Cover Picture: Eur. J. Immunol. 7'17

Our front cover features Toll-like receptor 2 (TLR2; red) expression by satellite glial cells (SGC) in a human trigeminal ganglion (TG). Sensory ganglia, including TG, contain neuronal cell bodies tightly enwrapped by a sheet of SGC that provide physical support and a protective barrier. The image is taken from Mitterreiter et al. (pp. 1181–1187), where the authors compared side-by-side the expression and functionality of TLR1-9 on SGC and microglia isolated from human TG and brain tissue, respectively. Both cell types expressed an analogous TLR repertoire and cytokine response to TLR ligands, strengthening the role of SGC as local antigen presenting cells that orchestrate ganglionic immune responses in pathogen defense and chronic pain.

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Editorial Board: Eur. J. Immunol. 7'17

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In this issue

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Of self-lipids, CD1-restricted T cells, and contact sensitization

Contact hypersensitivity (CHS) in rodents and contact dermatitis in humans are long-known pathological conditions caused by MHC-restricted T-cell responses. These responses are triggered upon T-cell recognition of neo-antigenic determinants, which are generated by a variety of environmental contact sensitizer (CS) chemicals associating with self-proteins to comprise these neo-antigens. In this issue of the European Journal of Immunology, Betts et al. [Eur. J. Immunol. 2017. 47: 1171–1180] provide intriguing data implying that common small molecule CSs such as dinitrochlorobenzene can also recruit and activate autoreactive CD1-restricted T cells specific for cell-endogenous lipids, which are enriched in human skin. The effects of dinitrochlorobenzene on CD1 T-cell recruitment and function were dependent on newly synthesized CD1 molecules and the presence of endogenous lipids. These findings shed new light on unanticipated mechanisms that have potential clinical relevance on a common and highly distressing disease state.

Small contact sensitizers (CSs) xenobiotics such as dinitrochlorobenzene cause contact dermatitis via self-protein modification and MHC-restricted T-cell activation. Their sensitizing mechanisms seem much wider as it is now shown that CSs can also activate autoreactive CD1-restricted T cells specific for cell-endogenous lipids, which are enriched in human skin.

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Impressum

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Journal roundup

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Contents: Eur. J. Immunol. 7'17

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The function of the immune system according to The Other Side of Bob Dylan

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Solution Combustion Synthesis: Low-Temperature Processing for p-Type Cu:NiO Thin Films for Transparent Electronics

Low-temperature solution processing opens a new window for the fabrication of oxide semiconductors due to its simple, low cost, and large-area uniformity. Herein, by using solution combustion synthesis (SCS), p-type Cu-doped NiO (Cu:NiO) thin films are fabricated at a temperature lower than 150 °C. The light doping of Cu substitutes the Ni site and disperses the valence band of the NiO matrix, leading to an enhanced p-type conductivity. Their integration into thin-film transistors (TFTs) demonstrates typical p-type semiconducting behavior. The optimized Cu_5%NiO TFT exhibits outstanding electrical performance with a hole mobility of 1.5 cm² V⁻¹ s⁻¹, a large on/off current ratio of ≈10⁴, and clear switching characteristics under dynamic measurements. The employment of a high-k ZrO₂ gate dielectric enables a low operating voltage (≤2 V) of the TFTs, which is critical for portable and battery-driven devices. The construction of a light-emitting-diode driving circuit demonstrates the high current control capability of the resultant TFTs. The achievement of the low-temperature-processed Cu:NiO thin films via SCS not only provides a feasible approach for low-cost flexible p-type oxide electronics but also represents a significant step toward the development of complementary metal–oxide semiconductor circuits.

A solution combustion synthesis is utilized to fabricate p-type oxide thin-film transistors (TFTs) at 150 °C. The doping of Cu into the NiO matrix can replace the Ni sites and enhance the p-type conductivity. The optimized Cu_5%NiO TFTs on both Si and ITO (indium tin oxide)/glass with ZrO₂ gate dielectrics exhibit an average hole mobility of >1 cm² V⁻¹ s⁻¹ and I_on/I_off of 10⁴.

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Abnormal Pressure-Induced Photoluminescence Enhancement and Phase Decomposition in Pyrochlore La2Sn2O7

La₂Sn₂O₇ is a transparent conducting oxide (TCO) material and shows a strong near-infrared fluorescent at ambient pressure and room temperature. By in situ high-pressure research, pressure-induced visible photoluminescence (PL) above 2 GPa near 2 eV is observed. The emergence of unusual visible PL behavior is associated with the seriously trigonal lattice distortion of the SnO₆ octehedra, under which the Sn–O1–Sn exchange angle θ is decreased below 22.1 GPa, thus enhancing the PL quantum yield leading to Sn ³P₁¹S₀ photons transition. Besides, bandgap closing followed by bandgap opening and the visible PL appearing at the point of the gap reversal, which is consistent with high-pressure phase decomposition, are discovered. The high-pressure PL results demonstrate a well-defined pressure window (7–17 GPa) with flat maximum PL yielding and sharp edges at both ends, which may provide a great calibration tool for pressure sensors for operation in the deep sea or at extreme conditions.

Under ambient conditions, La₂Sn₂O₇ shows a strong near-infrared (NIR) photoluminescence (PL). Starting from 2 GPa, pressure-induced visible PL appears while the bandgap reverses direction (starts increasing after an initial decrease) and reaches a near-flat maximum between 7 and 14 GPa with consumption of NIR PL. The well-defined visible-PL pressure window provides a great calibration tool for pressure sensors under extreme conditions.

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Superdurable Coating Fabricated from a Double-Sided Tape with Long Term “Zero” Bacterial Adhesion

There is no coating technology currently available to prevent the notorious biofilm formation issue. Here, a potential solution to fully address this tough issue is reported by developing a super-antifouling coating. The use of zwitterionic hydrogel (a double-sided tape) and commercial superglue is combined and a durable and ultrarobust antifouling zwitterionic (DURA-Z) coating is created that can be easily and universally applied on common substrates. Commercial superglue mostly for binding hydrophobic materials is used to strongly immobilize the superhydrophilic DURA-Z coating through interpenetration. DURA-Z coating effectively solves several key challenges preventing the current antifouling coatings from practical use, including difficult fabrication, low efficacy, poor toughness, and durability. The fabricated DURA-Z coating retains antifouling property after 90 d of immersion in water, 50 d of buffer shearing, and 30 d of water flushing, and after repeated knife scratch and sandpaper abrasion under 570 kPa. The DURA-Z coating achieves a rarely reported long-term biofilm resistance to both Gram-positive and Gram-negative bacteria and fungi: it remains almost "zero" microbe adhesion after continuously challenged by more than 10⁹ cells mL⁻¹ culture medium for 30 d.

A superdurable and ultrarobust antifouling zwitterionic (DURA-Z) coating fabricated by a double-sided tape that can be easily and universally applied on common substrates is reported. The DURA-Z coating achieves a rarely reported long-term biofilm resistance: it remains almost "zero" bacteria and fungi adhesion after being continuously challenged by more than 10⁹ microbe cells mL⁻¹ culture medium for 30 days.

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Microtubular Fuel Cell with Ultrahigh Power Output per Footprint

A novel realization of microtubular direct methanol fuel cells (µDMFC) with ultrahigh power output is reported by using "rolled-up" nanotechnology. The microtube (Pt-RuO₂-RUMT) is prepared by rolling up Ru₂O layers coated with magnetron-sputtered Pt nanoparticles (cat-NPs). The µDMFC is fabricated by embedding the tube in a fluidic cell. The footprint of per tube is as small as 1.5 × 10⁻⁴ cm². A power density of ≈257 mW cm⁻² is obtained, which is three orders of magnitude higher than the present microsized DFMCs. Atomic layer deposition technique is applied to alleviate the methanol crossover as well as improve stability of the tube, sustaining electrolyte flow for days. A laminar flow driven mechanism is proposed, and the kinetics of the fuel oxidation depends on a linear-diffusion-controlled process. The electrocatalytic performance on anode and cathode is studied by scanning both sides of the tube wall as an ex situ working electrode, respectively. This prototype µDFMC is extremely interesting for integration with micro- and nanoelectronics systems.

A novel realization of microdirect methanol fuel cells (µDMFC) is presented by utilizing rolled-up nanotechnology. A power density of 257 mW cm⁻² is obtained, which is three orders of magnitude higher than previous reported µDMFCs.

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Coexistence of Low Damping and Strong Magnetoelastic Coupling in Epitaxial Spinel Ferrite Thin Films

Low-loss magnetization dynamics and strong magnetoelastic coupling are generally mutually exclusive properties due to opposing dependencies on spin–orbit interactions. So far, the lack of low-damping, magnetostrictive ferrite films has hindered the development of power-efficient magnetoelectric and acoustic spintronic devices. Here, magnetically soft epitaxial spinel NiZnAl-ferrite thin films with an unusually low Gilbert damping parameter (<3 × 10⁻³), as well as strong magnetoelastic coupling evidenced by a giant strain-induced anisotropy field (≈1 T) and a sizable magnetostriction coefficient (≈10 ppm), are reported. This exceptional combination of low intrinsic damping and substantial magnetostriction arises from the cation chemistry of NiZnAl-ferrite. At the same time, the coherently strained film structure suppresses extrinsic damping, enables soft magnetic behavior, and generates large easy-plane magnetoelastic anisotropy. These findings provide a foundation for a new class of low-loss, magnetoelastic thin film materials that are promising for spin-mechanical devices.

