Ιατρικά Άρθρα: 01/25/18

Πέμπτη 25 Ιανουαρίου 2018

Cutaneous non-tuberculous mycobacteria in Western Sydney, Australia. Population study 1996–2013

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Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: A randomised controlled trial

BACKGROUND The benefit of adding opioid to a local anaesthetic for continuous thoracic paravertebral analgesia after video-assisted thoracic surgery (VATS) is unclear. OBJECTIVES To analyse the analgesic efficacy of ropivacaine and sufentanil in combination compared with ropivacaine alone after VATS. DESIGN A randomised, double-blinded, single-centre clinical trial. SETTING A tertiary university hospital between March 2010 and April 2014. PATIENTS Ninety patients were recruited, two were not included leaving 88 randomised into two groups. Eighteen patients were excluded from analysis and 70 completed the study. INTERVENTION To receive thoracic paravertebral analgesia with either 2 mg ml−1 ropivacaine and 0.25 μg ml−1 sufentanil (ropivacaine + sufentanil group) or 2 mg ml−1 ropivacaine alone (ropivacaine group) for 48 h postoperatively. Infusion rate was set at 0.15 ml kg−1 h−1 in both groups. MAIN OUTCOME MEASURES The primary endpoint was the mean total amount of self-administered morphine by the patients in each group at 48 h postoperatively. RESULTS The mean ± SD total amount of self-administered morphine was not significantly different between groups (53.1 ± 27.2 mg in the ropivacaine + sufentanil group vs. 58.8 ± 34.3 mg in the ropivacaine group; P = 0.72). No significant differences were found between the two groups in either in pain scores at rest or during movement, in opioid-related adverse reactions, in patient satisfaction or length of hospital stay. CONCLUSION Adding 0.25 μg ml−1 sufentanil to 2 mg ml−1 ropivacaine in continuous thoracic paravertebral analgesia for VATS did not reduce morphine consumption or pain scores when compared with ropivacaine alone. We cannot recommend its use for routine clinical practice. Further studies analysing different concentrations and infusion rates of sufentanil are needed before a lack of efficacy can be confirmed. TRIAL REGISTRATION Clinical trial registrations: EudraCT: 2009-014832-38. ClinicalTrials.gov: NCT 01082744. Correspondence to Christian Bauer, MD, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Anesthésie-Réanimation, 103 grande rue de la Croix-Rousse, 69004 Lyon, France Tel: +33 426732660; e-mail: christian.bauer@chu-lyon.fr Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Comparison of double intravenous vasopressor automated system using nexfin versus manual vasopressor bolus administration for maintenance of haemodynamic stability during spinal anaesthesia for caesarean delivery: A randomised double-blind controlled trial

BACKGROUND Hypotension is a common side effect of spinal anaesthesia during caesarean delivery and is associated with maternal and foetal adverse effects. We developed an updated double intravenous vasopressor automated (DIVA) system that administers phenylephrine or ephedrine based on continuous noninvasive haemodynamic monitoring using the Nexfin device. OBJECTIVE The aim of our present study is to compare the performance and reliability of the DIVA system against Manual Vasopressor Bolus administration. DESIGN A randomised, double-blind controlled trial. SETTING Single-centre, KK Women's and Children's Hospital, Singapore. PATIENTS Two hundred and thirty-six healthy women undergoing elective caesarean delivery under spinal anaesthesia. MAIN OUTCOME MEASURES The primary outcome was the incidence of maternal hypotension. The secondary outcome measures were reactive hypertension, total vasopressor requirement and maternal and neonatal outcomes. RESULTS The DIVA group had a significantly lower incidence of maternal hypotension, with 39.3% (46 of 117) patients having any SBP reading less than 80% of baseline compared with 57.5% (65 of 113) in the manual vasopressor bolus group (P = 0.008). The DIVA group also had fewer hypotensive episodes than the manual vasopressor bolus group (4.67 versus 7.77%; P

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The association between multiple pilomatrixomas and APC gene mutations

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Investigation of relationship between precursor of miRNA-944 and its mature form in lung squamous-cell carcinoma - the diagnostic value

Publication date: Available online 10 January 2018
Source:Pathology - Research and Practice
Author(s): Tomasz Powrózek, Radosław Mlak, Marcin Dziedzic, Teresa Małecka-Massalska, Dariusz Sagan
IntroductionMicroRNA (miRNA) are attractive markers of lung cancer, due to their regulatory role in cell cycle. However, we know more about function of miRNA in cancer development, there is still little known about role of their precursors (primary miRNA; pri-miRNA) in tumorgenesis. In present study we investigated potential role of miRNA-944 and its precursor pri-miRNA-944 in development of squamous-cell lung cancer (SCC) and explored interdependence between miRNA precursor and its mature form. This is a first available literature report analyzing pri-miRNA as a cancer diagnostic marker.Material and methodsExpression of miRNA-944 and its precursor was analyzed in 58 fresh-frozen tissues of non-small cell lung cancer and corresponding adjacent non-cancerous tissues using qRT-PCR. Expression of pri-miRNA-944 was correlated with TP63 and miRNA-944. Using ROC analysis diagnostic accuracy of studied markers was evaluated.ResultsmiRNA-944 and its precursor were significantly overexspressed in SCC compared to adenocarcinoma (AC) and non-cancerous tissue. pri-miRNA-944 strongly and positively correlated with TP63 (r = 0.739, p < 0.001) and with mature miRNA-944 expression (r = 0.691, p < 0.001). Also, TP63 expression significantly correlated with mature miRNA (r = 0.785, p < 0.001). Combined analysis of pri-miRNA-944 and mature miRNA-944 allowed to distinguish SCC tissue form AC with sensitivity of 93.3% and specificity of 100% (AUC = 0.978), and SCC from non-cancerous tissue with 92.9% sensitivity and 100% specificity (AUC = 0.992).ConclusionWe assumed that pri-miRNA-944 and miRNA-944 may be involved in early squamous-type differentiation of lung tumors. Moreover, analysis of both markers provided high diagnostic accuracy for SCC detection.

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Mutant KRAS Circulating Tumor DNA Is an Accurate Tool for Pancreatic Cancer Monitoring

AbstractBackground.Many new pancreatic cancer treatment combinations have been discovered in recent years, yet the prognosis of pancreatic ductal adenocarcinoma (PDAC) remains grim. The advent of new treatments highlights the need for better monitoring tools for treatment response, to allow a timely switch between different therapeutic regimens. Circulating tumor DNA (ctDNA) is a tool for cancer detection and characterization with growing clinical use. However, currently, ctDNA is not used for monitoring treatment response. The high prevalence of KRAS hotspot mutations in PDAC suggests that mutant KRAS can be an efficient ctDNA marker for PDAC monitoring.Subjects, Materials, and Methods.Seventeen metastatic PDAC patients were recruited and serial plasma samples were collected. CtDNA was extracted from the plasma, and KRAS mutation analysis was performed using next‐generation sequencing and correlated with serum CA19‐9 levels, imaging, and survival.Results.Plasma KRAS mutations were detected in 5/17 (29.4%) patients. KRAS ctDNA detection was associated with shorter survival (8 vs. 37.5 months). Our results show that, in ctDNA positive patients, ctDNA is at least comparable to CA19‐9 as a marker for monitoring treatment response. Furthermore, the rate of ctDNA change was inversely correlated with survival.Conclusion.Our results confirm that mutant KRAS ctDNA detection in metastatic PDAC patients is a poor prognostic marker. Additionally, we were able to show that mutant KRAS ctDNA analysis can be used to monitor treatment response in PDAC patients and that ctDNA dynamics is associated with survival. We suggest that ctDNA analysis in metastatic PDAC patients is a readily available tool for disease monitoring.Implications for Practice.Avoiding futile chemotherapy in metastatic pancreatic ductal adenocarcinoma (PDAC) patients by monitoring response to treatment is of utmost importance. A novel biomarker for monitoring treatment response in PDAC, using mutant KRAS circulating tumor DNA (ctDNA), is proposed. Results, although limited by small sample numbers, suggest that ctDNA can be an effective marker for disease monitoring and that ctDNA level over time is a better predictor of survival than the dynamics of the commonly used biomarker CA19‐9. Therefore, ctDNA analysis can be a useful tool for monitoring PDAC treatment response. These results should be further validated in larger sample numbers.

