On the water stability of ionic liquids/Cu-BTC composites: an experimental study

Abstract

Ionic liquids/metal-organic framework composites are recognized as promising adsorbents for CO₂ capture due to the outstanding adsorption performance, whereas their water stability, which is critical for the real application of ILs/MOF composites, has not been taken into consideration. In this work, the water stability of two ILs/Cu-BTC composites, i.e., 1-butyl-3-methylimidazolium tetrafluoroborate ([BMIM][BF₄]) /Cu-BTC and 1-butyl-3-methylimidazolium hexafluorophosphate ([BMIM][PF₆]) /Cu-BTC, were investigated. We found that the loading of ILs does not impose remarkable impacts on the crystalline structure of Cu-BTC upon water exposure; whereas the thermal stability and surface area of Cu-BTC were decreased by the incorporation of ILs, thereby leading to the reduced CO₂ uptake in spite of the enhanced CO₂ heat of adsorption. Furthermore, it was revealed that the decomposition of Cu-BTC occurred within the first hour of water exposure. Nevertheless, the loading of ILs retarded the decomposition of Cu-BTC according to the variations in BET surface area upon water exposure.

Graphical abstract

http://bit.ly/2N4bwZh

Toxicity evaluation of CdSe nanorods on macrophages and the protective effect of resveratrol

Abstract

Cadmium selenide (CdSe) nanomaterials (NMs) easily access to organism due to the applications in photocatalysis, gene therapy, and cell labeling, while the increasing environmental release and accumulating in lungs tend to pose threat to humans and the incidence of cytotoxicity largely compromises their application. Resveratrol is recognized as antioxidant and has protective effects on oxidative stress, depending on its special structure of scavenging free radicals. Herein, we demonstrated that CdSe nanorods induced apoptosis to macrophages and resveratrol exhibited an excellent ability to prevent cells from damage. CdSe nanorods with the average length of 70–100 nm caused an increasing reactive oxygen species (ROS) and disrupted the cellular antioxidant system. The cellular organelles including mitochondria, endoplasmic reticulum, and nuclei were both interfered by the oxidative stress. Notably, pretreatment of resveratrol could largely alleviate the apoptosis. Macrophages recovered the normal morphology and reinforced antioxidant system in the presence of resveratrol, which showed a selective protection towards the changes of mitochondrial function.

Graphical abstract

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http://bit.ly/2SK9rHk

Growth of semi-coherent Ni and NiO dual-phase nanoparticles using hollow cathode sputtering

Abstract

Anisotropic heterogenous Ni/NiO nanoparticles with controlled compositions are grown using a high-power pulsed hollow cathode process. These novel particles can be tuned to consist of single-phase Ni via two-phase Ni/NiO to fully oxidized NiO, with a size range of 5–25 nm for individual crystals. A novelty of this approach is the ability to assemble multiple particles of Ni and NiO into a single complex structure, increasing the Ni-NiO interface density. This type of particle growth is not seen before and is explained to be due to the fact that the process operates in a single-step approach, where both Ni and O can arrive at the formed nanoparticle nuclei and aid in the continuous particle growth. The finished particle will then be a consequence of the initially formed crystal, as well as the arrival rate ratio of the two species. These particles hold great potential for applications in fields, such as electro- and photocatalysis, where the ability to control the level of oxidation and/or interface density is of great importance.

Graphical abstract

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http://bit.ly/2Namf4J

Citric acid and itaconic acid accumulation: variations of the same story?

Abstract

Citric acid production by Aspergillus niger and itaconic acid production by Aspergillus terreus are two major examples of technical scale fungal fermentations based on metabolic overflow of primary metabolism. Both organic acids are formed by the same metabolic pathway, but whereas citric acid is the end product in A. niger, A. terreus performs two additional enzymatic steps leading to itaconic acid. Despite of this high similarity, the optimization of the production process and the mechanism and regulation of overflow of these two acids has mostly been investigated independently, thereby ignoring respective knowledge from the other. In this review, we will highlight where the similarities and the real differences of these two processes occur, which involves various aspects of medium composition, metabolic regulation and compartmentation, transcriptional regulation, and gene evolution. These comparative data may facilitate further investigations of citric acid and itaconic acid accumulation and may contribute to improvements in their industrial production.

http://bit.ly/2DC8A1X

Treatment of cancer stem cells from human colon adenocarcinoma cell line HT-29 with resveratrol and sulindac induced mesenchymal-endothelial transition rate

Abstract

In the current experiment, the combined regime of resveratrol and a Wnt-3a inhibitor, sulindac, were examined on the angiogenic potential of cancer stem cells from human colon adenocarcinoma cell line HT-29 during 7 days. Cancer stem cells were enriched via a magnetic-activated cell sorter technique and cultured in endothelial induction medium containing sulindac and resveratrol. Expression of endothelial markers such as the von Willebrand factor (vWF) and vascular endothelial cadherin (VE-cadherin) and genes participating in mesenchymal-to-epithelial transition was studied by real-time PCR assay. Protein levels of Wnt-3a and angiogenic factor YKL-40 were examined by western blotting. ELISA was used to determine the level of N-acetylgalactosaminyltransferase 11 (GALNT11) during mesenchymal-endothelial transition. Autophagy status was monitored by PCR array under treatment with the resveratrol plus sulindac. Results showed that resveratrol and sulindac had the potential to decrease the cell survival of HT-29 cancer cells and the clonogenic capacity of cancer stem cells compared with the control (p < 0.05). The expression of VE-cadherin and vWF was induced in cancer stem cells incubated with endothelial differentiation medium enriched with resveratrol (p < 0.05). Interestingly, the Wnt-3a level was increased in the presence of resveratrol and sulindac (p < 0.05). YKL-40 was reduced after cell exposure to sulindac and resveratrol. The intracellular content of resistance factor GALNT11 was diminished after treatment with resveratrol (p < 0.05). Resveratrol had the potential to induce the transcription of autophagy signaling genes in cancer stem cells during endothelial differentiation (p < 0.05). These data show that resveratrol could increase cancer stem cell trans-differentiation toward endothelial lineage while decrease cell resistance by modulation of autophagy signaling and GALNT11 synthesis.

http://bit.ly/2SAtjgY

The use of PRP injections in the management of knee osteoarthritis

Abstract

Osteoarthritis (OA) is a degenerative disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture that commonly affects the knee and/or hip joints. It is a major world public health problem and is predicted to increase rapidly with an ageing population and escalating rate of obesity. Autologous blood-derived products possess much promise in the repair and regeneration of tissue and have important roles in inflammation, angiogenesis, cell migration and metabolism in pathological conditions, including OA. Utilising platelet-rich plasma (PRP) to treat tendon, ligament and skeletal muscle has shown variable results across many studies with the current evidence base for the efficacy of PRP in treating sports injuries remaining inconclusive. More uniformly positive results have been observed by various studies for PRP in OA knee in comparison to hyaluronic acid, other intra-articular injections and placebo than in other musculoskeletal tissue. However, methodological concerns as well as satisfactory PRP product classification prevent the true characterisation of this treatment. Thus, further research is required to investigate how leukocyte inclusion, activation and platelet concentration affect therapeutic efficacy. Furthermore, the optimisation of timing, dosage, volume, frequency and rehabilitation strategies need to be ascertained. For knee OA management, these concerns must be addressed before this promising treatment can be widely implemented.

http://bit.ly/2DABf7u

Minute-to-minute urine flow rate variability: a retrospective survey of its ability to provide early warning of acute hypotension in critically ill multiple trauma patients

Abstract

Purpose

Dynamic changes in urine output and neurological status are the recognized clinical signs of hemodynamically significant hemorrhage. In the present study, we analyzed the dynamic minute-to-minute changes in the UFR and also the changes in its minute-to-minute variability in a group of critically ill multiple trauma patients whose blood pressures were normal on admission to the ICU but who subsequently developed hypotension within the first few hours of their ICU admission.

Patients and methods

The study was retrospective and observational. Demographic and clinical data were extracted from the computerized register information systems initially; the clinical and laboratory data of 100 critically ill patients with multiple trauma who were admitted to the ICU during the study period were analyzed. Of this group, ten patients were eventually included in the study on the basis of the inclusion criteria.

Results

The minute-to-minute urine flow rate (UFR) and urine flow rate variability (UFRV) both decreased significantly during the periods of hypotension (p values 0.001 and 0.006, respectively). Notably, the decrease in UFRV preceded by at least 30 min a corresponding decline in the systolic and mean arterial blood pressures, which manifested as a flattening of UFRV amplitude which was observed prior to the occurrence of the lowest recorded systolic and mean arterial blood pressures. Statistical analysis by the Pearson method demonstrated a strong direct correlation between the decrease in UFRV and the decrease in the MAP (R = 0.9, p = 0.001), and SBP (R = 0.86, p = 0.001) and the decreasing urine output per hour (R = 0.88, p < 0.001).

Conclusion

We found that changes in UFRV correlate strongly with systolic and mean arterial blood pressures. We feel that this parameter could potentially serve as an early signal of hemodynamic deterioration due to occult bleeding in critically ill trauma patients, and might also be able to identify the optimal end-point of hemodynamic resuscitative measures in these patients.

http://bit.ly/2SxBrP2

Anomalous right upper lobe pulmonary veins draining posterior to the pulmonary artery

Abstract

The anatomy of pulmonary vessels varies. The right upper pulmonary vein usually drains in front of the pulmonary artery to the left atrium. We herein describe a case of the right upper lobe pulmonary vein draining posterior to the pulmonary artery and absent right upper lobe pulmonary vein in the ventral hilum. A 64-year-old woman suspected to have lung cancer and scheduled for surgery underwent pre-operative three-dimensional computed tomography (3D-CT), which revealed that pulmonary vessels V1 + 3 and V2 drain posteriorly to the pulmonary artery. Video-assisted right upper lobectomy was performed because the patient was diagnosed with lung adenocarcinoma through intraoperative pathologic analysis, and all the pulmonary vessels were identified correctly during the operation. Despite the limited surgical field of video-assisted lobectomy, the operation was performed safely because the pre-operative 3D-CT assessment revealed the anatomy of the anomalous pulmonary vessels, helping us avoid missing any anomaly and vessel injury.

http://bit.ly/2IdBlr8

Endoscopic transorbital transtentorial approach to middle incisural space: preclinical cadaveric study

Abstract

Background

Endoscopic transorbital approach is a novel development of minimally invasive skull base surgery. Recently, anatomical studies have started to discuss the expanded utilization of endoscopic transorbital route for intracranial intradural lesions. The goal of this cadaveric study is to assess the feasibility of endoscopic transorbital transtentorial approach for exposure of middle incisural space.