A new thin-film magnetic insulator, epitaxial spinel NiZnAl-ferrite, with low damping and substantial magnetostriction, is presented. This exceptional combination of properties is enabled by the cation chemistry and coherently strained film growth of the NiZnAl-ferrite. The findings provide a foundation for a new class of low-loss, magnetoelastic thin films that are promising for spin-mechanical devices.

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Selenium-Doped Cathodes for Lithium–Organosulfur Batteries with Greatly Improved Volumetric Capacity and Coulombic Efficiency

For the first time a new strategy is reported to improve the volumetric capacity and Coulombic efficiency by selenium doping for lithium–organosulfur batteries. Selenium-doped cathodes with four sulfur atoms and one selenium atom (as the doped heteroatom) in the confined structure are designed and synthesized; this structure exhibits greatly improved volumetric/areal capacities, and a Coulombic efficiency of almost 100% for highly stable lithium–organosulfur batteries. The doping of Se significantly enhances the electronic conductivity of battery electrodes by a factor of 6.2 compared to pure sulfur electrodes, and completely restricts the production of long-chain lithium polysulfides. This allows achievement of a high gravimetric capacity of 700 mAh g⁻¹ close to its theoretical mass capacity, an exceptional volumetric capacity of 2457 mAh cm⁻³, and excellent capacity retention of 92% after 400 cycles. Shuttle effect is efficiently weakened since no long-chain polysulfides are detected from in situ UV/vis results throughout the entire cycling process arising from selenium doping, which is theoretically confirmed by density functional theory calculations.

A new type of selenium-doped organosulfur polymer cathode with four sulfur atoms and one selenium atom (as the doped heteroatom) in the confined structure is designed and synthesized. The resulting Se-doped electrodes exhibit greatly improved volumetric capacities and a Coulombic efficiency of almost 100% for highly stable lithium–organosulfur batteries.

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Underlying maternal infection likely cause of study findings [Letters]

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Family physicians support Open Pharma [News]

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Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score-matched observational cohort study [Research]

BACKGROUND:

Delay of surgery for hip fracture is associated with increased risk of morbidity and mortality, but the effects of surgical delays on mortality and resource use in the context of other emergency surgeries is poorly described. Our objective was to measure the independent association between delay of emergency surgery and in-hospital mortality, length of stay and costs.

METHODS:

We identified all adult patients who underwent emergency noncardiac surgery between January 2012 and October 2014 at a single tertiary care centre. Delay of surgery was defined as the time from surgical booking to operating room entry exceeding institutionally defined acceptable wait times, based on a standardized 5-level priority system that accounted for surgery type and indication. Patients with delayed surgery were matched to those without delay using propensity scores derived from variables that accounted for details of admission and the hospital stay, patient characteristics, physiologic instability, and surgical urgency and risk.

RESULTS:

Of 15 160 patients, 2820 (18.6%) experienced a delay. The mortality rates were 4.9% (138/2820) for those with delay and 3.2% (391/12 340) for those without delay (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.30–1.93). Within the propensity-matched cohort, delay was significantly associated with mortality (OR 1.56, 95% CI 1.18–2.06), increased length of stay (incident rate ratio 1.07, 95% CI 1.01–1.11) and higher total costs (incident rate ratio 1.06, 95% CI 1.01–1.11).

INTERPRETATION:

Delayed operating room access for emergency surgery was associated with increased risk of inhospital mortality, longer length of stay and higher costs. System issues appeared to underlie most delays and must be addressed to improve the outcomes of emergency surgery.

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Half of Canadians can expect cancer diagnosis during lifetime [News]

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Postpartum hypertension [Practice]

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Delivering timely surgery in Canadian hospitals [Commentary]

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Stairlike fracture of the sternum [Practice]

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The authors respond to "Underlying maternal infection likely cause of study findings" [Letters]

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Spoon versus knife [Humanities]

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Canadian women opting for less effective birth control [News]

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Using thermography responsibly [Letters]

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Pulling together [Coda]

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Cancer risk among Holocaust survivors in Israel—A nationwide study

BACKGROUND

Holocaust survivors during World War II were exposed to various factors that are associated with cancer risk. The objective of this study was to determine whether Holocaust survivors had an increased risk for developing cancer.

METHODS

The study population included 152,622 survivors. The main analysis was based on a comparison between individuals who were entitled to compensation for suffering persecution during the war and individuals who were denied such compensation. A complementary analysis compared survivors who were born in countries governed by Nazi Germany with survivors born in nonoccupied countries. A Cox proportional hazards model was used, with the time at risk of cancer development starting on either January 1, 1960, or the date of immigration to the date of cancer diagnosis or death or the date of last follow-up (December 31, 2006).

RESULTS

Cancer was diagnosed in 22.2% of those who were granted compensation versus 16% of those who were denied compensation (P < .0001). Adjusting for birth cohort, sex, country of origin, and period of immigration, both analyses revealed significant increased risks of developing cancer in those who were exposed. For those who were granted versus denied compensation, the hazard ratios were 1.06 (P < .001) for all sites, 1.12 (P = .07) for colorectal cancer, and 1.37 (P = .008) for lung cancer. For those born in occupied countries versus nonoccupied countries, the hazard ratios were 1.08 (P < .001), 1.08 (P = .003), and 1.12 (P = .02), respectively.

CONCLUSIONS

The current results, based on a large cohort of Holocaust survivors who were exposed to a variety of severe deprivations, add to the conflicting and sparse knowledge on this issue and support the notion that this group has a small but consistent increase in cancer development. [See related editorial on pages 000-000, this issue.] Cancer 2017. © 2017 American Cancer Society.

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Extreme population-level events: Do they have an impact on cancer?

The report by Sadetzki and colleagues in this issue showcases the impact of a horrendous event—the Holocaust—on subsequent health decades after the occurrence. Two additional calamities—country-wide famines and population-level discrimination—are provided as examples of this phenomenon to add evidence to the causal pathway identified by Sadetzki et al. See also pages 000-000.

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Facilitating mental health help-seeking by young adults with a dedicated online program: a feasibility study of Link

Objective

To explore the feasibility of a dedicated online youth mental health help-seeking intervention and to evaluate using a randomised controlled trial (RCT) study design in order to identify any modifications needed before commencement of the full-scale RCT.

Design

A pilot RCT with 1:1 randomisation to either the intervention or comparison arm.

Setting

An online study conducted Australia-wide.

Participants

18–25 year olds living in Australia were recruited via social media.

Intervention

Link is a dedicated online mental health help-seeking navigation tool that matches user's mental health issues, severity and service-type preferences (online, phone and face-to-face) with appropriate youth-friendly services. The comparison arm was usual help-seeking strategies with a link to Google.com.

Main outcome measures

The primary outcome was the number of acceptability and feasibility criteria successfully met. Intervention and study design acceptability and feasibility were assessed by nine criteria. Secondary outcomes, via online surveys (at baseline, 1 week and 1 month) measured service use, help-seeking intentions, psychological distress, barriers to help-seeking, attitudes towards mental health help-seeking, mental health literacy, satisfaction and trust.

Results

Fifty-one participants were randomised (intervention: n=24; comparison: n=27). Three out of four of the intervention and two out of five of the study design criteria were met. Unmet criteria could be addressed by modifications to the study design. Qualitative analysis demonstrated that Link was useful to participants and may have increased their positive experiences towards help-seeking. There were no observable differences between arms in any outcome measures and no harms were detected.

Conclusion

Generally, the Link intervention and study design were acceptable and feasible with modifications suggested for the four out of nine unmet criteria. The main trial will hence have shorter surveys and a simpler recruitment process, use positive affect as the primary outcome and will not link to Google.com for the comparison arm.

Trial registration number

Australian New Zealand Clinical Trials Registry, ACTRN12614000386639.

http://ift.tt/2tENNFn

The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol

Introduction

Emergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication between caller and call-taker is essential to this time-critical emergency, yet few studies have investigated the impact that linguistic factors may have on the nature of the interaction and the resulting trajectory of the call. This research aims to provide a better understanding of communication factors impacting on the accuracy and timeliness of ambulance dispatch.

Methods and analysis

A dataset of OHCA calls and their corresponding metadata will be analysed from an interdisciplinary perspective, combining linguistic analysis and health services research. The calls will be transcribed and coded for linguistic and interactional variables and then used to answer a series of research questions about the recognition of OHCA and the delivery of basic life-support instructions to bystanders. Linguistic analysis of calls will provide a deeper understanding of the interactional dynamics between caller and call-taker which may affect recognition and dispatch for OHCA. Findings from this research will translate into recommendations for modifications of the protocols for ambulance dispatch and provide directions for further research.

Ethics and dissemination

The study has been approved by the Curtin University Human Research Ethics Committee (HR128/2013) and the St John Ambulance Western Australia Research Advisory Group. Findings will be published in peer-reviewed journals and communicated to key audiences, including ambulance dispatch professionals.

