Myiasis in humans—a global case report evaluation and literature analysis

Abstract

Myiasis refers to the infestation of living humans and vertebrates with fly larvae that feed on necrotic or vital tissue of the host. Since the invasion of new fly species in Europe is currently being observed, which live obligatorily parasitically or are close relatives of such species, the aim of this study is to obtain a global overview of the distribution of myiasis-causing fly species in times of climate change and to assess the possible consequences for Western Europe. A systematic literature search was conducted using Pubmed/Medline for the years 1997 to 2017 and a total of 464 international case reports from 79 countries were evaluated. The described cases were caused by 41 different species. In 99.4% of the cases, it was a colonization by just one species, a maximum of three species were detected in a human. Casuistics from Western Europe mostly describe myiasis as a "holiday souvenir" from tropical regions. Reports of autochthonous cases are rare in comparison to other regions. With regard to rising temperatures and the invasion of new fly species, a noticeable increase in the number of cases in Western Europe is to be assumed, which could be an increasing problem in the clinical area and in care, which is why thorough monitoring for professional identification and treatment seems important in the future.

http://bit.ly/2B9zIET

In vitro and in vivo evaluation of rotary-jet-spun poly(ɛ-caprolactone) with high loading of nano-hydroxyapatite

Abstract

Herein, poly(ɛ-caprolactone) (PCL) mats with different amounts of nanohydroxyapatite (nHAp) were produced using rotary-jet spinning (RJS) and evaluated in vitro and in vivo. The mean fiber diameters of the PCL, PCL/nHAp (3%), PCL/nHAp (5%), and PCL/nHAp (20%) scaffolds were 1847 ± 1039, 1817 ± 1044, 1294 ± 4274, and 845 ± 248 nm, respectively. Initially, all the scaffolds showed superhydrophobic behavior (contact angle around of 140^oC), but decreased to 80° after 30 min. All the produced scaffolds were bioactive after soaking in simulated body fluid, especially PCL/nHAp (20%). The crystallinity of the PCL scaffolds decreased progressively from 46 to 21% after incorporation of 20% nHAp. In vitro and in vivo cytotoxicity were investigated, as well as the mats' ability to reduce bacteria biofilm formation. In vitro cellular differentiation was evaluated by measuring alkaline phosphatase activity and mineralized nodule formation. Overall, we identified the total ideal amount of nHAp to incorporate in PCL mats, which did not show in vitro or in vivo cytotoxicity and promoted lamellar bone formation independently of the amounts of nHAp. The scaffolds with nHAp showed reduced bacterial proliferation. Alizarin red staining was higher in materials associated with nHAp than in those without nHAp. Overall, this study demonstrates that PCL with nHAp prepared by RJS merits further evaluation for orthopedic applications.

http://bit.ly/2DEbvrW

Biofabrication for osteochondral tissue regeneration: bioink printability requirements

Abstract

Biofabrication allows the formation of 3D scaffolds through a precise spatial control. This is of foremost importance when aiming to mimic heterogeneous and anisotropic architecture, such as that of the osteochondral tissue. Osteochondral defects are a supreme challenge for tissue engineering due to the compositional and structural complexity of stratified architecture and contrasting biomechanical properties of the cartilage-bone interface. This review highlights the advancements and retreats witnessed by using developed bioinks for tissue regeneration, taking osteochondral tissue as a challenging example. Methods, materials and requirements for bioprinting were discussed, highlighting the pre and post-processing factors that researchers should consider towards the development of a clinical treatment.

http://bit.ly/2Ukf2kF

Apparent kleptoparasitism in fish—parasitic gnathiid isopods

Abstract

Gnathiid isopods are common external parasites/micropredators that feed on the blood of marine fishes. During the course of processing samples of gnathiid isopods collected from light traps in the central Philippines, we observed a gnathiid attached to and apparently feeding from the abdomen of another gnathiid. Because the abdomens of both gnathiids were enlarged, it was unclear whether one actually fed on the blood meal of the other. Introduction of unfed gnathiids with fed gnathiids revealed that one gnathiid could and did feed on the blood meal of another. This is the first observation of apparent conspecific kleptoparasitism reported for gnathiid isopods.

http://bit.ly/2B7kSPn

Unusual 18S rDNA of Acanthamoeba containing intron turned out to be a T5/T4 chimera

