Endovascular aortic arch repair using a double-branched approach

Abstract

The last 15 years have overwhelmed the surgical community with a range of approaches in treating pathologies involving the aortic arch of which some are here to stay. The ones to stay are—in the authors' opinion—refined classical surgical approaches such as the frozen elephant trunk technique, near-orthotopic combined vascular and endovascular approaches such as subclavian to carotid transposition/bypass and double transposition, and finally, near-orthotopic advanced endovascular solutions such as the double-endovascular repair using fenestrated and/or branched solutions which will be the main focus of this article.

http://bit.ly/2MVCORA

A hybrid heuristic algorithm for evolving models in simultaneous scenarios of classification and clustering

Abstract

Machine Learning is currently an important research field that attracts interest due to its importance for discovering hidden knowledge or patterns from big datasets. In this paper, we propose a heuristic algorithm which can solve problems related to only classification, only clustering, or classification with clustering by creating models with the ability to evolve to another class/cluster configuration without a retraining process for new incoming data. This algorithm combines supervised and unsupervised learning principles for the incremental construction of both classes and clusters, by using the main guidelines from two classical methods of classification based on distance and clustering based on prototypes, such as KNN and K-means. The algorithm is able to deal with labeled and unlabeled samples as inputs in order to create new groups (classes or clusters), merge or reconfigure existing ones. Basically, the creation of new groups follows three sequential steps: (i) locate the provisional group for an input sample using K-means, (ii) using 1NN, locate the nearest sample to the input sample, only considering the samples in the provisional group, and (iii) merge or reconfigure existing groups following specific guidelines. Several benchmarks, related to classification and clustering problems, were evaluated by our proposal; the results were compared with classical algorithms. On the other hand, artificial datasets with labeled and unlabeled samples have been created to show the ability of our algorithm in the hybrid context to solve classification and clustering combined. As a result, the algorithm is able to create clusters and classes, simultaneously, when required. Finally, a real case study of fault diagnosis in rotating machinery is presented for discovering new groups that might represent patterns from unknown data.

http://bit.ly/2Ska2A1

The sodium pump α1 subunit regulates bufalin sensitivity of human glioblastoma cells through the p53 signaling pathway

Abstract

Bufalin is the primary component of the traditional Chinese medicine "Chan Su," which has been widely used for cancer treatment at oncology clinics in certain countries. Evidence suggests that this compound possesses potent antitumor activities, although the exact molecular mechanism(s) require further elucidation. Therefore, this study aimed to further clarify the in vitro and in vivo antiglioma effects of bufalin and the molecular mechanism underlying the regulation of drug sensitivity. The anticancer effects of bufalin were determined by colony formation assays, apoptosis assays, and cellular redox state tests of glioma cells. Confocal microscopy was performed to determine the expression changes of the DNA damage biomarker γ-H2AX and the nuclear translocation of p53 in glioma cells. Western blotting and RT-PCR were used to detect the protein and gene expression levels, respectively. Here, we report that bufalin induced glioblastoma cell apoptosis and oxidative stress and triggered DNA damage. The critical roles of the sodium pump α1 subunit (ATP1A1) in mediating the XPO1-targeted anticancer effect of bufalin in human glioma were further confirmed. Mechanistic studies confirmed the important roles of Src and p53 signaling in mediating bufalin-induced apoptosis. Importantly, bufalin also inhibited the growth of glioma xenografts. In conclusion, our study indicated that therapies targeting the ATP1A1 and p53 signaling-mediated mitochondrial apoptotic pathways regulated by bufalin might be potential treatments for human glioma, and these findings will provide molecular bases for developing bufalin into a drug candidate for the treatment of malignant glioma.

http://bit.ly/2WTQotd

Automated recognition and discrimination of human–animal interactions using Fisher vector and hidden Markov model

Abstract

Human–animal interactions may affect the animal welfare and productivity in rearing environments. Previously proposed human–animal-related techniques focus on the manual discrimination of single animal behaviors or simple human–animal interactions. To address the automatic detection and classification of complex animal behaviors and the animals reactions to human, we propose an approach built upon both the visual representation with Fisher vectors and the end-to-end generative hidden Markov model to facilitate the discrimination of both coarse- and fine-grained animal–human interactions. To satisfy the requirement for abundant data samples of the generative approach, we recorded and annotated more than 480 hours of videos featuring eight persons and 210 laying hens during the process of feeding and cleaning. The experimental results show that the proposed method outperforms state-of-the-art approaches. According to the experimental performance of our method on practical videos, our approach can be used to monitor the human–animal interactions or animal behaviors in modern poultry farms.

http://bit.ly/2MV623b

Molecular characterization of Blastocystis in cattle in Turkey

Abstract

Blastocystis genus exist in a wide variety of hosts, including humans, birds, insects, annelids, amphibians, fish, and mammals. PCR-based molecular diagnostic methods have been successfully used to detect Blastocystis spp. in feces, and small subunit ribosomal ribonucleic acid (SSU rRNA) gene-based subtyping is the preferred method for diagnosis. There has been discussion about the subtypes of Blastocystis spp. which has been detected so far. To date, 26 different subtypes have been reported. The aim of this study was to determine the existence and diversity of Blastocystis spp. in cattle. In our study, a total of 80 stool samples were collected from cows and calves at 13 different farms in Burdur and one farm in Aydın. Using molecular method, a total of 9 samples out of 80 samples were found to be positive (11.25%) for Blastocystis. As a result of sequence analysis of Blastocystis positive samples, the subtype 14 was detected on seven samples, while in the other two samples, Blastocystis subtype 10 was identified. The ST10 and ST14 subtypes are commonly reported in animals but not isolated from human. Our analyses showed genetic differences among Blastocystis subtypes. Our study is the first Blastocystis subtyping study from cattle in Turkey.

http://bit.ly/2SCLZvt

Eugenol Attenuates Scopolamine-Induced Hippocampal Cholinergic, Glutamatergic, and Mitochondrial Toxicity in Experimental Rats

Abstract

Eugenol is one of the essential chemical constituents of several functional food plants including Eugenia caryophyllata Thunb. (Family: Myrtaceae). Eugenol exhibits neuroprotective and anti-stress activities through multimodal mechanisms of action. Further, eugenol exerts anti-amnesic activity in Alzheimer's disease (AD)–like animals perhaps through anti-oxidant mechanism to date. Hence, the present study was designed to elaborate the anti-amnesic activity of eugenol in scopolamine-challenged rodents. Scopolamine (3 mg/kg/day, i.p.) and eugenol (12.5, 25.0, and 50.0 mg/kg) were administered to male rats for 14 consecutive days of the experimental schedule at a time lag of 30 min. Eugenol (25.0 and 50.0 mg/kg) attenuated scopolamine-induced loss in learning ability in terms of increased escape latency at day-4 (D-4) and memory function in terms of decreased time spent in target quadrant at D-5 of Morris water maze test protocol. Moreover, eugenol attenuated scopolamine-induced loss in spatial memory in terms of decreased percentage of spontaneous alteration behavior in Y-maze test. Additionally, eugenol attenuated scopolamine-induced hippocampal cholinergic dysfunction (decrease in acetylcholine level, increase in acetylcholinesterase activity, and decrease in density and affinity of M₁ and total muscarinic receptor), glutamate neurotoxicity (increase in levels of glutamate, calcium, calcium-dependent calpain-2, and brain-derived neurotropic factor), and mitochondrial dysfunction (decrease in formazan produced, membrane potential, and oxidative stress) in rats. Thus, it could be considered as an alternate candidate in the management of AD. Moreover, inclusion of functional foods containing eugenol could be a better option to manage memory formation in neurological disorders.

http://bit.ly/2GxKE2M

Ustekinumab Safety in Psoriasis, Psoriatic Arthritis, and Crohn’s Disease: An Integrated Analysis of Phase II/III Clinical Development Programs

Abstract

Introduction

Theoretical risks of biologic agents remain under study.

Objective

The aim of this study was to integrate 1-year safety data from 12 ustekinumab registrational trials.

Methods

Patients had moderate-to-severe plaque psoriasis, active psoriatic arthritis (PsA) (± methotrexate), or moderate-to-severe Crohn's disease (CD; failed/intolerant of immunomodulators/corticosteroids). Psoriatic patients received subcutaneous ustekinumab 45/90 mg or placebo, generally at week 0, week 4, then every 12 weeks thereafter, while those with CD received a single intravenous ustekinumab dose (130 mg or weight range-based dosing of approximately 6 mg/kg) or placebo induction dose at week 0, followed by subcutaneous ustekinumab 90 mg at week 8 and every 8/12 weeks thereafter. The incidence rates of a priori-defined safety events were integrated post hoc (adjusted for duration of follow-up, reported per 100 patient-years [PYs]).

Results

Among 6280 enrolled patients, 5884 ustekinumab-treated patients (psoriasis: 3117; PsA: 1018; CD: 1749) contributed 4521 PYs versus 674 PYs in placebo-treated patients through year 1 (829 PYs and 385 PYs during 8- to 16-week controlled periods). Combined across diseases among ustekinumab- versus placebo-treated patients, respective incidences/100 PYs (95% confidence intervals) of infections were 125.4 (122.2–128.7) versus 129.4 (120.9–138.3) through year 1, and not meaningfully increased in patients who did versus those who did not receive methotrexate (92.5 [84.2–101.5] vs. 115.3 [109.9–121.0]), or significantly increased in patients who did versus those who did not receive corticosteroids (116.3 [107.3–125.9] vs. 107.3 [102.0–112.8]) at baseline. Major adverse cardiovascular events (0.5 [0.3–0.7] vs. 0.3 [0.0–1.1]), malignancies (0.4 [0.2–0.6] vs. 0.2 [0.0–0.8]), and deaths (0.1 [0.0–0.3] vs. 0.0 [0.0–0.4]) were rare across indications.

Conclusions

Ustekinumab demonstrated a favorable and consistent safety profile across registrational trials in approved indications.

