Πέμπτη 14 Φεβρουαρίου 2019
Synthesis and characterisation of polyaniline and/or MoO 2 /graphite composites from deep eutectic solvents via chemical polymerisation
Abstract
Novel polyaniline (Pani) and/or graphite (Gr)/molybdenum dioxide (MoO2) composites have been successfully synthesised via an in situ chemical polymerisation method using a Deep Eutectic Solvent (DES) as the electrolyte. The chemical structure and properties of the Pani composites were characterised using various analytical techniques such as Raman, FTIR and UV–Vis spectroscopies, Thermo-Gravimetric Analysis (TGA), X-ray diffraction (XRD) and conductivity measurements, confirming its semi-crystalline nature. The results show shifts in the Raman, XRD and FTIR spectral features associated with the Pani composites, indicating that a matrix of metal oxide and/or graphite had formed in the polymer. Higher electrical conductivity was observed for the Pani/Gr (5.58 S cm−1) and Pani/Gr/MoO2 (9.87 S cm−1) composites compared to pure Pani (1.25 S cm−1). The homogenous growth of Pani chains on the graphite and MoO2 network were clearly observed by Scanning Electron Microscopy (SEM) and Energy Dispersive Analysis by X-ray (EDAX). A larger surface area and greater porosity were achieved in the Pani/MoO2, Pani/Gr/MoO2 and Pani/Gr samples, while a more compact structure was obtained for the Pani sample. These findings support that the idea that the polymer/graphite composites would be more useful for electrochemical charge transport, supercapacitance and energy storage applications compared to those using the pure polymer alone.
http://bit.ly/2TPUMrs
Pro-metastatic functions of lipoproteins and extracellular vesicles in the acidic tumor microenvironment
Abstract
Although the overall mortality in cancer is steadily decreasing, major groups of patients still respond poorly to available treatments. The key clinical challenge discussed here relates to the inherent capacity of cancer cells to metabolically adapt to hypoxic and acidic stress, resulting in treatment resistance and a pro-metastatic behavior. Hence, a detailed understanding of stress adaptive responses is critical for the design of more rational therapeutic strategies for cancer. We will focus on the emerging role of extracellular vesicles (EVs) and lipoprotein particles in cancer cell metabolic stress adaptation and how these pathways may constitute potential Achilles' heels of the cancer cell machinery and alternative treatment targets of metastasis. In this context, common extracellular lipid uptake mechanisms, involving specific cell-surface receptors and endocytic pathways, may operate during remodeling of acidic atherosclerotic plaques as well as the tumor microenvironment. The role of endocytosis in regulating the cellular response to hypoxic and acidic stress through spatial coordination of receptor proteins may be exploited for therapeutic purposes. As a consequence, molecular mechanisms of endocytosis have attracted increasing attention as potential targets for tumor specific delivery of therapeutic substances, such as antibody–drug conjugates. The identification of internalizing surface proteins specific to the acidic tumor niche remains an unmet need of high clinical relevance. Among the currently explored, acidosis-related, internalizing target proteins, we will focus on the cell-surface proteoglycan carbonic anhydrase 9.
http://bit.ly/2X6ttLF
A mixed psychiatric and somatic care unit for trauma patients: 10 years of experience in an urban level I trauma center in the Netherlands
Abstract
Background
A medical-psychiatric unit (MPU) is a special ward where staff is trained in caring for patients with psychiatric or behavioural problems that need hospitalisation for physical health problems. It is well known that these patients are at higher risk of complications and have a longer length of stay resulting in higher costs than patients without psychiatric comorbidity. The objective of this study was to analyse the trauma patient population of the first 10 years of existence of the MPU in a level I trauma center.
Patients and methods
A retrospective analysis was performed in 2-year cohorts from 2006 to 2016. All trauma patients admitted to the MPU were compared with the overall trauma patient population in VUmc. Data (psychiatric diagnosis, substance abuse, trauma scores, surgical interventions, complications, mortality) were extracted from individual patient notes and the Regional Trauma Registry.
Results
258 patients were identified. 36% of all patients had a history of previous psychiatric admission and 30% had attempted suicide at least once in their lifetime. Substance abuse was the most common psychiatric diagnosis (39%), with psychotic disorder (28%) in second place. The median hospital stay was 21 days. Median MPU length of stay was 10 days (range 1–160). Injuries were self-inflicted in 57%. The most common mechanism of injury was fall from height with intentional jumping in second place. Penetrating injury rate was 24% and 33% had an ISS ≥ 16, compared to 5% and 15%, respectively, in the overall trauma patient population. The most common injuries were those of the head and neck. Complication rate was 49%.
Conclusion
Trauma patients that were admitted to the MPU of an urban level I trauma center had serious psychiatric comorbidity as well as high injury severity. Penetrating injury was much more common than in the overall trauma patient population. A high complication rate was noted. The high psychiatric comorbidity and the complicated care warrants combined psychiatric and somatic (nursing) care for this subpopulation of trauma patients. This should be taken into account in the prehospital triage to a trauma center. The institution of a MPU in level I trauma centers is recommended.
http://bit.ly/2TOEPBO
Asymptomatic giant cell hepatitis: a subtype of post-infantile giant cell hepatitis?
Abstract
Giant cell hepatitis in adults is considered a rapidly progressive and life-threatening disease, but there are few descriptions of a prolonged disease course. A 36-year-old Japanese man was referred to our hospital for further evaluation of abnormal liver function test results. Although asymptomatic, he had undergone follow-up for 9 years with these abnormalities. Because the cause of liver injury was not identified despite extensive noninvasive examinations, the patient underwent needle biopsy. He was finally diagnosed with post-infantile giant cell hepatitis (PIGCH) based on the presence of small numbers of giant multinucleated hepatocytes scattered primarily around the portal area. Necroinflammatory changes were very mild in the portal tracts and hepatic parenchyma. According to the histological findings as well as the accepted international diagnostic scoring system for autoimmune hepatitis (AIH), which is closely related to PIGCH, AIH was unlikely, although antinuclear antibody was positive at a titer of 1:160. The present case may describe an unknown subtype of PIGCH, characterized by insidious disease onset and progression with concurrent, mildly active underlying hepatitis, which is in contrast with the well-documented aggressive nature of PIGCH.
http://bit.ly/2GKfXYj
Hepatic angiomyolipoma with early drainage veins into the hepatic and portal vein
Abstract
Hepatic angiomyolipoma (AML) is a rare stromal tumor composed of variable admixtures of thick-walled vessels, smooth muscles and adipose tissue. One of the specific radiological findings of hepatic AML is an early drainage vein noted via enhanced computed tomography (CT). We report a case of hepatic AML showing early drainage veins into both the hepatic and portal vein. The case involved a 46-year-old woman who was referred to our hospital because of a giant hepatic tumor. CT revealed well-enhanced 14 cm and 1 cm tumors in the left and right lobes, respectively. Magnetic resonance imaging demonstrated the existence of adipose tissues in the larger tumor. Hepatic arteriography revealed early drainage veins draining into both the hepatic and portal vein. Based on a diagnosis of hepatic AML, left hepatectomy and partial hepatectomy were performed. Pathology revealed both tumors as hepatic AML based on human melanoma black-45 immuno-positivity. Hepatic AML with early drainage veins into both the hepatic and portal vein is rare. The dilated and retrogressive vein drains the abundant arterial blood flow of the tumor. The finding of early drainage veins into not only the hepatic vein but also the portal vein should be helpful for diagnosing hepatic AMLs.
http://bit.ly/2tm17iu
Community-acquired fulminant colitis caused by binary toxin-producing Clostridium difficile in Japan
Abstract
We report a case of community-acquired fulminant colitis caused by Clostridium difficile in Japan. A 46-year-old woman was diagnosed with severe infectious enterocolitis and was admitted at another hospital. The stool culture was positive for toxigenic C. difficile. Since the patient presented with fulminant C. difficile infection (CDI) with toxic megacolon, respiratory insufficiency, and circulatory failure, she was transferred to Kyorin University Hospital for intensive care. Intubation and antibiotic therapy were performed. The general condition improved with conservative treatment, and she was discharged without sequelae. While the recovered isolate was toxin A and B-positive and binary toxin-positive, it was identified as polymerase chain reaction (PCR) ribotype ts0592 and slpA sequence type ts0592. The isolate was different from PCR ribotype 027 epidemic in Europe and North America. In Japan, binary toxin-producing strains are rare and have not caused an epidemic to date. Furthermore, there are few data on community-acquired CDI in Japan. In this case, a non-elderly woman with no major risk factors such as antibiotic use, administration of proton pump inhibitor and history of gastrointestinal surgery developed community-acquired fulminant CDI caused by the binary toxin-positive strain, and ICU treatment was required. Further studies focusing on the role of binary toxin-positive C. difficile in the severity of community-acquired CDI are necessary.
http://bit.ly/2GJT0nU
Predictive factors for acute thrombogenesis occurring immediately after bypass procedure for moyamoya disease
Abstract
Extracranial-to-intracranial (EC-IC) bypass surgery is an effective treatment for patients with moyamoya disease and other conditions. Some patients with moyamoya disease have a risk of acute thrombogenesis at the anastomotic site just after bypass surgery. The purpose of this study was to study risk factors of acute thrombogenesis and determine effective countermeasures. This study included 48 patients (66 EC-IC bypass procedures) with moyamoya disease and 52 controls (54 procedures) without moyamoya disease. The development of acute thrombogenesis was compared between the moyamoya disease and control groups. In the moyamoya disease group, clinical and radiological characteristics were assessed with respect to acute thrombogenesis. In the patients with acute thrombogenesis, causes of technical problems were retrospectively examined. The incidence of acute thrombogenesis was significantly higher in the moyamoya disease group than those in the control group. In the moyamoya disease group, acute thrombogenesis was observed in seven patients. In the moyamoya disease group, the magnetic resonance angiography (MRA) scores were significantly higher in patients with acute thrombogenesis than those in the patients without acute thrombogenesis. In the multivariate analysis, the predictive factor of acute thrombogenesis in moyamoya disease was a high MRA score (odds ratio, 2.336; p = 0.009). During EC-IC bypass surgery for moyamoya disease, acute thrombogenesis should be considered to obtain a high patency rate, particularly in patients with high MRA scores. Acute thrombogenesis will not influence morbidity if proper countermeasures are followed; therefore, the prediction and recognition of white thrombus are important for a successful bypass surgery.
http://bit.ly/2GJccCo
Impact of Ethnicity-Specific Hepatic Microsomal Scaling Factor, Liver Weight, and Cytochrome P450 (CYP) 1A2 Content on Physiologically Based Prediction of CYP1A2-Mediated Pharmacokinetics in Young and Elderly Chinese Adults
Abstract
Background
The vast majority of physiological and biological data required for physiologically based predictions are primarily available in Caucasians rather than other ethnic populations, which leads to a lack of confidence in the application of physiologically based pharmacokinetic (PBPK) modeling for ethnicity-specific prediction of pharmacokinetics in the Chinese population.
