Αρχειοθήκη ιστολογίου

Αναζήτηση αυτού του ιστολογίου

Τρίτη 2 Οκτωβρίου 2018

Mutant superoxide dismutase aggregates from human spinal cord transmit amyotrophic lateral sclerosis

Abstract

Motor neurons containing aggregates of superoxide dismutase 1 (SOD1) are hallmarks of amyotrophic lateral sclerosis (ALS) caused by mutations in the gene encoding SOD1. We have previously reported that two strains of mutant human (h) SOD1 aggregates (denoted A and B) can arise in hSOD1-transgenic models for ALS and that inoculation of such aggregates into the lumbar spinal cord of mice results in rostrally spreading, templated hSOD1 aggregation and premature fatal ALS-like disease. Here, we explored whether mutant hSOD1 aggregates with prion-like properties also exist in human ALS. Aggregate seeds were prepared from spinal cords from an ALS patient carrying the hSOD1G127Gfs*7 truncation mutation and from mice transgenic for the same mutation. To separate from mono-, di- or any oligomeric hSOD1 species, the seed preparation protocol included ultracentrifugation through a density cushion. The core structure of hSOD1G127Gfs*7 aggregates present in mice was strain A-like. Inoculation of the patient- or mouse-derived seeds into lumbar spinal cord of adult hSOD1-expressing mice induced strain A aggregation propagating along the neuraxis and premature fatal ALS-like disease (p < 0.0001). Inoculation of human or murine control seeds had no effect. The potencies of the ALS patient-derived seed preparations were high and disease was initiated in the transgenic mice by levels of hSOD1G127Gfs*7 aggregates much lower than those found in the motor system of patients carrying the mutation. The results suggest that prion-like growth and spread of hSOD1 aggregation could be the primary pathogenic mechanism, not only in hSOD1 transgenic rodent models, but also in human ALS.



https://ift.tt/2zO0jHr

Porphyromonas gingivalis triggers NLRP3‐mediated inflammasome activation in macrophages in a bacterial gingipains‐independent manner

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


https://ift.tt/2NlCDxs

The role of the cerebellum in drug‐cue associative memory: functional interactions with the medial prefrontal cortex

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


https://ift.tt/2NfGNqM

Getting the most out of intensive longitudinal data: a methodological review of workload-injury studies

Objectives

To systematically identify and qualitatively review the statistical approaches used in prospective cohort studies of team sports that reported intensive longitudinal data (ILD) (>20 observations per athlete) and examined the relationship between athletic workloads and injuries. Since longitudinal research can be improved by aligning the (1) theoretical model, (2) temporal design and (3) statistical approach, we reviewed the statistical approaches used in these studies to evaluate how closely they aligned these three components.

Design

Methodological review.

Methods

After finding 6 systematic reviews and 1 consensus statement in our systematic search, we extracted 34 original prospective cohort studies of team sports that reported ILD (>20 observations per athlete) and examined the relationship between athletic workloads and injuries. Using Professor Linda Collins' three-part framework of aligning the theoretical model, temporal design and statistical approach, we qualitatively assessed how well the statistical approaches aligned with the intensive longitudinal nature of the data, and with the underlying theoretical model. Finally, we discussed the implications of each statistical approach and provide recommendations for future research.

Results

Statistical methods such as correlations, t-tests and simple linear/logistic regression were commonly used. However, these methods did not adequately address the (1) themes of theoretical models underlying workloads and injury, nor the (2) temporal design challenges (ILD). Although time-to-event analyses (eg, Cox proportional hazards and frailty models) and multilevel modelling are better-suited for ILD, these were used in fewer than a 10% of the studies (n=3).

Conclusions

Rapidly accelerating availability of ILD is the norm in many fields of healthcare delivery and thus health research. These data present an opportunity to better address research questions, especially when appropriate statistical analyses are chosen.



https://ift.tt/2zNF5Jw

Protocol for the Lactoferrin Infant Feeding Trial (LIFT): a randomised trial of adding lactoferrin to the feeds of very-low birthweight babies prior to hospital discharge

Introduction

Very-low birthweight (VLBW, <1500 g) infants comprise about 1%–1.4% of all births in high-income countries. Every year, about 3000 VLBW babies in Australia and New Zealand receive intensive care. Many die or else survive with severe brain injury, retinopathy, late-onset sepsis or necrotising enterocolitis (NEC), each of which carries substantial risk of disability.

Methods and analysis

This trial tests whether adding bovine lactoferrin (bLF) to feeds in VLBW infants improves (1) survival to hospital discharge free from brain injury, late-onset sepsis, NEC and treated retinopathy of prematurity (primary composite end point); (2) each component of the primary composite end point and (3) time to reach full enteral feeds, number of blood transfusions, chronic lung disease and length of hospital stay. It includes a cost-effectiveness analysis of bLF in improving survival free from major morbidity, and evaluates the effect of bLF on survival and developmental outcomes at 24 to 36 months corrected gestational age.

This is a multicentre, two-arm, randomised trial comparing the treatment group receiving bLF added to breast milk or formula milk daily (up to 250 mg/kg/day bLF) versus the control group receiving no bLF supplementation. The intervention is administered until 34 completed weeks corrected gestation or for 2 weeks, whichever is longer, or until discharge home, if earlier. The target sample size of 1500 participants yields 85% power, at the two-sided 5% level significance, to detect a difference in proportions meeting the primary outcome assuming the true probability is 74% in controls and 80.5% in the bLF group.

Ethics and dissemination

This protocol was approved by Northern Sydney Local Human Research Ethics Committee in January 2017 (Version 2.0, Reference 1003-118M) and other relevant ethics committees. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations.

Trial registration number

ACTRN12611000247976; Pre-results.



https://ift.tt/2P7es7V

Limited implementation of the framework convention on tobacco controls tobacco tax provision: global comparison

Objective

To quantify changes in tobacco tax rates and cigarette affordability after countries ratified the WHO Framework Convention on Tobacco Control (FCTC) using with the WHO MPOWER standards.

Methods

We used logistic regression to assess the association of FCTC ratification with adoption of at least 50% and 75% (high) of retail price tobacco tax rates for the most sold brands in countries, accounting for years since ratification and other covariates. We also compared cigarette affordability in 2014 with 1999.

Results

By 2014, 44% of high-income countries had taxes above 75% of retail value compared with 18% in 1998/1999. In 15 years, 69 countries increased the tobacco tax rate, 33 decreased it and one had the same tax rate. FCTC ratification was not associated with implementing high tobacco taxes. More fragile countries in terms of security, political, economic and social development were less likely to have at least 50% and 75% tobacco tax rates in 2014 compared with 1999. The higher the cigarette prices in 1999 the less likely the countries were to have at least 75% tobacco tax rates in 2014. However, cigarettes were less affordable in 2014 than in 1999 in countries that had ratified FCTC earlier.

Conclusions

Despite widespread FCTC ratification, implementing higher tobacco taxes remains incomplete. Guidelines for FCTC Article 6 implementation should assign definite targets for tobacco taxes and for implementation of a tax escalator that gradually increases taxes to match rising income levels. Fragile countries are less likely to have high tobacco taxes and less affordable cigarettes. The tobacco control community should intensify efforts to help fragile countries improve performance in FCTC implementation both through strengthening their administrative and technical capacity and through supporting basic functions of government.



https://ift.tt/2zNVEoV

Effect of psychosocial work factors on the risk of certified absences from work for a diagnosed mental health problem: a protocol of a systematic review and meta-analysis of prospective studies

Introduction

Mental health problems (MHPs) are frequent and disabling and are the first or second leading cause of certified sickness absences from work in industrialised countries. They are generally long lasting and generate a considerable human and socioeconomic burden. The deleterious effect of adverse psychosocial work factors on MHP has been documented. However, the evidence regarding the effect of these factors on absences from work for an MHP has not been synthesised since 2007. The proposed systematic review aims to synthesise the effect of adverse psychosocial work factors from three validated theoretical models (the demand–control–support, effort–reward–imbalance and organisational justice models) on the risk of certified absences from work for diagnosed MHP among workers.

Method and analysis

A systematic search strategy will be conducted in seven databases: Medline, Embase, CINAHL, Web of Science, PsycInfo, Sociological abstracts and IBSS. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, a multistep screening process by independent reviewers will lead to study selection. The search strategy was first run in 16 January 2017 and will be updated in October 2018. Only quantitative, prospective studies evaluating the effect of at least one psychosocial work factor from the validated theoretical models on certified absence from work for a diagnosed MHP will be considered for inclusion. Extracted data will be used for quantitative and qualitative evidence synthesis as well as to assess risk of bias and methodological quality. Meta-estimates will be provided for high-quality studies and by each psychosocial work factor, after considering homogeneity and number of studies.

Ethics and dissemination

As this study will be based only on published studies, ethics approval is not required. Given that psychosocial works factors are frequent and modifiable, the results of this systematic review may provide evidence to support prevention strategies that can help to reduce the human social and economic burden associated with medically certified absences from work for an MHP.

PROSPERO registration number

CRD42018091632.



https://ift.tt/2P7emNB

Dynamics and Determinants of HPV Infection: The Michigan HPV and Oropharyngeal Cancer (M-HOC) Study

Introduction

Human papillomavirus (HPV) is the primary cause of cervical and other anogenital cancers and is also associated with head and neck cancers. Incidence of HPV-related oropharyngeal squamous cell cancers (OPSCCs) is increasing, and HPV-related OPSCCs have surpassed cervical cancer as the most common HPV-related cancer in the USA. Given the multisite nature of HPV, there is strong interest in collecting data from both genital and oral sites, as well as associated data on social and sexual behaviours. The overarching goal of this study is to evaluate patterns of oral HPV infection incidence, clearance and persistence and their relationship to sexual behaviour history.

Methods and analysis

Participants are recruited from two populations: college students at a large public university and general population from the surrounding area. At the first study visit, participants complete a detailed sexual history, health and behaviour questionnaire. Follow-up visits occur every 3–4 months over 3 years, when participants complete an abbreviated questionnaire. All participants provide a saliva sample at each visit, and eligible participants may provide a cervicovaginal self-swab. Genetic material isolated from specimens is tested for 15 high-risk and 3 low-risk HPV types. Statistical analyses will examine outcome variables including HPV prevalence, incidence, persistence and clearance. Logistic regression models will be used to estimate odds ratios and 95% confidence intervals for associations between the outcomes of interest and demographic/behavioural variables collected in the questionnaires. The longitudinal HPV infection data and detailed sexual history data collected in the questionnaires will allow us to develop individual-based network models of HPV transmission and will be used to parameterise multiscale models of HPV-related OPSC carcinogenesis.

Ethics and dissemination

This study has been approved by the University of Michigan Institutional Review Board. All participants are consented in person by trained study staff. Study results will be disseminated through peer-reviewed publications.



https://ift.tt/2zN8Aey

Cognitive control and daily affect regulation in major depression and borderline personality disorder: protocol for an experimental ambulatory assessment study in Berlin, Germany

Introduction

Affective disturbances and difficulty in affect regulation are core features of major depressive disorder (MDD) as well as borderline personality disorder (BPD). Whereas depressed individuals are characterised by affective inertia, individuals with BPD are characterised by affective instability. Both groups have been found to use more maladaptive affect regulation strategies than healthy controls. Surprisingly, however, there have been hardly any studies directly comparing these two disorders to disentangle shared and disorder-specific deficits in affective dynamics and affect regulation.

Furthermore, theoretical models link deficits in affect regulation to deficits in cognitive control functions. Given that individuals with MDD or BPD are both characterised by impairments in cognitive control, the present study will further examine the link between individual differences in cognitive control and disturbances in affect dynamics and regulation in the daily life of individuals with MDD or BPD.

