Simens got the job, lost it over coruption. Finaly, after years of talk, it is a TETRA system covering Norway. Hope it is upp for the job. ExEMTNor
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Κυριακή 10 Απριλίου 2016
Nodnett - The New Digital Public Safety Communication System in Norway
Nodnett - The New Digital Public Safety Communication System in Norway
Simens got the job, lost it over coruption. Finaly, after years of talk, it is a TETRA system covering Norway. Hope it is upp for the job. ExEMTNor
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Nodnett - The New Digital Public Safety Communication System in Norway
Simens got the job, lost it over coruption. Finaly, after years of talk, it is a TETRA system covering Norway. Hope it is upp for the job. ExEMTNor
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National G6PD neonatal screening program in Gaza Strip of Palestine: rationale, challenges and recommendations
Abstract
Congenital genetic disorders affecting neonates or young children can have serious clinical consequences if undiagnosed and left untreated. Early detection and an accurate diagnosis are, therefore, of major importance for preventing negative patient outcomes. Even though the occurrence of each specific metabolic disorder may be rare, their collective impact of preventable complications may be of considerable importance to the public health. Our previous studies showed that G6PD deficiency is a problem of public health importance that has been shown to be a predominant cause of acute hemolytic anemia requiring hospitalization in Palestinian young children in Gaza Strip. Intriguingly, majority of these children had one of the three variants, Mediterraneanc.563T, African G6PD A-c.202A/c.376G and heretofore unrecognized as a common G6PD deficient variant G6PD Cairoc.404C.
The high prevalence of G6PD deficiency, as well as dietary factors in the region that precipitate anemia, argues for a need to protect the Palestinian children from a treatable and manageable genetic and metabolic disorder. The present work reviews and discusses rationales and challenges of G6PD screening program in Gaza Strip. We advocate adopting a national neonatal G6PD screening program in Gaza Strip to identify children at risk and promote wellness and health for Palestine.
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Characterization of a multiprotein complex involved in excitation-transcription coupling of skeletal muscle
Background: Electrical activity regulates the expression of skeletal muscle genes by a process known as "excitation-transcription" (E-T) coupling. We have demonstrated that release of adenosine 5′-triphosphate (ATP) during depolarization activates membrane P2X/P2Y receptors, being the fundamental mediators between electrical stimulation, slow intracellular calcium transients, and gene expression. We propose that this signaling pathway would require the proper coordination between the voltage sensor (dihydropyridine receptor, DHPR), pannexin 1 channels (Panx1, ATP release conduit), nucleotide receptors, and other signaling molecules. The goal of this study was to assess protein-protein interactions within the E-T machinery and to look for novel constituents in order to characterize the signaling complex. Methods: Newborn derived myotubes, adult fibers, or triad fractions from rat or mouse skeletal muscles were used. Co-immunoprecipitation, 2D blue native SDS/PAGE, confocal microscopy z-axis reconstruction, and proximity ligation assays were combined to assess the physical proximity of the putative complex interactors. An L6 cell line overexpressing Panx1 (L6-Panx1) was developed to study the influence of some of the complex interactors in modulation of gene expression. Results: Panx1, DHPR, P2Y 2 receptor (P2Y 2 R), and dystrophin co-immunoprecipitated in the different preparations assessed. 2D blue native SDS/PAGE showed that DHPR, Panx1, P2Y 2 R and caveolin-3 (Cav3) belong to the same multiprotein complex. We observed co-localization and protein-protein proximity between DHPR, Panx1, P2Y 2 R, and Cav3 in adult fibers and in the L6-Panx1 cell line. We found a very restricted location of Panx1 and Cav3 in a putative T-tubule zone near the sarcolemma, while DHPR was highly expressed all along the transverse (T)-tubule. By Panx1 overexpression, extracellular ATP levels were increased both at rest and after electrical stimulation. Basal mRNA levels of the early gene cfos and the oxidative metabolism markers citrate synthase and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) were significantly increased by Panx1 overexpression. Interleukin 6 expression evoked by 20-Hz electrical stimulation (270 pulses, 0.3 ms each) was also significantly upregulated in L6-Panx1 cells. Conclusions: We propose the existence of a relevant multiprotein complex that coordinates events involved in E-T coupling. Unveiling the molecular actors involved in the regulation of gene expression will contribute to the understanding and treatment of skeletal muscle disorders due to wrong-expressed proteins, as well as to improve skeletal muscle performance.
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Atypical antipsychotic medications and hyponatremia in older adults: a population-based cohort study
Background: A number of case reports have suggested a possible association between atypical antipsychotic medications and hyponatremia. Currently, there are no reliable estimates of hyponatremia risk from atypical antipsychotic drugs.ObjectiveThe objective of this study was to examine the 30-day risk of hospitalization with hyponatremia in older adults dispensed an atypical antipsychotic drug relative to no antipsychotic use.DesignThe design of this study was a retrospective, population-based cohort study.SettingThe setting of this study was in Ontario, Canada, from 2003 to 2012.PatientsAdults 65 years or older with an identified psychiatric condition who were newly dispensed risperidone, olanzapine, or quetiapine in the community setting compared to adults with similar indicators of baseline health who were not dispensed such a prescription.MeasurementsThe primary outcome was the 30-day risk of hospitalization with hyponatremia. The tracer outcome (an outcome that is not expected to be influenced by the study drugs) was the 30-day risk of hospitalization with bowel obstruction. These outcomes were assessed using hospital diagnosis codes. Methods: Using health administrative data, we applied a propensity score technique to match antipsychotic users 1:1 to non-users of antipsychotic drugs (58,008 patients in each group). We used conditional logistic regression to compare outcomes among the matched users and non-users. Results: A total of 104 baseline characteristics were well-balanced between the two matched groups. Atypical antipsychotic use compared to non-use was associated with an increased risk of hospitalization with hyponatremia within 30 days (86/58,008 (0.15 %) versus 53/58,008 (0.09 %); relative risk 1.62 (95 % confidence interval (CI) 1.15 to 2.29); absolute risk increase 0.06 % (95 % CI 0.02 to 0.10)). The limited number of events precluded some additional analyses to confirm if the association was robust. Atypical antipsychotic use compared to non-use was not associated with hospitalization with bowel obstruction within 30 days (55/58,008 (0.09 %) versus 44/58,008 (0.08 %); relative risk 1.25 (95 % CI 0.84 to 1.86)).LimitationsWe could only study older adults within our data sources. Conclusions: In this study, the use of an atypical antipsychotic was associated with a modest but statistically significant increase in the 30-day risk of a hospitalization with hyponatremia. The association was less pronounced than that described with other psychotropic drugs.
