Assessment of the availability of As and Pb in soils after in situ stabilization

Abstract

The in situ stabilization has been widely used to remediate metal-contaminated soil. However, the long-term retaining performance of heavy metals and the associated risk after in situ stabilization remains unclear and has evoked amounting concerns. Here, Pb- or As-contaminated soil was stabilized by a commercial amendment. The availability of Pb and As after in situ stabilization were estimated by ten different in vitro chemical extractions and DGT technique. After amendment application, a significant decline in extractable Pb or As was observed in treatments of Milli-Q water, 0.01 M CaCl₂, 0.1 M NaNO₃, 0.05 M (NH₄)₂SO₄, and 0.43 M HOAc. Potential available metal(loid)s determined by DGT also showed remarkable reduction. Meanwhile, the results of in vivo uptake assays demonstrated that Pb concentrations in shoots of ryegrass Lolium perenne L. declined to 12% of the control samples, comparable to the extraction ratio of 0.1 M NaNO₃ (15.8%) and 0.05 M (NH₄)₂SO₄ (17.3%). For As-contaminated soil, 0.43 M HOAC provided a better estimation of relative phytoavailability (64.6 vs. 65.4% in ryegrass) compared to other extraction methods. We propose that 0.1 M NaNO₃ or 0.05 M (NH₄)₂SO₄ for Pb and 0.43 M HOAc for As may serve as surrogate measures to estimate the lability of metal(loid)s after soil remediation of the tested contaminated soils. Further studies over a wider range of soil types and amendments are necessary to validate extraction methods.

http://ift.tt/2wy59Yc

Target Vessel Revascularization and Territory of Myocardial Ischemia in Patients With Chronic Total Occlusions

http://ift.tt/2ijBo7R

Managing Patients With Homozygous Familial Hypercholesterolemia

http://ift.tt/2ikHntc

Coronary Artery Disease in Patients With Out-of-Hospital Refractory Ventricular Fibrillation Cardiac Arrest

AbstractBackground

The prevalence of coronary artery disease (CAD) among patients with refractory out-of-hospital (OH) ventricular fibrillation (VF)/ventricular tachycardia (VT) cardiac arrest is unknown.

Objectives

The goal of this study was to describe the prevalence and complexity of CAD and report survival to hospital discharge in patients experiencing refractory VF/VT cardiac arrest treated with a novel protocol of early transport to a cardiac catheterization laboratory (CCL) for extracorporeal life support (ECLS) and revascularization.

Methods

Between December 1, 2015, and December 1, 2016, consecutive adult patients with refractory OH VF/VT cardiac arrest requiring ongoing cardiopulmonary resuscitation were transported by emergency medical services to the CCL. ECLS, coronary angiography, and percutaneous coronary intervention were performed, as appropriate. Functionally favorable survival to hospital discharge (Cerebral Performance Category 1 or 2) was determined. Outcomes in a historical comparison group were also evaluated.

Results

Sixty-two (86%) of 72 transported patients met emergency medical services transport criteria. Fifty-five (89%) of the 62 patients met criteria for continuing resuscitation on CCL arrival; 5 had return of spontaneous circulation, 50 received ECLS, and all 55 received coronary angiography. Forty-six (84%) of 55 patients had significant CAD, 35 (64%) of 55 had acute thrombotic lesions, and 46 (84%) of 55 had percutaneous coronary intervention with 2.7 ± 2.0 stents deployed per patient. The mean SYNTAX score was 29.4 ± 13.9. Twenty-six (42%) of 62 patients were discharged alive with Cerebral Performance Category 1 or 2 versus 26 (15.3%) of 170 in the historical comparison group (odds ratio: 4.0; 95% confidence interval: 2.08 to 7.7; p < 0.0001).

Conclusions

Complex but treatable CAD was prevalent in patients with refractory OH VF/VT cardiac arrest who also met criteria for continuing resuscitation in the CCL. A systems approach using ECLS and reperfusion seemed to improve functionally favorable survival.

http://ift.tt/2fZXtre

Reply: Ezetimibe, Risk Stratification, and Secondary Prevention

http://ift.tt/2ijvEee

Reinforcing the Links in the Chain of Survival

http://ift.tt/2ikTs1f

Computer-Interpreted Electrocardiograms: Benefits and Limitations

Abstract

Computerized interpretation of the electrocardiogram (CIE) was introduced to improve the correct interpretation of the electrocardiogram (ECG), facilitating health care decision making and reducing costs. Worldwide, millions of ECGs are recorded annually, with the majority automatically analyzed, followed by an immediate interpretation. Limitations in the diagnostic accuracy of CIE were soon recognized and still persist, despite ongoing improvement in ECG algorithms. Unfortunately, inexperienced physicians ordering the ECG may fail to recognize interpretation mistakes and accept the automated diagnosis without criticism. Clinical mismanagement may result, with the risk of exposing patients to useless investigations or potentially dangerous treatment. Consequently, CIE over-reading and confirmation by an experienced ECG reader are essential and are repeatedly recommended in published reports. Implementation of new ECG knowledge is also important. The current status of automated ECG interpretation is reviewed, with suggestions for improvement.

http://ift.tt/2ikTZ3u

Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings

AbstractBackground

Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair.

Objectives

This study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve [ViV]) and annuloplasty rings (valve-in-ring [ViR]).

Methods

From the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria.

Results

A total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 ± 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 ± 17.4% vs. 55.3 ± 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p = 0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p = 0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve gradients were similar between groups (6.4 ± 2.3 mm Hg vs. 5.8 ± 2.7 mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003). Furthermore, the ViR group had more frequent life-threatening bleeding (8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03), and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The 1-year all-cause mortality rate was significantly higher in the ViR group compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On multivariable analysis, failed annuloplasty ring was independently associated with all-cause mortality (hazard ratio: 2.70; 95% confidence interval: 1.34 to 5.43; p = 0.005).

Conclusions

The TMVR procedure provided acceptable outcomes in high-risk patients with degenerated bioprostheses or failed annuloplasty rings, but mitral ViR was associated with higher rates of procedural complications and mid-term mortality compared with mitral ViV.

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Reply: Issues With Estimating "Diastolic Function" and Left Ventricular Filling Pressure Using the New Guidelines

http://ift.tt/2ikBjAV

Transcatheter Mitral Valve Replacement When Mitral Surgery Fails: 10 Years Later

http://ift.tt/2ikTlTn

JACC Instructions for Authors

http://ift.tt/2ikTvdr

Improving the Appropriate Use of Transthoracic Echocardiography: The Echo WISELY Trial

AbstractBackground

Appropriate use criteria (AUC) have defined transthoracic echocardiogram (TTE) indications for which there is a clear lack of benefit as rarely appropriate (rA).

Objectives

This study sought to investigate the impact of an AUC-based educational intervention on outpatient TTE ordering by cardiologists and primary care providers.

Methods

The authors conducted a prospective, investigator-blinded, multicenter, randomized controlled trial of an AUC-based educational intervention aimed at reducing rA outpatient TTEs. The study was conducted at 8 hospitals across 2 countries. The authors randomized cardiologists and primary care providers to receive either intervention or control (no intervention). The primary outcome measure was the proportion of rA TTEs.

Results

One hundred and ninety-six physicians were randomized, and 179 were included in the analysis. From December 2014 to April 2016, the authors assessed 14,697 TTEs for appropriateness, of which 99% were classifiable using the 2011 AUC. The mean proportion of rA TTEs was significantly lower in the intervention versus the control group (8.8% vs. 10.1%; odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.57 to 0.99; p = 0.039). In physicians who ordered, on average, at least 1 TTE per month, there was a significantly lower proportion of rA TTEs in the intervention versus the control group (8.6% vs. 11.1%; OR: 0.76; 95% CI: 0.57 to 0.99; p = 0.047). There was no difference in the TTE ordering volume between the intervention and control groups (mean 77.7 ± 89.3 vs. 85.4 ± 111.4; p = 0.83).

Conclusions

An educational intervention reduced the number of rA TTEs ordered by attending physicians in a variety of ambulatory care environments. This may prove to be an effective strategy to improve the use of imaging. (A Multi-Centered Feedback and Education Intervention Designed to Reduce Inappropriate Transthoracic Echocardiograms [Echo WISELY]; NCT02038101)

http://ift.tt/2fZXo6U

Cerebral Amyloid Angiopathy: Diagnosis, Clinical Implications, and Management Strategies in Atrial Fibrillation

Abstract

With an aging population, clinicians are more frequently encountering patients with atrial fibrillation who are also at risk of intracerebral hemorrhage due to cerebral amyloid angiopathy, the result of β-amyloid deposition in cerebral vessels. Cerebral amyloid angiopathy is common among elderly patients, and is associated with an increased risk of intracerebral bleeding, especially with the use of anticoagulation. Despite this association, this entity is absent in current risk–benefit analysis models, which may result in underestimation of the chance of bleeding in the subset of patients with this disease. Determining the presence and burden of cerebral amyloid angiopathy is particularly important when planning to start or restart anticoagulation after an intracerebral hemorrhage. Given the lack of randomized trial data to guide management strategies, we discuss a heart–brain team approach that includes clinician–patient shared decision making for the use of pharmacologic and nonpharmacologic approaches to diminish stroke risk.

http://ift.tt/2fYGTIt

Appropriate and Appropriate Use: What Do These Words Really Mean?

http://ift.tt/2ikHo0e

ACC Tackling Prior Authorization

http://ift.tt/2fZrPKA

Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence

AbstractBackground

Spontaneous coronary artery dissection (SCAD) is underdiagnosed and an important cause of myocardial infarction (MI), especially in young women. Long-term cardiovascular outcomes, including recurrent SCAD, are inadequately reported.

