Current Concepts in Carious Tissue Removal

Abstract

Purpose of Review

To summarize current concepts in carious tissue removal.

Recent Findings

Traditionally, caries has been seen as an infectious disease and was treated by attempted complete removal of all cariogenic bacteria. The logical traditional aim of carious tissue removal—removing all bacteria from carious lesions—no longer applies. The contemporary aim of carious tissue removal is to maximize restoration longevity, without unnecessarily removing sound or remineralizable dentin. This is based on recent perspectives that dental caries is a biofilm-based and lifestyle-mediated disorder. In shallow lesions, as much carious tissue as possible should be removed, with removal until hard dentin is felt around the periphery of a cavity (to maximize restoration survival and seal the cavity) while centrally firm dentin is left (to retain remineralizable dentin). For deep lesions in teeth with vital pulps (without irreversible pulpitis or pulp necrosis), maintaining pulp vitality is the priority. Dentists should aim to avoid pulp exposure and accept leaving soft or leathery dentin in areas close to the dental pulp, while at the periphery, carious tissue should be removed until hard tissue is felt, ensuring that any remaining bacteria are sealed and inactivated and that the restoration has sufficient mechanical support against masticatory forces. An alternative for deep lesions is stepwise removal. Carious tissue strategies where no carious tissue removal at all is performed include sealing using plastic materials or stainless steel crowns, or non-restorative cavity control.

Summary

A range of carious tissue removal strategies are available and should be applied according to lesion characteristics, pulp vitality, and other patient related factors. Always striving to remove carious tooth tissue until hard dentin remains is not in line with current evidence and not recommended.

https://ift.tt/2uiN6Cl

Recent Trends in Tricalcium Silicates for Vital Pulp Therapy

Abstract

Purpose of Review

Tricalcium silicates are considered as materials of choice for vital pulp therapy. Recent development improved their mechanical and bioactive properties and broadened their clinical application fields. Incorporating resins to tricalcium silicates further decreased the setting time and simplified clinical procedures but raised questions about their potential toxicity.

Recent Findings

Tricalcium silicates represent an added value in vital pulp therapy. This is ascribed to the pulp high regeneration potential, material byproducts production upon hydration and growth factor release from target cells. Adding resins to tricalcium silicates decreases their hydration and subsequently leads to pulp toxicity.

Summary

Tricalcium silicates can be successfully used for vital pulp therapy in a broad range of clinical applications. Although long-term clinical studies are still required with these new materials, adding resins to tricalcium silicates is responsible for pulp disorganization and toxicity and cannot be recommended for direct pulp capping.

https://ift.tt/2m57lzO

The Future of Payment for Dental Care

Abstract

Purpose of Review

To examine the literature on dental reimbursement methods, with emphasis on paying for value (e.g., health care outcomes) rather than procedure. To make recommendations that would facilitate the expansion of access to dental care for those most in need and improve the oral health of the US population.

Recent Findings

Although the health care system is moving toward paying for performance and outcomes, dentistry lags behind. We review publications that identify obstacles to payment for outcomes in oral health as well as moving away from traditional fee-for-service reimbursement.

Summary

Payment for value in dentistry is a long way from becoming a reality; however, the testing of models within Medicaid that set aside a small percentage of the fee for a procedure to be reimbursed based on the improved oral health of the patient and/or the population of the practice may facilitate its adoption. A similar set aside in capitation-based programs could ensure the delivery of essential services and avoid the underutilization traditionally associated with this type of reimbursement system. Similar incentives could be tested in group practices and perhaps even community health centers. Widespread adoption of diagnostics code, missing in dental records, would enable better tracking of met needs. Educational systems that foster intra- and interprofessional teamwork and the appropriate use of personnel operating at the top of their competency would increase efficiency while adding value at the same or lower cost.

https://ift.tt/2zsa3cc

Smear Layer-Deproteinization: Improving the Adhesion of Self-Etch Adhesive Systems to Caries-Affected Dentin

Abstract

Purpose of review

This paper reviews a new method of dentin surface modification, smear layer-deproteinization for self-etch adhesive systems, particularly in relation to improving the adhesion to caries-affected dentin.

Recent Findings

Remnants of smear debris, which forms hybridized smear layer with self-etch adhesives, can prevent monomer infiltration and interfere with the chemical interaction of adhesive monomers and the underlying dentin. The hybridized smear layer weakens the physical and chemical properties of the resin-dentin hybridized complex both immediately and over time. Smear layer-deproteinization with NaOCl and HOCl solutions can improve the quality of resin-dentin interface of self-etch adhesives through elimination of the hybridized smear layer, development of monomer infiltration, and enhancement of the chemical interaction of adhesive monomers with hydroxyapatite due to an increase in the mineral/organic ratio on the dentin surface. These positive effects are influenced by the types of oxidizing solution and their application time and also depend upon the adhesive materials used because compromising effects of residual oxidized-byproducts at the dentin surface on the polymerization behavior of the adhesives are different between the materials. However, applying antioxidant/reducing agents can eliminate this problem.

Summary

Smear layer-deproteinization is more effective for improving the bonding efficacy of self-etch adhesives to caries-affected dentin than normal dentin because caries-affected dentin produces a thicker organic-rich smear layer. Smear layer-deproteinization with HOCl solution, which has a rapid and broad-spectrum antimicrobial activity with less irritating and sensitizing properties, along with the subsequent application of antioxidant/reducing agents could enhance the longevity of composite restoration with self-etch adhesives.

https://ift.tt/2m3oIkC

Fracture Toughness Testing of Dental Restoratives: a Critical Evaluation

Abstract

Purpose of Review

We intend by this short critical review to highlight important aspects regarding the mechanical testing of fracture toughness. The final aim is to increase the awareness to the test sensitivity, ultimately increasing the quality and reliability of reported testing results.

