Bullous pemphigoid following the replacement of vildagliptin with anagliptin

http://ift.tt/2uBsTaq

Replicon Particle Expressing the E2 Glycoprotein of Bovine Viral Diarrhea Virus Immunization and Evaluation of Antibody Response

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2szKo9F

Thymic Hyperplasia Associated with Graves' Disease: Pathophysiology and Proposed Management Algorithm

Thyroid , Vol. 0, No. 0.


http://ift.tt/2tAbC0U

Using Simulation to Improve Systems

Attempts to understand and improve health care delivery often focus on the characteristics of the patient and the characteristics of the health care providers, but larger systems surround and integrate with patients and providers. Components of health care delivery systems can support or interfere with efforts to provide optimal health care. Simulation in situ, involving real teams participating in simulations in real care settings, can be used to identify latent safety threats and improve the work environment while simultaneously supporting participant learning. Thoughtful planning and skilled debriefing are essential.

http://ift.tt/2tWta9Y

Total lower lip and chin reconstruction with radial forearm free flap: A novel approach

The management of large chin and lower lip defects is challenging due to this facial subunit's tremendous functional and aesthetic importance. Specific methods for total lower lip and mentum reconstruction are not well chronicled. Aesthetic and functional goals of this reconstruction include restoration of oral competence by maintaining lower lip height, vermilion reestablishment, color-matched skin introduction to the chin, sensation restoration, and ideally restoration of dynamic activity to the lower lip.

http://ift.tt/2tr3Sjy

Erratum to: Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?

http://ift.tt/2tWyKJv

Use of yeast ( Pichia kudriavzevii ) as a novel feed additive to ameliorate the effects of aflatoxin B 1 on broiler chicken performance

Abstract

The aim of this study was to evaluate the efficacy of autochthonous Pichia kudriavzevii as a novel bioadsorbent for aflatoxin B₁ (AFB₁). The selection of this yeast was based on the AFB₁ adsorption capacity previously demonstrated in vitro (Magnoli et al. 2016). One-day-old Cobb broilers (n = 160) were randomly assigned to four dietary treatments (T1: basal diet (B); T2: B + 0.1% yeast; T3: B + AFB₁, 100 μg/kg; T4: B + 0.1% yeast + AFB₁, 100 μg/kg). Performance parameters (average daily weight gain body, average daily consumption, feed conversion ratio, carcass weight, and dead weight), biochemical parameters (albumin, globulin, and albumin/globulin), liver pathological changes, and AFB₁ residual levels in the liver and excreta were evaluated. Significant differences (P < 0.05) in performance parameters were observed among treatments and controls: T3 group showed the lowest average daily body weight gain value while in T4 group, the value of this parameter increased significantly (P < 0.05). T3 and T4 groups showed the lowest and highest values for average daily feed consumption, respectively. The feed conversion ratio (FC) showed no significant differences among treatments. T3 group showed the lowest dead weight and carcass weight compared with T1 group. The biochemical parameters showed no significant differences among treatments. T3 group showed macroscopic and microscopic liver changes compared to the control. Aflatoxin B₁ levels (μg/g) were detected in broiler livers and showed significant differences among treatments (P < 0.05). In conclusion, native P. kudriavzevii incorporation (0.1%) in broiler diets containing AFB₁ was shown to be effective in ameliorating the adverse effects of AFB₁ on production.

http://ift.tt/2tSmU3z

Biphasic synovial sarcoma of the epiglottis: Case report and literature review

Publication date: Available online 6 July 2017
Source:Auris Nasus Larynx
Author(s): Marlene C. Wigand, Thomas K. Hoffmann, Thomas F.E. Barth, Johannes Veit
Synovial sarcomas are rare malignant tumors supposed to arise from pluripotent mesenchymal stem cells predominantly affecting the deep soft tissue of the lower and upper extremities in young adults. The occurrence of this tumor entity in the head and neck is very uncommon and hence, timely diagnosis and treatment of synovial sarcoma in this region remain a challenge.We describe the clinical and molecular pathological features of a biphasic synovial sarcoma of the epiglottis, a site where the primary manifestation of this tumor entity has not been documented to date. With this background the existing literature is being reviewed. Whilst wide excision of synovial sarcoma is considered as the primary mainstay of therapy, (neo)adjuvant treatment strategies have been proposed to increase local control and prolong disease-free survival.



http://ift.tt/2uUmMwW

Prognostic score in patients with recurrent or metastatic carcinoma of the head and neck treated with cetuximab and chemotherapy

by Teresa Magnes, Thomas Melchardt, Lukas Weiss, Christof Mittermair, Daniel Neureiter, Eckhard Klieser, Simon Gampenrieder, Gerhard Moser, Alexander Gaggl, Richard Greil, Alexander Egle

Despite modern treatment approaches, survival of patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) remains low and it is difficult to identify patients who derive optimal benefit from treatment. We therefore analyzed which commonly available laboratory and clinical parameters may help improve the prognostication in this patient group. This retrospective monocenter analysis includes 128 patients with recurrent or metastatic SCCHN treated with cetuximab alone or in combination with polychemotherapy as first line therapy. Factors with independent prognostic power in the multivariate analysis were used to build up a score separating patient groups with different survival. Patients had a median age of 61 years and 103 patients were treated with polychemotherapy plus cetuximab. An ECOG score above 1, high CRP and leukocyte levels, less intensive treatment and a time below 12 months from primary diagnosis to relapse remained as independent negative prognostic factors in multivariate analysis. Patients with 0 to 1 risk factors had a median OS of 13.6 months compared to a median OS of less than one month for patients 4 to 5 risk factors (p

http://ift.tt/2u0rT2o

Assessment of circulating copy number variant detection for cancer screening

by Bhuvan Molparia, Eshaan Nichani, Ali Torkamani

Current high-sensitivity cancer screening methods, largely utilizing correlative biomarkers, suffer from false positive rates that lead to unnecessary medical procedures and debatable public health benefit overall. Detection of circulating tumor DNA (ctDNA), a causal biomarker, has the potential to revolutionize cancer screening. Thus far, the majority of ctDNA studies have focused on detection of tumor-specific point mutations after cancer diagnosis for the purpose of post-treatment surveillance. However, ctDNA point mutation detection methods developed to date likely lack either the scope or analytical sensitivity necessary to be useful for cancer screening, due to the low (

http://ift.tt/2tVbNq7

Pembrolizumab, Chemotherapy, and Radiation Therapy With or Without Surgery in Treating Patients With Anaplastic Thyroid Cancer

Condition:   Thyroid Gland Undifferentiated (Anaplastic) Carcinoma
Interventions:   Drug: Docetaxel;   Drug: Doxorubicin Hydrochloride;   Radiation: Intensity-Modulated Radiation Therapy;   Other: Laboratory Biomarker Analysis;   Biological: Pembrolizumab;   Procedure: Therapeutic Conventional Surgery
Sponsors:   Mayo Clinic;   National Cancer Institute (NCI)
Not yet recruiting - verified July 2017

http://ift.tt/2uTDEnC

Effects of Voluntary Neck Extension on Cerebral Blood Flow, in Breath-hold Divers Ending an Apnoea of Two Minutes or More.

Condition:   Healthy Amateur Apneists
Intervention:   Other: apnea performing
Sponsor:   Nantes University Hospital
Not yet recruiting - verified July 2017

http://ift.tt/2tVxvu7

Use of Intra-Operative Shear Wave Ultrasound Vibrometry for Characterization of Esophageal Malignant Tumors

Condition:   Esophageal Cancer
Intervention:   Device: General Electric LOGIQ E9 ultrasound system
Sponsor:   Mayo Clinic
Recruiting - verified July 2017

http://ift.tt/2tVF0RJ

NCI-MATCH: Targeted Therapy Directed by Genetic Testing in Treating Patients With Advanced Refractory Solid Tumors, Lymphomas, or Multiple Myeloma

Conditions:   Advanced Malignant Solid Neoplasm;   Bladder Carcinoma;   Breast Carcinoma;   Cervical Carcinoma;   Colon Carcinoma;   Colorectal Carcinoma;   Endometrial Carcinoma;   Esophageal Carcinoma;   Gastric Carcinoma;   Glioma;   Head and Neck Carcinoma;   Kidney Carcinoma;   Liver and Intrahepatic Bile Duct Carcinoma;   Lung Carcinoma;   Lymphoma;   Malignant Uterine Neoplasm;   Melanoma;   Ovarian Carcinoma;   Pancreatic Carcinoma;   Plasma Cell Myeloma;   Prostate Carcinoma;   Rectal Carcinoma;   Recurrent Bladder Carcinoma;   Recurrent Breast Carcinoma;   Recurrent Cervical Carcinoma;   Recurrent Colon Carcinoma;   Recurrent Colorectal Carcinoma;   Recurrent Esophageal Carcinoma;   Recurrent Gastric Carcinoma;   Recurrent Glioma;   Recurrent Head and Neck Carcinoma;   Recurrent Liver Carcinoma;   Recurrent Lung Carcinoma;   Recurrent Lymphoma;   Recurrent Malignant Solid Neoplasm;   Recurrent Melanoma;   Recurrent Ovarian Carcinoma;   Recurrent Pancreatic Carcinoma;   Recurrent Plasma Cell Myeloma;   Recurrent Prostate Carcinoma;   Recurrent Rectal Carcinoma;   Recurrent Skin Carcinoma;   Recurrent Thyroid Gland Carcinoma;   Recurrent Uterine Corpus Carcinoma;   Refractory Lymphoma;   Refractory Malignant Solid Neoplasm;   Refractory Plasma Cell Myeloma;   Skin Carcinoma;   Thyroid Gland Carcinoma;   Uterine Corpus Cancer
Interventions:   Drug: Afatinib;   Drug: Akt inhibitor AZD5363;   Drug: Binimetinib;   Drug: Crizotinib;   Other: Cytology Specimen Collection Procedure;   Drug: Dabrafenib;   Drug: Dasatinib;   Drug: Defactinib;   Drug: FGFR Inhibitor AZD4547;   Other: Laboratory Biomarker Analysis;   Biological: Nivolumab;   Drug: Osimertinib;   Drug: Palbociclib;   Biological: Pertuzumab;   Drug: PI3K-beta Inhibitor GSK2636771;   Drug: Sapanisertib;   Drug: Sunitinib Malate;   Drug: Taselisib;   Drug: Trametinib;   Biological: Trastuzumab Emtansine;   Drug: Trk Inhibitor LOXO-101;   Drug: Vismodegib;   Drug: WEE1 Inhibitor AZD1775
Sponsor:   National Cancer Institute (NCI)
Recruiting - verified July 2017

http://ift.tt/2u0CpXt

Prognostic score in patients with recurrent or metastatic carcinoma of the head and neck treated with cetuximab and chemotherapy

by Teresa Magnes, Thomas Melchardt, Lukas Weiss, Christof Mittermair, Daniel Neureiter, Eckhard Klieser, Simon Gampenrieder, Gerhard Moser, Alexander Gaggl, Richard Greil, Alexander Egle

