Publication date: Available online 22 August 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Giuseppe Simone, Gabriele Tuderti, Mariaconsiglia Ferriero, Rocco Papalia, Leonardo Misuraca, Francesco Minisola, Manuela Costantini, Riccardo Mastroianni, Steno Sentinelli, Salvatore Guaglianone, Michele Gallucci
AimTo compare the cancer specific survival (CSS) between p2-RCC and a Propensity Score Matched (PSM) cohort of cc -RCC patients.MethodsFifty-five (4.6%) patients with p2-RCC and 920 cc-RCC patients were identified within a prospectively maintained institutional dataset of 1205 histologically proved RCC patients treated with either RN or PN. Univariable and multivariable Cox regression analyses were used to identify predictors of CSS after surgical treatment.A 1:2 PSM analysis based on independent predictors of oncologic outcomes was employed and CSS was compared between PSM selected cc-RCC patients using Kaplan Meier and Cox regression analysis.ResultsOverall, 55 (4.6%) p2-RCC and 920 (76.3%) cc-RCC patients were selected from the database; p2-RCC were significantly larger (p=0.001), more frequently locally advanced(p<0.001) and node positive(p<0.001) and had significantly higher Fuhrman grade (p<0.001) than cc-RCC.On multivariable Cox regression analysis age(p=0.025), histologic subtype(p=0.029), pN stage (p=0.006), size, pT stage, cM stage, sarcomatoid features and Fuhrman grade(all p<0.001) were independent predictors of CSS.After applying the PSM, 82 cc-RCC selected cases were comparable to 41 p2RCC for age(p=0.81), tumor size(p=0.39), pT(p=1.00) and pN(p=0.62) stages, cM stage(p=0.71) and Fuhrman grade (p=1).In this PSM cohort, 5 yr CSS was significantly lower in the p2-RCC (63% vs 72.4%;p=0.047). At multivariable Cox analysis p2 histology was an independent predictor of CSM (HR 2.46, 95% CI 1.04-5.83;p=0.041).ConclusionsWe confirmed the tendency of p2-RCC to present as locally advanced and metastatic disease more frequently than cc-RCC and demonstrated p2-RCC histology as an independent predictor of worse oncologic outcomes.
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Δευτέρα 22 Αυγούστου 2016
Papillary type 2 versus clear cell renal cell carcinoma: survival outcomes
Misoprostol Vaginal Insert in Labor Induction: A Cost–Consequences Model for 5 European Countries—An Economic Evaluation Supported with Literature Review and Retrospective Data Collection
Abstract
Introduction
The present study aimed to assess the costs and consequences of using an innovative medical technology, misoprostol vaginal insert (MVI), for the induction of labor (IOL), in place of alternative technologies used as a standard of care.
Methods
This was a retrospective study on cost and resource utilization connected with economic model development. Target population were women with an unfavorable cervix, from 36 weeks of gestation, for whom IOL is clinically indicated. Data on costs and resources was gathered via a dedicated questionnaire, delivered to clinical experts in five EU countries. The five countries participating in the project and providing completed questionnaires were Austria, Poland, Romania, Russia and Slovakia. A targeted literature review in Medline and Cochrane was conducted to identify randomized clinical trials meeting inclusion criteria and to obtain relative effectiveness data on MVI and the alternative technologies. A hospital perspective was considered as most relevant for the study. The economic model was developed to connect data on clinical effectiveness and safety from randomized clinical trials with real life data from local clinical practice.
Results
The use of MVI in most scenarios was related to a reduced consumption of hospital staff time and reduced length of patients' stay in hospital wards, leading to lower total costs with MVI when compared to local comparators.
Conclusions
IOL with the use of MVI generated savings from a hospital perspective in most countries and scenarios, in comparison to alternative technologies.
Funding
Sponsorship, article processing charges, and the open access charge for this study were funded by Ferring Pharmaceuticals Poland.
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How Can I Tell If My Child Has An Eating Disorder?
Dr. Sarah Garwood, a Washington University pediatrician at St. Louis Children's Hospital, discusses how to tell if your child has an eating disorder and what puts kids at risk for eating disorders.
While doctors don't know exactly what causes an eating disorder, different genetic and environmental factors contribute to an increased risk. Adolescence is the peak time for the development of eating disorders, but younger children even display concerns with their appearance and body size and shape.
Some of the signs that your child is developing an eating disorder include:
- A sudden change in eating habits: One example of this is if your child used to eat hamburgers for every meal but is now suddenly a vegetarian.
- Eliminating entire food groups: This might look like your child is choosing not to eat red meat, desserts, or eliminating carbohydrates completely from their diet.
- Not meeting growth expectations. This is especially a common sign of an eating disorder in younger children, who are typically expected to exhibit certain gains in height and weight relative to their age. In these circumstances, a possible sign of an eating disorder would be completely stunted growth.
- Obsession with food. Some adolescents will follow rigid rules around eating, preparing large meals and not engaging in those meals themselves.
How can you prevent your child from having an eating disorder? While there is no clear strategy for preventing eating disorders, as a parent you can try your best to encourage a healthy environment in your home. One way you can do this is trying to avoid talking about your weight in front of your kids. If you are constantly talking about being on a diet, it may make your children concerned about their size as well. A second way to prevent eating disorders in your children is to encourage them to be healthy and strong. Help them to be proud of what their bodies can do instead of constantly focusing on how they look.
If you suspect that your child has an eating disorder, learn more about the signs and symptoms and seek help early. Early intervention helps kids have a better prognosis than if you let the symptoms of an eating disorder continue. Contact the Family Resource Center at St. Louis Children's Hospital at 314.454.2350 or ask your pediatrician for more advice.
The post How Can I Tell If My Child Has An Eating Disorder? appeared first on ChildrensMD.
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Transitioning Kids Back to a School Sleep Schedule
Dr. Kelly Ross, Pediatrician at St. Louis Children's Hospital, talks about how to transition your child into a back to school sleeping schedule. First, it is important to begin easing your child into a regular sleeping schedule a couple of weeks in advance. It is not fair to expect your child to fall asleep at a bed time the night before the first day of school if there was no preparation. Most parents forget that just like going into your first day of work, the first day of school can be a huge stressor for kids and it can be even more difficult for them to fall asleep if a regular sleeping schedule is not in place in advance.
You want your kids to be at their very best for the first day of school, but that is difficult when they are sleep deprived. That is why it is so important to be proactive in getting your child in a regular sleeping schedule before the first day.
Many parents ask, "At what point do you hand this responsibility over to the kids?" Dr. Ross explains that her kids are teenagers, and they have even learned the consequences of not getting enough sleep. You don't want to force your kids into a regular sleeping schedule, but it is important that they learn these processes in a gentle, happy sort of way.
When your child is starting to be able to tell time, it is a good idea to practice by having an alarm clock in the room. However, it is too much to expect younger children to wake up on their own with an alarm clock.
As kids mature and head toward middle school or high school, waking up on their own with an alarm clock is a reasonable expectation. About a month before that change occurs, you want to have your kids set their alarm and then follow up to make sure that they are actually getting out of bed.
The post Transitioning Kids Back to a School Sleep Schedule appeared first on ChildrensMD.