Objectives

This study sought to describe the acute and long-term cardiovascular outcomes and assess the predictors of recurrent SCAD.

Methods

Nonatherosclerotic SCAD patients were prospectively followed at Vancouver General Hospital systematically to ascertain baseline, predisposing and precipitating stressors, angiographic features, revascularization, use of medication, and in-hospital and long-term cardiovascular events. Clinical predictors for recurrent de novo SCAD were tested using univariate and multivariate Cox regression models.

Results

The authors prospectively followed 327 SCAD patients. Average age was 52.5 ± 9.6 years, and 90.5% were women (56.9% postmenopausal). All presented with MI; 25.7% had ST-segment elevation MI, 74.3% had non–ST-segment elevation MI, and 8.9% had ventricular tachycardia/ventricular fibrillation. Precipitating emotional stressors were reported in 48.3% and physical stressors in 28.1%. Fibromuscular dysplasia was present in 62.7%, connective tissue disorder in 4.9%, and systemic inflammatory disease in 11.9%. The majority (83.1%) were initially treated medically, with only 16.5% or 2.2% undergoing in-hospital percutaneous coronary intervention or coronary artery bypass graft surgery, respectively. The majority of SCAD patients were taking aspirin and beta-blocker therapy at discharge and at follow-up. Median hospital stay was 3.0 days, and the overall major adverse event rate was 7.3%. Median long-term follow-up was 3.1 years, and overall major adverse cardiac event rate was 19.9% (death rate: 1.2%; recurrent MI: 16.8%; stroke/transient ischemic attack: 1.2%; revascularization: 5.8%). Recurrent SCAD occurred in 10.4% of patients. In multivariate modeling, only hypertension increased (hazard ratio: 2.46; p = 0.011) and beta-blocker use diminished (hazard ratio: 0.36; p = 0.004) recurrent SCAD.

Conclusions

In our large prospectively followed SCAD cohort, long-term cardiovascular events were common. Hypertension increased the risk of recurrent SCAD, whereas beta-blocker therapy appeared to be protective.

http://ift.tt/2fZt38A

Issues With Estimating "Diastolic Function" and Left Ventricular Filling Pressure Using the New Guidelines

http://ift.tt/2fZrMyo

Insights Into Spontaneous Coronary Artery Dissection: Can Recurrence Be Prevented?

http://ift.tt/2ilInNo

Ezetimibe, Risk Stratification, and Secondary Prevention

http://ift.tt/2fZ4995

Efficacy of Rosuvastatin in Children With Homozygous Familial Hypercholesterolemia and Association With Underlying Genetic Mutations

AbstractBackground

Homozygous familial hypercholesterolemia (HoFH), a rare genetic disorder, is characterized by extremely elevated levels of low-density lipoprotein cholesterol (LDL-C) and accelerated atherosclerotic cardiovascular disease. Statin treatment starts at diagnosis, but no statin has been formally evaluated in, or approved for, HoFH children.

Objectives

The authors sought to assess the LDL-C efficacy of rosuvastatin versus placebo in HoFH children, and the relationship with underlying genetic mutations.

Methods

This was a randomized, double-blind, 12-week, crossover study of rosuvastatin 20 mg versus placebo, followed by 12 weeks of open-label rosuvastatin. Patients discontinued all lipid-lowering treatment except ezetimibe and/or apheresis. Clinical and laboratory assessments were performed every 6 weeks. The relationship between LDL-C response and genetic mutations was assessed by adding children and adults from a prior HoFH rosuvastatin trial.

Results

Twenty patients were screened, 14 randomized, and 13 completed the study. The mean age was 10.9 years; 8 patients were on ezetimibe and 7 on apheresis. Mean LDL-C was 481 mg/dl (range: 229 to 742 mg/dl) on placebo and 396 mg/dl (range: 130 to 700 mg/dl) on rosuvastatin, producing a mean 85.4 mg/dl (22.3%) difference (p = 0.005). Efficacy was similar regardless of age or use of ezetimibe or apheresis, and was maintained for 12 weeks. Adverse events were few and not serious. Patients with 2 defective versus 2 negative LDL receptor mutations had mean LDL-C reductions of 23.5% (p = 0.0044) and 14% (p = 0.038), respectively.

Conclusions

This first-ever pediatric HoFH statin trial demonstrated safe and effective LDL-C reduction with rosuvastatin 20 mg alone or added to ezetimibe and/or apheresis. The LDL-C response in children and adults was related to underlying genetic mutations. (A Study to Evaluate the Efficacy and Safety of Rosuvastatin in Children and Adolescents With Homozygous Familial Hypercholesterolemia [HYDRA]; NCT02226198)

http://ift.tt/2fZXknG

Correction

http://ift.tt/2fZrFTu

Peri-hand space representation in the absence of a hand - evidence from congenital one-handers

Publication date: Available online 21 August 2017
Source:Cortex
Author(s): Roni O. Maimon-Mor, Heidi Johansen-Berg, Tamar R. Makin




http://ift.tt/2vTeKYU

tDCS modulation of naming in healthy participants: Negative results and still no explanation – a response to a commentary by Gauvin et al. (2017)

Publication date: Available online 19 August 2017
Source:Cortex
Author(s): Samuel.J. Westwood, Andrew Olson, R.Chris. Miall, Cristina Romani




http://ift.tt/2vTBmIF

Structural Encoding Processes Contribute to Individual Differences in Face and Object Cognition: Inferences from Psychometric Test Performance and Event-Related Brain Potentials

Publication date: Available online 19 August 2017
Source:Cortex
Author(s): Hadiseh Nowparast Rostami, Werner Sommer, Changsong Zhou, Oliver Wilhelm, Andrea Hildebrandt
The enhanced N1 component in event-related potentials (ERP) to face stimuli, termed N170, is considered to indicate the structural encoding of faces. Previously, individual differences in the latency of the N170 have been related to face and object cognition abilities. By orthogonally manipulating content domain (faces vs. objects) and task demands (easy/speed vs. difficult/accuracy) in both psychometric and EEG tasks, we investigated the uniqueness of the processes underlying face cognition as compared with object cognition and the extent to which the N1/N170 component can explain individual differences in face and object cognition abilities. Data were recorded from N=198 healthy young adults. Structural equation modeling confirmed that the accuracies of face perception and memory are specific abilities above general object cognition; in contrast, the speed of face processing was not differentiable from the speed of object cognition. Although there was considerable domain-general variance in the N170 shared with the N1, there was significant face-specific variance in the N170. The brain-behavior relationship showed that faster face-specific processes for structural encoding of faces are associated with higher accuracy in both perceiving and memorizing faces. Moreover, in difficult task conditions, qualitatively different processes are additionally needed for recognizing face and object stimuli as compared with easy tasks. The difficulty-dependent variance components in the N170 amplitude were related with both face and object memory performance. We discuss implications for understanding individual differences in face cognition.



http://ift.tt/2vTBkR3

Specific Contributions of Basal Ganglia and Cerebellum To The Neural Tracking of Rhythm

Publication date: Available online 19 August 2017
Source:Cortex
Author(s): Sylvie Nozaradan, Michael Schwartze, Christian Obermeier, Sonja A. Kotz
How specific brain networks track rhythmic sensory input over time remains a challenge in neuroimaging work. Here we show that subcortical areas, namely the basal ganglia and the cerebellum, specifically contribute to the neural tracking of rhythm. We tested patients with focal lesions in either of these areas and healthy controls by means of electroencephalography (EEG) while they listened to rhythmic sequences known to induce selective neural tracking at a frequency corresponding to the most-often perceived pulse-like beat. Both patients and controls displayed neural responses to the rhythmic sequences. However, these response patterns were different across groups, with patients showing reduced tracking at beat frequency, especially for the more challenging rhythms. In the cerebellar patients, this effect was specific to the rhythm played at a fast tempo, which places high demands on the temporally precise encoding of events. In contrast, basal ganglia patients showed more heterogeneous responses at beat frequency specifically for the most complex rhythm, which requires more internal generation of the beat. These findings provide electrophysiological evidence that these subcortical structures selectively shape the neural representation of rhythm. Moreover, they suggest that the processing of rhythmic auditory input relies on an extended cortico-subcortico-cortical functional network providing specific timing and entrainment sensitivities.



http://ift.tt/2x7aPGb

A Study of CDX-3379 and Cetuximab and in Patients With Advanced Head and Neck Squamous Cell Carcinoma

Condition:   Advanced Head and Neck Squamous Cell Carcinoma
Intervention:   Drug: CDX-3379 and cetuximab
Sponsor:   Celldex Therapeutics
Not yet recruiting - verified August 2017

http://ift.tt/2whgxaR

Voice Guard Processing Evaluation in a Cohort of Subjects Implanted With the Neuro Cochlear Implant System

Condition:   Cochlear Implantation
Interventions:   Device: XDP sound processing strategy;   Device: Voice Guard sound processing strategy;   Device: Voice Track
Sponsor:   Oticon Medical
Not yet recruiting - verified August 2017

http://ift.tt/2vXBDZk

Monocenter, Open Label Clinical Investigation on the Treatment of Radiation Induced Dermatitis With Xonrid®

Condition:   Radiodermatitis, Quality of Life
Intervention:   Device: Xonrid® gel
Sponsor:   Helsinn Healthcare SA
Recruiting - verified August 2017

http://ift.tt/2whmJjq

Cyclin D1 Based TPF Induction Chemotherapy for Oral Squamous Cell Carcinoma Patients at Clinical N2 Stage

Conditions:   Mouth Neoplasms;   Carcinoma, Squamous Cell
Interventions:   Drug: TPF group;   Procedure: surgery group;   Radiation: Post-operative radiotherapy
Sponsor:   Shanghai Jiao Tong University School of Medicine
Recruiting - verified November 2015

http://ift.tt/2x6gr3z

GDF15 Based TPF Induction Chemotherapy for OSCC Patients

Conditions:   Mouth Neoplasms;   Carcinoma, Squamous Cell
Interventions:   Drug: TPF induction chemotherapy;   Procedure: surgery group;   Radiation: Post-operative radiotherapy
Sponsor:   Shanghai Jiao Tong University School of Medicine
Recruiting - verified November 2015

http://ift.tt/2vSSbn1

Impact of postoperative radiotherapy and HER2/new overexpression in salivary duct carcinoma

Abstract

Aim

Retrospective Investigation of the prognostic relevance of clinicopathologic parameters in patients with salivary duct carcinoma (SDC).