Methods and analyses

We will use a smartphone application to assess negative and positive affect as well as affect regulation strategies at eight times a day for 7 days. We will further employ four computerised tasks to assess two cognitive control functions, namely interference control and discarding irrelevant information from working memory. Our hypotheses will be tested using a multimethod approach. Power analyses determined a sample size of 159 (53 MDD, 53 BPD, 53 controls) to detect medium effect sizes.

Ethics and dissemination

Ethics approval has been obtained from the Freie Universität Berlin. Data collection started in January 2017 and will last until the end of 2018. Results will be disseminated to relevant psychotherapeutic and patient communities in peer-reviewed journals, and at scientific conferences.



https://ift.tt/2P6mVba

Acupuncture treatment for knee osteoarthritis with sensitive points: protocol for a multicentre randomised controlled trial

Introduction

There is a lack of curative medical treatment for patients with knee osteoarthritis (KOA). Acupuncture represents an important alternative therapy. According to the theory of traditional Chinese medicine and preliminary clinical evidence, the patients' acupoints and tender points may become sensitised when the body suffers from a disease state; stimulation of such sensitive points could lead to a disease improvement. It is thus hypothesised that acupuncture at highly sensitised points on patients with KOA would achieve better treatment outcomes than acupuncture at low/non-sensitised points. Previously, we conducted a pilot trial to prove the feasibility of further investigation.

Methods and analysis

A three-arm, parallel, multicentre randomised controlled trial of 666 patients will be conducted at four hospitals of China. Eligible patients with KOA who consent to participate will be randomly assigned to a high-sensitisation group (patients receive acupuncture treatment at high-sensitive points), a low/non-sensitisation group (patients receive acupuncture treatment at low/non-sensitive points) or a waiting-list group (patients receive standard acupuncture treatment after the study is concluded) via a central randomisation system using 1:1:1 ratio. The primary outcome is the change of Western Ontario and McMaster Universities Osteoarthritis Index total score from baseline to 16 weeks. Outcome assessors and data analysts will be blinded and participants will be asked not to reveal their allocation to assessors. The outcome analyses will be performed both on the intention-to-treat and per-protocol population. The primary analyses will test if acupuncture at highly sensitised points would achieve statistically better treatment outcomes than acupuncture at low/non-sensitised points and no acupuncture (ie, waiting list), respectively. A small number of prespecified subgroup analyses will be conducted.

Ethics and dissemination

Ethics approval has been granted by the Bioethics Subcommittee of West China Hospital, Sichuan University: 2017 (Number 228). Results will be expected to be published in peer-reviewed journals.

Trial registration number

NCT03299439.



https://ift.tt/2P7eeO7

Association of Menieres disease and retinal vascular calibre: a prospective observational study in China

Objective

It is believed that Meniere's disease (MD) is associated with vascular disorders, but few studies have reported the relationship between retinal vascular disorders and MD. We evaluated and compared the retinal vascular calibres in patients with MD with healthy subjects matched for age, sex and vascular risk factors using retinal photographs to explore the association between MD and retinal vascular calibre.

Study design

A prospective study.

Setting

Tertiary referral centre.

Participants

Sixty patients with MD and 62 healthy subjects matched for age, sex and vascular risk factors were enrolled in this study. Twenty-four patients with MD had migraines, and 36 patients with MD did not have migraines.

Main outcome measure

Retinal vascular calibres were calculated and compared not only between patients with MD and healthy subjects but also between subgroups of patients with MD.

Results

Compared with healthy subjects, patients with MD had a slightly larger retinal artery calibre (126.30±10.45vs 119.61±15.86, p=0.006) and a higher retinal artery/vein ratio (0.79±0.09vs 0.75±0.10, p=0.005). Among patients with MD, those with migraines had a larger retinal artery calibre (130.73±11.55vs 123.35±8.61, p=0.006) than those without migraines. Moreover, the presence of migraines and the high frequency of vertigo attacks appeared to increase the retinal artery calibre.

Conclusions

Our study suggests that a relationship exists between retinal vascular calibre and MD. Although the pathophysiological relationship between migraine and MD remains unclear, the presence of migraine attacks may aggravate endolymphatic hydrops (EH) and accelerate the outflow of EH in patients with MD. More extensive studies are required to explore the association between retinal vascular calibre and MD.



https://ift.tt/2zOfgJE

Randomised controlled trial of the Limit of Detection of Troponin and ECG Discharge (LoDED) strategy versus usual care in adult patients with chest pain attending the emergency department: study protocol

Introduction

Observational data suggest a single high-sensitivity troponin blood test taken at emergency department (ED) presentation could be used to rule out major adverse cardiac events (MACE) in 10%–60% of ED patients with chest pain. This is done using an 'undetectable' cut-off (the Limit of Detection: LoD). We combined the LoD cut-off with ECG findings to create the LoDED strategy. We aim to establish whether the LoDED strategy works under real-life conditions, when compared with existing strategies, in a way that is cost-effective and acceptable to patients.

Methods and analysis

This is a parallel-group pragmatic randomised controlled trial across UK EDs. Adults presenting to ED with suspected cardiac chest pain will be randomised 1:1. Existing rule-out strategies in current use across study centres, using serial high-sensitivity troponin testing, will be compared with the LoDED strategy. The primary outcome is successful early discharge (discharge from hospital within 4 hours of arrival) without MACE occurring within 30 days. Secondary outcomes include initial length of hospital stay; comparative costs; patient satisfaction and acceptability to patients. To detect a 9% difference between the early discharge rates (assuming an 8% rate in the standard care group) with 90% power, 594 patients need to be recruited, assuming a 95% follow-up rate.

Ethics and dissemination

The study has been approved by the Frenchay Research Ethics Committee (reference 18/SW/0038). Results will be published in an international peer-reviewed journal. Lay summaries will be made available to patients.

Trial registration number

ISRCTN86184521; Pre-results.



https://ift.tt/2P7eaOn

Correction: Effect of iron and zinc-biofortified pearl millet consumption on growth and immune competence in children aged 12-18 months in India: study protocol for a randomised controlled trial

Mehta S, Finkelstein JL, Venkatramanan S, et al. Effect of iron and zinc-biofortified pearl millet consumption on growth and immune competence in children aged 12–18 months in India: study protocol for a randomised controlled trial. BMJ Open 2017;7:e017631. doi: 10.1136/bmjopen-2017-017631.

The previous version of this manuscript contains an error in using both ICTP-8203 and ICTP-8203Fe as only ICTP-8203Fe. Both designations should read as Dhanashakti.



https://ift.tt/2zOiOLM

Can the completeness of radiological cancer staging reports be improved using proforma reporting? A prospective multicentre non-blinded interventional study across 21 centres in the UK

Objectives

Following a diagnosis of cancer, the detailed assessment of prognostic stage by radiology is a crucial determinant of initial therapeutic strategy offered to patients. Pretherapeutic stage by imaging is known to be inconsistently documented. We tested whether the completeness of cancer staging radiology reports could be improved through a nationally introduced pilot of proforma-based reporting for a selection of six common cancers.

Design

Prospective interventional study comparing the completeness of radiology cancer staging reports before and after the introduction of proforma reporting.

Setting

Twenty-one UK National Health Service hospitals.

Participants

1283 cancer staging radiology reports were submitted.

Main outcome measures

Radiology staging reports across the six cancers types were evaluated before and after the implementation of proforma-based reporting. Report completeness was assessed using scoring forms listing the presence or absence of predetermined key staging data. Qualitative data regarding proforma implementation and usefulness were collected from questionnaires provided to radiologists and end-users.

Results

Electronic proforma-based reporting was successfully implemented in 15 of the 21 centres during the evaluation period. A total of 787 preproforma and 496 postproforma staging reports were evaluated. In the preproforma group, only 48.7% (5586/11 470) of key staging items were present compared with 87.3% (6043/6920) in the postproforma group. Thus, the introduction of proforma reporting produced a 78% improvement in staging completeness . This increase was seen across all cancer types and centres. The majority of participants found proforma reporting improved cancer reporting quality for their clinical practice .

Conclusion

The implementation of proforma reporting results in a significant improvement in the completeness of cancer staging reports. Proforma-based assessment of cancer stage enables objective comparisons of patient outcomes across centres. It should therefore become an auditable quality standard for cancer care.



https://ift.tt/2P7e8pJ

Downregulated miR‐144‐3p contributes to progression of lung adenocarcinoma through elevating the expression of EZH2

Cancer Medicine, EarlyView.


https://ift.tt/2zNGKz7

Determinants of mobile technology use and smartphone application interest in cancer patients

Cancer Medicine, EarlyView.


https://ift.tt/2P7e21l

New MiniPromoter Ple345 (NEFL) Drives Strong and Specific Expression in Retinal Ganglion Cells of Mouse and Primate Retina

Human Gene Therapy, Ahead of Print.


https://ift.tt/2zO6BHa

Purification of mRNA Encoding Chimeric Antigen Receptor Is Critical for Generation of a Robust T-Cell Response

Human Gene Therapy, Ahead of Print.


https://ift.tt/2P5ws2n

Bone Marrow–Derived Mesenchymal Stem Cell–Mediated Dual-Gene Therapy for Glioblastoma

Human Gene Therapy, Ahead of Print.


https://ift.tt/2zMC8cb

ABCA1 Overexpression in Endothelial Cells In Vitro Enhances ApoAI-Mediated Cholesterol Efflux and Decreases Inflammation

Human Gene Therapy, Ahead of Print.


https://ift.tt/2P68LHe

Melanoma cell-secreted exosomal miR-155-5p induce proangiogenic switch of cancer-associated fibroblasts via SOCS1/JAK2/STAT3 signaling pathway

Abstract

Background

Cancer-associated fibroblasts (CAFs) have been widely reported to promote tumor angiogenesis. However, the underlying mechanisms of the proangiogenic switch of CAFs remain poorly understood. This study aims to clarify the mechanisms underlying the proangiogenic switch of CAFs.

Methods

NIH/3T3 cells were treated with B16 and B16F10-derived exosomes. Then the CAFs markers and proangiogenic factors were detected by RT-PCR and Western blot. CCK-8 assay, transwell migration assay, tube formation assay, and in vivo Matrigel plug assay were conducted to determine the proangiogenic capability of CAFs. Western blot and AG490 were used to investigate the role of Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway in the proangiogenic switch of CAFs. Bioinformatics analysis, luciferase reporter assay, microRNA mimic and inhibitor, and xenograft models were used to investigate the role of mmu-miR-155-5p (miR-155) in the proangiogenic switch of CAFs.

Results

In this study, we show that melanoma cell-secreted exosomes can induce reprogramming of fibroblasts into CAFs and that exosomal miR-155 can trigger the proangiogenic switch of CAFs. Mechanistically exosomal miR-155 can be delivered into fibroblasts and promote the expression of proangiogenic factors, including vascular endothelial growth factor A (VEGFa), fibroblast growth factor 2 (FGF2), and matrix metalloproteinase 9 (MMP9), by directly targeting suppressor of cytokine signaling 1 (SOCS1). Downregulation of SOCS1 activates JAK2/STAT3 signaling pathway and elevates the expression levels of VEGFa, FGF2, and MMP9 in fibroblasts. Treatment with exosomes containing overexpressed miR-155 can promote angiogenesis, and the reduction of miR-155 in melanoma cell-secreted exosomes alleviates angiogenesis in vitro and in vivo.