Methods

Anatomical dissections were performed in four human cadaveric heads (8 sides) using 0- and 30-degree endoscopes. A stepwise description of endoscopic transorbital transtentorial approach to middle incisural space and related anatomy was provided.

Results

Orbital manipulation following superior eyelid crease incision with lateral canthotomy and cantholysis established space for bone drilling. Extradural stage consisted of extensive drilling of orbital roof of frontal bone, lessor, and greater wings of sphenoid bone. Intradural stage was composed of dissection of sphenoidal compartment of Sylvian fissure, lateral mobilization of mesial temporal lobe, and penetration of tentorium. A cross-shaped incision of tentorium provided direct visualization of crural cistern with anterolateral aspect of cerebral peduncle and upper pons. Interpeduncular cistern, prepontine cistern, and anterior portions of ambient and cerebellopontine cisterns were exposed by 30-degree endoscope.

Conclusion

The endoscopic transorbital transtentorial approach can be used as a minimally invasive surgery for exposure of middle incisural space. Extensive drilling of sphenoid wing and lateral mobilization of mesial temporal lobe are the main determinants of successful dissection. Further studies are needed to confirm the clinical feasibility of this novel approach.

http://bit.ly/2BzOG7h

Optimizing early enteral nutrition in severe stroke (OPENS): protocol for a multicentre randomized controlled trial

Abstract

Background

Malnutrition is one of the crucial factors associated with poor prognosis in critical ill patients, yet a significant evidence gap surrounds the management of initial enteral feeding in severe stroke. The Optimizing Early Enteral Nutrition in Severe Stroke (OPENS) trial will compare a strategy of modified full enteral nutrition (EN) (standard full EN in conjunction with prokinetic drug) and a strategy of permissive underfeeding (40 to 60% of estimated caloric requirements) with standard full EN (advancement to target nutrition goals) in patients with severe stroke.

Methods

The OPENS trial is a multicenter randomized controlled study. A total of 600 adult patients with severe stroke will be enrolled in 12 study sites in China, and randomized to standard full EN, modified full EN, or permissive underfeeding. The primary outcome measurement is the proportion of participants with a poor outcome (modified Rankin Scale ≥3) at day 90 of enrollment. Secondary outcomes include incidence rates of complications during hospitalization, disability at hospital discharge, and the ability of activities of daily living at day 90 of enrollment. The relationship between intervention and the primary outcome will be analyzed using multivariate logistic regression adjusted for study site, demographics, and baseline characteristics.

Discussion

The OPENS trial will explore the optimum initial feeding strategy for acute severe stroke. This trial is, therefore, an important step in bridging the evidence gap surrounding the enteral feeding for patients with severe stroke during the first week of hospitalization.

Trial registration

ClinicalTrials.gov Identifier: NCT02982668; First Posted: December 5, 2016.

http://bit.ly/2BvJrWk

Early risk assessment of circulating endothelial progenitor cells and plasma stromal cell-derived factor-1 for nondisabling ischemic cerebrovascular events

Abstract

Background

Endothelial progenitor cells (EPCs) play an important role in ischemic stroke. However, there are few studies on the relationship between EPC and nondisabling ischemic cerebrovascular events. Our aim was to investigate the association of EPCs and SDF-1 (serum stromal cell-derived factor-1) with NICE (nondisabling ischemic cerebrovascular events).

Methods

TIA (transient ischemic attack) and minor stroke patients (153 in total) who had an onset of symptoms within 1 day were consecutively collected. 83 of the patients were categorized into the HR-NICE (high-risk nondisabling ischemic cerebrovascular event) group, and 70 of the patients were in the NHR-NICE (non-high-risk nondisabling ischemic cerebrovascular events) group. Adopted FCM (flow cytometry) was used to measure EPCs, taking double-positive CD34/KDR as EPCs. ELISA was used to measure the concentrations of serum SDF-1 and VEGF (vascular endothelial growth factor). By the sequence of admission time, 15 patients were selected separately from the HR-NICE group and NHR-NICE group, and another 15 healthy volunteers were chosen as the NC (Normal Control) group. The MTT method was used to measure the proliferation of EPCs of peripheral blood in all groups, and the Boyden chamber was used to measure the migration of EPCs.

Results

Compared with the NHR-NICE group, the HR-NICE group was older and contained more patients with hypertension and diabetes. Triglyceride, total cholesterol, and low-density lipoprotein in the HR-NICE group were also higher. For factors such as smoking, BMI (body mass index), and HCY (homocysteine), there were no significant differences (P > 0.05). Circulating EPCs, SDF-1, and VEGF in the NHR-NICE group were all higher. According to the multifactor regression analysis, age, hypertension, diabetes, total cholesterol, EPCs, and SDF-1 are independent risk factors for HR-NICE. For EPCs of 48-h isolated cultures, proliferation and migration were observed to be weakened compared with those of the NC group (P < 0.05). EPCs in HR-NICE group had lower proliferation and migration than those in NHR-NICE group (P < 0.01).

Conclusions

For TIA and minor stroke patients, circulating EPCs and serum SDF-1 concentrations can be used to prognose HR-NICE. Factors that lead to high-risk NICE might be relevant to the decrease in proliferation and migration of circulating EPCs.

http://bit.ly/2BvJoK8

Mixed cerebrovascular disease in an elderly patient with mixed vascular risk factors: a case report

Abstract

Background

Mixed cerebrovascular disease is a diagnostic entity that presents with hemorrhagic and ischemic stroke clinically and/or subclinically. Here, we report a patient with mixed vascular risk factors, who presented with multiple intracerebral hemorrhages and a simultaneously occurring cerebral infarction with hemorrhagic transformation.

Case presentation

A 63-year-old male with no history of trauma or prior neurological disease presented with a sudden onset of weakness in his right limbs, followed by an episode of focal seizure without impaired awareness. The patient had a 4-year history of deep vein thrombosis in the lower limbs, and a 2-year history of Raynaud's phenomenon in the hands. He also had a family history of hypertension and thrombophilia. Head computed tomography plain scans showed two high densities in the bilateral parietal lobes and one mixed density in the left frontal lobe. The patient was diagnosed with mixed cerebrovascular disease. In this report, we make a systematic clinical reasoning regarding the etiological diagnosis, and discuss the possible pathogenic mechanisms leading to mixed cerebrovascular disease. We exclude coagulopathy, endocarditis, atrial fibrillation, patent foramen ovale, brain tumor, cerebral venous thrombosis, cerebral vascular malformation, cerebral amyloid angiopathy and vasculitis as causative factors. We identify hypertension, hereditary protein S deficiency, hypercholesteremia and hyperhomocysteinemia as contributing etiologies in this case.

Conclusion

This case presents complex underlying mechanisms of mixed cerebrovascular disease, in which hypertension and hyperhomocysteinemia are considered to play a central role.

http://bit.ly/2TTEVrC

The neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are independently associated with neurological disability and brain atrophy in multiple sclerosis

Abstract

Background

Serum hematological indices such as the neutrophil-lymphocyte ratio (NLR) or monocyte-lymphocyte ratio (MLR) have been used as biomarkers of pathogenic inflammation and prognostication in multiple areas of medicine; recent evidence shows correlation with psychological parameters as well.

Objectives/Aims: To characterize clinical, neuroimaging, and psycho-neuro-immunological associations with NLR and MLR in persons with multiple sclerosis (MS).

Methods

We identified a large cohort of clinically well-defined patients from our longitudinal database that included MS-related outcomes, disease-modifying therapy, patient-reported outcome (PRO) measures, and quantified cerebral MRI at 1.5 T. We queried hospital records for complete blood counts within 2 months of each clinic visit and excluded those obtained during clinical relapses. Four hundred eighty-three patients, with a mean of 3 longitudinal observations each, were identified who met these criteria. Initial analyses assessed the association between NLR and MLR as the outcomes, and psychological and demographic predictors in univariable and multivariable models controlling for age, gender and treatment. The second set of analyses assessed the association between clinical and MRI outcomes including whole brain atrophy and T2-hyperintense lesion volume, with NLR and MLR as predictors in univariable and multivariable models. All analyses used a mixed effects linear or logistic regression model with repeated measures.

Results

Unadjusted analyses demonstrated significant associations between higher (log-transformed) NLR (but not MLR) and PRO measures including increasing depression (p = 0.01), fatigue (p < 0.01), and decreased physical quality of life (p < 0.01). Higher NLR and MLR strongly predicted increased MS-related disability as assessed by the Expanded Disability Status Scale, independent of all demographic, clinical, treatment-related, and psychosocial variables (p < 0.001). Lastly, higher NLR and MLR significantly discriminated progressive from relapsing status (p ≤ 0.01 for both), and higher MLR correlated with increased whole-brain atrophy (p < 0.05) but not T2 hyperintense lesion volume (p > 0.05) even after controlling for all clinical and demographic covariates. Sensitivity analyses using a subset of untreated patients (N = 146) corroborated these results.

Conclusions

Elevated NLR and MLR may represent hematopoetic bias toward increased production and pro-inflammatory priming of the myeloid innate immune system (numerator) in conjunction with dysregulated adaptive immune processes (denominator), and consequently reflect a complementary and independent marker for severity of MS-related neurological disability and MRI outcomes.

http://bit.ly/2BvJiSM

Stroke prevention in patients with acute ischemic stroke and atrial fibrillation in Germany - a cross sectional survey

Abstract

Background

Atrial fibrillation (AF) is present in 15–20% of patients with acute ischemic stroke. Oral anticoagulation reduces the risk of AF-related recurrent stroke but clinical guideline recommendations are rather vague regarding its use in the acute phase of stroke. We aimed to assess the current clinical practice of medical stroke prevention in AF patients during the acute phase of ischemic stroke.

Methods

In April 2017, a standardized anonymous questionnaire was sent to clinical leads of all 298 certified stroke units in Germany.