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Prospective Evaluation of the Impact of the 21‐Gene Recurrence Score Assay on Adjuvant Treatment Decisions for Women with Node‐Positive Breast Cancer in Ontario, Canada

AbstractBackground.The 21‐gene Recurrence Score (RS) assay is only reimbursed in Ontario for node‐negative and micrometastatic node‐positive (N+) early‐stage breast cancer (EBC). We carried out a prospective study to evaluate the impact of the assay on treatment decisions for women with N+ EBC.Subjects, Materials, and Methods. Women with estrogen receptor‐positive, human epidermal growth receptor 2‐negative EBC and one to three positive axillary lymph nodes, who were candidates for adjuvant chemotherapy in addition to hormonal treatment, but in whom the benefit of chemotherapy was uncertain, were eligible. The primary objective was to characterize how the results of the RS assay affected physicians' recommendations for adjuvant chemotherapy. Secondary objectives were to characterize changes in the physicians' and patients' level of confidence in treatment recommendations, to determine whether the results of the RS assay affected patients' treatment preferences, and to determine the final treatment administered.Results.Seventy‐two patients were recruited; the mean age was 61. RS was <18 in 55%, between 18 and 30 in 36%, and ≥31 in 9% of patients. Treatment recommendations changed in 36% of all evaluable patients. The most significant change was in the group with a low RS. Physicians' and patients' confidence in treatment recommendations increased in 49% and 54% of cases, respectively. Upfront chemotherapy was recommended to 79% of patients before the assay; 42% ultimately received chemotherapy.Conclusion.The RS assay resulted in a substantial decrease in the number of patients who received chemotherapy and in an increase in physicians' and patients' confidence in the adjuvant treatment recommendations.Implications for Practice.This is the first decision impact study to include exclusively women with ER‐positive, HER2‐negative, early‐stage breast cancer with 1–3 positive lymph nodes, a population typically treated with adjuvant chemotherapy. This study provides evidence that, in these patients, the Oncotype Dx Recurrence Score assay influences systemic treatment decisions. Most of the changes in treatment recommendation resulted in withdrawal of chemotherapy or change in recommendation from a chemotherapy regimen with anthracyclines to a taxane‐only regimen. If prospective studies confirm that these decisions result in good outcomes, a reduction in the use of chemotherapy might result in pharmacoeconomic savings.

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EMA Review of Daratumumab for the Treatment of Adult Patients with Multiple Myeloma

AbstractOn May 20, 2016, a conditional marketing authorization valid through the European Union (EU) was issued for daratumumab as monotherapy for the treatment of adult patients with relapsed and refractory multiple myeloma, whose prior therapy included a proteasome inhibitor (PI) and an immunomodulatory drug (IMiD) and who had demonstrated disease progression on the last therapy. The review of daratumumab was conducted under the EMA's accelerated assessment program for drugs that are of major interest for public health, especially from the point of view of therapeutic innovation.Daratumumab monotherapy achieved an overall response rate of 29.2% (95% confidence interval [CI] 20.8 to 38.9) in patients with multiple myeloma who had received at least three prior lines of therapy (including a PI and IMiD) or were double refractory to a PI and an IMiD (Study MMY2002). In patients with multiple myeloma relapsed from or refractory to two or more different prior therapies, including IMiDs (e.g., thalidomide, lenalidomide) and PI, an overall response was observed in 15 patients (35.7%, 95% CI: 21.6 to 52.0) (Study GEN501).On April 28, 2017, the therapeutic indication was extended to include the use of daratumumab in combination with lenalidomide and dexamethasone, or bortezomib and dexamethasone, for the treatment of adult patients with multiple myeloma who have received at least one prior therapy. This was based on two subsequent phase III studies of daratumumab in combination with lenalidomide/low‐dose dexamethasone (MMY3003) and bortezomib/low dose dexamethasone (MMY3004).The most common side effects (grade 3–4) associated with daratumumab included neutropenia (37%), thrombocytopenia (23%), anemia (16%), pneumonia (10%), lymphopenia (8%), infusion‐related reactions (6%), upper respiratory tract infection (5%), and fatigue (5%).The objective of this study was to summarize the scientific review done by the CHMP of the application leading to regulatory approval in the EU. The full scientific assessment report and product information, including the Summary of Product Characteristics (SmPC), are available on the EMA website (http://ift.tt/2nh9lFx for Practice.A conditional Marketing authorization was issued in the European Union for daratumamb as monotherapy for the treatment of adult patients with relapsed and refractory multiple myeloma, based on the response rate data from two single‐agent studies. Darzalex, a novel monoclonal antibody targeted against CD38, demonstrated a durable response rate in a heavily pre‐treated population with limited treatment options based on the response rate data from two single‐agent studies. The addition of daratumumab to lenalidomide and dexamethasone (study MMY3003), or bortezomib and dexamethasone (MMY3004), demonstrated a positive effect on progression‐free survival in patients with multiple myeloma who had received at least one prior therapy. Following submission of the controlled data of the MMY3003 and MMY3004 studies, the efficacy and safety of daratumumab was confirmed and the approval of daratumumab was converted to standard approval.

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Chemotherapy Toxicity Risk Score for Treatment Decisions in Older Adults with Advanced Solid Tumors

AbstractBackground.The decision whether to treat older adults with advanced cancer with standard therapy (ST) or reduced therapy (RT) is complicated by heterogeneity in aging. We assessed the potential utility of the chemotherapy toxicity risk score (CTRS) [J Clin Oncol 2011;29:3457–3465] for treatment decisions in older adults.Materials and Methods.This was a prospective observational study of patients aged ≥65 years receiving first‐line chemotherapy for advanced cancer for which combination chemotherapy is the standard of care. Patients were categorized as high risk (CTRS ≥10), for whom RT (dose‐reduced combination or single‐agent chemotherapy) is deemed appropriate, or nonhigh risk (CTRS <10), for whom ST is deemed appropriate for toxicity. The primary objective was to estimate the agreement in chemotherapy choice (ST vs. RT) between the treating physician and the CTRS using a κ statistic.Results.Fifty‐eight patients (median age, 71 years) were enrolled. Thirty‐eight patients received ST (21 had CTRS <10, and 17 had CTRS ≥10), and 20 patients received RT (12 had CTRS ≥10, and 8 had CTRS <10), with minimal agreement in chemotherapy choice (κ = 0.14; 95% CI, −0.10 to 0.38). Grade 3–4 toxicity and hospitalization occurred in 60% and 27% of 55 patients with follow‐up data, respectively. Among patients receiving ST, patients with CTRS ≥10 had a higher incidence of toxicity (88% vs. 40%, p = .006) and hospitalization (50% vs. 15%, p = .03) than those with CTRS <10.Conclusion.Older patients with cancer with a high CTRS who receive combination chemotherapy have an exceedingly high rate of severe toxicity and hospitalization.Implications for Practice.The potential utility of the chemotherapy toxicity risk score (CTRS) in old adults with advanced solid tumors receiving first‐line chemotherapy was assessed. Little agreement was found between chemotherapy treatment decisions based on the clinical impression versus what was recommended based on the CTRS. Among patients treated with standard‐dose combination chemotherapy, patients with CTRS ≥10 had a very high incidence of grade 3–4 toxicities and hospitalization, which was significantly greater than that of patients with a low CTRS (<10). These findings suggest that the addition of CTRS to the clinical impression has a potential to improve treatment decisions.

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Serious Illness Conversations: Paving the Road with Metaphors

AbstractSerious illness conversations can influence the direction of care by supporting decision‐making compatible with the patient's goals. Effective use of core communication techniques, such as active listening and empathic statements, allows for a deeper understanding of the patients' goals, concerns, communication preferences, and questions. Metaphors can be used to augment end‐of‐life care planning. Used inappropriately, metaphors can cause misunderstandings and confusion. Applied skillfully, metaphors can personalize challenging discussions, improving patient comprehension and helping patients and their families to plan ahead. The art of communication is to use the right tool for the right person at the right time.Implications for Practice.Discussions with patients about serious illness concerns are especially challenging for the oncologist. This article provides guidance for preparing for such conversations, including examples of the use of metaphors to personalize and improve communication.

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Chemoprevention in Patients with Peutz‐Jeghers Syndrome: Lessons Learned

AbstractLessons Learned. Motivating patients to enroll in chemopreventive studies is challenging.Chemoprevention with toxic drugs is not feasible.Background.LKB1 mutations are the underlying genetic abnormality causing Peutz‐Jeghers syndrome (PJS) and are a potential target for everolimus. In this phase II study, the efficacy of everolimus on polyp and tumor growth in PJS patients was investigated.Methods.Adult patients with a proven LKB1 mutation and who were suitable for everolimus treatment were included in two different PJS cohorts: (a) patients with unresectable malignancies and (b) patients with high‐risk polyps. Treatment in both groups was oral everolimus, 10 mg daily. Response rates were primary endpoints for both cohorts.Results.Between October 2011 and April 2016, only two patients were enrolled, one in each cohort. A 49‐year‐old patient with advanced pancreatic cancer in cohort 1 was progressive after 2 months. A 52‐year‐old male patient in cohort 2 experienced severe toxicity and refused treatment after 4 months, even though endoscopy suggested stabilization of polyps. Adverse events included dental inflammations, mucositis, and rash. In 2016, the trial was aborted for lack of accrual, despite extensive accrual efforts in an area where PJS is highly prevalent and care is highly centralized.Conclusion.Due to accrual problems, no conclusions can be drawn about the value of everolimus in PJS treatment, questioning the feasibility of this agent for chemoprevention.

