Rejuvenation Research Aug 2017, Vol. 20, No. 4: 346-349.
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Δευτέρα 21 Αυγούστου 2017
Inflammation, Stem Cells, and the Aging Hypothalamus
Deficient Data Dissemination Does Damage
Rejuvenation Research Aug 2017, Vol. 20, No. 4: 261-262.
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Reconstruction of full-thickness cheek defect with a folded cervico-pectoral cutaneous flap following ablation of advanced oral cancer in elderly patient
Abstract
Background
Reconstruction of full-thickness cheek defects involving both the oral lining and the external facial skin following ablative surgery remains a difficult task. Free flap reconstruction is the main modality of treatment, but sometimes there is a reluctance to use it in elderly patients with several comorbidities for an increased risk of non-cancer-related cause of death.
Methods
This article describes a folded cervico-pectoral fasciocutaneous flap that has been used to reconstruct a full-thickness cheek defect in elderly patients. Moreover, surgical technique and aesthetic results 2 years after surgery are discussed in this article.
Results
Currently, after 2 years, the patient is free of disease and enjoys good health.
Conclusions
In conclusion, folded cervico-pectoral fasciocutaneous flap is a fast and practical technique for reconstructing full-thickness cheek defects after tumor excision. The flap was straightforward to perform and reliable in both blood supply and cosmetic outcome, and it provides a good alternative to free flaps for cheek and upper neck reconstruction of elderly patients.
Level of Evidence: Level V, therapeutic study.
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Anatomy of superficial inferior epigastric vessels: revival of superficial inferior epigastric (SIEA) flap
Abstract
Background
Development of perforator flaps evolves the perspective of reconstructive surgery to another level due to many of their advantages over the pedicled flaps, particularly lower donor-site morbidity and versatility in flap design. Superficial inferior epigastric artery (SIEA) flap offers this significant advantage over other lower abdominal flaps, as dissection of the rectus abdominis muscle is not required. However, both vascular agenesis and inappropriate vessel size for anastomosis are the major limitations. This study was therefore aimed to investigate these aspects of this flap.
Methods
Twenty cadavers were dissected bilaterally to demonstrate vascular anatomy of these vessels. The SIEA of each cadaver was dissected and traced from the origin (femoral arteries) to their presence in the subcutaneous layer. Originating patterns of these vessels, whether sharing a common trunk with other vessels such as superficial circumflex iliac (SCI) or superficial external pudendal (SEP) arteries, was determined and their diameters measured.
Results
SIEA agenesis rate was found to be 7.5% (3/40). The diameters greater than 1 and 1.5 mm were found in 86% (32/37) and 30% (11/37), respectively. The distance between its origin and point of entering Scarpa's fascia varies from 10.29 to 62.62 mm (mean 37.48 mm). As opposed to the artery, the superficial inferior epigastric vein was found to be present in all dissections with a diameter ranging from 2.12 to 5 mm (mean 3.09 mm) and the distance, as measured in SIEA, ranging from 20.1 to 74.28 mm (mean 41.24 mm). SIEA usually crosses the inguinal ligament within area between mid-inguinal point and 3 cm medially. Correlations were found (1) between SIEA diameter and pedicle length and (2) between bilateral pedicle lengths of both artery and vein.
Conclusions
The high prevalence of both SIEA presence and appropriate diameter for anastomosis, and thus flap success, makes the SIEA perforator flap an appropriate option for reconstructive treatment.
Level of Evidence: not ratable.
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Potential Implications of NORSTENT (Norwegian Coronary Stent Trial) in Contemporary Practice.
Author: Wiseth, Rune MD, PhD; Bonaa, Kaare Harald MD, PhD
Page: 701-703
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Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults: An Analysis of Data From the Society of Thoracic Surgeons Database.
Author: O'Byrne, Michael L. MD, MSCE; Kim, Sunghee PhD; Hornik, Christoph P. MD, MPH; Yerokun, Babatunde A. MD; Matsouaka, Roland A. PhD; Jacobs, Jeffrey P. MD; Jacobs, Marshall L. MD; Jonas, Richard A. MD
Page: 704-718
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Cerebral Perfusion and the Risk of Dementia: A Population-Based Study.
Author: Wolters, Frank J. MD; Zonneveld, Hazel I. MD; Hofman, Albert PhD; van der Lugt, Aad PhD; Koudstaal, Peter J. PhD; Vernooij, Meike W. PhD; Ikram, M. Arfan PhD; On Behalf of the Heart-Brain Connection Collaborative Research Group
Page: 719-728
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Cardioprotective Role of Tumor Necrosis Factor Receptor-Associated Factor 2 by Suppressing Apoptosis and Necroptosis.
Author: Guo, Xiaoyun PhD *; Yin, Haifeng PhD *; Li, Lei PhD; Chen, Yi MS; Li, Jing PhD; Doan, Jessica MD; Steinmetz, Rachel BS; Liu, Qinghang MD, PhD
Page: 729-742
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Death Receptor Signaling in the Heart: Cell Survival, Apoptosis, and Necroptosis.
Author: Amgalan, Dulguun MS; Chen, Yun PhD; Kitsis, Richard N. MD
Page: 743-746
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Inhibition of MicroRNA-146a and Overexpression of Its Target Dihydrolipoyl Succinyltransferase Protect Against Pressure Overload-Induced Cardiac Hypertrophy and Dysfunction.
Author: Heggermont, Ward A. MD, PhD *; Papageorgiou, Anna-Pia MSc, PhD *; Quaegebeur, Annelies MD, PhD; Deckx, Sophie MSc, PhD; Carai, Paolo MSc; Verhesen, Wouter BSc; Eelen, Guy MSc, PhD; Schoors, Sandra MSc, PhD; van Leeuwen, Rick BSc; Alekseev, Sergey MSc, PhD; Elzenaar, Ies MSc, PhD; Vinckier, Stefan MSc, PhD; Pokreisz, Peter MSc, PhD; Walravens, Ann-Sophie MSc; Gijsbers, Rik MSc, PhD; Van Den Haute, Chris MSc, PhD; Nickel, Alexander MSc, PhD; Schroen, Blanche MSc, PhD; van Bilsen, Marc MSc, PhD; Janssens, Stefan MD, PhD; Maack, Christoph MD, PhD; Pinto, Yigal MD, PhD; Carmeliet, Peter MD, PhD; Heymans, Stephane MD, PhD
Page: 747-761
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MicroRNA-146a as a Regulator of Cardiac Energy Metabolism.
Author: Demkes, Charlotte J. MSc; van Rooij, Eva PhD
Page: 762-764
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Leveraging Behavioral Economics to Improve Heart Failure Care and Outcomes.
Author: Chang, Leslie L. BS; DeVore, Adam D. MD, MHS; Granger, Bradi B. PhD, MSN, RN; Eapen, Zubin J. MD, MHS; Ariely, Dan PhD; Hernandez, Adrian F. MD, MHS
Page: 765-772
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An Irregular Wide Complex Tachycardia.
Author: Watts, Thomas E. MD; McElderry, H. Thomas MD; Kay, G. Neal MD
Page: 773-775
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Long Noncoding RNA Facilitated Gene Therapy Reduces Atherosclerosis in a Murine Model of Familial Hypercholesterolemia.
Author: Tontonoz, Peter MD, PhD; Wu, Xiaohui BS; Jones, Marius PhD; Zhang, Zhengyi PhD; Salisbury, David MS; Sallam, Tamer MD, PhD
Page: 776-778
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Letter by the Society of NeuroInterventional Surgery, the Cerebrovascular Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, and the Society of Vascular and Interventional Neurology Regarding Article, "Public Health Urgency Created by the Success of Mechanical Thrombectomy Studies in Stroke".
Author: Society of NeuroInterventional Surgery; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Society of Vascular and Interventional Neurology
Page: 779-780
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Response by Hopkins and Holmes to Letter Regarding Article, "Public Health Urgency Created by the Success of Mechanical Thrombectomy Studies in Stroke".
Author: Hopkins, L. Nelson MD; Holmes, David R. Jr MD
Page: 781-782
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Letter by Jiang and Qiao Regarding Article, "Chest Pain and T-Wave Inversions in a 56-Year-Old Man".
Author: Jiang, Xiao-Wei MD; Qiao, Shu-Bin MD, PhD
Page: 783
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Response by Verma and Knight to Letter Regarding Article, "Chest Pain and T-Wave Inversions in a 56-Year-Old Man".
Author: Verma, Nishant MD, MPH; Knight, Bradley P. MD
Page: 784
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Emergency contraception in a public health emergency “Zika virus outbreak”
Annals of Tropical Medicine and Public Health 2017 10(3):748-748
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A newer toolkit to respond to sexual violence on a global scale: World Health Organization
Annals of Tropical Medicine and Public Health 2017 10(3):495-496
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Relationship of strategies for emotion cognitive adjustment with psychological well-being and anxiety in mothers with cancer children
Annals of Tropical Medicine and Public Health 2017 10(3):702-706
Background and Purpose: The present study was aimed to examine the relationship between strategies of emotion cognitive adjustment and psychological well-being with anxiety in mothers with cancer children. Materials and Methods: The statistical population of the study consisted of 86 individuals, who were selected using convenience sampling method; they responded to psychological well-being and anxiety questionnaires. Results: The research method was descriptive of a correlational type. Data obtained from questionnaires were analyzed through multivariate regression in SPSS software, after being marked. Findings showed that there is a significant relationship between emotion cognitive adjustment strategies and anxiety and psychological well-being in mothers with cancer children. Conclusion: Results showed that emotion cognitive adjustment predicts about 27.1% of anxiety changes and about 26.8% of psychological well-being changes in mothers with cancer children.
