Synthesis of grafted natural pozzolan with 3-aminopropyltriethoxysilane: preparation, characterization, and application for removal of Brilliant Green 1 and Reactive Black 5 from aqueous solutions

Abstract

Natural pozzolan is an amorphous silicate-based material of volcanic origin. In this work, the natural pozzolan was modified by using 3-aminopropyltriethoxysilane (APTES) as a grafting agent. This material was characterized by pH_pzc, N₂ adsorption/desorption curves, FTIR, TGA/DTG, DRUV, SEM, and elementary analysis. The functionalized materials were used for the removal of Reactive Black 5 (RB-5) and Brilliant Green 1 (BG-1) dyes from aqueous solutions using batch-contact adsorption. The characterization of modified pozzolan by FTIR, TGA/DTG, BET, and DRUV–vis revealed the effectiveness of grafting of amine functional group on pozzolan structure. The kinetic adsorption data were better fitted with general order for both dyes while for equilibrium models were better fitted by the Liu isotherm model. The maximum sorption capacities Q _max (at 50 °C) obtained with the modified pozzolan were 350.6 and 300.9 mg g⁻¹ for BG-1 and RB-5, at pH 9.0 and 2.0, respectively. The thermodynamic parameters show that the removal of dyes was spontaneous and endothermic. The modified material was also tested for the treatment of simulated dye house effluents showing very high efficiency.

http://ift.tt/2w8V0ya

The Role of Charge in Protein Targeting Evolution

Publication date: Available online 2 August 2017
Source:Trends in Cell Biology
Author(s): Sriram G. Garg, Sven B. Gould




http://ift.tt/2vkCNQI

Hepatitis due to EBV-reactivation under infliximab in a psoriasis patient

http://ift.tt/2hpK1x7

Validation of a Simple Scoring System to Predict Sorafenib Effectiveness in Patients with Hepatocellular Carcinoma

Abstract

Background

Sorafenib is recommended for the treatment of advanced-stage hepatocellular carcinoma (HCC). Nonetheless, it is expensive, effective in few patients, and may cause significant adverse effects. Therefore, accurate selection of patients is needed. In a previous study, we constructed a simple scoring system to predict patients' outcomes based on the occurrence of sorafenib adverse effects.

Objective

The present study aimed to validate this scoring system in a real-life cohort of HCC patients.

Patients and Methods

Clinical records of 279 outpatients treated with sorafenib in eight Italian centers were retrospectively analyzed. Adverse effects considered to calculate the score were skin toxicity, diarrhea, and arterial hypertension, occurring during the first month of therapy. For each adverse effect, 1 point was assigned if present; and 0 points if absent (resulting in a total score between 0 and 3).

Results

Median overall survival (OS) was 10.8 months and median time to progression (TTP) was 5.1 months. At multivariate analysis, performance status, α-fetoprotein (AFP), and Child-Pugh score were independently associated with TTP and OS. A progressive increase of OS and TTP was observed in patients with scores from 0 to 3 (p < 0.001). Six-, 12-, and 24-month survival probabilities were 55.1, 24.5, and 7.9% in score 0 patients, and 100, 80.9, and 46.2% in score 3 patients, respectively. Complete response was observed in one patient (0.4%), partial responses in 41 (15.2%), and stable disease in 117 (43.5%). The disease control rate in patients with scores of 0, 1, 2, and 3 was 34.3, 51.6, 80.9, and 96.3%, respectively (p < 0.001). Complete or partial responses were not observed in score 0 patients.

Conclusions

We have validated a useful scoring system to predict outcomes in sorafenib-treated HCC patients. This score is easy to calculate and suitable for implementation in daily clinical practice.

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Editorial Board

Publication date: September 2017
Source:Annals of Anatomy - Anatomischer Anzeiger, Volume 213





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OBC

Publication date: September 2017
Source:Annals of Anatomy - Anatomischer Anzeiger, Volume 213





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SpectraCam®: A new polarized hyperspectral imaging system for repeatable and reproducible in vivo skin quantification of melanin, total hemoglobin, and oxygen saturation

Abstract

Background

An accurate way to determine skin pigmentation is to acquire the spectral reflectance of a skin sample and to quantify chromophores by reverse calculation from physical models of light propagation. Therefore, we tested a new hyperspectral imaging device and software suite, the SpectraCam^® system, and evaluated its accuracy to quantify skin chromophores.

Methods

Validation of the SpectraCam^® system was performed by, firstly, comparing the known and the acquired reflectance spectra of color phantoms. Repeatability and reproducibility were then evaluated by two operators who performed acquisitions at different time points and compared the acquired reflectance spectra. The specificity of the system was tested by quantitative analysis of single chromophore variation models: lentigo and pressure relief. Finally, we tested the ability of the SpectraCam^® system to detect variations in chromophore in the eye region due to the daily application of a new anti-dark circle cosmetic product.

Results

The SpectraCam^® system faithfully acquires the reflectance spectra of color phantoms (r²>0.90). The skin reflectance spectra acquired by different operators at different times are highly repeatable (r²>0.94) and reproducible (r²>0.99). The SpectraCam^® system can also produce qualitative maps that reveal local variations in skin chromophore or underlying structures such as blood vessels. The system is precise enough to detect melanin variation in lentigo or total hemoglobin and oxygen saturation variations upon pressure relief. It is also sensitive enough to detect a decrease in melanin in the eye region due to the application of an anti-dark circle cosmetic product.

Conclusion

The SpectraCam^® system proves to be rapid and produces high-resolution data encompassing a large field of view. It is a robust hyperspectral imaging system that quantifies melanin, total hemoglobin, and oxygen saturation and is well adapted to cosmetic research.

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Pathogen-mimicking nanocomplexes: self-stimulating oxidative stress in tumor microenvironment for chemo-immunotherapy

Publication date: Available online 2 August 2017
Source:Materials Today
Author(s): Kai Dong, Zhenhua Li, Hanjun Sun, Enguo Ju, Jinsong Ren, Xiaogang Qu
A novel drug-loaded pathogen-mimicking nanocomplex has been constructed for synergistic chemo-immunotherapy using detoxified lipopolysaccharide coated mesoporous silica nanoparticle. Detoxified lipopolysaccharide behaves as a dual-purpose entity that not only effectively mimics the function of the natural pathogen for triggering immune responses but also acts as a lid for inhibiting premature chemical drug release. In this approach, a knock-on effect would be observed at site of tumor: firstly, pathogen-mimicries elicited the elevated production of ROS; secondly, excessive production of ROS in turn oxidized the arylboronic ester to realize controlled chemotherapy; thirdly, in addition to inducing ROS generation, the nanocomplex would self-stimulate macrophages activation which subsequently activated cytotoxic T cells. Importantly, chemotherapy and immunotherapy were acting in a synergistic manner to inhibit solid tumor growth. Moreover, chemotherapeutic agents could be effectively released upon exposure to self-stimulating oxidative stress in which external addition of ROS was avoided. This proof of concept might open the door to a new generation of carrier materials in the field of cancer therapy.



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Corrigendum to “Measuring satisfaction with appearance: Validation of the FACE-Q scales for double-eyelid blepharoplasty with minor incision in young Asians- retrospective study of 200 cases” [J Plast Reconstr Aesthet Surg 70 (2017) 1129–1135]

The authors regret that the authorship of the original article was incorrect and should be cited as per the authorship of this corrigendum. To confirm, the order of authors should be as follows: Baoguo Chen, Huifeng Song, Quanwen Gao, Minghuo Xu, Jue Wang, Fang Wang, Shuai Chen, Jiang Wu, Huichao Li.

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Wheat productivity responses in the rice-based system under different no-till techniques and nitrogen sources

Abstract

No-till wheat is gaining popularity in rice-based cropping system as it provides a better chance for timely planting of wheat, management of crop residues, as well as environmental and soil sustainability. However, fertilizer application in no-tillage requires careful attention in order to optimize efficiency of fertilizer use by crops. The present study was conducted to develop the most favorable and economical no-till technique along with best blend of nitrogen for successful wheat production in residue-based cropping system. The experiment was composed of five no-till techniques viz., (1) even spreading of loose rice residue and wheat sowing with turbo seeder, (2) even spreading of loose rice residue and wheat sowing with happy seeder, (3) even spreading of loose rice residue and wheat sowing with zone disc tiller, (4) wheat sowing with conventional zero tillage drill after manual removal of rice residues, and (5) wheat sowing with conventional zero tillage drill after burning of rice residues. There were five blends of nitrogen (N) including (1) 100% N from urea, (2) 75% N from urea and 25% N from ammonium sulfate (AS), (3) 50% N from urea and 50% N from AS, (4) 25% N from urea and 75% N from AS, and (5) 100% N from AS. Different no-till techniques and N treatments significantly affected the stand establishment and yield-related traits of wheat during both growing seasons. Soil physical condition was improved by turbo seeder treatment, while it remained poor in residue burned field sown by conventional zero tillage drill. The results over the years revealed that turbo-seeded wheat with N fertilization in the form of 50% urea + 50% AS performed better in terms of productive tillers, grain yield and benefit cost ratio than other no-till techniques along different blends of nitrogen during both years of study. In crux, wheat sowing by turbo seeder along N fertilization in the form of 50% urea + 50% AS treatment is a viable and economical option to increase the wheat production in rice-based production system.

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Pain during topical photodynamic therapy - comparing methyl aminolevulinate (Metvix®) to aminolaevulinic acid (Ameluz®); an intra-individual clinical study

Publication date: Available online 2 August 2017
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Shiva Yazdanyar, Kian Zarchi, Gregor B.E. Jemec
BackgroundActinic keratoses are often treated by photodynamic therapy. However, the main side effects of this treatment is pain during and short after illumination.ObjectivesTo evaluate, in an intra-individual study, whether the pain response differ in treatment of actinic keratoses in scalp and forhead, using branded methyl aminolevulinate (MAL) and aminolaevulinic acid (ALA).Materials and methods Patients with mild to moderate actinic keratoses on forehead and scalp were treated with methyl aminolaevulinate (MAL)-PDT and aminolaevulinic acid (ALA)-PDT on two similar areas of forehead and scalp. The pain response were measured using visual analogue scale ranging from 0 to 10 during the illumination and 30minutes after the treatment.ResultsFourteen patients completed treatment to MAL and ALA-PDT. We found no significant difference in pain intensity between MAL and ALA-PDT, neither during the treatment (p-value=1) nor 30minutes after the treatment (p-value of 0.19).ConclusionsThis intra-individual study demonstrate no significant difference between the pain response during PDT using methyl aminolevulinate and aminolaevulinic acid.



