Scholar : Ειδοποίηση Μελετητή - [ ΑΠΟΚΑ

Ειδοποίηση Μελετητή:[ ΑΠΟΚΑΤΑΣΤΑΣΗ ]

Προστασία του υποθυρεοειδικού μυοκαρδίου απέναντι στην ισχαιμία

Κ Σφακιανούδης - 2017

... Η αποκατάσταση της λειτουργικότητας της αριστερής κοιλίας καθώς και το επίπεδο έκφρασης
των πρωτεινικών κινασών PKCE και PKCΔ αλλά και τα επίπεδα φωσφορυλίωσης της p46 and
p54 c-jun NH(2)-terminal kinases (JNKs) απέναντι στη ισχαιμία-επαναιμάτωση αποτέλεσαν ...

[PDF] Μελέτη δικτύων μέσης τάσης

Χ Λάζος - 2017

Page 1. ΠΑΝΕΠΙΣΤΗΜΙΟ ΠΑΤΡΩΝ ΤΜΗΜΑ ΗΛΕΚΤΡΟΛΟΓΩΝ ΜΗΧΑΝΙΚΩΝ ΚΑΙ
ΤΕΧΝΟΛΟΓΙΑΣ ΥΠΟΛΟΓΙΣΤΩΝ ΤΟΜΕΑΣ: ΣΥΣΤΗΜΑΤΩΝ ΗΛΕΚΤΡΙΚΗΣ ΕΝΕΡΓΕΙΑΣ
ΕΡΓΑΣΤΗΡΙΟ ΥΨΗΛΩΝ ΤΑΣΕΩΝ Διπλωματική Εργασία ...

[PDF] Ευρετική βελτιστοποίηση λειτουργίας υβριδικών ενεργειακών συστημάτων

Ν Μητρόπουλος - 2017

Page 1. Διατμηματικό Πρόγραμμα Μεταπτυχιακών Σπουδών «Κατανεμημένη πράσινη ηλεκτρική
ενέργεια και οι προηγμένες δικτυακές υποδομές για τη διαχείριση και την οικονομία της»
Μεταπτυχιακή Διπλωματική Εργασία του Μητρόπουλου Νικόλαου ...

[PDF] Μελέτη Του Φαινομένου Των Παράλληλων Ροών (loop Flows) Στην Κεντρική Ευρώπη

Φ Ευφροσύνη - 2017

Page 1. ΕΘΝΙΚΟ ΜΕΤΣΟΒΙΟ ΠΟΛΥΤΕΧΝΕΙΟ ΣΧΟΛΗ ΗΛΕΚΤΡΟΛΟΓΩΝ ΜΗΧΑΝΙΚΩΝ ΚΑΙ
ΜΗΧΑΝΙΚΩΝ ΥΠΟΛΟΓΙΣΤΩΝ ΤΟΜΕΑΣ ΗΛΕΚΤΡΙΚΗΣ ΙΣΧΥΟΣ Μελέτη του φαινομένου των
παράλληλων ροών (loop flows) στην Κεντρική Ευρώπη ΔΙΠΛΩΜΑΤΙΚΉ ΕΡΓΑΣΊΑ ...

[PDF] Η κοινωνική ασφάλιση ως ανθρώπινο δικαίωμα: νομικές και πολιτικές παράμετροι στη Νοτιοανατολική Ευρώπη: συγκριτική επισκόπηση Ελλάδας και Βουλγαρίας

Σ Βεντούλη - 2017

Page 1. ΠΑΝΕΠΙΣΤΗΜΙΟ ΜΑΚΕΔΟΝΙΑΣ ΤΜΗΜΑ ΒΑΛΚΑΝΙΚΩΝ, ΣΛΑΒΙΚΩΝ ΚΑΙ
ΑΝΑΤΟΛΙΚΩΝ ΣΠΟΥΔΩΝ ΣΟΥΛΤΑΝΑ Γ. ΒΕΝΤΟΥΛΗ ΔΙΔΑΚΤΟΡΙΚΗ ΔΙΑΤΡΙΒΗ Η
κοινωνική ασφάλιση ως ανθρώπινο δικαίωμα. Νομικές και πολιτικές ...

[PDF] Η πολιτική οικονομία των μακρών κυμάτων: θεωρητική και εμπειρική διερεύνηση

ΑΧ Παπαγεωργίου - 2017

Page 1. 1 Η Πολιτική Οικονομία των Μακρών Κυμάτων: Θεωρητική και Εμπειρική Διερεύνηση
διδακτορική διατριβή του Αριστοµένη-Χρήστου Παπαγεωργίου Page 2. 2 Επιβλέπων Καθηγητής:
Καθ. Τσουλφίδης Ελευθέριος Μέλη Τριµελούς Επιτροπής: Καθ. Καραγιάννη Στέλλα Καθ. ...

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Scholar : Ειδοποίηση Μελετητή - [ ΩΤΙΚΟ

Ειδοποίηση Μελετητή:[ ΩΤΙΚΟ ΠΤΕΡΥΓΙΟ ]

[PDF] Καταγραφή συμβάντων από κεραυνούς σε παγκόσμια κλίμακα για το έτος 2016

Σ Τζούδα - 2017

Page 1. 1 ΠΑΝΕΠΙΣΤΗΜΙΟ ΠΑΤΡΩΝ ΤΜΗΜΑ ΗΛΕΚΤΡΟΛΟΓΩΝ ΜΗΧΑΝΙΚΩΝ ΚΑΙ
ΤΕΧΝΟΛΟΓΙΑΣ ΥΠΟΛΟΓΙΣΤΩΝ ΤΟΜΕΑΣ: ΣΥΣΤΗΜΑΤΩΝ ΗΛΕΚΤΡΙΚΗΣ ΕΝΕΡΓΕΙΑΣ
ΕΡΓΑΣΤΗΡΙΟ ΥΨΗΛΩΝ ΤΑΣΕΩΝ Διπλωματική Εργασία ...

[PDF] Μουσική εκτέλεση και πιανιστική τεχνική: παρεγκεφαλιδικές καταβολές και μνημονική λειτουργία

Ά Τζούμα - 2017

... Το ανθρώπινο ακουστικό σύστημα χωρίζεται σε τμήματα, τα κυριότερα του οποίου είναι το έξω
ους, το μέσο ους και το έσω ους. Το έξω ους αποτελείται από το πτερύγιο, και τον έξω ακουστικό
πόρο. Ο έξω ακουστικός πόρος, λόγω της προοδευτικής στένωσης του ...

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Scholar : Ειδοποίηση Μελετητή - [ Πλαστ

Ειδοποίηση Μελετητή:[ Πλαστική Χειρουργική ]

[PDF] Κατασκευή delta-μικρο ρομποτικού βραχίονα

Α Ματσούκας - 2017

... Page 20. 2 Εισαγωγη Εξάποδο Ρομπότ (Hexapod - Stewart Platform) Το εξάποδο ρομπότ είναι
ένα παράλληλο ρομπότ που έχει 6 βαθ- μούς ελευθερίας [2]. Χρησιμοποείται ευρέως σε εφαρμογές
όπως προσο- μοιωτές πτήσης, υποθαλάσσια έρευνα, ορθοπεδική χειρουργική[4] κ.ά. ...

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Scholar : Ειδοποίηση Μελετητή - [ ΟΓΚΟΛ

Ειδοποίηση Μελετητή:[ ΟΓΚΟΛΟΓΙΑ ]

[PDF] Μελέτη του βαθμού ενημέρωσης των ογκολόγων-παθολόγων ως προς το αντικείμενο της φαρμακογονιδιωματικής στην Ελλάδα

Π Τσιάκα - 2017

Page 1. 1 ΠΑΝΕΠΙΣΤΗΜΙΟ ΠΑΤΡΩΝ ΤΜΗΜΑ ΦΑΡΜΑΚΕΥΤΙΚΗΣ ΜΕΤΑΠΤΥΧΙΑΚΟ
ΠΡΟΓΡΑΜΜΑ ΣΠΟΥΔΩΝ ΦΑΡΜΑΚΕΥΤΙΚΟ ΜΑΡΚΕΤΙΝΓΚ <<ΜΕΛΕΤΗ ΤΟΥ ΒΑΘΜΟΥ
ΕΝΗΜΕΡΩΣΗΣ ΤΩΝ ΟΓΚΟΛΟΓΩΝ- ΠΑΘΟΛΟΓΩΝ ΩΣ ΠΡΟΣ ΤΟ ΑΝΤΙΚΕΙΜΕΝΟ ...

[PDF] Αξιολόγηση ιστοσελίδων φαρμακευτικών καλλυντικών και συμπληρωμάτων διατροφής

Β Μανταδάκη - 2017

Page 1. ΠΑΝΕΠΙΣΤΗΜΙΟ ΠΑΤΡΩΝ ΤΜΗΜΑ ΦΑΡΜΑΚΕΥΤΙΚΗΣ ΜΕΤΑΠΤΥΧΙΑΚΟ ΔΙΠΛΩΜΑ
ΕΙΔΙΚΕΥΣΗΣ ΣΤΟ ΦΑΡΜΑΚΕΥΤΙΚΟ MARKETING ΔΙΠΛΩΜΑΤΙΚΗ ΕΡΓΑΣΙΑ «Αξιολόγηση
ιστοσελίδων φαρμακευτικών καλλυντικών και συμπληρωμάτων διατροφής» ...