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Addressing the challenges of diagnostic delay and longer treatment duration for multidrug resistant tuberculosis: World Health Organization
Annals of Tropical Medicine and Public Health 2017 10(3):497-498
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Zika virus disease: Potential risk for the athletes and the international visitors in the Rio Olympic Games, 2016
Annals of Tropical Medicine and Public Health 2017 10(3):762-764
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Strengthening research and development activities to effectively contain the epidemics of infectious diseases: World health organization
Annals of Tropical Medicine and Public Health 2017 10(3):499-500
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Network creation to support the international collaboration: A short note on Surindra – Niigata University relationship
Annals of Tropical Medicine and Public Health 2017 10(3):738-739
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Safe space: An effective option to ensure normalcy in the lives of refugee women and girls in conflict-affected Syria
Annals of Tropical Medicine and Public Health 2017 10(3):501-502
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Reactome analysis of Zika virus genes: Implication for pathogenesis
Annals of Tropical Medicine and Public Health 2017 10(3):755-755
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Involving fathers in achieving gender equality through a television reality show
Annals of Tropical Medicine and Public Health 2017 10(3):503-504
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How can we eradicate informal payments for health care in Asia?
Annals of Tropical Medicine and Public Health 2017 10(3):771-772
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Self-care and self-medication: A commentary
Annals of Tropical Medicine and Public Health 2017 10(3):505-506
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The challenges of antenna modification in medical practice: The MRI machine
Annals of Tropical Medicine and Public Health 2017 10(3):726-730
The challenges of modifying the antenna of imaging systems, e.g., MRI, are enormous. The electromagnetic principles for the non-ionizing radiation technique to view internal structures in the human body depend on many factors such as the ratings of the magnetic field, computer, digitizer, RF source, and electrical field. An incorporation of the Bloch NMR flow equation alongside the electromagnetic principles is quite complex. However, the modality was successfully developed to predict the radiofrequency appropriate for the successful imaging session. It was observed that the patient is currently under severe danger of excess exposure to electromagnetic fields.
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INSPIRE: A comprehensive package to reduce violence against children and provide a safe and nurturing environment
Annals of Tropical Medicine and Public Health 2017 10(3):507-508
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Taking major strides in dengue vaccine research: World health organization
Annals of Tropical Medicine and Public Health 2017 10(3):743-744
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Challenges in HIV care: Accelerating the pace of HIV-related services to accomplish the set global targets
Annals of Tropical Medicine and Public Health 2017 10(3):509-510
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Liver problem in zika virus infection: Possibility?
Annals of Tropical Medicine and Public Health 2017 10(3):751-752
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Census: A systematic and comprehensive tool to address the needs of the disadvantaged population groups
Annals of Tropical Medicine and Public Health 2017 10(3):511-512
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What can we learn from Google Map base GIS system on opisthorchiasis in northeastern Thailand?
Annals of Tropical Medicine and Public Health 2017 10(3):758-759
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Legal protection for women in Yemen: A sorry state
Annals of Tropical Medicine and Public Health 2017 10(3):513-514
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Concentration, sources and risk assessment of PAHs in bottom sediments
Abstract
The aims of the study were to investigate the concentration, sources and ecological risk of PAHs (polycyclic aromatic hydrocarbons) in bottom sediments collected from nine reservoirs located in south-eastern Poland. The concentration of ∑PAHs in sediments ranged from 150 to 33,900 μg kg−1. The total PAH concentration in the bottom sediments was arranged in the following order: Rybnik > Rzeszów > Brzóza Królewska > Brzóza Stadnicka > Besko > Chechło > Ożanna > Głuchów > Narożniki. BAP was the major compound in sediments from the Besko, Brzóza Stadnicka and Rzeszów reservoirs; FLT in the sediments from the Rybnik, Narożniki, Ożanna and Brzóza Królewska reservoirs; and FLN from the Głuchów and Chechło reservoirs. The major inputs of PAHs were of pyrolytic origin. However, petrogenic sources of PAHs occurred especially in the Chechło and Głuchów reservoirs. The ecological risk assessment indicated that non-adverse effects on the benthic fauna may occur for sediments from the Głuchów, Narozniki and Ożanna reservoirs, while slightly adverse effects were found for sediments from the Brzóza Królewska, Besko, Brzóza Stadnicka and Chechło reservoirs. The other sediments showed moderate (Rzeszów reservoirs) and strong effect (Rybnik reservoir) on biological communities. Individual PAHs such as NAP, PHE, FLT, PYR, BAA, CHR and BAP in sediments from the Rybnik reservoir and BAP in sediments from the Rzeszów reservoirs indicated a higher possibility of occurrence of an adverse ecological effect. PCA analysis found slight difference between the reservoirs in the profile of variable PAHs. Only the sediments from the Rybnik and Chechło reservoirs differ considerably from this grouping.
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Recommended standards for conducting and reporting ethnopharmacological field studies
Publication date: Available online 20 August 2017
Source:Journal of Ethnopharmacology
Author(s): Caroline S. Weckerle, Hugo J. de Boer, Rajindra K. Puri, Tinde van Andel, Rainer W. Bussmann, Marco Leonti
Ethnopharmacological relevanceWhat are the minimum methodological and conceptual requirements for an ethnopharmacological field study? How can the results of ethnopharmacological field studies be reported so that researchers with different backgrounds can draw on the results and develop new research questions and projects? And how should these field data be presented to get accepted in a scientific journal such as the Journal of Ethnopharmacology? The objective of this commentary is to create a reference that covers the basic standards necessary during planning, conducting and reporting of field research.Materials and methodsWe focus on conducting and reporting ethnopharmacological field studies on medicinal plants or materia medica and associated knowledge of a specific people or region.The article highlights the most frequent problems and pitfalls, and draws on published literature, fieldwork experience, and extensive insights from peer-review of field studies.ResultsResearch needs to be ethical and legal, and follow local and national regulations. Primary ethnopharmacological field data need to be collected and presented in a transparent and comprehensible way. In short this includes: 1) Relevant and concise research questions, 2) Thorough literature study encompassing all available information on the study site from different disciplines, 3) Appropriate methods to answer the research questions, 4) Proper plant use documentation, unambiguously linked to voucher specimens, and 5) Qualitative and quantitative analyses of the collected data, the latter relying on use-reports as basic units.ConclusionAlthough not exhaustive, we provide an overview of the necessary main issues to consider for field research and data reporting including a list of minimal standards and recommendations for best practices. For methodological details and how to correctly apply specific methods, we refer to further reading of suggested textbooks and methods manuals.
Graphical abstract
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Pomegranate peel extract attenuates D-galactose–induced oxidative stress and hearing loss by regulating PNUTS/PP1 activity in the mouse cochlea
Publication date: November 2017
Source:Neurobiology of Aging, Volume 59
Author(s): Shuangyue Liu, Tao Xu, Xidi Wu, Yuhan Lin, Dongyan Bao, Yang Di, Tingting Ma, Yan Dang, Peili Jia, Jianqiao Xian, Aimei Wang, Yongxin Liu
Oxidative stress is considered to be a major contributor to age-related hearing loss (ARHL). Here, we investigated whether pomegranate peel extract (PPE) protected against hearing loss by decreased oxidative stress in the cochlea of D-galactose–induced accelerated aging mice. The aging mice exhibited an increase in hearing threshold shifts and hair cells loss, which were improved in the PPE-treated aging mice. The aging mice also exhibited an increase in 4-hydroxynonenal, the expression of protein phosphatase 1 nuclear targeting subunit (PNUTS), p53 and caspase-3, and a decrease in protein phosphatase 1 (PP1) and MDM2 in the cochlea. PPE treatment reversed the changes in aforementioned molecules. Our results suggested that PPE can protect against ARHL, the underlying mechanisms may involve in the inhibition of oxidative damage of cochlea, possibly by regulating PNUTS/PP1 pathway. The results from the present study provide a new therapeutic strategy to use PPE for prevention of ARHL.
Graphical abstract
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Brachytherapy attains abscopal effects when combined with immunostimulatory monoclonal antibodies
Source:Brachytherapy
Author(s): María E. Rodriguez-Ruiz, Inmaculada Rodriguez, Benigno Barbes, Lina Mayorga, Alfonso Rodriguez Sanchez-Paulete, Mariano Ponz-Sarvise, José Luis Pérez-Gracia, Ignacio Melero
Purpose/ObjectivesPreclinical and clinical evidence indicate that the proimmune effects of radiotherapy can be synergistically augmented with immunostimulatory monoclonal antibodies (mAb) to act both on irradiated tumor lesions and on tumors at distant, nonirradiated sites. We have recently reported that external beam radiotherapy achieves abscopal effects when combined with antagonist anti-PD1 mAbs and agonist anti-CD137 (4-1BB) mAbs. The goal of this work is to study the abscopal effects of radiotherapy instigated by brachytherapy techniques.Methods and MaterialsMice bearing a subcutaneous colorectal carcinoma, MC38 (colorectal cancer), in both flanks were randomly assigned to receive brachytherapy or not (8 Gy × three fractions) to only one of the two grafted tumors, in combination with intraperitoneal immunostimulatory monoclonal antibodies (anti-PD1, anti-CD137, and/or their respective isotype controls). To study the abscopal effects of brachytherapy, we established an experimental set up that permits irradiation of mouse tumors sparing a distant site resembling metastasis. Such second nonirradiated tumor was used as indicator of abscopal effect. Tumor size was monitored every 2 days.ResultsAbscopal effects on distant nonirradiated subcutaneous tumor lesions of transplanted MC38-derived tumors only took place when brachytherapy was combined with immunostimulatory anti-PD1 and/or anti-CD137 mAbs.ConclusionsOur results demonstrate that immunotherapy-potentiated abscopal effects can be attained by brachytherapy. Accordingly, immunotherapy plus brachytherapy combinations are suitable for clinical translation.
