A prospective randomized controlled study comparing the pain relief in patients with osteoporotic vertebral compression fractures with the use of vertebroplasty or facet blocking

Abstract

Purpose

To compare the clinical and radiological outcomes of patients undergoing percutaneous vertebroplasty (PVP) versus those undergoing facet blocking (FB) for severe pain due to osteoporotic vertebral compression fractures (OVCFs).

Methods

Two hundred and six patients who had OVCFs on spine radiography and intractable back pain for ≤8 weeks were recruited between January 2009 and January 2013 (165 females and 41 males, age ≥55 years). Patients were randomly assigned to the PVP group (100 patients) or the FB group (106 patients). VAS, ODI, Roland Morris disability (RMD) scores, scores on the Standardized Physical Component of the SF-36 form (SPC) and scores on the Standardized Mental Component of the SF-36 form (SMC) were determined preoperatively and at each follow-up time (1 day, 1 week, 1, 3, 6, and 12 months). In addition, plain radiographs were obtained at 3, 6, and 12 months postoperatively to detect new fractures.

Results

Significantly lower VAS, ODI, and RMD scores for patients in the PVP group compared to those in the FB group were observed at follow-up of 1 day and 1 week (p < 0.05). However, differences in the VAS, ODI, RMD and SPC/MCS (SF-36) scores between the two groups at follow-ups of more than 1 month were statistically insignificant (p > 0.05). Difference in numbers of new fractures in the two groups at the follow-up of 12 months was also statistically insignificant.

Conclusions

PVP produced better pain relief than FB in the short term (≤1 week). However, the difference in pain-relief between these two techniques was insignificant in the long term (follow-up between 1 month and 12 months).

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Selective Imaging of Malignant Ascites in a Mouse Model of Peritoneal Metastasis Using in Vivo Dynamic Nuclear Polarization-Magnetic Resonance Imaging

Analytical Chemistry

DOI: 10.1021/acs.analchem.5b04821

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Intracranial multifocal plasma cell granuloma: a case with multiple operations without recurrence of surgically removed lesions

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Stress during neurosurgery: no need to worry?

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Stereotactic biopsy approach to the upper clivus through the middle fossa floor that avoids pneumatised cavities and the intradural compartment

Abstract

Background

Biopsies of clival lesions are usually performed, under general anaesthesia, through an anterior endoscopic approach or, alternatively, through a trans-nasal or trans-oral stereotactic approach.

Methods

A 57-year-old man with a symptomatic osteolytical lesion of the clivus, who refused general anaesthesia, underwent a sterotactically guided biopsy of the lesion by an antero-lateral approach through the temporal and sphenoid bones.

Results

Biopsy was successfully performed and the resulting diagnosis was myeloma. The patient was comfortable during and after surgery and there were no complications.

Conclusions

The present stereotactic antero-lateral approach to the biopsy of the upper clivus can be considered an useful adjunct to the current trans-oral and transnasal approaches that often require general anaesthesia.

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Selective amygdalohippocampectomy via trans-superior temporal gyrus keyhole approach

Abstract

Background

Hippocampal sclerosis is the most common cause of drug-resistant epilepsy amenable for surgical treatment and seizure control. The rationale of the selective amygdalohippocampectomy is to spare cerebral tissue not included in the seizure generator.

Method

Describe the selective amygdalohippocampectomy through the trans-superior temporal gyrus keyhole approach.

Conclusion

Selective amygdalohippocampectomy for temporal lobe epilepsy is performed when the data (semiology, neuroimaging, electroencephalography) point to the mesial temporal structures. The trans-superior temporal gyrus keyhole approach is a minimally invasive and safe technique that allows disconnection of the temporal stem and resection of temporomesial structures.

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Krüppel-like factor 2 promotes cell proliferation in hepatocellular carcinoma through up-regulation of c-myc

Volume 17, Issue 1, January 2016, pages 20-26<br/>10.1080/15384047.2015.1108484<br/>Kailin Zou

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Absence of germline CDKN2A mutation in Sicilian patients with familial malignant melanoma: Could it be a population-specific genetic signature?

Volume 17, Issue 1, January 2016, pages 83-90<br/>10.1080/15384047.2015.1108494<br/>Sara Di Lorenzo

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A case report of primary cardiac capillary hemangioma

Volume 17, Issue 1, January 2016, pages 11-13<br/>10.1080/15384047.2015.1109391<br/>Jidan Fan

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The role of NANOG transcriptional factor in the development of malignant phenotype of cancer cells

Volume 17, Issue 1, January 2016, pages 1-10<br/>10.1080/15384047.2015.1121348<br/>Natalia Gawlik-Rzemieniewska

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First-line treatment with hepatic arterial infusion plus capecitabine vs capecitabine alone for elderly patients with unresectable colorectal liver metastases

Volume 17, Issue 1, January 2016, pages 14-19<br/>10.1080/15384047.2015.1108487<br/>Xiaodong Li

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C. elegans and mutants with chronic nicotine exposure as a novel model of cancer phenotype

Volume 17, Issue 1, January 2016, pages 91-103<br/>10.1080/15384047.2015.1108495<br/>Rajani Kanteti

