Cysts of parathyroid origin are sometimes encountered and can easily be mistaken as thyroidal cysts. Functional parathyroid cysts, with symptoms and signs of hyperparathyroidism, are rare and may be a diagnost...
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Τρίτη 28 Νοεμβρίου 2017
Unusual presentations of functional parathyroid cysts: a case series and review of the literature
Unusual presentations of functional parathyroid cysts: a case series and review of the literature
Cysts of parathyroid origin are sometimes encountered and can easily be mistaken as thyroidal cysts. Functional parathyroid cysts, with symptoms and signs of hyperparathyroidism, are rare and may be a diagnost...
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Observed differentials in the levels of selected environmental contaminants among Mexican and other Hispanic American children, adolescents, adults, and senior citizens
Abstract
Starting with the 2007–2008 cycle, the National Health and Nutrition Examination Survey (NHANES) also oversampled Hispanics other than Mexicans (OHISP) making it possible to treat OHISP as a separate demographic group along with Mexican Americans (MAs), non-Hispanic whites (NHWs), and non-Hispanic blacks (NHBs). Yet, more often than not, OHISP have been merged with MA to form an all-Hispanic demographic group (HISP) thus limiting comparisons between NHW, NHB, and HISP. Consequently, for the first time, this study was undertaken to evaluate differences in the observed levels of selected environmental contaminants between MA and OHISP from five groups of environmental contaminants, namely, polycyclic aromatic hydrocarbons (PAHs), iodine uptake inhibitors (IUIs), environmental phenols (EPHs), priority pesticides (PPs), and perfluoroalkyl acids (PFAAs). Data for 2007–2010 from NHANES were used to conduct this study. OHISP children born in USA had higher levels of selected PAH metabolites than USA-born MA, and Mexican-born MA adolescents had higher levels of selected PAH metabolites than USA-born MA adolescents. USA-born adolescent MA had higher levels of selected parabens than USA-born adolescent OHISP, and OHISP adults born in another Spanish-speaking country had higher levels of selected parabens than USA-born OHISP adults. USA-born MA adults and seniors had higher levels of selected dichlorophenols than Mexico-born MA adults and seniors, respectively. Females had higher levels of selected PAH metabolites, EPHs, and PPs than males among children, adolescents, adults, and seniors, but the reverse was true for the levels of selected IUIs and PFAAs among adolescents and seniors. Smokers had higher levels of almost all PAH metabolites than non-smokers for adolescents, adults, and seniors. The same was true for urinary thiocynate for adolescents, adults, and seniors. OHISP is a multiracial multiethnic demographic group substantially different from MA with possibly different smoking behavior and with possibly differential levels of exposure to certain environmental contaminants and as such should be treated as a demographic group by itself.
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The Role of Nanomechanics in Healthcare
Abstract
Nanomechanics has played a vital role in pushing our capability to detect, probe, and manipulate the biological species, such as proteins, cells, and tissues, paving way to a deeper knowledge and superior strategies for healthcare. Nanomechanical characterization techniques, such as atomic force microscopy, nanoindentation, nanotribology, optical tweezers, and other hybrid techniques have been utilized to understand the mechanics and kinetics of biospecies. Investigation of the mechanics of cells and tissues has provided critical information about mechanical characteristics of host body environments. This information has been utilized for developing biomimetic materials and structures for tissue engineering and artificial implants. This review summarizes nanomechanical characterization techniques and their potential applications in healthcare research. The principles and examples of label-free detection of cancers and myocardial infarction by nanomechanical cantilevers are discussed. The vital importance of nanomechanics in regenerative medicine is highlighted from the perspective of material selection and design for developing biocompatible scaffolds. This review interconnects the advancements made in fundamental materials science research and biomedical technology, and therefore provides scientific insight that is of common interest to the researchers working in different disciplines of healthcare science and technology.
Nanomechanics is playing a vital role in pushing our capability to detect, probe, and manipulate the biological species, such as proteins, cells and tissues, paving way to knowledge and strategies for superior healthcare. Nanomechanics has enabled early diagnosis of life-threatening diseases, as well as facilitated the development of biomimetic implants for tissue engineering and prosthesis.
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Organ Bioprinting: Are We There Yet?
Abstract
About 15 years ago, bioprinting was coined as one of the ultimate solutions to engineer vascularized tissues, which was impossible to accomplish using the conventional tissue fabrication approaches. With the advances of 3D-printing technology during the past decades, one may expect 3D bioprinting being developed as much as 3D printing. Unfortunately, this is not the case. The printing principles of bioprinting are dramatically different from those applied in industrialized 3D printing, as they have to take the living components into account. While the conventional 3D-printing technologies are actually applied for biological or biomedical applications, true 3D bioprinting involving direct printing of cells and other biological substances for tissue reconstruction is still in its infancy. In this progress report, the current status of bioprinting in academia and industry is subjectively evaluated. The progress made is acknowledged, and the existing bottlenecks in bioprinting are discussed. Recent breakthroughs from a variety of associated fields, including mechanical engineering, robotic engineering, computing engineering, chemistry, material science, cellular biology, molecular biology, system control, and medicine may overcome some of these current bottlenecks. For this to happen, a convergence of these areas into a systemic research area "3D bioprinting" is needed to develop bioprinting as a viable approach for creating fully functional organs for standard clinical diagnosis and treatment including transplantation.
Bioprinting involving direct printing of cells and other biological substances for tissue or organ reconstruction is still in its infancy. A transdisciplinary effort combining the best international expertise in biology, engineering, chemistry, optics, robotics, material science, medicine, noninvasive diagnostic imaging as well as computer-aided design, to name just the most obvious, is needed to hopefully generate the necessary innovations in this fascinating field.
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Workplace Phobic Anxiety as a Mental Health Phenomenon in the Job Demands-Resources Model
Purpose. Anxiety-related problems at work are a serious problem in the occupational context, as they come along with sick leave and problems in work participation. The aim of this study is to analyse workplace phobic anxiety in nonclinical context using the Job Demands-Resources model. Methods. The study involved a sample of 739 workers from a retail company, mostly with permanent contracts. Structural equation modelling analyses were performed using AMOS software. Results. Both the health impairment and motivational variables in the JD-R model were significantly related to workplace phobic anxiety and subsequently to absenteeism, specifically, exhaustion mediated between perceived job demands and workplace phobic anxiety and work engagement mediated between perceived job resources and workplace phobic anxiety. Moreover, workplace phobic anxiety was significantly positively related to absenteeism. Conclusions. Results suggest that workplace phobic anxiety is a specific concept and an important issue in organizations for both workers' health and the organizational costs linked to absenteeism. Supervisors and occupational physicians should be aware of workplace phobic anxiety, especially when workers are on sick leave often or for long periods.
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Association of urinary concentrations of four chlorophenol pesticides with cardiometabolic risk factors and obesity in children and adolescents
Abstract
This study was undertaken to determine the association of four chlorophenol pesticides with cardiometabolic risk factors and obesity in children and adolescents. This cross-sectional study was conducted in 2016 on 242 children and adolescents, aged 6 to 18 years. The concentrations of 2,4-dichlorophenol (2,4-DCP), 2,5-dichlorophenol (2,5-DCP), 2,4,5-trichlorophenol (2,4,5-TCP), and 2,4,6-trichlorophenol (2,4,6-TCP) in the urine were examined and their association with indices of obesity and cardiometabolic risk factors was determined. Multivariate linear regression and multinomial logistic regression analyses were applied. Overall, 242 participants with mean (SD) ages of 11.3 (2.5) years completed the survey. After adjustment for confounders, a significant positive association was found between body mass index (BMI) z-score and waist circumference (WC) with 2,5-DCP (0.07 (95% CI 0.04, 0.1)) and 0.79 (95% CI 0.54, 1.03), respectively. A significant association of 2,4,5-TCP was only found with WC (0.23 (95% CI 0.0, 0.46), but the relationship with 2,4-DCP was not significant. 2,5-DCP had a significant relationship only with obesity (1.09 (95% CI 1.1, 1.19)), while 2,4-DCP and 2,4,5-TCP showed no significant correlation with overweight or obesity. 2,4-DCP showed a significant positive relationship with high density lipoprotein-cholesterol (HDL-C). Moreover, 2,5-DCP showed a significant negative relationship only with systolic blood pressure and 2,4,5-TCP had a statistically significant inverse association with total cholesterol and HDL-C (−0.71 (95% CI −0.98, −0.45)). This study suggests potential associations of chlorophenol pesticides with overweight, obesity, lipid profile, and blood pressure in children and adolescents. Longitudinal studies are necessary to assess the clinical impact of these findings.