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Is Your Child Ready For Kindergarten? Q&A with STL Children’s MomDocs
Dr. Dehra Harris, Pediatric Psychiatrist with Washington University at St. Louis Children's Hospital, gives advice on how to know if your child is ready for kindergarten. For parents, Dr. Harris explains, it is important to understand that there is nothing magical about the cutoff date for your child to start school. It is far more important to think about if your child is really ready for kindergarten. There are a few things you can do to determine your child's kindergarten readiness if you are unsure.
First, talk to your pediatrician. At every well child visit, your pediatrician will be doing developmental screenings to assess whether your child is on track and identify whether there are things you need to be concerned about. You can also get formal assessments from the school to ensure that your child has all the basics to be ready for the first day.
Next it's important to think about what skills your child needs to get through a typical day in kindergarten. These include fine motor skills such as using scissors or being able to draw basic letters. Watch when you are working at home together and see if these fine motor skills are being used.
Social skills are another large piece of assessing whether your child is ready for kindergarten. Observe how your child plays at the playground or with cousins at family events can help you see if they are ready.
Another useful indicator of kindergarten readiness is analyzing how your child responds to challenges. Some kids need a lot of challenges to keep from being bored and sometimes these are the kids who are better off if they begin school earlier. Other kids need a lot of early 'wins', so waiting another year to enroll them in kindergarten would help them be much more confident when they start.
If your child get's through the year in kindergarten and you still feel like they are struggling or falling behind, talk to the schools and get additional services to help or consider having your child repeat if necessary.
The post Is Your Child Ready For Kindergarten? Q&A with STL Children's MomDocs appeared first on ChildrensMD.
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Retinoblastoma-binding protein 2 (RBP2) is frequently expressed in neuroendocrine tumors and promotes the neoplastic phenotype
Retinoblastoma-binding protein 2 (RBP2) is frequently expressed in neuroendocrine tumors and promotes the neoplastic phenotype
Oncogenesis 5, e257 (August 2016). doi:10.1038/oncsis.2016.58
Authors: E C Maggi, J Trillo-Tinoco, A P Struckhoff, J Vijayaraghavan, L Del Valle & J S Crabtree
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Triglyceride/HDL ratio and its impact on the risk of diabetes mellitus development during ART
Objectives
Our primary aim was to study diabetes mellitus (DM) arising during combination ART (cART) and to attempt to identify associations between these cases and triglycerides (TRG) and the TRG to HDL-cholesterol (TRG/HDL) ratio. Our secondary aim was to analyse the association between DM development and hepatic fibrosis.
MethodsThis was a retrospective cohort study. Patients from the Icona Foundation study initiating first-line cART between 1997 and 2013 were selected and observed until new-onset DM or most recent clinical follow-up. The predictive value of TRG and TRG/HDL ratio levels on DM was evaluated using multivariable Poisson regression models.
ResultsThree-thousand, five-hundred and forty-six patients (males, 73.7%; median age, 38 years; median BMI, 23.1 kg/m2; and hepatitis C virus antibody positive, 22.1%) were included. Of these, 80 developed DM over 13 911 person-years of follow-up (PYFU), corresponding to 5.7 cases per 1000 PYFU (95% CI = 4.6–7.1). At multivariable analysis, latest TRG/HDL ratio, when high, was associated with significant increases in DM risk [relative risk (RR) = 1.63; 95% CI = 1.32–2.01 per 10 points higher], while current TRG, in contrast, was associated with new-onset DM only at crude analysis. Advanced liver fibrosis (defined as fibrosis-4 index >3.25) was also shown to be an independent risk factor for DM (RR = 2.91; 95% CI = 1.10–7.72).
ConclusionsHigh TRG/HDL ratio predicted risk of new-onset DM, independently of other traditional risk factors. Furthermore, our findings suggest that advanced hepatic fibrosis, estimated using the fibrosis-4 score, could provide an additional predictor for DM.
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CD4 cell count at initiation of ART, long-term likelihood of achieving CD4 >750 cells/mm3 and mortality risk
Objectives
We sought to evaluate associations between CD4 at ART initiation (AI), achieving CD4 >750 cells/mm3 (CD4 >750), long-term immunological recovery and survival.
MethodsThis was a prospective observational cohort study. We analysed data from ART-naive patients seen in 1996–2012 and followed ≥3 years after AI. We used Kaplan–Meier (KM) methods and log-rank tests to compare time to achieving CD4 >750 by CD4 at AI (CD4-AI); and Cox regression models and generalized estimating equations to identify factors associated with achieving CD4 >750 and mortality risk.
ResultsOf 1327 patients, followed for a median of 7.9 years, >85% received ART for ≥75% of follow-up time; 64 died. KM estimates evaluating likelihood of CD4 >750 during 5 years of follow-up, stratified by CD4-AI <50, 50–199, 200–349, 350–499 and 500–750, were 20%, 25%, 56%, 80% and 87%, respectively (log-rank P < 0.001). In adjusted models, CD4-AI ≥200 (versus CD4-AI <200) was associated with achievement of CD4 >750 [adjusted HR (aHR) = 4.77]. Blacks were less likely than whites to achieve CD4 >750 (33% versus 49%, aHR = 0.77). Mortality rates decreased with increasing CD4-AI (P = 0.004 across CD4 strata for AIDS causes and P = 0.009 for non-AIDS death causes). Among decedents with CD4-AI ≥50, 56% of deaths were due to non-AIDS causes.
ConclusionsHigher CD4-AI resulted in greater long-term CD4 gains, likelihood of achieving CD4 >750, longer survival and decreased mortality regardless of cause. Over 80% of persons with CD4-AI ≥350 achieved CD4 >750 by 4 years while 75% of persons with CD4-AI <200 did not. These data confirm the hazards of delayed AI and support early AI.
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Dolutegravir as monotherapy in HIV-1-infected individuals with suppressed HIV viraemia
Background
Reducing drug burden is a key challenge for achieving lifelong suppressive HIV therapy. Dolutegravir, with a high potency, long half-life and high genetic barrier, offers potential for monotherapy.
MethodsThis observational single-centre study enrolled all patients with HIV RNA (viral load) <50 copies/mL for at least 12 months, with CD4 >350 cells/mm3 and with no failure under integrase inhibitor therapy who had switched from suppressive ART to dolutegravir monotherapy (50 mg/day). Primary outcome was proportion of patients with viral load <50 copies/mL at week 24.
ResultsTwenty-eight patients treated for a median ART duration of 17 years (IQR 11–20), virally suppressed for a median of 79 months (IQR 42–95) and with a median CD4 count of 624 cells/mm3 (IQR 524–761), were enrolled. Baseline ART consisted of a three-drug (n = 10), two-drug (n = 10) or single-drug (n = 8) regimen with integrase inhibitor exposure in 13 patients. The proportion of patients maintaining viral load <50 copies/mL was 96% (95% CI 79%–100%) at week 4, 100% (95% CI = 85%–100%) at week 8, 93% (95% CI 76%–99%) at week 12 and 92% (75–99) at week 24. Three patients (3.70%; 95% CI 3.4%–10.8%) with prior integrase inhibitor experience had HIV RNA rebound with the presence of resistance mutations. Genotyping of HIV DNA using the Sanger method or ultradeep sequencing showed no integrase inhibitor resistance-associated mutations (RAMs) except for the mutation 74I in a patient on a suppressive elvitegravir regimen. The median within- and between-subject variability of dolutegravir C24 was 25% and 34%, respectively. Nine patients with a year of follow-up remained virally suppressed.