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Salvage brachytherapy for recurrent prostate cancer after definitive radiation therapy: A comparison of low-dose-rate and high-dose-rate brachytherapy and the importance of prostate-specific antigen doubling time
Source:Brachytherapy
Author(s): Marisa A. Kollmeier, Sean McBride, Amandeep Taggar, Erik Anderson, Mary Lin, Xin Pei, Shi Weiji, Laszlo Voros, Gilad Cohen, Yoshiya Yamada, Michael J. Zelefsky
BackgroundSalvage brachytherapy is a treatment option for patients with locally recurrent prostate cancer after primary radiation therapy. We reviewed our experience using low-dose-rate (LDR) or high-dose-rate (HDR) brachytherapy to compare the outcome and toxicity profiles of each approach in the salvage brachytherapy setting.Methods and MaterialsNinety-eight patients with biopsy-proven locally recurrent prostate cancer who underwent salvage brachytherapy (LDR = 37; HDR = 61) following an initial course of definitive radiotherapy between 4/2003 and 4/2015 were retrospectively reviewed. All patients underwent salvage brachytherapy using LDR or HDR. Androgen deprivation therapy was used in 45% of the patients. Prostate-specific antigen (PSA) failure was determined using the Phoenix (nadir+2) definition. Toxicity was graded using Common Terminology Criteria for Adverse Events version 4 and patient-reported questionnaires.ResultsMedian followup was 31 months. The 3-year PSA relapse-free survival (RFS) was 60.1% (95% CI, 49.6–72.5%). There was no difference between LDR and HDR brachytherapy in terms of PSA RFS (p = 0.84 by log-rank test). On multivariate analysis, only prostate-specific antigen doubling time (PSADT) <12 months was significantly associated with PSA relapse. The 3-year PSA RFS for patients with a PSADT <12 months was 39% compared with 73% for PSADT ≥12 months (p = 0.002 by long-rank test). There were no statistically significant differences in toxicity between LDR and HDR brachytherapy. There was a higher peak in urinary symptoms in LDR patients; however by 24–36 months, most patients in both groups returned to baseline.ConclusionsBoth LDR and HDR salvage brachytherapy are an excellent treatment options for appropriately selected patients with comparable outcome and toxicity. Patients with a PSADT < 12 months seem to have worse outcomes.
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Calcification Volume Reduces Stretch Capability and Predisposes Plaque to Rupture in an in vitro Model of Carotid Artery Stenting
Publication date: Available online 21 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): H.E. Barrett, E.M. Cunnane, H. Hidayat, J.M. O Brien, E.G. Kavanagh, M.T. Walsh
Objective/BackgroundCarotid artery stenting (CAS) in calcified arteries carries a higher peri-operative risk. This study investigates the relationship between the stretching limits of carotid plaque samples and calcification in order to determine a stretch tolerance criterion for endovascular intervention.MethodsSeventeen carotid plaque samples were acquired from standard endarterectomy procedures. The maximum stretch capability of the global plaque was determined by circumferentially extending the tissue to complete failure. Quantitative assessment of calcification was performed using high resolution computed tomography, including measures of percent calcification volume fraction (%CVF) and calcification configuration. Maximum stretch properties were then related to calcification measures in order to evaluate the predictive power of calcification for determining plaque stretching limits.ResultsA strong negative correlation was found between %CVF and stretch ratio with respect to specific calcification configuration types. All plaques with < 70% stenosis superseded the minimum required stretch threshold. Severe stenosis (> 70%) warrants a stretch of at least 2.33 during revascularisation and only plaques containing concentric calcifications with < 20% CVF successfully reached this minimum required stretch threshold.ConclusionThe addition of calcification measures to the stenosis classification may help in guiding endovascular intervention techniques to achieve a balance between an acceptable residual patency level while avoiding plaque rupture in calcified carotid plaques.
Graphical abstract
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Optimum ridge-to-furrow ratio in ridge-furrow mulching systems for improving water conservation in maize ( Zea may L.) production
Abstract
Water-saving cultivation techniques have been attracting increased attention worldwide. Ridge-furrow mulching system (RFMS), as a prospective rainwater harvesting system, has been widely adopted in arid and semi-arid areas. Field experiments were conducted in 2014 and 2015 to compare soil water storage, soil temperature, maize yield, and water use efficiency (WUE) among different ridge/furrow width arrangements in RFMS comprised of three different ridge/furrow ratios, i.e., 40:70 cm (RFMS40), 55:55 cm (RFMS55), and 70:40 cm (RFMS70) and conventional flat planting (CK, without mulching). All these four planting patterns had the same planting density. The RFMS technique not only increased soil temperature of the ridge but also improved soil moisture of the furrow when compared with CK. These positive effects were intensified with increasing ridge/furrow ratio in RFMS. This improvement in RFMS resulted in more stable and earlier seedling establishment. Maize yields were increased by 26.1, 36.4, and 50.3% under RFMS40, RFMS55, and RFMS70 treatments, respectively, when compared with CK across both years. RFMS did not decrease the evapotranspiration significantly, compared with CK. Eventually, WUE were enhanced by 25.7, 38.7, and 53.9% in RFMS40, RFMS55, and RFMS70, respectively, compared with CK. Taken together, our results suggest that increasing ratio of ridge to furrow in the case of RFMS70, can be recommended as high-yielding cultivation pattern for promoting precipitation use efficiency in the rain-fed semi-arid areas.
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Hyperaccumulating potential of Bidens pilosa L. for Cd and elucidation of its translocation behavior based on cell membrane permeability
Abstract
Phytoremediation with the use of hyperaccumulating plant species to remove excess trace metals from contaminated soil and water is considered a cost-effective non-invasive technique. Over 400 plant taxa worldwide have been identified as natural hyperaccumulators, but only very few are reported to hyperaccumulate Cd. Bidens pilosa L. is a newly found, promising Cd hyperaccumulator, although its potential to accumulate Cd and mechanism of this process are not yet well known. This paper was aimed at exploring hyperaccumulation capacity of B. pilosa for Cd, and its translocation behavior related to cell membrane permeability. The highest Cd concentration in shoots of B. pilosa grown in soil was 405.91 mg kg−1 and of that cultured in nutrient solution 1651.68 mg kg−1, indicating very high accumulation potential. Cd concentrations in the root, stem, leaf, and shoot of B. pilosa cultured in nutrient solution were all much higher than those in soil, while biomass development was considerably lower. This resulted in lesser differences between Cd maximum accumulation loads in the shoot (462 and 365 μg pot−1) and in the root (100 and 96 μg pot−1) of B. pilosa grown in solution and in soil, respectively. Relative electric conductivity (REC), K+ relative permeability ratio, and MDA (malondialdehyde) contents, which are major indices expressing cell membrane permeability, appeared to be closely related to Cd translocation and accumulation. The relative molecular mechanism of Cd accumulation/translocation in B. pilosa was found of importance and needs to be elucidated.
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Regeneration and reuse waste from an edible oil refinery
Abstract
A spent bleaching earth (SBE) from an edible oil refinery has been regenerated by thermal processing in oven, followed by washing with a cold solution of hydrochloric acid (1M). Optimal regeneration conditions have been controlled by decolorization tests of degummed and neutralized soybean oil. Optimal values of treatment (temperature 350°C, carbonization time 01 h, and HCl concentration 1M) gave a very efficient material. After bleaching oil by regenerated spent bleaching earth (RSBE), the chlorophyll-a and β-carotenes contained in crude edible oil and observed respectively at 430, 454, and 483 nm, value of λ max, are very much decreased. The results obtained after decolorization of edible oil by RSBE material indicate, that, during the process, the bleaching oil did not undergo any changes in the free fatty acid content. The peroxide value (PV) was reduced from 4.2 to 1.8 meq O2/kg, and the color has been improved (Lovibond color yellow/red: from 50/0.5 to 2.7/0.3, respectively). The RSBE material obtained was characterized by several techniques (FTIR, SEM). The results show that the heat treatment did not affect the mineral structure of RSBE, and the regenerated material recovered its porous structure.
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Assessment of the availability of As and Pb in soils after in situ stabilization
Abstract
The in situ stabilization has been widely used to remediate metal-contaminated soil. However, the long-term retaining performance of heavy metals and the associated risk after in situ stabilization remains unclear and has evoked amounting concerns. Here, Pb- or As-contaminated soil was stabilized by a commercial amendment. The availability of Pb and As after in situ stabilization were estimated by ten different in vitro chemical extractions and DGT technique. After amendment application, a significant decline in extractable Pb or As was observed in treatments of Milli-Q water, 0.01 M CaCl2, 0.1 M NaNO3, 0.05 M (NH4)2SO4, and 0.43 M HOAc. Potential available metal(loid)s determined by DGT also showed remarkable reduction. Meanwhile, the results of in vivo uptake assays demonstrated that Pb concentrations in shoots of ryegrass Lolium perenne L. declined to 12% of the control samples, comparable to the extraction ratio of 0.1 M NaNO3 (15.8%) and 0.05 M (NH4)2SO4 (17.3%). For As-contaminated soil, 0.43 M HOAC provided a better estimation of relative phytoavailability (64.6 vs. 65.4% in ryegrass) compared to other extraction methods. We propose that 0.1 M NaNO3 or 0.05 M (NH4)2SO4 for Pb and 0.43 M HOAc for As may serve as surrogate measures to estimate the lability of metal(loid)s after soil remediation of the tested contaminated soils. Further studies over a wider range of soil types and amendments are necessary to validate extraction methods.
