Monsoon-driven transport of atmospheric mercury to the South China Sea from the Chinese mainland and Southeast Asia—Observation of gaseous elemental mercury at a background station in South China

Abstract

Concentrations of gaseous elemental mercury (GEM) were continuously monitored from May 2011 to May 2012 at the Wuzhishan State Atmosphere Background Monitoring Station (109°29′30.2″ E, 18°50′11.0″ N) located in Hainan Island. This station is an ideal site for monitoring long-range transport of atmospheric pollutants from mainland China and Southeast Asia to South China Sea. Annual average GEM concentration was 1.58 ± 0.71 ng m⁻³ during the monitoring period, which was close to background values in the Northern Hemisphere. GEM concentrations showed a clear seasonal variation with relatively higher levels in autumn (1.86 ± 0.55 ng m⁻³) and winter (1.80 ± 0.62 ng m⁻³) and lower levels in spring (1.16 ± 0.45 ng m⁻³) and summer (1.43 ± 0.46 ng m⁻³). Long-range atmospheric transport dominated by monsoons was a dominant factor influencing the seasonal variations of GEM. The GEM diel trends were related to the wind speed and long-range atmospheric mercury transport. We observed 30 pollution episodes throughout the monitoring period. The analysis of wind direction and backward trajectory suggested that elevated GEM concentrations at the monitoring site were primarily related to the outflows of atmospheric Hg from mainland China and the Indochina peninsula. The △GEM/△CO values also suggested that GEM was significantly affected by the long-range transport from the anthropogenic sources and biomass burning in Asia and Indochina peninsula.

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Study of traffic-related pollutant removal from street canyon with trees: dispersion and deposition perspective

Abstract

Numerical experiments involving street canyons of varying aspect ratio with traffic-induced pollutants (PM_2.5) and implanted trees of varying aspect ratio, leaf area index, leaf area density distribution, trunk height, tree-covered area, and tree planting pattern under different wind conditions were conducted using a computational fluid dynamics (CFD) model, ENVI-met. Various aspects of dispersion and deposition were investigated, which include the influence of various tree configurations and wind condition on dispersion within the street canyon, pollutant mass at the free stream layer and street canyon, and comparison between mass removal by surface (leaf) deposition and mass enhancement due to the presence of trees. Results revealed that concentration level was enhanced especially within pedestrian level in street canyons with trees relative to their tree-free counterparts. Additionally, we found a dependence of the magnitude of concentration increase (within pedestrian level) and decrease (above pedestrian level) due to tree configuration and wind condition. Furthermore, we realized that only ∼0.1–3 % of PM_2.5 was dispersed to the free stream layer while a larger percentage (∼97 %) remained in the canyon, regardless of its aspect ratio, prevailing wind condition, and either tree-free or with tree (of various configuration). Lastly, results indicate that pollutant removal due to deposition on leaf surfaces is potentially sufficient to counterbalance the enhancement of PM_2.5 by such trees under some tree planting scenarios and wind conditions

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Preparation, characterization and environmental applications of Sr 1 − x (La,Bi) x TiO 3 perovskites immobilized on Ni-foam: photodegradation of the Acid Orange 7

Abstract

The Sr_1 − x La_x TiO₃ (0 ≤ x ≤ 0.4) and Sr_1 − x Bi_x TiO₃ (0 ≤ x ≤ 0.3) perovskites were prepared via solid state reaction by partially replacing the Sr²⁺ ions in the SrTiO₃ structure by La³⁺ or Bi³⁺ ions, characterized and utilized as photocatalysts immobilized in Ni-foam substrate in the degradation of the azo dye Acid Orange 7 (AO7). For both perovskite families, the XRD data reveal the existence of a predominant well-crystallized phase, belonging to a cubic perovskite in a Pm3m space group, with the presence of other minority phases. The characteristic dimension and the volume of the cell decrease with the introduction in the SrTiO₃ lattice of the La³⁺ or Bi³⁺ ions. The grain size of the Sr_1 − x La_x TiO₃ samples is around 100 nm and slightly lower for the Sr_1 − x Bi_x TiO₃ samples. Regarding the utilization of the prepared perovskite powders deposited over the Ni-foam substrates as catalysts in the photodegradation of AO7 solutions, the results show an improvement in the performance of the films of the substituted perovskite when compared to the SrTiO₃ perovskite, being the best results obtained with Sr_0.9Bi_0.1TiO₃.

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Health—exploring complexity: an interdisciplinary systems approach HEC2016

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The effect of enhanced carotenoid content of transgenic maize grain on fungal colonization and mycotoxin content

Abstract

Novel strategies that address vitamin A deficiency have been developed, such as high-carotenoid maize, a biofortified transgenic maize line rich in carotenoids generated by genetic transformation. The South African white maize inbred (M37W), which is devoid of carotenoids, was engineered to accumulate high levels of β-carotene (provitamin A), lutein, and zeaxanthin. Maize seeds contaminated with fumonisins and other mycotoxins pose a serious threat to both humans and livestock. During three consecutive harvests, the fungal incidence and the fumonisin and aflatoxin content of maize seeds grown in an experimental field in Catalonia (Northeastern Spain) were evaluated. Fungal infection was similar in high-carotenoid maize and its isogenic line, with Fusarium verticillioides being the most prevalent fungus in all the harvests. Neither Aspergillus spp. nor aflatoxin contamination was found. Fumonisin levels were lower in high carotenoid than in its isogenic line, but this reduction was statistically significant in only 2 of the 3 years of study. Our results suggest that high carotenoid content reduces fumonisin levels in maize grains.

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Relationship between soy milk intake and radiographic knee joint space narrowing and osteophytes

Abstract

The purpose of this study was to examine the cross-sectional association between dietary soy milk intake and the prevalence of radiographic knee joint space narrowing (JSN) and osteophytes (OST). Soy milk intake was assessed using a validated semiquantitative food frequency questionnaire and classified into three categories: never, <once a day, and ≥once a day. JSN and OST were assessed individually based on the Osteoarthritis Research Society International atlas. Multivariable logistic models were used after adjusting for potentially confounding factors. A total of 5764 subjects were included. Both the models suggested a significant inverse association between soy milk intake and OST. In model 1 (adjusted for age, body mass index, and sex), the prevalence of OST decreased in "≥once a day" category (OR 0.52, 95 % CI 0.28–0.98, P = 0.042) and "<once a day" category (OR 0.78, 95 % CI 0.66–0.93, P = 0.005) comparing to "never" category of soy milk intake, and the P for trend was 0.001. The outcomes were similar in model 2 (adjusted based on model 1, with additional factors of total energy intake, activity level, smoking status, alcohol-drinking status, educational background, diabetes, hypertension, and other dairy product intake) ("≥once a day" category: OR 0.49, 95 % CI 0.26–0.92, P = 0.026; "<once a day" category: OR 0.79, 95 % CI 0.67–0.94, P = 0.009), and the P for trend was 0.001. However, the significant associations between soy milk intake and JSN in both the models were not observed. Dietary soy milk intake was found to be negatively associated with OST, but not JSN, independent of some major confounding factors.

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Ultrasonographic assessment of superficial fibular nerve branches

Peripheral nerve injury is a possible complication of orthopaedic surgery and the correct diagnosis of patient's condition, after the intervention, is crucial for the specific rehabilitation program (Bade et al., 2010). The use of ultrasound (US) to assess nerves is well known and extensively shown in literature by many studies (Padua et al., 2013). High-frequency US is routinely applied for the evaluation of the main and largest nerve structures in limbs, like fibular nerve (Coraci et al., 2015).

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Added diagnostic value of magnetoencephalography (MEG) in patients suspected for epilepsy, where previous, extensive EEG workup was unrevealing

Although epilepsy can be diagnosed solely on clinical data, additional investigations are often needed after the first seizure to assess the probability of recurring seizures (Fisher et al. 2014). EEG is one of the most important investigations, which besides supporting diagnosis of epilepsy, also contributes to its classification (Berg et al. 2010). It is well established that in about 10-20% of patients with epilepsy, multiple EEG studies including sleep deprived EEG, fail to show abnormalities (Alving and Beniczky.

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Repetitive facial nerve stimulation in myasthenia gravis 1 minute after muscle activation is inferior to testing a second muscle at rest

To explore the increased diagnostic yield of repetitive nerve stimulation (RNS) following activation for myasthenia gravis (MG) diagnosis, and compare with testing an additional muscle at rest only.

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Splintless surgery: does patient-specific CAD-CAM osteosynthesis improve accuracy of Le Fort I osteotomy?

To analyse the accuracy of maxillary positioning after Le Fort I osteotomy, we retrospectively assessed the outcome in three patients (mean (range) age 40 (21 – 60) years) who had been treated with patient-specific CAD-CAM osteosynthesis plates as part of a bimaxillary osteotomy. Virtual surgical planning in each case was based on cone-beam computed tomography (CT) (Simplant® O&O, Dentsply Implants NV, Kessel-Lo, Belgium), and patient-specific CAD-CAM drilling guides and osteosynthesis plates were produced for maxillary positioning and fixation.