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Endothelial, platelet, and macrophage microparticle levels do not change acutely following transcatheter aortic valve replacement
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Role of sclerostin in the pathogenesis of chronic kidney disease-mineral bone disorder
Sclerostin is a 190-amino-acid glycoprotein that is mainly secreted by osteocytes, and it decreases bone formation by inhibiting the terminal differentiation of osteoblasts and promoting their apoptosis. Sclerostin blocks the Wnt signaling pathway in osteoblasts by binding to low-density lipoprotein receptor-related protein 5/6 (LRP-5/6) receptors. We reviewed the literature detailing the role of sclerostin in the pathogenesis of chronic kidney disease-bone mineral disorder (CKD-MBD). Increased serum sclerostin levels may be correlated with increased serum levels of phosphate and fibroblast growth factor 23 (FGF23) in hemodialysis patients with relatively low parathyroid hormone levels. Decreased Wnt/β-catenin signaling occurs regardless of the overall changes in bone formation rates, suggesting that a reduction in the anabolic response may be a common feature of renal bone disorders; however, additional mechanisms may contribute to the diversity of osteodystrophy phenotypes. Recent clinical studies demonstrated that treatment with anti-sclerostin antibodies improved bone quality in the context of low but not high turnover renal osteodystrophy. Sclerostin also appears in the circulation, suggesting that it plays additional roles outside the skeleton under normal conditions and in disease states. The serum sclerostin levels in CKD patients are several times higher than in healthy subjects. Recent data suggest that the higher serum sclerostin levels are associated with increased fracture rates, but the relationship between sclerostin and cardiovascular disease is unclear. CKD stage-specific epidemiologic studies are needed to assess whether sclerostin elevations affect comorbidities associated with CKD-MBD.
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Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals
Experts agree that careful cleaning and disinfection of environmental surfaces are essential elements of effective infection prevention programs. However, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. This is often due in part to a variety of personnel issues that many Environmental Services departments encounter. Failure to follow manufacturer's recommendations for disinfectant use and lack of antimicrobial activity of some disinfectants against healthcare-associated pathogens may also affect the efficacy of disinfection practices.Improved hydrogen peroxide-based liquid surface disinfectants and a combination product containing peracetic acid and hydrogen peroxide are effective alternatives to disinfectants currently in widespread use, and electrolyzed water (hypochlorous acid) and cold atmospheric pressure plasma show potential for use in hospitals. Creating "self-disinfecting" surfaces by coating medical equipment with metals such as copper or silver, or applying liquid compounds that have persistent antimicrobial activity surfaces are additional strategies that require further investigation.Newer "no-touch" (automated) decontamination technologies include aerosol and vaporized hydrogen peroxide, mobile devices that emit continuous ultraviolet (UV-C) light, a pulsed-xenon UV light system, and use of high-intensity narrow-spectrum (405 nm) light. These "no-touch" technologies have been shown to reduce bacterial contamination of surfaces. A micro-condensation hydrogen peroxide system has been associated in multiple studies with reductions in healthcare-associated colonization or infection, while there is more limited evidence of infection reduction by the pulsed-xenon system. A recently completed prospective, randomized controlled trial of continuous UV-C light should help determine the extent to which this technology can reduce healthcare-associated colonization and infections.In conclusion, continued efforts to improve traditional manual disinfection of surfaces are needed. In addition, Environmental Services departments should consider the use of newer disinfectants and no-touch decontamination technologies to improve disinfection of surfaces in healthcare.
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Severity and disease control before house dust mite immunotherapy initiation: ANTARES a French observational survey
Background: Allergen immunotherapy (AIT) may be prescribed for patients with allergic rhinitis (AR) induced by house dust mites (HDM) whether asthma is present or not. Current guidelines provide insufficient support for therapeutic management strategy of these patients. Allergists however have long-term experience with AIT. This study aims to describe the characteristics of the patients seen in clinical practice with HDM allergy and the process used to determine whether AIT should be initiated. Methods: This was an observational, multicenter, prospective and cross-sectional study, conducted in France from 2013 to 2014 with a representative sample of allergy specialists. Any patient over 5 years of age with confirmed HDM allergy untreated with AIT within the last 12 months was eligible. Data were prospectively collected using physician and patient questionnaires. Results: A total of 1589 patients (60 % adults, 40 % children) were included by 195 randomly selected allergists. A subgroup of 1212 patients (median age: 22 years; 52 % women) were selected for AIT treatment with a median time of AR diagnosis of 3 years. Amongst these, 59 % had a moderate to severe persistent AR according to AR and its Impact on Asthma guidelines, 57.5 % were polysensitized, and 56.5 % also suffered from conjunctivitis (median rhinitis total symptom score: 11). Asthma was present in 42 % of patients, and was controlled according to Global Initiative for Asthma guidelines in 62 % of patients. The asthma control questionnaire score was 1–1.5 in 20 % and ≥1.5 in 37 % of patients. A total of 57 % patients received a prescription of ≥2 medications (mainly antihistamines). Usual daily activities and sleep quality were slightly-to-moderately impaired as the mean rhinoconjunctivitis quality of life questionnaire score was 2.7 ± 1.5. The major driver of AIT prescription is AR uncontrolled by previous medications leading to patient dissatisfaction. Conclusions: HDM-AR associated conjunctivitis was present in 60 % and asthma in 40 % of cases. In >40 % of these cases, asthma was inadequately controlled at the start of AIT.
