Medications for Chronic Conditions and Periodontal Disease

Abstract

Purpose of the Review

This study aims to review the current literature and consider the use of medication in the medical literature and medication in the treatment of periodontal inflammation. Review articles and non-human studies were avoided. Pain-killers and antibiotics were not covered. Modified tetracycline was, however, included. Non-surgical periodontal therapy remains standard of care procedure in the management of periodontal inflammation.

Recent Findings

There is a large volume of publications with findings from adjunct treatment of periodontitis using non-steroidal anti-inflammatory drugs, also including aspirin. In recent years (2015–2018), there are with the exception of in vitro and animal studies. There are currently few human studies assessing the safety and efficacy of such medication to treat periodontal inflammation alone. In contrast, the medical literature has a large volume of such studies to control inflammatory processes. Foremost, studies primarily on cardiovascular diseases, rheumatoid arthritis, and osteoporosis have contributed information on the use of statins, bisphosphonates, cytokine inhibitors, and prednisone in the management of inflammation. Several of these studies have also identified that patients on such medication may benefit from reduced clinical evidence of periodontal inflammation. Due to side effects from many anti-inflammatory medications sole treatment of periodontal inflammation has yet to be considered. Diet rich in flavonoids may also provide potential benefits in the control of periodontal inflammation.

Summary

There is currently no scientific evidence to suggest anti-inflammatory treatment of periodontal inflammation. There are in vitro and non-human studies suggesting that some anti-inflammatory drugs may be effective in reducing the extent of periodontal inflammation. It should be recognized that patients under medical care may receive added dental benefits as the result of anti-inflammatory treatment of another systemic disease.

http://bit.ly/2QRM4GK

Decreased recognition of paraneoplastic pemphigus in patients previously treated with anti‐CD 20 monoclonal antibodies

http://bit.ly/2sv9gAY

Levels, distributions, and ecological risk assessments of polybrominated diphenyl ethers and alternative flame retardants in river sediments from Vaal River, South Africa

Abstract

Sediments are known to be the ultimate sink for most pollutants in the aquatic environment. In this study, the concentrations of both legacy polybrominated diphenyl ethers (PBDEs) and alternative halogenated flame retardants (AHFRs) were measured in sediments samples from the Vaal River catchment. The concentrations of Σ₇BDE-congeners ranged from 20 to 78 ng g⁻¹ dry weight (dw) with BDE-209, -99, and -153 as the dominant congeners. The concentrations observed ranged from 9.4–56, 4–32, and 1–10.6 ng g⁻¹ for BDE-209, -99, and -153, respectively. The concentrations of AHFRs, mainly contributed by decabromodiphenyl ethane (DBDPE) at approximately 95% of total AHFRs, ranged from 64 to 359 ng g⁻¹ dw while the concentration of polybrominated biphenyls (PBBs), mainly PBB-209, ranged from 3.3–7.1 ng g⁻¹ dw. The ratios of AHFRs to PBDEs observed in this study were 0.76, 1.17, and 7.3 for 2-ethyl-1-hexyl-2,3,4,5-tetrabromobenzoate and bis-(2-ethylhexyl)-tetrabromophthalate (EH-TBB & BEH-TEBP)/penta-BDE; 1,2-bis-(2,4,6-tribromophenoxy) ethane (BTBPE)/octa-BDE; and DBDPE/BDE209, respectively. These results indicate dominance of some AHFRs compared to PBDEs. Our results indicates that BDE-99 poses high risk (RQ > 1) while BDE-209 posed medium risk (0.1 < RQ < 1). Though the concentration of DBDPE was several orders of magnitude higher than BDE209, its ecological risk was found to be negligible (RQ < 0.01). Thus, more attention is required to regulate the input (especially the e-waste recycling sites) of brominated flame retardants into the environment.

http://bit.ly/2QRSuWy

Research on the electrostatic characteristic of coal-fired fly ash

Abstract

China is the biggest consumer of coal. Every year, half or more of China's coal is used in the power industry. Most thermal power plants in China use electrostatic precipitators to treat solid particulate matter in flue gas. The efficiency of the electrostatic precipitator in removing dust has a considerable influence on atmospheric pollutants. However, the most important factor affecting the efficiency of the electrostatic precipitator in removing dust is the dielectric properties of the fly ash. Through the study of volt-ampere characteristics, electrical and capacitive properties, and electrical breakdown characteristics of coal-fired fly ash, it is found that the V–I characteristics of ash samples in thermal power plant do not strictly follow the formula ( \( R=\frac{U}{I} \) ), the type of coal, and the chemistry of coal. Ingredients are related; disparate types of ash samples have disparate capacitances, and the measurement of capacitive contrast resistance has a certain influence.

http://bit.ly/2Dc5zWR

Impact of substrate material on algal biofilm biomass growth

Abstract

Algae are being grown for wastewater purification and biofuels production. Their growth on a substrate facilitates these uses by allowing facile separation of algae from the water. Here, we compare different materials to determine which would best serve this purpose. A mixed culture of Anabaena and Chlorella was grown on various synthetic and natural fiber fabric substrates in a trough system with recirculating simulated wastewater. Filter materials studied as substrates for algal growth were muslin, olefin, pellon (acrylic), two types of polyester, and two types of nylon. Biomass accumulation on the various filter substrates was recorded at 7, 14, and 28 days. Filters were weighed before and after the growth periods and changes in dry biomass were recorded. Biomass accumulation was significantly affected by the fabric type. Olefin fostered the greatest increase in biomass while nylon and polyester also supported competitive increases in biomass. Pellon showed the smallest biomass increase and muslin decreased in mass due to material disintegration. Other concerns such as abrasion resistance and UV susceptibility are discussed.

http://bit.ly/2TQtzUX

Isolation, characterization, and therapeutic activity of bergenin from marlberry ( Ardisia colorata Roxb.) leaf on diabetic testicular complications in Wistar albino rats

Abstract

Bergenin is one of the phytochemical constituents in marlberry (Ardisia colorata Roxb.) having antioxidant, anti-diabetic, and anti-inflammatory properties. A. colorata has been used as an herbal medicine in Southeast Asia particularly in Northeast India to treat diabetes. Bergenin was isolated from methanol extract of A. colorata leaf (MEACL) by column chromatography and TLC profiling. Characterization and structural validation of bergenin were performed by spectroscopic analyses. A LC-ESI-MS/MS method was developed for the quantitation of bergenin and validated as per the guidelines of FDA and EMA. The validated method was successfully utilized to quantify bergenin concentration in MEACL samples. Therapeutic efficacy of bergenin was investigated on streptozotocin-induced diabetic rats by following standard protocols. Bergenin supplementation significantly improved the physiological and metabolic processes and in turn reverses diabetic testicular dysfunction via increasing serum testosterone concentrations and expression pattern of PCNA, improving histopathological and histomorphometric manifestations, modulating spermatogenic events and germ cell proliferation, restoring sperm quality, reducing sperm DNA damage, and balancing the antioxidant enzymes levels. Hence, A. colorata leaf is one of the alternate rich resources of bergenin and could be used as a therapeutic agent for diabetic testicular complications.

http://bit.ly/2TTRDGO

The coracoid process is supplied by a direct branch of the 2nd part of the axillary artery permitting use of the coracoid as a vascularised bone flap, and improving it's viability in Latarjet or Bristow procedures

A comprehensive understanding of the anatomy of the vascular supply of the coracoid is needed to en- sure that the coracoid remains vascularised in order to optimize bone union during any coracoid transfer procedures. It is the purpose of this study to present an anatomical overview of the blood supply of the coracoid process, describing a previously unidentified vessel that arises directly from the axillary artery and nourishes the coracoid process, permitting the coracoid to be used as a free bone flap.

http://bit.ly/2DcNDeM

An evaluation of the levels of organochlorine compounds (OCPs and PCBs) in cultured freshwater and wild sea fish eggs as an exposure biomarker for environmental contamination