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Scholar : Ειδοποίηση Μελετητή - [ ΓΝΑΘΟ

Ειδοποίηση Μελετητή:[ ΓΝΑΘΟΣ ]

[PDF] Διερεύνηση επιλεγμένων αυτοσχεδιασμών (solo) της λάτιν τζάζ και της λάτιν μουσικής ως προς τη μορφή, την ανάπτυξη, το αρμονικό υπόβαθρο και τη δομή

Ε Αλεξίου - 2017

... Συνοδεύει την Rumba και άλλα λαϊκά στυλ. Page 22. 16 Quijada Η γνάθος από γάιδαρο ή μουλάρι
που παίζεται με το χτύπημα του κάτω μέρους της γνάθου έναντι στο πάνω παράγοντας τον ήχο .
Χρησιμοποιείται για εφέ . Πρόδρομος του σημερινού Vibra-Slap. Tambora ...

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Scholar : Ειδοποίηση Μελετητή - [ Undersea

Ειδοποίηση Μελετητή:[ Undersea "Hyperbaric Medicine" ]

Perception and action in swimming: Effects of aquatic environment on upper limb inter-segmental coordination

B Guignard, A Rouard, D Chollet, O Ayad, M Bonifazi… - Human Movement Science, 2017

... First, we hypothesized that the specific individual–environment relationship in the flume
would shorten both the stroke time and the underwater stroke phase durations and would
likewise reduce the possibility for actions of the upper limbs. ...

[PDF] STATIČNA APNEJA NA VDIH IN IZDIH V VODI IN NA KOPNEM

A KOŠTOMAJ

Page 1. ALEŠ KOŠTOMAJ STATIČNA APNEJA NA VDIH IN IZDIH V VODI IN NA KOPNEM
MAGISTRSKO DELO Ljubljana, 2016 Page 2. II Page 3. III ALEŠ KOŠTOMAJ STATIČNA APNEJA
NA VDIH IN IZDIH V VODI IN NA KOPNEM MAGISTRSKO DELO MENTOR: doc. dr. ...

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Scholar : Ειδοποίηση Μελετητή - [ ΓΛΩΣΣ

Ειδοποίηση Μελετητή:[ ΓΛΩΣΣΙΤΙΣ ]

[PDF] New Advances about the Effect of Vitamins on Human Health: Vitamins Supplements and Nutritional Aspects

N García Uribe, M Reig García-Galbis… - 2017

... Neuropathy (paraesthesia). Epileptiform convulsions in infants. Hypochromic anaemia, seborrheic
dermatitis and glossitis Sensory neuropathy and skin disorders. ... 2Affectation of the mucous
membranes, tongue (glossitis), lips (cheilitis) and hypervascularization of the cornea. ...

[PDF] A STUDY OF LIPID PROFILE IN ANEMIA PATIENTS-CASE-CONTROL STUDY IN INDIAN PATIENTS DONE IN THANJAVUR MEDICAL COLLEGE, TAMIL NADU

S Vetrivel, C Ganesan, VP Kannan

... Each patient was subjected to a detailed general physical examination with special emphasis
on pallor, koilonychias, icterus, pedal oedema, lymphadenopathy, glossitis, angular stomatitis,
petechiae, haemolytic facies, ankle ulcers, perioral pigmentation and knuckle ...

The Italian Pharmacovigilance Program: An Observational Study of Adverse Effects of Natalizumab in Multiple Sclerosis Therapy

S Giacoppo, M Ruscica, LM Grimaldi, P Bramanti… - Medical Science Monitor, 2017

Page 1. Received: 2017.01.11 Accepted: 2017.02.21 Published: 2017.09.02 2734
4 4 30 The Italian Pharmacovigilance Program: An Observational Study of Adverse
Effects of Natalizumab in Multiple Sclerosis Therapy CDEF ...

Antibiotics: A Guide to commonly used antimicrobials

DL Schlossberg, R Samuel - 2017

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Delayed Onset of Atrial Fibrillation and Ventricular Tachycardia after an Automobile Lightning Strike

Publication date: Available online 4 September 2017
Source:The Journal of Emergency Medicine
Author(s): Dorian Drigalla, Shannon E. Essler, C. Keith Stone
BackgroundLightning strike is a rare medical emergency. The primary cause of death in lightning strike victims is immediate cardiac arrest. The mortality rate from lightning exposure can be as high as 30%, with up to 70% of patients left with significant morbidity.Case ReportAn 86-year-old male was struck by lightning while driving his vehicle and crashed. On initial emergency medical services evaluation, he was asymptomatic with normal vital signs. During his transport, he lost consciousness several times and was found to be in atrial fibrillation with intermittent runs of ventricular tachycardia during the unconscious periods. In the emergency department, atrial fibrillation persisted and he experienced additional episodes of ventricular tachycardia. He was treated with i.v. amiodarone and admitted to cardiovascular intensive care unit, where he converted to a normal sinus rhythm on the amiodarone drip. He was discharged home without rhythm-control medications and did not have further episodes of dysrhythmias on follow-up visits.Why Should an Emergency Physician Be Aware of This?Lightning strikes are one of the most common injuries suffered from natural phenomenon, and short-term mortality ordinarily depends on the cardiac effects. This case demonstrates that the cardiac effects can be multiple, delayed, and recurrent, which compels the emergency physician to be vigilant in the initial evaluation and ongoing observation of patients with lightning injuries.



http://ift.tt/2eyOmd6

Successful Retrograde Intubation After Failed Fiberoptic Intubation and Percutaneous Cricothyrotomy

Publication date: Available online 4 September 2017
Source:The Journal of Emergency Medicine
Author(s): Stephanie Brenman, Sachin Gupta, Stephanie Tseeng
BackgroundAn obstructive neck lesion presents an airway challenge for any emergency physician. Retrograde intubation is an infrequently used airway alternative that can be employed in the difficult airway algorithm that requires little training and is less invasive than surgical cricothyrotomy.Case ReportWe report a case of a 31-year-old male patient who presented with respiratory distress progressing to respiratory failure from upper airway obstruction. The patient had significant tracheal thickening at the level of the thyroid gland based on a computed tomography report from 3 weeks prior to his presentation. Awake upright fiberoptic intubation and subsequent percutaneous cricothyrotomy were unsuccessful secondary to obstructive neck mass. We performed a retrograde intubation via tracheal approach and secured the airway via manipulation of a small-diameter endotracheal tube over the guidewire using visualization with video laryngoscopy. This case describes a combination of difficult airway techniques utilizing retrograde intubation with a Glidescope (Verathon Inc., Bothell, WA) as a rescue maneuver for a difficult airway secondary to a tracheal obstruction and supraglottic and subglottic stenosis. Follow-up confirmed the patient's diagnosis as granulomatosis with polyangiitis.Why Should an Emergency Physician Be Aware of This?In cases of supraglottic and subglottic narrowing or mass lesions, retrograde intubation can be a life-saving technique that is an important consideration in the difficult airway algorithm. This technique may be combined with other difficult airway techniques and is especially relevant and potentially life-saving for patients in whom an open cricothyrotomy is undesirable, such as patients with a potentially vascular neck mass, subglottic stenosis, localized neck trauma, or morbid obesity.



http://ift.tt/2iYth10

Re: “Systematic Review and Meta-analysis of the Association between C-reactive Protein and Major Cardiovascular Events in Patients with Peripheral Artery Disease: Do Not Ignore Patients with Critical Limb Ischaemia”

Publication date: Available online 4 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Mislav Vrsalovic




http://ift.tt/2gFN4kI

How Quickly Do Asymptomatic Infrarenal Abdominal Aortic Aneurysms Grow and What Factors Affect Aneurysm Growth Rates? Analysis of a Single Centre Surveillance Cohort Database

Publication date: Available online 4 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Mehtab Ahmad, Rakesh Mistry, James Hodson, Andrew W. Bradbury
Objective/BackgroundAbdominal aortic aneurysm (AAA) maximum antero-posterior diameter (MAPD) is the parameter most commonly used to inform the timing of surgical intervention. However, other factors, such as growth rates and patient comorbidities are likely to be important considerations as they may influence AAA related complications including rupture, operative outcomes, and the clinical and cost effectiveness of continued surveillance.MethodsThis was a retrospective analysis of a 20 year period of a single centre AAA surveillance database. In total, 5363 AAA measurements in 692 patients were analysed for patient demographics, including comorbidity and drug history, growth and rupture rates, and cause of death.ResultsA significant proportion of patients (n = 73; 11%) were kept under surveillance despite having a MAPD < 30 mm. Overall, mean aneurysm growth rate was 2.3 mm/year. Elective repair was undertaken in 20.1% and those who required surgical intervention had significantly faster growth rates. Only 3.9% of patients in surveillance ruptured, 40.7% of whom had a MAPD <55 mm at their last scan. Of the 214 deaths recorded, only 11.7% were related to AAA. The majority of patients who died in surveillance did so from malignancy. Patients with larger AAA (MAPD > 40 mm) on entry into surveillance were significantly more likely to receive surgical intervention, as were those whose AAA expanded >4 mm/year. Females had significantly higher growth rates, and those with diabetes had significantly smaller growth rates. Other comorbidities and drug history were not associated with AAA growth, or 5 and 10 year surgery free survival.ConclusionThe results highlight several areas for service improvement. Specifically, it is important not to maintain surveillance in patients who are very unlikely to ever grow to a point where AAA surgery would be contemplated on grounds or age and/or comorbidity. Similarly, patients should be discharged from surveillance when this likelihood becomes apparent.



