Prevalence and clinical characteristics of apparent therapy-resistant hypertension in patients with cardiovascular disease: a cross-sectional cohort study in secondary care

Objectives

Our aim was to investigate the prevalence of apparent therapy-resistant hypertension (aTRH) in patients with clinical manifest cardiovascular disease (CVD), and to study clinical characteristics related to aTRH in this population.

Setting

The SMART (Second Manifestations of ARTerial disease) study is a large, single-centre cohort study in secondary care.

Participants

Office blood pressure (BP) at inclusion was used to evaluate BP control in 6191 hypertensive patients with clinical manifest (cardio)vascular disease. Therapy-resistant hypertension was defined as BP ≥140/90 mm Hg despite use of antihypertensive drugs from ≥3 drug classes including a diuretic or use of ≥4 antihypertensive drugs irrespective of BP. Logistic regression analysis was used to explore the relationship between clinical characteristics measured at baseline and presence of aTRH.

Results

The prevalence of aTRH was 9.1% (95% CI 8.4 to 9.8). Prevalence increased with age and when albuminuria was present and was higher in patients with lower estimated glomerular filtration rate (eGFR). Presence of aTRH was related to diabetes, female sex, duration and multiple locations of vascular disease, body mass index and waist circumference. Carotid intima-media thickness was higher (0.99±0.28 vs 0.93±0.28 mm) and ankle-brachial index lower (1.07±0.20 vs 1.10±0.19) in patients with aTRH compared with patients without aTRH.

Conclusion

aTRH is prevalent in patients with clinical manifest CVD and is related to clinical factors known to be related with increased vascular risk, and with lower eGFR.

http://ift.tt/2wL9Com

Effect of time and day of admission on hospital care quality for patients with chronic obstructive pulmonary disease exacerbation in England and Wales: single cohort study

Objective

To evaluate if observed increased weekend mortality was associated with poorer quality of care for patients admitted to hospital with chronic obstructive pulmonary disease (COPD) exacerbation.

Design

Prospective case ascertainment cohort study.

Setting

199 acute hospitals in England and Wales, UK.

Participants

Consecutive COPD admissions, excluding subsequent readmissions, from 1 February to 30 April 2014 of whom 13 414 cases were entered into the study.

Main outcomes

Process of care mapped to the National Institute for Health and Care Excellence clinical quality standards, access to specialist respiratory teams and facilities, mortality and length of stay, related to time and day of the week of admission.

Results

Mortality was higher for weekend admissions (unadjusted OR 1.20, 95% CI 1.00 to 1.43), and for case-mix adjusted weekend mortality when calculated for admissions Friday morning through to Monday night (adjusted OR 1.19, 95% CI 1.00 to 1.43). Median time to death was 6 days. Some clinical processes were poorer on Mondays and during normal working hours but not weekends or out of hours. Specialist respiratory care was less available and less prompt for Friday and Saturday admissions. Admission to a specialist ward or high dependency unit was less likely on a Saturday or Sunday.

Conclusions

Increased mortality observed in weekend admissions is not easily explained by deficiencies in early clinical guideline care. Further study of out-of-hospital factors, specialty care and deaths later in the admission are required if effective interventions are to be made to reduce variation by day of the week of admission.

http://ift.tt/2f5FpsD

Crossover trial to test the acceptability of a locally produced lipid-based nutrient supplement (LNS) for children under 2 years in Cambodia: a study protocol

Introduction

The acceptability and efficacy of existing ready-to-use supplementary and therapeutic foods has been low in Cambodia, thus limiting success in preventing and treating malnutrition among Cambodian children. In that context, UNICEF and IRD have developed a locally produced, multiple micronutrient fortified lipid-based nutrient supplement. This food is innovative, in that it uses fish instead of milk as the animal source food. Very few supplementary foods have non-milk animal source foods, and in addition they have not been widely tested. This trial will assess the novel food's acceptability to children and caregivers.

Methods and analysis

This is a cluster-randomised, incomplete block, 4x4 crossover design with no blinding. It will take place in four sites in a community setting in periurban Phnom Penh. Healthy children aged 9–23 months (n=100) will eat each of four foods for 3 days at a time. The amount they consume will be measured, and at the end of each 3-day set, caregivers will assess how well their child liked the food. After 12 days, caregivers themselves will do a sensory test of the 4 foods and will rank them in terms of preference.

Ethics and dissemination

Ethical clearance was received from the University of Queensland Medical Research Ethics Committee (2014001070) and from Cambodia's National Ethics Committee for Health Research (03/8 NECHR).

Registration

ClinicalTrials.gov, identifier: LNS-CAMB-INFANTS; NCT02257437. Pre-results.

http://ift.tt/2f605R4

Factors associated with mortality due to neonatal pneumonia in India: a protocol for systematic review and planned meta-analysis

Introduction

India contributes to the highest number of neonatal deaths globally. It also has the greatest number of pneumonia-related neonatal deaths in the developing world. We aim to systematically review the evidence for the factors associated with mortality due to neonatal pneumonia in the Indian context, to address the lack of consolidated evidence on this important issue.

Methods and analysis

This protocol is part of a series of three reviews on neonatal pneumonia in India. Observational studies reporting on outcome of neonatal pneumonia in the Indian context, and published in English in peer-reviewed and indexed journals will be eligible for inclusion. Outcomes of this review will be the factors determining mortality due to neonatal pneumonia. A total of nine databases will be searched. Electronic and hand searching of published and grey literature will be performed. Selection of studies will be done in title, abstract and full text screening stages. Risk of bias, independently assessed by two authors, will be evaluated. Meta-analysis will be performed and heterogeneity assessed. Pooled effect estimates will be stated with 95% confidence intervals. Narrative synthesis will be done where meta-analysis cannot be performed. Publication bias will be evaluated and sensitivity analysis performed according to study quality. Quality of this review will be evaluated using AMSTAR (Assessing the Methodological quality of Systematic Reviews) and GRADE (Grades of Recommendation, Assessment, Development & Evaluation). A summary of findings table will be reported using GRADEPro.

Ethics and dissemination

Since this is a review involving analysis of secondary data which is available in the public domain, and does not involve human participants, ethical approval was not required. The findings of the study will be shared with all stakeholders of this research. Knowledge dissemination workshops will be conducted with relevant stakeholders to transfer the evidence, tailored to the stakeholder (eg, policy briefs, publications, information booklets, etc).

http://ift.tt/2wKO6jK

What is the test-retest reliability of the Malay version of the Hypertension Self-Care Profile self efficacy assessment tool? A validation study in primary care

Objectives

Self-efficacy and self-care measures are key attributes to optimal control of essential hypertension. Self-efficacy can be measured by the Hypertension Self-Care Profile (HTN-SCP) tool but its utility is dependent on the literacy and understanding of the subjects. A Malay version of the HTN-SCP Tool was developed to assess self-efficacy of Malay-literate patients with hypertension in the multi-ethnic Asian population in Singapore. The study aimed to determine the test-retest reliability of this tool which has been translated in Malay language.

Methods and Material

145 Malay-literate patients, aged 41-70 years, with essential hypertension were recruited in a polyclinic (primary care clinic) in Singapore. Forty-three percent of them completed both the first and second HTN SCP tool online, with a period of two weeks in between. The Cronbach's alpha and Intra-class correlation coefficient (ICC) were computed to assess its test-retest reliability and internal consistency.

Results

The Cronbach's alpha/ICC for "Behavior" (0.851/0.664)), "Motivation" (0.928/0.655) and "Self-efficacy" (0.945/0.682) domains showed high internal consistency, fair to good reliability and stability. No floor or ceiling effect was found for the "behavior" and "motivation" domains. However, the borderline ceiling effect (15.2) for "self-efficacy" suggested limited discriminating power of the tool for patients with high self-efficacy. Positive association was shown between the HTN-SCP score and reported self-care measures but it was not statistically significant.

Conclusion

Overall, the translated HTN-SCP tool showed satisfactory test-retest reliability and internal consistency amongst the Malay-literate study population. Further research is needed for its application in general practice to identify patients with low self-efficacy for possible intervention.

http://ift.tt/2f603bU

Patient experience and perceived acceptability of whole-body magnetic resonance imaging for staging colorectal and lung cancer compared with current staging scans: a qualitative study

Objective

To describe the experience and acceptability of whole-body magnetic resonance imaging (WB-MRI) staging compared with standard scans among patients with highly suspected or known colorectal or lung cancer.

Design

Qualitative study using one-to-one interviews with thematic analysis.

Setting

Patients recruited from 10 hospitals in London, East and South East England between March 2013 and July 2014.

Participants

51 patients (31 male, age range 40–89 years), with varying levels of social deprivation, were recruited consecutively from two parallel clinical trials comparing the diagnostic accuracy and cost-effectiveness of WB-MRI with standard scans for staging colorectal and lung cancer ('Streamline-C' and 'Streamline-L'). WB-MRI was offered as an additional scan as part of the trials.

Results

In general WB-MRI presented a greater challenge than standard scans, although all but four patients completed the WB-MRI. Key challenges were enclosed space, noise and scan duration; reduced patient tolerance was associated with claustrophobia, pulmonary symptoms and existing comorbidities. Coping strategies facilitated scan tolerance and were grouped into (1) those intended to help with physical and emotional challenges, and (2) those focused on motivation to complete the scan, for example focusing on health benefit. Our study suggests that good staff communication could reduce anxiety and boost coping strategies.

Conclusions

Although WB-MRI was perceived as more challenging than standard scans, it was sufficiently acceptable and tolerated by most patients to potentially replace them if appropriate.

Trial registration number

ISRCTN43958015 and ISRCTN50436483.

http://ift.tt/2wK9l58

Hospital volume and mortality for 25 types of inpatient treatment in German hospitals: observational study using complete national data from 2009 to 2014

Objectives

To explore the existence and strength of a relationship between hospital volume and mortality, to estimate minimum volume thresholds and to assess the potential benefit of centralisation of services.

Design

Observational population-based study using complete German hospital discharge data (Diagnosis-Related Group Statistics (DRG Statistics)).

Setting

All acute care hospitals in Germany.

Participants

All adult patients hospitalised for 1 out of 25 common or medically important types of inpatient treatment from 2009 to 2014.

Main outcome measure

Risk-adjusted inhospital mortality.

Results

Lower inhospital mortality in association with higher hospital volume was observed in 20 out of the 25 studied types of treatment when volume was categorised in quintiles and persisted in 17 types of treatment when volume was analysed as a continuous variable. Such a relationship was found in some of the studied emergency conditions and low-risk procedures. It was more consistently present regarding complex surgical procedures. For example, about 22 000 patients receiving open repair of abdominal aortic aneurysm were analysed. In very high-volume hospitals, risk-adjusted mortality was 4.7% (95% CI 4.1 to 5.4) compared with 7.8% (7.1 to 8.7) in very low volume hospitals. The

minimum volume above which risk of death would fall below the average mortality was estimated as 18 cases per year. If all hospitals providing this service would perform at least 18 cases per year, one death among 104 (76 to 166) patients could potentially be prevented.