Trial Registrations

ClinicalTrials.gov identifier: NCT00320216, NCT00267969, NCT00307437, NCT00454584, NCT00267956, NCT01009086, NCT01077362, NCT00265122, NCT00771667, NCT01369329, NCT01369342, and NCT01369355.

http://bit.ly/2Spgk1h

Editor’s Commentary for Special Issue: “The Role of Macrophages in HIV Persistence”

Abstract

Macrophages as reservoirs for persistent HIV infection has gained renewed importance, with an intense research focus dedicated to eradication strategies. Clearance of both latent and productive HIV from these important reservoirs is essential for successful eradication. This spe cial theme issue contains 11 papers, including 6 Invited Reviews, 1 Brief Report and 4 Original Articles, that focus on the various aspects of the macrophage as pertains to HIV persistence, latency and cure. These topics include: functional latency of macrophages and microglia, the link between peripheral monocytes and pathogenesis, macrophages as sources of HIV RNA and DNA in virally suppressed patients, brain imaging of neuroinflammation, macrophages as drug delivery vehicles, therapeutic strategies of infected macrophages for cure, and the role of drugs of abuse in enhancing macrophage viral persistence.

http://bit.ly/2I0oTuP

Correction to: Immunometabolism: Another Road to Sepsis and its Therapeutic Targeting

The original version of this article contained mistakes, and the authors would like to correct them. The correct details are given below: In the published article, the subheading "Immunometabolic Reprogramming Among MDSCs During Sepsis" should read as "Immunometabolic Reprogramming Among Endothelial Cells or ECs During Sepsis".

http://bit.ly/2I3sKr3

Epidemiology of gastrointestinal nematodes of alpacas in Australia: II. A longitudinal study

Abstract

We conducted a longitudinal survey on 13 alpaca farms in four climatic zones of Australia to understand the epidemiology of gastrointestinal nematodes (GINs) of alpacas. A total of 1688 fresh faecal samples were collected from both sexes of alpacas from May 2015 to April 2016 and processed for faecal egg counts (FEC) and molecular identification of eggs using the multiplexed-tandem PCR assay. Based on egg morphology, the overall prevalence of GINs was 61% while that for strongyles was 53%. The overall mean FEC was 168 eggs per gram (EPG) of faeces, with the highest count of 15,540 EPG. Weaners had the highest prevalence (73%) and mean FEC (295 EPG) of GINs followed by tuis, crias and adults. Alpacas in the winter rainfall zone had the highest prevalence (68%) as well as FEC (266 EPG) followed by Mediterranean-type, non-seasonal and summer rainfall zones. Trichostrongylus spp. (83%, 89/107), Haemonchus spp. (71%, 76/107) and Camelostrongylus mentulatus (63%, 67/107) were the three most common GINs of alpacas across all climatic zones. The mixed-effects zero-inflated negative binomial regression model used in this study showed that it could help to design parasite control interventions targeted at both the herd level and the individual alpaca level. The findings of this study showed that the epidemiology of GINs of alpacas is very similar to those of cattle and sheep, and careful attention should be paid when designing control strategies for domestic ruminants co-grazing with alpacas.

http://bit.ly/2I0IScA

Polymerization pattern characterization within a resin-based composite cured using different curing units at two distances

Abstract

Objectives

To investigate the relationship of the irradiance-beam-profile areas from six different light-curing units (LCUs) with the degree of conversion (DC), microhardness (KH), and cross-link density (CLD) throughout a resin-based composite (RBC) cured at two clinically relevant distances, and to explore the correlations among them.

Materials and methods

A mapping approach was used to measure DC using micro-Raman spectroscopy, KH using a Knoop indentor on a hardness tester, and %KH reduction after ethanol exposure, as an indicator for CLD within a nano-hybrid RBC increment (n = 3) at various depths. These sample composites were cured from two distances while maintaining the radiant exposure, using six different light-curing units: one quartz-tungsten-halogen; two single and three multiple-emission-peak light-emitting-diode units. Irradiance beam profiles were generated for each LCU at both distances, and localized irradiance values were calculated. Points across each depth were analyzed using repeated measures ANOVA. Correlations across multiple specimen locations and associations between beam uniformity corresponding with polymerization measurements were calculated using linear mixed models and Pearson correlation coefficients.

Results

Significant non-uniform polymerization patterns occurred within the specimens at various locations and depths. At 2-mm curing distance, the localized DC = 52.7–76.8%, KH = 39.0–66.7 kg/mm², and %KH reduction = 26.7–57.9%. At 8-mm curing distance, the localized DC = 50.4–78.6%, KH = 40.3–73.7 kg/mm², and %KH reduction = 28.2–56.8%. The localized irradiance values were weakly correlated with the corresponding DC, KH, and %KH reduction, with only a few significant correlations (p < 0.05).

Conclusions

Although significant differences were observed at each depth within the specimens, the localized irradiance values for all LCUs did not reflect the polymerization pattern and did not seem to have a major influence on polymerization patterns within the RBC, regardless of the curing distance.

Clinical relevance

Commonly used LCUs do not produce uniform polymerization regardless of the curing distance, which may contribute to the risk of RBC fracture.

http://bit.ly/2WRehBP

Visibility, location, and morphology of the primary maxillary sinus ostium and presence of accessory ostia: a retrospective analysis using cone beam computed tomography (CBCT)

Abstract

Objectives

This retrospective study evaluated the visibility, location, and morphology of the primary maxillary ostium (PMO), as well as the presence and number of accessory maxillary ostia (AMO) in the maxillary sinus using cone beam computed tomography (CBCT).

Materials and methods

CBCT scans with a large field of view with both maxillary sinuses entirely visible, acquired from February 2016 to February 2018, were initially screened. Patients were included if there was no history of surgical intervention/trauma in the sinus region. Two observers evaluated the CBCTs for PMO and AMOs independently. PMO and AMOs were evaluated in axial, coronal, and sagittal CBCT views. In case of disagreement, a third observer served as a referee. The findings were correlated with age, gender, condition of the sinus mucosa, and status of the dentition to assess for potential influencing factors.

Results

A total of 184 patients (368 maxillary sinuses) were included. PMO was present and patent in 346 (94.0%) of the 368 analyzed sinuses. Most of the PMOs were located above the attachment of and in the middle third of the inferior turbinate (76.1%) and exhibited a slit shape (71.1%). An AMO was present in 167 (45.5%) of the 368 analyzed sinuses, and 66 (17.9%) sinuses had multiple AMOs. Gender and sinus mucosa morphology were found to be influencing factors for the patency of the PMO. Furthermore, gender seems to be influencing the presence of an AMO.

Conclusions

Most of the analyzed maxillary sinus cavities in the present population had a patent PMO. Being male and having morphological changes of the sinus mucosa were factors associated with a reduced prevalence of a patent PMO.

Clinical relevance

A maxillary sinus with pathological findings of the mucosa seems to have a reduced prevalence of patent PMOs. Therefore, clinicians should take care to assess any clinical and radiographical sign indicating a potential maxillary sinusitis prior to surgical interventions in this region, especially in cases with planned sinus floor elevation.

http://bit.ly/2RPBKzo

Multimodal neuroimaging study reveals dissociable processes between structural and functional networks in patients with subacute intracerebral hemorrhage

Abstract

Emerging evidence has revealed widespread stroke-induced brain dysconnectivity, which leads to abnormal network organization. However, there are apparent discrepancies in dysconnectivity between structural connectivity and functional connectivity studies. In this work, resting-state fMRI and structural diffusion tensor imaging were obtained from 26 patients with subacute (10–14 days) intracerebral hemorrhage (ICH) and 20 matched healthy participants (patients/controls = 21/18 after head motion rejection). Graph theoretical approaches were applied to multimodal brain networks to quantitatively compare topological properties between both groups. Prominent small-world properties were found in the structural and functional brain networks of both groups. However, a significant deficit in global integration was revealed in the structural brain networks of the patient group and was associated with more severe clinical manifestations of ICH. Regarding ICH-related nodal deficits, reduced nodal interconnectivity was mainly detected in motor-related regions. Moreover, in the functional brain network, topological properties were mostly comparable between patients with ICH and healthy participants. Beyond the prominent small-world architecture in multimodal brain networks, there are dissociable alterations between structural and functional brain networks in patients with ICH. These findings highlight the potential for using aberrant network metrics as neural biomarkers for evaluation of the severity of ICH.

Graphical abstract

Intracerebral hemorrhage (ICH) also known as cerebral bleed, a major type of stroke, would significantly affect brain structure and function. Using multimodal neuroimaging, Zhang et al. investigate the ICH-related dysconnectivity in structural and functional brain networks and show a significantly disintegrated structural brain network with a preserved functional network topology in subacute phase (10–14 days).

http://bit.ly/2GzGxmz

Quantifying mode mixing and leakage in multivariate empirical mode decomposition and application in motor imagery–based brain-computer interface system

Abstract

Improper selection of the number and the amplitude of noise channels in noise-assisted multivariate empirical mode decomposition (NA-MEMD) would induce mode mixing and leakage in the obtained intrinsic mode functions (IMF), which would degrade the performance in applications like brain-computer interface (BCI) systems based on motor imagery. A measurement (ML-index) using no prior knowledge of the underlying components of the original signals was proposed to quantify the amount of mode mixing and leakage of IMFs. Both synthetic signals and electroencephalography (EEG) recordings from motor imagery experiments were used to test the validity. The BCI classification performance using NA-MEMD with the optimal parameters selected based on the ML-index was compared with the performance under the non-optimal parameter condition and the performance using the conventional filtering method. Test on synthetic signals demonstrated the ML-index can effectively quantify the amount of mode mixing and leakage, and help to improve the accuracy of extracting the underlying components. Test on EEG recordings showed the BCI classification performance can be significantly improved under the optimal parameter condition. This study provided a method to quantify the amount of mode mixing and leakage in IMFs and realized the optimization of the parameters associated with noise channels in NA-MEMD.

Graphical abstract

One of the synthetic multivariate signals comprised four components oscillating at different rates (middle column). Noise-assisted multivariate empirical mode decomposition (noise-assisted MEMD) was used to extract different components. Mode mixing issue occurred under the non-optimal parameter condition (left column). The issue was alleviated under the optimal parameter condition (right column) which can be obtained with the proposed method in this study.

http://bit.ly/2E0uTzz

Identification and evaluation of novel anchoring proteins for cell surface display on Saccharomyces cerevisiae

Abstract

The development of arming yeast strains as whole-cell biocatalysts involves a selection of effective anchoring proteins to display enzymes and proteins on yeast cell surface. To screen for novel anchoring proteins with improved efficiency, a bioinformatics pipeline for the identification of glycosylphosphatidylinositol-anchored cell wall proteins (GPI-CWPs) suitable for attaching passenger proteins to the cell surface of Saccharomyces cerevisiae has been developed. Here, the C-terminal sequences (CTSs) of putative GPI-CWPs were selected based on the criteria that the sequence must contain a serine/threonine-rich (S/T) region of at least 30% S/T content, a total threonine content of at least 10%, a continuous S/T stretch of at least 130 amino acids in length, and a continuous T-rich region of at least 10 amino acids in length. Of the predicted 790 proteins, 37 putative GPI-CWPs were selected from different yeast and fungal species to be evaluated for their performance in displaying yeast-enhanced green fluorescent protein and β-glucosidase enzyme. This led to the identification of five novel anchoring proteins with higher performance compared to α-agglutinin used as benchmark. In particular, the CTS of uncharacterized protein in Kluyveromyces lactis, namely 6_Kl, is the most efficient anchoring protein of the group. The CTS of 6_Kl protein provided a β-glucosidase activity of up to 23.5 U/g cell dry weight, which is 2.8 times higher than that of the CTS of α-agglutinin. These identified CTSs could be potential novel anchoring protein candidates for construction of efficient arming yeasts for biotechnology applications in the future.

