Αρχειοθήκη ιστολογίου

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Παρασκευή 22 Ιουνίου 2018

Strategy for esophageal non-epithelial tumors based on a retrospective analysis of a single facility

Abstract

Background

Although most esophageal non-epithelial tumors are benign tumors, such as leiomyomas, they also include gastrointestinal tumors (GISTs); thus, a histopathological diagnosis is indispensable to determine the optimal treatment strategy. However, no consensus has been reached as to the diagnostic methods and treatments for esophageal non-epithelial tumors. The purpose of this study was to evaluate the reliability of the diagnostic methods and treatments for esophageal non-epithelial tumors in our hospital.

Methods

All 28 cases of esophageal non-epithelial tumors at Kobe University Hospital from 2008 to 2016 were analyzed retrospectively with respect to the diagnostic methods, histopathological diagnosis, and treatments.

Results

Three diagnostic methods, endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA), endoscopic incisional biopsy, and endoscopic submucosal dissection (ESD)/endoscopic mucosal resection (EMR), were performed in our hospital. All GIST cases could be correctly diagnosed by EUS-FNA. Tumors less than approximately 20 mm in diameter and located in the superficial layer are good indications for ESD/EMR, which both play roles in diagnosis and treatment. The final diagnoses by these methods consisted of the following: 13 leiomyomas, 5 GISTs, 3 schwannomas, 2 liposarcomas, 3 cysts, 1 reactive lymphoid hyperplasia, and 1 granulosa cell tumor. Fifteen cases underwent surgery. Enucleation or partial resection was performed for leiomyomas, schwannomas and liposarcomas, while esophagectomy was performed for GISTs. Thus, sufficient management of non-epithelial tumors is achieved.

Conclusions

Improved endoscopic procedures, including EUS-FNA and ESD/EMR, enabled the appropriate diagnosis and treatment of esophageal non-epithelial tumors.



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Aβ inhibits mesenchymal stem cell–pericyte transition through MAPK pathway

Abstract
Multiple independent reports have demonstrated pericyte loss in both the hippocampus and cortex in human Alzheimer's disease (AD). The differentiation and recruitment of pericytes are the essential steps in vasculature development. However, the role of amyloid beta (Aβ) in pericyte differentiation has not yet been fully elucidated. In this study, we investigated the interaction between Aβ and differentiation of mesenchymal stem cells (MSCs) toward pericytes in culture. Our results showed that mice overexpressing Aβ-precursor protein (APP/PS1) exhibited the loss of pericytes compared with the control group mice, evidenced by the lack of desmin expression in the cortex of 12-month-old mice. Interestingly, we further found that both Aβ40 and Aβ42 inhibited the expressions of pericyte markers (α-SMA, desmin, and PDGFRβ) in cultured MSCs which can be differentiated into mature pericytes. Mechanistically, the inhibitory effects of Aβs on MSC–pericyte transition is mediated by the activation of the ERK1/2 MAPK signal pathway. These new insights into the roles of Aβ in pericyte differentiation may help to develop more effective strategies for the treatment of AD.

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Curative Ex Vivo Hepatocyte-Directed Gene Editing in a Mouse Model of Hereditary Tyrosinemia Type 1

Human Gene Therapy, Ahead of Print.


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Amelioration of Alpha-1 Antitrypsin Deficiency Diseases with Genome Editing in Transgenic Mice

Human Gene Therapy, Ahead of Print.


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Effect of different concentrations of pulverized mesocarp of Citrus paradisi Macf on the morphology and glass transition temperature of spray‐dried lemon juice powder

Food Science &Nutrition, EarlyView.


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Serotonin transporter inhibition during neonatal period induces sex‐dependent effects on mitochondrial bioenergetics in the rat brainstem

European Journal of Neuroscience, EarlyView.


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Correction to: Fludarabine and rituximab with escalating doses of lenalidomide followed by lenalidomide/rituximab maintenance in previously untreated chronic lymphocytic leukaemia (CLL): the REVLIRIT CLL-5 AGMT phase I/II study

The original version of this article contained a mistake. The name of Tanja Nicole Hartman should have been Tanja Nicole Hartmann. The original article has been corrected.



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Lymphoma in autopsy cases

Abstract

Lymphoproliferative disorders cause significant morbidity and mortality, either related to the disease itself or therapy complications. Some cases of lymphoma may have vague clinical presentation, especially in the absence of lymphadenopathy, and a clinical work up may not be conclusive. Our study focuses on autopsy cases of lymphoma patients, emphasizing clinically unsuspected cases. Autopsy records from the last 20 years at our institution were searched, and the clinical parameters were recorded. Fifteen cases of lymphoma were identified, and 5 cases were diagnosed at the time of autopsy. Most B-cell lymphoma cases were mainly nodal disease, while T-cell lymphoma cases had widespread extra-nodal disease. Most deaths in B-cell lymphoma are due to infection/therapy induced immunosuppression, whereas T-cell lymphoma deaths are due to organ infiltration by lymphoma. Postmortem examination may reveal clinically unsuspected lymphoma, especially in rapidly deteriorating patients with vague presentation such as skin rash, bowel obstruction/bleeding or pacemaker malfunction.



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Meetings Calendar

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7





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Table of Contents

Publication date: June 2018
Source:The Spine Journal, Volume 18, Issue 6





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Table of Contents

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7





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Attenuation of the degenerative effects of endothelin-1 on cartilaginous endplate cells by the endothelin receptor antagonist BQ-123 via the wnt/β-catenin signaling pathway

Publication date: Available online 7 June 2018
Source:The Spine Journal
Author(s): Wei Yuan, Zhen-Xi Li, Cheng-Long Zhao, Tian-Hui Hou, Si-Wang Hu, Wei-Bo Liu, Feng-Lai Yuan, Jian-Ru Xiao
BackgroundContext: Endothelin-1 (ET-1) is an inflammatory mediator associated with cartilage endplate (CEP) degeneration in the intervertebral disc. SOX9 is down-regulated during CEP degeneration, along with its targets, collagen II and aggrecan. Wnt/β-catenin signaling is associated with CEP degeneration and a downstream target of SOX9; however, the precise mechanism of CEP degeneration and the role of ET-1 are largely unknown.PurposeThe purpose of the study was to evaluate the influence of the endothelin A receptor antagonist, BQ-123, on ET-1-induced effects on cartilaginous endplate cells (CECs) associated with CEP degeneration via the Wnt/β-catenin signaling pathway.Study Design/SettingThe influence of ET-1 on the expression levels of collagen II, aggrecan, and SOX9 in CECs, and the effect of BQ-123 in this context, were investigated.MethodsTo establish a model for CEP degeneration, three lumbar discs (L3/4, L4/5, and L5/6 levels) in New Zealand white rabbits were punctured close to the vertebral endplate using a 14G needle. Intervertebral disc degeneration was evaluated by MRI four weeks after vertebral endplate injury. CECs were then isolated from the degenerated CEPs, to allow evaluation of the role of ET-1 and BQ-123, and investigate their effects on the Wnt/β-catenin signaling pathway. The expression of ET-1 in CECs from degenerated CEPs was analyzed by immunofluorescent staining. Changes in the levels of collagen II, aggrecan, and SOX9 were evaluated in CECs by real-time polymerase chain reaction (PCR) and western blotting. The Wnt/β-catenin signaling pathway was also investigated by western blotting.ResultsAfter four weeks, intervertebral discs with vertebral endplate injury exhibited clear signs of disc degeneration. Immunofluorescent staining showed that ET-1 was expressed in the cytoplasm of CECs. ET-1 stimulation significantly inhibited the expression of collagen II, aggrecan, and SOX9 in CECs, while BQ-123 increased the levels of these three molecules. In addition, ET-1 stimulation increased the expression of β-catenin, Cyclin D1, and Dvl1 in the Wnt/β-catenin signaling pathway of CECs from degenerated discs, and reduced the expression of GSK-3β, whereas BQ-123 had the opposite effect.ConclusionsET-1 can reduce levels of collagen II, aggrecan, and SOX9 in CECs through activation of the Wnt/β-catenin signaling pathway, whereas BQ-123 attenuates these negative effects, highlighting a new molecular mechanism with potential for exploitation for treatment of CEP degeneration.



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Table of Contents

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7





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Table of Contents

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7





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Dynamic Adaptation of Vertebral Endplate and Trabecular Bone following Annular Injury in a Rat Model of Degenerative Disc Disease

Publication date: Available online 8 June 2018
Source:The Spine Journal
Author(s): Tristan Maerz, Michael Newton, Abigail A. Marek, Michael Planalp, Kevin Baker
Background/ContextDegenerative disc disease (DDD) is associated with longitudinal remodeling of paravertebral tissues. While chronic vertebral changes in advanced stages of DDD are well-studied, very little data exists on acute vertebral bone remodeling at the onset and progression of DDD.PurposeTo longitudinally characterize bony remodeling in a rodent model of disc injury-induced DDD.Study Design/SettingIn vivo animal study involving a rat annulus fibrosus injury model of DDD.MethodsEight female Lewis rats were assigned to IVD injury (Puncture) or sham surgery (Sham). All rats underwent anterior, transperitoneal approach to the lumbar spine, and Puncture rats underwent annulus fibrosus injury at the L3-L4 and L5-L6 IVDs (n=8 per group). Live µCT imaging (10-μm voxel size) was performed 1 week prior to surgery and postoperatively at 2-week intervals up to a 12-week endpoint. Bone morphology and densitometry of the cranial vertebral body and bony endplate were analyzed and reported with respect to the pre-operative baseline scan. Sagittal Safranin-O/Fast-Green and Toluidine Blue histology evaluated using the Rutges IVD score and a custom vertebral endplate score.ResultsVertebral trabecular tissue mineral density (TMD), vertebral trabecular spacing (Tb.Sp), endplate TMD and endplate apparent bone mineral density (BMD) were all significantly greater in Puncture compared to Sham at 4 weeks and each subsequent timepoint. Puncture rats exhibited marginally lower endplate total volume (TV). Anterior endplate osteophyte formation and central physeal ossification were observed in Puncture rats. Endpoint histological analysis demonstrated moderate evidence of IVD degeneration, indicating that vertebral bone adaptation occurs in the acute phases of DDD onset and progression.ConclusionsAnnulus injury-induced DDD leads to acute and progressive changes to the morphology and densitometry of bone in the adjacent vertebral bodies and endplates.



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Table of Contents

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7





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Editorial Board

Publication date: June 2018
Source:The Spine Journal, Volume 18, Issue 6





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Editorial Board

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7





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Spinal manipulation for chronic low back pain: is it all it is cracked up to be?