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Coronary Artery Disease in Patients With Out-of-Hospital Refractory Ventricular Fibrillation Cardiac Arrest
AbstractBackground
The prevalence of coronary artery disease (CAD) among patients with refractory out-of-hospital (OH) ventricular fibrillation (VF)/ventricular tachycardia (VT) cardiac arrest is unknown.
ObjectivesThe goal of this study was to describe the prevalence and complexity of CAD and report survival to hospital discharge in patients experiencing refractory VF/VT cardiac arrest treated with a novel protocol of early transport to a cardiac catheterization laboratory (CCL) for extracorporeal life support (ECLS) and revascularization.
MethodsBetween December 1, 2015, and December 1, 2016, consecutive adult patients with refractory OH VF/VT cardiac arrest requiring ongoing cardiopulmonary resuscitation were transported by emergency medical services to the CCL. ECLS, coronary angiography, and percutaneous coronary intervention were performed, as appropriate. Functionally favorable survival to hospital discharge (Cerebral Performance Category 1 or 2) was determined. Outcomes in a historical comparison group were also evaluated.
ResultsSixty-two (86%) of 72 transported patients met emergency medical services transport criteria. Fifty-five (89%) of the 62 patients met criteria for continuing resuscitation on CCL arrival; 5 had return of spontaneous circulation, 50 received ECLS, and all 55 received coronary angiography. Forty-six (84%) of 55 patients had significant CAD, 35 (64%) of 55 had acute thrombotic lesions, and 46 (84%) of 55 had percutaneous coronary intervention with 2.7 ± 2.0 stents deployed per patient. The mean SYNTAX score was 29.4 ± 13.9. Twenty-six (42%) of 62 patients were discharged alive with Cerebral Performance Category 1 or 2 versus 26 (15.3%) of 170 in the historical comparison group (odds ratio: 4.0; 95% confidence interval: 2.08 to 7.7; p < 0.0001).
ConclusionsComplex but treatable CAD was prevalent in patients with refractory OH VF/VT cardiac arrest who also met criteria for continuing resuscitation in the CCL. A systems approach using ECLS and reperfusion seemed to improve functionally favorable survival.
http://ift.tt/2fZXtre
Computer-Interpreted Electrocardiograms: Benefits and Limitations
Abstract
Computerized interpretation of the electrocardiogram (CIE) was introduced to improve the correct interpretation of the electrocardiogram (ECG), facilitating health care decision making and reducing costs. Worldwide, millions of ECGs are recorded annually, with the majority automatically analyzed, followed by an immediate interpretation. Limitations in the diagnostic accuracy of CIE were soon recognized and still persist, despite ongoing improvement in ECG algorithms. Unfortunately, inexperienced physicians ordering the ECG may fail to recognize interpretation mistakes and accept the automated diagnosis without criticism. Clinical mismanagement may result, with the risk of exposing patients to useless investigations or potentially dangerous treatment. Consequently, CIE over-reading and confirmation by an experienced ECG reader are essential and are repeatedly recommended in published reports. Implementation of new ECG knowledge is also important. The current status of automated ECG interpretation is reviewed, with suggestions for improvement.
http://ift.tt/2ikTZ3u
Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings
AbstractBackground
Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair.
ObjectivesThis study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve [ViV]) and annuloplasty rings (valve-in-ring [ViR]).
MethodsFrom the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria.
ResultsA total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 ± 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 ± 17.4% vs. 55.3 ± 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p = 0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p = 0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve gradients were similar between groups (6.4 ± 2.3 mm Hg vs. 5.8 ± 2.7 mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003). Furthermore, the ViR group had more frequent life-threatening bleeding (8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03), and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The 1-year all-cause mortality rate was significantly higher in the ViR group compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On multivariable analysis, failed annuloplasty ring was independently associated with all-cause mortality (hazard ratio: 2.70; 95% confidence interval: 1.34 to 5.43; p = 0.005).
ConclusionsThe TMVR procedure provided acceptable outcomes in high-risk patients with degenerated bioprostheses or failed annuloplasty rings, but mitral ViR was associated with higher rates of procedural complications and mid-term mortality compared with mitral ViV.
http://ift.tt/2fZrRlG
Improving the Appropriate Use of Transthoracic Echocardiography: The Echo WISELY Trial
AbstractBackground
Appropriate use criteria (AUC) have defined transthoracic echocardiogram (TTE) indications for which there is a clear lack of benefit as rarely appropriate (rA).
ObjectivesThis study sought to investigate the impact of an AUC-based educational intervention on outpatient TTE ordering by cardiologists and primary care providers.
MethodsThe authors conducted a prospective, investigator-blinded, multicenter, randomized controlled trial of an AUC-based educational intervention aimed at reducing rA outpatient TTEs. The study was conducted at 8 hospitals across 2 countries. The authors randomized cardiologists and primary care providers to receive either intervention or control (no intervention). The primary outcome measure was the proportion of rA TTEs.
ResultsOne hundred and ninety-six physicians were randomized, and 179 were included in the analysis. From December 2014 to April 2016, the authors assessed 14,697 TTEs for appropriateness, of which 99% were classifiable using the 2011 AUC. The mean proportion of rA TTEs was significantly lower in the intervention versus the control group (8.8% vs. 10.1%; odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.57 to 0.99; p = 0.039). In physicians who ordered, on average, at least 1 TTE per month, there was a significantly lower proportion of rA TTEs in the intervention versus the control group (8.6% vs. 11.1%; OR: 0.76; 95% CI: 0.57 to 0.99; p = 0.047). There was no difference in the TTE ordering volume between the intervention and control groups (mean 77.7 ± 89.3 vs. 85.4 ± 111.4; p = 0.83).
ConclusionsAn educational intervention reduced the number of rA TTEs ordered by attending physicians in a variety of ambulatory care environments. This may prove to be an effective strategy to improve the use of imaging. (A Multi-Centered Feedback and Education Intervention Designed to Reduce Inappropriate Transthoracic Echocardiograms [Echo WISELY]; NCT02038101)
http://ift.tt/2fZXo6U
Cerebral Amyloid Angiopathy: Diagnosis, Clinical Implications, and Management Strategies in Atrial Fibrillation
Abstract
With an aging population, clinicians are more frequently encountering patients with atrial fibrillation who are also at risk of intracerebral hemorrhage due to cerebral amyloid angiopathy, the result of β-amyloid deposition in cerebral vessels. Cerebral amyloid angiopathy is common among elderly patients, and is associated with an increased risk of intracerebral bleeding, especially with the use of anticoagulation. Despite this association, this entity is absent in current risk–benefit analysis models, which may result in underestimation of the chance of bleeding in the subset of patients with this disease. Determining the presence and burden of cerebral amyloid angiopathy is particularly important when planning to start or restart anticoagulation after an intracerebral hemorrhage. Given the lack of randomized trial data to guide management strategies, we discuss a heart–brain team approach that includes clinician–patient shared decision making for the use of pharmacologic and nonpharmacologic approaches to diminish stroke risk.
http://ift.tt/2fYGTIt
Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence
AbstractBackground
Spontaneous coronary artery dissection (SCAD) is underdiagnosed and an important cause of myocardial infarction (MI), especially in young women. Long-term cardiovascular outcomes, including recurrent SCAD, are inadequately reported.
ObjectivesThis study sought to describe the acute and long-term cardiovascular outcomes and assess the predictors of recurrent SCAD.
MethodsNonatherosclerotic SCAD patients were prospectively followed at Vancouver General Hospital systematically to ascertain baseline, predisposing and precipitating stressors, angiographic features, revascularization, use of medication, and in-hospital and long-term cardiovascular events. Clinical predictors for recurrent de novo SCAD were tested using univariate and multivariate Cox regression models.
ResultsThe authors prospectively followed 327 SCAD patients. Average age was 52.5 ± 9.6 years, and 90.5% were women (56.9% postmenopausal). All presented with MI; 25.7% had ST-segment elevation MI, 74.3% had non–ST-segment elevation MI, and 8.9% had ventricular tachycardia/ventricular fibrillation. Precipitating emotional stressors were reported in 48.3% and physical stressors in 28.1%. Fibromuscular dysplasia was present in 62.7%, connective tissue disorder in 4.9%, and systemic inflammatory disease in 11.9%. The majority (83.1%) were initially treated medically, with only 16.5% or 2.2% undergoing in-hospital percutaneous coronary intervention or coronary artery bypass graft surgery, respectively. The majority of SCAD patients were taking aspirin and beta-blocker therapy at discharge and at follow-up. Median hospital stay was 3.0 days, and the overall major adverse event rate was 7.3%. Median long-term follow-up was 3.1 years, and overall major adverse cardiac event rate was 19.9% (death rate: 1.2%; recurrent MI: 16.8%; stroke/transient ischemic attack: 1.2%; revascularization: 5.8%). Recurrent SCAD occurred in 10.4% of patients. In multivariate modeling, only hypertension increased (hazard ratio: 2.46; p = 0.011) and beta-blocker use diminished (hazard ratio: 0.36; p = 0.004) recurrent SCAD.