Conclusions

Based on complete national hospital discharge data, the results confirmed volume–outcome relationships for many complex surgical procedures, as well as for some emergency conditions and low-risk procedures. Following these findings, the study identified areas where centralisation would provide a benefit for patients undergoing the specific type of treatment in German hospitals and quantified the possible impact of centralisation efforts.

http://ift.tt/2f6c1SU

The HAT TRICK programme for improving physical activity, healthy eating and connectedness among overweight, inactive men: study protocol of a pragmatic feasibility trial

Introduction

Physical activity, healthy eating and maintaining a healthy weight are associated with reduced risk of cardiovascular disease, type 2 diabetes and cancer and with improved mental health. Despite these benefits, many men do not meet recommended physical activity guidelines and have poor eating behaviours. Many health promotion programmes hold little appeal to men and consequently fail to influence men's health practices. HAT TRICK was designed as a 12-week face-to-face, gender-sensitised intervention for overweight and inactive men focusing on physical activity, healthy eating and social connectedness and was delivered in collaboration with a major junior Canadian ice hockey team (age range 16–20 years). The programme was implemented and evaluated to assess its feasibility. This article describes the intervention design and study protocol of HAT TRICK.

Methods and analysis

HAT TRICK participants (n=60) were men age 35 years, residing in the Okanagan Region of British Columbia, who accumulate 150 min of moderate to vigorous physical activity a week, with a body mass index of >25 kg/m² and a pant waist size of >38'. Each 90 min weekly session included targeted health education and theory-guided behavioural change techniques, as well as a progressive (ie, an increase in duration and intensity) group physical activity component. Outcome measures were collected at baseline, 12 weeks and 9 months and included the following: objectively measured anthropometrics, blood pressure, heart rate, physical activity and sedentary behaviour, as well as self-reported physical activity, sedentary behaviour, diet, smoking, alcohol consumption, sleep habits, risk of depression, health-related quality of life and social connectedness. Programme feasibility data (eg, recruitment, satisfaction, adherence, content delivery) were assessed at 12 weeks via interviews and self-report.

Ethics and dissemination

Ethical approval was obtained from the University of British Columbia Okanagan Behavioural Research Ethics Board (reference no H1600736). Study findings will be disseminated through academic meetings, peer-reviewed publication, web-based podcasts, social media, plain language summaries and co-delivered community presentations.

Trial registration number

ISRCTN43361357,Pre results

http://ift.tt/2wKLGkX

Procedural Pain Scale Evaluation (PROPoSE) study: protocol for an evaluation of the psychometric properties of behavioural pain scales for the assessment of procedural pain in infants and children aged 6-42 months

Introduction

Infants and children are frequently exposed to painful medical procedures such as immunisation, blood sampling and intravenous access. Over 40 scales for pain assessment are available, many designed for neonatal or postoperative pain. What is not well understood is how well these scales perform when used to assess procedural pain in infants and children.

Aim

The aim of this study was to test the psychometric and practical properties of the Face, Legs, Activity, Cry and Consolability (FLACC) scale, the Modified Behavioural Pain Scale (MBPS) and the Visual Analogue Scale (VAS) observer pain scale to quantify procedural pain intensity in infants and children aged from 6–42 months to determine their suitability for clinical and research purposes.

Methods and analysis

A prospective observational non-interventional study conducted at a single centre. The psychometric and practical performance of the FLACC scale, MBPS and the VAS observer pain scale and VAS observer distress scale used to assess children experiencing procedural pain will be assessed. Infants and young children aged 6–42 months undergoing one of four painful and/or distressing procedures were recruited and the procedure digitally video recorded. Clinicians and psychologists will be recruited to independently apply the scales to these video recordings to establish intrarater and inter-rater reliability, convergent validity responsiveness and specificity. Pain score distributions will be presented descriptively; reliability will be assessed using the intraclass correlation coefficient and Bland-Altman plots. Spearman correlations will be used to assess convergence and linear mixed modelling to explore the responsiveness of the scales to pain and their capacity to distinguish between pain and distress.

Ethics and dissemination

Ethical approval was provided by the Royal Children's Hospital Human Research Ethics Committee, approval number 35220B. The findings of this study will be disseminated via peer-reviewed journals and presented at international conferences.

http://ift.tt/2f6bHDG

Digital technology to facilitate Proactive Assessment of Obesity Risk during Infancy (ProAsk): a feasibility study

Objective

To assess the feasibility and acceptability of using digital technology for Proactive Assessment of Obesity Risk during Infancy (ProAsk) with the UK health visitors (HVs) and parents.

Design

Multicentre, pre- and post-intervention feasibility study with process evaluation.

Setting

Rural and urban deprived settings, UK community care.

Participants

66 parents of infants and 22 HVs.

Intervention

ProAsk was delivered on a tablet device. It comprises a validated risk prediction tool to quantify overweight risk status and a therapeutic wheel detailing motivational strategies for preventive parental behaviour. Parents were encouraged to agree goals for behaviour change with HVs who received motivational interviewing training.

Outcome measures

We assessed recruitment, response and attrition rates. Demographic details were collected, and overweight risk status. The proposed primary outcome measure was weight-for-age z-score. The proposed secondary outcomes were parenting self-efficacy, maternal feeding style, infant diet and exposure to physical activity/sedentary behaviour. Qualitative interviews ascertained the acceptability of study processes and intervention fidelity.

Results

HVs screened 324/589 infants for inclusion in the study and 66/226 (29%) eligible infants were recruited. Assessment of overweight risk was completed on 53 infants and 40% of these were identified as above population risk. Weight-for-age z-score (SD) between the infants at population risk and those above population risk differed significantly at baseline (–0.67 SD vs 0.32 SD). HVs were able to collect data and calculate overweight risk for the infants. Protocol adherence and intervention fidelity was a challenge. HVs and parents found the information provided in the therapeutic wheel appropriate and acceptable.

Conclusion

Study recruitment and protocol adherence were problematic. ProAsk was acceptable to most parents and HVs, but intervention fidelity was low. There was limited evidence to support the feasibility of implementing ProAsk without significant additional resources. A future study could evaluate ProAsk as a HV-supported, parent-led intervention.

Trial registration number

NCT02314494 (Feasibility Study Results)

http://ift.tt/2wKpBTN

Vegetable oils acting as encapsulated bioactives and costabilizers in miniemulsion polymerization reactions

Abstract

Vegetable oils with different chemical structures were successfully encapsulated and applied as costabilizers in miniemulsion polymerization reactions. The results were compared to hexadecane, a well-known costabilizer used for this type of polymerization. The great advantage of using vegetable oils is that besides acting as costabilizers, they are also encapsulated, increasing the application of the nanoparticles. Results showed that kinetics tend to be slower with argan oil, due to the higher concentration of double bonds present in the oil. When coconut oil and jojoba oil were used, the kinetic rate kept nearly the same. The different types of costabilizers did not affect the average size of the particle, and were able to keep the miniemulsion stable throughout the reaction. DSC analysis showed a decrease in the glass transition temperature when the vegetable oils were used. However, after a long period of storage, the Tg of the polymers increased. STEM images showed the formation of nanoparticles for hexadecane and the vegetable oils. However, the nanocapsule morphology appeared only when coconut oil, jojoba oil and hexadecane were used, while for argan oil no phase separation could be detected in the polymer particle.

Practical applications: Miniemulsion polymerization reactions allow the production of polymeric nanoparticles in only one step with high encapsulation efficiency. To obtain a stable miniemulsion, it is necessary the addition of a costabilizer. The vegetable oils were chosen because besides acting as costabilizers the vegetable oils can increase the application of the nanoparticles since they have important characteristics and functionalities. Furthermore, the vegetable oils are biodegradable. In this work, we proposed two oils that are not composed of unsaturated fatty acids, unlike many vegetable oils commonly used in the literature.

http://ift.tt/2wIZRsz

Storage conditions affect oxidative stability and nutritional composition of freeze-dried Nannochloropsis salina

Abstract

Microalgae biomass is known as a promising sustainable source of bioactive compounds. Application of microalgae biomass in food and feed products requires information regarding storage stability and optimised storage conditions to minimise unwanted deterioration which downgrades the bioactive composition of microalgae biomass. In order to investigate the worsening of the nutritional quality of freeze dried biomass, a multifactorial storage experiment was conducted on a high EPA (eicosapentaenoic acid) Nannochloropsis salina biomass. The storage time (0 to 56 days), storage temperature (5°C , 20°C and 40°C) and packaging conditions (under vacuum and ambient pressure) used as main factors. During the 56 days of storage, both time and temperature strongly influenced the oxidation reactions which result in deterioration of bioactive compounds such as carotenoids, tocopherols and EPA. Lipid deterioration occurred both due to enzyme-induced lipolysis and autoxidation. Carotenoids and α-tocopherol contents decreased during storage, but may still have prevented EPA from higher oxidative deteriorations due to their powerful antioxidant properties. Oxidation reactions, which resulted in the creation of primary and secondary volatile oxidation products, occurred mainly at the first days of storage. The resulting volatile compounds(measured by head space gas chromatography- mass spectrometry) declined further until day 56, probably due to reaction with amino acids, or decomposition to low molecular weight tertiary oxidation compounds. Storage of microalgae at low temperature is more effective than vacuum packaging.

Practical applications: Microalgae are known as a sustainable source of bioactive compounds, and their industrial scale application is growing very fast. Application of microalgae biomass in food, feed or cosmetics requires the knowledge of the optimum storage conditions to prevent the value-added compounds from deterioration. Results of this study improve our understanding of the chemical deterioration under different storage conditions and can help the producers/customers to extend the shelf life of microalgae biomass by choosing correct storage conditions.

http://ift.tt/2wacDMS

Meta-analysis of the association between alcohol consumption and abdominal aortic aneurysm

Background

Alcohol is a possible risk factor for abdominal aortic aneurysm (AAA), but evidence from individual studies is weak and inconsistent. Existing narrative reviews suggest the possibility of non-linear associations. The aim here was to quantify any association using a systematic literature review, followed by dose–response meta-analysis of prospective studies.

Methods

MEDLINE, Embase and Web of Science were searched systematically to January 2017 for relevant prospective studies of alcohol consumption and AAA risk. Summary estimates of highest versus lowest levels of consumption, and linear and non-linear dose–response curves were quantified using random-effects models.

Results

Eleven relevant cohorts were identified describing results from 3580 individuals with among 473 092 participants. Data were extracted from ten cohorts for meta-analyses of high versus low levels of alcohol consumption (risk ratio for AAA 0·93, 95 per cent c.i. 0·78 to 1·11; P = 0·4, I² = 47 per cent). The linear dose–response risk ratio for AAA, derived from 11 cohorts, was 1·00 (0·97 to 1·04) per 8 g alcohol per day (P = 0·9, I² = 73 per cent). Non-linear dose–response results showed a tick-shaped curve with lower risk up to 2 units/day, but increasing risk beyond that (P = 0·05). The increase in risk beyond 2 units/day was stronger in men than in women.

