Risk-adjusted treatment selection and outcome of patients with acute cholecystitis

Abstract

Purpose

Age and comorbidities increase the surgical risk for patients with acute cholecystitis and impact on the initial treatment selection. The aim of this article is the implementation of objective risk criteria that may be used to select the most appropriate treatment.

Methods

We carried out a prospective cohort study of all patients who were admitted to the hospital with a diagnosis of acute cholecystitis during 2014. They were initially allocated to three different treatment groups according to cholecystitis grade, number of days from clinical onset, and surgical risk scores as follows: immediate surgery by sepsis (EmergS), early surgery (EarlyS), or medical treatment group (MedT). Differences in the outcomes between the treatment groups were evaluated using bivariate and logistic regression analyses.

Results

A total of 149 patients were admitted; 44 % were >80 years old and 40 % were American Society of Anesthesiologists (ASA) > II. The mortality rate of the series was 0 % in EarlyS, 17 % in MedT, and 19 % in EmergS. The mortality rate was significantly associated with a higher degree of cholecystitis, age, and worse score values in risk scales and Charlson index. Logistic regression identified that the only independent predictors of death at the time of admission were the degree of cholecystitis (OR 2.87, p = 0.018) and the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score (OR 1.14, p = 0.001).

Conclusion

The evaluation for the initial treatment in acute cholecystitis should include a systematic determination of the degree of cholecystitis and a surgical risk assessment. Tokyo guideline recommendations should be reviewed.

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Joint Meeting of the German Association of Endocrine Surgeons (CAEK) and the British Association of Endocrine and Thyroid Surgeons (BAETS)

http://ift.tt/2dpVcEP

Thyroglossal Duct Cyst Carcinomas: A Clinicopathologic Series of 22 Cases with Staging Recommendations

Abstract

Carcinomas arising from thyroglossal duct remnant cysts (TGDCs) are rare, without well-defined management and staging criteria. All TGDCs (n = 685) diagnosed between 2005 and 2015 were retrospectively reviewed, with 22 carcinomas identified (3.2 % incidence). Twenty-two patients (17 females, 5 males), aged 12–64 years (mean 39.9 years; median 39 years) were identified. An anterior, superior midline neck mass was the presenting symptom in all patients. A cancer diagnosis [all papillary thyroid carcinoma (PTC)] was made after the Sistrunk procedure (SP), with a Bethesda Category V or VI classification preoperatively by fine needle aspiration in 5 of 12 cases tested. A SP was performed in all patients, with total thyroidectomy concurrently (n = 4) or subsequently (n = 12). A selected neck dissection was performed in 5 patients, with metastases found in 3. Of the patients who had a thyroidectomy, synchronous PTC was identified in 6 (thus, 6 of 22 patients had synchronous thyroid gland primaries). This supports an origin from extra-thyroidal remnants (cyst origin) rather than metastatic tumor from a thyroid gland primary. Follow-up radioactive iodine therapy was performed in 13 patients. Metastatic disease to local lymph nodes 57 months after presentation was seen in 1 patient, with all others alive and disease free (mean 3.8 years; range 0.4–10.8 years). The TGDCs ranged from 0.8 to 5 cm (mean 2.3 cm), while the PTCs ranged from 0.1 to 3.8 cm (mean 1.4 cm). All of the tumors were classical PTC, showing a sclerotic and infiltrative pattern, with a capsule present in 11. Lymphovascular invasion was detected in 11; margins were positive in 6. Using currently defined criteria, the patients were separated into AJCC stage group I (n = 21) or II (n = 1). However, if extension into the adipose tissue (n = 11), skeletal muscle (n = 10), or perineural/perivascular tissues (n = 10) were used to stage the patients, interpreted to represent the equivalent of "extrathyroidal extension" (n = 13) as defined for thyroid gland primaries, there would be 15 group I and 7 group III cases. All seven group III patients were ≥45 years. Three of four patients with lymph node metastasis also showed soft tissue extension. In conclusion, TGDC carcinomas (TGDCCa) are uncommon, with all classical PTC. For "microcarcinomas" (≤1 cm), conservative management can be used for patients <45 years (i.e., Sistrunk procedure only); for >1 cm tumors, and due to the high incidence of concurrent papillary carcinoma and higher stage at presentation in older patients, completion thyroidectomy is recommended for patients ≥45 years. Thus, even though a good prognosis can be expected for PTC developing in TGDCs, staging is advocated to more appropriately match therapeutic interventions.

http://ift.tt/2dpVgES

TNF-alpha and annexin A2: inflammation in thrombotic primary antiphospholipid syndrome

Abstract

Antiphospholipid syndrome (APS) is characterized by thromboses and/or pregnancy losses. Laboratory criterion for the diagnosis of APS is the presence of antiphospholipid antibodies (anticardiolipin, anti-beta2-glycoprotein I (aβ2gpI) and lupus anticoagulant). On the one hand, the latest classification criteria for the diagnosis of APS emphasized that thrombotic manifestations of the syndrome should be without any signs of an inflammatory process, while on the other hand, some recent reports have suggested that APS is a "pro-inflammatory state." This article is focused on the importance of TNF-alpha and annexin A2 (anxA2) for patients with vascular (thrombotic) manifestations of the primary APS. The classic antithrombotic and antiplatelet therapy does not protect APS patients from the development of recurrent thrombosis. Therefore, an urgent need for the introduction of new therapeutic approaches in the treatment of APS patients is obvious. This review provides a rationale for the necessity for the use of immunomodulatory medications that could interfere with β2gpI binding to its receptor(s), such as anxA2, and/or inhibit TNF-alpha activity.

http://ift.tt/2dHWdTW

Relationship between cigarette smoking and hyperuricemia in middle-aged and elderly population: a cross-sectional study

Abstract

The aim of the study was to estimate the cross-sectional association between cigarette smoking and the prevalence of hyperuricemia (HU) in the middle-aged and elderly males and females. A total of 3415 males and 2932 females were included in this study. HU was defined as SUA≥ 416 mmol/L for males and ≥360 mmol/L for females. The smoking status was classified into four categories based on daily smoking habit: (1) 0/day; (2) 1–10/day; (3) 11–20/day; and (4) >20/day. Multivariable logistic regressions were conducted to examine the aforementioned association. The prevalence of HU in the male and female sample was 25.0 and 10.0 %, respectively. In male subjects, the prevalence of HU in smokers (22.8 %) was significantly lower than that in non-smokers (26.5 %) (p = 0.016). Meanwhile, with adjustment for potential confounding factors, the prevalence of HU in smokers was still lower (OR = 0.83, 95 % CI 0.70–0.98, P = 0.033). Furthermore, a significantly inverse association between smoking status and HU was observed in the multivariable model. The multivariable-adjusted OR (95 % CI) for HU in the second, third and fourth category of smoking status was 0.84 (95 % CI 0.66–1.06), 0.90 (95 % CI 0.69–1.18) and 0.76 (95 % CI 0.58–0.99), respectively, compared with that in the first category. A clear trend (P for trend was 0.036) was observed. However, there was no significant association between cigarette smoking and HU in female subjects (P for trend was 0.739). This study indicated an inverse association between cigarette smoking and the prevalence of HU in the middle-aged and elderly male population, independent of some major confounding factors. The findings of this study expect further prospective studies to confirm the causal relationship.

http://ift.tt/2dpOIG7

Synthesis of Ag doped calcium phosphate particles and their antibacterial effect as additives in dental glass ionomer cements

Abstract

Developing dental restorations with enhanced antibacterial properties has been a constant quest for materials scientists. The aim of this study was to synthesize silver doped calcium phosphate particles and use them to improve antibacterial properties of conventional glass ionomer cement. The Ag doped monetite (Ag-DCPA) and hydroxyapatite (Ag-HA) were synthesized by precipitation method and characterized using X-ray diffraction, scanning electron microscope and X-ray fluorescence spectroscopy. The antibacterial properties of the cements aged for 1 day and 7 days were evaluated by direct contact measurement using staphylococcus epidermis Xen 43. Ion concentrations (F⁻ and Ag⁺) and pH were measured to correlate to the results of the antibacterial study. The compressive strength of the cements was evaluated with a crosshead speed of 1 mm/min. The glass ionomer cements containing silver doped hydroxyapatite or monetite showed improved antibacterial properties. Addition of silver doped hydroxyapatite or monetite did not change the pH and ion release of F⁻. Concentration of Ag⁺ was under the detection limit (0.001 mg/L) for all samples. Silver doped hydroxyapatite or monetite had no effect on the compressive strength of glass ionomer cement.

