Accuracy of screening women at familial risk of breast cancer without a known gene mutation: Individual patient data meta-analysis

Publication date: November 2017
Source:European Journal of Cancer, Volume 85
Author(s): Xuan-Anh Phi, Nehmat Houssami, Maartje J. Hooning, Christopher C. Riedl, Martin O. Leach, Francesco Sardanelli, Ellen Warner, Isabelle Trop, Sepideh Saadatmand, Madeleine M.A. Tilanus-Linthorst, Thomas H. Helbich, Edwin R. van den Heuvel, Harry J. de Koning, Inge-Marie Obdeijn, Geertruida H. de Bock
IntroductionWomen with a strong family history of breast cancer (BC) and without a known gene mutation have an increased risk of developing BC. We aimed to investigate the accuracy of screening using annual mammography with or without magnetic resonance imaging (MRI) for these women outside the general population screening program.MethodsAn individual patient data (IPD) meta-analysis was conducted using IPD from six prospective screening trials that had included women at increased risk for BC: only women with a strong familial risk for BC and without a known gene mutation were included in this analysis. A generalised linear mixed model was applied to estimate and compare screening accuracy (sensitivity, specificity and predictive values) for annual mammography with or without MRI.ResultsThere were 2226 women (median age: 41 years, interquartile range 35–47) with 7478 woman-years of follow-up, with a BC rate of 12 (95% confidence interval 9.3–14) in 1000 woman-years. Mammography screening had a sensitivity of 55% (standard error of mean [SE] 7.0) and a specificity of 94% (SE 1.3). Screening with MRI alone had a sensitivity of 89% (SE 4.6) and a specificity of 83% (SE 2.8). Adding MRI to mammography increased sensitivity to 98% (SE 1.8, P < 0.01 compared to mammography alone) but lowered specificity to 79% (SE 2.7, P < 0.01 compared with mammography alone).ConclusionIn this population of women with strong familial BC risk but without a known gene mutation, in whom BC incidence was high both before and after age 50, adding MRI to mammography substantially increased screening sensitivity but also decreased its specificity.



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Assessing value in breast reconstruction - a systematic review of cost-effectiveness studies

Breast reconstruction is one of the most common procedures performed by plastic surgeons and is achieved through various choices in both technology and method. Cost-effectiveness analyses are increasingly important in assessing differences in value between treatment options, which is relevant in a world of confined resources. A thorough evaluation of the cost-effectiveness literature can assist surgeons and health systems evaluate high value care models.

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87th Annual Meeting of the American Thyroid Association October 18–22, 2017, Victoria, British Columbia, Canada

Angela M. Leung and Mingzhao Xing
2017 ATA Annual Meeting Co-Chairs.

 We are excited that the 87th annual meeting of the American Thyroid Association (ATA) is almost upon us! On behalf of the Program Committee, we look forward to welcoming attendees and their guests to the annual meeting that will be held October 18–22, 2017, at the Fairmont Empress and Victoria Conference Centre in Victoria, British Columbia, Canada. Over this past year, the committee, comprised of experts from all thyroid disciplines, has thoughtfully worked to put together a program featuring the latest advances in basic, translational, and clinical thyroidology. Read More….

The post 87th Annual Meeting of the American Thyroid Association October 18–22, 2017, Victoria, British Columbia, Canada appeared first on American Thyroid Association.

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Cardiac pathologic findings in three unusual cases of sudden cardiac death related to anorexiant drugs

Publication date: Available online 9 October 2017
Source:Human Pathology
Author(s): Ornella Leone, Valentina Agostini, Alberto Foà, Bruna Cerbelli, Cira Rosaria Tiziana di Gioia, Mariarosaria Aromatario, Costantino Ciallella, Joaquin Lucena, Giulia d'Amati
Amphetamine congeners can be prescribed as anorexiant drugs, despite their potential side effects, including cardiac toxicity. However, the morphologic features of cardiac damage related to protracted use of these compounds are unknown. We provide a detailed description of cardiac autopsy findings in three cases of sudden death associated with protracted use of high-doses of phendimetrazine and/or phenylpropanolamine or bupropion prescribed as anorexiants, in association with other compounds. The main cardiac findings were similar in all three cases: i) mild–moderate hypertrophy of the left ventricle and/or the septum; ii) myocardial non-ischemic scarring (mid-mural and/or sub-epicardial) appearing as discrete foci or with a band/like morphology; iii) mild–moderate intramural small vessel disease, in absence of significant epicardial coronary artery stenosis; iv) acute/recent inflammatory lesions consistent with toxic myocarditis. In summary, the detailed pathology examination of the heart in these three cases revealed myocardial lesions identical to those reported in catecholamine myocardial damage, in all their various stages of evolution. In presence of a clinical history of long-term intake of anorexiants of this category, it is most important at autopsy to recognize and correctly interpret the acute and chronic myocardial lesions of the type herein described, since they represent an anatomical substrate for arrhythmic death.