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Colonisation of Irish patients with chronic obstructive pulmonary disease by Streptococcus pneumoniae and analysis of the pneumococcal vaccine coverage: a non-interventional, observational, prospective cohort study

Objectives

To characterise the pattern of colonisation and serotypes of Streptococcus pneumoniae among patients with chronic obstructive pulmonary disease (COPD) who currently receive the 23-valent pneumococcal polysaccharide vaccine (PPV-23) according to vaccination status, use of antibiotics and steroids. To investigate the prevalence of PPV-23 and 13-valent pneumococcal conjugate vaccine (PCV-13) serotypes within the study cohort.

Design

A non-interventional, observational, prospective cohort study with a 12 -month follow-up period inclusive of quarterly study visits.

Setting

Beaumont Hospital and The Royal College of Surgeons in Ireland Clinical Research Centre, Dublin, Ireland.

Participants

Patients with an established diagnosis of COPD attending a tertiary medical centre.

Primary outcome measure

Colonisation rate of S. pneumoniae in patients with COPD and characterisation of serotypes of S. pneumoniae with correlation to currently available pneumococcal vaccines. Sputum and oropharyngeal swab samples were collected for the isolation of S. pneumoniae.

Secondary outcome measure

Seasonality of colonisation of S. pneumoniae and its relationship with the incidence of exacerbations of COPD.

Results

S. pneumoniae was detected in 16 of 417 samples, a colonisation incident rate of 3.8% and in 11 of 133 (8%) patients at least once during the study. The majority of S. pneumoniae isolates were identified in spring and were non-vaccine serotypes for either the PPV-23 or PCV-13 (63%). The colonisation incident rate of S. pneumoniae fluctuated over the four seasons with a peak of 6.6% in spring and the lowest rate of 2.2% occurring during winter. Antibiotic use was highest during periods of low colonisation.

Conclusions

There is seasonal variation in S. pneumoniae colonisation among patients with COPD which may reflect antibiotic use in autumn and winter. The predominance of non-vaccine types suggests that PCV-13 may have limited impact among patients with COPD in Ireland who currently receive PPV-23.

Trial registration number

NCT02535546; post-results.

http://ift.tt/2tEMbvq

Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey

Background

Many adolescent girls in low-income and middle-income countries lack appropriate facilities and support in school to manage menstruation. Little research has been conducted on how menstruation affects school absence. This study examines the association of menstrual hygiene management knowledge, facilities and practice with absence from school during menstruation among Bangladeshi schoolgirls.

Methods

We conducted a nationally representative, cross-sectional study in Bangladeshi schools from March to June 2013 among girls 11 to 17 years old who reached menarche. We sampled 700 schools from 50 urban and 50 rural clusters using a probability proportional to size technique. We interviewed 2332 schoolgirls and conducted spot checks in each school for menstrual hygiene facilities. To assess factors associated with reported school absence, we estimated adjusted prevalence difference (APD) for controlling confounders' effect using generalised estimating equations to account for school-level clustering.

Results

Among schoolgirls who reached menarche, 41% (931) reported missing school, an average of 2.8 missed days per menstrual cycle. Students who felt uncomfortable at school during menstruation (99% vs 32%; APD=58%; CI 54 to 63) and who believed menstrual problems interfere with school performance (64% vs 30%; APD=27; CI 20 to 33) were more likely to miss school during menstruation than those who did not. School absence during menstruation was less common among girls attending schools with unlocked toilet for girls (35% vs 43%; APD=–5.4; CI –10 to –1.6). School absence was more common among girls who were forbidden from any activities during menstruation (41% vs 33%; APD=9.1; CI 3.3 to 14).

Conclusion

Risk factors for school absence included girl's attitude, misconceptions about menstruation, insufficient and inadequate facilities at school, and family restriction. Enabling girls to manage menstruation at school by providing knowledge and management methods prior to menarche, privacy and a positive social environment around menstrual issues has the potential to benefit students by reducing school absence.

http://ift.tt/2sVl2al

Open reduction and internal fixation of humeral shaft fractures versus conservative treatment with a functional brace: a study protocol of a randomised controlled trial embedded in a cohort

Introduction

Humeral shaft fractures represent 1%–3% of all fractures and 20% of humeral fractures in adults. The treatment of these fractures is mainly conservative and operative treatment is usually reserved for specific circumstances. To date, no randomised controlled trial (RCT) has compared operative treatment of humeral shaft fractures with conservative treatment.

Methods and analysis

We will conduct an RCT to compare the effectiveness and cost-effectiveness of surgical and conservative treatment of humeral shaft fractures. After providing informed consent, 80 patients from 18 years of age with humeral shaft fracture will be randomly assigned to open reduction and internal fixation with locking plate or conservative treatment with functional bracing. We will follow the patients for 10 years and compare the results at different time points. The primary outcome will be Disabilities of Arm, Shoulder and Hand (DASH) at 12 months. The secondary outcomes will include Numerical Rating Scale for pain at rest and in activities, Constant Score and quality of life instrument 15D. Patients not willing to participate in the RCT will be asked to participate in a prospective cohort follow-up study, 'the declined cohort'. This cohort will be followed up at the same time points as the randomised patients to assess the potential effect of participation bias on RCT results and to enhance the external validity of the RCT. In one of the recruiting centres, all cooperative patients with humeral shaft fractures not eligible for randomisation will be asked to participate in a 'non-eligible cohort' study. We will use blinded data interpretation of the randomised cohort to avoid biased interpretation of outcomes. Our null hypothesis is that there is no clinically relevant difference in the primary outcome measure between the two treatment groups. We will consider a difference of a minimum of 10 points in DASH clinically relevant.

Ethics and dissemination

The institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings of this study through peer-reviewed publications and conference presentations.

Trial registration number

NCT01719887; pre-results.

http://ift.tt/2tEXUdh

Prevalence of pregnancy-related complications and course of labour of surviving women who gave birth in selected health facilities in Rwanda: a health facility-based, cross-sectional study

Objectives

This study estimated health facility-based prevalence for pre-eclampsia/eclampsia, postpartum haemorrhage and caesarean section (CS) due to prolonged labour/dystocia. The background characteristics of Rwandan pregnant women, the course of labour and the level of healthcare were investigated in relation to pregnancy and delivery outcomes.

Methods

This is health facility-based study and data were collected in 2014–2015 through structured interviews and medical records (n=817) in Kigali and Northern Province, Rwanda. Frequencies and prevalence were used to describe participants' background factors, labour and delivery-related characteristics. Bivariable and multivariable logistic regression models were performed for different background factors and pregnancy/delivery outcomes.

Results

Pre-eclampsia/eclampsia, postpartum haemorrhage and CS due to prolonged labour/dystocia represented 1%, 2.7% and 5.4% of all participants, respectively. In total, 56.4% of the participants were transferred from facilities with low levels to those with higher levels of healthcare, and the majority were transferred from health centres to district hospitals, with CS as the main reason for transfer. Participants who arrived at the health facility with cervical dilation grade of ≤3 cm spent more hours in maternity ward than those who arrived with cervical dilatation grade of ≥4 cm. Risk factors for CS due to prolonged labour or dystocia were poor households, nulliparity and residence far from health facility.

Conclusions

The estimated health facility-based prevalence of pregnancy-related complications was relatively low in this sample from Rwanda. CS was the main reason for the transfer of pregnant women from health centres to district hospitals. Upgrading the capacity of health centres in the management of pregnant women in Rwanda may improve maternal and fetal health.

http://ift.tt/2sVkYY9

Normative visual acuity in Chinese preschoolers aged 36 to

Objectives

To document population-based normative data for uncorrected visual acuity (UCVA) in Chinese preschoolers aged 36 to <48 months without any sight-affecting abnormalities and to evaluate its effectiveness for vision referral.

Methods

In a population-based cohort of children in the Yuhuatai Pediatric Eye Disease Study, UCVA was measured by using the linear HOTV chart, followed by other ocular examinations. Reference population was defined as children without ophthalmic abnormalities or refractive error. Normative UCVA was obtained from the reference population. The UCVA referral cut-off was defined as the lowest fifth percentile of the normative distribution of UCVA.

Results

The analysis cohort consisted of 1606 Chinese preschoolers aged 36 to <48 months. Among them, a total of 791 children were included in the reference population. The 5th, 50th and 95th percentiles of the UCVA distribution in the reference population were 20/40, 20/32 and 20/25, respectively. UCVA improved with increasing age (p<0.0001), but worsen if prematurity was presented (p=0.041). Using the fifth percentile, UCVA cut-off from the reference population generated referral rates of 26.9% in the general population, and detected more than 86% of amblyopia cases.

Conclusions

We propose that UCVA no better than 20/40 measured by linear HOTV chart should be a referral cut-off for Chinese preschoolers aged 36 to <48 months. Most amblyopia cases can be identified with this age-specific and chart-specific UCVA cut-off.

http://ift.tt/2tEk937

A systematic review of the worldwide prevalence of survivors of poliomyelitis reported in 31 studies

Background

Accurate prevalence figures estimating the number of survivors of poliomyelitis (disease causing acute flaccid paralysis) following poliovirus infection are not available. We aim to undertake a systematic review of all literature concerning the prevalence of survivors of poliomyelitis.

Methods

Electronic databases were searched from 1900 up to May 2016 for peer-reviewed studies using a population-based approach witha defined denominator and some form of diagnostic or clinical verification of polio. Exclusion criteria were any prevalence data that were unable to be extracted or calculated and studies reporting on incidence only. The quality of each included study was assessed using an existing tool modified for use in prevalence studies. Average crude prevalence rates were used to calculate worldwide estimates.