http://ift.tt/2dpR5sD

TNF-alpha and annexin A2: inflammation in thrombotic primary antiphospholipid syndrome

Abstract

Antiphospholipid syndrome (APS) is characterized by thromboses and/or pregnancy losses. Laboratory criterion for the diagnosis of APS is the presence of antiphospholipid antibodies (anticardiolipin, anti-beta2-glycoprotein I (aβ2gpI) and lupus anticoagulant). On the one hand, the latest classification criteria for the diagnosis of APS emphasized that thrombotic manifestations of the syndrome should be without any signs of an inflammatory process, while on the other hand, some recent reports have suggested that APS is a "pro-inflammatory state." This article is focused on the importance of TNF-alpha and annexin A2 (anxA2) for patients with vascular (thrombotic) manifestations of the primary APS. The classic antithrombotic and antiplatelet therapy does not protect APS patients from the development of recurrent thrombosis. Therefore, an urgent need for the introduction of new therapeutic approaches in the treatment of APS patients is obvious. This review provides a rationale for the necessity for the use of immunomodulatory medications that could interfere with β2gpI binding to its receptor(s), such as anxA2, and/or inhibit TNF-alpha activity.

http://ift.tt/2dHWdTW

Relationship between cigarette smoking and hyperuricemia in middle-aged and elderly population: a cross-sectional study

Abstract

The aim of the study was to estimate the cross-sectional association between cigarette smoking and the prevalence of hyperuricemia (HU) in the middle-aged and elderly males and females. A total of 3415 males and 2932 females were included in this study. HU was defined as SUA≥ 416 mmol/L for males and ≥360 mmol/L for females. The smoking status was classified into four categories based on daily smoking habit: (1) 0/day; (2) 1–10/day; (3) 11–20/day; and (4) >20/day. Multivariable logistic regressions were conducted to examine the aforementioned association. The prevalence of HU in the male and female sample was 25.0 and 10.0 %, respectively. In male subjects, the prevalence of HU in smokers (22.8 %) was significantly lower than that in non-smokers (26.5 %) (p = 0.016). Meanwhile, with adjustment for potential confounding factors, the prevalence of HU in smokers was still lower (OR = 0.83, 95 % CI 0.70–0.98, P = 0.033). Furthermore, a significantly inverse association between smoking status and HU was observed in the multivariable model. The multivariable-adjusted OR (95 % CI) for HU in the second, third and fourth category of smoking status was 0.84 (95 % CI 0.66–1.06), 0.90 (95 % CI 0.69–1.18) and 0.76 (95 % CI 0.58–0.99), respectively, compared with that in the first category. A clear trend (P for trend was 0.036) was observed. However, there was no significant association between cigarette smoking and HU in female subjects (P for trend was 0.739). This study indicated an inverse association between cigarette smoking and the prevalence of HU in the middle-aged and elderly male population, independent of some major confounding factors. The findings of this study expect further prospective studies to confirm the causal relationship.

http://ift.tt/2dpOIG7

Erratum to: Soft Tissue Phantoms for Realistic Needle Insertion: A Comparative Study

http://ift.tt/2dHWeY0

Thoracic spine morphology of a pseudo-biped animal model (kangaroo) and comparisons with human and quadruped animals

Abstract

Purpose

Based on the structural anatomy, loading condition and range of motion (ROM), no quadruped animal has been shown to accurately mimic the structure and biomechanical function of the human spine. The objective of this study is to quantify the thoracic vertebrae geometry of the kangaroo, and compare with adult human, pig, sheep, and deer.

Methods

The thoracic vertebrae (T1–T12) from whole body CT scans of ten juvenile kangaroos (ages 11–14 months) were digitally reconstructed and geometric dimensions of the vertebral bodies, endplates, pedicles, spinal canal, processes, facets and intervertebral discs were recorded. Similar data available in the literature on the adult human, pig, sheep, and deer were compared to the kangaroo. A non-parametric trend analysis was performed.

Results

Thoracic vertebral dimensions of the juvenile kangaroo were found to be generally smaller than those of the adult human and quadruped animals. The most significant (p < 0.001) correlations (Rho) found between the human and kangaroo were in vertebrae and endplate dimensions (0.951 ≤ Rho ≤ 0.963), pedicles (0.851 ≤ Rho ≤ 0.951), and inter-facet heights (0.891 ≤ Rho ≤ 0.967). The deer displayed the least similar trends across vertebral levels.

Conclusions

Similarities in thoracic spine vertebral geometry, particularly of the vertebrae, pedicles and facets may render the kangaroo a more clinically relevant human surrogate for testing spinal implants. The pseudo-biped kangaroo may also be a more suitable model for the human thoracic spine for simulating spine deformities, based on previously published similarities in biomechanical loading, posture and ROM.

http://ift.tt/2dpJU3I

Herniectomy versus herniectomy with the DIAM spinal stabilization system in patients with sciatica and concomitant low back pain: results of a prospective randomized controlled multicenter trial

Abstract

Purpose

To investigate the short and medium term efficacy and patient outcomes of DIAM spinal stabilization system on back pain, disability, leg pain and quality of life.

Methods

165 patients were enrolled; 146 patients with a single level disc herniation (L2 to L5) were randomized: 75 investigational (herniectomy and DIAM) and 71 control (herniectomy alone) treated and followed up for 24 months.

Results

Significant improvements overtime (P < 0.001) in both groups but not significantly different between groups for visual analog scale (VAS) back pain at 6 months (investigational −3.97 ± 2.55 vs control–3.37 ± 3.15, P = 0.228) and Oswestry Disability Index (ODI) at 12 months (−38.55 ± 20.10 vs −37.19 ± 22.61, P = 0.719). For both outcomes, there was no statistically significant difference between the groups, at all postoperative time points. Although the enrolment ended before the intended sample size (308 patients) was reached, the number of patients reaching the VAS back pain minimally clinically important difference (MCID) of ≥2.2 at 6 months was higher in the investigational (79.4 % vs control 57.1 %, P = 0.008). These results were sustained throughout 24 months (82.8 vs 64.4 %, P < 0.05). In average, surgical duration (P < 0.001), blood loss (P = 0.029) and skin incision (P < 0.001) in the investigational were 10 min longer, 22.5 ml greater and 2.0 cm wider than control group (median values). Improved tertiary outcomes from BL to 24 mo in both groups (investigational vs control): VAS leg pain (mean decrease −6.41 ± 2.57 to −6.41 vs −5.61 ± to −3.30); improved quality of life (SF-36: 20.68 ± 9.44 vs 16.90 ± 10.74); pain medication reduction: 56.7 vs 47.9 %; return to work: 45.7 vs 38.0 %. Adverse event rates: 68.5 % investigational and 66.2 % control.

Conclusions

This is the first randomized controlled trial to report equivalent efficacy and safety of herniectomy with or without DIAM spinal stabilizing device. Leg pain, back pain and the level of disability were not significantly different between groups; however, number of patients reaching the MCID for back pain was significantly higher in the investigational group at 6 through 24 months.

http://ift.tt/2dHRQZi

Cobb-1 versus cobb-to-cobb anterior fusion for adolescent idiopathic scoliosis Lenke 5C curves: a radiological comparative study

Abstract

Purpose

Anterior fusion is a well-established procedure for the treatment of Lenke 5C adolescent idiopathic scoliosis (AIS). This retrospective study aimed to assess preoperative and postoperative radiographic differences between the conventional anterior fusion and anterior short fusions (ASF) in Lenke 5C AIS.