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7
Author(s): Mary O'Keeffe, Derek Griffin, Kieran O'Sullivan




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The Effect of Psychosocial Measures of Resilience and Self-Efficacy in Patients with Neck and Lower Back Pain

Publication date: Available online 12 June 2018
Source:The Spine Journal
Author(s): Shaan A. Ahmed, Govind Shantharam, Adam E.M. Eltorai, Davis A. Hartnett, Avi Goodman, Alan H. Daniels
BACKGROUND CONTEXTPsychosocial risk factors may predispose to progression of back and neck pain to chronic pain or disability. Resilience (the ability to recover from stress) and pain self-efficacy (confidence that one can perform daily activities despite pain) are important psychometric properties shown to affect health and illness.PURPOSETo examine the relationships among resilience, pain self-efficacy, and disability in spine patients.STUDY DESIGN/SETTINGProspective, single-center orthopedic spine clinic.PATIENT SAMPLE195 patients in a tertiary spine practice recruited between December 2016 and March 2017.OUTCOME MEASURESSelf-reported measures: Brief Resilience Scale (BRS), Pain Self-Efficacy Questionnaire Short-Form (PSEQ-2), Neck Disability Index (NDI), Oswestry Disability Index (ODI).METHODSA prospective study was conducted of new patients visiting an orthopaedic spine clinic complaining of neck pain or low back pain, with or without radiculopathy. Enrolled patients completed a survey of demographic information, the 6-question Brief Resilience Scale (BRS), the 2-question Pain Self-Efficacy Questionnaire Short Form (PSEQ-2), and Neck Disability Index (NDI) or Oswestry Disability Index (ODI) for neck or back pain, respectively. The relationship between BRS and NDI or ODI was examined, and the relationship between PSEQ-2 and NDI or ODI was also examined.RESULTSA total of 195 patients were evaluated. After excluding those with incomplete NDI or ODI, 180 patients were included in the analysis (46.1% male (83/180); mean age 53 (SD: 17) years). 139 (77.2%) subjects complained of low back pain and 41 (22.8%) subjects complained of neck pain. BRS was strongly negatively correlated with NDI (r = -0.61, p<0.0001) and moderately negatively correlated with ODI (r = -0.34, p<0.0001). PSEQ-2 was strongly negatively correlated with NDI (r = -0.69, p<0.0001) and strongly negatively correlated with ODI (r = -0.62, p<0.0001). BRS was moderately positively correlated with PSEQ-2 (r = 0.36, p<0.0001). For the low back pain cohort, the correlation between PSEQ-2 and ODI was significantly greater than the correlation between BRS and ODI (p=0.0003); this difference was not noted in the neck pain cohort (p=0.34).CONCLUSIONSLow resilience and low pain self-efficacy are both independently associated with greater functional disability in neck and low back pain patients. Spine surgeons may find it useful to incorporate the BRS and PSEQ-2 into preoperative assessment. Future studies should examine the utility of these simple validated questionnaires in predicting response to treatments, including surgical intervention.



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Surgical versus non-surgical management for type II odontoid fractures in the elderly population: a systematic review

Publication date: Available online 7 June 2018
Source:The Spine Journal
Author(s): Deep P. Sarode, Andreas K. Demetriades
BackgroundOdontoid process fractures, of which type II constitute the majority, are an increasingly important cause of morbidity and mortality in the elderly population. The incidence of geriatric type II fractures is steadily increasing in line with the ageing population. However, the decision between surgical and non-surgical intervention for type II fractures in the elderly remains controversial.PurposeTo synthesise the current published literature comparing outcomes following surgical and non-surgical interventions for type II odontoid fractures in the elderly population (≥65 years old).Study design/settingSystematic review and meta-analysis.MethodsA systematic search of MEDLINE, MEDLINE In-Progress & Other Non-Indexed Citations, Embase and CENTRAL was performed to identify available evidence in English language. Studies with extractable data for all type II odontoid fractures in participants aged 65 years or older and which compared surgical and non-surgical intervention were included. Methodological quality was assessed using the Downs & Black checklist. Primary outcomes were mortality at short-term follow-up (≤3 months), mortality at long-term follow-up (predetermined study endpoint or mean follow-up length) and radiological union rate. Funding was provided by the University of Edinburgh for travel-expenses to present this paper at the Society of British Neurological Sciences 2016 Conference ($170).ResultsTwelve studies (n=1098), all non-randomised, met eligibility criteria. Methodological quality was particularly poor in the confounding, bias and power domains of assessment. Substantial methodological and statistical heterogeneity allowed only a narrative synthesis of the primary outcomes. Overall, data on mortality at short-term follow-up appeared to favour neither surgical nor non-surgical intervention. A small favourable outcome in surgically managed patients over non-surgically managed patients in terms of mortality at long term follow-up was not proven conclusive due to considerable heterogeneity in study methodologies. Inadequate reporting of the time-point of union assessment introduced the potential for significant intra- and inter-study heterogeneity and precluded assessment of union rates.ConclusionsEvidence on this controversial topic is sparse, markedly heterogeneous and of poor quality. Well-designed prospective trials adhering to guidance published by the STROBE initiative are required to inform clinical practice on this contentious but growing issue. Future RCTs should include an assessment of frailty and/or medical co-morbidities with suitable patients subsequently randomised to surgical or non-surgical treatment.



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An Empiric Analysis of 5 Counter-measures Against Surgical Site Infections Following Spine Surgery—A Pragmatic Approach and Review of the Literature

Publication date: Available online 2 June 2018
Source:The Spine Journal
Author(s): Marko Tomov, Nathan Wanderman, Elie Berbari, Bradford Currier, Michael Yaszemski, Ahmad Nassr, Paul Huddleston, Mohamad Bydon, Brett Freedman
Background contextSurgical site infections (SSI) following spine surgery are debilitating complications to patients and costly to the healthcare system.PurposeReview the impact and cost effectiveness of five SSI prevention interventions on SSI rates in an orthopaedic spine surgery practice at a major quaternary healthcare system over a 10-year period.Study DesignRetrospective observational study.Patient SampleAll of the surgical patients of five spine surgeons in our department over a 10-year period were included in this study.Outcome MeasuresSSI rates per year, standardized infection ratios (SIR) for laminectomies and fusions during the most recent 3-year period, year of implementation and frequency of use of the different interventions, cost of the techniques.MethodsThe SSI prevention techniques described in this paper include application of intrawound vancomycin powder, wound irrigation with dilute betadine solution, preoperative chlorhexidine gluconate scrubs, preoperative screening with nasal swabbing and decolonization of S. aureus, and perioperative antibiotic administration. Our institution's Infection Prevention and Control (IPAC) data was analyzed for the yearly SSI rates for the orthopaedic spine surgery department from 2006-2016. In addition, our orthopaedic spine surgeons were polled to determined with what frequency and duration they have been using the different SSI prevention interventions.ResultsSSI rates decreased from almost 6% per year the first year of observation to less than 2% per year in the final six years of this study. A SIR of less than 1.0 for each year was observed for laminectomies and fusions for the 2013-2016 period. All surgeons polled at our institution uniformly used perioperative antibiotics, Hibiclens scrub, and the nasal swab protocol since the implementation of these techniques. Some variability existed in the frequency and duration of betadine irrigation and application of vancomycin powder. A cost analysis demonstrated these methods to be nominal compared to the cost of treating a single SSI.ConclusionsIt is possible to reduce SSI rates in spine surgery with easy, safe, and cost-effective protocols, when implemented in a standardized manner.



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Table of Contents

Publication date: June 2018
Source:The Spine Journal, Volume 18, Issue 6





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Clinically significant pedicle screw malposition is an underestimated cause of radiculopathy

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7
Author(s): Emily Jane Woo, Michael N. DiCuccio




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Health outcomes and costs of acute traumatic spinal injury in New South Wales, Australia

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7
Author(s): Rebecca Mitchell, Lara Harvey, Ralph Stanford, Jacqueline Close
Background ContextTraumatic spinal injuries are often associated with both long-term disability, higher frequency of hospital readmissions, and high medical costs for individuals of all ages. Age differences in terms of injury profile and health outcomes among those who sustain a spinal cord injury have been identified. However, factors that may influence health outcomes among those with a spinal injury have not been extensively examined at a population level.PurposeThe present study aims to describe the characteristics of traumatic spinal injury, identify factors predictive of mortality, and estimate the cost of hospital treatment for younger and older people.Study Design/SettingThis is a population-based retrospective epidemiological study using linked hospitalization and mortality records during January 1, 2010 to June 30, 2014 in New South Wales, Australia.Patient SampleThe present study included 13,429 hospitalizations.Outcome MeasuresMortality within 30 and 90 days of hospitalization, hospital length of stay (LOS), and hospitalization costs were determined.MethodsHospitalizations with a principal diagnosis of spinal cord injury or spinal fractures were used to identify traumatic spinal injuries. Age-standardized incidence rates were calculated and negative binomial regression was used to examine statistical significant changes over time. Cox proportional hazard regression was used to examine the effect of risk factors on survival at 90 days.ResultsThere were 13,429 hospitalizations, with 52.4% of individuals aged ≥65 years. The hospitalization rates for individuals aged ≤64 and ≥65 years were both estimated to significantly increase per year by 3.3% (95% confidence interval [CI] 0.97–5.79, p<.006) and 3.3% (95% CI 1.02–5.71, p=.005), respectively. For individuals aged ≥65 years, there were a higher proportion of women injured, comorbid conditions, injuries after a fall in the home or aged care facility, a longer hospital LOS, unplanned hospital admissions, and deaths than individual aged ≤64 years. The average cost per index hospitalization was AUD$23,808 for individuals aged ≤64 years and AUD$31,187 for individuals aged ≥65 years with a total estimated cost of AUD$371 million. Mortality risk at 90 days was increased for individuals who had one or more comorbidities, a higher injury severity score, and if their injury occurred in the home or an aged care facility.ConclusionsSpinal injury represents a substantial cost and results in debilitating injuries, particularly for older individuals. Spinal injury prevention efforts for older people should focus on the implementation of fall injury prevention, whereas for younger individuals, prevention measures should target road safety.



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Response to Letter to the Editor entitled “Spinal manipulation for chronic low back pain: is it all it is cracked up to be?” concerning “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis” by Coulter et al. Spine J; doi: 10.1016/j.spinee.2018.01.013

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7
Author(s): Ian D. Coulter, Cindy Crawford, Eric L. Hurwitz, Howard Vernon




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Ambulatory anterior cervical discectomy and fusion is associated with a higher risk of revision surgery and perioperative complications: an analysis of a large nationwide database

Publication date: July 2018
Source:The Spine Journal, Volume 18, Issue 7
Author(s): Armin Arshi, Christopher Wang, Howard Y. Park, Gideon W. Blumstein, Zorica Buser, Jeffrey C. Wang, Arya N. Shamie, Don Y. Park
Background ContextWith the changing landscape of health care, outpatient spine surgery is being more commonly performed to reduce cost and to improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the most common spine surgeries performed and demand is expected to increase with an aging population.PurposeThe objective of this study was to determine the nationwide trends and relative complication rates associated with outpatient ACDF.Study Design/SettingThis is a large-scale retrospective case control study.Patient SampleThe patient sample included Humana-insured patients who underwent one- to two-level ACDF as either outpatients or inpatients from 2011 to 2016Outcome MeasuresThe outcome measures included incidence and the adjusted odds ratio (OR) of postoperative medical and surgical complications within 1 year of the index surgery.Materials and MethodsA retrospective review was performed of the PearlDiver Humana insurance records database to identify patients undergoing one- to two-level ACDF (Current Procedural Terminology [CPT]-22551 and International Classification of Diseases [ICD]-9-816.2) as either outpatients or inpatients from 2011 to 2016. The incidence of perioperative medical and surgical complications was determined by querying for relevant ICD and CPT codes. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index was used to calculate ORs of complications among outpatients relative to inpatients undergoing ACDF.ResultsCohorts of 1,215 patients who underwent outpatient ACDF and 10,964 patients who underwent inpatient ACDF were identified. The median age was in the 65–69 age group for both cohorts. The annual relative incidence of outpatient ACDF increased from 0.11 in 2011 to 0.22 in 2016 (R2=0.82, p=.04). Adjusting for age, gender, and comorbidities, patients undergoing outpatient ACDF were more likely to undergo revision surgery for posterior fusion at both 6 months (OR 1.58, confidence interval [CI] 1.27–1.96, p<.001) and 1 year (OR 1.79, CI 1.51–2.13, p<.001) postoperatively. Outpatient ACDF was also associated with a higher likelihood of revision anterior fusion at 1 year postoperatively (OR 1.46, CI 1.26–1.70, p<.001). Among medical complications, postoperative acute renal failure was more frequently associated with outpatient ACDF than inpatient ACDF (OR 1.25, CI 1.06–1.49, p=.010). Adjusted rates of all other queried surgical and medical complications were comparable.ConclusionsOutpatient ACDF is increasing in frequency nationwide over the past several years. Nationwide data demonstrate a greater risk of perioperative surgical complications, including revision anterior and posterior fusion, as well as a higher risk of postoperative acute renal failure. Candidates for outpatient ACDF should be counseled and carefully selected to reduce these risks.