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Single Arm, Phase II Study of Cisplatin, Docetaxel, and Erlotinib in Patients with Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinomas

AbstractLessons Learned. The combination of cisplatin, docetaxel, and erlotinib as frontline treatment for recurrent and/or metastatic head and neck squamous cell carcinomas led to a response rate of 62%.This result exceeded the prespecified target response rate of 50% and represented an improvement compared with historical controls.This regimen warrants further investigation.Background.The epidermal growth factor receptor (EGFR) plays a key role in the carcinogenesis of head and neck squamous cell carcinomas (HNSCC). We conducted this clinical study to test the hypothesis that the addition of erlotinib to first‐line cisplatin and docetaxel for patients with recurrent and/or metastatic HNSCC would yield a response rate of at least 50%, representing an improvement from historical controls.Methods.Patients with recurrent and/or metastatic HNSCC, with at least one measurable lesion, no prior chemotherapy for recurrent and/or metastatic disease, prior combined modality therapy completed >6 months before enrollment, and performance status ≤2 were treated with cisplatin, docetaxel, and erlotinib for up to six cycles, followed by maintenance erlotinib until disease progression. The primary endpoint was response rate.Results.Fifty patients were enrolled (42 male, 12 never smokers, 19 with oropharynx cancer). The median number of cycles was five; 31 patients initiated maintenance erlotinib; 14 patients required erlotinib dose reductions. The objective response rate was 62%, and the median progression‐free and overall survival were 6.1 and 11.0 months, respectively. Toxicity profiles were consistent with the known side effects of the study drugs.Conclusion.The study met its primary endpoint and improved response rates compared with historical controls. The findings support further evaluation of the regimen for recurrent and/or metastatic HNSCCs.

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Preparation and characterization of Na 2 S-modified biochar for nickel removal

Abstract

Biochar has good adsorption ability to various contaminants. In this work, peanut shell, corncob, cotton stalks, and crayfish shell were pyrolyzed under three temperatures (300, 450, 600 °C) to obtain biochars for the removal of Ni²⁺. The biochars were further modified with 2 mol/L Na₂S solution. Characterization results showed that the specific surface area and total pore volume of the modified biochars increased substantially. Among all the adsorbents, the modified corncob biochar (450 °C) showed the best Ni²⁺ adsorption. The adsorption kinetics followed the Elovich model with an equilibrium time of 24 h. The maximum capacity of the modified biochar reached 15.40 mg/g. The adsorption process was affected by pH, temperature, and coexisting ions. Increasing pH (under 7) provided more adsorption sites which enhanced adsorption capacity. Experimental results also indicated that the main adsorption mechanism of Ni²⁺ was ion exchange. Findings from this work suggest that modified biochar can be used as an effective adsorbent for the removal of Ni²⁺ from wastewater.

Graphical abstract

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Nurses at the Bedside-Who Will Be Left to Care?.

Author: Kennedy, Maureen Shawn MA, RN, FAAN

Page: 7

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Prioritizing Care Despite Personal Judgments.

Author: Severini, January RN

Page: 10

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Veterans and Mental Health.

Author: Harrigan, Pamela N. BSN, RN

Page: 10

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Nursing Students and Ethical Development.

Author: Howland, Wendie A. MN, RN-BC, CRRN, CNLCP, LNCC via ajnoffthecharts.com

Page: 10

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Involving Nursing Assistants in Nursing Home QI.

Author: Abrahamson, Kathleen PhD, RN; Davila, Heather MPA; Hountz, Diane DNP, MS, RN, ANP

Page: 11

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Nurse-Led Health Clinics Show Positive Outcomes.

Author: Sofer, Dalia

Page: 12

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Updated Recommendations for Women's Health.

Author: Zolot, Joan PA

Page: 13

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NewsCAP: The American Society of Clinical Oncology (ASCO) calls for interventions to reduce cancer deaths from alcohol.

Author:

Page: 13

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The CDC Updates Guidelines for Congenital Zika.

Author: Stockwell, Serena

Page: 14

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NewsCAP: Never use infant sleep positioners, also called nests or antiroll products, warns the Food and Drug Administration (FDA).

Author:

Page: 14

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Reducing Heart Failure Readmissions Has Risks.

Author: Mechcatie, Elizabeth BSN, MA

Page: 15

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NewsCAP: Environmental noise reduction can improve health.

Author:

Page: 15

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NewsCAP: Private transport is linked to greater survival for some trauma victims.

Author:

Page: 15

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Nurses Pass the Baton: Exit Baby Boomers, Enter Millennials.

Author: Sofer, Dalia

Page: 17-18

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Opioid Prescribing in the United States.

Author: Guy, Gery P. Jr. PhD, MPH; Shults, Ruth A. PhD, MPH, BSN

Page: 19-20

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AJN On the Cover.

Author: Szulecki, Diane Editor

Page: 21

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AJN On the Web.

Author:

Page: 21

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Removing Practice Barriers.

Author: Kritz, Fran

Page: 22-23

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Whether We Like It or Not.

Author: Schnoeker-Shorb, Yvette A.

Page: 42

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CE: Original Research: Physical Activity Among Chinese American Immigrants with Prediabetes or Type 2 Diabetes.

Author: Hu Sophia, H. PhD, RN; Fu Mei, R. PhD, RN, FAAN; Liu, Shan PhD, RN; Lin, Yen-Kuang PhD; Chang, Wen-Yin PhD, RN

Page: 24-32

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Assessment of health-related quality of life among Asthmatic patients: The need for structured pharmaceutical care delivery system in Pakistan

Madeeha Malik, Adeela Khan, Azhar Hussain, Ayisha Hashmi

Journal of Pharmacy And Bioallied Sciences 2017 9(4):272-278

Asthma is considered as one of the most common chronic diseases in the world. As a result of serious physical, social, and psychological complications, asthma can reduce health-related quality of life (HRQoL). The present study was designed to assess the HRQoL including physical health, general health perception, emotional health, psychological health, and social functioning of asthmatic patients in Pakistan. A descriptive cross-sectional study design was used. Setting was public and private healthcare facilities. SF-36 was self-administered to a sample of 382 asthmatic patients. After data collection, data were clean coded and entered in SPSS version 21.0. Skewness test was performed and histograms with normal curves were used to check the normal distribution of data. Descriptive statistics comprising of frequency and percentages was calculated. The non-parametric tests including Mann–Whitney and Kruskal–Walis (P ≥ 0.05) were performed to find out the difference among different variables. The results of the current study highlighted a significant impact on several domains of HRQoL for asthmatic patients. Lowest scores for HRQoL were observed in the domain of general health (27.74 ± 18.29) followed by domain of mental health (38.26 ± 20.76) whereas highest scores were observed in the domain of social functioning (45.64 ± 25.89). The results of the study concluded that asthmatic patients in Pakistan had poor HRQoL. Well-structured pharmaceutical care delivery in the healthcare facilities can contribute toward better patient knowledge and management and can ultimately improve the HRQoL of asthma patients.

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Quality of life among patients undergoing hemodialysis in Penang, Malaysia

Diana Laila Ramatillah, Syed Azhar Syed Sulaiman, Amer Hayat Khan, Ong Loke Meng

Journal of Pharmacy And Bioallied Sciences 2017 9(4):229-238

Background Quality of life is one of the parameters to check the improvement of hemodialysis treatment among hemodialysed patients. Those patients will be dealing with this treatment in long term if this treatment is the only way for them to replace their kidney function and this thing will affect their quality of life. Objective To evaluate the quality of life patients on hemodialysis using kidney disease quality of life-short term 24 (KDQoL-SF24) Malaysian Version. Materials and Methods Cohort observational study was conducted in this study. The study included 78 hemodialysed patients in HD center Penang, Malaysia. Results There were 9 components which had the lower of the mean and standard deviation (SD) than the standard form; work status (15.01 ± 35.57), cognitive function (75.66 ± 13.75), quality of life social interaction (76.32 ± 16.11), sleep (55.86 ± 15.30), social support (59.61 ± 22.08), patient satisfaction (43.24 ± 15.32), physical functioning (50.06 ± 42.81), general health (29.62 ± 25.56), and role emotional (54.27 ± 49.92). In this HD center, the group of patient's age who had the lower mean ± SD from the KDQoL-SF Manual Standard were the first and the sixth groups of patient's age (≤20 and 61–70). Conclusion The study conducted in HD center, Penang, Malaysia showed that the scoring of work status, cognitive function, quality of social interaction, sleep, social support, patient satisfaction, physical functioning, general health, and role emotional were low than standard form.

