Four key challenges to the design of blended learning: A systematic literature review

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The Distribution of Two-Phase R32 Over an Impacting T-Junction

This experimental work studies the distribution of a two-phase refrigerant flow over a horizontal impacting T-junction. A setup was built which consists of two parts: a flow conditioner and a test section. The flow conditioner creates a two-phase mixtures (R32) at a saturation temperature between 10 °C and 20 °C with a mass flux of 150 to 700 kg/(m².s) and a vapour quality between 0 and 1. In the test section, the two-phase flow is distributed over two identical parallel sections using an impacting T-junction. The backpressure and heat input of each parallel section can be regulated. The mass flow rates and vapour qualities are measured before and after the T-junction. Further, the pressure gradient over the T-junction is measured. Also the void fraction before the T-junction is determined using a capacitive void fraction sensor. Using design of experiments, the main effects of superficial vapour velocity, superficial liquid velocity and saturation pressure on the distribution of R32 were studied. For R32, the two phases only distribute uniformly over the T-junction when the mass flow rate through the two outlet branches is equal. Furthermore, the experiments show a decreased tendency of the liquid to exit through the outlet with the lowest mass flow rate with increasing superficial vapour velocity. The opposite is noticed with an increased superficial liquid velocity at a high superficial vapour velocity. Finally, no effect of the saturation pressure was found. The obtained results were then compared with the results of water-air mixtures found in literature.

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A hairy port-wine stain with overlying hyperhidrosis on the thigh of a child

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Expression of monoacylglycerol lipase as a marker of tumour invasion and progression in malignant melanoma

Abstract

Background

Accumulating evidence suggests that the lipid lytic enzyme monoacylglycerol lipase (MAGL) promotes tumour invasion and metastasis through up-regulation of pro-tumourigenic signalling lipids in several tumour cell lines. However, the expression status of MAGL in clinical melanoma tissues and its clinico-pathological significance remain unclear.

Objective

To correlate the tumour expression status of MAGL with the clinico-pathological information of patients with malignant melanoma.

Methods

Polymerase chain reaction (PCR) array screening was performed, and the results were validated using immunocytochemical analysis of tumour and non-tumour melanocytic cell lines. Immunohistochemical staining for MAGL was performed for 74 melanoma samples, including 48 primary and 26 metastatic tumours, in which the expression of MAGL was determined by evaluating the percentage of MAGL-positive tumour cells and the MAGL staining intensity. Finally, we analysed the association of MAGL expression status with tumour progression, tumour thickness and vascular invasion of the primary lesion.

Results

Immunocytochemical analysis revealed that MAGL was expressed in all 12 melanoma cell lines, but not in normal human epidermal melanocytes. In the immunohistochemical analysis, positive staining for MAGL was noted in 32 of 48 (64.5%) primary lesions, 14 of 17 (82.4%) lymph node metastatic lesions and 7 of 9 (77.8%) skin metastatic lesions. Metastatic tumours had a significantly higher staining intensity (p=0.033 for lymph node, p=0.010 for skin). In the analysis of primary lesions, higher MAGL expression correlated with greater tumour thickness (p=0.015) and the presence of vascular invasion (p=0.017). On further evaluation of MAGL-positive primary lesions staining intensity of MAGL tended to be higher in deeper areas of the tumour mass.

Conclusions

The expression of MAGL in tumour cells reflects the aggressiveness of melanoma cells and may serve as a marker of tumour progression.

This article is protected by copyright. All rights reserved.

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Tumescent local anaesthesia for early dermatosurgery in infants

Abstract

Background

Early paediatric dermatosurgery reveals excellent cosmetic results due to high skin-elasticity and pronounced capacity to recover from trauma. Furthermore, the size of skin lesions increases during life proportionally to skin growth and therefore early removal is of major importance. Selected local anaesthetics like prilocaine can cause methaemoglobinemia. However, in contrast to general anaesthesia many other local anaesthetics do not bare any major risks for infants.

Objective

In this retrospective study, we analysed infants aged less than 7 months receiving tumescent local anaesthesia (TLA) followed by dermatosurgery at our department between 2005 and 2015. The analysis is mainly based on our records. Additional information for a subset of patients was gained by a postoperative survey.

Methods

92 infants (39 male, 53 female) with a median age of 4.2 months (range: 1.5 months; 6.7 months) were included in this study. Additional postoperative information was available for 33 of the 92 studied patients (35%).

Results

Infants were mainly operated for removal of a melanocytic nevus (n=54), followed by haemangioma (n=23), nevus sebaceous (n=6) and other lesions (n=9). The lesions were located on the scalp or neck (n=31), on the extremities (n=31), on the trunk (n=21), in the face (n=6) or on the buttocks (n=3). The median size of excision was 509mm² (range: 16mm²; 3600mm²). Primary defect closure was performed by intracutaneous (n=68) or extracutaneous (n=24) suture techniques. No side effects of local anaesthesia were observed in any patient. Postoperative complications include pain (1/33; 3%), wound healing disorder (1/33; 3%) and visible severe scarring (2/33; 6%).

Conclusions

The combination of TLA and dermatosurgery in infants is a suitable outpatient treatment option for small lesions without any major risks or side effects and the benefit of prolonged postoperative analgesia.

This article is protected by copyright. All rights reserved.

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A potential contribution of psoriasin to vascular and epithelial abnormalities and inflammation in systemic sclerosis

Abstract

Background

Antimicrobial peptides have attracted much attention as a member of disease-associated molecules in systemic sclerosis (SSc), which is pathologically characterized by immune abnormalities, vasculopathy, and tissue fibrosis.

Objective

To investigate the potential contribution of one of the anitimicrobial peptides psoriasin to the development of SSc.

Methods

Psoriasin expression in the skin samples and sera derived from SSc patients and its correlation with clinical parameters were analyzed. Psoriasin expression was evaluated by immunohistochemistry with skin samples from SSc patients and healthy controls. Serum levels of psoriasin were determined by enzyme-linked immunosorbent assay in 51 SSc patients and 19 healthy controls and assessed for the association with clinical symptoms.

Results

The expression of psoriasin was elevated in the epidermis of SSc lesional skin. Serum psoriasin levels were higher in SSc patients, especially in diffuse cutaneous SSc patients with disease duration of <6 years, than in healthy controls. With respect to clinical association, SSc patients with interstitial lung disease, telangiectasia, and pitting scars had significantly augmented levels of serum psoriasin than those without each of these symptoms. In the subgroup of patients with interstitial lung disease, the elevation of serum psoriasin levels was associated with higher ground-glass opacity scores. Furthermore, serum psoriasin levels were decreased after the treatment with intravenous cyclophosphamide pulse as compared to baseline values.

Conclusion

Our findings indicate a possible contribution of psoriasin to the development of clinical symptoms associated with vascular and epithelial abnormalities and inflammation in SSc, further supporting the roles of antimicrobial peptides in the SSc pathogenesis.

This article is protected by copyright. All rights reserved.

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Depression and Suicidality in Psoriasis: Review of the Literature Including the Cytokine Theory of Depression

Abstract

Psoriasis can be a socially isolating disease due to debilitating physical symptoms and the stigma patients feel because of the appearance of their skin. Mental health comorbidities such as anxiety, depression, and suicidal ideation and behavior (SIB) are prevalent in patients with psoriasis. Patients with mild psoriasis can experience psychiatric comorbidities; however, disorders such as depression and SIB are more common in patients with severe psoriasis or psoriatic arthritis. Psychiatric disorders can both result from and contribute to progression of psoriasis, suggesting that psoriasis and psychiatric conditions, such as depression, may have overlapping biological mechanisms. Proinflammatory cytokines such as interleukin (IL) 1 and IL-6 are elevated in both psoriasis and depression, indicating that the inflammatory process may be involved in the progression of both diseases. Elevated cytokine levels in the central nervous system cause physiologic and biochemical changes that may contribute to the development of depression. In this review of the literature, we discuss the evidence that supports the association of psoriasis with mental health disorders and the tools used to detect the presence of these comorbidities. Additionally, we review the most prominent hypotheses on the mechanisms by which the inflammatory response and elevated cytokines can cause depression. These results highlight the role that systemic inflammation plays in the various mental health comorbidities associated with psoriasis, including depression and SIB.

This article is protected by copyright. All rights reserved.

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Association of atopy and tentative diagnosis of skin cancer - results from occupational skin cancer screenings

Abstract

Background

The relationship between atopic conditions and carcinoma of the skin has been described inconsistently. Population-based data providing information on atopic diseases as well as on skin-cancer are sparse.

Objective

To determine the correlation between atopy and prevalence of precanceroses, nonmelanoma skin-cancer and malignant melanoma (MM), while taking into account known risk factors for skin cancer.

Methods

Data from occupational skin cancer screenings were analysed in a cross-sectional study. Dermatologists performed whole body examinations and collected medical histories. Subjects comprised all employees (16 to 70 years) examined from 2006 to 2014. 'Atopy' was defined by clinical screening diagnosis and/or by participant-reported, pre-existing atopic dermatitis, allergic asthma or other specified allergies confirmed by a physician. Tentative screening diagnoses of skin cancer related to actinic keratosis, basal cell carcinoma and malignant melanoma.

Results

The study cohort comprised 90,265 employees (mean age 43 ± 11 years, 58.5% male), 30.7% of whom were ever diagnosed with an atopic disease. Persons with atopic conditions recorded in their medical history and at the time of screening had a significantly lower prevalence of actinic keratosis (AK), basal cell carcinoma (BCC) and MM. After controlling for age, sex and relevant risk factors (skin type, childhood sun burns), atopy remained significantly protective against BCC (OR 0.77) and MM (OR 0.53).

Conclusion

Design limitations of the study include that all findings of skin cancer were based on clinical examination only and must therefore be considered tentative diagnoses. Furthermore, owing to the cross-sectional study design, causal pathways cannot be proven. However, analyses of data from such a large and general population-based cohort afford valuable insights into the relationship of atopic diseases and skin cancer. They provide the grounds for prospective cohort studies to evaluate and dissect the underlying mechanism.

This article is protected by copyright. All rights reserved.

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Infatile hemangiomas with minimal or arrested growth associated with soft tissue hypertrophy: a case series of 10 patients

Abstract

Background

Infantile hemangiomas with minimal or arrested growth (IH-MAGs) are characterized by a proliferative component of less than 25% of its surface area. The co-occurrence of IH-MAGs and soft tissue anomalies is rare and case series of this association are lacking.

Objective

We present ten cases of IH-MAGs associated with soft tissue hypertrophy and describe their clinical features.

Methods

We reviewed all infantile hemangiomas with minimal or arrested growth seen between 2009 to 2016 in the dermatology clinic department at Hospital Santa Creu i Sant Pau, Barcelona. To collect more patients, we also requested cases from the Hemangioma Investigator Group and members of the Spanish Society of Vascular Anomalies.

Results

Ten patients had IH-MAGs associated with soft tissue hypertrophy; seven involving the arm and three involving the leg. All displayed a segmental pattern, a doughy and puffy texture, and prominent surface veins. No significant asymmetries in limbs and no other visceral anomalies were observed at follow-up (range 15 months to 7 years). One patient reported coldness in the limb with infantile hemangioma, but RMI-angiography did not disclose a vascular malformation underneath the lesion. Ulceration was observed in three patients. The proliferative component in all IH -MAGs had faded at one-year follow-up, while soft tissue hypertrophy and prominent vessels remained unchanged.

