Medicine by Sfakianakis Alexandros: 06/13/17

Τρίτη 13 Ιουνίου 2017

The risk of malignancy among biologic-naïve pediatric psoriasis patients: A retrospective cohort study in a US claims database

Little published literature exists regarding malignancy risk in pediatric psoriasis patients.

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Real-world burden of comorbidities in US patients with psoriasis

Understanding background comorbidity rates in psoriasis can provide perspective for adverse events associated with new therapies.

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Healthy Skin for Everyone: The effectiveness of a community-based skin cancer education program in an underserved population

"Healthy Skin for Everyone," or "Piel Saludable Para Todos," is a community-based initiative to address the rising rates of skin cancer in minority populations that is coupled with poor mortality rates and lack of evidence-based interventions. In our study, community health workers from a large nonprofit, free clinic were trained to lead 45-minute interactive educational workshops followed by participant enrollment in a 12-week text-messaging program. Spanish-speaking adults over the age of 18 regardless of educational level were included.

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First Real-Time 100-Gb/s NRZ-OOK Transmission over 2 km with a Silicon Photonic Electro-Absorption Modulator

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Regional Anesthesia and Pain Medicine: US Anesthesiology Resident Training-The Year 2015.

Background and Objectives: The Anesthesiology Review Committee of the Accreditation Council for Graduate Medical Education sets core requirements for residency program accreditation. We periodically report and analyze the US anesthesiology residents' training experience in regional anesthesia and pain medicine. Methods: Resident caseload, procedure, and pain medicine evaluation data were aggregated for the resident cohort who graduated in 2015. These data were analyzed for present-day experience and compared with previous reports from years 1980, 1990, and 2000 graduates. Results: Data were available for 1631 residents who graduated from 129 training programs. Regional anesthesia as a portion of the overall anesthesiology residents' training experience remains unchanged since 1990. The distribution of regional anesthesia training has shifted from neuraxial to peripheral blocks. All residents at the 10th percentile and above achieved the benchmark for spinal, epidural, and peripheral nerve block anesthetics and for new pain evaluations. Conclusions: The focus of US anesthesiology resident training in regional anesthesia and pain medicine has changed over the past 15 years by shifting from neuraxial to peripheral nerve block techniques. Previous training deficits have resolved for spinal anesthesia and peripheral nerve block. Procedural experience in pain medicine overwhelmingly involves epidural and facet injections. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Biochemical and Pharmacological Characterization of a Mice Model of Complex Regional Pain Syndrome.

Background and Objectives: Complex regional pain syndrome is a challenging disease to treat. Recently, a mouse fracture model of complex regional pain syndrome has been developed that has many signs of the clinical syndrome. However, many aspects of the sensory neuron biochemistry and behavioral and pharmacological characterization of this model remain to be clarified. Methods: Mice were randomly assigned to fracture/cast or control (naive) groups. Fracture/cast mice underwent a closed distal tibia facture, with hindlimb wrapped in casting tape for 3 weeks. After cast removal, mice were tested for mechanical allodynia, burrowing behavior, and motor ability over a 12-week period. Protein immunohistochemistry was performed for substance P, calcitonin gene-related peptide, tropomyosin receptor kinase A, nerve growth factor, Nav1.7, and transient receptor potential cation-channel V1, colocalized in neurons, in the ipsilateral lumbar dorsal root ganglia (DRGs). Analgesic drugs were tested for pain-relieving efficacy. Results: Mechanical allodynia was greater in the ipsilateral hindpaw (P = 0.0002) in the fracture/cast group versus the control group, over the 3- to 12-week period. The amount of burrowing material removed was decreased (P = 0.0026), and there were deficits in spontaneous motor-rearing behavior (P = 0.018). Immunostaining of substance P, calcitonin gene-related peptide, Trk A receptor, nerve growth factor, Nav1.7, and transient receptor potential cation-channel V1 all demonstrated up-regulation in the DRGs of fracture mice versus controls (all P

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Recognition of Viral RNA by Pattern Recognition Receptors in the Induction of Innate Immunity and Excessive Inflammation During Respiratory Viral Infections

Viral Immunology , Vol. 0, No. 0.

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Regional Immune Responses in the Lung After Respiratory Virus Infections

Viral Immunology , Vol. 0, No. 0.

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Early bony changes associated with bisphosphonate-related osteonecrosis of the jaws in rats: A longitudinal in vivo study

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Josy Lorena Peres Vilarinho, Nathália Ferrare, Andreia Maria Rocha Moreira, Helora Freitas Moura, Ana Carolina Acevedo, Sacha Braun Chaves, Nilce Santos Melo, André Ferreira Leite, Sérgio Bruzadelli Macedo, Melissa Paoletti de Souza, Ana Tereza Bittencourt Guimarães, Paulo Tadeu Figueiredo
ObjectiveTo evaluate early bony changes in an animal model of Medication-Related Osteonecrosis of the Jaw (MRONJ) at the side of the local trauma and at the contralateral side, comparing with a control group. Bony changes were evaluated by Microcomputed Tomography (MicroCT) at three times points: at baseline (T0), after drug administration (T1) and after dental extraction (T2).DesignTwo groups were compared: the experimental group in which zoledronic acid (ZA) was administered (17 rats) and the control group (13 rats). Dental extractions of the lower left first molars were performed in all animals. The left side was considered as the supposed affected area in the ZA group, and the right side was considered as the unaffected area. In these areas, the following structural microtomographic bone parameters were calculated: Bone Mineral Density (BMD), Trabecular Thickness (Tb.Th), and Bone Volume Proportion (BV/TV). The comparison of quantitative bone parameters among the different sides and experimental phases of both studied groups were performed by ANOVA-factorial.ResultsNone of the animals of the control group developed MRONJ. In the ZA group, 76% presented bone exposure. From T0 to T1, Tb.Th and BV/TV increased, and in T2, the mean values were higher in ZA group than in the control group. BMD increased throughout the different phases of both groups.ConclusionsStructural bony changes occurred in the ZA group at both mandibular sides before the dental extraction (T1). Tb.Th and BV/TV should be further investigated as potential early bone markers of MRONJ.

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Immunological and epidemiological factors affecting candidiasis in HIV patients beginning antiretroviral therapy in an Asian clinic

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Endah A.T. Wulandari, Henny Saraswati, Robiatul Adawiyah, Samsuridjal Djauzi, Retno Wahyuningsih, Patricia Price
ObjectivesOropharyngeal candidiasis (OPC) is common in HIV patients beginning antiretroviral therapy (ART). Here we address the response to ART, and the roles of poor oral hygiene and defects in local innate immunity with a focus on salivary β-defensins, as they are implicated in control of candidiasis but have not been investigated in this context.DesignART naïve HIV-infected adults (n=82) with <200 CD4⁺ T-cells/mm³ attending clinics at Cipto Mangunkusumo Hospital, Jakarta, were examined at the commencement of ART, and 73 were re-examined after 3 months. OPC was detected by clinical examination, and Candida albicans and fungal burdens were determined following culture on CHROMagar and saboroud-dextrose agar (resp). Salivary β-defensins (−2 and −3) were quantified by ELISA. Healthy control subjects (n=40) matched the patients by age and gender.ResultsOPC was evident in 47 patients before ART, and associated with greater fingal burdens. No OPC was detected in healthy controls and culture positivity was rare. ART decreased the prevalence of OPC to 8/73 HIV patients re-examined after 3 months, with reduced total fungal and C. albicans burdens. The incidence of OPC was independent of oral hygiene. Hyposalivation was more common in untreated HIV patients (16%) than after 3 months on ART and was rare in healthy controls. HIV patients were also more likely to have acidic saliva. Salivary β-defensin-2 was elevated in the presence of C. albicans pseudohyphae and OPC after 3 months on ART, but β-defensin-3 was not affected by OPC or ART.ConclusionsART reduces the prevalence of OPC, and the total fungal and C. albicans burden. Levels of salivary β-defensin-2 may associate with OPC in HIV patients responding to ART.

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Anagen Effluvium in Association With Extracorporeal Membrane Oxygenation

Abstract

Anagen effluvium (AE) is a type of alopecia with hair loss during the growth phase of a hair follicle and is most often associated with cytotoxic chemotherapy. This report describes a case of AE in a critically ill 2-year-old boy who developed cardiorespiratory failure requiring extracorporeal membranous oxygenation. We postulate that the combination of hypotension and hypoxia with subsequent reperfusion triggered an apoptotic cascade in the hair matrix, resulting in AE.

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Geographic distribution of phylogenetic species of the Fusarium graminearum species complex and their 8-ketotrichothecene chemotypes on wheat spikes in Iran

Abstract

Isolates of the Fusarium graminearum species complex (FGSC, n = 446) were collected from wheat spikes from northern and western regions of Iran with a history of Fusarium head blight (FHB) occurrences. The trichothecene mycotoxin genotypes/chemotypes, the associated phylogenetic species, and geographical distribution of these isolates were analyzed. Two phylogenetic species, Fusarium asiaticum and F. graminearum, were identified and were found to belong to sequence characterized amplified region (SCAR) groups V and I. Isolates from F. asiaticum species lineage 6 were within SCAR group V, whereas F. graminearum species lineage 7 were of SCAR group I. Of the 446 isolates assayed, 274 were F. asiaticum species predominantly of the nivalenol (NIV) genotype, while other isolates were either deoxynivalenol (DON) plus 3-acetyldeoxynivalenol (3-AcDON) or DON plus 15-acetyldeoxynivalenol (15-AcDON) genotype. Based on Tri7 gene sequences, a new subpopulation of 15-AcDON producers was observed among F. asiaticum strains in which 11-bp repeats were absent in the Tri7 sequences. The trichothecene chemotype was confirmed and quantified by high-performance liquid chromatography (HPLC) in 46 FGSC isolates. Isolates produced NIV (33.4–108.2 μg/g) and DON (64.7–473.6 μg/g) plus either 3-AcDON (51.4–142.4 μg/g) or 15-AcDON (24.1–99.3 μg/g). Among FGSC isolates, F. asiaticum produced the highest levels of trichothecenes. Using BIOCLIM based on the climate data of 20-year during 1994–2014, modelling geographical distribution of FGSC showed that F. asiaticum was restricted to warmer and humid areas with a median value of mean annual temperature of about 17.5 °C and annual rainfall of 658 mm, respectively (P < 0.05). In contrast, F. graminearum (only 15-AcDON producers) was restricted to cooler and drier areas, with a median value of the mean annual temperature of 14.4 °C and an annual rainfall of 384 mm, respectively (P < 0.05). Based on climate parameters at anthesis, the recorded distribution of F. graminearum and F. asiaticum was similar to that based on BIOCLIM parameters. Therefore, geographic differences on the wheat-growing areas in Iran have had a significant effect on distribution of FGSC and their trichothecene chemotypes.