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Periodic characterization of alkyl-naphthalenes in stack gas and ambient air around a medical waste incinerator

Abstract

Due to the subtle occurrence of environmental polycyclic aromatic hydrocarbon (PAHs) pollution from incinerators, it is seldom considered a significant source of PAH pollution. However, considering the recent build-up of toxics in urban air, this may be a serious concern around the incinerator vicinity due to the potential consequences of PAHs on human health. Hence, this study determined 11 alkyl-naphthalene contributions from a hospital waste incinerator (HWI_0) into ambient air receptor points (HWI_1 to HWI_5) for a 1-year period: June 2014–May 2015. The HWI_0 and ambient gases were sampled using filter-sorbent sampling system and polyurethane foam (PUF) passive samplers, respectively, and all alkyl-naphthalenes were determined using GC-MS. Results showed that the source concentrations were in the range of 0–14.0 ng/m³ and generally higher than the receptor points. The receptor point concentration trends were mainly HWI_1 > HWI_2 ≥ HWI_3 ≥ HWI_5 ≥ HWI_4. Multivariate receptor model analysis suggested high correlations between source and the receptor points though there might be some significant contributions from other emission sources. The average monthly concentrations (∑alkyl-naphthalene) at HWI_0 and the receptors HWI_1, HWI_2, HWI_3, HWI_4 and HWI_5 were 67.4 ± 24.3, 57.9 ± 20.1, 42.8 ± 16.9, 39.7 ± 12.2, 36.5 ± 22.2 and 37.8 ± 15.4 ng/m³, respectively. Though these concentrations were lower than the estimated minimal risk level (MRL) for chronic inhalation exposure to naphthalene and its derivatives 0.003 mg/m³, continuous exposure to these pollutants might result in chronic effects. Finally, this study may be used to evaluate the environmental contribution of alkyl-naphthalenes from typical medical waste incinerator in Nigeria.

http://ift.tt/2wnlkEe

Mushrooms: from nutrition to mycoremediation

Abstract

Mushrooms are well known as important food items. The uses of mushrooms in the cuisine are manifolds and are being utilized for thousands of years in both Oriental and Occidental cultures. Medicinal properties of mushrooms show an immense potential as drugs for the treatment of various diseases as they are rich in a great variety of phytochemicals. In this review, we attempted to encompass the recent knowledge and scientific advancement about mushrooms and their utilization as food or curative properties, along with their natural ability to accumulate (heavy) metals/radionuclides, which leads to an important aspect of bioremediation. However, accumulation of heavy metals and radionuclides from natural or anthropogenic sources also involves potential nutritional hazards upon consumption. These hazards have been pointed out in this review incorporating a selection of the most recently published literature.

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Adsorption mechanism of chromium(III) using biosorbents of Jatropha curcas L.

Abstract

The removal of Cr³⁺ from water solutions by biosorbents from the rind, endosperm, and endosperm + episperm of the Jatropha curcas was evaluated. Adsorption tests were performed in batch systems for evaluating the influence of the solution's pH, adsorbent mass, contact time, initial Cr³⁺ concentrations, and solution temperature during the adsorption process. Kinetic, adsorption isotherm, and thermodynamic studies were performed to investigate the mechanisms that control adsorption. Ideal conditions for the adsorption process included pH of the solution of 5.5 and 8 g L⁻¹ adsorbent mass, within 60 min time contact between adsorbent and adsorbate. Maximum adsorption capacities by Langmuir model for rind, endosperm, and endosperm + episperm of the J. curcas were, respectively, 22.11, 18.20, and 22.88 mg g⁻¹, with the occurrence of chemosorption in mono and multilayers. Results show that the biosorbents obtained from J. curcas have a high potential to recuperate Cr³⁺ from contaminated water sources.

http://ift.tt/2wnyUY9

In vitro studies to evaluate the effect of varying culture conditions and IPL fluencies on tenocyte activities

Abstract

Tendons are dense, fibrous connective tissues which carry out the essential physiological role of transmitting mechanical forces from skeletal muscle to bone. From a clinical perspective, tendinopathy is very common, both within the sporting arena and amongst the sedentary population. Studies have shown that light therapy may stimulate tendon healing, and more recently, intense pulsed light (IPL) has attracted attention as a potential treatment modality for tendinopathy; however, its mechanism of action and effect on the tendon cells (tenocytes) is poorly understood. The present study therefore investigates the influence of IPL on an in vitro bovine tendon model. Tenocytes were irradiated with IPL at different devise settings and under variable culture conditions (e.g. utilising cell culture media with or without the pH indicator dye phenol red), and changes in tenocyte viability and migration were subsequently investigated using Alamar blue and scratch assays, respectively. Our data demonstrated that IPL fluencies of up to 15.9 J/cm² proved harmless to the tenocyte cultures (this was the case using culture media with or without phenol red) and resulted in a significant increase in cell viability under certain culture conditions. Furthermore, IPL treatment of tenocytes did not affect the rate of cell migration. This study demonstrates that irradiation with IPL is not detrimental to the tenocytes and may increase their viability under certain conditions, thus validating our in vitro model. Further studies are required to elucidate the effects of IPL application in the clinical situation.

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Editorial board

Publication date: October 2017
Source:Biomaterials, Volume 142





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Tetherless near-infrared control of brain activity in behaving animals using fully implantable upconversion microdevices

Publication date: October 2017
Source:Biomaterials, Volume 142
Author(s): Ying Wang, Xudong Lin, Xi Chen, Xian Chen, Zhen Xu, Wenchong Zhang, Qinghai Liao, Xin Duan, Xin Wang, Ming Liu, Feng Wang, Jufang He, Peng Shi
Many nanomaterials can be used as sensors or transducers in biomedical research and they form the essential components of transformative novel biotechnologies. In this study, we present an all-optical method for tetherless remote control of neural activity using fully implantable micro-devices based on upconversion technology. Upconversion nanoparticles (UCNPs) were used as transducers to convert near-infrared (NIR) energy to visible light in order to stimulate neurons expressing different opsin proteins. In our setup, UCNPs were packaged in a glass micro-optrode to form an implantable device with superb long-term biocompatibility. We showed that remotely applied NIR illumination is able to reliably trigger spiking activity in rat brains. In combination with a robotic laser projection system, the upconversion-based tetherless neural stimulation technique was implemented to modulate brain activity in various regions, including the striatum, ventral tegmental area, and visual cortex. Using this system, we were able to achieve behavioral conditioning in freely moving animals. Notably, our microscale device was at least one order of magnitude smaller in size (∼100 μm in diameter) and two orders of magnitude lighter in weight (less than 1 mg) than existing wireless optogenetic devices based on light-emitting diodes. This feature allows simultaneous implantation of multiple UCNP-optrodes to achieve modulation of brain function to control complex animal behavior. We believe that this technology not only represents a novel practical application of upconversion nanomaterials, but also opens up new possibilities for remote control of neural activity in the brains of behaving animals.



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Cancer cell membrane-coated biomimetic platform for tumor targeted photodynamic therapy and hypoxia-amplified bioreductive therapy

Publication date: October 2017
Source:Biomaterials, Volume 142
Author(s): Shi-Ying Li, Hong Cheng, Wen-Xiu Qiu, Lu Zhang, Shuang-Shuang Wan, Jing-Yue Zeng, Xian-Zheng Zhang
Modulating tumor microenvironment to amplify the therapeutic efficiency would be a novel strategy for effective cancer treatment. In this work, based on the TPZ-loaded porphyrinic metal organic framework PCN-224 (PCN stands for porous coordination network), a cancer cell membrane-coated nanoplatform (TPZ@PCN@Mem) was fabricated for tumor targeted PDT and the successively resulting hypoxia-amplified bioreductive therapy. After administration, TPZ@PCN@Mem exhibited the selective accumulation and long-term retention at tumor tissue due to the immune escape and homologous targeting endowed by the cancer membrane coating. Upon light irradiation, PCN-224-mediated toxic reactive oxygen species (ROS) were generated for PDT, and the resulting local hypoxia microenvironment would further accelerate the activation of TPZ for enhanced chemotherapy in 4T1 orthotopic tumor. The cascade synergistic therapeutic effects of TPZ@PCN@Mem could significantly suppress the primary tumor growth, and also inhibit its distal metastasis with minimal side effects. The study indicated an overwhelming superiority of utilizing this bioinspired strategy for tumor targeted PDT and hypoxia-activated bioreductive therapy, which provided a new insight for precise and effective tumor treatment.



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Cognitive and Contextual Correlates of Spontaneous and Deliberate Mind-Wandering.

Author: Robison, Matthew K.; Unsworth, Nash

DOI: 10.1037/xlm0000444

Publication Date: POST AUTHOR CORRECTIONS, 31 July 2017

http://ift.tt/2u5prZ7

The Articulatory In-Out Effect Resists Oral Motor Interference.

Author: Lindau, Berit; Topolinski, Sascha

DOI: 10.1037/xlm0000443

Publication Date: POST AUTHOR CORRECTIONS, 31 July 2017

http://ift.tt/2ulFYmA

Near-Independent Capacities and Highly Constrained Output Orders in the Simultaneous Free Recall of Auditory-Verbal and Visuo-Spatial Stimuli.

Author: Cortis Mack, Cathleen; Dent, Kevin; Ward, Geoff

DOI: 10.1037/xlm0000439

Publication Date: POST AUTHOR CORRECTIONS, 31 July 2017

http://ift.tt/2u5yY2j

Reading Dilemmas in a Foreign Language Reduces Both Deontological and Utilitarian Response Tendencies.

Author: Muda, Rafal; Niszczota, Pawel; Bialek, Michal; Conway, Paul

DOI: 10.1037/xlm0000447

Publication Date: POST AUTHOR CORRECTIONS, 31 July 2017

http://ift.tt/2ultQCe

The Acquisition of Simple Associations as Observed in Color-Word Contingency Learning.

Author: Lin, Olivia Y.-H.; MacLeod, Colin M.

DOI: 10.1037/xlm0000436

Publication Date: POST AUTHOR CORRECTIONS, 31 July 2017

http://ift.tt/2u64k8K

Seasonal variations of natural radionuclides, minor and trace elements in lake sediments and water in a lignite mining area of North-Western Greece

Abstract

The radiological and chemical pollution of a cluster of four lakes in a lignite mining area of North-Western Greece was investigated using a variety of analytical techniques. Alpha spectrometry was applied to measure the activity concentrations of the uranium radioisotopes (U-234, U-235, and U-238) in waters. The mass activities of U-238, Th-232, and K-40 in sediments were measured by high-resolution gamma spectrometry. Furthermore, the determination of the minor and trace elements was carried out by instrumental neutron activation analysis (INAA) in both water and sediments samples, respectively. Pollution levels were also evaluated by calculating enrichment factors (EFs), contamination factors (CFs) and pollution load index (PLI). The data were discussed taking into account several parameters such as the distance from the pollution source, temperature, and location and showed that the environmental impact in this region could not be considered as negligible. The deviation of the isotopic ratio of U-234/U-238 from the equilibrium value indicated waters with intensive dissolution of uranium. The activity values in both waters and sediments found to be low in cool periods and increased in warm periods. Moreover, the concentrations of the elements U, Zn, and Fe were raised in water samples indicating possible pollution as well as the CFs and PLI denoted accumulation in the sediments and moderate to severe contamination for Zn and Cr in some cases.