Results

Overall, 154 stroke unit leads participated (response rate 52%). Anticoagulation in the acute phase of stroke is considered feasible in more than 90% of AF patients with ischemic stroke. Clinicians assume that about two thirds of all AF patients (range 20–100%) are discharged on oral anticoagulation. According to local preferences, acetylsalicylic acid is given orally in the majority of patients with delayed initiation of oral anticoagulation. A non-vitamin K-dependent oral anticoagulant (NOAC) is more often prescribed than a vitamin K-dependent oral anticoagulant (VKA). VKA is more often chosen in patients with previous VKA intake than in VKA naive patients. In the minority of patients, stroke unit leads discuss the prescription of a specific oral anticoagulant with the treating general practitioner. Adherence to medical stroke prevention after hospital discharge is not assessed on a regular basis in any patient by the majority of participating stroke centers.

Conclusions

Early secondary stroke prevention in AF patients in German stroke units is based on OAC use but prescription modalities vary in clinical practice.

http://bit.ly/2TI2HqM

Precise estimation of doping-dependent Raman effect in inorganic solids

Abstract

Here we solve the problem of estimating the Raman frequency shift and the changes to Raman peak intensity due to doping (or changing chemical composition) and temperature consistently. The formalism employed to derive the temperature and doping-dependent Raman intensity ratio [or the ionization energy theory (IET)-based Raman intensity ratio] formula is based on the IET and the energy-level spacing renormalization group method. Therefore, our formalism is entirely based on first principles that does not require any guessed wavefunction nor intrinsic adjustable parameter anywhere in our analysis. The IET-Raman theory is then applied to Si(111), CdS, CdSe, \(\text{Cd}_{1-x}\text{Ca}_x\text{TiO}_3\) and 6H–SiC in order to expose the changes observed in the Raman spectra with respect to their peak intensity and frequency shift. We shall prove and highlight that the experimental Raman spectra obtained for the above-stated materials obey the physicochemical mechanism derived from the IET-Raman intensity formula unambiguously and without any exception. It is worth noting that the said formula can be implemented in all Raman spectroscopy machines as an additional feature to predict the Raman frequency shift and the Raman peak intensity with respect to temperature and changing chemical composition.

http://bit.ly/2TMHagy

Construction of solvable non-central potential using vector superpotential: a new approach

Abstract

We introduce here vector superpotential which is useful to find general potential form using supersymmetric quantum mechanics (SUSY QM) approach. Using the vector superpotential, we reconstruct different solved central potentials and non-central shape variant or shape invariant potentials. To construct and reconstruct the central potentials and non-central potentials, appropriate choice of radial part of the superpotential as well as angular and azimuthal parts of the superpotential is required. Our main aim is to construct angular and azimuthal parts of potential directly from the appropriate choice of vector superpotential. We have reconstructed few potentials which are solved by different researchers using different methods of solution and also constructed new non-central potentials.

http://bit.ly/2Bzdb4F

An Optimized Energy Saving Model for Hybrid Security Protocol in WMN

Abstract

Wireless mesh network (WMN) is an emerging field of research with a large number of applications and associated constraints. WMN is used as a new wireless broadband network structure which is completely based on IP technologies. It has the ability to produce high speed and wide area of coverage, and it also provides a high capacity for handling the nodes. To help authenticate messages, identify valid nodes and remove malevolent node. Security and privacy are two major problems in WMN. Unfortunately, in mesh networks most privacy-preserving schemes are vulnerable to attacks. The most dangerous attack to be noted in mesh network is node impersonation attack which makes them more insecure. WMN is said to be an emerging wireless broadband network structure, where it is completely based on the IP technologies. The mesh routers and clients play a vital role in the mesh networks where they act as a backbone and help the mesh networks to achieve their target in an efficient way. The important factor in the wireless mesh network is to provide a trusted handoff between the nodes, and they need an access authentication effectively. This area can be considered as the vulnerable one, and there is a chance for some attacks which makes the network unstable. Achieving the seamless handoff is a complex case in every dynamic heterogeneous wireless mesh network. This is because providing a security for such kind of structure is very difficult and the existing procedure for providing security for heterogeneous network gives protection for certain types of attacks. In this paper, we use an optimization algorithm for finding the best position for deploying mesh routers and for developing a hybrid and secured model for detecting node impersonation attack by combining ECDSA with CHAP. We also show how our proposed model can handle the throughput, authentication delay, etc., without facing any problem such as energy consumption and delay.

http://bit.ly/2TJwZJy

Riesenzellarteriitis

Zusammenfassung

Die Riesenzellarteriitis (RZA) ist die in der Gefäßmedizin bedeutsamste systemische Vaskulitis. Fortschritte in der bildgebenden Diagnostik, unter anderem der Sonographie, haben die Diagnosestellung der RZA in den letzten 2 Jahrzehnten dramatisch verbessert. Mit dem Interleukin-6-Rezeptor-Antagonisten Tocilizumab steht das erste spezifisch für die RZA zugelassene Medikament zur Verfügung. Angesichts häufiger kranialer und extrakranialer ischämischer Frühkomplikationen und dem bei dieser Erkrankung deutlich erhöhten Risiko für aortale Spätkomplikationen (insb. Aneurysma und Dissektion der thorakalen Aorta) ist der vaskuläre Mediziner heutzutage gefragt wie nie zuvor im interdisziplinären Management dieser Erkrankung.

http://bit.ly/2BCbZ0l

Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma

Abstract

Purpose

To see if road distance to hospital influences stoma reversal rate, time from index operation to stoma reversal, and occurrence of permanent stoma.

Methods

Data from all diagnosed cases of rectal cancer from three counties in northern Sweden were extracted from the Swedish Rectal Cancer Registry. The three counties are sparsely populated, with a population density roughly one fifth the average density in Sweden. Distances to nearest, operating, and largest hospital were obtained using Google Maps™. Matched data on socioeconomic variables were retrieved from Statistics Sweden.

Results

In univariate logistic regression analysis, patients living closer to the operating hospital had a higher likelihood of non-reversal than those living farther away (OR 0.3; 95% CI 0.12–0.76). However, no difference was seen in the multivariate analysis. Of the 717 cases included, 54% received a permanent stoma and 38% a defunctioning stoma at index surgery. The reversal rate of a defunctioning stoma was 83%. At follow-up, 61% still had a stoma, 89% of these were permanent, and 11% non-reversed defunctioning stomas. Median time to stoma reversal was 287 days (82–1557 days). Of all 227 stoma reversals, 77% were done more than 6 months after index surgery.

Conclusions

Longer distance to hospital is not a risk factor for non-reversal of a defunctioning stoma. Only 23% had their defunctioning stoma reversed within 6 months after index surgery. Future studies aiming to determine reversal rate need to extend their follow-up time in order to receive accurate results.

http://bit.ly/2TO0ydc

Laparoscopic surgery to treat leiomyosarcomas of the sigmoid colon:a case report and literature review

Abstract

Background

Leiomyosarcomas (LMSs) of the colon are extremely rare and highly aggressive. Although treatment of gastrointestinal LMS is not standardized, surgical resection is generally performed. The fact that the tumors are usually large at the time of diagnosis may explain why no report on laparoscopic resection of a colonic LMS has appeared.

Case presentation

A 46-year-old male presented with hematochezia 1 month in duration. Abdominal examination including palpation was normal. The levels of several blood tumor markers were normal. Colonoscopy revealed a polypoid lesion approximately 30 mm in diameter in the sigmoid colon 30 cm from the anal verge. Contrast-enhanced computed tomography revealed that the tumor was 28 mm in diameter, and that no lymph node or distant metastasis was apparent. Histopathological examination of a biopsy specimen revealed spindle-shaped cells exhibiting significant nuclear atypia and a trabecular proliferation pattern upon hematoxylin-eosin staining. Immunohistochemically, the sample was positive for SMA and desmin, and negative for c-kit, DOG-1, CD34, and S-100. Furthermore, the Ki-67 index was > 50%. We thus diagnosed a leiomyosarcoma of the sigmoid colon without any metastasis. We performed laparoscopic sigmoid colectomy and regional lymphadenectomy using five trocars. After complete curative resection, a colorectal end-to-end anastomosis was created employing the double-stapling technique. All surgical margins were negative, and no lymph node metastasis was observed. The postoperative course was uneventful, and the patient was discharged 9 days after operation. No recurrence was noted to 1 year after surgery.

Conclusions

We report the first case of a colonic LMS treated via laparoscopic surgery. Although further work is necessary to assess prognosis and to develop the treatment further, laparoscopic surgery to treat small colonic LMSs may be feasible, being both minimally invasive and curative.

http://bit.ly/2Gnhzru

Ten Commandments of Safe and Optimum Neck Dissection

http://bit.ly/2BAvcj8

Ärztliche Sorgfaltspflicht wahren

Der Deutsche Ärztetag hat das Fernbehandlungsverbot gelockert und damit einen wichtigen Grundstein für die Patientenbehandlung per Video, Telefon oder E-Mail gelegt. Ein Rechtsanwalt erklärt, für welche Patienten eine Fernbehandlung infrage kommt.

http://bit.ly/2TO0qdI

Botulinumtoxin A für eine schönere Halskurve

Ein verkürzter Hals wird von vielen als unästhetisch angesehen. Er kann unter anderem durch eine Hypertrophie des Trapeziusmuskels entstehen. Die Injektion von Botulinumtoxin A kann das Erscheinungsbild maßgeblich verbessern und die Patientenzufriedenheit erhöhen.

http://bit.ly/2BykrOa

Wenn es beim Einlesen der E-Card hakt

Immer wieder kommt es in Arztpraxen beim Einlesen von Gesundheitskarten zu technischen Problemen. Die Kassenärztliche Vereinigung Nordrhein gibt einen Überblick über die gängigsten Fehlermeldungen und hat Tipps, was dann zu tun ist.

http://bit.ly/2TO0j1M

Strahlende Haut durch Nahrungsergänzungsmittel

http://bit.ly/2Bxepxp

Dauerhafte Hautstraffung bei Cellulite

http://bit.ly/2TO0eLw

Kein automatischer Urlaubsverfall zum Jahreswechsel

Mit zwei Urteilen hat der Europäische Gerichtshof (EuGH) wiederholt die Arbeitnehmerrechte im Hinblick auf Urlaubsansprüche gestärkt. Der EuGH hat mit seinen Entscheidungen den lange geltenden Grundsatz über Bord geworfen, dass Urlaubsansprüche zum Jahresende automatisch verfallen. Dies kann für jeden Praxisinhaber erhebliche Mehrkosten und -belastungen mit sich bringen. Es lohnt also ein Blick auf die Auswirkungen der Urteile für die tägliche Praxis und darauf, wie man sich vor nachteiligen Folgen schützen kann.

http://bit.ly/2BxejG3

Atrophe Aknenarben: gelen statt nadeln?