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Drug-drug interaction-related uncontrolled glycemia

Mohamed Anwar Hammad, Balamurugan Tangiisuran, Abeer Mohamed Kharshid, Noorizan Abdul-Aziz, Yahaya Hassan, Nor Azizah Aziz, Tarek Mohamed Elsayed

Journal of Pharmacy And Bioallied Sciences 2017 9(4):221-228

Context: The literature of drug-drug interaction (DDI)-related uncontrolled causality, and preventability of DDI-induced UCG (HbA1c >7%) in outpatients glycemia (UCG) among outpatients with Type 2 diabetes mellitus is still limited. Aims: The aim of this study is to identify the prevalence, mechanism, severity, with Type 2 diabetes. Settings and Design: A cross-sectional study was conducted in Penang General Hospital. Methods: A computerized system for DDI checking was used to assess the severity and mechanism of DDIs. Drug interaction probability scale was used to evaluate the likelihood of DDIs. Preventability of DDIs has been determined by the instrument of Hallas. The UCG prevalence related to DDIs was further assessed. Statistical Analysis Used: SPSS 21.00 was used in this study. Results: From 425 outpatients with HbA1c% test, their mean age was 58.7 ± 12.8 years. Only 225 (52.9%) cases had controlled glycemia while 200 (47.1%) cases with UCG. They had multiple comorbidities, with a mean number of 3.8 ± 2.2/patient and often prescribed with multiple medications, with a mean number of 6.33 ± 4.67/patient. It has been detected that 86 DDIs causing UCG in 46 patients (23%) with range of (1 – 4) DDIs per patient. Drugs with DDI-induced UCG were as follows: diuretics (79%), salbutamol (9.2%), cortisones (5.8%), and others (6%). The majority of these DDIs were categorized as possible (77.9%) and preventable (37%). Conclusion: Nearly one-quarter of UCG was induced by DDIs; most of these DDIs are possible, and more than one-third are preventable. It was concluded that thiazide diuretics have the highest prevalence of DDI-related UCG.

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Factors affecting primaquine combination treatment in Malaria patients in Selangor, Malaysia

Norliza Mat Ariffin, Farida Islahudin, Mohd Makmor-Bakry, Endang Kumolosasi, Mohd Hafizi A Hamid

Journal of Pharmacy And Bioallied Sciences 2017 9(4):239-245

Introduction: Primaquine is vital for the management of liver-stage Plasmodium vivax and Plasmodium ovale malaria. However, primaquine effectiveness is dependent on various factors and differs between populations. Therefore, this study was conducted to identify factors that affect the length of stay and relapse during primaquine combination treatment in malaria-infected patients in the local setting. Materials and Methods: A retrospective study on the use of primaquine combination among P. vivax and P. ovale infected patients in Selangor, Malaysia within a 5-year period from 2011 to 2015 was obtained from the National Malaria Case Registry, Malaysia. Data collected were patient characteristics (age, gender, nationality, glucose-6-phosphate dehydrogenase, pregnancy); disease characteristics (survival, past malaria infection, parasite type, presence of gametocyte, parasite count, week onset, severity, transmission type); and treatment characteristics (type of antimalarial, treatment completion). Outcome measures were length of stay and relapse during a 1-year follow-up. Results: A total of 635 patients were included in the study. Based on a multivariate logistic regression analysis, the significant predictors for length of stay were gender (P = 0.009) and indigenous transmission (P < 0.001). Male patients had a shorter length of stay than females by 0.868 days (P = 0.009), and indigenous transmission took 1.82 days more compared to nonindigenous transmission (P < 0.001). Predictors for relapse were indigenous transmission of malaria (P = 0.019), which was 15.83 times more likely to relapse than nonindigenous transmission (P < 0.01). Conclusions: This study reveals that the effectiveness of primaquine was clinically associated with gender and indigenous transmission. To that end, vigilant monitoring of primaquine use is required to reduce relapse and future transmission.

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Evaluation of teaching clinical pharmacology of antiarrhythmic drugs to first-year MBBS students through worksheet-based small-group discussion

Ameya A Hasamnis, Aditya Arya

Journal of Pharmacy And Bioallied Sciences 2017 9(4):282-283

Cardiac arrhythmias are a major cause of morbidity and mortality across the world. Learning the science behind the use of antiarrhythmic drugs is essential for all medical graduates. However, many antiarrhythmic drugs are available, and most of them have complex pharmacodynamic and pharmacokinetic profiles. We tried to improvise our teaching by conducting interactive, worksheet-based, small-group discussion on antiarrhythmic drugs with preclinical students of School of Medicine, Taylor's University, Malaysia. This survey was conducted to analyze the outcomes of worksheet-based, small-group discussion.

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Assessment of queries received by the drug information center at King Saud Medical City

Dlal Abdulrahman Almazrou, Sheraz Ali, Jasser Ali Alzhrani

Journal of Pharmacy And Bioallied Sciences 2017 9(4):246-250

Background: The complexity of drug therapies has increased the need to evaluate the drug information scientifically. In this regard, the aim of drug information centers (DICs) is to promote rational use of drugs in a health-care setting. DI pharmacists play a vital role in providing the necessary and reliable information on drugs to promote the concept of rational drug use, eventually leading to a better patient outcome. The objective of the present study was to assess the drug-related queries received by the DIC at the King Saud Medical City (KSMC) from health-care professionals working in a large tertiary care setting. Methods: A retrospective analysis was conducted from February 2016 to January 2017. Data were collected using the DI request form, available in both printed and electronic formats for use by the health-care professionals. Descriptive statistics were used to calculate frequencies and percentages. Data analysis was performed using the Statistical Package of the Social Sciences software, version 16.0. Results: The current study received a total of 139 queries that were answered by the DIC pharmacists over a period of 1 year. The majority of queries were asked by pharmacists (61.2%), followed by physicians (23.7%) and nurses (10.10%). About half of the queries were related to the dosage and administration of the drugs. Lexicomp® acted as the common resource of information. Conclusion: DIC has been instrumental in the dissemination of drug-related information to health-care professionals since its inception in February 2016, resulting in the provision of quality health care to the patients. However, based on yearly queries, there still exists a need to increase the awareness of health-care professionals about the DIC at KSMC, which will urge them to take drug consultation from DIC pharmacists and promote patient safety.

http://ift.tt/2DNBUEF

Utilization and impact of electronic and print media on the patients’ health status: Physicians’ perspectives

Sadia Shakeel, Shagufta Nesar, Najia Rahim, Wajiha Iffat, Hafiza Fouzia Ahmed, Mehwish Rizvi, Shazia Jamshed

Journal of Pharmacy And Bioallied Sciences 2017 9(4):266-271

Aims: Despite an increased popularity of print and electronic media applications, there is a paucity of data reflecting doctors' opinions regarding efficient utilization of these resources for the betterment of public health. Hence, this study aimed to investigate the perception of physicians toward the effect of electronic and print media on the health status of patients. Setting and Design: The current research is a cross-sectional study conducted from January 2015 to July 2015. The study population comprised physicians rendering their services in different hospitals of Karachi, Pakistan, selected by the nonprobability convenience sampling technique. In this study, 500 questionnaires were distributed through email or direct correspondence. Methods and Materials: Physicians' perception toward the impact of electronic and print media on the health status of patients was assessed with a 20-item questionnaire. Different demographic characteristics, such as age, gender, institution, position, and experience of respondents, were recorded. Quantitative data were analyzed with the use of Statistical Package for Social Sciences, version 20.0 (SPSS, Chicago, IL). The association of the demographic characteristics of the responses of physicians was determined by one-way ANOVA using 0.05 level of significance. Results: In this study, 254 physicians provided consent to show their responses for research purposes. A response rate of 50.8% was obtained. Nearly one-third of the respondents negated that patients get health benefit using electronic and print media. The majority did not consider electronic and print media as lifestyle-modifying factors. Physicians thought that patients particularly do not rely on mass media for acquiring health information and consider healthcare professionals as unswerving information resource. Conclusions: Mass media can be productive resources to augment awareness among patients, although physicians seem unconvinced about the extended usage of print/electronic media.

http://ift.tt/2FhqiH2

Academic stress and prevalence of stress-related self-medication among undergraduate female students of health and non-health cluster colleges of a public sector University in Dammam, Saudi Arabia