Conclusions

In this first case series of IH-MAGS associated with soft tissue hypertrophy Soft tissue hypertrophy was not progressive and remained unchanged over time, unlike the proliferative component of classic infantile hemangioma. The origin of the prominent vessels and the higher ulceration risk are unknown; however, these findings are probably related to a minor disruption of local vessels not detected in imaging tests.

This article is protected by copyright. All rights reserved.

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Noonan syndrome with multiple lentigines with PTPN11 (T468M) gene mutation accompanied with solitary granular cell tumor

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Amenamevir, a novel helicase–primase inhibitor, for treatment of herpes zoster: A randomized, double-blind, valaciclovir-controlled phase 3 study

Abstract

Amenamevir is a potent helicase–primase inhibitor and a novel class of antiviral agent other than nucleoside compounds, such as aciclovir, valaciclovir and famciclovir. This study is the first randomized, double-blind, valaciclovir-controlled phase 3 study to evaluate the efficacy and safety of amenamevir in Japanese patients with herpes zoster when treated within 72 h after onset of rash. A total of 751 patients were randomly assigned to receive either amenamevir 400 mg or 200 mg p.o. once daily or valaciclovir 1000 mg three times daily (daily dose, 3000 mg) for 7 days. The primary efficacy end-point was the proportion of cessation of new lesion formation by day 4 ("day 4 cessation proportion"). The day 4 cessation proportions for amenamevir 400 and 200 mg and valaciclovir were 81.1% (197/243), 69.6% (172/247) and 75.1% (184/245), respectively. Non-inferiority of amenamevir 400 mg to valaciclovir was confirmed by a closed testing procedure. Days to cessation of new lesion formation, complete crusting, healing, pain resolution and virus disappearance were evaluated as secondary end-points. No significant differences were observed in any of the treatment groups. Amenamevir 400 and 200 mg were well tolerated as well as valaciclovir. The proportions of patients who experienced drug-related adverse events were 10.0% (25/249), 10.7% (27/252) and 12.0% (30/249) with amenamevir 400 and 200 mg and valaciclovir, respectively. In conclusion, amenamevir 400 mg appears to be effective and well tolerated for treatment of herpes zoster in immunocompetent Japanese patients.

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Alopecia developed in a transitional case from pemphigus foliaceus to pemphigus vulgaris

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Teachers and their implementation of differentiated instruction in the classroom

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Spiny keratoderma: case series and review

Abstract

Background

Spiny keratoderma is a rare, possibly under-reported, condition characterized by discrete keratotic plugs arising from the palms, soles, or both. It has been associated with malignancies though there is debate as to whether spiny keratoderma is a true paraneoplastic phenomenon. It has also been linked to a variety of non-neoplastic conditions, and several cases appear to be familial.

Methods

We describe two additional cases of this rare entity and review the literature.

Results

Thirty-seven cases of spiny keratoderma, including ours, have been reported in the literature. Average age at presentation was 63 years. Earliest age of onset was 11 months. A variety of ethnicities were represented. Ten cases were associated with malignancies. Six cases appeared to be inherited in an autosomal dominant fashion. Several cases were reported in healthy individuals as an incidental finding though it is possible that an associated malignancy or systemic disease will declare itself with time.

Treatment is generally unsatisfying with keratotic spines often recurring on cessation. Interestingly, in some patients, the spines resolve after treatment of an underlying malignancy.

Conclusions

This small case series provides an opportunity to revisit the fascinating phenomena of spiny keratoderma, its possible associations, and implications for follow-up. Due to the association with cancer, all patients presenting with spiny keratoderma should undergo baseline age-appropriate malignancy screening, thence 1-2 times yearly, or as symptoms arise.

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Leprosy: an enigmatic disease

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Antineoplastic therapy-associated flagellate dermatoses

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Adolescent girl with frizzy hair knotted in a bundle

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Role of oxidative stress in melasma: a prospective study on serum and blood markers of oxidative stress in melasma patients

Abstract

Background

Melasma is a common pigmentary disorder presenting in the dermatological clinic. Many factors have been implicated in the pathogenesis, however, the cause still remains elusive. Recently the effect of oxidative damage has been proposed in the etiopathogenesis of melasma. This study was undertaken to evaluate the role of oxidative stress in patients with melasma.

Material and methods

Fifty patients with melasma, age 18 years of age and older, and an equal number of age and sex-matched controls were included in the study. Baseline severity assessment using the modified Melasma Area and Severity Index (modified MASI score) was done in all patients. Serum malondialdehyde, blood superoxide dismutase, and blood glutathione peroxidase levels were measured in cases and controls group and results were compared.

Result

The serum levels of malondialdehyde, superoxide dismutase, and blood glutathione were significantly higher among the cases compared to controls. The difference in the serum concentrations was significant between the two groups (P < 0.01). A positive correlation was found between these enzyme levels and severity of melasma (modified MASI score); however, this correlation was statistically significant with serum malondialdehyde only. The level of oxidative stress among the male and female melasma patients was not statistically different.

Conclusion

Oxidative stress was found to be increased in cases of melasma compared to the control group in this study. This substantiates the role of oxidative stress in etiopathogenesis of melasma; however, further studies are required to reach a definitive conclusion.

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Safety and pharmacodynamics of intranasal GSK2245035, a TLR7 agonist for allergic rhinitis: a randomized trial

Abstract

Background

Toll-like receptor 7 (TLR7) stimulation in the airways may reduce responses to aeroallergens by induction of type 1 interferons (IFNs). GSK2245035 is a novel selective TLR7 agonist in pharmaceutical development.

Objective

Assessment of safety, pharmacodynamics and nasal allergic reactivity following repeated weekly intranasal (i.n.) GSK2245035.

Methods

This randomized, double-blind, placebo-controlled study (TL7116958) was conducted over two pollen seasons (2013–2014) and follow-up study (204509) conducted one year later. Participants with allergic rhinitis (n=42) were randomized to receive eight weekly doses of i.n. GSK2245035 (20 ng [2014 Cohort; n=14] or 80 ng [2013 Cohort; n=14]) or placebo (n=14). Adverse events (AEs), including cytokine release syndrome-AEs (CytoRS-AEs) and nasal symptoms were assessed. Nasal and serum IFN-inducible protein 10 (IP-10) were measured after doses 1 and 8, then 1 (follow-up visit [FUV] 1) and 3 (FUV2) weeks after final dose. Nasal allergen challenges (NAC) and allergic biomarkers assessment (nasal, serum) were conducted at baseline, FUV1, FUV2 and at a follow-up visit 1-year post final dose (FUV3; 2014 Cohort only). A Bayesian framework enabled probability statements for mean effect sizes.

Results

GSK2245035 induced CytoRS-AEs (most commonly headache, median duration <1 day) in 93% of participants at 80 ng, while AE incidence at 20 ng was similar to placebo. There was no evidence of nasal inflammation. Dose-related increases in nasal and serum IP-10 were observed 24h after doses 1 and 8 (>95% certainty). Both doses showed a trend in reducing Total Nasal Symptom Score 15 minutes post NAC at FUV1 and FUV2 but there was no reduction evident at FUV3. Nasal levels of selected allergic biomarkers demonstrated trends for reductions at FUV1, FUV2 and FUV3.

Conclusions and clinical relevance

Weekly i.n. GSK2245035 20 ng was well-tolerated and reduced allergic reactivity to nasal challenge for 3 weeks post treatment.

Clinicaltrials. gov identifiers

NCT01788813/NCT02446613

GSK identifiers

TL7116958/204509

This article is protected by copyright. All rights reserved.

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Histopathological investigation of intranodular echogenic foci detected by thyroid ultrasonography

To determine the predictability of sonography for detection of calcifications in thyroid nodules by histopathologic examination and to demonstrate the association between calcification pattern and malignancy.

http://ift.tt/2us0UtG

Metastatic squamous cell carcinoma to the superior cervical ganglion mimicking a retropharyngeal lymph node

Metastasis of squamous cell carcinoma (SCC) to the superior cervical ganglion (SCG) has never been reported. Its anatomic location may easily be mistaken for a retropharyngeal lymph node. We present the first case of SCC metastasis to the SCG.

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The contemporary utility of intraoperative frozen sections in thyroid surgery

To determine the accuracy of intraoperative frozen section analysis on thyroidectomy specimens stratified by the Bethesda classification scheme and its utility for intraoperative decision-making.

http://ift.tt/2usdf0G

Japanese standard for clinical stabilometry assessment: Current status and future directions

Stabilometry is a useful tool for examining patients with functional disorders of the vestibular system. However, measurement techniques and devices vary by country. Therefore, international standardization of stabilometry is mandatory to validate the exchange of important findings. This was advocated at the 1983 Posturography Meeting in Kyoto but has not been adopted worldwide, and each country has continued to use unique regional measurement methods. In Japan, stabilometry has widespread application in medical practice in conjunction with research into its applications.

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Japanese standard for clinical stabilometry assessment: Current status and future directions

Publication date: Available online 5 July 2017
Source:Auris Nasus Larynx
Author(s): Masahiko Yamamoto, Kazuo Ishikawa, Mitsuhiro Aoki, Keisuke Mizuta, Yatsuji Ito, Masatsugu Asai, Hideo Shojaku, Toshiaki Yamanaka, Chisato Fujimoto, Toshihisa Murofushi, Tomoe Yoshida
Stabilometry is a useful tool for examining patients with functional disorders of the vestibular system. However, measurement techniques and devices vary by country. Therefore, international standardization of stabilometry is mandatory to validate the exchange of important findings. This was advocated at the 1983 Posturography Meeting in Kyoto but has not been adopted worldwide, and each country has continued to use unique regional measurement methods. In Japan, stabilometry has widespread application in medical practice in conjunction with research into its applications. With a goal of international standardization, we present details of stabilometry measurement methods and their application in Japan, together with a brief history and potential future directions of stabilometry.



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The contemporary utility of intraoperative frozen sections in thyroid surgery

Publication date: Available online 5 July 2017
Source:American Journal of Otolaryngology
Author(s): Samuel J. Trosman, Rohith Bhargavan, Brandon L. Prendes, Brian B. Burkey, Joseph Scharpf
PurposeTo determine the accuracy of intraoperative frozen section analysis on thyroidectomy specimens stratified by the Bethesda classification scheme and its utility for intraoperative decision-making.Study designRetrospective chart review.MethodsA retrospective review was performed on all patients who underwent thyroidectomy or thyroid lobectomy with intraoperative frozen sections at a tertiary care academic center from 2009 to 2015.ResultsThere were 74 total patients who underwent partial or total thyroidectomy with intraoperative frozen section analysis of a thyroid nodule whom had previously undergone a thyroid fine needle aspiration of the nodule. The sensitivity, specificity, positive predictive value, and negative predictive value for a thyroid frozen section with respect to its prediction for malignancy was 81%, 95%, 98%, and 66%, respectively, with a diagnostic accuracy of 85%. For 37 patients with an indeterminate cytologic diagnosis on fine needle aspiration (Bethesda categories III–V), the sensitivity, specificity, positive predictive value, and negative predictive value for a thyroid frozen section was 81%, 91%, 95%, and 67%, respectively, with a diagnostic accuracy of 84%. False positives and false negatives resulted in 1 completion thyroidectomy for benign pathology and 3 reoperations for malignancy not discovered on frozen section.ConclusionWhile intraoperative frozen sections on thyroid specimens may be helpful if positive, the false negative rate remains high. There appears to be limited value in routine frozen sections to guide clinical management and decision-making in the era of the Bethesda system.



