Medicine by Alexandros G.Sfakianakis: 10/07/18

Κυριακή 7 Οκτωβρίου 2018

Individual preferences in motor coordination seen across the two hands: relations to movement stability and optimality

Abstract

The framework of the uncontrolled manifold (UCM) hypothesis was used to explore variables related to stability of task performance in the two hands of young healthy individuals. Fourteen young adults performed four-finger accurate constant force production tasks interrupted by a voluntary quick force pulse production and by an externally imposed displacement of all fingers. Three groups of variables were used to quantify stability of steady force production: (1) indices of the inter-trial variance were computed within the UCM and orthogonal to the UCM; (2) indices of motor equivalence were computed between steady-state intervals separated by the force pulse and by the finger-lifting episode; and (3) referent coordinate and apparent stiffness were computed using the data during the ascending phase of the finger-lifting episode. In another task, the subjects performed accurate constant force production with visual feedback removal after the 8th second, and the drop in the total force after the removal was computed. There were differences between the right and left hand in some outcome variables such as variance within the UCM, and the timing of anticipatory synergy adjustments prior to the force pulse, consistent with the dynamic dominance hypothesis. There were significant correlations between the two hands for indices that were unrelated to accuracy of performance: variance within the UCM, index of motor equivalence, referent coordinate, apparent stiffness, and the drop of total force after visual feedback removal. We interpret these findings within the concept of stability–optimality trade-off. In particular, we conclude that individual subjects select particular, person-specific solutions within the spectrum allowed by the explicit task constraints, and this choice is consistent between the two hands. We conclude with a hypothesis that selecting specific solutions within the stability–optimality trade-off may represent an individual's personal preference consistent between the two hands.

https://ift.tt/2CA2QaK

Investigation of eye movement pattern parameters of individuals with different fluid intelligence

Abstract

Eye movement studies are subject of interest in human cognition. Cortical activity and cognitive load impress eye movement influentially. Here, we investigated whether fluid intelligence (FI) has any effect on eye movement pattern in a comparative visual search (CVS) task. FI of individuals was measured using the Cattell test, and participants were divided into three groups: low FI, middle FI, and high FI. Eye movements of individuals were then recorded during the CVS task. Eye movement patterns were extracted and compared statistically among the three groups. Our experiment demonstrated that eye movement patterns were significantly different among the three groups. Pearson correlation coefficients between FI and eye movement parameters were also calculated to assess which of the eye movement parameters were most affected by FI. Our findings illustrate that saccade peak velocity had the greatest positive correlation with FI score and the ratio of total fixation duration to total saccade duration had the greatest negative correlation with FI. Next, we extracted 24 features from eye movement patterns and designed: (1) a classifier to categorize individuals and (2) a regression analysis to predict the FI score of individuals. In the best case examined, the classifier categorized subjects with 68.3% accuracy, and the regression predicted FI of individuals with a 0.54 correlation between observed FI and predicted FI. In our investigation, the results have emphasized that imposed loads on low FI individuals is greater than that of high FI individuals in the cognitive load tasks.

https://ift.tt/2Rz56Ds

Correlations between executive functions and adaptation to incrementally increasing sensorimotor discordances

Abstract

A previous study reported that movement directions adapt much better to 60° target displacements (double steps) when target displacements are introduced incrementally and not abruptly. The present study tested whether incremental adaptation to 60° discordances can be explained by specific cognitive abilities. The results showed that an increase of discordance size during adaptation enhanced reaction times. Furthermore, the individual performance in neuropsychological tests measuring sustained attention, figural fluency and perseveration predicted the rate of adaptation at different discordance sizes. These results are discussed with reference to recent models on directional selectivity and modularity during visually guided reaching.

https://ift.tt/2IJIagM

Do we need noninvasive biomarkers for delayed graft function after kidney transplantation?