ConclusionsDolutegravir has the potency to be further investigated as a single ART in randomized studies, particularly in patients with no prior exposure to integrase inhibitors.
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High rates of hepatitis C virus (HCV) cure using direct-acting antivirals in HIV/HCV-coinfected patients: a real-world perspective
Objectives
There are few data on the real-world experience of FDA-approved oral hepatitis C virus (HCV) direct-acting antiviral (DAA) drug combinations in HIV/HCV-coinfected patients. We evaluated the safety and efficacy of DAA therapies in a cohort of HIV/HCV patients in a large urban clinic in Chicago.
MethodsHIV/HCV-coinfected adults (≥18 years) enrolled in the Northwestern University Viral Hepatitis Registry between January 2013 and June 2015 were analysed. Treated patients received one of the following DAA combinations: sofosbuvir/ledipasvir, sofosbuvir/ribavirin, sofosbuvir/simeprevir or paritaprevir/ritonavir/ombitasvir/dasabuvir ± ribavirin. The primary outcome was sustained virological response at 12 weeks after DAA completion (SVR12).
ResultsSeventy-seven HIV/HCV patients were evaluated for DAA therapy. Most patients were male (62/77, 81%) and infected with HCV genotype 1 (67/77, 87%). Some 32/77 (42%) were cirrhotic and 29/77 (38%) had received prior treatment with an IFN-containing regimen. DAA therapy was more likely to be started in Caucasians than persons of other ethnicities (P = 0.01). The overall SVR12 rate was 92% in 52 patients who completed therapy and had follow-up by the end of the study: sofosbuvir/simeprevir, 32/33 (97%); sofosbuvir/ribavirin, 4/7 (57%); sofosbuvir/ledipasvir, 11/11 (100%); and paritaprevir/ritonavir/ombitasvir/dasabuvir, 1/1 (100%). Four patients relapsed after therapy with sofosbuvir/simeprevir (n = 1) or sofosbuvir/ribavirin (n = 3). Adverse events were uncommon and did not result in DAA treatment interruption or discontinuation.
ConclusionsThe HCV DAA combinations of sofosbuvir/ledipasvir and sofosbuvir/simeprevir were highly effective and well tolerated in this diverse population of HIV/HCV-coinfected patients, many of whom had advanced liver disease. HIV coinfection should not be considered a barrier to successful HCV treatment with DAAs.
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Factors associated with virological response to a switch regimen containing maraviroc for antiretroviral-experienced HIV-1-infected patients
Objectives
There are few data on clinical and virological factors associated with maraviroc virological response (VR) in clinical practice. This study aimed to identify factors associated with VR in 94 treatment-experienced, but CCR5 inhibitor-naive, HIV-1 patients switched to maraviroc-containing regimens.
MethodsPatients with HIV-1 RNA viral load (VL) <50 copies/mL switching to an antiretroviral treatment containing maraviroc were followed. VR was defined at month 3 as VL <50 copies/mL. The impact of age, baseline tropism, zenith VL, nadir CD4 cell count and CD4 cell count, HIV subtype (B versus non-B), genotypic susceptibility score of treatment, once- or twice-daily treatment and presence of raltegravir in optimized background therapy on VR was investigated.
ResultsBaseline characteristics were: median age 49 years (range 25–73 years), median CD4 cell count 481 cells/mm3 (range 57–1830 cells/mm3) and median nadir CD4 cell count 99 cells/mm3 (range 3–585). Maraviroc was administered twice daily in 88 of 94 patients and once daily in 6 of 94 patients (300 mg/day for 4 of 6 and 150 mg/day for 2 of 6). At month 3, 89.4% of patients were responders. A better VR to a switch regimen containing maraviroc was associated with the B subtype (P = 0.0216) and a lower zenith VL (median of 5.24 and 5.70 log10 copies/mL for patients in success or in failure, respectively) in univariate analysis. Only B subtype was associated with a better VR in multivariate analysis.
ConclusionsThis study evidenced the efficacy of a switch regimen containing maraviroc in clinical practice. VR was better for patients with a lower zenith VL and B subtype.
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Discontinuation of empirical antifungal therapy in ICU patients using 1,3-{beta}-D-glucan
Background
Empirical antifungal therapy in high-risk ICU patients is an attractive strategy, but overuse of antifungal agents is a potential problem.
ObjectivesWe evaluated if ICU patients at high risk to develop candidaemia identified by a prediction rule could discontinue empirical antifungal therapy on the basis of repeatedly negative 1-3-β-d-glucan (BDG) tests.
MethodsWe conducted a multicentre cohort study in 85 ICU patients receiving antibiotics or with central venous catheter plus two additional factors (dialysis, parenteral nutrition, surgery, pancreatitis or receipt of corticosteroids or other immunosuppressive agents) plus either fever, hypothermia, hypotension, acidosis, elevated C-reactive protein or leucocytosis. Blood cultures (days 1 and 2) and BDG (days 1–3, baseline period) were performed and anidulafungin was given. On day 4, patients with negative blood cultures and BDG discontinued antifungal therapy. Registered in ClinicalTrials.gov (NCT01734525).
ResultsThe incidence of candidaemia was 8.2% in patients selected versus 0.5% in patients without entry criteria (16.9 times higher). Sixty-four patients (75.3%) had baseline positive BDG, including 7 with candidaemia. All 21 patients with baseline negative BDG discontinued anidulafungin on day 4. None developed candidaemia until day 30.
ConclusionsEarly discontinuation of empirical echinocandin therapy in high-risk ICU patients based on consecutive negative BDG tests may be a reasonable strategy, with great potential to reduce the overuse of echinocandins in ICU patients. Prospective studies with a higher number of patients are needed.
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Efficacy of OZ439 (artefenomel) against early Plasmodium falciparum blood-stage malaria infection in healthy volunteers
Objectives
OZ439, or artefenomel, is an investigational synthetic ozonide antimalarial with similar potency, but a significantly improved pharmacokinetic profile, compared with artemisinins. We wished to measure key pharmacokinetic and pharmacodynamic parameters and the pharmacokinetic/pharmacodynamic relationship of artefenomel in humans to guide the drug's further development as combination therapy in patients.
Patients and methodsWe tested artefenomel in the human induced blood-stage malaria (IBSM) model. Plasmodium infection was monitored by quantitative PCR (qPCR) and upon reaching 1000 parasites/mL single doses of 100, 200 and 500 mg of artefenomel were administered orally with evaluation of drug exposure and parasitaemia until rescue treatment after 16 days or earlier, if required.
