Πέμπτη 21 Φεβρουαρίου 2019
Mesh-related visceral complications following inguinal hernia repair: an emerging topic
Abstract
The use of meshes in inguinal hernia repair (IHR) has gained popularity but new complications have been observed. Mesh-related visceral complications (MRVCs) are generally considered rare and hence are not studied in depth. We carried out a thorough literature search and collected 101 clinical reports published from 1992 to 2018. The reported complications seem to have tripled in the last decade. Ninety-seven cases met the inclusion criteria and they were subdivided into four groups (group A—onlay IHR, group B—3-D IHR, group C—preperitoneal IHR, group D—laparoscopic IHR) to be analyzed, according to the herniorraphy technique. Every prosthetic IHR can be followed by MRVCs but, according to the present review, the highest incidence is related to laparoscopic repairs, the lowest to Lichtenstein technique. Time-to-event was shorter in case of preperitoneal position of the prosthesis than when the mesh was implanted over the transversalis fascia. Urinary bladder involvement predominantly occurred after laparosopic IHR. A pathogenic correlation between the most frequently complained clinical signs and the previous mesh herniorraphy was rarely reported. The diagnosis was generally made at laparotomy, which was usually performed as an emergency. Removing the infected mesh and resecting or suture repairing the involved viscera was the challenging surgical treatment. Prevention of MRVCs after inguinal hernia repair appears to be an important significant issue. It is important to pay attention to the choice of a proper implantation site, avoiding direct contact between the mesh and viscera, and to select a proper device.
https://ift.tt/2SkTnaK
The controversy of the normal values of ultrasonography in carpal tunnel syndrome: diagnostic accuracy of wrist-dependent CSA revisited
Abstract
Introduction
No consensus exists about the upper limit of normal (ULN) of the cross-sectional area (CSA) of the median nerve in diagnosing carpal tunnel syndrome (CTS). Previously, we demonstrated a strong positive correlation between wrist circumference and CSA. ULN depending on wrist circumference turned out to have a low sensitivity, which was hypothesized to be caused by an age mismatch. The aim of this study was to re-evaluate the found invariance by augmentation of the healthy control group, adding older subjects, and to determine the diagnostic accuracy of the updated normal values.
Methods
CSA and wrist circumference were measured in an additional 42 healthy controls in the ages of 40–60. Univariable and multivariable linear regression analyses were applied to determine predicting factors for CSA. Diagnostic accuracy was assessed in a prospective cohort of 253 patients.
Results
A strong correlation was found between wrist circumference and CSA (r = 0.61). Wrist circumference is the most important independent predictor for ULN (r2 = 0.37). We managed to simplify our newly derived regression equations, which turned out to be unrelated to age. Sensitivity of our new equations is low, but higher than a general fixed cut-off value (53.4% and 47.4%, respectively).
Discussion
Wrist circumference is the most important independent predicting factor of CSA. By using our updated equations and taking wrist circumference into account, one can determine a more precise ULN for each individual, which will lead to the improvement of the diagnostic accuracy of ultrasonography (US). Sensitivity for US in diagnosing CTS remains low and it can therefore not replace EDX.
https://ift.tt/2XqAEhQ
Susceptibility of human villous (BeWo) and extravillous (HTR-8/SVneo) trophoblast cells to Toxoplasma gondii infection is modulated by intracellular iron availability
Abstract
Congenital toxoplasmosis is a serious health problem that can lead to miscarriage. HTR-8/SVneo is a first trimester extravillous trophoblast, while BeWo is a choriocarcinoma with properties of villous trophoblast cells. In the placenta, iron is taken up from Fe-transferrin through the transferrin receptor being the ion an important nutrient during pregnancy and also for Toxoplasma gondii proliferation. The aim of this study was to evaluate the role of iron in T. gondii proliferation in BeWo and HTR-8/SVneo cells and in human chorionic villous explants. The cells were infected with T. gondii, iron supplemented or deprived by holo-transferrin or deferoxamine, respectively, and parasite proliferation and genes related to iron balance were analyzed. It was verified that the addition of holo-transferrin increased, and DFO decreased the parasite multiplication in both trophoblastic cells, however, in a more expressive manner in HTR-8/SVneo, indicating that the parasite depends on iron storage in trophoblastic cells for its growth. Also, tachyzoites pretread with DFO proliferate normally in trophoblastic cells demonstrating that DFO itself does not interfere with parasite proliferation. Additionally, T. gondii infection induced enhancement in transferrin receptor mRNA expression levels in trophoblastic cells, and the expression was higher in HTR-8/SVneo compared with BeWo. Finally, DFO-treatment was able to reduce the parasite replication in villous explants. Thus, the iron supplementation can be a double-edged sword; in one hand, it could improve the supplement of an essential ion to embryo/fetus development, and on the other hand, could improve the parasite proliferation enhancing the risk of congenital infection.
https://ift.tt/2TcLIQ8
Routine Upper Gastrointestinal Fluoroscopy Before Laparoscopic Sleeve Gastrectomy: Is It Necessary?
Abstract
Background
Controversy exists regarding the clinical utility of routine preoperative upper gastrointestinal (GI) fluoroscopy in morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). The aim of our study was to determine the efficacy of these studies in detecting hiatal hernias (HH).
Methods
The institution's prospectively maintained, IRB-approved database was retrospectively queried to identify all consecutive patients who underwent LSG between 2011 and 2017. All patients underwent routine preoperative upper GI fluoroscopy. Reports from all imaging studies were retrospectively reviewed and compared to the presence of an intraoperative HH.
Results
During the study period, a total of 1810 patients (854 males, 956 females) underwent LSG at our institution. Mean age was 40.95 ± 13 years (range 11–75), and mean BMI was 42.8 ± 5 kg/m2 (range 30–86). The overall prevalence of HH was 11.1% (201 patients). All HHs detected were repaired. Considering the intraoperative identification of HH the gold standard for diagnosis, the sensitivity and specificity of preoperative UGI fluoroscopy for HH detection were 32% (66/201) and 94% (1512/1609), respectively. The median operative time was significantly longer when concomitant LSG and HH repair was performed compared to LSG alone (76 min vs. 55 min, p < 0.001, respectively). The foreknowledge of HH had no influence on the median operative times (77 min vs. 75 min, predicted vs. incidental, respectively, p = 1.34). HH repair did not affect the complication rate (p = 0.3).
Conclusion
Routine preoperative upper GI fluoroscopy holds a low sensitivity for HH detection. Health policy regulators should consider omitting this exam from routine preoperative evaluation for bariatric patients.
https://ift.tt/2BMJM6W
GC–QTOFMS with a low-energy electron ionization source for advancing isotopologue analysis in 13 C-based metabolic flux analysis
Abstract
For the study of different levels of (intra)cellular regulation and condition-dependent insight into metabolic activities, fluxomics experiments based on stable isotope tracer experiments using 13C have become a well-established approach. The experimentally obtained non-naturally distributed 13C labeling patterns of metabolite pools can be measured by mass spectrometric detection with front-end separation and can be consequently incorporated into biochemical network models. Here, despite a tedious derivatization step, gas chromatographic separation of polar metabolites is favorable because of the wide coverage range and high isomer separation efficiency. However, the typically employed electron ionization energy of 70 eV leads to significant fragmentation and consequently only low-abundant ions with an intact carbon backbone. Since these ions are considered a prerequisite for the analysis of the non-naturally distributed labeling patterns and further integration into modeling strategies, a softer ionization technique is needed. In the present work, a novel low energy electron ionization source is optimized for the analysis of primary metabolites and compared with a chemical ionization approach in terms of trueness, precision, and sensitivity.
https://ift.tt/2Xdxzlb
A visual object tracking benchmark for cell motility in time-lapse imaging
Abstract
Automatic tracking of cells is a widely studied problem in various biomedical applications. Although there are numerous approaches for the video object tracking task in different contexts, the performance of these methods depends on many factors regarding the specific application they are used for. This paper presents a comparative study that specifically targets cell tracking problem and compares performance behavior of the recent algorithms. We propose a framework for the performance evaluation of the tracking algorithms and compare several state-of-the-art object tracking approaches on an extensive time-lapse inverted microscopy dataset. We report the quantitative evaluations of the algorithms based on success rate and precision performance metrics.
