Background: Metabolic syndrome (MetS) has been identified as a major contributor to the development of cardiovascular disease (CVD). Current recommendations for dietary management of people with MetS involve quantitative and qualitative modifications of food intake, such as high consumption of vegetables, fruits, and whole grain foods. The results from our previous human trials revealed the potential of the dietary components high-oleic acid canola oil (HOCO)-docosahexaenoic acid (DHA) and high molecular weight barley β-glucan individually in managing CVD risk factors. Foods with a combination of HOCO-DHA and barley β-glucan have never been tested for their effects on CVD risk. The objective is to determine the effects of consuming novel foods HOCO-DHA, and barley β-glucan on managing CVD risk factors in people with MetS.Methods/DesignWe are conducting a randomized, single-blind crossover trial with four treatment phases of 28 days each separated by a 4-week washout interval. Participants (n=35) will be provided with weight-maintaining, healthy balanced diet recommendations according to their energy requirements during the intervention periods. Participants will receive muffins and cookies as treatment foods in a random order and will consume at least one meal per day at the research center under supervision. The four treatments include muffins and cookies consisting of (1) all-purpose flour and HOCO-DHA (50 g/day); (2) barley flour (4.36 g/day of β-glucan) and a blend of sunflower oil, safflower oil, and butter as control oil (50 g/day); (3) barley flour (4.36 g/day of β-glucan) and HOCO-DHA (50 g/day; dosage of DHA would be 3 g/day); and (4) all-purpose flour and control oil (50 g/day). At the beginning and end of each phase, we will evaluate anthropometrics; systolic and diastolic blood pressure; blood lipid profile; low-density lipoprotein subfractions and particle size; 10-year Framingham CVD risk score; inflammatory status; and plasma and red blood cell fatty acid profiles, fecal microbiome, and body composition by dual-energy X-ray absorptiometry. Conclusion: Cholesterol synthesis will also be studied, using a stable isotope approach. The proposed study will lead to innovation of novel food products, which may result in improvement in the overall cardiovascular health of humans.Trial registrationClinical trials.gov identifier: NCT02091583. Date of registration: 12 March 2014.
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Παρασκευή 30 Οκτωβρίου 2015
Effect of consuming novel foods consisting high oleic canola oil, barley β-glucan, and DHA on cardiovascular disease risk in humans: the CONFIDENCE (Canola Oil and Fibre with DHA Enhanced) study – protocol for a randomized controlled trial
Analysis of the Cochrane Review: Interventions for Improving Upper Limb Function after Stroke. Cochrane Database Syst Rev. 2014,11:CD010820.
Impairment of the upper limbs is quite frequent after stroke, making rehabilitation an essential step towards clinical recovery and patient empowerment. This review aimed to synthetize existing evidence regarding interventions for upper limb function improvement after Stroke and to assess which would bring some benefit. The Cochrane Database of Systematic Reviews, the Database of Reviews of Effects and PROSPERO databases were searched until June 2013 and 40 reviews have been included, covering 503 studies, 18 078 participants and 18 interventions, as well asdifferent doses and settings of interventions. The main results were: 1- Information currently available is insufficient to assess effectiveness of each intervention and to enable comparison of interventions; 2- Transcranial direct current stimulation brings no benefit for outcomes of activities of daily living; 3- Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy, mental practice, mirror therapy, interventions for sensory impairment, virtual reality
and repetitive task practice; 4- Unilateral arm training may be more effective than bilateral arm training; 5- Moderate-quality evidence showed a beneficial effect of robotics on measures of impairment and ADLs; 6- There is no evidence of benefit or harm for technics such as repetitive transcranial magnetic stimulation, music therapy, pharmacological interventions, electrical stimulation and other therapies. Currently available evidence is insufficient and of low quality, not supporting clear clinical decisions. High-quality studies are still needed.
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Hyperbaric Oxygen Therapy for the Treatment of Fournier’s Gangrene: A Review of 34 Cases
Introduction: Fournier's gangrene is a serious necrotizing infection that can be fatal if not promptly attended. Treatment for this condition consists of a combination of surgical debridement, antibiotherapy and supportive care. Hyperbaric oxygen therapy is used as an adjuvant for the optimization of infected tissue oxygenation and for its bactericidal and bacteriostatic effects.
Material and Methods: The data presented in this study encompass a period of 25 years of clinical records of patients with Fournier's gangrene that had been treated at our center with hyperbaric oxygen therapy.
Results: A total of 34 patients were treated. The vast majority of patients were males (94.1%) with a mean age of 53.7 years. Urinary tract was the most frequent source of infection and diabetes was most common comorbidity seen in patients. Mortality rate was 20.8%.
Discussion: The most common observed comorbidity was diabetes, suggesting diabetes as one predisposing factor. The majority of deceased patients had diabetes, although no significant correlation between diabetes and death was found. The area of residence of patients may affect patients' referral to these facilities.