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The psychological and physical health of fathers of children with Autism Spectrum Disorder compared to fathers of children with long-term disabilities and fathers of children without disabilities

Publication date: October 2017
Source:Research in Developmental Disabilities, Volume 69
Author(s): Monique Seymour, Rebecca Giallo, Catherine E. Wood
BackgroundThe psychological and physical health of fathers of children with Autism Spectrum Disorder (ASD) is under-researched. Due to the unique parenting demands, fathers of children with ASD may be at increased risk of experiencing psychological and physical health difficulties compared to fathers of children without disabilities (W/OD) and fathers of children with other long-term disabilities (LTD). What little research there is on fathers of children with ASD is often conducted on small clinical samples, or embeds the experiences of fathers within other groups.AimThe current study aimed to explore the extent to which fathers of children with ASD experience psychological distress and physical health issues (e.g., general health, smoking, chronic pain) compared to fathers of children W/OD and fathers of children with a LTD.MethodFrom a large, nationally representative sample of children, 159 fathers of children with ASD were identified, along with 45 fathers of children with a LTD and 6578 fathers of children W/OD.ResultsThe majority of fathers were experiencing good psychological and physical health. Approximately 1 in 6 fathers of children with ASD were experiencing elevated levels of psychological distress and poor global health, and were at significantly greater risk than fathers of children W/OD; although these differences were not found compared to fathers of children with a LTD.ConclusionsSome fathers of children with ASD may require additional support which not only focuses on their psychological wellbeing but also fathers' physical health. The current findings encourage health services to check-in with, or reach-out to fathers as they too may require additional support.



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Repair of Large Segmental Bone Defect using Vascularized Small Corticocancellous Bone in Rabbit Femur

J reconstr Microsurg
DOI: 10.1055/s-0037-1604437

Background Although free-vascularized long-bone transfer is useful for reconstruction of a large segmental bone defect, it is limited by availability of transplantable bone, meticulous microsurgical technique, and donor-site morbidities. Hence, easier, readily available, and safer surgical procedures are warranted. This study evaluated the effects of vascularized small corticocancellous bone grafting for reconstruction of a large segmental rabbit femur defect. Methods A 1.5 cm defect was created in the femurs of 40 New Zealand white rabbits and divided into a control group (n = 10, bone defect without graft), group A (n = 10, bone defect filled with morselized autogenous bone), group B (n = 10, bone defect grafted with a vascularized small corticocancellous bone and morselized autogenous bone), and group C (n = 10, bone defect grafted with a vascularized small corticocancellous bone). Simple radiographs were taken postoperatively, and bone healing ability was scored using Taira's radiologic scale. Histologic examinations were scored using Emery's histologic scale. The expression of osteogenesis-related growth factors (BMP-2, -4, and -7, VEGF, and RANKL) was analyzed. Results Radiologically, group B showed superior biological efficacy in bone formation and consolidation over the other groups. Histologically, the defect in group B was filled with more abundant mature bone than the other groups. Group B showed higher gene expression of BMP-2, -4, and -7, and VEGF. Conclusions The grafting of the morselized autogenous bone (MSB) combined with the vascularized small corticocancellous bone is more effective than that of the MSB alone for repairing a large segmental bone defect.
[...]

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Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Effects of anaesthesia and analgesia on long-term outcome after total knee replacement: A prospective, observational, multicentre study.

BACKGROUND: Perioperative regional anaesthesia may protect from persistent postsurgical pain (PPSP) and improve outcome after total knee arthroplasty (TKA). OBJECTIVES: Aim of this study was to evaluate the impact of regional anaesthesia on PPSP and long-term functional outcome after TKA. DESIGN: A web-based prospective observational registry. SETTING: Five Italian Private and University Hospitals from 2012 to 2015. PATIENTS: Undergoing primary unilateral TKA, aged more than 18 years, informed consent, American Society of Anesthesiologists (ASA) physical status classes 1 to 3, no previous knee surgery. INTERVENTION(S): Personal data (age, sex, BMI and ASA class), preoperative pain assessed by numerical rating scale (NRS) score, and risk factors for PPSP were registered preoperatively. Data on anaesthetic and analgesic techniques were collected. Postoperative pain (NRS), analgesic consumption, major complications and patient satisfaction were registered up to the time of discharge. PPSP was assessed by a blinded investigator during a phone call after 1, 3 and 6 months, together with patient satisfaction, quality of life (QOL) and walking ability. MAIN OUTCOME MEASURES: Experience of PPSP according to the type of peri-operative analgesia. RESULTS: Five hundred sixty-three patients completed the follow-up. At 6 months, 21.6% of patients experienced PPSP, whereas autonomy was improved only in 56.3%; QOL was worsened or unchanged in 30.7% of patients and improved in 69.3%. Patients receiving continuous regional anaesthesia (epidural or peripheral nerve block) showed a lower NRS through the whole peri-operative period up to 1 month compared with both single shot peripheral nerve block and those who did not receive any type of regional anaesthesia. No difference was found between these latter two groups. Differences in PPSP at 3 or 6 months were not significantly affected by the type of anaesthesia or postoperative analgesia. A higher NRS score at 1 month, younger age, history of anxiety or depression, pro-inflammatory status, higher BMI and a lower ASA physical status were associated with a higher incidence of PPSP and worsened QOL at 6 months. CONCLUSION: Continuous regional anaesthesia provides analgesic benefit for up to 1 month after surgery, but did not influence PPSP at 6 months. Better pain control at 1 month was associated with reduced PPSP. Patients with higher expectations from surgery, enhanced basal inflammation and a pessimistic outlook are more prone to develop PPSP. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02147730 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP (C) 2017 European Society of Anaesthesiology

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Title Page

Publication date: July–August 2017
Source:Current Problems in Cancer, Volume 41, Issue 4





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Information for Readers

Publication date: July–August 2017
Source:Current Problems in Cancer, Volume 41, Issue 4





http://ift.tt/2f9xptl

Table of Contents

Publication date: July–August 2017
Source:Current Problems in Cancer, Volume 41, Issue 4





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Disabling Central Paroxysmal Positioning Upbeat Nystagmus and Vertigo Associated With the Presence of Anti-Glutamic Acid Decarboxylase Antibodies.

An immune attack by anti-glutamic acid decarboxylase (GAD) antibodies is believed to cause a deficiency in gamma-aminobutyric acid-mediated neurotransmission in the cerebellum. This, in turn, leads to several eye movement disorders, including spontaneous downbeat (DBN) and periodic alternating nystagmus. We describe a 68-year-old diabetic woman with disabling paroxysmal positioning upbeat nystagmus (UBN) exclusively in the supine position, associated with asymptomatic spontaneous DBN, alternating skew deviation and hyperactive vestibulo-ocular reflex responses on head impulse testing, in whom high titers of anti-GAD antibodies were detected. After treatment with intravenous immunoglobulin, a complete resolution of positioning UBN and spontaneous DBN occurred, along with a decrease in anti-GAD antibody titers. Positioning UBN in this case may reflect a transient disinhibition of the central vestibular pathways carrying posterior semicircular canal signals, due to lack of normal inhibitory input from the cerebellar nodulus/uvula. Immunoglobulin restored cerebellar inhibitory output, possibly by improving gamma-aminobutyric acid neurotransmission. (C) 2017 by North American Neuro-Ophthalmology Society

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Efficient removal of copper from wastewater by using mechanically activated calcium carbonate

Publication date: 1 December 2017
Source:Journal of Environmental Management, Volume 203, Part 1
Author(s): Huimin Hu, Xuewei Li, Pengwu Huang, Qiwu Zhang, Wenyi Yuan
Copper removal from aqueous solution is necessary from the stances of both environmental protection and copper resource recycling. It is important to develop a new chemical precipitation method suitable for removing copper particularly at low concentration as the case of waste mine water, with regards to the various problems related to the current precipitation methods by using strong alkalis or soluble sulfides. In this research, we studied a possible chemical precipitation of copper ions at concentration around 60 mg/L or lower by cogrinding copper sulfate in water with calcium carbonate (CaCO3) using wet stirred ball milling. With the aid of ball milling, copper precipitation as a basic sulfate (posnjakite: Cu4 (SO4) (OH)6·H2O) occurred at a very high copper removal rate of 99.76%, to reduce the residual copper concentration in the solution less than 0.5 mg/L, reaching the discharge limit, even with the addition amount of CaCO3 as a stoichiometric ratio of CaCO3/Cu²⁺at 1:1. It is more interesting to notice that, at the same conditions, other heavy metals such as Ni, Mn, Zn and Cd do not precipitate obviously just with CaCO3 addition at CaCO3/M²⁺at 1:1 so that the precipitate without the impurities can be processed as good source to recover copper. This newly proposed concept can be further developed to treat wastewaters with other metals to serve both purposes of environmental purification and resource recovery in a similar way.

Graphical abstract

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“Malignant Pleural Mesothelioma: Diagnosis, Staging, Pitfalls and Follow-up”

Publication date: Available online 2 August 2017
Source:Seminars in Ultrasound, CT and MRI
Author(s): Erika G. Odisio, Edith M. Marom, Girish S. Shroff, Carol C. Wu, Ana Paula A. Benveniste, Mylene T. Truong, Marcelo F. Benveniste
Malignant Pleural Mesothelioma (MPM) is the most common primary neoplasm of the pleura. Imaging evaluation is essential in diagnosis, staging and assessment of treatment response in MPM. Computed tomography is the most commonly used modality for tumor staging. Assessment of tumor extension and lymph node involvement is essential in imaging evaluation as locally advanced tumors are amenable to resection. Knowledge of the full imaging spectrum of this rare disease, differential diagnosis, staging classification and the current guidelines for diagnostic evaluation and follow-up are essential in accurate interpretation to optimize patient management.



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Imaging of Metastases in the Chest: Mechanisms of Spread and Potential Pitfalls

Publication date: Available online 2 August 2017
Source:Seminars in Ultrasound, CT and MRI
Author(s): Girish S. Shroff, Marcelo F. Benveniste, Brett W. Carter, Patricia M. de Groot, Carol C. Wu, Chitra Viswanathan, Bradley S. Sabloff, Mylene T. Truong
Pulmonary and pleural metastases are routinely identified on thoracic computed tomography. Pulmonary metastases are the most common pulmonary neoplasms and commonly originate from primary malignancies of the lung, breast, colon, pancreas, stomach, skin (i.e., melanoma), head and neck, and kidney. Metastatic disease to the lungs may occur via three routes of spread: hematogenous, lymphatic, and endobronchial. Pleural metastases most commonly originate from primary malignancies of the lung and breast. Mechanisms of pleural metastatic involvement include hematogenous spread, direct invasion from a neighboring tumor, and retrograde lymphatic spread from the mediastinum. Awareness of the spectrum of appearances of metatastic disease in the chest is important in avoiding misinterpretation.



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CT Imaging of Complications Associated with Continuous-Flow Left Ventricular Assist Devices (LVADs)

Publication date: Available online 2 August 2017
Source:Seminars in Ultrasound, CT and MRI
Author(s): Girish S. Shroff, Daniel Ocazionez, Bindu Akkanti, Daniel Vargas, Alheli Garza, Pushpender Gupta, Jayeshkumar A. Patel, Manish K. Patel, Igor D. Gregoric
Heart failure is becoming increasingly prevalent, and more patients are being treated with left ventricular assist devices (LVADs), either as a bridge to transplant or as destination therapy. The use of continuous flow LVADs is on the rise. LVAD therapy is associated with several classes of complications, including bleeding, thrombosis, and infection. CT imaging can be used effectively to diagnose LVAD complications, including mediastinal hematomas and pericardial, abdominal wall, and retroperitoneal hemorrhage, inflow and outflow graft and aortic thrombi, and driveline and pump pocket infections. CT can also be helpful in cases of device malfunction and can detect outflow graft kinking and inflow cannula misalignment. When interpreting CT scans in patients with LVADs, accessory materials implanted with the device should not be mistaken for hemorrhage or calcification. With training in recognizing LVAD complications, radiologists can play an important role in the evaluation of patients with heart failure.



