Αρχειοθήκη ιστολογίου

Πέμπτη 4 Μαΐου 2017

Exacerbations of oral lichen planus and elevated levels of aminotransferases

Abstract

Background

Liver enzymes appear to be involved in oral lichen planus (OLP), but it is not known whether the elevation develops concomitantly with exacerbations of disease. We compared the levels of serum hepatic aspartate (AST) and alanine (ALT) aminotransferases as markers of OLP exacerbation in patients with chronic hepatitis C from those with chronic liver disorders, seronegative for hepatitis C virus (HCV).

Methods

We studied 71 patients with OLP, (48 HCV seropositive and 23 HCV seronegative with chronic liver diseases) measuring AST and ALT. Association of HCV infection status with serum aminotransferase levels in relation to several types of OLP, exacerbations, and clinical score was studied by means of logistic and linear regression (correcting for age and sex).

Results

Of 476 patients screened, 71 were eligible for the study. Patients in the HCV seropositive group had more elevation of AST and ALT levels (mean level, 51.0 U/l; normal level, <45) than patients in the HCV seronegative group (mean level, 47.5 U/l). Mean serum AST and ALT exceeded the upper limit of the normal range in 33 of 48 (68.8%) in the HCV antibody-positive group and in 9 of 23 (39.5%) in the HCV antibody-negative group. Exacerbations of OLP were more frequent in the high-level AST and ALT group, while HCV status group played a minor role.

Conclusions

Among patients with OLP, mild elevation in aminotransferase levels was more common in patients infected with HCV. AST and ALT concentrations were elevated in association with exacerbation of OLP.



http://ift.tt/2pfr9jO

Pyodermatitis-pyostomatitis vegetans associated with asymptomatic inflammatory bowel disease



http://ift.tt/2pGgAch

Complete involution of congenital melanocytic nevus without halo phenomenon in an infant



http://ift.tt/2pfndQk

Identification of students with asthma in Chicago schools

alertIcon.gif

Publication date: Available online 4 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anna Volerman, Stacy Ignoffo, Ashley Hull, Syrennia McArthur Hanshaw, Susan Taylor, Monica Vela, Valerie G. Press




http://ift.tt/2pLZlEX

Influence of FLG mutations and TSLP polymorphisms on atopic dermatitis onset age

alertIcon.gif

Publication date: Available online 4 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Joy Wan, Nandita Mitra, Ole J. Hoffstad, David J. Margolis




http://ift.tt/2pG4eRk

Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia

Publication date: Available online 4 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jeffery M. Franklin, Jocelyn R. Grunwell, Alice C. Bruce, Robin C. Smith, Anne M. Fitzpatrick
BackgroundRacial disparities are evident among children with asthma in the United States, with non-Hispanic black children at particularly high risk for poor asthma outcomes, including frequent emergency department (ED) use for asthma exacerbations.ObjectiveTo compare asthma features in non-Hispanic black vs white children in Atlanta, Georgia, and determine what clinical features predict future ED use for asthma.MethodsSelf-reported black and white children 6 to 17 years of age with persistent asthma treated with controller medications completed medical history questionnaires, lung function testing, aeroallergen sensitization testing, and venipuncture. Medical records were reviewed for asthma-related ED visits for 12 months after the initial study visit.ResultsA total of 276 children were enrolled. Black children, compared with white children, resided in more disadvantaged zip code areas and were more likely to have public insurance. Black children also had more features of asthma severity and more ED visits during the study period. Predictors of ED use, aside from a previous ED visit, differed by race. After adjustment for socioeconomic status, predictors of ED use in white children included an ED visit in the previous year and sensitization to pets and dust; in black children, predictors included ED use in the previous year, the number of asthma controller medications, forced expiratory volume in 1 second less than 80% predicted, blood eosinophil count greater than 4%, and mold sensitization.ConclusionAsthma features and ED use differ between black and white children in metropolitan Atlanta. Strategies to eliminate allergen exposure in the home and improve asthma control in these children may require tailoring for different racial groups.



http://ift.tt/2pMlaEt

The presence of atopy and its effect on bacterial colonization of the upper airways in children with adenoid vegetation

Publication date: Available online 3 May 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Gabriela Bugova, Barbora Uhliarova, Milos Jesenak, Andrej Hajtman
Background: The aim of this study was to determine the frequency of atopy and the influence of atopy on bacterial colonization of upper airway in children with adenoid hypertrophy. Material and methods: Forty children were enrolled in the prospective study. Presence of atopy was diagnosed by skin-prick test. Differences in bacterial colonization of middle nasal meatus and nasopharynx according to the presence of atopy were analyzed. Results: Atopy was diagnosed in 75% children with adenoid hypertrophy. Presence of atopy was associated with significantly more often colonization of pathogenic bacteria (Streptococcus pneumoniae, Hemophillus influaenzae, Moraxella catarrhalis, Staphylococcus aureus) in the middle nasal meatus but not in nasopharynx (P=0.045, P=0.483, respectively). Identification of pathogenic bacteria in middle nasal meatus did not correlate with isolation of pathogenic bacteria in nasopharynx in both groups of children. Conclusion: There is a high incidence of atopy in children with adenoid hypertrophy. Atopy is related to increased colonization by pathogenic bacteria in middle nasal meatus but not in nasopharynx.



http://ift.tt/2pFhoOK

Influence of FLG mutations and TSLP polymorphisms on atopic dermatitis onset age

Atopic dermatitis (AD) is a chronic, inflammatory skin disorder driven by complex biologic and environmental influences. AD has been divided into early-onset and late-onset forms, with some speculating that early-onset AD is driven predominantly by genetic factors, whereas late-onset disease is driven by environmental exposures.1 Among many genetic factors relevant to AD are filaggrin (FLG), an epidermal barrier protein, and thymic stromal lymphopoietin (TSLP), an interleukin 7–like cytokine that promotes TH2 cell differentiation.

http://ift.tt/2q500o4

Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia

Racial disparities are evident among children with asthma in the United States, with non-Hispanic black children at particularly high risk for poor asthma outcomes, including frequent emergency department (ED) use for asthma exacerbations.

http://ift.tt/2qFV2Lt

Identification of students with asthma in Chicago schools

Asthma is the most common chronic childhood condition, affecting 1 of every 11 children in the United States. Disparities are well documented, with minority and underserved youth disproportionately affected.1 In addition to causing medical complications that lead to emergency department visits and hospitalizations, asthma negatively affects school attendance, readiness, and achievement.2

http://ift.tt/2q4GIyW

Mucosal and systemic immune response to sublingual or intranasal immunization with phosphorylcholine

alertIcon.gif

Publication date: Available online 4 May 2017
Source:Auris Nasus Larynx
Author(s): Yoshiko Maseda, Junichiro Ohori, Norimitsu Tanaka, Hiromi Nagano, Keiichi Miyashita, Yuichi Kurono
ObjectivePhosphorylcholine (PC) is a structural component of a wide variety of pathogens including Streptococcus pneumoniae and Haemophilus influenzae. Here, the immune response in mice to PC immunization via the sublingual (SL) route versus the intranasal (IN) route was investigated in terms of efficacy and safety.MethodsBALB/c mice were immunized with PC-keyhole limpet hemocyanin (KLH) plus cholera toxin (CT) or CT alone via the IN or SL route. The immune response generated was studied in terms of PC-specific antibody titers, interferon (IFN)-γ and interleukin (IL)-4 production by CD4+ T cells, and cross-reactivity of PC-specific immunoglobulin (Ig)-A antibodies in nasal washes against S. pneumoniae and non-typeable H. influenzae.ResultsSL and IN immunization with PC-KLH plus CT resulted in a marked increase in the levels of PC-specific, mucosal IgA and serum IgM, IgG, and IgA antibodies. Additionally, SL immunization elicited significantly higher levels of PC-specific IgG2a subclass antibodies and IFN-γ in serum. On the other hand, IN immunization with CT alone remarkably increased the total IgE level in serum compared with SL and IN immunization with PC-KLH plus CT. PC-specific IgA antibodies in nasal wash samples reacted to most strains of S. pneumoniae and non-typeable H. influenzae.ConclusionSL immunization is as effective as IN immunization to induce PC-specific immune responses and more effective than IN immunization to reduce the production of IgE and to prevent the sensitization to allergen causing type I allergy.



http://ift.tt/2peHHbK

Vestibular syncope: A disorder associated with drop attack in Ménière’s disease

alertIcon.gif

Publication date: Available online 3 May 2017
Source:Auris Nasus Larynx
Author(s): Ilmari Pyykkö, Vinaya Manchaiah, Jing Zou, Hilla Levo, Erna Kentala
ObjectiveExperiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière's disease (MD). Vestibular syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously in people with vestibular disorders and without localizing neurological deficit.MethodsDuring clinical interactions, we encountered 5 patients with syncope during a Tumarkin attack of MD. Thereafter we evaluated data from 952 patients collected with a questionnaire from the Finnish Ménière Association (FMA). The data contained case histories with special attention to Tumarkin attacks, participation restriction, migraines, and syncope attacks. The mean age of the subjects participating in the study was 60.6 years (range 25–75 years). The duration of the disease was on average 9.8 years (range 0.5–35 years).ResultsIn the current study sample, attacks of syncope were reported by 38 patients (4%) in association with the vertigo attack. Syncope was associated with Tumarkin attacks (X2=16.7, p<0.001), migraine (X2=7.4, p<0.011), history of ischemic heart disease (X2=6.0, p<0.025), and history of cerebrovascular disease (X2=11.7, p<0.004). Duration of MD was correlated with syncope. Syncope was provoked by physical strain and environmental pressure, and was associated with impairment of the visual field (i.e., visual blurring). In logistic regression analysis, syncope was significantly associated with Tumarkin attacks (odds ratio 3.2), migraines (odds ratio 2.3) and nausea (odds ratio 1.3). The attack of syncope was experienced as frightening, and general health related quality of life (HRQoL) was significantly worsened. Also, the patients suffered more from fatigue.ConclusionThe current study indicates that patients with MD who suffer from Tumarkin attacks can suffer from syncope. It confirms the role of the otolith organ in controlling the circulatory homeostasis of the body. The actions are mediated through the vestibular sympathetic reflex.



http://ift.tt/2pFgYYw

Antigen processing and presentation in the thymus: implications for T cell repertoire selection

Kenta Kondo | Kensuke Takada | Yousuke Takahama

http://ift.tt/2qJZXdi

Mucosal and systemic immune response to sublingual or intranasal immunization with phosphorylcholine

Phosphorylcholine (PC) is a structural component of a wide variety of pathogens including Streptococcus pneumoniae and Haemophilus influenzae. Here, the immune response in mice to PC immunization via the sublingual (SL) route versus the intranasal (IN) route was investigated in terms of efficacy and safety.

http://ift.tt/2qFrrBS

Development and Characterization of Canine Distemper Virus Monoclonal Antibodies

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2q4uVk2

TLR2 mediates autophagy through ERK signaling pathway in Mycoplasma gallisepticum-infected RAW264.7 cells