ResultsA single 100 mg dose had only a transient effect, while the 200 mg dose resulted in a significant reduction in parasitaemia before early recrudescence. At the highest (500 mg) dose, initial clearance of parasites below the limit of detection of qPCR was observed, with a 48 h parasite reduction ratio (PRR48) >10 000 and a parasite clearance half-life of 3.6 h (95% CI 3.4–3.8 h). However, at this dose, recrudescence was seen in four of eight subjects 6–10 days after treatment. Pharmacokinetic/pharmacodynamic modelling predicted an MIC of 4.1 ng/mL.
ConclusionsThese results confirm the antimalarial potential of artefenomel for use in a single-exposure combination therapy. The observations from this study support and will assist further clinical development of artefenomel.
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A cohort study on breakthrough invasive fungal infections in high-risk patients receiving antifungal prophylaxis
Objectives
Antifungal prophylaxis is recommended for haematological patients at high risk of invasive fungal infections (IFIs). Incidence, optimal therapeutic management and outcome of breakthrough IFIs (bIFIs) are largely unknown.
MethodsTo assess bIFI incidence, treatment and outcomes, data on patients undergoing AML remission–induction and consolidation chemotherapy and from allogeneic HSCT recipients on antifungal prophylaxis with itraconazole, micafungin or posaconazole were extracted from the Cologne Cohort of Neutropenic Patients (CoCoNut). bIFIs were classified according to revised EORTC/MSG criteria.
ResultsFrom January 2004 to April 2013, 250 AML patients with 329 hospitalizations and 409 HSCT patients with 496 hospitalizations were identified. In AML patients, there were 16 (6.4%) proven or probable bIFIs and 44 (17.6%) possible bIFIs. In HSCT patients, there were 14 (3.4%) proven or probable bIFIs and 37 (9.0%) possible bIFIs. Proven cases included five candidaemias, two mucormycoses, three aspergilloses and one fusariosis. The most frequent choice for bIFI treatment was liposomal amphotericin B in AML patients (21/60; 35.0%) and continuation of posaconazole prophylaxis in HSCT patients (16/51; 31.4%). In HSCT recipients, survival on day 365 was significantly lower in bIFI patients (AML, 63.3% versus 70.0%; P = 0.297; HSCT, 49.0% versus 66.8%; P = 0.012). Comparison of continuation of prophylaxis versus switch of antifungal class as first-line treatment showed no significant difference regarding response to treatment and survival.
ConclusionsRates of bIFIs observed in our population were comparable to previous data. There was no clear shift towards rare species, as previously reported. A high variety of treatment approaches was observed.
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Bilateral hypoplasia of the maxillary sinus: swelling of the nasal mucosa after periapical periodontitis
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Matsushita, H. Yamamoto
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In vitro and in vivo anthelmintic effects of Caesalpinia bonducella (L.) Roxb. leaf extract on Hymenolepis diminuta (Cestoda) and Syphacia obvelata (Nematoda)
2016-08-22T14-22-20Z
Source: Journal of Intercultural Ethnopharmacology
Shyamalima Gogoi, Arun K. Yadav.
Background: Leaves of Caesalpinia bonducella (L.) Roxb., have been traditionally used as herbal remedy against intestinal helminths helminth infections in traditional medicine of India. Aim: This study was undertaken to evaluate the potential in vitro and in vivo anthelmintic effects of C. bonducella leaf extract against Syphacia obvelata (Nematoda) and Hymenolepis diminuta (Cestoda). Materials and Methods: The in vitro anthelmintic activity of the extract was investigated on adult Syphacia obvelata (Nematoda) and Hymenolepis diminuta (Cestoda) worms in terms of physical motility and mortality of parasites. The in vivo study was performed in H. diminuta-rat model and S. obvelata-mice model, by monitoring the egg per gram (EPG) of faeces count and worm count of animals following the treatment with different doses of plant extract. Results: The study recorded significant and dose-dependent anthelmintic effects of extract on both the parasites. In the in vitro study, 30 mg/ml concentration of extract caused mortality of H. diminuta in 2.5±0.2 h and S. obvelata in 3.57± 0.16 h. In the in vivo study, the extract showed a comparatively better efficacy on S. obvelata, where its 800 mg/kg dose revealed 93% reduction of worm load in mice, as compared to 85% reduction of H. diminuta worms in load. Conclusions: The findings suggest that leaf extract of C. bonducella possesses significant anthelmintic effects, and supports its use as an anthelmintic in traditional medicine. This appears to be the first report of in vivo anthelmintic activity of Caesalpinia bonducella against these parasites
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Comparison of Monofractal, Multifractal and gray level Co-occurrence matrix algorithms in analysis of Breast tumor microscopic images for prognosis of distant metastasis risk
Abstract
Breast cancer prognosis is a subject undergoing intense study due to its high clinical relevance for effective therapeutic management and a great patient interest in disease progression. Prognostic value of fractal and gray level co-occurrence matrix texture analysis algorithms has been previously established on tumour histology images, but without any direct performance comparison. Therefore, this study was designed to compare the prognostic power of the monofractal, multifractal and co-occurrence algorithms on the same set of images. The investigation was retrospective, with 51 patients selected on account of non-metastatic IBC diagnosis, stage IIIB. Image analysis was performed on digital images of primary tumour tissue sections stained with haematoxylin/eosin. Bootstrap-corrected Cox proportional hazards regression P-values indicated a significant association with metastasis outcome of at least one of the features within each group. AUC values were far better for co-occurrence (0.66–0.77) then for fractal features (0.60–0.64). Correction by the split-sample cross-validation likewise indicated the generalizability only for the co-occurrence features, with their classification accuracies ranging between 67 and 72 %, while accuracies of monofractal and multifractal features were reduced to nearly random 52–55 %. These findings indicate for the first time that the prognostic value of texture analysis of tumour histology is less dependent on the morphological complexity of the image as measured by fractal analysis, but predominantly on the spatial distribution of the gray pixel intensities as calculated by the co-occurrence features.
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Telomere shortening leads to an acceleration of synucleinopathy and impaired microglia response in a genetic mouse model
Abstract
Parkinson's disease is one of the most common neurodegenerative disorders of the elderly and ageing hence described to be a major risk factor. Telomere shortening as a result of the inability to fully replicate the ends of linear chromosomes is one of the hallmarks of ageing. The role of telomere dysfunction in neurological diseases and the ageing brain is not clarified and there is an ongoing discussion whether telomere shortening is linked to Parkinson's disease. Here we studied a mouse model of Parkinson's disease (Thy-1 [A30P] α-synuclein transgenic mouse model) in the background of telomere shortening (Terc knockout mouse model). α-synuclein transgenic mice with short telomeres (αSYNtg/tg G3Terc-/-) developed an accelerated disease with significantly decreased survival. This accelerated phenotype of mice with short telomeres was characterized by a declined motor performance and an increased formation of α-synuclein aggregates. Immunohistochemical analysis and mRNA expression studies revealed that the disease end-stage brain stem microglia showed an impaired response in αSYNtg/tg G3Terc-/- microglia animals. These results provide the first experimental data that telomere shortening accelerates α-synuclein pathology that is linked to limited microglia function in the brainstem.