Objectives
In this study we recalibrate the system parameters of Chinese-specific PBPK modeling and explore for the first time the relative importance of ethnicity-specific microsomal protein per gram of liver (MPPGL), liver weight, and cytochrome P450 (CYP) 1A2 abundance to the projection of drug disposition mediated by CYP1A2 in young and elderly Chinese adults.
Methods
Chinese MPPGL levels and associated variability were parameterized and incorporated for the first time into ethnicity-specific PBPK models for the Chinese adults. Parameterization of Chinese liver weights was also recalibrated on the basis of autopsy data from Chinese individuals (n = 4081) across the entire adult age range. Uncertainty surrounding the Chinese-specific CYP1A2 content has also been explored and clarified by conducting ethnicity-related PBPK simulations under different scenarios. Various ethnicity-related or 'what-if' scenarios for PBPK modeling were implemented to assess the predictive performance and explore the relative importance of ethnicity-specific MPPGL and liver weight to the projection of drug disposition mediated by CYP1A2 in terms of two typical CYP1A2 substrates, caffeine and theophylline, in young and elderly Chinese adults by comparing the predicted concentration–time data and associated pharmacokinetic parameter estimates with observations.
Results
Compared with 0.85, the liver scalar of 0.9 generally produced more accurate liver weight levels in virtual Chinese peers. Additionally, simulated MPPGL levels on the basis of Caucasian data were not able to reflect the age-independent pattern observed in Chinese adults, dissimilar to that on the basis of Chinese-specific adult MPPGL data. The modeling Scenarios A and B provided similar predictions for theophylline pharmacokinetics in young Chinese adults across different age groups, while Scenario B provided the most accurate prediction for theophylline pharmacokinetics in elderly Chinese adults. However, the use of a stratified value of CYP1A2 content derived from a Han Chinese cohort with a small sample size instead of the pooled value of all Chinese cohorts involved regardless of Chinese sub-ethnicity resulted in inadequate prediction of CYP1A2-mediated pharmacokinetics in terms of caffeine and theophylline in either young or elderly Chinese subjects. Additionally, the impact of ethnic-specific MPPGL on predictive accuracy of theophylline pharmacokinetics in elderly Chinese subjects is more evident than that of liver weight.
Conclusion
We provided quantitative information pertaining to Chinese-specific levels of liver weight and MPPGL, and recalibrated these system parameters for PBPK modeling for young and elderly Chinese subjects. Uncertainty surrounding the Chinese-specific CYP1A2 content has also been clarified. PBPK modeling based on the recalibrated system parameters can accurately simulate CYP1A2-mediated pharmacokinetics in both young and elderly Chinese adults, particularly in elderly individuals.
http://bit.ly/2tlIhIt
Autism, spectrum or clusters? An EEG coherence study
Abstract
Background
Autism prevalence continues to grow, yet a universally agreed upon etiology is lacking despite manifold evidence of abnormalities especially in terms of genetics and epigenetics. The authors postulate that the broad definition of an omnibus 'spectrum disorder' may inhibit delineation of meaningful clinical correlations. This paper presents evidence that an objectively defined, EEG based brain measure may be helpful in illuminating the autism spectrum versus subgroups (clusters) question.
Methods
Forty objectively defined EEG coherence factors created in prior studies demonstrated reliable separation of neuro-typical controls from subjects with autism, and reliable separation of subjects with Asperger's syndrome from all other subjects within the autism spectrum and from neurotypical controls. In the current study, these forty previously defined EEG coherence factors were used prospectively within a large (N = 430) population of subjects with autism in order to determine quantitatively the potential existence of separate clusters within this population.
Results
By use of a recently published software package, NbClust, the current investigation determined that the 40 EEG coherence factors reliably identified two distinct clusters within the larger population of subjects with autism. These two clusters demonstrated highly significant differences. Of interest, many more subjects with Asperger's syndrome fell into one rather than the other cluster.
Conclusions
EEG coherence factors provide evidence of two highly significant separate clusters within the subject population with autism. The establishment of a unitary "Autism Spectrum Disorder" does a disservice to patients and clinicians, hinders much needed scientific exploration, and likely leads to less than optimal educational and/or interventional efforts.
http://bit.ly/2EaVYjD
Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report
Abstract
Background
The deltopectoral approach is a well-described surgical approach to the proximal humerus and glenohumeral joint. One of the structures at risk during this approach is the axillary nerve. Typically, the axillary nerve arises off the posterior cord of the brachial plexus and courses lateral to the proximal humerus and inferior to the glenohumeral joint, exiting the axilla through the quadrangular space. We describe a case of an aberrant axillary nerve, coursing anteriorly across the glenohumeral joint within the deltopectoral groove encountered during a reverse total shoulder arthroplasty.
Case presentation
A 73-year-old female presented complaining of atraumatic progressive right shoulder pain of several months duration. Clinical and radiographic findings were consistent with advanced rotator cuff arthropathy. After failing appropriate non-operative treatment, the patient elected to undergo reverse total shoulder arthroplasty. During the deltopectoral approach to the glenohumeral joint, the axillary nerve was found to be coursing deep to the cephalic vein within the deltopectoral interval. The nerve was isolated and protected, and the glenohumeral joint was accessed via a small window in the anterior deltoid muscle. The remainder of the procedure was performed without complication. The patient was found to be healing well and with normal axillary nerve function at 4-month follow-up.
Conclusions
Neurologic lesions are well-documented complications of reverse total shoulder arthroplasty. The integrity of the axillary nerve is of particular importance to reverse total shoulder arthroplasty as it innervates the deltoid and post-operative function of the extremity is dependent upon a functioning deltoid muscle. Extreme care must be taken to avoid insult to the axillary nerve and any aberrant paths it may course around the glenohumeral joint.
http://bit.ly/2EaQq8K
Evaluation of intraoperative MRI-assisted stereotactic brain tissue biopsy: a single-center experience in China
Abstract
Background
This study aimed to investigate the value of high field-strength intraoperative magnetic resonance imaging (iMRI)-guided stereotactic biopsy in the surgery of intracranial space-occupying lesions.
Methods
A total of 87 patients who underwent stereotactic biopsy of intracranial lesions in the Peking University International Hospital from March 2016 to August 2018 were retrospectively surveyed; among these, 50 patients underwent MRI-guided stereotactic biopsy using the Leksell frame (iMRI group) and 37 cases received traditional stereotactic biopsy using the Leksell frame (control group). The accuracy rates and complications of the two groups were compared.
Results
A 100% positive diagnosis was observed in all cases (n = 50) in the iMRI group. In 4 cases, the biopsy site was clearly found to have deviated from the target point, and the biopsy was performed again. The control group had 33 cases (86.5%) with positive diagnosis. No severe complications like neural functional deficit were observed in the iMRI group, while two patients developed bleeding at the puncture site (1 case receiving surgery to remove the hematoma) in the control group. There were no deaths in either group.
Conclusion
iMRI-assisted stereotactic biopsy can confirm the target position and adjust the puncture path in real time. Compared to the traditional stereotactic biopsy technique, the iMRI method has a higher positive diagnostic rate, though surgical trauma and complications have no significant difference.
http://bit.ly/2UZMrBo
Correction to: Appendicitis as a manifestation of colon cancer: should we image the colon after appendicectomy in patients over the age of 40 years?
The above article originally published with an error present in Table 1 and is now presented correctly in this article.
http://bit.ly/2V0WRkf
Prevalence of alpha-1-antitrypsin deficiency carriers in a population with and without colonic diverticula. A multicentre prospective case-control study: the ALADDIN study
Abstract
Purpose
The underling pathophysiological mechanisms that cause the formation of colonic diverticula (diverticulosis) remain unclear. Connective tissue changes due to ageing that cause changes in collagen structure of the colonic wall is one theory. Alpha-1-antitrypsin (A1AT) is a protease inhibitor known to protect connective tissue in other organs. Associations between (carriers of) A1AT deficiency and the development of colonic diverticula will be the main focus of this study.
Methods
A multicentre prospective case-controlled study. In total, 230 patients ≥ 60 years with acute abdominal pain undergoing an abdominal computed tomography (CT) will be included. The research group consists of patients with diverticulosis and/or diverticulitis; controls are patients without diverticula (0 to ≤ 5 diverticula). Genotype analysis for A1AT deficiency will be performed.
Rationale
Hypothetically, connective tissue changes, in particular related to (carriers of) A1AT deficiency, can contribute to the development of diverticula and diverticulitis. We expect to find a higher prevalence of A1AT carriers in patients with diverticulosis compared to patients without diverticulosis. Having diverticulosis does not affect the general health of these individuals per se, when asymptomatic. Once an association is found, present findings can be the basis for a second study to assess the risk of developing acute diverticulitis and its disease course in carriers of A1AT deficiency. Because a large cohort is needed in the latter, we shall first perform a pilot study to investigate the likelihood of the primary hypothesis.
Trial registration
Netherlands Trial register, NTR6251, NL55016.094.15
http://bit.ly/2EbNIjo
Interdisziplinäre Zusammenarbeit bei Vaskulitiden
Zusammenfassung
Die Pathogenese der meisten Vaskulitiden beinhaltet die Einbeziehung multipler Organe und konsekutiv klinische Manifestationen in allen Fachdisziplinen, folglich handelt es sich meist um hochkomplexe Krankheitsbilder. Durch frühzeitige Diagnose und Therapie dieser Erkrankungen können relevante Komplikationen vermieden und die Prognose der Patienten deutlich verbessert werden. Kollegen aller Fachdisziplinen sollten bei anhaltenden Beschwerden, die auf etablierte Therapien nicht angemessen reagieren, immer eine Vaskulitis mit in Betracht ziehen. Umgekehrt sollte bei bekannter Vaskulitis jeder potenziell beteiligte Fachbereich in die Statuserhebung und die weitere Therapie eingebunden sein. Für die Langzeitprognose und kontinuierliche Therapieüberwachung sollte das Regime in der Hand eines Arztes liegen, der als Ansprechpartner für den Patienten da ist und in regelmäßigen Abständen mit den beteiligten Kollegen in Austausch steht.
http://bit.ly/2E9Reej
Therapiestrategien bei systemischen Vaskulitiden
Zusammenfassung
Die Therapie der Vaskulitiden umfasst heutzutage die gesamte Breite der konventionellen immunsuppressiven Medikamente sowie einzelne Biologika (insbesondere Rituximab). Im Einzelfall wird die medikamentöse Therapie bei Patienten mit Befall von mittleren und insbesondere großen Gefäßen durch angiologische Interventionen und gefäßchirurgische Operationen ergänzt, um Komplikationen wie Aneurysmen oder ischämische Verschlüsse von Gefäßen zu beheben. Dieser Artikel gibt einen Überblick über die Grundzüge v. a. der medikamentösen Therapie der Vaskulitiden, geht aber auch auf häufig durchgeführte interventionelle/operative Verfahren ein.
http://bit.ly/2V0WGW7
Genome-wide methylation profiling and copy number analysis in atypical fibroxanthomas and pleomorphic dermal sarcomas indicate a similar molecular phenotype
Abstract
Background
Atypical fibroxanthomas (AFX) and pleomorphic dermal sarcomas (PDS) are lesions of the skin with overlapping histologic features and unspecific molecular traits. PDS behaves aggressive compared to AFX. Thus, a precise delineation, although challenging in some instances, is relevant.