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Bilaterale Stimmbandparese eines langzeitbeatmeten Patienten mit DISH

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-112161

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

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Schädigung von mikrochirurgischen Instrumenten durch Aufbereitung in einer Zentralsterilisation

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-110857

Jedes Jahr werden in Krankenhäusern Risikomeldungen zu Verunreinigungen, Korrosion, Deformation oder vorzeitigem Verschleiß von Medizinprodukten gemacht. Zu den Auswirkungen des Aufbereitungsprozesses auf die Qualität und Haltbarkeit empfindlicher und sehr feiner Instrumente gibt es bisher sehr wenige Daten. Diese Arbeit untersucht, ob und gegebenenfalls in welchem Umfang mikrochirurgische Instrumente durch den Aufbereitungsprozess geschädigt werden. Material und Methoden Gegenstand der Untersuchung waren 22 mikrochirurgische Instrumente aus der Stapeschirurgie. Die fabrikneuen Instrumente zweier unterschiedlicher Hersteller A und B wurden jeweils 30 Mal einem Aufbereitungsprozess unterzogen, ohne dass sie jemals operativ oder anderweitig benutzt wurden. Nach jedem Aufbereitungsprozess wurden die Instrumente makroskopisch und mikroskopisch überprüft. Die Ergebnisse wurden mittels einer Fotodokumentation dargestellt und auf Basis dieser ausgewertet. Ergebnisse Bei nahezu allen Instrumenten kam es zu mechanischen Beschädigungen allein durch den Aufbereitungsprozess. In einigen Fällen wiesen die Instrumente bei der mikroskopischen Sichtkontrolle Verschmutzungen und Flecken auf. Schlussfolgerung Die Arbeit zeigt auf, wie elementar ein sorgfältiger Umgang mit empfindlichen Instrumenten bei deren Aufbereitung ist. Sie weist außerdem auf Probleme der bei mikrochirurgischen Instrumenten üblichen Lagerung mit Schutzhülsen hin. Als zukünftige Alternative sollte über eine statische Lagerung von mikrochirurgischen Instrumenten in speziellen Racks nachgedacht werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Factors associated with the choice of the first biologic in psoriasis: Real life analysis from the Psobioteq cohort

Abstract

Background

Decision making is a complex process. The aim of our study was to assess factors associated with the choice of the first biological treatment in patients with moderate-to-severe psoriasis.

Methods

Data on all patients included in the French prospective, observational, cohort, Psobioteq and initiating a first biologic prescription between July 2012 and July 2016 were analysed. Demographic information and clinical features were collected during routine clinical assessments by the dermatology team at the recruiting centres using a standardized case report form. The primary outcome was the nature of the first biologic treatment. Four groups were identified: adalimumab, etanercept, ustekinumab and infliximab groups. Factors associated with the choice of the first biological agent were determined by a multinomial logistic regression model adjusted on year of inclusion.

Results

The study population included the 830 biological-naïve patients who initiated a first biological agent. The mean age was 46.6 years (+/-SD 13.9), and 318 patients (38.3%) were female. The most commonly prescribed biologic was adalimumab: 355 (42.8%) patients, then etanercept (n=247, 29.8%), ustekinumab (n=194, 23.4%) and infliximab (n=34, 4.0%). In the multinomial logistic regression analysis, patients were significantly more likely to receive adalimumab if they had a severe psoriasis as defined by baseline PASI or if they had psoriatic arthritis compared to etanercept (aOR, 0.42; 95%CI, 0.16 to 1.07) and ustekinumab (aOR, 0.15; 95%CI, 0.04 to 0.52). Patients were significantly more likely to receive ustekinumab (aOR, 2.39; 95%CI, 1.04 to 5.50) if they had a positive screening for latent tuberculosis compared to adalimumab. Younger patients were also more likely to receive ustekinumab. Patients with chronic obstructive pulmonary disease were more likely to be prescribed ustekinumab or etanercept compared to adalimumab. There was a trend in favor of etanercept prescription in patients with cardiovascular co-morbidities, metabolic syndrome and in patients with a history of cancer.

Conclusion

We identified patient and disease related factors that have important influence on the choice of the first biological agent in clinical practice. Clinicians appear to have a holistic approach to patient characteristics when choosing a biological agent in psoriasis.

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Cryptogenic cirrhosis: misunderstood cause of yellow urticaria

Abstract

We read with great interest the paper by Combalia et al recently appeared on Journal of European Academy of Dermatology¹. The authors reported two cases of yellow urticaria related to liver cirrhosis, one due to hemochromatosis, and the other one to alcohol¹. With a total of ten cases reported in literature by now, we considered relevant to report another case we recently came across.

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Satisfaction of mountain guides with high sun protection as a tool to prevent NMSC

Abstract

Background

NMSC is an occupational disease for outdoor workers in Germany since 2015. Sustainable prevention is demanded and sunscreen promoted as an effective tool. However, studies on the satisfaction of sunscreen users are rare.

Objective

To evaluate the satisfaction of mountain guides using a high SPF sunscreen product as an appropriate prevention tool for mountain guides.

Methods

Motivating mountain and ski guides in Germany to use very high protection sunscreen (SPF50+, Actinica Lotion) during a 4 to 8 hours workday followed by the completion of a self-filled paper-based questionnaire about their experience and satisfaction with the product.

Results

Of 88 mountain and ski guides (61 men, 27 women) included in the study, 61.4% reported regular sunscreen use with the application of very high protection (SPF50+) in 18.6% of all cases. At the end of the workday, 78.6% found the product convenient and easy to include into their daily work and 79.3% felt sufficiently protected against the sun.

Conclusion

Overall satisfaction with the use of high SPF products during work is high in mountain and ski guides and could be an effective tool in prevention campaigns.

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Psoriasis Comorbidity affects Multiple Sclerosis Neurological Progression: a retrospective case –control analysis

Abstract

Background

Multiple sclerosis (MS) and psoriasis are inflammatory disorders, with epidemiological and biological associations. The impact of one disease on the course of the other has not been studied.

Objective

To characterize patients with psoriasis and MS, and to assess whether psoriasis comorbidity affected the progression of MS.

Methods

A retrospective case control study. Patients with psoriasis comorbidity were identified from 3456 patients included in the Sheba Hospital Multiple Sclerosis Center database. Clinical and demographical characteristics and MS progression-related outcomes in patients whose follow up exceeded 5 years were analyzed and compared to those of a matched control cohort of MS-only (MSO) patients.

Results

Forty-five (1.3%) MS patients had psoriasis comorbidity. Psoriasis preceded MS in thirty-five (78%) cases. The psoriasis was defined as mild, moderate, and severe in twenty-four (53%), twelve (27%), and nine (20%) cases, respectively. MS progression-related outcomes were evaluated in 35 patients that had follow-up over 5 years. Patients with psoriasis onset preceding relapsing-remitting MS (RRMS) had slower progression of disease compared to MSO patients, as manifested by a longer time to second relapse (p<0.01) and a longer time to significant neurological disability scores (p<0.03).

Conclusion

Psoriasis comorbidity preceding the onset of MS is associated with slower progression of disability.

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Prevention of livedoid vasculopathy recurrence by prolonged administration of rivaroxaban

Abstract

A 49-year-old man with known livedoid vasculopathy presented with recurrent painful (VAS 8/10) ulceration and necrosis on the foot (Figure 1). He was formerly treated with prostacyclin infusions, acetylsalicylic acid, intravenous immunoglobulins, different systemic antibiotics and a skin grafting. At admission an antithrombotic therapy with enoxaparin (Clexane^®) in a dose of 1 mg/ kg bodyweight (100 mg) once daily was initiated.

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Natural history of skin prick test reactivity

Allergic reactions to airborne allergens may have important consequences for affected individuals and are believed to be unstable through life, although evidence from longitudinal studies is limited.

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Validation of International consensus equation for acute serum total tryptase in mast cell activation: A perioperative perspective

Abstract

Introduction

There is no standardised method for assessing serum total mast cell tryptase (MCT) in anaphylaxis. The consensus equation (peak MCT should be>1.2x baseline tryptase+2mg/L) has been proposed to interpret acute MCT in mast cell activation syndrome (MCAS).

Aim

To validate consensus equation in a setting of perioperative anaphylaxis.

Methods

Analyses of suspected perioperative anaphylaxis during general anaesthesia (GA). Anaphylaxis was defined as per World Allergy Organisation (WAO) criteria. Timed serial MCT measurements were mapped against the consensus equation and receiver operating characteristic (ROC) curves produced.

Results

82 patients (60 females, mean age 56.5 years ± SD17.2) underwent investigation. 60 (73%) patients fulfilled WAO criteria for anaphylaxis and 22 patients did not (controls). Aetiology: 59% IgE-mediated anaphylaxis, 2% non-IgE mediated anaphylaxis, 12% anaphylaxis of unknown cause, and 27% deemed non-anaphylaxis. IgE-mediated anaphylaxis included - NMBA (35%), antibiotics (46%), chlorhexidine (8%), patent blue dye (8%) and others (8%). An acute MCT with a comparable baseline was available in 71/82 (87%) patients (60-anaphylaxis and 11-controls).The median (IQR) time from reaction to peak MCT was 1.34 (0.82-2.51) hours. Analyses confirmed that a rise in acute MCT greater than that defined by the equation had a sensitivity, specificity, positive predictive value (PPV) and negative (N) PV of 78%, 91%, 98%, and 44% respectively. The magnitude of increase in acute MCT above the threshold predicted by consensus equation was higher in the anaphylaxis group compared to controls (P=0.0001).