ConclusionsIn our large prospectively followed SCAD cohort, long-term cardiovascular events were common. Hypertension increased the risk of recurrent SCAD, whereas beta-blocker therapy appeared to be protective.
http://ift.tt/2fZt38A
Efficacy of Rosuvastatin in Children With Homozygous Familial Hypercholesterolemia and Association With Underlying Genetic Mutations
AbstractBackground
Homozygous familial hypercholesterolemia (HoFH), a rare genetic disorder, is characterized by extremely elevated levels of low-density lipoprotein cholesterol (LDL-C) and accelerated atherosclerotic cardiovascular disease. Statin treatment starts at diagnosis, but no statin has been formally evaluated in, or approved for, HoFH children.
ObjectivesThe authors sought to assess the LDL-C efficacy of rosuvastatin versus placebo in HoFH children, and the relationship with underlying genetic mutations.
MethodsThis was a randomized, double-blind, 12-week, crossover study of rosuvastatin 20 mg versus placebo, followed by 12 weeks of open-label rosuvastatin. Patients discontinued all lipid-lowering treatment except ezetimibe and/or apheresis. Clinical and laboratory assessments were performed every 6 weeks. The relationship between LDL-C response and genetic mutations was assessed by adding children and adults from a prior HoFH rosuvastatin trial.
ResultsTwenty patients were screened, 14 randomized, and 13 completed the study. The mean age was 10.9 years; 8 patients were on ezetimibe and 7 on apheresis. Mean LDL-C was 481 mg/dl (range: 229 to 742 mg/dl) on placebo and 396 mg/dl (range: 130 to 700 mg/dl) on rosuvastatin, producing a mean 85.4 mg/dl (22.3%) difference (p = 0.005). Efficacy was similar regardless of age or use of ezetimibe or apheresis, and was maintained for 12 weeks. Adverse events were few and not serious. Patients with 2 defective versus 2 negative LDL receptor mutations had mean LDL-C reductions of 23.5% (p = 0.0044) and 14% (p = 0.038), respectively.
ConclusionsThis first-ever pediatric HoFH statin trial demonstrated safe and effective LDL-C reduction with rosuvastatin 20 mg alone or added to ezetimibe and/or apheresis. The LDL-C response in children and adults was related to underlying genetic mutations. (A Study to Evaluate the Efficacy and Safety of Rosuvastatin in Children and Adolescents With Homozygous Familial Hypercholesterolemia [HYDRA]; NCT02226198)
http://ift.tt/2fZXknG
Peri-hand space representation in the absence of a hand - evidence from congenital one-handers
Source:Cortex
Author(s): Roni O. Maimon-Mor, Heidi Johansen-Berg, Tamar R. Makin
http://ift.tt/2vTeKYU
tDCS modulation of naming in healthy participants: Negative results and still no explanation – a response to a commentary by Gauvin et al. (2017)
Source:Cortex
Author(s): Samuel.J. Westwood, Andrew Olson, R.Chris. Miall, Cristina Romani
http://ift.tt/2vTBmIF
Structural Encoding Processes Contribute to Individual Differences in Face and Object Cognition: Inferences from Psychometric Test Performance and Event-Related Brain Potentials
Source:Cortex
Author(s): Hadiseh Nowparast Rostami, Werner Sommer, Changsong Zhou, Oliver Wilhelm, Andrea Hildebrandt
The enhanced N1 component in event-related potentials (ERP) to face stimuli, termed N170, is considered to indicate the structural encoding of faces. Previously, individual differences in the latency of the N170 have been related to face and object cognition abilities. By orthogonally manipulating content domain (faces vs. objects) and task demands (easy/speed vs. difficult/accuracy) in both psychometric and EEG tasks, we investigated the uniqueness of the processes underlying face cognition as compared with object cognition and the extent to which the N1/N170 component can explain individual differences in face and object cognition abilities. Data were recorded from N=198 healthy young adults. Structural equation modeling confirmed that the accuracies of face perception and memory are specific abilities above general object cognition; in contrast, the speed of face processing was not differentiable from the speed of object cognition. Although there was considerable domain-general variance in the N170 shared with the N1, there was significant face-specific variance in the N170. The brain-behavior relationship showed that faster face-specific processes for structural encoding of faces are associated with higher accuracy in both perceiving and memorizing faces. Moreover, in difficult task conditions, qualitatively different processes are additionally needed for recognizing face and object stimuli as compared with easy tasks. The difficulty-dependent variance components in the N170 amplitude were related with both face and object memory performance. We discuss implications for understanding individual differences in face cognition.
http://ift.tt/2vTBkR3
Specific Contributions of Basal Ganglia and Cerebellum To The Neural Tracking of Rhythm
Source:Cortex
Author(s): Sylvie Nozaradan, Michael Schwartze, Christian Obermeier, Sonja A. Kotz
How specific brain networks track rhythmic sensory input over time remains a challenge in neuroimaging work. Here we show that subcortical areas, namely the basal ganglia and the cerebellum, specifically contribute to the neural tracking of rhythm. We tested patients with focal lesions in either of these areas and healthy controls by means of electroencephalography (EEG) while they listened to rhythmic sequences known to induce selective neural tracking at a frequency corresponding to the most-often perceived pulse-like beat. Both patients and controls displayed neural responses to the rhythmic sequences. However, these response patterns were different across groups, with patients showing reduced tracking at beat frequency, especially for the more challenging rhythms. In the cerebellar patients, this effect was specific to the rhythm played at a fast tempo, which places high demands on the temporally precise encoding of events. In contrast, basal ganglia patients showed more heterogeneous responses at beat frequency specifically for the most complex rhythm, which requires more internal generation of the beat. These findings provide electrophysiological evidence that these subcortical structures selectively shape the neural representation of rhythm. Moreover, they suggest that the processing of rhythmic auditory input relies on an extended cortico-subcortico-cortical functional network providing specific timing and entrainment sensitivities.
http://ift.tt/2x7aPGb
A Study of CDX-3379 and Cetuximab and in Patients With Advanced Head and Neck Squamous Cell Carcinoma
Condition: Advanced Head and Neck Squamous Cell Carcinoma
Intervention: Drug: CDX-3379 and cetuximab
Sponsor: Celldex Therapeutics
Not yet recruiting - verified August 2017
http://ift.tt/2whgxaR
Intervention: Drug: CDX-3379 and cetuximab
Sponsor: Celldex Therapeutics
Not yet recruiting - verified August 2017
http://ift.tt/2whgxaR
Voice Guard Processing Evaluation in a Cohort of Subjects Implanted With the Neuro Cochlear Implant System
Condition: Cochlear Implantation
Interventions: Device: XDP sound processing strategy; Device: Voice Guard sound processing strategy; Device: Voice Track
Sponsor: Oticon Medical
Not yet recruiting - verified August 2017
http://ift.tt/2vXBDZk
Interventions: Device: XDP sound processing strategy; Device: Voice Guard sound processing strategy; Device: Voice Track
Sponsor: Oticon Medical
Not yet recruiting - verified August 2017
http://ift.tt/2vXBDZk
Monocenter, Open Label Clinical Investigation on the Treatment of Radiation Induced Dermatitis With Xonrid®
Condition: Radiodermatitis, Quality of Life
Intervention: Device: Xonrid® gel
Sponsor: Helsinn Healthcare SA
Recruiting - verified August 2017
http://ift.tt/2whmJjq
Intervention: Device: Xonrid® gel
Sponsor: Helsinn Healthcare SA
Recruiting - verified August 2017
http://ift.tt/2whmJjq
Cyclin D1 Based TPF Induction Chemotherapy for Oral Squamous Cell Carcinoma Patients at Clinical N2 Stage
Conditions: Mouth Neoplasms; Carcinoma, Squamous Cell
Interventions: Drug: TPF group; Procedure: surgery group; Radiation: Post-operative radiotherapy
Sponsor: Shanghai Jiao Tong University School of Medicine
Recruiting - verified November 2015
http://ift.tt/2x6gr3z
Interventions: Drug: TPF group; Procedure: surgery group; Radiation: Post-operative radiotherapy
Sponsor: Shanghai Jiao Tong University School of Medicine
Recruiting - verified November 2015
http://ift.tt/2x6gr3z
GDF15 Based TPF Induction Chemotherapy for OSCC Patients
Conditions: Mouth Neoplasms; Carcinoma, Squamous Cell
Interventions: Drug: TPF induction chemotherapy; Procedure: surgery group; Radiation: Post-operative radiotherapy
Sponsor: Shanghai Jiao Tong University School of Medicine
Recruiting - verified November 2015
http://ift.tt/2vSSbn1
Interventions: Drug: TPF induction chemotherapy; Procedure: surgery group; Radiation: Post-operative radiotherapy
Sponsor: Shanghai Jiao Tong University School of Medicine
Recruiting - verified November 2015
http://ift.tt/2vSSbn1
Impact of postoperative radiotherapy and HER2/new overexpression in salivary duct carcinoma
Abstract
Aim
Retrospective Investigation of the prognostic relevance of clinicopathologic parameters in patients with salivary duct carcinoma (SDC).
