A major predicament for Intensive Care Unit (ICU) patients is inconsistent and ineffective communication means. Patients rated most communication sessions as difficult and unsuccessful. This, in turn, can cause distress, unrecognized pain, anxiety, and fear. As such, we designed a portable BCI system for ICU communications (BCI4ICU) optimized to operate effectively in an ICU environment. The system utilizes a wearable EEG cap coupled with an Android app designed on a mobile device that serves as visual stimuli and data processing module. Furthermore, to overcome the challenges that BCI systems face today in real-world scenarios, we propose a novel subject-specific Gaussian Mixture Model- (GMM-) based training and adaptation algorithm. First, we incorporate subject-specific information in the training phase of the SSVEP identification model using GMM-based training and adaptation. We evaluate subject-specific models against other subjects. Subsequently, from the GMM discriminative scores, we generate the transformed vectors, which are passed to our predictive model. Finally, the adapted mixture mean scores of the subject-specific GMMs are utilized to generate the high-dimensional supervectors. Our experimental results demonstrate that the proposed system achieved 98.7% average identification accuracy, which is promising in order to provide effective and consistent communication for patients in the intensive care.
http://ift.tt/2nCi06m
Κυριακή 4 Φεβρουαρίου 2018
Portable Brain-Computer Interface for the Intensive Care Unit Patient Communication Using Subject-Dependent SSVEP Identification
Manipulation of Phonon Transport in Thermoelectrics
Abstract
For several decades, thermoelectric advancements have largely relied on the reduction of lattice thermal conductivity (κL). According to the Boltzmann transport theory of phonons, κL mainly depends on the specific heat, the velocity, and the scattering of phonons. Intensifying the scattering rate of phonons is the focus for reducing the lattice thermal conductivity. Effective scattering sources include 0D point defects, 1D dislocations, and 2D interfaces, each of which has a particular range of frequencies where phonon scattering is most effective. Because acoustic phonons are generally the main contributors to κL due to their much higher velocities compared to optical phonons, many low-κL thermoelectrics rely on crystal structure complexity leading to a small fraction of acoustic phonons and/or weak chemical bonds enabling an overall low phonon propagation velocity. While these thermal strategies are successful for advancing thermoelectrics, the principles used can be integrated with approaches such as band engineering to improve the electronic properties, which can promote this energy technology from niche applications into the mainstream.
Phonon transport is reviewed, considering its guiding principles, and including a summary of newly proven strategies and further considerations for κL-minimization. Most of the strategies presented can effectively reduce the lattice thermal conductivity, which leads to a great increase in thermoelectric performance in many materials.
http://ift.tt/2s7DpJh
Soft Ultrathin Electronics Innervated Adaptive Fully Soft Robots
Abstract
Soft robots outperform the conventional hard robots on significantly enhanced safety, adaptability, and complex motions. The development of fully soft robots, especially fully from smart soft materials to mimic soft animals, is still nascent. In addition, to date, existing soft robots cannot adapt themselves to the surrounding environment, i.e., sensing and adaptive motion or response, like animals. Here, compliant ultrathin sensing and actuating electronics innervated fully soft robots that can sense the environment and perform soft bodied crawling adaptively, mimicking an inchworm, are reported. The soft robots are constructed with actuators of open-mesh shaped ultrathin deformable heaters, sensors of single-crystal Si optoelectronic photodetectors, and thermally responsive artificial muscle of carbon-black-doped liquid-crystal elastomer (LCE-CB) nanocomposite. The results demonstrate that adaptive crawling locomotion can be realized through the conjugation of sensing and actuation, where the sensors sense the environment and actuators respond correspondingly to control the locomotion autonomously through regulating the deformation of LCE-CB bimorphs and the locomotion of the robots. The strategy of innervating soft sensing and actuating electronics with artificial muscles paves the way for the development of smart autonomous soft robots.
A fully soft robot that contains no rigid components is developed with demonstrated capabilities in inchworm-like locomotion. The fully soft robot is designed in the fashion of hybridization of artificial muscle of carbon-black-doped liquid-crystal elastomer nanocomposite with soft sensors of ultrathin Si optoelectronic sensors and soft actuators from open-mesh shaped thin resistive heaters.
http://ift.tt/2BVTMID
Mimicking Synaptic Plasticity and Neural Network Using Memtranstors
Abstract
Artificial synaptic devices that mimic the functions of biological synapses have drawn enormous interest because of their potential in developing brain-inspired computing. Current studies are focusing on memristive devices in which the change of the conductance state is used to emulate synaptic behaviors. Here, a new type of artificial synaptic devices based on the memtranstor is demonstrated, which is a fundamental circuit memelement in addition to the memristor, memcapacitor, and meminductor. The state of transtance (presented by the magnetoelectric voltage) in memtranstors acting as the synaptic weight can be tuned continuously with a large number of nonvolatile levels by engineering the applied voltage pulses. Synaptic behaviors including the long-term potentiation, long-term depression, and spiking-time-dependent plasticity are implemented in memtranstors made of Ni/0.7Pb(Mg1/3Nb2/3)O3-0.3PbTiO3/Ni multiferroic heterostructures. Simulations reveal the capability of pattern learning in a memtranstor network. The work elucidates the promise of memtranstors as artificial synaptic devices with low energy consumption.
An artifical synaptic device employing magnetoelectric effects is demonstrated based on memtranstors made of Ni/0.7Pb(Mg1/3Nb2/3)O3–0.3PbTiO3/Ni multiferroic heterostructures. The memtranstance presented by the magnetoelectric voltage serves as the synaptic weight and is tuned with a large number of nonvolatile levels to mimic the functionality of biological synapses. These results reveal the great potential of memtranstors as artificial synaptic devices with low energy consumption.
http://ift.tt/2nCEUul
Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions
Summary
We convened an international group of experts to standardize definitions of New-Onset Refractory Status Epilepticus (NORSE), Febrile Infection-Related Epilepsy Syndrome (FIRES), and related conditions. This was done to enable improved communication for investigators, physicians, families, patients, and other caregivers. Consensus definitions were achieved via email messages, phone calls, an in-person consensus conference, and collaborative manuscript preparation. Panel members were from 8 countries and included adult and pediatric experts in epilepsy, electroencephalography (EEG), and neurocritical care. The proposed consensus definitions are as follows: NORSE is a clinical presentation, not a specific diagnosis, in a patient without active epilepsy or other preexisting relevant neurological disorder, with new onset of refractory status epilepticus without a clear acute or active structural, toxic or metabolic cause. FIRES is a subcategory of NORSE, applicable for all ages, that requires a prior febrile infection starting between 2 weeks and 24 hours prior to onset of refractory status epilepticus, with or without fever at onset of status epilepticus. Proposed consensus definitions are also provided for Infantile Hemiconvulsion-Hemiplegia and Epilepsy syndrome (IHHE) and for prolonged, refractory and super-refractory status epilepticus. This document has been endorsed by the Critical Care EEG Monitoring Research Consortium. We hope these consensus definitions will promote improved communication, permit multicenter research, and ultimately improve understanding and treatment of these conditions.
http://ift.tt/2BV11QU
Managing the Mental Distress of the Hematopoietic Stem Cell Transplant (HSCT) Patient: a Focus on Delirium
Abstract
Purpose of Review
To highlight the breadth and types of mental distress experienced by hematopoietic stem cell transplant (HSCT) patients and highlight the need for better prevention and management of delirium.