Conclusions: Although Fournier's gangrene is a rare condition, it is nevertheless a fatal illness, namely in patients with comorbidities like diabetes. Hyperbaric oxygen therapy is recommended as an adjuvant to conventional therapy and should be considered whenever available. To further assess the role of hyperbaric oxygen therapy, in the treatment of this condition, additional studies should be carried out.
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Alcohol and Youth in Portugal: An Intervention Through the Triangle Project
Keywords: Adolescent; Alcohol Drinking; Portugal.
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Haemorrhagic Gingival Hypertrophy: A Striking Presentation of Acute Myelomonocytic Leukaemia
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Pantothenate Kinase Associated Neurodegeneration in Two Brothers
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Takotsubo Cardiomyopathy: Cause of a Cardiogenic Shock
Takotsubo cardiomyopathy, of unknown etiology, is characterized by sudden and transient systolic dysfunction of the mid-apical segments of the left ventricle without significant coronary disease, and full normalization of segmental changes. More common in middle-aged women, it is cause of differential diagnosis with acute coronary syndrome. We present the case of a 59 year old woman admitted to the emergency room with sudden chest pain and dyspnea. At presentation: acute hypotensive pulmonary edema requiring aminergic support and invasive ventilation. Blood tests showed elevated necrosis myocardial enzymes. Serial electrocardiograms: sinus rhythm with progressive inversion of the T wave through the precordial leads (v2 - v6). Control echocardiograms: overall decreased
systolic function with apical akinesia, and full reversal of the changes in 2 weeks. Cardiogenic shock of unknown etiology was admitted and a coronary computed tomography angiography was performed excluding coronary heart disease, supporting the diagnosis of Takotsubo cardiomyopathy.
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Auto-Immune Pancreatitis: The Diagnostic Role of Imaging Studies
Auto-immune pancreatitis is an uncommon and underdiagnosed pathology. Its clinical picture is not specific and the diagnosis is therefore difficult. Imaging studies have a crucial role in the diagnostic process and also in the follow-up of treatment. With the objective of emphasizing the importance of imaging in the correct diagnosis of this pathology, the authors report the case of a patient with longterm unspecific abdominal complaints that was diagnosed as auto-immune pancreatitis after laboratorial and imaging investigation. Assuming this diagnosis it was instituted treatment with oral methylprednisolone, which succeeded, with progressive resolution of the clinical, laboratorial and imaging findings.
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Hypothyroidism Associated to TSH Hormone-Receptor Autoantibodies with Blocking Activity Assessed In Vitro
Thyroid-stimulating hormone-receptor autoantibodies normally causes hyperthyroidism. However, they might have blocking activity causing hypothyroidism. A 11-year-old girl followed due to type 1 diabetes mellitus, celiac disease and euthyroid lymphocytic thyroiditis at diagnosis. Two years after the initial evaluation, thyroid-stimulating hormone was suppressed with normal free T4; nine months later, a biochemical evolution to hypothyroidism with thyroid-stimulating hormone-receptor autoantibodies elevation was seen; the patient remained always asymptomatic. Chinese hamster ovary cells were transfected with the recombinant human thyroid-stimulating hormone -receptor, and then exposed to the patient´s serum; it was estimated a 'moderate' blocking activity of these thyroid-stimulating hormone-receptor autoantibodies, and concomitantly excluded stimulating action. In this case, the acknowledgment of the blocking activity of the serum thyroid-stimulating hormone-receptor autoantibodies, supported the hypothesis of a multifactorial aetiology of the hypothyroidism, which in the absence of the in vitro tests, we would consider only as a consequence of the destructive process associated to lymphocytic thyroiditis.
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Periarticular Corticosteroid Injection in the Therapeutic Approach of Musculoskeletal Disease in General Practice: A systematic Review
Material and Methods: Qualitative analysis of randomized control trials, cost-effectiveness studies, cross-sectional studies, retrospective cohort studies and observational studies, using PRISMA model. Data Sources: PubMed, Cochrane Library and Essential Evidence Plus. Eligibility criteria: corticosteroid injection mention in the treatment of musculoskeletal disease and an element that indicates primary health care context.
Results: Nine randomized control trials, three cost-effectiveness studies, three cross-sectional studies, three descriptive studies and one retrospective cohort study were reviewed. Most success parameters of corticosteroid injections performed by general practitioners showed short term efficacy; at long term they did not outstand other therapeutic options. The balance between the economic burden ascribed to this technique utilization in primary health care context and gain in subject's quality of life is favorable. The eleven studies assessing security registered only minor side effects and no serious ones.