Methods

An experienced pathologist reviewed 67 patients with de novo SDC or SDC ex pleomorphic adenoma. Paraffin-embedded tumor samples were examined by immunohistochemistry for expression of HER2/neu, androgen (AR), progesterone (PR), estrogen (ER), epidermal growth factor (EGFR) and programmed death ligand 1 (PD-L1-R) receptor. In 45 patients who had cM0 and follow-up data available, survival rates were calculated (Kaplan–Meier method) and prognostic variables were analyzed (univariate analysis: log-rank test; multivariate analysis: Cox-regression analysis).

Results

Overexpression of HER2/neu, AR, ER, PR, EGFR, PD-L1-R was found in 25.4%, 84%, 0%, 0%, 17.9%, 16.4% of patients. Overall (OS), disease-free (DFS), distant-metastases-free survival (DMFS) and locoregional control (LRC) were 92.3/72.4/56.9%, 78.2/58.1/58.1%, 85.4/65.2/65.2% and 89.7/81.9/81.9% after 1/3/5 years (medial follow-up 26 months). In univariate analysis a positive resection margin (p = 0.008) and no postoperative radiotherapy (p = 0.001) predict an increased locoregional recurrence rate. In multivariate analysis only postoperative radiotherapy is statistically significant (p = 0.004). Presence of lymph node metastases, a lymph node density >4 and HER2/neu overexpression predict decreased DFS and DMFS. In multivariate HER2/neu overexpression was the only significant predictor for reduced DFS (p = 0.04) and DMFS (p = 0.02).

Conclusion

Postoperative radiotherapy is the only significant predictor for LRC. HER2/neu receptor expression is an independent prognostic factor for decreased DFS and DMFS in patients with SDC. In addition to radio(chemo)therapy, intensified first-line treatment regimens should also be evaluated in the future.

http://ift.tt/2vSoxyf

Effects of Cd(II) on the stability of humic acid-coated nano-TiO 2 particles in aquatic environments

Abstract

The stability of nanoparticles (NPs) in aquatic environments is important to evaluate their adverse effects on aquatic ecosystems and human health. Nanoparticle stability is known to be influenced by coexisting ions and dissolved organic matter. This study was designed to investigate the effects of coexisting low-level Cd(II) on the stability of humic acid-coated nano-TiO₂ (HA-TiO₂) particles in aquatic environments by measuring their aggregation kinetics through time-resolved dynamic light scattering (DLS) and monitoring suspended HA-TiO₂ concentrations via optical absorbance changes over time. The particles exhibited aggregation behavior consistent with the classic Derjaguin–Landau–Verwey–Overbeek (DLVO) theory. The results showed that Cd(II) concentration, pH, and ionic strength had various effects on the aggregation kinetics of the HA-TiO₂ NPs. The HA-TiO₂ particles aggregated faster as the Cd(II) concentration increased whereas the stability of the nanoparticles increased as the solution pH increased or ionic strength decreased regardless of the Cd(II) concentration. At the fixed pH and ionic strength conditions, the addition of Cd(II) promoted aggregation of nanoparticles, leading to higher attachment efficiencies. The enhanced aggregation of the HA-TiO₂ NPs in the presence of coexisting cadmium ions in aqueous solutions indicated that the fate and transport of nanoparticles could be greatly affected by heavy metals in aquatic environments.

http://ift.tt/2uZ4Zcw

Protease production by the keratinolytic Bacillus sp. CL18 through feather bioprocessing

Abstract

Bacillus sp. CL18 was investigated to propose a bioprocess for protease production using feathers as organic substrate. In feather broth (FB), containing feathers as sole organic substrate (1–100 g l⁻¹), maximal protease production was observed at 30 g l⁻¹ (FB30) after 6 days of cultivation, whereas increased feather concentrations negatively affected protease production and feather degradation. Protease production peaks were always observed earlier during cultivations than maximal feather degradation. In FB30, 80% of initial feathers mass were degraded after 7 days. Addition of glucose, sucrose, starch, yeast extract (2 g l⁻¹), CaCl₂, or MgCl₂ (10 mmol l⁻¹) to FB30 decreased protease production and feather degradation. FB30 supplementation with NH₄Cl (1 g l⁻¹) resulted in less apparent negative effects on protease production, whereas peptone (2 g l⁻¹) increased protease yields earlier during cultivations (3 days). Through a central composite design employed to investigate the effects of peptone and NH₄Cl (0.5–4.5 g l⁻¹) on protease production and feather degradation, FB30 supplementation with peptone and NH₄Cl (0.5–1.1 g l⁻¹) increased protease production within a shorter cultivation time (5 days) and hastened complete feather degradation (6 days). Feather bioconversion concurs with sustainable production of value-added products.

http://ift.tt/2viypxK

Total and settling velocity-fractionated pollution potential of sewer sediments in Jiaxing, China

Abstract

Sewer sediments and their associated contaminant released along with wet-weather discharges pose potential pollution risks to environment. This paper presents total characteristics of sediments collected from Jiaxing, China. Size distribution and concentrations of volatile solids (VS) and four metals (Pb, Cu, Zn, Cr) of sediment samples from seven land use categories were analyzed. Then, the sediment samples were graded five fractions according to its settling velocity through the custom-built settling velocity-grading device. Sediment mass and pollution load distribution based on settling velocity were also assessed. The results show that there are relatively high level of heavy metal load in the sediment of separated storm drainage systems in Jiaxing, especially for the catchment of residential area (RA), road of developed area (RDA), and industrial area (IA). Although grain size follows a trend of increasing along with settling velocity, the methods of settling velocity grading are meaningful for stormwater treatment facilities with precipitation. For all land use categories, the pollution concentrations of the three lower settling velocity-fractionated sediment are relatively consistent and higher than others. Combined with mass distribution, the pollution percentage of fraction with different velocities for seven land use categories were also evaluated. Based on it, the statistical conclusion of design target settling velocity to different pollution load removal rates are drawn, which is helpful to guide design of on-site precipitation separation facilities.

http://ift.tt/2uYZBpN

Le devoir d’information du Médecin (CAA de Nantes ; 2 juin 2016)

Publication date: Available online 21 August 2017
Source:Médecine & Droit
Author(s): Gérard Memeteau
Une patiente n'est pas informée de l'identité du chirurgien qui doit l'opérer. L'Oniam qui prétend que ce manque d'information est constitutif d'une perte de chance d'échapper à l'intervention est débouté de sa prétention : « aucun lien de causalité ne peut être établi entre le défaut d'information relevé et la perte de chance invoquée ».Every physician has a duty of information. He must tell the patient the risk as and benefices of the treatments. Some authors write actually that it is a legal duty and not only a contractual one. But, there is not only the physician; there is also the private or public hospital. That institution ought to present to the patient a competent professional and to inform the public herself about the specialties offered. The judgement tries to precise the parts of those informations.



http://ift.tt/2xksgT8

La Médecine Antique, V. Nutton. Les Belles Lettres, Paris (2016)

Publication date: Available online 21 August 2017
Source:Médecine & Droit
Author(s): Philippe Biclet




http://ift.tt/2wqIvBO

Le concept du système universel d’enregistrement du sexe/genre

Publication date: Available online 21 August 2017
Source:Médecine & Droit
Author(s): George G. Tumanishvili
Dans le monde contemporain, l'idée d'égalité justifie un soutien mental, socioculturel et législatif. Chacune de ces composantes est un maillon important d'une chaîne que nous appelons aujourd'hui l'égalité. L'égalité entre les sexes et la non-discrimination sous quelle forme que ce soit, à première vue, représente la base convenue par la plupart des pays, mais les idées d'égalité manquent souvent d'un soutien normatif, même au niveau législatif. Dans cet article, l'auteur présente un Système Universel d'enregistrement du Sexe/Genre. En appliquant ce système, il deviendra possible d'assurer la norme initiale d'égalité en matière de sexe et de genre, qui a été négligée par la majorité qualifiée des pays jusqu'à ce jour.In the modern world, the idea of equality needs a mental, social-cultural and legislative support. Each of these components is an important link of a chain that we call equality today. Equality between genders and non-discrimination in any form, at first glance, represents the basis that has been agreed by most countries so far, however, the ideas of equality often lack normative support even at the legislative level too. In this article is presented a Universal System of Sex/Gender Registration created by the author. By the implementing/applying this system, the modern world will be able to ensure the standard of initial equality regarding sex and gender, which has been neglected by the qualified majority of countries to date.