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Metastatic squamous cell carcinoma to the superior cervical ganglion mimicking a retropharyngeal lymph node

Publication date: Available online 5 July 2017
Source:American Journal of Otolaryngology
Author(s): Sami P. Moubayed, Rosalie Machado, Marcela Osorio, Azita Khorsandi, Juan Hernandez-Prera, Mark L. Urken
BackgroundMetastasis of squamous cell carcinoma (SCC) to the superior cervical ganglion (SCG) has never been reported. Its anatomic location may easily be mistaken for a retropharyngeal lymph node. We present the first case of SCC metastasis to the SCG.MethodsWe report a case of a 69year-old never smoking male, who presented with right retropharyngeal PETCT-avid disease following chemoradiation for squamous cell carcinoma of the tonsil. He was brought to the operating room for resection, intraoperative radiation and reconstruction.ResultsIntraoperatively, visualization and frozen section confirmed squamous cell carcinoma located in the superior cervical ganglion. The ganglion was resected, intraoperative radiation was given and the patient was reconstructed with a radial forearm free flap. Postoperatively, the patient displayed features of a Horner's syndrome.ConclusionsThe superior cervical ganglion may be mistaken for a retropharyngeal lymph node. Although extremely rare, these entities may be differentiated on the basis of radiological studies.



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Histopathological investigation of intranodular echogenic foci detected by thyroid ultrasonography

Publication date: Available online 5 July 2017
Source:American Journal of Otolaryngology
Author(s): Bilici Suat, Yiğit Özgür, Onur Fırat, Hamit Bahtiyar, Nazlı Mehmet Ali, Günver Feray, Karagöz Yeşim
ObjectiveTo determine the predictability of sonography for detection of calcifications in thyroid nodules by histopathologic examination and to demonstrate the association between calcification pattern and malignancy.MethodsWe prospectively evaluated 81 dominant nodules from 81 patients. Thyroid glands were assessed preoperatively with thyroid ultrasonography, and the presence of sonographic calcification was specified as intranodular coarse and micro calcification. Micro and coarse calcification in surgery specimens were specified postoperatively as present or absent in the histopathological evaluation. The correlation between sonographic and histopathologic calcifications and the relationship between malignancy and calcification patterns were determined.ResultsCalcification was detected histopathologically in 66.7% of the sonographically calcified nodules and in 12.8% of the sonographically noncalcified nodules. The sensitivity and specificity of sonography for detecting histopathologic calcification were 84.8 and 70.8%, respectively, while positive and negative predictive values were 66.7 and 87.2%, respectively. The sonographical and histopathological outcomes for detection of coarse and micro calcification showed 85 and 50% compatibility, respectively. The difference in malignancy rates between sonographic coarse and micro calcified nodules was not significant (p<0.976). Histopathologic detection of calcification showed no significant difference between malignant and benign nodules (p<0.129).ConclusionHistopathology confirmed a high rate of sonographic macrocalcifications. The micro and macro patterns of sonographic calcification showed no particular association with thyroid malignancy. The preoperative risk of malignancy should be determined in conjunction with other known sonographic risk factors and diagnostic tests.



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Anesthesia for Intestinal Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Christine Nguyen-Buckley, Melissa Wong

Teaser

The diagnosis of irreversible intestinal failure confers significant morbidity, mortality, and decreased quality of life. Patients with irreversible intestinal failure may be treated with intestinal transplantation. Intestinal transplantation may include intestine only, liver–intestine, or other visceral elements. Intestinal transplantation candidates present with systemic manifestations of intestinal failure requiring multidisciplinary evaluation at an intestinal transplantation center. Central access may be difficult in intestinal transplantation candidates. Intestinal transplantation is a complex operation with potential for hemodynamic and metabolic instability. Patient and graft survival are improving, but graft failure remains the most common postoperative complication.


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Anesthesia for Heart Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Davinder Ramsingh, Reed Harvey, Alec Runyon, Michael Benggon

Teaser

This review seeks to evaluate current practices in heart transplantation. The goals of this article were to review current practices for heart transplantation and its anesthesia management. The article reviews current demographics and discusses the current criteria for candidacy for heart transplantation. The process for donor and receipt selection is reviewed. This is followed by a review of mechanical circulatory support devices as they pertain to heart transplantation. The pre-anesthesia and intraoperative considerations are also discussed. Finally, management after transplantation also is reviewed.


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Transplantation Anesthesia: The Role of the Anesthesiologist

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Lee A. Fleisher




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Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Joshua Herborn, Suraj Parulkar

Teaser

As solid organ transplantation increases and patient survival improves, it will become more common for these patients to present for nontransplant surgery. Recipients may present with medical problems unique to the transplant and important considerations are necessary to keep the transplanted organ functioning. A comprehensive preoperative examination with specific focus on graft functioning is required, and the anesthesiologist needs pay close attention to considerations of immunosuppressive regimens, blood product administration, and the risk benefits of invasive monitoring in these immunosuppressed patients. This article reviews the posttransplant physiology and anesthetic considerations for patients after solid organ transplantation.


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Anesthesia and Perioperative Care in Reconstructive Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Raymond M. Planinsic, Jay S. Raval, Vijay S. Gorantla

Teaser

Reconstructive transplantation of vascularized composite allografts (VCAs), such as upper extremity, craniofacial, abdominal, lower extremity, or genitourinary transplants, has emerged as a cutting-edge specialty with more than 50 programs in the United States and 30 programs across the world performing these procedures. Most VCAs involve complicated technical planning and preparation, protracted surgery, and complex immunosuppressive or immunomodulatory protocols, each associated with unique anesthesiology challenges. This article outlines key procedural, patient, and protocol-related aspects of VCA relevant to anesthesiology management with the goal of ensuring patient safety and optimizing surgical, immunologic, and functional outcomes.


http://ift.tt/2uruVtt

Anesthesia for Lung Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Alina Nicoara, John Anderson- Dam

Teaser

Perioperative management of patients undergoing lung transplantation is challenging and requires constant communication among the surgical, anesthesia, perfusion, and nursing teams. Although all aspects of anesthetic management are important, certain intraoperative strategies (mechanical ventilation, fluid management, extracorporeal mechanical support deployment) have tremendous impact on the subsequent evolution of the lung transplant recipient, especially with respect to allograft function and should be carefully considered. This review highlights some of the intraoperative anesthetic challenges and opportunities during lung transplantation.


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Anesthesia Management of Organ Donors

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Victor W. Xia, Michelle Braunfeld

Teaser

The shortage of suitable organs is the biggest obstacle for transplants. At present, most organs for transplant in the United States are from donation after neurologic determination of death (brain death). Potential organs for transplant need to maintain their viability during a series of insults, including the original disease, physiologic derangements during the dying process, ischemia, and reperfusion. Proper donor management before, during, and after procurement has potential to increase the number and quality of organs from donors. Anesthesiologists need to understand the physiologic derangements associated with brain death and the updated donor management during the periprocurement period.


http://ift.tt/2urBQTs

Infectious Complications and Malignancies Arising After Liver Transplantation

Publication date: Available online 5 July 2017
Source:Anesthesiology Clinics
Author(s): Dame W. Idossa, Douglas Alano Simonetto

Teaser

Since the first liver transplant was performed in 1963, great advancements have been made in hepatic transplantation. Surgical techniques have been revised and improved, diagnostic methods for identifying and preventing infections have been developed, and more conservative use of immunosuppressive agents have resulted in better long-term posttransplant outcomes. A total of 7841 liver transplantations were performed in the United States in 2016, resulting in greater than 85% survival at 1 year posttransplant. However, technical surgical complications, infections, rejections, and chronic medical conditions persist. In this review, we discuss the infectious complications and malignancies that may arise after liver transplantation.


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Response to Letter to the Editor: Prevalence of vestibular and balance disorders in children and adolescents according to age category: A multi-center study in Korea

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Jong Dae Lee, Chang-Hee Kim, Seok Min Hong, Sung Huhn Kim, Myung-Whan Suh, Min-Beom Kim, Dae Bo Shim, Hosuk Chu, No Hee Lee, Minbum Kim, Sung Kwang Hong, Jae-Hyun Seo




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Editorial Board

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99





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Letter to the Editor, regarding the article: "Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-centre study" (2017; 94: 36–39)

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Roeland B. van Leeuwen, Elisabeth A. Cats, Tjasse D. Bruintjes




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Letter to the editor regarding ‘Evaluation of vitamin D levels in children with primary epistaxis’

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): M. Volkan Akdoğan, Evren Hızal




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Reconstruction of parotidectomy and lateral skull base defects.

Purpose of review: The purpose of this review is to summarize the options for reconstruction of parotid and lateral skull base defects based on the size and functional requirements of the defect. Recent findings: Free grafts with dermal fat or acellular human dermis, superficial musculoaponeurotic system flaps, and sternocleidomastoid flaps have been successful in preventing Frey's syndrome and restoring facial contour defects after superficial and total parotidectomy. Lateral skull base resections often require reconstruction with pedicled or free flaps to restore extensive soft tissue and dural defects. Supraclavicular artery island flaps and submental flaps have been recently been gaining popularity for use for these purposes. Free tissue transfer remains the best reconstructive option for repair of large soft tissue and/or dural defects. The most reliable free flap for lateral skull base reconstruction is the anterolateral thigh flap, which is highly versatile because of its large skin paddle and potential for harvest with varying amounts of fascial and muscle tissue. Summary: Here we will summarize the most appropriate and widely used reconstructive options for parotid and lateral skull base defects of various sizes, discussing the most recent evidence pertaining to each technique along with advantages and limitations of each reconstructive strategy. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tNWLSM

Hearing health access in developing countries.

Purpose of review: The developing world carries a disproportionate burden of hearing loss. Individuals with hearing loss in austere settings worldwide are also potentially impacted by their impairment to a greater extent owing to underdeveloped or nonexistent hearing health infrastructure. The purpose of this review is to examine the state of the literature on hearing health access in developing countries and identify areas for improvement. Recent findings: Over the last 10 years progress has been made in some areas, whereas other aspects of hearing health in developing countries have changed very little. There has been expansion of efforts to train primary care and local hearing healthcare providers to recognize and appropriately treat preventable causes of hearing loss in the developing world. Applications of telehealth to connect providers and patients in rural locales have grown. Adaptions of newborn hearing screening programs that better fit local resources and customs have been reported. There has been a considerable increase in interest, including cost-benefit analyses, with regard to the use of cochlear implants in the developing world. Summary: In spite of progress, the developing world still shoulders a disproportionate amount of the world's hearing loss, in particular chronic ear disease, and there is a paucity of well trained local hearing healthcare professionals to deal with the challenge. The role of international humanitarian efforts, telemedicine, and education is highlighted. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uLYp4O

Reconstruction of parotidectomy and lateral skull base defects.

