Factors associated with hazardous alcohol use and motivation to reduce drinking among HIV primary care patients: Baseline findings from the Health & Motivation study

Publication date: September 2018
Source:Addictive Behaviors, Volume 84
Author(s): Michael J. Silverberg, Wendy A. Leyden, Amy Leibowitz, C. Bradley Hare, Hannah J. Jang, Stacy Sterling, Sheryl L. Catz, Sujaya Parthasarathy, Michael A. Horberg, Derek D. Satre
BackgroundLimited primary care-based research has examined hazardous drinking risk factors and motivation to reduce use in persons with HIV (PWH).MethodsWe computed prevalence ratios (PR) for factors associated with recent (<30 days) hazardous alcohol use (i.e., 4+/5+ drinks in a single day for women/men), elevated Alcohol Use Disorders Identification Test (AUDIT) scores, and importance and confidence (1–10 Likert scales) to reduce drinking among PWH in primary care.ResultsOf 614 participants, 48% reported recent hazardous drinking and 12% reported high alcohol use severity (i.e., AUDIT zone 3 or higher). Factors associated with greater alcohol severity included moderate/severe anxiety (PR: 2.07; 95% CI: 1.18, 3.63), tobacco use (PR: 1.79; 1.11, 2.88), and other substance use (PR: 1.72; 1.04, 2.83). Factors associated with lower alcohol severity included age 50–59 years (PR: 0.46; 0.22, 2.00) compared with age 20–39 years, and having some college/college degree (PR: 0.61; 0.38, 0.97) compared with ≤high school. Factors associated with greater importance to reduce drinking (scores >5) included: moderate/severe depression (PR: 1.43; 1.03, 2.00) and other substance use (PR: 1.49; 1.11, 2.01). Lower importance was associated with incomes above $50,000 (PR: 0.65; 0.46, 0.91) and marijuana use (PR: 0.65; 0.49, 0.87). HIV-specific factors (e.g., CD4 and HIV RNA levels) were not associated with alcohol outcomes.ConclusionsThis study identified modifiable participant characteristics associated with alcohol outcomes in PWH, including anxiety and depression severity, tobacco use, and other substance use.



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Declining trends in drug dealing among adolescents in the United States

Publication date: September 2018
Source:Addictive Behaviors, Volume 84
Author(s): Michael G. Vaughn, Millan A. AbiNader, Christopher P. Salas-Wright, Sehun Oh, Katherine J. Holzer
IntroductionThe link between drug selling and other delinquent behaviors in adolescence is well established. Less is known regarding the trends in drug selling among youth in the US and whether they are consistent with the recently observed decline in problem behaviors among this population.MethodsData were collected between 2002 and 2015 as part of the National Survey on Drug Use and Health (NSDUH). Participants included 233,435 US youth aged 12–17. The primary variable of interest was self-reported past year drug-selling. Logistic regression assessed trends in drug-selling among male and female subgroups.ResultsBetween 2002 and 2015, the prevalence of drug-selling decreased significantly across all youth (AOR = 0.970, p < .001). Analysis of gender differences revealed that the rate of drug-selling decreased significantly among boys (AOR = 0.962, p < .001), however, the trend remained stable for girls (AOR = 0.987, p > .05). The decrease in drug-selling was observed for nearly all male subgroups, African-American girls (0.946, p < .01) and girls reporting no illegal substance use in the past year (0.960, p < .05).ConclusionsThe prevalence of past year drug-selling among youth in the US is declining significantly, especially for boys.



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Humification process in different kinds of organic residue by composting and vermicomposting: have microbioreactors really accelerated the process?

Abstract

The organic matter existing in nature presents as a complex system of various substances. The humic fraction refers to the humic substances (HS) and consists of humic acids (HA), fulvic acids (FA), and humins, according to solubility in aqueous solution. The physical and chemical characteristics of HA, FA, and humins depend on many factors, among which is the type of original organic material. Two processes for the stabilization of organic materials are known worldwide: composting and vermicomposting. Cattle manure, rice straw, sugarcane bagasse, and vegetable wastes from leaves were the organic residues chosen for the composting and vermicomposting processes. In this study, the differences between the HS extracted from such composted and vermicomposted residues were evaluated. The so-extracted HS were evaluated by spectroscopy in the regions of infrared and ultraviolet-visible, and pyrolysis coupled with gas chromatography with mass spectrometric detection is applied. Thus, we expect that the results obtained here indicate which of the two processes is more efficient in the biotransformation of organic residues in a short period with respect to the HS content. It was also observed that the basic units of the humic fractions generated (although they presented different degrees of maturation) are the same. Altogether, the data reported here bring to light that the structures of the HS are very similar, differing in quantities. These results can still be extrapolated to several other raw materials, since the most variable organic matrices were used here to allow this data extrapolation. In addition, the process seems to lead to the formation of more aliphatic substances, counterpoising what is found in the literature.

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Scholar : Chinese Journal of Stomatology, Year 2018, Issue 03 -New Issue Alert.

New Issue TOC Alert Dear Valued Customer, We are pleased to deliver your requested table of contents alert for Chinese Journal of Stomatology. Year 2018 Issue 03 is now available on CAOD. In this issue: A glance at the American training mode of the clinical postgraduate students of periodontology through postdoctoral program in periodontics of University of Washington School of Dentistry (从华盛顿大学牙医学院课程设计浅谈美国牙周专业临床研究生专科培养模式) Hu Wenjie ...... page:145-149 A preliminary study on the effect of histatin 5 inhibiting Porphyromonas gingivalis and Fusobacterium nucleatum co-aggregation (唾液富组蛋白5抑制牙龈卟啉单胞菌与具核梭杆菌共聚的初步研究) Wang Hongyan, ,Liu Jinwen, ,Li Qian, ,Tan Lisi, ,Lin Li, ,Pan Yaping ...... page:150-156 Temporal expression of triggering receptors expressed by myeloid cells-1 during the development of experimental periodontitis in rat (髓样细胞触发受体1在大鼠牙周炎发展中时序性表达的研究) Wu Wuchao, ,Chen Shanshan, ,Wang Kun, ,Yang Yun, ,Wu Yafei, ,Zhao Lei ...... page:157-163 Combined periodontal and implant treatment of chronic periodontitis patient with severe alveolar bone defects:a case report (慢性牙周炎伴前牙重度骨缺损患者牙周-种植-修复联合治疗一例) Lin Zhikai, ,Shu Rong ...... page:164-168 Treatment of gingival recession at mandibular anterior tooth by transplantation of subepithelial connective tissue graft combined with coronally repositioned:a case report (上皮下结缔组织移植联合冠向复位瓣改善下前牙牙龈退缩一例) Guo Yun, ,Cao Zhengguo ...... page:169-172 Mucogingival surgery for treatment of multiple recession defects of gingiva: a case report (膜龈手术治疗全口多牙位牙龈退缩一例) Hu Congjiao, ,Luo Lijun, ,Zhang Fengjing, ,Xie Yufeng ...... page:173-176 Combined periodontal-orthodontal treatment for generalized aggressive periodontitis: a case report (广泛型侵袭性牙周炎牙周-正畸联合治疗一例) Huang Jiaping, ,Shen Tianyu, ,Zhang Zhuoming, ,Wu Yanmin ...... page:177-181 Multi-disciplinary treatment of generalized aggressive periodontitis: a case report (广泛型侵袭性牙周炎牙周-修复-正畸联合治疗一例) Chen Ziyuan, ,Zhong Jinsheng, ,Li Fei, ,Shi Jie, ,Zhang Hao ...... page:182-186 Langerhans cell histiocytosis with periodontal lesions as the initial manifestation: a case report (以牙周病变为首发表现的朗格汉斯细胞组织细胞增多症一例) Li Xiaocong, ,Chen Dong, ,Chen Tianxuan, ,Lu Fangli, ,Ma Jie, ,Zhao Chunmei ...... page:187-190 Clinicopathological analysis of 98 cases of benign lymphoidenosis of oral mucosa (98例口腔黏膜良性淋巴组织增生病的临床病理分析) Hou Yali, ,Zhang Hao, ,Hao Yali, ,Yang Yanxiao, ,Li Hexiang ...... page:191-194 Effects of casein phosphopeptide-amorphic calcium phosphate on enamel erosion: an in situ study (酪蛋白磷酸多肽-非结晶型磷酸钙对牙釉质抗酸蚀性能影响的原位研究) Ye Xinyi, ,Zheng Haiyan, ,Cheng Shaolong, ,Cheng Hui, ,Yu Hao ...... page:195-200 Treatment of occlusal disorder caused by old mid-facial fracture (299例面中部陈旧性骨折伴咬合紊乱的临床处理及疗效观察) Gao Ning, ,Fu Kun, ,He Wei ...... page:201-204 tou gao xu zhi (投稿须知) ...... page:204 Analysis on the reasons for orthodontic re-treatment (202例正畸患者的再矫治原因分析) Wang Hengyang, ,Dai Xin, ,Liu Yang, ,Li Jiaojiao, ,Hou Zhiming ...... page:205-208 Clinical application of the bilateral radial forearm flap for tongue cancer reconstruction (前臂桡侧双叶皮瓣在舌癌术后缺损修复重建中的临床应用) Ou Yan, ,Li Zan, ,Li Hui, ,Peng Wen, ,Mao Huangxing, ,Liu Zeyang ...... page:209-211 Research progress of gingival aesthetics evaluation in aesthetic restoration of anterior area (前牙美学修复中牙龈美学效果评价的研究进展) Ma Yixin, ,Ma Yuanyuan ...... page:212-216 CAOD TOC Alerts Note Thank you for choosing CAOD Table of Contents (TOC) Alert Service. You are receiving this email because you have requested to receive information from CAOD as a registered user of our Table of Content Alert for journals. To manage your TOC Alerts, please click here. For all enquiries, problems or suggestions regarding this service, please contact info@oriprobe.com. China/Asia on Demand (CAOD) Customer Service

Scholar : Journal of Clinical Otorhinolaryngology Head and Neck Surgery, Year 2018, Issue 06 -New Issue Alert.