Abstract

The free-living amoebae of the genus Acanthamoeba are widely investigated for their diversity and evolution. Studies usually employ biomolecular methods targeting the 18S rRNA gene, assigning strains according to a well-established genotyping system. Strains from at least four genotypes contain introns in their rDNA. By retracing the evolutionary history of these introns within the amoebae, we found that the 18S rDNA of TUMSJ-341 strain (ATCC PRA-11), assigned to the genotype T5 (A. lenticulata), proved very unusual in our analyses, not corresponding to the characteristics of the group. The sequence contains a group I intron recovered only in A. lenticulata. At BLAST, however, the intron-less 18S rDNA of TUMSJ-341 does not match with T5 strains but shows some affinity with strains from genotype T4, suggesting a new genotype. Our accurate analysis of this sequence finally revealed a mixture of variable regions, showing that such discordant results are due to the insertion into the gene of a strain T5 of a DNA fragment containing hypervariable regions specific for a T4 strain. Data presented herein indicate that this sequence is probably a chimera.

http://bit.ly/2Teb3WB

Distribution of Alaria spp. mesocercariae in waterfrogs

Abstract

The distribution of Alaria-spp.-mesocercariae within the host is relevant for the examination via Alaria spp. mesocercariae migration technique (AMT) regarding predilection sites and may indicate an interaction between parasite and host. Naturally Alaria-exposed frogs of Pelophylax species (n = 13) were examined for systemic distribution and localization-specific parasite density of Alaria spp. mesocercariae. The frogs were necropsied and their body was divided into the following localizations: inner organs, head, torso, forelimbs, and hind limbs. The localizations were analyzed individually and in toto using Alaria spp. mesocercariae migration technique. Our results showed neither statistical differences concerning the number of mesocercariae in the different localizations nor in respect of the rate of positive localizations. Therefore, an accumulation in a particular predilection site seems unlikely. Further research on a representative sample is necessary before final conclusions can be drawn.

http://bit.ly/2B8ETVy

Improved detection of DNA Schistosoma haematobium from eggs extracted by bead beating in urine

Abstract

Diagnosis of Schistosoma haematobium relies primarily on microscopical analysis of urine. The method is time consuming and requires some expertise. Genus-specific real-time PCRs have been developed, but we still observed low sensitivity. In the present study, in order to achieve a more sensitive DNA detection of eggs of S. haematobium in urine samples, we wanted to develop a novel protocol of DNA extraction using mechanic disruption of eggs by bead beating as supplementary step. We tested Schistosoma spp. internal transcribed spacer 2 real-time PCR after both methods with and without bead beating. First, we preliminary assessed the DNA detection after bead beating using dilution of 2, 10, 50, and 90 eggs/10 mL, and the Ct value analysis showed significant improved DNA detection per each point of egg concentration using the novel supplementary step. Twenty microscopy positive and five microscopy negative urine samples were used to validate the procedure. All urines came from imported cases and admitted at center for tropical medicine, and were examined by microscopy. PCR results after novel method with bead beating showed 100% to be positive for S. haematobium, compared with 85% positive by our standard extraction procedure. Results confirmed mechanic disruption of eggs by bead beating before DNA extraction to be highly effective method for the detection of S. haematobium DNA in urine.

http://bit.ly/2Tia8EX

Evaluating the ontogenetic external morphology of an ectoparasitic Torix tukubana (Hirudinida: Glossiphoniidae), with records of its new host amphibian species

Abstract

Torix is a leech genus containing freshwater proboscidate species, and several members of this taxon are ectoparasites specific to amphibians. Torix tukubana inhabits mountain streams in Japan, and only two frog species are known to be hosts. We collected this leech from two other amphibians, Onychodactylus japonicus (Japanese clawed salamander) and Rana ornativentris (montane brown frog), for the first time. This finding suggests that the host specificity of T. tukubana is low. The immature individuals of T. tukubana were also collected and identified based on DNA data. This is the first juvenile record of this species confirmed by its DNA barcode sequences. Several morphological characters known from large individuals and used as diagnostic characteristics in taxonomic keys were not observed in the juveniles, suggesting that these are ontogenetic traits.

http://bit.ly/2TjdGqe

Pathological and molecular characterization of avian malaria in captive Magellanic penguins ( Spheniscus magellanicus ) in South America