http://ift.tt/2ijh9ac

A Case of Methemoglobinemia Successfully Treated with Hyperbaric Oxygenation Monotherapy

Publication date: Available online 21 August 2017
Source:The Journal of Emergency Medicine
Author(s): Youngmo Cho, Sung Wook Park, Sang-Kyoon Han, Hyung bin Kim, Seok Ran Yeom
BackgroundMethylene blue is the first-line therapy for methemoglobinemia, but it can be intermittently unavailable due to production issues. For this clinical scenario, alternative treatment options need to be explored. Hyperbaric oxygenation (HBO) is conventionally applied as an adjunctive therapy during the systemic administration of methylene blue. Currently, little is known regarding the effects of HBO monotherapy in methemoglobinemia. We report a case of methemoglobinemia that was successfully treated with HBO monotherapy.Case ReportA 41-year-old man presented to the Emergency Department with dyspnea and dizziness subsequent to smoking in a garage filled with motor vehicle exhaust gas. There were no abnormal heart or lung sounds. While administering oxygen flowing at 15 L/min via a mask with a reservoir bag, blood tests revealed high methemoglobin (MetHb) levels at 59.6%. He was treated with HBO monotherapy, and sequential tests showed that the MetHb level decreased significantly to 34.0%, 12.8%, 6.2%, and eventually, 3.5%. He was discharged with stable vital signs the next day.Why Should an Emergency Physician Be Aware of This?HBO monotherapy is an effective alternative treatment for methemoglobinemia when methylene blue is not available.



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Assessment of time to glucose peak during an oral glucose tolerance test

Abstract

We read with interest the article from Chung et al. on the association between time to glucose peak and prediabetes.¹ We agree with the authors in that the morphology of the glucose curve is worth investigating as an additional indicator of prediabetes and diabetes risk. This is a rather well studied topic in the literature, and most authors agree that adding an intermediate glucose measurement (at 30 or 60 minutes) improves the ability to identify subgroups with forms of dysglycaemia not picked up by the traditional guidelines based on fasting and 2-hour values.

This article is protected by copyright. All rights reserved.

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Comparison of heavy metal levels of farmed and escaped farmed rainbow trout and health risk assessment associated with their consumption

Abstract

In this study, levels of ten metals (arsenic, cadmium, cobalt, chromium, copper, iron, manganese, nickel, lead, and zinc) in muscles of farmed and escaped farmed rainbow trout (Oncorhynchus mykiss) in the Keban Dam Reservoir (Turkey) were determined. Also, human health risks associated with their consumption were assessed. Of ten metals, only Co and Fe levels in escaped rainbow trout were significantly higher than those in farmed rainbow trout. The metal levels in farmed and escaped rainbow trout were below the maximum permissible limits. The estimated daily intake (EDI) of each metal in both farmed and escaped farmed rainbow trout was much lower than the respective tolerable daily intake (TDI). The target hazard quotient (THQ) values for individual metal and the total THQ values for combined metals were lower than 1 in both farmed and escaped rainbow trout, indicating no health risk for humans. The cancer risk (CR) values estimated for inorganic As in both farmed and escaped rainbow trout indicated low carcinogenic risk to the consumers. According to the maximum allowable monthly consumption limits (CR_mm), adults may safely consume 24 meals of farmed rainbow trout per month or 39 meals of escaped rainbow trout per month, with minimal adverse carcinogenic and non-carcinogenic health effects. This study revealed that the risk from consuming farmed and escaped farmed rainbow trout in the Keban Dam Reservoir due to these trace elements is minimal.

http://ift.tt/2wqRouV

Episiotomy scar endometriosis

Publication date: Available online 20 August 2017
Source:Medical Journal Armed Forces India
Author(s): Vatsla Dadhwal, Aparna Sharma, Kavita Khoiwal, Tripti Nakra




http://ift.tt/2vhWpRo

Blood–tumor barrier opening changes in brain metastases from pre to one-month post radiation therapy

Publication date: Available online 20 August 2017
Source:Radiotherapy and Oncology
Author(s): Feifei Teng, Christina I. Tsien, Theodore S. Lawrence, Yue Cao
PurposeBlood–tumor barrier is a limiting factor for effectiveness of systemic therapy to brain metastases. This study aimed to assess the extent and time course of BTB opening in BM following whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) to determine optimal timing for systemic therapy.Materials and method30 patients received WBRT or SRS and a total of 64 metastatic lesions were analyzed. Dynamic contrast-enhanced MRI were acquired, to quantify a transfer constant (K^trans), pre-RT, 1–2weeks after starting RT (Wk1-2), and 1-month post-RT (1M post-RT). Lesions were categorized as either low or high permeability based upon the pre-RT percentage volume of a lesion with K^trans>0.005min⁻¹ (%Vall) less or greater than 50%. Time-course changes of %Vall after RT were analyzed.ResultsFifty-seven lesions had high-permeability and seven had low-permeability at baseline. Intra-patient and inter-lesion heterogeneity was observed in six patients who had both low- (n=7) and high-permeability lesions (n=10). Also, lesion permeability showed a significant size-effect at baseline. For high-permeability lesions, either received WBRT (n=43) or SRS (n=14), %Vall decreased non-significantly following RT (from 85.4% pre-RT to 76.9% 1M post-RT). For low-permeability lesions (n=7, all received WBRT), %Vall increased from 5.6% pre-RT to 30.2% at Wk1-2 and to 52.6% 1M−post (p=0.01).ConclusionOur preliminary results suggest that 2–4weeks after RT, when BTB opening is high for both low- and high-permeability brain metastatic lesions, could be optimal time to start systemic therapy.



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Percutaneous management of complex acquired aortic coarctation in an adult with tetralogy of Fallot and pulmonary atresia

Michael D Seckeler, Emily Lawson, Brent J Barber, Scott E Klewer

Annals of Pediatric Cardiology 2017 10(3):295-297

We present the case of a female adult with complex cyanotic congenital heart disease who had long-standing thoracic aortic obstruction due to scarring from earlier surgical procedures. She was symptomatic but felt to be too high risk for surgical intervention. With careful planning, she was able to undergo successful stenting of her aorta with subsequent clinical improvement. This case highlights some of the complexities of caring for adults with congenital heart disease and the importance of a thorough understanding of their anatomy and physiology and prior interventions before undertaking interventions.

http://ift.tt/2wh8VW6

Change of guard: Introducing the new editor of the Annals of Pediatric Cardiology, Dr. KS Iyer

Raman Krishna Kumar

Annals of Pediatric Cardiology 2017 10(3):223-223



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Quantification of ventricular unloading by 3D echocardiography in single ventricle of left ventricular morphology following superior cavo-pulmonary anastomosis and Fontan completion – a feasibility study

Deepa Sasikumar, Bijulal Sasidharan, Baiju S Dharan, Arun Gopalakrishnan, Kavasseri M Krishnamoorthy, Sivasubramanian Sivasankaran

Annals of Pediatric Cardiology 2017 10(3):224-229

Background: Three-dimensional echocardiography. (3DE) is comparable to cardiac magnetic resonance imaging for estimating ventricular volume in congenital heart diseases. However, there are limited data on estimation of ventricular volumes by 3DE in univentricular heart and change in ventricular volumes after surgical creation of cavopulmonary connection. We sought to quantify the unloading of the single ventricle of left ventricular. (LV) morphology by 3DE after superior cavopulmonary anastomosis. (SCPA) or Fontan operation over a period of 3 months and thereby derive a preliminary 3DE data set on this patient subset. Patients and Methods: Eighteen patients with functional single ventricle of LV morphology, who underwent SCPA or completion of Fontan circulation, were included in the study. Volume of the ventricle was estimated by 3DE before surgery and after surgery. (in the early postoperative phase and 3 months after surgery), and indexed end-diastolic volume. (EDV), end.systolic volume. (ESV), and ejection fraction. (EF) were derived. Results: Twelve patients underwent SCPA and six patients underwent staged completion of Fontan circulation. Before surgery, EDV was similar in both groups. There was a significant fall in EDV immediately after SCPA (from 48.3 ± 14.9 ml/m2 to 39.5 ± 12.3 ml/m2). However, EDV increased at 3 months' follow-up to 41.3 ± 10.5 ml/m2. There was no significant fall in EDV immediately after Fontan operation (47.2 ± 10.1 ml/m2−46.6 ± 14.2 ml/m2), but EDV continued to fall at 3 months of follow-up (44.7 ± 10. ml/m2). There was no significant change in ESV in either group, but EF fell significantly after SCPA. Conclusions: We provide preliminary information on 3DE volume data of single ventricle of LV morphology and the pattern of unloading after SCPA and Fontan operation. Immediate significant volume unloading occurred after SCPA which tended to catch-up after 3 months, whereas continued fall in ventricular volume with time was noted after Fontan.

http://ift.tt/2vWX7FX

Hypoplastic left heart syndrome with coronary-cameral fistulas: Echocardiographic demonstration of coronary artery steal and successful interventional treatment

Arshid Mir, Mary Niu, Merick Yamada, Ed Overholt

Annals of Pediatric Cardiology 2017 10(3):306-309

We report a case of a patient with hypoplastic left heart syndrome with significant coronary-cameral fistulas and exertional symptoms from coronary steal. Symptoms resolved following successful coil occlusion of his left ventricle.

