Pigmented apocrine hamartoma of the vulva: a case report

Abstract

We herein report a patient who clinically presented with a pigmented, flat plaque in the vulvar area. Histological examination showed a benign lesion mainly composed of tubular and cystic glands with apocrine differentiation. The most striking histological feature was the deposition of finely granular melanin pigment both in the epithelial cells and in the luminal surface of the glands. In addition, Melan-A immunostaining demonstrated the presence of numerous melanocytes within the lesion suggesting that the pigment deposition was secondary to colonization of the lesion by melanocytes. We therefore diagnosed this lesion as 'pigmented apocrine hamartoma'. To the best of our knowledge only three cases of pigmented apocrine hamartoma have been reported in the literature so far.

http://ift.tt/2jpci7v

Non-invasive Identification of Vulnerable Atherosclerotic Plaques Using Texture Analysis in Ultrasound Carotid Elastography: An In Vivo Feasibility Study Validated by Magnetic Resonance Imaging

Publication date: Available online 30 January 2017
Source:Ultrasound in Medicine & Biology
Author(s): Chengwu Huang, Qiong He, Manwei Huang, Lingyun Huang, Xihai Zhao, Chun Yuan, Jianwen Luo
The aims of this study were to quantify the textural information of strain rate images in ultrasound carotid elastography and evaluate the feasibility of using the textural features in discriminating stable and vulnerable plaques with magnetic resonance imaging as an in vivo reference. Ultrasound radiofrequency data were acquired in 80 carotid plaques from 52 patients, mainly in the longitudinal imaging view, and axial strain rate images were estimated with an ultrasound carotid elastography technique based on an optical flow algorithm. Four textural features of strain rate images—contrast, homogeneity, correlation and angular second moment—were derived based on the gray-level co-occurrence matrix in plaque regions to quantify the deformation distribution pattern. Conventional elastographic indices based on the magnitude of the absolute strain rate, such as the maximum, mean, median, standard deviation and 99th percentile of the axial strain rate, were also obtained for comparison. Composition measurement with magnetic resonance imaging identified 30 plaques as vulnerable and the other 50 as stable. The four textural features, as well as the magnitude of strain rate images, significantly differed between the two groups of plaques. The best performing features for plaque classification were found to be the contrast and 99th percentile of the absolute strain rate, with a comparative area under the receiver operating characteristic curve of 0.81; a slightly higher maximum accuracy of plaque classification can be achieved by the textural feature of contrast (83.8% vs. 81.3%). The results indicate that the use of texture analysis in plaque classification is feasible and that larger local deformations and higher level of complexity in deformation patterns (associated with the elastic or stiffness heterogeneity of plaque tissues) are more likely to occur in vulnerable plaques.



http://ift.tt/2jOc4pg

Chromatin dynamics during the cell cycle at centromeres

During the cell cycle, the centromeres of chromosomes have important roles and face key challenges, such as mediating successful chromosome segregation during mitosis and faithfully propagating their chromatin state to daughter chromosomes during S phase. This Review describes cell cycle-related features of centromeres, focusing on the nature and dynamics of centromeric chromatin, how it is intricately regulated and the potential implications for disease when these processes are disrupted.

http://ift.tt/2klMBo3

Genetic variation: Giving context to phenotype prediction

http://ift.tt/2klGyjz

Non-coding RNA: Pri-miRNA processing: structure is key

http://ift.tt/2kODOrD

Technique: SMiLE-seq illuminates transcription factor motifs

http://ift.tt/2kloE08

Evolving health care through personal genomics

The advent of genomic technologies is changing health care systems, with genomic data increasingly being applied to guide individual patient care. In this Essay, Rehm discusses how genomics is becoming an essential part of clinical care and the existing challenges that must be surmounted to take full advantage of personal genomic information.

http://ift.tt/2kOAywi

Rapid malachite green degradation using Fe73.5Si13.5B9Cu1Nb3 metallic glass for activation of persulfate under UV–Vis light

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): S.X. Liang, Z. Jia, W.C. Zhang, W.M. Wang, L.C. Zhang
In this work, it is the first time to report that Fe73.5Si13.5B9Cu1Nb3 metallic glass having unique atomic structure was employed for activation of persulfate under UV–Vis light. The investigation evaluated the importance of influencing parameters, including dye concentration, persulfate concentration, ribbon dosage and light intensity, on malachite green (MG) dye degradation. The results reveal that 100% dye color removal with a reaction rate of k=0.0849min⁻¹ could be achieved within 30min under specific parameters control. In addition, surface decay behavior of the catalyst also plays a significant effect on the reusability and sustainability. The inclusion of Nb atom in Fe73.5Si13.5B9Cu1Nb3 promotes enrichment of Si atom on the ribbon surface, causing the formation of Si and Nb oxides to further improve the surface stability on both of free and roller-contacted surfaces. The precipitations on reused ribbon surface are confirmed as α-Fe, iron oxide and Si, Nb oxides, revealing a high potential of catalytic reusability for wastewater treatment. The present work will open a new gate for further realizing the high performance of industrial water treatment using metallic glass.

Graphical abstract

http://ift.tt/2jO22UW

Sol-gel hot injection synthesis of ZnO nanoparticles into a porous silica matrix and reaction mechanism

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Ahmed Barhoum, Guy Van Assche, Hubert Rahier, Manuel Fleisch, Sara Bals, Marie-Paule Delplancked, Frederic Leroux, Detlef Bahnemann
Despite the enormous interest in the properties and applications of porous silica matrix, only a few attempts have been reported to deposit metal and metal oxide nanoparticles (NPs) inside the porous silica matrix. We report a simple approach (i.e. sol-gel hot injection) for insitu synthesis of ZnO NPs inside a porous silica matrix. Control of the Zn:Si molar ratio, reaction temperature, pH value, and annealing temperature permits formation of ZnO NPs (≤10nm) inside a porous silica particles, without additives or organic solvents. Results revealed that a solid state reaction inside the ZnO/SiO2 nanocomposites occurs with increasing the annealing temperature. The reaction of ZnO NPs with SiO2 matrix was insignificant up to approximately 500°C. However, ZnO NPs react strongly with the silica matrix when the nanocomposites are annealed at temperatures above 700°C. Extensive annealing of the ZnO/SiO2 nanocomposite at 900°C yields 3D structures made of 500nm rod-like, 5–7μm tube-like and 3–5μm needle-like Zn2SiO4 crystals. A possible mechanism for forming ZnO NPs inside porous silica matrix and phase transformation of the ZnO/SiO2 nanocomposites into 3D architectures of Zn2SiO4 are carefully discussed.

Graphical abstract

http://ift.tt/2jO85Jd

Effects of processing routes on room temperature tensile strength and elongation for Inconel 718

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Yung-Ta Chen, An-Chou Yeh, Ming-Yen Li, Shih-Ming Kuo
For oil and gas industrial applications, materials of deep downhole drilling components are required to possess tensile strength over 1400MPa at room temperature. The present study demonstrates that processing design for Inconel 718 can widen the spectrum of its mechanical properties to meet the demand for ultra-high room temperature tensile strength. The range of room temperature tensile properties achieved in this study include tensile strength of 1785MPa in one end of spectrum, and large tensile strain over 40% in the other end. Furthermore, a well-balanced tensile property of 1430MPa with 18% tensile strain can be achieved by minimizing the formation of pre-aging δ precipitates through direct aging process. The strengthening mechanisms and the trade-off between tensile strength and ductility have been investigated and discussed.

Graphical abstract

http://ift.tt/2jNZruu

Preparation of pH-sensitive core-shell organic corrosion inhibitor and its release behavior in simulated concrete pore solutions

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Yangyang Zhu, Yuwei Ma, Qijun Yu, Jiangxiong Wei, Jie Hu
In this paper, core-shell organic corrosion inhibitors (COCI) based on poly(ethylene oxide)-b-polystyrene (PEO-b-PS) copolymers were successfully prepared. The release process of benzotriazole (BTA) reserved in COCI was investigated by UV spectrophotometry in deionized water and simulated concrete pore (SCP) solutions with different pH values, and the size and morphology of COCI were determined by dynamic light scattering measurements and SEM combined with EDS before and after the release process. The release amount of BTA was slightly higher (9%) in deionized water with lower pH values, which was related to the higher protonation degree of oxygen groups in PEO moieties and less compact structure of COCI at lower pH environment. In SCP solutions, the pH sensitivity of BTA release process was more pronounced, evidenced by 5 times lower release amount of BTA in SCP solution with a pH value of 13, compared to SCP solutions with pH values lower than 11. The most plausible reason is that in SCP solution with a pH value of 13, the existence of Ca²⁺ and high alkaline environment are beneficial for the agglomeration of COCI and formation of Na-rich layer around COCI, hindering the diffusion rate and subsequently release process of the reserved BTA.

Graphical abstract

http://ift.tt/2jO5OxS

Mechanical properties and dynamic constitutive model of 42CrMo steel

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Zhiwu Zhu, Yesen Lu, Qijun Xie, Dingyuan Li, Ning Gao
42CrMo steel used in high-speed train axles withstands complex loading conditions. To study the mechanical properties and the stress-strain relationship of 42CrMo steel, it was subjected to quasi-static and dynamic compression experiments. Experiments at eight different strain rates, ranging from 10⁻³ to 4500s⁻¹, demonstrate that it exhibits rate-dependent plastic behavior, thermal softening, and work-hardening behaviors. The dislocation theory explains the deformation mechanism of 42CrMo steel. Furthermore, a new constitutive model, which includes the thermal softening effect, based on the Zerilli–Armstrong constitutive model, is proposed to describe the dynamic mechanical behavior of 42CrMo steel. The model results are in good agreement with the experimental data, demonstrating that the proposed constitutive model describes the mechanical behavior of 42CrMo steel at various strain rates very well.

Graphical abstract

http://ift.tt/2jO3CpP

Effect of Ni addition on the wettability and microstructure of Sn2.5Ag0.7Cu0.1RE solder alloy

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Yaoli Wang, Guangxin Wang, Kexing Song, Keke Zhang
In order to study the effect of Ni addition on the wettability and microstructure of Sn2.5Ag0.7Cu0.1RE solder alloy, samples of 7compositions were prepared with Ni content ranging from 0 to 0.5% and contents of other alloying elements (Ag, Cu and RE) being kept the same. Results obtained have shown that the wettability of Sn2.5Ag0.7Cu0.1RE can be largely improved by adding 0.1% Ni in the alloy, and Sn2.5Ag0.7Cu0.1RE0.1Ni exhibits a better wettability than the commercially used Sn3.8Ag0.7Cu alloy. The wetting angle measured on Cu substrate is clearly larger than that measured on Cu wire, which is considering the "static" and "dynamic" natures of the two testing procedures. In addition, Ni has been found to be able to reduce the volume fraction of primary Sn, increase the ratio of eutectic structure and form a much finer eutectic microstructure from a three-dimensional view of the microstructure after deep-etching. Moreover, Ni shows a clear impact on the interface between Cu substrate and solder alloy. Compared to the solder alloy without Ni, adding 0.1% Ni leads to a relative flatter and thinner interface. For the solder alloy with 0.5% Ni, micro-cracks are observed at the interface.

