Formation of Multiple Nitrosamines from the Ozonation of Corresponding Precursor Secondary Amines: Influencing Factors and Transformation Mechanisms

Abstract

Since nitrosamine disinfection by products is highly carcinogenic, they have attracted considerable attention due to their increased presence in ambient waterways and potable water supplies. For the present study, the potential formation of nitrosamines from corresponding precursor secondary amines during ozonation was investigated. The results revealed that five nitrosamines were observed during the ozonation of their corresponding secondary amines. The molar yields initially increased and then decreased with longer contact times and higher ozone doses. These phenomena indicated that ozone not only promoted nitrosamine formation but also degraded the formed nitrosamines. High pH had a positive influence on nitrosamine formation at room temperature. Further, coexisting substances including nitrate, nitrite, humic acid, and tert-butanol inhibited the generation of nitrosamines due to hydroxyl radical (·OH) competition and scavengers, whereas in the presence of hydroxylamine, nitrosamine formation increased considerably without ozone due to its capacity for independent formation between secondary amines and hydroxylamine. Further, the generation of nitrosamines from secondary amines was primarily attributed to O₃ and ·OH oxidation, which was produced through the decomposition of ozone. The transformation pathways were mainly comprised of the indirect routes between the O₃/·OH intermediates. The findings of this study were helpful toward expanding the knowledge of nitrosamine formation during the corresponding precursor secondary amine ozonation process.

http://bit.ly/2SjymkC

Correction to: Cladribine Tablets: A Review in Relapsing MS

The article Cladribine Tablets: A Review in Relapsing MS, written by Emma D. Deeks, was originally published Online First without open access.

http://bit.ly/2sSiaJ1

MRI assessment of hepatocellular carcinoma after locoregional therapy

Abstract

Liver cirrhosis and hepatocellular carcinoma (HCC) constitute one of the major causes of morbidity, mortality, and high health care costs worldwide. Multiple treatment options are available for HCC depending on the clinical status of the patient, size and location of the tumor, and available techniques and expertise. Locoregional treatment options are multiple. The most challenging part is how to assess the treatment response by different imaging modalities, but our scope will be assessing the response to locoregional therapy for HCC by MRI. This will be addressed by conventional MR methods using LI-RADS v2018 and by functional MR using diffusion-weighted imaging, perfusion, and highlighting the value of the novel intravoxel incoherent motion (IVIM).

http://bit.ly/2DGBWNF

Spontaneous bone regeneration after surgical extraction of a horizontally impacted mandibular third molar: a retrospective panoramic radiograph analysis

Abstract

Background

The mandibular third molar (M3) is typically the last permanent tooth to erupt because of insufficient space and thick soft tissues covering its surface. Problems such as alveolar bone loss, development of a periodontal pocket, exposure of cementum, gingival recession, and dental caries can be found in the adjacent second molars (M2) following M3 extraction. The specific aims of the study were to assess the amount and rate of bone regeneration on the distal surface of M2 and to evaluate the aspects of bone regeneration in terms of varying degree of impaction.

Methods

Four series of panoramic radiographic images were obtained from the selected cases, including images from the first visit, immediately after extraction, 6 weeks, and 6 months after extraction. ImageJ software® (NIH, USA) was used to measure linear distance from the region of interest to the distal root of the adjacent M2. Radiographic infrabony defect (RID) values were calculated from the measured radiographic bone height and cementoenamel junction with distortion compensation. Repeated measures of analysis of variance and one-way analysis of variance were conducted to analyze the statistical significant difference between RID and time, and a Spearman correlation test was conducted to assess the relationship between Pederson's difficulty index (DI) and RID.

Results

A large RID (> 6 mm) can be reduced gradually and consistently over time. More than half of the samples recovered nearly to their normal healthy condition (RID ≤ 3 mm) by the 6-month follow-up. DI affected the first 6 weeks of post-extraction period and only showed a significant positive correlation with respect to the difference between baseline and final RID.

Conclusions

Additional treatments on M2 for a minimum of 6 months after an M3 extraction could be recommended. Although DI may affect bone regeneration during the early healing period, further study is required to elucidate any possible factors associated with the healing process. The DI does not cause any long-term adverse effects on bone regeneration after surgical extraction.

http://bit.ly/2HGArTJ

Mid-term follow-up results of calcaneal reconstruction for calcaneal malunion

Abstract

Background

We hypothesized that calcaneal reconstruction can relieve chronic pain due to calcaneal malunion. We report the mid-term follow-up results of calcaneal reconstruction for calcaneal malunion.

Methods

We reviewed the records of 10 male patients (10 ft) who underwent calcaneal reconstruction for calcaneal malunion between January 2009 and July 2014 at the mid-term follow-up. Talocalcaneal height and angle, calcaneal pitch, calcaneal width, Böhler angle, Stephens classification, and Zwipp classification were evaluated by three orthopedic doctors at each visit (pre-reconstruction, post-reconstruction, and at the last follow-up).

Results

The mean follow-up period was 67.1 months (range, 48–101 months). The sites of pain before reconstruction were lateral aspect (4 patients), plantar aspect (3 patients), diffuse pain (2 patients), and anterior aspect (1 patient). There was a significant difference in talocalcaneal height, talocalcaneal angle, calcaneal pitch, calcaneal width, and Böhler angle before and after reconstruction (p < 0.05). There was no significant difference between reconstruction and the last follow-up. Radiological measurement agreement was calculated to be moderate to strong (intraclass correlation coefficient: 0.659–0.988). Mean American Orthopedic Foot & Ankle Society Ankle and Hindfoot score improved from 66.50 ± 9.37 pre-reconstruction to 80.30 ± 8.52 at the last follow-up (p < 0.05). The mean visual analog scale score improved from 8.60 ± 1.43 before reconstruction to 3.40 ± 0.84 at the last follow-up (p < 0.05). Most patients were satisfied with the outcome postoperatively.

Conclusions

Our results showed substantial improvement in the clinical and radiological outcomes after calcaneal reconstruction of calcaneal malunion. This outcome was maintained until the mid-term follow-up. Therefore, calcaneal reconstruction may be a good option for the treatment of chronic pain caused by the malunion of a calcaneal fracture without severe subtalar arthritis. Further prospective studies are needed to test this theory.

Level of Evidence: Level IV, Retrospective Case Series.

http://bit.ly/2B902Ps

What is the evidence to support early supervised exercise therapy after primary total knee replacement? A systematic review and meta-analysis

Abstract

Background

Total knee replacement (TKR) patients participate in early supervised exercise therapy programs, despite a lack of evidence for such programs or the optimal type, duration or frequency to provide the best clinical outcomes. As hospital stay rates decrease worldwide, the first days after joint replacement surgery are of increasing clinical importance. The purpose of this study was to investigate any reported effects of published early exercise therapy following TKR surgery.