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Long noncoding RNA MEG3 is downregulated in cervical cancer and affects cell proliferation and apoptosis by regulating miR-21

Volume 17, Issue 1, January 2016, pages 104-113<br/>10.1080/15384047.2015.1108496<br/>Jun Zhang

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Antitumor effects and molecular mechanisms of ponatinib on endometrial cancer cells harboring activating FGFR2 mutations

Volume 17, Issue 1, January 2016, pages 65-78<br/>10.1080/15384047.2015.1108492<br/>Do-Hee Kim

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Circulating miR-21-5p and miR-148a-3p as emerging non-invasive biomarkers in thymic epithelial tumors

Volume 17, Issue 1, January 2016, pages 79-82<br/>10.1080/15384047.2015.1108493<br/>Teresa Bellissimo

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Combination with vorinostat overcomes ABT-263 (navitoclax) resistance of small cell lung cancer

Volume 17, Issue 1, January 2016, pages 27-35<br/>10.1080/15384047.2015.1108485<br/>Wataru Nakajima

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Fat4 suppression induces Yap translocation accounting for the promoted proliferation and migration of gastric cancer cells

Volume 17, Issue 1, January 2016, pages 36-47<br/>10.1080/15384047.2015.1108488<br/>Liangang Ma

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Tangeretin derivative, 5-acetyloxy-6,7,8,4′-tetramethoxyflavone induces G2/M arrest, apoptosis and autophagy in human non-small cell lung cancer cells in vitro and in vivo

Volume 17, Issue 1, January 2016, pages 48-64<br/>10.1080/15384047.2015.1108491<br/>Yi Rong Li

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Menin localization in cell membrane compartment

Volume 17, Issue 1, January 2016, pages 114-122<br/>10.1080/15384047.2015.1108497<br/>Xin He

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TWiP 102: Nursing eosinophils

The TWiPyzoites solve the case of the Uncommon Parasite, and discuss the role of eosinophils in promoting the growth of Trichinella in skeletal muscle.

Hosts: 

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The influence of dose distribution on treatment outcome in the SCOPE 1 oesophageal cancer trial

The first aim of this study was to assess plan quality using a conformity index (CI) and analyse its influence on patient outcome. The second aim was to identify whether clinical and technological factors incl...

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Abdominal tuberculosis manifested as tuberculosis of the urachal sinus in an adolescent and the role of laparoscopy in the management: a rare case report

Abdominal tuberculosis (TB) is an uncommon affliction in adolescence. It is usually associated with pulmonary tuberculosis. The disease is caused by lymphohaematogenous spread after primary infection in the lu...

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Identification of Dominant Excitation Patterns and Sources of Atrial Fibrillation by Causality Analysis

Abstract

Burden of atrial fibrillation (AF) can be reduced by ablation of sources of electrical impulses driving AF but driver identification is still challenging. This study presents a new methodology based on causality analysis that allows identifying the hierarchically dominant areas driving AF. Identification of dominant propagation patterns was achieved by computing causal relations between intracardiac multi-electrode catheter recordings of four paroxysmal AF patients during sinus rhythm, pacing and AF. In addition, realistic mathematical models of the atria during AF were used to validate the methodology both in the presence and absence of dominant frequency (DF) gradients. During electrical pacing, sources of propagation patterns detected by causality analysis were consistent with the location of the stimulating catheter. During AF, propagation patterns presented temporal variability, but a dominant direction accounted for significantly more propagations than other directions (49 ± 15% vs. 14 ± 13% or less, p < 0.01). Both in patients with a DF gradient and in mathematical models, causal maps allowed the identification of sites responsible for maintenance of AF. Causal maps allowed the identification of atrial dominant sites. In particular, causality analysis resulted in stable dominant cause–effect propagation directions during AF and could serve as a guide for performing ablation procedures in AF patients.

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A Pre-Hospital Patient Education Program Improves Outcomes of Bariatric Surgery

Abstract

Background

We designed an assessment and education program which was delivered to patients prior to first outpatient appointment for bariatric surgery. We hypothesised that this program would streamline care and would lead to improved weight loss following bariatric surgery.

Methods

The program incorporates a structured general practitioners (GP) review, a patient information evening and an on-line learning package. It was introduced in September 2012. Patient flow through the program was recorded. Outcomes of the new program were compared with contemporaneously treated patients who did not undertake the pre-hospital program.

Results

All 636 patients on the waiting list for first appointment at the Alfred Health bariatric surgery clinic were invited to participate. There were 400 patients ultimately removed from the waiting list for first appointment. Of the remaining 236 patients, 229 consented to participate in the new program. The mean BMI was 47.8 ± 9.2. The fail to attend first appointment rate dropped from 12 to 2.1 %. At 12 months post-bariatric surgery, patients who undertook the new program (n = 82) had a mean excess weight loss (EWL) of 41.1 ± 20.3 % where as those treated on the standard pathway (n = 61) had a mean EWL 32 ± 18.0 % (p = 0.012).

Conclusions

The introduction of a pre-hospital education program has led to an improvement in attendance rates and early weight loss post-bariatric surgery.

