A comprehensive treatment for peritoneal metastases from gastric cancer with curative intent

Publication date: August 2016
Source:European Journal of Surgical Oncology (EJSO), Volume 42, Issue 8
Author(s): Y. Yonemura, E. Canbay, Y. Li, F. Coccolini, O. Glehen, P.H. Sugarbaker, D. Morris, B. Moran, S. Gonzaletz-Moreno, M. Deraco, P. Piso, D. Elias, D. Batlett, H. Ishibashi, A. Mizumoto, V. Verwaal, H. Mahtem
Recently, Peritoneal Surface Oncology Group International (PSOGI) developed a novel comprehensive treatment consisting of cytoreductive surgery (CRS) and perioperative chemotherapy (POC) for the treatment of peritoneal metastases (PM) from gastric cancer with curative intent. This article reviews the results of this treatment and verifies its indication.In this strategy, peritoneal cancer index (PCI) is determined by laparoscopy, and a peritoneal port is placed. Neoadjuvant bidirectional intraperitoneal/systemic chemotherapy (NIPS) is performed for 3 cycles, and then laparotomy is performed. Cytoreductive surgery with peritonectomy procedures and hyperthermic intraperitoneal chemoperfusion (HIPEC) are performed.Multivariate analyses showed that completeness of cytoreduction, pathologic response to NIPS and PCI level and cytologic status after NIPS, as independent prognostic factors. PCI less than cut-off level after NIPS, negative cytology after NIPS, and positive response to NIPS were identified as the indications for comprehensive treatment. Patients who hold these criteria should be considered as the candidates for CRS and HIPEC.

Teaser

Peritoneal metastases of gastric cancer can be treated with combined treatment approach when the patient have PCI level less than 6, negative cytology, and a positive response to neoadjuvant chemotherapy.


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Assessment of metastatic risk of gastric GIST based on treatment-naïve CT features

Publication date: August 2016
Source:European Journal of Surgical Oncology (EJSO), Volume 42, Issue 8
Author(s): A.C. O'Neill, A.B. Shinagare, V. Kurra, S.H. Tirumani, J.P. Jagannathan, A.D. Baheti, J.L. Hornick, S. George, N.H. Ramaiya
ObjectiveTo study whether the CT features of treatment-naïve gastric GIST may be used to assess metastatic risk.MethodsIn this IRB approved retrospective study, with informed consent waived, contrast enhanced CT images of 143 patients with pathologically confirmed treatment-naïve gastric GIST (74 men, 69 women; mean age 61 years, SD ± 14) were reviewed in consensus by two oncoradiologists blinded to clinicopathologic features and clinical outcome and morphologic features were recorded. The metastatic spread was recorded using available imaging studies and electronic medical records (median follow up 40 months, interquartile range, IQR, 21–61). The association of maximum size in any plane (≤10 cm or >10 cm), outline (smooth or irregular/lobulated), cystic areas (≤50% or >50%), exophytic component (≤50% or >50%), and enhancing solid component (present or absent) with metastatic disease were analyzed using univariate (Fisher's exact test) and multivariate (logistic regression) analysis.ResultsMetastatic disease developed in 42 (29%) patients (28 at presentation, 14 during follow-up); 23 (16%) patients died. On multivariate analysis, tumor size >10 cm (p = 0.0001, OR 9.9), irregular/lobulated outline (p = 0.001, OR 5.6) and presence of a enhancing solid component (p < 0.0001, OR 9.1) were independent predictors of metastatic disease. On subgroup analysis, an irregular/lobulated outline and an enhancing solid component were more frequently associated with metastases in tumors ≤5 cm and >5–≤10 cm (p < 0.05).ConclusionCT morphologic features can be used to assess the metastatic risk of treatment-naïve gastric GIST. Risk assessment based on pretreatment CT is especially useful for patients receiving neoadjuvant tyrosine kinase inhibitors and those with tumors <5 cm in size.



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Calendar

Publication date: August 2016
Source:European Journal of Surgical Oncology (EJSO), Volume 42, Issue 8





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Male sexual dysfunction after rectal cancer surgery: Results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212

Publication date: Available online 30 July 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Shuji Saito, Shin Fujita, Junki Mizusawa, Yukihide Kanemitsu, Norio Saito, Yusuke Kinugasa, Yoshihiro Akazai, Mitsuyoshi Ota, Masayuki Ohue, Koji Komori, Manabu Shiozawa, Takashi Yamaguchi, Takayuki Akasu, Yoshihiro Moriya
BackgroundWe conducted a randomized controlled trial (JCOG0212) to determine whether the outcome of mesorectal excision (ME) alone for rectal cancer is not inferior to that of ME with lateral lymph node dissection (LLND). The present study focused on male sexual dysfunction after surgery.Methodology: Eligibility criteria included clinical stage II/III rectal cancer, the lower margin of the lesion below the peritoneal reflection, the absence of lateral pelvic lymph node enlargement, and no preoperative radiotherapy. After confirmation of R0 resection by ME, patients were intraoperatively randomized. Questionnaires using the International Index of Erectile Function (IIEF-5) about the sexual function of men were collected before and 1 year after surgery. Sexual dysfunction incidence was defined as the ratio of patients showing sexual dysfunction after surgery relative to the number who had no erectile dysfunction before surgery.ResultsAmong 701 patients enrolled between June 2003 and August 2010, 472 males were included. Among them, 343 (73%) completed preoperative and postoperative questionnaires. According to the study protocol, the incidences of sexual dysfunction in patients who underwent ME alone and ME with LLND were 68% (17/25; 95%CI, 47%–85%) and 79% (23/29; 95%CI, 60%–92%), respectively (p = 0.37). Incidences of sexual dysfunction in patients with no or only mild erectile dysfunction before surgery who underwent ME alone and ME with LLND were 59% (48/81) and 71% (67/95), respectively (p = 0.15). Multivariate analysis identified age as the only risk factor for sexual dysfunction after surgery (p = 0.02).ConclusionsLLND may not increase sexual dysfunction incidence after rectal cancer surgery. This incidence is associated with increased age.This trial is registered with ClinicalTrials.gov, number NCT00190541 and University Hospital Medical Information Network Clinical Trials Registry, number C000000034.



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Influence of sawdust on peak expiratory flow rate in sawmill workers of central India working in unprotected environment and its correlation with duration of exposure

2016-08-06T10-43-09Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Piyush M Kherde, Neelam V Mishra, Shrinivas S Chitta, Shailesh D Gahukar.
Background: Exposure to wood-dust has long been linked with a variety of adverse health effects. Objective: This study was designed to investigate the effects of saw-dust on peak expiratory flow rate (PEFR) and further to reduce the possible health risks in sawmill workers by providing information on sawdust hazards. Materials and Methods: A total of 50 apparently healthy male sawmill workers, without using any personal protective measures, with a mean age of 33.14 ± 9.64 years with mean duration of exposure 7.92 ± 5.47 years were selected. Age, sex and anthropometrically matched 50 healthy subjects of same socio-economic status who were not exposed to wood industries with mean age of 33.92 ± 9.68 years were selected as control group. A questionnaire was used to assess respiratory symptoms. Computerized spirometer (RMS-Helios 401, Transducer No.400-666) was used to measure PEFR. The data were analyzed using STATA version 10.0, applying unpaired t-test, ANOVA, and Pearsons correlation coefficient. Results: Unpaired t-test showed mean PEFR values in the sawmill workers 6.44 ± 1.45 L/s were significantly lower than in controls 7.18 ± 1.15 L/s and as the duration of exposure to saw dust increases PEFR also significantly decreases in sawmill workers. It also showed negative correlation exists between PEFR and duration of exposure on correlating both factors with Pearsons test (r = −0.6075) with significant P = 0.0001. Conclusion: Inflammatory changes in the respiratory tracts which lead to increased airway resistance thereby bringing about the remodeling of the airway; it can elicit pulmonary inflammation via different mechanisms and is accompanied by induction of several pro-inflammatory cytokines and chemokines, microorganisms, and toxins contained in different types of wood are potentially implicated in occurrence of asthma by inducing increased bronchial responsiveness or by damaging bronchial epithelial cells. It is possible to control the levels to within safe occupational limits with a well-designed, efficient and properly used exhaust ventilation system which should be periodically maintained. Suppression of dust technical control measures such as pre-wetting and water-sprinkling should be practiced and workers should be educated about the importance of using protective devices along with encouragement for using personal protective equipment during processing and cutting of woods.