Methods

Radiographic data of 42 consecutive cases of Lenke 5C AIS, which were surgically treated through anterior segmental fusion, were analyzed retrospectively. Patients have been divided into two groups: C group (n = 19) treated by the conventional fusion from the proximal end vertebra to the distal end vertebra of the main curve and C-1 group (n = 23) treated by ASF, sparing the lowest end vertebra of the main curve. Cobb angles of main curve, apical vertebra tilt, C7 coronal tilt, lowest instrumented vertebra angle (LIV angle), LIV adjacent level disc angulation (LIVDA), and the first uninstrumented vertebra angle (FUV angle) were measured on anteroposterior radiographs of the entire spine. LIVDA, FUV wedging, and rotation were measured on stretch films. C7 sagittal tilt, lumbar lordosis, thoracic kyphosis, and proximal kyphosis junction were measured on lateral radiographs of the entire spine. Repeated-measures analysis of variance and fisher test were used for the statistical analysis.

Results

The preoperative main curve was 39.9 ± 9.1° in the C group vs. (versus) 42.8 ± 11.8° in the C-1 group. At a mean follow-up of 26.2 months (range 10.5–66.3 months), postoperative main curve improved of 75.8 ± 21.2 % (10.4 ± 9.2°, p < 0.001) in the C group and of 52.7 ± 18.7 % (20.1 ± 8.1°, p < 0.001) in the C-1 group. All parameters improved except the LIVDA, which was slightly impaired, especially in the C-1 group with 5.6 ± 4.2° vs. 4.4 ± 2.2° in the C group. On stretch films, FUV rotation was the only parameter to differ; it was graded at 1 ± 0.7 in the C-1 group vs. 0.6 ± 0.5 in the C group (p = 0.04). No disk obliquity just under the future instrumentation and equivalent FUV wedging were found in any of the two groups.

Conclusions

The conventional anterior fusion and ASF give equivalent correction in Lenke 5C AIS, but ASF seems to induce adding-on of the disk below the LIV. FUV rotation on stretch films does not seem to be a predictive factor of postoperative radiological outcome.

http://ift.tt/2dpKjTu

Tourism guide cloud service quality: What actually delights customers?

The emergence of advanced IT and cloud services has beneficially supported the information-intensive tourism industry, simultaneously caused extreme competitions in attracting customers through building effici...

http://ift.tt/2dPp90q

Prevalence and genotyping of Chlamydia trachomatis in symptomatic male patients from Istanbul, Turkey

This study was conducted to determine the prevalence and distribution of urogenital Chlamydia trachomatis genotypes in symptomatic male patients who were referred to the clinics of the Istanbul Faculty of Medicin...

http://ift.tt/2driC9M

Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm

Irrigation-induced increase in intrarenal pressure is of concern because it may cause infection due to increased pyelovenous and pyelolymphatic absorption. This study is the first to compare prospectively the ...

http://ift.tt/2dPqmF5

Antibacterial and antioxidant activity of Portuguese Lavandula luisieri (Rozeira) Rivas-Martinez and its relation with their chemical composition

Lavandula luisieri (Rozeira) Rivas-Martinez is an endemic aromatic Labiatae the Iberian Peninsula, common in semi-arid regions of southern Portugal and southwestern Spain, that produces a...

http://ift.tt/2drl7sq

Living with idiopathic basal ganglia calcification 3: a qualitative study describing the lives and illness of people diagnosed with a rare neurological disease

Idiopathic basal ganglia calcification (IBGC) is a rare, intractable disease with unknown etiology. IBGC3 is a familial genetic disease defined by genetic mutations in the major causative gene (SLC20A2). People w...

http://ift.tt/2dPqGnl

Improvement in functional performance with high-speed power training in older adults is optimized in those with the highest training velocity

Abstract

Purpose

To identify whether variability in limb movement velocity during high-speed power training (HSPT) may impact physical functioning in older adults.

Methods

42 older men and women (71.3 ± 6.6 years) were randomized to lower extremity HSPT (n = 28) or control (CON; n = 14) (Analysis 1) for 12 weeks. A second analysis (Analysis 2) allocated HSPT into high-velocity (n = 14) or low-velocity (n = 14) based on a limb movement speed above or below the median average velocity during the 12-week HSPT intervention. Habitual gait speed, maximal gait speed, timed up-and-go, and the short physical performance battery were measured at baseline and 12 weeks. Change scores were compared between HSPT and CON (Analysis 1), and high-velocity, low-velocity, and CON (Analysis 2) using ANCOVA. Statistical significance was accepted at p < 0.05.

Results

Analysis 1 There were no group differences in habitual gait speed, maximal gait speed, or timed up-and-go between HSPT and CON (all p > 0.05). Short physical performance battery was greater in HSPT (0.96 ± 0.19) compared to CON (0.10 ± 0.26; p = 0.01). Analysis 2 There were no group differences in the change in habitual GS (p = 0.33) among high-velocity, low-velocity and CON. There were significant group differences in the change in maximal GS (p = 0.007), timed up-and-go (p = 0.03), and short physical performance battery (p = 0.03).

Conclusions

There is considerable variation in self-selected maximal limb velocity during HSPT in older adults. In the present cohort, an average limb velocity of 0.88 m/s during HSPT was necessary to ensure optimal improvement in functional performance for older adults, but this threshold will need further investigation.

http://ift.tt/2dCwwXM

Direct Visualization of Neurotransmitters in Rat Brain Slices by Desorption Electrospray Ionization Mass Spectrometry Imaging (DESI - MS)

Abstract

Mass spectrometry imaging (MSI) of neurotransmitters has so far been mainly performed by matrix-assisted laser desorption/ionization (MALDI) where derivatization reagents, deuterated matrix and/or high resolution, or tandem MS have been applied to circumvent problems with interfering ion peaks from matrix and from isobaric species. We herein describe the application of desorption electrospray ionization mass spectrometry imaging (DESI)-MSI in rat brain coronal and sagittal slices for direct spatial monitoring of neurotransmitters and choline with no need of derivatization reagents and/or deuterated materials. The amino acids γ-aminobutyric (GABA), glutamate, aspartate, serine, as well as acetylcholine, dopamine, and choline were successfully imaged using a commercial DESI source coupled to a hybrid quadrupole-Orbitrap mass spectrometer. The spatial distribution of the analyzed compounds in different brain regions was determined. We conclude that the ambient matrix-free DESI-MSI is suitable for neurotransmitter imaging and could be applied in studies that involve evaluation of imbalances in neurotransmitters levels.

Graphical Abstract

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http://ift.tt/2dr7Tft

Separation of cis and trans Isomers of Polyproline by FAIMS Mass Spectrometry

Abstract

High field asymmetric waveform ion mobility spectrometry (FAIMS) is well-established as a tool for separating peptide isomers (sequence inversions and post-translationally modified localization variants). Here, we demonstrate the FAIMS is able to differentiate cis and trans isomers of polyproline. Polyproline assumes an all-cis conformation—the PPI helix—in 1-propanol, and an all-trans conformation—the PPII helix—in aqueous solutions. Differentiation of these conformers may be achieved both through use of a cylindrical FAIMS device and a miniaturized ultrahigh field planar FAIMS device.

Graphical Abstract

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http://ift.tt/2dr7NVg

Role of Leptin and SOCS3 in Inhibiting the Type I Interferon Response During Obesity

Abstract

Obesity provokes an imbalance in the immune system, including an aberrant type I interferon response during some viral infections and after TLR stimulation. SOCS3 overexpression and altered systemic leptin levels could be responsible for the reduced type I interferon production in people with obesity and, eventually, significantly increase the risk of viral infection. The aim of this study was to determine whether SOCS3- and leptin-induced tolerance are responsible for the reduced type I interferon production in people with obesity. SOCS3 overexpression in PBMCs from people with obesity was inhibited with the small interfering RNA (siRNA) assay, and leptin-induced tolerance was evaluated in PBMCs from non-obese volunte\ers and U937 cells treated with TLR ligands. SOCS3, but not SOCS1, gene silencing via siRNA increased the type I interferon response in PBMCs obtained from people with obesity. On the other hand, leptin induced SOCS3 expression and inhibited type I interferons in PBMCs from healthy donors and in U937 monocytes stimulated with TLR ligands. Taken together, these results demonstrate that reduced type I interferon production in obesity is caused by SOCS3 overexpression as well as tolerance induced by leptin. Here, we demonstrate a key role of leptin and SOCS3 in inhibiting the type I interferon response during obesity.