https://ift.tt/2TWYwY6
Clinical Infectious Diseases
| The Association of Antibiotic Stewardship With Fluoroquinolone Prescribing in Michigan Hospitals: A Multi-hospital Cohort Study Abstract Background Fluoroquinolones increase the risk of Clostridioides difficile infection and antibiotic resistance. Hospitals often use pre-prescription approval or prospective audit and feedback to target fluoroquinolone prescribing. Whether these strategies impact aggregate fluoroquinolone use is unknown.Methods This study is a 48-hospital, retrospective cohort of general-care, medical patients hospitalized with pneumonia or positive urine culture between December 2015–September 2017. Hospitals were surveyed on their use of pre-prescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing during hospitalization (fluoroquinolone stewardship). After controlling for hospital clustering and patient factors, aggregate (inpatient and post-discharge) fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin) exposure was compared between hospitals with and without fluoroquinolone stewardship.Results There were 11 748 patients (6820 pneumonia; 4928 positive urine culture) included at 48 hospitals. All hospitals responded to the survey: 29.2% (14/48) reported using pre-prescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing. After adjustment, fluoroquinolone stewardship was associated with fewer patients receiving a fluoroquinolone (37.1% vs 48.2%; P = .01) and fewer fluoroquinolone treatment days per 1000 patients (2282 vs 3096 days/1000 patients; P = .01), driven by lower inpatient prescribing. However, most (66.6%) fluoroquinolone treatment days occurred after discharge, and hospitals with fluoroquinolone stewardship had twice as many new fluoroquinolone starts after discharge as hospitals without (15.6% vs 8.4%; P = .003).Conclusions Hospital-based stewardship interventions targeting fluoroquinolone prescribing were associated with less fluoroquinolone prescribing during hospitalization, but not at discharge. To limit aggregate fluoroquinolone exposure, stewardship programs should target both inpatient and discharge prescribing. | ||||||||||||||||||
| Prevalence, Predictors, and Successful Treatment Outcomes of Xpert MTB/RIF–identified Rifampicin-resistant Tuberculosis in Post-conflict Eastern Democratic Republic of the Congo, 2012–2017: A Retrospective Province-Wide Cohort Study Abstract Background Multidrug-resistant tuberculosis (MDR-TB) jeopardizes global TB control. The prevalence and predictors of Rifampicin-resistant (RR) TB, a proxy for MDR-TB, and the treatment outcomes with standard and shortened regimens have not been assessed in post-conflict regions, such as the South Kivu province in the eastern Democratic Republic of the Congo (DRC). We aimed to fill this knowledge gap and to inform the DRC National TB Program.Methods of adults and children evaluated for pulmonary TB by sputum smear microscopy and Xpert MTB/RIF (Xpert) from February 2012 to June 2017. Multivariable logistic regression, Kaplan–Meier estimates, and multivariable Cox regression were used to assess independent predictors of RR-TB and treatment failure/death.Results Of 1535 patients Xpert-positive for TB, 11% had RR-TB. Independent predictors of RR-TB were a positive sputum smear (adjusted odds ratio [aOR] 2.42, 95% confidence interval [CI] 1.63–3.59), retreatment of TB (aOR 4.92, 95% CI 2.31–10.45), and one or more prior TB episodes (aOR 1.77 per episode, 95% CI 1.01–3.10). Over 45% of RR-TB patients had no prior TB history or treatment. The median time from Xpert diagnosis to RR-TB treatment initiation was 12 days (interquartile range 3–60.2). Cures were achieved in 30/36 (83%) and 84/114 (74%) of patients on 9- vs 20/24-month MDR-TB regimens, respectively (P = .06). Predictors of treatment failure/death were the absence of directly observed therapy (DOT; adjusted hazard ratio [aHR] 2.77, 95% CI 1.2–6.66) and any serious adverse drug event (aHR 4.28, 95% CI 1.88–9.71).Conclusions Favorable RR-TB cure rates are achievable in this post-conflict setting with a high RR-TB prevalence. An expanded Xpert scale-up; the prompt initiation of shorter, safer, highly effective MDR-TB regimens; and treatment adherence support are critically needed to optimize outcomes.
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| Hepatitis C Guidance 2018 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection Abstract Recognizing the importance of timely guidance regarding the rapidly evolving field of hepatitis C management, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) developed a web-based process for the expeditious formulation and dissemination of evidence-based recommendations. Launched in 2014, the hepatitis C virus (HCV) guidance website undergoes periodic updates as necessitated by availability of new therapeutic agents and/or research data. A major update was released electronically in September 2017, prompted primarily by approval of new direct-acting antiviral agents and expansion of the guidance's scope. This update summarizes the latest release of the HCV guidance and focuses on new or amended recommendations since the previous September 2015 print publication. The recommendations herein were developed by volunteer hepatology and infectious disease experts representing AASLD and IDSA and have been peer reviewed and approved by each society's governing board. |
Correction to: Effects of Carbohydrate Mouth Rinse on Cycling Time Trial Performance: A Systematic Review and Meta-Analysis
Section 3.2, Fig. 2: The wording on the x-axis which previously read.
https://ift.tt/2SSgYVm
Dynamical behaviors of polylactide crystallization
Abstract
In this paper, we presented a detailed investigation on the dielectric relaxation behavior of amorphous PLLA, and analyzed the evolution of segmental relaxation dynamic during the isothermal cold- and melt-crystallization process of PLLA at different temperatures. The amorphous PLLA exhibits a segmental relaxation process and a dielectric normal relaxation process at the temperature from the glass transition temperature to the melting point of PLLA. For both melt- and cold-crystallized PLLA, it was found that the relaxation strength of the segmental relaxation process increases with temperature. A significant increase of α breadth and decrement of intensity with increasing crystallization temperature could be detected. The obtained results indicate the segmental dynamics of PLLA were not determined by crystallinity but by the degree of supercooling. The change trends of segmental evolution during the cold isothermal crystallization process are different from that during the melt isothermal crystallization process. The maximum loss frequency of segmental relaxation process of PLLA shifts to the lower frequency range continually during the cold crystallization, but it keeps almost unchanged during the melt crystallization process.
https://ift.tt/2GTW0OE
Temperature and humidity index (THI)-induced rumen bacterial community changes in goats
Abstract
The rumen microbiome is thought to play an important role in maintaining normal gastrointestinal metabolism and nutrient absorption in ruminants. The present study was designed to investigate the effect of heat stress on the rumen microbiome of goats using 16S rRNA sequencing technology. Six female goats were randomly allocated into two control metabolic chambers: A and B (in which the temperature and humidity could be precisely controlled with a precision deviation of ± 0.5 °C and ± 5%, with three goats/chamber). Dynamic changes in the rumen bacterial community were detected under 16 gradually increasing temperature and humidity indexes (THIs). Heat stress had no significant effect on alpha diversity but affected the main phyla and genera of the goat rumen microbiota. With a deeper level of heat stress, the TH groups formed a distinct cluster that differed from that of the control check (CK) group. The dominant phylum transitioned from Firmicutes to Bacteroidetes, and co-exclusion occurred between these two phyla. With the increase in THI, the content of probiotics in the Lachnospiraceae_ND3007_group (P < 0.05) decreased, and the abundance of pathogenic bacteria, such as Erysipelotrichaceae_UCG-004 and Treponema_2, increased; however, the difference between the groups was not significant (P > 0.05). Phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) was used to predict bacterial function, and we found that the ambient environment significantly affected the balance between carbohydrate and energy metabolism (P < 0.05). In conclusion, heat stress changed the composition of rumen microbes and affected metabolic function. This experiment provides a theoretical basis for exploring the effects of environmental factors on the rumen of goats.