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Comparative study of simple auditory reaction time in blind and blindfolded sighted individuals

2016-08-06T10-43-09Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Bhavana G Bhirud, Lalita M Chandan.
Background: The ability of blinds to adapt themselves to cope with environmental stimuli depends on the quickness of response which in turn depends on sensory perception and central processing. Aims and Objectives: In this study, simple auditory reaction time has been used to evaluate the processing speed of the central nervous system and coordination between sensory and motor systems in congenitally blind and sighted subjects. Materials and Methods: 30 congenitally blind braille readers and 30 age and gender matched controls were included in the study. Simple auditory reaction time was evaluated. Results: The auditory reaction time is significantly reduced, in congenitally blind participants compared to blindfolded sighted participants. Conclusion: Congenitally blind subjects outperformed blindfolded sighted subjects with respect to auditory reaction time.


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Evaluation of the effects of low-intensity laser radiation in treatment of chronic salpingo-oophoritis in women

2016-08-06T10-43-09Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Meerim B Osmonova.
Background: The paper presents the data of an evaluation of low-intensity infrared laser radiation in the treatment of women with chronic salpingo-oophoritis (CSO). Aims and Objective: The research was aimed to determine effects of low-intensity laser radiation (LILR) in the treatment of CSO in women based on individual sensitivity, interleukin (IL) blood levels, and clinical success rates of the treatment. The research object included 74 women of reproductive age. Materials and Methods: The evaluation of the treatment was performed based on a study of blood serum individual sensitivity to a selected mode of laser radiation, blood cytokine levels (IL - 1β, 4, 6), and clinical success rates of the treatment. Results: The effects of LILR in women with CSO are aimed at inhibiting the production of inflammatory mediators following the activation of quantum absorption and generation of secondary radiations and a bio-energetic resonance. Conclusion: Womens body being highly sensitive to infrared laser radiation substantially increases clinical success rates of the treatment compared to the treatment without laser therapy (pain relief, reducing a number of disease recurrences, reducing obstruction of the fallopian tubes).


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A study on the anticonvulsant activity of Withania somnifera (Dunal) in albino rats

2016-08-06T10-43-09Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Santhosh Kumar Raju, Basavanna PL, Nagesh HN, Ajay D Shanbhag.
Background: The present study is an investigation of antiepileptic activity of Withania somnifera (Ashwagandha) is a well-known plant which is being used in tuberculosis, emaciation, sterility, and it has immunomodulatory, anabolic, anti-inflammatory, and antianxiety activities. Aims and Objectives: To find the efficacy of the alcoholic extract of W. somnifera (Dunal) in preventing experimentally-induced seizures. Materials and Methods: The alcoholic extract of W. somnifera was subjected to pilot study and then screened for anticonvulsant activity on maximal electroshock (MES) and pentylenetetrazole (PTZ)-induced seizures models in albino Wistar rats. Animals were treated with W. somnifera at doses of 100 mg/kg, 200 mg/kg, and 300 mg/kg body weight and compared the results with control and standard. Results: Study results showed that W. somnifera extract at the dose of 300 mg/kg body weight when compared to control group highly significant (P

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Scalable histopathological image analysis via supervised hashing with multiple features

Publication date: Available online 5 August 2016
Source:Medical Image Analysis
Author(s): Menglin Jiang, Shaoting Zhang, Junzhou Huang, Lin Yang, Dimitris N. Metaxas
Histopathology is crucial to diagnosis of cancer, yet its interpretation is tedious and challenging. To facilitate this procedure, content-based image retrieval methods have been developed as case-based reasoning tools. Especially, with the rapid growth of digital histopathology, hashing-based retrieval approaches are gaining popularity due to their exceptional efficiency and scalability. Nevertheless, few hashing-based histopathological image analysis methods perform feature fusion, despite the fact that it is a common practice to improve image retrieval performance. In response, we exploit joint kernel-based supervised hashing (JKSH) to integrate complementary features in a hashing framework. Specifically, hashing functions are designed based on linearly combined kernel functions associated with individual features. Supervised information is incorporated to bridge the semantic gap between low-level features and high-level diagnosis. An alternating optimization method is utilized to learn the kernel combination and hashing functions. The obtained hashing functions compress multiple high-dimensional features into tens of binary bits, enabling fast retrieval from a large database. Our approach is extensively validated on 3121 breast-tissue histopathological images by distinguishing between actionable and benign cases. It achieves 88.1% retrieval precision and 91.3% classification accuracy within 16.5 ms query time, comparing favorably with traditional methods.

Graphical abstract

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Influence of Androgen Deprivation Therapy on the Uptake of PSMA-Targeted Agents: Emerging Opportunities and Challenges

Abstract

Prostate-specific membrane antigen (PSMA) is an attractive target for both diagnosis and therapy because of its high expression in the vast majority of prostate cancers. Development of small molecules for targeting PSMA is important for molecular imaging and radionuclide therapy of prostate cancer. Recent evidence implies that androgen-deprivation therapy increase PSMA-ligand uptake in some cases. The reported upregulations in PSMA-ligand uptake after exposure to second-generation antiandrogens such as enzalutamide and abiraterone might disturb PSMA-targeted imaging for staging and response monitoring of patients undergoing treatment with antiandrogen-based drugs. On the other hand, second-generation antiandrogens are emerging as potential endoradio-/chemosensitizers. Therefore, the enhancement of the therapeutic efficiency of PSMA-targeted theranostic methods can be listed as a new capability of antiandrogens. In this manuscript, we will present what is currently known about the mechanism of increasing PSMA uptake following exposure to antiandrogens. In addition, we will discuss whether these above-mentioned antiandrogens could play the role of endoradio-/chemosensitizers in combination with the well-established PSMA-targeted methods for pre-targeting of prostate cancer.

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Filtration Isolation of Nucleic Acids: A Simple and Rapid DNA Extraction Method

We describe here a simple and rapid paper-based DNA extraction method of HIV proviral DNA from whole blood detected by quantitative PCR. This protocol can be extended for use in detecting other genetic markers or using alternative amplification methods.

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Microglial role in the development of chronic pain.