Conclusions

These results demonstrate that by promoting the expression of proangiogenic factors in recipient fibroblasts via SOCS1/JAK2/STAT3 signaling pathway, melanoma cell-secreted exosomal miR-155 can induce the proangiogenic switch of CAFs. Although tumor angiogenesis is modulated by various factors, exosomal miR-155 may be a potential target for controlling melanoma angiogenesis and used to set up novel strategies to treat melanoma.



https://ift.tt/2QobonS

The antinutritional and vitamin composition of high‐quality yam flour as affected by yam specie, pretreatment, and drying method

Food Science &Nutrition, EarlyView.


https://ift.tt/2O3uD9N

Utilization of Chemical Deposition Technique for Preparation of Miniature 170Tm Sources and Preliminary Quality Assessment for Potential Use in Brachytherapy

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


https://ift.tt/2IAiUJM

Gallic acid activates hippocampal BDNF-Akt-mTOR signaling in chronic mild stress

Abstract

Gallic acid (3,4,5-trihydroxybenzoic acid) is a naturally occurring polyphenolic compound. Previous study has shown that gallic acid possessed significant antidepressant-like activity in mice, which was partly mediated by increasing serotonin and catecholamine levels. The main aim of the present study is to investigate the possible effects of gallic acid on brain-derived neurotrophic factor (BDNF) signaling activation. Mice were exposed to chronic mild stress (CMS) and orally administrated with gallic acid for four weeks. The behavioral results showed that gallic acid not only reversed the decreased sucrose preference, but also attenuated the increased immobility time. In addition, gallic acid promoted both the BDNF and p-TrkB levels in the hippocampus induced by CMS. Moreover, the results also demonstrated that the inactivated Akt-mTOR signaling pathway, as well as its downstream effectors induced by CMS was activated again by gallic acid. Last, immunofluorescence detection indicated that gallic acid reversed the newborn neurons inhibition in the dentate gyrus by CMS. In conclusion, these results show that the activation of the hippocampal BDNF-Akt-mTOR signaling is involved in the antidepressant-like effects of gallic acid.



https://ift.tt/2O1aZeA

3D Deep Learning from CT Scans Predicts Tumor Invasiveness of Subcentimeter Pulmonary Adenocarcinomas

Identification of early-stage pulmonary adenocarcinomas prior to surgery, especially in cases of sub-centimeter cancers, would be clinically important and could provide guidance to clinical decision making. In this study, we developed a deep learning system based on 3D convolutional neural networks and multi-task learning, which automatically predicts tumor invasiveness, together with 3D nodule segmentation masks. The system processes a 3D nodule-centered patch of pre-processed CT and learns a deep representation of a given nodule without the need for any additional information. A dataset of 651 nodules with manually segmented voxel-wise masks and pathological labels of atypical adenomatous hyperplasia (AAH), adenocarcinomas in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive pulmonary adenocarcinoma (IA) was used in this study. We trained and validated our deep learning system on 523 nodules and tested its performance on 128 nodules. An observer study with 2 groups of radiologists, 2 senior and 2 junior, was also investigated. We merged AAH and AIS into one single category AAH-AIS, comprising a 3-category classification in our study. The proposed deep learning system achieved better classification performance than the radiologists; in terms of 3-class weighted average F1 score, the model achieved 63.3% while the radiologists achieved 55.6%, 56.6%, 54.3%, and 51.0%, respectively. These results suggest that deep learning methods improve the yield of discriminative results and hold promise in the CADx application domain, which could help doctors work efficiently and facilitate the application of precision medicine.

https://ift.tt/2IxtUaE

A novel small molecule inhibitor of MRCK prevents radiation-driven invasion in glioblastoma

Glioblastoma (GBM) is an aggressive and incurable primary brain tumor that causes severe neurological, cognitive, and psychological symptoms. Symptoms are caused and exacerbated by the infiltrative properties of GBM cells, which enable them to pervade the healthy brain and disrupt normal function. Recent research has indicated that, while radiotherapy (RT) remains the most effective component of multimodality therapy for GBM patients, it can provoke a more infiltrative phenotype in GBM cells that survive treatment. Here we demonstrate an essential role of the actin-myosin regulatory kinase myotonic dystrophy kinase-related CDC42- binding kinase (MRCK) in mediating the pro-invasive effects of radiation. MRCK-mediated invasion occurred via downstream signaling to effector molecules MYPT1 and MLC2. MRCK was activated by clinically relevant doses per fraction of radiation, and this activation was concomitant with an increase in GBM cell motility and invasion. Furthermore, ablation of MRCK activity either by RNAi or by inhibition with the novel small molecule inhibitor BDP-9066 prevented radiation-driven increases in motility both in vitro and in a clinically relevant orthotopic xenograft model of GBM. Crucially, treatment with BDP-9066 in combination with RT significantly increased survival in this model and markedly reduced infiltration of the contralateral cerebral hemisphere.

https://ift.tt/2xQQjvy

HERC2 facilitates BLM and WRN helicase complex interaction with RPA to suppress G-quadruplex DNA

BLM and WRN are RecQ DNA helicases essential for genomic stability. Here we demonstrate that HERC2, a HECT E3 ligase, is critical for their functions to suppress G-quadruplex (G4) DNA. HERC2 interacted with BLM, WRN, and replication protein A (RPA) complexes during the S-phase of the cell cycle. Depletion of HERC2 dissociated RPA from BLM and WRN complexes and significantly increased G4 formation. Triple depletion revealed that HERC2 has an epistatic relationship with BLM and WRN in their G4-suppressing function. In vitro, HERC2 released RPA onto single-stranded DNA (ssDNA) rather than anchoring onto RPA-coated ssDNA. CRISPR/Cas9-mediated deletion of the catalytic ubiquitin-binding site of HERC2 inhibited ubiquitination of RPA2, caused RPA accumulation in the helicase complexes, and increased G4, indicating an essential role for E3 activity in the suppression of G4. Both depletion of HERC2 and inactivation of E3 sensitized cells to the G4-interacting compounds telomestatin and pyridostatin. Overall, these results indicate that HERC2 is a master regulator of G4 suppression that affects the sensitivity of cells to G4 stabilizers. Given that HERC2 expression is frequently reduced in many types of cancers, G4 accumulation as a result of HERC2 deficiency may provide a therapeutic target for G4 stabilizers.

https://ift.tt/2Izaq5x

Dental implants‐associated release of titanium particles: A systematic review

Clinical Oral Implants Research, EarlyView.


https://ift.tt/2Niq5a7

Arming an oncolytic herpes simplex virus Type 1 with a single chain fragment variable antibody against PD-1 for experimental glioblastoma therapy.

Purpose: Glioblastoma (GBM) is resistant to standard of care. Immune checkpoints inhibitors (such as anti-PD-1 monoclonal antibodies) efficiently restore anti-tumor T-cell activity. We engineered a new oncolytic herpes simplex virus (oHSV) expressing a single-chain antibody against PD-1 (scFvPD-1) to evaluate its efficacy in mouse models of GBM. Experimental plan: NG34scFvPD-1expresses the human GADD34 gene transcriptionally controlled by the Nestin promoter to allow replication in GBM cells and a scFvPD-1 cDNA transcriptionally controlled by the CMV promoter. ELISA assays were performed to detect binding of scFvPD-1 to mouse and human PD-1. In vitro cytotoxicity and replication assays were performed to measure NG34scFvPD-1 oncolysis, and scFvPD-1 expression and secretion were determined. In vivo survival studies using orthotopic mouse GBM models were performed to evaluate the therapeutic potency of NG34scFvPD-1. Results: NG34scFvPD-1 infected GBM cells express and secrete scFvPD-1 that binds mouse PD-1. The introduction of the scFvPD-1 sequence in the viral backbone does not alter the oncolytic properties of NG34scFvPD-1. In situ NG34scFvPD-1 treatment improved the survival with a tail of durable survivorship in two syngeneic immunocompetent mouse models of GBM. Mice that survived the first GBM challenge rejected the second challenge of GBM when implanted in the contralateral hemisphere. However, this was not true when athymic mice were employed as the recipients of the second challenge, consistent with the need for an intact immune system to obtain a memory response. Conclusion: NG34scFvPD-1 treatment induces a durable anti-tumor response in two preclinical mouse models of GBM with evidence for antitumor memory.



https://ift.tt/2xTdmpw

A Phase 1/2 Study of evofosfamide, A Hypoxia-Activated Prodrug with or without Bortezomib in Subjects with Relapsed/Refractory Multiple Myeloma

Purpose: The presence of hypoxia in the diseased bone marrow presents a new therapeutic target for multiple myeloma (MM). Evofosfamide (formerly TH-302) is a 2-nitroimidazole prodrug of the DNA alkylator bromo-isophosphoramide mustard that is selectively activated under hypoxia. A phase 1/2 study investigating evofosfamide in combination with dexamethasone (EvoD) and in combination with bortezomib and dexamethasone (EvoBorD) in relapsed/refractory MM. Experimental Design: 59 patients initiated therapy, 31 received EvoD and 28 received EvoBorD. Pts were heavily pre-treated with a median number of prior therapies of 7 (range: 2-15). All had previously received bortezomib and immunomodulators. The maximum tolerated dose (MTD), treatment toxicity, and efficacy were determined. Results: The MTD was established at 340 mg/m2 Evo+D with dose limiting mucositis at higher doses. For EVOBorD, no patient had a dose limiting toxicity and the recommended phase 2 dose was established at 340 mg/m2. The most common ≥ Gr 3 adverse events were thrombocytopenia (25 patients), anemia (24 patients), neutropenia (15 patients) and leukopenia (9 patients). Skin toxicity was reported in 42 (71%). Responses included 1 VGPR, 3 PR, 2 MR, 20 SD and 4 PD for EvoD and 1 CR, 2 PR, 1 MR, 18 SD and 5 PD for EvoBorD. Disease stabilization was observed in over 80% and this was reflective of the prolonged overall survival of 11.2 months. Conclusions: Evofosfamide can be administered at 340 mg/m2 twice a week with or without bortezomib. Clinical activity has been noted in patients with heavily pre-treated relapsed refractory MM.



https://ift.tt/2DPTER5

Loss of RBMS3 Confers Platinum-resistance in Epithelial Ovarian Cancer via Activation of miR-126-5p/{beta}-catenin/CBP signaling

Purpose: The development of resistance to platinum-based chemotherapy remains the unsurmountable obstacle in cancer treatment and consequently leads to tumor relapse. This study aims to investigate the mechanism by which loss of RBMS3 induced chemoresistance in epithelial ovarian cancer (EOC). Experimental design: Fluorescence in situ hybridization and immunochemistry were used to determine deletion frequency and expression of RBMS3 in 15 clinical EOC tissues and 150 clinicopathologically characterized EOC specimens. The effects of RBMS3 deletion and CBP/β-catenin antagonist PRI-724 in chemoresistance were examined by clone formation and Annexin V assays in vitro, and by intraperitoneal tumor model in vivo. The mechanism by which RBMS3 loss sustained activation of miR-126-5p/β-catenin/CBP signaling and the effects of RBMS3 and miR-126-5p competitively regulating DKK3, AXIN1, BACH1 and NFAT5 was explored using CLIP-seq, RIP, electrophoretic mobility shift and immunoblotting immunofluorescence assays. Results: Loss of RBMS3 in EOC was correlated with the overall and relapse-free survival. Genetic ablation of RBMS3 significantly enhanced, whereas restoration of RBMS3 reduced, the chemoresistance ability of EOC cells both in vitro and in vivo. RBMS3 inhibited β-catenin/CBP signaling through directly associating with and stabilizing multiple negative regulators, including DKK3, AXIN1, BACH1 and NFAT5, via competitively preventing the miR-126-5p-mediated repression of these transcripts. Importantly, co-therapy of CBP/β-catenin antagonist PRI-724 induced sensitization of RBMS3-deleted EOC to platinum therapy. Conclusions: Our results demonstrate that genetic ablation of RBMS3 contributes to chemoresistance and PRI-724 may serve as a potential tailored treatment for patients with RBMS3-deleted EOC.



https://ift.tt/2xTZRpx

Fusion kinases identified by genomic analyses of sporadic microsatellite instability-high colorectal cancers