Recent Findings

In a well-intended attempt to facilitate testing procedures or provide alternatives for testing material interfaces, authors are resorting to adaptation of testing methodologies without proper theoretical and experimental validation. The assumption of validity in such cases endangers the perpetration of testing strategies that are not safeguarded by sound theoretical bases. The use of improper statistical treatments based on extreme-value distributions further aggravates this scenario.

Summary

We supply here some directions for authors concerning method selection, interpretation of data scatter, statistical treatment, and possibilities for test validation.

https://ift.tt/2L0hqfo

Beyond JAAD - October 2018

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Andrew Bronin, Robert Phelps, Robert Sidbury

https://ift.tt/2N1x7jO

Methotrexate for alopecia areata: a systematic review and meta-analysis

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Kevin Phan, Vignesh Ramachandran, Deshan Frank Sebaratnam

Abstract

Background

Methotrexate has been used both as an adjunct for low-risk maintenance therapy after initiation with corticosteroids for alopecia areata (AA) and as standalone therapy in some investigations, based on a lack of definitive evidence/guidelines.

Objective

To (1) determine the efficacy and risks associated with methotrexate therapy for AA (2) determine differences efficacy of combination with corticosteroids versus standalone treatment, and (3) determine relative efficacy of methotrexate in adult versus pediatric populations.

Methods

A systematic review and meta-analysis was performed according to recommended PRISMA guidelines.

Results

Methotrexate has reasonable effectiveness in patients with severe AA, and that adults appear to be more responsive to methotrexate treatment compared to pediatric cases. Methotrexate in conjunction with corticosteroids result in higher good/complete response rates compared to those treated with methotrexate alone. A large proportion of recurrence rates occurred in the setting of tapering treatment. Complication rates were acceptable and similar between adults and pediatric cases.

Limitations

Studies reviewed were retrospective observational studies with heterogeneity between centers in terms of dosages/protocols for methotrexate use in AA, and adjunctive treatments with a lack of data beyond one year.

Conclusion

Methotrexate is an effective monotherapy or adjunct to corticosteroid in the treatment of severe AA.

https://ift.tt/2KIwOOd

Surgical Pearl: A Granny Sliding Knot for High Tension Closures

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Jeffrey F. Scott, Mona Ascha, Whitney Pollard, Jeremy S. Bordeaux

https://ift.tt/2N3tytt

Ustekinumab treatment for neutrophilic dermatoses associated with Crohn’s disease: a multicenter-retrospective study

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Tullia de Risi-Pugliese, Philippe Seksik, Jean-David Bouaziz, François Chasset, Philippe Moguelet, Jean-Marc Gornet, Anne Bourrier, Aurélien Amiot, Laurent Beaugerie, Camille Francès, Sarah Guégan, Ustek-CDND study group

https://ift.tt/2KOwg9O

Drug-Induced Phototoxicity: A Systematic Review

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Whan B. Kim, A.J. Shelley, K. Novice, J. Joo, H.W. Lim, S.J. Glassman

Abstract

Background

Phototoxicity has been attributed to numerous oral drugs over the past 60 years.

Objective

Determine the quality of evidence supporting suspected phototoxicity from oral drugs

Methods

MEDLINE and EMBASE databases were searched for all studies containing original data for drug-induced phototoxicity published between May 1959 and December 2016. Study quality was assessed using a modified GRADE scale.

Results

The review included 240 eligible studies with a total of 2466 subjects. There were 1134 cases of suspected phototoxicity associated with 129 drugs. Most associations were supported by either very low-quality or low-quality evidence (89.1% of the studies). Medications supported by stronger evidence were vemurafenib, non-steroidal anti-inflammatory drugs (NSAIDs), and antibiotics, specifically fluoroquinolones and tetracyclines. The most frequently reported drugs were: vemurafenib, voriconazole, doxycycline, hydrochlorothiazide, amiodarone, and chlorpromazine. Photobiologic evaluation was performed in only 56 studies (23.3%), while challenge-rechallenge was done in 10% of cases.

Limitations

Only English-language publications were reviewed. Phototoxicity cases incorrectly termed photoallergy would not have been included.

Conclusions

Most purported associations between oral drugs and phototoxicity are not supported by high-quality evidence. Despite the variable quality of data, clinicians should be aware of the possible consequences of chronic use of culprit drugs.

https://ift.tt/2N2T95T

The ALT-70 Predictive Model Outperforms Thermal Imaging for the Diagnosis of Lower Extremity Cellulitis: A Prospective Evaluation

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): David G. Li, Anna K. Dewan, Fan Di Xia, Hasan Khosravi, Cara Joyce, Arash Mostaghimi

Abstract

Background

We previously demonstrated dermatology consultation to substantially reduce cellulitis misdiagnosis rates; however, broad implementation is impractical due to existing practice patterns and reimbursement systems. Meanwhile, efforts to improve diagnostic accuracy have culminated in point-of-care tools, including the ALT-70 predictive model for lower extremity cellulitis and thermal imaging.

Objective

To prospectively evaluate the performance of ALT-70 and thermal imaging in diagnosing lower extremity cellulitis in a head-to-head comparison.

Methods

We collected ALT-70 and thermal imaging data from patients with presumed lower extremity cellulitis and compared classification measures and accuracy for ALT-70, thermal imaging, and combination testing (ALT-70 plus thermal imaging).

Results

We enrolled 67 patients with ALT-70 and thermal imaging data. ALT-70 conferred the highest sensitivity (97.8%) and negative predictive value (90.9%), while combination testing had the highest specificity (71.4%) and positive predictive value (86.6%). ALT-70 had improved classification measures compared to thermal imaging. Combination testing conferred a marginal benefit to ALT-70 alone.

