Publication date: Available online 31 July 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Claudia Bolognesi, Marco Bruzzone, Marcello Ceppi, Micheline Kirsch-Volders
Vinyl chloride (VC) is widely used in industry in the production of polyvinyl chloride (PVC), which is used to manufacture a large variety of materials. VC was classified as a known (Group 1) human carcinogen by IARC on the basis of increased risk for liver angiosarcoma and hepatocellular cancer, and the carcinogenicity of VC was shown to be mediated by a genotoxic mechanism. Following inhalation, the compound is rapidly absorbed and metabolized in the liver to the electrophilic metabolites chloroethylene-oxide and chloroacetaldehyde, which form DNA adducts that can be processed into point mutations in cancer-related genes detected in humans and rats exposed to VC. A number of genotoxicity biomarkers were applied in workers exposed to VC to detect early biological responses associated with the carcinogenesis process. The present systematic review analyzed the published studies in which the cytokinesis-block micronucleus assay in peripheral lymphocytes (L-CBMN) was applied in VC-exposed subjects. Thirteen out of fifteen retrieved studies performed in China showed increased MN frequencies (FR 1.92-3.98) associated with increased cumulative exposure or employment time. Twofold and more than threefold increases were detected in PVC-exposed workers exposed to a mean of 50ppm of VC in the former Yugoslavia and in South India, respectively. The meta-analysis of MN frequency from six eligible studies confirmed this tendency (pooled MR 2.32 − 95% CI 1.64-3.27). The benchmark dose lower limit for 10% excess risk (BMDL 10) calculated from three studies resulted in an estimated exposure limit of 0.03-0.07mg/m3. Overall the results of this review showed the need for further studies, especially because PVC products from China may contain high levels of uncoupled VCM that could represent a source of exposure to workers and consumers. Moreover, the results underline the importance of re-evaluating the recommended exposure limits using new biomonitoring methods in addition to MN.
http://ift.tt/2tTwhNb
Δευτέρα 31 Ιουλίου 2017
The lymphocyte cytokinesis block micronucleus test in human populations occupationally exposed to vinyl chloride: a systematic review and meta-analysis
Phylogenetic diversity and functional characterization of the Manila clam microbiota: a culture-based approach
Abstract
According to the hologenome theory, the microbiota contributes to the fitness of the holobiont having an important role in its adaptation, survival, development, health, and evolution. Environmental stress also affects the microbiota and its capability to assist the holobiont in coping with stress factors. Here, we analyzed the diversity of cultivable bacteria associated with Manila clam tissues (mantle, gills, hemolymph) in two non-contaminated sites (Portugal and France) and one metal-contaminated site (Portugal). A total of 240 isolates were obtained. Representative isolates (n = 198) of the overall diversity were identified by 16S rDNA sequencing and subjected to functional characterization. Isolates affiliated with Proteobacteria, Actinobacteria, Firmicutes, and Bacteroidetes. Proteobacteria (mostly Pseudoalteromonadaceae and Vibrionaceae) were dominant in non-contaminated sites while Actinobacteria (mostly Microbacteriaceae) dominated in the metal-contaminated site. The main factor affecting the microbiota composition was contamination. No significant differences were observed between clam tissues and geographic regions. Several isolates tested positive for antibacterial activity, biofilm formation, protease, and siderophore production. The results show that the Manila clam harbors a diverse microbiota that may contribute to clam protection and overall fitness, as well as to its adaptation to stressful environments. In addition, the Manila clam microbiota is revealed as a promising source of novel probiotics with potential application in aquaculture.
http://ift.tt/2f3z43C
Outcome of patients with lung adenocarcinoma with transformation to small-cell lung cancer following tyrosine kinase inhibitors treatment: A Systematic Review and Pooled Analysis
Publication date: Available online 31 July 2017
Source:Cancer Treatment Reviews
Author(s): Elisa Roca, Cristina Gurizzan, Vito Amoroso, William Vermi, Vittorio Ferrari, Alfredo Berruti
BackgroundLung adenocarcinoma can transform to small-cell lung cancer (SCLC) when resistance to tyrosine kinase inhibitors (TKIs) develops. This phenomenon has repeatedly been described in several case reports and small patient series. The characteristics and treatment outcomes of this population, however, have not been comprehensively reported.MethodsWe performed a systematic review of the published literature to obtain explorative information on the clinical and pathological features and prognosis of the reported cases.ResultsTwenty-five eligible publications were identified, contributing to 39 patients. The median time from initial diagnosis of lung adenocarcinoma to the transformation to SCLC (ttSCLC) was 19 months (range 1-61 months). The median survival after SCLC diagnosis was 6 months. Female gender was significantly associated with longer ttSCLC at the multivariable analysis. Smoking status seemed to be associated with worse prognosis after the diagnosis of SCLC.ConclusionIn this series of published cases, the transformation to a SCLC phenotype after an initial diagnosis of lung adenocarcinoma following TKI therapy appeared to be a late phenomenon. The prognosis after SCLC diagnosis is poor and current treatment strategies derived from primary SCLC seem to be largely inefficacious. New therapies are needed in the management of transformed SCLC.
http://ift.tt/2vcXOg5
Immunotherapy in ovarian, endometrial and cervical cancer: state of the art and future perspectives
Publication date: Available online 31 July 2017
Source:Cancer Treatment Reviews
Author(s): Jole Ventriglia, Immacolata Paciolla, Carmela Pisano, Sabrina Chiara Cecere, Marilena Di Napoli, Rosa Tambaro, Daniela Califano, Simona Losito, Giosuè Scognamiglio, Sergio Venanzio Setola, Laura Arenare, Sandro Pignata, Chiara Della Pepa
The tumors of the female genital tract represent a leading cause of morbidity and mortality among women worldwide. Substantial progresses have been made in ovarian cancer, with the increasing knowledge about BRCA mutated tumors and the recent development of PARP inhibitors, and in cervical cancer, thanks to extensive screening and widespread of vaccination against Human Papilloma Virus. Nevertheless many needs remain unmet, advanced stage diseases are still incurable and cervical and endometrial carcinoma, as well as platinum-resistant ovarian carcinoma, can certainly be classifiable among the cancers with poor sensitivity to conventional chemotherapy. Immunotherapy, including a number of approaches, checkpoint inhibitors, adoptive cellular transfer, vaccines, has experienced a remarkable growth in the last few years and it is already an available option in melanoma, lung and renal malignancies. We reviewed the main findings about the immune microenvironment in ovarian, endometrial and cervical cancer with a special focus on the clinical data, the therapeutic implications and the most promising novel agents.
http://ift.tt/2vdm1TT
Efficacy and tolerability of a double-conjugated retinoid cream vs 1.0% retinol cream or 0.025% tretinoin cream in subjects with mild to severe photoaging
Summary
Background
Topical retinoids are used to treat the visible signs of photoaging. While efficacious, they are irritating.
Objective
Evaluate the effectiveness and tolerability of a double-conjugate retinoid cream (AlphaRet Overnight Cream; AHA-Ret) in improving visible signs of photoaging vs 1.0% retinol or 0.025% tretinoin.
Methods
A 12-week, split-face, randomized trial was conducted in 48 female subjects, aged 30-65 years with mild to severe photodamage. AHA-Ret was applied to one side of the face and either retinol (n=24) or tretinoin (n=24) to the other side (PM). Expert blinded evaluation of images and Nova measurements occurred at 4, 8, and 12 weeks. Tolerability was assessed throughout the study.
Results
Forty-seven subjects completed the study. AHA-Ret demonstrated significant reductions in average severity from baseline: Fine Lines/Wrinkles (P<.001; all time points); Erythema (P=.004, P<.0001; 8 and 12 weeks, respectively); Dyschromia (P<.0001; all time points); Skin Tone (P<.0001; all time points), and Pore Size (P=.035, P<.0001; 8 and 12 weeks, respectively). AHA-Ret induced less Erythema vs retinol at 8 (P=.008) and 12 (P<.02) weeks. AHA-Ret was noninferior to prescription tretinoin in all categories at 4 and 8 weeks, and for Fine Lines/Wrinkles, Erythema, Dyschromia, and Skin Tone at 12 weeks. Improvements in Hydration occurred at every time point with AHA-Ret only (P<.04, P<.03, P<.01). Less irritation was reported with AHA-Ret vs retinol or tretinoin.
Conclusions
Treatment with a double-conjugate retinoid cream demonstrated early reductions in photodamage and improvements in Hydration. AHA-Ret induced less Erythema vs retinol and was more tolerable vs retinol and tretinoin.
http://ift.tt/2uSGZVb
Conceptualisation, development and validation of T-QoL© (Teenagers’ Quality of Life): a patient-focused measure to assess quality of life of adolescents with skin diseases
Abstract
Aim
To develop and validate a dermatology-specific quality of life (QoL) instrument for adolescents with skin diseases.
Methods
Qualitative semi-structured interviews were conducted with adolescents with skin disease to gain in-depth understanding of how skin diseases affect their QoL. A prototype instrument based on the themes identified from content analysis of interviews was tested in several stages, using Classical Test Theory (CTT) and Item Response Theory (IRT) models to develop this new tool and conduct its psychometric evaluation.
Results
Thirty-three QoL issues were identified from semi-structured interviews with 50 adolescents. A questionnaire based on items derived from content analysis of interviews was subjected to Rasch analysis: factor analysis identified three domains, therefore not supporting the validity of T-QoL as a unidimensional measure. Psychometric evaluation of the final 18-item questionnaire was carried out in a cohort of 203 adolescents. Convergent validity was demonstrated by significant correlation with Skindex-Teen and CDLQI or DLQI. The T-QoL showed excellent internal consistency reliability: Cronbach's α=0.89 for total scale score and 0.85, 0.60, and 0.74 respectively for domains 1, 2 and 3. Test-retest reliability was high in stable subjects. T-QoL showed sensitivity to change in two sub-groups of patients who indicated change in their self-assessed disease severity.
