Integrating Tobacco Use Treatment Into Practice Billing and Documentation

Balancing population-based efforts to modify the social and environmental factors that promote tobacco dependence with efforts to improve the delivery of case-based treatments is necessary for realizing maximum reductions in the cost and consequences of the disease. Public health antismoking campaigns following the 1964 Surgeon General's report on the health risks of smoking have changed social norms, prevented initiation among youth, and promoted abstinence among the addicted. However, the rate of progress enjoyed to date is unlikely to continue into the coming decades, given that current annual unassisted cessation rates among prevalent smokers remains fairly low. With more than 1 billion patient interactions annually, there is an enormous unrealized capacity for health-care systems to have an effect on this problem. Clinicians report a perceived lack of reimbursement as a significant barrier to full integration of tobacco dependence into health care. A more complete understanding of the coding and documentation requirements for successful practice in this critically important area is a prerequisite to increasing engagement. This paper presents several case-based scenarios illustrating important practice management issues related to the treatment of tobacco dependence in health care.

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Short-term Exposure to Ambient Fine Particulate Matter Increases Hospitalizations and Mortality in COPD A Systematic Review and Meta-analysis

Background

Many epidemiologic studies have documented variable relationships between ambient particulate matter (PM) and COPD hospitalizations and mortality in cities worldwide.

Methods

Comprehensive and systematic searches were performed in the electronic reference databases (PubMed, EMBASE, Google Scholar, Ovid, and Web of Science) with specific search terms and selection criteria for relevant studies. Summary ORs and 95% CIs were calculated to evaluate the relationship between short-term exposure to PM with aerodynamic diameters ≤ 2.5 μm (PM2.5) and COPD hospitalizations and mortality. The sources of heterogeneity and the effect of potential confounders were explored using subgroup analyses. Study findings were analyzed using a random effects model and a fixed effects model in COPD hospitalizations and mortality, respectively.

Results

The search yielded 12 studies suitable for meta-analysis of hospitalizations and six studies suitable for the mortality meta-analysis until April 15, 2015. A 10-μg/m3 increase in daily PM2.5 (lag days 0-7) was associated with a 3.1% (95% CI, 1.6%-4.6%) increase in COPD hospitalizations and a 2.5% (95% CI, 1.5%-3.5%) increase in COPD mortality. Significant publication bias was not found in studies focusing on the relationship between short-term PM2.5 exposure and COPD hospitalizations and mortality.

Conclusions

Our combined analysis indicated that short-term exposure to a 10-μg/m3 increment of ambient PM2.5 is associated with increased COPD hospitalizations and mortality. Further study is needed to elucidate to what extent this relationship is causal, together with other factors, and to elucidate the mechanism by which PM2.5 induces activation of cellular processes promoting COPD exacerbations.

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Hepatopulmonary Syndrome in Patients With Cystic Fibrosis and Liver Disease

Hepatopulmonary syndrome (HPS) is a liver-induced lung disorder defined as a triad of liver disease, pulmonary vascular dilatation, and a defect in oxygenation. It can complicate chronic liver disease of any etiology, but is most commonly associated with portal hypertension. Severe liver disease with portal hypertension is present in 2% to 8% of patients with cystic fibrosis (CF), but to date, to our knowledge, only one patient with CF has been reported to suffer from HPS. Here, we describe two patients with CF diagnosed with HPS, one subsequent to unresolved hypoxemia and the other following screening for HPS performed in our center. We speculate that HPS is underdiagnosed in patients with CF because of their coexisting respiratory morbidity, and we advocate routine screening for every patient with CF who has liver disease and portal hypertension.

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Risk of Active Tuberculosis in the Five Years Following Infection . . . 15%?

Background

It is often stated that the lifetime risk of developing active TB after an index infection is 5% to 10%, one-half of which accrues in the 2 to 5 years following infection. The goal of this study was to determine whether such estimates are consistent with local programmatic data.

Methods

This study included close contacts of individuals with active pulmonary TB notified in the Australian state of Victoria from January 1, 2005, to December 31, 2013, who we deemed to have been infected as a result of their exposure. Survival analysis was first performed on the assumption of complete follow-up through to the end of the study period. The analysis was then repeated with imputation of censorship for migration, death, and preventive treatment, using local mortality and migration data combined with programmatic data on the administration of preventive therapy.