Abstract

In this study, the eggs of 30 wild Black Sea whiting (Merlangius merlangus euxinus, Nordmann, 1840) and 30 farmed freshwater rainbow trout (Oncorhynchus mykiss, Walbaum, 1792) collected from Samsun Province in Turkey were analyzed to determine the level of contamination by nine organochlorine pesticides (OCPs), namely α-hexachlorocyclohexane (α-HCH), β-HCH, γ-HCH (lindane), hexachlorobenzene (HCB), aldrin, 2,4′-dichlorodiphenyltrichloroethane (DDT), 4,4′-DDT, 2,4′-dichlorodiphenyldichloroethylene (DDE), 4,4′-DDE, and 15 polychlorinated biphenyls (PCBs) (PCB-28, -70, -74, -81, -99, -101, -118, -138, -153, -156, -170, -180, -183, -187, and -208), and their potential use as biomarkers to monitor levels of environmental contamination. OCPs and PCBs in the fat of fish eggs were extracted cryogenically and their concentrations were determined with a gas chromatography-electron capture detector (GC-ECD). The whiting eggs showed high OCP and PCB levels compared to the rainbow trout eggs. The median ∑ DDT values for whiting and rainbow trout eggs were 1601.62 ng g⁻¹ fat (range 824.87–5049.81) and 406.49 ng g⁻¹ fat (range 199.88–588.82); median ∑Indicator PCBs were 1264.24 ng g⁻¹ fat (range 520.05–6140.32) and 82.11 ng g⁻¹ fat (range 2.85–215.97); and median ∑ HCHs were 155.66 ng g⁻¹ fat (range 35.45–330.40) and 13.48 ng g⁻¹ fat (range 4.44–66.44), respectively. In the whiting eggs, the ∑Indicator PCB level was above the maximum residue limit (MRL) of 200 ng g⁻¹ fat stated in the European Commission Regulation (EC) and Turkish Food Codex (TFC). In addition, there was a significant difference between the contamination levels of the eggs of the two species. In conclusion, it appears that fish eggs can serve as a valuable biomarker for the level of contamination of persistent organochlorine contaminants in different aquatic environments.

http://bit.ly/2RxEZAk

Essential oil of Chrysanthemum indicum L.: potential biocontrol agent against plant pathogen Phytophthora nicotianae

Abstract

Phytophthora nicotianae is currently considered one of the most devastating oomycete plant pathogens, and its control frequently relies solely on the use of systemic fungicides. There is an urgent need to find environment-friendly control techniques. This study examined the chemical composition, inhibitory activity, and possible modes of action of the essential oil of Chrysanthemum indicum L. (EOC) flower heads against P. nicotianae. The EOC was obtained using hydrodistillation at a 0.15% yielded. It inhibited mycelial growth and spore germination of P. nicotianae at a minimum inhibitory concentration (MIC) of 200 μL/L, and exhibited fumigation effects (92.68% inhibition at 157.48 μL/L). Marked deformation of P. nicotianae mycelia included deformed tip enlargement, shrinkage, and rupture. Further, 55 and 47 compounds were identified using gas chromatography-mass spectrometry (GC-MS) and headspace solid-phase microextraction (HS-SPME) GC-MS analyses, representing 88.2% and 98.91% of the total EOC, respectively. Monoterpenes (25.77%) and sesquiterpenes (54.14%) were the major components identified using GC-MS, whereas monoterpenes were the main constituents in the HS-SPME GC-MS analysis. The higher proportions of sesquiterpenes and monoterpenes could be responsible for the inhibitory activity of EOC, which increased mycelia membrane permeability and the content of mycelial malondialdehyde (MDA) in a dose-dependent manner. Cell death also occurred. Thus, destruction of the cell wall and membrane might be two modes of action of EOC. Our results would be useful for the development of a new plant source of fungicide for P. nicotianae-induced disease.

http://bit.ly/2RrERSQ

Diagnostik der Sepsis – Teil 2: Erregeridentifikation

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 38-48
DOI: 10.1055/a-0756-4651

Im Rahmen der Sepsis und des septischen Schocks spielen, trotz der zunehmenden Verbreitung von neuen molekularbiologischen Verfahren, der kulturelle Erregernachweis und die Resistenztestung weiterhin die entscheidende Rolle in der antimikrobiellen Therapie auf der Intensivstation. Hierbei kann der Erregernachweis für die antimikrobielle Therapie einerseits direkt aus dem Patientenblut, andererseits aber auch aus diversen anderen Probenmaterialien (respiratorische Sekrete, Punktat, intraoperative Abstriche etc.) geführt werden. Ein Nachteil konventioneller kultureller Verfahren im Kontext kritisch kranker Patienten ist die zeitliche Latenz bis zum Erregernachweis bzw. zum Ergebnis der Resistenztestung. Molekularbiologische Verfahren wie Techniken der Erregerdiagnostik und Resistenztestung, die auf Polymerase Chain Reaction (PCR) oder vor allem Next-Generation Sequencing (NGS) basieren, versprechen hier zwar kürzere Umlaufzeiten, sind aber aktuell noch kein klinischer Standard. Trotzdem besitzen diese Verfahren das Potenzial, einen Paradigmenwechsel in der Erregerdiagnostik herbeizuführen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Sechs-Monats-Outcome nach restriktivem oder liberalem Transfusionsregime in der Herzchirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 4-4
DOI: 10.1055/a-0817-3208

Georg Thieme Verlag KG Stuttgart · New York

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Sepsis-Update: Definition und Epidemiologie

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 10-20
DOI: 10.1055/a-0625-5492

Sepsis ist eine häufige Erkrankung auf den Intensivstationen weltweit, die mit einer relevanten Morbidität und Mortalität einhergeht. Bis heute gibt es keine spezifische Therapie der Sepsis – allein die frühe Diagnosestellung und schnellstmögliche therapeutische Intervention können das Outcome der Patienten verbessern. Daher ist eine Definition des Krankheitsbildes der Sepsis mit hoher diagnostischer Sensitivität und Spezifität unabdingbar.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Ketamin: weniger Nebenwirkungen bei langsamer Infusion?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 5-6
DOI: 10.1055/a-0817-2141

Georg Thieme Verlag KG Stuttgart · New York

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DGEM-Leitlinie: Klinische Ernährung in der Intensivmedizin – Kurzversion

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 63-73
DOI: 10.1055/a-0805-4118

Fragestellung Variationen in der klinischen Ernährungstherapie können die Prognose kritisch kranker Patienten beeinflussen. Hier präsentieren wir die Kurzversion der aktualisierten, konsensbasierten S2k-Leitlinie „Klinische Ernährung in der Intensivmedizin" der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Kooperation mit 7 anderen nationalen Fachgesellschaften. Als Zielpopulation der Leitlinie wurden kritisch kranke, erwachsene Patienten, die an mindestens einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden, definiert. Methodik Die früheren Leitlinien der DGEM wurden in Einklang mit den aktuellen Richtlinien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) als S2k-Leitlinie aktualisiert. Als Grundlage für die Empfehlungen wurde die Evidenz von randomisiert-kontrollierten Studien, Metaanalysen und Beobachtungsstudien mit angemessener Fallzahl und hoher methodologischer Qualität (bis Mai 2018) sowie aktuell gültige Leitlinien internationaler Fachgesellschaften herangezogen und kommentiert. Die Empfehlungsstärke ist rein sprachlich beschrieben. Jede Empfehlung wurde mittels Delphi-Verfahren abschließend bewertet und konsentiert. Ergebnisse In der vorliegenden Kurzversion werden alle 69 Empfehlungen für essenzielle, praxisrelevante Bestandteile der klinischen Ernährung der Zielpopulation zusammenfassend dargestellt. Ein spezifischer Fokus ist die Adjustierung der Ernährung gemäß den Phasen der kritischen Erkrankung sowie gemäß der individuellen Toleranz gegenüber exogener Substratzufuhr. Unter anderem werden Empfehlungen zur Beurteilung des Ernährungszustandes, zur Indikation für eine klinische Ernährungstherapie, zum Zeitpunkt des Beginns, zum Applikationsweg, zur Menge und Zusammensetzung der Ernährungssubstrate (Makro- und Mikronährstoffe) sowie zu speziellen Aspekten der Ernährung bei adipösen kritisch kranken Patienten und Patienten mit extrakorporalen Unterstützungsverfahren gegeben. Schlussfolgerung Die Kurzversion der Leitlinie gibt eine prägnante Übersicht über alle 69 aktualisierten Handlungsempfehlungen zur enteralen und parenteralen Ernährung erwachsener kritisch kranker Patienten, die an mind. einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden. Die Gültigkeit der Leitlinie beträgt voraussichtlich 5 Jahre (2018 – 2023).
[...]