Der Schweregrad atropher Aknenarben war sechs Monate nach der Behandlung mit topischem Tazaroten-Gel bei guter Verträglichkeit in gleichem Maß verbessert wie nach Microneedling, so eine Studie.

http://bit.ly/2TTETQw

Ein Schritt in die richtige Richtung!

http://bit.ly/2BxegtR

Efficacy of PD-1 blockade in cervical cancer is related to a CD8 + FoxP3 + CD25 + T-cell subset with operational effector functions despite high immune checkpoint levels

Abstract

Background

Cervical cancer (CxCa) is mainly a locally invading disease that metastasizes to loco-regional lymph node basins before involving distant organs in more advanced stages. Local immune potentiation of tumor-draining lymph nodes (TDLN) may thus protect against tumor progression.

Methods

To identify therapeutic targets for local immune modulation, multi-parameter flow cytometric T-cell profiling of primary cervical tumors (PT) and TDLN (n = 37) was performed. The in-vitro effect of PD-1 blockade on T-cell reactivity to HPV16 E6 oncoproteins was determined in cultures of TDLN and PT single cell suspensions (n = 19). Also, intracellular cytokine staining (ICS) upon anti-CD3 stimulation was performed in metastatic TDLN (LN+) and PT (n = 7), as well as multiplexed immunofluorescence histochemistry staining (n = 8).

Results

Our data revealed elevated rates of activated regulatory T cells (aTregs) and of central or effector memory CD8⁺ T cells in metastatic TDLN (LN+) as compared to tumor-free TDLN (LN-), and equally high or even higher rates of these subsets in PT. Both memory subsets co-expressed multiple immune checkpoints. PD-1 blockade significantly enhanced detectable E6-specific T-cell responses in 4/5 HPV16+ LN+ and in 1/5 HPV16+ PT. Whereas aTreg rates were higher in anti-PD-1 non-responders, in responders elevated levels of CD8⁺FoxP3⁺CD25⁺ T cells were observed, which correlated with the efficacy of PD-1 blockade (P = 0.018). This subset was characterized by an early effector memory phenotype with particularly high levels of co-expressed PD-1, CTLA-4, TIM-3 and LAG-3 checkpoints, but, rather than exhausted, was shown upon polyclonal activation to produce higher levels of Granzyme-B and effector cytokines as compared to its CD8⁺FoxP3⁻ counterparts.

Conclusion

These observations support local PD-(L)1 blockade to interrupt loco-regional immune suppression in CxCa and control metastatic spread to TDLN. Furthermore, our data identify CD8⁺FoxP3⁺CD25⁺ T cells as therapeutic targets, which may also serve as predictive biomarker for PD-(L)1 checkpoint blockade.

http://bit.ly/2DBaLCH

The motility regulator flhDC drives intracellular accumulation and tumor colonization of Salmonella

Abstract

Background

Salmonella have potential as anticancer therapeutic because of their innate tumor specificity. In clinical studies, this specificity has been hampered by heterogeneous responses. Understanding the mechanisms that control tumor colonization would enable the design of more robust therapeutic strains. Two mechanisms that could affect tumor colonization are intracellular accumulation and intratumoral motility. Both of these mechanisms have elements that are controlled by the master motility regulator flhDC. We hypothesized that 1) overexpressing flhDC in Salmonella increases intracellular bacterial accumulation in tumor cell masses, and 2) intracellular accumulation of Salmonella drives tumor colonization in vitro.

Methods

To test these hypotheses, we transformed Salmonella with genetic circuits that induce flhDC and express green fluorescent protein after intracellular invasion. The genetically modified Salmonella was perfused into an in vitro tumor-on-a-chip device. Time-lapse fluorescence microscopy was used to quantify intracellular and colonization dynamics within tumor masses. A mathematical model was used to determine how these mechanisms are related to each other.

Results

Overexpression of flhDC increased intracellular accumulation and tumor colonization 2.5 and 5 times more than control Salmonella, respectively (P < 0.05). Non-motile Salmonella accumulated in cancer cells 26 times less than controls (P < 0.001). Minimally invasive, ΔsipB, Salmonella colonized tumor masses 2.5 times less than controls (P < 0.05). When flhDC was selectively induced after penetration into tumor masses, Salmonella both accumulated intracellularly and colonized tumor masses 2 times more than controls (P < 0.05). Mathematical modeling of tumor colonization dynamics demonstrated that intracellular accumulation increased retention of Salmonella in tumors by effectively causing the bacteria to bind to cancer cells and preventing leakage out of the tumors. These results demonstrated that increasing intracellular bacterial density increased overall tumor colonization and that flhDC could be used to control both.

Conclusions

This study demonstrates a mechanistic link between motility, intracellular accumulation and tumor colonization. Based on our results, we envision that therapeutic strains of Salmonella could use inducible flhDC to drive tumor colonization. More intratumoral bacteria would enable delivery of higher therapeutic payloads into tumors and would improve treatment efficacy.

http://bit.ly/2SvzPFB

New Face of Hepatitis C

Abstract

Chronic hepatitis C viral (HCV) infection continues to carry a high burden of disease despite recent and emerging advancements in treatment. The persistently high prevalence of HCV is attributed to the rising opioid epidemic, with a history of injection drug use as the primary risk factor for infection. As a result, the epidemiology of HCV-infected individuals is changing. Previously a disease of "Baby Boomers," males, and non-Hispanic blacks, the new generation of patients with HCV includes younger adults from 20 to 39 years of age, both men and women similarly represented, and non-Hispanic whites. Shifting trends in these demographics may be attributed to the use of injection drugs, which also has suggested impact on fibrosis progression in infected individuals. Awareness of the changing face of HCV is necessary to expand and revise recommendations regarding screening, outreach, and care engagement of infected individuals, in order to best identify patients at-risk for infection.

http://bit.ly/2DCid0k

Young adult-onset, very slowly progressive cognitive decline with spastic paraparesis in Alzheimer’s disease with cotton wool plaques due to a novel presenilin1 G417S mutation

http://bit.ly/2BANuk2

Heterogeneous nuclear ribonucleoproteins R and Q accumulate in pathological inclusions in FTLD-FUS

Abstract

Frontotemporal lobar degeneration (FTLD) is pathologically subdivided based on the presence of particular pathological proteins that are identified in inclusion bodies observed post-mortem. The FTLD-FUS subgroup is defined by the presence of the fused in sarcoma protein (FUS) in pathological inclusions. FUS is a heterogeneous nuclear ribonucleoprotein (hnRNP) protein and a member of the FET (FUS, EWS, TAF15) protein family. It shuttles between the nucleus and cytoplasm, and has been implicated in many cellular functions including translation, splicing, and RNA transport. EWS, TAF15 and the nuclear import receptor transportin have been shown to co-accumulate with FUS in neuronal inclusions specifically in FTLD-FUS, with transportin-positive inclusions most frequently observed. Here, we report the identification of hnRNP R and hnRNP Q in neuronal cytoplasmic and intranuclear inclusions in the frontal cortex and hippocampus of FTLD-FUS patients, as frequently as transportin. hnRNP R and hnRNP Q were not found in the characteristic pathological inclusions observed in FTLD-TDP (subtypes A-C). Additionally, we studied the expression of hnRNP R in the frontal and temporal cortices from patients with FTLD and found significantly increased expression of the heterogeneous nuclear ribonucleoprotein R in several FTLD disease groups. Our identification of the frequent presence of hnRNP R and hnRNP Q in FTLD-FUS inclusions suggests a potential role for these hnRNPs in FTLD-FUS pathogenesis and supports the role of dysfunctional RNA metabolism in FTLD.

http://bit.ly/2TL9gIX

Cochlear implantation via middle fossa approach - a case report.

Related Articles

Cochlear implantation via middle fossa approach - a case report.

Cochlear Implants Int. 2019 Feb 11;:1-6

Authors: Mankekar G, Arriaga MA, Viator D, Volk JM

Abstract
OBJECTIVE: Cochlear implantation is routinely performed all over the world via the post-auricular, facial recess approach. Our case study describes the middle fossa approach for the management of bilateral profound sensorineural hearing loss in a female child with multiple external, middle and inner ear malformations. The middle fossa approach has been reported sporadically and has been used inconsistently in patients with chronic otitis media and inner ear malformations.
CASE STUDY: A 3-year-old female child presented with bilateral profound sensorineural hearing loss, bilateral anotia, right cochlear nerve agenesis, right facial paralysis, bilateral mild inner ear dysplasia and an aberrant left facial nerve covering the left round window. Further tests indicated that she was a suitable candidate for cochlear implantation and was medically cleared for surgery. In view of the multiple malformations and high risk of injury to her only functioning left facial nerve on the side with a cochlear nerve, cochlear implantation via a middle fossa approach was performed.
CONCLUSION: Middle fossa approach to cochlear implantation is challenging but can be safely performed even in children and offers an option in patients when a routine mastoidectomy, facial recess and round window approach cannot be undertaken.

PMID: 30741118 [PubMed - as supplied by publisher]

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Examination of the Patient with Dizziness or Imbalance.

Related Articles

Examination of the Patient with Dizziness or Imbalance.

Med Clin North Am. 2019 Mar;103(2):191-201

Authors: Whitman GT

Abstract
Dizziness and imbalance are common and challenging chief complaints carrying high morbidity, due to their association with falls, injuries, and loss of quality of life. The physical examination represents an opportunity to collect objective clinical data that facilitate an understanding of symptoms that might otherwise be enigmatic and ineffable. This review focuses on the examination techniques used routinely by physicians who provide specialized care for patients with dizziness and imbalance.

PMID: 30704676 [PubMed - indexed for MEDLINE]

from #Audiology via ola Kala on Inoreader http://bit.ly/2SPuwA4
via IFTTT

Cochlear implantation via middle fossa approach - a case report.

Related Articles

Cochlear implantation via middle fossa approach - a case report.

