Primary amenorrhoea and clitoromegaly in a nulliparous woman: successful medical and surgical management

Clitoromegaly is an important sign of virilisation and poses difficulty in sex determination, when present since birth. The diagnosis and treatment in an adult is a major challenge to the treating gynaecologist. The primary reason for its development is androgen excess due to congenital adrenal hyperplasia, polycystic ovarian syndrome, ovarian virilising tumours, neurofibromas, adrenal neoplasm and prolonged intake of anabolic steroids. A case of young nulliparous married woman who presented with primary amenorrhoea and clitoromegaly and was managed successfully has been reported.

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Giant left breast hamartoma in a 45-year-old woman

This is a case of a woman in her fifth decade of life who presented with a lump in her left breast. The patient underwent extensive breast investigations which did not confirm one particular diagnosis. The lesion was excised, and histological findings confirmed the diagnosis of a giant breast hamartoma. This case is interesting due to the largeness. As well as this, giant breast hamartomas are uncommon, and this case highlights the difficulty in their diagnosis and frequent misdiagnoses, potentially contributing to their reported low incidence rates. Diagnosis is difficult due to the complex appearance of the mass on imaging, raising the possibility of malignancy. Core biopsy is unremarkable, with the final diagnosis only possible on histological examination of the resected mass.

https://ift.tt/2Qi7Zaf

Hypoxic hepatitis and furosemide

Hypoxic hepatitis is a rather common complication of heart, circulatory or respiratory failure. We present the case of a patient with hypoxic hepatitis in the setting of heart failure and dehydration from furosemide as a reminder of an important clinical lesson. The pathogenesis of hypoxia (especially in the case of heart failure) is explained by a two-hit mechanism in which the liver at risk of hypoxic injury by passive hepatic congestion (right heart failure) is subsequently exposed to systemic hypoperfusion, which leads to a marked and transient elevation of aminotransferases. In the case presented, the use of furosemide (at least partially) promoted the second hit because it helped to generate hypotension and splanchnic hypovolaemia and favoured hepatic hypoxia.

https://ift.tt/2OvR5rD

Red colour venous flow in the suprasternal view: a red flag sign

Description 

A 3-day-old full-term neonate, born by normal vaginal delivery, was presented with respiratory distress and mild cyanosis. His room air saturation in all four limbs was 84%. The clinical examination was unremarkable. Chest X-ray showed cardiomegaly and increased pulmonary vascular markings. Transthoracic echocardiography revealed 8 mm ostium secundum atrial septal defect (ASD) with bidirectional shunt and dilated right atrium and right ventricle with absence of individual pulmonary veins (PV) draining into left atrium (LA). Suprasternal view showed vertical vein (VV) which was recognised as a vessel lateral to LA with red-coloured continuous flow on Doppler (figure 1). The PVs were draining into the venous confluence behind the LA which was draining into the VV. VV connects into the left innominate vein which finally forms the right superior vena cava (figure 1, video 1).

Figure 1

Suprasternal view demonstrating vertical vein....

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Use of long saphenous vein graft in acute on chronic mesenteric ischaemia

Acute mesenteric ischaemia is a relatively rare surgical emergency, but despite advances in diagnostic tests, the mortality of this condition remains stubbornly high (50%–80%). This is principally because of the non-specific nature of the presenting symptoms and subsequent delay in diagnosis. We report an unusual case of acute mesenteric ischaemia treated by emergency laparotomy, small bowel resection and revascularisation using reversed long saphenous vein graft.

https://ift.tt/2OuqZVW

Primary undifferentiated pleomorphic cardiac sarcoma with MDM2 amplification presenting as acute left-sided heart failure

Primary cardiac tumours are a rare clinical entity that can present with myriad of non-specific cardiopulmonary symptoms. We describe a case of a 61-year-old previously healthy woman who presented with progressive dyspnoea and lower extremity swelling, suggestive of acute left-sided heart failure. Transthoracic echocardiogram revealed a large, 3.7x3.2 cm intracardiac mass resulting in severe mitral valvular dysfunction. The patient underwent surgical resection of the mass, however, negative margins were not obtained, and the tumour quickly returned. Histological and molecular analysis was consistent with the diagnosis of undifferentiated pleomorphic sarcoma with murine double minute 2 (MDM2) amplification. Given the overall grim prognosis, the patient chose to pursue comfort-based care. She died at home 9 months after the initial diagnosis. Here, we provide an updated review of the literature for the classification of undifferentiated pleomorphic cardiac sarcoma and potential treatment modalities.

https://ift.tt/2QgTJ1o

A delayed diagnosis: recurrent fever and beta thalassaemia

Familial Mediterranean fever and beta-thalassaemia are two genetic disorders, with a largely common geographical distribution. However, they have not much else in common, as the first is an autoinflammatory disorder, while the other is a haemoglobinopathy. We describe a patient with known beta-thalassaemia intermedia who presented with recurrent fevers and he was diagnosed with familial Mediterranean fever 2 years later. We discuss whether there is an association between the two disorders and the cognitive biases that lead to the delay in the diagnosis of familial Mediterranean fever.

https://ift.tt/2OrAHIg

Imaging features of toxic megacolon

Description 

A 27-year-old woman presents with vomiting and abdominal pain for 2 days. She had been diagnosed with ulcerative colitis (UC) 2 weeks prior and was started on oral sulfasalazine and prednisolone. Currently, she is afebrile and not tachycardic. On examination, the abdomen was distended and tender centrally. Serial abdominal radiographs showed persistently dilated transverse colon with loss of haustra (figure 1). CT abdomen revealed diffuse bowel thickening involving the ascending colon, caecum and terminal ileum with multiple pseudopolyps at the ascending colon (figure 2). The transverse colon is dilated up to 6.8 cm (figure 3). There are also multiple enlarged right-sided mesenteric nodes. A diagnosis of toxic megacolon (TM) was made. She deteriorated during admission due to acute pulmonary embolism. Blood investigations showed marked leucocytosis (32x10⁹/L) and raised C-reactive proteins (98.7 mg/L). Subtotal colectomy involving the caecum until splenic flexure was performed followed by ileostomy and mucous...

https://ift.tt/2Qk8l04

Modified laparoscopic Janeway gastrostomy: a novel adjunct for the management of choledocholithiasis in Roux-en-Y patients

A 76-year-old woman with surgical history of Roux-en-Y gastric bypass presented with recurrent choledocholithiasis. Double balloon enteroscopy was unsuccessful in cannulating the biliary tree, thus, requiring surgically assisted endoscopic retrograde cholangiopancreaticogram (ERCP) access. Due to her stable clinical status, the non-urgent indication and multiple anticipated ERCPs for definitive biliary clearance, a more durable port of access to the ampulla was desired. A modified laparoscopic Janeway gastrostomy of the gastric remnant was performed and served as access for multiple subsequent endoscopic procedures with successful clearance of the biliary tree.

https://ift.tt/2OrAODG

DRESS syndrome due to vemurafenib treatment: switching BRAF inhibitor to solve a big problem

We present a case report of an early-onset drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) induced by vemurafenib (BRAF inhibitor) in a middle-age man affected by a metastatic, BRAF mutant melanoma who was started on first-line metastatic treatment with vemurafenib and cobimetinib.

After initiating the treatment, the patient presented an extensive cutaneous rash with eosinophilia and renal impairment. Due the constellation of signs and symptoms, a diagnosis of DRESS syndrome was made which strongly contraindicated the reintroduction of vemurafenib due to its hypersensibility reaction. Thus, vemurafenib was stopped immediately, and we started corticoid treatment with clinical improvement.

Due to the contraindication to start vemurafenib again, after multidisciplinary view of the case and having balanced the risks and benefits, we successfully performed a switch to another BRAF inhibitor in a progressively ascending pattern, without any skin toxicity and with a good response of the metastatic melanoma.

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Focus on saving money lets patients and surgeons down [Letters]

https://ift.tt/2Qnyn2A

Influence of socioeconomic events on cause-specific mortality in urban Shanghai, China, from 1974 to 2015: a population-based longitudinal study [Research]

Background:

Understanding how socioeconomic events influence cause-specific mortality is essential for optimizing disease-control strategies. We characterized long-term trends in cause-specific mortality in a stable population from a very large urban centre.

Methods:

We derived population data from 1974 to 2015 on vital status, demographics and causes of death from the death registration system in Yangpu District, Shanghai, China. We examined temporal trends in mortality and assessed the effects of age, period and birth cohort.

Results:

Over 41 879 864 person-years of follow-up, we analyzed 290 332 deaths: 3.80% from communicable conditions (group 1), 86.50% from noncommunicable diseases (group 2), and 5.56% from injuries (group 3). Age-standardized mortality decreased after 1988 for group 1 (average annual percentage change [AAPC] –6.7, 95% confidence interval [CI] –9.3 to –4.1), after 1995 for group 2 (AAPC –2.9, 95% CI –3.5 to –2.3), and after 1994 for group 3 (AAPC –5.4, 95% CI –6.3 to –4.5), after improvements in public health and clinical service infrastructure and the removal of polluting industries during the 1980s. We observed increased mortality from group 2 and group 3 causes in those born between 1955 and 1965, a period that included the Great Chinese Famine. Cause-specific mortality risks increased in those born after 1949 for cancer and diabetes only.

Interpretation:

Birth cohorts exposed to extreme starvation in early life had increased premature cause-specific mortality in later life. Decreased cause-specific mortality followed improvements in public health, medical infrastructure and pollution control, but not for cancer or diabetes, likely because of exposure to new risk factors.

https://ift.tt/2OknIZ9

A perioperative approach to the opioid crisis [Commentary]

https://ift.tt/2Qg6TvI

Improving the quality of health care in Canada [Analysis]

https://ift.tt/2OpQLdN

Medical students protest steadily rising tuition fees [News]

https://ift.tt/2QnycEs

Progressive renal failure complicated by transient and recurrent ureteral obstruction [Practice]

https://ift.tt/2OqTXG6

To what end, evolutionary medicine? [Letters]

https://ift.tt/2Qg6Obo

Chronic pulmonary aspergillosis after pulmonary tuberculosis [Practice]

https://ift.tt/2OnU3hA

How many doctors do we actually need? [News]

https://ift.tt/2Qg6HN0

An open letter to all of the medical journals who send me daily offers to publish my "high-impact research in next months issue" [Humanities]

https://ift.tt/2OuSgqW

Closing male-female gaps in clinical care requires addressing entrenched ideas on gender risks [News]

https://ift.tt/2Qg6Dge

PET imaging of [ 11 C]PBR28 in Parkinson’s disease patients does not indicate increased binding to TSPO despite reduced dopamine transporter binding

Abstract

Purpose

To examine the hypothesis that cerebral binding to the 18 kDa translocator protein (TSPO), a marker of microglia activation, is elevated in Parkinson's disease (PD), and to assess the relationship between brain TSPO binding and dopaminergic pathology in PD.

Methods

The radioligand [¹¹C]PBR28 was used for quantitative assessment of brain TSPO in 16 control subjects and 16 PD patients. To analyse the relationship between dopaminergic pathology and brain TSPO binding, PET studies of the dopamine transporter (DAT) were undertaken in PD patients using the DAT radioligand [¹⁸F]FE-PE2I. The total distribution volume of [¹¹C]PBR28 was quantified in nigrostriatal regions, limbic cortices and thalamus, and the binding potential of [¹⁸F]FE-PE2I was quantified in nigrostriatal regions.

Results

Based on genotype analysis of the TSPO rs6971 polymorphism, 16 subjects (8 control subjects and 8 PD patients) were identified as high-affinity binders, and the remaining subjects were identified as mixed-affinity binders. A two-way ANOVA showed a strong main effect of TSPO genotype on the cerebral binding of [¹¹C]PBR28, whereas no statistically significant main effect of diagnostic group, or a group by genotype interaction was found for any of the regions analysed. [¹⁸F]FE-PE2I PET studies in patients indicated a marked reduction in nigrostriatal binding to DAT. However, no correlations between the binding parameters were found for [¹¹C]PBR28 and [¹⁸F]FE-PE2I.