Abstract

Avian malaria is a mosquito-borne disease that affects multiple avian species and is caused by protozoans of the genus Plasmodium. An avian malaria infection caused by Plasmodium sp. in Magellanic penguins (Spheniscus magellanicus) with high mortality is described in a zoo in Southern Brazil. Clinically, three birds presented signs of inappetence, anorexia, pale mucosa, dyspnea, and opisthotonus, with death in a clinical course of 5–8 h. At the necropsy, all birds exhibited pale mucosa, marked splenomegaly and hepatomegaly, in addition to moderate leptomeningeal blood vessels ingurgitation in the brain. Microscopically, multiple exoerythrocytic meronts were observed in the cytoplasm of endothelial cells in the spleen, liver, heart, lungs, brain, kidneys, and pancreas. The spleen had a multifocal perivascular inflammatory infiltrate of lymphocytes, plasma cells, and macrophages, which also exhibited hemosiderosis and erythrophagocytosis. The liver had a multifocal periportal inflammatory infiltrate of lymphocytes, macrophages, and plasma cells, in addition to marked hemosiderosis in the hepatic sinusoids. Fragments of spleen, liver, brain, skeletal muscle, and lung were tested by the polymerase chain reaction technique for the detection of a fragment of the cytochrome B gene from haemosporidians, which resulted positive for Plasmodium spp. After sequencing, the samples were phylogenetically associated to Plasmodium sp. detected in Turdus albicollis (KU562808) in Brazil and matched to the lineage TURALB01 previously detected in T. albicollis. Avian malaria infections caused by Plasmodium sp. of lineage TURALB01 may occur in S. magellanicus with high mortality, and, thus, it is essential to detect and characterize the agent involved to obtain the differential diagnosis of the condition.

http://bit.ly/2B50n5W

Comparison of different staining methods for determination of viability on Mesocestoides vogae tetrathyridia

Abstract

Mesocestoides vogae is widely employed as a model for studying the biology, differentiation, and experimental chemotherapy of cestodes. Currently, there are few techniques to measure the viability of M. vogae metacestodes during pharmacological experiments. The aim of the present work was to evaluate and compare different staining techniques to determine objectively the viability of M. vogae tetrathyridia. Eosin (0.05% w/v), methylene blue (0.01% w/v), propidium iodide (PI, 2 μg/ml), and fluorescein diacetate (FDA, 0.5 μg/ml) solutions were tested against live, heat-killed (cultivated at 65 °C for 2 h) and thymol-treated tetrathyridia (50 and 250 μg/ml). Parasites were counted under a dissecting microscope or a fluorescence compound microscope, as appropriate. Studies by scanning electron microscope were performed to compare the ultrastructural damage with the viability of parasites. After comparing the performance of different dyes, we chose the eosin staining technique because its simplicity, rapidity, sensitivity, low cost and fidelity.

http://bit.ly/2TgtSsh

Changes in blood lactate and muscle activation in elite rock climbers during a 15-m speed climb

Abstract

Purpose

The purpose of this study was to investigate the changes in blood lactate concentration (BL) and muscle activity patterns during a 15-m speed climbing competition that consisted of ten consecutive climbing actions on a standardized artificial wall in trained rock climbers.

Methods

Twelve trained rock climbers participated in this study. Surface electromyography (sEMG) and video signals were synchronized and recorded during climbing. The blood lactate was also tested 3 min after completing the climb.

Results

The average climbing time was 8.1 ± 2.1 s for the 15-m speed climb across all subjects, accompanied by a BL of 7.6 ± 1.9 mmol/L. The climbing speed and power firstly increased and then slightly decreased relative to peak value during the 15-m speed climbing. The results showed there was a positive correlation between the BL and the climbing time, r = 0.59, P = 0.043. The sEMG showed the flexor digitorum superficialis (FDS) electric activity was the highest, followed by the biceps brachii (BB) and latissimus dorsi. The instantaneous median frequency of sEMG of FDS and BB significantly decreased during the 15-m speed climbing. All the participants showed the higher sEMG RMS (%) in the terminal phase than that in the initial phase, especially with a greater increase in the left upper limbs. However, the lower limbs muscles presented no significant changes in the sEMG amplitude during climbing.

Conclusions

The FDS and BB play an important role in completing the 15-m speed climbing. The median frequency of arm EMG decreased more than that of legs, suggesting more fatigue. The blood lactate concentration increases in the current study suggest that a certain amount of glycolysis supplies energy in completing 15-m speed rock climbing. Based on the current data, it is suggested that muscular endurance of FDS and BB muscles in upper limbs should be improved for our climbers in this study.

http://bit.ly/2WnqPRi

Dietary Diversity, Food Security, and Body Image among Women and Children on San Cristobal Island, Galapagos

Abstract

Objectives: We conducted a study of the food environment and nutritional status among women and children living on a Galapagos Island. Anthropometric and body silhouette data give insight into body size perceptions for women and their young children. We frame our findings in the context of the nutrition transition. Methods: A convenience sample was recruited via word-of-mouth for in-depth interviews and assessments of household food security, dietary intake, anthropometrics, and body image. Interviews took place in 2011 on San Cristobal Island, one of four inhabited islands in the Galapagos archipelago. Twenty women with children between the ages of one and six participated, all permanent residents of San Cristobal Island. Results: Most women (60%) reported limited availability of fresh produce due to an unreliable food supply shipped from mainland Ecuador. Despite reported food insecurity in our sample (55%), more than half of the children (55%) experienced high dietary diversity measured by 24 h recall. Women tended to report less dietary diversity than their children, which may be linked to a stated desire to be thinner. Eighty percent of children were classified as normal weight, while 75% of women were overweight or obese. Conclusions for Practice: Results provide an initial survey of the food landscape on one Galapagos Island. By combining qualitative interviews with indicators of nutritional status, the narrative data allow an interpretation of issues of food security, dietary intakes, dietary diversity, and body size. This study forms the basis for a larger examination of these issues in the Galapagos islands.