Despite modern treatment approaches, survival of patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) remains low and it is difficult to identify patients who derive optimal benefit from treatment. We therefore analyzed which commonly available laboratory and clinical parameters may help improve the prognostication in this patient group. This retrospective monocenter analysis includes 128 patients with recurrent or metastatic SCCHN treated with cetuximab alone or in combination with polychemotherapy as first line therapy. Factors with independent prognostic power in the multivariate analysis were used to build up a score separating patient groups with different survival. Patients had a median age of 61 years and 103 patients were treated with polychemotherapy plus cetuximab. An ECOG score above 1, high CRP and leukocyte levels, less intensive treatment and a time below 12 months from primary diagnosis to relapse remained as independent negative prognostic factors in multivariate analysis. Patients with 0 to 1 risk factors had a median OS of 13.6 months compared to a median OS of less than one month for patients 4 to 5 risk factors (p

http://ift.tt/2u0rT2o

Assessment of circulating copy number variant detection for cancer screening

by Bhuvan Molparia, Eshaan Nichani, Ali Torkamani

Current high-sensitivity cancer screening methods, largely utilizing correlative biomarkers, suffer from false positive rates that lead to unnecessary medical procedures and debatable public health benefit overall. Detection of circulating tumor DNA (ctDNA), a causal biomarker, has the potential to revolutionize cancer screening. Thus far, the majority of ctDNA studies have focused on detection of tumor-specific point mutations after cancer diagnosis for the purpose of post-treatment surveillance. However, ctDNA point mutation detection methods developed to date likely lack either the scope or analytical sensitivity necessary to be useful for cancer screening, due to the low (

http://ift.tt/2tVbNq7

Autoimmunity and allergy control in adults submitted to complete thymectomy early in infancy

by Susana L. Silva, Adriana Albuquerque, Andreia J. Amaral, Quan-Zhen Li, Catarina Mota, Rémi Cheynier, Rui M. M. Victorino, M. Conceição Pereira-Santos, Ana E. Sousa

The contribution of the decline in thymic activity for the emergence of autoimmunity is still debatable. Immune-competent adults submitted to complete thymectomy early in life provide a unique model to address this question. We applied here strict criteria to identify adults lacking thymic activity based on sjTREC levels, to exclude thymic rebound and/or ectopic thymuses. In agreement, they featured severe naïve CD4 T-cell depletion and contraction of T-cell receptor diversity. Notwithstanding this, there was neither increased incidence of autoimmune disease in comparison with age-matched controls nor significant changes in their IgG/IgA/IgM/IgE autoreactivity profiles, as assessed through extensive arrays. We reasoned that the observed relative preservation of the regulatory T-cell compartment, including maintenance of naïve regulatory CD4 T-cells, may contribute to limit the emergence of autoimmunity upon thymectomy. Our findings have implications in other clinical settings with impaired thymic activity, and are particularly relevant to studies of autoimmunity in ageing.

http://ift.tt/2u08UFd

PRAC Wants Lactose Out of Injectable Methylprednisolone

The committee advises against the use of injectable methylprednisolone containing lactose in patients with suspected or known allergy to cow's milk proteins.
News Alerts

http://ift.tt/2uyZFZB

Georgia Public Health Chief Brenda Fitzgerald, MD, to Head CDC

Widely respected in public health circles and politically connected, Dr Fitzgerald is perhaps best known for an initiative to encourage language development in babies.
News Alerts

http://ift.tt/2uz2l9s

Personalized Vaccines Hold Cancer at Bay in Two Early Trials

A novel class of personalized cancer vaccines, tailored to the tumors of individual patients, kept disease in check in two early-stage clinical trials, pointing to a new way to help the immune system fight back.
Reuters Health Information

http://ift.tt/2tWwOkQ

Continuing Nivolumab After Melanoma Progression Benefits Some Patients

Some clinically stable patients with advanced melanoma benefit from continued nivolumab treatment after disease progression, researchers say.
Reuters Health Information

http://ift.tt/2tuILLN

Autoimmunity and allergy control in adults submitted to complete thymectomy early in infancy

by Susana L. Silva, Adriana Albuquerque, Andreia J. Amaral, Quan-Zhen Li, Catarina Mota, Rémi Cheynier, Rui M. M. Victorino, M. Conceição Pereira-Santos, Ana E. Sousa

The contribution of the decline in thymic activity for the emergence of autoimmunity is still debatable. Immune-competent adults submitted to complete thymectomy early in life provide a unique model to address this question. We applied here strict criteria to identify adults lacking thymic activity based on sjTREC levels, to exclude thymic rebound and/or ectopic thymuses. In agreement, they featured severe naïve CD4 T-cell depletion and contraction of T-cell receptor diversity. Notwithstanding this, there was neither increased incidence of autoimmune disease in comparison with age-matched controls nor significant changes in their IgG/IgA/IgM/IgE autoreactivity profiles, as assessed through extensive arrays. We reasoned that the observed relative preservation of the regulatory T-cell compartment, including maintenance of naïve regulatory CD4 T-cells, may contribute to limit the emergence of autoimmunity upon thymectomy. Our findings have implications in other clinical settings with impaired thymic activity, and are particularly relevant to studies of autoimmunity in ageing.

http://ift.tt/2u08UFd

The microbiota and autoimmunity: Their role in thyroid autoimmune diseases

Publication date: Available online 6 July 2017
Source:Clinical Immunology
Author(s): Hedda L. Köhling, Sue F. Plummer, Julian R. Marchesi, Kelly S. Davidge, Marian Ludgate
Since the 1970s, the role of infectious diseases in the pathogenesis of Graves' disease (GD) has been an object of intensive research. The last decade has witnessed many studies on Yersinia enterocolitica, Helicobacter pylori and other bacterial organisms and their potential impact on GD. Retrospective, prospective and molecular binding studies have been performed with contrary outcomes. Until now it is not clear whether bacterial infections can trigger autoimmune thyroid disease. Common risk factors for GD (gender, smoking, stress, and pregnancy) reveal profound changes in the bacterial communities of the gut compared to that of healthy controls but a pathogenetic link between GD and dysbiosis has not yet been fully elucidated. Conventional bacterial culture, in vitro models, next generation and high-throughput DNA sequencing are applicable methods to assess the impact of bacteria in disease onset and development. Further studies on the involvement of bacteria in GD are needed and may contribute to the understanding of pathogenetic processes. This review will examine available evidence on the subject.



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Wat met lichamelijke schade bij arbeids(weg)ongeval

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Info aanvullend pensioen via MyPension.be

http://ift.tt/2uSELUE

Nu ook online info over uw aanvullend pensioen

http://ift.tt/2tUIFPI

deel 9 : Verzekeringen

http://ift.tt/2uSM6nd

Kunt u zich verzekeren tegen cybermisdaad ?

verzekerbaarheid van cybercrime

http://ift.tt/2tUTbWX

Let's do it again! The representation of nudity in the Dutch-Flemish monolingual remake

http://ift.tt/2tZVOrl

Least-square estimation of the equivalent circuit parameters of a via-hole from TDR-reflectogram, including on-board rise time and delay estimation.

http://ift.tt/2tUvoGT

ISCALAR MAGNETOSTATIC POTENTIAL APPROACH TO THE PREDICTION OF THE EXCESS INDUCTANCE OF GROUNDED VIAS AND VIAS THROUGH A HOLE IN A GROUND PLANE.

http://ift.tt/2uSf0DN

PREDICTION OF THE EXCESS CAPACITANCE OF A VIA-HOLE THROUGH A MULTILAYERED BOARD INCLUDING THE EFFECT OF CONNECTING MICROSTRIPS OR STRIPLINES.

http://ift.tt/2tUk9hG

When Empowering Leadership Fosters Creative Performance: the Role of Problem Solving Demands and Creative Personality

The purpose of this paper is to investigate the circumstances under which empowering leadership fosters creative performance. Arguments were developed for a three-way interaction of empowering leadership, problem solving demands and creative personality in this linkage. These arguments resulted in competing hypotheses from a fit and a compensation perspective. The results from a survey of 213 employees of a Flemish large industrial organization were used. We found that less creative employees in jobs with high problem solving demands particularly benefit from empowering leadership. This paper adds to a more complex understanding of the effectiveness of empowering leadership by highlighting the relevance of the simultaneous interplay of contextual and personal factors.

http://ift.tt/2uSsfV6

Formula E: Next Generation Motorsport with Next Generation Fans

http://ift.tt/2tUxlmB

Emergent Ecosystem for Radical Innovation: Entrepreneurial Probing at Formula E

http://ift.tt/2uSgspR

Financial Management in Practice

http://ift.tt/2tUk4KU

FINANCIEEL MANAGEMENT TOEGEPAST

http://ift.tt/2uSECAE

Entrepreneurhsip, a way of life

http://ift.tt/2tU8MpW

Evaluating business process maturity models

Maturity models have become important aids to support process improvement. However, researchers have frequently criticized the many business process maturity models (BPMMs) for differing in quality, which creates a demand for comparing and evaluating these models. This paper describes a well-founded, ranked, and weighted set of critical criteria for BPMMs that are most important to prospective users. The paper also demonstrates how this set can serve as a standard or guideline for designing BPMMs. In evaluating the used sample of BPMMs against the set of criteria, we reveal gaps and shortcomings of current BPMMs, make suggestions for raising the quality of BPMMs, and highlight future research avenues.

http://ift.tt/2uSEt0e

The role of multi-actor governance in aligning farm modernization and sustainable rural development

http://ift.tt/2tTYvKj

Creating Spatial Synergies around Food in Cities

http://ift.tt/2uSqkA8

The impact of performance management systems on employee wellbeing and performance: Mutual gains and conflicting outcomes

http://ift.tt/2tU7R8O

CHANGING LOVE IN ‘SCENER UR ETT ÄKTENSKAP’ (INGMAR BERGMAN, 1973)

http://ift.tt/2uSs8sE

Persistent Vulval Symptoms in a 16-Year-Old Girl

http://ift.tt/2txLMuu

Patient Perspectives: What is Tinea?

http://ift.tt/2sNVcVO

Asymptomatic Upper Lip Swelling in an 8-Year-Old Boy

http://ift.tt/2tyadZ2

Issue Information

http://ift.tt/2txFICo

Multiple Milia as an Isolated Skin Manifestation of Dominant Dystrophic Epidermolysis Bullosa: Evidence of Phenotypic Variability

http://ift.tt/2sNTunv

Recurrent Erythematous Papules and Nodules on the Trunk and Extremities of a 3-Year-Old Girl

http://ift.tt/2sOffU7

Deviated septum: Causes, symptoms, and treatment

It is quite common for people to not have a straight septum. What is a deviated septum, what causes it, and how is a deviated septum diagnosed?

http://ift.tt/2ty6z1k

A World without Hunger: Organic or GM Crops?

It has been estimated that the world population will increase to 9.2 billion by 2050; supplying the growing population with food will require a significant increase in agricultural production. A number of agricultural and ecological scientists believe that a large-scale shift to organic farming (OF) would not only increase the world's food supply, but might be the only way to eradicate hunger sustainably. Nevertheless, OF has recently come under new scrutiny, not just from critics who fear that a large-scale shift in this direction would cause billions to starve but also from farmers and development agencies who question whether such a shift could improve food security. Meanwhile, the use of genetically modified (GM) crops is growing around the world, leading to possible opportunities to combat food insecurity and hunger. However, the development of GM crops has been a matter of considerable interest and worldwide public controversy. So far, no one has comprehensively analyzed whether a widespread shift to OF or GM would be the sole solution for both food security and safety. Using a literature review from databases of peer-reviewed scientific publications, books, and official publications, this study aims to address this issue. Results indicate that OF and GM, to different extents, are able to ensure food security and safety. In developed countries, given that there are relatively few farmers and that their productivity, even without GMOs, is relatively high, OF could be more a viable option. However, OF is significantly less efficient in land-use terms and may lead to more land being used for agriculture due to its lower yield. In developing countries, where many small-scale farmers have low agricultural productivity and limited access to agricultural technologies and information, an approach with both GM and OF might be a more realistic approach to ensure food security and safety.

http://ift.tt/2sUu8PP

A comparative study on basophil activation test, histamine release assay and passive sensitization histamine release assay in the diagnosis of peanut allergy

Abstract

Background

Allergy can be diagnosed using basophil tests. Several methods measuring basophil activation are available. This study aimed at comparing basophil activation test (BAT), histamine release assay (HR) and passive sensitization histamine release assay (passive HR) in the diagnosis of peanut allergy.