Conclusion
Built on rich qualitative data from patients, the T-QoL is a simple and valid tool to quantify the impact of skin disease on adolescents' QoL; it could be used as an outcome measure in both clinical practice and clinical research.
This article is protected by copyright. All rights reserved.
http://ift.tt/2vdwNcJ
The protective effect of platelet released growth factors and bone augmentation (Bio-Oss®) on ethanol impaired osteoblasts
Publication date: Available online 31 July 2017
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Tolga Taha Sönmez, Andreas Bayer, Tillman Cremer, Jennifer Vanessa Phi Hock, Bernd Lethaus, Nisreen Kweider, Christoph Jan Wruck, Wolf Drescher, Holger Jahr, Sebastian Lippross, Thomas Pufe, Mersedeh Tohidnezhad
BackgroundChronic alcohol consumption is a known limiting factor for bone healing. One promising strategy to improve bone augmentation techniques with Bio-Oss® in oral and maxillofacial surgery might be the supportive application of platelet-concentrated biomaterials as platelet-released growth factor (PRGF). To address this matter, we performed an in vitro study investigating the protective effects of PRGF and Bio-Oss® in ethanol (EtOH) treated osteoblasts.MethodsThe SAOS-2 osteosarcoma cell line, with and without EtOH pretreatment was used. The cell viability, proliferation and alkali phosphatase activity (ALP) after application of 0%, 5% and 10% PRGF and Bio-Oss® were assessed.ResultsThe application of PRGF and Bio-Oss® in EtOH impaired osteoblasts showed a significant beneficial influence increasing the viability of the osteoblasts in cell culture. The synergistic effect of Bio-Oss® and 5% PRGF on the proliferation of osteoblasts was also demonstrated. Bio-Oss® only in combination with PRGF increases the alkaline phosphatase (ALP) activity in EtOH pretreated cells.ConclusionsThese results indicate that the simultaneous application of PRGF and Bio-Oss® inhibits EtOH induced bone healing impairment. Furthermore, in the cells, PRGF induced a protective mechanism which might promote bone regeneration.
http://ift.tt/2uSLnnh
68 Ga-DOTATATE PET/CT in recurrent medullary thyroid carcinoma: a lesion-by-lesion comparison with 111 In-octreotide SPECT/CT and conventional imaging
Abstract
Purpose
The aim of this study was to prospectively compare the detection rate of 68Ga-DOTATATE PET-CT with 111In-octreotide SPECT-CT and conventional imaging (CI) in medullary thyroid carcinoma (MTC) patients with increased calcitonin (Ctn) levels but negative CI after thyroidectomy.
Methods
Fifteen patients with raised Ctn levels and/or CI evidence of recurrence underwent 68Ga-DOTATATE PET-CT, 111In-octreotide SPECT-CT and CI. Histopathology, CI and biochemical/clinical/imaging follow-up were used as the reference standard. PET/CT, SPECT/CT and CI were compared in a lesion-based and organ-based analysis.
Results
PET/CT evidenced recurrence in 14 of 15 patients. There were 13 true positive (TP), 1 true negative (TN), 1 false positive (FP) and no false negative (FN) cases, resulting in a sensitivity and accuracy of 100% and 93%. SPECT/CT was positive in 6 of 15 cases. There were 6 TP, 2 TN, 7 FN and no FP cases, resulting in a sensitivity of 46% and accuracy of 53%. CI procedures detected tumor lesions in 14 of 15 patients. There were 13 TP, 1TN, 1 FP and no FN cases with a sensitivity of 100% and accuracy of 93%.
A significantly higher number of lesions was detected by PET/CT (112 lesions, p = 0.005) and CI (109 lesions, p = 0.005) in comparison to SPECT/CT (16 lesions). There was no significant difference between PET/CT and CI for the total number of detected lesions (p = 0.734). PET/CT detected more lesions than SPECT/CT regardless of the organ. PET/CT detected more bone lesions but missed some neck nodal metastases evidenced by CI. The number of lesions per region demonstrated by PET/CT and CI were similar in the other sites.
Conclusion
68Ga-DOTATATE PET/CT is superior to 111In-octreotide SPECT/CT for the detection of recurrent MTC demonstrating a significantly higher number of lesions. 68Ga-DOTATATE PET/CT showed a superior detection rate compared to CI in demonstrating bone metastases.
http://ift.tt/2f3kucd
Imaging children suffering from lymphoma: an evaluation of different 18 F-FDG PET/MRI protocols compared to whole-body DW-MRI
Abstract
Objectives
The objectives of this study were to evaluate and compare the diagnostic potential of different PET/MRI reading protocols, entailing non-enhanced / contrast-enhanced and diffusion-weighted 18F–FDG PET/MR imaging and whole-body diffusion-weighted MRI for lesion detection and determination of the tumor stage in pediatric lymphoma patients.
Methods
A total of 28 18F–FDG PET/MRI datasets were included for analysis of four different reading protocols: (1) PET/MRI utilizing sole unenhanced T2w and T1w imaging, (2) PET/MRI utilizing additional contrast enhanced sequences, (3) PET/MR imaging utilizing unenhanced, contrast enhanced and DW imaging or (4) WB-DW-MRI. Statistical analyses were performed on a per-patient and a per-lesion basis. Follow-up and prior examinations as well as histopathology served as reference standards.
Results
PET/MRI correctly identified all 17 examinations with active lymphoma disease, while WB-DW-MRI correctly identified 15/17 examinations. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 96%, 96.5%, 97%, 95%, and 96% for PET/MRI1; 97%, 96.5%, 97%, 96.5%, and 97% for PET/MRI2; 97%, 96.5%, 97%, 96.5%, and 97% for PET/MRI3 and 77%, 96%, 96%, 78.5% and 86% for MRI-DWI.
Conclusion
18F–FDG PET/MRI is superior to WB-DW-MRI in staging pediatric lymphoma patients. Neither application of contrast media nor DWI leads to a noticeable improvement of the diagnostic accuracy of PET/MRI. Thus, unenhanced PET/MRI may play a crucial role for the diagnostic work-up of pediatric lymphoma patients in the future.
http://ift.tt/2hiEuZp
Development of standardized image interpretation for 68Ga-PSMA PET/CT to detect prostate cancer recurrent lesions
Abstract
Methods
After primary treatment, biochemical relapse (BCR) occurs in a substantial number of patients with prostate cancer (PCa). PET/CT imaging with prostate-specific membrane antigen based tracers (68Ga-PSMA) has shown promising results for BCR patients. However, a standardized image interpretation methodology has yet to be properly agreed. The aim of this study, which was promoted and funded by European Association of Nuclear Medicine (EANM), is to define standardized image interpretation criteria for 68Ga-PSMA PET/CT to detect recurrent PCa lesions in patients treated with primary curative intent therapy (radical prostatectomy or radiotherapy) who presented a biochemical recurrence. In the first phase inter-rater agreement between seven readers from seven international centers was calculated on the reading of 68Ga-PSMA PET/CT images of 49 patients with BCR. Each reader evaluated findings in five different sites of recurrence (local, loco-regional lymph nodes, distant lymph nodes, bone, and other). In the second phase the re-analysis was limited to cases with poor, slight, fair, or moderate agreement [Krippendorff's (K) alpha<0.61]. Finally, on the basis of the consensus readings, we sought to define a list of revised consensus criteria for 68Ga-PSMA PET/CT interpretation.
Results
Between-reader agreement for the presence of anomalous findings in any of the five sites was only moderate (K's alpha: 0.47). The agreement improved and became substantial when readers had to judge whether the anomalous findings were suggestive for a pathologic, uncertain, or non-pathologic image (K's alpha: 0.64). K's alpha calculations for each of the five sites of recurrence were also performed and evaluated. First Delphi round was thus conducted. A more detailed definition of the criteria was proposed by the project coordinator, which was then discussed and finally agreed by the seven readers. After the second Delphi round only four cases of disagreement still remained. These were evaluated for a final round, allowing a final agreement table to be written.
Conclusion
We hope that by developing these consensus guidelines on the interpretation of 68Ga-PSMA PET/CT, clinicians reporting these studies will be able to provide more consistent clinical reports and that within clinical trials, abnormality classifications will be harmonized, allowing more robust assessment of its diagnostic performance.
http://ift.tt/2f3hInq
Patterns of failure after radical prostatectomy in prostate cancer – implications for radiation therapy planning after 68 Ga-PSMA-PET imaging
Abstract
Background
Salvage radiotherapy (SRT) after radical prostatectomy (RPE) and lymphadenectomy (LAE) is the appropriate radiotherapy option for patients with persistent/ recurrent prostate cancer (PC). 68Ga-PSMA-PET imaging has been shown to accurately detect PC lesions in a primary setting as well as for local recurrence or for lymph node (LN) metastases.
Objective
In this study we evaluated the patterns of recurrence after RPE in patients with PC, putting a highlight on the differentiation between sites that would have been covered by a standard radiation therapy (RT) field in consensus after the RTOG consensus and others that would have not.
Methods and materials
Thirty-one out of 83 patients (37%) with high-risk PC were the subject of our study. Information from 68Ga-PSMA-PET imaging was used to individualize treatment plans to include suspicious lesions as well as possibly boost sites with tracer uptake in LN or the prostate bed. For evaluation, 68Ga-PSMA-PET-positive LN were contoured in a patient dataset with a standard lymph drainage (RTOG consensus on CTV definition of pelvic lymph nodes) radiation field depicting color-coded nodes that would have been infield or outfield of that standard lymph drainage field and thereby visualizing typical patterns of failure of a "blind" radiation therapy after RPE and LAE.
Results
Compared to negative conventional imaging (CT/MRI), lesions suspicious for PC were detected in 27/31 cases (87.1%) by 68Ga-PSMA-PET imaging, which resulted in changes to the radiation concept. There were 16/31 patients (51.6%) that received a simultaneous integrated boost (SIB) to a subarea of the prostate bed (in only three cases this dose escalation would have been planned without the additional knowledge of 68Ga-PSMA-PET imaging) and 18/31 (58.1%) to uncommon (namely presacral, paravesical, pararectal, preacetabular and obturatoric) LN sites. Furthermore, 14 patients (45.2%) had a changed TNM staging result by means of 68Ga-PSMA-PET imaging.