Methods

Databases PubMed, CINAHL, Embase, Cochrane, and Pedro were searched up to August 2018 for trials which investigated an early supervised exercise therapy, commencing within 48 h of surgery. Risk of bias was evaluated using a Modified Downs and Black Checklist and meta-analysis of results was conducted using Review Manager (RevMan). Standardised Mean Differences (SMD) or Mean Differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses.

Results

Four studies (323 patients) that used four different interventions were identified, including Modified Quadriceps Setting, Flexion Splinting, Passive Flexion Ranging and a Drop and Dangle Flexion regime. Patients receiving the Drop and Dangle flexion protocol had superior flexion in the first 2 days after TKR and at discharge, the Flexion Splint patients were discharged earlier and had greater flexion at 6-weeks postoperatively, and the Modified Quadriceps Setting group showed greater hamstring and gluteal muscle strength. Results of the methodological quality assessment showed included studies were of moderate quality. The meta-analysis included 3 of the 4 trials and found no significant differences between groups in maximum knee flexion (MD = 1.34; 95% CI, − 5.55–8.24) or knee society scores (MD = − 1.17; 95% CI, − 4.32–1.98) assessed at 6 weeks post-operatively.

Conclusion

The paucity and heterogeneity of existing studies that examine early supervised exercise therapy following TKR surgery makes it challenging for clinicians to deliver high-quality evidence-based exercise programs in the early postoperative period. Although superior knee flexion range was found across differing regimes, the meta-analysis showed no significant difference in this outcome between groups at 6 weeks. The results of this review show high quality randomized clinical trials are urgently needed to evaluate the impact of early exercise following TKR surgery.

Trial Registration

This review was registered with PROSPERO (CRD42017081016).

http://bit.ly/2TjVEEr

Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study

Abstract

Background

Flight-related neck, shoulder and low back pain are the most common musculoskeletal disorders among helicopter pilots and their crewmembers, thus becoming a growing concern. Information on the combined prevalence of these types of pain and related risks are scarce. The aim of this study was therefore to estimate pain prevalence and to evaluate potential risk factors for neck pain among helicopter pilots and crewmembers within the armed forces, the airborne police and airborne rescue organizations in Austria.

Methods

Among a cohort of 104 helicopter pilots and 117 crewmembers (69.8% compliance), demographics, flying experience, use of Night Vision Goggles (NVG), helicopter type flown, prevalence and intensity of musculoskeletal symptoms (pain was defined as any reported pain experience, ache or discomfort) were collected by an online-based questionnaire.

Results

For helicopter pilots the 12-month prevalence of neck pain was 67.3%, followed by low back (48.1%) and shoulder pain (43.3%). Among crewmembers, the 12-month pain prevalence were 45.3, 36.8 and 30.8% among the neck, lower back and shoulder, respectively. During this period, 41.8% of these helicopter pilots had experienced 8–30 pain days in the areas of neck (45.7%), shoulder (37.8%) and lower back (42.0%) whereas 47.8% of crewmembers self-reported 1–7 days of neck (54.7%), low back (44.2%) and shoulder (44.4%) pain in the previous year. The 3-month prevalence of neck pain was 64.4% followed by low back (42.3%) and shoulder pain (38.5%) for helicopter pilots. Among crewmembers, 41.9% suffered from neck, 29.9% from low back and 29.1% from shoulder pain the previous 3 months. Multivariate regression analysis revealed NVG use (OR 1.9, 95% CI, 1.06–3.50, p = 0.032), shoulder pain (OR 4.9, 95% CI, 2.48–9.55, p < 0.001) and low back pain (OR 2.3, 95% CI, 1.21–4.31, p = 0.011) to be significantly associated with neck pain.

Conclusions

The 12- and 3-month prevalence of neck, shoulder and low back is considerably high among both, helicopter pilots and crewmembers confirming the existence of this growing concern. The use of NVG devices, shoulder and low back pain in the previous 12 months represent independent risk factors for neck pain. These findings highlight the need for longitudinal studies.

http://bit.ly/2B8ZKYS

Major automatic diabetic retinopathy screening systems and related core algorithms: a review

Abstract

Diabetic retinopathy (DR), one of the major and long-term microvascular complications of diabetes, is the most common cause of vision loss and blindness in the working population of the world. Even with the management of diabetes, most patients will develop some forms of DR after approximately 20 years. However, DR is a treatable disease throughout the disease progression. To provide appropriate DR management, the USA and European countries have successfully implemented systematic early DR screening programs. At the same time, some computer-aided DR screening systems, which combine advanced DR detection algorithms and telemedicine technology, have also been developed for early-stage DR detection. Some of them have been tested in the DR screening programs. In this paper, we focus on a review of the major automatic DR screening systems which have performed large-scale evaluation rather than give an extensive review of all published DR grading algorithms. We first present the structures of the automatic systems and their supporting algorithms developed by the research groups, as well as the practices of the systems in their screening programs. We further present a more detailed review of the DR lesion detection algorithms in each system and reveal how the DR screening systems successfully practiced in clinical trials or large-scale screening programs. We also review recently new research areas as well as deep learning-based DR screening systems and compare them with the traditional lesion detection-based DR screening systems. The performances of the systems in the trials are summarized by considering the specificity and sensitivity with respect to the scale of testing datasets. At last, we will discuss future challenges.

http://bit.ly/2Uxrg9Z

Forest gaps influence fungal community assembly in a weeping cypress forest

Abstract

The forest gap crucially influences forest environments, but its effects on local fungal community assembly are not fully understood. In this study, the fungal community in a weeping cypress forest was investigated as a function of forest gap locations based on forest clearing, using amplicon sequencing of the ITS2 region. The results showed that the fungal community significantly varied with the variations in soil properties related to gap location. Deterministic processes played pivotal roles in fungal community assembly, which was mainly driven by the temperature, moisture, available nitrogen, and microbial carbon in soil. Beta diversity of the fungal community increased from the gap center to the closed canopy. The relative abundances of dominant orders such as Microascales, Sordariales, and Chaetothyriales regularly varied as a function of gap location, and they were potential indicators for different gap locations. Based on network analysis, gap locations caused distinct co-occurrence patterns of fungal communities. This study shed light on the roles of forest gaps in the assembly of local fungal communities and provided additional strategies to manage forest ecosystems.

http://bit.ly/2G9AzbV

Lightness/pitch and elevation/pitch crossmodal correspondences are low-level sensory effects

Abstract

We tested the sensory versus decisional origins of two established audiovisual crossmodal correspondences (CMCs; lightness/pitch and elevation/pitch), applying a signal discrimination paradigm to low-level stimulus features and controlling for attentional cueing. An audiovisual stimulus randomly varied along two visual dimensions (lightness: black/white; elevation: high/low) and one auditory dimension (pitch: high/low), and participants discriminated either only lightness, only elevation, or both lightness and elevation. The discrimination task and the stimulus duration varied between subjects. To investigate the influence of crossmodal congruency, we considered the effect of each CMC (lightness/pitch and elevation/pitch) on the sensitivity and criterion of each discrimination as a function of stimulus duration. There were three main findings. First, discrimination sensitivity was significantly higher for visual targets paired congruently (compared with incongruently) with tones while criterion was unaffected. Second, the sensitivity increase occurred for all stimulus durations, ruling out attentional cueing effects. Third, the sensitivity increase was feature specific such that only the CMC that related to the feature being discriminated influenced sensitivity (i.e. lightness congruency only influenced lightness discrimination and elevation congruency only influenced elevation discrimination in the single and dual task conditions). We suggest that these congruency effects reflect low-level sensory processes.