https://ift.tt/2EpMfGt
Separation and characterization of marine dissolved organic matter (DOM) by combination of Fe(OH) 3 co-precipitation and solid phase extraction followed by ESI FT-ICR MS
Abstract
Marine dissolved organic matter (DOM) constitutes a major carbon pool in the global carbon cycle. Characterization of its chemical composition will improve our understanding of its role in global biogeochemical cycles. Currently, solid phase extraction (SPE) followed by Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) analysis has become a powerful approach to characterize the molecular composition of DOM. However, some components in marine DOM, such as highly oxygenated tannin-like molecules, were lost during the SPE process. In this study, a sequential combination of co-precipitation and SPE procedure was proposed to improve the yield of marine DOM extraction. Ferric hydroxide was used as the co-precipitation agent to separate marine DOM, and SPE was carried out for the extraction of DOM from dissolved and precipitate fractions. The total yield in total organic carbon (TOC) and the number of assigned molecules of SPE-DOM increased by 25% and 51%, respectively, compared with those by direct SPE process. The combined process has good selectivity on tannin-like compounds. The result is instructive for the understanding of DOM molecular composition and potential for a routine method for DOM extraction from environmental water samples, especially for marine DOM containing a small amount of tannin-like compounds.
https://ift.tt/2BN9QiB
Graphene quantum dots enhanced ToF-SIMS for single-cell imaging
Abstract
Time-of-flight secondary ion mass spectrometry (ToF-SIMS) has shown promising applications in single-cell analysis owing to its high spatial resolution molecular imaging capability. One of the main drawbacks hindering progress in this field is the relatively low ionization efficiency for biological systems. The complex chemical micro-environment in single cells typically causes severe matrix effects, leading to significant signal suppression of biomolecules. In this work, we investigated the signal enhancement effect of graphene quantum dots (GE QDs) in ToF-SIMS analysis. A × 160 magnification of ToF-SIMS signal for amiodarone casted on glass slide was observed by adding amino-functionalized GE QDs (amino-GE QDs), which was significantly higher than adding previously reported signal enhancement materials and hydroxyl group-functionalized GE QDs (hydroxyl-GE QDs). A possible mechanism for GE QD-induced signal enhancement was proposed. Further, effects of amino-GE QDs and hydroxyl-GE QDs on amiodarone-treated breast cancer cells were compared. A significant signal improvement for lipids and amiodarone was achieved using both types of GE QDs, especially for amino-GE QDs. In addition, ToF-SIMS chemical mapping of single cells with better quality was obtained after signal enhancement. Our strategy for effective ToF-SIMS signal enhancement holds great potential for further investigation of drug metabolism pathways and the interactions between the cell and micro-environment.
https://ift.tt/2U4mGQw
An electrochemical aptamer-based sensor for the rapid and convenient measurement of l -tryptophan
Abstract
The field of precision medicine—the possibility to accurately tailor pharmacological treatments to each specific patient—would be significantly advanced by the ability to rapidly, conveniently, and cost-effectively measure biomarkers directly at the point of care. Electrochemical aptamer-based (E-AB) sensors appear a promising approach to this end due to their low cost, ease of use, and good analytical performance in complex clinical samples. Thus motivated, we present here the development of an E-AB sensor for the measurement of the amino acid l-tryptophan, a diagnostic marker indicative of a number of metabolic and mental health disorders, in urine. The sensor employs a previously reported DNA aptamer able to recognize the complex formed between tryptophan and a rhodium-based receptor. We adopted the aptamer to the E-AB sensing platform by truncating it, causing it to undergo a binding-induced conformational change, modifying it with a redox-reporting methylene blue, and attaching it to an interrogating electrode. The resulting sensor is able to measure tryptophan concentrations in the micromolar range in minutes and readily discriminates between its target and other aromatic and non-aromatic amino acids. Using it, we demonstrate the measurement of clinically relevant tryptophan levels in synthetic urine in a process requiring only a single dilution step. The speed and convenience with which this is achieved suggest that the E-AB platform could significantly improve the ease and frequency with which metabolic diseases are monitored.
Graphical Abstract
https://ift.tt/2BMWjaR
Selective ratiometric fluorescence detection of hypochlorite by using aggregation-induced emission dots
Abstract
The development of simple and effective tools for selective ratiometric detection of hypochlorite (ClO−) is one of the most important goals for elucidating the biofunction of ClO− in associated diseases. However, most developmental probes suffer from the notorious aggregation-caused quenching (ACQ) effect that greatly limits their applications. Herein, we report on novel aggregation-induced emission dots (AIED) for ratiometric detection of ClO− via a co-precipitation strategy. The AIED nanoprobe displayed a ratiometric signal output, which was more promising to minimize the bad environmental factors and simultaneously avoided the ACQ effect. Notably, amphiphilic block copolymer endowed the nanoprobe with stable water dispersibility and easy modification. The as-prepared AIED probe exhibited high sensitivity (~ 89 nM), high selectivity, outstanding photostability, and prominent long-term fluorescence stability. Furthermore, the as-prepared AIED was applied for the visualized fluorescence detection of ClO− and further utilized to detect ClO− in real samples. We expect the nanoprobe to be an outstanding tool to understand ClO−-associated diseases.
Graphical abstract
Illustration of the probe for the detection of ClO−.
https://ift.tt/2TXYoI0
Progress report: familial pancreatic cancer
Abstract
A hereditary predisposition to pancreatic ductal adenocarcinoma (PDAC) is reported in approximately 5% of patients. Familial pancreatic cancer (FPC) accounts for the vast majority of hereditary PDAC cases. FPC defines families with two or more affected first-degree relatives with PDAC that do not fulfil the criteria of any other inherited tumor syndrome or families with PDAC in three or more relatives of any degree. The current progress report focuses on the knowledge of FPC with regard to molecular pathogenesis, clinical and molecular diagnosis, surveillance and novel treatment options reported in the last 5 years.
https://ift.tt/2U4msZG
Accuracy of crowns based on digital intraoral scanning compared to conventional impression—a split-mouth randomised clinical study
Abstract
Objectives
The aim of this prospective in vivo study was to evaluate the accuracy of the marginal and internal fit of crowns based on conventional impression (CI) or intraoral scan (IOS) in a randomised, split-mouth set-up.
Materials and methods
Nineteen patients needing full coverage crowns, fitting a split-mouth design, were provided with two lithium disilicate crowns: one based on a CI and one based on an IOS. The marginal and internal accuracy of the crowns were assessed with the replica technique and clinically using a modified California Dental Association (CDA) quality evaluation system.
Results
At the preparation margin, the median gap was 60 μm for IOS and 78 μm for CI. For the other points, the median gap ranged from 91 to 159 μm for IOS and 109 to 181 μm for CI. The accuracy of the IOS was statistically significantly better at all point except at the cusp tip. All crowns where rated R or S at both the 6- and 12-month follow-up appointments. The results for the clinical evaluation with CDA for marginal integrity showed no statistically significant difference between the two impression methods at both the 6- and 12-month evaluations.
Conclusions
Crowns based on IOS show statistically significantly better marginal and internal adaptation before cementation compared to conventional impression. However, the clinical evaluation showed similar marginal adaptation.