S01615890.gif

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Ziyin Lu, Daoyuan Xie, Ying Chen, Erjie Tian, Ishfaq Muhammad, Xueping Chen, Yusong Miao, Wanjun Hu, Ziyong Wu, Huili Ni, Jiuqing Xin, Yuan Li, Jichang Li
Toll-like receptor 2 (TLR2) plays a crucial role in early innate immune response of host to various microorganisms. Mycoplasma gallisepticum (MG) is one of the major pathogen that can cause chronic respiratory diseases in chickens, but the molecular mechanism of MG infection still remained unclear. In this study, we examined the typical hallmarks of autophagy and multiple signaling pathways by western blot, immunofluorescence microscopy and electron microscopy. The results indicated that infection of mouse macrophage cell line RAW264.7 with MG activated autophagy and mitogen-activated protein kinases (MAPKs). Silencing of TLR2 by siRNA substantially down-regulated MG-triggered autophagy in macrophages, and markedly reduced MG-induced extracellular regulated protein kinase (ERK) in macrophages but did not down-regulate c-Jun N-terminal kinase (JNK) and p38. Importantly, in macrophages, inhibition of ERK by PD98059 (ERK inhibitor) also significantly attenuated the level of autophagy upon MG infection, and the simultaneous treatment of TLR2 siRNA and PD98059 showed a similar effect on MG-induced autophagy as compared with TLR2 siRNA treatment alone. These findings thus demonstrate that TLR2 may mediate MG-induced autophagy through ERK signaling pathway in macrophage.



http://ift.tt/2qwWfYl

Influence of Deviated Nasal Septum on Nasal Epithelium: An Analysis

Abstract

Nasal obstruction is one of the most common complaint that ENT surgeon faces in his day to day practice. Deviated nasal septum is the most common cause for the nasal obstruction. It causes altered airflow dynamics which leads to various histopathological changes in nasal mucosa.Histopathological changes like lymphocytic infiltration and squamous metaplasia were studied and comparison was done between convex and concave side. A prospective randomized study conducted on 42 patients of deviated nasal septum from January 2015 to December 2015 selected from inpatient department of Otorhinolaryngology, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. This study determined significantly higher rate of squamous metaplasia and lymphocytic infiltration in septal mucosa on concave side when compared with convex side. Furthermore, there was increased lymphocytic infiltration and squamous metaplasia in lateral wall mucosa on concave side as compared to convex side but the difference was not statistically different. Deviated nasal septum predisposes the nasal epithelium to chronic inflammation and squamous metaplasia as a result of altered airflow. Due to changes in pathophysiology the patient is more susceptible to chronic rhinitis/rhinosinusitis.



http://ift.tt/2q2LpcF

Novel compound heterozygous MYO7A mutations in Moroccan families with autosomal recessive non-syndromic hearing loss

by Amina Bakhchane, Majida Charif, Amale Bousfiha, Redouane Boulouiz, Halima Nahili, Hassan Rouba, Hicham Charoute, Guy Lenaers, Abdelhamid Barakat

The MYO7A gene encodes a protein belonging to the unconventional myosin super family. Mutations within MYO7A can lead to either non syndromic hearing loss or to the Usher syndrome type 1B (USH1B). Here, we report the results of genetic analyses performed on Moroccan families with autosomal recessive non syndromic hearing loss that identified two families with compound heterozygous MYO7A mutations. Five mutations (c.6025delG, c.6229T>A, c.3500T>A, c.5617C>T and c.4487C>A) were identified in these families, the latter presenting two differently affected branches. Multiple bioinformatics programs and molecular modelling predicted the pathogenic effect of these mutations. In conclusion, the absence of vestibular and retinal symptom in the affected patients suggests that these families have the isolated non-syndromic hearing loss DFNB2 (nonsyndromic autosomal recessive hearing loss) presentation, instead of USH1B.

http://ift.tt/2pdtf3E

Conservative Surgical and Non-surgical Options in Management of T3 Laryngeal Cancer

Abstract

Purpose of Review

We herein address the most up-to-date findings in the literature in relation to surgical and non-surgical organ preservation strategies aimed at treatment of T3 laryngeal cancer.

Recent Findings

T3 laryngeal cancer represents an advanced stage of neoplastic lesions that poses significant challenges in terms of oncologic outcomes as well as function preservation. In the present form of the TNM staging system, T3 of the larynx includes a wide range of different neoplasms that spread into the visceral (paraglottic and pre-epiglottic) spaces of the organ or tend to infiltrate its cartilaginous framework. A number of therapeutic tools are available for its management and include transoral laser microsurgery, open-neck partial laryngectomies, non-surgical organ preservation strategies (mainly in the form of concurrent chemoradiation), and total laryngectomy with/without complementary (chemo)-radiotherapy according to the postoperative histopathologic evaluation of the surgical specimen.

Summary

No prospective randomized controlled trial has been performed to compare the different options in terms of oncologic and functional outcomes due to the multiple tumor and patient-related variables that should ideally be taken into account. Therefore, lacking precise evidence-based data, the choice among the different therapeutic alternatives, even in the presence of a multidisciplinary head and neck cancer team, is mainly made on the basis of institutional and cultural preferences.



http://ift.tt/2pEcPnG

A Study to Assess The Efficacy of Local Application of Oral Probiotic in Treating Recurrent Aphthous Ulcer and Oral Candidiasis

Abstract

To study the efficacy of local application of oral probiotics in improving oral health in recurrent aphthous ulcer and oral candidiasis. Eighty patients with diagnosis of recurrent aphthous ulcer and oral candidiasis were included in the study. They were divided into group A = 40 patients (patients treated with oral application of probiotic as an adjuvant) and group B = 40 patients (patients treated without probiotic). Both the groups were divided into two subgroups, group AU and group BU for recurrent aphthous ulcer and group AC and BC for oral candidiasis. Clinical signs and symptoms were assessed at the beginning of the study and at the end of the study. Pregnant or lactating women, patients with localised or systemic diseases such as Steven Johnson syndrome, ulcerative colitis, Behcet's syndrome and patients on chemotherapy or radiotherapy were excluded from the study. Bacillus Clausii, was used as a probiotic in our study. Patients in group A showed significant improvement in erythema (p = 0.001), pain reduction (p = 0.0001), decreased oral thrush (p = 0.006) and burning sensation in the mouth (p = 0.005) on day 5, whereas there was no significant difference on day 10 follow up. The study demonstrated the efficacy and rapidity of response to oral probiotic as an adjuvant in treating aphthous ulcer and oral candidiasis. Hence, oral application of probiotics can be used as an adjuvant in treating various oral pathology.



http://ift.tt/2pDYeZp

Botulinum toxin-induced acute anterior uveitis in a patient with Behçet’s disease under infliximab treatment: a case report

Injections of lipopolysaccharide in animal models generate acute anterior uveitis (also known as endotoxin-induced uveitis), but the effects of lipopolysaccharide injection are unknown in humans. We describe a...

http://ift.tt/2pKp68y

A splenic artery aneurysm presenting with multiple episodes of upper gastrointestinal bleeding: a case report

Splenic artery aneurysm is rare and its diagnosis is challenging due to the nonspecific nature of the clinical presentation. We report a case of a splenic artery aneurysm in which the patient presented with ch...

http://ift.tt/2p1Lc9r

Influence of Deviated Nasal Septum on Nasal Epithelium: An Analysis

Abstract

Nasal obstruction is one of the most common complaint that ENT surgeon faces in his day to day practice. Deviated nasal septum is the most common cause for the nasal obstruction. It causes altered airflow dynamics which leads to various histopathological changes in nasal mucosa.Histopathological changes like lymphocytic infiltration and squamous metaplasia were studied and comparison was done between convex and concave side. A prospective randomized study conducted on 42 patients of deviated nasal septum from January 2015 to December 2015 selected from inpatient department of Otorhinolaryngology, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. This study determined significantly higher rate of squamous metaplasia and lymphocytic infiltration in septal mucosa on concave side when compared with convex side. Furthermore, there was increased lymphocytic infiltration and squamous metaplasia in lateral wall mucosa on concave side as compared to convex side but the difference was not statistically different. Deviated nasal septum predisposes the nasal epithelium to chronic inflammation and squamous metaplasia as a result of altered airflow. Due to changes in pathophysiology the patient is more susceptible to chronic rhinitis/rhinosinusitis.



http://ift.tt/2q2LpcF

Influence of Deviated Nasal Septum on Nasal Epithelium: An Analysis

Abstract

Nasal obstruction is one of the most common complaint that ENT surgeon faces in his day to day practice. Deviated nasal septum is the most common cause for the nasal obstruction. It causes altered airflow dynamics which leads to various histopathological changes in nasal mucosa.Histopathological changes like lymphocytic infiltration and squamous metaplasia were studied and comparison was done between convex and concave side. A prospective randomized study conducted on 42 patients of deviated nasal septum from January 2015 to December 2015 selected from inpatient department of Otorhinolaryngology, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. This study determined significantly higher rate of squamous metaplasia and lymphocytic infiltration in septal mucosa on concave side when compared with convex side. Furthermore, there was increased lymphocytic infiltration and squamous metaplasia in lateral wall mucosa on concave side as compared to convex side but the difference was not statistically different. Deviated nasal septum predisposes the nasal epithelium to chronic inflammation and squamous metaplasia as a result of altered airflow. Due to changes in pathophysiology the patient is more susceptible to chronic rhinitis/rhinosinusitis.



http://ift.tt/2q2LpcF

The Duffy Antigen Receptor for Chemokines (DARC) Regulates Asthma Pathophysiology

Abstract

Background

The Duffy Antigen Receptor for Chemokines (DARC) is an atypical receptor that regulates pro-inflammatory cytokines. However, the role of DARC in asthma pathophysiology is unknown.

Objective

To determine the role of DARC in allergic airways disease in mice, and the association between DARC single nucleotide polymorphisms (SNPs) and clinical outcomes in patients with asthma.

Methods

Mice with targeted disruption of the Darc gene (Darc∆E2) or WT mice were challenged over three weeks with house dust mite (HDM) antigen. Allergic airways disease was assessed 24 hours and 7 days following the final challenge. Additionally, associations between DARC SNPs and clinical outcomes were analyzed in a cohort of poorly-controlled asthmatics.

Results

Total airway inflammation following HDM did not differ between Darc∆E2 and WT mice. At 24 hours, Darc∆E2 mice had increased airway hyperresponsiveness; however, at 7 days airway hyperresponsiveness had completely resolved in Darc∆E2 but persisted in WT mice. In poorly-controlled asthmatics, DARC SNPs were associated with worse asthma control at randomization and subsequent increased risk of healthcare utilization (odds ratio 3.13(1.37-7.27), p=0.0062).

Conclusions and Clinical Relevance

Our animal model and human patient data suggest a novel role for DARC in the temporal regulation in asthma pathophysiology and symptoms.