Conclusion

Although the linear dose–response analysis revealed little evidence of an association between alcohol consumption and AAA risk, a tick-shaped trend in the association was observed. This non-linear dose–response analysis revealed reduced risks for alcohol consumption below 2 units/day, masking increased risks for 2 or more units/day.

http://ift.tt/2w9Pw56

Outbreak of Fusarium oxysporum infections in children with cancer: an experience with 7 episodes of catheter-related fungemia

Fusarium species are widely spread in nature as plant pathogens but are also able to cause opportunistic fungal infections in humans. We report a cluster of Fusarium oxysporum bloodstr...

http://ift.tt/2eHN53r

Suicide in children and adolescents: a Tunisian perspective from 2009 to 2015

Abstract

This study presents the characteristics of child and adolescent suicides which occurred in Kairouan, Tunisia. Data were collected from autopsy records of the Forensic Department of the University Hospital Ibn El Jazzar of Kairouan. General characteristics of suicides among children and adolescents (under the age of 18) between 2009 and 2015 were retrospectively reviewed. A total of 49 cases, with a female predominance (61.2%) and a mean age of 15.4 ± 2.1, were registered. Most of the victims were from rural areas (93.1%). In most cases, suicide occurred in the victim's home or the surrounding area (73.4%). The identified precipitating factors were family problems in 55.1%, and school issues in 12.2%. The most common suicide method was hanging (69.38%) for both genders, followed by self-immolation for males and poisoning for females, the majority using pesticides. This study offers useful information to understand the risk factors in Tunisian child and adolescent suicides and provides a basis for the development of urgently needed preventive strategies.

http://ift.tt/2eHX1u0

Body farms – characteristics and contributions

http://ift.tt/2w9Jvp2

Socioeconomic status and breast cancer treatment

Abstract

Purpose

Evidence suggests substantial disparities in breast cancer survival by socioeconomic status (SES). We examine the extent to which receipt of newer, less invasive, or more effective treatments—a plausible source of disparities in survival—varies by SES among elderly women with early-stage breast cancer.

Methods

Multivariate regression analyses applied to 11,368 women (age 66–90 years) identified from SEER-Medicare as having invasive breast cancer diagnosed in 2006–2009. Socioeconomic status was defined based on Medicaid enrollment and level of poverty of the census tract of residence. All analyses controlled for demographic, clinical health status, spatial, and healthcare system characteristics.

Results

Poor and near-poor women were less likely than high SES women to receive sentinel lymph node biopsy and radiation after breast-conserving surgery (BCS). Poor women were also less likely than near-poor or high SES women to receive any axillary surgery and adjuvant chemotherapy. There were no significant differences in use of aromatase inhibitors (AI) between poor and high SES women. However, near-poor women who initiated hormonal therapy were more likely to rely exclusively on tamoxifen, and less likely to use the more expensive but more effective AI when compared to both poor and high SES women.

Conclusions

Our results indicate that SES disparities in the receipt of treatments for incident breast cancer are both pervasive and substantial. These disparities remained despite women's geographic area of residence and extent of disease, suggesting important gaps in access to effective breast cancer care.

http://ift.tt/2j6uEux

Epidemiologic and clinical parameters of West Nile virus infections in humans: a scoping review

Clinical syndromes associated with West Nile virus (WNV) infection range from fever to neuroinvasive disease. Understanding WNV epidemiology and disease history is important for guiding patient care and health...

http://ift.tt/2w9XmvD

Chronic lower extremity wound infection due to Kerstersia gyiorum in a patient with Buerger’s disease: a case report

Kerstersia gyiorum is an extremely rare pathogen of human infection. It can cause chronic infection in patients with underlying conditions. It can easily be misdiagnosed if proper diag...

http://ift.tt/2wINRHx

Predictors of supplementation for breastfed babies in a Baby-Friendly hospital

Publication date: Available online 6 September 2017
Source:Women and Birth
Author(s): Stefanie Kalmakoff, Andrew Gray, Sally Baddock
ProblemSupplementation of breastfed babies is common during the hospital stay.BackgroundThe Baby Friendly Hospital Initiative (BFHI) optimises practices to support exclusive breastfeeding, yet supplementation is still prevalent.ObjectiveTo determine predictors for supplementation in a cohort of breastfed babies in a Baby-Friendly hospital.MethodsElectronic hospital records of 1530 healthy term or near term singleton infants and their mothers were examined retrospectively and analysed to identify factors associated with in-hospital supplementation using Poisson regression (unadjusted and adjusted).FindingsFifteen percent of breastfed infants were supplemented during their hospital stay. Analysis by multivariable Poisson regression found that supplementation was independently associated with overweight (reference normal weight) (aRR [adjusted relative risk]=1.46; 95% CI: 1.11–1.93); primiparity (aRR=1.40; 95% CI: 1.09–1.80); early term gestation (37–37⁶ weeks, aRR=2.79; 95% CI: 1.88–4.15; 38–38⁶ weeks, aRR=2.03, 95%CI: 1.46–2.82); birthweight less than 2500 grams (reference 3000–3499 grams) (aRR=3.60; 95% CI: 2.32–5.60) and use of postpartum uterotonic (aRR=2.47; 95% CI: 1.09–5.55). Greater than 65 minutes of skin-to-skin contact at birth reduced the risk of supplementation (aRR=0.66; 95% CI; 0.48–0.92).ConclusionThese identified predictors for supplementation, can inform the development of interventions for mother-infant pairs antenatally or in the early postpartum period around increased breastfeeding education and support to reduce supplementation. It may also be possible to reduce supplementation through judicious use of postpartum uterotonics and facilitation of mother-infant skin-to-skin contact at birth for greater than one hour duration.



http://ift.tt/2w9eq56

Changes in foot posture during pregnancy and their relation with musculoskeletal pain: A longitudinal cohort study

Publication date: Available online 6 September 2017
Source:Women and Birth
Author(s): Francisco Javier Vico Pardo, Andres López del Amo, Manuel Pardo Rios, Gabriel Gijon-Nogueron, Cristina Castro Yuste
AimTo examine foot posture changes during the three trimesters of pregnancy and to determine whether there is a relationship between these changes and the pain experienced in this period.MethodsThe study sample consisted of 62 pregnant women who attended the Gynaecology Service at Hospital ​Santa María del Puerto (Cádiz, Spain), between January 2013 and May 2014. In their first visit, the following sociodemographic and anthropometric data were recorded: age, weight, height and foot size. In addition, information was obtained regarding pain in the lower back, knees, ankles and feet. In this first visit, too, the Foot Posture Index (FPI) was assessed, and three subsequent controls were performed during the first, second and third months of pregnancy (termed Stages 1, 2 and 3, respectively).ResultsIn Stage 1, the average foot size (i.e., shoe size) was 38.3 (SD 1.5). This size did not change between Stages 1, 2 and 3. However, body weight and BMI did present statistically significant changes during this period (p<0.0001). The FPI varied during pregnancy but no relation was observed between these changes and the onset of pain.ConclusionsDuring pregnancy, pronation increases but this does not appear to influence the onset of pain in the lower limbs.



http://ift.tt/2wIFJGL

Urinary miR-155-5p and CXCL10 as prognostic and predictive biomarkers of rejection, graft outcome and treatment response in kidney transplantation

Abstract

Background and Purpose

MicroRNAs (miRNAs) may be useful biomarkers of rejection and allograft outcome in kidney transplantation. Elevated urinary CXCL10 levels have been associated with acute rejection (AR) and may predict allograft failure. We examined the correlation of miRNA, CXCL10 levels and immunosuppressive drug exposure with AR and graft function in kidney transplant recipients.

Experimental Approach

Eighty de novo kidney transplant recipients were recruited from four European centres. All patients received tacrolimus, mycophenolate mofetil, and methylprednisolone. Urinary pellet expression of miR-142-3p, miR-210-3p, and miR-155-5p was assessed by qPCR and urinary CXCL10 levels by ELISA at the 1^st week and the 1^st, 2^nd, 3^rd and 6^th month post-transplantation.

Key Results

Eight patients experienced AR. Before and during AR, patients showed a significant increase of urinary miR-142-3p, miR-155-5p, and CXCL10 levels and a decrease of miR-210-3p levels. Receiver Operating Characteristic curve analysis showed that miR-155-5p (AUC=0.875; P=0.046) and CXCL10 (AUC=0.865; P=0.029) had excellent capacity to discriminate between rejectors and non-rejectors. The optimal cut-off values for the prognosis of AR were 0.51, with 85% sensitivity and 86% specificity for miR-155-5p and 84.73 pg/ml, with 84% sensitivity and 80% specificity for CXCL10. miR-155-5p and CXCL10 levels correlated with glomerular filtration rate. Levels of both biomarkers normalised after recovery of graft function.

Conclusions and Implications

The regular early post-transplantation monitoring of urinary miR-155-5p and CXCL10 can help in the prognosis of AR and graft dysfunction. Large prospective randomised multicentre trials are warranted to refine our cut-off values and validate the clinical usefulness of these biomarkers.

http://ift.tt/2xcJshs

BIOMARKERS IN SOLID ORGAN TRANSPLANTATION

Abstract

Recipients of solid organs such as kidney and heart are treated with standard immunosuppressive regimens, and personalized medicine has not yet reached the clinic for this patient population. Biomarkers potentially will allow treatment regimens to be adjusted, according to the needs of the individual patient. Biomarkers may reflect the degree of immunosuppression of the immune system, or they may reflect early damage to the transplanted organ.

http://ift.tt/2wJYOXE

Reduced risk of decompensation and death associated with use of statins in patients with alcoholic cirrhosis. A nationwide case-cohort study

Summary

Background

Reports have indicated that the use of statins may ameliorate the course of cirrhosis.

Aim

To determine the relationship between use of statins and mortality rate in patients with cirrhosis.

Methods

We did a retrospective case-cohort analysis based on data from the Danish registers from the period 1995 through 2014. Index date was time of diagnosis of cirrhosis (ICD-10: K703) and cohort entry depended on whether the patient was statin user or not. We used propensity score matching with a statin:non-statin ratio of 1:2. We included the exposure to statins (ATC classification C10AA) from the index date until death or end of follow-up based on prescription claims. Use of statins based on at least two statin claims as well as the longitudinal pattern over time of statin claims was tested against mortality. The main outcome was mortality rate.

Results

A total of 24 748 patients with alcoholic cirrhosis were identified and 5417 were eligible for matching. The mean age was 56 (SD 10) years and 36% were females. The prevalence of use of statins was 15%. We included 744 in the matched cohort. Mortality rates were 88 (95% CI 73-105) per 1000 years for patients using statin and 127 (95% CI 114-141) for non-statin patients with a HR of 0.57 (95% CI 0.45-0.71). A more regular pattern of statin claims was related to a lower risk of death.