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The Short Scar Periareolar Inferior Pedicle Reduction Mammaplasty

Publication date: Available online 5 February 2016
Source:Clinics in Plastic Surgery
Author(s): Dennis C. Hammond, Kuylhee Kim

Teaser

Breast reduction is one of the most common plastic surgery procedures performed on the breast. There are now numerous alternatives to the standard inverted-T inferior pedicle technique. The short scar periareolar inferior pedicle reduction (SPAIR) mammaplasty is one of these techniques. The procedure was designed to reduce the scar burden associated with breast reduction. However, postoperative complications can occur. The purpose of this article is to outline these potential complications that are of particular concern with the SPAIR mammaplasty and describe methods for their treatment and prevention.


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Complications in Plastic Surgery

Publication date: Available online 5 February 2016
Source:Clinics in Plastic Surgery
Author(s): Dennis C. Hammond




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Systematic review of depression in mild traumatic brain injury: study protocol

Of the over 1 million reported cases of traumatic brain injuries reported annually in the USA, a sizeable proportion are characterized as mild. Although it is generally well-accepted that most people who suffe...

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Reassessment of Olduvai Bed I cercopithecoids: A new biochronological and biogeographical link to the South African fossil record

Publication date: March 2016
Source:Journal of Human Evolution, Volume 92
Author(s): Christopher C. Gilbert, Stephen R. Frost, Eric Delson
Fossil monkeys have long been used as important faunal elements in studies of African Plio-Pleistocene biochronology, particularly in the case of the South African karst cave sites. Cercopithecoid fossils have been known from Tanzania's Olduvai Gorge for nearly a century, with multiple taxa documented including Theropithecus oswaldi and Cercopithecoides kimeui, along with papionins and colobines less clearly attributable to species. A small number of large papionin fossils, including a partial male cranium and partial female skull, have been previously identified as an early form of Papio, but noted as distinct from extant baboons as well as other fossil Papio species. In 2013 we reviewed the Olduvai cercopithecoid material at the National Museum of Tanzania, with a particular focus on the specimens from Beds I–IV. Quantitative and qualitative comparisons of the Olduvai papionins largely confirmed previous observations, with one notable exception. The large papionin taxon from Bed I previously recognized as Papio sp. is more properly recognized as Gorgopithecus major, a taxon previously known only from South Africa. Features shared between the Olduvai specimens and G. major include relatively short and concavo-convex tubular nasals, antero-posteriorly curved upper incisor roots, downwardly curved brow ridges in the midline, and robust zygomatic arches. The recognition of G. major at Olduvai Bed I, a well-known horizon with precise radiometric dates, provides an important biochronological and biogeographical link with South African localities Kromdraai A, Swartkrans Member 1 and possibly Swartkrans Members 2–3 and Cooper's A and D.



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Voice Modulation: A Window into the Origins of Human Vocal Control?

Publication date: Available online 5 February 2016
Source:Trends in Cognitive Sciences
Author(s): Katarzyna Pisanski, Valentina Cartei, Carolyn McGettigan, Jordan Raine, David Reby
An unresolved issue in comparative approaches to speech evolution is the apparent absence of an intermediate vocal communication system between human speech and the less flexible vocal repertoires of other primates. We argue that humans' ability to modulate nonverbal vocal features evolutionarily linked to expression of body size and sex (fundamental and formant frequencies) provides a largely overlooked window into the nature of this intermediate system. Recent behavioral and neural evidence indicates that humans' vocal control abilities, commonly assumed to subserve speech, extend to these nonverbal dimensions. This capacity appears in continuity with context-dependent frequency modulations recently identified in other mammals, including primates, and may represent a living relic of early vocal control abilities that led to articulated human speech.



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“The Penitent Magdalene”: Tiziano Vecellio (1488/1490–1576)

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Serum levels of the bone turnover markers dickkopf-1, sclerostin, osteoprotegerin, osteopontin, osteocalcin and 25-hydroxyvitamin D in Swedish geriatric patients aged 75 years or older with a fresh hip fracture and in healthy controls

Abstract

Background

Bone turnover markers have a potential clinical use in describing bone remodeling and in predicting fractures.

Aims

In an elderly population ≥75 years with a fresh hip fracture, and in healthy controls, investigate bone turnover markers and their relation to each other, to vitamin D status and to bone mineral density (BMD).

Methods

In a cross-sectional study serum levels of dickkopf-1 (DKK-1), sclerostin (SOST), osteoprotegerin (OPG), osteopontin (OPN), osteocalcin, 25-hydroxyvitamin D (25(OH)D) were analyzed in 89 Swedish patients with a fresh hip fracture and in 82 healthy volunteers. Serum levels of bone markers were determined by Luminex technique.

