Publication date: Available online 1 December 2017
Source:Journal of Surgical Education
Author(s): Brenessa Lindeman, Emil Petrusa, Sophia McKinley, Daniel A. Hashimoto, Denise Gee, Douglas S. Smink, John T. Mullen, Roy Phitayakorn
ObjectivesBurnout is common among surgical residents and may be related to personality characteristics, emotional intelligence (EI), or work experiences.DesignLongitudinal cohort study over 1 year.SettingTertiary academic medical centers in the Northeast.ParticipantsAll general surgery residents in 2 programs (n = 143) were invited to complete an electronic survey at 3 time points; 88, 64, and 69 residents completed the survey (overall response rate 52%).ResultsSevere burnout was observed in 51% of residents (n = 41). Higher scores were associated with female sex (p = 0.02). Burnout scores were highest at the beginning and end of the academic year; EI and personality scores remained stable. On bivariate analysis, high EI score (p < 0.001), agreeableness and emotional stability personality features (p = 0.003), and positive job experiences (p < 0.01) were protective against burnout. Higher EI and positive work experiences were independent predictors of lower burnout (p < 0.01) after multivariable adjustment.ConclusionsSurgical residents have high levels of burnout. Higher EI and positive work experiences are associated with lower burnout. Focused interventions to improve EI and optimize the work environment may prevent or lessen burnout.
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Πέμπτη 30 Νοεμβρίου 2017
Association of Burnout With Emotional Intelligence and Personality in Surgical Residents: Can We Predict Who Is Most at Risk?
Numéro 10/2017. Questions
Source:Revue des Maladies Respiratoires
http://ift.tt/2zUcsMJ
Microangiopathie thrombotique tumorale pulmonaire
Source:Revue des Maladies Respiratoires
Author(s): M. Merad, A. Alibay, S. Ammari, S. Antoun, A. Bouguerba, S. Ayed, F. Vincent
Le syndrome de microangiopathie thrombotique tumorale pulmonaire est une entité clinicopathologique rare où des micro-emboles de cellules tumorales dans la microcirculation pulmonaire induisent une microangiopathie thrombotique, une insuffisance respiratoire et un tableau de cœur pulmonaire aigus ou subaigus. Ses caractéristiques histologiques comprennent des micro-emboles tumoraux dans les petites artères et artérioles du poumon, associés à une prolifération fibrocellulaire et fibromusculaire de l'intima et parfois à la formation de thrombus. Le diagnostic est extrêmement difficile avant le décès. Ainsi, un grand nombre des observations rapportées reposent sur des données autopsiques. De très rares observations de diagnostics réalisés avant le décès suggèrent l'éventuelle efficacité d'une chimiothérapie. De nombreux détails restent à élucider, la recherche interdisciplinaire étant une priorité avec une étroite collaboration entre pathologistes et cliniciens afin de mieux comprendre ce syndrome le plus souvent mortel. Grâce à cette collaboration, il est éventuellement possible que ce syndrome ne soit plus considéré comme toujours ultimement fatal, l'utilisation de thérapeutiques ciblées permettant des survies de plusieurs mois après le diagnostic.Pulmonary tumor thrombotic microangiopathy syndrome is a rare clinicopathological entity in which tumor cell micro-emboli in the pulmonary microcirculation induced thrombotic microangiopathy. This can cause respiratory failure, and acute or sub-acute right heart failure. Histological features include micro tumor emboli in the small arteries and arterioles of the lung associated with thrombus formation and fibro-cellular and fibro-muscular intimal proliferation. The diagnosis is however extremely difficult to make before death. Thus, most of the observations reported are based on autopsy data. Very rare diagnostic observations made before death suggest the potential effectiveness of chemotherapy. Many details remain to be elucidated, interdisciplinary research is a priority with close collaboration between pathologists and clinicians to better understand this, often fatal, syndrome. It may be that the use of targeted therapies will improve the very poor prognosis allowing survival of several weeks or months after diagnosis.
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Éditorial : série moisissures intérieures
Source:Revue des Maladies Respiratoires
Author(s): D. Caillaud, D. Charpin
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Numéro 10/2017. Réponses
Source:Revue des Maladies Respiratoires
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Editorial board
Source:Revue des Maladies Respiratoires, Volume 34, Issue 9
http://ift.tt/2zUx5Ip
Correction to: Adaptation in toxic environments: comparative genomics of loci carrying antibiotic resistance genes derived from acid mine drainage waters
Abstract
The original version of this article unfortunately contains a mistake.
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Editorial Board
Source:Dental Materials, Volume 33, Issue 12
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Bone Marrow Myeloid Cells Regulate Myeloid-Biased Hematopoietic Stem Cells via a Histamine-Dependent Feedback Loop
Publication date: Available online 30 November 2017
Source:Cell Stem Cell
Author(s): Xiaowei Chen, Huan Deng, Michael J. Churchill, Larry L. Luchsinger, Xing Du, Timothy H. Chu, Richard A. Friedman, Moritz Middelhoff, Hongxu Ding, Yagnesh H. Tailor, Alexander L.E. Wang, Haibo Liu, Zhengchuan Niu, Hongshan Wang, Zhenyu Jiang, Simon Renders, Siu-Hong Ho, Spandan V. Shah, Pavel Tishchenko, Wenju Chang, Theresa C. Swayne, Laura Munteanu, Andrea Califano, Ryota Takahashi, Karan K. Nagar, Bernhard W. Renz, Daniel L. Worthley, C. Benedikt Westphalen, Yoku Hayakawa, Samuel Asfaha, Florence Borot, Chyuan-Sheng Lin, Hans-Willem Snoeck, Siddhartha Mukherjee, Timothy C. Wang
Myeloid-biased hematopoietic stem cells (MB-HSCs) play critical roles in recovery from injury, but little is known about how they are regulated within the bone marrow niche. Here we describe an auto-/paracrine physiologic circuit that controls quiescence of MB-HSCs and hematopoietic progenitors marked by histidine decarboxylase (Hdc). Committed Hdc+ myeloid cells lie in close anatomical proximity to MB-HSCs and produce histamine, which activates the H2 receptor on MB-HSCs to promote their quiescence and self-renewal. Depleting histamine-producing cells enforces cell cycle entry, induces loss of serial transplant capacity, and sensitizes animals to chemotherapeutic injury. Increasing demand for myeloid cells via lipopolysaccharide (LPS) treatment specifically recruits MB-HSCs and progenitors into the cell cycle; cycling MB-HSCs fail to revert into quiescence in the absence of histamine feedback, leading to their depletion, while an H2 agonist protects MB-HSCs from depletion after sepsis. Thus, histamine couples lineage-specific physiological demands to intrinsically primed MB-HSCs to enforce homeostasis.