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Calf hemodialysate hypothesis: Nutritive value plus placebo effect

Publication date: November 2017
Source:Medical Hypotheses, Volume 109
Author(s): Sergei V. Jargin




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Reactions between methylglyoxal and its scavengers in-vivo appear to be catalyzed enzymatically

Publication date: Available online 9 October 2017
Source:Medical Hypotheses
Author(s): Benjamin Szwergold
Methylglyoxal (MGO) is an important contributor to the development of diabetic complications. In this paper I propose that MGO, not detoxified by the glyoxalase system, is removed from circulation by MGO-scavengers. Furthermore, since rates of reactions between MGO and its scavengers in-vitro are low, I propose that in-vivo these reactions are catalyzed enzymatically.



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M. biceps femoris - a wolf in sheep’s clothing: The downside of a lower limb injury prevention training

Publication date: Available online 9 October 2017
Source:Medical Hypotheses
Author(s): Thomas Ertelt, Thomas Gronwald
Both, hamstring and ACL injuries are amongst the most typical injuries, particularly in change of direction and high speed running sports. They're also difficult to treat. Therefore, in the past few years, sports medicine practitioners and exercise scientists have mainly been focusing on the de velopment and implementation of preventive programs in order to reduce the number of lower limb injuries, mainly by improving knee alignment. A number of studies have been able to prove the success of these training interventions, which are mainly addressing sensorimotor abilities and plyometric activities. The number of non‐contact hamstring injuries has nevertheless been on the rise, particularly in sports like soccer and football. Therefore, the purpose of the following article is to introduce the hypothesis that the above‐mentioned training interventions have a massive influence on the activation patterns on the targeted muscle group, and on the biceps femoris in particular. Muscle function and the resulting internal load are directly related to muscle architec ture at the insertion. Training induced adaptations in hamstring activation patterns can thus lead to an increased injury susceptibility. In this case, a simulation model that directly relates to an acute deceleration maneuver provides valuable insights into the function of the biceps femoris muscle, especially when the rate of activity and the muscle geometry at the insertion area are taken into consideration. We conclude that there needs to be a greater individualization of pre vention programs, especially in regards to anatomical requirements, in order to further reduce injury rates in elite sports. Moreover, it would also seem reasonable to apply a similar approach to aspects of chronic pain such as chronic non‐specific low back pain.



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Organizational downsizing and alcohol use: A national study of U.S. workers during the Great Recession

Publication date: February 2018
Source:Addictive Behaviors, Volume 77
Author(s): Michael R. Frone
Organizational downsizing, which represents the reduction of an organization's workforce, results in a stressful work environment for those who survive the downsizing. However, we know little about the association between surviving an organizational downsizing and employee alcohol use. This study explored the association between exposure to organizational downsizing and four dimensions of alcohol use during the Great Recession. Also explored were the moderating influences of length of recession exposure, state drinking culture, gender, age, education, family income, and financial demands. Data for this study came from a national telephone survey of U.S. workers that was conducted from December 2008 to April 2011 (N=2296). The results revealed that exposure to organizational downsizing was positively associated with usual frequency of drinking, number of drinks consumed per usual drinking occasion, and both the frequency of binge drinking and drinking to intoxication. Length of exposure to the recession moderated the association between organizational downsizing exposure and usual number of drinks consumed. The conditional effects revealed that this association became stronger as length of exposure to the recession increased. Furthermore, age moderated the associations between organizational downsizing exposure and the usual number of drinks consumed and the frequency of binge drinking and intoxication. The conditional effects revealed that these associations were positive and significant among young survivors (ages 40 or younger), but were nonsignificant among middle-aged survivors (over 40years of age). State drinking culture, gender, education, family income, and financial demands did not moderate the associations between organizational downsizing exposure and alcohol use.