Purpose of review: The purpose of this review is to summarize the options for reconstruction of parotid and lateral skull base defects based on the size and functional requirements of the defect. Recent findings: Free grafts with dermal fat or acellular human dermis, superficial musculoaponeurotic system flaps, and sternocleidomastoid flaps have been successful in preventing Frey's syndrome and restoring facial contour defects after superficial and total parotidectomy. Lateral skull base resections often require reconstruction with pedicled or free flaps to restore extensive soft tissue and dural defects. Supraclavicular artery island flaps and submental flaps have been recently been gaining popularity for use for these purposes. Free tissue transfer remains the best reconstructive option for repair of large soft tissue and/or dural defects. The most reliable free flap for lateral skull base reconstruction is the anterolateral thigh flap, which is highly versatile because of its large skin paddle and potential for harvest with varying amounts of fascial and muscle tissue. Summary: Here we will summarize the most appropriate and widely used reconstructive options for parotid and lateral skull base defects of various sizes, discussing the most recent evidence pertaining to each technique along with advantages and limitations of each reconstructive strategy. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tNWLSM

Hearing health access in developing countries.

Purpose of review: The developing world carries a disproportionate burden of hearing loss. Individuals with hearing loss in austere settings worldwide are also potentially impacted by their impairment to a greater extent owing to underdeveloped or nonexistent hearing health infrastructure. The purpose of this review is to examine the state of the literature on hearing health access in developing countries and identify areas for improvement. Recent findings: Over the last 10 years progress has been made in some areas, whereas other aspects of hearing health in developing countries have changed very little. There has been expansion of efforts to train primary care and local hearing healthcare providers to recognize and appropriately treat preventable causes of hearing loss in the developing world. Applications of telehealth to connect providers and patients in rural locales have grown. Adaptions of newborn hearing screening programs that better fit local resources and customs have been reported. There has been a considerable increase in interest, including cost-benefit analyses, with regard to the use of cochlear implants in the developing world. Summary: In spite of progress, the developing world still shoulders a disproportionate amount of the world's hearing loss, in particular chronic ear disease, and there is a paucity of well trained local hearing healthcare professionals to deal with the challenge. The role of international humanitarian efforts, telemedicine, and education is highlighted. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uLYp4O

Breakthrough attacks in patients with hereditary angioedema receiving long-term prophylaxis are responsive to icatibant: findings from the Icatibant Outcome Survey

Patients with hereditary angioedema (HAE) due to C1-inhibitor deficiency (C1-INH-HAE) experience recurrent attacks of cutaneous or submucosal edema that may be frequent and severe; prophylactic treatments can ...

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Echocardiographic Assessment of Mitral Stenosis Orifice Area: A Comparison of a Novel Three-Dimensional Method Versus Conventional Techniques.

BACKGROUND: A comprehensive evaluation of mitral stenosis (MS) severity commonly utilizes two-dimensional (2D) echocardiography techniques. However, the complex three-dimensional (3D) structure of the mitral valve (MV) poses challenges to accurate measurements of its orifice area by 2D imaging modalities. We aimed to assess MS severity by comparing measurements of the MV orifice area using conventional echocardiography methods to 3D orifice area (3DOA), a novel echocardiographic technique which minimizes geometric assumptions. METHODS: Routine 2D and 3D intraoperative transesophageal echocardiographic images from 26 adult cardiac surgery patients with at least moderate rheumatic MS were retrospectively reviewed. Measurements of the MV orifice area obtained by pressure half-time (PHT), proximal isovelocity surface area (PISA), continuity equation, and 3D planimetry were compared to those acquired using 3DOA. RESULTS: MV areas derived by PHT, PISA, continuity equation, 3D planimetry, and 3DOA (mean value +/- standard deviation) were 1.12 +/- 0.27, 1.03 +/- 0.27, 1.16 +/- 0.35, 0.97 +/- 0.25, and 0.76 +/- 0.21 cm2, respectively. Areas obtained from the 3DOA method were significantly smaller than areas derived from PHT (mean difference 0.35 cm2, P

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Tranexamic Acid Does Not Influence Cardioprotection by Ischemic Preconditioning and Remote Ischemic Preconditioning.

Prior studies have suggested that the antifibrinolytic drug aprotinin increases the infarct size after ischemia and reperfusion (I/R) and attenuates the effect of ischemic preconditioning (IPC). Aprotinin was replaced by tranexamic acid (TXA) in clinical practice. Here, we investigated whether TXA influences I/R injury and/or cardioprotection initiated by IPC and/or remote ischemic preconditioning (RIPC). Anesthetized male Wistar rats were randomized to 6 groups. Control animals were not further treated. Administration of TXA was combined with and without IPC and RIPC. Estimated treatment effect was 20%. Compared to control group (56% +/- 11%), IPC reduced infarct size by 46% (30% +/- 6%; mean difference, 26%; 95% confidence interval, 19-33; P

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Reporting of Perioperative Adverse Events by Pediatric Anesthesiologists at a Tertiary Children's Hospital: Targeted Interventions to Increase the Rate of Reporting.

BACKGROUND: Incident reporting systems (IRSs) are important patient safety tools for identifying risks and opportunities for improvement. A major IRS limitation is underreporting of incidents. Perioperative anesthesia IRSs have been established at multiple pediatric institutions and a national pediatric anesthesia IRS for perioperative serious adverse events (SAEs) is maintained by Wake Up Safe (WUS), a patient safety organization dedicated to pediatric anesthesia quality improvement. A confidential, electronic, perioperative IRS was instituted at our tertiary children's hospital, which is a WUS member. The primary study aim was to increase the rate of incident reporting by anesthesiologists at our institution through a series of interventions. The secondary aim was to characterize our reporting behavior relative to national practice by referencing SAE data from WUS. METHODS: Perioperative adverse events reported over a 71-month period (November 2010 to September 2016) were categorized and the monthly reporting rates determined. Effects of 6 interventions targeted to increase the reporting rate were analyzed using control charts. Intervention 5 involved interviewing pediatric anesthesiologists to ascertain incident reporting barriers and motivators. A key driver diagram was developed and used to guide an improvement initiative. Incidents that fulfilled WUS criteria for SAEs were identified and categorized. SAE reporting rates over a 27-month period for 12 WUS member institutions were determined. RESULTS: 2689 perioperative adverse events were noted in 1980 of 72,384 anesthetics. Mean monthly adverse event case rate was 273 (95% confidence interval, 250-297) per 10,000 anesthetics. A subgroup involving 54,469 cases had 529 SAEs in 440 anesthetics; a mean monthly SAE case rate of 80 (95% confidence interval, 69-91) per 10,000 anesthetics. Cardiac, respiratory, and airway events predominated. Relative to WUS peer members, our institution is a high-reporting outlier. The rate of incident reporting per 10,000 anesthetics was sustainably increased from 149 +/- 35 to 387 +/- 73 (mean +/- SD) after implementing mandatory IRS data entry and Intervention 5 quality improvement initiative. Barriers to reporting included concern for punitive repercussions, feelings of incompetence, poor education about what constitutes an event, lack of feedback, and the perception that reporting had no value. These were addressed by IRS education, cultivation of a culture of safety where reporting is encouraged, reporter feedback, and better inclusion of anesthesiologists in patient safety work. CONCLUSIONS: Electronic mandatory IRS data entry and an initiative to understand and address reporting barriers and motivators were associated with sustained increases in the adverse event reporting rate. These strategies to minimize underreporting enhance IRS value for learning and may be generalizable. (C) 2017 International Anesthesia Research Society

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The US Opioid Crisis: A Role for Enhanced Recovery After Surgery.

No abstract available

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Prophylactic Norepinephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery.

BACKGROUND: The use of norepinephrine for maintaining blood pressure (BP) during spinal anesthesia for cesarean delivery has been described recently. However, its administration by titrated manually controlled infusion in this context has not been evaluated. METHODS: In a double-blinded, randomized controlled trial, 110 healthy women having spinal anesthesia for elective cesarean delivery were randomly allocated to 1 of 2 groups. In group 1, patients received an infusion of 5 [mu]g/mL norepinephrine that was started at 30 mL/h (2.5 [mu]g/ min) immediately after intrathecal injection and then manually adjusted within the range 0-60 mL/h (0-5 [mu]g/min), according to values of systolic BP measured noninvasively at 1-minute intervals until delivery, with the objective of maintaining values near baseline. In group 2, no prophylactic vasopressor was given, and a bolus of 1 mL norepinephrine 5 [mu]g/mL (5 [mu]g) was given whenever systolic BP decreased to

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Methodological and Reporting Quality of Systematic Reviews Published in the Highest Ranking Journals in the Field of Pain.

BACKGROUND: Systematic reviews (SRs) are important for making clinical recommendations and guidelines. We analyzed methodological and reporting quality of pain-related SRs published in the top-ranking anesthesiology journals. METHODS: This was a cross-sectional meta-epidemiological study. SRs published from 2005 to 2015 in the first quartile journals within the Journal Citation Reports category Anesthesiology were analyzed based on the Journal Citation Reports impact factor for year 2014. Each SR was assessed by 2 independent authors using Assessment of Multiple Systematic Reviews (AMSTAR) and Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) tools. Total score (median and interquartile range, IQR) on checklists, temporal trends in total score, correlation in total scores between the 2 checklists, and variability of those results between journals were analyzed. RESULTS: A total of 446 SRs were included. Median total score of AMSTAR was 6/11 (IQR: 4-7) and of PRISMA 18.5/27 (IQR: 15-22). High compliance (reported in over 90% SRs) was found in only 1 of 11 AMSTAR and 5 of 27 PRISMA items. Low compliance was found for the majority of AMSTAR and PRISMA individual items. Linear regression indicated that there was no improvement in the methodological and reporting quality of SRs before and after the publication of the 2 checklists (AMSTAR: F(1,8) = 0.22; P = .65, PRISMA: F(1,7) = 0.22; P = .47). Total scores of AMSTAR and PRISMA had positive association (R = 0.71; P

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Patients Undergoing Orthotopic Liver Transplantation Require Lower Concentrations of the Volatile Anesthetic Sevoflurane.

BACKGROUND: Sevoflurane is a volatile anesthetic commonly used to maintain anesthesia in patients with end-stage liver disease (ESLD) undergoing orthotopic liver transplantation (OLT). Growing evidence suggests that patients with ESLD have decreased anesthetic requirements compared to patients with preserved liver function. The potency of volatile anesthetics is expressed as the minimum alveolar concentration (MAC). In this prospective, blinded study, we compared the MAC of sevoflurane among patients with ESLD undergoing OLT and patients with normal liver function undergoing major abdominal surgery. METHODS: After propofol-induced anesthesia, the MAC of sevoflurane was assessed by evaluating motor response to initial skin incision in patients undergoing OLT and in patients with normal liver function undergoing major abdominal surgery. The MAC was determined using Dixon "up-and-down" method and compared between groups. In addition, the bispectral index was documented immediately before and after skin incision. RESULTS: Twenty patients undergoing OLT and 20 control patients were included in the study. The MAC of sevoflurane in patients undergoing OLT was 1.3% (95% confidence interval [CI], 1.1-1.4). In comparison, the MAC of sevoflurane in patients with normal liver function was 1.7% (95% CI, 1.6-1.9), equal to a relative reduction of the MAC in patients with ESLD of 26% (95% CI, 14-39). The bispectral index was higher in patients with ESLD than in control patients at 3 minutes before (47 [95% CI, 40-53] vs 35 [95% CI, 31-40], P = .011), 1 minute before (48 [95% CI, 42-54] vs 37 [95% CI, 33-43], P = .03), and 1 minute after skin incision (57 [95% CI, 50-64] vs 41 [95% CI, 36-47], P

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Anesthesia Adverse Events Voluntarily Reported in the Veterans Health Administration and Lessons Learned.

