomegestrol acetate on meningioma: a case report

Abstract

Cyproterone acetate (CPA) is an antiandrogenic drug which has recently been recognized to promote the occurrence and growth of intracranial meningiomas. Nomegestrol acetate (NOMAC) is a widely used progestin-like drug that could be suggested as an alternative for patients taking CPA. We report a case of CPA-related meningioma for which relay from CPA to NOMAC led to further tumor growth and cessation of NOMAC-induced tumor shrinkage. We suggest NOMAC can have a similar effect than CPA on meningiomas. The use of NOMAC as replacement for CPA in the presence of a meningioma should be discouraged until further evidence becomes available on the role of NOMAC in such instances.

http://bit.ly/2HA7CIG

Syringo-subarachnoid shunt: how I do it

Abstract

Background

Syringo-subarachnoid shunt (SSS) is a valid method for the treatment of syringomyelia persisting after foramen magnum decompression (FMD) for Chiari I malformation.

Method

We give a brief overview on indication and outcome of SSS, followed by a detailed description of the surgical anatomy, and of the microsurgical technique. In particular, we highlight some key points for complication avoidance.

Conclusion

SSS is a valid option to treat syringomyelia, since in experienced hands, the outcome is good in most patients, including those with holocord syringomyelia. Careful understanding of anatomy and spinal cord physiology is required to minimize complications.

http://bit.ly/2S2hijh

Neuroendoscopy—a minimally invasive alternative in the surgical management of traumatic intracerebral contusions?

http://bit.ly/2HwRnMA

Imaging features of adrenal masses

Abstract

The widespread use of imaging examinations has increased the detection of incidental adrenal lesions, which are mostly benign and non-functioning adenomas. The differentiation of a benign from a malignant adrenal mass can be crucial especially in oncology patients since it would greatly affect treatment and prognosis. In this setting, imaging plays a key role in the detection and characterization of adrenal lesions, with several imaging tools which can be employed by radiologists. A thorough knowledge of the imaging features of adrenal masses is essential to better characterize these lesions, avoiding a misinterpretation of imaging findings, which frequently overlap between benign and malignant conditions, thus helping clinicians and surgeons in the management of patients. The purpose of this paper is to provide an overview of the main imaging features of adrenal masses and tumor-like conditions recalling the strengths and weaknesses of imaging modalities commonly used in adrenal imaging.

http://bit.ly/2WlHuo0

Mucormycosis: Pathogenesis and Pathology

Abstract

Purpose of Review

Mucormycosis is an opportunistic fungal infection associated with high mortality. Understanding the pathogenesis and the resultant pathology in various organs enables to improve early diagnosis and treatment options.

Recent Findings

An immunocompetent host with intact skin/mucosal barrier and innate immunity is usually resistant to the infection; however, natural disasters and trauma account for the disease in healthy hosts. Neutropenia, immunosuppression, hyperglycemia, ketoacidosis, and other factors impair host defenses and make increased serum iron available to the pathogen for its growth. The fungus has special iron assimilation mechanisms. The cell wall composition and genetic alterations allow rapid growth in host environment and evade host defenses. Expression of CotH proteins on the spores and hyphae facilitates adhesion to the receptors on endothelial cells, angioinvasion, and dissemination. Elaboration of lytic enzymes and proteases along with mycotoxins augment fungal invasion. Rhinocerebral mucormycosis is the most common clinical form. The pathology hall mark in various organs is angioinvasion resulting in hemorrhage, infarction, and suppurative inflammation.

Summary

The host defenses and how the risk factors alter and impair the host's ability to prevent the invasion of the fungus are reviewed. The virulence factors of the fungus to rapidly grow and disseminate in the host by evading recognition, suppressing immune response, manipulate the environment to derive nutrition, and cause disease are discussed.

http://bit.ly/2DBLp8Q

The Ambivalent Role of lncRNA Xist in Carcinogenesis

Abstract

Long non-coding RNA (lncRNA) Xist has emerged as a key modulator in dosage compensation by randomly inactivating one of the X chromosomes in mammals during embryonic development. Dysregulation of X chromosome inactivation (XCI) due to deletion of Xist has been proven to induce hematologic cancer in mice. However, this phenomenon is not consistent in humans as growing evidence suggests Xist can suppress or promote cancer growth in different organs of the human body. In this review, we discuss recent advances of XCI in human embryonic stem cells and provide an explanation for the seemingly contradictory roles of Xist in development of human cancer.