Graphical abstract
Teaser
Chen et al. show that histidine decarboxylase (Hdc) marks quiescent myeloid-biased HSCs (MB-HSCs). Daughter myeloid cells form a spatial cluster with Hdc+ MB-HSCs and secrete histamine to enforce their quiescence and protect them from depletion, following activation by a variety of physiologic insults.http://ift.tt/2ivcLWH
Hypoxic Induction of Vasorin Regulates Notch1 Turnover to Maintain Glioma Stem-like Cells
Publication date: Available online 30 November 2017
Source:Cell Stem Cell
Author(s): Jianghong Man, Xingjiang Yu, Haidong Huang, Wenchao Zhou, Chaomei Xiang, Haohao Huang, Lucio Miele, Zhenggang Liu, Gurkan Bebek, Shideng Bao, Jennifer S. Yu
Tumor hypoxia is associated with poor patient survival and is a characteristic of glioblastoma. Notch signaling is implicated in maintaining glioma stem-like cells (GSCs) within the hypoxic niche, although the molecular mechanisms linking hypoxia to Notch activation have not been clearly delineated. Here we show that Vasorin is a critical link between hypoxia and Notch signaling in GSCs. Vasorin is preferentially induced in GSCs by a HIF1α/STAT3 co-activator complex and stabilizes Notch1 protein at the cell membrane. This interaction prevents Numb from binding Notch1, rescuing it from Numb-mediated lysosomal degradation. Thus, Vasorin acts as a switch to augment Notch signaling under hypoxic conditions. Vasorin promotes tumor growth and reduces survival in mouse models of glioblastoma, and its expression correlates with increased aggression of human gliomas. These findings provide mechanistic insights into how hypoxia promotes Notch signaling in glioma and identify Vasorin as a potential therapeutic target.
Graphical abstract
Teaser
Man et al. show that hypoxia preferentially augments Notch signaling in glioma stem-like cells by inducing the HIF1/STAT3 target gene Vasorin. Vasorin functions as a competitive inhibitor of Numb to reduce Notch turnover, augmenting Notch signaling under hypoxic stress.http://ift.tt/2ivcIKv
Dye-Independent Methods Reveal Elevated Mitochondrial Mass in Hematopoietic Stem Cells
Publication date: Available online 30 November 2017
Source:Cell Stem Cell
Author(s): Mariana Justino de Almeida, Larry L. Luchsinger, David J. Corrigan, Linda J. Williams, Hans-Willem Snoeck
Hematopoietic stem cells (HSCs) produce most cellular energy through glycolysis rather than through mitochondrial respiration. Consistent with this notion, mitochondrial mass has been reported to be low in HSCs. However, we found that staining with MitoTracker Green, a commonly used dye to measure mitochondrial content, leads to artefactually low fluorescence specifically in HSCs because of dye efflux. Using mtDNA quantification, enumeration of mitochondrial nucleoids, and fluorescence intensity of a genetically encoded mitochondrial reporter, we unequivocally show here that HSCs and multipotential progenitors (MPPs) have higher mitochondrial mass than lineage-committed progenitors and mature cells. Despite similar mitochondrial mass, respiratory capacity of MPPs exceeds that of HSCs. Furthermore, although elevated mitophagy has been invoked to explain low mitochondrial mass in HSCs, we observed that mitochondrial turnover capacity is comparatively low in HSCs. We propose that the role of mitochondria in HSC biology may have to be revisited in light of these findings.
Graphical abstract
Teaser
Snoeck and colleagues show that efflux of a mitochondrial content-reporting dye leads to the erroneous conclusion that HSCs have low mitochondrial content. Using alternative methodologies, they show that HSCs exhibit high mitochondrial content yet possess limited respiratory and turnover capacity. Mitochondria likely perform an essential yet unknown function in HSCs.http://ift.tt/2ivcEKL
Comparative Efficacy of Daratumumab Monotherapy and Pomalidomide Plus Low‐Dose Dexamethasone in the Treatment of Multiple Myeloma: A Matching Adjusted Indirect Comparison
AbstractBackground.Daratumumab (a human CD38‐directed monoclonal antibody) and pomalidomide (an immunomodulatory drug) plus dexamethasone are both relatively new treatment options for patients with heavily pretreated multiple myeloma. A matching adjusted indirect comparison (MAIC) was used to compare absolute treatment effects of daratumumab versus pomalidomide + low‐dose dexamethasone (LoDex; 40 mg) on overall survival (OS), while adjusting for differences between the trial populations.Materials and Methods.The MAIC method reduces the risk of bias associated with naïve indirect comparisons. Data from 148 patients receiving daratumumab (16 mg/kg), pooled from the GEN501 and SIRIUS studies, were compared separately with data from patients receiving pomalidomide + LoDex in the MM‐003 and STRATUS studies.Results.The MAIC‐adjusted hazard ratio (HR) for OS of daratumumab versus pomalidomide + LoDex was 0.56 (95% confidence interval [CI], 0.38–0.83; p = .0041) for MM‐003 and 0.51 (95% CI, 0.37–0.69; p < .0001) for STRATUS. The treatment benefit was even more pronounced when the daratumumab population was restricted to pomalidomide‐naïve patients (MM‐003: HR, 0.33; 95% CI, 0.17–0.66; p = .0017; STRATUS: HR, 0.41; 95% CI, 0.21–0.79; p = .0082). An additional analysis indicated a consistent trend of the OS benefit across subgroups based on M‐protein level reduction (≥50%, ≥25%, and <25%).Conclusion.The MAIC results suggest that daratumumab improves OS compared with pomalidomide + LoDex in patients with heavily pretreated multiple myeloma.Implications for Practice.This matching adjusted indirect comparison of clinical trial data from four studies analyzes the survival outcomes of patients with heavily pretreated, relapsed/refractory multiple myeloma who received either daratumumab monotherapy or pomalidomide plus low‐dose dexamethasone. Using this method, daratumumab conferred a significant overall survival benefit compared with pomalidomide plus low‐dose dexamethasone. In the absence of head‐to‐head trials, these indirect comparisons provide useful insights to clinicians and reimbursement authorities around the relative efficacy of treatments.
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Pre‐ and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey
AbstractBackground.The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre‐ and postoperative chemotherapy is unclear and debated among experts.Materials and Methods.Medical oncology experts of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group were asked to participate in this survey on the use of pre‐ and postoperative chemotherapy in STS. Experts from 12 centers in Belgium, France, Germany, Great Britain, Italy, Switzerland, and The Netherlands agreed to participate and provided their treatment algorithm. Answers were converted into decision trees based on the objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies.Results.Several criteria used for decision‐making in extremity STS were identified: chemosensitivity, fitness, grading, location, and size. In addition, resectability and resection status were relevant in the pre‐ and postoperative setting, respectively. Preoperative chemotherapy is considered in most centers for marginally resectable tumors only. Yet, in some centers, neoadjuvant chemotherapy is used routinely and partially combined with hyperthermia. Although most centers do not recommend postoperative chemotherapy, some offer this treatment on a regular basis. Radiotherapy is an undisputed treatment modality in extremity STS.Conclusion.Due to lacking evidence on the utility of pre‐ and postoperative chemotherapy in localized extremity STS, treatment strategies vary considerably among European experts. The majority recommended neoadjuvant chemotherapy for marginally resectable grade 2–3 tumors; the majority did not recommend postoperative chemotherapy in any setting.Implications for Practice.The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre‐ and postoperative chemotherapy is unclear and debated among experts. This study analyzed the decision‐making process among 12 European experts on systemic therapy for STS. A wide range of recommendations among experts regarding the use of perioperative chemotherapy was discovered. Discrepancies in the use of decision criteria were also uncovered, including the definition of what constitutes high‐risk cancer, which is a basis for many to recommend chemotherapy. Before any standardization is possible, a common use of decision criteria is necessary.