http://bit.ly/2WsVvAA

On the relationship between value-driven and stimulus-driven attentional capture

Abstract

Reward history, physical salience, and task relevance all influence the degree to which a stimulus competes for attention, reflecting value-driven, stimulus-driven, and goal-contingent attentional capture, respectively. Theories of value-driven attention have likened reward cues to physically salient stimuli, positing that reward cues are preferentially processed in early visual areas as a result of value-modulated plasticity in the visual system. Such theories predict a strong coupling between value-driven and stimulus-driven attentional capture across individuals. In the present study, we directly test this hypothesis, and demonstrate a robust correlation between value-driven and stimulus-driven attentional capture. Our findings suggest substantive overlap in the mechanisms of competition underlying the attentional priority of reward cues and physically salient stimuli.

http://bit.ly/2RkDTDb

Non-obesogenic doses of fatty acids modulate the functionality of the circadian clock in the liver

Abstract

Saturated fatty acids, such as palmitate, lead to circadian disruption in cell culture. Moreover, information regarding the effects of unsaturated fatty acids on circadian parameters is scarce. We aimed at studying the effects of low doses of saturated as well as unsaturated fatty acids on circadian metabolism in vivo and at deciphering the mechanism by which fatty acids convey their effect. Mice were fed non-obesogenic doses of palm or olive oil and hepatocytes were treated with palmitate and oleate. Mice fed non-obesogenic doses of palm oil showed increased signaling towards fatty acid synthesis, while olive oil increased signaling towards fatty acid oxidation. Low doses of palmitate and oleate were sufficient to alter circadian rhythms, due to changes in the expression and/or activity of key metabolic proteins. Palmitate, but not oleate, counteracted the reduction in lipid accumulation and BMAL1-induced expression of mitochondrial genes involved in fatty acid oxidation. Palmitate was also found to interfere with the transcriptional activity of CLOCK:BMAL1 by preventing BMAL1 deacetylation and activation. In addition, palmitate, but not oleate, reduced PER2-mediated transcriptional activation and increased REV-ERBα-mediated transcriptional inhibition of Bmal1. The inhibition of PER2-mediated transcriptional activation by palmitate was achieved by interfering with PER2 nuclear translocation. Indeed, PER2 reduced fat accumulation in hepatocytes and this reduction was prevented by palmitate. Herein, we show that the detrimental metabolic alteration seen with high doses of palmitate manifests itself early on even with non-obesogenic levels. This is achieved by modulating BMAL1 at several levels abrogating its activity and expression.

http://bit.ly/2RXQwsM

Investigation on Dabigatran Etexilate and Worsening of Renal Function in Patients with Atrial fibrillation: The IDEA Study

Abstract

Background and Objectives

Warfarin-related nephropathy is an unexplained acute kidney injury, and may occur in patients with supratherapeutic INR, in the absence of overt bleeding. Similar findings have been observed in rats treated with dabigatran etexilate. We conducted a prospective study in dabigatran etexilate-treated patients to assess the incidence of dabigatran-related nephropathy and to investigate the possible correlation between dabigatran plasma concentration (DPC) and worsening renal function.

Method

One hundred and seven patients treated long term with dabigatran etexilate for non-valvular atrial fibrillation (NVAF) were followed up for 90 days. DPC, serum creatinine (SCr) and serum cystatin C were prospectively measured. Ninety five patients had complete follow-up data and were evaluable for primary endpoint.

Results

Eleven patients had supratherapeutic DPC, defined as DPC higher than 200 ng/ml at study enrolment, but at the end of follow-up no patient showed a persistent increase in SCr. No patients experienced acute kidney injury.

Conclusions

Our study shows that no persistent renal detrimental effect is associated with dabigatran treatment. An increase in SCr during dabigatran treatment is reversible and it seems to be unrelated to dabigatran itself.

http://bit.ly/2MEWdpQ

Steady-State Relative Permeability Measurements of Tight and Shale Rocks Considering Capillary End Effect

Abstract

Relative permeability (k_r) data are the key factors for describing the behaviour of the multi-phase flow in porous media. During the k_r measurements of low-permeability rocks, high capillary pressure can cause a significant liquid hold-up at the core outlet. This liquid hold-up, which is known as capillary end effect (CEE), is the main difficulty for laboratory measurements of relative permeability (k_r) for tight and shale rocks. In this paper, a novel method is proposed to correct the CEE during the steady-state relative permeability (SS-k_r) measurements. The integrity of the proposed method is evaluated by a set of artificially generated data and the experimental SS-k_r data of an Eagle Ford shale sample. It is shown that accurate k_r data can be obtained using the proposed technique. This technique can be used to estimate reliable k_r data without any saturation profile measurement equipment, such as CT scan or MRI.

http://bit.ly/2Gaigng

Parameter identification of nonlinear system using an improved Lozi map based chaotic optimization algorithm (ILCOA)

Abstract

In this paper, an efficient stochastic optimization algorithm is presented for parameter identification of nonlinear systems. Due to its robust performance, short running time and desirable potency to find local minimums the Lozi map-based chaotic optimization algorithm is an appropriate choice to estimate unknown parameters of nonlinear dynamic systems. To enhance the identification efficacy and in order to escape local minimum, a modified version of this algorithm with higher stability and better performance is rendered in this paper. An Improved Lozi map-based chaotic optimization algorithm (ILCOA) is employed to identify three nonlinear systems and the performance of the proposed algorithm is compared with other optimization algorithms. The simulation results of identification endorse the effectiveness of the proposed method.

http://bit.ly/2FX0Hrr

A Qualitative Exploration of Mothers’ Experiences Receiving Mental Health Services in a Supermarket Setting

Abstract

Objectives Innovative mental health care delivery models have been proposed as a method to address disparities in access and utilization. The aim of this study is to characterize patients' perspectives and experiences of participating in one such innovative delivery model, group cognitive behavioral therapy within a supermarket setting. Methods In this qualitative study, 16 mothers were interviewed to explore their experiences and perspectives of receiving group-based cognitive behavioral therapy in a supermarket setting, as part of their participation in an academic-community research collaborative whose mission is to address mental health needs within low-resourced communities. Data from semi-structured interviews were analyzed using inductive coding. Results Five themes related to receiving mental health services in a supermarket setting emerged from the data: (1) Participants reported a convergence of life stressors and their introduction to supermarket-based services; (2) Participants perceived the supermarket setting as convenient; (3) Participants perceived the supermarket setting as less stigmatizing; (4) Participants perceived services in the supermarket as an acceptable form of mental health treatment; and (5) Participants described the program staff as an influential component of their treatment experience. Conclusions Understanding patient experiences of various service delivery models is critical to improving access to treatment and addressing disparities in mental health service utilization and outcomes. This study supports the use of innovative delivery models to increase access to mental health services in low-resourced communities.