http://bit.ly/2Gz5nTW

Saroglitazar Deactivates the Hepatic LPS/TLR4 Signaling Pathway and Ameliorates Adipocyte Dysfunction in Rats with High-Fat Emulsion/LPS Model-Induced Non-alcoholic Steatohepatitis

Abstract

The most epidemic liver disorder non-alcoholic steatohepatitis (NASH) is characterized by hepatic steatosis and inflammation with hepatocellular damage. Recently, it is predictable to be the extensive cause for liver transplantation. The absence of an approved therapeutic agent for NASH is the reason for investigating saroglitazar (SAR) which showed promising effects as a dual PPAR-α/γ agonist in recent studies on NASH. Here, we aimed to investigate the effect of SAR on NASH induced in rats by the administration of high-fat emulsion (HFE) and small doses of lipopolysaccharides (LPS) for 5 weeks. Rats were divided into three groups: negative control group (saline and standard rodent chow), model group (HFE(10 ml/kg/day, oral gavage) + LPS(0.5 mg/kg/week, i.p)), and SAR-treated group (HFE(10 ml/kg/day, oral gavage) + LPS(0.5 mg/kg/week, i.p.) + SAR(4 mg/kg/day, oral gavage) starting at week 3.Treatment with SAR successfully ameliorated the damaging effects of HFE with LPS, by counteracting body weight gain and biochemically by normalization of liver function parameters activity, glucose, insulin, homeostasis model of assessment (HOMA-IR) score, lipid profile levels, and histopathological examination. Significant changes in adipokine levels were perceived, resulting in a significant decline in serum leptin and tumor necrosis factor-α (TNF-α) level concurrent with adiponectin normalization. The positive effects observed for SAR on NASH are due to the downregulation of the LPS/TLR4 pathway, as indicated by the suppression of hepatic Toll-like receptor 4 (TLR4), NF-κB, TNF-α, and transforming growth factor-β1 (TGF-β1) expression. In conclusion, this work verified that SAR ameliorates NASH through deactivation of the hepatic LPS/TLR4 pathway and inhibition of adipocyte dysfunction.

http://bit.ly/2SJxWEI

Shedding light on vasculitis in Egypt: a multicenter retrospective cohort study of characteristics, management, and outcome

Abstract

Objectives

The frequency of different vasculitides and their characteristics vary among different regions. The identification of geographic disparities of disease phenotypes helps the development of international criteria, allowing the classification of patients of different ethnicities. This study aimed to describe the frequency, characteristics, course, response to treatment, and outcome of the different adulthood vasculitides in Egypt.

Methods

This was a multicenter study in which the medical records of adult Egyptian patients diagnosed with vasculitis between 2002 and 2018 were retrospectively reviewed.

Results

The most frequent vasculitides in Egypt were Behçet's disease (76%), hepatitis C virus vasculitis (13.9%), and granulomatosis with polyangiitis (3.9%). Most patients (73.8%) had a major event at the time of diagnosis. Generalized granulomatosis with polyangiitis was more common than the localized type (90% versus 10%, respectively). The aortic arch and its branches were the most common affected sites of Takayasu arteritis. Of vasculitides, Behçet's disease and giant cell arteritis were associated with the greatest rates of relapse (62.7% and 33.3%, respectively). Delayed diagnosis and permanent organ damage were reported in 69.9% and 68.9% of patients, respectively. A low mortality rate was noted (1.3%).

Conclusions

The most common types of adulthood vasculitides in Egypt are Behçet's disease, hepatitis C virus vasculitis, and granulomatosis with polyangiitis. Major organ involvement is frequent. Delayed diagnosis and permanent organ damage are common.

http://bit.ly/2SozTHj

Spatio-temporal variation and the use of host body surface by ectoparasites of the chelonians Phrynops geoffroanus and Mesoclemmys tuberculata in areas of the Caatinga and Atlantic Forest in northeast Brazil

Abstract

Ectoparasites such as hematophagous leeches and monogeneans are common in chelonians, occupying different parts of the body. Thus, the present study aimed to identify and describe the fauna of ectoparasites that infest Phrynops geoffroanus and Mesoclemmys tuberculata to evaluate the effect of host conditions and seasonality (dry and rainy season) on the abundance and composition of ectoparasites. We verified the presence of ectoparasites in 73.2% of the examined turtles, with four species of leeches belonging to Glossiphoniidae, Haementeria brasiliensis sensu Cordero, 1937, Helobdella cf. adiastola, Haementeria sp1., and Haementeria sp2., and one monogenean Polystomatidae, Polystomoides brasiliensis. For both chelonians, we observed a significant difference in the abundance of ectoparasites in relation to sex, biome, and season, which was unrelated to length and mass. Leeches were more frequent in the cavities of the hind limbs in P. geoffroanus, and the anterior limbs of M. tuberculata. The general spatial niche overlap of ectoparasites was high, except for that of the monogenean P. brasiliensis, which did not overlap with those of other leech species. The present study is the first report of the presence of H. brasiliensis and P. brasiliensis parasitizing M. tuberculata, and Helobdella cf. adiastola in a phoretic relationship with P. geoffroanus and M. tuberculata. Finally, the differences in infestation levels may reflect ecological factors, differences in behavioral patterns of the hosts, and different anthropic alterations suffered in the Caatinga and Atlantic Forest biomes.

http://bit.ly/2RTJ7Go

Accuracy of MDS-UPDRS section IV for detecting motor fluctuations in Parkinson’s disease

Abstract

Background

In a precedent paper, we validated part IV of the Unified Parkinson's Disease Rating Scale (UPDRS) for detecting motor fluctuations in Parkinson's Disease (PD) patients using a 12-h Waking-Day Motor Assessment (WDMA) as gold standard, showing a high sensitivity (> 80%) and a lower specificity (< 45%). The aim of this study was to validate the Movement Disorder Society-UPDRS (MDS-UPDRS) part IV, especially items 4.3 and 4.5, using the same methodology.

Methods

PD patients attending the Movement Disorders Clinic at the University Hospital in Catania were consecutively enrolled in the study. A diurnal WDMA was performed to detect motor fluctuations. At each time interval, the motor impairment was evaluated using the motor section of the MDS-UPDRS. Presence or absence of motor fluctuations and the type of motor fluctuation were assessed by four blinded expert raters in movement disorders, by evaluating the graphical representations of the WDMA. We evaluated sensitivity and specificity together with 95% Confidence Interval (CI) of items 4.3 and 4.5, using WDMA as gold standard.

Results

We estimated for item 4.3 of the MDS-UPDRS a sensitivity of 74.3% (95% CI 56.7–87.5) and a specificity of 70.6% (95% CI 44–89.7), while for item 4.5, a sensitivity of 67.9% (95% CI 47.6–84.1) and a specificity of 66.7% (95% CI 44.7–84.4).

Conclusions

The present showed a higher specificity level for MDS-UPDRS with respect to the UPDRS, while a slightly lower sensitivity mainly for predictable OFF.

http://bit.ly/2I0xJZi

Two New Android Apps for People with Hearing Loss

Google has released two new Android apps, Life Transcribe and Sound Amplifier, to help those who are hard of hearing communicate more easily and independently in a wide variety of settings. Live Transcribe automatically translates spoken words into text on the user's phone screen. App users can also choose from more than 70 languages and dialects to read accurate captions in the language that's being spoken, and they can respond to who they're speaking with on a type-back keyboard. Live Transcribe is powered by Google's speech recognition technology, so the text adjusts as the conversation flows.  This app is currently in beta at http://bit.ly/2GwaLXR and as an accessibility setting on the Pixel 3 smartphone.

The other new app, Sound Amplifier, helps people with hearing impairment carry on conversations in loud environments by boosting quiet sounds and reducing unwanted or distracting noises through their headphones. App users can personalize their listening experience for each ear by adjusting audio and microphone settings with a simple tuning interface. Sound Amplifier is available on the Play Store (http://bit.ly/2GCNlAf) and supports Android 9 Pie or later phones and comes pre-installed on Pixel 3. 

Published: 2/8/2019 1:06:00 PM

from #Audiology via ola Kala on Inoreader http://bit.ly/2BnTtbN
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Wearables Set to Become Must-Haves in Hearing Care

Wearables, including hearables, health trackers, and remote patient monitoring devices, will become indispensable to health care, with $23 billion forecast to be spent annually on these devices and 5 million people remotely monitored by health care providers by 2023, according to a new report by Juniper Research. Assistive hearables, or connected hearing aids, will mean this sector generates revenues over $40 million by 2022. The research firm predicts that manufacturers of these devices will seek to adjust their business models and generate revenues from devices being monitored, such as by selling data collected to insurance providers, which will bring in $855 million by 2023. Data privacy and consent will be a significant barrier. Michael Larner, the author of this report, said it's vital that patients are made aware of how their personal data will be used. "If not, making wearables a 'must have' to provide personalized care or receive medical insurance risks a backlash from patients and heightened regulatory scrutiny; stalling the effectiveness of remote monitoring," he said. The full research document is available for purchase at http://bit.ly/2Di1a3H. 

Published: 2/8/2019 12:25:00 PM

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

Two New Android Apps for People with Hearing Loss

Google has released two new Android apps, Life Transcribe and Sound Amplifier, to help those who are hard of hearing communicate more easily and independently in a wide variety of settings. Live Transcribe automatically translates spoken words into text on the user's phone screen. App users can also choose from more than 70 languages and dialects to read accurate captions in the language that's being spoken, and they can respond to who they're speaking with on a type-back keyboard. Live Transcribe is powered by Google's speech recognition technology, so the text adjusts as the conversation flows.  This app is currently in beta at http://bit.ly/2GwaLXR and as an accessibility setting on the Pixel 3 smartphone.

The other new app, Sound Amplifier, helps people with hearing impairment carry on conversations in loud environments by boosting quiet sounds and reducing unwanted or distracting noises through their headphones. App users can personalize their listening experience for each ear by adjusting audio and microphone settings with a simple tuning interface. Sound Amplifier is available on the Play Store (http://bit.ly/2GCNlAf) and supports Android 9 Pie or later phones and comes pre-installed on Pixel 3. 

Published: 2/8/2019 1:06:00 PM

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

Wearables Set to Become Must-Haves in Hearing Care

Wearables, including hearables, health trackers, and remote patient monitoring devices, will become indispensable to health care, with $23 billion forecast to be spent annually on these devices and 5 million people remotely monitored by health care providers by 2023, according to a new report by Juniper Research. Assistive hearables, or connected hearing aids, will mean this sector generates revenues over $40 million by 2022. The research firm predicts that manufacturers of these devices will seek to adjust their business models and generate revenues from devices being monitored, such as by selling data collected to insurance providers, which will bring in $855 million by 2023. Data privacy and consent will be a significant barrier. Michael Larner, the author of this report, said it's vital that patients are made aware of how their personal data will be used. "If not, making wearables a 'must have' to provide personalized care or receive medical insurance risks a backlash from patients and heightened regulatory scrutiny; stalling the effectiveness of remote monitoring," he said. The full research document is available for purchase at http://bit.ly/2Di1a3H. 