Georg Thieme Verlag KG Stuttgart · New York

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ICU: Lactoferrin gegen nosokomiale Infektionen?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 6-7
DOI: 10.1055/a-0817-2154

Georg Thieme Verlag KG Stuttgart · New York

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Diagnostik der Sepsis – Teil 1: allgemeine Diagnostik und Fokussuche-/sanierung

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 22-36
DOI: 10.1055/a-0625-5507

Die Sepsis ist ein medizinischer Notfall mit weiterhin hoher Sterblichkeit. Die Surviving Sepsis Campaign (SSC) gibt für die Diagnostik und die Gabe eines adäquaten Breitspektrumantibiotikums ein Zeitfenster von max. 1 h nach Stellen der Verdachtsdiagnose „Sepsis" vor. Aktuell wird dieses sog. 1 h-Maßnahmenbündel kritisch diskutiert. Als Kernaspekt der Fokussuche orientiert sich die Art der Bildgebung am vermuteten Fokus und dem Patientenkollektiv. Bei kritisch kranken Patienten ist die kontrastmittelverstärkte Computertomografie häufig Mittel der Wahl. Die Erregerdetektion erfolgt meist kulturbasiert. Daher sind mikrobiologische Proben aus einfach zugänglichen Kompartimenten, mindestens aber die Entnahme von 2 Blutkultursets, obligat und sollten vor der Gabe eines Antibiotikums erfolgen. Von herausragender Bedeutung sind vor allem intraoperative Abstriche aus sonst sterilen Kompartimenten. Suspekte Katheter (z. B. zentralvenöse Katheter, Dialysekatheter) oder potenziell infizierte implantierte Medizinprodukte (z. B. Schrittmacher, Defibrillatoren) sollten – wenn vertretbar – zügig entfernt und einer mikrobiologischen Aufarbeitung zugeführt werden. Generell sollten alle notwendigen Maßnahmen zur Fokussanierung/-kontrolle so schnell wie medizinisch/logistisch möglich, mindestens aber innerhalb von 6(– 12)h nach Beginn der Sepsis, erfolgt sein. Es existiert bislang kein spezifischer Biomarker für das Krankheitsbild der Sepsis. Biomarker wie das Procalcitonin (PCT) und das C-reaktive Protein (CRP) spielen im Kontext der Sepsis beim infektiologischen Management und Therapiemonitoring auf der Intensivstation eine wichtige Rolle. Vielversprechende Biomarker wie das midregionale Pro-Adrenomedullin (MR-proADM) oder das Presepsin werden außerhalb von Studien noch nicht in der klinischen Routine eingesetzt. Als Marker von Mikrozirkulationsstörungen und eines gestörten Metabolismus spielt das Laktat (bzw. die Laktat-Clearance) als prognostischer Parameter der Sepsis eine große Rolle.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Sepsis – weiter eine große Herausforderung!

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 8-9
DOI: 10.1055/a-0808-1194

Georg Thieme Verlag KG Stuttgart · New York

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Sepsis-Update: evidenzbasierte Therapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 50-62
DOI: 10.1055/a-0625-5521

Sepsis und septischer Schock stellen medizinische Notfälle dar, die einer kompetenten Früherkennung und eines entsprechenden sofortigen, zielgerichteten Managements bedürfen. Die Therapie der Sepsis und des septischen Schocks hat sich während der letzten Jahre kontinuierlich weiterentwickelt. Dieser Beitrag gibt einen Überblick über die aktuelle Evidenz der Therapie der Sepsis und des septischen Schocks und deren Umsetzung in die klinische Praxis.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Heute aus der Gynäkologie: Neugeborenenreanimation und Notsectio

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 74-78
DOI: 10.1055/s-0042-101628

Georg Thieme Verlag KG Stuttgart · New York

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ICU: welches Antibiotikum bei vancomycinresistenten Enterokokken (VRE)?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 4-5
DOI: 10.1055/a-0817-2987

Georg Thieme Verlag KG Stuttgart · New York

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18 F-FDG PET/CT diagnostic performance in solitary and multiple pulmonary nodules detected in patients with previous cancer history: reports of 182 nodules

Abstract

Purpose

In oncological patients, ¹⁸F-FDG PET/CT performance for pulmonary nodules' characterization is not well-established. Thus, the purpose of this study was to evaluate the ¹⁸F-FDG PET/CT diagnostic performance in pulmonary nodules detected during follow-up in oncological patients and the relationship between malignancy and nodules' characteristics.

Methods

We retrospectively evaluated 182 pulmonary nodules (121 solitary, 61 multiple; mean size = 16.5 ± 8.1 mm, mean SUVmax = 5.2 ± 5.1) in 148 oncological patients (89 males; mean age = 69.5 ± 8.4 years). Final diagnosis was established by histology or radiological follow-up. Diagnostic performance of ¹⁸F-FDG visual analysis (malignancy-criterion: uptake ≥ mediastinal activity), ROC curve analysis for SUVmax and nodules' characteristics were assessed.

Results

In 182 nodules, the prevalence of malignancy was 75.8%; PET/CT provided sensitivity = 79%, specificity = 81.8%, accuracy = 79.7%, PPV = 93.1%, NPV = 55.4%; ROC analysis (SUVmax cut-off = 1.7) provided sensitivity = 85.5%, specificity = 72.7%. In 121 solitary nodules, the prevalence of malignancy was 87.6%; PET/CT provided sensitivity = 82.1%, specificity = 73.3%, accuracy = 81%, PPV = 95.6%, NPV = 36.7%; ROC analysis (SUVmax cut-off = 2) provided sensitivity = 84%, specificity = 80%. In 61 multiple nodules, the prevalence of malignancy was 52.5%; PET/CT (nodule and patient-based analysis, respectively) provided sensitivity = 68.7% and 88.9%, specificity = 86.2% and 55.6%, accuracy = 77% and 77.8%, PPV = 84.4% and 80%, NPV = 71.8% and 71.5%; ROC analysis (nodule-based, SUVmax cut-off = 1.8) provided sensitivity = 71.9%, specificity = 82.8%. Malignant nodules were prevalent in males, in solitary pattern and in upper lobes, and had significantly greater size and metabolic activity (SUVmax and TLG) than benign ones, with no differences in interval-time between previous cancer diagnosis and nodule detection, patients' age or other nodules' features (lung side, central/peripheral). When comparing solitary and multiple patterns, malignant nodules had significantly greater size and metabolic activity than benign ones in both groups.

Conclusions

In oncological patients, ¹⁸F-FDG PET/CT provides good diagnostic performance for ruling in the malignancy in pulmonary nodules detected during follow-up, even at small size and especially when solitary. In multiple patterns, PET seems useful in the perspective of a personalized management, for identifying the "reference" nodule deserving histological assessment.

http://bit.ly/2QLZYKB

A new frontier for amyloid PET imaging: multiple sclerosis

http://bit.ly/2VSo3mG

Bertoldo, F., Boccardo, F., Bombardieri, E., Evangelista, L., Valdagni, R. (Eds.) Bone Metastases from Prostate Cancer: Biology, Diagnosis and Management

http://bit.ly/2QSzp6m

Longitudinal association between astrocyte function and glucose metabolism in autosomal dominant Alzheimer’s disease

Abstract

Purpose

The spatial resolution of ¹⁸F-fluorodeoxyglucose PET does not allow the specific cellular origin of its signal to be determined, but it is commonly accepted that transport and trapping of ¹⁸F-fluorodeoxyglucose reflects neuronal glucose metabolism. The main frameworks for the diagnosis of Alzheimer's disease suggest that hypometabolism measured with ¹⁸F-fluorodeoxyglucose PET is a biomarker of neuronal injury and neurodegeneration. There is preclinical evidence to suggest that astrocytes contribute, at least partially, to the in vivo ¹⁸F-fluorodeoxyglucose PET signal. However, due to a paucity of PET tracers for imaging astrocytic processes, the relationship between astrocyte function and glucose metabolism in human brain is not fully understood. The aim of this study was to investigate the longitudinal association between astrocyte function and glucose metabolism in Alzheimer's disease.