Results

S-25-hydroxyvitamin D (S-25(OH)D) was decreased in patients compared to controls (48 ± 21 vs. 76 ± 25 nmol/L, p < 0.001). SOST, but none of the other bone turnover markers correlated with BMD (r = 0.50, p < 0.001). Compared with controls, higher levels of OPG (488 ± 1.4 vs. 191 ± 1.4 ng/L, p < 0.001), OPN (69 ± 1.7 vs. 19 ± 1.4 µg/L, p < 0.001), DKK-1 (273 ± 1.7 vs. 168 ± 1.7 ng/L, p < 0.001), and lower levels of osteocalcin (5.8 ± 3.5 vs. 9.5 ± 3.6 µg/L, p < 0.001), were found in the fracture group. Levels of OPG, DKK-1 and SOST in both groups were positively associated. S-25(OH)D concentration was not found to be strongly associated with any of the bone markers.

Conclusions

In contrast to findings in other studies, we found no strong correlation between 25(OH)D and the investigated bone markers. Both in patients with a fresh hip fracture and in healthy elderly, DKK-1, SOST and OPG appear to be associated. This suggests a relevance in these relationships meriting further investigation.

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Uranium biosorption from aqueous solution onto Eichhornia crassipes

Publication date: April 2016
Source:Journal of Environmental Radioactivity, Volume 154
Author(s): Zheng-ji Yi, Jun Yao, Hui-lun Chen, Fei Wang, Zhi-min Yuan, Xing Liu
Batch experiments were conducted to investigate the biosorption of U(VI) from aqueous solutions onto the nonliving biomass of an aquatic macrophyte Eichhornia crassipes. The results showed that the adsorption of U(VI) onto E. crassipes was highly pH-dependent and the best pH for U(VI) removal was 5.5. U(VI) adsorption proceeded rapidly with an equilibrium time of 30 min and conformed to pseudo-second-order kinetics. The Langmuir isotherm model was determined to best describe U(VI) biosorption with a maximum monolayer adsorption capacity of 142.85 mg/g. Thermodynamic calculation results indicated that the U(VI) biosorption process was spontaneous and endothermic. Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy analysis implied that the functional groups (amino, hydroxyl, and carboxyl) may be responsible for the U(VI) adsorption process, in which the coordination and ion exchange mechanisms could be involved. We conclude that E. crassipes biomass is a promising biosorbent for the removal of uranium pollutants.



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Characterizations of bio-accumulations, subcellular distribution and chemical forms of cesium in Brassica juncea, and Vicia faba

Publication date: April 2016
Source:Journal of Environmental Radioactivity, Volume 154
Author(s): Qian Fu, Jin-long Lai, Zong-ya Tao, Na Han, Guo Wu
We aim to investigate the tolerance and enrichment mechanism of cesium (Cs) in hyperaccumulation plants. In this study, Brassica juncea and Vicia faba were subjected to varying doses of Cs for 21 days to investigate the differences in bio-accumulations, subcellular distribution and chemical forms of Cs in two cultivars by differential centrifugation, and extraction of Cs in different chemical forms, respectively. The results showed that 49.87%–61.08% of the Cs were in the leaf of B. juncea, while in V. faba, 1.58%–79.29% of the Cs was in the root. The translocation factor (TF) arrived 2.79 to 3.71 in B. juncea, while it only reached 0.26 to 0.62 in V. faba. Cs subcellular distribution of the two plants was in sequence as follows: soluble fraction > cell wall >> organelles. Cs was more easily distributed to metal-sensitive fractions of V. faba. The inorganic Cs (F-ethanol), and water-soluble Cs (F-dH2O) are the main existing types of Cs in the two plants. In B. juncea, the relative content of inorganic Cs, and organic acids/CsH2PO4 (F-dH2O) were higher than that of V. faba in the stem. This suggests that Cs may induce related transporter gene expression (such as phosphate transporter, organic cation, high affinity nitrate transporter, amino acid permease, etc.) to help the transport of Cs between root to shoot.



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Bioreduction of U(VI) and stability of immobilized uranium under suboxic conditions

Publication date: April 2016
Source:Journal of Environmental Radioactivity, Volume 154
Author(s): Nan Hu, De-xin Ding, Shi-mi Li, Xiang Tan, Guang-yue Li, Yong-dong Wang, Fei Xu
In order to study the bioreduction of U(VI) and stability of immobilized uranium under suboxic conditions, microcosm were amended with ethanol, lactate and glucose, and incubated under suboxic conditions. During the incubation, total dissolved U in amended microcosms decreased from 0.95 mg/L to 0.03 mg/L. Pyrosequencing results showed that, the proportion of anaerobic microorganisms capable of reducing U(VI) under suboxic conditions was small compared with that under anoxic conditions; the proportion of aerobic and facultative anaerobic microorganisms capable of consuming the dissolved oxygen was large; and some of the facultative anaerobic microorganisms could reduce U(VI). These results indicated that different microbial communities were responsible for the bioreduction of U(VI) under suboxic and anoxic conditions. After the electron donors were exhausted, total dissolved U in the amended microcosms remained unchanged, while the U(VI)/U(IV) ratio in the solid phase of sediments increased obviously. This implied that the performance of bioreduction of the U(VI) can be maintained under suboxic condition.

Teaser

Different microbial communities were responsible for the bioreduction of U(VI) under suboxic and anoxic conditions.