Published: 2/8/2019 12:25:00 PM

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

Effects of Biogas Slurry Application on Crop Production and Soil Properties in a Rice–Wheat Rotation on Coastal Reclaimed Farmland

Abstract

The field experiment of a rice–wheat rotation system was conducted on a coastal reclaimed farmland with different application rates of biogas slurry from a large-scale standardized hoggery. Crop yield, grain quality, and soil properties were examined to determine the appropriate application rate. At the slurry application rates of 480 m³ ha⁻¹ for rice and 9.00–11.25 m³ ha⁻¹ for wheat, grain yields of rice and wheat were 8.9 and 15.7% higher than those under conventional fertilization, respectively. When 840 m³ ha⁻¹ biogas slurry was applied to the rice field, the grain amino acid content was significantly higher than that of conventionally fertilized rice. In the rice–wheat rotation system, under biogas slurry treatments, soil pH and EC did not significantly increase; the contents of soil Pb, Cr, Cu, and Zn were within allowable limits; the contents of soil alkali-hydrolyzable nitrogen were greatly increased and significantly higher than those under conventional fertilization treatment; and the content of soil organic matter had no significant difference with that under no fertilization treatment. Therefore, the recommended application rate of biogas slurry on coastal reclaimed farmland should be 480 and 9.00–11.25 m³ ha⁻¹ for rice and wheat, respectively.

http://bit.ly/2tdjQg8

Two New Android Apps for People with Hearing Loss

Google has released two new Android apps, Life Transcribe and Sound Amplifier, to help those who are hard of hearing communicate more easily and independently in a wide variety of settings. Live Transcribe automatically translates spoken words into text on the user's phone screen. App users can also choose from more than 70 languages and dialects to read accurate captions in the language that's being spoken, and they can respond to who they're speaking with on a type-back keyboard. Live Transcribe is powered by Google's speech recognition technology, so the text adjusts as the conversation flows.  This app is currently in beta at http://bit.ly/2GwaLXR and as an accessibility setting on the Pixel 3 smartphone.

The other new app, Sound Amplifier, helps people with hearing impairment carry on conversations in loud environments by boosting quiet sounds and reducing unwanted or distracting noises through their headphones. App users can personalize their listening experience for each ear by adjusting audio and microphone settings with a simple tuning interface. Sound Amplifier is available on the Play Store (http://bit.ly/2GCNlAf) and supports Android 9 Pie or later phones and comes pre-installed on Pixel 3. 

Published: 2/8/2019 1:06:00 PM

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

Wearables Set to Become Must-Haves in Hearing Care

Wearables, including hearables, health trackers, and remote patient monitoring devices, will become indispensable to health care, with $23 billion forecast to be spent annually on these devices and 5 million people remotely monitored by health care providers by 2023, according to a new report by Juniper Research. Assistive hearables, or connected hearing aids, will mean this sector generates revenues over $40 million by 2022. The research firm predicts that manufacturers of these devices will seek to adjust their business models and generate revenues from devices being monitored, such as by selling data collected to insurance providers, which will bring in $855 million by 2023. Data privacy and consent will be a significant barrier. Michael Larner, the author of this report, said it's vital that patients are made aware of how their personal data will be used. "If not, making wearables a 'must have' to provide personalized care or receive medical insurance risks a backlash from patients and heightened regulatory scrutiny; stalling the effectiveness of remote monitoring," he said. The full research document is available for purchase at http://bit.ly/2Di1a3H. 

Published: 2/8/2019 12:25:00 PM

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

A Practical Guide to Treatment of Childhood Absence Epilepsy

Abstract

Childhood absence epilepsy (CAE) is a common pediatric epilepsy syndrome with distinct seizure semiology, electroencephalography (EEG) features, and treatment. A diagnosis of CAE can be obtained during an office visit with a careful history, physical exam including prolonged hyperventilation, and a routine EEG. The treatment of choice for CAE with absence seizures only is ethosuximide. Valproic acid and lamotrigine are also effective treatments for many patients, but when compared to ethosuximide, valproic acid has more adverse effects and lamotrigine is less effective. Attention to predictors of response to treatment, including clinical, electrographic, and genetic factors, is increasing. Refractory CAE occurs in fewer than half of patients, and treatment strategies are available, though efficacy data are lacking. Careful assessment and treatment of psychosocial comorbidities is essential in caring for patients with CAE.

http://bit.ly/2DjYhiS

Two Diverse Hemodynamic Forces, a Mechanical Stretch and a High Wall Shear Stress, Determine Intracranial Aneurysm Formation

Abstract

Intracranial aneurysm (IA) usually induced at a bifurcation site of intracranial arteries causes a lethal subarachnoid hemorrhage. Currently, IA is considered as a macrophage-mediated inflammatory disease triggered by a high wall shear stress (WSS) on endothelial cells. However, considered the fact that a high WSS can be observed at every bifurcation site, some other factors are required to develop IAs. We therefore aimed to clarify mechanisms underlying the initiation of IAs using a rat model. We found the transient outward bulging and excessive mechanical stretch at a prospective site of IA formation. Fibroblasts at the adventitia of IA walls were activated and produced (C-C motif) ligand 2 (CCL2) as well in endothelial cells loaded on high WSS at the earliest stage. Consistently, the mechanical stretch induced production of CCL2 in primary culture of fibroblasts and promoted migration of macrophages in a Transwell system. Our results suggest that distinct hemodynamic forces, mechanical stretch on fibroblasts and high WSS on endothelial cells, regulate macrophage-mediated IA formation.

http://bit.ly/2WRAu2H

The efficacy of using 3D printing models in the treatment of fractures: a randomised clinical trial

Abstract

Background

The aim of this study was to evaluate the efficacy of the use of three-dimensional (3D) printing models for preoperative planning in cases of complex fracture.

Methods

In total, 48 patients with AO type C fractures of the distal radius were enrolled in the study between January 2014 and January 2015. They were divided randomly into 3D model (n = 23) and routine treatment (n = 25) groups. A 3D digital model of each distal radius fracture in the former group was constructed. The model was exported to a 3D printer for construction of a full solid model. During each operation, the operative time, amount of blood loss, and frequency of intraoperative fluoroscopy were recorded, which were regarded as primary outcome measures. Patients were followed to evaluate surgical outcomes by Gartland–Werley scores, radiological evaluation, and range of motion of wrist, and these were regarded as the secondary outcome measures. In addition, we invited surgeons and patients to complete questionnaires.

Results

The treatment of complex fractures using the 3D printing approach reduced the frequency of intraoperative fluoroscopy, blood loss volume, and operative time, but did not improve postoperative function compared with routine treatment. The patients wanted the doctor to use the 3D model to describe the condition and introduce the operative plan because it facilitated their understanding. The orthopaedic surgeons thought that the 3D model was useful for communication with patients, but were much less satisfied with its use in preoperative planning.

Conclusion

Our study revealed that 3D printing models effectively help the doctors plan and perform the operation and provide more effective communication between doctors and patients, but can not improve postoperative function compared with routine treatment.

Trial Registration

This trial was registered at the Chinese Clinical Trial Registry on May 9, 2017 (ChiCTR-IRP-17011343, http://www.chictr.org.cn/showproj.aspx?proj=19264).

http://bit.ly/2Sk8lm5

Hip pain in children with cerebral palsy: a population-based registry study of risk factors

Abstract

Background

Hip pain is prevalent in children with cerebral palsy (CP). Hip displacement is a known risk factor for hip pain. However, many children do not have displaced hips but still have hip pain and the aetiologies are poorly understood. The aims of this study were to investigate: 1. the prevalence of hip pain related to age, gender, gross motor function, degree of hip displacement and 2. the associations between hip pain and age, gender, gross motor function, degree of hip displacement, ranges of hip and knee motion (ROM) and degree of spasticity in the muscles around the hip.

Methods

This was a cross-sectional retrospective register study based on data from the Swedish follow-up programme and national healthcare registry CPUP, which includes > 95% of children with CP in Sweden. The participants were born in 2000 or later and 4–16 years of age. Data from the latest examination were used. In Aim 1, the prevalence of hip pain was calculated using frequencies and crosstabs. Differences between groups were calculated using chi-square tests and independent samples t-tests. In Aim 2, associations between hip pain and the variables were analysed using logistic regression.

Results

The overall prevalence of hip pain was 7%. No significant gender difference was found. Hip pain prevalence increased with age, lower gross motor function and higher degree of hip displacement. The median migration percentage (MP) in painful hips was 26%, compared to 21% in hips where pain was not reported. In the multivariable analysis, significant associations with hip pain were found for MP > 30% and decreased ROM in abduction, flexion and inwards rotation of the hip (p < 0.05).

Conclusion

Hip displacement was associated with hip pain. However, hip displacement was not present in the majority of painful hips. In addition to hip displacement, decreased ROM was also associated with hip pain.

http://bit.ly/2Dn36b0

A longitudinal investigation of the factors associated with increased RISk of playing-related musculoskeletal disorders in MUsic students (RISMUS): a study protocol

Abstract

Background

The achievement and improvement of skills in musical techniques to reach the highest levels of performance may expose music students to a wide range of playing-related musculoskeletal disorders (PRMDs).

In order to establish effective solutions for PRMDs and to develop future preventive measures, it is fundamental to firstly identify the main risk factors that play a significant role in the development of musculoskeletal conditions and symptoms.

The aim of the study is to identify those factors associated with increased risk of PRMDs among music students.

A further goal is to characterise this population and describe the clinical features of PRMDs, as well as to determine the evolving course of PRMDs in music students during their training.

Methods

One hundred and ninety schools have been invited to participate in this study, sixty of which have already confirmed officially their support for the investigation's recruitment procedures, by means of a subsequent distribution of the link to a web-based questionnaire to their student groups (total potential student numbers available: n = 12,000 [based on ~ 200 students per school on average, and 60 volunteering schools]; expected number of students: n = 3000 [based on a 25% response rate from the 12,000 students attending the 60 volunteering schools]).

The web-based questionnaire includes questions about any PRMD that students have experienced during their training, and different potential risk factors (i.e. lifestyle and physical activity, practice habits, behaviour toward prevention and health history, level of stress, perfectionism, fatigue and disability).

Overall recurrence or new onsets of PRMDs will be assessed at 6 and 12 months after the first data collection to investigate and record the development of new incidents within a period of a year and to enable characterisation of the nature and the evolving course of PRMDs.

Discussion

To the best of our knowledge, no other longitudinal studies on risk factors for PRMDs among music students have been conducted so far. Therefore, this study can be considered as an opportunity to begin filling the gaps within current research in this field and to generate new knowledge within musical contexts in education and employment.