Clinical relevance
Crowns based on a fully digital workflow can provide clinically acceptable marginal adaptation, comparable to crowns based on CI.
https://ift.tt/2BMCDUh
Glycoprotein Nonmetastatic Melanoma Protein B (GPNMB) Ameliorates the Inflammatory Response in Periodontal Disease
Abstract
Glycoprotein nonmetastatic melanoma protein B (GPNMB) is a type I transmembrane protein that can modulate osteoblasts and bone mineralization. Periodontal disease (PD) is characterized by gum inflammation, alveolar bone resorption, and tooth loss. In this study, we found that GPNMB is highly expressed in inflamed periodontal tissue through microarray and immunohistochemistry (IHC) assays. The role of GPNMB in the pathogenesis of PD was evaluated with primary human periodontal ligament cells (hPDLCs) treated with lipopolysaccharide (LPS) and a GPNMB-expressing lentivirus (lenti-GP). In the hPDLCs treated with LPS and lenti-GP, the expression of tumor necrosis factor (TNF)-α and interleukin (IL)-6 was suppressed and that of IL-10 was upregulated. GPNMB significantly decreased apoptosis in the hPDLCs treated with LPS. GPNMB could upregulate the expression of Jumonji domain-containing protein 3 (Jmjd3), a histone 3 lysine 27 (H3K27) demethylase that is linked to the modulation of the inflammatory response and apoptosis. Taken together, our data find that GPNMB is highly expressed in gum tissue with PD and may be an anti-inflammatory player in the pathogenesis of PD.
https://ift.tt/2IswZMR
Secukinumab: A Review in Ankylosing Spondylitis
Abstract
Secukinumab (Cosentyx®), a first-in-class fully human monoclonal antibody against interleukin-17A, is approved in several countries, including the USA and those of the EU, for the treatment of ankylosing spondylitis (AS). Subcutaneous secukinumab significantly improved the clinical signs and symptoms of AS versus placebo in three of four phase III trials. The benefits of secukinumab were generally seen regardless of whether patients had or had not received previous tumour necrosis factor (TNF) inhibitor therapy, and were sustained during longer-term (up to 5 years) treatment. Secukinumab was also associated with improvements in spinal mobility, physical function, health-related quality of life and work productivity in some of the trials. In MEASURE 1, secukinumab reduced inflammation in the sacroiliac joint, and slowed radiographic progression. Secukinumab was generally well tolerated during up to 5 years' treatment; the most commonly reported adverse event was nasopharyngitis. In the minority of patients who developed anti-drug antibodies (ADAs), ADAs did not decrease efficacy or increase adverse events. In conclusion, secukinumab is an effective therapy for TNF inhibitor-naive patients with active AS, and provides a useful treatment option for patients who have an inadequate response to or are intolerant of TNF inhibitors.
https://ift.tt/2tAlrgu
Erenumab for Preventive Treatment of Migraine: A Systematic Review and Meta-Analysis of Efficacy and Safety
Abstract
Background
Novel therapeutic options with improved efficacy and safety profiles are needed for the prophylaxis of migraine. In recent years, the inhibition of calcitonin gene-related peptide (CGRP) signaling has attracted growing interest in the pharmacological research on migraine. Erenumab is the first fully human monoclonal antibody directed against the CGRP receptor to be approved for use in migraineurs.
Objective
To evaluate the efficacy and safety of erenumab as preventive treatment in patients with migraine using meta-analytical techniques.
Methods
Randomized, placebo-controlled, single- or double-blinded trials were identified through a systematic literature search (October week 4, 2018). Main outcomes included the changes from baseline in monthly migraine days (MMD) and monthly acute migraine-specific medication days (MSMD) at week 12, and the incidence of adverse events (AEs), severe AEs (SAEs) and treatment withdrawal due to AEs. Mean difference (MD) and risk ratio (RR) with 95% confidence intervals (95% CIs) were estimated.
Results
Across the five included trials, erenumab given as a subcutaneous injection at a monthly dosage of 70 mg and 140 mg was associated with a significantly greater reduction in baseline MMD (70 mg: MD − 1.3, 95% CI − 1.7 to − 1.0, p < 0.001; 140 mg: MD − 1.9, 95% CI − 2.3 to − 1.4, p < 0.001) and MSMD (70 mg: MD − 1.0, 95% CI − 1.6 to − 0.4, p < 0.001; 140 mg: MD − 1.8, 95% CI − 2.5 to − 1.1, p < 0.001) than placebo. There were no differences in the occurrence of AEs, SAEs, and drug withdrawal due to AEs between the erenumab and placebo groups.
Conclusions
Erenumab is an efficacious and well tolerated preventive treatment in adult patients with episodic and chronic migraine.
https://ift.tt/2H15dVD
Changes in Gut Microbiota and Hormones After Bariatric Surgery: a Bench-to-Bedside Review
Abstract
Overweight and obesity are among the most prevalent non-communicable diseases which are generally treated successfully by bariatric or sleeve surgery. There are evidences affirming that sleeve surgery can manipulate the pH of the stomach and interact with the metabolism of fatty acids, carbohydrates, and bile acid transfer, leading to the overgrowth of gut microbiota. Therefore, this study aims to review the changes in gut microbiota and hormones after bariatric surgery.
https://ift.tt/2Nl48sN
A phthalimidoalkanamide derived novel DNMT inhibitor enhanced radiosensitivity of A549 cells by inhibition of homologous recombination of DNA damage
Summary
Purpose To elucidate the radiosensitizing effect and underlying mechanism of a new kind of DNA methyltransferase (DNMT) inhibitor with biological availability. Methods A novel non-nucleoside compound, designated as MA-17, was recently derived from a phthalimido alkanamide structure. DNMT expressions were confirmed in cultured human lung cancer (A549) and normal astrocyte (NHA) cells, radiosensitivity was measured using clonogenic assay, and assays of cell cycle alteration, apoptosis, DNA damage repair, and differential gene expression were undertaken. Results MA-17 significantly radiosensitized A549 cells with a mean dose enhancement ratio (DER) of 1.43 at the surviving fraction of 0.2 (p < 0.05 by one-tailed ratio paired t-test). MA-17 did not affect normal astrocytes (mean DER0.2, 1.016; p = 0.420). MA-17 demonstrated a mean half-life of 1.0 h in vivo and a relatively even distribution in various tissues. Pretreatment with MA-17 increased sub-G1 fractions and inhibited the repair of DNA double-strand breaks, which are induced by irradiation. We found that MA-17 also down-regulated DNA homologous recombination and the Fanconi anemia pathway (FANCA, BRCA1, and RAD51C) in A549 cells. This bioinformatics finding was confirmed in validation Western blot to evaluate the expression of vital proteins. Conclusions A novel phthalimido alkanamide derivative, a DNMT inhibitor, possessed both biostability and favorable and substantial radiosensitizing effects by augmenting apoptosis or inhibiting DNA damage repair.
https://ift.tt/2BLEg4S
A phthalimidoalkanamide derived novel DNMT inhibitor enhanced radiosensitivity of A549 cells by inhibition of homologous recombination of DNA damage
Summary
Purpose To elucidate the radiosensitizing effect and underlying mechanism of a new kind of DNA methyltransferase (DNMT) inhibitor with biological availability. Methods A novel non-nucleoside compound, designated as MA-17, was recently derived from a phthalimido alkanamide structure. DNMT expressions were confirmed in cultured human lung cancer (A549) and normal astrocyte (NHA) cells, radiosensitivity was measured using clonogenic assay, and assays of cell cycle alteration, apoptosis, DNA damage repair, and differential gene expression were undertaken. Results MA-17 significantly radiosensitized A549 cells with a mean dose enhancement ratio (DER) of 1.43 at the surviving fraction of 0.2 (p < 0.05 by one-tailed ratio paired t-test). MA-17 did not affect normal astrocytes (mean DER0.2, 1.016; p = 0.420). MA-17 demonstrated a mean half-life of 1.0 h in vivo and a relatively even distribution in various tissues. Pretreatment with MA-17 increased sub-G1 fractions and inhibited the repair of DNA double-strand breaks, which are induced by irradiation. We found that MA-17 also down-regulated DNA homologous recombination and the Fanconi anemia pathway (FANCA, BRCA1, and RAD51C) in A549 cells. This bioinformatics finding was confirmed in validation Western blot to evaluate the expression of vital proteins. Conclusions A novel phthalimido alkanamide derivative, a DNMT inhibitor, possessed both biostability and favorable and substantial radiosensitizing effects by augmenting apoptosis or inhibiting DNA damage repair.
https://ift.tt/2BLEg4S
External root resorption in maxillary and mandibular second molars associated with impacted third molars: a cone-beam computed tomographic study
Abstract
Objective
To separately investigate the prevalence and risk factors of external root resorption (ERR) in maxillary and mandibular second molars (M2s) adjacent to impacted third molars (M3s).
Materials and methods
CBCT scans involving 184 maxillary and 323 mandibular impacted M3s were included. Age, gender, the impaction status of M3, the presence, severity, and location of ERR in M2 were assessed. Risk factors were identified by multivariate logistic regression analyses.