http://ift.tt/2cRaWdC

Primary Care Screening Methods and Outcomes for Asylum Seekers in New York City

Abstract

Effective screening in primary care among asylum-seekers in the US is critical as this population grows. This study aimed to evaluate disease prevalence and screening methods in this high-risk group. Two hundred ten new clients from 51 countries, plus Tibet, who were accepted into a program for asylum seekers from 2012 to 2014 were included. Screening rates and outcomes for infectious, non-communicable, and mental illnesses were evaluated. Screening rates were highest for PTSD, depression, hepatitis B, and latent tuberculosis. Seventy-one percent of clients screened positive for depression and 55 % for PTSD, followed by latent tuberculosis (41 %), hypertension (10 %), hepatitis B (9.4 %), and HIV (0.8 %). Overall screening rates were high. Point of care testing was more effective than testing that required a repeat visit. A large psychiatric and infectious disease burden was identified. These findings can inform future primary care screening efforts for asylum seekers in the US.

http://ift.tt/2dHUu5w

The effect of tending and commercial thinning on the genetic diversity of Scots pine stands

Abstract

The objective of this study was to estimate the effect of pre-commercial tending and commercial thinning on the genetic diversity parameters, especially rare allele loss and diameter–heterozygosity associations, in Scots pine stands by retrospectively modelling the removal of inferior/superior trees. Modelling was based on empirical data of DNA polymorphism in (a) a 60-year-old natural stand and (b) a 20-year-old young stand planted with seeds collected in a seed orchard. Within each of these stands, approximately 400 trees were systematically sampled within 1-ha plots (800 trees in total) and genotyped at 5 neutral and 7 EST-derived nuclear microsatellite markers. There was no significant association between heterozygosity, common allele number and tree diameter in either stand. Even at a high intensity, both simulated tending and commercial thinning had minor effects on the heterozygosity and allelic diversity but caused a significant loss of rare alleles. However, there was a nonlinear relationship between the loss of rare alleles and the thinning intensity in the young stand, such that below 30 % thinning intensity, the rare alleles were lost at a markedly lower rate. In conclusion, the association between commercial value and genetic diversity is weak in Scots pine. Thinning causes loss of rare alleles; however, for specific cases, it could be possible to identify the margins for a slow rate of rare allele loss.

http://ift.tt/2dGC0NR

The vascular plant colonization on decaying Picea abies logs in Karkonosze mountain forest belts: the effects of forest community type, cryptogam cover, log decomposition and forest management

Abstract

Among the vascular plants there is a lack of the typical epixylous species but they are a constant component on decaying wood. Their distribution patterns on this kind of substrate seem to be the least known among phototrophs. A total of 454 dead logs of Picea abies were analyzed with regard to cover of vascular plants and the independent morphometric features of logs and altitude. Four types of forest were compared, and the frequency and cover of the most frequent species were analyzed across the forest communities along the decomposition stage. Among the logs that were studied, 292 were colonized by vascular plants. The highest number of colonized logs was recorded in Calamagrostio villosae-Piceetum and the lowest in a deciduous beech forest of the Fagetalia order. Detrended correspondence analysis revealed that the dead logs occurring in the four forest communities differed significantly in species composition. Constrained correspondence analysis showed that six variables significantly explained the species variation, i.e., altitude, shade, moisture, decomposition stage, cover of bryophytes and status of forest (protected vs. managed). The results of the indicator value method indicated that of the 34 found species, ten could be treated as indicator species for the forest communities that were analyzed. The statistical analysis did not confirm significant role of coarse woody debris as a secondary habitat for rare and protected vascular plants.

http://ift.tt/2d0PxC1

New Business Structures Creating Organizational Opportunities and Challenges for Work Disability Prevention

Abstract

Purpose Flexible work arrangements are growing in order to develop resource-efficient production and because of advanced technologies, new societal values, changing demographics, and globalization. The article aims to illustrate the emerging challenges and opportunities for work disability prevention efforts among workers in alternate work arrangements. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability," held October 14–16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a roundtable discussion with experts having direct employer experience. Results Both worker and employer perspectives were considered, and four common alternate work arrangements were identified: (a) temporary and contingent employment; (b) small workplaces; (c) virtual work/telework; and (d) lone workers. There was sparse available research of return-to-work (RTW) and workplace disability management strategies with regard to alternate work patterns. Limited research findings and a review of the grey literature suggested that regulations and guidelines concerning disabled workers are often ambiguous, leading to unsatisfactory protection. At the workplace level, there was a lack of research evidence on how flexible work arrangements could be handled or leveraged to support RTW and prevent disability. Potential negative consequences of this lack of organizational guidance and information are higher costs for employers and insurers and feelings of job insecurity, lack of social support and integration, or work intensification for disabled workers. Conclusions Future studies of RTW and workplace disability prevention strategies should be designed to reflect the multiple work patterns that currently exist across many working populations, and in particular, flexible work arrangements should be explored in more detail as a possible mechanism for preventing disability. Labor laws and policies need to be developed to fit flexible work arrangements.

http://ift.tt/2dPe4wi

Sustaining Work Participation Across the Life Course

Abstract

Introduction Many disability prevention strategies are focused on acute injuries and brief illness episodes, but there will be growing challenges for employers to manage circumstances of recurrent, chronic, or fluctuating symptoms in an aging workforce. The goal of this article is to summarize existing peer-review research in this area, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long sponsored collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability", held October 14–16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the scientific and industry literature, group discussion to identify key areas and challenges, drafting of initial documents, and feedback from peer researchers and a special panel of experts with employer experience. Results Cancer and mental illness were chosen as examples of chronic or recurring conditions that might challenge conventional workplace return-to-work practices. Workplace problems identified in the literature included fatigue, emotional exhaustion, poor supervisor and co-worker support, stigma, discrimination, and difficulties finding appropriate accommodations. Workplace intervention research is generally lacking, but there is preliminary support for improving workplace self-management strategies, collaborative problem-solving, and providing checklists and other tools for job accommodation, ideas echoed in the literature directed toward employers. Research might be improved by following workers from an earlier stage of developing workplace concerns. Conclusions Future research of work disability should focus on earlier identification of at-risk workers with chronic conditions, the use of more innovative and flexible accommodation strategies matched to specific functional losses, stronger integration of the workplace into on-going rehabilitation efforts, and a better understanding of stigma and other social factors at work.

http://ift.tt/2dr3pW2

Crickette M. Sanz, Josep Call, and Christophe Boesch (Eds.): Tool Use in Animals: Cognition and Ecology

http://ift.tt/2cZLbeG

A large survey among European trainees in clinical microbiology and infectious disease on training systems and training adequacy: identifying the gaps and suggesting improvements

Abstract

The purpose of this investigation was to perform a survey among European clinical microbiology (CM) and infectious disease (ID) trainees on training satisfaction, training tools, and competency assessment. An online, anonymous survey in the English language was carried out between April and July 2015. There were 25 questions: seven in a 5-point Likert scale (1: worst scenario, 5: best scenario) and the remainder as closed multiple-choice questions in five areas (satisfaction, adequacy, system, mentorship, and evaluation of training). Included were 419 respondents (215 CM, 159 ID, and 45 combined CM/ID) from 31 European countries [mean age (standard deviation) 32.4 (5.3) years, 65.9 % women]. Regarding satisfaction on the training scheme, CM and ID scored 3.6 (0.9) and 3.2 (1.0), respectively. These scores varied between countries, ranging from 2.5 (1.0) for Italian ID to 4.3 (0.8) for Danish CM trainees. The majority of respondents considered training in management and health economics inadequate and e-learning and continuing medical education programs insufficient. Many trainees (65.3 % of CM and 62.9 % of ID) would like to have more opportunities to spend a part of their training abroad and expected their mentor to be more involved in helping with future career plans (63.5 % of CM and 53.4 % of ID) and practical skills (53.0 % of CM and 61.2 % of ID). Two-thirds of the respondents across the specialties agreed that a European exam should be developed, but half of them thought it should not be made mandatory. This survey shows high heterogeneity in training conditions in European countries, identifies perceived gaps in training, and suggests areas for improvements.

http://ift.tt/2dGOIfb

Preliminary study on the assessment of visceral adipose tissue using dual-energy x-ray absorptiometry in chronic obstructive pulmonary disease

Abstract

Background

Visceral adipose tissue (VAT) was shown to be increased in patients with chronic obstructive pulmonary disease (COPD) compared to control subjects with comparable body mass index (BMI). Our aim was to determine the relation of VAT by dual-energy x-ray absorptiometry (DEXA) in patients with COPD by disease severity, BMI, other indices of body composition and static lung volumes.