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A Study on Free Light Chain Assay and Serum Immunofixation Electrophoresis for the Diagnosis of Monoclonal Gammopathies
Abstract
Demonstration of monoclonal immunoglobulin molecule in serum forms the mainstay in the diagnosis of monoclonal gammopathies. The major tests that help in this regard are serum protein electrophoresis (SPEP), serum immunofixation electrophoresis (sIFE) and serum free light chain assay (sFLC). Our objectives were to study the accuracy of sFLC and sIFE in the diagnosis of monoclonal gammopathies and also to study the role of combination of SPEP + sIFE + sFLC in the diagnosis of the same. 46 patients who attended the hemato-oncology clinic with signs and symptoms suggestive of monoclonal gammopathy were enrolled in this study. SPEP, sIFE, sFLC and pre-treatment serum beta-2 microglobulin levels were analysed among the study population. Both SPEP and sIFE were performed in the Interlab Genios fully automated machine. Serum beta-2 microglobulin and sFLC were estimated by immunoturbidimetry in Beckman Coulter AU 2700 analyzer. The accuracy of sIFE came to be 80% with respect to sFLC assay. Sensitivity, specificity, positive and negative predictive value of sIFE with respect to sFLC were 81.3, 78.6, 89.7 and 64.7% respectively. It was observed that a combination panel of SPEP + sIFE + sFLC could detect all the cases of myeloma included in this study. Further testing in large samples is required for generalising the findings of this study. The pre-treatment beta-2 microglobulin levels were significantly higher in the group which was positive for myeloma. A combination panel of SPEP + sIFE + sFLC prove to be more useful than individual tests for the detection of myeloma.
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Copper(0) Mediated Single Electron Transfer Controlled Radical Polymerization toward CF Bonds on Poly(vinylidene fluoride)
Abstract
The first copper(0) mediated controlled radical polymerization (CRP) of methyl methacrylate (MMA) toward CF bonds onto poly(vinylidene fluoride) (PVDF) is reported with rather high activity. By avoiding the halogen exchange, Cu0 instead of CuI complexes utilized as catalyst is responsible for the significantly improved polymerization activity. Using F
H decoupled nuclear magnetic resonance technique, the grafting sites onto PVDF are finely located. From this, detailed topologic information including the grafting density, average length of each side chain, along with the overall grafted content of PMMA, is detected by tracking the polymerization as a function of time. This work offers not only a facile CRP strategy based on inactive C
F bonds but also a deep insight into the cleavage of F-bearing compounds in organic chemistry.
The first copper(0) mediated controlled radical polymerization of methyl methacrylate toward CF bonds onto poly(vinylidene fluoride) (PVDF) with rather high activity is reported. This method may provide a facile strategy to prepare PVDF-based graft copolymers.
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Kinetics of Thermal Polymerization Can Be Studied during Continuous Cooling
Abstract
It is demonstrated that differential scanning calorimetry can measure the kinetics of the thermally initiated polymerization during continuous cooling. The measurements are accomplished by switching from fast heating to much slower cooling. The study is exemplified by crosslinking polymerization (curing) of diglycidyl ether of bisphenol A epoxy and m-phenylenediamine taken in stoichiometric and nonstoichiometric ratios and measured under heating and cooling conditions. An advanced isoconversional method reveals that the reaction in the nonstoichiometric system follows the kinetics of the single-step type. Its activation energy is constant and the same for heating and cooling conditions. The stoichiometric system exhibits the multistep kinetics characterized by the dependencies of the activation energy on temperature that differ qualitatively for cooling and heating runs. The discovered differences emphasize the need for further systematic studies of the thermal polymerization during continuous cooling.
Differential scanning calorimetry (DSC) can measure the kinetics of the thermally initiated polymerization during continuous cooling. Analysis of DSC data on crosslinking epoxy-amine polymerization by an isoconversional method has revealed qualitatively different dependencies of the activation energy on temperature for heating and cooling conditions. This result emphasizes the need for systematic studies of the thermal polymerization during continuous cooling.
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Online education improves pediatric residents’ understanding of atopic dermatitis
Abstract
Background/Objectives
Pediatricians manage skin conditions such as atopic dermatitis (AD) but report that their dermatologic training is inadequate. Online modules may enhance medical education when sufficient didactic or clinical teaching experiences are lacking. We assessed whether an online module about AD improved pediatric residents' knowledge and changed their clinical management of AD.
Methods
Target and control cohorts of pediatric residents from two institutions were recruited. Target subjects took a 30-question test about AD early in their residency, reviewed the online module, and repeated the test 6 months and 1 year later. The control subjects, who had 1 year of clinical experience but had not reviewed the online module, also took the test. The mean percentage of correct answers was calculated and compared using two-sided, two-sample independent t tests and repeated-measures analysis of variance. For a subset of participants, clinical documentation from AD encounters was reviewed and 13 practice behaviors were compared using the Fisher exact test.
Results
Twenty-five subjects in the target cohort and 29 subjects in the control cohort completed the study. The target cohort improved from 18.0 ± 3.2 to 23.4 ± 3.4 correctly answered questions over 1 year (P < .001). This final value was greater than that of the control cohort (20.7 ± 4.5; P = .01). Meaningful differences in practice behaviors were not seen.
Conclusion
Pediatric residents who reviewed an online module about AD demonstrated statistically significant improvement in disease-specific knowledge over time and had statistically significantly higher scores than controls. Online dermatology education may effectively supplement traditional clinical teaching.
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Suppressive and enhancing effects of nicotine on food-seeking behavior
Source:Behavioural Brain Research, Volume 339
Author(s): Korinna Romero, Carter W. Daniels, Cassandra D. Gipson, Federico Sanabria
The present study examined how systemic low doses of nicotine affect the microstructure of reinforced food-seeking behavior in rats. Rats were first given an acute saline or nicotine treatment (0.1–0.6mg/kg, with an inter-injection interval of at least 48h), and then a chronic saline or nicotine treatment (0.3mg/kg/day for 10 consecutive days). Immediately after each injection, rats were required to press a lever five times to obtain food that was available at unpredictable times (on average every 80s) with constant probability. Acute nicotine dose-dependently suppressed behavior prior to the delivery of the first reinforcer, but enhanced food-reinforced behavior afterwards. These effects were primarily observed in the time it took rats to initiate food-seeking behavior. Enhancing effects were also observed in the microstructure of food-seeking behavior, with lower nicotine doses (0.1–0.3mg/kg) increasing the rate at which response bouts were initiated, and higher doses (0.3–0.6mg/kg) increasing within-bout response rates. A pre-feeding control suggests that changes in appetite alone cannot explain these effects. Over the course of chronic nicotine exposure, tolerance developed to the suppressive, but not to the enhancing effects of nicotine on food-seeking behavior. These results suggest that (a) lower doses of nicotine enhance the reward value of food and/or food-associated stimuli, (b) higher doses of nicotine enhance motoric activity, and (c) ostensive sensitization effects of nicotine on behavior partially reflect a tolerance to its transient suppressive motoric effects.
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NAD-biosynthetic enzyme NMNAT1 reduces early behavioral impairment in the htau mouse model of tauopathy
Source:Behavioural Brain Research, Volume 339
Author(s): Francesca Rossi, Philippine C. Geiszler, Weina Meng, Matthew R. Barron, Malcolm Prior, Anna Herd-Smith, Andrea Loreto, Maria Yanez Lopez, Henryk Faas, Marie-Christine Pardon, Laura Conforti
NAD metabolism and the NAD biosynthetic enzymes nicotinamide nucleotide adenylyltransferases (NMNATs) are thought to play a key neuroprotective role in tauopathies, including Alzheimer's disease. Here, we investigated whether modulating the expression of the NMNAT nuclear isoform NMNAT1, which is important for neuronal maintenance, influences the development of behavioral and neuropathological abnormalities in htau mice, which express non-mutant human tau isoforms and represent a model of tauopathy relevant to Alzheimer's disease. Prior to the development of cognitive symptoms, htau mice exhibit tau hyperphosphorylation associated with a selective deficit in food burrowing, a behavior reminiscent to activities of daily living which are impaired early in Alzheimer's disease. We crossed htau mice with Nmnat1 transgenic and knockout mice and tested the resulting offspring until the age of 6 months. We show that overexpression of NMNAT1 ameliorates the early deficit in food burrowing characteristic of htau mice. At 6 months of age, htau mice did not show neurodegenerative changes in both the cortex and hippocampus, and these were not induced by downregulating NMNAT1 levels. Modulating NMNAT1 levels produced a corresponding effect on NMNAT enzymatic activity but did not alter NAD levels in htau mice. Although changes in local NAD levels and subsequent modulation of NAD-dependent enzymes cannot be ruled out, this suggests that the effects seen on behavior may be due to changes in tau phosphorylation. Our results suggest that increasing NMNAT1 levels can slow the progression of symptoms and neuropathological features of tauopathy, but the underlying mechanisms remain to be established.
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Incidence and risk factors for deep surgical site infection after open reduction and internal fixation of closed tibial plateau fractures in adults
This study aimed to investigate the incidence and risk factors of deep surgical site infection (DSSI) during hospitalisation after closed tibial plateau fractures treated with open reduction and internal fixation (ORIF). We performed this retrospective study at a university-affiliated hospital with an advanced trauma centre. The data of adult patients with closed tibial plateau fractures treated with ORIF from January 2012 to February 2017 were extracted from the electronic medical records. Demographics, injury-related and surgery-related variables of DSSI and non-DSSI groups were compared by univariate test. Multivariate logistic analysis models were used to investigate the independent risk factors. In total, 676 patients with complete data met the inclusion criteria and were included, and of them, 17 developed DSSI (2.51%) during hospitalisation. Approximately 60% (9/17) of DSSI was caused by Staphylococcus aureus. Compared to the non-DSSI group, DSSI patients had a significantly longer stay in hospital (25.8 vs 15.2 days). Independent risk factors of DSSI identified by multivariate analysis were higher BMI (>26.0) (OR, 1.58; 95% CI, 1.09 to 3.27; P = 0.032), prolonged surgical duration (>138 min) (OR, 4.26; 95% CI, 1.54 to 11.19; P = 0.005) and current smoking (OR, 3.42; 95% CI, 1.47 to 8.62; P = 0.01). A relatively low incidence rate of DSSI (2.51%) was found in this study, and several significant risk factors were identified. Smoking cessation programmes should be implemented immediately after hospitalisation, especially for obesity and morbid obesity patients. Detailed and comprehensive preoperative assessment and a considerate operative plan should be guaranteed to reduce surgical duration.