http://bit.ly/2DEk9Xu

Seasonal Loading and Concentration Patterns for Fecal Bacteroidales qPCR Markers and Relationships to Water Quality Parameters at Baseflow

Abstract

Bacteria belonging to the Order Bacteroidales predominate the intestines of warm-blooded animals, and monitoring of these bacteria can indicate fecal pollution impacts to a waterbody. Differences in seasonal concentrations and loadings for Bacteroidales and their relationship with physicochemical water parameters were investigated in temperate, inland streams. Seasonal samples (n = 321) were collected during baseflow in three central Tennessee, USA, watersheds. To estimate total fecal bacteria in receiving streams, general Bacteroidales 16S rRNA gene targets were analyzed by quantitative PCR and reported as concentration and loadings for individual and combined watersheds. In most cases, Bacteroidales marker concentrations were highest during spring/summer and loading values were highest in the spring. Bacteroidales concentrations were positively correlated with temperature and total suspended solids and negatively with dissolved oxygen, while no consistent correlations were found between loadings and abiotic factors. Temperature, total suspended solids, and dissolved oxygen are likely drivers influencing seasonal patterns for Bacteroidales concentrations. Researchers and water quality stakeholders should carefully consider measurement type (concentration versus loading), season, and water quality parameters as elements that could impact results when developing fecal monitoring projects.

http://bit.ly/2DD6DDz

Associations between sensorimotor gating mechanisms and athletic performance in a variety of physical conditioning tests

Abstract

Purpose

The elite athlete is fine-tuned all around to deliver favorable results in sporting events. In this study, we address the question of whether basic movements—such as reflexes—and heterogeneous attentional modulation components—such as sensorimotor gating mechanisms—are also tuned up to maximize the results of middle-distance runners in physical conditioning tests.

Methods

We selected an array of professional middle-distance runners and healthy counterparts that were submitted to measurement of (1) physical conditioning parameters, including somatotype, jump, strength, and flexibility tests; and (2) sensorimotor gating mechanisms, including acoustic startle reflex, prepulse inhibition, and habituation.

Results

Our results showed athletes scored better on the athletic tests compared to controls, as expected. They also exhibited a lower startle amplitude, while maintaining higher prepulse inhibition values. They reacted faster to the acoustic stimuli, and sex-related differences—found in controls—were not present in athletes. Our data also pointed out to substantial correlations between sensorimotor gating and physical conditioning parameters.

Conclusions

All in all, these data may point to physical conditioning-driven neural plasticity of brain sensorimotor gating circuits in charge of triggering involuntary movements to harness control and efficiency over reflexed muscle activity.

http://bit.ly/2B6x42K

AMTAS Pro vs Flex: Operation and Integration

GSI AMTAS software is available in two versions, AMTAS Pro and AMTAS Flex; both provide reliable automated hearing assessments, but are used in different testing scenarios. Detailed knowledge of the operation and integration of AMTAS Pro and Flex ensure maximum efficiency for audiologic testing.

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

AMTAS Pro vs Flex: Operation and Integration

GSI AMTAS software is available in two versions, AMTAS Pro and AMTAS Flex; both provide reliable automated hearing assessments, but are used in different testing scenarios. Detailed knowledge of the operation and integration of AMTAS Pro and Flex ensure maximum efficiency for audiologic testing.

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

AMTAS Pro vs Flex: Operation and Integration

GSI AMTAS software is available in two versions, AMTAS Pro and AMTAS Flex; both provide reliable automated hearing assessments, but are used in different testing scenarios. Detailed knowledge of the operation and integration of AMTAS Pro and Flex ensure maximum efficiency for audiologic testing.