New Issue TOC Alert Dear Valued Customer, We are pleased to deliver your requested table of contents alert for Journal of Clinical Otorhinolaryngology Head and Neck Surgery. Year 2018 Issue 06 is now available on CAOD. In this issue: sang yin gong neng de ping gu yu zhen duan liu cheng de jian li (嗓音功能的评估与诊断流程的建立) YU Zhenkun, HU Huiying ...... page:401-404 she kou fu wei qian zuo zhuang ruan gu fu wei shu zhi liao huan zuo guan jie tuo wei de lin chuang fen xi ("蛇口"复位钳杓状软骨复位术治疗环杓关节脱位的临床分析) ZHANG Qingxiang, HE Shuangba, CHE Zigang, HU Huiying, LIU Yaqun, LU Zuozuo, YU Zhenkun ...... page:404-407 shu qian sang yin xun lian zai sheng dai xi rou xian wei shou shu huan zhe sang yin hui fu zhong de xiao guo guan cha (术前嗓音训练在声带息肉显微手术患者嗓音恢复中的效果观察) GAO Zuo, WANG Zuoqing, HUANG Zuoge, CHEN Weifeng, JIAO Yanchao, MA Yanli, ZHUANG Peiyun ...... page:408-411 zhen fa xing hou jing luan de lin chuang te dian fen xi (阵发性喉痉挛的临床特点分析) LI Xueyan, XU Wen, CHENG Liyu ...... page:412-414+419 91 li wu zheng zhuang zhi yuan zhe de tuo ye wei dan bai mei han liang ji yan hou fan liu liang biao ping fen fen xi (91例无症状志愿者的唾液胃蛋白酶含量及咽喉反流量表评分分析) CHEN Meixiang, HOU Chenzuo, CHEN Zuo, LI Yanping, ZENG Yanling ...... page:415-419 hou ji dian tu zai sheng dai ma bi yu huan zuo guan jie tuo wei ji bing zhong de jian bie jia zhi (喉肌电图在声带麻痹与环杓关节脱位疾病中的鉴别价值) YU Pengcheng, GAO Zuo, LI Xumao, ZHAO Xia, SUN Guangbin ...... page:420-423 15 li sheng dai xian wei chen ji zheng de lin chuang te zheng fen xi (15例声带纤维沉积症的临床特征分析) CHEN Hao, SUN Jingwu, WAN Guanglun, HU Yanming ...... page:424-426 er nei jing shou shu shi zuo hua yi xian huan shi ji shu ge ming ? (耳内镜手术是昙花一现还是技术革命?) KONG Weijia, DING Xiuyong, WANG Yunfeng, WANG Wuqing, SUN Yu, ZHANG Wen, CHEN Yang, WANG Zhaoyan, YANG Haidi, YANG Qiong, ZHAO Yu, HOU Zhaozuo, MEI Lingyun ...... page:427-434 ci gong zhen mi san zhang liang cheng xiang ping jia te fa xing shi xiu nao bai zhi wei xi jie gou sun hai de yan jiu (磁共振弥散张量成像评价特发性失嗅脑白质微细结构损害的研究) YAO Linyin, GUO Zuochen, ZHAN Xiaojun, SUN Zhifu, LI Zuo, WEI Yongxiang ...... page:435-438 cheng ren dan ce bi - bi zuo bing bian 376 li lin chuang bing li fen xi (成人单侧鼻-鼻窦病变376例临床病例分析) CUI Zuoyan, WANG Liqin, YIN Min, CHEN Zuo, LU Meiping, ZHOU Han, DONG Weida, CHEN Zhibin, CHENG Lei ...... page:439-442+446 jie shou mian yi zhi liao de bian ying xing bi yan er tong huan zhe wai zhou xue zhong il-25 il-33 de biao da he eos ji shu ji yi yi (接受免疫治疗的变应性鼻炎儿童患者外周血中IL-25、IL-33的表达和EOS计数及意义) FAN Hua, ZUO Taijie, YE Linsong, LI Fengti, LIN Gansheng, LIANG Youqiong, ZUO Shenhong ...... page:443-446 yuan hua qing su tong guo zi shi tu jing zeng qiang hou ai xi bao dui shun bo hua liao min gan xing de yan jiu (原花青素通过自噬途径增强喉癌细胞对顺铂化疗敏感性的研究) YU Feng, LIU Zuo, GONG Xiaorong, ZHOU Yibo, LIN Ying ...... page:447-451+456 xian wei wai ke ji shu fu zhu bi - lu di zhong liu qie chu de lin chuang ti hui (显微外科技术辅助鼻-颅底肿瘤切除的临床体会) ZHU Zuojie, CHEN Zhibin ...... page:452-456 cheng ren zi fa xing nao ji ye bi lou zhen zhi de lin chuang fen xi (成人自发性脑脊液鼻漏诊治的临床分析) ZHU Zhengjie, CHENG Zuo, YANG Jun, HUANG Zuo, MENG Guozhen, CAO Rongping ...... page:457-461 bi zhong ge pian qu he bing wai bi de wei zheng xing shou shu zhi liao fang fa tan tao (鼻中隔偏曲合并歪鼻的微整形手术治疗方法探讨) ZUO Yifeng, ZHANG Zuozuo, ZHANG Xinran, ZHANG Qingfeng ...... page:462-464 yan gu guan qiu nang kuo zhang cheng xing shu lian he gu mo zhi guan zhi liao man xing yan chi kai fang xing yan gu guan gong neng bu liang de liao xiao fen xi (咽鼓管球囊扩张成形术联合鼓膜置管治疗慢性延迟开放型咽鼓管功能不良的疗效分析) QIN Huan, YANG Jun ...... page:465-469 xiao er qi guan cha guan qiu nang kuo zhang zhi liao man xing shang zuo zuo yan 98 li liao xiao fen xi (小儿气管插管球囊扩张治疗慢性上颌窦炎98例疗效分析) JIANG Jianqiao, SHI Xiangyang, ZHANG Xuejuan ...... page:470-471 er yuan xing mouret nong zhong 1 li (耳源性Mouret脓肿1例) HAO Xinping, CHEN Biao, LI Yongxin ...... page:472-473 bo dong xing di pin gan yin shen jing xing er long (波动性低频感音神经性耳聋) LIN Ying, WANG Jinling, SUN Fei, SHEN Jinjin, WANG Chaoxia, QIU Jianhua, CHA Dingjun ...... page:474-476 yan sheng fan she zai osahs zhen duan yu zhi liao zhong de ying yong jin zhan (咽声反射在OSAHS诊断与治疗中的应用进展) RONG Zuo, MA Jiangang, LI Xinyu, CAI Li, JIANG Xinxia, WANG Yanxia ...... page:477-480 lun wen zhong biao ge de shi yong gui fan (论文中表格的使用规范) ...... page:480 CAOD TOC Alerts Note Thank you for choosing CAOD Table of Contents (TOC) Alert Service. You are receiving this email because you have requested to receive information from CAOD as a registered user of our Table of Content Alert for journals. To manage your TOC Alerts, please click here. For all enquiries, problems or suggestions regarding this service, please contact info@oriprobe.com. China/Asia on Demand (CAOD) Customer Service

Crosstalk between YAP/TAZ and Notch Signaling

Publication date: Available online 14 April 2018
Source:Trends in Cell Biology
Author(s): Antonio Totaro, Martina Castellan, Daniele Di Biagio, Stefano Piccolo
How the behavior of cells in living tissues is orchestrated according to tissue needs, size, and developmental stage is still poorly understood. Advances in these directions are essential to understand morphogenesis, 'self-organization' phenomena, to build new tissues for regenerative medicine or to reverse the changes in deranged organs, such as in cancer or in genetic disorders. This review outlines a new scenario by which the crosstalk between the Yes-associated protein/transcriptional coactivator with PDZ-binding motif (YAP/TAZ) transcription factors and Notch signaling influences cell self-renewal, stem cell differentiation, cell fate decisions, epithelial–stromal interactions, inflammation, morphogenesis, and large-scale gene oscillations.