Results

Of 613 infected close contacts, 67 (10.9%) developed active TB during the study period. Assuming complete follow-up, the 1,650-day cumulative hazard was 11.5% (95% CI, 8.9-14.1). With imputation of censorship for death, migration, and preventive therapy, the median 1,650-day cumulative hazard over 10,000 simulations was 14.5% (95% CI, 11.1-17.9). Most risk accrued in the first 5 months after infection, and risk was greatest in the group aged Conclusions

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Refractory Case of Paroxysmal Autonomic Instability With Dystonia Syndrome Secondary to Hypoxia

Paroxysmal autonomic instability with dystonia (PAID) is a syndrome commonly related to traumatic brain injury (TBI) and rarely to anoxia associated with symptoms of dystonia, tachycardia, tachypnea, and diaphoresis. This is a case of a 20-year-old man who was stabbed in the heart. He underwent surgical repair of a ventricular septal defect and mitral valve replacement. Postoperatively, he developed dystonia with tachycardia and tachypnea consistent with PAID syndrome, secondary to prolonged hypoxia. Traditionally, this poorly understood syndrome is treated with morphine, clonazepam, and nonselective β-blockers. Second-line medications commonly used are baclofen, dantrolene, and gabapentin, which are aimed at the dystonia itself. In this case, both first- and second-line agents were ineffective. A 72-hour dexmedetomidine infusion resulted in complete resolution of symptoms. This is the first case of anoxia-induced PAID syndrome to be effectively treated with dexmedetomidine, which was previously used in a case induced by TBI.

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Recalibration of the HAS-BLED Score Should Hemorrhagic Stroke Account for One or Two Points?

After a hemorrhagic stroke, it is uncertain whether this event scores one point (either for stroke or bleeding) or two points (one point each for stroke and bleeding) on the bleeding risk score termed HAS-BLED (hypertension, abnormal renal/liver function [one or two points], stroke, bleeding history or predisposition, labile international normalized ratio [INR], elderly [> 65 years], drugs/alcohol concomitantly [one or two points]). We investigated the value of a recalibration of the HAS-BLED score to account for two points from a hemorrhagic stroke. Data were analyzed from the Danish nationwide cohort of patients with incident atrial fibrillation (AF) from January 1999 to December 2013. The primary outcome in this observational study was major bleeding. The original and the recalibrated HAS-BLED scores were assessed, and the event rates of major bleeding were calculated. The predictive accuracy of major bleeding was compared by using C-statistics, the net reclassification index (NRI), and integrated discrimination improvement (IDI). An event rate for major bleeding of 4.3 per 100 person-years was recorded in the 210,299 patients with AF. The C-statistics for the two scores were modest: 0.613 (95% CI, 0.607-0.619) for the original score and 0.616 (95% CI, 0.610-0.622) for the recalibrated score. The NRI was 10.0% (95% CI, 7.6-12.4). The relative IDI was 23.6% (95% CI, 15.7-31.5), reflecting that the recalibrated HAS-BLED score more accurately predicted bleeding events. Recalibration of the "S" component in the HAS-BLED score (counting two points for a hemorrhagic stroke) resulted in an increase in the C-statistics, NRI, and IDI. This approach could potentially aid physicians in more accurate assessments of bleeding risk in patients with AF.

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Codger

It will be his knee that helps the bone manpay a bit of tuition,for his advance is full wince and waddle.Though on a wet day, a disc of some sort and the hipwill squeal as harshly.Such a frame is stuff for aspirin and descriptionenough to weary the nimble.His aches enjoy regard reserved for favored sons or baseball,and so he drinks his tea with them alone.Gone are the swell pals, new cleats, that college girl, thefirst good check, the tang of rye.All tucked into lifeboats and vanished horizons ago.These few companions, this final boat will waitand help him cross the rail and slip the davitsTo a dim and yielding sea.

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Antithrombotic Therapy for VTE Disease CHEST Guideline and Expert Panel Report

Background

We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics.

Methods

We generate strong (Grade 1) and weak (Grade 2) recommendations based on high- (Grade A), moderate- (Grade B), and low- (Grade C) quality evidence.

Results

For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C). For VTE and cancer, we suggest LMWH over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C), or edoxaban (Grade 2C). We have not changed recommendations for who should stop anticoagulation at 3 months or receive extended therapy. For VTE treated with anticoagulants, we recommend against an inferior vena cava filter (Grade 1B). For DVT, we suggest not using compression stockings routinely to prevent PTS (Grade 2B). For subsegmental pulmonary embolism and no proximal DVT, we suggest clinical surveillance over anticoagulation with a low risk of recurrent VTE (Grade 2C), and anticoagulation over clinical surveillance with a high risk (Grade 2C). We suggest thrombolytic therapy for pulmonary embolism with hypotension (Grade 2B), and systemic therapy over catheter-directed thrombolysis (Grade 2C). For recurrent VTE on a non-LMWH anticoagulant, we suggest LMWH (Grade 2C); for recurrent VTE on LMWH, we suggest increasing the LMWH dose (Grade 2C).

Conclusions

Of 54 recommendations included in the 30 statements, 20 were strong and none was based on high-quality evidence, highlighting the need for further research.