Methods

294 COPD patients admitted for rehabilitation were studied. Lung function, static lung volumes and body composition (i.e. BMI, waist circumference, fat-free mass, fat mass and fat distribution between android and gynoid fat mass) were assessed before entering pulmonary rehabilitation. VAT was estimated within the android region by using DEXA. Patients were stratified for gender, BMI (cut-off of 25 kg/m²) and GOLD stage. To assess the impact of VAT on lung volumes, patients were also stratified for VAT less and above 50^th percentile.

Results

Both male and female patients with more severe airflow limitation had significantly lower VAT values, but these differences disappeared after stratification for BMI. VAT was significantly and strongly correlated with other body composition parameters (all p < 0.001). Patients with moderate to severe airflow limitation and lower VAT had increased static lung hyperinflation and lower diffusing capacity for carbon monoxide. Nevertheless, multivariate stepwise regression models including for BMI, age, gender and forced expiratory volume in 1 s (FEV₁) as confounders did not confirm an independent role for VAT on static lung hyperinflation and diffusion capacity.

Conclusion

After stratification for BMI, VAT is comparable in moderate to very severe COPD patients. Furthermore, BMI and demographics, but not VAT, were independent predictors of static lung hyperinflation and diffusing capacity in COPD.

http://ift.tt/2dcqr0L

Barbed Sutures in Body-Contouring: Outcome Analysis of 695 Procedures in 623 Patients and Technical Advances

Abstract

Introduction

Surgical wound closure is often complicated by suture-related issues. The recent introduction of knotless barbed sutures may address the shortcomings of conventional sutures and offer the additional benefit of reduced operating time. In this paper, we describe our experience with barbed sutures for body-contouring procedures. We share technical insights and evaluate postoperative complications.

Patients and Methods

A retrospective assessment of prospectively collected data over a period of more than 5 years was undertaken. Six hundred twenty-three consecutive patients underwent 695 body-contouring procedures with barbed suture closure. Patients were followed for at least 12 weeks postoperatively. Patient demographics, operation time as well as suture-related complications, such as wound dehiscence and wound site infection were recorded and analyzed.

Results

Barbed sutures can facilitate skin closure, rectus plication, quilting, and deep layer closure in body-contouring procedures. The average operating time in our study cohort was 108 min with reduction mammoplasty being the quickest (94 min) and bodylift (156 min) being the slowest procedure. Sixty-eight patients experienced suture-related complications resulting in an overall complication rate of 9.7 % with thigh lift having the most (15 %) and reduction mammoplasty (7 %) the fewest adverse events.

Conclusion

The use of barbed sutures allows quick closure of lengthy body-contouring incision lines with low complication rates. Our observations support that barbed sutures are safe, convenient and effective. In our hands barbed sutures appear to be superior to traditional wound-closure techniques in body-contouring procedures.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

http://ift.tt/2dC9cto

A Potential Complication of Barbed Sutures Preventing Foreign Body Granulomas Induced by Surgical Cloth Particles

http://ift.tt/2dcnzkp

The Use of Integra Dermal Regeneration Template Versus Flaps for Reconstruction of Full-Thickness Scalp Defects Involving the Calvaria: A Cost–Benefit Analysis

Abstract

Background

INTEGRA^® Dermal Regeneration Template is a well-known and widely used acellular dermal matrix. Although it helps to solve many challenging problems in reconstructive surgery, the product cost may make it an expensive alternative compared to other reconstruction procedures. This retrospective study aims at comparing INTEGRA-based treatment to flap surgery in terms of cost and benefit.

Patients and Methods

We considered only patients treated for scalp defects with bone exposure in order to obtain two groups as homogeneous as possible. We identified two groups of patients: 17 patients treated with INTEGRA and 18 patients treated with flaps. All patients were admitted in our institution between 2004 and 2010, and presented a defect of the scalp following trauma or surgery for cancer, causing a loss of the soft tissues of the scalp with bone exposure without pericranium. To calculate the cost in constant euros of each treatment, three parameters were evaluated for each patient: cost of the surgical procedure (number of doctors and nurses involved, surgery duration, anesthesia, material used for surgery), hospitalization cost (hospitalization duration, dressings, drugs, topical agents), and outpatient cost (number of dressing changes, personnel cost, dressings type, anti-infective agents). The statistical test used in this study was the Wilcoxon Mann–Whitney (α = 0.05).

Results

No significant difference was characterized between the two groups for gender, age, presence of diabetes, mean defect size, and number of surgical procedures. All patients healed with good quality and durable closure. The median total cost per patient was €11,121 (interquartile range (IQR) 8327–15,571) for the INTEGRA group and €7259 (IQR 1852–24,443) for the flap group (p = 0.34). A subgroup of patients (six patients in the INTEGRA group and five patients in the flap group) showing defects larger than 100 cm² were considered in a second analysis. Median total cost was €11,825 (IQR 10,695–15,751) for the INTEGRA group and €23,244 (IQR 17,348–26,942) for the flap group.

Conclusion

Both treatments led to a good healing of the lesions with formation of soft and resistant tissue. No significant difference was characterized between the two groups for days of hospitalization and costs. In cases of patients with defects larger than 100 cm² for whom major surgery is needed, the treatment with INTEGRA seemed to be less expensive than the treatment with free flaps or pedicle flaps.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors.http://ift.tt/18t7xNj.

http://ift.tt/2dC7t7i

Effect of Plyometric Training on Vertical Jump Performance in Female Athletes: A Systematic Review and Meta-Analysis

Abstract

Background

Plyometric training is an effective method to prevent knee injuries in female athletes; however, the effects of plyometric training on jump performance in female athletes is unclear.

Objective

The aim of this systematic review and meta-analysis was to determine the effectiveness of plyometric training on vertical jump (VJ) performance of amateur, collegiate and elite female athletes.

Methods

Six electronic databases were searched (PubMed, MEDLINE, ERIC, Google Scholar, SCIndex and ScienceDirect). The included studies were coded for the following criteria: training status, training modality and type of outcome measures. The methodological quality of each study was assessed using the physiotherapy evidence database (PEDro) scale. The effects of plyometric training on VJ performance were based on the following standardised pre–post testing effect size (ES) thresholds: trivial (<0.20), small (0.21–0.60), moderate (0.61–1.20), large (1.21–2.00), very large (2.01–4.00) and extremely large (>4.00).

Results

A total of 16 studies met the inclusion criteria. The meta-analysis revealed that plyometric training had a most likely moderate effect on countermovement jump (CMJ) height performance (ES = 1.09; 95 % confidence interval [CI] 0.57–1.61; I ² = 75.60 %). Plyometric training interventions of less than 10 weeks in duration had a most likely small effect on CMJ height performance (ES = 0.58; 95 % CI 0.25–0.91). In contrast, plyometric training durations greater than 10 weeks had a most likely large effect on CMJ height (ES = 1.87; 95 % CI 0.73–3.01). The effect of plyometric training on concentric-only squat jump (SJ) height was likely small (ES = 0.44; 95 % CI −0.09 to 0.97). Similar effects were observed on SJ height after 6 weeks of plyometric training in amateur (ES = 0.35) and young (ES = 0.49) athletes, respectively. The effect of plyometric training on CMJ height with the arm swing was likely large (ES = 1.31; 95 % CI −0.04 to 2.65). The largest plyometric training effects were observed in drop jump (DJ) height performance (ES = 3.59; 95 % CI −3.04 to 10.23). Most likely extremely large plyometric training effects on DJ height performance (ES = 7.07; 95 % CI 4.71–9.43) were observed following 12 weeks of plyometric training. In contrast, a possibly small positive training effect (ES = 0.30; 95 % CI −0.63 to 1.23) was observed following 6 weeks of plyometric training.