Conclusions

Our results showed an association between regular use of statins and reduced mortality in patients with alcoholic cirrhosis.

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Cover

The cover image, by Tabea Flügge et al., is based on the Original Article Registration of cone beam computed tomography data and intraoral surface scans – A prerequisite for guided implant surgery with CAD/CAM drilling guides, DOI: 10.1111/clr.12925.

http://ift.tt/2w9U1N0

Testosterone inhibits the growth of prostate cancer xenografts in nude mice

Abstract

Background

Traditional beliefs of androgen's stimulating effects on the growth of prostate cancer (PCa) have been challenged in recent years. Our previous in vitro study indicated that physiological normal levels of androgens inhibited the proliferation of PCa cells. In this in vivo study, the ability of testosterone (T) to inhibit PCa growth was assessed by testing the tumor incidence rate and tumor growth rate of PCa xenografts on nude mice.

Methods

Different serum testosterone levels were manipulated in male nude/nude athymic mice by orchiectomy or inserting different dosages of T pellets subcutaneously. PCa cells were injected subcutaneously to nude mice and tumor incidence rate and tumor growth rate of PCa xenografts were tested.

Results

The data demonstrated that low levels of serum T resulted in the highest PCa incidence rate (50%). This PCa incidence rate in mice with low T levels was significantly higher than that in mice treated with higher doses of T (24%, P < 0.01) and mice that underwent orchiectomy (8%, P < 0.001). Mice that had low serum T levels had the shortest tumor volume doubling time (112 h). This doubling time was significantly shorter than that in the high dose 5 mg T arm (158 h, P < 0.001) and in the orchiectomy arm (468 h, P < 0.001).

Conclusion

These results indicated that low T levels are optimal for PCa cell growth. Castrate T levels, as seen after orchiectomy, are not sufficient to support PCa cell growth. Higher levels of serum T inhibited PCa cell growth.

http://ift.tt/2vO2hqP

Machine-Learning-Based Electronic Triage More Accurately Differentiates Patients With Respect to Clinical Outcomes Compared With the Emergency Severity Index

Standards for emergency department (ED) triage in the United States rely heavily on subjective assessment and are limited in their ability to risk-stratify patients. This study seeks to evaluate an electronic triage system (e-triage) based on machine learning that predicts likelihood of acute outcomes enabling improved patient differentiation.

http://ift.tt/2gJD1Yv

[Cr 3 O(O 2 CCH 2 CH 3 ) 6 (H 2 O) 3 ]NO 3 ·H 2 O (Cr3) Toxicity Potential in Bacterial and Mammalian Cells

Abstract

Chromium(III) has generally been considered to be essential for proper carbohydrate and lipid metabolism, and, despite recent evidence to the contrary, chromium(III)-containing compounds remain one of the most popular commercial dietary supplements. Cr3, or [Cr₃O(O₂CCH₂CH₃)₆(H₂O)₃]NO₃·H₂O, is a trivalent chromium compound that is a promising chromium nutritional supplement. Studies with Cr3 have indicated that it is non-toxic in developmental and short- and long-term exposure studies in rodents, but the safety of this compound to chromosomes and cells has not been explored. The current study evaluates the mutagenicity, cytotoxicity, and clastogenicity of Cr3 in bacterial and mammalian cells and compares these results with similar studies using the bestselling Cr(III) nutritional supplement, chromium picolinate (CrPic). The mutagenicity of CrPic and Cr3 was tested in Escherichia coli FX-11 and Salmonella typhimurium (TA 98 and TA 100). Cytotoxicity was measured as a decrease in plating efficiency relative to controls after treatment with Cr3 and CrPic for 24 h in CHO K1 cells. Clastogenicity was measured by counting the number of metaphases damaged and of the total number chromosomal aberrations in CHO K1 cells. Mutagenesis assays in E. coli and S. typhimurium were negative. All treatments of Cr3 produced ≥ 84% plating efficiency except 80 μg/cm², which reduced the plating efficiency to 62%. Cr3 at any treatment level did not produce a significant increase in the number of cells with abnormal metaphases, while treatments using ≥ 40 μg/cm² of CrPic elevated the number significantly. These data suggest that Cr3 is significantly less mutagenic in bacteria cells and less clastogenic in CHO K1 cells, while CrPic is clastogenic in CHO K1 cells.

http://ift.tt/2eHHuug

Effects of low-to-moderate alcohol supplementation on urinary estrogen metabolites in postmenopausal women in a controlled feeding study

Abstract

Heavy alcohol drinking is associated with increased breast cancer risk, but associations with low-to-moderate alcohol consumption are less clear and the biological mechanisms are not well defined. The objective of this study was to evaluate the effects of 8 weeks of low (15 g/d) and moderate (30 g/d) alcohol ingestion on concentrations of 15 urinary estrogen metabolites (EMs) in postmenopausal women (n = 51) in a controlled feeding study with a randomized crossover design. Compared to no alcohol, 15 g/day for 8 weeks had no effect on urinary EMs. However, compared to no alcohol, 30 g/day for 8 weeks decreased urinary 2-hydroestrone (2-OHE1) by 3.3% (P = 0.055) and increased 16-epiestriol (16-EpiE3) by 26.6% (P = 0.037). Trends for reduced urinary 2-OHE1 (P = 0.045), reduced ratio of 2-OH:16OH pathways (P = 0.008), and increased 16-EpiE3 (P = 0.035) were observed as alcohol ingestion increased from 0 g to 15 g to 30 g/d. Moderate alcohol consumption for 8 weeks had modest effects on urinary concentrations of 2-OHE1 and 16-EpiE3 among postmenopausal women in a carefully controlled feeding study.

Recent evidence indicates that postmenopausal breast cancer risk increases with higher levels of 16-EpiE3 and decreases with lower levels of 2-OHE1 in different prospective cohorts. Since moderate alcohol consumption in our study of postmenopausal women increased 16-EpiE3 and lowered 2-OHE1, these results imply that moderate drinking may have dual effects on later breast cancer development, but this finding needs confirmation.

http://ift.tt/2gJ5GNj

miR-199a-3p and miR-214-3p improve the overall survival prediction of muscle-invasive bladder cancer patients after radical cystectomy

Abstract

To improve the clinical decision-making regarding further treatment management and follow-up scheduling for patients with muscle-invasive bladder cancer (MIBC) after radical cystectomy (RC), a better prediction accuracy of prognosis for these patients is urgently needed. The objective of this study was to evaluate the validity of differentially expressed microRNAs (miRNAs) based on a previous study as prognostic markers for overall survival (OS) after RC in models combined with clinicopathological data. The expression of six miRNAs (miR-100-5p, miR-130b-3p, miR-141-3p, miR-199a-3p, miR-205-5p, and miR-214-3p) was measured by RT-qPCR in formalin-fixed, paraffin-embedded tissue samples from 156 MIBC patients who received RC in three urological centers. Samples from 2000 to 2013 were used according to their tissue availability, with follow-up until June 2016. The patient cohort was randomly divided into a training (n = 100) and test set (n = 56). Seventy-three samples from adjacent normal tissue were used as controls. Kaplan–Meier, univariate and multivariate Cox regression, and decision curve analyses were carried out to assess the association of clinicopathological variables and miRNAs to OS. Both increased (miR-130b-3p and miR-141-3p) and reduced (miR-100-5p, miR-199a-3p, and miR-214-3p) miRNA expressions were found in MIBC samples in comparison to nonmalignant tissue samples (P < 0.0001). miR-199a-3p and miR-214-3p were independent markers of OS in Cox regression models with the significant clinicopathological variables age, tumor status, and lymph node status. The prediction model with the clinicopathological variables was improved by these two miRNAs in both sets. The predictive benefit was confirmed by decision curve analysis. In conclusion, the inclusion of both miRNAs into models based on clinical data for the outcome prediction of MIBC patients after RC could be a valuable approach to improve prognostic accuracy.

This study demonstrated the usefulness of the microRNAs miR-199a-3p and miR-214-3p in formalin-fixed, paraffin-embedded tissue samples from patients with muscle-invasive bladder cancer after radical cystectomy as predictive biomarkers of overall survival. In this aspect, the miRNAs combined with traditional clinicopathological factors improved the prediction accuracy for overall survival and could be useful to facilitate clinical decision making for further treatment strategies.

http://ift.tt/2f5OUI0

Long-term outcomes in patients treated with proton therapy for localized prostate cancer

Abstract

The aim of this retrospective study was to report long-term clinical outcomes in patients treated with proton therapy (PT) for localized prostate cancer. Between 2001 and 2014, 1375 consecutive patients were treated with PT. Patients were classified into prognostic risk groups based on the National Comprehensive Cancer Network criteria. Freedom from biochemical relapse (FFBR), cancer-specific survival (CSS) and incidence of late gastrointestinal (GI)/genitourinary (GU) toxicities were calculated. Multivariate analysis was performed to identify clinical prognostic factors for FFBR and late toxicities. The median follow-up period was 70 months (range, 4–145 months). In total, 99% of patients received 74 Gy (relative biologic effectiveness [RBE]); 56% of patients received neoadjuvant androgen deprivation therapy. For the low-, intermediate-, high-, and very high-risk groups, 5-year FFBR was 99% (95% confidence intervals [CI], 96–100%), 91% (95% CI, 88–93%), 86% (95% CI, 82–89%), and 66% (95% CI, 53–76%), respectively, and 5-year CSS was 100% (95% CI, 100–100%), 100% (95% CI, 100–100%) , 99% (95% CI, 97–100%), and 95% (95% CI, 94–98%), respectively. Patient age, T classification, Gleason score, prostate-specific antigen, and percentage of positive cores were significant prognostic factors for FFBR. Grade 2 or higher GI and GU toxicities were 3.9% and 2.0%. Patient age was a prognostic factor for both late GI and GU toxicities. This study represents the largest cohort of patients treated with PT for localized prostate cancer, with the longest follow-up to date. Our results demonstrate that the biochemical control of PT is favorable particularly for high- and very high-risk patients with lower late genitourinary toxicity and indicates the necessity of considering patient age in the treatment protocols.

Proton therapy for localized prostate cancer demonstrates favorable biochemical control particularly for high- and very high-risk patients and a lower incidence of late genitourinary toxicity. Our findings indicate the necessity of considering patient age in the treatment protocols.

http://ift.tt/2gIwYDi

Survival of cutaneous melanoma based on sex, age, and stage in the United States, 1992–2011

Abstract

Women diagnosed with cutaneous melanoma have a survival advantage compared to men, which has been hypothesized to be due to difference in behavior and/or biology (sex hormones). It remains controversial whether this advantage is dependent on age or stage of disease. We sought to compare melanoma-specific survival between females in pre, peri, and postmenopausal age groups to males in the same age group, adjusting for stage of disease. This is a retrospective population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed from 1 January 1992 through 31 January 2011 with primary invasive cutaneous melanoma were included in our cohort. Melanoma-specific survival was the main outcome studied. Of the 106,511 subjects that were included, 45% were female. Females in all age groups (18–45, 46–54, and ≥55) with localized and regional disease, were less likely to die from melanoma compared to males in the same age group. Among patients with localized and regional disease, the relative risk of death due to melanoma increased with advancing age at diagnosis; this increase was more pronounced among females than males. In contrast, we observed no female survival advantage among patients with distant disease and no effect of age on relative risk of death from melanoma. Females with localized and regional melanoma have a decreased risk of death compared to males within all age groups. Our data show no differences in survival between men and women with metastatic melanoma, indicating that the influence of sex on survival is limited to early stage disease but not confined to pre or perimenopausal age groups.