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Atmospheric stability effects on potential radiological releases at a nuclear research facility in Romania: Characterising the atmospheric mixing state

Publication date: April 2016
Source:Journal of Environmental Radioactivity, Volume 154
Author(s): Scott D. Chambers, Dan Galeriu, Alastair G. Williams, Anca Melintescu, Alan D. Griffiths, Jagoda Crawford, Leisa Dyer, Marin Duma, Bogdan Zorila
A radon-based nocturnal stability classification scheme is developed for a flat inland site near Bucharest, Romania, characterised by significant local surface roughness heterogeneity, and compared with traditional meteorologically-based techniques. Eight months of hourly meteorological and atmospheric radon observations from a 60 m tower at the IFIN-HH nuclear research facility are analysed. Heterogeneous surface roughness conditions in the 1 km radius exclusion zone around the site hinder accurate characterisation of nocturnal atmospheric mixing conditions using conventional meteorological techniques, so a radon-based scheme is trialled. When the nocturnal boundary layer is very stable, the Pasquill–Gifford "radiation" scheme overestimates the atmosphere's capacity to dilute pollutants with near-surface sources (such as tritiated water vapour) by 20% compared to the radon-based scheme. Under these conditions, near-surface wind speeds drop well below 1 m s⁻¹ and nocturnal mixing depths vary from ∼25 m to less than 10 m above ground level (a.g.l.). Combining nocturnal radon with daytime ceilometer data, we were able to reconstruct the full diurnal cycle of mixing depths. Average daytime mixing depths at this flat inland site range from 1200 to 1800 m a.g.l. in summer, and 500–900 m a.g.l. in winter. Using tower observations to constrain the nocturnal radon-derived effective mixing depth, we were able to estimate the seasonal range in the Bucharest regional radon flux as: 12 mBq m⁻² s⁻¹ in winter to 14 mBq m⁻² s⁻¹ in summer.



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Pattern of traumatised anterior teeth among adult Nigerians and complications from late presentation

The objectives of this study were to determine the prevalence and pattern of traumatic dental injury (TDI) among adults presenting in a tertiary health care facility in Nigeria, the time interval between inju...

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Knowledge, attitude and practice regarding dengue fever among general patients of a rural tertiary-care hospital in Sasaram, Bihar

2016-02-06T07-42-38Z
Source: International Journal of Community Medicine and Public Health
Sahana Mohapatra, Ahmad Nadeem Aslami.
Background: Dengue fever (DF) is a rapidly spreading mosquito-borne viral illness all over the world. DF has expanded to new countries and from urban to rural areas. DF has emerged as a notable public health problem in recent decades. Rapid urbanization, environmental changes and neglected rural areas result in vector breeding which causes rise in dengue outbreaks. The objective of this study was to assess the knowledge, attitudes and practices (KAP) regarding DF among patients of a rural tertiary care hospital in Sasaram, Bihar. Methods: We conducted a hospital based cross-sectional survey among general OPD patients using a pre-designed questionnaire. The study was approved by institutional ethical committee. KAP assessment was done by a scoring system. KAP of DF among study population was represented as proportions (%). Results: Out of 223 individuals interviewed, 93% identified fever as a cardinal symptom of DF. The knowledge about other symptoms of DF was low among participants. Only 17.5% knew that DF is transmitted by Aedes mosquitoes. The correct timing of biting time was known by only 14%. Despite low knowledge, the participants had good attitude and most of them reported good preventive practices against dengue prevention and control. Conclusions: The knowledge of participants of our study was low and the attitude and practice was good in lieu of protection from other mosquito borne diseases. Therefore massive awareness campaigns are urgently required to protect the health of people against DF and to limit in future spread of DF in this part of our country.


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Resilience, Pain Interference and Upper-Limb Loss: Testing the Mediating Effects of Positive Emotion and Activity Restriction on Distress

Publication date: Available online 5 February 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Michaela V.V. Walsh, Trey W. Armstrong, Julia Poritz, Timothy R. Elliott, Warren T. Jackson, Tiffany Ryan
ObjectiveTo test mediating effects of positive emotion and activity restriction on the associations of resilience and pain interference to distress reported by individuals with traumatic upper-limb loss evaluated for prosthetics.DesignCross-sectional correlational study of several demographic and self-report measures of resilience, pain interference, activity restriction, positive emotions, and symptoms of depression and post-traumatic stress.SettingSix Advanced Arm Dynamics regional centers.Participants263 prospective participants consented to be evaluated for eligibility/need of upper extremity prosthetics; 202 (57 women, 145 men) sustained traumatic injuries. Average age was 41.81 (SD = 14.83; range of 18.01 - 72.95 years). Participants identified as White (70.8%) followed by Black (10.4%), Hispanic (9.4%), Asian (3.0%), and Other (1.8%).InterventionsNot applicable.Main Outcome Measure(s)Primary Care Post-traumatic Stress Disorder Screen³³, Depression screen.³⁴ResultsResilience and pain interference were significantly correlated in predicted directions with positive emotions, activity restriction and the two distress variables. A path model revealed that the associations of resilience and pain interference to both distress variables were completely mediated by positive emotions and activity restriction. There were no significant direct effects of resilience or pain interference to either distress variable.Conclusion(s)Resilience may facilitate adjustment via beneficial and predicted associations with positive emotions and active engagement with environment. These relationships are independent of the significant and inverse associations of pain interference on these same variables. Longitudinal research is needed to understand interactions between positive emotions and activity over time in promoting adjustment following traumatic limb loss. Individuals reporting depression and/or PTSD symptoms may require interventions that reduce avoidance and promote activities that may increase the likelihood of experiencing positive emotions.