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Correntropy based sperm detection: a novel spatiotemporal processing for analyzing videos of human semen
Abstract
In this article a new spatiotemporal processing is introduced for detecting sperms in captured videos from semen specimen. In the proposed method, the temporal processing indicates primary sperms by estimating correntropy of the history sequences which are constructed for image pixels. This procedure is completed by a spatial processing that stabilizes the correct sperms by considering their connectivity. Performance of the proposed method is evaluated on several sequences captured from semen specimens containing various numbers of sperms with different shapes and contrasts. The obtained results show greater ability of the proposed method in distinguishing sperms from background of semen compared to some state of art algorithms in such way that its detection rate is at least 4% higher than the best among its alternatives without increasing false detections.
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Is insomnia a risk factor for new-onset asthma? A population-based study in Taiwan
Objectives
To determine whether insomnia at baseline is a risk factor for new-onset asthma.
MethodsWe recruited 48 871 patients with insomnia (insomnia group) newly diagnosed between 2002 and 2007, and 97 742 matched controls without insomnia (control group) from Taiwan's Longitudinal Health Insurance Database 2000. All of the patients were followed up for 4 years to see whether new-onset asthma developed. Patients with previous asthma or insomnia were excluded. The Poisson regression was used to estimate the incidence rate ratios (IRRs) and 95% CIs of asthma. Cox proportional hazard regression was used to calculate the risk of asthma between the two groups.
ResultsAfter a 4-year follow-up, 424 patients in the insomnia group and 409 in the control group developed asthma. The incidence rate of asthma was significantly higher in the insomnia group (22.01vs10.57 per 10 000 person-years). Patients with insomnia have a higher risk of developing new-onset asthma during the 4-year follow-up (HR: 2.08, 95% CI 1.82 to 2.39). The difference remained significant after adjustment (adjusted HR: 1.89, 95% CI 1.64 to 2.17).
ConclusionsThis large population-based study suggests that insomnia at baseline is a risk factor for developing asthma.
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Study of depression influencing factors with zero-inflated regression models in a large-scale population survey
Objectives
The number of depression symptoms can be considered as count data in order to get complete and accurate analyses findings in studies of depression. This study aims to compare the goodness of fit of four count outcomes models by a large survey sample to identify the optimum model for a risk factor study of the number of depression symptoms.
Methods15 820 subjects, aged 10 to 80 years old, who were not suffering from serious chronic diseases and had not run a high fever in the past 15 days, agreed to take part in this survey; 15 462 subjects completed all the survey scales. The number of depression symptoms was the sum of the 'positive' responses of seven depression questions. Four count outcomes models and a logistic model were constructed to identify the optimum model of the number of depression symptoms.
ResultsThe mean number of depression symptoms was 1.37±1.55. The over-dispersion test statistic O was 308.011. The alpha dispersion parameter was 0.475 (95% CI 0.443 to 0.508), which was significantly larger than 0. The Vuong test statistic Z was 6.782 and the P value was <0.001, which showed that there were too many zero counts to be accounted for with traditional negative binomial distribution. The zero-inflated negative binomial (ZINB) model had the largest log likelihood and smallest AIC and BIC, suggesting best goodness of fit. In addition, predictive probabilities for many counts in the ZINB model fitted the observed counts best.
ConclusionsAll fitting test statistics and the predictive probability curve produced the same findings that the ZINB model was the best model for fitting the number of depression symptoms, assessing both the presence or absence of depression and its severity.
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Protective effect of smoking against pterygium development in men: a nationwide longitudinal cohort study in South Korea
Objective
The present study aimed to evaluate the association between smoking and incident pterygium in adult Korean men.
DesignA retrospective nationwide longitudinal cohort.
SettingNational Health Insurance database of South Korea.
ParticipantsThis study included Korean men (age range: 40–79 years) registered in the Korea National Health Insurance Service database from 2002 through 2013. We compared HRs for pterygium between 90 547 current/past and 90 547 never-smokers via 1:1 propensity-matched analysis.
Primary outcome measureIncident cases of pterygium were identified from the database.
ResultsPterygium developed in 5389 (6.0%) never-smokers and 3898 (4.3%) past/current smokers (P<0.001). The incidence of pterygium per 1000 person-years in never-smokers and in past/current smokers was 6.5 and 4.7, respectively (age-adjusted HR, 0.73; 95% CI, 0.70 to 0.76). This protective effect was more pronounced among current smokers than among past smokers (for current smokers: HR, 0.68; 95% CI, 0.65 to 0.71 and for past smokers: HR, 0.85; 95% CI, 0.80 to 0.90). A longer duration of smoking and higher amounts of cigarette consumption were associated with a lower incidence of pterygium.
ConclusionsLongitudinally, cigarette smoking was associated with a reduced risk of pterygium, and this protective effect was more pronounced among current smokers than among past smokers.
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Use of humour in medical education: a survey of students and teachers at a medical school in China
Objective
Humour is a powerful resource in medical education. The purpose of this study is to investigate what students and teachers think about the use of humour. What challenges do teachers face in using humour and how they address them are also the subject of the present study.
DesignSeparate cross-sectional questionnaire surveys.
SettingTongji Medical College and Tongji Hospital in China.
Participants327 students at Tongji Medical College and 165 physician teachers at Tongji Hospital in China.
Main outcome measuresThe primary study outcome was assessed by proportion.
Results87% of student and teacher respondents agreed with using humour in the didactic setting. They felt humour fostered a positive didactic atmosphere. Interesting clinical case was the most frequently used humour type by teachers and considered the most effective by students. Lack of humorous materials related to the lecture subject was the main challenge to humour use cited by teachers. Collecting humorous materials in teacher's daily work and life, observing teachers with a reputation for successfully using humour, and efficiently using the internet-enhanced humour use ability.
ConclusionThe present study confirms that most medical students and physician teachers support the use of humour in medical didactics, with particular strategies aiding its use and positive impact.
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Lived experience of women with gestational diabetes mellitus living in China: a qualitative interview study
Objective
To explore the lived experience of women with gestational diabetes mellitus (GDM) living in China in order to add knowledge about how the Chinese women suffer from GDM.
DesignA qualitative interpretive interview study. Data were collected with a snowball sampling technique. Phenomenological hermeneutics was used as the analysis method based on Ricoeur's phenomenological hermeneutical interpretation theory.
SettingThe study was performed at the participants' work places, or at the obstetric clinics or wards at two provincial hospitals and one municipal hospital in the southeast of China.
ParticipantsInclusion criteria were age ≥18 years, diagnosis of GDM without other pregnancy complications, in 34th gestational weeks—postpartum 4th weeks and speaking Mandarin Chinese without speech impediment. 62 women, who met the inclusion criteria, took part in the study.
ResultsThe lived experience of the women with GDM living in China was formulated into a main theme: 'longing for caring care'. The main theme was derived from four themes: being stricken by GDM, wishing to receive caring GDM care, being left alone to struggle with GDM and trying to adjust and adapt to life with GDM.
ConclusionThe eagerness for caring care in China was highlighted. The lack of caring care could be one of the possible reasons why the professional–patient relations were deteriorating in China. It could be useful for health providers and health policymakers to receive education and training about caring care. Using the health metaphor of balance and 'patient participation' and 'patient-centred' approaches may benefit women with GDM and thus improve the quality of care in China.
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Postpartum management of hypertensive disorders of pregnancy: a systematic review
Objectives
Hypertensive disorders of pregnancy (HDP) affect one in ten pregnancies and often persist postpartum when complications can occur. We aimed to determine the effectiveness and safety of pharmacological interventions, other interventions and different care models for postpartum hypertension management.
DesignA systematic review was undertaken. Nine electronic databases, including Medline, were searched from inception to 16 March 2017. After duplicate removal, 4561 records were screened. Two authors independently selected studies, extracted study characteristics and data, and assessed methodological quality.
SettingRandomised controlled trials, case–control studies and cohort studies from any country and healthcare setting.
ParticipantsPostnatal women with HDP.
InterventionsTherapeutic intervention for management of hypertension, compared with another intervention, placebo or no intervention.
Primary and secondary outcome measuresOutcome data were collected for maternal mortality and severe morbidity; systolic, diastolic and mean arterial blood pressure (BP) control; and safety data. Secondary outcome data collected included the length of postnatal hospital stay and laboratory values.
Results39 studies were included (n=2901). Results were heterogeneous in terms of intervention, comparison and outcome requiring a narrative approach. There were insufficient data to recommend any single pharmacological intervention. 18 studies reported calcium-channel blockers, vasodilators and beta-blockers lowered BP postpartum. 12 of these reported safety data. Limited data existed regarding management in the weeks following hospital discharge. Neither loop diuretics (three studies) nor corticosteroids (one study) produced clinical benefit. Uterine curettage significantly reduced BP over the first 48 hours postpartum (range 6–13 mm Hg) compared with standard care (eight studies), with safety data only reported by four of eight studies.
