People with diabetes may be at higher risk for acquiring infections through both glucose-dependent and biologic pathways independent of glycemic control. Our aim was to estimate the association between diabete...
http://ift.tt/2E4tmWU
Δευτέρα 5 Φεβρουαρίου 2018
Diabetes and the occurrence of infection in primary care: a matched cohort study
Interfacial Coupling Effect in Organic/Inorganic Nanocomposites with High Energy Density
Abstract
Organic/inorganic nanocomposites (OINs) can be potentially used as high-performance capacitors due to their rapid charge–discharge capability along with respectable power density. The coupling effect of the filler/matrix interface plays a prominent role in the dielectric and electric properties of OINs. Along with a review of contemporary theoretical models, recent advances in interfacial optimization to improve energy density through careful interface control and design are also presented. Possible mechanisms that may improve energy density and potential applications for high-energy-density capacitors are also highlighted.
The interfacial coupling effect plays a prominent role in the high energy density of organic/inorganic nanocomposites. Recent state-of-the-art advances in interfacial optimization to improve energy density through careful interface control and design are described. Particular focus is placed on the mechanism possibly responsible for improved energy density.
http://ift.tt/2E36aYV
A Plasmonic Sensor Array with Ultrahigh Figures of Merit and Resonance Linewidths down to 3 nm
Abstract
Surface plasmon polaritons (SPPs) are extremely sensitive to the surrounding refractive index and have found important applications in ultrasensitive label-free sensing. Reducing the linewidth of an SPP mode is an effective way to improve the figure of merit (FOM) and hence the sensitivity of the plasmonic mode. Many efforts have been devoted to achieving a narrow linewidth by mode coupling, which inevitably results in an asymmetrical lineshape compromising the performance. Instead, the SPP modes are directly narrowed by elaborately engineering periodic plasmonic structures with minimized feature sizes to effectively reduce the radiative losses. A narrow linewidth smaller than 8 nm is achieved over a wide wavelength ranging from 600 to 960 nm and a minimum full width at half maximum of 3 nm at 960 nm. Benefiting from the almost perfect Lorentzian lineshape and the extremely narrow linewidth, a record FOM value of 730 is obtained. The sensor is capable of detecting bovine serum albumin with an ultralow concentration of 10−10m. The sensor has great potential for practical application for its ultrahigh FOM, broad working wavelength, and ease of high-throughput fabrication.
A plasmonic array with linewidth down to 3 nm is reported, which benefits from the nearly completely suppressed metal losses. The array shows an ultrahigh sensitivity, with a record figure of merit of 730 for the bulk sensing. The array can work over a broad wavelength from 600 to 960 nm and can be fabricated with a low cost.
http://ift.tt/2EKeaiH
Visually Imperceptible Liquid-Metal Circuits for Transparent, Stretchable Electronics with Direct Laser Writing
Abstract
A material architecture and laser-based microfabrication technique is introduced to produce electrically conductive films (sheet resistance = 2.95 Ω sq−1; resistivity = 1.77 × 10−6 Ω m) that are soft, elastic (strain limit >100%), and optically transparent. The films are composed of a grid-like array of visually imperceptible liquid-metal (LM) lines on a clear elastomer. Unlike previous efforts in transparent LM circuitry, the current approach enables fully imperceptible electronics that have not only high optical transmittance (>85% at 550 nm) but are also invisible under typical lighting conditions and reading distances. This unique combination of properties is enabled with a laser writing technique that results in LM grid patterns with a line width and pitch as small as 4.5 and 100 µm, respectively—yielding grid-like wiring that has adequate conductivity for digital functionality but is also well below the threshold for visual perception. The electrical, mechanical, electromechanical, and optomechanical properties of the films are characterized and it is found that high conductivity and transparency are preserved at tensile strains of ≈100%. To demonstrate their effectiveness for emerging applications in transparent displays and sensing electronics, the material architecture is incorporated into a couple of illustrative use cases related to chemical hazard warning.
A visually imperceptible liquid-metal–elastomer conductor for stretchable electronics is presented using the direct laser writing technique. This material architecture shows the unique combination of low sheet resistance (Rs < 3 Ω sq−1), high transmittance (T > 85%), and large extensibility (ε > 100%) and is visually imperceptible. This enables new applications in "second skin" wearable computing, human–computer interaction, and soft robotics that depend on soft, elastic, and optically transparent functionality.
http://ift.tt/2BcmCaK
Mixed Valence Perovskite Cs2Au2I6: A Potential Material for Thin-Film Pb-Free Photovoltaic Cells with Ultrahigh Efficiency
Abstract
New light is shed on the previously known perovskite material, Cs2Au2I6, as a potential active material for high-efficiency thin-film Pb-free photovoltaic cells. First-principles calculations demonstrate that Cs2Au2I6 has an optimal band gap that is close to the Shockley–Queisser value. The band gap size is governed by intermediate band formation. Charge disproportionation on Au makes Cs2Au2I6 a double-perovskite material, although it is stoichiometrically a single perovskite. In contrast to most previously discussed double perovskites, Cs2Au2I6 has a direct-band-gap feature, and optical simulation predicts that a very thin layer of active material is sufficient to achieve a high photoconversion efficiency using a polycrystalline film layer. The already confirmed synthesizability of this material, coupled with the state-of-the-art multiscale simulations connecting from the material to the device, strongly suggests that Cs2Au2I6 will serve as the active material in highly efficient, nontoxic, and thin-film perovskite solar cells in the very near future.
Cs2Au2I6 is an interesting perovskite material having mixed-valence Au centers. The current state-of-the-art multiscale simulation shows that this old-but-new material is highly advantageous as a lead-free and stable material for very thin-film perovskite solar cells (PSCs). This work is expected to inspire experimentalists to realize this new concept in PSCs based on mixed-valence perovskites.
http://ift.tt/2BIhkVF
Identification and Validation of Appropriate Reference Genes for qRT-PCR Analysis in Corynebacterium glutamicum
Abstract
Real-time quantitative PCR (qRT-PCR) is a fast and efficient technology for detecting gene expression levels in the study of the Corynebacterium glutamicum protein expression system, but it requires normalization to ensure the reliability of the results obtained. We selected 13 genes from the commonly used housekeeping genes and from transcriptome data as candidate reference genes. The Ct values of the 13 genes were obtained by qRT-PCR at different fermentation stages and under three stress conditions (temperature, acid, and salt). The expression stability of the reference genes was evaluated by geNorm and NormFinder software. For the study of different growth stages, the most appropriate reference genes are Ncgl2772 and leua, which encode acetyl-CoA carboxylase beta subunit and 2-isopropylmalate synthase, separately. For the study of different stress factors, the optimal minimum number of reference genes is 3, with Ncgl2772, gyrb encoding DNA gyrase B and siga encoding RNA polymerase sigma factor A as the most suitable combination. Additionally, clpx and clpc, encoding ClpX and ClpC protease subunits, were used to validate the candidate reference genes. The identification of new reference genes makes qRT-PCR more convenient, and using these genes for normalization can improve the accuracy and reliability of the measurements of target gene expression levels obtained by qRT-PCR for C. glutamicum.http://ift.tt/2BXRKYu
Epidemiology of distal radius fractures in polytrauma patients and the influence of high traumatic energy transfer
Publication date: Available online 5 February 2018
Source:Injury
Author(s): Steven Ferree, Quirine M.J. van der Vliet, Femke Nawijn, Abhiram R. Bhashyam, Roderick M. Houwert, Luke P.H. Leenen, Falco Hietbrink
IntroductionFor several extremity fractures differences in morphology, incidence rate and functional outcome were found when polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyze fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF.MethodsThis was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system.ResultsA total of 830 patients with a DRF were included, 12% were polytrauma. The incidence rate of DRF in polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for polytrauma and high-energy monotrauma patients. Non-union rates were higher in polytrauma patients.ConclusionHigher energy mechanisms of injury, in polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients.
http://ift.tt/2E7L9jO
Atrial Fibrillation for the Neurologist: Preventing both Ischemic and Hemorrhagic Strokes
Abstract
Purpose of Review
This review aims to help neurologists managing atrial fibrillation (AF) patients who had an ischemic stroke and/or with intracranial hemorrhage (ICH) markers, therefore at high embolic/hemorrhagic risks.
Recent Findings
Implantable loop recorders have substantially improved the accuracy of AF detection. Recent research yielded a set of powerful neuroimaging markers that can stratify ICH risk. Direct oral anticoagulants (DOAC) are easier to use with a lower ICH risk than warfarin in a general AF population. Finally, the FDA-approved left atrial appendage closure (LAAC) with the WATCHMAN device provides an option without the need for life-long anticoagulation.
Summary
In this review, we introduce the concept of preventing both ischemic and hemorrhagic strokes in AF patients through accurate AF diagnosis and stratification of both embolic and ICH risks. LAAC can be considered in patients at higher hemorrhagic risks while warfarin/DOAC use should be individualized in the majority of AF patients at a low risk of bleeding.
http://ift.tt/2GOhzh3
Leech management before application on patient: a nationwide survey of practices in French university hospitals
Leech therapy in plastic/reconstructive microsurgery significantly improves a successful outcome of flap salvage but the drawback is a risk of severe infection that results in a drop of the salvage rates from ...
http://ift.tt/2FPhR5Z
Cancers, Vol. 10, Pages 44: Integrin Inhibitors in Prostate Cancer
Cancers, Vol. 10, Pages 44: Integrin Inhibitors in Prostate Cancer
Cancers doi: 10.3390/cancers10020044
Authors: Maylein Juan-Rivera Magaly Martínez-Ferrer
Prostate cancer (PCa) is the most frequently diagnosed cancer and the third highest cause of cancer-related deaths in men in the U.S. The development of chemotherapeutic agents that can bind PCa tumor cells with high specificity is critical in order to increase treatment effectiveness. Integrin receptors and their corresponding ligands have different expression patterns in PCa cells. They have been identified as promising targets to inhibit pathways involved in PCa progression. Currently, several compounds have proven to target specific integrins and their subunits in PCa cells. In this article, we review the role of integrins inhibitors in PCa and their potential as therapeutic targets for PCa treatments. We have discussed the following: natural compounds, monoclonal antibodies, statins, campothecins analog, aptamers, d-aminoacid, and snake venom. Recent studies have shown that their mechanisms of action result in decrease cell migration, cell invasion, cell proliferation, and metastasis of PCa cells.
http://ift.tt/2nHgpfm
Metformin-induced anticancer activities: recent insights
Authors: Safe, Stephen / Nair, Vijayalekshmi / Karki, Keshav
http://ift.tt/2DOPbwM
LncRNA PART1 modulates toll-like receptor pathways to influence cell proliferation and apoptosis in prostate cancer cells
Authors: Sun, Ming / Geng, Donghua / Li, Shuqiang / Chen, Zhaofu / Zhao, Wenyan
http://ift.tt/2nhgB3Z
Changes of the peripheral blood mononuclear cells membrane fluidity from type 1 Gaucher disease patients: an electron paramagnetic resonance study
Authors: Pavićević, Aleksandra / Lakočević, Milan / Popović, Milan / Popović-Bijelić, Ana / Daković, Marko / Mojović, Miloš
http://ift.tt/2DOOvaI
How human serum albumin recognizes DNA and RNA
Authors: Alinovskaya, Ludmila I. / Sedykh, Sergey E. / Ivanisenko, Nikita V. / Soboleva, Svetlana E. / Nevinsky, Georgy A.
http://ift.tt/2my6w3h
Is it appropriate to perform video-assisted thoracoscopic surgery for advanced lung cancer?