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Treatment outcomes of 17 patients with atypical spinal meningioma, including 4 with metastases: A retrospective observational study

Publication date: Available online 13 June 2018
Source:The Spine Journal
Author(s): Sung Hyun Noh, Kyung Hyun Kim, Dong Ah Shin, Jeong Yoon Park, Seong Yi, Sung Uk Kuh, Keung Nyun Kim, Dong Kyu Chin, Keun Su Kim, Do Heum Yoon, Yong Eun Cho
BACKGROUND CONTEXTBecause of the scarcity of atypical spinal meningioma, there is a lack of research on this type of tumor or its associated metastases.PURPOSEThe aim of this study was to investigate the biological behavior of atypical spinal meningioma and identify its prognostic factors by reviewing surgical and clinical outcomes of patients with these tumors.STUDY DESIGN/SETTINGA retrospective chart review was performed.PATIENT SAMPLEWe retrospectively reviewed the data from all patients who underwent spinal cord tumor excision between 1994 and 2017. Seventeen patients were pathologically proven to have atypical spinal meningioma.OUTCOME MEASURESWe examined patients' neurologic status by determining their Nurick scores before and after surgery. Moreover, imaging studies, laboratory data, and the employed surgical method were analyzed retrospectively, as was the Ki-67 index and prognosis following postoperative radiation therapy.METHODSThe ranges, locations, and pathologic diagnoses of the tumors were extracted from the radiological and pathological records of each patient. The extent of surgery and progression of disease were confirmed using postoperative enhanced magnetic resonance imaging. Patients were divided into 2 atypical spinal meningioma groups: primary and metastatic. The demographics, age, sex, presenting symptom duration, tumor location, Simpson resection grade, Ki-67, radiotherapy, recurrence, overall survival, and progression-free survival of patients in both groups were compared.RESULTSSeventeen patients were included in the analysis, of whom 12 (70%), 4 (24%), and 1 (6%) had tumors in the thoracic, cervical, and sacral regions, respectively. Complete and subtotal resections were achieved in 15 (88%) and 2 (12%) patients, respectively. Overall and progression-free survival rates in patients who underwent complete resection were longer than those in patients who underwent subtotal resection (P<0.001). Four patients (24%) had metastatic meningiomas in the brain, among whom 3 were administered adjuvant radiotherapy after surgery. Two patient with intramedullary atypical spinal meningioma had metastatic tumors and experienced poorer prognoses. The 5-year overall and progression-free survival rates were 84.4% and 85.2%, respectively. The Simpson resection grade, Ki-67 index, and preoperative neurologic status were found to be important prognostic factors on univariate Cox regression analysis (P<0.05).CONCLUSIONSComplete resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma. If subtotal resection is performed, adjuvant therapy can be administered.



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The Suffering of Children

Every pediatrician has his or her own tips for putting young patients at ease in the exam room. Mine include referring to even the tiniest Spanish-speaking patients as usted rather than tú, as a sign of respect, and sitting at or below their level to avoid looming over them. Most important, I…

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Housing Immigrant Children — The Inhumanity of Constant Illumination

On the Wednesday before the summer solstice in the United States, President Donald Trump ended his administration's policy of forced separation of immigrant children from their parents at the U.S.–Mexico border — a practice characterized by the president of the American Academy of Pediatrics (AAP)…

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Cotton Late Embryogenesis Abundant (LEA2) Genes Promote Root Growth and Confers Drought Stress Tolerance in Transgenic Arabidopsis thaliana

Late embryogenesis abundant (LEA) proteins play key roles in plant drought tolerance. In this study, 157, 85 and 89 candidate LEA2 proteins were identified in G. hirsutum, G. arboreum and G. raimondii respectively. LEA2 genes were classified into 6 groups, designated as group 1 to 6. Phylogenetic tree analysis revealed orthologous gene pairs within the cotton genome. The cotton specific LEA2 motifs identified were E, R and D in addition to Y, K and S motifs. The genes were distributed on all chromosomes. LEA2s were found to be highly enriched in non-polar, aliphatic amino acid residues, with leucine being the highest, 9.1% in proportion. The miRNA, ghr-miR827a/b/c/d and ghr-miR164 targeted many genes are known to be drought stress responsive. Various stress-responsive regulatory elements, ABA-responsive element (ABRE), Drought-responsive Element (DRE/CRT), MYBS and low-temperature-responsive element (LTRE) were detected. Most genes were highly expressed in leaves and roots, being the primary organs greatly affected by water deficit. The expression levels were much higher in G. tomentosum as opposed to G. hirsutum. The tolerant genotype had higher capacity to induce more of LEA2 genes. Over expression of the transformed gene Cot_AD24498 showed that the LEA2 genes are involved in promoting root growth and in turn confers drought stress tolerance. We therefore infer that Cot_AD24498, CotAD_20020, CotAD_21924 and CotAD_59405 could be the candidate genes with profound functions under drought stress in upland cotton among the LEA2 genes. The transformed Arabidopsis plants showed higher tolerance levels to drought stress compared to the wild types. There was significant increase in antioxidants, catalase (CAT), peroxidase (POD) and superoxide dismutase (SOD) accumulation, increased root length and significant reduction in oxidants, Hydrogen peroxide (H2O2) and malondialdehyde (MDA) concentrations in the leaves of transformed lines under drought stress condition. This study provides comprehensive analysis of LEA2 proteins in cotton thus forms primary foundation for breeders to utilize these genes in developing drought tolerant genotypes.



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ovoD Co-selection: A Method for Enriching CRISPR/Cas9-Edited Alleles in Drosophila

Screening for successful CRISPR/Cas9 editing events remains a time consuming technical bottleneck in the field of Drosophila genome editing. This step can be particularly laborious for events that do not cause a visible phenotype, or those which occur at relatively low frequency. A promising strategy to enrich for desired CRISPR events is to co-select for an independent CRISPR event that produces an easily detectable phenotype. Here, we describe a simple negative co-selection strategy involving CRISPR-editing of a dominant female sterile allele, ovoD1. In this system ("ovoDco-selection"), the only functional germ cells in injected females are those that have been edited at the ovoD1locus, and thus all offspring of these flies have undergone editing of at least one locus. We demonstrate that ovoDco-selection can be used to enrich for knock-out mutagenesis via nonhomologous end-joining (NHEJ), and for knock-in alleles via homology-directed repair (HDR). Altogether, our results demonstrate that ovoD co-selection reduces the amount of screening necessary to isolate desired CRISPR events in Drosophila.



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Cemiplimab Achieves Responses in Cutaneous Squamous Cell Carcinoma [Research Watch]

PD-1 blockade with cemiplimab has antitumor activity with adverse events similar to other PD-1 inhibitors.



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AR Enhancer Amplification Drives Castration-Resistant Prostate Cancer [Research Watch]

Duplication of an AR enhancer occurs in most patients with CRPC and promotes disease progression.



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Ivosidenib Deemed Safe, Effective in AML [News in Brief]

Study suggests that IDH1 inhibitor induces remission in patients with relapsed or refractory disease.



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Mitophagy in Gut Epithelial Cells Promotes Antitumor Immunity [Research Watch]

Increased mitophagy in intestinal epithelial cells drives antigen presentation in colorectal cancer.



https://ift.tt/2lw3VWy

An OXPHOS Inhibitor Has Antitumor Activity in Multiple Tumor Models [Research Watch]

A medicinal chemistry approach identified IACS-010759 as a clinical-grade small-molecule OXPHOS inhibitor.



https://ift.tt/2yCjlly

Master Regulators May Be Therapeutic Targets for Precision Oncology [Research Watch]

OncoTreat identified master regulators in gastroenteropancreatic neuroendocrine tumors (GEP-NET).



https://ift.tt/2lw3Tho

Study Reveals Germline Genetics of Medulloblastoma [News in Brief]

Researchers identify six mutations that account for 6% of cases, a finding that could improve treatment.



https://ift.tt/2ttCTCT

Acquired and genetic host susceptibility factors and microbial pathogenic factors that predispose to nontuberculous mycobacterial infections

Jennifer R Honda | Scott Alper | Xiyuan Bai | Edward D Chan

https://ift.tt/2yChuwU

Cytokine modulation of atopic itch

Anna M Trier | Brian S Kim

https://ift.tt/2tq0rsa

Correction to: KrioBlast TM as a New Technology of Hyper-fast Cryopreservation of Cells and Tissues. Part II. 2. Kinetic Vitrification of Human Pluripotent Stem Cells and Spermatozoa

The title of the article should be «KrioBlastTM as a New Technology of Hyper-fast Cryopreservation of Cells and Tissues. Part II. 2. Kinetic Vitrification of Human Pluripotent Stem Cells and Spermatozoa».



https://ift.tt/2K5nsvT

Long non-coding RNA CRYBG3 blocks cytokinesis by directly binding G-actin

The dynamic interchange between monomeric globular actin (G-actin) and polymeric filamentous actin filaments (F-actin) is fundamental and essential to many cellular processes including cytokinesis and maintenance of genomic stability. Here we report that the long non-coding RNA LNC CRYBG3 directly binds G-actin to inhibit its polymerization and formation of contractile rings, resulting in M-Phase cell arrest. Knockdown of LNC CRYBG3 in tumor cells enhanced their malignant phenotypes. Nucleotide sequence 228-237 of the full-length LNC CRYBG3 and the ser14 domain of beta-actin are essential for their interaction, and mutation of either of these sites abrogated binding of LNC CRYBG3 to G-actin. Binding of LNC CRYBG3 to G-actin blocked nuclear localization of MAL, which consequently kept serum response factor (SRF) away from the promoter region of several immediate early genes, including JUNB and Arp3, which are necessary for cellular proliferation, tumor growth, adhesion, movement, and metastasis. These findings reveal a novel lncRNA-actin-MAL-SRF pathway and highlight LNC CRYBG3 as a means to block cytokinesis and treat cancer by targeting the actin cytoskeleton.

https://ift.tt/2K3TNmq

Some California Mosquitoes Can Carry Zika Virus

FRIDAY, June 22, 2018 -- Aedes mosquitoes in California can spread the Zika virus, according to a study published online June 21 in PLOS Neglected Tropical Diseases. Laboratory studies have shown that several species of Aedes mosquitoes can transmit...

https://ift.tt/2yCihOw

Periodontal Inflammation a Risk With Tongue Piercing

FRIDAY, June 22, 2018 -- There is an association between tongue piercings and periodontal inflammation, according to two studies presented at EuroPeri9, the annual meeting of the European Federation of Periodontology, held from June 20 to 23 in...

https://ift.tt/2MS1Noj

E-Cigarettes May Help Some Quit Tobacco Smoking

FRIDAY, June 22, 2018 -- Some individuals self-report that electronic cigarettes (e-cigarettes) help them quit smoking conventional cigarettes, according to a small study published online June 20 in the Harm Reduction Journal. Caitlin Notley, Ph.D.,...

https://ift.tt/2twoLZh

Risk of OD Highest for First Days of Opioid + Benzodiazepine Use

FRIDAY, June 22, 2018 -- Concurrent benzodiazepine use is associated with increased risk of opioid-related overdose, with the risk highest on the first days of concurrent use, according to a study published online June 22 in JAMA Network...

https://ift.tt/2MS1OIT

Presence of Nurse Practitioners Growing in Primary Care

FRIDAY, June 22, 2018 -- Nurse practitioners (NPs) are a growing segment of the primary care workforce, according to a study published in the June issue of Health Affairs. Hilary Barnes, Ph.D., from the University of Delaware in Newark, and...

https://ift.tt/2txo5Ts

Expansile invasive growth pattern is definite evidence for the diagnosis of small hepatocellular carcinomas: a comparative study of 37 cases

Small hepatocellular carcinomas (HCCs), including small and early HCCs (seHCC), small and progressed HCCs (spHCC), are rarely encountered in daily practice. Definite diagnosis is difficult for general pathologists. In this study, we reviewed 1025 cases of HCC and examined for the histologic characteristics of small hepatocellular carcinomas, to facilitate more accurate diagnosis. Slides of archived HCC cases were reviewed by two senior pathologists and small HCC were identified according to the canonical criteria.

https://ift.tt/2MSZW2S

Does ezrin play a predictive role in cancer patients undergoing radiotherapy and/or chemotherapy?