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Allergic reactions to milk appear sooner than reactions to hen’s eggs: a retrospective study
Background: Oral food challenge test doses are recommended to be performed at least 20 min apart; however, the times of symptom provocation from the start of the oral food challenge have never been compared between different foods. In this study, the durations from the start of the oral food challenge to symptom development in children with egg or milk allergy were compared. Methods: Thirty-eight and 74 children who had previously passed oral food challenges to 96 g of yogurt and pumpkin cake containing ¼ whole egg underwent oral food challenges with 200 mL raw cow's milk and 1 whole scrambled egg, respectively; of these, 15/38 and 33/74 children had a reaction. Results: The median ages of patients with a positive challenge were 5.8 and 5.1 years for milk and eggs, respectively. The median times for the first symptom occurrence were 20 min (range, 5–55 min) and 50 min (5–480 min), respectively (p = 0.009). The first symptoms developed within 30, 60, and 90 min in 12/15 (80 %), 15/15 (100 %), and 15/15 (100 %) children with milk allergies, and in 10/33 (30.3 %), 20/33 (60.6 %), and 26/33 (78.8 %) children with egg allergies, respectively. The median times of peak symptoms were 50 min (10–210 min) and 120 min (30–560 min) (p = 0.001), and those of symptom disappearance were 90 min (30–240 min) and 180 min (80–700 min) for milk and eggs (p = 0.002), respectively.DiscussionBased on the results of our study, symptoms developed within 30 min for only a subset of patients for eggs, and may even take upwards of 60 min to develop. The times of symptom disappearance were 90 min and 180 min for milk and eggs, respectively, indicating that egg-allergic patients should be observed for a longer period time than milk-allergic patients. Conclusions: Allergic reactions induced by milk appeared and disappeared sooner than those induced by eggs.
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Child maltreatment and pediatric asthma: a review of the literature
Background: Child maltreatment is a common problem with known adverse consequences, yet its contributions to the development and course of pediatric asthma are only poorly understood.MainThis review first describes possible pathways connecting child maltreatment to pediatric asthma, including aspects of the physical home environment, health behaviors and disease management, and psychological consequences of child maltreatment. We subsequently review existing studies, which generally report an association between maltreatment experiences and asthma outcomes in childhood. However, this literature is in its early stages; there are only a handful studies, most of them rely on self-reports of both child maltreatment and asthma history, and none have investigated the physiological underpinnings of this association. Taken together, however, the studies are suggestive of child maltreatment playing a role in pediatric asthma incidence and expression that should be explored further. Conclusion: Existing data are sparse and do not allow for specific conclusions. However, the data are suggestive of child maltreatment influencing asthma risk and morbidity long before the adult years. Future research should focus on understanding how child maltreatment contributes to asthma disease risk and progression in this highly vulnerable population.
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TWiV 384: Agent 003, a view to a fish kill
Hosts: Vincent Racaniello, Dickson Despommier, Alan Dove and
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A novel ICK mutation causes ciliary disruption and lethal endocrine-cerebro-osteodysplasia syndrome
Background: Endocrine-cerebro-osteodysplasia (ECO) syndrome [MIM:612651] caused by a recessive mutation (p.R272Q) in Intestinal cell kinase (ICK) shows significant clinical overlap with ciliary disorders. Similarities are strongest between ECO syndrome, the Majewski and Mohr-Majewski short-rib thoracic dysplasia (SRTD) with polydactyly syndromes, and hydrolethalus syndrome. In this study, we present a novel homozygous ICK mutation in a fetus with ECO syndrome and compare the effect of this mutation with the previously reported ICK variant on ciliogenesis and cilium morphology. Results: Through homozygosity mapping and whole-exome sequencing, we identified a second variant (c.358G > T; p.G120C) in ICK in a Turkish fetus presenting with ECO syndrome. In vitro studies of wild-type and mutant mRFP-ICK (p.G120C and p.R272Q) revealed that, in contrast to the wild-type protein that localizes along the ciliary axoneme and/or is present in the ciliary base, mutant proteins rather enrich in the ciliary tip. In addition, immunocytochemistry revealed a decreased number of cilia in ICK p.R272Q-affected cells. Conclusions: Through identification of a novel ICK mutation, we confirm that disruption of ICK causes ECO syndrome, which clinically overlaps with the spectrum of ciliopathies. Expression of ICK-mutated proteins result in an abnormal ciliary localization compared to wild-type protein. Primary fibroblasts derived from an individual with ECO syndrome display ciliogenesis defects. In aggregate, our findings are consistent with recent reports that show that ICK regulates ciliary biology in vitro and in mice, confirming that ECO syndrome is a severe ciliopathy.