No abstract available

https://ift.tt/2ylETPS

Perfusion of Porcine Kidneys with Macromolecular Heparin Reduces Early Ischemia Reperfusion Injury

Background Previously we have been able to demonstrate the possibility of coating the inner surface of the renal arteries in porcine kidneys with a heparin conjugate during hypothermic machine perfusion (HMP). The purpose of this study was to assess the efficacy of this treatment in reducing early ischemia-reperfusion injury. Method Brain death was induced in male landrace pigs by stepwise volume expansion of an epidural balloon catheter until negative cerebral perfusion pressure was obtained. Both kidneys (matched pairs; n=6+6) were preserved for 20 hours by HMP during which 50 mg heparin conjugate was added to 1 of the HMP systems (treated group). A customized ex vivo normothermic oxygenated perfusion (NP) system with added exogenous creatinine was used to evaluate early kidney function. Blood, urine and histological samples were collected during the subsequent 3 hours of NP. Results Kidney weight was lower at the end of NP (p=0.017) in the treated group compared to control kidneys. The rate of decline in creatinine level was faster (p=0.024), total urinary volume was higher (p=0.031) and the level of urine neutrophil gelatinase-associated lipocalin (NGAL) was lower (p=0.031) in the treated group. Histologically, less tubular changes were seen (p=0.046). During NP intrarenal resistance remained lower (p

https://ift.tt/2pHyFG3

Ceritinib for Untreated Anaplastic Lymphoma Kinase-Positive Advanced Non-Small-Cell Lung: An Evidence Review Group Evaluation of a NICE Single Technology Appraisal

Abstract

The National Institute for Health and Care Excellence (NICE) invited the company that manufactures ceritinib (Zykadia^®, Novartis) to submit evidence on the clinical and cost effectiveness of the drug, as a first-line treatment for adults with anaplastic lymphoma kinase (ALK)-positive (+) advanced non-small-cell lung cancer (NSCLC), as part of the Institute's single technology appraisal (STA) process. The CRD (Centre for Reviews and Dissemination) and CHE (Centre for Health Economics) Technology Assessment Group at the University of York was commissioned to act as the Evidence Review Group (ERG). This paper describes the Company's submission (CS), the ERG review and NICE's subsequent decisions. The evidence submitted in support of ceritinib, as the first-line treatment in ALK+ advanced NSCLC, was a phase III, international, multicentre, open-label randomised controlled trial (RCT) comparing ceritinib with pemetrexed/cisplatin plus pemetrexed maintenance therapy (chemotherapy [CT] group). The results indicated that ceritinib prolonged progression-free survival (PFS) compared with CT. The only comparator considered in the CS was crizotinib. The evidence selected in support of crizotinib was PROFILE 1014, an open-label RCT of crizotinib, compared with pemetrexed/cisplatin CT (without maintenance therapy), in previously untreated advanced or metastatic ALK+ NSCLC. The design and population of PROFILE 1014 was similar to that of ASCEND-4, though there were some differences between the trials. The Company considered it not possible to perform an 'anchor-based' analysis of first-line ceritinib and crizotinib, and presented a Matching-Adjusted Indirect Comparison (MAIC) of ceritinib and crizotinib using only the ALK inhibitor arm of ASCEND-4 and PROFILE 1014. The indirect comparison suggests that ceritinib may be more effective in prolonging PFS than crizotinib. The ERG agreed that an indirect comparison using only the ALK inhibitor arm of the trials was the only option available in the present assessment; however, a number of limitations and potential bias were identified in this analysis. The Company's model estimated that ceritinib was cost effective when compared with crizotinib. However, the ERG highlighted several concerns with the Company's analysis; the ERG's preferred base case estimated an incremental cost-effectiveness ratio of £69,255 per quality-adjusted life-year (no patient access scheme [PAS] included). The ERG considered the economic analysis to be sensitive to changes in assumption used, partly due to the due to the immaturity of the overall survival data from trials, which leads to uncertainty around the extrapolation used. The NICE Appraisal Committee concluded that ceritinib is recommended, within its marketing authorisation, as an option for untreated ALK+ advanced NSCLC in adults, if the Company provides it with the discount agreed in the PAS.

https://ift.tt/2E4vMt5

Systematic Review and Meta-analysis of Short- versus Long-Acting Granulocyte Colony-Stimulating Factors for Reduction of Chemotherapy-Induced Febrile Neutropenia

Abstract

Introduction

Short- and long-acting granulocyte-colony stimulating factors (G-CSFs) are approved for the reduction of febrile neutropenia. A systematic literature review was performed to identify randomized controlled trials (RCTs) and non-RCTs reporting the use of G-CSFs following chemotherapy treatment.

Methods

Medline^®/Medline in-process, Embase^®, and the Cochrane Library were searched for studies published between January 2003 and June 2016. A hand-search of relevant conference proceedings was conducted for meetings held between 2012 and 2016. Eligible studies were restricted to those reporting a direct, head-to-head comparison of short- versus long-acting G-CSFs for reduction of chemotherapy-induced febrile neutropenia. Risk-of-bias assessments were performed for full publications only.