Results

Thirty-one studies met criteria with 90% of studies conducted in low-income to lower middle-income countries. Significant variability in the prevalence of survivors of poliomyelitis was revealed, in low- income to lower middle-income (15 per 100 000 in Nigeria to 1733 in India) and upper-middle to high-income countries (24 (Japan) to 380 per 100 000 (Brazil). The total combined prevalence of survivors of poliomyelitis for those studies at low to moderate risk of bias ranged from 165 (high-income countries) to 425 (low-income to lower middle-income countries) per 100 000 person-years. Historical lameness surveys of children predominated, with wide variation in case definition and assessment criteria, and limited relevance to current prevalence given the lack of incidence of poliovirus infection in the ensuing years.

Conclusions

These results highlight the need for future epidemiological studies of poliomyelitis to examine nationally representative samples, including all ages and greater focus on high-income countries. Such efforts will improve capacity to provide reliable and more robust worldwide prevalence estimates.

http://ift.tt/2sVwZg4

Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East

Objectives

Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF.

Design

Analysis of prospectively collected data.

Setting

The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries.

Participants

5005 patients with acute HF.

Outcome measures

We studied the effect of beta blockers non-withdrawal on intrahospital, 3-month and 12-month mortality and rehospitalisation for HF in patients with acute decompensated chronic heart failure (ADCHF) and acute de novo heart failure (ADNHF) and a left ventricular ejection fraction (LVEF) <40%.

Results

44.1% of patients were already on beta blockers on inclusion. Among those, 57.8% had an LVEF <40%. Further, 79.9% were diagnosed with ADCHF and 20.4% with ADNHF. Mean age was 61 (SD 13.9) in the ADCHF group and 59.8 (SD 13.8) in the ADNHF group. Intrahospital mortality was lower in patients whose beta blocker therapy was not withdrawn in both the ADCHF and ADNHF groups. This protective effect persisted after multivariate analysis (OR 0.05, 95% CI 0.022 to 0.112; OR 0.018, 95% CI 0.003 to 0.122, respectively, p<0.001 for both) and propensity score matching even after correcting for variables that remained significant in the new model (OR 0.084, 95% CI 0.015 to 0.468, p=0.005; OR 0.047, 95% CI 0.013 to 0.169, p<0.001, respectively). At 3 months, mortality was still lower only in patients with ADCHF in whom beta blockers were maintained during initial hospitalisation. However, the benefit was lost after correcting for confounding factors. Interestingly, rehospitalisation for HF and length of hospital stay were unaffected by beta blockers discontinuation in all patients.

Conclusion

In summary, non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction is associated with lower intrahospital mortality but does not influence 3-month and 12-month mortality, rehospitalisation for heart failure,and the length of hospital stay.

Trial registration number

NCT01467973; Post-results.

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Parental knowledge, attitudes and beliefs on fever: a cross-sectional study in Ireland

Objectives

Fever is a common symptom of mostly benign illness in young children, yet concerning for parents. The aim of this study was to describe parental knowledge, attitudes and beliefs regarding fever in children aged ≤5 years of age.

Design

A cross-sectional study using a previously validated questionnaire. Results were analysed using descriptive statistics and multivariable logistic regression.

Setting

Purposively selected primary schools (n=8) in Cork, Ireland, using a paper-based questionnaire. Data were collected from a cross-sectional internet-based questionnaire with a convenience sample of parents via websites and web pages (n=10) previously identified in an interview study.

Participants

Parents with at least one child aged ≤5 years were invited to participate in the study.

Main outcome measures

Parental knowledge, attitudes and beliefs when managing fever in children.

Results

One thousand one hundred and four parents contributed to this research (121 parents from schools and 983 parents through an online questionnaire). Almost two-thirds of parents (63.1%) identified temperatures at which they define fever that were either below or above the recognised definition of temperature (38°C). Nearly two of every three parents (64.6%) alternate between two fever-reducing medications when managing a child's fever. Among parents, years of parenting experience, age, sex, educational status or marital status did not predict being able to correctly identify a fever, neither did they predict if the parent alternated between fever-reducing medications.

Conclusions

Parental knowledge of fever and fever management was found to be deficient which concurs with existing literature. Parental experience and other sociodemographic factors were generally not helpful in identifying parents with high or low levels of knowledge. Resources to help parents when managing a febrile illness need to be introduced to help all parents provide effective care.

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Prevalence of metabolic syndrome, discrete or comorbid diabetes and hypertension in sub-Saharan Africa among people living with HIV versus HIV-negative populations: a systematic review and meta-analysis protocol

Introduction

Metabolic disorder and high blood pressure are common complications globally, and specifically among people living with HIV (PLHIV). Diabetes, metabolic syndrome and hypertension are major risk factors for cardiovascular diseases and their related complications. However, the burden of metabolic syndrome, discrete or comorbid diabetes and hypertension in PLHIV compared with HIV-negative population has not been quantified. This review and meta-analysis aims to compare and analyse the prevalence of these trio conditions between HIV-negative and HIV-positive populations in sub-Saharan Africa (SSA).

Methods and analysis

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guides the methods for this study. Eligibility criteria will be published original articles (English and French language) from SSA that present the prevalence of metabolic syndrome, discrete and/or comorbid diabetes, and hypertension comparisons between PLHIV and HIV-negative populations. The following databases will be searched from January 1990 to February 2017: PubMed/Medline, EBSCOhost, Web of Science, Google Scholar, Scopus, African Index Medicus and Cochrane Database of Systematic Reviews. Eligibility screening and data extraction will be conducted independently by two reviewers, and disagreements resolved by an independent reviewer. Methodological quality and risk of bias will be assessed for individual included studies, while meta-analysis will be used to estimate study outcomes prevalence according to subgroups. Sensitivity analysis will also be performed to further test the robustness of the findings.

Ethics and dissemination

This proposed study does not require ethical approval. The results will be published as a scientific article in a peer-reviewed journal, and presented at conferences and to relevant health agencies.

Trial registration number

PROSPERO registration number (CRD42016045727).

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Temporal changes in predicted risk of type 2 diabetes in Germany: findings from the German Health Interview and Examination Surveys 1997-1999 and 2008-2011

Objective

Over time, prevalence changes in individual diabetes risk factors have been observed for Germany and other European countries. We aimed to investigate the temporal change of a summary measure of type 2 diabetes risk in Germany.

Design

Comparison of data from two cross-sectional surveys that are about 12 years apart.

Setting

Two nationwide health examination surveys representative for the non-institutionalised population aged 18–79 years in Germany.

Participants

The study included participants without diagnosed diabetes from the national health examination surveys in 1997–1999 (n=6457) and 2008–2011 (n=6095).

Outcome measures

Predicted 5-year type 2 diabetes risk was calculated using the German Diabetes Risk Score (GDRS), which considers information on age, anthropometry, lifestyle factors, hypertension and family history of diabetes.

Results

Between the two survey periods, the overall age- and sex-standardised predicted 5-year risk of type 2 diabetes decreased by 27% from 1.5% (95% CI 1.4% to 1.6%) to 1.1% (1.0% to 1.2%). The decrease in red meat intake and waist circumference had the highest impact on the overall decrease in diabetes risk. In stratified analyses, diabetes risk decreased among both sexes and within strata of age and body mass index. Diabetes risk also decreased among highly educated persons, but remained unchanged among persons with a middle or low educational level.

Conclusions

Monitoring type 2 diabetes risk by a summary measure such as the GDRS could essentially contribute to interpret the dynamics in diabetes epidemiology.

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Endo Provides Update On Opana ER

DUBLIN, July 6, 2017 /PRNewswire/ -- Endo International plc (NASDAQ: ENDP) continues to believe in the safety, efficacy, and favorable benefit-risk profile of Opana ER (oxymorphone hydrochloride extended release) when used as intended, and notes...

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Drag Gender: Experiences of Gender for Gay and Queer Men who Perform Drag

Abstract

The present study explored the experience and understanding of gender for gay and queer men who perform drag. It is part of a 20-year program of research focused on how LGBTQ gender identities arise, why they coalesce, and how they are enacted within their social contexts. Interviewers on this topic involving 18 participants were subjected to a grounded theory analysis. Drag genders were tied to common experiences of overcoming social messages that maligned femininity within men, an appreciation of performance arts, and a desire to use social power to confront issues of sexism, genderism, and/or heterosexism. At the same time, participants reported differences in experiencing gender as binary or fluid and in whether they experienced their gender as shifting when engaged in performance. The study contributes to the program of research on LGBTQ genders by examining how drag gender is both essential and constructed, and how it resist sets of oppressive values and is eroticized. It examines how gendered communication functions when performed for audiences and how the social position of these men is both elevated and stigmatized within LGBTQ community. Drag gender's multiple meanings are credited to its position between gay and transgender politics within this socially transformative moment in time.