Results
The prevalence of ERR was 32.6% in maxillary and 52.9% in mandibular M2s (P < 0.001). Mesio-angulated and deeply impacted M3s were identified as risk factors for both ERR in maxillary and mandibular M2s (P < 0.05). Besides, age over 25 increased the risk of ERR in maxillary M2s (P < 0.05). ERR in maxillary M2s was overall more severe than that in mandibular M2s (P < 0.001). For maxillary M2s, ERR mostly occurred at the apical third, while the mandibular M2s ERR was most frequently detected at the cervical third.
Conclusions
ERR occurring in M2s adjacent to impacted M3s is common, especially in mandibular M2s. ERR in maxillary M2s cannot be neglected because of its relatively high severity. Mesial angulation and impaction depth of M3 are significantly associated with ERR in M2s. For ERR in maxillary M2s, age is another predictive parameter.
Clinical relevance
Considering the presence of ERR is associated with M3s' impaction, watchful monitoring or prophylactic removal of impacted M3s should be deliberated especially for the patients over 25 years and with mesially inclined and deeply positioned M3s.
https://ift.tt/2GHDbiq
Management of De Novo Carotid Stenosis and Postintervention Restenosis—Carotid Endarterectomy Versus Carotid Artery Stenting—a Review of Literature
Abstract
The current literature indicates carotid endarterectomy (CEA) as the preferred treatment for symptomatic, moderate to severe carotid artery stenosis. However, recommendations for the management of acute tandem stenosis and complete occlusion, as well as postintervention restenosis of the carotid artery, remain controversial. Here, we review the literature evaluating these conditions and provide suggestions for clinical decision-making. Acute tandem stenosis or occlusion of the common and internal carotid arteries may be treated with angioplasty alone, reserving carotid artery stenting (CAS) or CEA for severe and complex cases. Patients who underwent CEA and developed ipsilateral restenosis may be subjected to angioplasty followed by CAS, which carries a lower risk of cranial nerve injury and subsequent restenosis of the artery. For post-CAS restenosis, current evidence recommends angioplasty and CAS for the management of moderate stenosis and CEA for severe stenosis of the carotid artery. Given the lack of level 1 evidence for the management of these conditions, the abovementioned recommendations may assist clinical decision-making; however, each case and its unique risks and benefits need to be assessed individually. Future studies evaluating and defining the risks and benefits of specific treatment strategies, such as CEA and CAS, in patients with acute tandem stenosis, occlusion, and postintervention restenosis of the carotid artery need to be conducted.
https://ift.tt/2GX4Uec
Normative anthropometry and proportions of the Kenyan-African face and comparative anthropometry in relation to African Americans and North American Whites
Abstract
Background
There is no normative craniofacial anthropometric data for the Kenyan-African population. The purpose of this investigation was to determine normative anthropometric craniofacial measurements and proportional relationships for Kenyans of African descent and to compare the data with African Americans (AA), North American Whites (NAW), and neoclassical canons.
Methods
Twenty-five direct facial anthropometric measurements, and 4 angular measurements, were taken on 72 Kenyan-African participants (age range 18–30 years) recruited at the University of Nairobi in Kenya. The data were compared with AA and NAW populations, and neoclassical canons. Descriptive statistics of the variables were computed for the study population.
Results
Significant differences between both Kenyan males and females were detected in forehead height (~ 5 mm greater for males, ~ 4.5 mm for females), nasal height (reduced by ~ 4 mm in males, ~ 3 mm in females), nasal width (8–9 mm greater), upper lip height (> 3 mm), and eye width (greater by ~ 3 mm) compared to NAW subjects. All vertical measurements obtained were significantly different compared with NAW. Differences were observed in comparison with AA subjects, but less marked. Mouth width was similar in all groups. Angular measurements were variable. Neoclassical canons did not apply to the Kenyan population.
Conclusions
Anthropometric measurements of NAW showed clear differences when compared with the Kenyan population, and variations exist with comparative AA data. The anthropometric data in terms of linear measurements, angular measurements, and proportional values described may serve as a database for facial analysis in the Kenyan-African population.
https://ift.tt/2Eneplb
What and when can a fetus hear?
The developing fetus begins to hear around the 18th week of pregnancy and starts to hear low frequencies from outside the woman's body soon after. Learn more about when a fetus can hear.
from #Audiology via ola Kala on Inoreader https://ift.tt/2BODJyO
What and when can a fetus hear?
The developing fetus begins to hear around the 18th week of pregnancy and starts to hear low frequencies from outside the woman's body soon after. Learn more about when a fetus can hear.
from #Audiology via ola Kala on Inoreader https://ift.tt/2BODJyO
via IFTTT
from #Audiology via ola Kala on Inoreader https://ift.tt/2BODJyO
via IFTTT
Direct capture of carbon dioxide from air via lime-based sorbents
Abstract
Direct air capture (DAC) is a developing technology for removing carbon dioxide (CO2) from the atmosphere or from low-CO2-containing sources. In principle, it could be used to remove sufficient CO2 from the atmosphere to compensate for hard-to-decarbonize sectors, such as aviation, or even for polishing gas streams containing relatively low CO2 concentrations. In this paper, the performance of lime-based sorbents for CO2 capture from air in a fixed bed was investigated. The effects of sorbent type, particle diameter, air flow rate, and relative humidity on the breakthrough time, breakthrough shape, and global reaction rate over a series of capture and regeneration cycles were examined. The greatest reaction rates and conversions were obtained when the sorbents were pre-hydrated and inlet air was humidified to 55% relative humidity. Humidifying the air alone leads to axial carbonation gradients since there is competition between CO2 and water with the available CaO. Negligible conversion, over the duration of the experiment, is obtained in a dry system without pre-hydration and humid air. A shrinking-core gas–solid reaction model was fitted to the breakthrough curves in order to estimate the surface reaction and effective diffusion constants. Although the surface reaction constants of the two sorbents were similar, the pelletized limestone had a greater effective diffusivity due to its greater porosity. At mild calcination conditions with air at 850 °C, the pelletized particles maintained their activity over nine carbonation–calcination cycles with a conversion drop of only 9% points. However, calcination under oxy-fuel conditions (CO2 at 920 °C) reduced the pellet carbonation conversion from 81 to 59% and pore surface area from 12.01 to 3.20 m2/g after only 4 cycles. This research clearly shows that DAC using lime-based sorbents is technically feasible, and that regeneration schemes compatible with technologies like calcium looping (CaL) are applicable for the air capture option. Finally, this study demonstrates that DAC using lime-based materials can be in the future a strategy to address emissions from transportation and distributed CO2 sources and to mitigate climate change.
https://ift.tt/2GSbcMl
What and when can a fetus hear?
The developing fetus begins to hear around the 18th week of pregnancy and starts to hear low frequencies from outside the woman's body soon after. Learn more about when a fetus can hear.
from #Audiology via ola Kala on Inoreader https://ift.tt/2BODJyO
via IFTTT
from #Audiology via ola Kala on Inoreader https://ift.tt/2BODJyO
via IFTTT
Capillary Vibrating Sharp-Edge Spray Ionization (cVSSI) for Voltage-Free Liquid Chromatography-Mass Spectrometry
Abstract
Here, we report a continuous flow-based ionization method, capillary vibrating sharp-edge spray ionization (cVSSI), that nebulizes liquid sample directly at the outlet of a capillary without using high-speed nebulization gas or a high electrical field. cVSSI is built upon the recently reported VSSI principle which nebulizes bulk liquid using vibrating sharp-edges. By attaching a short piece of fused silica capillary on top of the vibrating glass slide in VSSI, liquid is nebulized at the outlet of the capillary as the result of the vibration. Utilizing standard 360-μm OD/100-μm ID capillary, cVSSI works with a wide range of flow rates from 1 μL/min to 1 mL/min. The power consumption is as low as 130 mW. ESI-like MS spectra are obtained for small molecules, peptides, and proteins. Five orders of magnitude linear response for acetaminophen solution is achieved with a limit of detection (LOD) of 3 nM. cVSSI is also demonstrated to be compatible with LC-MS analysis. Two LC-MS applications are demonstrated with cVSSI: (1) separation and detection of a mixture of small molecules and (2) bottom-up proteomics using a protein digest. A mixture of nine common metabolites was appropriately separated and detected using LC-cVSSI-MS. In the bottom-up experiment, 78 peptides were detected using LC-cVSSI-MS/MS with a protein coverage of 100% for cytochrome c, which is comparable with the coverage obtained using LC-ESI-MS. cVSSI offers a means of interfacing LC or other continuous flow-based applications to mass spectrometers with the salient features of voltage-free, flexibility, small footprint, and low power consumption.