Future Oncology, Ahead of Print.
http://ift.tt/2nKEEbS
Enhanced Recovery After Surgery (ERAS®) in thoracic surgical oncology
Future Oncology, Ahead of Print.
http://ift.tt/2E3Dh2W
TGF-β requires the activation of canonical and non-canonical signalling pathways to induce skeletal muscle atrophy
Authors: Ábrigo, Johanna / Campos, Fabian / Simon, Felipe / Riedel, Claudia / Cabrera, Daniel / Vilos, Cristian / Cabello-Verrugio, Claudio
http://ift.tt/2Ff2DXW
The dinoponeratoxin peptides from the giant ant Dinoponera quadriceps display in vitro antitrypanosomal activity
Authors: Lima, Dânya Bandeira / Mello, Clarissa Perdigão / Bandeira, Izabel Cristina Justino / Pessoa Bezerra de Menezes, Ramon Róseo Paula / Sampaio, Tiago Lima / Falcão, Cláudio Borges / Morlighem, Jean-Étienne R.L. / Rádis-Baptista, Gandhi / Martins, Alice Maria Costa
http://ift.tt/2CVLeGM
PARP-1 and PARP-2 activity in cancer-induced cachexia: potential therapeutic implications
Authors: Barreiro, Esther / Gea, Joaquim
http://ift.tt/2AKY2dh
High-content hydrogen water-induced downregulation of miR-136 alleviates non-alcoholic fatty liver disease by regulating Nrf2 via targeting MEG3
Authors: Wang, Xiang / Wang, Jiao
http://ift.tt/2CZnIb9
Interaction of the middle domains stabilizes Hsp90α dimer in a closed conformation with high affinity for p23
Authors: Synoradzki, Kamil / Miszta, Przemyslaw / Kazlauskas, Egidijus / Mickevičiūtė, Aurelija / Michailovienė, Vilma / Matulis, Daumantas / Filipek, Slawomir / Bieganowski, Pawel
http://ift.tt/2DHrbw6
Biomechanistic insights into the roles of oxidative stress in generating complex neurological disorders
Authors: Yusuf, Mohammad / Khan, Maria / Robaian, Majed A. / Khan, Riaz A.
http://ift.tt/2Fhy7MY
The inhibition of the mitochondrial F1FO-ATPase activity when activated by Ca2+ opens new regulatory roles for NAD+
Authors: Nesci, Salvatore / Trombetti, Fabiana / Ventrella, Vittoria / Pirini, Maurizio / Pagliarani, Alessandra
http://ift.tt/2ALj5MS
Structure and function of the human parvulins Pin1 and Par14/17
Authors: Matena, Anja / Rehic, Edisa / Hönig, Dana / Kamba, Bianca / Bayer, Peter
http://ift.tt/2CXP9D7
Mechanisms, pathophysiological roles and methods for analyzing mitophagy – recent insights
Authors: Williams, Jessica A. / Ding, Wen-Xing
http://ift.tt/2CXP9mB
Sympathetic vasomotor activity during dynamic exercise with resistive breathing: Sex differences and the nerve to show it!
Abstract
Respiratory muscle metaboreflexes exert substantial influence over cardiorespiratory and autonomic control, exemplified during heavy dynamic exercise in health, and in obstructive airways disease even at rest.
This article is protected by copyright. All rights reserved
http://ift.tt/2GSy1Ns
Extracorporeal Photopheresis (ECP) Treatment : Letter to Health Care Providers - Death and Pulmonary Embolism
Audience: Health Professional, Dermotology, Oncology [Posted 02/05/2018] ISSUE: The FDA is evaluating recent reports of venous thromboembolism (VTE), including pulmonary embolism (PE), in patients who received autologous immune cell therapy with...
http://ift.tt/2E7d7MQ
Extracorporeal Photopheresis (ECP) Treatment : Letter to Health Care Providers - Death and Pulmonary Embolism
Audience: Health Professional, Dermotology, Oncology [Posted 02/05/2018] ISSUE: The FDA is evaluating recent reports of venous thromboembolism (VTE), including pulmonary embolism (PE), in patients who received autologous immune cell therapy with...
http://ift.tt/2E7d7MQ
Associations of TNFRSF1A Polymorphisms with Autoimmune Thyroid Diseases: A Case-Control Study
Horm Metab Res 2018; 50: 117-123
DOI: 10.1055/s-0043-124435
Previous studies have shown associations of polymorphisms in the tumor necrosis factor (TNF) receptor super family member 1A (TNFRSF1A) gene with several groups of inflammatory and autoimmune related diseases, but associations of TNFRSF1A polymorphisms with autoimmune thyroid diseases (AITD), mainly including two sub-types of Hashimoto's thyroiditis (HT) and Graves' disease (GD), in the Chinese Han population is unclear. A case-control study of 1812 subjects (965 AITD patients and 847 unrelated healthy controls) was conducted to assess AITD associations with five single nucleotide polymorphisms (SNPs), including rs4149576, rs4149577, rs4149570, rs1800693, and rs767455 in the TNFRSF1A gene locus. Genotyping was performed and evaluated using the platform of ligase detection reaction. No significant difference was observed in the allele and genotype frequencies between HT or GD patients and controls in any of the five SNPs in the TNFRSF1A gene (all p values >0.05). However, a moderate association of rs4149570 with HT was found after adjusting for age and gender [odds ratio (OR)=1.40, p=0.03]. No obvious difference was found in the haplotype distribution of any of the five SNPs in the TNFRSF1A gene between the AITD patients and controls. These data suggest that these five SNPs in the TNFRSF1A gene are not associated with AITD in the Chinese Han population, but rs4149570 shows a weak association with HT after adjusting for gender and age.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2Ej0kX0
Eighteen-Year Effect of Androgen Therapy on Bone Mineral Density in Trans(gender) Men
Horm Metab Res 2018; 50: 133-137
DOI: 10.1055/s-0043-118747
The study explores the influence of long-term androgen supplementation (18 years) on bone metabolism in trans(gender) men. Thirty five trans(gender) men aged (47±4) were treated with adequate dose of testosterone. BMD was measured by DEXA at lumbar spine and neck and T score was determined. Biochemical parameters of bone turnover were measured in all patients. As compared with female and male age matched controls they showed a not significantly different T-score at spine [1.213±0.15 in trans(gender) men vs. 1.192±0.19 in females and 1.203±0.06 g/cm2 in males (p<0.01)]. BMD in the hip skeleton in trans(gender) men (0.950±g/cm2) was statistically higher than females (0.822±0.09) but not statistically different from normal males 0.988±0.06). Circulating biochemical markers of bone formation, and resorption were not different between the trans(gender) men, and matched controls. We conclude that BMD at the hip (site rich in cortical bone) after adequate dose of testosterone therapy is higher while it is not different at the spine (trabecular bone) in trans(gender) men even after 18 years of testosterone administration.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2nNPEFh
Effect of Conjugated Linoleic Acid on Leptin Level: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Horm Metab Res 2018; 50: 106-116
DOI: 10.1055/s-0044-100041
The results of human clinical trials examining the effects of conjugated linoleic acid (CLA) on leptin concentration are inconsistent. Our objective was to elucidate the role of conjugated linoleic acid supplementation on leptin through a systematic review and a meta-analysis of available randomized placebo-controlled trials (RCTs). We searched the PubMed, SCOPUS, and ISI web of science up to February2017, in English, to identify RCTs investigating the effect of CLA supplements on plasma leptin concentrations. Weighted mean differences (WMDs) and their respective 95% confidence intervals (CIs) were calculated to assess the efficacy of CLA on leptin concentration by using random effects. Statistical heterogeneity, study quality, meta-regression and publication bias were used based on standard methods. Nineteen RCTs (comprising 26 treatment arms) with 1045 subjects were included in this meta-analysis. Random-effect meta-analysis found a slight but not significant reduction in plasma leptin concentrations (WMD: –0.38 ng/ml, 95% CI: –1.08, 0.32, p=0.286); I2=53.24%, p=0.001), following CLA supplementation. The pooled effect size was robust and remained non-significant in the leave-one-out sensitivity analysis. Subgroup analysis based on BMI status showed that the CLA supplementation significantly reduces leptin when used for obese subjects (WMD: –1.47 ng/ml, 95% CI: –2.15, –0.79, p<0.001) and in the subset of trials lasting<24 weeks of duration (WMD: –0.76 ng/ml, 95% CI: –1.40, –0.12, p=0.019). CLA supplementation might moderately decrease circulatory leptin levels only among obese adults for shorter than 24 weeks. Additional high-quality studies are needed to replicate our results.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2EljcV6
Double Major Duodenal Papillae: A Rare Congenital Anomaly of Hepatic and Pancreatic Drainage System
A 36-year-old man who presented with intractable nausea and vomiting had double major duodenal papillae, which were noticed during esophagogastroduodenoscopy (Figure A). This is an incidental but fascinating finding.
http://ift.tt/2EKpprE
Defining the Scope of Prognosis: Primary Care Clinicians' Perspectives on Predicting the Future Health of Older Adults
Studies examining the attitudes of clinicians towards prognostication for older adults have focused on life expectancy prediction. Little is known about whether clinicians approach prognostication in other ways.
http://ift.tt/2BcY5CD
Rasch Analysis of the Edmonton Symptom Assessment System (ESAS)
The Edmonton Symptom Assessment System (ESAS) is a widely used multi-symptom assessment tool in cancer and palliative care settings but its psychometric properties have not been widely tested using modern psychometric methods such as Rasch analysis.
http://ift.tt/2BFmqSD
The Long-Term Impact of Neurofeedback on Symptom Burden and Interference in Patients with Chronic Chemotherapy-Induced Neuropathy: Analysis of a Randomized Controlled Trial
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment, and may adversely affect quality of life for years.
http://ift.tt/2BdFs1s
A pragmatic evaluation of symptom distress after group meditation for cancer patients and caregivers: a preliminary report.