Graphical abstract

http://ift.tt/2jOaLqt

A comprehensive microstructural analysis of Al–WC micro- and nano-composites prepared by spark plasma sintering

Publication date: 5 April 2017
Source:Materials & Design, Volume 119
Author(s): Amir Pakdel, Agnieszka Witecka, Gaulthier Rydzek, Dayangku Noorfazidah Awang Shri
There have been many investigations on metal matrix microcomposites produced by conventional casting routes; however, in the past decade, the focus has shifted more toward nanocomposites produced via solid state routes. To have a realistic view of performance prediction and optimum design of such composites, in this work Al matrix composites (AMCs) reinforced with WC microparticles, nanoparticles, and bimodal micro-/nano-particles were prepared by spark plasma sintering. The effects of particle size and concentration, and process variables (i.e. sintering temperature, duration, and pressure) on the evolution of microstructure, density and hardness of the composites were studied comprehensively. Full densification of AMCs with high particle concentration was problematic because of ceramic cluster formations in the microstructure. This effect was more emphasized in AMCs containing nanoparticles. AMCs with microparticles were more easily densified, but their hardness benefits were inferior. On the other hand, the mixture of micro- and nano-particles in Al-WC bimodal composites led to better matrix reinforcement integrity and an overall improvement in the microstructural properties. Finally, increasing the sintering temperature improved the microstructural features and hardness of the composites (more enhanced in high wt.% samples), but sintering duration and pressure did not have a big impact on the composite properties.

Graphical abstract

http://ift.tt/2jO4U4e

Mindfulness within psychological interventions for the treatment of dermatologic diseases

http://ift.tt/2jxuib5

Ustekinumab for the treatment of acrodermatitis continua of Hallopeau refractory to anti-TNF agents

Abstract

Acrodermatitis continua of Hallopeau (ACH) is a variant of pustular psoriasis that is often very difficult to treat. Almost all anti-psoriatic agents have been used in the treatment of ACH. Ustekinumab, a fully human monoclonal antibody of the IgG1 class, is directed to the shared p40 subunit of cytokines IL-12 and IL-23. Herein, we present our experience of ustekinumab use in a 50-year-old man who was resistant to anti-tumor necrosis factor-α agents. Though initial therapy with ustekinumab achieved a sustained response in our patient, after a seven months of interruption, retreatment resulted in a slower and poorer response than the initial regimen. Both responses of our patient reflects: (i) the recalcitrant chronic nature of ACH in some patients, (ii) the value of ustekinumab in ACH treatment, (iii) the fact that, as with other biologics, a loss of response may also occur with ustekinumab when the treatment is interrupted. All these data provides evidence for the fact that the course of ACH is unpredictable and possibly indicate that concerning current biologics used in the treatment of ACH, we have still failed to hit the target we aimed for.

http://ift.tt/2klxURX

A causal role for hyperinsulinemia in obesity

Insulin modulates the biochemical pathways controlling lipid uptake, lipolysis and lipogenesis at multiple levels. Elevated insulin levels are associated with obesity, and conversely, dietary and pharmacological manipulations that reduce insulin have occasionally been reported to cause weight loss. However, the causal role of insulin hypersecretion in the development of mammalian obesity remained controversial in the absence of direct loss-of-function experiments. Here, we discuss theoretical considerations around the causal role of excess insulin for obesity, as well as recent studies employing mice that are genetically incapable of the rapid and sustained hyperinsulinemia that normally accompanies a high-fat diet. We also discuss new evidence demonstrating that modest reductions in circulating insulin prevent weight gain, with sustained effects that can persist after insulin levels normalize. Importantly, evidence from long-term studies reveals that a modest reduction in circulating insulin is not associated with impaired glucose homeostasis, meaning that body weight and lipid homeostasis are actually more sensitive to small changes in circulating insulin than glucose homeostasis in these models. Collectively, the evidence from new studies on genetic loss-of-function models forces a re-evaluation of current paradigms related to obesity, insulin resistance and diabetes. The potential for translation of these findings to humans is briefly discussed.

http://ift.tt/2jNFBPM

Exogenous thyroxine improves glucose intolerance in insulin-resistant rats

Both hypothyroidism and hyperthyroidism are associated with glucose intolerance, calling into question the contribution of thyroid hormones (TH) on glucose regulation. TH analogues and derivatives may be effective treatment options for glucose intolerance and insulin resistance (IR), but their potential glucoregulatory effects during conditions of impaired metabolism are not well described. To assess the effects of thyroxine (T₄) on glucose intolerance in a model of insulin resistance, an oral glucose tolerance test (oGTT) was performed on three groups of rats (n = 8): (1) lean, Long Evans Tokushima Otsuka (LETO), (2) obese, Otsuka Long Evans Tokushima Fatty (OLETF) and (3) OLETF + T₄ (8.0 µg/100 g BM/day x 5 weeks). T₄ attenuated glucose intolerance by 15% and decreased IR index (IRI) by 34% in T₄-treated OLETF compared to untreated OLETF despite a 31% decrease in muscle Glut4 mRNA expression. T₄ increased the mRNA expressions of muscle monocarboxylate transporter 10 (Mct10), deiodinase type 2 (Di2), sirtuin 1 (Sirt1) and uncoupling protein 2 (Ucp2) by 1.8-, 2.2-, 2.7- and 1.4-fold, respectively, compared to OLETF. Activation of AMP-activated protein kinase (AMPK) and insulin receptor were not significantly altered suggesting that the improvements in glucose intolerance and IR were independent of enhanced insulin-mediated signaling. The results suggest that T₄ treatment increased the influx of T₄ in skeletal muscle and, with an increase of DI2, increased the availability of the biologically active T₃ to upregulate key factors such SIRT1 and UCP2 involved in cellular metabolism and glucose homeostasis.

http://ift.tt/2kOkTwQ

Predictive value of [ 18 F]-fluoride PET for monitoring bone remodeling in patients with orthopedic conditions treated with a Taylor spatial frame

Abstract

Purpose

The Taylor Spatial Frame (TSF) is used to correct orthopedic conditions such as correction osteotomies in delayed fracture healing and pseudarthrosis. Long-term TSF-treatments are common and may lead to complications. Current conventional radiological methods are often unsatisfactory for therapy monitoring. Hence, an imaging technique capable of quantifying bone healing progression would be advantageous.

Methods

A cohort of 24 patients with different orthopedic conditions, pseudarthrosis (n = 10), deformities subjected to correction osteotomy (n = 9), and fracture (n = 5) underwent dynamic [¹⁸F]-fluoride (Na¹⁸F) PET/CT at 8 weeks and 4 months, respectively, after application of a TSF. Parametric images, corresponding to the net transport rate of [¹⁸F]-fluoride from plasma to bone, K _i were calculated. The ratio of the maximum K _i at PET scan 2 and 1 ( \( {\overline{K}}_{i, \max } \) ) as well as the ratio of the maximum Standard Uptake Value at PET scan 2 and 1 ( \( {\overline{SUV}}_{\max } \) ) were calculated for each individual. Different treatment end-points were scored, and the overall treatment outcome score was compared with the osteoblastic activity progression as scored with \( {\overline{K}}_{i, \max } \) or \( {\overline{SUV}}_{\max } \) .

Results

\( {\overline{K}}_{i, \max } \) and \( {\overline{SUV}}_{\max } \) were not correlated within each orthopedic group (p > 0.1 for all groups), nor for the pooled population (p = 0.12). The distribution of \( {\overline{K}}_{i, \max } \) was found significantly different among the different orthopedic groups (p = 0.0046) -also for \( {\overline{SUV}}_{\max } \) (p = 0.022). The positive and negative treatment predictive values for \( {\overline{K}}_{i, \max } \) were 66.7 % and 77.8 %, respectively. Corresponding values for \( {\overline{SUV}}_{\max } \) were 25 % and 33.3 %

Conclusions

The \( {\overline{K}}_{i, \max } \) obtained from dynamic [¹⁸F]-fluoride-PET imaging is a promising predictive factor to evaluate changes in bone healing in response to TSF treatment.

http://ift.tt/2jPK1U7

On the accuracy and reproducibility of a novel probabilistic atlas-based generation for calculation of head attenuation maps on integrated PET/MR scanners

Abstract

Purpose

To propose an MR-based method for generating continuous-valued head attenuation maps and to assess its accuracy and reproducibility. Demonstrating that novel MR-based photon attenuation correction methods are both accurate and reproducible is essential prior to using them routinely in research and clinical studies on integrated PET/MR scanners.

Methods

Continuous-valued linear attenuation coefficient maps ("μ-maps") were generated by combining atlases that provided the prior probability of voxel positions belonging to a certain tissue class (air, soft tissue, or bone) and an MR intensity-based likelihood classifier to produce posterior probability maps of tissue classes. These probabilities were used as weights to generate the μ-maps. The accuracy of this probabilistic atlas-based continuous-valued μ-map ("PAC-map") generation method was assessed by calculating the voxel-wise absolute relative change (RC) between the MR-based and scaled CT-based attenuation-corrected PET images. To assess reproducibility, we performed pair-wise comparisons of the RC values obtained from the PET images reconstructed using the μ-maps generated from the data acquired at three time points.

Results

The proposed method produced continuous-valued μ-maps that qualitatively reflected the variable anatomy in patients with brain tumor and agreed well with the scaled CT-based μ-maps. The absolute RC comparing the resulting PET volumes was 1.76 ± 2.33 %, quantitatively demonstrating that the method is accurate. Additionally, we also showed that the method is highly reproducible, the mean RC value for the PET images reconstructed using the μ-maps obtained at the three visits being 0.65 ± 0.95 %.

Conclusion

Accurate and highly reproducible continuous-valued head μ-maps can be generated from MR data using a probabilistic atlas-based approach.

http://ift.tt/2klcPad

In Vivo Spiking Dynamics of Intra- and Extratelencephalic Projection Neurons in Rat Motor Cortex

<span class="paragraphSection"><div class="boxTitle">Abstract</div>In motor cortex, 2 types of deep layer pyramidal cells send their axons to other areas: intratelencephalic (IT)-type neurons specifically project bilaterally to the cerebral cortex and striatum, whereas neurons of the extratelencephalic (ET)-type, termed conventionally pyramidal tract-type, project ipsilaterally to the thalamus and other areas. Although they have totally different synaptic and membrane potential properties in vitro, little is known about the differences between them in ongoing spiking dynamics in vivo. We identified IT-type and ET-type neurons, as well as fast-spiking-type interneurons, using novel multineuronal analysis based on optogenetically evoked spike collision along their axons in behaving/resting rats expressing channelrhodopsin-2 (<span style="font-style:italic;">Multi-Linc</span> method). We found "postspike suppression" (~100 ms) as a characteristic of ET-type neurons in spike auto-correlograms, and it remained constant independent of behavioral conditions in functionally different ET-type neurons. Postspike suppression followed even solitary spikes, and spike bursts significantly extended its duration. We also observed relatively strong spike synchrony in pairs containing IT-type neurons. Thus, spiking dynamics in IT-type and ET-type neurons may be optimized differently for precise and coordinated motor control.</span>

http://ift.tt/2kaZpeq

Mirroring in the Human Brain: Deciphering the Spatial-Temporal Patterns of the Human Mirror Neuron System

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Embodied theories of cognition emphasize the central role of sensorimotor transformations in the representation of others' actions. Support for these theories is derived from the discovery of the mirror neuron system (MNS) in primates, from noninvasive techniques in humans, and from a limited number of intracranial studies. To understand the neural dynamics of the human MNS, more studies with precise spatial and temporal resolutions are essential. We used electrocorticography to define activation patterns in sensorimotor, parietal and/or frontal neuronal populations, during a viewing and grasping task. Our results show robust high gamma activation for both conditions in classic MNS sites. Furthermore, we provide novel evidence for 2 different populations of neurons: sites that were only active for viewing and grasping ("pure mirroring") and sites that were also active between viewing and grasping, and perhaps serve a more general attentional role. Lastly, a subgroup of parietal electrodes showed earlier peaks than all other regions. These results highlight the complexity of spatial-temporal patterns within the MNS and provide a critical link between single-unit research in monkeys and noninvasive techniques in human.</span>

http://ift.tt/2joKfFu

Health Services Research in Improving the Delivery of Care for Patients with Cardiovascular Diseases: Moving From Observation to Innovation to Action.