Results

The search strategy yielded 4044 articles for electronic screening. Thirty-six publications were evaluated for the meta-analysis: 11 of 12 RCTs and 2 of 24 non-RCTs administered doses of the short-acting G-CSF filgrastim for ≥ 7 days. In RCT studies, there was no statistically significant difference in outcomes of interest between short- and long-acting G-CSFs. In non-RCTs, the overall risk was lower with long-acting G-CSF than with short-acting G-CSF for incidence of febrile neutropenia [overall relative risk (RR) = 0.67, P = 0.023], hospitalizations (overall RR = 0.68, P < 0.05), and chemotherapy dose delays (overall RR = 0.68, P = 0.020).

Conclusions

Overall, the weight of evidence from RCTs indicates little difference in efficacy between the short- and long-acting G-CSFs if dosed according to recommended guidelines. There is some evidence for greater efficacy for long-acting G-CSFs in non-RCTs, which may be a result of under-dosing of short-acting G-CSFs in general practice in real-world usage.

Funding

Hospira Inc, which was acquired by Pfizer Inc in September 2015, and Pfizer Inc.

https://ift.tt/2II3Mdn

The use of gasoline in a complex suicide

Abstract

This case represents a planned complex suicide in which the victim shot himself in the head after dousing his living quarters with gasoline. The spark induced ignition of gasoline vapors and led to an explosion. Liquid gasoline is not flammable, but the vapor/mixture of gases above the surface of the liquid is. In this case the victim might have counted on the resulting fire and/or explosion, but we are not able to tell that with certainty. We have assumed that the plan was for the gunshot to the head to lead to instantaneous death, and for the flame and/or explosion to lead to the destruction of the body. The explosion launched the body out of the apartment, meaning it did not get charred. It is also our assumption that the victim did not expect that the explosion would eject his body from the flames and lead to less severe burns than he had calculated, making this complex suicide "less successful" than he had planned.

https://ift.tt/2ykiceP

Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England

Abstract

Objective

This article presents alternative parental health spillover quantification methods in the context of a randomised controlled trial comparing family therapy with treatment as usual as an intervention for self-harming adolescents, and discusses the practical limitations of those methods.

Methods

The trial followed a sample of 754 participants aged 11–17 years. Health utilities are measured using answers to the EuroQoL 5 Dimensions 3 Levels (EQ-5D-3L) for the adolescent and the Health Utility Index (HUI2) for one parent at baseline, 6 and 12 months. We use regression analyses to evaluate the association between the parent's and adolescent's health utilities as part of an explanatory regression model including health-related and demographic characteristics of both the adolescent and the parent. We then measure cost-effectiveness over a 12-month period as mean incremental cost-effectiveness ratios using various spillover quantification methods. We propose an original quantification based on the use of a household welfare function along with an equivalence scale to generate a health gain within the family to be added to the adolescent's quality-adjusted life-year gain.

Results

We find that the parent's health utility increased over the duration of the trial and is significantly and positively associated with adolescent's health utility at 6 and 12 months but not at baseline. When considering the adolescent's health gain only, the incremental cost-effectiveness ratio is £40,453 per quality-adjusted life-year. When including the health spillover to one parent, the incremental cost-effectiveness ratio estimates range from £27,167 per quality-adjusted life-year to £40,838 per quality-adjusted life-year and can be a dominated option depending on the quantification method used.

Conclusion

According to the health spillover quantification method considered, the incremental cost-effectiveness ratios vary from within the National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold range to not being cost-effective.

https://ift.tt/2PlCzzR

Insecticides Resistance Status of An. gambiae in Areas of Varying Agrochemical Use in Côte D’Ivoire