Methods

The current investigation combined longitudinal PET data from patients with autosomal dominant Alzheimer's disease, including data on astrocyte function (¹¹C-deuterium-l-deprenyl binding) and glucose metabolism (¹⁸F-fluorodeoxyglucose uptake). Research participants included 7 presymptomatic and 4 symptomatic mutation carriers (age 44.9 ± 9.8 years and 58.0 ± 3.7 years, respectively) and 16 noncarriers (age 51.1 ± 14.2 years). Eight carriers and eight noncarriers underwent longitudinal follow-up PET imaging at an average of 2.8 ± 0.2 and 3.0 ± 0.5 years from baseline, respectively.

Results

Longitudinal decline in astrocyte function as measured using ¹¹C-deuterium-l-deprenyl PET was significantly associated with progressive hypometabolism (¹⁸F-fluorodeoxyglucose uptake) in mutation carriers; no significant association was observed in noncarriers.

Conclusion

The emerging data shift the accepted wisdom that decreases in cerebral metabolism measured with ¹⁸F-fluorodeoxyglucose solely reflect neuronal injury, and places astrocytes more centrally in the development of Alzheimer's disease.

http://bit.ly/2VXL9Z1

Correction to: Why harmonization is needed when using FDG PET/CT as a prognosticator: demonstration with EARL-compliant SUV as an independent prognostic factor in lung cancer

An error occurred in the labelling of Fig. 3, where math symbols for SUV thresholds were inverted in panel b when the EARL threshold was applied to the PSF dataset and vice versa. This figure should read as follows: Fig. 3: Prognostic value of tumour SUVmax

http://bit.ly/2QQRy4r

Performance of 18 F-FDG PET/MRI and 18 F-FDG PET/CT for T and N staging in patients with non-small-cell lung cancer

http://bit.ly/2VXLzyz

Severe posterior hypometabolism but normal perfusion in a patient with chronic fatigue syndrome/myalgic encephalomyelitis revealed by PET/MRI

http://bit.ly/2QRo8DA

Amyloid burden identifies neuropsychological phenotypes at increased risk of progression to Alzheimer’s disease in mild cognitive impairment patients

Abstract

Purpose

The extent of amyloid burden associated with cognitive impairment in amnestic mild cognitive impairment is unknown. The primary aim of the study was to determine the extent to which amyloid burden is associated to the cognitive impairment. The secondary objective was to test the relationship between amyloid accumulation and memory or cognitive impairment.

Materials and methods

In this prospective study 66 participants with amnestic mild cognitive impairment underwent clinical, neuropsychological and PET amyloid imaging tests. Composite scores assessing memory and non-memory domains were used to identify two clinical classes of neuropsychological phenotypes expressing different degree of cognitive impairment. Detection of amyloid status and definition of optimal amyloid ± cutoff for discrimination relied on unsupervised k-means clustering method.

Results

Threshold for identifying low and high amyloid retention groups was of SUVr = 1.3. Aß + participants showed poorer global cognitive and episodic memory performance than subjects with low amyloid deposition. Aß positivity significantly identified individuals with episodic memory impairment with a sensitivity and specificity of 80 and 79%, (χ2 = 21.48; P < 0.00001). Positive and negative predictive values were 82 and 76%, respectively. Amyloid deposition increased linearly as function of memory impairment with a rate of 0.13/ point of composite memory score (R = −44, P = 0.0003).

Conclusion

The amyloid burden of SUVr = 1.3 allows early identification of subjects with episodic memory impairment which might predict progression from MCI to Alzheimer's disease.

Trial registration

EudraCT 2015-001184-39.

http://bit.ly/2VXIEpU

Improved beta-amyloid PET reproducibility using two-phase acquisition and grey matter delineation

Abstract

Purpose

We investigated whether the reproducibility of standard visual reporting (STD method) in flutemetamol (FMM) PET can be improved using a newly introduced method that uses grey matter edges derived from the perfusion phase (GM-EDGE method).

Methods

Two-phase FMM PET was performed in 121 patients with mild cognitive impairment. Five nuclear medicine physicians blindly and independently evaluated all late-phase scans, initially employing the STD method and later the GM-EDGE method. A five-point scale was used to express the degree of amyloid positivity, and a binary classification (positive/negative) was used in combination with subjective confidence (five-point scale). Multirater Fleiss' kappa, intraclass correlation coefficient (ICC) and inter-rater reliability (Cohen's kappa) were determined for the STD and GM-EDGE methods.

Results

The weighted Cohen's kappa values for the five-point measure of amyloid positivity ranged from 0.63 to 0.73 (median 0.70) for the STD method and from 0.76 to 0.89 (median 0.80) for the GM-EDGE method (ICC 0.84, 95% CI 0.79–0.88, for the STD method; 0.91, 95% CI 0.89–0.94, for the GM-EDGE method). The nonweighted Cohen's kappa value for the binary classification ranged from 0.73 to 0.93 (median 0.82) for the STD method and 0.90 to 0.97 (median 0.93) for the GM-EDGE method (Fleiss' kappa 0.82, 95% CI 0.77–0.88, for the STD method; 0.93, 95% CI 0.87–0.99, for the GM-EDGE method). The GM-EDGE method resulted in significantly greater subjective confidence in the readings of four physicians (p < 0.010). The binary classification was concordant among all five physicians in 80.8% of the scans using the STD method and in 91.6% of the scans using the GM-EDGE method (p = 0.016).

Conclusion

The newly introduced GM-EDGE method was associated with significantly higher inter-rater agreement among physicians and higher subjective confidence in the reading. The method is easy to implement in clinical practice, especially when the perfusion phase is utilized clinically.

http://bit.ly/2QOhEoQ

Mutational profile of papillary thyroid microcarcinoma with extensive lymph node metastasis

Abstract

Purpose

Papillary thyroid microcarcinoma (PTMC) has excellent outcomes, but extensive lymph node (LN) metastasis can be associated with fatal outcomes. We evaluated the mutational profiles of primary tumors and their metastatic LNs of PTMCs with extensive lateral cervical LN metastases.

Methods

Formalin-fixed, paraffin-embedded archival samples from 16 sets of normal thyroid tissue, the primary PTMC, and the largest metastatic LN were used for targeted sequencing.

Results

A total of seven somatic variants were confirmed in the PTMCs compared to the normal tissue. The BRAF^V600E mutation was the most common and seen in 12 primary tumors (75%) and 11 metastatic LNs (69%). A nonsense mutation in AR and an in-frame deletion in ACVR2A were detected in one primary tumor and its metastatic LN (6%). Missense mutations in KMT2A, RAF1, and ROS1 were detected in one primary tumor (3%). A frameshift deletion mutation in JAK2 was detected in a metastatic LN (3%). In PTMCs without the BRAF mutation, an ALK and RET rearrangement (one PTMC and its metastatic LN, 6%) was detected. In one patient, the BRAF mutation was detected in the primary tumor, but only a RET rearrangement was detected in its metastatic LN. No mutations were detected in two patients.