Author: Maddox, Thomas M. MD, MSc; Ho, P. Michael MD, PhD

Page: 403-405

http://ift.tt/2jxplit

Next-Generation Sequencing in Cardiovascular Disease: Present Clinical Applications and the Horizon of Precision Medicine.

Author: Parikh, Victoria N. MD; Ashley, Euan A. FRCP, DPhil

Page: 406-409

http://ift.tt/2kllcCZ

Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation: Analysis of a Large, Prospective, Multicenter, International Registry.

Author: Lazam, Siham MS; Vanoverschelde, Jean-Louis MD, PhD; Tribouilloy, Christophe MD, PhD; Grigioni, Francesco MD, PhD; Suri, Rakesh M. MD, PhD; Avierinos, Jean-Francois MD; Meester, Christophe de PhD; Barbieri, Andrea MD; Rusinaru, Dan MD, PhD; Russo, Antonio MD; Pasquet, Agnes MD, PhD; Michelena, Hector I. MD; Huebner, Marianne PhD; Maalouf, Joseph MD; Clavel, Marie-Annick DVM, PhD; Szymanski, Catherine MD, PhD; Enriquez-Sarano, Maurice MD; On behalf of the MIDA (Mitral Regurgitation International Database) Investigators

Page: 410-422

http://ift.tt/2jxbdWA

Valve Repair: A Durable Surgical Option in Degenerative Mitral Regurgitation.

Author: Prendergast, Bernard D. DM; De Bonis, Michele MD

Page: 423-425

http://ift.tt/2klfX66

Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults: The Atherosclerosis Risk in Communities Study.

Author: Shah, Amil M. MD, MPH; Claggett, Brian PhD; Kitzman, Dalane MD; Biering-Sorensen, Tor MD, PhD; Jensen, Jan Skov MD, PhD, DMSc; Cheng, Susan MD; Matsushita, Kunihiro MD, PhD; Konety, Suma MD; Folsom, Aaron R. MD, MPH; Mosley, Thomas H. PhD; Wright, Jacqueline D. DrPH; Heiss, Gerardo MD, PhD; Solomon, Scott D. MD

Page: 426-439

http://ift.tt/2jx7b0e

Impact of Computed Tomography Perfusion Imaging on the Response to Tenecteplase in Ischemic Stroke: Analysis of 2 Randomized Controlled Trials.

Author: Bivard, Andrew PhD; Huang, Xuya; McElduff, Patrick PhD; Levi, Christopher R.; Campbell, Bruce C.V.; Cheripelli, Bharath Kumar; Kalladka, Dheeraj; Moreton, Fiona Catherine; Ford, Ian PhD; Bladin, Christopher F.; Davis, Stephen M.; Donnan, Geoffrey A.; Muir, Keith W. MD; Parsons, Mark W.

Page: 440-448

http://ift.tt/2kleFYX

Discovery and Validation of Agonistic Angiotensin Receptor Autoantibodies as Biomarkers of Adverse Outcomes.

Author: Abadir, Peter M. MD; Jain, Alka PhD; Powell, Laura J. BS; Xue, Qian-Li PhD; Tian, Jing MS; Hamilton, Robert G. PhD, DABMLI; Bennett, David A. MD; Finucane, Thomas MD; Walston, Jeremy D. MD; Fedarko, Neal S. PhD

Page: 449-459

http://ift.tt/2jxfaud

Plasma Metabolomics Implicates Modified Transfer RNAs and Altered Bioenergetics in the Outcomes of Pulmonary Arterial Hypertension.

Author: Rhodes, Christopher J. PhD; Ghataorhe, Pavandeep BM, BCh; Wharton, John PhD; Rue-Albrecht, Kevin C. PhD; Hadinnapola, Charaka BM, BCh; Watson, Geoffrey BM, BCh; Bleda, Marta PhD; Haimel, Matthias BSc; Coghlan, Gerry MD; Corris, Paul A. MD; Howard, Luke S. DPhil; Kiely, David G. MD; Peacock, Andrew J. MD; Pepke-Zaba, Joanna PhD; Toshner, Mark R. MD; Wort, S. John PhD; Gibbs, J. Simon R. MD; Lawrie, Allan PhD; Graf, Stefan PhD; Morrell, Nicholas W. MD; Wilkins, Martin R. MD

Page: 460-475

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The Role of Efferocytosis in Atherosclerosis.

Author: Kojima, Yoko MD, PhD; Weissman, Irving L. MD; Leeper, Nicholas J. MD

Page: 476-489

http://ift.tt/2jx9mRB

Abnormal ECG, Seizures, and Associated Neurological Deficits.

Author: Reiffel, James A. MD

Page: 490-491

http://ift.tt/2kliuNM

Linear rheology of carbon black filled polystyrene

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Yihu Song, Yeqiang Tan, Qiang Zheng
Filling can cause polymer melt to undergo a so-called fluid-to-solid transition usually assigned to filler networking effect and heterogeneously retarded polymer dynamics while theories developed nowadays could not account for the several important aspects involving in the reinforcement and dissipation of the composites including the influence of molecular weight of the matrix. Herein linear dynamic rheological behaviors of carbon black filled polystyrene (PS) was investigated, disclosing significantly influences of weight-averaged molecular weight (Mw) of PS on the reinforcement and dissipation in and beyond the hydrodynamics regime. Attempts to create rheological master curves in hydrodynamics regime, taking account for both dynamics retardation in bulk polymer phase and strain amplification effect induced by filler, disclose time-concentration superpositions. The viscoelastic contributions from the dynamically retarded polymer phase and the viscoelastic "filler phase" are thus evaluated.

Graphical abstract

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Complex interplay of short- and long-chain branching on thermal and rheological properties of ethylene/α-olefin copolymers made by metallocene catalysts with oscillating ligand structure

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Mostafa Ahmadi, Faezeh Rezaei, Seyed Mohammad Mahdi Mortazavi, Mehdi Entezam, Florian J. Stadler
Unbridged oscillatory metallocenes are prone to produce heterogeneous chain microstructure, for instance, giving rise to elastomeric polypropylene. Here, we use the bis(2-phenylindenyl)ZrCl2/MAO catalyst system, featuring oscillating ligands, to copolymerize ethylene with several α-olefins. Through investigation of chain microstructure, thermal and rheological properties, we show that the complex behavior of these materials can be justified by considering a catalyst with dual active center having different comonomer affinities. This behavior is consistent with the proposed mechanism of fast oscillating ligands, becoming locked upon proximity of cocatalyst counteranion, leading to diverse stereo- and comonomer selectivity. The unlocked, oscillating active center with lower comonomer response gives rise to mostly linear chains and is not affected by the presence of comonomer, while the locked one creates long chain branched chains, whose frequency decreases by introduction of comonomer. Copolymer samples exhibited bimodal MWD, dual crystallization mechanisms, and low frequency plateau modulus, specifically at higher comonomer levels. It was concluded that the overall behavior is determined by complex interplay of SCB and LCB, which leads to thermorheological complexity as well as phase separation.

Graphical abstract

http://ift.tt/2kJ2lif

Wilhelmy balance characterization beyond contact angles: Differentiating leaching from nanosurface reorganization and optimizing surface modification

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Chenyu Wang, Sithara Nair, Kenneth J. Wynne
Over and above measurements of contact angles, this article provides examples from our work that emphasize unexpected wetting behavior using the Wilhelmy Plate (WP) method. These findings either would not have been noticed by conventional sessile drop methods or might have been dismissed due to deviations associated with measurements or sample-to-sample variations in surface composition. The examples chosen for this article include: (1) Wilhelmy plate force distance curves providing a sensitive measure for the detection of leaching or diffusion of species from polydimethylsiloxane elastomeric coatings, (2) A Dynamic Contact Angle (DCA) investigation of a polyurethane to establish whether changes in CAs vs immersion time were due to leaching of substances that changed the surface tension of water or to nanosurface reorganization of polymer chains, (3) Changing network formation conditions that give low or high receding contact angles (θR) and "sticky or slippery" wetting of water drops on a widely used Sylgard 184 silicone coating as well as the impact of θR on ice adhesion and (4) Polymer surface modification for introducing special functionality via a modifier is shown to depend on a balance of miscibility and immiscibility that resulted in an unexpected "more is less" dependence on concentration for a fluorous modifier and a condensation cured silicone.

Graphical abstract

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Branching analysis of star-shaped polybutadienes by temperature gradient interaction chromatography-triple detection

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Hyojoon Lee, Jinseok Yang, Taihyun Chang
Size exclusion chromatography (SEC) coupled with triple detection (TD) method is widely used for branching analysis of polymers. However, there is an inherent limitation of SEC-TD method that SEC separates polymers according their hydrodynamic size. The SEC resolution of branched polymers is not high since the hydrodynamic size of branched polymers does not change as much as linear polymers with molecular weight (MW), let alone the serious band-broadening in SEC. As a solution of the problem, we propose temperature gradient interaction chromatography (TGIC)-TD method taking advantage of TGIC's characteristics of separating branched polymers according to their MW with much higher resolution than SEC. The potential of the method was demonstrated using regular star-shaped polybutadienes prepared by anionic polymerization. They are characterized by both SEC-TD and TGIC-TD methods. Detailed analysis of branch distribution is possible for narrow MW fractions in TGIC-TD while SEC-TD only provides with average branch number for SEC fractions.

Graphical abstract

http://ift.tt/2kJ2fY9

One-step enzymatic synthesis of poly(p-dioxanone-co-butylene-co-succinate) copolyesters with well-defined structure and enhanced degradability

Publication date: 24 February 2017
Source:Polymer, Volume 111
Author(s): Wu-Cheng Nie, Hai-Chun Dang, Xiu-Li Wang, Fei Song, Yu-Zhong Wang
In this work, we present a mild one-step enzymatic-catalyzed copolymerization of diethyl succinate, 1,4-butanediol and p-dioxanone (PDO) to synthesize poly(p-dioxanone-co-butylene-co-succinate) copolyesters. Their chemical structure, triad distributions, and molecular weight of the copolyesters are characterized by ¹H NMR, ¹³C NMR and GPC. All copolyesters have narrow molecular weight polydispersity (1.3–1.5) and higher molecular weight (Mw) values (23700–33200 g mol⁻¹), which are well controlled by varying the amount of PDO units from 9 to 30 mol%. NMR, DSC, and XRD results show that copolyesters are semicrystalline random copolyesters and thermal properties depended on their composition. Furthermore, the degradation rate of the poly(p-dioxanone-co-butylene-co-succinate) are enhanced compared to PBS.

