Enhanced Procoagulant Activity on Blood Cells after Acute Ischemic Stroke

Abstract

The role of phosphatidylserine (PS)-mediated procoagulant activity (PCA) in stroke remains unclear. To ascertain this role, early dynamic evolution of PS exposure on blood cells and released microparticles (MPs) and the corresponding PCA were evaluated in patients with acute ischemic stroke (AIS). Flow cytometry analyses revealed that initial levels of PS exposure on erythrocyte, platelet, and leukocyte were 2.40-, 1.36-, and 1.38-fold higher, respectively, in AIS than the risk factor-matched (RF) controls. Concomitantly, total PS⁺ MPs were increased in AIS (1949 ± 483/μl) compared with the RF group (1674 ± 387/μl; P = 0.019) and healthy controls (1052 ± 179/μl; P < 0.001). Specifically, PS⁺ erythrocytes gradually increased within 1 week. PS⁺ platelets and MPs peaked at 24 h and declined at 7 days, while PS⁺ leukocytes were markedly elevated at 24 h. Further, PS exposure on blood cells and MPs in stroke resulted in shortened clotting time with an accompanying increase in FXa and thrombin formation significantly. Treatment with lactadherin, a PS antagonist, delayed the coagulation time by approximately 20 % and blocked the generation of FXa and thrombin by about 50 %. Furthermore, initial counts of PS⁺ platelets and platelet MPs significantly correlated with stroke severity. Thrombin generation promoted by platelets and MPs at 12 h was significantly higher in patients with cardioembolism than in patients without. The thrombophilic susceptibility of AIS patients can be partly ascribed to PS exposure on blood cells and the release of MPs. Our studies identify PS exposure as a potentially novel therapeutic target in the treatment of AIS.

http://ift.tt/2d17LTg

Laser capture microdissection microscopy and genome sequencing of the avian malaria parasite, Plasmodium relictum

Abstract

Acquiring genomic material from avian malaria parasites for genome sequencing has proven problematic due to the nucleation of avian erythrocytes, which produces a large ratio of host to parasite DNA (∼1 million to 1 bp). We tested the ability of laser capture microdissection microscopy to isolate parasite cells from individual avian erythrocytes for four avian Plasmodium species, and subsequently applied whole genome amplification and Illumina sequencing methods to Plasmodium relictum (lineage pSGS1) to produce sequence reads of the P. relictum genome. We assembled ∼335 kbp of parasite DNA from this species, but were unable to completely avoid contamination by host DNA and other sources. However, it is clear that laser capture microdissection holds promise for the isolation of genomic material from haemosporidian parasites in intracellular life stages. In particular, laser capture microdissection may prove useful for isolating individual parasite species from co-infected hosts. Although not explicitly tested in this study, laser capture microdissection may also have important applications for isolation of rare parasite lineages and museum specimens for which no fresh material exists.

http://ift.tt/2cnRtGo

Panorama Dermatologische Praxis

http://ift.tt/2cPoABB

Anti-tuberculosis drug concentrations in tuberculosis patients with and without diabetes mellitus

Abstract

Purpose

The aim of the study was to compare plasma concentrations of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA) between tuberculosis (TB) patients with and without diabetes mellitus (DM).

Methods

Two-hour post-dosing concentrations of RMP, INH and PZA were determined in adult TB patients that were studied with (n = 452) and without DM (n = 1460), treated with a thrice-weekly regimen in India. Drug concentrations were estimated by HPLC.

Results

The median (IQR) INH [6.6 (3.9–10.0) and 7.8 (4.6–11.3)] and PZA [31.0 (22.3–38.0) and 34.1 (24.6–42.7)] microgram per milliliter concentrations were significantly lower in diabetic than non-diabetic TB patients (p < 0.001 for both drugs). Blood glucose was negatively correlated with plasma INH (r = −0.09, p < 0.001) and PZA (r = −0.092, p < 0.001). Multiple linear regression analysis showed RMP, INH and PZA concentrations were influenced by age and drug doses, INH and PZA by DM, RMP by alcohol use and PZA by gender and category of ATT. DM reduced INH and PZA concentrations by 0.8 and 3.0 μg/ml, respectively.

Conclusions

TB patients with DM had lower INH and PZA concentrations. Negative correlation between blood glucose and drug concentrations suggests delayed absorption/faster elimination of INH and PZA in the presence of elevated glucose.

http://ift.tt/2cBA74z

Comparison between a novel and conventional artificial pancreas for perioperative glycemic control using a closed-loop system

Abstract

This clinical study aimed to compare a novel and conventional artificial pancreas (AP) used in surgical patients for perioperative glycemic control, with respect to usability, blood glucose measurements, and glycemic control characteristics. From July in 2010 to March in 2015, 177 patients underwent perioperative glycemic control using a novel AP. Among them, 166 patients were eligible for inclusion in this study. Intensive insulin therapy (IIT) targeting a blood glucose range of 80–110 mg/dL was implemented in 82 patients (49 %), and the remaining 84 patients (51 %) received a less-intensive regime of insulin therapy. Data were collected prospectively and were reviewed or analyzed retrospectively. A comparison study of 324 patients undergoing IIT for glycemic control using a novel (n = 82) or conventional AP (n = 242) was conducted retrospectively. All patients had no hypoglycemia. The comparison study revealed no significant differences in perioperative mean blood glucose level, achievement rates for target blood glucose range, and variability in blood glucose level achieved with IIT between the novel AP and conventional AP groups. The usability, performance with respect to blood glucose measurement, and glycemic control characteristics of IIT were comparable between novel and conventional AP systems. However, the novel AP was easier to manipulate than the conventional AP due to its smaller size, lower weight, and shorter time for preparation. In the near future, this novel AP system might be accepted worldwide as a safe and useful device for use in perioperative glycemic control.

http://ift.tt/2cl9S1v

FDHUP: Fast algorithm for mining discriminative high utility patterns

Abstract

Recently, high utility pattern mining (HUPM) has been extensively studied. Many approaches for HUPM have been proposed in recent years, but most of them aim at mining HUPs without any consideration for their frequency. This has the major drawback that any combination of a low utility item with a very high utility pattern is regarded as a HUP, even if this combination has low affinity and contains items that rarely co-occur. Thus, frequency should be a key criterion to select HUPs. To address this issue, and derive high utility interesting patterns (HUIPs) with strong frequency affinity, the HUIPM algorithm was proposed. However, it recursively constructs a series of conditional trees to produce candidates and then derive the HUIPs. This procedure is time-consuming and may lead to a combinatorial explosion when the minimum utility threshold is set relatively low. In this paper, an efficient algorithm named fast algorithm for mining discriminative high utility patterns (DHUPs) with strong frequency affinity (FDHUP) is proposed to efficiently discover DHUPs by considering both the utility and frequency affinity constraints. Two compact structures named EI-table and FU-tree and three pruning strategies are introduced in the proposed algorithm to reduce the search space, and efficiently and effectively discover DHUPs. An extensive experimental study shows that the proposed FDHUP algorithm considerably outperforms the state-of-the-art HUIPM algorithm in terms of execution time, memory consumption, and scalability.

http://ift.tt/2d9Aetp

Preoperative oral antibiotics reduce infections after colorectal cancer surgery

Abstract

Aim

The objectives were to recognize the risk factors for surgical site infections (SSIs) after surgery due to colorectal cancer and to assess the impact of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (ABX) on SSIs.