This article is protected by copyright. All rights reserved.



http://ift.tt/2qE3gnd

An Enlarging Neck Mass

A man in his 50s presented with sudden onset of neck swelling, pain, respiratory distress, and jaw pain; his neck was diffusely swollen without palpable fluctuance, induration, or a discrete mass, and imaging showed a large hyperdense mass. What is your diagnosis?

http://ift.tt/2pdiej3

Association Between Ibuprofen Use and Surgically Managed Posttonsillectomy Hemorrhage

This cohort study evaluates the association between ibuprofen use and severity of posttonsillectomy hemorrhage using transfusion events as a marker of severity in pediatric patients undergoing tonsillectomy.

http://ift.tt/2pDilH3

Posttonsillectomy Hemorrhage in the Ibuprofen Era

The perioperative treatment of children undergoing tonsillectomy with or without adenoidectomy has changed considerably since the publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation "Clinical Practice Guideline: Tonsillectomy in Children" in 2011. Intraoperative dexamethasone has been advocated, perioperative antibiotics have been discouraged, and the previously commonly used combination of acetaminophen and narcotics (codeine or oxycodone hydrochloride) for postoperative pain management has been replaced by the alternative combination of acetaminophen and nonsteroidal anti-inflammatory drugs, principally ibuprofen. The latter recommendation is based principally on the following 3 factors: the comparative effectiveness of ibuprofen to narcotics for posttonsillectomy pain control; the absence of evidence in systematic review that the use of nonsteroidal anti-inflammatory drugs after tonsillectomy is associated with an increased risk for bleeding or clinical intervention owing to bleeding; and concerns regarding the ultrarapid metabolism of codeine and, to a lesser degree, oxycodone in specific individuals, resulting in significantly higher plasma concentrations of morphine compared with normal metabolizers. Indeed, documentation from 1969 to 2012 of multiple cases of death or overdose after tonsillectomy in pediatric patients who had taken codeine postoperatively prompted the US Food and Drug Administration to issue a black box warning in 2013 stating that codeine use was contraindicated in children for this indication.

http://ift.tt/2pK9VMw

Targeted Training in Flexible Transnasal Laryngoscopy Diagnosis

This study assesses the value of targeted education of interns in identifying abnormal fiberoptic laryngoscopy findings.

http://ift.tt/2pDigTL

Severity Staging System for Nonmetastatic Papillary Thyroid Carcinoma

This cohort study evaluates whether patient demographic, clinical, and morphologic information can be used to create a more prognostically accurate cancer staging system for nonmetastatic papillary thyroid carcinoma.

http://ift.tt/2pDliYv

Interview mit Herrn Magnus v. Stackelberg, stellvertretender Vorstandsvorsitzender des GKV-Spitzenverbands



http://ift.tt/2pDch1s

Vagal nerve stimulator masquerading as an inhaled foreign body in a child

Description

An 8-year-old girl with a history of cyclin-dependent kinase-like 5 (CDKL5) disorder was presented to the emergency department with a short history of stridor and intermittent respiratory distress following eating a biscuit. She had a background of CDKL5 disorder causing neurodevelopmental delay, including being non-verbal, and refractory epilepsy for which she had received a vagal nerve stimulator (VNS) implanted 2 years prior. On initial examination she was noted to be maintaining her oxygen saturations but with intermittent worsening of her stridor and a barking cough. There was no clear preceding history of an upper respiratory tract infection. Given the concerns regarding a potential inhaled foreign body and only minor improvement with steroids and nebulised adrenaline, she was transferred to theatre for formal microlaryngobronchoscopy.

Microlaryngobronchoscopy confirmed oedema of the glottis (figure 1) and subglottis but no inhaled foreign body. It was noted that there was intermittent laryngospasm affecting...



http://ift.tt/2pcLNkD

To show the efficacy of compressive sutures alone in the management of acute hydrops in a keratoconus patient

A 17-year-old boy presented with sudden loss of vision in the left eye (OS) for 3 days. He was diagnosed with acute hydrops following keratoconic progression in OS. The patient was initially started on topical medical therapy, including steroids and hypertonic eye drops; showing no signs of resolution. Hence, the patient was planned for full-thickness compressive corneal sutures. Four sutures were placed along the central oedematous area covering the area of ruptured Descemet's membrane. Signs of resolution were noticed by 1st week and there was complete resolution of oedema by 3rd post-op week. Sutures were removed by 7th postoperative week/45th day. The patient was doing fine with visual acuity of 6/60 in the last visit with no symptoms of discomfort and no signs of corneal vascularisation. Full-thickness corneal compressive sutures is an effective alternative in cases of acute hydrops if perfluoropropane gas is not available.



http://ift.tt/2pCxXuH

Median philtrum sinus: a rare presentation and review of management options

Nasal dermoids are rare congenital abnormalities, and there is only one previously reported case of a philtrum sinus tract extending to the skull base. A 2-month-old boy was presented with an incidental finding of a median philtrum sinus with no infective features and no other abnormal clinical findings. MRI demonstrated a sinus tract extending from the philtrum to the crista galli. On multidisciplinary review, a conservative approach was taken due to the asymptomatic nature of the patient. Given the rarity of nasal dermoids, diagnosis requires precise clinical examination and MRI to identify the extent of the tract. Management options require a multidisciplinary case-specific approach and include non-surgical as well as surgical approaches.



http://ift.tt/2pcTRBU

Atraumatic chylous ascites: an unusual presentation of bladder cancer

We describe a case of bladder cancer presenting with atraumatic chylous ascites, which remains an extremely rare presentation of this condition. A previously well, elderly ex-smoker with no prior history of abdominal surgery was referred for investigation of progressive dyspnoea, increasing peripheral oedema and new-onset ascites, on a background of long-standing alcohol consumption (four standard drinks daily). Liver biochemistry and coagulation profile were normal apart from marked hypoalbuminaemia. Doppler ultrasound of the liver demonstrated normal echotexture and patent vasculature. Abdominal paracentesis yielded 8 L of milk-coloured, triglyceride-rich fluid with abundant malignant cells. Urine cytology demonstrated malignant transitional cells, with radiological evidence of a large enhancing bladder mass, with evidence of adjacent lymphadenopathy and omental involvement. A diagnosis of metastatic stage IV transitional cell bladder cancer was made. The patient declined palliative chemotherapy and passed away 2 months after their initial presentation.



http://ift.tt/2pCHfqr

ERG and OCT findings of a patient with a clinical diagnosis of occult macular dystrophy in a patient of Ashkenazi Jewish descent associated with a novel mutation in the gene encoding RP1L1

A 57-year-old man with a past medical history of diabetes presented for consultation with a several year history of slowly progressive vision loss in both eyes, which continued to deteriorate over 7 years of follow-up. Multimodal imaging was performed and was significant for the following: on spectral domain optical coherence tomography, a gap lesion was present in the ellipsoid layer, beneath the umbo, as well as subtle macular changes on auto fluorescence imaging. Multifocal electroretinography was performed and was abnormal, and a clinical diagnosis of occult macular dystrophy was made. The patient was subsequently evaluated with genetic testing that revealed a novel p.P73S:c 217C>T nonsense mutation within the retinitis pigmentosa 1-like-1 (RP1L1) gene. The clinical significance of the identified variation will require further investigation.



http://ift.tt/2pcya5b

Cytogenetically confirmed primary Ewings sarcoma of the pancreas

Ewing's sarcoma is a highly aggressive malignant tumour most commonly affecting long bones in children and adolescents. It is part of the Ewing's sarcoma family of tumours (ESFTs) that also include peripheral primitive neuroectodermal tumour and Askin's tumours. ESFTs share common cytogenetic aberrations, antigenic profiles and proto-oncogene expression with an overall similar clinical course. In 99% of ESFTs, genetic translocation with molecular fusion involves the EWSR1 gene on 22q12. Approximately 30% of ESFTs are extraosseous, most commonly occurring in the soft tissues of extremities, pelvis, retroperitoneum and chest wall. Primary presentation in solid organs is very rare but has been described in multiple sites including the pancreas. Accurate diagnosis of a Ewing's sarcoma in a solid organ is critical in facilitating correct treatment. We report the case of a 17-year-old girl with cytogenetically confirmed primary pancreatic Ewing's sarcoma and provide a brief review of the published literature.



http://ift.tt/2pCBokN

Look before you leap: a curious case of giant pulmonary bulla

Description

A 56-year-old white woman with a history of chronic obstructive pulmonary disease, hypertension, deep vein thrombosis and chronic alcohol abuse was brought to the emergency room after having two episodes of seizures at home. She was confused and could not give any history. Vital signs were stable and limited neurological exam was unremarkable except for confusion. CT scan of the head was negative for any acute intracranial abnormality and she was admitted for presumed alcohol withdrawal. Soon after admission, she developed shortness of breath, tachycardia and a low-grade fever. On auscultation, she was found to have no breath sounds on the right and a chest X-ray was obtained which showed a large lucency occupying the majority of the right hemithorax (figure 1). The next question for us was if this was a tension pneumothorax and if the patient needs an urgent tube thoracostomy. However, because...



http://ift.tt/2pcWT9a

First US experience with Pipeline Flex with Shield Technology using aspirin as antiplatelet monotherapy

Flow diversion has revolutionised the treatment of intracranial aneurysms, and the Pipeline Embolization Device (PED) remains the only flow diverter (FD) approved in the USA. However, thromboembolic events remain an issue for FDs. Attempting to minimise these incidents, a newer PED has been developed with the use of covalent bonding of phosphorylcholine onto the Pipeline device that has been known as Shield Technology (PED Shield), which in vitro has demonstrated a significant reduction in material thrombogenicity. We report the first US experience of the PED Shield in the treatment of a ruptured fusiform aneurysm located in the right vertebral artery in an attempt to mitigate complications related to the use of dual-antiplatelet therapy and discuss our rationale for using the new FD, using aspirin only as the antiplatelet regimen.



http://ift.tt/2pCHaTF

Secondary multifocal osteosarcoma developing on the background of bone infarct

Description

A 49-year-old-man presented to orthopaedics clinic with complaint of recently growing thigh pain. He had a history of oral and inhaler forms of steroid usage for asthma and allergy on his background. X-ray examination of the left femur showed medullary lytic lesions localised in distal diaphysis–metaphysis causing cortical destruction (figure 1). Contrast-enhanced MRI revealed medullary bone infarcts in distal diaphysis–metaphysis of the distal femur and proximal tibia bilaterally (figure 2). In this infarct area, there were multiple lesions causing cortical destructions with soft tissue components, and showing prominent enhancement on postcontrast images. The largest one is measured 4x2.5 cm. Multiple smaller lesions which were presenting similiar imaging characteristics without soft tissue components were also seen. Histological evaluation revealed the diagnosis of osteosarcoma.

Figure 1

(A, B) X-ray examination of the left femur showed the medullary lytic lesions (arrows) localised in distal diaphysis–metaphysis causing cortical...



http://ift.tt/2pcP4AH

Chronische Urtikaria im Kindesalter

Zusammenfassung

Die chronische Urtikaria (CU) ist definiert durch urtikarielle Episoden mit oder ohne Angioödeme, die länger als 6 Wochen täglich oder fast täglich auftreten. Ihre plötzliche Manifestationsform mit und ohne bekannte Ursache wird als chronische spontane Urtikaria bezeichnet. Hiervon wird die chronische induzierbare Urtikaria abgegrenzt. Das differenzialdiagnostische Spektrum der CU im Kindesalter reicht von selbstlimitierenden Dermatosen bis zu schwerwiegenden Systemerkrankungen. Nur bei entsprechendem anamnestischem Verdacht werden weitere, gezielte Untersuchungen zur Detektion potenzieller Triggerfaktoren oder Grunderkrankungen unternommen. Die Behandlung der CU folgt internationalen Leitlinien und wird zunächst mit modernen, nichtsedierenden H1-Antihistaminika auch in hoher Dosierung durchgeführt. Bei Beschwerdepersistenz können nach sorgfältiger, individueller Abwägung zusätzlich Omalizumab, Ciclosporin oder Montelukast eingesetzt werden.



http://ift.tt/2qDGITR

Commentary to: Long-term results of a modified expansion sphincter pharyngoplasty for sleep-disordered breathing



http://ift.tt/2qIMZwK

"Commentary to: 'Endoscopic and clinical benefits of hyaluronic acid in children with chronic adenoiditis and middle ear disease'"?



http://ift.tt/2p9ussd

Identification of educational needs in the management of overweight and obesity: results of an international survey of attitudes and practice