http://bit.ly/2FXk8jQ

Semi-active control of ambulance stretcher system based on parallel mechanism with MR dampers and perturbation analysis

Abstract

The recumbent patients on ambulance stretcher experience multi-dimensional excitations due to road roughness. In order to isolate the multi-dimensional vibrations validly, a novel ambulance stretcher system based on 4-PUU parallel mechanism with Magneto-Rheological dampers is proposed. Firstly, the kinematic and dynamic equation are deduced by geometric relation and Lagrange equation respectively. Subsequently, the vibration isolation performance is investigated in time and frequency domain. The robustness of LQR algorithm is addressed with parameters perturbation by deducing Lyapunov equation. Further, selecting RMS values as the index of vibration isolation performance, the index which includes geometric parameters perturbation, mass and spring uncertainties is discussed. Simulations demonstrate the stretcher system can effectively isolate multi-dimensional vibrations in sensitive frequency range for supine patients with perturbation and uncertainties. The RMS values show different characteristics because of altering Jacobin matrix of the stretcher.

http://bit.ly/2HG1HBN

A Qualitative Exploration of Mothers’ Experiences Receiving Mental Health Services in a Supermarket Setting

Abstract

Objectives Innovative mental health care delivery models have been proposed as a method to address disparities in access and utilization. The aim of this study is to characterize patients' perspectives and experiences of participating in one such innovative delivery model, group cognitive behavioral therapy within a supermarket setting. Methods In this qualitative study, 16 mothers were interviewed to explore their experiences and perspectives of receiving group-based cognitive behavioral therapy in a supermarket setting, as part of their participation in an academic-community research collaborative whose mission is to address mental health needs within low-resourced communities. Data from semi-structured interviews were analyzed using inductive coding. Results Five themes related to receiving mental health services in a supermarket setting emerged from the data: (1) Participants reported a convergence of life stressors and their introduction to supermarket-based services; (2) Participants perceived the supermarket setting as convenient; (3) Participants perceived the supermarket setting as less stigmatizing; (4) Participants perceived services in the supermarket as an acceptable form of mental health treatment; and (5) Participants described the program staff as an influential component of their treatment experience. Conclusions Understanding patient experiences of various service delivery models is critical to improving access to treatment and addressing disparities in mental health service utilization and outcomes. This study supports the use of innovative delivery models to increase access to mental health services in low-resourced communities.

http://bit.ly/2FXk8jQ

Eruptive Epidermoidzysten nach Imiquimod-Therapie eines rezidivierenden Basalzellkarzinoms

Zusammenfassung

Eruptive Epidermoidzysten stellen eine seltene Nebenwirkung von Imiquimod zur Behandlung von Basalzellkarzinomen dar. Bis dato wurden 8 Fälle in der Literatur beschrieben. Wir präsentieren den Fall einer 75-jährigen kaukasischen Patientin mit einem 8‑mal rezidivierten Basalzellkarzinom der Nase. Nach mehrfachen Exzisionen und Therapie mit Vismodegib erhielt die Patientin schließlich Imiquimod 5 % Creme in der Standarddosierung 5‑mal wöchentlich für die Dauer von 6 Wochen. Zwei Monate nach dem Absetzen von Imiquimod zeigten sich eruptive Epidermoidzysten.

http://bit.ly/2SbZQZD

Phytoremediation of Lead and Chromium Contaminated Soil Improves with the Endogenous Phenolics and Proline Production in Parthenium , Cannabis , Euphorbia , and Rumex Species

Abstract

Phytoremediation is the most promising and emerging technology for remediation of metal-contaminated sites. The aim of the current research was to investigate the metals accumulation potential of four weed species i.e., Parthenium, Cannabis, Euphorbia, and Rumex species. The endogenous free proline, total phenolic, carotenoids, and chlorophyll contents were assessed under metals stress and correlated with metals accumulation in plants. Plants of each species were allowed to grow in reference (uncontaminated) soil and other group on industrial effluent-contaminated soil under natural environment. Phytoextraction potentials of these plants were evaluated for removal of lead (Pb) and chromium (Cr). The heavy metal concentration in plant parts was analyzed by atomic absorption spectrophotometer. Varied accumulation of metals was found among different weed species. Moreover, metal accumulation was different within plant tissues i.e., roots, leaves, and stem. Cannabis and Parthenium showed bio-concentration BCF > 1 for Pb, reflecting their high metal accumulation potential and both plants were found superior than Rumex and Euphorbia for Cr accumulation. The endogenous free proline and phenolic contents showed significantly positive correlation with Pb accumulation in four plants i.e., Parthenium (R2 = 0.977, R2 = 0.9996), Cannabis (R2 = 0.9924, R2 = 0.9999), Euporbia (R2 = 0.9992, R2 = 0.9832), Rumex (R2 = 0.6033, R2 = 0.8272) respectively. Similarly, Cr accumulation in plants showed significantly positive correlation with proline and phenolic but the BCF ˂ 1.The chlorophyll and carotenoids contents in all plants negatively correlated with Pb and Cr concentration.

http://bit.ly/2Bbs790

Inhibition of pSTAT1 by tofacitinib accounts for the early improvement of experimental chronic synovitis

Abstract

Background

In order to gain insight into the early effects drawn by JAK inhibitors on intra-joint JAK/STAT-dependent signaling, we sought synovial activation of STATs and their end-products, along with their modification with tofacitinib (TOFA), at flare-up in antigen induced arthritis (AIA). New Zealand rabbits were randomly assigned to four groups –healthy controls, AIA, TOFA-treated AIA, or TOFA-treated controls–. AIA was induced with 4 weekly intra-articular ovalbumin injections in sensitized animals. TOFA (10 mg·kg^− 1·day^− 1) was administered for the last 2 weeks. Animals were euthanized 24 h after the last injection.

Results

AIA animals showed high-grade synovitis, which was partially improved by TOFA. No effects of the treatment were found on serum C-reactive protein or on the synovial macrophage infiltration at this stage. Synovial MMP-1,-3 and -13 expression levels in treated AIA rabbits were found to drop to those of controls, while a downregulation of IL6, IFNγ and TNF was evident in treated versus untreated AIA rabbits. Concurrently, a reduction in pSTAT1 and SOCS1, but not in pSTAT3, SOCS3 or active NFκB-p65, was noted with TOFA.

Conclusions

Studying the mechanism of action of immunomodulatory drugs represents a major challenge in vivo, since drug-dependent decreases in inflammation very likely mask direct effects on disease mechanisms. This study design allowed us to prevent any confounding effect resulting from reductions in the overall inflammatory status, hence assessing the true pharmacological actions of TOFA in a very severe synovitis. Our findings point to pSTAT1 and MMPs as early molecular readouts of response to this JAK inhibitor.

http://bit.ly/2MDk894

Caregiver stress in children with craniosynostosis: a systematic literature review

Abstract

Objectives

We present an overview of the literature on caregiver stress in children with craniosynostosis and report common trends in the literature.