BACKGROUND: Anesthesia providers have long been pioneers in patient safety. Despite remarkable efforts, anesthesia errors still occur, resulting in complications, injuries, and even death. The Veterans Health Administration (VHA) National Center of Patient Safety uses root cause analysis (RCA) to examine why system-related adverse events occur and how to prevent future similar events. This study describes the types of anesthesia adverse events reported in VHA hospitals and their root causes and preventative actions. METHODS: RCA reports from VHA hospitals from May 30, 2012, to May 1, 2015, were reviewed for root causes, severity of patient outcomes, and actions. These elements were coded by consensus and analyzed using descriptive statistics. RESULTS: During the study period, 3228 RCAs were submitted, of which 292 involved an anesthesia provider. Thirty-six of these were specific to anesthesia care. We reviewed these 36 RCA reports of adverse events specific to anesthesia care. Types of event included medication errors (28%, 10), regional blocks (14%, 5), airway management (14%, 5), skin integrity or position (11%, 4), other (11%, 4), consent issues (8%, 3), equipment (8%, 3), and intravenous access and anesthesia awareness (3%, 1 each). Of the 36 anesthesia events reported, 5 (14%) were identified as being catastrophic, 10 (28%) major, 12 (34%) moderate, and 9 (26%) minor. The majority of root causes identified a need for improved standardization of processes. CONCLUSIONS: This analysis points to the need for systemwide implementation of human factors engineering-based approaches to work toward further eliminating anesthesia-related adverse events. Such actions include standardization of processes, forcing functions, separating storage of look-alike sound-alike medications, limiting stock of high-risk medication strengths, bar coding medications, use of cognitive aids such as checklists, and high-fidelity simulation. (C) 2017 International Anesthesia Research Society

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Identifying novel genes and biological processes relevant to the development of cancer therapy-induced mucositis: An informative gene network analysis

by Cielito C. Reyes-Gibby, Stephanie C. Melkonian, Jian Wang, Robert K. Yu, Samuel A. Shelburne, Charles Lu, Gary Brandon Gunn, Mark S. Chambers, Ehab Y. Hanna, Sai-Ching J. Yeung, Sanjay Shete

Mucositis is a complex, dose-limiting toxicity of chemotherapy or radiotherapy that leads to painful mouth ulcers, difficulty eating or swallowing, gastrointestinal distress, and reduced quality of life for patients with cancer. Mucositis is most common for those undergoing high-dose chemotherapy and hematopoietic stem cell transplantation and for those being treated for malignancies of the head and neck. Treatment and management of mucositis remain challenging. It is expected that multiple genes are involved in the formation, severity, and persistence of mucositis. We used Ingenuity Pathway Analysis (IPA), a novel network-based approach that integrates complex intracellular and intercellular interactions involved in diseases, to systematically explore the molecular complexity of mucositis. As a first step, we searched the literature to identify genes that harbor or are close to the genetic variants significantly associated with mucositis. Our literature review identified 27 candidate genes, of which ERCC1, XRCC1, and MTHFR were the most frequently studied for mucositis. On the basis of this 27-gene list, we used IPA to generate gene networks for mucositis. The most biologically significant novel molecules identified through IPA analyses included TP53, CTNNB1, MYC, RB1, P38 MAPK, and EP300. Additionally, uracil degradation II (reductive) and thymine degradation pathways (p = 1.06⁻⁰⁸) were most significant. Finally, utilizing 66 SNPs within the 8 most connected IPA-derived candidate molecules, we conducted a genetic association study for oral mucositis in the head and neck cancer patients who were treated using chemotherapy and/or radiation therapy (186 head and neck cancer patients with oral mucositis vs. 699 head and neck cancer patients without oral mucositis). The top ranked gene identified through this association analysis was RB1 (rs2227311, p-value = 0.034, odds ratio = 0.67). In conclusion, gene network analysis identified novel molecules and biological processes, including pathways related to inflammation and oxidative stress, that are relevant to mucositis development, thus providing the basis for future studies to improve the management and treatment of mucositis in patients with cancer.

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Issue Information

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Computational fluid dynamics and the study of sinonasal pathophysiology

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Determinants of Incident Metabolic Syndrome in a Middle Eastern Population: Isfahan Cohort Study

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


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Nonblanching, Palpable Skin Lesions With a Linear Pattern in Henoch-Schönlein Syndrome

This case series examines the prevalence and characteristics of linear nonblanching skin lesions in children with Henoch-Schönlein syndrome.

http://ift.tt/2sqc2Wk

Diversity in the Selection of Dermatology Applicants

In Reply We appreciate the thoughtful responses by both Oussedik and Gross to our article, which raise important questions regarding the emphasis on research and standardized testing in the dermatology resident selection process.

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Diversity in the Selection of Dermatology Applicants

To the Editor In the name of diversity, Drs Chen and Shinkai propose eliminating Step 1 scores and research experience, among other things, as selection criteria for dermatology residency. However, Step 1 scores objectively test knowledge-based learning in the basic science years of medical school and are the only standardized assessment for all applicants to residency positions. Among the possible reasons that underrepresented minorities (URMs) have low Step 1 scores presented is that "studying for a good grade…can significantly undermine…learning for the joy of learning."^(p259) Why would joyful learning preclude attaining good grades and demonstrating competency by Step 1 performance? In addition, research experience is important for residency applicants and for dermatology as a specialty. If URMs cannot afford to do research, then perhaps medical student research needs better funding. Rather than discouraging research by medical students and the mentorship provided by the faculty member, it behooves the specialty to find a way to support such research, especially by URMs.

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Nivolumab for Treatment-Related Vitiligo in Relapsed Metastatic Melanoma

This case report describes the use of nivolumab therapy for treatment-related vitiligo in a patient with relapsed metastatic melanoma.

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Diversity in the Selection of Dermatology Applicants

To the Editor We read with great interest the Viewpoint by Chen and Shinkai on rethinking the paradigm by which dermatology applicants are selected. Dermatology is considered one of the least diverse specialties, and to address this lack of diversity in our specialty, Chen and Shinkai offer 6 outstanding recommendations. However, we believe that 1 additional imperative consideration should have been addressed—the role of the research fellowship and its implications for dermatology resident selection.

http://ift.tt/2sqc0Oc

Perineural Invasion of Cutaneous Squamous Cell Carcinoma

This systematic review and pooled analysis compares disease-related outcomes and survival between patients with cutaneous squamous cell carcinoma and clinical perineural invasion vs patients with cutaneous squamous cell carcinoma and incidental perineural invasion.

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Topical Steroids in Chinese Cosmetics

This Viewpoint highlights the importance of eliminating topical steroids from Chinese cosmetic products.

http://ift.tt/2sqkMf4

Geographic Reasoning on Multi-Modal Fire Spread Data

This paper presents the general architecture of a multi-sensor GIS platform, i.e., fireGIS, which serves as a guideline for effective use of sensor data and geographic information in systems for fire incident management. The proposed platform allows the generation of real-time heatmaps that show the space-time distribution of fire risk levels across an area of concern based on multi-modal sensing. Such levels are to assist the decision makers in taking actions and aims at facilitating quick fire emergency response. Results of real fire experiments in a large-scale road tunnel show the feasibility of our approach.

http://ift.tt/2tIxOZo

Expression of Hormone Receptors and HER-2 in Benign and Malignant Salivary Gland Tumors

Abstract

With the advent of targeted therapies, expression of sex hormone receptors and HER-2 in salivary gland tumors (SGTs) is of clinical interest. Previous reports of estrogen (ER) and progesterone (PR) receptor expression have varied. Androgen receptor (AR) and HER-2 overexpression are frequently reported in salivary duct carcinoma (SDC), but have not been studied systematically in other SGTs. This study examines ER, PR, AR, and HER-2 expression in SGTs. Immunohistochemistry for ER, PR, AR, and HER-2 was performed on 254 SGTs (134 malignant). ER, PR, and AR expression was scored using Allred system. HER-2 expression was scored using Dako HercepTest guidelines. FISH for HER-2 amplification was performed on select cases with HER-2 overexpression (2–3+). No SGT demonstrated strong expression of ER or PR. Combined strong AR and HER-2 expression was seen in 22 carcinomas: 14/25 SDC, 3/16 poorly differentiated, two oncocytic, and one each carcinoma ex pleomorphic adenoma, squamous cell, and intraductal carcinoma. Eighteen additional high grade carcinomas had HER-2 overexpression with absent, weak, or moderate AR expression; eight high grade carcinomas had isolated strong AR expression with 0–1+ HER-2 staining. Of 15 tested cases, six demonstrated HER-2 amplification by FISH, all of which had 3+ immunoreactivity. Neither benign nor malignant SGTs had strong expression of ER or PR. None of the benign SGTs overexpressed AR or HER-2. Coexpression of AR and HER-2 should not define SDC, but immunostaining should be considered in high grade salivary carcinomas, as some show overexpression and may benefit from targeted therapy.

http://ift.tt/2sLKPNj

Expression of Hormone Receptors and HER-2 in Benign and Malignant Salivary Gland Tumors

Abstract

With the advent of targeted therapies, expression of sex hormone receptors and HER-2 in salivary gland tumors (SGTs) is of clinical interest. Previous reports of estrogen (ER) and progesterone (PR) receptor expression have varied. Androgen receptor (AR) and HER-2 overexpression are frequently reported in salivary duct carcinoma (SDC), but have not been studied systematically in other SGTs. This study examines ER, PR, AR, and HER-2 expression in SGTs. Immunohistochemistry for ER, PR, AR, and HER-2 was performed on 254 SGTs (134 malignant). ER, PR, and AR expression was scored using Allred system. HER-2 expression was scored using Dako HercepTest guidelines. FISH for HER-2 amplification was performed on select cases with HER-2 overexpression (2–3+). No SGT demonstrated strong expression of ER or PR. Combined strong AR and HER-2 expression was seen in 22 carcinomas: 14/25 SDC, 3/16 poorly differentiated, two oncocytic, and one each carcinoma ex pleomorphic adenoma, squamous cell, and intraductal carcinoma. Eighteen additional high grade carcinomas had HER-2 overexpression with absent, weak, or moderate AR expression; eight high grade carcinomas had isolated strong AR expression with 0–1+ HER-2 staining. Of 15 tested cases, six demonstrated HER-2 amplification by FISH, all of which had 3+ immunoreactivity. Neither benign nor malignant SGTs had strong expression of ER or PR. None of the benign SGTs overexpressed AR or HER-2. Coexpression of AR and HER-2 should not define SDC, but immunostaining should be considered in high grade salivary carcinomas, as some show overexpression and may benefit from targeted therapy.

http://ift.tt/2sLKPNj

Vertaling van een essay van Yoko Tawada "Accent"

Dit is een vertaling van een Duitstalig essay van de in het Duits en Japans schrijvende auteur Yoko Tawada. Het essay werd gepubliceerd in Yoko Tawada "akzentfrei", konkursbuch Verlag Claudia Gehrke, Tübingen 2016 (22-29).