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Hollywood’s Miracle Mile

Percodanized with a double-dose Ativan kicker,the big shot's head balloons into a watermelondense as a Grauman Chinese sidewalk staror Wilshire Boulevard manhole cover.Throw velvet linesto a drowning plastic vs. reconstructive surgeonwho is already on a tightrope, neck in a vice-- would have hung himself if only he could.No one can lift the cervical collar from its bed.Everyone reassures, Superhero, hang in there.Viable by a thread, when mistresses aren't looking,imagininga human slinky,his six-pack abs and hair transplant backbendthen flop from king-sized mattress onto the red carpet.Determined not to slip that very last micro-millimeterof spinal canalwhich would pith our celebrity to death, pretzelwon't untwist, losing consciousness, he hears the Dadhe never met urge from the grave,Son don't you give up.While the departed's being processed then possiblyaccepted into one or another tier of heaven, Godrequired a quiet tearful poem about the fragility of life…I observed my wife's Medicare birthday from above.Our kids and their's played on the white sand, picnicked.First year unable to be there because of damned painthat kept me upstairs in traction,I took pride in howthe family carried on. Sons fondly helped their matriarchup the steps. One daughter-in-law packed the beach gear,the other clutched a baby. Back in the condominium,unconsoled grandchildrenasked if if if Grampa saw their waves from the seawhen they saw me perched at the picture windowin a tarnished chair wearing my new cervical halo.

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Assessing Differences in Mortality Rates and Risk Factors Between Hispanic and Non-Hispanic Patients With Cystic Fibrosis in California

Background

Over the past 30 years, therapeutic advances have extended the median lifespan of patients with cystic fibrosis (CF). Hispanic patients are a vulnerable subpopulation with a high prevalence of risk factors for worse health outcomes. The consequences of these differences on health outcomes have not been well described. The objective of this study was to characterize the difference in health outcomes, including mortality rate, between Hispanic and non-Hispanic patients with CF.

Methods

This study is a retrospective analysis of CF Foundation Patient Registry data of California residents with CF, diagnosed during or after 1991, from 1991 to 2010. Ethnicity was self-reported. The primary outcome was mortality. Hazard ratios were estimated from a Cox regression model, stratified by sex, and adjusted for socioeconomic status, clinical risk factors, and year of diagnosis.

Results

Of 1,719 patients, 485 (28.2%) self-identified as Hispanic. Eighty-five deaths occurred, with an overall mortality rate of 4.9%. The unadjusted mortality rate was higher among Hispanic patients than among non-Hispanic patients (9.1% vs 3.3%, P Conclusions

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Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches

Abstract

Hypoglycemia is increasingly recognized as a complication of bariatric surgery. Typically, hypoglycemia does not appear immediately postoperatively, but rather more than 1 year later, and usually occurs 1–3 h after meals. While rare, insulinoma has been reported after bariatric surgery. Clinical factors which should raise suspicion for insulinoma and the need for comprehensive clinical and biochemical evaluation include hypoglycemia occurring in the fasting state, predating bariatric surgery, and/or worsening immediately postoperatively, and lack of response to conservative therapy. Localization and successful resection of insulinoma can be achieved using novel endoscopic ultrasound and surgical approaches. In summary, hypoglycemia presenting shortly after gastric bypass or with a dominant fasting pattern should be fully evaluated to exclude insulinoma. Additionally, evaluation prior to gastric bypass should include screening for history of hypoglycemia symptoms.

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Long-Term Effect of Gastric Bypass and Sleeve Gastrectomy on Severe Obesity: Do Preoperative Weight Loss and Binge Eating Behavior Predict the Outcome of Bariatric Surgery?

Abstract

Background

Few studies have examined weight loss sustainability after sleeve gastrectomy (SG). The purpose of this study was to determine long-term outcome after SG and gastric bypass (GBP) and learn whether preoperative weight loss and binge eating behavior can be used to predict outcome.

Materials and Methods

Together, 257 patients (64 % women) were operated, 163 by GBP and 94 by SG. Binge eating was assessed by binge eating scale (BES) and preoperative weight loss was advised to all, including very low-calorie diet for 5 weeks. Postoperative visits took place at 1 and 2 years, and long-term outcome was at median 5 years (range 2.29–6.85). Multivariate linear regression analysis was used to predict outcome at 2-year and long-term control.

Results

Median age was 48 years, weight 141.1 kg, and BMI 48.2 kg/m². Preoperative weight loss was median 4.9 % before GBP and 3.8 % before SG, P = 0.04. Total weight loss at year one was 24.1 % in GBP and 23.7 % in SG (P = 0.40), at year two 24.4 and 23.4 % (P = 0.26), and at long-term control 23.0 and 20.2 % (P = 0.006), respectively. Weight was analyzed in 93, 88, and 89 % of those alive, respectively. BES did not predict weight outcome, but larger preoperative weight loss predicted less postoperative weight loss at 2 years.

Conclusion

On long term, weight loss was better maintained after GBP compared with SG. Binge eating behavior was not a significant predictor, but larger preoperative weight loss predicted less postoperative weight loss for the next 2 years.

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Maintenance of Multivitamin Supplements After Sleeve Gastrectomy

Abstract

Introduction

After all bariatric procedures, multivitamin supplements are uniformly prescribed to minimize eventual deficiencies. These supplements are usually maintained long time, even during the whole life after malabsorptive techniques, while these are maintained at least during 1 year after restrictive procedures. Given that sleeve gastrectomy does not alter intestinal absorption, the supplements are possibly unnecessary, once the patient can take an adequate diet.