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Brain morphology, cognition, and β-amyloid in older adults with superior memory performance

Publication date: July 2018
Source:Neurobiology of Aging, Volume 67
Author(s): Theresa M. Harrison, Anne Maass, Suzanne L. Baker, William J. Jagust
The mechanisms underlying superior cognitive performance in some older adults are poorly understood. We used a multimodal approach to characterize imaging and cognitive features of 26 successful agers (SA; defined by superior episodic memory ability) and 103 typical older adults. Cortical thickness was greater in multiple regions in SA including right anterior cingulate and prefrontal cortex and was related to baseline memory performance. Similarly, hippocampal volume was greater in SA and associated with baseline memory. SA also had lower white matter hypointensity volumes and faster processing speed. While PiB burden did not differ, there was a significant group interaction in the relationship between age and PiB such that older SA individuals were less likely to have high brain β-amyloid. Over time, memory performance in typical older adults declined more rapidly than in SA, although there was limited evidence for different rates of brain atrophy. These findings indicate that superior memory in aging is related to greater cortical and white matter integrity as well as slower decline in memory performance.



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The effect of long-term treatment with coenzyme Q10 on nucleic acid modifications by oxidation in children with Down syndrome

Publication date: July 2018
Source:Neurobiology of Aging, Volume 67
Author(s): Emil List Larsen, Lucia Padella, Helle Kirstine Mørup Bergholdt, Trine Henriksen, Lucia Santoro, Orazio Gabrielli, Henrik Enghusen Poulsen, Gian Paolo Littarru, Patrick Orlando, Luca Tiano
Elevated levels of oxidative nucleic acid modifications have been proposed to be associated with some of the clinical characteristics of Down syndrome. Oral intake of coenzyme Q10 improves oxidative status and shows a tendency toward protective effect on DNA oxidation in certain age groups of children with Down syndrome. Here, we demonstrate that long-term (i.e., 4 years) treatment with coenzyme Q10 (ubiquinone) at the dosage of 4 mg/kg/d does not affect whole body DNA and RNA oxidation.



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ANOTHER “LETHAL TRIAD”—RISK FACTORS FOR VIOLENT INJURY AND LONG-TERM MORTALITY AMONG ADULT VICTIMS OF VIOLENT INJURY

Publication date: Available online 14 April 2018
Source:The Journal of Emergency Medicine
Author(s): Adam D. Laytin, Martha Shumway, Alicia Boccellari, Catherine J. Juillard, Rochelle A. Dicker
BackgroundMental illness, substance abuse, and poverty are risk factors for violent injury, and violent injury is a risk factor for early mortality that can be attenuated through hospital-based violence intervention programs. Most of these programs focus on victims under the age of 30 years. Little is known about risk factors or long-term mortality among older victims of violent injury.ObjectivesTo explore the prevalence of risk factors for violent injury among younger (age < 30 years) and older (age 30 ≥ years) victims of violent injury, to determine the long-term mortality rates in these age groups, and to explore the association between risk factors for violent injury and long-term mortality.MethodsAdults with violent injuries were enrolled between 2001 and 2004. Demographic and injury data were recorded on enrollment. Ten-year mortality rates were measured. Descriptive analysis and logistic regression were used to compare older and younger subjects.ResultsAmong 541 subjects, 70% were over age 30. The overall 10-year mortality rate was 15%, and was much higher than in the age-matched general population in both age groups. Risk factors for violent injury including mental illness, substance abuse, and poverty were prevalent, especially among older subjects, and were each independently associated with increased risk of long-term mortality.ConclusionMental illness, substance abuse, and poverty constitute a "lethal triad" that is associated with an increased risk of long-term mortality among victims of violent injury, including both younger adults and those over age 30 years. Both groups may benefit from targeted risk-reduction efforts. Emergency department visits offer an invaluable opportunity to engage these vulnerable patients.



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High serum procalcitonin concentration and dynamics of its changes as a prognostic factor of mortality

https://ift.tt/2vfUwKh

Tips and troubleshooting during intubation with AirTraq videolaryngoscope

https://ift.tt/2Hm4Q8p

Always check anaesthetic equipment

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Autoimmune anti-N-methyl-D-aspartate receptor encephalitis — the current state of knowledge based on a clinical case

The aim of this article is to conduct an overview of the current state of knowledge about patients presenting anti-Nmethyl- D-aspartate receptor encephalitis associated with neoplastic process, as well as diagnosis and treatment. This disease concerns mainly young women and correlates with ovarian teratoma. Most important problems seems to be the difficulties in making a proper diagnosis ensuing from the rarity of this syndrome, the period from the appearance the first symptoms to starting treatment and the correct handling of intensive care complications. There are only a few articles describing severe, complicated cases of this type of encephalitis, requiring treatment in an intensive care unit.

https://ift.tt/2HldZOJ

Day and time of admissions to intensive care units — does it matter?

Background: The literature data pertaining to the significance of day and time of ICU admission for outcomes of patients are inconsistent. The issue has not been analysed in Poland to date. The aim of the study was to gather information about differences between patients admitted to ICU outside regular working hours (off-hours) and those admitted during working hours (on-hours). Methods: Analysis involved 20,651 patients from the Silesian Registry of Intensive Care Units carried out since 2010. The findings demonstrated that 34.8% of patients were admitted to ICUs during on-hours (between 8.00 a.m. and 3 p.m. on weekdays) and 65.2% were admitted during off-hours (outside regular working hours). The incidence of admissions and data of patients in both groups were compared in terms of the population characteristics and treatment outcomes. Results: The incidence of admissions (calculated per each 24 hours of treatment) was found to be almost twice as high during on-hours, as compared to off-hours (14.5 vs. 6.9 patients/day). Patients admitted to the ICU during on-hours were less likely to be admitted from the surgical department (19.1% vs. 31.0%, P Conclusions: Patients admitted to ICUs during off-hours are in more severe general condition and their treatment outcomes are worse, as compared to patients admitted to ICU during on-hours.

https://ift.tt/2vi70kK

The impact of the blood glucose levels of non-diabetic critically ill patients on their clinical outcome

Background: Stress hyperglycaemia is thought to result from a hormonal response (release of catecholamines,
glucocorticoids, glucagon, etc.) following stress, sepsis or trauma. Although stress hyperglycaemia is a very common
finding in critically ill populations, there are many non-diabetic critically ill patients who do not develop a hyperglycaemic
stress response to trauma or acute illness. We suggest that the lack of a hyperglycaemic stress response
during the acute phase of a critical illness may correlate significantly with the clinical outcome of these critically ill
non-diabetic patients.

Methods: This was a retrospective study of 700 non-diabetic critically ill patients admitted to the general intensive
care unit (ICU) at Soroka Medical Center, Beer Sheva, Israel. We analyzed the clinical impact of the blood glucose levels
of these patients measured during their first week of ICU hospitalization on their clinical outcome.

Results: Age, male gender, and the Acute Physiology and Chronic Health Evaluation (APACHE) score were found to
be independent risk factors for new episodes of infection during the patients' stay in the ICU. Age and the APACHE
and Sequential Organ Failure Assessment scores were found to be independent risk factors for intra-ICU mortality. In
contrast, blood glucose analysis performed during the patients' stay in the ICU was not found to be an independent
predictor for new infectious events or for mortality during the ICU stay.

Conclusion: Our study did not demonstrate an association between blood glucose levels and clinical outcomes in
non-diabetic critically ill patients.

https://ift.tt/2HlyURI

Impact of anaemia on outcome in burn patients

Background: Currently, most critical care physicians maintain a patient's haemoglobin levels at 7 to 8 g dL-1. However,
little data have been available on haemoglobin-related outcomes in burn patients. The purpose of this study was
to evaluate inpatients with greater than 20% total body surface area burns and the effects of haemoglobin below
8 g dL-1 on clinical outcomes.

Methods: This study included 70 patients with burns amounting to greater than 20% of total body surface area. Data
were retrospectively evaluated and included age, gender, adult respiratory distress syndrome presence, length of
intensive care unit stay, length of mechanical ventilation, days requiring vasopressors, renal insufficiency, positive
cultures/infections, cardiovascular complications, number of operations, inhalation injury, and mortality. Logistic
regression analyses that were adjusted for age, sex, and percent total body surface area were used to assess the
relationships between haemoglobin and multiple clinical outcomes. Odds ratios (OR) were estimated with 99%
confidence intervals (99% CI).

Results: Haemoglobin below 8 g dL-1 was associated with a need for vasopressors (OR = 2.17; 99% CI = 1.03–8.22).
Furthermore, haemoglobin below 8 g dL-1 was associated with higher positive wound (OR = 2.86; 99% CI = 1.00–34.40),
urine (OR = 4.63; 99% CI = 1.15–67.00), and lung cultures (OR = 2.24; 99% CI = 1.06–5.47). These associations largely
remained after controlling for blood transfusions.