Methods

Records from two colorectal centers were used. Risk factors of SSIs were categorized into patient-, disease-, and treatment-dependent.

Results

A group of 2240 patients was included. SSIs were noted in 364 patients (16.3 %). MBP+/ABX+ was connected with a lower incidence of anastomotic leak (AL) and organ-space SSIs: 2.4 vs. 6.3 %; p = 0.008 and 3.6 vs. 7.2 %; p = 0.017, respectively. Patient-dependent factors: obesity increased the risk of skin superficial SSIs, adjusted OR 1.53 (1.47–1.59 95 % confidence interval (95 % CI)), and deep incisional SSIs 1.42 (1.39–1.45 95 % CI). Disease-dependent factors: rectal cancer was associated with a higher risk of skin superficial and deep incisional SSIs, adjusted OR 1.28 (1.22–1.34 95 % CI) and 1.13 (1.09–1.15 95 % CI). Treatment-dependent factors: MBP+/ABX+ was associated with a lower risk of organ-space SSIs, adjusted OR 0.53 (0.44–0.59 95 % CI). Radiotherapy increased the risk of organ-space SSIs, adjusted OR 1.78 (1.75–1.80 95 % CI). The risk of organ-space SSIs was the highest after low anterior resection, adjusted OR 1.62 (1.60–1.64 95 % CI).

Conclusions

If possible, MBP and ABX should always be administered to decrease the risk of AL and organ-space SSIs. Factors strictly related to the treatment mostly increased the risk of organ-space SSIs.

http://ift.tt/2d9xJHB

Preventive Effects of Poloxamer 188 on Muscle Cell Damage Mechanics Under Oxidative Stress

Abstract

High oxidative stress can occur during ischemic reperfusion and chronic inflammation. It has been hypothesized that such oxidative challenges could contribute to clinical risks such as deep tissue pressure ulcers. Skeletal muscles can be challenged by inflammation-induced or reperfusion-induced oxidative stress. Oxidative stress reportedly can lower the compressive damage threshold of skeletal muscles cells, causing actin filament depolymerization, and reduce membrane sealing ability. Skeletal muscles thus become easier to be damaged by mechanical loading under prolonged oxidative exposure. In this study, we investigated the preventive effect of poloxamer 188 (P188) on skeletal muscle cells against extrinsic oxidative challenges (H₂O₂). It was found that with 1 mM P188 pre-treatment for 1 h, skeletal muscle cells could maintain their compressive damage threshold. The actin polymerization dynamics largely remained stable in term of the expression of cofilin, thymosin beta 4 and profilin. Laser photoporation demonstrated that membrane sealing ability was preserved even as the cells were challenged by H₂O₂. These findings suggest that P188 pre-treatment can help skeletal muscle cells retain their normal mechanical integrity in oxidative environments, adding a potential clinical use of P188 against the combined challenge of mechanical-oxidative stresses. Such effect may help to prevent deep tissue ulcer development.

http://ift.tt/2d0B88q

Formation et organisation en endoscopie

http://ift.tt/2cBEBs7

Analysis of photobiomodulation associated or not with platelet-rich plasma on repair of muscle tissue by Raman spectroscopy

Abstract

Treatment of muscle injuries usually results in the interruption of sports practice; thus, studies aimed at accelerating the return to activity, with proper tissue repair, are important. Therefore, this study aimed to evaluate the effects of photobiomodulation (PBM), associated or not with platelet-rich plasma (PRP), on the treatment of muscle injury. Thirty-five animals were used and divided into five groups (n = 7): control (C), control lesion (CL), lesion treated with low-level laser therapy (LLLT) (LLt), lesion treated with PRP (LP), and lesion treated with both techniques, LLLT and PRP (LLtP). Muscle injury was induced by stretching the gastrocnemius muscle, and the animals in the LLtP and LP groups received the application of PRP immediately following the injury. The LLLT was applied daily for 7 days. The animals were euthanized 7 days after the injury. Analysis of the NADH/NAD ratio and collagen was performed by Raman spectroscopy; in addition to which, histological analysis of the gastrocnemius muscle was performed. The LLtP group demonstrated a reduction in the area of injury, regenerating cells and a healthy appearance of muscle fibers. The Raman analyses showed a reduction in the NADH/NAD ratio in the CL group, demonstrating oxidative stress, and the collagen presented a reduction in the CL and LLt groups, when compared with the C group. It is concluded that either PBM or PRP, and the association of both, was able to reduce the oxidative stress promoted by injury and modulate collagen production at the site of the injury. Furthermore, although both treatments individually were effective for repairing the damage caused by muscle injury, the association of both demonstrated a better histological aspect.

http://ift.tt/2cBCXGJ

ECG imaging of ventricular tachycardia: evaluation against simultaneous non-contact mapping and CMR-derived grey zone

Abstract

ECG imaging is an emerging technology for the reconstruction of cardiac electric activity from non-invasively measured body surface potential maps. In this case report, we present the first evaluation of transmurally imaged activation times against endocardially reconstructed isochrones for a case of sustained monomorphic ventricular tachycardia (VT). Computer models of the thorax and whole heart were produced from MR images. A recently published approach was applied to facilitate electrode localization in the catheter laboratory, which allows for the acquisition of body surface potential maps while performing non-contact mapping for the reconstruction of local activation times. ECG imaging was then realized using Tikhonov regularization with spatio-temporal smoothing as proposed by Huiskamp and Greensite and further with the spline-based approach by Erem et al. Activation times were computed from transmurally reconstructed transmembrane voltages. The results showed good qualitative agreement between the non-invasively and invasively reconstructed activation times. Also, low amplitudes in the imaged transmembrane voltages were found to correlate with volumes of scar and grey zone in delayed gadolinium enhancement cardiac MR. The study underlines the ability of ECG imaging to produce activation times of ventricular electric activity—and to represent effects of scar tissue in the imaged transmembrane voltages.

http://ift.tt/2d0CqQF

What is the predictor of surgical mortality in adult colorectal perforation? The clinical characteristics and results of a multivariate logistic regression analysis

Abstract

Purpose

Colorectal perforations are a serious condition associated with a high mortality. The aim of this study was to describe the clinical characteristics and identify predictors for the surgical mortality in adult patients with colorectal perforation, thereby achieving better outcomes.