http://ift.tt/2sGijBz

Mechanisms of action, resistance and toxicity of insecticides targeting GABA receptors

Buckingham, S; Ihara, M; Sattelle, DB; Matsuda, K; (2017) Mechanisms of action, resistance and toxicity of insecticides targeting GABA receptors. Current Medicinal Chemistry 10.2174/0929867324666170613075736 . (In press).

http://ift.tt/2tgHbyA

Psychosocial factors and physiological responsivity: studies of stress-related processes

Wright, CE; (2006) Psychosocial factors and physiological responsivity: studies of stress-related processes. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sMyyIu

Uptake and metabolism of sulphated steroids by the blood-brain barrier in the adult male rat

Qaiser, MZ; Dolman, DEM; Begley, DJ; Abbott, NJ; Cazacu-Davidescu, M; Corol, DI; Fry, JP; (2017) Uptake and metabolism of sulphated steroids by the blood-brain barrier in the adult male rat. Journal of Neurochemistry 10.1111/jnc.14117 . (In press).

http://ift.tt/2tgPWbQ

Pulse, polarization and topology shaping of polariton fluids

Dominici, L; Colas, D; Donati, S; Dagvadorj, G; Gianfrate, A; Muñoz, CS; Ballarini, D; Dominici, L; Colas, D; Donati, S; Dagvadorj, G; Gianfrate, A; Muñoz, CS; Ballarini, D; De Giorgi, M; Gigli, G; Szymańska, MH; Laussy, FP; Sanvitto, D; - view fewer (2017) Pulse, polarization and topology shaping of polariton fluids. In: Andrews, DL and Galvez, EJ and Glückstad, J, (eds.) Complex Light and Optical Forces XI. (pp. 101200E1-101200E19). Society of Photo-Optical Instrumentation Engineers (SPIE) Green open access

http://ift.tt/2sMoOxH

Proteomic analysis of the neutrophil cytoskeleton, defining the function of grancalcin

Xu, P; (2006) Proteomic analysis of the neutrophil cytoskeleton, defining the function of grancalcin. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tgUiQi

Predictors and correlates of relational aggression in a school transition

Ramsey, B; (2008) Predictors and correlates of relational aggression in a school transition. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sMwsbD

Methylome analysis of extreme chemoresponsive patients identifies novel markers of platinum sensitivity in high-grade serous ovarian cancer.

Tomar, T; Alkema, NG; Schreuder, L; Meersma, GJ; de Meyer, T; van Criekinge, W; Klip, HG; Tomar, T; Alkema, NG; Schreuder, L; Meersma, GJ; de Meyer, T; van Criekinge, W; Klip, HG; Fiegl, H; van Nieuwenhuysen, E; Vergote, I; Widschwendter, M; Schuuring, E; van der Zee, AGJ; de Jong, S; Wisman, GBA; - view fewer (2017) Methylome analysis of extreme chemoresponsive patients identifies novel markers of platinum sensitivity in high-grade serous ovarian cancer. BMC Med , 15 (1) , Article 116. 10.1186/s12916-017-0870-0 . Green open access

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Practice and outcomes for radical urological cancer surgery in England: a study based on hospital episode statistics and a review of the literature

Nuttall, M; (2006) Practice and outcomes for radical urological cancer surgery in England: a study based on hospital episode statistics and a review of the literature. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sLUgw4

Portosystemic shunts in cirrhosis are associated to more complications and deteriorated quality of life: an international cohort study

Simon-Talero, M; Roccarina, D; Majumdar, A; Tsochatzis, EA; Martinez, J; Picon, C; Albillos, A; Simon-Talero, M; Roccarina, D; Majumdar, A; Tsochatzis, EA; Martinez, J; Picon, C; Albillos, A; Lampichler, K; Toth, D; Reiberger, T; Baiges, A; Darnell, A; Hernandez-Gea, V; Low, G; Abraldes, JG; Tandon, P; Llop, E; Lopez, M; Calleja, JL; Praktiknjo, M; Kukuk, G; Trebicka, J; Maurer, M; Berzigotti, A; Zipprich, A; Ripoll, C; Triolo, M; La Mura, V; Vangrinsven, G; Laleman, W; Garcia-Martinez, R; Banares, R; Dam, A; Krag, A; Augustin, S; Genesca, J; - view fewer (2017) Portosystemic shunts in cirrhosis are associated to more complications and deteriorated quality of life: an international cohort study. Presented at: International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver, Amsterdam, NETHERLANDS.

http://ift.tt/2tgQ233

Positron impact ionization phenomena

Murtagh, DJ; (2007) Positron impact ionization phenomena. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sMypVs

A Four-Biomarker Blood Signature Discriminates Systemic Inflammation Due to Viral Infection Versus Other Etiologies

Sampson, DL; Fox, BA; Yager, TD; Bhide, S; Cermelli, S; McHugh, LC; Seldon, TA; Sampson, DL; Fox, BA; Yager, TD; Bhide, S; Cermelli, S; McHugh, LC; Seldon, TA; Brandon, RA; Sullivan, E; Zimmerman, JJ; Noursadeghi, M; Brandon, RB; - view fewer (2017) A Four-Biomarker Blood Signature Discriminates Systemic Inflammation Due to Viral Infection Versus Other Etiologies. Science Reports , 7 (1) , Article 2914. 10.1038/s41598-017-02325-8 . Green open access

http://ift.tt/2th9FIn

Associations between tobacco control mass media campaign expenditure and smoking prevalence and quitting in England: a time series analysis

Kuipers, MAG; Beard, E; West, R; Brown, J; (2017) Associations between tobacco control mass media campaign expenditure and smoking prevalence and quitting in England: a time series analysis. Tobacco Control 10.1136/tobaccocontrol-2017-053662 . (In press). Green open access

http://ift.tt/2sMyrwy

Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary.

Kumar, RK; Singhal, A; Vaidya, U; Banerjee, S; Anwar, F; Rao, S; (2017) Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary. [Review]. Front Nutr , 4 , Article 20. 10.3389/fnut.2017.00020 . Green open access

http://ift.tt/2tgB79k

Quantification of within-sample genetic heterogeneity from SNP-array data.

Martinez, P; Kimberley, C; BirkBak, NJ; Marquard, A; Szallasi, Z; Graham, TA; (2017) Quantification of within-sample genetic heterogeneity from SNP-array data. Sci Rep , 7 (1) , Article 3248. 10.1038/s41598-017-03496-0 . Green open access

http://ift.tt/2sM4rAV

Adaptive Deep Brain Stimulation for Movement Disorders: The Long Road to Clinical Therapy

Meidahl, AC; Tinkhauser, G; Herz, DM; Cagnan, H; Debarros, J; Brown, P; (2017) Adaptive Deep Brain Stimulation for Movement Disorders: The Long Road to Clinical Therapy. Movement Disorders , 32 (6) pp. 810-819. 10.1002/mds.27022 . Green open access

http://ift.tt/2tgJ9yM

PEI-mediated transient gene expression in cell culture for the rapid production of therapeutic proteins

Tait, AS; (2005) PEI-mediated transient gene expression in cell culture for the rapid production of therapeutic proteins. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sM4WL6

Comparison of subjective sleep and fatigue in breast- and bottle-feeding mothers

http://ift.tt/2sGd5FW

Exploring the potential role of the advanced nurse practitioner within a care path for patients with chronic fatigue syndrome

http://ift.tt/2tpFGfY

Study of Efficacy and Safety of NIR178 and PDR001 Combination in Patients With Selected Solid Tumors and Non-Hodgkin Lymphoma

Conditions:   NSCLC;   RCC;   Pancreatic Cancer;   Urothelial Cancer;   Head and Neck Cancer;   DLBCL;   Microsatellite Stable (MSS) Colon Cancer, TNBC;   Melanoma
Interventions:   Drug: NIR178 continuosly and PDR001 combination;   Drug: NIR178 in combination with 400mg PDR001 continuously or intermittent;   Drug: NIR178/PDR001 combo- schedule to be determined
Sponsor:   Novartis Pharmaceuticals
Not yet recruiting - verified June 2017

http://ift.tt/2uK7XNC

Improving Evidence-Based Care for Cancer Patients

Conditions:   Head and Neck Cancer;   Prostate Cancer;   Breast Cancer;   Lung Cancer;   Gynecologic Cancer;   Gastrointestinal Cancer
Interventions:   Other: Survey;   Other: Saliva sample;   Other: Smoking Status questions;   Other: Health Services
Sponsor:   Medical University of South Carolina
Recruiting - verified November 2016

http://ift.tt/2tM3T1V

De improviserende planner : inspiratie voor nieuwe competenties binnen gedeelde stadsontwikkeling

http://ift.tt/2sLPwH2

Powerful New Technique Can Clone Thousands of Genes at Once

Scientists at Johns Hopkins, Rutgers, the University of Trento in Italy, and Harvard Medical School report they have developed a new molecular technique called LASSO cloning, which can be used to isolate thousands of long DNA sequences at the same time, more than ever before possible.

http://ift.tt/2tgLNVo

‘Se lieie la favola’: Apuleian Play in Basile’s 'Lo cunto de li cunti'

http://ift.tt/2sMghuF

Een onwaarschijnlijk verhaal: de Latijnse sprookjes van een middeleeuwse Cisterciënzer

http://ift.tt/2tgAFI1

HgSe/CdE (E = S, Se) Core/Shell Nanocrystals by Colloidal Atomic Layer Deposition

http://ift.tt/2sM6xRv

In het spoor van Vergilius

http://ift.tt/2tgFKQL

E-health beyond technology: analyzing the paradigm shift that lies beneath

http://ift.tt/2sM4fl4

A Monk’s Tale: Framing the Fictional in John of Alta Silva's 'Dolopathos'

http://ift.tt/2tgHFVk

Een zwerver komt thuis – telkens opnieuw: de klassieke mythe in de moderne jeugdliteratuur

http://ift.tt/2tgIFJf

Non-destructive monitoring of delamination healing of a CFRP composite with a thermoplastic ionomer interlayer

A comparative study is performed on the monitoring of delamination healing in CFRP-ionomer sandwich composites by non-destructive techniques and destructive compression testing. Artificial delaminations of various areal dimensions and nature were introduced during production of the composites. The extent of the delamination and the healing thereof was monitored in both air and water-coupled ultrasonic C-scan experiments as well as by the frequency shift of the local defect resonance (LDR). It is shown that the LDR approach can be used to detect the early stage healing of the delaminations while ultrasonic C-scanning techniques are very effective to determine the extent of healing in the final stages of the repair process. A quasi-linear relation was observed between the delaminated area measured with ultrasonic C-scan and the compressive failure strength in destructive testing. This correlation shows the beneficial effect on the compression strength of the delaminated area reduction by on-demand healing.

http://ift.tt/2th1BY7

Nieuwe grondhouding in ruimtelijk beleid : pleidooi voor twee handelingsperspectieven : strategisch organiseren en lerend organiseren

http://ift.tt/2sM5dxJ

The appropriated city : citizens taking control?

http://ift.tt/2tgiP80

Real-time emotion classification of tweets

Despite adding emotions to applications has proven to enhance the user experience, emotion recognition applications are still not widely available nor used. Within this paper, emotion recognition is done on Twitter tweets using six emotion classification algorithms that are compared on precision and timing. The paper shows that precision can be enhanced by 5.02% compared to the current state-of-the-art by improving the features. Furthermore, the presented algorithms work in real-time.