Recent Findings
Recent publications highlight additional risks factors which predict for mental distress during the HSCT process. Despite new medications and additional psychological reports, there is little progress in non-pharmacologic or medication therapy in the prevention and treatment of delirium.
Summary
Mental distress, especially delirium, is common during the HSCT process. The morbidity associated with delirium and other mental distress can still be significant at 6–12 months after the completion of the procedure affecting patient functioning and quality of life (QOL). Medication interventions may be helpful but should be used sparingly for targeted patients during HSCT. Additional interventions are needed to prevent and treat delirium in HSCT patients.
http://ift.tt/2Ei0ptR
History and highlights of the teratological collection in the Museum Anatomicum of Leiden University, The Netherlands
The anatomical collection of the Anatomical Museum of Leiden University Medical Center (historically referred to as Museum Anatomicum Academiae Lugduno-Batavae) houses and maintains more than 13,000 unique anatomical, pathological and zoological specimens, and include the oldest teratological specimens of The Netherlands. Throughout four centuries hundreds of teratological specimens were acquired by more than a dozen collectors. Due to the rich history of this vast collection, teratological specimens can be investigated in a unique retrospective sight going back almost four centuries. The entire 19th century collection was described in full detail by Eduard Sandifort (1742–1814) and his son Gerard Sandifort (1779–1848). Efforts were made to re-describe, re-diagnose and re-categorize all present human teratological specimens, and to match them with historical descriptions. In the extant collection a total of 642 human teratological specimens were identified, including exceptional conditions such as faciocranioschisis and conjoined twins discordant for cyclopia, and sirenomelia. Both father and son Sandifort differed in their opinion regarding the causative explanation of congenital anomalies. Whereas, their contemporaries Wouter Van Doeveren (1730–1783) and Andreas Bonn (1738–1817) both presented an interesting view on how congenital anomalies were perceived and explained during the 18th and 19th centuries; the golden age of descriptive teratology. Although this enormous collection is almost 400 years old, it still impresses scientists, (bio)medical students, and laymen visiting and exploring the collections of the Museum Anatomicum in Leiden, The Netherlands.
http://ift.tt/2E02VFG
A parent-of-origin analysis of paternal genetic variants and increased risk of conotruncal heart defects
The association between conotruncal heart defects (CTHDs) and maternal genetic and environmental exposures is well studied. However, little is known about paternal genetic or environmental exposures and risk of CTHDs. We assessed the effect of paternal genetic variants in the folate, homocysteine, and transsulfuration pathways on risk of CTHDs in offspring. We utilized National Birth Defects Prevention Study data to conduct a family-based case only study using 616 live-born infants with CTHDs, born October 1997—August 2008. Maternal, paternal and infant DNA was genotyped using an Illumina® Golden Gate custom single nucleotide polymorphism (SNP) panel. Relative risks (RR) and 95% confidence intervals (CI) from log-linear models determined parent of origin effects for 921 SNPs in 60 candidate genes involved in the folate, homocysteine, and transsulfuration pathways on risk of CTHDs. The risk of CTHD among children who inherited a paternally derived copy of the A allele on GLRX (rs17085159) or the T allele of GLRX (rs12109442) was 0.23 (95%CI: 0.12, 0.42; p = 1.09 × 10−6) and 0.27 (95%CI: 0.14, 0.50; p = 2.06 × 10−5) times the risk among children who inherited a maternal copy of the same allele. The paternally inherited copy of the GSR (rs7818511) A allele had a 0.31 (95%CI: 0.18, 0.53; p = 9.94 × 10−6] risk of CTHD compared to children with the maternal copy of the same allele. The risk of CTHD is less influenced by variants in paternal genes involved in the folate, homocysteine, or transsulfuration pathways than variants in maternal genes in those pathways.
http://ift.tt/2nJzGfp
Neoadjuvant radiotherapy provided survival benefit compared to adjuvant radiotherapy for hepatocellular carcinoma
Background
This study compared the impact of neoadjuvant radiotherapy (RT) and adjuvant RT on survival for patients with hepatocellular carcinoma (HCC).
Methods
Patients with HCC were identified from the Surveillance, Epidemiology and End Results (SEER) database. The Kaplan–Meier method and multivariate Cox regression analysis were used to compare the impact of neoadjuvant RT on survival with adjuvant RT. Subsequently, a propensity score-matched analysis was performed to confirm the result.
Results
A total of 244 patients with HCC identified from the SEER database (2004–2014) received preoperative or post-operative radiation. A total of 151 patients received post-operative RT and 93 patients received preoperative RT. Preoperative RT had a clear superiority in terms of unadjusted overall survival and cancer-specific survival (P < 0.001 for log-rank test). After adjusting for confounding variables, hazard ratios (HRs) for all-cause (HR: 0.33; 95% CI: 0.19–0.53, P < 0.001) and cancer-specific (HR: 0.32; 95% CI: 0.19–0.53, P < 0.001) mortality risks in preoperative RT group were significantly lower than that of post-operative RT group. Subsequently, a propensity score-matched analysis was performed to confirm this result. Further univariate and multivariate survival analyses revealed that there was a persistent superiority of overall survival and cancer-specific survival in patients who received preoperative radiation than patients without RT.
Conclusion
We found that neoadjuvant RT was associated with improved long-term survival for patients with HCC versus adjuvant RT.
http://ift.tt/2nCjs8E
Neurological Complications of Acute and Chronic Sinusitis
Abstract
Purpose of Review
Acute and chronic sinusitis can give rise to a wide array of intracranial and orbital complications. These complications include brain abscess, subdural empyema, epidural abscess, meningitis, venous sinus thrombosis, frontal bone osteomyelitis, and orbital cellulitis and abscess. Despite numerous medical advances, these complications carry a risk of mortality and significant morbidity.
Recent Findings
Recent studies have shown improvement in both the mortality and the morbidity associated with the neurologic complications of acute and chronic sinusitis. However, there are still a large portion of patients with long-term sequelae, and the literature reports a morbidity rate of approximately 30%. The most common post-treatment morbidities include permanent changes in vision, seizures, and hemiparesis.