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Names and “Doing Gender”: How Forenames and Surnames Contribute to Gender Identities, Difference, and Inequalities

Abstract

Names, as proper nouns, are clearly important for the identification of individuals in everyday life. In the present article, I argue that forenames and surnames need also to be recognized as "doing" words, important in the categorization of sex at birth and in the ongoing management of gender conduct appropriate to sex category. Using evidence on personal naming practices in the United States and United Kingdom, I examine what happens at crisis points of sexed and gendered naming in the life course (for example, at the birth of babies, at marriage, and during gender-identity transitions). I show how forenames and surnames help in the embodied doing of gender and, likewise, that bodies are key to gendered practices of forenaming and surnaming: we have "gendered embodied named identities." Whether normative and compliant, pragmatic, or creative and resistant, forenaming and surnaming practices are revealed as core to the production and reproduction of binary sex categories and to gendered identities, difference, hierarchies, and inequalities.

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Angiogenesis and Lymphangiogenesis in the Adrenocortical Tumors

Abstract

Adrenocortical tumors (ACT) are common adrenal tumors. The majority of ACTs are non-functioning and benign, while adrenocortical carcinomas (ACC) are rare, usually very aggressive and often metastasized when first diagnosed. Our aim was to assess whether blood and lymph vessel density within ACTs correlate with the malignancy character or tumor functionality. For that, the microvascular distribution was evaluated by immunohistochemistry staining with D2–40 antibody, for lymph vessels and CD-31 antibody, for blood vessels, in ACCs (n = 15), adenomas with Cushing syndrome (n = 9) and non-functioning adenomas (n = 10). The percentage of stained area was quantified by computerized morphometric analysis. D2–40 expression was significantly lower in ACC as compared to adenomas with Cushing syndrome (p < 0.01) and correlated positively with the expression of the steroidogenic acute regulatory protein (StAR) (R² = 0.553, p < 0.001). CD31 expression was found to be significantly higher in ACC as compared to adenomas with Cushing syndrome (p < 0.05). Our results show that angiogenesis is increased in ACC, suggesting that this phenomenon may have an important role in ACT biological behavior, while lymph vascular density seems to be more closely related to the tumor functional status than malignancy.

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The Tumor Entity Denominated “ clear cell-papillary renal cell carcinoma” According to the WHO 2016 new Classification , have the Clinical Characters of a Renal Cell Adenoma as does Harbor a Benign Outcome

Abstract

The new WHO 2016 classification of renal neoplasia encounters the new entity called "clear cell papillary renal cell carcinoma" (ccpRCC). The ccpRCC has been long included as a subtype of clear cell RCC histotype and it actually ranges from 2 to 9% in different routinely available cohort of renal carcinomas. Of important note, ccpRCC does not show any recurrences or metastases or lymph-node invasion and the outcome is always good. We reviewed twenty-four publications with available follow-up for patients (no. 362) affected by clear cell papillary RCCs/renal adenomatoid tumours and notably ccpRCC harbors an indolent clinical behavior after a mean of 38 months (3,5 years) of follow-up. This paper reviews the histological, molecular and clinical features characterizing ccpRCC, with the goal of focusing the knowledge of the benign fashion of this new tumour entity, supporting the idea of a new renal cell adenoma recruited morphologically from ex conventional clear cell RCC tumours.

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Final Report of a Prospective Randomized Trial to Evaluate the Dose-Response Relationship for Postoperative Radiation Therapy and Pathologic Risk Groups in Patients With Head and Neck Cancer

To present the long-term and final report of a phase 3 trial designed to assess dose-response relationship for postoperative radiation therapy (PORT) and pathologic risk groups in head and neck cancer.

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Immune Checkpoint Inhibition in Cancers that Affect the Head and Neck

In this Oncology Scan from the Head and Neck cancer group (1, 2) we review landmark articles that appeared in 2016 on the role of immune checkpoint inhibition in cancers that affect the head and neck (3-6). These articles are the first to provide data on the possibility of long-term survival using PD-1 pathway inhibitors in metastatic head and neck squamous cell carcinoma (HNSCC) and Merkel cell carcinoma, a type of skin cancer that involves the head and neck in over 40% of cases. These articles draw attention to the intrinsic differences in response to immunotherapy between virus-associated and virus-unassociated disease and the utility of predictive biomarkers.

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Why So Challenging to Personalize Radiation Dose?

The primary treatment tool for radiation oncologists is of course, radiation. After many decades of clinical application, one would think the optimal radiation dose and fractionation for virtually every cancer would be beautifully defined according to clinical data for each tumor type. Not so in fact. For the majority of human cancers, radiation doses routinely prescribed in clinical practice largely reflect adjacent normal tissue tolerance and perceived patient safety (1, 2). We routinely limit radiation dose to bowel, brain, heart, lung, kidney, spinal cord, and many other normal organs according to the severity of clinical consequences from exceeding normal tissue tolerance.

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Issue Highlights

Parameswaran and Burtness

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A Clarion Call for Large-Scale Collaborative Studies of Pediatric Proton Therapy

In 2010, there were 24 proton therapy centers operating around the world. During the past 6 years, 33 new centers have opened, 32 are under construction, and 17 are in the planning phase (1).

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Breast Cancer: Biology or Stage?

A 44-year-old woman was found to have 2 groups of calcifications within the left breast on routine screening mammogram: one at 2 o'clock measuring 28 mm and a second at 3 o'clock measuring 40 mm. Follow-up diagnostic mammogram confirmed multiple groups of pleomorphic calcifications spanning >7 cm in the upper outer quadrant. Stereotactic core needle biopsy noted invasive carcinoma, predominantly lobular type, grade 2, estrogen receptor positive (Allred 8), progesterone receptor positive (Allred 8), HER2 negative (0) at the 2 o'clock site; and ductal carcinoma in situ without invasion at 3 o'clock.

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PMRT: Please Mind Randomized Trials

A 44-year-old woman with 2 synchronous left upper–outer quadrant high-grade estrogen receptor (ER)–positive, progesterone receptor–positive, HER2-negative pT1c pN0(i+)(sn) breast cancers undergoes mastectomy and sentinel lymph biopsy, followed by adjuvant chemotherapy for an OncotypeDx (Genomic Health, Redwood City, CA) Recurrence Score (RS) of 45 (1). We estimate her 10-year risk of locoregional relapse (LRR) without postmastectomy radiation therapy (PMRT) to be <6%. In a secondary analysis of National Surgical Adjuvant Breast and Bowel Project B-28, women with ER-positive pN1 breast cancer treated with mastectomy, anthracycline-based chemotherapy, and tamoxifen without PMRT had low rates of LRR, regardless of the OncotypeDx RS (2).

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Meetings

September 11-13, 2017

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Psychotropic polypharmacy in Australia, 2006 to 2015: a descriptive cohort study

Abstract

Aims

To describe psychotropic polypharmacy in Australia between 2006 and 2015.

Methods

We used pharmaceutical claims from a national 10% sample of people with complete dispensing histories to estimate the annual prevalence of the combined use (overlap of > 60 days exposure) of ≥2 psychotropics overall and within the same class or subclass (class and subclass polypharmacy). We also estimated the proportion of polypharmacy episodes involving one, two, three and four or more unique prescribers.

Results

The prevalence of class polypharmacy between 2006 and 2015 in people dispensed specific psychotropic classes was 5.9% to 7.3% for antipsychotics, 2.1% to 3.7% for antidepressants and 4.3% to 2.9% for benzodiazepines. The prevalence of antipsychotic polypharmacy was higher than expected given the prevalence of antipsychotic exposure and combinations of sedating agents were notably common. Overall, 26.7% of polypharmacy episodes involved multiple prescribers but having multiple prescribers occurred more frequently for class and subclass polypharmacy and people with ≥4 concomitant psychotropics.

Discussion

Psychotropic polypharmacy is common, despite limited evidence of risks and benefits. Increases in polypharmacy with multiple prescribers may be due to poor communication with patients and between health care professionals.

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Impact of Carbohydrate-Electrolyte Beverage Ingestion on Heart Rate Response While Climbing Mountain Fuji at ~3000 m

We sought to investigate whether carbohydrate-electrolyte beverage ingestion reduced heart rate (HR) in twenty-three healthy young adults while climbing Mount Fuji at a given exercise intensity. Twenty-three healthy adults were randomly divided into two groups: the tap water (11 males [M] and 1 female [F]) and the carbohydrate-electrolyte group (10 M and 1 F). HR and activity energy expenditure (AEE) were recorded every min. The HRs for the first 30 minutes of climbing were not significantly different between the groups [121 ± 2 beats per min (bpm) in the tap water and 116 ± 3 bpm in the carbohydrate-electrolyte]; however, HR significantly increased with climbing in the tap water group (129 ± 2 bpm) but showed no significant increase in the carbohydrate-electrolyte group (121 ± 3 bpm). In addition, body weight changes throughout two days ascending and descending on Mount Fuji were inversely related to changes in resting HR. Further, individual variation of body weight changes was suppressed by carbohydrate-electrolyte drink. Collectively, carbohydrate-electrolyte beverage intake may attenuate an increase in HR at a given AEE while mountaineering at ~3000 m compared with tap water intake.