Conclusion

The mutational frequency of PTMCs was really low, even in those with extensive LN metastasis. The mutational status of the primary tumor and its metastatic LNs were not significantly different, and this suggests a minor role for genetic alterations in the process of LN metastasis in PTMC.

http://bit.ly/2MbitY6

Effect of spiral undersampling patterns on FISP MRF parameter maps

Publication date: Available online 15 January 2019

Source: Magnetic Resonance Imaging

Author(s): Gregor Körzdörfer, Josef Pfeuffer, Thomas Kluge, Matthias Gebhardt, Bernhard Hensel, Craig H. Meyer, Mathias Nittka

Abstract

Purpose

Artifacts arising from undersampling are not always treatable as incoherent noise for the pattern matching process in Magnetic Resonance Fingerprinting (MRF). To estimate the effect of undersampling artifacts on MRF quantitative results, spiral sampling trajectories and their temporal variation is examined.

Methods

The effect of sampling trajectories and their variation during the MRF experiment was assessed by characterizing aliasing artifacts. Temporal rearrangements of sampling trajectories were tested and evaluated in simulations and scans of phantoms and in a volunteer brain.

Results

Results show that some temporal variations of sampling patterns can lead to spatial biases in MRF parameter maps. Observed effects are consistent with derived performance indicators for different interleaving schemes, leading to substantially improved MRF sampling patterns.

Conclusion

With the help of the presented simulation framework, MRF implementations can be investigated and improved. This was demonstrated for a spiral FISP (Fast imaging with steady-state free precession) MRF implementation, where a significantly improved interleaving scheme was identified, and confirmed by experiment.

http://bit.ly/2Hmt1oK

Susceptibility weighted MRI after uterine artery embolization for leiomyoma

Publication date: Available online 15 January 2019

Source: Magnetic Resonance Imaging

Author(s): Yasuyuki Yamahana, Tetsuya Katsumori, Hiroshi Miura, Shunsuke Asai, Sachimi Yamada, Akiko Takahata, Kei Yamada

Abstract

Purpose

To evaluate whether susceptibility-weighted MR imaging (SWI) findings are associated with tumor infarction on contrast-enhanced MRI (CE-MRI) after uterine artery embolization (UAE) for leiomyoma.

Methods

This was a single institution, retrospective study. Between February 2016 and April 2017, 27 consecutive patients underwent UAE and completed SWI and CE-MRI before and 1 week after UAE. Two blinded readers independently reviewed the MRI of 261 tumors ≥1 cm in all patients. We evaluated the relationship between the hypointense peripheral rim observed on the tumor surface on post-procedural SWI and the infarction rates (≥90%, <90%) of each tumor based on post-procedural CE-MRI. Inter-reader correlation coefficients (ICC) and the sensitivity and specificity of the rim were measured.

Results

Substantial inter-reader agreement was noted in post-procedural SWI interpretations (ICC = 0.681, 95% CI; 0.547, 0.771). The rim was observed in 66.7% (174/261) of tumors by reader 1 and 55.9% (146/261) of tumors by reader 2 on post-procedural SWI. Correlations were observed between the rim and ≥90% tumor infarction by readers 1 and 2 (Spearman's coefficient = 0.474 and 0.438, p < 0.001 and p < 0.001, respectively). The sensitivity and specificity of the rim to tumor infarction were 77.2 and 82.6% (reader 1), and 65.8 and 100% (reader 2), respectively.

Conclusions

The present study demonstrated that the hypointense peripheral rim was observed on some leiomyomas on SWI immediately after UAE. The rim correlated with tumor infarction on post-procedural CE-MRI. This SWI finding was helpful for evaluating embolic effects on leiomyomas in the acute phase after UAE.

http://bit.ly/2RN3Ak1

Space-time variant weighted regularization in compressed sensing cardiac cine MRI

Publication date: Available online 14 January 2019

Source: Magnetic Resonance Imaging

Author(s): Alejandro Godino-Moya, Javier Royuela-del-Val, Muhammad Usman, Rosa-María Menchón-Lara, Marcos Martín-Fernández, Claudia Prieto, Carlos Alberola-López

Abstract

Purpose

To analyze the impact on image quality and motion fidelity of a motion-weighted space-time variant regularization term in compressed sensing cardiac cine MRI.

Methods

k-t SPARSE-SENSE with temporal total variation (tTV) is used as the base reconstruction algorithm. Motion in the dynamic image is estimated by means of a robust registration technique for non-rigid motion. The resulting deformation fields are used to leverage the regularization term. The results are compared with standard k-t SPARSE-SENSE with tTV regularization as well as with an improved version of this algorithm that makes use of tTV and temporal Fast Fourier Transform regularization in x-f domain.

Results

The proposed method with space-time variant regularization provides higher motion fidelity and image quality than the two previously reported methods. Difference images between undersampled reconstruction and fully sampled reference images show less systematic errors with the proposed approach.

Conclusions

Usage of a space-time variant regularization offers reconstructions with better image quality than the state of the art approaches used for comparison.

http://bit.ly/2HqC6gj

Mutational profile of papillary thyroid microcarcinoma with extensive lymph node metastasis

Abstract

Purpose

Papillary thyroid microcarcinoma (PTMC) has excellent outcomes, but extensive lymph node (LN) metastasis can be associated with fatal outcomes. We evaluated the mutational profiles of primary tumors and their metastatic LNs of PTMCs with extensive lateral cervical LN metastases.

Methods

Formalin-fixed, paraffin-embedded archival samples from 16 sets of normal thyroid tissue, the primary PTMC, and the largest metastatic LN were used for targeted sequencing.

Results

A total of seven somatic variants were confirmed in the PTMCs compared to the normal tissue. The BRAF^V600E mutation was the most common and seen in 12 primary tumors (75%) and 11 metastatic LNs (69%). A nonsense mutation in AR and an in-frame deletion in ACVR2A were detected in one primary tumor and its metastatic LN (6%). Missense mutations in KMT2A, RAF1, and ROS1 were detected in one primary tumor (3%). A frameshift deletion mutation in JAK2 was detected in a metastatic LN (3%). In PTMCs without the BRAF mutation, an ALK and RET rearrangement (one PTMC and its metastatic LN, 6%) was detected. In one patient, the BRAF mutation was detected in the primary tumor, but only a RET rearrangement was detected in its metastatic LN. No mutations were detected in two patients.

Conclusion

The mutational frequency of PTMCs was really low, even in those with extensive LN metastasis. The mutational status of the primary tumor and its metastatic LNs were not significantly different, and this suggests a minor role for genetic alterations in the process of LN metastasis in PTMC.

http://bit.ly/2MbitY6

Water-soluble ion components of PM 10 during the winter-spring season in a typical polluted city in Northeast China

Abstract

From January 1 to April 22, 2014, an online analyzer for monitoring aerosols and gases (MARGA) was used to measure and analyze water-soluble ions in inhalable particulate matter with a diameter less than 10 μm (PM₁₀) during winter-spring in Shenyang city, China. The results yielded three main findings. (1) During the entire observation period and in seven pollution episodes, SO₄²⁻, NO₃⁻, and NH₄⁺ (SNA) accounted for 84.4–93.1% of the total water-soluble ions (TWSIs). TWSIs accounted for 32% of PM₁₀ mass during the entire observation period, and the contribution of TWSIs in PM₁₀ ranged from 33.4–43.1% in the seven pollution episodes. The contribution of TWSIs components increased during the pollution episodes, but certain differences were observed in different pollution episodes. In terms of ionic equilibrium, the total concentration of negative ions was slightly greater than that of positive ions and the difference was 3.1% of the total ion load on average, indicating that local aerosols are mainly neutral. The water-soluble ions show clear diurnal variation with the high concentration around 09:00 for SO₄²⁻, NH₄⁺, and Cl⁻ which is consistent with the high heating grade index. (2) Pollution episodes often occur in Northeast China, especially during the winter period. Due to the low temperature in the winter, the local coal burning for heating is one of the main sources of pollution besides vehicle exhaust and industrial pollution, which is supported by the higher NO₃⁻/SO₄²⁻ ratio in April than that in January to March. Sometimes, under the prevailing wind directions of W and SSW, the long-distance transport of pollutants from the Beijing-Tianjin-Hebei region and Shandong province superimposed on local pollution leads to the most severe pollution, such as Ep3 and Ep5. (3) SO₄²⁻ concentration is closely related to ambient water vapor pressure (e*), with increase as e* increased depending on the temperature. NO₃⁻ concentration showed a linear relationship of excess NH₄⁺, which suggests homogeneous gas-phase reaction of ammonia and nitric acid is possibly an important pathways of nitrate formation in the haze pollution process in Shenyang City. In addition, our results also suggest the nighttime liquid-phase reaction may cause large increases of nitrate in the haze pollution process.