Summary
Although the overall incidence of neurologic complications from a sinogenic source are rare, the potential long-term complications can be devastating making prompt diagnosis and treatment vital to improving outcomes.
http://ift.tt/2E0SK3M
Issue Information
Cover of this issue. Expression of 15-PGDH (brown) in pancreatic cancer is reduced by co-culture of activated macrophages (Green). See also Arima et al. (pp. 462–470 of this issue).
http://ift.tt/2GMqBeE
Staging for Head and Neck Cancer: Purpose, Process and Progress
Abstract
With advancing knowledge and new data available, periodic revisions in the TNM staging system is essential. In addition, new disease entities entering in the spectrum of neoplastic diseases demand that a staging system be developed to facilitate their treatment algorithms and outcomes. The most recent revisions in the AJCC/UICC staging system were published in the eighth edition of the AJCC staging manual. This presentation gives a historical background on the AJCC/UICC staging process and highlights major changes introduced in the eighth edition for cancers of the head and neck.
http://ift.tt/2E2PwZy
Vitamin D supplementation for bone health in adults with epilepsy: A systematic review
Summary
Objective
Several antiepileptic drugs (AEDs) have been associated with a detrimental effect on bone health through a reduction in serum vitamin D. Subsequently, several studies have investigated the effect of vitamin D supplementation in persons with epilepsy being treated with AEDs. The present systematic review of published literature was conducted to determine the effect of vitamin D intervention on bone health in adults with epilepsy.
Methods
The following databases were searched using keywords including but not limited to epilepsy, bone, and vitamin D: PubMed, Medline, Embase, Scopus, Cochrane Clinical Trials, International Pharmaceutical Abstracts, Health Canada Clinical Trials Database, ClinicalTrials.gov, EU Clinical Trials, and Google. Studies were eligible if there was an epilepsy diagnosis, participants were adults (18+ years old), and vitamin D treatment and bone outcome were provided. Articles were screened independently by 2 reviewers. Methodological quality was assessed using the Cochrane Collaboration's tool and a modified Newcastle Ottawa Scale for nonrandomized studies.
Results
Nine studies were found to be eligible for this review. After vitamin D treatment, there appeared to be positive changes in bone turnover markers; 3 of 8 studies found the increase in serum calcium to be significant, 6 of 8 studies found the decrease in alkaline phosphatase to be significant, and 2 of 4 studies found the decrease in parathyroid hormone to be significant. All 6 studies that investigated bone mineralization had significant findings; however, due to varying methodologies, the impact of vitamin D on bone mineralization was inconclusive.
Significance
Vitamin D does appear to have some benefit to bone health in adults with epilepsy, and therefore supplementation could potentially be a requisite to using some AEDs. To clarify the role of vitamin D supplementation to manage the adverse effect of AEDs on bone health in adults with epilepsy, long-term trials that use higher doses (>1800 IU) and measure bone mineral density are necessary.
http://ift.tt/2s7db9Q
Complications following immediate compared to delayed deep inferior epigastric artery perforator flap breast reconstructions
Abstract
Purpose
As more breast cancer patients opt for immediate breast reconstruction, the incidence of complications should be evaluated. The aim of this study was to analyze the recipient-site complications and flap re-explorations of immediate compared to delayed deep inferior epigastric artery perforator (DIEP) flap breast reconstructions.
Methods
For this multicenter retrospective cohort study, the medical records of all patients who underwent DIEP flap breast reconstruction in three hospitals in the Netherlands between January 2010 and June 2017 were reviewed. Patient demographics, risk factors, timing of reconstruction, recipient-site complications, and flap re-explorations were recorded.
Results
A total of 910 DIEP flap breast reconstructions (n = 397 immediate and n = 513 delayed reconstructions) in 737 patients were included. There were no significant differences in major complications or flap re-explorations between immediate and delayed reconstructions. The total flap failure rate was 1.5 and 2.5% in the immediate and delayed group, respectively. Significantly more hematomas (OR 2.91; 95% CI 1.59–5.30; p = 0.001) and seromas (OR 3.60; 95% CI 1.14–11.4; p = 0.029) occurred in immediate reconstructions, whereas wound problems were more frequently observed in delayed reconstructions (OR 1.99; 95% CI 1.27–3.11; p = 0.003). Correction for potential confounders still showed significant differences for hematoma and seroma, but no longer for wound problems (p = 0.052).
Conclusions
This study demonstrated similar incidences of major recipient-site complications and flap re-explorations between immediate and delayed DIEP flap breast reconstructions. However, hematoma and seroma occurred significantly more often in immediate reconstructions, while wound problems were more frequently observed in delayed reconstructions.
http://ift.tt/2s63Q1L
Cover
The cover image, by Jin Whan Lee et al., is based on the Original Research New bone formation and trabecular bone microarchitecture of highly porous tantalum compared to titanium implant threads: A pilot canine study, DOI: 10.1111/clr.13074.
http://ift.tt/2DZMqpb
How removing visual information affects grasping movements
Abstract
Our interaction with objects is facilitated by the availability of visual feedback. Here, we investigate how and when visual feedback affects the way we grasp an object. Based on the main views on grasping (reach-and-grasp and double-pointing views), we designed four experiments to test: (1) whether the availability of visual feedback influences the digits independently, and (2) whether the absence of visual feedback affects the initial part of the movement. Our results show that occluding (part of) the hand's movement path influences the movement trajectory from the beginning. Thus, people consider the available feedback when planning their movements. The influence of the visual feedback depends on which digit is occluded, but its effect is not restricted to the occluded digit. Our findings indicate that the control mechanisms are more complex than those suggested by current views on grasping.
http://ift.tt/2BUbQTn
Improving Supportive Care Access Among Cancer Outpatients: The Preliminary Design of a Data-Driven and Technology-Based Intervention (S724)
Despite focus on early integration of palliative and supportive care for cancer patients, patients with cancer struggle to preserve normalcy in a highly disruptive context.
http://ift.tt/2FLzjsd
A Systematic Review of Advance Care Planning Interventions for Clients with Cancer Using the Transtheoretical Model of Behavior Change (S721)
Cancer is the 2nd leading cause of death in the United States, with nearly 600,000 deaths in 2013. Advance care planning (ACP) has been associated with care consistent with client preferences, satisfaction with the quality of death, and satisfaction with care. Despite these benefits, clients with cancer have modest engagement in ACP. ACP is a process of behavior change, and is connected to the Trans theoretical Model of Behavior Change (TTM). This systematic review analyzed approaches to ACP intervention design for clients with cancer using the TTM to identify opportunities for increasing ACP engagement.
http://ift.tt/2EiD8I6
Symptom Burden and Quality of Life in Children Who Died of Cancer (S720)
Cancer is the leading cause of non-accidental deaths in children aged 5 to 14. Despite increased awareness of the importance of aggressive symptom management, children with cancer still suffer from high symptom burden and decreased quality of life (QoL).