ConclusionThere was insufficient evidence to recommend a particular BP threshold, agent or model of care, but three classes of antihypertensive appeared variably effective. Further comparative research, including robust safety data, is required. Curettage reduced BP, but without adequate reporting of harms, so it cannot currently be recommended.
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Protocol for the melatools skin self-monitoring trial: a phase II randomised controlled trial of an intervention for primary care patients at higher risk of melanoma
Introduction
Melanoma is the fifth most common cancer in the UK. Incidence rates have quadrupled over the last 30 years and continue to rise, especially among younger people. As routine screening of the general population is not currently recommended in the UK, a focus on secondary prevention through early detection and prompt treatment in individuals at increased risk of melanoma could make an important contribution to improve melanoma outcomes. This paper describes the protocol for a phase II, multisite, randomised controlled trial, in the primary care setting, for patients at increased risk of melanoma. A skin self-monitoring (SSM) smartphone 'App' was used to improve symptom appraisal and encourage help seeking in primary care, thereby promoting early presentation with skin changes suspicious of melanoma.
Methods and analysisWe aim to recruit 200 participants from general practice waiting rooms in the East of England. Eligible patients are those identified at higher melanoma risk (using a real-time risk assessment tool), without a personal history of melanoma, aged 18 to 75 years. Participants will be invited to a primary care nurse consultation, and randomised to the intervention group (standard written advice on skin cancer detection and sun protection, loading of an SSM 'App' onto the participant's smartphone and instructions on use including self-monitoring reminders) or control group (standard written advice alone). The primary outcomes are consultation rates for changes to a pigmented skin lesion, and the patient interval (time from first noticing a skin change to consultation). Secondary outcomes include patient sun protection behaviours, psychosocial outcomes, and measures of trial feasibility and acceptability.
Ethics and disseminationNHS ethical approval has been obtained from Cambridgeshire and Hertfordshire research ethics committee (REC reference 16/EE/0248). The findings from the MelaTools SSM Trial will be disseminated widely through peer-reviewed publications and scientific conferences.
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Improving hearing and vision in dementia: protocol for a field trial of a new intervention
Introduction
Quality of life and other key outcomes may be improved by optimising hearing and vision function in people living with dementia. To date, there is limited research assessing the efficacy of interventions aimed at improving hearing and vision in people with dementia. Here, we outline a protocol to field test a newly developed home-based intervention, designed to optimise sensory functioning in people with dementia in three European sites. The results of this study will inform the design and conduct of a full-scale randomised controlled trial (RCT) in five European sites.
Methods and analysisIn this multisite, single arm, open label, feasibility study, participants with dementia (n=24) will be assessed for hearing and vision impairments and be prescribed a hearing aid and/or glasses. Each participant will have a study partner ('dyads'). A subset of dyads will receive 'sensory support' from a 'sensory support therapist', comprising home visits over 12 weeks. The therapist will offer the following intervention: adherence support for corrective devices; adaptations to the home environment to facilitate sensory function; communication training; and referral to community-based support services. The primary outcomes will be process measures assessing the feasibility, tolerability and acceptability of: (1) the intervention components; (2) the method of implementation of the intervention and (3) the study procedures, including outcome assessment measures. Quantitative data will be collected at baseline and follow-up. Qualitative data using semistructured interviews will be collected postintervention and weekly, using participant diaries. Finally, we will explore a model of cost-effectiveness to apply in the subsequent full-scale trial. This feasibility study is a necessary step in the development of a complex, individualised, psychosocial intervention. The data gathered will allow logistical and theoretical processes to be refined in preparation for a full-scale RCT.
Ethics and disseminationEthical approval was obtained in all three participating countries. Results of the field trial will be submitted for publication in a peer-reviewed journal.
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A rapid review to identify physical activity accrued while playing golf
Objective
To identify physical activity (PA) accrued while playing golf and modifiers of PA accrued.
DesignA rapid review of primary research studies. Quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tool for cohort and cross-sectional studies.
Methods and outcomesThe following databases were searched from 1900 to March 2017: SPORTDiscus, Web of Science, PsycINFO, MEDLINE, Google Scholar, Google Advanced Search, ProQuest, WHO International Clinical Trials Registry Platform. All primary research investigating golf or golfers with any of the following outcomes was included: metabolic equivalent of task, oxygen uptake, energy expenditure, heart rate, step count, distance covered, strength, flexibility, balance, sedentary behaviour.
ResultsPhase one searching identified 4944 citations and phase two searching identified 170 citations. In total, 19 articles met inclusion criteria. Golf is primarily a moderate intensity PA, but may be low intensity depending on the playing population and various modifiers. Less PA is accrued by those who ride a golf cart compared with those walking the course.
ConclusionsGolf can be encouraged in order to attain PA recommendations. Further research is required into the relationship between golf and strength and flexibility PA recommendations and how modifiers affect PA accrued.
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Review of systematic reviews of non-pharmacological interventions to improve quality of life in cancer survivors
Objectives
Over two million people in the UK are living with and beyond cancer. A third report diminished quality of life.
DesignA review of published systematic reviews to identify effective non-pharmacological interventions to improve the quality of life of cancer survivors.
Data sourcesDatabases searched until May 2017 included PubMed, Cochrane Central, EMBASE, MEDLINE, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO.
Study selectionPublished systematic reviews of randomised trials of non-pharmacological interventions for people living with and beyond cancer were included; included reviews targeted patients aged over 18. All participants had already received a cancer diagnosis. Interventions located in any healthcare setting, home or online were included. Reviews of alternative therapies or those non-English reports were excluded. Two researchers independently assessed titles, abstracts and the full text of papers, and independently extracted the data.
OutcomesThe primary outcome of interest was any measure of global (overall) quality of life.
Analytical methodsQuality assessment assessing methdological quality of systematic reviews (AMSTAR) and narrative synthesis, evaluating effectiveness of non-pharmacological interventions and their components.
ResultsOf 14 430 unique titles, 21 were included in the review of reviews. There was little overlap in the primary papers across these reviews. Thirteen reviews covered mixed tumour groups, seven focused on breast cancer and one focused on prostate cancer. Face-to-face interventions were often combined with online, telephone and paper-based reading materials. Interventions included physical, psychological or behavioural, multidimensional rehabilitation and online approaches. Yoga specifically, physical exercise more generally, cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR) programmes showed benefit in terms of quality of life.
ConclusionsExercise-based interventions were effective in the short (less than 3–8 months) and long term. CBT and MBSR also showed benefits, especially in the short term. The evidence for multidisciplinary, online and educational interventions was equivocal.
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A case report of brown tumor in a patient with chronic renal failure and renal cell carcinoma
We report a case of a 72 year old male with hyperparathyroidism secondary to end stage diabetic renal disease and coexisting bilateral chromophobe renal cell carcinomas. The patient presented with back and groin pain, right pelvic hemorrhage, and multiple lytic bone lesions concerning for metastatic renal cell carcinoma. Fine needle aspiration cytology demonstrated benign appearing osteoclasts and spindled cells. A concurrent core biopsy showed foci of spindled cell proliferation populated by osteoclast-like giant cells with stromal hemorrhage without evidence of metastatic carcinoma. The cytologic and histologic findings, in correlation with the clinical history, radiographic features, markedly increased parathyroid hormone levels and other serologic studies, were diagnostic of the reactive lesion seen in brown tumor of hyperparathyroidism secondary to chronic renal failure.
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Ethanol traces in natural waters checked using a new DMFC enzymatic device
Abstract
The use of fuels with strong percentage of ethanol that is done in countries such as Brazil and Australia causes a more and more relevant presence of traces of ethanol in natural waters. The ethanol present in these fuels seems to contribute to increase, through various mechanisms, the concentration of hydrocarbons in the same waters and soil. The ethanol content in natural waters must therefore be monitored frequently. It was therefore proposed a very simple innovative method, based on a catalytic fuel cell with the alcohol dehydrogenase enzyme immobilized in the anodic compartment of the device. The analytical performances of this new device were then evaluated by checking traces of alcohol in different types of natural waters (rain, river, and groundwater), with a good degree of precision and with an acceptable level of accuracy.
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Resurgent sodium current promotes action potential firing in the avian auditory brainstem
Abstract
Auditory brainstem neurons are functionally primed to fire action potentials (APs) at markedly high-rates in order to rapidly encode acoustic information of sound. This specialization is critical for survival and the comprehension of behaviourally relevant communication functions, including sound localization and understanding speech in noise. Here, we investigated underlying ion channel mechanisms essential for high-rate AP firing in neurons of the chicken nucleus magnocellularis (NM) – the avian analog of bushy cells of the mammalian anteroventral cochlear nucleus. In addition to the established function of high-voltage activated potassium channels, we found that resurgent sodium current (INaR) plays a role in regulating rapid firing activity of late-developing (embryonic [E] days 19–21) NM neurons. INaR of late-developing NM neurons showed similar properties with mammalian neurons in that its unique mechanism of an "open channel block state" facilitated the recovery and increased the availability of sodium (NaV) channels after depolarization. Using a computational model of NM neurons, we demonstrated that removal of INaR reduced high-rate AP firing. We found weak INaR during a prehearing period (E11-12), which transformed to resemble late-developing INaR properties around hearing onset (E14-16). Anatomically, we detected strong NaV1.6 expression near maturation, which became increasingly less distinct at hearing onset and prehearing periods, suggesting that multiple NaV channel subtypes may contribute to INaR during development. We conclude that INaR plays an important role in regulating rapid AP firing for NM neurons, a property that may be evolutionarily conserved for functions related to similar avian and mammalian hearing.