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The European Medicines Agency Review of Panobinostat (Farydak) for the Treatment of Adult Patients with Relapsed and/or Refractory Multiple Myeloma
AbstractOn August 28, 2015, a marketing authorization valid through the European Union was issued for panobinostat, in combination with bortezomib and dexamethasone, for the treatment of adult patients with relapsed and/or refractory multiple myeloma who have received at least two prior regimens including bortezomib and an immunomodulatory agent (IMiD).Panobinostat is an orally available histone deacetylase (HDAC) inhibitor that inhibits the enzymatic activity of HDAC proteins at nanomolar concentrations. HDAC proteins catalyze the removal of acetyl groups from the lysine residues of histones and some nonhistone proteins. Inhibition of HDAC activity results in increased acetylation of histone proteins, an epigenetic alteration that results in a relaxing of chromatin, leading to transcriptional activation. The recommended starting dose of panobinostat is 20 mg, taken orally in a cyclical manner for up to 48 weeks.The use of panobinostat in combination with bortezomib and dexamethasone was studied in a randomized, double‐blind, placebo‐controlled, multicenter phase III study (PANORAMA I) in 768 patients with relapsed or relapsed and refractory multiple myeloma who had received one to three prior lines of therapies. In the subgroup of patients who have received at least two prior regimens including bortezomib and an IMiD, there was a difference of 7.8 months in the progression‐free survival in favor of the experimental arm (12.5 months for panobinostat + bortezomib + dexamethasone vs. 4.7 months for placebo + bortezomib + dexamethasone; hazard ratio = 0.47, 95% confidence interal 0.31–0.72; log‐rank p value = .0003). The incidence of grade 3–4 adverse events suspected to be related to study drug was 76.9% vs. 51.2%, for the panobinostat and the placebo group, respectively. The most common side effects (grade 3–4) associated with panobinostat included diarrhea (18.9%), fatigue (14.7%), nausea (4.5%), vomiting (5.5%), thrombocytopenia (43.6%), anemia (7.9%), neutropenia (16.5%) and lymphopenia (8.1%).This article summarizes the scientific review of the application leading to regulatory approval in the European Union. The full scientific assessment report and product information, including the Summary of Product Characteristics, are available on the European Medicines Agency website (http://ift.tt/28Lv8Np).Implications for Practice.Farydak was approved in the European Union in combination with bortezomib and dexamethasone, for the treatment of adult patients with relapsed and/or refractory multiple myeloma who have received at least two prior regimens including bortezomib and an immunomodulatory agent (IMiD). The addition of panobinostat to bortezomib and dexamethasone resulted in a clinically meaningful and statistically significant improvement of progression‐free survival compared with bortezomib and dexamethasone, and an additional therapeutic option with a new mechanism of action was considered valuable. Although the toxicity associated with panobinostat combination was significant, at the time of the marketing authorization of panobinostat, it was considered that it was acceptable and that it should be left to the clinician and the patient to decide whether the panobinostat combination is the preferred treatment option or not.
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Clinical Thyroidology High-Impact Articles
FREE ACCESS through December 14, 2017.
Read Now:
Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration
Stephanie A. Fish
Are Wider TSH Cutoffs for Reflex Testing of Free T4 Feasible, Safe and Cost-Effective?
Jacques Orgiazzi
Punctate Echogenic Foci on Thyroid Ultrasound Do Not Necessarily Represent Calcifications on Histopathology
Martin Biermann
Significant Variations of Thyroid Testing in the U.S. Argue for Improved Standardization of Practice Patterns
Angela M. Leung
The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.
http://ift.tt/2iuNGv4
Transformation of sulfaquinoxaline by chlorine and UV light in water: kinetics and by-product identification
Abstract
Sulfaquinoxaline (SQX) is an antimicrobial of the sulfonamide class, frequently detected at low levels in drinking and surface water as organic micropollutant. The main goal of the present study is the evaluation of SQX reactivity during chlorination and UV irradiations which are two processes mainly used in water treatment plants. The SQX transformation by chlorination and UV lights (254 nm) was investigated in purified water at common conditions used for water disinfection (pH = 7.2, temperature = 25 °C, [chlorine] = 3 mg L−1). The result shows a slow degradation of SQX during photolysis compared with chlorination process. Kinetic studies that fitted a fluence-based first-order kinetic model were used to determine the kinetic constants of SQX degradation; they were equal to 0.7 × 10−4 and 0.7 × 10−2 s−1corresponding to the half time lives of 162 and 1.64 min during photolysis and chlorination, respectively. In the second step, seven by-products were generated during a chlorination and photo-transformation of SQX and identified using liquid chromatography with electrospray ionization and tandem mass spectrometry (MS-MS). SO2 extrusion and direct decomposition were the common degradation pathway during photolysis and chlorination. Hydroxylation and isomerization were observed during photodegradation only while electrophilic substitution was observed during chlorination process.
http://ift.tt/2i5H2aS
Comparative studies on the performance and emissions of a direct injection diesel engine fueled with neem oil and pumpkin seed oil biodiesel with and without fuel preheater
Abstract
In the present experimental analysis, two non-edible oils namely neem oil and pumpkin seed oil were considered. They are converted into respective biodiesels namely neem oil methyl ester (B1) and pumpkin seed oil methyl ester (B2) through transesterification process and their physical and chemical properties were examined using ASTM standards. Diesel was used as a baseline fuel in Kirloskar TV1 model direct injection four stroke diesel engine. A fuel preheater was designed and fabricated to operate at various temperatures (60, 70, and 80 °C). Diesel showed higher brake thermal efficiency (BTE) than biodiesel samples. Lower brake specific fuel consumption (BSFC) was obtained with diesel than B1 sample. B1 exhibited lower BSFC than B2 sample without preheating process. High preheating temperature (80 °C) results in lower fuel consumption for B1 sample. The engine emission characteristics like carbon monoxide (CO), hydrocarbon (HC), and smoke were found lower with B1 sample than diesel and B2 except oxides of nitrogen (NOx) emission. In preheating of fuel, B1 sample with high preheating temperature showed lower CO, HC, and smoke emission (except NOx) than B2 sample.