Cochlear Implants Int. 2019 Feb 11;:1-6

Authors: Mankekar G, Arriaga MA, Viator D, Volk JM

Abstract
OBJECTIVE: Cochlear implantation is routinely performed all over the world via the post-auricular, facial recess approach. Our case study describes the middle fossa approach for the management of bilateral profound sensorineural hearing loss in a female child with multiple external, middle and inner ear malformations. The middle fossa approach has been reported sporadically and has been used inconsistently in patients with chronic otitis media and inner ear malformations.
CASE STUDY: A 3-year-old female child presented with bilateral profound sensorineural hearing loss, bilateral anotia, right cochlear nerve agenesis, right facial paralysis, bilateral mild inner ear dysplasia and an aberrant left facial nerve covering the left round window. Further tests indicated that she was a suitable candidate for cochlear implantation and was medically cleared for surgery. In view of the multiple malformations and high risk of injury to her only functioning left facial nerve on the side with a cochlear nerve, cochlear implantation via a middle fossa approach was performed.
CONCLUSION: Middle fossa approach to cochlear implantation is challenging but can be safely performed even in children and offers an option in patients when a routine mastoidectomy, facial recess and round window approach cannot be undertaken.

PMID: 30741118 [PubMed - as supplied by publisher]

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

Examination of the Patient with Dizziness or Imbalance.

Related Articles

Examination of the Patient with Dizziness or Imbalance.

Med Clin North Am. 2019 Mar;103(2):191-201

Authors: Whitman GT

Abstract
Dizziness and imbalance are common and challenging chief complaints carrying high morbidity, due to their association with falls, injuries, and loss of quality of life. The physical examination represents an opportunity to collect objective clinical data that facilitate an understanding of symptoms that might otherwise be enigmatic and ineffable. This review focuses on the examination techniques used routinely by physicians who provide specialized care for patients with dizziness and imbalance.

PMID: 30704676 [PubMed - indexed for MEDLINE]

from #Audiology via ola Kala on Inoreader http://bit.ly/2SPuwA4

Cochlear implantation via middle fossa approach - a case report.

Related Articles

Cochlear implantation via middle fossa approach - a case report.

Cochlear Implants Int. 2019 Feb 11;:1-6

Authors: Mankekar G, Arriaga MA, Viator D, Volk JM

Abstract
OBJECTIVE: Cochlear implantation is routinely performed all over the world via the post-auricular, facial recess approach. Our case study describes the middle fossa approach for the management of bilateral profound sensorineural hearing loss in a female child with multiple external, middle and inner ear malformations. The middle fossa approach has been reported sporadically and has been used inconsistently in patients with chronic otitis media and inner ear malformations.
CASE STUDY: A 3-year-old female child presented with bilateral profound sensorineural hearing loss, bilateral anotia, right cochlear nerve agenesis, right facial paralysis, bilateral mild inner ear dysplasia and an aberrant left facial nerve covering the left round window. Further tests indicated that she was a suitable candidate for cochlear implantation and was medically cleared for surgery. In view of the multiple malformations and high risk of injury to her only functioning left facial nerve on the side with a cochlear nerve, cochlear implantation via a middle fossa approach was performed.
CONCLUSION: Middle fossa approach to cochlear implantation is challenging but can be safely performed even in children and offers an option in patients when a routine mastoidectomy, facial recess and round window approach cannot be undertaken.

PMID: 30741118 [PubMed - as supplied by publisher]

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

Examination of the Patient with Dizziness or Imbalance.

Related Articles

Examination of the Patient with Dizziness or Imbalance.

Med Clin North Am. 2019 Mar;103(2):191-201

Authors: Whitman GT

Abstract
Dizziness and imbalance are common and challenging chief complaints carrying high morbidity, due to their association with falls, injuries, and loss of quality of life. The physical examination represents an opportunity to collect objective clinical data that facilitate an understanding of symptoms that might otherwise be enigmatic and ineffable. This review focuses on the examination techniques used routinely by physicians who provide specialized care for patients with dizziness and imbalance.

PMID: 30704676 [PubMed - indexed for MEDLINE]

from #Audiology via ola Kala on Inoreader http://bit.ly/2SPuwA4
via IFTTT

A candidate for lung cancer treatment: arsenic trioxide

Abstract

Arsenic trioxide (ATO), a highly effective drug in treating acute promyelocytic leukemia with low toxicity, demonstrates a significant effect on lung cancer. The anti-cancer mechanisms of ATO include inhibition of cancer stem-like cells, induction of apoptosis, anti-angiogenesis, sensitization of chemotherapy and radiotherapy, anti-cancer effects of hypoxia, and immunoregulation properties. In addition, some studies have reported that different lung cancers respond differently to ATO. It was concluded on numerous studies that the rational combination of administration and encapsulation of ATO have promising potentials in increasing drug efficacy and decreasing adverse drug effects. We reviewed the efficacy of ATO in the treatment of lung cancer in recent years to provide some views for further study.

http://bit.ly/2E64rV6

Asymmetric cavernous sinus enlargement: a novel finding in Sturge–Weber syndrome

Abstract

Purpose

Enlargement of deep cerebral veins and choroid plexus engorgement are frequently reported in Sturge–Weber syndrome. We aim to describe cavernous sinus involvement in patients with this syndrome and to identify possible clinical-neuroimaging correlations.

Methods

Sixty patients with Sturge–Weber syndrome (31 females, mean age 4.5 years) and 120 age/sex-matched controls were included in this retrospective study. We performed a visual analysis to identify patients with asymmetric cavernous sinus enlargement. Then, we measured on axial T2WI the left (A), right (B), and bilateral (LL) transverse diameters of the cavernous sinus. We calculated the module of the difference |A-B| and the cavernous sinus asymmetry index as the ratio |A-B|/LL. Differences among groups were assessed by Mann–Whitney U and Kruskal–Wallis tests. Clinicoradiological associations were evaluated by Fisher exact test.

Results

We found seven subjects (11.6%) with asymmetric CS enlargement. The |A-B| and cavernous sinus asymmetry index were higher in patients with asymmetric CS enlargement compared with controls and patients without visible CS abnormalities (p_B < 0.05). Asymmetric CS enlargement was always ipsilateral to facial port-wine stains (7/7), and, when present, to leptomeningeal vascular malformations (4/7). It was significantly associated with ipsilateral bone marrow changes (p = 0.013) and dilated veins (p = 0.002). Together with brain atrophy and deep venous dilatation, this sign was associated with neurological deficits (p < 0.05).

Conclusions

We expanded the spectrum of venous abnormalities in SWS, showing the presence of asymmetric cavernous sinus enlargement in more than one tenth of patients, likely related to increased venous drainage.

http://bit.ly/2TKqgzc

Neuroradiological and clinical features in ophthalmoplegia

Abstract

Purpose

Especially in acute onset of ophthalmoplegia, efficient neuroradiological evaluation is necessary to assist differential diagnosis, clinical course, and treatment options.

Methods

Different manifestations of ophthalmoplegia are explained and illustrated by characteristic neuroradiological and clinical findings.

Results

To present those ophthalmoplegic disorders in a clear manner, this review refers to different neuroanatomical structures and compartments. From neuroophthalmological point of view, diseases going ahead with ophthalmoplegia can be divided into (1) efferent infranuclear/peripheral disturbances involving oculomotor cranial nerves, (2) conjugate gaze abnormalities due to internuclear or supranuclear lesions, and (3) diseases of the extraocular eye muscles or their impairment due to intraorbital pathologies.

Conclusion

The knowledge of the relationship between neurological findings in ophthalmoplegia and involved neuroanatomical structures is crucial, and neuroradiology can be focused on circumscribed anatomical regions, using optimized investigation protocols.

http://bit.ly/2tkcmYN

Face recognition with single sample per person using HOG–LDB and SVDL

Abstract

The recognition rate of some face recognition methods that require a certain number of samples will be significantly reduced in case only one sample is available for training. Aim at this situation, a new feature extraction method, HOG–LDB (histogram of oriented gradients–local difference binary), is proposed. Then, we combined this method with SVDL (sparse variation dictionary learning) to recognize the probe images with different facial variations (e.g., illuminations, poses, expressions and disguises). The descriptor of HOG–LDB can extract the edge features and local pattern features of the image. After the feature extraction, SVDL is employed in the generic training set and the generic variation dictionary is obtained. Then, the dictionary is used for predicting the subjects of the probe images with different facial variations. Finally, experimental results on the AR dataset, the Yale dataset, the Extended Yale B dataset and the CMU-PIE dataset proved the validity of the proposed method.

http://bit.ly/2SHPctX

Photo-Assisted Dietary Method Improves Estimates of Dietary Intake Among People with Sleeve Gastrectomy

Abstract

Introduction

Bariatric operations are effective obesity treatments because of the significant reductions in food intake after surgery, but weight regain remains a problem in a small group of patients after surgery. Estimating food intake is difficult due to dieting status, weight, gender, and challenges with estimating portion size. We aimed to evaluate the use of digital food photography in comparison to conventional methods among patients after sleeve gastrectomy.

Methods

Participants used a mobile device (mHealth) to photo-document their dietary intake of all food and beverages consumed before and after eating. They also completed a 24 h food recall interview with a dietician.

Results

Data from 383 eating occasions were analyzed. Food intake using 24 h recall was reported as 972.5 ± 77 kcal and estimates from photographs were 802.9 ± 63.4 kcal, with a difference of 169.6 ± 451.4 kcal (95% confidence interval (CI) of 41.4 to 297.9 kcal, p = 0.005). There was no difference for protein intake, but carbohydrate intake reported during the 24 h recall was 541.2 ± 298 kcal and estimates from photographs were 395.2 ± 219.6 kcal, with a difference of 145.8 ± 256.3 kcal (95% CI of 73.2 to 218.8 kcal, p = 0.0001).