Methods
An experienced pathologist reviewed 67 patients with de novo SDC or SDC ex pleomorphic adenoma. Paraffin-embedded tumor samples were examined by immunohistochemistry for expression of HER2/neu, androgen (AR), progesterone (PR), estrogen (ER), epidermal growth factor (EGFR) and programmed death ligand 1 (PD-L1-R) receptor. In 45 patients who had cM0 and follow-up data available, survival rates were calculated (Kaplan–Meier method) and prognostic variables were analyzed (univariate analysis: log-rank test; multivariate analysis: Cox-regression analysis).
Results
Overexpression of HER2/neu, AR, ER, PR, EGFR, PD-L1-R was found in 25.4%, 84%, 0%, 0%, 17.9%, 16.4% of patients. Overall (OS), disease-free (DFS), distant-metastases-free survival (DMFS) and locoregional control (LRC) were 92.3/72.4/56.9%, 78.2/58.1/58.1%, 85.4/65.2/65.2% and 89.7/81.9/81.9% after 1/3/5 years (medial follow-up 26 months). In univariate analysis a positive resection margin (p = 0.008) and no postoperative radiotherapy (p = 0.001) predict an increased locoregional recurrence rate. In multivariate analysis only postoperative radiotherapy is statistically significant (p = 0.004). Presence of lymph node metastases, a lymph node density >4 and HER2/neu overexpression predict decreased DFS and DMFS. In multivariate HER2/neu overexpression was the only significant predictor for reduced DFS (p = 0.04) and DMFS (p = 0.02).
Conclusion
Postoperative radiotherapy is the only significant predictor for LRC. HER2/neu receptor expression is an independent prognostic factor for decreased DFS and DMFS in patients with SDC. In addition to radio(chemo)therapy, intensified first-line treatment regimens should also be evaluated in the future.
http://ift.tt/2vSoxyf
Effects of Cd(II) on the stability of humic acid-coated nano-TiO 2 particles in aquatic environments
Abstract
The stability of nanoparticles (NPs) in aquatic environments is important to evaluate their adverse effects on aquatic ecosystems and human health. Nanoparticle stability is known to be influenced by coexisting ions and dissolved organic matter. This study was designed to investigate the effects of coexisting low-level Cd(II) on the stability of humic acid-coated nano-TiO2 (HA-TiO2) particles in aquatic environments by measuring their aggregation kinetics through time-resolved dynamic light scattering (DLS) and monitoring suspended HA-TiO2 concentrations via optical absorbance changes over time. The particles exhibited aggregation behavior consistent with the classic Derjaguin–Landau–Verwey–Overbeek (DLVO) theory. The results showed that Cd(II) concentration, pH, and ionic strength had various effects on the aggregation kinetics of the HA-TiO2 NPs. The HA-TiO2 particles aggregated faster as the Cd(II) concentration increased whereas the stability of the nanoparticles increased as the solution pH increased or ionic strength decreased regardless of the Cd(II) concentration. At the fixed pH and ionic strength conditions, the addition of Cd(II) promoted aggregation of nanoparticles, leading to higher attachment efficiencies. The enhanced aggregation of the HA-TiO2 NPs in the presence of coexisting cadmium ions in aqueous solutions indicated that the fate and transport of nanoparticles could be greatly affected by heavy metals in aquatic environments.
http://ift.tt/2uZ4Zcw
Protease production by the keratinolytic Bacillus sp. CL18 through feather bioprocessing
Abstract
Bacillus sp. CL18 was investigated to propose a bioprocess for protease production using feathers as organic substrate. In feather broth (FB), containing feathers as sole organic substrate (1–100 g l−1), maximal protease production was observed at 30 g l−1 (FB30) after 6 days of cultivation, whereas increased feather concentrations negatively affected protease production and feather degradation. Protease production peaks were always observed earlier during cultivations than maximal feather degradation. In FB30, 80% of initial feathers mass were degraded after 7 days. Addition of glucose, sucrose, starch, yeast extract (2 g l−1), CaCl2, or MgCl2 (10 mmol l−1) to FB30 decreased protease production and feather degradation. FB30 supplementation with NH4Cl (1 g l−1) resulted in less apparent negative effects on protease production, whereas peptone (2 g l−1) increased protease yields earlier during cultivations (3 days). Through a central composite design employed to investigate the effects of peptone and NH4Cl (0.5–4.5 g l−1) on protease production and feather degradation, FB30 supplementation with peptone and NH4Cl (0.5–1.1 g l−1) increased protease production within a shorter cultivation time (5 days) and hastened complete feather degradation (6 days). Feather bioconversion concurs with sustainable production of value-added products.
http://ift.tt/2viypxK
Total and settling velocity-fractionated pollution potential of sewer sediments in Jiaxing, China
Abstract
Sewer sediments and their associated contaminant released along with wet-weather discharges pose potential pollution risks to environment. This paper presents total characteristics of sediments collected from Jiaxing, China. Size distribution and concentrations of volatile solids (VS) and four metals (Pb, Cu, Zn, Cr) of sediment samples from seven land use categories were analyzed. Then, the sediment samples were graded five fractions according to its settling velocity through the custom-built settling velocity-grading device. Sediment mass and pollution load distribution based on settling velocity were also assessed. The results show that there are relatively high level of heavy metal load in the sediment of separated storm drainage systems in Jiaxing, especially for the catchment of residential area (RA), road of developed area (RDA), and industrial area (IA). Although grain size follows a trend of increasing along with settling velocity, the methods of settling velocity grading are meaningful for stormwater treatment facilities with precipitation. For all land use categories, the pollution concentrations of the three lower settling velocity-fractionated sediment are relatively consistent and higher than others. Combined with mass distribution, the pollution percentage of fraction with different velocities for seven land use categories were also evaluated. Based on it, the statistical conclusion of design target settling velocity to different pollution load removal rates are drawn, which is helpful to guide design of on-site precipitation separation facilities.
http://ift.tt/2uYZBpN
Le devoir d’information du Médecin (CAA de Nantes ; 2 juin 2016)
Source:Médecine & Droit
Author(s): Gérard Memeteau
Une patiente n'est pas informée de l'identité du chirurgien qui doit l'opérer. L'Oniam qui prétend que ce manque d'information est constitutif d'une perte de chance d'échapper à l'intervention est débouté de sa prétention : « aucun lien de causalité ne peut être établi entre le défaut d'information relevé et la perte de chance invoquée ».Every physician has a duty of information. He must tell the patient the risk as and benefices of the treatments. Some authors write actually that it is a legal duty and not only a contractual one. But, there is not only the physician; there is also the private or public hospital. That institution ought to present to the patient a competent professional and to inform the public herself about the specialties offered. The judgement tries to precise the parts of those informations.
http://ift.tt/2xksgT8
La Médecine Antique, V. Nutton. Les Belles Lettres, Paris (2016)
Source:Médecine & Droit
Author(s): Philippe Biclet
http://ift.tt/2wqIvBO
Le concept du système universel d’enregistrement du sexe/genre
Source:Médecine & Droit
Author(s): George G. Tumanishvili
Dans le monde contemporain, l'idée d'égalité justifie un soutien mental, socioculturel et législatif. Chacune de ces composantes est un maillon important d'une chaîne que nous appelons aujourd'hui l'égalité. L'égalité entre les sexes et la non-discrimination sous quelle forme que ce soit, à première vue, représente la base convenue par la plupart des pays, mais les idées d'égalité manquent souvent d'un soutien normatif, même au niveau législatif. Dans cet article, l'auteur présente un Système Universel d'enregistrement du Sexe/Genre. En appliquant ce système, il deviendra possible d'assurer la norme initiale d'égalité en matière de sexe et de genre, qui a été négligée par la majorité qualifiée des pays jusqu'à ce jour.In the modern world, the idea of equality needs a mental, social-cultural and legislative support. Each of these components is an important link of a chain that we call equality today. Equality between genders and non-discrimination in any form, at first glance, represents the basis that has been agreed by most countries so far, however, the ideas of equality often lack normative support even at the legislative level too. In this article is presented a Universal System of Sex/Gender Registration created by the author. By the implementing/applying this system, the modern world will be able to ensure the standard of initial equality regarding sex and gender, which has been neglected by the qualified majority of countries to date.
http://ift.tt/2ijh9ac
A Case of Methemoglobinemia Successfully Treated with Hyperbaric Oxygenation Monotherapy
Source:The Journal of Emergency Medicine
Author(s): Youngmo Cho, Sung Wook Park, Sang-Kyoon Han, Hyung bin Kim, Seok Ran Yeom
BackgroundMethylene blue is the first-line therapy for methemoglobinemia, but it can be intermittently unavailable due to production issues. For this clinical scenario, alternative treatment options need to be explored. Hyperbaric oxygenation (HBO) is conventionally applied as an adjunctive therapy during the systemic administration of methylene blue. Currently, little is known regarding the effects of HBO monotherapy in methemoglobinemia. We report a case of methemoglobinemia that was successfully treated with HBO monotherapy.Case ReportA 41-year-old man presented to the Emergency Department with dyspnea and dizziness subsequent to smoking in a garage filled with motor vehicle exhaust gas. There were no abnormal heart or lung sounds. While administering oxygen flowing at 15 L/min via a mask with a reservoir bag, blood tests revealed high methemoglobin (MetHb) levels at 59.6%. He was treated with HBO monotherapy, and sequential tests showed that the MetHb level decreased significantly to 34.0%, 12.8%, 6.2%, and eventually, 3.5%. He was discharged with stable vital signs the next day.Why Should an Emergency Physician Be Aware of This?HBO monotherapy is an effective alternative treatment for methemoglobinemia when methylene blue is not available.
http://ift.tt/2wwT3i3
Assessment of time to glucose peak during an oral glucose tolerance test
Abstract
We read with interest the article from Chung et al. on the association between time to glucose peak and prediabetes.1 We agree with the authors in that the morphology of the glucose curve is worth investigating as an additional indicator of prediabetes and diabetes risk. This is a rather well studied topic in the literature, and most authors agree that adding an intermediate glucose measurement (at 30 or 60 minutes) improves the ability to identify subgroups with forms of dysglycaemia not picked up by the traditional guidelines based on fasting and 2-hour values.