Conclusion
Compared to conventional CT or MRI staging, 68Ga-PSMA-PET imaging detects more PC lesions and, thus, significantly influences radiation planning in recurrent prostate cancer patients enabling individually tailored treatment.
http://ift.tt/2f3qEcx
Monitoring early response to chemoradiotherapy with 18 F-FMISO dynamic PET in head and neck cancer
Abstract
Purpose
There is growing recognition that biologic features of the tumor microenvironment affect the response to cancer therapies and the outcome of cancer patients. In head and neck cancer (HNC) one such feature is hypoxia. We investigated the utility of 18F-fluoromisonidazole (FMISO) dynamic positron emission tomography (dPET) for monitoring the early microenvironmental response to chemoradiotherapy in HNC.
Experimental design
Seventy-two HNC patients underwent FMISO dPET scans in a customized immobilization mask (0–30 min dynamic acquisition, followed by 10 min static acquisitions starting at ∼95 min and ∼160 min post-injection) at baseline and early into treatment where patients have already received one cycle of chemotherapy and anywhere from five to ten fractions of 2 Gy per fraction radiation therapy. Voxelwise pharmacokinetic modeling was conducted using an irreversible one-plasma two-tissue compartment model to calculate surrogate biomarkers of tumor hypoxia (k 3 and Tumor-to-Blood Ratio (TBR)), perfusion (K 1 ) and FMISO distribution volume (DV). Additionally, Tumor-to-Muscle Ratios (TMR) were derived by visual inspection by an experienced nuclear medicine physician, with TMR > 1.2 defining hypoxia.
Results
One hundred and thirty-five lesions in total were analyzed. TBR, k 3 and DV decreased on early response scans, while no significant change was observed for K 1 . The k 3 -TBR correlation decreased substantially from baseline scans (Pearson's r = 0.72 and 0.76 for mean intratumor and pooled voxelwise values, respectively) to early response scans (Pearson's r = 0.39 and 0.40, respectively). Both concordant and discordant examples of changes in intratumor k 3 and TBR were identified; the latter partially mediated by the change in DV. In 13 normoxic patients according to visual analysis (all having lesions with TMR = 1.2), subvolumes were identified where k 3 indicated the presence of hypoxia.
Conclusion
Pharmacokinetic modeling of FMISO dynamic PET reveals a more detailed characterization of the tumor microenvironment and assessment of response to chemoradiotherapy in HNC patients than a single static image does. In a clinical trial where absence of hypoxia in primary tumor and lymph nodes would lead to de-escalation of therapy, the observed disagreement between visual analysis and pharmacokinetic modeling results would have affected patient management in <20% cases. While simple static PET imaging is easily implemented for clinical trials, the clinical applicability of pharmacokinetic modeling remains to be investigated.
http://ift.tt/2hiEbhd
Practical recommendations for radium-223 treatment of metastatic castration-resistant prostate cancer
Abstract
Purpose
Radium Ra 223 dichloride (radium-223, Xofigo®) is the first targeted alpha therapy for patients with castration-resistant prostate cancer and symptomatic bone metastases. Radium-223 provides a new treatment option for this setting, but also necessitates a new treatment management approach. We provide straightforward and practical recommendations for European nuclear medicine centres to optimize radium-223 service provision.
Methods
An independent research consultancy agency observed radium-223 procedures and conducted interviews with all key staff members involved in radium-223 treatment delivery in 11 nuclear medicine centres across six countries (Germany, Italy, the Netherlands, Spain, Switzerland and the UK) experienced in administering radium-223. The findings were collated and discussed at a meeting of experts from these centres, during which key consensus recommendations were defined.
Results
The recommendations cover centre organization and preparation; patient referral; radium-223 ordering, preparation and disposal; radium-223 treatment delivery/administration; and patient experience. Guidance includes structured coordination and communication within centres and multidisciplinary teams, focusing on sharing best practice to provide high-quality, patient-centred care throughout the treatment pathway.
Conclusions
These expert recommendations are intended to complement existing management guidelines. Sharing best practice and experience will help nuclear medicine centres to optimize radium-223 service provision and improve patient care.
http://ift.tt/2f3b4h2
The role of 18 F-FDG PET/CT in the detection of osteosarcoma recurrence
Abstract
Aim
The aim of this study was to investigate the diagnostic accuracy of 18F-FDG-PET/CT in osteosarcoma patients suspicious for disease recurrence after adequate surgical therapy.
Methods
Inclusion criteria were: a) adequate surgical treatment for proven osteosarcoma and documented complete remission after therapy; b) 18F-FDG-PET/CT performed during follow-up for clinical/diagnostic suspicion of relapse; c) new surgical treatment with excision of the suspected lesions; d) histological validation of 18F-FDG-PET/CT findings. Thirty-seven patients matching all inclusion criteria were retrospectively enrolled (20 men and 17 female). Primary surgical treatment consists of resection (31 cases) or amputation (six cases). 18F-FDG-PET/CT performance was assessed with a per-patient and per-site evaluation of sensitivity, specificity, accuracy, positive predicting value (PPV), and negative predicting value (NPV). The sites of relapse were classified as local, lung, lymphnodes (LNs), and distant (other skeletal segments and/or distant soft tissue). The disease-free survival (DFS) and the overall survival (OS) after 18F-FDG PET/CT were evaluated.
Results
18F-FDG-PET/CT was positive in 89.2% (33/37) of patients. Local uptake only was observed in 35.1% patients (13/37); lung uptake only in 18.9% (7/37); distant uptake only in 2.7% (1/37) case; multiple sites of uptake in 32.4% (12/37). Histology resulted positive in 92% (34/37) of patients. A total of 51 pathologic lesions were evaluated (22 local relapse, 11 lung metastasis, 10 metastatic LNs, eight distant metastatic lesions). On a per-patient analysis 18F-FDG-PET/CT showed a sensitivity, specificity, accuracy, PPV, and NPV of 91%, 75%, 89%, 97%, 50%. On a per-site analysis the performance for local relapse was 96%, 100%, 97%, 100%, 93%, while for lung relapse detection was 80%, 100%, 92%, 100%, 88%. The mean follow-up after 18F-FDG-PET/CT was 21.5 months. At the last follow-up, 19% (7/37) of patients were death with disease, 38% (14/37) were alive with disease, and 43% (16/37) had no evidence of disease. Overall survival was 90% and 75% at 24 and 60 months, respectively.
Conclusion
18F-FDG-PET/CT showed valuable results for detecting recurrence(s) in osteosarcoma patients with suspicious of relapse after treatment, particularly in the detection of local relapse and lung metastasis.
http://ift.tt/2f31nzd
Early PET imaging with [68]Ga-PSMA-11 increases the detection rate of local recurrence in prostate cancer patients with biochemical recurrence
Abstract
Purpose
PET/CT using 68Ga-labelled prostate-specific membrane antigen PSMA-11 (HBEDD-CC) has emerged as a promising imaging method in the diagnostic evaluation of prostate cancer (PC) patients with biochemical recurrence. However, assessment of local recurrence (LR) may be limited by intense physiologic tracer accumulation in the urinary bladder on whole-body scans, normally conducted 60 min post-tracer injection (p.i.). It could be shown on early dynamic imaging studies that 68Ga-PSMA-11 uptake in PC lesions occurs earlier than tracer accumulation in the urinary bladder. This study aims to investigate whether early static PET acquisition increases detection rate of local recurrence on 68Ga-PSMA-11 PET/CT in comparison to PET imaging 60 min p.i..
Methods
203 consecutive PC patients with biochemical failure referred to 68Ga-PSMA-11 PET/CT were analysed retrospectively (median prostate specific antigen (PSA) value: 1.44 ng/ml). In addition to whole-body PET/CT scans 60 min p.i., early static imaging of the pelvis was performed, starting at a median time of 283 s p.i. (range: 243–491 s). Assessment was based on visual analysis and calculation of maximum standardized uptake value (SUVmax) of pathologic lesions present in the pelvic area found on early PET imaging and on 60 min-PET scans.
Results
26 patients (12.8%) were judged positive for LR on PET scans 60 min p.i. (median SUVmax: 10.8; range: 4.7–40.9), whereas 50 patients (24.6%) revealed a lesion suggestive of LR on early PET imaging (median SUVmax: 5.9; range: 2.9–17.6), resulting in a significant rise in detection rate (p < 0.001). Equivocal findings on PET scans 60 min p.i. decreased significantly with the help of early imaging (15.8% vs. 4.5% of patients; p < 0.001). Tracer activity in the urinary bladder with a median SUVmax of 8.2 was present in 63 patients on early PET scans (31.0%). However, acquisition starting time of early PET scans differed significantly in the patient groups with and without urinary bladder activity (median starting time of 321 vs. 275 s p.i.; range: 281–491 vs. 243–311 s p.i.; p < 0.001). Median SUVmax value of lesions suggestive of LR on early images was significantly higher in comparison to gluteal muscle, inguinal vessels and seminal vesicle/anastomosis (median SUVmax: 5.9 vs. 1.9, 4.0 and 2.4, respectively).