Complementary health approaches such as meditation may help improve cancer patient and caregiver symptoms, yet little research has examined the clinical application of these programs.
http://ift.tt/2BHiiS8
Factors Influencing Inpatient Physician-Patient Discussion About End-of-Life Decision Making (S726)
In the hospital, patients with advanced cancer often face high stakes decision making. While numerous studies have documented variation in patient decision-making role preferences, the way physicians, patients, and family members incorporate these preferences in an end-of-life (EOL) discussion is not well understood.
http://ift.tt/2BaV85n
Being in Two Places at Once: Utilizing Clinical Video Telemedicine Technology to Provide Remote Hospice/Palliative Care Services (FR418)
An important trend in palliative medicine is integration early in the course of chronic, serious, life limiting or life-threatening illnesses. There are, however, several barriers to accessing palliative care including: Workforce shortage, distance to travel to medical centers where these services are available (especially for rural or physician underserved areas), progressive disease processes, frailty and functional decline, mobility challenges, symptom burden, and even psychiatric symptoms (agoraphobia).
http://ift.tt/2BFmnpV
Beclin1 circulating levels and accelerated aging markers in COPD
Beclin1 circulating levels and accelerated aging markers in COPD
Beclin1 circulating levels and accelerated aging markers in COPD, Published online: 05 February 2018; doi:10.1038/s41419-017-0178-1
Beclin1 circulating levels and accelerated aging markers in COPDhttp://ift.tt/2E550QG
Time-Dependent Effects of POT1 Knockdown on Proliferation, Tumorigenicity, and HDACi Response of SK-OV3 Ovarian Cancer Cells
The roles of protection of telomeres 1 (POT1) in human ovarian cancer have not been fully elucidated. Here, we investigated the impact of POT1 knockdown (POT1-KD) on in vitro cell proliferation, tumorigenesis, and histone deacetylase inhibitor (HDACi) response in human ovarian cancer-derived SK-OV3 cells. The POT1 gene was knocked down by infection with POT1 lenti-shRNA. POT1, c-Myc, and hTERT mRNA levels and relative telomere length were determined by qRT-PCR; POT1 protein levels were determined by western blot. The relative telomerase activity levels were detected using qTRAP; cell proliferation was assessed using cumulative population doubling (cPD) experiments. Cell tumorigenicity was evaluated by anchorage-independent cell growth assays, and cell response to HDACi was determined by luminescence cell viability assays. Results indicate that lenti-shRNA-mediated POT1-KD significantly reduced POT1 mRNA and protein expression. POT1-KD immediately downregulated c-Myc expression, which led to the inhibition of cell proliferation, tumorigenesis, and HDACi response. However, after brief suppression, c-Myc expression increased in the medium term, which resulted in enhanced cell proliferation, tumorigenesis, and HDACi response in the POT1-KD cells. Furthermore, we discovered that c-Myc regulated cell proliferation and tumorigenesis via hTERT/telomerase/telomere pathway.
http://ift.tt/2BY5AKb
The Use of Functional MRI in Cervical Cancer Patients with Incomplete Response on PET/CT Following Image-Based High-Dose Rate Brachytherapy
While the outcomes of definitive chemoradiation therapy for cervical cancer continue to improve, identifying patients at risk for early post-treatment failure remains a challenge. We have investigated the prognostic value of post treatment PET/CT metabolic response and functional MRI in an effort to hasten the diagnosis of persistent disease following definitive treatment. This report describes our findings in a series of 244 patients with clinical stage IB1-IVA cervical cancer treated with image-based HDR brachytherapy.
http://ift.tt/2BcR3hf
In Vitro and In Vivo Characterization of a Preclinical Radiation-Adapted Model for Ewing Sarcoma
Ewing sarcoma (ES) is the second most common pediatric bone cancer, and patients with relapsed/resistant disease have a five-year overall survival rate of only 15-20%. Front-line standard of care treatment for patients with ES includes chemotherapy and local control with surgery and/or radiation. We have developed novel in vitro and in vivo radiation-adapted ES models that demonstrate a relationship between metabolism and radioresistance as well as identify several candidate biomarkers for radioresistant disease in ES.
http://ift.tt/2BFGZy6
Dysphagia treatment for patients with head and neck cancer treated with radiotherapy: A meta-analysis review
Patients undergoing radiotherapy with or without chemotherapy (C/RT) for head and neck cancer (HNC) often develop dysphagia. Interventions from speech-language pathologists aim to maintain or improve swallow physiology and function; however, it is unclear which interventions have the greatest benefit.
http://ift.tt/2BI9cVb
Postmastectomy Radiotherapy in Women with T1–T2 Tumors and One to Three Positive Lymph Nodes: Analysis of the Breast International Group 02-98 Trial
The purpose of the current study was to analyze the impact of postmastectomy radiation therapy (PMRT) for patients with T1-T2 tumors and 1-3 positive lymph nodes enrolled on the Breast International Group (BIG) 02-98 trial.
http://ift.tt/2BGjzsm
Electromagnetic-guided MLC Tracking Radiotherapy for Prostate Cancer Patients: Prospective Clinical Trial Results
To report on the primary and secondary outcomes of the prospective clinical trial of electromagnetic-guided MLC tracking radiotherapy for prostate cancer.
http://ift.tt/2BdmLLl
Does Prophylactic Radiotherapy to avoid Gynecomastia in Patients with Prostate Cancer increase the risk of Breast Cancer?
Nordic patients with prostate cancer receive prophylactic radiotherapy to the breast buds to avoid gynecomastia when treated with antiandrogen monotherapy. In this study with data from the Norwegian Cancer Registry, we did not find increased risk of breast cancer (BC) in irradiated patients compared to non-irradiated patients. It is noteworthy that in the RT group, there were two cases of malignant phyllodes breast tumor, an extremely rare type of BC associated with gynecomastia.
http://ift.tt/2Bb7vym
New Strategies Are Needed to Stop Overdose Fatalities: The Case for Supervised Injection Facilities
With the explosion of highly potent fentanyl and its analogues in the illicit drug supply, overdose fatalities are occurring with alarming frequency and speed, leaving little time for first responders to find and resuscitate victims. Supervised injection facilities can help combat this problem. In addition to other benefits, these facilities offer sterile equipment and a hygienic environment for medically supervised drug injection.
http://ift.tt/2E5K1th
http://ift.tt/2E5K1th
qSOFA, Cue Confusion
In this issue, a systematic review by Fernando and colleagues compares the prognostic accuracy of the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and the systemic inflammatory response syndrome (SIRS) criteria for identification of patients with sepsis. The editorialists discuss the confusion surrounding sepsis scores and note that neither qSOFA nor the SIRS criteria are diagnostic for infection or sepsis, although they do offer information on the host's inflammatory reaction to an insult and the degree of physiologic perturbation.
http://ift.tt/2ELFfSQ
http://ift.tt/2ELFfSQ
Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection A Systematic Review and Meta-analysis
Background:
The quick Sequential Organ Failure Assessment (qSOFA) has been proposed for prediction of mortality in patients with suspected infection. Purpose:
To summarize and compare the prognostic accuracy of qSOFA and the systemic inflammatory response syndrome (SIRS) criteria for prediction of mortality in adult patients with suspected infection. Data Sources:
Four databases from inception through November 2017. Study Selection:
English-language studies using qSOFA for prediction of mortality (in-hospital, 28-day, or 30-day) in adult patients with suspected infection in the intensive care unit (ICU), emergency department (ED), or hospital wards. Data Extraction:
Two investigators independently extracted data and assessed study quality using standard criteria. Data Synthesis:
Thirty-eight studies were included (n = 385 333). qSOFA was associated with a pooled sensitivity of 60.8% (95% CI, 51.4% to 69.4%) and a pooled specificity of 72.0% (CI, 63.4% to 79.2%) for mortality. The SIRS criteria were associated with a pooled sensitivity of 88.1% (CI, 82.3% to 92.1%) and a pooled specificity of 25.8% (CI, 17.1% to 36.9%). The pooled sensitivity of qSOFA was higher in the ICU population (87.2% [CI, 75.8% to 93.7%]) than the non-ICU population (51.2% [CI, 43.6% to 58.7%]). The pooled specificity of qSOFA was higher in the non-ICU population (79.6% [CI, 73.3% to 84.7%]) than the ICU population (33.3% [CI, 23.8% to 44.4%]). Limitation:
Potential risk of bias in included studies due to qSOFA interpretation and patient selection. Conclusion:
qSOFA had poor sensitivity and moderate specificity for short-term mortality. The SIRS criteria had sensitivity superior to that of qSOFA, supporting their use for screening of patients and as a prompt for treatment initiation. Primary Funding Source:
Canadian Association of Emergency Physicians. (PROSPERO: CRD42017075964)http://ift.tt/2E3Iq72
Effect of Hot Tea Consumption and Its Interactions With Alcohol and Tobacco Use on the Risk for Esophageal Cancer A Population-Based Cohort Study
Background:
Although consumption of tea at high-temperatures has been suggested as a risk factor for esophageal cancer, an association has not been observed consistently, and whether any relationship is independent of alcohol and tobacco exposure has not been evaluated. Objective:
To examine whether high-temperature tea drinking, along with the established risk factors of alcohol consumption and smoking, is associated with esophageal cancer risk. Design:
China Kadoorie Biobank, a prospective cohort study established during 2004 to 2008. Setting:
10 areas across China. Participants:
456 155 persons aged 30 to 79 years. Those who had cancer at baseline or who reduced consumption of tea, alcohol, or tobacco before baseline were excluded. Measurements:
The usual temperature at which tea was consumed, other tea consumption metrics, and lifestyle behaviors were self-reported once, at baseline. Outcome was esophageal cancer incidence up to 2015. Results:
During a median follow-up of 9.2 years, 1731 incident esophageal cancer cases were documented. High-temperature tea drinking combined with either alcohol consumption or smoking was associated with a greater risk for esophageal cancer than hot tea drinking alone. Compared with participants who drank tea less than weekly and consumed fewer than 15 g of alcohol daily, those who drank burning-hot tea and 15 g or more of alcohol daily had the greatest risk for esophageal cancer (hazard ratio [HR], 5.00 [95% CI, 3.64 to 6.88]). Likewise, the HR for current smokers who drank burning-hot tea daily was 2.03 (CI, 1.55 to 2.67). Limitation:
Tea consumption was self-reported once, at baseline, leading to potential nondifferential misclassification and attenuation of the association. Conclusion:
Drinking tea at high temperatures is associated with an increased risk for esophageal cancer when combined with excessive alcohol or tobacco use. Primary Funding Source:
National Natural Science Foundation of China and National Key Research and Development Program.http://ift.tt/2ELFb5y
Hot Tea and Esophageal Cancer
In their current Annals report, Yu and colleagues show that drinking high-temperature tea, when combined with tobacco or alcohol use, is associated with an increased risk for esophageal cancer. The editorialists discuss these findings in light of what is known about thermal irritation and cancer.