Graphical abstract

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Adhesion of blended polymer films

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Christopher Staszel, Suman Sinha-Ray, Alexander L. Yarin, Behnam Pourdeyhimi
In this work, the adhesion energies of two dissimilar polymer films after thermal bonding are studied. The films were formed from the emulsions of polycaprolactone (PCL) and nylon-6 (N6) spin-coated onto metal substrates. After that, the solidified blend polymer films on the metal substrates were faced with additional PCL films on metal substrates and thermally bonded to them. The surface structure of blend films was elucidated prior to thermal bonding by staining them using Rhodamine B. The dye stained only N6 leaving PCL undyed and the exposed structure was analyzed using digital photography, which revealed the surface concentration of PCL, as well as the N6 and PCL distributions over the surfaces. It was discovered that PCL-N6 domains would remain partially mixed, influencing the adhesion energy measured.

Graphical abstract

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Strain sensing behaviors of epoxy nanocomposites with carbon nanotubes under cyclic deformation

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Xiaohan Cao, Xiangdong Wei, Guojie Li, Chao Hu, Kun Dai, Jiang Guo, Guoqiang Zheng, Chuntai Liu, Changyu Shen, Zhanhu Guo
The strain sensing behavior of multi-walled carbon nanotubes (MWCNT)/epoxy (EP) conductive composites subjected to tensile strain was studied in detail. With increasing the load to rupture, the responsivity (ΔR/R0, R0 is the original resistance, ΔR is instantaneous change in resistance) increased in a linear fashion and then began to decrease at a critical strain (εc), which was remarkably different from the thermoplastic conductive composites only with a monotonic increase of the responsivity. It was attributed to the decrease of the nanotube contact points, the increase in the gaps before εc, and the reorientation and violent alignment of nanotubes in the zones of high local deformation (after εc). In addition, when the extension-retraction cycles were applied, the values of max ΔR/R0 showed a distinct tendency with different strains around the εc. These behaviors were attributed to the competition of network destruction and reconstruction during the cyclic deformation. The mechanism of this unique sensing behavior was proposed as well.

Graphical abstract

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Crystal structures and phase transition behavior of Poly(nonamethylene terephthalamide) and its model compounds

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Hiroko Yamamoto, Kohji Tashiro, Kiyotaka Ishino, Masahide Takahashi, Ryokei Endo, Mitsunori Asada, Yaqi Li, Katsuyoshi Katsube, Takahiro Ishii
The crystal structure and phase transition behavior of poly(nonamethylene terephthalamide) (PA9T, -[CO-C6H4-CONH-(CH2)9-NH]n-) and its related model compounds (ATm,C6H5-CONH-(CH2)m-NHCO-C6H5 (m = 7–12)) have been investigated by carrying out the temperature dependent measurements of wide-angle X-ray diffraction (WAXD), small-angle X-ray scattering (SAXS) and infrared spectra along with the DSC measurement. The crystal structure of PA9T at room temperature was determined by analyzing the X-ray diffraction diagram measured for the uniaxially-oriented sample. The nonamethylene segmental part takes the zigzag conformation, which was supported by the quantitative analysis of the methylene progression bands observed in the infrared spectra. The temperature dependence of WAXD, SAXS and infrared spectra of PA9T revealed the existence of the 2-staged order-to-disorder phase transitions: at room temperature this polymer exists as phase I, the crystal structure of which was analyzed as mentioned above. In the relatively low and wide temperature region (190–270 °C for the unoriented sample), phase I transforms to phase II, in which the methylene conformation is disordered, the aromatic amide part is slightly rotated and the intermolecular hydrogen bonds become weaker but the hydrogen bonds are still kept alive. In the temperature region immediately below the melting point (270–310 °C for the unoriented sample), the phase II is melted once and recrystallizes into phase III, where the intermolecular hydrogen bonds are mostly broken in addition to the further disordering of the methylene segments and aromatic amide groups. The thus-occurring violent thermal motions cause a remarkable increase of the long period in this transition region. The molecular chains are still highly oriented and so the phase III may be assumed to be in a kind of liquid crystalline state. The crystal structural changes detected in these phase transitions of PA9T were confirmed by the analysis of the X-ray diffraction and IR spectral data collected for the low molecular-weight model compounds.

Graphical abstract

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Diverse morphological formations and lamellar dimensions of poly(ε-caprolactone) crystals in the monolayers grafted onto solid substrates

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Takayuki Ikehara, Toshiyuki Kataoka
Poly(ε-caprolactone) (PCL) chains grafted onto Si substrates, namely PCL brushes, exhibited diverse structures such as dendrites, branched linear crystals, and curved crystals with dendrites when they were isothermally crystallized from melts. The crystallization was possible over a wide range of temperature. The discussion on the lamellar thickness of the dendrites indicated that the equilibrium melting point, Tm^°, in a grafted layer was higher than the values reported for bulk-crystallized PCL and that the surface free energy of the fold surfaces of lamellae was within the range reported so for. The value of Tm^° implied that the conformational entropy is reduced in the grafted layers than in bulk. The grafted layers were prepared using a novel "grafting-to" method, where the middle parts of the polymer molecules, instead of the chain ends, are reacted to silanized Si substrates.

Graphical abstract

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Preparation of amorphous nanocomposites with quick heat triggered shape memory behavior

Publication date: Available online 30 January 2017
Source:Polymer
Author(s): Masoud Babaahmadi, Mohammad Sabzi, Gholam Reza Mahdavinia, Mohsen Keramati
The aim of this work was to prepare shape memory materials from poly(vinyl acetate) (PVAc), a low-cost commercial polymer, through the simple solution mixing method without need for complex synthetic routes. However, neat PVAc with inherent low strength and modulus exhibited inappropriate shape memory behavior. Therefore, stiff graphene nanoplatelets were incorporated within the PVAc matrix to improve its thermomechanical properties. Transmission electron microscopy (TEM) observations showed that graphene nanoplatelets built up a dense 3D network throughout PVAc. Furthermore, tensile and dynamic mechanical analysis (DMA) results demonstrated that the strength and modulus of PVAc were noticeably enhanced by introducing graphene nanoplatelets. DMA revealed that the PVAc/graphene nanocomposites possess excellent shape memory properties, as the fixation ratio (Rf) and recovery ratio (Rr) could be as high as 99.8 and 98.2%, respectively, and the original shape recovery time was ∼5 s. The remarkable improvement in the shape memory properties of nanocomposites was correlated to great stored elastic strain energy in nanocomposites providing a high driving force for subsequent quick and almost complete shape recovery. In addition, enhanced heat transfer rate in the presence of graphene network can also account for high speed thermal actuation of the developed nanocomposites.

Graphical abstract

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Ixekizumab: A Review in Moderate to Severe Plaque Psoriasis

Abstract

Ixekizumab (Taltz^®) is a subcutaneously administered, humanized anti-interleukin-17A monoclonal antibody indicated for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy (USA and EU) or phototherapy (USA). In the phase 3 UNCOVER trials in this patient population, ixekizumab was superior to placebo or etanercept in terms of the proportion of patients achieving a ≥75% reduction from baseline in the Psoriasis Area and Severity Index and in those achieving a static Physician Global Assessment score of 0 or 1, after 12 weeks of induction treatment. Clinical responses to ixekizumab were seen as early as week 1. Patients receiving ixekizumab also reported improvements in health-related quality of life, itching, and work productivity. Clinical responses to ixekizumab were sustained during additional 48 weeks of maintenance treatment. Ixekizumab was generally well tolerated and exhibited low immunogenicity in the UNCOVER trials during up to 60 weeks of therapy. Currently available data indicate that ixekizumab is an effective and generally well tolerated treatment option for patients with moderate to severe plaque psoriasis. It has the potential advantage of one maintenance dose for every 4 weeks.

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Trauma associated sleep disorder: a parasomnia induced by trauma

Nightmares and disruptive nocturnal behaviors that develop after traumatic experiences have long been recognized as having different clinical characteristics that overlap with other established parasomnia diagnoses. The inciting experience is typically in the setting of extreme traumatic stress coupled with periods of sleep disruption and/or deprivation. The limited number of laboratory documented cases and symptomatic overlap with REM sleep behavior disorder (RBD) and posttraumatic stress disorder (PTSD) have contributed to difficulties in identifying what is a unique parasomnia.

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Low Yield of Chest Radiography in General Inpatients and Outpatients with “Positive PPD” Results in a Country with Low Prevalence of TB

Publication date: Available online 30 January 2017
Source:Academic Radiology
Author(s): Ronald L. Eisenberg, Benedikt H. Heidinger
Rationale and ObjectivesThe purpose of this study was to assess the frequency and spectrum of abnormalities on routine screening chest radiographs among inpatients and outpatients with "positive purified protein derivative (PPD)" in a large tertiary care academic medical center in a country with low prevalence of tuberculosis (TB).Materials and MethodsThe reports of all chest radiographs of general inpatients and outpatients referred for positive PPD (2010–2014) were evaluated for the frequency of evidence of active or latent TB and the spectrum of imaging findings. The results of additional chest radiographs and computed tomography scans were recorded, as were additional relevant clinical histories and symptoms.ResultsOf the 2518 patients who underwent chest radiography for positive PPD, the radiographs were normal in 91.3%. The vast majority of the abnormal radiographs demonstrated findings consistent with old tuberculous disease. There were three cases (0.1%) of active TB, all of which were either recent immigrants from an endemic area or had other relevant histories or clinical symptoms suggestive of the disease.ConclusionsUniversal chest radiography in general inpatient and outpatient populations referred for positive PPD is of low yield for detecting active disease in a country with low prevalence of TB.



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Intraductal Papillary Mucinous Neoplasms of the Pancreas

Publication date: Available online 30 January 2017
Source:Academic Radiology
Author(s): Wanbo Xu, Xiaojin Liu, Jiawen Zhang, Li Yang
Rationale and ObjectivesIntraductal papillary mucinous neoplasms (IPMNs) are precancerous lesions of the pancreas. Computed tomography (CT) has been recommended to screen the malignant potential of IPMNs. However, data evaluating the use of CT to differentiate categories of IPMN based on disease progression are limited. This study aimed to explore the correlation between CT characteristics and pathology in IPMN associated with invasive carcinoma.Materials and MethodsA total of 31 patients with intraductal papillary mucinous carcinoma (IPMC) treated at one local regional hospital in Shanghai, China, were enrolled in this study. Patients were divided into two groups based on invasion component and characterized as follows: group A, an invasive component of less than 50% (IPMC-I); and group B, with invasion of 50% or greater and defined as pancreatic ductal adenocarcinoma associated with IPMN (PDAC-IPMN). First, we analyzed the imaging information of the 31 patients retrospectively. Then, we compared the imaging differences between the two groups.ResultsFifteen patients with IPMC-1 and 16 patients with PDAC-IPMN were identified. There was no statistically significant difference in sex, age, lesion location, radiologic type, tumor size, mural nodule size, and lymphatic metastasis between the two groups. However, the arterial increased CT values were significantly different between the two groups (P < .01), with values of 29.2 ± 12.4 HU for group A and 14.2 ± 8.8 HU for group B. The venous increased CT values were 44.6 ± 12.0 HU for group A and 28.4 ± 12.3 HU for group B, and these were significantly different between the two groups (P < .01). In group A, 13 cases (86.7%) were classified as T1 or T2 stage, and in group B, eight cases (50.0%) were classified as T1 and T2 stage. There was a statistically significant difference in tumor classification between group A and group B patients (P < .05).ConclusionsIPMC-I and PDAC-IPMN have different characteristics in CT imaging, and we demonstrated that CT scans based on blood supply and lymphatic metastasis could be used to evaluate and potentially screen for variation in IPMC disease outcomes.