Conclusions
Performance of early imaging in 68Ga-PSMA-11 PET/CT in addition to whole-body scans 60 min p.i. increases the detection rate of local recurrence in PC patients with biochemical recurrence. Acquisition of early PET images should be started as early as 5 min p.i. in order to avoid disturbing tracer activity in the urinary bladder occuring at a later time point.
http://ift.tt/2hi9sk5
PET and PET/CT with radiolabeled choline in prostate cancer: a critical reappraisal of 20 years of clinical studies
Abstract
We here aim to provide a comprehensive and critical review of the literature concerning the clinical applications of positron emission tomography/computed tomography (PET/CT) with radiolabeled choline in patients with prostate cancer (PCa). We will initially briefly summarize the historical context that brought to the synthesis of [11C]choline, which occurred exactly 20 years ago. We have arbitrarily grouped the clinical studies in three different periods, according to the year in which they were published and according to their relation with their applications in urology, radiotherapy and oncology. Studies at initial staging and, more extensively, studies in patients with biochemical failure, as well as factors predicting positive PET/CT will be reviewed. The capability of PET/CT with radiolabeled choline to provide prognostic information on PCa-specific survival will also be examined. The last sections will be devoted to the use of radiolabeled choline for monitoring the response to androgen deprivation therapy, radiotherapy, and chemotherapy. The accuracy and the limits of the technique will be discussed according to the information available from standard validation processes, including biopsy or histology. The clinical impact of the technique will be discussed on the basis of changes induced in the management of patients and in the evaluation of the response to therapy. Current indications to PET/CT, as officially endorsed by guidelines, or as routinely performed in the clinical practice will be illustrated. Emphasis will be made on methodological factors that might have influenced the results of the studies or their interpretation. Finally, we will briefly highlight the potential role of positron emission tomography/magnetic resonance and of new radiotracers for PCa imaging.
http://ift.tt/2f3b3cY
Selective removal of carious lesion with Er:YAG laser followed by dentin biomodification with chitosan
Abstract
The aim of this study was to evaluate the effect of Er:YAG laser for selective removal of carious lesion, followed by biomodification with chitosan gel where the subsurface microhardness, chemical composition, and morphological changes of the residual caries-affected dentin were examined. Artificial dentinal lesions were created by pH-cycling method (14 days) in 104 bovine specimens (5 × 5 mm). Specimens were randomly divided according to the carious removal method: bur (low-speed handpiece) or Er:YAG laser (250 mJ/4 Hz). Specimens were treated with 35% phosphoric acid and were subdivided into two groups according to dentin biomodification: without chitosan (control) and 2.5% chitosan. Forty specimens were restored with an adhesive system and composite resin. Subsurface microhardness tests were performed in sound dentin, caries-affected dentin, residual caries-affected dentin, and after the restoration. The other 64 specimens were subjected to SEM-EDS atomic analysis. Data were statistically analyzed (p < 0.05). After the Er:YAG laser excavation, the microhardness value of residual caries-affected dentin was higher (p < 0.05) than bur-treated dentin. A significant decrease in the amount of Ca, P, and Ca/P ratio was found after the removal of carious lesions with Er:YAG laser (p < 0.05). The biomodification with chitosan did not influence the microhardness and atomic percentage of Ca, P, and Ca/P ratio of residual caries-affected dentin (p > 0.05). SEM analysis showed morphological changes on residual caries-affected dentin (p > 0.05). The selective removal of carious dentin with Er:YAG laser increased microhardness of residual caries-affected dentin, changing its surface morphology and chemical composition. The biomodification with chitosan did not influence the structural and chemical composition of residual caries-affected dentin.
http://ift.tt/2vc54sY
Factor Structure of the Intolerance of Uncertainty Scale for Children
Source:Journal of Anxiety Disorders
Author(s): Danielle Cornacchio, Amanda L. Sanchez, Stefany Coxe, Amy Roy, Donna B. Pincus, Kendra L. Read, Robert M. Holaway, Philip C. Kendall, Jonathan S. Comer
Intolerance of uncertainty (IU), a dispositional negative orientation toward uncertainty and its consequences, has been studied in adults, but research has only recently examined IU in youth. Despite some advances, little is known about the factor structure of measures of IU in youth. The present study used confirmatory factor analysis to examine the structure of IU as measured by the Intolerance of Uncertainty Scale for Children (IUSC; Comer et al., 2009) in a sample of youth (N=368) 9-18 years of age (Mage=12.47) with and without anxiety disorders and their mothers. Findings demonstrated multiple acceptable factor structures: a correlated factors 2-factor structure and a bifactor model where a general factor underlies all items. While the bifactor model provides better fit and reliability to the data, multivariate analyses indicated that the 2-factor structure distinguishes apprehensive anxiety regarding future events (prospective IU) from present-focused inhibition of behavior due to uncertainty and negative reactions to the presence of uncertainty (inhibitory IU); a total IU score predicted all anxiety domains for self- and parent-reports except for parent-report harm avoidance. Findings are discussed in terms of consistency of IU across adult and youth samples, and how results can inform treatment efforts and etiologic models of IU and anxiety.
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Effect of mechanical loading on the metabolic activity of cells in the temporomandibular joint: a systematic review
Abstract
Objectives
The purpose of this systematic review was to elucidate how different modalities and intensities of mechanical loading affect the metabolic activity of cells within the fibro-cartilage of the temporomandibular joint (TMJ).
Materials and methods
A systematic review was conducted according to PRISMA guidelines using PubMed, Embase, and Web of Science databases. The articles were selected following a priori formulated inclusion criteria (viz., in vivo and in vitro studies, mechanical loading experiments on TMJ, and the response of the TMJ).
A total of 254 records were identified. After removal of duplicates, 234 records were screened by assessing eligibility criteria for inclusion. Forty-nine articles were selected for full-text assessment. Of those, 23 were excluded because they presented high risk of bias or were reviews. Twenty-six experimental studies were included in this systematic review: 15 in vivo studies and 11 in vitro ones.
Conclusion
The studies showed that dynamic mechanical loading is an important stimulus for mandibular growth and for the homeostasis of TMJ cartilage. When this loading is applied at a low intensity, it prevents breakdown of inflamed cartilage. Yet, frequent overloading at excessive levels induces accelerated cell death and an increased cartilage degradation.
Clinical Significance
Knowledge about the way temporomandibular joint (TMJ) fibrocartilage responds to different types and intensities of mechanical loading is important to improve existing treatment protocols of degenerative joint disease of the TMJ, and also to better understand the regenerative pathway of this particular type of cartilage.
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Dural metastasis of nasopharyngeal carcinoma: A case report
Publication date: Available online 16 June 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Mohd Irman Shah Ibrahim, Aishah Harizah Abdullah Alwi, Amran Mohamad, Norhafiza Mat Lazim
Nasopharyngeal carcinoma (NPC) with dural metastasis is extremely rare, mostly asymptomatic, leaving it to be highly at risk of being overlooked. We report a case of a woman with dural metastasis of NPC almost 1year post concurrent chemoradiotherapy (CCRT) that was detected following a trivial trauma to her head. Owing to its rare occurence, it presents a great challenge for clinicians to make a prompt diagnosis because delayed in the treatment may lead to a fatal outcome.
http://ift.tt/2hiVE9k
Effect of glycerol test on audiovestibular tests in patients with Meniere’s disease
Publication date: Available online 9 May 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Enass S. Mohamed, Eman A. Said, Nashwa A. Mahmoud
This stud to explore the effect of glycerol on audiovestibular tests in patients with Meniere's disease (MD) and to reflect different pathologic states of endolymphatic hydrops (EH) in the inner ear and compare the results of glycerol on these results.SubjectsThirty patients and 15 normal volunteers.MethodsEach subject of this study underwent pure tone audiometry testing, evoked vestibular evoked myogenic potential (VEMP) and Vidionystagmography (VNG) before G1 and 2h after glycerol G2 administration (1.3g/kg).ResultsAffected ears were 32 and unaffected ears were 28. The affected ears had higher hearing and SRT thresholds when compared to the unaffected ears and control group. VEMPs of the affected ears were normal in six ears (18.75%), absent in four ears (12.5%) and augmented amplitude in 22 (68.75%), their VNG results showed peripheral vestibular disorder. After oral administration of glycerol, the previous test battery was repeated and it's result on PTA showed that 53.13% (17/32) of affected ears had positive glycerol test mainly in stage II and III. Ten of the 32 affected ears (31.26%) showed improvement of VEMPs after glycerol administration. Also, two (7.8%) of the unaffected ears showed positive glycerol. Latency of the VEMP had no significant changes after glycerol administration and there was no statistical correlation between the results of G-PTA and G-VEMP. There was statistical significant improvement of the slow peak velocity of caloric test in patient's affected ears and insignificant improvement in control group and in unaffected ears after glycerol administration.
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Editorial Board
Publication date: March 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Volume 18, Issue 1
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Comparative study between selective nerve blocks and the intravenous opioids in mastoid surgery
Publication date: Available online 17 June 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Santosh Kumar Swain, Chandrasekhar Pradhan, Sidharth Mohanty, Mahesh Chandra Sahu
ObjectiveThis double-blind randomized trial was conducted to compare the efficacy of selective nerve blocks over intravenous use of morphine during mastoid surgery.Materials and methodsA total of 50 patients between the ages 25 to 45years were divided into two groups as per the anaesthetic techniques used; nerve block group (N) and intravenous morphine group (M). After induction of general anaesthesia and before surgical incision: Group N patients (nerve block group) were given Great Auricular Nerve (GAN) and Auriculo-Temporal Nerve (ATN) block with 0.25% bupivacaine. Group M patients (morphine group) received 0.1mg/kg morphine. In the post anaesthesia care unit (PACU), Visual Analogue Scale (VAS) was used to assess post operative pain, Ramsay Sedation Scale (RSS) for sedation and post operative nausea and vomiting (PONV) impact scale score.ResultsVAS scores and requirement of rescue analgesics in the PACU was significantly less in the N Group for first 3h. The group N patients had a less frequent incidence of vomiting requiring intervention and were ready to be discharged from hospital after 3h of surgery.ConclusionCombination of GAN and ATN block with general anaesthesia is an uncomplicated, effective and well tolerated method for the safe conduct of mastoid surgery.