Methods
We examined the value of DNA-methylation profiling and copy number analysis for separating these tumors. DNA-methylation data were generated from 17 AFX and 15 PDS using the Illumina EPIC array. These were compared with DNA-methylation data generated from 196 tumors encompassing potential histologic mimics like cutaneous squamous carcinomas (cSCC; n = 19), basal cell carcinomas (n = 10), melanoma metastases originating from the skin (n = 11), leiomyosarcomas (n = 11), angiosarcomas of the skin and soft tissue (n = 11), malignant peripheral nerve sheath tumors (n = 19), dermatofibrosarcomas protuberans (n = 13), extraskeletal myxoid chondrosarcomas (n = 9), myxoid liposarcomas (n = 14), schwannomas (n = 10), neurofibromas (n = 21), alveolar (n = 19) and embryonal (n = 17) rhabdomyosarcomas as well as undifferentiated pleomorphic sarcomas (n = 12).
Results
DNA-methylation profiling did not separate AFX from PDS. The DNA-methylation profiles of the other cases, however, were distinct from AFX/PDS. They reliably assigned to subtype-specific DNA-methylation clusters, although overlap occurred between some AFX/PDS and cSCC. Copy number profiling revealed alterations in a similar frequency and distribution between AFX and PDS. They involved losses of 9p (22/32) and 13q (25/32). Gains frequently involved 8q (8/32). Notably, a homozygous deletion of CDKN2A was more frequent in PDS (6/15) than in AFX (2/17), whereas amplifications were non-recurrent and overall rare (5/32).
Conclusions
Our findings support the concept that AFX and PDS belong to a common tumor spectrum. We could demonstrate the diagnostic value of DNA-methylation profiling to delineating AFX/PDS from potential mimics. However, the assessment of certain histologic features remains crucial for separating PDS from AFX.
http://bit.ly/2SBu9cY
Comparative analysis of the value of diffusion kurtosis imaging and diffusion-weighted imaging in evaluating the histological features of endometrial cancer
Abstract
Purpose
This study evaluated and compared the performances of diffusion kurtosis imaging (DKI) and diffusion-weighted imaging (DWI) for diagnosing and histologically grading endometrial cancer.
Materials and methods
In this retrospective study, DKI and DWI data for 61 patients with endometrial cancer and 30 patients with a normal endometrium were analyzed, and the mean kurtosis (MK), mean diffusion coefficient (MD) and apparent diffusion coefficient (ADC) values for the endometrial cancer tissue and normal endometrial tissue were acquired. The parameters for the normal endometrium group (G0) and the endometrial cancer groups (G1, G2 and G3) were compared and analyzed. The receiver operating characteristic (ROC) curve was used to evaluate each parameter's diagnostic accuracy and threshold. Spearman correlation analysis was used to analyze the correlations between all parameters and histological grades.
Results
The MK values for the G0, G1, G2 and G3 groups increased gradually, while the MD and ADC values decreased gradually. Except for the differences in the ADC values between G0 and G1, the differences among the groups were statistically significant (P < 0.05). The MK values had the highest diagnostic accuracy in differentiating G0 and (G1 + G2 + G3), G0 and G1, G1 and G2, and G2 and G3 (AUC = 0.93, 0.76, 0.91, 0.91, P < 0.05). MK was maximally correlated with histological grade, followed by MD and ADC (MK > MD > ADC; r = − 0.85, + 0.82, + 0.76, P < 0.01).
Conclusion
Both DKI and DWI can be used to evaluate the diagnosis and histological grading of endometrial cancer. Compared with DWI, the DKI model is a more complete mathematical model with more sensitive parameters, which can more effectively evaluate the pathological and physiological characteristics of endometrial cancer.
http://bit.ly/2DKd6ev
Comprehensive gene expression meta-analysis identifies signature genes that distinguish microglia from peripheral monocytes/macrophages in health and glioma
Abstract
Monocytes/macrophages have begun to emerge as key cellular modulators of brain homeostasis and central nervous system (CNS) disease. In the healthy brain, resident microglia are the predominant macrophage cell population; however, under conditions of blood-brain barrier leakage, peripheral monocytes/macrophages can infiltrate the brain and participate in CNS disease pathogenesis. Distinguishing these two populations is often challenging, owing to a paucity of universally accepted and reliable markers. To identify discriminatory marker sets for microglia and peripheral monocytes/macrophages, we employed a large meta-analytic approach using five published murine transcriptional datasets. Following hierarchical clustering, we filtered the top differentially expressed genes (DEGs) through a brain cell type-specific sequencing database, which led to the identification of eight microglia and eight peripheral monocyte/macrophage markers. We then validated their differential expression, leveraging a published single cell RNA sequencing dataset and quantitative RT-PCR using freshly isolated microglia and peripheral monocytes/macrophages from two different mouse strains. We further verified the translation of these DEGs at the protein level. As top microglia DEGs, we identified P2ry12, Tmem119, Slc2a5 and Fcrls, whereas Emilin2, Gda, Hp and Sell emerged as the best DEGs for identifying peripheral monocytes/macrophages. Lastly, we evaluated their utility in discriminating monocyte/macrophage populations in the setting of brain pathology (glioma), and found that these DEG sets distinguished glioma-associated microglia from macrophages in both RCAS and GL261 mouse models of glioblastoma. Taken together, this unbiased bioinformatic approach facilitated the discovery of a robust set of microglia and peripheral monocyte/macrophage expression markers to discriminate these monocyte populations in both health and disease.
http://bit.ly/2N8Nz3g
Correction to: The Influence of a Xanthine-Catechin Chemical Matrix on in vitro Macrophage-Activation Triggered by Antipsychotic Ziprasidone
After publication of our article it came to our attention that it contains a number of errors with regard to the citations. The details are provided below:
http://bit.ly/2GHzTeh
Seven genes for the prognostic prediction in patients with glioma
Abstract
Purpose
Glioma is a common malignant tumor of the central nervous system, which is characterized by a low cure rate, high morbidity, and high recurrence rate. Consequently, it is imperative to explore some indicators for prognostic prediction in glioma.
Methods
We obtained glioma data from The Cancer Genome Atlas (TCGA). Differentially expressed genes (DEGs) were obtained by R software from TCGA data sets. Through Cox regression analysis, risk scores were obtained to assess the weighted gene-expression levels, which could predict the prognosis of patients with glioma. The validity and the prognostic value of this model in glioma were confirmed by the manifestation of receiver-operating characteristic (ROC) curves, area under the curve (AUC), and 5-year overall survival (OS).
Results
In total, 920 DEGs of transcriptome genes in glioma were extracted from the TCGA database. We identified a novel seven-gene signature associated with glioma. Among them, AL118505.1 and SMOC1 were positively related to the 5-year OS of patients with glioma, showing a better prognosis for glioma; however, RAB42, SHOX2, IGFBP2, HIST1H3G, and IGF2BP3 were negatively related to 5-year OS, displaying a worse prognosis. In addition, according to risk scores, AL118505.1 was also a protective factor, while others were risk factors. Furthermore, the expression levels of SHOX2, IGFBP2, and IGF2BP3 were significantly positively correlated with glioma grades. Receiver-operating characteristic (ROC) curve assessed the accuracy and sensitivity of the gene signature. Each of the seven genes for patients with the distribution of the risk score was presented in the heat map.
Conclusion
We identified a novel seven-gene signature in patients with glioma, which could be used as a predictor for the prognosis of patients with glioma in the future.
http://bit.ly/2SRlKSf
Recommendations for follow-up of colorectal cancer survivors
Abstract
Colorectal cancer (CRC) is one of the tumours with the highest incidence and mortality in the Spanish population. Nevertheless, the advances in prevention and treatment have contributed to an increased number of patients who survive for prolonged periods of time. In addition, despite recurrences, improved survival following metastasis resection is likewise on the rise. This underscores the importance of carrying out follow-up programmes even in low-risk patients for the early detection of recurrence. The main objective of this article is to provide a set of recommendations for optimising the follow-up of CRC survivors as well as for managing the sequelae that result from either pharmacological or surgical treatment.
http://bit.ly/2N60tip
Elevated expression of GNAS promotes breast cancer cell proliferation and migration via the PI3K/AKT/Snail1/E-cadherin axis
Abstract
Purpose
Although it has been well established that G protein plays pivotal roles in physiologic or pathologic conditions, including cancer formation, its role in breast cancer, especially specific subunits, remains largely unknown. Our work aimed to evaluate the correlation of the G protein alpha subunit (GNAS) with breast cancer and to investigate the underlying molecular mechanism.
Methods
The expression of GNAS was determined by breast tumor tissue microarray of 150 patients with complete follow-up information. The correlation between GNAS expression and clinical features was assessed. CCK8, EdU incorporation, flow cytometry, wound healing, transwell, western blot and tumor formation assays were carried out in nude mice to study the biological function of GNAS and the underlying molecular mechanism in breast cancer by silencing GNAS using a specific siRNA.
Results
High GNAS expression showed a close correlation with a reduced overall survival (p = 0.021), frequent distal metastasis (p = 0.026), advanced clinical stage (p = 0.001), stronger cell proliferation (ki67+ positive cell rate, p = 0.0351) and enhanced cancer cell migration, which was further confirmed by in vitro and in vivo assays and might be dependent on the PI3K/AKT/Snail1/E-cadherin axis.
Conclusion
The data suggested that GNAS promoted breast cancer cell proliferation and migration (EMT) through the PI3K/AKT/Snail1/E-cadherin signaling pathway. These findings also indicate that GNAS can serve as a potential prognostic indicator and novel therapeutic target in breast cancer.
http://bit.ly/2SOn5ZT
Effects of PCSK9 inhibitors on LDL cholesterol, cardiovascular morbidity and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials
Abstract
Background and aims
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors determine a wide reduction of LDL cholesterol, greater than other lipid-lowering agents. The present meta-analysis is aimed at the assessment of PCSK9 inhibitors effect on LDL Cholesterol, cardiovascular morbidity and all-cause mortality.