Methods

BAT, HR, and passive HR were performed on eleven peanut allergic and fourteen non-allergic subjects. Blood was incubated with peanut extract or anti-IgE and tests performed as follows: BAT - CD63-upregulation assessed by flow cytometry; HR - released histamine quantified by a glass fiber-based fluorometric method; Passive HR - IgE-stripped donor basophils were incubated with participants' serum and histamine release quantified as HR.

Results

CDsens, a measure of basophil allergen sensitivity, was significantly higher for BAT (80.1 ± 17.4) compared to HR (23.4 ± 10.31) and passive HR (11.1 ± 2.0). BAT, HR, and passive HR had a clinical sensitivity of 100%, 100%, and 82%, and specificity of 100%, 100%, and 100%, respectively when excluding inconclusive results. BAT identified 11 of 11 allergic patients, HR 10 and passive HR 9. Likewise, BAT recognized 12 of 14 non-allergic subjects, HR 10 and passive HR 13. However, the tests' diagnostic performances were not statistically different. Interestingly, non-releasers in HR but not in BAT had lower basophil count compared to releasers (249 vs. 630 counts/min).

Conclusion

BAT displayed a significant higher CDsens compared to HR and passive HR. The basophil tests' diagnostic performances were not significantly different. Still, BAT could diagnose subjects with low basophil number in contrast to HR.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tZGtag

Studies of photodynamic therapy: Investigation of physiological mechanisms and dosimetry

Woodhams, JH; (2006) Studies of photodynamic therapy: Investigation of physiological mechanisms and dosimetry. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sUTWLL

Reticular dysgenesis: international survey on clinical presentation, transplantation, and outcome

Hoenig, M; Lagresle-Peyrou, C; Pannicke, U; Notarangelo, LD; Porta, F; Gennery, AR; Slatter, M; Hoenig, M; Lagresle-Peyrou, C; Pannicke, U; Notarangelo, LD; Porta, F; Gennery, AR; Slatter, M; Cowan, MJ; Stepensky, P; Al-Mousa, H; Al-Zahrani, D; Pai, S-Y; Al Herz, W; Gaspar, HB; Veys, P; Oshima, K; Imai, K; Yabe, H; Noroski, LM; Wulffraat, NM; Sykora, K-W; Soler-Palacin, P; Muramatsu, H; Al Hilali, M; Moshous, D; Debatin, K-M; Schuetz, C; Jacobsen, E-M; Schulz, AS; Schwarz, K; Fischer, A; Friedrich, W; Cavazzana, M; - view fewer (2017) Reticular dysgenesis: international survey on clinical presentation, transplantation, and outcome. Blood , 129 (21) pp. 2928-2938. 10.1182/blood-2016-11-745638 .

http://ift.tt/2toLLL0

Stochastic dominance to account for uncertainty and risk in conservation decisions

Canessa, S; Ewen, JG; West, M; McCarthy, MA; Walshe, TV; (2016) Stochastic dominance to account for uncertainty and risk in conservation decisions. Conservation Letters , 9 (4) pp. 260-266. 10.1111/conl.12218 . Green open access

http://ift.tt/2sUS4T7

Studies into the transmission of hepatitis B virus that mutate following therapy with nucleoside analogues and the potential for such transmission to be serologically undetectable

Sloan, RD; (2008) Studies into the transmission of hepatitis B virus that mutate following therapy with nucleoside analogues and the potential for such transmission to be serologically undetectable. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tp59rq

Simple non-invasive fibrosis scores identify patients with nonalcoholic fatty liver disease who progress to advanced fibrosis/cirrhosis: evidence from a large cohort of patients with sequential liver biopsies

Mcpherson, S; Pais, R; Valenti, L; Schattenberg, JM; Dufour, J-F; Tsochatzis, E; Francque, S; Mcpherson, S; Pais, R; Valenti, L; Schattenberg, JM; Dufour, J-F; Tsochatzis, E; Francque, S; Hardy, T; Boyle, M; Tiniakos, D; Ratziu, V; Anstee, Q; - view fewer (2017) Simple non-invasive fibrosis scores identify patients with nonalcoholic fatty liver disease who progress to advanced fibrosis/cirrhosis: evidence from a large cohort of patients with sequential liver biopsies. Presented at: International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver, Amsterdam, Netherlands. Green open access

http://ift.tt/2sUHcVp

Strategies to enhance the efficacy of chemotherapy

Sabharwal, A; (2008) Strategies to enhance the efficacy of chemotherapy. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tpcGGR

Staging urban change, reimaging the city: The politics of place marketing in the 'New Berlin' (1989-2004)

Colomb, CM; (2008) Staging urban change, reimaging the city: The politics of place marketing in the 'New Berlin' (1989-2004). Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sUI3VZ

Assessment for learning? Thinking outside the (black) box

Hargreaves, E; (2005) Assessment for learning? Thinking outside the (black) box. Cambridge Journal of Education , 35 (2) pp. 213-224. 10.1080/03057640500146880 .

http://ift.tt/2tp8tCS

Lucy Huskinson: Nietzsche and Jung. The Whole Self in the Union of Opposites

Liebscher, M; (2006) Lucy Huskinson: Nietzsche and Jung. The Whole Self in the Union of Opposites. Nietzsche-Studien , 35 pp. 393-397. 10.1515/9783110186468.393 .

http://ift.tt/2sUXgX0

Stability of small molecular clusters modelled with stochastic and deterministic dynamics

Natarajan, S; (2007) Stability of small molecular clusters modelled with stochastic and deterministic dynamics. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tpanDD

Spectroscopy and dynamics of Rydberg states of NO in static and ramped electric fields

Patel, R; (2008) Spectroscopy and dynamics of Rydberg states of NO in static and ramped electric fields. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sUH9ZJ

Suspended timber ground floors: measured heat loss compared with models

Pelsmakers, S; Croxford, B; Elwell, CA; (2017) Suspended timber ground floors: measured heat loss compared with models. Building Research & Information 10.1080/09613218.2017.1331315 . (In press). Green open access

http://ift.tt/2sUHbkj

Roman Cargoes: Underwater Evidence from the Eastern Mediterranean

Strauss, EJ; (2007) Roman Cargoes: Underwater Evidence from the Eastern Mediterranean. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2toJijO

The dynamic excitation of a granular chain: Contact mechanics finite element analysis and experimental validation.

Gélat, P; Yang, J; Akanji, O; Thomas, PJ; Hutchins, D; Harput, S; Freear, S; Gélat, P; Yang, J; Akanji, O; Thomas, PJ; Hutchins, D; Harput, S; Freear, S; Saffari, N; - view fewer (2017) The dynamic excitation of a granular chain: Contact mechanics finite element analysis and experimental validation. J Acoust Soc Am , 141 (6) , Article 4240. 10.1121/1.4983466 .

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Socioeconomic position, self-rated health and mortality in Russia

Perlman, FJA; (2006) Socioeconomic position, self-rated health and mortality in Russia. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tpaj6R

Synthesis and Exciton Dynamics of Donor-Orthogonal Acceptor Conjugated Polymers: Reducing the Singlet-Triplet Energy Gap.

Freeman, DME; Musser, AJ; Frost, JM; Stern, HL; Forster, AK; Fallon, KJ; Rapidis, AG; Freeman, DME; Musser, AJ; Frost, JM; Stern, HL; Forster, AK; Fallon, KJ; Rapidis, AG; Cacialli, F; McCulloch, I; Clarke, TM; Friend, RH; Bronstein, H; - view fewer (2017) Synthesis and Exciton Dynamics of Donor-Orthogonal Acceptor Conjugated Polymers: Reducing the Singlet-Triplet Energy Gap. J Am Chem Soc 10.1021/jacs.7b03327 . (In press).

http://ift.tt/2sUjPeK

Nucleation of fractal nanocrystallites upon annealing of Fe-based metallic glass

Diao, J; Chen, B; Luo, Q; Lin, W; Liu, X; Shen, J; Robinson, I; (2017) Nucleation of fractal nanocrystallites upon annealing of Fe-based metallic glass. [Review]. Journal of Materials Research , 32 (10) pp. 1880-1887. 10.1557/jmr.2017.79 .

http://ift.tt/2tp9hYh

Social competence and executive function in children treated with Bone Marrow Transplant (BMT) for congenital immunodeficiency

Skucek, E; (2008) Social competence and executive function in children treated with Bone Marrow Transplant (BMT) for congenital immunodeficiency. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sUZLc2

Unusual acute lupus hemophagocytic syndrome – a test of diagnostic criteria: a case report

Hemophagocytic lymphohistiocytosis is an aggressive life-threatening syndrome of excessive immune activation. Hemophagocytic lymphohistiocytosis due to systemic lupus erythematosus is described as acute lupus ...

http://ift.tt/2uyjhNq

Mesenteric cysts and mesenteric venous thrombosis leading to intestinal necrosis in pregnancy managed with laparotomy: a case report and review of the literature

Mesenteric cyst is a rare clinical entity especially in pregnancy; therefore, few cases have been reported in the literature. The standard method of their treatment is surgical excision either with laparotomy ...

http://ift.tt/2tZk5Ot

BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007)

Abstract

This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10–15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.

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Cover Image

The cover image, by J. Just et al., is based on the Original Article Clinical phenotypes in asthma during childhood, DOI 10.1111/cea.12939

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Issue Information

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Rhinitis guidelines

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Forthcoming Meetings

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Silver Alginate Hydrogel Micro- and Nanocontainers for Theranostics: Synthesis, Encapsulation, Remote Release, and Detection

We have designed multifunctional silver alginate hydrogel microcontainers referred to as loaded microcapsules with different sizes by assembling them via a template assisted approach using natural, highly porous calcium carbonate cores. Sodium alginate was immobilized into the pores of calcium carbonate particles of different sizes followed by cross-linking via addition of silver ions, which had a dual purpose: on one hand, the were used as a cross-linking agent, albeit in the monovalent form, while on the other hand they have led to formation of silver nanoparticles. Monovalent silver ions, an unusual cross-linking agent, improve the sensitivity to ultrasound, lead to homogeneous distribution of silver nanoparticles. Silver nanoparticles appeared on the shell of the alginate microcapsules in the twin-structure as determined by transmission electron microscopy. Remote release of a payload from alginate containers by ultrasound was found to strongly depend on the particle size. The possibility to use such particles as a platform for label-free molecule detection based on the surface enhanced Raman scattering was demonstrated. Cytotoxicity and cell uptake studies conducted in this work have revealed that microcontainers exhibit nonessential level of toxicity with an efficient uptake of cells. The above-described functionalities constitute building blocks of a theranostic system, where detection and remote release can be achieved with the same carrier.

http://ift.tt/2tU1jHo

Schoolmoeheid aan het eind van het basisonderwijs: Oorzaken en evolutie op korte termijn

http://ift.tt/2uSiIO2

Problematic Patriarchy: Jack Nicholson’s Mischievous Masculinities, 1969-75

http://ift.tt/2tQbWv9

Service provider DevOps for large scale modern network services

Network service providers are facing challenges for deploying new services mainly due to the growing complexity of software architecture and development process. Moreover, the recent architectural innovation of network systems such as Network Function Virtualization (NFV), Software-defined Networking (SDN), and Cloud computing increases the development and operation complexity yet again. One of the emerging solutions to this problem is a novel software development concept, namely DevOps, that is widely employed by major Internet software companies. Although the goals of DevOps in data centers are well-suited for the demands of agile service creation, additional requirements specific to the virtualized and software-defined network environment are important to be addressed from the perspective of modern network carriers. In this paper, we thoroughly debate DevOps requirements for developing a modern service creation platform by taking EU FP7 project UNIFY as a reference architecture and suggest the corresponding extensions of UNIFY interfaces that meet the discovered requirements.