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When the party continues: Impulsivity and the effect of employment on young adults' post-college alcohol use

Publication date: February 2018
Source:Addictive Behaviors, Volume 77
Author(s): I.M. Geisner, J. Koopmann, P. Bamberger, M. Wang, M.E. Larimer, I. Nahum-Shani, S. Bacharach
BackgroundThe transition from college to work is both an exciting and potentially high risk time for young adults. As students transition from academic settings to full-time employment, they must navigate new social demands, work demands, and adjust their drinking behaviors accordingly. Research has shown that there are both protective factors and risk factors associated with starting a new job when it comes to alcohol use, and individual differences can moderate these factors.Method1361 students were recruited from 4 geographically diverse universities and followed 1month pre- and 1month post-graduation. Drinking frequency, quantity, consequences, and impulsivity were assessed.ResultsFull-time employment was related to increased drinking quantity but not related to changes in other drinking outcomes. However, impulsivity moderated the relationship between employment and drinking. For those reporting higher levels of impulsivity at baseline, full-time employment was associated with an increase in drinking variables (quantity and frequency), whereas drinking was unaffected by full-time employment status among those reporting lower levels of impulsivity. Implications for future research are discussed.



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Smoking and drinking behaviors of military spouses: Findings from the Millennium Cohort Family Study

Publication date: February 2018
Source:Addictive Behaviors, Volume 77
Author(s): Daniel W. Trone, Teresa M. Powell, Lauren M. Bauer, Amber D. Seelig, Arthur V. Peterson, Alyson J. Littman, Emily C. Williams, Charles C. Maynard, Jonathan B. Bricker, Edward J. Boyko
Introduction: The associations between stressful military experiences and tobacco use and alcohol misuse among Service members are well documented. However, little is known about whether stressful military experiences are associated with tobacco use and alcohol misuse among military spouses. Methods: Using 9872 Service member–spouse dyads enrolled in the Millennium Cohort Family Study, we employed logistic regression to estimate the odds of self-reported cigarette smoking, risky drinking, and problem drinking among spouses by Service member deployment status, communication regarding deployment, and stress associated with military-related experiences, while adjusting for demographic, mental health, military experiences, and Service member military characteristics. Results: Current cigarette smoking, risky drinking, and problem drinking were reported by 17.2%, 36.3%, and 7.3% of military spouses, respectively. Current deployment was not found to be associated with spousal smoking or drinking behaviors. Communication about deployment experiences with spouses was associated with lower odds of smoking, but not with risky or problem drinking. Spouses bothered by communicated deployment experiences and those who reported feeling very stressed by a combat-related deployment or duty assignment had consistently higher odds of both risky and problem drinking. Conclusions: Our findings suggest that contextual characteristics about the deployment experience, as well as the perceived stress of those experiences, may be more impactful than the simple fact of Service member deployment itself. These results suggest that considering the impact of deployment experiences on military spouses reveals important dimensions of military community adaptation and risk.



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Testing weight motives and guilt/shame as mediators of the relationship between alcohol use and physical activity

Publication date: February 2018
Source:Addictive Behaviors, Volume 77
Author(s): Tonya Dodge, Paige Clarke
ObjectivesTest whether weight motives and guilt/shame mediate the positive relationship between physical activity and alcohol use among college-attending young adults.DesignA longitudinal design was employed.MethodYoung adults who were attending college (N=371) completed two self-administered questionnaires separated by approximately one month. Heavy episodic drinking was assessed at Time 1. Vigorous physical activity, moderate physical activity, weight motives, and guilt/shame were assessed at Time 2.ResultsResults are consistent with weight motives as a mediator of the positive relationship between heavy episodic drinking and vigorous physical activity. Results were inconsistent with guilt/shame as a mediator of this relationship. There was no statistically significant relationship between heavy episodic drinking and moderate physical activity.ConclusionsHeavy episodic drinking was related to vigorous but not to moderate physical activity in the subsequent 30-days. Furthermore, the results are consistent with weight motives as a mediator of the relationship between alcohol use and vigorous physical activity.