http://bit.ly/2G2GzDu

Development of biodegradable coatings for maize seeds and their application for Azospirillum brasilense immobilization

Abstract

The objective of this study was to develop biodegradable coatings for agriculture crop seeds based on starch, gelatin, and polyvinyl alcohol (PVA). Developed materials were characterized according to their microstructures, barrier properties, influence on germination of maize seeds, and ability to sustain Azospirillum brasilense Ab-V5 viability in coated maize seeds. The coatings were obtained employing different proportions of starch, gelatin, and PVA, ranging from 0 to 3.0 g/100 g of each material, respectively. Samples formulated with the pure polymers showed the highest values of water absorption capacity, solubility, and water vapor permeability, and the ternary mixtures showed the lowest values. Single polymer formulations and the binary starch-gelatin mixture (CS50GL50) favored maize seeds germination compared to the uncoated maize seeds. In addition, seed coating obtained from CS50GL50 formulation resulted in A. brasilense Ab-V5 viability in coated seeds up to 15 days after bacterial immobilization, being considered a promising low-cost, biodegradable, and renewable source material to be used in agriculture.

http://bit.ly/2B8Luzn

Comparative analysis of two non-specific nucleases of the phospholipase D family from the plant pathogen competitor bacterium Pantoea agglomerans

Abstract

Bacterial non-specific nucleases of the phospholipase D family are widely distributed among the members of the Enterobacteriaceae. Each genome mainly contains a single copy of a gene encoding a phospholipase D family protein. However, two distantly related isozymes (< 40% identity at the protein level) were identified by BLAST-analyses in the plant pathogenic competitor enterobacterium Pantoea agglomerans. The two nucleases PaNuc-1 and PaNuc-2 were produced in Escherichia coli. Identical gene constructs and expression conditions resulted in the production of PaNuc-1 in soluble form, while PaNuc-2 remained insoluble in inclusion bodies. PaNuc-2 was refolded and both proteins were purified by a combination of affinity and ion exchange chromatography. Proteolytic removal of the HIS-tag allowed the characterization of pure and mature tag-less proteins. Enzymatic properties of both isozymes revealed that they are non-specific nucleases, displaying activities against RNA, single- and double-stranded genomic DNA as well as circular plasmids. However, their biochemical activity profiles were clearly different, with PaNuc-1 being optimally active at 70 °C and pH 7.0, while PaNuc-2 was most active at 45 °C and pH 7.0. The enzymes retained > 90% nuclease activity at EDTA concentrations of 4 mM (PaNuc-2) and 20 mM (PaNuc-1), respectively. Different enzymatic properties suggest that the roles of PaNuc-1 and PaNuc-2 differ in the cell and might be the result of functional diversification after an ancient gene duplication event took place. The fact that both enzymes could be easily produced in recombinant form and their tolerance against metal ion chelators in combination with a broad substrate promiscuity might pave the way to versatile biotechnological applications.

http://bit.ly/2Tib5Nd

Bovine colostrum-driven modulation of intestinal epithelial cells for increased commensal colonisation

Abstract

Nutritional intake may influence the intestinal epithelial glycome and in turn the available attachment sites for bacteria. In this study, we tested the hypothesis that bovine colostrum may influence the intestinal cell surface and in turn the attachment of commensal organisms. Human HT-29 intestinal cells were exposed to a bovine colostrum fraction (BCF) rich in free oligosaccharides. The adherence of several commensal bacteria, comprising mainly bifidobacteria, to the intestinal cells was significantly enhanced (up to 52-fold) for all strains tested which spanned species that are found across the human lifespan. Importantly, the changes to the HT-29 cell surface did not support enhanced adhesion of the enteric pathogens tested. The gene expression profile of the HT-29 cells following treatment with the BCF was evaluated by microarray analysis. Many so called "glyco-genes" (glycosyltransferases and genes involved in the complex biosynthetic pathways of glycans) were found to be differentially regulated suggesting modulation of the enzymatic addition of sugars to glycoconjugate proteins. The microarray data was further validated by means of real-time PCR. The current findings provide an insight into how commensal microorganisms colonise the human gut and highlight the potential of colostrum and milk components as functional ingredients that can potentially increase commensal numbers in individuals with lower counts of health-promoting bacteria.

http://bit.ly/2B4x2Zo

Severe Chronic Kidney Disease Is Associated with a Lower Efficiency of Bariatric Surgery

Abstract

Background

Obesity is a risk factor for chronic kidney disease (CKD) and a relative contraindication for renal transplantation. Bariatric surgery (BS) is an option to address this issue but we hypothesize that severe CKD is associated with a loss of efficacy of BS which could justify recommending it at an earlier stage of the CKD.