Dear Editor,

https://ift.tt/2Mh8wY4

SASH1, a potential therapeutic target for cancer—reply

We have read the letter to the editor "SASH1, a potential therapeutic target for cancer" written by Qianqian Wang. We are honored that our manuscript attracts attention in such a short time [1]. Just as emerging studies have demonstrated, SASH1 is a candidate for tumor suppression in multiple cancers. Due to structural features, SASH1 participates in the regulation of various signaling pathways. Sun et al. [2] found that overexpression of SASH1 diminished the phosphorylation of PI3K and Akt, and thus inhibited thyroid cancer cell proliferation and invasion.

https://ift.tt/2tso98b

Poor Prognostic Impact of FGF4 Amplification in Patients with Esophageal Squamous Cell Carcinoma

In the present study, we aimed to determine the prognostic impact and clinicopathological feature of FGF4 amplification in patients with esophageal squamous cell carcinoma (ESCC). Fluorescence in situ hybridization (FISH) with FGF4 probe was analyzed using tissue microarray consisting of representative cores of 267 ESCC cases. FGF4 amplification was observed in 52.8% (141/267) of patients. Patients with FGF4 amplification showed a significantly shorter disease free survival (DFS) or disease-specific overall survival (OS) compared with those without FGF4 amplification (both P<0.05).

https://ift.tt/2McPXUT

Utility of STAT 6 and 13q14 deletion in the classification of the benign spindle cell stromal tumors of the breast

The boundaries of the benign spindle cell stromal tumors of the breast are still confusing. This is the reason why different names are interchangeably used for the same tumor and vice versa the same name for different tumors. Therefore we studied the immunoexpression of easily available markers, such as CD34, alpha-smooth muscle actin, desmin, with the addition of STAT6, as well as the chromosome 13q14 region by fluorescence in situ hybridization analysis in a series of 19 cases of benign spindle cell stromal tumors of the breast.

https://ift.tt/2MSPHLE

Integration of conventional cell viability assays for reliable and reproducible read-outs: experimental evidence

Short-term viability assays of cultured cells in 96-well plates are routinely used to determine the cytotoxicity or safety of drugs. These are often based on the formation of chromogen, generated selectively i...

https://ift.tt/2IjDlIZ

Brief report: Parental attitudes and knowledge on routine childhood immunization: an experience from Central Sri Lanka

A lack of correct awareness about immunization among parents put them at risk of falling prey to the anti-vaccine movement. This risk is present even in countries with a high vaccine uptake. This study was don...

https://ift.tt/2K3a6Ab

Investigating the functionality of a ribosome-binding mutant of NAA15 using Saccharomyces cerevisiae

N-terminal acetylation is a common protein modification that occurs preferentially co-translationally as the substrate N-terminus is emerging from the ribosome. The major N-terminal acetyltransferase complex A...

https://ift.tt/2Ij77hc

Systematic review of cognitive event related potentials in euthymic bipolar disorder

Bipolar disorder (BD) is a chronic psychiatric disorder characterized by recurring manic or hypomanic episodes and additional depressive episodes usually separated by periods of euthymic mood (APA 2013). Mood changes in BD are known to negatively impact cognitive performance, with evidence of cognitive abnormalities becoming more severe during manic and depressive episodes (Ferrier et al., 1999; Clark et al., 2002; Martinez-Aran et al., 2004). Disturbances in cognition affect social and occupational functioning of individuals (Green 2006; Malhi et al., 2007), with improvement in the quality of life and clinical symptoms associated with increased cognitive skills (Campanella 2013).

https://ift.tt/2KkcJNr

Behavioral and electrophysiological evidence for GABAergic modulation through transcutaneous vagus nerve stimulation

Transcutaneous vagus nerve stimulation (tVNS) is a relatively new technique (Ventureyra 2000), which was developed to pose an alternative to direct or invasive vagus nerve stimulation (iVNS) for the treatment of drug-refractory epilepsy, depression and other disorders (Hein et al. 2013; Lehtimäki et al. 2013; Bauer et al. 2016). In contrast to iVNS, where a stimulation lead is surgically wrapped around the vagus nerve in the neck, tVNS can be applied to different locations of the outer ear innervated by the auricular branch of the vagus nerve, mostly the cymba conchae or the tragus through electrodes attached to the skin (Kraus et al.

https://ift.tt/2KfDSgT

Somatosensory temporal discrimination in Parkinson’s disease, dystonia and essential tremor: pathophysiological and clinical implications

The somatosensory temporal discrimination threshold (STDT) measures a subject's ability to discriminate sensory stimuli in the temporal domain (Artieda et al. 1992; Conte et al. 2010; Tinazzi et al. 2013). Several studies have investigated the physiological mechanisms underlying the STDT in healthy subjects (Conte et al. 2012; Conte et al. 2017a; Lee et al. 2017; Leodori et al. 2017; Rocchi et al. 2016). Findings from neurophysiological studies based on transcranial magnetic stimulation suggest that the STDT strongly relies on inhibitory interneurons in the primary somatosensory cortex (S1) (Antelmi et al.

https://ift.tt/2Kkcx0F

MEG revealed new functional hub of atypical brain network in autism spectrum disorders

Autism spectrum disorders (ASD) are neurodevelopmental disorders with continuous disturbance of cognitive flexibility and social communication, restricted, repetitive patterns of interests and behavior (O'Connor, 2012; Schelinski et al., 2016). Emerging evidence has been almost proving the idea that ASD is a condition of altered brain functional connectivity, especially in resting-state. Previous brain connectivity studies using functional magnetic resonance imaging (fMRI) in young adults with ASD showed reduction of resting-state connectivity at the medial prefrontal cortex (mPFC), the anterior hub of the default-mode network (DMN), and the posterior cingulate cortex (PCC), the posterior hub of the DMN (Kennedy and Courchesne, 2008, Di Martino et al, 2009).

https://ift.tt/2K8SQFz

Gene expression profile of Dclk1+ cells in intestinal tumors

Accumulating evidence has shown the existence of tumor stem cells with therapeutic potential. Previously, we reported that doublecortin like kinase 1 (Dclk1) marks tumor stem cells but not normal stem cells in the intestine of ApcMin/+ mice, and that Dclk1- and Lgr5-double positive tumor cells are the tumor stem cells of intestinal tumors.

https://ift.tt/2KcbXP2

Clinical efficacy of the Toll-like receptor 9 agonist cobitolimod using patient-reported-outcomes defined clinical endpoints in patients with ulcerative colitis

The Toll-like-receptor 9 (TLR-9) agonist cobitolimod (DIMS0150, Kappaproct®) is a promising therapeutic option for ulcerative colitis (UC) patients.

https://ift.tt/2Keakni

Corneal Ring Abscess after Cardiac Surgery

Left ventricular dysfunction, lung collapse, and sepsis necessitated a prolonged stay in the cardiac intensive care unit for a 5-month-old baby after surgical closure of a ventricular septal defect. Although eye cleaning with normal saline-soaked gauze was carried out as a routine, there were gaps in the instillation of lubricant eye drops when the ventilated child was under the influence of muscle relaxant drugs. He was noted to have purulent discharge from his eyes.1 Closer examination revealed a ring abscess of the cornea of the left eye (Figure, A).

https://ift.tt/2tmsp8X

Impact of Gastrostomy Placement on Nutritional Status, Physical Health, and Parental Well-Being of Females with Rett Syndrome: A Longitudinal Study of an Australian Population

To evaluate how age-related trends in nutritional status, physical health, and parental well-being in females with Rett syndrome may be related to gastrostomy placement and to examine the impact of the procedure on mortality.

https://ift.tt/2MiXSQH

TREX1 Mutation Causing Autosomal Dominant Thrombotic Microangiopathy and CKD—A Novel Presentation

Renal thrombotic microangiopathy (TMA) involves diverse causes and clinical presentations. Genetic determinants causing alternate pathway complement dysregulation underlie a substantial proportion of cases. In a significant proportion of TMAs, no defect in complement regulation is identified. Mutations in the major mammalian 3′ DNA repair exonuclease 1 (TREX1) have been associated with autoimmune and cerebroretinal vasculopathy syndromes. Carboxy-terminal TREX1 mutations that result in only altered localization of the exonuclease protein with preserved catalytic function cause microangiopathy of the brain and retina, termed retinal vasculopathy and cerebral leukodystrophy (RVCL).

https://ift.tt/2tmGN0V

Sézary Syndrome Presenting With Renal Involvement

Sézary syndrome is a rare aggressive leukemic variant of primary cutaneous T-cell lymphoma, typically presenting with erythroderma, lymphadenopathy, and an atypical clonal T-cell population. Though it often involves the spleen and liver, we report a case of Sézary syndrome with renal involvement that was treated successfully. Visceral involvement confers a poor prognosis requiring systemic treatment. The patient we describe was a 66-year-old man who was referred from Dermatology services for deteriorating kidney function.

https://ift.tt/2MiZEkP

Prescription patterns of traditional Chinese medicine amongst Taiwanese children: a population-based cohort study

Traditional Chinese medicine (TCM) has been used by Chinese patients and in many other countries worldwide. However, epidemiological reports and prescription patterns on children are few.

https://ift.tt/2K3PjfG

Dendrobium nobile Lindley and its bibenzyl component moscatilin are able to protect retinal cells from ischemia/hypoxia by dowregulating placental growth factor and upregulating Norrie disease protein

Presumably, progression of developmental retinal vascular disorders is mainly driven by persistent ischemia/hypoxia. An investigation into vision-threatening retinal ischemia remains important. Our aim was to ...

https://ift.tt/2KcdNQ5

Naringin ameliorates the high glucose-induced rat mesangial cell inflammatory reaction by modulating the NLRP3 Inflammasome

The Nucleotide binding and oligomerization domain-like receptorfamily pyrin domain-containing 3 (NLRP3)-inflammasome plays an important role in various diseases, including a variety of kidney diseases. Naringi...

https://ift.tt/2K5wvgk

A systematic review and meta-analysis of vertical transmission route of HIV in Ethiopia

The burden of mother-to-child transmission rate of HIV is high and risk factors are common in Ethiopia. This systematic review and meta-analysis intended to provide the pooled estimation of mother-to-child tra...

https://ift.tt/2lqC7me

Identification of genetic variants associated with dengue or West Nile virus disease: a systematic review and meta-analysis

Dengue and West Nile viruses are highly cross-reactive and have numerous parallels in geography, potential vector host (Aedes family of mosquitoes), and initial symptoms of infection. While the vast majority (> 8...

https://ift.tt/2tvRf5p

Nationwide Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation (J-POPS): first analysis on survival

Abstract

Background

Investigating oncological outcomes in patients registered in the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation (J-POPS) in terms of biochemical relapse-free survival (bRFS) by the Phoenix and the newly developed J-POPS definitions, exploration of predictive factors for bRFS, and preliminary verification of pitfalls of prostate-specific antigen (PSA) failure definitions.