This article is protected by copyright. All rights reserved
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Interaction-Dominant Causation in Mind and Brain, and Its Implication for Questions of Generalization and Replication
Abstract
The dominant assumption about the causal architecture of the mind is, that it is composed of a stable set of components that contribute independently to relevant observables that are employed to measure cognitive activity. This view has been called component-dominant dynamics. An alternative has been proposed, according to which the different components are not independent, but fundamentally interdependent, and are not stable basic properties of the mind, but rather an emergent feature of the mind given a particular task context. This view has been called interaction-dominant dynamics. In this paper, we review evidence for interaction-dominant dynamics as the causal architecture of the mind. We point out, that such an architecture is consistent with problems of convergence in research on the level of results and theorizing. Moreover, we point out that if interaction-dominant dynamics as the causal architecture of the mind were to be true, this would naturally lead to (some degree of) problems with generalization and replicability in sciences of the mind and brain, and would probably warrant changes in the scientific practice with regard to study-design and data analysis.
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Control networks and hubs
Abstract
Executive control functions are associated with frontal, parietal, cingulate, and insular brain regions that interact through distributed large-scale networks. Here, we discuss how fMRI functional connectivity can shed light on the organization of control networks and how they interact with other parts of the brain. In the first section of our review, we present convergent evidence from fMRI functional connectivity, activation, and lesion studies that there are multiple dissociable control networks in the brain with distinct functional properties. In the second section, we discuss how graph theoretical concepts can help illuminate the mechanisms by which control networks interact with other brain regions to carry out goal-directed functions, focusing on the role of specialized hub regions for mediating cross-network interactions. Again, we use a combination of functional connectivity, lesion, and task activation studies to bolster this claim. We conclude that a large-scale network perspective provides important neurobiological constraints on the neural underpinnings of executive control, which will guide future basic and translational research into executive function and its disruption in disease.
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Enniatin B and ochratoxin A in the blood serum of workers from the waste management setting
Abstract
The waste management occupational environment is recognized by the simultaneous presence of several substances and biologic agents. Therefore, workers are exposed simultaneously to multiple contaminants. Occupational exposure to aflatoxin B1 in one Portuguese waste sorting plant was already reported. However, besides this mycotoxin, data regarding fungal contamination showed that exposure to other mycotoxins could be expected. A study was developed to analyze if exposure to other mycotoxins besides aflatoxin B1 was occurring in the workers from the waste sorting plant previously assessed and to discuss how these findings need to be considered in the risk assessment process. In addition to aflatoxin B1 detected previously by ELISA, two additional mycotoxins and one mycotoxin degradation product were detected and quantified by a multi-mycotoxin HPLC-MS/MS approach: Enniatin B and ochratoxin A as well as 2'R-ochratoxin A. Besides the confirmation of co-exposure to several mycotoxins, results probably indicate different exposure routes for the mycotoxins reported.
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Current and New Therapeutic Strategies for Relapsed and Refractory Multiple Myeloma: An Update
Abstract
Although survival of multiple myeloma patients has at least doubled during recent years, most patients eventually relapse, and treatment at this stage may be particularly complex. At the time of relapse, the use of alternative drugs to those given upfront is current practice. However, many new options are currently available for the treatment of relapsed multiple myeloma, including recently approved drugs, such as the second- and third-generation proteasome inhibitors carfilzomib and ixazomib, the immunomodulatory agent pomalidomide, the monoclonal antibodies daratumumab and elotuzumab and the histone deacetylase inhibitor panobinostat, but also new targeted agents are under active investigation (e.g. signal transduction modulators, kinesin spindle protein inhibitors, and inhibitors of NF-kB, MAPK, AKT). We here describe a new paradigm for the treatment of relapsed multiple myeloma. The final goal should be finding a balance among efficacy, toxicity, and cost and, at the end of the road, achieving long-lasting control of the disease and eventually even cure in a subset of patients.
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Induction of DNA double-strand breaks in human gingival fibroblasts by eluates from titanium dioxide modified glass ionomer cements
Source:Dental Materials
Author(s): Arunee Laiteerapong, Franz-Xaver Reichl, Yang Yang, Reinhard Hickel, Christof HÖgg
Objectives(1) To investigate the genotoxicity of a glass ionomer cement (GIC) and GIC incorporated with titanium dioxide nanopoarticle (TiO2NPs) and with microparticle (TiO2MPs) on DNA double-strand breaks of human gingival fibroblast cells (HGFs). (2) To compare the genotoxic differences between GIC and two modified cements.MethodsTiO2NPsGIC and TiO2MPsGIC were prepared by adding 10% w/w of TiO2NPs and TiO2MPs to the GIC powder and hand-mixed followed the manufacturer instruction. Dulbecco's Minimum Essential Medium (DMEM) was used as a culture medium for HGFs and eluate preparation. Eluates from all groups were collected for XTT cell viability assay to obtain EC50 values. γ-H2AX immunofluorescence assay was performed to detect DNA double-strand breaks (DSBs) of HGFs.ResultsEC50 values were from 38% to 60% and eluate concentrations at 20% and 5% were selected for γ-H2AX immunofluorescence assay. At both concentrations, HGFs exposed to eluates from all cements groups had fewer mean foci per cell and higher percentage of free foci cells than H2O2 (p<0.05). At 20% concentration, cells exposed to eluates from both TiO2NPsGIC and TiO2MPsGIC groups had fewer mean foci per cell and higher percentage of free foci cell than GIC and culture medium (p<0.05).SignificanceNeither GIC nor 10% TiO2-modified GICs had a genotoxic effect on HGFs. Both TiO2NPsGIC and TiO2MPsGIC demonstrated less genotoxic effect than GIC. When comparing between the two modified cements, there was no genotoxic difference between the modified cements from different particle sizes (nanoparticle and micro-particle) of TiO2.
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Bisphenol A release from an orthodontic resin composite: A GC/MS and LC/MS study
Source:Dental Materials
Author(s): Marc Deviot, Isabelle Lachaise, Christof Högg, Jürgen Durner, Franz-Xaver Reichl, Jean-Pierre Attal, Elisabeth Dursun
ObjectivesFirst, to analyse the in vitro release of BPA and Bis-GMA from an orthodontic resin composite (Transbond XT, 3M Unitek), stored in various conditions, by gas chromatography/mass spectrometry (GC/MS) and liquid chromatography/mass spectrometry (LC/MS); then to extrapolate the data to the clinical situation. Secondly, to explore the thermal stability of Bis-GMA.MethodsCylinders of resin composite were prepared and stored according to 3 different protocols: (1) they were light-cured 20s, then placed in artificial saliva; (2) they were light-cured 2s, then placed in acetonitrile; (3) they were light-cured 2s, then placed in methanol. For each group, BPA and Bis-GMA release were determined with GC/MS and/or LC/MS at least after one week. Besides, 120 brackets (10 of each type) were bonded over metal teeth, then debonded, and the weight and the surface of resin composite residues were measured. BPA and Bis-GMA release of adhesive residues were extrapolated from the data obtained with the cylinders. Besides, BPA release from a heated Bis-GMA solution was measured.ResultsWith GC/MC, BPA was detected in all samples. With LC/MS, BPA was detected only from samples immersed in MeOH; Bis-GMA was detected, in varying amount according to the extraction media and the light-curing time. BPA was found after heating of the Bis-GMA solution.SignificanceContamination risk and the heat applied in GC/MS may overestimate the BPA release from resin composite. Based on the LC/MS results, the risk of BPA release after orthodontic bonding would be more than 42000 times lower than the TDI for a 30-kg child.
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Using glass-graded zirconia to increase delamination growth resistance in porcelain/zirconia dental structures
Source:Dental Materials
Author(s): Herzl Chai, Adam J. Mieleszko, Stephen J. Chu, Yu Zhang
ObjectivePorcelain fused to zirconia (PFZ) restorations are widely used in prosthetic dentistry. However, their tendency to delaminate along the P/Z interface remains a practical problem so that assessing and improving the interfacial strength are important design aspects. This work examines the effect of modifying the zirconia veneering surface with an in-house felspathic glass on the interfacial fracture resistance of fused P/Z.MethodsThree material systems are studied: porcelain fused to zirconia (control) and porcelain fused to glass-graded zirconia with and without the presence of a glass interlayer. The specimens were loaded in a four-point-bend fixture with the porcelain veneer in tension. The evolution of damage is followed with the aid of a video camera. The interfacial fracture energy GC was determined with the aid of a FEA, taking into account the stress shielding effects due to the presence of adjacent channel cracks.ResultsSimilarly to a previous study on PFZ specimens, the fracture sequence consisted of unstable growth of channel cracks in the veneer followed by stable cracking along the P/Z interface. However, the value of GC for the graded zirconia was approximately 3 times that of the control zirconia, which is due to the good adhesion between porcelain and the glass network structure on the zirconia surface.SignificanceCombined with its improved bonding to resin-based cements, increased resistance to surface damage and good esthetic quality, graded zirconia emerges as a viable material concept for dental restorations.