Conclusions: Contrary to most other patient groups, burn patients with burns amounting to greater than 20% of
total body surface area and low haemoglobin levels were more likely to develop positive cultures in urine, wounds,
and the lung and require vasopressor treatment.

https://ift.tt/2vhospq

Allergen component analysis as a tool in the diagnosis and management of occupational allergy

Publication date: Available online 9 April 2018
Source:Molecular Immunology
Author(s): Monika Raulf
We are now in the epoch of "molecular allergology" and numerous clinically relevant allergenic molecules are available improving the performance of in vitro allergen tests and allergen detection methods. This review is focusing on characterized occupational allergens and their implementation into the in vitro diagnosis for occupational allergy and in allergen detection methods.More than 400 occupational agents are identified and documented as being 'respiratory sensitizers', but currently only a limited number of them are characterized on the molecular level and available for routine diagnosis as native or recombinant allergens. One exception, however, is natural rubber latex (NRL) from Hevea brasiliensis still remaining an important occupational allergen source. Characterization of 15 NRL allergens led to the development of assays for the determination of allergen content of NRL materials and the implementation of component-resolved diagnosis (CRD) for specific IgE antibody measurement. Microarray or singleplex using recombinant or native allergens are reliable tools for NRL allergy diagnosis. In addition, NRL allergy is an excellent model for improving extract-based specific IgE measurement by amplification of NRL extract preparation with stable recombinant major allergen rHev b 5. Despite the many efforts to characterize the occupationally relevant wheat allergens for baker's asthma, the most frequently occurring forms of occupational asthma, the results are highly diverse. Wheat sensitization profiles of bakers showed great interindividual variability and no wheat allergen could be classified as the major allergen. For diagnosis of baker's asthma, a whole wheat extract is still the best option for specific IgE determination. But single wheat allergens might help to discriminate between wheat-induced food allergy, grass pollen allergy and baker's asthma. For workplace-related allergens like coffee, wood, soybean, seafood and moulds allergens are characterized and few of them are available, but their relevance for occupational sensitization routes should be verified in the further studies.



https://ift.tt/2qzEFAH

The 100 most-cited papers in general thoracic surgery: A bibliography analysis

Publication date: May 2018
Source:International Journal of Surgery, Volume 53
Author(s): Hongdou Ding, Xiao Song, Linsong Chen, Xinlin Zheng, Gening Jiang
BackgroundThe status of citations can reflect the impact of a paper and its contribution to surgical practice. The aim of our study was to identify and review the 100 most-cited papers in general thoracic surgery.Materials and methodsRelevant papers on general thoracic surgery were searched through Thomson Reuters Web of Science in the last week of November 2017. Results were returned in descending order of total citations. Their titles and abstracts were reviewed to identify whether they met our inclusion criteria by two thoracic surgeons independently. Characteristics of the first 100 papers, including title, journal name, country, first author, year of publication, total citations, citations in latest 5 years and average citation per year (ACY) were extracted and analyzed.ResultsOf the 100 papers, the mean number of citations was 322 with a range from 184 to 921. 19 journals published the papers from 1956 to 2012. Annals of Surgery had the largest number (29), followed by Journal of Thoracic and Cardiovascular Surgery (22) and Annals of Thoracic Surgery (21). The majority of the papers were published in 2000s (48) and originated from United States of America (62). There were 65 retrospective studies, 13 RCTs and 11 prospective studies. Orringer MB and Grillo HC contributed 4 first-author articles respectively. There were 53 papers on esophagus, 36 on lung, 6 on pleura and 5 on trachea.ConclusionsOur study identified the most-cited papers in the past several decades and offered insights into the development and advances of general thoracic surgery. It can help us understand the evidential basis of clinical decision-making today in the area.



https://ift.tt/2vcRrLi

Architected multi-directional functionally graded cellular plates

Publication date: 15 June 2018
Source:Materials & Design, Volume 148
Author(s): H. Niknam, A.H. Akbarzadeh, D. Rodrigue, D. Therriault
Inspired by natural materials like bamboo and the dentin-enamel junction of tooth, the concept of architected multi-directional functionally graded cellular materials (FGCMs) is introduced. These architected porous materials are made by assembling porous unit cells of dissimilar densities and cell topologies. To evaluate the potential of multi-directional FGCMs for improving the performance of lightweight structural elements, the mechanical properties of functionally graded cellular (FGC) plates are analyzed. For the numerical analyses, standard mechanics homogenization is used to predict the mechanical properties of cells with arbitrary superellipse voids. The homogenized effective properties along with finite element method and shear deformation theory are exploited to predict the mechanical responses of plates made of multi-directional FGCMs. Numerical results reveal substantial improvement in structural responses when FGCMs are appropriately used; e.g. 56% improvement in bending stiffness is found in an FGC rectangular plate compared to a cellular plate with the same weight and with uniform distribution of constitutive cells. Numerical results show that cell variation through the thickness of FGC plates is more effective on the structural responses than variation through the length or width. Finally, multi-objective optimization is implemented to show the maximum improvement achievable via architecture variation within FGC structures.



https://ift.tt/2GYiMGy

Ultra-thin MoO3 film goes wafer-scaled nano-architectonics by atomic layer deposition

Publication date: 5 July 2018
Source:Materials & Design, Volume 149
Author(s): Hongyan Xu, Mohammad Karbalaei Akbari, Zhenyin Hai, Zihan Wei, Lachlan Hyde, Francis Verpoort, Chenyang Xue, Serge Zhuiykov
From the technical and design points of view, it is quite difficult to maintain the integrity of nano-films during the deposition process to fabricate practical devices based on ultra-thin semiconductor films. Thus, defect-free wafer-scaled development of ultra-thin quasi two-dimensional (2D) oxide semiconductor films represents serious challenges. Plasma-enhanced atomic layer deposition (PE-ALD) made it possible to fabricate ultra-thin MoO3 nano-films (4.6nm) over the wafer-scaled granular Au electrode. The detailed ALD recipe for ultra-thin MoO3 film was established and verified. The C12H30N4Mo and O2 plasma were used as Mo precursor and oxygen source, respectively. The growth of crystalline phases was observed when the ALD temperature of 250°C was employed. Higher ALD temperature resulted in an increase of growth rate over Au substrate (1.21Ǻ/cycle). The precise recipe design enabled the scalable fabrication of environmental sensors based on ultra-thin MoO3 films with precise thickness controllability. Electrochemical sensors based on the fabricated MoO3 nanostructures demonstrated reliable performance to hydrazine (N2H4) detection.

Graphical abstract

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Structure and band gap tunable CuInS2 nanocrystal synthesized by hot-injection method with altering the dose of oleylamine

Publication date: 5 July 2018
Source:Materials & Design, Volume 149
Author(s): Liwang Liu, Hong Li, Zirui Liu, Ya-Hong Xie
By hot-injection method with altering the dose of oleylamine (OAm) in a reaction system, CuInS2 (CIS) nanocrystal with tunable structure and band gap is synthesized. Through various measurements, including X-ray diffraction (XRD), transmission electron microscopy (TEM), and X-ray photoelectron spectroscopy (XPS), it is demonstrated experimentally that when the dose of OAm is relatively high (2.0 and 2.5ml in this work), the combination phase of pseudo-chalcopyrite/wurtzite are obtained with a surprising existence of nanotwins. Besides, the molar fraction of wurtzite is larger in the sample using 2.5ml OAm in the reaction system. However, when the dose of OAm becomes low, (0, 1.0 and 1.5ml), pure zinc-blende CIS pyramidal quantum dots (QDs) can be prepared. This indicates that oleylamine promotes the formation of wurtzite structure. In addition, the band gap is larger with increasing of OAm, following the quantum refinement effects. This work serves as a facile method of synthesizing CIS nanocrystal with tunable structure and band gap, which will be possibly applied in the fabrication of their optoelectronic devices.

Graphical abstract

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Thickness-dependent structural and electromechanical properties of (Na0.85K0.15)0.5Bi0.5TiO3 multilayer thin film-based heterostructures

Publication date: 5 July 2018
Source:Materials & Design, Volume 149
Author(s): Yunyi Wu, Siu Wing Or
(Na0.85K0.15)0.5Bi0.5TiO3 (NKBT) multilayer thin films with different thicknesses of 100–700nm, corresponding to 2–14 layers with each layer of ~50nm thickness, are synthesized on Pt(111)/Ti/SiO2/Si substrates to form Pt/NKBT/Pt/Ti/SiO2/Si heterostructures using different spin-coating and annealing conditions in a modified aqueous sol-gel process. The multilayer thin films spin-coated by two steps (step 1/2) at 600/4000rpm for 6/30s and annealed at 700°C for 5min with a heating rate of 30°C/s show a dense, uniform, and continuous morphology as well as a pure perovskite structure with a rhombohedral–tetragonal phase transition at ~140°C and no preferential orientation in the heterostructures. Their structural and electromechanical properties exhibit consistent improvement trends with increasing thickness from 100 to 550nm (i.e., 2–11 layers). The 550nm-thick, 11-layer films demonstrate the best ferroelectric, dielectric, piezoelectric, and electric performance in terms of the highest remnant polarization, saturation polarization, dielectric constant, and effective piezoelectric constant of 18.3μC/cm², 53.6μC/cm², 463, and 64pm/V, as well as the lowest coercive field, dielectric loss tangent, and leakage current density of 116kV/cm, 0.057, and 27μA/cm², respectively. The observed thickness-dependent improvement is explained by an interfacial passive layer effect where the motion of both 180° and non-180° domain walls is enhanced in the thicker multilayer thin films by weakening the influence of domain pinning in the interfacial passive layers between the multilayer thin films and the substrates.