Introduction

Craniosynostosis occurs approximately 1 in 2500 births. As this is a diagnosis most common in infants and often requires surgical treatment, this is a significant and stressful ordeal for caregivers. Caregiver stress impacts various outcomes for the child, and little is understood and known about caregiver stress in the pediatric craniosynostosis population.

Methods

A literature search for all articles pertaining to craniosynostosis and parental/caregiver stress was conducted using PubMed, Embase, PsychINFO, and CINAHL databases.

Results

Seven articles on caregiver stress in craniofacial abnormalities patients and three articles on caregiver stress in pediatric craniosynostosis patients specifically were identified. Three articles on parental satisfaction after craniosynostosis repair were also identified and included in the review. Few published studies exist in the literature on caregiver stress in children with craniosynostosis and no clear trends were identified. It is evident that caregiver stress significantly affects the psychosocial outcomes of children with craniosynostosis. However, there are an equal number of studies reporting significant differences in caregiver stress in children with craniosynostosis as those reporting no significant differences.

Conclusions

There is evidence that caregiver stress affects psychosocial outcomes of children with craniosynostosis, but no clear trends of either increased or decreased levels of stress were identified in caregivers of children with craniosynostosis. Additional research is needed to identify risk factors related to caregiver stress.

http://bit.ly/2BbNU02

Serial measurement of S100B and NSE in pediatric traumatic brain injury

Abstract

Purpose

Increased serum biomakers, such as S100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE), are associated with traumatic brain injury (TBI). The purpose of this study is to investigate the serum levels of S100B and NSE in pediatric TBI patients and to predict a clinical outcome.

Methods

Peripheral venous blood was collected within 6 h of injury and at 1 week to measure S100B and NSE. The serum S100B and NSE levels were measured using commercially available enzyme-linked immunosorbent assay kits. The authors divided participants into two groups at admission: a favorable group (patients with Glasgow Coma Scale [GCS] scores of 10–15) and an unfavorable group (patients with GCS scores of less than 9). Both S100B and NSE levels were compared between the two groups at the time of admission and 1 week later.

Results

Ten pediatric patients were enrolled (5 in the favorable group, 5 in the unfavorable group). The median serum S100B level of 134.21 pg/ml (range, 51.00–789.65 pg/ml) in patients with TBI at admission dropped to 41.49 pg/ml (range, 25.65–260.93 pg/ml) after 1 week, with significant differences between the traumatic event and 1 week later (p = 0.007). The median serum NSE level of 14.76 ng/ml (range, 6.48–21.23 ng/ml) in patients with TBI at admission was higher than that after 1 week (4.96 ng/ml, range, 3.01–31.21 ng/ml), with significant differences (p = 0.015). A significant difference was observed in S100B after 1 week between patients in the favorable and unfavorable groups (p = 0.047). One patient whose serum S100B and NSE levels were elevated 1 week after TBI eventually died.

Conclusions

Elevated serum S100B and NSE levels in pediatric TBI patients decreased 1 week after traumatic events. The serum S100B level 1 week after TBI was related to the severity of brain damage. These results indicated that serum S100B and NSE might play a role in predicting the prognosis and monitoring ongoing brain injury in pediatric TBI patients.

http://bit.ly/2TkweGF

Is arachnoid cyst a static disease? A case report and literature review

Abstract

Introduction

The increasing use of intracranial imaging has led to more frequent diagnoses of arachnoid cysts (ACs). Although ACs are a frequent finding on neuroimaging in children, the prevalence and natural history of these cysts are not well defined. Most ACs may persist and remain asymptomatic throughout life and not require treatment. However, there have been some case reports of ACs that have become larger or smaller over time and, in rare cases, have even spontaneously resolved. It is the authors' practice to recommend serial neuroimaging in patients with asymptomatic sylvian ACs and not offer surgery to patients without symptoms, even in those with a relatively large cyst.

Case report

The present article describes a case involving a 6-year-old boy with a large, asymptomatic AC in the left Sylvian fissure involving the temporo-frontal region, which resolved spontaneously during the 2-year follow-up period after initial diagnosis without any surgical intervention. Currently, at the 7-year follow-up, the patient has remained neurologically intact, attends school, and is symptom-free.

Conclusion

Clinicians should be mindful of the possibility of spontaneous regression when encountering patients with asymptomatic and/or incidentally diagnosed sylvian ACs.

http://bit.ly/2B8fOdo

“It is not what it seems.” Ultrasound findings in a case of unusual iatrogenic ulnar nerve damage

http://bit.ly/2TlpwA6

Delayed-onset paralysis induced by spontaneous spinal epidural hematoma communicated with hematoma in the paraspinal muscle in a 6-month-old girl: a case report

Abstract

Spontaneous spinal epidural hematoma (SSEH) very rarely develops in infants younger than 1 year old. To our knowledge, no previous case of delayed-onset paralysis induced by SSEH communicated with hematoma in the paraspinal muscle has been reported in the literature. The authors present the case of a 6-month-old girl with a tumor mass on her back who developed a paresis of her bilateral lower limbs. On spinal magnetic resonance imaging, the epidural mass appeared to be a dumbbell type and communicated with the mass in the paraspinal muscle through T12/L1 intervertebral foramen at the right side. After excision of the mass in the paraspinal muscle, hemi-laminectomy of T10-L3 was performed. No solid lesion was also present in the spinal canal and it was found to be an epidural hematoma. No malignancy was observed on pathological examination, and vascular and nerve system tumors were negative. When a tumor mass suddenly develops on the back of an infant and motor impairment of the lower limbs develops as the mass gradually enlarges, differential diagnosis should be performed taking SSEH into consideration.

http://bit.ly/2HBbB7W

Enlarging teratoma syndrome

Abstract

Introduction

Teratomas are derived from all three germ layers and make up 3% of all childhood tumors. They are histologically classified as mature or immature. We present a case that was operated on when 30 days old for a sacrococcygeal mature teratoma and then showed long segment involvement in the thoracolumbar region 9 months after the surgery. The MRI (magnetic resonance imaging) showed a mass starting at the thoracal 4 level and extending to the lumbar 3 level with significant spinal cord compression in the extradural space.

Result

The laminae between thoracal 4 and lumbar 3 levels were removed en bloc at a single surgical session and laminoplasty was performed after tumor resection. We also removed the tumor growing into the extrapleural space at the thoracal 5, 6, and 9, 10, 11, 12 levels using the costotransversectomy procedure.

Conclusions

We emphasize with this case that mature teratomas can show aggressive growth following surgery and that the development of spinal deformities can be prevented with laminoplasty.

http://bit.ly/2B8UBQC

The quality of life in extracorporeal life support survivors: single-center experience of a long-term follow-up

Abstract

Objective

To evaluate the health-related quality of life on a very long-term follow-up in patients treated with extracorporeal membrane oxygenation (ECMO) during neonatal and pediatric age.