Limitations

Single-center design may limit generalizability.

Conclusion

ALT-70 outperformed thermal imaging in diagnosing lower extremity cellulitis. The accuracy of the ALT-70 was high and consistent with previously published reports. Broad implementation of ALT-70 into clinical practice may decrease misdiagnosis rates of lower extremity cellulitis.

https://ift.tt/2KN4xGf

Mohs micrographic surgery (MMS) with MART-1 immunostaining for atypical intraepidermal melanocytic proliferation (AIMP)

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Jeremy R. Etzkorn, Olivia S. Jew, Thuzar M. Shin, Joseph F. Sobanko, Donald E. Neal, Christopher J. Miller

Abstract

Background

The efficacy of Mohs micrographic surgery (MMS) for atypical intraepidermal melanocytic proliferation (AIMP) is unknown.

Objective

To ascertain the frequency of diagnostic change to melanoma (upstaging) and the frequency of local recurrence after MMS for AIMP. A secondary outcome was the frequency of subclinical spread (defined as the requirement for greater than one stage of MMS to achieve tumor-free margins).

Methods

Retrospective, cross-sectional study of 223 AIMP (with 92.4% located on the head, neck, hand, foot, or pretibial leg) treated with MMS with MART-1 immunostaining.

Results

Upstaging to unequivocal MIS or invasive melanoma was identified in 18.8% (42/223) of all AIMP. The local recurrence rate was 0% (0/223) with a mean follow-up time of 2.7 years (998 days). Subclinical spread was present in 23.8% (53/223) of AIMP.

Limitations

Single site, retrospective design, observational study, lack of objective criteria to diagnose AIMP

Conclusion

MMS with MART-1 immunostaining achieves excellent local control of specialty-site AIMP and permits definitive removal of subclinical spread prior to reconstruction. The central debulking excision should be evaluated with formalin-fixed paraffin-embedded sections, since a significant percentage of AIMP are reclassified as MIS or invasive melanoma.

https://ift.tt/2N3txWr

Pigmentation of basal cell carcinoma is inversely associated with tumor aggressiveness in Asian patients

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Hye-Rim Moon, Tae Jun Park, Ki Woong Ro, Hwa Jung Ryu, Soo Hong Seo, Sang Wook Son, Il-Hwan Kim

https://ift.tt/2KMK2JG

Intralesional Immunotherapy for the Treatment of Warts: A Network Meta-analysis

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Samar Salman, Mohamed Shehata Ahmed, Ahmed Mohamed Ibrahim, Omar Mohamed Mattar, Hassan El-Shirbiny, Sameh Sarsik, Ahmed M. Afifi, Ruba Marwan Anis, Nadim Aiman Yakoub Agha, Abdelrahman Ibrahim Abushouk

Abstract

Background

Without clear evidence, selecting among the existing immunotherapeutic options for warts remains challenging.

Objective

Through network meta-analyses, we aimed to evaluate the comparative efficacy of different intralesional immunotherapeutic modalities.

Methods

We included randomized controlled trials (RCTs) comparing intralesional immunotherapeutic modalities to cryotherapy, placebo or imiquimod. All outcomes were presented as odds ratio (OR) with 95% confidence-interval. Both conventional and network meta-analyses (with a frequentist approach) were conducted on R software. The P-score was used to rank different treatments.

Results

Network meta-analysis of 17 RCTs (1676 patients) showed that PPD (OR=39.56), MMR (OR=17.46) and INF-β (OR=15.55) had the highest efficacy in terms of complete recovery at the primary site, compared to placebo. Regarding complete recovery at the distant site, autoinoculation (OR=79.95), PPD (OR=42.95) and MMR (OR=15.39) were all statistically superior to placebo. According to the P-score, MMR was more effective than other modalities in reducing recurrence rate at the same site.

Limitations

Relatively-small sample size in some comparisons and variability in baseline characteristics.

Conclusion

PPD and MMR were the most effective in achieving complete primary and distant recovery (along with autoinoculation for distant recovery) and reducing the recurrence rate at the same site, compared to cryotherapy and other immunotherapeutic modalities.

https://ift.tt/2N56cUb

Efficacy, Safety, and Comparison of Sonic Hedgehog Inhibitors in Basal Cell Carcinomas: A Systematic Review and Meta-Analysis

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Pingxing Xie, Philippe Lefrançois

Abstract

Background

Sonic Hedgehog Inhibitors (SHHi) provide an additional treatment option for basal cell carcinomas (BCC), especially for metastatic or locally advanced BCC. However, studies have been heterogeneous and lacking direct comparisons between molecules.

Objective

To determine the efficacy and safety of SHHi, as a class of molecules, for treating BCC, and to compare them individually.

Methods

We performed a PRISMA-compliant systematic review of studies followed by a meta-analysis.

Results

Eighteen articles were included in our meta-analysis; sixteen articles were combined for efficacy and sixteen for safety. In locally advanced BCC, Overall Response Rates (ORR) were similar for vismodegib and sonidegib (69% vs. 57%), but not Complete Response Rates (31% vs. 3%). In metastatic disease, the ORR of vismodegib was 2.7-fold higher than the ORR of sonidegib (39% vs. 15%). For side effects affecting a majority of patients, combined prevalences were 67.1%, 54.1% and 57.7% for muscle spasms, dysgeusia, and alopecia, respectively, in similar proportions for sonidegib and vismodegib. Patients receiving sonidegib experienced more upper GI distress than patients receiving vismodegib.