Purpose: Colorectal cancers (CRCs) with microsatellite instability-high (MSI-H) status, due to mismatch repair deficiency, are associated with poor patient outcomes after relapse. We aimed to identify novel therapeutic targets for them. Experimental Design: We performed MSI analyses of over 2,800 surgically resected colorectal tumors obtained from consecutive patients treated in Japan from 1998 through June 2016. Whole-exome sequencing, transcriptome sequencing, and methylation analyses were performed on 149 of 162 tumors showing MSI in BAT25 and BAT26 loci. We analyzed patient survival times using Bonferroni-adjusted log-rank tests. Results: Sporadic MSI-H CRCs with promoter methylation of MLH1 (called MM) had a clinicopathological profile that was distinct from that of CRCs of patients with germline mutations (Lynch syndrome-associated) or somatic, Lynch-like mutations in mismatch repair genes. MM tumors had more insertions and deletions and more recurrent mutations in BRAF and RNF43 than Lynch syndrome-associated or Lynch-like MSI-H tumors. Eleven fusion kinases were exclusively detected in MM MSI-H CRCs lacking oncogenic KRAS/BRAF missense mutations and were associated with worse post-relapse prognosis. We developed a simple method to identify MM tumors and applied it to a validation cohort of 28 MSI-H CRCs, identifying 16 MM tumors and 2 fusion kinases. Conclusions: We discovered that fusion kinases are frequently observed among sporadic MM MSI-H CRCs. The new method to identify MM tumors enables us to straightforwardly group MSI-H patients into candidates of Lynch syndrome or fusion kinase carriers.



https://ift.tt/2DPfRyA

Gene Expression Profiling Reveals Aberrant T-cell Marker Expression on Tumor Cells of Waldenström's Macroglobulinemia

Purpose: That the malignant clone of Waldenström's macroglobulinemia (WM) demonstrates significant intraclonal heterogeneity with respect to plasmacytoid differentiation indicates the mechanistic complexity of tumorigenesis and progression. Identification of WM genes by comparing different stages of B cells may provide novel druggable targets. Experimental Design: The gene expression signatures of CD19+ B cells (BC) and CD138+ plasma cells (PC) from 19 patients with WM were compared to those of BC from peripheral blood and tonsil and to those of PC from the marrow of healthy (N-PC) and multiple myeloma donors (MM-PC), as well as tonsil (T-PC). The flow cytometry and immunofluorescence were used to examine T-cell marker expression on WM tumor cells. Results: Consistent with defective differentiation, both BC and PC from WM cases expressed abnormal differentiation markers. Sets of 55 and 46 genes were differentially expressed in WM-BC and WM-PC, respectively; and 40 genes uniquely dysregulated in WM samples were identified. Dysregulated genes included cytokines, growth factor receptors, and oncogenes not previously implicated in WM or other plasma cell dyscrasias. Interestingly, strong upregulation of both IL6 and IL6R was confirmed. Supervised cluster analysis of PC revealed that marrow-derived WM-PC was either MM-PC-like or T-PC-like, but not N-PC-like. The aberrant expression of T cell markers was confirmed at the protein level in WM-BC. Conclusions: We showed that comparative microarray profiles allowed to gain more comprehensive insights into the biology of WM. The data presented here have implications for the development of novel therapies, such as targeting aberrant T-cell markers in WM.



https://ift.tt/2xVV5I5

PIE-1 Translation in the Germline Lineage Contributes to PIE-1 Asymmetry in the Early Caenorhabditis elegans Embryo

In the C. elegans embryo, the germline lineage is established through successive asymmetric cell divisions that each generate a somatic and a germline daughter cell. PIE-1 is an essential maternal factor that is enriched in embryonic germline cells and is required for germline specification. We estimated the absolute concentration of PIE-1::GFP in germline cells and find that PIE-1::GFP concentration increases by roughly 4.5 fold, from 92 nM to 424 nM, between the 1 and 4-cell stages. Previous studies have shown that the preferential inheritance of PIE-1 by germline daughter cells and the degradation of PIE-1 in somatic cells are important for PIE-1 enrichment in germline cells. In this study, we provide evidence that the preferential translation of maternal PIE-1::GFP transcripts in the germline also contributes to PIE-1::GFP enrichment. Through an RNAi screen, we identified Y14 and MAG-1 (Drosophila tsunagi and mago nashi) as regulators of embryonic PIE-1::GFP levels. We show that Y14 and MAG-1 do not regulate PIE-1 degradation, segregation or synthesis in the early embryo, but do regulate the concentration of maternally-deposited PIE-1::GFP. Taken together, or findings point to an important role for translational control in the regulation of PIE-1 levels in the germline lineage.



https://ift.tt/2NXfNS2

Reprogramming of mitochondrial metabolism by innate immunity

Johan Garaude

https://ift.tt/2NWVfJr

Remodeling of the collagen matrix in aging skin promotes melanoma metastasis and affects immune cell motility [Research Articles]

Physical changes in skin are among the most visible signs of aging. We found that young dermal fibroblasts secrete high levels of extracellular matrix (ECM) constituents, including proteoglycans, glycoproteins and cartilage-linking proteins. The most abundantly secreted was HAPLN1, a hyaluronic and proteoglycan link protein. HAPLN1 was lost in aged fibroblasts, resulting in a more aligned ECM that promoted metastasis of melanoma cells. Reconstituting HAPLN1 inhibited metastasis in an aged microenvironment, in 3D skin reconstruction models, and in vivo. Intriguingly, aged fibroblast-derived matrices had the opposite effects on the migration of T-cells, inhibiting their motility. HAPLN1 treatment of aged fibroblasts restored motility of mononuclear immune cells, while impeding that of polymorphonuclear immune cells, which in turn affected Treg recruitment. These data suggest while age-related physical changes in the ECM can promote tumor cell motility, they may adversely impact the motility of some immune cells, resulting in an overall change in the immune microenvironment. Understanding the physical changes in aging skin may provide avenues for more effective therapy for older melanoma patients.



https://ift.tt/2y95Nu5

Age-Related Changes in HAPLN1 Increase Lymphatic Permeability and Affect Routes of Melanoma Metastasis [Research Articles]

Older melanoma patients have lower rates of sentinel lymph node (LN) metastases yet paradoxically have inferior survival. Patient age correlated with an inability to retain Technetium radiotracer during sentinel LN biopsy in over 1000 patients, and high technecium counts correlated to better survival. We hypothesized that loss of integrity in the lymphatic vasculature due to ECM degradation might play a role. We have implicated HAPLN1 in age-dependent ECM degradation in the dermis. Here we queried whether HAPLN1 could be altered in the lymphatic ECM. Lymphatic HAPLN1 expression was prognostic of long-term patient survival. Adding rHAPLN1 to aged fibroblast ECMs in vitro reduced endothelial permeability via modulation of VE-Cadherin junctions, whereas endothelial permeability was increased following HAPLN1-knockdown in young fibroblasts. In vivo, reconstitution of HAPLN1 in aged mice increased the number of LN metastases, but reduced visceral metastases. These data suggest that age-related changes in ECM can contribute to impaired lymphatics.



https://ift.tt/2Ov8TTG

Two Win Nobel for Immune Regulation Discoveries [News in Brief]

James Allison, PhD, and Tasuku Honjo, MD, PhD, will share the prestigious award for research on T-cell proteins CTLA4 and PD-1.



https://ift.tt/2yciEf0

Soft Drinks Account for One-Fifth of Youth Beverage Consumption

TUESDAY, Oct. 2, 2018 -- Despite dietary recommendations, soft drinks make up about one-fifth of total beverage consumption by U.S. youth, according to a September data brief published by the U.S. Centers for Disease Control and Prevention National...

https://ift.tt/2NWSQOV

For Employer-Based Plans, Spending Across Services Steady

TUESDAY, Oct. 2, 2018 -- Despite large health policy changes, the distribution of spending across service areas has remained fairly consistent over the past 10 years for those enrolled in employer-sponsored insurance, according to a study published...

https://ift.tt/2ya9KyT

Southern Dietary Pattern Mediates Racial Difference in HTN

TUESDAY, Oct. 2, 2018 -- For black men and women, the Southern dietary pattern is the largest mediating factor for differences in the incidence of hypertension, according to a study published in the Oct. 2 issue of the Journal of the American...

https://ift.tt/2y8sfnf

Voluntary Recall of Robaxin 750 mg Due to Dosage Misprint

TUESDAY, Oct. 2, 2018 -- Endo Pharmaceuticals is voluntarily recalling two lots of Robaxin (methocarbamol tablets) 750 mg tablets (100-count bottles) due to incorrect dosage information. According to the recall notice, the products have incorrect...

https://ift.tt/2NWSlV3

An ABCG2 non-substrate anticancer agent FL118 targets drug-resistant cancer stem-like cells and overcomes treatment resistance of human pancreatic cancer

Abstract

Background

Pancreatic cancer is a deadly disease with a very low 5-year patient survival rate of 6–8%. The major challenges of eliminating pancreatic cancer are treatment resistance and stromal barriers to optimal drug access within the tumor. Therefore, effective molecular targeting drugs with high intra-tumor access and retention are urgently needed for managing this devastating disease in the clinic.

Methods

This study has used the following in vitro and in vivo techniques for the investigation of exceptional anticancer drug FL118's efficacy in treatment of resistant pancreatic cancer: cell culture; immunoblotting analysis to test protein expression; DNA sub-G1 flow cytometry analyses to test cell death; MTT assay to test cell viability; pancreatic cancer stem cell assays (fluorescence microscopy tracing; matrigel assay; CD44-positive cell colony formation assay); human luciferase-labeled pancreatic tumor orthotopic animal model in vivo imaging; pancreatic cancer patient-derived xenograft (PDX) animal models; and toxicology studies with immune-competent BALB/cj mice and beagle dogs.

Results

Our studies found that FL118 alone preferentially killed cisplatin-resistant cancer cells, while a combination of FL118 with cisplatin synergistically killed resistant pancreatic cancer cells and reduced spheroid formation of treatment-resistant pancreatic cancer stem-like cells. Furthermore, using in vivo-imaging, we found that FL118 in combination with cisplatin strongly inhibited both drug-resistant pancreatic xenograft tumor growth and metastasis. In PDX model, we demonstrated that FL118 alone effectively eliminated PDX tumors, while FL118 in combination with gemcitabine eliminated PDX tumors that showed relative resistance (less sensitivity) to treatment with FL118. These FL118 efficacy results are consistent with our molecular-targeting data showing that FL118 inhibited the expression of multiple antiapoptotic proteins (survivin, Mcl-1, XIAP, cIAP2) and ERCC6, a critical regulator of DNA repair, in treatment-resistant pancreatic stem-like cancer cells. Furthermore, FL118 toxicity studies in BALB/cj mice and beagle dogs indicated that FL118 exhibits favorable hematopoietic and biochemical toxicities.