Conclusion

The findings do not support the hypothesis of elevated cerebral TSPO binding or a relationship between TSPO binding and dopaminergic pathology in PD.

https://ift.tt/2xNXgxg

Effect of Nelumbo nucifera fruit on scopolamine induced memory deficits and motor coordination

Abstract

From prehistoric time till today herbal medications are supposed to have neuroprotective effects both by inhibiting acetyl cholinesterase enzyme or antioxidant ability and are also affordable. Thus extensive studies are necessary to investigate the pharmacological effects of herbal plants. The goal of the present study was to ascertain the outcome of Nelumbo nucifera fruit (NNF) on scopolamine induced amnestic rats along with motor coordination in mice in order to explore its pharmacological use in disorders like Alzheimer's disease (AD). The effect of NNF on learning and memory was assessed by Morris water maze test using 35 Wister rats weighing 200–230 g evenly divided in to five groups. While motor coordination was assessed using Rot rod test, 35 male locally bred albino mice weighing 20–25 g were equally divided in to five groups. Group I was kept as control (10 ml/kg gum tragacanth). Group II, III and IV were labeled as treated groups (NNF 50, 100 and 200 mg/kg). Group V served as reference group (piracetam 200 mg/kg). All drugs were given by oral route as a single dose for 15 days in both experiments to rats and mice, however scopolamine (1 mg/kg IP) was used in Morris water maze test 40 min after the administration of drugs to rats for the induction of amnesia. In Morris water maze test, N. nucifera fruit caused highly significant and significant decrease in escape latency in the amnestic rats at 200 and 100 mg/kg as compared to control. In Rota rod test, N. nucifera fruit did not exhibit any notable changes in the riding time at any dose as compared to control. N. nucifera fruit have demonstrated ameliorating effects on memory without affecting muscle coordination. Hence NNF seems to have great potential for therapeutic application in memory disorders, such as AD which may be due to its ability to enhance cholinergic neurotransmission and exerting antioxidant effect and thus encourage more preclinical and clinical trials in this field.

https://ift.tt/2P0ybWN

FDA-Approved Drug Epidiolex (cannabidiol) Placed in Schedule V of Controlled Substance Act

September 27, 2018 -- WASHINGTON - The Department of Justice and Drug Enforcement Administration today announced that Epidiolex, the newly approved medication by the Food & Drug Administration, is being placed in schedule V of the Controlled...

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EM Nerd-An Addendum to the Case of the Non-inferior Inferiority

Until recently the management of acute appendicitis has lay squarely in the hands of the surgeon. But there is a growing body of evidence examining the use of antibiotics alone in uncomplicated appendicitis. Most of the data exploring this question has found that the majority of patients treated with antibiotics alone will avoid surgery in […]

EMCrit Project by Rory Spiegel.

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The Quantified Athlete: Associations of Wearables for High School Athletes

The adoption of wearable technology in competitive sports can be an advantage to performance and training. Athletes who use personalised data to quantify their performances with the possibilities of sharing with others may use wearables to reinforce the athletic identity. Despite these changes, few studies have actually examined the associations between wearables and developing athletes in their quest for professional sports. Student athletes (n = 437, age = 17y) still in high schools completed a web-based survey about their professional aspirations, athletic identity, and the association with wearables. Wearables were measured by ownership and usage of apps, fitness trackers, or sports watches. Odds ratio (OR) and 95% confidence intervals (CI) were reported. Most high school athletes had apps (64.3%) or fitness trackers (65.2%) and over half of the athletes (58%) had aspirations for professional sport. Athletic identity was positively associated with ownership and usage of apps and fitness trackers. The OR was greater for professional sport aspiration with fitness trackers owners (OR = 2.60, CI = 1.44-4.73) and users (OR = 4.04, CI = 2.09-7.81) than athletes without fitness trackers. Wearables were common among high school athletes and it was part of their athletic identity. For professional aspiring athletes, wearables have the potential to help provide data to support suitable training and competition schedules at a time when students may be overloaded with academic pressures.

https://ift.tt/2xOCNbQ

Predictive Role of Urinary Metabolic Profile for Abnormal MRI Score in Preterm Neonates

Background and Objective. Early identification of neonates at risk for brain injury is important to start appropriate intervention. Urinary metabolomics is a source of potential, noninvasive biomarkers of brain disease. We studied the urinary metabolic profile at 2 and 10 days in preterm neonates with normal/mild and moderate/severe MRI abnormalities at term equivalent age. Methods. Urine samples were collected at two and 10 days after birth in 30 extremely preterm infants and analyzed using proton magnetic resonance spectroscopy. A 3 T MRI was performed at term equivalent age, and images were scored for white matter (WM), cortical grey matter (cGM), deep GM, and cerebellar abnormalities. Infants were divided in two groups: normal/mild and moderately/severely abnormal MRI scores. Results. No significant clustering was seen between normal/mild and moderate/severe MRI scores for all regions at both time points. The ROC curves distinguished neonates at 2 and 10 days who later developed a markedly less mature cGM score from the others (2 d: area under the curve (AUC) = 0.72, specificity (SP) = 65%, sensitivity (SE) = 75% and 10 d: AUC = 0.80, SP = 78%, SE = 80%) and a moderately to severely abnormal WM score (2 d: AUC = 0.71, specificity (SP) = 80%, sensitivity (SE) = 72% and 10 d: AUC = 0.69, SP = 64%, SE = 89%). Conclusions. Early urinary spectra of preterm infants were able to discriminate metabolic profiles in patients with moderately/severely abnormal cGM and WM scores at term equivalent age. Urine spectra are promising for early identification of neonates at risk of brain damage and allow understanding of the pathogenesis of altered brain development.

https://ift.tt/2Qjs8wq

Monthly News Roundup - September 2018

Ajovy for Migraine Prevention Cleared With Two Dosing Options Ajovy (fremanezumab-vfrm), an injectable migraine preventive for adults was FDA-approved this month. From Teva, it is the second approved migraine preventive that targets the...

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Updates on the Status of Vitamin D as a Risk Factor for Respiratory Distress Syndrome

To update the guidelines regarding vitamin D status in respiratory distress syndrome, we reviewed recent human and animal studies on the benefits of vitamin D in respiratory distress. We searched PubMed and ProQuest for studies on the use of vitamin D from 2009 to 2017. The common parameters in these studies included the use of lung tissue, phospholipids, blood, and plasma to assess the effects of vitamin D on respiratory syndrome. The metabolized form of vitamin D used in these studies was 1,25(OH)2D3 in animal studies and 25(OH)D in human studies. Vitamin D supplementation decreases the risk of respiratory distress syndrome, improves the quality of life, and is relatively effective and safe for preterm neonates as well as during lung maturation. However, although vitamin D supplementation may offer benefits for respiratory distress syndrome, the optimal dosing strategies for specific types of risk factors in the lungs must be clarified to confirm the therapeutic efficacy.

https://ift.tt/2Opac6v

Manipulating the stereoselectivity of a thermostable alcohol dehydrogenase by directed evolution for efficient asymmetric synthesis of arylpropanols

Journal Name: Biological Chemistry
Issue: Ahead of print


https://ift.tt/2It34Ra

Characterization of the cholesterol efflux of apolipoprotein E-containing high-density lipoprotein in THP-1 cells

Journal Name: Biological Chemistry
Issue: Ahead of print


https://ift.tt/2xNpecM

Saccharomyces cerevisiae Exponential Growth Kinetics in Batch Culture to Analyze Respiratory and Fermentative Metabolism

Here we present a protocol to estimate the respiratory and fermentative metabolism by fitting the exponential growth of Saccharomyces cerevisiae to the exponential growth equation. Calculation of the kinetic parameters allows for the screening of influences of substances/compounds on fermentation or mitochondrial respiration.

https://ift.tt/2OXOiEj

Single-cell Transcriptomic Analyses of Mouse Pancreatic Endocrine Cells

We describe a method for the isolation of endocrine cells from embryonic, neonatal and postnatal pancreases followed by single-cell RNA sequencing. This method allows analyses of pancreatic endocrine lineage development, cell heterogeneity and transcriptomic dynamics.

https://ift.tt/2NW92A9

Common Variable Immunodeficiency with Genetic Defects Identified by Whole Exome Sequencing

Common variable immunodeficiency (CVID) belongs to the primary immunodeficiency disorders (PIDs), presenting a profound heterogeneity in phenotype and genotype, with monogenic or complex causes. Recurrent respiratory infections are the most common clinical manifestations. CVID patients can also develop various autoimmune and lymphoproliferative complications. Genetic testing such as whole exome sequencing (WES) can be utilized to investigate likely genetic defects, helping for better clinical management. We described the clinical phenotypes of three sporadic cases of CVID, who developed recurrent respiratory infections with different autoimmune and lymphoproliferative complications. WES was applied to screen disease-causing or disease-associated mutations. Two patients were identified to have monogenic disorders, with compound heterozygous mutations in LRBA for one patient and a frameshift insertion in NFKB1 for another. The third patient was identified to be a complex form of CVID. Two novel mutations were identified, respectively, in LRBA and NFKB1. A combination of clinical and genetic diagnosis can be more extensively utilized in the clinical practice due to the complexity and heterogeneity of CVID.

https://ift.tt/2y1XJLN

Understanding the Motives of Undertaking Physical Activity with Different Levels of Intensity among Adolescents: Results of the INDARES Study

Background. The aim of this study was to evaluate the relationship between the motives for undertaking physical activity (PA) and the intensity of PA in Polish adolescents. Methods. The study included 1,231 students, 515 boys (age 16.2 ± 0.7 years) and 716 girls (age 16.3 ± 0.6 years). The participants were recruited from secondary schools in 20 conurbations throughout Poland. The International Physical Activity Questionnaire-Long Form and the Motives for Physical Activity Measure-Revised were used. Results. In boys, all motives predicted a 10.4% variance in vigorous intensity of PA (F(5, 509) = 11.822, p

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Multiple Low Frequency Ultrasound Enhances Bactericidal Activity of Vancomycin against Methicillin-Resistant Staphylococcus aureus Biofilms

Methicillin-resistant Staphylococcus aureus (MRSA) biofilm infections are difficult to treat due to the high antimicrobial resistance of biofilm. Therefore, new treatments are needed for more effective bacteria clearance. This study was to investigate whether low frequency ultrasound (LFU) can enhance the activity of antimicrobial agents against MRSA biofilm infection. Broth microdilution method was used to determine the minimum inhibitory concentration (MIC) of vancomycin (VAN), linezolid (LIN), and levofloxacin (LEV) against three clinical isolated strains, including one methicillin-susceptible Staphylococcus aureus (MSSA) strain and two MRSA strains. Effects of various influencing factors, such as antimicrobial agents, drug concentrations, ultrasonic intensity, and single (S-LFU, 5 or 15 min) or multiple ultrasound (M-LFU, 5 min every 8 h), on the inhibition of biofilms were investigated. The bactericidal effects of S-LFU or M-LFU on MRSA or MSSA biofilms were determined by colony counts. Right after ultrasound, synergistic effects were observed in groups of S-LFU combined with three antimicrobial agents against MSSA biofilm, but for MRSA biofilm, only S-LFU plus VAN had synergistic effect. At the time point of 24 h, M-LFU plus VAN treatment had synergistic bactericidal effect against MRSA and MSSA biofilms, and the synergy showed that VAN is concentration-dependent, but no synergistic effects were observed in all S-LFU combination groups. In conclusion, combination of M-LFU and antimicrobial agents had a better synergistic effect than S-LFU against MRSA or MSSA biofilm. LFU may be useful in treating biofilm infection in the future.