http://bit.ly/2FwimWC

Experimental assessment and multi-response optimization of diesel engine performance and emission characteristics fuelled with Aegle marmelos seed cake pyrolysis oil-diesel blends using Grey relational analysis coupled principal component analysis

Abstract

This research focuses on the detailed experimental assessment of compression ignition (CI) engine behavior fuelled with Aegle marmelos (AM) seed cake pyrolysis oil blends. The study on effects of engine performance and emission a characteristic was designed using L₂₅ orthogonal array (OA). These multi-objectives were normalized through gray relational analysis (GRA). Likewise, the principal component analysis (PCA) was performed to assess the weighting values respective to every performance and emission characteristics. The variability induced by using the input process parameters was allocated using analysis of variance (ANOVA). Hence, GRA-coupled PCA were employed to determine the optimal combination of CI engine control factors. The greater combination of engine characteristics levels were selected with F₅ and W₅. The higher brake thermal efficiency (BTE) have been obtained for F20 fuel as 22.01% at peak engine load, which is 11.43% for diesel. At peak load condition, F20 fuel emits 14.99% lower HC and 18.52% lower CO as compared to diesel fuel. The improved engine performance and emission characters can be attained by setting the optimal engine parameter combination as F20 blend at full engine load condition. The validation experiments show an improved average engine performance of 67.36% and average lower emission of 64.99% with the composite desirability of 0.8458.

http://bit.ly/2FAr9pO

Analysis of the spatial variation of indoor radon concentrations (national survey in Bulgaria)

Abstract

This paper presents the methodology and results of the national radon survey in Bulgaria and its spatial variability. The measurements were carried out in 2778 dwellings using CR-39 track detectors over two successive 9 and 3-month periods from April 2015 to March 2016. The arithmetic (AM) and geometric (GM) means of annual indoor radon concentration were 111 ± 105 Bq/m³ and 81 Bq/m³ (GSD = 2.15), respectively. The distribution of data has been accepted to be log-normal. Two hypotheses have been investigated in the paper. The first one was a spatial variation of indoor radon concentration and the second was spatiality of the factor that influences radon variation. The indoor radon concentrations in the 28 districts have been significantly different, which prove the first hypothesis. The influence of the factors, geology (geotectonic unit, type of rock, and faults distance of the measuring site), type of the region, and the presence of the basement in the building on radon spatial variation, was examined. The analyses have been shown that they significantly affect radon variations but with a relatively small contribution in comparison to the radon variation between district. Furthermore, the significance and contribution of the investigated factors were different in each district, which confirmed the second hypothesis for their spatiality.

http://bit.ly/2FrXa4b

Journal of Nursing and Midwifery Sciences, a publication of Mazandaran University of Medical Sciences, is a peer-reviewed online journal with Quarterly print on demand compilation of issues published. The journal's full text is available online at: http://www.jnmsjournal.org. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository.