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Bio-inspired hybrid scaffold of zinc oxide-functionalized multi-wall carbon nanotubes reinforced polyurethane nanofibers for bone tissue engineering
Publication date: 5 November 2017
Source:Materials & Design, Volume 133
Author(s): Bishnu Kumar Shrestha, Sita Shrestha, Arjun Prasad Tiwari, Jeong-In Kim, Sung Won Ko, Han-Joo Kim, Chan Hee Park, Cheol Sang Kim
In this study, we prepared nanotopographical polyurethane (PU)-based bioactive scaffolds that incorporated uniformly dispersed functionalized multi-wall carbon nanotubes (fMWCNTs) and zinc oxide (ZnO) nanoparticles (NPs) using an electrospinning technique. We found that well dispersed fMWCNTs along with ZnO NPs reinforced PU fibers demonstrated significant improvement in mechanical strength, hydrophilicity, thermal stability, electrical conductivity, degradability, biomineralization, and biocompatibility. Inspired by the exciting nature of biopolymeric composite (PU/ZnO-fMWCNTs) membranes, these hybrid scaffolds offer extensive interest to tissue engineering as a potential biomedical application. The specific bioactive properties and cell-biomaterial interaction of electrospun scaffold containing 0.2wt% ZnO with 0.4wt% fMWCNTs were found to demonstrate anti-bacterial activity and cytocompatibility. Furthermore, the highly charged density, large surface-to-volume ratio, and more functional groups in fMWCNTs integrated on the scaffolds promote osteogenic differentiation of pre-osteoblast (MC3T3-E1) cells. Therefore, the novel as-prepared multifunctional electrospun fibrous scaffold could suggest new avenues for exploration as promising osteoproductive and osteoinductive biomaterials that offer great benefit to bone tissue engineering.
Graphical abstract
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Tailoring modulus and hardness of in-situ formed β-Ti in bulk metallic glass composites by precipitation of isothermal ω-Ti
Publication date: 5 November 2017
Source:Materials & Design, Volume 133
Author(s): L. Zhang, S. Chen, H.M. Fu, H. Li, Z.W. Zhu, H.W. Zhang, Z.K. Li, A.M. Wang, H.F. Zhang
It is challenging to tailor the mechanical properties of in-situ formed β phases in Ti/Zr-based bulk metallic glass composites (β-type BMGCs) without changing the morphologies of the β phases. Recently, BMGCs containing metastable β-Ti/Zr phases (metastable β-type BMGCs) exhibit an exothermic reaction below the glass transition temperature (sub-Tg) of the glassy matrices during heating, however, the corresponding structural origin remains unclear. In this work, the precipitation of ω phase inside β phase was revealed to account for the sub-Tg exothermic event of the metastable Ti45.7Zr33Cu5.8Co3Be12.5 BMGC. The sub-Tg annealing of metastable β-type BMGCs causes the precipitation of nanometer-sized isothermal ω phase, which leads to a large increase in the modulus and hardness of the crystalline phase. This finding provides a novel route to tailor the modulus and hardness of the crystalline phases in BMGCs without changing their morphologies, including volume fractions, sizes, and distributions. On this basis, the influence of the modulus and hardness of the crystalline phase on mechanical properties of BMGCs was exclusively investigated. Our experimental results together with finite-element simulations proved that lower modulus and hardness of the crystalline phase benefit a larger plasticity of BMGCs.
Graphical abstract
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The Impact of the Cosurgeon Model on Bilateral Autologous Breast Reconstruction
J reconstr Microsurg
DOI: 10.1055/s-0037-1604106
Background Microsurgical breast reconstructions (MBRs) are time and labor intensive procedures. To circumvent these barriers, plastic surgeons have started working together as cosurgeons (CSs). This study aims to evaluate the impact of the CS model (CSM) specifically on bilateral MBR. The hypothesis is that CS procedures reduce operative time and surgical complications. Study Design This was a single institutional retrospective cohort study, which included all consecutive patients who underwent bilateral MBR from 2014 to 2016. Patients were grouped into single surgeon (SS) or CSs based on the number of the attending plastic surgeons present. Demographic and clinical characteristics including age, body mass index, smoking, American Society of Anesthesiologist class, radiation, and the timing of the reconstruction were assessed. Univariate and multivariate analyses were performed for outcomes including operative time and postoperative complications. Results Of the 136 patients included in the study, 41% had breast reconstruction performed by CSs, whereas 59% had a SS. Sociodemographic features were evenly distributed with the exception of a greater number of delayed reconstructions in the SS group (33 vs. 13%; p <0.01). Pedicle TRAMS (transverse rectus abdominis musculocutaneous flaps) were performed in 5 versus 0% of SS versus CS cases, respectively. Rates of major (4 vs. 16%) and minor (11 vs. 24%) complications were significantly lower in CS procedures. Multivariate analyses demonstrated CS operations required significantly shorter operative time by 73 minutes (p <0.001), and trended toward a reduced postoperative complication rate (p = 0.07). Conclusion The CSM is associated with improved operative efficiency for bilateral MBR. Further evaluation of the CSM may prove useful in other surgical disciplines with time and labor intense procedures.
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Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Stable Coronary Syndromes: The Case for Consolidating the Nomenclature of Stable Ischemic Heart Disease.
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Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial).
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Intensive Blood Pressure Lowering and Regression of Left Ventricular Hypertrophy.
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Associations Between Adding a Radial Artery Graft to Single and Bilateral Internal Thoracic Artery Grafts and Outcomes: Insights From the Arterial Revascularization Trial.
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Human Plasma Thioredoxin-80 Increases With Age and in ApoE-/- Mice Induces Inflammation, Angiogenesis, and Atherosclerosis.
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Functional Characterization of the GUCY1A3 Coronary Artery Disease Risk Locus.
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Should We Perform Catheter Ablation for Asymptomatic Atrial Fibrillation?.
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Soda Taxes Take Off Across the Country.
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Chest Pain in an 18-Year-Old Man.
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Letter by Shi et al Regarding Article, "Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis".
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Letter by Banack et al Regarding Article, "Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis".
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Letter by Butcher et al Regarding Article, "Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis".
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Response by Mariscalco and Murphy to Letters Regarding Article, "Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis".
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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
http://ift.tt/2ueb6o6
Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
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A comparative intracellular proteomic profiling of Pseudomonas aeruginosa strain ASP-53 grown on pyrene or glucose as sole source of carbon and identification of some key enzymes of pyrene biodegradation pathway
Publication date: Available online 31 July 2017
Source:Journal of Proteomics
Author(s): Ashis K. Mukherjee, Pabitra Bhagowati, Bhim Bahadur Biswa, Abhishek Chanda, Bhargab Kalita
Pseudomonas aeruginosa strain ASP-53, isolated from a petroleum oil-contaminated soil sample, was found to be an efficient degrader of pyrene. PCR amplification of selected hydrocarbon catabolic genes (alkB gene, which encodes for monooxygenase, and the C12O, C23O, and PAH-RHDα genes encoding for the dioxygenase enzyme) from the genomic DNA of P. aeruginosa strain ASP-53 suggested its hydrocarbon degradation potential. The GC–MS analysis demonstrated 30.1% pyrene degradation by P. aeruginosa strain ASP-53 after 144h of incubation at pH6.5, 37°C. Expressions of 115 and 196 intracellular proteins were unambiguously identified and quantitated by shotgun proteomics analysis when the isolate was grown in medium containing pyrene and glucose, respectively. The pyrene-induced uniquely expressed and up-regulated proteins in P. aeruginosa strain ASP-53 in addition to substrate (pyrene) metabolism are also likely to be associated with different cellular functions for example-related to protein folding (molecular chaperone), stress response, metabolism of carbohydrate, proteins and amino acids, and fatty acids; transport of metabolites, energy generation such as ATP synthesis, electron transport and nitrate assimilation, and other oxidation-reduction reactions. Proteomic analyses identified some important enzymes involved in pyrene degradation by P. aeruginosa ASP-53 which shows that this bacterium follows the salicylate pathway of pyrene degradation.SignificanceThis study is the first report on proteomic analysis of pyrene biodegradation pathway by Pseudomonas aeruginosa, isolated from a petroleum-oil contaminated soil sample. The pathway displays partial similarity with deduced pyrene degradation mechanisms of Mycobacterium vanbaalenii PYR-1. The GC–MS analysis as well as PCR amplification of hydrocarbon catabolic genes substantiated the potency of the bacterium under study to effectively degrade high molecular weight, toxic PAH such as pyrene for its filed scale bioremediation experiments. The proteomics approach (LC-MS/MS analysis) identified the differentially regulated intracellular proteins of the isolate P. aeruginosa ASP-53 when grown in pyrene medium. This study identified some important pyrene biodegradation enzymes in Pseudomonas aeruginosa ASP-53 and highlights that the bacterium follows salicylate pathway for pyrene degradation.
Graphical abstract
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Early hominin landscape use in the Lower Omo Valley, Ethiopia: Insights from the taphonomical analysis of Oldowan occurrences in the Shungura Formation (Member F)
Source:Journal of Human Evolution, Volume 111
Author(s): Tiphaine Maurin, Pascal Bertran, Anne Delagnes, Jean-Renaud Boisserie
The Oldowan archeological record of the Shungura Formation, Member F (Lower Omo valley, Ethiopia) comprises more than one hundred occurrences distributed within archeological complexes, where multiple small spots were found in association with one or two larger occurrences. Such spatial patterning could reflect hominin spatial behavior, repeated occupations within a single sedimentary unit, or taphonomic and/or collection biases. Here we test these hypotheses by way of a geoarcheological and taphonomical analysis using four criteria to assess the preservation of the lithic assemblages: (1) size composition, (2) artifact abrasion, (3) bone abrasion, and (4) orientations of lithic artifacts and bones (i.e., fabrics). We propose a new model of taphonomically induced spatial patterning where the multiple, small, well circumscribed occurrences result primarily from post-depositional processes and therefore do not reflect any underlying behavioral patterns. The large number of archeological occurrences documented in Member F, therefore, corresponds to a limited number of primary occupations (<10). The archeological occupation is mainly restricted to the lower part of Member F and may reflect a single or a small number of occupation episodes, which were located on previous levees of the paleo-Omo River, in nearby floodplain areas, or on the riverbank. This strongly suggests that most of the knapping activities originally took place close to the river. This preference of the Omo toolmakers for riverine environments could explain the scarcity of archeological material in the upper part of Member F that comprises primarily distal floodplain sedimentary facies.