https://ift.tt/2tA3i2m
PEGylated poly(amidoamine) dendrimers-based drug loading vehicles for delivering carboplatin in treatment of various cancerous cells
Abstract
The fourth generation (G4) of poly(amidoamine) dendrimer was PEGylated and then physically incorporated with carboplatin to develop the new drug delivery carrier. The proton nuclear magnetic resonance (1H NMR) and Fourier-transform infrared spectroscopy (FTIR) were utilized to confirm the successful synthesis and incorporation. The PEGylation leads to increase the particle dimension of G4 dendrimer to 4.04 to 30.67 nm that was still in the effective range for killing cancerous cells. The cytotoxicity on L929 fibroblasts demonstrated that the PEGylation of G4 could eliminate the toxic caused by amine surrounding groups of G4. Three cancerous cells including the cervical cancer cell line (HeLa), the adenocarcinomic human alveolar basal epithelial cells (A549), and the human breast cancer cell line (MCF7) were treated with G4-PEG@CAR as a function of CAR concentrations. The results of resazurin test and live/dead assay indicated that the killing effect of G4-PEG@CAR on three representative cells were achieved and increased following the enhancement of CAR concentration. Furthermore, the better effectiveness of G4-PEG@CAR was achieved on Hela.
https://ift.tt/2EohbXq
A preliminary calculation of cement carbon dioxide in China from 1949 to 2050
Abstract
Carbon dioxide (CO2) emissions from China are of global concern. As energy-, resource-intensive and greenhouse gas (GHG) pollution emissions, China's cement-related CO2 emissions and environmental effect attracted more and more attention reasonably. A multiple-year's cement CO2 emissions were estimated in China based on actual and projected cement output and CO2 emission factor (EF) from the perspective of technological improvement for the period 1949–2050. The more than 100 years' time scale was divided into three periods: 1949–1979, 1980–2015, and 2016–2050, which mainly based on China's socio-economy and technological improvement (i.e., transformed cement kilns and popularized waste heat recovery, WHR). The bottom-up model was used for calculating cement-related CO2 emissions after analyzing processes of cement production, and we found China's comprehensive cement CO2 EF (CCEF) was about 1694.31 kg CO2 per ton of cement in 1949, and declined to 737.01 kg CO2 per ton of cement in 2015. Furthermore, it is likely that China's cement output is about 1617.50 Mt in 2050. Meanwhile, China's CCEF is about 576.02 kg CO2 per ton of cement which based on likely realistic scenario (LRS), and CO2 emissions are about 931.71 Mt in 2050, which is about half lower than those in 2014. It is important for calculating China's cement emissions in the society and rank around the world. For China's cement CO2 emission reduction, the contribution of technological innovation or improvement (TII) was undeniable, but the degree of CO2 reduction was limited, especially when the technological diffusion rate was close to saturation. The Chinese government is ambitious in controlling cement-related CO2 emissions and should start with controlling cement capacity, utilization of alternative raw materials (ARMs) and alternative fuels (AFs), and establishing a sound carbon trading market.
https://ift.tt/2tx4sLO
Statistically correlating NMR spectra and LC-MS data to facilitate the identification of individual metabolites in metabolomics mixtures
Abstract
NMR and LC-MS are two powerful techniques for metabolomics studies. In NMR spectra and LC-MS data collected on a series of metabolite mixtures, signals of the same individual metabolite are quantitatively correlated, based on the fact that NMR and LC-MS signals are derived from the same metabolite covary. Deconvoluting NMR spectra and LC-MS data of the mixtures through this kind of statistical correlation, NMR and LC-MS spectra of individual metabolites can be obtained as if the specific metabolite is virtually isolated from the mixture. Integrating NMR and LC-MS spectra, more abundant and orthogonal information on the same compound can significantly facilitate the identification of individual metabolites in the mixture. This strategy was demonstrated by deconvoluting 1D 13C, DEPT, HSQC, TOCSY, and LC-MS spectra acquired on 10 mixtures consisting of 6 typical metabolites with varying concentration. Based on statistical correlation analysis, NMR and LC-MS signals of individual metabolites in the mixtures can be extracted as if their spectra are acquired on the purified metabolite, which notably facilitates structure identification. Statistically correlating NMR spectra and LC-MS data (CoNaM) may represent a novel approach to identification of individual compounds in a mixture. The success of this strategy on the synthetic metabolite mixtures encourages application of the proposed strategy of CoNaM to biological samples (such as serum and cell extracts) in metabolomics studies to facilitate identification of potential biomarkers.
https://ift.tt/2V57qD0
Emergency Transjugular Intrahepatic Portosystemic Shunt: an Effective and Safe Treatment for Uncontrolled Variceal Bleeding
Abstract
Background
Uncontrolled variceal bleeding (VB) remains a great challenge for clinical treatment. Emergency transjugular intrahepatic portosystemic shunt (TIPS) is a salvage procedure, but unsatisfactory clinical outcomes and a high incidence of complications have been reported. This study aimed to investigate the effect and safety of emergency TIPS performed in our institution during recent years.
Methods
Fifty-eight consecutive cirrhotic patients with uncontrolled VB who underwent emergency TIPS from March 2009 to November 2017 in our hospital were followed until the last clinical evaluation, liver transplantation (LT), or death.
Results
Overall, 5, 36, and 17 patients belonged to Child-Pugh class A, B, and C, respectively. TIPS was successfully performed in 57 (98.3%) patients at 89.5 h (mean) after initial bleeding. After TIPS, bleeding ceased in 52 (91.2%) patients, and 51 (89.5%) patients had a portal pressure gradient below 12 mmHg. Only one (1.8%) major procedure-related complication occurred without any clinical consequences, and no procedure-related deaths occurred. During follow-up, 55 hepatic encephalopathy (HE) episodes occurred in 19 (33.3%) patients, and the median time of the first HE episode was 3.1 months. Seven (12.3%) patients experienced shunt dysfunction after 8.7 months (median). The 6-week, 1-year, and 2-year variceal rebleeding rates were 10.5%, 17.1%, and 20.0%, respectively. The LT-free survival rates at 6 weeks, 1 year, and 2 years were 87.7%, 81.8% and 73.6%, respectively.
Conclusion
Our study highlights the fact that emergency TIPS could be effective for patients with liver cirrhosis and uncontrolled VB with few potential complications.
https://ift.tt/2XgiFKU
Primary Clinical Application of Y-Shaped Jogged Stent Implantation in Patients with Malignant Hilar Biliary Obstruction
Abstract
Objective
To assess the feasibility, safety, and efficacy of Y-shaped jogged stent in patients with malignant hilar biliary obstruction.
Methods
A total of 196 patients with malignant hilar biliary obstruction treated by biliary tract stent implantation from August 2010 to August 2017 were retrospectively reviewed. Seventeen consecutive patients who were treated with Y-shaped jogged stent implantation were identified as the Y-shaped jogged stent implantation group. Seventeen matched patients undergoing unilateral stent placement combined with percutaneous transhepatic cholangial drainage (PTCD) were enrolled as the control group. Baseline characteristics of patients, stent patency time, and survival time were compared.