Leiter, LA; Astrup, A; Andrews, RC; Cuevas, A; Horn, DB; Kunešová, M; Wittert, G; Leiter, LA; Astrup, A; Andrews, RC; Cuevas, A; Horn, DB; Kunešová, M; Wittert, G; Finer, N; - view fewer (2015) Identification of educational needs in the management of overweight and obesity: results of an international survey of attitudes and practice. Clinical obesity , 5 (5) pp. 245-255. 10.1111/cob.12109 .

http://ift.tt/2p0WoD8

Evolutionary changes in transcription factor coding sequence quantitatively alter sensory organ development and function

Weinberger, S; Topping, MP; Yan, J; Claeys, A; De Geest, N; Ozbay, D; Hassan, T; Weinberger, S; Topping, MP; Yan, J; Claeys, A; De Geest, N; Ozbay, D; Hassan, T; He, X; Albert, JT; Hassan, BA; Ramaekers, A; - view fewer (2017) Evolutionary changes in transcription factor coding sequence quantitatively alter sensory organ development and function. Elife , 6 10.7554/eLife.26402 . (In press). Green open access

http://ift.tt/2p1fRnv

A logic-reasoning based system to harness bioprocess experimental data and knowledge for design

Zhang, J; Hunter, A; Zhou, Y; (2013) A logic-reasoning based system to harness bioprocess experimental data and knowledge for design. Biochemical Engineering Journal , 74 pp. 127-135. 10.1016/j.bej.2013.02.016 .

http://ift.tt/2pcjSkR

Beyond market failures: the market creating and shaping roles of state investment banks

Mazzucato, M; Penna, CCR; (2016) Beyond market failures: the market creating and shaping roles of state investment banks. Journal of Economic Policy Reform , 19 (4) pp. 305-326. 10.1080/17487870.2016.1216416 .

http://ift.tt/2pcBFIT

Generating Toxic Landscapes: Impact on Well-being of Cotton Farmers in Telangana, India

Jadhav, SS; Kannuri, N; (2017) Generating Toxic Landscapes: Impact on Well-being of Cotton Farmers in Telangana, India. Anthropology and Medicine (In press).

http://ift.tt/2pchDOA

Mitochondrial diseases: Translation matters

Pearce, S; Nezich, CL; Spinazzola, A; (2013) Mitochondrial diseases: Translation matters. Molecular and Cellular Neuroscience , 55 pp. 1-12. 10.1016/j.mcn.2012.08.013 .

http://ift.tt/2p12jbs

Human trafficking and labour exploitation in the casual construction industry: An analysis of three major investigations in the United Kingdom involving Irish Traveller offending groups

Cockbain, EP; Brayley-Morris, H; (2017) Human trafficking and labour exploitation in the casual construction industry: An analysis of three major investigations in the United Kingdom involving Irish Traveller offending groups. Policing: A Journal Of Policy And Practice (In press).

http://ift.tt/2pcyMrf

Iterative Soft/Hard Thresholding with Homotopy Continuation for Sparse Recovery

Jin, B; Jiao, Y; Lu, X; (2017) Iterative Soft/Hard Thresholding with Homotopy Continuation for Sparse Recovery. IEEE Signal Processing Letters , 24 (6) pp. 784-788. 10.1109/LSP.2017.2693406 . Green open access

http://ift.tt/2p12d3q

Handling Attrition in Longitudinal Studies: The Case for Refreshment Samples

Deng, Y; Hillygus, DS; Reiter, JP; Si, Y; Zheng, S; (2013) Handling Attrition in Longitudinal Studies: The Case for Refreshment Samples. Statistical Science , 28 (2) pp. 238-256. 10.1214/13-STS414 . Green open access

http://ift.tt/2pcCGAo

State and irrigation: archeological and textual evidence of water management in late Bronze Age China

Zhuang, Y; (2017) State and irrigation: archeological and textual evidence of water management in late Bronze Age China. Wiley Interdisciplinary Reviews: Water , Article e1217. 10.1002/WAT2.1217 . (In press).

http://ift.tt/2p15jET

Simultaneously high gravimetric and volumetric methane uptake characteristics of the metal–organic framework NU-111

Peng, Y; Gadipelli, S; Wilmer, CE; Eryazici, I; Snurr, RQ; Hupp, JT; Yildirim, T; Peng, Y; Gadipelli, S; Wilmer, CE; Eryazici, I; Snurr, RQ; Hupp, JT; Yildirim, T; Farha, OK; - view fewer (2013) Simultaneously high gravimetric and volumetric methane uptake characteristics of the metal–organic framework NU-111. Chemical Communications , 49 (29) p. 2992. 10.1039/c3cc40819a .

http://ift.tt/2pcy1Pa

Primary vs. Staged closure of exomphalos major – cardiac anomalies do not affect outcome

Rees, CM; Pierro, A; Kiely, EM; Curry, JI; Cross, KMK; Yates, RW; Eaton, SJ; Rees, CM; Pierro, A; Kiely, EM; Curry, JI; Cross, KMK; Yates, RW; Eaton, SJ; De Coppi, P; - view fewer (2017) Primary vs. Staged closure of exomphalos major – cardiac anomalies do not affect outcome. European Journal of Pediatric Surgery (In press).

http://ift.tt/2p1cAnW

Fluid Dynamic Characterization of a Laboratory Scale Rocked Bag Bioreactor

Marsh, DTJ; Odeleye, AOO; Ducci, A; Osborne, MD; Lye, GJ; Micheletti, M; (2017) Fluid Dynamic Characterization of a Laboratory Scale Rocked Bag Bioreactor. AIChE Journal 10.1002/aic.15734 . (In press).

http://ift.tt/2pcFoWE

Citrate-stabilized gold nanoparticles hinder fibrillogenesis of a pathological variant of beta(2)-microglobulin

Cantarutti, C; Raimondi, S; Brancolini, G; Corazza, A; Giorgetti, S; Ballico, M; Zanini, S; Cantarutti, C; Raimondi, S; Brancolini, G; Corazza, A; Giorgetti, S; Ballico, M; Zanini, S; Palmisano, G; Bertoncin, P; Marchese, L; Mangione, PP; Bellotti, V; Corni, S; Fogolari, F; Esposito, G; - view fewer (2017) Citrate-stabilized gold nanoparticles hinder fibrillogenesis of a pathological variant of beta(2)-microglobulin. Nanoscale , 9 (11) pp. 3941-3951. 10.1039/c6nr09362k .

http://ift.tt/2p1hOQT

Hyperglycemia-induced renal P2X7 receptor activation enhances diabetes-related injury

Menzies, RI; Booth, JWR; Mullins, JJ; Bailey, MA; Tam, FWK; Norman, JT; Unwin, RJ; (2017) Hyperglycemia-induced renal P2X7 receptor activation enhances diabetes-related injury. EBioMedicine 10.1016/j.ebiom.2017.04.011 . (In press). Green open access

http://ift.tt/2p12Jyr

Clubbing

Gibb, C; Smith, PJ; Miller, R; (2013) Clubbing. [Editorial comment]. British Journal of Hospital Medicine , 74 (S11) C170-C172. 10.12968/hmed.2013.74.Sup11.C170 . Green open access

http://ift.tt/2pcJWw4

Toughening by nanostructure

Ruiz-Pérez, L; Royston, GJ; Fairclough, JPA; Ryan, AJ; (2008) Toughening by nanostructure. Polymer , 49 (21) pp. 4475-4488. 10.1016/j.polymer.2008.07.048 . Green open access

http://ift.tt/2p1bybJ

Galaxy and Mass Assembly (GAMA): Probing the merger histories of massive galaxies via stellar populations

Ferreras, I; Hopkins, AM; Gunawardhana, MLP; Sansom, AE; Owers, MS; Driver, S; Davies, L; Ferreras, I; Hopkins, AM; Gunawardhana, MLP; Sansom, AE; Owers, MS; Driver, S; Davies, L; Robotham, A; Taylor, EN; Konstantopoulos, I; Brough, S; Norberg, P; Croom, S; Loveday, J; Wang, L; Bremer, M; - view fewer (2017) Galaxy and Mass Assembly (GAMA): Probing the merger histories of massive galaxies via stellar populations. Monthly Notices of the Royal Astronomical Society , 468 (1) pp. 607-619. 10.1093/mnras/stx503 . Green open access

http://ift.tt/2pcnymG

Lessons from the CAGI-4 Hopkins clinical panel challenge

Chandonia, J-M; Adhikari, A; Carraro, M; Chhibber, A; Cutting, GR; Fu, Y; Gasparini, A; Chandonia, J-M; Adhikari, A; Carraro, M; Chhibber, A; Cutting, GR; Fu, Y; Gasparini, A; Jones, DT; Kramer, A; Kundu, K; Lam, HYK; Leonardi, E; Moult, J; Pal, LR; Searls, DB; Shah, S; Sunyaev, S; Tosatto, SCE; Yin, Y; Buckley, BA; - view fewer (2017) Lessons from the CAGI-4 Hopkins clinical panel challenge. Human Mutation 10.1002/humu.23225 . (In press).

http://ift.tt/2p12fIK

Media Alert: “Surgical Olympics” to be Held for Medical Students

As part of an intensive weeklong boot camp to prepare fourth-year medical students who have matched into a surgical residency, the Johns Hopkins Department of Surgery will hold a "Surgical Olympics."  

Students will rotate through three stations (rated for time and accuracy), hang out in the "Olympic Village" between stations, and wrap up with a Jeopardy-style match.



http://ift.tt/2p0YW4k

Therapeutic use of hyaluronic acid fillers in the treatment of corticosteroid-induced skin and subcutaneous atrophy



http://ift.tt/2pC0d0e

Full Wave Propagation Modelling in View to Integrated ICRH Wave Coupling/RF Sheaths Modelling

RF sheaths rectification can be the reason for operational limits for Ion Cyclotron Range of Frequencies (ICRF) heating systems via impurity production or excessive heat loads. To simulate this process in realistic geometry, the Self-consistent Sheaths and Waves for Ion Cyclotron Heating (SSWICH) code is a minimal set of coupled equations that computes self-consistently wave propagation and DC plasma biasing. The present version of its wave propagation module only deals with the Slow Wave assumed to be the source of RF sheath oscillations. However the ICRF power coupling to the plasma is due to the fast wave (FW). This paper proposes to replace this one wave equation module by a full wave module in either 2D or 3D as a first step towards integrated modelling of RF sheaths and wave coupling. Since the FW is propagative in the main plasma, Perfectly Matched Layers (PMLs) adapted for plasmas were implemented at the inner side of the simulation domain to absorb outgoing waves and tested numerically with tilted BD in Cartesian geometry, by either rotating the cold magnetized plasma dielectric tensors in 2D or rotating the coordinate vector basis in 3D. The PML was further formulated in cylindrical coordinates to account for for the toroidal curvature of the plasma. Toroidal curvature itself does not seem to change much the coupling. A detailed 3D geometrical description of Tore Supra and ASDEX Upgrade (AUG) antennas was included in the coupling code. The full antenna structure was introduced, since its toroidal symmetry with respect to the septum plane is broken (FS bars, toroidal phasing, non-symmetrical structure). Reliable convergence has been obtained with the density profile up to the leading edge of antenna limiters. Parallel electric field maps have been obtained as an input for the present version of SSWICH.

http://ift.tt/2pcbPEG

Nail melanoma in situ: clinical, dermoscopic, pathologic clues, and steps for minimally invasive treatment