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Chromosome 1q gain and tenascin-C expression are candidate markers to define different risk groups in pediatric posterior fossa ependymoma
Abstract
Intracranial classic (WHO grade II) and anaplastic (WHO grade III) ependymomas are among the most common tumors in pediatric patients and have due to frequent recurrences and late relapses a relatively poor outcome. The impact of histopathological grading on patient outcome is controversial and therefore, molecular prognostic and predictive markers are needed to improve patient outcome. To date, the most promising candidate marker is chromosome 1q gain, which has been associated in independent studies with adverse outcome. Furthermore, gene expression and methylation profiles revealed distinct molecular subgroups in the supratentorial and posterior fossa (PF) compartment and Laminin alpha-2 (LAMA2) and Neural Epidermal Growth Factor Like-2 (NELL2) were suggested as surrogate markers for the two PF subgroups PF-EPN-A and PF-EPN-B. PF-EPN-A tumors were also characterized by tenascin-C (TNC) expression and tenascin-C has been suggested as candidate gene on 9q, involved in tumor progression. Therefore, we have analyzed the status of chromosome 1q, TNC, LAMA2, and NELL2 expression in a series of pediatric PF ependymomas in terms of their frequency, associations among themselves, and clinical parameters, as well as their prognostic impact. We confirm the negative prognostic impact of 1q gain and TNC expression and could classify PF ependymomas by these two markers into three molecular subgroups. Tumors with combined 1q gain and TNC expression had the poorest, tumors without 1q gain and TNC expression had a favorable and TNC positive 1q non-gained cases had an intermediate outcome. We found also differences in age and tumor grade in the three subgroups and thus, provide evidence that PF pediatric ependymomas can be divided by chromosome 1q status and TNC expression in three molecular subgroups with distinct clinico-pathological features. These analyses require only few amounts of tumor tissue, are broadly available in the routine clinical neuropathological setting and thus, could be used in further therapy trials to optimize treatment of ependymoma patients.
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Prove It: Real-time feedback devices improve CPR training
Today is training day for the crew of station 27. After breakfast, dispatch places both the engine and the medic crews out of service and sends them to the training center. Today's class is a CPR refresher course.
However, this refresher course is different than any previously taught. Today, the instructors are adding a new CPR feedback device to the manikin practice, which will provide real-time performance data to the crew. The instructor explains the devices will help insure everyone provides the correct rate, depth, and recoil. The device also provides an audible warning when a pause in chest compressions lasts for 10 or more seconds. The instructor explains the department will place one of these devices on every response vehicle in the city during the next week in the hopes of fine-tuning CPR performance and improving out-of-hospital cardiac arrest survival rates for the community.
Initially, the devices are a bit cumbersome for the crew. No one has ever used one before and it takes some getting used to. As each of the firefighters and medics take turns on the manikin, they slowly begin to adjust their performance based on the feedback provided by the device.
However, one of the station officers is becoming increasingly frustrated with the device. He grumbles about being CPR certified for more than 25 years and he does not need a machine to tell him how to do CPR. He thinks his department could have saved the money spent for these devices on something with a greater benefit to the department.
Despite the best intentions of the training officer, the lieutenant remains unconvinced the device will actually change the way he and his crew perform CPR.
Study review: CPR performance with a feedback device
Using a manikin, researchers measured the impact that various CPR feedback or prompt devices had on specific CPR quality metrics, such as chest compression depth, compression rate, inadequate recoil and incorrect hand position [1]. The participants were all nurses who had previous experience with CPR, but had never used any type of feedback or prompt device. Each nurse either worked in the emergency department or as part of the EMS team with an average (mean) work experience of 12.4 years. Before starting the study, members of the research team trained the nurses to correctly use each of the devices.
The researchers compared manual CPR without the use of a device (standard CPR) to CPR using each of three commonly available devices; TrueCPR™ Coaching Device from Physio-Control, CPR-Ezy™ from Health Affairs, LTD. and the iCPR app from DSign S.r.l. Random assignment determined which device (or no device) each nurse would start with. Each nurse performed eight minutes of single rescuer CPR with the randomly assigned device (or no device).
Upon conclusion, the nurse rested for 20 minutes before being assigned to one of the remaining options. This process continued until each nurse performed eight minutes of CPR with each of the three devices and eight minutes of standard CPR without a device.
After completing all four CPR sessions, each nurse also completed a survey that described a personal level of confidence, whether each device was easy and comfortable to use and whether each device provided a distraction from performing CPR.
Researchers collected the data for this study during the summer of 2014, before the release of the 2015 AHA CPR Guidelines. As a result, the researchers compared all CPR quality measures to those recommended by the 2010 European Resuscitation Council (ERC) Guidelines, which called for a chest compression depth of at least 5 cm (50 mm), a rate between 100 and 120 compressions per minute, full chest recoil and hands positioned on the lower half of the sternum [2].
Results: Feedback device comparison
The only study condition to achieve the recommended chest compression depth of 50 mm was CPR performed while using the TrueCPR™ feedback device. With this device, nurses achieved significantly deeper chest compressions than with the other devices or no device at all. In decreasing order, nurses achieved a mean chest compression depth of 54.5 mm with TrueCPR™, 45.6 mm with CPR-Ezy™, 44.6 mm with standard CPR using no feedback device and 39.6 mm using the iCPR app. Not only did the TrueCPR™ device produce deeper average chest compressions, but the device also produced the highest proportion of compressions meeting the ERC depth recommendations.
All three of the devices had a significant impact on chest compression rate. The only condition that produced a chest compression rate outside of the recommended rate (100-120 per minute) was standard CPR without the use of a device. In decreasing order, nurses performed CPR at a mean rate of 129 compressions per minute using standard CPR with no device, 110 compressions per minute using TrueCPR™, 104 compressions per minute using the iCPR app, and 102 compressions per minute using CPR-Ezy™.
Since the ERC recommended a compression depth greater than 50 mm, full chest recoil should also be greater than 50 mm. Use of the TrueCPR™ device resulted in a significantly higher proportion of compressions meeting the recommendation for chest recoil. In decreasing order, the proportion of compressions meeting the ERC recommendations for chest recoil was 78 percent with TrueCPR™, 70 percent with CPR-Ezy™, 68 percent with standard CPR using no device, and 65 percent using the iCPR app.
The manikin and software program used in this study were able to measure whether the compression point was on the lower half of the sternum (correct), or in some other location, such as too far to one side or too high or low on the chest (incorrect). Use of the TrueCPR™ device resulted in the highest proportion of compressions in the correct position. In decreasing order, the proportion of chest compressions with the correct pressure point was 98 percent with TrueCPR™, 95 percent with standard CPR using no feedback device, 93 percent with CPR-Ezy™, and 77 percent using the iCPR app.
Finally, the researchers created a metric called effective compression, which was defined as the proportion of compressions meeting the ERC recommendations for depth, recoil, and hand position. TrueCPR™ significantly outperformed any of the other conditions. In decreasing order, the proportion of effective chest compressions was 86 percent with TrueCPR™, 40 percent with CPR-Ezy™, 38 percent with standard CPR using no device, and 33 percent using the iCPR app. The proportion of effective chest compressions associated with TrueCPR™ remained significantly better regardless of whether the measurement occurred at the beginning of the eight-minute CPR period (90 percent) or the end (76 percent).