Trial registration

ClinicalTrials.gov (NCT03622190), registration date 09/08/2018.

http://bit.ly/2SlrwMB

Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis

Abstract

Background

Comparative studies of total hip arthroplasty using the direct anterior approach (DAA) compared with the anterolateral approach (ALA) by gait analysis compared the results of the two groups, the damage to the abductor muscle, with objective and detailed kinematic as well as kinetic data of actual gait. The purpose of this systematic review was to analyze the differences in gait such as time-dependent parameters, kinetics, and kinematics after THA using the DAA compared with ALA.

Methods

PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE and AHRQ carried out a comprehensive search for all relevant randomized controlled trials and comparative studies, up to December 2018. Based on the following criteria, studies were selected: 1) study design: randomized controlled trials or non-randomized comparative studies; 2) study population: patients with primary osteoarthritis or avascular necrosis; 3) intervention: total hip arthroplasty by DAA or ALA; 4) Kinetic and kinematic data after gait analysis in the plains during postoperative follow-up.

Results

Of the 148 studies, 7 randomized controlled trials and 5 comparative studies were finally included in this systematic review. The peak hip flexion within 3 months after surgery was described in two studies and was significantly higher in the DAA group. (OR = 1.90; 95% CI [1.67,2.13]; P < 0.01, Z = 16.18). The gait speed within 3 months after surgery was reported in 3 studies and was significantly higher in the DAA group than in the ALA group. (SMD = 0.17; 95% CI [0.12,0.22]; P < 0.01, Z = 6.62) There was no difference between the two groups in stride length, step length, and hip range of motion in sagittal plane.

Conclusions

In this meta-analysis, gait speed and peak hip flexion within 3 months after surgery were significantly higher in the DAA group than in the ALA group. Despite a few significant differences between two approaches, determining whether the reported differences in terms of postoperative gait values are clinically meaningful remains a substantial challenge.

http://bit.ly/2Dn35Uu

Lengthening of free fibular grafts for reconstruction of the residual leg length discrepancy

Abstract

Background

We evaluated our results of lengthening of free vascularized fibular grafts using a unilateral external fixator in patients with residual leg length discrepancy after free vascularized fibular graft for lower limb reconstruction.

Cases presentation

Two patients were administrated to our hospital with residual tibial length discrepancy after vascularized free fibular graft surgery. Lengthening of the free vascularized fibular graft with a unilateral external fixator was performed to correct the leg length discrepancy. Both patients recovered well with no difficult in activities of daily living at the last follow-up.

Conclusions

This study shows that lengthening of free vascularized fibular grafts with an external fixator is an effective treatment for massive residual leg shortening after vascularized free fibular graft surgery.

http://bit.ly/2Sil7Sn

Distinction between MPO-ANCA and PR3-ANCA-associated glomerulonephritis in Chinese patients: a retrospective single-center study

Abstract

Objectives

To retrospectively investigate the clinical and histological features and outcomes of ANCA-associated glomerulonephritis (AAGN) with different ANCA serotypes.

Method

A total of 467 AAGN patients were divided into MPO-AAGN (MPO) and PR3-AAGN (PR3) groups according to ANCA serotype. Clinical and histological features and renal outcomes were compared.

Results

In this study, 429 (91.9%) patients tested positive for MPO-ANCA, and 38 (8.1%) for PR3-ANCA. The median age at diagnosis (P = 0.017) and proportion of females (P = 0.003) were higher in the MPO group. Joint (P < 0.001), ENT (P = 0.000), skin (P = 0.007), and eye (P = 0.014) involvements were more common in the PR3 group. Compared with that in the PR3-group, a higher proportion of patients in the MPO group had microscopic polyangiitis (P = 0.000), and a lower proportion of exhibited granulomatosis with polyangiitis (P = 0.000). Patients in the MPO group also exhibited lower BVAS scores (P = 0.003) and higher serum albumin levels (P = 0.009). Histologically, a lower proportion of MPO patients had crescentic glomerulonephritis (P = 0.028) and acute tubule-interstitial lesion scores (P = 0.007), but a higher proportion of these patients exhibited mixed class glomerulonephritis (P = 0.032) than in the PR3 group. The relapse rate was lower (P = 0.020), and the 5-year relapse-free survival rate (P = 0.003) was higher in the MPO group than in the PR3 group. However, the 5-year renal survival rates (P = 0.106) were not significantly different.

Conclusions

MPO-ANCA was predominant in Chinese patients with ANCA-associated vasculitis and renal disease. The epidemiological characteristics, extra-renal involvement, and histopathological classes and outcomes were different between MPO-positive and PR3-positive patients, implying that they might be two different disease entities.

http://bit.ly/2MVkUhW

Managed retreat as a strategy for climate change adaptation in small communities: public health implications

Abstract

In coming decades, sea level rise associated with climate change will make some communities uninhabitable. Managed retreat, or planned relocation, is a proactive response prior to catastrophic necessity. Managed retreat has disruptive health, sociocultural, and economic impacts on communities that relocate. Health impacts include mental health, social capital, food security, water supply, sanitation, infectious diseases, injury, and health care access. We searched peer-reviewed and gray literature for reports on small island or coastal communities at various stages of relocation primarily due to sea level rise. We reviewed these reports to identify public health impacts and barriers to relocation. We identified eight relevant small communities in the USA (Alaska, Louisiana, and Washington), Panama, Fiji, Papua New Guinea, Solomon Islands, and Vanuatu. Affected populations range from 60 to 2700 persons and are predominantly indigenous people who rely on subsistence fishing and agriculture. Few reports directly addressed public health issues. While some relocations were successful, barriers to relocation in other communities include place attachment, potential loss of livelihoods, and lack of funding, suitable land, community consensus, and governance procedures. Further research is needed on the health impacts of managed retreat and how to facilitate population resilience. Studies could include surveillance of health indicators before and after communities relocate due to sea level rise, drought, or other environmental hazards. Lessons learned may inform relocation of both small and large communities affected by climate change.

http://bit.ly/2DkHLz3

Percutaneous periarticular multi-drug injection at one day after total knee arthroplasty as a component of multimodal pain management: a randomized control trial

Abstract

Background

Although intraoperative periarticular multi-drug injection has been used for postoperative pain control after total knee arthroplasty (TKA), the injection has the inherent shortcoming of limited acting time. This randomized controlled trial was performed to assess whether adding percutaneous periarticular multi-drug injection at the day following TKA would improve the postoperative pain relief.

Methods

A total of 43 participants were randomly assigned to receive additional periarticular injection at 08:30, postoperative day 1 or no additional injection. The multi-drug solution including 40 mg of methylprednisolone, 150 mg of ropivacaine, and 0.1 mg of epinephrine was infiltrated into the muscle belly of the vastus medialis. In both groups, patients were treated with intraoperative periarticular multi-drug injection and postoperative intravenous and oral nonsteroidal anti-inflammatory drugs. We did not use any narcotic pain medications postoperatively. The primary outcome was the patients' global assessment of postoperative pain at rest measured using a visual analog scale (VAS) and quantified as the area under the curve (AUC) of serial assessments until 20:00, postoperative day 5.

Results

The mean AUC for the postoperative pain VAS at rest was 1616 ± 1191 in patients received the additional periarticular injection versus 2808 ± 1494 in those received no injection (mean difference, − 1192; 95% confidence interval, − 2043 to − 340; p = 0.007). No wound complication or surgical site infection was observed in either groups.

Conclusions

Adding percutaneous periarticular multi-drug injection at the day following TKA may provide better postoperative pain relief. Further studies are needed to confirm the safety of the percutaneous injection.

Trial registration

University Hospital Medical Information Network UMIN000029003. Registered 5 September 2017.

http://bit.ly/2tcTKda

Nonnative implicit phonetic training in multiple reverberant environments

Abstract

Speech intelligibility is adversely affected by reverberation, particularly when listening to a foreign language. However, little is known about how phonetic learning is affected by room acoustics. This study investigated how room reverberation impacts the acquisition of novel phonetic categories during implicit training in virtual environments. Listeners were trained to distinguish a difficult nonnative dental-retroflex contrast in phonemes presented either in a fixed room (anechoic or reverberant) or in multiple anechoic and reverberant spaces typical of everyday listening. Training employed a videogame in which phonetic stimuli were paired with rewards delivered upon successful task performance, in accordance with the task-irrelevant perceptual learning paradigm. Before and after training, participants were tested using familiar and unfamiliar speech tokens, speakers, and rooms. Implicit training performed in multiple rooms induced learning, while training in a single environment did not. The multiple-room training improvement generalized to untrained rooms and tokens, but not to untrained voices. These results show that, following implicit training, nonnative listeners can overcome the detrimental effects of reverberation and that exposure to sounds in multiple reverberant environments during training enhances implicit phonetic learning rather than disrupting it.

http://bit.ly/2E0jMGP

The role of eye movements in manual responses to social and nonsocial cues

Abstract

Gaze and arrow cues cause covert attention shifts even when they are uninformative. Nonetheless, it is unclear to what extent oculomotor behavior influences manual responses to social and nonsocial stimuli. In two experiments, we tracked the gaze of participants during the cueing task with nonpredictive gaze and arrow cues. In Experiment 1, the discrimination task was easy and eye movements were not necessary, whereas in Experiment 2 they were instrumental in identifying the target. Validity effects on manual response time (RT) were similar for the two cues in Experiment 1 and in Experiment 2, though in the presence of eye movements observers were overall slower to respond to the arrow cue compared with the gaze cue. Cue direction had an effect on saccadic performance before the discrimination was presented and throughout the duration of the trial. Furthermore, we found evidence of a distinct impact of the type of cue on diverse oculomotor components. While saccade latencies were affected by the type of cue, both before and after the target onset, saccade landing positions were not. Critically, the manual validity effect was predicted by the landing position of the initial eye movement. This work suggests that the relationship between eye movements and attention is not straightforward. In the presence of overt selection, saccade latency related to the overall speed of manual response, while eye movements landing position was closely related to manual performance in response to different cues.

http://bit.ly/2GuomPi

Effects of talker continuity and speech rate on auditory working memory

Abstract

Speech processing is slower and less accurate when listeners encounter speech from multiple talkers compared to one continuous talker. However, interference from multiple talkers has been investigated only using immediate speech recognition or long-term memory recognition tasks. These tasks reveal opposite effects of speech processing time on speech recognition – while fast processing of multi-talker speech impedes immediate recognition, it also results in more abstract and less talker-specific long-term memories for speech. Here, we investigated whether and how processing multi-talker speech disrupts working memory maintenance, an intermediate stage between perceptual recognition and long-term memory. In a digit sequence recall task, listeners encoded seven-digit sequences and recalled them after a 5-s delay. Sequences were spoken by either a single talker or multiple talkers at one of three presentation rates (0-, 200-, and 500-ms inter-digit intervals). Listeners' recall was slower and less accurate for sequences spoken by multiple talkers than a single talker. Especially for the fastest presentation rate, listeners were less efficient when recalling sequences spoken by multiple talkers. Our results reveal that talker-specificity effects for speech working memory are most prominent when listeners must rapidly encode speech. These results suggest that, like immediate speech recognition, working memory for speech is susceptible to interference from variability across talkers. While many studies ascribe effects of talker variability to the need to calibrate perception to talker-specific acoustics, these results are also consistent with the idea that a sudden change of talkers disrupts attentional focus, interfering with efficient working-memory processing.

http://bit.ly/2E0ooNm

Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study

Abstract

Background

Patients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD). This may impact treatment decision strategy. The aim was to study whether patients with non-operated traumatic PASD have less shoulder impairment than those with RASD.