BACKGROUND: Nail unit melanoma (NUM) is a variant of acral lentiginous melanoma. The differential diagnosis is wide but an acquired brown streak in the nail of a fair-skinned adult person must be considered a potential melanoma. Dermoscopy helps clinicians to more accurately decide if a nail apparatus biopsy is necessary. OBJECTIVE: Detailed evaluation of clinical and dermoscopy features and description of conservative surgery of in situ NUM. METHODS: Retrospective study of in situ NUM diagnosed and treated with conservative surgical management in the authors' center from 2008 to 2013. RESULTS: Six cases of NUM were identified: 2 male and 4 female patients, age range at diagnosis of 44 to 76 years. All patients underwent complete nail unit removal with at least 6-mm security margins around the anatomic boundaries of the nail. The follow-up varies from 4 to 62 months. CONCLUSION: Nail unit melanomas pose a difficult diagnostic and therapeutic challenge. Wide excision is sufficient, whereas phalanx amputation is unnecessary and associated with significant morbidity for patients with in situ or early invasive melanoma. Full-thickness skin grafting or second-intention healing after total nail unit excision is a simple procedure providing a good functional and cosmetic outcome.

http://ift.tt/2p0Op97

The euros and sense of stents: do we get value for money?



http://ift.tt/2pC2jxt

In-flight allergic emergencies

Allergic and hypersensitivity reactions such as anaphylaxis and asthma exacerbations may occur during air travel. Although the exact incidence of in-flight asthma and allergic emergencies is not known, we have...

http://ift.tt/2pBA166

UPCC 36315 A Phase II Study Of Everolimus (RAD001) And Lenvatinib (E7080) In Patients With Metastatic Differentiated Thyroid Cancer Who Have Progressed on Lenvatinib Alone

Condition:   Thyroid Cancer
Interventions:   Drug: Lenvatinib;   Drug: Everolimus
Sponsor:   Abramson Cancer Center of the University of Pennsylvania
Recruiting - verified May 2017

http://ift.tt/2pc2f4G

Robot-assisted IVOR-LEWIS Esophagectomy

Condition:   Clinical or Oncologic Benefits of Robot-assisted IVOR-LEWIS in Esophageal Cancer
Intervention:  
Sponsor:   Ruijin Hospital
Recruiting - verified May 2017

http://ift.tt/2pchaM8

Ramucirumab Plus Irinotecan for Previously Treated Advanced Gastric or Gastro-esophageal Junction Adenocarcinoma

Conditions:   Gastric Adenocarcinoma;   Gastro-esophageal Junction Adenocarcinoma
Interventions:   Drug: Irinotecan;   Drug: Ramucirumab;   Genetic: Blood for angiome profiling;   Genetic: Blood for cfDNA
Sponsors:   Washington University School of Medicine;   Eli Lilly and Company
Not yet recruiting - verified May 2017

http://ift.tt/2p0VqXC

A Randomized Phase II Study to Compare the Safety and Efficacy of Dalteparin vs. Rivaroxaban for Cancer-associated Venous Thromboembolism

Conditions:   Cancer-associated Thrombosis;   Esophageal Cancer;   Gastric Cancer;   Hepatobiliary Cancer;   Pancreatic Cancer;   Duodenal Cancer
Interventions:   Drug: Rivaroxaban;   Drug: Dalteparin
Sponsor:   Asan Medical Center
Recruiting - verified May 2017

http://ift.tt/2p0Z8Rf

Sheath dynamics of a planar atmospheric pressure RF plasma



http://ift.tt/2p8ZBvS

Older adults' attentional deployment : differential gaze patterns for different negative mood states

Background and objectives: Older adults are characterized by an attentional preference for positive over negative information. Since this positivity effect is considered to be an emotion regulation strategy, it should be more pronounced when emotion regulation is needed. In contrast to previous studies that focused on the effects of sad mood on attention, we used a stressor to activate emotion regulation and evaluate the effects of different types of mood state changes. Moreover, we evaluated mood effects on attentional processes using a paradigm that allows disentangling between different attentional engagement and disengagement processes. Methods: Sixty older adults were randomly assigned to receive a stressor or a control task. Before and after this manipulation, mood state levels (happy, sad, nervous, calm) were assessed. Next, attentional processing of happy, sad, and angry faces was investigated using an eye-tracking paradigm in which participants had to either engage their attention towards or disengage their attention away from emotional stimuli. Results: Changes in different mood state levels were associated with different attentional disengagement strategies. As expected, older adults who increased in sad mood level showed a larger positivity effect as evidenced by a longer time to disengage attention from happy faces. However, older adults who received the tension induction and who decreased in calm mood level were characterized by longer times to disengage attention from sad faces. Limitations: The stressor was only partially effective as it led to changes in calm mood, but not in nervous mood. Conclusions: These results suggest that older adults may deploy a positivity effect in attention (i.e., longer times to disengage from positive information) in order to regulate sad mood, but that this effect may be hampered during the confrontation with stressors. (C) 2016 Elsevier Ltd. All rights reserved.

http://ift.tt/2q29rVg

Hart boven Hard op een kruispunt



http://ift.tt/2q2jcmf

Materials for DEMO and reactor applications-boundary conditions and new concepts

DEMO is the name for the first stage prototype fusion reactor considered to be the next step after ITER towards realizing fusion. For the realization of fusion energy especially, materials questions pose a significant challenge already today. Heat, particle and neutron loads are a significant problem to material lifetime when extrapolating to DEMO. For many of the issues faced, advanced materials solutions are under discussion or already under development. In particular, components such as the first wall and the divertor of the reactor can benefit from introducing new approaches such as composites or new alloys into the discussion. Cracking, oxidation as well as fuel management are driving issues when deciding for new materials. Here W-f/W composites as well as strengthened CuCrZr components together with oxidation resilient tungsten alloys allow the step towards a fusion reactor. In addition, neutron induced effects such as transmutation, embrittlement and after-heat and activation are essential. Therefore, when designing a component an approach taking into account all aspects is required.

http://ift.tt/2p91NTW

Adherence to oral hypoglycaemic agents among type-2 diabetes patients of Turkish descent

Scientific attention for medication adherence among people with chronic diseases has grown exponentially during the last decades. Despite the fact that the prevalence of DM is higher in non-White ethnic minorities only few studies on adherence to OHA in these populations were published. In chapter 1 (section 2), we presented the results of our systematic literature review on adherence to OHA in non-White ethnic minorities. Demographic, disease-related, treatment-related, socioeconomic and cultural factors were associated with adherence to OHA in the non-White ethnic minorities under study. However, because the included studies suffered from several methodological difficulties we also proposed methodological improvements for future research. The systematic literature review drew our attention to the multitude of factors, some of which may be culturally shaped, influencing adherence to OHA. As such it lay the foundation for our qualitative research study in which we explored perspectives of T2DM-patients of Turkish descent. Furthermore, the, often limited, insights and methodological shortcomings of the included studies strengthened the argumentation for our research design in which a detailed exploration, using qualitative methods, would precede a quantitative assessment of factors influencing OHA. To explore factors influencing adherence to OHA among T2DM-patients of Turkish descent we first conducted a qualitative study, using in-depth interviews (chapter 3). A theoretical sampling procedure was used, meaning analysis results of earlier conducted interviews led to adjusted or new inclusion criteria for patients to be interviewed in the course of the study. This process stopped when theoretical saturation was reached. This cycle of data collection, data analysis and selection of new cases provided us with a broad overview of factors potentially influencing adherence to OHA and a detailed exploration of how influencing factors are interconnected. Furthermore, this theoretical sampling procedure guaranteed the validity of our results because preliminary insights were confirmed, nuanced or sometimes contradicted by newly collected cases. Results from our qualitative study showed adherence to OHA was influenced by a multitude of barriers and facilitators. Next to beliefs about OHA, polypharmacy, beliefs about the course of diabetes, forgetfulness, the perception of the doctor's medical expertise, feelings of depression and social support; factors which are also found in other ethnic groups; some factors distinctive for T2DM patients of Turkish descent emerged. Respondents' causal beliefs about stress and the Belgian climate often led to nonadherence during less stressful periods, like summer holidays in Turkey. Some respondents adjusted their medication use to food intake or during Ramadan fasting. Concerns about OHA led to the use of herbal medicine, which in turn can lead to nonadherence to OHA. The religious framework used to interpret diabetes led, in combination with feelings of depression, to nonadherence but facilitated medication adherence in other patients. The use of qualitative methods also provided detailed insights into the ways these different factors are interconnected, and thus on how one or more factors can strengthen or counter the effect of another factor on adherence to OHA. The perception of the GP's medical expertise as diabetes care provider appeared to be important: firstly because it was able to counter the negative influence of factors like medication beliefs or illness beliefs on adherence to OHA and, secondly, because it may to be a factor distinguishing adherers from nonadherers. These patterns of interdepedendent factors may also be different from men and women, especially among first-generation migrants. Women seemed to adopt a more passive role towards the pharmacological treatment of T2DM probably because of their low educational level, limited language proficiency and the adoption of culturally shaped traditional gender roles. To further investigate whether Ramadan fasting had an impact on adherence to OHA and/or insulin we conducted a cross-sectional study on participation at Ramadan fasting, the use of OHA and/or insulin during Ramadan fasting and advice received from health care providers on Ramadan and diabetes (chapter 4). About half of the sample had received recommendations from their healthcare provider(s) about Ramadan fasting and diabetes. A low prevalence of Ramadan fasting among Turkish migrants with diabetes living in Belgium was observed. Six out of ten patients who actually fasted received recommendations about the intake of diabetes medication. Self-reported medication adherence during Ramadan, defined as following the (modified) regimen prescribed by the doctor, was very high. This study also showed health care workers could improve the provision of information on Ramadan fasting and diabetes. Furthermore, Ramadan fasting was less common among DM patients of Turkish descent living in Belgium compared to patients in Muslim countries. The impact of Ramadan fasting on adherence to OHA and/or insulin may be of minor importance. However, our results are based on a small convenience sample, and thus need to be validated in future studies using larger, at random samples. Because GPs and PHs play an important role in promoting adherence to OHA we conducted a qualitative study, using focus groups, to explore their perspectives on factors influencing adherence to OHA among T2DM-patients of Turkish descent, and on barriers to promoting adherence to OHA in this population (chapter 5). Both professional groups identified most obstacles to adherence to OHA found in our qualitative study with T2DM patients of Turkish descent. GPs and PHs mentioned the lack of knowledge about diabetes and hypoglycaemic medication, medication beliefs, culturally shaped illness beliefs, depression, social support, fatalism (often contributed to religiosity), religious and cultural habits, the health care provider's authority, financial barriers and policies encouraging generic prescribing as obstacles of medication adherence in this population. However, some of the influences described in our interview study were not recognized by most GPs and PHs: the influence of causal beliefs about stress and the Belgian climate, the use of herbal medicine and the positive impact of religiosity on medication adherence. A multitude of barriers to promoting adherence to OHA, both at the level of the patient and at the level of diabetes care provision, were mentioned. At the level of the patient identified barriers were the low educational level, high rates of illiteracy, language disconcordance, a lack of continuity of care, cultural habits and religious demands, culturally shaped gender roles, the influence of ideas about diabetes treatment present in the Turkish community and expectations about consultations. At the level of diabetes care provision the barriers were: the lack of time in consultations (which hinders the exploration of patients' perspectives), a reluctance to discuss medication adherence (out of fear to damage the patientprovider relationship or to arouse concerns about OHAs) and the lack of a close cooperation between GPs and PHs. GPs and PHs suggested several practical solutions to overcome barriers at the patient level: initiatives to overcome language barriers and the use of reminder systems to tackle unintentional nonadherence. Health care providers might also profit from training in cultural competencies and skills to promote behavioural change. At the level of diabetes care provision initiatives to stimulate cooperation between GPs and PHs could be taken, and patients could be stimulated to visit the same GP and PH. To validate the results from our qualitative study and to provide an estimate of the nonadherence rate to OHA we conducted an exploratory, cross-sectional survey study in a, probably, representative sample of T2DM patients of Turkish descent (chapter 6). We have tried to obtain this representative sample of T2DM patients of Turkish descent living in Belgium using a wide variety of recruitment channels and tens of recruiters. Nonadherence to OHA was measured with the medication possession ratio, based on pharmacy databases. Approximately 40 % of T2DM patients of Turkish descent in this sample were nonadherent (MPR<80%) to OHA, with a mean medication possession ratio of 82%. These figures are comparable to nonadherence rates and mean medication possession ratios found in other ethnic groups. However, nonadherence may be underestimated because we can not be completely sure about the sample's representativeness and because adherence rates based on pharmacy databases do not measure the actual intake of medicines. The finding from our qualitative study that patients reduced or temporarily stopped their intake of OHA during their stays in Turkey was confirmed. Approximately one out of four patients who had stayed in Turkey reported these behaviours. According to the results of our qualitative study, this might be explained by patients' perspectives of the influence of stress on diabetes. In order to identify factors influencing adherence to OHA we included a large pool of potential covariates based on the results from our qualitative study with patients, our systematic literature review and other literature reviews. Employment status, living situation, the type of OHA regimen, forgetfulness and the trust put in the GP as diabetes care provider influenced adherence to OHA in this sample. Medication beliefs, illness beliefs, social support, mental health, polypharmacy and the use of CAM did not influence adherence to OHA when controlling for a multitude of other covariates. Results of the qualitative study were only partly confirmed due to the small sample size in the cross-sectional survey study and, to the fact that the influence of some of the factors identified in the qualitative study may only have an important impact on adherence to OHA in a minority of patients.