Patients and Methods

A prospective randomized study of patients undergoing a laparoscopic sleeve gastrectomy was performed. Patients were randomized into two groups: those patients receiving the multivitamin supplement (Multicentrum, Pfizer, 1 tablet/day) during 3 months (group 1) and those receiving the supplement during 12 months (group 2). Laboratory data were recorded: vitamins (D, B12 and folic acid) and oligoelements (calcium, iron, phosphorus, magnesium and zinc) at 3, 6 and 12 months after surgery.

Results

Eighty patients were included, 40 in each group. At 3 months, 7.5 % of the patients presented iron deficiency and 2.5 % ferritin one, similarly in both groups, that was corrected with specific extra iron supplements. At 6 months, one patient (2.5 %) in group 1 presented iron deficiency and one in group 2 vitamin D deficiency (NS). At 12 months, only one patient in group 2 presented vitamin D deficiency, treated with specific supplements.

Conclusion

The maintenance of multivitamin supplements more than 3 months postoperatively seems to be of no benefit. It is preferable monitoring laboratory values and adding specific supplements when necessary.

ClinicalTrials.gov Identifier

NCT02620137

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Preliminary Results of the Influence of Duodenojejunal Bypass in a Porcine Model of Streptozotocin-Induced Diabetes Mellitus

Abstract

Background

Type 2 diabetic obese patients present with a normalization of plasma glucose levels shortly after most bariatric procedures, before any significant weight loss takes place. There is only scarce literature in the new field of metabolic surgery, with most experiments being performed on small animal models.

Aim

Our aim is to develop a reliable large animal model for assessment of surgical correction of diabetes.

Method

Titrated doses of streptozotocin (STZ) were used for induction of diabetes mellitus. After standardization of the surgical technique to avoid any restrictive component, three groups were created, a duodenojejunal bypass (DJB; n = 4), a gastroileal conduit (GIC; n = 3) near the ileocecal valve, and a sham (control; n = 5) group. Preoperative and postoperative glycemic curves were recorded by means of intravenous glucose tolerance tests. Body weight fluctuations were recorded as well.

Results

Diabetes was successfully induced with the use of STZ in all cases. Animals in the sham group remained diabetic for 3 weeks after operation. There was normalization of blood glucose levels in the operative groups during the 3-week postoperative follow-up, without significant body weight changes. The duodenojejunal group resulted in stronger positive response of glycemia.

Conclusion

STZ-induced diabetes in swine leads to a reliable large animal model for assessment of metabolic surgical procedures. STZ is an effective but highly toxic means for inducing stable diabetes in the sensitive porcine model. Duodenojejunal bypass, although less invasive, seems to exert better antidiabetic effects than gastroileal conduit.

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Impact of Reduced Renal Function on the Glucose-Lowering Effects of Luseogliflozin, a Selective SGLT2 Inhibitor, Assessed by Continuous Glucose Monitoring in Japanese Patients with Type 2 Diabetes Mellitus

Abstract

Introduction

We investigated the impact of reduced renal function on 24-h glucose variability in Japanese patients with type 2 diabetes mellitus (T2DM) treated with luseogliflozin.

Methods

In this double-blind, placebo-controlled, crossover study, 37 Japanese patients with T2DM [glycated hemoglobin (HbA1c) 7.0–10.0%] and estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m² were randomized into two groups in which patients first received luseogliflozin then placebo, or vice versa, for 7 days each. Twenty-four-hour glucose variability was measured on day 7 in each period and was compared among patients divided into three groups according to their baseline eGFR (mL/min/1.73 m²): normal (≥90; n = 13; normal group), normal-to-mildly reduced renal function (≥75 to <90; n = 12; normal–mild group), and mild-to-moderately reduced renal function (<75; n = 9; mild–moderate group).

Results

The mean [95% confidence interval (CI)] placebo-subtracted 24-h cumulative urinary glucose excretion (g) was 82.1 (72.7, 91.5), 82.5 (73.4, 91.5), and 62.2 (51.2, 73.3); the placebo-subtracted 24-h mean glucose concentration (mg/dL) was −24.39 (−32.53, −16.26), −28.28 (−39.35, −17.22), and −11.53 (−23.93, 0.86); and the placebo-subtracted peak postprandial glucose (mg/dL) was −26.9 (−46.9, −6.9), −38.1 (−59.6, −16.6), and 1.5 (−25.5, 28.4) in the normal, normal–mild, and mild–moderate groups, respectively. The mean lowest glucose concentrations (placebo vs. luseogliflozin, mg/dL) decreased to similar levels in the normal (115.4 vs. 93.4), normal–mild (121.0 vs. 97.9), and mild–moderate (104.0 vs. 91.1) groups.