Background. Insecticide resistance monitoring of the malaria vectors to different classes of insecticides is necessary for resistance management. Malaria vector control management approaches are essentially based on IRS and LLINs. However, insecticide resistance is caused by several sources of selection and in case the selection pressure is from agricultural practices, then measures need to be taken to avoid a failure of the control methods put in place. The current study was undertaken to monitor the susceptibility of vectors to different classes of insecticides in areas of varying agrochemical use patterns. Methods. A survey to determine the agricultural chemical use pattern was undertaken in ten localities across Côte d'Ivoire. In addition, WHO susceptibility tests were carried out on adults Anopheles gambiae s.l. mosquitoes emerging from collected larvae from the sites surveyed. Four insecticides from each class of the four classes of insecticides were evaluated using the standard susceptibility test methods. Furthermore, the target site mutations involved in resistance mechanisms were identified following the Taqman assay protocols and mosquito species were identified using SINE-PCR. Results. The mortalities of all the An. gambiae s.l populations were similar regardless of the pesticide use pattern. The vectors were resistant to DDT, deltamethrin, and bendiocarb in all localities. In contrast, mosquitoes showed high susceptibility to malathion. High frequency of the Kdr-West gene allele was observed (70-100%). A single Kdr-East mutation was identified in a mosquito that harboured both Ace-1 and Kdr-West genes. Conclusion. Cultivated marshlands representing good habitats for mosquito development may deeply contribute to the selection of resistance genes given the intensive use of agrochemical for crop protection. In view of these, special attention must be given to them to mitigate mosquito resistance to insecticides.

https://ift.tt/2pIZTvT

Zearalenone Changes the Diversity and Composition of Caecum Microbiota in Weaned Rabbit

Mycotoxins exhibit several severe effects on intestinal health, but few studies have assessed mycotoxins effect on the intestinal microflora and its repercussions to humans and animals. In this study, we evaluated the effect of zearalenone (ZEA), one of the most harmful mycotoxins on the structure of caecal microbiota in rabbits. Twenty-eight male weaned rabbits were randomly divided into four groups and orally given different concentrations of ZEA (400, 800, and 1600 μg/kg.b.w). Microbial communities in caecum samples of rabbits were analyzed for 16S rRNA by Illumina sequencing through Illumina Miseq platform after being fed for 28 days. The results showed that increasing ZEA doses increased the species richness but did not significantly increased the species diversity of the caecum microbiota in the rabbits. In addition, the caecum microbiota from the samples in different ZEA-treated groups was clustered according to their dosing regimens. At the phylum level, ZEA decreased the abundance of Actinobacteria and significantly increased the abundance of Cyanobacteria, Synergistetes, and Proteobacteria. At the genus level, there were declines in the abundance of Adlercreutzia, Blautia, Desulfitobacter, Lactobacillus, Oxalobacter, and p-75-a5. The decrease of abundance in Lactobacillus, Desulfitobacter, and p-75-a5 was particularly noticeable. In conclusion, zearalenone could increase α-diversity but significantly decrease the abundance of some bacteria with the important metabolic functions. These findings suggested that ZEA could modify the caecum microbiota.

https://ift.tt/2ypGJz8

Phase II trial of palbociclib in patients with metastatic urothelial cancer after failure of first-line chemotherapy

Phase II trial of palbociclib in patients with metastatic urothelial cancer after failure of first-line chemotherapy

Phase II trial of palbociclib in patients with metastatic urothelial cancer after failure of first-line chemotherapy, Published online: 08 October 2018; doi:10.1038/s41416-018-0229-0

Phase II trial of palbociclib in patients with metastatic urothelial cancer after failure of first-line chemotherapy

https://ift.tt/2PkP1zN

A minority-group of renal cell cancer patients with high infiltration of CD20+B-cells is associated with poor prognosis

A minority-group of renal cell cancer patients with high infiltration of CD20+B-cells is associated with poor prognosis

A minority-group of renal cell cancer patients with high infiltration of CD20+B-cells is associated with poor prognosis, Published online: 08 October 2018; doi:10.1038/s41416-018-0266-8

A minority-group of renal cell cancer patients with high infiltration of CD20+B-cells is associated with poor prognosis

https://ift.tt/2y5czCc

Ovarian tumours of different histologic type and clinical stage induce similar changes in lipid metabolism

Ovarian tumours of different histologic type and clinical stage induce similar changes in lipid metabolism

Ovarian tumours of different histologic type and clinical stage induce similar changes in lipid metabolism, Published online: 08 October 2018; doi:10.1038/s41416-018-0270-z

Ovarian tumours of different histologic type and clinical stage induce similar changes in lipid metabolism

https://ift.tt/2NvZNRY

Complications and Management of a Rare Case of Disseminated Coccidioidomycosis to the Vertebral Spine