Methods

A retrospective study of adult patients diagnosed with colorectal perforation operated was performed. The clinical variables that might influence the surgical mortality were first analyzed, and the significant variables were then analyzed using a logistic regression model.

Results

A total of 423 patients were identified, and the surgical mortality rate was 36.9 %. The most common etiology was diverticulitis (38.2 %). The highest etiology-specific mortality was for colorectal cancer (61.5 %) and ischemic proctocolitis (59.8 %). In a logistic analysis, the significant predictors for the surgical mortality were ≥3 comorbidities (p = 0.034), preoperation American Society of Anesthesiologists score ≥4 (p = 0.025), preoperative sepsis or septic shock (p < 0.001), colorectal cancer or ischemic proctocolitis (p = 0.035), reoperation (p = 0.041), and Hinchey classification grade IV (p = 0.024).

Conclusion

We demonstrated that ≥3 comorbidities, a preoperation American Society of Anesthesiologists score ≥4, preoperative sepsis or septic shock, colorectal cancer or ischemic proctocolitis, reoperation, and Hinchey classification grade IV are predictors for the surgical mortality in the adult cases of colorectal perforation. These predictors should be taken into consideration to prevent surgical mortality and to reduce potentially unnecessary medical expenses.

http://ift.tt/2ckVk1U

Aphasie: evidenzbasierte Therapieansätze

Zusammenfassung

Sprachtherapie ist ein unverzichtbarer Baustein in der Rehabilitation aphasischer Störungen nach einem Schlaganfall. Vor dem Hintergrund der prognostizierten Zunahme von Aphasien und den limitierten Ressourcen des Gesundheitssystems ist die Entwicklung effizienter und nachhaltiger Behandlungsmethoden von herausragender Bedeutung. Die konsensbasierten Behandlungskonzepte sollten dabei ebenso wie innovative Verfahren im Sinne der evidenzbasierten Medizin hinsichtlich ihrer Wirksamkeit überprüft werden. Für die Rehabilitation subakuter und chronischer Aphasien konnte die Wirksamkeit hochfrequenter klassischer Sprachübungstherapie auf hoher Evidenzstufe nachgewiesen werden. Darüber hinausgehende neu entwickelte Therapiekonzepte beruhen meist auf kleineren Studien mit geringerer Evidenzstufe. Beispielhaft zu nennen sind hier das computerbasierte hochfrequente Benenntraining, videobasierte Übungen zur Verbalisierung komplexer Inhalte und die Therapie nach der „Forced-use"-Methode mit standardisierten Inhalten. Gleichzeitig werden Sprachtrainingsadjuvanzien zur Verstärkung der Therapieeffekte evaluiert; hier sind insbesondere die nichtinvasive Hirnstimulation und die pharmakologische Modulation zu nennen. Transkranielle Gleichstromstimulation zeigt in mehreren randomisierten kontrollierten Studien einen positiven Effekt bei Aphasien, aber die Auswahl der Patienten und die jeweils optimalen Stimulationsprotokolle bedürfen weiterer Erforschung. Auch für die Wirksamkeit medikamentöser Unterstützung des Sprachlernens gibt es Hinweise, doch auch hier sind vor einem breiten Einsatz weitere randomisierte und kontrollierte Studien mit größeren Fallzahlen notwendig.

http://ift.tt/2cFYJLL

Psychotherapeutische Versorgung traumatisierter geflüchteter Menschen in Deutschland

Zusammenfassung

Kriegs- und gewaltbedingte traumatische Erfahrungen können zu einem breiten Spektrum an psychischen und somatischen Belastungsfolgen führen. Das Belastungserleben traumatisierter Geflüchteter wird häufig durch spezifische Postmigrationsstressoren aggraviert. Die aktuelle Versorgungssituation in Deutschland ist durch zahlreiche Restriktionen charakterisiert. Die unterschiedlichen Aufenthaltstitel sind mit einem begrenzten Zugang zu medizinischen und psychotherapeutischen Leistungen verbunden. Zusätzlich erschweren mehrere Hindernisse den Zugang dieser Patientengruppe ins Gesundheitssystem (u. a. unzureichende Ausbildung von Fachkräften, Sprachbarrieren, mangelnde Finanzierung von Dolmetschern). Empirische Studien zeigen, dass traumatisierte Geflüchtete von traumafokussierten, evidenzbasierten Ansätzen profitieren. Die Behandlung ist über den störungsspezifischen Fokus hinaus mit besonderen Herausforderungen bzw. Themen verbunden (z. B. Einsatz von Dolmetschern, migrations- und kulturspezifische sowie rechtliche Aspekte). In spezialisierten Behandlungszentren für traumarisierte geflüchtete Menschen hat sich ein multidisziplinärer Behandlungsansatz bewährt, der psychotherapeutische, medizinische, sozialarbeiterische sowie aufenthaltsrechtliche und integrative Angebote mit einschließt.

http://ift.tt/2cI5C2s

Internetbasierte Interventionen in der Behandlung psychischer Störungen

Zusammenfassung

Hintergrund

Psychische Erkrankungen werden oft nicht oder nicht ausreichend behandelt. Internetbasierte Interventionen werden als eine Möglichkeit angesehen, diese Lücke in der Versorgung psychischer Störungen zu schließen. Das Angebot an Interventionen ist jedoch sehr unübersichtlich.

Fragestellung

Das Ziel dieser Arbeit ist es, einen Vorschlag für Kriterien zu entwickeln, anhand derer Behandler und Patienten empfehlenswerte internetbasierte Interventionen erkennen können.

Methoden

Auf Grundlage einer selektiven Literaturrecherche wurde zunächst die Evidenz zu internetbasierten Interventionen zur Behandlung psychischer Störungen zusammengefasst. Ein Expertengremium entwickelte dann auf Grundlage etablierter Systeme Qualitätskriterien zur systematischen Begutachtung telemedizinischer Anwendungen.

Ergebnisse

Internetbasierte Interventionen sind wirksam in der Behandlung einer Reihe psychischer Störungen. Die beste Evidenz besteht bei Depressionen und Angststörungen. Es wurde ein Vorschlag für einen Katalog von Kriterien entwickelt, anhand derer verfügbare internetbasierte Interventionen mithilfe einer Checkliste evaluiert werden können. Diese Kriterien werden in einem nächsten Schritt mit anderen Interessengruppen abgestimmt.