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

The influence of prior ramucirumab treatment on the clinical activity of FOLFIRI as third-line therapy in patients with metastatic gastric Cancer

Summary

Purpose Few data described the activity of chemotherapy after ramucirumab plus paclitaxel progression in metastatic gastric cancer patients. The aim of this phase II study is to assess the efficacy and safety of the FOLFIRI regimen as a third-line of treatment. Methods The study enrolled patients with histologically proven metastatic gastric cancer or gastroesophageal junction carcinoma whose disease had progressed after ramucirumab-based second line of treatment. Treatment consisted of biweekly irinotecan 150 mg/m2 as a 1-h infusion on day 1, folinic acid 100 mg/m2 intravenously on days 1–2, and 5-fluorouracil as a 400 mg/m2 bolus and then 600 mg/m2 continuous infusion over 22 h on days 1–2. Primary end-point was tumor response rate (confirmed complete and partial response). Results Twenty-six patients were enrolled. Overall response rate and disease control rate were 11.5% and 38.5%. The median progression free survival (PFS) was 52 days (95% CI:42–74), and the median overall survival was 117 days (95% CI: 94–154). no unexpected adverse events have been observed. A longer PFS and OS were observed in patients who had achieved PFS ≥ 3 months during prior ramucirumab treatment. Conclusions Our findings suggest a poor efficacy of the FOLFIRI regimen in metastatic gastric or gastroesophageal junction cancer patients whose disease progressed during a ramucirumab-based second line of treatment. However, FOLFIRI could be an option for patients who responded to prior ramucirumab.

http://bit.ly/2FWaa26

Effects of Phosphorus Modified Bio-char on Metals in Uranium-Containing Soil

Abstract

The level of radioactivity in the soil has been increasing unpredictably due to the human uranium mining exploitation of uranium over the past 100 years. Remediation of metals in actual soil confronts many challenges, remaining poorly understood. This study intends to investigate the concentrations and distributions of U, Cd, Zn, Pb, and Cu in soils surrounded by a uranium mill tailing pond. Furthermore, a phosphorus-modified bio-char was prepared in order to determine its role in immobilizing uranium in soil samples. Results show that the contents of U and Pb are much higher than that of the background values, due to the influence of the uranium mill tailing pond. Phosphorus can enhance the immobilization efficiency of U, Cd, Pb, and Cu in soil samples. The concentration of uranium in the leaching supernatant of phosphorus-modified bio-char group is lower than that of control and unmodified bio-char groups due to the fact that the biosorption occurred in the exterior surface of the biomass, which imply that phosphorus-modified bio-char is a potential immobilization material to reduce the leaching rate of metals. These findings can provide references for remediation technology of metals in natural soil.

http://bit.ly/2RmsYsC

Degradation of Paracetamol Adsorbed on Inorganic Supports Under UV Irradiation

Abstract

The purpose of this piece of work is to study the process of adsorption of paracetamol on activated carbon, silica and alumina and their degradation using UV radiation. The results demonstrate a higher adsorption of paracetamol on alumina and activated carbon, while a minor value was observed in the case of silica. The H-bonding and π-stacking interactions between paracetamol and supports can be explained by the variation in the adsorption capacity values. When the paracetamol adsorbed was irradiated with two different UV irradiance values (59.78 mW cm⁻² and 119.56 mW cm⁻²) for 120 min, the higher degradation percentage was observed on activated carbon with a value of 79%. In the case of alumina and silica, the maximum percentages obtained were 65% and 77%, respectively. The incorporation of H₂O₂ in the reaction medium increases the rate of degradation, mainly at higher irradiance, reaching the maximum values in less time.

http://bit.ly/2Wqn658

The influence of prior ramucirumab treatment on the clinical activity of FOLFIRI as third-line therapy in patients with metastatic gastric Cancer

Summary

Purpose Few data described the activity of chemotherapy after ramucirumab plus paclitaxel progression in metastatic gastric cancer patients. The aim of this phase II study is to assess the efficacy and safety of the FOLFIRI regimen as a third-line of treatment. Methods The study enrolled patients with histologically proven metastatic gastric cancer or gastroesophageal junction carcinoma whose disease had progressed after ramucirumab-based second line of treatment. Treatment consisted of biweekly irinotecan 150 mg/m2 as a 1-h infusion on day 1, folinic acid 100 mg/m2 intravenously on days 1–2, and 5-fluorouracil as a 400 mg/m2 bolus and then 600 mg/m2 continuous infusion over 22 h on days 1–2. Primary end-point was tumor response rate (confirmed complete and partial response). Results Twenty-six patients were enrolled. Overall response rate and disease control rate were 11.5% and 38.5%. The median progression free survival (PFS) was 52 days (95% CI:42–74), and the median overall survival was 117 days (95% CI: 94–154). no unexpected adverse events have been observed. A longer PFS and OS were observed in patients who had achieved PFS ≥ 3 months during prior ramucirumab treatment. Conclusions Our findings suggest a poor efficacy of the FOLFIRI regimen in metastatic gastric or gastroesophageal junction cancer patients whose disease progressed during a ramucirumab-based second line of treatment. However, FOLFIRI could be an option for patients who responded to prior ramucirumab.

http://bit.ly/2FWaa26

Immediate intraoperative sentinel lymph node analysis by frozen section is predictive of lymph node metastasis in endometrial cancer

