Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Πέμπτη 13 Απριλίου 2017
Language, gender and sexual identity: Poststructuralist perspectives Heiko Motschenbacher (2010) and An interdisciplinary bibliography on language, gender and sexuality (2000–2011) Heiko Motschenbacher (2012)
Language, gender and sexual identity: Poststructuralist perspectives Heiko Motschenbacher (2010) Amsterdam and Philadelphia: John Benjamins. Pp. xii + 209 ISBN: 978 90 272 1868 1 (Hb; alk. Paper) ISBN 978 90 272 8750 2 (Eb)
An interdisciplinary bibliography on language, gender and sexuality (2000–2011) Heiko Motschenbacher (2012)Amsterdam and Philadelphia: John Benjamins. Pp. vii + 294 ISBN: 978 90 272 1200 9 (Hb; alk. Paper) ISBN 978 90 272 7315 4 (Eb)
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Street remarks to women in five countries and four languages: Impositions of engagement and intimacy
In this paper I analyze the remarks men make to passing young women on the street in 134 naturally occurring encounters that were video recorded in 2013 and 2014 across five countries and four languages and posted on the internet. I categorize these remarks in terms of the speech acts they contain, showing the most common acts, in descending order of frequency, to be addressing, greeting, expressing astonishment or admiration, summoning, and asking rhetorical questions. In immediate interactional terms, the great majority of the men's actions are thus oriented to constituting what Goffman (1963) called a 'focused interaction', a face-to-face engagement with a common focus of attention. The very ordinariness of these acts in terms of content and surface meaning – they are not vulgar or explicitly threatening – may explain why defenders of street remarks regularly draw attention to seemingly benign referential or speech act content, e.g., 'He was just saying "Hi"' or 'He was just giving her a compliment'. At another level, however, street remarks impose intimacy on passing strangers, thus flouting the normative conventions for interaction through which we manage social and personal risk and establish trust. Women targeted by street remarks treat them as breaches by not responding to them. The very ordinariness of the language in the street remarks documented, along with the relative difficulty of articulating the implicit social conventions that they breach, may veil their harm and indirectly contribute to the perpetuation of male domination of women in public spaces.
http://ift.tt/2oFtVS5
‘ ¡Uy!, ¿quién pidió pollo?’ A qualitative analysis of the piropo practice by construction workers in Bogotá, Colombia
This paper analyzes the discursive practice of piropos performed by construction workers and addressed to female pedestrians in Bogotá, Colombia. Following an interactional sociolinguistic approach, the paper investigates the distinctive features of the piropo practice within this group. The investigators collected 87 naturalistic interactions and 40 interviews of speakers using ethnographic techniques. The analysis includes the study of the content and the form of piropos along with body language and the general performance of the speaker and the addressee. The results show that the speakers follow the patterns of piropo interactions in the Hispanic culture, even though they use specific features for the preparatory acts, the enunciation, and the offset of piropos. The observational data suggest that the practice is grounded on machismo ideologies that trigger public deployment of masculinity. On the other hand, interview data display speakers' perceptions of piropos as a flirtatious activity and a verbal game. The paper provides naturalistic evidence of the piropo practice in a Hispanic context and contributes to the discussion of gender roles in the public space.
http://ift.tt/2oaJgXX
Discourse in f(r)iction. Production and reception of gender roles discourse in an audio-visual text about piropos
This paper studies the constraints the audience – and also producers – find when attempting to deconstruct a traditional gendered practice (piropos) in a recent fictional clip that depicts this practice in an unconventional way, with women as the performers. The production of the clip is analyzed using multimodal discourse analysis tools to explore how the audiovisual text (re)produces specific gender(ed) meanings at the interplay of several semiotic resources. The reception of the clip is analyzed with the aid of the appraisal model, to study how participants in three focus groups (female, male and mixed) interactively co-construct meanings to evaluate the clip, the producers, the narrative and even the piropos depicted. The discussion centers on three aspects evaluated by participants: the genre/purpose of the text, its open ending or the lack of an explicit moral, and the mismatch between fiction and social reality.
http://ift.tt/2oFlA0Q
‘ ¡Quién fuera noche para caerle encima!’ Piropos in Chile: Sexual harassment or flirtation?
Piropos, a type of flirtatious street talk, are a discourse practice that social movements against street harassment in Chile have condemned for their male chauvinist and sexist content. This paper analyzes the structure of piropos to see their effects in both the way piropos portray women, and the discourse piropos promote and/or maintain towards women. From a compendium (Memoria chilena, 2008), 67 piropos were selected and grouped based on the conceptual metaphor (Lakoff and Johnson, 2003) they use to represent women in society. Conceptual metaphors represented women as religious entities, food, criminals or offenders, and objects found in nature. A fifth metaphor included under the label 'transfiguration' represents the objectification of the one uttering the piropo in order to get closer to the receiver of this discourse practice. The methodology considered (1) power and social distance (Poynton, 1989; Kerbrat-Orecchioni, 1992) to understand the relationship between the participants of this practice, and (2) transitivity (Halliday, 2014) to understand how lexical choices of both processes and participants reflect how human experience is expressed. The analysis revealed that the piropos analyzed use several resources to perpetuate a male chauvinist discourse that objectifies women and considers them as inferior and, generally, powerless.
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Dexamethasone promotes regeneration of crushed inferior alveolar nerve by inhibiting NF-κB activation in adult rats
Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Wei Gao, Dongdong Tong, Qing Li, Ping Huang, Fenghe Zhang
PurposeNuclear factor kappa B (NF-κB), which is closely related to inflammation, has become a topic of interest for research. The aim of this study is to investigate the effects of dexamethasone (Dex), an inhibitor of NF-κB, on inferior alveolar nerve injury in adult rats.Materials and methodsThe crushed inferior alveolar model is established in Wistar rats and they are randomly divided into three groups according to treatment: pyrrolidine dithiocarbamate (PDTC), dexamethasone (Dex), and saline (physiological saline). After treatment, the rats are respectively sacrificed at 3, 7, and 14d, and inferior alveolar nerves are extracted for histochemical and western blot analysis.ResultCompared with the PDTC and saline groups, nerve fibers in the Dex group are regularly arranged with few vacuoles, which is similar to normal inferior alveolar nerves. Immunofluorescent results show significantly decreased NF-κB expression in the Dex group. Western bolt shows higher expression of GAP-43 and lower expression of NF-κB.ConclusionTaken together, all results show that dexamethasone significantly improved the regeneration of crushed inferior alveolar nerves by inhibiting NF-κB activation in adult rats.
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Overexpression and varied clinical significance of Th9 versus Th17 cells in distinct subtypes of oral lichen planus
Source:Archives of Oral Biology, Volume 80
Author(s): Hui Wang, Jingping Bai, Zhenhua Luo, Jie Fu, Hongjian Wang, Zheng Sun
ObjectiveOral lichen planus (OLP) presents with large numbers of T lymphocytes accumulating beneath the epithelium of the oral mucosa; however, its aetiology remains obscure. A potential role for an emerging novel T cell subset, Th9, in OLP has recently been suggested but remains to be clarified. The current aim was to investigate the expression and potential clinical significance of Th9 cells in distinct subtypes of OLP.Materials and methodsPeripheral blood samples were collected from 41 OLP patients and 18 healthy controls (HCs). Flow cytometric analysis was used to detect the CD4+ T helper subset Th9 (IL-9+IL-17−CD4+ Th cells) and Th17 (IL-9−IL-17+CD4+ Th cells) expression levels.ResultsFlow cytometry results showed significantly elevated levels of Th9 cells in reticular and erosive OLP compared to HCs. Th9 expression in erosive OLP was less than in reticular OLP, indicating that Th9 but not Th17 cells may play a predominant role in reticular disease. However, in erosive OLP patients, we found much higher levels of Th17 cells compared to reticular OLP patients and HCs, indicating that Th17 dominates in erosive OLP. Statistical analysis showed positive correlations of Th9 cells and Th17 cells in patients with reticular or erosive OLP but none in HCs.ConclusionsTh9 and Th17 cells may take the predominant roles in reticular and erosive OLP respectively, and their numbers were positively correlated in reticular and erosive OLP patients. Elevated circulating Th9 cells may help maintain immune balance in OLP immunopathogenesis, which requires further investigation.
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Hypermethylation of Death-Associated Protein Kinase (DAPK1) and its association with oral carcinogenesis - An experimental and meta-analysis study
Source:Archives of Oral Biology, Volume 80
Author(s): Chinchu Jayaprakash, Vinay Koshy Varghese, Ravishankara Bellampalli, Raghu Radhakrishnan, Satadru Ray, Shama Prasada Kabekkodu, Kapaettu Satyamoorthy
ObjectivesThe value of abnormal DNA methylation of DAPK1 promoter and its association with various cancers have been suggested in the literature. To establish the significance of DNA methylation of DAPK1 promoter in oral squamous cell carcinoma (OSCC), we a) performed a case-control study, b) evaluated published data for its utility in the diagnosis and prognosis of OSCC and c) identified the association of DAPK1 gene expression with promoter DNA methylation status.DesignBisulfite gene sequencing of DAPK1 promoter region was performed on non-malignant and malignant oral samples. Further, using a systematic search, 330 publications were retrieved from PubMed, Scopus, and Google Scholar and 11 relevant articles were identified.ResultsSignificant association of DAPK1 promoter methylation with OSCC (p<0.0001) was observed in the case-control study. The studies chosen for meta-analysis showed prognostic and predictive significance of DAPK1 gene promoter, despite defined inconsistencies in few studies. Overall, we obtained a statistically significant (p-value<0.001) association for both sensitivity and specificity of DAPK1 DNA promoter methylation in oral cancer cases, without publication bias.ConclusionDNA hypermethylation of DAPK1 gene promoter is a promising biomarker for OSCC prediction/prognostics and suggests further validation in large distinct cohorts to facilitate translation to clinics.
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Intracellular DNA sensing pathway of cGAS-cGAMP is decreased in human newborns and young children
Source:Molecular Immunology, Volume 87
Author(s): Zhan-sheng Wang, Yu-lu Liu, Nan Mi, Dao-yun Duan
Newborns are highly susceptible to DNA virus infections, which may result from the characteristics of neonatal innate immune systems. Here we analyzed for the first time the development of innate immune sensing and signaling of intracellular DNA virus infection in human newborns and young children. Both mRNA and protein expression of cGAS, an intracellular DNA sensor, were shown to be significantly reduced in neonatal peripheral blood mononuclear cells (PBMCs). In addition, cGAS expression in neonatal PBMCs could be induced upon herpes simplex virus type 1 (HSV-1) or interferon-α (IFNα) stimulation. Furthermore, production of the second messenger cGAMP and activation of the transcriptional factor IRF3 was severely decreased in neonatal cord blood mononuclear cells (CBMCs) or PBMCs compared with adults. In contrast, the downstream signaling STING-TBK1-IRF3 appeared to be functional in neonatal PBMCs, as demonstrated by the fact that IRF3 phosphorylation and IFNβ production in these cells could be activated by cGAMP. Intriguingly, decreased expression of cGAS in neonatal cells can be rescued by DNA demethylation, with concomitant enhancement in IFNβ induction by HSV-1. Thus, cGAS restoration or STING stimulation by small molecules during infancy might improve the age-dependent susceptibility to DNA virus infection.
http://ift.tt/2p1zGur
Infection control practices in Mohs micrographic surgery: a U.K. national survey
Abstract
Mohs micrographic surgery (MMS) is generally considered a safe and effective method of treating certain types of skin cancers, with low reported rates of surgical site infections.1,2 Practices relating to infection control vary considerably amongst surgeons. Furthermore, emerging evidence suggests clean surgical techniques do not increase infection rates compared to sterile surgical techniques. We sought to establish the current infection control practices amongst surgeons practising MMS in the U.K.