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E-cigarette use among treatment-seeking smokers: Moderation of abstinence by use frequency

Publication date: February 2018
Source:Addictive Behaviors, Volume 77
Author(s): Emily N. Subialka Nowariak, Rebecca K. Lien, Raymond G. Boyle, Michael S. Amato, Laura A. Beebe
IntroductionEmerging literature suggests that frequency of use of electronic cigarettes (e-cigarettes) may be an important moderating variable in the relationship between e-cigarette use and smoking cessation. However, few studies have focused specifically on treatment-seekers, a group that may differ in important ways from smokers in the general population. This study looks at the relationship between e-cigarette use frequency and abstinence among a sample of treatment-seeking tobacco users.MethodsSeven-month follow-up survey data from N=2760 treatment-seeking tobacco users who utilized statewide tobacco quitlines in three states were used to assess the relationship between 30-day point prevalence abstinence and e-cigarette use frequency at follow-up. E-cigarette use was examined in two ways. First, we looked at any use in the past 30days versus no use. Additionally, past 30-day e-cigarette use frequency was categorized into four groups: 0days, 1–5days – infrequent, 6–29days – intermediate, 30days – daily. Logistic regression models were constructed predicting 30-day point prevalence tobacco abstinence.ResultsBoth infrequent (AOR=0.35; CI=0.20–0.59) and intermediate (AOR=0.50; CI=0.32–0.80) past 30-day e-cigarette use were associated with lower rates of tobacco abstinence versus no past 30-day use. However, daily e-cigarette users (AOR=1.16; CI=0.71–1.70) had similar 30-day abstinence when compared to non-users.ConclusionsResults from this study of treatment-seekers support findings from studies of general population tobacco users that suggest frequency of e-cigarette use is an important moderating variable in the relationship between e-cigarette use and tobacco cessation. Future studies should employ more refined measures of e-cigarette use.



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Sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents: Prevalence and correlates

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The comparison of pinch strength among female typists and female non-typists

Publication date: Available online 9 October 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Zahra Rojhani-Shirazi, Ladan Hemmati, Zahra Saadat, Zeinab Shirzadi
BackgroundTyping is a common activity involving repetitive motion that can increase the risk of work-related injuries. To the best of our knowledge, the effect of typing on the pinch strength has not been investigated so far.ObjectiveTo investigate the pinch strength amongst female typists and non-typists.MethodThirty female typists and 30 female non-typists, aged 20–30 years old, participated in this prospective study. The pinch strength of the second, third, fourth and fifth fingers of the dominant hand was measured in a sitting position, using a pinch gauge. The data were analyzed using independent sample t-test.ResultsThe results showed that there were significant differences in the pinch strength of the second, third and fourth fingers between the two groups. The strength of these fingers was reduced more than that in female non-typists.ConclusionOur results suggest that pinch strength might have decreased in female typists due to sharing common attentional resources, muscle fiber composition, and muscle fiber fatigue.



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A Practical Guide About Tattooing in Patients with Chronic Skin Disorders and Other Medical Conditions

Abstract

With tattoos becoming increasingly mainstream, dermatologists are more and more often consulted by patients who are considering getting an ornamental, cosmetic, or even a medical tattoo, and who subsequently ask for advice. This includes not only patients with chronic skin diseases such as psoriasis or atopic dermatitis but also patients with other medical conditions. This review first explores the reasons why patients may want to get a tattoo and aims to offer some key information to dermatologists on what they should know about tattooing and the main risks associated with this procedure. Second, the risks and recommendations of tattooing in patients with specific skin diseases are described more in detail, and the relative and strict contraindications discussed, including the necessity to discontinue certain treatments that could influence the outcome of the procedure and the final result. Our aim was to provide dermatologists with the current knowledge they need to help their patients make adequate and informed choices on skin art, focusing specifically on considerations in patients with chronic skin conditions. Finally, other aspects regarding some general systemic conditions and concomitant diseases that the patient could present are also addressed. In particular, the risks of tattooing in patients with diabetes, coagulation disorders, heart conditions, immunosuppressive treatments, and pregnancy are discussed.