http://ift.tt/2sxpQyt

Taking Advertising Literacy to a Higher Level: An Exploratory Multilevel Analysis of Children's Advertising Literacy

As few studies focus on how children's coping with advertising is affected by their environment, the present study uses multilevel analysis to explore the role of both primary (i.e. parents) and secondary socializing agents (i.e. classmates, teachers) in children's advertising literacy. The results show that children's cognitive advertising literacy and attitudes toward advertising are to a large extent determined by class-level processes. Their moral advertising literacy is a more individual matter, yet greatly influenced by children's teachers – though in a remarkable manner. Parents do not seem to have much of an impact, except through socioeconomic factors such as educational background.

http://ift.tt/2tZgUWY

Evaluation of performance models for farm-specific optimization of pig production

Farm-specific optimization of pig production can be supported with a production function mechanistically derived from dynamic growth and feed intake information, hereafter called performance curves. Production theoretical optimization requires, first, an accurate description of underlying processes and, second, possibilities for calibrations with available on-farm data. The objective is to evaluate accuracy and calibration requirements of seven models: the Gompertz, Monomolecular, Richards and Generalized Michaelis-Menten (GMM) model for growth and the cumulative feed intake and weight (CFIW), Bridges and Giesen models for both growth and feed intake. Evaluation is done with data from four trials with four sexes of a Pietrain x hybrid sow cross: boars, barrows, gilts and GnRH-vaccinated boars. Accuracy was evaluated with Root Mean Squared Errors (RMSE) of predictions versus observations and F-tests for differences in goodness-of-fit to discriminate between models. Calibration possibilities were evaluated through fitting the models through limited data. The Giesen, Bridges and GMM model, describing sigmoidal growth patterns, showed the highest accuracy. In terms of calibration possibilities, the Bridges model slightly outperformed the other. The Giesen model is accurate for describing feed intake of boars, barrows, gilts. GnRH-vaccinated animals showed unstable variance with increasing age of the animal, which could only partially been solved with extensions to the Bridges and Giesen model. The research showed that dynamic growth and feed intake curves can be reasonably estimated from limited on-farm collectable data and generic functional forms, and as such account for farm specificity in production-theoretical economic optimization.

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From persuasive messages to tactics: Exploring children’s knowledge and judgment of new advertising formats

Despite that contemporary advertising is decreasingly about persuading children through persuasive messages and increasingly about influencing them through implicit tactics, little attention has been given to how children may cope with advertising by understanding and evaluating the new advertising tactics. Drawing on 12 focus groups entailing 60 European children of ages 9-11, this article investigates children's advertising literacy by exploring their knowledge and judgments (and according reasoning strategies) of the new advertising formats. In particular, insight is provided into children's critical reflection on the tactics of brand integration, interactivity and personalization in the advertising formats brand placement, advergames and retargeted pre-roll video ads on social media. It is shown that while children not spontaneously do so, they appear to have the ability to understand these tactics and form judgments about their (moral) appropriateness, thereby considering a wide range of societal actors.

http://ift.tt/2tZ7ACx

Effects of low to moderate levels of deoxynivalenol on feed and water intake, weight gain, and slaughtering traits of broiler chickens

Abstract

The aim of the study was to evaluate the effects of low to moderate oral exposure to the Fusarium toxin deoxynivalenol (DON; derived from culture material) on performance, water intake, and carcass parameters of broilers during early and late developmental phases. A total of 160 Ross 308 broilers were randomly allocated to four different feeding groups (n = 40/group) including 0 (control), 2.5, 5, and 10 mg DON/kg wheat-soybean meal-based feed. Three consecutive replicates of the experiment were performed. Half of the broilers were slaughtered in week 3 of the trial whereas the other half were slaughtered in week 5. Dry matter intake (DMI) and water intake (WI) were recorded on a daily basis and the body weight (BW) and BW gain (BWG) were determined weekly. The following carcass traits were recorded and calculated in absolute and relative data: dressed carcass weight, breast muscle weight, leg weight, and liver weight. Data showed that BW (P < 0.001), BWG (P = 0.005), and DMI (P < 0.001) were reduced by DON-feeding during the entire feeding period. The ratio of DMI to body weight gain (DMI/BWG) was not affected by the treatment. However, the ratio of water to DMI (WI/DMI) increased in DON-treated birds (P = 0.021). Contrast analysis showed that DON tendentially reduced slaughter weight (P = 0.082) and decreased leg yield (P = 0.037) in DON-fed chickens in week 5 of the experiment. Liver organ weight decreased in the 3-week-old DON-fed broilers compared to that in the control-fed birds (P = 0.037). In conclusion, the study suggests that DMI and BW were negatively affected under the experimental conditions at DON levels lower than the current guidance value in the European Union of 5 mg/kg feed. The study also indicates that broilers fed on low to moderate level DON-contaminated diets showed increased WI/DMI ratio which might have negative influence on wet litter syndrome.

http://ift.tt/2uy1WV6

Development and performance of Triple-GEM detectors for the upgrade of the muon system of the CMS experiment

The CMS Collaboration is evaluating GEM detectors for the upgrade of the muon system. This contribution will focus on the R&D performed on chambers design features and will discuss the performance of the upgraded detector.

http://ift.tt/2sUwMox

Researchers Find Handwritten Opioid Prescriptions are More Prone to Mistakes

In a small study of opioid prescriptions filled at a Johns Hopkins Medicine outpatient pharmacy, researchers found that handwritten orders for the drugs contribute heavily to a trio of prescribing and processing errors in contrast to those created electronically.

http://ift.tt/2sO06C4

Emotional and Sensory Evaluation of Cheese: The Effect of Health Labels

http://ift.tt/2sxcbYk

Optimizing a protocol for protoplast fusion of Saccharomyces cerevisiae with highly osmophilic yeasts

http://ift.tt/2tPW8bN

Epidemiology of antimicrobial resistance in commensal E. coli

http://ift.tt/2swFR80

Trapping in proton irradiated p(+)-n-n(+) silicon sensors at fluences anticipated at the HL-LHC outer tracker

The degradation of signal in silicon sensors is studied under conditions expected at the CERN High-Luminosity LHC. 200 mu m thick n-type silicon sensors are irradiated with protons of different energies to fluences of up to 3.10(15) neq/cm(2). Pulsed red laser light with a wavelength of 672 nm is used to generate electron-hole pairs in the sensors. The induced signals are used to determine the charge collection efficiencies separately for electrons and holes drifting through the sensor. The effective trapping rates are extracted by comparing the results to simulation. The electric field is simulated using Synopsys device simulation assuming two effective defects. The generation and drift of charge carriers are simulated in an independent simulation based on PixelAV. The effective trapping rates are determined from the measured charge collection efficiencies and the simulated and measured time-resolved current pulses are compared. The effective trapping rates determined for both electrons and holes are about 50% smaller than those obtained using standard extrapolations of studies at low fluences and suggest an improved tracker performance over initial expectations.

http://ift.tt/2tPVmvv

Risk of cutaneous T-cell lymphoma in patients with chronic lymphocytic leukemia and other subtypes of non-Hodgkin lymphoma

Abstract

Background

Second hematologic cancers in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) are well documented and include Hodgkin lymphoma, therapy-related acute myeloid leukemia/myelodysplastic syndromes, and transformation to diffuse large B-cell lymphoma. Although cutaneous T-cell lymphoma (CTCL) has been reported in patients with CLL, the incidence and comparison to expected rates are unknown. We evaluated the incidence of CTCL among patients with CLL or other non-Hodgkin lymphoma (NHL) subtypes using data from the Surveillance, Epidemiology, and End Results (SEER) Program.

Methods

We searched the SEER 13 registries for patients with a diagnosis of CLL and NHL between 1992 and 2008. Among patients identified, we evaluated the incidence of CTCL.

Results

Among 31,286 patients with CLL, the incidence of CTCL was not significantly higher in men than women: 104.2 (95% CI, 50.0–191.8) and 28.1 (95% CI, 3.4–101.3) per 1,000,000 person-years, respectively (P = 0.06). Among 97,691 patients with NHL, the incidence of CTCL was similar in men and women (97.9 [95% CI, 62.0–146.9] and 92.0 [95% CI, 56.2–142.1] per 1,000,000 person-years, respectively; P = 0.84). The incidence of CTCL among males with CLL (standardized incidence ratio [SIR], 3.0 [95% CI, 1.4–5.5]), males with NHL (SIR, 3.7 [95% CI, 2.3–5.5]), and females with NHL (SIR, 5.9 [95% CI, 3.6–9.1]) was significantly higher than expected in the general population (all P < 0.001).

Conclusion

The risk of CTCL is greater in men with CLL than in the general population. In patients with NHL, both men and women are at greater risk for CTCL than in the general population.

http://ift.tt/2uRvoVd

Simonides and the role of the poet

Rawles, RJ; (2008) Simonides and the role of the poet. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sNZ4pL

Simulation studies of the organic solid state

Torrisi, A; (2007) Simulation studies of the organic solid state. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2txCC1g

High strain rate deformation of porous sandstone and the asymmetry of earthquake damage in shallow fault zones

Aben, FM; Doan, M-L; Gratier, J-P; Renard, F; (2017) High strain rate deformation of porous sandstone and the asymmetry of earthquake damage in shallow fault zones. Earth and Planetary Science Letters , 463 pp. 81-91. 10.1016/j.epsl.2017.01.016 .

http://ift.tt/2sO0EIc

Effect of major school playground reconstruction on physical activity and sedentary behaviour: Camden active spaces.

Hamer, M; Aggio, D; Knock, G; Kipps, C; Shankar, A; Smith, L; (2017) Effect of major school playground reconstruction on physical activity and sedentary behaviour: Camden active spaces. BMC Public Health , 17 (1) , Article 552. 10.1186/s12889-017-4483-5 . Green open access

http://ift.tt/2txBR8c

Erratum: Hearing the Shape of the Ising Model with a Programmable Superconducting-Flux Annealer.

Vinci, W; Markström, K; Boixo, S; Roy, A; Spedalieri, FM; Warburton, PA; Severini, S; (2017) Erratum: Hearing the Shape of the Ising Model with a Programmable Superconducting-Flux Annealer. [Corrigendum]. Sci Rep , 7 , Article 40651. 10.1038/srep40651 . Green open access

http://ift.tt/2sOpAiV

Optical Binding of Nanowires

Simpson, SH; Zemanek, P; Marago, OM; Jones, PH; Hanna, S; (2017) Optical Binding of Nanowires. Nano Letters , 17 (6) pp. 3485-3492. 10.1021/acs.nanolett.7b00494 .

http://ift.tt/2txbFL6

Fat Harvest Using a Closed-Suction Drain.