Methods

A retrospective study (n = 101 patients) to test primarily for differences in weight loss at 6 and 12 months according to estimated glomerular filtration rate categories (eGFR < 30 including patients on dialysis, 30–60, 60–90, and ≥ 90 ml/min/1.73 m²) was performed with multivariate analysis adjusted for sex, age, BMI, surgical procedure, and diabetes. We used a second method to confirm our hypothesis comparing weight loss in patients with stage 4–5 CKD (eGFR < 30 ml/min/1.73 m², n = 17), and matched controls with eGFR ≥ 90 ml/min/1.73 m².

Results

In the first comparison, the multivariate analysis showed a significant positive association between eGFR and weight loss. However, after exclusion of the subgroup of patients with eGFR < 30 ml/min/1.73 m², the difference between groups was no more significant. In addition, percent total weight loss (%TWL) was significantly lower in patients with severe CKD compared to controls: − 15% vs − 23% at 6 months (p < 0.01); − 17% vs − 27% at 12 months (p < 0.01). The percent excess weight loss at 1 year reached 47% in patients with stage 4–5 CKD and 68% in controls subjects (p < 0.01). Surgery was a success at 12 months (weight loss > 50% of excess weight) in 38% of advanced CKD and 88% of controls (p < 0.01).

Conclusion

The efficacy of BS was reduced in patients with advanced CKD. These results support early BS in patients with early-to-moderate CKD.

http://bit.ly/2HARnuR

Comorbidities associated with obstructive sleep apnea: a retrospective Egyptian study on 244 patients

Abstract

Purpose

The aim of the present study was to assess prevalence of associated comorbidities in a group of patients diagnosed with obstructive sleep apnea syndrome (OSAS).

Methods

This retrospective study enrolled 244 consecutive patients diagnosed by polysomnogram with OSAS between October 2010 and January 2015 after being referred to our Sleep-Related Breathing Disorders Unit, Chest Diseases Department, in the Alexandria Main University Hospital.

Results

Of 244 patients, 47% were men, mean age was 56.9 years, and mean apnea–hypopnea index was 43.6 events per hour. Patients were categorized into two groups: group 1 (38%), mild and moderate OSAS, and group 2 (62%), severe, very severe, and extreme OSAS. Comorbidities were present in 91% of patients. The most common comorbidities were obesity, hypertension (HTN), and diabetes mellitus (DM). Prevalence of obesity, HTN, DM, congestive heart failure, deep vein thrombosis, pulmonary embolism (PE), and hypothyroidism was significantly higher in severity group 2. PE, bronchial asthma, and chronic obstructive pulmonary disease were significantly higher among men, whereas hypothyroidism was significantly higher among women. During this period of over 4 years, mortality rate was 8%. The majority of deaths occurred at night. Most of the studied patients (60%) either received no treatment or were not adherent to positive airway pressure (PAP) therapy. None of the patients received surgicaltreatment. The majority (50%) gained access to PAP therapy through donations. Associated hypoventilation was the only significant predictor of PAP adherence. Quality of life was significantly better among PAP adherent patients.

Conclusions

Patients suffering from OSAS have very high prevalence of comorbidities indicating a great burden on the healthcare system. Despite this fact, over 50% of the patients studied did not receive any treatment. Charities were the main portal fortreatment.

http://bit.ly/2HB8M6D

Maternal chronic intermittent hypoxia in rats causes early atherosclerosis with increased expression of Caveolin-1 in offspring

Abstract

Objective

The objective of our research was to explore the effects of maternal and postpartum chronic intermittent hypoxia (CIH) exposure on atherosclerosis in adulthood offspring of rats, and the role of Caveolin-1 in the course.