Methods

Between July 2005 and June 2007, 2316 clinically localized patients underwent permanent seed implantation. The primary endpoint was bRFS. One of the secondary endpoints was overall survival (OS).

Results

The median age was 69 and performance status was 0 in 99.1% of participants. The median biologically effective dose (BED) was about 180 Gy2. During a median follow-up of 60.0 months, 8.4 and 5.9% had PSA failure by the Phoenix and the J-POPS definitions, respectively. The 5-year bRFSs based on the Phoenix and the J-POPS definitions were 89.1 and 91.6%, respectively. The 5-year OS was 97.3%. According to multivariate analyses, only age affected bRFS based on the Phoenix definition, whereas the risk group and BED independently affected bRFS based on the J-POPS definition. A spontaneous PSA decrease was seen in 91.1% of participants after PSA failure based on the Phoenix definition alone, but in only 22.2% after PSA failure based on the J-POPS definition alone.

Conclusion

The world's largest registration study, J-POPS, consisted of patients with longevity, and a highly quality-controlled BED resulted in excellent bRFS and OS. The high likelihood of PSA bounce by the Phoenix definition should be taken into account, especially in younger patients.

Clinical trial information

NCT00534196.



https://ift.tt/2K9zAaT

Vertigo May Worsen Odds of Recovery in Sudden Hearing Loss

FRIDAY, June 22, 2018 -- For patients with sudden sensorineural hearing loss (SSHL), vertigo may be negatively associated with recovery of hearing, according to a review published online June 21 in JAMA Otolaryngology-Head & Neck...

https://ift.tt/2tlrYfc

Handheld Device Can ID Cardiac Dysfunction in Cancer Survivors

FRIDAY, June 22, 2018 -- A novel handheld mHealth platform (Vivio) can accurately detect cardiac dysfunction in anthracycline-exposed childhood cancer survivors, according to a study published online June 21 in Clinical Cancer Research. Saro H....

https://ift.tt/2yBAwU8

Outpatient Care Less Efficient for Neonatal Abstinence Syndrome

FRIDAY, June 22, 2018 -- In infants with neonatal abstinence syndrome (NAS) outpatient pharmacotherapy is associated with longer length of therapy and higher rates of emergency department utilization than exclusive inpatient treatment, according to...

https://ift.tt/2tlFm30

Most Teens, Young Adults With Type 1 Diabetes Report Stigma

FRIDAY, June 22, 2018 -- Stigma is common in teens with type 1 diabetes and is associated with poor glycemic control, according to a study published recently in the Journal of Medical Internet Research. Anne-Sophie Brazeau, Ph.D., R.D., from McGill...

https://ift.tt/2ts3HTX

Post-Endoscopic Infection More Common Than Previously Thought

FRIDAY, June 22, 2018 -- The rates of post-endoscopic infection within seven days vary from 1.1 per 1,000 procedures for screening colonoscopy to 3 per 1,000 procedures for osophagogastroduodenoscopies (OGDs), according to a study published online...

https://ift.tt/2tkWLc5

Palliative Care Reduces Odds of Suicide in Lung Cancer Patients

FRIDAY, June 22, 2018 -- Patients with advanced lung cancer have increased incidence of suicide, which is reduced in association with receipt of palliative care, according to a study which was presented recently at the annual meeting of the American...

https://ift.tt/2ts3GiR

Police Killings of Unarmed Blacks Impact Community Mental Health

FRIDAY, June 22, 2018 -- For black U.S. adults, police killings of unarmed black Americans have adverse effects on mental health, according to a study published online June 21 in The Lancet. Jacob Bor, Sc.D., from the Boston University School of...

https://ift.tt/2yFzAOS

Long-Term Risk of Anastomotic Ulceration After RYGB

FRIDAY, June 22, 2018 -- There is a significant long-term risk of anastomotic ulceration (AU) after Roux-en-Y gastric bypass (RYGB), which increases over time and with history of tobacco use, according to a research letter published online June 20...

https://ift.tt/2MOF3FZ

Effect of Shock Wave Treatment for Erectile Dysfunction Wanes

FRIDAY, June 22, 2018 -- Low-intensity shock wave treatment is effective for short-term treatment of erectile dysfunction, but its efficacy declines after two years, particularly in those with initial severe dysfunction, according to a study...

https://ift.tt/2tu6ZGc

Allergic Rhinitis Has Negative Impact on QOL in Teens

FRIDAY, June 22, 2018 -- For adolescents, allergic rhinitis (AR) has a negative impact, affecting quality of life, daily functioning, and sleep, according to a review published online recently in the Annals of Allergy, Asthma &...

https://ift.tt/2MMaqAS

Approval Expanded for Venetoclax in Chronic Lymphocytic Leukemia

FDA expanded the approval of venetoclax (Venclexta) for people with chronic lymphocytic leukemia (CLL) to include those whose cancer has progressed after previous treatment, regardless of whether their cancer cells have the deletion 17p gene alteration.



https://ift.tt/2IgHyNy

Tox and Hound – Fellow Friday – Methylene Blue Infusions

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Continuous Methylene Blue Infusions for Treating Recurrent Methemoglobinemia by Steve Curry Banner – University Medical Center Phoenix University of Arizona College of Medicine – Phoenix A 2012 report out of Oregon serves as one of many examples reminding us that some serious cases of methemoglobinemia require more than a single injection of methylene blue in […]

EMCrit Project by Tox & Hound.



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Tox and Hound – Fellow Friday

yeah-blackboard-fellow-friday-1.jpg?resi

Welcome to Fellow Friday! As a new feature, your friends at The Tox & The Hound will have regularly occurring posts from exciting guest authors that take a deep, deep dive into deeper toxicology topics. Posts that will have toxicology fellows putting down their slide rule, straightening their pocket protectors, and taking notes. Love structures? […]

EMCrit Project by Tox & Hound.



https://ift.tt/2yETOb8

Incidence of faecal occult blood test interval cancers in population-based colorectal cancer screening: a systematic review and meta-analysis

Objective

Faecal immunochemical tests (FITs) are replacing guaiac faecal occult blood tests (gFOBTs) for colorectal cancer (CRC) screening. Incidence of interval colorectal cancer (iCRC) following a negative stool test result is not yet known. We aimed to compare incidence of iCRC following a negative FIT or gFOBT.

Design

We searched Ovid Medline, Embase, Cochrane Library, Science Citation Index, PubMed and Google Scholar from inception to 12 December 2017 for citations related to CRC screening based on stool tests. We included studies on FIT or gFOBT iCRC in average-risk screening populations. Main outcome was pooled incidence rate of iCRCs per 100 000 person-years (p-y). Pooled incidence rates were obtained by fitting random-effect Poisson regression models.

Results

We identified 7 426 records and included 29 studies. Meta-analyses comprised data of 6 987 825 subjects with a negative test result, in whom 11 932 screen-detected CRCs and 5 548 gFOBT or FIT iCRCs were documented. Median faecal haemoglobin (Hb) positivity cut-off used was 20 (range 10–200) µg Hb/g faeces in the 17 studies that provided FIT results. Pooled incidence rates of iCRC following FIT and gFOBT were 20 (95% CI 14 to 29; I2=99%) and 34 (95% CI 20 to 57; I2=99%) per 100 000 p-y, respectively. Pooled incidence rate ratio of FIT versus gFOBT iCRC was 0.58 (95% CI 0.32 to 1.07; I2=99%) and 0.36 (95% CI 0.17 to 0.75; I2=10%) in sensitivity analysis. For every FIT iCRC, 2.6 screen-detected CRCs were found (ratio 1:2.6); for gFOBT, the ratio between iCRC and screen-detected CRC was 1:1.2. Age below 60 years and the third screening round were significantly associated with a lower iCRC rate.

Conclusion

A negative gFOBT result is associated with a higher iCRC incidence than a negative FIT. This supports the use of FIT over gFOBT as CRC screening tool.



https://ift.tt/2IgiM0l

Lactobacillus rhamnosus GG protects the intestinal epithelium from radiation injury through release of lipoteichoic acid, macrophage activation and the migration of mesenchymal stem cells

Objective

Lactobacillus rhamnosus GG (LGG), a probiotic, given by gavage is radioprotective of the mouse intestine. LGG-induced radioprotection is toll-like receptor 2 (TLR2) and cyclooxygenase-2 (COX-2)-dependent and is associated with the migration of COX-2+mesenchymal stem cells (MSCs) from the lamina propria of the villus to the lamina propria near the crypt epithelial stem cells. Our goals were to define the mechanism of LGG radioprotection including identification of the TLR2 agonist, and the mechanism of the MSC migration and to determine the safety and efficacy of this approach in models relevant to clinical radiation therapy.

Design

Intestinal radioprotection was modelled in vitro with cell lines and enteroids as well as in vivo by assaying clinical outcomes and crypt survival. Fractionated abdominal and single dose radiation were used along with syngeneic CT26 colon tumour grafts to assess tumour radioprotection.

Results

LGG with a mutation in the processing of lipoteichoic acid (LTA), a TLR2 agonist, was not radioprotective, while LTA agonist and native LGG were. An agonist of CXCR4 blocked LGG-induced MSC migration and LGG-induced radioprotection. LGG given by gavage induced expression of CXCL12, a CXCR4 agonist, in pericryptal macrophages and depletion of macrophages by clodronate liposomes blocked LGG-induced MSC migration and radioprotection. LTA effectively protected the normal intestinal crypt, but not tumours in fractionated radiation regimens.

Conclusions

LGG acts as a 'time-release capsule' releasing radioprotective LTA. LTA then primes the epithelial stem cell niche to protect epithelial stem cells by triggering a multicellular, adaptive immune signalling cascade involving macrophages and PGE2 secreting MSCs.