Graphical abstract

https://ift.tt/2qwVrAH

Tungsten doped manganese dioxide for efficient removal of gaseous formaldehyde at ambient temperatures

Publication date: 5 July 2018
Source:Materials & Design, Volume 149
Author(s): Fang Liu, Ranran Cao, Shaopeng Rong, Pengyi Zhang
Room-temperature active catalysts are very important to combat against ubiquitous indoor HCHO pollution. Here, tungsten doped MnO2 (W-MnO2) was first synthesized and investigated for HCHO decomposition at ambient temperature. With addition of WCl6 as precursor into the mixture of permanganate and manganese chloride, tungsten-doped δ-MnO2 with weak crystallinity and large specific surface area (>230m²/g) was synthesized. Substitution of W⁶⁺ for Mn in MnO6 groups reduced the chemical valence of Mn and made adsorbed surface oxygen species more active. As a result, the W-MnO2 catalyst with the nominal W/Mn ratio achieved efficient and stable activity for real-level indoor HCHO (0.3mg/m³) under the GHSV as high as 600L/gcat·h, the removal efficiency reaching 90% at 30°C and 60% at 5°C, respectively.

Graphical abstract

https://ift.tt/2GZ9KJ5

Sustainable hierarchical porous biomass carbons enriched with pyridinic and pyrrolic nitrogen for asymmetric supercapacitor

Publication date: 5 July 2018
Source:Materials & Design, Volume 149
Author(s): Shuai Yu, Xinqiang Zhu, Gaobo Lou, Yatao Wu, Keting Xu, Yan Zhang, Lumin Zhang, Enhui Zhu, Hao Chen, Zhehong Shen, Binfu Bao, Shenyuan Fu
Asymmetric supercapacitors usually possess higher energy density than symmetric supercapacitors. It's still a big challenge to synthesize low-cost and high-performance negative electrode active materials for the practical production of asymmetric supercapacitors. In this research, ginkgo leaf derived nitrogen-doped carbon was prepared and investigated as an electrode active material for the utilization in supercapacitors. Due to the hierarchical porous architecture, high N content, and ultrahigh ratio (86.5%) of pyridinic plus pyrrolic N species, the ginkgo leaf derived nitrogen-doped carbon material delivered a better specific capacitance (345Fg⁻¹ at 0.2Ag⁻¹) compared to pristine ginkgo leaf derived carbon and KOH-activated carbon without N-doping. Moreover, an asymmetric supercapacitor with this nitrogen-doped carbon as the negative electrode material also displayed an excellent energy density (42.2Whkg⁻¹ at 700Wkg⁻¹) and satisfactory electrochemical cycling reliability. In addition, these performances are also superior to those of some similar carbon materials, manifesting a good potential of this nitrogen-doped carbon to fabricate high-performance asymmetric supercapacitors.

Graphical abstract

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Editorial Board

Publication date: 15 June 2018
Source:Materials & Design, Volume 148





https://ift.tt/2qwWf8w

Application of uncertainty and sensitivity analysis to the air quality SHERPA modelling tool

Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): E. Pisoni, D. Albrecht, T.A. Mara, R. Rosati, S. Tarantola, P. Thunis
Air quality has significantly improved in Europe over the past few decades. Nonetheless we still find high concentrations in measurements mainly in specific regions or cities. This dimensional shift, from EU-wide to hot-spot exceedances, calls for a novel approach to regional air quality management (to complement EU-wide existing policies). The SHERPA (Screening for High Emission Reduction Potentials on Air quality) modelling tool was developed in this context. It provides an additional tool to be used in support to regional/local decision makers responsible for the design of air quality plans. It is therefore important to evaluate the quality of the SHERPA model, and its behavior in the face of various kinds of uncertainty. Uncertainty and sensitivity analysis techniques can be used for this purpose. They both reveal the links between assumptions and forecasts, help in-model simplification and may highlight unexpected relationships between inputs and outputs.Thus, a policy steered SHERPA module - predicting air quality improvement linked to emission reduction scenarios - was evaluated by means of (1) uncertainty analysis (UA) to quantify uncertainty in the model output, and (2) by sensitivity analysis (SA) to identify the most influential input sources of this uncertainty. The results of this study provide relevant information about the key variables driving the SHERPA output uncertainty, and advise policy-makers and modellers where to place their efforts for an improved decision-making process.



https://ift.tt/2IVcvYr

A national-scale review of air pollutant concentrations measured in the U.S. near-road monitoring network during 2014 and 2015

Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): Jennifer L. DeWinter, Steven G. Brown, Annie F. Seagram, Karin Landsberg, Douglas S. Eisinger
In 2010, the U.S. Environmental Protection Agency (EPA) revised the National Ambient Air Quality Standards (NAAQS) for NO2 to include a primary health-based standard for hourly NO2, and required air quality monitoring next to major roadways in urban areas in the U.S. Requirements for near-road measurements also include carbon monoxide (CO) and particulate matter smaller than 2.5 μm in diameter (PM2.5). We performed a national-scale assessment of air pollutants measured at 81 sites in the near-road environment during the first two years (2014 and 2015) of the new measurement program. We evaluated how concentrations at these locations compared to the NAAQS, to concentrations measured at other sites within the same urban areas, and when considering their site characteristics (distance of monitor to road, traffic volume, and meteorology). We also estimated the contribution of emissions from adjacent roadways at each near-road site to the PM2.5 concentrations above the local urban background concentrations, i.e., the near-road "increment." Hourly values of CO reached a maximum of 4.8 ppm across 31 sites in 2014 and 9.6 ppm across 47 sites in 2015, and were well below the NAAQS levels for both the 1-hr (35 ppm) and 8-hr (9 ppm) standards. Hourly concentrations of near-road NO2 reached 258 ppb across 40 sites in 2014; however, there were only two occurrences of a daily 1-hr maximum NO2 concentration above 100 ppb (the level of the hourly NO2 standard). In 2015, hourly concentrations of near-road NO2, monitored at 61 sites in 55 urban areas, reached 154 ppb. Only 0.0015% (n = 5) of hourly NO2 observations in 2015 exceeded 100 ppb. The highest annual NO2 average recorded in 2015 (29.9 ppb) occurred at the Ontario site located along I-10 in the Los Angeles, California, area and was below the level of the NO2 annual standard (53 ppb); in 2014, the highest annual mean NO2 was also observed in Los Angeles at the Anaheim site (27.1 ppb). In 2014, sites in Cincinnati, Indianapolis, and Louisville recorded annual average PM2.5 concentrations at or above 12 μg/m³ (the level of the annual standard). There were 15 occurrences in 2014 of 24-hr PM2.5 concentrations above the NAAQS level of 35 μg/m³. Annual average PM2.5 exceeded 12 μg/m³ at near-road sites in five urban areas in 2015, and there were 33 days across 12 near-road locations with 24-hr PM2.5 concentrations above 35 μg/m³. Across the near-road monitoring network, annual average PM2.5 concentrations did not have a significant relationship with traffic volume or distance between the monitor and the adjacent roadway; rather, variations in PM2.5 were mostly driven by urban-scale PM2.5, with a typically small "increment" above urban-scale concentrations due to a site's proximity to the roadway. We estimated this increment, i.e., the difference between near-road PM2.5 concentrations and the concentrations at sites in the urban area of each near-road monitor, to be on average 1.2 μg/m³ (σ = 0.3 μg/m³), with a range of −1.2 μg/m³ to 3.1 μg/m³ across the 26 sites (four of which had a negative increment). The near-road increment is on average 13% of the near-road PM2.5, and 15% of the near-road PM2.5 for sites within 20 m of the roadway.



https://ift.tt/2H2154T

Adipose tissue, but not skeletal muscle, sirtuin 1 expression is decreased in obesity and related to insulin sensitivity

Abstract

Purpose

Sirtuin 1 may regulate glucose and lipid metabolism. We aimed to assess adipose tissue and skeletal muscle sirtuin 1 expression in relation to insulin sensitivity, the expression of proinflammatory and metabolic genes, and to study the regulation of sirtuin 1 expression by hyperinsulinemia and circulating free fatty acids elevation.

Methods

We examined 60 normal-weight, 42 overweight and 15 obese young subjects. The hyperinsulinemic-euglycemic clamp technique was applied throughout to measure insulin sensitivity. In 20 subjects, two 6 h clamps were performed, one of them with concurrent Intralipid/heparin infusion. Biopsies of subcutaneous adipose tissue and skeletal muscle were collected for the measurement of gene and protein expression.