Conclusion

Plyometric training is an effective form of training to improve VJ performance (e.g. CMJ, SJ and DJ) in female athletes. The benefits of plyometric training on VJ performance are greater for interventions of longer duration (≥10 weeks).

http://ift.tt/2d0iUVf

Slackline Training (Balancing Over Narrow Nylon Ribbons) and Balance Performance: A Meta-Analytical Review

Abstract

Background

Adequate static and dynamic balance performance is an important prerequisite during daily and sporting life. Various traditional and innovative balance training concepts have been suggested to improve postural control or neuromuscular fall risk profiles over recent years. Whether slackline training (balancing over narrow nylon ribbons) serves as an appropriate training strategy to improve static and dynamic balance performance is as yet unclear.

Objective

The aim was to examine the occurrence and magnitude of effects of slackline training compared with an inactive control condition on static and dynamic balance performance parameters in children, adults and seniors.

Data sources

Five biomedical and psychological databases (CINAHL, EMBASE, ISI Web of Knowledge, PubMed, SPORTDiscus) were screened using the following search terms with Boolean conjunctions: (slacklin* OR slack-lin* OR tight rop* OR tightrop* OR Slackline-based OR line-based OR slackrop* OR slack-rop* OR floppy wir* OR rop* balanc* OR ropedanc* OR rope-danc*)

Study selection

Randomized and non-randomized controlled trials that applied slackline training as an exercise intervention compared with an inactive control condition focusing on static and dynamic balance performance (perturbed and non-perturbed single leg stance) in healthy children, adults and seniors were screened for eligibility.

Data extraction

Eligibility and study quality [Physiotherapy Evidence Database (PEDro) scale] were independently assessed by two researchers. Standardized mean differences (SMDs) calculated as weighted Hedges' g served as main outcomes in order to compare slackline training versus inactive control on slackline standing as well as dynamic and static balance performance parameters. Statistical analyses were conducted using a random-effects, inverse-variance model.

Results

Eight trials (mean PEDro score 6.5 ± 0.9) with 204 healthy participants were included. Of the included subjects, 35 % were children or adolescents, 39 % were adults and 26 % were seniors. Slackline training varied from 4 to 6 weeks with 16 ± 7 training sessions on average, ranging from 8 to 28 sessions. Mean overall slackline training covered 380 ± 128 min. Very large task-specific effects in favor of slackline training compared with the inactive control condition were found for slackline standing time {SMD 4.63 [95 % confidence interval (CI) 3.67–5.59], p < 0.001}. Small and moderate pooled transfer effects were observed for dynamic [SMD 0.52 (95 % CI 0.08–0.96), p = 0.02] and static [SMD 0.30 (95 % CI −0.03 to 0.64), p = 0.07] standing balance performance, respectively.

Conclusions

Slackline training mainly revealed meaningful task-specific training effects in balance performance tasks that are closely related to the training content, such as slackline standing time and dynamic standing balance. Transfer effects to static and dynamic standing balance performance tasks are limited. As a consequence, slackline devices should be embedded into a challenging and multimodal balance training program and not used as the sole form of training.

http://ift.tt/2dFHZSZ

Real-time monitoring of oxidative injury of vascular endothelial cells and protective effect of quercetin using quartz crystal microbalance

Abstract

The adhesion, spreading, and proliferation of human umbilical vein endothelial cell line (HUVEC-C) cells, on a gold electrode were monitored using quartz crystal microbalance (QCM) measurements. The viscodensity effect caused by the normal action of the cells led to a decrease of the resonant frequency and increase of the motional resistance. The oxidative injury of HUVEC-C cells appeared immediately with the addition of H₂O₂, exhibiting the decline of cellular spreading area and cell coverage on the electrode surface and resulting in inverted QCM responses. The injured extent of the cells was found to be related to the content of H₂O₂. It is found that 0.05 mM quercetin added beforehand in the growth medium could remove completely the oxidative action of 1.0 mM H₂O₂. Quercetin with increased dosage still exerted a partial protective effect on HUVEC-C cells against oxidative injury induced by 2.5 mM H₂O₂. The microscope observations, electrochemical measurements, and MTT analysis validate the QCM assay results, indicating that quercetin is a valuable flavonoid anti-oxidant in the precaution and treatment for the oxidative injury of vascular endothelium.

Graphical Abstract

Upper part: Microscope images (×400) of 7.5×10⁴ HUVEC-C cells adhered to the substrate at 48 h in the presence of H₂O₂. Middle part: Real-time Δf ₀ and ΔR ₁ responses to the addition of 7.5×10⁴ HUVEC-C cells onto QCM gold electrode in the presence of H₂O₂ added at 24 h after the introduction of the cells. Lower part: Microscope images (×400) of 7.5×10⁴ HUVEC-C cells adhered to the substrate at 48 h in the presence of quercetin added at 18 h and H₂O₂ added at 24 h after the introduction of the cells

http://ift.tt/2dP0RDP

Katja Dettmer-Wilde and Werner Engewald (Eds): Practical gas chromatography: a comprehensive reference

http://ift.tt/2dP18qh

Cadmium(II)-based metal–organic nanotubes as solid-phase microextraction coating for ultratrace-level analysis of polychlorinated biphenyls in seawater samples

Abstract

In this study, stable cadmium(II)-based metal–organic nanotubes (Cd-MONTs) were prepared and used as a coating material for solid-phase microextraction (SPME) of polychlorinated biphenyls (PCBs) from environmental water samples. The as-prepared Cd-MONT SPME coating material was characterized by thermal gravimetric analysis, scanning electron microscopy, and X-ray diffraction. The synthesized Cd-MONTs exhibited high thermal stability (385 °C) and excellent extraction performance toward PCBs. The important conditions were optimized systematically by the response surface method. Under the optimal conditions, the new fiber achieved high enrichment factors (938–3417), low limits of detection (1.80–8.73 pg L⁻¹), and wide linearity (10–5000 pg L⁻¹). The method developed was used in ultratrace-level analysis of PCBs in seawater samples, with satisfactory results for each sample.

http://ift.tt/2dqS7RN

Study of in-vitro metabolism of selected antibiotic drugs in human liver microsomes by liquid chromatography coupled with tandem mass spectrometry

Abstract

High performance liquid chromatography coupled with triple-quadrupole mass spectrometry was applied in the determination of in vitro metabolism products of selected antibiotic drugs (cefotaxime, ciprofloxacin, fluconazole, gentamicin, clindamycin, linezolid, and metronidazole). The analytes were separated on a reversed phase C18 column, with acetonitrile and 0.1 % aqueous formic acid as the mobile phase. Tandem mass spectrometry with positive electrospray ionization was used to facilitate the structural characterization of the potential metabolites. Metabolism studies on human liver microsomes were performed via cytochromes P450 (phase I) and via NADPH/UDP-glucuronosyltransferase (phase II) mediated reactions. LC-MS/MS experiments allowed potential metabolite peaks, including sum formulae suggestions, to be identified; high resolution MS/MS experiments led to the identification of various oxidative and reductive modifications of target compounds in phase I biotransformation, and conjugation products with glucuronic acid in phase II reactions. A total of 11 potential metabolites and their proposed structures were characterized during the incubation of human liver microsomes by comparing their retention times and spectral patterns with those of the parent drug. Dehydrogenation and reactions of side chains such as hydroxylation and hydrolysis of ester bonds constituted the major metabolic pathways. Finally, LC-MS/MS spectrometry was revealed to be a suitable analytical tool to procure a feasible analytical base for the envisioned in vivo experiments.

Graphical Abstract

Workflow overview of in vitro drug metabolism studies.

http://ift.tt/2dP0M39

Comparison of supraintercondylar and supracondylar femur fractures treated with condylar buttress plates

Abstract

Background

Treatment of supraintercondylar (AO/OTA 33-C) and supracondylar (AO/OTA 33-A) femur fractures is generally challenging. Standard treatments include open reduction and internal fixation. However, optimal implants are now being well-defined. This study focus on the comparison between clinical and functional outcomes of fractures treated with condylar buttress plates (CBPs).

Methods

We treated 87 patients with supraintercondylar or supracondylar femur fracture from 2004 to 2008, including 30 supraintercondylar and 24 supracondylar fractures treated with CBPs. Both knee and function scores (per Knee Society) were given to clinical and functional outcomes, and concomitant knee function was assessed per Mize criteria.