Trial registration number

NCT01790035; Pre-results.



https://ift.tt/2K0xK0f

Patients with colorectal cancer have identical strains of Fusobacterium nucleatum in their colorectal cancer and oral cavity

We read with great interest the article by Flemer et al, which suggests that analysis of the oral microbiota could potentially be used as a screening method for colorectal cancer (CRC) and polyp detection.1 Fusobacterium (F.) nucleatum is one of the most densely colonised bacterial species in the oral cavity and is known to be associated with periodontitis.2 Recently, many researchers have demonstrated that F. nucleatum is related to CRC development and pathogenicity.3 4 However, the relationship between F. nucleatum in CRC and the oral cavity is not well understood. For this purpose, we examined whether identical strains of F. nucleatum could be isolated from CRC and saliva specimens obtained from the same patient. The approach used in this study is detailed in figure 1A (see online  for details). We collected CRC and saliva samples from 14 patients (online ) and isolated bacteria...



https://ift.tt/2MhkWyS

Human gut microbiome: hopes, threats and promises

The microbiome has received increasing attention over the last 15 years. Although gut microbes have been explored for several decades, investigations of the role of microorganisms that reside in the human gut has attracted much attention beyond classical infectious diseases. For example, numerous studies have reported changes in the gut microbiota during not only obesity, diabetes, and liver diseases but also cancer and even neurodegenerative diseases. The human gut microbiota is viewed as a potential source of novel therapeutics. Between 2013 and 2017, the number of publications focusing on the gut microbiota was, remarkably, 12 900, which represents four-fifths of the total number of publications over the last 40 years that investigated this topic. This review discusses recent evidence of the impact of the gut microbiota on metabolic disorders and focus on selected key mechanisms. This review also aims to provide a critical analysis of the current knowledge in this field, identify putative key issues or problems and discuss misinterpretations. The abundance of metagenomic data generated on comparing diseased and healthy subjects can lead to the erroneous claim that a bacterium is causally linked with the protection or the onset of a disease. In fact, environmental factors such as dietary habits, drug treatments, intestinal motility and stool frequency and consistency are all factors that influence the composition of the microbiota and should be considered. The cases of the bacteria Prevotella copri and Akkermansia muciniphila will be discussed as key examples.



https://ift.tt/2K0xApF

Kratom (mitragyna speciosa) powder products by Gaia Ethnobotanical: Recall - Due to Potential Salmonella Contamination

[Posted 06/22/2018] AUDIENCE: Consumer, Health Professional ISSUE: The products have been found by the FDA via sample testing and finding to have salmonella contamination. In lieu of such FDA findings the company has implemented standard operating...

https://ift.tt/2tjJ1hG

Kratom (mitragyna speciosa) powder products by Gaia Ethnobotanical: Recall - Due to Potential Salmonella Contamination

[Posted 06/22/2018] AUDIENCE: Consumer, Health Professional ISSUE: The products have been found by the FDA via sample testing and finding to have salmonella contamination. In lieu of such FDA findings the company has implemented standard operating...

https://ift.tt/2tjJ1hG

Cancers, Vol. 10, Pages 213: Human Oncoviruses and p53 Tumor Suppressor Pathway Deregulation at the Origin of Human Cancers

Cancers, Vol. 10, Pages 213: Human Oncoviruses and p53 Tumor Suppressor Pathway Deregulation at the Origin of Human Cancers

Cancers doi: 10.3390/cancers10070213

Authors: Maria Lina Tornesello Clorinda Annunziata Anna Lucia Tornesello Luigi Buonaguro Franco Maria Buonaguro

Viral oncogenesis is a multistep process largely depending on the complex interplay between viruses and host factors. The oncoviruses are capable of subverting the cell signaling machinery and metabolic pathways and exploit them for infection, replication, and persistence. Several viral oncoproteins are able to functionally inactivate the tumor suppressor p53, causing deregulated expression of many genes orchestrated by p53, such as those involved in apoptosis, DNA stability, and cell proliferation. The Epstein–Barr virus (EBV) BZLF1, the high-risk human papillomavirus (HPV) E6, and the hepatitis C virus (HCV) NS5 proteins have shown to directly bind to and degrade p53. The hepatitis B virus (HBV) HBx and the human T cell lymphotropic virus-1 (HTLV-1) Tax proteins inhibit p53 activity through the modulation of p300/CBP nuclear factors, while the Kaposi's sarcoma herpesvirus (HHV8) LANA, vIRF-1 and vIRF-3 proteins have been shown to destabilize the oncosuppressor, causing a decrease in its levels in the infected cells. The large T antigen of the Merkel cell polyomavirus (MCPyV) does not bind to p53 but significantly reduces p53-dependent transcription. This review describes the main molecular mechanisms involved in the interaction between viral oncoproteins and p53-related pathways as well as in the development of therapeutic strategies targeting such interactions.



https://ift.tt/2JY1ydP

Metabolic scaling of stress hormones in vertebrates

Abstract
Glucocorticoids are stress hormones that can strongly influence physiology, behavior and an organism's ability to cope with environmental change. Despite their importance, and the wealth of studies that have sought to understand how and why glucocorticoid (GC) concentrations vary within species, we do not have a clear understanding of how circulating glucocorticoid levels vary within and across the major vertebrate clades. New research has proposed that much interspecific variation in GC concentrations can be explained by variation in metabolism and body mass. Specifically, GC concentrations should vary proportionally with mass-specific metabolic rates and, given known scaling relationships between body mass and metabolic rate, GC concentrations should scale to the -1/4 power of body mass and to the power of 1 with mass-specific metabolic rate. Here, we use HormoneBase, the newly compiled database that includes data plasma GC concentrations from free-living and unmanipulated vertebrates, to evaluate this hypothesis. Specifically, we explored the relationships between body mass or mass-specific metabolic rate and either baseline or stress-induced GC (cortisol or corticosterone) concentrations in tetrapods. Our phylogenetically-informed models suggest that, whereas the relationship between GC concentrations and body mass across tetrapods and among mammals is close to -1/4 power, this relationship does not exist in amphibians, reptiles and birds. Moreover, with the exception of a positive association between stress-induced GC concentrations and mass-specific metabolic rate in birds, we found little evidence that GC concentrations are linked to metabolic rate, although the number of species sampled was quite limited for amphibians and somewhat so for reptiles and mammals. Nevertheless, these results stand in contrast to the generally accepted association between the two and suggests that our observed positive association between body mass and GC concentrations may not be due to the well-established link between mass and metabolism. Large-scale comparative approaches can come with drawbacks, such as pooling and pairing observations from separate sources. However, these broad analyses provide an important counterbalance to the vast majority of studies examining variation in GC concentrations at the population or species level, and can be a powerful approach to testing both long-standing and new questions in biology.

https://ift.tt/2tv7ikb

Blank Canvas: The Case for Descriptive Taxonomy

Synopsis
Describing species is fundamental to understanding the biosphere and the origins of biodiversity. Without descriptions, we miss many of the most improbable, interesting and informative aspects of species, higher taxa and evolutionary history. Further, descriptive taxonomy opens a treasure trove of nature-inspired solutions for creating a sustainable future.

https://ift.tt/2MNfAfS

The Comparative Biology of Mitochondrial Function and the Rate of Aging

Abstract
The mitochondrial hypothesis of aging evolved from the rate-of-living theory. That theory posited that the rate of aging was largely determined by the rate of energy expenditure. The mechanistic link between energy expenditure and aging was hypothesized to be oxidative stress. As both energy expenditure and reactive oxygen species (ROS) centered on the mitochondria that organelle became a central focus of aging research. Until about the turn of the 21st century available evidence largely supported the efficiency of mitochondrial function as a key contributor to aging. However as methods for investigating mitochondrial oxidant production and tissue level oxidative damage improved, evidentiary support for the theory weakened. Recently, direct disruption of mitochondrial function has been shown not to shorten life or health as expected, but in many cases in multiple laboratory species disrupted mitochondrial function has lengthened life, sometimes without apparent tradeoffs. Does this mean that mitochondrial function plays no role in aging as had been posited for many years? One key consideration is that experiments under laboratory conditions can be misleading about physiological processes that occur in the uncertain conditions of nature. Before we discard the mitochondrial hypothesis of aging, more field experiments targeted at that hypothesis need to be performed. Fortunately, emerging technology is making such experiment more possible than ever before.

https://ift.tt/2tuqNJr

Magnetic resonance imaging of arterial stroke mimics: a pictorial review

Abstract

Acute ischaemic stroke represents the most common cause of new sudden neurological deficit, but other diseases mimicking stroke happen in about one-third of the cases. Magnetic resonance imaging (MRI) is the best technique to identify those 'stroke mimics'. In this article, we propose a diagnostic approach of those stroke mimics on MRI according to an algorithm based on diffusion-weighted imaging (DWI), which can be abnormal or normal, followed by the results of other common additional MRI sequences, such as T2 with gradient recalled echo weighted imaging (T2-GRE) and fluid-attenuated inversion recovery (FLAIR). Analysis of the signal intensity of the parenchyma, the intracranial arteries and, overall, of the veins, is crucial on T2-GRE, while anatomic distribution of the parenchymal lesions is essential on FLAIR. Among stroke mimics with abnormal DWI, T2-GRE demonstrates obvious abnormalities in case of intracerebral haemorrhage or cerebral amyloid angiopathy, but this sequence also allows to propose alternative diagnoses when DWI is negative, such as in migraine aura or headaches with associated neurological deficits and lymphocytosis (HaNDL), in which cortical venous prominence is observed at the acute phase on T2-GRE. FLAIR is also of major interest when DWI is positive by better showing evocative distribution of cerebral lesions in case of seizure (involving the hippocampus, pulvinar and cortex), hypoglycaemia (bilateral lesions in the posterior limb of the internal capsules, corona radiata, striata or splenium of the corpus callosum) or in posterior reversible encephalopathy syndrome (PRES). Other real stroke mimics such as mitochondrial myopathy, encephalopathy, lactic acidosis, stroke-like episodes (MELAS), Susac's syndrome, brain tumour, demyelinating diseases and herpes simplex encephalitis are also included in our detailed and practical algorithm.

Key points

• About 30% of sudden neurological deficits are due to non-ischaemic causes.

• MRI is the best technique to identify stroke mimics.

• Our practical illustrated algorithm based on DWI helps to recognise stroke mimics.



https://ift.tt/2MhyzhU

New Research From Psychological Science

Read about the latest research published in Psychological Science:

Structure and Implementation of Novel Task Rules: A Cross-Sectional Developmental Study 
Frederick Verbruggen, Rossy McLaren, Maayan Pereg, and Nachshon Meiran

The authors tested how children and adolescents performed in new tasks that required learning instructions and structuring the tasks hierarchically. They presented images of cartoon characters that lived on the left or on the right side of the street on a computer screen. Then, they instructed participants to bring the cartoons home in the evening (go phase) and to take them to school (located on the left or right side of the screen) in the morning (next phase) before sending them home. Evening and morning were signaled by light-blue and dark-blue backgrounds, respectively, and the cartoons were moved by pressing the appropriate left or right key. This task required learning both mapping rules and the structure of tasks so as to minimize interference between tasks. All participants responded more slowly when the next phase was incompatible with the learned rules, but the youngest children showed more interference, indicating that the ability to hierarchically structure tasks develops with age. Thus, children were able to learn new rules but had difficulty in discriminating when to use them, showing worse task structuring than adolescents.

Statistical Learning Creates Novel Object Associations via Transitive Relations
Yu Luo and Jiaying Zhao

Statistical learning can occur without observers being consciously aware of it, for example, when multiple objects regularly appear at the same time. These associations between objects lead to transitive inferences, so objects that have never been directly associated in the real world are associated mentally. The authors tested this idea and its limits in eight experiments. They presented abstract stimuli or names of cities, countries, and parks in a sequence that allowed participants to unconsciously extract associations between the stimuli. After being exposed to the stimuli while performing a cover task, participants completed a task where they had to judge the familiarity of sequences of stimuli. These sequences could be similar to the initial ones, foil sequences, or transitive sequences that could be inferred from the initial ones (e.g., if presented with A-B, B-C, the transitive pair would be A-C). The results showed that participants judged the initial and the transitive sequences as more familiar than the foils, suggesting that they formed transitive inferences. The effect also occurred across categorical hierarchies, with participants making inferences from cities to parks and countries. Thus, new transitive associations between objects may be automatically inferred as a consequence of statistical learning.