Conclusion

Together, our studies suggest that FL118 is a promising anticancer drug for further clinical development to effectively treat drug-resistant pancreatic cancer alone or in combination with other pancreatic cancer chemotherapeutic drugs.



https://ift.tt/2xU6DvA

Evaluation of protective effect of aqueous extract of Phyllanthus emblica fruit on duodenum mucosa in experimentally induced diarrhea in albino Wistar rats

Abstract

Phyllanthus emblica fruit is an excellent source of antioxidants which is widely used for different gastric ailments in Ayurveda and traditional herbal medicine. Thus, the aim of this study was to investigate the antioxidative and protective role of aqueous extract of Phyllanthus emblica fruit (AEPEF) on intestinal mucosa against castor oil-induced diarrhea. Rats were randomly divided into five groups (N = 6). After acclimatization of 7 days, group I (control) and group II (loperamide) were given distilled water @ 20 ml/kg body weight (BW) orally whereas rats of group III, group IV, and group V received AEPEF @ 200 mg, 400 mg, and 600 mg/kg BW respectively, daily for 14 days. On the 15th day, diarrhea was induced with 1 ml castor oil to each rat orally. Onset time of diarrhea and percentage inhibition of defecation revealed significantly (p < 0.05) higher onset time and higher percentage inhibition of defecation respectively in group II, group V, and group IV as compared to group I. In groups IV and V, lipid peroxidation was significantly low whereas superoxide dismutase, catalase, and glutathione peroxidase found to be significantly increased as compared to groups I and II. Duodenal histopathology of group IV and group V revealed no change in mucosal integrity whereas degenerative changes like stunting, infiltration of polymorphs, and villous atrophy were observed in group I and group II. The study concludes that prior treatment with AEPEF delays the induction of diarrhea and protects intestinal mucosa from the deleterious effect of castor oil-induced oxidative damage.



https://ift.tt/2DP8J5i

A Systematic Review of Training in Symptom Management in Palliative Care within Postgraduate Medical Curriculums

Symptom management is a priority area within palliative care core competencies for generalist providers. While several educational initiatives exist, a comprehensive evidence synthesis on the effectiveness of symptom management training on trainees' learning and patient-reported outcomes is lacking.

https://ift.tt/2xVFsR5

Iodine Nutrition and Thyroid Function in Pregnant Women Exposed to Different Iodine Sources

Abstract

Pregnant women are more vulnerable to iodine deficiency and iodine excess. The study aimed to assess the changes in iodine nutrition and thyroid function of pregnant women exposed to different iodine sources resulting in various iodine intakes during pregnancy. From 2016 to 2017, 2004 healthy pregnant women aged 20–35 years from Shandong and Tianjin, China, were enrolled. Urinary iodine concentration (UIC), drinking water iodine content (WIC), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroid hormone (FT4), thyroglobulin (Tg), serum thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured. Pregnant women in both Shandong and Tianjin were iodine sufficient, but the median UIC in pregnant women was significantly higher in Shandong (244 μg/L) than that in Tianjin (159 μg/L). No differences were found in UIC over the course of gestation in Shandong. In Tianjin, the UIC decreased during 13–24 weeks and stabilized thereafter. Compared with Tianjin, TSH levels were higher and FT3 and FT4 levels were lower in Shandong. Both FT3 and FT4 significantly decreased during pregnancy in Shandong and Tianjin. TSH and Tg increased over the course of gestation in both Shandong and Tianjin. The iodine status of pregnant women in Tianjin and Shandong were sufficient, but different changing patterns in UIC and thyroid function during pregnancy were presented. More attention should be focused on iodine nutrition of pregnant women, even in iodine-sufficient areas.



https://ift.tt/2y9QJfV

Iliopsoas snapping hip: improving the diagnostic value of magnetic resonance imaging with a novel parameter

Abstract

Objective

To illustrate an advanced imaging parameter that describes the course of the iliopsoas tendon, and evaluate its correlations with iliopsoas internal hip snapping syndrome.

Methods

This retrospective cohort study reviewed hip MRI images of all patients seen by a single surgeon between January 2015 and March 2016. The comparison group included all patients with clinical internal hip snapping, versus the control group that did not. MRI images were processed using minimum intensity projection. Measurements obtained of the pelvis and course of the iliopsoas tendon included: pelvic incidence, coronal angle, and sagittal opening angle (SOA). Comparison of measurements between the groups was performed with Mann–Whitney U analysis and receiver operator curve (ROC) plotting, with a significance cutoff of p = 0.05.

Results

The control group (n = 85) and comparison group (n = 48) demonstrated no difference in age or gender. Pelvic incidence was similar [51.3 (± 10.7) degrees control versus 52.2 (± 7.7) degrees comparison (p = 0.36)], as was coronal angle [13.9 (± 4.6) degrees control versus 14.8 (±4.8) degrees comparison (p = 0.15)]. There was a significant difference in SOA [137.0 (± 5.9) degrees control versus 141.9 (± 6.5) degrees comparison (p < 0.01)]. ROC analysis revealed SOA threshold of 140 degrees for clinical IP hip snapping (p < 0.01), with odds ratio 5.2 (2.4–11.3) for SOA > 140 degrees.

Conclusions

Iliopsoas hip snapping is often part of a more complex disease process. While challenging to diagnose, advanced imaging parameters, like the sagittal opening angle, relate with clinical pathology. The SOA offers diagnostic value, with a threshold of greater than 140 degrees significantly correlating with clinical presentation.



https://ift.tt/2y5VqaA

Pycnogenol® supplementation improved the erythrocyte stability of packed donkeys during the late hot-dry season in Zaria, Nigeria

Abstract

The aim of this study was to determine the effect of pycnogenol® (PYC) on erythrocyte stability of donkeys subjected to packing during the late hot-dry season. Ten donkeys, divided into two groups, served as experimental subjects. P-PYC group (n = 5) was subjected to packing only, while P+PYC group (n = 5) was administered with PYC (10 mg/kg) and subjected to packing. Erythrocytes obtained from each animal in the experimental groups were added into saline solution of different concentrations (0.9, 0.6, 0.4. 0.2, and 0.0 g/100 ml). Erythrocyte osmotic fragility index (EOFI) was evaluated spectrophotometrically. The concentration of isoprostane was also determined. The mean EOFI was significantly (P < 0.05) higher in P-PYC group 3 and 7 days after packing at 0.6 g/100 ml, with values of 32.4 ± 3.2 and 53.4 ± 4.3%, respectively. However, there was no significant (P > 0.05) difference in the MCF recorded in both groups, before, after, 3, and 7 days after packing. Percentage erythrocyte stability was significantly higher (P < 0.05) in P+PYC group, especially during, and 7 days after packing with values of 24.3 ± 9.2 and − 23.3 ± 22.8%, respectively when compared with the values of 8.6 ± 3.3 and − 79.7 ± 9.3% obtained in P-PYC group, respectively. Mean isoprostane concentration was significantly (P < 0.05) higher in P-PYC group when compared with the value in P+PYC group, 7 days after packing. In conclusion, environmental and packing stresses decreased stability of the erythrocytes in donkeys; however, PYC may have played an ameliorative role.



https://ift.tt/2Oy4aAs

Bladder preservation approach versus radical cystectomy for high-grade non-muscle-invasive bladder cancer: a meta-analysis of cohort studies

Abstract

Background

High-grade non-muscle-invasive bladder cancer is superficial; nonetheless, it is an aggressive cancer. Proper management strategy selection following transurethral resection between bladder preservation (BP) and radical cystectomy (RC) could result in delayed or excessive treatment. Hence, selecting the optimal treatment modality remains controversial to date.

Methods

We searched MEDLINE, The Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wanfang database through 12 April 2018. Quality and publication bias were assessed using the Newcastle-Ottawa Scale and Begg's/Egger's test. We collected 2-year, 5-year, 10-year, and 15-year survival rate and hazard ratio (HR) for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Using the Review Manager 5.2 software, we used the odds ratio (OR) of specific years and HR for meta-analysis. Subgroup analysis was performed by the original tumor state, radical cystectomy timing, bladder preservation modality, and age.

Results

In total, 11 cohorts with 1735 patients were selected for the meta-analysis. All OR of OS supported BP as a better treatment option; however, all OR of PFS had no significant differences. As for CSS, only the 15-year OR reflected a statistical significance preferring RC. Subgroup analysis showed that BP is more appropriate for patients older than 65 and G3 tumor. Limited data demonstrated that late RC (> 3 months) is more effective compared to early RC (< 3 months) and intravesical Bacillus Calmette–Guerin was not statistically different from that of RC. The mixed BP modalities were significantly better compared to RC in OS and worse in CSS, with both having a very low evidence strength.

Conclusions

BP is a superior treatment modality compare to RC, especially for older patients and T1G3 or lower grade tumors. However, the superior BP modality was unclear. Conversely, RC could be a better option for younger patients. More specifically, late RC may be more beneficial but had a very-low-level of evidence. Quality of life should be considered equal to survival outcome; hence, post-treatment follow-up needs to be performed. Prospective randomized studies should be performed to overcome the limitations of this meta-analysis study.

Registration

Registration ID is CRD42018093491.



https://ift.tt/2OvNr0N

Penile cutaneous horn: still an enigma

Ajay Aggarwal<br />Sep 10, 2018; 2018:bcr-2018-225930-bcr-2018-225930<br />Images in...

https://ift.tt/2OvrYoJ

Blacks Less Likely to Receive Guideline-Based NSTEMI Therapy

TUESDAY, Oct. 2, 2018 -- Black patients have a lower likelihood of receiving guideline-based therapies for non-ST-segment-elevation myocardial infarction (NSTEMI), according to a study published online Sept. 20 in the Journal of the American Heart...

https://ift.tt/2xSlrdY

Alternative Medicines May Aid in the Treatment of Psoriasis

TUESDAY, Oct. 2, 2018 -- Some complementary and alternative medicines (CAMs) may be helpful in the treatment of psoriasis, according to a review published online Sept. 5 in JAMA Dermatology. A. Caresse Gamret, from the University of Miami, and...

https://ift.tt/2P5UWZp

Interviews Can Help Ensure Physician Candidates Fit Culture

TUESDAY, Oct. 2, 2018 -- In preparing to interview to hire a new physician, practices must understand their own cultures, according to an article published in Medical Economics. According to the article, there are five questions that can help a...

https://ift.tt/2P5UURh

Negligible Drop in Neoplastic Lesion Dx After First Round of FIT

TUESDAY, Oct. 2, 2018 -- After the first round of a fecal immunochemical test (FIT)-based, multiple-round, long-term screening program, there is a negligible reduction in detection rates for neoplastic lesions in the proximal versus the distal...

https://ift.tt/2xSlRRA

Global Cognition Up for Youth Meeting Movement Guidelines

TUESDAY, Oct. 2, 2018 -- Meeting recommendations on adequate sleep time and physical activity and limiting recreational screen time are associated with superior global cognition among children, according to a study published online Sept. 26 in The...

https://ift.tt/2P5LbKD

Second Opinion at NCI Center Valuable for Breast CA Patients

TUESDAY, Oct. 2, 2018 -- Almost 43 percent of patients diagnosed with breast cancer presenting to a National Cancer Institute (NCI)-designated cancer center for a second opinion have a change in diagnosis, according to a study published in the...

https://ift.tt/2xSlnuK

Hyperbaric Oxygen + Standard Tx Benefits Sudden Hearing Loss

TUESDAY, Oct. 2, 2018 -- Hyperbaric oxygen therapy (HBOT) added to standard medical therapy (MT) seems beneficial for sudden sensorineural hearing loss (SSNHL), according to a review published online Sept. 27 in JAMA Otolaryngology-Head & Neck...

https://ift.tt/2P6D68q

Number of Health-Related Data Breaches Increasing

TUESDAY, Oct. 2, 2018 -- The number of health data breaches has steadily increased since 2010, according to a research letter published in the Sept. 25 issue of the Journal of the American Medical Association. Thomas H. McCoy Jr., M.D., and Roy H....

https://ift.tt/2xSlmqG

Telemedicine RTI Visits Shorter When Antibiotic Prescribed

TUESDAY, Oct. 2, 2018 -- In a direct-to-consumer (DTC) telemedicine setting, respiratory tract infection (RTI) encounters in which antibiotics are prescribed are shorter than other encounters, according to a research letter published online Oct. 2...

https://ift.tt/2P1I32w

Ondansetron in Pregnancy Not Linked to Most Birth Defects

TUESDAY, Oct. 2, 2018 -- Use of ondansetron for the treatment of nausea and vomiting in pregnancy does not appear to be associated with birth defects, according to research published in the August issue of Obstetrics & Gynecology. Samantha E....

https://ift.tt/2xSlKp8

The regenerating family member 3 {beta} instigates IL-17A-mediated neutrophil recruitment downstream of NOD1/2 signalling for controlling colonisation resistance independently of microbiota community structure

Objective

Loss of the Crohn's disease predisposing NOD2 gene results in an intestinal microenvironment conducive for colonisation by attaching-and-effacing enteropathogens. However, it remains elusive whether it relies on the intracellular recruitment of the serine-threonine kinase RIPK2 by NOD2, a step that is required for its activation of the transcription factor NF-B.