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Identifying High-Cost, High-Risk Patients Using Administrative Databases in Tuscany, Italy

Objective. (1) Assessing the performance of the algorithm in terms of sensitivity and positive predictive value, considering General Practitioners' (GPs) judgement as benchmark, and (2) describing adverse events (hospitalisation, death, and health services' consumption) of complex patients compared to the general population. Data Sources. (i) Tuscany administrative database containing health data (2013-5); (ii) lists of complex patients indicated by GPs; and (iii) annual health registry of Tuscany. Study Design. The present study is a validation study. It compares a list of complex patients extracted through an administrative algorithm (criteria of high health consumption) to a gold standard list of patients indicated by GPs. GPs' decision was subjective but fairly well reasoned. The study compares also adverse outcomes (Emergency Room visits, hospitalisation, and death) between identified complex patients and general population. Principal Findings. Considering GPs' judgement, the algorithm showed a sensitivity of 72.8% and a positive predictive value of 64.4%. The complex cases presented here have higher incidence rates/100,000 (death 46.8; ER visits 223.2, hospitalisations 110.87, laboratory tests 1284.01, and specialist examinations 870.37) compared to the general population. Conclusions. The final validated algorithm showed acceptable sensitivity and positive predictive value.

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Space-based bias of covert visual attention in complex regional pain syndrome

Abstract

Some patients with complex regional pain syndrome report that movements of the affected limb are slow, more effortful, and lack automaticity. These symptoms have been likened to the syndrome that sometimes follows brain injury called hemispatial neglect, in which patients exhibit attentional impairments and problems with movements affecting the contralesional side of the body and space. Psychophysical testing of patients with complex regional pain syndrome has found evidence for spatial biases when judging visual targets distanced at 2 m, but not in directions that indicate reduced attention to the affected side. In contrast, when judging visual or tactile stimuli presented on their own body surface, or pictures of hands and feet within arm's reach, patients with complex regional pain syndrome exhibited a bias away from the affected side. What is not yet known is whether patients with complex regional pain syndrome only have biased attention for bodily-specific information in the space within arm's reach, or whether they also show a bias for information that is not associated with the body, suggesting a more generalized attention deficit. Using a temporal order judgement task, we found that patients with complex regional pain syndrome processed visual stimuli more slowly on the affected side (relative to the unaffected side) when the lights were projected onto a blank surface (i.e. when no bodily information was visible), and when the lights were projected onto the dorsal surfaces of their uncrossed hands. However, with the arms crossed (such that the left and right lights projected onto the right and left hands, respectively), patients' responses were no different than controls. These results provide the first demonstration of a generalized attention bias away from the affected side of space in complex regional pain syndrome patients that is not specifically related to bodily information. They also suggest a separate and additional bias of visual attention away from the affected hand. The strength of attention bias was predicted by scores on a self-report measure of body perception distortion; but not by pain intensity, time since diagnosis, or affected body side (left or right). At an individual level, those patients whose upper limbs were most affected had a higher incidence of inattention than those whose lower limbs were most affected. However, at a group level, affected limb (upper or lower) did not predict bias magnitude; nor did three measures designed to assess possible asymmetries in the distribution of movements across space. It is concluded that inattention in near space in complex regional pain syndrome may arise in parallel with a distorted perception of the body.awx152media15495542665001

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Analysis of two treatment modalities for the prevention of vomiting after trauma: orogastric tube or anti-emetics

Publication date: Available online 8 July 2017
Source:Injury
Author(s): H.D. Vermeijden, L.P.H. Leenen, M. van Polen, M.G.W. Dijkgraaf, F. Hietbrink
IntroductionVomiting in the emergency department after trauma occurs frequently and might lead to aspiration of gastric content. An orogastric tube (OGT) is a way to prevent emesis. However, this is an inconvenient procedure and may actually trigger vomiting. Therefore, a change in policy was applied from preferably an OGT to the administration of anti-emetics in a selected population. The aim of this study was to analyse the prevention of vomiting in trauma patients after OGT or anti-emetics.Materials and methodsRetrospective cohort study. Data of all trauma patients presented at the crash room of the emergency department between July 1st 2013 and July 1st 2014 were collected from the local trauma registry and electronic patient documentation system and comprising 6 months preceding and 6 months after change of policy. Vomiting and nausea after trauma were recorded. Furthermore, complications such as aspiration and cardiac arrhythmias were documented.ResultsA total of 1446 patients were presented after trauma. 230 patients were promptly intubated. An additional 763 patients were fully responsive and did not complain of nausea. The remaining 453 patients were further analysed. 44 patients received OGT placement procedure and 409 patients received anti-emetics. Significant difference was found in patients vomiting after OGT placement or anti-emetics (20.5% vs. 2.7%; P<0.001). Patients who received anti-emetics were not more at risk for cardiac arrhythmias. After matched control analysis, there was still a significant difference was found.Discussion and conclusionAdministration of anti-emetics is suitable and effective for the prevention of vomiting after trauma in this selected population, without an increased risk for complications.



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The Optical Fractionator Technique to Estimate Cell Numbers in a Rat Model of Electroconvulsive Therapy

Here, we present a stereological method, the optical fractionator, used to quantify the formation of new neurons, and their survival, in the rat hippocampus following electroconvulsive stimulation. When correctly implemented, the sensitivity and efficiency of stereological methods ensures accurate estimates with a fixed and predetermined precision.

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New device that performs chest compressions used to save 67-year-old man's life

The fire department's brand new LUCAS 3 Chest Compression System performed consistent and accurate chest compressions on the victim

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Mo. bill targets ambulance calls to abortion clinics

The bill would make it illegal for abortion clinic staff to ask ambulances to respond to calls at their facilities without sirens or lights

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Anticancer Effects of Sinocrassulosides VI/VII from Silene viscidula on HeLa Cells

Natural products are becoming increasingly important in chemoprevention and for cancer therapy. Silene viscidula (S. viscidula), a traditional Chinese herb, has long been used as an anti-inflammatory and neuroleptic agent. However, the anticancer activity of S. viscidula has remained unclear. In this study, 16 compounds were extracted from S. viscidula. Among those compounds, sinocrassulosides VI/VII, an inseparable isomer mixture, possess the strongest inhibitory activity on HeLa cells with the IC50 value of 2.37 μM. Mechanism studies found that sinocrassulosides VI/VII downregulated the expression of cyclin D1 and decreased retinoblastoma (Rb) phosphorylation, which arrested HeLa cells in the G1 phase. Also, sinocrassulosides VI/VII could induce senescence via the upregulation of p16 and a significant increase of β-galactosidase (β-gal) staining. Our results suggest that sinocrassulosides VI/VII may be a new therapeutic potential agent for cervical cancer. In addition, we explored the structure-activity relationships of three groups of the configurational isomer with similar chemical structure from S. viscidula. We first demonstrated that the length of the ester chains linked to the carboxyl group of the glucuronic acid residue could affect the potent cytotoxicity. This finding will open new avenues for developing effective anticancer compounds by modifying the components derived from plants in nature.

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Issue Information

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Issue Information - Cover

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Plumbagin Alleviates Capillarization of Hepatic Sinusoids In Vitro by Downregulating ET-1, VEGF, LN, and Type IV Collagen

Critical roles for liver sinusoidal endothelial cells (LSECs) in liver fibrosis have been demonstrated, while little is known regarding the underlying molecular mechanisms of drugs delivered to the LSECs. Our previous study revealed that plumbagin plays an antifibrotic role in liver fibrosis. In this study, we investigated whether plumbagin alleviates capillarization of hepatic sinusoids by downregulating endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), laminin (LN), and type IV collagen on leptin-stimulated LSECs. We found that normal LSECs had mostly open fenestrae and no organized basement membrane. Leptin-stimulated LSECs showed the formation of a continuous basement membrane with few open fenestrae, which were the features of capillarization. Expression of ET-1, VEGF, LN, and type IV collagen was enhanced in leptin-stimulated LSECs. Plumbagin was used to treat leptin-stimulated LSECs. The sizes and numbers of open fenestrae were markedly decreased, and no basement membrane production was found after plumbagin administration. Plumbagin decreased the levels of ET-1, VEGF, LN, and type IV collagen in leptin-stimulated LSECs. Plumbagin promoted downregulation of ET-1, VEGF, LN, and type IV collagen mRNA. Altogether, our data reveal that plumbagin reverses capillarization of hepatic sinusoids by downregulation of ET-1, VEGF, LN, and type IV collagen.

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New Onset Insomnia in a Pediatric Patient: A Case of Anti-NMDA Receptor Encephalitis

Anti-NMDAR encephalitis is becoming more widely recognized as a cause of encephalopathy in both adults and children. Certain clinical features such as mood lability, movement disorders, speech dysfunction, seizures, and autonomic instability in a pediatric patient should prompt immediate concern and evaluation for autoimmune encephalitis among providers. We present the case of a pediatric patient with anti-NMDAR encephalitis in which the symptom prompting medical evaluation was insomnia. Insomnia has not previously been emphasized in the literature as a presenting feature of this disease in children and has a broad differential. Recognition of the symptoms of anti-NMDAR encephalitis and its variable presentation are key to early diagnosis and prompt initiation of treatment which may help to improve outcomes.