This article is protected by copyright. All rights reserved.
http://ift.tt/2iiQQky
Comparison of heavy metal levels of farmed and escaped farmed rainbow trout and health risk assessment associated with their consumption
Abstract
In this study, levels of ten metals (arsenic, cadmium, cobalt, chromium, copper, iron, manganese, nickel, lead, and zinc) in muscles of farmed and escaped farmed rainbow trout (Oncorhynchus mykiss) in the Keban Dam Reservoir (Turkey) were determined. Also, human health risks associated with their consumption were assessed. Of ten metals, only Co and Fe levels in escaped rainbow trout were significantly higher than those in farmed rainbow trout. The metal levels in farmed and escaped rainbow trout were below the maximum permissible limits. The estimated daily intake (EDI) of each metal in both farmed and escaped farmed rainbow trout was much lower than the respective tolerable daily intake (TDI). The target hazard quotient (THQ) values for individual metal and the total THQ values for combined metals were lower than 1 in both farmed and escaped rainbow trout, indicating no health risk for humans. The cancer risk (CR) values estimated for inorganic As in both farmed and escaped rainbow trout indicated low carcinogenic risk to the consumers. According to the maximum allowable monthly consumption limits (CRmm), adults may safely consume 24 meals of farmed rainbow trout per month or 39 meals of escaped rainbow trout per month, with minimal adverse carcinogenic and non-carcinogenic health effects. This study revealed that the risk from consuming farmed and escaped farmed rainbow trout in the Keban Dam Reservoir due to these trace elements is minimal.
http://ift.tt/2wqRouV
Episiotomy scar endometriosis
Publication date: Available online 20 August 2017
Source:Medical Journal Armed Forces India
Author(s): Vatsla Dadhwal, Aparna Sharma, Kavita Khoiwal, Tripti Nakra
http://ift.tt/2vhWpRo
Blood–tumor barrier opening changes in brain metastases from pre to one-month post radiation therapy
Source:Radiotherapy and Oncology
Author(s): Feifei Teng, Christina I. Tsien, Theodore S. Lawrence, Yue Cao
PurposeBlood–tumor barrier is a limiting factor for effectiveness of systemic therapy to brain metastases. This study aimed to assess the extent and time course of BTB opening in BM following whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) to determine optimal timing for systemic therapy.Materials and method30 patients received WBRT or SRS and a total of 64 metastatic lesions were analyzed. Dynamic contrast-enhanced MRI were acquired, to quantify a transfer constant (Ktrans), pre-RT, 1–2weeks after starting RT (Wk1-2), and 1-month post-RT (1M post-RT). Lesions were categorized as either low or high permeability based upon the pre-RT percentage volume of a lesion with Ktrans>0.005min−1 (%Vall) less or greater than 50%. Time-course changes of %Vall after RT were analyzed.ResultsFifty-seven lesions had high-permeability and seven had low-permeability at baseline. Intra-patient and inter-lesion heterogeneity was observed in six patients who had both low- (n=7) and high-permeability lesions (n=10). Also, lesion permeability showed a significant size-effect at baseline. For high-permeability lesions, either received WBRT (n=43) or SRS (n=14), %Vall decreased non-significantly following RT (from 85.4% pre-RT to 76.9% 1M post-RT). For low-permeability lesions (n=7, all received WBRT), %Vall increased from 5.6% pre-RT to 30.2% at Wk1-2 and to 52.6% 1M−post (p=0.01).ConclusionOur preliminary results suggest that 2–4weeks after RT, when BTB opening is high for both low- and high-permeability brain metastatic lesions, could be optimal time to start systemic therapy.
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Percutaneous management of complex acquired aortic coarctation in an adult with tetralogy of Fallot and pulmonary atresia
Annals of Pediatric Cardiology 2017 10(3):295-297
We present the case of a female adult with complex cyanotic congenital heart disease who had long-standing thoracic aortic obstruction due to scarring from earlier surgical procedures. She was symptomatic but felt to be too high risk for surgical intervention. With careful planning, she was able to undergo successful stenting of her aorta with subsequent clinical improvement. This case highlights some of the complexities of caring for adults with congenital heart disease and the importance of a thorough understanding of their anatomy and physiology and prior interventions before undertaking interventions.
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Change of guard: Introducing the new editor of the Annals of Pediatric Cardiology, Dr. KS Iyer
Annals of Pediatric Cardiology 2017 10(3):223-223
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Quantification of ventricular unloading by 3D echocardiography in single ventricle of left ventricular morphology following superior cavo-pulmonary anastomosis and Fontan completion – a feasibility study
Annals of Pediatric Cardiology 2017 10(3):224-229
Background: Three-dimensional echocardiography. (3DE) is comparable to cardiac magnetic resonance imaging for estimating ventricular volume in congenital heart diseases. However, there are limited data on estimation of ventricular volumes by 3DE in univentricular heart and change in ventricular volumes after surgical creation of cavopulmonary connection. We sought to quantify the unloading of the single ventricle of left ventricular. (LV) morphology by 3DE after superior cavopulmonary anastomosis. (SCPA) or Fontan operation over a period of 3 months and thereby derive a preliminary 3DE data set on this patient subset. Patients and Methods: Eighteen patients with functional single ventricle of LV morphology, who underwent SCPA or completion of Fontan circulation, were included in the study. Volume of the ventricle was estimated by 3DE before surgery and after surgery. (in the early postoperative phase and 3 months after surgery), and indexed end-diastolic volume. (EDV), end.systolic volume. (ESV), and ejection fraction. (EF) were derived. Results: Twelve patients underwent SCPA and six patients underwent staged completion of Fontan circulation. Before surgery, EDV was similar in both groups. There was a significant fall in EDV immediately after SCPA (from 48.3 ± 14.9 ml/m2 to 39.5 ± 12.3 ml/m2). However, EDV increased at 3 months' follow-up to 41.3 ± 10.5 ml/m2. There was no significant fall in EDV immediately after Fontan operation (47.2 ± 10.1 ml/m2−46.6 ± 14.2 ml/m2), but EDV continued to fall at 3 months of follow-up (44.7 ± 10. ml/m2). There was no significant change in ESV in either group, but EF fell significantly after SCPA. Conclusions: We provide preliminary information on 3DE volume data of single ventricle of LV morphology and the pattern of unloading after SCPA and Fontan operation. Immediate significant volume unloading occurred after SCPA which tended to catch-up after 3 months, whereas continued fall in ventricular volume with time was noted after Fontan.
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Hypoplastic left heart syndrome with coronary-cameral fistulas: Echocardiographic demonstration of coronary artery steal and successful interventional treatment
Annals of Pediatric Cardiology 2017 10(3):306-309
We report a case of a patient with hypoplastic left heart syndrome with significant coronary-cameral fistulas and exertional symptoms from coronary steal. Symptoms resolved following successful coil occlusion of his left ventricle.
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Speckle tracking evaluation of right ventricular functions in children with sickle cell disease
Annals of Pediatric Cardiology 2017 10(3):230-233
Background: Cardiac dysfunction is a risk factor for death in patients with sickle cell disease (SCD). Aim of the Work: Aim of the work is to evaluate the right ventricular systolic and diastolic functions by tissue Doppler and speckling tracking imaging in children with SCD. Subjects and Methods: Thirty children with SCD and thirty controls were subjected to clinical, laboratory evaluations, and echocardiographic study using GE Vivid 7 (GE Medical System, Horten, Norway with a 3.5-MHz multifrequency transducer) including; Two-dimensional and tissue Doppler echocardiographic study (lateral tricuspid valve annulus peak E' velocity, lateral tricuspid valve annulus peak A' velocity, E'/A' ratio, isovolumetric relaxation time, lateral tricuspid valve annulus S' and septal S' waves and peak longitudinal systolic strain [PLSS] and time to PLSS) were done in six right ventricular segments. Results: There was a significant decrease in right ventricular systolic and diastolic function in patients group when compared to controls. Conclusions: Children with SCD have impaired right ventricular systolic and diastolic functions when compared to healthy children with early evaluation of the systolic dysfunction by speckle tracking imaging technique.
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Flecainide toxicity in a preterm neonate with permanent junctional reciprocating tachycardia
Annals of Pediatric Cardiology 2017 10(3):288-292
We report a case of flecainide toxicity in a premature neonate with permanent junctional reciprocating tachycardia which was managed successfully by reversal of the sodium blockade with intravenous sodium bicarbonate and supportive care. This report highlights the importance of strict supervision and monitoring while administering antiarrhythmic drugs in neonates and prompt institution of appropriate remedial action for treatment when toxicity is suspected.