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Effect of voriconazole on risk of nonmelanoma skin cancer after hematopoietic cell transplantation

Publication date: Available online 2 August 2017
Source:Journal of the American Academy of Dermatology
Author(s): Lawrence F. Kuklinski, Shufeng Li, Margaret R. Karagas, Wen-Kai Weng, Bernice Y. Kwong
BackgroundVoriconazole has previously been associated with increased risk for cutaneous squamous cell carcinoma (SCC) in solid organ transplant recipients. Less is known about the risk in patients after hematopoietic cell transplantation (HCT).ObjectiveWe evaluated the effect of voriconazole on the risk for nonmelanoma skin cancer (NMSC), including SCC and basal cell carcionoma, among those who have undergone allogeneic and autologous HCT.MethodsIn all, 1220 individuals who had undergone allogeneic HCT and 1418 who had undergone autologous HCT were included in a retrospective cohort study. Multivariate analysis included voriconazole exposure and other known risk factors for NMSC.ResultsIn multivariate analysis, voriconazole use increased the risk for NMSC (hazard ratio, 1.82; 95% confidence interval, 1.13-2.91) among those who had undergone allogeneic HCT, particularly for SCC (hazard ratio, 2.25; 95% confidence interval, 1.30-3.89). Voriconazole use did not appear to confer increased risk for NMSC among those who had undergone autologous HCT.LimitationsThis is a retrospective study.ConclusionVoriconazole use represents an independent factor that may contribute to increased risk specifically for SCC in the allogeneic HCT population.



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Risk of cutaneous squamous cell carcinoma after treatment of basal cell carcinoma with vismodegib

Publication date: Available online 2 August 2017
Source:Journal of the American Academy of Dermatology
Author(s): Tina Bhutani, Michael Abrouk, Camelia S. Sima, Natalia Sadetsky, Jeannie Hou, Ivor Caro, Mary-Margaret Chren, Sarah T. Arron
BackgroundVismodegib is a first-in-class agent targeting the hedgehog signaling pathway for treatment of patients with locally advanced basal cell carcinoma (BCC) and metastatic BCC. There have been concerns about the development of squamous cell carcinoma (SCC) in patients treated with this drug.ObjectiveWe sought to determine whether treatment with vismodegib is associated with an increase in the risk of cutaneous SCC.MethodsIn this retrospective cohort study, patients treated with vismodegib as part of phase I and II clinical studies were compared with participants from the University of California, San Francisco, Nonmelanoma Skin Cancer Cohort who received standard therapy for primary BCC. In total, 1675 patients were included in the analysis, and the development of SCC after vismodegib exposure was assessed.ResultsThe use of vismodegib was not associated with an increased risk of subsequent development of SCC (adjusted hazard ratio, 0.57; 95% confidence interval, 0.28-1.16). Covariates including age, sex, history of previous nonmelanoma skin cancer, and number of visits per year were significantly associated with the development of SCC.LimitationsA limitation of the study was that a historic control cohort was used as a comparator.ConclusionsVismodegib was not associated with an increased risk of subsequent SCC when compared with standard surgical treatment of BCC.



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The effect of secukinumab on moderate-to-severe scalp psoriasis: Results of a 24-week, randomized, double-blind, placebo-controlled phase 3b study

Publication date: Available online 2 August 2017
Source:Journal of the American Academy of Dermatology
Author(s): Jerry Bagel, Kristina Callis Duffin, Angela Moore, Laura K. Ferris, Kimberly Siu, Jennifer Steadman, Farid Kianifard, Judit Nyirady, Mark Lebwohl
BackgroundModerate-to-severe scalp psoriasis has not been evaluated in prospective trials of patients without moderate-to-severe body psoriasis.ObjectiveEvaluate the efficacy and safety of secukinumab in moderate-to-severe scalp psoriasis.MethodsIn this 24-week, double-blind, phase 3b study, 102 patients were randomized 1:1 to subcutaneous secukinumab 300 mg or placebo at baseline, weeks 1, 2, and 3, and then every 4 weeks from week 4 to 20. The primary efficacy variable was 90% improvement of Psoriasis Scalp Severity Index (PSSI 90) score from baseline to week 12.ResultsAt week 12, PSSI 90 (secukinumab 300 mg vs placebo, 52.9% vs 2.0%) and Investigator's Global Assessment modified 2011 scalp responses of 0 or 1 (secukinumab 300 mg vs placebo, 56.9% vs 5.9%) were significantly greater with secukinumab 300 mg than placebo (P < .001 for both). In addition, significantly more patients achieved complete clearance of scalp psoriasis at week 12 with secukinumab 300 mg than placebo (35.3% vs 0%; P < .001). The median time to 50% reduction in PSSI score was 3.29 weeks with secukinumab 300 mg. The safety profile of secukinumab was consistent with previous phase 3 studies.LimitationsThere was no active comparator arm.ConclusionSecukinumab is efficacious and well-tolerated for patients with extensive moderate-to-severe scalp psoriasis.



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Editorial Board

Publication date: September 2017
Source:Journal of Human Evolution, Volume 110





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What Factors Influence Resident Research Publication in the Division of Plastic Surgery?

Publication date: Available online 2 August 2017
Source:Journal of Surgical Education
Author(s): Sara Yumeen, Emily S Ho, Karen Wong, Gregory H Borschel
BackgroundLess than half of abstracts presented at biomedical conferences are published in peer-reviewed journals. The publication rate of these abstracts and factors influencing their publication warrants investigation to optimize knowledge dissemination.PurposeTo determine publication rates of abstracts published at the University of Toronto, Division of Plastic and Reconstructive Surgery Annual Research Symposium. Following, to explore the barriers and facilitators of publication rate through a focus group with senior residents.MethodsPubMed, MedLine, and Scopus were searched to determine the successful publication rate of abstracts published in the University of Toronto Research Symposium Program in a 9-year period. Multiple logistical regression analysis was undertaken to discern factors associated with publication. Thematic analysis of a focus group with plastic surgery residents was undertaken to further explore the barriers and facilitators of publication.ResultsOf 126 abstracts presented, 39.7% were published as peer-reviewed articles. The association between abstract topic, type (basic science or clinical), presenting author rank, faculty investigator rank, or publication rate were not statistically significant. Faculty investigator affiliated site was statistically significantly associated with publication. Six major themes arose from the qualitative analysis: quality of research question, faculty investigator attributes, availability of supports, research program expectations, time factors, and collaboration between residents. These results implicate variables that influence quantitatively determined publication rates and point to implementation of changes that may improve resident research experience and productivity in Plastic Surgery.



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Closed-Loop Communication Improves Task Completion in Pediatric Trauma Resuscitation

Publication date: Available online 2 August 2017
Source:Journal of Surgical Education
Author(s): Ibrahim Abd El-Shafy, Jennifer Delgado, Meredith Akerman, Francesca Bullaro, Nathan A.M. Christopherson, Jose M. Prince
BackgroundPediatric trauma care requires effective and clear communication in a time-sensitive manner amongst a variety of disciplines. Programs such as Crew Resource Management in aviation have been developed to systematically prevent errors. Similarly, teamSTEPPS has been promoted in healthcare with a strong focus on communication. We aim to evaluate the ability of closed-loop communication to improve time-to-task completion in pediatric trauma activations.MethodsAll pediatric trauma activations from January to September, 2016 at an American College of Surgeons verified level I pediatric trauma center were video recorded and included in the study. Two independent reviewers identified and classified all verbal orders issued by the trauma team leader for order audibility, directed responsibility, check-back, and time-to-task-completion. The impact of pre-notification and level of activation on time-to-task-completion was also evaluated. All analyses were performed using SAS® version 9.4(SAS Institute Inc., Cary, NC).ResultsIn total, 89 trauma activation videos were reviewed, with 387 verbal orders identified. Of those, 126(32.6%) were directed, 372(96.1%) audible, and 101(26.1%) closed-loop. On average each order required 3.85 minutes to be completed. There was a significant reduction in time-to-task-completion when closed-loop communication was utilized (p < 0.0001). Orders with closed-loop communication were completed 3.6 times sooner as compared to orders with an open-loop [HR = 3.6 (95% CI: 2.5, 5.3)]. There was not a significant difference in time-to-task-completion with respect to pre-notification by emergency service providers (p < 0.6100). [HR = 1.1 (95% CI: 0.9, 1.3)]. There was also not a significant difference in time-to-task-completion with respect to level of trauma team activation (p < 0.2229). [HR = 1.3 (95% CI: 0.8, 2.1)].ConclusionWhile closed-loop communication prevents medical errors, our study highlights the potential to increase the speed and efficiency with which tasks are completed in the setting of pediatric trauma resuscitation. Trauma drills and systems of communication that emphasize the use of closed-loop communication should be incorporated into the training of trauma team leaders.Level of EvidenceThis is a prospective observational study with intervention level II evidence.



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Low-Cost Training Simulator for Open Dismembered Pyeloplasty: Development and Face Validation

Publication date: Available online 1 August 2017
Source:Journal of Surgical Education
Author(s): Julien Rod, Jean-Baptiste Marret, Jules Kohaut, Yves Aigrain, Jean Philippe Jais, Philine de Vries, Stephen Lortat-Jacob, Jean Breaud, Thomas Blanc
PurposeSurgical simulation has benefited from a surge in interest over the last decade because of the increasing need for a change in the traditional apprenticeship model of teaching surgery. Open surgery for ureteropelvic junction (UPJ) poses unique training challenges owing to smaller workspaces, and finer sutures used that require increased surgical dexterity when compared with adult analogues. We describe the development and face validation of a low-cost training simulator for open dismembered pyeloplasty.Materials and methodsThe simulator is built with A4 Kraft envelopes, catheter tip syringe filled with 30mL of air, tape, 260 modeling balloon, and 11-in party balloon. Evaluation of the device is based on an evaluation form including 11 items on a 5-point Likert-type scale. Thirty-one departments of pediatric surgery in France were contacted and received a pack containing 4 to 10 devices, already set up and ready for use, a tutorial and an evaluation form. Candidates were stratified according to their level of expertise.ResultsA total of 180 devices were sent. Procedures on the device were performed 118 times (65%) by expert surgeons (n = 44), fellows (n = 25), and residents (n = 49). Statistically significant difference was noted for 4 items (anatomy, model exposition, UPJ resection, and difficulty) for the 3 levels of expertise. The global score evaluation for realistic items, face validity, and usability was 4.2 (range: 1-5).ConclusionThis low-cost model is evaluated as an efficient tool for UPJ teaching and training. It shows promise as an educational tool.