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The impact of environmental factors on resuming valued activities post-stroke: A systematic review of qualitative and quantitative findings

Publication date: Available online 5 February 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sandra Jellema, Rob van der Sande, Suzanne van Hees, Jana Zajec, Esther M.J. Steultjens, Maria W.G. Nijhuis-van der Sanden
ObjectiveInvestigate how reengagement in valued activities post-stroke is influenced by environmental factors.Data SourcesPubMed, CINAHL and PsycINFO were searched to June 2015 using multiple search terms for stroke, activities, disability and home and community environments, with the following constraints: English, Humans, Adults.Study SelectionStudies were included that contained data on how reengagement in valued activities of community-dwelling stroke-survivors, was influenced by the environment. Two reviewers independently selected the studies. The search yielded 3,726 records; 39 studies were eventually included.Data ExtractionFindings were extracted from qualitative, quantitative and mixed-design studies. Two reviewers independently assessed study quality using the Oxford Critical Appraisal Skills Programme lists and independently extracted results.Data SynthesisThematic analysis was conducted on qualitative data, revealing nine themes related to the iterative nature of the process of reengagement and the associated environmental factors. During the process of reengagement, environmental factors interact with personal and disease-related factors in a gradual process of shaping or abandoning valued activities. The sociocultural context in this case determines what activities are valued and can be resumed by stroke-survivors. Social support, activity opportunities and obligations; familiar and accessible environments; resources and reminders and a step-by-step return, facilitate stroke-survivors to explore, adapt, resume and maintain their activities. Social support is helpful at all stages of the process and particularly is important in case stroke-survivors are fearful to explore their activity possibilities. Quantitative data identified, largely endorsed above findings. No quantitative data were found in respect to the iterative nature of the process, familiar environments or accessibility.ConclusionsReengagement in valued activities is a gradual process. In each stage of the process, several environmental factors play a role. During rehabilitation, professionals should pay attention to the role physical and social environmental factors have in reengagement post-stroke and find ways to optimize stroke-survivors' environments.



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“The Penitent Magdalene”: Tiziano Vecellio (1488/1490–1576)

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Serum levels of the bone turnover markers dickkopf-1, sclerostin, osteoprotegerin, osteopontin, osteocalcin and 25-hydroxyvitamin D in Swedish geriatric patients aged 75 years or older with a fresh hip fracture and in healthy controls

Abstract

Background

Bone turnover markers have a potential clinical use in describing bone remodeling and in predicting fractures.

Aims

In an elderly population ≥75 years with a fresh hip fracture, and in healthy controls, investigate bone turnover markers and their relation to each other, to vitamin D status and to bone mineral density (BMD).

Methods

In a cross-sectional study serum levels of dickkopf-1 (DKK-1), sclerostin (SOST), osteoprotegerin (OPG), osteopontin (OPN), osteocalcin, 25-hydroxyvitamin D (25(OH)D) were analyzed in 89 Swedish patients with a fresh hip fracture and in 82 healthy volunteers. Serum levels of bone markers were determined by Luminex technique.

Results

S-25-hydroxyvitamin D (S-25(OH)D) was decreased in patients compared to controls (48 ± 21 vs. 76 ± 25 nmol/L, p < 0.001). SOST, but none of the other bone turnover markers correlated with BMD (r = 0.50, p < 0.001). Compared with controls, higher levels of OPG (488 ± 1.4 vs. 191 ± 1.4 ng/L, p < 0.001), OPN (69 ± 1.7 vs. 19 ± 1.4 µg/L, p < 0.001), DKK-1 (273 ± 1.7 vs. 168 ± 1.7 ng/L, p < 0.001), and lower levels of osteocalcin (5.8 ± 3.5 vs. 9.5 ± 3.6 µg/L, p < 0.001), were found in the fracture group. Levels of OPG, DKK-1 and SOST in both groups were positively associated. S-25(OH)D concentration was not found to be strongly associated with any of the bone markers.

Conclusions

In contrast to findings in other studies, we found no strong correlation between 25(OH)D and the investigated bone markers. Both in patients with a fresh hip fracture and in healthy elderly, DKK-1, SOST and OPG appear to be associated. This suggests a relevance in these relationships meriting further investigation.