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Mammary analogue secretory carcinoma of the salivary glands: a diagnostic dilemma

Mammary analogue secretory carcinoma (MASC) is a recently identified salivary gland neoplasm that can mimic other salivary gland tumours such as acinic cell carcinoma and cystadenocarcinoma. It is distinguished from these by differences in immunohistochemical profile and the identification of an ETV6-NTRK3 translocation (12;15)(p13;q25), which is also found in secretory carcinomas of the breast. Previous publications have suggested that MASC tumours have similar biological behaviour to acinic cell carcinoma.

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Re: Smartphone photography in oral and maxillofacial surgery

The use of photography in oral and maxillofacial surgery (OMFS) and other specialties has become an integral part of documentation and serves a purpose in medicolegal matters. In response to the papers in your journal about smartphone photography,1,2 I am writing to inform you of an integrated software application used at Addenbrooke's, Cambridge University Trust Hospital, which allows clinicians to use their smartphones to take photographs, which are uploaded directly on to the patient's electronic record.

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Spending on Bariatric Surgery in the Unified Health System from 2010 to 2014: a Study Based on the Specialist Hospitals Authorized by the Ministry of Health

Abstract

Background

The aim of this study is to analyze the production of 76 specialist hospitals for the morbidly obese in Brazil's public healthcare system (SUS) from 2010 to 2014 in terms of quantity and costs of bariatric surgery and its complications.

Methods

Secondary data from the SUS Hospital Information System and the National Healthcare Establishments Registry were used. Current spending on bariatric surgery and its medical and postoperative complications were analyzed.

Results

There was a 60 % rise in the number of surgeries between 2010 and 2014. This increase was not homogeneous among the hospitals studied, since only 19 performed the minimum number of surgeries required. Women accounted for 85 % of the surgeries carried out, and 32 % were aged between 35 and 44 years. The Roux-en-Y technique was the most widely used (93.7 % of the total), followed by sleeve gastrectomy. The ratio between the occurrence of medical complications and total number of surgeries performed in each hospital varied significantly (between 0 and 5.97 %) but was lower for postoperative complications, ranging from 0 to 1.7 %. There was a nominal increase of 44 % in average expenditure on postoperative complications between 2013 and 2014, while the average cost of medical complications decreased by 8.7 % in the same period.

Conclusions

Despite the rise in the number of bariatric surgeries in Brazil, there is still a high demand for surgeries that is not being met, while most specialist hospitals fail to perform the minimum number of surgeries stipulated by the Ministry of Health.

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A randomized split-face clinical trial of daylight photodynamic therapy with methyl aminolaevulinate vs ingenol mebutate gel for the treatment of multiple actinic keratoses of the face and scalp

Publication date: Available online 13 August 2016
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Erica Moggio, Mariachiara Arisi, PierGiacomo Calzavara-Pinton
IntroductionDaylight photodynamic therapy with methyl aminolaevulinate (dlPDT) and ingenol mebutate gel (IMB) are approved therapeutic options for multiple actinic keratoses (AKs).The aim of this comparative, intra-patient, split- face, randomized clinical trial was to compare treatment outcomes of dlPDT and IMB.MethodsTwo symmetrical contralateral areas of 25cm² harboring a similar (≥5) number of AKs were selected and randomly assigned to 3 days' IMB treatment cycle or an only session of dlPDT. The next day the local skin reaction (LSR) score was registered. Patients scored pain (VAS) after the treatment and time to wound closure. After 90 days, the complete remission (CR) rate of lesions and patients, the cosmetic outcome and patients' preference were assessed.Results22 patients with a total of 311 AKs were enrolled. The mean pain VAS score was 3.55± 1.82 with IMB and 2.05± 0.72 with dlPDT (p<0.01). The mean LSR score was 9.91 ±4.24 and 4.59± 4.03 (p<0.01), respectively; mean days to wound closure were 9.45± 3.51 and 4.36 ±1.18days (p<0.01), respectively. After 3 months, 119 lesions with IMB and 120 lesions with dlPDT healed and the CR rate with IMB (75.8%) was non-inferior to the CR rate with dlPDT (77.9%). The comparisons of CR rates of grade I and II of AKs did not show an inferiority of a treatment compared to the other. Eight patients (36.4%) had all lesions cleared with IMB and 7 (31.8%) with dlPDT (p=NS). The cosmetic outcome was better with dlPDT and 17 patients evaluated dlPDT as their preferred treatment.ConclusionsA 3 days' treatment cycle with IMB and a single session of dlPDT had a similar efficacy for both grade I AKs and grade II AKs but dl PDT showed lower pain and inflammation scores, quicker wound closure and better cosmetic outcome and patients preference.



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Prognostic significance of HLA class I and II expression in patients with diffuse large B cell lymphoma treated with standard chemoimmunotherapy

Abstract

Loss of tumor cell human leukocyte antigen (HLA) is an immune escape mechanism for malignancies. However, the effect of low HLA class I or class II expression in diffuse large B cell lymphoma (DLBCL) treated with chemoimmunotherapy with the monoclonal antibody rituximab is largely unknown. We retrospectively analyzed samples and other data from 144 patients with DLBCL who were newly diagnosed in our institution and treated with standard R-CHOP therapy. We used antibodies against pan-HLA class I and pan-HLA class II molecules to assess HLA expression and its effect on prognosis. In a multivariate analysis, loss of HLA class II expression was a significantly independent adverse factor for progression-free survival (PFS; hazard ratio 2.3; 95 % confidence interval 1.2–4.6; P = 0.01). Although HLA class I loss of expression did not correlate with prognosis, the combination of HLA class I⁺ with either low peripheral lymphocyte count or CD3⁺ lymphocyte count was an adverse prognostic factor for PFS. Loss of HLA class II is an International Prognostic Index (IPI)-independent adverse factor for PFS in patients with DLBCL treated with standard therapy. However, in contrast to other solid cancers, HLA class I loss was not solely a prognostic factor in DLBCL.

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Potential for Reducing On-Farm Greenhouse Gas and Ammonia Emissions from Dairy Cows with Prolonged Dietary Tannin Additions

Abstract

Dairy cows are responsible for significant emissions of enteric methane (CH₄) and produce nitrous oxide (N₂O) and ammonia (NH₃) gas from manure. As an abatement strategy, we explored the effects of long-term condensed tannin (Quebracho and chestnut extracts) addition to dairy cow diets. Previous studies have demonstrated that tannins in cow diets reduce methane and ammonia efflux, but none have done so over a >1-month time period. A modified stanchion barn equipped with gas analysis instrumentation measured CH₄, N₂O, and NH₃ fluxes into and from the barn, at the onset of the experiment, and 45 and 90 days after feeding groups of lactating dairy cows a control diet or two levels of tannin extract at 0.45 and 1.8 % of dietary dry matter. Few statistical differences among treatments were observed, likely a consequence of high variability and low sample size necessary for conducting a study of this duration. However, on a per-cow basis, low and high tannin diets lowered CH₄ emissions by 56 g cow⁻¹ day⁻¹ and by 48 g cow day⁻¹, respectively. Diet tannin additions lowered CH₄ (33 %), NH₃ (23 %), and N₂O (70 %) per unit milk corrected emissions in the high tannin treatment compared to the control at the end of the experiment, without significant loss in milk production. These results suggest that relatively low concentrations of diet tannin additions can reduce ruminant CH₄ and gaseous N emissions from manure. The tannin effect observed after 90 days is a starting point for considering tannin additions as a potential long-term strategy for improving the environmental footprint of milk production.

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Biosurfactant Production by Marine-Originated Bacteria Bacillus Subtilis and Its Application for Crude Oil Removal

Abstract

Biosurfactants have been considered as promising candidates for oil spill cleanup as they are generally more biodegradable, less toxic, and better in enhancing biodegradation than chemical surfactants. This study targeted the marine microbial biosurfactants to examine their enhanced production methods and application for the removal of crude oil from soil. The biosurfactants generated by Bacillus subtilis, which was isolated from the Atlantic Ocean, were investigated in this study. The economic production medium using different carbon (n-hexadecane, diesel oil, glycerol, glucose, starch, and sucrose) and nitrogen sources (NaNO₃, (NH₄)₂SO₄, and yeast extract) was studied. The best performance of biosurfactant production was achieved when using glycerol as carbon source and sodium nitrate and yeast extract as nitrogen sources in the substrate. The production rate was enhanced five times compared with that of the original screening recipe. The fermentative production of the generated biosurfactants could reduce the surface tension of water to 27 mN/m and with strong surface activity (∼36.4 mN/m) even after dilution for 10 times. The critical micellar concentration (CMC) of the product was 507 mg/L. A thin layer chromatography (TLC) analysis indicated that the purified product was a mixture of lipopeptide and glycolipid. The microbially produced biosurfactants were further examined as a soil-washing agent to enhance crude oil removal in a soil column system. The removal rates of 58 and 65 % were achieved using the biosurfactant solution with concentrations of 4 and 8 g/L, respectively. The results demonstrated the potential of marine microbial biosurfactants in cleaning crude oil-contaminated soil.