Purpose of review: The review aims to present the latest research into microglia and their role in pain. Recent findings: Microglia affect sex and age-dependent differences in pain. The various microglial phenotypes make their involvement in pain more complex but provide more potential as pain modulators. Summary: Glial cells, composed of microglia, astrocytes, and oligodendrocytes, outnumber neurons in the central nervous system. The crosstalk between these cells and neurons is now established as participating in the development of chronic pain. There has been a great advance in the description of microglia reactivity from pro to anti-inflammatory phenotypes. The modulation of these phenotypes could be a potential target for pain therapy. Recently, different microglial reactivity between man and woman and between neonates and adults, in response to nerve injury were described, which could explain some of the sex differences in pain sensitivity and the absence of neuropathic pain development in neonates. Clinical trials using microglia as a target have been carried out in various neurological diseases and pain, with limited efficacy in the latter, but there are nonetheless, indications that with some improvement in study strategies microglia could be a future target for pain control. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The Clinicopathological correlation in suspected cases of chronic liver disease with the aid of liver biopsy – A study in tertiary health centre

2016-08-06T10-06-30Z
Source: International Journal of Medical Science and Public Health
Abhishek Verma, Somya Sinha, N K Panicker.
Background: Hepatic disorders are prevalent in all ages. They are challenging to both pathologist as well as clinician in view of the ill-understood etiopathogenesis. Histological assessment of the liver and thus, liver biopsy is a cornerstone in the evaluation and management of patient with chronic liver disease. Objective: To study histological spectrum in patient of chronic liver diseases, correlate clinical and biochemical features with morphology on liver biopsy and to evaluate the role of liver biopsy in the diagnosis and management of Chronic Liver Disease. Materials and Methods: This study is based on liver biopsies obtained from 62 patients with suspicion of Chronic Liver Disease based on clinical features and findings on other investigations. Relevant biochemical and other investigations were done before liver biopsy was resorted to. The size of the intact liver biopsy obtained ranged from 1.5 to 2.5 cms though fragmented biopsy was also obtained in certain cases and was subjected to routine H & E staining and special stains in some cases were performed. Result: Out of 62 biopsies performed, fatty liver due to Non- alcoholic steatohepatitis (NASH) was seen in 27 % of cases followed by alcoholic cirrhosis in 19 % of cases while least case was found of hepatitis C in only 03 % cases . Males were affected more. Conclusion: Liver biopsy study is the gold standard for diagnosis of chronic liver diseases.


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Attitude and practice of primary care physician towards online consultation

2016-08-06T10-06-30Z
Source: International Journal of Medical Science and Public Health
Hanan Fahad Alotaybi, Emad Madani Al-Shareef, Raja Al-Raddadi.
Background: Internet technology is affecting many industries, including health care, and physicians are increasingly using email as a part of their workday. Objectives: To determine the attitudes towards E-mail consultation among general practitioners and family physician in primary healthcare (PHC), Jeddah city, Saudi Arabia who reported practice of email consultations in general practice and to identify the factors or barrier influencing Email communication in different sector of primary health care in Jeddah. Materials and Methods: . This cross-sectional study was conducted during a year Apri 2014 to April 2014. All general practitioners and family physicians of both gender and different nationality working at PHC centers, Jeddah city throughout the study period were included. Different attitudes of PHC physicians towards E-mail consultation with their patients was assesses through a self-administered questionnaire. Results: The total number of selected physicians for the study was 150, about 127 of them responded to the study with respondent rate of 84%. Most of the respondents in this study were females (66.1%) versus 33.9% of males. General practitioners were 27.6% and 24.4% were consultants. Most of physicians (62 %) were not currently using computers at work site and only 38% exclusively use computer in the practice. Only 25 % had internet access and 45% had intranet. Physician attitude toward e-mailing patients was gen¬erally positive. About forty seven of respondents use e-mail to communicate with other GPs within the practice, (55%) with GPs outside the work place and (15%) with administrative staff. In this study using of email with international organization was highest (60%). About 31.5% of respondent physicians received an e-mail from their patients. Seventy percent of received e-mails were about medical consultation, 11% for repeated prescription, 11% for making an appointment, 32% for general medical consultation and 46 % for information about medical condition. Risk of confidentiality with email doesnt emphasis worries in 18% of physicians. The majority expressed the view that there was sufficient time to respond to most of patient email 52 (43.7%). Moreover, about 17% of respondent considered e-mail use in clinical practice is an additional burden in an already onerous job. Conclusion: The general attitude of physicians toward computer and internet use in work place was positive although the use of e-mail in medical consultations of patients was very limited.


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Protective Role of Liriodendrin in Sepsis-Induced Acute Lung Injury

Abstract

In current study, we investigated the role of liriodendrin, a constituent isolated from Sargentodoxa cuneata (Oliv.) Rehd. Et Wils (Sargentodoxaceae), in cecal ligation and puncture (CLP)-induced acute lung inflammatory response and injury (ALI). The inflammatory mediator levels in bronchoalveolar lavage fluid (BALF) were determined by enzyme-linked immunosorbent assay (ELISA). Pathologic changes in lung tissues were evaluated via pathological section with hematoxylin and eosin (H&E) staining. To investigate the mechanism whereby liriodendrin regulates lung inflammation, the phosphorylation of the NF-kB (p65) and expression of vascular endothelial growth factor (VEGF) were determined by western blot assay. We show that liriodendrin treatment significantly improved the survival rate of mice with CLP-induced sepsis. Pulmonary histopathologic changes, alveolar hemorrhage, and neutrophil infiltration were markedly decreased by liriodendrin. In addition, liriodendrin decreased the production of the proinflammatory mediators including (TNF-α, IL-1β, MCP-1, and IL-6) in lung tissues. Vascular permeability and lung myeloperoxidase (MPO) accumulation in the liriodendrin-treated mice were substantially reduced. Moreover, liriodendrin treatment significantly suppressed the expression of VEGF and activation of NF-kB in the lung. We further show that liriodendrin significantly reduced the production of proinflammatory mediators and downregulated NF-kB signaling in LPS-stimulated RAW 264.7 macrophage cells. Moreover, liriodendrin prevented the generation of reactive oxygen species (ROS) by upregulating the expression of SIRT1 in RAW 264.7 cells. These findings provide a novel theoretical basis for the possible application of liriodendrin in clinic.

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How do different delivery schedules of tailored web-based physical activity advice for breast cancer survivors influence intervention use and efficacy?

Abstract

Purpose

The purpose of the study is to investigate the impact of differing delivery schedules of computer-tailored physical activity modules on engagement and physical activity behaviour change in a web-based intervention targeting breast cancer survivors.

Methods

Insufficiently active breast cancer survivors (n = 492) were randomly assigned to receive one of the following intervention schedules over 12 weeks: a three-module intervention delivered monthly, a three-module intervention delivered weekly or a single module intervention. Engagement with the website (number of logins, time on site, modules viewed, action plans completed) was measured using tracking software. Other outcomes (website acceptability, physical activity behaviour) were assessed using online surveys. Physical activity outcomes were analysed using regression models for both study completers and when applying intention-to-treat (using multiple imputation).

Results

Completers allocated to the monthly module group rated the intervention higher (b = 2.2 95 % CI = 0.02–4.53) on acceptability and had higher levels of resistance-training (IRR = 1.88, 95 % CI = 1.16–3.04) than those in the single module group. When accounting for missing data, these differences were no longer significant. The completion of at least two action plans was higher among those allocated to the monthly module group compared to those in the weekly module group (53 vs 40 %, p = 0.02); though the completion of at least two modules was higher in the weekly module group compared to the monthly module group (60 vs 46 %; p = 0.01). There were no other significant between group differences observed.