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A novel link between keratoderma and cardiomyopathy: Contiguous gene deletion involving the desmoglein gene cluster
Abstract
Desmocollin and desmoglein proteins are important in intercellular adhesion in both the skin and the heart.1 Heterozygous mutations in desmocollin 2 (DSC2)2 and desmoglein 2 (DSG2)3 can both result in desmosomal dysfunction in cardiomyocytes, leading to development of fibro-fatty tissue, termed arrythmogenic right ventricular cardiomyopathy (ARVC). Heterozygous truncating mutations in desmoglein 1 (DSG1), an intervening gene, can present as a striate palmoplantar keratoderma, whilst homozygous DSG1 mutations can cause severe dermatitis, allergies and metabolic wasting.4 Unlike mutations in plakoglobins and desmoplakins that affect both tissues, the desmogleins, desmocollins and plakophillins typically affect either skin or heart.1 Here we present a patient with a novel heterozygous deletion resulting in loss of a 2.6Mb region including DSC2, DSG2 and DSG1, associated with ARVC and keratoderma (Fig. 1).
This article is protected by copyright. All rights reserved.
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Evolution of the skin manifestations of X-linked Pigmentary Reticulate Disorder
Abstract
X-linked reticulate pigmentary disorder (XLPDR, MIM 301220) is a rare syndrome first recognized by Partington1. The cardinal manifestations of the disorder are diffuse reticulate hyperpigmentation, hypohidrosis, and unique facial features, as well as recurrent pneumonias and sterile inflammation in various organs1-9. The syndrome is exceedingly rare and only 20 patients have been reported worldwide. Recently, we identified that the disorder is associated with a recurrent intronic mutation in POLA1, the gene encoding the catalytic subunit of DNA Polymerase-α9. Here, we report a new case of XLPDR and include the first detailed description of the evolution of its dermatologic features, as well as confirmation of the same intronic POLA1 mutation.
This article is protected by copyright. All rights reserved.
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Targeted next-generation sequencing identifies 9 novel FLG variants in Chinese Han patients with ichthyosis vulgaris
Abstract
Ichthyosis vulgaris (IV, OMIM #146700) is a common semidominant disorder of keratinization, which is characterized by the xerosis, scaling, keratosis pilaris, palmar and plantar hyperlinearity, and a strong association with atopic disorders.1
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Can local radiotherapy and IL-12 synergise to overcome the immunosuppressive tumor microenvironment and allow “in situ tumor vaccination”?
Abstract
The abscopal effect, which is the spontaneous regression of tumors or metastases outside the radiation field, occurs rarely in cancer patients. Interestingly, radiotherapy (RT) triggers an immunogenic cell death (ICD) that is able to generate tumor-specific cytotoxic CD8+ T cells that are efficient in killing cancer cells. The key question is: why is this "abscopal effect" so uncommon in cancer patients treated with RT? Most probably, the main reason may be related to the highly immunosuppressive tumor microenvironment of well-established tumors that constantly antagonizes the anti-tumor immune responses triggered by RT. In this case, additional or combinatorial immunotherapy is needed to attenuate these immunosuppressive networks and, therefore, substantially increases the efficacy of RT. Here, we describe a potentially promising synergistic radio-immunotherapy "in situ tumor vaccination" protocol by antagonizing the tumor-immunosuppressive microenvironment with a combinatorial approach using local RT and IL-12-based TH1 response augmentation.
http://ift.tt/2owyfCB
Cover Image
The cover image, by Andrew Rosko et al., is based on the Original Article Positron emission tomography–CT prediction of occult nodal metastasis in recurrent laryngeal cancer, DOI: 10.1002/hed.24719.
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Clinical, functional and inflammatory characteristics in patients with pauci-granulocytic stable asthma: comparison with different sputum phenotypes
Abstract
Background
According to induced sputum cell count, four different asthma phenotypes have been recognised(eosinophilic, neutrophilic, mixed and pauci-granulocytic). The aim of the present study was to detect functional and inflammatory characteristics of patients with pauci-granulocytic asthma.
Methods
240 asthmatic patients were categorised in the four phenotypes according to cell counts in induced sputum. All patients underwent pulmonary function tests, and measurement of FeNO. The levels of IL-8, IL-13, and ECP were also measured in sputum supernatant. Treatment, asthma control and the presence of Severe Refractory Asthma(SRA) were also recorded.
Results
Patients were categorized in the four phenotypes as follows: eosinophilic (40%), mixed (6.7%), neutrophilic (5.4%) and pauci-granulocytic (47.9%). Although ACT did not differ between groups (p=0.288) patients with pauci-granulocytic asthma had better lung function (FEV1%pred) (median (IQR):71.5(59.0-88.75) vs 69.0(59.0-77.6) vs 68.0(60.0-85.5) vs 80.5(69.7-95.0), p=0.009] for eosinophilic, mixed, neutrophilic and pauci-granulocytic asthma respectively, p=0.009). SRA occurred more frequently in the eosinophilic and mixed phenotype (41.6% and 43.7% respectively) and less frequently in the neutrophilic and pauci-granulocytic phenotype (25% and 21.7% respectively, p=0.01). FeNO, ECP and IL-8 were all low in the pauci-granulocytic, whereas as expected FeNO and ECP were higher in eosinophilic and mixed asthma, while IL-8 was higher in patients with neutrophilic and mixed asthma(p<0.001 for all comparisons). Interestingly, 14.8% of patients with pauci-granulocytic asthma had poor asthma control.
Conclusion
Pauci-granulocytic asthma most likely represents a "benign" asthma phenotype, related to a good response to treatment, rather than a "true" phenotype of asthma. However, pauci-granulocytic patients that remain not-well-controlled despite optimal treatment represent an asthmatic population that requires further study for potential novel targeted interventions.
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Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: a systematic review
Abstract
Chronic spontaneous urticaria (CSU) patients are widely held to often have other autoimmune disorders, including autoimmune thyroid disease. Here, we systematically evaluated the literature on the prevalence of thyroid autoimmunity in CSU and vice versa. There is a strong link between CSU and elevated levels of IgG anti-thyroid autoantibodies (AAbs), with most of a large number of studies reporting rates of ≥10%. Levels of IgG against thyroid peroxidase (TPO) are more often elevated in CSU than those of other IgG anti-thyroid AAbs (strong evidence). Levels of IgG anti-thyroid AAbs are more often elevated in adult CSU patients than in children (strong evidence). CSU patients exhibit significantly higher levels of IgG anti-thyroid AAbs (strong evidence) and IgE-anti-TPO (weak evidence) than controls. Elevated IgG anti-thyroid AAbs in CSU are linked to the use of glucocorticoids (weak evidence) but not to disease duration or severity/activity, gender, age or ASST response (inconsistent evidence). Thyroid dysfunction rates are increased in CSU patients (strong evidence). Hypothyroidism and Hashimoto's thyroiditis are more common than hyperthyroidism and Graves' disease (strong evidence). Thyroid dysfunction is more common in adult CSU patients than in children (strong evidence) and in female than male CSU patients (weak evidence). Urticaria including CSU is more prevalent in patients with thyroid autoimmunity than in healthy controls (weak evidence). CSU can improve in response to treatment with levothyroxine or other thyroid drugs (strong evidence). Pathogenic mechanisms in CSU patients with thyroid autoimmunity may include IgE against autoantigens, immune complexes and complement.
This article is protected by copyright. All rights reserved.
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Transcriptome analysis of severely active chronic spontaneous urticaria shows an overall immunological skin involvement
Abstract
Background
The knowledge about chronic spontaneous urticaria (CSU) phenotypes is based on its clinical characteristics, associated comorbidities, course of the disease and its response to the available effective drugs. Genotype expression and its further correlation with CSU phenotypes are still unknown. We describe the cutaneous transcriptome of patients suffering a severely active CSU refractory to antihistamine treatment.
Methods
Through the bioinformatic analysis of the whole Human Genome with Oligo Microarrays and Quantitative real-time polymerase chain reaction (qPCR), relevant genes expressed in non-lesional [NLS-CSU] and lesional skin [LS-CSU]) and peripheral blood were identified in 20 patients suffering from severely active CSU and 10 healthy controls (HCs)
Results
From 39 genes differentially expressed in NLS-CSU when compared with HCs, 31 (79.48%) were confirmed by qPCR corresponding to genes involved in epidermal homeostasis and dermal repair. From the analysis comparing LS-CSU with NLS-CSU, a selection of 142 genes was studied with qPCR, and 103 (72.53%) were confirmed. Differentially expressed genes in the phenomenon of wheal development are involved in a variety of biological functions as, epidermal differentiation, intracellular signal function, transcriptional factors cell cycle differentiation, inflammation or coagulation. Differentially expressed genes that uniformly increase or decrease along the skin worsening until the wheal appearance are shown.
Conclusion
The skin of CSU patients with a severely active disease shows an overall immunological skin involvement showing a peculiar gene profile.
This article is protected by copyright. All rights reserved.
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Chirurgische Techniken zur Behandlung des Vestibularisschwannoms
Zusammenfassung
Hintergrund
Die Mikrochirurgie der Vestibularisschwannome ist anspruchsvoll, auch wenn nicht jeder dieser Tumoren eine Herausforderung für erfahrene Chirurgen darstellt. Sinnvoll kann man die Entscheidungen zur Balance zwischen Funktionserhaltung und vollständiger Resektion nur gestalten, wenn man die chirurgischen Techniken im Detail kennt und beherrscht.
Ziel der Arbeit
Die mikrochirurgischen Techniken sowie deren Vorzüge und Gefahren werden auf dem aktuellen Stand skizziert.
Methoden
Die Recherche zu den 3 aktuellen Op.-Techniken anhand der wesentlichen Literatur wird durch die Gewichtung der Vorzüge und Komplikationsmöglichkeiten aus eigener Erfahrung ergänzt.
Ergebnisse
Die mikrochirurgischen Zugänge translabyrinthär, retrosigmoidal und subtemporal sind bezüglich ihrer Modifikationen und der damit erzielbaren Op.-Ergebnisse gut dokumentiert. Eine hörerhaltende Tumorentfernung ist nur über die beiden letzteren Zugänge möglich. Indikationsstellung und Funktionserhaltung sind wesentlich von der Tumorgröße und präexistenten neurologischen Defiziten abhängig. Präoperative Diagnostik und Op.-Vorbereitung unterscheiden sich lediglich bezüglich einer für die halbsitzende Position notwendigen transösophagealen Echokardiographie. Die klassischen Op.-Techniken wurden durch ein verfeinertes intraoperatives Monitoring, endoskopische Sicht, spezielle Mikroinstrumente und den Einsatz von Navigationssystemen ergänzt.