ORIGINAL ARTICLES
	The effect of concurrent endurance and resistance training on cardio-respiratory capacity and cardiovascular risk markers among sedentary overweight or obese post-menopausal women	p. 123
	Anahita Shabani, Ramin Shabani, Setila Dalili, Afagh Hassanzadeh Rad DOI:10.4103/JNMS.JNMS_34_18   Context: Exercise training has been inversely associated with cardiovascular risk factors. However, the clinical trials examining the effect of exercise training on reducing cardiovascular risk factors have produced conflicting results. Aims: We aimed to assess the effect of concurrent exercise training on cardiorespiratory capacity and cardio-vascular risk factors among sedentary overweight or obese post-menopausal women. Settings and Design: This randomized controlled trial was done in 2016. Materials and Methods: This study was conducted on 22 healthy post-menopausal overweight and obese females, which randomly divided into concurrent endurance and resistance (ER) exercise (n = 12) and control (n = 10) groups. The participants did not have any history of any serious medical condition or using drugs. Demographic questionnaire was completed, vital signs and biochemical tests were measured, and Rockport one-mile submaximal exercise test for assessing maximal oxygen consumption (VO2max) was performed before and after the study. Statistical Analysis Used: Mean, standard deviation, and paired and independent t-test were used for statistical analysis. Results: The data from the ER groups showed that the body mass index (BMI), heart rate (HR), systolic and diastolic blood pressure, triglyceride, high-sensitivity C-reactive protein (CRP) decreased, high-density lipoprotein, and VO2max increased significantly, during the 8 weeks (P < 0.05). Moreover, no changes were found in the cardiovascular risk factors of women who did not exercise (P > 0.05). Conclusion: Concurrent ER training can be a suitable exercise program for improving plasma lipid profile as well as reducing body composition, high-sensitivity CRP, and increasing VO2max in postmenopausal women.
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	The effect of staff training on the amount of sound pollution in the intensive care unit	p. 130
	Kobra Zamani, Hossein Ali Asgharnia, Jamshid Yazdani, Zohreh Taraghi DOI:10.4103/JNMS.JNMS_38_18   Context: Sound pollution is a common problem in intensive care units (ICUs) with unfavorable consequences.Aims: The aim of the current study was to determine the effect of staff training on the amount of sound pollution in the ICU. Setting and Design: This quasi-experimental study was conducted in the ICU of Rouhani Hospital in Babol. Materials and Methods: Level of equivalent (leq) sound was measured in three work shifts for 2 weeks, before and after training, in 2 workdays and a holiday, using a systematic network stationing method. The sample size was determined based on the days of measurement, work-shift, and measuring stations (6 × 3 × 10 = 180). Indirect training was performed. A 2-week opportunity was given to study materials. Statistical Analysis Used:Data were analyzed using paired t-test and RMANOVA. Results: Following the training, the mean leq in all stations (ten stations) decreased from 67.21 to 62.11 dB (P = 0.002). Conclusion: Although the amount of sound pollution decreased significantly after training, it was still higher than standard. To achieve the desired level of sound, continuous monitoring of sound at intervals of 6 months, along with structural engineering and equipment, is suggested.
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	The effect of relaxation exercises on emotions of primigravida women in famenin	p. 134
	Farzaneh Soltani, Samerah Ghlichkhani, Arezoo Shayan, Parisa Parsa, Ghodratollah Roshanaei DOI:10.4103/JNMS.JNMS_32_18   Context: Recognizing effective interventions for improving women's positive emotion can improve mental health and self-confidence in anxious women, at least during pregnancy. Aim: This study aimed to investigate the effect of relaxation training on positive and negative emotions of primigravida women. Setting and Design: In this randomized quasi-experimental study, 100 primigravida women with gestational age of 28–32 weeks, who were referred to the prenatal care centers in Famenin City (Hamadan, Iran), were randomly assigned into two groups of intervention and control, using randomized blocking. Methods and Material: All the pregnant women completed the positive and negative affect schedule questionnaire. In the intervention group, eight sessions were held twice a week with emphasis on relaxation techniques. The control group received routine prenatal care.Statistical Analysis Used: Descriptive statistics, independent and paired t-tests were used to compare the difference between and within two groups. Results: The mean score of positive emotion increased from 31.92 ± 6.39 to 34.12 ± 5.41 after intervention (P = 0.034). In contrast, the mean score of positive emotion in the control group reduced from 33.62 ± 6.58 to 26.92 ± 6.35 after the intervention (P < 0.001). In addition, there was a significant difference between the mean scores of positive emotion in the two groups after the intervention (P < 0.001). The mean score of negative emotion reduced from 24.12 ± 7.06 to 17.18 ± 5.95 in the intervention group (P < 0.001). On the other hand, the mean score of negative emotion in the control group increased from 22.08 ± 6.85 to 28.42 ± 7.24 after the intervention (P < 0.001). There was a significant difference between the mean scores of negative emotion in the two groups after the intervention (P < 0.001). The mean score of positive emotion of the women increased after the intervention (from 31.92 ± 6.39 to 34.12 ± 5.41) (P = 0.034). In contrast, the mean score of positive emotion of the women in the control group reduced after the intervention (from 33.62 ± 6.58 to 26.92 ± 6.35) (P < 0.001). Also, the mean score of negative emotion reduced in the intervention group (from 24.12 ± 7.06 to 17.18 ± 5.95). On the other hand, the mean score of negative emotion of the women in the control group significantly increased after the intervention (from 22.08 ± 6.85 to 28.42 ± 7.24).Conclusion: Research findings suggest that relaxation training may increase positive emotion and reduced negative emotion in pregnant women. It is recommended that relaxation techniques are used in prenatal care centers as a simple and available health intervention in pregnancy.
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	Qualitative needs assessment: Iranian parents' perspectives in sexuality education of their children	p. 140
	Jila Ganji, Mohammad Hassan Emamian, Raziyeh Maasoumi, Afsanah Keramat, Effat Merghati-Khoei DOI:10.4103/JNMS.JNMS_42_18   Context: Parental education in sexuality plays a vital role in children's lives. Aims: The purpose of this study was to explore Iranian parents' perspectives about the needs of children sexuality education. Setting and Design: This qualitative study was done in 2016. Materials and Methods: In this qualitative inquiry, seven sessions of community group interview and focus group discussions were conducted with the parents of Ghaemshahr, Iran, using purposive sampling (n = 39, 27 mothers and 12 fathers). Statistical Analysis Used:We employed thematic analysis method to extract our findings. Results: The findings were categorized into three essential needs: (1) parents' preparedness, (2) efficacious parental management, and (3) supportive environments. The sub-theme describing the theme 1 includes "the need for adequate knowledge to answer the sexual questions and the child's sexual curiosity" and "the need for awareness about the time of beginning an appropriate sexuality education for children." Moreover, the sub-theme describing theme 2 includes "the need for sufficient skills to begin proper and intimate communication," "the need for effective monitoring and care," and "the need for capability in managing the child sexual behavior." Moreover, the sub-theme describing theme 3 includes "the need to receive training from sexual health professionals," "the need for authorized sexuality education programs," "the need for national-wide policy-making and strategy planning in sexuality education," and "the need for a comprehensive and complete educational resource." Conclusion: Our findings suggest that to address the goals in sexuality education for children, parents' need to be prepared in knowledge, and gaining positive attitude and practical skills. To achieve these goals, supportive environments must be provided by policy-makers and health providers with culturally appropriate strategy planning.
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	Strategies for improving the integrated program of HIV/AIDS with sexual and reproductive health: using nominal group technique	p. 147
	Maryam Hajizadevalokolaee, Zohreh Shahhosseini, Soghra Khani, Fereshteh Yazdani, Zeinab Hamzeghardeshi DOI:10.4103/JNMS.JNMS_35_18   Context: The spread of HIV is growing, so that its way of transmission has created worries in the field of sexual and reproductive health, because the wave of transmission has changed from injection to sexual activities.Aims: To evaluate the perspectives of sexual and reproductive health experts and providers on strategies for improving the integrated program of HIV/AIDS with sexual and reproductive health using the nominal group technique (NGT). Setting and Design: Mazandaran University of Medical Sciences, Sari, Iran. NGT. Materials and Methods: It was a semiquantitative/qualitative methodology research through NGT, based on the opinions of 30 experts and sexual and reproductive health providers in the field of health in Mazandaran (2016).Statistical Analysis Used: Semiquantitative/qualitative analysis. Results: In total, 15 cases got the scores of 2–62 as strategies to improve the integrated program of HIV/AIDS with sexual and reproductive health. The highest scores were found in society-centered level and stigma management, and the lowest scores were found in individual-centered level and negotiation skill training. Conclusion: One of the strategies to improve the integrated program of HIV/AIDS was the empowerment of women and men in sexual and reproductive health and stigma management. Based on the results, the NGT is a useful tool for doing researches and prioritizing the programs. Based on the expert opinion, it can be concluded that designing strategies based on individual-, community-, and society-centered approach would be an appropriate approach for improving the integrated program of HIV/AIDS with sexual and reproductive health issues in Iranian society.
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	Evaluation of occupational hazards for nurses in intensive care units of tertiary care centers	p. 153
	Kobra Abdi Zarrini, Akram Sanagoo, Leila Jouybari, Mohammad Ali Vakili, Ali Kavosi DOI:10.4103/JNMS.JNMS_52_18   Context: Nursing is a high-risk occupation, and intensive care units (ICUs) are one of the most sensitive hospital wards. Aim: This study aimed to determine the level of occupational hazards among nurses in the ICUs. Setting and Design: This descriptive-analytical study was conducted on a total of 281 nurses in the ICUs of tertiary care centers in Golestan and Mazandaran Universities of Medical Sciences in 2017. Materials and Methods: Data were collected using a five-dimensional occupational hazard questionnaire. Statistical Analysis Used: Data analysis was performed in SPSS software (version 16) and descriptive and inferential statistics were considered statistically significant (P < 0.05). Results: In this study, 75.1% of the nurses were female and 50.9% of the participants were within the age range of 26–35 years. The total mean and standard deviation of occupational hazards was 3.20 ± 0.66. In addition, the mean values and standard deviations of chemical, ergonomic, biological, psychosocial, and organizational, as well as physical hazards were reported to be 2.43 ± 1.06, 2.6 ± 0.82, 2.63 ± 0.91, 3.38 ± 0.7, and 3.38 ± 0.86, respectively. According to the results, significant differences were observed between occupational hazards and variables of gender, marital status, educational level, and work experience (P = 0.0001). Conclusion: Occupational hazard level was moderate among nurses in the ICUs, and most of the damages were related to the physical dimension. In addition to holding educational workshops in tertiary care centers by the related officials, proper preventive plans must be designed to reduce occupational injuries.
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	Incidence and risk factors of pressure ulcers among general surgery patients	p. 159
	Ensieh Ramezanpour, Amir Emami Zeydi, Mohammad Ali Heidari Gorji, Jamshid Yazdani Charati, Mahmood Moosazadeh, Vida Shafipour DOI:10.4103/JNMS.JNMS_23_17   Context: Pressure ulcers are among the main postoperative complications which isassociated with an increased length of hospitalization. Determining risk factors of postsurgical pressureulcers is crucial for developing prevention and treatment strategies. Aims: This study aimed to investigate the incidence rate of pressure ulcer and related risk factors after general surgery. Settings and Design: This descriptive cross-sectional study was carried out in three hospitals in Mazandaran province in 2016. Materials and Methods: The sample size was 191 surgical patients undergoing general surgery by using census method. Data were collected in pre-, intra-, and post-operative period using demographic and clinical questionnaires and also, through the Braden Scale for Predicting Pressure Ulcer Risk. Statistical Analysis Used: Descriptive statistics, t-test, Chi-square, and univariateand multivariate logistic regression were used to analyze the data. Results: The incidence rate of postoperative pressure ulcers in patients was 17.8% (34 out of 191 patients). Based on the multivariate logistic regression model, significant correlations existed between the incidence of pressure ulcers and the following variables: age over 70 years old (P = 0.003), history of hypertension (P = 0.035), history of heart diseases (P = 0.029), Braden score <15 (P = 0.017), type of surgery (P = 0.003), and type of anesthesia (P = 0.015).Conclusions: Since it is critical to consider the incidence of postoperative pressure ulcers among patients, further measurements are required to identify high-risk people and use preventive protocols by nurses at pre-, intra-, and post-operative levels. Moreover, it requires extra attention in patients over 70 years, those with a history of hypertension and heart diseases, and those undergoing emergency surgery and spinal anesthesia.
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	The relationship between the quality of nursing care and the satisfaction of pregnant mothers	p. 165
	Ali Hatami, Zohreh Saeidlandi, Azam Jahanghiri Mehr, Akram Hemmatipour DOI:10.4103/JNMS.JNMS_44_18   Context: The Health System Development Plan is one of the key steps taken by the eleventh government to promote health services in the country. Aims: The aim of this study was to determine the relationship between the quality of nursing care and the satisfaction of pregnant mothers from the implementation of the health system development plan. Settings and Design: This research was an analytic cross-sectional study. The study population included 163 mothers who were hospitalized before delivery and 18 nurses from maternity sections who were selected by the census method during the 3 months of September 2017–November 2017. Material and Methods: The data collection tool was a demographic data form, quality patient care scale, and a researcher-made questionnaire on the satisfaction of hospitalized mothers in maternity sections of the implementation of the Health System Reform Plan. Statistical Analysis Used: Data were analyzed using descriptive statistics, Mann–Whitney test, and correlation coefficient in SPSS-16 software. Results: The results showed that the quality of care in nurses at the desired level (63%) and the satisfaction of mother maternity sections of the delivery system had a moderate level of implementation of the Health System Development Plan (56.3%). The results of Pearson's correlation test showed that there is a statistically significant relationship between the quality of nursing care and patient satisfaction (P = 0.001). Conclusions: The satisfaction of the mothers participating in the research was that the quality of nursing care was often modest after implementing the Health System Reform Plan.
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Molecular epidemiology of locally acquired Hansen’s disease in Central Florida