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Evaluation of Glass Wool Filters and Hollow-Fiber Ultrafiltration Concentration Methods for qPCR Detection of Human Adenoviruses and Polyomaviruses in River Water

Abstract

Pathogenic human viruses cause over half of gastroenteritis cases associated with recreational water use worldwide. They are difficult to concentrate from environmental waters due to low numbers and small sizes. Rapid enumeration of viruses by quantitative polymerase chain reaction (qPCR) has the potential to improve water quality analysis and risk assessment. However, capturing and recovering these viruses from environmental water remain formidable barriers to routine use. Here, we compared the recovery efficiencies of human adenoviruses (HAdVs) and human polyomaviruses (HPyVs) from 10-L river water samples seeded with raw human wastewater (100 and 10 mL) using hollow-fiber ultrafiltration (HFUF) and glass wool filter (GWF) methods. The mean recovery efficiencies of HAdVs in river water samples through HFUF were 36 and 86 % for 100 and 10 mL of seeded human wastewater, respectively. In contrast, the estimated mean recovery efficiencies of HAdVs in river water samples through GWF were 1.3 and 3 % for 100 and 10 mL seeded raw human wastewater, respectively. Similar trends were also observed for HPyVs. Recovery efficiencies of HFUF method were significantly higher (P < 0.05) than GWF for both HAdVs and HPyVs. Our results clearly suggest that HFUF would be a preferred method for concentrating HAdVs and HPyVs from river water followed by subsequent detection and quantification with PCR/qPCR assays.

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Aluminum and Chromium Toxicity in Maize: Implications for Agronomic Attributes, Net Photosynthesis, Physio-Biochemical Oscillations, and Metal Accumulation in Different Plant Parts

Abstract

Phytotoxic effects of a single heavy metal on different crops are widely reported; however, consequences of combined metal toxicity on maize are rarely investigated. In this study, a pot experiment was conducted to assess the phytotoxic effects both Al and Cr on morphophysiological and biochemical traits, photosynthetic gas exchange capacities, metal uptake, and translocation in different plant parts. Plants were exposed to Al³⁺ (100 μM), Cr⁶⁺ (100 μM), and Al³⁺ + Cr⁶⁺ (100 + 100 μM), and data were collected at pre- and post-silking stages while uncontaminated pots were served as control (Ck). Results depicted that both Al and Cr impaired maize growth and yield response and inhibited photosynthesis and gas exchange attributes i.e., transpiration, stomatal conductance, inter-cellular CO₂, as well as water use efficiency (WUE) and intrinsic water use efficiency (WUEi). Moreover, Al and Cr toxicities caused lipid peroxidation and membrane damage while activated antioxidative defense system in terms of superoxide dismutase (SOD), peroxidaes (POD), and catalase (CAT) and mediated reduced glutathione contents (GSH). Increased proline and reduced protein contents were also observed with a combined metal toxicity. Interestingly, Cr proved to be more toxic than Al whereas affects were more apparent where both Al and Cr were applied simultaneously. Plant exposure to both Al and Cr increased metal contents in different plant parts, while maximum metal contents were recorded in roots followed by stem, leaves, corn ear, and grains. Overall severity in phytotoxic effects was observed as Al+Cr > Cr > Al > Ck. Additionally, values of combined application of both Al + Cr were higher than those of the linear sum of Al and Cr alone, suggesting that synergistic effects of Al + Cr were more toxic than their individual effects. Hence, combined metal toxicity proved more damaging for maize than individual metal stress.

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Malnutrition in Pre-school Children across Different Geographic Areas and Socio-Demographic Groups in Ghana

Abstract

Objective Malnutrition in children pervades all aspects of their health, growth, cognitive and social development and can lead to irreversible and lifelong effects. We examine the prevalence and determinants of malnutrition in children under 5 in the Ghanaian population. Methods Using data from the latest available Ghana Demographic and Health Survey (GDHS), we estimated and compared prevalence of malnutrition in children among the different subgroups of the population. We used multivariable logistic regression to identify potential factors associated with childhood malnutrition in Ghana. Results Overall, 35.6 % (95 % CI: 33.6, 37.6) of Ghanaian children under 5 years of age suffer from some form of malnutrition. Specifically, 27.5 % (95 % CI: 25.1, 28.7), 13.8 % (95 % CI: 12.5, 15.3), 8.9 % (95 % CI: 7.8, 10.2) were stunted, underweight and wasted, respectively. Results from the logistic regression indicate that gender and age of the child, educational and nutritional status of the mother, and financial status of the household are risk factors associated with childhood malnutrition in Ghana. Conclusions for Practice In view of the observed high rate of malnutrition among Ghanaian children despite the interventions that have been in place since the 1990s, there is a need for increased awareness and improved targeted interventions as well as knowledge translation tools including extensive education on infant and young child feeding practices.

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Creating Supportive Breastfeeding Policies in Early Childhood Education Programs: A Qualitative Study from a Multi-Site Intervention

Abstract

Objectives To understand the process by which early childhood education (ECE) providers effectively used an existing intervention to facilitate the creation or strengthening of a written breastfeeding policy, understand the factors important to this process, and present a logic model to guide future intervention design and evaluation. Methods A purposive sample of interviewees who recently completed an ECE nutrition and physical activity intervention and reported positive pre-post scores for breastfeeding support were recruited to complete semi-structured interviews. Interviews were recorded, transcribed, and coded, following a Grounded Theory approach. Results The ECE programs (n = 23) had a written breastfeeding policy and were located across six states in the United States. The most common aspects of breastfeeding support covered in the policies were handling and storing of breastmilk, pieces of equipment to be provided (e.g., breast pump), and the creation of a space or room designated for breastfeeding and pumping. Many factors important to the policy creation process were identified such as motivation, education, technical assistance, perceptions of parental indifference, staff buy-in, and time and administrative constraints. Once motivated to create a policy, ECE providers described actions, such as gathering background information and model policies, discussing policy needs with stakeholders, utilizing technical assistance, and overcoming barriers. Conclusions for Practice From these findings, a logic model was created to guide future intervention design and evaluation, and several recommendations were made to help guide subsequent interventions in promoting the development and implementation of written breastfeeding policies at ECE programs.

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Firefighter/Paramedic Trainee - Villages Public Safety Department

VILLAGES PUBLIC SAFETY DEPARTMENT 3035 MORSE BOULEVARD THE VILLAGES, FLORIDA 32163 Updated: August 11, 2016 Classification: Firefighter/Paramedic Trainee Villages Public Safety Department is currently hiring for Firefighter/Paramedic Trainee. National Testing Network (NTN) FireTEAM and a valid CPAT are required for this position. All NTN testing must be completed by September 2, 2016. Salary Information: ...

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Chondromatose de l’articulation temporomandibulaire : étude multicentrique et mise au point à partir de 14 cas

Publication date: Available online 13 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): E. Massereau, F. Cheynet, H. Bénateau, A. Veyssière, Y. Bencheman, A. Gallucci, S. Hammoutène, C. Chossegros
IntroductionLe but de notre étude était d'analyser une série de patients atteints de chondromatose de l'articulation temporomandibulaire (ATM) pris en charge dans les services de stomatologie et de chirurgie maxillofaciale des centres hospitaliers universitaires de la Conception à Marseille et de Caen et de réaliser une mise au point sur cette pathologie.Matériel et méthodeIl s'agissait d'une étude rétrospective sur dossiers colligeant tous les patients pris en charge pour une chondromatose de l'ATM dans l'un des 2 services. Les paramètres suivants ont été analysés : sexe, âges lors de la découverte et lors de l'intervention chirurgicale, symptômes, côté de l'atteinte, imagerie, histologie, récidive et tout autre élément jugé pertinent.RésultatsQuatorze patients ont pu être inclus : 85,7 % étaient des femmes. La moyenne d'âge de découverte était de 40,14ans (σ = 13,82 ; IC95 : 32,90–47,38) (41ans pour les femmes [σ = 14,74 ; IC95 : 33,28–48,72] et 35ans pour les hommes [σ = 5,66 ; IC95 : 27,16–42,84]). L'âge moyen lors de l'intervention chirurgicale était de 40,86ans (σ = 14,18 ; IC95 : 33,43–48,28). Il n'existait pas de prédominance de côté ; 57,14 % des patients présentait un syndrome articulaire, 57,14 % un syndrome tumoral, 28,57 % une douleur et 14,29 % des céphalées. La radiographie panoramique était anormale dans 3 cas seulement. Le scanner montrait des calcifications intra-articulaires dans la moitié des cas seulement mais des remaniements arthrosiques dans tous les cas. L'imagerie par résonance magnétique (IRM) montrait constamment des fragments cartilagineux. Lorsqu'elle était réalisée, l'histologie ne montrait pas d'anomalie synoviale dans un cas et de multiples nodules avec différenciation cartilagineuse nette dans un cas. Un patient a présenté une deuxième localisation controlatérale à 10ans.DiscussionLa chondromatose est d'évolution lente et est longtemps asymptomatique. L'IRM permet d'évoquer le diagnostic et de localiser précisément les ostéochondromes. Le diagnostic définitif est fait par l'histologie qui met en évidence une métaplasie synoviale et des chondromes plus ou moins ossifiés. Le principal diagnostic différentiel à éliminer pour des raisons pronostiques est le chondrosarcome synovial. Le traitement est chirurgical avec ablation des chondromes. L'évolution est en général favorable.IntroductionThe aim of our study was to analyse a series of patients suffering from temporomandibular joint (TMJ) chondromatosis treated in 2 departments of stomatology and maxillofacial surgery (University hospitals of the Conception in Marseille and of Caen) and to make a general review of this disease.Material and methodsWe conducted a retrospective study including all the patients treated for a TMJ chondromatosis in one of these 2 departments. Following parameters were analyzed: sex, ages at discovery and at surgery, symptoms, side, imaging, histology, recurrence and any other events considered as relevant.ResultsFourteen patients could be included: 85.7 % were women. Average age at diagnosis was 40.14 (σ = 13.82; IC95: 32.90–47.38) (41 for women [σ = 14.74; IC95: 33.28–48.72] and 35 years for men [σ = 5.66, IC95: 27.16–42.84]). Average age at surgery was 40.86 (σ = 14.18; IC95: 33.43–48.28). There was no predominance of side; 57.14 % of the patients had a joint syndrome, 57.14 % a tumor syndrome, 28.57 % had pain and 14.29 % had headaches. Panoramic X-ray was informative in 3 cases only. CT scan showed intra-articular calcifications in half of the cases only but arthrosic modifications in all the cases. Magnetic resonance imaging (MRI) constantly showed intra-articular cartilage fragments. When histology was performed, it found the synovial to be normal in one case and multiple nodules with clear cartilaginous differentiation in another case. One patient suffered from a second contralateral localization 10 years later.DiscussionChondromatosis has a slow evolution and is asymptomatic for a long time. MRI allows to evoke the diagnosis and to locate precisely the osteochondromas. Diagnosis is confirmed by histology that highlights a synovial metaplasia and more or less calcified chondromas. The main differential diagnosis to be eliminated because of prognostic reasons is the synovial chondrosarcoma. Treatment consists in surgical removing of the chondromas. Evolution is usually favorable.