Diskussion

Unter Berücksichtigung von Qualitätskriterien können über das Internet verbreitete evidenzbasierte Interventionen zur Verbesserung der Versorgung von psychischen Störungen beitragen.

http://ift.tt/2cFY5hc

Liquorzytologie

Zusammenfassung

Die Liquorzytologie ist Bestandteil des integrierten Liquorbefunds. Insbesondere für die Diagnostik und Differenzialdiagnostik liquorraumnaher entzündlicher, hämorrhagischer und neoplastischer Prozesse ist sie unerlässlich. Der vorliegende Beitrag fasst Vorgehensweise und typische Befundkonstellationen zusammen. Grundlegende moderne immunzytochemische und durchflusszytometrische Methoden der Liquorzytologie werden vorgestellt. Die Bedeutung dieser Methodik wird zusammenfassend mit Blick auf die klinische Relevanz kritisch diskutiert.

http://ift.tt/2cI6jbX

DGPPN-Teilhabekompass zu beruflichen Integrationsmaßnahmen für Menschen mit psychischen Erkrankungen

Zusammenfassung

Arbeit für psychisch kranke Menschen ist ein Kernbereich rehabilitativer Psychiatrie. In Deutschland ist die Definition von Rehabilitation für Menschen mit psychischen Erkrankungen eng an die unterschiedlichen Sozialleistungsgebiete und an die stark gegliederte Versorgungskette aus Prävention, Akutbehandlung sowie Rehabilitation und Pflege angelehnt. Menschen mit psychischen Erkrankungen erfolgreich bei der Inanspruchnahme beruflicher Integrationsmaßnahmen zu unterstützen, kann nicht nur mit inhaltlichen, sondern auch mit strukturell-organisatorischen Hürden verbunden sein: Das System ist kompliziert, viele einrichtungs- und settingspezifische Gegebenheiten verhindern nicht selten die notwendige zeitnahe Umsetzung rehabilitativer Maßnahmen. Wesentliche Aspekte in diesem Feld sind unzureichende Kenntnis bei Behandlern über etablierte Rehabilitationsmaßnahmen, unklare Verantwortlichkeiten für Teilhabebemühungen im fachärztlichen Aus- und Weiterbildungssektor sowie quasi nicht verfügbare Informationen über (positive) Erfahrungen aus integrativen, setting- und sektorübergreifenden Modellprojekten zur Förderung der beruflichen Teilhabe in Deutschland. Der vorgestellte Teilhabekompass zur beruflichen Integration für Menschen mit psychischen Erkrankungen setzt hier an: Er soll eine Orientierungshilfe für niedergelassene psychiatrisch-psychotherapeutische Fachärzte, Haus- und Allgemeinärzte, Ärzte der Gesundheitsämter/sozialpsychiatrischen Dienste sowie im stationären und teilstationären psychiatrisch-psychotherapeutischen Setting tätige Ärzte sein. Sowohl die Papier- als auch die geplante Onlineversion sollen dem Adressatenkreis helfen, Menschen mit vor allem schweren psychischen Erkrankungen zeitnah und erfolgreich durch die breite Angebotspalette beruflicher Integrationsmaßnahmen in Deutschland zu navigieren.

http://ift.tt/2cFZ7tB

Liquordiagnostik bei Multipler Sklerose

Zusammenfassung

Die Multiple Sklerose (MS) geht als chronisch-entzündliche Erkrankung des zentralen Nervensystems (ZNS) mit typischen Veränderungen im Liquor einher. In der Diagnostik der MS ist die Liquoruntersuchung daher neben der Magnetresonanztomographie ein zentrales Verfahren, welches einerseits die Diagnose einer MS untermauern und andererseits hilfreich in der Abgrenzung von Differenzialdiagnosen sein kann. Der wichtigste Liquorbefund bei der MS ist der Nachweis einer persistierenden polyspezifischen intrathekalen Immunglobulinsynthese. Diese Übersichtsarbeit gibt einen Überblick über Liquorbefunde bei der MS, weist auf praxisrelevante Aspekte und diagnostische Fallstricke hin und stellt neue Entwicklungen in der Liquordiagnostik bei der MS dar.

http://ift.tt/2cI5LTB

Rheumatology and Immunology

Abstract

Skeletal damage is a hallmark of many chronic rheumatic diseases such as rheumatic arthritis (RA), ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE) and is known as inflammation-induced bone loss in the rheumatic diseases. Vitamin D exercises a regulatory function in the maintenance of immune homeostasis, and it has been demonstrated that the net effect of vitamin D is an enhancement of innate immunity. A role has been ascribed to vitamin D in autoimmune disorders such as multiple sclerosis and rheumatoid arthritis.

http://ift.tt/2dfh15A

Bone Disorders

http://ift.tt/2cONCB2

Extending the Limits of Resection for Colorectal Liver Metastases: Bilateral Disease

http://ift.tt/2cQ0llt

The Sooner, the Better? The Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis: Data from the National Swedish Registry for Gallstone Surgery, GallRiks

Abstract

Up-front cholecystectomy is the recommended therapy for acute cholecystitis (AC). However, the scientific basis for the definition of the optimal timing for surgery is scarce. The aim of this study was to analyze how the timing of surgery, after the admission to hospital for AC, affects the intra- and postoperative outcomes. Within the national Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks), all patients undergoing cholecystectomy for acute cholecystitis between January 2006 and December 2014 were identified. Data regarding patient characteristics, intra- and postoperative adverse events (AEs), bile duct injuries, and 30- and 90-day mortality risk were captured, and the correlation between the surgical timing and these parameters was analyzed. In total, data on 87,108 cholecystectomies were analyzed of which 15,760 (18.1 %) were performed due to AC. Bile duct injury, 30- and 90-day mortality risk, and intra- and postoperative AEs were significantly higher if the time from admission to surgery exceeded 4 days. The time course between surgery and complication risks seemed to be optimal if surgery was done within 2 days after hospital admission. Although AC patients operated on the day of hospital admission had a slightly increased AE rate as well as 30- and 90-day mortality rates than those operated during the interval of 1–2 days after admission, the bile duct injury and conversion rates were, in fact, significantly lower. The optimal timing of cholecystectomy for patients with AC seems to be within 2 days after admission. However, the somewhat higher frequency of AE on admission day may emphasize the importance of optimizing the patient before surgery as well as ensuring that adequate surgical resources are available.

http://ift.tt/2d377aK

Treatment of chronic subdural hematoma by novel YL-1 hollow needle aspiration drainage system (697 cases report)