Amin, K; Zakeri, R; Mallucci, P; (2016) Fat Harvest Using a Closed-Suction Drain. Arch Plast Surg , 43 (3) pp. 288-290. 10.5999/aps.2016.43.3.288 . Green open access

http://ift.tt/2sNpSGR

Role of the homeobox HESX1/HESX1 in forebrain and pituitary development in mouse and human

Sajedi, E; (2008) Role of the homeobox HESX1/HESX1 in forebrain and pituitary development in mouse and human. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2txyG0q

Resilience in the face of unemployment: developmental trajectories of protective resources

Shaw, RJ; (2008) Resilience in the face of unemployment: developmental trajectories of protective resources. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2sNXSCD

Representing space: the development, content and accuracy of mental representations by the blind and visually impaired

Schinazi, VR; (2008) Representing space: the development, content and accuracy of mental representations by the blind and visually impaired. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2txbQWD

When is the Fukui function not normalized? : the danger of inconsistent energy interpolation models in density functional theory

When one defines the energy of a molecule with a noninteger number of electrons by interpolation of the energy values for integer-charged states, the interpolated electron density, Fukui function, and higher-order derivatives of the density are generally not normalized correctly. The necessary and sufficient condition for consistent energy interpolation models is that the corresponding interpolated electron density is correctly normalized to the number of electrons. A necessary, but not sufficient, condition for correct normalization is that the energy interpolant be a linear function of the reference energies. Consistent with this general rule, polynomial interpolation models and, in particular, the quadratic E vs N model popularized by Parr and Pearson, do give normalized densities and density derivatives. Interestingly, an interpolation model based on the square root of the electron number also satisfies the normalization constraints. We also derive consistent least-norm interpolation models. In contrast to these models, the popular rational and exponential forms for E vs N do not give normalized electron densities and density derivatives.

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Crystal structure and absolute configuration of 28-O-acetylbetulin

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Adrenal incidentaloma in a patient with HIV/AIDS

Abstract

Human immunodeficiency virus (HIV) is well known to be associated with various neoplasms and opportunistic infections. Kaposi sarcoma (KS), associated with human herpes virus 8 (HHV8) infection, is the most common tumour in HIV positive patients and is also an acquired immune deficiency syndrome (AIDS) defining illness. Cutaneous manifestations are the most common presenting symptom; however, visceral involvement is also recognized. We present the case of a 55-year-old male who was diagnosed with AIDS-related KS, who was referred to our surgical unit with an indeterminate left adrenal lesion. He subsequently started antiretroviral therapy and given the indeterminate nature of his adrenal lesion, we performed a laparoscopic left adrenalectomy, with KS of the adrenal gland confirmed on histology

http://ift.tt/2tYQDbk

Eccrine angiokeratomatous hamartoma: case report of a 1.5-year girl

Abstract

Eccrine angiokeratomatous hamartoma is a rare newly defined vascular lesion of the skin, the first case of which was reported in 2006 (Kanitakis J, Ly A, Claudy A. Eccrine angiokeratomatous hamartoma: a new variant of eccrine hamartoma with angiokeratoma. J Am Acad Dermatol 2006; 55: S104–6). On web Literature Search, Only three previously documented cases of the lesions were found. A 1.5-year-old female child presented with a painless lesion on her right leg since birth which has been gradually increasing in size and recently developed central ulceration. Histological examination of the excised lesion confirmed the diagnosis. This is the first of the cases to be reported in paediatric age-group (<2 years)

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Myomectomies for massive hemoperitoneum from spontaneous bleeding of a uterine myoma

Abstract

Massive hemoperitoneum from spontaneous bleeding of uterine myoma is an extremely rare condition, that needs urgent surgical exploration. We report a 40-year-old woman, admitted for acute onset of abdominal pain. Physical examination revealed hypovolemic shock. The hemoglobin level was of 5 g/dL. Ultrasonography revealed hemoperitoneum. Emergency surgical exploration was planned. There was hemoperitoneum of 3 L, uterine myomas with multiple subserous myomas, bleeding from superficial ruptured varice overlying the most largest subserous myoma, which measured 15 cm. Glove adapted as a tourniquet, was applied at the base of the uterus, and myomectomies were performed with removal of around twenty myomas. The postoperative course was uneventful. Myomectomies can be safely and effectively performed by using a tourniquet, for massive hemoperitoneum with precarious hemodynamic status due to subserous myoma bleeding, despite the number and the size of myomas.

http://ift.tt/2tZ2M02

Treatment, short-term outcomes, and costs associated with larynx cancer care in commercially insured patients

Objectives/Hypothesis

To examine associations between treatment, complications, and costs in patients with laryngeal cancer.

Study Design

Retrospective cross-sectional analysis of MarketScan Commercial Claim and Encounters data.

Methods

We evaluated 10,969 patients diagnosed with laryngeal cancer from 2010 to 2012 using cross-tabulations and multivariate regression.

Results

Chemoradiation was significantly associated with supraglottic tumors (relative risk ratio [RRR] = 5.9 [4.4–7.8]), pretreatment gastrostomy (RRR = 4.0 [2.7–6.1]), and alcohol abuse (RRR = 0.5 [0.3–0.9]). Treatment-related complications occurred in 23% of patients, with medical complications in 22% and surgical complications in 7%. Chemoradiation (odds ratio [OR] = 3.7 [2.6–5.2]), major surgical procedures (OR = 4.9 [3.5–6.8]), reconstruction (OR = 7.7 (4.1–14.7)], and advanced comorbidity (OR = 9.7 [5.7–16.5] were associated with acute complications. Recurrent/persistent disease occurred in 23% of patients and was associated with high-volume care (OR = 1.4 [1.1–1.8]). Salvage surgery was performed in 46% of patients with recurrent/persistent disease and was less likely for supraglottic disease (OR = 0.5 [0.4–0.8]) and after chemoradiation (OR = 0.4 [0.2–0.6]). Initial treatment and 1-year overall costs for chemoradiation were higher than all other treatment categories, after controlling for all other variables including complications and salvage. High-volume care was associated with significantly lower costs of care for surgical patients but was not associated with differences in costs of care for nonoperative treatment.

Conclusions

In commercially insured patients <65 years old with laryngeal cancer, chemoradiation was associated with increased costs, an increased likelihood of treatment-related medical complications, and a reduced likelihood of surgical salvage. Higher-volume surgical care was associated with lower initial treatment and 1-year costs of care. These data have implications for discussions of value and quality in an era of healthcare reform.

Level of Evidence

2c Laryngoscope, 2017

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Ventilation with high versus low peep levels during general anaesthesia for open abdominal surgery does not affect postoperative spirometry: A randomised clinical trial

BACKGROUND: Invasive mechanical ventilation during general anaesthesia for surgery typically causes atelectasis and impairs postoperative lung function. OBJECTIVE: We investigated the effect of intraoperative ventilation with high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RMs) on postoperative spirometry. DESIGN: This was a preplanned, single-centre substudy of an international multicentre randomised controlled trial, the PROVHILO trial. SETTING: University hospital from November 2011 to January 2013. PATIENTS: Nonobese patients scheduled for major abdominal surgery at a high risk of postoperative pulmonary complications (PPCs). INTERVENTION: Intraoperative low tidal volume ventilation with PEEP levels of 12 cmH2O and RM (the high PEEP group) or with PEEP levels of 2 cmH2O or less without RM (the low PEEP group). MAIN OUTCOME MEASURES: Time-weighted averages (TWAs) of the forced expiratory volume in 1 s (FEV1) and the forced vital capacity (FVC) up to postoperative day five. RESULTS: Thirty-one patients were allocated to the high PEEP group and 32 to the low PEEP group. No postoperative spirometry test results were available for 6 patients. In both groups, TWA of FEV1 and FVC until postoperative day five were lower than preoperative values. Postoperative spirometry test results were not different between the high and low PEEP group; Data are median [interquartile range], TWA FVC 1.8 [1.6 to 2.4] versus 1.7 [1.2 to 2.4] l (P = NS) and TWA FEV1 1.2 [1.1 to 2.5] versus 1.2 [0.9 to 1.9] l (P = NS). Patients who developed PPCs had lower FEV1 and FVC on postoperative day five; 1.1 [0.9 to 1.6] versus 1.6 [1.4 to 1.9] l (P = 0.001) and 1.6 [1.2 to 2.6] versus 2.3 [1.7 to 2.6] l (P = 0.036), respectively. CONCLUSION: Postoperative spirometry is not affected by PEEP and RM during intraoperative ventilation for open abdominal surgery in nonobese patients at a high risk of PPCs, but rather is associated with the development of PPCs. TRIAL REGISTRATION: ClinicalTrials.gov NCT01441791.

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A case series of life-threatening succinylcholine-induced anaphylaxis

No abstract available

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Postoperative pulmonary complications - Still room for improvement

No abstract available

http://ift.tt/2sTXIVx

Muscle relaxation for tracheal intubation during paediatric anaesthesia: A meta-analysis and trial sequential analysis

BACKGROUND: Muscle relaxation for tracheal intubation during paediatric anaesthesia remains a subject of debate. OBJECTIVE: The aim of the current meta-analysis was to investigate the effect of muscle relaxants (MR) compared with opioids on intubation conditions in children. DESIGN: Meta-analysis of randomised controlled studies. DATA SOURCES: Exhaustive literature analysis. ELIGIBILITY CRITERIA: Clinical trials, with no high-risk bias, that examined the effect of MR in comparison with opioids on intubation conditions (excellent: primary outcome, acceptable: secondary outcome) in children were included. RESULTS: Excellent intubation conditions were not significantly different in their occurrence between children receiving MR or opioids, risk ratio [95% Confidence Interval]  = 1.17 [0.96, 1.43], I2 = 36%, number of studies = 5, number of patients = 226. However, trial sequential analysis indicated the lack of power of this result and the need for more trials to provide certainty for this outcome (81 patients needed in future trials). Acceptable intubation conditions were more frequent when administering MR, risk ratio = 1.25 [1.06, 1.47], I2 = 70%, number of studies = 6, number of patients = 362. This effect was confirmed using the trial sequential analysis. Grading of Recommendations Assessment, Development and Evaluation analysis found a low and moderate quality of evidences for excellent and acceptable intubation conditions, respectively. CONCLUSION: The current meta-analysis shows that the use of MR during tracheal intubation might improve the quality of intubation conditions. Further studies, including at least 81 children, are required to confirm this and determine the impact of MR on complications related to intubation.

http://ift.tt/2uRgfU0

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries

BACKGROUND: Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES: To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN: This was a prospective international 1-week observational study using the 'Assess Respiratory Risk in Surgical Patients in Catalonia risk score' (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING: Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES: The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS: A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P 

http://ift.tt/2tTwW3J

Anaesthesia and orphan disease series: What is the yield?