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Potential of Maintaining a Healthy Vaginal Environment by Two Lactobacillus Strains Isolated from Cocoa Fermentation

Bacteria in the genera Mycoplasma and Ureaplasma do not have cell walls and therefore interact with host cells through lipid-associated membrane proteins (LAMP). These lipoproteins are important for both surface adhesion and modulation of host immune responses. Mycoplasma and Ureaplasma have been implicated in cases of bacterial vaginosis (BV), which can cause infertility, abortion, and premature delivery. In contrast, bacteria of the genus Lactobacillus, which are present in the vaginal microbiota of healthy women, are thought to inhibit local colonization by pathogenic microorganisms. The aim of the present study was to evaluate the in vitro interactions between lipoproteins of Mycoplasma and Ureaplasma species and vaginal lineage (HMVII) cells and to study the effect of Lactobacillus isolates from cocoa fermentation on these interactions. The tested Lactobacillus strains showed some important probiotic characteristics, with autoaggregation percentages of 28.55% and 31.82% for L. fermentum FA4 and L. plantarum PA3 strains, respectively, and percent adhesion values of 31.66 and 41.65%, respectively. The two strains were hydrophobic, with moderate to high hydrophobicity values, 65.33% and 71.12% for L. fermentum FA4 and L. plantarum PA3 in toluene. Both strains secreted acids into the culture medium with pH=4.32 and pH=4.33, respectively, and showed antibiotics susceptibility profiles similar to those of other lactobacilli. The strains were also able to inhibit the death of vaginal epithelial cells after incubation with U. parvum LAMP from 41.03% to 2.43% (L. fermentum FA4) and 0.43% (L. plantarum PA3) and also managed to significantly decrease the rate of cell death caused by the interaction with LAMP of M. hominis from 34.29% to 14.06% (L. fermentum FA4) and 14.61% (L. plantarum PA3), thus demonstrating their potential for maintaining a healthy vaginal environment.

https://ift.tt/2NcxKH9

Harmful Roles of TLR3 and TLR9 in Cardiac Dysfunction Developing during Polymicrobial Sepsis

We determined the roles of TLR3 and TLR9 in adverse events of polymicrobial sepsis, with a focus on development of septic cardiomyopathy, progression of which we have recently shown to be complement- and histones-dependent. So Wt, TLR3-knocked out (K.O.), and TLR9-K.O. mice were subjected to polymicrobial sepsis following cecal ligation and puncture (CLP). In the absence of either TLR3 or TLR9, the intensity of echocardiogram (Echo)-Doppler dysfunction during development of cardiomyopathy was substantially reduced in the K.O. mice. Based on our prior studies emphasizing the adverse effects of plasma C5a and histones in the cardiomyopathy of sepsis, in TLR3- and TLR9-K.O. mice, there were striking reductions in plasma levels of C5a and histones as well as reduced levels of cytokines in plasma and heart tissue after CLP. Since we know that histones cause cardiac dysfunction, rat cardiomyocytes (CMs) were exposed in vitro to the histones (purified from calf thymus), which caused bleb formation on the surfaces of CMs, suggesting histones may perturb the cell membrane of CMs. In vitro, exposure of CMs to the histones for 3 hours caused lactate dehydrogenase release from CMs. These data indicate that sepsis-induced cardiac dysfunction requires presence of TLR3 and TLR9 and may be linked to histone-induced damage of CMs.

https://ift.tt/2OkYutI

Green Tea Polyphenols and Padma Hepaten Inhibit Candida albicans Biofilm Formation

Candida albicans (C. albicans) is the most prevalent opportunistic human pathogenic fungus and can cause mucosal membrane infections and invade the blood. In the oral cavity, it can ferment dietary sugars, produce organic acids and therefore has a role in caries development. In this study, we examined whether the polyphenol rich extractions Polyphenon from green tea (PPFGT) and Padma Hepaten (PH) can inhibit the caries-inducing properties of C. albicans. Biofilms of C. albicans were grown in the presence of PPFGT and PH. Formation of biofilms was tested spectrophotometrically after crystal violet staining. Exopolysaccharides (EPS) secretion was quantified using confocal scanning laser microscopy (CSLM). Treated C. albicans morphology was demonstrated using scanning electron microscopy (SEM). Expression of virulence-related genes was tested using qRT-PCR. Development of biofilm was also tested on an orthodontic surface (Essix) to assess biofilm inhibition ability on such appliances. Both PPFGT and PH dose-dependently inhibited biofilm formation, with no inhibition on planktonic growth. The strongest inhibition was obtained using the combination of the substances. Crystal violet staining showed a significant reduction of 45% in biofilm formation using a concentration of 2.5mg/ml PPFGT and 0.16mg/ml PH. A concentration of 1.25 mg/ml PPFGT and 0.16 mg/ml PH inhibited candidal growth by 88% and EPS secretion by 74% according to CSLM. A reduction in biofilm formation and in the transition from yeast to hyphal morphotype was observed using SEM. A strong reduction was found in the expression of hwp1, eap1, and als3 virulence associated genes. These results demonstrate the inhibitory effect of natural PPFGT polyphenolic extraction on C. albicans biofilm formation and EPS secretion, alone and together with PH. In an era of increased drug resistance, the use of phytomedicine to constrain biofilm development, without killing host cells, may pave the way to a novel therapeutic concept, especially in children as orthodontic patients.

https://ift.tt/2y0NXti

Utilization Pattern of Traditional Chinese Medicine among Fracture Patients: A Taiwan Hospital-Based Cross-Sectional Study

Traditional Chinese medicine (TCM) divides fracture treatment into three stages. Many TCM herbs and formulas have been used to treat fractures for thousands of years. However, research regarding the Chinese herbal products (CHPs) that should be used at different periods of treatment is still lacking. This study aims to identify the CHPs that should be used at different periods of treatment as well as confirm the TCM theory of fracture periods medicine. We used prescriptions of TCM outpatients with fracture diagnoses analyzed using the Chang Gung Research Database (CGRD) from 2000 to 2015. According to the number of days between the date of the fracture and the clinic visit date, all patients were assigned to one of three groups. Patients with a date gap of 0-13 days were assigned to the early period group; those with a date gap of 14-82 days were assigned to the middle period group; and those with a date gap of 83-182 days were assigned to the late period group. We observed the average number of herbal formulas prescribed by the TCM doctor at each visit was 2.78, and the average number of single herbs prescribed was 6.47. The top three prescriptions in the early fracture period were Zheng-gu-zi-jin-dang, Shu-jing-huo-xue-tang, and Wu-ling-san. In the middle fracture period, the top three formulas were Zheng-gu-zi-jin-dang, Shu-jing-huo-xue-tang, and Zhi-bai-di-huang-wan. In the late fracture period, the top three formulas were Shu-jing-huo-xue-tang, Gui-lu-er-xian-jiao, and Du-huo-ji-sheng-tang. The main single herbs used in the early fracture period were Yan-hu-suo, Gu-sui-bu, and Dan-shen. From the middle to the late period, the most prescribed single herbs were Xu-duan, Gu-sui-bu, and Yan-hu-suo. We concluded that the results showed that the CGRD utilization pattern roughly meets the TCM theory at different fracture periods.

https://ift.tt/2Oq12GE

Anti-Inflammatory and Antioxidant Properties of the Extract, Tiliroside, and Patuletin 3-O-β-D-Glucopyranoside from Pfaffia townsendii (Amaranthaceae)

Brazilian ginseng, including Pfaffia townsendii, is used in popular medicine as a natural anti-inflammatory, tonic, analgesic, and antidiabetic agent. In this study, we investigated the chemical composition and evaluated the antioxidant and anti-inflammatory activities of the P. townsendii ethanolic extract as well as the major isolated glycoside flavonoids tiliroside and patuletin 3-O-β-D-glucopyranoside. Chromatographic techniques and spectroscopic analysis were used for the isolation and identification of the major compounds. The antioxidant potential was determined through DPPH and ORAC-FL assays. The total phenolic content was measured using Folin-Ciocalteu reagent. The anti-inflammatory activity was determined based on a model of paw edema and carrageenan- (Cg-) induced pleurisy. We identified three phenolic acids, one carboxylic acid and two flavonoids, patuletin 3-O-β-D-glucopyranoside, and tiliroside. The ethanol crude extracts, partitions and isolated flavonoids (4581 μmol of Trolox equivalents/g of extract in ORAC and a SC50 of approximately 31.9 μg/mL in the DPPH assay) demonstrated antioxidant activity, and the ethanolic extract as well as isolated flavonoids inhibited paw edema induced by Cg and leukocyte migration in the Cg-induced pleurisy model. The extract, tiliroside, and patuletin 3-O-β-D-glucopyranoside obtained from P. townsendii have therapeutic potential against oxidative stress-related and inflammatory disorders.

https://ift.tt/2y0NUh6

The Effect of Xialiqi Capsule on Testosterone-Induced Benign Prostatic Hyperplasia in Rats

Benign prostatic hyperplasia (BPH) is common among elderly men, of which inflammation, oxidative stress, proliferative, and apoptotic changes play important roles. Xialiqi (XLQ) capsule, a traditional Chinese herbal formula, is used as a potential drug in treating BPH. This study aims to evaluate the therapeutic effect of XLQ capsule on testosterone propionate- (TP-) induced BPH in rats. Fifty male Sprague-Dawley rats were randomly divided into 5 groups: sham control, BPH model, high and low dose of XLQ, and finasteride as a positive control group. All groups were treated with appropriate drugs/normal saline for 28 consecutive days. Prostate weights were recorded; histopathological changes and content of IL-8, TNF-α, DHT, SOD, MDA, caspase-3, and PCNA of the prostate were determined. Animals with BPH demonstrated significantly increased prostate weights and prostate index, higher levels of IL-8, TNF-α, DHT, MDA, and PCNA, but lower activity of SOD and reduced expression of caspase-3. After treatment with XLQ, significant reductions of prostate weights, prostate index, IL-8, TNF-α, DHT, MDA, and PCNA, increased activity of SOD, and higher level of caspase-3 were shown. The present study indicates that XLQ can effectively prevent the development of TP-induced BPH model through mechanisms of anti-inflammation, antioxidation, antiproliferation, and proapoptosis.

https://ift.tt/2Oq1ftq

Immunological and Clinical Characteristics of Systemic Lupus Erythematosus: A Series from Morocco

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with a high female predominance. To date, studies about SLE in Morocco are few. This retrospective study describes the clinical and immunological features in a series of 50 SLE Moroccan patients in University Hospital Center of Rabat, Morocco, between December 2011 and December 2013. All patients were screened for antinuclear antibodies (ANA) and anti-DNA antibodies by indirect immunofluorescence, followed by identification of anti-extractable nuclear antigen antibodies by ELISA. The female to male ratio was 6.1:1. Mean age was 31.72 years. The main clinical manifestations were arthritis (82%), mucocutaneous manifestations (80%), renal manifestations (50%), and hematological features (46%). Of the mucocutaneous features, the highest frequencies were observed in the malar rash (68%) and photosensitivity (60%). Of the hematological features, lymphopenia was most frequently observed in 30% of patients, followed by hemolytic anemia in 16% and leucopenia and thrombocytopenia in 8%. Central nervous system was involved in 10%. ANA were found in 88%, anti-DNA antibodies in 56%, and anti-Sm antibodies in 50%. Anti-SSA, anti-SSB, anti-Sm/RNP, and anti-Scl70 antibodies were detected in 38%, 10%, 48%, and 8%, respectively. Our data show that, in our patients, the main clinical and immunological features of SLE remain comparable to patients from other Arab countries.

https://ift.tt/2xOJ2fX

Characterisation of Patients with Systemic Lupus Erythematosus in Malta: A Population Based Cohort Cross-Sectional Study

Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disorder. The aim of this study was to characterise the SLE patients living in Malta in order to estimate the prevalence and incidence of SLE and characterise the clinical presentation as well as identify any unmet needs. 107 SLE patients who fulfilled SLICC classification criteria were identified. These were invited to participate in the study by means of an interview, blood and urine tests, and filling of the following questionnaires: Fatigue Severity Scale (FSS), visual analogue scale (VAS) for fatigue, Hospital Anxiety and Depression Scale (HADS), VAS for pain, Pittsburgh Sleep Quality Index (PSQI), and modified Health Assessment Questionnaire (mHAQ). The estimated prevalence of SLE in Malta is 29.3 patients per 100,000 and the estimated incidence is 1.48 per 100,000 per year. 93.5% of SLE patients were female, and the mean age at diagnosis was 33.1 years. 60.8% were overweight or obese and body mass index (BMI) had a significant positive correlation with daily dose of prednisolone (R=0.177, p=0.046). 20.7% and 3.3% had a moderate and high disease activity, respectively, as measured by SLEDAI-2K. Disease activity had a significant positive correlation with functional disability measured by mHAQ (R=0.417, p3.7) and 57.6% had a high level of anxiety (HADS ≥8). This study has identified a number of unmet needs of SLE patients, including obesity, uncontrolled disease activity, fatigue, and anxiety.

https://ift.tt/2P476lC

Squalene Stimulates a Key Innate Immune Cell to Foster Wound Healing and Tissue Repair