Methods and results
A Medline and Clinicaltrials.gov search for eligible studies until December 1, 2017, was performed. All randomized trials (> 12 weeks) comparing PCSK-9 inhibitors with placebo or active drugs were retrieved. Primary endpoints: (a) LDL cholesterol at endpoint; (b) Major cardiovascular events (MACE); (c) All-cause mortality. Data extraction was performed independently by two of the authors, and conflicts resolved by a third investigator. A total of 38 trials fulfilling the inclusion criteria were identified, with mean duration of 36.4 weeks. The reduction of LDL cholesterol at endpoint, versus placebo, ezetimibe, and high-dose statins was − 65.3 [− 69.6, − 60.9]%, − 57.7 [− 68.3;− 47.0]%, and − 34.5 [− 40.8;− 28.1]%, respectively, with alirocumab possibly showing a smaller effect than the other drugs of the class. Treatment with PCSK9 inhibitors was associated with a reduction in the incidence of MACE (Mantel–Haenszel Odds Ratio [MH-OR] 0.83 [0.78, 0.88]), with significant effects of alirocumab and evolocumab only. The number needed to treat for 2 years for preventing one event was 89. All-cause mortality and cardiovascular mortality were not reduced by treatment with PCSK-9 inhibitors (MH-OR 0.94 [0.84, 1.04] and 0.97[0.86;1.09]).
Conclusions
PCSK-9 inhibitors are effective in reducing LDL cholesterol and the incidence of major cardiovascular events in high-risk patients. Bococizumab does not show significant effects on MACE.
Registration number
PROSPERO-CRD42018087640.
http://bit.ly/2TLgsVn
Theoretical and experimental modeling of interstitial laser hyperthermia with surface cooling device using Nd 3+ -doped nanoparticles
Abstract
To improve methods of laser hyperthermia for the treatment of bulk malignant neoplasms, an urgent task is the development of techniques and devices that automatically control heating at a given tissue depth and ensure its uniformity. The article proposes the concept of a system for performing hyperthermia with real-time spectroscopic temperature control and surface cooling, which allows to record spectra of diffusely scattered radiation and fluorescent signal from various depths of biological tissues by the means of the variation of the angle and distance between the fiber source of laser radiation and the receiving fiber. Theoretical and experimental modeling of the spatial distribution of diffusely scattered radiation and temperature inside the tissue with a fiber optic device providing surface cooling of the irradiated tissue, and recording spectral information from a given depth in real time, is presented. Simulation of radiation propagation in biological tissues, depending on the distance between the source and the receiver and the angle of their tilt, was carried out using the Monte Carlo method. Modeling of the temperature distribution inside the tissues was carried out by means of a numerical solution of the heat conduction equation. Experimental modeling was carried out on phantoms of biological tissues simulating their scattering properties as well as accumulation of the investigated nanoparticles doped with Nd3+ ions. It was shown that inorganic nanoparticles doped with rare-earth Nd3+ ions can be used as temperature labels for feedback to the therapeutic laser. According to the results of the theoretical simulation, optimal configurations of the relative arrangement of the fibers were chosen, as well as the optimum surface cooling temperatures for the given power densities. The heating of the phantom of the neoplasm containing the investigated nanoparticles doped with Nd3+ ions by laser radiation with an 805-nm wavelength and power density of 1 W/cm2 up to 42 °C at a depth of 1 cm while maintaining the surface temperature within the limits of the norm was demonstrated.
http://bit.ly/2X32z76
Posterior laryngofissure using a surgical contact diode laser: an experimental feasibility study
Abstract
To evaluate the feasibility of a 980-nm contact diode laser (CDL) as a method for creating a posterior laryngofissure in live pigs. Twenty-eight Landrace pigs (15–20 kg) were anesthetized, intubated, ventilated, and submitted to a cervical tracheostomy. An anterior and posterior midline longitudinal laryngofissure incision was created according to randomization—control (n = 4), posterior laryngofissure with a scalpel blade; electrocautery (n = 12), posterior laryngofissure by electrocautery (10, 15, 20, 25 W powers); CDL (n = 12), posterior laryngofissure by the CDL (10, 15, 20, 25 W peak powers in pulsed mode). Larynx and proximal trachea were excised, prepared for histopathology, and digital morphometric analysis. Measurements in and within each group were analyzed (Kruskal-Wallis and Dunn test) with a level of significance of p < 0.05. Incision width was not different between the groups, as well as in the powers used in CDL (p = 0.161) and electrocautery group (p = 0.319). The depth of the incisions was smaller in the Laser group compared to control (p = 0.007), and in the electrocautery compared to control (p = 0.026). Incision area was smaller in CDL compared with the control (p = 0.027), and not different between laser and electrocautery groups (p = 0.199). The lateral thermal damage produced by electrocautery was the largest, with a significant difference between laser and electrocautery (p = 0.018), and between electrocautery and control (p = 0.004), whereas the comparison between laser and control showed no significant differences (p = 0.588). The posterior laryngofissure incision using a 980-nm CDL is feasible resulting in smaller incisional area and less lateral thermal damage.
http://bit.ly/2S2Expg
Influence of Er:YAG laser pulse duration on the long-term stability of organic matrix and resin-dentin interface
Abstract
The purpose of this study was to explore the influence of Er:YAG laser irradiation with different pulse durations on the organic matrix, micromorphology of the hybrid layer (HL), and bond strength over time. Sixty caries-free human molars were cut to obtain flat dentin surfaces which were randomly divided into 4 groups: control (not irradiated–G1) and laser groups (80 mJ/2 Hz) with pulse duration ranging between 50 (G2), 300 (G3), and 600 μs (G4). A self-etch adhesive system (Universal 3M ESPE) was applied on pre-treated dentin surfaces and cylinders of resin composite were built up and stressed in a universal testing machine (μSBS) at 24 h and after12 months (n = 12). In addition, 3 other dentin-bonded specimens were prepared as previously described for each group with the adhesive doped with 0.1 wt% Rhodamine B to analyze hybrid layer morphology under Confocal Laser Microscope Scanning (CLMS). Organic matrix and collagen fibrils were analyzed by second harmonic generation (SGH). Two-way ANOVA and Tukey's test detected significantly higher μSBS values for the control group, whereas the lower values were observed in all laser groups at 24 h (p < 0.05). Storage in artificial saliva did not reduce μSBS in all groups. The low signal emitted by SHG images below the irradiated area demonstrated thermal damage of the collagen matrix. CLMS images of laser groups exhibited thicker and irregular resin-dentin interfaces than the control group. Regardless of the pulse duration, Er:YAG laser pre-treatment altered the organic matrix and HL formation which resulted in low μSBS values at 24 h. The alterations on dentin's organic structure did not jeopardize the μSBS after 1 year of saliva storage.
http://bit.ly/2X3dfTp
Effects of low-level laser therapy on the organization of articular cartilage in an experimental microcrystalline arthritis model
Abstract
The aim of this study was to evaluate the effects of low-level laser therapy using the gallium arsenide laser (λ = 830 nm) on the articular cartilage (AC) organization from knee joint in an experimental model of microcrystalline arthritis in adult male Wistar rats. Seventy-two animals were divided into three groups: A (control), B (induced arthritis), and C (induced arthritis + laser therapy). The arthritis was induced in the right knee using 2 mg of Na4P2O7 in 0.5 mL of saline solution. The treatments were daily applied in the patellar region of the right knee after 48 h of induction. On the 7th, 14th, and 21st days of treatment, the animals were euthanized and their right knees were removed and processed for structural and biochemical analysis of the AC. The chondrocytes positively labeled for the TUNEL reaction were lower in C than in B on the 14th and 21st days. The content of glycosaminoglycans and hydroxyproline in A and C was higher than B on the 21st day. The amount of tibial TNF-α in B and C was lower than in A. The amount of tibial BMP-7 in B and C was higher than in A. The femoral MMP-13 was lower in B and C than for A. The tibial TGF-β for C was higher than the others. The femoral ADAMT-S4 content of A and C presented similar and inferior data to B on the 21st day. The AsGa-830 nm therapy preserved the content of glycosaminoglycans, reduced the cellular changes and the inflammatory process compared to the untreated group.
http://bit.ly/2X5zsjs
The skin rejuvenation associated treatment—Fraxel laser, Microbotox, and low G prime hyaluronic acid: preliminary results
Abstract
Minimally invasive facial rejuvenation procedures reached an all-time high in the 2016. This reveals a growing interest in a smoother, younger, and tighter look accessible using the esthetic medicine tools like botulinum toxin and dermal filler injections, laser, and microdermabrasion. Forty-five patients from 35 to 52 years old (medium age 43.8), 38 women and 7 men underwent 5 sessions of Fraxel laser, 1 session of very low G prime HA, and Microbotox injection treatments from January 2016 and January 2017, were included in this study. In this study, we demonstrated that the usage of three treatments together, like mBTX, Volite, and Fractional laser, have a better result despite every single technique alone. The clinical result showed 98% (44 patients, 6 males, 38 females) of the patients had a smoother skin surface, brighter, more hydrated, and elastic skin; 68% of our patients (31 patients, 5 males, 26 females) showed less skin defects and staining as well as less small wrinkles, thanks to Fraxel laser treatment; 98% (44 patients, 6 males, 38 females) showed tighter skin with less sebaceous gland secretion. The aim of this study was to demonstrate that the combination of three techniques acts better and faster than single treatment to contrast facial aging and to improve skin texture and quality.
http://bit.ly/2GI6YH1
Minimally invasive erbium laser treatment for selected snorers
Abstract
The aim of this paper is to present our results and experience in the treatment of snoring using the non-ablative Erbium: Yttrium Aluminum Garnet (Er:YAG) laser. Twenty-four patients (18 male and 6 female) with snoring problems due to soft palate hypertrophy were treated with 3 treatment procedures with Er:YAG 2940-nm laser (long pulse mode, 10 Hz, fluence 1.8–2.0 J/cm2) performed at 2-week intervals. The treatment procedures were performed in outpatient settings. One treatment session lasts 15–20 min. Subjective (questionnaires) and objective (polygraph) outcome measures were assessed at baseline and 3 months after the final laser treatment. Wilcoxon Signed Rank was used to compare before and after scores. All polygraph variables showed some improvement 3 months after the end of treatment; however, only the reduction of the number of hypopnea episodes per hour was statistically significant (p = 0.034). In 13/24 patients, snoring time accounted for less than 5% of the sleep time after the treatment compared to 6/24 patients at baseline. The questionnaire survey showed statistically significant improvement in the quality of sleep and life of the patients as well as their partners after Er:YAG treatment (p < 0.001). The assessment of daytime sleepiness using the Epworth scale also improved 3 months after the end of treatment (p = 0.010). Based on our observations, the treatment of snoring with the Er:YAG laser is an effective and non-invasive therapeutic method. Further studies with long-term follow-up and a control group are warranted to confirm the promising results obtained in case series.