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In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable
Background: Esophageal pressure (Pes) can provide information to guide mechanical ventilation in acute respiratory failure. However, both relative changes and absolute values of Pes can be affected by inappropriate filling of the esophageal balloon and by the elastance of the esophagus wall. We evaluated the feasibility and effectiveness of a calibration procedure consisting in optimization of balloon filling and subtraction of the pressure generated by the esophagus wall (Pew). Methods: An esophageal balloon was progressively filled in 36 patients under controlled mechanical ventilation. V BEST was the filling volume associated with the largest tidal increase of Pes. Esophageal wall elastance was quantified and Pew was computed at each filling volume. Different filling strategies were compared by performing a validation occlusion test. Results: Fifty series of measurements were performed. V BEST was 3.5 ± 1.9 ml (range 0.5–6.0). Esophagus elastance was 1.1 ± 0.5 cmH 2 O/ml (0.3–3.1). Both Pew and the result of the occlusion test differed among filling strategies. At filling volumes of 0.5, V BEST and 4.0 ml respectively, Pew was 0.0 ± 0.1, 2.0 ± 1.9, and 3.0 ± 1.7 cmH 2 O (p < 0.0001), whereas the occlusion test was satisfactory in 22 %, 98 %, and 88 % of cases (p < 0.0001). Conclusions: Under mechanical ventilation, an increase of balloon filling above the conventionally recommended low volumes warrants complete transmission of Pes swings, but is associated with significant elevation of baseline. A simple calibration procedure allows finding the filling volume associated with the best transmission of tidal Pes change and subtracting the associated baseline artifact, thus making measurement of absolute values of Pes reliable.
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Pulmonary embolism as a complication of an electrophysiological study: a case report
Background: Electrophysiological studies have become an established practice in the evaluation and treatment of arrhythmias. Symptomatic pulmonary embolism as a result of deep vein thrombosis arising from multiple venous sheath femoral vein catheterization is an uncommon complication associated with it. We report the case of a 33-year-old woman who developed pulmonary embolism after an electrophysiological study, which was successfully treated at a cardiac hospital in Bangladesh.Case presentationA 33-year-old Bangladeshi woman with hypertension and diabetes had initially presented with recurrent episodes of paroxysmal atrial fibrillation that manifested as palpitations for 2 years. Her atrial fibrillation was drug-refractory and could not be attributed to a treatable etiology. She had undergone an electrophysiological study at a different hospital, where right femoral venous catheterization was performed followed by the insertion of three venous sheaths. However, tachyarrhythmia could not be induced and a procedure to isolate the pulmonary vein was postponed because all the veins could not be isolated. Forty-eight hours later, she presented to our hospital with shortness of breath, chest heaviness, palpitations, and recurrent episodes of syncope.She had normal coronary arteries and no other risk factors for venous thromboembolism. She was hemodynamically stable on examination. There was echocardiographic evidence of pulmonary hypertension and right ventricular dilatation and dysfunction. A computed tomography pulmonary angiogram confirmed pulmonary embolus in the descending branch of her left pulmonary artery, extending up to the segmental arteries.Subsequently, a duplex ultrasound confirmed acute deep vein thrombosis affecting her right ilio-femoral segment. She was successfully managed with subcutaneous enoxaparin and oral warfarin (target international normalized ratio 2.5–3). Conclusions: Pulmonary embolism is a rare but serious complication that may occur in patients who undergo electrophysiological studies. Multiple venous sheaths inserted into the femoral vein and catheter-induced endothelial injury, further compounded by prolonged procedural time, may be responsible for the increased thrombogenicity leading to deep vein thrombosis and subsequent pulmonary embolism. An adequate observation time after the procedure and clinical alertness are necessary for rapid diagnosis and treatment.
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miR-29b and miR-198 overexpression in CD8 + T cells of renal cell carcinoma patients down-modulates JAK3 and MCL-1 leading to immune dysfunction
Background: Mammalian microRNAs (miR) regulate the expression of genes relevant for the development of adaptive and innate immunity against cancer. Since T cell dysfunction has previously been reported in patients with renal cell carcinoma (RCC; clear cell type), we aimed to analyze these immune cells for genetic and protein differences when compared to normal donor T cells freshly after isolation and 35 days after in vitro stimulation (IVS) with HLA-matched RCC tumor cells. Methods: We investigated gene expression profiles of tumor-reactive CD8 + T cells obtained from RCC patient and compared with their HLA-matched healthy sibling donors using a microarray approach. In addition, miRNAs analysis was performed in a validation cohort of peripheral blood CD8 + T cells from 25 RCC patients compared to 15 healthy volunteers. Results: We observed that CD8 + T cells from RCC patients expressed reduced levels of anti-apoptotic and proliferation-associated gene products when compared with normal donor T cells both pre- and post-IVS. In particular, JAK3 and MCL-1 were down-regulated in patient CD8 + T cells versus their normal counterparts, likely due to defective suppressor activity of miR-29b and miR-198 in RCC CD8 + T cells. Indeed, specific inhibition of miR-29b or miR-198 in peripheral blood mononuclear cells (PBMCs) isolated from RCC patients, resulted in the up-regulation of JAK3 and MCL-1 proteins and significant improvement of cell survival in vitro. Conclusions: Our results suggest that miR-29b and miR-198 dysregulation in RCC patient CD8 + T cells is associated with dysfunctional immunity and foreshadow the development of miR-targeted therapeutics to correct such T cell defects in vivo.
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Historical concept of the crystalline lens
Leffler CT, Hadi TM, Udupa A, Schwartz SG, Schwartz D
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Using a Whole Person Approach to Support People With Cancer: A Longitudinal, Mixed-Methods Service Evaluation
Introduction. Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this article is to (a) evaluate short- and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC) and (b) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods. Longitudinal mixed-methods service evaluation (n = 135). Data collected included health-related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity–MYCaW); lifestyle behavior (bespoke questionnaire), and participants' experiences over 12 months postcourse. Results. Statistically and clinically significant improvements from baseline to 12 months in severity of MYCaW Concerns (n = 64; P < .000) and mean total HRQoL (n = 66; P < .000). The majority of MYCaW concerns were "psychological and emotional" and about participants' well-being. Spiritual, emotional, and functional well-being contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. Three to 6 months postcourse was identified as the time when more support was most likely to be needed. Conclusions. Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behavior change were also identified. These data then informed wider and more person-centered clinical provision to increase the maintenance of positive long-term behavior changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed.