Discussion: The periarticular corticosteroid injection technique performance places it as a therapeutic option treating musculoskeletal disease in Portuguese primary health care. Nevertheless further evidence is required to support its efficacy and safety parameters, namely at national level.
Conclusion: Corticosteroid injection utilization in primary health care constitutes an effective and safe option, with the potential to improve primary health care service rendering in an economically sustainable way.
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Monoclonal Antibodies for Multiple Sclerosis Treatment
Since their introduction in medical therapy, in the last quarter of the 20th century, monoclonal antibodies have gained an increasing importance in the treatment of various diseases. Neurology has been one of the medical specialties benefiting of the therapeutic potential of these monoclonal antibodies and certain neurological conditions may now contain such drugs in their therapeutic algorithms. Multiple sclerosis is one of these diseases and, in addition to the monoclonal antibodies already licensed for clinical use, several others are in development for future utilization in this specific area. The future will certainly pass through this kind of drugs and, in this article, a review of the most relevant data related to monoclonal antibodies already in use and also in clinical development for multiple sclerosis treatment will be performed.
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Current Clinical Indications for Small Bowel Capsule Endoscopy
Introduction: Small bowel capsule endoscopy is currently the first line diagnostic examination for many diseases affecting the small bowel. This article aims to review and critically address the current indications of small bowel capsule endoscopy in clinical practice.
Material and Methods: Bibliographic review of relevant and recent papers indexed in PubMed.
Results and Discussion: Small bowel capsule endoscopy enables a non-invasive full-assessment of the small bowel mucosa, with high diagnostic yield even for subtle lesions. In patients with obscure gastrointestinal bleeding, diagnostic yield is higher when performed early after the onset of bleeding. Endoscopic treatment of angioectasias using balloon-assisted enteroscopy may contribute to reduce rebleeding, while the risk of rebleeding in patients with "negative" small bowel capsule endoscopy is debatable. Cross-sectional imaging
may be more accurate than small bowel capsule endoscopy for the diagnosis of large small bowel tumors. The Smooth Protruding Index on Capsule Endoscopy (SPICE score) may help to differentiate submucosal tumors from innocent bulges. Small bowel capsule endoscopy is also a key diagnostic instrument in patients with suspected Crohn's disease and non-diagnostic ileocolonoscopy; it may also influence prognosis and therapeutic management, by determining disease extent and activity in patients with known Crohn's disease. The role of small bowel capsule endoscopy to investigate possible complications in patients with non-responsive coeliac
disease is evolving.
Conclusions: Small bowel capsule endoscopy is a valuable diagnostic instrument for patients with obscure gastrointestinal bleeding and/or suspected small bowel tumors; it may also be a key examination in patients with suspected Crohn's disease, or patients with known Crohn's disease to fully assess disease extension and activity; finally, it may contribute for the diagnosis of complications of non-responsive coeliac disease.
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Mediterranean Spotted Fever: Retrospective Review of Hospitalized Cases and Predictive Factors of Severe Disease
Material and Methods: We evaluate cases admitted to a central hospital during 12-year period. The risk factors were determined by uni and multivariate analysis, comparing patients admitted in general infirmary versus intermediate/intensive care units or in case of death.
Results: We reviewed 71 cases of Mediterranean spotted fever. The mean age was 63.3 ± 16.7 years and 52.1% were male. The eschar was observed in 62.0%. Fever and rash were the most common clinical findings. Forty five percent of patients developed complications and 22.5% were admitted to intermediate and/or intensive care units. Apyrexia, dyspnea, renal failure and elevated lactic dehydrogenase levels at admission were predictors of severe disease development (p < 0.034). Alcoholism was related with prolonged hospitalization (p = 0.020). Absence of fever (p = 0.019) and elevated serum creatinine levels (p = 0.028) were identified as independent factors associated with severe outcome. The mortality rate was 2.8%.
Discussion: Although Mediterranean spotted fever is usually assumed to be benign, severe cases are emerging.
Conclusion: Early identification of the infection and continuous patient surveillance are crucial, particularly in those with greater risk of developing severe or fatal disease.
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Acute Ischemic Stroke on Cancer Patients, a Distinct Etiology? A Case-Control Study
Introduction: It is still unclear whether the etiology of ischemic stroke differs between cancer and non-cancer patients. Stroke and cancer share common modifiable risk factors but evidence suggests that cancer patients have specific conditions that increase the risk of stroke. Our goal was to compare the etiology of ischemic stroke in cancer and non-cancer patients.
Material and Methods: Case-control study conducted in patients admitted to a stroke unit between January 2007 and December 2012. Cases had a concomitant diagnosis of cancer and acute ischemic stroke, controls of only stroke. Age, gender, vascular risk factors and etiology were compared between groups.