Results

Obese subjects had lower adipose sirtuin 1 in comparison with normal-weight and overweight participants. Muscle sirtuin 1 did not differ between the groups. Adipose tissue sirtuin 1 was related to insulin sensitivity, adipose tissue SLC2A4. The relationship between adipose tissue sirtuin 1 and insulin sensitivity was still present after controlling for BMI, however, it disappeared after controlling for adipose tissue SLC2A4. Muscle sirtuin 1 was not related to insulin sensitivity. Hyperisulinemia decreased adipose tissue and increased muscle sirtuin 1 expression. Intralipid/heparin infusion negated these effects.

Conclusions

Adipose tissue, but not muscle, sirtuin 1 is associated with insulin sensitivity in humans, possibly because of its correlation with adipose tissue SLC2A4 expression. Insulin differentially regulates adipose tissue and skeletal muscle sirtuin 1 expression in the short-term and circulating free fatty acids elevation negates these effects, which may be associated with lipid-induced insulin resistance.

https://ift.tt/2BevPzq

Predicting an adrenal crisis: can we do it?

https://ift.tt/2HVMt7S

Effect of ezetimibe on glycemic control: a systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose

Given the increased risk of incident diabetes and the side effects on glycemic control with statin treatment, statin and ezetimibe combination therapy has been widely used. However, whether the same concern exists in ezetimibe remains uncertain. This meta-analysis aimed to investigate the influence of ezetimibe treatment on glycemic control.

Methods

Articles were searched from PubMed, EMBASE, and Cochrane Library. Randomized controlled trials (RCTs) were included if they compared the effects of ezetimibe with placebo, ezetimibe plus statin with the same statin, or low-dose stain plus ezetimibe with high-dose statin on FBG and glycosylated hemoglobin A1c (HbA1c).

Results

Of the 2440 articles retrieved, 16 RCTs were included. Ezetimibe did not cause side effects on FBG (WMD −0.62, 95% CI: −3.13 to 1.90) and HbA1c (WMD 0.07, 95% CI: −0.07 to 0.20%). No significant changes in FBG (WMD −1.78, 95% CI: −6.33 to 2.77%) and HbA1c (WMD −0.05, 95% CI: −0.14 to 0.05%) were observed in ezetimibe plus low-dose statin treatment compared with high-dose statin. According to subgroup analysis, in comparison with high-dose statin, ezetimibe plus low-dose statin taken for more than 3 months showed a significant decrease in FBG (WMD −7.12, 95% CI: −13.86 to −0.38%) compared with that taken for less than 3 months (WMD 0.90, 95% CI: −2.91 to 4.71%). Nevertheless, this difference was invalid when the study conducted by Dagli et al. was removed.

Conclusions

Compared with high-dose statin therapy, ezetimibe with low-dose statin for more than 3 months may have a beneficial tendency of effects on glycemic control.

https://ift.tt/2DYCArF

Gain-of-function SNPs in NLRP3 and IL1B genes confer protection against obesity and T2D: undiscovered role of inflammasome genetics in metabolic homeostasis?

https://ift.tt/2GNbllp

Clinical study of pregnancy-associated fulminant type 1 diabetes

Abstract

Background

Studies reported that fulminant type 1 diabetes (fT1DM) can occurred during pregnancy or within 2 weeks after delivery, and was defined as pregnancy-associated fulminant type 1 diabetes (PF). In PF patients, plasma glucose (PG) levels have an abrupt rise while glycated hemoglobin (HbA_1C) levels are not markedly elevated, resulting in a sharply increased PG/HbA_1C ratio.

Methods

We studied 30 PF patients, 21 non-pregnant fulminant type 1 diabetes (NPF) patients, and 26 female patients of child-bearing age (13–49 years) with diabetic ketoacidosis (DKA), all from China. We analyzed the PG/HbA_1C ratio among these groups, with the goal of finding a method for predicting PF. The clinical and biochemical characteristics of the PF and NPF patients were analyzed and compared with the characteristics of the DKA patients. In order to detect PF in DKA patients, receiver-operating characteristic curves analysis was used to identify the cut-off points of the PG/HbA_1C ratio.

Results

When we compared the clinical characteristics of these three groups, we found that the onset of hyperglycemic symptoms, arterial PH value, serum potassium, PG, HbA_1C, fasting and postprandial serum C-peptide concentration, glutamic acid decarboxylase (GAD) antibodies positivity were all significantly different (P < 0.001). The PG/HbA_1C ratio was significantly higher in PF and NPF patients (5.29 ± 1.39 and 6.38 ± 2.62) than in DKA patients (1.93 ± 0.55; P < 0.001). Receiver-operating characteristic (ROC) curves analyses showed that PG/HbA_1C ratio at a cut-off value of 3.3 resulted in the highest Youden index, with corresponding sensitivity of 93 and 100% specificity for identifying PF from DKA.

Conclusions

PF patients showed a more severe acidosis, with maternal and fetal mortality rates being high. PG/HbA_1C ratio with a threshold of ≥3.3 can be used as a cut-off point in predicting PF from DKA in China. Elevated PG/HbA_1C ratio at the time of diagnosis is predictive for more severe insulin secretion dysfunction and poor prognosis.

https://ift.tt/2GWJMS5

IGF-1-based screening reveals a low prevalence of acromegaly in patients with obstructive sleep apnea

Abstract

Purpose

Recent epidemiologic studies suggest a high prevalence of acromegaly. The prevalence of obstructive sleep apnea syndrome (OSAS) in acromegaly patients ranges from 47 to 70%. A recent study identified 2 patients with acromegaly among 567 OSAS patients. However, it remains unclear whether screening for acromegaly among OSAS patients is necessary. The aim was to screen for acromegaly among OSAS patients by measuring IGF-1 levels and performing confirmatory tests if necessary.

Methods

We performed a prospective cross-sectional diagnostic study on the prevalence of acromegaly in patients with OSAS. A total of 507 patients with a confirmed diagnosis of OSAS (357 male, 150 female) were screened.

Results

Seven male and three female patients (1.97% of total) were positively screened for elevated IGF-1 levels. Nine out of ten patients suppressed growth hormone levels during OGTT excluding acromegaly, whereas one individual was identified to have acromegaly according to established criteria (1/507, prevalence 0.2%). Analysis of the data showed no correlation between elevated IGF-1 values and the severity of OSAS or BMI.

Conclusions

Our data demonstrate a low prevalence of acromegaly in patients with OSAS. Until data from population-based studies is available we suggest restricting screening for acromegaly in OSAS to those patients who have additional clinical features of acromegaly.

https://ift.tt/2qlMcmK

The associations of metabolic syndrome with incident hypertension, type 2 diabetes mellitus and chronic kidney disease: a cohort study

Abstract

Purpose

Metabolic syndrome (MetS) has been extensively studied for its long-term health effects, typically through conventional Cox proportional hazards regression modeling of the overall association of MetS with a single outcome. Such an approach neglects the inherent links between MetS-related disease outcomes and fails to provide sufficient insights into the impact of each component of MetS over time.

Methods

We therefore conducted a retrospective cohort study of 63,680 individuals who received health check-ups at the MJ Health Screening Center in Taiwan from 1997–2005 to study the subsequent risks of hypertension, type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) simultaneously for MetS and its components. Multivariate-adjusted hazard ratios (HRs) were calculated using Cox models for multiple failure outcomes.

Results

At baseline, MetS was identified in 7835 participants. Over a median follow-up of 3 years, 8252, 1634, and 6714 participants developed hypertension, T2DM and CKD, respectively. The HR for MetS was 2.41 (95% CI 2.29–2.53) for hypertension, 5.17 (95% CI 4.68–5.71) for T2DM and 1.22 (95% CI 1.15–1.31) for CKD. Three MetS components showed the strongest association with each of the outcomes: elevated blood pressure with hypertension (HR = 3.62, 95% CI 3.46–3.79), raised fasting plasma glucose with T2DM (HR = 8.89, 95% CI 7.86–10.06) and elevated triglycerides with CKD (HR = 1.14, 95% CI 1.08–1.21).

Conclusions

MetS may help identify individuals with metabolic profiles that confer incremental risks for multiple diseases. Additionally, several components of the syndrome should be considered by clinicians, as they show stronger associations with specific diseases than MetS.

https://ift.tt/2GP7jsz

Pancreatic neuroendocrine tumors in MEN1 disease: a mono-centric longitudinal and prognostic study

Abstract

Purpose

Multiple endocrine neoplasia type 1 (MEN1) is an inherited endocrine neoplastic syndrome associated with a greater risk of endocrine tumor development like pancreatic neuroendocrine tumors (p-NET), with different clinical characteristics from sporadic ones. This paper aims to compare clinical, hystological and morphological aspects of p-NET in patients affected from MEN1 (MEN1+) and not-affected ones (MEN1−).

Methods

We performed a retrospective observational study. Data was collected between December 2010 and December 2015, including patients with a histological diagnosis of p-NET and radiological imaging. We compared clinical, histological, radiological, and prognostic aspects of MEN+ p-NET with MEN−1 p-NET.