Abstract

Sentinel lymph nodes sampling (SLN) in endometrial cancer is being evaluated as a means to gather prognostic information about lymphatic metastasis while avoiding the morbidity associated with complete lymphadenectomy. SLN ultrastaging has been advocated to identify low-volume metastases, but its value remains uncertain. This study aims to evaluate a pathological protocol for the immediate intraoperative SLN work-up using H&E staining alone. In this retrospective single-center study, patients received standardized cervical injection of indocyanine green, SLN mapping followed by pelvic lymphadenectomy with or without para-aortic lymphadenectomy. SLNs were entirely frozen, multiple H&E stained sections prepared and evaluated intraoperatively. No immunohistochemistry was performed. SLN results were compared with the complete lymphadenectomy specimen. Over 3.5 years, 90 patients were identified who underwent SLN mapping and subsequent complete pelvic lymphadenectomy. At least one SLN was detected in 79 (88%) patients. The median number of SLNs removed was 2.0. Para-aortic SLNs were detected in 7%. Final pathology showed 67% Type I tumors, 76% locally confined. The mean number of lymph nodes removed during complete lymphadenectomy was 21. In this series, only 6 patients had lymph node metastases. 5/6 were identified by the described SLN approach resulting in 83.3% sensitivity and a negative predictive value of 98.7%. Our approach permits immediate intraoperative results and helps guide the primary surgery. The immediate SLN work-up using frozen sections showed both high accuracy and negative predictive value. The comparably lower sensitivity may be related to the low number of patients with positive lymph nodes (7.6%).

http://bit.ly/2G1Dx2i

Training of laparoscopic novices both individually and in dyads using a simulation task

Abstract

Non-technical skill training improves outcomes in surgery and quantifying the effects of this training may aid in designing surgical teaching models. In our study, 12 novices performed a wire-chaser laparoscopic task in 9 training sessions, working both as individuals and dyads. Task duration (p < 0.001), number of ring-wire contacts (p < 0.001), total duration of contact (p < 0.001), and number of pick up attempts (p = 0.044) all showed significant improvement in both groups with no significant difference in the learning curves between individuals and dyads. There was, however, an interaction effect for the number of ring-wire contacts (p = 0.027) whereby the number of contacts dropped more dramatically among dyads. Dyads also performed significantly more anticipatory movements than individuals (p = 0.005). Novices performed similarly when working individually and as dyads, suggesting that the need for collaboration neither hindered nor helped performance for our particular task.

http://bit.ly/2FSoIQb

Voriconazole: A Review of Population Pharmacokinetic Analyses

Abstract

Numerous population pharmacokinetic studies on voriconazole have been conducted in recent years. This review aimed to comprehensively summarize the population pharmacokinetic models for voriconazole and to determine which covariates have been identified and which remain to be explored. We searched the PubMed and EMBASE databases from inception to March 2018 for population pharmacokinetic analyses of voriconazole using the nonlinear mixed-effect method. A total of 16 studies were included in this review, of which 11 models were described in adult populations, four were described in pediatric populations, and the remaining study included both adult and pediatric populations. The absorption profiles of voriconazole in both adult and pediatric studies were best described as first-order absorption models. The typical distribution volumes were similar in adult and pediatric patients, but the estimated clearances in pediatric patients were significantly higher than those in adult patients. The most commonly identified covariates were body weight, the cytochrome P450 2C19 genotype, liver function, and concomitant medications. Only one study evaluated the model using an external method. Further population pharmacokinetic studies on pediatric patients aged younger than 2 years are warranted. Furthermore, new or controversial potential covariates, such as inflammation, the cytochrome P450 3A4 genotype, concomitant medications (particularly various types and dosages of proton pump inhibitors and glucocorticoids), and various measures of body weight, should be tested because the unexplained variability remains relatively high. In addition, previously published models should be externally evaluated, and the predictive performance of the various models should be compared.

http://bit.ly/2DCP0DL

Tumor necrosis factor alpha and interleukin-1 beta levels in cerebrospinal fluid examination for the diagnosis of ventriculoperitoneal shunt-related ventriculitis

Abstract

Purpose

Ventriculitis is known to develop after chronic inflammation and bacterial invasion of the ventricular surface with a recurrence of shunt infections. The aim of this study is to evaluate the diagnostic value of elevation in cerebrospinal fluid (CSF) interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) together with CSF culture and laboratory test results in the diagnosis of ventriculoperitoneal (VP) shunt-related ventriculitis, which is known to be more problematic than conventional shunt infection.