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A High-Definition Video Teaching Module for Thyroidectomy Surgery

Publication date: Available online 2 August 2017
Source:Journal of Surgical Education
Author(s): Amr F. Hamour, Adrian I. Mendez, Jeffrey R. Harris, Vincent L. Biron, Hadi Seikaly, David W.J. Côté
ObjectiveWith the changing landscape of postgraduate surgical education to competency-based curricula, there emerges a need for alternative forms of training. Video teaching modules have been shown to be effective tools in surgical education, complementing traditional postgraduate curricula. There is a lack of validated modules described in the literature, specifically for teaching thyroidectomy. The primary objective of this study was to develop and validate a high definition video-based teaching module instructing thyroidectomy surgery to Otolaryngology—Head and Neck Surgery trainees.DesignThis prospective study included intermediate to senior Otolaryngology—Head and Neck Surgery residents. Each participant first performed a thyroid lobectomy, serving as the initial assessment. After a washout period of at least 3 weeks, each participant was given the teaching module. The 15-minute module was developed using a 3-camera system and detailed a step-by-step approach to the surgery. After exposure to the module, each trainee performed the same procedure. Recordings of both procedures were deidentified and reviewed by a blinded, independent evaluator. Scoring was done using the Observational Clinical Human Reliability Assessment (OCHRA) system.SettingUniversity of Alberta Hospital and Royal Alexandra Hospital, Edmonton, Alberta, Canada.ParticipantsA total of 6 intermediate to senior Otolaryngology—Head and Neck Surgery residents entered and completed the study.ResultsThe mean error rate was 8.8 errors per procedure before module exposure and 4.5 errors per procedure after exposure, representing a 49% decrease in error occurrence (p < 0.05). The mean staff takeover event rate was 10.5 takeovers per procedure prior to module exposure and 5.0 takeovers per procedure after exposure, representing a 52% decrease in error occurrence (p < 0.05).ConclusionHigh-definition video teaching modules are a useful complement to traditional surgical training. In a climate where new innovations for teaching thyroid surgery are needed, properly constructed and validated video teaching modules can serve as important tools in supplementing traditional surgical training.



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Evidence for specificity of the impact of punishment on error-related brain activity in high versus low trait anxious individuals

Publication date: Available online 2 August 2017
Source:International Journal of Psychophysiology
Author(s): Alexandria Meyer, Magda Gawlowska
A previous study suggests that when participants were punished with a loud noise after committing errors, the error-related negativity (ERN) was enhanced in high trait anxious individuals. The current study sought to extend these findings by examining the ERN in conditions when punishment was related and unrelated to error commission as a function of individual differences in trait anxiety symptoms; further, the current study utilized an electric shock as an aversive unconditioned stimulus. Results confirmed that the ERN was increased when errors were punished among high trait anxious individuals compared to low anxious individuals; this effect was not observed when punishment was unrelated to errors. Findings suggest that the threat-value of errors may underlie the association between certain anxious traits and punishment-related increases in the ERN.



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Thyroid Open Access Articles

OPEN ACCESS
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Latest Impact Factor: 5.515
The Official Journal of: American Thyroid Association

No Effect of Levothyroxine and Levothyroxine-induced Subclinical Thyrotoxicosis on the Pharmacokinetics of Sorafenib in Healthy Male Subjects
Funan Huang, Antoinette Ajavon-Hartmann, Erya Huang, John Lettieri, Rong Liu, Carol Pena, Matthias Berse

Prevalence and characterization of thyroid hemiagenesis in Japan: The Fukushima Health Management Survey
Satoru Suzuki, Sanae Midorikawa , Takashi Matsuzuka, Toshihiko Fukushima, Yuko Ito, Hiroki Shimura, Hideto Takahashi, Tetsuya Ohira, Akira Ohtsuru, Masafumi Abe, Shinichi Suzuki, Shunichi Yamashita

Sorafenib in Japanese Patients with Locally Advanced or Metastatic Medullary Thyroid Carcinoma and Anaplastic Thyroid Carcinoma
Yasuhiro Ito, Naoyoshi Onoda, Ken-ichi Ito, Iwao Sugitani, Shunji Takahashi, Iku Yamaguchi, Koki Kabu, Katsuya Tsukada

Defining Radioiodine-refractory Differentiated Thyroid Cancer: Efficacy and Safety of Lenvatinib by Radioiodine-refractory Criteria in the SELECT Trial
Naomi Kiyota, Bruce Robinson, Manisha H Shah MD, Ana O. Hoff, Matthew Taylor, Di Li, Corina E. Dutcus, Eun Kyung Lee, Sung-Bae Kim, Makoto Tahara

The post Thyroid Open Access Articles appeared first on American Thyroid Association.

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Ultrasound Imaging of the Renal Parenchyma of Premature Neonates for the Assessment of Renal Growth and Glomerulomegaly

Publication date: Available online 2 August 2017
Source:Ultrasound in Medicine & Biology
Author(s): Sonja Brennan, Yogavijayan Kandasamy
Evidence is increasingly showing that prematurity results in chronic kidney disease. We hypothesized that we could use ultrasound imaging to measure and monitor the growth of the renal parenchyma in premature neonates. We conducted a prospective, case-control study to compare renal parenchymal growth between neonates born prematurely and term neonates. The study patients underwent ultrasound assessment at 32 wk postmenstrual age (PMA) and 37 wk PMA. Term neonates (gestation >37 completed wk) admitted to the neonatal unit with minor neonatal conditions were recruited into the control group. Complete data sets were available in 91 premature neonates and during the same period, 56 term neonates were recruited as the control. The median birth weight (preterm babies) was 930 g (780–1220 g), and the mean gestational age was 27.0 wk (2.1 wk). Total renal volume (TRV) increased from 14.6 (4.3) cm³ to 20.5 (5.3) cm³ from 32 to 37 wk PMA. During the same period, the total renal parenchyma (TRP) thickness increased from 1.6 (0.3) cm to 1.8 (0.3) cm. At 37 wk PMA, ex-premature neonates have a significantly smaller total renal volume (20.5 [5.3] versus 25.9 [6.4] cm³; p < 0.001) and total renal parenchyma thickness (1.8 [0.3] versus 2.0 [0.2] cm; p = 0.015) compared with term (control) neonates. However, premature neonates at 37 wk PMA have a larger TRP:TRV ratio compared with term neonates (0.09 [0.02] versus 0.0 8 [0.02] cm⁻²; p < 0.001). Reduced nephron endowment as a result of prematurity may cause the remaining nephrons to undergo compensatory glomerulomegaly and we postulate this is the reason for the observed differences. Ultrasound imaging of the renal parenchyma shows promise in assessing the effects of prematurity on the developing kidney.



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Fluid Resuscitation in Septic Patients Improves Systolic but not Diastolic Middle Cerebral Artery Flow Velocity

Publication date: Available online 2 August 2017
Source:Ultrasound in Medicine & Biology
Author(s): Annika A. de Goede, Bert G. Loef, Auke C. Reidinga, Arjen Schaafsma
To investigate the effects of fluid resuscitation on cerebral hemodynamics in sepsis, the following set of transcranial Doppler (TCD) parameters was used: maximal change in flow velocity (FV) during stroke onset (acc), maximal FV during first (sys1) or second (sys2) phase of systole and mean diastolic FV (dias@560). We aim to evaluate changes in cerebral hemodynamics that result from (i) sepsis and (ii) adequate fluid resuscitation in critically ill septic patients. In the majority of 16 septic patients sys2 was initially absent but reappeared during the period of fluid resuscitation; whereas sys2 absence was never seen in healthy controls. Second, adequate fluid resuscitation resulted in a significant increase of the systolic FV components (acc, sys1, sys2 and systolic blood pressure); whereas the diastolic components (dias@560 and diastolic blood pressure) remained unchanged. Sys2 absence and reappearance in sepsis suggests that TCD could become a non-invasive alternative for hemodynamic monitoring.



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Six-minute walk performance in persons with multiple sclerosis while using passive or powered ankle-foot orthoses

Publication date: Available online 2 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Morgan K. Boes, Rachel E. Bollaert, Richard Kesler, Yvonne C. Learmonth, Mazharul Islam, Matthew N. Petrucci, Robert W. Motl, Elizabeth T. Hsiao-Wecksler
ObjectiveTo determine if a powered ankle-foot orthosis that provides dorsiflexor and plantarflexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS)DesignShort-term interventionSettingUniversity research laboratoryParticipantsSixteen participants with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive ankle-foot orthosis (AFO). Participants were persons with moderate to severe neurological disability.InterventionsThree 6-minute walk tests (6MW), one per footwear condition: shoes (no AFO), prescribed passive AFO, and powered portable AFO (PPAFO). Assistive devices were worn on the impaired limb.Main Outcome MeasuresDistance walked and metabolic cost of transport were collected during each 6MW and compared between footwear conditions.ResultsEach participant completed all three 6MW tests within the experimental design. PPAFO use resulted in a shorter 6MW distance than a passive AFO or shoes. There were no differences in metabolic cost of transport based on footwear.ConclusionsThe current embodiment of this portable powered AFO did not improve endurance walking performance based on 6MW in a sampling of participants with gait impairment due to MS. Further research is required to determine if expanded training or modified design of this powered orthosis can be effective at improving endurance walking performance in persons with gait impairment due to MS.



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Angiogenesis Inhibition in the Second-Line Treatment of Metastatic Colorectal Cancer: A Systematic Review and Pooled Analysis

Publication date: Available online 2 August 2017
Source:Seminars in Oncology
Author(s): Ralph Chebib, Loic Verlingue, Nathalie Cozic, Matthieu Faron, Pascal Burtin, Valérie Boige, Antoine Hollebecque, David Malka
The last two decades have seen intensive efforts devoted to the development of compounds that target angiogenesis for the treatment of metastatic colorectal cancer (mCRC). In this review, we describe supporting evidence and ongoing development of angiogenesis inhibitors in the second-line treatment of mCRC, and summarize relevant randomized trials to help therapeutic decision-making in daily practice.



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"Mind the Gap" Revisted

Publication date: Available online 2 August 2017
Source:Seminars in Oncology
Author(s): John Zalcberg




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STEAP4: its emerging role in metabolism and homeostasis of cellular iron and copper

Preserving energy homeostasis in the presence of stressors such as proinflammatory cytokines and nutrient overload is crucial to maintaining normal cellular function. Six transmembrane epithelial antigen of the prostate 4 (STEAP4), a metalloreductase involved in iron and copper homeostasis, is thought to play a potentially important role in the cellular response to inflammatory stress. Genome-wide association studies have linked various mutations in STEAP4 with the development of metabolic disorders such as obesity, metabolic syndrome and type 2 diabetes. Several studies have shown that expression of Steap4 is modulated by inflammatory cytokines, hormones and other indicators of cellular stress and that STEAP4 may protect cells from damage, helping to maintain normal metabolic function. STEAP4 appears to be particularly relevant in metabolically oriented cells, such as adipocytes, hepatocytes and pancreatic islet cells. These cells struggle to maintain their function in iron or copper overloaded states, presumably due to increased oxidative stress, suggesting STEAP4's role in metal homeostasis is critical to the maintenance of cellular homeostasis in general, and in preventing the onset of metabolic disease. In this review, we explore genetic associations of STEAP4 with metabolic disorders, and we examine STEAP4 tissue expression, subcellular localization, regulation, structure and function as it relates to metabolic diseases. We then examine how STEAP4's role as a regulator of cellular iron and copper may relate to type 2 diabetes.