Anti-inflammatory effects of virgin olive oil (VOO) have been described recently, along with its wound healing effect. One of the main minor compounds found in VOO is squalene (SQ), which also possesses preventive effects against skin damage and anti-inflammatory properties. The inflammatory response is involved in wound healing and manages the whole process by macrophages, among others, as the main innate cells with a critical role in the promotion and resolution of inflammation for tissue repair. Because of that, this work is claimed to describe the role that squalene exerts in the immunomodulation of M1 proinflammatory macrophages, which are the first cells implicate in recent injuries. Pro- and anti-inflammatory cytokines were analysed using TPH1 cell experimental model. SQ induced an increase in the synthesis of anti-inflammatory cytokines, such as IL-10, IL-13, and IL-4, and a decrease in proinflammatory signals, such as TNF-α and NF-κB in M1 proinflammatory macrophages. Furthermore, SQ enhanced remodelling and repairing signals (TIMP-2) and recruitment signals of eosinophils and neutrophils, responsible for phagocytosis processes. These results suggest that SQ is able to promote wound healing by driving macrophage response in inflammation. Therefore, squalene could be useful at the resolution stage of wound healing.

https://ift.tt/2NPdNuY

Diabetes and Metabolism Disorders Medicinal Plants: A Glance at the Past and a Look to the Future 2018

https://ift.tt/2QkFg4F

Investigating the Antiproliferative and Antioxidant Properties of Pancratium maritimum L. (Amaryllidaceae) Stems, Flowers, Bulbs, and Fruits Extracts

Pancratium maritimum stems, flowers, bulbs, and fruits extracts were investigated for their antiproliferative and antioxidant properties. Total phenols and total flavonoids were also determined. The in vitro antiproliferative activity was tested against seven cancer cell lines such as C32, HeLa, MDA-MB-231, PC3, A549, MCF-7, and LNCaP by using SRB assay. Interesting results were obtained with stems ethanol extract (ET1) against C32 cells (IC50 of 27.1 μg/mL) and fruits aqueous extract (AQ) against MCF-7 cell line (IC50 of 36.5 μg/mL). To define the antioxidant activity, four tests such as DPPH, ABTS FRAP, and β-carotene bleaching tests were used. The most promising ABTS scavenging capacity was observed with fruits ethanol extract (ET1) that showed an IC50 value of 6.9 μg/mL. According to the correlation results, the phenols and flavonoids content could provide a fundamental contribution to the antioxidant and antiproliferative activity of P. maritimum extracts.

https://ift.tt/2NO1XRQ

A retrospective cohort study of peri‐implant condition in Chinese patients with different periodontal condition and maintenance frequency

Clinical Oral Implants Research, Volume 0, Issue ja, -Not available-.


https://ift.tt/2OYwqJB

Manipulation of the balance between Th2 and Th2/1 hybrid cells affects parasite nematode fitness in mice

European Journal of Immunology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2OlIsj6

Intravenous immunoglobulin protects from experimental allergic bronchopulmonary aspergillosis via a sialylation‐dependent mechanism

European Journal of Immunology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Qf8Fgu

A New Model of Diarrhea with Spleen-Kidney Yang Deficiency Syndrome

Objective. The aim of this study was to examine a new method to create a rat model of diarrhea with spleen-kidney yang deficiency syndrome. Methods. A senna leaf (Folium sennae) decoction was made in 3 concentrations of 1.0, 0.5, and 0.25 g/mL. Rats were randomly divided into 4 groups: the control (C)-, high (H)-, middle (M)-, and low (L)- dose groups. The groups received saline, 1.0, 0.5, or 0.25 g/mL senna leaf decoction, respectively, for 4 weeks. Body weight monitoring, food consumption, water intake, defecation frequency, stool Bristol score, weight-loaded forced swimming test, forelimb grip strength test, D-xylose absorption test, serum cortisone, adrenocorticotropic hormone (ACTH), 24 h urine 17-hydroxycorticosteroid (17-OHCS), and histopathological detection were conducted to assess the success of the senna leaf decoction-induced model. Results. This study showed that the senna leaf decoction could induce diarrhea and dose-dependently slow body weight growth, reduce food consumption, and increase water intake, stool Bristol score, and defecation frequency. Statistical differences were found between groups H and M in rectal temperature, weight-loaded forced swimming time, forelimb grip strength, and serum cortisone. The D-xylose absorption test also showed dysfunction of intestinal absorption in groups H and M. The serum cortisone and 24 h urine 17-OHCS were significantly reduced in group H. Conclusions. Gastric gavage of 10 mL/kg of body weight of a high concentration of a senna leaf decoction (1.0 g/mL) for 4 weeks was used to create a rat model of diarrhea with spleen-kidney yang deficiency syndrome.

https://ift.tt/2QkwPX3

Gynura procumbens Improved Fertility of Diabetic Rats: Preliminary Study of Sperm Proteomic

Gynura procumbens (GP) is a medicinal herb that has long been known as anti-inflammatory and antihyperglycaemic. Recently, this herbal extract has been associated with a profertility effect, suggesting its applicability in treating both diabetes and male infertility. In this study, the effects of GP aqueous extract (GPAE) on diabetic rats were investigated through evaluating testes histology and androgen hormone levels as well as the implantation sites of female rats on copulation with the treated male rats. Three dosages of GPAE were used (150, 300, and 450 mg/kg), and there were three control groups [normal, diabetic, and metformin-treated diabetic]. Testes histology, androgen hormone levels, and number of implantation sites of the GPAE-treated groups matched those of the normal group in contrast to the diabetic and metformin-treated diabetic controls. Sperm proteomics analysis identified 666 proteins, but only 88 were consistently found in all the control and 450-mg/kg GPAE-treated groups. Four proteins, including cysteine-rich secretory protein 1, carboxylesterase 5A, zona pellucida binding protein, and phosphatidylethanolamine-binding protein 1, were significantly upregulated with GPAE treatment compared with the diabetic control, matching the protein levels of the normal group. These proteins were mainly involved in sperm maturation, sperm capacitation, and sperm-egg interaction, suggesting that GP treatment was able to restore the fertility of male diabetic rats at molecular protein level. In conclusion, GP treatment effectively treats infertility of male diabetic rats, possibly through the upregulation of proteins related to sperm maturation and sperm-egg interaction.

https://ift.tt/2RelU2a

Acupuncture and Related Therapies for Obesity: A Network Meta-Analysis

Obesity is a worldwide public health problem. Currently, increasing evidence suggests acupuncture and related therapies are effective for obesity. This network meta-analysis (NMA) was performed to compare the effectiveness of different acupuncture and related therapies. We searched potential randomized controlled trials (RCTs) in three international databases. Thirty-four trials involving 2283 participants were included. Pairwise meta-analysis showed that acupuncture and related therapies were superior to lifestyle modification and placebo in reducing weight and body mass index (BMI). Based on decreases in body weight, results from NMA showed that acupoint catgut embedding (standard mean difference [SMD]: 1.26; 95% credible interval [95% CI], 0.46–2.06), acupuncture (SMD: 2.72; 95% CrI, 0.06–5.29), and combination of acupuncture and related theories (SMD: 3.65; 95% CrI, 0.96–6.94) were more effective than placebo. Another NMA result indicated that acupoint catgut embedding (SMD: 0.63; 95% CI, 0.25–1.11), acupuncture (SMD: 1.28; 95% CrI, 0.43–2.06), combination of acupuncture and related therapies (SMD: 1.44; 95% CrI, 0.64–2.38), and electroacupuncture (SMD: 0.60; 95% CrI, 0.03–1.22) were superior to lifestyle modification in decreasing BMI. Combination of acupuncture and related therapies was ranked the optimal method for both reducing weight and BMI. Further studies will clarify which combination of acupuncture and related therapies is better.

https://ift.tt/2QlTnXu

Applications of Bioinformatics and Systems Biology in Precision Medicine and Immunooncology

https://ift.tt/2xLQJmS

Innervation of the Anconeus Epitrochlearis Muscle: MRI and Cadaveric Studies

Clinical Anatomy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2y1QBz4

Adoptive Transfers of CD4+CD25+ Tregs Raise Foxp3 Expression and Alleviate Mouse Enteritis

CD4+CD25+Foxp3+ Tregs control the immune response and maintain immune homeostasis. This study examined whether Tregs can affect mouse enteritis and the Foxp3 (Forkhead transcription factor) transcriptional pathway. Mouse CD4+CD25+ Treg cells were labelled using CFSE (5,6-carboxyfluorescein diacetate succinimidyl ester) and transferred to enteritis model mice. The mice were randomly divided into an enteritis group, a Treg-infusion group, a Treg-inhibiting group, and a control group. Histopathology, ELISA, flow cytometry, western blot, immunohistochemistry, and immunofluorescence were performed. Our results demonstrated that CD4+CD25+ Tregs were successfully transferred. The disease activity index (DAI) scores in the Tregs-infusion group were lower than those of the enteritis and Tregs-inhibiting groups. The number of goblet cells and inflammatory cells was reduced, and the levels of IL-1β, TNF-α, NO, and PGE2 were significantly decreased in the Tregs-infusion group compared to those in the enteritis group (p

https://ift.tt/2xV4FeD

Emergency versus Elective Cervical Cerclage: An Audit of Our First Two Years of Service

One of the biggest obstetric challenges is the diagnosis and management of a short cervix as cervical length has an inverse relationship with risk of preterm birth. A cervical cerclage is a surgical procedure to reduce the risk of preterm birth and can be placed in an elective or emergency setting. This is a retrospective review of cervical cerclages inserted at an outer metropolitan hospital from February 2014 to May 2017. Since the introduction of the service, a total of 43 patients were identified as requiring a cervical cerclage. Four of these patients were transferred to tertiary hospitals. Of the 39 cerclages inserted, 26 were elective and 13 were emergency, placed at a mean gestation of 15.6 and 19.6 weeks. In total, there were 35 live births, 2 stillbirths, and 2 neonatal deaths. The maternal demographics (age, gravidity, parity, and preterm risk factors) were not statistically significant between the two groups. The mean pregnancy prolongation and birthweight was greater in the elective than the emergency group (21.4 versus 14.1 weeks; 3148.2 versus 2447.2 grams). There was no obvious pattern with which patients received antibiotics pre-, intra-, or postoperatively or received a vaginal swab. This audit identified the need for improvements to guidelines to standardise the use of antibiotics and progesterone in women with a cervical cerclage.

https://ift.tt/2DIihPD

Attitude towards Mental Illness among Primary Healthcare Providers: A Community-Based Study in Rural China

Objective. There are no studies that have explored attitudes towards mental illness that are held by rural primary healthcare (PHC) providers. The aim of this study was to conduct evidential and comparative research about attitudes towards mental illness among primary healthcare providers from different mental health service models in China rural communities. Methods. A self-administered questionnaire was conducted with a total of 361 rural primary healthcare providers engaged in mental health service delivery. Results. Total attitude score mark of rural primary healthcare providers shows that most PHC providers still held pessimistic and negative attitude towards mental illness patients. 71.3% of respondents agreed that "the mental patients often impulsively perform destruction of property"; 72.9% agreed that "mental patients are burdens to the families and society." There are also positive correlations between attitudes and abilities of primary healthcare providers to mental illness. Conclusion. This study provides baseline evidence that primary healthcare providers in rural China hold negative attitudes towards mental illness. It is critical to improve negative attitudes and understanding about the importance of the management of severe mental illness among rural primary healthcare workers in mental health services. We should take comprehensive methods to enrich primary healthcare providers' professional knowledge about mental illness and eliminate discrimination and inappropriate perception against the mental illness.

https://ift.tt/2DP89nY

Polyunsaturated fatty acids and atherosclerosis: insights from pre‐clinical studies

European Journal of Lipid Science and Technology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2DE5Ynn

Characterization of nitrophospholipid‐peptide covalent adducts by electrospray tandem mass spectrometry: a first screening analysis using different instrumental platforms

European Journal of Lipid Science and Technology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2OldBmH

Minding the Gap: A Qualitative Study of Provider Experience to Optimize Care for Critically Ill Children in General Emergency Departments

Academic Emergency Medicine, Volume 0, Issue ja, -Not available-.