http://ift.tt/2wgIRu3

Speckle tracking evaluation of right ventricular functions in children with sickle cell disease

Osama Abd Rab Elrasol Tolba, Mohamed Ramadan El-Shanshory, Mohamed Abd Elaziz El-Gamasy, Walid Ahmed El-Shehaby

Annals of Pediatric Cardiology 2017 10(3):230-233

Background: Cardiac dysfunction is a risk factor for death in patients with sickle cell disease (SCD). Aim of the Work: Aim of the work is to evaluate the right ventricular systolic and diastolic functions by tissue Doppler and speckling tracking imaging in children with SCD. Subjects and Methods: Thirty children with SCD and thirty controls were subjected to clinical, laboratory evaluations, and echocardiographic study using GE Vivid 7 (GE Medical System, Horten, Norway with a 3.5-MHz multifrequency transducer) including; Two-dimensional and tissue Doppler echocardiographic study (lateral tricuspid valve annulus peak E' velocity, lateral tricuspid valve annulus peak A' velocity, E'/A' ratio, isovolumetric relaxation time, lateral tricuspid valve annulus S' and septal S' waves and peak longitudinal systolic strain [PLSS] and time to PLSS) were done in six right ventricular segments. Results: There was a significant decrease in right ventricular systolic and diastolic function in patients group when compared to controls. Conclusions: Children with SCD have impaired right ventricular systolic and diastolic functions when compared to healthy children with early evaluation of the systolic dysfunction by speckle tracking imaging technique.

http://ift.tt/2whc5sK

Flecainide toxicity in a preterm neonate with permanent junctional reciprocating tachycardia

Balaganesh Karmegaraj, Danish Menon, Mukund A Prabhu, Balu Vaidyanathan

Annals of Pediatric Cardiology 2017 10(3):288-292

We report a case of flecainide toxicity in a premature neonate with permanent junctional reciprocating tachycardia which was managed successfully by reversal of the sodium blockade with intravenous sodium bicarbonate and supportive care. This report highlights the importance of strict supervision and monitoring while administering antiarrhythmic drugs in neonates and prompt institution of appropriate remedial action for treatment when toxicity is suspected.

http://ift.tt/2wgIT59

Intraocular pressure in children after congenital heart surgery: A single-center study

Sunali Goyal, Paul H Phillips, Lamonda A Corder, Michael J Robertson, Xiomara Garcia, Michael L Schmitz, Punkaj Gupta

Annals of Pediatric Cardiology 2017 10(3):234-239

Background: The impact of varied cardiac physiologies on intraocular pressure (IOP) among children undergoing heart operations is unknown. Aim: The aim of this study was to determine the IOP among children with varying cardiovascular physiologies and varying hemodynamics after their heart operation. Setting and Design: This was a prospective, observational study. Materials and Methods: Patients ≤18 years undergoing congenital heart surgery were included in this study. IOP measurement was performed by Icare® tonometer between 3 and 14 days after heart operation. Statistical Analysis: Summary statistics were estimated for all demographic, anthropometric, and clinical data. Results: A total of 116 eyes from 58 children were included. The mean and standard deviation age was 28.4 (45.8) months. Single-ventricle anatomy was present in 26 patients (45%). Despite similar heart rate and blood pressure, the mean IOP among the patients with single-ventricle anatomy was significantly elevated as compared to patients with two-ventricle anatomy (18 mm Hg vs. 12 mm Hg, P < 0.001). There was no difference in IOP measurements based on the complexity of operation performed. We noted that patients undergoing surgical palliation with central shunt (21 mm Hg), Fontan operation (19 mm Hg), bidirectional Glenn operation (19 mm Hg), Norwood operation (19 mm Hg), or definitive repairs such as tetralogy of Fallot repair (17 mm Hg), and atrioventricular canal repair (19 mm Hg) were associated with the highest IOPs in the study cohort. Conclusions: This study demonstrates that IOPs vary with varying cardiovascular physiology after pediatric cardiac surgery.

http://ift.tt/2vWnyvn

Anomalous origin of the left brachiocephalic artery in the right aortic arch: Is there a method to the madness?

Mani Ram Krishna, Ganesh Kumar Gnanappa, Rachel Fitzpatrick, Julian Ayer, David Winlaw

Annals of Pediatric Cardiology 2017 10(3):301-303

The anomalous origin of the left brachiocephalic artery in a right sided aortic arch is a rare vascular ring which might lead to esophageal compression. The exact embryological origin of this anomaly is still widely debated. We present an infant who presented with esophageal compression symptoms and review the various hypotheses about the embryological origin of this anomaly.

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Initial experience with the 3.3 Fr Mongoose® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients

Zachary Hena, Nicole J Sutton, Gregory J Gates, Benjamin H Taragin, Robert H Pass

Annals of Pediatric Cardiology 2017 10(3):240-244

Background: Smaller femoral arterial sheaths may be associated with fewer vascular complications. The 3.3 Fr Mongoose® Pediavascular pigtail catheter is a catheter that allows higher flow rates, potentially resulting in improved angiographic quality. We reviewed our experience with this small catheter during patent ductus arteriosus (PDA) closure. Materials and Methods: Review of patients ≤20 kg in whom the Mongoose® catheter was used during PDA closure from 12/13 to 4/15. Angiographic efficacy and procedural details were compared to ten 4 Fr catheter cases. Comparisons were performed using Mann–Whitney U-test; P < 0.05 was statistically significant. Results: Twelve (9 female) patients were catheterized with a 3.3 Fr Mongoose®. Median weight 10.5 kg (range 6.4–18.2), height 81 cm (range 37–111), and body surface area (BSA) 0.47 m2 (range 0.33–0.75) were similar to ten patients (3 females) in the 4 Fr control group (P = NS); median weight 9.9 kg (range 6–16.8), height 80 cm (range 64–102), and BSA 0.46 m2 (range 0.31–0.74). Angiographic quality was subjectively adequate with both with no difference in the median pixel density between the two techniques (3.3 Fr: 76.7 [range 33.5–90] and 4 Fr: [70; 38–102]; P = NS). Contrast used was similar between the groups (3.3 Fr: median 4.2 ml/kg and 4 Fr: 4.9 ml/kg; P = NS). Median radiation dose was similar in the two groups (3.3 Fr: 28.1 mGy [range 17.2–38] and 4 Fr: 38 mGy [range 20.4–58.5]; P = NS). All ducts were closed at latest follow-up ( P = NS). No complications were encountered. Conclusions: The 3.3 Fr Mongoose® allowed similar angiography to the 4 Fr pigtail catheter, allowing safe and effective transcatheter PDA closure in small children.

http://ift.tt/2wgL3Sn

Staphylococcal endocarditis after chicken pox in a child with structurally normal heart

Dheeraj Deo Bhatt, Nihit Kharkwal, Dinesh Kumar Yadav

Annals of Pediatric Cardiology 2017 10(3):312-313



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Does heart-type fatty acid-binding protein predict clinical outcomes after pediatric cardiac surgery?

Egmond S Evers, Varsha Walavalkar, Suresh Pujar, Latha Balasubramanian, Frits W Prinzen, Tammo Delhaas, Ward Y Vanagt, Shreesha Maiya

Annals of Pediatric Cardiology 2017 10(3):245-247

Introduction: The early identification of vulnerable pediatric cardiac surgery patients can help clinicians provide them with timely support. Heart-type fatty acid-binding protein. (H-FABP) is an early biomarker of myocardial injury in acute myocardial infarction in adults. In this study, we evaluated the correlations between postoperative H-FABP, creatine kinase-myocardial band (CK-MB), troponin-I, total bypass time, and clinical outcomes. Methods: In 32 pediatric patients that underwent ventricular septal defect. closure we measured H-FABP, troponin-I and CK-MB preoperatively and 1, 3, and 6 h after aortic declamping. Spearman's Rho correlations were calculated between laboratory and clinical parameters including inotropic support duration, aortic cross-clamp time, total bypass time, ventilation.weaning.time, and total Intensive Care Unit stay. Results: H-FABP, CK-MB, troponin-I, and total bypass time have a similarly weak to moderate correlation with clinical outcome measures. Conclusions: The predictive value of H-FABP for clinical outcome is not stronger than that of CK-MB, Troponin-I, or bypass times.

http://ift.tt/2vWCl9l

Chronic antepartum maternal hyperoxygenation in a case of severe fetal Ebstein's anomaly with circular shunt physiology

Alisa Arunamata, David M Axelrod, Katherine Bianco, Sowmya Balasubramanian, Amy Quirin, Theresa A Tacy

Annals of Pediatric Cardiology 2017 10(3):284-287

Perinatal mortality remains high among fetuses diagnosed with Ebstein's anomaly of the tricuspid valve. The subgroup of patients with pulmonary valve regurgitation is at particularly high risk. In the setting of pulmonary valve regurgitation, early constriction of the ductus arteriosus may be a novel perinatal management strategy to reduce systemic steal resulting from circular shunt physiology. We report the use of chronic antepartum maternal oxygen therapy for constriction of the fetal ductus arteriosus and modulation of fetal pulmonary vascular resistance in a late presentation of Ebstein's anomaly with severe tricuspid valve regurgitation, reversal of flow in the ductus arteriosus, and continuous pulmonary valve regurgitation.

http://ift.tt/2vWRAyY

Brugada syndrome in children - Stepping into unchartered territory

Shashank P Behere, Steven N Weindling

Annals of Pediatric Cardiology 2017 10(3):248-258

Brugada syndrome (BrS) is an autosomal dominant inherited channelopathy. It is associated with a typical pattern of ST-segment elevation in the precordial leads V1–V3 and potentially lethal ventricular arrhythmias in otherwise healthy patients. It is frequently seen in young Asian males, in whom it has previously been described as sudden unexplained nocturnal death syndrome. Although it typically presents in young adults, it is also known to present in children and infants, especially in the presence of fever. Our understanding of the genetic pathogenesis and management of BrS has grown substantially considering that it has only been 24 years since its first description as a unique clinical entity. However, there remains much to be learned, especially in the pediatric population. This review aims to discuss the epidemiology, genetics, and pathogenesis of BrS. We will also discuss established standards and new innovations in the diagnosis, prognostication, risk stratification, and management of BrS. Literature search was run on the National Center for Biotechnology Information's website, using the Medical Subject Headings (MeSH) database with the search term "Brugada Syndrome" (MeSH), and was run on the PubMed database using the age filter (birth–18 years), yielding 334 results. The abstracts of all these articles were studied, and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles were further explored and read in full.