No abstract available

http://ift.tt/2tTKRXz

Magnesium sulphate improves pulmonary function after video-assisted thoracoscopic surgery: A randomised double-blind placebo-controlled study

BACKGROUND: Reduced lung volumes are unavoidable after lung resection surgery. Magnesium sulphate (MgSO4) administration has been reported to reduce the requirement for neuromuscular blocking drugs and postoperative analgesics in surgical patients. OBJECTIVE: To investigate the effect of MgSO4 on pulmonary function after video-assisted thoracoscopic surgery (VATS). DESIGN: A randomised, double-blind, placebo-controlled trial. SETTING: A university tertiary care centre. PATIENTS: Sixty-six patients scheduled for pulmonary lobectomy or segmentectomy via VATS. INTERVENTION: Patients were allocated to one of two groups: the Mg (MgSO4 50 mg kg−1 intravenously for 10 min, followed by a continuous infusion of 15 mg kg−1 h−1 during surgery) or the control (same volume of 0.9% saline). MAIN OUTCOME MEASURES: Pulmonary function tests [forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate] were measured before surgery and at three time points after surgery (2, 24 and 48 h postoperatively) using a portable spirometer. Twelve months after surgery, pulmonary function test values were repeated at a regular outpatient follow-up visit. RESULTS: FEV1 at 24 (1.7 ± 0.6 vs. 1.3 ± 0.5 l, P = 0.033) and 48 h (1.7 ± 0.6 vs. 1.4 ± 0.5 l, P = 0.021) and FVC at 24 (2.0 ± 0.8 vs. 1.6 ± 0.6 l, P = 0.038) and 48 h (2.2 ± 0.8 vs. 1.7 ± 0.7 l, P = 0.008) after surgery were significantly greater in the Mg group. Patients in the Mg group required less rocuronium than those in the control group (64.2 ± 19.9 vs. 74.9 ± 20.3 mg, respectively; P = 0.041). Consumption of postoperative patient-controlled analgesia was also significantly less at 24 and 48 h after surgery in the Mg group (P = 0.022 and 0.015, respectively), although pain scores and rescue analgesics were comparable. Five patients in the control group were diagnosed with postoperative pneumonia using clinical and radiological criteria before discharge. FEV1 and FVC at 12 months after surgery were not different between the two groups. CONCLUSION: Intraoperative administration of MgSO4 improved pulmonary function and reduced the need for rocuronium and postoperative analgesics in patients who underwent VATS. TRIAL REGISTRATION: cris.nih.go.kr identifier: KCT0001410

http://ift.tt/2tTg6C2

Frequency and risk factors for malnutrition in children undergoing general anaesthesia in a French university hospital: A cross-sectional observational study

BACKGROUND: Malnutrition is often underdiagnosed in hospitalised children, although it is associated with postoperative complications, longer hospital lengths of stay and increased healthcare-related costs. OBJECTIVE: We aimed to estimate the frequency of, and identify factors associated with, malnutrition in children undergoing anaesthesia. DESIGN: Cross-sectional observational study. SETTING: Paediatric anaesthesia department at the University Children's Hospital, Bordeaux, France. PARTICIPANTS: A total of 985 patients aged less than 18 years. MAIN OUTCOME MEASURES: Anthropometric measurements, American Society of Anesthesiologists physical status classification score and the Pediatric Nutritional Risk Score (PNRS) recorded at the pre-anaesthesia evaluation. RESULTS: When assessed as a Waterlow index less than 80%, malnutrition was present in 7.6% children. This increased to 8.1% of children assessed by clinical signs and to 11% of children when defined by a BMI less than the third percentile. In a univariate analysis, children with a BMI less than the third percentile were more often born prematurely (22.4 vs 10.4%; P = 0.0008), were small for gestational age at birth (18.4 vs 4.5%; P 

http://ift.tt/2tTroXa

Effects of different fresh gas flows with or without a heat and moisture exchanger on inhaled gas humidity in adults undergoing general anaesthesia: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND: The minimum inhaled gas absolute humidity level is 20 mgH2O l−1 for short-duration use in general anaesthesia and 30 mgH2O l−1 for long-duration use in intensive care to avoid respiratory tract dehydration. OBJECTIVE: The aim is to compare the effects of different fresh gas flows (FGFs) through a circle rebreathing system with or without a heat and moisture exchanger (HME) on inhaled gas absolute humidity in adults undergoing general anaesthesia. DESIGN: Systematic review and meta-analyses of randomised controlled trials. We defined FGF (l min−1) as minimal (0.25 to 0.5), low (0.6 to 1.0) or high (≥2). We extracted the inhaled gas absolute humidity data at 60 and 120 min after connection of the patient to the breathing circuit. The effect size is expressed as the mean differences and corresponding 95% confidence intervals (CI). DATA SOURCES: PubMed, EMBASE, SciELO, LILACS and CENTRAL until January 2017. RESULTS: We included 10 studies. The inhaled gas absolute humidity was higher with minimal flow compared with low flow at 120 min [mean differences 2.51 (95%CI: 0.32 to 4.70); P = 0.02] but not at 60 min [mean differences 2.95 (95%CI: −0.95 to 6.84); P = 0.14], and higher with low flow compared with high flow at 120 min [mean differences 7.19 (95%CI: 4.53 to 9.86); P 

http://ift.tt/2tT5iE3

Anaesthesia and orphan disease: Management of a case of Strumpell–Lorrain disease and review of the literature

No abstract available

http://ift.tt/2uRr20x

Pulse photoplethysmographic amplitude and heart rate variability during laparoscopic cholecystectomy: A prospective observational study

BACKGROUND: Surgical stress affects the autonomic nervous system by increasing sympathetic outflow. One method of monitoring sympathetic activity is pulse photoplethysmographic analysis. From this two indices can be derived – autonomic nervous system state (ANSS) and ANSS index (ANSSi). It has recently been claimed that these indices can be used to measure sympathetic activity in anaesthetised patients, but their validity has not yet been demonstrated. OBJECTIVE: To measure changes in pulse photoplethysmographic indices and determine any agreement with autonomic nervous system modulation of the cardiovascular system in healthy study participants during surgery under general anaesthesia. DESIGN: Prospective observational study. SETTING: Single-centre study based at a tertiary care centre in Milan, Italy. PATIENTS: Healthy patients undergoing general anaesthesia for elective laparoscopic cholecystectomy. INTERVENTIONS: ANSS, ANSSi, and heart rate variability (HRV) were analysed at three main times: baseline, after induction of general anaesthesia, and after pneumoperitoneum insufflation. MAIN OUTCOME MEASURES: The magnitude of changes in photoplethysmographic and HRV indices was measured. The agreement between pulse photoplethysmographic and HRV-derived indices was assessed by Bland–Altman plots. RESULTS: In total, 52 patients were enrolled and their data analysed. Both pulse photoplethysmographic and HRV indices changed during the study phases. An agreement was found between ANSSi and low frequency spectral components of HRV [bias 10.2nu, 95% confidence interval (CI) −13 to 33.4], high frequency spectral components of HRV (bias 6.1 nu, 95% CI −16.3 to 28.6), and low frequency/high frequency ratio (bias 16.1nu, 95% CI −1.4 to 33.5). The agreement was weaker between ANSSI and HRV indices. CONCLUSION: The study endorses the use of pulse photoplethysmographic indices ANSS and ANSSi as surrogates to estimate changes of autonomic modulation of the cardiovascular system in healthy adults during surgery under general anaesthesia. Orcid ID: http://ift.tt/2tTz9MS.

http://ift.tt/2tTz9fQ

Mobile phone text messaging reminder decreases the rate of nonattendance at a preoperative anaesthesia clinic

No abstract available

http://ift.tt/2tT5h2X

Drones in 101 vragen

http://ift.tt/2uRnKub

Studying the Effect of the Flame Passage on the Convective Heat Transfer in a S.I. Engine

http://ift.tt/2tTxhnj

Governance of security in mass events. In-depth study on steering processes and dynamics in occasional security networks

http://ift.tt/2uROXNh

Plural Policing. Vision of local police chiefs on pulbic private partnership

http://ift.tt/2tTvgqX

El Campesinado

http://ift.tt/2uRDUn7

Central hypothyroidism in Miniature Schnauzers

Background: Primary hypothyroidism is a common endocrinopathy in dogs. In contrast, central hypothyroidism is rare in this species. Objectives: The objective of this article is to describe the occurrence and clinical presentation of central hypothyroidism in Miniature Schnauzers. Additionally, the possible role of the thyroid-stimulating hormone (TSH)-releasing hormone receptor (TRHR) gene and the TSH beta (TSHB) gene was investigated. Animals: Miniature Schnauzers with proven central hypothyroidism, based on scintigraphy, and the results of a 3-day-TSH-stimulation test, or a TSH-releasing hormone (TRH)-stimulation test or both, presented to the Department of Clinical Sciences of Companion Animals at Utrecht University or the Department of Medicine and Clinical Biology of Small Animals at Ghent University from 2008 to 2012. Methods: Retrospective study. Pituitary function tests, thyroid scintigraphy, and computed tomography (CT) of the pituitary area were performed. Gene fragments of affected dogs and controls were amplified by polymerase chain reaction (PCR). Subsequently, the deoxyribonucleic acid (DNA) sequences of the products were analyzed. Results: Central hypothyroidism was diagnosed in 7 Miniature Schnauzers. Three dogs had disproportionate dwarfism and at least one of them had a combined deficiency of TSH and prolactin. No disease-causing mutations were found in the TSHB gene and the exons of the TRHR gene of these Schnauzers. Conclusions and clinical importance: Central hypothyroidism could be underdiagnosed in Miniature Schnauzers with hypothyroidism, especially in those of normal stature. The fact that this rare disorder occurred in 7 dogs from the same breed suggests that central hypothyroidism could have a genetic background in Miniature Schnauzers.

http://ift.tt/2tTzSO4

Governance of security in mass events

http://ift.tt/2uRoUpv

Depression prevention: Examining the causal role of cognitive control in depression vulnerability

http://ift.tt/2tTmwBp

The Belgian Co-operative Model: Elements of Succes and Failure

Europe has a long tradition of consumer co-operatives and historians have mainly focused on the success stories, as they often tend to do. This chapter assesses initiatives that proved successful as well as unsuccessful in the Dutch speaking part of Belgium in the period 1875-1914. It analyses the Ghent Vooruit co-operative, one of the most outstanding examples of a successful project, even by European standards , while contrasting it with De Werker(The Worker), an Antwerp co-operative which hardly managed to survive, and De Zon(The Sun) in the provincial town of Zele. The latter went bankrupt in 1903. Are there any lessons to be learned from these examples? And are they equally valid in other cases? In other words, is it possible to suggest some factors which contribute to the success or failure of consumer co-operatives in general?

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Drones in 75 vragen en antwoorden

http://ift.tt/2tTn8qz

Intratumoural interleukin 12 gene therapy stimulates the immune system and decreases angiogenesis in dogs with spontaneous cancer

http://ift.tt/2twV2zl

Standardized exercise tests in horses : current situation and future perspectives

The purpose of this literature review is to clarify how exercise capacity can be measured in horses and which standardized exercise tests (SETs) exist. In this review, the measurement of the exercise capacity of horses is discussed and the standardized exercise tests (SET) are described. Two main types of SETs are used. Laboratory or treadmill tests are easy to standardize and provide more options to use all kinds of measuring devices, since the horse stays on the treadmill. On the other hand, field tests are conducted under the natural conditions associated with the specific sports discipline, and are easier to implement in the training schedule. However, field tests encompass interfering variables, such as weather conditions, ground surface conditions and the rider or jockey. Several variables are measured in order to calculate the fitness level which may be expressed by different parameters, such as V200 (speed at a heart rate of 200 beats per minute), V1a4 (speed at a blood lactic acid level of 4 mmol/L) and VO2max (maximum oxygen uptake).

http://ift.tt/2sMFoT8

Immunological, anti-angiogenic and clinical effects of intratumoral interleukin 12 electrogene therapy combined with metronomic cyclophosphamide in dogs with spontaneous cancer : a pilot study

http://ift.tt/2txmFs0

Diagnosis and ultrasound-guided retrieval of a vaginal foreign body in a dog and a cat

In this case report, the diagnosis and ultrasound-guided retrieval of an intravaginal grass awn in a dog and a cat are described. The dog was presented with chronic vaginal discharge for over two years. The cat was presented for acute lethargy and bloody vaginal discharge and a two-week history of a perivulvar leakage. Ultrasonographic diagnosis included the visualization of a linear, hyperechoic and spindle-shaped structure and mild thickness of the vagina. The grass awns were successfully retrieved non-invasively, under general anesthesia using ultrasound-guided Hartmann forceps inserted into the vagina. Ultrasound-guided grass awn retrieval from the vagina appears to be a safe and inexpensive procedure.

http://ift.tt/2sMSVu7

Peri-articular histiocytic sarcoma and synovial cell sarcoma in Bernese Mountain dogs : a retrospective investigation of the prevalence of these tumours in association with previously diseased joints

http://ift.tt/2txcFyM

Anesthesia for minimally invasive neurosurgery.