Methods

The study included a total of 34 patients with a VP shunt due to hydrocephalus, who presented with a headache, fever, and shunt infection at the Emergency Department and had a pre-diagnosis of ventriculitis. Nineteen patients were diagnosed with shunt-related infection or ventriculitis using the CSF obtained from the shunt pump. The IL-1β and TNF-α levels from the CSF samples of all patients were measured using the Micro ELISA immunoassay method.

Results

CSF direct microscopic observation revealed that the mean cell count, IL-1β level, CRP level, and blood leukocyte level were higher in patients with ventriculitis compared to those diagnosed with shunt infection (p = 0.02, p = 0.009, p = 0.004, and p = 0.009, respectively). The probability of predicting positive culture outcome was 92.7% with 90.9% sensitivity and 82.6% specificity when IL-1β values exceeded 4.0 pg/ml. TNF-α values did not show a significant, reliable pattern compared to IL-1β.

Conclusions

IL-1β is a reliable parameter which shall be used in the diagnosis of ventriculitis by predicting positive culture outcome with high sensitivity and specificity.

http://bit.ly/2B5DkaW

Novel Treatment Opportunities Against Cognitive Impairment in Parkinson’s Disease with an Emphasis on Diabetes-Related Pathways

Abstract

Cognitive impairment is highly prevalent in patients with Parkinson's disease (PD) and causes adverse health outcomes. Novel procognitive therapies are needed to address this unmet need. It is now established that there is an increased risk of dementia in patients with type 2 diabetes mellitus (T2DM) and, moreover, T2DM and PD may have common underlying biological mechanisms. As such, T2DM medications are emerging as potential therapies in the context of PD dementia (PDD). In this review, we provide an update on pathophysiological mechanisms underlying cognitive impairments and PDD, focusing on diabetes-related pathways. Finally, we have conducted a review of ongoing clinical trials in PD patients with dementia, highlighting the multiple pharmacological mechanisms that are targeted to achieve cognitive enhancement.

http://bit.ly/2Wnywqz

Management of concussion in soccer

Abstract

Background

When participating in contact sports, (mild) head trauma is a common incident—observed in both professional and amateur sports. When head trauma results in transient neurological impairment, a sports-related concussion has occurred. Acute concussion, repetitive concussions, as well as cumulative "sub-concussive" head impacts may increase the risk of developing cognitive and behavioral deficits for athletes, as well as accelerated cerebral degeneration. While this concept has been well established for classic contact sports like American Football, Rugby, or Boxing, there is still an awareness gap for the role of sports-related concussion in the context of the world's most popular sport—Soccer.

Methods

Here, we review the relevance of sport-related concussion for Soccer as well as its diagnosis and management. Finally, we provide insight into future directions for research in this field.

Results

Soccer fulfills the criteria of a contact sport and is characterized by a high incidence of concussion. There is ample evidence that these events cause functional and structural cerebral disorders. Furthermore, heading, as a repeat sub-concussive impact, has been linked to structural brain changes and neurocognitive impairment. As a consequence, recommendations for the diagnosis and management of concussion in soccer have been formulated by consensus groups. In order to minimize the risk of repetitive concussion in soccer the rapid and reliable side-line diagnosis of concussion with adoption of a strict remove-from-play protocol is essential, followed by a supervised, graduated return-to-play protocol. Recent studies, however, demonstrate that adherence to these recommendations by players, coaches, clubs, and officials is insufficient, calling for stricter enforcement. In addition, future research to solidify the pathophysiological relevance of concussion for soccer athletes seems to be needed. Advanced neuroimaging and neurochemical biomarker analyses (e.g. S100β, tau and neurofilament light (NfL)) may assist in detecting concussion-related structural brain changes and selecting athletes at risk for irreversible damage.

Conclusion

Sports-related concussion represents a genuine neurosurgical field of interest. Given the high socioeconomic relevance, neurosurgeons should get involved in prevention and management of concussion in soccer.

http://bit.ly/2B6mpVD

Predictive factors of hepatitis C virus eradication after interferon-free therapy in HIV coinfection

Abstract

Real-life cohorts have shown that the effectiveness of all-oral, direct-acting antivirals (DAA) for HCV treatment is > 90%. We aimed to explore the predictive factors of DAA success in HIV coinfection. This is an observational prospective study within the cohort "VIH-DOC", Madrid, Spain. HIV/HCV-coinfected patients were included if they had been treated with DAAs between 9 January 2015 and 31 August 2016. The sustained virological response (SVR) was analysed in the intention-to-treat population. Binary logistic regression was used to study the impact of cirrhosis, anti-HCV therapy experience and the IL28B polymorphism on SVR, besides factors with a p value < 0.15 from the univariate analysis. DAA were prescribed to 423 patients. SVR was confirmed in 92.9%. The univariate analysis showed higher proportion of patients with SVR among those with DAA adherence ≥ 95% (difference + 10.3%, 95% CI 3.5–19.6) and a baseline CD4+ cell count ≥ 200/μL (difference + 14.7%, 95% CI 4.1–31.0). Logistic regression evinced that both DAA adherence and baseline CD4+ cell counts predicted the SVR (OR 3.9, 95% CI 1.8–8.8, and OR 5.2, 95% CI 1.9–13.9, respectively). Moreover, men who reported having sex with other men (MSM) were less likely to achieve SVR (OR 4.2, 95% CI 1.1–16.1). Among MSM, three of three patients without SVR were suspected to have experienced HCV reinfection. DAA for HCV in HIV-coinfected patients is highly effective. DAA adherence ≥ 95% and a baseline CD4+ count ≥ 200/μL predicted a higher probability of SVR. A lower rate of SVR was found in MSM, presumably due to a higher frequency of HCV reinfection.