http://ift.tt/2q2g0qR

Risk factors associated with cytological endometritis diagnosed at artificial insemination in dairy cows



http://ift.tt/2qvJQDM

Televising Flemish LGBTQs : Mapping LGBTQ characters in Flemish television fiction



http://ift.tt/2qIHez6

The Dark Side of Employee Referral Bonus Programs: Potential Applicants’ Awareness of a Referral Bonus and Perceptions of Organizational Attractiveness

The purpose of this study is to examine the effects of potential applicants' awareness of employees being rewarded for referrals on organizational attractiveness, based on credibility theory and the multiple inference model. In a first study (N=450), final-year students were less attracted to the organization when they knew employee referrals were rewarded, which was partially explained by lower credibility perceptions. Moreover, varying the specific characteristics of the referral bonus program (i.e., timing, size, type, recipient) did not improve potential applicants' perceptions of credibility and attractiveness. A second study (N=127) replicated the negative effect of referral bonuses on organizational attractiveness and found that it could be explained by both potential applicants' inferences about the referrer's other-oriented motive and lower referrer credibility. Whether employees explicitly stated their referral reason was bonus-driven or not did not affect these results.

http://ift.tt/2qvtcnR

Advice giving, managing interruptions and the construction of ‘teachable moments’



http://ift.tt/2qIILou

Therapeutic hysteroscopy in an outpatient office-based setting compared to conventional inpatient treatment: superior? : a cohort study



http://ift.tt/2qvyXBY

Investigating liquid-metal embrittlement of T91 steel by fracture toughness tests

Heavy liquid metals such as lead bismuth eutectic (LBE) are chosen as the coolant to innovative Generation IV (Gen IV) reactors where ferritic/martensitic T91 steel is a candidate material for high temperature applications. It is known that LBE has a degrading effect on the mechanical properties of this steel. This degrading effect, which is known as liquid metal embrittlement (LME), has been screened by several tests such as tensile and small punch tests, and was most severe in the temperature range from 300 degrees C to 425 degrees C. To meet the design needs, mechanical properties such as fracture toughness should be addressed by corresponding tests. For this reason liquid-metal embrittlement of T91 steel was investigated by fracture toughness tests at 350 degrees C. Tests were conducted in Ar-5% H-2 and LBE under the same experimental conditions Tests in Ar-5% H2 were used as reference. The basic procedure in the ASTM E 1820 standard was followed to perform tests and the normalization data reduction (NDR) method was used for the analysis. Comparison of the tests demonstrated that the elasticeplastic fracture toughness (J(1C)) of the material was reduced by a factor in LBE and the fracture mode changed from ductile to quasi-cleavage. It was also shown that the precracking environment played an important role in observing LME of the material since it impacts the contact conditions between LBE and steel at the crack tip. It was demonstrated that when specimens were pre-cracked in air and tested in LBE, wetting of the crack surface by LBE could not be achieved. When specimens were pre-cracked in LBE though, they showed a significant reduction in fracture toughness. (C) 2015 Elsevier B.V. All rights reserved.

http://ift.tt/2qIu9FV

Participatief werken : een effectief instrument voor integratie in de hedendaagse diverse samenleving?



http://ift.tt/2qvDTqz

The role of the researcher in interview narrative



http://ift.tt/2qIpV18

De stedenbouwkundige vergunning, de verkavelingsvergunning, de handhaving, de informatieverplichtingen inzake ruimtelijke ordening en de rechten van voorkoop

Town and Country Planning Law, Preemption Rights

http://ift.tt/2qvJSvn

De vrijheid van meningsuiting van de advocaat



http://ift.tt/2qIIJgm

Cardioversion of a supraventricular tachycardia (SVT) in a 7-year-old using a postural modification of the Valsalva manoeuvre

A boy aged 7 years presented with his parents to the emergency department (ED). He had a known diagnosis of paroxysmal supraventricular tachycardia (SVT) and was under the care of paediatricians. He had been suffering episodes of palpitations and chest pain for over a year and had been prescribed atenolol 25 mg ON, though the side effects meant he had not taken it for a month prior to presentation. He had 2 previous confirmed episodes of SVT, one that reverted with Valsalva manoeuvres, and the other with intravenous adenosine. In the ED, an ECG was recorded showing SVT at 180 bpm. Aside from his tachycardia, he was haemodynamically stable. The postural modification of the Valsalva technique was performed within 5 min of arrival, with reversion to sinus rhythm occurring during the leg-lift phase on the first attempt. After 30 min of observation, the child remained stable and was discharged home.



http://ift.tt/2pcfeDo

Australian validation of the Cancer of the Prostate Risk Assessment Post-Surgical score to predict biochemical recurrence after radical prostatectomy

Background

The Cancer of the Prostate Risk Assessment Post-Surgical (CAPRA-S) score is a simple post-operative risk assessment tool predicting disease recurrence after radical prostatectomy, which is easily calculated using available clinical data. To be widely useful, risk tools require multiple external validations. We aimed to validate the CAPRA-S score in an Australian multi-institutional population, including private and public settings and reflecting community practice.

Methods

The study population were all men on the South Australian Prostate Cancer Clinical Outcomes Collaborative Database with localized prostate cancer diagnosed during 1998–2013, who underwent radical prostatectomy without adjuvant therapy (n = 1664). Predictive performance was assessed via Kaplan–Meier and Cox proportional regression analyses, Harrell's Concordance index, calibration plots and decision curve analysis.

Results

Biochemical recurrence occurred in 342 (21%) cases. Five-year recurrence-free probabilities for CAPRA-S scores indicating low (0–2), intermediate (3–5) and high risk were 95, 79 and 46%, respectively. The hazard ratio for CAPRA-S score increments was 1.56 (95% confidence interval 1.49–1.64). The Concordance index for 5-year recurrence-free survival was 0.77. The calibration plot showed good correlation between predicted and observed recurrence-free survival across scores. Limitations include the retrospective nature and small numbers with higher CAPRA-S scores.

Conclusions

The CAPRA-S score is an accurate predictor of recurrence after radical prostatectomy in our cohort, supporting its utility in the Australian setting. This simple tool can assist in post-surgical selection of patients who would benefit from adjuvant therapy while avoiding morbidity among those less likely to benefit.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2q1ORnM
via IFTTT

Complexity and Contradiction in Architecture



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pbKqmq
via IFTTT

Isolation and phylogenetic study of Rift Valley fever virus from the first imported case to China

Abstract



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2p0NxBJ
via IFTTT

How to Create the Impossible: Interview With XPRIZE Runner-Up Team Dynamical Biomarkers Group


For the past five years, Taiwan-based Dynamical Biomarkers Group has been developing a prototype device which pairs diagnostic algorithms with analytical methodology in a user-friendly device, all controlled through a smartphone. For their efforts, they were selected as the second-place finalist of the Qualcomm Tricorder XPRIZE and received $1 million toward further development of their Tricorder.

Equally as impressive as the first-place winning DxtER, the Tricorder from Dynamical Biomarkers Group consists of a system of three modules: a vitals sensing monitor, a blood and urine test kit, and a multifunction scope. Designed simply and intuitively with consumers in mind, the system connects with a user-friendly smartphone app.

We asked Dr. Chung-Kang Peng, Ph.D, the team leader of Dynamical Biomarkers Group, to share a little more about his experience developing the device, what's next for it, and, in the spirit of Star Trek, what he thinks the next 50 years of healthcare might look like:

 

Scott Jung, Medgadget: What was your approach toward the design of your prototype?

Dr. Chung-Kang Peng: Our approach was very simple: we, first and foremost, put priority in recruiting the right people and institutions into our team. We wanted people who were willing to share their ideas, think out of the box, and were generally excited about making a Tricorder device a reality. Our team was ultimately composed of 3 types of members: (1) clinicians and physician researchers who provided important insights about disease conditions and patient experiences and who ultimately grounded the device to levels of medical validity, (2) biological engineers and physicists who brought state-of-the-art technologies such as microfluidics and electronic sensing and who pushed the boundaries of exploration, and (3) electrical and material engineers, software programmers, and designers who facilitated the fabrication of the device and the creation of apps and who balanced clinical validity and exciting technologies under the confines of material feasibility.

Once we had the right people, the design of the prototype became an almost natural, organic process. Typically, the process began with clinical experts educating the team on a specific medical condition and various ways in which the condition can be diagnosed. This was followed by engineers and designers exploring novel, yet feasible ways in which these conditions can be assessed. Subsequently, the design and fabrication of the diagnostic tests were completed, followed by rigorous testing with a close eye on diagnostic accuracy and user experience. Naturally, this process was not singular, and we went through numerous failures and iterations.

Ultimately, the final challenge was to integrate all the diagnostic pieces together and to assemble them together into a coherent set of parts with shared appearances, themes, and procedures.

 

Medgadget: What were some of the biggest lessons you learned through this experience?

Peng: Probably the biggest lesson from this experience is that creating a Tricorder-like device is not impossible. Prior to embarking on this challenge, the idea of creating a device capable of accurately diagnosing 15 medical conditions seemed so distant and nearly unachievable – particularly within the 3 year time-frame initially proposed by the XPRIZE Foundation. Now, we feel that not only are we close to achieving this goal but that we are also capable of expanding the Tricorder capabilities to many more conditions: of course, with the important recognition that it took a village to get us here, and it will take a village to take us farther. Close collaboration between academia and industry will be extremely important and so is the capacity to tackle this challenge with novel clinical validation methodologies, crowd-sourcing, and recruitment of ambitious, unafraid scientists and pioneers.