Methods

In a cross-sectional study baseline data from patients with PASD and RASD in a randomised controlled trial of non-operative shoulder exercise treatment were used. Shoulder function was self-reported (Western Ontario Shoulder Instability (WOSI), Tampa Scale of Kinesiophobia (TSK), General Health (EQ-5D-VAS), Numeric Pain Rating Scale (NPRS)), and measured (Constant-Murley shoulder Score (CMS total), CMS - Range of Motion (CMS-ROM, CMS – strength, proprioception, clinical tests).

Results

In total, 56 patients (34 (28 men) with PASD and 22 (21 men) with RASD) (mean age 26 years) participated. WOSI total was 1064 and 1048, and TSK above 37 (indicating high re-injury fear) was present in 33 (97%) and 21 (96%) of the groups with PASD and RASD, with no group difference. CMS total (66.4 and 70.4), CMS-ROM (28.7 and 31.5), CMS-strength (injured shoulder: 7.6 kg and 9.1 kg), proprioception and clinical tests were the same. Furthermore, 26 (76%) with PASD and 13 (59%) with RASD reported not to have received non-operative shoulder treatment.

Conclusions

Non-operated patients with PASD and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients RASD and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.

http://bit.ly/2BrIMF8

Two stage revision with a proximal femur replacement

Abstract

Background

Despite very good prosthesis retention times, the growing numbers of primary implantations of hip endoprostheses are leading to increasing numbers of revision operations. Periprosthetic infection, particularly in revision implants, often leads to a massive loss of bone stock, so that in a two-stage exchange the only option left is implantation of a megaendoprosthesis. This retrospective study investigated the clinical and functional outcome for patients who received megaendoprostheses in the proximal femur in two-stage exchange procedures.

Methods

Forty-nine patients were treated between 1996 and 2014 (mean age 71 years, mean follow-up period 52 months). Microorganisms were isolated intraoperatively in 44 patients (89.9%). The reinfection rate was documented in patients who did not undergo any further revision surgery due to mechanical failure (primary) and in patients who had subsequent revisions after reimplantation and subsequent reinfection (secondary).

Results

The mean C-reactive protein level at the time of reimplantation was 1.25 mg/dL (range 0.5–3.4). The primary success rate with curative treatment for prosthetic joint infection was 92% (four of 49 patients). The secondary success rate with infection revision cases was 82% (three of 17 revision cases). The mean Harris hip score was 69 (range 36–94). The majority of patients needed different types of walking aid or even wheelchairs, and only 50% of the patients were able to walk outside.

Conclusions

Reinfections occurred in only 8% of patients who underwent two-stage exchanges with a proximal femur replacement. When revision surgery for the proximal femur replacement was required for mechanical reasons, however, the associated reinfections increased the reinfection rate to 18%. Proximal femur replacement achieves a clear reduction in pain, maintenance of leg length, and restoration of limited mobility, and the procedure thus represents a clear alternative to the extensive Girdlestone procedure, which is even more immobilising, or mutilating amputation.

http://bit.ly/2TEr7RY

Prevalence and factors associated with low back pain among health care workers in southwestern Saudi Arabia

Abstract

Background

The purpose was to measure the prevalence and related risk factors of low back pain (LBP) among health care workers (HCWs) at different levels of health care in southwestern Saudi Arabia.

Methods

A cross-sectional study using a self-administered questionnaire was conducted among HCWs providing primary, secondary and tertiary health care services in the Aseer region, southwestern Saudi Arabia. The questionnaire collected data regarding having LBP in the past 12 months, socio-demographics, work conditions and history of chronic diseases, regular physical exercise and overexertional back trauma. Univariate and multivariable logistic regression analyses were performed.

Results

Out of 740 participants, the overall prevalence of LBP in the past 12 months amounted to73.9% (95% CI: 70.7–77.0). The prevalence of LBP with neurological symptoms reached 50.0%. The prevalence of LBP necessitating medications and or physiotherapy was 40.5%, while the prevalence of LBP requiring medical consultation was 20%. Using multivariable logistic regression, the following risk factors were identified: working in secondary and tertiary hospitals (aOR = 1.32, 95% CI:1.01–1.76), increased BMI (aOR = 1.10, 95% CI:1.01–3.65), and positive history of overexertional back trauma (aOR = 11.52, 95% CI:4.14–32.08). On the other hand, practising regular physical exercise was a significant protective factor (aOR = 0.61, 95% CI: 0.42–0.89).

Conclusions

LBP is a common problem among HCWs. Many preventable risk factors have been identified, including exertional back trauma, increased BMI and lack of regular physical exercise. Occupational health and safety programmes to build ergonomically safe working conditions and encourage regular physical exercise are needed.

http://bit.ly/2Bntdyf

Comparing Australian orthopaedic surgeons’ reported use of thromboprophylaxis following arthroplasty in 2012 and 2017

Abstract

Background

It is generally accepted that all arthroplasty patients should receive venous thromboembolism (VTE) and bleeding risk assessments, and that postoperative thromboprophylaxis be routinely prescribed where appropriate. Guideline recommendations regarding what to prescribe, however, have been inconsistent over the years, particularly regarding the appropriateness of aspirin. Our aim was to explore thromboprophylaxis patterns in use following hip and knee arthroplasty in Australia, and to examine associated variables.

Methods

Orthopaedic surgeons were invited via mail to participate in two national surveys, conducted in 2012 (N = 478) and 2017 (N = 820), respectively.

Results

The final response rates were 50.0 and 65.8% for 2012 and 2017, respectively. The thromboprophylaxis prescribing routines reported by respondents were divided into four categories: anticoagulant-only (the same anticoagulant-only routine for everyone), aspirin-only (aspirin for everyone), staged-supply (an anticoagulant during the initial postoperative period, followed by aspirin, for everyone) and risk-stratification routines (differing regimens depending on patients' perceived risk of VTE). The most common approaches reported were anticoagulant-only routines; however, their popularity almost halved within the five-year period (from ~ 74% to ~ 41%). Conversely, staged-supply and risk-stratification protocol usage increased by more than two and nine times, respectively. In 2017, over one-half of surgeons reported prescribing aspirin in their practice. Reported concern for postoperative VTE and infections (OR 0.555 95% CI 0.396–0.779, p = 0.001 and OR 1.455 95% CI 1.010–2.097, p = 0.044 respectively), as well as Arthroplasty Society membership (OR 2.814 95% CI 1.367–5.790, p = 0.005) were predictors for use of aspirin (Cox and Snell R square = 0.072). The factor most commonly reported to shape surgeons' protocols was research literature. Factors limiting prescribing of pharmacological prophylaxis included a perception that it increases bleeding and wound infection risk, is inconvenient, and lacks evidence applicable to real-world practice.

Conclusions

VTE prevention post-arthroplasty is an evolving and multi-faceted entity, influenced by a range of factors and seemingly in need of robust evidence from large clinical trials to guide practice. The data highlighted potential short-falls in practice related to aspirin over-use, which could be further explored and addressed in future studies in order to optimise patient outcomes and reduce the significant morbidity and healthcare costs associated with VTE following these increasingly common surgical procedures.

http://bit.ly/2TGPgY0

Does thread shape affect the fixation strength of the bioabsorbable interference screws for anterior cruciate ligament reconstructions? A biomechanical study

Abstract

Background

The purpose of this study was to compare the biomechanical behaviour of two bioabsorbable interference screws with different geometries.

Methods

Two different pitch (2.5 and 5 mm) bioabsorbable interference screws, both 9 × 30 mm, were tested. Tests were performed with forty bovine digital extensor tendons and skeletally mature porcine tibiae. Two protocols of cyclic tests at 1 Hz were performed: 1000 cycles from 50 to 250 N, and 5000 cycles from 100 to 300 N (n = 10 for each type of test and screw). After the cyclic loading, a final ramp displacement until failure at 0.5 mm/s was applied.

Results

The stiffness after the cyclic phase of the tests was not statistically different between the two screws (1000th cycle: 2.5 mm pitch 280.3 ± 56.4 N/mm, 5 mm pitch 275.2 ± 65.0 N/mm, P = .965; 5000th cycle: 2.5 mm pitch 281.3 ± 66.4 N/mm, 5 mm pitch 286.1 ± 79.4 N/mm, P = .814). The yield load was not significantly different between the screws (1000 cycle tests: 2.5 mm pitch 482.2 ± 120.2 N, 5 mm pitch 495.9 ± 131.3 N, P = .508; 5000 cycle tests: 2.5 mm pitch 476.4 ± 65.3 N, 5 mm pitch 494.3 ± 39.2 N, P = .391). No correlation was found between the insertion torque and yield load (1000 cycle tests, R² = 0.013; 5000 cycle tests, R² = 0.006).

Conclusions

The pitch of bioabsorbable interference screws does not seem to affect fixation strength. Also, the authors recommend not to use insertion torque alone to estimate the fixation strength.

http://bit.ly/2BsdVIN

Mutations in the SPAST gene causing hereditary spastic paraplegia are related to global topological alterations in brain functional networks

Abstract

Aim

Our aim was to describe the rearrangements of the brain activity related to genetic mutations in the SPAST gene.

Methods

Ten SPG4 patients and ten controls underwent a 5 min resting state magnetoencephalography recording and neurological examination. A beamformer algorithm reconstructed the activity of 90 brain areas. The phase lag index was used to estimate synchrony between brain areas. The minimum spanning tree was used to estimate topological metrics such as the leaf fraction (a measure of network integration) and the degree divergence (a measure of the resilience of the network against pathological events). The betweenness centrality (a measure to estimate the centrality of the brain areas) was used to estimate the centrality of each brain area.

Results

Our results showed topological rearrangements in the beta band. Specifically, the degree divergence was lower in patients as compared to controls and this parameter related to clinical disability. No differences appeared in leaf fraction nor in betweenness centrality.