Conclusion

This study provides preliminary evidence that web-based computer-tailored interventions can be used to increase physical activity among breast cancer survivors. Further, there were some outcome differences based on how the tailored modules were delivered, with the most favourable outcomes observed in the monthly delivery group.

Implications for Cancer Survivors

This study will be useful for informing the design of future web-based interventions targeting breast cancer survivors.

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Spatio-Temporal Epidemiological Analysis of Livestock Diseases: A Case of Tamil Nadu State In India

2016-08-06T09-51-07Z
Source: International Journal of Livestock Research
Paramanandham Krishnamoorthy, Gurappa Naidu Govindaraj, Bibek Ranjan Shome, Habibur Rahman.
In the present study, spatio-temporal analysis of eight livestock diseases was undertaken for Tamil Nadu state in India. Data(2002-14) on outbreaks, diagnosed cases, death cases were collected and analyzed for cumulative outbreaks, year, seasonal and zone wise, and calculated prevalence, mortality and case fatality rates(CFR). Cumulative outbreaks revealed Anthrax(109) was high followed by Foot and mouth disease[FMD](99), Peste des petits ruminants[PPR](45) and other diseases. Season wise analysis revealed increased outbreaks during North east monsoon. Agroclimatic zone and cluster analysis revealed highest outbreaks occurred in Northeastern and South zones. Prevalence rate was high in FMD(4.37) and low in BQ, ET(0.005). Mortality and CFR were highest in PPR(1.97) and Anthrax(96.71%) and lowest in BQ, ET(0.04) and FMD(11.79%), respectively. Bio-climatograhs showed relationship between rainfall and disease outbreaks. Thus, preventive vaccinations against anthrax, FMD, PPR have to be initiated in two zones before monsoon to mitigate livestock diseases in Tamil Nadu and boost economy.


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A Survey of Graduates of Combined Emergency Medicine–Pediatrics Residency Programs: An Update

Publication date: Available online 5 August 2016
Source:The Journal of Emergency Medicine
Author(s): Ashley M. Strobel, Rose M. Chasm, Dale P. Woolridge
BackgroundIn 1998, emergency medicine–pediatrics (EM-PEDS) graduates were no longer eligible for the pediatric emergency medicine (PEM) sub-board certification examination. There is a paucity of guidance regarding the various training options for medical students who are interested in PEM.ObjectivesWe sought to to determine attitudes and personal satisfaction of graduates from EM-PEDS combined training programs.MethodsWe surveyed 71 graduates from three EM-PEDS residences in the United States.ResultsAll respondents consider their combined training to be an asset when seeking a job, 92% find it to be an asset to their career, and 88% think it provided added flexibility to job searches. The most commonly reported shortcoming was their ineligibility for the PEM sub-board certification. The lack of this designation was perceived to be a detriment to securing academic positions in dedicated children's hospitals. When surveyed regarding which training offers the better skill set for the practice of PEM, 90% (44/49) stated combined EM-PEDS training. When asked which training track gives them the better professional advancement in PEM, 52% (23/44) chose combined EM-PEDS residency, 27% (12/44) chose a pediatrics residency followed by a PEM fellowship, and 25% (11/44) chose an EM residency then a PEM fellowship. No EM-PEDS respondents considered PEM fellowship training after the completion of the dual training program.ConclusionEM-PEDS graduates found combined training to be an asset in their career. They felt that it provided flexibility in job searches, and that it was ideal training for the skill set required for the practice of PEM. EM-PEDS graduates' practices varied, including mixed settings, free-standing children's hospitals, and community emergency departments.



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β-asarone increases MEF2D and TH levels and reduces α-synuclein level in 6-OHDA-induced rats via regulating the HSP70/MAPK/MEF2D/Beclin-1 pathway: Chaperone-mediated autophagy activation, macroautophagy inhibition and HSP70 up-expression

Publication date: 15 October 2016
Source:Behavioural Brain Research, Volume 313
Author(s): Liping Huang, Minzhen Deng, Yuping He, Shiyao Lu, Shu Liu, Yongqi Fang
Inactive myocyte enhancer factor 2D (MEF2D) and alpha-synuclein (α-syn) aggregation will cause neuronal death. MEF2D or α-syn degradation is also associated with macroautophagy, chaperone-mediated autophagy (CMA) and heat-shock protein 70 (HSP70). We found that β-asarone had positive effects on treating 6-hydroxydopamine (6-OHDA)-induced rats, but mechanisms of β-asarone affecting on MEF2D and α-syn via regulating the HSP70/MAPK/MEF2D/Beclin-1 pathway remain unclear. Unilateral 6-OHDA injection into the medial forebrain bundle was used to create PD rats, which were divided into four groups and administered for 30days: 6-OHDA model group, MEF2D inhibitor-treated group (SB203580, 0.5mg/kg, i.p.), MEF2D activator-treated group (LiCl, 100mg/kg, i.p.), β-asarone-treated group (15mg/kg, p.o.). Expressions of tyrosine hydroxylase (TH), α-syn, heat-shock cognate protein 70 (HSC70), lysosome-associated membrane protein type 2a (LAMP-2A), MEF2D, HSP70, Beclin-1, light chain 3B (LC3B) and p62 in the mesencephalon were measured after 30-day administration. α-syn, Beclin-1 and LC3B levels were higher in the 6-OHDA model group, while TH, MEF2D, HSC70, LAMP-2A, p62 levels were lower compared to the sham-operated group. Our results also showed thatβ-asarone treatment reduced protein and mRNA levels of α-syn, Beclin-1 and LC3B, but increased HSP70, TH, MEF2D, HSC70, LAMP-2A and p62 levels compared to the 6-OHDA model group. Additionally, certain correlations among α-syn, TH, Beclin-1, LC3B, p62, HSP70, LAMP-2A and MEF2D were also discovered in this study. These findings suggested that β-asarone treatment could increase MEF2D and TH as well as reduce α-syn to protect against 6-OHDA induced damage in PD rat mesencephalon via modulating the HSP70/MAPK/MEF2D/Beclin-1 pathway.

Graphical abstract

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Prostaglandin D2 signaling mediated by the CRTH2 receptor is involved in MK-801-induced cognitive dysfunction

Publication date: 1 November 2016
Source:Behavioural Brain Research, Volume 314
Author(s): Yusuke Onaka, Norihito Shintani, Takanobu Nakazawa, Takuya Kanoh, Yukio Ago, Toshio Matsuda, Ryota Hashimoto, Kazutaka Ohi, Hiroyuki Hirai, Kin-ya Nagata, Masataka Nakamura, Atsushi Kasai, Atsuko Hayata-Takano, Kazuki Nagayasu, Kazuhiro Takuma, Asao Ogawa, Akemichi Baba, Hitoshi Hashimoto
Chemoattractant receptor-homologous molecule expressed on T helper type 2 cells (CRTH2), which is a second receptor for prostaglandin (PG) D2, is involved in inflammatory responses in peripheral tissue; however, its role in cognitive function remains unclear. Here, we demonstrate that CRTH2 is involved in cognitive function using a well-established animal model of cognitive dysfunction induced by MK-801, an N-methyl-d-aspartate receptor antagonist. Genetic deletion and pharmacological inhibition of CRTH2 suppressed MK-801-induced cognitive dysfunction. Pharmacological inhibition of cyclooxygenase-1, a rate-limiting enzyme in PG synthesis, also suppressed MK-801-induced cognitive dysfunction. Moreover, an MK-801-induced increase in c-Fos expression in the paraventricular nucleus (PVN) was abolished in the CRTH2-deficient mice. Together, these results suggest that PGD2-CRTH2 signaling is involved in both MK-801-induced cognitive dysfunction and neuronal activity regulation in the PVN. Furthermore, genetic association studies suggest that CRTH2 is weakly associated with cognitive function in humans. Our study provides evidence that PGD2-CRTH2 signaling is involved in cognitive function and may represent a potential therapeutic target for cognitive dysfunction in patients with psychiatric disorders.