Results

Union rate of supraintercondylar fractures was 90 % (27/30) and supracondylar fractures was 91.7 % (22/24) (P = 0.68). In supraintercondylar group, 16.7 % revealed postoperative varus deformity, whereas none in supracondylar group (P = 0.045). Knee Society knee score was 73.6 in supraintercondylar group and 85.5 in supracondylar group (P = 0.009); and function score was 62.5 in supraintercondylar group and 83.1 in supracondylar group (P = 0.023). A satisfactory result based on modified Mize criteria was achieved in 50 % of supraintercondylar fractures and in 79.1 % of supracondylar fractures (P = 0.09).

Conclusions

Use of CBPs for supraintercondylar and supracondylar femur fractures treatment led to a high union rate. However, a high rate of varus deformity occurred in patients with supraintercondylar but not supracondylar fractures. Moreover, CBP treatment in patients with supracondylar fractures led to better functional outcomes than those with supraintercondylar fractures.

http://ift.tt/2dGE5Jz

Linking Swedish health data registers to establish a research database and a shared decision-making tool in hip replacement

Abstract

Background

Sweden offers a unique opportunity to researchers to construct comprehensive databases that encompass a wide variety of healthcare related data. Statistics Sweden and the National Board of Health and Welfare collect individual level data for all Swedish residents that ranges from medical diagnoses to socioeconomic information. In addition to the information collected by governmental agencies the medical profession has initiated nationwide Quality Registers that collect data on specific diagnoses and interventions. The Quality Registers analyze activity within healthcare institutions, with the aims of improving clinical care and fostering clinical research.

Main body

The Swedish Hip Arthroplasty Register (SHAR) has been collecting data since 1979. Joint replacement in general and hip replacement in particular is considered a success story with low mortality and complication rate. It is credited to the pioneering work of the SHAR that the revision rate following hip replacement surgery in Sweden is amongst the lowest in the world. This has been accomplished by the diligent follow-up of patients with feedback of outcomes to the providers of the healthcare along with post market surveillance of individual implant performance. During its existence SHAR has experienced a constant organic growth. One major development was the introduction of the Patient Reported Outcome Measures program, giving a voice to the patients in healthcare performance evaluation. The next aim for SHAR is to integrate patients' wishes and expectations with the surgeons' expertise in the form of a Shared Decision-Making (SDM) instrument. The first step in building such an instrument is to assemble the necessary data. This involves linking the SHARs database with the two aforementioned governmental agencies. The linkage is done by the 10-digit personal identity number assigned at birth (or immigration) for every Swedish resident. The anonymized data is stored on encrypted serves and can only be accessed after double identification.

Conclusion

This data will serve as starting point for several research projects and clinical improvement work.

http://ift.tt/2d0Wkf4

Prediction of Antiphospholipid syndrome using Annexin A5 competition assay in patients with SLE

Abstract

A significantly high correlation between reduced activity of Annexin A5 by the flow cytometric assay (FCA) and the diagnosis of antiphospholipid syndrome (APS) has been reported. The aim of this study was to assess the clinical and laboratory significance of the Annexin A5 competition assay among patients with systemic lupus erythematosus (SLE). The FCA competition assay was performed on blood samples from 57 consecutive SLE patients. The FCA was performed according to a previously validated method. Forty-seven patients (82.5 %) had SLE without APS and ten (17.5 %) had SLE with APS. Twenty-four (42 %) of the patients had mean levels of AnxA5 fluorescence below the mean and standard deviation of the controls and were considered positive. SLE patients with a positive FCA were found to have an increased risk for a hypercoagulable or vascular state (86 % of the patients had cerebrovascular disease, 89 % had Raynaud's phenomenon, and 80 % had deep vein thrombosis). The risk for any hypercoagulable or vascular state was significantly increased (P = 0.012, RR−2.3, 95 % CI 1.4–3.8). A positive FCA assay was found in 90 % of the patients with APS (P < 0.001), with a sensitivity of 90 % and a specificity of 68 % for this diagnosis. The positive and negative predictive values were 0.4 and 0.97, respectively. Correlations were found between positive FCA and positive Anti-Cardiolipin antibody (P < 0.001), and Anti-β2 glycoprotein I levels (P = 0.013). Our findings suggest that the FCA is a practical assay for the detection of clinically relevant APS among patients with SLE.

http://ift.tt/2dGImxs

Regulatory T Cells in SLE: Biology and Use in Treatment

Abstract

T regulatory cells (Tregs) represent a phenotypically and functionally heterogeneous group of lymphocytes that exert immunosuppressive activities on effector immune responses. Tregs play a key role in maintaining immune tolerance and homeostasis through diverse mechanisms which involve interactions with components of both the innate and adaptive immune systems. As in many autoimmune diseases, Tregs have been proposed to play a relevant role in the pathogenesis of systemic lupus erythematosus (SLE), an autoimmune disease characterized by a progressive breakdown of tolerance to self-antigens and the presence of concomitant hyperactive immune responses. Here, we review how Tregs dysfunction in SLE has been manipulated experimentally and preclinically in the attempt to restore, at last in part, the immune disturbances in the disease.

http://ift.tt/2cQIDMo

Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature

Abstract

Introduction

Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal cause of strokes in both adults and children, and it is usually due to vertebral artery dissection (VAD). VAD has been found to be usually a consequence of traumatic vertebral artery injury. ABAO usually presents with symptoms of acute ischemic stroke (AIS) of the posterior circulation or transient ischemic attack (TIA). It may lead to death or long-term disability if not promptly recanalized. Basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents.

Clinical presentation

We report the case of a 23-month old baby that came to the emergency room of our hospital for progressive impairment of consciousness associated with widespread stiffness and plaintive cry, appeared after accidental fall from stroller. An emergency brain CT scan was obtained showing multiple infarction lesions in the brainstem and left cerebellum suggestive of acute stroke in posterior circulation territories. An MR scan with angiography and diffusion-weighted sequences confirmed the multiple infarction lesions and demonstrated poor representation of the flow signal at the V3 segment of the left vertebral artery and absent representation of the flow signal at the distal segment of the basilar artery suggestive of acute thrombotic occlusion. The patient was immediately referred to interventional neuroradiology unit, and digital subtraction angiography showed complete basilar artery occlusion and left vertebral artery dissection at extracranial V2-V3 segment. The patient underwent intra-arterial thrombectomy using stent retrievers and occlusion of the V2-V3 segment of the left vertebral artery. The patient survived and long-term outcome was excellent.

Conclusions

To our knowledge, only nine cases of ABAO in children treated with intra-arterial thrombectomy have been previously reported in the literature. In only three cases, the Solitaire stent was applied. Our case is the first case of basilar artery occlusion treated with Solitaire stent, in a child under 24 months. The reports that are available so far indicate that basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents.

http://ift.tt/2dcgCA1

Tadpole-shaped lateralized parietal atretic cephalocele associated with an ipsilateral lacrimal gland fistula and schizencephalic clefts

Abstract

Background

Parietal atretic cephalocele (AC) and its associated intracranial venous anomalies, such as vertical embryonic positioning of the straight sinus (VEP of SS), have, in previous reports, been exclusively restricted to the midline.

Clinical presentation

We report a patient with lateralized parietal AC on the right side. The AC was in the shape of a tadpole, with a large head and a long tail, extending to the proximity of the right external canthus, where a lacrimal gland fistula was observed. The superior sagittal sinus and VEP of SS were also displaced to the right side, although the sagittal suture was located at the midline. Schizencephalic clefts in the right posterior cortex were also observed.

Conclusion

The parietal AC, which was initially located in the midline, could conceivably have been displaced to the right side by other developmental processes. However, the relationship between lateralized AC and associated multiple anomalies on the ipsilateral side is difficult to explain monogenetically. Our case study indicates that AC might have a broader spectrum of clinical symptoms than was once thought to be the case.

http://ift.tt/2dC087L

Ileal pouch–anal anastomosis for ulcerative colitis: a Canadian institution’s experience

Abstract

Background

We aimed to summarize the outcomes of ulcerative colitis (UC) patients receiving an ileal pouch–anal anastamosis (IPAA) over an 11-year period at a high-volume Canadian inflammatory bowel disease (IBD) center.

Methods

A retrospective chart review was performed for subjects with UC who underwent IPAA between 2002 and 2013. Patient charts were reviewed for demographic data, clinical characteristics, preoperative medical treatment, and surgical outcomes. Univariate and multivariate logistic regression modeling were used to determine significant factors in postoperative outcomes.