Schlussfolgerung
Die Wahl des chirurgischen Zugangs hängt oft wesentlich von der persönlichen Präferenz und Erfahrung des Operateurs ab. Präoperatives Hörvermögen und Ausdehnung des Tumors sind die entscheidenden objektiven Auswahlkriterien.
http://ift.tt/2ow7qP2
Totally implantable hearing system: Five-year hearing results
Objectives/Hypothesis
1) To provide long-term hearing outcome measures of a totally implantable hearing system (implant) and compare to the baseline unaided (BLU) and baseline aided (BLA) conditions, and 2) discuss relevant safety measures.
Study Design
Prospective, nonrandomized, multicenter, single-subject-as-own-control design.
Methods
Fifty-one subjects with mild to severe sensorineural hearing loss were implanted between 2008 and 2009 and enrolled in this postmarket approval study in the setting of private and hospital-based practices. Forty-nine of these subjects completed the 5-year study, which included annual follow-ups. Primary effectiveness endpoints were speech reception threshold (SRT) and word recognition scores at 50 dB (WRS50s). Secondary effectiveness endpoints were WRSs and the Abbreviated Profile of Hearing Aid Benefit (APHAB) scores. Adverse Device Effects (ADEs) and Serious Adverse Device Effects (SADEs) reported during the study period and a comparison of bone conduction scores are submitted as safety measures.
Results
Compared to the BLA condition, 1) SRT scores were improved at every annual follow-up; 2) WRS50s were better in 49%, and the same in 41% at the 5-year follow-up; 3) WRSs were improved by 17% at the 5-year follow-up; and 4) APHAB scores were improved in most subscales at every annual follow-up. There were three SADEs in three subjects and 15 ADEs in 11 subjects. Bone conduction scores increased by 3.7 dB at the 5-year follow-up. Average battery life was 4.9 years.
Conclusions
The implant compared favorably to the subjects' hearing aid throughout the 5-year period in all of the areas measured and was found to be safe.
Level of Evidence
2b Laryngoscope, 2017
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A Young Man With Proptosis Causing Decreased Visual Acuity
A teenage boy had deteriorating vision and swelling in his right eye, right ear pain, and forehead tenderness; endoscopy revealed a fleshy, red soft-tissue mass in the superior nasal cavity. What is your diagnosis?
http://ift.tt/2pb8GIF
http://ift.tt/2pb8GIF
Oral Cavity and Oropharyngeal Cancer Biomarkers in Surgical Drain Fluid
This cohort study determines whether there is an association between biomarker levels in surgical drain fluid of patients with head and neck cancer and disease-free survival and cancer recurrence.
http://ift.tt/2obUZo3
http://ift.tt/2obUZo3
Preoperative Calcium and Calcitriol and Hypocalcemia After Thyroidectomy
This cohort study compares the incidence of symptomatic hypocalcemia following administration of calcium and calcitriol supplementation given preoperatively and postoperatively vs postoperative therapy alone in patients undergoing total thyroidectomy.
http://ift.tt/2paZQdG
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Inaugural Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction
This report communicates the findings of the North American Airway Collaborative Symposium on Advanced Surgical Techniques in Adult Airway Reconstruction.
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Significance of intraoperative findings in revision tympanomastoidectomy
The study was designed to assess correlations between intraoperative findings in revision tympanomastoidectomy as predictors of cholesteatoma recurrence.
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Tiebout and Crime. How crime affect the income tax capacity.
Despite the extensive literature on the relation between crime and migration, not much is known about how crime affects the tax capacity of local communities. This paper empirically investigates whether the Flemish local income tax base yield is sensitive to changes in the local crime level. The underlying assumptions are twofold. In a Tiebout world rational voters holding the local government accountable for the safety of its citizens move out when the local level of security gets too much alienated from what they want it to be (first assumption). If migration is due to crime, the more wealthy citizens are expected to move first. Looking for a place elsewhere implies transaction costs, which the more wealthy citizens are more likely to be able to afford. As a consequence, the average income per capita and so the income distribution will be affected, which in turn, will influence the local income tax base yield (second assumption). Ceteris paribus, the decreasing average income per capita, results in a lower local income tax base yield. In absence of a higher level governments' compensation, decreasing local tax revenues could prove to be disastrous for a crime-ridden municipality. When communities do not succeed in forcing back the number of offences, this can be the onset of a cumulative process of urban deterioration. A spatial panel data model containing several proxies for the local level of crime in 306 Flemish municipalities covering the period 2000-2014 is used to test the relation between crime and the local income tax base yield. When using aggregate crime rate statistics, the total number of offenses per capita, no significant results were found. Yet when using the type specific crime statistics, significant results do were found. By regressing the specific types of crime and the control variable onto household mobility (per capita efflux- en influx of citizens) the first assumption was confirmed. Respectively, a negative and a positive link was found between the per capita efflux- and influx of citizens, and the change in the relative number of violent crime per capita. Results regarding the efflux of citizens were persistent up until a 1 year lag. To investigate the second assumption, a 2SLS panel data analysis was used. These results show that crime induced household mobility does indeed lower the income tax base yield and therefore confirms the second assumption. An increase in per capita violent crimes, will stimulate the per capita efflux of people, in turn lowering the local income tax base yield. A negative result was also found for the crime induced per capita efflux of citizens, although it was barely insignificant. By confirming both assumptions we present evidence for a relation between changes in local crime rates and the income tax base yield of a municipality, coming about thru household mobility
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Examining non-linear relationships in strategic planning, performance measurement and public service performance
The advent of public management, a focus on outcomes and results, has led to the adoption of strategic management practices in public organizations and academic interest therein (Ferlie and Ongaro 2015, Poister, Pitts, and Edwards 2010). Strategic management in public organizations encompasses strategy formulation (i.e. the process of strategy making), strategy content (i.e. the stance and actions resulting from strategy making) and strategy implementation (i.e. the follow-up and evaluation of selected strategies and actions) (Bryson, Berry, and Yang 2010, Boyne and Walker 2004). In order to connect strategy formulation and implementation, public organizations can use strategic management tools such as strategic planning to define strategic goals (SG) and action plans (AP), and performance measurement (PM) to define performance indicators (PI) linked to these SG and AP, and set targets for these indicators (Poister 2010). Underlying strategic management's popularity among public administration scholars is the assumption that strategic management is linked to public service performance (PSP) (Boyne and Walker 2010). Legislative initiatives in some jurisdictions have imposed strategic management tools upon governments –e.g. Government Performance and Results Act in the United States, Best Value in England and Wales, and the Policy and Management Cycle in Flanders, Belgium. The implementation of these practices suggests that policymakers believe these tools will "work" in a public-sector setting. There are, however, critical voices about the use of strategic management tools in public sector settings. For example, Bovaird (2008) strongly challenges the effectiveness of planning-based tools in public organizations arguing that more emergent types of strategy making are necessary for the complex, adaptive nature of the public sector. Empirical evidence from large-n quantitative studies examining the strategic management-PSP relationship is limited. Given the concerns about the value of strategic management tools in public organizations, and in particular concerns associated with strategic planning and performance measurement, richer empirical evidence is essential to more clearly understand the relationship between these tools and PSP (George and Desmidt, 2014). Such evidence can help to address the contradiction where, on the one hand, strategic management tools are being adopted by public organizations worldwide and, on the other hand, we do not fully know whether these tools actually deliver on their promises, and rebuff critiques. This study addresses this contradiction by positing that while SG and AP (i.e. core elements of strategic planning) and PI and targets (i.e. core elements of performance measurement) are associated with PSP the relationship is not linear. Building from propositions developed by Boyne (2010) for PI and targets we hypothesize that this association is concave and curvilinear –indicating that, initially, a positive association exists but this association becomes negative when too many SG, AP, PI and targets are put in place. This hypothesis is tested by drawing on data from 308 Flemish municipalities. In Flanders (i.e. the northern, Dutch-speaking part of Belgium), municipalities have been obliged by the Flemish Government to formulate a multi-annual plan including SG and AP for the 5-year policy cycle 2014-2019 with PI and targets tied to these SG and AP. One of the key rationales underlying this obligation, is the Flemish Government's expectation that this system will improve the financial performance of municipalities and, specifically, their "Self-Financing Margin", a measure that evaluates the long term financial stability of a municipality. To address this, data for the independent variables are gathered by analyzing the multi-annual plan of each Flemish municipality and data for the dependent variable are gathered by identifying the Self-Financing Margin in the annual account of each municipality. Due to our hypotheses and data both a linear and nonlinear model are tested using OLS regression analysis. Preliminary multivariate statistical results show that strategic goals and performance indicators –two central elements of strategic planning and performance measurement– have a concave curvilinear relationship with PSP, implying an initial positive association which becomes negative when too many strategic goals and performance indicators are formulated. This finding ties in with the essence of effective strategic management tools, namely to provide focus and make fundamental choices on the organization's course. The contributions of this study to public administration theory and practice are threefold. First, we address the calls for more large-n quantitative evidence by investigating the relation between strategic planning, performance measurement and PSP in all 308 Flemish municipalities. Second, by hypothesizing and testing for nonlinear relations between strategic planning, performance measurement and PSP, we theoretically and empirically extend previous research by incorporating a core assumption underlying strategic management theory into public management theory; namely that successful strategic management tools should offer focus and prioritization in order to avoid "muddling through" –an abundance of tools could thus be counterproductive (Porter 1996). Third, our paper is relevant to policymakers because it tests a core assumption underlying many NPM reforms, that strategic management tools enhance the PSP of public organizations (George and Desmidt 2014, Jimenez 2013).
http://ift.tt/2obHcxP
Qualitative analysis of Substance P, NK1-receptor and nerve ingrowth in Substance P-treated ruptured rat Achilles tendon
Substance P has a stimulating effect on fibroblast proliferation, collagen organization, and angiogenesis in ruptured and subsequently sutured rat Achilles tendon. This effect is also reflected in the biomechanical properties of the tendon. The aim of this study was to substantiate the effect of exogenous substance P on endogenous substance P, NK-1 receptor, and nerve ingrowth in an in vivo tendon-healing setting. Ninety-six male Sprague-Dawley rats were randomly assigned to one of four groups and injected with saline, substance P (10(-6) mu mol/kg BW and 10-8 mu mol/kg BW) associated with neutral endopeptidase inhibitors, or neutral endopeptidase inhibitors alone into the paratendinous region of the ruptured and subsequently sutured Achilles tendons from the second until the sixth day postoperatively. Substance P, NK-1 receptor, and nerve ingrowth (PGP 9.5) were analysed using immunofluorescence at four different time points : one, two, four and six weeks postoperatively. In all groups substance P was predominantly expressed in the extracellular matrix during the first two weeks, corresponding to fibroblast proliferation, and first disappeared from the saline group in the proliferative phase. In contrast, substance P was not expressed in the blood vessel wall during the first two weeks, when angiogenesis was most pronounced. NK-1 receptor was almost always expressed in the blood vessel wall and in the extracellular matrix during this period and disappeared progressively afterwards. No nerve ingrowth was identified. Exogenously administered substance P in sutured rat Achilles tendon rupture does not stimulate sensory nerve ingrowth, but seems to have a booster effect on endogenous substance P for fibroblast proliferation via autocrine/paracrine stimulation.
http://ift.tt/2nJif1e
Combined endonasal and eyelid approach for management of extensive frontal sinus inverting papilloma
Objectives
Sinonasal inverting papilloma (IP) is a benign but locally aggressive mucosal neoplasm with a high recurrence rate. Extension into the frontal sinus presents surgical challenges for endonasal resection. This study presents an orbitofrontal approach for managing extensive IP.