Conclusion

This equation has a high specificity, PPV with a moderate NPV and sensitivity in perioperative anaphylaxis.

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Association between polymorphisms in pre-miRNA genes and risk of oral squamous cell cancer in a Chinese population

by Enjiao Zhang, Zhongfei Xu, Weiyi Duan, Shaohui Huang, Li Lu

Background

MicroRNAs play important roles in the development of human cancers. This case-control study is to evaluate the roles of the polymorphisms in pre-miRNAs on risk of oral cancer in a Chinese population.

Methods

The genotypes of three polymorphisms were determined in 340 patients with oral squamous cell cancer and 340 healthy controls who were frequency matched for age and sex. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated to assess the association. All analyses were performed using the SPSS software. 3.154() 0.001.

Results

For miR-499 rs3746444, individuals carrying homozygous CC genotype had increased risks of oral cancer compared with the homozygous wild TT genotype (adjusted OR was 3.154, 95%CI was 1.555–6.397, P value was 0.001). The C allele of miR-499 rs3746444 was associated with a higher risk of oral cancer with significant odds ratio of 1.453. In the stratified analyses by sex, the associations between miR-499 rs3746444 and miR-146a rs2910164 polymorphisms with the susceptibility of oral squamous cell cancer were significant in males. However, with 1/4 as many subjects there were no significant associations between the three polymorphisms and oral cancer risks in females. The joint effects of miRNA polymorphisms and smoking on the risk of OSCC were analyzed and the results suggested that the association between microRNA genetic variants and OSCC risk was modified by smoking.

Conclusions

These findings suggest that miR-499 rs3746444 and miR-146a rs2910164 polymorphisms may contribute to genetic susceptibility to oral squamous cell cancer.

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Osteosarcoma of the lower limb metastasized to the septum and right side of the heart: a case report

Metastatic cardiac tumors are far more common than primary tumors. Although the hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom ...

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Chronic exposure to tetracyclines and subsequent diagnosis for non-melanoma skin cancer in a large Midwestern U.S. patient population

Abstract

Tetracyclines (TCNs) are commonly used in the management of several chronic dermatological disorders, partly due to their affinity for inflamed skin tissue, as they are known to suppress cytokines including tumor necrosis factor-alpha and interleukin-6 that are typically involved in inflammatory skin disorders.¹ TCNs are known to be photoreactive following ultraviolet (UV) radiation exposure, a known risk factor for the development of nonmelanoma skin cancer (NMSC), notably basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).² Previous studies examining the relationship between photoreactive medications, including psoralen compounds and sulfonamide moieties, and NMSC suggest an association.

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Digit preserving surgery of subungual melanoma, a case series using vacuum assisted closure and full thickness skin grafting

Abstract

Acrolentiginous melanoma (ALM) is the second most common nail organ tumour and frequently, affects the thumb or the great toe.^1,2 Digit amputation is still the gold standard for many surgeons;³ it does, however, not protect against local recurrence. An alternative represents complete tumour resection with distal phalanx preservation, which has proven valuable, especially for well demarcated thinner tumours.^4,5

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Nodular scabies in infants: dermoscopic examination may avoid a diagnostic pitfall

Abstract

infantile scabies sometimes manifests with atypical clinical presentation, leading to misdiagnosis. Monomorphic primary lesions or different coexisting lesions may be present. Specific pediatric localizations are scalp and face¹, but in infants the most common are palms, soles and axillae. Irritability and poor feeding are more often referred by parents than itching.

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Hyperbilirubinemia: The common denominator of Yellow Urticaria

Abstract

Rosso et al recently enlarged to ten the list of patients diagnosed with yellow urticaria (YU). These cases of YU remind clinicians that the skin, besides forming a biological barrier to protect internal organs and systems from the external environment, frequently reflects underlying internal diseases.

YU has been described secondary to infective hepatitis1, liver cirrhosis (regardless of the cause) ^{2, 3, 4, 5, 6}, acute liver failure⁷, and metastatic disease of the liver⁸.

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Diagnostic accuracy of skin lesions amongst plastic surgeons and a dermatologist

Abstract

There have been few studies investigating diagnostic accuracy between plastic surgeons, or comparing this with dermatologists. Use of dermoscopy by dermatologists has widened the diagnostic gap between dermatologists and plastic surgeons, with plastic surgery lagging behind dermatology in learning this technique. Consequently, plastic surgeons are likely to have a lower threshold for performing a diagnostic or excisional biopsy than dermatologists, leading to a higher rate of intervention for lesions that could otherwise be managed non-surgically.

http://ift.tt/2roszOl

Johns Hopkins Medicine Expands Collaboration with Allegheny Health Network and Highmark

Officials at Johns Hopkins Medicine announced today an expansion of its five-year affiliation with Allegheny Health Network (AHN) and Highmark, which provide health care services and insurance to people in Western Pennsylvania, West Virginia and Delaware. The newly expanded relationship aims to support the care of patients with rare and complex adult and pediatric cancers and some organ-transplant patients, widen the portfolio of cancer clinical trials available to AHN's patients, facilitate participation in medical education, and collaborate on genomic sequencing and precision medicine research.

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Practice-Changing Study for Melanoma Surgery

A major clinical trial settles the matter of whether or not to remove all of a melanoma patient's regional lymph nodes when some 'sentinel' nodes have cancer.
Medscape Medical News

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Treating Psoriasis May Curb Vascular Inflammation

Improving psoriasis severity is associated with improvement in aortic vascular inflammation, suggesting that alleviating inflammation in the skin can favorably affect the vasculature, researchers say.
Reuters Health Information

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Tanning Bed Use Declining Among U.S. Adults

The number of U.S. adults using indoor tanning machines decreased by a third between 2010 and 2015, a recent study suggests.
Reuters Health Information

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Correction for Ferrari et al., Hypoxia treatment reverses neurodegenerative disease in a mouse model of Leigh syndrome [Correction]

MEDICAL SCIENCES Correction for "Hypoxia treatment reverses neurodegenerative disease in a mouse model of Leigh syndrome," by Michele Ferrari, Isha H. Jain, Olga Goldberger, Emanuele Rezoagli, Robrecht Thoonen, Kai-Hung Chen, David E. Sosnovik, Marielle Scherrer-Crosbie, Vamsi K. Mootha, and Warren M. Zapol, which appeared in issue 21, May 23, 2017,...

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Hidden role of intermolecular proton transfer in the anomalously diffuse vibrational spectrum of a trapped hydronium ion [Chemistry]

We report the vibrational spectra of the hydronium and methyl-ammonium ions captured in the C3v binding pocket of the 18-crown-6 ether ionophore. Although the NH stretching bands of the CH3NH3+ ion are consistent with harmonic expectations, the OH stretching bands of H3O+ are surprisingly broad, appearing as a diffuse background...

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Electron localization in rod-shaped triicosahedral gold nanocluster [Chemistry]

Atomically precise gold nanocluster based on linear assembly of repeating icosahedrons (clusters of clusters) is a unique type of linear nanostructure, which exhibits strong near-infrared absorption as their free electrons are confined in a one-dimensional quantum box. Little is known about the carrier dynamics in these nanoclusters, which limit their...

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Correction for Ding et al., Hepatitis E virus ORF3 is a functional ion channel required for release of infectious particles [Correction]

MICROBIOLOGY Correction for "Hepatitis E virus ORF3 is a functional ion channel required for release of infectious particles," by Qiang Ding, Brigitte Heller, Juan M. V. Capuccino, Bokai Song, Ila Nimgaonkar, Gabriela Hrebikova, Jorge E. Contreras, and Alexander Ploss, which appeared in issue 5, January 31, 2017, of Proc Natl...

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A helicase-independent activity of eIF4A in promoting mRNA recruitment to the human ribosome [Biophysics and Computational Biology]

In the scanning model of translation initiation, the decoding site and latch of the 40S subunit must open to allow the recruitment and migration of messenger RNA (mRNA); however, the precise molecular details for how initiation factors regulate mRNA accommodation into the decoding site have not yet been elucidated. Eukaryotic...

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Structural basis for ligand binding to an enzyme by a conformational selection pathway [Biophysics and Computational Biology]

Proteins can bind target molecules through either induced fit or conformational selection pathways. In the conformational selection model, a protein samples a scarcely populated high-energy state that resembles a target-bound conformation. In enzymatic catalysis, such high-energy states have been identified as crucial entities for activity and the dynamic interconversion between...

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Rifamycin action on RNA polymerase in antibiotic-tolerant Mycobacterium tuberculosis results in differentially detectable populations [Microbiology]

Mycobacterium tuberculosis (Mtb) encounters stresses during the pathogenesis and treatment of tuberculosis (TB) that can suppress replication of the bacteria and render them phenotypically tolerant to most available drugs. Where studied, the majority of Mtb in the sputum of most untreated subjects with active TB have been found to be...

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How an alloreactive T-cell receptor achieves peptide and MHC specificity [Immunology and Inflammation]

T-cell receptor (TCR) allorecognition is often presumed to be relatively nonspecific, attributable to either a TCR focus on exposed major histocompatibility complex (MHC) polymorphisms or the degenerate recognition of allopeptides. However, paradoxically, alloreactivity can proceed with high peptide and MHC specificity. Although the underlying mechanisms remain unclear, the existence of...

http://ift.tt/2rrYFnd

The POTRA domains of Toc75 exhibit chaperone-like function to facilitate import into chloroplasts [Plant Biology]

Protein trafficking across membranes is an essential function in cells; however, the exact mechanism for how this occurs is not well understood. In the endosymbionts, mitochondria and chloroplasts, the vast majority of proteins are synthesized in the cytoplasm as preproteins and then imported into the organelles via specialized machineries. In...

http://ift.tt/2rs4aSR

Myosin Va’s adaptor protein melanophilin enforces track selection on the microtubule and actin networks in vitro [Biochemistry]

Pigment organelles, or melanosomes, are transported by kinesin, dynein, and myosin motors. As such, melanosome transport is an excellent model system to study the functional relationship between the microtubule- and actin-based transport systems. In mammalian melanocytes, it is well known that the Rab27a/melanophilin/myosin Va complex mediates actin-based transport in vivo....