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Professional Social Networking in Radiology: Who Is There and What Are They Doing?

Publication date: Available online 30 January 2017
Source:Academic Radiology
Author(s): Sumir S. Patel, C. Matthew Hawkins, James V. Rawson, Jenny K. Hoang
Rationale and ObjectivesAlthough it is perceived that the use of social media professionally is increasing among radiologists, little is known about the habits and demographics of this subspecialty. This study aims to compare radiologists who use social networking for professional purposes to those who do not with regard to their characteristics, habits, and attitudes.Materials and MethodsRadiologists were invited by e-mail and through posts on social networks to participate in a survey on the use of social media platforms. Questions included type of user, pattern of use, and benefits and barriers. Professional users and professional nonusers were compared.ResultsOne hundred eighty-six radiologists responded. One hundred ten (59.1%) used social networking for professional purposes, 34 (18.2%) for personal-use only, and 42 (22.6%) denied using social media. LinkedIn was the most common platform among all professional users, and Twitter was the most commonly used platform among highly active professional users. Trainees comprised 52 out of 110 (47.3%) professional social networking users compared to 18 out of 76 (23.7%) nonusers (P < 0.01). A subgroup analysis on Twitter use for professional purposes revealed a significant gender difference: 15 out of 66 (22.7%) professional Twitter users were female compared to 48 out of 120 (40.0%) non-Twitter users (P < 0.05). The greatest barrier to professional social media use for nonusers was confidentiality.ConclusionNearly 60% of radiologist respondents use social networking for professional purposes. Radiology is likely to see growth in the role of social networking in the coming years as nearly half of professional users are radiology trainees. Twitter use for professional purposes among radiologists was disproportionately male. It is important to be cognizant of gender imbalance and to improve visibility of female leaders on social networking.



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Development and Assessment of a Novel Task Trainer and Targeting Tasks for Ultrasound-guided Invasive Procedures

Publication date: Available online 30 January 2017
Source:Academic Radiology
Author(s): Joshua F. Nitsche, Kristina M. Shumard, Brian C. Brost
Rationale and ObjectivesThe American Institute of Ultrasound in Medicine (AIUM) recommends that all providers performing ultrasound-guided invasive procedures be competent in a core set of guidance skills common to all ultrasound-guided procedures, including in-plane and out-of-plane needle guidance and needle imaging optimization techniques such as probe translation, rotation, and heel-toe standoff. To allow for the practice and assessment of these core skills, we have created a novel task trainer and set of targeting tasks, and sought to obtain validity evidence in the content and response process domains for this training and assessment system according to the Standards for Educational and Psychological Testing.Materials and MethodsWe have constructed an ultrasound-guided invasive procedure training system and five targeting tasks that focused on the needle guidance skills outlined by the AIUM. All tasks were performed by obstetrics and gynecology or maternal-fetal medicine physicians with and without experience in ultrasound-guided invasive procedures during a series of simulation workshops. All participants completed a survey regarding the trainer's and the tasks' usefulness in the training of inexperienced physicians.ResultsThe physicians who completed the tasks had favorable views of task trainer and curriculum. The targeting curriculum was felt to allow practice of all of the core guidance skills outlined by the AIUM. The average response provided for all of the tasks was 4.0 or greater, with half of the items having an average response of 4.5 or higher.ConclusionsWe have constructed a task trainer that incorporates all of the core skills outlined by the AIUM. All five tasks received very favorable reviews from both experienced and inexperienced providers. Taken together, our findings suggest they have strong content and response process validity evidence.



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Regulation of antimicrobial resistance by extracytoplasmic function (ECF) sigma factors

Publication date: Available online 30 January 2017
Source:Microbes and Infection
Author(s): Emily C. Woods, Shonna M. McBride
Extracytoplasmic function (ECF) sigma factors are a subfamily of σ⁷⁰ sigma factors that activate genes involved in stress-response functions. In many bacteria, ECF sigma factors regulate resistance to antimicrobial compounds. This review will summarize the ECF sigma factors that regulate antimicrobial resistance in model organisms and clinically relevant pathogens.



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A big thank you to our reviewers in the past year!

Exp Clin Endocrinol Diabetes 2017; 125: 1-3
DOI: 10.1055/s-0042-123975

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Stereotactic body radiotherapy (SBRT) in recurrent or oligometastatic pancreatic cancer

Abstract

Background

Stereotactic body radiotherapy (SBRT) in pancreatic cancer can be limited by its proximity to organs at risk (OAR). In this analysis, we evaluated the toxicity and efficacy of two different treatment approaches in patients with locally recurrent or oligometastatic pancreatic cancer.

Materials and methods

According to the prescription method, patients were divided in two cohorts (C1 and C2). The planning target volume (PTV) was created through a 4 mm expansion of the internal target volume. In C2, a subvolume was additionally created, a simultaneous integrated protection (SIP), which is the overlap of the PTV with the planning risk volume of an OAR to which we prescribed a reduced dose.

Results

In all, 18 patients were treated (7 with local recurrences, 9 for oligometastases, 2 for both). Twelve of 23 lesions were treated without SIP (C1) and 11 with SIP (C2). The median follow-up was 12.8 months. Median overall survival (OS) was 13.2 (95% confidence interval [CI] 9.8–14.6) months. The OS rates at 6 and 12 months were 87 and 58%, respectively. Freedom from local progression for combined cohorts at 6 and 12 months was 93 and 67% (95% CI 15–36), respectively. Local control was not statistically different between the two groups. One patient in C2 experienced grade ≥3 acute toxicities and 1 patient in C1 experienced a grade ≥3 late toxicity.

Conclusion

The SIP approach is a useful prescription method for abdominal SBRT with a favorable toxicity profile which does not compromise local control and overall survival despite dose sacrifices in small subvolumes.

http://ift.tt/2jOr83B

Ultrastructural changes in peripheral arteries and nerves in diabetic ischemic lower limbs, by electron microscope

Publication date: Available online 30 January 2017
Source:Alexandria Journal of Medicine
Author(s): Mohamed E. Salem, Abdel-Azzem A. Ismael, Amr Salem, Tarek Salem
BackgroundThe results of "light and electron microscopic study" of the peripheral arteries and nerves biopsies in diabetic neuropathy comparing with biopsies of normal arteries and nerves of traumatic amputation as a control group.Aim of the workTo evaluate the "electron microscopic changes" in the peripheral small arteries and nerves in the diabetic ischemic lower limbs.Patients and methodsFrom January 2015 to June 2016 a total number of 20 patients with diabetic ischemic lower limbs (Diabetic patients group) compared with 20 non diabetic non ischemic persons as (Control group) who undergone traumatic lower limb amputation. All cases were subjected to complete history taking, complete clinical examination, and routine laboratory investigations. "Light and electron microscopic studies" of biopsies from the peripheral small arteries and nerves e.g. digital or posterior tibial arteries and nerves during amputation of diabetic gangrene of the toes, below knee, above knee amputation and from traumatic amputation of the control group.ResultsThe results of an "electron microscopic study" of diabetic peripheral arteries and nerves biopsies, 12 out of 20 cases showed thrombi in small vessels. In some small vessels, masses of fibrin were seen within the lumen. In other vessels, older thrombi were present. 17 out of 20 cases showed endothelial cells hyperplasia in some vessels. The degree of hyperplasia was sufficient to occlude the lumen of the vessels. Some vessels showed degenerate pericytes and endothelial cells which contained large lipid droplets. The peripheral nerves showed patchy demyelination, areas of degeneration and regeneration, areas of infarction and necrosis and collagen fibers deposition. Among the control group, no cases contained thrombi, degenerated vessels, degenerate pericytes or lipid droplets within the endothelial cells.ConclusionThe present study found that the diabetic microangiopathy is the main cause of diabetic neuropathy and diabetic foot lesions.



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Effectiveness of antiangiogenic drugs in glioblastoma patients: a systematic review and meta-analysis of randomized clinical trials

Publication date: Available online 30 January 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Giuseppe Lombardi, Ardi Pambuku, Luisa Bellu, Miriam Farina, Della Puppa Alessandro, Denaro Luca, Vittorina Zagonel
Backgroundglioblastomas are highly vascularized tumors and various antiangiogenic drugs have been investigated in clinical trials showing unclear results. We performed a systematic review and a meta-analysis to clarify and evaluate their effectiveness in glioblastoma patients.Patients and methodswe searched relevant published and unpublished randomized clinical trials analyzing antiangiogenic drugs versus chemotherapy in glioblastoma patients from January 2006 to January 2016 in MEDLINE, WEB of SCIENCE, ASCO, ESMO and SNO databases.Resultsfourteen randomized clinical trials were identified (7 with bevacizumab, 2 cilengitide, 1 enzastaurin, 1 dasatinib, 1 vandetanib, 1 temsirolimus, 1 cediranib) were identified including 4330 patients. Antiangiogenic drugs showed no improvement in overall survival with a pooled HR of 1.00, a trend for an inferior outcome, in terms of overall survival, was observed in the group of patients receiving antiangiogenic drug alone compared to cytotoxic drug alone (HR=1.24, p=0.056). Bevacizumab did not improve overall survival. Twelve trials (4113 patients) were analyzed for progression-free survival. Among antiangiogenic drugs, only bevacizumab demonstrated an improvement of progression-free survival (HR=0.63, p<0.001), both alone (HR=0.60, p=0.003) or in combination to chemotherapy (HR=0.63; p<0.001), both as first-line treatment (HR=0.70, p<0.001) or in recurrent disease (HR=0.52, p<0.001).Conclusionsantiangiogenic drugs did not improve overall survival in glioblastoma patients, either as first or second-line treatment, and either as single agent or in combination with chemotherapy. Among antiangiogenic drugs, only bevacizumab improved progression-free survival regardless of treatment line, both as single agent or in combination with chemotherapy



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Health risk assessment of cadmium pollution emergency for urban populations in Foshan City, China

Abstract

With rapid socioeconomic development, water pollution emergency has become increasingly common and could potentially harm the environment and human health, especially heavy metal pollution. In this paper, we investigate the Cd pollution emergency that occurred in the Pearl River network, China, in 2005, and we build a migration and transformation model for heavy metals to simulate the spatiotemporal distribution of Cd concentrations under various scenarios of Cd pollution emergency in Foshan City. Moreover, human health hazard and carcinogenic risk for local residents of Foshan City were evaluated. The primary conclusions were as follows: (1) the number of carcinogen-affected people per year under scenario 1 reached 254.41 when the frequency was 0.1 year/time; specifically, the number of people with cancer per year in the area of the Datang, Lubao, and Nanbian waterworks was 189.36 accounting for 74% of the total number per year; (2) at the frequency of 5 years/time, the Lubao waterwork is the only one in extremely high- or high-risk grade, while besides it, the risk grade in the Datang, Nanbian, Xinan, Shitang, and Jianlibao waterworks is in the extremely high or high grade when the frequency is 0.1 year/time; (3) when Cd pollution accidents with the same level occurs again, Cd concentration decreases to a low level in the water only if the migration distance of Cd is at least 40–50 km. Based on the health risk assessment of Cd pollution, this study gives the recommendation that the distance should keep above 50 km in tidal river network of the Pearl River Delta between those factories existing the possibility of heavy metal pollution and the drinking water source. Only then can the public protect themselves from hazardous effects of higher levels of heavy metal.