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Evidence of Neanderthals in the Balkans: The infant radius from Kozarnika Cave (Bulgaria)
Source:Journal of Human Evolution, Volume 111
Author(s): Anne-marie Tillier, Nikolay Sirakov, Aleta Guadelli, Philippe Fernandez, Svoboda Sirakova, Irena Dimitrova, Catherine Ferrier, Guillaume Guérin, Maryam Heidari, Ivailo Krumov, Jean-Claude Leblanc, Viviana Miteva, Vasil Popov, Stanimira Taneva, Jean-Luc Guadelli
Excavations conducted by a Bulgarian-French team at Kozarnika Cave (Balkans, Bulgaria) during several seasons yielded a long Paleolithic archaeological sequence and led to the discovery of important faunal, lithic, and human samples. This paper aims to describe the unpublished radius shaft of an infant who died approximately before the sixth month postnatal that was recovered from layer 10b, which contained East Balkan Levallois Mousterian with bifacial leaf points. The layer was dated between 130 and 200 ka (large mammals biochronology) and between 128 ± 13 ka and 183 ± 14 ka (OSL), i.e. OIS6. Here we show that, given the scarcity of Middle Pleistocene infant remains in general, and Middle Paleolithic human remains from this part of Eastern Europe in particular, the study of the Kozarnika specimen is of special interest. We discuss its place in the Middle Pleistocene European hominine record and substantiate the hypothesis of early Neanderthal presence in the eastern Balkans.
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Paleolithic subsistence strategies and changes in site use at Klissoura Cave 1 (Peloponnese, Greece)
Source:Journal of Human Evolution, Volume 111
Author(s): Britt M. Starkovich
Klissoura Cave 1 in southern Greece preserves a long archaeological sequence that spans roughly 90,000 years and includes Middle Paleolithic, Uluzzian, Upper Paleolithic, and Mesolithic deposits. The site provides a unique opportunity to examine diachronic change and shifts in the intensity of site use across the Late Pleistocene. There is an overall picture of the intensified use of faunal resources at the site, evidenced by a shift from large to small game, and to small fast-moving taxa in particular. This trend is independent of climatic change and fluctuations in site use, and most likely reflects a broader, regional growth of hominin populations. At the same time, multiple lines of evidence (e.g., input of artifacts and features, sedimentation mechanisms, and intensification of faunal resources) indicate that the intensity of site use changed, with a sharp increase from the Middle Paleolithic to Aurignacian. This allows us to address a fundamental issue in the study of human evolution: differences in population size and site use between Neandertals and modern humans. At Klissoura Cave 1, the increase in occupation intensity might be related to population growth or larger group size, but it might also be due to changes in season of site use, more favorable environmental conditions at the beginning of the Upper Paleolithic, and/or changes in the composition of people occupying the site. These explanations are not necessarily mutually exclusive, and indeed the data support a combination of factors. Ascribing the increase in occupation intensity to larger Upper Paleolithic populations more broadly is difficult, particularly because there is little consensus on this topic elsewhere in Eurasia. The data are complicated and vary greatly between sites and regions. This makes Klissoura Cave 1, as the only currently available case study in southeastern Europe, a critical example in understanding the range of variation in demography and site use across the Middle to Upper Paleolithic transition.
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Landscape scale heterogeneity in the East Turkana ecosystem during the Okote Member (1.56–1.38 Ma)
Source:Journal of Human Evolution
Author(s): D.B. Patterson, D.R. Braun, A.K. Behrensmeyer, S.B. Lehmann, S.R. Merritt, J.S. Reeves, B.A. Wood, R. Bobe
Placing the biological adaptations of Pleistocene hominins within a well-resolved ecological framework has been a longstanding goal of paleoanthropology. This effort, however, has been challenging due to the discontinuous nature of paleoecological data spanning many important periods in hominin evolution. Sediments from the Upper Burgi (1.98–1.87 Ma), KBS (1.87–1.56 Ma) and Okote (1.56–1.38 Ma) members of the Koobi Fora Formation at East Turkana in northern Kenya document an important time interval in the evolutionary history of the hominin genera Homo and Paranthropus. Although much attention has been paid to Upper Burgi and KBS member deposits, far less is known regarding the East Turkana paleoecosystem during Okote Member times. This study pairs spatially-resolved faunal abundance data with stable isotope geochemistry from mammalian enamel to investigate landscape-scale ecosystem variability during Okote Member times. We find that during this period 1) taxa within the East Turkana large mammal community were distributed heterogeneously across space, 2) the abundance of C3 and C4 vegetation varied between East Turkana subregions, and 3) the Karari subregion, an area with abundant evidence of hominin stone tool manufacture, had significantly more C3 vegetation than regions closer to the central axis of the Turkana Basin (i.e., Ileret and Koobi Fora). These findings indicate that the East Turkana paleoecosystem during the Okote Member was highly variable across space and provided a complex adaptive landscape for Pleistocene hominins.
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Sevoflurane attenuates systemic inflammation compared with propofol, but does not modulate neuro-inflammation: A laboratory rat study.
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Review of Extra-Skeletal Activity on Tc-99m MDP Bone Scintigraphy and Value of Cross-sectional and SPECT-CT Imaging Correlation
Source:Current Problems in Diagnostic Radiology
Author(s): Mohammed Bermo, Sanaz Behnia, Joanna Fair, Robert S. Miyaoka, Saeed Elojeimy
Recognizing the different mechanisms and imaging appearance of extra-skeletal Tc-99m methylene diphosphonate (MDP) uptake enhances the diagnostic value of bone scan interpretation. In this article, we present a pictorial review of the different mechanisms of extra-skeletal Tc-99m MDP uptake on bone scintigraphy including neoplastic, inflammatory, ischemic, traumatic, excretory, and iatrogenic. We also illustrate through case examples the added value of correlation with cross-sectional and SPECT-CT imaging in localizing and characterizing challenging cases of extra-skeletal uptake.
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Biogenic synthesis of gold nanoparticles from Terminalia arjuna bark extract: assessment of safety aspects and neuroprotective potential via antioxidant, anticholinesterase, and antiamyloidogenic effects
Abstract
The development of neuroprotective drugs through eco-friendly production routes is a major challenge for current pharmacology. The present study was carried out to synthesize gold nanoparticles (AuNPs) through biogenic route using ethanolic bark extract of Terminalia arjuna, a plant of high interest in Asian traditional medicine, and to evaluate its neuroprotective effects. The synthesized AuNPs were characterized by UV-Vis spectroscopy, FTIR spectroscopy, XRD, FESEM, EDX, HRTEM, DLS, and zeta potential analyses. UV-Vis spectroscopy showed a characteristics SPR absorption band at 536 nm specific for AuNPs. XRD, TEM, and FESEM analyses revealed the formation of face-centered cubic crystalline, spherical and triangular shaped AuNPs, with size ranging between 20 and 50 nm. DLS and ZP analysis illustrated that the average size of AuNPs was 30 nm, which was found to be stable at 45 mv. The neuroprotective potential of AuNPs was evaluated by assessing its antioxidant, cholinesterase inhibitory, and antiamyloidogenic activities. AuNPs showed dose-dependant inhibition of acetylcholinesterase and butyrylcholinesterase with IC50 value of 4.25 ± 0.02 and 5.05 ± 0.02 μg/ml, respectively. In vitro antioxidant assays illustrated that AuNPs exhibited the highest reducing power and DPPH radical scavenging activity. In addition, AuNPs also efficiently suppressed the fibrillation of Aβ and destabilized the preformed mature fibrils. Results of toxicity studies in PBMC and adult zebra fish illustrated that AuNPs are non-toxic and biocompatible. Overall, our results highlighted the AuNPs promising potential in terms of antioxidant, anticholinesterase, antiamyloidogenic effects, and non-lethality allowing us to propose these nanomaterials as a suitable candidate for the development of drugs helpful in the treatment of neurodegenerative disorders like Alzheimer's disease.
Graphical abstract
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Good bye, thank you, ethics and other things…
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):65-65
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The science and art of eyebrow transplantation by follicular unit extraction
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):66-71
Eyebrows constitute a very important and prominent feature of the face. With growing information, eyebrow transplant has become a popular procedure. However, though it is a small area it requires a lot of precision and knowledge regarding anatomy, designing of brows, extraction and implantation technique. This article gives a comprehensive view regarding eyebrow transplant with special emphasis on follicular unit extraction technique, which has become the most popular technique.
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Giant pedunculated tumour on the finger
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):113-114
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Effectiveness of fibrin glue in adherence of skin graft
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):72-75
Background: Graft fixation is important for graft take. Fibrin glue has been proposed as an ideal material, because of its human origin and it provides firm adhesion in seconds or minutes. Objective: To evaluate the efficiency of fibrin glue, in increasing the take of skin graft. Assessment includes surgical time taken for graft fixation, haematoma/seroma formation, engraftment and wound closure by day 14. Methods: The study is an observational prospective study conducted in the Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, from January 2016 to June 2016. Sixteen patients who underwent split skin grafting were assessed during the study period. Fibrin glue was used on the recipient bed before grafting. Results: Better haemostasis and graft adhesion, with a significant reduction of surgical time, were noted. Conclusion: The safety profile of fibrin glue was excellent as indicated by the lack of any related serious adverse experiences. These findings demonstrate that it is safe and effective for attachment of skin grafts, with outcomes at least as good as conventional methods.