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Estimation of the future remnant liver function is a better tool to predict post-hepatectomy liver failure than platelet-based liver scores

Publication date: Available online 4 September 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): T. Chapelle, B. Op de Beeck, A. Driessen, G. Roeyen, B. Bracke, V. Hartman, I. Huyghe, S. Morrison, D. Ysebaert, S. Francque
IntroductionRecently, there has been increasing interest in the preoperative prediction and prevention of post-hepatectomy liver failure (PHLF). This is a particular concern in colorectal liver metastases (CRLM), when surgery follows potentially hepatotoxic chemotherapy. Platelet-based liver scores (PBLS) such as APRI and FIB-4 are predictive of chemotherapy-associated liver injury (CALI) and PHLF. Estimation of the future liver remnant function (eFLRF) by combining ^99mTc-Mebrofenin Hepatobiliary Scintigraphy (HBS^BSA) with future liver remnant volume ratio (FLRV%), is predictive of PHLF and related mortality. We hypothesized that a HBS^BSA based formula was a better predictor for PHLF than PBLS in chemotherapy-pretreated CRLM.MethodsBetween 2012 and 2016, 140 patients underwent liver resection for CRLM following systemic therapy. HBS^BSA, FLRV%, eFLRF and PBLS were calculated and compared for their value in predicting PHLF.ResultseFLRF and FLRV% had a better predictive value for PHLF than HBS^BSA alone and APRI and FIB-4 (AUC = 0.800, 0.843 versus 0.652, 0.635 and 0.658 respectively). In a subgroup analysis (Oxaliplatin all, Oxaliplatin ≥ 6 cycles, Irinotecan all and Irinotecan ≥ 6 cycles), eFLRF was the only factor predictive for PHLF in all subgroups (all: p ≤ 0.05). Prediction of HBS^BSA for chemotherapy associated steato-hepatitis (CASH) reached significance (p = 0.06). FIB-4 was predictive for sinusoidal obstruction syndrome (SOS) (p = 0.011). Only weak correlation was found between HBS^BSA and PBLS.ConclusioneFLRF is a better predictor of PHLF than PBLS or HBS^BSA alone. PBLS seem to measure other aspects of liver function or damage than HBS^BSA.



http://ift.tt/2x6kfVQ

Margin Width and Local Recurrence after Breast Conserving Surgery for Ductal Carcinoma In Situ

Publication date: Available online 4 September 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Gregory E. Ekatah, Arran Turnbull, Laura Arthur, Jeremy Thomas, Christine Dodds, J.Michael Dixon
IntroductionDuctal Carcinoma in situ (DCIS) represents 5% of symptomatic and 20-30% of screen detected cancers. Breast conserving surgery (BCS) +/- radiotherapy is performed in over 70% of women with DCIS. What constitutes an adequate margin for BCS remains unclear.MethodsA single institution follow up study has been conducted of 466 patients with pure DCIS treated by BCS between 2000 and 2010 of whom 292 received whole breast radiotherapy and 167 did not. Patients were selected for radiotherapy based on perceived risk of in breast tumor recurrence (IBTR). Distance to nearest radial margin was measured; 10 patients had a margin width of <1mm, 94 had widths of 1-2mm and 362 had widths of >2mm. There was no association of margin width and the use of radiotherapy.ResultsAt a median follow up of 7.2 years there were 44 IBTR (27 DCIS and 17 invasive). There was no evidence that margin widths >2mm resulted in a lower rate of IBTR than margin widths of 1-2mm. The actuarial IBTR rates at 5 and 10 years for margins of 1-2mm were 9.0% (95% CI +/- 5.9%) and 9.0% (95% CI +/- 5.9%) respectively and for margins of >2mm were 8.0% (95% CI +/- 3.9%) and 13.0% (95% CI +/- 3.9%) respectively, Odds Ratio for IBTR 1-2mm vs >2mm was 0.839 (95% CI 0.392-1.827) p=0.846. In a multivariate analysis only DCIS size predicted for IBTR (HR 2.73 p<0.0001).Conclusion1mm appears a sufficient margin width for BCS in DCIS irrespective of whether patients receive radiotherapy.



http://ift.tt/2xKdhmp

Emotion suppression and food intake in the context of a couple discussion: A dyadic analysis

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Marilou Côté, Marie-Pierre Gagnon-Girouard, Stéphane Sabourin, Catherine Bégin
Using dyadic analysis, this study examined whether emotion suppression is a valid mediator in the relationship between mood change following a stressful couple discussion and subsequent food intake among cohabiting couples. In a laboratory setting, 80 heterosexual couples were presented with a bogus taste test immediately after discussing aspects that they would like each other to change. Mood change, emotion suppression and appetite perceptions were self-reported using visual analogue scales, and BMI was calculated based on objective measures. The moderated-mediation Actor-Partner Interdependence Model revealed a significant indirect conditional effect, showing that mood worsening was significantly associated with higher emotion suppression and that emotion suppression was significantly associated with more food intake among spouses with a high BMI. For spouses with a low BMI, the reverse effect was found, i.e., mood worsening was significantly associated with less food intake through the indirect effect of emotion suppression. Furthermore, an indirect partner effect was observed regardless of BMI, i.e., mood worsening was related to more food intake, which was mediated by the partner's emotion suppression. These results highlight the key role of emotion suppression in the relationship between mood change and food intake in the context of a stressful couple discussion.



http://ift.tt/2gH9ceK

Measurement invariance of the feeding practices and Structure Questionnaire-28 among a community of socioeconomically disadvantaged mothers and fathers

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Elena Jansen, Holly A. Harris, Kimberley M. Mallan, Lynne Daniels, Karen Thorpe
ObjectiveDetermine whether feeding practices across mothers and fathers are interpreted and measured with equivalent accuracy (measurement invariance) using the Feeding Practices and Structure Questionnaire-28 (FPSQ-28).DesignCross-sectional hard-copy and online survey design; Setting: Socioeconomically disadvantaged community in Queensland, Australia.ParticipantsMothers (n = 279) and fathers (n = 225) of 2- to 5-year old children.Variables measuredParental feeding practices were measured using the 7 multi-item factors from the FPSQ-28.AnalysisConfirmatory factor analysis (CFA) was applied to evaluate the factor structure of the FPSQ-28 among mothers and fathers from a socioeconomically disadvantaged community. Measurement invariance between mothers and fathers was examined using hierarchical multi-group CFAs.ResultsThe 7-factor FPSQ-28 model showed good fit and was invariant across parent gender.Conclusions and implicationsThe FPSQ-28 subscales appear to be interpreted equivalently, and thus to measure the same constructs, irrespective of the gender of the parents. The questionnaire can be used to measure or compare mothers' and fathers' self-reported feeding practices and examine influence on child health outcomes. In the current sample of mothers and fathers recruited from a socioeconomically disadvantaged community, mothers used more 'covert restriction' than fathers.



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Repeatability of the infant food reinforcement paradigm: Implications of individual and developmental differences

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Kai Ling Kong, Rina D. Eiden, Stephanie Anzman-Frasca, Corrin L. Stier, Rocco A. Paluch, Jessica Mendez, Emily Slominski, Gowthami Gengatharan, Leonard H. Epstein
The relative reinforcing value of food versus engagement in other behaviors may be related to the development of obesity, and interventions to reduce FRR may prevent the development of obesity. Our laboratory recently developed a paradigm to measure the reinforcing value of food versus an alternative behavior (i.e., playing with bubbles) in infants using a computerized laboratory task, during which infants press a button to earn reinforcers following a progressive ratio schedule of reinforcement. The primary purpose of this study was to examine the short-term (within 2 weeks) repeatability of this measure, specifically the outcome of infant food reinforcing ratio (FRR), or how hard infants will work for food relative to the alternative. The secondary aim was to examine whether infant age and temperament dimensions related to novelty responsiveness (high intensity pleasure and approach) moderated the repeatability of FRR. Thirty-seven infants aged 9–18 months completed this study. Repeated measures analysis of variance (ANOVA) showed no differences between time 1 and time 2 in responding for food (F = 0.463, p = 0.501), bubbles (F = 1.793, p = 0.189), or overall FRR (F = 0.797, p = 0.378). Regression models showed the association between BUB Pmax at time 1 and time 2 were moderated by infant age (p = 0.04), with greater repeatability in older infants. Linear regression models also demonstrated that the infant temperamental dimension of high intensity pleasure significantly predicted BUB Pmax at time 1 (β = 2.89, p = 0.01), but not at time 2. Overall, our findings support the repeatability of this measure for food portion of the reinforcement task, but demonstrated that the measure of non-food portion of the task required modification, in particular among children younger than 13 months old.