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Carcinomes intra-osseux primitifs des mâchoires de novo (type 3)

Publication date: Available online 13 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): A.C. Ray, J.M. Foletti, N. Graillon, L. Guyot, C. Chossegros
IntroductionLe carcinome intra-osseux primitif (CIOP) des mâchoires est un carcinome épidermoïde rare d'origine épithéliale et de localisation initialement strictement intra-osseuse. Le CIOP de type 3 (CIOP3) correspond histologiquement à un carcinome intra-osseux primitif de novo. Du fait de la rareté de cette affection, nous proposons l'analyse d'un cas clinique personnel et une analyse de la littérature.Matériel et méthodeDeux moteurs de recherche (Pubmed^®, Sciencedirect^®) ont été interrogés à l'aide des mots clés carcinoma, intraosseous, jaws, squamous cell carcinoma sur la période 1976–février 2016. Les articles rapportant des lésions répondant aux critères diagnostiques des CIOP3 et faisant mention d'un traitement précis ont été retenus.RésultatsTrente articles totalisant 54 patients (sex-ratio : 2,4 ; âge moyen : 56,8ans ; extrêmes : 24–78ans) répondaient aux critères d'inclusion. Les symptômes les plus fréquents étaient une tuméfaction (53 %), une douleur (44,9 %) et des paresthésies du nerf alvéolaire inférieur (30,6 %). Le délai diagnostique était de 13 semaines. La classification de Zwetyenga et al. montrait plus de 80 % de stades T2 et T3. Les lésions étaient majoritairement mandibulaires (85,2 %) et postérieures. Moins d'un tiers des patients avaient une adénopathie et 10 % avaient une métastase à distance. Le traitement a associé chirurgie et radiothérapie. Un total de 70,8 % étaient en rémission sans signe de récidive avec un suivi moyen de 74,8 mois. Nous rapportons le cas d'un patient de 58ans, sans antécédent, présentant, depuis plusieurs mois, une gingivite avec mobilité dentaire dans le secteur mandibulaire droit. La radiographie panoramique montrait une lyse osseuse en regard de la dent 46. En l'absence de cicatrisation alvéolaire après extraction et antibiothérapie, une biopsie a été réalisée et a diagnostiqué un carcinome épidermoïde différencié kératinisant. Le scanner et l'IRM ont montré une ostéolyse corticale, un envahissement des structures adjacentes et une adénopathie dans le secteur IB homolatéral. Le patient a été traité par une association chimiothérapie d'induction–chirurgie. Une chimio- et une radiothérapie postopératoires sont en cours.DiscussionLe CIOP3 est une tumeur rare, touchant préférentiellement les hommes de 50ans. Le diagnostic doit être évoqué devant une tuméfaction douloureuse associée à des signes d'atteinte nerveuse. Le délai jusqu'au diagnostic est long. Les tumeurs sont souvent vues à des stades avancés. Le traitement associe classiquement la chirurgie et la radiothérapie.IntroductionPrimary intraosseous carcinoma (PIOC) of the jaws is a rare epidermoid carcinoma from epithelial origin and initially strictly localized within the bone. Histologically, type 3 PIOC (PIOC3) is a de novo primary intraosseous carcinoma. Because of the rarity of this illness, we propose an analysis of a personal case and a revue of the literature.Material and methodsTwo search engines (Pubmed^®, Sciencedirect^®) were questioned over the period 1976–February 2016 by using following keywords carcinoma, intraosseous, jaws, squamous cell carcinoma. Articles reporting proven PIOC3 and mentioning a precise treatment were selected.ResultsThirty articles concerning 54 patients (sex ratio: 2.4; mean age: 56.8; extreme: 24–78) met the inclusion criterions. The most common symptoms were swelling (53%), pain (44.9%) and infra-alveolar nerve paresthesia (30.6%). The time to diagnosis was 13 weeks. Classification of Zwetyenga et al. showed more than 80% of T2 and T3 stages. The lesions were predominantly mandibular (85.2%) and posterior. Less than a third of patients had lymph node and 10% had distant metastasis. Treatment consisted mostly in a combination of surgery and radiotherapy. With a mean follow-up of 74.8 months, 70.8% were in remission with no evidence of recurrence. We report the case of a 58-year-old patient, with no medical history, complaining since several months about periodontitis with teeth mobility in the right mandibular area. The panoramic X-ray showed a bone lysis at the place of tooth No. 46. In the absence of alveolar healing after extraction and antibiotherapy, a biopsy was made that diagnosed a differentiated keratinizing squamous cell carcinoma. CT scan and MRI showed a mandibular cortical bone loss with involvement of adjacent structures and lymphadenopathy in the ipsilateral IB area. The patient was treated with a combination of chemotherapy and surgery. Postoperative chemo- and radiotherapy is still going on.DiscussionThe PIOC3 is a rare tumor, mainly arising in males around 50. Diagnosis should be evoked in the presence of painful swelling and nervous symptoms. The time to diagnosis is long. Tumors are usually seen at late stages. Treatment classically combines surgery and radiotherapy.



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Re: Smartphone photography in oral and maxillofacial surgery

Publication date: Available online 12 August 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Meghal Vora, Mark Thompson




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Splintless surgery: does patient-specific CAD-CAM osteosynthesis improve accuracy of Le Fort I osteotomy?

Publication date: Available online 13 August 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. Kraeima, J. Jansma, R.H. Schepers
To analyse the accuracy of maxillary positioning after Le Fort I osteotomy, we retrospectively assessed the outcome in three patients (mean (range) age 40 (21 – 60) years) who had been treated with patient-specific CAD-CAM osteosynthesis plates as part of a bimaxillary osteotomy. Virtual surgical planning in each case was based on cone-beam computed tomography (CT) (Simplant® O&O, Dentsply Implants NV, Kessel-Lo, Belgium), and patient-specific CAD-CAM drilling guides and osteosynthesis plates were produced for maxillary positioning and fixation. We evaluated the accuracy of the placement by virtual comparison of the preoperative and postoperative images. In the upper dentition, postoperative analysis showed a mean (SD) deviation of 1.3 (1.4) mm from the preoperative plan. The method enables accurate placement of the maxilla, independent of the condyle or mandible, without the need for extraoral reference points.



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Mammary analogue secretory carcinoma of the salivary glands: a diagnostic dilemma

Publication date: Available online 12 August 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): N. Hindocha, M.H. Wilson, M. Pring, C.W. Hughes, S.J. Thomas
Mammary analogue secretory carcinoma (MASC) is a recently identified salivary gland neoplasm that can mimic other salivary gland tumours such as acinic cell carcinoma and cystadenocarcinoma. It is distinguished from these by differences in immunohistochemical profile and the identification of an ETV6-NTRK3 translocation (12;15)(p13;q25), which is also found in secretory carcinomas of the breast. Previous publications have suggested that MASC tumours have similar biological behaviour to acinic cell carcinoma. We report two cases of MASC that affected the upper lip, and showed an infiltrative and locally aggressive growth pattern that required several operations to ensure clearance of microscopic tumour cells.