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Reconstructions of small scalp defects with step flap
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):106-108
Introduction: Defects of the scalp arise from several aetiologies including trauma, burn, injury, infection, radiation and surgical excision of tumours. Multiple options for reconstruction of scalp defects exist that included primary closure, skin grafts, local flaps, regional and distal free flaps.Patients and Methods: This was a prospective case-series study, which was carried out in the Department of Plastic Surgery of our Hospital. Step flap was used for small (2.5 cm × 2.5 cm) scalp skin defects reconstructions after skin tumour ablations. In this 2 years study, 15 patients (7 female , 8 male), ranging from 40 to 72 years (mean, 53 years), underwent an operation with local step flap for reconstruction of scalp defects caused by basal cell carcinoma or squamous cell carcinoma excision.Results: The patients who present with small scalp malignant tumours need complete resection and perfect reconstruction. This study showed that step flap with sufficient releasing was an effective method for reconstruction of small scalp defects due to skin malignancies. We had no case of flap complications such as ischaemia or necrosis.Conclusion: We recommend this local flap (z-flap) as a new approach for small scalp defect reconstruction in all areas of hair-bearing scalp.
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Fractional carbon dioxide, long pulse Nd:YAG and pulsed dye laser in the management of keloids
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):76-80
Background: Keloids are abnormal wound responses characterised by excessive deposition of collagen and glycoprotein. They are both aesthetically and symptomatically distressing for most of the patients. There are reports of keloid management with pulsed dye laser (PDL), fractional carbon dioxide (CO2) laser and neodymium-doped yttrium aluminium garnet (Nd:YAG) laser individually and also in combination of CO2 with PDL and CO2 with Nd:YAG. Here, we discuss a combination of all the 3 lasers as a therapy for keloids. Aim: This study aims to assess the efficacy of fractional CO2 laser, long pulse Nd:YAG laser and PDL in the management of keloids. Materials and Methods: Fifteen patients with keloids were treated by fractional CO2 laser, followed by PDL and long pulse Nd:YAG laser at monthly intervals. Four patients discontinued the study and were lost for follow-up. Photographs were taken at the beginning of the treatment and at the end of five sessions. Clinical improvement was analysed based on a visual analogue scale graded by three blinded observers after assessing the clinical photographs for the improvement in size, colour and aesthetic impression. Results: Of the 11 patients, one patient had excellent improvement, one patient had good improvement, four patients had moderate improvement, two patients had mild improvement and three had no improvement. Conclusion: Lasers may have a synergistic effect when combined with other modalities of treatment but cannot be used as monotherapy in the treatment of keloids.
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Successful management of angiolymphoid hyperplasia with eosinophilia by radiofrequency
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):116-118
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Simplified non-cultured non-trypsinised epidermal cell graft technique followed by psoralen and ultraviolet a light therapy for stable vitiligo
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):81-85
Background and Aims: Stable vitiligo can be treated by various surgical procedures. Non-cultured melanocyte grafting techniques were developed to overcome the time-consuming process of culture while at the same time providing acceptable results. All the techniques using non-cultured melanocyte transfer involve trypsinisation as an integral step. Jodhpur technique used by the author is autologous, non-cultured, non-trypsinised, epidermal cell grafting. Settings and Design: The study was conducted on patients visiting the dermatology outpatient department of a tertiary health centre in Western Rajasthan. Materials and Methods: At the donor site, mupirocin ointment was applied and dermabrasion was done with the help of micromotor dermabrader till pinpoint bleeding was seen. The paste-like material obtained by this procedure containing melanocytes and keratinocytes admixed with the ointment base was harvested with spatula and was subsequently spread over the recipient area. Recipient site was prepared in the same manner by dermabrasion. After 10 days, dressing at both sites was removed taking utmost care at the recipient site as there was a theoretical risk of dislodging epidermal cells. Results: In a study of 437 vitiligo patches, more than 75% re-pigmentation (excellent improvement) was seen in 41% of the patches. Lesions on thigh (100%), face (75%) and trunk (50%) showed maximal excellent improvement, whereas patches on joints and acral areas did not show much improvement. Conclusions: This technique is a simplified, cost effective, less time-consuming alternative to other techniques which involve tryspsinisation of melanocytes and at the same time provides satisfactory uniform pigmentation.
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Assessment of the efficacy and safety of hyaluronic acid gel injection in the restoration of fullness of the upper lips
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):101-105
Background and Aim: Lips have a significant role in face aesthetic perception, and lip augmentation is one of the most commonly requested aesthetic procedures. Non-permanent dermal fillers, such as hyaluronic acid (HA), are used for augmenting the lips. This article presents the results of Phase II, before – after designed study, assessing the safety and efficacy of a soft tissue HA filler, for upper lip augmentation.Materials and Methods: Investigators treated 10 healthy adult women 28–45 years old, using a single injection of Hyamax Kiss soft tissue HA filler (a product from Hyamed Laboratories, Switzerland) for upper lip augmentation. The primary efficacy endpoint was an increase in lip fullness at least one grade on Medicis Lip Fullness Scale at 2, 12 and 24 weeks post-treatment. Furthermore, the effectiveness and durability of filler were assessed using a 5-point Investigator's Global Assessment (IGA). Adverse events and volunteers' satisfaction were reported using visual analog scale.Results: Response to treatment (as defined above) after 2, 12 and 24 weeks were observed in 80%, 70% and 80% of patients, respectively. No statistical difference was found in response to treatment rate between follow-up visits (P = 0.83). The mean value of IGA score in weeks 2, 12 and 24 were 3.4 ± 0.96, 3.3 ± 0.67 and 3.3 ± 0.67, respectively. The study subjects were almost all satisfied with their lip improvement. Reported adverse effects were temporary and mostly mild in severity.Conclusion: Soft tissue HA filler tested in this study was well tolerated, efficient and durable when used for upper lip augmentation.
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A spilt head study of efficacy of placebo versus platelet-rich plasma injections in the treatment of androgenic alopecia
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):86-89
Background: Platelet-rich plasma (PRP) is an autologous concentration of human platelets contained in a small volume of plasma with haemostatic and tissue repairing effects. Being enriched by various growth factors, PRP has become the focus of attention in numerous fields of medicine. Androgenic alopecia (AGA) is a common chronic hair loss disorder, characterised by progressive hair loss. Despite the therapeutic options available, there is low patient compliance and satisfaction rate. The topical and often systemic adverse effects of therapy has lead to the search of new treatment options for AGA. Recently, PRP has received growing attention as a potential therapeutic tool for hair loss. Aim: To compare the efficacy of placebo versus PRP injections in the treatment of male AGA. Patients and Methods: Fifty male patients with AGA (Grade III to VI) were enrolled in the study. PRP was prepared using the double-spin method and injected in the androgen-related areas of scalp on the left side. Normal saline was injected on the right side in a similar fashion. Treatment sessions were performed with an interval of 21 days, and six sittings were completed for every patient. Results: Hair loss reduced with evidence of new hair growth. Digital image analysis showed an overall improvement in hair density and quality as lanugo-like hair became thicker, normal hair. An improvement in hair density, quality and thickness on trichoscopy was noted. Conclusion: Our data suggest that PRP injections have therapeutic effect on male pattern hair loss with no major side effects and high patient satisfaction overall.
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A simplified reconstructive technique for full-thickness central defects of the auricle with the use of a post-auricular folded flap
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):109-112
Background: Post-auricular flaps have proved very effective in the reconstruction of most types of partial auricular defects. However, few reports exist regarding the reconstruction of centrally located perforating defects of the auricle. Objectives: This paper aimed to describe a one-stage technique including a post-auricular folded flap (PAFF) for reconstruction of full-thickness defects of central auricular sites. Patients and Methods: Between March 2010 and November 2014, five male patients were treated with this reconstructive technique under local anaesthesia. At the time of surgery, patients' age ranged from 76 to 86 years (mean age, 79.8). The patients suffered from a central and full-thickness defect owing to surgical excision of a skin malignancy or failed reconstruction procedures secondary to surgical excision of a skin malignancy. Results: Healing was uneventful for all the included patients, without signs of dehiscence, necrosis, hematoma and infection. The defects were completely repaired, without the need of further operations. During the follow-up period, all the patients remained satisfied with the aesthetic outcome. Conclusions: This technique constitutes an immediate, effective and low-morbidity procedure to repair full-thickness central defects of the auricle. Since PAFF requires only one surgical operation under local anaesthesia, patients with burdened medical history may profit from this technique.
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Safety and efficacy of intralesional vitamin D3 in cutaneous warts: An open uncontrolled trial
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):90-94
Background: Cutaneous warts are treated primarily with destructive methods such as cryotherapy or electrocautery. These modalities of treatment are time-consuming and may be associated with scarring in multiple warts. Immunotherapy is emerging as a new modality of treatment which acts on enhancing cell-mediated immunity against human papillomavirus for clearance of both treated and distant warts. Aims: This study aims to evaluate the safety and efficacy of intralesional Vitamin D3 for the treatment of cutaneous warts. Materials and Methods: Patients with multiple warts were selected for immunotherapy. Vitamin D3 (0.2 ml, 15 mg/ml) was injected to the base of warts after injecting with lignocaine (0.2 ml, 20 mg/ml). The injections were repeated 2 weeks apart for a maximum of 4 sessions or until complete clearance, whichever was earlier. A maximum of 2 warts were treated per session and patients were followed up for 6 months after the last injection. Results: Forty-two patients with multiple warts were recruited for the study who completed the 6-month follow-up period and were available for analysis. Of these, 23 had palmoplantar warts, 18 had verruca vulgaris and 1 patient had filiform wart. In total, 33 of 42 patients (78.57%) showed complete response, 6 patients (14.28%) showed moderate response and three patients (7.14%) showed mild response. Recurrence was observed in one patient with the palmoplantar wart. No serious adverse effects were reported. Limitations: Lack of control group was the main drawback in our study. Conclusion: Intralesional Vitamin D3 is safe and effective for treatment of multiple cutaneous warts.