http://ift.tt/2kkslDs

Impact of aeration disturbances on endogenous phosphorus fractions and their algae growth potential from malodorous river sediment

Abstract

The present work assessed the impact of aeration disturbances on sediment-bound phosphorus fractions and their algae growth potential from a typical malodorous river. Phosphorus was sequentially extracted by a modified version of Hedley fractionation method. It was found that the mean contents of TP was 1476.1 ± 60.3 mg/kg, consisting mainly of dilute HCl-extractable P (52.6%) and NaOH-P (19.2%). The algae growth potential tests demonstrated that algae growth had varied P-level requirements for different P speciation and NaOH-P promoted algae growth remarkably and its promoting effect was positively related to its concentration. Additionally, intermittent overlying water aeration modes were recommended, and run 1 (7.0 mg/L, 12 h) was deemed as the optimized aerated mode in terms of its relatively low ecological risk and high P retention. It was noted that NaOH-P was most affected by aeration disturbance and exhibited marked increase with the elevated dissolved oxygen (DO) level whether for intermittent overlying water or sediment aeration. This research helps to gain improved understanding of the ecological risk on sediment P, and NaOH-P is recognized as one ecologically important P fraction in the sediments considering its relatively high proportion and bioavailability.

http://ift.tt/2jwpjaV

“To make a molehill out of a mountain”: An ERP-study on cognitive reappraisal of negative pictures in children with and without ADHD

Publication date: Available online 30 January 2017
Source:Clinical Neurophysiology
Author(s): Valerie Van Cauwenberge, Rachida El Kaddouri, Karel Hoppenbrouwers, Jan R. Wiersema
ObjectiveWe investigated cognitive reappraisal in children with ADHD by means of the late positive potential (LPP) and self-report ratings. We expected diminished LPP modulation following reappraisal and lower self-report scores in children with ADHD.MethodsEighteen children with ADHD and 24 typically developing (TD) children (8-12 years) performed a cognitive reappraisal task, while EEG was recorded, and filled out a questionnaire on cognitive reappraisal.ResultsDespite the lack of main reappraisal effects on LPP, LPP were less positively modulated during reappraisal in ADHD compared to TD children.ConclusionsChildren with ADHD reported less use of reappraisal and could be distinguished from TD children based on LLP modulation. However the lack of main effects of reappraisal on LPP in both groups hinders clear interpretation of this finding and questions the suitability of LPP modulation within the current paradigm as a neural index of reappraisal in children 8-12 years old, and warrants further research on the inter-individual variability and sensitivity of LPP modulation as a neural index of emotion regulation in children.SignificanceThis is the first study investigating the LPP during cognitive reappraisal in children with ADHD.



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Impact of volume-conducted potential in interpretation of cortico-cortical evoked potential: detailed analysis of high-resolution electrocorticography using two mathematical approaches

Publication date: Available online 30 January 2017
Source:Clinical Neurophysiology
Author(s): Seijiro Shimada, Naoto Kunii, Kensuke Kawai, Takeshi Matsuo, Yohei Ishishita, Kenji Ibayashi, Nobuhito Saito
ObjectiveCortico-cortical evoked potential (CCEP) has been utilized to evaluate connectivity between cortices. However, previous reports have rarely referred to the impact of volume-conducted potential (VCP) which must be a confounding factor of large potential around the stimulation site. To address this issue, we challenged the null hypothesis that VCP accounts for the majority of the recorded potential, particularly around the stimulation site.MethodsCCEP was recorded with high-density intracranial electrodes in 8 patients with intractable epilepsy. First, we performed regression analysis for describing the relationship between the distance and potential of each electrode. Second, we performed principal component analysis (PCA) to reveal the temporal features of recorded waveforms.ResultsThe regression curve, declining by the inverse square of the distance, fitted tightly to the plots (R²: 0.878 to 0.991) with outliers. PCA suggested the responses around the stimulation site had the same temporal features. We also observed the continuous declination over the anatomical gap and the phase reversal phenomena around the stimulation site.ConclusionsThese results were consistent with the null hypothesis.SignificanceThis study highlighted the risk of misinterpreting CCEP mapping, and proposed mathematical removal of VCP, which could lead to more reliable mapping based on CCEP.



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Magnetoencephalography with temporal spread imaging to visualize propagation of epileptic activity

Publication date: Available online 30 January 2017
Source:Clinical Neurophysiology
Author(s): Sumiya Shibata, Masao Matsuhashi, Takeharu Kunieda, Yukihiro Yamao, Rika Inano, Takayuki Kikuchi, Hisaji Imamura, Shigetoshi Takaya, Riki Matsumoto, Akio Ikeda, Ryosuke Takahashi, Tatsuya Mima, Hidenao Fukuyama, Nobuhiro Mikuni, Susumu Miyamoto
ObjectiveWe describe temporal spread imaging (TSI) that can identify the spatiotemporal pattern of epileptic activity using Magnetoencephalography (MEG).MethodsA three-dimensional grid of voxels covering the brain is created. The array-gain minimum-variance spatial filter is applied to an interictal spike to estimate the magnitude of the source and the time (Ta) when the magnitude exceeds a predefined threshold at each voxel. This calculation is performed through all spikes. Each voxel has the mean Ta (<Ta>) and spike number (Nsp), which is the number of spikes whose source exceeds the threshold. Then, a random resampling method is used to determine the cutoff value of Nsp for the statistically reproducible pattern of the activity. Finally, all the voxels where the source exceeds the threshold reproducibly shown on the MRI with a color scale representing <Ta>.ResultsFour patients with intractable mesial temporal lobe epilepsy (MTLE) were analyzed. In three patients, the common pattern of the overlap between the propagation and the hypometabolism shown by fluorodeoxyglucose-positron emission tomography (FDG-PET) was identified.ConclusionsTSI can visualize statistically reproducible patterns of the temporal and spatial spread of epileptic activity.SignificanceTSI can assess the statistical significance of the spatiotemporal pattern based on its reproducibility.



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Prescription drug monitoring programs, nonmedical use of prescription drugs, and heroin use: Evidence from the National Survey of Drug Use and Health

Publication date: June 2017
Source:Addictive Behaviors, Volume 69
Author(s): Mir M. Ali, William N. Dowd, Timothy Classen, Ryan Mutter, Scott P. Novak
In the United States, nonmedical prescription opioid use is a major public health concern. Various policy initiatives have been undertaken to tackle this crisis, including state prescription drug monitoring programs (PDMPs). This study uses the 2004–2014 National Survey of Drug Use and Health (NSDUH) and exploits state-level variation in the timing of PDMP implementation and PDMP characteristics to investigate whether PDMPs are associated with a reduction in prescription opioid misuse or whether they have the unintended consequence of increasing heroin use. In addition, the study examines the impact of PDMPs on the availability of opioids from various sources. The study finds no effect of PDMP status on various measures of nonmedical prescription opioid use (abuse, dependence, and initiation), but finds evidence of a reduction in the number of days of opioid misuse in the past year. The study also finds that implementation of PDMP was not associated with an increase in heroin use or initiation, but was associated with an increase in number of days of heroin use in the past year. Findings also suggest that PDMPs were associated with a significant decline in doctor shopping among individuals without increasing reliance on illegal sources (e.g., drug dealers, stealing, etc.) or social sources (friends or relatives) as a means of obtaining opioids. The President's FY2017 budget proposed the allocation of $1.1 billion in an effort to reduce prescription drug misuse, and highlighted the use of PDMPs as a policy tool. This study documents evidence that PDMPs might be having measurable impact.



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National Election Results: The Potential Impact on the ACC, Its Members, and Our Patients

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Correction

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Safety of Very Low Low-Density Lipoprotein Cholesterol Levels With Alirocumab: Pooled Data From Randomized Trials

AbstractBackground

Proprotein convertase subtilisin/kexin type 9 monoclonal antibodies can reduce low-density lipoprotein cholesterol (LDL-C) to very low levels when added to background lipid-lowering therapy.

Objectives

The safety of alirocumab was evaluated in patients with at least 2 consecutive LDL-C values <25 or <15 mg/dl in the ODYSSEY program, with follow-up as long as 104 weeks.

Methods

Pooled data from 14 trials were analyzed (double-blind treatment 8 to 104 weeks; n = 3,340 alirocumab, n = 1,894 control [placebo or ezetimibe]; representing 4,029 [alirocumab] and 2,114 [control] double-blind patient-years' exposure).

Results

In alirocumab-treated patients, 839 (25.1%) achieved 2 consecutive LDL-C values <25 mg/dl, and 314 (9.4%) achieved <15 mg/dl. Baseline LDL-C was lower (mean 100.3 vs. 134.3 mg/dl) in patients with LDL-C <25 versus ≥25 mg/dl. Similar rates of adverse events occurred in patients achieving LDL-C <25 and <15 mg/dl (72.7% and 71.7%, respectively), compared with 76.6% in those who did not achieve LDL-C <25 mg/dl. Neurological and neurocognitive events were similar among the 3 groups. In a propensity score analysis, the rate of cataracts was higher in patients with LDL-C <25 mg/dl (2.6%) versus ≥25 mg/dl (0.8%; hazard ratio: 3.40; 95% confidence interval: 1.58 to 7.35). However, no difference in cataract incidence was observed between pooled alirocumab and control groups.

Conclusions

LDL-C levels <25 or <15 mg/dl on alirocumab were not associated with an increase in overall treatment-emergent adverse event rates or neurocognitive events, although cataract incidence appeared to be increased in the group achieving LDL-C levels <25 mg/dl. (Pooled analyses of already reported trials; NCT01288443, NCT01288469, NCT01266876, NCT01812707, NCT01507831, NCT01617655, NCT01623115, NCT01709500, NCT01644175, NCT01644188, NCT01730040, NCT01730053, NCT01644474, and NCT01709513)

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Reply: Percutaneous Revascularization of Left Main Disease: Could the Angiographic Follow-Up Improve the Survival?

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Low-Density Lipoprotein Cholesterol and the On-Target Effects of Therapy: How Low Is Too Low?

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Mode of Death in Heart Failure With Preserved Ejection Fraction

Abstract

Little is known about specific modes of death in patients with heart failure with preserved ejection fraction (HFpEF). Herein, the authors critically appraise the current state of data and offer potential future directions. They conducted a systematic review of 1,608 published HFpEF papers from January 1, 1985, to December 31, 2015, which yielded 8 randomized clinical trials and 24 epidemiological studies with mode-of-death data. Noncardiovascular modes of death represent an important competing risk in HFpEF. Although sudden death accounted for ~25% to 30% of deaths in trials, its definition is nonspecific; it is unclear what proportion represents arrhythmic deaths. Moving forward, reporting and definitions of modes of death must be standardized and tailored to the HFpEF population. Broad-scale systematic autopsies and long-term rhythm monitoring may clarify the underlying pathology and mechanisms driving mortal events. There is an unmet need for a longitudinal multicenter, global registry of patients with HFpEF to map its natural history.

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Outcomes of Intensive Blood Pressure Lowering in Older Hypertensive Patients

AbstractBackground

The 2014 Eighth Joint National Committee panel recommended a therapeutic target of systolic blood pressure (BP) <150 mm Hg in patients ≥60 years of age, a departure from prior recommendation of <140 mm Hg.