In local and regional cutaneous melanoma, women of all ages have a significant survival benefit over men. However, data from the SEER registry indicate that this female survival advantage is decreased when the disease is metastatic, suggesting an unknown protective biology is lost in distant disease.

http://ift.tt/2f4CD6H

Prognostic effect of parotid area lymph node metastases after preliminary diagnosis of nasopharyngeal carcinoma: a propensity score matching study

Abstract

Parotid area lymph node (PLN) metastasis in nasopharyngeal carcinoma (NPC) is rare, and its prognosis remains largely unknown. Our study aimed to investigate the prognostic value and staging categories of PLN metastasis in patients with NPC and treated with intensity-modulated radiation therapy (IMRT), to provide a reference for clinical treatment for NPC with PLN metastasis. Records for 1616 untreated NPC patients without distant metastasis was retrospectively reviewed. All patients underwent magnetic resonance imaging (MRI) examination prior to treatment and then received IMRT as their primary treatment. Forty-five NPC patients (2.8%) showed initial PLN metastasis on follow-up MRI. PLN metastasis was significantly associated with the N classification and clinical stage. Univariate analysis showed that PLN metastasis had an unfavorable influence on overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional relapse-free survival (RRFS) in NPC patients. Using propensity score matching (PSM) to calibrate selection bias and confounding bias, it was observed that PLN metastasis remained an adverse prognostic factor for OS, PFS, DMFS, and RRFS. Furthermore, the 5-year DMFS and RRFS curves for PLN metastasis were significantly separated from that for N2 disease but crossed that for N3 disease. Therefore, PLN metastasis was found to be an adverse prognostic factor for NPC and to be associated with the same DMFS as N3 disease. Therefore, more aggressive therapeutic strategies consistent with those for N3 disease are recommended for NPC with PLN metastasis to reduce distant metastasis.

PLN metastasis was found to be an adverse prognostic factor for NPC and to be correlated with the same DMFS as N3 disease.

http://ift.tt/2gIqpkr

Pretreatment with fish oil attenuates heart ischemia consequences in rats

Abstract

Omega-3 polyunsaturated fatty acid (ω-3 PUFA)-rich fish oil supplementation has protective effects on heart ischemic injury. Left ventricular (LV) ischemia was induced in rats by permanent ligation of the left coronary artery. Saline, fish oil or soybean oil was administered daily by gavage (3 g kg⁻¹ b.w.) for 20 days before inducing ischemia. Outcomes were assessed 24 hours after left coronary artery ligation. Pretreatment with fish oil decreased the ω-6/ω-3 fatty acid ratio in the LV. Reduction in infarct size and in the intensity of ventricular systolic dysfunction was found in the fish oil group as compared with the saline or soybean oil groups through echocardiographic evaluation. LV glycogen levels were decreased in the fish oil group as compared with the saline before infarction. Soybean oil pretreatment led to a further increase in the LV levels of CINC 2/αβ, IL1β and TNFα induced by the heart infarction. In heart infarcted rats, fish oil pretreatment decreased creatine kinase and caspase 3 activities; prevented the decrease in the coronary blood flow; increased LV levels of ATP and lactate; increased the mRNA levels of iNOS, eNOS, HIF-1α, GLUT-1, VEGF-α and p53 in the LV as measured by RT-PCR; and did not change LV pro-inflammatory cytokine levels as compared to the control group. Fish oil protected the heart from ischemia as indicated by the decrease in the heart infarction area and systolic dysfunction associated with increased LV ATP levels and maintenance of the coronary blood flow with no change in pro-inflammatory cytokine levels.

This article is protected by copyright. All rights reserved

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Erratum to: Clinical experience with four cases of jackhammer esophagus

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The Transcriptional Response of Candida albicans to Weak Organic Acids, Carbon Source and MIG1 Inactivation Unveils a Role for HGT16 in Mediating the Fungistatic Effect of Acetic Acid

Candida albicans is a resident fungus of the human intestinal microflora. Commonly isolated at low abundance in healthy people, C. albicans outcompetes local microbiota during candidiasis episodes. Under normal conditions, members of the human gastrointestinal microbiota were shown to keep C. albicans colonization under control. By releasing weak organic acids (WOAs), bacteria are able to moderate yeast growth. This mechanism displayed a synergistic effect in vitro with the absence of glucose in medium of culture, which underline the complex interaction that C. albicans faces in its natural environment. Inactivation of the transcriptional regulator MIG1 in C. albicans results in a lack of sensitivity to this synergistic outcome. To decipher C. albicans transcriptional responses to glucose, WOAs and the role of MIG1, we performed RNA sequencing on four biological replicates exposed to combinations of these 3 parameters. We were able to characterise the i) glucose response, ii) response to acetic and butyric acid, iii) MIG1 regulation of C. albicans and iv) genes responsible for WOAs resistance. We identified a group of 6 genes linked to WOAs sensitivity in a glucose-MIG1-dependent manner and inactivated one of these genes, the putative glucose transporter HGT16, in a SC5314 wild-type background. As expected, the mutant displayed a partial complementation to WOAs resistance in absence of glucose. This result points towards a mechanism of WOAs sensitivity in C. albicans involving membrane transporters which could be exploited to control yeast colonisation in human body niches.

http://ift.tt/2wJNtGS

Genome-Wide Analysis of DNA Methylation During Ovule Development of Female-Sterile Rice fsv1

The regulation of female fertility is an important field of rice sexual reproduction research. DNA methylation is an essential epigenetic modification that dynamically regulates gene expression during development processes. However, few reports have described the methylation profiles of female sterile rice during ovule development. In this study, ovules were continuously acquired from the beginning of megaspore mother cell meiosis until the mature female gametophyte formation period, and global DNA methylation patterns were compared in the ovules of a high-frequency female-sterile line (fsv1) and a wild-type rice line (Gui99) using whole-genome bisulfite sequencing (WGBS). Profiling of the global DNA methylation revealed hypomethylation, and 3471 significantly differentially methylated regions (DMRs) were observed in fsv1 ovules compared with Gui99. Based on functional annotation and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis of differentially methylated genes (DMGs), we observed more DMGs enriched in cellular component, reproduction regulation, metabolic pathway and other pathways. In particular, many ovule development genes and plant hormone-related genes showed significantly different methylation patterns in the two rice lines, and these differences may provide important clues for revealing the mechanism of female gametophyte abortion.

http://ift.tt/2vMNLjj

Comparative NMR and NIRS Analysis of Oxygen Dependent Metabolism in Exercising Finger Flexor Muscles

Muscle contraction requires the physiology to adapt rapidly to meet the surge in energy demand. To investigate the shift in metabolic control, especially between oxygen and metabolism, researchers often depend on near infrared spectroscopy (NIRS) to measure non-invasively the tissue O₂. Because NIRS detects the overlapping myoglobin (Mb) and hemoglobin (Hb) signals in muscle, interpreting the data as an index of cellular or vascular O₂ requires deconvoluting the relative contribution. Currently, many in the NIRS field ascribe the signal to Hb. In contrast, ¹H NMR has only detected the Mb signal in contracting muscle, and comparative NIRS and NMR experiments indicate a predominant Mb contribution. The present study has examined the question of the NIRS signal origin by measuring simultaneously the ¹H, ³¹P NMR, and NIRS signals in finger flexor muscles during the transition from rest to contraction, recovery, ischemia, and reperfusion. The experiment results confirm a predominant Mb contribution to the NIRS signal from muscle. Given the NMR and NIRS corroborated changes in the intracellular O₂, the analysis shows that at the onset of muscle contraction, O₂ declines immediately and reaches new steady states as contraction intensity rises. Moreover, lactate formation increases even under quite aerobic condition.

http://ift.tt/2wJT93B

The in vitro zebrafish heart as a model to investigate the chronotropic effects of vapor anesthetics

In addition to their intended clinical actions, all general anesthetic agents in common use have detrimental intra- and post-surgical side effects on organs and systems including the heart. The major cardiac side effect of anesthesia is bradycardia, which increases the probability of insufficient systemic perfusion during surgery. These side effects also occur in all vertebrate species so far examined, but the underlying mechanisms are not clear. The zebrafish heart is a powerful model for studying cardiac electrophysiology, employing the same pacemaker system and neural control as do mammalian hearts. In this study isolated zebrafish hearts were significantly bradycardic during exposure to the vapor anesthetics sevoflurane (SEVO), desflurane (DES) and isoflurane (ISO). Bradycardia induced by DES and ISO continued during pharmacological blockade of the intracardiac portion of the autonomic nervous system, but the chronotropic effect of SEVO was eliminated during blockade. Bradycardia evoked by vagosympathetic nerve stimulation was augmented during DES and ISO exposure; nerve stimulation during SEVO exposure had no effect. Together these results support the hypothesis that the cardiac chronotropic effect of SEVO occurs via a neurally mediated mechanism while DES and ISO act directly upon cardiac pacemaker cells via an as yet unknown mechanism.

http://ift.tt/2xcc76e

Insulin Sensitivity, Leptin, Adiponectin, Resistin, and Testosterone in Adult Male and Female Rats After Maternal-Neonatal Separation and Environmental Stress

Care of premature infants often requires parental and caregiver separation particularly during hypoxic and hypothermic episodes. We have established a neonatal rat model of human prematurity involving maternal-neonatal separation and hypoxia with spontaneous hypothermia prevented with external heat. Adults previously exposed to these neonatal stressors show a sex difference in the insulin and glucose response to arginine stimulation suggesting a state of insulin resistance. The current study used this cohort of adult rats to evaluate insulin resistance (Homeostatic Model Assessment of Insulin Resistance [HOMA-IR]), plasma adipokines (reflecting insulin resistance states), and testosterone. The major findings were that daily maternal-neonatal separation led to an increase in body weight and HOMA-IR in adult male and female rats and increased plasma leptin in adult male rats only; neither prior neonatal hypoxia (without or with body temperature control) nor neonatal hypothermia altered subsequent adult HOMA-IR or plasma adiponectin. Adult male-female differences in plasma leptin were lost with prior exposure to neonatal hypoxia or hypothermia; male-female differences in resistin were lost in the adults with prior neonatal hypoxia allowing spontaneous hypothermia Exposure of neonates to daily hypoxia while preventing spontaneous hypothermia led to a decrease in plasma testosterone in adult male rats. We conclude that neonatal stressors result in subsequent adult sex-dependent increases in insulin resistance and adipokines, and that our rat model of prematurity with hypoxia with the prevention of hypothermia alters adult testosterone dynamics.