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Glomus tumour with intramedullary bone cyst: A rare presentation
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):114-116
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The clinical pattern of axillary hidradenitis suppurativa among Saudi Arabians: Mode of presentation and treatment challenges
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):95-100
Background: Hidradenitis suppurativa is a chronic follicular occlusive disease affecting the folliculopilosebaceous unit. The clinical course is variable, ranging from mild to severe cases. Definitive evidence-based guidelines for the management are lacking. In addition, the multifaceted clinical features and the unpredictable course of the disease make a uniform approach to treatment impractical. As a result, there are multiple therapeutic approaches. Therefore, in this study, we aim to analyze the results of management of axillary hidradenitis suppurativa among the local community in Saudi Arabia. Materials and Methods: A retrospective cohort database analysis of 1369 patients diagnosed and treated for axillary hidradenitis suppurativa between January 2004 and December 2013 was done. Seven hundred and forty-one (54.12%) were females and 628 (45.87%) were males. All patients with Stage I disease favored the conservative method while all patients with Stage II chose the surgical approach. Results: The mean age was 25.5 years. Nine hundred and seventy-four (71.15%) patients were treated conservatively; the mean healing time was 5.5 weeks. Three hundred and ninety-five (28.85%) patients were treated surgically. One hundred and fourteen (28.9%) had incision and drainage, 281 (71.1%) had complete excision; all wounds eventually healed without significant scarring. The recurrence rate was 12.5% (122 patients) in the conservative method group and zero (0%) in the surgical method group. Conclusions: Hidradenitis suppurativa remains a challenging clinical condition for patients and physicians. Further studies need to focus not only on the etiology of this disease but also on the optimal treatment regimen. Public awareness programs are necessary to avoid late presentation and complications.
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Aesthetic correction of smoker's lip using 1064 nm Q-switched neodymium-doped yttrium aluminium garnet laser
Journal of Cutaneous and Aesthetic Surgery 2017 10(2):118-119
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Editorial Board
Source:American Journal of Infection Control, Volume 45, Issue 8
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Implementation in the midst of complexity: Using ethnography to study health care–associated infection prevention and control
Source:American Journal of Infection Control
Author(s): Mary Jo Knobloch, Kevin V. Thomas, Erin Patterson, Michele L. Zimbric, Jackson Musuuza, Nasia Safdar
BackgroundContextual factors associated with health care settings make reducing health care–associated infections (HAIs) a complex task. The aim of this article is to highlight how ethnography can assist in understanding contextual factors that support or hinder the implementation of evidence-based practices for reducing HAIs.MethodsWe conducted a review of ethnographic studies specifically related to HAI prevention and control in the last 5 years (2012-2017).ResultsTwelve studies specific to HAIs and ethnographic methods were found. Researchers used various methods with video-reflexive sessions used in 6 of the 12 studies. Ethnography was used to understand variation in data reporting, identify barriers to adherence, explore patient perceptions of isolation practices and highlight the influence of physical design on infection prevention practices. The term ethnography was used to describe varied research methods. Most studies were conducted outside the United States, and authors indicate insights gained using ethnographic methods (whether observations, interviews, or reflexive video recording) as beneficial to unraveling the complexities of HAI prevention.ConclusionsEthnography is well-suited for HAI prevention, especially video-reflexive ethnography, for activating patients and clinicians in infection control work. In this era of increasing pressure to reduce HAIs within complex work systems, ethnographic methods can promote understanding of contextual factors and may expedite translation evidence to practice.
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APIC Masthead
Source:American Journal of Infection Control, Volume 45, Issue 8
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Information for Readers
Source:American Journal of Infection Control, Volume 45, Issue 8
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Effectiveness of cleaning-disinfection wipes and sprays against multidrug-resistant outbreak strains
Publication date: 1 August 2017
Source:American Journal of Infection Control, Volume 45, Issue 8
Author(s): Nikki Kenters, Elisabeth G.W. Huijskens, Sophie C.J. de Wit, Joost van Rosmalen, Andreas Voss
BackgroundHospital rooms play an important role in the transmission of several health care–associated pathogens. During the last few years, a number of innovative cleaning-disinfecting products have been brought to market. In this study, commercially available products combining cleaning and disinfection were compared, using 2 different application methods. The aim was to determine which product was most effective in simultaneous cleaning and disinfection of surfaces.MethodsSeven cleaning-disinfecting wipes and sprays based on different active ingredients were tested for their efficacy in removal of microbial burden and proteins. Efficacy was tested with known Dutch outbreak strains: vancomycin-resistant enterococci (VRE), Klebsiella pneumoniae OXA-48, or Acinetobacter baumannii.ResultsFor all bacteria, ready-to-use cleaning-disinfecting products reduced the microbial count with a log10 reduction >5 with a 5-minute exposure time, with the exception of a spray based on hydrogen peroxide. Omitting the aforementioned hydrogen peroxide spray, there were no significant differences between use of a wipe or spray in bacterial load reduction. Using adenosine triphosphate (ATP) measurements, a significant difference in log10 relative light units (RLU) reduction between various bacteria (P ≤ .001) was observed.ConclusionsIn general, a >5 log10 reduction of colony forming units (CFU) for tested wipes and sprays was obtained for all tested bacteria strains, with exception of hydrogen peroxide spray and VRE. Although ATP may show a difference between pre- and postcleaning, RLU reduction does not correlate with actual CFU reductions.
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Information for Authors
Source:American Journal of Infection Control, Volume 45, Issue 8
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New from APIC: ASC Intensive offers 4 days of concentrated training for ambulatory care practice settings
Source:American Journal of Infection Control, Volume 45, Issue 8
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Table of Contents
Source:American Journal of Infection Control, Volume 45, Issue 8
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Journal Club: Hand hygiene compliance in a universal gloving setting
Source:American Journal of Infection Control, Volume 45, Issue 8
Author(s): Timothy Landers, Jeanette Harris
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Journal Club: Developing a user-friendly report for electronically assisted surveillance of catheter-associated urinary tract infections
Source:American Journal of Infection Control, Volume 45, Issue 8
Author(s): Michael Fritz Estinville, Amanda Hessels, James Davis
The article chosen for this Journal Club commentary describes the development and testing of a report format using automated data to report urinary catheter utilization and catheter-associated urinary tract infections (CAUTIs).1 This research sought to address a gap in knowledge regarding the optimal display and content of data reports, communicating to diverse audiences, which used surveillance data from Department of Veterans Affairs' electronic health records. The specific research aim of this project was to develop and pilot test report formats deemed usable and trustworthy by the end user, and discover the best way to deliver to the ideal audience automated data, which is formatted and presented in a way that is acceptable to the end user.
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Use of a patient empowerment tool for hand hygiene
Source:American Journal of Infection Control, Volume 45, Issue 8
Author(s): Allison Lastinger, Kayeromi Gomez, Ellen Manegold, Rashida Khakoo
BackgroundPatient empowerment is recognized as an important component of a multimodal strategy to improve hand hygiene adherence. We examined the attitudes of adult patients and parents of pediatric patients toward a new patient empowerment tool (PET) at our hospital. We also surveyed physicians to determine their perceptions about the PET.MethodsA cross-sectional survey was performed of hospitalized children's parents and adult patients in a 531-bed tertiary care teaching hospital in West Virginia. Surveys were anonymous and self-administered. A separate survey was administered via e-mail to resident and attending physicians from the departments of internal medicine, pediatrics, and family medicine.ResultsMost parents and adult patients felt it was their role to speak up if a provider did not perform hand hygiene, but a smaller number actually felt comfortable using the PET. Only 54.9% of physicians felt that patients should be involved in reminding providers to perform hand hygiene. Overall, physicians indicated that they would prefer a patient to use words rather than the PET to remind them to perform hand hygiene.ConclusionsIn our study, parents and adult patients supported use of the PET, but physicians were less supportive. As the patient empowerment movement grows, we should work to improve physician acceptance of patient involvement if it is to be successful.
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Hand hygiene compliance in a universal gloving setting
Source:American Journal of Infection Control, Volume 45, Issue 8
Author(s): Noriko Kuruno, Kei Kasahara, Keiichi Mikasa
BackgroundThe use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions. However, gloves may carry organisms unless they are changed properly. In addition, hand hygiene is required before donning and after removing gloves, and there are scarce data regarding glove changing and hand hygiene in a universal gloving setting.MethodsThis nonrandomized observational before-after study evaluated the effect of education and feedback regarding hand hygiene. Compliance with hand hygiene and glove use was directly observed in a universal gloving setting at a 10-bed intensive care unit in a Japanese tertiary care university teaching hospital.ResultsA total of 6,050 hand hygiene opportunities were identified. Overall, hand hygiene compliance steadily increased from study period 1 (16.1%) to period 5 (56.8%), although there were indication-specific differences in the baseline compliance, the degree of improvement, and the reasons for noncompliance. There were decreases in the compliance with universal gloving and the incidence of methicillin-resistant Staphylococcus aureus.ConclusionIt is difficult to properly perform glove use and hand hygiene in a universal gloving setting, given its complexity. Direct observation with specific feedback and education may be effective in improving compliance.
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Effect of hand lotion on the effectiveness of hygienic hand antisepsis: Implications for practicing hand hygiene
Source:American Journal of Infection Control, Volume 45, Issue 8
Author(s): Helga Paula, Nils-Olaf Hübner, Ojan Assadian, Katja Bransmöller, Romy Baguhl, Harald Löffler, Axel Kramer
BackgroundSkin protection products should be used after washing hands with soap, during breaks, after work, and during leisure time. Aside from their beneficial effects, skin care products may also interact with alcohol-based hand disinfectants by reducing their efficacy. The aim of this study was to investigate the effect of a hand lotion on the effectiveness of hygienic hand antisepsis using an alcohol-based handrub.MethodsThe effect of a protective hand lotion against an isopropyl alcohol-based handrub was investigated in 20 healthy volunteers according to the European standard test procedure EN 1500 in the following combinations: handwashing and application of hand lotion, only application of hand lotion, and no washing and no hand lotion (control), each for 5 minutes or 1 hour before hand antisepsis. The difference in microbiologic before-and-after values were expressed as log reduction factor.ResultsThe effectiveness of hand antisepsis was not significantly affected in any of the groups using the tested hand lotion.ConclusionsHand antisepsis may be delayed for 5 minutes after hand lotion application. Shorter time intervals might be possible but were not tested.
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Summary Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an un...
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