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Super enhancers at the miR-146a and miR-155 genes contribute to self-regulation of inflammation

Publication date: Available online 5 February 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Qiong Duan, Xiaoxiao Mao, Yi Xiao, Zhenzhen Liu, Yangui Wang, Haoyang Zhou, Zhengxiang Zhou, Jinxing Cai, Ke Xia, Qubo Zhu, Jun Qi, He Huang, Jorge Plutzky, Tianlun Yang
Inflammatory response is essential to host defense and repair, and requires tight regulation as excessive and constant inflammatory response is deleterious. We recently identified that one of the general but key mechanisms for inflammatory gene transcription regulation is controlled by the formation of super enhancers mediated by NF-κB, and bromodomain and extraterminal (BET) proteins.Given that microRNA transcription shares a similar mechanism to mRNA, we assume that the inflammatory microRNAs transcription could be NF-κB and BET bromodomain dependent. In the present study, we confirmed that inflammatory stimuli changed human umbilical vein endothelial cells (HUVEC) microRNA profile. Among these microRNAs, miR-146a and miR-155, two well-estabolished inflammatory microRNAs, are both downregulated at transcriptional level by NF-κB and BET bromodomain inhibition. To pursue this mechanism, we analysized the ChIP-seq data and found that NF-κB, BRD4 and RNA POL II rapidly distributed at the upstream regions of miR-146a and miR-155, and more importantly mediated the formation of the super enhancers that drive miR-146a and miR-155 transcription. These microRNAs transcription driven by super enhancers in turn downregulate both in vitro and in vivo canonical inflammatory gene expression through targeting inflammatory mediators. This novel finding demonstrated how the host self-regulates inflammatory genes expression at both transcriptional and post-transcriptional level to ensure the appropriate level of the host inflammatory response.



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Successful rapid subcutaneous desensitization to Anakinra in a case of delayed-type hypersensitivity reaction

Drug hypersensitivity reactions may deprive patients of drug therapy. Successful desensitization protocols have been reported for common drugs and now for monoclonal antibodies^1,2. A 24 year-old woman followed for refractory adult-onset Still's disease was treated with anakinra (Kineret^®) subcutaneously (100mg each day) leading to rapid clinical improvement of her symptoms. However, one month later, she developed severe, symmetrical, erythematous skin plaques on the lower back and legs (Fig. 1a). Pathological examination of a skin lesional biopsy showed the presence of a perivascular mononuclear infiltrate associated with an inflammatory infiltrate localized at the dermal epidermal junction suggesting a lichenoid pattern (Fig 1b).

This article is protected by copyright. All rights reserved.

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Risk of bias does not differ between full papers and letters reporting dermatological randomised controlled trials

Results of randomised controlled trials (RCTs) are often reported in letters rather than published within full papers. Trial results that are published as letters are often missed from bibliographic searches, especially if the term "randomized controlled trial" is not included in the title of the letter. Such RCT letters generally require "hand searching" in order to identify them.¹

This article is protected by copyright. All rights reserved.

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Comment on “TNFα plays a significant role in the Aldara-induced skin inflammation in mice”

With great interest we read the recent publication from Vinter and colleagues describing the role of TNFα in the Aldara model¹. Through the use of scoring skin inflammation, RT-PCR, and histology, they showed that TNFα-deficient mice showed less erythema, scaling, epidermal hyperplasia, Ki67, CD3⁺ T cells staining and splenomegaly. The authors continued by quantifying several mediating cytokines, such as IL-17A, IL-22, IL-12p40, and IL-23p19; which were significantly reduced in TNFα-knockouts.

This article is protected by copyright. All rights reserved.

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Two cases of overlap-severe cutaneous adverse reactions to benznidazole treatment for asymptomatic Chagas′ disease in a non-endemic country

Abstract

Chagas′ disease is a parasitosis endemic to South America normally treated with benznidazole as first choice, which has been associated with numerous cutaneous reactions. However, very few benznidazole-associated severe cutaneous adverse reactions (SCARs) have been reported to date. The rise of Chagas′ disease in non-endemic countries represents a growing public health challenge.

We report two patients who met the criteria for DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome and SJS/TEN (Stevens-Johnson syndrome / Toxic Epidermal Necrolysis) according to the RegiSCAR scoring systems—thus, deemed overlapping cases—with LTT (lymphocyte transformation test) positive for benznidazole. Both required intensive care unit admission (ICU), and both survived.

Considering the rising application of this drug for trypanosomyasis in immigrant populations, clinicians should be aware of this newly reported, potentially life-threatening risk.

This article is protected by copyright. All rights reserved.

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Methotrexate in psoriasis under real world conditions: long-term efficacy and tolerability

Methotrexate (MTX) is a mainstay in psoriasis treatment. Yet, the evidence base for this treatment is sparse. Recent evidence has accumulated with MTX serving as comparator treatment for other biologics^1-4,5. However, clinical studies do not directly reflect long term drug performance in routine care⁶.

This article is protected by copyright. All rights reserved.