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Congenital left atrial appendage aneurysm: Atypical presentation

Mehdi Bamous, Mahdi Aithoussa, Ayoub Abetti, Abdelatif Boulahya

Annals of Pediatric Cardiology 2017 10(3):293-294

Congenital left atrial appendage aneurysm is a rare condition caused by dysplasia of the atrial muscles. We report a case of a 14-year-old boy, with a 5-month history of cough and in sinus rhythm. Transthoracic echocardiography and computerized tomographic angiography confirmed the aneurysm of the left atrial appendage which was resected through median sternotomy on cardiopulmonary bypass. This case is presented not only for its rarity but also for its atypical clinical presentation.

http://ift.tt/2vWPoaH

Human herpesvirus 6-induced inflammatory cardiomyopathy in immunocompetent children

Surabhi Reddy, Eva Eliassen, Gerhard R Krueger, Bibhuti B Das

Annals of Pediatric Cardiology 2017 10(3):259-268

Over the last decade, human herpesvirus 6 (HHV-6) has been implicated in the etiology of pediatric myocarditis and subsequent dilated cardiomyopathy (DCM). This review provides an overview of recent literature investigating the pathophysiological relevance of HHV-6 in inflammatory cardiomyopathy. We examined 11 cases of previously published pediatric myocarditis and/or DCM associated with HHV-6 and also our experience of detection of virus particles in vascular endothelium of HHV-6 positive endomyocardial biopsy tissue by electron microscopy. The exact role of the presence of HHV-6 and its load remains controversial as the virus is also found in the heart of healthy controls. Therefore, the question remains open whether and how cardiac HHV-6 may be of pathogenetic importance. Quantitative polymerase chain reaction or mRNA testing allows differentiation between low-level latent virus found in asymptomatic myocardium and active HHV-6 infection. Although only a small number of pediatric cases have been reported in literature, HHV-6 should be considered as a causative agent of inflammatory cardiomyopathy, especially in children under three who might be experiencing a primary infection. Future studies are needed to establish a threshold for determining active infection in biopsy samples and the role of coinfections other cardiotropic viruses.

http://ift.tt/2vWFUMT

Consideration of pyloric stenosis as a cause of feeding dysfunction in children with cyanotic heart disease

Nayan T Srivastava, John J Parent, Marcus S Schamberger

Annals of Pediatric Cardiology 2017 10(3):298-300

Feeding difficulty has been reported at a higher incidence in infants with cyanotic heart disease and single ventricle physiology necessitating specialized feeding strategies. However, structural causes of feed intolerance in this subset of patients should not be ignored. This case series highlights three recent cases of pyloric stenosis in infants with left-sided obstructive lesions at our institution. In all three cases, the initial presumed diagnosis was feeding intolerance related to heart disease, and there was significant clinical improvement following identification and correction of pyloric stenosis.

http://ift.tt/2vWPXl1

Clarifying the anatomy and physiology of totally anomalous systemic venous connection

Saurabh Kumar Gupta, Rajnish Juneja, Robert H Anderson, Gurpreet S Gulati, Velayoudam Devagorou

Annals of Pediatric Cardiology 2017 10(3):269-277

The description of totally anomalous systemic venous connection is limited to case reports. In this review, we seek to clarify anatomic, physiologic, and hemodynamic aspects of this extremely rare anomaly. We also present findings of two patients in whom connection of all the systemic veins was anomalous. In the first patient, with usual atrial arrangement, all systemic veins, including the coronary sinus, were connected anomalously to the morphologically left atrium. Limited left-to-right shunt across an atrial septal defect provided the only source of blood flow to the lungs. The diagnosis was established by saline contrast echocardiography and cardiac catheterization. Extreme hypoplasia of the right ventricle precluded corrective surgery, so we performed a bidirectional Glenn operation, along with atrial septectomy. The second patient had isomerism of the left atrial appendages, which creates problems in the definition in anatomic terms since the connection of the systemic veins can never be normal anatomically when both atriums possess a morphologically left appendage. Our patient, nonetheless, had all the systemic and pulmonary veins, connected to the left-sided atrial chamber which then connected to the left ventricle, thus producing hemodynamics of totally anomalous systemic venous connection. We propose an algorithm for evaluation of this hemodynamic combination and discuss management options. We also intend to clarify the potential differences between connection and drainage, with particular attention to the arrangement of atrial appendages. Even though the hemodynamics may be comparable, in anatomic terms, both systemic and pulmonary venoatrial connection will always be anomalous with isomeric atrial appendages.

http://ift.tt/2wg303w

Central perforation of atretic pulmonary valve using coronary microcatheter

Saurabh Kumar Gupta, Rajnish Juneja, Anita Saxena

Annals of Pediatric Cardiology 2017 10(3):304-305

Percutaneous perforation of pulmonary valve, using 0.014" guidewires meant for coronary artery chronic total occlusion (CTO), is increasingly being performed for select cases of pulmonary atresia with intact ventricular septum (PA-IVS). Despite growing experience, procedural failures and complications are not uncommon. Even in infants treated successfully, the orifice created in the atretic pulmonary valve is eccentric. In this report, we present usefulness of coronary microcatheter in alignment of perforating coronary guidewire to the center of atretic pulmonary valve resulting in central perforation.

http://ift.tt/2vWCjyf

Anomalous origin of right pulmonary artery from innominate artery: Repair using pulmonary artery pedicled flap plasty

Roy Varghese, Jai Ganesh, Jeeva Nandam, Sujathaa Ravikumar, Sivakumar Kothandam

Annals of Pediatric Cardiology 2017 10(3):278-280

Origin of the right pulmonary artery from innominate artery is an exceedingly rare anomaly. We report two cases with this anomaly that underwent surgical repair. The surgical technique described achieves tissue-to-tissue anastomosis using a pedicled flap from the main pulmonary artery.

http://ift.tt/2vWPUFR

Ductal aneurysm with postsubclavian coarctation of aorta in an adult

Dibya Ranjan Behera, Krishna Kumar Mohanan Nair, Bijulal Sasidharan

Annals of Pediatric Cardiology 2017 10(3):310-311

We describe a case of ductal aneurysm in an adult patient with post subclavian coarctation of aorta, which is a very rare association.

http://ift.tt/2vWNtD0

Review on investigations of antisense oligonucleotides with the use of mass spectrometry

Publication date: 1 January 2018
Source:Talanta, Volume 176
Author(s): Sylwia Studzińska
Antisense oligonucleotides have been investigated as potential drugs for years. They inhibit target gene or protein expression. The present review summarizes their modifications, modes of action, and applications of liquid chromatography coupled with mass spectrometry for qualitative and quantitative analysis of these compounds. The most recent reports on a given topic were given prominence, while some early studies were reviewed in order to provide a theoretical background. The present review covers the issues of using ion-exchange chromatography, ion-pair reversed-phase high performance liquid chromatography and hydrophilic interaction chromatography for the separation of antisense oligonucleotides. The application of mass spectrometry was described with regard to the ionization type used for the determination of these potential therapeutics. Moreover, the current approaches and applications of mass spectrometry for quantitative analysis of antisense oligonucleotides and their metabolites as well as their impurities during in vitro and in vivo studies were discussed. Finally, certain conclusions and perspectives on the determination of therapeutic oligonucleotides in various samples were briefly described.

Graphical abstract

http://ift.tt/2vhCAKa

Noninvasive penetration of 5 nm hyaluronic acid molecules across the epidermal barrier (in vitro) and its interaction with human skin cells

Abstract

Objective

Hyaluronic acid represents one of the major components of the extracellular environment. The main challenge remains in the ability to deliver these molecules noninvasively across the skin barrier, which can be overcome by the reduction in size to an extent that allows these molecules to pass across the skin barrier.

The aim of this study was to measure the penetration and bioavailability of low molecular weight hyaluronic acid to cross an epidermal barrier model.

Methods

Determining the quantity of hyaluronic acid in the test solutions was carried with method of photocolorimetry analysis. Investigation of the interaction of cells with LMWHA was studied with a confocal microscope.

Results

The study showed that LMWHA is able to cross the epidermis. Most effective penetration level is during the first 6 hours reaching 75%, and then the concentration started to decline and reached the equilibrium state within the following 2 hours. Confocal laser microscopy demonstrated different distribution and behavior of these molecules among the keratinocytes and fibroblasts.