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Primary Hepatic Osteosarcoma: A Rare Cause of Primary Liver Tumor
Introduction: Extraosseous osteosarcomas are rare, accounting for approximately 4% of all osteosarcomas. A literature review yields very few cases of osteosarcoma primarily arising from the hepatic parenchyma. Case report: This report describes a case of a man in his 50s with a history of hepatitis C and cirrhosis who presented with 5 days of progressive right upper quadrant pain. Magnetic resonance imaging of the abdomen and pelvis demonstrated a 4.4 cm × 4.8 cm × 4.8 cm right hepatic lobe mass with a large area of necrosis and peripheral enhancement. The subsequent liver biopsy showed few cores of tumor composed of fibroblastic malignant cells producing lace-like osteoid matrix. Osteosarcomatous foci in other parts of the body were excluded by performing extensive physical examination, radiologic imaging, and biopsy. Hence, a primary osteosarcoma was diagnosed. The patient underwent portal vein embolization in preparation for a surgical resection of the right liver lobe. He was admitted six weeks after the embolization for dyspnea and abdominal distension and expired due to abdominal hematoma and pulmonary embolism. Conclusion: Based on the rarity, lack of consensus in treatment, and dismal prognosis, extraosseous osteosarcoma should be considered a separate entity from osseous osteosarcoma. More data and research are needed in this rare and understudied malignancy.
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Substance abuse and personality disorder comorbidity in adolescent outpatients: are girls more severely ill than boys?
Background: Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender. Methods: The sample consisted of 153 adolescents, aged 14–17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality. Results: 18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD. Conclusions: We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances.Trial registration The regional committee for medical research ethics for eastern Norway approved the study protocol in October 2004 (REK: 11395). Address correspondence and reprint requests to: Hans Ole Korsgaard, The Nic Waal Institute, Lovisenberg Diakonale Hospital, P.O. Box 2970 Nydalen, N-0440 Oslo, Norway; E-mail hansole.korsgaard@tele5.no
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New record for the deep-sea genus Tripoplax (Mollusca: Polyplacophora) in the eastern Pacific
Background: Most species of Polyplacophora are found in shallow, coastal water, and their distribution and ecology is generally well known. On the contrary, information related with distribution, biology and ecology of deep-sea chitons is scarce. Methods: Specimens of the deep-sea mollusks fauna were obtained during sampling operations of western Mexico (TALUD project) aimed at the study of invertebrate fauna occurring under the Oxygen Minimum Zone (OMZ). The material reported herein is part of the Polyplacophora fauna collected with a benthic sledge off the west coast of the Baja California Peninsula, in the eastern Pacific, Mexico. Results: The deep-sea chiton Tripoplax cf. balaenophila Schwabe & Sellanes 2004 was collected in 530–625 m depth, in the following environmental conditions: dissolved oxygen, <0.25 ml/l; temperature, 6.44 °C; salinity, 34.47. It represents a range extension of 63° of latitude (ca 8280 km) to the north for this species previously known only from the type locality, off Concepción, Chile. Conclusions: Tripoplax cf. balaenophila is associated with the lower boundary of the Minimum Oxygen Zone occurring off western Mexico, an habitat characterized by severe hypoxic conditions and colonized by well-adapted species that are generally abundant. Assignment of species to Tripoplax or Lepidozona is still a conflictive issue. The existing discrepancy in slit number and the assignment of "balaenophila" to Tripoplax cannot be solved without a more thorough review of both genera. The disjunct distribution of the genera Tripoplax in the eastern Pacific is also an interesting biogeographical issue.
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New sighting of the endangered species blackchin guitarfish, Rhinobatos cemiculus, in the South Aegean Sea
Background: A new record of the endangered species blackchin guitarfish, Rhinobatos cemiculus (925 mm TL) is here reported from South Aegean Sea. On 11 January 2015, a single specimen was collected by longline off from the Kuşadası Bay, Turkey. This new finding confirms the presence of the species along the Anatolian coasts of Aegean Sea and shows that the species is occuring in the South Aegean Sea. Results: Rhinobatos cemiculus belonging to family Rhinobatidae was identified and its distribution was compared for the Aegean and Mediterranean Sea based on literature. The main identification and some measurements of morphometric characteristics were given. Conclusions: In terms of distribution of fish taxa, Aegean coasts of Turkey has the highest diversity with 449 species, which of 64 species belong to Elasmobranchii. This report aims to close information gaps in distribution endangered cartilaginous fish throughout the Turkish Aegean coasts.
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Nonfunctioning pituitary macroadenoma: a case report from the patient perspective
Background: Nonfunctioning pituitary macroadenoma (NFPA) is a tumour of the endocrine system that is virtually always benign and can be difficult to detect. This case report is presented from the patient's perspective to highlight experiences that led to the eventual diagnosis of this condition.Case presentationA 48 year-old male experienced prolonged and unexplained reduced athletic performance worsening over five years. The patient reported decreased libido, which initiated a testosterone blood test. This confirmed reduced testosterone levels and resulted in an endocrinology referral. A subsequent dynamic contrast MRI of the pituitary region revealed a mass. The most frequent symptoms of NFPA are visual field defects, headaches and features of hypopituitarism (includes fatigue, dizziness, dry skin, irregular periods in women and sexual dysfunction in men). Conclusion: Clinicians should consider this differential diagnosis in middle-aged athletes with diminished athletic performance from an unknown cause, test visual fields and inquire if symptoms of headaches or hypopituitarism are present.