Conclusion

This post hoc subanalysis revealed that although mild-to-moderately reduced renal function attenuated the glucose-lowering effects of luseogliflozin on peak postprandial glucose, it did not attenuate the effects of luseogliflozin on fasting glucose. These findings may explain the smaller increase in urinary glucose excretion in these patients relative to patients with normal renal function or normal-to-moderately reduced renal function. Further studies may be needed to examine these findings in large populations of patients with T2DM and reduced renal function.

Trial registration

JapicCTI-142548.

Funding

Taisho Pharmaceutical Co., Ltd.

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Methotrexate and Rheumatoid Arthritis: Current Evidence Regarding Subcutaneous Versus Oral Routes of Administration

Abstract

Methotrexate (MTX) is still considered the drug of choice in rheumatoid arthritis (RA) management. Comparing subcutaneous (MTX SC) and oral (MTX OR) routes of administration is important to optimize the everyday therapeutic strategy in the real-life setting. This review summarizes scientific evidence currently available on this topic. As shown by pharmacokinetic studies, at the same dose level, bioavailability of MTX SC is significantly higher and less variable than that of MTX OR. This difference is even more pronounced for medium-to-high dosages (i.e., >15 mg/week). With regard to clinical response (Disease Activity Score-28, American College of Rheumatology Criteria), randomized, double-blind studies and retrospective or longitudinal analyses in real-life settings showed that MTX SC is more effective than MTX OR. This is true both in MTX-naive patients with early RA, and in patients who switch from MTX OR to MTX SC due to previous treatment failure, lack of efficacy and/or adverse events. Finally, MTX SC has a better tolerability profile than MTX OR, with fewer gastroenterological side effects. Delaying the use of more expensive biological therapies by switching from MTX OR to MTX SC in non-responders might provide cost savings, with relevant implications in the management of patients with RA.

Funding

Alfa Wassermann.

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Interplay of the histone methyltransferases SDG8 and SDG26 in the regulation of transcription and plant flowering and development

Publication date: Available online 4 February 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Boyu Liu, Alexandre Berr, Cheng Chang, Chunlin Liu, Wen-Hui Shen, Ying Ruan
Histone methylations play fundamental roles in epigenetic regulation of transcription in many eukaryotes. In the model plant Arabidopsis thaliana as in human, a same histone lysine residue (e.g. H3K4 or H3K36) can be a potential target substrate for various different histone lysine methyltransferases (HKMTs). Using powerful genetic tool in Arabidopsis, we here investigate the interplay between two close HKMT homologues, SET DOMAIN GROUP 8 (SDG8) and SDG26, in regulating transcription and plant growth and development. We show that the sdg8 mutation is epistatic to the sdg26 one, leading to a sdg8 sdg26 double mutant exhibiting defects similar to sdg8 (reduced level of H3K36me3, increased level of H3K36me1, reduced plant body size, early flowering associated with reduced expression of FLC and MAFs and increased expression of FT and SOC1), but opposite to sdg26 (increased rosette size, late flowering associated with increased FLC and MAF5 expression and reduced FT and SOC1 expression). In parallel to the finding of the epistasis of SDG8, our study also unravels novel functions of SDG26 in H3K36me1 deposition and in the interplay with SDG8 in regulating the genome-wide gene expression. The implication of various HKMTs in establishing different forms of histone methylation and gene-context specific chromatin modifications likely provides an advantageous mechanism for the regulation of transcription to cope with complex and plastic growth and developmental programs in plants and possibly also in other organisms.



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Evaluation of timing of first vaccination in children after hematopoietic allogeneic stem cell transplantation

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Battling resistance mechanisms in antihormonal prostate cancer treatment: novel agents and combinations

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A breath test for diagnosing malignant pleural mesothelioma

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Long-term perspectives on terrestrial and aquatic carbon cycling from palaeolimnology

McGowan, S; Anderson, NJ; Edwards, ME; Langdon, PG; Jones, VJ; Turner, S; van Hardenbroek, M; McGowan, S; Anderson, NJ; Edwards, ME; Langdon, PG; Jones, VJ; Turner, S; van Hardenbroek, M; Whiteford, E; Wiik, E; - view fewer (2015) Long-term perspectives on terrestrial and aquatic carbon cycling from palaeolimnology. Wiley Interdisciplinary Reviews: Water 10.1002/wat2.1130 . Green open access

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Epistemic Disjunctivism and the Evidential Problem

Zalabardo, J; (2015) Epistemic Disjunctivism and the Evidential Problem. Analysis , 75 (4) pp. 615-627. 10.1093/analys/anv047 .

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Innovative solutions and applications for polymer light-emitting diodes

Bausi, F; (2016) Innovative solutions and applications for polymer light-emitting diodes. Doctoral thesis, UCL (University College London).

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Developmental function of Drosophila RASSF9 and RASSF10

Banerjee, JJ; (2016) Developmental function of Drosophila RASSF9 and RASSF10. Doctoral thesis, UCL (University College London). Green open access

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Characterisation of the optic radiations in children in health and disease

Ayala Soriano, S; (2016) Characterisation of the optic radiations in children in health and disease. Doctoral thesis, UCL (University College London).