Fatima Al Rasheed, Atta Abbas Naqvi, Rizwan Ahmad, Niyaz Ahmad

Journal of Pharmacy And Bioallied Sciences 2017 9(4):251-258

Objective: The objective was to report academic stress and prevalence of stress-related self-medication among undergraduate female students of health and nonhealth cluster colleges at a public sector university in Dammam, Saudi Arabia. Materials and Methods: A 5-month cross-sectional survey was conducted in the university. The survey included the English version of 10-item Perceived Stress Scale (PSS) to report self-perceived stress. Student responses were analyzed by SPSS version 22 software. Results: The majority of students (85%) perceived examinations as a stressor. Most of the students (64%) had perceived moderate stress that increased as students progressed from preparatory year to 4th year. It declined in students of 5th and 6th year. The prevalence of stress related was reported at 39.58%. Highest prevalence of stress-induced self-medication was reported from College of Nursing (59.09%) and lowest (29.69%) from clinical pharmacy. Most common drug used to self-medicate during stress was caffeine (49.5%). The PSS score was significantly associated with colleges and study levels. Conclusion: Students studying in health cluster colleges reported high academic stress and self-medication practice. The major stressors identified were examination and course load. Student counseling sessions and counseling by pharmacists regarding self-care may help in the reduction of such stressors and may promote responsible self-medication. Self-evaluation and quality assurance process of curriculum may highlight areas for improvement in the courses. This may help in lowering academic stress among students.

http://ift.tt/2DPa9LQ

Moxibustion (Artemisia plant at acupuncture point) as alternative therapy in Hypertension: A promising approach

Mohammad Jamshed Siddiqui, Mohamad Fadly Bin Kamarudin, Abdul Kareem Mohammed Al-Shami, Siti Zaiton Mat So'ad, Shazia Qasim Jamshed

Journal of Pharmacy And Bioallied Sciences 2017 9(4):279-281

Hypertension is a pathological condition in which the blood pressure is higher than under normal physiological conditions, i.e., 140/90 mmHg or higher. Blood pressure is measured as the force exerted by the blood pumped by the heart against the walls of arteries (aorta) and distributed throughout the body. Use of complementary and alternative medicine as a cure for hypertension is a common phenomenon because of the high risk of cardiovascular complications and kidney diseases caused by conventional Western medicine. It is reported that high blood pressure causes ~49% of myocardial infarction and 62% of strokes. Effective treatment of hypertension is restricted by adverse effects and cost of the medication. Moxibustion is the application of heat by burning a small bundle of tightly bound moxa, to targeted acupoint, and sometimes it is used along with acupuncture. Encouraging results have been reported on randomized trials indicating the efficacy of moxibustion. But more controlled clinical trials are required to further establish the potential efficacy of moxibustion approach in hypertension.

http://ift.tt/2FhQPUR

Molecular simulation studies of 3,3′-Diindolylmethane as a Potent MicroRNA-21 Antagonist

Md Junaid, Raju Dash, Nazrul Islam, Jui Chowdhury, Md. Jahangir Alam, Saikat Dev Nath, Mohammad Abu Sayem Shakil, Ashifa Azam, Syed Mustyen Quader, SM Zahid Hosen

Journal of Pharmacy And Bioallied Sciences 2017 9(4):259-265

Objective: In recent decades, the overexpression of microRNA-21 (miR-21) is found to be progressively linked with many diseases such as different types of cancers, cardiovascular diseases, and inﬂammation. Thereby, it has become an attractive target for pharmacological and genetic modulation in various diseases, and also for overcoming the resistance to chemotherapy in several cancers. Here, in this study, the role of molecular therapeutics of 3,3′-diindolylmethane (DIM) has been investigated for its ability to bind with the precursor miRNA as a target of miR-21 (hsa-mir-21), which may alter the catalyzation process of dicer, a RNase III enzyme, involved in miRNA transcription. Methods: In this context, the present study describes the potential binding and the structure alteration properties of DIM to precursor miR-21 (pre-miR-21) through Molecular Docking and Molecular Dynamics simulation techniques. Results: As a corollary, DIM formed both non-bonded and covalent interactions with the bases of pre-miR, while covalent interaction with guanine in the 6th position was found to be consensus in molecular dynamics simulation. Furthermore, the stability of both DIM and pre-miR-21 was found to be inversely correlated to each other in binding condition. Conclusion: This result indicates that DIM can be used in target-based therapy and also as a lead for further development of potent small molecule miRNA antagonist.

http://ift.tt/2DLZ66a

Deflazacort-induced Acneiform Eruptions

Mohammed Shakeel Mohammed Bashir, Mohammad Saleem, Uday Choudhari

Journal of Pharmacy And Bioallied Sciences 2017 9(4):284-286

A 38-year-old male suffering from a low backache since 3 months was diagnosed as a case of L4-L5 disc prolapse after magnetic resonance imaging examination. He was treated with tolperisone, aceclofenac, and paracetamol in these drugs deflazacort added later. From the 2nd day of an addition of deflazacort in the therapy, sharply marginated, infiltrative, and erythematous skin eruptions with discrete itching sensations were seen. It was diagnosed as deflazacort-induced acneiform eruption and treated with doxycycline for 2 months which led to the disappearance of acneiform eruptions.

http://ift.tt/2FicyMm

Highly efficient degradation of berberine chloride form wastewater by a novel three-dimensional electrode photoelectrocatalytic system

Abstract

Fe₂O₃/graphite (Fe₂O₃/C) and nano-TiO₂-coated glass bead were prepared by impregnation and sol–gel method respectively and employed as the catalyst of a novel three-dimensional electrode photoelectrocatalytic (3-D PEC) system. The photoexcited electrons can transfer from TiO₂, Fe₂O₃ to counter electrode. It improves the migration of photoexcited charges, retards the fast recombination of electron–hole, and increases the lifetime of photogenerated holes (h⁺). In addition, the cycle reaction of Fe³⁺/Fe²⁺ on Fe₂O₃/C surface enhanced the Fenton reaction which can produce more hydroxyl radicals (·OH) and promote the capacity of mineralization of the pollutants. This novel 3-D PEC system showed excellent performance for the degradation of berberine chloride form (BCF). At the pH value of 3, 93% BCF was removed within 60 min; besides, 98.64% COD removal rate, 78.96% mineralization, 21.47% mineralization current efficiency, and just 3.16 kW h g⁻¹TOC energy cost were obtained in 120 min. In this study, we proposed the 3-D PEC mechanism. Electron spin resonance (ESR) and scavenging experiments suggest that the major reactive oxygen species (ROS) are superoxide radicals (O₂^·−), ·OH, and h⁺, while the role of sulfate radical (SO₄^·−) is insignificant. This work provides a new dimension for the design of reactors for wastewater treatment and the construction of the 3-D PEC system can potentially be utilized in water purification.

http://ift.tt/2E8wCRM

Hydration of dicalcium silicate and diffusion through neo-formed calcium-silicate-hydrates at weathered surfaces control the long-term leaching behaviour of basic oxygen furnace (BOF) steelmaking slag

Abstract

Alkalinity generation and toxic trace metal (such as vanadium) leaching from basic oxygen furnace (BOF) steel slag particles must be properly understood and managed by pre-conditioning if beneficial reuse of slag is to be maximised. Water leaching under aerated conditions was investigated using fresh BOF slag at three different particle sizes (0.5–1.0, 2–5 and 10 × 10 × 20 mm blocks) and a 6-month pre-weathered block. There were several distinct leaching stages observed over time associated with different phases controlling the solution chemistry: (1) free-lime (CaO) dissolution (days 0–2); (2) dicalcium silicate (Ca₂SiO₄) dissolution (days 2–14) and (3) Ca–Si–H and CaCO₃ formation and subsequent dissolution (days 14–73). Experiments with the smallest size fraction resulted in the highest Ca, Si and V concentrations, highlighting the role of surface area in controlling initial leaching. After ~2 weeks, the solution Ca/Si ratio (0.7–0.9) evolved to equal those found within a Ca–Si–H phase that replaced dicalcium silicate and free-lime phases in a 30- to 150-μm altered surface region. V release was a two-stage process; initially, V was released by dicalcium silicate dissolution, but V also isomorphically substituted for Si into the neo-formed Ca–Si–H in the alteration zone. Therefore, on longer timescales, the release of V to solution was primarily controlled by considerably slower Ca–Si–H dissolution rates, which decreased the rate of V release by an order of magnitude. Overall, the results indicate that the BOF slag leaching mechanism evolves from a situation initially dominated by rapid hydration and dissolution of primary dicalcium silicate/free-lime phases, to a slow diffusion limited process controlled by the solubility of secondary Ca–Si–H and CaCO₃ phases that replace and cover more reactive primary slag phases at particle surfaces.

http://ift.tt/2DCRXBV

Effects of integrated Neuromuscular Inhibition Technique on pain threshold and pain intensity in patients with upper trapezius trigger points