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Herniotomy in young adults as an alternative to mesh repair: a retrospective cohort study

Abstract

Introduction

Inguinal hernia repair is one of the most frequently performed procedures. An alternative to mesh repair could be herniotomy, where no mesh is placed and only minimal dissection is done. The European Hernia Society guidelines on the treatment of inguinal hernia in adult patients, which were released in 2009 and expired some time ago, states that all adult (>30 years of age) male patients with a symptomatic inguinal hernia should be operated on using a mesh technique. We hypothesize that the herniotomy is a good alternative to mesh repair in young patients.

Methods

In this retrospective cohort study, the postoperative complications and recurrence rate after a herniotomy procedure were studied. All patients between the ages of 18 and 40 at the time of the surgery were included from January 1st 1997 until December 31st 2010.

Results

In our cohort of 234 patients, the recurrence rate was 4.7 %. When we focus on the patients in the ages ranging from 18 to 25 years old at the time of the surgery, we found a recurrence rate of 0 versus 9.2 % in ages 26–40. These recurrence rates are comparable to those in current literature.

Conclusion

A herniotomy seems to be an efficient procedure with acceptable recurrence rates in patients up to 30 years of age. Postoperative pain seems to be low compared to other techniques. In patients older than 30 years recurrence rates seem to increase which necessitates the use of mesh implants. The main finding is zero recurrences in patients up to 25 years of age. Because there is a limited amount of similar studies that evaluated the complications of a herniotomy, we believe these results warrant the commencement of a randomized controlled trial to add more evidence to this topic. This cohort study is a small, but important contribution to the advice to perform a randomized controlled trial. Based on the limited evidence that is known so far, this procedure might be the treatment of choice in the repair of primary inguinal hernia in young adult patients up to 30 years of age.

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No enterocutaneous fistula development in a cohort of 695 patients after incisional hernia repair using intraperitoneal uncoated polyproylene mesh

Abstract

Purpose

To determine the incidence of enterocutaneous fistulas (ECFs) developed after elective incisional hernia (IH) repair using intraperitoneal uncoated polypropylene (PPE) mesh.

Methods

This is a retrospective descriptive study of a prospective cohort of patients undergoing elective IH repair using intraperitoneal uncoated PPE mesh at the Department of General Surgery of a high complexity University Hospital.

Results

Between January 1992 and December 2013, 695 IH repairs were performed using intraperitoneal uncoated PPE mesh. The omentum was placed between the mesh and bowel in 507 patients (73 %). In 188 patients (27 %) it was not possible to place the omentum between the mesh and bowel; therefore, in 69 patients (9.92 %) the PPE mesh was placed over the bowel, whereas in 119 patients (17.12 %) a Vicryl® mesh was placed between the bowel and PPE mesh. Six hundred and seventy-eight (97.5 %) IH repairs were open whereas 17 (2.5 %) were laparoscopic. Postoperative complications consisted of seroma (5.9 %), hematoma (4.3 %), wound infection (4.8 %), and mesh infection (4.0 %). Recurrence of IH occurred in 52 patients (7.4 %) after a mean follow-up of 59 months. Four (0.5 %) patients required additional surgery due to intestinal occlusion. Neither acute nor chronic ECFs were encountered during follow-up in 695 patients.

Conclusion

Based on these results, the placement of intraperitoneal uncoated PPE mesh for elective IH repair might be a safe procedure that is not associated with ECF formation.

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Discrete element simulation of dynamic behaviour of partially saturated sand

Abstract

The discrete element method (DEM) together with the finite element method (FEM) in LS-DYNA was employed to investigate the dynamic behaviour of sand under impact loading. In this approach, the partially saturated sand was modelled in DEM with capillary forces being taken into account through an implicit capillary contact model, while other solids were simulated using FEM. A slump test was first performed with dry sand to calibrate the contact parameters in DEM. Low velocity impact tests were then conducted to investigate the effect of water saturation on the shape and height of sand piles after impact, and to validate the simulations. It was found in the experiments that an increasing water saturation (in the range between 10 and 30 %) affected the height of sand pile for a given drop height due to an increasing cohesion between particles. The simulations captured the experimental ejecta patterns and sand pile height. Finally, a low confinement split Hopkinson pressure bar test from earlier literature was modelled; the DEM–FEM simulations could reproduce the trends of experimentally observed stress–strain curves of partially saturated sand under high strain rate loading, indicating that it was feasible to model dynamic behaviour of dry and wet sand with low saturation (<20 %) in LS-DYNA; however, a number of questions remain open about the effect of grain shape, grain crushing and viscosity.

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TCF-1 participates in the occurrence of dedifferentiated chondrosarcoma

Abstract

The present study demonstrated that T cell factor 1 (TCF-1) protein, a component of the canonical Wnt/β-catenin signaling pathway, can regulate the expression of runt-related transcription factor 2 (runx2) gene and Sry-related HMG box 9 (sox9) gene, which may participate in the differentiation of chondrosarcoma. Dedifferentiated chondrosarcoma (DDCS) is a special variant of conventional chondrosarcoma (CCS), associated with poor survival and high metastasis rate. However, little is known about the mechanism of its occurrence; thus, no effective treatment is available except surgery. Earlier, high expression of runx2 and low expression of sox9 were found in DDCS compared with CCS. Using Western blot to detect clinical tissue samples (including 8 CCS samples and 8 DDCS samples) and immunohistochemistry to detect 85 different-grade chondrosarcoma specimens, a high expression of TCF-1 in DDCS tissues was found compared with CCS tissues. This difference in expression was related to patients' prognosis. Results of luciferase, chromatin immunoprecipitation, and gel electrophoresis mobility shift assays demonstrated that TCF-1 protein could bind to the promoter of runx2 gene directly and sox9 gene indirectly. Hence, it could regulate expression of runx2 gene positively and sox9 gene negatively. Furthermore, in vitro and in vivo experiments showed that TCF-1 protein was closely related to the phenotype and aggressiveness of chondrosarcoma. In conclusion, this study proved that TCF-1 participates in the dedifferentiation of DDCS, which may be mediated by runx2 gene and sox9 gene. Also, TCF-1 can be of important prognostic value and a promising therapeutic target for DDCS patients.

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Follow up in posterior urethral valve after primary valve fulguration or diversion with fulguration with special references to urodynamic studies

2016-08-13T13-00-44Z
Source: International Journal of Medical Science and Public Health
Lalit Kumar, Rahul Tiwari, Amit Sandhu, Sakshi Agarwal, Bajrang Tak.
Background: Follow up of posterior urethral valve patients is very crucial as it is commonest congenital obstruction of the lower urinary tract. Objective: To evaluate outcome after surgery with special reference to urodynamic studies. Materials and Methods: Study has been carried out retrospectively. Fifty cases of PUV of age ≥3 years were included in the study between the time period of July 2010 to June 2012. Long term outcome had been evaluated by renal profile, MCU, and UDS regarding bladder dysfunction. In most of the cases the initial presentation data were collected retrospectively at the time of follow up. At that time UDS was performed if there was no contraindication. 50 cases were divided into 2 groups. Group 1 included 18 patients which were managed only by primary valve fulguration while group 2 included 32 patients which required urinary diversion procedure. Result: The mean value of serum creatinine in group 1 was 1.486±0.7646 mg/dl at the time of initial presentation and 0.8511±0.22721 mg/dl at the time of follow up while for group 2 it was 1.737±0.9734 mg/dl and 1.0913±0.41396 mg/dl, respectively. The mean value of PdetMax was 79.20±33.842 cm H2O in group1 and it was 51.14±28.141 cm H2O in group 2. Mean value of bladder compliance was 15.86±17.902 mL/cm H2O in group 1 and 6.26±3.605 mL/cm H2O in group 2. PdetMax and bladder compliance showed significantly better results in group 1 as p


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A Community based cross sectional study of dog bites in children in a rural district of Tamil Nadu

2016-08-13T13-00-44Z
Source: International Journal of Medical Science and Public Health
Murugan Venkatesan, Amol Dongre, Kalaiselvan Ganapathy.
Background: Worldwide dog bites are becoming a significant public health problem and the annual frequency of dog bite injuries in children is estimated to be 22 per 1000 children of which less than half of them are reported in medical facilities. Objective: To study the period prevalence of dog bites in children, its risk factors and treatment seeking behavior. Materials and Methods: The present cross sectional study was conducted in field practicing areas of rural health centre covering 4150 households in 34 villages involving 5841 children. Data was collected by trained medical interns and social workers. Collected data was entered and analyzed using EPI_INFO software (3.5.3). Result: The period prevalence of dog bites episodes in last one year is 17.9 per 1000 children. Most of bites happened in male children (51.5%), less than 10 years of age (56%), and children below poverty line (80%). Almost 78% of bites are unprovoked and the most common place of bites is in and around the house (70%). The most common site of bite is lower limb (53.6%) followed by upper limb (27.6%). The most common treatment source for bites is primary health centre followed by traditional faith healers. Almost 67% of wounds belonging to class 3 wounds but only 4% of dog bite victims received immunoglobulins. Conclusion: Period prevalence of dog bites is high and it is common in children belonging to poor socioeconomic conditions. In a country with very high population of unvaccinated dogs, health education program focusing on prevention of dog bites, correct methods of local wound treatment, vaccine, and rabies immunoglobulins are needed.