Coccidioidomycosis, also known as San Joaquin Valley Fever or Valley Fever, is mostly a pulmonary infection caused by inhalation of spores in an endemic region. Dissemination to bone, joints, meninges, and skin occurs less than one percent of the time. Skeletal involvement accounts for approximately half of the disseminated coccidioidomycosis with the vertebrae as the most common skeletal region. We present a very rare case of disseminated coccidioidomycosis with osteomyelitis and compression fracture of the lumbar vertebral body. This case depicts some of the potential issues that can arise in managing coccidioidomycosis, especially when noncompliance to initial azoles occurs, that can lead to dissemination and complicated bone infections necessitating surgical intervention along with continuous medical therapy.

https://ift.tt/2pIZPw9

FDA Alerts Consumers and Pet Owners of Silver Star Brand’s Voluntary Recall of Homeopathic Drug Products

Audience: Consumers, Pet Owners The Food and Drug Administration is alerting consumers and pet owners about a voluntary recall of certain lots of eight products – six products for humans, including four Native Remedies and two Healthful Naturals,...

https://ift.tt/2pHD248

Ovarian tumours of different histologic type and clinical stage induce similar changes in lipid metabolism

https://ift.tt/2pH6mHG

Phase II trial of palbociclib in patients with metastatic urothelial cancer after failure of first-line chemotherapy

https://ift.tt/2ymgkm5

A minority-group of renal cell cancer patients with high infiltration of CD20+B-cells is associated with poor prognosis

https://ift.tt/2pE90y2

FDA Alerts Consumers and Pet Owners of Silver Star Brand’s Voluntary Recall of Homeopathic Drug Products

Assessing the Particulate Matter Removal Abilities of Tree Leaves

The ultrasonic cleaning method was applied to elute the particulate matter (PM) retained on leaf surfaces after PM was eluted by the conventional cleaning methods (water cleaning only or water cleaning plus brush cleaning). The methodology can help to improve the estimation accuracy for PM retention capacity of leaves.

https://ift.tt/2pIEO4J

Retinal Cryo-sections, Whole-Mounts, and Hypotonic Isolated Vasculature Preparations for Immunohistochemical Visualization of Microvascular Pericytes

We demonstrate three different tissue preparation techniques for immunohistochemical visualization of rat retinal microvascular pericytes, i.e., cryo-sections, whole-mounts, and hypotonic isolation of the vascular network.

https://ift.tt/2CtQ2CD

Lentiviral Mediated Production of Transgenic Mice: A Simple and Highly Efficient Method for Direct Study of Founders

Here, we present a protocol to promote transgene integration and production of founder transgenic mice with high efficacy by a simple injection of a lentiviral vector in the perivitelline space of a fertilized oocyte.

https://ift.tt/2Cw2vFZ

Rates of Neurovascular Injury, Compartment Syndrome, and Early Infection in Operatively Treated Civilian Ballistic Forearm Fractures

Publication date: Available online 6 October 2018

Source: Injury

Author(s): Siddhant K. Mehta, Wood W. Dale, Michael D. Dedwylder, Patrick F. Bergin, Clay A. Spitler

Abstract

Purpose

The purpose of this study is to evaluate the incidence of neurovascular injuries, compartment syndrome, early postoperative infection as well as the injury factors predictive of neurovascular injury following ballistic fractures of the radius and ulna.

Methods

A retrospective review was performed to identify all ballistic fractures of the radius and ulna in skeletally mature patients over a 5-year period at a single level-1 trauma center. Chart and radiographic review was performed to identify patient and injury demographics, associated neurologic or vascular injuries, and fracture characteristics. Fracture location was measured on computerized imaging software and fractures were grouped into bone(s) segments involved. Proximal, mid-diaphyseal, and distal locations were used for statistical analysis.

Results

Fifty-six extremities in fifty-five patients were identified (mean age 32 years; male to female ratio 9:1). Overall incidence of neurologic injury was 50%, arterial injury 32%, and compartment syndrome 7.1%. Presence of a proximal third forearm fracture was associated with an increased risk for neurologic injury (p < 0.01), with an odds ratio of 5.7 (95% confidence interval, 1.7 to 18.4). Furthermore, all high velocity/energy ballistic injuries had associated neurologic injuries (p = 0.02).

Conclusion

Ballistic forearm fractures result in high rates of neurovascular injury. Fractures caused by high velocity/energy firearms have extremely high rates of neurologic injury when compared with low velocity ballistic injuries. Ballistic fractures involving the proximal third of the radius or ulna are five times more likely to be associated with neurologic injury after a ballistic injury and should be assessed carefully on initial evaluation.

https://ift.tt/2CvQHDF