http://ift.tt/2EILdUv
http://ift.tt/2EILdUv
Statistical Code to Support the Scientific Story
Assel and Vickers report the shortcomings of statistical code supporting research reports in high-impact medical journals. In this editorial, Annals' statistical editors argue that clearly presented and transparently reported statistical code is a sine qua non for reproducible research. They describe the attributes of code that communicates clearly to readers the path that researchers took to arrive at their findings.
http://ift.tt/2E5bUkU
http://ift.tt/2E5bUkU
Aims and scope
Publication date: February 2018
Source:Women and Birth, Volume 31, Issue 1
http://ift.tt/2GSTSEz
Individualized Glycemic Control for U.S. Adults With Type 2 Diabetes A Cost-Effectiveness Analysis
Background:
Intensive glycemic control in type 2 diabetes (glycated hemoglobin [HbA1c] level <7%) is an established, cost-effective standard of care. However, guidelines recommend individualizing goals on the basis of age, comorbidity, diabetes duration, and complications. Objective:
To estimate the cost-effectiveness of individualized control versus uniform intensive control (HbA1c level <7%) for the U.S. population with type 2 diabetes. Design:
Patient-level Monte Carlo–based Markov model. Data Sources:
National Health and Nutrition Examination Survey 2011–2012. Target Population:
The approximately 17.3 million persons in the United States with diabetes diagnosed at age 30 years or older. Time Horizon:
Lifetime. Perspective:
Health care sector. Intervention:
Individualized versus uniform intensive glycemic control. Outcome Measures:
Average lifetime costs, life-years, and quality-adjusted life-years (QALYs). Results of Base-Case Analysis:
Individualized control saved $13 547 per patient compared with uniform intensive control ($105 307 vs. $118 854), primarily due to lower medication costs ($34 521 vs. $48 763). Individualized control decreased life expectancy (20.63 vs. 20.73 years) due to an increase in complications but produced more QALYs (16.68 vs. 16.58) due to fewer hypoglycemic events and fewer medications. Results of Sensitivity Analysis:
Individualized control was cost-saving and generated more QALYs compared with uniform intensive control, except in analyses where the disutility associated with receiving diabetes medications was decreased by at least 60%. Limitation:
The model did not account for effects of early versus later intensive glycemic control. Conclusion:
Health policies and clinical programs that encourage an individualized approach to glycemic control for U.S. adults with type 2 diabetes reduce costs and increase quality of life compared with uniform intensive control. Additional research is needed to confirm the risks and benefits of this strategy. Primary Funding Source:
National Institute of Diabetes and Digestive and Kidney Diseases.http://ift.tt/2BeF8Qj
Improving Care for Ground-Level Falls in Assisted Living
Williams and colleagues' prospective cohort study examined an intervention to avoid unnecessary transport to the emergency department for residents in assisted living facilities who fall. The editorialists discuss the findings and conclude that the study provides an example of a much-needed health care innovation pushing our health system toward the triple aim of improving patient experience and population health and reducing costs of care.
http://ift.tt/2jyTYKG
http://ift.tt/2jyTYKG
Improving Decisions About Transport to the Emergency Department for Assisted Living Residents Who Fall
Background:
Residents of assisted living facilities who fall may not be seriously ill or injured, but policies often require immediate transport to an emergency department regardless of the patient's condition. Objective:
To determine whether unnecessary transport can be avoided. Design:
Prospective cohort study. Setting:
One large county with a single system of emergency medical services. Participants:
Convenience sample of residents in 22 assisted living facilities served by 1 group of primary care physicians. Intervention:
Paramedics providing emergency medical services followed a protocol that included consulting with a physician by telephone. Measurements:
The number of transports after a fall and the number of time-sensitive conditions in nontransported patients. Results:
Of the 1473 eligible residents, 953 consented to participate in the study (mean age, 86 years; 76% female) and 359 had 840 falls in 43 months. The protocol recommended nontransport after 553 falls. Eleven of these patients had a time-sensitive condition. At least 7 of them received appropriate care: 4 requested and received transport despite the protocol recommendation, and 3 had minor injuries that were successfully managed on site. Three additional patients had fractures that were diagnosed by outpatient radiography. The final patient developed vomiting and diarrhea, started palliative care, and died 60 hours after the fall. At least 549 of the 553 patients (99.3% [95% CI, 98.2% to 99.8%]) with a protocol recommendation for nontransport received appropriate care. Limitation:
The resources required for this program will preclude use in some locations. Conclusion:
Shared decision making between paramedics and primary care physicians can prevent transport to the emergency department for many residents of assisted living facilities who fall. Primary Funding Source:
None.http://ift.tt/2jxZ75R
Risk-Targeted Lung Cancer Screening A Cost-Effectiveness Analysis
Background:
Targeting low-dose computed tomography (LDCT) for lung cancer screening to persons at highest risk for lung cancer mortality has been suggested to improve screening efficiency. Objective:
To quantify the value of risk-targeted selection for lung cancer screening compared with National Lung Screening Trial (NLST) eligibility criteria. Design:
Cost-effectiveness analysis using a multistate prediction model. Data Sources:
NLST. Target Population:
Current and former smokers eligible for lung cancer screening. Time Horizon:
Lifetime. Perspective:
Health care sector. Intervention:
Risk-targeted versus NLST-based screening. Outcome Measures:
Incremental 7-year mortality, life expectancy, quality-adjusted life-years (QALYs), costs, and cost-effectiveness of screening with LDCT versus chest radiography at each decile of lung cancer mortality risk. Results of Base-Case Analysis:
Participants at greater risk for lung cancer mortality were older and had more comorbid conditions and higher screening-related costs. The incremental lung cancer mortality benefits during the first 7 years ranged from 1.2 to 9.5 lung cancer deaths prevented per 10 000 person-years for the lowest to highest risk deciles, respectively (extreme decile ratio, 7.9). The gradient of benefits across risk groups, however, was attenuated in terms of life-years (extreme decile ratio, 3.6) and QALYs (extreme decile ratio, 2.4). The incremental cost-effectiveness ratios (ICERs) were similar across risk deciles ($75 000 per QALY in the lowest risk decile to $53 000 per QALY in the highest risk decile). Payers willing to pay $100 000 per QALY would pay for LDCT screening for all decile groups. Results of Sensitivity Analysis:
Alternative assumptions did not substantially alter our findings. Limitation:
Our model did not account for all correlated differences between lung cancer mortality risk and quality of life. Conclusions:
Although risk targeting may improve screening efficiency in terms of early lung cancer mortality per person screened, the gains in efficiency are attenuated and modest in terms of life-years, QALYs, and cost-effectiveness. Primary Funding Source:
National Institutes of Health (U01NS086294).http://ift.tt/2CfrBoE
Associations Between Marijuana Use and Cardiovascular Risk Factors and Outcomes A Systematic Review
Background:
Marijuana use is increasing in the United States, and its effect on cardiovascular health is unknown. Purpose:
To review harms and benefits of marijuana use in relation to cardiovascular risk factors and clinical outcomes. Data Sources:
PubMed, MEDLINE, EMBASE, PsycINFO, and the Cochrane Library between 1 January 1975 and 30 September 2017. Study Selection:
Observational studies that were published in English, enrolled adults using any form of marijuana, and reported on vascular risk factors (hyperglycemia, diabetes, dyslipidemia, and obesity) or on outcomes (stroke, myocardial infarction, cardiovascular mortality, and all-cause mortality in cardiovascular cohorts). Data Extraction:
Study characteristics and quality were assessed by 4 reviewers independently; strength of evidence for each outcome was graded by consensus. Data Synthesis:
13 and 11 studies examined associations between marijuana use and cardiovascular risk factors and clinical outcomes, respectively. Although 6 studies suggested a metabolic benefit from marijuana use, they were based on cross-sectional designs and were not supported by prospective studies. Evidence examining the effect of marijuana on diabetes, dyslipidemia, acute myocardial infarction, stroke, or cardiovascular and all-cause mortality was insufficient. Although the current literature includes several long-term prospective studies, they are limited by recall bias, inadequate exposure assessment, minimal marijuana exposure, and a predominance of low-risk cohorts. Limitation:
Poor- or moderate-quality data, inadequate assessment of marijuana exposure and minimal exposure in the populations studied, and variation in study design. Conclusion:
Evidence examining the effect of marijuana on cardiovascular risk factors and outcomes, including stroke and myocardial infarction, is insufficient. Primary Funding Source:
National Heart, Lung, and Blood Institute. (PROSPERO: CRD42016051297)http://ift.tt/2E0360M
Provider Types and Outcomes in Obstructive Sleep Apnea Case Finding and Treatment A Systematic Review
Background:
Obstructive sleep apnea (OSA) diagnosis and care models rely on sleep specialist physicians (SSPs) and can be expensive and inefficient. Purpose:
To assess OSA case-finding accuracy and comparative effectiveness of care by non–sleep specialists (NSSs) and SSPs. Data Sources:
MEDLINE and CINAHL from January 2000 through July 2017. Study Selection:
English-language trials or observational studies comparing case finding or care by SSPs versus providers not specifically trained as SSPs (NSSs) for adults with suspected or diagnosed OSA. Data Extraction:
One investigator extracted data and assessed risk of bias and strength of evidence, with confirmation by a second investigator. Primary outcomes were patient-centered (mortality, access to care, quality of life, patient satisfaction, adherence, symptom scores, and adverse events). Intermediate outcomes included resource use, costs, time to initiation of treatment, and case finding. Data Synthesis:
Four observational studies (n = 580; mean age, 52 years; 77% male) reported good agreement between NSSs and SSPs on appropriate diagnostic testing and classification of OSA severity (low-strength evidence). Five randomized trials and 3 observational studies (n = 1515; mean age, 52 years; 68% male) found that care provided by NSSs and SSPs resulted in similar quality of life, adherence, and symptom scores (low-strength evidence). Evidence was insufficient for access to care and adverse events. Limitations:
Many outcomes were reported infrequently or not at all. Many NSSs had extensive training or experience in sleep medicine, which limits generalizability of findings to providers with less experience. Conclusion:
Care by NSSs and SSPs resulted in similar outcomes in adults with known or suspected OSA. Studies are needed to determine care model implementation and reproducibility of results in nonacademic settings and among less experienced NSSs. Primary Funding Source:
Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO: CRD42016036810 [full Veterans Affairs Evidence-based Synthesis Program report])http://ift.tt/2ElcX1d
Cellulitis and Soft Tissue Infections
Cellulitis and soft tissue infections are a diverse group of diseases that range from uncomplicated cellulitis to necrotizing fasciitis. Management of predisposing conditions is the primary means of prevention. Cellulitis is a clinical diagnosis and thus is made on the basis of history and physical examination. Imaging may be helpful for characterizing purulent soft tissue infections and associated osteomyelitis. Treatment varies according to the type of infection. The foundations of treatment are drainage of purulence and antibiotics, the latter targeted at the infection's most likely cause.