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Downregulation of Thromboxane A2 Receptor Occurs Mainly via Nuclear Factor-KappaB Signaling Pathway in Rat Renal Artery

Thromboxane A2 (TXA2) acts on TXA2 receptors (TP) to regulate renal artery blood flow and subsequently contributes to the pathogenesis of renal ischemia. The present study was designed to examine if nuclear factor-kappaB (NF-κB) signaling pathway is involved in the downregulation of TP receptors in rat renal artery. Rat renal artery segments were organ cultured for 6 or 24 h. Downregulation of TP receptors was monitored using myograph (contractile function), real-time PCR (receptor mRNA), and immunohistochemistry (receptor protein). Specific inhibitors (MG-132 and BMS345541) for NF-κB signaling pathway were used to dissect the underlying molecular mechanisms involved. Compared to fresh (noncultured) segments, organ culture of the renal artery segments for 24 h induced a significant rightward shift of U46619 (TP receptor agonist) contractile response curves (pEC50: versus , ). This decreased contractile response to U46619 was paralleled with decreased TP receptor mRNA and protein expressions in the renal artery smooth muscle cells. Specific inhibitors (MG-132 and BMS345541) for NF-κB signaling pathway significantly abolished the decreased TP protein expression and receptor-mediated contractions. In conclusion, downregulation of TP receptors in the renal artery smooth muscle cells occurs mainly via the NF-κB signaling pathway.

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Thiocarbamates from Moringa oleifera Seeds Bioactive against Virulent and Multidrug-Resistant Vibrio Species

Prospect of antibacterial agents may provide an alternative therapy for diseases caused by multidrug-resistant bacteria. This study aimed to evaluate the in vitro bioactivity of Moringa oleifera seed extracts against 100 vibrios isolated from the marine shrimp Litopenaeus vannamei. Ethanol extracts at low (MOS-E) and hot (MOS-ES) temperature are shown to be bioactive against 92% and 90% of the strains, respectively. The most efficient Minimum Inhibitory Concentration (MIC) levels of MOS-E and MOS-ES against a high percentage of strains were 32 µg mL−1. Bioguided screening of bioactive compounds showed that the ethyl acetate fraction from both extracts was the only one that showed antibacterial activity. Vibriocidal substances, niazirine and niazimicine, were isolated from the aforementioned fraction through chromatographic fractionation.

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A Systems Vaccinology Approach Reveals Temporal Transcriptomic Changes of Immune Responses to the Yellow Fever 17D Vaccine.

Related Articles

A Systems Vaccinology Approach Reveals Temporal Transcriptomic Changes of Immune Responses to the Yellow Fever 17D Vaccine.

J Immunol. 2017 Jul 07;:

Authors: Hou J, Wang S, Jia M, Li D, Liu Y, Li Z, Zhu H, Xu H, Sun M, Lu L, Zhou Z, Peng H, Zhang Q, Fu S, Liang G, Yao L, Yu X, Carpp LN, Huang Y, McElrath J, Self S, Shao Y

Abstract
In this study, we used a systems vaccinology approach to identify temporal changes in immune response signatures to the yellow fever (YF)-17D vaccine, with the aim of comprehensively characterizing immune responses associated with protective immunity. We conducted a cohort study in which 21 healthy subjects in China were administered one dose of the YF-17D vaccine; PBMCs were collected at 0 h and then at 4 h and days 1, 2, 3, 5, 7, 14, 28, 84, and 168 postvaccination, and analyzed by transcriptional profiling and immunological assays. At 4 h postvaccination, genes associated with innate cell differentiation and cytokine pathways were dramatically downregulated, whereas receptor genes were upregulated, compared with their baseline levels at 0 h. Immune response pathways were primarily upregulated on days 5 and 7, accompanied by the upregulation of the transcriptional factors JUP, STAT1, and EIF2AK2. We also observed robust activation of innate immunity within 2 d postvaccination and a durable adaptive response, as assessed by transcriptional profiling. Coexpression network analysis indicated that lysosome activity and lymphocyte proliferation were associated with dendritic cell (DC) and CD4(+) T cell responses; FGL2, NFAM1, CCR1, and TNFSF13B were involved in these associations. Moreover, individuals who were baseline-seropositive for Abs against another flavivirus exhibited significantly impaired DC, NK cell, and T cell function in response to YF-17D vaccination. Overall, our findings indicate that YF-17D vaccination induces a prompt innate immune response and DC activation, a robust Ag-specific T cell response, and a persistent B cell/memory B cell response.

PMID: 28687661 [PubMed - as supplied by publisher]

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Post-transcriptional regulation of PARG mRNA by HuR facilitates DNA repair and resistance to PARP inhibitors.

Related Articles

Post-transcriptional regulation of PARG mRNA by HuR facilitates DNA repair and resistance to PARP inhibitors.

Cancer Res. 2017 Jul 07;:

Authors: Chand SN, Zarei M, Schiewer MJ, Kamath AR, Romeo C, Lal S, Cozzitorto JA, Nevler A, Scolaro L, Londin E, Jiang W, Meisner-Kober N, Pishvaian MJ, Knudsen KE, Yeo CJ, Pascal JM, Winter JM, Brody JR

Abstract
The majority of pancreatic ductal adenocarcinomas (PDA) rely on the mRNA stability factor HuR (ELAV-L1) to drive cancer growth and progression. Here we show that CRISPR-Cas9-mediated silencing of the HuR locus increases the relative sensitivity of PDA cells to PARP inhibitors (PARPi). PDA cells treated with PARPi stimulated translocation of HuR from the nucleus to the cytoplasm, specifically promoting stabilization of a new target, polyADP-ribose glycohydrolase (PARG) mRNA, by binding a unique sequence embedded in its 3' untranslated region (UTR). HuR-dependent upregulation of PARG expression facilitated DNA repair via hydrolysis of polyADP-ribose on related repair proteins. Accordingly, strategies to inhibit HuR directly promoted DNA damage accumulation, inefficient PAR removal, and persistent PARP-1 residency on chromatin (PARP-1 trapping). Immunoprecipitation assays demonstrated that the PARP1 protein binds and post-translationally modifies HuR in PARPi-treated PDA cells. In a mouse xenograft model of human PDA, PARPi monotherapy combined with targeted silencing of HuR significantly reduced tumor growth compared to PARPi therapy alone. Our results highlight the HuR-PARG axis as an opportunity to enhance PARPi-based therapies.

PMID: 28687616 [PubMed - as supplied by publisher]

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PEGylated Curcumin Derivative Attenuates Hepatic Steatosis via CREB/PPAR-γ/CD36 Pathway

Curcumin has the potential to cure dyslipidemia and nonalcoholic fatty liver disease (NAFLD). However, its therapeutic effects are curbed by poor bioavailability. Our previous work has shown that modification of curcumin with polyethylene glycol (PEG) improves blood concentration and tissue distribution. This study sought to investigate the role of a novel PEGylated curcumin derivative (Curc-mPEG454) in regulating hepatic lipid metabolism and to elucidate the underlying molecular mechanism in a high-fat-diet- (HFD-) fed C57BL/6J mouse model. Mice were fed either a control chow diet (D12450B), an HFD (D12492) as the NAFLD model, or an HFD with Curc-mPEG454 administered by intraperitoneal injection at 50 mg/kg or 100 mg/kg for 16 weeks. We found that Curc-mPEG454 significantly lowered the body weight and serum triglyceride (TG) levels and reduced liver lipid accumulation in HFD-induced NAFLD mice. It was also shown that Curc-mPEG454 suppressed the HFD-induced upregulated expression of CD36 and hepatic peroxisome proliferator activated receptor-γ (PPAR-γ), a positive regulator of CD36. Moreover, Curc-mPEG454 dramatically activated cAMP response element-binding (CREB) protein, which negatively controls hepatic PPAR-γ expression. These findings suggest that Curc-mPEG454 reverses HFD-induced hepatic steatosis via the activation of CREB inhibition of the hepatic PPAR-γ/CD36 pathway, which may be an effective therapeutic for high-fat-diet-induced NAFLD.

http://ift.tt/2tZEC4I

Laryngeal Rosai-Dorfman Disease (Sinus Histiocytosis with Massive Lymphadenopathy): A Retrospective Study of 5 Cases

This study was performed to investigate the clinical manifestations, treatment methods, and prognosis of Rosai-Dorfman disease (RDD) with laryngeal involvement. Five clinical cases of RDD with laryngeal involvement diagnosed between 1986 and 2015 were retrospectively analyzed. The laryngeal lesions of these 5 patients mostly involved the glottis and subglottis, with the main symptoms being a hoarse voice and airway obstruction. In addition, the patients mostly exhibited a unilateral or asymmetric onset that was manifested by a laryngeal submucosal nodular mass. The patients were subjected to a regimen of hormone treatment combined with surgical resection. The median follow-up duration was 101 months (8–384 months). One case was lost, and the remaining 4 subjects are alive with disease. The follow-up examinations revealed that 4 subjects had stable laryngeal conditions, whereas one showed minor progression. RDD with laryngeal involvement is clinically rare and differs considerably from classical RDD in age of onset, gender composition, and extranodal involvement. The regimen of hormone treatment combined with surgical resection can stabilize the patient's general condition and laryngeal lesion. Tracheotomies are recommended for patients with dyspnea. After their conditions stabilize, decannulation can be successfully performed in most cases. This therapeutic regimen generally delivers a good prognosis.