Study Design
Case series.
Methods
Four patients seen between 2012 and 2016 with biopsy-proven IP with lateral frontal sinus extension underwent a combined endonasal and transpalpebral approach for tumor resection.
Patient demographic data, preoperative characteristics, imaging, and follow-up data were compiled through retrospective chart review. Patients were selected for this approach when the tumor extended to the posterior frontal sinus wall, lateral frontal sinus recess, and orbit. Tumors were first approached endonasally until the frontal recess was reached. A Draf IIB or Draf III procedure was then performed to gain better exposure. Orbitofrontal exposure was achieved through an upper eyelid incision. Miniorbitofrontal craniotomy window was designed based on tumor location. Resection of the frontal and orbital extension was enhanced by endoscopic-assisted dissection through the orbitofrontal window.
Results
The transpalpebral approach provided access to all walls of the ipsilateral frontal sinus, the intersinus septum, and the medial aspect of the contralateral sinus. Complete tumor resection was achieved in all patients. There were no orbital complications, no visible eyelid asymmetry or scarring, and all patients had preserved forehead sensation. There were no recurrences on follow-up.
Conclusion
Combining a transpalpebral orbitofrontal craniotomy with the endonasal approach allows complete resection of invasive IP with extension into the frontal sinus. This is achieved with great cosmetic results.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2p0M5i6
Investigating hyperventilation syndrome in patients suffering from empty nose syndrome
Objectives/Hypothesis
Patients with empty nose syndrome (ENS) following turbinate surgery often complain about breathing difficulties. We set out to determine if dyspnea in patients with ENS was associated with hyperventilation syndrome (HVS). We hypothesized that lower airway symptoms in ENS could be explained by HVS.
Study Design
Observational prospective study.
Methods
All consecutive patients referred to our center for ENS over 1 year were invited to participate. Patients completed the Nijmegen score and underwent a hyperventilation provocation test (HVPT) and arterial blood gas and cardiopulmonary tests. HVS was defined by a delayed return of the end-tidal partial pressure of carbon dioxide in the expired gas to baseline during HVPT. Patients with HVS were asked to complete the Sinonasal Outcome Test (SNOT)-16 questionnaire before and after a specific eight-session respiratory rehabilitation program.
Results
Twenty-two of the 29 patients referred for ENS during the study period were eligible for inclusion and underwent a complete workup. HVS was diagnosed in 17 of these patients (77.3%). In the five patients who completed the SNOT-16, the score was significantly lower after rehabilitation.
Conclusions
This study suggests that HVS is frequent in patients with ENS, and that symptoms can be improved by respiratory rehabilitation. Pathophysiological links between ENS and HVS deserve to be further explored.
Level of Evidence
2b Laryngoscope, 2017
http://ift.tt/2o9FOwt
Microvascular anastomosis simulation using a chicken thigh model: Interval versus massed training
Objectives/Hypothesis
To compare the effectiveness of massed versus interval training when teaching otolaryngology residents microvascular suturing on a validated microsurgical model.
Study Design
Otolaryngology residents were placed into interval (n = 7) or massed (n = 7) training groups. The interval group performed three separate 30-minute practice sessions separated by at least 1 week, and the massed group performed a single 90-minute practice session. Both groups viewed a video demonstration and recorded a pretest prior to the first training session. A post-test was administered following the last practice session.
Methods
At an academic medical center, 14 otolaryngology residents were assigned using stratified randomization to interval or massed training. Blinded evaluators graded performance using a validated microvascular Objective Structured Assessment of Technical Skill tool. The tool is comprised of two major components: task-specific score (TSS) and global rating scale (GRS). Participants also received pre- and poststudy surveys to compare subjective confidence in multiple aspects of microvascular skill acquisition.
Results
Overall, all residents showed increased TSS and GRS on post- versus pretest. After completion of training, the interval group had a statistically significant increase in both TSS and GRS, whereas the massed group's increase was not significant. Residents in both groups reported significantly increased levels of confidence after completion of the study.
Conclusions
Self-directed learning using a chicken thigh artery model may benefit microsurgical skills, competence, and confidence for resident surgeons. Interval training results in significant improvement in early development of microvascular anastomosis skills, whereas massed training does not.
Level of Evidence
NA Laryngoscope, 2017
http://ift.tt/2o9MSsX
Nasopharyngeal papillomas treated with CO2 laser and human papillomavirus vaccination
This case report describes the use of CO2 laser and quadrivalent human papillomavirus (HPV) vaccination in two patients with nasopharyngeal HPV11-positive recurrent respiratory papillomas (RRP). These patients initially underwent CO2 laser excision but developed recurrent lesions and underwent HPV vaccination as adjunct therapy. The recurrent lesions shrank after vaccination and were again excised with CO2 laser. Subsequently, these patients had no recurrence of lesions on long-term follow-up at 33 months or 6 years after surgery. Thus, in patients with nasopharyngeal RRP, resection with CO2 laser, and HPV vaccination as adjunct therapy should be considered in HPV11-associated cases. Laryngoscope, 2017
http://ift.tt/2p0IsbS
Successful ablation of plunging ranula by ultrasound-guided percutaneous ethanol injection
Evidence supporting any one treatment for plunging ranula is limited. Standard treatment—complete excision of the sublingual gland and ranula—is invasive and morbid given the close operative proximity to the submandibular duct and lingual nerve. OK-432 (Picibanil; Chugai Pharmaceutical Co., Tokyo, Japan) sclerotherapy has been studied as a less invasive treatment but is inaccessible in the United States. This report illustrates the successful management of a plunging ranula using ultrasound-guided percutaneous ethanol injection. Within 2 months of the procedure, the patient had complete resolution of the plunging ranula, with no associated side effects. We propose that ultrasound-guided percutaneous ethanol injection be considered for the management of plunging ranula. Laryngoscope, 2016
http://ift.tt/2p0UguX
A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures
Objectives
Currently, there are no cardiovascular (CV) preprocedure screening parameters for patients undergoing in-office laryngeal procedures (IOLP). Studies have shown significant changes in CV measures for IOLP. The aim was to develop and evaluate a pre-IOLP CV screening protocol.
Methods
Review of IOLP literature and consultation with an anesthesiologist and cardiologist led to the development of CV parameters and questions related to four metabolic equivalents (METS) of work as a patient-screening tool before IOLP. A separate cohort was screened with only a modified CV protocol. All patients were screened for heart rate (HR) and blood pressure (BP) elevation prior to the procedure. Need for further CV evaluation was characterized as systolic blood pressure BP >160, diastolic BP >100, and/or HR >110 beats/minute. Patients whose BP/HR exceeded these values were referred to their primary care physician (PCP) before re-screening. If parameters were exceeded again at the second screen, then the procedure was done under monitored anesthesia care.
Results
The first study phase included 56 patients. The fail rate was 40% largely related to four METS of work. The second study phase included 440 patients. The screen fail rate was 15 patients of 572 (2.6%). Of these, 12 patients of 132 (9.1%) failed the initial screen and were sent to their PCP for further evaluation, and five of 440 (1.4%) patients failed on the day of the procedure. Overall, five of 440 (1.5%) patients would qualify to have their site of service changed for their laryngology procedure from an unmonitored to a monitored setting due to the prescreening criteria.
Conclusion
Few patients needed further workup based upon the in-office CV parameters set in this study. Patients with CV risk factors were identified by the screening protocol. Having established hemodynamic parameters in place may improve the safety of IOLP with a very low physician burden.
Level of Evidence
2b Laryngoscope, 2017
http://ift.tt/2o9KT89
PET/CT-directed Hyperfractionated Radiation Dose Escalation in Esophageal Cancer
Condition: Esophageal Cancer
Interventions: Radiation: radiochemotherapy 1; Radiation: radiochemotherapy 2; Radiation: radiochemotherapy 3; Radiation: radiochemotherapy 4; Radiation: radiochemotherapy 5; Radiation: radiochemotherapy 6
Sponsor: Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Recruiting - verified April 2017
http://ift.tt/2pxF5FE
Interventions: Radiation: radiochemotherapy 1; Radiation: radiochemotherapy 2; Radiation: radiochemotherapy 3; Radiation: radiochemotherapy 4; Radiation: radiochemotherapy 5; Radiation: radiochemotherapy 6
Sponsor: Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Recruiting - verified April 2017
http://ift.tt/2pxF5FE
Neck Drains for SLNDs
Condition: Neck Disease, Head and Neck Cancer
Intervention: Procedure: remove drain
Sponsor: University of California, San Francisco
Recruiting - verified April 2017
http://ift.tt/2ovLzHH
Intervention: Procedure: remove drain
Sponsor: University of California, San Francisco
Recruiting - verified April 2017
http://ift.tt/2ovLzHH
Effect of Live Combined Bifidobacterium,Lactobacillus and Enterococcus Capsules on Oral Mucositis in Nasopharyngeal Carcinoma Patients Receiving Radiotherapy.