http://ift.tt/2FJmK0r
The GAP-ED Project: Improving Care for Frail and Elderly Patients Presenting to the Emergency Department (QI835)
Older adults in the ED are a vulnerable population at risk of return visits, unnecessary hospitalization, and death. ED admissions data at Long Island Jewish Medical Center (LIJMC) revealed an elderly population with multiple revisits for non-emergency medical care. The Geriatric and Palliative (GAP) Division and ED at LIJMC implemented a multidisciplinary GAP-ED Team, delivering geriatric and palliative expertise to the ED.
http://ift.tt/2EdF30D
Hospice Medical Director Update and Exam Prep (P01)
Join peers and national experts to explore and further develop the skills needed to successfully navigate today's hospice environment. This intensive review will serve as part of your preparation for the Hospice Medical Director Certification Board exam and is based on the exam blueprint (www.hmdcb.org). The workshop also serves as a great orientation for those new to the hospice field or as a critical update for all hospice practitioners and managers.
http://ift.tt/2FM1Ldz
Focus Group Findings on Needs and Supports for Family Caregivers Caring for a Family Member with Cognitive Impairment (S749)
To develop educational course content for healthcare providers on supporting caregivers of individuals with dementia, we conducted formative research into the current challenges, experiences and knowledge gaps of family caregivers.
http://ift.tt/2Eg1X7u
VitalTalk: Intensive Small Group Training—Addressing Goals of Care (P02)
As a palliative care consultant from any professional background, discussing goals of therapy when things are not going well is the most common reason for an inpatient consult. Discussing goals of care is difficult because it requires the consultant to accomplish a number of interrelated, emotional tasks in a short period of time: deliver bad news, assess what is important to the patient, and make a recommendation about how to best proceed. Using a mix of short didactic talks and experiential practice, this workshop will help participants develop a toolkit of skills useful for handling these difficult conversations.
http://ift.tt/2FMgK7b
Parenting with Life-Limiting Illness: Strategies to Support Families with Dependent Children (FR437)
Patients living with life-limiting illness who are raising dependent children face unique stressors during the period of terminal illness and end-of-life. Parents have concerns about the impact of their disease and potential death on their children and their ability to simultaneously manage treatment and caregiving responsibilities. They also have concerns about how to optimally communicate with children, particularly when treatment choices or prognosis is uncertain. Among parents with advanced cancer, the severity of parental concerns is linked to increased symptoms of anxiety and worse health-related quality of life.
http://ift.tt/2Ed7hJ0
Palliative Nursing Leadership Intensive (P03)
Leadership in palliative care is characterized by leading others with a clear vision of palliative care initiatives, motivating and inspiring others to achieve excellence in care, positively relating to others to create healthy work environments, and changing the behavior of others to work collaboratively in palliative care (Speck, 2006). Palliative nursing leadership is neither defined nor grounded by level of nursing practice nor education but rather on qualities. These leadership qualities may be attained by any nurse at any level from the bedside nurse, the nurse group leader or organizer, to the nurse in a designated leadership position.
http://ift.tt/2FHk2bG
What Works Best For Whom? Exploring the Efficacy of Two Psychosocial Interventions in Palliative Care (FR419D)
Attention to psychosocial aspects of care are central to comprehensive palliative care. Yet, our understanding of which interventions are best applied to which patient populations is in its infancy requiring increased evidence.
http://ift.tt/2EgYtlg
ACHPN® Certification Review: Advanced Practice Registered Nurse (P04)
The purpose of this HPNA Endorsed ACHPN® Review Course is to promote education of the APRN seeking augmentation of their professional development through specialty hospice and palliative advanced registered nursing certification. This one-day, provider-directed, provider-paced, live intensive course is designed to assist with preparation for the advanced hospice and palliative nurse certification exam through didactic course presentation with active learner engagement, case study examinations, practice exam questions and self-check/reflection to highlight self-identifying topics that require further preparation and study in advance of sitting for the ACHPN® examination.
http://ift.tt/2FM1DL7
WGYLM?TM Strategies to Encourage Advance Care Planning of Healthcare Providers (QI819)
Conversations regarding healthcare decisions are central to patient- and family-centered care. Early and regular advanced care planning (ACP) conversations benefit the patient, family, multidisciplinary team, and healthcare system.
http://ift.tt/2EgXRfs
HPM Fellowship Directors Program: Managing the Good, the Bad, and the Ugly—Expert Strategies for the Assessment and Remediation of Palliative Care Fellows (P05)
The fellowship directors program will provide participants with the opportunity to learn about the latest advances in fellow-level education and to develop connections with other palliative care educators. This year's program will focus on the assessment and remediation of palliative care fellows, two of the biggest challenges program directors face. First, the Executive Director of Milestones Development at the ACGME will lead a session about using the Milestones, leading an effective Clinical Competency Committee, and performing faculty development using the Milestones and assessment tools.
http://ift.tt/2FLXdE6
Exploring Approaches to the Management of Acute Neoplasm Related Pain in Patients on Buprenorphine or Methadone for Opioid Dependence (S765)
Opioid abuse is a devastating, costly, and growing problem in the United States. To improve access to addiction treatment buprenorphine has become widely available. Data on best strategies in treatment of cancer pain in patients on buprenorphine or methadone for addiction are lacking. Optimal acute neoplasm related pain management in opioid dependent patients with cancer is a clinical challenge in both inpatient and outpatient settings due to balancing concerns for exacerbating physical dependence while avoiding under-treatment.
http://ift.tt/2Ehv8XZ
AAHPM Leadership Forum: Ignite—Using StrengthsFinder Leadership Strategies to Increase the Performance of You and Your Team in Palliative Care and Hospice Settings (P06)
Would you like to discover what makes you stand out? This half-day session will focus on utilizing a strengths-based approach to create consistent and positive outcomes to everyday challenges in hospice and palliative care settings. Strengths are the unique combination of talents, knowledge, and skills that every person possesses. Participants will complete a StrengthsFinder assessment which will help to identify personal strengths to focus on to become a more effective leader. They will also learn how to develop these strengths in order to do what they do best every day.
http://ift.tt/2FL1S8W
Utilization of High-Fidelity Simulation to Teach Advance Care Planning to Undergraduate Nursing Students (S733)
The lack of clinical opportunities for palliative care and end-of-life experiences for undergraduate nursing students creates a void in the students' confidence, comfort, communication, and attitude to deal with these situations. Nurses report they are uncomfortable, fearful, helpless, anxious, and often feel inadequately prepared in dealing with death and dying. Research has found that simulations improve the students' experience with dying patients in a controlled, safe, and interactive learning environment.