Conclusion

Reducing the size of hyaluronic acid to 5 nm enhance their transport across the epidermal layer. The concentration of hyaluronic acid molecules was higher on the fibroblast surface in comparison to their extracellular environment.

http://ift.tt/2vRJWr6

Neurophysiologically-informed markers of individual variability and pharmacological manipulation of human cortical gamma

Publication date: 1 November 2017
Source:NeuroImage, Volume 161
Author(s): A.D. Shaw, R.J. Moran, S.D. Muthukumaraswamy, J. Brealy, D.E. Linden, K.J. Friston, K.D. Singh
The ability to quantify synaptic function at the level of cortical microcircuits from non-invasive data would be enormously useful in the study of neuronal processing in humans and the pathophysiology that attends many neuropsychiatric disorders. Here, we provide proof of principle that one can estimate inter-and intra-laminar interactions among specific neuronal populations using induced gamma responses in the visual cortex of human subjects – using dynamic causal modelling based upon the canonical microcircuit (CMC; a simplistic model of a cortical column). Using variability in induced (spectral) responses over a large cohort of normal subjects, we find that the predominant determinants of gamma responses rest on recurrent and intrinsic connections between superficial pyramidal cells and inhibitory interneurons. Furthermore, variations in beta responses were mediated by inter-subject differences in the intrinsic connections between deep pyramidal cells and inhibitory interneurons. Interestingly, we also show that increasing the self-inhibition of superficial pyramidal cells suppresses the amplitude of gamma activity, while increasing its peak frequency. This systematic and nonlinear relationship was only disclosed by modelling the causes of induced responses. Crucially, we were able to validate this form of neurophysiological phenotyping by showing a selective effect of the GABA re-uptake inhibitor tiagabine on the rate constants of inhibitory interneurons. Remarkably, we were able to recover the pharmacodynamics of this effect over the course of several hours on a per subject basis. These findings speak to the possibility of measuring population specific synaptic function – and its response to pharmacological intervention – to provide subject-specific biomarkers of mesoscopic neuronal processes using non-invasive data. Finally, our results demonstrate that, using the CMC as a proxy, the synaptic mechanisms that underlie the gain control of neuronal message passing within and between different levels of cortical hierarchies may now be amenable to quantitative study using non-invasive (MEG) procedures.



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Audio-visual synchrony and spatial attention enhance processing of dynamic visual stimulation independently and in parallel: A frequency-tagging study

Publication date: 1 November 2017
Source:NeuroImage, Volume 161
Author(s): Amra Covic, Christian Keitel, Emanuele Porcu, Erich Schröger, Matthias M. Müller
The neural processing of a visual stimulus can be facilitated by attending to its position or by a co-occurring auditory tone. Using frequency-tagging, we investigated whether facilitation by spatial attention and audio-visual synchrony rely on similar neural processes. Participants attended to one of two flickering Gabor patches (14.17 and 17 Hz) located in opposite lower visual fields. Gabor patches further "pulsed" (i.e. showed smooth spatial frequency variations) at distinct rates (3.14 and 3.63 Hz). Frequency-modulating an auditory stimulus at the pulse-rate of one of the visual stimuli established audio-visual synchrony. Flicker and pulsed stimulation elicited stimulus-locked rhythmic electrophysiological brain responses that allowed tracking the neural processing of simultaneously presented Gabor patches. These steady-state responses (SSRs) were quantified in the spectral domain to examine visual stimulus processing under conditions of synchronous vs. asynchronous tone presentation and when respective stimulus positions were attended vs. unattended. Strikingly, unique patterns of effects on pulse- and flicker driven SSRs indicated that spatial attention and audiovisual synchrony facilitated early visual processing in parallel and via different cortical processes. We found attention effects to resemble the classical top-down gain effect facilitating both, flicker and pulse-driven SSRs. Audio-visual synchrony, in turn, only amplified synchrony-producing stimulus aspects (i.e. pulse-driven SSRs) possibly highlighting the role of temporally co-occurring sights and sounds in bottom-up multisensory integration.



http://ift.tt/2wwwh9V

Parsing the neural signatures of reduced error detection in older age

Publication date: 1 November 2017
Source:NeuroImage, Volume 161
Author(s): Siobhán Harty, Peter R. Murphy, Ian H. Robertson, Redmond G. O'Connell
Recent work has demonstrated that explicit error detection relies on a neural evidence accumulation process that can be traced in the human electroencephalogram (EEG). Here, we sought to establish the impact of natural aging on this process by recording EEG from young (18–35 years) and older adults (65–88 years) during the performance of a Go/No-Go paradigm in which participants were required to overtly signal their errors. Despite performing the task with equivalent accuracy, older adults reported substantially fewer errors, and the timing of their reports were both slower and more variable. These behavioral differences were linked to three key neurophysiological changes reflecting distinct parameters of the error detection decision process: a reduction in medial frontal delta/theta (2–7 Hz) activity, indicating diminished top-down input to the decision process; a slower rate of evidence accumulation as indexed by the rate of rise of a centro-parietal signal, known as the error positivity; and a higher motor execution threshold as indexed by lateralized beta-band (16–30 Hz) activity. Our data provide novel insight into how the natural aging process affects the neural underpinnings of error detection.



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An adaptive, individualized fMRI delay discounting procedure to increase flexibility and optimize scanner time

Publication date: 1 November 2017
Source:NeuroImage, Volume 161
Author(s): Mikhail N. Koffarnus, Harshawardhan U. Deshpande, Jonathan M. Lisinski, Anders Eklund, Warren K. Bickel, Stephen M. LaConte
Research on the rate at which people discount the value of future rewards has become increasingly prevalent as discount rate has been shown to be associated with many unhealthy patterns of behavior such as drug abuse, gambling, and overeating. fMRI research points to a fronto-parietal-limbic pathway that is active during decisions between smaller amounts of money now and larger amounts available after a delay. Researchers in this area have used different variants of delay discounting tasks and reported various contrasts between choice trials of different types from these tasks. For instance, researchers have compared 1) choices of delayed monetary amounts to choices of the immediate monetary amounts, 2) 'hard' choices made near one's point of indifference to 'easy' choices that require little thought, and 3) trials where an immediate choice is available versus trials where one is unavailable, regardless of actual eventual choice. These differences in procedure and analysis make comparison of results across studies difficult. In the present experiment, we designed a delay discounting task with the intended capability of being able to construct contrasts of all three comparisons listed above while optimizing scanning time to reduce costs and avoid participant fatigue. This was accomplished with an algorithm that customized the choice trials presented to each participant with the goal of equalizing choice trials of each type. We compared this task, which we refer to here as the individualized discounting task (IDT), to two other delay discounting tasks previously reported in the literature (McClure et al., 2004; Amlung et al., 2014) in 18 participants. Results show that the IDT can examine each of the three contrasts mentioned above, while yielding a similar degree of activation as the reference tasks. This suggests that this new task could be used in delay discounting fMRI studies to allow researchers to more easily compare their results to a majority of previous research while minimizing scanning duration.



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Cortical representation of persistent visual stimuli

Publication date: 1 November 2017
Source:NeuroImage, Volume 161
Author(s): Edden M. Gerber, Tal Golan, Robert T. Knight, Leon Y. Deouell
Research into visual neural activity has focused almost exclusively on onset- or change-driven responses and little is known about how information is encoded in the brain during sustained periods of visual perception. We used intracranial recordings in humans to determine the degree to which the presence of a visual stimulus is persistently encoded by neural activity. The correspondence between stimulus duration and neural response duration was strongest in early visual cortex and gradually diminished along the visual hierarchy, such that is was weakest in inferior-temporal category-selective regions. A similar posterior-anterior gradient was found within inferior temporal face-selective regions, with posterior but not anterior sites showing persistent face-selective activity. The results suggest that regions that appear uniform in terms of their category selectivity are dissociated by how they temporally represent a stimulus in support of ongoing visual perception, and delineate a large-scale organizing principle of the ventral visual stream.



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Real-time motion analytics during brain MRI improve data quality and reduce costs

Publication date: 1 November 2017
Source:NeuroImage, Volume 161
Author(s): Nico U.F. Dosenbach, Jonathan M. Koller, Eric A. Earl, Oscar Miranda-Dominguez, Rachel L. Klein, Andrew N. Van, Abraham Z. Snyder, Bonnie J. Nagel, Joel T. Nigg, Annie L. Nguyen, Victoria Wesevich, Deanna J. Greene, Damien A. Fair
Head motion systematically distorts clinical and research MRI data. Motion artifacts have biased findings from many structural and functional brain MRI studies. An effective way to remove motion artifacts is to exclude MRI data frames affected by head motion. However, such post-hoc frame censoring can lead to data loss rates of 50% or more in our pediatric patient cohorts. Hence, many scanner operators collect additional 'buffer data', an expensive practice that, by itself, does not guarantee sufficient high-quality MRI data for a given participant. Therefore, we developed an easy-to-setup, easy-to-use Framewise Integrated Real-time MRI Monitoring (FIRMM) software suite that provides scanner operators with head motion analytics in real-time, allowing them to scan each subject until the desired amount of low-movement data has been collected. Our analyses show that using FIRMM to identify the ideal scan time for each person can reduce total brain MRI scan times and associated costs by 50% or more.