Design

Prospective follow-up study.

Setting

Pediatric Intensive Care Unit of a tertiary-care University-Hospital.

Patients

Out of 20 neonates and 21 children treated with ECMO in our center, 24 patients underwent short-term neurological follow-up. Twenty of them underwent long-term neurological follow-up.

Intervention

Short-term follow-up was performed at 18 months and consisted in clinical evaluation, electroencephalography, and neuroimaging. Long-term follow-up was performed in 2017, at the mean period 19.72 years from ECMO (median 20.75, range 11.50–24.08) and consisted in a standardized questionnaires self-evaluation (PedsQL 4.0 Generic Core Scale) of health-related quality of life and an interviewed about the presence of organ morbidity, school level, or work position.

Measurements and main results

Sixty-one percent (25/41) of the patients survived within 30 days after ECMO treatment. Short-term follow-up was performed in 24 patients (1 patient but died before the evaluation): 21 patients (87%) showed a normal neurological status, and 3 developed severe disability. Long-term follow-up was performed in 20 long-term survivors (3 patients were not possible to be contacted and considered lost to follow-up): mean age of patients at long-term follow-up was 21.23 (median 20.96, range 13.33–35.58) years; 90% (18/20) of them have no disability with a complete normal quality of life and 95% have no cognitive impairment.

Conclusions

ECMO represents a life-saving treatment for infants and children with respiratory and/or heart failure; survivors show a good quality of life comparable to healthy peers.

http://bit.ly/2Tk2KJb

Ventral and dorsal tethering bands of the spinal cord in the same patient: a case report

Abstract

Fibrous bands are one of the causes of tethered cord syndrome and these can be located on the dorsal or more rarely, ventral aspect of the dura mater. We report a case of dorsal and ventral tethering bands in the same patient found at surgery for tethered cord syndrome. Such fibrous bands restrict normal movement of the spinal cord and lead to a variety of neurological symptoms. To our knowledge, we report the first case of dorsal and ventral tethering bands of the spinal cord in the same patient. This case report aims to increase awareness of such anatomical variations and emphasize the importance of meticulous surgical dissection in order to identify such bands.

http://bit.ly/2BbMC5l

Radiosurgical treatment of arteriovenous malformations in a retrospective study group of 33 children: the importance of radiobiological scores

Abstract

Purpose

Arteriovenous malformations' (AVMs) obliteration depends on several factors; among the many factors that must be considered to obtain a high rate of obliteration and a low rate of complications, Flickinger-Pollock Score (FPS) seems to have an important role but still have to be validated in the pediatric population while Paddick-Conformity Index (PCI) still has no demonstration of its utility on the outcome and is considered only as a treatment quality marker.

Methods

We retrospectively analyzed 33 consecutive children (2–18 years) with an AVM, treated with stereotactic radiosurgery Gamma Knife (SRS-GK) from 2001 to 2014 in our institution. We assess angiographic (DSA) Obliteration Rate (OR) as well FPS and PCI to draw conclusions.

Results

DSA-OR was 60.6% with a rate of hemorrhage of 0%. median target volume (TV) was 3.60 cc (mean 4.32 ± 3.63; range 0.15–14.2), median PD was 22 Gy (mean 21.4 ± 2.6; range 16.5–25). Median percentage of coverage was 98% (mean 97 ± 3; range 84–100). The median modified FPS was 0.78 (mean 0.89 ± 0.52; range 0.21–2.1) and highly correlate with OR (p = 0.01). The median PCI was 0.65 (mean 0.65 ± 0.14; range 0.34–0.95) A PCI lower than 0.57 highly correlates with final OR (p = 0.02).

Conclusion

SRS-GK was safe and gradually effective in children. A prescription dose-like that used in adult population (i.e. > 18 and between 20 and 25 Gy) is essential to achieve obliteration. A PD of 23 Gy and 22 Gy did impact OR, respectively (p = 0.02) and (p = 0.05). FPS and PCI are valuable scores that seem to correlate with the OR also in the pediatric population although further prospective studies are needed to confirm these observations.

http://bit.ly/2TkyFZY

A rare clinical presentation: a pleomorphic xanthoastrocytoma presenting with intracerebral haemorrhage and metastasizing vigorously—case report and review of the literature

Abstract

Metastasis of an intracranial tumour is not a common situation in our daily neurosurgical practice. Pleomorphic xanthoastrocytoma is also a rare glial tumour with relatively a favourable prognosis among other CNS pathologies. Here, we present an anaplastic pleomorphic xanthoastrocytoma case which shows both haematogenous and lymphatic metastasis which is described first time in the up-to-date literature. Our case is a 17-year-old male operated for a right occipital intra-axial lesion with a diagnosis of anaplastic pleomorphic xanthoastrocytoma which recurs 5 years later and metastasize vigorously through haematogenous and lymphatic routes. A rare-presenting symptom for this pathology is also intracerebral haemorrhage. This is the ninth case report in the literature which presents initially with this entity.

http://bit.ly/2S8wvzh

Onyx embolization of a ruptured anterior inferior cerebellar artery in a neonate

Abstract

Aneurysmal subarachnoid hemorrhage (SAH) is rare in neonates. The authors present a unique report of a neonate with SAH from anterior inferior cerebellar artery (AICA) aneurysm rupture that was successfully treated with Onyx embolization. This case report demonstrates the utility of Onyx embolization for posterior circulation aneurysms in neonates and the successful management of SAH in this population.

http://bit.ly/2BaaJS5

Physiologic closure time of the metopic suture in South Australian infants from 3D CT scans

Abstract

Metopic synostosis is a craniofacial condition characterised by the premature fusion of the metopic suture. This early fusion restricts frontal bone growth [17] and has significant impacts on the developing infant during a critical phase of rapid growth and development [4]. Diagnosis of the condition is usually achieved by clinical assessment, followed by a three-dimensional computed tomography (3D CT) scan, verifying premature metopic suture fusion.

Purpose

This retrospective study aims to investigate the timing of metopic suture fusion in the developing infant in an Australian subpopulation.

Methods

The study evaluates metopic suture fusion in 258 cranial 3D CT scans of children aged 0–24 months over a 5-year period (2011–2016), scanned at Women's and Children's Hospital.

Results

The findings suggest that the age range over which physiologic metopic suture fusion occurs is larger than previously reported.

Conclusions

The approximate range for physiologic fusion was found to be 3–19 months and patients with fusion within this range can be considered normal. Complete suture fusion is expected by 19 months. Additionally, results indicate suture fusion prior to 3 months is abnormal and diagnostically indicative of metopic synostosis.

http://bit.ly/2Tlkrbc

Einführung und Evaluation eines neuen Kurrikulums Psychiatrie und Psychotherapie

Zusammenfassung

Hintergrund

Traditionell war die Lehre im Fach Psychiatrie und Psychotherapie an der Westfälischen Wilhelms-Universität Münster mit einer hohen Anzahl an Vorlesungen auf die Vermittlung von Faktenwissen ausgerichtet. Gemäß den aktuellen Richtlinien für eine kompetenzbasierte Lehre in der Medizin wurden ab dem Wintersemester 2016/2017 entsprechende Änderungen durchgeführt und deren Umsetzung evaluiert.