Results: Fifty-six cases were identified; 64.3% were men with a mean age of 71 years; 21 patients had evidence of active cancer. Gastrointestinal cancer (25.9%) was the most common; 151 controls were included matched for gender and age. Common modifiable vascular risk factors, between groups (cases versus controls) were not significantly different, except for diabetes mellitus, more frequent in the control group (16.1% vs 33.8%, p = 0.02). Previous thrombotic events were more frequent in the cancer cohort (8.9% vs 0.7%, p = 0.007). Other determined etiology subtype (TOAST classification) was more frequent in cancer patients when compared to controls (13.0% vs 0.8%, p < 0.01), and a hypercoagulable state was significantly more prevalent in active cancer patients.
Discussion: In our case-control study two subsets of cancer patients were delineated. In a subgroup, cancer and stroke co-exist, sharing traditional vascular risk factors. In another subset of patients, stroke appears to be directly related to the presence of a malignancy, where hypercoagulopathy turns out to be a decisive mechanism.
Conclusion: In clinical grounds, hypercoagulopathy as stroke etiology should prompt the physician to screen the patient for occult cancer.
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Suicidal Behavior among Portuguese Psychiatry Trainees: Comparison with the European Situation
Material and Methods: A structured and anonymous questionnaire was sent by email to 159 portuguese trainees of adult psychiatry and child and adolescence psychiatry with questions about personal history of suicidal ideation and suicide attempts, as well as family history of suicide attempts and completed suicides. This is part of the BoSS Study (Burnout Syndrome Study) performed in 21 countries worldwide. Data was analysed in SPSS v.19.
Results: From the inquired population, 62 trainees (40,3%) partially responded, and 46 (29%) were complete responders - these entered the final analysis. There was a ratio of 2:1 (female:male) and a mean age of 29 years. The suicidal ideation was present in passive form in 44% and in active form in 33%; also, 4.3% of respondents had previous suicide attempts. In first degree relatives, 22% had attempted suicide and 13% completed suicide.
Discussion: The results are worriying and may be associated with some factors to which this population is exposed.
Conclusion: It is necessary further research to better understand this phenomenon, its causes and potential modifiers.
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Neonatal Morbidity in Term Newborns Born by Elective Cesarean Section
Objective: To evaluate neonatal morbidity in term newborns born by elective cesarean section.
Material and Methods: Retrospective study of all term elective cesarean sections (scheduled and without labor) performed in level III maternity, in the last 11 years (2003 - 2013). High risk pregnancies were excluded: twins, premature rupture of membranes, preeclampsia, poorly controlled diabetes mellitus, Rh isoimmunization and congenital malformations. Two groups of newborns with gestational age less than 39 weeks and equal or greater than 39 weeks gestational age were compared.
Results: In our sample, 45% of elective caesarean sections were performed before 39 weeks. Infants born before 39 weeks were more frequently admitted in neonatal intensive care, odds ratio 2.4 [1.4 – 4.1] p = 0.001, had more respiratory morbidity, odds ratio 2.4 [1.6 - 3.8] p < 0.001, more hyperbilirubinaemia odds ratio 2.3 [1.5 – 3.7] p < 0.001, more hypoglycaemia and/or feeding difficulties odds ratio 1.6 [1.2 – 2.4] p = 0.006, and longer admissions (more than five days), odds ratio 2.0 [1.4 - 3] p < 0.001.
Discussion: As in other studies 'early term' had higher respiratory and metabolic morbidity and consequently had a longer hospital stay.
Conclusion: These findings support recommendations to delay elective cesarean delay until 39 weeks of gestation.
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Translation, Cultural Adaptation and Validation of the Power of Food Scale for Use by Adult Populations in Portugal
Introduction: The Power of Food Scale measures appetite for, rather than consumption of, palatable foods - a construct frequently designated as hedonic hunger. The purpose of this study was to examine the psychometric properties of a Portuguese version of the Power of Food Scale, namely reliability and construct validity.
Material and Methods: Data was obtained from 1266 adult participants sampled from three different populations in Portugal: two nonclinical samples and one multi-center sample of severely obese candidates for weight-loss surgery.
Results: We found that the factor structure of the Portuguese version of the Power of Food Scale is similar to that of the original scale and that the Portuguese version of the Power of Food Scale has good internal structure, test-retest reliability and construct validity. In addition, we provide the first contribution towards defining population norms for Power of Food Scale scores.
Discussion: The Portuguese version of the Power of Food Scale proved to have good psychometric properties: it is a valid and reliable tool for measuring hedonic hunger, supporting its use both in clinical and non-clinical samples, as well as in prospective studies.
Conclusion: Our results show that the Portuguese version of the Power of Food Scale is a useful measure for researchers and clinicians who are interested in exploring the construct of hedonic hunger in Portuguese-speaking populations, including those suffering from obesity.