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What does a person's eating identity add to environmental influences on fruit and vegetable intake?

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Xiaonan Ma, Christine E. Blake, Timothy L. Barnes, Bethany A. Bell, Angela D. Liese
ObjectiveTo evaluate whether knowledge of a person's eating identity (EI) can explain any additional variation in fruit and vegetable intake above and beyond that explained by food environment characteristics, perceptions of the food environment, and shopping behaviors.DesignCross-sectional study.SettingA total of 968 adults were recruited for a telephone survey by the Survey Research Laboratory in an eight-county region in South Carolina.SubjectsThe survey queried information on shopping behaviors, perceptions of the food environment, demographic and address information, fruit and vegetable intake, and EI. EI was assessed using the Eating Identity Type Inventory, a 12-item instrument that differentiates four eating identity types: healthy, emotional, meat, and picky. Statistical analyses were restricted to 819 participants with complete data.ResultsHealthy EI and picky EI were significantly and directly related to fruit and vegetable intake, with coefficients of 0.31 (p-value<0.001) for healthy EI and −0.16 (p-value<0.001) for picky EI, whereas emotional EI (β = 0.00, p-value = 0.905) and meat EI (β = −0.04, p-value = 0.258) showed no association. Shopping frequency also directly and significantly influenced fruit and vegetable intake (β = 0.13, p-value = 0.033). With the inclusion of EI, 16.3% of the variation in fruit and vegetable intake was explained.ConclusionsPerceptions and GIS-based measures of environmental factors alone do not explain a substantial amount of variation in fruit and vegetable intake. EI, especially healthy EI and picky EI, is an important, independent predictor of fruit and vegetable intake and contributes significantly to explaining the variation in fruit and vegetable intake.



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Clinicopathologic and gene expression analysis of initial biopsies from patients with eosinophilic esophagitis refractory to therapy

Publication date: Available online 4 September 2017
Source:Human Pathology
Author(s): Ayesha S. Siddique, David C. Corney, Shamlal Mangray, Kara A. Lombardo, Sonja Chen, Alexander S. Marwaha, Murray B. Resnick, Michael Herzlinger, Andres Matoso
Some patients with eosinophilic esophagitis (EoE) do not respond to therapy. The clinicopathologic characteristics, and gene expression profile at time of presentation could help predict response to therapy. Refractory EoE was defined as persistence of symptoms and biopsies with histologic features of EoE after 6months of therapy with proton pump inhibitors and topical corticosteroids. Initial biopsies from refractory EoE patients (n=21), responder to therapy (n=8), patients who relapsed (n=6), and reflux controls (n=24) were studied. RNA was isolated from a subset of cases and gene expression analysis of 285 genes involved in inflammation was performed using NanoString technology. There was no difference in the presentating symptoms among groups. The number of eosinophils/HPF amongst non-responders was higher (66±15) than responders (39±8; P<.0001) and similar to patients who relapsed (62±11). Six genes were expressed by at least 4-fold compared to reflux at a false discovery rate (FDR)<0.05, including overexpression of ALOX15, CCL26 and FCER2, RTNLB, and RNASE2, and underexpression of DSG1. EoE patients refractory to therapy or who relapsed showed a trend towards higher ALOX15 expression compared to patients with good response to therapy (364.4 and 425 fold change, P=.097 and P=.07). RTNLB was significantly overexpressed in patients who were refractory to therapy versus those who responded favorably (10-fold vs. 3-fold; P<.01). In conclusion, the number of eosinophils/HPF in the initial biopsy inversely correlates with therapy response. Overexpression of RTNLB in refractory to therapy patients and overexpression of ALOX15 and CCL26 suggest they are critical in the EoE pathogenesis.



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Net1, a therapeutic potential target for cancer

Publication date: Available online 4 September 2017
Source:Human Pathology
Author(s): Chen Chen, Qiu Ji




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Neutrophil Infiltration is a Favorable Prognostic Factor in Early Stages of Colon Cancer

Publication date: Available online 4 September 2017
Source:Human Pathology
Author(s): Maria L Wikberg, Agnes Ling, Xingru Li, Åke Öberg, Sofia Edin, Richard Palmqvist
The tumor immune response has been proven critical to prognosis in colorectal cancer (CRC), but studies on the prognostic role of neutrophil infiltration have shown contradictory results. The aim of this study was to elucidate the prognostic role of infiltrating neutrophils at different intratumoral subsites and in different molecular subgroups of CRC. The relations between neutrophil infiltration and infiltration of other immune cells (T-cell and macrophage subsets) were also addressed. Expression of the neutrophil marker CD66b was assessed by immunohistochemistry in 448 archival human tumor tissue samples from patients surgically resected for CRC. The infiltration of CD66b-positive cells was semi-quantitatively evaluated along the tumor invasive front, in the tumor center, and within the tumor epithelium (intraepithelial expression). We found that poor infiltration of CD66b-positive cells in the tumor front indicated a worse patient prognosis. The prognostic significance of CD66b infiltration was found to be mainly independent of tumor molecular characteristics and maintained significance in multivariable analysis of stage I-II colon cancers. We further analyzed the prognostic impact of CD66b-positive cells in relation to other immune markers (NOS2, CD163, Tbet, FOXP3, and CD8) and found that neutrophil infiltration, even though strongly correlated to infiltration of other immune cell subsets, had additional prognostic value. In conclusion, we find that low infiltration of neutrophils in the tumor front is an independent prognostic factor for a poorer patient prognosis in early stages of colon cancers. Further studies are needed to elucidate the biological role of neutrophils in colorectal carcinogenesis.



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Histone deacetylases inhibition: a potential diagnostic and therapeutic target for cancers

Publication date: Available online 4 September 2017
Source:Human Pathology
Author(s): Dexi Zhou, Kui Yang, Yuanyuan Wu, Jiajie Luan




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Prognostic value of microRNA-9 and microRNA-155 expression in triple-negative breast cancer

Publication date: Available online 4 September 2017
Source:Human Pathology
Author(s): Min Hye Jang, Hyun Jeong Kim, Jae Moon Gwak, Yul Ri Chung, So Yeon Park
MicroRNAs (miRNAs) are involved in regulation of epithelial-mesenchymal transition (EMT) during breast cancer progression. The purpose of this study was to analyze the clinicopathologic significance of expression of EMT-related miRNAs, miR-9 and miR-155, in triple-negative breast cancers (TNBCs). We analyzed relative expression levels of miR-9 and miR-155 in 190 surgically resected TNBC specimens using quantitative real-time polymerase chain reaction. Then we analyzed the relationship between these miRNA expression levels and EMT marker expression (vimentin, smooth muscle actin (SMA), osteonectin, N-cadherin, E-cadherin, CD146, and ZEB1) assessed by immunohistochemistry. We also evaluated the prognostic significance of these miRNA expression levels. While miR-9 expression level showed a positive correlation with pT category, miR-155 expression level did not correlate with any clinicopathologic features of TNBCs. In relation to EMT phenotype, miR-9 expression was not associated with EMT marker expression except for SMA. However, miR-155 expression level correlated inversely with the expression of several EMT markers including SMA, osteonectin, and CD146. We observed that both miR-9 and miR-155 could be prognostic markers in TNBC in opposite ways; high level of miR-9 expression showed significant association with poor disease-free survival and distant metastasis-free survival (DMFS) in TNBC, while high level of miR-155 expression was associated with better DMFS. Our study suggests that expression levels of both miR-9 and miR-155 can serve as candidates for prognostic biomarkers in TNBCs.



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Diagnostic Value of Histone 3 Mutations in Osteoclast-Rich Bone Tumors

Publication date: Available online 4 September 2017
Source:Human Pathology
Author(s): Erik Nohr, Lik Hang Lee, Justin M Cates, Marco Perizzolo, Doha Itani
Differentiating osteoclast-rich lesions of bone (giant cell tumor of bone [GCTB], chondroblastoma [CBA], and aneurysmal bone cyst [ABC]) can be challenging, especially in small biopsies or fine needle aspirations. Mutations affecting codons 34 and 36 of either H3 Histone Family Member 3A (H3F3A) and/or 3B (H3F3B) are characteristically seen in GCTB and CBAs. We devised a simple assay to identify these mutations and evaluated its applicability for routine clinical diagnosis. 124 tissue specimens from 108 patients (43 GCTBs, 38 CBAs and 27 ABCs) were collected from the archives of the Calgary Laboratory Services/University of Calgary and Vanderbilt University Medical Center. Histology was reviewed by an expert orthopedic pathologist. A single base extension assay (SNaPshot©) is used to interrogate each nucleotide in codons 34 and 36 of H3F3A and codon 36 of H3F3B. Final diagnoses were generated after re-reviewing cases and incorporating molecular findings. 38 of 43 GCTBs (88%) had an H3F3A G34W mutation; 35 of 38 CBAs (92%) had a K36M mutation in either H3F3B (N=31; 82%) or H3F3A (N=4; 11%); none of 27 ABCs had a tested mutation. Molecular findings changed the histomorphologic diagnosis in 5 cases (3 GCTB changed to ABC, and 2 ABC changed to GCTB). These findings support the diagnostic utility of mutational analysis for this differential diagnosis in certain challenging cases when clinicoradiologic and histomorphologic features are not definitive, particularly for distinguishing cellular ABC versus GCTB with secondary ABC.