Ziel der Arbeit

Im Rahmen eines Lehrprojekts wurden Vorlesungen reduziert, effektiver mit dem Praktikum verzahnt und durch die Formulierung von Lernzielen auf den Nationalen Kompetenzbasierten Lernzielkatalog Medizin (NKLM) und Entrustable Professional Activities (EPAs) fokussiert.

Material und Methoden

Die Präsenz-Vorlesungen wurden mittels E‑Learning im Sinne eines Inverted-Classroom-Konzepts multimedial aufbereitet, die theoretischen Inhalte wurden durch einen Selbsttest und ein an praktischen EPAs orientiertes Praktikum verstetigt. Die bisherige Multiple-Choice-Klausur wurde durch eine kompetenzbasierte, praktische Stationenprüfung mit Simulationspatienten ergänzt. Evaluiert wurden zwei Semesterkohorten, die je mit und ohne modernisierte Lehrform die formative Stationenprüfung durchliefen. Neben dem Leistungszuwachs auf theoretischer und praktischer Ebene wurden Einflussvariablen, wie z. B. Vorwissen und Motivation, erhoben.

Ergebnisse

Es zeigte sich eine Verbesserung der praktischen Fertigkeiten der Kohorte nach der Einführung des neuen Kurrikulums ohne eine Reduktion theoretischer Kenntnisse. Relevante Einflussvariablen ließen sich nicht eruieren.

Diskussion

Unsere Ergebnisse zeigen, dass eine kompetenzbasierte Neuausrichtung des Kurrikulums im Fach Psychiatrie und Psychotherapie zu mehr praktischen Fähigkeiten führt und so die Ausbildung zukünftiger Mediziner zu eigenverantwortlich Handelnden unterstützt.

http://bit.ly/2RUyAPL

Akzeptanz, Bedarf, Konsultationsgründe und Beratungsoutcome von Epilepsieberatung in Hessen und Unterfranken

Zusammenfassung

Hintergrund und Ziel

Die Diagnose einer Epilepsie geht häufig mit relevanten Einschränkungen für Patienten einher, wodurch eine Vielzahl verschiedener Probleme entstehen können, die einer gezielten und professionellen Beratung bedürfen. Seit 1996 existieren in einigen Bundesländern spezialisierte Epilepsieberatungsstellen (EBS), die in solchen Fällen als Anlaufstelle dienen sollen. Ziel dieser prospektiven, multizentrischen Kohortenstudie an sechs EBS in Hessen und Unterfranken war es, Akzeptanz, Nachfrage und häufige Konsultationsgründe von EBS zu erfassen und zu analysieren.

Resultate

Insgesamt wurden über 12 Monate (06/2014 bis 05/2015) 435 Klienten, hiervon 74,3 % Erwachsene (n = 323, mittleres Alter 40,3 ± 14,7 Jahre; Spannweite 18–76 Jahre, 51,7 % weiblich) und 25,7 % Kinder und Jugendliche (n = 112, mittleres Alter 9,4 ± 4,8 Jahre; Spannweite 1–17 Jahre, 52,7 % weiblich) eingeschlossen. Im Mittel wurden 2,5 (Median 2,0; SD ± 2,8, Spannweite 1–20) ambulante Vorstellungen an EBS pro Jahr angegeben, wobei eine allgemeine Beratung zum Umgang mit Epilepsie (Erwachsene 55,7 %, Kinder 51,8 %), Aufklärung und Information über die Erkrankung (43,7 % bzw. 41,1 %) und Hilfe bei der Beantragung von Hilfsleistungen (39,0 % bzw. 46,4 %) die häufigsten Vorstellungsgründe waren. Die Distanz zwischen Wohnort und EBS war in Bayern signifikant kürzer als in Hessen (p < 0,002). Die Zufriedenheit der Klienten war bei einem mittleren ZUF-8-Skalenwert von 29,0 (max. 32) hoch, 96,4 % der Klienten beurteilen die Qualität der Beratung als gut oder sehr gut und 96,6 % würden bei neuen Problemen erneut eine EBS aufsuchen. Bei konkreter Bedrohung des Arbeits‑, Ausbildungs- oder Schulplatzes konnte mithilfe der Beratung in 72,0 % der Fälle ein Arbeits‑, Ausbildungsplatzverlust bzw. ein Schulwechsel abgewendet werden.

Fazit

Epilepsieberatungsstellen stellen ein akzeptiertes, effektives und wertgeschätztes zusätzliches Hilfsangebot für Patienten mit Epilepsie und deren Angehörige bzw. Erziehungsberechtigte dar, welche das bestehende epilepsiespezifische ambulante und stationäre Versorgungsangebot ergänzt. Ein bundesweites Angebot an EBS wäre begrüßenswert.

http://bit.ly/2CPYJ8d

Dgcr8 knockout approaches to understand microRNA functions in vitro and in vivo

Abstract

Biologic function of the majority of microRNAs (miRNAs) is still unknown. Uncovering the function of miRNAs is hurdled by redundancy among different miRNAs. The deletion of Dgcr8 leads to the deficiency in producing all canonical miRNAs, therefore, overcoming the redundancy issue. Dgcr8 knockout strategy has been instrumental in understanding the function of miRNAs in a variety of cells in vitro and in vivo. In this review, we will first give a brief introduction about miRNAs, miRNA biogenesis pathway and the role of Dgcr8 in miRNA biogenesis. We will then summarize studies performed with Dgcr8 knockout cell models with a focus on embryonic stem cells. After that, we will summarize results from various in vivo Dgcr8 knockout models. Given significant phenotypic differences in various tissues between Dgcr8 and Dicer knockout, we will also briefly review current progresses on understanding miRNA-independent functions of miRNA biogenesis factors. Finally, we will discuss the potential use of a new strategy to stably express miRNAs in Dgcr8 knockout cells. In future, Dgcr8 knockout approaches coupled with innovations in miRNA rescue strategy may provide further insights into miRNA functions in vitro and in vivo.

http://bit.ly/2HLivYm

Similarity join on time series by utilizing a dynamic segmentation index

Abstract

Similarity join on time series databases is an essential operation for data analysis applications. Due to the curse of dimensionality, it is not suitable to use traditional index techniques, such as R-tree and kd-tree. In the paper, a dynamic segment index (i.e., DSTree) is utilized to reduce the huge comparison cost on the similarity join on time series databases. However, the DSTree is designed for similarity search and only supports bound estimations between a time series and a batch of time series in a DSTree node. To make the DSTree suitable for the similarity join on time series databases, it is necessary to have tight bounds for the nodes to achieve a better pruning power, where the biggest challenge is that the DSTree nodes may have different segmentations. To solve the problem aforementioned, a segmentation alignment and synopsis evaluation method is proposed to support the estimation of DSTree nodes to significantly reduce the time cost by pruning unnecessary comparisons. Moreover, to make our approach I/O efficient, a caching strategy is proposed by taking advantage of both graph partitioning and the locality of the DSTree index. The efficiency and effectiveness of the proposed approaches are verified by experiments on real-life datasets.