http://ift.tt/2jBxchk
Effects of lead, cadmium, chromium, and arsenic on the sorption of lindane and norfloxacin by river biofilms, particles, and sediments
Abstract
The sorption of both classic and emerging organic contaminants onto aquatic solids is a critical process that controls their fate in natural waters. Sorption is affected by numerous factors, including coexisting heavy metals. The mechanisms of the influence of heavy metals, especially those occurring in acid radical anions, are still unclear. Here, the effects of Pb, Cd, Cr, and As on the sorption of lindane and norfloxacin (NOR) onto natural biofilms, suspended particles, and sediments from one river were investigated following batch equilibration methods. In addition, changes in representative components that have important roles in sorption from these solids in the presence and absence of metals were characterized by spectrum analyses. The results indicated that sorption of lindane and NOR on the three solids in the absence of heavy metals was highly linear and nonlinear, respectively. Pb and Cd promoted and Cr and As suppressed hydrophobic lindane sorption on the three solids. This was because Pb and Cd enhanced but Cr and As weakened the hydrophobicity of these solids. Pb, Cd, Cr, and As decreased NOR sorption on sediments and suspended particles at pH 5.7~6.3. This was due to electrostatic competition between cationic Pb/Cd and NORH2+, and the combination of Cr/As acid radicals with NORH2+, which suppressed its ion-exchange adsorption. Pb, Cd, Cr, and As generally increased the sorption of NOR onto the biofilms at pH 5.7~6.3. Pb and Cd strengthened the flocculation of dissolved organic matter combined with NORH2+ onto the biofilms. Cr and As enhanced the hydrophilicity of biofilms, and then increased their sorption of NOR with active hydrophilic groups. The mechanisms of how different heavy metals affect NOR sorption by biofilms were more complicated than the mechanisms affecting lindane sorption, as well as by sediments and particles.
http://ift.tt/2AlAcWJ
Intense phototoxic reactions to photodynamic therapy in immunosuppressed renal transplant patients
Source:Photodiagnosis and Photodynamic Therapy, Volume 21
Author(s): V.K. Ortner, M. Haedersdal, H.C. Wulf, K. Togsverd-Bo
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Pregnancy and Lifetime Exposure to Fine Particulate Matter and Infant Mortality in Massachusetts, 2001–2007
http://ift.tt/2BpqC4z
Maternal Lifetime Stress and Prenatal Psychological Functioning and Decreased Placental Mitochondrial DNA Copy Number in the PRISM Study
http://ift.tt/2BpLOYi
Measuring the Impact of Disasters Using Publicly Available Data: Application to Hurricane Sandy (2012)
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Work-Related Biomechanical Exposure and Job Strain as Separate and Joint Predictors of Musculoskeletal Diseases: A 28-Year Prospective Follow-up Study
http://ift.tt/2Bo368g
Group-Based Trajectory of Body Shape From Ages 5 to 55 Years and Cardiometabolic Disease Risk in 2 US Cohorts
http://ift.tt/2j6cMNK
Advanced Maternal Age and the Risk of Low Birth Weight and Preterm Delivery: a Within-Family Analysis Using Finnish Population Registers
http://ift.tt/2BpROjD
Neighborhood Physical Environment and Changes in Body Mass Index: Results From the Multi-Ethnic Study of Atherosclerosis
http://ift.tt/2j6mzTY
Potential for Bias When Estimating Critical Windows for Air Pollution in Children’s Health
http://ift.tt/2BoWS7P
Historical anthropogenic mercury in two lakes of Central Chile: comparison between an urban and rural lake
Abstract
Mercury concentrations in the environment tend to decrease in recent years due to environmental restrictions. Lakes store mercury in their sediments, making them potential secondary contamination sources. In South America, the occurrence of mercury in lake systems has been associated mainly with volcanic emissions and only few records anthropogenic contamination in the pre-Hispanic period. The objective of this research was to study historical anthropogenic mercury concentration in two lakes in Central Chile (La Señoraza and Pillo), in order to establish background mercury levels and their variations from preindustrial to modern periods. Different background levels and mercury concentrations were found in each lake, with significantly higher concentrations in Lake La Señoraza during the last 150 years. Mining-related activities during the nineteenth century could have a negligible influence on mercury concentrations. Later on, the use of coal railroads and subsequent employment of mercury in the cellulose industry were associated with three- and fourfold increases in mercury concentration over the nineteenth century background levels, which decrease once these activities ceased. However, in the case of Lake Pillo, an important increase in mercury concentration can be observed between 1990 and the early twenty-first century, which could be related to a higher watershed/lake area ratio, extensive agriculture, and volcanic emission, being the latter that could have contributed with mercury to both systems. Nevertheless, sedimentological characteristics in Lake Pillo can be favorable to retain mercury in this aquatic system up to the present day.
http://ift.tt/2AoIbCz
Spatio-temporal evaluation of emerging contaminants and their partitioning along a Brazilian watershed
Abstract
The occurrence, partitioning, and spatio-temporal distribution of seven pharmaceuticals for human use, three steroid hormones and one personal care product were determined in surface water, suspended particulate matter (SPM), and sediment of Piraí Creek and Jundiaí River (Jundiaí River Basin, São Paulo, Brazil). The maximum average detected concentrations of the compounds in the Piraí River samples were < 30 ng L−1, except for caffeine (222 ng L−1). In Jundiaí River samples, most of the compounds were frequently detected, wherein caffeine had the highest concentration, with maximum average concentrations of 14,050 ng L−1, followed by atenolol (431 ng L−1), ibuprofen (268 ng L−1) and diclofenac (214 ng L−1). Atenolol, propranolol, estrone, and triclosan were the contaminants most frequently detected in sediment and SPM samples. Triclosan had the highest average proportion of SPM as opposed to in the aqueous phase (> 75%). Contaminants with acid functional groups showed, in general, a lower tendency to bind to particulate matter and sediments. In addition, hydrophobicity had an important effect on their environmental partitioning. The spatial distribution of contaminants along the Jundiaí River was mainly affected by the higher concentration of contaminants in water samples collected downstream from a sewage treatment plant (STP). The results obtained here clearly showed the importance of the analysis of some contaminants in the whole water, meaning both dissolved and particulate compartments in the water, and that the partitioning is ruled by a set of parameters associated to the physicochemical characteristics of contaminants and the matrix properties of the studied, which need be considered in an integrated approach to understand the fate of emerging chemical contaminants in aquatic environments.
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What is the Preferred Resuscitation Fluid for Patients with Severe Sepsis and Septic Shock?
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Michael E. Winters, Robert Sherwin, Gary M. Vilke, Gabriel Wardi
BackgroundCurrent guidelines for the management of patients with severe sepsis and septic shock recommend crystalloids as the initial fluid solution of choice in the resuscitation of these patients. In recent years, there have been numerous studies published on the type of fluid used in the resuscitation of patients with sepsis. The primary goal of this article is to determine the preferred intravenous fluid for the resuscitation of patients with severe sepsis and septic shock.MethodsA MEDLINE literature review was completed to identify studies that investigated the type of resuscitation fluid in the management of patients with severe sepsis and septic shock. Articles included were those published in English between 2011 and 2016, enrolled human subjects, and limited to the following types: randomized controlled trial, prospective observational trial, retrospective cohort trial, and meta-analyses. All selected articles then underwent a structured review by the authors.ResultsNine thousand sixty-two articles were identified in the search. After use of predetermined criteria, 17 articles were selected for review. Eleven of these were original investigations and six were meta-analyses and systemic reviews.ConclusionCrystalloids are the preferred solution for the resuscitation of emergency department patients with severe sepsis and septic shock. Balanced crystalloids may improve patient-centered outcomes and should be considered as an alternative to normal saline, if available. There is strong evidence that suggests semi-synthetic colloids decrease survival and should be avoided. The role of albumin in the resuscitation of patients with severe sepsis and sepsis is uncertain.