Abstract

It is written to discuss the effect and syndromes of novel YL-1 hollow needle aspiration drainage system to treat chronic subdural hematoma. Collecting clinical data about 697 patients with chronic subdural hematoma in neurosurgery of People' Hospital in North Jiangsu from January 2004 to December 2014, including clinical manifestation, imaging data, operation time, postoperative complications and prognostic factors and so on. 593 patients got cured, 53 patients with recurrence, 19 patients with acute subdural hematoma, 13 patients with poor drainage, 9 case of patients with acute epidural hematoma, puncture failure in 6 cases, 3 cases of pulmonary infection, one got intracranial hemorrhage (brain stem and basal ganglia hemorrhage). The total time of the operation is 15–28 min, the mean time is 18 ± 3.6 min, the average retention time of novel YL-1 hollow needle aspiration drainage system was 2.6 ± 1.3 days, the average use of urokinase was 30,000 ± 2.10,000 units. It takes a short time for novel YL-1 hollow needle aspiration drainage system to treat chronic subdural hematoma without any syndromes like brain tissue injury, tension pneumocrania, intracranial infection and so on. The clinical cure rate is 85.08 %, recurrence rate is 7.6 %. Using novel YL-1 hollow needle aspiration drainage system to treat chronic subdural hematoma is such a minimally invasive surgical technology which has a higher curative rate, small damage, is also easy to operate with security and less severe complications.

http://ift.tt/2d385DZ

Bilateral isolated facial palsy with fast recovery in infectious mononucleosis

http://ift.tt/2cQ0DZy

Phage display biopanning and isolation of target-unrelated peptides: in search of nonspecific binders hidden in a combinatorial library

Abstract

Phage display is known as a powerful methodology for the identification of targeting ligands that specifically bind to a variety of targets. The high-throughput screening of phage display combinatorial peptide libraries is performed through the affinity selection method of biopanning. Although phage display selection has proven very successful in the discovery of numerous high-affinity target-binding peptides with potential application in drug discovery and delivery, the enrichment of false-positive target-unrelated peptides (TUPs) without any actual affinity towards the target remains a major problem of library screening. Selection-related TUPs may emerge because of binding to the components of the screening system rather than the target. Propagation-related TUPs may arise as a result of faster growth rate of some phage clones enabling them to outcompete slow-propagating clones. Amplification of the library between rounds of biopanning makes a significant contribution to the selection of phage clones with propagation advantage. Distinguishing nonspecific TUPs from true target binders is of particular importance for the translation of biopanning findings from basic research to clinical applications. Different experimental and in silico approaches are applied to assess the specificity of phage display-derived peptides towards the target. Bioinformatic tools are playing a rapidly growing role in the analysis of biopanning data and identification of target-irrelevant TUPs. Recent progress in the introduction of efficient strategies for TUP detection holds enormous promise for the discovery of clinically relevant cell- and tissue-homing peptides and paves the way for the development of novel targeted diagnostic and therapeutic platforms in pharmaceutical areas.

http://ift.tt/2d378LX

Improving the Interoperability in the Digital Home Through the Automatic Generation of Software Adapters from a SysML Model

Abstract

In the context of the Digital Home, where multiple heterogeneous systems live together, many efforts have been made to achieve the standardization that will guarantee the interoperability among them. The Digital Home Compliant (DHC) open communication protocol arises to meet that requirement by means of a software adapter for each device that acts as intermediary with the DHC network. Based on the fact that all the adapters have a high proportion of source code in common, this paper aims to go a step further in the use of the protocol automating the adapters' process generation, following the Model Driven Architecture approach. The Web Services Java code is created from a template and a SysML model of the system, allowing the automatic deployment of the adapter and therefore, enhancing the global interoperability of the system. The case of study of a specific adapter development – Roomba service robot – is explained in this communication to illustrate the advantages of this proposal.

http://ift.tt/2cBnFSD

Distributed Time-Varying Formation Tracking Analysis and Design for Second-Order Multi-Agent Systems

Abstract

Distributed time-varying formation tracking analysis and design problems for second-order multi-agent systems with one leader are studied respectively, where the states of followers form a predefined time-varying formation while tracking the state of the leader. Different from the previous results on formation tracking control, the formation for the followers can be described by specified time-varying vectors and the trajectory of the leader can also be time-varying. A distributed formation tracking protocol is constructed using only neighboring relative information. Necessary and sufficient conditions for second-order multi-agent systems with one leader to achieve time-varying formation tracking are proposed by utilizing the properties of the Laplacian matrix, where the formation tracking feasibility constraint is also given. An approach to design the formation tracking protocol is proposed by solving an algebraic Riccati equation. The presented results can be applied to deal with the target enclosing problems and consensus tracking problems for second-order multi-agent systems with one target/leader. An application in the target enclosing of multiple vehicles is provided to demonstrate the effectiveness of the theoretical results.

http://ift.tt/2d9jbrA

Current clinical trials testing the combination of immunotherapy with radiotherapy

Abstract

Increasing evidence demonstrates that radiation acts as an immune stimulus, recruiting immune mediators that enable anti-tumor responses within and outside the radiation field. There has been a rapid expansion in the number of clinical trials harnessing radiation to enhance antitumor immunity. If positive, results of these trials will lead to a paradigm shift in the use of radiotherapy. In this review, we discuss the rationale for trials combining radiation with various immunotherapies, provide an update of recent clinical trial results and highlight trials currently in progress. We also address issues pertaining to the optimal incorporation of immunotherapy with radiation, including sequencing of treatment, radiation dosing and evaluation of clinical trial endpoints.

http://ift.tt/2cFXoED

A case report of Grover’s disease from immunotherapy-a skin toxicity induced by inhibition of CTLA-4 but not PD-1

Abstract

Background

Immune related adverse events (irAEs) are common side effects of checkpoint inhibitory (CPI) therapies targeting CTLA-4 and PD-1/PD-L1. Grover's disease is an uncommon dermatologic condition with unclear pathogenesis previously reported as an irAE with ipilimumab.

Case Presentation

We report an additional case of ipilimumab-induced Grover's disease. Interestingly, this dermatologic side effect did not appear with use of anti-PD-1 therapy in our patient. Immune analysis was performed and suggests a possible role of Th2 cells in its patholgenesis.

Conclusion

This case suggests that Grover's disease is an irAE induced by Ipilimumab. Our immune analysis suggests that Th2 cells may be pathogenic mediators which warrants further study.

http://ift.tt/2cI2Cmy

Increased FDG avidity in lymphoid tissue associated with response to combined immune checkpoint blockade

Abstract

Background

Antibodies against programmed death 1 (PD-1) receptor and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) have transformed the systemic treatment of melanoma and many other cancers. Understanding the spectrum of benign findings and atypical response patterns seen in immune checkpoint blockade is important for accurately assessing treatment response as these immunotherapies become more widely used.

Case presentation

We report a 63-year-old man with metastatic melanoma successfully treated with combination CTLA-4 and PD-1 blockade (ipilimumab and nivolumab), after non-response to pembrolizumab monotherapy. The initial impression of disease progression, based on cutaneous and PET/CT findings of increased fluoro-2-deoxy-D-glucose (FDG) uptake in benign lymphoid tissue, proved to be erroneous after assiduous review of radiographic imaging and correlative pathology.