http://ift.tt/2EbQQg7
Providing Palliative Care to Patients and Families with Pre-Existing Mental Health and Substance Use Issues (P07)
Managing mental health and addiction in hospice and palliative care is a critical component of quality care for patients facing serious illness who also have pre-existing behavioral and/or substance use issues. Reports underscore the high prevalence and burden of behavioral health disorders, particularly in the presence of other physical health conditions. Despite this concern, patients can experience fragmented care that leads to suboptimal services and outcomes, including poor patient and family satisfaction, and higher costs.
http://ift.tt/2FHMASI
Evolving from Individual Wellness to Departmental Wellbeing: How to Achieve Resilience and Longevity in Palliative Medicine (FR433)
With rates of burnout for palliative clinicians as high as 62% in recent studies it is imperative to the wellbeing of providers and their organizations to recognize those instances in which care given may be exceeded by patient needs. Complex, vulnerable patients increase the unmet demand for more palliative services and contribute to lack of wellness and resiliency in providers. The National Wellness Institute sees wellness as an evolving process through which a person achieves his or her full potential.
http://ift.tt/2Ehv2zB
The ABCs of MOC and Exam Prep (P08)
In 2018, the first recertification examination in HPM will be offered to members certifying in 2008. The purpose of this session is to provide a high-level overview of the MOC process, examination blueprint, and AAHPM resources available to those taking the examination. Most of the session will be spent reviewing selected questions from the HPM-PASS product and include the use of an Audience Response System as a platform to discuss the correct answers and rationale. Additionally, attendees with receive information of techniques to improve exam-taking skills.
http://ift.tt/2FIRKO8
A Retrospective Review of the Role of Palliative Care in Patients Evaluated for Left Ventricular Device Implantation (QI827)
Left Ventricular Assist Device (LVAD) is a therapy that can prolong life in advanced heart failure patients. This population and their caregivers can have significant physical, emotional, and psychosocial needs. In October 2014, to improve the quality of care for this population, the Joint Commission recommended Palliative Care be added to the core interdisciplinary team. In 2016, North Shore University Hospital (NSUH) started their LVAD program and collaborated with the Geriatrics and Palliative (GAP) Care team to meet this quality measure.
http://ift.tt/2Eiwt0L
Effects of training physicians in electronic prescribing in the outpatient setting on clinical, learning and behavioural outcomes, a cluster randomized trial
Abstract
Aims
Electronic prescribing systems may improve medication safety, but only when used appropriately. Effects of a task-analysis based training were evaluated in the outpatient setting on clinical, learning and behavioral outcomes, compared with usual educational approach.
Methods
Multicenter, cluster-randomized trial (MEDUCATE trial) with physicians as unit of analysis. Setting: Outpatient clinics of two academic hospitals. Participants: Specialist and residents of internal medicine and their patients. Intervention: Small group session, e-Learning. Primary outcome: proportion of medication discrepancies per physician: measured as discrepancies between medications registered by physicians in the electronic prescribing system and those reported by patients. Clinical consequences: estimated by the proportion of patients per physician with at least one missed drug-drug interaction with potential for causing adverse drug events. A questionnaire assessed physicians' knowledge and skills.
Results
Among 124 participating physicians, for 115 (93%) data for the primary outcome were available. 1094 patients were included. A mean of 48% of registered medications per physician were discrepant with the medications their patients reported in both groups (p=0.14). Due to registration omissions, a mean of 4% of patients per physician had one or more missed drug-drug interactions with the potential to cause a clinically relevant adverse drug event in the intervention group, and 7% in controls (p=0.11). Percentage correct answers on the knowledge and skills-test were higher in the intervention group (57%) compared to controls (51%; p=0.01).
Conclusion
The training equipped outpatient physicians with knowledge and skills for appropriate use of electronic prescribing systems, but had no effect on medication discrepancies.
http://ift.tt/2DZG4dm
Threats to global antimicrobial resistance control Centrally approved and unapproved antibiotic formulations sold in India
Introduction
Rising antimicrobial resistance (AMR) is a global health crisis. India has among the highest resistance rates and antibiotic consumption internationally. Extensive use of fixed dose combination (FDC) antibiotics and of unapproved formulations are claimed contributory factors but there has been no systematic examination of formulations or volumes sold.
Objective
To investigate the regulatory approval status and sales volumes of systemic antibiotics marketed in India.
Methods
This was an ecological study using regulatory records in India, the UK and US to determine the approval status in each country of systemic antibiotic FDC and single drug formulations (SDFs) marketed in India. Pharmatrac® sales data were used to determine the formulations and volumes sold in India (2007-2012), branded-product numbers, and manufacturers.
Results
Of 118 systemic antibiotic FDC formulations marketed in India, 43(36%) were approved but 75 (64%) had no record of regulatory approval; 5(4%) formulations were approved in the UK and/or US. Almost half of formulations (58/118,49%) comprised dual antimicrobials, most unapproved in India (43/58,74%), and many pharmacologically problematic. In contrast, 80/86(93%) SDFs were approved in India and over two-thirds in the UK and/or US.
Total antibiotic sales increased by 26% from 2056 Million-Units (2007-08) to 2583 Million-Units (2011-12). FDC sales rose by 38% versus 20% for SDFs. By 2011-12, FDCs comprised one-third of sales (872 Million-Units). Over one-third of FDCs sold (300.26 Million-Units, 34.5%) were of unapproved formulations. Multi-National Companies manufactured unapproved formulations and accounted for 19% of FDC and of SDF sales annually.
Conclusions
Sales in India of antibiotic FDCs, including unapproved formulations, are rising. In the context of increasing AMR rates nationally and globally, unapproved antibiotic FDCs undermine India's national AMR strategy and should be banned from sale.
http://ift.tt/2GNEARw
Single-Cell Quantification of Protein Degradation Rates by Time-Lapse Fluorescence Microscopy in Adherent Cell Culture
This protocol describes a method to determine protein half-lives in single living adherent cells, using pulse labeling and fluorescence time-lapse imaging of SNAP-tag fusion proteins.
http://ift.tt/2GLu39e
Prevalence of Irritable Bowel Syndrome and Chronic Fatigue 10 Years after Giardia Infection
Patients who had a gastrointestinal parasite infection were more likely to experience irritable bowel syndrome and chronic fatigue up to 10 years after the initial infection was resolved, as compared to uninfected individuals.
http://ift.tt/2EGhc7L
Clinical Utility of EEG in Diagnosing and Monitoring Epilepsy in Adults
Epilepsy is a common, chronic, complex group of neurological disorders. Worldwide, more than 50 million people have epilepsy, affecting humans of all ages, ethnicity, social background, and geographic location (Perucca et al., 2014a; England et al., 2012). It is characterized by an ongoing predisposition to recurrent seizures. Newer definitions of epilepsy include patients with reflex seizures, those with two or more unprovoked seizures greater than 24 hours apart, and high-risk individuals with a single seizure and at least a 60% likelihood of experiencing recurrent seizures over the ensuing 10 years as compared to the general population (Fisher et al., 2014).