http://ift.tt/2nElVPM
Should This Patient Receive Hormone Therapy for Her Menopausal Symptoms? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Hormone therapy (HT) was widely prescribed in the 1980s and 1990s and has been controversial since the initial results of the Women's Health Initiative (WHI) trial in the early 2000s suggested that it increased risk for breast cancer and coronary heart disease and did not prolong life. However, more recent data and reexamination of the WHI results suggest that HT is safe and effective for many women when used around the time of menopause. Two experts debate the 2017 Hormone Therapy Position Statement of The North American Menopause Society, which recommends HT as first-line treatment of vasomotor symptoms, and apply it to the care of Ms. R, a 52-year-old woman with severe hot flashes, sleep disturbance, and irritability.
http://ift.tt/2BXwm5v
Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2018*
The Advisory Committee on Immunization Practices (ACIP) presents the recommended Immunization Schedule for Adults Aged 19 Years or Older for 2018. This schedule has been approved by the ACIP, American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Nurse-Midwives.
http://ift.tt/2BZEmmC
http://ift.tt/2BZEmmC
Opportunities and Challenges in Genomic Sequencing for Precision Cancer Care
Cancer is defined by diverse somatic and germline alterations that promote aberrant cell growth. Tumor genomic profiling to guide therapy is now part of standard management in several solid tumor types. The authors discuss how recent technical advances in next-generation sequencing technology, coupled with decreasing costs, present an opportunity to improve patient outcomes through routine, prospective tumor and germline genomic profiling.
http://ift.tt/2AGywFV
http://ift.tt/2AGywFV
Model-Based Eligibility for Lung Cancer Screening: Where Theory Meets Practice
Cheung and colleagues argue for moving from lung cancer screening based on the National Lung Screening Trial eligibility criteria toward risk-based testing, and Kumar and colleagues examine the cost-effectiveness of risk-based screening. The editorialists discuss the findings of these studies and note that regardless of the criteria used to identify persons for testing, lung cancer screening remains woefully underutilized.
http://ift.tt/2CdDbB3
http://ift.tt/2CdDbB3
Short Sleep Duration Is Weakly Associated with Carotid Intima-Media Thickness in Adolescents
To investigate the relationship between sleep duration and carotid intima-media thickness (CIMT) in adolescents. We hypothesized that short sleep duration was associated with an increased CIMT.
http://ift.tt/2s9HQ69
Developing prehospital clinical practice guidelines for resource limited settings: why re-invent the wheel?
Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, the volume of literature is not matched by research into alternative methods of CPG develop...
http://ift.tt/2nHUa8m
Identification of a major quantitative trait locus underlying salt tolerance in ‘Jidou 12’ soybean cultivar
Identification of the quantitative trait locus (QTL) underlying salt tolerance is a prerequisite for marker-assisted selection in the salt-tolerant breeding process.
http://ift.tt/2E3UN7d
Professionalism and non-technical skills in Radiology in the UK: a review of the national curriculum
To drive quality and safe clinical practice, professional values and non-technical skills need to be explicit in all postgraduate medical curricula and appropriate assessment tools should be available for teac...
http://ift.tt/2nKVnfi
Variability in gut mucosal secretory IgA in mice along a working day
To assess the variability of secretory immunoglobulin A (S-IgA) in the lumen and feces of mice along a working day.
http://ift.tt/2E6O10A
Predictors of therapy failure in newly diagnosed pulmonary tuberculosis cases in Beira, Mozambique
Tuberculosis (TB) remains a major global health issue, ranking in the top ten causes of death worldwide. A deep understanding of factors influencing poor treatment outcomes may allow the development of additio...
http://ift.tt/2nM4Hzj
Detection of a CDH1 Rare Transcript Variant in Fresh-frozen Gastric Cancer Tissues by Chip-based Digital PCR
The manuscript describes a chip-based digital PCR assay to detect a rare CDH1 transcript variant (CDH1a) in fresh-frozen normal and tumor tissues obtained from patients with gastric cancer.
http://ift.tt/2BYdTFV
Color Spot Test As a Presumptive Tool for the Rapid Detection of Synthetic Cathinones
Here we present a simple, inexpensive, and selective chemical spot test protocol for the detection of synthetic cathinones, a class of new psychoactive substances. The protocol is suitable for use in various areas of law enforcement that encounter illicit material.
http://ift.tt/2nGwq5e
EMCrit RACC Podcast 217 – The Ultimate “Ultimate” BVM
So in prior posts, I have discussed the jerry-rigged "ultimate" BVM. But there is a better way–the creation of a manufactured BVM that helps us not kill patients. It would have the following characteristics: Facets of the Ultimate BVM Now on to the Vodcast…
EMCrit Project by Scott Weingart.
http://ift.tt/2BXR0SW
Simple Generation of a High Yield Culture of Induced Neurons from Human Adult Skin Fibroblasts
Direct neuronal reprogramming generates neurons that maintain the age of the starting somatic cell. Here, we describe a single vector-based method to generate induced neurons from dermal fibroblasts obtained from adult human donors.
http://ift.tt/2GS1M0I
Zika Virus Infection of Cultured Human Fetal Brain Neural Stem Cells for Immunocytochemical Analysis
http://ift.tt/2s84M5X
A Novel In Vitro Live-imaging Assay of Astrocyte-mediated Phagocytosis Using pH Indicator-conjugated Synaptosomes
http://ift.tt/2GPOAcN
Pancreatic cyst biopsy: Improvement in diagnosis with micro forceps biopsy
Clinician's Corner represents the opinions and views of the author and does not reflect any policy or opinion of the American Cancer Society, Cancer Cytopathology, or Wiley unless this is clearly specified. Cancer Cytopathol 2018. © 2018 American Cancer Society.
http://ift.tt/2ElYB31
Cytologic-histologic correlation of programmed death-ligand 1 immunohistochemistry in lung carcinomas
BACKGROUND
Programmed cell death protein 1 inhibitors increasingly are being used to treat patients with advanced lung carcinomas. Programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) in tumor cells (TCs) and tumor-infiltrating immune cells (ICs) is used to select patients for programmed cell death protein 1 inhibition, but few studies have evaluated PD-L1 IHC in cytology specimens. The objective of the current study was to compare PD-L1 IHC in cytology cell blocks and matched surgical specimens.
METHODS
A total of 56 cytology specimens obtained between 2013 and 2016 with matching surgical specimens were stained with anti-PD-L1. Membranous positivity was scored as a percentage of the TCs and ICs by 2 pathologists. Results were compared between cytology and surgical specimens, and interobserver concordance was assessed.
RESULTS
The average PD-L1 positivity rate was 28% in TCs and 5% in ICs in surgical specimens (standard deviations of 37% and 7%, respectively), and 21% in TCs and 8% in ICs in cytology specimens (standard deviations of 33% and 15%, respectively). Interobserver concordance was high for TCs in surgical and cytology specimens (intraclass correlation coefficients of 0.96 and 0.96, respectively), and was moderate for ICs in surgical and cytology specimens (intraclass correlation coefficients of 0.47 and 0.67, respectively). There was moderate to high correlation between PD-L1 positivity in TCs between surgical and cytology specimens (Spearman correlation coefficient [Spearman r], 0.69), particularly among fine-needle aspiration specimens (Spearman r, 0.78), but not between PD-L1 positivity in ICs in surgical and cytology specimens (Spearman r, 0.14), including among fine-needle aspiration specimens (Spearman r, 0.23).
CONCLUSIONS
Tumor PD-L1 IHC positivity in cytology specimens appears to correlate strongly with results obtained from matching surgical specimens. PD-L1 IHC in ICs within cytology specimens does not reflect results in matched surgical specimens and should not be used in clinical decision making. Cancer Cytopathol 2018. © 2018 American Cancer Society.
http://ift.tt/2FOspSS
Hospital Standards to Promote Optimal Surgical Care of the Older Adult: A Report From the Coalition for Quality in Geriatric Surgery
Objective: The aim of this study was to establish high-quality, valid standards to improve surgical care of the older adult. Background: The aging population increases demand for high-quality surgical care. Building upon prior guidelines, quality indicators, and pilot projects, the Coalition for Quality in Geriatric Surgery (CQGS) includes 58 diverse stakeholder organizations committed to improving geriatric surgery. Methods: Using a modified RAND-UCLA Appropriateness Methodology, 44 of 58 CQGS Stakeholders twice rated validity (primary outcome) and feasibility for 308 standards, ranging from goals and decision-making, pre-operative assessment and optimization, perioperative and postoperative care, to transitions of care beyond the acute care hospital. Results: Three hundred six of 308 (99%) standards were rated as valid to improve quality of geriatric surgery. There were 4 sections. Section 1 included 157 (57%) standards and focused on goals and decision-making, preoperative optimization, and transitions into and out of the hospital. Section 2 included 84 (27.3%) standards focused on in-hospital care, across the immediate preoperative, intraoperative, and postoperative phases. Section 3 included 59 (19.1%) standards about program management, including personnel and committee structure, credentialing, and education. Section 4 included 8 (2.6%) standards establishing overarching concepts for data collection and patient follow-up. Two hundred ninety of 308 standards (94.2%) were rated as feasible; 18 (5.8%) were rated as uncertain in feasibility. Conclusions: CQGS Stakeholders rated the vast majority of standards of care as highly valid (99%) and feasible (94%) for improving the quality of surgical care provided to older adults. Future work will focus on a pilot phase to better understand and address challenges to implementation of the standards.http://ift.tt/2nKE1za
Estimation of the incidence of severe fever with thrombocytopenia syndrome in high endemic areas in China: an inpatient-based retrospective study
Severe fever with thrombocytopenia syndrome (SFTS) is a severe viral disease caused by SFTSV. It is important to estimate the rate of missed SFTS diagnosis and to further understand the actual incidence in hig...