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Quality of Recovery after Anesthesia: Validation of the Portuguese Version of the “Quality of Recovery 15” Questionnaire
Background: The "Quality of Recovery 15" questionnaire is used for the study of quality recovery after anesthesia. The aim of this study was to validate the Portuguese version of "Quality of Recovery 15" questionnaire.
Material and Methods: After study approval by the institutional ethics committee, an observational and cohort prospective study was conducted on patients scheduled for elective surgery from June to August 2013. The "Quality of Recovery 15" questionnaire was translated in accordance with available guidelines. The "Quality of Recovery 15" Portuguese version was used before surgery (T0) and 24h postoperatively (T1) on 170 patients. Patients who were unable to give informed consent or had cognitive impairment were excluded. Poor quality of recovery was defined for "Quality of Recovery 15" score at T1 lower than the mean "Quality of Recovery 15"
score minus 1 standard deviation. Reliability and observer disagreement was assessed using interclass correlation. Non-parametric tests were used for comparisons.
Results: There was a negative correlation between "Quality of Recovery 15" score and time spent in the postanesthesia care
(ρ = −0.264, p = 0.004) and length of hospital stay (ρ = −0.274, p = 0.004). Thirty-two patients (19%) had poor quality of recovery. Patients with poor quality of recovery had more frequently diabetes mellitus and hypertension and they were taking antidepressants drugs more frequently. Patients with poor quality of recovery were more frequently submitted to combined anesthesia and less frequently to general anesthesia and locoregional anesthesia (p = 0.008). The questionnaire had a good internal consistency and test–retest reliability was good.
Discussion: The Portuguese version of the "Quality of Recovery 15" showed a good correlation with the original.
Conclusion: This questionnaire appears to be an accurate and reliable assessment for quality of recovery.
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The Importance of Early Referral in Pediatric Acute Liver Failure
Objectives: To characterize acute liver failure admissions in a Pediatric Intensive Care Unit of the portuguese pediatric liver
transplantation center. To compare results before (A) and after (B) 2008.
Material and Methods: Observational, retrospective study during a 20 year period (1994-2014). Inclusion criteria: age < 18 years old and acute liver failure (INR ≥ 2 without vitamin K response and hepatocellular necrosis). Children with previous liver disease were excluded.
Results: Fifty children were included, with median age of 24.5 months. The most common etiology under 2 years old was metabolic (34.6%) and above that age was infectious (29.2%). Forty six percent were submitted to liver transplantation and 78% of them survived. Overall mortality was 34%. Median referral time was 7 days in period A (n = 35) and 2 days in period B (n = 15; p = 0.006). Pediatric risk of mortality´s median was 14.7 in period A and 6.5 in B (p = 0.019). Mortality was 37% vs 26% in periods A and B, respectively (p = 0.474).
Discussion and Conclusions: Overall mortality was similar to the observed in other European centers. Liver transplantation is in fact the most effective therapeutic option. After 2008, there was a reduction in referral time and cases severity on admission; however, mortality has not reduced so far.
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Characterization and Evolution of Avoidable Admissions in Portugal: The Impact of Two Methodologic Approaches
Material and Methods: Over 12 million hospitalizations were analyzed between 2000 and 2012 using the national hospital discharge databases. We used two different methodologies to identify the hospitalizations for Ambulatory Care Sensitive Conditions, determining their concordance. We also estimated potential improvement scenarios.
Results: In 2012, 4.4% and 32.4% of the hospitalizations for medical causes were avoidable according to the Canadian and Spanish methodologies respectively. The hospitalizations are more frequent in children and the elderly. The most frequent causes vary according to the age group and methodology. During the analyzed period the rate of admissions has dropped 20% according to the Canadian methodology and increased 16% according to the Spanish methodology. There are regional clusters of performance under and above the national average. The concordance between methodologies is low. The improvement scenarios estimated possible reductions between 20.3% and 53.5% of the hospitalizations.
Discussion: The avoidable admissions assume a relevant volume in Portugal. Although in theory they are avoidable their complete elimination is a practical impossibility. Their study, however, allows the evaluation and results motorization enabling to establish intervention priorities.
Conclusion: To have a precise characterization of the avoidable admissions in Portugal it is necessary to achieve consensus on the identification methodology.
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Thirdhand Smoke: A Concept to Remember!
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Prophylactic use of the Arabin cervical pessary in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO): preliminary experience
Abstract
Objective
To describe whether the prophylactic use of a cervical pessary decreases the rate of premature birth in congenital diaphragmatic hernia (CDH) fetuses treated with fetoscopic tracheal occlusion (FETO).
Methods
Consecutive series of all cases with CDH and FETO and a group of CDH without FETO. In a subgroup of the FETO group, a prophylactic cervical pessary was inserted the day following the procedure. Gestational age (GA) at birth was the primary outcome.