Conclusions

SHHi as a class lead to partial responses for locally advanced BCC disease. Side effects are similar across molecules, common, associated with high discontinuation rates, and warrant discussion beforehand.

https://ift.tt/2KHT4Ys

Topical Glycopyrronium Tosylate for the Treatment of Primary Axillary Hyperhidrosis: Results from the ATMOS-1 and ATMOS-2 Phase 3 Randomized Controlled Trials

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Dee Anna Glaser, Adelaide A. Hebert, Alexander Nast, William P. Werschler, Lawrence Green, Richard Mamelok, Janice Drew, John Quiring, David M. Pariser

Abstract

Background

Glycopyrronium tosylate (GT) is a topical anticholinergic developed for once-daily treatment of primary axillary hyperhidrosis.

Objective

Assess the efficacy and safety of GT for primary axillary hyperhidrosis.

Methods

ATMOS-1 and ATMOS-2 were replicate randomized, double-blind, vehicle-controlled, 4-week phase 3 trials. Patients were randomized 2:1 to GT 3.75% or vehicle applied once daily to each axilla for 4 weeks. Coprimary endpoints were responder rate (≥4-point improvement from Baseline) on Item 2 (sweating severity) of the Axillary Sweating Daily Diary (ASDD), a newly developed patient-reported outcome, and absolute change from Baseline in axillary gravimetric sweat production at Week 4. Safety evaluation included treatment-emergent adverse events (TEAEs).

Results

Pooled data, consistent with individual trial results show significantly more GT-treated patients achieved ASDD Item 2 response versus vehicle (59.5% vs 27.6%) and had reduced sweat production from Baseline (-107.6mg/5min vs -92.1mg/5min) at Week 4 (P<0.001 for both coprimary endpoints). Most TEAEs were mild or moderate and infrequently led to discontinuation.

Limitations

Short trial duration and inherent challenges in gravimetrically assessing sweat production.

Conclusions

Daily, topically-applied GT over 4 weeks reduced sweating severity as measured by ASDD-Item 2, reduced sweat production as measured gravimetrically, and was generally well tolerated in primary axillary hyperhidrosis patients.

https://ift.tt/2N2l2eb

Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Nicole M. Golbari, Martina L. Porter, Alexa B. Kimball

Abstract

Background

Hormonal therapy is a potential treatment for hidradenitis suppurativa (HS). However, little data exists describing the efficacy of spironolactone in HS treatment.

Objective

To assess whether spironolactone treatment improves HS disease severity and patient reported pain.

Methods

We performed a single center chart review of female HS patients treated with spironolactone between 2000 and 2017. Primary outcome measurements included the HS Physician Global Assessment (HSPGA), Hurley Staging, inflammatory lesion count, fistula count, and a numeric rating scale for pain.

Results

Subjects on average were exposed to 75mg of spironolactone daily over a 7.1-month follow-up period. Patients achieved significant disease improvement with regards to pain (Δ-1.5, P=.01), inflammatory lesions (Δ-1.3, P=.02), and HSPGA (Δ-0.6, P<.001). As expected, no change was found for Hurley stage (Δ0, P=.32) or fistulas (Δ0, P=.73). There was no difference in improvement between subjects who received less than 75mg daily (n= 25, average 45mg/day) and those who received greater than 100mg daily (n=21, average 112mg/day).

Limitations

Retrospective nature, limited sample size, and variations in severity measures documented were limiting factors.

Conclusions

Management of HS with spironolactone reduces lesion count, HSPGA and pain. Lower doses appear to be effective and may be an appropriate option for patients with tolerability concerns.

https://ift.tt/2KHSWrW

“Comparing the eighth and the seventh editions of the ajcc staging system and the brigham and women’s hospital alternative staging system for cutaneous squamous cell carcinoma: implications for clinical practice”

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): J. Cañueto, J. Burguillo, D. Moyano-Bueno, A. Viñolas-Cuadros, A. Conde-Ferreirós, Luis Antonio Corchete-Sánchez, J. Pérez-Losada, C. Román-Curto

Abstract

Background

The new 8^th edition of the American Joint Committee on Cancer (AJCC) staging system incorporates changes regarding cutaneous squamous cell carcinoma (CSCC).

Objectives

We aimed to compare the 8^th edition of the AJCC (AJCC-8) staging system with the previous 7^th edition (AJCC-7) and the Brigham and Women's Hospital alternative staging system, to identify their usefulness and the utility of their risk factors in defining prognostic groups in CSCC.

Methods

A series of 186 CSCCs of the head and neck was retrospectively collected. All three staging systems were compared in their ability to predict poor prognosis. Binary logistic regression models were built to determine which risk factors were most relevant.

Results

Poor prognosis was mainly associated with T2-AJCC-7, with T2b/T3-BWH's and with T3-AJCC-8. The AJCC-8 and the BWH's staging systems displayed overlap between each other in predicting poor prognosis and both were superior to the AJCC-7. The new risk factors incorporated into the AJCC-8 and the poor degree of differentiation were independently associated with poor outcome.

Limitations

Retrospective study and few cases with bone invasion.