Conclusion

After sleeve gastrectomy, patients reported eating more total calories and calories from carbohydrates compared to estimations using photographs. The implication for patients are that tools such as mHealth might be useful to optimize food intake and calories after sleeve gastrectomy, especially for those patients that may struggle with weight regain after surgery.

http://bit.ly/2SvrPVb

Preventing Skin Cancer Among Staff and Guests at Seaside Hotels

Abstract

Beach users and outdoor workers in resort areas are major risk groups for skin cancer, and therefore seaside hotels constitute a strategic area in which to conduct awareness-raising campaigns and interventions. The main aim of the present study is to describe habits, attitudes and knowledge related to sun exposure, the sunburn events experienced and potentially malignant skin lesions observed among hotel staff and guests recruited during a skin cancer prevention campaign at seaside hotels in the western Costa del Sol (southern Spain). This descriptive cross-sectional study was conducted at four seaside hotels in the western Costa del Sol. An 8-day awareness-raising campaign on skin cancer was conducted for hotel guests and staff, who were invited to complete a questionnaire about their habits, attitudes and knowledge regarding photoprotection, and to receive a comprehensive skin examination. The questionnaire on habits, attitudes and knowledge related to sun exposure was completed by 542 participants. The most common photoprotection practice was the use of sunglasses (79.3%). Potentially dangerous lesions were identified in 39 persons (14%). In addition, 94.0% reported having gained new knowledge, 89.6% had changed their attitudes towards sun tanning and 94.7% intended to improve their photoprotection practices in the future. Seaside hotels are an optimal scenario for conducting studies aimed at skin cancer prevention and reduction. Further studies should be carried out in other geographical areas to confirm our results, to evaluate the costs and benefits of such interventions and determine their long-term impact on health.

http://bit.ly/2TQ2rWQ

Perceptions of Cancer Causes, Prevention, and Treatment Among Navajo Cancer Survivors

Abstract

Native Americans experience cancer-related health disparities. Yet, little is known about the current cancer experience in one of the largest Native American tribe, Navajo. A qualitative study of among Navajo cancer survivors, in which focus groups and individual interviews included questions related to perceptions of cancer causes, prevention, and treatment, allowed us to evaluate several aspects of the cancer experience from the Navajo perspective. An experienced, bilingual facilitator led the discussions using a standardized guide. Discussions were audio-recorded, documented by field notes, translated, as needed, and transcribed. NVivo software was used to summarize major themes according to the PEN-3 and health belief models. Navajo cancer survivors (N = 32) were both males (n = 13) and females (n = 19) that had been previously diagnosed with a variety of cancers: colorectal, breast, ovarian, cervical, esophageal, gall bladder, stomach, prostate, kidney, and hematologic. Many survivors had accurate knowledge of risk factors for cancer. Barriers to screening and clinical care included language, expense, geography, fear, lack of information, skepticism related to Western medicine, and treatment side effects. While some survivors experienced familial support, others were isolated from the family and community due to the perspective of cancer as a contagion. However, resilience, hope, trust in select community organizations, a desire to restore balance, and to support younger generations were positive attributes expressed regarding the treatment and recovery process. These evaluations need to be replicated across a larger cross-section of the Native cancer survivor community.

http://bit.ly/2BwUWgj

Comprehensive analysis of genetic aberrations linked to tumorigenesis in regenerative nodules of liver cirrhosis

Abstract

Background

Hepatocellular carcinoma (HCC) recurrently develops in cirrhotic liver containing a number of regenerative nodules (RNs). However, the biological tumorigenic potential of RNs is still unclear. To uncover the molecular bases of tumorigenesis in liver cirrhosis, we investigated the genetic aberrations in RNs of cirrhotic tissues using next-generation sequencing.

Methods

We isolated 205 RNs and 7 HCC tissues from the whole explanted livers of 10 randomly selected patients who had undergone living-donor liver transplantation. Whole-exome sequencing and additional targeted deep sequencing on 30 selected HCC-related genes were conducted to reveal the mutational landscape of RNs and HCCs.

Results

Whole-exome sequencing demonstrated that RNs frequently harbored relatively high-abundance genetic alterations, suggesting a clonal structure of each RN in cirrhotic liver. The mutation signature observed in RNs was similar to those determined in HCC, characterized by a predominance of C>T transitions, followed by T>C and C>A mutations. Targeted deep sequencing analyses of RNs identified nonsynonymous low-abundance mutations in various tumor-related genes, including TP53 and ARID1A. In contrast, TERT promoter mutations were not detected in any of the RNs examined. Consistently, TERT expression levels in RNs were comparable to those in normal livers, whereas every HCC tissue demonstrated an elevated level of TERT expression.

Conclusion

Analyses of RNs constructing cirrhotic liver indicated that a variety of genetic aberrations accumulate in the cirrhotic liver before the development of clinically and histologically overt HCC. These aberrations in RNs could provide the basis of tumorigenesis in patients with liver cirrhosis.

http://bit.ly/2X1wZa7

Radiology reporting of low-grade glioma growth underestimates tumor expansion

Abstract

Background

An important aspect in the management of patients with diffuse low-grade gliomas (LGGs) involves monitoring the lesions via serial magnetic resonance imaging (MRI). However, radiological interpretations of LGG interval scans are often qualitative and thus difficult to use clinically.

Methods

To contextualize these assessments, we retrospectively compared radiological interpretations of LGG growth or stability to volume change measured by manual segmentation. Tumor diameter was also measured in one, two, and three dimensions to evaluate reported methods for assessment of glioma progression, including RECIST criteria, Macdonald/RANO criteria, and mean tumor diameter/ellipsoid method.

Results

Tumors evaluated as stable by radiologists grew a median volume of 5.1 mL (11.1%) relative to the comparison scan, and those evaluated as having grown had a median volume increase of 13.3 mL (23.7%). Diameter-based measurements corresponded well but tended to overestimate gold standard segmented volumes. In addition, agreement with segmented volume measurements improved from 17.6 ± 8.0 to 4.5 ± 5.8 to 3.9 ± 3.6 mm for diameter and from 104.0 ± 96.6 to 25.3 ± 36.8 to 15.9 ± 21.3 mL for volume with radiological measurements in one, two, and three dimensions, respectively. Measurement overestimation increased with tumor size.

Conclusions

Given accumulating evidence that LGG volume and growth are prognostic factors, there is a need for objective lesion measurement. Current radiological reporting workflows fail to appreciate and communicate the true expansion of LGGs. While volumetric analysis remains the gold standard for assessment of growth, careful diametric measurements in three dimensions may be an acceptable alternative.

http://bit.ly/2Gls8eN

Step-wise pterional combined epidural and subdural approach to clip large carotid-ophthalmic segment aneurysms

Abstract

Background

Microsurgical clipping of large ophthalmic-carotid artery (OA) aneurysms is technically challenging. Among the reported approaches, pterional combined epidural and subdural approach is one of the efficient choices.

Method

We have applied this approach to treat a 33-year old female patient with a left large OA aneurysm. The step-wise technical details of this approach are reported.

Conclusion

We show that it is a safe way to clip large OA aneurysms through a step-wise pterional combined epidural and subdural approach, which could make a clear anatomy and a confident manipulation.

http://bit.ly/2Ib99VU

The association between preoperative edema and postoperative cognitive functioning and health-related quality of life in WHO grade I meningioma patients

Abstract

Background

Studies on the associations between preoperative cerebral edema, cognitive functioning, and health-related quality of life (HRQOL) in WHO grade I meningioma patients are virtually lacking. We studied the association between preoperative cerebral edema on postoperative cognitive functioning and HRQOL 6 months postoperatively in WHO grade I meningioma patients.

Methods

Twenty-one consecutive WHO grade I meningioma patients, who underwent surgery, were matched individually for age, gender, and educational level to healthy controls. Tumor and edema volume were assessed on preoperative T1- and T2-weighted MRI images, respectively. At least 5 months postoperatively, functional status, cognitive functioning, and HRQOL, using a cognitive test battery and the Short-Form Health Survey (SF-36), were determined. The correlation between preoperative tumor and cerebral edema volume with postoperative cognitive functioning and HRQOL was investigated using Kendall's tau coefficients.

Results

Compared to healthy controls, patients had lower verbal memory capacity (p = .012), whereas HRQOL was similar to matched healthy controls. In all cognitive domains, postoperative functioning was much lower in patients with preoperative cerebral edema than in those without. There were significant correlations between preoperative cerebral edema and tumor volume and postoperative cognitive functioning. Preoperative cerebral edema and/or tumor volume were not associated with HRQOL.

Conclusions

Our results suggest that WHO grade I meningioma patients with larger volumes of preoperative cerebral edema are more at risk of experiencing limitations in longer-term cognitive functioning than patients with no or less edema preoperatively. This is an important knowledge for neurologists and neurosurgeons treating patients with a meningioma. More studies regarding the effect of peritumoral edema on cognitive functioning in meningioma patients are necessary.

http://bit.ly/2GrljrY

Early postoperative MRI after resection of brain metastases—complete tumour resection associated with prolonged survival

Abstract

Background

This study aimed to investigate the incidence of residual tumour after resection of brain metastases using early postoperative magnetic resonance imaging (MRI) and the influence of residual tumour on overall patient survival.

Methods

Data from 72 consecutive adult patients undergoing surgery for cerebral metastases over an 18-month study period were retrospectively collected. Early postoperative MRI was used to determine the presence of postoperative residual tumour. Patients were divided into three groups according to the presence of tumour remnant on early postoperative MRI: "no residual tumour", "non-measurable residual tumour" and "measurable residual tumour". Survival analysis (mean estimate survival time) was performed using the Kaplan–Meier and log-rank (mantel cox) tests and compared between groups. Surgical reports were evaluated with regard to the surgeon statement about intraoperative extent of resection (EOR) and compared with the presence of tumour remnant found on the early postoperative MRI.

Results

Sixty-eight procedures were followed by early postoperative MRI. MRI verified the presence of "measurable residual tumour" following 15 procedures (22%). MRI confirmed complete resection in 57%. Gross total resection was described by the operating surgeon in 85% of the procedures. There was a significant difference in survival time after surgery between the group having no residual tumour on MRI and the group with measurable residual tumour (p = 0.025). This difference could not be explained by the differences in postoperative radiation therapy. The longest survival was found in patients with non-measurable and no residual tumour on early postoperative MRI, who also received postoperative radiotherapy.