Publication date: Available online 17 January 2018
Source:Journal of Bodywork and Movement Therapies
Author(s): Zahra Saadat, Ladan Hemmati, Soraya Pirouzi, Mahnaz Ataollahi, Fatemeh Ali-mohammadi
IntroductionUpper trapezius trigger points are among the most common causes of neck pain. This study aimed to investigate the effects of integrated Neuromuscular Inhibition Technique (INIT) on pain intensity and threshold.Materials & MethodsThirty two female participants with upper trapezius trigger points were recruited in this study. The participants were assigned to control (n = 16) or intervention (n = 16). The intervention group received INIT in one session, consisted of muscle energy technique, ischemic compression and strain-counter strain. Pain threshold and intensity were measured using Pressure Pain Threshold (PPT) and Numerical Pain Scale (NPS). These measurements were performed at baseline, immediately after treatment and 24 h after treatment.FindingsThe results showed that pain intensity significantly decreased in the intervention group immediately after treatment (P = .01) and 24 h after treatment (P = .009) in comparison with the control group. There were no significant differences in pressure pain threshold between both groups.ConclusionIt seems that Integrated Neuromuscular Inhibition Technique can reduce pain intensity in patients with upper trapezius trigger points.

http://ift.tt/2DCLIlu

Editorial Board

Publication date: January 2018
Source:Journal of Bodywork and Movement Therapies, Volume 22, Issue 1

http://ift.tt/2Bu9eew

Postneedling soreness after myofascial trigger point dry needling: Current status and future research

Publication date: Available online 17 January 2018
Source:Journal of Bodywork and Movement Therapies
Author(s): Aitor Martín-Pintado-Zugasti, Orlando Mayoral del Moral, Robert D. Gerwin, Josue Fernández-Carnero
Post-dry needling soreness is a common complication of myofascial trigger point (MTrP) dry needling treatment. The prevention, management and relevance of this complication remain uncertain. This paper examines the current state of knowledge and suggests directions for further studies in this area. MTrPs are hypersensitive nodules in skeletal muscles' taut bands, present in several pain conditions. Dry needling has been recommended for relieving MTrP pain. MTrP dry needling procedures have shown to be associated with postneedling soreness, which is thought to be a consequence of the neuromuscular damage, and hemorrhagic and inflammatory reaction generated by the needle. Postneedling soreness is a very frequent effect after deep dry needling, usually lasting less than 72 h. It may not be especially distressing for most patients. However, patients presenting with higher levels of postneedling soreness, not perceiving dry needling effectiveness in the first session, or not having high myofascial pain intensity before treatment, could be the most likely to find postneedling soreness more distressing, functionally limiting and to abandon treatment. Future research should assess the clinical relevance of postneedling soreness. Postneedling soreness should be considered when investigating dry needling effectiveness since it could overlie the original myofascial pain and influence the patients' pain ratings.

http://ift.tt/2ncWAwc

Impacts of urbanization on regional nonpoint source pollution: case study for Beijing, China

Abstract

Due to limits on available data, the effects of urban sprawl on regional nonpoint source pollution (NPS) have not been investigated over long time periods. In this paper, the characteristics of urban sprawl from 1999 to 2014 in Beijing were explored by analyzing historical land-use data. The Event Mean Concentration data have been collected from all available references, which were used to estimate the variation in urban NPSs. Moreover, the impacts of variation in urban sprawl on regional NPSs were qualified. The results indicated that the urbanization process showed different influences on pollutants, while COD and TN were identified as key NPS pollutants. Residential areas contributed more NPS pollutants than did roads, which played a tremendous role in the control of urban NPS. The results also suggested in part that the impact of urban sprawl on the variation of COD decreased while TN increased in Beijing during the study period. These results would provide insight into the impacts of urban sprawl on NPS variation over a long period, as well as the reference for reasonable urban planning directives.

http://ift.tt/2naScxY

Solar energy harvesting by magnetic-semiconductor nanoheterostructure in water treatment technology

Abstract

Photocatalytic degradation of toxic organic pollutants in the wastewater using dispersed semiconductor nanophotocatalysts has a number of advantages such as high activity, cost effectiveness, and utilization of free solar energy. However, it is difficult to recover and recycle nanophotocatalysts since the fine dispersed nanoparticles are easily suspended in waters. Furthermore, a large amount of photocatalysts will lead to color contamination. Thus, it is necessary to prepare photocatalysts with easy separation for the reusable application. To take advantage of high photocatalysis activity and reusability, magnetic photocatalysts with separation function were utilized. In this review, the photocatalytic principle, structure, and application of the magnetic-semiconductor nanoheterostructure photocatalysts under solar light are evaluated.

Graphical abstract

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http://ift.tt/2n8m6CX

Comparative impact of systemic delivery of atorvastatin, simvastatin, and lovastatin on bone mineral density of the ovariectomized rats

Abstract

Purpose

In addition to lipid-lowering properties, statins have been suggested to affect bone turnover by increasing the osteoblastic bone formation and blocking the osteoclastogenesis. However, there are many controversial reports regarding the beneficial effect of statins on osteoporosis. In this study, we investigated the therapeutic effects of the most important lipophilic statins administered orally for 60 days to the ovariectomized (OVX) female Sprague–Dawley rats and compared the effects on different harvested trabecular and compact bones.

Methods

Thirty female rats were divided into five equal groups including the normal rats, untreated OVX rats (negative control), and the OVX rats treated with atorvastatin (20 mg/kg/day), simvastatin (25 mg/kg/day), and lovastatin (20 mg/kg/day). The osteoporotic animals were treated daily for 60 days and euthanized at the end of experiments. The effectiveness of these treatments was evaluated by biomechanical testing, histopathologic, histomorphometric, micro-CT scan, real-time PCR, and serum biochemical analysis. Moreover, the hepatotoxicity and rhabdomyolysis related with these treatments were assessed by biochemistry analysis and histopathological evaluation.

Results

The results and statistical analysis showed that systemic delivery of simvastatin and lovastatin significantly increased serum calcium level, expression of osteogenic genes, bone mineral density (BMD), and biomechanical properties in comparison to the untreated OVX rats, especially in trabecular bones (P < 0.05). The results of different analysis also indicated that there was no statistical difference between the atorvastatin-treated animals and the negative control. Among all treatments, only atorvastatin showed an evident hepatotoxicity and myopathy.

Conclusions

It was concluded that the lovastatin and simvastatin efficiently ameliorated the OVX-induced osteoporosis. Moreover, the simvastatin-treated animals showed more resemblance to the normal group in terms of BMD, expression of osteogenic genes, serum biochemical parameters, histomorphometric findings, and biomechanical performance with no significant side-effects.

http://ift.tt/2DLdnA1

Comparative impact of systemic delivery of atorvastatin, simvastatin, and lovastatin on bone mineral density of the ovariectomized rats

Abstract

Purpose

Methods

Results

Conclusions

http://ift.tt/2Dz3Rg8

Terbinafine-induced liver injury may be asymptomatic: need for regular monitoring: reply from the authors

http://ift.tt/2DH8mcE

Propranolol Hydrochloride (Hemangiol) [Internet].

Infantile hemangiomas (IHs) are the most common vascular tumours occurring in children. The incidence and prevalence of IH in Canada is uncertain; however, the manufacturer has estimated that the incidence of IH ranges from 4.5% to 10.0%. Hemangiol is an oral solution containing 3.75 mg/mL propranolol that is indicated for the treatment of proliferating IH requiring systemic therapy in the following circumstances: life- or function-threatening hemangioma; ulcerated hemangioma with pain and/or lack of response to simple wound care measures; or hemangioma with a risk of permanent scarring or disfigurement. The manufacturer has requested that propranolol oral solution receive a recommendation to reimburse in accordance with the Health Canada–approved indication.

http://ift.tt/2DChPhq

Soaking Up the Rays: Light Therapy and Visual Culture in Britain, c. 1890–1940.

Soaking up the rays forges a new path for exploring Britain's fickle love of the light by investigating the beginnings of light therapy in the country, from c.1890–1940. Despite rapidly becoming a leading treatment for tuberculosis, rickets and other infections and skin diseases, light therapy was a contentious medical practice. Bodily exposure to light, whether for therapeutic or aesthetic ends, persists as a contested subject to this day: recommended to counter psoriasis and other skin conditions as well as Seasonal Affective Disorder (SAD) and depression; closely linked to notions of beauty, happiness and well-being, fuelling tourism to sunny locales abroad and the tanning industry at home; and yet with repeated health warnings that it is a dangerous carcinogen. By analysing archival photographs, illustrated medical texts, advertisements, lamps, and goggles and their visual representation of how light acted upon the body, Woloshyn assesses their complicated contribution to the founding of light therapy. Soaking up the rays will appeal to those intrigued by medicine's visual culture, especially academics and students of the histories of art and visual culture, material cultures, medicine, science and technology, and popular culture.

http://ift.tt/2E5orpj

Pathogen-Reduced Platelets for the Prevention of Bleeding

This Clinical Evidence Synopsis summarizes 12 randomized clinical trials to compare whether pathogen-reduced platelets are as effective as standard platelets for the prevention of bleeding in platelet transfusions.

http://ift.tt/2ndiZsr

Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Systematic Review for the U.S. Preventive Services Task Force [Internet].