http://ift.tt/2nE9QJM
Right prefrontal cortex specialization for visuospatial working memory and developmental alterations in prefrontal cortex recruitment in school-age children
Working memory (WM) is a system for maintaining and manipulating information (Baddeley et al., 1974), which has a subsystem that specifically processes visuospatial information (i.e., visuospatial WM: VSWM). Cornoldi et al. (2004) have proposed a continuity model of WM assuming the existence of two dimensions: a horizontal continuum comprising different content types (e.g., verbal or visuospatial information) and a vertical continuum distinguishing between passive storage and active processing. Passive storage is the retention of information that is not modified after encoding, whereas active processing is associated with integration, transformation, modification, and/or manipulation of stored information (Cornoldi et al., 2000; Cornoldi et al., 2004).
http://ift.tt/2DZQREt
Symmetry of cortical planning for initiating stepping in sub-acute stroke
After stroke, many people exhibit altered movement patterns making normal performance of balance and walking difficult (Duncan et al., 1992). However, the influence of motor planning on performance of balance and walking post-stroke is not well understood. Motor planning is defined as the integration of sensory afferent information (Ghez et al., 1997), such as limb position and muscle force (Kandel et al., 2000), with a functional goal (Zimmermann et al., 2012) to generate a movement (Peters et al., 2015).
http://ift.tt/2nH75Yk
Peripheral Neuropathies and the Vestibular System: Is there a role for Vestibular Rehabilitation?
Vestibular evoked myogenic potentials (VEMPs) are used to objectively evaluate function and dysfunction of the vestibular system, specifically the sacullo-collic pathway (mainly, with the use of cervical VEMPs (cVEMPs)) and the utriculo-ocular pathway (mainly, with the use of ocular VEMPs (oVEMPs) (Colebatch et al., 1994; Rosengren et al., 2005; Iwasaki et al., 2007; Todd et al., 2007; Rosengren et al., 2009; Zhang et al., 2011). Together with other paramedical examinations, notably the caloric test and the video head impulse test (vHIT), all parts of the vestibular labyrinth may now be objectively and quantitatively examined.
http://ift.tt/2DZQLg5
Characterization of the stimulus waveforms generated by implantable pulse generators for deep brain stimulation
Deep brain stimulation (DBS) is an established therapy to treat several neurological disorders (e.g. essential tremor, Parkinson's disease, dystonia, obsessive-compulsive disorder) (Benabid et al., 1991; Greenberg et al., 2010; Obeso et al., 2001; Vidailhet et al., 2005) and its efficacy is being explored for a range of additional indications (e.g. epilepsy, treatment-resistant depression, neuropathic pain, Tourette syndrome) (Fisher et al., 2010; Holtzheimer, 2012; Lempka et al., 2017; Malone et al., 2009; Morrell and RNS System in Epilepsy Study Group, 2011; Schrock et al., 2015).
http://ift.tt/2nE9Qtg
Functional cortical source connectivity of resting state electroencephalographic alpha rhythms shows similar abnormalities in patients with mild cognitive impairment due to Alzheimer’s and Parkinson’s diseases
About 50-70% of 46 million of cases of dementia worldwide are due to Alzheimer's (ADD) and Parkinson's (PDD) neurodegenerative diseases across aging (Prince et al., 2015). ADD typically presents a major amnesic syndrome and minor linguistic, visuospatial, and visual disease variants (Dubois et al., 2014). PDD manifest attentional, verbal, and executive cognitive deficits in association with motor manifestations such as akinesia, tremor, postural instability, and rigidity (Aarsland et al., 2003; Buter et al., 2008; Dubois and Pillon, 1996; Emre et al., 2007; Huber et al., 1989; Hughes et al., 2000; Levy et al., 2000; Walker et al., 2015; Wolters, 2001).
http://ift.tt/2E13lM7
Corrigendum to “Ultrasound in polyneuropathies – Is size or structure all that matters?” [Clin. Neurophysiol. 128 (2017) 2519–2520]
The authors regret that author the name of author K. Pitarokoili was misspelled as 'K. Pitarokoilli' in the original article. This has now been corrected.
http://ift.tt/2nG5lhO
Safety and Efficacy of Intravenous Lidocaine for Pain Management in the Emergency Department: A Systematic Review
We evaluate the safety and efficacy of intravenous lidocaine in adult patients with acute and chronic pain who are undergoing pain management in the emergency department (ED).
http://ift.tt/2nI1u3V
Outcomes of Endoscopic Intervention for Overt Gastrointestinal Bleeding in Severe Thrombocytopenia
Gastrointestinal bleeding (GIB) in the setting of thrombocytopenia raises concerns about endoscopic procedure risk. We aimed to assess the safety and outcomes of endoscopy for overt GIB in the setting of severe thrombocytopenia in liver cirrhosis (LC) and non-liver cirrhosis (NLC).
http://ift.tt/2BUTpOj
Outcomes of endoscopic biliary drainage in pancreatic cancer patients with an indwelling gastroduodenal stent: a multicenter cohort study in west Japan
Gastroduodenal and biliary obstruction may occur synchronously or asynchronously in advanced pancreatic cancer, and endoscopic double stent placement may be required. EUS-guided biliary drainage (EUS-BD) is often performed after unsuccessful endoscopic transpapillary stent placement (ETS), and EUS-BD may be beneficial in double stent placement. This retrospective multicenter cohort study compared the outcomes of ETS and EUS-BD in patients with an indwelling gastroduodenal stent (GDS).
http://ift.tt/2nBihX2
The importance of EGFR as a biomarker in molecular apocrine breast cancer
Molecular apocrine breast cancer (MABC) is a molecular subtype with a poor prognosis, and there is urgent need to find new therapeutic targets. Epidermal growth factor receptor (EGFR) plays an important part in regulating the biological behavior of tumor cells, and EGFR-targeted drugs have already been used in therapy for lung and colorectal cancers. The purpose of this study was to analyze the significance of EGFR expression in MABC. A total of 400 patients with invasive breast cancer were analyzed, including 200 MABC and 200 nonMABC cases.
http://ift.tt/2nIqXdn
Strong Androgen Receptor Expression Can Aid in Distinguishing GATA3+ Metastases
GATA3 is a transcription factor used clinically as a marker of breast or urothelial differentiation. A marker is yet needed to distinguish these in the case of the GATA3 positive tumor of unknown origin. We tested classical markers of breast differentiation and hormonal signaling to see which correlated strongest with GATA3 expression in breast cancer and thus which could help correctly identify breast origin in the case of the GATA3 positive tumor of unknown origin. GATA3, estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), HER2, GCDFP15, and mammaglobin expression was inter-correlated in a histologically diverse 259 case breast cancer tissue microarray.