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Issue Highlights
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
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Contents
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
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Response to Letter to the Editor
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Jan Van Keer, Karel Van Keer, Joachim Van Calster, Inge Derdelinckx
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Partial Contents of Volume 54, Number 1
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
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Blood Biomarkers for the Early Diagnosis of Stroke
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Heather Roesly
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Management of Pediatric Perforated Appendicitis
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Forrest Andersen
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Editorial Board
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
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Comparison of Lactic Acid Levels in Children with Suspected and Confirmed Intussusception
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Vanessa Tamas, Paul Ishimine
BackgroundCurrently, no laboratory test can identify children with intussusception. Lactic acid is a marker of ischemia in gastrointestinal emergencies.ObjectivesWe present a case series comparing lactic acid levels in children with suspected and confirmed intussusception.MethodsThis is a prospective single case series of 39 patients who had suspected intussusception. Patients were eligible if they underwent abdominal ultrasound screening for suspected intussusception. Blood collected at the time of peripheral intravenous line placement was analyzed for lactic acid levels before ultrasound.ResultsThirty-nine patients were enrolled; 16 were diagnosed with intussusception. Mean (± standard deviation) lactic acid levels were not significantly different between children with suspected (1.7 ± 0.69 mmol/L) and confirmed intussusception (1.93 ± 1.13 mmol/L).ConclusionsLactic acid levels cannot identify children with intussusception.
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Emergency Coagulation Assessment During Treatment with Direct Oral Anticoagulants
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Krysia Crabtree
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Emergency Medicine Myths: Ectopic Pregnancy Evaluation, Risk Factors, and Presentation
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Jennifer J. Robertson, Brit Long, Alex Koyfman
BackgroundEctopic pregnancy (EP) is an important cause of morbidity and mortality in females of reproductive age. Proper diagnosis and treatment are critical, as complications such as rupture, hemorrhagic shock, and even death can occur.ObjectiveEP is a condition emergency physicians are trained to detect, yet there are multiple myths concerning its evaluation and diagnosis. This article reviews several of these myths in order to improve emergency department (ED) evaluation and diagnosis.DiscussionEP is a difficult diagnosis and may be missed on initial ED visit. While the diagnosis is often delayed simply due to very early presentations, it can also be missed because patients may not have all the same risk factors or demonstrate the same symptoms. They may also not demonstrate the same serum B-human chorionic gonadotropin levels and trends or have the same ultrasound findings at equivalent gestational ages. Some patients with early EP may have positive ultrasound findings with serum β-hCG levels under a defined discriminatory zone (DZ). On the other hand, some patients with an early viable intrauterine pregnancy may have no visible findings on initial ultrasound, but have serum β-hCG (quantitative) levels well above the DZ. Although rare, EP has even been demonstrated in women with negative urine β-hCG tests or low serum β-hCG levels.ConclusionsWhile EP may be a challenging diagnosis, understanding the myths surrounding EP may help emergency physicians consider it, even when patient risk factors, symptoms, or ED laboratory or imaging studies do not initially or easily define the diagnosis.
http://ift.tt/2Bokp9h
Rotational Thromboelastometry Significantly Optimizes Transfusion Practices for Damage Control Resuscitation in Combat Casualties
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Heather Roesly
http://ift.tt/2j4JPls
Patterns and Outcomes Associated with Timeliness of Initial Crystalloid Resuscitation in Prospective Sepsis and Septic Shock Cohort
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Forrest Andersen
http://ift.tt/2BpFRuy
Unintentional Marijuana Exposure Presenting as Altered Mental Status in the Pediatric Emergency Department: A Case Series
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Anita A. Thomas, Suzan Mazor
BackgroundUnintentional tetrahydrocannabinol (THC) exposure in pediatric patients can present as altered mental status. Altered mental status in a pediatric patient often leads to invasive diagnostic testing.Case ReportThe following cases describe 3 pediatric patients in Washington state who presented to a tertiary care children's hospital emergency department (ED) with altered mental status, later found to have urine toxicology screening positive for inactive THC metabolite (positive THC toxicology screen). Case 1 is a 6-year-old boy who presented with vomiting, lethargy, and hallucinations. Case 2 is a 5-year-old girl who presented with nausea, slurred speech, ataxia, and lethargy in the setting of a minor head injury. Case 3 is a 7-month-old boy who presented with vomiting and lethargy in the setting of a minor fall the day prior to ED evaluation. All children had extensive work-ups before the diagnosis was made; 2 were discharged home and 1 was admitted to the pediatric intensive care unit.Why Should an Emergency Physician Be Aware of This?As access to marijuana increases with growing legalization, it is important to be familiar with state marijuana legislation, to consider and ask families about access to marijuana products as a potential contributor to altered mental status, and to be aware of potential caretaker reluctance regarding disclosure of marijuana use secondary to perceived stigma. Maintaining awareness of the clinical effects of THC exposure in children may limit invasive testing in a hemodynamically stable child with altered mental status.
http://ift.tt/2Bpt9f0
Klebsiella pneumoniae Invasive Liver Abscess Syndrome and Endophthalmitis
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Beuy Joob, Viroj Wiwanitkit
http://ift.tt/2j5Fiz9
Low Yield of Clinically Significant Injury With Head-To-Pelvis Computed Tomography in Blunt Trauma Evaluation
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Shelby P. Murphy, Noah Hawthorne, David Haase, Chika Chiku, Jason Wen, Robert M. Rodriguez
BackgroundMany trauma centers have adopted routine head-to-pelvis computed tomography (CT) imaging for the evaluation of adults with blunt trauma.ObjectiveWe sought to determine the yields of detecting clinically significant injuries (CSIs) with CT in >1 anatomic region.MethodsWe conducted this observational cohort study of all trauma activation patients >14 years of age who received CT imaging during blunt trauma evaluation at a Level 1 trauma center from April to October 2014. Expert panels determined the clinical significance of head, neck, chest, abdomen, and pelvis injuries seen on CT. We calculated yields of CSI, defined as the number of patients with CSI divided by the total number of patients who underwent CT imaging. The 3 specified anatomic regions considered were head/neck, chest, and abdomen/pelvis.ResultsThe median age of 1236 patients who had CT was 48 years; 69% were male; 51.2% were admitted; and hospital mortality was 4.4%. Yields of CSI with 95% confidence intervals (CIs) were: head/neck region injury 11.3% (9.6–13.3%); chest region injury only 7.9% (6.0–10.4%); abdomen/pelvis region injury only 5.1% (3.7–7.0%); both head/neck and chest CSI 2.8% (1.7–4.5%); both head/neck and abdomen/pelvis CSI 1.6% (0.9–2.9%); and both chest and abdomen/pelvis CSI 1.1% (0.5–2.4%). The yield of CSI in all 3 anatomic regions with head-to-pelvis CT was 0.6% (0.2–1.7%), and 76.7% (68.8–83.1%) of CSIs occurred in isolation.ConclusionsDuring multiple anatomic region CT imagng for adult blunt trauma evaluation, the yield for CSI in >1 region is low. In low-risk populations, selective CT imaging of anatomic regions (instead of reflexive head-to-pelvis CT imaging) may be more appropriate.