Conclusions

These findings indicate that increased FDG uptake in benign lymphoid tissue seen on PET/CT may be a surrogate marker of immune activation and treatment response. Prospective studies will be invaluable in validating immune-related radiographic findings as a prognostic biomarker of response in cancer patients being treated with immune checkpoint blockade.

http://ift.tt/2cFXDzK

Re-discovering NK cell allo-reactivity in the therapy of solid tumors

http://ift.tt/2cI2iEr

Biomarkers immune monitoring technology primer: Immunoscore® Colon

http://ift.tt/2cFXr3b

Into the clinic: Talimogene laherparepvec (T-VEC), a first-in-class intratumoral oncolytic viral therapy

Abstract

With the recent regulatory approval of Talimogene laherparepvec (T-VEC) for the treatment of advanced of melanoma in the United States, Europe and Australia, oncolytic virus immunotherapy has earned its place in the clinic. However, the adoption of T-VEC by the U.S. oncology community has been slow, and so far has been largely limited to specialized cancer centers. Limiting factors include the intratumoral route of administration, which is unfamiliar to medical oncologists, biosafety concerns related to the use of a live virus in the clinic, and the explosion of other therapeutic strategies now available for the treatment of advanced melanoma. Herein, we review the development of T-VEC, and suggest how it fits into the in the current clinical treatment paradigm, and provide pearls for drug preparation, administration, and monitoring of response to therapy.

http://ift.tt/2cI2F1C

Adjuvants for peptide-based cancer vaccines

Abstract

Cancer therapies based on T cells have shown impressive clinical benefit. In particular, immune checkpoint blockade therapies with anti-CTLA-4 and anti-PD-1/PD-L1 are causing dramatic tumor shrinkage and prolonged patient survival in a variety of cancers. However, many patients do not benefit, possibly due to insufficient spontaneous T cell reactivity against their tumors and/or lacking immune cell infiltration to tumor site. Such tumor-specific T cell responses could be induced through anti-cancer vaccination; but despite great success in animal models, only a few of many cancer vaccine trials have demonstrated robust clinical benefit. One reason for this difference may be the use of potent, effective vaccine adjuvants in animal models, vs. the use of safe, but very weak, vaccine adjuvants in clinical trials. As vaccine adjuvants dictate the type and magnitude of the T cell response after vaccination, it is critical to understand how they work to design safe, but also effective, cancer vaccines for clinical use. Here we discuss current insights into the mechanism of action and practical application of vaccine adjuvants, with a focus on peptide-based cancer vaccines.

http://ift.tt/2cFXBaQ

A retrospective analysis of High-Dose Interleukin-2 (HD IL-2) following Ipilimumab in metastatic melanoma

Abstract

Background

High dose interleukin-2 (HD IL-2) can induce durable responses in a subset of patients leading to long-term survival. Immune checkpoint blockade (ICB) has demonstrated similarly durable responses in a larger proportion of patients. However, not all patients respond to immune checkpoint blockade and subsequent therapeutic options need to be explored.

Methods

The PROCLAIM database was queried for patients with metastatic melanoma who had received HD IL-2 after treatment with ipilimumab or without prior ICB. Patient characteristics, toxicity and efficacy were analyzed.

Results

A total of 52 metastatic melanoma patients were treated with high dose IL-2 after ipilimumab and 276 patients were treated with high dose IL-2 without prior ICB. The overall response rate in the prior ipilimumab group was 21 % as compared to 12 % in the group that had not received prior ipilimumab. The median overall survival, measured from the initiation of HD IL-2 therapy, was 19.3 months in the prior ipilimumab group and 19.4 months in the no prior ICB group. Toxicities observed on HD IL-2 were relatively equivalent between the groups although there were cases of CTLA4 antibody-induced colitis reported after HD IL-2 treatment and a CTLA4 antibody-induced colitis related death.

Conclusion

In this retrospective analysis HD IL-2 therapy displayed antitumor activity in melanoma patients who progressed following treatment with ipilimumab. Most HD IL-2 toxicity was not worsened by prior ipilimumab therapy except for one treatment related death from colitis. Care should be taken to avoid reactivation of CTLA4 antibody-induced colitis.

http://ift.tt/2cI3703

Enhanced crystallization behaviour and impact toughness of poly(ethylene terephthalate) with a phenyl phosphonic acid salts compound

Abstract

Low crystallization rate and inherent brittleness characteristics limit the wide application of PET. In this paper, it was found that a low molecular weight Phenyl phosphonic acid salts compound (TMC-210) is a very effective nucleator and can enhance the impact strength very much. So, the effect of TMC-210 on the crystallization behaviour and mechanical properties of poly(ethylene terephthalate) were systematically evaluated by differential scanning calorimetry (DSC), polarized optical microscopy (POM), wide angle X-ray diffraction (WAXD), scanning electron microscope (SEM) and mechanical properties test. The results show that TMC-210 obviously improves the crystallization temperature and accelerates the crystallization rate of PET and reflects a significant heterogeneous nucleating effect with a nucleation efficiency of 99.8 % when introducing a low content of 0.6 wt% TMC-210. The spherulites size and number of blended PET are greater than pure PET. The crystal structure of PET does not change but the blends with high TMC-210 content appears new diffraction peaks in x-ray diffraction spectrogram and it may attribute to the agglomeration of TMC-210 particles, which is verified by SEM observation. The impact fracture surface of PET develops a brittle ductile transition and thus the impact strength of PET improves significantly. Additionally, Lauritzen–Hoffman equation was used to discuss the effect of TMC-210 on the fold surface free energy (σ _e) of PET in the crystallization process and found that the σ _e values of PET/TMC-210 blends is smaller than that of pure PET.

http://ift.tt/2dhSkIp

Diagnostic accuracy of whole-brain CT perfusion in the detection of acute infratentorial infarctions

Abstract

Introduction

Although the diagnostic performance of whole-brain computed tomographic perfusion (WB-CTP) in the detection of supratentorial infarctions is well established, its value in the detection of infratentorial strokes remains less well defined. We examined its diagnostic accuracy in the detection of infratentorial infarctions and compared it to nonenhanced computed tomography (NECT), aiming to identify factors influencing its detection rate.

Methods

Out of a cohort of 1380 patients who underwent WB-CTP due to suspected stroke, we retrospectively included all patients with MRI-confirmed infratentorial strokes and compared it to control patients without infratentorial strokes. Two blinded readers evaluated NECT and four different CTP maps independently for the presence and location of infratentorial ischemic perfusion deficits.