Objectives

This study assessed the efficacy and safety of intensive BP-lowering strategies in older (age ≥65 years) hypertensive patients.

Methods

The MEDLINE, Scopus, EMBASE, and Cochrane databases were searched for all relevant randomized controlled trials from 1965 through July 1, 2016. Cardiovascular (major adverse cardiovascular events [MACE], cardiovascular mortality, stroke, myocardial infarction, and heart failure), and safety (serious adverse events and renal failure) were evaluated. Random and fixed effects analysis were used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs).

Results

We identified 4 high-quality trials involving 10,857 older hypertensive patients with a mean follow-up of 3.1 years. Intensive BP lowering was associated with a 29% reduction in MACE (RR: 0.71; 95% CI: 0.60 to 0.84), 33% in cardiovascular mortality (RR: 0.67; 95% CI: 0.45 to 0.98), and 37% in heart failure (RR: 0.63; 95% CI: 0.43 to 0.99) compared with standard BP lowering. Rates of myocardial infarction and stroke did not differ between the 2 groups. There was no significant difference in the incidence of serious adverse events (RR: 1.02; 95% CI: 0.94 to 1.09) or renal failure (RR: 1.81; 95% CI: 0.86 to 3.80) between the 2 groups. The fixed effects model yielded largely similar results, except for an increase in the risk of renal failure (RR: 2.03; 95% CI: 1.30 to 3.18) with intensive BP-lowering therapy.

Conclusions

In older hypertensive patients, intensive BP control (systolic BP <140 mm Hg) decreased MACE, including cardiovascular mortality and heart failure. Data on adverse events were limited, but suggested an increased risk of renal failure. When considering intensive BP control, clinicians should carefully weigh benefits against potential risks.

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Development of a Right Ventricular Outflow Tract Gradient During Upright Exercise: A Hemodynamic Observation

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Searching for the Optimal Blood Pressure Range in the Elderly: Are We There Yet?

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Reply: Medication Adherence and Cardiovascular Outcomes

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Isolated Subepicardial Right Ventricular Outflow Tract Scar in Athletes With Ventricular Tachycardia

AbstractBackground

High-level endurance training has been associated with right ventricular pathological remodeling and ventricular tachycardia (VT). Although overlap with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been suggested, the arrhythmogenic substrate for VTs in athletes is unknown.

Objectives

The goal of this study was to evaluate whether electroanatomic scar patterns related to sustained VT can distinguish exercise-induced arrhythmogenic remodeling from ARVC and post-inflammatory cardiomyopathies.

Methods

In 57 consecutive patients (mean age 48 ± 16 years; 83% male) undergoing catheter ablation for scar-related right ventricular VT, 2 distinct scar distributions were identified: 1) scars involving the subtricuspid right ventricle in 46 patients (group A); and 2) scars restricted to the anterior subepicardial right ventricular outflow tract in 11 patients (group B).

Results

Definite ARVC or post-inflammatory cardiomyopathy was diagnosed in 40 (87%) of 46 group A patients but was not diagnosed in any patients in group B. All group B patients underwent intensive endurance training for a median of 15 h/week (interquartile range [IQR]: 10 to 20 h/week) for a median of 13 years (IQR: 10 to 18 years). The cycle lengths of scar-related VTs were significantly faster in group B patients (257 ± 34 ms vs. 328 ± 72 ms in group A; p = 0.003). Catheter ablation resulted in complete procedural success in 10 (91%) of 11 group B patients compared with 26 (57%) of 46 group A patients (p = 0.034). During a median follow-up of 27 months (IQR: 6 to 62 months), 50% of group A patients but none of the group B patients had a VT recurrence.

Conclusions

This study describes a novel clinical entity of an isolated subepicardial right ventricular outflow tract scar serving as a substrate for fast VT in high-level endurance athletes that can be successfully treated by ablation. This scar pattern may allow distinguishing exercise-induced arrhythmogenic remodeling from ARVC and post-inflammatory cardiomyopathy.

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Instructions For Authors

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Scar-Related Right Ventricular Tachycardias in Athletes: Too Much of a Good Thing?

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ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thor

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Transcaval Access and Closure for Transcatheter Aortic Valve Replacement: A Prospective Investigation

AbstractBackground

Transcaval access may enable fully percutaneous transcatheter aortic valve replacement (TAVR) without the hazards and discomfort of transthoracic (transapical or transaortic) access.

Objectives

The authors performed a prospective, independently adjudicated, multicenter, single-arm trial of transcaval access for TAVR in patients who were ineligible for femoral artery access and had high or prohibitive risk of complications from transthoracic access.

Methods

A total of 100 patients underwent attempted percutaneous transcaval access to the abdominal aorta by electrifying a caval guidewire and advancing it into a pre-positioned aortic snare. After exchanging for a rigid guidewire, conventional TAVR was performed through transcaval introducer sheaths. Transcaval access ports were closed with nitinol cardiac occluders. A core laboratory analyzed pre-discharge and 30-day abdominal computed tomograms. The Society of Thoracic Surgeons predicted risk of mortality was 9.6 ± 6.3%.

Results

Transcaval access was successful in 99 of 100 patients. Device success (access and closure with a nitinol cardiac occluder without death or emergency surgical rescue) occurred 98 of 99 patients; 1 subject had closure with a covered stent. Inpatient survival was 96%, and 30-day survival was 92%. Second Valve Academic Research Consortium (VARC-2) life-threatening bleeding and modified VARC-2 major vascular complications possibly related to transcaval access were 7% and 13%, respectively. Median length of stay was 4 days (range 2 to 6 days). There were no vascular complications after discharge.

Conclusions

Transcaval access enabled TAVR in patients who were not good candidates for transthoracic access. Bleeding and vascular complications, using permeable nitinol cardiac occluders to close the access ports, were common but acceptable in this high-risk cohort. Transcaval access should be investigated in patients who are eligible for transthoracic access. Purpose-built closure devices are in development that may simplify the procedure and reduce bleeding. (Transcaval Access for Transcatheter Aortic Valve Replacement in People With No Good Options for Aortic Access; NCT02280824)

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Cardiac Outcomes With Pregnancy After Cardiotoxic Therapy for Childhood Cancer

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The Caval-Aortic Access for Performing TAVR: Pushing the Limits of Alternative Access for Nontransfemoral Candidates

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Percutaneous Revascularization of Left Main Disease: Could the Angiographic Follow-Up Improve the Survival?

http://ift.tt/2kHxH9a

Randomized Comparison of Allogeneic Versus Autologous Mesenchymal Stem Cells for Nonischemic Dilated Cardiomyopathy: POSEIDON-DCM Trial

AbstractBackground

Although human mesenchymal stem cells (hMSCs) have been tested in ischemic cardiomyopathy, few studies exist in chronic nonischemic dilated cardiomyopathy (NIDCM).

Objectives

The authors conducted a randomized comparison of safety and efficacy of autologous (auto) versus allogeneic (allo) bone marrow-derived hMSCs in NIDCM.

Methods

Thirty-seven patients were randomized to either allo- or auto-hMSCs in a 1:1 ratio. Patients were recruited between December 2011 and July 2015 at the University of Miami Hospital. Patients received hMSCs (100 million) by transendocardial stem cell injection in 10 left ventricular sites. Treated patients were evaluated at baseline, 30 days, and 3-, 6-, and 12-months for safety (serious adverse events [SAE]), and efficacy endpoints: ejection fraction, Minnesota Living with Heart Failure Questionnaire, 6-min walk test, major adverse cardiac events, and immune biomarkers.

Results

There were no 30-day treatment-emergent SAEs. Twelve-month SAE incidence was 28.2% with allo-hMSCs versus 63.5% with auto-hMSCs (p = 0.1004 for the comparison). One allo-hMSC patient developed an elevated (>80) donor-specific calculated panel reactive antibody level. The ejection fraction increased in allo-hMSC patients by 8.0 percentage points (p = 0.004) compared with 5.4 with auto-hMSCs (p = 0.116; allo vs. auto p = 0.4887). The 6-min walk test increased with allo-hMSCs by 37.0 m (p = 0.04), but not auto-hMSCs at 7.3 m (p = 0.71; auto vs. allo p = 0.0168). MLHFQ score decreased in allo-hMSC (p = 0.0022) and auto-hMSC patients (p = 0.463; auto vs. allo p = 0.172). The major adverse cardiac event rate was lower, too, in the allo group (p = 0.0186 vs. auto). Tumor necrosis factor-α decreased (p = 0.0001 for each), to a greater extent with allo-hMSCs versus auto-hMSCs at 6 months (p = 0.05).

Conclusions

These findings demonstrated safety and clinically meaningful efficacy of allo-hMSC versus auto-hMSC in NIDCM patients. Pivotal trials of allo-hMSCs are warranted based on these results. (Percutaneous Stem Cell Injection Delivery Effects on Neomyogenesis in Dilated Cardiomyopathy [PoseidonDCM]; NCT01392625)

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Medication Adherence and Cardiovascular Outcomes

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Pars plana vitrectomy with 360° versus localized laser retinopexy in the management of retinal detachment with undetected breaks intraoperatively: a retrospective, comparative, interventional study

Abstract

The purpose of this study is to compare the efficacy of intraoperative 360° and localized laser retinopexy in 23-gauge pars plana vitrectomy (PPV) for rhegmatogenous retinal detachments (RRD) with undetected retinal breaks intraoperatively. This is a retrospective, comparative, interventional study. Medical records of 48 consecutive eyes with RRD of intraoperative undetected retinal breaks were reviewed. Nineteen patients (group I) received 360° laser retinopexy in PPV, while the remaining 29 patients (group II) underwent localized laser retinopexy. In group I, a triple row of confluent medium-white laser burns were placed posterior to the ora serrata. Anatomical and visual outcomes of the two groups were compared. The mean follow-up period was 13.46 ± 3.02 months. No significant difference was identified in baseline characteristics. A single-operation reattachment rate of 89.47% was achieved in group I, which was significantly higher than that of group II (55.17%, p = 0.01), and this trend was not weakened after adjustment for the confounding factor (odds ratio 0.15, p = 0.03). Moreover, greater improvement of postoperative best-corrected visual acuity was observed in group I. Significant complications sufficient to require further operation included proliferative vitreoretinopathy in 2 (4.17%) eyes and epiretinal membrane in 4 (8.33%) eyes. Three hundred sixty-degree laser retinopexy was associated with better anatomic and visual outcomes in RRD patients with unseen breaks intraoperatively, when compared with localized laser retinopexy in PPV.

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Photobiostimulation reverses allodynia and peripheral nerve damage in streptozotocin-induced type 1 diabetes

Abstract

For better evaluation of the efficacy of low-level laser therapy in treating painful diabetic neuropathy and in protecting nerve fiber damage, we conducted a study with type 1 diabetic rats induced by streptozotocin. It is well known that diabetic peripheral neuropathy is the leading cause of pain in those individuals who suffer from diabetes. Despite the efficacy of insulin in controlling glucose level in blood, there is no effective treatment to prevent or reverse neuropathic damage for total pain relief.Male Wistar rats were divided into saline, vehicle, and treatment groups. A single intraperitoneal (i.p.) injection of streptozotocin (STZ) (85 mg/kg) was administered for the induction of diabetes. The von Frey filaments were used to assess nociceptive thresholds (allodynia). Behavioral measurements were accessed 14, 28, 48, and 56 days after STZ administration. Rats were irradiated with GaAs Laser (Gallium Arsenide, Laserpulse, Ibramed Brazil) emitting a wavelength of 904 nm, an output power of 45 mWpk, beam spot size at target 0.13 cm², a frequency of 9500 Hz, a pulse time 60 ns, and an energy density of 6,23 J/cm².The application of four sessions of low-level laser therapy was sufficient to reverse allodynia and protect peripheral nerve damage in diabetic rats.The results of this study indicate that low-level laser therapy is feasible to treat painful diabetic condition in rats using this protocol. Although its efficacy in reversing painful stimuli and protecting nerve fibers from damage was demonstrated, this treatment protocol must be further evaluated in biochemical levels to confirm its biological effects.