We conducted this systematic review to support the U.S. Preventive Services Task Force (USPSTF) in updating its 2012 recommendation on behavioral counseling to promote a healthful diet and physical activity for the primary prevention of cardiovascular disease (CVD) in adults without known CVD risk factors. Our review addressed four key questions: 1) Do primary care behavioral counseling interventions to improve diet, increase physical activity, and/or reduce sedentary behavior improve health outcomes in adults? 2) Do primary care behavioral counseling interventions to improve diet, increase physical activity, and/or reduce sedentary behavior improve intermediate outcomes associated with CVD in adults? 3) Do primary care behavioral counseling interventions to improve diet, increase physical activity, and/or reduce sedentary behavior improve associated health behaviors in adults? 4) What adverse events are associated with primary care behavioral counseling interventions to improve diet, increase physical activity, and/or reduce sedentary behavior in adults?

http://ift.tt/2DzJM9w

Metronomic Therapy for Progressive Pediatric Solid Malignant Tumors—Reply

In Reply We thank Fang et al for their interest in our study. Just eyeballing the progression-free and overall survival Kaplan-Meier curves, it is evident that survival experiences in both arms of the study are essentially similar without any meaningful difference. The restricted mean survival (event-free) time (RMST) up to a specific time point is an attractive new but seldom-used alternative approach to evaluate differences in the Kaplan-Meier curves, if the curves show apparent differences and the proportional hazards assumption is not plausible. When Kaplan-Meier curves overlap with no apparent differences, the proportional hazards assumption is redundant. Furthermore, the RMST approach needs a prespecification of time point because it varies with the time point at which we truncate our graphs for assessing clinically meaningful outcomes.

http://ift.tt/2DE28dv

Screening for Obesity and Interventions for Weight Management in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet].

Overweight and obesity are common among children and adolescents in the United States, are associated with a number of negative health effects, and increase the likelihood of obesity in adulthood.

http://ift.tt/2E9T7G9

Patient Portal Use in Oncology Practice

This study examines the association of accessing electronic oncology patient portal data with patient characteristics and type of portal content.

http://ift.tt/2nb5aLb

Metronomic Therapy for Progressive Pediatric Solid Malignant Tumors

To the Editor First of all, we congratulate Pramanik et al for carrying out the first randomized clinical trial in the field of metronomic chemotherapy. However, we would like to raise some pertinent issues.

http://ift.tt/2DDvzfN

Metronomic Therapy for Progressive Pediatric Solid Malignant Tumors

To the Editor In the trial conducted by Pramanik and colleagues for treating progressive pediatric solid malignant tumors, the primary end point was progression-free survival (PFS). The hazard ratio (HR) for metronomic chemotherapy vs best supportive care (BSC) was 0.69 (95% CI, 0.47-1.03; P = .07). Numerically, this HR value is impressive, but it is not statistically significant. Therefore, the authors concluded that metronomic chemotherapy would not improve PFS, compared with placebo, among pediatric patients with extracranial progressive solid malignant tumors. The profile of the difference of the 2 Kaplan-Meier PFS curves in Figure 2 of the article for metronomic chemotherapy and BSC suggests that the proportional hazards model assumption is not plausible. That is, the HR is not constant over the entire study follow-up time. This implies that the observed HR is difficult to interpret clinically and, furthermore, it is likely that the test based on HR might not have enough statistical power to detect a real metronomic treatment effect. The authors also reported that the median PFS times between the 2 arms were similar. On the other hand, visually the Kaplan-Meier curves suggested that metronomic chemotherapy appeared to prolong the patients' PFS after 2 months of follow-up. For this situation, the median is not sensitive enough to capture the relatively long-term survival profile from metronomic chemotherapy. It is also known that generally the estimate of the median survival time is notoriously unstable and results in an inconclusive claim about the treatment difference.

http://ift.tt/2nbVdxf

Residual Risk–Based Eligibility in Breast Cancer Adjuvant Trials

This modeling study calculates individualized residual risk estimates for patients with early-stage breast cancer and assesses whether defining eligibility based on a minimum residual risk threshold could increase the reliability of clinical trial power calculations.

http://ift.tt/2DCCSUN

Comparison Between Adjuvant and Early-Salvage Postprostatectomy Radiotherapy for Prostate Cancer

This multi-institutional cohort study compares adjuvant radiotherapy with early-salvage radiotherapy used to manage postoperative patients with prostate cancer who have adverse pathological features.

http://ift.tt/2nbUVGF

Descriptive Analysis of the Arterial Supply to the Auricle in Patients with Unilateral Microtia

Background: Microtia is a congenital auricular deformity that occurs in 1:5,000–10,000 births. It can cause severe impairment to the patient's self-esteem and problems regarding social integration. Multiple measures have been described in attempt to better operative outcomes of these patients. We used computed tomography (CT) angiography to analyze the vascular pattern of the auricular region before surgery. Methods: Fourteen patients with unilateral microtia were included. All underwent CT angiogram plus tridimensional reconstruction. Both healthy and microtic auricles were analyzed descriptively in terms of main arterial supply, pattern, diameter of subbranches, and angulation. The sample was divided in 2 age groups for better understanding of the data. Results: Blood supply to the auricle was found to depend on 2 main vessels: temporal superficial artery (TSA) and its subbranches (superior, middle, and lower branch) and posterior auricular (PA) artery. In the microtic group, TSA was the dominant artery in 13 of 14 cases (92%). Superior, middle, and inferior branches were present in 4, 3, and 0 cases, respectively. Three of the microtic auricles presented supply from PA artery, from which in 1 case, it represented the only supply to the region. Conclusions: There is wide variability in the blood supply of both healthy and microtic auricles; however, we were able to identify some tendencies in our sample. Further research is needed to prove the benefit of a preoperative imaging study in these patients. Still, in our experience, we found it useful as a complement for surgical planning.

http://ift.tt/2BsjdRN

Monitoring key organic indoor pollutants and their elimination in a biotrickling biofilter

Abstract

A biotrickling filter was evaluated to treat the air of the interior of a bioprocess research laboratory. Initially, various solid-phase microextraction (SPME) fibers were used to identify and quantify the volatile organic pollutants and hexane, methyl isobutyl ketone, benzene, toluene, and xylene were further selected as indicators due to their prevalence and relative abundance. The system treated organic loading rates between 0.16 mg_carbon m⁻³ h⁻¹ and close to 30 mg_carbon m⁻³ h⁻¹ achieving removal efficiencies (RE) over 85% during 136 operational days. Respirometry experiments demonstrated that moderate acidification (below 5.0), due to microbial activity, adversely affected biofilter performance and consequently pH control was necessary to maintain performance.

http://ift.tt/2DBiLCn

CDX2 and LEF-1 expression in pilomatrical tumors and their utility in the diagnosis of pilomatrical carcinoma

Abstract

Background

The Wnt signaling pathway has been implicated in the pathogenesis of pilomatrical tumors. LEF-1 is a downstream component of this pathway, and CDX2 has been postulated to regulate it, but little is known about expression of these transcription factors in pilomatrical tumors.

Methods

Immunohistochemistry for CDX2, β-catenin, LEF-1, CK19, CK5, SATB2, Cadherin 17, and Androgen receptor was performed on pilomatricomas (PMs) (N=12), pilomatrical carcinomas (PMCAs) (N=12), and non-pilomatrical cutaneous tumors (N=18).

Results

PMs and PMCAs were positive for CDX2 (9/12 PMs, sens=75%,spec=100%;11/12 PMCAs, sens=92%,spec=100%;p<0.01), β-catenin (12/12 PMs, sens=100%, spec=94%;10/12 PMCAs, sens=83%, spec=94%;p<0.01), and LEF-1 (12/12 PMs, sens=100%, spec=56%;12/12 PMCAs, sens=100%, spec=56%;p<0.01 ). CDX2 expression was commonly focal, within a discrete subpopulation of squamoid cells. The LEF-1 expression pattern was different and discernable between pilomatrical tumors (strong, diffuse) and non-pilomatrical tumors (weak, patchy).