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Reduced locomotor activity and exploratory behavior in CC chemokine receptor 4 deficient mice

Publication date: 1 November 2016
Source:Behavioural Brain Research, Volume 314
Author(s): Oliver Ambrée, Irene Klassen, Irmgard Förster, Volker Arolt, Stefanie Scheu, Judith Alferink
Chemokines and their receptors are key regulators of immune cell trafficking and activation. Recent findings suggest that they may also play pathophysiological roles in psychiatric diseases like depression and anxiety disorders. The CC chemokine receptor 4 (CCR4) and its two ligands, CCL17 and CCL22, are functionally involved in neuroinflammation as well as anti-infectious and autoimmune responses. However, their influence on behavior remains unknown. Here we characterized the functional role of the CCR4-CCL17 chemokine-receptor axis in the modulation of anxiety-related behavior, locomotor activity, and object exploration and recognition. Additionally, we investigated social exploration of CCR4 and CCL17 knockout mice and wild type (WT) controls. CCR4 knockout (CCR4^−/−) mice exhibited fewer anxiety-related behaviors in the elevated plus-maze, diminished locomotor activity, exploratory behavior, and social exploration, while their recognition memory was not affected. In contrast, CCL17 deficient mice did not show an altered behavior compared to WT mice regarding locomotor activity, anxiety-related behavior, social exploration, and object recognition memory. In the dark-light and object recognition tests, CCL17^−/− mice even covered longer distances than WT mice. These data demonstrate a mechanistic or developmental role of CCR4 in the regulation of locomotor and exploratory behaviors, whereas the ligand CCL17 appears not to be involved in the behaviors measured here. Thus, either CCL17 and the alternative ligand CCL22 may be redundant, or CCL22 is the main activator of CCR4 in these processes. Taken together, these findings contribute to the growing evidence regarding the involvement of chemokines and their receptors in the regulation of behavior.



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On the feasibility of the Chevron Notch Beam method to measure fracture toughness of fine-grained zirconia ceramics

Publication date: Available online 5 August 2016
Source:Dental Materials
Author(s): Andreas Kailer, Marc Stephan
ObjectiveThe fracture toughness determination of fine-grained zirconia ceramics using the chevron notched beam method (CNB) was investigated to assess the feasibility of this method for quality assurance and material characterization.MethodsCNB tests were performed using four different yttria-stabilized zirconia ceramics under various testing modes and conditions, including displacement-controlled and load-rate-controlled four point bending to assess the influence of slow crack growth and identify most suitable test parameters. For comparison, tests using single-edge V-notch beams (SEVNB) were conducted.ResultsIt was observed that the CNB method yields well-reproducible results. However, slow crack growth effects significantly affect the measured KIC values, especially when slow loading rates are used. To minimize the effect of slow crack growth, the application of high loading rates is recommended.SignificanceDespite a certain effort needed for setting up a sample preparation routine, the CNB method is considered to be very useful for measuring and controlling the fracture toughness of zirconia ceramics.



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Introduction to Special Issue on Mitochondrial Redox Signaling in Health and Disease

Publication date: Available online 5 August 2016
Source:Free Radical Biology and Medicine
Author(s): Juan P. Bolaños, Enrique Cadenas, Michael R. Duchen, Mark B. Hampton, Giovanni E. Mann, Michael P. Murphy




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A Randomized, Double-Blind, Multicenter, Phase III Study to Evaluate the Efficacy and Safety of Fimasartan/Amlodipine Combined Therapy Versus Fimasartan Monotherapy in Patients With Essential Hypertension Unresponsive to Fimasartan Monotherapy

Publication date: Available online 5 August 2016
Source:Clinical Therapeutics
Author(s): Kwang-il Kim, Mi-Seung Shin, Sang-Hyun Ihm, Ho-Joong Youn, Ki-Chul Sung, Shung Chull Chae, Chang-Wook Nam, Hong Seog Seo, Seong-Mi Park, Moo-Yong Rhee, Moo Hyun Kim, Kwang Soo Cha, Yong-Jin Kim, Jae-Joong Kim, Kook Jin Chun, Byung-Su Yoo, Sungha Park, Eun-Seok Shin, Dong-Soo Kim, Doo Il Kim, Kye Hun Kim, Seung-Jae Joo, Jin-Ok Jeong, Jinho Shin, Cheol Ho Kim
PurposeThe goal of this study was to evaluate whether the blood pressure–lowering efficacy of fimasartan/amlodipine combination therapy was superior to that of fimasartan monotherapy after 8 weeks of treatment in patients with hypertension who had failed to respond adequately to fimasartan monotherapy.MethodsThis trial was a randomized, double-blind, multicenter, Phase III clinical study. Patients who failed to respond after 4 weeks of treatment with 60 mg daily of fimasartan (sitting systolic blood pressure [SiSBP]) ≥140 mm Hg) were randomized to receive either daily fimasartan 60 mg or fimasartan/amlodipine 60 mg/10 mg. The primary efficacy end point was the change in SiSBP from baseline to week 8. Secondary end points included the change in SiSBP from baseline to week 4, the changes in sitting diastolic blood pressure from baseline to weeks 4 and 8, and the response rate (SiSBP <140 mm Hg or decrease in SiSBP ≥20 mm Hg) or control rate (SiSBP <140 mm Hg) at week 8. Treatment-emergent adverse events were also assessed.FindingsOf 143 patients randomized to treatment, 137 patients who had available efficacy data were analyzed. The mean age of patients was 59.1 (8.9) years, and 100 (73.0%) were male. Baseline SiSBP and sitting diastolic blood pressure were 150.6 (9.2) mm Hg and 91.7 (8.6) mm Hg, respectively. In the fimasartan/amlodipine combination group, a greater reduction in SiSBP from baseline to week 8 was observed compared with the fimasartan group (7.8 [13.3] mm Hg in the fimasartan group vs 20.5 [14.6] mm Hg in the fimasartan/amlodipine group; P < 0.0001). This reduction was observed after 4 weeks. The mean SiSBP changes from baseline to week 4 were 8.1 (15.8) mm Hg in the fimasartan group and 20.1 (14.7) mm Hg in the fimasartan/amlodipine group (P < 0.0001). At week 8, the response rate was significantly higher in the fimasartan/amlodipine (82.1%) group than in the fimasartan (32.9%) group (P < 0.0001). The control rate at week 8 was also higher in the fimasartan/amlodipine (79.1%) group than in the fimasartan (31.4%) group (P < 0.0001). Adverse drug reactions were observed in 9 patients (6.3%), with no significant differences between treatment groups. There were no serious adverse events associated with the study drugs.ImplicationsFimasartan/amlodipine combination therapy exhibited superior efficacy in reducing blood pressure, with no increase in adverse drug reactions, compared with fimasartan monotherapy. ClinicalTrials.gov identifier: NCT02152306.