Conclusions

The AJCC-8 is more distinctive, monotonous and homogeneous than the AJCC-7 and shows some overlap in the stratification of tumors with the BWH's system.

https://ift.tt/2MZNiy6

The joint toxicity effect of five antibiotics and dibutyl phthalate to luminescent bacteria ( Vibrio fischeri )

Abstract

Antibiotics and phthalate esters are two kinds of emerging pollutants and are ubiquitous in the aquatic ecosystem. To date, few studies analyzed the combined toxicity of the mixtures of antibiotics and phthalate esters, and their joint toxicity effect mode remains unknown. Here, we investigated the single and joint toxicity of dibutyl phthalate (DBP) and five antibiotics, namely, oxytetracycline hydrochloride (OTC), chlortetracycline hydrochloride (CTC), sulfamethazine (SMZ), sulfamerazine (SMR), and sulfadiazine (SD), to luminescent bacteria of Vibrio fischeri. The median effect concentration (EC₅₀) values of the test chemicals were ranked as CTC (6.67 mg/L) > OTC (25.12 mg/L) > SD (67.61 mg/L) > SMR (141.51 mg/L) > DBP (148.38 mg/L) > SMZ (245.07 mg/L). The joint toxicities of the binary mixtures of antibiotics and DBP were evaluated by the concentration addition (CA) and independent action (IA) models. The joint toxicity effects of CTC-DBP, OTC-DBP, SMZ-DBP, SMR-DBP, and SD-DBP all appeared to be synergism. Our study revealed that sulfonamides combined with DBP could be as toxic as or even more toxic than tetracycline. Thus, the joint toxicity effect should be considered when assessing the ecological risks of binary or multicomponent pollutants.

https://ift.tt/2zzs7kT

Several newly discovered Mo-enriched plants with a focus on Macleaya cordata

Abstract

Phytoremediation as an alternative strategy has been a widespread attention. The screening of enriched plants and hyperaccumulators is the key of the strategy. So this study examined the status of heavy metal pollution in molybdenum (Mo) mine soils, metal accumulation in plants growing on mine, and their tolerance strategies. The analysis of 14 soils and 27 plant samples in mining area showed that Mo, zinc (Zn), and cadmium (Cd) concentrations exceeded soil safety standards and their levels varied in 27 plant samples. Mo was the heavy pollution with an average total content of 256.1 mg/kg in soils. As Mo-enriched plants, Mo concentrations of Macleaya cordata (Willd.) R. Br. and Morus australis Poir. were 704.4 and 772.4 mg/kg, respectively. M. cordata was selected as the research material, due to its high biomass. Molybdenum significantly decreased the biomass and photosynthesis of M. cordata at high concentration (> 200 μmol/L), but its biomass and photosynthesis reached the maximum after 50 μmol/L Mo treatment, respectively. Analysis of the subcellular distribution and chemical speciation showed that Mo was distributed a certain way in the extracts and that this suggested that it may be present in cell wall and soluble fraction of roots (51.9–63.9%; 26.1–44.7%) or shoots (30.0–44.4%; 47.3–56.0%) and complexed to organic acid, pectate, oxalate, and protein. This might be responsible for the adaptation of M. cordata to Mo stress. Therefore, M. cordata could serve as a potential plant to utilize for the phytoremediation of Mo-contaminated soil.

https://ift.tt/2u7Epf7

Relationship between transient severe motion of the liver in gadoxetic acid or iodinated contrast agent-enhanced imaging and arterial oxygen saturation and heart rate changes

Publication date: Available online 10 July 2018

Source: Magnetic Resonance Imaging

Author(s): Akihiko Kanki, Tsutomu Tamada, Toshinori Abe, Hiroyuki Ikenaga, Koji Yoshida, Katsuyoshi Ito

Abstract

Purpose

To clarify the relationship between transient sever motion artifact in arterial phase (TSMA) and changes in peripheral capillary oxygen saturation (SpO₂) and heart rate (HR) after contrast media administration during MRI or CT of the liver.

Methods

87 patients undergoing 61 MRI examination with gadoxetic acid or 26 CT examination with iodinated contrast were included. Dynamic contrast-enhanced imaging (DCEI) was obtained at four vascular phase acquisitions. Reviewers extracted the segmental data of SpO₂ and HR in each phase from consecutive data in DCE-CT or DCE-MRI. In addition, reviewers scored for respiratory motion in each phase using 5-point scale. Patients with an arterial score of 4–5, and other phase scores of 1–2 were considered to be exhibiting TSMA.

Results

In gadoxetic acid, mean SpO₂ of arterial phase was significantly lower than three other phases (P = 0.045 to P < 0.001). However, the decrease in SpO₂ in arterial phase compared with other phases was <1%. Mean HR in gadoxetic acid or iodinated contrast agent was highest in the portal-phase. The incidence of TSM was 0% in patients with iodinated contrast agent and was 8.2% (5/61 patients; TSM group) in patients with gadoxetic acid, respectively. In addition, there was no significant difference in mean SpO₂ of arterial phase between the TSM group (97.5% ± 1.08%) and non-TSM group (96.4% ± 1.85%) (P = 0.219).

Conclusion

The slight decrease in SpO₂ in arterial phase is not associated with TSMA.

https://ift.tt/2KIvHy1

3D Printed Electrodes for Improved Gas Reactant Transport for Electrochemical Reactions

3D Printing and Additive Manufacturing, Ahead of Print.


https://ift.tt/2L4aBpZ

Emerging contaminants removal by granular activated carbon obtained from residual Macauba biomass

Abstract

The removal of emergent contaminants via adsorption on granular activated carbon, prepared from Macauba palm, has been studied, contributing to the recovery of the residual biomass, endocarp, obtained in the Macauba palm oil extraction process. The material was characterized by different techniques, such as Raman spectroscopy, thermal analysis, adsorption/desorption of N₂, zeta potential, and scanning electron microscopy. The N₂ adsorption studies showed that the material presents wide micropores and narrow mesopores, and has a surface area of 907.0 m² g⁻¹. Its maximum adsorption capacity towards the three main emerging contaminants (bisphenol A, ethinylestradiol, and amoxicillin) is much higher than that obtained with benchmark adsorbents (0.148, 0.104, and 0.072 mmol g⁻¹, respectively). The influence of temperature and pH on the adsorption was also analyzed, allowing an improved description of the adsorption mechanism and showing very promising results.

https://ift.tt/2ul2eiu

Concentrations of PCDD/Fs in the neighborhood of a hazardous waste incinerator: human health risks