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Intraocular pressure in children after congenital heart surgery: A single-center study
Annals of Pediatric Cardiology 2017 10(3):234-239
Background: The impact of varied cardiac physiologies on intraocular pressure (IOP) among children undergoing heart operations is unknown. Aim: The aim of this study was to determine the IOP among children with varying cardiovascular physiologies and varying hemodynamics after their heart operation. Setting and Design: This was a prospective, observational study. Materials and Methods: Patients ≤18 years undergoing congenital heart surgery were included in this study. IOP measurement was performed by Icare® tonometer between 3 and 14 days after heart operation. Statistical Analysis: Summary statistics were estimated for all demographic, anthropometric, and clinical data. Results: A total of 116 eyes from 58 children were included. The mean and standard deviation age was 28.4 (45.8) months. Single-ventricle anatomy was present in 26 patients (45%). Despite similar heart rate and blood pressure, the mean IOP among the patients with single-ventricle anatomy was significantly elevated as compared to patients with two-ventricle anatomy (18 mm Hg vs. 12 mm Hg, P < 0.001). There was no difference in IOP measurements based on the complexity of operation performed. We noted that patients undergoing surgical palliation with central shunt (21 mm Hg), Fontan operation (19 mm Hg), bidirectional Glenn operation (19 mm Hg), Norwood operation (19 mm Hg), or definitive repairs such as tetralogy of Fallot repair (17 mm Hg), and atrioventricular canal repair (19 mm Hg) were associated with the highest IOPs in the study cohort. Conclusions: This study demonstrates that IOPs vary with varying cardiovascular physiology after pediatric cardiac surgery.
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Anomalous origin of the left brachiocephalic artery in the right aortic arch: Is there a method to the madness?
Annals of Pediatric Cardiology 2017 10(3):301-303
The anomalous origin of the left brachiocephalic artery in a right sided aortic arch is a rare vascular ring which might lead to esophageal compression. The exact embryological origin of this anomaly is still widely debated. We present an infant who presented with esophageal compression symptoms and review the various hypotheses about the embryological origin of this anomaly.
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Initial experience with the 3.3 Fr Mongoose® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients
Annals of Pediatric Cardiology 2017 10(3):240-244
Background: Smaller femoral arterial sheaths may be associated with fewer vascular complications. The 3.3 Fr Mongoose® Pediavascular pigtail catheter is a catheter that allows higher flow rates, potentially resulting in improved angiographic quality. We reviewed our experience with this small catheter during patent ductus arteriosus (PDA) closure. Materials and Methods: Review of patients ≤20 kg in whom the Mongoose® catheter was used during PDA closure from 12/13 to 4/15. Angiographic efficacy and procedural details were compared to ten 4 Fr catheter cases. Comparisons were performed using Mann–Whitney U-test; P < 0.05 was statistically significant. Results: Twelve (9 female) patients were catheterized with a 3.3 Fr Mongoose®. Median weight 10.5 kg (range 6.4–18.2), height 81 cm (range 37–111), and body surface area (BSA) 0.47 m2 (range 0.33–0.75) were similar to ten patients (3 females) in the 4 Fr control group (P = NS); median weight 9.9 kg (range 6–16.8), height 80 cm (range 64–102), and BSA 0.46 m2 (range 0.31–0.74). Angiographic quality was subjectively adequate with both with no difference in the median pixel density between the two techniques (3.3 Fr: 76.7 [range 33.5–90] and 4 Fr: [70; 38–102]; P = NS). Contrast used was similar between the groups (3.3 Fr: median 4.2 ml/kg and 4 Fr: 4.9 ml/kg; P = NS). Median radiation dose was similar in the two groups (3.3 Fr: 28.1 mGy [range 17.2–38] and 4 Fr: 38 mGy [range 20.4–58.5]; P = NS). All ducts were closed at latest follow-up ( P = NS). No complications were encountered. Conclusions: The 3.3 Fr Mongoose® allowed similar angiography to the 4 Fr pigtail catheter, allowing safe and effective transcatheter PDA closure in small children.
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Staphylococcal endocarditis after chicken pox in a child with structurally normal heart
Annals of Pediatric Cardiology 2017 10(3):312-313
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Does heart-type fatty acid-binding protein predict clinical outcomes after pediatric cardiac surgery?
Annals of Pediatric Cardiology 2017 10(3):245-247
Introduction: The early identification of vulnerable pediatric cardiac surgery patients can help clinicians provide them with timely support. Heart-type fatty acid-binding protein. (H-FABP) is an early biomarker of myocardial injury in acute myocardial infarction in adults. In this study, we evaluated the correlations between postoperative H-FABP, creatine kinase-myocardial band (CK-MB), troponin-I, total bypass time, and clinical outcomes. Methods: In 32 pediatric patients that underwent ventricular septal defect. closure we measured H-FABP, troponin-I and CK-MB preoperatively and 1, 3, and 6 h after aortic declamping. Spearman's Rho correlations were calculated between laboratory and clinical parameters including inotropic support duration, aortic cross-clamp time, total bypass time, ventilation.weaning.time, and total Intensive Care Unit stay. Results: H-FABP, CK-MB, troponin-I, and total bypass time have a similarly weak to moderate correlation with clinical outcome measures. Conclusions: The predictive value of H-FABP for clinical outcome is not stronger than that of CK-MB, Troponin-I, or bypass times.
http://ift.tt/2vWCl9l
Chronic antepartum maternal hyperoxygenation in a case of severe fetal Ebstein's anomaly with circular shunt physiology
Annals of Pediatric Cardiology 2017 10(3):284-287
Perinatal mortality remains high among fetuses diagnosed with Ebstein's anomaly of the tricuspid valve. The subgroup of patients with pulmonary valve regurgitation is at particularly high risk. In the setting of pulmonary valve regurgitation, early constriction of the ductus arteriosus may be a novel perinatal management strategy to reduce systemic steal resulting from circular shunt physiology. We report the use of chronic antepartum maternal oxygen therapy for constriction of the fetal ductus arteriosus and modulation of fetal pulmonary vascular resistance in a late presentation of Ebstein's anomaly with severe tricuspid valve regurgitation, reversal of flow in the ductus arteriosus, and continuous pulmonary valve regurgitation.
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Brugada syndrome in children - Stepping into unchartered territory
Annals of Pediatric Cardiology 2017 10(3):248-258
Brugada syndrome (BrS) is an autosomal dominant inherited channelopathy. It is associated with a typical pattern of ST-segment elevation in the precordial leads V1–V3 and potentially lethal ventricular arrhythmias in otherwise healthy patients. It is frequently seen in young Asian males, in whom it has previously been described as sudden unexplained nocturnal death syndrome. Although it typically presents in young adults, it is also known to present in children and infants, especially in the presence of fever. Our understanding of the genetic pathogenesis and management of BrS has grown substantially considering that it has only been 24 years since its first description as a unique clinical entity. However, there remains much to be learned, especially in the pediatric population. This review aims to discuss the epidemiology, genetics, and pathogenesis of BrS. We will also discuss established standards and new innovations in the diagnosis, prognostication, risk stratification, and management of BrS. Literature search was run on the National Center for Biotechnology Information's website, using the Medical Subject Headings (MeSH) database with the search term "Brugada Syndrome" (MeSH), and was run on the PubMed database using the age filter (birth–18 years), yielding 334 results. The abstracts of all these articles were studied, and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles were further explored and read in full.
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Congenital left atrial appendage aneurysm: Atypical presentation
Annals of Pediatric Cardiology 2017 10(3):293-294
Congenital left atrial appendage aneurysm is a rare condition caused by dysplasia of the atrial muscles. We report a case of a 14-year-old boy, with a 5-month history of cough and in sinus rhythm. Transthoracic echocardiography and computerized tomographic angiography confirmed the aneurysm of the left atrial appendage which was resected through median sternotomy on cardiopulmonary bypass. This case is presented not only for its rarity but also for its atypical clinical presentation.
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Human herpesvirus 6-induced inflammatory cardiomyopathy in immunocompetent children
Annals of Pediatric Cardiology 2017 10(3):259-268
Over the last decade, human herpesvirus 6 (HHV-6) has been implicated in the etiology of pediatric myocarditis and subsequent dilated cardiomyopathy (DCM). This review provides an overview of recent literature investigating the pathophysiological relevance of HHV-6 in inflammatory cardiomyopathy. We examined 11 cases of previously published pediatric myocarditis and/or DCM associated with HHV-6 and also our experience of detection of virus particles in vascular endothelium of HHV-6 positive endomyocardial biopsy tissue by electron microscopy. The exact role of the presence of HHV-6 and its load remains controversial as the virus is also found in the heart of healthy controls. Therefore, the question remains open whether and how cardiac HHV-6 may be of pathogenetic importance. Quantitative polymerase chain reaction or mRNA testing allows differentiation between low-level latent virus found in asymptomatic myocardium and active HHV-6 infection. Although only a small number of pediatric cases have been reported in literature, HHV-6 should be considered as a causative agent of inflammatory cardiomyopathy, especially in children under three who might be experiencing a primary infection. Future studies are needed to establish a threshold for determining active infection in biopsy samples and the role of coinfections other cardiotropic viruses.
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Consideration of pyloric stenosis as a cause of feeding dysfunction in children with cyanotic heart disease
Annals of Pediatric Cardiology 2017 10(3):298-300
Feeding difficulty has been reported at a higher incidence in infants with cyanotic heart disease and single ventricle physiology necessitating specialized feeding strategies. However, structural causes of feed intolerance in this subset of patients should not be ignored. This case series highlights three recent cases of pyloric stenosis in infants with left-sided obstructive lesions at our institution. In all three cases, the initial presumed diagnosis was feeding intolerance related to heart disease, and there was significant clinical improvement following identification and correction of pyloric stenosis.
http://ift.tt/2vWPXl1
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