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Impact of nanohydroxyapatite on enamel surface roughness and color change after orthodontic debonding
Background: The aim of this prospective in vitro study was to evaluate the effect of nanohydroxyapatite (nanoHAP) serum on the enamel surface roughness and tooth color stability after orthodontic debonding procedure. Methods: The crowns of 30 premolars were embedded in acrylic blocks with a 4 mm × 5-mm-sized window on the middle third of buccal surfaces. Primary roughness values were evaluated by an atomic force microscope (AFM). After bracket debonding, and polishing procedures, the second roughness parameters were recorded. Specimens were then randomly assigned to two equal groups. NanoHAP serum and HAP toothpaste were applied for 10 days in the first and second groups, respectively. Then, after the third AFM, initial color parameters were measured. Following 1-week immersion in the coffee solution, second color assessment was performed. The fourth AFM was registered after 2 months of aging process. Results: All roughness parameters were elevated following debonding procedure. There was no statistically significant reduction in roughness parameters after 10 days of nanoHAP serum or HAP toothpaste application. Both groups showed significant color change after immersion in the coffee solution. Conclusions: NanoHAP serum with the protocols used in this study could not restore enamel surfaces to their original condition.
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Αυτοτραυματισμός και ψυχική ανακούφιση
Στο δυτικό ημισφαίριο είναι ιατρικά πιστοποιημένο το γεγονός ότι ο αυτοτραυματισμός με ξυράφι, ιδιαίτερα στους εφήβους, αποτελεί ένα μαζικό φαινόμενο.
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Το σύστημα επιβράβευσης και η ντοπαμίνη
Η ντοπαμίνη αποτελεί ένα νευροδιαβιβαστή που υποβοηθάει τη μεταβίβαση ερεθισμάτων μεταξύ των εγκεφαλικών συνάψεων˙ παράγεται κυρίως από κύτταρα του ίδιου του εγκεφάλου σε συγκεκριμένες περιοχές.
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Developing a nicotine patch adherence intervention for HIV-positive Latino smokers
Source:Addictive Behaviors, Volume 59
Author(s): William G. Shadel, Frank H. Galvan, Joan S. Tucker
This paper describes two phases of formative research that had the goal of developing a treatment designed to improve adherence with the nicotine patch in HIV-positive Latino smokers. Each research phase (Phase I and II) was conducted independent of the other and used different qualitative methods to inform the development of the intervention. Phase I interviewed n=14 smokers who had previous experience using the nicotine patch to gain detailed understanding of how, when, and why they used it; their perceived barriers to using it; and their perspective on ways to improve adherence to it. Phase II provided n=35 smokers with brief smoking cessation treatment and nicotine patches, then interviewed them in "near real time" over a two month period about their use of the patch during a quit attempt (e.g., perceived barriers and facilitators). Authors of the paper extracted relevant themes emerging from the interview transcripts across the two phases. Results indicated that consistent use of the nicotine patch was associated with maintaining high motivation for use (i.e., not necessarily motivation to quit, but motivation to continue patch use); linking its use with established daily routines (e.g., with taking other medications, with brushing teeth); and maintaining realistic expectations for patch efficacy (e.g., that users may still experience some level of craving and/or withdrawal). This information will used to develop and pilot test a brief treatment module that focuses on improving nicotine patch adherence.
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PREVALENCE AND DISTRIBUTION PATTERN OF DYSLIPIDEMIA IN A SEMI-URBAN COMMUNITY IN SOUTH WESTERN NIGERIA
2016-04-10T15-00-11Z
Source: International Journal of Tropical Medicine and Public Health
Ifeoluwa Silvanus Abiodun, Temitope Oyewole Olusanya, Oluwakemi Anike Ladipo, Aminat Oluwadamilola Oluberu.
Objectives: Dyslipidemia, as a major risk factor, is independently associated with cardiovascular diseases. There is paucity of data on the prevalence and distribution pattern of dyslipidemia in semi-urban communities, as most researches have focused on urban and rural areas. We aimed to determine the prevalence and distribution pattern of dyslipidemia in a semi-urban community in south western Nigeria. Materials and methods: 100 apparently healthy adult Nigerians (52 males and 48 females) were involved in the study, with a mean age of 51.29 ± 9.79. 10mls of blood was drawn from each of the study participants and the serum was analyzed for fasting plasma glucose, lipid parameters (total cholesterol, HDL cholesterol, Triglycerides, LDL cholesterol) using standard methods. Results: The prevalence of dyslipidemia in this study was 35%. Elevated total cholesterol was the commonest from of dyslipidemia observed in this study while, elevated triglycerides were the least observed. 54% of the population had a BMI greater than 25kg/m2 with just about 16% being obese. We also reported a mean BMI value of 25.53 ± 4.97. The study also showed a significant positive correlation of BMI with total cholesterol, LDL, TG, hypertension and age. Conclusion: This study has demonstrated the prevalence of dyslipidemia, even in semi-urban Nigerian populations. There is also increasing prevalence of obesity/overweight which is strongly correlated with TC, TG, and LDL which may influence the rate of occurrence of hypertensive disease.
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Post-traumatic Aneurysm of the Left Internal Carotid Artery
Publication date: Available online 10 April 2016
Source:European Journal of Vascular and Endovascular Surgery
Author(s): S.H. Koter, T.U. Cohnert
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Using Light Sheet Fluorescence Microscopy to Image Zebrafish Eye Development
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Spontaneous gallbladder perforation in a child secondary to a gallbladder cyst: a rare presentation and review of literature
Abstract
Spontaneous gallbladder perforation is rare in children. The etiology of gallbladder perforation varies greatly and is often unknown. Identified causes include infection, congenital, stones or choledochal cysts. Presently there are only five reported cases of spontaneous gallbladder perforation in children in the English literature. As such, the optimal method of diagnosis and management remains controversial. We report the case of a 2-year-old girl who presented with peritonitis secondary to spontaneous gallbladder perforation.