http://bit.ly/2X3dhuv
Voice improvement in patients with recurrent respiratory papillomatosis after combined treatment with cidofovir and CO 2 laser surgery
Abstract
Mechanical debulking of laryngeal papillomas is associated with voice disorders due to impairment of the vocal fold's mucosa. Intraepithelial injection of cidofovir reduces damage to the laryngeal structures and thus improves vocal parameters. The aim of our study was to compare vocal quality before and after cidofovir and CO2 laser treatment by means of objective phoniatric parameters and to obtain evidence concerning voice outcomes. The vocal parameters of 42 patients with RRP were assessed before and after intralesional cidofovir and CO2 laser debulking treatment (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm; Lumenis Ltd., Yokneam, Israel). The laser was used in SuperPulse™ mode with power tailored on the target structures (average 7 W). The depth of tissue penetration was 1 mm with a single burst of energy lasting 0.3 ms. Most of the patients had previously undergone traditional surgery (1–105 procedures); in 7/42, the video stroboscopic examination revealed extensive scar tissue covering the mucosa of the vocal folds, limiting the mucosal wave. The significance level for all calculations was p < 0.05. Statistical analysis was performed using Statistica 10 by StatSoft Polska. The methodology included subjective voice evaluation (GRBAS), videostroboscopy, analysis of the acoustic laryngeal tone (MDVP), spectrographic analysis, and voice handicap index (VHI). The GRBAS scale during spontaneous conversation revealed better phonation results after cidofovir treatment in all 42 patients. Scars were not observed in the presented group. In the MDVP laryngeal tone analysis before surgery parameters defining the amplitude and frequency of laryngeal tone were significantly elevated compared to the state after surgery. After treatment, both jitter and shimmer were reduced in all subjects. Even more pronounced changes were observed in the spectrographic analysis. In all analyzed patients, there was a significant reduction in VHI scores showing improvement in voice self-assessment. A satisfactory improvement in voice quality was observed in all RRP patients treated with cidofovir and CO2 laser.
http://bit.ly/2S2tmgd
Lasers for Becker’s nevus
Abstract
Becker's nevus is a common pigmented dermatosis, usually featured by ipsilateral pigmented patch with hypertrichosis. Becker's nevus is often treated with various types of lasers although other regimens are available. However, clinical outcomes appear inconsistent among studies. To summarize the clinical outcomes of Becker's nevus treated with lasers via literature review. A variety of lasers had been used alone or in combination to treat Becker's nevus. Laser wavelengths used for Becker's nevus ranged from 504 to 10,600 nm, while the number of treatment varied from 1 to 12 sessions. The clinical outcomes were mixed although combination of lasers with different wavelengths appeared to achieve a better efficacy. Adverse effects were usually mild to moderate erythema. While lasers are relatively safe, their efficacy for Becker's nevus is moderate. It seems that combination therapy could improve the outcome. However, trials in larger group of patients are required to validate the efficacy of each type of lasers for Becker's nevus.
http://bit.ly/2S2tAUB
Sustainable Return to Work: A Systematic Review Focusing on Personal and Social Factors
Abstract
Purpose A systematic review was conducted to evaluate the impact of important personal and social factors on sustainable return to work (RTW) after ill-health due musculoskeletal disorders (MSDs) and common mental disorders (CMDs) and to compare the effects of these personal and social factors across both conditions. Sustainable RTW is defined as a stable full-time or part-time RTW to either original or modified job for a period of at least 3 months without relapse or sickness absence re-occurrence. Methods A literature search was conducted in 13 databases and 79 studies were selected for the review, of which the methodological design was graded as very high, high and low quality. Results The most consistent evidence for achieving sustainable RTW for both MSDs and CMDs was from support from line managers or supervisors and co-workers, positive attitude, self-efficacy, young age and higher education levels. Job crafting, economic status, length of absence and job contract/security showed promising results, but too few studies exist to draw definite conclusions. Results regarding gender were inconsistent. Conclusions This review demonstrates that a variety of personal and social factors have positive and negative influences on sustainable RTW. We suggest that the social environment and how it interrelates with personal factors like attitudes and self-efficacy should be studied in more detail in the future as the inter-relationship between these factors appears to impact positively on sustainable RTW outcomes. Areas for future research include more high-quality studies on job crafting, economic status/income, length of absence, job contract/security and gender.
http://bit.ly/2X3Nl1P
Outcomes following cardiac transplantation in adults
Abstract
For a carefully selected group of patients with advanced heart failure where prognosis and quality of life remain poor, cardiac transplantation is the treatment of choice. Long-term survival and quality of life are now excellent in most patients post-transplantation, but important short- and long-term complications remain a significant concern. The mainstay of early and longer term post-transplant care is the surveillance for and treatment of these complications. This review article provides an overview of the contemporary outcomes after heart transplant, the more commonly encountered problems and their management in the early and late stages.
http://bit.ly/2SQ6s08
Aortic root remodeling in bicuspid and tricuspid aortic valves—long-term results
Abstract
Background
Root remodeling is one form of valve-preserving root replacement to treat patients with aortic regurgitation (AR) and root aneurysm. We have consistently used it for patients with and without connective tissue disease and different aortic valve morphologies. The objective of this retrospective study was to review 23 years of experience with root remodeling.
Methods and patients
Between 10/95 and 9/2018, 1004 of 1038 root remodeling procedures were performed in patients with tricuspid (n = 589) or bicuspid (n = 414) anatomy of the aortic valve in our institution. Aortic aneurysm was present in 932 cases, 73 procedures were performed for acute aortic dissection type A. The severity of aortic regurgitation ranged from grade I to grade IV (mean 2.5 ± 0.8).
Results
All patients underwent root remodeling, concomitant operations were performed in 433, and cusp repair in 883 instances. Hospital mortality was 2%. Overall freedom from reoperation was 92% at 10 years and 89% at 15 years. It was 94% for tricuspid valves at 10 and 15 years, and 88% for bicuspid aortic valves at 10 years and 80% at 15 years (p = 0.003).
Conclusion
In conclusion, root remodeling is a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve form reproducible restoration of aortic valve function can be achieved.
http://bit.ly/2SN79Hx
Recent understanding of the pathophysiology of functional dyspepsia: role of the duodenum as the pathogenic center
Abstract
Over almost 30 years since functional dyspepsia (FD) was defined, researchers have endeavored to elucidate the pathophysiology of functional gastrointestinal disorders. Now a consensus is emerging that the gastric symptoms of FD are caused mainly by gastric motility abnormalities and gastric hypersensitivity. The involvement of other causative factors including acid, Helicobacter pylori, psychological factors, and diet has been debated, but how they are involved in the manifestation of dyspeptic symptoms remains unclear. We believe that most of those factors cause FD symptoms by inducing gastric motility abnormalities and gastric hypersensitivity via the duodenum. Here, we discuss 2 possible reasons why patients with FD experience chronic upper abdominal symptoms: (1) the possibility that the contents of the duodenum of patients with FD differ from those of healthy persons and the different contents stimulate the duodenum, and (2) the possibility that the duodenum of patients with FD is more sensitive to noxious stimuli because of low-grade inflammation and increased mucosal permeability.
http://bit.ly/2tlWjJY
Diuretic Resistance in Heart Failure
Abstract
Purpose of Review
Diuretic resistance (DR) occurs along a spectrum of relative severity and contributes to worsening of acute heart failure (AHF) during an inpatient stay. This review gives an overview of mechanisms of DR with a focus on loop diuretics and summarizes the current literature regarding the prognostic value of diuretic efficiency and predictors of natriuretic response in AHF.
Recent Findings
The pharmacokinetics of diuretics are impaired in chronic heart failure, but little is known about mechanisms of DR in AHF. Almost all diuresis after administration of a loop diuretic dose occurs in the first few hours after administration and within-dose DR can develop. Recent studies suggest that DR at the level of the nephron may be more important than defects in diuretic delivery to the tubule. Because loop diuretics induce natriuresis, urine sodium (UNa) concentration may serve as a functional, physiological, and direct measure for diuretic responsiveness to a given loop diuretic dose.
Summary
Identifying and targeting individuals with DR for more aggressive, tailored therapy represents an important opportunity to improve outcomes. A better understanding of the mechanistic underpinnings of DR in AHF is needed to identify additional biomarkers and guide future trials and therapies.
http://bit.ly/2GK7HaL
Cardiac Contractility Modulation and Baroreflex Activation Therapy in Heart Failure Patients
Abstract
Purpose of Review
Despite advances in medical therapy, heart failure with reduced ejection fraction (HFrEF) is still a leading cause of mortality, hospitalizations, and healthcare costs. In this review, we describe two novel, implantable devices for the treatment of patients with HFrEF, cardiac contractility modulation (CCM), and baroreflex activation therapy (BAT), and summarize literature regarding these devices from the last 5 years.
Recent Findings
CCM improves quality of life and functional capacity as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, 6-min hall walk test (6MHWT) distance, New York Heart Association (NYHA) functional class, peak oxygen consumption (pVO2), heart failure (HF) hospitalizations, and mortality. BAT improves MLHFQ, 6-min walk test distance, NYHA functional class, and HF hospitalizations. Both devices have been shown to be safe.
Summary
CCM and BAT have been shown to be safe and effective treatment modalities for HFrEF. CCM has been approved for use in Europe and has been implanted in thousands of patients. BAT has also been approved in Europe and continues to show promise in treating patients with HFrEF who fail optimal medical therapy (OMT). At present, both therapies are considered investigational in the USA.
http://bit.ly/2tqmaAs
Vasodilator Therapies in the Treatment of Acute Heart Failure
Abstract
Purpose of Review
Vasodilators are commonly recommended to treat acute heart failure (AHF), yet they are infrequently used. This review aims to evaluate the clinical utility of traditional, historical, and novel vasodilators in the treatment of AHF.
Recent Findings
No traditional vasodilator (i.e., nitroglycerin) therapy definitely improves short- or long-term outcomes. Despite repeated efforts to develop new pharmacologic treatments, no novel therapy outperforms traditional management. At the present time, we continue to recommend traditional vasodilators, such as nitroglycerin.
Summary
The use of select vasodilators in the treatment of AHF improves hemodynamics and provides short-term relief; however, data regarding long-term benefits is lacking.
http://bit.ly/2GK7DI3
The Role of Troponin for Acute Heart Failure
Abstract
Purpose of Review
To review the mechanisms, clinical interpretation, prognostic role, and future research regarding cardiac troponin (cTn) in the assessment of acute heart failure (AHF) patients presenting to the emergency department (ED).
Recent Findings
cTn has become a necessary component of the evaluation of AHF patients in the ED, largely because of its independently predictive value as a prognosticator of poor outcome. High-sensitivity assays (hs-cTn) may add risk stratification value beyond conventional assays, specifically with regard to identifying low-risk AHF patients. Moreover, as the complex mechanisms of cTn release in AHF continue to be elucidated, recent studies suggest that many of the key hemodynamic derangements that define specific AHF syndromes may also be direct culprits in cTn release.