Results

Of the 45 patients enrolled, 13 MEN1+ and 21 MEN1− cases were analyzed. Frequency of not secreting p-NETs and insulin secreting p-NETs, histopathological grades and Ki67 expression were superimposable between MEN1+ and MEN1− patients. MEN1+ pNETs are more often multicentric compared to MEN1− pNETs. Frequency of liver and nodes metastatic spread was higher in MEN1− p-NET compared to MEN1+ p-NET. Analyzing p-NET according to the disease outcome, we found that recovered and stable p-NETs in MEN1+ patients, compared to MEN1− cases, are diagnosed at lower age (p = 0.04/p = 0.002) and that are more frequently multifocal lesions (p = 0.009/p = 0.002).

Conclusions

In our study pNETs in MEN1+ and pNETs in MEN1− don't significantly differ for prognosis but only for clinical features. p-NET stage disease and prognosis can be positively influenced by early diagnosis and screening in index patients' first-degree relatives

https://ift.tt/2qlMb2a

Morphologic and molecular pathway of cushing syndrome cardiomyopathy

https://ift.tt/2GJkdIy

Longitudinal AddiQoL scores may identify higher risk for adrenal crises in Addison’s disease

Abstract

Purpose

Several studies have shown a reduced quality of life (QoL) in patients with Addison's disease (AD), but investigations of QoL over a long-term course are lacking. Adrenal crises (AC) are life-threatening complications in AD. The purpose of this prospective study was to test whether the repeated use of QoL-questionnaires can detect prodromal periods of an AC.

Methods

110 patients with AD were asked to complete the disease specific-QoL questionnaire AddiQoL and a short questionnaire about adverse events once monthly over a period of ten months. AC was defined if at least two of the following symptoms were reported: (a) hypotension, (b) nausea or vomiting, (c) severe fatigue, (d) documented hyponatremia, hyperkalemia, or hypoglycemia, and subsequent parenteral glucocorticoid administration was carried out.

Results

Prevalence of AC was 10.9/100 patient years. AddiQoL scores in patients with AC showed a trend (p = 0,08) to a wider fluctuation over time. Subjective precrises not meeting the criteria for AC were reported by 31 patients who had significantly lower AddiQoL scores (p = 0,018).

Conclusions

These are the first data showing the course of QoL during a period of ten months in patients with AD. Incidence of AC exceeds previous data. Our data show, that subjective precrises in AD associate with lower QoL. AC, as well as precrises affect intraindividual AddiQol-scores over time with a trend to a stronger fluctuation. Longitudinal AddiQol scores and self-reporting of precrises via patient diaries are additional clinical tools to identify higher risk for critical events.

https://ift.tt/2Es6die

Verification of candidate microRNA markers for parathyroid carcinoma

Abstract

Purpose

Parathyroid carcinoma (PCa) is a rare endocrine malignancy with poor prognosis and is often difficult to accurately diagnose both before and after surgery. Dysregulated microRNA (miRNA) levels have been identified in PCa using a limited number of samples. The aim of the present study was to verify a group of miRNA markers in a new series of samples to explore their potential significance in PCa diagnosis.

Methods

A total of 58 tissue samples, including 17 PCa lesions and 41 sporadic parathyroid adenomas (PAds), were obtained from 56 primary hyperparathyroidism (pHPT) patients. Candidate miRNAs (miR-139-5p, miR-155-5p, miR-222-3p, miR-26b-5p, miR-296-5p, miR-30b-5p, miR-372-3p, miR-503-5p, miR-517c-3p, miR-7-5p, and miR-126-5p) were quantified by TaqMan real-time quantitative PCR assays.

Results

Up-regulated miR-222 (p = 0.041) levels and down-regulated miR-139 (p = 0.003), miR-30b (p < 0.001), miR-517c (p = 0.038), and miR-126* (p = 0.002) levels were found in PCa relative to PAd. Binary logistic regression analysis showed that miR-139 and miR-30b were the best diagnostic markers. The combination of miR-139 and miR-30b yielded an area under the receiver operating characteristic curve of 0.888. Additionally, serum calcium (r_s  = −0.518, p < 0.001), intact parathyroid hormone (iPTH) (r_s  = −0.495, p < 0.001), and alkaline phosphatase (ALP) (r_s  = −0.523, p < 0.001) levels were negatively correlated with miR-30b levels.

Conclusions

miR-139, miR-222, miR-30b, miR-517c, and miR-126* were differentially expressed between PCa and PAd. The combined analysis of miR-139 and miR-30b may be used as a potential diagnostic strategy for distinguishing PCa from PAd.

https://ift.tt/2GkfE2I

Oro-dental pathologies in acromegaly

Abstract

Purpose

Oro-dental pathologies (ODP) such as enlargement of the tongue, mandibular prognathism, and spaced teeth are characteristic features of acromegaly. Their frequency of occurrence during the course of the disease is largely unresolved. Purpose of this study was to assess ODP and oro-dental treatments in patients with acromegaly with regard to the length of the diagnostic process, tumor histology, and quality of life (QoL).

Methods

Single-center retrospective survey study using questionnaires on dental symptoms, diagnostic process, and treatment in patients with acromegaly operated on a growth hormone-secreting pituitary adenoma. The association between ODP and QoL was assessed using the Short-Form 36 (SF-36) Health Survey.

Results

145/314 patients completed the questionnaires. 80.7% were affected by any ODP, most frequently enlargement of the tongue (57.9%), spaced teeth (42.8%), mandibular growth (24.1%), and mandibular prognathism (22.1%). ODP were significantly more frequent in patients with sparsely vs. densely granulated adenomas (p = 0.045). Early diagnosis within 2 years was associated with significantly fewer ODP than later diagnosis (68.5 vs. 87.2%, p = 0.009). Treatments included dental crowns (16.6%), dental bridges (12.4%), dental implants (9.7%), dental prostheses (3.4%), orthodontal (i.e., braces, 6.9%), and surgical correction of the teeth (2.1%). Physical QoL was significantly lower in patients with ODP than in those without (p = 0.014).

Conclusion

In our large series of patients, four of five patients were affected by ODP at any time during the course of the disease. The results highlight the importance of early identification and treatment of oro-dental problems in patients with acromegaly as hallmarks of the disease.

https://ift.tt/2HhKd9O

Complete evaluation of pituitary tumours in a single tertiary care institution

Abstract

Introduction

We retrospectively evaluated all patients with pituitary tumours treated in our department from 1/1/1997 to 01/11/2014.

Patients and methods

Two hundred and fifteen patients (124 females, 91 males, mean age 50.9 years) were treated because of pituitary tumours. All patients underwent basal hormonal analysis and when required dynamic testing in order to check for hormonal activity. Pituitary masses were divided into groups concerning their hormonal status and were further classified according to gender, age at diagnosis, tumour size, and the development of postoperative pituitary insufficiency when neurosurgical intervention was conducted.

Results

One hundred and twenty-one patients had hormonally inactive tumours (non-functional adenomas; 56.3%), 57 prolactinomas (26.5%), 17 growth hormone secreting adenomas (7.9%), 16 Cushing's disease (7.4%), and 4 craniopharyngiomas (1.9%). Tumours with maximum size <1 cm (microadenomas) were detected in 62 patients (28.8%) and ≥1 cm (macroadenomas) in 153 (71.2%) of all cases (rate 1:2.5). Ninty eight patients (45.6%) had surgery (87 transsphenoidal and 11 transcranial), of this group 34 with hormonally active tumours (37.8% of the 90 patients of this subcohort). Indications for surgery were an increased risk or manifestation of chiasma syndrome and clinical symptoms due to hormonal hypersecretion. Complete [32 cases (32.6%)] or partial [33 cases (33.7%)] postoperative insufficiency in minimum one pituitary axis was present in 65/98 (66.3%) of the operated patients.

Conclusions

Pituitary adenoma prevalence is rising due to widely available imaging procedures. The majority of the tumours in our cohort were macroadenomas and hormonally inactive. Tumour extirpation via the transsphenoidal or transcranial route resulted in functional pituitary impairment of variable extent in 2/3 of the patients.

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Low-dose Synachten test with measurement of salivary cortisol in adult patients with β-thalassemia major

Abstract

Purpose

Beta-thalassemia major is a severe, congenital hematological disorder and, if untreated, leads to early mortality. Progress in therapeutical strategies improved clinical outcomes and life expectancy; however, increased survival led to the development of new disorders, including endocrinopathies. Little is known on the possible impairment of adrenocortical function, a potentially life-threatening condition, in long-term thalassaemic survivors. We therefore decided to assess adrenal reserve and the value of salivary cortisol during ACTH stimulation in the diagnosis of adrenocortical insufficiency in adult patients with β-thalassemia major.

Methods

Cross-sectional study including 72 adults with β-thalassemia major. Patients were tested with 1 µg ACTH for serum and salivary cortisol.

Results

Subnormal serum cortisol responses to ACTH stimulation (i.e., <500 nmol/l) were registered in 15 out of 72 patients. Salivary cortisol increased in parallel with serum cortisol and a clear-cut positive correlation was detected at each timepoint. Moreover, peak salivary cortisol values after ACTH stimulation were significantly lower in patients with impaired adrenal reserve (513.6 ± 52.33 vs. 914.1 ± 44.04 nmol/l p < 0.0001).