http://ift.tt/2sM3xnT

Expression of Hormone Receptors and HER-2 in Benign and Malignant Salivary Gland Tumors

Abstract

With the advent of targeted therapies, expression of sex hormone receptors and HER-2 in salivary gland tumors (SGTs) is of clinical interest. Previous reports of estrogen (ER) and progesterone (PR) receptor expression have varied. Androgen receptor (AR) and HER-2 overexpression are frequently reported in salivary duct carcinoma (SDC), but have not been studied systematically in other SGTs. This study examines ER, PR, AR, and HER-2 expression in SGTs. Immunohistochemistry for ER, PR, AR, and HER-2 was performed on 254 SGTs (134 malignant). ER, PR, and AR expression was scored using Allred system. HER-2 expression was scored using Dako HercepTest guidelines. FISH for HER-2 amplification was performed on select cases with HER-2 overexpression (2–3+). No SGT demonstrated strong expression of ER or PR. Combined strong AR and HER-2 expression was seen in 22 carcinomas: 14/25 SDC, 3/16 poorly differentiated, two oncocytic, and one each carcinoma ex pleomorphic adenoma, squamous cell, and intraductal carcinoma. Eighteen additional high grade carcinomas had HER-2 overexpression with absent, weak, or moderate AR expression; eight high grade carcinomas had isolated strong AR expression with 0–1+ HER-2 staining. Of 15 tested cases, six demonstrated HER-2 amplification by FISH, all of which had 3+ immunoreactivity. Neither benign nor malignant SGTs had strong expression of ER or PR. None of the benign SGTs overexpressed AR or HER-2. Coexpression of AR and HER-2 should not define SDC, but immunostaining should be considered in high grade salivary carcinomas, as some show overexpression and may benefit from targeted therapy.

http://ift.tt/2sLKPNj

Chronophysiological features of the normal mineral composition of human saliva

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Lyudmila V. Bel'skaya, Victor K. Kosenok, Elena A. Sarf
BackgroundThe high rate of changes in the composition of saliva can be used for the monitoring of various biorhythms in order to study the physiological characteristics of the human body.Research objectiveThe study of the dynamics of the near-24-h mineral composition of saliva in men and women.MethodsThe study involved 20 men and 20 women, age 23.1±0.9years. Saliva samples were collected every 3h during the day within 10min. The mineral composition of saliva was defined by the capillary electrophoresis technique. The cross-group differences were evaluated using the non-parametric criterion.ResultsIt was shown that the maximum values of the mineralizing capacity fall to 7–8 a.m. and 18–19p.m., which is due to the change in the rate of saliva secretion. The near-24-h dynamics of the saliva pH practically coincides with the dynamics of the Ca/P ratio; there are evident maxima at 9:00 am and 15–18p.m. The values of the Na/K ratio are out of phase with the Ca/P ratio. There is one maximum, corresponding to 3 am in the night, and one minimum at 12–13p.m., which is due to a decreased level of sodium and increased potassium concentration. Statistically valid differences between men and women in pH (p<0.001), concentrations of inorganic phosphorus (p<0.001), as well as Ca/P coefficient (p=0.011) were identified.ConclusionThe dynamics of the studied parameters during 24h is characterized by pronounced intervals.



http://ift.tt/2tLBYzo

Influence of STRO-1 selection on osteogenic potential of human tooth germ derived mesenchymal stem cells

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Pinar Ercal, Gorke G. Pekozer, Osman Z. Gumru, Gamze T. Kose, Mustafa Ramazanoglu
Mesenchymal stem cells derived from the human tooth germ (hTGSCs) are a heterogeneous cell population that can differentiate into osteogenic, neurogenic, and adipogenic lineages. The aim of this study was to compare the osteogenic differentiation capacity of STRO-1 positive (STRO-1+) hTGSCs and unsorted heterogeneous hTGSCs and to establish if STRO-1+ cells are more committed to osteogenic differentiation. HTGSCs were isolated from impacted third molar tooth germ tissues of adolescents, and a subpopulation of STRO-1+ hTGSCs was obtained by fluorescence-activated cell sorting. STRO-1+, STRO-1 negative (STRO-1−), and unsorted cells were cultured in osteogenic and standard culture media to compare their capacity to differentiate towards osteoblastic lineage. Cells were tested for proliferation rates, alkaline phosphatase activity, and amounts of accumulated calcium. Gene expression levels of the RUNX2, osteocalcin, and osteonectin genes were analyzed with real time PCR. Mineralization and osteogenic protein expression were examined by using von Kossa staining and confocal microscopy. Our results indicated that osteogenically induced cell populations showed greater mineralization capacity than non-induced cells. However, expression levels of early and late osteogenic markers were not significantly different between STRO-1+ and unsorted cells. In conclusion, the selection by STRO-1 expression does not yield cells with osteogenic capacity higher than that of the heterogeneous hTGSC population. Cell sorting using osteogenic markers other than STRO-1 might be beneficial in obtaining a more sensitive osteogenic sub-population from unsorted heterogenous hTGSCs.



http://ift.tt/2uJu32A

Characterization of methacrylated polysaccharides in combination with amine-based monomers for application in mortar

Smart pH-responsive superabsorbent polymers (SAPs) could be useful for self-healing of cracks in mortar. They will swell minimally during the alkaline conditions of mixing, leading to only small macro pores but will swell stronger with a lower pH when water enters the cracks. As such, polysaccharides (alginate, chitosan and agarose) were methacrylated and cross-linked with amine-based monomers (dimethylaminoethyl methacrylate and dimethylaminopropyl methacrylamide) to induce a varying pH-sensitivity. These materials showed a strong cross-linking efficiency and induced moisture uptake capacities up to 122% at 95% relative humidity with a negligible hysteresis. Additionally, interesting pH-responsive swelling capacities were obtained, especially for SAPs based on chitosan and agarose with values up to 110 gwater/gSAP. Most of these materials showed limited hydrolysis in cement filtrate solutions, making them very promising for use in mortar. (C) 2017 Elsevier Ltd. All rights reserved.

http://ift.tt/2upG4ef

Crack Mitigation in Concrete: Superabsorbent Polymers as Key to Success?

Cracking is a major concern in building applications. Cracks may arise from shrinkage, freeze/thawing and/or structural stresses, amongst others. Several solutions can be found but superabsorbent polymers (SAPs) seem to be interesting to counteract these problems. At an early age, the absorbed water by the SAPs may be used to mitigate autogenous and plastic shrinkage. The formed macro pores may increase the freeze/thaw resistance. The swelling upon water ingress may seal a crack from intruding fluids and may regain the overall water-tightness. The latter water may promote autogenous healing. The use of superabsorbent polymers is thus very interesting. This review paper summarizes the current research and gives a critical note towards the use of superabsorbent polymers in cementitious materials.

http://ift.tt/2tQfTAG

Évaluation de la prise en charge institutionnelle d’enfants atteints d’un trouble envahissant du développement

Objective. – Starting from a review of the basic principles for the treatment of autism according to Lacanian psychoanalysis, we present a prospective study of the evolution of 24 children with pervasive developmental disorder who received institutional therapy oriented by Lacanian psychoanalysis. The efficacy of this therapy was evaluated on scales assessing socialization, communication, autonomy, motor functioning and intellec- tual and developmental quotients. Then, to describe the therapeutic process, to specify the prerequisites and to assess the beneficial effects, the study is completed by a clinical case. Method. – Twenty-four children took part in our study. All received a diagnosis of infantile autism (n = 14) or atypical autism (n = 10). Their mean age was 7 years and 5 months. Standardized evaluations were carried out using the Vineland Social Maturity Scale (for socio-adaptive behaviours) and the Harvey and Columbia scales (intelligence and developmental quotients), at two distinct moments: at admission and after 2 years of treatment. Results. – The results attest a statistically significant progression in all socio-adaptive domains on the Vine- land scale (communication, autonomy, motor functioning and socialization). A statistically significant improvement in the developmental quotient was also observed for the 11 children who were evaluated both at admission and after two years of treatment. The clinical study shows that by respecting certain preconditions, it is possible for clinicians to form a partnership with the child with autism and to provide support enabling a subjective dynamic to develop. This helps the child with autism to tolerate the introduc- tion of small changes in the repetitive and rigid constructions she or he adheres to. This openness to change makes it possible to widen and complexify the circuits established around the objects to which the child is attached. Discussion.–Evaluating the efficacy of a treatment on the basis of statistical criteria is not the same as making an evaluation using clinical criteria. Our statistical evaluation made it clear that significant changes could be observed in all the domains assessed on standardised scales. Our clinical study, in turn, enabled the question of the subject to be addressed. In this way, it is possible to observe speci- fic elements around which a child has constructed his own solutions, and has been able to open up to others.

http://ift.tt/2uplB9w

Characterization of methacrylated alginate and acrylic monomers as versatile SAPs

Superabsorbent polymers (SAPs) based on polysaccharides, especially alginate, could offer a valuable solution in a plethora of applications going from drug delivery to self-healing concrete. This has already been proven with both calcium alginate and methacrylated alginate combined with acrylic acid. In this manuscript, the effect of varying the degree of methacrylation and use of a combination of acrylic acid and acrylamide is investigated to explore the effects on the relevant SAP characteristics. The materials showed high gel fractions and a strong swelling capacity up to 630 g(water)/g(SAP), especially for superabsorbent polymers with a low degree of substitution. The SAPs also showed only a limited hydrolysis in aqueous and cement filtrate solutions. (C) 2017 Elsevier Ltd. All rights reserved.

http://ift.tt/2tPUzep

Children's Depression Inventory-2

http://ift.tt/2upjVwO

Noncontiguous multi-tiered spinal tuberculosis associated with sternal localization: a case report

Tuberculous spondylodiscitis is a frequent localization of tuberculosis. Multi-tiered involvement and an association with sternal localization are rare.

http://ift.tt/2tLwCEc

Helicobacter pylori modulates cisplatin sensitivity in gastric cancer by down-regulating miR-141 expression

http://ift.tt/2tIn4dI

Issue Information

http://ift.tt/2sp9UhE

Attenuation Effect with Non-Linear Loads for Small Stand-Alone Grids

This paper presents the effect of non-linear loads on the overall voltage quality in small powered stand-alone (islanded) systems. The iterative effect between current and voltage distortion is related to the source's impedance and this study illustrates the different harmonic behavior between power electronic (PE) inverters and electro-mechanical generators directly coupled to the load. A 2,5kW nominal power islanded system with non-linear loads is evaluated with both cases. The PE inverter is an off-the-shelf grid-interactive inverter designed for a combination of battery storage and solar power. The electromechanical generator is a synchronous machine with external speed and excitation control. Due to their inherently different behavior and output topology the attenuation effect is shown to be completely different with important complications for reliable operation of such systems.

http://ift.tt/2soYxX6

Observation of water evaporation and stratum corneum hydration and pH during the clinical course of a patient with acquired idiopathic generalized anhidrosis

http://ift.tt/2uJDL57

The sensitivity of gas hydrate reservoirs to climate change: Perspectives from a new combined model for permafrost-related and marine settings