In a head-to-head comparison of user satisfaction variables between the three devices, the study participants found the TrueCPR™ device easiest and most comfortable to use. The device also provided the user with the highest level of confidence and produced the least amount of distraction.
In the multivariate regression analysis, the researchers also found that both provider experience and work location influenced the overall proportion of effective chest compressions. Nurses with more experience outperformed those with less experience when performing standard CPR without a device and when using the iCPR app. Additionally, those nurses primarily assigned to EMS fieldwork outperformed those assigned to the ED when performing standard CPR without a device and when using the iCPR app.
What this means for you
The term feedback device is commonly used to describe a variety of tools with a common goal to improve the quality of CPR provided during a resuscitation attempt. However, the term may or may not actually describe the way the device works. True feedback devices offer information about what rescuers are actually doing, so they can make real time adjustments to CPR performance. In this study, the TrueCPR™ and the CPR-Ezy™ devices functioned as true feedback devices.
Prompt devices on the other hand do not provide information about how rescuers are performing. While the rescuer can make real-time adjustments to CPR performance based on that information, the device is not actually measuring what the rescuer is doing. For example, metronomes use an audible tone to prompt the rescuer to perform chest compressions at a predetermined rate, but cannot measure if the rescuer is actually performing synchronized compressions.
Intuitively, it is reasonable to expect feedbacks devices to outperform prompt devices. However, all feedback devices may not have the same impact on performance. In this study, only one of the feedback devices significantly outperformed the prompt device. Incidentally, that feedback device even outperformed standard non-device assisted CPR.
Generally, CPR training utilizing a real time feedback component results in improved student performance. Use of the TrueCPR™ device during CPR training improved compression rate and depth performance on a manikin by a group of in-hospital healthcare providers [3]. In a randomized controlled trial involving trained rescuers, one type of feedback device utilizing pressure sensing technology (CPR-Ezy™) significantly improved compression depth while a different device utilizing an accelerometer (Q-CPR™) resulted in worsening depths [4]. Researchers at the Medical University of Vienna found improved CPR measures when medical students received feedback during training, but performance measures associated with a mechanical device were no better or no worse than those associated with feedback from a trained human instructor [5].
However, the impact of this improved training on clinical outcomes is less clear. Early studies could find no significant improvement in outcome variables associated with the use of a feedback device in either the in-hospital [6] or out-of-hospital environments [7]. More recently, a multi-center study of in-hospital cardiac arrest could not demonstrate any survival advantages associated with the addition of feedback devices to a standard resuscitation attempt [8].
In contrast, secondary analysis of data collected during an investigation of CPR quality related to the use of one specific real-time audio-visual feedback device during an out-of-hospital resuscitation attempt transported by a helicopter demonstrated that use of the device resulted in increased survival to emergency department arrival, but not increased survival for an additional 24-hours or increased survival to hospital discharge [9]. Similarly, use of the Cardio First Angel™ CPR device instead of manual CPR with no feedback device in ICU patients resulted in improved ROSC and reduced rib fractures in ICU patients [10]. In contrast, the odds of surviving neurologically intact following an out-of-hospital cardiac arrest were reduced by about 50 percent when rescuers used the Q-CPR feedback device during the resuscitation [11].
In the largest trial to date to address this issue, researchers with the Resuscitation Outcomes Consortium could find no survival advantages provided by the use of a feedback device during resuscitation from out-of-hospital cardiac arrest [12]. The most recent meta-analysis of clinical trials using audio-visual feedback devices during resuscitation could find no evidence the devices improve clinical outcomes [13].
In a before and after observational study, the addition of real-time audiovisual feedback along with a targeted CPR quality training curriculum improved clinical CPR quality metrics, which resulted in an increased likelihood of both survival to hospital discharge and favorable function outcome [14]. However, because of the nature of this study no one can be sure whether the improved outcome measures resulted from the real-time feedback, the increased focus on quality CPR training, or some other unmeasured variable.
There are a number of possible reasons why no study has ever been able to clearly demonstrate clinical improvement with the use of any of these devices. First, survival following out-of-hospital cardiac arrest is time dependent. Patients generally have more favorable outcomes when ROSC occurs sooner rather than later. To increase the chances of survival, the first three links in the chain of survival should occur before EMS personnel arrive on the scene. If they do not, the chances of survival significantly decrease. By the time EMS arrives on the scene to begin using a feedback device, it is possible the window of opportunity for many of the early variables known to improve survival has already closed.
Although simulation data shows the use of feedback or prompt devices does improve CPR metrics, it is possible the improvements do not represent meaningful or useful data for real patients. Performing CPR on a manikin during a training situation is different than performing CPR on a human being in the ICU or ED, which is different still from performing CPR in the out-of-hospital environment.
The 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommends the use of feedback devices as an adjunct to CPR training [15]. If feedback devices are not available, instructors should substitute prompt devices during CPR training.
Feedback and prompt devices appear to improve CPR quality metrics obtained during the simulated management of cardiac arrest. However, not all of the devices perform equally. EMS agencies considering the addition of feedback devices to the management of out-of-hospital cardiac arrest should investigate all options before choosing a particular technology.
The author has no financial interest, arrangement, or direct affiliation with any corporation that has a direct interest in the subject matter of this presentation, including manufacturer(s) of any products or provider(s) of services mentioned.
References
- Truszewski, Z., Szarpak, L., Kurowski, A., Evrin, T., Zasko, P., Bogdanski, L., & Czyzewski, L. (2016). Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses. American Journal of Emergency Medicine, 34(3), 381–385. doi:10.1016/j.ajem.2015.11.003
- Koster, R. W., Baubin, M. A., Bossaert, L. L., Caballero, A., Cassan, P., Castrén, M., Granjag, C., Handley, A. J., Monsieurs, K. G., Perkins, G. D., Raffay, V., & Sandroni, C. (2010). European Resuscitation Council guidelines for resuscitation 2010 section 2. Adult basic life support and use of automated external defibrillators. Resuscitation, 81(10), 1277–1292. doi:10.1016/j.resuscitation.2010.08.009
- Wutzler, A., Bannehr, M., von Ulmenstein, S., Loehr, L., Förster, J., Kühnle, Y., Finn, A., Storm, C., & Haverkamp, W. (2015). Performance of chest compressions with the use of a new audio-visual feedback device: A randomized manikin study in health care professionals. Resuscitation, 87, 81-85. doi:10.1016/j.resuscitation.2014.10.004
- Yeung, J., Davies, R., Gao, F., & Perkins, G. D. (2014). A randomised control trial of prompt and feedback devices and their impact on quality of chest compressions--a simulation study. Resuscitation, 85(4), 553-559. doi:10.1016/j.resuscitation.2014.01.015
- Pavo, N., Goliasch, G., Nierscher, F. J., Stumpf, D., Haugk, M., Breckwoldt, J., Ruetzler, K., Greif, R., & Fischer, H. (2016). Short structured feedback training is equivalent to a mechanical feedback device in two-rescuer BLS: A randomised simulation study. Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine, 24(1), 70. doi:10.1186/s13049-016-0265-9
- Abella, B. S., Edelson, D. P., Kim, S., Retzer, E., Myklebust, H., Barry, A. M., O'Hearn, N., Hoek, T. L., & Becker, L. B. (2007). CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system. Resuscitation, 73(1), 54-61. doi:10.1016/j.resuscitation.2006.10.027
- Kramer-Johansen, J., Myklebust, H., Wik, L., Fellows, B., Svensson, L., Sorebo, H., & Steen, P. A. (2006). Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: A prospective interventional study. Resuscitation, 71(3), 283-292. doi:10.1016/j.resuscitation.2006.05.011
- Couper, K., Kimani, P. K., Abella, B. S., et al. (2015). The system-wide effect of real-time audiovisual feedback and postevent debriefing for in-hospital cardiac arrest: The cardiopulmonary resuscitation quality improvement initiative. Critical Care Medicine, 43(11), 2321-2331.