Methods

Sixteen rats were assigned to two groups (n = 8), maternal normoxia and CIH group. After delivery, two male pups per litter were selected and breastfed for 1 month, which then randomly received postpartum normoxia or CIH. Thus, 4 groups were created as follows (n = 8): (1) maternal normoxia and postpartum normoxia group, (2) maternal CIH and postpartum normoxia group, (3) maternal CIH and postpartum CIH group, and (4) maternal normoxia and postpartum CIH group. The offspring were weighed at birth and weaning. After the duration of 12-week experiment, morphological changes, the expression of Caveolin-1 and NF-κB p65 in the aorta were detected.

Results

Maternal CIH resulted in significantly lower body weight and thicker intima (P < 0.001). CIH upregulated the expression of Caveolin-1 and NF-κB p65 significantly (P < 0.01). There was a synergistic effect of maternal and postpartum CIH on the thickening of intima (P < 0.05), also on the expression of Caveolin-1 and NF-κB p65 (P < 0.01).

Conclusions

The results demonstrate that maternal CIH exposure causes a postpartum catch-up growth and early atherosclerotic changes followed by upregulating Caveolin-1 expression. Besides, maternal CIH enhances the atherosclerotic changes caused by postpartum CIH. Oxidative stress probably implicates in above effects.

http://bit.ly/2SaPWaz

Effects of a contingent vibratory stimulus delivered by an intra-oral device on sleep bruxism: a pilot study

Abstract

Purpose

Although sleep bruxism (SB) is one of the most important clinical problems in dental practice, there is no definitive method for controlling it. This pilot study evaluated the effects of contingent vibratory feedback stimuli using an occlusal splint for inhibition of sleep bruxism.

Methods

Thirteen subjects with clinically diagnosed SB participated after providing an informed consent. Portable polysomnographic recordings were conducted in the subjects' home environment to make a definitive SB diagnosis and to evaluate the effects of the vibratory stimuli on SB. A force-based bruxism detection system, which used a pressure-sensitive piezoelectric film embedded in the occlusal splint, was utilized to trigger vibration feedback stimuli, which was scheduled to be applied intermittently for 30 min, at 30-min intervals.

Results

The number of SB episodes (times/hour), the total SB duration (seconds/hour), the mean duration of SB episodes (seconds/episode), and the micro-arousal index (times/hour) were scored for each time period (with and without vibration). The effects of the vibration on these scores were tested (paired t test; p < 0.05). The number of SB episodes tended to decrease with the vibration stimuli, and the decrease in the total SB duration was statistically significant (14.3 ± 9.5 vs. 26.0 ± 20.0, p = 0.03). No substantial change was found in terms of the micro-arousal index.

Conclusions

These study results suggested that the SB inhibitory system employing a vibratory stimulus might be able to suppress the total SB duration without disturbing sleep.

http://bit.ly/2HzTtuT

Long-term adherence to ambulatory initiated continuous positive airway pressure in non-syndromic OSA children

Abstract

Purpose

In children, the usual indications for continuous positive airway pressure (CPAP) are residual OSA after adenotonsillectomy and/or persistent OSA due to obesity. Data concerning adherence (hours/night) following ambulatory CPAP initiation are scarce.

Methods

An observational cohort of 78 children was followed over 2 years. All exhibited sleep-disordered breathing (SDB) symptoms, were assessed by polysomnography, and prescribed CPAP. CPAP was initiated at hospital for 10 children.

Results

OSA children, mean age 10.4 ± 3.2 years, were mostly males (75.6%), with a mean body mass index of 21.2 ± 7.3 kg/m², and mean apnea+hypopnea index of 12.2 ± 10.6 events/hour. Seventy-two children were still on CPAP at 3 months, 63 at 6 months, 55 at 1 year, and 34 at 2 years. CPAP was discontinued thanks to rehabilitation programs, dento-facial orthopedics, and/or weight loss. Mean CPAP adherence at 1, 3, 6, 12, and 24 months was respectively 6.1 ± 2.8, 6.2 ± 2.6, 6.2 ± 2.8, 6.3 ± 2.8, and 7.0 ± 2.7 h/night. There was a trend towards higher CPAP adherence and younger age, primary versus middle/high school attendance, higher baseline apnea+hypopnea index, and neurocognitive disorders.

Conclusion

In our population, mean CPAP adherence defined in hours per night was high and did not decrease during the 24-month follow-up. These findings support the feasibility of ambulatory CPAP initiation in non-syndromic OSA. The high CPAP adherence is expected to be associated with improvements in neurocognition, and in metabolic and cardiovascular parameters.

http://bit.ly/2S4cABx