Conditions: Oral Mucositis; Quality of Life
Intervention: Other: Lactobacillus, Bifidobacterium and Enterococcus
Sponsor: Jiangxi Provincial Cancer Hospital
Recruiting - verified April 2017
http://ift.tt/2pxwSBe
Intervention: Other: Lactobacillus, Bifidobacterium and Enterococcus
Sponsor: Jiangxi Provincial Cancer Hospital
Recruiting - verified April 2017
http://ift.tt/2pxwSBe
Randomized trial of the immunogenicity and safety of the hepatitis B vaccine given in an accelerated schedule coadministered with the human papillomavirus type 16/18AS04-adjuvanted cervical cancer vaccine
The human papillomavirus type 16/18 (HPV-16/18) AS04-adjuvanted cervical cancer vaccine is licensed for females aged 10 years and above and is therefore likely to be coadministered with other licensed vaccines, such as hepatitis B. In this randomized, open-label study, we compared the immunogenicity of the hepatitis B vaccine administered alone (HepB group) or with the HPV-16/18 AS04-adjuvanted vaccine (HepB + HPV group) in healthy women aged 20 to 25 years (clinical trial NCT00637195). The hepatitis B vaccine was given at 0, 1, 2, and 12 months (an accelerated schedule which may be required by women at high risk), and the HPV-16/18 vaccine was given at 0, 1, and 6 months. One month after the third dose of hepatitis B vaccine, in the according-to-protocol cohort (n = 72 HepB + HPV; n = 76 HepB), hepatitis B seroprotection rates (titer of >= 10 mIU/ml) were 96.4% (95% confidence interval [CI], 87.5 to 99.6) and 96.9% (CI, 89.2 to 99.6) in the HepB + HPV and HepB groups, respectively, in women initially seronegative for anti-hepatitis B surface antigen (HBs) and anti-hepatitis B core antigen (HBc). Corresponding geometric mean titers of anti-HBs antibodies were 60.2 mIU/ml (CI, 40.0 to 90.5) and 71.3 mIU/ml (CI, 53.9 to 94.3). Anti-HBs antibody titers rose substantially after the fourth dose of hepatitis B vaccine. All women initially seronegative for anti-HPV-16 and anti-HPV-18 antibodies seroconverted after the second HPV-16/18 vaccine dose and remained seropositive up to 1 month after the third dose. Both vaccines were generally well tolerated, with no difference in reactogenicity between groups. In conclusion, coadministration of the HPV-16/18 AS04-adjuvanted vaccine did not affect the immunogenicity or safety of the hepatitis B vaccine administered in an accelerated schedule in young women.
http://ift.tt/2oD3qwI
Effect on cellular and humoral immune responses of the AS03 adjuvant system in an A/H1N1/2009 influenza virus Vaccine administered to adults during two randomized controlled trials
The influence of AS03(A), a tocopherol oil-in-water emulsion-based adjuvant system, on humoral and cell-mediated responses to A/California/7/2009 H1N1 pandemic vaccine was investigated. In two observer-blind studies, a total of 261 healthy adults aged 18 to 60 years were randomized to receive either AS03(A)-adjuvanted H1N1 vaccine containing 3.75 mu g hemagglutinin (HA) or nonadjuvanted H1N1 vaccine containing 15 or 3.75 mu g HA on days 0 and 21. Hemagglutination inhibition (HI) antibody and T-cell responses were analyzed up to day 42. A first dose of AS03(A)-adjuvanted vaccine (3.75 mu g HA) or nonadjuvanted vaccine (15 mu g HA) induced HI responses of similar magnitudes that exceeded licensure criteria (e. g., 94 to 100% with titers of >= 40). A lower response following 3.75 mu g HA without adjuvant was observed (73% with titers of >= 40). Following a second dose, geometric mean HI titers at day 42 were higher for AS03A-adjuvanted vaccine (636 and 637) relative to nonadjuvanted vaccine (341 for 15 mu g HA and 150 for 3.75 mu g HA). Over the 42-day period, the increase in frequency of A/H1N1/2009-specific CD4(+) T cells was significantly higher in the adjuvanted group than in the nonadjuvanted group. There was no evidence of correlation between baseline CD4(+) T-cell frequencies and day 21 HI antibody titers, while there was some correlation (R = 0.35) between day 21 CD4(+) T-cell frequencies and day 42 HI titers. AS03A adjuvant enhanced the humoral and CD4(+) T-cell-mediated responses to A/H1N1/2009 vaccine. Baseline A/H1N1/2009-specific CD4(+) T-cell frequencies did not predict post-dose 1 antibody responses, but there was some correlation between post-dose 1 CD4(+) T-cell frequencies and post-dose 2 antibody responses.
http://ift.tt/2pcIcn4
Studying the host-microbiota interaction in the human gastrointestinal tract: basic concepts and in vitro approaches
Bacteria in the human gut exceed the number of cells in our body by a 100-fold. At the level of the gastrointestinal epithelium, a constant battle is fought for equilibrium between the microbiota and the human body. These interactions play a key role in many aspects of host health, influencing energy harvest from food, colonization by pathogens, and the immune system, to name but a few. Unfortunately, the study of this host-microbiota interaction in vivo is limited by the inaccessibility of the digestive tract. Therefore, in vitro technology that focuses on the simulation of this epithelial environment offers an ideal platform with which to conduct mechanistic research that could shed more light on this environment and help explain in vivo observations. However, the limitation of currently available tools could yield results with limited reliability for an in vivo situation. The aim of this mini-review is to focus on the importance of studying the host-microbiota interaction in the gastrointestinal tract and to evaluate the state of the art of the available in vitro techniques. Finally, we aim to identify those missing factors that, if present, would allow the creation of a model that would constitute a better simulation of biofilm formation, i.e. one more closely resembling the in vivo situation.
http://ift.tt/2oDfbDo
Increasing recombinant protein production in Escherichia coli K12 by increasing the biomass yield of the host cell
For more than three decades micro-organisms have been employed as hosts for recombinant protein production, with the most popular organisms being Escherichia coli and Saccharomyces cerevisiae (1). One of the crucial factors to obtain high product yields in recombinant protein bioprocesses is the biomass yield of the host cell. High biomass yields not only result in less carbon loss and higher conversion to recombinant protein due to a potential higher drain of precursors, but are also accompanied by lower conversion to growth inhibiting byproducts, such as acetate (2). Furthermore, acidic byproducts hinder the expression of heterologous proteins (3) and consequently decrease protein yield in a direct and indirect manner. Many strategies have been tested to decrease the amount of acetate produced, including optimal feeding, choice of other carbon sources and metabolic engineering (4). Fed-batch and continuous feeding strategies result in low residual glucose concentrations and minimize overflow metabolism ('Crabtree effect') (5; 6). Aristidou and coworkers improved biomass yield and protein production by using fructose as a primary carbon source without greatly affecting the fermentation cost (7). A third strategy is to alter the genetic machinery. Knocking out genes that code for acetate producing pathways, i.e. acetate kinase-phosphate acetyltransferase (ackA-pta) and pyruvate oxidase (poxB ) decrease acetate yield dramatically, but at the expense of lactate and pyruvate (8). The objective of this study was to focus on the combined effect of a global and a local regulator to increase biomass yield and hence recombinant protein production using GFP as a biomarker. Deletion of arcA reduces the repression on expression of TCA cycle genes (9) while deletion of iclR removes the repression on the aceBAK operon and opens the glyoxylate pathway (10; 11) in aerobic batch cultivations. This metabolic engineering approach simultaneously decreased the acetate yield with 70% and increased the biomass yield of the host cell with 50%. Due to a lower carbon loss and a lower inhibition of protein production by acetate, the GFP production of the ∆arcA∆iclR double knockout strain increased with 100% as opposed to the wild type E. coli K12. Further deletion of genes lon and ompT encoding for non-specific proteases even further increases GFP-production (3 times the wild type value). The effect of a deletion of arcA and iclR was also evaluated in a E. coli BL21 genetic background. However in this industrial strain the deletion had no effect on protein production. References [1] Ferrer-Miralles N, Domingo-Esp ́ J, Corchero JL, V ́zquez E, Villaverde A: Microbial factories for recombinant pharmaceuticals. Microb Cell Fact 2009, 8:17 [2] El-Mansi EM, Holms WH: Control of carbon flux to acetate excretion during growth of Escherichia coli in batch and continuous cultures. J Gen Microbiol 1989, 135(11):2875–2883. [3] Jensen EB, Carlsen S: Production of recombinant human growth hormone in Escherichia coli: expression of different precursors and physiological effects of glucose, acetate, and salts. Biotechnol Bioeng 1990, 36:1–11 [4] De Mey M, Maeseneire SD, Soetaert W, Vandamme E: Minimizing acetate formation in E. coli fermentations. J. Ind. Microbiol. Biotechnol. 2007, 34:689–700. [5] Babaeipour V, Shojaosadati SA, Khalilzadeh R, Maghsoudi N, Tabandeh F: A proposed feeding strategy for the overproduction of recombinant proteins in Escherichia coli. Biotechnol Appl Biochem 2008, 49(Pt 2):141–147. [6] San KY, Bennett GN, Aristidou AA, Chou CH: Strategies in high-level expression of recombinant protein in Escherichia coli. Ann N Y Acad Sci 1994, 721:257–267. [7] Aristidou AA, San KY, Bennett GN: Improvement of biomass yield and recombinant gene expression in Escherichia coli by using fructose as the primary carbon source. Biotechnol Prog 1999, 15:140–145. [8] De Mey M, Lequeux GJ, Beauprez JJ, Maertens J, Horen EV, Soetaert WK, Vanrolleghem PA, Vandamme EJ: Comparison of different strategies to reduce acetate formation in Escherichia coli. Biotechnol Prog 2007. [9] Perrenoud A, Sauer U: Impact of global transcriptional regulation by ArcA, ArcB, Cra,Crp, Cya, Fnr, and Mlc on glucose catabolism in Escherichia coli . J. Bacteriol. 2005, 187:3171–3179. [10] van de Walle M, Shiloach J: Proposed mechanism of acetate accumulation in two recombinant Escherichia coli strains during high density fermentation. Biotechnol Bioeng 1998, 57:71–78. [11] Maharjan RP, Yu PL, Seeto S, Ferenci T: The role of isocitrate lyase and the glyoxylate cycle in Escherichia coli growing under glucose limitation. Res Microbiol 2005, 156(2):178–183.
http://ift.tt/2pcPOpy
Is perioperative administration of 5% dextrose effective in reducing the incidence of PONV in laparoscopic cholecystectomy?: A randomized control trial
To compare the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in laparoscopic cholecystectomy.
http://ift.tt/2nIFCIk
Automated anesthesia carts reduce drug recording errors in medication administrations — A single center study in the largest tertiary referral hospital in China
To clinically evaluate a type of patented automated anesthesia cart in medication administrations in anesthesia.
http://ift.tt/2pcIIle
Efficacy of prophylactic doses of intravenous nitroglycerin in preventing myocardial ischemia under general anesthesia: A systematic review and meta-analysis with trial sequential analysis
To evaluate the efficacy of intravenous nitroglycerin (TNG) in preventing intraoperative myocardial ischemia (MI) under general anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate (HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure (PCWP) associated with TNG administration both before and after the induction of anesthesia.
http://ift.tt/2nIK6Pe
Scheduling non-operating room anesthesia cases in endoscopy: Using the sandbox analogy
For many hospitals, the non-operating room anesthesia (NORA) workload continues to expand. We developed a new NORA scheduling process with shared block time – a sandbox - amongst all of the gastroenterology groups and measured the efficacy of the intervention using basic operating room management metrics.
http://ift.tt/2pcClhN
11 Johns Hopkins Nurses Receive 2017 Excellence in Nursing Award from Baltimore Magazine
Baltimore magazine is honoring 11 Johns Hopkins nurses and nurse leaders for their extraordinary contributions to health care in its third annual "Excellence in Nursing" issue this May.
http://ift.tt/2o9BSMr
Cure of cancer for seven cancer sites in the Flemish Region
Cumulative relative survival curves for many cancers reach a plateau several years after diagnosis, indicating that the cancer survivor group has reached "statistical" cure. Parametric mixture cure model analysis on grouped relative survival curves provide an interesting way to determine the proportion of statistically cured cases and the mean survival time of the fatal cases in particular for population-based cancer registries. Based on the relative survival data from the Belgian Cancer Registry, parametric cure models were applied to seven cancer sites (cervix, colon, corpus uteri, skin melanoma, pancreas, stomach and oesophagus), at the Flemish Regional level for the incidence period 1999-2011. Statistical cure was observed for the examined cancer sites except for oesophageal cancer. The estimated cured proportion ranged from 5.9% [5.7, 6.1] for pancreatic cancer to 80.8% [80.5, 81.2] for skin melanoma. Cure results were further stratified by gender or age group. Stratified cured proportions were higher for females compared to males in colon cancer, stomach cancer, pancreas cancer and skin melanoma, which can mainly be attributed to differences in stage and age distribution between both sexes. This study demonstrates the applicability of cure rate models for the selected cancer sites after 14 years of follow-up and presents the first population-based results on the cure of cancer in Belgium.