http://ift.tt/2BptfDo
Expedited Discharge from an Academic Emergency Department: A Pilot Program
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Andrew Goldsmith, Luis Ticona, Ryan Thompson, Benjamin A. White, Joan Strauss, Robert Seger, David F.M. Brown, Ali S. Raja, Brian J. Yun
BackgroundAs the numbers of emergency department (ED) visits and inpatient admissions continue to increase, there is growing interest in alternatives to inpatient hospitalization.ObjectiveOur aim was to investigate a novel approach to expediting discharges from the ED with multidisciplinary discharge services to prevent an avoidable admission into the hospital.MethodsThis pilot study was conducted at a large urban tertiary-care ED in 2016. All patients presenting to the ED with planned inpatient or observation admission were considered for discharge with enhanced discharge planning services. The patients selected, discharge diagnoses, and outcomes were analyzed by descriptive statistics. This study was approved by the study site's Institutional Review Board, including waiver of patient consent.ResultsDuring the pilot period, 57 out of 143 (40%) selected patients with planned admission were discharged with enhanced discharge planning services. Median ED length of stay was 17.2 h and mean patient age was 73 years old. Of these patients, 7 (12%) returned within 72 h and 4 (0.07%) were subsequently admitted to the hospital.ConclusionsIn this pilot study, a novel approach to expediting discharges from the ED with multidisciplinary discharge services was feasible and resulted in fewer admissions to the hospital.
http://ift.tt/2j4JFKS
Health Care Usage and Suicide Risk Screening within 1 Year of Suicide Death
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Amy R. Stuck, Michael P. Wilson, Christen E. Chalmers, Jonathan Lucas, Andrew Sarkin, Kyle Choi, Kimberly Center
BackgroundResearch indicates patients often seek medical care within 1 year of suicide. Health care encounters are a crucial opportunity for health professionals to identify patients at highest risk and provide preventative services.ObjectiveStudy aims were to determine the characteristics of persons seeking health care within 12 months of suicide death and evaluate suicide risk screening (SRS) frequency in the emergency department (ED) vs. clinic settings.MethodsMedical examiner and hospital data of patients who died by suicide from 2007 to 2013 were evaluated. Descriptive analyses included demographics and frequency of ED vs. clinic visits. We also compared SRS before and after implementation of The Joint Commission's recommendation to assess suicide risk.ResultsThe 224 deceased patients were primarily single white males (mean age 67 years). Mental health issues, substance abuse, and prior suicide attempts were present alone or in combination in 74%. Visits were primarily behavioral health or substance abuse problems in the ED, and medical issues in the clinic. After implementation of universal SRS in the ED, screening increased from 39% to 92%. Among patients screened in the ED, 73% (37 of 51) screened negative for suicide risk.ConclusionsUniversal SRS increased the number of people screened in the ED. However, negative SRS may not equate to reduced risk for future suicide within 1 year. Future studies might investigate targeted screening of individuals with known suicide risk factors, as well as alternatives to patient self-report of intent to self-harm for patients with mental health or substance abuse problems.
http://ift.tt/2BoDJTy
The effect of time restricted visual sensory input on asymmetry of ground reaction force components in female children
Publication date: Available online 29 November 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Mozhgan Faraji Aylar, AmirAli Jafarnezhadgero, Fatemeh Salari Esker, Robert Barber, D.G.E. Robertson
The association between visual sensory and the asymmetry index of sit-to-stand ground reaction force characteristics is not fully understood. Therefore, the purpose of this study was to investigate asymmetry index of sit-to-stand ground reaction forces, their times–to-peak, vertical loading rate, impulses, and free moment in blind and sighted children. 15 female children with congenital blindness and 30 healthy girls with no visual impairments volunteered to participate in this study. The girls with congenital blindness were placed in one group and the girls with no visual impairments were randomly divided into two groups of 15. The two condition groups consisted of, one eyes open and the other, eyes closed. The participants in the eyes closed group were asked to close their eyes for 20 min before the test, whereas those in the eyes open group kept their eyes open. Kinematic and kinetic data were collected using an eight-camera motion analysis system synchronized with two force plates embedded in the floor. A MANOVA test was run for between-group comparisons. There were no distinctive biomechanical alternations in all axes of ground reaction forces and their times-to-peak, vertical loading rate, impulses and free moments in congenital blindness and eyes closed groups compared with the eyes open group. However, eyes closed was associated with increased total time and second phase duration of sit-to-stand performance by 69% (p = 0.008) and 62% (p = 0.008), respectively. These findings reveal that individuals who are visually restricted in the short term, do not develop stereotypical movement strategies for sit-to-stand.
http://ift.tt/2AhAsYQ
An examination of the relationship between dynamic knee joint stiffness and gait pattern of children with cerebral palsy
Publication date: Available online 29 November 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Manuela Galli, Veronica Cimolin, Claudia Condoluci, Pier Francesco Costici, Reinald Brunner
Dynamic joint stiffness represents the resistance that a joint opposes to an applied moment. Stiffness arises in conditions of joint laxity, instability and increased co-contraction and is commonly utilized as a means to stabilize the joint. The knee joint seems to be crucial for determining the walking pattern. The aim of this study was to investigate the association between the gait pattern, globally quantified by the Gait Profile Score (GPS), which indicates the 'quality' of a particular walking strategy, and knee dynamic joint stiffness (Kk) in children with diplegia. Kk is expressed by plotting the values of the knee flexion-extension moment versus the knee flexion-extension angle during weight acceptance. In this interval, the linear regression was fitted. The angular coefficient of the linear regression corresponded to the joint stiffness index. Sixty-one children with diplegia and 18 healthy individuals took part in this study. From their gait analysis data, the GPS (with its Gait Variable Scores-GVSs) and the Kk were calculated. Data showed that GPS (p = 2.73 × 10−21) and GVSs values for the patients with diplegia were higher in comparison to healthy controls. The Kk values for patients were not statistically different from those of controls. The correlation between Kk and GPS did not show the presence of any significant relationship (r = −0.04; p > 0.05). Thus, the functional limitation in diplegic children does not seems to be strictly related to Kk.
http://ift.tt/2AmaaCU
Indoor air quality of everyday use spaces dedicated to specific purposes—a review
Abstract
According to literature data, some of the main factors which significantly affect the quality of the indoor environment in residential households or apartments are human activities such as cooking, smoking, cleaning, and indoor exercising. The paper presents a literature overview related to air quality in everyday use spaces dedicated to specific purposes which are integral parts of residential buildings, such as kitchens, basements, and individual garages. Some aspects of air quality in large-scale car parks, as a specific type of indoor environment, are also discussed. All those areas are characterized by relatively short time use. On the other hand, high and very high concentration levels of xenobiotics can be observed, resulting in higher exposure risk. The main compounds or group of chemical compounds are presented and discussed. The main factors influencing the type and amount of chemical pollutants present in the air of such areas are indicated.