Results
There was no significant difference in the age, gender, tumor type and stage, biliary obstruction classification, bilirubin level at diagnosis, presence of metastasis, or chemotherapy between the Y-stent group and the control group (P > 0.05). One week after surgery, the reduction rate of bilirubin was significantly higher in the Y-stent group (88.2% vs 53.0%, P < 0.05). The mean stent patency time was longer in the Y-stent group (7.3 ± 1.0 months vs 5.7 ± 0.9 months, P < 0.05). The mean survival time of the Y-stent group (9.1 ± 1.5 months) was longer than the control group (7.2 ± 1.1 months, P > 0.05). There was no severe complication occurred in both two groups.
Conclusion
Y-shaped jogged stent implantation was a safe, feasible, and effective approach in the treatment of patients with malignant hilar biliary obstruction, with the significantly prolonged stent patency time and survival time.
https://ift.tt/2Si3flo
Carious lesion activity assessment in clinical practice: a systematic review
Abstract
Objectives
The objective of the manuscript is to systematically review the different techniques developed for activity assessment of coronal carious lesions (AACCL) in clinical settings.
Materials and methods
A search of PubMed identified original articles in English reporting on the different concepts/tools for AACCL in clinical settings and, when available, data related to their in vivo/in situ validation in terms of sensitivity, specificity, inter- and intra-examiner reproducibilities, area under the receiving operating curve, positive predictive value, negative predictive value, and relative risk of lesion progression.
Results
The present review included 25 articles. Four groups of techniques are available (1) systems based on combinations of visual and tactile criteria; devices based on (2) pH assessment, (3) fluorescence, or (4) bioluminescence. The most studied systems are those based on combinations of visual and tactile parameters when bioluminescence suffers from the lack of in vivo evaluation. Validation studies showed a wide disparity among protocols in terms of populations, dentitions, teeth surfaces, study design, the gold standard, and validation criteria.
Conclusion
There is a need for definition and harmonization of standards for activity assessment-related concepts/tools, as well as further investigations for in vivo validation of newly developed tools.
Clinical relevance
Carious lesion activity is an important component to be taken into account when making decisions as to appropriate clinical caries management. The development and use of validated techniques which are easy to use in everyday dental practice are important.
https://ift.tt/2T9GYuC
Weight Loss, Remission of Comorbidities, and Quality of Life After Bariatric Surgery in Young Adult Patients
Abstract
Introduction
One of the current criteria for bariatric surgery is to be of an age between 18 and 65 years. In all the available literature, there is a lack of studies focusing on the results of bariatric surgery in younger patient. This could be of great interest because the weight loss response can be altered by differences in metabolism or compliance rate. In recent years, a high amount of patients between 18 and 25 years of age have undergone bariatric surgery in our center, and it is our aim to evaluate the weight loss results in this youngest patient group.
Methods
All preoperative and perioperative data from patients aged 18–25 and 35–55 years (control group) were collected retrospectively. Bariatric procedures took place between 2011 and 2014. Follow-up data were gathered prospectively by collecting (laboratory) measurements and questionnaires.
Results
In total, 103 young adults (mean age 22.5) were matched to 103 adult control patients (mean age 42.6) on BMI and date of surgery. Of the young adults' group, 75 patients underwent a Roux-en-Y gastric bypass (RYGB) compared with 80 patients in the control group. Three years after RYGB, mean %total body weight loss (%TBWL) was 34 (± 9) and 30.3 (± 9) (p = 0.03), respectively.
Conclusion
Bariatric surgery is effective in young adults, and results after RYGB are even better compared with age groups in which bariatric surgery is most often performed. The high remission rate of comorbidities shows the importance of effective treatment options at a young age and preventing damaging effects in the long term.
https://ift.tt/2U10KWy
Respiratory analysis as a tool to detect physiological changes in Anisakis larvae subjected to stress
Abstract
Human infection due to eating fish parasitized by live Anisakis larvae in the third stage is considered an important health problem, and the application of treatments to ensure their mortality in the fish products is crucial to prevent the risk of infection. Mobility is used to assess viability, but mobile larvae may not always be infective and immobile larvae may be erroneously considered as non-viable. The objective was to establish whether the analysis of respiratory activity by means of the oxygen consumption rate (OCR) of Anisakis could be used to identify subtle differences between larvae that were still considered viable in terms of their mobility but had been subjected to thermal and/or chemical stress. The metabolic modulators FCCP [carbonyl cyanide 4-(trifluoromethoxy) phenylhydrazone] and sodium azide were used and the basal, maximum, spare and residual respiration rates calculated. Results showed that maximum respiratory capacity of larvae subjected to freezing significantly decreased immediately after thawing, but after some acclimatization, they recovered their capacity fully. However, when these larvae were stored at 4.6 °C, their mitochondria became dysfunctional faster than those of untreated larvae. OCR also showed that mitochondria of larvae were affected by incubation at 37 °C in NaCl or gastric juice. To conclude, OCR of Anisakis in the presence of metabolic modulators can help to identify subtle changes that occur in the larva. These measurements could be used to characterize larvae subjected to various stresses so that a broader picture of Anisakis pathogenic potential can be gained.
https://ift.tt/2V4U9dE
How to manage accidental and unintended exposure in radiology: an ESR white paper
Abstract
Since February 2018, the Directive 2013/59/EURATOM (EU-BSS) requires all EU member states to implement a system for recording and analysis of all accidental or unintended medical exposures (Article 63). An ESR questionnaire in May 2018 among ESR member countries including all EU member states (MS) revealed a very heterogeneous and unsatisfactory situation in transposition of the EU-BSS. Some MS just translated this part of the directive, others used effective dose as reporting criteria and others used physical dose parameters from the modalities. This white paper will help national scientific organisations advice their national regulators and authorities on how to provide a simple and practicable implementation of the directive. ESR recommends notification and reporting criteria for significant events based on physical quantities and units and not on effective dose or text-based criteria like "significantly different" (EU-BSS, Article 4 (99)).
https://ift.tt/2TYoryA
EyeSAM: graph-based localization and mapping of retinal vasculature during intraocular microsurgery
Abstract
Purpose
Robot-assisted intraocular microsurgery can improve performance by aiding the surgeon in operating on delicate micron-scale anatomical structures of the eye. In order to account for the eyeball motion that is typical in intraocular surgery, there is a need for fast and accurate algorithms that map the retinal vasculature and localize the retina with respect to the microscope.
Methods
This work extends our previous work by a graph-based SLAM formulation using a sparse incremental smoothing and mapping (iSAM) algorithm.
Results
The resulting technique, "EyeSAM," performs SLAM for intraoperative vitreoretinal surgical use while avoiding spurious duplication of structures as with the previous simpler technique. The technique also yields reduction in average pixel error in the camera motion estimation.
Conclusions
This work provides techniques to improve intraoperative tracking of retinal vasculature by handling loop closures and achieving increased robustness to quick shaky motions and drift due to uncertainties in the motion estimation.
https://ift.tt/2GCtlOW
Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development
Abstract
Postpartum depression is one of the most common complications of childbirth. Untreated postpartum depression can have substantial adverse effects on the well-being of the mother and child, negatively impacting child cognitive, behavioral, and emotional development with lasting consequences. There are a number of therapeutic interventions for postpartum depression including pharmacotherapy, psychotherapy, neuromodulation, and hormonal therapy among others, most of which have been adapted from the treatment of major depressive disorder outside of the peripartum period. Current evidence of antidepressant treatment for postpartum depression is limited by the small number of randomized clinical trials, underpowered samples, and the lack of long-term follow-up. The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides, and neuroactive steroids. Evidence supporting the role of neuroactive steroids and γ-aminobutyric acid (GABA) in the pathophysiology of postpartum depression led to the investigation of synthetic neuroactive steroids and their analogs as potential treatment for postpartum depression. Brexanolone, a soluble proprietary intravenous preparation of synthetic allopregnanolone, has been developed. A recent series of open-label and placebo-controlled randomized clinical trials of brexanolone in postpartum depression demonstrated a rapid reduction in depressive symptoms, and has led to the submission for regulatory approval to the US Food and Drug Administration (decision due in March 2019). SAGE-217, an allopregnanolone analog, with oral bioavailability, was recently tested in a randomized, double-blind, placebo-controlled phase III study in severe postpartum depression, with reportedly positive results. Finally, a 3β-methylated synthetic analog of allopregnanolone, ganaxolone, is being tested in both intravenous and oral forms, in randomized, double-blind, placebo-controlled phase II studies in severe postpartum depression.
https://ift.tt/2Ip023U
Observations, knowledge, and attitude towards treatment options in patients with dry mouth: a survey among German dentists
Abstract
Objectives
The aim of this study was to investigate the attitude, observations, and knowledge of German dentists regarding the management of dry mouth.