Results
59 fetuses with FETO and 47 expectantly managed were included. The last 15 FETO had a cervical pessary inserted. The median GA at delivery in the FETO group with pessary was 35.1 weeks and was not different from that in the FETO group without a pessary (34.3 weeks; p = 0.28), but was below that in the expectantly managed group (38.3 weeks; p < 0.001).
Conclusion
Early results suggest that prophylactic use of an Arabin cervical pessary does not prolong gestation of CDH fetuses treated with FETO. This article is protected by copyright. All rights reserved.
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Medial temporal lobe atrophy, white matter hyperintensities and cognitive impairment among Nigerian African stroke survivors
Background: Neuroimaging features associated with vascular cognitive impairment have not been examined in sub-Saharan Africans. We determined magnetic resonance imaging (MRI) features associated with cognitive impairment in a sample of Nigerian stroke survivors. Methods: Stroke survivors underwent brain MRI with standardized assessment of brain volumes and visual rating of medial temporal lobe atrophy (MTA), and white matter hyperintensities (WMH) at 3 months post-stroke. Demographic, clinical and psychometric assessments of global cognitive function, executive function, mental speed and memory were related to changes in structural MRI. Results: In our pilot sample of 58 stroke survivors (60.1 ± 10.7 years old) MTA correlated significantly with age (r = 0.525), WMH (r = 0.461), memory (r = −0.702), executive function (r = −0.369) and general cognitive performance (r = −0.378). On univariate analysis, age >60 years (p = 0.016), low educational attainment (p < 0.001 to p < 0.003), total brain volume (p < 0.024 and p < 0.025) and MTA (p < 0.003 to p < 0.007) but not total WMH (p < 0.073, p = 0.610) were associated with cognitive outcome. In a two-step multivariate regression analysis, MTA (p < 0.035 and p < 0.016) and low educational attainment (p < 0.012 and p < 0.019) were sustained as independent statistical predictors of cognitive outcome. Conclusions: Medial temporal lobe atrophy was a significant neuroimaging predictor of early post-stroke cognitive dysfunction in the Nigerian African stroke survivors. These observations have implications for a vascular basis of MTA in older stroke survivors among sub-Saharan Africans.
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Pulsed Direct Current Electrospray: Enabling Systematic Analysis of Small Volume Sample by Boosting Sample Economy
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Sensitive Trimodal Magnetic Resonance Imaging-Surface-Enhanced Resonance Raman Scattering-Fluorescence Detection of Cancer Cells with Stable Magneto-Plasmonic Nanoprobes
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Enhancement of the Carbon Dots/K2S2O8 Chemiluminescence System Induced by Triethylamine
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CIUSuite: A Quantitative Analysis Package for Collision Induced Unfolding Measurements of Gas-Phase Protein Ions
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Imaging of Proteins in Tissue Samples Using Nanospray Desorption Electrospray Ionization Mass Spectrometry
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Modified-Atmospheric Pressure-Matrix Assisted Laser Desorption/Ionization Identification of Friction Modifier Additives Oleamide and Ethoxylated Tallow Amines on Varied Metal Target Materials and Tribologically Stressed Steel Surfaces
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To Your Health: NLM update: Explaining health risks in drug advertising
Listen to the To Your Health: NLM update on Explaining health risks in drug advertising. The transcript is also available.
The risks of U.S. Food and Drug Administration (FDA)-approved medications should be explained with the same dexterity as promoting its benefits by direct-to-consumer advertisers, suggests an interesting perspective recently published in The New England Journal of Medicine.
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To Your Health: NLM update: Ebola vaccine's initial success
Listen to the To Your Health: NLM update on Ebola vaccine's initial success. The transcript is also available.
A vaccine to prevent Ebola was successful in an initial clinical trial within the West African nation of Guinea, reports a pioneering study and editorial recently published in The Lancet.
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Tomosynthesis Imaging
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Optimization of an on-board imaging system for extremely rapid radiation therapy
Next-generation extremely rapid radiation therapy systems could mitigate the need for motion management, improve patient comfort during the treatment, and increase patient throughput for cost effectiveness. Such systems require an on-board imaging system that is competitively priced, fast, and of sufficiently high quality to allow good registration between the image taken on the day of treatment and the image taken the day of treatment planning. In this study, three different detectors for a custom on-board CT system were investigated to select the best design for integration with an extremely rapid radiation therapy system.