Purpose of review: With an ultimate aim of improving patients overall outcome and satisfaction, minimally invasive surgical approach is becoming more of a norm. The related anesthetic evidence has not expanded at the same rate as surgical and technological advancement. This article reviews the recent evidence on anesthesia and perioperative concerns for patients undergoing minimally invasive neurosurgery. Recent findings: Minimally invasive cranial and spinal surgeries have been made possible only by vast technological development. Points of surgical interest can be precisely located with the help of stereotaxy and neuronavigation and special endoscopes which decrease the tissue trauma. The principles of neuroanethesia remain the same, but few concerns are specific for each technique. Dexmedetomidine has a favorable profile for procedures carried out under sedation technique. As the new surgical techniques are coming up, lesser known anesthetic concerns may also come into light. Summary: Over the last year, little new information has been added to existing literature regarding anesthesia for minimally invasive neurosurgeries. Neuroanesthesia goals remain the same and less invasive surgical techniques do not translate into safe anesthesia. Specific concerns for each procedure should be taken into consideration. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2swF6M1

Criteria for Intensive Care admission and monitoring after elective craniotomy.

Purpose of review: The current article revises the recent evidence on ICU admission criteria and postoperative neuromonitoring for patients undergoing elective craniotomy. Recent findings: Only a small proportion of elective postoperative neurosurgical patients require specific medical interventions and invasive monitoring. Among these, patients undergoing elective craniotomy are frequently admitted to neuro-ICU, specialist postanaesthesia care units or intermediate-level care unit in the postoperative period. Craniotomy patients have a high risk of neurological complications in the immediate postoperative period and might require advanced neuromonitoring, especially if sedation is continued in the ICU. Furthermore, the concept of enhanced recovery after surgery with the goal of improving functional capacity after surgery and decreasing morbidity has expanded to encompass neurosurgery. Postoperative clinical examination and neurological scores, bispectral index and simplified electroencephalography, and morning discharge huddles are the most used strategies in this context. Summary: After elective craniotomy, ICU admission should be warranted to patients who show new neurological deficits, especially when these include reduced consciousness or deficits of the lower cranial nerves, or have surgical indication for delayed extubation. Currently, evidence does not allow defining standardized protocol to guide ICU admission and postoperative neuromonitoring. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tPpxDd

A rare graft-versus-host disease-like thymoma-associated paraneoplastic autoimmune multiorgan syndrome

http://ift.tt/2sTNSTG

Scheduling an Indoor Football League: a Tabu Search Based Approach

http://ift.tt/2uwVMnT

Innovations in cytogenomic technologies for prenatal diagnosis

http://ift.tt/2tY2CWB

The Circle Method maximizes Carry-over

http://ift.tt/2uxl9WY

Scheduling the Australian Football League

http://ift.tt/2tYywSI

Evaluation and management of nonsyndromic congenital hearing loss.

Purpose of review: Nonsyndromic congenital hearing loss represents the largest proportion of paediatric sensorineural hearing loss. The optimal evaluation and management of affected patients remains clinically challenging. Current controversies in the diagnostic work-up of nonsyndromic congenital hearing loss are presented in this review. Recent findings: The improved diagnostic yield of comprehensive genetic testing due to new sequencing technologies is changing the diagnostic for congenital hearing loss. Concerns for both ionizing radiation and general anaesthetic exposure are also driving shifts in imaging modality preferences for infants and toddlers. Summary: A thoughtful systematic, targeted approach taking into consideration the audiologic phenotype of the patient is recommended for the work-up of nonsyndromic congenital hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2sTJx2F

Current assessment of newborn hearing screening protocols.

Purpose of review: The objective of this article is to assess current newborn hearing screening protocols. We will focus on technologies or modalities used, protocol steps, training of screeners, timing of first screen, and loss to follow-up. A summary of program reports focusing on protocols from Greece, China, South Africa, France, Spain, South Korea, Denmark, Italy, Turkey, Taiwan, South Korea, Poland and Iran as they are recently reported will also be presented. Recent findings: Community-based hearing screening programs in South Africa and efforts in the Asian region are being reported. The use of automated auditory brainstem response and staged procedures are gaining popularity because of low refer rates. However, follow-up issues remain a problem. The importance of having trained nonprofessional screeners and an efficient database is becoming more evident as the number of newborns screened for hearing loss increase each year. Summary: There are many reported protocols using different technologies, involving several stages, implemented in different settings which should not confuse but rather guide stakeholders so that programs may attain certain benchmarks and ultimately help the hard-at-hearing child in achieving his or her full potential. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tnUU6I

Increasing access to hearing rehabilitation for older adults.

Purpose of review: To provide an update on the recent research and policy developments affecting the current and future care of the 23 million older Americans with untreated hearing loss. Recent findings: Increasing evidence supports the association of age-related hearing loss with significant negative outcomes that affect the ability of older adults to age well. Despite an evolving understanding of the role hearing loss plays in the well being and vitality of older adults, the vast majority of older adults go untreated and hearing health care disparities exist. Recent work to understand the multitude of factors involved in hearing health care decisions, coupled with innovative approaches and technology to deliver hearing care, aim to provide more older adults with equal access to the tools needed to age well. Most importantly, significant national efforts and policy proposals substantiate these efforts and will be reviewed. Summary: Age-related hearing loss is a critical public health issue that affects almost all older adults. Through the application of novel approaches and perspectives, the delivery of hearing health care for older adults is evolving to provide more affordable and accessible care. Accompanying policy efforts provide the necessary support needed to increase access to care significantly. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2sTvZEz

Invariant natural killer cells change after an oral allergy desensitization protocol for cow's milk

Abstract

Background

Cow milk (CM) allergy (CMA) affects up to 3% of the pediatric population and recent data suggest that only about 50% will outgrow by age 8. Oral immunotherapy (OIT) is a type of immune-modulating treatment that is able to induce desensitization to food allergens, to increase tolerance threshold, to reduce the risk of anaphylaxis, and to improve the patient's quality of life. The examination of the immunological changes observed during the establishment of food allergy (FA) desensitization in FA patients is a window into the pathogenesis of food allergy and food tolerance development. In this pathway, we have previously found that invariant natural killer T cells (iNKTs) are involved in CM allergy sensitization and now examine their role in OIT.

Methods

In this study, 10 of the 11 children with CM induced anaphylaxis enrolled in a CMA OIT clinical trial and completed the protocol. Peripheral blood iNKTs were quantitatively and qualitatively via flow cytometry characterized ex-vivo and after culture with milk lipids before and after completing the OIT protocol.

Results

After completing OIT for CM, children were able to reintroduce CM in their diet. For the first time, we demonstrated that OIT induced a significant increase in the peripheral blood iNKT, as well as their switch from a T helper (Th-2; i.e. IL-4, IL-13) to Th-1 (i.e. IFN-γ) cytokine profile.

Conclusions and clinical relevance

This study confirms the efficacy and safety of CM-OIT as well as the role of iNKT cells in CM allergy.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tnKiEI

Stem cell derived gametes : a slippery slope towards designer babies?

Study question: Is the fear for designer babies a convincing argument against the development of stem cell derived (SCD-) gametes? Summary answer: Although SCD-gametes can facilitate the creation of designer babies, this need not undermine the entire enterprise of in vitro gamete derivation. What is known already: The dawn of new reproductive techniques is often accompanied by fears for eugenic practices, the creation of so-called designer babies in particular. The reproductive use of SCD-gametes feeds similar worries, in view of the possibility to select and design embryos with desired nondisease related traits. While such practices have a negative moral connotation, it should be investigated whether or not this moral worry is justified, both in terms of the scientific possibilities (state of the art), and the moral wrongness of selecting and or editing embryos in function of non-disease related traits. Study design, size, duration: A literature study was performed to delineate how the terms 'eugenics' and 'designer baby' are used and how they relate to each other. Next, claims in the scientific and ethical literature about how SCD-gametes may be used for eugenic purposes were inventoried. These claims were critically evaluated for scientific accurateness. Finally, we question whether the claimed possibility of selecting or genetically designing future offspring based on non-disease related traits is necessarily a morally bad thing. Participants/materials, setting, methods: Literature study, conceptual analysis, normative analysis. Main results and the role of chance: A first possibility is to produce large numbers of gametes (especially oocytes) and embryos to select genetic traits. Second, stem cells could be edited via CRISPR/Cas9 and differentiated into gametes. Third, SCD-gamete technology could be used to recombine SCDgametes with other gametes and derive gametes from the resulting embryos (and so on) to shape the genome through selective breeding, by combining desirable traits that arise in different embryos. Fourth, at present somatic cell nuclear transfer (SCNT) is hindered by the short supply of human oocytes. This could be overcome by means of SCD-gametes. By facilitating SCNT, SCD-gamete technology could ease the creation of embryos with the same genome as someone with a desirable genotype. A last possibility would be to create gametes from persons with desired traits (e.g. via induced pluripotent stem cells) and make these available via gamete banks. Each of these scenarios is premised upon further scientific developments. Given the rapid advance in CRISPR/Cas9, it might become possible to edit embryos so that SCD-gamete technology will be neither a sufficient nor a necessary condition to genetically design offspring. If SCD-gamete technology would become safe, it might nevertheless facilitate eugenic purposes, of which the moral wrongness remains contested. Limitations, reasons for caution: Gamete derivation from human stem cells is still in the research phase. The question of the moral wrongness of enhancement and eugenics is explored but not 'answered', as it is a fundamentally normative question. Similarly, 'designer baby' is a stipulative concept, as it is contested which interventions amount to 'designing'. Wider implications of the findings: The causal link between SCD-gamete technology and eugenics/designer babies is weak and speculative. Moreover, the wrongness of such an evolution is contested. Trial registration number: n/a.

http://ift.tt/2tx7uPp

Kunst in Café artistique Flessinghe

http://ift.tt/2sMUTKG

Genetic diversity analysis of Moroccan lentil (Lens culinaris Medik.) landraces using Simple Sequence Repeat and Amplified Fragment Length Polymorphisms reveals functional adaptation towards agro-environmental origins

In the absence of previous molecular characterization, we assessed genetic diversity of 53 Moroccan lentil landraces including two local cultivars using simple sequence repeat (SSR) and amplified fragment length polymorphisms (AFLP). Nineteen SSRs yielded 213 alleles, and seven AFLP primer combinations gave 766 fragments of which 422 were polymorphic. Moderate to high genetic variation was observed. Several small groups of landraces were differentiated. Interestingly, one of the smallest groups contained short-cycle landraces with high early vegetative growth. Landraces in that group were from the dry land location of Abda, where they were likely selected for adaptation to drought and heat stress over centuries. Another group contained two landraces from highland areas that may have been selected for specific adaptation to cold stress. A third group contained one landrace from the Zear region known for its seed quality and has been proposed for the protected designation of origin (PDO) quality mark. Both techniques gave evidence of differentiation of the latter landrace supporting the idea of PDO attribution. Functional grouping according to agro-environmental origins, cycle duration and early vegetative vigour was observed.

http://ift.tt/2tx8B1I

Genetic variability for root and shoot traits in a lentil (Lens culinaris Medik.) recombinant inbred line population and their association with drought tolerance

Lentil (Lens culinaris Medik.) is usually grown under rainfed environments and often encounters drought stress from limited rainfall. Little information is available about shoot and root traits in association with drought tolerance. We studied variability for root and shoot traits related to drought tolerance using an F6–8 population of 133 recombinant inbred lines (RILs) from the cross ILL6002 × ILL5888. We found important variation between genotypes and also high variation in heritability values for root and shoot traits at 38 days after sowing the parents and RILs under both well-watered and drought-stressed treatments during two consecutive seasons in the greenhouse. The higher heritability values were obtained under drought stress treatment and suggest that selection in water-limited environments would be more effective in achieving genetic gains. Drought had reduced trait values, except root–shoot ratio that was likely to be enhanced underlying the importance of this trait for drought tolerance. The quantitative and continuous distributions of variation are the evidence for polygenic control of these traits and the possibility of mapping the quantitative trait loci (QTL). Statistically significant associations between root and shoot traits such as dry shoot biomass and chlorophyll content were noted, highlighting the reliability of indirect selection for underground traits (root) based on these aboveground traits in breeding programs. Significant correlations and regressions were demonstrated between dry root biomass, lateral root number, root surface area, dry shoot biomass, root–shoot ratio, chlorophyll content and drought tolerance as estimated by wilting severity from limited water supply. This shows the importance of a well-developed root system and early biomass development for drought tolerance. Identification and mapping of QTL related to studied traits in this population would be a first step for starting marker-assisted selection.

http://ift.tt/2sN12Xr

Erosive pustular dermatosis of the scalp following topical ingenol mebutate for actinic keratoses

http://ift.tt/2sTnoBB

Evaluation and management of nonsyndromic congenital hearing loss.