Summary
cTn is released in AHF in response to both non-ischemic (e.g., increased afterload, increased preload, inflammatory signaling, altered calcium handling) and ischemic mechanisms. cTn detectable on conventional sensitivity assays predicts poor prognosis when measured in the ED or when noted in historical data such as past ED visits or at the time of discharge from the most recent AHF hospitalization. hs-cTn assays provide detectable values in nearly all AHF patients. Evidence is evolving on using hs-cTn levels below the upper limit of normal to potentially identify low-risk ED patients, and further research is needed. Among the classically cited risk factors for AHF mortality, cTn and natriuretic peptides stand as independent and synergistic prognostic factors even after adjustment for confounders. Many other risk factors, such as ejection fraction, often failed to retain ED prognostic value beyond these two biomarkers.
http://bit.ly/2tlWcOy
The prevalence and anatomy of parathyroid glands: a meta-analysis with implications for parathyroid surgery
Abstract
Purpose
The anatomy of parathyroid glands (PTG) is highly variable in the population. The aim of this study was to conduct a systematic analysis on the prevalence and location of PTG in healthy and hyperparathyroidism (HPT) patients.
Methods
An extensive search of the major electronic databases was conducted to identify all studies that reported relevant data on the number of PTG per patient and location of PTG. The data was extracted from the eligible studies and pooled into a meta-analysis.
Results
The overall analysis of 26 studies (n = 7005 patients; n = 23,519 PTG) on the number of PTG showed that 81.4% (95% CI 65.4–85.8) of patients have four PTG. A total of 15.9% of PTG are present in ectopic locations, with 11.6% (95% CI 5.1–19.1) in the neck and 4.3% (95% CI 0.7–9.9) in mediastinum. The subgroup analysis of ectopic PTG showed that 51.7% of ectopic PTG in the neck are localized in retroesophageal/paraesophageal space or in the thyroid gland. No significant differences were observed between the healthy and HPT patients and cadaveric and intraoperative studies.
Conclusions
Knowledge regarding the prevalence, location, and anatomy of PTG is essential for surgeons planning for and carrying out parathyroidectomies, as any unidentified PTG, either supernumerary or in ectopic location, can result in unsuccessful treatment and need for reoperation.
http://bit.ly/2tqlv1W
Zika Virus-Associated Aseptic Meningitis and Guillain–Barre Syndrome in a Traveler Returning from Latin America: a Case Report and Mini-Review
Abstract
ZIKV-associated Guillain–Barré syndrome presents with an accelerated clinical course compared to classic post-infectious Guillain–Barré syndrome. Clinicians should anticipate and screen patients with ZIKV infection for neurologic complications bearing in mind that these may manifest during the acute viremic phase or during early convalescence.
http://bit.ly/2IhGEpw
Recent Innovations in Diagnosis and Treatment of Pediatric Tuberculosis
Abstract
Purpose of Review
Tuberculosis is leading cause of global morbidity and mortality and a significant proportion of the burden of disease occurs in children. In the past 5 years, a number of innovations have improved the diagnosis and treatment for children with both latent tuberculosis infection and active disease.
Recent Findings
This review discusses three key areas of innovation. First, we assess utilization and performance of interferon-gamma release assays (IGRAs) in different clinical and epidemiologic scenarios. Recent literature has demonstrated good performance of IGRAs for diagnosis of latent tuberculosis infection, particularly in low-incidence settings such as TB control programs in North America. For high-incidence populations, or when testing is done for possible active TB disease, IGRA performance has some important limitations, but IGRA sensitivity when measured against culture proven disease may be better than earlier studies suggested. The second area of innovation is in increased uptake of nucleic acid amplification (NAA) tests and broader application in non-sputum samples for both pediatric pulmonary and extrapulmonary tuberculosis. Finally, recent studies have provided solid evidence in support of shorter treatment courses for pediatric latent tuberculosis infection, such as 12 weeks of weekly isoniazid and rifapentine or 4 months daily rifampin, that improve compliance and may reduce resources required for TB control.
Summary
Many recent innovations in pediatric tuberculosis relate to an improved understanding of how to optimally use existing tests and treatments. Until diagnostic tests and interventions such as vaccination are developed that can dramatically alter the paradigm of pediatric TB management and control, it is important for stakeholders to have a nuanced understanding of tools currently available.
http://bit.ly/2GqAmlK
Zika Virus-Associated Aseptic Meningitis and Guillain–Barre Syndrome in a Traveler Returning from Latin America: a Case Report and Mini-Review
Abstract
ZIKV-associated Guillain–Barré syndrome presents with an accelerated clinical course compared to classic post-infectious Guillain–Barré syndrome. Clinicians should anticipate and screen patients with ZIKV infection for neurologic complications bearing in mind that these may manifest during the acute viremic phase or during early convalescence.
http://bit.ly/2IhGEpw
Recent Innovations in Diagnosis and Treatment of Pediatric Tuberculosis
Abstract
Purpose of Review
Tuberculosis is leading cause of global morbidity and mortality and a significant proportion of the burden of disease occurs in children. In the past 5 years, a number of innovations have improved the diagnosis and treatment for children with both latent tuberculosis infection and active disease.
Recent Findings
This review discusses three key areas of innovation. First, we assess utilization and performance of interferon-gamma release assays (IGRAs) in different clinical and epidemiologic scenarios. Recent literature has demonstrated good performance of IGRAs for diagnosis of latent tuberculosis infection, particularly in low-incidence settings such as TB control programs in North America. For high-incidence populations, or when testing is done for possible active TB disease, IGRA performance has some important limitations, but IGRA sensitivity when measured against culture proven disease may be better than earlier studies suggested. The second area of innovation is in increased uptake of nucleic acid amplification (NAA) tests and broader application in non-sputum samples for both pediatric pulmonary and extrapulmonary tuberculosis. Finally, recent studies have provided solid evidence in support of shorter treatment courses for pediatric latent tuberculosis infection, such as 12 weeks of weekly isoniazid and rifapentine or 4 months daily rifampin, that improve compliance and may reduce resources required for TB control.
Summary
Many recent innovations in pediatric tuberculosis relate to an improved understanding of how to optimally use existing tests and treatments. Until diagnostic tests and interventions such as vaccination are developed that can dramatically alter the paradigm of pediatric TB management and control, it is important for stakeholders to have a nuanced understanding of tools currently available.
http://bit.ly/2GqAmlK
Aggressive Cutaneous Malignancies: A New and Dangerous Phenomenon in Transplant Patients
Abstract
Purpose of Review
In the general population, the incidence of cutaneous malignancies has been rising. However, a particular high-risk population—transplant recipients—suffer at an alarming rate from the incidence of aggressive cutaneous malignancies. The purpose of this review is to examine the latest literature on the epidemiology, risk factors, pathogenesis, prognosis, prevention, and management of highly aggressive cutaneous cancers in the transplant population.
Recent Findings
With innovations in immunosuppression, surgical technique, and perioperative care, organ transplant recipients are now living longer but now suffer from increasing morbidity secondary to the rising incidence of these aggressive cutaneous cancers. Currently, the three most common causes of delayed mortality following organ transplantation are complications associated with infectious diseases, cardiovascular disease and malignancy.
Summary
Cutaneous malignancies have now become the most common malignancy in this unique population.
http://bit.ly/2SXRDsx
Diagnostic delay is common among patients with hypophosphatasia: initial findings from a longitudinal, prospective, global registry
Abstract
Background
Hypophosphatasia (HPP) is a rare, systemic disease caused by mutation(s) within the ALPL gene encoding tissue-nonspecific alkaline phosphatase (ALP). HPP has a heterogeneous presentation, which coupled with its rarity, often leads to missed/delayed diagnosis and an incomplete understanding of its natural history. To better understand the epidemiology and clinical course of HPP, including timing of diagnosis after first reported manifestation, we present baseline data for patients enrolled in the Global HPP Registry.
Methods
Data were analyzed from patients with an HPP diagnosis confirmed by low serum ALP activity and/or an ALPL pathogenic variant, regardless of prior or current treatment, according to age at enrollment (children: < 18 y; adult: ≥18 y). All analyses were descriptive.
Results
Of 269 patients from 11 countries enrolled January 2015–September 2017, 121 (45.0%) were children and 148 (55.0%) were adults. The majority of children and adults were female (61.2 and 73.0%, respectively) and white (57.7 and 90.0%, respectively). Children had a median (min, max) age at earliest reported HPP manifestation of 7.2 months (− 2.3 mo, 16.0 y), which was > 12 months before diagnosis at age 20.4 months (− 0.2 mo, 16.0 y). In adults, the earliest reported manifestation occurred at a median (min, max) age of 37.6 years (0.2 y, 75.2 y), which preceded age at diagnosis (47.5 years [0.2 y, 75.2 y]) by ~ 10 years. Premature loss of deciduous teeth (48.2%, age ≥ 6 mo), bone deformity (32.5%), and failure to thrive (26.7%) were most commonly reported in the HPP-related disease history of children. Pain (74.5%), orthopedic procedures and therapies (44.6%), and recurrent and poorly healing fractures (36.5%) were most commonly reported in the HPP-related disease history of adults.
Conclusions
The Global HPP Registry represents the largest observational study of patients with HPP, capturing real world data. This analysis shows that diagnostic delay is common, reflecting limited awareness of HPP, and that HPP is associated with systemic manifestations across all ages. Many patients diagnosed in adulthood had HPP manifestations in childhood, highlighting the importance of taking thorough medical histories to ensure timely diagnosis.
Trial registration
Clinicaltrials.gov: NCT02306720, December 2014; ENCePP.eu: EUPAS13526, May 2016 (retrospectively registered).
http://bit.ly/2SFxMyY
Patellofemoral kinematic characteristics in anterior cruciate ligament deficiency and reconstruction
Abstract
Background
It is very important to dynamically evaluate the functional outcome in the knee after anterior cruciate ligament (ACL) reconstruction under physiological weight bearing. The objective of the current study is that we would like to compare the patellofemoral joint kinematics in three ACL status: ACL intact, ACL deficiency, ACL reconstruction.
Methods
Twenty patients with unilateral ACL deficient knees were recruited as preoperative group. Six months after ACL reconstruction, these ten subjects were included as postoperative subjects. Ten normal subjects with healthy knees as the control group. Each subject was asked to walk up a custom set of stairs and a single-plane fluoroscopic imaging system was used to determine the 6DOF kinematics of the injured knees, ACL reconstructed knees, and intact knees.
Results
ACL deficient knees showed reduced patellar flexion angle and reduced distal patellar translation during knee flexion. ACL reconstructed knees showed abnormal patellofemoral joint kinematics compared to ACL intact and ACL deficient knees, exhibiting increased patellar external rotation, lateral tilt, lateral translation during knee flexion.