Graphical abstract

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Identification of preliminary core outcome domains for communication about childhood vaccination: An online Delphi survey

Publication date: Available online 20 August 2017
Source:Vaccine
Author(s): Jessica Kaufman, Rebecca Ryan, Simon Lewin, Xavier Bosch-Capblanch, Claire Glenton, Julie Cliff, Angela Oyo-Ita, Artur Manuel Muloliwa, Afiong Oku, Heather Ames, Gabriel Rada, Yuri Cartier, Sophie Hill
BackgroundCommunication interventions for childhood vaccination are promising strategies to address vaccine hesitancy, but current research is limited by the outcomes measured. Most studies measure only vaccination-related outcomes, with minimal consideration of vaccine hesitancy-relevant intermediate outcomes. This impedes understanding of which interventions or elements are effective.It is also unknown which outcomes are important to the range of stakeholders affected by vaccine hesitancy. Outcome selection shapes the evidence base, informing future interventions and trials, and should reflect stakeholder priorities.Therefore, our aim was to identify which outcome domains (i.e. broad outcome categories) are most important to different stakeholders, identifying preliminary core outcome domains to inform evaluation of three common vaccination communication types: (i) communication to inform or educate, (ii) remind or recall, and (iii) enhance community ownership.MethodsWe conducted a two-stage online Delphi survey, involving four stakeholder groups: parents or community members, healthcare providers, researchers, and government or non-governmental organisation representatives. Participants rated the importance of eight outcome domains for each of the three communication types. They also rated specific outcomes within one domain ("attitudes or beliefs") and provided feedback about the survey.ResultsCollectively, stakeholder groups prioritised outcome domains differently when considering the effects of different communication types. For communication that aims to (i) inform or educate, the most important outcome domain is "knowledge or understanding"; for (ii) reminder communication, "vaccination status and behaviours"; and for (iii) community engagement communication, "community participation". All stakeholder groups rated most outcome domains as very important or critical. The highest rated specific outcome within the "attitudes or beliefs" domain was "trust".ConclusionThis Delphi survey expands the field of core outcomes research and identifies preliminary core outcome domains for measuring the effects of communication about childhood vaccination. The findings support the argument that vaccination communication is not a single homogenous intervention – it has a range of purposes, and vaccination communication evaluators should select outcomes accordingly.



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Dual use issues in research – A subject of increasing concern?

Publication date: Available online 20 August 2017
Source:Vaccine
Author(s): Trevor W. Drew, Uwe Ulex Mueller-Doblies
Dual use is defined as the application of materials, knowledge or technologies for military or terrorist purposes, as well as for good. In biological science, it is considered to be a growing threat as the genetics of pathogenicity traits and toxins are becoming on one hand elucidated in a detail that was not anticipated 20years ago and on the other hand technological advances in genetic engineering and synthetic biology are continually enabling easier access to these technologies. On a theoretical and policy level, much has happened over the past decade, but translating these policies and concepts to operational level awareness and robust processes requires more attention. Where the research is conducted, scientists have to make ethical judgements and account for their data sharing and publication policies. How can we ensure the requirement for dual use review is taken on board, but is not skewing research detrimentally and imposing a disproportionate burden?



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Scholar : Journal of Natural History, Volume 51, Issue 29-30, August 2017 is now available online on Taylor & Francis Online

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The online platform for Taylor & Francis Online content Journal of Natural History, Volume 51, Issue 29-30, August 2017 is now available online on Taylor & Francis Online. This new issue contains the following articles: Original Articles Macroinvertebrate richness is lower in high-elevation lakes vs nearby streams: evidence from Grand Teton National Park, Wyoming Scott Hotaling, Lusha M. Tronstad & James Cody Bish Pages: 1657-1669 | DOI: 10.1080/00222933.2017.1353149 Eight new species of the genus Promalactis (Lepidoptera: Oecophoridae) from Indonesia, with a checklist of the genus Sora Kim , John B. Heppner & Kyu-Tek Park Pages: 1671-1695 | DOI: 10.1080/00222933.2017.1353154 First record of genus Promalactis Meyrick (Lepidoptera: oecophoridae) from Cambodia with five new species Sora Kim , Ram Keshari Duwal , John B. Heppner, Wonhoon Lee, Yang-Seop Bae & Seunghwan Lee Pages: 1697-1712 | DOI: 10.1080/00222933.2017.1355501 Four new species of the genus Trichomyia − subgenus Septemtrichomyia Bravo (Diptera: Psychodidae: Trichomyiinae) from Brazil Maíra Xavier Araújo, Claudiney Biral Dos Santos, Freddy Bravo & Claudio J.B. de Carvalho Pages: 1713-1725 | DOI: 10.1080/00222933.2017.1353148 Life cycles and host–parasitoid relationships of five species of Leucospis wasps in Argentina (Hymenoptera: Leucospidae) Juan Pablo Torretta, Gonzalo A. R. Molina & Daniel A. Aquino Pages: 1727-1742 | DOI: 10.1080/00222933.2017.1353151 The taxonomic identity of Anthidium fasciatellum Friese, 1917 (Hymenoptera: Apoidea: Anthidiini) Max Kasparek Pages: 1743-1757 | DOI: 10.1080/00222933.2017.1353152 A new genus and species of the termitophilous Neotropical Hybosorinae (Coleoptera: Scarabaeoidea: Hybosoridae) associated with Cornitermes (Isoptera: Termitidae) in the Cerrado ecoregion in Brazil Andrey V. Frolov , Federico C. Ocampo , Lilia A. Akhmetova & Fernando Vaz-de-Mello Pages: 1759-1765 | DOI: 10.1080/00222933.2017.1353150 Revision of the Neotropical scarab beetle genus Aegidiellus Paulian (Coleoptera: Scarabaeidae: Orphninae) with description of two new species Andrey V. Frolov , Lilia A. Akhmetova & Fernando Z. Vaz-de-Mello Pages: 1767-1779 | DOI: 10.1080/00222933.2017.1353153 Cladocera and Copepoda of Shokalsky Island: new data from northwest Siberia Anna A. Novichkova & Elena S. Chertoprud Pages: 1781-1793 | DOI: 10.1080/00222933.2017.1355077 To update which email alerts you receive, manage your alerts within the My Account area. You can also unsubscribe from this alert with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Globalisation and its effect on pollution in Malaysia: the role of Trans-Pacific Partnership (TPP) agreement

Abstract

The main objective of this study is to investigate the influence of the globalisation (Trans-Pacific Partnership (TPP) agreement in particular) on air pollution in Malaysia. To achieve this goal, the Autoregressive Distributed Lag (ARDL) model, Johansen cointegration test and fully modified ordinary least square (FMOLS) methods are utilised. CO₂ emission is used as an indicator of pollution while GDP per capita and urbanisation serve as its other determinants. In addition, this study uses Malaysia's total trade with 10 TPP members as an indicator of globalisation and analyse its effect on CO₂ emission in Malaysia. The outcome of this research shows that the variables are cointegrated. Additionally, GDP per capita, urbanisation and trade between Malaysia and its 10 TPP partners have a positive impact on CO₂ emissions in general. Based on the outcome of this research, important policy implications are provided for the investigated country.

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Scholar : These new articles for Journal of Natural History are available online

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The online platform for Taylor & Francis Online content New for Journal of Natural History and online now on Taylor & Francis Online: Article Aggressive, omnivorous, invasive: the Erythraean moon crab Matuta victor (Fabricius, 1781) (Crustacea: Decapoda: Matutidae) in the eastern Mediterranean sea Gianna Innocenti , Gianluca Stasolla , Moti Mendelson & Bella S. Galil Pages: 1-10 | DOI: 10.1080/00222933.2017.1363305 To update which email alerts you receive, manage your alerts within the My Account area. You can also unsubscribe from this alert with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Scholar : These new articles for Journal of Tourism and Cultural Change are available online

The online platform for Taylor & Francis Online content New for Journal of Tourism and Cultural Change and online now on Taylor & Francis Online: Book Reviews Alternative tourism in Budapest: class, culture and identity in a postsocialist city Emanuela Guano Pages: 1-2 | DOI: 10.1080/14766825.2017.1364001 To update which email alerts you receive, manage your alerts within the My Account area. You can also unsubscribe from this alert with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Scholar : These new articles for Asian Journal of Political Science are available online

The online platform for Taylor & Francis Online content New for Asian Journal of Political Science and online now on Taylor & Francis Online: Original Articles Local climate governance and policy innovation in China: a case study of a piloting emission trading scheme in Guangdong province Bo Chen, Wei Shen, Peter Newell & Yao Wang Pages: 1-21 | DOI: 10.1080/02185377.2017.1352524 Find out more about the issues and challenges in Governing Asia. This collection includes free access papers on security challenges, the Abe and Modi administration, reflections on the Chinese Governance and more. Browse today! To update which email alerts you receive, manage your alerts within the My Account area. You can also unsubscribe from this alert with one click. If you need any further help, please contact us at support@tandfonline.com Please do not reply to this email. To ensure that you receive your alerts and information from Taylor & Francis Online, please add "alerts@tandfonline.com" and "info@tandfonline.com" to your safe senders list. Taylor & Francis, an Informa business. Taylor & Francis is a trading name of Informa UK Limited, registered in England under no. 1072954. Registered office: 5 Howick Place, London, SW1P 1WG.

Gene therapy: Human genome editing in heart disease

Nature Reviews Genetics. doi:10.1038/nrg.2017.69

Author: Gregory B. Lim

http://ift.tt/2fXosUc

Human genetic variation and the gut microbiome in disease

Nature Reviews Genetics. doi:10.1038/nrg.2017.63

Authors: Andrew Brantley Hall, Andrew C. Tolonen & Ramnik J. Xavier

http://ift.tt/2ijzLHi