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Yttrium-90 Radioembolization for Hepatocellular Carcinoma Prior to Liver Transplantation

Abstract

Background

Liver transplantation (LT) is a well-established procedure for hepatocellular carcinoma (HCC) within the Milan criteria. Yttrium-90 microspheres radioembolization (Y90-RE) has shown to be an effective and safe treatment of primary liver tumors. We retrospectively evaluate the efficacy of the Y90-RE in patients with HCC prior to LT.

Methods

From January 2002 to December 2015, 365 patients were transplanted at the San Camillo Hospital Center. One hundred forty-three patients were transplanted for HCC, and in 22 cases the patients were treated with Y90-RE before LT.

Results

Three patients were treated with Y90-RE within the Milan criteria, and 19 patients were out of criteria before Y90-RE. Four patients had an increasing MELD score between Y90-RE and LT. On the other hand, alpha-fetoprotein decreases after Y90-RE treatment in all cases. No patient death was observed in Y90-RE procedure or at LT. In 78.9 % of cases, a successful downstaging was observed, and in 100 % of cases bridging was achieved. From Y90-RE treatment overall survival was 43.9 months. From LT, overall mean survival was 30.2 months with a free survival of 29.6 months. The overall survival after LT analysis between the patients treated with Y90-RE and patients without was not significant (p = 0.113). Free survival analysis was not significant (p = 0.897) between the two populations.

Conclusions

We successfully performed LT in patients after Y90-RE treatment both as bridging and downstaging for HCC and obtained a similar overall and free survival of LT for HCC within Milan criteria. Y90-RE becomes a real option to provide curative therapy for patients who traditionally are not considered eligible for surgery.

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The Effect of Unenhanced MRI on the Surgeons’ Decision-Making Process in Females with Suspected Appendicitis

Abstract

Background

This prospective study evaluated the impact of the results of unenhanced magnetic resonance imaging (MRI) on the surgeon's diagnosis of acute appendicitis in potentially fertile females.

Methods

112 female patients, aged 12–55, with suspected appendicitis underwent MRI of the abdomen. At three defined intervals; admission and clinical re-evaluation before and after revealing the MRI results, the surgeon recorded the attendance of each patient in operative treatment, observation or discharge. Appendicitis was confirmed or declined by pathology or by telephone follow-up in case of non-intervention.

Findings

Appendicitis was confirmed in 29 of 112 patients. At admission the surgeon's disposition had a sensitivity of 97 % and specificity of 29 %. After knowing the MRI results, sensitivity was 97 % and specificity 64 %. The sensitivity and specificity of MRI alone were 89 and 100 %, with a negative and positive predictive value of 96 and 100 %, respectively.

Conclusion

We believe that MRI should perhaps be standard in all female patients during their reproductive years with suspected appendicitis. It avoids an operation in 32 % of cases and allows earlier planning for patients with an equivocal clinical picture. Trial number: OND1292733 (Narcis.nl).

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Challenges in epilepsy-associated tumors

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Detecting fatigue thresholds from electromyographic signals: A systematic review on approaches and methodologies

Publication date: Available online 5 August 2016
Source:Journal of Electromyography and Kinesiology
Author(s): Ertl Peter, Kruse Annika, Tilp Markus
The aim of the current paper was to systematically review the relevant existing electromyographic threshold concepts within the literature. The electronic databases MEDLINE and SCOPUS were screened for papers published between January 1980 and April 2015 including the keywords: neuromuscular fatigue threshold, anaerobic threshold, electromyographic threshold, muscular fatigue, aerobic-anaerobictransition, ventilatory threshold, exercise testing, and cycle-ergometer. 32 articles were assessed with regard to their electromyographic methodologies, description of results, statistical analysis and test protocols. Only one article was of very good quality. 21 were of good quality and two articles were of very low quality. The review process revealed that: (i) there is consistent evidence of one or two non-linear increases of EMG that might reflect the additional recruitment of motor units (MU) or different fibre types during fatiguing cycle ergometer exercise, (ii) most studies reported no statistically significant difference between electromyographic and metabolic thresholds, (iii) one minute protocols with increments between 10-25W appear most appropriate to detect muscular threshold, (iv) threshold detection from the vastus medialis, vastus lateralis, and rectus femoris is recommended. (v) There is a great variety in study protocols, measurement techniques, and data processing. Therefore, we recommend further research and standardization in the detection of EMGTs.



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Influence of timing variability between motor unit potentials on M-wave characteristics

Publication date: Available online 5 August 2016
Source:Journal of Electromyography and Kinesiology
Author(s): Javier Rodriguez-Falces, Armando Malanda, Iban Latasa, Ana Lavilla-Oiz, Javier Navallas
The transient enlargement of the compound muscle action potential (M wave) after a conditioning contraction is referred to as potentiation. It has been recently shown that the potentiation of the first and second phases of a monopolar M wave differed drastically; namely, the first phase remained largely unchanged, whereas the second phase underwent a marked enlargement and shortening. This dissimilar potentiation of the first and second phases has been suggested to be attributed to a transient increase in conduction velocity after the contraction. Here, we present a series of simulations to test if changes in the timing variability between motor unit potentials (MUPs) can be responsible for the unequal potentiation (and shortening) of the first and the second M-wave phases. We found that an increase in the mean motor unit conduction velocity resulted in a marked enlargement and narrowing of both the first and second M-wave phases. The enlargement of the first phase caused by a global increase in motor unit conduction velocities was apparent even for the electrode located over the innervation zone and became more pronounced with increasing distance to the innervation zone, whereas the potentiation of the second phase was largely independent of electrode position. Our simulations indicate that it is unlikely that an increase in motor unit conduction velocities (accompanied or not by changes in their distribution) could account for the experimental observation that only the second phase of a monopolar M wave, but not the first, is enlarged after a brief contraction. However, the combination of an increase in the motor unit conduction velocities and a spreading of the motor unit activation times could potentially explain the asymmetric potentiation of the M-wave phases.



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Cancer Risk Factor Knowledge Among Young Adults

Abstract

Cancer is the second leading cause of death in the USA. Incidence and mortality rates for cancer have risen steadily and cost the healthcare system over $264 billion annually. Cancer risk can be reduced by restricting alcohol consumption, avoiding tobacco, eating a balanced diet, limiting sun exposure, exercising, and seeking routine cancer screenings. The purpose of this study is to examine cancer risk factor knowledge among college students. Researchers surveyed undergraduate and graduate students (n = 758) at a mid-sized public university in the Southeast about their knowledge regarding cancer risk factors including smoking, alcohol consumption, diet, obesity, hypertension, and human papillomavirus (HPV). Participants were mostly able to identify the association between cancers and health risk behaviors that have received widespread media coverage, are somewhat intuitive, or are salient to their life stage such as drinking, tanning, and smoking. Nearly all participants correctly reported exposure to ultraviolet (UV) rays, and smoking increased risk of developing skin and lung cancer, respectively. Most students correctly identified an increased risk of liver cancer associated with alcohol use but missed head/neck and breast cancer. However, knowledge of less publicized relationships was insufficient. The findings offer encouragement to public health professionals that campaigns have increased awareness of cancer risk. However, there were many relationships that revealed a lack of knowledge, and future campaigns can target lesser-known cancer risk relationships to reduce the personal tragedy and societal burden of cancer.