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Improving Drug-Like Properties of Insulin and GLP-1 via Molecule Design and Formulation and Improving Diabetes Management with Device & Drug Delivery

Publication date: Available online 30 January 2017
Source:Advanced Drug Delivery Reviews
Author(s): Sergei Pechenov, Himanshu Bhattacharjee, Daniel Yin, Sachin Mittal, Anand Subramony
There is an increased incidence of diabetes worldwide. The discovery of insulin revolutionized the management of diabetes, the revelation of glucagon-like peptide -1 (GLP-1) and introduction of GLP-1 mimetics to clinical practice was another breakthrough. Continued translational research resulted in better understanding of diabetes, which, in combination with cutting-edge biology, chemistry, and pharmaceutical tools, have allowed for the development of safer, more effective and convenient insulins and GLP-1s. Advances in self-administration of insulin and GLP-1 therapies with use of drug-device combination products have improved the outcomes of diabetes management and quality of life for diabetic patients. The synergies of insulin and GLP-1 actions have led to development of devices that can deliver both molecules simultaneously. New chimeric GLP-1-incretins and insulin-GLP-1-incretin molecules are also being developed. The objective of this review is to summarize molecular designs to improve the drug-like properties of insulin and GLP-1 and to highlight the continued advancement of drug-device combinations to improve diabetes management.

Graphical abstract

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Commentary on “Cranial Nerve Injury After Carotid Endarterectomy: Incidence, Risk Factors, and Time Trends”

Publication date: Available online 30 January 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): G.J. de Borst




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Effectiveness of antiangiogenic drugs in glioblastoma patients: a systematic review and meta-analysis of randomized clinical trials

Publication date: Available online 30 January 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Giuseppe Lombardi, Ardi Pambuku, Luisa Bellu, Miriam Farina, Della Puppa Alessandro, Denaro Luca, Vittorina Zagonel
Backgroundglioblastomas are highly vascularized tumors and various antiangiogenic drugs have been investigated in clinical trials showing unclear results. We performed a systematic review and a meta-analysis to clarify and evaluate their effectiveness in glioblastoma patients.Patients and methodswe searched relevant published and unpublished randomized clinical trials analyzing antiangiogenic drugs versus chemotherapy in glioblastoma patients from January 2006 to January 2016 in MEDLINE, WEB of SCIENCE, ASCO, ESMO and SNO databases.Resultsfourteen randomized clinical trials were identified (7 with bevacizumab, 2 cilengitide, 1 enzastaurin, 1 dasatinib, 1 vandetanib, 1 temsirolimus, 1 cediranib) were identified including 4330 patients. Antiangiogenic drugs showed no improvement in overall survival with a pooled HR of 1.00, a trend for an inferior outcome, in terms of overall survival, was observed in the group of patients receiving antiangiogenic drug alone compared to cytotoxic drug alone (HR=1.24, p=0.056). Bevacizumab did not improve overall survival. Twelve trials (4113 patients) were analyzed for progression-free survival. Among antiangiogenic drugs, only bevacizumab demonstrated an improvement of progression-free survival (HR=0.63, p<0.001), both alone (HR=0.60, p=0.003) or in combination to chemotherapy (HR=0.63; p<0.001), both as first-line treatment (HR=0.70, p<0.001) or in recurrent disease (HR=0.52, p<0.001).Conclusionsantiangiogenic drugs did not improve overall survival in glioblastoma patients, either as first or second-line treatment, and either as single agent or in combination with chemotherapy. Among antiangiogenic drugs, only bevacizumab improved progression-free survival regardless of treatment line, both as single agent or in combination with chemotherapy



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Implementation of a New UPMC Gamma Knife Radiosurgery Quality Assurance Registry

Object: In this report, we discuss the development of a new, comprehensive, Health Insurance Portability and Accountability Act-compliant electronic quality assurance (QA) registry for Gamma Knife (GK) radiosurgery patients. This registry can be used to query outcomes, link with current hospital electronic medical records, and share data with future corporate or national professional society registries under development. Methods: A clinical task force comprising physicians and regulatory, legal, and information technology (IT) experts was created to define the nomenclature, regulatory requirements, hosting site, and required capabilities of the proposed system. A team of physicians and IT experts defined the clinical parameters and designed the query functions for the registry. Results: The UPMC GK Registry was established as a QA registry exempt from Institutional Review Board oversight. In order to facilitate subsequent query functions (analytics), data entry was created for 3 main categories: brain tumors, vascular malformations, and functional disorders. A Microsoft SQL-based database infrastructure was employed. Conclusions: We developed a new UPMC GK QA registry and successfully migrated our previous data on 13,000 patients into the registry. This simplified and user-friendly registry offers clinicians the opportunity to participate in national registries and to contribute to multicenter evidence-based outcome analyses.
Stereotact Funct Neurosurg 2017;95:49-59

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High tumor-infiltrating FoxP3+ T cells predict poor survival in estrogen receptor-positive breast cancer: a meta-analysis

Publication date: Available online 30 January 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Qian Feng, Qingping Yang, Linquan Wu, xiaojin Huang, Rongshou Wu, Shanshan Rao, Wenjun Liao, Yong Huang, Enliang Li
AimsTumor-infiltrating FoxP3⁺ T cells and FoxP3⁺ tumor cells have been reported in breast cancer (BC), which impaired immunity and promoted tumors progression. However, their prognostic value for survival in patients with breast BC remains controversial.MethodsA meta-analysis was performed. Original data included the hazard ratios (HR) of overall survival (OS), relapse-free survival and odds ratio (OR) in BC patients. We pooled HR/OR with 95% confidence intervals (CI) to estimate the hazard.ResultsThe overall survival of high tumor-infiltrating FoxP3⁺ T cells patients was lower than low tumor-infiltrating FoxP3⁺ T cells patients with estrogen receptor (ER)-positive (HR 0.86, 95% CI 0.77-0.96; P=0.009) but not ER-negative (HR 1.09, 95% CI 0.82-1.45; P=0.569) BC. And FoxP3⁺ tumor cells were not associated with the overall survival and recurrences of BC patients (P>0.05). In addition, a significant association was revealed between high tumor-infiltrating FoxP3⁺ T cells and grade (Ⅰ+Ⅱ/Ⅲ: OR 0.31, 95% CI 0.17-0.56; P<0.001), ER status (present: OR 2.39, 95% CI 1.51-3.76; P<0.001), HER2 status (present: OR 0.53, 95% CI 0.36-0.78; P=0.001), PR status (present: OR 1.88, 95% CI 1.31-2.71; P<0.001). And a significant association was revealed between positive FoxP3⁺ tumor cells and Nodal status (present: OR 0.48, 95% CI 0.23-0.97; P=0.04), grade (Ⅰ+Ⅱ/Ⅲ: OR 0.44, 95% CI 0.22-0.85; P=0.01), PR status (present: OR 2.37, 95% CI 1.54-3.36; P<0.001).ConclusionsHigh tumor-infiltrating FoxP3⁺ T cells were associated with a poorer prognosis for ER-positive BC, but not for ER-negative BC.



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Efficacy of Oral Moisturizing Jelly on Oral Health and Nutrition in Post-radiotherapy Head and Neck Cancer Patients

Conditions:   Cancer of Head Neck;   Radiation-Induced Xerostomia;   Dry Mouth
Interventions:   Dietary Supplement: Oral moisturizing jelly;   Other: Artificial saliva
Sponsors:   Dental Innovation Foundation Under Royal Patronage;   Mahidol University;   Srinakharinwirot University;   Ministry of Health, Thailand
Not yet recruiting - verified January 2017

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The Safety and Efficacy Test of Nutri-PEITC Jelly in Head and Neck Cancer Patients

Conditions:   Head and Neck Neoplasms;   Quality of Life;   Nutrition Related Cancer
Interventions:   Dietary Supplement: Nutri-jelly with PEITC;   Dietary Supplement: Nutri-jelly
Sponsors:   Dental Innovation Foundation Under Royal Patronage;   Mahidol University;   Srinakharinwirot University;   Ministry of Health, Thailand
Recruiting - verified January 2017

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Physiotherapy After Anterior Cervical Spine Surgery

Conditions:   Cervical Disc Disease;   Radiculopathy, Cervical
Interventions:   Other: Prescribed Physical Activity;   Other: Exercises with Internet support
Sponsor:   Linkoeping University
Not yet recruiting - verified January 2017

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Tocilizumab Promotes Regulatory T-cell Alleviation in STAT3 Gain-of-function−associated Multi-organ Autoimmune Syndrome

Publication date: Available online 30 January 2017
Source:Clinical Therapeutics
Author(s): Tawfik Khoury, Vered Molho-Pessach, Yuval Ramot, Abu Rmeileh Ayman, Orly Elpeleg, Neville Berkman, Abraham Zlotogorski, Yaron Ilan
PurposeSignal transducer and activator of transcription 3 is a member of a family of proteins involved in the regulation of inflammation, differentiation, proliferation, and survival of cells. Here we describe a 38-year-old male who has experienced gastrointestinal, dermatologic, pulmonary, and malignant manifestations.MethodsWhole-exome sequencing, validated by Sanger sequencing, was performed after extensive investigations.FindingsWhole-exome sequencing revealed a heterozygous missense mutation in the signal transducer and activator of transcription 3 gene, c.1261G>A (p.G421R). Fluorescence-activated cell sorting analysis of peripheral T lymphocytes revealed low levels of CD4⁺CD25⁺FoxP3 and CD8⁺CD25⁺FoxP3 regulatory T cells. After treatment with 2 cycles of tocilizumab, an interleukin-6 receptor antibody, a significant increase in the level of regulatory T cells was observed, accompanied by clinical improvement.ImplicationsThis case sheds light on the emerging role of signal transducer and activator of transcription 3 gain-of-function mutation in the pathogenesis of autoimmune diseases, and further addresses the therapeutic role of interleukin-6 blocker treatment in this syndrome.



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Rapid assessment methodology in NORM measurements from building materials of Uzbekistan

Publication date: April 2017
Source:Journal of Environmental Radioactivity, Volumes 169–170
Author(s): A.A. Safarov, A.N. Safarov, A.N. Azimov, I.G. Darby
Utilizing low cost NaI(Tl) scintillation detector systems we present methodology for the rapid screening of building material samples and the determination of their Radium Equivalent Activity (Raeq). Materials from Uzbekistan as a representative developing country have been measured and a correction coefficient for Radium activity is deduced. The use of the correction coefficient offers the possibility to decrease analysis times thus enabling the express measurement of a large quantity of samples. The reduction in time, cost and the use of inexpensive equipment can democratize the practice of screening NORM in building materials in the international community.



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