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Structure-guided evolution of antigenically distinct adeno-associated virus variants for immune evasion [Microbiology]

Preexisting neutralizing antibodies (NAbs) against adeno-associated viruses (AAVs) pose a major, unresolved challenge that restricts patient enrollment in gene therapy clinical trials using recombinant AAV vectors. Structural studies suggest that despite a high degree of sequence variability, antibody recognition sites or antigenic hotspots on AAVs and other related parvoviruses might...

http://ift.tt/2rXdd20

Mechanistic insights on the reduction of glutathione disulfide by protein disulfide isomerase [Biophysics and Computational Biology]

We explore the enzymatic mechanism of the reduction of glutathione disulfide (GSSG) by the reduced a domain of human protein disulfide isomerase (hPDI) with atomistic resolution. We use classical molecular dynamics and hybrid quantum mechanics/molecular mechanics calculations at the mPW1N/6–311+G(2d,2p):FF99SB//mPW1N/6–31G(d):FF99SB level. The reaction proceeds in two stages: (i) a thiol-disulfide...

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Input timing for spatial processing is precisely tuned via constant synaptic delays and myelination patterns in the auditory brainstem [Neuroscience]

Precise timing of synaptic inputs is a fundamental principle of neural circuit processing. The temporal precision of postsynaptic input integration is known to vary with the computational requirements of a circuit, yet how the timing of action potentials is tuned presynaptically to match these processing demands is not well understood....

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Superresolution microscopy reveals the three-dimensional organization of meiotic chromosome axes in intact Caenorhabditis elegans tissue [Cell Biology]

When cells enter meiosis, their chromosomes reorganize as linear arrays of chromatin loops anchored to a central axis. Meiotic chromosome axes form a platform for the assembly of the synaptonemal complex (SC) and play central roles in other meiotic processes, including homologous pairing, recombination, and chromosome segregation. However, little is...

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Auxin steers root cell expansion via apoplastic pH regulation in Arabidopsis thaliana [Plant Biology]

Plant cells are embedded within cell walls, which provide structural integrity, but also spatially constrain cells, and must therefore be modified to allow cellular expansion. The long-standing acid growth theory postulates that auxin triggers apoplast acidification, thereby activating cell wall-loosening enzymes that enable cell expansion in shoots. Interestingly, this model...

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Evidence for self-organization in determining spatial patterns of stream nutrients, despite primacy of the geomorphic template [Ecology]

Nutrients in freshwater ecosystems are highly variable in space and time. Nevertheless, the variety of processes contributing to nutrient patchiness, and the wide range of spatial and temporal scales at which these processes operate, obfuscate how this spatial heterogeneity is generated. Here, we describe the spatial structure of stream nutrient...

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Thermal combination therapies for local drug delivery by magnetic resonance-guided high-intensity focused ultrasound [Medical Sciences]

Several thermal-therapy strategies such as thermal ablation, hyperthermia-triggered drug delivery from temperature-sensitive liposomes (TSLs), and combinations of the above were investigated in a rhabdomyosarcoma rat tumor model (n = 113). Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) was used as a noninvasive heating device with precise temperature control for image-guided drug...

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RNA-seq reveals conservation of function among the yolk sacs of human, mouse, and chicken [Evolution]

The yolk sac is phylogenetically the oldest of the extraembryonic membranes. The human embryo retains a yolk sac, which goes through primary and secondary phases of development, but its importance is controversial. Although it is known to synthesize proteins, its transport functions are widely considered vestigial. Here, we report RNA-sequencing...

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AraC-like transcriptional activator CuxR binds c-di-GMP by a PilZ-like mechanism to regulate extracellular polysaccharide production [Microbiology]

Cyclic dimeric GMP (c-di-GMP) has emerged as a key regulatory player in the transition between planktonic and sedentary biofilm-associated bacterial lifestyles. It controls a multitude of processes including production of extracellular polysaccharides (EPSs). The PilZ domain, consisting of an N-terminal "RxxxR" motif and a β-barrel domain, represents a prototype c-di-GMP...

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Estimating the parameters of background selection and selective sweeps in Drosophila in the presence of gene conversion [Evolution]

We used whole-genome resequencing data from a population of Drosophila melanogaster to investigate the causes of the negative correlation between the within-population synonymous nucleotide site diversity (πS) of a gene and its degree of divergence from related species at nonsynonymous nucleotide sites (KA). By using the estimated distributions of mutational...

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Teen valedictorian battles cancer while working as an EMT

WVU Medicine MORGANTOWN, W.Va. — After graduating valedictorian of the Gilmer County High School Class of 2017, Tyler Moore, 18, is spending his summer as an emergency medical technician in his hometown of Glenville before he begins studying to be a doctor. He's not your typical overachiever – he has also been battling cancer for the last eight years. At age 9, Moore began experiencing ...

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Does 'job predict exposure to magnetic fields?

Koeman et al reported an association between amyotrophic lateral sclerosis and estimated exposure to extremely low-frequency magnetic fields (MF) from a cohort study in the Netherlands.1

The authors omitted to mention the most recent findings from a similarly powered cohort study from the UK electricity supply industry.2 The omission is unfortunate, not just because the UK study found no convincing associations, but also because consideration of the different exposure assessment methods used in these two studies highlights a weakness of the methods used in the Dutch study.

The Dutch study used a job-exposure matrix (JEM) to assess exposure, a modified version of the JEM published by Bowman et al in 2007.3 This latter paper highlighted the problem with assessing exposure to MF using a JEM when it states: 'The underlying assumption behind all these JEM methodologies is that jobs relate to magnetic field exposure.' That assumption is,...

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"Novel Approach for Maximizing Follow-up in Cosmetic Surgery Clinical Trials: The Ideal Implant Core Trial Experience".

BACKGROUND-: High follow-up rates are critical for robust research with minimal bias and particularly important for breast implant Core Studies seeking FDA approval. The Core Study for IDEAL IMPLANT, the most recently FDA-approved breast implant, utilized a novel incentive payment model to achieve higher follow-up rates than in previous breast implant trials. METHODS-: At enrollment, $3,500 was deposited into an independent, irrevocable trust for each of the 502 subjects and invested in a diversified portfolio. If a follow-up visit is missed, the subject is exited from the study and compensated for completed visits, but the remainder of her share of the funds stay in the trust. At the conclusion of the 10-year study, the trust will be divided among those subjects who completed all required follow-up visits. For primary and revision augmentation cohorts, FDA published follow-up rates from Core Studies were compared for all currently available breast implants. RESULTS-: Five-year follow-up rates for the IDEAL IMPLANT Core Study are higher for both primary augmentation and revision augmentation cohorts (94.9% and 96.7%, respectively) when compared to all other trials that have used FDA standardized follow-up reporting (MemoryShape,(R) Allergan 410,(R) and Sientra(R) Core Studies). CONCLUSIONS-: This trial demonstrates the utility of a novel incentive strategy to maximize follow-up in cosmetic surgery patients. This strategy may benefit future cosmetic surgery trials and perhaps any prospective research trial by providing more complete data. (C)2017American Society of Plastic Surgeons

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Antithrombotic therapies in digit replantation with papaverine administration: A prospective, observational study.

Background: The primary objective of this study was to investigate whether the application of antithrombotic therapies affects the success rate of digit replantation. Methods: Total 477 digits of 319 patients who received dextran with low molecular weight heparin (dextran-LMWH), dextran with prostaglandin E1 (dextran-PGE1), or no antithrombotic therapy after replantation of complete amputated digits from 1 January 2012 to 1 January 2016 were included in this study. Papaverine were given by intramuscular injection to all patients with 90mg/day postoperatively. Results: There was no significant difference in all potential risk factors including age, smoking, Tamai's level of amputation, causes of injury and warm ischemia time among groups. The survival rate of digits from patients who received dextran-LMWH, dextran-PGE1, or no antithrombotic therapy had no significant difference. Conclusions: Antithrombotic therapies showed no significant benefit for digital replantation in patients receiving papaverine. (C)2017American Society of Plastic Surgeons

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Immediate Breast Reconstruction with Abdominal Free Flap and Adjuvant Radiotherapy, Evaluation of Quality of Life and Outcomes.

Background: The effects of postoperative radiotherapy on free flap based breast reconstruction are still controversial. Poor outcomes, breast distortion and fat necrosis have been traditionally documented. The aim of this study was to evaluate whether adjuvant radiotherapy affects the quality of life, satisfaction and cosmetic result in patients undergoing immediate breast reconstruction with autologous free flap. Methods: Between January 2013 and December 2016, 230 patients underwent mastectomy with immediate free flap reconstruction at the authors institution. Patients were divided in two groups depending on having received PMRT (Post mastectomy radiotherapy). Quality of life measured with BREAST Q questionnaire, self-reported aesthetic outcomes and general satisfaction were assessed and compared. Fat necrosis of the flap and its severity was also analysed as the main surgical outcome. Results: Mean follow-up time after reconstruction was 23 months (6-48 months) No significant difference in quality of life or satisfaction scores were found between patients that underwent PMRT and patients who did not receive adjuvant RT. There were no significant differences in rates of fat necrosis among both groups. (11.1% vs 13.76% p=0.75) Conclusions: PMRT in patients undergoing immediate breast reconstruction with free flap does not seem to affect quality of life, satisfaction with the outcome and the cosmetic result as perceived by the patients. The potential need for postoperative radiotherapy should not hinder women from the benefits of autologous immediate breast reconstruction. (C)2017American Society of Plastic Surgeons

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Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetrical Brachial Plexus Injury.