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Selective 5-aminolevulinic acid-induced protoporphyrin IX fluorescence in Gliomas

Abstract

Malignant gliomas are locally invasive tumors that offer a poor prognosis. Evidence shows that complete resection of the tumor at the time of surgery confers a significant improvement in overall survival. In recent years, 5- aminolevulinic acid (ALA)-induced fluorescence has been used by neurosurgeons to good effect in increasing the rate of complete resection. Despite the considerable interest in the use of 5-ALA in fluorescence-guided neurosurgery, the mechanisms behind the accumulation of Protoporphyrin IX (PpIX) in neoplastic tissue are unclear. In this review, we summarize the evidence in the literature on the mechanisms underlying the selective production of PpIX with a specific focus on gliomas.

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Sleep apnea is associated with an increased risk of mood disorders: a population-based cohort study

Abstract

Purpose

The symptoms of sleep apnea, such as sleep fragmentation and oxygen desaturation, might be risk factors for subsequent mood disorder (MD), but associations between sleep apnea and MD remain unclear. This nationwide population-based study thus aimed to identify the risk of MD in patients with vs. without sleep apnea.

Methods

This cohort study used data from the National Health Insurance database. In total, 5415 patients diagnosed with sleep apnea between 2000 and 2010 were evaluated, and 27,075 matched non-sleep apnea enrollees were included as a comparison cohort. All subjects were followed until 2011. The Cox proportional hazard ratio (HR) was used to investigate the relationship between MD and sleep apnea while controlling covariates and comorbidities of sleep apnea.

Results

Of 5415, 154 patients with sleep apnea (2.84 %) were diagnosed with MD during the follow-up period in comparison with 306 of 27,075 individuals (1.13 %) without antecedent sleep apnea. After adjusting for the selected factors and comorbidities, we found that patients with sleep apnea were from 1.82- to 2.07-fold greater risk of MD than the comparisons. Of the three subcategories of MD (major depressive disorder, bipolar disorder, and unspecified MD), sleep apnea had the highest predisposing risk with respect to major depressive disorder (adjusted HR from 1.82 to 2.07) and bipolar disorder (adjusted HR from 2.15 to 3.24).

Conclusions

There is a greater likelihood of MD manifesting in patients with a history of sleep apnea. Health professionals are thus advised to carefully monitor the psychological impacts of sleep apnea.

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A formal framework to represent spatial knowledge

Abstract

Visual representations are an essential element in human–computer interaction and can be conceived as a collection of graphical objects arranged in a two-dimensional space. It is quite natural to model visual representations through the qualitative relationships holding between their objects, and therefore, qualitative spatial relations are a fundamental way of representing spatial knowledge. To this aim, in this paper we present a framework of qualitative spatial relations providing a general, domain-independent approach to specify visual representations.

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The Importance of Having Sulfur

Publication date: Available online 5 August 2016
Source:Journal of Genetics and Genomics
Author(s): Anna Koprivova, Stanislav Kopriva
Sulfur is an essential nutrient for all living organisms. Plants take up inorganic sulfate from soil, reduce it, and incorporate into cysteine which is a source of reduced sulfur for other cellular components. Among them the amino acid methionine is of great importance as it is essential for animal and human nutrition. Sulfate assimilation pathway and its control are well understood on the physiological level. The bulk of knowledge on the regulation of the pathway, however, has been derived from the model plant Arabidopsis. Given the importance of sulfur for crop yield and quality, this review will summarize the knowledge of sulfur metabolism in crop plants and will discuss how manipulation of sulfur metabolism can help to improve crop productivity.



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Molecular insights of organochlorine biocide-induced toxicity in zebrafish: Whole-adult-organism toxicogenomics, targeted gene expression and histological analyses

Publication date: Available online 5 August 2016
Source:Journal of Genetics and Genomics
Author(s): Eei Yin Lui, Caixia Li, Zhi-Hua Li, Zhiyuan Gong, Siew Hong Lam




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A rare case of intervertebral internal hernia

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Sports hernia repair with adductor tenotomy

Abstract

Purpose

Sports hernias, or athletic pubalgia, is common in athletes, and primarily involves injury to the fascia, muscles, and tendons of the inguinal region near their insertion onto the pubic bone. However, management varies widely, and rectus and adductor tenotomies have not been adequately described. The purpose of this manuscript is to demonstrate a suture repair and a rectus and adductor longus tenotomy technique for sports hernias.

Methods

After magnetic-resonance-imaging confirmation of sports hernias with rectus and adductor tendonitis, 22 patients underwent a suture herniorrhaphy with adductor tenotomy. The procedure is performed through a 4-cm incision, and a fascial release of the rectus abdominis and adductor tenotomy is performed to relieve the opposing vector forces on the pubic bone.

Results

All 22 patients returned to their respective sports and regained their ability to perform at a high level, including professional status. No further surgery was required.

Conclusion

In athletes with MRI confirmation of rectus and adductor longus injuries, tenotomies along with a herniorraphy may improve outcomes. A suture repair to reinforce the inguinal floor prevents mesh-related complications, especially in young athletes.

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No inequalities in survival from colorectal cancer by education and socioeconomic deprivation - a population-based study in the North Region of Portugal, 2000-2002

Abstract

Background

Association between cancer survival and socioeconomic status has been reported in various countries but it has never been studied in Portugal. We aimed here to study the role of education and socioeconomic deprivation level on survival from colorectal cancer in the North Region of Portugal using a population-based cancer registry dataset.

Methods

We analysed a cohort of patients aged 15–84 years, diagnosed with a colorectal cancer in the North Region of Portugal between 2000 and 2002. Education and socioeconomic deprivation level was assigned to each patient based on their area of residence. We measured socioeconomic deprivation using the recently developed European Deprivation Index. Net survival was estimated using Pohar-Perme estimator and age-adjusted excess hazard ratios were estimated using parametric flexible models. Since no deprivation-specific life tables were available, we performed a sensitivity analysis to test the robustness of the results to life tables adjusted for education and socioeconomic deprivation level.

Results

A total of 4,105 cases were included in the analysis. In male patients (56.3 %), a pattern of worse 5- and 10-year net survival in the less educated (survival gap between extreme education groups: -7 % and -10 % at 5 and 10 years, respectively) and more deprived groups (survival gap between extreme EDI groups: -5 % both at 5 and 10 years) was observed when using general life tables. No such clear pattern was found among female patients. In both sexes, when likely differences in background mortality by education or deprivation were accounted for in the sensitivity analysis, any differences in net survival between education or deprivation groups vanished.

Conclusions

Our study shows that observed differences in survival by education and EDI level are most likely attributable to inequalities in background survival. Also, it confirms the importance of using the relevant life tables and of performing sensitivity analysis when evaluating socioeconomic inequalities in cancer survival. Comparison studies of different healthcare systems organization should be performed to better understand its influence on cancer survival inequalities.

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Involvement of Protein Kinase C-δ in the Realization of Cardioprotective Effect of Ischemic Postconditioning

Experiments on isolated perfused rat heart modeled 45-min global ischemia followed by 30-min reperfusion. Ischemic postconditioning was modeled by 3 cycles of reperfusion (30 sec) and ischemia (30 sec). Cardiomyocyte necrosis was assessed by the level of creatine phosphokinase in the perfusate. Postconditioning reduced the release of creatine phosphokinase from the heart by 30%. The cardioprotective effect of ischemic postconditioning was eliminated after inhibition of protein kinase C with cheleritrin or after blockade of δ-isoform of protein kinase C with rottlerin. These findings attest to participation of protein kinase C-δ in the realization of the cardioprotective effect of postconditioning.