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Tumoral FOXP3 expression is associated with favorable clinicopathological variables and good prognosis in gastric adenocarcinoma; the tumor suppressor function of tumoral FOXP3 is related with the P21 expression in gastric adenocarcinoma

Publication date: Available online 4 September 2017
Source:Human Pathology
Author(s): Kyu Yeoun Won, Gou Young Kim, Hyung Kyung Kim, Sung Il Choi, Sang Hyun Kim, Go Eun Bae, Jun Uk Lim, Sung-Jig Lim
The function and its contribution of tumoral FOXP3 in gastric cancer development remains poorly understood. Thus, we studied the expression of tumoral FOXP3 and its relationship with the well-known tumor suppressor proteins P21 and P53 in gastric adenocarcinoma. The tissue microarray (TMA) was constructed from 182 cases of gastric adenocarcinoma. The immunohistochemistry was performed on 4μm tissue sections from each TMA block. We found that positive tumoral FOXP3 expression was significantly correlated with a lower T category, a lower N category, a lower recurrence rate, and less lymphatic invasion. Furthermore, the survival analysis revealed that the tumoral FOXP3-positive group had significantly increased overall survival and disease-free survival rates compared to the tumoral FOXP3-negative group. Additionally, P21 expression showed a significant positive correlation with tumoral FOXP3 expression in gastric adenocarcinoma cells. Taken together, these findings demonstrate that tumoral FOXP3 expression is associated with favorable clinicopathological variables and good prognosis in gastric adenocarcinoma through increased expression of the tumor suppression protein P21.



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Vertical distribution of archaeal communities associated with anaerobic degradation of pentabromodiphenyl ether (BDE-99) in river-based groundwater recharge with reclaimed water

Abstract

When groundwater is recharged with reclaimed water, the presence of trace amounts of biorefractory pentabromodiphenyl ether (PBDE, specifically BDE-99) might cause potential groundwater pollution. A laboratory-scale column was designed to investigate the distribution of the community of archaea in this scenario and the associated anaerobic degradation of BDE-99. The concentration of BDE-99 decreased significantly as soil depth increased, and fluorescence in situ hybridization (FISH) analysis suggested that archaea exerted significant effects on the biodegradation of PBDE. Through 454 pyrosequencing of 16s rRNA genes, we found that the distribution and structure of the archaeal community associated with anaerobic degradation of BDE-99 in the river-based aquifer media changed significantly between different soil depths. The primary debrominated metabolites varied with changes in the vertically distributed archaeal community. The archaea in the surface layer were dominated by Methanomethylovorans, and the middle layer was mainly composed of Nitrososphaera. Nitrosopumilus and Nitrososphaera were equally abundant in the bottom layer. In addition, Methanomethylovorans abundance depended on the depth of soil, and the relative abundance of Nitrosopumilus increased with increasing depth, which was associated with the oxidation-reduction potential and the content of intermediate metabolites. We propose that Nitrososphaera and Nitrosopumilus might be the key archaeal taxa mediating the biodegradation of BDE-99.

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Factors influencing As(V) stabilization in the mine soils amended with iron-rich materials

Abstract

Chemical stability of As(V) in amended mine-impacted soils was assessed according to functions of incubation period (0, 1, 2, 4, and 6 months), amendment dose (2.5 and 5%), and application timing (0 and 3rd month). Six soils contaminated with 26–209 mg kg⁻¹ of As(V) were collected from two abandoned mine sites and were treated with two alkaline iron-rich materials (mine discharge sludge (MS) and steel-making slag (SS)). Seventeen to 23% of As(V) in soils was labile. After each designated time, As(V) stability was assessed by the labile fractions determined with sequential extraction procedures (F1–F5). Over 6 months, a reduction (26.9–70.4%) of the two labile fractions (F1 and F2) and a quantitative increase (7.4–29.9%) of As(V) in F3 were observed (r ² = 0.956). Two recalcitrant fractions (F4 and F5) remained unchanged. Temporal change of As(V) stability in a sample was well described by the two-domain model (k _fast, k _slow, and F_fast). The stabilization (%) correlated well with the fast-stabilizing domain (F_fast), clay content (%), and Fe oxide content (mg kg⁻¹), but correlated poorly with kinetic rate constants (k _fast and k _slow). Until the 3rd month, the 2.5%-MS amended sample resulted in lower As(V) stabilization (25–40%) compared to the 5% sample (50–60%). However, the second 2.5% MS addition on the 2.5% sample upon the lapse of the 3rd month led to a substantial reduction (up to 38%) of labile As(V) fraction in the following 4th and 6th months. As a result, an additional 15–25% of As(V) stability was obtained when splitting the amendment dose into 3-month intervals. In conclusion, the As(V) stabilization by Fe-rich amendment is time-dependent and its efficacy can be improved by optimizing the amendment dose and its timing.

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Prediction of membrane fouling using artificial neural networks for wastewater treated by membrane bioreactor technologies: bottlenecks and possibilities

Abstract

Membrane fouling is a major concern for the optimization of membrane bioreactor (MBR) technologies. Numerous studies have been led in the field of membrane fouling control in order to assess with precision the fouling mechanisms which affect membrane resistance to filtration, such as the wastewater characteristics, the mixed liquor constituents, or the operational conditions, for example. Worldwide applications of MBRs in wastewater treatment plants treating all kinds of influents require new methods to predict membrane fouling and thus optimize operating MBRs. That is why new models capable of simulating membrane fouling phenomenon were progressively developed, using mainly a mathematical or numerical approach. Faced with the limits of such models, artificial neural networks (ANNs) were progressively considered to predict membrane fouling in MBRs and showed great potential. This review summarizes fouling control methods used in MBRs and models built in order to predict membrane fouling. A critical study of the application of ANNs in the prediction of membrane fouling in MBRs was carried out with the aim of presenting the bottlenecks associated with this method and the possibilities for further investigation on the subject.

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The microbiology of oral lichen planus: Is microbial infection the cause of oral lichen planus?

Summary

Oral lichen planus (OLP) is a variant of LP, a common chronic mucocutaneous inflammatory disease. While cutaneous lesions of LP are self-limiting, OLP lesions are non-remissive, alternating periods of exacerbation and quiescence, and only symptomatic treatments exist for OLP. The precise etiology and pathogenesis of OLP are hardly understood, which is a major obstacle to the development of new therapeutics for this disease. OLP is considered a T cell-mediated inflammatory disease. Although various antigens have been considered, what actually triggers the inflammatory response of T cells is unknown. Suggested predisposing factors include genetic factors, stress, trauma, and infection. The aim of this review was to determine whether microbial infection can cause OLP. We first reviewed the association between OLP and microbial factors, including viral, fungal, and bacterial infections. In addition, each microbial factor associated with OLP was assessed by modified guidelines of Fredricks and Relman to determine whether it establishes a causal relationship. In conclusion, no microbial factor yet fulfills the guidelines to establish the causality of OLP. By focusing on the unclarified issues, however, the potential roles of microbial factors in the pathogenesis of OLP will be soon elucidated.

This article is protected by copyright. All rights reserved.

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Cutaneous melanoma in Birt-Hogg-Dubé syndrome – part of the clinical spectrum?

Abstract

Birt-Hogg-Dubé syndrome (BHDS) is a rare genetic disorder caused by mutations in the FLCN gene. Clinically, BHDS is highly heterogeneous even within the same family. The most characteristic features of BHDS are fibrofolliculomas, lung cysts that confer the risk of pneumothorax, and benign or malignant renal tumours. Additionally, several other tumours are discussed to be possibly linked to BHDS including colon and breast cancer, thyroid tumors, and parathyroid adenomas.

This article is protected by copyright. All rights reserved.

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Compassion focussed self-help for skin conditions in individuals with insecure attachment: A pilot evaluation of the acceptability and potential effectiveness

Abstract

Further research is needed to develop psychological interventions for people living with skin condition. This research letter reports on a preliminary evaluation of targeted self-help^a encompassing mindful breathing and compassionate imagery (i.e., evoking a self- compassionate mental images), with the aim of reducing skin specific related distress such as shame. The aim of this 4-week preliminary study was to investigate the usability and acceptability of self-help for people living with skin conditions, through a feedback form administered two weeks after the intervention.

This article is protected by copyright. All rights reserved.