Background: Upper trunk obstetrical brachial plexus injury (OBPI) can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and healthcare costs between nerve grafting and distal nerve transfers in children with upper trunk OBPI. Methods: In this prospective cohort study, children who received triple nerve transfers were followed with the Active Movement Scale (AMS) for 2 years. Their outcomes were compared to children who underwent nerve graft reconstruction. To assess healthcare utilization, a cost analysis was also performed. Results: Twelve patients who underwent nerve grafting were compared to 14 patients who underwent triple nerve transfers. Both groups had similar baseline characteristics and showed improved shoulder and elbow function following surgery. However, the nerve transfer group displayed significantly greater improvement in shoulder external rotation and forearm supination 2 years post-surgery (p

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Factors Associated with Lymphosclerosis: An Analysis on 962 Lymphatic Vessels.

Background: Lymphaticovenular anastomosis (LVA) is a useful treatment option for compression-refractory lower extremity lymphedema (LEL), but its efficacy largely depends on severity of lymphosclerosis. To maximize LVA efficacy, it is important to elucidate factors associated with severe lymphosclerosis (SLS). Methods: Medical charts of 134 LEL patients who underwent preoperative indocyanine green (ICG) lymphography and LVA were reviewed to obtain data of clinical demographics, ICG lymphography findings, and intraoperative findings. Based on intraoperative findings of lymphatic vessels, severity of lymphosclerosis were classified into s0, s1, s2, and s3. Lymphatic vessels with s3 sclerosis was defined as SLS. Logistic regression analysis was used to identify independent factors associated with SLS. Results: In total, 962 lymphatic vessels were analyzed, among which SLS was observed in 97 (10.1%). Multivariate analysis revealed that independent factors associated with SLS were higher body mass index (odds ration [OR], 1.803; 95% confidence interval [CI], 1.041-3.123; P = 0.035), incision site in the thigh/foot compared with in the groin (OR, 2.355/4.471; 95% CI 1.201-4.617/2.135-9.362; P = 0.013/

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Propensity score-matching analysis of postoperative radiotherapy for stage IIIA-N2 non-small cell lung cancer using the Surveillance, Epidemiology, and End Results database

To investigate the effects of postoperative radiotherapy (PORT) on the survival of patients with resected stage IIIA-N2 non-small cell lung cancer (NSCLC).

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Transanal Hartmann’s colostomy reversal assisted by laparoscopy: outcomes of the first 10 patients

Abstract

Introduction

Restoration of intestinal continuity after Hartmann's procedure is a technically difficult surgery associated with significant morbidity and mortality. This study presents the short-term results of a new approach: a transanal Hartmann's colostomy reversal assisted by laparoscopy.

Method

This is a retrospective analysis of data collected in one tertiary hospital, from October 2013 to November 2015.

Results

During the study period, there were ten cases of transanal Hartmann's reversal. Reasons for Hartmann's procedure were: complicated diverticulitis (4), anastomotic leak (3), and recto-sigmoid cancer (3). Rectal stump length was 10.4 ± 4.5 cm. Reconstruction was achieved in all patients. One low colorectal anastomosis was hand-sewn, the other 9 were stapled. Mean operative time was 204 ± 65 min. Diverting loop ileostomies were created in five patients and all were closed during the following year. One case required hand-assistance but there was no conversion to open surgery. Iatrogenic laparoscopic enterotomies occurred in four patients and all were repaired primarily without consequences. Three patients had a total of four post-operative complications: ileus (2), abdominal abscess and wound infection (1). None required reoperation. Mean length of stay was 7.2 ± 4.3 days. One required readmission.

Conclusion

A transanal Hartmann's reversal assisted by laparoscopy is a new approach for a difficult surgery. It has the potential to be an additional tool in the case of hostile pelvises or with a rectal stump difficult to identify. The surgery remains challenging and indications need to be clarified.

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Analysis of adipose tissue immune gene expression after vaccination of rainbow trout with adjuvanted bacterins reveals an association with side effects

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Kimberly A. Veenstra, Tiehui Wang, Ayham Alnabulsi, Alex Douglas, K. Spencer Russell, Lincoln Tubbs, Juliette Ben Arous, Christopher J. Secombes
Most existing fish vaccines are presented in the form of oil-based emulsions delivered by intraperitoneal injection. Whilst very effective they are frequently associated with inflammatory responses that can result in clinically significant side-effects often involving the adipose tissue that is in direct contact with the vaccine. To explore the potential of immune gene expression changes in the adipose tissue of fish to be markers of vaccination efficacy or development of side-effects we have studied the response to a bacterial (Aeromonas salmonicida) vaccine administered with two different adjuvants. The first adjuvant was Montanide™ ISA 763A VG, thought to induce a mostly humoral response, and the second was Montanide™ ISA 761 VG that gives a more balanced humoral and cell mediated response. Following vaccination tissue samples were collected at days 3, 14 and 28 for RTqPCR analysis. Fifty immune genes were studied with a focus on a) pro-inflammatory associated molecules and b) adaptive immune response related molecules linked with possible Th1, Th2, Th17 and T-regulatory pathways, with the expression data analysed for associations with Speilberg post-vaccination side effect scores. The results showed that the adipose tissue is a particularly sensitive and discriminatory tissue for studying adjuvant effects. A clear upregulation of many immune genes occurred in response to both vaccine groups, which persisted over time and overlapped with the appearance of visible adhesions. Our analysis revealed a relationship between adipose tissue immune function and the development of vaccine-induced adhesions giving the potential to use immune gene expression profiling in this tissue to predict the side-effects seen.

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Antidepressant Actions of Ketamine Mediated by the Mechanistic Target of Rapamycin, Nitric Oxide, and Rheb

Abstract

The weeks/months it takes for traditional antidepressants to act pose an obstacle in the management of depression. Ketamine's prompt and sustained antidepressant effects constitute a major advance. Multiple studies implicate glutamatergic signaling to protein synthesis machinery and synapse formation in ketamine's antidepressant effects. Here we review evidence linking ketamine to glutamate receptor subtypes and protein homeostasis. We describe a signaling cascade wherein nitric oxide drives the formation of a ternary protein complex comprised of glyceraldehyde 3-phosphate dehydrogenase, seven in absentia homolog 1, and Ras homolog enriched in brain downstream of the glutamate N-methyl-D-aspartate receptor. Seven in absentia homolog 1 ubiquitylates and degrades Ras homolog enriched in brain leading to inhibition of mechanistic target of rapamycin. Ketamine inhibits this molecular cascade leading to activation of mechanistic target of rapamycin and, in turn, to antidepressant actions.

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Gasdermins: Effectors of Pyroptosis

Publication date: Available online 12 June 2017
Source:Trends in Cell Biology
Author(s): Stephen B. Kovacs, Edward A. Miao
Pyroptosis is a form of lytic programmed cell death initiated by inflammasomes, which detect cytosolic contamination or perturbation. This drives activation of caspase-1 or caspase-11/4/5, which cleave gasdermin D, separating its N-terminal pore-forming domain (PFD) from the C-terminal repressor domain (RD). The PFD oligomerizes to form large pores in the membrane that drive swelling and membrane rupture. Gasdermin D is one of six (in humans) gasdermin family members; several other gasdermins have also been shown to form pores that cause pyroptosis after cleavage to activate their PFDs. One of these, gasdermin E, is activated by caspase-3 cleavage. We review our current understanding of pyroptosis as well as current knowledge of the gasdermin family.

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A Comparison of Coverbal Gesture Use in Oral Discourse Among Speakers With Fluent and Nonfluent Aphasia

Purpose

Coverbal gesture use, which is affected by the presence and degree of aphasia, can be culturally specific. The purpose of this study was to compare gesture use among Cantonese-speaking individuals: 23 neurologically healthy speakers, 23 speakers with fluent aphasia, and 21 speakers with nonfluent aphasia.

Method

Multimedia data of discourse samples from these speakers were extracted from the Cantonese AphasiaBank. Gestures were independently annotated on their forms and functions to determine how gesturing rate and distribution of gestures differed across speaker groups. A multiple regression was conducted to determine the most predictive variable(s) for gesture-to-word ratio.

Results

Although speakers with nonfluent aphasia gestured most frequently, the rate of gesture use in counterparts with fluent aphasia did not differ significantly from controls. Different patterns of gesture functions in the 3 speaker groups revealed that gesture plays a minor role in lexical retrieval whereas its role in enhancing communication dominates among the speakers with aphasia. The percentages of complete sentences and dysfluency strongly predicted the gesturing rate in aphasia.

Conclusions

The current results supported the sketch model of language–gesture association. The relationship between gesture production and linguistic abilities and clinical implications for gesture-based language intervention for speakers with aphasia are also discussed.

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Automated Assessment of Child Vocalization Development Using LENA

Purpose

To produce a novel, efficient measure of children's expressive vocal development on the basis of automatic vocalization assessment (AVA), child vocalizations were automatically identified and extracted from audio recordings using Language Environment Analysis (LENA) System technology.

Method

Assessment was based on full-day audio recordings collected in a child's unrestricted, natural language environment. AVA estimates were derived using automatic speech recognition modeling techniques to categorize and quantify the sounds in child vocalizations (e.g., protophones and phonemes). These were expressed as phone and biphone frequencies, reduced to principal components, and inputted to age-based multiple linear regression models to predict independently collected criterion-expressive language scores. From these models, we generated vocal development AVA estimates as age-standardized scores and development age estimates.

Result

AVA estimates demonstrated strong statistical reliability and validity when compared with standard criterion expressive language assessments.

Conclusions

Automated analysis of child vocalizations extracted from full-day recordings in natural settings offers a novel and efficient means to assess children's expressive vocal development. More research remains to identify specific mechanisms of operation.

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Speech-Processing Fatigue in Children: Auditory Event-Related Potential and Behavioral Measures

Purpose

Fatigue related to speech processing is an understudied area that may have significant negative effects, especially in children who spend the majority of their school days listening to classroom instruction.

Method

This study examined the feasibility of using auditory P300 responses and behavioral indices (lapses of attention and self-report) to measure fatigue resulting from sustained listening demands in 27 children (M = 9.28 years).

Results

Consistent with predictions, increased lapses of attention, longer reaction times, reduced P300 amplitudes to infrequent target stimuli, and self-report of greater fatigue were observed after the completion of a series of demanding listening tasks compared with the baseline values. The event-related potential responses correlated with the behavioral measures of performance.