Purpose of review: Nonsyndromic congenital hearing loss represents the largest proportion of paediatric sensorineural hearing loss. The optimal evaluation and management of affected patients remains clinically challenging. Current controversies in the diagnostic work-up of nonsyndromic congenital hearing loss are presented in this review. Recent findings: The improved diagnostic yield of comprehensive genetic testing due to new sequencing technologies is changing the diagnostic for congenital hearing loss. Concerns for both ionizing radiation and general anaesthetic exposure are also driving shifts in imaging modality preferences for infants and toddlers. Summary: A thoughtful systematic, targeted approach taking into consideration the audiologic phenotype of the patient is recommended for the work-up of nonsyndromic congenital hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2sTJx2F

Current assessment of newborn hearing screening protocols.

Purpose of review: The objective of this article is to assess current newborn hearing screening protocols. We will focus on technologies or modalities used, protocol steps, training of screeners, timing of first screen, and loss to follow-up. A summary of program reports focusing on protocols from Greece, China, South Africa, France, Spain, South Korea, Denmark, Italy, Turkey, Taiwan, South Korea, Poland and Iran as they are recently reported will also be presented. Recent findings: Community-based hearing screening programs in South Africa and efforts in the Asian region are being reported. The use of automated auditory brainstem response and staged procedures are gaining popularity because of low refer rates. However, follow-up issues remain a problem. The importance of having trained nonprofessional screeners and an efficient database is becoming more evident as the number of newborns screened for hearing loss increase each year. Summary: There are many reported protocols using different technologies, involving several stages, implemented in different settings which should not confuse but rather guide stakeholders so that programs may attain certain benchmarks and ultimately help the hard-at-hearing child in achieving his or her full potential. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tnUU6I

Increasing access to hearing rehabilitation for older adults.

Purpose of review: To provide an update on the recent research and policy developments affecting the current and future care of the 23 million older Americans with untreated hearing loss. Recent findings: Increasing evidence supports the association of age-related hearing loss with significant negative outcomes that affect the ability of older adults to age well. Despite an evolving understanding of the role hearing loss plays in the well being and vitality of older adults, the vast majority of older adults go untreated and hearing health care disparities exist. Recent work to understand the multitude of factors involved in hearing health care decisions, coupled with innovative approaches and technology to deliver hearing care, aim to provide more older adults with equal access to the tools needed to age well. Most importantly, significant national efforts and policy proposals substantiate these efforts and will be reviewed. Summary: Age-related hearing loss is a critical public health issue that affects almost all older adults. Through the application of novel approaches and perspectives, the delivery of hearing health care for older adults is evolving to provide more affordable and accessible care. Accompanying policy efforts provide the necessary support needed to increase access to care significantly. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2sTvZEz

Novel insights in the adaptation of avian H9N2 influenza viruses to swine

http://ift.tt/2sMTcx0

Work-family conflict and mental health in newlywed and recently cohabiting couples : a couple perspective

http://ift.tt/2twEwz3

Baseline Morphine Consumption May Explain Between-Study Heterogeneity in Meta-analyses of Adjuvant Analgesics and Improve Precision and Accuracy of Effect Estimates.

BACKGROUND: Statistical heterogeneity can increase the uncertainty of results and reduce the quality of evidence derived from systematic reviews. At present, it is uncertain what the major factors are that account for heterogeneity in meta-analyses of analgesic adjuncts. Therefore, the aim of this review was to identify whether various covariates could explain statistical heterogeneity and use this to improve accuracy when reporting the efficacy of analgesics. METHODS: We searched for reviews using MEDLINE, EMBASE, CINAHL, AMED, and the Cochrane Database of Systematic Reviews. First, we identified the existence of considerable statistical heterogeneity (I2 > 75%). Second, we conducted meta-regression analysis for the outcome of 24-hour morphine consumption using baseline risk (control group morphine consumption) and other clinical and methodological covariates. Finally, we constructed a league table of adjuvant analgesics using a novel method of reporting effect estimates assuming a fixed consumption of 50 mg postoperative morphine. RESULTS: We included 344 randomized controlled trials with 28,130 participants. Ninety-one percent of analyses showed considerable statistical heterogeneity. Baseline risk was a significant cause of between-study heterogeneity for acetaminophen, nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors, tramadol, ketamine, [alpha]2-agonists, gabapentin, pregabalin, lidocaine, magnesium, and dexamethasone (R2 = 21%-100%; P 10 mg). We could not exclude a moderate clinically significant effect with ketamine. Dexamethasone demonstrated a small clinical benefit (>5 mg). CONCLUSIONS: We empirically identified baseline morphine consumption as the major source of heterogeneity in meta-analyses of adjuvant analgesics across all surgical interventions. Controlling for baseline morphine consumption, clinicians can use audit data to estimate the morphine-reducing effect of adding any adjuvant for their local population, regardless which surgery they undergo. Moreover, we have utilized these findings to present a novel method of reporting and an amended method of graphically displaying effect estimates, which both reduces confounding from variable baseline risk in included trials and is able to adjust for other clinical and methodological confounding variables. We recommend use of these methods in clinical practice and future reviews of analgesics for postoperative pain. (C) 2017 International Anesthesia Research Society

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Preoperatively Screened Obstructive Sleep Apnea Is Associated With Worse Postoperative Outcomes Than Previously Diagnosed Obstructive Sleep Apnea.

BACKGROUND: Obstructive sleep apnea (OSA) affects up to 26% of US adults, is often undiagnosed, and increases perioperative morbidity. We hypothesized that patients screened on the day of surgery as moderate/high risk for OSA (S-OSA) present similar perioperative respiratory complications, hospital use, and mortality than patients with previously diagnosed OSA (D-OSA). Second, we hypothesized that both OSA groups have more respiratory complications than No-OSA patients. METHODS: The electronic medical database from 1 academic and 2 community hospitals was retrospectively queried to identify adults undergoing nonemergent inpatient surgery (January 1, 2012, to December 31, 2014). Based on the day-of-surgery preoperative assessment and STOP-BANG (Snoring, Tiredness, Observed apnea during sleep, high blood Pressure, Body mass index >35, Age >50 years, thick Neck, Gender male) score, they were classified as D-OSA, S-OSA, or No-OSA. Perioperative respiratory events and interventions, hospital use, and mortality were measured. The primary outcome composite (adverse respiratory events [AREs]) included perioperative hypoxemic events and difficult airway management. Hypoxemic event was defined as peripheral saturation of oxygen (SpO2) =3 minutes, or if validated and/or manually entered into the medical chart. Hypoxemia was classified as mild (lowest SpO2 86%-89%) or moderate/severe (lowest SpO2 =1 moderate/severe hypoxemic event after discharge from the postanesthesia care unit (PACU; 39.9% in S-OSA; 39.5% in D-OSA; and 27.1% in No-OSA patients). S-OSA patients compared to D-OSA patients presented lower rates of moderate/severe hypoxemia in the PACU but similar intraoperatively and postoperatively, higher difficult mask ventilation rates, and similar difficult intubation reports. After adjusting for demographic, health, and surgical differences and hospital type, the likelihood of >=1 ARE was not different in S-OSA and D-OSA patients (adjusted odds ratio 0.90 [99% confidence interval, 0.75-1.09]; P = .15). S-OSA patients compared to D-OSA patients had significantly increased postoperative reintubation, mechanical ventilation, direct intensive care unit admission after surgery, hospital length of stay, and 30-day all-cause mortality. CONCLUSIONS: Patients classified as S-OSA have similar rates of AREs to D-OSA patients, but increased postoperative respiratory interventions, hospital use, and 30-day all-cause mortality. These worse postoperative outcomes in S-OSA patients than D-OSA patients could reflect the lack of awareness and appropriate management of this bedside S-OSA diagnosis after PACU discharge. Multidisciplinary interventions are needed for these high-risk patients. (C) 2017 International Anesthesia Research Society

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House of Suicide in Les Morticoles by Daudet: A Prime Literary Allusion to Suicide Assisted by Anesthesia.

No abstract available

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Role of Sigma-1 Receptor/p38 MAPK Inhibition in Acupoint Catgut Embedding-Mediated Analgesic Effects in Complete Freund's Adjuvant-Induced Inflammatory Pain.

BACKGROUND: The endoplasmic reticulum chaperone protein Sigma-1 receptor (Sig-1 R) and mitogen-activated protein kinases (MAPKs) are involved in the mechanism of pain. Acupoint stimulation exerts an exact antihyperalgesic effect in inflammatory pain. However, whether Sig-1 R and MAPKs are associated with the acupoint stimulation-induced analgesic effects is not clear. This study investigated the analgesic effect of acupoint catgut embedding (ACE) and the inhibition of Sig-1 R and MAPKs in ACE analgesia. METHODS: Rats were prepared with intrathecal catheter implantation. ACE was applied to bilateral "Kunlun" (BL60), "Zusanli" (ST36), and "Sanyinjiao" (SP6) acupoints in the rat model of inflammatory pain (complete Freund's adjuvant [CFA] intraplantar injection). Then, Sig-1R agonist PRE084 or saline was intrathecally given daily. The paw withdrawal thresholds and paw edema were measured before CFA injection and at 1, 3, and 5 day after CFA injection. Western bolt was used to evaluate the protein expression of spinal Sig-1R, p38MAPK, and extracellular signal-regulated kinase (ERK), and immunohistochemistry of Sig-1R was detected at 1, 3, and 5 days after CFA injection. RESULTS: ACE exhibited specific analgesic effects. ACE increased paw withdrawal thresholds and markedly decreased CFA-induced paw edema at 1, 3, and 5 days. ACE downregulated the protein expression of Sig-1R, which was increased significantly at 1, 3, and 5 days after CFA injection. ACE decreased the expression of p38 MAPK and ERK at 1 and 3 days but not at 5 days. However, an injection of Sig-1R agonist PRE084 markedly reversed these alterations, except ERK expression. CONCLUSIONS: The present study demonstrated that ACE exhibited antihyperalgesic effects via the inhibition of the Sig-1R that modulated p38 MAPK, but not ERK, expression in the CFA-induced inflammatory pain model in rats. (C) 2017 International Anesthesia Research Society

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Acute Intracardiac Thrombosis and Pulmonary Thromboembolism After Cardiopulmonary Bypass: A Systematic Review of Reported Cases.

Intracardiac thrombosis (ICT) and pulmonary thromboembolism (PE) after cardiopulmonary bypass (CPB) are life-threatening events, but pathological mechanisms are not yet well defined. The aim of this review is to provide an update of case literature of a postbypass hypercoagulable state. Case commonalities among 48 ICT/PE events included congestive heart failure (50%), platelet transfusion (37.5%), CPB duration greater than 3 hours (37.5%), and aortic injury (27.1%). Preexisting thrombophilia was rarely reported, and 16.7% had low activated clotting time,

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