http://ift.tt/2pxCX0H
One- and two-dimensional liquid crystal structures for lasing applications
Liquid crystal (LC) lasers have gained a lot of research interest in the last decade. Especially out-of-plane emitting chiral nematic liquid crystal (CLC) lasers have been studied extensively. These regular CLC lasers have a one-dimensional (1D) structure and the active cavity length is inherently limited. By using CLCs in two-and three-dimensional structures, the flexibility and applicability of the laser structures can be strongly enhanced. In this paper we focus on 2D in-plane emitting CLC lasers with a lying helix structure. We elaborate further on different techniques to obtain the lying helix structure and we analyze the lasing properties and compare these to regular 1D out-of-plane emitting CLC and NLC lasers. Both differences in emission spectrum, laser threshold, slope efficiency and maximal output energy are discussed.
http://ift.tt/2ovffVk
Comparison of the efficacy of autogenous inactivated Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) vaccines with that of commercial vaccines against homologous and heterologous challenges
Background: The porcine reproductive and respiratory syndrome virus (PRRSV) is a rapidly evolving pathogen of swine. At present, there is a high demand for safe and more effective vaccines that can be adapted regularly to emerging virus variants. A recent study showed that, by the use of a controlled inactivation procedure, an experimental BEI-inactivated PRRSV vaccine can be developed that offers partial protection against homologous challenge with the prototype strain LV. At present, it is however not known if this vaccine can be adapted to currently circulating virus variants. In this study, two recent PRRSV field isolates (07 V063 and 08 V194) were used for BEI-inactivated vaccine production. The main objective of this study was to assess the efficacy of these experimental BEI-inactivated vaccines against homologous and heterologous challenge and to compare it with an experimental LV-based BEI-inactivated vaccine and commercial inactivated and attenuated vaccines. In addition, the induction of challenge virus-specific (neutralizing) antibodies by the different vaccines was assessed. Results: In a first experiment (challenge with 07 V063), vaccination with the experimental homologous (07 V063) inactivated vaccine shortened the viremic phase upon challenge with approximately 2 weeks compared to the mock-vaccinated control group. Vaccination with the commercial attenuated vaccines reduced the duration of viremia with approximately one week compared to the mock-vaccinated control group. In contrast, the experimental heterologous (LV) inactivated vaccine and the commercial inactivated vaccine did not influence viremia. Interestingly, both the homologous and the heterologous experimental inactivated vaccine induced 07 V063-specific neutralizing antibodies upon vaccination, while the commercial inactivated and attenuated vaccines failed to do so. In the second experiment (challenge with 08 V194), use of the experimental homologous (08 V194) inactivated vaccine shortened viremia upon challenge with approximately 3 weeks compared to the mock-vaccinated control group. Similar results were obtained with the commercial attenuated vaccine. The experimental heterologous (07 V063 and LV) inactivated vaccines did not significantly alter viremia. In this experiment, 08 V194-specific neutralizing antibodies were induced by the experimental homologous and heterologous inactivated vaccines and a faster appearance post challenge was observed with the commercial attenuated vaccine. Conclusions: The experimental homologous inactivated vaccines significantly shortened viremia upon challenge. Despite the concerns regarding the efficacy of the commercial attenuated vaccines used on the farms where the field isolates were obtained, use of commercial attenuated vaccines clearly shortened the viremic phase upon challenge. In contrast, the experimental heterologous inactivated vaccines and the commercial inactivated vaccine had no or only a limited influence on viremia. The observation that homologous BEI-inactivated vaccines can provide a more or less standardized, predictable degree of protection against a specific virus variant suggests that such vaccines may prove useful in case virus variants emerge that escape the immunity induced by the attenuated vaccines.
http://ift.tt/2pxl6XQ
Mutations in CDC45, encoding an essential component of the pre-initiation complex, cause Meier-Gorlin syndrome and craniosynostosis
DNA replication precisely duplicates the genome to ensure stable inheritance of genetic information. Impaired licensing of origins of replication during the G(1) phase of the cell cycle has been implicated in Meier-Gorlin syndrome (MGS), a disorder defined by the triad of short stature, microtia, and a/hypoplastic patellae. Biallelic partial loss-of-function mutations in multiple components of the pre-replication complex (preRC; ORC1, ORC4, ORC6, CDT1, or CDC6) as well as de novo stabilizing mutations in the licensing inhibitor, GMNN, cause MGS. Here we report the identification of mutations in CDC45 in 15 affected individuals from 12 families with MGS and/or craniosynostosis. CDC45 encodes a component of both the pre-initiation (preIC) and CMG helicase complexes, required for initiation of DNA replication origin firing and ongoing DNA synthesis during S-phase itself, respectively, and hence is functionally distinct from previously identified MGS-associated genes. The phenotypes of affected individuals range from syndromic coronal craniosynostosis to severe growth restriction, fulfilling diagnostic criteria for Meier-Gorlin syndrome. All mutations identified were biallelic and included synonymous mutations altering splicing of physiological CDC45 transcripts, as well as amino acid substitutions expected to result in partial loss of function. Functionally, mutations reduce levels of full-length transcripts and protein in subject cells, consistent with partial loss of CDC45 function and a predicted limited rate of DNA replication and cell proliferation. Our findings therefore implicate the preIC as an additional protein complex involved in the etiology of MGS and connect the core cellular machinery of genome replication with growth, chondrogenesis, and cranial suture homeostasis.
http://ift.tt/2papfEy
Interpathologist concordance in the histological diagnosis of focal prostatic atrophy lesions, acute and chronic prostatitis, PIN, and prostate cancer
Abstract
Epidemiological and biological evidence indicates a causal relationship between the presence of proliferative atrophic lesions and the development of prostatic intraepithelial neoplasia (PIN) and prostate cancer. The presence of inflammatory and atrophic lesions of the prostate is widely underestimated and they are not generally mentioned in pathology reports. We performed a histopathological concordance study among eight genitourinary specialists and seven generalist pathologists, using 116 histological slides of prostate lesions, including proliferative atrophic lesions, PIN, and cancer. The overall agreement between all possible pairs of reviewers was 80% for prostate cancer, 67% for PIN, and 49% for proliferative atrophic lesions. When using as gold standard the assessment of a single genitourinary pathologist, the mean agreement percentage increased to 97% for prostate cancer, 92% for PIN, and 72% for proliferative atrophic lesions.
http://ift.tt/2o9h3jT
Firm, ulcerated nodule with peripheral scale on the arm
A 46-year-old previously healthy woman originally presented to the dermatology clinic for a full skin examination and was incidentally noted to have a nodule on her right arm. The patient stated that the lesion had been present for several months and began as a small pink papule that had been slowly increasing in size. She denied any itching, tenderness, pain, or bleeding. The physical examination revealed a 1.0-cm firm, ulcerated pink nodule with peripheral scale on the right proximal arm (Fig 1).
http://ift.tt/2oCL7I5
Who wrote this paper? The ethical issues of authorship
Authorship of scientific manuscripts and publishing new information is fundamental to academic medicine. Furthermore, publications are tied to academic promotion, professional recognition, or monetary rewards, such as bonuses or securing of research funds. Unfortunately this demand for publication can put tremendous pressure on researchers and academic physicians, which can lead to corner cutting, inappropriate behavior, and undeserved authorship.1 Research often involves many members of an intradisciplinary or an interdisciplinary team, not all of whom will fulfill authorship requirements.
http://ift.tt/2oCPVgy
Comparing the sensitivity of auramine-rhodamine fluorescence to polymerase chain reaction in the detection of Mycobacterium leprae in Fite-negative tissue sections
To the Editor: Twenty-three skin biopsy specimens from 18 patients with leprosy that were Fite-negative but positive by polymerase chain reaction studies were stained with auramine-rhodamine (AR) and examined under a fluorescent microscope. The clinical features and details of armadillo exposure have been described in a separate report. The current study focused on the utility of AR staining in these patients.
http://ift.tt/2oCNDhb
Establishment of a dermatology global health outreach and residency partnership program in Guatemala
To the Editor: To improve international health equity, residency programs can build sustainable partnerships beyond global health rotations.1 Heeding this goal, the University of Pennsylvania (Penn) department of dermatology and the Instituto de Dermatología y Cirugia de Piel (INDERMA), a dermatology residency training program near Guatemala City, Guatemala, founded a partnership in 2013. The Penn-INDERMA dermatology educational exchange program was built upon relationships between Penn and Guatemala established by other university departments.
http://ift.tt/2nIsPpp
Progressive hyperpigmented rash in a middle-aged man
A 44-year-old Indian man presented with a 1-year history of a progressive, nonremitting, asymptomatic rash. The physical examination revealed multiple oval-shaped, hyperpigmented macules and patches scattered on his trunk, thighs, and neck (Figs 1 and 2). In addition, papular lesions were seen on his left wrist. He had no oral or nail involvement. His medications included febuxostat and simvastatin, and a trial discontinuation of these medications failed to resolve the rash. A punch biopsy specimen was obtained (Fig 3), and the laboratory work-up, including autoimmune work-up, was negative.
http://ift.tt/2pccBBY
A survey-based study of management of longitudinal melanonychia amongst attending and resident dermatologists
To the Editor: Subungual melanoma (SM) represents 0.7% to 3.5% of melanoma cases, but often carries a worse prognosis than similarly staged cutaneous melanomas.1-3 While longitudinal melanonychia (LM), a brown-black band of the nail plate, is the most common presenting sign of SM (2/3 of cases), it is not specific for SM.4 In fact, in 1 study, only 6.8% cases of LM showed histologic evidence of SM, with the remaining cases benign etiologies, including subungual hematoma, nail matrix nevus, trauma, nail apparatus lentigo, and melanocytic activation.
http://ift.tt/2nIj1vJ
Lack of efficacy of topical timolol for cutaneous telangiectasias in patients with hereditary hemorrhagic telangiectasia: Results of a pilot study
To the Editor: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant condition that results from mutations in several genes that lead to mucocutaneous telangiectasias and visceral arteriovenous malformations.1 Cutaneous telangiectasias do not usually occur until after puberty and the lesions increase in size and number with time. The lesions can be socially stigmatizing for patients and can bleed with minor trauma.
http://ift.tt/2nIktho
The use of gentian violet 2% solution to identify holes in the deep margin of tissue excised during Mohs micrographic surgery
Complete Mohs microscopic margin assessment requires excision of intact, contiguous tissue at both the peripheral and deep margins. Integrity of the deep margin may not be possible for deeply invasive tumors that extend to anatomic structures that are difficult to resect under local anesthesia (eg, bone) or whose resection would increase surgical morbidity (eg, tendon) or would benefit from care by other subspecialties. Precisely marking the holes in the soft tissue excision can guide further targeted resection.