Conclusion

These findings suggest that neural and behavioral responses indexing attention and processing resources show promise as effective markers of fatigue in children.

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Analysis of adipose tissue immune gene expression after vaccination of rainbow trout with adjuvanted bacterins reveals an association with side effects

Safer alternative for extraction of impacted supernumerary teeth of a patient in the mixed dentition stage with the aid of an image-guided operating system

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5
Author(s): W. Wang, M. Somar, K. Lv

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Long acting systemic HIV pre-exposure prophylaxis: an examination of the field

Abstract

Oral pre-exposure prophylaxis for the prevention of HIV-1 transmission (HIV PrEP) has been widely successful as demonstrated by a number of clinical trials. However, studies have also demonstrated the need for patients to tightly adhere to oral dosing regimens in order to maintain protective plasma and tissue concentrations. This is especially true for women, who experience less forgiveness from dose skipping than men in clinical trials of HIV PrEP. There is increasing interest in long-acting (LA), user-independent forms of HIV PrEP that could overcome this adherence challenge. These technologies have taken multiple forms including LA injectables and implantables. Phase III efficacy trials are ongoing for a LA injectable candidate for HIV PrEP. This review will focus on the design considerations for both LA injectable and implantable platforms for HIV PrEP. Additionally, we have summarized the existing LA technologies currently in clinical and pre-clinical studies for HIV PrEP as well as other technologies that have been applied to HIV PrEP and contraceptives. Our discussion will focus on the potential application of these technologies in low resource areas, and their use in global women's health.

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Fluorescent miRNA analysis enhanced by mesopore effects of polydopamine nanoquenchers

Analyst, 2017, Accepted Manuscript
DOI: 10.1039/C7AN00528H, Paper

Zhenqiang Wang, Jixi Zhang, Feng Chen, Kaiyong Cai
The combination of fluorophore-labelled single-strand DNA probes and nanomaterial quenchers has shown great potential in miRNA detection. The development of advanced detection systems by understanding and controlling the fluorescence quenching/recovery...
The content of this RSS Feed (c) The Royal Society of Chemistry

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ARLTS1 polymorphism is associated with an increased risk of familial cancer: evidence from a meta-analysis

Abstract

Adenosine diphosphate (ADP)-ribosylation factor-like tumour suppressor gene 1(ARLTS1) might be associated with an increased risk of several types of familial cancers. However, previous studies have shown that cancer susceptibility is not completely consistent with ARLTS1 polymorphisms, and the precise mechanism remains unknown. Therefore, we conducted a meta-analysis of case-control studies by searching the PubMed, Embase, OVID, Science Direct and Chinese National Knowledge Infrastructure (CNKI) databases. In total, 12 studies met the inclusion criteria and were included in this meta-analysis. Statistical analyses were performed using STATA 11.0 software. Overall, the Cys148Arg T > C variant significantly increased cancer risk (CC vs. TT: OR = 1.27, 95% CI = 1.15–1.41, P < 0.05). The stratification indicated that the Cys148Arg variant is significantly associated with sporadic cancer (CC vs. TT: OR = 1.36, 95% CI = 1.18–1.55) and familial cancer (CC vs. TT: OR = 1.26, 95% CI = 1.12–1.43). Trp149Stop, Pro131Leu, Ser99Ser and Leu132Leu were not correlated with cancer susceptibility. Based on these results, we demonstrated that the ARLTS1 Cys148Arg polymorphism is associated with an increased risk of sporadic cancer and familial cancer, and there were no associations between the other four SNPs (i.e., Trp149Stop, Pro131Leu, Ser99Ser and Leu132Leu) and cancer risk.

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Editorial Board

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5

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Challenging hierarchy in healthcare teams – ways to flatten gradients to improve teamwork and patient care

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5
Author(s): B. Green, R.S. Oeppen, D.W. Smith, P.A. Brennan
In healthcare, mistakes that are potentially harmful or fatal to patients are often the result of poor communication between members of a team. This is particularly important in high-risk areas such as operating theatres or during any intervention, and the ability to challenge colleagues who are in authority when something does not seem right or is clearly wrong, is crucial. Colleagues in oral and maxillofacial surgery recognised the importance of this as early as 2004, and it is now well known that failure or reluctance to challenge others who might be wrong can severely compromise a patient's safety. The Royal College of Surgeons of Edinburgh runs popular regular courses (Non-technical Skills for Surgeons, NOTSS) that teach how to ensure safety through good communication and teamwork. In this paper we introduce the concept of hierarchical challenge, and discuss models and approaches to address situations when problems arise within a team.

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Three-dimensional facial changes correlated with sagittal jaw movements in patients with class III skeletal deformities

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5
Author(s): M. Verdenik, N. Ihan Hren
The aim of this prospective study was to correlate the postoperative 3-dimensional facial changes in skeletal class III deformity with sagittal jaw movements in 84 patients who had been treated by one piece Le Fort I maxillary advancement only (n=18), mandibular setback only (n=38), or both procedures (n=28). At the times of evaluation before and six months after operation all patients had fixed orthodontic appliances. Soft tissue changes were evaluated on optical 3-dimensional scans, while lateral cephalograms were superimposed to assess sagittal jaw movements. Three-dimensional surface facial scans were divided into 11 regions. We modelled soft tissue changes in each region by linear regression with maxillary (point A) and mandibular (point B) sagittal movements as predictors, and adjusted for sex, age, body mass index, type of operation, and interincisal angle. We found the highest values of regression coefficients (around 0.5) for the sagittal movements of the variables points A and B within the regions of the upper and lower lips. This meant that for each mm of maxillary advancement and mandibular setback, the soft tissue moved 0.5mm. In the sides of the face the regression coefficients were between 0.1 and 0.3, as were those within regions indirectly affected by the operations.

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Training Groups

Use of Thudichum nasal speculum for retraction during insertion of dental implants

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5
Author(s): Ashwant Kumar Vadepally, Ramen Sinha

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Oxygen activation by copper complexes with an aromatic bis(guanidine) ligand

Combining the new aromatic bis(guanidine) ligand bis(tetramethylguanidino)toluene (TMG2tol) and different copper salts led to four new complexes. The molecular structures were analysed by X-ray diffraction. Three of the complexes are active for biomimetic activation of oxygen. It is the first time a bis-µ-oxido species of an aromatic guanidine copper complex is analysed by Raman and UV/Vis spectroscopy. The formation and decay of the dicopper bis-µ-oxido species was investigated at low temperatures up to 273 K by UV/Vis spectroscopy with a stopped-flow setup. The results showed that the Cu2O2 intermediate of an aromatic guanidine copper complex decays much faster than most known bis(guanidine) complexes. Moreover, natural bond orbital (NBO) analyses revealed that the aromatic guanidine is the stronger donor compared to the aliphatic one.

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Measurement of the Maximum Frequency of Electroglottographic Fluctuations in the Expiration Phase of Volitional Cough as a Functional Test for Cough Efficiency

Abstract

The hypotheses of the present study were that the maximum frequency of fluctuation of electroglottographic (EGG) signals in the expiration phase of volitional cough (VC) reflects the cough efficiency and that this EGG parameter is affected by impaired laryngeal closure, expiratory effort strength, and gender. For 20 normal healthy adults and 20 patients diagnosed with unilateral vocal fold paralysis (UVFP), each participant was fitted with EGG electrodes on the neck, had a transnasal laryngo-fiberscope inserted, and was asked to perform weak/strong VC tasks while EGG signals and a high-speed digital image of the larynx were recorded. The maximum frequency was calculated in the EGG fluctuation region coinciding with vigorous vocal fold vibration in the laryngeal HSDIs. In addition, each participant underwent spirometry for measurement of three aerodynamic parameters, including peak expiratory air flow (PEAF), during weak/strong VC tasks. Significant differences were found for both maximum EGG frequency and PEAF between the healthy and UVFP groups and between the weak and strong VC tasks. Among the three cough aerodynamic parameters, PEAF showed the highest positive correlation with the maximum EGG frequency. The correlation coefficients between the maximum EGG frequency and PEAF recorded simultaneously were 0.574 for the whole group, and 0.782/0.717/0.823/0.688 for the male/female/male-healthy/male-UVFP subgroups, respectively. Consequently, the maximum EGG frequency measured in the expiration phase of VC was shown to reflect the velocity of expiratory airflow to some extent and was suggested to be affected by vocal fold physical properties, glottal closure condition, and the expiratory function.

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Base-Promoted, Deborylative Secondary Alkylation of N-Heteroaromatic N-Oxides with Internal gem-Bis[(pinacolato)boryl]alkanes: A Facile Derivatization of 2,2[prime or minute]-Bipyridyl Analogues

Chem. Commun., 2017, Accepted Manuscript
DOI: 10.1039/C7CC03731G, Communication

Chiwon Hwang, woohyun jo, Seung Hwan Cho
A base-promoted, secondary alkylation of N-heteroaromatic N-oxides using internal gem-bis[(pinacolato)boryl]alkanes as alkylation reagents is reported. The reaction exhibit broad scope, providing deoxygenated secondary alkylated N-heteroaromatic compounds with high efficiency. The...
The content of this RSS Feed (c) The Royal Society of Chemistry

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Erratum to: Effects of platelet rich plasma (PRP) on human gingival fibroblast, osteoblast and periodontal ligament cell behaviour

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Analysis of Pressure Distribution During Direct Microlaryngoscopy

Publication date: Available online 12 June 2017
Source:Journal of Voice
Author(s): Busheng Tong, Rui Fang
ObjectiveThis study aimed to investigate the pressure distribution during direct microlaryngoscopy and its relation with the positioning of the patient.Study DesignThis is a prospective study in cadavers.Materials and MethodsThe pressure distribution during direct microlaryngoscopy was investigated in five adult fresh cadavers by using matrix-based piezoresistive thin-film sensors. The pressure among three head and neck positions (extension-extension, neutral, and flexion-extension) was studied.ResultsThe real-time pressure and its distribution were recorded as 3-D contours. The map commonly showed two peak pressure points, with one focused on the middle of the laryngoscope (peak pressure 1) and the other one focused on the distal part of the laryngoscope (peak pressure 2). The mean average pressure in this study was 38 ± 13 kPa, and the flexion-extension position had the lowest average pressure and peak pressure. However, the average pressure and peak pressure 1 showed no significant difference among the three positions (P > 0.05); peak pressure 2 in the flexion-extension position was significantly lower than that in the extension-extension position (P = 0.024) and the neutral position (P = 0.020).ConclusionsThe results of this study indicate that the flexion-extension position induced lower pressure exerted on the laryngoscope and is an optimal position for direct microlaryngoscopy. Hyoid bone may play an important role in the pressure exerted.