When the Good Looks Bad: An Experimental Exploration of the Repulsion Effect
Mikhail S. Spektor, David Kellen, and Jared M. Hotaling

When choosing from different options, the introduction of a similar-but-worse option tends to increase the probability that people will choose a similar-but-better option (attraction effect). Yet some recent studies showed the opposite—a repulsion effect, in which similar-but-worse options "taint" the similar-but-better options, leading to a preference for the competitor over the target. The authors tested the robustness of the repulsion effect and its possible boundaries. In several preregistered experiments consisting of several trials, they asked participants to decide which of three rectangles was the largest, manipulating the characteristics of one of them as a decoy (the similar-but-worse option). The results showed a repulsion effect across experiments, regardless of whether participants were rewarded for correct answers or punished for incorrect answers. However, the arrangement of the options on the screen and their design seemed to influence the effect observed. The repulsion effect diminished when the target and decoy were the most different (i.e., had the largest difference in area). And, when the options were arranged along a horizontal line instead of in a triangle, an attraction effect was more likely than a repulsion effect.



https://ift.tt/2lrxrg0

Identification of phenol- and p-cresol-producing intestinal bacteria by using media supplemented with tyrosine and its metabolites

Abstract
To identify intestinal bacteria that produce phenols (phenol and p-cresol), we screened 153 strains within 153 species in 44 genera by culture-based assay using broth media supplemented with 200 μM each of tyrosine and its predicted microbial metabolic intermediates (4-hydroxyphenylpyruvate, DL-4-hydroxyphenyllactate, 3-(p-hydroxyphenyl)propionate, 4-hydroxyphenylacetate, and 4-hydroxybenzoate). Phenol-producing activity was found in 36 strains and p-cresol-producing activity in 55 strains. Sixteen strains had both types of activity. Phylogenetic analysis based on the 16S rRNA gene sequences of strains that produced 100 μM or more of phenols revealed that 16 phenol producers belonged to the Coriobacteriaceae, Enterobacteriaceae, Fusobacteriaceae, and Clostridium clusters I and XIVa; four p-cresol-producing bacteria belonged to the Coriobacteriaceae and Clostridium clusters XI and XIVa; and one strain producing both belonged to the Coriobacteriaceae. A genomic search for protein homologs of enzymes involved in the metabolism of tyrosine to phenols in 10 phenol producers and four p-cresol producers, the draft genomes of which were available in public databases, predicted that phenol producers harbored tyrosine phenol-lyase or hydroxyarylic acid decarboxylase, or both, and p-cresol producers harbored p-hydroxyphenylacetate decarboxylase or tyrosine lyase, or both. These results provide important information about the bacterial strains that contribute to production of phenols in the intestine.

https://ift.tt/2tulzO9

How to prevent the next fracture

Publication date: Available online 21 June 2018
Source:Injury
Author(s): Paul Mitchell, Kristina Åkesson
During the last decade, policymakers, learned societies, non-governmental organisations (NGOs) and some national alliances of all three of these groups have advocated, developed and implemented systematic approaches to fragility fracture care and prevention in a growing number of countries. This chapter reviews the impact of Orthogeriatric Services (OGS) and Fracture Liaison Services (FLS) on delivery of best practice in secondary fracture prevention. An overview of national and international strategies intended to promote widespread implementation of these service models is also provided.



https://ift.tt/2KehTH6

Physiotherapy following fragility fractures

Publication date: Available online 21 June 2018
Source:Injury
Author(s): Monica R. Perracini, Morten Tange Kristensen, Caitriona Cunningham, Cathie Sherrington
Physiotherapy can play a vital role in the pathway of care of people after fragility fracture and includes interventions of early mobilisation and prescription of structured exercise programmes for maximising functional recovery and reducing the risk of falls and future fractures. Although the optimal nature of physiotherapist interventions after hip and vertebral fracture requires further investigation in large-scale trials, evidence supports the prescription of high-intensity and extended exercise interventions. This article will overview interventions in the acute and chronic phases after hip fractures, interventions after vertebral fracture and the role of physiotherapy in the prevention of further fractures.



https://ift.tt/2MIGHsJ

Proliferative and osteogenic differentiation capacity of mesenchymal stromal cells: Influence of harvesting site and donor age

Publication date: Available online 21 June 2018
Source:Injury
Author(s): Wolf Christian Prall, Maximilian Michael Saller, Anna Scheumaier, Timo Tucholski, Sara Taha, Wolfgang Böcker, Hans Polzer
Human mesenchymal stromal cells (hMSCs) are the cellular source of new bone formation and an essential component of autologous bone grafts. Autologous bone graft harvesting is routinely conducted at the iliac crest, although alternative donor sites with lower complication rates are available. Thus, the aim of this study was to compare hMSCs harvested from the iliac crest and the proximal tibia regarding their proliferative and osteogenic differentiation capacity. Furthermore, we investigated the influence of donor age on these biological properties.HMSCs were isolated from iliac crest or proximal tibia bone grafts of 46 patients. Proliferative capacity was assessed by cumulative population doublings, population doubling time, colony forming units and cell proliferation assays. Osteogenic capacity was assessed by quantification of extracellular calcium deposition and marker gene expression levels. The number of hMSCs per gram harvested tissue was determined. Furthermore, the adipogenic and chondrogenic differentiation capacity were quantified using BODIPY and Safranin Orange staining, respectively. Additional analyses were carried out after grouping young (18–49 years) and aged (≥50 years) donors.HMSCs derived from the proximal tibia featured a comparable proliferative and osteogenic differentiation capacity. No significant differences were found for any analysis conducted, when compared to hMSCs obtained from the iliac crest. Furthermore, no significant differences could be revealed when comparing young and aged donors. This was equally true for hMSCs from both donor sites after comparison within the same age group.Our study demonstrates comparable biological properties of hMSCs derived from both donor sites, the iliac crest and the proximal tibia. Furthermore, aging does not alter proliferative and osteogenic differentiation capacity. Consequently, the proximal tibia should be considered more closely as an alternative donor site in patients of all age groups.



https://ift.tt/2MhrVbs

Letter to editor regarding the article by Wang et al “Open reduction and internal fixation in a one-stage anterior cruciate ligament reconstruction surgery for the treatment of tibial plateau fractures: A case report and literature review”

Publication date: Available online 21 June 2018
Source:Injury
Author(s): Antony Roy, Mohsina Subair




https://ift.tt/2MPeUqD

Hip Fracture audit: creating a ‘critical mass of expertise and enthusiasm for hip fracture care’?

Publication date: Available online 21 June 2018
Source:Injury
Author(s): Colin Currie
The care of frail older people admitted with hip fracture has improved greatly over the last half-century, largely as a result of combined medical care and surgical care and the rise – over the last four decades – of large-scale hip fracture audit.A series of European initiatives evolved. The first national hip fracture audit was the Swedish Rikshöft in the late 1980s, and the largest so far is the UK National Fracture Database (NHFD), launched in 2007. An external evaluation of the NHFD demonstrated statistically significant increases in survival at up to 1 year associated with improved early care: with rising geriatrician involvement and falling delays to surgery, and from which lessons have been learned.Comparable national audits have emerged since in northern Europe and in Australia and New Zealand, and most recently in Spain and Japan. Like the NHFD, these use the synergy of agreed clinical standards and regular – ideally continuous – audit feedback that can prompt and monitor clinical and service developments, often demonstrating both rising quality and improved cost effectiveness.In addition, important benchmarking studies of hip fracture care have been reported from India and China, both of which face huge challenges in providing care of fragility fractures in populations characterised by first-generation mass ageing. The 'halo effect' of the impact of growing expertise in hip fracture care on the care of other fragility fractures is noteworthy and now relevant globally.Although many national audits have now published encouraging reports of progress, the details of context and process determinants of the initiation and development of effective hip fracture audit have received relatively little attention.To address this, an extended discussion section – based on the author's experience of participation in several substantial audits, variously supporting and observing many others, and from his numerous discussions with audit colleagues over the years – may be of value in offering practical advice on some obvious and less obvious practical issues that arise in the setting up of large-scale hip fracture audits in a variety of healthcare contexts.



https://ift.tt/2KcKn46

Cardiovascular disease risk marker responses to breaking up prolonged sedentary time in individuals with paraplegia: the Spinal Cord Injury Move More (SCIMM) randomised crossover laboratory trial protocol

Introduction

Sedentary behaviour is a distinct risk factor for cardiovascular disease (CVD) and could partly explain the increased prevalence of CVD in people with spinal cord injury (SCI). Interrupting prolonged sitting periods with regular short bouts of walking acutely suppresses postprandial glucose and lipids in able-bodied individuals. However, the acute CVD risk marker response to breaking up prolonged sedentary time in people with SCI has not been investigated.

Methods and analysis

A randomised two-condition laboratory crossover trial will compare: (1) breaking up prolonged sedentary time with 2 min moderate-intensity arm-crank activity every 20 min, with (2) uninterrupted prolonged sedentary time (control) in people with SCI. Outcomes will include acute effects on postprandial glucose, insulin, lipids and blood pressure. Blood samples will be collected and blood pressure measured at regular intervals during each 51/2-hour condition.

Ethics and dissemination

This study was approved by the Cambridge South National Health Service Research Ethics Committee. This research will help determine if breaking up prolonged sedentary time could be effective in lowering CVD risk in people with SCI. The findings of the research will be published in a peer-reviewed journal and disseminated to relevant user groups.

Trial registration number

ISRCTN51868437; Pre-results.



https://ift.tt/2Kdhpo4

Older kidney transplantation candidates expectations of improvement in life and health following kidney transplantation: semistructured interviews with enlisted dialysis patients aged 65 years and older

Objective

The aim was to study the expectations of improvement in life and health following kidney transplantation (KTx) in a population of wait-listed patients ≥65 years with end-stage kidney disease.

Design

Qualitative research with individual in-depth interviews.

Setting

Patients on dialysis enlisted for a KTx from a deceased donor were included from an ongoing study of older patients' perspectives on KTx. Qualitative face-to-face interviews were conducted in a safe and familiar setting, and were analysed thematically using the theoretical framework of lifespan.

Informants

Fifteen patients (median age 70 years, range 65–82) from all parts of Norway were interviewed. Informants were included consecutively until no new information was gained.

Results

Two main themes were evident: receiving a kidney is getting life back and grasp the chance. In addition, the themes 'hard to loose capacity and strength', 'reduced freedom' and 'life on hold' described the actual situation and thereby illuminated the informants' expectations. The informants tried to balance positive expectations and realism towards KTx, and they were hoping to become free from dialysis and to live a normal life.

Conclusion

This study shows that older KTx candidates comprise a heterogeneous group of patients who take individual approaches that allow them to maintain autonomy and control while waiting for a transplant. This study provides new knowledge about the older KTx candidates relevant for clinicians, patients and researchers.



https://ift.tt/2KdN9Gf

Association between acculturation and body weight status among migrant children in Guangzhou, China: a cross-sectional study

Objective

To assess the association between acculturation and body weight status among internal migrant children in China.

Design, setting and participants

A cross-sectional study was conducted among 1154 pairs of migrant children aged 11–17 years and their primary caregivers in Guangzhou, China, from April to May 2016.

Measures

Migrant children's body weight status was measured by body mass index. Acculturation was measured by a questionnaire, developed and validated by the research team. The questionnaire had three dimensions with five factors, namely language, social interaction, custom, dressing and diet. Social anxiety was measured by Social Anxiety Scale for Children. Food intake was measured by the food frequency table that was developed from a previous study. Logistic regression was performed to examine the association between acculturation and overweight/obesity while controlling for migrant children's and their caregivers' demographic characteristics, children's social anxiety and food intake.