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Markowitz Minimum Variance Portfolio Optimization using New Machine Learning Methods

Awoye, OA; (2016) Markowitz Minimum Variance Portfolio Optimization using New Machine Learning Methods. Doctoral thesis, (UCL) University College London. Green open access

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Aspects of Processing in the Visual Thalamus; Context, Correlations, and Re–entrant Signals

Andolina, IM; (2016) Aspects of Processing in the Visual Thalamus; Context, Correlations, and Re–entrant Signals. Doctoral thesis, UCL (University College London).

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The development and testing of an oral health-related quality of life measure for children/adolescents with Down syndrome (OH-QOLADS)

Aljameel, AHM; (2016) The development and testing of an oral health-related quality of life measure for children/adolescents with Down syndrome (OH-QOLADS). Doctoral thesis, UCL (University College London). Green open access

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Regulation of adipogenesis and inflammation: role(s) of adipose microRNAs

Al-Jabir, MJMH; (2016) Regulation of adipogenesis and inflammation: role(s) of adipose microRNAs. Doctoral thesis, UCL (University College London). Green open access

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Synthesis and catalytic performance of hierarchically structured zeolitic materials

Adedigba, A-LA; (2016) Synthesis and catalytic performance of hierarchically structured zeolitic materials. Doctoral thesis, UCL (University College London).

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D.C. Department of Health says three confirmed cases of Zika in the District

The D.C. Department of Health says it has confirmed three cases of Zika in the District — all of which involved people who contracted it after traveling abroad. The virus, which has been linked to birth defects in the Americas, is primarily spread through mosquito bites. Of the victims, on...

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Abnormal villous morphology mimicking a hydatidiform mole associated with paternal trisomy of chromosomes 3,7,8 and unipaternal disomy of chromosome 11

Pregnancies affected by non-molar chromosomal abnormality may sometimes demonstrate abnormal chorionic villous morphology that is similar to partial hydatidiform mole. Determination of the underlying aetiology...

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DLC-1 is an independent prognostic marker and potential therapeutic target in hepatocellular cancer

The 5-year survival rate of patients with hepatocellular cancer (HCC) was very low because of invasion and metastasis in the early stage. Biomarkers might help predict early occurrence of invasion and metastas...

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State of diagnostic quandary solved by modern technology: a rare case of Madelung's disease

Madelung's disease is a neglected metabolic disease characterised by generalised multiple fatty tissue deposits. A 64-year-old Caucasian woman presented with generalised weakness and symptomatic hypoglycaemia with altered mental status. Physical examination showed very distinct physical characteristics with multiple lumps distributed over the upper body. Her neurological symptoms were solved by giving intravenous glucose and optimisation of medical treatment. Even though she had unique characteristics of Madelung's disease, many physicians, on several occasions, failed to recognise her 'hidden diagnosis'. This diagnostic uncertainty was able to be solved by searching the Internet for similar clinical features and images. This case demonstrates characteristics and unique features of a rare disease that can be seen in a female patient even though it is mostly found in males.

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Penile gangrene as a sign of uncontrolled diabetes mellitus

Description

A 33-year-old African-American man with a previous medical history of type II diabetes mellitus and tobacco abuse presented to our outpatient clinic because of a penile lesion. The lesion started 1 month prior to presentation. The patient reported a history of minor injury while zipping his pants, which resulted in slight redness at the tip of his glans penis, progressing to blackish discolouration. He was sexually active with one female partner and reported infrequent oral sex. He had no penile discharge, no pain and no urinary symptoms.

His diabetes mellitus was diagnosed 3 years prior to presentation. He was non-compliant with oral hypoglycaemic medications. Examination showed normal vital signs and superficial dry gangrene with no drainage (figure 1). He had no inguinal lymphadenopathy. The reminder of his physical examination, including cardiovascular examination, was normal. Lab investigations showed haemoglobin A1c of 12.9% (reference 0–5.7%). Comprehensive metabolic panel, complete...

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'Too much of a coincidence: identical twins with exertional heatstroke in the same race

This report discusses a unique case of monozygotic male twins who both collapsed with exertional heat stroke (EHS) during the same marathon in relatively cool conditions. The twins were official race pacers in a popular city marathon held in the early spring in the UK. Both recovered uneventfully due to the prompt recognition of EHS and use of aggressive cooling measures, which prevented life-threatening complications. The case illustrates that EHS is a complex illness with a possible genetic predisposition, which can occur among runners even in cooler conditions. This link is explored together with the influence of their role as race pacers and the additional backpack worn in the development of EHS.

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Validierung von SleepMinder® zur Erfassung der Schlafqualität bei Patienten mit OSAS

Zusammenfassung

Hintergrund

Die kardiorespiratorische Polysomnographie (PSG) ist der Goldstandard der Diagnostik schlafbezogener Atemstörungen (SBAS) und stellt aufgrund des großen Zeit- und Kostenaufwands den letzten Schritt einer Stufendiagnostik dar.