http://bit.ly/2CUsUek

Publishing trends in Journal of Paediatric Surgery, Pediatric Surgery International and European Journal of Pediatric Surgery over the past three decades

Abstract

The aim of this study was an analysis of the changing publication trends over the last three decades in the Journal of Pediatric Surgery (JPS), Pediatric Surgery International (PSI) and European Journal of Pediatric Surgery (EJPS) by studying the bibliometric variables, authorship, collaboration, and citation trends. A previously applied methodology using intermittent years was applied to review the archives of JPS, PSI and EJPS over the last 30 years. Citation data were collected from the Web of Science database. Statistical analysis was performed using SAS 9.4 software. A total of 1917 articles originating from 63 countries met the inclusion criteria. The number of articles published every year increased significantly in the last three decades from 336 in 1987 to 626 in 2017 (P < 0.0001). Multinational papers made up 5% of the total, of which 58% involved more than one continent. A majority of papers (75%) were single institution papers, there was strong evidence of an increase in multi-institution publications over time. There was a statistically significant increase in the number of female first and corresponding author. The publishing landscape of paediatric surgery has evolved to be more inclusive with increased collaboration, female authors and mentors and more publications from developing nations.

http://bit.ly/2DFbLHp

Surgical training in spine surgery: safety and patient-rated outcome

Abstract

Purpose

The aim of this study was to investigate the difference in patient-reported outcomes and surgical complication rates between lumbar procedures carried out either by experienced board-certified spine surgeons (BCS) or by supervised spine surgery residents (RES) in a large Swiss teaching hospital.

Methods

This was a single-center retrospective analysis of data collected prospectively within the framework of the EUROSPINE Spine Tango Registry. It involved the data of 1415 patients undergoing first-time surgery in our institution between the years 2004 and 2016. Patients were divided into three groups based on the surgical procedure: lumbar single-level fusion (SLF), single-level decompression (SLD) for lumbar spinal stenosis and disc hernia procedures (DH). Patient-reported outcome measures (primary outcome) included the multidimensional Core Outcome Measures Index (COMI) preoperatively and 3 and 12 months postoperatively plus single items concerning satisfaction with care and global treatment outcome (GTO). Secondary outcomes included surgical variables such as blood loss, duration of surgery, complication rates and length of stay.

Results

There were no significant differences between the RES and BCS patient groups for most of the demographic and baseline clinical variables with the exception of age in the SLD group (p = 0.012), BMI in the DH group (p = 0.02) and leg pain in the SLF group (p = 0.03). COMI scores improved significantly after all three types of procedure (p < 0.0001) without significant difference (p > 0.05) between the patients of RES and BCS. There was no significant difference (p > 0.05) between RES and BCS patients with regard to satisfaction and GTO. There were no significant differences between RES and BCS (p > 0.05) in the surgical or medical complication rates.

Conclusion

In the given setting, surgical training of spine surgery residents under guided supervision by board-certified spine surgeons was shown to be safe, as it was not associated with greater morbidity or mortality. Furthermore, it had no detrimental influence on patient-reported outcomes. The findings can be used to give reassurance to prospective patients that are to be operated on by supervised spine surgery residents.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

http://bit.ly/2G5eDyO

First Indian practice guidelines in cardiac surgery ... Never too late!

http://bit.ly/2S8zw2B

Spotlight on fungal pectin utilization—from phytopathogenicity to molecular recognition and industrial applications

Abstract

Pectin is a complex polysaccharide with d-galacturonic acid as its main component that predominantly accumulates in the middle lamella of the plant cell wall. Integrity and depolymerization of pectic structures have long been identified as relevant factors in fungal phytosymbiosis and phytopathogenicity in the context of tissue penetration and carbon source supply. While the pectic content of a plant cell wall can vary significantly, pectin was reported to account for up to 20–25% of the total dry weight in soft and non-woody tissues with non- or mildly lignified secondary cell walls, such as found in citrus peel, sugar beet pulp, and apple pomace. Due to their potential applications in various industrial sectors, pectic sugars from these and similar agricultural waste streams have been recognized as valuable targets for a diverse set of biotechnological fermentations.

Recent advances in uncovering the molecular regulation mechanisms for pectinase expression in saprophytic fungi have led to a better understanding of fungal pectin sensing and utilization that could help to improve industrial, pectin-based fermentations. Related research in phytopathogenic fungi has furthermore added to our knowledge regarding the relevance of pectinases in plant cell wall penetration during onset of disease and is therefore highly relevant for agricultural sciences and the agricultural industry. This review therefore aims at summarizing (i) the role of pectinases in phytopathogenicity, (ii) the global regulation patterns for pectinase expression in saprophytic filamentous fungi as a highly specialized class of pectin degraders, and (iii) the current industrial applications in pectic sugar fermentations and transformations.

http://bit.ly/2G7zKAo

Geometrically nonlinear bending of functionally graded nanocomposite trapezoidal plates reinforced with graphene platelets (GPLs)

Abstract

This paper investigates the nonlinear bending behaviours of functionally graded trapezoidal nanocomposite plates reinforced with graphene platelets (GPLs) under thermo-mechanical loading by employing finite element method. The modified Halpin–Tsai model and rule of mixtures are adopted to determine the Young's modulus, Poisson's ratio and the thermal expansion coefficient of the nanocomposites. The influences of a number of factors, including the distribution pattern, concentration and size of GPLs, plate geometry and temperature, on the nonlinear bending of the nanocomposite plates are comprehensively investigated. Numerical results demonstrate that dispersing a small amount of GPLs into nanocomposites can significantly enhance the nonlinear bending performance of the trapezoidal plates. The trapezoidal plates with more GPLs dispersing close to the top and bottom surfaces has the minimum bending deflection and are less sensitive to the temperature increases. GPLs with fewer layers and larger surface area are better reinforcing fillers than their counterparts. Moreover, the plates with bigger bottom angles are found to have better bending performances. However, when the bottom angles are greater than 75°, the variation of the bottom angles will have limited effects on the bending behaviours of the trapezoidal plates.

http://bit.ly/2CRKLTn

Severe reduction in tacrolimus concentrations with concomitant metamizole (dipyrone) therapy in transplant patients

http://bit.ly/2G4NL1U

Is an elevated burden of antiarrhythmic drug (AAD) side-effects the unavoidable price to be traded for a durable suppression of AF relapses in ablated patients? The weaknesses and risks of the AAD suppression algorithm used by current models of AF secondary prevention after catheter ablation

http://bit.ly/2CQEwPB