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Olmutinib-induced palmoplantar keratoderma

Abstract

olmutinib is a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) for the treatment of non-small cell lung cancer (NSCLC), especially for those harboring T790M mutations, the most common reason for other EGFR-TKI resistance. We describe three patients who developed acquired palmoplantar keratoderma (PPK) after taking olmutinib, an adverse event which has not been reported in previous generations of EGFR-TKIs.

This article is protected by copyright. All rights reserved.

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Fathers Day

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JACC Instructions for Authors

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Left Atrial Fibrosis and Risk of Cerebrovascular and Cardiovascular Events in Patients With Atrial Fibrillation

AbstractBackground

Severity of left atrial (LA) fibrosis is a strong predictor of atrial fibrillation (AF) ablation success and has been associated with a history of stroke, hypertension, and heart failure (HF). However, it is unclear whether more severe LA fibrosis independently increases the risk of major adverse cardiovascular and cerebrovascular events (MACCE) among those with AF.

Objectives

The goal of this study was to evaluate the occurrence and frequency of MACCE by strata of LA fibrosis severity in patients with AF.

Methods

This was a retrospective cohort study of 1,228 patients with AF who underwent late gadolinium enhancement (LGE)–cardiac magnetic resonance imaging to quantify LA fibrosis severity between January 2007 and June 2015. Patients were stratified according to Utah stage of LA LGE criteria, and observed for the occurrence of MACCE, which included a composite of stroke or transient ischemic attack (TIA), myocardial infarction, acute decompensated HF, or cardiovascular death. Disease risk score (DRS) stratification was used to control for between-group differences in baseline characteristics and risk.

Results

During follow-up, 62 strokes or TIAs, 42 myocardial infarctions, 156 HF events, and 38 cardiovascular deaths occurred. In DRS stratified analysis, the hazard ratio comparing patients with stage IV versus stage I LA LGE was 1.67 (95% confidence interval: 1.01 to 2.76) for the composite MACCE outcome. The only individual component of the MACCE outcome to remain significantly associated with advanced LGE following DRS stratification was stroke or TIA (hazard ratio: 3.94; 95% confidence interval: 1.72 to 8.98).

Conclusions

This retrospective analysis demonstrated that more severe LA LGE is associated with increased MACCE risk, driven primarily by increased risk of stroke or TIA.

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Reply: Early Revascularization in NSTE-ACS: Insights From the ICTUS Long-Term Follow-Up

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Is Atrial Fibrillation a Necessary Component of the Thrombogenic Atrium?

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Unraveling Vascular Inflammation: From Immunology to Imaging

Abstract

Inflammation is a critical factor in early atherosclerosis and its progression to myocardial infarction. The search for valid surrogate markers of arterial vascular inflammation led to the increasing use of positron emission tomography/computed tomography. Indeed, vascular inflammation is associated with future risk for myocardial infarction and can be modulated with short-term therapies, such as statins, that mitigate cardiovascular risk. However, to better understand vascular inflammation and its mechanisms, a panel was recently convened of world experts in immunology, human translational research, and positron emission tomographic vascular imaging. This contemporary review first strives to understand the diverse roles of immune cells implicated in atherogenesis. Next, the authors describe human chronic inflammatory disease models that can help elucidate the pathophysiology of vascular inflammation. Finally, the authors review positron emission tomography–based imaging techniques to characterize the vessel wall in vivo.

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Care Patterns and Outcomes in Atrial Fibrillation Patients With and Without Diabetes: ORBIT-AF Registry

AbstractBackground

Diabetes is a well-established risk factor for thromboembolism in patients with atrial fibrillation (AF), but less is known about how diabetes influences outcomes among AF patients.

Objectives

This study assessed whether symptoms, health status, care, and outcomes differ between AF patients with and without diabetes.

Methods

The cohort study included 9,749 patients from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry, a prospective, nationwide, outpatient registry of patients with incident and prevalent AF. Outcomes included symptoms, health status, and AF treatment, as well as 2-year risk of death, hospitalization, thromboembolic events, heart failure (HF), and AF progression.

Results

Patients with diabetes (29.5%) were younger, more likely to have hypertension, chronic kidney disease, HF, coronary heart disease, and stroke. Compared to patients without diabetes, patients with diabetes also had a lower Atrial Fibrillation Effects on Quality of Life score of 80 (interquartile range [IQR]: 62.5 to 92.6) versus 82.4 (IQR: 67.6 to 93.5; p = 0.025) and were more likely to receive anticoagulation (p < 0.001). Diabetes was associated with higher mortality risk, including overall (adjusted hazard ratio [aHR]: 1.63; 95% confidence interval [CI]: 1.04 to 2.56, for age <70 years vs. aHR: 1.25; 95% CI: 1.09 to 1.44, for age ≥70 years) and cardiovascular (CV) mortality (aHR: 2.20; 95% CI: 1.22 to 3.98, for age <70 years vs. 1.24; 95% CI: 1.02 to 1.51 for age ≥70 years). Diabetes conferred a higher risk of non-CV death, sudden cardiac death, hospitalization, CV hospitalization, and non-CV and nonbleeding-related hospitalization, but no increase in risks of thromboembolic events, bleeding-related hospitalization, new-onset HF, and AF progression.

Conclusions

Among AF patients, diabetes was associated with worse AF symptoms and lower quality of life, and increased risk of death and hospitalizations, but not thromboembolic or bleeding events.

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A Collaborative Cardiologist-Intensivist Management Model Improves Cardiac Intensive Care Unit Outcomes

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Concomitant Diabetes and Atrial Fibrillation: No Sugarcoating the Bittersweet Reality

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Reply: Potent P2Y12 Inhibitor Therapy for All? But What About Ethnicity?

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Hemodynamic Response to Nitroprusside in Patients With Low-Gradient Severe Aortic Stenosis and Preserved Ejection Fraction

AbstractBackground

Low-gradient severe aortic stenosis (LGSAS) with preserved ejection fraction (EF) is incompletely understood. The influence of arterial afterload and diastolic dysfunction on the hemodynamic presentation of LGSAS remains unknown.

Objectives

The authors sought to determine the acute hemodynamic response to sodium nitroprusside in LGSAS with preserved EF.

Methods

Symptomatic patients with LGSAS and preserved EF underwent cardiac catheterization with comparison of hemodynamic measurements before and after nitroprusside.

Results

Forty-one subjects (25 with low flow [LF], stroke volume index [SVI] ≤35 ml/m², 16 with normal flow [NF]) were included. At baseline, LF patients had lower total arterial compliance (0.36 ± 0.12 ml/m²/mm Hg vs. 0.48 ± 0.16 ml/m²/mm Hg; p = 0.01) and greater effective arterial elastance (2.77 ± 0.84 mm Hg · m²/ml vs. 1.89 ± 0.82 mm Hg · m²/ml; p = 0.002). In all patients, nitroprusside reduced elastance, left ventricular filling pressures, and pulmonary artery pressures and improved compliance (p < 0.05). Aortic valve area increased to ≥1.0 cm² in 6 LF (24%) and 4 NF (25%) subjects. Change in SVI with nitroprusside varied inversely to baseline SVI and demonstrated improvement in LF only (3 ± 6 ml/m²; p = 0.02).

Conclusions

Nitroprusside reduces afterload and left ventricular filling pressures in patients with LGSAS and preserved EF, enabling reclassification to moderate stenosis in 25% of patients. An inverse relationship between baseline SVI and change in SVI with afterload reduction was observed, suggesting that heightened sensitivity to afterload is a significant contributor to LF-LGSAS pathophysiology. These data highlight the utility of afterload reduction in the diagnostic assessment of LGSAS.

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The Evolving Future of Instantaneous Wave-Free Ratio and Fractional Flow Reserve

Abstract

In this review, the authors reflect upon the role of coronary physiology in the modern management of coronary artery disease. They critically appraise the scientific background of the instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR), from early experimental studies to validation studies against indexes of ischemia, to clinical trials assessing outcome. At this important juncture for the field, the authors make predictions for the future of physiological stenosis assessment, outlining developments for both iFR and FFR in new clinical domains beyond the confines of stable angina. With a focus on the evolving future of iFR and FFR, the authors describe how physiological assessment with iFR may advance its application from simply justifying to guiding revascularization.

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Evaluating Resistance in Our Assessing Patients With Aortic Stenosis: OHM Sweet OHM

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Bridge to Transplantation: Advanced Heart Failure and Transplant Cardiology Training for Cardiovascular Disease Fellows

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Prognostic Significance of Central Apneas Throughout a 24-Hour Period in Patients With Heart Failure

AbstractBackground

Large trials using noninvasive mechanical ventilation to treat central apnea (CA) occurring at night ("sleep apnea") in patients with systolic heart failure (HF) have failed to improve prognosis. The prevalence and prognostic value of CA during daytime and over an entire 24-h period are not well described.

Objectives

This study evaluated the occurrence and prognostic significance of nighttime, daytime, and 24-h CA episodes in a large cohort of patients with systolic HF.