Ziel

Das Ziel war die Bestimmung der diagnostische Aussagekraft von SleepMinder® (Resmed Sensor Technologies, Dublin, Irland) bei der Erkennung von Schlafdauer (engl. Total Sleep Time [TST]) und Schlafeffizienz (SE).

Material und Methoden

SleepMinder® ist ein kontaktloses Screeninggerät zur Analyse respiratorischer Ereignisse und der Schlafqualität, basierend auf dem Prinzip der Reflexion leistungsarmer Radiowellen. In einem Kollektiv von 57 Patienten mit Verdacht auf SBAS wurde simultan zu einer PSG eine Messung mit SleepMinder® durchgeführt und die diagnostische Aussagekraft der durch SleepMinder® erhaltenen Ergebnisse ermittelt. Zusätzlich wurde der Einfluss von periodischen Beinbewegungen (PLM) auf die klinische Güte von SleepMinder® untersucht.

Ergebnisse

SleepMinder® überschätzt im Vergleich zur PSG die TST, wobei kein statistisch signifikanter Unterschied beim Vergleich zwischen Gruppe 1 (Apnoe-Hypopnoe-Index [AHI] < 15/h) und Gruppe 2 (AHI ≥ 15/h) bestand. Gruppe 1 zeigte eine Abweichung von 5 % und Gruppe 2 eine von 6 % beim Vergleich der mittels SleepMinder® und PSG bestimmten TST. Bei 51 % der Patienten trat eine Abweichung < 10 % auf, bei 70 % der Patienten < 20 % und bei 9 % der Patienten ≥ 30 %. Die mittlere Abweichung lag bei 24 min. Für den Vergleich von SE_PSG und SE_{SleepMinder®} ergab sich eine Abweichung von 1 % in Gruppe 1 und von 7 % in Gruppe 2 (p = n. s.). Auch hier fand sich kein statistisch signifikanter Unterschied zwischen den untersuchten Gruppen. Bei 49 % der Patienten zeigte sich eine Abweichung < 10 %, bei 67 % der Patienten < 20 % und bei 7 % der Patienten ≥ 30 %. Die mittlere Abweichung lag bei 2 %.

Diskussion

Die Möglichkeit durch SleepMinder® TST und SE mit moderater Genauigkeit zu schätzen kann beim Screening zur Bestimmung von SBAS eine nützliche Zusatzfunktion sein, um zu entscheiden, ob bspw. ein geringer AHI darauf zurückzuführen ist, dass der Patient während der Nacht kaum geschlafen hat.

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Confirmatory factor analysis of the Child Oral Health Impact Profile (Korean version)

Empirical support for the factor structure of the Child Oral Health Impact Profile (COHIP) has not been fully established. The purposes of this study were to evaluate the factor structure of the Korean version of the COHIP (COHIP-K) empirically using confirmatory factor analysis (CFA) based on the theoretical framework and then to assess whether any of the factors in the structure could be grouped into a simpler single second-order factor. Data were collected through self-reported COHIP-K responses from a representative community sample of 2,236 Korean children, 8–15 yr of age. Because a large inter-factor correlation of 0.92 was estimated in the original five-factor structure, the two strongly correlated factors were combined into one factor, resulting in a four-factor structure. The revised four-factor model showed a reasonable fit with appropriate inter-factor correlations. Additionally, the second-order model with four sub-factors was reasonable with sufficient fit and showed equal fit to the revised four-factor model. A cross-validation procedure confirmed the appropriateness of the findings. Our analysis empirically supported a four-factor structure of COHIP-K, a summarized second-order model, and the use of an integrated summary COHIP score.

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Nanoparticles of Gadolinium-Incorporated Prussian Blue with PEG Coating as an Effective Oral MRI Contrast Agent for Gastrointestinal Tract Imaging

Analyst, 2016, Accepted Manuscript
DOI: 10.1039/C5AN01873K, Paper

Songping D Huang, Vindya S Perera, Guojun Chen, Qing Cai
Biocompatible nanoparticles of gadolinium-incorporated Prussian blue with the empirical formula K0.94Gd0.02Fe[Fe(CN)6] exhibit extremely high stability against the release of Gd3+ and CN- ions under the acidic conditions similar to stomach...
The content of this RSS Feed (c) The Royal Society of Chemistry

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Protein profile of basal prostate epithelial progenitor cells—stage-specific embryonal antigen 4 expressing cells have enhanced regenerative potential in vivo