- Sainio, M., Kämäräinen, A., Huhtala, H., Aaltonen, P., Tenhunen, J., Olkkola, K. T., & Hoppu, S. (2013). Real-time audiovisual feedback system in a physician-staffed helicopter emergency medical service in Finland: The quality results and barriers to implementation. Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine, 21, 50. doi:10.1186/1757-7241-21-50
- Vahedian-Azimi, A., Hajiesmaeili, M., Amirsavadkouhi, A., Jamaati, H., Izadi, M., Madani, S. J., Hashemian, S. M. R., & Miller, A. C. (2016). Effect of the Cardio First Angel™ device on CPR indices: A randomized controlled clinical trial. Critical Care, 20(1), 147. doi:10.1186/s13054-016-1296-3
- Pearson, D. A., Darrell Nelson, R., Monk, L., Tyson, C., Jollis, J. G., Granger, C. B., Corbett, C., Garvey, L., & Runyon, M. S. (2016). Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative. Resuscitation, 105, 165-172. doi:10.1016/j.resuscitation.2016.04.008
- Hostler, D., Everson-Stewart, S., Rea, T. D., Stiell, I. G., Callaway, C. W., Kudenchuk, P. J., Sears, G. K., Emerson, S. M., Nichol, G., & the Resuscitation Outcomes Consortium Investigators. (2011). Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: Prospective, cluster-randomised trial. British Medical Journal, 342, d512. doi:10.1136/bmj.d512
- Kirkbright, S., Finn, J., Tohira, H., Bremner, A., Jacobs, I., & Celenza, A. (2014). Audiovisual feed- back device use by health care professionals during CPR: A systematic review and meta-analysis of randomized and non-randomized trials. Resuscitation, 85(4), 460–471. doi:10.1016/j.resuscitation.2013.12.012
- Bobrow, B. J., Vadeboncoeur, T. F., Stolz, U., Silver, A. E., Tobin, J. M., Crawford, S. A., Mason, T. K., Schirmer, J., Smith, G. A., & Spaite, D. W. (2013). The influence of scenario-based training and real-time audiovisual feedback on out-of-hospital cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest. Annals of Emergency Medicine, 62(1), 47-56. doi:10.1016/j.annemergmed.2012.12.020
- Bhanji, F., Donoghue, A. J., Wolff, M. S., Flores, G. E., Halamek, L. P., Berman, J. M., Sinz, E. H., & Cheng, A. (2015). Part 14: Education: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 132(suppl 2), S561–S573. doi:10.1161/CIR.0000000000000268
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Antidiarrheal activity of 80 % methanol extract of the aerial part of Ajuga remota Benth (Lamiaceae) in mice
In the Ethiopian traditional medicine, the aerial part of Ajuga remota Benth is used in the treatment of diarrhea. There are different mechanisms by which Ajuga remota may have antidiarrheal effect. Some of the p...
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Bo-Gan-Whan regulates proliferation and migration of vascular smooth muscle cells
Bo-Gan-Whan (BGH), a Korean polyherbal medicine, is used as a hepatoprotective drug. It has six natural sources, and has been demonstrated to have anti-oxidative, anti-cancer, and anti-inflammatory properties;...
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Fungal vincristine from Eutypella spp - CrP14 isolated from Catharanthus roseus induces apoptosis in human squamous carcinoma cell line -A431
Catharanthus roseus, a medicinal plant, is known to produce secondary metabolites, vincristine and vinblastine, which are terpenoid indole alkaloids. Previously we have reported that E...
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Ethanolic extract of Schizonepeta tenuifolia attenuates osteoclast formation and activation in vitro and protects against lipopolysaccharide-induced bone loss in vivo
Excessive osteoclast activity is a major cause of metabolic bone disorders, such as osteopenia, rheumatoid arthritis, and osteoporosis. Thus, discovery of agents targeting osteoclast differentiation and bone r...
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Multiple cellular effects of leaf extracts from Parinari curatellifolia
Parinari curatellifolia is a prominent plant in folk medicine in Sub-Saharan Africa. The plant decoctions are used to treat various ailments, including the treatment of cancer, pneumon...
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Prove It: Real-time feedback devices improve CPR training
Researchers measured the impact several CPR feedback or prompt devices had on chest compression depth, compression rate recoil and hand position.
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A Non-Dissociative Open-Flask Hydroboration with Ammonia Borane: Ready Synthesis of Ammonia-Trialkylboranes and Aminodialkylboranes
DOI: 10.1039/C6CC06151F, Communication
Under open-flask conditions, ammonia borane hydroborates olefins in refluxing tetrahydrofuran. Unlike conventional hydroboration, the Lewis base (ammonia) is not dissociated from the boron center. Terminal alkenes selectively provide ammonia-trialkylborane complexes....
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Authors’ Reply to the Letter Adequate Interpretation of Acid–Base Equilibrium at High Altitude
High Altitude Medicine & Biology , Vol. 0, No. 0.
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Brief Working Memory and Physiological Monitoring During a High-Altitude Expedition
High Altitude Medicine & Biology , Vol. 0, No. 0.
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Jealousy, Infidelity, and the Difficulty of Diagnosing Pathology: A CBT Approach to Coping with Sexual Betrayal and the Green-Eyed Monster
Abstract
Humans have evolved adaptations for infidelity, as well defenses against a partner's betrayal—centrally the emotion of jealousy. Both create problems that bring couples to therapy. Diagnosing jealousy as pathological versus normal turns out to be difficult, in part because infidelity has evolved to be concealed from the betrayed mate, which creates a signal detection problem. Because missing an infidelity committed by a mate has been more costly in evolutionary currencies than falsely suspecting a partner of cheating, selection has created an error management cognitive bias to over-infer a partner's betrayal. Moreover, adaptations for jealousy become activated by predictors of infidelity, such as mate value discrepancies, when no actual infidelities have occurred. Cognitive-behavior therapy (CBT) offers several ways to deal with these complexities. One way is to highlight potential mismatches, distinguishing between jealous emotions that were functional in ancestral environments but are less so in modern environments. A second is to distinguish between the goal of personal well-being and reproductive outcomes. Understanding the evolutionary logic of jealousy, in short, provides patients with conceptual tools for cognitively reframing jealousy and infidelity.