http://ift.tt/2wJUvvz

Circadian variability of body temperature responses to methamphetamine

Vital parameters of living organisms exhibit circadian rhythmicity. Although rats are nocturnal animals, most of the studies involving rats are performed during the day. The objective of this study was to examine the circadian variability of the body temperature responses to methamphetamine (Meth). Body temperature was recorded in male Sprague-Dawley rats received Meth (1 or 5 mg/kg) or saline at 10am or 10pm. The baseline body temperature at night was 0.8ºC higher than during the day. Both during the day and at night 1 mg/kg of Meth induced monophasic hyperthermia. However, the maximal temperature increase at night was 50% smaller than during the daytime. Injection of 5 mg/kg of Meth during the daytime caused a delayed hyperthermic response. In contrast, the same dose at night produced responses with a tendency towards a decrease of body temperature. Using mathematical modeling, we previously showed that the complex dose-dependence of the daytime temperature responses to Meth results from an interplay between inhibitory and excitatory drives. Here, using the model, we explain the suppression of the hyperthermia in response to Meth at night. First, we found that the baseline activity of the excitatory drive is greater at night. It appears partially saturated, and, thus, is additionally activated by Meth to a lesser extent. Therefore, the excitatory component causes lesser hyperthermia or becomes overpowered by the inhibitory drive in response to the higher dose. Second, at night the injection of Meth results in reduction of the equilibrium body temperature leading to gradual cooling counteracting hyperthermia.

http://ift.tt/2xckrms

Hemoglobin polymerization via disulfide bond formation in the hypoxia-tolerant turtle Trachemys scripta: implications for antioxidant defense and O2 transport

The ability of many reptilian hemoglobins (Hbs) to form high-molecular weight polymers, albeit known for decades, has not been investigated in detail. Given that turtle Hbs often contain a high number of cysteine (Cys), potentially contributing to the red blood cell defense against reactive oxygen species, we have examined whether polymerization of Hb could occur via intermolecular disulfide bonds in red blood cells of freshwater turtle Trachemys scripta, a species that is highly tolerant of hypoxia and oxidative stress. We find that one of the two Hb isoforms of the hemolysate, HbA, is prone to polymerization in vitro into linear flexible chains of different size that are visible by electron microscopy, but not the HbD isoform. Polymerization of purified HbA is favored by hydrogen peroxide, a main cellular reactive oxygen species and a thiol oxidant, and inhibited by thiol reduction and alkylation, indicating that HbA polymerization is due to disulfide bonds. By using mass spectrometry, we identify Cys5 of the α^A subunit of HbA as specifically responsible for forming disulfide bonds between adjacent HbA tetramers. Polymerization of HbA does not affect oxygen affinity, cooperativity and sensitivity to the allosteric cofactor ATP, indicating that HbA is still fully functional. Polymers also form in T. scripta blood after exposure to anoxia but not normoxia, indicating that they are of physiologically relevance. Taken together, these results show that HbA polymers may form during oxidative stress and that Cys5α^A of HbA is a key element of the antioxidant capacity of turtle red blood cells.

http://ift.tt/2wJSUFO

An Essential Role of Maspin in Embryogenesis and Tumor Suppression—Response

http://ift.tt/2w8WJma

An Essential Role of Maspin in Embryogenesis and Tumor Suppression—Letter

http://ift.tt/2wIbPTh

Response to the letter to the editor of Lambros et al.

http://ift.tt/2xQpOoo

Game of TOR — The Target of Rapamycin Rules Four Kingdoms

The 2017 Albert Lasker Basic Medical Research Award, announced September 6, recognizes Michael N. Hall of the University of Basel for his discovery of the target of rapamycin (TOR), a nutrient-sensing enzyme that regulates cell and organismal growth in nearly all eukaryotic species. Because of its…

http://ift.tt/2w8Sff5

Genetic Associations with Gestational Duration and Spontaneous Preterm Birth

Preterm birth (defined as birth before 37 completed weeks of gestation) affects 9.6% of pregnancies in the United States and more than 15 million pregnancies worldwide each year. It is the leading cause of death in neonates and children under the age of 5 years. The majority of preterm births arise…

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Gilead Buying Kite for $11.9 Billion [News in Brief]

CAR T therapies bolster company's oncology pipeline.

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Equipping NK Cells with CARs [News in Brief]

Off-the-shelf immunotherapy feasible with this cell type; phase I/II trial under way.

http://ift.tt/2f54nIi

Expression of C4.4A in an In Vitro Human Tissue-Engineered Skin Model

A multi-LU-domain-containing protein denoted C4.4A exhibits a tightly regulated membrane-associated expression in the suprabasal layers of stratified squamous epithelia such as skin and the esophagus, and the expression of C4.4A is dysregulated in various pathological conditions. However, the biological function of C4.4A remains unknown. To enable further studies, we evaluated the expression of C4.4A in monolayer cultures of normal human keratinocytes and in tissue-engineered skin substitutes (TESs) produced by the self-assembly approach, which allow the formation of a fully differentiated epidermis tissue. Results showed that, in monolayer, C4.4A was highly expressed in the centre of keratinocyte colonies at cell-cell contacts areas, while some cells located at the periphery presented little C4.4A expression. In TES, emergence of C4.4A expression coincided with the formation of the stratum spinosum. After the creation of a wound within the TES, C4.4A expression was observed in the suprabasal keratinocytes of the migrating epithelium, with the exception of the foremost leading keratinocytes, which were negative for C4.4A. Our results are consistent with previous data in mouse embryogenesis and wound healing. Based on these findings, we conclude that this human TES model provides an excellent surrogate for studies of C4.4A and Haldisin expressions in human stratified epithelia.

http://ift.tt/2j54xnN

Integrating “Evo” and “Devo”: The Limb as Model Structure

Abstract

Reconciling the origins of morphological diversity with the deep homology of underlying mechanisms is a question fundamental to the goals of evolutionary developmental biology ("evo–devo" or EDB). In this paper I argue that differing research agendas in evolutionary and developmental biology have hindered how we address this question, but that the limb provides ideal "common ground" for their fuller integration. To support this idea, I review two previous analyses of limb variation in mammal, bird, and reptile taxa that offer complementary approaches to explaining diversity. Specifically, I present evidence suggesting that: (1) a shared genetic architecture affects the pattern of between limb developmental integration, while their functional dissociation is linked to both increased phenotypic evolvability and diversity of interlimb proportions, and (2) within limb proportional diversity is biased such that proximal and distal segments function as tradeoffs while the middle segment is more conservative, a signal that is both evident from early in morphogenesis and suggestive of an "inhibitory cascade" model of limb proximo–distal axis development. In the first case, shared genetic mechanisms predict both observed developmental integration between limbs and patterns of clade-specific diversity. In the second case, underappreciated patterns of phenotypic diversity suggest novel insights into the underlying developmental mechanisms by which variation is generated. These studies show how insights from both evolutionary and developmental biology of the limb may be used to generate novel testable hypotheses into the origins of diversity that are broadly applicable to the integration of EDB.

http://ift.tt/2f5SceC

Oxytocin Neurons Exhibit Extensive Functional Plasticity Due To Offspring Age in Mothers and Fathers

Abstract

The needs of offspring change as they develop. Thus, parents should concomitantly change their investment based on the age-related needs of the offspring as they mature. Due to the high costs of parental care, it is optimal for parents to exhibit a shift from intense caregiving of young offspring to promoting independence in older offspring. Yet, the neural mechanisms that underlie shifts in parental behavior are poorly understood, and little is known about how the parental brain responds to offspring of different ages. To elucidate mechanisms that relate to shifts in parental behavior as offspring develop, we examined behavioral and neural responses of male and female prairie voles (Microtus ochrogaster), a biparental rodent, to interactions with offspring at different stages of development (ranging from neonatal to weaning age). Importantly, in biparental species, males and females may adjust their behavior differentially as offspring develop. Because the nonapeptides, vasopressin (VP) and oxytocin (OT), are well known for modulating aspects of parental care, we focused on functional activity of distinct VP and OT cell groups within the maternal and paternal brain in response to separation from, reunion (after a brief period of separation) with, or no separation from offspring of different ages. We found several differences in the neural responses of individual VP and OT cell groups that varied based on the age of pups and sex of the parent. Hypothalamic VP neurons exhibit similar functional responses in both mothers and fathers. However, hypothalamic and amygdalar OT neurons exhibit differential functional responses to being separated from pups based on the sex of the parent. Our results also reveal that the developmental stage of offspring significantly impacts neural function within OT, but not VP, cell groups of both mothers and fathers. These findings provide insight into the functional plastic capabilities of the nonapeptide system, specifically in relation to parental behavior. Identifying neural mechanisms that exhibit functional plasticity can elucidate one way in which animals are able to shift behavior on relatively short timescales in order to exhibit the most context-appropriate and adaptive behaviors.

http://ift.tt/2j3CGEe

Everolimus for the Treatment of Tuberous Sclerosis Complex–Related Cardiac Rhabdomyomas in Pediatric Patients

Cardiac rhabdomyoma (cRHM), a benign, smooth-muscle hamartoma, occurs predominantly in infants and children; approximately 75% of affected children are aged ≤1 year, and 33% are aged ≤1 month.1,2 cRHM is the most common type of primary cardiac tumor identified in pediatric patients, accounting for >60% of all primary cardiac tumors in this population,2-4 with an estimated incidence of 0.02%-0.08% of live births.2,5 It is also the most common cardiac tumor of the fetus.2

http://ift.tt/2gIAWMw

Timing and Chronicity of Maternal Depression Symptoms and Children's Verbal Abilities

To test the associations between the timing and chronicity of maternal depression symptoms (MDS) and children's long-term verbal abilities.

http://ift.tt/2gJ0RUf

Bilirubin Uridine Diphosphate-glucuronosyltransferase Polymorphism as a Risk Factor for Prolonged Hyperbilirubinemia in Japanese Preterm Infants

To determine whether a variant of the bilirubin uridine diphosphate-glucuronosyltransferase gene (UGT1A1*6) is a risk factor for prolonged hyperbilirubinemia in preterm infants.

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Delayed Presentation and Prolonged Survival of a Child with Surfactant Protein B Deficiency

Surfactant protein B encoding gene mutations have been related to early onset fatal respiratory distress in full-term neonates. We report a school-aged male child homozygous for a surfactant protein B encoding gene missense mutation who presented after the neonatal period. His respiratory insufficiency responded to high dose intravenous methylprednisolone and hydroxychloroquine.

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The Use of Echocardiography for Pediatric Patients Presenting with Syncope

To assess the frequency, yield, and cost of echocardiograms meeting "rarely appropriate" criteria.

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Unintentional Cannabis Ingestion in Children: A Systematic Review

To analyze published reports of unintentional cannabis ingestions in children to determine presenting signs and symptoms, route of exposure, treatment, and outcome.