Medgadget: Many major consumer technology companies are investing in healthcare, and your team received support from HTC. What role did they play in the development of the device and what is their long-term interest in your device, as well as the healthcare space? How did this relationship come about?

Peng: Once the Tricorder competition was announced, I was able to pitch and sell the vision of the Tricorder to HTC and to convince them of our competitiveness if they were to join the team. As expected, HTC was and remains an absolutely critical component of our team – without whom our Tricorder would not have been possible. Their resources and expertise in designing and fabricating the Tricorder sets were absolutely essential. We are in the process of laying out the long-term plans for the Tricorder and determining what aspects of it mandates additional research and development.

 

Medgadget: If you had an additional year to work on your device, what were some of the ideas and features you wanted to implement that ended up on the cutting room floor?

Peng: We initially proposed and explored the use of various technologies such as the Electronic Nose Sensor and Microfluidic chips for blood tests. Ultimately, these were eliminated partly due to the 5 pound weight restriction imposed by the XPRIZE rules and partly due to logistical challenges in ensuring the correct environmental conditions for optimal implementation of these technologies. We intend to continue researching these novel technologies and to explore other affordable, easy-to-use innovations (such as rapid, low-cost paper-based assays).

 

Medgadet: What's next for your device? What's next for your team?

Peng: We plan to develop a 2nd generation Tricorder device system and hope to apply this technology to remote areas where medical access is limited. In the immediate future, we hope to apply this to rural areas of China and then to possibly extend the implementation to other developing areas such as India, South America, and Africa. In addition, we plan on validating our existing diagnostic tests, expanding the repertoire to multiple other medical conditions, creating a mechanism to rapidly validate clinical diagnostic tests in a large-scale manner, exploring novel technologies and collaborations, and establishing ways in which patients can play a more proactive role in guiding the direction of our work.

 

Medgadget: Star Trek recently celebrated its 50th birthday. What do you envision the next 50 years of healthcare looking like?

Peng: Like many others, we envision healthcare to be more personalized, affordable, and responsive within the next 50 years. But we also envision that our medical sciences will increasingly appreciate the dynamic properties of our human body. The body is composed of trillions of cells that are somehow perfectly orchestrated in an integrated, purposeful manner. This dynamic coordination and synchronization is largely still unknown to us and will likely become increasingly revealed to us over the next few decades.

Flashback: Qualcomm Tricorder X PRIZE Winners Announced…

Medgadget?d=yIl2AUoC8zA Medgadget?d=qj6IDK7rITs Medgadget?i=j_TATPmHLR0:1pF7YIndbrk:gIN9


from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pKEkfH
via IFTTT

The ties that bind: what's in a title?

Background

Many Australian and New Zealand surgeons use the title 'Mister' rather than 'Doctor', a practice dating back to traditions established over 600 years ago. The Royal Australasian College of Surgeons is currently undergoing a period of critical self-reflection, embodied by its 'Respect' campaign. Active measures to embrace diversity and encourage women into surgery are underway.

Methods

This paper reviews the historical basis to the use of gendered titles and their current use amongst fellows. De-identified demographic data from the college register of active fellows was searched by self-identified title, country or state, and gender. Data were further reviewed by surgical sub-specialty and year of fellowship.

Results

The college dataset suggests that there is significant variance in the preference for gendered titles, determined predominantly by geography rather than specialty. The highest use of gendered titles (by male and female surgeons) was in Victoria/Tasmania (58% male, 22% female) and New Zealand (81% male, 17% female). By contrast, only 2% of female surgeons in other states elected a gendered title (Miss/Mrs/Ms).

Conclusion

Surgery is the only profession that continues to use gendered titles. As the College of Surgeons moves towards greater equity and diversity, consideration should be given to phasing out the use of gendered titles, which serve to divide rather than unite our profession.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2qIam9t
via IFTTT

Zebrafish modeling of the β4GalT7-deficient type of Ehlers-Danlos syndrome



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pBaDNY
via IFTTT

Elementen van een duurzaam kunstenbeleid. Naar een kwaliteitsvolle omgeving voor de kunsten

Een duurzaam kunstenlandschap vraagt, naast sterke en creatieve actoren, en dus voldoende mogelijkheden voor de kunstenaar om te werken en te leven, een gepaste omgeving en een voldoende breed 'contactvlak' tussen de kunsten en de samenleving. 'Cultuur' is geen luxe of versiersel, maar een essentiële grondstof voor onze samenleving. Naast het ondersteunen van creatieve actoren moet cultuurbeleid ook een omgeving creëren waarbinnen de kunsten opgenomen kunnen worden in het publieke leven.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pBs4hg
via IFTTT

Managing arguments in social work encounters



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pBmIT4
via IFTTT

Als uw huurders uit elkaar gaan



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pBmoUz
via IFTTT

Physical Activity in the Digital Age: An Empirical Investigation into the Motivational Affordances of Online Fitness Communities



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pc6oFO
via IFTTT

A memetic algorithm to maximise the employee substitutability in personnel shift scheduling

Personnel rosters are typically constructed for a medium-term period under the assumption of a deterministic operating environment. However, organisations usually operate in a stochastic environment and are confronted with unexpected events in the short term. These unexpected events affect the workability of the personnel roster and need to be resolved efficiently and effectively. To facilitate this short-term recovery, it is important to consider robustness by adopting proactive scheduling strategies during the roster construction. In this paper, we discuss a proactive strategy that maximises the employee substitutability value in a personnel shift scheduling context. We propose a problem-specific population-based approach with local and evolutionary search heuristics to solve the resulting non-linear personnel shift scheduling problem and obtain a medium-term personnel shift roster with a maximised employee substitutability value. Detailed computational experiments are presented to validate the design of our heuristic procedure and the selection of the heuristic operators.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pc6oWk
via IFTTT

Treating suspected uterine cavity abnormalities by hysteroscopy to improve reproductive outcome in women with unexplained infertility or prior to IUI, IVF, or ICSI

Endometrial polyps, submucous fibroids, uterine septa, and intrauterine adhesions can be found by ultrasound (US), HSG, hysteroscopy, or any combined in 10–15 % of infertile women. Observational studies suggest a better reproductive outcome when these anomalies are removed by operative hysteroscopy. The current Cochrane review assesses the effectiveness of hysteroscopy for treating these suspected anomalies in women with otherwise unexplained infertility or prior to intrauterine insemination, in vitro fertilization, or intracytoplasmic sperm injection.

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pbYkEV
via IFTTT

Homozygosity mapping-guided exome sequencing in LCA patients of consanguineous origin reveals mutations in known genes and a novel candidate gene



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pc70Ls
via IFTTT

GGCX-associated phenotypes : an overview in search of genotype-phenotype correlations



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pBmBao
via IFTTT

De portemonne van nieuw samengestelde gezinnen



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pBs5lk
via IFTTT

An Unstable Sublime. Milton’s Pandemonium and the BaldacchIno at St. Peter’s in Rome



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pbZTD5
via IFTTT

Bauen wie Rumpelstilzchen / Rumpelstiltskining



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pc6ZXU
via IFTTT

Pursuing trust in child protection meetings : familiarisation and informality



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pBwZi8
via IFTTT

GGCX-associated phenotypes : an overview in search of genotype-phenotype correlations



http://ift.tt/2pBmBao

An Unstable Sublime. Milton’s Pandemonium and the BaldacchIno at St. Peter’s in Rome



http://ift.tt/2pbZTD5

Treating suspected uterine cavity abnormalities by hysteroscopy to improve reproductive outcome in women with unexplained infertility or prior to IUI, IVF, or ICSI

Endometrial polyps, submucous fibroids, uterine septa, and intrauterine adhesions can be found by ultrasound (US), HSG, hysteroscopy, or any combined in 10–15 % of infertile women. Observational studies suggest a better reproductive outcome when these anomalies are removed by operative hysteroscopy. The current Cochrane review assesses the effectiveness of hysteroscopy for treating these suspected anomalies in women with otherwise unexplained infertility or prior to intrauterine insemination, in vitro fertilization, or intracytoplasmic sperm injection.

http://ift.tt/2pbYkEV

Bauen wie Rumpelstilzchen / Rumpelstiltskining



http://ift.tt/2pc6ZXU

Complexity and Contradiction in Architecture



http://ift.tt/2pbKqmq

Als uw huurders uit elkaar gaan



http://ift.tt/2pBmoUz

Homozygosity mapping-guided exome sequencing in LCA patients of consanguineous origin reveals mutations in known genes and a novel candidate gene



http://ift.tt/2pc70Ls

Physical Activity in the Digital Age: An Empirical Investigation into the Motivational Affordances of Online Fitness Communities



http://ift.tt/2pc6oFO

Pursuing trust in child protection meetings : familiarisation and informality



http://ift.tt/2pBwZi8

Zebrafish modeling of the β4GalT7-deficient type of Ehlers-Danlos syndrome



http://ift.tt/2pBaDNY

De portemonne van nieuw samengestelde gezinnen



http://ift.tt/2pBs5lk

A memetic algorithm to maximise the employee substitutability in personnel shift scheduling

Personnel rosters are typically constructed for a medium-term period under the assumption of a deterministic operating environment. However, organisations usually operate in a stochastic environment and are confronted with unexpected events in the short term. These unexpected events affect the workability of the personnel roster and need to be resolved efficiently and effectively. To facilitate this short-term recovery, it is important to consider robustness by adopting proactive scheduling strategies during the roster construction. In this paper, we discuss a proactive strategy that maximises the employee substitutability value in a personnel shift scheduling context. We propose a problem-specific population-based approach with local and evolutionary search heuristics to solve the resulting non-linear personnel shift scheduling problem and obtain a medium-term personnel shift roster with a maximised employee substitutability value. Detailed computational experiments are presented to validate the design of our heuristic procedure and the selection of the heuristic operators.

http://ift.tt/2pc6oWk

Elementen van een duurzaam kunstenbeleid. Naar een kwaliteitsvolle omgeving voor de kunsten

Een duurzaam kunstenlandschap vraagt, naast sterke en creatieve actoren, en dus voldoende mogelijkheden voor de kunstenaar om te werken en te leven, een gepaste omgeving en een voldoende breed 'contactvlak' tussen de kunsten en de samenleving. 'Cultuur' is geen luxe of versiersel, maar een essentiële grondstof voor onze samenleving. Naast het ondersteunen van creatieve actoren moet cultuurbeleid ook een omgeving creëren waarbinnen de kunsten opgenomen kunnen worden in het publieke leven.

http://ift.tt/2pBs4hg

Managing arguments in social work encounters



http://ift.tt/2pBmIT4

Translation and transcultural adaptation of the VHI-10 questionnaire: the VHI-10lb.

Related Articles

Translation and transcultural adaptation of the VHI-10 questionnaire: the VHI-10lb.

Eur Arch Otorhinolaryngol. 2017 May 02;:

Authors: Khalaf M, Matar N

Abstract
Subjective assessment tools are essential in voice disorders evaluation. The Voice Handicap Index-30 (VHI-30) and the Voice Handicap Index-10 (VHI-10) are the most studied and used questionnaires to assess the severity of the handicap caused by hoarseness on the quality of life of dysphonic patients and, therefore, guiding physician's therapeutic decision making. The aim of our study is to validate a Lebanese version of the VHI-10. The Lebanese Arabic version of the VHI-10 (VHI-10lb) was obtained after a forward translation towards Lebanese Arabic then a back-translation towards English and a pilot study. It was then submitted to 154 participants with clinical dysphonia and 100 healthy subjects. The questionnaire's intrinsic parameters such as the reliability, the reproducibility, the validity, the sensitivity, and the study of the correlation between each item and the total score were measured for the validation of the questionnaire. The results show a high internal consistency of the VHI-10lb (Cronbach's α 0.915) and an intra-class correlation coefficient of 0.963 in the reliability analysis (p < 0.001). The VHI-10lb is also found to be clinically valid (p < 0.001) and sensitive to the improvement of the quality of life after treatment of dysphonic patients (p < 0.001). The Lebanese version of the VHI-10, the VHI-10lb, can be used to self-assess the severity of the impact of dysphonia on the quality of life of the affected patients. This study allows to add the VHI-10lb to the voice evaluation tools adapted to the Lebanese population.