Results

The study was designed as a retrospective case-control study and included 280 patients (cases/controls = 1/3). WB-CTP revealed a greater diagnostic sensitivity than NECT (41.4 vs. 17.1 %, P = 0.003). The specificity, however, was comparable (93.3 vs. 95.0 %). Mean transit time (MTT) and time to drain (TTD) were the most sensitive (41.4 and 40.0 %) and cerebral blood volume (CBV) the most specific (99.5 %) perfusion maps. Infarctions detected using WB-CTP were significantly larger than those not detected (15.0 vs. 2.2 ml; P = 0.0007); infarct location, however, did not influence the detection rate.

Conclusion

The detection of infratentorial infarctions can be improved by assessing WB-CTP as part of the multimodal stroke workup. However, it remains a diagnostic challenge, especially small volume infarctions in the brainstem are likely to be missed.

http://ift.tt/2d0z9ke

Imprint of the atmospheric attenuation process on electron distribution in EAS

Abstract

The lateral density distribution (LDD) of shower particles in an extensive air shower (EAS) experiment is commonly approximated by a particular type of lateral density function (LDF). A standard perception is being used in air shower physics since long, according to which the LDD is assumed to be symmetric about the EAS axis, and the adopted LDF is adequate for the description of the LDD. However, the simulated electron density of a non-vertical EAS is asymmetric. In this work, such asymmetry in the LDD can be qualitatively explained as the atmospheric attenuation suffered by each shower particle. Quantitatively, the asymmetry can be roughly described in terms of a gap length (GL) between the EAS core and the center of the modified density pattern consisting of several equi-density ellipses. This study also validates the use of such a modeling of the atmospheric attenuation on the electromagnetic component in an EAS by investigating the so called GL in simulated density data. A modified LDF is proposed, based on these features of the simulated densities for the purpose of shower reconstruction in EAS experiments. The GL arises from attenuation effect is found to increase with the mass of the shower initiating particle. A different radial dependence of the local age parameter (LAP) is seen, if the modified LDF is applied to simulated electron densities. Primary cosmic-ray mass sensitivity of the LAP is also re-examined.

http://ift.tt/2cPXbxY

Automated brain tumour detection and segmentation using superpixel-based extremely randomized trees in FLAIR MRI

Abstract

Purpose

We propose a fully automated method for detection and segmentation of the abnormal tissue associated with brain tumour (tumour core and oedema) from Fluid- Attenuated Inversion Recovery (FLAIR) Magnetic Resonance Imaging (MRI).

Methods

The method is based on superpixel technique and classification of each superpixel. A number of novel image features including intensity-based, Gabor textons, fractal analysis and curvatures are calculated from each superpixel within the entire brain area in FLAIR MRI to ensure a robust classification. Extremely randomized trees (ERT) classifier is compared with support vector machine (SVM) to classify each superpixel into tumour and non-tumour.

Results

The proposed method is evaluated on two datasets: (1) Our own clinical dataset: 19 MRI FLAIR images of patients with gliomas of grade II to IV, and (2) BRATS 2012 dataset: 30 FLAIR images with 10 low-grade and 20 high-grade gliomas. The experimental results demonstrate the high detection and segmentation performance of the proposed method using ERT classifier. For our own cohort, the average detection sensitivity, balanced error rate and the Dice overlap measure for the segmented tumour against the ground truth are 89.48 %, 6 % and 0.91, respectively, while, for the BRATS dataset, the corresponding evaluation results are 88.09 %, 6 % and 0.88, respectively.

Conclusions

This provides a close match to expert delineation across all grades of glioma, leading to a faster and more reproducible method of brain tumour detection and delineation to aid patient management.

http://ift.tt/2cNPWIo

Manual for maintenance of multi-host ixodid ticks in the laboratory

Abstract

Use of laboratory animals as hosts for blood-sucking arthropods remains a time-proven and the most efficient method for establishment and propagation of slowly feeding ixodid ticks, despite introduction of techniques involving artificial feeding on either animal skins or synthetic membranes. New Zealand White rabbits are usually the most accessible and most suitable hosts routinely used for establishment and maintenance of a large variety of multi-host tick species. Here we describe standard procedures for maintaining colonies of multi-host ixodid ticks by feeding all developmental stages (larvae, nymphs, and adults) upon New Zealand White rabbits. When needed, the same procedures can be easily adapted to other species of laboratory or domestic animals from mice to dogs and goats. A summary of our experience in maintaining laboratory colonies of Ixodes scapularis, Ixodes pacificus, Amblyomma americanum, Dermacentor variabilis, Dermacentor occidentalis, Haemaphysalis leporispalustris, and Rhipicephalus sanguineus with descriptions of the complete laboratory life cycles and reliable production of uninfected ticks under standardized conditions has been published by Troughton and Levin (J Med Entomol 44:732–740, 2007). Here we provide step-by-step recommendations for various procedures used in the maintenance of ixodid tick colonies based on over 20 years of experience.

http://ift.tt/2cOHoB3

Serum metabolomics analysis for early detection of colorectal cancer

Abstract

Background

Although colorectal cancer (CRC) is one of the most common causes of cancer mortality, early-stage detection improves survival rates dramatically. Because cancer impacts important metabolic pathways, the alteration of metabolite levels as a potential biomarker of early-stage cancer has been the focus of many studies. Here, we used CE-TOFMS, a novel and promising method with small injection volume and high resolution, to separate and detect ionic compounds based on the different migration rates of charged metabolites in order to detect metabolic biomarkers in patients with CRC.

Methods

A total of 56 patients with CRC (n = 14 each of Stages I-IV), 60 healthy controls, and 59 patients with colonic adenoma were included in this study. Metabolome analysis was conducted by CE-TOFMS on serum samples of patients and controls using the Advanced Scan package (Human Metabolome Technologies).

Results

We obtained 334 metabolites in the serum, of which 139 were identified as known substances. Among these 139 known metabolites, 16 were correlated with CRC stage by upregulation and 44 by downregulation, with benzoic acid (r = −0.649, t = 11.653, p = 6.07599E−24), octanoic acid (r = 0.557, t = 9.183, p = 7.9557E−17), decanoic acid (r = 0.539, t = 8.749, p = 1.24352E−15), and histidine (r = −0.513, t = 8.194, p = 3.90224E−14) exhibiting significant correlation.

Conclusions

To the best of our knowledge, this is the first report to determine the correlation between serum metabolites and CRC stage using CE-TOFMS. Our results show that benzoic acid exhibited excellent diagnostic power and could potentially serve as a novel disease biomarker for CRC diagnosis.

http://ift.tt/2dhN6wf

Influence of previous abdominal surgery on surgical outcomes between laparoscopic and open surgery in elderly patients with colorectal cancer: subanalysis of a large multicenter study in Japan

Abstract

Background

The aim of the present study was to examine the technical and oncological feasibility of laparoscopic surgery (LAP) in elderly patients with a history of abdominal surgery.