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Work Equity and Investment-based Pediatric Departmental Reorganization

Beginning about 5 years ago, at a time of challenges for academic pediatrics, we addressed productivity, training, and financial opportunities in our midsized pediatric department.1,2 Departmental academic productivity had been stagnant, program competitiveness for training positions was an opportunity, and clinical growth was flat.

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Response to letter re: Carotid atherosclerotic plaques standardized uptake values: methodological issues on reproducibility and accuracy

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Clinical profile of cannabis-associated acute pancreatitis

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A Research Agenda for Curing Chronic Hepatitis B Virus Infection

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Recovery From Ropivacaine-Induced or Levobupivacaine-Induced Cardiac Arrest in Rats: Comparison of Lipid Emulsion Effects.

BACKGROUND: Lipid emulsion treatment appears to have application in the treatment of local anesthetic-induced cardiac arrest. To examine whether the efficacy of lipid resuscitation in the treatment of local anesthetic-induced cardiac arrest is affected by lipophilicity, the effects of lipid infusions were compared between levobupivacaine-induced (high lipophilicity) and ropivacaine-induced (lower lipophilicity) rat cardiac arrest model. METHODS: A total of 28 female Sprague-Dawley rats were anesthetized using sevoflurane, which subsequently underwent tracheostomy, followed by femoral artery and vein cannulation. Two hours after the discontinuation of sevoflurane, either levobupivacaine 0.2% (n = 14) or ropivacaine 0.2% (n = 14) was administered at a rate of 2 mg/kg/min to the awake rats. When the pulse pressure decreased to 0, the infusion of local anesthetic was discontinued, and treatment with chest compressions and ventilation with 100% oxygen were immediately initiated. The total doses of local anesthetics needed to trigger the first seizure and pulse pressure of 0 mm Hg were calculated. The 2 groups were each subdivided into a lipid emulsion group (n = 7) and a control group (n = 7). In the lipid emulsion group, 20% lipid emulsion was administered intravenously (5 mL/kg bolus plus continuous infusion of 0.5 mL/kg/min), while in the control group, the same volume of normal saline was administered. Chest compressions were discontinued when the rate-pressure product had increased by more than 20% of baseline. RESULTS: The cumulative doses of levobupivacaine and ropivacaine that produced seizures and 0 pulse pressure showed no significant difference. Mean arterial blood pressure (MAP) values were higher in the levobupivacaine group than in the ropivacaine group after resuscitation was initiated (P 20% baseline), while only 2 of 7 rats in the control group achieved spontaneous circulation at 10 minutes. In ropivacaine-induced cardiac arrest, there were no significant differences in heart rate and MAP between the lipid and control groups from the start of resuscitation to 10 minutes; spontaneous circulation returned in 6 of 7 lipid group rats, but in only 2 of 7 control group rats at 10 minutes. CONCLUSIONS: Lipid emulsion treatment was more effective for levobupivacaine-induced cardiac arrest than for ropivacaine-induced cardiac arrest. Although lipid therapy is also effective for ropivacaine-induced cardiac arrest, it takes more time than in levobupivacaine-induced cardiac arrest. This suggests that the lipophilicity of local anesthetics influences the efficacy of lipid infusion when treating cardiac arrest caused by these drugs. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. (C) 2017 International Anesthesia Research Society

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Eikelboom filamentous morphotypes 0675 and 0041 embrace members of the Chloroflexi : resolving their phylogeny, and design of FISH probes for their in situ identification

Abstract

Although the phylogeny of many of the filamentous Bacteria responsible for bulking in activated sludge plants is now known, and FISH probes have been designed for their in situ identification, there are some noticeable exceptions. This study reports the identification of the Eikelboom morphotypes type 0041 and type 0675. Because these morphotypes differ only in their filament diameters, they are often considered together in surveys based on microscopic identifications. Here we show that they are phylogenetically distinct, and so should be viewed no longer as morphological variants of a single population. Amplicon sequencing data of Australian EBPR plant biomass containing types 0041 and 0675, and phylogenetic analysis has revealed that both, like many other bulking filament morphotypes, are members of the phylum Chloroflexi and probably representatives of two different genera. FISH probes are described here targeting each. Surveys carried out on Australian activated sludge plants suggest that type 0675 occur more in plants designed to remove phosphorus, while type 0041 shows no such preference, and was seen in biomass samples from a wide range of plant configurations.

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Grazing resistance of bacterial biofilms: A matter of predators’ feeding trait

Abstract

Biofilm formation in bacteria is considered to be one strategy to avoid protozoan grazing. However, this assumption is largely based on experiments with suspension-feeding protozoans. Here we test the hypothesis that grazing resistance depends on both the grazers' feeding trait and the bacterial phenotype, rather than being a general characteristic of bacterial biofilms. We combined batch experiments with mathematical modelling, considering the bacterium Pseudomonas putida and either a suspension-feeding (i.e. the ciliate Paramecium tetraurelia) or a surface-feeding grazer (i.e. the amoeba Acanthamoeba castellanii). We find that both plankton and biofilm phenotypes were consumed, when exposed to their specialized grazer, whereas the other phenotype remained grazing-resistant. This was consistently shown in two experiments (starting with either only planktonic bacteria or with additional pre-grown biofilms) and matches model predictions. In the experiments, the plankton-feeder strongly stimulated the biofilm biomass. This stimulation of the resistant prey phenotype was not predicted by the model and it was not observed for the biofilm-feeders, suggesting the existence of additional mechanisms that stimulate biofilm formation besides selective feeding. Overall, our results confirm our hypothesis that grazing resistance is a matter of the grazers' trait (i.e. feeding type) rather than a biofilm-specific property.

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New facet of non-O1/non-O139 Vibrio cholerae hemolysin A: a competitive factor for the environmental niche

Abstract

Different serogroups of Vibrio cholerae may inhabit the same ecological niche. However, serogroup O1/O139 strains are rarely isolated from their ecological sources. Quite plausibly, the non-O1/non-O139 vibrios and other bacterial species suppress growth of the O1/O139 that shares the same niche. Our bacterial inhibition assay data indicated that certain non-O1/non-O139 strains used a contact-dependent type VI secretion system (T6SS) to suppress growth of the O1 El Tor, N16961 pandemic strain. Meanwhile, comparative proteomics of the O1 and the suppressive non-O1/non-O139 co-cultured in the simulated natural aquatic microcosm showed that SecB and HlyD were upregulated in the latter. The HlyD-related effective factor was subsequently found to be HlyA. However, not all hlyA-positive-non-O1/non-O139 strains mediated growth suppression of the N16961 V. cholerae; only the strains harboring intact cluster I HlyA could exert this activity. The demolition feature of the HlyA is located in the ricin-like lectin domain (β-Trefoil) which plays an important role in the target cell binding. In conclusion, the results of this study indicated that non-O1/non-O139 V. cholerae suppressed the growth of the O1 pandemic strain using contact-dependent T6SS as well as secreting the O1 − detrimental hemolysin A during their co-persistence in the aquatic habitat.

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Intra-Aortic Balloon Pumps by Datascope/MAQUET: Class I Recall - False Blood Detection Alarm, Ingress of Fluid Into Pump

Audience: Risk Manager, Cardiology, Surgery Models CS100i, CSO100, CS300 [Posted 09/06/2017] ISSUE: Datascope Corp./MAQUET is recalling its CS100i, CS100, and CS300 Intra-Aortic Balloon Pumps manufactured July 1, 2003 to June 16, 2017 due to False...

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Intra-Aortic Balloon Pumps by Datascope/MAQUET: Class I Recall - False Blood Detection Alarm, Ingress of Fluid Into Pump

Audience: Risk Manager, Cardiology, Surgery Models CS100i, CSO100, CS300 [Posted 09/06/2017] ISSUE: Datascope Corp./MAQUET is recalling its CS100i, CS100, and CS300 Intra-Aortic Balloon Pumps manufactured July 1, 2003 to June 16, 2017 due to False...

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Personalized Peptide Arrays for Detection of HLA Alloantibodies in Organ Transplantation

Mismatches in human leukocyte antigen (HLA) sequences between organ donor and recipient pairs are the major cause of antibody-mediated rejection in organ transplantation. Here we present the use of custom antigen arrays that are based on individual donors' HLA sequences to probe anti-donor HLA alloantibodies in organ recipients.

http://ift.tt/2vMFWtK

Patient Age and Tumor Subtype Predict the Extent of Axillary Surgery Among Breast Cancer Patients Eligible for the American College of Surgeons Oncology Group Trial Z0011

Abstract

Background

The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial established the safety of omitting axillary lymph node dissection (ALND) for early-stage breast cancer patients with limited nodal disease undergoing lumpectomy. We examined the extent of axillary surgery among women eligible for Z0011 based on patient age and tumor subtype.

Methods

Patients with cT1–2, cN0 breast cancers and one or two positive nodes diagnosed from 2009 to 2014 and treated with lumpectomy were identified in the National Cancer Data Base. Sentinel lymph node biopsy (SLNB) was defined as the removal of 1–5 nodes and ALND as the removal of 10 nodes or more. Tumor subtype was categorized as luminal, human epidermal growth factor 2-positive (HER2+), or triple-negative. Logistic regression was used to estimate the odds of receiving SLNB alone versus ALND.

Results

The inclusion criteria were met by 28,631 patients (21,029 SLNB-alone and 7602 ALND patients). Patients 70 years of age or older were more likely to undergo SLNB alone than ALND (27.0% vs 20.1%; p < 0.001). The radiation therapy use rate was 89.4% after SLNB alone and 89.7% after ALND. In the multivariate analysis, the uptake of Z0011 recommendations increased over time (2014 vs 2009: odds ratio [OR] 13.02; p < 0.001). Younger patients were less likely to undergo SLNB alone than older patients (age <40 vs ≥70: OR 0.59; p < 0.001). Patients with HER2+ (OR 0.89) or triple-negative disease (OR 0.79) (p < 0.001) were less likely to undergo SLNB alone than those with luminal subtypes.

Conclusions

Among women potentially eligible for ACOSOG Z0011, the use of SLNB alone increased over time in all groups, but the extent of axillary surgery differed by patient age and tumor subtype.

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Issue Information–ISSN page

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Announcements

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Uric acid, an important screening tool to detect inborn errors of metabolism: a case series

Uric acid is the metabolic end product of purine metabolism in humans. Altered serum and urine uric acid level (both above and below the reference ranges) is an indispensable marker in detecting rare inborn er...

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Inguinal canal angioleiomyoma: case report of a rare disease entity within inguinal canal

Angioleiomyoma is an uncommon benign soft tissue tumor and originates from the vascular smooth muscle. It often causes pain and is rarely found in inguinal region. We present a rare case of inguinal canal angi...

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How to Build a Dichoptic Presentation System That Includes an Eye Tracker

We recently proposed a method that allows dichoptic visual stimulus presentation and binocular eye tracking simultaneously1. The key is the combination of an infrared eye tracker and the corresponding infrared-transparent mirrors. This manuscript provides an in depth protocol for initial setup and everyday operation.