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The highly overlapping actions of Lh signaling and Fsh signaling on zebrafish spermatogenesis

Gonadotropin signaling plays a pivotal role in the spermatogenesis of vertebrates, but exactly how gonadotropins regulate the process in non-mammalian species remains elusive. Using a gene knockout approach in zebrafish, we have previously demonstrated the non-canonical action of gonadotropin signaling on spermatogenesis by analyzing four single mutant lines (lhb, lhr, fshb and fshr) and three double mutant lines (lhb;fshb, lhr;fshr and fshb;lhr). In this study, we further investigated the actions of gonadotropins on the testis by establishing three other double-mutant zebrafish lines (lhb;lhr, fshb;fshr and lhb;fshr). All lhb;lhr and fshb;fshr mutant males were fertile. Analysis on the gonadosomatic index and testicular histology in these lhb;lhr and fshb;fshr mutants demonstrated that Lh signaling and Fsh signaling could functionally compensate each other in the testis. Intriguingly, it was found that the lhb;fshr mutant male fish were also morphologically and histologically normal and functionally fertile, a phenomenon which could be explained by the cross-activation of Lhr by Fsh. We have demonstrated this cross-reactivity for the first time in zebrafish. Fsh was shown to activate Lhr using three different assay systems, in which Lh-Fshr activation was also confirmed. Taken together, we conclude that the action of Lh signaling and Fsh signaling is redundant in that either alone can support zebrafish spermatogenesis based on two observations. First, that either Lh signaling or Fsh signaling alone is sufficient to support male fertility. Second, that the two gonadotropin ligands could promiscuously activate both receptors. Apart from revealing the complexity of gonadotropin signaling in controlling male reproduction in zebrafish, this study also shed light toward a better understanding on the evolution of gonadotropin signaling in vertebrates from fish to mammals.

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HB-EGF regulates Prss56 expression during mouse decidualization via EGFR/ERK/EGR2 signaling pathway

Embryo implantation and decidualization are key steps for successful reproduction. Although numerous factors have been identified to be involved in embryo implantation and decidualization, the mechanisms underlying these processes are still unclear. Based on our preliminary data, Prss56, a trypsin-like serine protease, is strongly expressed at implantation site in mouse uterus. However, the expression, regulation and function of Prss56 during early pregnancy are still unknown. In mouse uterus, Prss56 is strongly expressed in the subluminal stromal cells at implantation site on day 5 of pregnancy compared to inter-implantation site. Under delayed implantation, Prss56 expression is undetected. After delayed implantation is activated by estrogen, Prss56 is obviously induced at implantation site. Under artificial decidualization, Prss56 signal is seen at the primary decidual zone at the initial stage of artificial decidualization. When stromal cells are induced for in vitro decidualization, Prss56 expression is significantly elevated. Dtprp expression under in vitro decidualization is suppressed by Prss56 siRNA. In cultured stromal cells, HB-EGF markedly stimulates Prss56 expression through EGFR/ERK pathway. Based on promoter analysis, we also showed that Egr2 is involved in Prss56 regulation by HB-EGF. Collectively, Prss56 expression at implantation site is modulated by HB-EGF/EGFR/ERK signaling pathway and involved in mouse decidualization.

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Empathy deficits and adolescent sexual offending: A systematic review of the evidence base

Publication date: Available online 2 August 2017
Source:Aggression and Violent Behavior
Author(s): Andrew Baly, Stephen Butler
Although empathy deficits are commonly assumed to contribute to adolescent sex offending, no systematic review of the evidence base has been undertaken. To rectify this omission, this review examines whether current evidence supports the existence of a relationship between empathy and adolescent sexual offending. A systematic search of the evidence base found sixteen relevant empirical studies, which provided evidence that was inconclusive or subject to methodological limitations. The review suggests that further systematic and methodologically-sound research is required to determine the extent and nature of the relationship between empathy and adolescent sex offending, that any relationship between the two is unlikely to be straightforward, and that explanations of the mechanisms involved should be integrated into wider multifactorial explanations for this behavior.



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Risk prediction instruments in geriatric surgery are available but often ignored

No abstract available

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Compressed air injection technique for Shamrock lumbar plexus block

No abstract available

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History of anaesthesia: The ketamine story – past, present and future

No abstract available

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Rocuronium is more hepatotoxic than succinylcholine in vitro

BACKGROUND: The development of liver failure is a major problem in critically ill patients. The hepatotoxicity of many drugs, as one important reason for liver failure, is poorly screened for in human models. Rocuronium and succinylcholine are neuromuscular blocking agents used for tracheal intubation and for rapid-sequence induction. OBJECTIVE: We used an in-vitro test with a permanent cell line and compared rocuronium and succinylcholine for hepatotoxicity. DESIGN: In-vitro study. SETTING: A basic science laboratory, University Hospital Rostock, Germany. MATERIAL/(PATIENTS): The basic test compound is the permanent human liver cell line HepG2/C3A. In a standardised microtitre plate assay the toxicity of different concentrations of rocuronium, succinylcholine and plasma control was tested. INTERVENTIONS: After two incubation periods of 3 days, the viability of cells (XTT test, lactate dehydrogenase release and trypan blue staining), micro-albumin synthesis and the cytochrome 1A2 activity (metabolism of ethoxyresorufin) were measured. MAIN OUTCOME MEASURES: Differences between rocuronium and succinylcholine were assessed using the Kruskal–Wallis one-way test and two-tailed Mann–Whitney U test. RESULTS: Rocuronium, but not succinylcholine, led to a significant dose-dependent decrease of viability, albumin synthesis and cytochrome 1A2 activity of test cells. CONCLUSION: An in-vitro test with a cell line showed hepatotoxicity of rocuronium that was dose-dependent. Further studies are needed to investigate the underlying mechanisms of the effects of rocuronium on hepatic cellular integrity. TRIAL REGISTRATION: Not suitable.

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Efficacy and safety of buprenorphine in peripheral nerve blocks: A meta-analysis of randomised controlled trials

BACKGROUND: The duration of analgesia provided by nerve blocks is limited if local anaesthetics are administered alone. Therefore, a variety of additives to local anaesthetics have been investigated to prolong postoperative analgesia following single-shot nerve blocks. OBJECTIVE(S): The aims of the current meta-analysis were to assess the efficacy and safety of the addition of perineural buprenorphine to local anaesthetic compared with local anaesthetic alone, or combined with systemic administration of buprenorphine, or other perineural opioids for peripheral nerve blocks. DESIGN: Systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES: The following data sources were systematically searched: MEDLINE, CENTRAL and EMBASE (till 03/2016). ELIGIBILITY CRITERIA: All RCTs focusing on the efficacy and safety of perineural buprenorphine combined with local anaesthetic compared with local anaesthetic alone, or in combination with systemic buprenorphine, or other perineural opioids for peripheral nerve blocks were included. RESULTS: We included 13 RCTs (685 patients). Participants treated with perineural buprenorphine combined with local anaesthetic showed a longer duration of analgesia compared with those receiving local anaesthetic alone [mean difference 8.64 h, 95% confidence interval (CI) (6.44 to 10.85); P 

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Postoperative nausea and vomiting: solutions and questions

No abstract available

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Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block: A comparative cadaveric study

BACKGROUND: The dermatomal level of analgesia achieved with quadratus lumborum blocks varies according to the location of injection. The most commonly used approaches are either at the postero-lateral aspect or anterior to the quadratus lumborum muscle. OBJECTIVE: To determine whether the site of injection of contrast dye around the quadratus lumborum muscle of cadavers affects the extent and mechanism of dye spread. DESIGN: Observational human cadaver study. SETTING: Cleveland Clinic cadaveric laboratory. PARTICIPANTS: Six fresh human cadavers. INTERVENTIONS: The cadavers received either a posterior quadratus lumborum block or an anterior subcostal quadratus lumborum block on each side. MAIN OUTCOME MEASURES: Cadavers were dissected to determine the extent of dye spread. RESULTS: The posterior quadratus lumborum block approach revealed consistently deep staining of the iliohypogastric, ilioinguinal, subcostal nerve, T11 to 12 and L1 nerve roots. In addition, staining of the middle thoracolumbar fascia was seen in all specimens but only variable staining of T10 nerve roots. The anterior subcostal quadratus lumborum block approach in all specimens demonstrated predictable deep staining of the iliohypogastric and ilioinguinal nerves, subcostal nerves, T11 to 12 and L1 nerve roots, and in addition traversing the arcuate ligaments to involve T9 to 12 nerve roots with variable staining of higher thoracic nerve roots. CONCLUSIONS: Our cadaveric study demonstrates that injection of dye on the posterior aspect of quadratus lumborum muscle led to injectate spread through the lateral and posterior abdominal wall but with limited cranial spread, whereas the anterior approach produced broader coverage of the lower to mid-thoracic region. Clinical translation of these findings to determine the practical significance is warranted.

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Anaesthesiology and ethics: Presumed consent with real consequences

No abstract available

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Thoracic paravertebral block for postoperative pain management after renal surgery: A randomised controlled trial

BACKGROUND: Thoracic paravertebral block (ThPVB) combined with general anaesthesia is used in thoracic and general surgery. It provides effective analgesia, reduces surgical stress response and the incidence of chronic postoperative pain. OBJECTIVE: To assess the efficacy of ThPVB in reducing opioid requirements and decreasing the intensity of pain after renal surgery. DESIGN: A randomised, open label study. SETTING: A single university hospital. Study conducted from August 2013 to February 2014. PARTICIPANTS: In total, 68 patients scheduled for elective renal surgery (open nephrectomy or open nephron-sparing surgery). INTERVENTIONS: Preoperative ThPVB with 0.5% bupivacaine combined with general anaesthesia, followed by postoperative oxycodone combined with nonopioid analgesics as rescue drugs. Follow-up period: 48 h. MAIN OUTCOME MEASURES: Total dose of postoperative oxycodone required, pain intensity, occurrence of opioid related adverse events, ThPVB-related adverse events and patient satisfaction. RESULTS: A total of 68 patients were randomised into two groups and, of these, 10 were subsequently excluded from analysis. Patients in group paravertebral block (PVB; n = 27) had general anaesthesia and ThPVB, and those in group general (anaesthesia) (GEN) (n = 31) formed a control group receiving general anaesthesia only. Compared with patients in group GEN, patients who received ThPVB required 39% less i.v. oxycodone over the first 48 h and had less pain at rest (P 

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Plasma levels of local anaesthetic following supraclavicular block

No abstract available

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Loss of resistance: A randomised controlled trial assessing four low-fidelity epidural puncture simulators

BACKGROUND: Detecting loss of resistance (LOR) can either be taught with dedicated simulators, with a cost ranging from €1500 to 3000, or with the 'Greengrocer's Model', requiring simply a banana. OBJECTIVES: The purpose of this study was to compare three dedicated epidural puncture training simulators and a banana in their ability to simulate LOR. Our hypothesis was that there was a difference between the four simulators when comparing the detection of LOR. DESIGN: Single-blinded, randomised, controlled study. SETTING: Department of Anaesthesiology and Pain Therapy, Bern University Hospital, Switzerland. PARTICIPANTS: Fifty-five consultant anaesthesiologists. INTERVENTIONS: The participants were asked to insert an epidural catheter in four different epidural puncture training simulators: Lumbar Puncture Simulator II (Kyoto Kagaku, Kyoto, Japan), Lumbar Epidural Injection Trainer (Erler-Zimmer, Lauf, Germany), Normal Adult Lumbar Puncture/Epidural Tissue (Simulab Corp., Seattle, Washington, USA) and a banana. The simulators were placed in identical boxes to blind the participants. MAIN OUTCOME MEASURES: The primary outcome was the detection of LOR rated on a 100-mm visual analogue scale, in which 0 mm represented 'completely unrealistic' and 100 mm represented 'indistinguishable from a real patient'. RESULTS: The mean visual analogue scale scores for LOR in the four simulators were significantly different: 60 ± 25 mm [95% confidence interval (CI), 55 to 65 mm], 50 ± 29 mm (95% CI, 44 to 55 mm), 64 ± 24 mm (95% CI, 58 to 69 mm) and 49 ± 32 mm (95% CI, 44 to 54 mm); P less than 0.001, Friedman test. CONCLUSION: Two of the three dedicated epidural simulators were rated more realistic in detecting LOR than the banana, but some participants preferred the banana to the other three simulators. Given the relative cost of a banana compared with a dedicated simulator, we suggest that a banana be used to teach the technique of LOR for epidural puncture. TRIAL REGISTRATION: KEK Nr: Req-2015-z087.