Methods

We conducted a propensity score-matched case–control study of colorectal cancer (CRC) patients aged ≥80 years that were treated at 41 hospitals between 2003 and 2007. We included 601 patients who had a history of abdominal surgery and underwent curative and elective surgery for stage 0 to III CRC. After the matching procedure, 153 patients were included in each cohort. The surgical outcomes of LAP and open surgery (OS) were compared. P-values of <0.05 were considered statistically significant.

Results

LAP resulted in a significantly longer surgical time (220 vs. 170 min, p < 0.001), but significantly less intraoperative blood loss (39 vs. 100 ml, p < 0.001). A number of postoperative recovery-related parameters, including the length of the hospitalization period (12 vs. 14 days, p = 0.002), and the days to the resumption of fluid (2 vs. 3 days, p < 0.001) and solid food intake (4 vs. 5 days, p < 0.001), were significantly better in the LAP group. Moreover, the overall morbidity rate (43 vs. 66 %, p = 0.009) and the frequency of postoperative ileus (7 vs. 19 %, p = 0.023) were significantly lower in the LAP group, while the frequencies of other morbidities did not differ significantly between the groups. In the survival analyses, overall survival and disease-free survival did not differ between the two groups.

Conclusions

In this population, LAP can be performed safely in elderly CRC patients with a history of abdominal surgery, and LAP resulted in a lower postoperative morbidity rate than OS.

http://ift.tt/2d0tE4Z

Low-intensity laser (660 nm) on sternotomy healing in patients who underwent coronary artery bypass graft: a randomized, double-blind study

Abstract

The aim of this study was to analyze the healing effects of low-level laser therapy (LLLT) on the longitudinal sternotomy incisions of patients who underwent coronary artery bypass graft (CABG). The volunteers were randomized into three groups of equal size (n = 30): control, placebo, and laser (λ = 660 nm and spatial average energy fluency [SAEF] = 1.06 J/cm²). The patients in the laser group underwent irradiation on postoperative days 2, 4, 6, and 8, and their sternotomy incisions were photographed immediately after the surgery and 8 days later for analysis. Three researchers who were blinded to the patient treatment groups analyzed the incision photographs to assess hyperemia and wound closure on the day of hospital discharge (eighth postoperative day). The sternotomy incisions in the LLLT group demonstrated less hyperemia, incisional bleeding, and dehiscence (p ≤ 0.005).

http://ift.tt/2d1xeil

Effect of low-level laser therapy on angiogenesis and matrix metalloproteinase-2 immunoexpression in wound repair

Abstract

Low-level laser therapy (LLLT) induces anti-inflammatory and angiogenic activities in wound healing. However, the mechanism of action and optimal parameters require further clarification. In this study, we investigated the effects of LLLT on wound healing matrix metalloproteinase (MMP)-2 immunoexpression and angiogenic processes. Twenty female Wistar rats were randomly divided into four groups (n = 5) according to the treatments as follows. CG7 and CG14 were control groups at days 7 and 14, respectively, which received physiological saline (0.9 % NaCl daily). LG7 and LG14 were laser therapy groups at days 7 and 14, respectively, which received two (LG7) or four (LG14) LLLT applications (40 mW; 660 nm; 4 J/cm²). A dorsal skin sample in the wound area (measuring 2 cm²) was removed after the experimental period, and then the animals were euthanized. The specimens were processed for qualitative and quantitative histological analyses and measurement of MMP-2 expression in the dermis and epidermis. A persistent crust and moderate number of inflammatory cells were found in CG7 and CG14 groups. In the LG14 group, wounds demonstrated complete re-epithelization at the remodeling phase. Angiogenesis and MMP-2 expression were higher in LLLT-treated groups, particularly the LG14 group, which correlated according to the Spearman correlation test. LLLT improves wound healing by enhancing neocollagenesis, increasing the amount of new vessels formed in the tissue (neoangiogenesis), and modulating MMP-2 expression. Epidermal overexpression of MMP-2 was correlated to angiogenic processes.

http://ift.tt/2cOcZRL

Clinical usefulness of pectoral nerve block for the management of zoster-associated pain: case reports and technical description

Abstract

The recently introduced pectoral nerve (Pecs) block is a simple alterative to the conventional thoracic paravertebral block or epidural block for breast surgery. It produces excellent analgesia and can be used to provide balanced anesthesia and as a rescue block in cases where performing a neuraxial blockade is not possible. In the thoracic region, a neuraxial blockade is often used to manage zoster-associated pain. However, this can be challenging for physicians due to the increased risk of hemodynamic instability in the upper thoracic level, and comorbid and contraindicated medical conditions such as coagulopathy. Here, we introduce an ultrasound-guided Pecs block for the management of herpes zoster-associated pain, which could be an effective alternative to other interventional options in the thoracic region.

http://ift.tt/2d2Wc0J

A randomized, double-blind trial evaluating the efficacy of palonosetron with total intravenous anesthesia using propofol and remifentanil for the prevention of postoperative nausea and vomiting after gynecologic surgery

Abstract

Purpose

Palonosetron has potent and long-acting antiemetic effects for postoperative nausea and vomiting (PONV). The aim of this study was to prospectively evaluate the efficacy of palonosetron when used with total intravenous anesthesia (TIVA) using propofol and remifentanil for the prevention of PONV in patients undergoing laparoscopic gynecologic surgery.

Methods

This prospective double-blind study comprised 100 female American Society of Anesthesiologist physical status I and II patients who were undergoing laparoscopic gynecologic surgery under TIVA. The patients were randomly assigned to two groups—the palonosetron plus TIVA group (palonosetron 0.075 mg i.v., n = 50) and the TIVA group (normal saline 1.5 ml i.v., n = 50). The treatments were given before the induction of anesthesia. The incidence of PONV, severity, number of rescue antiemetics, adverse effects, and patient satisfaction during the first 24 h after surgery were evaluated.

Results

The demographic profiles of the patients in the two groups were comparable. The overall incidence of PONV (0–24 h) was significantly lower in the TIVA plus palonosetron group than in the TIVA group (34 vs 58 %, p = 0.027). In particular, during the 6–24 h after surgery, the incidence of PONV (14 vs 30 %, p = 0.03) and the incidence of moderate to severe nausea (6 vs 22 %, p = 0.041) were significantly lower in the TIVA plus palonosetron group than in the TIVA group. There were no significant differences in adverse effects, use of rescue antiemetics or patient satisfaction.

Conclusion

Combining palonosetron with TIVA can be considered as a good method to prevent PONV, not only during the short postoperative period but also especially during the 6–24-h period after anesthesia.

http://ift.tt/2cPKgvU