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Treatment of infraorbital dark circles using 694-nm fractional Q-switched ruby laser

Abstract

The objective of this study was to evaluate the efficacy and safety of using a 694-nm fractional Q-switched ruby laser to treat infraorbital dark circles. Thirty women with infraorbital dark circles (predominant color: dark/brown) participated in this open-labeled study. The participants received eight sessions of 694-nm fractional Q-switched ruby laser treatment using a fluence of 3.0–3.5 J/cm², at an interval of 7 days. The melanin deposition in the lesional skin was observed in vivo using reflectance confocal microscopy (RCM). The morphological changes were evaluated using a global evaluation, an overall self-assessment, and a Mexameter. Twenty-eight of the 30 patients showed global improvements that they rated as excellent or good. Twenty-six patients rated their overall satisfaction as excellent or good. The melanin index indicated a substantial decrease from 240.44 (baseline) to 194.56 (P < 0.05). The RCM results showed a dramatic decrease in melanin deposition in the upper dermis. The adverse effects were minimal. The characteristic finding of dark/brown infraorbital dark circles is caused by increased melanin deposition in the upper dermis. The treatment of these infraorbital dark circles using a 694-nm fractional QSR laser is safe and effective.

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Evaluation of Clinicopathological Factors Related to the Prognosis of Gastric Neuroendocrine Carcinoma

Publication date: Available online 13 August 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Jian-Wei Xie, Yu-Qin Sun, Chang-Yin Feng, Chao-Hui Zheng, Ping Li, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ying-Hong Yang, Chang-Ming Huang
BackgroundResearch on the clinicopathology and prognosis of gastric neuroendocrine carcinoma (GNEC) is rare, and a uniform standard for treatment has not been established. Therefore, we retrospectively analyzed the clinical data of 132 cases of GNEC to investigate the factors influencing prognosis.MethodsA total of 132 patients diagnosed with GNEC at Fujian Medical University Union Hospital from January 2006 to December 2013 were enrolled. This study was performed to analyze the factors related to patient prognosis.ResultsIn total, 58 men and 74 women whose ages ranged from 38 to 83 years old (62 ± 10) were enrolled. The 1- and 3-year survival rates for these patients were 83.9% and 47.6%, respectively. Of these patients, 100 underwent radical resection, 22 underwent palliative resection, and 10 received chemotherapy alone. The median survival times following radical resection, palliative resection and chemotherapy alone were 48, 20 and 12 months, respectively (P<0.01). Univariate and multivariate survival analyses of patients who underwent radical resection showed that tumor size, N stage, Ki-67 labeling index, mitotic index and the application of postoperative adjuvant chemotherapy were independent factors affecting patient prognosis. The correlation analysis of the Ki-67 labeling index and mitotic index with prognosis showed that patient survival decreased significantly when the Ki-67 labeling index increased (P<0.05).ConclusionsPatients who underwent radical resection had the best prognosis among GNEC. For these patients, tumor size, N stage, Ki-67 labeling index, mitotic index and the application of postoperative adjuvant chemotherapy were the clinicopathological factors significantly associated with patient prognosis.



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Core needle biopsy for the assessment of unilateral male breast lesions

Publication date: Available online 13 August 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): G. Bicchierai, J. Nori, L. Livi, D. De Benedetto, E. Vanzi, C. Boeri, S. Bianchi, C. Becherini, I. Meattini
The importance of preoperative histological diagnosis in the assessment of breast lesions in women is widely established, but in men with breast lesions histological diagnosis is obtained in a limited number of cases. The aim of this study was to report our single-center experience in a large series of 131 CNB performed for suspicious male breast lesions. Our data confirmed that CNB is an effective method in distinguishing between benign and neoplastic lesions in the male breast, thus validating the few published data. CNB should be a routine part of the unilateral male breast swelling diagnostic assessment, being precious tool for the clinicians for surgery planning or avoidance.



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Designing Microfluidic Devices for Studying Cellular Responses Under Single or Coexisting Chemical/Electrical/Shear Stress Stimuli

Micro-fabricated devices integrated with fluidic components provide an in vitro platform for cell studies mimicking the in vivo micro-environment. We developed polymethylmethacrylate-based microfluidic chips for studying cellular responses under single or coexisting chemical/electrical/shear stress stimuli.

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Topical treatment of melanoma metastases with imiquimod, plus administration of a cancer vaccine, promotes immune signatures in the metastases

Abstract

Introduction

Infiltration of cancers by T cells is associated with improved patient survival and response to immune therapies; however, optimal approaches to induce T cell infiltration of tumors are not known. This study was designed to assess whether topical treatment of melanoma metastases with the TLR7 agonist imiquimod plus administration of a multipeptide cancer vaccine will improve immune cell infiltration of melanoma metastases.

Patients and methods

Eligible patients were immunized with a vaccine comprised of 12 melanoma peptides and a tetanus toxoid-derived helper peptide, and imiquimod was applied topically to metastatic tumors daily. Adverse events were recorded, and effects on the tumor microenvironment were evaluated from sequential tumor biopsies. T cell responses were assessed by IFNγ ELIspot assay and T cell tetramer staining. Patient tumors were evaluated for immune cell infiltration, cytokine and chemokine production, and gene expression.

Results and conclusions

Four eligible patients were enrolled, and administration of imiquimod and vaccination were well tolerated. Circulating T cell responses to the vaccine was detected by ex vivo ELIspot assay in 3 of 4 patients. Treatment of metastases with imiquimod induced immune cell infiltration and favorable gene signatures in the patients with circulating T cell responses. This study supports further study of topical imiquimod combined with vaccines or other immune therapies for the treatment of melanoma.

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Intratumoral interferon-gamma increases chemokine production but fails to increase T cell infiltration of human melanoma metastases

Abstract

Introduction

Optimal approaches to induce T cell infiltration of tumors are not known. Chemokines CXCL9, CXCL10, and CXCL11 support effector T cell recruitment and may be induced by IFN. This study tests the hypothesis that intratumoral administration of IFNγ will induce CXCL9–11 and will induce T cell recruitment and anti-tumor immune signatures in melanoma metastases.

Patients and methods

Nine eligible patients were immunized with a vaccine comprised of 12 class I MHC-restricted melanoma peptides and received IFNγ intratumorally. Effects on the tumor microenvironment were evaluated in sequential tumor biopsies. Adverse events (AEs) were recorded. T cell responses to vaccination were assessed in PBMC by IFNγ ELISPOT assay. Tumor biopsies were evaluated for immune cell infiltration, chemokine protein expression, and gene expression.

Results

Vaccination and intratumoral administration of IFNγ were well tolerated. Circulating T cell responses to vaccine were detected in six of nine patients. IFNγ increased production of chemokines CXCL10, CXCL11, and CCL5 in patient tumors. Neither vaccination alone, nor the addition of IFNγ promoted immune cell infiltration or induced anti-tumor immune gene signatures.

Conclusion

The melanoma vaccine induced circulating T cell responses, but it failed to infiltrate metastases, thus highlighting the need for combination strategies to support T cell infiltration. A single intratumoral injection of IFNγ induced T cell-attracting chemokines; however, it also induced secondary immune regulation that may paradoxically limit immune infiltration and effector functions. Alternate dosing strategies or additional combinatorial treatments may be needed to promote trafficking and retention of tumor-reactive T cells in melanoma metastases.

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Technical quality of a matching-taper single-cone filling technique following rotary instrumentation compared with lateral compaction after manual preparation: a retrospective study

Abstract

Objectives

The objectives of the study were to evaluate the radiographic technical quality of root canal treatment before and after the implementation of a nickel-titanium rotary (NiTiR) preparation followed by a matching-taper single-cone (mSC) obturation and to detect the procedural errors associated with this technique.

Materials and methods

A random sample of 535 patients received root canal treatment at the Department of Conservative Dentistry and Periodontology at the University of Würzburg: 254 teeth were treated in 2002–2003 by using stainless steel instruments (SSI) for preparation and a lateral compaction (LC) technique (classic group (CG)). Two hundred eighty-one teeth were root filled in 2012–2013 employing NiTiR instruments for the root canal shaping and a mSC technique (advanced group (AG)). The quality assessments were based on the radiographic criteria of the European Society of Endodontology. The presence of voids was recorded separately for the apical, central and cervical thirds of the root canals. Procedural errors, such as ledges, apical transportations, perforations and fractured instruments, were detected. The root canal fillings in the CG and AG were compared using chi-squared and Fisher's exact tests. Multivariable logistic regression was performed to investigate the association between the independent variables (patient age, tooth type and type of treatment) and the dependent variables (density and length).