https://ift.tt/2zFO7bz

Whole exome sequencing resolves complex phenotype and identifies CC2D2A mutations underlying non‐syndromic rod‐cone dystrophy

Clinical Genetics, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xLeueU

Genetic variant in the β2‐Adrenergic receptor (Arg16Gly) influences fat free mass, muscle strength, and motor unit behavior in young men

Experimental Physiology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2RczeV6

Finite Element Investigation of the Effects of the Low-Frequency Vibration Generated by Vehicle Driving on the Human Lumbar Mechanical Properties

Long-term exposure to low-frequency vibration generated by vehicle driving impairs human lumbar spine health. However, few studies have investigated how low-frequency vibration affects human lumbar mechanical properties. This study established a poroelastic finite element model of human lumbar spinal segments L2–L3 to perform time-dependent vibrational simulation analysis and investigated the effects of different vibrational frequencies generated by normal vehicle driving on the lumbar mechanical properties in one hour. Analysis results showed that vibrational load caused more injury to lumbar health than static load, and vibration at the resonant frequency generated the most serious injury. The axial effective stress and the radial displacement in the intervertebral disc, as well as the fluid loss in the nucleus pulposus, increased, whereas the pore pressure in the nucleus pulposus decreased with increased vibrational frequency under the same vibrational time, which may aggravate the injury degree of human lumbar spine. Therefore, long-term driving on a well-paved road also induces negative effects on human lumbar spine health. When driving on a nonpaved road or operating engineering machinery under poor navigating condition, the auto seat transmits relatively high vibrational frequency, which is highly detrimental to the lumbar spine health of a driver.

https://ift.tt/2RaKocT

The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: a randomized triple-blind clinical trial

One of the most common orthopedic problems is the incidence of pressure ulcer followed by immobility. This study aimed to investigate the effect of Aloe Vera gel on the prevention of pressure ulcer in patients ho...

https://ift.tt/2RaZLBW

Rush progression and fatal result of septic shock related to central line catheter infection in cirrhosis patient with brain stroke

Catheter-related blood stream infection (CRBSI) is one of the most common intractable healthcare-associated infections because catheters can be easily contaminated by resistant bacteria, and is associated with...

https://ift.tt/2xODLF4

Cases of visual impairment caused by cerebral venous sinus occlusion-induced intracranial hypertension in the absence of headache

Cerebral venous sinus thrombosis or stenosis (here collectively referred to as cerebral venous sinus occlusion, CVSO) can cause chronically-elevated intracranial pressure (ICP). Patients may have no neurologic...

https://ift.tt/2DGs1d5

Visual outcome is similar in optic neuritis patients treated with oral and i.v. high-dose methylprednisolone: a retrospective study on 56 patients

To investigate visual recovery after treatment of acute optic neuritis (ON) with either oral or intravenous high-dose methylprednisolone, in order to establish the best route of administration.

https://ift.tt/2xQWv6N

Phenotypic analysis of antibiotic resistance and genotypic study of the vacA, cagA, iceA, oipA and babA genotypes of the Helicobacter pylori strains isolated from raw milk

Foods with animal origins and particularly milk play a considerable role in transmission of Helicobacter pylori. The current study was performed to assess phenotypic characters of antibiotic resistance and genoty...

https://ift.tt/2NbzLDk

Send more data: a systematic review of mathematical models of antimicrobial resistance

Antimicrobial resistance is a global health problem that demands all possible means to control it. Mathematical modelling is a valuable tool for understanding the mechanisms of AMR development and spread, and ...

https://ift.tt/2zFB222

Factors associated with bacteraemia due to multidrug-resistant organisms among bacteraemic patients with multidrug-resistant organism carriage: a case control study

Infections caused by multidrug-resistant organisms (MDRO) are emerging worldwide. Physicians are increasingly faced with the question of whether patients need empiric antibiotic treatment covering these pathog...

https://ift.tt/2zFAWHI

ABCC4 Variants Modify Susceptibility to Kawasaki Disease in a Southern Chinese Population

A previous family-based linkage study revealed that Kawasaki disease (KD) was associated with variations of the ATP-binding cassette subfamily C member 4 (ABCC4) gene in most European populations. However, significant differences exist among ethnic populations in European and Chinese subjects; therefore, whether ABCC4 variants indicate susceptibility to KD in Chinese children is unclear. The purpose of this research was to evaluate correlations between ABCC4 gene polymorphisms and susceptibility to KD in a Southern Chinese population. We genotyped six polymorphisms (rs7986087, rs868853, rs3765534, rs1751034, rs3742106, and rs9561778) in 775 KD patients and 774 healthy controls. Ninety-five percent confidence intervals (95% CIs) and odds ratios (ORs) were used to assess the strength of each association. We found that the rs7986087 T variant genotype was associated with significantly higher susceptibility to KD (adjusted OR = 1.30, 95% CI = 1.05–1.60 for rs7986087 CT/TT). However, the rs868853 T variant genotype was associated with significantly lower susceptibility to KD (adjusted OR = 0.74, 95% CI = 0.59–0.92 for rs868853 CT/CC). Compared with the patients with 0–4 ABCC4 risk genotypes, the patients with 5-6 ABCC4 risk genotypes had a significantly increased risk of KD (adjusted OR = 1.63, 95% CI = 1.07–2.47), and this risk was more significant in the subgroups of females, subjects aged 12–60 months, and individuals with coronary artery lesions. These results indicate that specific single-nucleotide polymorphisms in the ABCC4 gene may increase susceptibility to KD in a Southern Chinese population.

https://ift.tt/2Qiftdf

Validation of blood culture gram staining for the detection of Staphylococcus aureus by the ‘oozing sign’ surrounding clustered gram-positive cocci: a prospective observational study

Staphylococcus aureus bacteraemia is a common and significant infection, associated with high rates of mortality. Therefore, early identification is important for the initiation of appropriate treatment. The obje...

https://ift.tt/2NbQs1k

High prevalence and clonal dissemination of OXA-72-producing Acinetobacter baumannii in a Chinese hospital: a cross sectional study

Carbapenem resistance in Acinetobacter baumannii in China was mainly mediated by OXA-23-like carbapenemases, while OXA-24/40-like carbapenemases were rarely identified. OXA-72 is one variant of OXA-24/40-like car...

https://ift.tt/2xKPu7y

Antimicrobial use by WHO methodology at primary health care centers: a cross sectional study in Punjab, Pakistan

To investigate the antimicrobial (AM) use and prescribing patterns at primary health care centers (PHCCs) in Punjab, Pakistan.

https://ift.tt/2NaRfzF

Impact of alcohol consumption on tuberculosis treatment outcomes: a prospective longitudinal cohort study protocol

An estimated 10% of tuberculosis (TB) deaths are attributable to problematic alcohol use globally, however the causal pathways through which problem alcohol use has an impact on TB treatment outcome is not cle...

https://ift.tt/2xPAPb4

Carbapenem susceptibilities of Gram-negative pathogens in intra-abdominal and urinary tract infections: updated report of SMART 2015 in China

To evaluate the susceptibility rates of aerobic and facultative Gram-negative bacterial isolates from Chinese intra-abdominal infections (IAI) and urinary tract infections (UTI) focusing on carbapenems and com...

https://ift.tt/2Nc1tjd

Author’s Response

The intriguing questions raised by Campbell deserve several comments:.

https://ift.tt/2DHTbAb

Fidelity and feasibility of a brief emergency department intervention to empower adults with serious illness to initiate advance care planning conversations

Emergency Department (ED) visits provide opportunities to empower patients to discuss advance care planning (ACP) with their outpatient clinicians, but systematically developed, feasible interventions do not currently exist. Brief negotiated interview (BNI) interventions, which allow ED clinicians to efficiently motivate patients, have potential to meet this need.

https://ift.tt/2DHSVBd

Table of Contents

https://ift.tt/2DFoID5

Editorial Board

https://ift.tt/2zEyMIc

Concordance between Proxy Level of Care Preference and Advance Directives among Nursing Home Residents with Advanced Dementia: A Cluster Randomized Clinical Trial

Care consistent with goals is the desired outcome of advance care planning (ACP).

https://ift.tt/2DHTj2D

Comparability of the Australian national Cancer Symptom Trials (CST) group’s study populations to national referrals to non-CST specialist palliative care services participating in the Palliative Care Outcomes Collaboration (PCOC)

Utilising the results of phase III studies in clinical practice depends on how representative study participants are of the clinical population to whom the results will be applied. The closer the characteristics between the sub-group who participate in a clinical trial and the whole population, the easier it is for clinicians to apply the results directly to the patient that he/she is treating. Trial participation is generally more happenstance than a systematic sampling of a population, and is limited by eligibility criteria that do not reflect the entire clinical population.

https://ift.tt/2zFfWRa

Prognostication using SCORTEN in SJS and TEN

Often in cases of severe injury or pathology, unclear prognosis and the lack of availability of concrete mortality measurements make goals of care (GOC) discussions with patients and their families difficult. Palliative care providers are sometimes involved in the care of patients with severe dermatological illnesses, such as Steven's Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN), and knowledge of the prognostic tools used in these conditions is helpful. The incidence of SJS is estimated at 1-6 cases/million people and the incidence of TEN is 0.4-1.2 cases/million people; the mortality rates are 1-5% and 25-35%, respectively (1).

https://ift.tt/2DHTeMn

Review of Muriel Gillick: Old and Sick in America

I began following the work of Muriel Gillick in the 1990s, when I was a doctoral student in health care ethics. At a time when the ethics literature was focused on genetics and new technologies driving critical care in academic medical centers, Gillick was one of the few writing cogently about the ethical questions I found compelling: how best to care for elderly persons outside the hospital, especially when such persons can no longer make decisions for themselves. From frequent nursing-home-to-hospital transfers, to feeding tubes for dementia patients, to the possibilities and limitations of advance care planning, Gillick writes with a clarity and real-world perspective that I have always found helpful.

https://ift.tt/2zG8XaZ

Family caregivers’ subjective caregiving burden, quality of life, and depressive symptoms are associated with terminally ill cancer patients’ distinct patterns of conjoint symptom distress and functional impairment in their last 6 months of life

Family caregivers constitute a critical component of the end-of-life (EOL) care system with considerable cost to themselves. However, the joint association of terminally ill cancer patients' symptom distress and functional impairment with caregivers' subjective caregiving burden, quality of life (QOL), and depressive symptoms remains unknown.

https://ift.tt/2zEv4hJ

Heart Rate Variability as an indicator of nociceptive pain in disorders of consciousness?

Heart rate variability (HRV) is thought to reflect the affective and physiological aspects of pain and is emerging as a possible descriptor of the functional brain organization contributing to homeostasis.

https://ift.tt/2DHT8Ev

Centering Care: The Role of Labyrinths for Fostering Reflection in Pediatric Palliative and Critical Care Settings

The labyrinth represents an ancient symbol of wholeness and is thus applicable to health care settings as patients and providers alike seek healing and wholeness. A labyrinth combines the imagery of winding spirals together to compose a meandering but purposeful path.1 The labyrinth shape represents a journey toward the center (centering) and back again out into the world (caring re-entry).2 The labyrinth tradition dates back 3500 years ago with varying geographies from Crete to Egypt to Scandinavia claiming original origin.

https://ift.tt/2zFdSIV

Patients’ Hopes for Advanced Cancer Treatment

Little is known about the hopes patients with advanced (incurable) cancer have for their treatment.

https://ift.tt/2DHT7QX

Response to Hyoscine butylbromide for the management of death rattle: sooner rather than later

I read the recent paper regarding death rattle treatment with great interest (1). The authors are commended for giving consideration to this naturally occurring patient noise that is distressing to clinicians and families.

https://ift.tt/2zFBqgT

When we document end-of-life care, words still matter

In the September, 2018 edition of the Journal of Pain and Symptom Management, the study "Language used by health care professionals to describe dying at an acute care hospital" focused on specific word choices when documenting about end-of-life care. (1) They accurately note that, in acute care settings, the patient's medical record often becomes the primary mechanism for communication between providers. Imprecise documentation can lead to poor transfer of knowledge and even implicit bias. (2) Wentlandt et al describe the "implied state" category as most frequently used by non-palliative care providers, which labels patients by the care they receive (e.g.