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Effects of different sterilization methods on surface characteristics and biofilm formation on zirconia in vitro
Source:Dental Materials
Author(s): Aifang Han, James K.H. Tsoi, Jukka P. Matinlinna, Yu Zhang, Zhuofan Chen
ObjectiveThe current laboratory study was to investigate the effect of different sterilization treatments on surface characteristics of zirconia, and biofilm formation on zirconia surface after exposure to these sterilization treatments.MethodsCommercially available zirconia discs (Cerconbase, Degu-Dent, Hanau, Germany) were prepared and polished to the same value of surface roughness. The discs were treated with one of the following sterilization methods steam autoclave sterilization, dry heat sterilization, ultraviolet C (UVC) irradiation, and gamma (γ) ray irradiation. The characteristics of zirconia surfaces were evaluated by scanning electron microscopy (SEM), surface roughness, surface free energy (SFE), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD) measurements. Then, Staphylococcus aureus (S.a.) and Porphyromonas gingivalis (P.g.) bacteria were used and cultured on the respective sterilized zirconia surfaces. The amount of biofilm formation on zirconia surface was quantified by colony forming unit (CFU) counts.ResultsSignificant modifications were detected on the colour and SFE of zirconia. The colour of zirconia samples after UVC irradiation became light yellow whilst dark brown colour was observed after gamma ray irradiation. Moreover, UVC and gamma ray irradiation increased the hydrophilicity of zirconia surface. Overall, dry heat sterilized samples showed the significantly lowest amount of bacteria growth on zirconia, while UVC and gamma ray irradiation resulted in the highest.SignificanceIt is evident that various sterilization methods could change the surface which contribute to different biofilm formation and colour on zirconia.
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Effect of tribochemical treatments and silane reactivity on resin bonding to zirconia
Source:Dental Materials
Author(s): Raphael Pilo, Maria Dimitriadi, Anna Palaghia, George Eliades
ObjectiveThe aim of the study was to assess the roughness, structure and bond strength with zirconia of four grit-blasting treatments combined with three silane types, the reactivity of which was evaluated, as well.MethodsThe grit-blasted treatments performed on zirconia (Lava) were alumina (ALU), CoJet (COJ), SilJet (SLJ) and SilJet Plus (SJP, with silica-encapsulated silane). The other two silanes selected were the S-Bond (SB, prehydrolyzed) and Clearfil Ceramic Primer Plus (CP, prehydrolyzed with 10-MDP). The activity of the silanols in the silanes was evaluated by FTIR spectroscopy. Optical profilometry and Raman microspectroscopy were used for the assessment of roughness (Sa, Sz, Sdr parameters) and structure (monoclinic volume-Vm) of zirconia, before (REF) and after grit-blasting, and a shear bond strength (SBS) with a flowable resin composite, for the investigation of the bonding capacity of the treatments.ResultsOnly SB demonstrated reactive silanols. CP and the SJP silanes were mostly in a polymerized siloxane state. Roughness was increased after grit-blasting as follows: ALU>SLJ,SJP>COJ>REF (Sa,Sz) and ALU>SLJ,COJ,SJP>REF (Sdr). ALU demonstrated the highest Vm (7.52%) from all other treatments (4.16–4.81%) and the REF (0%). COJ and SLJ showed the highest SBS (14–15.94MPa) regardless of the silane type used. SJP showed no significant differences from SLJ-SB and COJ-SB. Weibull analysis showed a reliability (β) ranking of COJ, SJP, SLJ, ALU-CP>ALU-SB>REF and a characteristic life (η) ranking of COJ, SLJ, ≥SLJ-SB, SJP, ALU≥ALU-SB,REF-CP>REF-SB.SignificanceThe reactivity of the silanes used showed great variations to support a predictable effect in all treatments. CP with deactivated silanols demonstrated a) the most reliable and strongest treatment with a silica-rich powder (COJ), despite the lowest Sa,Sz substrate values and b) high strength with a low-silica powder (SLJ) with higher Sa,Sz substrate values. Therefore, it may be concluded that 10-MDP greatly contributes to the bonding mechanism of the silane containing primers.
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The effect of chewing simulation on surface roughness of resin composite when opposed by zirconia ceramic and lithium disilicate ceramic
Source:Dental Materials
Author(s): Ting Khee Ho, Julian D. Satterthwaite, Nikolaos Silikas
ObjectiveTo assess the change in surface roughness of nanohybrid resin composite (Tetric EvoCeram) after antagonist wear against monolithic zirconia and lithium disilicate ceramics through a simulated chewing test using a three-dimensional (3D) profilometer.MethodsA total of 40 Tetric EvoCeram™ resin composite specimens against either a Lava™ Plus zirconia antagonist (n=20) or IPS e.max Press lithium disilicate antagonist (n=20) were prepared for the study. The surface roughness profiles of each resin composite before and after an in-vitro simulated chewing test were analysed using a 3D profilometer and Talymap software. After the simulated chewing, the surface profiles of representative Tetric EvoCeram specimens from each group were analysed using scanning electron microscopy. Independent t-test and paired t-test were used for statistical analysis.ResultsFor both lithium disilicate and zirconia groups, all surface roughness parameters (Ra, Rt, Sa, Sq,) of Tetric EvoCeram were significantly higher post-chewing compared to pre-chewing (p<0.05); the post-chewing surface roughness parameters of Tetric EvoCeram for the lithium disilicate group were significantly higher (p<0.05) than in the zirconia group.SignificanceThis chewing simulation test showed that Tetric EvoCeram composites exhibited a rougher surface when opposing lithium disilicate ceramic compared to opposing zirconia ceramic.
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Dentin bonding systems: From dentin collagen structure to bond preservation and clinical applications
Source:Dental Materials
Author(s): Lorenzo Breschi, Tatjana Maravic, Sandra Ribeiro Cunha, Allegra Comba, Milena Cadenaro, Leo Tjäderhane, David H. Pashley, Franklin R. Tay, Annalisa Mazzoni
ObjectivesEfforts towards achieving durable resin–dentin bonds have been made for decades, including the understanding of the mechanisms underlying hybrid layer (HL) degradation, manufacturing of improved adhesive systems, as well as developing strategies for the preservation of the HL.MethodsThis study critically discusses the available peer-reviewed research concerning the formation and preservation of the HL, the mechanisms that lead to the degradation of the HL as well as the strategies to prevent it.ResultsThe degradation of the HL occurs through two main mechanisms: the enzymatic degradation of its collagen fibrils, and the leaching of the resin from the HL. They are enabled by residual unbound water between the denuded collagen fibrils, trapped at the bottom of the HL. Consequently, endogenous dentinal enzymes, such as the matrix metalloproteinases (MMPs) and cysteine cathepsins are activated and can degrade the denuded collagen matrix. Strategies for the preservation of the HL over time have been developed, and they entail the removal of the unbound water from the gaps between the collagen fibrils as well as different modes of silencing endogenous enzymatic activity.SignificanceAlthough there are many more hurdles to be crossed in the field of adhesive dentistry, impressive progress has been achieved so far, and the vast amount of available research on the topic is an indicator of the importance of this matter and of the great efforts of researchers and dental material companies to reach a new level in the quality and longevity of resin–dentin bonds.
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Effect of titania content and biomimetic coating on the mechanical properties of the Y-TZP/TiO2 composite
Source:Dental Materials
Author(s): Ranulfo Benedito de Paula Miranda, Walter Gomes Miranda, Dolores Ribeiro Ricci Lazar, Valter Ussui, Juliana Marchi, Paulo Francisco Cesar
ObjectiveTo investigate the effect of titania addition (0, 10 and 30mol%) on the microstructure, relative density, Young's modulus (E), Poisson's ratio (υ), mechanical properties (flexural strength, σf, and Weibull modulus, m) of a Y-TZP/TiO2 composite. The effect of the presence of a biomimetic coating on the microstructure and mechanical properties was also evaluated.MethodsY-TZP (3mol% of yttria) and Y-TZP/TiO2 composite (10 or 30mol% of titania) were synthesized by co-precipitation. The powders were pressed and sintered at 1400°C/2h. The surfaces, with and without biomimetic coating, were characterized by X-ray diffraction analysis and scanning electron microscopy. The relative density was measured by the Archimedes' principle. E and υ were measured by ultrasonic pulse-echo method. For the mechanical properties the specimens (n=30 for each group) were tested in a universal testing machine.ResultsTitania addition increased the grain size of the composite and caused a significant decrease in the flexural strength (in MPa, control 815.4a; T10 455.7b and T30 336.0c), E (in GPa, control 213.4a; T10 155.8b and T30 134.0c) and relative density (control 99.0%a; T10 94.4%c and T30 96.3%b) of the Y-TZP/TiO2 composite. The presence of 30% titania caused substantial increase in m and υ. Biomimetic coating did not affect the mechanical properties of the composite.SignificanceThe Y-TZP/TiO2 composite coated with a layer of CaP has great potential to be used as implant material. Although addition of titania affected the properties of the composite, the application of a biomimetic coating did not jeopardize its reliability.