http://ift.tt/2uY0zOL

FGFR3, a marker suggestive of favorable prognosis in urothelial carcinoma

Abstract

The detection of fibroblast growth factor receptor 3 (FGFR3) mutations in noninvasive bladder cancer mostly and a finding of FGFR3 overexpression in many invasive bladder cancers (BC) has created hope that targeted therapy against FGFR3 may have a major role in the treatment of BC. We aimed to evaluate immunohistochemically the expression of FGFR3 in urothelial carcinoma of the urinary bladder and correlate the results with various clinicopathologic variables to show the possible prognostic value of this marker. This study included 100 archived paraffin blocks of variable grades and stages of urothelial carcinoma. All cases were immunohistochemically stained with anti-FGFR3 antibody. FGFR3 immunostaining was detected in 88% (88/100) of urothelial carcinoma cases. A significant correlation was detected between FGFR3 expressions with the grade and depth of tumor invasion as 34% of low-grade cases (P = 0.002) and 26% of pTa-stage tumors (P = 0.02) showed high level of FGFR3 expression. Moreover, FGFR3 was significantly highly expressed in 34% of non-muscle-invasive tumors (P = 0.007), 34% of tumors with papillary growth pattern (P = 0.017), and lower-stage tumors (P = 0.00). In conclusion, high expression of FGFR3 in urothelial carcinomas with statistically significant relationships regarding its expression levels with parameters of favorable prognosis like low grade and pTa stage, presence of papillary architecture, and lower-stage urothelial carcinomas raised the probability that FGFR3 expression may have a role in early development of urothelial neoplasia. Further studies are required to investigate the applicability of FGFR3-targeted agents as an additional treatment regimen in patients with FGFR3 overexpression.

http://ift.tt/2tZFAOt

Zonulin: A Potential Marker of Intestine Injury in Newborns

Introduction. Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in newborns presenting symptoms of infection and/or inflammation of the gut or being at risk of intestinal pathology. Material and Methods. Serum ZO was assessed in 81 newborns diagnosed with sepsis, necrotizing enterocolitis (NEC), rotavirus infection, and gastroschisis, also in extremely low gestational age babies, and in controls (healthy newborns). ZO concentration was compared to C-reactive protein (CRP) and procalcitonin (PCT) values, leucocyte and platelet count, basic demographic data, and the value of the Neonatal Therapeutic Intervention Scoring System (NTISS). Results. Median values of ZO were markedly higher in groups with rotavirus infection and gastroschisis (36.0 (1-3Q: 26.0–43.2) and 20.3 (1-3Q: 17.7–28.2) ng/ml, resp.) versus controls (3.5 (1-3Q: 2.7–4.8) ng/ml). Its concentration in the NEC group was twice as high as in controls but did not reach statistical significance. ZO levels were not related to NTISS, CRP, and PCT. Conclusions. Zonulin is a promising biomarker of intestinal condition, markedly elevated in rotavirus infections. Its role in defining the severity of necrotizing enterocolitis and the risk for perforation is not well described and needs further evaluation. An increase in zonulin may not be parallel to the release of inflammatory markers, and low CRP should not exclude an injury to neonatal intestine.

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Synergistic Uric Acid-Lowering Effects of the Combination of Chrysanthemum indicum Linne Flower and Cinnamomum cassia (L.) J. Persl Bark Extracts

Chrysanthemum indicum Linne flower (CF) and Cinnamomum cassia (L.) J. Persl bark (CB) extracts have served as the main ingredients in several prescriptions designed to treat hyperuricemia and gout in traditional Chinese and Korean medicine. However, little is known about the combination effects of a CF and CB (CC) mixture on hyperuricemia. In our study, we investigated the antihyperuricemic effects of CC mixture and the mechanisms underlying these effects in normal and potassium oxonate- (PO-) induced hyperuricemic rats. The CC mixture significantly decreased uric acid levels in normal and PO-induced hyperuricemic rats and showed the enhanced hypouricemic effect compared to CF or CB alone. Furthermore, the CC mixture increased renal uric acid excretion in PO-induced hyperuricemic rat. We found that CC mixture and its major components, chlorogenic acid, 3,4-dicaffeoylquinic acid (isochlorogenic acid), coumarin, cinnamaldehyde, trans-cinnamic acid, and o-methoxycinnamaldehyde, inhibit the activity of xanthine oxidase (XOD) in vitro. The CC mixture exerts antihyperuricemic effects accompanied partially by XOD activity inhibition. Therefore, the CC mixture may have potential as a treatment for hyperuricemia and gout.

http://ift.tt/2tCm6NA

Long-Term Course to Lumbar Disc Resorption Patients and Predictive Factors Associated with Disc Resorption

The long-term course to lumbar intervertebral disc herniation (LDH) patients receiving integrative Korean medicine treatment and predictive factors associated with disc resorption were investigated. LDH patients who received integrative Korean medicine treatment from February 2012 to December 2015 and were registered in the "longitudinal project for LDH on MRI" were included. Disc resorption amount was measured 3-dimensionally with disc degeneration and modic change levels on baseline and follow-up MRIs. Patient characteristics, Korean medicine use, pain, symptom recurrence, and satisfaction were assessed through medical records and phone surveys. Of 505 participants, 19 did not show disc resorption, while 486 did. A total of 220 displayed resorption rates of ≥50%. LDH volume at baseline was  mm3, and that on follow-up MRI was  mm3, indicating a 47.5% decrease (). Predictive factors for disc resorption were disc extrusion, Komori migration classification, and LDH amount. Approximately 68.4% did not experience symptom recurrence over the -month follow-up, and 90.3% were satisfied with Korean medicine treatment. The majority of LDH patients who improved after integrative Korean medicine treatment showed disc resorption within 1 year with favorable long-term outcomes. Predictive factors for disc resorption should be duly considered for informed decision-making. This trial is registered with ClinicalTrials.gov NCT02841163.

http://ift.tt/2u5Afpt

Focal Defects of the Knee Articular Surface: Evidence of a Regenerative Potential Pattern in Osteochondritis Dissecans and Degenerative Lesions

The surgical treatment of knee articular focal lesions may offer heterogeneous clinical results. Osteochondritis dissecans (OCD) lesions showed to heal better than degenerative lesions (DL) but the underlying biological reasons are unknown. We evaluated the basal histological and immunohistochemical characteristics of these lesions analyzing a series of osteochondral fragments from young patients with similar age but presenting different etiology. Osteochondral tissue samples were stained with Safranin O and graded using a histological score. Markers of mesenchymal progenitor cells (CD146), osteoclasts (tartrate-resistant acid phosphatase, TRAP), and vessels (CD34) were evaluated. Histological score showed a higher degeneration of both cartilage and bone compartments in OCD compared to DL fragments. Only CD146-positive cells were found at the same percentage in cartilage compartment of both DL and OCD patients. By contrast, in the bone compartment a significantly higher percentage of CD146, TRAP, and CD34 markers was found in OCD compared to DL patients. These data showed distinct histological characteristics of osteochondral focal lesions located in the same anatomical region but having a different etiology. The higher percentages of these markers in OCD than in DL, mainly associated with a high bone turnover, could help to explain the higher clinical healing potential of OCD patients.

http://ift.tt/2u5zBbE

Blue-black grassquit ( Volatina jacarina ) leucocyte and average weight reference values

Abstract

The bird species Volatina jacarina is popularly known as blue-black grassquit. They are widely distributed geographically and are not considered threatened for extinction. They are popularly domesticated because of their pleasant singing they can be found in many households. That means Veterinarians are sometimes confronted with those animals. This requires a certain knowledge about these birds, including in terms of reference values. Due to the lack of hematological data for this species, the present study aimed to calculate reference values for leukocytes and mean weight for this bird. To this end, 13 blue-black grassquit were captured at a private ranch located in Guarapari (ES), Southeastern Brazil. The birds were weighed for the determination of their average weight. Moreover, blood samples were drawn in order to conduct a leukocyte count. The mean weight found for V. jacarina was 11.7 ± 3.2 g. The average values determined for leukocytes were 53.8 ± 14.6% lymphocytes, 45.1 ± 15.2% for heterophils and 1.2 ± 1.5 for monocytes. The data found was compared with those in the literature, thus contributing to a better knowledge of the species.

http://ift.tt/2sCvKOP

Enterobius vermicularis infection among appendectomy specimens in Qom Province, Central Iran: a retrospective study

Abstract

The role of parasites in the pathogenesis of appendicitis has long been discussed. Enterobius vermicularis (E. vermicularis) is the most common parasitic worm found in the removed appendices. The main objective of this study was to determine the prevalence of parasitic infections among appendectomy specimens in Qom Province, Central Iran. This retrospective study was conducted at Nekoii Hospital of Qom City, from 21 March 2005 to 19 March 2016 (11-year period). The histopathology reports and recorded demographic data concerning 13,744 performed appendectomies were reviewed and then extracted using a structured template form. Out of the 13,744 surgically removed appendices, E. vermicularis was observed in 31 (0.22%) specimens. A total of the patients having E. vermicularis infection, 21 (67.74%) were female and 22 (70.97%) were less than 15 years old. According to the histopathology examinations, the appendix tissue was inflamed only in 3 (9.68%) specimens infected with E. vermicularis worm. The obtained results indicate that the presence of E. vermicularis in the appendix lumen rarely causes inflammation, and in most cases can lead to clinical signs of appendiceal colic or symptoms mimicking acute appendicitis. Therefore, the parasitic infections should be considered in the differential diagnosis of appendicitis.

http://ift.tt/2t0HRV9