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A predictive bone drilling force model for haptic rendering with experimental validation using fresh cadaveric bone
Abstract
Purpose
Bone drilling simulators with virtual and haptic feedback provide a safe, cost-effective and repeatable alternative to traditional surgical training methods. To develop such a simulator, accurate haptic rendering based on a force model is required to feedback bone drilling forces based on user input. Current predictive bone drilling force models based on bovine bones with various drilling conditions and parameters are not representative of the bone drilling process in bone surgery. The objective of this study was to provide a bone drilling force model for haptic rendering based on calibration and validation experiments in fresh cadaveric bones with different bone densities.
Methods
Using a commonly used drill bit geometry (2 mm diameter), feed rates (20–60 mm/min) and spindle speeds (4000–6000 rpm) in orthognathic surgeries, the bone drilling forces of specimens from two groups were measured and the calibration coefficients of the specific normal and frictional pressures were determined.
Results
The comparison of the predicted forces and the measured forces from validation experiments with a large range of feed rates and spindle speeds demonstrates that the proposed bone drilling forces can predict the trends and average forces well.
Conclusion
The presented bone drilling force model can be used for haptic rendering in surgical simulators.
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Endologix Ovation Alto Abdominal Stent Graft Implanted In First Patients
Endologix (Irvine, California), a company that recently merged with TriVascular (Santa Rosa, California), announced that its Ovation Alto Abdominal Stent Graft System has been implanted in two patients for the first time.
Still an investigational device and not approved for sale in any market, the Ovation Alto is designed to allow more patients to benefit from endovascular aortic repair (EVAR) that have short and difficult to work with aortic necks. This is thanks to shape changing O-rings that have been positioned at the end of the device, sealing the lumen just below the renal arteries.
The implantations took place at the Auckland City Hospital in New Zealand and the company believes it can obtain regulatory approval in Europe next year and in the U.S. in 2018.
Dr. Andrew Hill, one of the surgeons who worked on implanting the Ovation Alto had the following to say in a press release: "The Ovation Alto system has the potential to increase the number of AAA patients treated with EVAR due to its unique sealing technology and ultra-low profile design. The new system is designed to provide the broadest indications of all infrarenal EVAR devices, which represents an important advancement for physicians and their AAA patients."
Via: Endologix…
This post Endologix Ovation Alto Abdominal Stent Graft Implanted In First Patients appeared first on Medgadget.
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Electrocatalytic Water Oxidation by a Molecular Cobalt Complex through a High Valent Cobalt Oxo Intermediate
DOI: 10.1039/C6CC05773J, Communication
Biuret-modified tetraamidomacrocyclic cobalt complex [CoIII-bTAML]- is shown to catalyze electrochemical water oxidation at basic pH leading to formation of O2. Electrochemical and spectroscopic studies indicate a high valent cobalt oxo...
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A Solid-State Valence Tautomeric Octahedral {CoII[(BQ-N-Cat)]2}0 Complex Formation via Ligand-Centered Phenolic C-O Bond breaking and Co-O Bond making
DOI: 10.1039/C6CC06433G, Communication
Ligand H4LO(AP/AP) underwent ligand-centered C-O bond cleavage during complexation reaction with Co(II)-salt. Thus formed octahedral {CoII[(BQ-N-Cat)]2}0 complex showed valence tautomerization in solid state. While, the process was triggered by the...
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From ACQ to AIE: the Suppression of the Strong - Interaction of Naphthalene Diimide Derivatives through the Adjustment of Their Flexible Chains
DOI: 10.1039/C6CC06176A, Communication
Different from the normal ACQ-to-AIE conversion by the introduction of aromatic rotors accompanying with the realization of twist conformation and prolonged [small pi]-system, in this communication, the adjustment of the flexible...
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Novel 3D scaffold with enhanced physical and cell response properties for bone tissue regeneration, fabricated by patterned electrospinning/electrospraying
Abstract
Developing three dimensional scaffolds mimicking the nanoscale structure of native extracellular matrix is a key parameter in tissue regeneration. In this study, we aimed to introduce a novel 3D structures composed of nanofibers (NF) and micro particles (MP) and compare their efficiency with 2D nanofibrous scaffold. The conventional nanofibrous PCL scaffolds are 2D mats fabricated by the electrospinning technique, whereas the NF/MP and patterned NF/MP PCL scaffolds are three dimensional structures fabricated by a modified electrospinning/electrospraying technique. The mentioned method was carried out by varying the electrospinning solution parameters and use of a metal mesh as the collector. Detailed fabrication process and morphological properties of the fabricated structures is discussed and porosity, pore size and PBS solution absorption value of the prepared structures are reported. Compared with the 2D structure, 3D scaffolds possessed enhanced porosity and pore size which led to the significant increase in their water uptake capacity. In vitro cell experiments were carried out on the prepared structures by the use of MG-63 osteosarcoma cell line. The fabricated 3D structures offered significantly increased cell attachment, spread and diffusion which were confirmed by SEM analysis. In vitro cytocompatibility assessed by MTT colorimetric assay indicated a continuous cell proliferation over 21 days on the innovative 3D structure, while on 2D mat cell proliferation stopped at early time points. Enhanced osteogenic differentiation of the seeded MG-63 cells on 3D scaffold was confirmed by the remarkable ALP activity together with increased and accelerated calcium deposition on this structure compared to 2D mat. Massive and well distributed bone minerals formed on patterned 3D structure were shown by EDX analysis. In comparison between NF/MP quasi-3D and Patterned NF/MP 3D scaffolds, patterned structures proceeded in all of the above properties. As such, the innovative Patterned NF/MP 3D scaffold could be considered as a proper bone graft substitute for bone tissue regeneration.
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Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy
Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prev...
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Qigong/tai chi for sleep and fatigue in prostate cancer patients undergoing radiotherapy: A randomized controlled trial
Abstract
Objectives
Sleep disturbances and fatigue are common in prostate cancer patients undergoing radiotherapy. Prior research suggests mind-body techniques may improve these outcomes. We conducted a randomized-controlled trial of qigong/tai chi (QGTC) in men with prostate cancer undergoing radiotherapy.
Methods
Men with prostate cancer starting definitive radiation were randomized to one of three groups: (1) QGTC; (2) light exercise (LE); or (3) wait list control (WLC). Sleep disturbances (PSQI) and fatigue (BFI) were assessed at baseline, mid-radiotherapy (T2), during the last week of radiotherapy (T3) and at 1 (T4) and 3 months (T5) after the end of radiotherapy. Patients in the QGTC and LE groups attended three 40-minute classes per week throughout radiotherapy.
Results
Ninety patients were randomized to the three groups (QGTC = 26; LE = 26; WLC = 24). QGTC group reported longer sleep duration at mid-XRT (QGTC = 7.01 hours; LE = 6.42; WL = 6.50; p = 0.05) but this difference did not persist over time. There were no group differences in other domains of sleep or fatigue. Exploratory analyses conducted to examine the effect of health-related QOL (EPIC and AUA score) on sleep and fatigue showed significant correlations across multiple domains.
Conclusions
QGTC during radiation for prostate cancer resulted in superior sleep duration midway through radiation, but this effect was not durable and there were no differences in other domains of sleep or fatigue. Exploratory analysis demonstrated that both sleep and fatigue were highly correlated with prostate cancer related physical symptoms. Future mind-body intervention studies should incorporate multi-modal therapy focused on improving physical symptoms in this population.
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