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Qualitative and Quantitative Assays for Detection and Characterization of Protein Antimicrobials
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Long Noncoding RNAs as Novel Biomarkers Have a Promising Future in Cancer Diagnostics
Cancers have a high mortality rate due to lack of suitable specific early diagnosis tumor biomarkers. Emerging evidence is accumulating that lncRNAs (long noncoding RNAs) are involved in tumorigenesis, tumor cells proliferation, invasion, migration, apoptosis, and angiogenesis. Furthermore, extracellular lncRNAs can circulate in body fluids; they can be detected and strongly resist RNases. Many researchers have found that lncRNAs could be good candidates for tumor biomarkers and possessed high specificity, high sensitivity, and noninvasive characteristics. In this review, we summarize the detection methods and possible sources of circulating lncRNAs and outline the biological functions and expression level of the most significant lncRNAs in tissues, cell lines, and body fluids (whole blood, plasma, urine, gastric juice, and saliva) of different kinds of tumors. We evaluate the diagnostic performance of lncRNAs as tumor biomarkers. However, the biological functions and the mechanisms of circulating lncRNAs secretion have not been fully understood. The uniform normalization protocol of sample collection, lncRNAs extraction, endogenous control selection, quality assessment, and quantitative data analysis has not been established. Therefore, we put forward some recommendations that might be investigated in the future if we want to adopt lncRNAs in clinical practice.
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Monte Carlo simulation of semiconductor detector response to 222Rn and 220Rn environments
Source:Journal of Environmental Radioactivity, Volumes 158–159
Author(s): J. Irlinger, S. Trinkl, M. Wielunksi, J. Tschiersch, W. Rühm
A new electronic radon/thoron monitor employing semiconductor detectors based on a passive diffusion chamber design has been recently developed at the Helmholtz Zentrum München (HMGU). This device allows for acquisition of alpha particle energy spectra, in order to distinguish alpha particles originating from radon and radon progeny decays, as well as those originating from thoron and its progeny decays. A Monte-Carlo application is described which uses the Geant4 toolkit to simulate these alpha particle spectra. Reasonable agreement between measured and simulated spectra were obtained for both 220Rn and 222Rn, in the energy range between 1 and 10 MeV. Measured calibration factors could be reproduced by the simulation, given the uncertainties involved in the measurement and simulation. The simulated alpha particle spectra can now be used to interpret spectra measured in mixed radon/thoron atmospheres. The results agreed well with measurements performed in both radon and thoron gas environments. It is concluded that the developed simulation allows for an accurate prediction of calibration factors and alpha particle energy spectra.
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Risks of Mycotoxins from Mycoinsecticides to Humans
There are more than thirty mycotoxins produced by fungal entomopathogens. Totally, they belong to two classes, NRP and PK mycotoxins. Most of mycotoxins have not been paid sufficient attention yet. Generally, mycotoxins do not exist in mycoinsecticide and might not be released to environments unless entomogenous fungus proliferates and produces mycotoxins in host insects or probably in plants. Some mycotoxins, destruxins as an example, are decomposed in host insects before they, with the insect's cadavers together, are released to environments. Many species of fungal entomopathogens have the endophytic characteristics. But we do not know if fungal entomopathogens produce mycotoxins in plants and release them to environments. On the contrary, the same mycotoxins produced by phytopathogens such as Fusarium spp. and Aspergillus spp. have been paid enough concerns. In conclusion, mycotoxins from mycoinsecticides have limited ways to enter environments. The risks of mycotoxins from mycoinsecticides contaminating foods are controllable.
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The First Outbreak Caused by Acinetobacter baumannii ST208 and ST195 in China
This study aimed to analyze the clinical characteristics of patients and molecular mechanisms of the first outbreak mainly caused by sequence types (STs) 208 multidrug resistant (MDR) Acinetobacter baumannii in China. A total of 10 clinical samples were collected from 5 patients who were involved in the outbreak. Bacterial identification and antibiotic sensitivity tests were performed by the VITEK-2 COMPACT automated system. MICs of tigecycline for clinical isolates were determined using broth microdilution. The clonal relatedness of A. baumannii clinical isolates in our local settings was determinated by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 7 A. baumannii strains were isolated and all were MDR strains; two of them were carbapenem-nonsusceptible strains. blaOXA-23 was the only acquired carbapenemase gene in the isolates. The isolates belonged to a single clonal pulsotype determined by PFGE and two sequences types (STs) determined by MLST. The isolates belonged to the globally disseminated clonal complex 92, among which ST195 and ST208 were the most common sequence types (71.43% and 28.57%). The outbreak was successfully controlled by stringent infection control measures, especially improving the hand hygiene compliance and enhancing antimicrobial stewardship. In conclusion, this is the first description of an outbreak caused mainly by A. baumannii of ST208 in China. Infection control measures should be strengthened when infection outbreaks in hospital.
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Protective Effects of Caffeic Acid Phenethyl Ester on Fluoxetine-Induced Hepatotoxicity: An Experimental Study
Background. The aim of the study was to analyse the effect of caffeic acid phenethyl ester (CAPE) on fluoxetine-induced hepatotoxicity in rats. Materials and Methods. Group I served as control. Group II received CAPE intraperitoneally. Group III received fluoxetine per orally. Group IV received fluoxetine and CAPE. The total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), and liver enzymes including paraoxonase-1 (PON-1), aspartate transaminase, and alanine transaminase levels were measured. Liver tissues were processed histopathologically for evaluation of liver injury and to validate the serum enzyme levels. Results. An increase in TOS and OSI and a decrease in TAC and PON-1 levels in serum and liver tissues of Group III were observed compared to Groups I and II. After treatment with CAPE, the level of TOS and OSI decreased while TAC and PON-1 increased in serum and liver in Group IV. Histopathological examination of the liver revealed hepatic injury after fluoxetine treatment and reduction of injury with CAPE treatment. Conclusion. Our results suggested that CAPE treatment provided protection against fluoxetine toxicity. Following CAPE treatment with fluoxetine-induced hepatotoxicity, TOS and OSI levels decreased, whereas PON-1 and TAC increased in the serum and liver.