Three different CT detectors are proposed: low-resolution (all 4 × 4 mm pixels), medium-resolution (a combination of 4 × 4 mm pixels and 2 × 2 mm pixels), and high-resolution (all 1 × 1 mm pixels). An in-house program was used to generate projection images of a numerical anthropomorphic phantom and to reconstruct the projections into CT datasets, henceforth called "realistic" images. Scatter was calculated using a separate Monte Carlo simulation, and the model included an antiscatter grid and bowtie filter. Diagnostic-quality images of the phantom were generated to represent the patient scan at the time of treatment planning. Commercial deformable registration software was used to register the diagnostic-quality scan to images produced by the various on-board detector configurations. The deformation fields were compared against a "gold standard" deformation field generated by registering initial and deformed images of the numerical phantoms that were used to make the diagnostic and treatment-day images. Registrations of on-board imaging system data were judged by the amount their deformation fields differed from the corresponding gold standard deformation fields—the smaller the difference, the better the system. To evaluate the registrations, the pointwise distance between gold standard and realistic registration deformation fields was computed.
By most global metrics (e.g., mean, median, and maximum pointwise distance), the high-resolution detector had the best performance but the medium-resolution detector was comparable. For all medium- and high-resolution detector registrations, mean error between the realistic and gold standard deformation fields was less than 4 mm. By pointwise metrics (e.g., tracking a small lesion), the high- and medium-resolution detectors performed similarly. For these detectors, the smallest error between the realistic and gold standard registrations was 0.6 mm and the largest error was 3.6 mm.
The medium-resolution CT detector was selected as the best for an extremely rapid radiation therapy system. In essentially all test cases, data from this detector produced a significantly better registration than data from the low-resolution detector and a comparable registration to data from the high-resolution detector. The medium-resolution detector provides an appropriate compromise between registration accuracy and system cost.
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Image-derived and arterial blood sampled input functions for quantitative PET imaging of the angiotensin II subtype 1 receptor in the kidney
The radioligand 11C-KR31173 has been introduced for positron emission tomography (PET) imaging of the angiotensin II subtype 1 receptor in the kidney in vivo. To study the biokinetics of 11C-KR31173 with a compartmental model, the input function is needed. Collection and analysis of arterial blood samples are the established approach to obtain the input function but they are not feasible in patients with renal diseases. The goal of this study was to develop a quantitative technique that can provide an accurate image-derived input function (ID-IF) to replace the conventional invasive arterial sampling and test the method in pigs with the goal of translation into human studies.
The experimental animals were injected with [11C]KR31173 and scanned up to 90 min with dynamic PET. Arterial blood samples were collected for the artery derived input function (AD-IF) and used as a gold standard for ID-IF. Before PET, magnetic resonance angiography of the kidneys was obtained to provide the anatomical information required for derivation of the recovery coefficients in the abdominal aorta, a requirement for partial volume correction of the ID-IF. Different image reconstruction methods, filtered back projection (FBP) and ordered subset expectation maximization (OS-EM), were investigated for the best trade-off between bias and variance of the ID-IF. The effects of kidney uptakes on the quantitative accuracy of ID-IF were also studied. Biological variables such as red blood cell binding and radioligand metabolism were also taken into consideration. A single blood sample was used for calibration in the later phase of the input function.
In the first 2 min after injection, the OS-EM based ID-IF was found to be biased, and the bias was found to be induced by the kidney uptake. No such bias was found with the FBP based image reconstruction method. However, the OS-EM based image reconstruction was found to reduce variance in the subsequent phase of the ID-IF. The combined use of FBP and OS-EM resulted in reduced bias and noise. After performing all the necessary corrections, the areas under the curves (AUCs) of the AD-IF were close to that of the AD-IF (average AUC ratio =1 ± 0.08) during the early phase. When applied in a two-tissue-compartmental kinetic model, the average difference between the estimated model parameters from ID-IF and AD-IF was 10% which was within the error of the estimation method.
The bias of radioligand concentration in the aorta from the OS-EM image reconstruction is significantly affected by radioligand uptake in the adjacent kidney and cannot be neglected for quantitative evaluation. With careful calibrations and corrections, the ID-IF derived from quantitative dynamic PET images can be used as the input function of the compartmental model to quantify the renal kinetics of 11C-KR31173 in experimental animals and the authors intend to evaluate this method in future human studies.
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A round-robin gamma stereotactic radiosurgery dosimetry interinstitution comparison of calibration protocols
Absorbed dose calibration for gamma stereotactic radiosurgery is challenging due to the unique geometric conditions, dosimetry characteristics, and nonstandard field size of these devices. Members of the American Association of Physicists in Medicine (AAPM) Task Group 178 on Gamma Stereotactic Radiosurgery Dosimetry and Quality Assurance have participated in a round-robin exchange of calibrated measurement instrumentation and phantoms exploring two approved and two proposed calibration protocols or formalisms on ten gamma radiosurgery units. The objectives of this study were to benchmark and compare new formalisms to existing calibration methods, while maintaining traceability to U.S. primary dosimetry calibration laboratory standards.