Design

Colonisation resistance was evaluated in wild type and mutant mice, as well as in ex-germ-free (ex-GF) mice which were colonised either with faeces from Ripk2-deficient mice or with bacteria with similar preferences for carbohydrates to those acquired by the pathogen. The severity of the mucosal pathology was quantified at several time points postinfection by using a previously established scoring. The community resilience in response to infection was evaluated by 16S ribosomal RNA gene sequence analysis. The control of pathogen virulence was evaluated by monitoring the secretion of Citrobacter-specific antibody response in the faeces.

Results

Primary infection was similarly outcompeted in ex-GF Ripk2-deficient and control mice, demonstrating that the susceptibility to infection resulting from RIPK2 deficiency cannot be solely attributed to specific microbiota community structures. In contrast, delayed clearance of Citrobacter rodentium and exacerbated histopathology were preceded by a weakened propensity of intestinal macrophages to afford innate lymphoid cell activation. This tissue protection unexpectedly required the regenerating family member 3β by instigating interleukin (IL) 17A-mediated neutrophil recruitment to the intestine and subsequent phosphorylation of signal transducer and activator of transcription 3.

Conclusions

These results unveil a previously unrecognised mechanism that efficiently protects from colonisation by diarrhoeagenic bacteria early in infection.



https://ift.tt/2RjYx7q

Disparities in the management of paediatric splenic injury

BJS, EarlyView.


https://ift.tt/2xSrXle

Comments on Doguet et al. (2017) ‘Muscle length effect on corticospinal excitability during maximal concentric, isometric and eccentric contractions of the knee extensors’

Experimental Physiology, Volume 103, Issue 10, Page 1435-1436, 1 October 2018.


https://ift.tt/2QrB2Z7

Editorial Board

Experimental Physiology, Volume 103, Issue 10, Page 1439-1442, 1 October 2018.


https://ift.tt/2Oxp0Qq

Contents: Eur. J. Lipid Sci. Technol. 10∕2018

European Journal of Lipid Science and Technology, Volume 120, Issue 10, October 2018.


https://ift.tt/2NizIWf

Editorial Board: Eur. J. Lipid Sci. Technol. 10∕2018

European Journal of Lipid Science and Technology, Volume 120, Issue 10, October 2018.


https://ift.tt/2zLiRb6

Robotic versus laparoscopic surgery for rectal cancer in male urogenital function preservation, a meta-analysis

Abstract

Background

Urogenital dysfunction after rectal cancer surgery can largely affect patients' postoperative quality of life. Whether robotic surgery can be a better option when comparing with laparoscopic surgery is still not well-known.

Methods

Comprehensive search in PubMed, Embase, Cochrane Library, and Clinical Trials was conducted to identify relevant studies in March 2018. Studies comparing robotic surgery with laparoscopic surgery were included. Measurement of urogenital function was through the International Prostate Symptom Score and International Index of Erectile Function.

Results

Six studies with 386 patients in robotic group and 421 patients in laparoscopic group were finally included. Pooled analysis indicated that bladder function was better at 12 months in the robotic group after the procedures (mean difference, − 0.30, 95% CI, − 0.52 to − 0.08). No significant difference was found at 3 and 6 months postoperatively (mean difference, − 0.37, 95% CI, − 1.48 to 0.73; mean difference, − 1.21, 95% CI, − 2.69 to 0.28). Sexual function was better at 3 months in the robotic group after surgery (mean difference, − 3.28, 95% CI, − 6.08 to − 0.49) and not significantly different at 6 and 12 months. (mean difference, 3.78, 95% CI, − 7.37 to 14.93; mean difference, − 2.82, 95% CI, − 8.43 to 2.80).

Conclusion

Robotic surgery may offer faster recovery in urogenital function compared to laparoscopic surgery for rectal cancer.



https://ift.tt/2y3ssrG

How I do a colonic J‐pouch prolapse repair after coloanal anastomosis with an aponeurotic graft

ANZ Journal of Surgery, EarlyView.


https://ift.tt/2NX5Dkl

Case report of hypereosinophilic syndrome presenting as severe ischaemic colitis

ANZ Journal of Surgery, EarlyView.


https://ift.tt/2NdZoU8

Laparoscopic resection of an urachal abscess caused by migration of a fish bone: a case report

ANZ Journal of Surgery, EarlyView.


https://ift.tt/2NX5i13

Monitoring outcomes in spine surgery: rationale behind the Australian Spine Registry

ANZ Journal of Surgery, Volume 88, Issue 10, Page 950-951, October 2018.


https://ift.tt/2NX5n4R

Re: Patients requiring an acute operation: where are the delays in the process?

ANZ Journal of Surgery, Volume 88, Issue 10, Page 1089-1090, October 2018.


https://ift.tt/2NdZ7AA

Progress towards a sustainable clinical academic training pathway

ANZ Journal of Surgery, Volume 88, Issue 10, Page 952-953, October 2018.


https://ift.tt/2NZl4sq

Re: Wound tension and ‘closability’ with keystone flaps, V‐Y flaps and primary closure: a study in fresh‐frozen cadavers

ANZ Journal of Surgery, Volume 88, Issue 10, Page 1087-1088, October 2018.


https://ift.tt/2NdZ5ss

Bullying in surgery: will it help the speciality?

ANZ Journal of Surgery, Volume 88, Issue 10, Page 1088-1089, October 2018.


https://ift.tt/2NfDDDm

Time to die: choice or chance

ANZ Journal of Surgery, Volume 88, Issue 10, Page 947-948, October 2018.


https://ift.tt/2NVNiUO

Response to Re: Wound tension and ‘closability’ with keystone flaps, V‐Y flaps and primary closure: a study in fresh‐frozen cadavers

ANZ Journal of Surgery, Volume 88, Issue 10, Page 1089-1089, October 2018.


https://ift.tt/2NdYZRC

Is robotic radical cystectomy ready for prime time?

ANZ Journal of Surgery, Volume 88, Issue 10, Page 948-949, October 2018.


https://ift.tt/2NYXlID

Re: Small bowel obstruction and perforation following ingestion of an oyster shell

ANZ Journal of Surgery, Volume 88, Issue 10, Page 1088-1088, October 2018.


https://ift.tt/2Nis8uM

Issue information ‐ JEB

ANZ Journal of Surgery, Volume 88, Issue 10, Page 941-941, October 2018.


https://ift.tt/2O1AKLN

Is modern perioperative care too complicated for surgeons?

ANZ Journal of Surgery, Volume 88, Issue 10, Page 951-952, October 2018.


https://ift.tt/2NhArXY

Issue information ‐ TOC

ANZ Journal of Surgery, Volume 88, Issue 10, Page 942-945, October 2018.


https://ift.tt/2NWLXwU

Regulatory T Cells Promote Macrophage Efferocytosis during Inflammation Resolution

Regulatory T cells suppress inflammation and promote tissue repair in multiple contexts. Proto, Doran, et al. show that Treg cells enhance the ability of macrophages to engulf apoptotic cells (efferocytosis) and thereby promote resolution of inflammation.

https://ift.tt/2Ri5PIS

Secreted IgD Amplifies Humoral T Helper 2 Cell Responses by Binding Basophils via Galectin-9 and CD44

The function of IgD has been mysterious. Shan et al. find that IgD recognized food antigens and targeted basophils through galectin-9. IgD ligation by antigen induced basophil secretion of IL-4, IL-5, and IL-13, which amplified Th2 cell-mediated IgG1 and IgE production by B cells. IgD also constrained IgE-mediated basophil degranulation.

https://ift.tt/2RjzjGn

B Cells Are the Dominant Antigen-Presenting Cells that Activate Naive CD4+ T Cells upon Immunization with a Virus-Derived Nanoparticle Antigen

Initiation of CD4+ T cell response depends on antigen-presenting cells. Contrary to the paradigm that dendritic cells are required for this process, Hong et al. show that antigen-specific B cells are essential and sufficient to activate naive CD4+ T cells in response to virus-like particles or influenza vaccination.

https://ift.tt/2Nimitm

Ariz. fire dept. responders to be equipped with body armor

The Mesa City Council voted to spend $262,000 on body armor for firefighters and paramedics

https://ift.tt/2NXXKuR

Association between pregnant women’s experience of stress and partners’ fly-in-fly-out work

Publication date: Available online 1 October 2018

Source: Women and Birth

Author(s): Dawson C. Cooke, Garth Kendall, Jianghong Li, Michael Dockery

Abstract
Background

It is relatively common in Western Australia for men to commute long distances and work away from home for extended periods of time, often referred to as fly-in-fly-out work. Women are particularly susceptible to the effects of stress during pregnancy, and the absence of a partner due to working away could be an additional risk to their wellbeing. While there is little published fly-in-fly-out literature, there is evidence that working non-standard hours, more generally, has a negative impact on health and well-being of workers and their families.

Aim

To determine if there is an association between pregnant women's report of stress and their partners working fly-in-fly-out, and if so, is there is a differential impact that is dependent on family socioeconomic status.

Methods

Data from a Western Australian pregnancy cohort study were analysed (n = 394 families). Couples completed self-report ratings of anxiety, depression, stress, family functioning, and stressful life events. Comparisons were made between three groups: fly-in-fly-out workers, non-fly-in-fly-out regular schedule workers, and non-fly-in-fly-out irregular schedule workers.

Results

After controlling for a range of variables, women's stress was significantly associated (< .05) with their partners working fly-in-fly-out. Neither women's education, partners' occupation nor an interaction between partners' fly-in-fly-out work and partners' occupation were significantly associated with women's stress.

Conclusion

There is some evidence that the pregnant partners of fly-in-fly-out workers perceive their lives to be more stressful than women whose partner works non-fly-in-fly-out regular schedules.



https://ift.tt/2xRZSdw

Antihyperglycemic and Antilipidemic Effects of the Ethanol Extract Mixture of Ligularia fischeri and Momordica charantia in Type II Diabetes-Mimicking Mice

The extract of the Momordica charantia fruit (MCE) is recognized as an alternative treatment for diabetes. The extract of Ligularia fischeri leaves (LFE) is traditionally used as a folk medicine for treating inflammatory diseases in Korea as well. In this study, we investigated the synergistic effect of MCE combined with LFE on antihyperglycemic and antihyperlipidemic potentials. Based on the α-glucosidase inhibitory effect and promotion of adipocyte differentiation in the 3T3-L1 cell line, the MLM was prepared with MCE:LFE (8:2 weight:weight). MLM showed the synergistic effects in the promotion of the glucose uptake rate, suppression of dipeptidyl peptidase-4 (DPP-4) mRNA expression, upregulation of an insulin receptor substrate and glucose transporter type-4 expression, and an increase in insulin-associated signaling in C2C12 cells. In addition, the efficacy of peroxisome proliferator-activated receptor-γ agonism and glucose uptake rate by MLM supplementation was significantly enhanced in vitro. Then, the antihyperglycemic and antihyperlipidemic effects of MCE, LFE, and MLM at the dose of 50, 100, and 200 mg/kg/day (n = 6 per each group) were determined in streptozotocin (STZ)-insulted mice fed an atherogenic diet (ATH) for 4 weeks. In addition, MLM (50, 100, and 200 mg/kg/day, n = 5 per each group) was supplemented in ATH-fed db/db mice for 10 weeks. Compared with MCE or LFE alone, MLM supplementation led to a more significant reduction of glucose levels in both STZ/ATH and db/db/ATH mice as well as lowered lipid profiles in STZ/ATH mice. In addition, the stimulation of islet of Langerhans regeneration was more pronounced by MLM supplementation in both mice models. In conclusion, antihyperglycemic and antihyperlipidemic effects were strengthened by the combined extracts of L. fischeri and M. charantia (MLM) in diabetes-mimicking mice.

https://ift.tt/2O0bJQS

Hepatoprotective and Antioxidant Activities of Oil from Baru Almonds (Dipteryx alata Vog.) in a Preclinical Model of Lipotoxicity and Dyslipidemia