http://ift.tt/2BYyiul
Chemo-enzymatic Synthesis of N-glycans for Array Development and HIV Antibody Profiling
http://ift.tt/2nLrQ55
2D Ultrathin MXene-Based Drug-Delivery Nanoplatform for Synergistic Photothermal Ablation and Chemotherapy of Cancer
Abstract
Two-dimensional (2D) MXenes, as a new 2D functional material nanosystem, have been extensively explored for broad applications. However, their specific performance and applications in theranostic nanomedicine have still rarely been explored. This work reports on the drug-delivery performance and synergistic therapeutic efficiency of Ti3C2 MXenes for highly efficient tumor eradication. These Ti3C2 MXenes not only possess high drug-loading capability of as high as 211.8%, but also exhibit both pH-responsive and near infrared laser-triggered on-demand drug release. Especially, based on the high photothermal-conversion capability of Ti3C2 MXenes, they have been further explored for efficient tumor eradication by synergistic photothermal ablation and chemotherapy, which has been systematically demonstrated both in vitro and in vivo. These Ti3C2 MXenes have also been demonstrated as the desirable contrast agents for photoacoustic imaging, showing the potential for diagnostic-imaging guidance and monitoring during therapy. The high in vivo histocompatibility of Ti3C2 and their easy excretion out of the body have been evaluated and demonstrated, showing the potential high biosafety for further clinical translation. This work paves a new way for broadening biomedical applications of MXenes in nanomedicine where they can exert the high performance and functionality for synergistic therapy, especially on combating cancer.
Two-dimensional (2D) Ti3C2 MXene-based nanosheets have been successfully constructed for controllable drug releasing and synergistic photothermal hyperthermia/chemotherapy against cancer. Especially, based on the high photothermal-conversion capability of 2D Ti3C2 MXenes, they have been further explored for highly efficient tumor eradication by synergistic Ti3C2-assisted photothermal ablation and chemotherapy, which has been systematically demonstrated both in vitro and in vivo.
http://ift.tt/2GObnFM
Granulomatous diseases of the breast and axilla: radiological findings with pathological correlation
Abstract
Objectives
This article reviews our experience and describes the literature findings of granulomatous diseases of the breast and axilla.
Methods
After approval of the Institutional Review Board was obtained, the surgical pathological records from January 2000 to January 2017 were searched for the keyword granulomatous. Clinical, imaging and histology findings were reviewed by both a fellowship-trained radiologist and a breast-imaging consultant radiologist, reviewing 127 patients (age range, 32–86 years; 126 women and 1 man).
Results
Most common causes of granulomatous lesions of the breast and axilla included silicone granulomas 33% (n = 42), fat necrosis 29% (n = 37) and suture granulomas 11% (n = 14). In 16% (n = 20), no cause could be found and clinical history was consistent with idiopathic granulomatous mastitis. Other granulomatous aetiologies included granulomatous infections, sarcoidosis and Sjögren's syndrome. Causes of axillary granulomatous disease were similar to the breast; however, a case of cat-scratch disease was found that only involved the axillary lymph nodes. They can have a variable appearance on imaging and may mimic malignancy with irregular masses seen on mammography, ultrasound and magnetic resonance imaging. Fistulas to the skin and nipple retraction can suggest chronicity and a granulomatous aetiology. Combination of clinical history, laboratory and imaging findings can be diagnostic.
Conclusions
Granulomatous processes of the breast are rare. The diagnosis can, however, be made if there is relevant history (prior trauma, silicone breast implants, lactation), laboratory (systemic or infectious processes) and imaging findings (fistula, nipple retraction). Recognising these entities is important for establishing pathological concordance after biopsy and for preventing unnecessary treatment.
Teaching points
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Breast granulomatous are rare but can mimic breast carcinoma on imaging
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Imaging with clinical and laboratory findings can correctly diagnosis specific granulomatous breast diseases
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Recognition of the imaging findings allows appropriate pathological concordance and treatment
http://ift.tt/2E6qZHa
Germline promoter hypermethylation in BRCA1 and BRCA2 genes is not present in hereditary breast cancer patients
Abstract
Purpose
Germline promoter hypermethylation of BRCA1 and BRCA2 genes is an alternative event of gene silencing that has not been widely investigated in hereditary breast and ovarian cancer (HBOC) syndrome.
Methods
We analyzed germline BRCA promoter hypermethylation in HBOC patients with and without BRCA mutations and control subjects, using a recently developed BRCA methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) assay.
Results
Neither the patients tested nor the control subjects showed germline hypermethylation of the BRCA1 and BRCA2 promoter regions analyzed.
Conclusions
Despite the results achieved at somatic levels by other researchers, these were not confirmed in our study at the germline level. Our results show the need to establish more predictive CpG sites in the BRCA promoter regions to optimize the MS-MLPA assay for the detection of germline hypermethylation as an effective pre-screening tool for whole-BRCA genetic analysis in HBOC, because we can not rule out the existence of germline promoter hypermethylation in BRCA.
http://ift.tt/2sbcgVH
Avian Semen Collection by Cloacal Massage and Isolation of DNA from Sperm
This protocol describes cloacal massage, a non-invasive manual technique for collecting semen from birds, and DNA extraction from avian sperm using a commercial extraction kit with modifications.
http://ift.tt/2BXCdHS
Fluorescent peptide highlights micronodules in murine hepatocellular carcinoma models and human in vitro
Abstract
Early detection and clear delineation of microscopic lesions during surgery are critical to the prognosis and survival of patients with hepatocellular carcinoma (HCC), a devastating malignancy without effective treatments except for resection. Tools to specifically identify and differentiate micronodules from normal tissue in HCC patients can have a positive impact on survival. Here, we discovered a peptide that preferentially binds to HCC cells through phage display. Significant accumulation of the fluorescence-labeled peptide in tumor from ectopic and orthotopic HCC mice was observed within 2 h of systemic injection. Contrast between tumor and surrounding liver is up to 6.5-fold and useful contrast lasts for 30 h. Micronodules (0.03 cm in diameter) in liver and lung can clearly be distinguished from normal tissue with this fluorescence-labeled peptide in orthotopic HCC mice and HCC patients. Compared to indocyanine green (ICG), an FDA-approved imaging contrast agent, up to 8.7-fold higher differentiation ratio of tumor-to-fibrosis is achieved with this fluorescence-labeled peptide. Importantly, this peptide enables up to 10-fold differentiation between HCC-to-peritumoral tissue in human tissues and the complete removal of tumor in HCC mice with surgical navigation. No abnormalities in behavior or activity are observed after systemic treatment, indicating the absence of overt toxicity. The peptide is metabolized with a half-life of approximately 4 h in serum. Conclusions: Our findings demonstrate that micronodules can be specifically differentiated with high sensitivity from surrounding tissue with this molecule, opening clinical possibilities for early detection and precise surgery of HCC. This article is protected by copyright. All rights reserved.
http://ift.tt/2FMtCKy
Hepatocellular Carcinoma: Liver Biopsy in the Balance
Abstract
The use of liver biopsy to diagnose hepatocellular carcinoma is governed by the balance of the risks of the procedure (morbidity, mortality, inadequate sampling), the relative utility of non-invasive techniques and the benefits of precise diagnosis, prognostic and theragnostic information and access to tissue for molecular analysis. In this issue of Hepatology, identification of the macrotrabecular subtype of hepatocellular carcinoma on liver biopsy is shown to add clinically useful prognostic information as well as molecular correlations. This article is protected by copyright. All rights reserved.
http://ift.tt/2EkSCM4
Predicting clinical diagnosis in Huntington's disease: An imaging polymarker
Abstract
Objective: Huntington's disease (HD) gene-carriers can be identified prior to clinical diagnosis; however, statistical models for predicting when overt motor symptoms will manifest are too imprecise to be useful at the level of the individual. Perfecting this prediction is integral to the search for disease modifying therapies. This study aimed to identify an imaging marker capable of reliably predicting real-life clinical diagnosis in HD.
Method: A multivariate machine learning approach was applied to resting-state and structural MRI scans from 19 pre-manifest HD gene carriers (preHD, 8 of whom developed clinical disease in the 5 years post-scanning) and 21 healthy controls. A classification model was developed using cross-group comparisons between preHD and controls, and within the preHD group in relation to "estimated" and "actual" proximity to disease onset. Imaging measures were modelled individually, and combined, and permutation modelling robustly tested classification accuracy.
Results: Classification performance for preHDs vs. controls was greatest when all measures were combined. The resulting polymarker predicted converters with high accuracy including those who were not expected to manifest in that timescale based on the currently adopted statistical models.
Interpretation: We propose that a holistic multivariate machine learning treatment of brain abnormalities in the premanifest phase can be used to accurately identify those patients within 5 years of developing motor features of Huntington's disease, with implications for prognostication and preclinical trials. This article is protected by copyright. All rights reserved.
http://ift.tt/2s9jMQX
Orthostatic Heart Rate Changes in Patients with Autonomic Failure caused by Neurodegenerative Synucleinopathies
ABSTRACT
Objective: Blunted tachycardia during hypotension is a characteristic feature of patients with autonomic failure, but the range has not been defined. This study reports the range of orthostatic heart rate (HR) changes in patients with autonomic failure caused by neurodegenerative synucleinopathies.
Methods: Patients evaluated at sites of the U.S. Autonomic Consortium (NCT01799915) underwent standardized autonomic function tests and full neurological evaluation.
Results: We identified 402 patients with orthostatic hypotension (OH) who had normal sinus rhythm. Of these, 378 had impaired sympathetic activation, i.e., neurogenic OH, and based on their neurological examination were diagnosed with Parkinson disease, dementia with Lewy bodies, pure autonomic failure or multiple system atrophy. The remaining 24 patients had preserved sympathetic activation and their OH was classified as non-neurogenic, due to volume depletion, anemia or polypharmacy. Patients with neurogenic OH had twice the fall in systolic blood pressure (SBP) [-44±25 vs. -21±14 mmHg (mean±SD), p<0.0001] but only one third of the increase in HR than those with non-neurogenic OH (8±8 vs. 25±11 bpm, p<0.0001). A ΔHR/ΔSBP ratio of 0.492 bpm/mmHg had excellent sensitivity (91.3%) and specificity (88.4%) to distinguish between patients with neurogenic vs. non-neurogenic OH (AUC=0.96, p<0.0001). Within patients with neurogenic OH, HR increased more in those with multiple system atrophy (p=0.0003), but there was considerable overlap with patients with Lewy body disorders.