Nine institutions made measurements using ten gamma stereotactic radiosurgery units in three different 160 mm diameter spherical phantoms [acrylonitrile butadiene styrene (ABS) plastic, Solid Water, and liquid water] and in air using a positioning jig. Two calibrated miniature ionization chambers and one calibrated electrometer were circulated for all measurements. Reference dose-rates at the phantom center were determined using the well-established AAPM TG-21 or TG-51 dose calibration protocols and using two proposed dose calibration protocols/formalisms: an in-air protocol and a formalism proposed by the International Atomic Energy Agency (IAEA) working group for small and nonstandard radiation fields. Each institution's results were normalized to the dose-rate determined at that institution using the TG-21 protocol in the ABS phantom.
Percentages of dose-rates within 1.5% of the reference dose-rate (TG-21 + ABS phantom) for the eight chamber-protocol-phantom combinations were the following: 88% for TG-21, 70% for TG-51, 93% for the new IAEA nonstandard-field formalism, and 65% for the new in-air protocol. Averages and standard deviations for dose-rates over all measurements relative to the TG-21 + ABS dose-rate were 0.999 ± 0.009 (TG-21), 0.991 ± 0.013 (TG-51), 1.000 ± 0.009 (IAEA), and 1.009 ± 0.012 (in-air). There were no statistically significant differences (i.e., p > 0.05) between the two ionization chambers for the TG-21 protocol applied to all dosimetry phantoms. The mean results using the TG-51 protocol were notably lower than those for the other dosimetry protocols, with a standard deviation 2–3 times larger. The in-air protocol was not statistically different from TG-21 for the A16 chamber in the liquid water or ABS phantoms (p = 0.300 and p = 0.135) but was statistically different from TG-21 for the PTW chamber in all phantoms (p = 0.006 for Solid Water, 0.014 for liquid water, and 0.020 for ABS). Results of IAEA formalism were statistically different from TG-21 results only for the combination of the A16 chamber with the liquid water phantom (p = 0.017). In the latter case, dose-rates measured with the two protocols differed by only 0.4%. For other phantom-ionization-chamber combinations, the new IAEA formalism was not statistically different from TG-21.
Although further investigation is needed to validate the new protocols for other ionization chambers, these results can serve as a reference to quantitatively compare different calibration protocols and ionization chambers if a particular method is chosen by a professional society to serve as a standardized calibration protocol.
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A simple clot based assay for detection of procoagulant cell-derived microparticles
Journal Name: Clinical Chemistry and Laboratory Medicine (CCLM)
Issue: Ahead of print
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Establishment of reference intervals of clinical chemistry analytes for adult population in Saudi Arabia: a study conducted as a part of the IFCC global study on reference values
Journal Name: Clinical Chemistry and Laboratory Medicine (CCLM)
Issue: Ahead of print
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Incidence and determinants of neonatal morbidity after elective caesarean section at the national referral hospital in Kampala, Uganda
Background: Elective caesarean sections (ECS) have been implicated in increased risk of adverse neonatal outcomes. The primary objective was to assess the incidence and determinants of neonatal morbidity after elective caesarean section deliveries. The secondary objective was to describe the maternal morbidity associated with elective caesarean section. Methods: This was a prospective cohort study of women admitted for ECS, as well as their newborns, conducted at Mulago hospital from March 1, 2013 to February 28, 2014. These were followed from the time of the operation until 6 weeks after hospitalization following the caesarean delivery. Data was collected using an interviewer-administered questionnaire and review of medical records for demographic characteristics, obstetric history, current pregnancy complications and pregnancy outcomes up to hospital discharge. Study outcomes were maternal and neonatal morbidity. The data was analyzed using Stata version 12. Results: There were 25,846 deliveries during the study period, of which 20,083 (77.7 %) were vaginal deliveries or assisted deliveries, and 5763 (22.3 %) were caesarean sections. Of the caesarean sections, 920 (15.9 %) were ECS. The commonest maternal morbidity was hemorrhage (17.2 %). A birth weight less than 2500 g (aRR 11.0 [95 % CI 8.1–17.2]) or more than 4000 g (aRR 12.2 [95 % CI 10.6–23.2]), delivery at gestation age less than or equal to 38 weeks (aRR 1.62 [95 % 1.20–2.10]), multigravidity (aRR 1.70 [95 % CI 1.20–2.90]) and using general anaesthesia (aRR 2.43 [95 % CI 1.20–5.90]) were associated with risk of neonatal morbidity. The commonest neonatal morbidity is respiratory distress especially if delivery occurs at a gestation age of 37 weeks or lower, if the birth weight is less than 2500 g or more than 4000 g, and if general anesthesia is used. Conclusion: Our study shows that at Mulago Hospital, ECS is associated with significant neonatal and maternal morbidity. We recommend that elective caesarean sections be performed after 39 weeks of gestation, and preferably avoid using general anaesthesia.
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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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