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Effect of Circulation Parameters on Functional Status of HepaRG Spheroids Cultured in Microbioreactor

We studied the relationship between microcirculation parameters and functional status of HepaRG cells in spheroids and chose an optimal regimen within the physiologically permissible limits of mechanical impact for the cells that maintains the expression of functional genes of the liver.

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Clinical Morphological Studies of Myelofibrosis with Different Types of Bone Marrow Involvement in Patients with Chronic Lymphocytic Leukemia

Clinical-morphological study of myelofibrosis was carried out in patients with chronic lymphocytic leukemia at the debut of the disease. Trephinobiopsy specimens of the ileac bone, aspirated specimens of the bone marrow, and peripheral blood smears were studied in 80 patients. Chronic lymphocytic leukemia was associated with myelofibrosis of different severity in 22.5% cases. Morphometric analysis of trephinobiopsy specimens showed that the severity (histology and dissemination) of myelofibrosis correlated with the type of tumor involvement of the bone marrow. Focal tumor involvement of the bone marrow predominated in trephinobiopsy specimens from patients without myelofibrosis, while patients with myelofibrosis developed mainly diffuse tumor infiltration, associated with the greatest dissemination of the initial and manifest myelofibrosis. No myelofibrosis was found in patients with interstitial tumor involvement of the bone marrow. The severity of the initial and manifest myelofibrosis directly correlated with the tumor involvement of the bone marrow and peripheral blood. Evaluation of the prognosis showed that initial myelofibrosis was associated with disease standing of 5.5 months, while manifest condition with a disease of 8.5 months and longer.

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Relationship between Morphofunctional Changes in Open Traumatic Brain Injury and the Severity of Brain Damage in Rats

A correlation between the severity of morphofunctional disturbances and the volume of brain tissue injury determined by MRT was demonstrated on the model of open traumatic brain injury in rats. A relationship between the studied parameters (limb placing and beam walking tests and histological changes) and impact force (the height of load fell onto exposed brain surface) was revealed.

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Oxidative Stress and Catalase Gene

We studied the frequency of alleles and genotypes of CAT gene -262C>T polymorphism (rs1001179) in Russian and Buryat adolescents. The frequency of -262T allele was 28.31% in Russians and 16.84% in Buryats (p<0.01). In both ethnic groups, a correlation between the study polymorphism and concentration of diene conjugates was observed. Carriers of TT-genotype of CAT gene-262C>T polymorphism had lower level of diene conjugates than carriers of CT- and CC-genotypes.

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Experimental Evaluation of Biodegradable Film Compositions Based on Gelatin with Colchicine

Biodegradable film compositions based on natural biopolymer gelatin with immobilized colchicine were prepared and their efficiency in prevention of the adhesion process in the pericardium was evaluated on rabbit model of postoperative pericarditis. The use of gelatin-based biodegradable film compositions significantly reduced the intensity of adhesion formation in the pericardial cavity, while immobilization of anti-inflammatory drug colchicine amplified their anti-adhesion activity.

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Effect of Fluoxetine on Neurogenesis in Hippocampal Dentate Gyrus after Global Transient Cerebral Ischemia in Rats

Changes in cerebral neurogenesis provoked by ischemia and the effect of fluoxetine on this process were studied using a three-vessel occlusion model of global transient cerebral ischemia. The global transient cerebral ischemia was modeled on male Wistar rats by transient occlusion of three major vessels originating from the aortic arch and supplying the brain (brachiocephalic trunk, left subclavian artery, and left common carotid artery). The cells expressing doublecortin (DCX, a marker of young neurons) were counted in the hippocampal dentate gyrus on day 31 after ischemia modeling. It was found that ischemia inhibited neurogenesis in the dentate gyrus in comparison with sham-operated controls (p<0.05), while fluoxetine (20 mg/kg/day) injected over 10 days after surgery restored neurogenesis to the control level (p<0.001).

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Expression of Cytokine Genes and Growth Factors in Rat Lungs and Kidneys after Subtotal Hepatectomy

Expression of il1b, il6, il10, tnfa, hgf, tgfb, vegf, and fgf2 genes in the lungs and kidneys was examined on rat model of liver regeneration after subtotal hepatectomy. Enhanced expression of il6, il10, tnfa, hgf, and fgf2 genes was detected at the early terms after 80% liver resection.

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Serological Analysis of Immunogenic Properties of Recombinant Meningococcus IgA1 Protease-Based Proteins

Using the genome sequence of IgA1 protease of N. meningitidis of serogroup B, four recombinant proteins of different structure and molecular weight were constructed. These proteins were equal in inducing the formation of specific antibodies to IgA1 protease and had protective properties against meningococci. In the sera of immunized mice, anti-IgA1 protease antibodies were detected by whole-cell ELISA, which indicated the presence of IgA1 protease on the surface of these bacteria. We hypothesized that the protective properties of IgA1 protease-based antigens and IgA1 protease analogs could be realized not only via impairment of bacterium adhesion to the mucosa, but also via suppression of this pathogen in the organism. The presented findings seem promising for using these proteins as the basis for anti-meningococcus vaccine.

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Antiproliferative Effects of Modified Bioflavonoid in Ex Vivo Model

We studied the effect of modified bioflavonoid and reference drug quercetin dihydrate on proliferation of mononuclears triggered by T- and B-cell mitogens. Lymphocytes were in vivo pretreated with the examined agents followed by their explantation and in vitro activation with T- and B-cell mitogens in cell culture. Intraperitoneal injection of modified bioflavonoid and quercetin dihydrate produced a dose-dependent inhibition of proliferation of the in vitroactivated splenocytes; modified bioflavonoid demonstrated higher antiproliferative activity.

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Physiological Features of Perigonadal Adipose Tissue Containing Uncoupling Protein UCP1 in ICR Mice

Immunoreactive uncoupling protein UCP1 was found in the perigonadal fat of only twothirds of 14-week-old male ICR mice. The presence of UCP1 had no effect on the rate of O₂ consumption by the adipose tissue. The cellularity of perigonadal fat estimated by the DNA content was significantly higher in tissue containing UCP1 than in samples without this protein. This regularity was also observed after adaptation of mice to moderate cold (10oC) over 8 weeks.

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Physicians’ identification of the need for palliative care in people with intellectual disabilities

Publication date: December 2016
Source:Research in Developmental Disabilities, Volume 59
Author(s): Cis Vrijmoeth, Pleun Barten, Willem J.J. Assendelft, Milou G.M. Christians, Dederieke A.M. Festen, Marijke Tonino, Kris C.P. Vissers, Marieke Groot
BackgroundA growing number of people with intellectual disabilities (ID) is suffering from life-threatening chronic illnesses and is therefore in need for palliative care.AimsWe aimed to explore how the need for palliative care is recognized in people with ID.Methods and proceduresWe conducted a semi-structured interview study among 10 ID-physicians in the Netherlands.Outcomes and resultsIdentification of people with ID in need for palliative care mostly results from a process in which multiple signals from different information sources converge and lead to a growing awareness. As a result, ID-physicians do not expect people to return to their prior level of health or functioning, but rather expect an irreversible decline leading to death. The presence, stage and prognosis of the disease, physician-patient interaction, and communication with proxies who provide contextual information are factors influencing the process.Conclusions and implicationsDistinctive for a population of people with ID are the frequent diagnostic uncertainty in people with ID, the patients' communicational abilities and the reliance of ID-physicians on close proxies. We argue for a proactive attitude of physicians regarding care and support of people with ID with palliative care needs.



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