Interpretation: A blunted HR increase during hypotension suggests a neurogenic cause. A ΔHR/ΔSBP ratio lower than 0.5 bpm/mmHg is diagnostic of neurogenic OH. This article is protected by copyright. All rights reserved.
http://ift.tt/2E68DlG
Single-institution experience of intensity-modulated radiotherapy for malignant pleural mesothelioma at University of Catania
Future Oncology, Ahead of Print.
http://ift.tt/2FKWwuw
Somatic and germline FOXP3 mosaicism in the mother of a boy with IPEX syndrome
Abstract
This is the first identification of FOXP3 mosaicism and description of two different mutational events in IPEX syndrome. Our study provides precise diagnosis and counseling for this family to avoid recurrence of this devastating disease.
This article is protected by copyright. All rights reserved
http://ift.tt/2GOLPIL
Antiaflatoxigenic effect of fullerene C60 nanoparticles at environmentally plausible concentrations
Increased interest in fullerene C60 and derivatives in recent years implies an intensification of their environmental spread. Yet, the potential risks for living organisms are largely unknown, including the inter...
http://ift.tt/2nBbuwD
Correction to: Comparison of the gut microbiota composition between wild and captive sika deer (Cervus nippon hortulorum) from feces by high-throughput sequencing
The authors regret the following errors occurred in the original publication of the article (Guan et al. 2017). The corrected texts have been presented with this erratum.
http://ift.tt/2C0i0S4
Gut Bacteria Influence Effectiveness of a Type of Immunotherapy
Using mouse models of cancer, researchers found that altering gut microbiome could affect whether tumors responded to checkpoint inhibition.
http://ift.tt/2E3dBj0
Feasibility of 15 O-water PET studies of auditory system activation during general anesthesia in children
Abstract
Background
15O-Water positron emission tomography (PET) enables functional imaging of the auditory system during stimulation via a promontory electrode or cochlear implant, which is not possible using functional magnetic resonance imaging (fMRI). Although PET has been introduced in this context decades ago, its feasibility when performed during general anesthesia has not yet been explored. However, due to a shift to earlier (and bilateral) auditory implantation, the need to study children during general anesthesia appeared, since they are not able to cooperate during scanning. Therefore, we evaluated retrospectively results of individual SPM (statistical parametric mapping) analysis of 15O-water PET in 17 children studied during general anesthesia and compared them to those in 9 adults studied while awake. Specifically, the influence of scan duration, smoothing filter kernel employed during preprocessing, and cut-off value used for statistical inferences were evaluated. Frequencies, peak heights, and extents of activations in auditory and extra-auditory brain regions (AR and eAR) were registered.
Results
It was possible to demonstrate activations in auditory brain regions during general anesthesia; however, the frequency and markedness of positive findings were dependent on some of the abovementioned influence factors. Scan duration (60 vs. 90 s) had no significant influence on peak height of auditory cortex activations. To achieve a similar frequency and extent of AR activations during general anesthesia compared to waking state, a lower cut-off for statistical inferences (p < 0.05 or p < 0.01 vs. p < 0.001) had to be applied. However, this lower cut-off was frequently associated with unexpected, "artificial" activations in eAR. These activations in eAR could be slightly reduced by the use of a stronger smoothing filter kernel during preprocessing of the data (e.g., [30 mm]3).
Conclusions
Our data indicate that it is feasible to detect auditory cortex activations in 15O-water PET during general anesthesia. Combined with the improved signal to noise ratios of modern PET scanners, this suggests reasonable prospects for further evaluation of the method for clinical use in auditory implant users. Adapted parameters for data analysis seem to be helpful to improve the proportion of signals in AR versus eAR.
http://ift.tt/2E4tABt
Endovascular Treatment of Dural Arteriovenous Fistulas of the Anterior or Posterior Condylar Vein
Abstract
Dural arteriovenous fistulas (DAVF) involving the anterior and posterior condylar vein at the skull base are rare but important to recognize. Due to the highly variable anatomy of the venous system of the skull base, detailed anatomical knowledge is essential for correct diagnosis and appropriate treatment of these lesions. In this report we review the normal anatomy of the condylar veins and describe rare and, to our knowledge, not previously reported anatomical variants. We also highlight the treatment modalities for these lesions with focus on the endovascular transvenous occlusion based on four consecutive cases from our center.
http://ift.tt/2nF5aEt
A Novel, Well-Resolved Direct Laser Bioprinting System for Rapid Cell Encapsulation and Microwell Fabrication
Abstract
A direct laser bioprinting (DLBP) system is introduced in this work. The DLBP system applies visible-laser-induced photo-crosslinking at a wavelength of 405 nm using the photoinitiator VA-086. It is shown that such a system can fabricate vertical structures with fine features (less than 50 µm) and high cell viability (greater than 95%). Experimental characterizations and theoretical simulations are presented, and good agreement is seen between the experiments and theory. The DLBP system is applied to the fabrication of (1) cell-laden hydrogel microgrids, (2) hydrogel microwells, as well as a test of (3) cell encapsulation, and (4) cell seeding. The DLBP system is found to be a promising tool for bioprinting.
Existing bioprinting methods have difficulties in achieving high cell viability and fine resolution simultaneously. This work introduces a new type of bioprinting method named "direct laser bioprinting" (DLBP). The DLBP utilizes the focused laser beamspot to selectively photo-crosslink a hydrogel prepolymer solution. It is proven to perform the rapid fabrication of cell-laden hydrogels with fine resolution and high cell viability.
http://ift.tt/2BXoO2P
Progress of Multicompartmental Particles for Medical Applications
Abstract
Particulate materials are becoming increasingly used in the literature for medical applications, but translation to the clinical setting has remained challenging as many particle systems face challenges from in vivo barriers. Multicompartmental particles that can incorporate several materials in an individual particle may allow for more intricate control and addressing of issues that otherwise standard particles are unable to. Here, some of the advances made in the use of multicompartmental particles for medical applications are briefly described.
Multicompartmental particles comprise a broad class of anisotropic particles that have become of interest in a variety of applications. As more sophisticated and reliable materials processing techniques are developed, increasingly robust data are published demonstrating their potential, particularly in medical applications. Here, the recent progress in the development of multicompartmental particles in medicine is reviewed.
http://ift.tt/2nE1CSJ
Efficacy of Treatments for Opioid-induced Constipation: A Systematic Review and Meta-Analysis
Opioid induced constipation (OIC) is a common problem in patients on chronic opioid therapy for cancer-related and non-cancer related pain. Approved treatments for OIC are methylnaltrexone, naloxone, naloxegol, alvimopan, naldemedine, and lubiprostone. Since a meta-analysis performed in 2014, 2 new agents have been approved by the Food and Drug Administration (FDA) for treatment of OIC (naloxegol and naldemedine).
http://ift.tt/2FLZ4Zu
High Risk of Advanced Colorectal Neoplasia in Patients With Primary Sclerosing Cholangitis Associated With Inflammatory Bowel Disease
Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC, termed PSC-IBD) are at increased risk for colorectal cancer (CRC), but their risk following a diagnosis of low-grade dysplasia (LGD) is not well described. We aimed to determine the rate of advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia and/or colorectal cancer, following a diagnosis of indefinite dysplasia or LGD in this population.
http://ift.tt/2EhXK3n
The unregulated probiotic market
This narrative review provides an overview of the current regulation of probiotics, with a focus on those used for the dietary management of medical conditions (Medical Foods).
http://ift.tt/2FM3wY8
Under-dilated TIPS Associate With Efficacy and Reduced Encephalopathy in a Prospective, Non-randomized Study of Patients With Cirrhosis
Portosystemic encephalopathy (PSE) is the most feared complication after transjugular intrahepatic porto-systemic shunt (TIPS) in cirrhotic patients. This study showed that placement of TIPS under-dilated up to 6 mm halves the post-procedural risk of PSE while maintaining clinical and hemodynamic efficacy.
http://ift.tt/2EhXzVL
EEG-like signals can be synthesized from surface representations of single motor units of facial muscles
Abstract
Electrodes for recording electroencephalogram (EEG) are placed on or around cranial muscles; hence, their electrical activity may contaminate the EEG signal even at rest conditions. Due to its role in maintaining mandibular posture, tonic activity of temporalis muscle interferes with the EEG signal particularly at fronto-temporal locations at single motor unit (SMU) level. By obtaining surface representation of a motor unit, we can evaluate its interference in EEG and if we could sum surface representations of several tonically active motor units, we could estimate the overall myogenic contamination in EEG. Therefore, in this study, we followed re-composition (RC) approach and generated EEG-like artefact model using surface representations of single motor units (RC). Furthermore, we compared signal characteristics of RC signals with simultaneously recorded EEG signal at different locations in terms of power spectral density and coherence. First, we found that RC signal represented the power spectral distribution of an EMG signal. Second, RC signal reflected the discharge rate of a SMU giving the greatest surface representation amplitude and strongest interference appeared as distinguishable frequency peak on RC power spectra. Moreover, for strong interferences, RC also contaminated the EEG at F7 and other EEG electrodes. These findings are important to illustrate the susceptibility of EEG signal to myogenic artefacts even at rest and the research using EEG coherence comparisons should consider muscle activity while drawing conclusions about neuronal interactions and oscillations.
http://ift.tt/2GMwjx0
Neural changes associated with cerebellar tDCS studied using MR spectroscopy
Abstract
Anodal cerebellar transcranial direct current stimulation (tDCS) is known to enhance motor learning, and therefore, has been suggested to hold promise as a therapeutic intervention. However, the neural mechanisms underpinning the effects of cerebellar tDCS are currently unknown. We investigated the neural changes associated with cerebellar tDCS using magnetic resonance spectroscopy (MRS). 34 healthy participants were divided into two groups which received either concurrent anodal or sham cerebellar tDCS during a visuomotor adaptation task. The anodal group underwent an additional session involving MRS in which the main inhibitory and excitatory neurotransmitters: GABA and glutamate (Glu) were measured pre-, during, and post anodal cerebellar tDCS, but without the behavioural task. We found no significant group-level changes in GABA or glutamate during- or post-tDCS compared to pre-tDCS levels, however, there was large degree of variability across participants. Although cerebellar tDCS did not affect visuomotor adaptation, surprisingly cerebellar tDCS increased motor memory retention with this being strongly correlated with a decrease in cerebellar glutamate levels during tDCS across participants. This work provides novel insights regarding the neural mechanisms which may underlie cerebellar tDCS, but also reveals limitations in the ability to produce robust effects across participants and between studies.
http://ift.tt/2GS0Mde
Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer
Background
Although some retrospective studies have suggested the value of adjuvant therapy, no recommended standard exists in bile duct cancer. The aim of this study was to test the hypothesis that adjuvant gemcitabine chemotherapy would improve survival probability in resected bile duct cancer.