Abstract

In 1996–1998, a wide surveillance program was initiated in the vicinity of a new hazardous waste incinerator (HWI) placed in Constantí (Catalonia, Spain), which started its regular operations in 1999. The program was aimed at assessing the environmental impact of the facility on the surrounding environment, as well as to evaluate the potential risks for the population living in the neighborhood. Since then, among other measurements, the concentrations of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) have been periodically determined in soil and herbage samples. This study shows the results, corresponding to the period 2013–2016. Data were compared with those obtained in the baseline survey (1996–1998), as well as with those of the previous survey (2011–2012). The median PCDD/F concentrations in soils were 0.44 and 0.33 ng toxic equivalent (I-TEQ)/kg in 2015 and 2016, respectively, with a significant decrease in relation to the baseline survey, and a non-significant decrease between 2015 and 2016. In turn, PCDD/F levels in vegetation showed some fluctuations over time, being the concentrations of PCDD/Fs in 2013 very similar to those found in 2012 (1.11 and 1.23 ng I-TEQ/kg, respectively). These concentrations notably decreased along the three last campaigns (0.16, 0.23, and 0.17 ng I-TEQ/kg in 2014, 2015, and 2016, respectively). These changes would be more related to a number of environmental factors rather than to a variation of PCDD/F emissions by the HWI. With respect to human health risks, exposure to PCDD/Fs in the area under potential influence of the HWI is not of concern, as the current environmental concentrations of PCDD/Fs do not mean additional carcinogenic or non-carcinogenic risks for the local population.

https://ift.tt/2KOesvu

Valorization of biochars from pinewood gasification and municipal solid waste torrefaction as peat substitutes

Abstract

Gasification and torrefaction have both gained significant interest as bioenergy techniques. During biomass gasification together with fuel gas, carbon-rich solid substances are produced, whereas torrefaction process is mainly used to prepare a final product with higher calorific value and carbon content than the feedstock, through a low temperature pyrolysis. Both materials (carbon wastes from gasification and torrefied product) could be classified as alternatives to biochar obtained from slow pyrolysis of biomass. The use of biochar, typically from the slow pyrolysis of biomass, as soil amendment and, more recently, as growing media components has been widely researched. However, to our knowledge, no studies have compared the use of biochar from gasification and torrefaction as growing media component for growing media formulation. The objective of this work was to study the effect of two biochars on peat-based growing media: a pinewood gasification biochar (BG) and a biochar (BT) obtained by torrefaction of the organic fraction of municipal solid waste. Growing media mixing PT (peat) with 50%vol of BG or BT were prepared and characterized according to their chemical, thermal and hydrophysical properties. Phytotoxic experiments and growth of Lolium perenne were also performed. Results indicated that peat substitution in growing media by BG and BT at a 50%vol ratio improved their hydrophysical properties. Specifically, bulk density increased more than 50%, air space increased by 43%, the increment of the total porosity was 20%, and, finally, the water holding capacity increased by 18.3%. Significantly, a positive effect on plant biomass production (yield increment: 274%) was observed after addition of BT, whereas no significant differences were observed after addition of BG biochar. Therefore, it can be concluded that both BT and BG could be used as peat substitutes in growing media formulation.

https://ift.tt/2N1hf0J

Comparative effect of organic amendments on physio-biochemical traits of young and old bean leaves grown under cadmium stress: a multivariate analysis

Abstract

The current study investigated the influence of organic amendments on cadmium (Cd) uptake and its effects on biochemical attributes of young and old leaves of bean. Bean seedlings were exposed to two levels of Cd (25 and 100 μM) in the presence and absence of different levels of ethylenediaminetetraacetic acid (EDTA) and citric acid (CA). An increase in Cd concentration in growth medium significantly enhanced Cd accumulation in bean roots and shoot. Cadmium stress increased the production of H₂O₂ which resulted in lipid peroxidation and decreased chlorophyll contents. The presence of organic amendments significantly affected Cd accumulation and toxicity to bean plants. Application of EDTA alleviated Cd toxicity in terms of chlorophyll contents, H₂O₂ contents, and lipid peroxidation possibly by chelating toxic Cd ions, and as such forming Cd-EDTA complexes. The presence of CA decreased Cd toxicity by decreasing its uptake. The biochemical responses (H₂O₂ contents, lipid peroxidation, and chlorophyll contents) of bean plants were more severely affected by Cd treatments in old leaves compared to young leaves. This study shows that the effect of CA and EDTA on biochemical behavior of Cd varies greatly with applied levels of Cd and amendments as well as the age of leaves. Based on the results, it is proposed that the presence of organic amendments can greatly affect biogeochemical behavior of Cd in the soil-plant system (ecosystem).

https://ift.tt/2L2KSOF

The diagnostic accuracy of increased late night salivary cortisol for Cushing’s syndrome: a real-life prospective study

Abstract

Introduction and aim

A prompt diagnosis of Cushing's Syndrome (CS) in high-risk populations is mandatory: 1-mg dexamethasone suppression test (1-mg DST), late night salivary cortisol (LNSC), and urinary-free cortisol (UFC) are recommended, despite thresholds calculated in retrospective studies. Our aim was to study the diagnostic accuracy of LNSC measured with chemiluminescence assay in a prospective study, confirming discrepancies with mass spectrometry (MS).

Materials and methods

We enrolled 117 controls and 164 suspected CS (CS = 47, non-CS = 117). In case of increased LNSC, high clinical suspicion of CS or adrenal incidentaloma, patients were hospitalized to exclude/confirm CS.