The oil obtained from baru (Dipteryx alata Vog.) almonds exhibits high energy value and is reported in popular medicine for the treatment of rheumatic diseases and reproductive disturbances. Although baru oil is used in domestic cuisine, the chemical characterization of this oil and its effects on lipid metabolism are still poorly understood. Therefore, this study evaluated the fatty acid (FA) profile and the effects of baru oil on liver and aorta in a murine model of dyslipidemia. The chromatographic profile of baru oil showed high levels of unsaturated FAs, especially oleic acid. Saturated FAs, such as palmitic and lignoceric acids, were found in lower amounts. Hypercholesterolemia was induced in male Wistar rats by daily administration of a lipid emulsion by gavage for 15 weeks. Biochemical and histopathological analysis were performed on serum, aorta, and liver. The results demonstrated that animals developed marked hypercholesterolemia, liver steatosis, and increased lipid peroxidation in the aorta. Treatment with baru oil attenuated lipid peroxidation and drastically reduced liver damage, especially ballooning degeneration and steatosis. By restricting vascular and hepatic injury, this oil showed potential applicability as a functional food, reinforcing its use in popular medicine and domestic cuisine.

https://ift.tt/2P8jKjz

Haematometrocolpos due to transverse vaginal septum with distal atretic vagina

Description 

A 15-year-old girl presented with cyclical pelvic, lower abdominal pain and cramping beginning at age 13. She had not yet had onset of menarche and no history of sexual intercourse. On examination, she presented with lower abdominal distension, which felt like a firm mass extending up to the umbilicus and into the pelvic cavity. Abdominal ultrasound showed an ectopic right kidney in the paramedian position at the level of the umbilicus. Ultrasound also showed a large midline cystic structure located between the urinary bladder and rectum, containing low-level homogenous echoes suggestive of blood products. MRI confirmed the ultrasound findings as it showed the endometrial, endocervical and vaginal canal were distended by low-signal material (T2 and short-tau inversion recovery). Images appeared hyperintense on T1W1, suggestive of haematometrocolpos due to a complete transverse vaginal septum at the level of the pubic symphysis, distal portion of vagina was atretic (



https://ift.tt/2IALMli

Spontaneous rupture of a pancreatic pseudocyst

Description 

This is a case of a 50-year-old woman with medical history significant for chronic pancreatitis secondary to alcohol abuse who initially presented with a 3-week history of progressively worsening epigastric pain. The patient described the pain as sharp, radiating to the back, worsened with intake of both solid foods and liquids and relieved with self-induced emesis. On admission, the patient was hypertensive, but other vitals were within normal limits. The abdomen was soft; however, there is a firm palpable mass extending from the epigastric to the right and left upper quadrants. Labs were remarkable for hypokalaemia with potassium (K) 3 meq/L (normal range 3.5–4.9 meq/L), mildly elevated lipase 132 U/L (7–60 U/L) and an elevated alkaline phosphatase of 164 U/L (41–108 U/L). CT of the abdomen with contrast (figures 1 and 2) showed a large cystic structure measuring 12.9x21.2 cm directly adjacent to the body of the pancreas and...



https://ift.tt/2ICmhA5

Olmesartan-induced enteropathy

Olmesartan-induced enteropathy (OIE) typically presents with a constellation of signs and symptoms including chronic diarrhoea, weight loss and villous atrophy on biopsy. We describe a 68-year-old Caucasian woman with a history of hypothyroidism and hypertension who presented to our hospital with recurrent episodes of acute intermittent diarrhoea, nausea, vomiting, renal failure and 15 lbs weight loss. After an extensive workup, she was diagnosed with possible OIE. Cessation of the offending drug resulted in improvement of clinical symptoms and also hospital admissions for severe diarrhoea reinforcing the diagnosis of OIE. Among the adverse effects of drug therapy, diarrhoea is a relatively frequent adverse event accounting for about 7%. This report serves as an addition to existing literature and to increase the awareness of olmesartan-induced sprue-like enteropathy among the primary care physicians and gastroenterologists.



https://ift.tt/2xTqzPf

Saccular internal carotid artery aneurysm masquerading as a pituitary macroadenoma

Description 

An 84-year-old woman presented to the emergency department with a 3-day history of progressive binocular diplopia on right-sided horizontal gaze, accompanied with gradual-onset right-sided periorbital headache, vomiting and diarrhoea. Medical history consisted of hypertension and chronic kidney disease, stage 2.

Clinical examination demonstrated right-sided VI cranial nerve palsy, normal pupillary light reaction, visual acuity and fields. No other neurological deficits elicited. No clinical features of hypercortisolism, growth hormone excess or adrenal insufficiency were displayed.

Initial blood tests revealed an acute-on-chronic kidney injury (AKI). Admission estimated glomerular filtration rate was 42 mL/min, baseline 74; admission creatinine 180 μmol/L, baseline 142. An urgent CT head, non-contrast in view of the AKI, was performed. Intravenous fluids were administered. CT revealed a 39x18x14 mm sellar mass, involving the pituitary fossa, extending into the left and right cavernous sinus, sphenoid sinus and posterior sella turcica.

On the next day, MRI of the pituitary (figure...



https://ift.tt/2IvXFZy

Miliary tuberculosis and herpes pharyngitis after a trip to a developing country: dangers of biologics

The use of biologic drugs has expanded since its introduction in the late 1990s. With growing medical use and newer biologic drugs in development, opportunistic infections like Mycobacterium tuberculosis remain important adverse effects. It carries major public health concerns, yet evidence-based clinical guidelines for more routine interval screening in patients taking immunosuppressants and exposed to tuberculosis (TB) are lacking. We illustrate a case of an elderly Indian-born man living in the USA with psoriatic arthritis who was on adalimumab for 10 years. He presented with disseminated TB and herpes simplex virus type 1 (HSV-1) pharyngitis, a year after an innocuous trip to India. Our case draws attention to the adverse effects of biologic drugs and highlights the importance of regular rescreening for a high-risk population. As the use of biologic treatment increases, physicians must be vigilant in more frequent screening, monitoring and identifying related opportunistic infections, notably M. tuberculosis infections.



https://ift.tt/2xVAXpw

Ace the case: a 14-year-old with lower extremity weakness and blurry vision

Description 

A 14-year-old girl presented with progressive upper and lower extremity weakness. Symptoms started 5 months prior with intermittent bilateral calf pain coincident with onset of lower extremity weakness. Initial evaluation revealed normal complete blood count, complelete metabolic panel, inflammatory markers, muscle enzymes and MRI brain and spine with/without contrast. Electromyography demonstrated an acute to subacute polyradiculitis affecting the upper and lower extremities.

She was admitted for expedited evaluation. Examination was significant for lower extremity weakness and absent reflexes. Lumbar puncture (LP) showed lymphocytic pleocytosis and markedly elevated protein. Thorough infectious, oncological and rheumatological evaluations were all unremarkable. Most notable was that CSF Neuromyelitis Optica IgG and paraneoplastic antibody panel were negative, and serum ACE was normal. She was started on intravenous immunoglobulin for empiric treatment of chronic inflammatory demyelinating polyneuropathy (CIDP).

While hospitalised, she developed left eye blurred vision. Ophthalmological examination demonstrated bilateral optic nerve oedema. Repeat MRI...



https://ift.tt/2IwqwNr

Unusual and rare case of generalised lymphadenopathy: Kimuras disease

We report a case of Kimura's disease in a 65-year-old woman who presented with generalised itching, abdominal pain, facial puffiness, difficulty in swallowing and loss of appetite. She was found to have generalised lymphadenopathy and a fine-needle aspiration cytology initially done revealed 'reactive lymphadenitis' which was inconclusive. PET-CT done showed features suggestive of lymphoma. Hence, lymph node biopsy was done for confirmation and incidentally after immunohistochemistry staining it turned out to be Kimura's disease. High-dose steroid therapy was started and patient showed dramatic clinical and symptomatic improvement. Kimura's disease almost always presents as cervical lymphadenopathy and usually never causes compressive symptoms. Our patient presented with compressive symptoms and generalised lymphadenopathy which is a rarity.



https://ift.tt/2xRTW4e

Third-degree burns associated with transcutaneous pacing

A 69-year-old severely obese diabetic woman developed nausea, vomiting and diarrhoea which caused multiple metabolic alterations leading to hypotension and bradycardia due to slow atrioventricular junctional rhythm. Transcutaneous pacing (TCP) was initiated and maintained until the underlying heart rate and blood pressure normalised. TCP gel pads were kept in place prophylactically after pacing was terminated. Gel pads remained attached to the anterior thorax and back for a total of 36 hours. During this time the patient developed third-degree burns at the side of gel pad attachment. With appropriate wound care and after a long hospitalisation, the patient was discharged in stable condition. This case demonstrates that prolonged use of TCP gel pads without frequent replacement may lead to third-degree burns. It also suggest that prophylactic use of TCP gel pads should be avoided.



https://ift.tt/2IytReS

Dual ectopic thyroid gland

Description 

Ectopic thyroid tissue (ETT) occurs due to a disorder in the embryonic development of the thyroid gland with incomplete migration of the thyroid tissue from the median plate of the floor of the pharyngeal gut to its usual site. ETT is a rare entity, with an estimated prevalence of 1/100 000–300 000 in the general population, increasing to 1/4000–8000 in patients with thyroid dysfunction. The mechanisms responsible for thyroid morphogenesis have not yet been fully elucidated but certain transcription factors such as TITF1/NKX2-1, PAX8, HHEX or FOXE1 play a key role in this process. ETT mainly affects young women and is often asymptomatic.1 In 90% of the cases, ETT is located at the base of the tongue. The occurrence of two ectopic foci simultaneously is particularly rare.2 The authors present the case of a 30-year-old female patient under endocrinology's care due to autoimmune subclinical hypothyroidism. She...



https://ift.tt/2xU4u3b

Giant right coronary artery aneurysm complicated by a fistula to the right atrium, mimicking a ruptured sinus of Valsalva aneurysm

Patients with a coronary aneurysm alone do not generally exhibit continuous murmurs; however, murmurs may be detected in the presence of a fistula. A 57-year-old woman with chest pain was referred to us with a suspected diagnosis of a ruptured sinus of Valsalva aneurysm owing to the presence of a continuous murmur that was detected on physical examination. However, CT revealed a giant right coronary artery aneurysm draining into the right atrium. Consequently, surgery was performed. This case highlights the importance of implementing multiple imaging modalities for adequate differential diagnoses of patients presenting with continuous murmurs.



https://ift.tt/2IytJMq

Beliefs and reality of e-cigarette smoking

In this global health case study, we describe a case of nicotine addiction due to chronic use of electronic cigarettes (e-cigarette) and discuss the beliefs on safety and awareness of their side effects. Many people believe that smoking an e-cigarette (vaping) does not have any side effects, especially among teenagers and young adults. Teenagers using an e-cigarette at a young age are twice as likely to try cigarettes later in their life because of nicotine dependency or other social factors. More recent studies have shown long-term systemic side effects of vaping regardless of traditional cigarette smoking history. This report was done for further assessing their risk and to clear out misconceptions of this large-scale condition.



https://ift.tt/2y0VXeT

Advancement of the Harrington technique for reconstruction of pathological fractures of the acetabulum

A 59-year-old man presented with hip pain secondary to metastatic prostate carcinoma affecting multiple sites, including his left acetabulum. The patient's prognosis was good, he was active, independent, with a good quality of life, so was offered surgical reconstruction. The Harrington method involves passing metal rods from the ileum to the ischium and pubis to create a scaffold for hip replacement. This is the gold standard for reconstruction of acetabular metastatic defects. However, this method is prone to failure by medialisation of the construct in the long term. We present our technique of employing a novel modification to the Harrington reconstruction that offers additional support medially with a suprapectineal plate. This construct is strong and durable enough to facilitate immediate weight-bearing and prevent long-term medialisation.