Conclusion
These findings imply that some alterations persist after ACL deficiency and ACL reconstruction. These abnormal changes will be the onset of degeneration in patellofemoral joint even if the ACL is reconstructed in a way that restores the clinical anteroposterior stability of the knee. Some biomechanical changes should be made to improve the outcome of intervention especially in surgical treatment like ACL reconstruction.
http://bit.ly/2DQ1uqL
Does isolated greater trochanter implication affect hip abducent strength and functions in intertrochanteric fracture?
Abstract
Background
A fracture in the isolated greater trochanter is an infrequent type of femoral intertrochanteric fracture. The gluteus medius and gluteus minimus are abducent muscle groups with attachments located on the greater trochanter. Thus, a fracture of the greater trochanter could cause avulsion injury of these attachment points and eventually affect the abducent function of the hip joint and cause chronic pain. Despite these prospects, the impact of a greater trochanter fracture on abducent strength and hip joint function have yet to be investigated.
Methods
Patients who were diagnosed with an isolated greater trochanter fracture (via computed tomography scan and X-ray) and underwent conservative treatment from June 2013 to October 2016 were included in the present study. Magnetic resonance imaging (MRI) was used to verify the morbidity of recessive fractures. Patients' Harris Hip Scores were determined at 3 months, 6 months, and 12 months and the abducent strength and range of motion of the hip joint on the injured side were analyzed and compared to those on the healthy side.
Result
Among 32 patients, there were 7 individuals diagnosed with isolated greater trochanter fractures by MRI, and 25 individuals whose fractures were found to have extended into the intertrochanteric region, wherein the recessive intertrochanteric region fractures had no relationship with patients' age, gender, or weight. After 12 months of conservative treatment, 7 patients still complained of pain in the hip joint. The average Harris Hip Score was 87.84 ± 4.83, and the abducent range of the hip joint on the injured side (42.02 ± 13.93°) was not significantly different from that of the healthy side (46.24 ± 7.93°). The abducent strength of the hip joint of the injured side was 121.32 ± 41.06 N which was significantly lower than that of healthy side (137.44 ± 42.21 N).
Conclusion
Results from this investigation suggest that an isolated greater trochanter fracture attenuates the abducent strength of the hip joint, which may be related to injuries of the ligaments and muscles around the greater trochanter. The surgical skills and methods of addressing isolated greater trochanter fractures merit further investigation.
http://bit.ly/2SzEEO8
The systematic review and meta-analysis of X-ray detective rate of Kashin-Beck disease from 1992 to 2016
Abstract
Background
Kashin-Beck disease (KBD) is a serious human endemic chronic osteochondral disease. However, quantitative syntheses of X-ray detective rate studies for KBD are rare. We performed an initial systematic review and meta-analysis to assess the X-ray detective rate of KBD in China.
Methods
For this systematic review and meta-analysis, we searched five databases (PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), WanFang Data and the China Science and Technology Journal Database (VIP))using a comprehensive search strategy to identify studies of KBD X-ray detective rate in China that were published from database inception to January 13, 2018. The X-ray detective rate of KBD was determined via an analysis of published studies using a random effect meta-analysis with the proportions approach. Subgroup analysis and meta-regression were used to explore heterogeneity, and study quality was assessed using the risk of bias tool.
Results
A total of 53 studies involving 14,039 samples with X-ray detective rate in 163,340 observations in total were included in this meta-analysis. These studies were geographically diverse (3 endemic areas). The pooled overall X-ray detective rate for KBD was 11% (95%CI,8–15%;Z = 13.14; p < 0.001). The pooled X-ray detective rate estimates were 11% (95%CI, 6–17%; Z = 7.06; p < 0.001) for northeast endemic areas, 13% (95%CI, 7–20%; Z = 7.45; p < 0.001) for northwest endemic areas, and 8% (95%CI, 5–12%; Z = 7.90; p < 0.001) for southwest endemic areas. There was a significant relationship between the survey year and the X-ray detective rate of KBD.
Conclusions
Our systematic review found that the summary estimate of the X-ray detective rate of KBD was 11% and, that KBD X-ray positive rate ranged from 8.00 to 15.00% depending on the study. Further research is required to identify effective strategies for preventing and treating KBD.
http://bit.ly/2DEtIof
Complications after direct anterior versus Watson-Jones approach in total hip arthroplasty: results from a matched pair analysis on 1408 patients
Abstract
Background
The direct anterior approach (DAA) has gained popularity in total hip arthroplasty (THA) over the past decade. A large number of studies have compared the DAA to other approaches with inclusion of a learning curve phase. The aim of this study was to compare the complication rate and bleeding between the DAA and the anterolateral approach after the learning curve phase.
Methods
For this retrospective, single-institutional study, propensity score matching was performed, from an initial cohort of 1408 patients receiving an elective THA. Two matching groups were created, comprising of 396 patients each. After matching, both groups were similar in age, gender, body mass index, anesthesiologist's score and surgeon's experience.
Results
Average age in the matched groups was 68.7 ± 10.3 years. The total blood loss was similar in both groups, 450 vs 469 mL (p = 0.400), whereas the transfusion rate (14.1 vs 5.8%, p < 0.001) and the overall complication rate (17.6 vs 12.1%, p = 0.018) were lower in the DAA group. The overall fracture rate was comparable, 1.5 vs 1% (p = 0.376), as well as the early infection rate, 0.3 vs 1% (p = 0.162). The dislocation rate was significantly increased in the DAA group, 2.2 vs 0.5% (p = 0.032).
Conclusions
The direct anterior approach has comparable short-term surgical complications with reduced transfusion and general complication rates.
Level of evidence
Level III retrospective study.
http://bit.ly/2SCTbZx
Comparison of CPG’s for the diagnosis, prognosis and management of non-specific neck pain: a systematic review
Abstract
Background
Neck pain (NP) is a very common musculoskeletal condition with potential for a high burden in disability and length of disorder. Clinical practice guidelines (CPG) give recommendations to clinicians for providing optimal care for patients however best practice recommendations are often contradictory. The purpose for this review was to conduct a SR of CPGs to assess the management recommendations for NP (diagnosis, treatment, prognosis, imaging).
Methods
Standard SR methodology was employed including a grey literature search (including the National Guideline Clearing House). Medline, Cinahl, Embase, ILC, Cochrane, Central, and Lilacs were searched from 1995-to March 2018. Two raters evaluated all citations and a third rater resolved any disagreements. The AGREE II was used to assess risk of bias of each CPG. Data was extracted and included CPG purpose, type of NP problem and clinical recommendations. The AGREE II critical appraisal tool was used to assess risk of bias of each CPG.
Results
From 640 articles, 241 were available for screening. A total of 46 guidelines were selected. CPG's were categorized by the NP population (General NP, whiplash, interventional, headache and risk for vertebral insufficiency) and type of clinical aim (diagnosis, prognosis, treatment, imaging). Each clinical NP population had a large overlap of clinical aims presented. The CPGs were directed to a variety of clinicians that included physicians, physiotherapists and chiropractors. Results suggest heterogeneity in CPG recommendations within each clinical aim. CPG characteristics accounting for these differences are outlined.
Conclusion
The majority of CPGs were developed for general NP that focused on treatment recommendations, with fewer number aimed at recommendations for diagnosis, prognosis, and outcomes. Heterogeneity of recommendations within the categories were noted as were potential factors associated with these differences, including CPG quality as assessed by the AGREE II.
http://bit.ly/2DFlpsk
Effect of Vitamin D supplementation on synovial tissue volume and subchondral bone marrow lesion volume in symptomatic knee osteoarthritis
Abstract
Background
Data from a recent clinical trial of vitamin D therapy in knee OA suggests that, compared to placebo, vitamin D therapy may be associated with a reduction in effusion-synovitis. Our aim was, using contrast-enhanced (CE) magnetic resonance imaging (MRI), to examine the effect of vitamin D therapy on synovial tissue volume (STV) and also subchondral bone marrow lesion (BML) volume in men and women with symptomatic knee OA.
Methods
Data was acquired from participants who took part in a randomised placebo-controlled trial (UK VIDEO) investigating the effect of vitamin D therapy (800 IU cholecalciferol daily) on radiographic joint space narrowing. A subsample had serial CE MRI scans acquired during the trial. Subjects with serial images were assessed (N = 50) for STV and subchondral BML volume. The difference in the mean change from baseline in these structural outcomes between intervention and placebo groups was assessed using random-effects modelling.
Results
The mean age of the 50 subjects (24 active group, 26 placebo group) who contributed data to the analysis was 63.3 years (SD 6.5) and 74% were female. There was no significant difference at 2 years follow-up between the vitamin D and placebo groups in the mean change from baseline for STV (93.9 mm3, 95% CI -1605.0 to 1792.7) and subchondral BML volume (− 313.5 mm3, 95% CI -4244.7 to 3617.7).
Conclusions
Vitamin D supplementation does not appear to have an effect on synovitis or BML volume in patients with symptomatic knee OA.
Trial registration
VIDEO was registered with EudraCT: ref. 2004-000169-37. The protocol for the trial can be accessed at https://www.ctu.mrc.ac.uk/studies/all-studies/v/video/
http://bit.ly/2SxQEjl
Size-dependent sub-proteome analysis of urinary exosomes
Abstract
Exosomes are cell-derived functional microparticles which exist in most body fluids. They carry abundant signaling molecules to transfer information between cells and microenvironment. Research on exosomes' heterogeneity and constitute variations has been a heated topic in recent years. In this work, size-dependent sub-proteome analysis of urinary exosomes was investigated by size exclusion chromatography (SEC) firstly. The particle size of urinary exosomes is distributed in four main ranges naturally. We found out that these fractions contained sub-proteomes with great difference in constitution. In each fraction, 206, 134, 157, and 276 unique proteins were identified by LC-MS/MS. Differential expression of exosomal markers such as TSG101, CD9, CD63, and caveolin-1 was observed in these fractions by western blots. Biological function annotation indicated that the proteins identified in each fraction were involved in different molecular and cellular processes. It is proven that SEC can serve as an efficient analytical tool for exosomes isolation and fractionation. This work provides a new strategy to classify exosomes into sub-populations for comprehensive study of heterogeneous functionalities.
Graphical abstract
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http://bit.ly/2Ie6yup
Recent trends in analysis of nanoparticles in biological matrices
Abstract
The need to assess the human and environmental risks of nanoparticles (NPs) has prompted an adaptation of existing techniques and the development of new ones. Nanoparticle analysis poses a great challenge as the analytical information has to consider both physical (e.g. size and shape) and chemical (e.g. elemental composition) state of the analyte. Furthermore, one has to contemplate the transformation of NPs during the sample preparation and provide sufficient information about the new species derived from such alteration. Traditional techniques commonly used for NP analysis such as microscopy and light scattering are still frequently used for NPs in simple matrices; however, they have limitations in the analysis of complex environmental and biological samples. On the other hand, recent improvements in data acquisition frequencies and reduction of settling time of ICP-MS brought inorganic mass spectrometry into the forefront of NPs analysis. However, with the increasing demand of analytical information related to NPs, emerging techniques such as enhanced darkfield hyperspectral imaging, nano-SIMS and mass cytometry are in their way to fill the gaps. This trend review presents and discusses the state-of-the-art analytical techniques and sample preparation methods for NP analysis in biological matrices.