https://ift.tt/2DHT4EL

Molding Idle Musings into Art: What reflective writing does for me

"For me, no experience is complete until I've written about it." Michael Longley, Irish poet. The Vitality of Ordinary Things (2018) [podcast] On Being with Krista Tippett. Available at: https://ift.tt/2qtDHpM

https://ift.tt/2zFJ7nu

PC-FACS

PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at pc-facs@aahpm.org.

https://ift.tt/2zEyMba

Physicians’ Attitudes Towards Euthanasia and Assisted Suicide In Italy

Euthanasia and assisted suicide are matter of discussion all over the world 1. In Italy, many cases raised by media recently provided the impetus for a new law regulating the living will. Of concern, it has been recently reported that there is a lack of knowledge among patients about the meaning of end-of-life issues 2. Physician-assisted suicide and euthanasia have been increasingly debated in the public arena, and in some European countries, legislation exists to regulate these end-of-life issues 3.

https://ift.tt/2DI7FjE

Walking but not talking: Laryngeal separation as a novel approach to improve quality of life in bulbar amyotrophic lateral sclerosis

Patients diagnosed with bulbar amyotrophic lateral sclerosis (ALS) inevitably experience acute aspiration due to progressive facial and laryngeal weakness. As they develop complete dysphagia and loss of speech, patients with bulbar ALS often experience a sensation of "drowning" with acute life-threatening airway obstruction during these aspiration events. Here we present a case of utilizing laryngotracheal separation (LTS) as a strategy to eliminate oropharyngeal aspiration with the goal of improving symptom management in a patient with bulbar ALS.

https://ift.tt/2zFBixV

Pain and Emergency Department Use in the Last Month of Life Among Older Adults with Dementia

Pain may be a potentially modifiable risk factor for expensive and burdensome Emergency Department (ED) visits near the end-of-life for older adults with dementia.

https://ift.tt/2zEX6K8

Managing medicines for patients dying at home: A review of family caregivers’ experiences

Increased life expectancy, technical advances in treatment and symptom control, and the extension of palliative care in community settings not only lengthen life, but make it possible for many patients to be cared for, and to die, at home. Moreover, death increasingly occurs in late old age and after a prolonged period of co-morbidity and/or frailty. This has far reaching consequences for the way that professional services are resourced and organised, and for the informal carers who are often responsible for providing the greater part of patient care, including management of complex medication regimes.

https://ift.tt/2DHSSW3

Hydrogen Sulfide Protects against Chemical Hypoxia-Induced Injury via Attenuation of ROS-Mediated Ca2+ Overload and Mitochondrial Dysfunction in Human Bronchial Epithelial Cells

Oxidative stress induced by hypoxia/ischemia resulted in the excessive reactive oxygen species (ROS) and the relative inadequate antioxidants. As the initial barrier to environmental pollutants and allergic stimuli, airway epithelial cell is vulnerable to oxidative stress. In recent years, the antioxidant effect of hydrogen sulfide (H2S) has attracted much attention. Therefore, in this study, we explored the impact of H2S on CoCl2-induced cell injury in 16HBE14o- cells. The effect of CoCl2 on the cell viability was detected by Cell Counting Kit (CCK-8) and the level of ROS in 16HBE14o- cells in response to varying doses (100–1000 μmol/L) of CoCl2 (a common chemical mimic of hypoxia) was measured by using fluorescent probe DCFH-DA. It was shown that, in 16HBE14o- cells, CoCl2 acutely increased the ROS content in a dose-dependent manner, and the increased ROS was inhibited by the NaHS (as a donor of H2S). Moreover, the calcium ion fluorescence probe Fura-2/AM and fluorescence dye Rh123 were used to investigate the intracellular calcium concentration ([Ca2+) and mitochondria membrane potential (MMP) in 16HBE14o- cells, respectively. In addition, we examined apoptosis of 16HBE14o- cells with Hoechst 33342. The results showed that the CoCl2 effectively elevated the Ca2+ influx, declined the MMP, and aggravated apoptosis, which were abrogated by NaHS. These results demonstrate that H2S could attenuate CoCl2-induced hypoxia injury via reducing ROS to perform an agonistic role for the Ca2+ influx and MMP dissipation.

https://ift.tt/2P0E322

Upregulation of BUB1B, CCNB1, CDC7, CDC20, and MCM3 in Tumor Tissues Predicted Worse Overall Survival and Disease-Free Survival in Hepatocellular Carcinoma Patients

Objective. To evaluate the association between upregulated differentially expressed genes (DEGs) and the outcomes of patients with hepatocellular carcinoma (HCC). Methods. Using Gene Expression Omnibus (GEO) datasets including GSE45436, GSE55092, GSE60502, GSE84402, and GSE17548, we detected upregulated DEGs in tumors. KEGG, GO, and Reactome enrichment analysis of the DEGs was conducted to clarify their function. The impact of the upregulated DEGs on patients' survival was analyzed based on TCGA profile. Results. 161 shared upregulated DEGs were identified among GSE45436, GSE55092, GSE60502, and GSE84402 profiles. Cell cycle was the shared pathway/biological process in the gene sets investigation among databases of KEGG, GO, and Reactome. After being validated in GSE17548, 13 genes including BUB1B, CCNA2, CCNB1, CCNE2, CDC20, CDC6, CDC7, CDK1, CDK4, CDKN2A, CHEK1, MAD2L1, and MCM3 in cell cycle pathway were shared in the three databases for enrichment. The expression of BUB1B, CCNB1, CDC7, CDC20, and MCM3 was upregulated in HCC tissues when compared with adjacent normal tissues in 6.67%, 7.5%, 8.06%, 5.56%, and 9.72% of HCC patients, respectively. Overexpression of BUB1B, CCNB1, CDC7, CDC20, and MCM3 in HCC tissues accounted for poorer overall survival (OS) and disease-free survival (DFS) in HCC patients (all log rank P

https://ift.tt/2NQzZot

P094 A new butyrate-releaser compound for the treatment of cow's milk allergy

https://ift.tt/2xNFiv8

P122 A yellow child: a case report of carotenodermia

https://ift.tt/2xWpRjo

P139 More than an ileus

https://ift.tt/2xNTQLj

P102 Dietary treatment with extensively hydrolyzed casein formula with the probiotic L. rhamnosus GG prevents the occurrence of functional gastrointestinal disorders in children with cow's milk allergy

https://ift.tt/2xYUjt5

P147 Gluten deprivation: is this a real nutritional change for Celiac disease children?

https://ift.tt/2xM0oKl

P131 Evaluation of the intestinal microbiota of pediatric patients in therapy with proton pump inhibitors

https://ift.tt/2y1s11i

P114 Diagnosing Celiac disease: a single Italian center experience

https://ift.tt/2xLGwqr

P098 Personalized approach for the management of potential Celiac children

https://ift.tt/2y0oYGt

P106 Adherence to the new ESPGHAN 2012 guidelines for the diagnosis of Celiac disease in Santa Maria Nuova Hospital Pediatric Unit (Reggio Emilia)

https://ift.tt/2xO2SHT

P143 Protein tolerance in patients with in-born error of protein metabolism after liver transplantation

https://ift.tt/2y1dZg6

P135 Risk factors for gastrointestinal and respiratory diseases in neurologically impaired (NI) children

https://ift.tt/2xPsh3Y

P126 Importance of biopsy for the diagnosis of seronegative Celiac disease in an adolescent with suggestive symptoms

https://ift.tt/2xWpQfk

P118 How much Celiac disease in 2017? The experience of a pediatric gastroenterologic unit in Milan

https://ift.tt/2xLhTdA

P110 A case of hematochezia: casual or causal association of lymphoid nodular hyperplasia and juvenile polypoid neoformation?

https://ift.tt/2xZVlFg

P092 Observational study on transition care for young adults with inflammatory bowel disease: results and perspectives

https://ift.tt/2xLuMo8

P096 Children with “borderline” TTG values in a screening for Coeliac disease on school population: follow-up after two years

https://ift.tt/2xVJFTS

P100 CoMiSS: a new tool to start a cow's milk-free diet in infants

https://ift.tt/2xLMeZo

P173 Gluten-free diet and adiposity rebound in Celiac children

https://ift.tt/2xWpG7I

P169 Infantile feeding disorders: when even surgery is not enough. an intriguing clinical case

https://ift.tt/2xNdirr

P165 Early enteral nutrition versus early parenteral nutrition in critically ill children: safety and efficacy

https://ift.tt/2y1rZXe

Clinical Protocol of Producing Adipose Tissue-Derived Stromal Vascular Fraction for Potential Cartilage Regeneration

Here, we present a protocol to produce an adipose tissue-derived stromal vascular fraction and its application to improve knee functions by regenerating cartilage-like tissue in human patients with osteoarthritis.

https://ift.tt/2QiPQsJ

Purification and characterization of an amyloglucosidase from an ericoid mycorrhizal fungus (Leohumicola incrustata)

This study aimed to purify and characterize amyloglucosidase (AMG) from Leohumicola incrustata. AMG was purified to homogeneity from cell-free culture filtrate of an ERM fungus grown in a modified Melin–Norkrans ...

https://ift.tt/2NPgfBY

Probe-free label system for rapid detection of Cronobacter genus in powdered infant formula

Cronobacter species previously known as Enterobacter sakazakii poses high risks to neonates and infants. In this work a rapid detection method was developed which combined loop-mediated isothermal amplification w...

https://ift.tt/2Nd8Yqt

Porcine As a Training Module for Head and Neck Microvascular Reconstruction

Here we present a protocol for the use of the pig superior epigastric artery perforator flap as a learning module for head and neck microvascular reconstruction.

https://ift.tt/2xZtAwt

Treatment Patterns, Healthcare Resource Utilization and Costs Among Schizophrenia Patients Treated with Long-Acting Injectable Versus Oral Antipsychotics

Abstract

Introduction

Long-acting injectable (LAI) antipsychotic use may reduce healthcare resource utilization compared with oral antipsychotic use by improving adherence and reducing dosing frequency. Our goal was to examine treatment patterns, healthcare utilization, and costs among recently diagnosed schizophrenia patients receiving oral versus LAI antipsychotics.

Methods

The MarketScan Multi-state Medicaid database was used to identify schizophrenia patients aged ≥ 18 years who received an LAI or oral antipsychotic between January 1, 2011 and December 31, 2014. Primary outcomes included treatment patterns such as adherence (measured as proportion of days covered-PDC), persistence, discontinuation, switching, and healthcare resource utilization and costs. Propensity score matching (PSM) was used to control for differences in baseline characteristics between the cohorts. Outcomes were assessed over a 12-month post-index period and compared between treatment cohorts.

Results

After PSM, 2302 patients were included in each of the LAI and oral antipsychotics cohorts. There were no differences in PDC or therapy switching between the two cohorts. Compared with the oral cohort, patients receiving LAIs had lower discontinuation rates (46.1 vs. 61.6%, p < 0.001), fewer inpatient admissions (0.5 vs. 0.9, p < 0.001), hospital days (3.9 vs. 6.5, p < 0.001), and ER visits (2.4 vs. 2.9, p = 0.007), and a higher number of prescription fills (29.5 vs. 25.3, p < 0.001). Patients prescribed LAIs had lower monthly inpatient ($US4007 vs. 8769, p < 0.001) and ER visits costs ($682 vs. 891, p < 0.001) but higher monthly medication costs ($10,713 vs. $655, p < 0.001) compared with the oral cohort over the 12-month post-index period. Overall, both cohorts had similar total medical costs (LAI vs. oral: $24,988 vs. 23,887, p = 0.354) during the follow-up period.

Conclusion

Patients receiving LAIs were more likely to remain on medication compared with the oral group, which may account for reduced inpatient admissions. Hospitalization cost reductions offset the higher costs of LAI medications, resulting in no increase in total healthcare costs relative to oral antipsychotic use.

Funding

Alkermes Inc.

https://ift.tt/2R7QN8x

Relationship between folate concentration and expression of folate-associated genes in tissue and plasma after intraoperative administration of leucovorin in patients with colorectal cancer

Abstract

Purpose

The aim of study was to investigate the relationship between folate concentration and expression of folate-associated genes in tumour, mucosa and plasma of patients with colorectal cancer, after intraoperative administration of bolus leucovorin (LV).