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Should the transversus abdominis plane block be performed for laparoscopic colorectal surgery?

No abstract available

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Impact of reversal strategies on the incidence of postoperative residual paralysis after rocuronium relaxation without neuromuscular monitoring: A partially randomised placebo controlled trial

BACKGROUND: Electronic neuromuscular monitoring is not widely used to determine either the reversal requirements for neuromuscular block before extubation of the trachea, or to determine if there is any subsequent postoperative residual neuromuscular block (PORNB). OBJECTIVES: To investigate the incidence of PORNB using acceleromyography after spontaneous recovery of rocuronium-induced block and to compare this with the administration of sugammadex, neostigmine or a placebo. DESIGN: Partially randomised, partially randomised, placebo-controlled, double-blind, four-group parallel-arm study. SETTING: Single-centre study performed between October 2013 and December 2015 in a university hospital. PATIENTS: Of the 134 eligible patients, 128 gave their consent and 125 of these completed the study. INTERVENTIONS: Patients received general anaesthesia with propofol, sevoflurane, fentanyl and rocuronium. Neuromuscular transmission was measured by acceleromyography (TOF-Watch-SX; Organon Teknika B.V., Boxtel, the Netherlands) but the anaesthetist was blind to the results. If the anaesthetist deemed pharmacological reversal to be necessary before extubation of the trachea then patients were assigned randomly to receive either sugammadex (2.0 mg kg−1), neostigmine (0.05 mg kg−1) or a placebo. In the postanaesthesia care unit, an independent anaesthetist, unaware of the treatment given, assessed the neuromuscular function using acceleromyography. MAIN OUTCOME MEASURES: The incidence of a normalised train-of-four ratio less than 0.9 on arrival in the recovery room. RESULTS: In total, 125 patients were recruited. Neuromuscular block was allowed to recover spontaneously in 50 patients, whereas the remainder received either sugammadex (27), neostigmine (26) or placebo (22). The number of cases with PORNB were one (3.7%), four (15%), 13 (26%) and 10 (45%) after sugammadex, neostigmine, spontaneous recovery and placebo, respectively. Sugammadex and neostigmine were more effective than placebo [odds ratio (OR): 0.05, 95% confidence interval (CI): 0.005 to 0.403, P = 0.005; OR: 0.22, 95% CI: 0.056 to 0.85, P = 0.028, respectively]. Sugammadex performed better than spontaneous recovery (OR: 0.11, 95% CI: 0.014 to 0.89, P = 0.039) unlike neostigmine (OR: 0.52, 95% CI: 0.15 to 1.79, P = 0.297). Yet, antagonism (pooled data) was more effective than spontaneous recovery (OR: 0.3, 95% CI: 0.1 to 0.9, P = 0.03). CONCLUSION: Although pharmacological reversal based on clinical signs was superior to spontaneous recovery it did not prevent PORNB, irrespective of the reversal agent. TRIAL REGISTRATION: The study is registered under EUDRACT number 2013-001965-17.

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Reply to: postoperative nausea and vomiting: solutions and questions

No abstract available

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Effects of calcium chloride coadministered with neostigmine on neuromuscular blockade recovery: A double-blind randomised study

BACKGROUND: Ionised calcium plays an important role in neuromuscular transmission, but its effects on the reversal of nondepolarising neuromuscular blockade have not been fully evaluated. OBJECTIVE: We examined whether calcium chloride coadministered with neostigmine could enhance the rate of neuromuscular recovery. DESIGN: Randomised double-blind trial. SETTING: A tertiary teaching hospital. PATIENTS: In total, 53 patients undergoing elective surgery under general anaesthesia with neuromuscular monitoring by acceleromyography using a TOF-Watch SX monitor. INTERVENTIONS: Patients were randomly allocated to receive either 5 mg kg−1 of calcium chloride (calcium group, n = 26) or the same volume of normal saline (control group, n = 27) coadministered with 25 μg kg−1 of neostigmine and 15 μg kg−1 of atropine at the end of surgery. MAIN OUTCOME MEASURES: The primary end point was the neuromuscular recovery time [time from neostigmine administration to recovery of the TOF ratio (TOFr) to 0.9]. Secondary end points included the TOFr at 5, 10 and 20 min after neostigmine administration and the incidence of postoperative residual curarisation (PORC), defined as a TOFr less than 0.9 at each time point. RESULTS: The neuromuscular recovery time was significantly faster in the calcium group than in the control group (median [Q1 to Q3]; 5.0 [3.0 to 7.0] vs. 6.7 [5.7 to 10.0] min, respectively; P = 0.007). At 5 min after neostigmine administration, the TOFr was higher [87 (74 to 100) vs. 68 (51 to 81)%, respectively; P = 0.002] and the incidence of PORC was lower (50.0 vs. 81.5%, respectively; P = 0.016) in the calcium group than in the control group. There were no differences between the two groups with respect to the TOFr or incidence of PORC at 10 and 20 min after neostigmine administration. CONCLUSION: Calcium chloride coadministered with neostigmine enhanced neuromuscular recovery in the early period of nondepolarising neuromuscular blockade reversal.

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Reply to: risk prediction instruments in geriatric surgery are available but often ignored

No abstract available

http://ift.tt/2uZqtD9

Inclusion of PET-CT into planning of primary or neoadjuvant chemoradiotherapy of esophageal cancer improves prognosis

Abstract

Background

PET-CT is widely used for both the staging and planning of primary or neoadjuvant chemoradiotherapy for esophageal cancer. Inclusion of PET-CT information into radiotherapy planning often leads to substantial modifications of the target volume. In the case of detection of distant metastases, it may also result in a switch to a palliative treatment approach. This spares patients from therapy-related toxicities that provide no clinical benefit. However, due to a lack of studies, it is currently unclear whether the advantages of PET-CT also translate into a measurable improvement in patient survival.

Patients and methods

A retrospective analysis assessed the survival data of 145 patients with esophageal carcinoma stages I (eight patients; 5%), II (45; 31%), III (79; 55%), IV (8; 5%) and unknown (5; 4%). Patients were treated between 1999 and 2014 either with primary chemoradiation (n = 101) or neoadjuvant chemoradiation at the Department of Radiation Oncology, University Medical Center Mainz, followed by transabdominal or transthoracic tumor resection (n = 44). Of the 145 patients, 64 (44%) had undergone PET-CT.

Results

Univariate analysis showed the use of PET-CT to be associated with significantly longer local recurrence-free survival (p = 0.006) and tended to translate into a measurable improvement of overall survival (p = 0.071). Since more patients underwent surgery in the group planned using PET-CT (20% vs. 44%; p = 0.002), we carried out a multivariate Cox regression analysis to adjust for this possible confounding factor. Surgery (p = 0.042; HR 0.55; 95% confidence interval: 0.31–0.98) as well as the use of PET-CT (p = 0.048; HR 0.60; 95% confidence interval: 0.36–0.99) nearly halved the risk of local recurrence. It was only in the group of patients with PET-CT that a trend towards a shorter overall survival was evident in lymph node-positive patients (p = 0.16), whereas nodal stage did not impact on survival in patients staged without PET-CT (p = 0.97).

Conclusion

To the best of our knowledge these data suggest for the first time that the use of PET-CT in the framework of staging and planning of primary or neoadjuvant chemoradiotherapy for esophageal cancer has a favorable impact on patient survival.

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Bleomycin-induced pulmonary toxicopathological changes in rats and its prevention by walnut extract

Publication date: October 2017
Source:Biomedicine & Pharmacotherapy, Volume 94
Author(s): Saba Beigh, Hina Rashid, Shikha Sharma, Suhel Parvez, Sheikh Raisuddin
Oxidative stress-related inflammation and apoptosis are important pathogenic consequences, which result in acute pulmonary toxicity. Bleomycin (BLM) is used to treat various forms of cancers. However, its prolonged administration is associated with major toxicity to respiratory system. We studied the effect of walnut (Juglans regia) extract in a rat model of BLM-induced pulmonary toxicopathy. We also studied parameters of inflammation, apoptosis and oxidative stress in various groups of animals. Prophylactic treatment of total methanolic extract of walnut at the dose of 150mg/kg b.w. was given per os to Wistar rats for 14days prior to BLM exposure. A single intratracheal injection of BLM (10U/kg b.w.) was administered on the eleventh day of the treatment. There was a marked increase in the hydroxyproline level, lipid peroxidation, nitric oxide production, and in the activities of xanthine oxidase and myeloperoxidase in the lung tissue in BLM-treated animals when compared to control animals. BLM also decreased the activities of antioxidant enzymes such as glutathione reductase and catalase and increased the lung inflammation and apoptosis by upregulating the NF-κB signaling pathway and caspase-3 expression. Treatment with walnut extract attenuated these changes in a significant manner. Walnut extract significantly modulated the lung injury as measured by markers of cellular injury such as lactate dehydrogenase and alkaline phosphatase, total cell count, total protein and reduced glutathione in bronchoalveolar lavage fluid. Histological findings supported the protective effects of walnut extract against BLM-induced lung injury. Walnut which has been shown to have numerous medicinally valuable constituents including ellagic acid showed efficacy in preventing the various toxicopathological effects of BLM in rat lungs. Overall, walnut extract decreases BLM-induced oxidative stress and lung inflammation by modulating the alveolar macrophage inflammatory response in rats and thus protecting them from the pathological effect of BLM.