Conclusions

This study reaffirms the importance of the Wnt signaling pathway in the tumorigenesis of pilomatrical tumors, and introduces CDX2 as a possible regulator and marker of pilomatrical tumorigenesis. LEF-1 and CDX2 performed at least as well as β-catenin, if not better when taking into account expression pattern, as a diagnostic marker for pilomatrical carcinoma, and should be considered in the workup of ambiguous primitive-appearing cutaneous tumors.

http://ift.tt/2rHk2Gu

Cutaneous Intravascular CD30+ T-cell Pseudolymphoma Occurring in a Regressing Keratoacanthoma

Abstract

Cutaneous intravascular CD30+ pseudolymphoma is an uncommon incidental finding that may mimic intravascular or angiotropic lymphoma. We describe a 78-year-old female with a traumatized regressing keratoacanthoma on her left cheek. A shave biopsy was performed which revealed intravascular staining of atypical lymphocytes positive for CD45, CD3 and CD30. Clinical exam revealed no other evidence of lymphoma, the patient denied constitutional symptoms, and routine blood work was normal. The patient is healthy and doing well 28 months after her first visit. CD30+ pseudolymphoma should be distinguished from malignant intravascular lymphoproliferative disorders.

http://ift.tt/2Ge8IFj

#dermpathJC: The First Online Dermatopathology Twitter Journal Club

Twitter, an online social media platform created in the spring of 2006, has now reached approximately 328 million active monthly users¹. It allows for rapid exchange of ideas in 140 character tweets.

http://ift.tt/2rHaGL4

Lichen planopilaris and frontal fibrosing alopecia cannot be differentiated by histopathology

Abstract

Background

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) represent two entities that cause primary cicatricial alopecia. These entities are clinically different; nevertheless the literature suggests that FFA represents a form of LPP. The main argument in support of this hypothesis is that previous studies comparing the histologic findings have not found obvious differences between these diseases.

Methods

Our objective was to more critically compare and contrast 20 histologic findings of these diseases in a large number of patients in order to determine any significant histologic differences between LPP and FFA.

Results

We found three parameters that were statistically different, namely the presence of terminal catagen-telogen hairs (50% FFA versus 23.5% LPP; p = 0.020); a severe perifollicular inflammatory infiltrate (29.4% LPP versus 4.6% FFA; p = 0.010); and a zone of concentric lamellar fibroplasia (85.3% LPP versus 63.6% FFA; p = 0.041).

Conclusions

Although a few histologic features differ between FFA and LPP, we believe these differences are too subtle or non-specific to distinguish between them with confidence. Therefore, clinical correlation is essential to establish the diagnosis.

http://ift.tt/2GgUwLx

NQO1 downregulation potentiates menadione-induced endothelial-mesenchymal transition during rosette formation in Fuchs endothelial corneal dystrophy

Publication date: 20 February 2018
Source:Free Radical Biology and Medicine, Volume 116
Author(s): Kishore Reddy Katikireddy, Tomas L. White, Taiga Miyajima, Shivakumar Vasanth, Duna Raoof, Yuming Chen, Marianne O. Price, Francis W. Price, Ula V. Jurkunas
Fuchs endothelial corneal dystrophy (FECD) is a genetic and oxidative stress disorder of post-mitotic human corneal endothelial cells (HCEnCs), which normally exhibit hexagonal shape and form a compact monolayer compatible with normal corneal functioning and clear vision. FECD is associated with increased DNA damage, which in turn leads to HCEnC loss, resulting in the formation rosettes and aberrant extracellular matrix (ECM) deposition in the form of pro-fibrotic guttae. Since the mechanism of ECM deposition in FECD is currently unknown, we aimed to investigate the role of endothelial-mesenchymal transition (EMT) in FECD using a previously established cellular in vitro model that recapitulates the characteristic rosette formation, by employing menadione (MN)-induced oxidative stress. We demonstrate that MN treatment alone, or a combination of MN and TGF-β1 induces reactive oxygen species (ROS), cell death, and EMT in HCEnCs during rosette formation, resulting in upregulation of EMT- and FECD-associated markers such as Snail1, N-cadherin, ZEB1, and transforming growth factor-beta-induced (TGFβI), respectively. Additionally, FECD ex vivo specimens displayed a loss of organized junctional staining of plasma membrane-bound N-cadherin, with corresponding increase in fibronectin and Snail1 compared to ex vivo controls. Addition of N-acetylcysteine (NAC) downregulated all EMT markers and abolished rosette formation. Loss of NQO1, a metabolizing enzyme of MN, led to greater increase in intracellular ROS levels as well as a significant upregulation of Snail1, fibronectin, and N-cadherin compared to normal cells, indicating that NQO1 regulates Snail1-mediated EMT. This study provides first line evidence that MN-induced oxidative stress leads to EMT in corneal endothelial cells, and the effect of which is further potentiated when redox cycling activity of MN is enhanced by the absence of NQO1. Given that NAC inhibits Snail-mediated EMT, this may be a potential therapeutic intervention for FECD.

Graphical abstract

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An engineered cell line lacking OGG1 and MUTYH glycosylases implicates the accumulation of genomic 8-oxoguanine as the basis for paraquat mutagenicity

Publication date: 20 February 2018
Source:Free Radical Biology and Medicine, Volume 116
Author(s): Preechaya Tajai, Bogdan I. Fedeles, Tawit Suriyo, Panida Navasumrit, Jantamas Kanitwithayanun, John M. Essigmann, Jutamaad Satayavivad
Paraquat (1,1′-dimethyl, 4,4′-bipyridinium dichloride; PQ), a widely used herbicide, is toxic to mammals through ingestion, inhalation and skin contact. Epidemiological data suggest that PQ is also mutagenic and carcinogenic, especially in high doses. The toxic and mutagenic properties of PQ are attributed to the ability of the molecule to redox-cycle, which generates reactive oxygen species (ROS) and subsequent oxidative stress. ROS also cause oxidative DNA damage such as 8-oxoguanine (8OG), a mutagenic base that, when replicated, causes G to T transversion mutations. The present study employed the CHO-derived cell line AS52 to quantify the mutagenic properties of low doses of PQ. By containing a functional, chromosomally-integrated copy of the bacterial gpt gene, AS52 cells a facile system for evaluating the mutagenic properties of genotoxicants. To bolster the sensitivity of this system for detecting mutagenesis of weak mutagens like PQ, and to provide a tool for mechanistic evaluation of the mutagenic process, we constructed a new AS52-derived cell line defective for 8OG DNA repair. Specifically, we employed CRISPR-Cas9 technology to knock out 8-oxoguanine DNA glycosylase (OGG1) and MUTYH glycosylase, two key enzymes involved in the base excision repair of 8OG. The double knock-out (DKO) AS52 cells were found to be more sensitive to PQ toxicity than the parental (WT) AS52 cell line. They experienced higher levels of ROS, which translated into more DNA double-strand breaks, which explained the PQ toxicity. The increased ROS levels also led to more 8OG genomic accumulation, and a higher level of mutations in the DKO cells, suggesting that PQ mutagenesis is mediated primarily by 8OG genomic accumulation. Consistent with this view, antioxidant co-treatment lowered induced cellular ROS and PQ-induced mutagenesis. Taken together, our data demonstrate the strong protective role of OGG1 and MUTYH against PQ-induced mutagenesis. Moreover, our experiments establish the engineered OGG1^-/-MUTYH^-/- AS52 cell line and associated methods as a versatile cellular system for studying in quantitative terms the mutagenesis of other agents, environmental or endogenous, that induce oxidative stress.

Graphical abstract

Following a literature search and thorough analysis of existing case difficulty assessment forms, the web-based tool was developed using an online survey builder (Qualtrics, Qualtrics Lab, UT, USA). Following feedback from a pilot study, it was refined and improved. A study was performed, using the updated version (EndoApp) on a cohort (n = 53) of dental professionals and dental students. The participants were e-mailed instructions detailing the assessment of five test cases using EndoApp, followed by completion of a structured feedback form. Analysis of the EndoApp responses was used to evaluate usage times, whereas the results of the feedback forms were used to assess user experience and relevance, other potential applications and comments on further improvement/s.

Results

The average usage time was 2 min 7 s; the average times needed for the last three (Cases 3–5) were significantly less than the preceding two (Cases 1 & 2) test cases. An overwhelming majority of participants expressed favourable views on user experience and relevance of the web-based case difficulty assessment tool. Only two participants (4%) were unlikely or very unlikely to use EndoApp again. The potential application of EndoApp as an 'educational tool' and for 'primary care triage' was deemed the most popular features and of greater importance than the secondary options of 'fee setting' and as a 'dento-legal justification tool'.

Conclusions

Within the study limitations, owing to its ability to quantify the level of difficulty and provide guidance, EndoApp was considered user-friendly and helped facilitate endodontic case difficulty assessment. From the feedback, further improvements and the development of a Smartphone App version are in progress.

Clinical relevance

EndoApp may facilitate treatment planning, improve treatment cost-effectiveness and reduce frequency of procedural errors by providing appropriate guidance on endodontic case management.

http://ift.tt/2rF4Bi9

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Πέμπτη 25 Ιανουαρίου 2018

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