Results

Adequate length was achieved significantly more often in the AG compared to the CG for molars (p = 0.017), mandibular teeth (p = 0.013) and primary root canal treatments (p = 0.024). No significant difference was detected between the AG and CG regarding adequate length in general (p = 0.051) or adequate overall quality of root canal filling (p = 0.1). In the AG, a significant decrease in procedural errors was evident (p = 0.019) and decreases in the densities of the root canal fillings in the cervical (p = 0.01) and central (p = 0.01) thirds of the root canals were also observed. Moreover, root canals in elderly patients exhibited fewer voids (p = 0.009).

Conclusions

Rotary root canal preparation followed by a matching-taper single-cone filling technique provides a reliable shaping of the root canal, with fewer procedural errors and a more acceptable filling quality in terms of length and homogeneity in the apical third. Less favourable results were achieved in the central and cervical parts of the root canals.

Clinical relevance

The matching-taper single-cone technique seems to effectively obturate well-tapered root canals after adequate rotary instrumentation. Irregularly shaped canals require additional lateral or warm vertical condensation to avoid voids.

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Vocal Problems in Sports and Fitness Instructors: A Study of Prevalence, Risk Factors, and Need for Prevention in France

Publication date: Available online 12 August 2016
Source:Journal of Voice
Author(s): Lionel Fontan, Marie Fraval, Anne Michon, Sébastien Déjean, Muriel Welby-Gieusse
ObjectivesSports and fitness instructors (SFIs) are known for being a high-risk population for voice difficulties (VD). However, past studies have encountered various methodological difficulties in determining prevalence and risk factors for VD in SFIs, such as limited population, gender and selection biases, or poor statistical power, because VD were studied as a binary variable. The present research work addresses these issues and aims at studying the prevalence of vocal problems and risk factors in French SFIs, a population in which no such study was conducted yet. Another objective is to survey the French SFIs' habits and expectations regarding vocal prevention and care.Study designThis is a cross-sectional study.MethodsThree hundred and twenty SFIs answered a questionnaire, whether in an online (n = 267) or a paper (n = 53) version. The questionnaire consisted of 31 items addressing self-reported vocal difficulties, supposed risk factors, and personal health-care history, followed by the Voice Handicap Index assessment.ResultsPrevalence of self-reported vocal difficulties is 55%. The Voice Handicap Index is significantly associated with gender, age, and variables related to work environment (noise and music) and habits (shouting, frequency of classes), as well as with daily sleeping time. Results also indicate that a minority of the SFIs (37%) received information on vocal difficulties, whereas a majority (80%) declares being interested in participating in prevention programs.ConclusionsThis work confirms that SFIs are a high-risk population for VD, underlines the need for specific information programs in France, and provides relevant data for driving such preventive actions.



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Pre- and Poststimulation Study on the Phonatory Aerodynamic System on Participants with Dysphonia

Publication date: Available online 12 August 2016
Source:Journal of Voice
Author(s): Natalie Schaeffer
PurposeThe purpose of this preliminary investigation was to examine the sensitivity of the Phonatory Aerodynamic System (PAS) in an exploratory investigation that looked at the effects of stimulation training (pre and post stimulation) on 20 participants with vocal complaints. The following parameters were tested: subglottal pressure, sound pressure level, airflow, and fundamental frequency.MethodsA total of 20 participants with vocal complaints performed the Voicing Efficiency protocol on the (PAS). The participants spoke into a mask and repeated the utterance /papapa/ five times on a single breath for three sets (pausing between sets). Measurements of the parameters were recorded on the PAS. Subsequently, the participants were given stimulation training involving the coordination of respiration and phonation and purposely engaging the abdominal muscles upon phonation. They repeated the same PAS task, using the training. Their parameters after training were compared to normal values to determine improvements post stimulation results.ResultsThe participants showed improvement in a number of parameters post stimulation, especially subglottal pressure and fundamental frequency (i.e., closer to normal values in comparison with pre-stimulation results) and on the graphic readouts; the respiratory waveforms showed greater consistency and evenness on certain parameters compared with those in the pre-training graphs. Perceptually, the participants' voices revealed reduced noise and strain.ConclusionPost stimulation, a number of parameters improved towards normal values; the respiratory graphic waveforms were more consistent and even, and perceptually improved vocal quality was noted by judges and participants.



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Drug utilization pattern of antiepileptic drugs in a tertiary care teaching rural hospital

2016-08-13T12-17-30Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Pragna M Patel, Amit M Shah, Bharat M Gajjar.
Background: Antiepileptic drugs (AEDs) are also commonly used therapy for other conditions like prophylaxis for a manicdepressive disorder, to relieve neuralgic pain and for many more conditions apart from epilepsy. Data suggest that 45% of AEDs prescriptions were for conditions other than epilepsy. All of these uses are off-label except for some AEDs approved for limited indications. Aims and Objective: To study the AEDs utilization pattern in a tertiary care teaching rural hospital in India. Materials and Methods: Patients who prescribed AEDs by treating physician from the various outpatient departments of a tertiary care hospital were enrolled in the study irrespective of their diagnosis. Their demographic data, clinical profile and drug use related details were obtained from the case files and history and analyzed. Results: Out of total 160 patients enrolled, the majority were male 103 (64.4%), in the age group of 18-65 years (123, 76.9%), and from neuromedicine 149 (93.1%) department. 81 (50.63%), 45 (28.12%), and 10 (6.25%) were diagnosed as epilepsy, pain, and psychomotor disorders, respectively, and remaining patients having a dual indication for AEDs prescription. Partial epilepsy (45, 47.87%) was the most common type and cryptogenic (44, 46.80%) was most common aetiological factor among epileptic patients. Average number of AEDs prescribed per patient was 1.331. 113 (70.6%) patients were managed by monotherapy. Most frequently prescribed AEDs were pregabalin (20.19%) followed by phenytoin (16.90%). Conventional AEDs (78.95%) were prescribed more frequently than newer AEDs (21.05%) for epilepsy; while newer AEDs (68.10%) were frequently prescribed in patients suffering from non-epileptic condition. 52% of drugs were prescribed by generic name. No fixed dose combinations of AEDs were prescribed throughout this study period. Conclusions: The use of AEDs not limited to epilepsy only. AEDs were prescribed more frequently in neuropathic pain and psychiatric disorders other than epilepsy. AEDs are usually prescribed as monotherapy and by generic name and not as fixed dose combination. Awareness about off-label use of ADEs is essential for its appropriate use.


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The pattern of adverse drug events to antiepileptic drugs: A cross-sectional study at a tertiary care teaching hospital

2016-08-13T12-17-30Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Bharat M Gajjar, Amit M Shah, Pragna M Patel.
Background: The goal of antiepileptic therapy is to achieve complete seizure control with minimum adverse effects impacting negatively on the quality of life. The drugs available in the market for the treatment of epilepsy have their own new and unique adverse drug reaction profile. Aims and Objective: To study the pattern of adverse drug events (ADEs) to antiepileptic drugs (AEDs) in a tertiary care teaching rural hospital in India. Materials and Methods: Data of all the patients visited the Outpatient Department of Neuromedicine, Neurosurgery, and Paediatric Department of the Shree Krishna Hospital in the study duration and who received AEDs as treatment, irrespective of diagnosis, age or sex were collected after obtaining written informed consent from the patients. All the adverse events reported spontaneously as well as founded by researcher during the interview at each visit were recorded in the case record form with all necessary information. Results: Total 112 ADEs were reported from 58 (36.25%) patients in 6-month follow-up. Central nervous system was most frequently affected with 68 (60.71%) ADEs followed by the gastrointestinal system (68, 60.71%). Phenytoin was most commonly suspected AEDs (with 39 cases) followed by carbamazepine (in 23 cases). Causality assessment by the WHO-UMC criteria most common association was possible in 75 (66.96%) cases, probable 21 (18.75%), certain 6 (5.36%), and conditional/unclassified 10 (8.93%). Similar result was obtained by Naranjos criteria as possible 84 (75.00%), probable 22 (19.64%), and definite 6 (5.36%). 91 (80.36%) ADEs were not preventable by modified Schumock and Thornton scale. Severity assessment by Hartwigs criteria showed 79 (70.53%) ADEs as mild. Number of AEDs given per patient had a statistical correlation with ADEs. Conclusions: There are higher chances of development of ADEs in patients taking AEDs. However, at individualized regimens, the burden of ADEs is likely to be related more to individual responsiveness, type of AEDs/AED combinations chosen, and physician treatment skills, intensive therapeutic surveillance, education about epilepsy and the importance of drug compliance, and psychosocial interventions.