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A value proposition: In the quest to minimize low-value cancer care, the effort to raise quality and lower costs remains a work in progress

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Issue Information

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The critical role of EBUS-TBNA cytology in the staging of mediastinal lymph nodes in lung cancer patients: A correlation study with positron emission tomography findings

BACKGROUND

The sensitivity and specificity of positron emission tomography (PET) have been significantly improved for the identification of malignancies in recent years; however, it is still necessary to confirm PET findings in a lymph node (LN) by direct tissue sampling. Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is the most commonly used approach for diagnosing and staging mediastinal LNs, particularly in lung cancer patients with locally advanced disease. Despite this fact, evidence-based studies of EBUS-TBNA cytology and PET findings are still suboptimal.

METHODS

The electronic database at the Johns Hopkins Medical Institutions and the pathology archives were searched to identify patients with mediastinal lymphadenopathy who had both EBUS-TBNA mediastinal LN sampling and a PET scan over a 14-month period. Patients suspected of having lung cancer and patients with a history of lung cancer were included in this study. Cytological diagnoses and follow-up surgical LN diagnoses were reviewed and correlated with PET scan findings.

RESULTS

A total of 140 LNs from 79 patients, including 86 PET-positive LNs and 54 PET-negative LNs, were included. The most frequently sampled LNs were 4R and 7. The average size of PET-positive and PET-negative LNs was 1.2 and 1.6 cm, respectively. Among PET-positive LNs, 41.9% were malignant, 41.9% showed reactive changes or granulomatous inflammation, and 9.3% were nondiagnostic by EBUS-TBNA. However, among PET-negative LNs, 74.1% showed reactive changes or granulomatous inflammation, 7.4% were malignant, and 18.5% were nondiagnostic by EBUS-TBNA.

CONCLUSIONS

The data demonstrate that EBUS-TBNA cytology improves the diagnostic accuracy of mediastinal LNs and clinical staging. Furthermore, EBUS-TBNA may identify additional malignant LNs (7.4%), and this highlights the risk for false-negative findings with PET scanning in isolation. Cancer (Cancer Cytopathol) 2017. © 2017 American Cancer Society.

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Two different techniques of manufacturing TMJ replacements – a technical report

Publication date: Available online 12 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Marcin Kozakiewicz, Tomasz Wach, Piotr Szymor, Rafał Zieliński
IntroductionPresently, during the surgical treatment of the patients in maxillofacial surgery, one can use various medical implants. Moreover custom made implants are being used. Replacements may be fitted to the structure and shape of the human skull owing to CAD/CAM (custom aided design/manufacture) called customized implants. This study was aimed to report for the first time clinical material from which custom implants, using two different techniques, were manufactured to reconstruct the temporomandibular joint (TMJ).Material and methodsIn this study, eleven patients with an average age of 54 years were included. All of the patients underwent TMJ reconstruction using direct metal laser sintering (DMLS) or computer numerical control milling (CNC) techniques for implant manufacture. Four of the eleven patients had a malignancy diagnosis, and seven had a benign diagnosis. Patients complained of hypomobility of the TMJ, facial asymmetry, pain and swelling of the preauricular region. Treatment included 7 CNC milled implants and 4 implants in DMLS.ResultsMore metallic implant parts with a rough surface were associated with the DMLS technique. Post operational, uneventful healing was observed in all clinical cases during an average of 26.8 months of follow-up. Three months post-operation, facial nerve palsy, swallowing disturbances and pain were not observed. Infections, allergic reactions to materials and re-ankylosis were also not observed. Replacements received correct forms and functions owing to the CAM techniques. Post-operational maximal interincisal opening improved (p<0.01) and was not significantly related to preoperational opening, age, sex, diagnosis or adjuvant radiotherapy.ConclusionConsidering both methods, the feature that differentiates the manufacture technique is the more subtractive surface finishing required for the DMLS implant than the CNC implant. Both techniques resulted the same clinical outcomes and can be used successfully in patients with neoplastic lesions and other TMJ disorders. Unfortunately, DMLS is more vulnerable to fracture.

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The prognostic value of proton magnetic resonance spectroscopy in term newborns treated with therapeutic hypothermia following asphyxia

Publication date: Available online 12 June 2017
Source:Magnetic Resonance Imaging
Author(s): Paul E. Sijens, Katharina Wischniowsky, Hendrik J. ter Horst
ObjectiveThe purpose of this study was to correlate brain metabolism assessed shortly after therapeutic hyperthermia by ¹H magnetic resonance spectroscopy (MRS), with neurodevelopmental outcome.MethodsAt the age of 6.0±1.8days, brain metabolites of 35 term asphyxiated newborns, treated with therapeutic hypothermia, were quantified by multivoxel proton MRS of a volume cranial to the corpus callosum, containing both gray and white matter. At the age of 30months the Bayley Scale of Infant Development-III was performed.ResultsInfants that died had lower gray matter NAA levels than infants that survived (P=0.005). In surviving infants (28 of 35) there was a trend of negative correlation between gray matter choline levels and gross motor outcome (r=−0.45). In the white matter, choline correlated negatively with fine motor skills (r=−0.40), and creatine positively with gross motor skills (r=0.58, P=0.02). There was no relationship between lactate levels and outcome.ConclusionMRS of asphyxiated neonates treated by therapeutic hypothermia can serve as predictor of outcome. Unlike previously reported associations in untreated asphyxiates, lactate levels had no relationship with outcome, which indicates that one of the working mechanisms of therapeutic hypothermia is reduction of the metabolic rate.

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Methylation markers differentiate thyroid cancer from benign nodules

Abstract

Purpose

The incidence of thyroid cancer (TC) is increasing. Cytology by itself cannot distinguish TC from some benign nodules especially in certain subtypes of TC. Our immediate goal is to identify DNA methylation markers for early detection of TC and to molecularly differentiate TC subtypes from benign nodules.

Methods

Promoter methylation status of 21 candidate genes was examined on formalin-fixed paraffin-embedded tissue (FFPE) utilizing quantitative methylation-specific polymerase chain reaction (QMSP) in a retrospective cohort of 329 patients (56% white, 29% African American, 61% female) comprising 71 normal thyroid, 83 benign nodules [follicular adenomas (FA)], 90 follicular TC (FTC) and 85 papillary TC (PTC). All genes were analyzed individually (Kruskal–Wallis and Wilcoxon rank sum tests) and in combination (logistic regression models) to identify genes whose methylation levels might best separate groups.

Results

Combination gene panels TPO and UCHL1 (ROC = 0.607, sensitivity 78%) discriminated FTC from FA, and RASSF1 and TPO (ROC = 0.881, sensitivity 78%) discriminated FTC from normal. Methylation of TSHR distinguished PTC from FTC (ROC = 0.701, sensitivity 84%) and PTC from FA (ROC = 0.685, sensitivity 70%). The six gene panel of TIMP3, RARB2, SERPINB5, RASSF1, TPO and TSHR, which differentiates PTC from normal thyroid, had the best combination sensitivity (91%) and specificity (81%) of the panels addressing discrimination of cancer tissue.

Conclusions

Aberrant gene methylation used in combination panels may be useful clinically in differentiating FTC and PTC from benign nodules. If confirmed in additional studies, these findings could help reduce the over diagnosis of thyroid cancer and surgeries related to over diagnosis.

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Management of unresectable, locally advanced pancreatic adenocarcinoma

Abstract

The diagnosis of unresectable locally advanced pancreatic adenocarcinoma (LAPC) requires confirmation, through imaging tests, of the unfeasibility of achieving a complete surgical resection, in the absence of metastatic spread. The increase in overall survival (OS), together with an appropriate symptom management is the therapeutic target in LAPC, maintaining an acceptable quality of life and, if possible, increasing the time until the appearance of metastasis. Chemoradiation (CRT) improves OS compared to best support treatment or radiotherapy (RT) but with greater toxicity. No significant increase in OS has been achieved with CRT when compared to chemotherapy (QT) alone in patients without disease progression after four months of treatment with QT. However, a significantly better local control, that is, a significant increase in the time to disease progression was associated with this approach. The greater effectiveness of the schemes FOLFIRINOX and gemcitabine (Gem) + Nab-paclitaxel compared to gemcitabine alone, has been extrapolated from metastatic disease to LAPC, representing a possible alternative for patients with good performance status (ECOG 0–1). In the absence of randomized clinical trials, Gem is the standard treatment in LAPC. If disease control is achieved after 4–6 cycles of QT, the use of CRT for consolidation can be considered an option vs QT treatment maintenance. Capecitabine has a better toxicity profile and effectiveness compared to gemcitabine as a radiosensitizer. After local progression, and without evidence of metastases, treatment with RT or CRT, in selected patients, can support to maintain the regional disease control.

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Neoadjuvant treatment for borderline and resectable pancreatic ductal adenocarcinoma

Abstract

Nowadays and given the improvement in response rate with the new schemes of treatment with chemotherapy, the interest in neoadjuvant treatment for pancreatic ductal adenocarcinoma, allowing the early application of systemic therapies, has also increased. However, treatment selection fundamentally depends on decisions taken by multidisciplinary committees due to the absence of randomized trials on this indication and because the available evidence is based primarily on small studies. The present manuscript tries to establish recommendations based on the available evidence and expert opinion to correctly select the indication, the type of treatment, as well as its duration and how to correctly follow-up patients during treatment with chemotherapy.

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Penetrating cardiac trauma: analysis of 240 cases from a hospital in Bogota, Colombia

Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteri...