Publication date: Available online 15 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Christina Dai, Ahmed Ansari, Shawn Shih, Vilma Marks, Rahul Sharma, Jeffrey Greenwald

http://bit.ly/2TXkpGz

Note to dermatopathologists: when it comes to moderately atypical nevi, leave the treatment plan to clinicians

Publication date: Available online 15 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Thomas N. Helm, Catherine G. Chung, Klaus F. Helm

http://bit.ly/2DbGSd2

Microneedling with dermaroller 192 needles along with 5-fluorouracil solution in the treatment of stable vitiligo

Publication date: Available online 15 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Akshy Kumar, Rakesh Bharti, Shail Agarwal

http://bit.ly/2TKIvnA

Risk of neurodegenerative disorders in Korean patients with vitiligo: A nationwide retrospective cohort study

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Tae-Gyun Kim, Jaeyong Shin, Shinwon Hwang, Si-Hyung Lee, Hyeon Chang Kim, Sang Ho Oh

http://bit.ly/2DaX8eB

Melanoma and Melanoma In-Situ Diagnosis after Excision of Atypical Intraepidermal Melanocytic Proliferation (AIMP): A Retrospective Cross-Sectional Analysis

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Nina R. Blank, Brian P. Hibler, Ian W. Tattersall, Courtney J. Ensslin, Erica H. Lee, Stephen W. Dusza, Kishwer S. Nehal, Klaus J. Busam, Anthony M. Rossi

Abstract

Background

There is little evidence to guide surgical management of biopsies yielding the histologic descriptor "atypical intraepidermal melanocytic proliferation" (AIMP).

Objective

Determine frequency of and factors associated with melanoma and melanoma in-situ (MIS) diagnoses after excision of AIMP and evaluate margins used to completely excise AIMP.

Methods

Retrospective, cross-sectional study of 1127 biopsies reported as AIMP and subsequently excised within one academic institution.

Results

Melanoma (in-situ, stage 1A) was diagnosed after excision in 8.2% (92/1127) of AIMP samples. Characteristics associated with melanoma/MIS diagnosis included age 60-79 (OR 8.1, 95% CI 2.5-26.2), age >80 (OR 7.2, 95% CI 1.7-31.5), head/neck location (OR 4.9, 95% CI 3.1-7.7), clinical lesion partially biopsied (OR 11.0, 95% CI 6.7-18.1), and lesion extending to deep biopsy margin (OR 15.1, 95% CI 1.7-136.0). Average surgical margin used to excise AIMP lesions was 4.5mm (SD 1.8).

Limitations

Single-site, retrospective, observational study; interobserver variability across dermatopathologists.

Conclusion

Dermatologists and pathologists can endeavor to avoid ambiguous melanocytic designations whenever possible through excisional biopsy technique, interdisciplinary communication, and ancillary studies. In the event of AIMP biopsy, physicians should consider the term a histological description rather than a diagnosis, and, during surgical planning, use clinicopathologic correlation while bearing in mind factors that might predict true melanoma/MIS.

http://bit.ly/2TSBnG2

Rosacea: Relative risk vs Absolute Risk of Malignant Comorbidities

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Leonardo A. Tjahjono, Abigail Cline, William W. Huang, Alan B. Fleischer, Steven R. Feldman

http://bit.ly/2DbMGDu

Hydroa vacciniforme-like lymphoproliferative disorder: Clinicopathologic study of 41 cases

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Yanghe Liu, Cuiling Ma, Gang Wang, Lei Wang

Abstract

Background

Hydroa vacciniforme-like lymphoproliferative disorder (HVLLPD) is a rare Epstein-Barr virus (EBV)-related disease usually found in East Asians and Latin Americans.

Objective

To report the characteristics of HVLLPD in Chinese patients.

Methods

Retrospective analysis of HVLLPD patients from a single institute.

Results

Forty-one patients were enrolled. All cases presented with papulovesicular lesions, mainly distributed on sun-exposed areas. Twenty-six cases showed systemic symptoms. Follow-up data was available in 20 cases, 16 patients were alive, and 4 patients died. Among the 4 deceased patients, 3 had serum EBV DNA test and showed high viral loads. These 3 patients also received chemotherapy. Histopathology was characterized by dense proliferation of lymphocytes in the dermis. Angiotropism or angiodestruction was found in majority cases, while prominent cellular polymorphism was noticed in only 4 cases. All cases were positive for CD3, TIA-1, and EBV-encoded RNA in situ hybridization.

Limitations

This was a retrospective study.

Conclusions

HVLLPD in Chinese patients showed indolent behavior in the majority of cases, which differed from HVLLPD characteristics in Latin Americans. Patients with high serum EBV DNA loads had an increased risk of evolving into aggressive disease. Chemotherapy should not be considered as first line treatment for most Chinese patients.

http://bit.ly/2TSBoK6

Risk of bias assessment in primary studies for the development of systematic reviews: a reflection about exposure to systemic dermatological drugs and its effects on infertility and teratogenicity in males

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Gianfranco Enriquez-Gutierrez, Fernando Sosaya-Muñoz, Claudia Rojas-Varona, Edward Mezones-Holguín

http://bit.ly/2DaX929

Efficacy and safety of antiscabietic agents: A systematic review and network meta-analysis of randomized controlled trials

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Kunlawat Thadanipon, Thunyarat Anothaisintawee, Sasivimol Rattanasiri, Ammarin Thakkinstian, John Attia

Abstract

Background

Many drugs have been used to treat scabies, but it is unclear which of them is the most efficacious.

Objective

To evaluate the comparative efficacy and safety of antiscabietic agents.

Methods

Systematic review of randomized controlled trials was conducted. Direct and network meta-analyses were applied to 13 antiscabietic agents on 3 outcomes (cure, persistent itching, and adverse events). Their probability of having highest efficacy and safety was estimated and ranked.

Results

Network meta-analysis based on 52 trials in 9917 patients indicated that permethrin (the reference treatment) had significantly higher cure rate than sulfur, malathion, lindane, crotamiton, and benzyl benzoate. Permethrin+oral ivermectin combination had non-significantly higher cure rate than permethrin. Permethrin+oral ivermectin combination, topical ivermectin, and synergized pyrethrins were the treatment ranked highest in terms of cure, persistent itching, and adverse events, respectively. Based on clusterd ranking, permethrin, oral ivermectin, and synergized pyrethrins seemed to retain balance between cure and adverse events.

Limitations

There are small numbers of trials and patients in some comparisons, and high risk of bias in some trials.

Conclusion

There is no one treatment that ranked highest in all aspects. Physicians should consider the drug's efficacy and safety profiles, along with ease of administration.

http://bit.ly/2TOAdLt