http://ift.tt/2E2TTIk
Detecting the Lyme Disease Spirochete, Borrelia Burgdorferi, in Ticks Using Nested PCR
Nested PCR is a sensitive, specific, and straightforward technique that can be applied to tick DNA extracts to probe for Borrelia burgdorferi, the causative agent of Lyme disease. The initial PCR experiment uses gene-specific primers to generate long amplicons, which then become templates for a subsequent reaction using internal primers.
http://ift.tt/2Efml8Y
Placental Pathology in Neonatal Stroke: A Retrospective Case-Control Study
To assess the association of placental abnormalities with neonatal stroke.
http://ift.tt/2s5GMQP
Effect of Dietary Counseling on a Comprehensive Metabolic Profile from Childhood to Adulthood
To study the effects of repeated, infancy-onset dietary counseling on a detailed metabolic profile. Effects of dietary saturated fat replacement on circulating concentrations of metabolic biomarkers still remain unknown.
http://ift.tt/2GICRg6
Infant Iron Deficiency and Iron Supplementation Predict Adolescent Internalizing, Externalizing, and Social Problems
To evaluate associations between iron supplementation and iron deficiency in infancy and internalizing, externalizing, and social problems in adolescence.
http://ift.tt/2nLnYBd
Design and Characterization Methodology for Efficient Wide Range Tunable MEMS Filters
A protocol for a fixed-fixed beam design using a laser Doppler vibrometer (LDV), including the measurement of frequency tuning, modification of tuning capability, and avoidance of device failure and stiction, is presented. The superiority of the LDV method over the network analyzer is demonstrated due to its higher mode capability.
http://ift.tt/2s40dJT
Efficacy of Medical Therapies for Fistulizing Crohn’s Disease: Systematic Review and Meta-analysis
Pooled evidence suggests that TNF antagonists are effective for the induction and maintenance of fistula response and fistula remission. More efficacy data are needed on novel therapies including vedolizumab, ustekinumab and mesenchymal stem cells.
http://ift.tt/2GIZG3n
Prevalence and characteristics of pruritus and association with quality of life in people living with HIV: a cross-sectional study
Pruritus is a common complaint of people living with HIV/AIDS (PLWHA) and can cause significant morbidity [1]. Chronic pruritus is a multi-faceted symptom that includes physical, psychological, and functional aspects [2]. Therefore, it is critical to assess pruritus in relationship to quality of life (QOL) in PLWHA. Data is limited on the relationship between chronic pruritus and HIV and effect on QOL [3,4]. The prevalence of chronic itch among PLWHA in one report was 45% and associated with decreased QOL [4].
http://ift.tt/2GKIA50
Palliative Sedation for Existential Suffering: A Systematic Review of Argument-Based Ethics Literature
While unanimity exists on using palliative sedation (PS) for controlling refractory physical suffering in end-of-life situations, using it for controlling refractory existential suffering (PS-ES) is controversial. Complicating the debate is that definitions and terminology for existential suffering are unclear, ambiguous, and imprecise, leading to a lack of consensus for clinical practice.
http://ift.tt/2sa8ps8
Symptoms do not Correlate With Findings From Colonoscopy in Children with Inflammatory Bowel Disease and Primary Sclerosing Cholangitis
Primary sclerosing cholangitis-associated colitis (PSC-IBD) is frequently active endoscopically and histologically even without symptoms, possibly explaining the disconnect between the mild clinical course but greater risk of colon cancer. Fecal calprotectin is more accurate for determining bowel healing in PSC-IBD.
http://ift.tt/2GN7QHJ
Diagnostic Performance of Measurement of Fecal Elastase-1 in Detection of Exocrine Pancreatic Insufficiency – Systematic Review and Meta-analysis
Tests to quantify fecal levels of chymotrypsin like elastase family member 3 (CELA3 or elastase-1) in feces are widely used to identify patients with exocrine pancreatic insufficiency (EPI). However, the diagnostic accuracy of this test, an ELISA, is not clear. We performed a systematic review and meta-analysis to determine the accuracy of measurement of fecal elastase-1 in detection of EPI.
http://ift.tt/2GN5DMO
Clinical Significance of Hemostatic Parameters in the Prediction for Type 2 Diabetes Mellitus and Diabetic Nephropathy
It would be important to predict type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN). This study was aimed at evaluating the predicting significance of hemostatic parameters for T2DM and DN. Plasma coagulation and hematologic parameters before treatment were measured in 297 T2DM patients. The risk factors and their predicting power were evaluated. T2DM patients without complications exhibited significantly different activated partial thromboplastin time (aPTT), platelet (PLT), and D-dimer (D-D) levels compared with controls (). Fibrinogen (FIB), PLT, and D-D increased in DN patients compared with those without complications (). Both aPTT and PLT were the independent risk factors for T2DM (OR: 1.320 and 1.211, , resp.), and FIB and PLT were the independent risk factors for DN (OR: 1.611 and 1.194, , resp.). The area under ROC curve (AUC) of aPTT and PLT was 0.592 and 0.647, respectively, with low sensitivity in predicting T2DM. AUC of FIB was 0.874 with high sensitivity (85%) and specificity (76%) for DN, and that of PLT was 0.564, with sensitivity (60%) and specificity (89%) based on the cutoff values of 3.15 g/L and 245 × 109/L, respectively. This study suggests that hemostatic parameters have a low predicting value for T2DM, whereas fibrinogen is a powerful predictor for DN.
http://ift.tt/2BSmB8x
High Expression of ITGA3 Promotes Proliferation and Cell Cycle Progression and Indicates Poor Prognosis in Intrahepatic Cholangiocarcinoma
Integrin subunit alpha 3 (ITGA3) interacts with a beta 1 subunit to form a member of the integrin family. Integrins are heterodimeric integral membrane proteins that serve as cell surface adhesion proteins. In this research, we investigated the biological function of this protein in human intrahepatic cholangiocarcinoma (ICC) for the first time. Here, using Western blotting and immunohistochemistry assays, we discovered that ITGA3 was overexpressed in ICC cell lines and ICC patients. Moreover, we found ITGA3 expression correlated with several clinicopathological features, including tumor size, lymph node metastasis, and the TNM stage. Patients with high ITGA3 expression underwent a worse prognosis after complete resection compared with patients with low ITGA3 expression in terms of overall survival. Furthermore, we demonstrated that ITGA3 could significantly promote ICC cell proliferation and cell cycle progression in vitro. However, as a classical cell surface adhesion molecule, we found ITGA3 correlated negatively with the migration and invasion of ICC cell lines, which differs from other malignant tumors. Generally, these findings suggest that ITGA3 may play a role as a potential oncogene in ICC and suppression of ITGA3 expression may establish a novel target for guiding the therapy of ICC patients.