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An interproximal model to determine the erosion-protective effect of calcium silicate, sodium phosphate, fluoride formulations
Source:Dental Materials
Author(s): Natalie J. Wood, Siân Bodfel Jones, Nick Chapman, Andrew Joiner, Carole J. Philpotts, Nicola X. West
ObjectivesPrevious work has shown the effectiveness of a newly developed interproximal model to differentiate between the amount of remineralization caused by toothpastes used with or without a dual-phase gel treatment system containing calcium silicate, sodium phosphate salts and fluoride to repair acid-softened enamel. The aim of this study was to utilize the same interproximal model to identify how effective calcium silicate phosphate toothpastes are at reducing surface softening in the early stages of erosion. The model was also used to identify the effect of increasing the frequency of acid exposure on the reduction in surface hardness.MethodsHuman enamel specimens were prepared and mounted in an interproximal face-to-face arrangement and exposed to a cycling regime of whole human saliva, treatment, artificial saliva and 1% citric acid pH 3.75. Specimens were measured by surface microhardness at baseline and after three and seven days. The frequency of acid exposure was increased from 2 to 4 cycles a day for the second part of the study.ResultsThe results showed that specimens treated with the calcium silicate phosphate toothpastes softened less than those treated with control fluoridated or non-fluoride toothpastes at each time point and following an increase in the frequency of acid exposure.SignificanceThis work has demonstrated how an interproximal model can also be successfully used to determine differences in the erosion protection of various treatments as well as determining how they perform when the frequency of acid exposure is increased.
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Mechanism of bioactive molecular extraction from mineralized dentin by calcium hydroxide and tricalcium silicate cement
Source:Dental Materials
Author(s): Xue-qing Huang, John Camba, Li-sha Gu, Brian E. Bergeron, Domenico Ricucci, David H. Pashley, Franklin R. Tay, Li-na Niu
ObjectivesThe objective of the present study was to elucidate the mechanism of bioactive molecule extraction from mineralized dentin by calcium hydroxide (Ca(OH)2) and tricalcium silicate cements (TSC).Methods and resultsTransmission electron microscopy was used to provide evidence for collagen degradation in dentin surfaces covered with Ca(OH)2 or a set, hydrated TSC for 1–3 months. A one micron thick collagen degradation zone was observed on the dentin surface. Fourier transform-infrared spectroscopy was used to identify increases in apatite/collagen ratio in dentin exposed to Ca(OH)2. Using three-point bending, dentin exposed to Ca(OH)2 exhibited significant reduction in flexural strength. Using size exclusion chromatography, it was found that the small size of the hydroxyl ions derived from Ca(OH)2 enabled those ions to infiltrate the intrafibrillar compartment of mineralized collagen and degrade the collagen fibrils without affecting the apatite minerals. Using ELISA, TGF-β1 was found to be extracted from dentin covered with Ca(OH)2 for 3 months. Unlike acids that dissolve the mineral component of dentin to release bioactive molecules, alkaline materials such as Ca(OH)2 or TSC released growth factors such as TGF-β1 via collagen degradation.SignificanceThe bioactive molecule extraction capacities of Ca(OH)2 and TSC render these dental materials excellent for pulp capping and endodontic regeneration. These highly desirable properties, however, appear to be intertwined with the untoward effect of degradation of the collagen matrix within mineralized dentin, resulting in reduced flexural strength.
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Hierarchical microcrack model for materials exemplified at enamel
Source:Dental Materials
Author(s): H. Özcoban, E.D. Yilmaz, G.A. Schneider
ObjectiveThis article investigates the mechanical properties of a material with hierarchically arranged microcracks.MethodsHierarchically structured biomaterials such as enamel exhibit superior mechanical properties as being stiff and damage tolerant at the same time. The common mechanical explanation for this behavior is based on the hierarchically structured arrangement of hard minerals and soft organics and their cooperative deformation mechanisms. In situ mechanical experiments with mm-sized bovine enamel bending bars an scanning electron microscope reveal that enamel is able to withstand mechanical loading even if it contains microcracks on different lengths scales. To clarify this issue an analytical hierarchical microcrack model of non-interacting cracks is presented.Results and SignificanceThe model predicts a decrease of the elastic modulus and the fracture strength with increasing levels of hierarchy. The fracture strain on the other hand may decrease or increase with the number of hierarchical levels, depending on the microcrack density. This simple hierarchical microcrack model is able to explain already published experiments with focused ion beam prepared μm-sized enamel cantilevers on different hierarchical levels. In addition it is shown that microcracking during loading in hierarchical materials may lead to substantial pseudoplastic behavior.
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Light irradiance through novel CAD–CAM block materials and degree of conversion of composite cements
Source:Dental Materials
Author(s): Diogo Pedrollo Lise, Annelies Van Ende, Jan De Munck, Kumiko Yoshihara, Noriyuki Nagaoka, Luiz Clovis Cardoso Vieira, Bart Van Meerbeek
ObjectiveTo assess light irradiance (LI) delivered by two light-curing units (LCU's) and to measure the degree of conversion (DC) of three composite cements, when cured through different thicknesses of two novel CAD–CAM block materials.Methods100-μm-thick films of a dual-curable composite cement (G-CEM LinkAce, GC), a light-curable flowable resin-based composite (RBC) (G-ænial Universal Flo, GC) and a micro-hybrid RBC (G-ænial Posterior, GC) were investigated as luting agents. Two 'polymer–ceramic' CAD–CAM blocks (Cerasmart, GC; Enamic, Vita Zahnfabrik) were sectioned in slabs with different thicknesses (1, 3 and 5mm). LI at the bottom of the specimens was measured using a calibrated spectrometer, while being light-cured through the CAD–CAM block slabs for 40s with a low- (±500mW/cm2) or high- (±1,600mW/cm2) irradiance LCU (n=5). After light-curing, micro-Raman spectra of the composite films were acquired to determine DC at 5min, 10min, 1h and 24h. LI data were statistically analyzed by Kruskal–Wallis followed by post-hoc comparisons, while a linear mixed-effect model was applied for the DC analysis. In addition, the CAD–CAM blocks ultrastructure was characterized upon argon-ion slicing using scanning transmission electron microscopy (STEM). Finally, light transmission (LT) through each CAD–CAM block material was assessed using a spectrophotometer.ResultsCuring-light attenuation and DC were significantly influenced by thickness and type of the overlying material. LCU only had a significant effect on DC of the micro-hybrid RBC. DC significantly increased over time for all composite cements. CAD–CAM block structural analysis revealed a relatively small and homogenous filler configuration (mean filler size of 0.2–0.5μm) for Cerasmart, while Enamic contained ceramic grains varying in shape and size (1–10μm), which were interconnected by the polymer-based network. LT was much higher at a wavelength range of 300–800nm for Cerasmart than for Enamic.SignificanceLight-curable composite cements can be cured through a restoration up to 2.7-mm thickness, depending on the kind of CAD–CAM material. A high-irradiance LCU only has a limited effect on the maximum thickness of the polymer–ceramic CAD–CAM material that can be cured through.
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Free flap reconstruction for trauma in the early post-partum period
Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rebecca A. Rollett, Helen E. Douglas, Philippa Jackson, Jonathan D. Wiper
We present the case of a patient who suffered significant polytrauma, fracturing her pelvis, femur and tibia and requiring emergency caesarian section of her 36-week old foetus. Forty eight hours later she underwent free flap reconstruction of her open tibial fracture. The issues involved in performing free flap surgery in the early postpartum period and specific surgical and pharmacological measures taken to overcome the physiological hypercoagulable state of post-partum patients are described along with a summary of the literature.
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Silicone lip implant for augmentation in cleft lip
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A. Paddle, M. Wordsworth, D. Atherton
Patients with a history of cleft lip repaired in childhood commonly present requesting upper lip revision to improve deficiency in the volume of the upper lip vermillion and disharmony with respect to the volume of the lower lip. There are a number of techniques available to address this issue, however some of these carry the risk of potential donor site morbidity and the longevity of the volume of enhancement achieved is often unpredictable. We describe six successful cleft lip augmentation cases using a silicone lip implant, a technique only previously reported in the aesthetic augmentation population, and show how in the right patient, this can be a rewarding reconstructive option.
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Refining the cross-finger flap: considerations of flap insetting, aesthetics and donor site morbidity
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Chew-Wei Chong, Cheng-Hung Lin, Yu-Te Lin, Chung-Chen Hsu, Shih-Heng Chen
We described a laterally based cross-finger flap for reconstruction of soft tissue defects in the fingers. This modification enables coverage of volar or dorsal soft tissue defects at the distal, middle or proximal phalanx. From March 2015 to January 2017, a total of 12 patients (13 fingers) underwent soft tissue reconstruction of the fingers with a laterally based cross-finger flap. The flap dimensions ranged from 13 x 7 mm to 43 x 13 mm. Eleven of the 13 flaps survived completely. The two flap failures were attributed to injuries in the donor fingers, rendering the blood supply of the flaps unreliable. All donor sites were closed primarily without the need for skin grafting, negating the problem of donor site morbidity that is associated with skin graft harvesting. The laterally based cross-finger flap is a versatile flap with less donor site morbidity and better aesthetics than a conventional cross-finger flap. We described the design of the flap, as well as the advantages and disadvantages, in doing a laterally based cross-finger flap.