Conclusion

Residual tumour was seen on MRI after 22% of the procedures. The intraoperative assessment of EOR performed by the surgeon diverged from the early postoperative MRI in 40% of procedures. Correct assessment of residual tumour thus requires early postoperative MRI. Measurable residual tumour on early postoperative MRI was associated with shorter overall survival independent on postoperative radiotherapy.

http://bit.ly/2Ib98kO

Carbon dioxide direct air capture for effective climate change mitigation based on renewable electricity: a new type of energy system sector coupling

Abstract

Pathways for achieving the 1.5–2 °C global temperature moderation target imply a massive scaling of carbon dioxide (CO₂) removal technologies, in particular in the 2040s and onwards. CO₂ direct air capture (DAC) is among the most promising negative emission technologies (NETs). The energy demands for low-temperature solid-sorbent DAC are mainly heat at around 100 °C and electricity, which lead to sustainably operated DAC systems based on low-cost renewable electricity and heat pumps for the heat supply. This analysis is carried out for the case of the Maghreb region, which enjoys abundantly available low-cost renewable energy resources. The energy transition results for the Maghreb region lead to a solar photovoltaic (PV)-dominated energy supply with some wind energy contribution. DAC systems will need the same energy supply structure. The research investigates the levelised cost of CO₂ DAC (LCOD) in high spatial resolution and is based on full hourly modelling for the Maghreb region. The key results are LCOD of about 55 €/t_CO2 in 2050 with a further cost reduction potential of up to 50%. The area demand is considered and concluded to be negligible. Major conclusions for CO₂ removal as a new energy sector are drawn. Key options for a global climate change mitigation strategy are first an energy transition towards renewable energy and second NETs for achieving the targets of the Paris Agreement.

http://bit.ly/2SPOVow

Genome sequence of a spore-laccase forming, BPA-degrading Bacillus sp. GZB isolated from an electronic-waste recycling site reveals insights into BPA degradation pathways

Abstract

Bisphenol A (BPA) is a synthetic chemical with known deleterious effects on biota. A genome sequencing project is an important starting point for designing a suitable BPA bioremediation process, because it provides valuable genomic information about the physiological, metabolic, and genetic potential of the microbes used for the treatment. This study explored genomic insights provided by the BPA-degrading strain Bacillus sp. GZB, previously isolated from electronic-waste-dismantling site. The GZB genome is a circular chromosome, comprised of a total of 4,077,007 bp with G+C content comprising 46.2%. Genome contained 23 contigs encoded by 3881 protein-coding genes with nine rRNA and 53 tRNA genes. A comparative study demonstrated that strain GZB bloomed with some potential features as compared to other Bacillus species. In addition, strain GZB developed spore cells and displayed laccase activity while growing at elevated stress levels. Most importantly, strain GZB contained many protein-coding genes associated with BPA degradation, as well as the degradation of several other compounds. The protein-coding genes in the genome revealed the genetic mechanisms associated with the BPA degradation by strain GZB. This study predicts four possible degradation pathways for BPA, contributing to the possible use of strain GZB to remediate different polluted environments in the future.

http://bit.ly/2I73G2l

The influence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis

Abstract

Background

The aim of this systematic review and meta-analysis was to evaluate the morbidity of loop ileostomy (LI) and loop colostomy (LC) creation in restorative anterior resection for rectal cancer as well as the morbidity of their reversal.

Methods

PubMed, EMBASE, MEDLINE via Ovid, and Cochrane Library were systematically searched for records published from 1980 to 2017 by three independent researchers. The primary endpoint was overall morbidity after stoma creation and reversal. Mantel-Haenszel odds ratio (OR) was used to compare categorical variables. Clinical significance was evaluated using numbers needed to treat (NNT).

Results

Six studies (two randomized controlled trials and four observational studies) totaling 1063 patients (666 LI and 397 LC) were included in the meta-analysis. Overall morbidity rate after both stoma creation and closure was 15.6% in LI vs. 20.4% in LC [OR(95%CI) = 0.67 (0.29, 1.58); p = 0.36] [NNT(95%CI) = 21 (> 10.4 to benefit, > 2430.2 to harm)]. Morbidity rate after stoma creation was both statistically and clinically significantly lower after LI [18.2% vs. 30.6%; OR(95%CI) = 0.42 (0.25, 0.70); p = 0.001; NNT(95%CI) = 9 (4.7, 29.3)]. Dehydration rate was 3.1% (8/259) in LI vs. 0% (0/168) in LC. The difference was not statistically or clinically significant [OR(95%CI) = 3.00 (0.74, 12.22); p = 0.13; NNT (95%CI) = 33 (19.2, 101.9)]. Ileus rates after stoma closure were significantly higher in LI as compared to LC [5.2% vs. 1.7%; OR(95%CI) = 2.65 (1.13, 6.18); p = 0.02].

Conclusions

This meta-analysis found no difference between LI and LC in overall morbidity after stoma creation and closure. Morbidity rates following the creation of LI were significantly decreased at the cost of a risk for dehydration.

http://bit.ly/2SMttAW

Self-reported snoring and incident cardiovascular disease events: results from the Jackson Heart Study

Abstract

Purpose

Evidence suggests that snoring is associated with increased risk for cardiovascular disease (CVD) events such as myocardial infarction and stroke. Limited data exists pertaining to this association among African Americans. We therefore examined the association between self-reported habitual snoring and incident CVD in the Jackson Heart Study (JHS), a population-based cohort study of African Americans.

Methods

Self-reported data on snoring and risk factors for CVD were collected at baseline (2000–2004). Participants were followed prospectively for the development of incident CVD. Habitual snoring was defined as present if the participants reported it as "often" or "almost always" or absent if reported as "sometimes," "never," or "seldom." A CVD event included stroke, myocardial infarction, coronary revascularization procedure, or fatal CHD event. Cox proportional hazards models assessed the independent association between self-reported habitual snoring and incident CVD event adjusting for multiple covariates, including age, sex, hypertension, body mass index, diabetes, hypercholesterolemia, and smoking status.

Results

The snorer group consisted of 787 participants (mean age 52.1 years) and the nonsnorer group consisted of 3708 participants (mean age 54.9 years). Frequency of incident CVD events in the snorer group was not significantly different from the nonsnorer group. The fully adjusted hazard ratio for a CVD event in the snorer group was 1.01 (95% confidence interval [0.69, 1.47], p value of 0.96).

Conclusion

In conclusion, self-reported habitual snoring was not associated with incident CVD among this large African American cohort. Future studies providing objective data on snoring and sleep apnea may provide more information on the snoring-CVD association among African Americans.

Trial registration

Identification Number: NCT00005485

http://bit.ly/2GnzPkm

TAVR—present, future, and challenges in developing countries

Abstract

Transcatheter aortic valve replacement (TAVR) has become a well-established therapy for inoperable and high-risk patients of Aortic Stenosis in most of the part of the world. The technological advancements in the hemodynamic performance and design of valve prosthesis and also the data provided by various trials regarding the safety and efficacy of TAVR have widened the scope of TAVR in intermediate and low-risk groups also. The main focus of this review is to discuss the feasibility of TAVR in developing countries. Along with this review, it also gives a detailed outlook of the pros and cons of TAVR along with insight into the future of TAVR and its adoption into the low-risk group.

http://bit.ly/2WXMvng

Source localization of epileptiform discharges in childhood absence epilepsy using a distributed source model: a standardized, low-resolution, brain electromagnetic tomography (sLORETA) study

Abstract

Localizing the source of epileptiform discharges in generalized epilepsy has been controversial for the past few decades. Recent neuroimaging studies have shown that epileptiform discharges in generalized epilepsy can be localized to a particular region. Childhood absence epilepsy (CAE) is the most common generalized epilepsy in childhood and is considered the prototype of idiopathic generalized epilepsy (IGE). To better understand electrophysiological changes and their development in CAE, we investigated the origin of epileptiform discharges. We performed distributed source localization with standardized, low-resolution, brain electromagnetic tomography (sLORETA). In 16 children with CAE, sLORETA images corresponding to the midpoint of the ascending phase and the negative peak of the spike were obtained from a total of 242 EEG epochs (121 epochs at each timepoint). Maximal current source density (CSD) was mostly located in the frontal lobe (69.4%). At the gyral level, maximal CSD was most commonly in the superior frontal gyrus (39.3%) followed by the middle frontal gyrus (14.0%) and medial frontal gyrus (8.7%). At the hemisphere level, maximal CSD was dominant in the right cerebral hemisphere (63.6%). These results were consistent at the midpoint of the ascending phase and the negative peak of the spike. Our results demonstrated that the major source of epileptiform discharges in CAE was the frontal lobe. These results suggest that the frontal lobe is involved in generating CAE. This finding is consistent with recent studies that have suggested selective cortical involvement, especially in the frontal regions, in IGE.

http://bit.ly/2GnZA4k

Acid-Generating Waste Rocks as Capillary Break Layers in Covers with Capillary Barrier Effects for Mine Site Reclamation

Abstract

Tailings and waste rocks can be used to build covers with capillary barrier effects (CCBE) for the purposes of reclaiming acid-generating waste storage facilities while enhancing the value of the materials available on site. The efficiency of non-acid generating tailings, desulfurized tailings, and non-reactive waste rocks as cover materials was demonstrated in previous laboratory and field studies. However, acid-generating waste rocks are usually not considered for cover construction because of the risk of contamination. Nonetheless, using acid-generating waste rocks as the bottom capillary break layer in a CCBE could have economic and logistical benefits for companies, including helping to reduce the volume of waste rock piles and to valorize material that are generally considered to be problematic. In this study, laboratory column tests were performed to evaluate cover scenarios using acid-generating waste rocks from Westwood-Doyon mine (Québec, Canada). These waste rocks were placed under a moisture-retaining layer made of desulfurized tailings. A column test with non-acid-generating waste rocks was also performed for comparison purposes. Columns were submitted to eight wetting/drainage cycles. The performance of these systems was assessed by monitoring the volumetric water content in the different layers and by analyzing the water quality of the leachates. Significant reductions in contamination were observed when covers were added on the reactive waste rocks. These results suggest that it could be possible to valorize acid-generating waste rocks in cover systems.

http://bit.ly/2DynhCY

Grasshopper optimization algorithm–based approach for the optimization of ensemble classifier and feature selection to classify epileptic EEG signals

Abstract

Epilepsy is one of the most common neurological disease worldwide. It is diagnosed by analyzing a long electroencephalogram (EEG) recording in a clinical environment, which may be much prone to errors and a time-consuming task. In this paper, a methodology for the classification of an epileptic seizure is proposed for analyzing EEG signals. EEG signal is decomposed into intrinsic mode functions (IMFs) using empirical mode decomposition (EMD). A fusion, of the extracted non-linear and spike-based features from each of the IMF signals, is made. The parameters of five machine learning algorithms; k-nearest neighbor (k-NN), extreme learning machine (ELM), random forest (RF), support vector machine (SVM), and artificial neural network (ANN) are optimized, as well as a set of the significant features is chosen using grasshopper optimization algorithm (GOA). These classifiers with their optimized parameters are ensembled together for the classification of epileptic seizures. The results show that ensemble classifier performs better than individual classifier. A comparison of the proposed methodology with state of the art epileptic seizure detection techniques is also made for validation.