Conclusion

Mutations in the SPAST gene are related to a reorganization of the brain topology.

http://bit.ly/2GsJW6V

Establishment and characterization of a novel dedifferentiated chondrosarcoma cell line, NCC-dCS1-C1

Abstract

Dedifferentiated chondrosarcoma is an aggressive mesenchymal tumor of the bone, and novel therapies are needed to improve its clinical outcomes. Patient-derived cell lines are essential tools for elucidating disease mechanisms associated with poor prognosis and for developing therapies. However, few lines and xenografts have been previously reported in dedifferentiated chondrosarcoma. We established a novel patient-derived dedifferentiated chondrosarcoma cell line, NCC-dCS1-C1. Primary dedifferentiated chondrosarcoma tissues were obtained at the time of surgery and subjected to primary tissue culture. The cell line was established and authenticated by assessing DNA microsatellite short tandem repeats. The cells maintained in monolayer cultures exhibited constant growth, spheroid formation capacity, and invasion ability. When the cells were implanted into mice, they exhibited histological features similar to those of the original tumor. Genomic analysis of single nucleotide polymorphisms showed aberrant genomic contents. The DNA sequencing revealed the absence of IDH1/2 mutations. The global targeted sequencing revealed that the cell line preserved homozygous deletion of CDKN2A and CREBBP. A proteomic study by mass spectrometry unveiled similar but distinct molecular backgrounds in the original tumor and the established cell line, suggesting that tumor cell functions might be altered during the establishment of the cell line. Using a screening approach, four anti-cancer drugs with anti-proliferative effects at a low concentration were identified. In conclusion, a novel dedifferentiated chondrosarcoma cell line, NCC-dCS1-C1, was successfully established from primary tumor tissues. The NCC-dCS1-C1 cell line will be a useful tool for investigations of the mechanisms underlying dedifferentiated chondrosarcomas.

http://bit.ly/2DnaO4R

Sara Kenney and John Watkiss, Surgeon X, Vol. 1–6: The Path of Most Resistance (London: Image Comics, 2017), 218 pp., $14.99, ISBN-10: 1534301542

http://bit.ly/2SDYbMD

Deep domain adaptation with manifold aligned label transfer

Abstract

We propose a novel deep learning domain adaptation method that performs transductive learning from the source domain to the target domain based on cluster matching between the source and target features. The proposed method combines Adaptive Batch Normalization and Locality Preserving Projection-based subspace alignment on deep features to produce a common feature space for label transfer. Adaptive Batch Normalization automatically conditions the features from the source/target domain by normalizing the activations in each layer of our network. Following Manifold Subspace Alignment, we cluster the data in each domain using Gaussian Mixture Model clustering in feature space. The clusters are matched between domains to transfer labels from the closest source cluster to each target cluster. The transfer labels are compared to the network prediction, and the samples with consistent labels are used to adapt the network on the target domain. The proposed manifold-guided label transfer method produces state-of-the-art results for deep adaptation on digit recognition datasets. Furthermore, we perform domain adaptation on remote sensing datasets.

http://bit.ly/2DpDj2a

Erratum zu: Inzidentalome der Nebennieren. Diagnostisches und therapeutisches Konzept aus endokrinologischer Sicht

Erratum zu:

Chirurg 2018

http://bit.ly/2TDEyl9

In Tab. 1 war die Zuordnung des Conn- und Cushing-Syndroms vertauscht. Wir bitten um die Beachtung der korrekt dargestellten …

http://bit.ly/2BpIuyA

Sara Kenney and John Watkiss, Surgeon X, Vol. 1–6: The Path of Most Resistance (London: Image Comics, 2017), 218 pp., $14.99, ISBN-10: 1534301542

http://bit.ly/2SDYbMD

The role of wearables in spinal posture analysis: a systematic review

Abstract

Background

Wearables consist of numerous technologies that are worn on the body and measure parameters such as step count, distance travelled, heart rate and sleep quantity. Recently, various wearable systems have been designed capable of detecting spinal posture and providing live biofeedback when poor posture is sustained. It is hypothesised that long-term use of these wearables may improve spinal posture.

Research questions

To (1) examine the capabilities of current devices assessing spine posture, (2) to identify studies implementing such devices in the clinical setting and (3) comment on the clinical practicality of integration of such devices into routine care where appropriate.

Methods

A comprehensive systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) across the following databases: PubMed; MEDLINE; EMBASE; Cochrane; and Scopus. Articles related to wearables systems able to measure spinal posture were selected amongst all published studies dated from 1980 onwards. Extracted data was collected as per a predetermined checklist including device types, study objectives, findings and limitations.

Results

A total of 37 articles were extensively reviewed and analysed in the final review. The proposed wearables most commonly used Inertial Measurement Units (IMUs) as the underlying technology. Wearables measuring spinal posture have been proposed to be used in the following settings: post-operative rehabilitation; treatment of musculoskeletal disorders; diagnosis of pathological spinal posture; monitoring of progression of Parkinson's Disease; detection of falls; workplace occupational health and safety; comparison of interventions.

Conclusions

This is the first and only study to specifically review wearable devices that monitor spinal posture. Our findings suggest that currently available devices are capable of assessing spinal posture with good accuracy in the clinical setting. However, further validation regarding the long-term use of these technologies and improvements regarding practicality is required for commercialisation.

http://bit.ly/2GCS3hp

Establishment and characterization of a novel cell line, NCC-MFS1-C1, derived from a patient with myxofibrosarcoma

Abstract

Myxofibrosarcoma (MFS) is an aggressive sarcoma that requires novel therapeutic approaches to improve its clinical outcome. Cell lines are a valuable tool for pre-clinical research; however, there is a lack of patient-derived cell lines of MFS available from public cell banks. This study aimed to develop a patient-derived cell line of MFS. A cell line designated NCC-MFS1-C1 was established from the primary tumor tissue of an 82-year-old male patient with MFS. The short tandem repeat pattern of NCC-MFS1-C1 cells was identical to that of the original tumor, but distinct from that of any other cell lines in public cell banks. NCC-MFS1-C1 cells were maintained as a monolayer culture for over 20 passages in 19 months; the cells exhibited spindle-like morphology, continuous growth, and ability for spheroid formation and invasion. Genomic assay showed that NCC-MFS1-C1 cells had gain and loss of genetic loci. Proteomic profiling revealed that the original tumor and the derived NCC-MFS1-C1 cells had similar, but distinct protein expression patterns. Screening of anti-cancer drugs in NCC-MFS1-C1 cells identified five candidate drugs for MFS. In conclusion, we established a novel MFS cell line, NCC-MFS1-C1, which could be used to study tumor development and effects of anti-cancer drugs.

http://bit.ly/2te52hs

Computed tomography in suspected anastomotic leakage after colorectal surgery: evaluating mortality rates after false-negative imaging

Abstract

Purposes

We sought to investigate the accuracy of abdominal CT scanning for anastomotic leakage and the effect of false-negative scans on the delay in therapeutic intervention and clinical outcome.

Method

Data from a prospectively bi-institutionally maintained database of all patients who underwent elective colorectal surgery with primary anastomosis for malignant or benign disease between 2010 and 2017 were reviewed. Patients with confirmed anastomotic dehiscence at reintervention who underwent a postoperative CT scan for suspected leakage were identified and radiological reports were retrieved.

Results

Seventy-six patients with anastomotic dehiscence were included in the study. American Society of Anesthesiologists score, sex, type of surgical procedure, malignancy, and type of anastomosis do not correlate with postoperative false-negative CT imaging. Postoperative false-negative CT scan, however, led to delayed reintervention (3 vs. 6 h, p = 0.023) and increased mortality (five deaths vs. no deaths, p = 0.043). Free abdominal air (p = 0.001) and extraluminal contrast extravasation (p = 0.001) were found to be predictive of accuracy in anastomotic leakage diagnosis.

Conclusion

The suboptimal specificity of a postoperative CT scan in suspected anastomotic leakage after colorectal surgery can delay reintervention and increase mortality.

http://bit.ly/2MU34Ml

A deep transfer learning approach for improved post-traumatic stress disorder diagnosis

Abstract

Post-traumatic stress disorder (PTSD) is a traumatic-stressor-related disorder developed by exposure to a traumatic or adverse environmental event that caused serious harm or injury. Structured interview is the only widely accepted clinical practice for PTSD diagnosis but suffers from several limitations including the stigma associated with the disease. Diagnosis of PTSD patients by analyzing speech signals has been investigated as an alternative since recent years, where speech signals are processed to extract frequency features and these features are then fed into a classification model for PTSD diagnosis. In this paper, we developed a deep belief network (DBN) model combined with a transfer learning (TL) strategy for PTSD diagnosis. We computed three categories of speech features and utilized the DBN model to fuse these features. The TL strategy was utilized to transfer knowledge learned from a large speech recognition database, TIMIT, for PTSD detection where PTSD patient data are difficult to collect. We evaluated the proposed methods on two PTSD speech databases, each of which consists of audio recordings from 26 patients. We compared the proposed methods with other popular methods and showed that the state-of-the-art support vector machine (SVM) classifier only achieved an accuracy of 57.68%, and TL strategy boosted the performance of the DBN from 61.53 to 74.99%. Altogether, our method provides a pragmatic and promising tool for PTSD diagnosis. Preliminary results of this study were presented in Banerjee (in: 2017 IEEE international conference on data mining (ICDM), IEEE, 2017).

http://bit.ly/2SEFZlZ

Capsaicin supplementation increases time to exhaustion in high-intensity intermittent exercise without modifying metabolic responses in physically active men

Abstract

Purpose

The purpose of this study was to investigate the acute effect of capsaicin supplementation on performance and physiological responses during high-intensity intermittent exercise (HIIE).

Method

Thirteen physically active men (age = 24.4 ± 4.0 years; height = 176.4 ± 6.9 cm; body mass  =  78.7 ± 13.8 kg; running training per week = 3.9 ± 0.9 h) performed an incremental running test to determine peak oxygen uptake ( \(\dot {V}_}}\) ) and the speed associated with \(\dot {V}_}}\) (s \(\dot {V}_}}\) ). Thereafter, subjects completed two randomized, double-blind HIIE (15s:15 s at 120% s \(\dot {V}_}}\) ) trials 45-min after consuming capsaicin (12 mg) or an isocaloric placebo. Time to exhaustion, blood lactate concentration, oxygen consumption during and 20 min post-exercise, energy expenditure, time spent above 90% of \(\dot {V}_}}\) , and the rate of perceived exertion were evaluated.

Results

There was no difference between capsaicin and placebo for any variable except time to exhaustion [capsaicin: 1530 ± 515 s (102 efforts) vs placebo: 1342 ± 446 s (89 efforts); p < 0.001].