http://ift.tt/2nIkqCe
Lower extremity erythema and tightening in an elderly male
A 71-year-old man presented with lower extremity erythema and skin thickening. His medical history included metastatic prostate cancer treated with docetaxel, complicated by treatment-limiting lower extremity edema. He had previously undergone gadolinium-contrasted magnetic resonance imaging and remotely used L-tryptophan. One month after chemotherapy, progressive painful lower extremity tightening and erythema had developed. He denied dysphagia, Raynaud phenomenon symptoms, myalgias, weakness, or renal dysfunction.
http://ift.tt/2pcEf1F
Preventing disruption of surgical dressings in patients with cognitive impairment
Cognitively impaired patients often have a decreased ability to participate in their own healing and may be unable or unwilling to comply with a physician's treatment. They are more likely to pick at a surgical site or peel off dressings, which may result in an increased incidence of postoperative infection.1
http://ift.tt/2pck2sM
A warning sign of other vascular/skeletal abnormalities
A 2-year-old male (Fig 1) was referred for asymptomatic skin lesions on the lip and neck that had been present since birth. The physical examination revealed the presence of a capillary malformation on the lower lip of deep red color and well-defined frayed edges that exceeded the lip vermilion (Fig 2). He also had a purple-blue rubbery tumor on the anterior aspect of his neck that became more evident with crying. The patient also had mild facial asymmetry with a cranial perimeter in the upper normal limit.
http://ift.tt/2nIkD8s
Surgical staples for hemostasis during scalp surgery
In patients with implanted electrical devices, electrocautery has the potential to burn tissue around the device or to reprogram it; thus, use of bipolar electrocautery is preferred. However, focal use of bipolar electrocautery during scalp reconstruction is usually time-consuming because of the abundant vascularity and the frequent retraction of vessels after the incision, and insufficient hemostasis often results. Optimization of hemostasis is needed in these patients.
http://ift.tt/2pcriFd
Nail removal in pachyonychia congenita: Patient-reported survey outcomes
To the Editor: Pachyonychia congenita (PC), a genodermatosis characterized by onychodystrophy and painful palmoplantar keratoderma, is caused by mutations in several keratin genes (KRT6A, KRT6B, KRT6C, KRT16, KRT17). The nail dystrophy may cause pain, infection, and functional and psychosocial impairment.1 Prior studies on nail removal are limited.2,3
http://ift.tt/2nIrH5g
Power Consumption and Temperature Distribution in WRGB Active-Matrix OLED Displays
In this paper, the power consumption of a white-red-green-blue (WRGB) active-matrix organic light-emitting device (OLED) display and the resulting temperature distribution across the display are analyzed as a function of the applied image and the luminance of the emitted light. It has been shown previously that temperature directly impacts the picture quality of an OLED display. Luminance, spectral radiance, power and temperature measurements are performed on a 55-in WRGB OLED display with a resolution of 1920 1080. A power model is presented that allows calculating the display's power consumption for a given applied image. This involves the dependency of the efficiency of the white OLED on the current density, the wavelength dependent transmission of the color filters and the contribution of each of the subpixels in producing the display's nominal white. The output of the power model is used as input for a basic thermal model that simulates the temperature distribution across the display. The thermal model is based on 3D computational fluid dynamics analysis framework (FloEFD). A good agreement between the simulations and measurements on the sample WRGB OLED display is obtained.
http://ift.tt/2pa4Mj7
Impact of Long-Term Stress on the Light Output of a WRGB AMOLED Display
This paper describes how long-term use impacts the light output of a commercial 55" WRGB AMOLED display with InGaZnO TFT backplane. This covers effects which are known by the terms "aging", "image-sticking," and "burn-in." The focus is on three different observations: permanent change in light output as a function of time, permanent screen burn-in, and permanent shift in color point. Fromthis work it can be concluded that state-of-the art OLED displays still suffer from light output instability under prolonged stress. The results suggest that the permanent change in light output can be explained by the combination of three different phenomena: a decrease in efficiency of the OLEDs as a function of time for active subpixels, a positive threshold voltage shift of the driving transistor for active subpixels, and a negative threshold voltage shift of the driving transistor for inactive subpixels, if they are illuminated and/or kept at high temperature.To our knowledge, this is the first work that describes and quantifies the permanent change in light output of a commercial WRGB OLED panel with InGaZnO TFT backplane. It sheds light on which effects occur and can be a valuable tool, both in the design and optimization of OLED panels and in the determining the circumstances under which this technology may be applicable.
http://ift.tt/2o9jZgs
Deregulation of the replisome factor MCMBP prompts oncogenesis in colorectal carcinomas through chromosomal instability
Genetic instability has emerged as an important hallmark of human neoplasia. Although most types of cancers exhibit genetic instability to some extent, in colorectal cancers genetic instability is a distinctive characteristic. Recent studies have shown that deregulation of genes involved in sister chromatid cohesion can result in chromosomal instability in colorectal cancers. Here, we show that the replisome factor minichromosome maintenance complex-binding protein (MCMBP), which is directly involved in the dynamics of the minichromosome maintenance complex and contributes to maintaining sister chromatid cohesion, is transcriptionally misregulated in different types of carcinomas. Cellular studies revealed that both MCMBP knockdown and overexpression in different breast and colorectal cell lines is associated with the emergence of a subpopulation of cells with abnormal nuclear morphology that likely arise as a consequence of aberrant cohesion events. Association analysis integrating gene expression data with clinical information revealed that enhanced MCMBP transcript levels correlate with an increased probability of relapse risk in colorectal cancers and different types of carcinomas. Moreover, a detailed study of a cohort of colorectal tumors showed that the MCMBP protein accumulates to high levels in cancer cells, whereas in normal proliferating tissue its abundance is low, indicating that MCMBP could be exploited as a novel diagnostic marker for this type of carcinoma.
http://ift.tt/2p9Syak
Three unrelated individuals with perinatally lethal osteogenesis imperfecta resulting from identical glycine 502 serine substitutions in the α2 chain of type I collagen
In general, osteogenesis imperfecta is caused by heterozygous mutations in either of the genes encoding the alpha 1 or alpha 2 chains of type I collagen (COL1A1 and COL1A2, respectively). Usually, these mutations are unique to the affected individual or individuals within a family. In this study, single-strand conformation polymorphism mapping analysis has been coupled with sequence analysis to identify a single base mutation in the alpha 2(I) gene of type I collagen; this mutation is identical in three unrelated individuals with perinatal lethal osteogenesis imperfecta. The heterozygous G to A transition at a CpG dinucleotide results in a Gly502Ser substitution in the alpha 2 chain of type I collagen.
http://ift.tt/2o9gYNq
Case 11-2017 — A 61-Year-Old Woman with Leg Swelling, Back Pain, and Hydronephrosis
Presentation of Case. Dr. Areej El-Jawahri (Hematology–Oncology): A 61-year-old woman was seen in the emergency department of this hospital because of leg swelling and back pain. The patient had been in her usual health until approximately 3 months before this presentation, when mild swelling of…
http://ift.tt/2o9WRxK
FDA OKs Marketing of Whole Slide Imaging for Digital Pathology
FDA data review found that diagnoses based on digital interpretation were similar to those based on traditional glass slides read by light microscopy.
FDA Approvals
http://ift.tt/2pwwXFp
Demonstration of sympathetic nerve innervation in a patient with takotsubo cardiomyopathy using single-photon emission CT
Description
A 16-year-old male patient with anorexia nervosa was admitted to our hospital because of unconsciousness. He was in hypoglycaemic shock, with a serum glucose level of 40 mg/dL, and recovered consciousness after a venous injection of glucose. The patient's systolic blood pressure remained <70 mm Hg after he recovered consciousness. A 12-lead ECG showed Q waves and ST segment elevation in the precordial leads, and echocardiography showed hypokinesis of the midventricle and apex. Next, we performed coronary angiography, which revealed the absence of stenosis of the coronary arteries. Left ventriculography showed findings typical of takotsubo cardiomyopathy, apical ballooning with akinesis of the midventricle and apex and hyperkinetic basal segments (figure 1). 201Tl and iodofiltic acid (123)I-dual cardiac single-photon emission CT (SPECT) (figure 2A,B) at 1 week showed the absence of perfusion defect and fatty acid metabolism abnormality at the apex. Metaiodobenzylguanidine cardiac SPECT (figure 2C)...
http://ift.tt/2pwU6Yd
Rectus sheath haematoma: a rare masquerader for abdominal pain
Rectus sheath haematoma is a rare cause of abdominal pain. It can be easily confused for other causes of acute abdomen and may even lead to unnecessary laparotomies. Our patient has the rectus sheath haematoma because of violent coughing and on presentation had no obvious clinical sign pointing to the same. Diagnosis was made by a CT scan of the abdomen, and patient was treated conservatively. Rectus sheath haematomas are usually present on the posterior aspect of the rectus muscles and thus may not be clinically appreciable.
http://ift.tt/2oCpKGQ
Postpartum tubo-ovarian abscess, likely arising from pelvic inflammatory disease during pregnancy
Description
A female aged 18 years presented 2 weeks postnormal vaginal delivery with worsening generalised abdominal pain radiating to the back since delivery, with associated night sweats. She was vomiting, had loose bowel motions and had difficulty passing urine, but denied dysuria. On examination, she was febrile, tachypnoeic and tachycardic, and had a pale complexion. Her abdomen was distended with maximal tenderness in the left illiac fossa and associated rebound and percussion tenderness. She was unable to pass urine in the emergency department. Blood tests demonstrated a raised white cell count, C reactive protein 344 and CA-125 145.