Results

Seven hundred fifty-eight were included from the IBD database. The median age at the time of surgery was 37.1 (±12.1). Mean preoperative disease duration was 8.1 years (±8.7). Three hundred sixty-nine patients (48.7 %) had systemic corticosteroids (>15 mg/day) within 30 days prior to surgery. Of these, 286 patients had high dose (>30 mg/day) corticosteroids within 7 days of their first surgery. One hundred nine (14.0 %) IPAA procedures were performed laparoscopically. Pelvic pouches were created in traditional 2 (n = 460) and 3 (n = 285) stages; the remainder (n = 13) was performed in non-traditional staged operations. Early complications, defined as occurring within the same stay in hospital, consisted of pelvic abscess (n = 135, 17.8 %), small bowel obstruction (n = 134, 17.7 %), wound infection (n = 108, 14.3 %), and deep vein thrombosis (n = 33, 4.4 %). The overall pouch leak rate was 92 (12.1 %). There was one death in our study. The median length of stay was 10.3 days (SD6.0). Late complications, defined as occurring after discharge from hospital, consisted of anal stricture (n = 55, 7.3 %), pouch fistula (n = 26, 3.4 %), and functional pouch failure (n = 7, 0.9 %).

Conclusions

IPAA has been found to be a safe and effective method of surgical management of UC patients in a high-volume IBD center.

http://ift.tt/2dpdwy8

Incidental ferumoxytol artifacts in clinical brain MR imaging

Abstract

Introduction

Ferumoxytol (Feraheme) is a parenteral therapy approved for treatment of iron deficiency anemia. The product insert for ferumoxytol states that it may affect the diagnostic ability of MRI for up to 3 months. However, the expected effects may not be commonly recognized among clinical neuroradiologists. Our purpose is to describe the artifacts we have seen at our institution during routine clinical practice.

Methods

We reviewed the patients at our institution that had brain MRI performed within 90 days of receiving intravenous ferumoxytol. The imaging was reviewed for specific findings, including diffusion-weighted imaging vascular susceptibility artifact, gradient-echo echo-planar T2*-weighted vascular susceptibility artifact, SWI/SWAN vascular susceptibility artifact, hypointense vascular signal on T2-weighted images, pre-gadolinium contrast vascular enhancement on magnetization-prepared rapid acquisition gradient echo (MPRAGE) imaging, and effects on post-gadolinium contrast T1 imaging.

Results

Multiple artifacts were observed in patients having a brain MRI within 3 days of receiving intravenous ferumoxytol. These included susceptibility artifact on DWI, GRE, and SWAN/SWI imaging, pre-gadolinium contrast increased vascular signal on MPRAGE imaging, and decreased expected enhancement on post-gadolinium contrast T1-weighted imaging.

Conclusion

Ferumoxytol can create imaging artifacts which complicate clinical interpretation when brain MRI is performed within 3 days of administration. Recognition of the constellation of artifacts produced by ferumoxytol is important in order to obviate additional unnecessary examinations and mitigate errors in interpretation.

http://ift.tt/2dPVlNT

Consensus on the management of advanced radioactive iodine-refractory differentiated thyroid cancer on behalf of the Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and Spanish Rare Cancer Working Group (GETHI)

Abstract

Thyroid cancer is the single most prevalent endocrine malignancy; differentiated thyroid cancer (DTC) accounts for more than 90 % of all malignancies and its incidence has been rising steadily. For more patients, surgical treatment, radioactive iodine (RAI) ablation, and thyroid-stimulating hormone (TSH) suppressive therapy achieve an overall survival (OS) rate of 97.7 % at 5 years. Nevertheless, locoregional recurrence occurs in up to 20 % and distant metastases in approximately 10 % at 10 years. Two-thirds of these patients will never be cured with radioactive iodine therapy and will become RAI-refractory, with a 3-year OS rate of less than 50 %. Over the last decade, substantial progress has been made in the management of RAI-refractory DTC. Given the controversy in some areas, the Spanish Task Force for Thyroid Cancer on behalf of Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and the Spanish Rare Cancer Working Group (GETHI) have created a national joint task force to reach a consensus addressing the most challenging aspects of management in these patients. In this way, multidisciplinary management should be mandatory and nuclear medicine targeted therapy, novel molecular targeted agents, and combinations are currently changing the natural history of RAI-refractory DTC.

http://ift.tt/2dHqRBq

Closing Gaps: Strength-Based Approaches to Research with Aboriginal Children with Neurodevelopmental Disorders

Abstract

There is substantial literature on fetal alcohol spectrum disorder (FASD) research involving Aboriginal children, but little related literature on other common neurodevelopmental conditions such as autism spectrum disorder (ASD) or cerebral palsy (CP) for this population. As part of our work in cross-cultural neuroethics, we examined this phenomenon as a case study in Canada. We conducted semi-structured interviews with health researchers working on the frontline with First Nation communities to obtain perspectives about: (1) reasons for the lack of ASD and CP research within the Aboriginal context, (2) the potential ethical and social implications of this disparity, and (3) recommendations for change. Participants reported that the major barriers to engage in ASD or CP research are under-reporting and under-diagnosis of these conditions in Aboriginal communities, difficulties in establishing trust between community members and researchers, challenges in accessing children living under the care of child welfare services, and lack of support from universities and funding agencies to encourage community partnerships. They further perceived threats to justice as the population is denied the benefits of ASD and CP research, and stigma related to the possible over-representation of FASD in the population. The adoption of strength- and community-based practices to improve engagement and address disparities, and to create health databases with prevalence rates that are representative of all forms of disability in both Aboriginal and non-Aboriginal populations are critical steps to close these gaps.

http://ift.tt/2dORqo4

Dynamic measures of skeletal muscle dialysate and plasma amino acid concentration in response to exercise and nutrient ingestion in healthy adult males

Abstract

Nutrient stimulation of muscle protein synthesis (MPS) is regulated by the change in extracellular essential amino acid (EAA) concentration. In vivo microdialysis (MD) is a minimally invasive sampling technique, capable of sampling solute in the interstitial space of a target tissue. In a contralateral limb design (REST vs. EX), this study utilised in vivo MD to examine the change in skeletal muscle dialysate amino acid concentration following ingestion of whey protein isolate (WPI) and flavoured water (CON). Four male subjects undertook unilateral, concentric lower limb knee extensor resistance exercise (RE) on two occasions. After RE, an MD catheter (CMA 63) was inserted into m. vastus lateralis of the exercise and resting leg and sampled serially over 7 h. Following a 2.5 h equilibration period subjects consumed either 0.55 g/kg WPI or CON. Peak plasma EAA (2656 ± 152 µM) preceded the peak in dialysate EAA (2345 ± 164 µM) by 30 min in response to WPI ingestion; however, the post-prandial elevation in dialysate EAA extended beyond that of the plasma. This resulted in no difference in the dialysate EAA area under the curve (ΔAUC₂₇₀) relative to plasma in response to WPI ingestion [220 ± 29 vs. 206 ± 7.9 mmol min/L (p = 0.700)]. A bout of unilateral lower limb RE had no effect of the subsequent dialysate amino acid concentration in response to either WPI or CON ingestion. These data represent a novel report describing the time course and magnitude of change in skeletal muscle dialysate concentration of key nutrient regulators of MPS sampled by in vivo MD, in response to nutrient ingestion with and without RE.

http://ift.tt/2dbtW7J

Regulatory T Cells in SLE: Biology and Use in Treatment

Abstract

T regulatory cells (Tregs) represent a phenotypically and functionally heterogeneous group of lymphocytes that exert immunosuppressive activities on effector immune responses. Tregs play a key role in maintaining immune tolerance and homeostasis through diverse mechanisms which involve interactions with components of both the innate and adaptive immune systems. As in many autoimmune diseases, Tregs have been proposed to play a relevant role in the pathogenesis of systemic lupus erythematosus (SLE), an autoimmune disease characterized by a progressive breakdown of tolerance to self-antigens and the presence of concomitant hyperactive immune responses. Here, we review how Tregs dysfunction in SLE has been manipulated experimentally and preclinically in the attempt to restore, at last in part, the immune disturbances in the disease.

http://ift.tt/2cQIDMo