Graphical abstract

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Desalted Salicornia europaea extract attenuated vascular neointima formation by inhibiting the MAPK pathway-mediated migration and proliferation in vascular smooth muscle cells

Publication date: October 2017
Source:Biomedicine & Pharmacotherapy, Volume 94
Author(s): Kyung Jong Won, Kang Pa Lee, Suji Baek, Long Cui, Mee-Hyang Kweon, Seung Hyo Jung, Yun-Kyoung Ryu, Jung Min Hong, Eun-Ah Cho, Hwa-Sup Shin, Bokyung Kim
Salicornia europaea L. (SE) has been used as folk medicine for the treatment of various diseases such as obesity, diabetes, and cancer. However, its effects on atherosclerotic events in vascular smooth muscle cells (VSMCs) remain unknown. The present study explored the effects of the ethyl acetate fraction of desalted SE hot water extract (SEWEAF) on atherosclerotic responses (especially migration and proliferation) in VSMCs and vascular neointima formation. Treatment with the SEWEAF significantly suppressed the platelet-derived growth factor (PDGF)-BB-induced VSMC migration and proliferation as well the phosphorylation of mitogen-activated protein kinases (MAPKs) such as the p38 MAPK and extracellular signal-regulated kinase (ERK) 1/2. Moreover, oral administration of the SEWEAF resulted in the attenuation of neointima formation in balloon-injured rat carotid arteries. Additionally, HPLC analysis showed that the major components in the two subfractions of the SEWEAF were five phenolic acids and four flavonols. In the SEWEAF components, for which atherosclerosis-linked responses in VSMCs have not been known, p-coumaric acid, quercetin-3-β-d-glucoside, and isorhamnetin-3-β-d-glucoside inhibited both PDGF-BB-induced migration and proliferation and isorhamnetin attenuated only PDGF-BB-stimulated VSMC proliferation. These results suggest that the SEWEAF may suppress PDGF-BB-induced VSMC migration by downregulating the phosphorylation of p38 MAPK and ERK1/2, thus leading to the reduction of neointimal hyperplasia during vascular remodeling. Therefore, the desalted SE extract, SEWEAF may be a potential ingredient for dietary supplements or nutraceuticals to ameliorate and/or prevent vascular remodeling-related disorders.



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RXR heterodimers orchestrate transcriptional control of neurogenesis and cell fate specification

Publication date: Available online 2 August 2017
Source:Molecular and Cellular Endocrinology
Author(s): Zoltan Simandi, Attila Horvath, Ixchelt Cuaranta-Monroy, Sascha Sauer, Jean-Francois Deleuze, Laszlo Nagy
Retinoid X Receptors (RXRs) are unique and enigmatic members of the nuclear receptor (NR) family with extensive and complex biological functions in cellular differentiation. On the one hand, RXRs through permissive heterodimerization with other NRs are able to integrate multiple lipid signaling pathways and are believed to play a central role to coordinate the development of the central nervous system. On the other hand, RXRs may have heterodimer-independent functions as well. Therefore, a more RXR-centric analysis is warranted to identify its genomic binding sites and regulated gene networks, which are orchestrating the earliest events in neuronal differentiation.Recently developed genome-wide approaches allow systematic analyses of the RXR-driven neural differentiation. Here we applied next generation sequencing-based methodology to track the dynamic redistribution of the RXR cistrome along the path of embryonic stem cell to glutamatergic neuron differentiation. We identified Retinoic Acid Receptor (RAR) and Liver X Receptor (LXR) as dominant heterodimeric partners of RXR in these cellular stages. Our data presented here characterize the RAR:RXR and LXR:RXR-mediated transcriptional program in embryonic stem cells, neural progenitors and terminally differentiated neurons. Considering the growing evidence for dysregulated RXR-mediated signaling in neurodegenerative disorders, such as Alzheimer's Disease or Amyotrophic Lateral Sclerosis, the data presented here will be also a valuable resource for the field of neuro(patho)biology.

Graphical abstract

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The effect of primary hyperparathyroidism on pancreatic exocrine function

Abstract

Background

Elastase-1 is a proteolytic enzyme secreted by pancreatic acinar cells, and measurements of the concentration this enzyme are used to evaluate pancreatic exocrine function. We aimed to determine whether pancreatic exocrine function declines due to chronic hypercalcemia by measuring fecal elastase levels.

Methods

75 patients with primary hyperparathyroidism (18 men and 47 women) and 30 healthy subjects (11 men and 19 women) participated in this study. Renal function tests, lipid parameters, bone mineral density, and serum calcium, phosphorus, vitamin D, parathormone, glucose, and thyroid stimulating hormone levels as well as fecal elastase concentrations, were determined in these patients and controls.

Results

The mean fecal elastase level was 335.3 ± 181.4 μg/g in the PHPT group and 317.4 ± 157.3 μg/g in the control group. There was no significant difference in fecal elastase levels between the two groups (p = 0.5).

Conclusions

Chronic hypercalcemia in primary hyperparathyroidism did not decrease the fecal elastase level, which is an indirect indicator of chronic pancreatitis; therefore, chronic hypercalcemia in PHPT may not cause chronic pancreatitis.

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Predicting risky sexual behaviors among college student drinkers as a function of event-level drinking motives and alcohol use

Publication date: January 2018
Source:Addictive Behaviors, Volume 76
Author(s): Tess M. Kilwein, Alison Looby
BackgroundRisky sexual behaviors (e.g., sex without protection against pregnancy or sexually transmitted infections, sexual coercion, sex with unknown partners) are common among college students. To effectively decrease these behaviors, it is necessary to further understand factors associated with their occurrence. Drinking motives are a known predictor of both alcohol use and alcohol-related consequences, which may theoretically include risky sex. This study aimed to understand how drinking motivation interacts with alcohol use to predict risky sexual behaviors among college student drinkers.MethodsOne-hundred and eight primarily female (83.3%) college students (age: M=19.09, SD=1.16) who endorsed past-month alcohol use and lifetime history of sexual activity completed up to four weekly Internet surveys assessing daily quantity of alcohol use, drinking motives (i.e., social, enhancement, coping, conformity), and engagement in risky sexual behavior. From 403 reported drinking episodes, four Generalized Estimating Equations were used to predict risky sex from person-centered drinking quantity and drinking motives.ResultsStrong social motives significantly increased the odds of engaging in risky sexual behaviors (p=0.004). Additionally, there was a significant interaction, such that the relationship between risky sex and drinking depends on enhancement motives (p=0.021).ConclusionsInterventions targeting social and enhancement motives for drinking may be particularly effective in reducing the occurrence of risky sexual behaviors among college students, which may result in a reduction of the negative physical and psychological health outcomes accompanying these behaviors.



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The effect of e-cigarette warning labels on college students' perception of e-cigarettes and intention to use e-cigarettes

Publication date: January 2018
Source:Addictive Behaviors, Volume 76
Author(s): Hsiao-Yun Lee, Hsien-Chang Lin, Dong-Chul Seo, David K. Lohrmann
ObjectiveThis study examined the effect of two e-cigarette warning labels on college students' perceived advantages and risks of e-cigarette use, as well as students' intentions to use e-cigarettes. The company-produced e-cigarette warning label carries abundant information with small font size while the governmental warning label has only two sentences presented in large font size. The effect of both labels have not yet been examined and verified.MethodsData were collected in October 2015 from college students at a Midwestern university. A pretest-posttest design was employed with 338 students exposed to the warning label proposed by the FDA and 328 students exposed to the label created by e-cigarette companies. Structural equation modeling analysis was implemented to examine the effect of warning labels with the analytical model grounded in the Theory of Planned Behavior.ResultsFindings showed that college students' perceived advantages of e-cigarette use were positively related to their intentions to use e-cigarettes, while perceived risks were negatively associated with their intentions. When comparing two labels, the governmental label was found to reduce college students' intentions to use e-cigarettes via increasing perceived risks of e-cigarette use (β=0.10, p<0.05), however, not via decreasing perceived advantages of e-cigarette use. The warning label currently used by e-cigarette companies showed no influence on beliefs about or intentions to use e-cigarettes.ConclusionsThe warning label proposed by the FDA is more effective than that created by e-cigarette companies, however, has room for improvement to make a greater impact on e-cigarette use intention.



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A phase I/II dose escalation study of the use of intensity modulated radiotherapy (IMRT) to treat the prostate and pelvic nodes in patients with prostate cancer

Publication date: Available online 2 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Miguel Reis Ferreira, Atia Khan, Karen Thomas, Lesley Truelove, Helen McNair, Annie Gao, Chris C. Parker, Robert Huddart, Margaret Bidmead, Ros Eeles, Vincent Khoo, Nicholas J. van As, Vibeke N. Hansen, David P. Dearnaley
BackgroundThe role of pelvic lymph node (PLN) radiotherapy in advanced localised prostate cancer (PCa) remains controversial. In order to minimise toxicity, past studies limited the dose delivered to the PLN. We used Intensity Modulated Radiotherapy (IMRT) to investigate the feasibility of dose-escalation and hypofractionation of PLN-IMRT in PCa.MethodsIn a phase I/II study, patients with advanced localised PCa were sequentially treated with 70-74Gy to the prostate and dose-escalating PLN-IMRT at doses of 50Gy (Cohort 1), 55Gy (Cohort 2) and 60Gy (Cohort 3) in 35-37 fractions. Two hypofractionated cohorts received 60Gy to the prostate and 47Gy to PLN in 20 fractions over 4 weeks (Cohort 4) and 5 weeks (Cohort 5). All patients received long-course androgen deprivation therapy. Primary outcome was late RTOG toxicity at 2 years post-radiotherapy for all cohorts. Secondary outcomes were acute and late toxicity using other clinician/patient-reported instruments and treatment efficacy.FindingsBetween Aug 9, 2000 and June 9, 2010, 447 patients were enrolled. Median follow-up was 90 months. The 2-year rates of grade 2+ bowel/bladder toxicity were: Cohort 1 - 8.3%/4.2% (95%CI 2.2-29.4/0.6-26.1); Cohort 2 - 8.9%/5.9% (4.1-18.7/2.3-15.0); Cohort 3 - 13.2%/2.9% (8.6-20.2/1.1-7.7); Cohort 4 - 16.4%/4.8% (9.2-28.4/1.6-14.3); Cohort 5 - 12.2%/7.3% (7.6-19.5/3.9-13.6). Prevalence of bowel and bladder toxicity appeared stable over time. Other scales mirrored these results. The biochemical/clinical failure-free rate was 71% (66-75%) at 5 years for the whole group with pelvic lymph node control in 94% of patients.InterpretationThe study shows the safety and tolerability of PLN-IMRT. Ongoing and planned phase III studies will need to demonstrate an increase in efficacy using PLN-IMRT to offset the small increase in bowel side-effects compared with prostate-only IMRT.

Teaser

Elective pelvic lymph node (PLN) radiotherapy and hypofractionation for advanced localised prostate cancer remains controversial. We report a single-centre sequential cohort study using IMRT to deliver conventionally-fractionated 50Gy, 55Gy, and 60Gy to the PLN and 70-74Gy (2Gy/fraction) to the prostate. Additionally we studied modest hypofractionation delivering 60Gy (3Gy/fraction) to the prostate with 47Gy to the PLN over 4-5 weeks. Our findings highlight the safety of dose-escalation and hypofractionation in PLN-IMRT.


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