Methods
This was a randomized phase III trial. Patients with resected bile duct cancer were assigned randomly to gemcitabine and observation groups, which were balanced with respect to lymph node status, residual tumour status and tumour location. Gemcitabine was given intravenously at a dose of 1000 mg/m2, administered on days 1, 8 and 15 every 4 weeks for six cycles. The primary endpoint was overall survival, and secondary endpoints were relapse-free survival, subgroup analysis and toxicity.
Results
Some 225 patients were included (117 gemcitabine, 108 observation). Baseline characteristics were well balanced between the gemcitabine and observation groups. There were no significant differences in overall survival (median 62·3 versus 63·8 months respectively; hazard ratio 1·01, 95 per cent c.i. 0·70 to 1·45; P = 0·964) and relapse-free survival (median 36·0 versus 39·9 months; hazard ratio 0·93, 0·66 to 1·32; P = 0·693). There were no survival differences between the two groups in subsets stratified by lymph node status and margin status. Although haematological toxicity occurred frequently in the gemcitabine group, most toxicities were transient, and grade 3/4 non-haematological toxicity was rare.
Conclusion
The survival probability in patients with resected bile duct cancer was not significantly different between the gemcitabine adjuvant chemotherapy group and the observation group. Registration number: UMIN 000000820 (http://www.umin.ac.jp/).
http://ift.tt/2FIhPwT
Health-related quality of life after open transhiatal and transthoracic oesophagectomy for cancer
Background
Transhiatal and transthoracic oesophagectomy in patients with oesophageal cancer have similar survival rates. Whether these approaches differ in health-related quality of life (HRQoL) is uncertain and was examined in this study.
Methods
Patients undergoing transhiatal or transthoracic surgery for lower-third oesophageal or gastro-oesophageal junctional cancer between 2011 and 2015 were selected from an institutional database. HRQoL outcomes were measured at 6 and 12 months after surgery using validated written questionnaires (European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25). Linear mixed models provided mean score differences (MSDs) with 95 per cent confidence intervals, adjusted for preoperative HRQoL, age, physical status (ASA fitness grade), tumour location, tumour stage, neoadjuvant therapy, adjuvant therapy and postoperative complications. MSD values of 10 or more were regarded as clinically relevant.
Results
Some 146 patients underwent transhiatal (86, 58·9 per cent) or transthoracic (60, 41·1 per cent) oesophagectomy. The HRQoL questionnaires were returned by 111 patients at 6 months and 74 at 12 months. At 6 months, transthoracic oesophagectomy was associated with worse role function (MSD –12, 95 per cent c.i. –23 to 0; P = 0·046). At 12 months, patients in the transthoracic group had more nausea and vomiting (MSD 11, 0 to 22; P = 0·045), dyspnoea (MSD 13, 1 to 25; P = 0·029) and constipation (MSD 20, 7 to 33; P = 0·003) than those in the transhiatal group.
Conclusion
Transhiatal oesophagectomy seems to offer better HRQoL than transthoracic oesophagectomy 6 and 12 months after surgery.
http://ift.tt/2EkLyia
Meta-analysis of metabolic surgery versus medical treatment for microvascular complications in patients with type 2 diabetes mellitus
Background
This study aimed to examine the effect of metabolic surgery on pre-existing and future microvascular complications in patients with type 2 diabetes mellitus (T2DM) in comparison with medical treatment. Although metabolic surgery is the most effective treatment for obese patients with T2DM regarding glycaemic control, it is unclear whether the incidence or severity of microvascular complications is reduced.
Methods
A systematic literature search was performed in MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) with no language restrictions, looking for RCTs, case–control trials and cohort studies that assessed the effect of metabolic surgery on the incidence of microvascular diabetic complications compared with medical treatment as control. The study was registered in the International prospective register of systematic reviews (CRD42016042994).
Results
The literature search yielded 1559 articles. Ten studies (3 RCTs, 7 controlled clinical trials) investigating 17 532 patients were included. Metabolic surgery reduced the incidence of microvascular complications (odds ratio 0·26, 95 per cent c.i. 0·16 to 0·42; P < 0·001) compared with medical treatment. Pre-existing diabetic nephropathy was strongly improved by metabolic surgery versus medical treatment (odds ratio 15·41, 1·28 to 185·46; P = 0·03).
Conclusion
In patients with T2DM, metabolic surgery prevented the development of microvascular complications better than medical treatment . Metabolic surgery improved pre-existing diabetic nephropathy compared with medical treatment.
http://ift.tt/2FLKEZa
Impact of abdominal aortic aneurysm screening on quality of life
Background
Screening for abdominal aortic aneurysm (AAA) is known to reduce AAA-related mortality; however, the psychological impact of population AAA screening is unclear. The aim was to assess the impact of AAA diagnosis on quality of life (QoL) using data from an established AAA screening programme.
Methods
Mental and physical QoL scores for men diagnosed with AAA through participation in the English and Welsh AAA screening programmes were compared with no-AAA controls. Participants were identified through the United Kingdom Aneurysm Growth Study (UKAGS), a nationwide prospective cohort study of men with an AAA of less than 55 mm diagnosed through voluntary participation in screening. The UKAGS participants completed QoL questionnaires at the time of screening and annually thereafter.
Results
A transient reduction in mental QoL scores was observed following the diagnosis of AAA, returning to baseline levels after 12 months. Physical QoL remained consistently lower in the AAA cohort. Participants thought about their AAA and the AAA growth progressively less 12 months after the initial screening diagnosis. AAA growth rate had no influence over QoL parameters.
Discussion
This study suggests that screening for AAA does reduce mental QoL; however, this effect is transient (less than 12 months). Men diagnosed with AAA have a consistently worse physical QoL compared with controls.
http://ift.tt/2FMkwgK
Quality of life after hepatic resection
Background
Long-term quality of life (QoL) after liver resection is becoming increasingly important, as improvements in operative methods and perioperative care have decreased morbidity and mortality rates. In this study, postoperative QoL after resection of benign or malignant liver tumours was evaluated.
Methods
In this single-centre study, QoL was evaluated prospectively using the European Organisation for Research and Treatment of Cancer QLQ-C30 and the liver-specific QLQ-LMC21 module before, and 1, 3, 6 and 12 months after open or laparoscopic liver surgery.
Results
Between June 2007 and January 2013, 188 patients (130 with malignant and 58 with benign tumours) requiring major liver resection were included. Global health status was no different between the two groups before and 1 month after liver resection. All patients showed an improvement in global health status at 3, 6 and 12 months after surgery. Patients with benign tumours had better global health status than those with malignant tumours at these time points (P < 0·001, P = 0·002 and P = 0·006 respectively). Patients with benign disease had better physical function scores (P = 0·011, P = 0·025 and P = 0·041) and lower fatigue scores (P = 0·001, P = 0·002 and P = 0·002) at 3, 6 and 12 months than those with malignant disease.
Conclusion
This study confirmed overall good QoL in patients undergoing liver resection for benign or malignant tumours, which improved after surgery. Benign diseases were associated with better short- and long-term QoL scores.
http://ift.tt/2FL7wZ0
Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism
Background
Normocalcaemic primary hyperparathyroidism (NcPHPT) is a new clinical entity being diagnosed increasingly among patients with mild primary hyperparathyroidism (PHPT). The aim of this study was to evaluate quality of life and non-specific symptoms before and after parathyroidectomy in patients with NcPHPT compared with those with hypercalcaemic mild PHPT (Hc-m-PHPT).
Methods
This was a prospective multicentre study of patients with mild PHPT from four university hospitals. Patients were evaluated before operation, and 3, 6 and 12 months after surgery for quality of life using the SF-36-v2® questionnaire, as well as for 25 non-specific symptoms.
Results
Before operation, the only statistically significant difference between the NcPHPT and Hc-m-PHPT groups was in the mean(s.d.) blood calcium level (2·54 versus 2·73 mmol; P < 0·001). At 1 year after surgery, the blood calcium level had improved significantly in both groups, with no significant difference between them. Quality of life improved significantly in each group compared with its preoperative score, with regard to the physical component summary (P = 0·040 and P = 0·016 respectively), whereas the mental component summary improved significantly in the Hc-m-PHPT group only (P = 0·043). Only two non-specific symptoms improved significantly in the NcPHPT group compared with nine in the Hc-m-PHPT group.
Conclusion
Parathyroidectomy mildly improves quality of life and some non-specific symptoms in patients with NcPHPT.
http://ift.tt/2FMkw0e
Surgeon volume and prognosis of patients with advanced papillary thyroid cancer and lateral nodal metastasis
Background
Surgery is the most important treatment modality for papillary thyroid cancer (PTC). However, the relationship between surgeon volume and long-term oncological outcomes has not been explored.
Methods
Patients diagnosed with N1b PTC after initial thyroid surgery between 1 July 1994 and 31 December 2011 were eligible for inclusion in the study. Surgeons were categorized into high (at least 100 operations per year) and low (fewer than 100 operations per year) volume groups. Kaplan–Meier survival analysis according to surgeon volume was performed, and Cox proportional hazard modelling was used to estimate hazard ratios (HRs) with 95 per cent confidence intervals according to patient, tumour and surgeon factors.
Results
A total of 1103 patients with a median follow-up of 81 (i.q.r. 62–108) months were included in the study. During follow-up, 200 patients (18·1 per cent) developed structural recurrence. A high surgeon volume was associated with low structural recurrence (P = 0·006). After adjustment for age, sex and conventional risk factors for recurrence (histology, tumour size, gross extrathyroidal extension, margin status, more than 5 positive lymph nodes, radioactive iodine therapy), the adjusted HR for structural recurrence for low-volume surgeons was 1·46 (95 per cent c.i. 1·08 to 1·96), compared with high-volume surgeons. Distant metastasis (P = 0·242) and disease-specific mortality (P = 0·288) were not affected by surgeon volume.
Conclusion
Surgeon volume is associated with structural recurrence, but not distant metastasis or cancer-specific death in patients with N1b PTC. Surgeon volume is important in initial surgery for advanced PTC with extensive nodal metastasis in order to ensure curative outcome and reduce treatment-related morbidity.
http://ift.tt/2Ejjo7g
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Αλέξανδρος Γ. Σφακιανάκης Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,0030693260717...
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heory of COVID-19 pathogenesis Publication date: November 2020Source: Medical Hypotheses, Volume 144Author(s): Yuichiro J. Suzuki ScienceD...
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