She had a CT abdomen which showed a large pelvic abscess (figure 1 and figure 2) with internal septations posterior to the uterus (figure 3) and bilateral hydronephrosis and hydroureter. She was given intravenous antibiotics and underwent a laparotomy with drainage of pelvic abscess. Intraoperative findings included...
http://ift.tt/2pwJXer
Serum Cytokine Profile in a Patient Diagnosed with Dysferlinopathy
Limb-girdle muscular dystrophy type 2 (LGMD2B) is a mild form of dysferlinopathy, characterized by limb weakness and wasting. It is an autosomal recessive disease, with currently 140 mutations in the LGMD2B gene identified. Lack of functional dysferlin inhibits muscle fiber regeneration in voluntary muscles, the main pathological finding in LGMD2B patients. However, the immune system has been suggested to contribute to muscle cell death and tissue regeneration. Serum levels of 27 cytokines were evaluated in a dysferlinopathy patient. Levels of 8 cytokines differed in patient serum compared to controls. Five cytokines (IL-10, IL-17, CCL2, CXCL10, and G-CSF) were higher while 3 were lower in the patient than in controls (IL-2, IL-8, and CCL11). Together, these data on serum cytokine profile of this dysferlinopathy patient suggest immune response activation, which could explain leukocyte infiltration in the muscle tissue.
http://ift.tt/2p9Bilu
Polymyalgia rheumatica and vagal paraganglioma
Publication date: Available online 12 April 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): V. L'Huillier, O. Mauvais, S. Valmary-Degano, L. Tavernier
IntroductionVagal paraganglioma are rare tumors that are mostly asymptomatic. We report a case of vagal paraganglioma associated with paraneoplastic polymyalgia rheumatica and review the literature on benign paragangliomas of the head and neck associated with paraneoplastic syndrome.Case reportA 53-year-old man presented with atypical polymyalgia rheumatica. MRI revealed a tumor that was then surgically excised. Histological examination confirmed the diagnosis of benign vagal paraganglioma. Rapid, complete and permanent resolution of all rheumatological symptoms were observed postoperatively, confirming the diagnosis of paraneoplastic polymyalgia rheumatica.ConclusionParaganglioma of the neck associated with paraneoplastic syndrome remains exceptional. A predisposing gene mutation must be systematically investigated. Long-term surveillance must be ensured due to the risk of local recurrence, second tumors or metastasis.
http://ift.tt/2p9xyAk
A rare tumor of the auricle
Publication date: Available online 12 April 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M.V. Akdoğan, O. Topal, H. Erinanç
http://ift.tt/2o9ZK1v
Neonatal airway: challenging endotracheal intubation in infants with tracheal malformations at birth
Intubating newborn infants can be exacting. We describe two cases of endotracheal intubations in infants born with tracheal malformations. A male infant aged 30 weeks required intubation at birth for respiratory distress. Repeated attempts at intubation failed to achieve an optimal endotracheal tube position as the tube could not advance beyond the vocal cords. Hence ventilation continued with suboptimal air entry in the lungs. Bronchoscopy and CT scan confirmed tracheal stenosis. Slide tracheoplasty was successfully executed on day 78 of life. A female infant aged 33 weeks was intubated at birth for perinatal depression. Attempts at intubation were unsuccessful due to non-visualisation of the laryngeal inlet. Oesophagus was intubated and attempts to inflate showed air entry in the lungs, suggesting a fistulous communication between oesophagus and airway. A contrast oesophagogram showed a fistula connecting oesophagus and carina. With airway patency in question and associated major anomalies, parents were counselled and support was withdrawn.
http://ift.tt/2oCljM9
Unique long non-coding RNA expression signature in ETV6/RUNX1-driven B-cell precursor acute lymphoblastic leukemia
Overwhelming evidence indicates that long non-coding RNAs have essential roles in tumorigenesis. Nevertheless, their role in the molecular pathogenesis of pediatric B-cell precursor acute lymphoblastic leukemia has not been extensively explored. Here, we conducted a comprehensive analysis of the long non-coding RNA transcriptome in ETV6/RUNX1-positive BCP-ALL, one of the most frequent subtypes of pediatric leukemia. First, we used primary leukemia patient samples to identify an ETV6/RUNX1 specific expression signature consisting of 596 lncRNA transcripts. Next, integration of this lncRNA signature with RNA sequencing of BCP-ALL cell lines and lncRNA profiling of an in vitro model system of ETV6/RUNX1 knockdown, revealed that lnc-NKX2-3-1, lnc-TIMM21-5, lnc-ASTN1-1 and lnc-RTN4R-1 are truly regulated by the oncogenic fusion protein. Moreover, sustained inactivation of lnc-RTN4R-1 and lnc-NKX2-3-1 in ETV6/RUNX1 positive cells caused profound changes in gene expression. All together, our study defined a unique lncRNA expression signature associated with ETV6/RUNX1-positive BCP-ALL and identified lnc-RTN4R-1 and lnc-NKX2-3-1 as lncRNAs that might be functionally implicated in the biology of this prevalent subtype of human leukemia.
http://ift.tt/2pwPdi0
Role of the Ubiquitin C-Terminal Hydrolase L1-Modulated Ubiquitin Proteasome System in Auditory Cortex Senescence
Background/Aims: According to recent studies, central auditory impairments are closely related to neurodegenerative diseases. However, the mechanism of central presbycusis remains unclear. Ubiquitin C-terminal hydrolase L1 (UCHL1) is important in maintaining proteasomal activity; however, the detailed mechanism has not yet been fully elucidated. This study aims to investigate the molecular alterations involved in UCHL1 regulation during auditory cortex aging. Methods:D-Galactose (D-gal) induces oxidative stress and senescence in the auditory cortex, as reported in our previous studies. Primary auditory cortex cells were treated with D-gal for 72 h or 5 days. The proteins related to the ubiquitin proteasome system (UPS) and proteasomal activities were evaluated. UCHL1 was overexpressed, and the effects of UCHL1 on the UPS and proteasomal activity were analyzed. Results: Proteasomal activity was elevated at 72 h and decreased at 5 days in D-gal-treated primary auditory cortex cells. We also found that overexpression of UCHL1 increased the UPS-related proteins UBE1, PSMA7, ubiquitinated proteins, and monoubiquitin, and proteasomal activity. Conclusion: The results suggest that UCHL1 may modify the aging process in the auditory cortex by regulating UPS- related proteins.
ORL 2017;79:153-163
http://ift.tt/2ouUGrL
ORL 2017;79:153-163
http://ift.tt/2ouUGrL
An update of common autosomal recessive non-syndromic hearing loss genes in Iranian population
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Tohid Ghasemnejad, Mahmoud Shekari Khaniani, Fatemeh Zarei, Mina Farbodnia, Sima Mansoori Derakhsahan
Autosomal-recessive genes are responsible for about 80% of the hereditary non-syndromic hearing loss (NSHL) cases. In Iran, due to consanguineous marriages, NSHL is the second most frequent disability after intellectual disability, occurring one in 16 individuals. Enormous heterogeneity in the genetic pathology of hearing loss causes a major challenge in identification of responsible genes. In Iran, GJB2 is responsible for the most cases of pre-lingual and non-syndromic hearing loss (with frequency of 16.7%) which followed by other genes with lower frequency. Although several studies have indicated that a large proportion of both syndromic and non-syndromic hearing loss in Iranian populations are caused by defects in just a few genes, new detection strategies such as NGS (Next-generation sequencing) have increased the spectrum of responsible mutations. However, by applying this technique in Iran patients screening, the role of lots of novel related genes have been reported. In this review, we aim to describe function of these genes and their contribution to non-syndromic genetic hearing loss in Iranian population and we classify the genes by their functions.
http://ift.tt/2ouSDUR
Laryngotracheal anomalies and airway fluoroscopy in infants
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Amal Isaiah, Kevin D. Pereira
ObjectivesThe role of airway fluoroscopy in the diagnosis of laryngotracheal anomalies in infants is controversial. We aimed to (i) compare airway fluoroscopic characteristics with endoscopic findings in infants presenting for evaluation of upper airway obstruction and (ii) assess the as low as is reasonably achievable (ALARA) status for airway fluoroscopy as an initial diagnostic test in suspected laryngotracheal anomalies.Materials and methodsWe performed a retrospective review of children who underwent fluoroscopy and endoscopic evaluation of the airway in the operating room for suspected laryngotracheal anatomic abnormalities. Thirty-four infants who underwent both procedures at a tertiary level university-based children's hospital from January 1, 2008 to December 1, 2013 were included. Infants with suspected foreign bodies or an existing tracheostomy were excluded. Intraoperative findings from endoscopy and radiologic interpretation from fluoroscopy were compared using standard tools for validation of a diagnostic test. These metrics were compared with historic data that suggested good correlation between radiologic and endoscopic findings in older children.ResultsThe median age was 3.6 months (range 1–8 months). The sensitivity of airway fluoroscopy for determining laryngotracheal pathology was 18%. Specificity, positive predictive value and negative predictive value were 83%, 67% and 35%, respectively. Although each fluoroscopic exposure was optimized for pediatric patients, the median cumulative exposure to ionizing radiation was 19 mR (range 10–34 mR).ConclusionsAirway fluoroscopy yields metrics that are overall poor to be considered a valid and accurate universal radiologic diagnostic test in infants evaluated for laryngotracheal pathology. The cumulative exposure to ionizing radiation from use of a fluoroscope cannot be justified by the sensitivity of the test and may not conform to ALARA standards for imaging in this population.
http://ift.tt/2pwq9rm
Effect of the external nasal dilator on adolescent athleteswith and without allergic rhinitis
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Ricardo Reis Dinardi, Cláudia Ribeiro de Andrade, Cássio da Cunha Ibiapina
ObjectivesThe ability to effectively breathe through the nose is an important component of physical exercise. The goal of this study is to evaluate the effect of the external nasal dilator (END) on healthy adolescent athletes and those with allergic rhinitis.MethodsClinical trial, double-blind, crossover, in which we evaluated healthy adolescent athletes with allergic rhinitis, using experimental and placebo ENDs, submitted to a maximum cardio-respiratory test in randomized order. Predicted values for peak nasal inspiratory flow (PNIF%) and nasal resistance (NR) were obtained, and the rating of perceived exertion (RPE) was also assessed after the race test.Results65 adolescents participated in the study, 30 of whom had allergic rhinitis. The use of experimental ENDs demonstrated a statistically significant improvement in peak nasal inspiratory flow values (predicted %), nasal resistance, maximal oxygen uptake value (VO2Max.) and rating of perceived exertion, both in the healthy group and the one with allergic rhinitis.ConclusionResults suggested that END reduces nasal resistance, improves maximal oxygen uptake and rating of perceived exertion after a maximum cardio-respiratory test on healthy adolescents and those with allergic rhinitis.
http://ift.tt/2ouJUSo
A global social support system : what the international community could learn from the United States' National Basketball Association's scheme for redistribution of new talent
If global trade were fair, it is argued, then international aid would be unnecessary and inequalities inherent to the economic system would be justifiable. Here, we argue that while global trade is unfair, in part because richer countries set the rules, we believe that additional interventions must go beyond trade regulation and short-term aid to redress inequalities among countries that will persist and possibly worsen in spite of such measures. Drawing on an example of measures taken to redress the characteristics of a system that inherently increases inequality, the ability of dominant teams in the National Basketball Association (NBA) to recruit the most talented players, we argue that market-based competition even in the context of fair rules will create and amplify economic inequalities. We argue that, just as the NBA created a draft to reduce the emergence of severe inequalities among teams, systems of social support within richer countries should be paralleled by a global system to counterbalance persisting inequalities among countries that are produced by market forces. We explain how such a mechanism might operate among integrated market economies, and identify the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) as an example of such an emerging form of global social support.
http://ift.tt/2o9KXDV
Navigating between stealth advocacy and unconscious dogmatism : the challenge of researching the norms, politics and power of global health
Global health research is essentially a normative undertaking: we use it to propose policies that ought to be implemented. To arrive at a normative conclusion in a logical way requires at least one normative premise, one that cannot be derived from empirical evidence alone. But there is no widely accepted normative premise for global health, and the actors with the power to set policies may use a different normative premise than the scholars that propose policies - which may explain the 'implementation gap' in global health. If global health scholars shy away from the normative debate - because it requires normative premises that cannot be derived from empirical evidence alone - they not only mislead each other, they also prevent and stymie debate on the role of the powerhouses of global health, their normative premises, and the rights and wrongs of these premises. The humanities and social sciences are better equipped - and less reluctant - to approach the normative debate in a scientifically valid manner, and ought to be better integrated in the interdisciplinary research that global health research is, or should be.
http://ift.tt/2oBZegL
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