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Neuropathological diagnosis of vascular cognitive impairment and vascular dementia with implications for Alzheimer’s disease
Abstract
Vascular dementia (VaD) is recognised as a neurocognitive disorder, which is explained by numerous vascular causes in the general absence of other pathologies. The heterogeneity of cerebrovascular disease makes it challenging to elucidate the neuropathological substrates and mechanisms of VaD as well as vascular cognitive impairment (VCI). Consensus and accurate diagnosis of VaD relies on wide-ranging clinical, neuropsychometric and neuroimaging measures with subsequent pathological confirmation. Pathological diagnosis of suspected clinical VaD requires adequate postmortem brain sampling and rigorous assessment methods to identify important substrates. Factors that define the subtypes of VaD include the nature and extent of vascular pathologies, degree of involvement of extra and intracranial vessels and the anatomical location of tissue changes. Atherosclerotic and cardioembolic diseases appear the most common substrates of vascular brain injury or infarction. Small vessel disease characterised by arteriolosclerosis and lacunar infarcts also causes cortical and subcortical microinfarcts, which appear to be the most robust substrates of cognitive impairment. Diffuse WM changes with loss of myelin and axonal abnormalities are common to almost all subtypes of VaD. Medial temporal lobe and hippocampal atrophy accompanied by variable hippocampal sclerosis are also features of VaD as they are of Alzheimer's disease. Recent observations suggest that there is a vascular basis for neuronal atrophy in both the temporal and frontal lobes in VaD that is entirely independent of any Alzheimer pathology. Further knowledge on specific neuronal and dendro-synaptic changes in key regions resulting in executive dysfunction and other cognitive deficits, which define VCI and VaD, needs to be gathered. Hereditary arteriopathies such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy or CADASIL have provided insights into the mechanisms of dementia associated with cerebral small vessel disease. Greater understanding of the neurochemical and molecular investigations is needed to better define microvascular disease and vascular substrates of dementia. The investigation of relevant animal models would be valuable in exploring the pathogenesis as well as prevention of the vascular causes of cognitive impairment.
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The talking language in some major Gram-negative bacteria
Abstract
Cell–cell interaction or quorum sensing (QS) is a vital biochemical/physiological process in bacteria that is required for various physiological functions, including nutrient uptake, competence development, biofilm formation, sporulation, as well as for toxin secretion. In natural environment, bacteria live in close association with other bacteria and interaction among them is crucial for survival. The QS-regulated gene expression in bacteria is a cell density-dependent process and the initiation process depends on the threshold level of the signaling molecule, N-acyl-homoserine lactone (AHL). The present review summarizes the QS signal and its respective circuit in Gram-negative bacteria. Most of the human pathogens belong to Gram-negative group, and only a few of them cause disease through QS system. Thus, inhibition of pathogenic bacteria is important. Use of antibiotics creates a selective pressure (antibiotics act as natural selection factor to promote one group of bacteria over another group) for emerging multidrug-resistant bacteria and will not be suitable for long-term use. The alternative process of inhibition of QS in bacteria using different natural and synthetic molecules is called quorum quenching. However, in the long run, QS inhibitors or blockers may also develop resistance, but obviously it will solve some sort of problems. In this review, we also have stated the mode of action of quorum-quenching molecule. The understanding of QS network in pathogenic Gram-negative bacteria will help us to solve many health-related problems in future.
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Frequent Flyers: Ambulance history with Capt. Salty
See all of Lenwood Brown's comics.
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EMS - Paramedic and EMT Reserve - Show Low EMS
Part Time – Reserve Positions available (12 and 24 Hour Shifts) Show Low EMS is the Emergency Medical Service provider for the city of Show Low and surrounding areas in Navajo County. We respond to thousands of 911 Emergency Calls and Non-Emergency calls for transport each year. Show Low EMS is looking for Reserve Paramedic and EMT professionals that enjoy using their skills in the 911 Emergency ...
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EMS - Paramedic and EMT Reserve - Show Low EMS
Part Time – Reserve Positions available (12 and 24 Hour Shifts) Show Low EMS is the Emergency Medical Service provider for the city of Show Low and surrounding areas in Navajo County. We respond to thousands of 911 Emergency Calls and Non-Emergency calls for transport each year. Show Low EMS is looking for Reserve Paramedic and EMT professionals that enjoy using their skills in the 911 Emergency ...
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No Significant Reduction of Circulating Endothelial-Derived and Platelet-Derived Microparticles in Patients with Psoriasis Successfully Treated with Anti-IL12/23
Psoriasis is associated with atherosclerosis, in which circulating microparticles play an important role. In severe psoriasis, there was an increase of endothelial- and platelet- microparticles which could be decreased by anti-TNFα. However, whether anti-IL-12/23 treatment would decrease the level of microparticles remains unknown. Our study showed that, despite the clinical improvement of psoriasis after IL-12/13 blockage, the increased levels of circulating CD41a and CD31 microparticles were unchanged after anti-IL-12/23. This result suggested that anti-IL12/23 treatment may not alter the development of cardiovascular disease in patients with psoriasis.
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Synergistic Effect of Carbon Nanotubes and Graphene on Diopside Scaffolds
A synergetic effect between carbon nanotubes (CNTs) and graphene on diopside (Di) scaffolds was demonstrated. 3D network architecture in the matrix was formed through the 1D CNTs inlaid among the 2D graphene platelets (GNPs). The mechanical properties of the CNTs/GNPs/Di scaffolds were significantly improved compared with the CNTs/Di scaffolds and GNPs/Di scaffolds. In addition, the scaffolds exhibited excellent apatite-forming ability, a modest degradation rate, and stable mechanical properties in simulated body fluid (SBF). Moreover, cell culturing tests indicated that the scaffolds supported the cells attachment and proliferation. Taken together, the CNTs/GNPs/Di scaffolds offered great potential for bone tissue engineering.
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