Materials and methods
A questionnaire including queries about attitudes, observations, and treatment options in patients with dry mouth was developed and sent to all 1251 dentist members of a regional German dental association.
Results
An overall total of 284 returned questionnaires were included in the analyses, which relates to a response rate of 22.7%. Dentists infrequently encountered dry mouth in their clinical routine, yet were well aware that patients suffer from the symptoms of dry mouth; for affected patients, the majority of participating dentists provided specific dental prophylaxis measures. Drug side effects, neoplasia, and psychological disorders were regarded as the primary etiological factors for dry mouth, and caries, increased plaque formation, and rhagades as the most frequently observed clinical symptoms. While the majority of participating dentists was of the opinion that saliva substitutes are useful treatment options in patients with dry mouth, only few frequently recommended their use. Mechanical and gustatory stimulation of salivary flow as well as the advice to rinse with water were the most frequently pursued treatment options.
Conclusions
Despite the high prevalence of dry mouth identified in epidemiological studies, it appears to be an infrequent observation in clinical routine.
Clinical relevance
Pre- and postgraduate education should sensitize dentists for dry mouth and its treatment options.
https://ift.tt/2txlU2U
Lausanne checklist for safe stereotactic radiosurgery
Abstract
Introduction
Stereotactic radiosurgery (SRS) is increasingly used as a minimally invasive alternative in many neurosurgical conditions, including benign and malignant tumors, vascular malformations, and functional procedures. As for any surgical procedure, strict safety guidelines and checklists are necessary to avoid errors and the inherent unnecessary complications. With regard to the former, other groups have already reported human and/or technical errors. We describe our safety checklist for Gamma Knife radiosurgical procedures.
Methods
We describe our checklist protocol after an experience gained over 1500 radiosurgical procedures, using Gamma Knife radiosurgery, performed over a period of 8 years, while employing the same list of items. Minor implementation has been performed over time to address some safety issues that could be improved.
Results
Two types of checklist are displayed. One is related to the indications when a specific tissue volume is irradiated, including tumors or vascular disorders. The second corresponds to functional disorders, such as when the dose is prescribed to one specific point. Using these checklists, no human error had been reported during the past 8 years of practice in our institution.
Conclusion
The use of a safety checklist for SRS procedures promotes a zero-tolerance attitude for errors. This can lower the complications and is of major help in promoting multidisciplinary cooperation. We highly recommend the use of such tool, especially in the context of the increased use of SRS in the neurosurgical field.
https://ift.tt/2GWlpHq
Hemorrhagic burden in poor-grade aneurysmal subarachnoid hemorrhage: a volumetric analysis of different bleeding distributions
Abstract
Background
Volumetric assessment of aneurysmal bleeding has been evaluated in few studies and emerged as a promising outcome predictor. There is a lack of studies evaluating its impact in the poor-grade population.
Methods
Retrospective review of 63 consecutive poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients, defined as grade IV and V according to the World Federation of Neurological Surgeons (WFNS) classifications. Global intracranial bleeding volume was calculated with its subarachnoid, intracerebral (ICH), and intraventricular (IVH) portions by means of analytical software. Univariate and multivariate analyses were performed in order to identify independent predictors of outcome. Good outcome was defined as modified Rankin Scale (mRS) 0–2 and mortality as mRS 6. The cutoff values of bleeding volumes were derived by receiver operating curve (ROC) analysis.
Results
Mean follow-up was of 12.5 (± 1.5) months. Thirty (47.7%) patients achieved good outcome, whereas 19 (30.2) patients out of 63 died. Global intracranial bleeding resulted as an independent predictor of good outcome (cutoff 24 mL). Furthermore, ICH relative percentage of global volume (10% of total) and pure SAH (64% of total) emerged respectively as independent predictors of worsened and improved outcome. Global bleeding volume (cutoff 51 mL) along with global cerebral edema showed to independently predict mortality in the examined poor-grade aSAH population.
Conclusions
Volumetric assessment of aneurysmal bleeding has the potential for identifying cutoff values that independently predict outcome. Further insights into the relative importance of different bleeding volumes may be implicated in better tailoring the management of this dismal aSAH population.
https://ift.tt/2GW4gxu
Seasonality of bruxism: evidence from Google Trends
Abstract
Objective
Seasonality of bruxism and its symptoms has not been tested and reflects a major niche in our understanding and the epidemiology of bruxism. Our aim is to use the Google Trends data to examine whether there was a seasonal pattern in the Google search volumes of bruxism and its symptoms on a population basis.
Methods
In the observational, ecological research, we interrogated Google Trends for the following query terms: [bruxism] and [teeth grinding + teeth clenching] to obtain the internet search query volume. These queries were searched within the USA, the UK, Canada, and Australia from January 2004 to December 2017.
Results
The cosinor analysis showed statistically significant seasonal patterns in [bruxism] in the USA (amplitude {A} = 1.91, p = 0.003), Canada (A = 1.91, p < 0.001), and Australia (A = 2.25, p < 0.001), and a trend towards a seasonal variation in the UK (A = 1.11, p = 0.032), with a peak in the winter months and trough in the summer months. Similarly, a statistically significant seasonal variation was found in [teeth grinding + teeth clenching] in the USA (A = 5.54, p < 0.001), the UK (A = 4.36, p < 0.001), and Australia (A = 3.11, p < 0.001), and a trend towards a seasonal variation in Canada (A = 1.53, p = 0.034). The peaks in winter and troughs in summer were reversed by 6 months in countries of northern hemisphere compared to Australia. Time series plots emphasized the consistency of seasonal trend that was ascertained in the cosinor analysis, by repeating in nearly all years.
Conclusion
The preliminary evidence showed a seasonal variation in bruxism and its symptoms, with a peak in the winter months. This novel finding in bruxism epidemiology requires to be verified with clinical studies, and further researches are necessary to elucidate the potential mechanism behind seasonal variation in bruxism.
https://ift.tt/2XfcUgu
Oncologic outcomes for low rectal adenocarcinoma following low anterior resection with coloanal anastomosis versus abdominoperineal resection: a National Cancer Database propensity matched analysis
Abstract
Purpose
Low anterior resection with coloanal anastomosis (CAA) for low rectal cancer is a technically difficult operation with limited data available on oncologic outcomes. We aim to investigate overall survival and operative oncologic outcomes in patients who underwent CAA compared to abdominoperineal resection (APR).
Methods
The National Cancer Database (2004–2013) was used to identify patients with non-metastatic rectal adenocarcinoma who underwent CAA or APR. Patients were 1:1 matched on age, gender, Charlson score, tumor size, tumor grade, pathologic stage, and radiation treatment with propensity scores. The primary outcome was overall survival. Secondary outcomes included 30-day mortality and resection margins.
Results
Following matching, 3536 patients remained in each group. No significant differences in matched demographic, treatment, or tumor variables were seen between groups. There was no significant difference in 30-day mortality (1.24% vs. 1.39%, p = 0.60). Following resection, margins were more likely to be negative after CAA compared with APR (5.26% vs. 8.14%, p < 0.001). When stratified by pathologic stage, there was a significant survival advantage for individuals undergoing CAA compared to APR (stage 1 HR 0.72, [95% CI 0.62–0.85], p < 0.001; stage 2 HR 0.76, [95% CI 0.65–0.88], p < 0.001; stage 3 HR 0.76, [95% CI 0.67–0.85], p < 0.001).
Conclusions
Patients undergoing CAA compared with APR for rectal cancer have better overall survival and are less likely to have positive margins despite the technically challenging operation.
https://ift.tt/2T7yYdG
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