http://ift.tt/2nGlzr7
Evaluation of Cerebral White Matter in Prelingually Deaf Children Using Diffusion Tensor Imaging
This study compared white matter development in prelingually deaf and normal-hearing children using a tract-based spatial statistics (TBSS) method. Diffusion tensor imaging (DTI) was performed in 21 prelingually deaf (DEAF group) and 20 normal-hearing (HEAR group) subjects aged from 1.7 to 7.7 years. Using TBSS, we evaluated the regions of significant difference in fractional anisotropy (FA) between the groups. Correlations between FA values and age in each group were also analyzed using voxel-wise correlation analyses on the TBSS skeleton. Lower FA values of the white matter tract of Heschl's gyrus, the inferior frontooccipital fasciculus, the uncinate fasciculus, the superior longitudinal fasciculus, and the forceps major were evident in the DEAF group compared with those in the HEAR group below 4 years of age, while the difference was not significant in older subjects. We also found that age-related development of the white matter tracts may continue until 8 years of age in deaf children. These results imply that development of the cerebral white matter tracts is delayed in prelingually deaf children.
http://ift.tt/2s11RvC
Incidence and Predictive Model for Lateral Pelvic Lymph Node Metastasis in Lower Rectal Cancer
Abstract
The lateral pelvic lymph node recurrence after curative resection in rectal cancer has been reported in more than 20% of cases and the lateral pelvic lymph node (LPLN) metastasis is an independent risk factor for local recurrence. A prospective cohort study with diagnosis of lower rectal cancer stages II and III performed to identify the factors with significant correlation with LPLN metastasis was categorised based on the number of positive factors and proposed a risk stratification model to uncover a possible benefit of LPLD in specific patient subgroups. Forty-three patients with lower rectal cancer underwent curative surgery, total mesorectal excision with bilateral lateral pelvic lymph node dissection. Pre-operative, female gender, raised serum CEA (> 5 ng/mL), cT4, enlarged mesorectal lymph nodes, borderline enlarged LPLN on MRI, lower location (< 5 cm from anal verge), large size (> 5 cm) and non-circumferential lesion were significant predictors for LPLN metastasis. Histopathological, higher tumour grade, higher pT and pN stage, and the presence of LVI were significant factors. On cox-proportional hazard model analysis, female gender, large tumour, cT4, enlarged mesorectal lymph nodes, borderline enlarged LPLN, pN1 and positive LVI were associated with significant hazard. In conclusion, a specific group of patients with lower rectal cancer of stages II and III might be have treated with LPND in spite of concurrent chemo-radiation to achieve satisfactory oncological outcome. The proposed stratification grouping is strongly guiding the patient for lateral pelvic lymph node dissection. Further study to prove the oncological advantage of LPND is warranted at large scale.
http://ift.tt/2nFgRdm
Regulation of Spontaneous Contractions in Intact Rat Bladder Strips and the Effects of Hydrogen Peroxide
Enhanced spontaneous contractions are associated with overactive bladder. Elevated levels of reactive oxygen species might contribute to enhanced spontaneous contractions. We investigated the regulation of spontaneous contractions and the effects of hydrogen peroxide (H2O2) in intact rat bladder strips. The spontaneous contractions were measured using a tissue bath system. The vehicle or the specific activators/blockers were applied and followed by the application of 0.003 g% H2O2. The basal tension, amplitude, and frequency of spontaneous contractions were quantified. Nisoldipine and bisindolylmaleimide 1 had no effects on spontaneous contractions. SKF96365 and Y27632 decreased basal tension and amplitude. Ryanodine slightly increased frequency. Both iberiotoxin and NS-1619 increased amplitude. Apamin reduced frequency but increased amplitude. NS-309 inhibited both the amplitude and frequency. The basal tension and amplitude increased when H2O2 was applied. Pretreatment with NS-309 inhibited H2O2-elicited augmented amplitude and frequency, while pretreatment with Y-27632 inhibited the augmented basal tension. The combined application of NS-309 and Y27632 almost eliminated spontaneous contractions and its augmentation induced by H2O2. In conclusion, Ca2+ influx, Rho kinase activation, and SK channel inactivation play important roles in spontaneous contractions in intact bladder strips, whereas only latter two mechanisms may be involved in H2O2-elicited increased spontaneous contractions.
http://ift.tt/2E0v9QX
Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up
Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.
http://ift.tt/2nHpaVX
Melatonin Modulation of Sirtuin-1 Attenuates Liver Injury in a Hypercholesterolemic Mouse Model
Hypercholesterolemia increases and exacerbates stress signals leading also to liver damage (LD) and failure. Sirtuin1 (SIRT1) is involved in lifespan extension and it plays an essential role in hepatic lipid metabolism. However, its involvement in liver hypercholesterolemic damage is not yet completely defined. This in vivo study evaluated the role of SIRT1 in the hypercholesterolemic-related LD and, then, investigated how oral supplementation of melatonin, pleiotropic indoleamine, may be protective. Control mice and apolipoprotein E-deficient mice (ApoE−/−) of 6 and 15 weeks of age were treated or not treated with melatonin at the dose of 10 mg/kg/day for 9 weeks. In this study, we evaluated serum biochemical markers, liver SIRT1 expression, and oxidative stress markers. We observed that hypercholesterolemia increased significantly serum cholesterol and triglycerides, reduced significantly liver SIRT1, and, in turn, induced hepatic oxidative stress in untreated ApoE−/− mice with respect to control mice. Interestingly, melatonin treatment improved serum biochemical markers and hepatic morphological impairment and inhibited oxidative stress through its antioxidant properties and also by SIRT1 upregulation. In summary, melatonin oral supplementation may represent a new protective approach to block hypercholesterolemic liver alterations involving also a SIRT1-dependent mechanism.
http://ift.tt/2ECUAF2
PROM and Labour Effects on Urinary Metabolome: A Pilot Study
Since pathologies and complications occurring during pregnancy and/or during labour may cause adverse outcomes for both newborns and mothers, there is a growing interest in metabolomic applications on pregnancy investigation. In fact, metabolomics has proved to be an efficient strategy for the description of several perinatal conditions. In particular, this study focuses on premature rupture of membranes (PROM) in pregnancy at term. For this project, urine samples were collected at three different clinical conditions: out of labour before PROM occurrence (Ph1), out of labour with PROM (Ph2), and during labour with PROM (Ph3). GC-MS analysis, followed by univariate and multivariate statistical analysis, was able to discriminate among the different classes, highlighting the metabolites most involved in the discrimination.
http://ift.tt/2s6cvkR
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Αλέξανδρος Γ. Σφακιανάκης Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,0030693260717...
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heory of COVID-19 pathogenesis Publication date: November 2020Source: Medical Hypotheses, Volume 144Author(s): Yuichiro J. Suzuki ScienceD...
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Alimentary Pharmacology &Therapeutics, EarlyView. https://ift.tt/2qECBIJ