http://ift.tt/2AtjEyy
Trends in Cancer Survival by Health Insurance Status in California From 1997 to 2014
http://ift.tt/2nigpEL
Zoledronic Acid Dosing in Patients With Metastatic Breast Cancer
http://ift.tt/2zDHS5J
Lymph Node Burden and Mortality Risk in Hypopharynx and Larynx Cancer
http://ift.tt/2ngSghX
Metastatic Lymph Node Burden in Hypopharyngeal and Laryngeal Cancer
http://ift.tt/2zCehtq
Efficacy of Medicaid for Patients With Cancer in California
http://ift.tt/2nm5biX
Zoledronic Acid Dosing in Patients With Metastatic Breast Cancer—Reply
http://ift.tt/2zBQxpk
Zoledronic Acid Dosing in Patients With Metastatic Breast Cancer
http://ift.tt/2nfBkIN
Cancer of the Head of the Pancreas: Early Surgery or Preoperative Biliary Drainage?
Intervention: Device: Tannenbaum Fr 10 stent or WallFlex stent
Sponsor: Helsinki University Central Hospital
Recruiting
http://ift.tt/2Arredd
Pembrolizumab Plus Epacadostat, Pembrolizumab Monotherapy, and the EXTREME Regimen in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (KEYNOTE-669/ECHO-304)
Interventions: Drug: Pembrolizumab; Drug: Epacadostat; Drug: Cetuximab; Drug: Cisplatin; Drug: Carboplatin; Drug: 5-Fluorouracil
Sponsors: Incyte Corporation; Merck Sharp & Dohme Corp.
Not yet recruiting
http://ift.tt/2isbzDC
Radiotherapy vs Neck Dissection for Clinical T1/2N0 Supraglottic Cancer
Interventions: Radiation: Radiatherapy; Procedure: Selective neck dissection
Sponsors: Tianjin Medical University Cancer Institute and Hospital; Tianjin Medical University General Hospital; Tianjin Medical University Second Hospital
Not yet recruiting
http://ift.tt/2ArqV23
A genome-wide DNA methylation analysis in peripheral blood from patients identifies risk loci associated with Graves’ orbitopathy
Abstract
Objective
Graves' orbitopathy (GO) is an inflammatory orbital disease of autoimmune origin with the potential to cause severe functional and psychosocial effects. The pathogenesis has not been fully elucidated. We investigated whether DNA methylation was associated with GO incidence in Chinese patients.
Materials and methods
Six GO patients and six age-matched controls were recruited, and genome-wide DNA methylation patterns were analyzed in their peripheral blood. t tests were performed to determine differential methylated sites in genomic regions and the univariable logistic regression analyses was performed to evaluate their risk with GO incidence. Cluster analysis and principal component analysis (PCA) were performed to determine the effects of the extracted differentially methylated sites.
Results
One hundred and forty-eight differentially methylated sites were identified, including CD14 (fold change = 4.31, p = 0.005), IL17RE (fold change = 2.128, p = 0.005), and DRD4 (fold change = 0.25, p = 0.004), and were supported by cluster and PCA analyses. Univariable logistic regression analyses showed that the methylation patterns at 12 loci were associated with GO incidence. The relative risk per 1% decrease in methylation at ZCCHC6 and GLI3 was 0.15 (95% CI 0.03–0.91; p = 0.039) and 0.65 (95% CI 0.42–0.98; p = 0.042), respectively. Pearson correlation analyses demonstrated that methylation levels at IL17RE were positively associated with Clinical Activity Score (CAS) (r = 0.967, p < 0.05).
Conclusions
Our results demonstrate that differential methylation levels at analyzed sites (genes) may be risk markers of GO. DNA methylation analysis could provide new insights into understanding the disease and provide new treatment strategies for GO in Chinese patients.
http://ift.tt/2zDdAAc
NAFLD/NASH in patients with type 2 diabetes and related treatment options
Abstract
Type 2 diabetes may reduce life expectancy and patients' quality of life due to its micro- and macro-vascular complications and to the higher risk of several types of cancer. An emerging important factor is represented by the hepatic involvement; it is recognized that excessive hepatic fat accumulation represents a typical feature of diabetic patients and that it also plays an important pathogenic role. It is now evident that non-alcoholic fatty liver disease (NAFLD), generally perceived as a benign condition, may have on the contrary an important deleterious impact for diabetic patients increasing the risk to develop cardiovascular complications but also serious hepatic diseases, in particular non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Lifestyle intervention, bariatric surgery and several drug therapies have now accumulated evidence of efficacy in treating NASH. On the other hand, their durability and safety in the long-term is yet to be proven and their use may be sometimes associated with side effects or higher risk of adverse events limiting the regular administration or contraindicating it. Professional health care providers, building awareness about the importance of these hepatic complications, should put more efforts in primary prevention using a behavioral therapy needing a multidisciplinary approach, in secondary prevention applying on a regular basis in the clinical setting available predictive algorithms to identify the patients at higher cardiovascular and hepatologic risk, and in tertiary prevention treating, when not contraindicated, the diabetic patients preferentially with drugs with proven benefit on NAFLD/NASH.
http://ift.tt/2nerhUe
Impact assessment of projected climate change on diffuse phosphorous loss in Xin’anjiang catchment, China
Abstract
Diffuse nutrient loss is a serious threat to water security and has severely deteriorated water quality throughout the world. Xin'anjiang catchment, as a main drinking water source for Hangzhou City, has been a national concern for water environment protection with payment for watershed services construction. Detection of diffuse phosphorous (DP) pollution dynamics under climate change is significant for sustainable water quality management. In this study, the impact of projected climate change on DP load was analyzed using SWAT to simulate the future changes of diffuse components (carriers: water discharge and sediment; nutrient: DP) at both station and sub-catchment scales under three climate change scenarios (RCP2.6, RCP4.5, and RCP8.5). Results showed that wetting and warming years were expected with increasing tendencies of both precipitation and temperature in the two future periods (2020s: 2021~2030, 2030s: 2031~2040) except in the 2020s in the RCP2.6 scenario, and the annual average increasing ratios of precipitation and temperature reached − 1.79~3.79% and 0.48~1.27 °C, respectively, comparing with those in the baseline (2000s: 2001~2010). Climate change evidently altered annual and monthly average water discharge and sediment load, while it has a remarkable impact on the timing and monthly value of DP load at station scale. DP load tended to increase in the non-flood season at Yuliang due to strengthened nutrient flushing from rice land into rivers with increasing precipitation and enhanced phosphorous cycle in soil layers with increasing temperature, while it tended to decrease in the flood season at Yuliang and in most months at Tunxi due to restricted phosphorous reaction with reduced dissolved oxygen content and enhanced dilution effect. Spatial variability existed in the changes of sediment load and DP load at sub-catchment scale due to climate change. DP load tended to decrease in most sub-catchments and was the most remarkable in the RCP8.5 scenario (2020s, − 9.00~2.63%; 2030s, − 11.16~7.89%), followed by RCP2.6 (2020s, − 10.00~2.90%; 2030s, − 9.00~6.63%) and RCP4.5 (2020s, − 6.81~5.49%, 2030s, − 10.00~9.09%) scenarios. Decreasing of DP load mainly aggregated in the western and eastern mountainous regions, while it tended to increase in the northern and middle regions. This study was expected to provide insights into diffuse nutrient loss control and management in Xin'anjiang catchment, and scientific references for the implementation of water environmental protection in China.