http://bit.ly/2UsiVnZ

Impact of erythrocytes on bacterial growth and antimicrobial activity of selected antibiotics

Abstract

It has been shown that protein binding, temperature, and pH influence in vitro pharmacodynamic (PD) models. The fact that corpuscular blood compounds might also have an important impact is something which has, until now, often been neglected. We investigated if the addition of human erythrocytes to standard growth media (Mueller Hinton Broth, MHBII) has an influence on bacterial growth behavior and on antibiotic efficacy. We did this by using bacterial growth assays and time kill curves (TKC) of selected strains (Escherichia coli ATCC25922, Staphylococcus aureus ATCC29213, and Pseudomonas aeruginosa ATCC27853) over 24 h. The final concentration of erythrocytes was set to match the physiological concentrations in the blood of a healthy human, i.e., 3 × 10^6 cells/μl in MHBII. Meropenem, ciprofloxacin, and tigecycline were tested with concentrations several-fold above and below the minimal inhibitory concentration (MIC). Moreover, HPLC analysis of antibiotic stability and distribution in erythrocytes was performed. Meropenem, ciprofloxacin, and tigecycline showed the greatest decline in activity against E. coli when erythrocytes were present. A mean difference in log10 bacterial killing between pure MHBII and 50%-Ery of 3.83, 1.33, and 2.42 was found for ciprofloxacin, meropenem, and tigecycline, respectively. In the case of ciprofloxacin, HPLC analysis revealed that less extracellular antibiotic is available in the presence of erythrocytes. We have demonstrated that erythrocytes do influence antimicrobial activity and that this might have an impact on the extrapolation of in vitro activity testing to in vivo efficacy in patients.

http://bit.ly/2DEZRgF

Mechanomyography-based muscle fatigue detection during electrically elicited cycling in patients with spinal cord injury

Abstract

Patients with spinal cord injury (SCI) benefit from muscle training with functional electrical stimulation (FES). For safety reasons and to optimize training outcome, the fatigue state of the target muscle must be monitored. Detection of muscle fatigue from mel frequency cepstral coefficient (MFCC) feature of mechanomyographic (MMG) signal using support vector machine (SVM) classifier is a promising new approach. Five individuals with SCI performed FES cycling exercises for 30 min. MMG signals were recorded on the quadriceps muscle group (rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM)) and categorized into non-fatigued and fatigued muscle contractions for the first and last 10 min of the cycling session. For each subject, a total of 1800 contraction-related MMG signals were used to train the SVM classifier and another 300 signals were used for testing. The average classification accuracy (4-fold) of non-fatigued and fatigued state was 90.7% using MFCC feature, 74.5% using root mean square (RMS), and 88.8% with combined MFCC and RMS features. Inter-subject prediction accuracy suggested training and testing data to be based on a particular subject or large collection of subjects to improve fatigue prediction capacity.

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http://bit.ly/2FT0ipW

Fluorescence microscopy image classification of 2D HeLa cells based on the CapsNet neural network

Abstract

The development of computer technology now allows the quick and efficient automatic fluorescence microscopy generation of a large number of images of proteins in specific subcellular compartments using fluorescence microscopy. Digital image processing and pattern recognition technology can easily classify these images, identify the subcellular location of proteins, and subsequently carry out related work such as analysis and investigation of protein function. Here, based on a fluorescence microscopy 2D image dataset of HeLa cells, the CapsNet network model was used to classify ten types of images of proteins in different subcellular compartments. Capsules in the CapsNet network model were trained to capture the possibility of certain features and variants rather than to capture the characteristics of a specific variant. The capsule at the same level predicted the instantiation parameters of the higher level capsule through the transformation matrix, and the higher level capsule became active when multiple dynamic routing forecasts were consistent. Experiments show that using the CapsNet network model to classify 2D HeLa datasets can achieve higher accuracy.

Graphical abstract

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http://bit.ly/2G5rdy8