Abstract

The long-term propagation of basal prostate progenitor cells ex vivo has been very difficult in the past. The development of novel methods to expand prostate progenitor cells in vitro allows determining their cell surface phenotype in greater detail. Mouse (Lin⁻Sca-1⁺ CD49f⁺ Trop2^high-phenotype) and human (Lin⁻ CD49f⁺ TROP2^high) basal prostate progenitor cells were expanded in vitro. Human and mouse cells were screened using 242 anti-human or 176 antimouse monoclonal antibodies recognizing the cell surface protein profile. Quantitative expression was evaluated at the single-cell level using flow cytometry. Differentially expressed cell surface proteins were evaluated in conjunction with the known CD49f⁺/TROP2^high phenotype of basal prostate progenitor cells and characterized by in vivo sandwich-transplantation experiments using nude mice. The phenotype of basal prostate progenitor cells was determined as CD9⁺/CD24⁺/CD29⁺/CD44⁺/CD47⁺/CD49f⁺/CD104⁺/CD147⁺/CD326⁺/Trop2^high of mouse as well as human origin. Our analysis revealed several proteins, such as CD13, Syndecan-1 and stage-specific embryonal antigens (SSEAs), as being differentially expressed on murine and human CD49f⁺ TROP2⁺ basal prostate progenitor cells. Transplantation experiments suggest that CD49f⁺ TROP2^high SSEA-4^high human prostate basal progenitor cells to be more potent to regenerate prostate tubules in vivo as compared with CD49f⁺ TROP2^high or CD49f⁺ TROP2^high SSEA-4^low cells. Determination of the cell surface protein profile of functionally defined murine and human basal prostate progenitor cells reveals differentially expressed proteins that may change the potency and regenerative function of epithelial progenitor cells within the prostate. SSEA-4 is a candidate cell surface marker that putatively enables a more accurate identification of the basal PESC lineage.

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Overexpression of WDR79 in non-small cell lung cancer is linked to tumour progression

Abstract

WD-repeat protein 79 (WDR79), a member of the WD-repeat protein family, acts as a scaffold protein, participating in telomerase assembly, Cajal body formation and DNA double-strand break repair. Here, we first report that WDR79 is frequently overexpressed in cell lines and tissues derived from non-small cell lung cancer (NSCLC). Knockdown of WDR79 significantly inhibited the proliferation of NSCLC cells in vitro and in vivo by inducing cell cycle arrest and apoptosis. WD-repeat protein 79 -induced cell cycle arrest at the G0/G1 phase was associated with the expression of G0/G1-related cyclins and cyclin-dependent kinase complexes. We also provide evidence that WDR79 knockdown induces apoptosis via a mitochondrial pathway. Collectively, these results suggest that WDR79 is involved in the tumorigenesis of NSCLC and is a potential novel diagnostic marker and therapeutic target for NSCLC.

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Combining glucose and sodium acetate improves the growth of Neochloris oleoabundans under mixotrophic conditions

Mixotrophic cultivation is a potential approach to produce microalgal biomass that can be used as raw materials for renewable biofuels and animal feed, although using a suitable, cost-effective organic carbon ...

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Frequent Flyers: Organizing the supply room

See all of Lenwood Brown's comics.

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CT scan radiation not tied to cancer: Newspaper Reports

ET Health Reports: The widespread belief that radiation from X-rays, CT scans and other medical imaging can cause cancer is based on an unproven, decades-old theoretical model and has never been conclusively proven, scientists say. The model, known as linear no-threshold (LNT), is used to estimate cancer risks from low-dose radiation such as medical imaging, the researchers said. However, risk estimates based on this model are only theoretical.

Further Reading: ET Healthworld

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frontiers neuroscience; +16 new citations

16 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

frontiers neuroscience

These pubmed results were generated on 2016/02/05

PubMed comprises more than 24 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Physical Anthropology and Osteoarchaeology in Europe: History, Current Trends and Challenges

Abstract

This paper provides an overview of the development and current practice of physical anthropology as relating to the treatment of archaeological skeletal remains in Europe. The evolution of physical anthropology as a discipline is covered in detail from the 18^th century onwards and current trends in education and research are also discussed. Additional topics include a synthesis of the legislative framework for studying human skeletal remains in over 40 European jurisdictions, while also addressing challenges, future trends and emerging ethical questions. This overview is the product of an extensive review of the literature partnered with information received via questionnaires completed by colleagues working in nearly 50 European countries. This article is protected by copyright. All rights reserved.

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Resource savings by urban mining: the case of desktop and laptop computers in Belgium

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Cow or goat? Population pressure and livestock keeping in Burundi

Livestock contributes significantly to livelihoods in developing countries. Yet, most academic studies focus on dairy cattle and neglect that many smallholder farmers in mixed-cropping systems prefer goats, sheep, pigs or poultry over cattle. Using a unique dataset from a national representative agricultural survey in Burundi, we estimate the determinants of livestock keeping with a multivariate probit model. We find that wealthier households keep more livestock, but population density and access to markets are also key determinants. Moreover, even the wealthiest households switch from cattle to smaller animals in densely populated regions, where pressure on land is high and access to pastures limited. This has important policy implications since it questions the emphasis of most development programs by NGOs and governments in Sub-Saharan Africa which promote dairy cattle.

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The origin and implications of variations in soil-related properties within Macrotermes falciger mounds

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Resource usage of integrated pig–biogas–fish system: partitioning and substitution within attributional life cycle assessment

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