Results

LNSC levels were higher in patients with suspected CS, CS, and non-CS than controls. Considering 16 nmol/L as threshold for CS, overall LNSC revealed SE 97% and SP 84% in the whole group of subjects considered, achieving positive/negative likelihood ratio of 5.56/0.045, respectively. 35 out of 81 subjects with increased LNSC were non-CS (15 diabetic and 20 obese): considering only those patients with increased likelihood to have a CS (the non-CS patients) SP decreased to 70%, and further reduced to 60% if we discharged subjects with adrenal incidentaloma. MS analyses reduced partially the number of false-positive LNSC.

Conclusions

LNSC measured in automated chemiluminescence is reliable in clinical practice: it present a high diagnostic accuracy to exclude hypercortisolism in patients with normal cortisol levels. MS could be used to reduce the number of false-positive results; nevertheless, some non-CS subjects with functional hypercortisolism could have a mild impairment of cortisol rhythm.

https://ift.tt/2L21NUG

RAGE and Its Ligands: Molecular Interplay Between Glycation, Inflammation, and Hallmarks of Cancer—a Review

Abstract

Risk of cancer especially of colon, breast, and pancreas is high in diabetic and obese patients, with potential involvement of augmented expression of RAGE (receptor for advanced glycation end products) and its ligands, namely AGEs (advanced glycation end products), HMGB1 (high-mobility group box 1 protein), and S100 group of proteins. Studies have reported the involvement of RAGE activation by its ligands in growth and survival of cancers, including metastasis and poor prognosis. We propose that this receptor-ligand axis provides the molecular link between certain pre-existing states as hypoxia, hyperglycemia, glycation, inflammation, oxidative stress, and onset of cancers. The chronic inflammatory, hyperglycemic milieu accompanied by glycoxidative stress as in diabetes and obesity, concomitant with the formation of RAGE ligands, instigates RAGE and cancer stem cells, leading to the oncogenic transformation of normal and pre-malignant tissues towards development of neoplasms. We have aimed to elucidate the complete signalling map initiated upon RAGE-ligand splicing, from oncogenesis to progression, epithelial-mesenchymal transition, invasion, cancer stem cell renewal, chemo-resistance, and cancer relapse. We have attributed the complex molecular functions of RAGE-ligand signalling cues to every aspect of cancer promotion, explaining the central network in bridging glycation, inflammation, oxidation, and the hallmarks of cancer. Underlining the substantial requisite for anti-neoplastic agents targeting RAGE and its ligands, we have explicitly discoursed RAGE and its allied components (AGEs, soluble RAGE, RAGE gene polymorphisms) as potential diagnostic and prognostic biomarkers for prompt detection of cancers and implication in impending RAGE-ligand directed, novel combinatorial, and targeted onco-therapeutics.

https://ift.tt/2m697Rn

Severe Graves’ Orbitopathy occurring in a patient with thyroid hemiagenesis

https://ift.tt/2L2QkBl

Pattern of dysphagia after swallowing-sparing intensity-modulated radiotherapy (IMRT) of head and neck cancers: results of a mono-institutional prospective study

Abstract

Background and purpose

A prospective instrumental assessment of late dysphagia using swallowing organs at risk (SWOARs)-sparing IMRT for nasopharyngeal and oropharyngeal cancers.

Materials and methods

Objective instrumental assessment included fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy (VFS) at baseline, and at 6 and 12 months after treatment. FEES assessed the pharyngeal residue according to the Farneti pooling score (P-score) as follows: 4–5 no dysphagia; 6–7 mild dysphagia; 8–9 moderate dysphagia; 10–11 severe dysphagia. Three different consistencies were tested for the P‑score: liquid (L), semisolid (SS), and solid (S). VFS assessed penetration-aspiration according to the Penetration-Aspiration Scale (PAS) and two different consistencies of the bolus were tested: thin liquid barium (L) and paste barium (S).

Results

38 patients were evaluable. There was a significant worsening of the P‑score at 6 months both for SS (p = 0.015) and S (p < 0.001), which persisted only for S at 12 months (p < 0.0001). Similarly, there was a significant worsening of the PAS score at 6 and 12 months (p = 0.065 and 0.039, respectively) for the S bolus. Overall, 3–7 and 10–14% aspiration after L and S was observed, respectively.

Conclusions

Promising results using a SWOARs-sparing IMRT technique are reported. Therefore, treatment plans should be optimized for reducing doses to these structures.

https://ift.tt/2NES3y7

Stellenwert der stereotaktischen Radiotherapie für das nichtresezierte Pankreaskarzinom

https://ift.tt/2KZ0kvm

Neoadjuvante Chemotherapie vor radikaler Hysterektomie beim Zervixkarzinom – Response ist nicht Überleben

https://ift.tt/2KUl22F

Adjustment of insulin doses when switching from glargine 100 U/ml or detemir to degludec: an observational study

Abstract

Background

Degludec is a long-acting insulin with a longer duration of action and a greater day-to-day reproducibility of absorption in comparison with previous long-acting insulin formulations. The aim is the definition of the change in insulin needs in patients switching from detemir/glargine to degludec in real-life conditions.

Methods

In this retrospective cohort observational study, all outpatients with either type 1 or type 2 diabetes, starting therapy with degludec insulin—after a prior treatment with either detemir or glargine insulin for at least 6 months—were included.

Results

The analysis was performed on 266 patients, 172 and 96 with type 1 and type 2 diabetes, respectively. The equations describing the relationship between baseline and follow-up doses of basal insulin (6 months) were Y = 3.39 + 0.78X and Y = 0.44 + 0.69X, in patients receiving detemir/glargine either once or twice daily, respectively (Y = degludec dose at 6 months and X = basal insulin dose at switch). The corresponding equations for prandial insulin doses were y = 1.83 + 0.83*x and y = 2.85 + 0.80*x for those on pre-switch once or twice-daily basal insulin, respectively. In type 2 diabetes, the switch was associated with a reduction of basal insulin doses only in those with a prior twice-daily treatment with basal insulin. The reduction of prandial insulin reached statistical significance only in patients previously treated with basal insulin once daily.