Graphical abstract
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http://bit.ly/2Gr0gFM
Classifying single fibers based on fluorinated surface treatments
Abstract
Fibers are an important form of forensic evidence, but their evidential value can be severely limited when the identified characteristics of the fibers are common, such as blue cotton. Detecting chemical fiber treatments offers an avenue to further classify fibers and to improve their evidential value. In this report, we investigate the potential of fluoropolymer fiber coatings, used to impart oil and water-repellent properties in fabrics, for differentiating between fibers. The thin nature of these fiber surface modifications creates an analytical challenge for their detection on a single fiber, a typical sample size for forensic evidence. Specifically, pyrolysis-gas chromatography-mass spectrometry (py-GC-MS) has shown promising selectivity but the sensitivity of the method is not adequate for single-fiber analysis of fluorinated coatings. To overcome this challenge, we utilize a newly developed elemental ionization source, plasma-assisted reaction chemical ionization (PARCI). The high sensitivity of py-GC-PARCI-MS for elemental fluorine analysis offers selective and sensitive detection of fluorinated pyrolysates among the non-fluorinated pyrolysates of the fiber core. As a result, fluoropolymer coatings are detected from 10-mm single-fiber samples. The technique is applied for classification of 22 fiber types, resulting in 4 distinct groups via hierarchical cluster analysis based on similarity of fluorine pyrograms. These results present the first study to classify fibers based on fluorinated coatings, and highlight the potential of py-GC-PARCI-MS for forensic analyses.
Graphical Abstract
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http://bit.ly/2IbKhx3
Highly sensitive and selective “off-on” fluorescent sensing platform for ClO − in water based on silicon quantum dots coupled with nanosilver
Abstract
We present a new "off-on" fluorescence probe for detecting hypochlorite (ClO−) based on silicon quantum dots coupled with silver nanoparticles (SiQDs/AgNPs) as nanocomplexes. Via introducing N-[3-(trimethoxysilyl)propyl]ethylenediamine and catechol as initial reactants, silicon quantum dots (SiQDs) with excellent properties were synthesized through a simple hydrothermal method. Transmission electron microscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy were used to characterize the morphology and structure of quantum dots. The fluorescence of SiQDs could be quenched by the silver nanoparticles (AgNPs) by surface plasmon-enhanced energy transfer (SPEET) from SiQDs (donor) to AgNPs (acceptor). The AgNPs could be etched by adding ClO−, thus freeing the SiQDs from the AgNP surfaces and restoring the SiQDs' fluorescence. The sensing system exhibits many advantages, such as wide linear response range, high sensitivity, and excellent selectivity. Under optimized conditions, wide linear ranges (from 0.1 to 100.0 μM) and low detection limits (0.08 μM) were obtained for ClO−.
Graphical Abstract
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http://bit.ly/2GqUO5P
Comparison of the Bile Reflux Frequency in One Anastomosis Gastric Bypass and Roux-en-Y Gastric Bypass: a Cohort Study
Abstract
Introduction
One of the most acceptable procedures in bariatric surgery is laparoscopic gastric bypass. Laparoscopic Roux-en-Y gastric bypass (RYGB) is a common technique used in bariatric surgery. Recently, one anastomosis gastric bypass (OAGB) has been suggested as a simple, fast, and effective technique for obesity treatment. This study aims to compare the frequency of histologically proven bile reflux in OAGB and RYGB among patients with morbid obesity.
Methods
This prospective cohort study was performed from 2015 to 2017 in the Department Of Bariatric Surgery of [blinded]. Patients who had undergone RYGB or OAGB surgery were enrolled. Patients who had undergone revisional surgery were excluded. Data on demographics, symptoms, fasting blood sugar, lipid profile, endoscopic, and histologic findings (based on the Sydney bile reflux index) of bile reflux and postoperative complications were collected and compared for the two techniques.
Results
A total of 122 obese patients (22 males) who had undergone RYGB or OAGB surgery were included. The Sydney bile reflux index showed no statistically significant difference between RYGB and OAGB groups. Similarly, no statistically significant difference was found in the self-reported history of bile reflux–related symptoms, bile reflux markers in esophagogastroduodenoscopy, and postoperative complications between groups.
Conclusions
OAGB and RYGB appear to be equal with respect to postoperative complications, bile reflux frequency, bile reflux index, and the Sydney system score.
http://bit.ly/2tlAdY2
Egg fibrils and transmission in the acanthocephalan Acanthocephalus dirus
Abstract
Acanthocephalans have multi-host life cycles that include arthropods as intermediate hosts and vertebrates as definitive hosts. Eggs are dispersed into the habitat from definitive hosts and in some species eggs possess fibrils, which have been proposed to facilitate transmission to intermediate hosts. We examined the potential role of fibrils in transmission of the acanthocephalan Acanthocephalus dirus to its intermediate host Caecidotea intermedius, a stream-dwelling isopod. We identify three properties of fibrils that could favor transmission. First, there was a slow rate of fibril release, which was dependent on the actions of stream microorganisms. Second, eggs with fibrils were more likely to adhere to the substrate than those without fibrils. Third, in feeding trials, isopods exposed to eggs with fibrils had a higher infection prevalence than isopods exposed to eggs without fibrils. These properties could favor transmission by increasing the likelihood that eggs sink to the sediment occupied by their target hosts before adhering to items on the substrate (e.g., leaves) and by increasing recruitment after the eggs have been consumed.
http://bit.ly/2V3yanD
Interrogating vulnerability in the Global Framework for Climate Services
Abstract
Over the past decade, the Global Framework for Climate Services (GFCS) has emerged as a major influence on the practice of and discourse about climate services, which aim to reduce the vulnerability of society to climate-related hazards through better provision of climate information and engagement of users of climate services. Yet, there is little research into the relations, practices, and discourses produced and institutionalized through the GFCS. The treatment of vulnerability in climate services, and by the GFCS in particular, remains understudied. To address this gap, we conduct a document analysis of key GFCS reports to interrogate framings of vulnerability and examine their implications for the development and practice of climate services for adaptation. Although we see attention to vulnerability in official GFCS discourse, we find that, with a few exceptions, identifying climate vulnerabilities is largely a cursory exercise that does not meaningfully engage in the complex social processes that contribute to differential vulnerabilities. To meet its own objectives, and the larger vision of climate services, we propose that the GFCS draw upon a rich literature on vulnerability and promote the global development of climate services that considers the coupled physical and social dimensions of vulnerability and prioritizes climate services for the most vulnerable.
http://bit.ly/2Swmdd4
Performance of yeast-like cell counting (YLCC) using the Sysmex UF-1000i for clinical candiduria screening
Abstract
Candiduria is common in clinical practice. However, an effective and convenient assay to screen for candiduria is still needed. This study aimed to evaluate the performance of the Sysmex UF-1000i urine analyzer for yeast-like cell counting (YLCC) to screen for candiduria prior to urine culture. We retrospectively analyzed data from 5233 urine samples from 1813 patients, including 837 males and 976 females. Urine culture and urinalysis-obtained YLCC data were used to estimate the performance of YLCC in diagnosing candiduria. Different cutoff values were used to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The YLCC-positive rates differed according to the Candida colony-forming units (CFU) counts in the urine samples. A sharp drop in YLCC-positive rate (from 64.3 to 22.0%) was observed between the urine groups with 104 CFUs and 103 CFUs. A cutoff value of 0 YLCs/μL results in the highest Youden index (0.71) with 77.04% sensitivity and 93.68% specificity. In a group of 34 hospitalized candiduria patients with serial urinalysis data, 25 were YLCC-positive before urine culture. In conclusion, YLCC with the Sysmax UF-1000i could serve as an auxiliary technique to exclude culture-negative specimens prior to urine culture. Positive YLCC results could imply candiduria, especially when persistent YLCC-positive results were observed.
http://bit.ly/2tl9P0B
The use of an acellular matrix derived from human dermis for the treatment of full-thickness skin wounds
Abstract
Full-thickness skin wounds occur in many different clinical cases and the use of biological acellular dermal matrices (ADMs) to reconstruct the damaged area is increasing in the field of plastic and reconstructive surgery. In particular, the ability of ADMs to maintain the structural properties of extracellular matrix as well as to provide a suitable environment for cell growth makes their use suitable for the improvement of wound healing and the reduction of side effects deriving from contracture and scar tissue formation. In this study, we describe the clinical use of a recently developed human dermal matrix (HDM) in combination with graft skin as an alternative reconstructive solution for the treatment of full-thickness skin wounds. The HDM was applied in combination with autologous graft skin on three different clinical cases in which full-thickness skin wounds occurred. The clinical outcomes were evaluated in the patients during their follow-up. Histological as well as ultra-structural analysis were also performed on skin biopsy of the clinical case 3 one year after the treatment with HDM. The use of HDM stimulates the wound healing process in all clinical cases of full-thickness skin wounds here described with a functional and aesthetic rescue of the damaged area. Histological and ultra-structural analysis show a regenerative healing of the wound area with well-organized/oriented connective tissue in which cellular infiltration as well as blood vessels are evident. Our results support the clinical use of HDM as a permanent dermal replacement for the treatment of full-thickness skin wounds.
http://bit.ly/2SQUKSF
Climate engineering–induced changes in correlations between Earth system variables—implications for appropriate indicator selection
Abstract
Climate engineering (CE) deployment would alter prevailing relationships between Earth system variables, making indicators and metrics used so far in the climate change assessment context less appropriate to assess CE measures. Achieving a comprehensive CE assessment requires a systematic and transparent reevaluation of the indicator selection process from Earth system variables. Here, we provide a first step towards such a systematic assessment of changes in correlations between Earth system variables following simulated deployment of different CE methods. We therefore analyze changes in the correlation structure of a broad set of Earth system variables for two conventional climate change scenarios without CE and with three idealized CE model experiments: (i) solar radiation management, (ii) large-scale afforestation, and (iii) ocean alkalinity enhancement. First, we investigate how the three CE scenarios alter prevailing correlations between Earth system variables when compared to an intermediate-high and a business-as-usual future climate change scenario. Second, we contrast the indicators identified for the non-CE climate change scenarios and the indicators identified when all five scenarios are considered. Finally, we use the identified indicator sets for an evaluation of the five climate change scenarios. We find that the additional indicators provide valuable information for the assessment of the CE measures, and their application hence allows for a more comprehensive and a comparative assessment of the mitigation and CE deployment scenarios.
http://bit.ly/2SXpfXu
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