Results

Seventy-six out of 1154 (6.6%) migrant children were overweight, and 36 (3.1%) were obese. The overall prevalence of overweight/obesity was 12.5% in boys, and 6.1% in girls (p<0.001), respectively. The mean scores of acculturation were 41.8 (SD=14.6). Migrant children had the highest level of acculturation in the aspect of dressing (mean=61.7, SD=16.6), followed by language (mean=47.9, SD=22.3), diet (mean=45.0, SD=18.5), social interaction (mean=42.4, SD=21.3) and custom (mean=27.6, SD=19.2). After controlling for confounding factors, the levels of acculturation was negatively associated with overweight/obesity (adjusted OR (aOR)=0.98, 95% CI 0.97 to 1.00, p=0.030). Furthermore, migrant children who had urban-to-urban migrant caregivers were more likely to be overweight/obese (aOR=2.07, 95% CI 1.16 to 3.69, p=0.014) than their counterparts living with rural-to-urban migrant caregivers.

Conclusions

The low levels of acculturation was associated with overweight/obesity among migrant children in Guangzhou, China. Promoting healthy acculturation and social campaign on healthy body weight may help prevent childhood overweight/obesity. Young migrant children, boys and children living with urban-to-urban migrant caregivers should be the target subgroups.



https://ift.tt/2Kf9jLu

Emergency admissions and long-term conditions during transition from paediatric to adult care: a cross-sectional study using Hospital Episode Statistics data

Objective

To determine whether changes in emergency admission rates during transition from paediatric to adult hospital services differed in children and young people (CYP) with and without underlying long-term conditions (LTCs).

Design

Cross-sectional study.

Setting

Emergency admissions between 2009 and 2011 recorded in the Hospital Episode Statistics Admitted Patient Care data in England.

Participants

763 199 CYP aged 10–24 years with and without underlying LTCs (LTCs were defined using the International Classification of Diseases, 10th Revision codes recorded in the past 5 years).

Primary and secondary outcome measures

We calculated emergency admission rates before (10–15 years) and after transition (19–24 years), stratified by gender, LTC and primary diagnosis. We used negative binomial regression to estimate adjusted incidence rate ratios (IRRs).

Results

We included 1 109 978 emergency admissions, of which 63.2% were in children with LTCs. The emergency admission rate increased across the age of transition for all CYP, more so for those with LTCs (IRRLTC: 1.55, 99% CI 1.47 to 1.63), compared with those without (IRRnoLTC: 1.21, 99% CI 1.18 to 1.23). The rates increased most rapidly for CYP with mental health problems, MEDReG (metabolic, endocrine, digestive, renal, genitourinary) disorders, and multiple LTCs (both genders) and respiratory disorders (female only). Small or no increased rates were found for CYP without LTCs and for those with cancer or cardiovascular disease. Increases in length of stay were driven by long admissions (10+ days) for a minority (1%) of CYP with mental health problems and potentially psychosomatic symptoms. Non-specific symptoms related to abdominal pain (girls only), gastrointestinal and respiratory problems were the most frequent primary diagnoses.

Conclusions

The increased rates and duration of emergency admissions and predominance of non-specific admission diagnoses during transition in CYP with underlying LTCs may reflect unmet physical or mental health needs.



https://ift.tt/2IkpbaC

Using facilitator-receiver peer dyads matched according to socioeconomic status to promote behaviour change in overweight adolescents: a feasibility study

Objective

To evaluate the feasibility of an innovative peer intervention promoting healthy eating and physical activity, which purposefully selected peer facilitators according to socioeconomic status to target less-advantaged overweight receivers.

Setting

Nine high schools, two middle schools.

Participants

One hundred and fifty-six adolescents were approached to become facilitators, of whom 18 were trained. Thirty-two of 56 potential receivers agreed to participate.

Intervention

The peer intervention was carried out in 2013–2014 and embedded in a larger trial: PRALIMAP-INÈS (Promotion de l'ALIMentation et l'Activité Physique-INEgalité de Santé). Facilitanoators were selected and trained to organise weight-control activities with specific peer receivers participating in the programme.

Primary and secondary outcome measures

Different types of data were collected to assess demand, acceptability, implementation and practicality of the intervention. For the facilitators, this included 6 training sessions, 11 mid-programme interviews, 4 end-of-programme sessions, telephone notes and text message exchanges. All six potential receivers in one school were also interviewed. Sociodemographic and health characteristics were also analysed.

Results

Agreeing to participate was more likely when asked by a peer compared with a professional (51.2% discordant pairs; p<0.02). Twelve activities, mostly based on physical activity and implemented during weekends or holidays, were carried out. The mean age of active receivers was 16 and their body mass index was higher than other participants. For both facilitators and active receivers, there were more participating girls. Qualitative analysis reveals key implementation challenges for facilitators. Interviews with the receivers highlight social difficulties, with most feeling bad about their appearance and wanting to lose weight. Those who participated in peer activities were very positive about the experience especially social support.

Conclusions

The present study suggests the peer intervention is feasible provided organisational difficulties are addressed. Good practice recommendations are formulated, including a longer training session, organising a joint meeting with the facilitators and receivers, matching dyads on place of residence and multiplying modes of contact.

Trial registration number

NCT01688453.



https://ift.tt/2JXCFyV

Pattern and spectrum of tornado injury and its geographical information system distribution in Yancheng, China: a cross-sectional study

Objectives

Few studies of tornado injuries have considered differences related to damage levels and Enhanced-Fujita (EF) scale ratings. This study aimed to evaluate the pattern, spectrum and geographical distribution of injuries related to the Yancheng tornado and provide guidelines for effective emergency medical strategies.

Setting

The study was conducted at three hospitals which treated patients with injuries related to the tornado in Yancheng, China.

Participants

We obtained the records of 451 patients with tornado-related injuries. Of these, 401 valid trauma medical records were included; 50 other records were excluded for insufficient information. Informed consent was obtained from all patients by telephone.

Main outcome measures

We analysed patients' injury sites and types and used the abbreviated injury scale (AIS) to standardise injury severity. Geographical information system and non-parametric tests were used to analyse the effects of geographical factors on casualties.

Results

Women, middle-aged/elderly individuals (age>45 years) and children/adolescents (<18 years) accounted for 51.62%, 77.30% and 12.47% of injured patients, respectively. This caused a dumbbell-shaped age distribution. Head (46.63%), body surface (39.90%) and lower-limb (29.43%) injuries were common, as were soft-tissue injuries (90.77%), fractures (38.90%) and organ damage (19.70%). Minor injuries (AIS=1) were common (60.85%), whereas critical/fatal injuries (AIS≥5) were very rare (2.50%). Although the densities of injury varied among damage levels and EF ratings for different areas, area-wise differences in injury severity (AIS scores) were not significant (p>0.05).

Conclusion

We recommend the use of helmets to prevent head injuries caused by tornadoes and suggest prioritising the treatment of high-risk head and multiple-organ injuries. Additionally, medical rescuers should follow the 'same quality and different quantity' principle: the injured in all affected areas should receive equal attention, but numbers of medical personnel should be allocated based on the level of effects from the tornado.



https://ift.tt/2IhSZ7T

Quantifying intervals to diagnosis in myeloma: a systematic review and meta-analysis

Objectives

To quantify the duration of each step of the diagnostic pathway for patients with multiple myeloma from symptom onset to confirmation of diagnosis.

Design

Systematic review and meta-analysis.

Data sources and selection criteria

The MEDLINE and Embase databases were searched up until January 2018 to identify articles that reported time intervals from onset of symptoms to diagnosis. Articles focusing on children or adolescents and on the asymptomatic form of the disease (monoclonal gammopathies and smouldering myeloma) were excluded.

Data collection and data analysis

Data were extracted independently by two reviewers. Weighted estimates of the median and IQR were calculated. Risk of bias was assessed using the Aarhus checklist.

Main results

Nine studies were included. The patient interval (first symptom to first presentation) had a median of 26.3 days (IQR: 1–98, n=465, two studies). Subsequently, the primary care interval (first presentation to first referral) was 21.6 days (IQR: 4.6–55.8, n=326, two studies), the diagnostic interval (first presentation to diagnosis) was 108.6 days (IQR: 33.3–241.7, n=5395, seven studies) and the time to diagnosis (first symptom to diagnosis) interval was 163 days (IQR: 84–306, n=341, one study). No studies reported data for the referral to diagnosis interval.

Conclusion

The review demonstrates that there is scope for significant reductions in the time to myeloma diagnosis. At present, many patients experience a diagnostic interval longer than 3 months until diagnosis is confirmed.

Review registration

Not available. Protocol available in the appendix.



https://ift.tt/2JXCx2p

PREHAB study: a protocol for a prospective randomised clinical trial of exercise therapy for people living with frailty having cancer surgery

Introduction

Exercise prehabilitation may improve outcomes after surgery. Frailty is a key predictor of adverse postoperative outcomes in older people; the multidimensional nature of frailty makes this a population who may derive substantial benefit from exercise prehabilitation. The objective of this trial is to test the efficacy of exercise prehabilitation to improve postoperative functional outcomes for people living with frailty having cancer surgery with curative intent.

Methods and analysis

We will conduct a single-centre, parallel-arm randomised controlled trial of home-based exercise prehabilitation versus standard care among consenting patients >60 years having elective cancer surgery (intra-abdominal and intrathoracic) and who are frail (Clinical Frailty Scale >4). The intervention consists of > 3 weeks of exercise prehabilitation (strength, aerobic and stretching). The primary outcome is the 6 min walk test at the first postoperative clinic visit. Secondary outcomes include the short physical performance battery, health-related quality of life, disability-free survival, complications and health resource utilisation. The primary outcome will be analysed by intention to treat using analysis of covariance. Outcomes up to 1 year after surgery will be ascertained through linkage to administrative data.

Ethics and dissemination

Ethical approval has been granted by our ethics review board (Protocol Approval #2016009–01H). Results will be disseminated through presentation at scientific conferences, through peer-reviewed publication, stakeholder organisations and engagement of social and traditional media.

Trial registration number

NCT02934230; Pre-results.



https://ift.tt/2IfBnJC

National mixed methods evaluation of the effects of removing legal barriers to full practice authority of Dutch nurse practitioners and physician assistants

Objective

To evaluate the effects of granting legal full practice authority (FPA) to nurse practitioners (NP) and physician assistants (PA) regarding the performance of specified reserved medical procedures and to support governmental decision-making.

Design

Nationwide mixed methods design with triangulation of quantitative (Pre-post test design) and qualitative data (expert interviews and focus groups).

Methods

Surveys focused on the performance of the procedures (monthly number, authorisation mode, consultations and procedural time) and legal cross-compliance requirements (adherence with protocols, competence). Interviews focused on competence, knowledge, skills, responsibilities, routine behaviour, NP/PA role, acceptance, organisational structure, collaboration, consultation, NP/PA positioning, adherence with protocols and resources. Data collection took place between 2011 and 2015.

Results

Quantitative data included 1251 NPs, 798 PAs and 504 physicians. Besides, expert interviews with 33 healthcare providers and 28 key stakeholders, and 5 focus groups (31 healthcare providers) were held.

After obtaining FPA, the proportion of NPs and PAs performing reserved procedures increased from 77% to 85% and from 86% to 93%, respectively; the proportion of procedures performed on own authority increased from 63% to 76% for NPs and from 67% to 71% for PAs. The mean number of monthly contacts between NPs/PAs and physicians about procedures decreased (from 81 to 49 and from 107 to 54, respectively), as did the mean duration in minutes (from 9.9 to 8.6 and from 8.8 to 7.4, respectively). Utilisation of FPA was dependent on the setting, as scepticism of physicians and medical boards hampered full implementation. Legal cross-compliance requirements were mostly fulfilled.

Conclusions

Informal practice was legalised. The opportunities to independently perform catheterisations, injections, prescribing, punctures and small surgical procedures were highly used. Care processes were organised more efficiently, services were performed by the most appropriate healthcare provider and conditions were met. This led to the recommendation to continue with FPA.



https://ift.tt/2JXCnYR