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Analysis of the Correlation between Deformational Plagiocephaly and Neurodevelopment delay: methodological issues
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Saeid Safiri, Salman Khazaei, Erfan Ayubi
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Long-term functional outcome in case series of tibial osteomyelitis reconstruction with free tissue transfer
Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Keisuke Takanari, Kazuhiro Toriyama, Miki Kambe, Ryota Nakamura, Yutaka Nakamura, Hideyoshi Sato, Katsumi Ebisawa, Satoshi Tsukushi, Yoshihiro Nishida, Yuzuru Kamei
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Post-operative care of VRAM flaps for perineal reconstruction
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): David Boccara, Kevin Serror, Samuel Levy, Maurice Mimoun, Marc Chaouat
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The use of a ‘pocket’ printer to improve documentation and patient care
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): John A.G. Gibson, Thomas D. Dobbs, Emman J. Combellack, Iain S. Whitaker
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Spreader graft placement: location, location, location
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Marc A. Seifman, Andrew L. Greensmith
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Analysis of the correlation between deformational plagiocephaly and neurodevelopment delay: methodological issues
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Mohammed Ahmed Hussein, Jinae Lee, Yong Oock Kim
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Bleeding on the cutting edge; a systematic review of anticoagulant and antiplatelet continuation in minor cutaneous surgery
Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Alexander Isted, Lilli Cooper, R. James Colville
BackgroundAnticoagulant and antiplatelet (AC/AP) use is common and practice surrounding AC/AP continuation or cessation peri-operatively for minor cutaneous surgery lacks evidence-based consensus.ObjectiveTo determine the risks of haemorrhagic and thromboembolic complications associated with the continuation or cessation of AC/AP therapy in minor cutaneous surgery.MethodsA systematic literature search was conducted using PubMed, MEDLINE, Embase and CENTRAL, to identify all articles involving the use of AC/AP in patients undergoing minor cutaneous surgery, including skin grafts and local flaps. Eligible studies were randomised control trials, prospective studies and retrospective studies in the English language. Studies investigating free-flap repairs, oculoplastic surgery and hand surgery were excluded.Results30 studies included data from over 14,000 patients, of which more than 5,000 took regular AC/AP therapy. Thromboembolic events were rare but carry high morbidity and even mortality, and in these studies three events were associated with cessation of AC/AP. There was no increase in haemorrhagic complications in patients taking aspirin monotherapy, but evidence is conflicting regarding warfarin and clopidogrel monotherapy, which show a small increase in rate of bleeding complications. However, no increase in wound dehiscence, graft failure, wound infection or cosmetic outcome was seen. Too few studies investigated DOAC use to draw reliable conclusions. Data are sparse in comparing multiple versus single AC/AP regimens. Use of skin grafts or local flaps may have a greater complication rate than direct closure in patients on one or more AC/AP, but evidence is limited.ConclusionA case-by-case risk assessment is warranted in all patients but where possible, clinicians should prioritise meticulous haemostasis over cessation of agents.
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Outcome measurement in plastic surgery
Publication date: Available online 28 November 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Justin C.R. Wormald, Jeremy N. Rodrigues
Outcome measurement in plastic surgery is often surgeon-centred, and clinician-derived. Greater emphasis is being placed on patient-reported outcomes (PROs), in which the patient's perspective is measured directly from them. Numerous patient-reported outcome measures (PROMs) have been developed in a range of fields, with a number of good quality PROMs in plastic surgery. They can be deployed to support diagnosis, disease severity determination, referral pathways, treatment decision-making, post-operative care and in determining cost-effectiveness. In order to understand the impact of disease and health interventions, appropriate PROMs are a logical choice in plastic surgery, where many conditions involve detriment of function or cosmesis. PROMS can be classified as disease-specific, domain-specific, dimension-specific, population-specific and generic. Choosing the correct outcome and measure can be nebulous. The two most important considerations are: is it suitable for the intended purpose? and how valid is it? Measurement that combines being patient-centred and also aligns with clinicians' understanding is achievable, and can be studied scientifically. Rational design of new PROMs and considered choice of measures is critical in clinical practice and research. There are a number of tools that can be employed to assess the quality of PROMs that are outlined in this overview. Clinicians should consider the quality of measures both in their own practice and when critically appraising evidence. This overview of outcome measurement in plastic surgery provides a tool set enabling plastic surgeons to understand, implement and analyse outcome measures across clinical and academic practice.
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Aesthetic day surgery safety in a UK facility- a 4 year retrospective study and discussion of the literature
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): B. Strong, D. Sainsbury, P. Hodgkinson, M. Ragbir, N. Williams
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Sentinel node biopsy in desmoplastic thin melanoma: histogenetic reccomandations
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Pusiol Teresa
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A prospective, randomized-controlled pilot study comparing closed suction versus negative pressure drains for panniculectomy patients
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Marc E. Walker, Cynthia Tsay, P. Niclas Broer, Victor Z. Zhu, Tracy Sturrock, Reuben Ng, Leslie M. Scoutt, J. Grant Thomson, Stephanie L. Kwei
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Serial excision with power-stretching of the skin in giant melanocytic nevi therapy
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hans-Martin Häfner, Helmut Breuninger
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Efficacy and safety of topical depigmenting agent in healthy human fair skin female volunteers: A single-arm study
Summary
Background
Skin hyperpigmentation is the darkening of skin due to the increased production of melanin in the body.
Objectives
To evaluate the efficacy and safety of a botanical-based Rosa E pigmentation serum in healthy fair skin female volunteers with wrinkles, skin tone, and pigmentation.
Methods
This was a single-arm, open label study conducted in healthy Indian females; 18 subjects aged 30-55, having fair Caucasian-like skin with at least 2 dark skin pigments with facial wrinkles diagnosed by dermatologist were selected. Rosa E pigmentation serum was applied twice a day for 84 days. Effect was evaluated by (i) instrumental technique (spectrophotometer® 2600D), (ii) clinically by dermatologist regarding product efficacy (skin tone, antiwrinkle, pigmentation), and (iii) volunteers self-evaluation.
Results
The L* value of spectrophotometer reading represents lightness in the skin pigment. Reduction in the pigment was reported from day 14, with significant reductions observed till day 84 compared with baseline. Significant (P < .0001) skin pigmentation lightening was seen on day 14 (1.11) vastly improving on day 84 (1.94) based on photographic assessments. The significant reduction in skin pigment was 76.85%, Felix von Luschan skin color score was 30.24% (P < .0001) with a 7.38-fold reduction in skin tone and 57% reduction in facial wrinkles at day 84 from baseline.
Conclusions
Rosa E pigmentation serum was found safe and effective in significant reduction in skin pigments, improvement of skin tone, and antiwrinkle properties instrumentally, clinically, and self-evaluation by volunteers. In these evaluations, best results were seen the longer the Rosa E was used.
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Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method
Source:American Journal of Otolaryngology
Author(s): Anindya Nayak, Sunil Kumar, Rubeena Arora, Gautam Bir Singh
PurposeTo diagnose Laryngopharyngeal Reflux by observing colour (Red, Green, Blue) at the interarytenoid area during 70° laryngeal endoscopy.Materials and methodsEndoscopic images from 50 normal controls and 50 patients of LPR were obtained in this observational study. LPR patients were selected on the basis of RSI and RFS. Images were analysed using ImageJ, a free image analysis software, developed by the National Institute of Health (NIH). Colour changes in the form of RGB (red, green, blue) values were calculated and analysed at the interarytenoid area. The values in the normal and patient group were compared and correlated with RSI and RFS.ResultsRGB values of the LPR group and the normal group were statistically different (P value<0.01). Strong correlation was also found between R and G values and both RFS and RSI. However, no correlation was seen with B values.ConclusionImage analysis is an easy, economical and objective method to diagnose LPR.
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Letter to the editor
Source:American Journal of Otolaryngology
Author(s): Satvinder Singh Bakshi
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Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method
Source:American Journal of Otolaryngology
Author(s): Anindya Nayak, Sunil Kumar, Rubeena Arora, Gautam Bir Singh
PurposeTo diagnose Laryngopharyngeal Reflux by observing colour (Red, Green, Blue) at the interarytenoid area during 70° laryngeal endoscopy.Materials and methodsEndoscopic images from 50 normal controls and 50 patients of LPR were obtained in this observational study. LPR patients were selected on the basis of RSI and RFS. Images were analysed using ImageJ, a free image analysis software, developed by the National Institute of Health (NIH). Colour changes in the form of RGB (red, green, blue) values were calculated and analysed at the interarytenoid area. The values in the normal and patient group were compared and correlated with RSI and RFS.ResultsRGB values of the LPR group and the normal group were statistically different (P value<0.01). Strong correlation was also found between R and G values and both RFS and RSI. However, no correlation was seen with B values.ConclusionImage analysis is an easy, economical and objective method to diagnose LPR.
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Letter to the editor
Source:American Journal of Otolaryngology
Author(s): Satvinder Singh Bakshi
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Synechococcus plasticity under environmental changes
Abstract
Cyanobacteria are among the oldest photoautotrophic organisms on Earth, and have contributed to shaping the planet's biogeochemistry with their significant biomass and key metabolic activities. Synechococcus, the focus of this review, is one of the prevalent genera in the order Chroococcales, common in oceans and lakes and characterized by a coccoid unicellular or microcolony morphology. The evolution of its phycobilisomes is the key of the adaptation of this tiny photosynthetic cell to different light regimes and environmental conditions. Furthermore, Synechococcus strains are widely distributed from the equator to the poles, showing an extreme adaptability to high and low temperatures. Because of their structural plasticity and ecological adaptability, these cyanobacteria are particularly interesting in the current condition of fast climate change. Moreover, picocyanobacteria of the Synechococcus genus have a potentially vast impact on global cycles thanks to their significant role in the biogeochemical cycles of aquatic ecosystems. As increasing abundances are predicted for this genus worldwide, and in light of the connection between cyanobacteria and global change events, a better characterization of these organisms promises important and timely ecological insights. Here, I will summarize the morphological and genetic characteristics of Synechococcus strains and their distribution in freshwater lakes, also considering its marine counterpart.from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2gVsAoI
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