Methods

Eighty patients were randomized into four groups to receive 0, 60, 200, or 500 mg/m² LV, respectively. Tissue and plasma folate concentrations were assessed by LC–MS/MS. Gene expression of ABCC3/MRP3, FPGS, GGH, MTHFD1L, SLC46A1/PCFT, and SLC19A1/RFC-1 was determined using quantitative PCR.

Results

The folate concentration in tumour increased with increasing dosage of LV. Half of the patients treated with 60 mg/m² did not reach a level above the levels of untreated patients. A significant correlation between folate concentration in tumour and mucosa was found in untreated patients, and in the group treated with 60 mg/m² LV. The 5-MTHF/LV ratio correlated negatively with folate concentration in mucosa, whereas a positive correlation was found in tumour of patients who received 200 or 500 mg/m² LV. A positive correlation was found between folate concentration and expression of all genes, except MTHFD1L, in patients who received LV. There was a negative correlation between 5-MTHF concentration in plasma of untreated patients and expression of GGH and SLC46A1/PCFT in tumour.

Conclusions

The results indicate the possibility of using the individual plasma 5-MTHF/LV ratio after LV injection as a surrogate marker for tissue folate concentration. Expression of several folate-associated genes is associated with folate concentration in tissue and plasma and may become useful when predicting response to LV treatment.

https://ift.tt/2NNAgJ0

Liquid biopsies to track trastuzumab resistance in metastatic HER2-positive gastric cancer

Objective

To monitor trastuzumab resistance and determine the underlying mechanisms for the limited response rate and rapid emergence of resistance of HER2+ metastatic gastric cancer (mGC).

Design

Targeted sequencing of 416 clinically relevant genes was performed in 78 paired plasma and tissue biopsy samples to determine plasma-tissue concordance. Then, we performed longitudinal analyses of 97 serial plasma samples collected from 24 patients who were HER2+ to track the resistance during trastuzumab treatment and validated the identified candidate resistance genes.

Results

The results from targeted sequencing-based detection of somatic copy number alterations (SCNA) of HER2 gene were highly consistent with fluorescence in situ hybridisation data, and the detected HER2 SCNA was better than plasma carcinoembryonic antigen levels at predicting tumour shrinkage and progression. Furthermore, most patients with innate trastuzumab resistance presented high HER2 SCNA during progression compared with baseline, while HER2 SCNA decreased in patients with acquired resistance. PIK3CA mutations were significantly enriched in patients with innate resistance, and ERBB2/4 genes were the most mutated genes, accounting for trastuzumab resistance in six (35.3%) and five (29.4%) patients in baseline and progression plasma, respectively. Patients with PIK3CA/R1/C3 or ERBB2/4 mutations in the baseline plasma had significantly worse progression-free survival. Additionally, mutations in NF1 contributed to trastuzumab resistance, which was further confirmed through in vitro and in vivo studies, while combined HER2 and MEK/ERK blockade overcame trastuzumab resistance.

Conclusion

Longitudinal circulating tumour DNA sequencing provides novel insights into gene alterations underlying trastuzumab resistance in HER2+mGC.

https://ift.tt/2xK7j6I

Distributed and adaptive location identification system for mobile devices

Indoor location identification and navigation need to be as simple, seamless, and ubiquitous as its outdoor GPS-based counterpart is. It would be of great convenience to the mobile user to be able to continue ...

https://ift.tt/2zEdNWa

Connection between 'chalky teeth' in children and the uptake of Bisphenol A not likely

Medical associations are reporting increased occurrences of disturbed dental mineralization in children. The so-called 'chalky teeth' show discoloration and can be extremely sensitive to pain. Furthermore they tend to react sensitively to heat, cold and brushing.

https://ift.tt/2Qfm1cL

Blood pressure targeting by partial REBOA is possible in severe hemorrhagic shock in pigs and produces less circulatory, metabolic and inflammatory sequelae than total REBOA

Publication date: Available online 29 September 2018

Source: Injury

Author(s): Mitra Sadeghi, Tal Martin Hörer, Daniel Forsman, Emanuel Moses Dogan, Kjell Jansson, Csaba Kindler, Per Skoog, Kristofer Fredrik Nilsson

Abstract

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective adjunct in exsanguinating torso hemorrhage, but causes ischemic injury to distal organs. The aim was to investigate whether blood pressure targeting by partial REBOA (pREBOA) is possible in porcine severe hemorrhagic shock and to compare pREBOA and total REBOA (tREBOA) regarding hemodynamic, metabolic and inflammatory effects.

Methods

Eighteen anesthetized pigs were exposed to induced controlled hemorrhage to a systolic blood pressure (SBP) of 50 mmHg and randomized into three groups of thoracic REBOA: 30 min of pREBOA (target SBP 80-100 mmHg), tREBOA, and control. They were then resuscitated by autologous transfusion and monitored for 3 h. Hemodynamics, blood gases, mesenteric blood flow, intraperitoneal metabolites, organ damage markers, histopathology from the small bowel, and inflammatory markers were analyzed.

Results

Severe hemorrhagic shock was induced in all groups. In pREBOA the targeted blood pressure was reached. The mesenteric blood flow was sustained in pREBOA, while it was completely obstructed in tREBOA. Arterial pH was lower, and lactate and troponin levels were significantly higher in tREBOA than in pREBOA and controls during the reperfusion period. Intraperitoneal metabolites, the cytokine response and histological analyses from the small bowel were mostly affected in the tREBOA compared to the pREBOA and control groups.

Conclusion

Partial REBOA allows blood pressure titration while maintaining perfusion to distal organs, and reduces the ischemic burden in a state of severe hemorrhagic shock. Partial REBOA may lower the risks of post-resuscitation metabolic and inflammatory impacts, and organ dysfunction.

https://ift.tt/2OfbVeH

The protective effect of Irisin against ischemia-reperfusion injury after perforator flap grafting in rats

Publication date: Available online 28 September 2018

Source: Injury

Author(s): Gang Zhao, Xin Zhang, Peng Xu, Jing-Yi Mi, Yong-Jun Rui

Abstract

Background

Ischemia-reperfusion injury is one of the reasons for failure of flap grafting. In the present study, we investigated the protective effect of irisin on the survival of perforator flaps in rats.

Methods

A total of 48 adult Sprague-Dawley rats were divided into 2 groups and subjected to vascular clipping of perforator flap. Rats in the experimental group (n = 24) received daily tail intravenous injection of irisin (2 ng/g) for 3 days, while the rest rats in the control group (n = 24) received injection of saline solution of the same dose. On the 7th post-operative day, the surviving area of the flaps were recorded as the percentage of the total flap area. Histology study with haematoxylin and eosin staining were performed in all flaps. Flaps were also evaluated with lead oxide-gelatine-enhanced flap angiography. Immunohistochemical study was performed to evaluate the expression of ErG, a marker of vascular endothelial cells. The tissue of "choke vessels" was excised for quantification of p-Akt/Akt by western blot assay on the 7th post-operative day.

Results

On the 7th post-operative day, the percentage of surviving flap area was significantly larger in the rats with irisin administration (experimental group), compared with the control group (P = 0.011). The density of microvessels was significantly higher in the experimental group (P = 0.03) in the histological study and angiography, with a higher expression level of ErG in the immunochemical study (P = 0.01). The p-Akt/Akt was also higher in the experimental group in Western blotting analysis (P < 0.001).

Conclusion

Irisin has a beneficial effect on protecting perforator flaps from ischemic-reperfusion injury following the flap grafting surgery. It was potentially achieved by promoting proliferation of vascular endothelial cells after flap revascularization. Upregulation of the PI3K/Akt signaling pathway was potentially related with this process.

https://ift.tt/2QffEWT

Impact of body mass index on outcomes after thoracic trauma – a matched-triplet analysis of the TraumaRegister DGU®

Publication date: Available online 28 September 2018

Source: Injury

Author(s): Mark Schieren, Andreas Böhmer, Rolf Lefering, Thomas Paffrath, Frank Wappler, Jerome Defosse, TraumaRegister DGU

Abstract

Introduction

Chest trauma and obesity are both associated with increased risks for respiratory complications (e.g. hypoxia, hypercarbia, pneumonia), which are frequent causes of posttraumatic morbidity and mortality. However, as there is only limited and inconsistent evidence, the aim of our study was to analyse the effect of body mass index (BMI) on patient outcomes after thoracic trauma.

Patients and Methods

We screened 50.519 patients entered in TraumaRegister DGU^®, between 2004-2009, when the BMI was part of the standardized dataset. After matching for injury patterns and severity of trauma we performed a matched tripled analysis with regard to the BMI (group 1: < 25.0 kg/m²; group 2: 25.0-29.9 kg/m²; group 3: > 30.0 kg/m²). Data are shown as percentages and mean values with standard deviation.

Results

The matching process yielded a cohort of 828 patients with serious blunt thoracic trauma, evenly distributed over the 3 BMI groups (276 triplets). BMI did not have an impact on the need for prehospital or emergency department interventions. There was a trend towards more liberal use of whole-body-CT scanning with increasing BMI (group 1: 68.8%; group 2: 73.2%; group 3: 75.0%). Additional abdominal injuries were more common in normal weight patients (Group 1: 28.3%; Group 2: 14.9%; Group 3: 17.8%). Obesity (BMI > 30.0 kg/m²) had a significant impact on the duration of mechanical ventilation (in days; group 1: 6.5 (9.4); group 2: 6.4 (8.9); group 3: 9.1 (14.4); p = 0.002), ICU days (in days; group 1: 11.5 (11.5); group 2: 10.9 (9.6); group 3: 14.1 (16.7); p = 0.005) and hospital length of stay (in days; group 1: 27.8 (19.3); group 2: 27.4 (19.2); group 3: 32.2 (25.9); p = 0.009). There were no significant differences regarding overall mortality (group 1: 3.6%; group 2: 1.8%; group 3: 4.0%; p = 0.26).

Conclusions

Obesity has a negative impact on outcomes after blunt chest trauma, as it is associated with prolonged duration of mechanical ventilation, ICU and hospital length of stay. Mortality did not seem to be affected, yet, further research is required to confirm these results in a larger cohort.

https://ift.tt/2OfbmBB

Low back pain intensity among childbearing women and associated predictors. A cohort study

Publication date: Available online 28 September 2018

Source: Women and Birth

Author(s): Mette G. Backhausen, Jane M. Bendix, Peter Damm, Ann Tabor, Hanne K. Hegaard

Abstract

Background

Low back pain is a common condition among childbearing women, causing physical disability and an increased risk of sick leave and obstetric complications.

Aims

To assess the prevalence and intensity of low back pain during pregnancy, to describe the physical disability and sick leave in relation to the severity of low back pain and to identify predictors of moderate to severe low back pain in socio-demographic, health and obstetric characteristics among childbearing women.

Methods

A cohort study was undertaken (n = 566) during August 2015 to March 2016. Questionnaires were used to obtain information about low back pain intensity, physical disability due to low back pain and sick leave at 20 and 32 weeks of gestation. Of the 654 eligible women, 87% completed the first questionnaire.

Findings

Three out of four reported any low back pain at 20 weeks of gestation, and nine out of ten women at 32 weeks. Of these women, one in three reported moderate to severe pain at 20 weeks, increasing to half of the women at 32 weeks. Both sick leave and physical disability increased with increasing low back pain scores. Pre-pregnancy low back pain, multiparity and lower level of education were all identified as predictors of moderate to severe low back pain.

Conclusions

Women with pre-pregnancy low back pain, multiparity and lower level of education, represent the group of women with the highest risk of moderate to severe low back pain during pregnancy and should be payed special attention.

https://ift.tt/2RfNIn8

The association between social support and postpartum depression in women: A cross sectional study

Publication date: Available online 28 September 2018

Source: Women and Birth

Author(s): Atefeh Vaezi, Fatemeh Soojoodi, Arash Tehrani Banihashemi, Marzieh Nojomi

Abstract

Background

Prevalence of postpartum depression is estimated to be about 10–15% worldwide. Many risk factors are supposed to play a role leading a new mother to maternal postpartum depression which can considerably affect the baby, mother, family and also the society.

Objective

To investigate the prevalence of maternal postpartum depression and its association with social support.

Methods

Using a cross-sectional study, 200 new mothers who attended three teaching hospitals in Tehran, Iran were selected with a convenience sampling. Postpartum depression was assessed using the Iranian version of Edinburgh Postpartum Depression Scale and women's levels of social support were measured using the Iranian version of Social Support Questionnaire.