https://ift.tt/2IyIEpI

Troubleshooting a dialysis line: when blue runs red

We present the case of a critically ill woman whose dialysis line was noted to be circulating bright red blood. Located in the right internal jugular vein, the line had previously been working normally with the change occurring shortly after the patient was liberated from positive pressure mechanical ventilation. An arterial malposition was ruled out and subsequent investigations revealed the presence of a left-sided partial anomalous pulmonary venous connection (PAPVC) that had been previously undiagnosed. The identification of a left-sided PAPVC from blood gas measurements taken from a right internal jugular vein dialysis catheter in this case provides an informative opportunity to consider the intricate physiological relationship between the respiratory and cardiovascular systems in critically ill patients requiring invasive procedures and treatments.



https://ift.tt/2xPaolW

Ehrlichiosis masquerading as thrombotic thrombocytopenic purpura

Ehrlichiosis is a rare tickborne illness that can manifest from an asymptomatic, self-limiting disease to a severe presentation with encephalopathy and renal failure. Ehrlichiosis is diagnosed largely based on patient history with confirmatory tests including peripheral blood smear, serology and PCR. Empiric treatment is warranted in patients with suspected tick bites as a delay in treatment can result in multiorgan failure. We discuss a case of ehrlichiosis that presented with the classic pentad of thrombotic thrombocytopenic purpura (TTP). A history of a tick bite was elicited and intravenous doxycycline 100 mg two times a day was initiated. Tick panel results revealed a positive Ehrlichia chaffeensis IgG and IgM titres, consistent with human monocytic ehrlichiosis. Autoimmune workup and antibodies to Borreliaburgdorferi were negative, and ADAMTS13 activity assay results were inconsistent with TTP. The patient completed 14 days of intravenous doxycycline and had an uneventful recovery.



https://ift.tt/2IyIu1A

Diabetic ketoalkalosis: misnomer or undiagnosed variant of diabetic ketoacidosis

Usually, hyperglycaemia crisis presents with acidotic pH, but ketoalkalosis is a rare and unheard entity presenting in diabetic ketoacidosis. We describe three unique cases where the patients present with hyperglycaemia >250 mg/dL, normal or alkalotic pH, and bicarbonate >20 meq/L, which does not meet criteria for diabetic ketoacidosis. However, once these patients were supplemented with intravenous fluids, diagnosis of diabetic ketoacidosis was evident in laboratory analysis. These case series provide a learning opportunity in diagnosing and management of this rare phenomenon.



https://ift.tt/2xRXKmq

Pancake kidney: an incidental finding in a young man

Description 

An 18-year-old man presented to the surgery emergency department with signs and symptoms of acute intestinal obstruction. There was a previous history of exploratory laparotomy for intestinal obstruction 8 years ago. Abdominal examination revealed a healthy transverse scar in the right lumbar region extending to the umbilical region, abdominal distension and no tenderness or guarding. The patient was managed conservatively by nasogastric tube decompression and intravenous fluids support. A contrast-enhanced computed tomography (CECT) of the abdomen was done. The patient responded well to the conservative management, and the intestinal obstruction was relieved. The CECT abdomen reported an ectopic location of bilateral kidneys, lying in the lower abdomen. The kidneys were para-median in location and extending between L4 and S2 vertebrae. Upper and mid-pole of both kidneys were fused across the midline (figures 1 and 2). No evidence of any calculus or hydronephrosis was seen. Opacification of bilateral...



https://ift.tt/2IAZEfi

First-line ibrutinib for Bing-Neel syndrome

The authors present a case of an elderly man with a history of Waldenstrom macroglobulinaemia in remission who presented with progressively worsening gait abnormalities and falls for several months. His examination was notable for bilateral lower extremity weakness and an unsteady gait. Brain and spinal MRI showed focal leptomeningeal enhancement in the brain and spinal column. Lumbar puncture was performed and cerebrospinal fluid flow cytometry demonstrated a monoclonal CD5/CD10-negative, CD20-positive B-cell lymphocyte population consistent with a diagnosis of Bing-Neel syndrome. He was started on ibrutinib, an oral Bruton's tyrosine kinase inhibitor, and had marked improvement in his weakness and gait. Repeat imaging 2 months after starting ibrutinib showed improvement in his leptomeningeal enhancement. During subsequent follow-up, he continued to tolerate ibrutinib and had a sustained clinical response.



https://ift.tt/2xRTUt8

Case of pneumomediastinum due to alveolar rupture following endotracheal intubation

Description 

A 57-year-old woman presented to the outpatient department with complaints of shortness of breath and fever for the past 2 days. She had no known comorbidities. She was admitted in intensive care unit (ICU) in view of type 1 respiratory failure. Initial chest X-ray showed bilateral lower zone non-homogenous opacity (figure 1A). She was initially managed with antibiotics and non-invasive ventilation. However, due to worsening respiratory failure and metabolic acidosis, patient was intubated. Postintubation, patient was connected to a ventilator in volume control mode with fraction of inspired oxygen of 90%, Positive end expiratory pressure (PEEP) of 10, tidal volume of 350 mL, respiratory set rate of 20 and the ratio of duration of inspiration to the duration of expiration (I:E ratio) of 1:3.3. Chest X-ray repeated following intubation showed features suggestive of pneumomediastinum (figure 1B). The CT thorax done post intubation showed pneumoprecardium (



https://ift.tt/2IyIej8

Pigmentary retinopathy in Kearns-Sayre syndrome

Description 

An 11-year-old girl with moderate ptosis and chronic progressive ophthalmoplegia (figure 1) was referred for retinal evaluation in view of nyctalopia. Visual acuity on presentation was 20/40 OU. Slit-lamp examination revealed a normal anterior segment. There was no similar family history. Multicolour scanning laser photographs (figure 2A, B) showed retinal pigment granularity in OU that was better appreciated on autofluorescence imaging as speckled hypoautofluorescence and hyperautofluorescence (figure 2C, D). Horizontal spectral domain optical coherence tomography scans through fovea revealed hyper-reflective deposits above the retinal pigment epithelium (figure 2E, F). Systemic workup revealed the gross motor weakness of both upper and lower limbs, mild hearing loss and no cardiac conduction defects. The patient was referred to a paediatric neurologist for further evaluation. Cerebrospinal fluid tap was done which showed elevated lactate (3.10 mg/dL) and protein levels (96 mg/dL). ECG showed no conduction blocks. A muscle biopsy showed...



https://ift.tt/2xVATWO

Cancers, Vol. 10, Pages 369: Physical Activity and Gastric Cancer Risk in Patients with and without Helicobacter pylori Infection in A Korean Population: A Hospital-Based Case-Control Study

Cancers, Vol. 10, Pages 369: Physical Activity and Gastric Cancer Risk in Patients with and without Helicobacter pylori Infection in A Korean Population: A Hospital-Based Case-Control Study

Cancers doi: 10.3390/cancers10100369

Authors: Madhawa Neranjan Gunathilake Jeonghee Lee Aelee Jang Il Ju Choi Young-Il Kim Jeongseon Kim

Although physical activity (PA) is beneficial for prolonging lifespan, evidence for the protective role of PA against the development of gastric cancer (GC) is not yet well established. This study assessed the association between PA and GC risk in patients with and without Helicobacter pylori (H. pylori) infection in a Korean population. In total, 415 GC patients and 830 controls were enrolled at the National Cancer Center, Korea. The International Physical Activity Questionnaire-Short Form was used to collect PA data. The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models. In the H. pylori-positive group, subjects who engaged in regular exercise showed a significantly reduced risk of GC in the entire population (OR = 0.52, 95% CI = 0.38&ndash;0.70) and in females (OR = 0.60, 95% CI = 0.21&ndash;0.64). Subjects who engaged in a high level of total PA showed a significantly reduced risk of GC relative to subjects in the lowest tertile in the fully adjusted model (OR = 0.46, 95% CI = 0.32&ndash;0.65, p-trend &lt; 0.001). There was an inverse association between PA and GC risk in the entire population, and in the H. pylori-positive subgroup. Our data indicate the need for the promotion of all domains of PA, especially for Korean populations.



https://ift.tt/2Opj7VB

Deletions in SERPING1 Lead to Lower C1 Inhibitor Function: Lower C1 Inhibitor Function Can Predict Disease Severity

Background: How genotype affects phenotype in hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) has not been totally clarified. In this study, we investigated the relationship between different types of mutations and various phenotypic characteristics. Methods: Clinical data from 81 patients from 47 families were recorded. Complement proteins were analyzed from 61 untreated patients. The coding exons and the exon-intron boundaries of the SERPING1 gene were sequenced, and deletion/duplication analysis with multiple ligation dependent probe amplification was performed. The relationship of complement protein with the mutation type was analyzed by using generalized estimating equations. Results: Thirty-five different mutations (15 novel and 2/15 homozygous) were identified. There was no causative mutation in 6 patients (7.4%). Patients with deletion and large deletion had the lowest (5.05%, 0–18.7; 5.8%, 0–16.5%, respectively), and the none mutation group had the highest C1 inhibitor function (23.3%, 11–78%, p #x3c; 0.001). C1 inhibitor function levels decreased as the age of the disease progressed (r = –0.352, p = 0.005). Lower C1 inhibitor function levels caused severer disease (r = –0.404, p = 0.001) and more frequent annual attacks (r = –0.289, p = 0.024). In the off-attack period, C1q levels were lower than normal in 9.8% of the patients. Conclusion: Deletion mutations may represent the most unfavorable effect on C1 inhibitor function. The earlier disease onset age could be a sign for lower C1 inhibitor function levels in adult life. C1q levels could also be low in C1-INH-HAE patients, as in acquired angioedema. Lower C1 inhibitor function can predict disease severity and may have negative impacts on the course of C1-INH-HAE.
Int Arch Allergy Immunol

https://ift.tt/2xNXODB

A comparison of growth among growth friendly systems for scoliosis: a systematic review

Publication date: Available online 2 October 2018

Source: The Spine Journal

Author(s): Sebastiaan P.J. Wijdicks, Isabel N. Tromp, Muharrem Yazici, Diederik H.R. Kempen, René M. Castelein, Moyo C. Kruyt

Abstract
Background

The optimal method for surgical treatment of early onset scoliosis is currently unknown. Although the aim of growth-friendly systems is to reduce the curve and maintain growth, there is no consensus on how to measure spinal growth during and after the treatment. Different measurements of different segments (T1-S1, T1-T12, instrumented length) are used for different time points to evaluate growth. The aim of this review is to assess what measurements are used and to compare the growth-friendly systems based on spinal growth during treatment.

Methods

The electronic MEDLINE, EMBASE and Cochrane databases were systematically searched for original articles that reported growth for traditional growing rods (TGR), VEPTR, Shilla, Magnetically controlled growing rods (MCGR) and Luque-trolley systems. All measurements were recorded and weighted averages calculated in centimeter per year were compared.

Results

We included 52 studies (26 TGR, 12 MCGR, 6 VEPTR, 4 Luque-trolley, 1 Shilla and 3 mixed). Often only one segment was reported (T1-S1 length in 22 studies, T1-T12 length in 2 studies and instrumented length in 5 studies). The remaining 22 studies reported T1-S1 length in combination with T1-T12 length (15 studies) or instrumented length (8 studies). Spinal growth achieved by initial correction only, was a considerable 3.9 cm (based on 34 studies) as well as the spinal growth achieved by the final fusion surgery (2.3 cm in 4 studies). To specifically assess growth achieved with the system, length gain after initial surgery and before final fusion in growth system graduates was considered. Only 4 TGR studies reported on this "true" spinal growth with 0.6 cm and 0.3 cm per year in the T1-S1 and T1-T12 segment respectively.

Conclusion

Reporting on spinal growth is currently inadequate and does not allow a good comparison of different techniques. However, all systems often report growth similar to Dimeglio's T1-S1 spinal growth of 1 cm per year. It should be recognized though that a considerable portion of the reported spinal growth is due to the initial and final surgical correction and not due to the growth-friendly implant.



https://ift.tt/2y2zNaY