Conclusions

The present results provide a suggestion for a simple method for the adjustment of basal and prandial insulin doses in type 1 diabetic patients, switching from glargine or detemir to degludec.

https://ift.tt/2zlKMjL

Self-reported quantity, compulsiveness and motives of exercise in patients with eating disorders and healthy controls: differences and similarities

Abstract

Background

Compulsive exercise (CE) is a frequent symptom in patients with eating disorders (EDs). It includes, in addition to quantitatively excessive exercise behaviour, a driven aspect and specific motives of exercise. CE is generally associated with worse therapy outcomes. The aims of the study were to compare self-reported quantity of exercise, compulsiveness of exercise as well as motives for exercise between patients with anorexia nervosa (AN), bulimia nervosa (BN) and healthy controls (HC). Additionally, we wanted to explore predictors of compulsive exercise (CE) in each group.

Methods

We investigated 335 female participants (n = 226 inpatients, n = 109 HC) and assessed self-reported quantity of exercise, compulsiveness of exercise (Compulsive Exercise Test), motives for exercise (Exercise Motivations Inventory-2), ED symptoms (Eating Disorder Inventory-2), obsessive-compulsiveness (Obsessive-Compulsive Inventory-Revised), general psychopathology (Brief Symptom Inventory-18) and depression (Beck Depression Inventory-2).

Results

Both patients with AN and BN exercised significantly more hours per week and showed significantly higher CE than HC; no differences were found between patients with AN and BN. Patients with EDs and HC also partly varied in motives for exercise. Specific motives were enjoyment, challenge, recognition and weight management in patients with EDs in contrast to ill-health avoidance and affiliation in HC. Patients with AN and BN only differed in regard to exercise for appearance reasons in which patients with BN scored higher. The most relevant predictor of CE across groups was exercise for weight and shape reasons.

Conclusions

Exercise behaviours and motives differ between patients with EDs and HC. CE was pronounced in both patients with AN and BN. Therefore, future research should focus not only on CE in patients with AN, but also on CE in patients with BN. Similarities in CE in patients with AN and BN support a transdiagnostic approach during the development of interventions specifically targeting CE in patients with EDs.

https://ift.tt/2N1OQrs

Cultural Adaptation and Piloting of a Smoking Cessation Intervention for Smokers With HIV

Conditions:   Hiv;   Cigarette Smoking
Intervention:   Behavioral: Computer delivered smoking cessation counseling
Sponsor:   Johns Hopkins University
Recruiting

https://ift.tt/2u61xdU

Changes in the Microenvironment of HPV-induced Head and Neck Cancers in West Indies and Metropolitan Population

Condition:   Immunotherapy
Intervention:   Biological: Immunotherapy
Sponsors:   University Hospital Center of Martinique;   European Georges Pompidou Hospital
Recruiting

https://ift.tt/2zu6XnQ

Cost analysis of a wait-and-see strategy after radiochemotherapy in distal rectal cancer

Abstract

Background

Nonoperative management (NOM) of rectal cancer after radiochemotherapy (RtChx) in patients with a clinical complete response is an emerging strategy with the goal to improve quality of life without compromising cure rates. However close monitoring with both magnetic resonance imaging (MRI) and rectoscopy is required for the early detection of possible local regrowths. We therefore performed a cost analysis comparing the costs of immediate surgery with the costs for MRI and rectoscopy during surveillance as in the upcoming CAO/ARO/AIO-16 trial.

Methods

MRIs and rectoscopies of patients with a clinical complete response after RtChx over the course of 5 years were simulated and compared with immediate surgery after RtChx. Transition probabilities between health stages (no evidence of disease, local regrowth and salvage surgery, distant failure) were derived from the literature. Costs for ambulatory imaging and endoscopic studies were calculated according to the "Gebührenordnung für Ärzte" (GOÄ), costs for surgery based on the diagnosis-related groups system. Three different scenarios with higher costs for salvage surgery or higher regrowth rates were simulated.

Results

A patient without disease recurrence will generate costs for MRI and rectoscopy of 6344 € over 5 years compared with costs of 14,511 € for immediate radical surgery. When 25% local regrowths with subsequent salvage surgery were included in the model, the average costs per patient are 8299 €. In our simulations a NOM strategy was cost-saving compared with immediate surgery in all three scenarios.

Conclusion

A NOM strategy with an intensive surveillance using MRI and rectoscopy will produce costs that are expected to remain below those of immediate surgery.

https://ift.tt/2uhPPfs

Current and future treatment of hidradenitis suppurativa

British Journal of Dermatology, EarlyView.


https://ift.tt/2KMwQF2

A Chinese herbal medicine preparation (PTQX) for children with moderate to severe atopic eczema: a pilot RCT

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2N3ahbN

Methotrexate restores the function of peripheral blood regulatory T cells in psoriasis vulgaris via the CD73/AMPK/mTOR pathway

British Journal of Dermatology, EarlyView.


https://ift.tt/2KMwK08

Correction to: Brevibacillus laterosporus isolated from the digestive tract of honeybees has high antimicrobial activity and promotes growth and productivity of honeybee’s colonies

The original publication of this paper contains a mistake. The correct affiliation no. 3 is shown in this paper.

https://ift.tt/2zoX1MA

A theoretical and experimental study of the temporal reduction in UV protection provided by a facial day cream

International Journal of Cosmetic Science, Volume 0, Issue ja, -Not available-.


https://ift.tt/2KJExeO