Methods

Consecutive patients receiving guideline-recommended treatment for HF (n = 525; left ventricular ejection fraction [LVEF] of 33 ± 9%; 66 ± 12 years of age; 77% males) underwent prospective evaluation, including 24-h respiratory recording, and were followed-up using cardiac mortality as an endpoint.

Results

The 24-h prevalence of predominant CAs (apnea/hypopnea index [AHI] ≥5 events/h, with CA of >50%) was 64.8% (nighttime: 69.1%; daytime: 57.0%), whereas the prevalence of predominant obstructive apneas (OA) was 12.8% (AHI ≥5 events/h with OAs >50%; nighttime: 14.7%; daytime: 5.9%). Episodes of CA were associated with neurohormonal activation, ventricular arrhythmic burden, and systolic/diastolic dysfunction (all p < 0.05). During a median 34-month follow-up (interquartile range [IQR]: 17 to 36 months), 50 cardiac deaths occurred. Nighttime, daytime, and 24-h moderate-to-severe CAs were associated with increased cardiac mortality (AHI of </≥15 events/h; log-rank: 6.6, 8.7, and 5.3, respectively; all p < 0.05; central apnea index [CAI] of </≥10 events/h; log-rank 8.9, 11.2, and 10.9, respectively; all p < 0.001). Age, B-type natriuretic peptide level, renal dysfunction, 24-h AHI, CAI, and time with oxygen saturation of <90% were independent predictors of outcome.

Conclusions

In systolic HF patients, CAs occurred throughout a 24-h period and were associated with a neurohormonal activation, ventricular arrhythmic burden, and worse prognosis.

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Sudden Cardiac Death in Professional Soccer Players

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Ambulatory Apnea Monitoring in Heart Failure: Proceed With Caution

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Early Revascularization in NSTE-ACS: Insights From the ICTUS Long-Term Follow-Up

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Efficacy and Safety of Ticagrelor Over Time in Patients With Prior MI in PEGASUS-TIMI 54

AbstractBackground

Ticagrelor reduces ischemic risk in patients with prior myocardial infarction (MI). It remains unclear whether ischemic risk and the benefits of prolonged P2Y₁₂ inhibition in this population remain consistent over time.

Objectives

The study sought to investigate the pattern of ischemic risk over time and whether the efficacy and safety of ticagrelor were similar early and late after randomization.

Methods

The PEGASUS-TIMI (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis In Myocardial Infarction) 54 trial randomized patients with prior MI (median 1.7 years prior) to ticagrelor 90 mg, ticagrelor 60 mg, or placebo on a background of aspirin. The rates of cardiovascular (CV) death, MI, and stroke as well as TIMI major bleeding were analyzed at yearly landmarks (years 1, 2, and 3).

Results

A total of 21,162 patients were randomized and followed for 33 months (median), with 28% of patients ≥5 years from MI at trial conclusion. The risk of CV death, MI, or stroke in the placebo arm remained roughly constant over the trial at an ~3% annualized rate. The benefit of ticagrelor 60 mg was consistent at each subsequent landmark (year 1 hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.67 to 0.99; year 2 HR: 0.90; 95% CI: 0.74 to 1.11; and year 3 HR: 0.79; 95% CI: 0.62 to 1.00). TIMI major bleeding was increased with ticagrelor 60 mg at each landmark, but with the greatest hazard in the first year (year 1 HR: 3.22; year 2 HR: 2.07; year 3 HR: 1.65).

Conclusions

Patients with a history of MI remain at persistent high risk for CVD, MI, and stroke as late as 5 years after MI. The efficacy of low-dose ticagrelor is consistent over time with a trend toward less excess bleeding. (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562)

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Potent P2Y12 Inhibitor Therapy for All?: But What About Ethnicity?

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Extracellular reactive oxygen species are generated by a plasma membrane oxidative phosphorylation system

Publication date: November 2017
Source:Free Radical Biology and Medicine, Volume 112
Author(s): Hyun Lee, Bong-Woo Kim, Jung-Woo Lee, Jin Hong, Jung-Wha Lee, Hong-Lim Kim, Jae-Seon Lee, Young-Gyu Ko
Although the oxidative phosphorylation (OXPHOS) system has been found in mitochondria and the plasma membrane of various mammalian cell lines, understanding the physiological functions of the plasma membrane OXPHOS system is challenging. Here, we demonstrated that OXPHOS I, II, III, IV and V subunits were expressed in the plasma membrane of HepG2 cells and primary mouse hepatocytes, as determined by non-permeabilized immunofluorescence, total internal reflection fluorescence (TIRF) microscopy, cell surface-biotin labeling and plasma membrane and lipid raft isolation. Next, we demonstrated that NADH administration generated extracellular superoxide and improved insulin signaling in HepG2 cells and primary mouse hepatocytes. The NADH-dependent generation of extracellular superoxide was prevented by knockdown of NDUFV-1, the first subunit of OXPHOS I receiving electrons from NADH and the NADH-improved insulin signaling was abolished by extracellular catalase. Thus, we conclude that the OXPHOS system in the plasma membrane may be required for the generation of extracellular ROS and the regulation of insulin signaling.

Graphical abstract

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Quality of life in people with vitiligo: a systematic review and meta-analysis

Abstract

Vitiligo is cosmetically disfiguring and has profound psychosocial effects due to stigmatization, problems in sexual function, anxiety, self-esteem and difficulty finding employment. Previous studies suggest a reduction in quality of life (QoL) due to vitiligo, but to date no systematic review has quantified this in comparison to people without vitiligo. Therefore, the aim of this review was to compare QoL in people with and without vitiligo.

This article is protected by copyright. All rights reserved.

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Überleben nach radikaler Dissektion oder Beobachtung beim malignen Melanom mit Pförtnerlymphknotenmetastasen

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Treatment-induced changes in the androgen receptor axis: Liquid biopsies as diagnostic/prognostic tools for prostate cancer

Publication date: Available online 4 September 2017
Source:Molecular and Cellular Endocrinology
Author(s): S. Prekovic, T. Van den Broeck, L. Moris, E. Smeets, F. Claessens, S. Joniau, C. Helsen, G. Attard
Prostate cancer progression and treatment relapse is associated with changes in the androgen receptor axis, and analysis of alternations of androgen receptor signaling is valuable for prognostics and treatment optimization. The profile of androgen receptor axis is currently obtained from biopsy specimens, which are not always easy to obtain. Moreover, the information acquired only provides a snapshot of the tumor biology, with strict spatial and temporal limitations. On the other hand, circulation is easily accessible source of both circulating tumor cells and circulating tumor DNA, which can be sampled at numerous time points. This Review will explore the potential use of androgen receptor axis alternations detectable in the blood in therapeutic decision-making and precision medicine for advancing metastatic castration-resistant prostate cancer.



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The impact of androgen actions in neurons on metabolic health and disease

Publication date: Available online 4 September 2017
Source:Molecular and Cellular Endocrinology
Author(s): Jamie Morford, Sheng Wu, Franck Mauvais-Jarvis
The male hormone testosterone exerts different effects on glucose and energy homeostasis in males and females. Testosterone deficiency predisposes males to visceral obesity, insulin resistance and type 2 diabetes. However, testosterone excess predisposes females to similar metabolic dysfunction. Here, we review the effects of testosterone actions in the central nervous system on metabolic function in males and females. In particular, we highlight changes within the hypothalamus that control glucose and energy homeostasis. We distinguish the organizational effects of testosterone in the programming of neural circuitry during development from the activational effects of testosterone during adulthood. Finally, we explore potential sites where androgen might be acting to impact metabolism within the central nervous system.



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Antenatal/early postnatal hypothyroidism alters arterial tone regulation in 2-week-old rats

The mechanisms of vascular alterations resulting from early thyroid hormones deficiency are poorly understood. We tested the hypothesis that antenatal/early postnatal hypothyroidism would alter the activity of endothelial NO pathway and Rho-kinase pathway, which are specific for developing vasculature. Dams were treated with propylthiouracil (PTU, 7 ppm) in drinking water during gestation and 2 weeks after delivery, and their progeny had normal body weight but markedly reduced blood levels of thyroid hormones (ELISA). Small arteries from 2-week-old male pups were studied using wire myography, qPCR and Western blotting. Mesenteric arteries of PTU pups, compared to controls, demonstrated smaller maximum response to α₁-adrenergic agonist methoxamine and reduced mRNA contents of smooth muscle differentiation markers α-actin and SERCA2A. Inhibition of basal NO synthesis by l-NNA led to tonic contraction of mesenteric arteries and augmented their contractile responses to methoxamine; both l-NNA effects were impaired in PTU pups. PTU pups demonstrated lower blood level of NO metabolites compared to control group (Griess reaction). Rho-kinase inhibitor Y27632 strongly reduced mesenteric arteries responses to methoxamine in PTU pups, that was accompanied by elevated Rho-kinase content in their arteries in comparison to control ones. Unlike mesenteric, saphenous arteries of PTU pups, compared to controls, had no changes in α-actin and SERCA2A contents and in responses to l-NNA and Y27632. In conclusion, thyroid hormones deficiency suppresses the anticontractile effect of NO and potentiates the procontractile Rho-kinase effects in mesenteric arteries of 2-week-old pups. Such alterations disturb perinatal cardiovascular homeostasis and might lead to cardiovascular pathologies in adulthood.