http://ift.tt/2kcr42I
Ruptured de novo Aneurysm following Gamma Knife Surgery for Arteriovenous Malformation: Case Report
Stereotactic radiosurgery is a well-known treatment tool for arteriovenous malformations (AVMs). The method has high validity and minimal invasiveness, but late-onset problems involving tumor formation and vasculopathy induced by radiation have been reported. We present a rare case of a radiation-induced ruptured de novo aneurysm following Gamma Knife surgery (GKS) for an AVM. A 17-year-old, right-handed male underwent GKS for AVM at the left parietal lobe. After 3 years, a follow-up angiogram showed a residual AVM at the angular gyrus. Then, a 2nd GKS was performed for the residual lesion. Six years after the 1st GKS, the AVM disappeared on the angiogram. Seven years later, he suffered a sudden onset of headache. A left carotid angiogram revealed a ruptured aneurysm at the M2-M3 junction of the middle cerebral artery parietal branch. Coil embolization was performed, and the aneurysm was occluded. The patient was discharged without any neurologic deficits.
Stereotact Funct Neurosurg 2017;95:379-384
http://ift.tt/2niT3is
Suppressed Adiponectin Levels and Increased Adiponectin Response to Oral Glucose Load in Lean Women with Severe Acne Normalizes after Isotretinoin Treatment
Dermatology
http://ift.tt/2ipGmkg
The IgG response against Staphylococcus aureus is associated with severe atopic dermatitis in children
Abstract
Background
An altered immune response against Staphylococcus (S.) aureus might contribute to inflammation and barrier damage in atopic dermatitis (AD).
Objectives
We profiled IgG antibodies against 55 S. aureus antigens in sera of children with mild to severe AD using a Luminex assay. Additionally, we evaluated the association between IgG levels and disease severity.
Methods
In this cross-sectional study, we included children with AD of two interventional study cohorts, namely SMA (n= 131) and the older DAVOS cohort (n= 76). AD severity was assessed using the Self Administrated-Eczema Area and Severity Index (SA-EASI) and levels of thymus and activation-regulated chemokine (TARC) in serum. IgG antibody levels against 55 S. aureus antigens were quantified simultaneously using a Luminex assay. Pair-wise correlations were calculated between the 55 IgG levels using the Spearman rank correlation test. A linear regression analysis was performed to test for associations between 55 IgG levels and SA-EASI and TARC adjusting for age, sex and S. aureus colonisation.
Results
In the SMA cohort 16 antigens were associated with SA-EASI and 12 antigens were associated with TARC (10 overlapping antigens; P-values from 0.001 to 0.044). The associated IgG antibodies targeted mainly secreted proteins with immune-modulatory functions. In the DAVOS study, IgG levels against only four and one S. aureus antigen(s) were associated with SA-EASI and TARC, respectively (no overlap).
Conclusions
In young children, severity of AD is associated with an IgG response directed against S. aureus antigens with mainly immune-modulatory functions. These findings encourage further evaluation of the role of S. aureus in AD pathogenesis.
This article is protected by copyright. All rights reserved.
http://ift.tt/2kbORzY
Individualized Treatment Approaches for Langerhans Cell Histiocytosis
Langerhans cell histiocytosis (LCH) belongs to the rare histiocytic disorders, and has an estimated incidence of 1-2 cases per million adults [1]. Myeloid dendritic cells that express the same antigens (CD1a, CD207) as epidermal Langerhans cell seem to be the precursor cells for LCH [2]. Clinical presentation of patients with LCH may vary in site and extent of involvement. In 45% of patients LCH manifests as a multisystem disease including 77% bone, 39% skin, 19% lymph node, 16% liver, 13% spleen, 13% oral mucosa, 10% lung, and 6% CNS involvement [3].
This article is protected by copyright. All rights reserved.
http://ift.tt/2BnlkGO
Involvement of the middle frontal gyrus in language switching as revealed by electrical stimulation mapping and functional magnetic resonance imaging in bilingual brain tumor patients
Publication date: February 2018
Source:Cortex, Volume 99
Author(s): Joanna Sierpowska, Alejandro Fernandez-Coello, Alba Gomez-Andres, Àngels Camins, Sara Castañer, Montserrat Juncadella, Andreu Gabarrós, Antoni Rodríguez-Fornells
Neural basis of language switching and the cognitive models of bilingualism remain controversial. We explored the functional neuroanatomy of language switching implementing a new multimodal protocol assessing neuropsychological, functional magnetic resonance and intraoperative electrical stimulation mapping results.A prospective series of 9 Spanish–Catalan bilingual candidates for awake brain surgery underwent a specific language switching paradigm implemented both before and after surgery, throughout the electrical stimulation procedure and during functional magnetic resonance both pre- and postoperatively. All patients were harboring left-hemispheric intrinsic brain lesions and were presenting functional language-related activations within the affected hemisphere.Language functional maps were reconstructed on the basis of the intraoperative electrical stimulation results and compared to the functional magnetic resonance findings. Single language-naming sites (Spanish and Catalan), as well as language switching naming sites were detected by electrical stimulation mapping in 8 patients (in one patient only Spanish related sites were detected). Single naming points outnumbered the switching points and did not overlap with each other. Within the frontal lobe, the single language naming sites were found significantly more frequently within the inferior frontal gyrus as compared to the middle frontal gyrus [X2 (1) = 20.3, p < .001]. Contrarily, switching naming sites were distributed across the middle frontal gyrus significantly more often than within the inferior frontal gyrus [X2 (1) = 4.1, p = .043]. Notably, there was not always an overlap between functional magnetic resonance and electrical stimulation mapping findings. After surgery, patients did not report involuntary language switching and their neuropsychological scores did not differ significantly from the pre-surgical examinations. Our results suggest a functional division of the frontal cortex between naming and language switching functions, supporting that non-language specific cognitive control prefrontal regions (middle frontal gyrus) are essential to maintain an effective communication together with the classical language-related sites (inferior frontal gyrus).
http://ift.tt/2ngjKEp
Scholar : These new articles for Acute Cardiac Care are available online
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Scholar : These new articles for Advances in Mental Health are available online
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Scholar : Studies in Chinese Religions, Volume 3, Issue 3, September 2017 is now available online on Taylor & Francis Online
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Summary Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an un...
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