Results

Prevalence of postpartum depression was 43.5% in new mothers. The mean (±Standard Deviation) score of social support network was 2.09 ± 0.99; which is lower in depressed mothers in comparison to non-depressed mothers (1.78 ± 0.87 vs. 2.33 ± 1.00 respectively, P < 0.001). A reverse significant association was found between social support and postpartum depression after adjusting for confounding variables such as past history of depression, illness of baby and medication consumption during pregnancy (Odds Ratio = 0.47, 95% Confidence Interval = 0.33–0.67).

Conclusion

The bigger the social network of a mother, the less postpartum depression occurs. It is suggested to educate the family about the very important role of social support and improve it in every aspect of health care in order to prevent postpartum depression.

https://ift.tt/2QkpYNr

The relationship between maternal weight gain in pregnancy and newborn weight

Publication date: Available online 28 September 2018

Source: Women and Birth

Author(s): Danhua Zhang, Longfei Zhang, Zhiping Wang

Abstract

Aim

This study investigated the impacts of different pre-pregnancy body mass indexes and gestational weight gain on the risk of delivering a high birth weight infant in China.

Methods

A retrospective cohort study was conducted from 2013 to 2014 in the Maternal and Child Health Care Hospital of Jinan City, Shandong Province and 2415 women who had a singleton birth were included in the study. A logistic regression model and restricted cubic spline regression were used to analyse the association.

Findings

The risk of delivering a high birth weight infant increases when the mother's pre-pregnancy body mass index exceeds 24 kg/m². Compared with women whose pre-pregnancy body mass index was 21 kg/m², the adjusted risk of delivering a high birth weight infant doubled when the mother's pre-pregnancy body mass index was 29 kg/m², and nearly tripled when the mother's pre-pregnancy body mass index was 31 kg/m². Compared with women who had a gestational weight gain of 12.0 kg, women having a gestational weight gain of 20.0 kg, 22.0 kg, and 26.0 kg had a 1.7-, 2.2-, and 3.5-fold increased risk of delivering a high birth weight infant. When the mother experiences a gestational weight gain greater than 27 kg, the risk of delivering a high birth weight infant is at least 4-fold greater than that for a mother who has a gestational weight gain of 12.0 kg.

Conclusions

Proposed strategies to raise public awareness of the risks to infants posed by high maternal pre-pregnancy body mass index and gestational weight gain are required. All clinical recommendations and measures are for all pregnant women, not just overweight and obese pregnant women.

https://ift.tt/2RfNxZ0

Previous breastfeeding experience and its influence on breastfeeding outcomes in subsequent births: A systematic review

Publication date: Available online 28 September 2018

Source: Women and Birth

Author(s): Yi Huang, Yan-Qiong Ouyang, Sharon R. Redding

Abstract

Problem

Despite widely recognized benefits of breastfeeding, the worldwide rate of six months exclusive breastfeeding has not up to the WHO recommendation. Multiparas are considered more likely to initiate breastfeeding and breastfeed much longer. This, however, is not always the case if they have unsuccessful previous breastfeeding experience. Therefore, whether and how previous breastfeeding experience affect subsequent breastfeeding outcomes need to be explored sufficiently.

Objective

The objective of this review is to summarize the evidence of association between previous breastfeeding experience and subsequent breastfeeding outcomes.

Methods

A systematic search of Embase, Web of Science, PubMed, Cochrane Library and CINAHL databases from inception to March, 2018 is conducted for cohort studies regarding "previous breastfeeding experience" as an influencing factor to subsequent breastfeeding initiation and duration. A narrative synthesis is used in this review according to PRISMA and study quality is assessed using the Newcastle-Ottawa Scale.

Findings

Fifteen articles were eligible for this review. Previous breastfeeding experience was consistently correlated with subsequent breastfeeding initiation and duration. However, previous short breastfeeding duration and unsatisfactory experience negatively affected subsequent breastfeeding.

Conclusions

Robust evidence for the effect of previous breastfeeding experience on subsequent breastfeeding is present. Midwives and breastfeeding/lactation consultants need to provide customized interventions for mothers according to detailed previous breastfeeding experience in order to improve breastfeeding initiation and breastfeeding duration.

https://ift.tt/2QgUQOu

Cancers, Vol. 10, Pages 367: Molecular Scoring of Hepatocellular Carcinoma for Predicting Metastatic Recurrence and Requirements of Systemic Chemotherapy

Cancers, Vol. 10, Pages 367: Molecular Scoring of Hepatocellular Carcinoma for Predicting Metastatic Recurrence and Requirements of Systemic Chemotherapy

Cancers doi: 10.3390/cancers10100367

Authors: Nishida Nishimura Kaido Minaga Yamao Kamata Takenaka Ida Hagiwara Minami Sakurai Watanabe Kudo

Hepatocellular carcinoma (HCC) causes one of the most frequent cancer-related deaths; an HCC subset shows rapid progression that affects survival. We clarify molecular features of aggressive HCC, and establish a molecular scoring system that predicts metastasis after curative treatment. In total, 125 HCCs were examined for TP53, CTNNB1, and TERT promoter mutation, methylation of 8 tumor suppressor genes, and 3 repetitive DNA sequences to estimate promoter hypermethylation and global hypomethylation. A fractional allelic loss (FAL) was calculated to represent chromosomal instability through microsatellite analysis. Molecular subclasses were determined using corresponding and hierarchical clustering analyses. Next, twenty-five HCC patients who underwent liver transplantation were analyzed for associations between molecular characteristics and metastatic recurrence; survival analyses were validated using a publicly available dataset of 376 HCC cases from the Cancer Genome Atlas (TCGA). An HCC subtype characterized by TP53 mutation, high FAL, and global hypomethylation was associated with aggressive tumor characteristics, like vascular invasion; CTNNB1 mutation was a feature of the less-progressive phenotype. A number of molecular risk factors, including TP53 mutation, high FAL, significant global hypomethylation, and absence of CTNNB1 mutation, were noted to predict shorter recurrence-free survival in patients who underwent liver transplantation (p = 0.0090 by log-rank test). These findings were validated in a cohort of resected HCC cases from TCGA (p = 0.0076). We concluded that molecular risks determined by common genetic and epigenetic alterations could predict metastatic recurrence after curative treatments, and could be a marker for considering systemic therapy for HCC patients.

https://ift.tt/2NcKnlk

Cross-sectional increase of adherence to multidisciplinary tumor board decisions

Abstract

Background

Cancer research has made great progress in the recent years. With the increasing number of options in diagnosis and therapy the implementation of tumorboards (TUBs) has become standard procedure in the treatment of cancer patients. Adherence tests on tumor board decisions are intended to enable quality assurance and enhancement for work in tumor boards in order to continuously optimize treatment options for cancer patients.

Methods

Subject of this study was the adherence of the recommendations made in three of 14 tumorboards, which take place weekly in the Center for Integrated Oncology (CIO) at the University Hospital Bonn. In total, therapy recommendations of 3815 patient cases were checked on their implementation. A classification into four groups has been made according to the degree of implementation. A second classification followed regarding the reasons for differences between the recommendation and the therapy which the patient actually received.

Results

The study showed that 80.1% of all recommendations in the three TUBs were implemented. 8.3% of all recommendations showed a deviance. Most important reasons for the deviances were patient wish (36.5%), patient death (26%) and doctoral decision, due to the patient's comorbidities or side effects of the treatment (24.1%).Interestingly, deviance in all three tumor boards in total significantly decreased over time.

Conclusions

Aim of the study was to clarify the use of tumor boards and find approaches to make them more efficient. Based on the results efficiency might be optimized by increased consideration of patients` preferences, improved presentation of patient-related data, more detailed documentation and further structuring of the tumor board meetings.

https://ift.tt/2OYboL8

High recurrence and in-hospital mortality rates, and rising proportion of healthcare-associated Clostridium difficile infections in a university hospital in Croatia

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https://ift.tt/2R8M72n

Treatment of Candida sternal infection following cardiac surgery – a review of literature

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https://ift.tt/2QicVvU

Commercialized fecal microbiota transplantation provides efficacious treatment of Clostridium difficile infection

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https://ift.tt/2Rfueiu

Expression signatures of exosomal long non-coding RNAs in urine serve as novel non-invasive biomarkers for diagnosis and recurrence prediction of bladder cancer

Abstract

Recently, expression signatures of exosomal long non-coding RNAs (lncRNAs) have been proposed as potential non-invasive biomarkers for cancer detection. In this study, we aimed to develop a urinary exosome (UE)-derived lncRNA panel for diagnosis and recurrence prediction of bladder cancer (BC). Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to screen and evaluate the expressions of eight candidate lncRNAs in a training set (208 urine samples) and a validation set (160 urine samples). A panel consisting of three differently expressed lncRNAs (MALAT1, PCAT-1 and SPRY4-IT1) was established for BC diagnosis in the training set, showing an area under the receiver-operating characteristic (ROC) curve (AUC) of 0.854. Subsequently, the performance of the panel was further verified with an AUC of 0.813 in the validation set, which was significantly higher than that of urine cytology (0.619). In addition, Kaplan-Meier analysis suggested that the up-regulation of PCAT-1 and MALAT1 was associated with poor recurrence-free survival (RFS) of non-muscle-invasive BC (NMIBC) (p < 0.001 and p = 0.002, respectively), and multivariate Cox proportional hazards regression analysis revealed that exosomal PCAT-1 overexpression was an independent prognostic factor for the RFS of NMIBC (p = 0.018). Collectively, our findings indicated that UE-derived lncRNAs possessed considerable clinical value in the diagnosis and prognosis of BC.

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Cancers, Vol. 10, Pages 366: Bipolar Tumor-Associated Macrophages in Ovarian Cancer as Targets for Therapy

Cancers, Vol. 10, Pages 366: Bipolar Tumor-Associated Macrophages in Ovarian Cancer as Targets for Therapy

Cancers doi: 10.3390/cancers10100366

Authors: Vijayalaxmi Gupta Fiona Yull Dineo Khabele

Ovarian cancer, a rare but fatal disease, has been a challenging area in the field of gynecological cancer. Ovarian cancer is characterized by peritoneal metastasis, which is facilitated by a cross-talk between tumor cells and other cells in the tumor microenvironment (TME). In epithelial ovarian cancer, tumor-associated macrophages (TAMs) constitute over 50% of cells in the peritoneal TME and malignant ascites, and are potential targets for therapy. Here, we review the bipolar nature of TAMs and the evolving strategies to target TAMs in ovarian cancer.

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Lymphovascular invasion and extranodal tumour extension are risk indicators of breast cancer related lymphoedema: an observational retrospective study with long-term follow-up

Abstract

Background

Breast cancer related lymphoedema (BCRL) occurs in a substantial proportion of breast cancer survivors and is a major contributor to patients' disability. Regrettably, there are no validated predictive biomarkers, diagnostic tools, and strong evidence-supported therapeutic strategies for BCRL. Here, we provide an integrative characterization of a large series of women with node-positive breast cancers and identify new bona fide predictors of BCRL occurrence.

Methods

Three hundred thirty-two cases of surgically-treated node-positive breast cancers were retrospectively collected (2–10.2 years of follow-up). Among them, 62 patients developed BCRL. To identify demographic and clinicopathologic features related to BCRL, Fisher's exact test or Chi-squared test were carried out for categorical variables; the Wilcoxon rank-sum was employed for continuous variables. Factors associated with BCRL occurrence were assessed using a Cox proportional hazards regression model.

Results

En-bloc dissection of the axillary lymph nodes but not the type of breast surgery impacted on BCRL development. Most of BCRL patients had a Luminal A-like neoplasm. The median number of lymph nodes involved by metastatic deposits was significantly higher in BCRL compared to the control group (p = 0.04). Both peritumoral lymphovascular invasion (LVI) and extranodal extension (ENE) of the metastasis had a negative impact on BCRL-free survival (p = 0.01). Specifically, patients with LVI and left side localization harboured 4-fold higher risk of developing BCRL, while right axillary nodes metastases with ENE increased the probability of BCRL compared to ENE-negative patients.

Conclusions

Assessment of LVI and ENE should be integrated with clinical and surgical data to improve BCRL risk stratification.

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