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Midostaurin: First Global Approval

Abstract

Midostaurin (Rydapt^®) is a multikinase inhibitor being developed by Novartis Pharmaceuticals. In April 2017, midostaurin was approved in the USA for the treatment of adult patients with newly diagnosed, FMS-like tyrosine kinase 3 (FLT3) mutation-positive acute myeloid leukaemia (AML) [in combination with standard cytarabine and daunorubicin induction, and cytarabine consolidation], or aggressive systemic mastocytosis (ASM), systemic mastocytosis with associated haematological neoplasm (SM-AHN) or mast cell leukaemia (MCL) [collectively known as advanced SM]. The article summarizes the milestones in the development of midostaurin leading to this first global approval.

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Clinical Pharmacokinetics of Levornidazole in Elderly Subjects and Dosing Regimen Evaluation Using Pharmacokinetic/Pharmacodynamic Analysis

Publication date: Available online 12 June 2017
Source:Clinical Therapeutics
Author(s): Beining Guo, Gaoli He, Xiaojie Wu, Jicheng Yu, Guoying Cao, Yi Li, Yaxin Fan, Yuancheng Chen, Yaoguo Shi, Yingyuan Zhang, Jing Zhang
PurposeLevornidazole, the levo-isomer of ornidazole, is a third-generation nitroimidazole derivative newly developed after metronidazole, tinidazole, and ornidazole. An open-label, parallel-controlled, single-dose study was conducted for the investigation of the pharmacokinetic (PK) profile of levornidazole and its metabolites in healthy elderly Chinese subjects, and for the evaluation of 2 dosing regimens in the elderly.MethodsLevornidazole was intravenously administered at 500 mg to healthy elderly (aged 60–80 years) or young subjects (aged 19–45 years). The PK profiles of levornidazole and its metabolites in elderly subjects were evaluated and compared with those in the young group. WinNonlin software was used for simulating the PK profile of levornidazole in the elderly population following the dosing regimens of 500 mg BID and 750 mg once daily for 7 days. Monte Carlo simulation was used for estimating the cumulative fraction of response and probability of target attainment of both dosing regimens against Bacteroides spp.ResultsThe Cmax, AUC0–24, and AUC0–∞ values of levornidazole in the elderly group were 11.98 μg/mL, 131.36 μg·h/mL, and 173.61 μg·h/mL, respectively. The t1/2, CLt, and mean residence time from time 0 to infinity were 12.21 hours, 2.91 L/h, and 16.46 hours. The metabolic ratios of metabolites (M) 1, 2, 4, and 6 were <3.0%, and that of M16 was 17.70%. The urinary excretion values of levornidazole, M1, M2, M4, M6, and M16 over 96 hours were 10.21%, 0.92%, ~0%, 2.69%, 0.54%, and 41.98%. The PK properties of levornidazole and the urinary excretion of all metabolites were not statistically different between the 2 groups. The cumulative fraction of response was >90% against B fragilis and other Bacteroides spp, and the probability of target attainment was >90% when the minimum inhibitory concentration was ≤1 μg/mL, in both groups.ImplicationsNo dosing regimen adjustment is suggested when levornidazole is used in elderly patients with normal hepatic functioning and mild renal dysfunction. The findings from the PK/PD analysis imply that both regimens may achieve satisfactory clinical and microbiological efficacy against anaerobic infections in elderly patients. Chinese Clinical Trial Registry (http://ift.tt/1hvxAeO) identifier: ChiCTR-OPC-16007938.

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Masthead

Publication date: April 2017
Source:Clinical Therapeutics, Volume 39, Issue 4

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Masthead

Publication date: May 2017
Source:Clinical Therapeutics, Volume 39, Issue 5

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To be disordered or not to be disordered: is that still a question for proteins in the cell?

Abstract

There is ample evidence that many proteins or regions of proteins lack a well-defined folded structure under native-like conditions. These are called intrinsically disordered proteins (IDPs) or intrinsically disordered regions (IDRs). Whether this intrinsic disorder is also their main structural characteristic in living cells has been a matter of intense debate. The structural analysis of IDPs became an important challenge also because of their involvement in a plethora of human diseases, which made IDPs attractive targets for therapeutic development. Therefore, biophysical approaches are increasingly being employed to probe the structural and dynamical state of proteins, not only in isolation in a test tube, but also in a complex biological environment and even within intact cells. Here, we survey direct and indirect evidence that structural disorder is in fact the physiological state of many proteins in the proteome. The paradigmatic case of α-synuclein is used to illustrate the controversial nature of this topic.

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Assessing the Feasibility and Effectiveness of an App in Improving Knowledge on Oral Cancer—an Interventional Study

Abstract

Although current oral health care initiatives have proved to be quite successful, a great number of individuals are unaware of how their choice of daily activities compromises their oral health. That is why newer technologies like WhatsApp can definitely serve as a platform to communicate dental advice, thereby strengthening the bridge between health and technology. The objective of the study was to assess the effectiveness of WhatsApp as a tool for providing health education on tobacco and oral cancer as compared to the conventional health education via PowerPoint. The study was a cluster randomized controlled trial, single-center study. The students of 18–24 years of age with WhatsApp application active in their mobile phones were included. Four classes with 182 students were randomly divided into intervention and control groups. Control group received health education on oral cancer using a PowerPoint presentation weekly, for a total of 4 weeks. Intervention group received health education through WhatsApp messaging thrice a week for 4 weeks. Pre- and post-health education knowledge scores were assessed using a questionnaire and compared using unpaired and paired two-sample t tests. Statistically significant increase in knowledge scores was seen in both groups, with highly significant improvement in the intervention group (p value = 0.00). Intergroup comparison showed no significant difference in knowledge scores at baseline, but a significant difference in post intervention knowledge scores (t = -15.05 p<0.001) WhatsApp can be a more effective tool for providing dental education on tobacco and oral cancer as compared to conventional audio-visual aids.

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Issue Information - TOC

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Patient Care Specialist II (Paramedic)-Acuity Adaptable - Eskenazi Health

JOB SUMMARY: The Acuity Adaptable Patient Care Specialist II is responsible for patient care in the area of assignment under RN supervision. The Patient Care Specialist II performs limited respiratory treatments, phlebotomy procedures, dressing changes, EKGs, medication administration, starts IVs, as well as other patient care activities. REQUIREMENTS: -Active Indiana certification as a Paramedic -Current ...

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AliveCor and Microlife Detected 67% and 83% of Patients with Atrial Fibrillation

A study from The University of Hong Kong in a primary care setting showed that the AliveCor Heart Monitor and Microlife WatchBP Office AFIB demonstrated less than expected sensitivity. 2052 patients (mean age = 68 years old) with hypertension and/or diabetes were screened for atrial fibrillation using these two automated devices and their algorithms. The reference diagnosis was made by two blinded and independent cardiologists, who interpreted the signal from the AliveCor's single-lead ECG. If either device detected atrial fibrillation, a 12-lead ECG study was conducted to confirm.

24 of the patients were diagnosed with atrial fibrillation. The AliveCor ECG detected 16 of 24 of them (sensitivity = 67%; 95% CI = 44.7-84.4%) and produced 11 false negatives (specificity = 99.5%). The Microlife WatchBP detected 20 of 24 of them (sensitivity = 83%; 95% CI = 63-95%) and produced 27 false positives (98.7% specificity).

Atrial fibrillation is a condition of the heart that causes it to beat abnormally. It is estimated to affect 33.5 million people worldwide and can be present without symptoms in 3% – 35% of patients around the world. In normal rhythm, a signal generated by the atria of the heart moves smoothly from the top to bottom, and then back up. When atrial fibrillation is present, the top of the heart instead beats rapidly and without coordination, causing stuttering and therefore inefficient blood flow. In symptomatic patients, it typically causes feelings of palpitations, increased heart rate, shortness of breath, and exercise intolerance. It can sometimes cause chest pains if the rapid heartbeats lead to ischemia. Importantly, atrial fibrillation can cause stroke (4-5% of patients), as chaotic blood flow can create blood clots that travel to become lodged in blood vessels of the brain. It's therefore important to diagnose atrial fibrillation early, so that preventative measures can be taken, reducing risk of stroke by up to 80 percent.

Given this, it's slightly jarring that in this study, the FDA-approved AliveCor ECG accurately caught only 67% of patients with stroke and the WatchBP caught only 83%. Interestingly, these results were much lower than the previous validation studies, which reported catching 98% and 98.5% patients using AliveCor and 94.9% using WatchBP. This raises questions of their validity and use in a primary care settings where general practitioners would benefit from a quick screening algorithm to deliver timely care. The algorithms may need further refinement, and/or the clinicians may need further training to use the devices more accurately.

Study in journal Circulation: Head-to-Head Comparison of the AliveCor Heart Monitor and Microlife WatchBP Office AFIB for Atrial Fibrillation Screening in a Primary Care Setting…

Product pages: WatchBP Office AFIB; AliveCor…

Medgadget?i=Q8o7_uKOTgo:1hhYubnHxAA:gIN9

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The relation between the continuous and the discrete: A note on the first principles of speech dynamics

Publication date: Available online 12 June 2017
Source:Journal of Phonetics
Author(s): Khalil Iskarous
The goal of this paper is to show how dynamical theories of phonetics and phonology bridge the dualistic gap between discrete phonological descriptions and continuous phonetic descriptions. By delving into the first principles of dynamics, it is shown that dynamical theories do not assume separate sets of principles to describe discrete and continuous aspects of a system. Rather, the discrete description is shown to predict the continuous one, using the concept of a differential equation, which is thoroughly explained. Linear and nonlinear differential equations are introduced using a discrete approximation, and then used to show how phonological contrast has been accounted for using dynamical systems analysis. A dynamical recurrent neural network model of word formation is then discussed to show how linguistic plans for words are serialized and coordinated into motoric word plans for different articulatory systems in the vocal tract. Furthermore, it is shown that many aspects of the discrete, time-invariant phonological description can be predicted from observed variable continuous phonetic functions, using the principle of least squares and recurrent neural networks.

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Τρίτη 13 Ιουνίου 2017

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