Graphical abstract

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http://bit.ly/2WZ5JJ5

L-type Ca 2+ channels’ involvement in IFN-γ-induced signaling in rat ventricular cardiomyocytes

Abstract

The purpose of this study was to examine the effects of interferon-γ (IFN-γ) on calcium movement in rat ventricular myocytes. L-type Ca²⁺ currents (I_Ca,L) were recorded with the whole-cell configuration of the patch-clamp techniques. IFN-γ induces current density reduction at the test potential of 0 mV by 47.6 ± 7.4%. Heparin, a selective inhibitor of inositol-1,4,5-triphosphate (IP₃)–induced Ca²⁺ release, applied via a patch pipette, induced an I_Ca,L amplitude decrease of about 46 ± 5.6%. The addition of IFN-γ to heparin-treated cells has no effect on I_Ca,L. Ryanodine induced an I_Ca,L current amplitude decrease of 35.1 ± 6.2%. The addition of IFN-γ to ryanodine-treated cells caused an additional I_Ca,L inhibiting of 17.6 ± 4.8%. Both cyclopiazonic acid (CPA), a specific SERCA inhibitor, and a combination of CPA and ryanodine caused a significant reduction of the I_Ca,L amplitudes. Subsequent addition of IFN-γ inhibited I_Ca,L for an additional 16.3 ± 4.4%. The employment of chelerythrine in this study prevented IFN-γ-induced L-type Ca²⁺ channel inhibition in only 10 min from the start of perfusion. Proposed mechanisms of regulation involved IFN-γ-induced IP3-sensitive Ca²⁺ release probably by a Ca²⁺-dependent translocation of PKC from the cytoplasm to the cell membrane as the obligatory first step of the IFN-γ-induced PKC-dependent L-type Ca²⁺ channel inhibition.

http://bit.ly/2RZ1ARR

Modulating the Effect of Iron and Total Organic Carbon on the Efficiency of a Hydrogen Peroxide-Based Algaecide for Suppressing Cyanobacteria

Abstract

The intensity and frequency of cyanobacteria-dominated harmful algal blooms (cHABs) has been increasing. A key issue associated with cHABs is the potential to release cyanotoxins, such as microcystin. One of the primary methods for addressing cHABs in a reservoir is the application of algaecides. This research evaluated the impact of common environmental factors (i.e., Fe, total organic carbon) on the efficacy of a hydrogen peroxide-based algaecide to attain control of a targeted cyanobacterial population. The results found that sodium carbonate peroxydrate (SCP, trade name PAK®27) at half the manufacturer's suggested application was effective at suppressing cyanobacteria for 2 weeks. For example, reactors that contained a full level of TOC and 1 mg/L Fe significantly decreased by 89% from 21,899 to 2437 ± 987 cells/mL (p < 0.05) by 2 days after treatment with half-dose SCP while reactors that contained the full-dose TOC and no SCP treatment depicted an increase in cyanobacteria population over the first week. Furthermore, as the cyanobacteria population decreased, the algal assemblage began to switch to being green algae dominant. Under the experimental conditions evaluated, Fe and total organic content did not interfere with the efficacy of SCP. SCP can provide effective control of cyanobacteria in a variety of environmental conditions.

http://bit.ly/2StejkU

Joshua Edel, Aleksandar Ivanov, MinJun Kim (Eds.): Nanofluidics, 2nd ed.

http://bit.ly/2tjd20I

Enhanced electrochemiluminescent brightness and stability of porphyrins by supramolecular pinning and pinching for sensitive zinc detection

Abstract

Ultrasensitive electrochemiluminescence (ECL) detection can benefit substantially from the rational configuration of emitter−enhancer stereochemistry. Here, using zinc(II) meso-5,10,15,20-tetra(4-sulfonatophenyl)porphyrin (ZnTSPP) as a model, we demonstrate that both the ECL intensity and the photostability of this emitter were significantly improved when it was trapped in pyridyl-bridged β-cyclodextrin dimer (Py(CD)₂); a synthetic enhancer that is ECL inactive. Through NMR characterization, we confirmed that ZnTSPP formed a clam-like inclusion complex involving pinning and pinching forces from the biocompatible container Py(CD)₂. Up to a threefold increase in the ECL brightness of ZnTSPP was witnessed when it was encapsulated in β-CD. Absorption and emission spectroscopic data revealed that both the extended excitation lifetime and the restricted mobility of the guest contributed to the observed improvement in signal transduction within the host molecule. This bioinspired entrapment also led to a marked boost in ECL stability. With the aid of the newly identified coreactant H₂O₂, the hollow TSPP@Py(CD)₂ system was employed to create a Zn²⁺-selective probe that was capable of sensitive and accurate zinc detection. The observed increase in ECL conversion and enhanced photophysical properties of this compact supramolecular assembly render it a novel template for enhancing ECL in analytical applications.

Graphical abstract

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http://bit.ly/2I4vpR1

Whose harm? Which metaphysic?

Abstract

Douglas Diekema has argued that it is not the best interest standard, but the harm principle that serves as the moral basis for ethicists, clinicians, and the courts to trigger state intervention to limit parental authority in the clinic. Diekema claims the harm principle is especially effective in justifying state intervention in cases of religiously motivated medical neglect in pediatrics involving Jehovah's Witnesses and Christian Scientists. I argue that Diekema has not articulated a harm principle that is capable of justifying state intervention in these cases. Where disagreements over appropriate care are tethered to metaphysical disagreements (as they are for Jehovah's Witnesses and Christian Scientists), it is moral-metaphysical standards, rather than merely moral standards, that are needed to provide substantive guidance. I provide a discussion of Diekema's harm principle to the broader end of highlighting an inconsistency between the theory and practice of secular bioethics when overriding religiously based medical decisions. In a secular state, ethicists, clinicians, and the courts are purportedly neutral with respect to moral-metaphysical positions, especially regarding those claims considered to be religious. However, the practice of overriding religiously based parental requests requires doffing the mantle of neutrality. In the search for a meaningful standard by which to override religiously based parental requests in pediatrics, bioethicists cannot avoid some minimal metaphysical commitments. To resolve this inconsistency, bioethicists must either begin permitting religiously based requests, even at the cost of children's lives, or admit that at least some moral-metaphysical disputes can be rationally adjudicated.

http://bit.ly/2GovbTq

Ultrasound findings in paediatric cholestasis: how to image the patient and what to look for

Abstract

Paediatric biliary tract and gallbladder diseases include a variety of entities with a wide range of clinical presentations. Cholestasis represents an impaired secretion of bilirubin by hepatocytes, manifesting with high blood levels of conjugated bilirubin and jaundice. Various causes may be involved, which can be recognised analysing blood tests and hepatobiliary imaging, while sometimes liver biopsy or surgery may be necessary. High-resolution real-time ultrasonography is an important tool for differentiation of obstructive and non-obstructive causes of jaundice in infants and children. In this paper, we briefly review the normal anatomy and the ultrasound aspects of main pathologies affecting gallbladder and biliary tree in neonatal and paediatric age.

http://bit.ly/2UVk1Zs

Inducing therapeutic hypothermia via selective brain cooling: a finite element modeling analysis

Abstract

Therapeutic hypothermia is a treatment method to reduce brain injuries after stroke, especially for cerebral ischemia. This study investigates in the temperature distribution of the head within selective brain cooling (SBC). Anatomically accurate geometries based on CT images of head and neck regions are used to develop the 3D geometry and physical model for the finite element modeling. Two cooling methods, the direct head surface cooling strategy and the combination cooling strategy of both head and neck, are evaluated to analyze the inducing hypothermia. The results show that for direct head surface cooling, the scalp and skull temperatures decrease significantly as the blood perfusion rate is constrained, but it is hard to affect the brain core temperature. To achieve a lower cerebral temperature, combination cooling strategy of both head and neck is an effective method in improving deep brain cooling. In normal condition, the cerebral temperature is reduced by about 0.12 °C in 60 min of hypothermia, while the temperature drop is approximately 0.98 °C in ischemic condition.

Graphical abstract

In this study, the 3D geometry of the head and carotid artery model based on the computed tomography (CT) were derived separately and the corresponding investigations were conducted to validate the reliability of the model. Direct head surface cooling strategy and the combination cooling strategy of both the head and neck were numerically researched.

http://bit.ly/2IadXuv

A Flexible Suspension Technique of Blepharoplasty: Clinical Application and Comparison with Traditional Technique

Abstract

Background

Double-eyelid blepharoplasty is one of the most popular aesthetic surgeries in China. But the traditional method produces a hidebound double eyelid due to its rigid suturing between the skin and the tarsus. The authors of this article concluded a novel technique of "flexible suspension technique" compared with traditional blepharoplasty which is considered as a "rigid fixation technique."

Methods

This is a retrospective study of two groups of 100 Chinese Han females, on whom double-eyelid blepharoplasty was performed, 50 cases by "flexible suspension technique" and the other 50 by "rigid fixation technique." The basic procedure of "flexible suspension technique" is suturing the orbicularis oculi muscle to the septal extension. Thus, the surgical connection between skin and tarsus is flexible. The surgical results were evaluated and compared using the Global Aesthetic Improvement Scale and Visual Analogue Scale/Score.

Results

The "very much improved" rate in the "flexible suspension technique" group was higher than that in the "rigid fixation technique" group (p < 0.05). Postoperative appearances of the "flexible suspension technique" group were also better than the "rigid fixation technique" group with less edema (p < 0.05) and slighter incision scars (p < 0.05). However, the incidences of asymmetry and fold loss were higher in the "flexible suspension technique" group (p < 0.05).

Conclusion

The flexible suspension technique blepharoplasty can obtain a more natural appearance and has less adverse effects and shorter recovery time.

Level of Evidence IV

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

http://bit.ly/2BtSQh2

Influence of Cr Alloying (1.5 to 5 at.%) on Martensitic Phase Transformation Temperatures in Co-Ni-Ga-Cr Thin Films

Abstract

A Co-Ni-Ga-Cr thin film materials library with a Cr concentration gradient ranging from 1.5 at.% to 5 at.% was magnetron-sputtered to determine the influence of Cr additions on the martensite transformation temperature of non-stoichiometric Co₂NiGa-based Heusler alloys. An increase of the phase transformation temperature from 30 °C for 5 at.% Cr up to 100 °C for 1.5 at.% Cr was determined by a peak fitting analysis of temperature-dependent X-ray diffraction data.

http://bit.ly/2Staxb5