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Evaluation of perceived stress in bus drivers of Pune city

2016-08-13T12-17-30Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Anuradha Rajiv Joshi, Savita Madhukar Vaidya.
Background: Occupational stress has an aversive affect on individuals and organizations. Stress leads to physical and mental ill-health. Bus driving is a classic example of high-strain occupation. In a metropolitan city like Pune, drivers have responsibility to overcome traffic congestion and to get passengers safely and comfortably in scheduled time to the desired destination. Stress in bus drivers leads to absenteeism, substance abuse, decreased productivity, and increased accident rates. Stress detection will help in taking measures for stress reduction. Thus, this study was planned to assess perceived stress in Pune Mahanagar Parivahan Mahamandal Ltd (PMPML) bus drivers of Pune city. Aims and Objectives: To study and compare perceived stress score using Perceived Stress Scale (PSS) in PMPML bus drivers and office staff. Materials and Methods: This was a cross-sectional observational study. Study group (n = 130) included PMPML bus drivers and control group (n = 130) included volunteers from office staff of general population. In both the groups, PSS score was estimated with the help of PSS questionnaire. Data were analyzed by Students t-test. Results: Statistically significant increase in PSS score was observed in the study group. Conclusions: It is evident from the study that PSS score was very high in bus drivers as compared to office staff. This indicates that bus driving is a tremendously stressful job, and effective measures should be taken to reduce stress in bus drivers.


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Protective effects of the roots of Angelica sinensis on strenuous exercise-induced sports anemia in rats

Publication date: 4 December 2016
Source:Journal of Ethnopharmacology, Volume 193
Author(s): Chih-Wei Chang, Yi-Ming Chen, Yi-Ju Hsu, Chi-Chang Huang, Yu-Tse Wu, Mei-Chich Hsu
Ethnopharmacological relevanceSports anemia is a persistent and severe problem in athletes owing to strenuous exercise-induced oxidative stress and hepcidin upregulation. The roots of Angelica sinensis (AS), a familiar traditional Chinese medicine, has been used for replenishing blood since antiquity.Aim of the studyTo evaluate the effects of ethanolic AS extract in a 4-week study on sports anemia in female Wistar rats.Materials and methodsTo induce anemia, a strenuous exercise protocol consisting of running and swimming was employed with increasing intensity. Animals were randomly assigned to the following groups: control group; strenuous exercise group; and strenuous exercise and AS extract-treated group (300mgkg⁻¹d⁻¹). After 4 weeks, rats underwent exhaustive swimming and forelimb grip strength test. The blood biochemical markers and hepatic antioxidant activities were determined. Hepatic interleukin-6 and muscle glycogen were observed through immunohistochemical and Periodic acid–Schiff staining, respectively.ResultsAS extract (consisting of ferulic acid, Z-ligustilide, and n-butylidenephthalide) treatment improved forelimb grip strength and rescued exercise-induced anemia by significantly elevating the red blood cell counts and hemoglobin concentrations as well as hematocrit levels (p<0.05). AS modulated the iron metabolism through decreasing serum hepcidin-25 concentrations by 33.0% (p<0.05) and increasing serum iron levels by 34.3% (p<0.01). The hepatic injury marker serum alanine aminotransferase concentrations were also reduced, followed by increased antioxidant enzyme catalase expression in the liver (p<0.05). Furthermore, substantial attenuation of hepatic interleukin-6 expression and preservation of muscle glycogen content suggested the additional roles of AS acting on sports anemia and physical performance.ConclusionOur findings evidenced a novel and promising therapeutic approach for AS treatment for rescuing the anemic condition induced following 4 weeks of strenuous exercise.

Graphical abstract

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Use of plants in oral health care by the population of Mahajanga, Madagascar

Publication date: 4 December 2016
Source:Journal of Ethnopharmacology, Volume 193
Author(s): Lala Nirina Ranjarisoa, Noëline Razanamihaja, Herintsoa Rafatro
BackgroundThe use of medicinal plants to address oral health problems is not well documented in Madagascar, yet the country is full of endemic flora. The aim of this study was to collect information on the use of plants in the region of Mahajanga, Madagascar, for the treatments of oral diseases mainly tooth decay.MethodsThe ethnobotanical survey with respect to the use of plants for curing dental problems was carried out in 2012. A cluster sampling at three levels was applied when choosing the study sites. The target population was made up of heads of household. The following data were collected from a semi-structured questionnaire: name of plants, part used, mode of preparation, and administration. The Informant Consensus Factor and Fidelity Level indexes were calculated for each condition treated and used plants.The Results revealed that 93 per cent of the targeted population has used plants to calm dental pain, whereas 44.2% have reported using plants due to financial problems. About 65 species of plants are commonly used for oral health care and 63 of them treated caries. Cajanus cajan (L.) Millsp. was the most plant used. It was mostly used in crushed form of 5 to 9 leaves which were prepared and placed directly on the affected oral part or in the tooth cavity. In general, the treatment lasted about 5 days or minus. The ICF were 0.83 for caries and 0.81 for periodontal diseases.ConclusionThis ethnobotanical survey will serve as database for further phytochemical and pharmacological study of plants in order to identify their active components and advise the population on the most effective administration.

Graphical abstract

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A flexible mixed-signal image processing pipeline using 3D chip stacks

Abstract

This work presents a highly flexible mixed-signal CMOS image sensor suitable for smart camera applications. These systems need to fit different constraints regarding power consumption, speed and quality, and the optimal compromise may differ depending on the application. Moreover, the best implementation of a desired image processing task may be in the analog or the digital domain, or even a combined computation. Different aspects starting from the image sensor and signal acquisition up to the pre-processing in analog and digital domain are investigated in this paper to optimize not just one part of the system, but the whole system altogether. Moreover, it is shown that analog processing algorithms can improve signal quality, processing speed and latency while being able to save power, which is important for real-time systems. In order to be able to carry out spatial operations, the state-of-the-art sensor is modified to be able to read out multiple pixels at the same time. This allows analog spatial filter operations which consume significantly less power. As an example, an averaging filter is described which needs less than 5.3 % of the power–time product of a digital implementation for one computation. To enhance data throughput and flexibility, 3D chip stacking is proposed to partition the sensor in smaller units and enable massively parallel processing.

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Reconstitution of Basic Mitotic Spindles in Spherical Emulsion Droplets

The assembly and positioning of the mitotic spindle depend on the combined forces generated by microtubule dynamics, motor proteins and cross-linkers. Here we present our recently developed methods in which the geometrical confinement of spherical emulsion droplets is used for the bottom-up reconstitution of basic mitotic spindles.

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Radiothérapie des cancers des cavités nasosinusiennes

Publication date: Available online 12 August 2016
Source:Cancer/Radiothérapie
Author(s): G. Peyraga, C. Lafond, Y. Pointreau, P. Giraud, P. Maingon
Les tumeurs nasosinusiennes sont rares (10 % des tumeurs de la tête et du cou) et sont principalement représentées par les carcinomes épidermoïdes des fosses nasales ou du sinus maxillaire et les adénocarcinomes de l'ethmoïde (maladie professionnelle, poussière de bois). Le signe clinique le plus fréquent est l'obstruction nasale, mais on peut aussi retrouver une rhinorrhée et/ou une épistaxis (signes à présentation le plus souvent unilatérale). Une imagerie par résonance magnétique du massif facial est systématique dans le bilan initial avant traitement. La prise en charge consiste en une chirurgie première si le patient est opérable et la tumeur résécable. Si ce n'est pas le cas, le traitement consiste en une radiothérapie associée à une chimiothérapie, en fonction des données initiales (stade T3/T4 ou atteinte ganglionnaire). Après chirurgie première, une radiothérapie est indiquée (sauf si stade T1N0 avec résection complète), associée à une chimiothérapie en fonction des données postopératoires (rupture capsulaire ou résection incomplète). Une irradiation ganglionnaire est à discuter au cas par cas, mais est indiquée devant tout envahissement ganglionnaire. La radiothérapie doit être délivrée avec modulation d'intensité (RCMI), statique ou dynamique, et guidée par l'imagerie (IGRT). Selon le rapport 83 de l'International Commission on Radiation Units and Measurements (ICRU), les doses reçues par les organes à risque et les volumes cibles doivent être rapportées. Enfin, après une imagerie de référence post-thérapeutique entre 2 et 4 mois, le suivi est alterné avec le chirurgien ORL tous les 2 à 3 mois pendant 2ans, puis tous les 4 à 6 mois pour 5ans au minimum.The nasal cavity and parasinusal cancer are rare (10% of tumors of the head and neck) and are mainly represented by squamous cell carcinoma of the nasal cavity or the maxillary sinus and adenocarcinoma of the ethmoid sinus (occupational disease, wood dust). The most common clinical sign is nasal obstruction, but tumors can also manifest as rhinorrhea and/or epistaxis (usually unilateral signs). A magnetic resonance imaging of the facial structure is systematic for staging before treatment. The treatment consists of a first surgery if the patient is operable with a resectable tumor. If it is not the case, the treatment consists of radiotherapy (RT) associated with chemotherapy (CT) according to the initial data (T3/T4 or N+). After first surgery, RT is indicated (except T1N0 with complete resection) associated with a CT based on postoperative data (capsular effraction or incomplete resection). Lymph node irradiation is considered case by case, but is indicated in any nodal involvement. RT must be an intensity modulated RT (IMRT), static or dynamic, and must be imagery guided (IGRT). According to ICRU 83, doses to organs at risk and target volumes must be carried. Finally, after a post-treatment baseline imaging between 2 and 4 months, monitoring will be alternated with the ENT surgeon every 2 or 3 months for 2 years, then every 4 to 6 months for 5 years.



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