Conclusions

Our results attest to the need for testing for adrenal insufficiency among adult thalassaemic patients, as up to 20% presented impaired adrenal reserve. Salivary and serum cortisol levels during stimulation with ACTH were closely correlated and the use of salivary cortisol sampling during ACTH testing may represent a surrogate to serum cortisol in these patients.

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Association of glycaemic variability evaluated by continuous glucose monitoring with diabetic peripheral neuropathy in type 2 diabetic patients

Abstract

Purpose

Diabetic peripheral neuropathy (DPN), a common microvascular complication of diabetes, is linked to glycaemic derangements. Glycaemic variability, as a pattern of glycaemic derangements, is a key risk factor for diabetic complications. We investigated the association of glycaemic variability with DPN in a large-scale sample of type 2 diabetic patients.

Methods

In this cross-sectional study, we enrolled 982 type 2 diabetic patients who were screened for DPN and monitored by a continuous glucose monitoring (CGM) system between February 2011 and January 2017. Multiple glycaemic variability parameters, including the mean amplitude of glycaemic excursions (MAGE), mean of daily differences (MODD), standard deviation of glucose (SD), and 24-h mean glucose (24-h MG), were calculated from glucose profiles obtained from CGM. Other possible risks for DPN were also examined.

Results

Of the recruited type 2 diabetic patients, 20.1% (n = 197) presented with DPN, and these patients also had a higher MAGE, MODD, SD, and 24-h MG than patients without DPN (p < 0.001). Using univariate and multiple logistic regression analyses, MAGE and conventional risks including diabetic duration, HOMA-IR, and hemoglobin A1c (HbA1c) were found to be independent contributors to DPN, and the corresponding odds ratios (95% confidence interval) were 4.57 (3.48–6.01), 1.10 (1.03–1.17), 1.24 (1.09–1.41), and 1.33 (1.15–1.53), respectively. Receiver operating characteristic analysis indicated that the optimal MAGE cutoff value for predicting DPN was 4.60 mmol/L; the corresponding sensitivity was 64.47%, and the specificity was 75.54%.

Conclusions

In addition to conventional risks including diabetic duration, HOMA-IR and HbA1c, increased glycaemic variability assessed by MAGE is a significant independent contributor to DPN in type 2 diabetic patients.

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Disseminated Granulomatous Perifollicular Dermatosis With Comedones: A Follicular Variant of Lichen Nitidus or a New Entity?

Abstract: The presence of acquired generalized keratotic follicular papules and comedones developing in adulthood constitute an uncommon clinical situation. Although this clinical presentation has been described in several noninflammatory, inflammatory, and neoplastic skin disorders, its association with an exclusive perifollicular epitheliod or granulomatous inflammatory reaction represents an exceedingly rare phenomenon. We report a case of a 57-year-old male patient presenting clinically numerous acquired disseminated follicular papules and comedones, showing isolated perifollicular sarcoid-like granulomatous inflammatory infiltrates at the histological examination. These lesions experienced a complete spontaneous resolution after several months. The possibility that this disseminated, epithelioid, granulomatous, perifollicular dermatosis may represent an isolated follicular variant of lichen nitidus or a previously nonreported skin disorder is discussed. Correspondence: Gustavo Deza, MD, Department of Dermatology, Hospital del Mar- Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Passeig Marítim, 25-29, 08003 Barcelona, Spain (e-mail: gustavo.deza@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Papular Lesion on the Knee of a 7-Year-Old Girl

No abstract available

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Abstracts Presented at the 21st Joint Meeting of the International Society of Dermatopathology, February 14–15, 2018, the Westin San Diego, San Diego, California, USA

No abstract available

https://ift.tt/2vikNb2

Posters Presented at the 21st Joint Meeting of the International Society of Dermatopathology, February 14, 2018, the Westin San Diego, San Diego, California, USA

No abstract available

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Pre-treatment with proton pump inhibitors decreases the success of primary Helicobacter pylori eradication using a vonoprazan-based regimen

Publication date: Available online 13 April 2018
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Satoshi Shinozaki, Hiroyuki Osawa, Hirotsugu Sakamoto, Yoshikazu Hayashi, Yasutoshi Kobayashi, Yoshimasa Miura, Alan Kawarai Lefor, Hironori Yamamoto
Vonoprazan-based regimens have improved the rate of successful Helicobacter pylori (H. pylori) eradication, but it has not reached 100%. The aim of this study is to clarify significant predictors of successful H. pylori eradication using a vonoprazan-based regimen. In this retrospective cohort study, 174 patients who underwent primary H. pylori eradication therapy were included. All patients underwent esophagogastroduodenoscopy before treatment. The vonoprazan-based regimen includes amoxicillin 750 mg, clarithromycin 200 mg and vonoprazan 20 mg twice daily for one week. Pre-treatment with a proton pump inhibitor (PPI) was defined as continued PPI use for more than four weeks prior to eradication therapy. The rates of successful eradication were 83% (145/174) in intention-to-treat analysis and 85% (145/171) in per-protocol analysis. Predictors of successful eradication among 171 patients were evaluated in per-protocol analysis. In univariate analysis, male gender was a significant positive predictor of successful eradication (odds ratio [OR] 3.813, 95% confidence interval [CI] 1.363–10.663, p = 0.010) and pre-treatment with PPIs was a negative predictor (OR 0.193, 95%CI 0.076–0.485, p < 0.001). In multivariate analysis, male gender remained a positive predictor (OR 3.826, 95%CI 1.317–11.116, p = 0.013), and pre-treatment with PPIs (OR 0.232, 95%CI 0.087–0.615, p = 0.003) remained a negative predictor. In conclusion, pre-treatment with PPIs before eradication therapy decreases the rate of successful eradication. Therefore, it may be desirable to discontinue pre-treatment with PPIs prior to eradication therapy, because of the potential to improve the rate of successful eradication.



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Vitamin D: And its role in breast cancer

Publication date: Available online 5 April 2018
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Miriam de La Puente-Yagüe, Maria A. Cuadrado-Cenzual, María J. Ciudad-Cabañas, Marta Hernández-Cabria, Luis Collado-Yurrita
Vitamin D is a fat soluble vitamin that plays a role in calcium and phosphorus homeostasis. Recently, extensive research on its extraskeletal actions has linked vitamin D deficiency to an increased risk of infection, diabetes mellitus types 1 and 2, cardiovascular disease, obesity, asthma, inflammatory bowel disease, colon, breast, prostate and ovarian cancer and some neurological diseases. There are various mechanisms by which vitamin D influences the natural history of cancer. These include the role of vitamin D in the induction of apoptosis, stimulation of cell differentiation, anti-inflammatory and antiproliferative effects and inhibition of angiogenesis, invasion and metastasis. The aim of this review is to clarify the true role of vitamin D in the onset of breast cancer and evolution of the disease after treatment. A further aim is to suggest new research directions to identify indications and requirements for vitamin D supplementation in patients with breast cancer.



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Increased cumulative doses and appearance of hand-foot skin reaction prolonged progression free survival in sorafenib-treated advanced hepatocellular carcinoma patients

Publication date: Available online 4 April 2018
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Wen-Tsan Chang, Sheng-Nan Lu, Kung-Ming Rau, Ching-Shan Huang, King-Teh Lee
Sorafenib has been recommended as a new palliative therapy for advanced hepatocellular carcinoma (HCC). However, the clinical outcome of patients receiving sorafenib therapy varies. This study sought to identify which clinical method could be used to predict clinical outcome of sorafenib monotherapy in patients with advanced HCC. A total of 146 advanced HCC patients with Child-Pugh A liver function were enrolled from June 2011 to September 2015. Sorafenib doses ranged from 200 mg once daily to 400 mg twice daily. Clinical and pathological parameters were collected. There was no predefined primary endpoint. Tumor response rate, adverse events, overall survival (OS), and progression-free survival (PFS) were analyzed. The follow-up period was 1718 days (median: 859 days). The median dosage of sorafenib was 562.35 mg.Forty patients (27.4%) had stable disease and 106 patients (72.6%) had progression disease. The OS was 432.21 ± 360.52 days (median: 329 days) and PFS was 167.05 ± 166.50 days (median: 102.5 days). No sorafenib toxic effect-related mortality was encountered. The most common severe adverse events (≧grade 3) were hand-foot skin reactions (HFSR) (16, 11.0%), diarrhea (7, 4.8%), and alopecia (1, 0.7%). The following patients had longer median PFS (mPFS): those receiving total dosage > 55000 mg (217 vs.63 days; HR = 0.20,95%CI = 0.11–0.38; p < 0.001), those receiving daily dosage <562 mg (140 vs.69 days; HR = 0.27, 95%CI = 0.17–0.46; p < 0.001), those with treatment durations > 112 days (231vs.64 days; HR = 0.37, 95%CI = 0.19–0.74; p < 0.001), and those with HFSR (105 vs.75 days; HR = 0.60,95% CI = 0.6–0.98; p = 0.04). In conclusion, increased cumulative doses of sorafenib as well as the appearance of HFSR were indicators of prolonged mPFS in sorafenib-treated advanced HCC patients.



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