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The impact of IUGR on pancreatic islet development and {beta}-cell function

Placental insufficiency is a primary cause of intrauterine growth restriction (IUGR). IUGR increases the risk of developing type 2 diabetes mellitus (T2DM) throughout life, which indicates that insults from placental insufficiency impair β-cell development during the perinatal period because β-cells have a central role in the regulation of glucose tolerance. The severely IUGR fetal pancreas is characterized by smaller islets, less β-cells, and lower insulin secretion. Because of the important associations among impaired islet growth, β-cell dysfunction, impaired fetal growth, and the propensity for T2DM, significant progress has been made in understanding the pathophysiology of IUGR and programing events in the fetal endocrine pancreas. Animal models of IUGR replicate many of the observations in severe cases of human IUGR and allow us to refine our understanding of the pathophysiology of developmental and functional defects in islet from IUGR fetuses. Almost all models demonstrate a phenotype of progressive loss of β-cell mass and impaired β-cell function. This review will first provide evidence of impaired human islet development and β-cell function associated with IUGR and the impact on glucose homeostasis including the development of glucose intolerance and diabetes in adulthood. We then discuss evidence for the mechanisms regulating β-cell mass and insulin secretion in the IUGR fetus, including the role of hypoxia, catecholamines, nutrients, growth factors, and pancreatic vascularity. We focus on recent evidence from experimental interventions in established models of IUGR to understand better the pathophysiological mechanisms linking placental insufficiency with impaired islet development and β-cell function.

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Conditional deletion of ELL2 induces murine prostate intraepithelial neoplasia

Elongation factor, RNA polymerase II, 2 (ELL2) is an RNA Pol II elongation factor with functional properties similar to ELL that can interact with the prostate tumor suppressor EAF2. In the prostate, ELL2 is an androgen response gene that is upregulated in benign prostatic hyperplasia (BPH). We recently showed that ELL2 loss could enhance prostate cancer cell proliferation and migration, and that ELL2 gene expression was downregulated in high Gleason score prostate cancer specimens. Here, prostate-specific deletion of ELL2 in a mouse model revealed a potential role for ELL2 as a prostate tumor suppressor in vivo. Ell2-knockout mice exhibited prostatic defects including increased epithelial proliferation, vascularity and PIN lesions similar to the previously determined prostate phenotype in Eaf2-knockout mice. Microarray analysis of prostates from Ell2-knockout and wild-type mice on a C57BL/6J background at age 3 months and qPCR validation at 17 months of age revealed a number of differentially expressed genes associated with proliferation, cellular motility and epithelial and neural differentiation. OncoPrint analysis identified combined downregulation or deletion in prostate adenocarcinoma cases from the Cancer Genome Atlas (TCGA) data portal. These results suggest that ELL2 and its pathway genes likely play an important role in the development and progression of prostate cancer.

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Characterization of the human thyroid epigenome

The thyroid gland, necessary for normal human growth and development, functions as an essential regulator of metabolism by the production and secretion of appropriate levels of thyroid hormone. However, assessment of abnormal thyroid function may be challenging suggesting a more fundamental understanding of normal function is needed. One way to characterize normal gland function is to study the epigenome and resulting transcriptome within its constituent cells. This study generates the first published reference epigenomes for human thyroid from four individuals using ChIP-seq and RNA-seq. We profiled six histone modifications (H3K4me1, H3K4me3, H3K27ac, H3K36me3, H3K9me3, H3K27me3), identified chromatin states using a hidden Markov model, produced a novel quantitative metric for model selection and established epigenomic maps of 19 chromatin states. We found that epigenetic features characterizing promoters and transcription elongation tend to be more consistent than regions characterizing enhancers or Polycomb-repressed regions and that epigenetically active genes consistent across all epigenomes tend to have higher expression than those not marked as epigenetically active in all epigenomes. We also identified a set of 18 genes epigenetically active and consistently expressed in the thyroid that are likely highly relevant to thyroid function. Altogether, these epigenomes represent a powerful resource to develop a deeper understanding of the underlying molecular biology of thyroid function and provide contextual information of thyroid and human epigenomic data for comparison and integration into future studies.

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The thermogenic effect of nesfatin-1 requires recruitment of the melanocortin system

Nesfatin-1 is a bioactive polypeptide expressed both in the brain and peripheral tissues and involved in the control of energy balance by reducing food intake. Central administration of nesfatin-1 significantly increases energy expenditure, as demonstrated by a higher dry heat loss; yet, the mechanisms underlying the thermogenic effect of central nesfatin-1 remain unknown. Therefore, in this study, we sought to investigate whether the increase in energy expenditure induced by nesfatin-1 is mediated by the central melanocortin pathway, which was previously reported to mediate central nesfatin-1's effects on feeding and numerous other physiological functions. With the application of direct calorimetry, we found that intracerebroventricular nesfatin-1 (25 pmol) treatment increased dry heat loss and that this effect was fully blocked by simultaneous administration of an equimolar dose of the melanocortin 3/4 receptor antagonist, SHU9119. Interestingly, the nesfatin-1-induced increase in dry heat loss was positively correlated with body weight loss. In addition, as assessed with thermal imaging, intracerebroventricular nesfatin-1 (100 pmol) increased interscapular brown adipose tissue (iBAT) as well as tail temperature, suggesting increased heat production in the iBAT and heat dissipation over the tail surface. Finally, nesfatin-1 upregulated pro-opiomelanocortin and melanocortin 3 receptor mRNA expression in the hypothalamus, accompanied by a significant increase in iodothyronine deiodinase 2 and by a nonsignificant increase in uncoupling protein 1 and peroxisome proliferator-activated receptor gamma coactivator-1 alpha mRNA in the iBAT. Overall, we clearly demonstrate that nesfatin-1 requires the activation of the central melanocortin system to increase iBAT thermogenesis and, in turn, overall energy expenditure.

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Tunable magnetocaloric properties of Gd based alloys via Zn and Cd additions

Publication date: 15 November 2017
Source:Materials & Design, Volume 134
Author(s): XiaoChen Wang, Jiang Bing, JianXin Wang, QianQian Lu, XueLing Hou, Hui Xu
Magnetocaloric effect by employing direct measurements of the adiabatic temperature changes (ΔTad) with a low magnetic field change (ΔH) up to 1.2T are investigated, for the Gd based alloys with Zn and Cd substituted for Gd individually or synchronously. A comparative study of the adiabatic temperature change (ΔTad) and magnetic entropy change (ΔSM) near room temperature has been reported in three different alloys of Gd1−xZnx, Gd1−yCdy and Gd0.95(Zn1−zCdz)0.05. Effects of Zn and Cd content on magnetocaloric effect and the Curie temperature (Tc) are studied in different alloys. A direct correlation between phase structure and ΔTad, ΔSM, Tc was discussed in three different types alloys of Gd1−xZnx, Gd1−yCdy, and Gd0.95(Zn1−zCdz)0.05. Mechanism of Zn improving the ΔTad and Cd increasing the Tc is revealed. It is expected that magnetic refrigeration near room temperature has a potential for superseding the traditional gas refrigeration.

Graphical abstract

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Optimization and in line potentiometric monitoring of enhanced photocatalytic degradation kinetics of gemifloxacin using TiO 2 nanoparticles/H 2 O 2

Abstract

Gemifloxacin (GEM) is a broad-spectrum quinolone antibiotic. The presence of GEM residuals in industrial and hospital wastewater has been associated with genotoxicity and antibiotic resistance. In this contribution, the photodegradation of GEM using titanium dioxide nanoparticles (TiO₂NPs)/H₂O₂ as a catalyst was optimized to eliminate residual drug and its photodegradates with antibacterial activity. A half-factorial design was implemented, investigating the effects of pH, initial concentration, H₂O₂ concentration, TiO₂NP loading, and irradiation time. Owing to the time-dependent, multi-transformation of GEM into a wide range of structurally related photodegradation products, the monitoring of GEM throughout the experiments was achieved using both HPLC and potentiometric ion-selective electrodes (ISE). The sensor enabled in-line tracking of residual GEM in the presence of its photodegradates in real time. Results indicated that the pH, irradiation time, and GEM initial concentration were the most significant factors. At the optimum set of experimental conditions, the reaction followed first-order reaction kinetics with a mean percentage degradation of ~ 95% in less than 30 min of irradiation time and almost complete loss of antibacterial activity against Escherichia coli. The promising results demonstrated the efficiency of UV/TiO₂NP/H₂O₂ as a photocatalyst for the breakdown of the pharmacophore of fluoroquinolones from water samples. The high selectivity, minimal solvent consumption, and lack of harmful waste generation confirmed the superiority of in-line monitoring using ISE. Optimization and in-line monitoring protocol should be applicable also at the pharmaceutical industry scale to eliminate the risk of antibiotic resistance.

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