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L’homme qui voulait simplement arrêter de fumer…

Publication date: Available online 5 February 2016
Source:Revue des Maladies Respiratoires
Author(s): A. Audemard-Verger, V. Lepennec, F. Galateau-Salle, R. Verdon




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Interactions cœur–poumons au cours de la ventilation mécanique

Publication date: Available online 5 February 2016
Source:Revue des Maladies Respiratoires
Author(s): B. Lamia, L.-C. Molano, J.-F. Muir, A. Cuvelier
IntroductionLes conséquences hémodynamiques de la ventilation mécanique sont multiples et complexes et peuvent affecter tous les déterminants de la performance cardiaque que sont la fréquence cardiaque, la précharge, la contractilité et la postcharge. Ces conséquences concernent tant le cœur droit que le cœur gauche, d'autant plus qu'il existe une interdépendance entre le ventricule droit et le ventricule gauche.État des connaissancesLa mise sous ventilation modifie le volume pulmonaire mais aussi la pression intra-thoracique. Les variations du volume pulmonaire ont des conséquences sur les résistances vasculaires pulmonaires, la vasoconstriction pulmonaire hypoxique et l'interdépendance ventriculaire. Les variations de pression intra-thoracique ont un impact majeur et affectent le retour veineux systémique, la précharge ventriculaire droite, la précharge ventriculaire gauche, la postcharge ventriculaire gauche, la postcharge ventriculaire droite et la contractilité myocardique. Les conséquences hémodynamiques de la ventilation en pression positive vont dépendre des pathologies cardiorespiratoires chroniques sous-jacentes lors desquelles survienne l'insuffisance respiratoire aiguë posant l'indication de la mise sous ventilation.ConclusionDans cette revue, nous décrirons en particulier la situation de la décompensation aiguë de BPCO, de l'insuffisance cardiaque gauche aiguë et du sevrage de la ventilation.IntroductionThe haemodynamic consequences of ventilation are multiple and complex and may affect all the determinants of cardiac performance such as heart rate, preload, contractility and afterload. These consequences affect both right and left ventricle and are also related to the biventricular interdependence.State-of-the-artVentilation modifies the lung volume and also the intrathoracic pressure. Variations in lung volume have consequences on the pulmonary vascular resistance, hypoxic pulmonary vasoconstriction and ventricular interdependence. Variations in intrathoracic pressure have a major impact and affect systemic venous return, right ventricular preload, left ventricular preload, right ventricular afterload, left ventricular afterload and myocardial contracility. The haemodynamic consequences of positive pressure ventilation depend on the underlying chronic cardiopulmonary pathologies leading to the acute respiratory failure that was the indication for ventilation.ConclusionIn this review, we will focus on severe COPD exacerbation, acute left heart failure and weaning from ventilation.



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Pneumopathie organisée cryptogénique

Publication date: Available online 5 February 2016
Source:Revue des Maladies Respiratoires
Author(s): N. Petitpierre, C. Beigelman, I. Letovanec, R. Lazor
IntroductionLa pneumopathie organisée est une réaction inflammatoire particulière du parenchyme pulmonaire donnant lieu à un syndrome clinico-pathologique. Elle est dite secondaire lorsqu'une cause a pu être identifiée et cryptogénique dans le cas contraire. La présentation clinique habituelle est caractérisée par l'apparition subaiguë de symptômes généraux et respiratoires, avec classiquement des condensations plurifocales à l'imagerie thoracique.État des connaissancesLa pneumopathie organisée cryptogénique est caractérisée histologiquement par la présence de bourgeons de tissu conjonctif intra-alvéolaires. La pathogenèse débute par une lésion de l'épithélium alvéolaire conduisant à un dépôt de fibrine dans les espaces aériens, puis une migration de fibroblastes produisant une matrice myxoïde intra-alvéolaire. Une caractéristique remarquable de la pneumopathie organisée est la résolution complète de ces bourgeons fibroblastiques sous traitement corticoïde, contrairement à ce qui s'observe en cas de fibrose pulmonaire. La réponse clinique aux corticostéroïdes est habituellement rapide et excellente. Les rechutes sont fréquentes mais généralement sans gravité.Perspectives et conclusionsSi les caractéristiques clinico-pathologiques de la pneumopathie organisée cryptogénique sont maintenant bien établies, il reste de nombreuses questions à élucider, notamment les mécanismes impliqués dans la réversibilité des lésions pulmonaires, et la place des traitements d'épargne corticoïde, tels que les macrolides à effet immunomodulateur.IntroductionOrganizing pneumonia is a particular type of inflammatory reaction of the lung which gives rise to a clinico-pathological syndrome. It is called "secondary" when a cause such as an infection, a drug toxicity, or a connective tissue disease can be identified, or "cryptogenic" when no cause is identified. The clinical picture is usually characterized by the subacute onset of fever, fatigue, cough and dyspnea, with multiple subpleural areas of consolidation on thoracic imaging.State of the artOrganizing pneumonia is characterised by the presence of buds of endoalveolar connective tissue. These result from an injury to the alveolar epithelium, followed by the deposition of fibrin in the alveolar spaces, and the migration of fibroblasts which produce a myxoid endoalveolar matrix. A remarkable feature of organizing pneumonia is the complete disappearance of these endoalveolar buds with corticosteroid treatment, in sharp contrast with what is seen in pulmonary fibrosis. The clinical response to corticosteroids is usually prompt and excellent. Relapses are frequent but usually benign.Perspectives and conclusionAs the clinical, imaging and pathological characteristics of organizing pneumonia are now well established, many questions remain unanswered, such as the mechanisms involved in the complete reversibility of the pulmonary lesions, and the role of steroid-sparing treatments such as immunomodulatory macrolides.



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