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Prostate Cancer: Self-Normalized Detection of ANXA3 from Untreated Urine of Prostate Cancer Patients without Digital Rectal Examination (Adv. Healthcare Mater. 17/2017)

In article number 1700449, Kwan Hyi Lee and co-workers describe an ion-responsive urine sensor for analyzing minuscule amounts of prostate cancer biomarkers. Patients' untreated urine samples are loaded onto the sensor, and the resulting signals are proportional to the amount of the urine cancer biomarker within the patients' urine. The resulting signals are also confirmed to be proportional to the size of the tumor volume measured from patients' magnetic resonance images.

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Micelles: Multifunctional Polymeric Micelles for Combining Chelation and Detection of Iron in Living Cells (Adv. Healthcare Mater. 17/2017)

May P. Xiong and co-workers construct multifunctional Pluronics F127 micelles for iron chelation and fluorescence detection by introducing tetraphenylethene and the chelating drug deferoxamine into self-assembling polymeric micelles in article 1700162. Deferoxamine can simultaneously be used to chelate iron(III) and quench the fluorescence emission of tetraphenylethene. This fluorescence "turn-off" process can be used to monitor the iron chelation process in an iron overload cell model.

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Neural Stimulation: Multiplexed Optogenetic Stimulation of Neurons with Spectrum-Selective Upconversion Nanoparticles (Adv. Healthcare Mater. 17/2017)

An all-optical neural stimulation strategy is demonstrated by utilizing spectrum-tunable NaYF4 based upconversion nanoparticles, which are used as transducers to absorb near-infrared energy and to emit visible light for stimulating neurons expressing channelrhodopsin proteins by Feng Wang, Peng Shi, and co-workers in article 1700446. Depending on the different dopants in the particles, the spectrum of their upconverted emission can be tuned to accommodate different opsin proteins for multiplexed and combinatorial neural stimulation, which is systematically characterized in cultured primary neurons as well as in rodent animals.

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Masthead: (Adv. Healthcare Mater. 17/2017)

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Contents: (Adv. Healthcare Mater. 17/2017)

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Kayexalate (sodium polystyrene sulfonate): Drug Safety Communication - FDA Recommends Separating Dosing

Audience: Internal Medicine, Nephrology, Cardiology, Pharmacy [Posted 09/06/2017] ISSUE: FDA is recommending that patients avoid taking the potassium-lowering drug sodium polystyrene sulfonate (Kayexalate) at the same time as other medicines taken...

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Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases

The red blood cell distribution width (RDW) obtained from a standard complete blood count (CBC) is a convenient and inexpensive biochemical parameter representing the variability in size of circulating erythrocytes. Over the past few decades, RDW with mean corpuscular volume (MCV) has been used to identify quite a few hematological system diseases including iron-deficiency anemia and bone marrow dysfunction. In recent years, many clinical studies have proved that the alterations of RDW levels may be associated with the incidence and prognosis in many cardiovascular and cerebrovascular diseases (CVDs). Therefore, early detection and intervention in time of these vascular diseases is critical for delaying their progression. RDW as a new predictive marker and an independent risk factor plays a significant role in assessing the severity and progression of CVDs. However, the mechanisms of the association between RDW and the prognosis of CVDs remain unclear. In this review, we will provide an overview of the representative literatures concerning hypothetical and potential epidemiological associations between RDW and CVDs and discuss the underlying mechanisms.

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Kayexalate (sodium polystyrene sulfonate): Drug Safety Communication - FDA Recommends Separating Dosing

Audience: Internal Medicine, Nephrology, Cardiology, Pharmacy [Posted 09/06/2017] ISSUE: FDA is recommending that patients avoid taking the potassium-lowering drug sodium polystyrene sulfonate (Kayexalate) at the same time as other medicines taken...

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Use of the “dual construct” for the management of complex spinal reconstructions

Publication date: Available online 5 September 2017
Source:The Spine Journal
Author(s): Francis H. Shen, Rabia Qureshi, Rose Tyger, Rebecca Lehman, Anuj Singla, Adam Shimer, Hamid Hassanzadeh
Background ContextSurgical management of complex spinal reconstructions remains a clinical challenge, as pseudoarthrosis with subsequent rod breakage can occur. Increased rod density in the form of "satellite" or "outrigger" rods have been described; however rod-fracture above or below satellite rods persist and can result in dissociation of the construct, loss of correction, and recurrence of deformity. The use of four distinct and mechanically independent rods (Dual Construct) reduces this concern. Since the original case description in 2006, there have been no other studies that utilize the Dual Construct for the surgical management of complex spinal reconstructions.PurposeThe purpose of this study is to review the long-term experience and surgical technique utilizing the Dual Construct, and to present our complications, rod fracture rates, and outcomes for the surgical management of complex spinal reconstructions.Study DesignTechnique with Case Series OutcomesPatient SamplePatients from single-institute undergoing Dual Construct, 2010-2014 available for 2 year follow-upOutcomes MeasuredRadiographic and functional outcomes, complications, rod fracture rates and revision surgery ratesMethodsRetrospective review was conducted from a single institution between period of 2010 and 2014 with a subsequent 2-year follow-up period. Extensive review of patients' medical record, radiographs, and advanced imaging where available was performed. Medical record was evaluated for patient demographics, surgical procedure, and complications. Radiographic measurements included presence or absence of implant failure and proximal junctional kyphosis/distal junctional kyphosis.ResultsA total of 36 patients underwent surgical reconstruction. The average estimated blood loss was 1,856 cc (range, 400 – 4,000 cc). The average length of stay was 7.3 days (range, 4 – 22 days).Clinical follow-up reported 21 patients (58.3%) with no or minimal pain. There were 6 deaths during the follow-up unrelated to the index procedure. Radiographic follow-up revealed 3 patients (8.3%) with rod fracture; 1 patient with 1 rod fracture, and 2 patients with 2 rod fracture. No patients had 3 or all 4 rods fractures. There were no screw fractures. None of the patients with rod fractures required revision surgery.ConclusionsThe biggest advantage of the Dual Construct is that rod breakage, although uncommon, is typically minimal, or asymptomatic, and more importantly does not result in loss of alignment, and therefore has not required revision surgery. The Dual Construct approach is a safe alternative to traditional 2-rod constructs, with encouraging outcomes at follow-up.



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Establishing benchmarks for the volume-outcome relationship for common lumbar spine surgical procedures

Publication date: Available online 5 September 2017
Source:The Spine Journal
Author(s): Andrew J. Schoenfeld, Daniel J. Sturgeon, Camden B. Burns, Tyler J. Hunt, Christopher M. Bono
Background ContextThe importance of surgeon volume as a quality measure has been defined for a number of surgical specialties. Meaningful procedural volume benchmarks have not been established, however, particularly with respect to lumbar spine surgery.PurposeTo establish surgeon volume benchmarks for the performance of four common lumbar spine surgical procedures (discectomy, decompression, lumbar interbody fusion, lumbar posterolateral fusion).Study DesignRetrospective review of data in the Florida Statewide Inpatient Dataset (2011-2014).Patient SamplePatients who underwent one of the four lumbar spine surgical procedures under study.Outcome MeasuresThe development of a complication or hospital readmission within 90-days of the surgical procedure.MethodsFor each specific procedure, individual surgeon volume was separately plotted against the number of complications and readmissions in a spline analysis that adjusted for co-variates. Spline cut points were used to create a categorical variable of procedure volume for each individual procedure. Log-binomial regression analysis was then separately performed using the categorical volume-outcome metric for each individual procedure and for the outcomes of 90-day complications and 90-day readmissions.ResultsIn all, 187,185 spine surgical procedures met inclusion criteria, performed by 5,514 different surgeons at 178 hospitals. Spline analysis determined that the procedure volume cut-point was 25 for decompressions, 40 for discectomy, 43 for interbody fusion and 35 for posterolateral fusions. For surgeons who failed to meet the volume metric, there was a 63% increase in the risk of complications following decompressions, a 56% increase in the risk of complications following discectomy, a 15% increase in the risk of complications following lumbar interbody fusions and a 47% increase in the risk of complications following posterolateral fusions. Findings were similar for readmission measures.ConclusionsThe results of this work allow us to identify meaningful volume-based benchmarks for the performance of common lumbar spine surgical procedures including decompression, discectomy and fusion-based procedures. Based on our determinations readily achievable goals for individual surgeons would approximate an average of four discectomy and lumbar interbody fusion procedures per month, three posterolateral lumbar fusions per month and at least one decompression surgery every other week.



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The Qualitative Grading of Muscle Fat Infiltration in Whiplash Using Fat/Water Magnetic Resonance Imaging

Publication date: Available online 5 September 2017
Source:The Spine Journal
Author(s): Rebecca Abbott, Anneli Peolsson, Janne West, James M. Elliott, Ulrika Åslund, Anette Karlsson, Olof Dahlqvist Leinhard
Background contextDevelopment of muscle fat infiltration (MFI) in the neck muscles is associated with poor functional recovery following whiplash injury. Custom software and time-consuming manual segmentation of magnetic resonance (MR) images is required for quantitative analysis and presents as a barrier for clinical translation.PurposeThe purpose of this work was to establish a qualitative MR measure for MFI and evaluate its ability to differentiate between individuals with severe whiplash-associated disorder (WAD), mild/moderate WAD, and healthy controls.Study Design/SettingCross-SectionalPatient SampleThirty-one subjects with WAD and 31 age and sex matched controls were recruited from an ongoing randomized controlled trial.Outcome MeasuresThe cervical multifidus was visually identified and segmented into eighths in the axial fat/water images (C4-C7). MFI was assessed on a visual scale: 0 for no or marginal MFI, 1 for light MFI and 2 for distinct MFI. The participants with WAD were divided in two groups: mild/moderate and severe based on neck disability index (NDI) % scores.MethodsThe mean regional MFI was compared between the healthy controls and each of the WAD groups using the Mann-Whitney U-test. ROC-analyses were carried out to evaluate the validity of the qualitative method. The study received funding from the Swedish Research Council and the Medical research council of South-East Sweden (FORSS). AP and UÅ have no conflicts of interests to report. ODL, JW and AK are stockowners in Advanced MR Analytics AB (AMRA). JE reports relevant activities outside the body of work as 35% investment/ownership in a medical consulting start-up, Pain ID, LLC.ResultsTwenty-one (68%) patients had mild/moderate disability and 10 (32%) were considered severe. Inter- and intra- rater reliability was excellent when grading was averaged by level or when frequency of grade 2 was considered. Statistically significant differences (p<0.05) in regional MFI were particularly notable between the severe WAD group and healthy controls. The ROC-curve, based on detection of distinct MFI, showed an area-under-the curve of 0.768 (95% CI 0.59-0.94) for discrimination of WAD participants.ConclusionsThese preliminary results suggest a qualitative MR measure for MFI is reliable and valid, and may prove useful towards the classification of WAD in radiology practice.



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