Conclusion

In conclusion, capsaicin supplementation increased time to exhaustion in high-intensity intermittent exercise without modifying the metabolic response of exercise or the rate of perceived exertion in physically active men. Capsaicin could be used to increase the training load during specific exercise training sessions.

http://bit.ly/2SvfgbF

Nonlinear multibody dynamics and finite element modeling of occupant response: part I—rear vehicle collision

Abstract

With the rise in vehicle ownership, the need to reduce the risk of injury among vehicle occupants that arises from vehicle collisions is important to occupants, insurers, manufacturers and policy makers alike. The human head and neck are of special interest, due to their vulnerable nature and the severity of potential injury in these collisions. This work is divided into two parts: In Part I, we focus our attention to modeling rear collision that could lead to whiplash. Specifically, two multibody dynamics (MBD) models of the cervical spine of the 50th percentile male are developed using realistic geometries, accelerations and biofidelic variable intervertebral rotational stiffness. Furthermore, nonlinear finite element (FE) simulations of two generic compact sedan vehicles in rear collision scenario were performed. Using the acceleration profiles measured at the driver's seat of the colliding vehicles, FE simulation of a seated and restrained occupant in rear collision was performed to determine the occupant response. The resultant accelerations, measured at the T1 vertebra of the occupant model, were used as an input to the MBD models to obtain their kinematic response. Validation of the MBD models shows great agreement with experimentally published data. Comparison between the MBD and FE simulations for a 32 km/h vehicle-to-vehicle impact shows similar trends in head trajectory. However, the MBD models reported less peak head displacements compared to the FE model. This is attributed to the failure of the anterior longitudinal ligament at the mid cervical spine leading to increased intervertebral rotation in the FE model.

http://bit.ly/2MT3Ngy

Comparison of the efficacy of trastuzumab emtansine between patients with metastatic human epidermal growth factor receptor 2-positive breast cancers previously treated with combination trastuzumab and pertuzumab and with trastuzumab only in Japanese population

Abstract

Background

Trastuzumab emtansine (T-DM1) has been approved since 2013 for patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) who had received trastuzumab (Tmab) and taxane. However, no clinical trial has evaluated the efficacy of T-DM1 in those who have previously received pertuzumab (Pmab). This study aimed to compare the efficacy of T-DM1 between patients who had received Tmab and Pmab and those who had received Tmab only in Japanese population.

Methods

We identified all patients with HER2-positive MBC who received T-DM1 between April 1, 2014 and February 28, 2017 in our institution. The patients were divided into the Tmab group (i.e., those who received only Tmab before T-DM1 treatment) and the Tmab/Pmab group (i.e., those who received Tmab and Pmab before T-DM1 treatment), and progression-free survival (PFS) and best response were compared between the two groups.

Results

A total of 42 patients were enrolled for outcome analysis. The median follow-up period was 4.8 months, and the median number of prior chemotherapy regimens for metastatic disease before T-DM1 was 1 (range 1–2) in the Tmab/Pmab group and 2 (range 0–6) in the Tmab group. The median PFS was 2.8 months in the Tmab/Pmab group (95% confidence interval [CI] 1.7–4.8 months) and 7.8 months in the Tmab group (95% CI 5.5–15.9 months) (p = 0.0030). The best response was lower in the Tmab/Pmab group (11.1% vs. 25.0%).

Conclusions

Patients with HER2-positive MBC who received Tmab and Pmab treatment before T-DM1 have fewer benefits from T-DM1.

http://bit.ly/2Btc8mC

A case of HeartMate II implantation in non-dilated left ventricle

Abstract

Left ventricular assist device is an established therapeutic option for the patient with end-stage heart failure. Recently, durable continuous-flow devices have replaced earlier generation of pulsatile devices and their desirable features are accelerating the utilization of these devices. However, their powerful performance could sometimes induce unfavorable complications such as sucking, especially in not so dilated left ventricle. Special maneuvers such as cannula position and lower pump speed may be reasonable for patients with non-dilated left ventricular, however, those managements have not been established yet to date. Right ventricular failure is also another concern in these devices. We experienced a patient who got a HeartMate II in spade-shaped, non-dilated left ventricle concomitant with right ventricular dysfunction, and successfully managed her.

http://bit.ly/2GgYRBW

A new technique for low-volume continuous sampling of spent dialysate: a validation study

Abstract

The measure of hemodialysis (HD) adequacy recommended nowadays by most guidelines, Kt/V-urea, presents significant drawbacks. Direct dialysis quantification (DDQ) through total dialysate collection (TDC), considered the gold standard measure of HD adequacy, is cumbersome, which precludes its widespread use in clinical practice. The present study aims to validate a low-volume continuous sampling of spent dialysate (CSSD). Cross-sectional study carried out at a university hospital. Throughout 4-h hemodialysis sessions, urea removal was measured by three DDQ methods: TDC, CSSD, and fractional sampling of dialysate (FSD). The primary outcome was the comparison between the total mass of urea removed measured by TDC and the dialysate sampling techniques. The comparison between urea distribution volume (UDV) estimated by anthropometric method and through DDQ was a secondary outcome. The analysis was done through linear regression and Bland–Altman concordance method. Twenty HD sessions were studied. The mean amount of urea collected in TDC and calculated from the 40-mL sample of CSSD were 33.70 ± 11.70 g and 33.90 ± 11.70 g, respectively [r 0.96, p < 0.0001; bias − 0.2 (95% CI − 1.8 to 1.4); limits of agreement − 6.8 to 6.4]. The anthropometric measure, when compared with DDQ method, underestimated UDV in patients with smaller body size. This new simple, inexpensive, and small volume CSSD technique can provide accurate information about the total amount of solutes removed by hemodialysis.

http://bit.ly/2DnOIPK

N -acetylglucosaminyltransferases and nucleotide sugar transporters form multi-enzyme–multi-transporter assemblies in golgi membranes in vivo

Abstract

Branching and processing of N-glycans in the medial-Golgi rely both on the transport of the donor UDP-N-acetylglucosamine (UDP-GlcNAc) to the Golgi lumen by the SLC35A3 nucleotide sugar transporter (NST) as well as on the addition of the GlcNAc residue to terminal mannoses in nascent N-glycans by several linkage-specific N-acetyl-glucosaminyltransferases (MGAT1-MGAT5). Previous data indicate that the MGATs and NSTs both form higher order assemblies in the Golgi membranes. Here, we investigate their specific and mutual interactions using high-throughput FRET- and BiFC-based interaction screens. We show that MGAT1, MGAT2, MGAT3, MGAT4B (but not MGAT5) and Golgi alpha-mannosidase IIX (MAN2A2) form several distinct molecular assemblies with each other and that the MAN2A2 acts as a central hub for the interactions. Similar assemblies were also detected between the NSTs SLC35A2, SLC35A3, and SLC35A4. Using in vivo BiFC-based FRET interaction screens, we also identified novel ternary complexes between the MGATs themselves or between the MGATs and the NSTs. These findings suggest that the MGATs and the NSTs self-assemble into multi-enzyme/multi-transporter complexes in the Golgi membranes in vivo to facilitate efficient synthesis of complex N-glycans.

http://bit.ly/2DZFT0c

Guidelines for the use of cerebral oximetry by near-infrared spectroscopy in cardiovascular anesthesia: a report by the cerebrospinal Division of the Academic Committee of the Japanese Society of Cardiovascular Anesthesiologists (JSCVA)

Abstract

Cerebral Oximetry by Near-infrared Spectroscopy (NIRS) has been used in cardiovascular anesthesia, but there was no guideline of regional cerebral oxygen saturation measured by cerebral oximetry by NIRS. This guideline provides recommendations applicable to patients at a risk of developing cerebral ischemia in cardiovascular surgery. Guidelines are intended to define practices meeting the needs of patients in most, but not all, circumstances, and should not replace clinical judgment. The Japanese Society of Cardiovascular Anesthesiologists (JSCVA) Task Force on Guidelines make an effort to ensure that the guideline writing committee contains broad views in using cerebral oximetry. Adherence to recommendations could be enhanced by shared decision making between healthcare providers and patients. This guideline was focused on cerebral oximetry of pediatric and adult cardiovascular disease. We hope this guideline would play an important role in using cerebral oximetry by measured NIRS.

http://bit.ly/2BqJkLv

Current mechanisms of low graft flow and conduit choice for the right coronary artery based on the severity of native coronary stenosis and myocardial flow demand

Abstract

Objectives

We investigated current mechanisms causing low graft flow (LGF) following coronary artery bypass grafting, particularly for the right coronary artery (RCA).

Methods

We retrospectively assessed 230 individual bypass grafts as the sole bypass graft for the RCA using preoperative and postoperative quantitative angiography. Overall, 155 in-situ gastroepiploic arteries (GEAs) and 75 saphenous vein grafts (SVGs) were included. The size and status of the revascularised area were examined to determine whether these factors were associated with LGF (defined as ≤ 20 mL/min with intraoperative flowmetry). A distal lesion was defined as stenosis at segment #4, whereas a proximal lesion was stenosis at #1, #2 and #3.

Results

Graft flow in the SVG and the GEA for distal lesion was significantly less compared with that for proximal lesion (34 ± 26 vs. 60 ± 46, p < 0.0001 and 22 ± 12 vs. 43 ± 28, p = 0.0004, respectively). For proximal lesion, LGF was significantly more frequent when the minimal luminal diameter was over 1.27 compared with when it was less than 1.27 (p = 0.02). Prior myocardial infarction significantly correlated with LGF in the GEA (p = 0.007) and the SVG (p = 0.03). In 55 bypass grafts with LGF, the causes were competitive flow in 20.0%, small revascularised area in 38.1% and prior myocardial infarction in 32.7%.

Conclusions

Along with the current strategy based on the severity of native coronary stenosis, the incidence of competitive flow decreased remarkably. This resulted in flow demand, myocardial status and collateral vessels more influential on graft patency.

http://bit.ly/2GwJ1SM

ISSLS Prize in Basic science 2019: Physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration

Abstract

Purpose

Chronic low back pain causes structural remodelling and inflammation in the multifidus muscle. Collagen expression is increased in the multifidus of humans with lumbar disc degeneration. However, the extent and mechanisms underlying the increased fibrotic activity in the multifidus are unknown. Physical activity reduces local inflammation that precedes multifidus fibrosis during intervertebral disc degeneration (IDD), but its effect on amelioration of fibrosis is unknown. This study aimed to assess the development of fibrosis and its underlying genetic network during IDD and the impact of physical activity.

Methods

Wild-type and SPARC-null mice were either sedentary or housed with a running wheel, to allow voluntary physical activity. At 12 months of age, IDD was assessed with MRI, and multifidus muscle samples were harvested from L2 to L6. In SPARC-null mice, the L1/2 and L3/4 discs had low and high levels of IDD, respectively. Thus, multifidus samples from L2 and L4 were allocated to low- and high-IDD groups compared to assess the effects of IDD and physical activity on connective tissue and fibrotic genes.

Results

High IDD was associated with greater connective tissue thickness and dysregulation of collagen-III, fibronectin, CTGF, substance P, TIMP1 and TIMP2 in the multifidus muscle. Physical activity attenuated the IDD-dependent increased connective tissue thickness and reduced the expression of collagen-I, fibronectin, CTGF, substance P, MMP2 and TIMP2 in SPARC-null animals and wild-type mice. Collagen-III and TIMP1 were only reduced in wild-type animals.

Conclusions

These data reveal the fibrotic networks that promote fibrosis in the multifidus muscle during chronic IDD. Furthermore, physical activity is shown to reduce fibrosis and regulate the fibrotic gene network.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

http://bit.ly/2SfxH4y