Gas hydrate reservoirs store large quantities of gas in sediments on continental margins, in deep lakes, and in continental and relic sub-shelf permafrost. The gas hydrate structure is only stable at sufficiently low temperature and high pressure, and may therefore collapse under changing climatic conditions. If a temperature rise or pressure drop (e.g. through falling sea level) is effective enough to dissociate hydrate deposits, methane (the most common gas component in hydrates and a potent greenhouse gas) is released from the hydrate structure and may eventually enter into the atmosphere. This may generate a positive feedback effect, as resulting enhanced greenhouse gas levels would additionally warm the atmosphere and hence maintain or reinforce hydrate dissociation. The significance of this mechanism has been debated over the past decades, often within the framework of geologically rapid Quaternary climatic oscillations and present-day climate warming. An extensive set of studies has addressed the climate-sensitivity of gas hydrate reservoirs in various study areas and geological settings, and by means of various approaches. No real consensus has yet been reached on the matter. In this study, we seek to evaluate the sensitivity of gas hydrate reservoirs to changes in global climate from a more general perspective, by firstly reviewing the available literature, and secondly developing a new numerical model to quantify gas hydrate destabilization under changing environmental conditions. Qualities of the model include the wide applicability to both marine and permafrost-related hydrate reservoirs and the integrative approach, combining existing hydrate formation models with a dissocation model that accounts for the consumption of latent heat during hydrate dissociation. To determine which settings are most vulnerable, and to acquire insight into the extent, fashion and rates of hydrate dissociation, we apply the model to four distinct types of hydrate reservoirs across a hypothetic high-latitude continental margin under two specific cases of climate change: the last deglaciation following the Last Glacial Maximum and present-day climate warming. The simulations indicate that hydrates on the upper continental slope and in association with thin, sub-shelf permafrost are most sensitive to the imposed climatic variations, whereas deepwater and onshore permafrost-related reservoirs react in a more stable way. However, the deep (i.e. at several tens to hundreds of meters subsurface depth) stratigraphic-type hydrates considered in this study constitute by far the largest fraction of the global gas hydrate volume, but dissociate on slow timescales of thousands to hundreds of thousands of years, even in the most sensitive environments. In contrast, shallow (i.e. at, or a few meters below the surface or seafloor) structural-type hydrates are able to respond to climatic variations on sub-millennial timescales, but the volumes of gas they may release are probably insignificant to the global carbon cycle and climate. Quaternary and present-day climate change do affect the stability of gas hydrate reservoirs, but at long timescales where hydrate volumes are large, and on short timescales where hydrate volumes are small. Consequently, gas hydrates dissociate to an extent that is too small or at a pace that is too slow to create a strong positive feedback effect. While the release of methane from the disintegration of gas hydrates is observed on different margins today, it is not likely to have played a leading role in Quaternary climatic variations or to become a significant process in the coming centuries as a result of present-day rising temperatures.

http://ift.tt/2tLpXKr

Joint proceedings of the second RDF stream processing and the querying the web of data workshops

http://ift.tt/2uJw6nr

Presence of antimicrobial resistance in coliform bacteria from hatching broiler eggs with emphasis on ESBL/AmpC-producing bacteria

Antimicrobial resistance is recognized as one of the most important global health challenges. Broilers are an important reservoir of antimicrobial-resistant bacteria in general and, more particularly, extended-spectrum beta-lactamases (ESBL)/AmpC-producing Enterobacteriaceae. Since contamination of 1-day-old chicks is a potential risk factor for the introduction of antimicrobial-resistant Enterobacteriaceae in the broiler production chain, the presence of antimicrobial-resistant coliform bacteria in broiler hatching eggs was explored in the present study. Samples from 186 hatching eggs, collected from 11 broiler breeder farms, were inoculated on MacConkey agar with or without ceftiofur and investigated for the presence of antimicrobial-resistant lactose-positive Enterobacteriaceae, particularly, ESBL/AmpC-producers. Escherichia coli and Enterobacter cloacae were obtained from the eggshells in 10 out of 11 (10/11) sampled farms. The majority of the isolates were recovered from crushed eggshells after external decontamination suggesting that these bacteria are concealed from the disinfectants in the egg shell pores. Antimicrobial resistance testing revealed that approximately 30% of the isolates showed resistance to ampicillin, tetracycline, trimethoprim and sulphonamides, while the majority of isolates were susceptible to amoxicillin-clavulanic acid, nitrofurantoin, aminoglycosides, florfenicol, neomycin and apramycin. Resistance to extended-spectrum cephalosporins was detected in eight Enterobacteriaceae isolates from five different broiler breeder farms. The ESBL phenotype was confirmed by the double disk synergy test and bla(SHV-12), bla(TEM-52) and bla(ACT-39) resistance genes were detected by PCR. This report is the first to present broiler hatching eggs as carriers and a potential source of ESBL/AmpC-producing Enterobacteriaceae for broiler chicks.

http://ift.tt/2tLucpd

Determinant factors of physical fitness in European children

This study was designed to explore the determinants of physical fitness in European children aged 6-11 years, cross-sectionally and longitudinally. There were sufficient data on 4903 children (50.6 % girls) on measured physical fitness (cardio-respiratory, muscular strength, flexibility, balance, and speed) and possible determinants related to child characteristics, child lifestyle and parental factors. Multivariate and mixed linear regression models were conducted. Age, sex, children's BMI and physical activity were independent and strong determinants of children's fitness. Significant but small effects were found for low maternal BMI, high psychosocial well-being and fruit and vegetable intake as protective determinants. Sleep duration, breakfast intake, parental age and education and paternal BMI did not have a consistently significant effect on physical fitness. The role of determinants depended on children's sex and the specific PF component. Longitudinal analyses especially highlighted the importance of child's BMI as physical fitness determinant, independent of physical activity. BMI together with physical activity, diet and psychosocial factors are modifiable targets to enhance physical fitness. This calls for policy approaches that combine these factors in a systematic way.

http://ift.tt/2uJConc

Hope dies last... A qualitative study into the meaning of hope for people with cancer in the palliative phase

Palliative patients may have strong hope, even hope for a cure, despite knowing their prognosis. Health professionals do not always understand patients who have this kind of hope. The aim of this article was to explore the meaning of hope among patients with cancer in the palliative phase. A secondary analysis was conducted including a constant comparative analysis to uncover the processes underlying the maintenance of hope, of previously collected interview data (n = 76). The meaning of hope is related to the importance of the object it is attached to, rather than to a real chance of achieving this object. Hope has a dual function: patients hope because they cannot forsake it and because they benefit so much from it. Hope can spring from many sources and is influenced by various factors. If there are fewer potent sources to tap into, people create hope themselves and this type of self-created hope takes more effort to maintain. Patients use different strategies to increase their hope, described as the 'the work of hope'. A better understanding of the work of hope can lead to better psychosocial support by health professionals. Health professionals convey many messages that affect the work of hope.

http://ift.tt/2tLmueH

Auditory Processing after Early Left Hemisphere Injury: A Case Report

Murphy, CFB; Stavrinos, G; Chong, K; Sirimanna, T; Bamiou, D-E; (2017) Auditory Processing after Early Left Hemisphere Injury: A Case Report. Frontiers in Neurology , 8 , Article 226. 10.3389/fneur.2017.00226 . Green open access

http://ift.tt/2sFepsC

Optical studies in a firing stratified-charge G-DI engine

Todd, AR; (2007) Optical studies in a firing stratified-charge G-DI engine. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tp14le

The abrupt onset of the modern South Asian Monsoon winds

Betzler, C; Eberli, GP; Kroon, D; Wright, JD; Swart, PK; Nath, BN; Alvarez-Zarikian, CA; Betzler, C; Eberli, GP; Kroon, D; Wright, JD; Swart, PK; Nath, BN; Alvarez-Zarikian, CA; Alonso-García, M; Bialik, OM; Blättler, CL; Guo, JA; Haffen, S; Horozal, S; Inoue, M; Jovane, L; Lanci, L; Laya, JC; Mee, ALH; Lüdmann, T; Nakakuni, M; Niino, K; Petruny, LM; Pratiwi, SD; Reijmer, JJG; Reolid, J; Slagle, AL; Sloss, CR; Su, X; Yao, Z; Young, JR; - view fewer (2016) The abrupt onset of the modern South Asian Monsoon winds. Scientific Reports , 6 , Article 29838. 10.1038/srep29838 . Green open access

http://ift.tt/2sFLGnp

Practical guidelines to minimise language and cognitive confounds in the diagnosis of CAPD: a brief tutorial.

Chermak, GD; Bamiou, D-E; Vivian Iliadou, V; Musiek, FE; (2017) Practical guidelines to minimise language and cognitive confounds in the diagnosis of CAPD: a brief tutorial. Int J Audiol , 56 (7) pp. 499-506. 10.1080/14992027.2017.1284351 .

http://ift.tt/2toUeMP

Observing actions after stroke: investigating the potential of the mirror neuron system as a rehabilitation tool

Samson, G; (2008) Observing actions after stroke: investigating the potential of the mirror neuron system as a rehabilitation tool. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sFGdgm

Systems of Indoctrination: Accelerated Christian Education in England

Scaramanga, J; (2017) Systems of Indoctrination: Accelerated Christian Education in England. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tpaCgp

New approaches to gene therapy and prognostic markers in melanoma

Ramsden, A; (2005) New approaches to gene therapy and prognostic markers in melanoma. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tLjBKQ

Awake dynamics and brain-wide direct inputs of hypothalamic MCH and orexin networks

Gonzalez, JA; Iordanidou, P; Strom, M; Adamantidis, A; Burdakov, D; (2016) Awake dynamics and brain-wide direct inputs of hypothalamic MCH and orexin networks. Nature Communications , 7 , Article 113. 10.1038/ncomms11395 . Green open access

http://ift.tt/2uJpBAY

Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group

Stacchiotti, S; Gronchi, A; Fossati, P; Akiyama, T; Alapetite, C; Baumann, M; Blay, JY; Stacchiotti, S; Gronchi, A; Fossati, P; Akiyama, T; Alapetite, C; Baumann, M; Blay, JY; Bolle, S; Boriani, S; Bruzzi, P; Capanna, R; Caraceni, A; Casadei, R; Colia, V; Debus, J; Delaney, T; Desai, A; Dileo, P; Dijkstra, S; Doglietto, F; Flanagan, A; Froelich, S; Gardner, PA; Gelderblom, H; Gokaslan, ZL; Haas, R; Heery, C; Hindi, N; Hohenberger, P; Hornicek, F; Imai, R; Jeys, L; Jones, RL; Kasper, B; Kawai, A; Krengli, M; Leithner, A; Logowska, I; Martin Broto, J; Mazzatenta, D; Morosi, C; Nicolai, P; Norum, OJ; Patel, S; Penel, N; Picci, P; Pilotti, S; Radaelli, S; Ricchini, F; Rutkowski, P; Scheipl, S; Sen, C; Tamborini, E; Thornton, KA; Timmermann, B; Torri, V; Tunn, PU; Uhl, M; Yamada, Y; Weber, DC; Vanel, D; Varga, PP; Vleggeert-Lankamp, CLA; Casali, PG; Sommer, J; - view fewer (2017) Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group. Annals of Oncology , 28 (6) pp. 1230-1242. 10.1093/annonc/mdx054 . Green open access

http://ift.tt/2uJemZl