PMID: 28466355 [PubMed - as supplied by publisher]



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2qCJVD6
via IFTTT

Translation and transcultural adaptation of the VHI-10 questionnaire: the VHI-10lb.

Related Articles

Translation and transcultural adaptation of the VHI-10 questionnaire: the VHI-10lb.

Eur Arch Otorhinolaryngol. 2017 May 02;:

Authors: Khalaf M, Matar N

Abstract
Subjective assessment tools are essential in voice disorders evaluation. The Voice Handicap Index-30 (VHI-30) and the Voice Handicap Index-10 (VHI-10) are the most studied and used questionnaires to assess the severity of the handicap caused by hoarseness on the quality of life of dysphonic patients and, therefore, guiding physician's therapeutic decision making. The aim of our study is to validate a Lebanese version of the VHI-10. The Lebanese Arabic version of the VHI-10 (VHI-10lb) was obtained after a forward translation towards Lebanese Arabic then a back-translation towards English and a pilot study. It was then submitted to 154 participants with clinical dysphonia and 100 healthy subjects. The questionnaire's intrinsic parameters such as the reliability, the reproducibility, the validity, the sensitivity, and the study of the correlation between each item and the total score were measured for the validation of the questionnaire. The results show a high internal consistency of the VHI-10lb (Cronbach's α 0.915) and an intra-class correlation coefficient of 0.963 in the reliability analysis (p < 0.001). The VHI-10lb is also found to be clinically valid (p < 0.001) and sensitive to the improvement of the quality of life after treatment of dysphonic patients (p < 0.001). The Lebanese version of the VHI-10, the VHI-10lb, can be used to self-assess the severity of the impact of dysphonia on the quality of life of the affected patients. This study allows to add the VHI-10lb to the voice evaluation tools adapted to the Lebanese population.

PMID: 28466355 [PubMed - as supplied by publisher]



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2qCJVD6
via IFTTT

The Effect of a Vocal Loading Test on Cough and Phonation in Patients With Chronic Cough.

Related Articles

The Effect of a Vocal Loading Test on Cough and Phonation in Patients With Chronic Cough.

J Voice. 2017 Apr 28;:

Authors: Vertigan AE, Kapela SM, Franke I, Gibson PG

Abstract
OBJECTIVE/HYPOTHESIS: Talking is a significant trigger for cough in patients with chronic cough; however, the stimulus required to trigger cough has not been quantified. The aim of this study was to examine the effect of a vocal loading task on phonation and cough behavior in patients with chronic cough and identify change following therapy.
STUDY DESIGN: This is a prospective observational study.
METHODS: This study involved 33 patients with chronic cough. Participants were assessed with the lingWAVES Vocal Loading Test protocol before and after intervention for chronic cough.
RESULTS: At baseline, almost 40% of patients had impaired vocal function and were unable to complete the vocal loading test. This improved following therapy, with 94% of patients being able to complete the test at follow-up. There was difficulty maintaining phonation, with 60% of the task unvoiced at baseline. This improved following therapy. The vocal loading test triggered coughing in 58% of patients; however, this improved following intervention. Acoustic measures during the vocal loading test did not change following therapy.
CONCLUSION: Phonation is an important trigger for cough. Patients with chronic cough demonstrated impaired performance on tests of vocal loading. Most parameters improved following therapy.

PMID: 28461166 [PubMed - as supplied by publisher]



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2qCtwOR
via IFTTT

Recurrent otorrhea in chronic suppurative otitis media: is biofilm the missing link?

Related Articles

Recurrent otorrhea in chronic suppurative otitis media: is biofilm the missing link?

Eur Arch Otorhinolaryngol. 2017 May 02;:

Authors: Jensen RG, Johansen HK, Bjarnsholt T, Eickhardt-Sørensen SR, Homøe P

Abstract
Dispersal of bacteria from a biofilm in the middle ear, serving as a bacterial reservoir, could explain the recurrent and chronic nature of chronic suppurative otitis media (CSOM). The objective of this study is to investigate if the same strains of bacteria could be detected in repeated episodes of otorrhea in CSOM. In a prospective case series at a primary healthcare clinic in Nuuk, Greenland, patients with more than 14 days of otorrhea were included consecutively. Samples for culturing and biofilm analysis were taken at enrollment and at any subsequent episode with otorrhea. Participants were treated with daily saline irrigation and Ciprofloxacin eardrops for 7-14 days. Biofilm was identified in otorrhea in 81% (17/21) of participants at enrollment. Multispecies infections dominated with Non-typeable Haemophilus Influenzae (NTHI), Staphyloccocus aureus, and anaerobes being the most frequent pathogens. After the initial treatment, 19 (90%) had dry ears. Median observation period was 140 days (range 14-280) where 13 participants had one or more recurrences. Median time to first recurrence was 60 days (range 14-197). Among the 13 with recurrence, three individuals had the same genotype of bacteria at a subsequent episode. Another two had the same phenotype (NTHI). The remaining eight had new multispecies infections. We confirmed a high rate of biofilm in CSOM. However, the clinical implication might be of minor importance when treating with irrigation and antibiotic eardrops, as recurrent episodes of otorrhea were dominated by new pathogens in each episode.

PMID: 28466356 [PubMed - as supplied by publisher]



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2qCDEHg
via IFTTT

Vocal fold granulomas.

Related Articles

Vocal fold granulomas.

Ear Nose Throat J. 2016 Aug;95(8):314

Authors: Lesser H, Rutt A, Sataloff RT

PMID: 27551840 [PubMed - indexed for MEDLINE]



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2p8PYwU
via IFTTT

The effects of the stem cell on ciliary regeneration of injured rabbit sinonasal epithelium.

Related Articles

The effects of the stem cell on ciliary regeneration of injured rabbit sinonasal epithelium.

Eur Arch Otorhinolaryngol. 2017 May 02;:

Authors: Kavuzlu A, Tatar EÇ, Karagöz T, Pınarlı FA, Tatar İ, Bayır Ö, Korkmaz MH

Abstract
Defects in mucosal healing after sinonasal surgery cause infection, scar formation causing obstruction, relapse of the disease within a shorter period and revision surgery. The present study aimed to create a functional ciliated epithelium using a stem cell and stem cell sheet of adipose tissue origin and to show such regeneration ultra-structurally on experimentally injured rabbit nasal epithelium. This was an experimental animal study and basic research. A total of 18 white New Zealand rabbits were divided into three groups. The medial wall of the maxillary sinus of the subjects was peeled off bilaterally. No additional procedure was applied to the subjects in Group 1. In Group 2, adipose tissue-derived mesenchymal stem cell was implanted on the wound edges of the subjects. In Group 3, a stem cell sheet of three layers was laid onto the defect area. All subjects were killed after 3 weeks. The presence of the stem cell stained with bromo-deoxyuridine was assessed with a light microscope, whereas cilia density, ciliated orientation and cilia structure were evaluated with a scanning electron microscope. Ciliary densities in Group 2 and Group 3 were statistically superior compared to the control group (p < 0.001, p = 0.007). Cilia morphology in Group 2 and Group 3 was also better than the control group (p < 0.01, p = 0.048). Ciliary orientation in Group 2 was scored highest (p < 0.01). The ratio of BrDu-stained cells was observed to be 27% in Group 3 and 8% in Group 2. Sub-epithelial recovery was observed to be better in Group 3. Adipose tissue-derived mesenchymal stem cell increased the healing of the injured maxillary sinus mucosa of the rabbits in terms of cilia presence, density and morphology regardless of the implementation technique. Level of evidence NA.

PMID: 28466357 [PubMed - as supplied by publisher]



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2p8S2Fb
via IFTTT

Vocal fold paresis - a debilitating and underdiagnosed condition.

Related Articles

Vocal fold paresis - a debilitating and underdiagnosed condition.

J Laryngol Otol. 2017 May 02;:1-5

Authors: Harris G, O'Meara C, Pemberton C, Rough J, Darveniza P, Tisch S, Cole I

Abstract
OBJECTIVES: To review the clinical signs of vocal fold paresis on laryngeal videostroboscopy, to quantify its impact on patients' quality of life and to confirm the benefit of laryngeal electromyography in its diagnosis.
METHODS: Twenty-nine vocal fold paresis patients were referred for laryngeal electromyography. Voice Handicap Index 10 results were compared to 43 patients diagnosed with vocal fold paralysis. Laryngeal videostroboscopy analysis was conducted to determine side of paresis.
RESULTS: Blinded laryngeal electromyography confirmed vocal fold paresis in 92.6 per cent of cases, with vocal fold lag being the most common diagnostic sign. The laryngology team accurately predicted side of paresis in 76 per cent of cases. Total Voice Handicap Index 10 responses were not significantly different between vocal fold paralysis and vocal fold paresis groups (26.08 ± 0.21 and 22.93 ± 0.17, respectively).
CONCLUSION: Vocal fold paresis has a significant impact on quality of life. This study shows that laryngeal electromyography is an important diagnostic tool. Patients with persisting dysphonia and apparently normal vocal fold movement, who fail to respond to appropriate speech therapy, should be investigated for a diagnosis of vocal fold paresis.

PMID: 28462766 [PubMed - as supplied by publisher]



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2qCDeko
via IFTTT

Computed tomography findings predicting the success of silodosin for medical expulsive therapy of ureteral stones

Publication date: Available online 3 May 2017
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Serdar Celik, Firat Akdeniz, Muge Afsar Yildirim, Ozan Bozkurt, Merve Gursoy Bulut, Mehmet Levent Hacihasanoglu, Omer Demir
Aim of the study is to investigate the relationship between non-contrast computed tomography (NCCT) findings and stone expulsion rate with medical expulsive therapy (MET) using silodosin for ureteral stones in male adults. Between January 2014 and June 2015, we retrospectively reviewed the patient charts with uncomplicated ureteral stones on NCCT images, who were treated with silodosin for MET. Stone diameter, volume and hounsfield units (HU) measured by NCCT and treatment findings were noted at the end of treatment. Patients were divided into three groups according to the localization as distal, mid and proximal ureteral stones. NCCT and treatment findings were compared between MET success and failure groups in different localizations. Stone expulsion rate was 81.3% for 134 distal, 45.5% for 22 mid and 27.7% for 47 proximal stones. Stone diameter, volume, and HU were significantly lower for success groups with distal and proximal stones (p < 0.05). In ROC analysis the cut-off values for stone volume and HU were detected as 48.7 mm3 and 598 HU for success group with proximal stones. Stone expulsion rate was found to be 24 times more (OR = 24; p = 0.001) in patients with <598 HU and 14 times more (OR = 14; p = 0.002) in patients with <48.7 mm3 proximal stones. Lower stone diameter, volume and HU were significant predictors of success with silodosin for MET for ureteral stones. Patients with <598 HU and/or <48.7 mm3 proximal stones may be prescribed silodosin for MET.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2pBFr0X
via IFTTT