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Update on tumor-infiltrating lymphocytes (TILs) in breast cancer, including recommendations to assess TILs in residual disease after neoadjuvant therapy and in carcinoma in situ: a report of the International Immuno-Oncology Biomarker Working Group on Breast Cancer

Publication date: Available online 9 October 2017
Source:Seminars in Cancer Biology
Author(s): Maria Vittoria Dieci, Nina Radosevic-Robin, Susan Fineberg, Gert van den Eynden, Nils Ternes, Frederique Penault-Llorca, Giancarlo Pruneri, Timothy M. D'Alfonso, Sandra Demaria, Carlos Castaneda, Joselyn Sanchez, Sunil Badve, Stefan Michiels, Veerle Bossuyt, Federico Rojo, Baljit Singh, Torsten Nielsen, Giuseppe Viale, Seong-Rim Kim, Stephen Hewitt, Stephan Wienert, Sybille Loibl, David Rimm, Fraser Symmans, Carsten Denkert, Sylvia Adams, Sherene Loi, Roberto Salgado
Morphological evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer is gaining momentum as evidence strengthens the clinical relevance of this immunological biomarker. TILs in the post-neoadjuvant residual disease setting are acquiring increasing importance as a stratifying marker in clinical trials, considering the raising interest on immunotherapeutic strategies after neoadjuvant chemotherapy. TILs in ductal carcinoma in situ, with or without invasive carcinoma, represent an emerging area of clinical breast cancer research. The aim of this report is to update pathologists, clinicians and researchers on TIL assessment in both the post-neoadjuvant residual disease and the ductal carcinoma in situ settings. The International Immuno-Oncology Working Group proposes a method for assessing TILs in these settings, based on the previously published International Guidelines on TIL Assessment in Breast Cancer. In this regard, these recommendations represent a consensus guidance for pathologists, aimed to achieve the highest possible consistency among future studies.



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Response of MG63 osteoblasts on bacterial challenge is dependent on the state of differentiation

Summary

The present in-vitro-study examines molecular processes relevant during bone homeostasis after Aggregatibacter actinomycetemcomitans (A.a.) and Porphyromonas gingivalis (P.g.) infection with a focus on the differentiation level of osteoblasts. Regenerative processes are often hindered by the recurrence of bacterial infections, which can ultimately provoke a severe destruction of bone tissue. To get more detailed insights into such a complex scenario, we have used undifferentiated MG63 osteoblast-like cells as an experimental paradigm to examine the impact of two oral pathogens, A.a. and P.g., on proliferation, cytotoxicity, and osteogenic differentiation. Cell culture experiments were performed to analyze cellular behavior. The level of genes interfering with bone tissue integrity (matrix metalloproteinases and their tissue inhibitors) and osteogenic markers (alkaline phosphatase, Runx2, human β-defensin-2) was compared in undifferentiated versus differentiated MG63 cells using real-time polymerase chain reaction. Functional activity of matrix metalloproteinases was quantified by zymography. Western Blot analysis was used to verify the phosphorylation state of mitogen-activated protein kinases p38 and extracellular-signal regulated kinases ERK1/2. When co-cultured with undifferentiated MG63 cells, oral pathogens provoked distinct cellular effects. Only A.a. reduced cell proliferation, increased cell death, and induced osteogenic differentiation. A comparison of the MMP network stability in the presence of oral pathogens revealed a partial sensitivity towards P.g. but not A.a. Thus, beside the proof of concept that MG63 cells co-cultured with oral pathogens can serve as an in-vitro-model for mimicking destructive and regenerative events after bacterial infections, our data indicate that double infections might counterbalance otherwise positive effects.

This article is protected by copyright. All rights reserved.

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Antibacterial effect and bond strength of a modified dental adhesive containing the peptide nisin

Publication date: Available online 9 October 2017
Source:Peptides
Author(s): Meixuan Su, Shunyi Yao, Lisha Gu, Zihua Huang, Sui Mai
This study attempted to incorporate the antibacterial peptide nisin into an etch-and-rinse dental adhesive to evaluate the antibacterial activity of the modified adhesive against Streptococcus mutans and the bond strength. Single Bond 2 was used as a negative control, and nisin was incorporated at 1%, 3%, and 5% (w/v). The antibacterial activity against S. mutans was evaluated using the film contact test, the agar diffusion test, XTT assays and confocal laser scanning microscopy (CLSM). The microtensile bond strength (μTBS) of the modified dental adhesive was also evaluated. The cured nisin-incorporated dental adhesive exhibited a significant inhibitory effect on the growth of S. mutans (P<0.05), and the inhibitory effect was strengthened as the nisin concentration increased (P<0.05). However, no significant differences in the agar diffusion test were found for the cured nisin-incorporated adhesives compared with the control group. Based on XTT results and CLSM images, the cured nisin-incorporated adhesive interfered with the adherence of S. mutans and the integrity of its biofilms (P<0.05). Compared with the control group, the 1% nisin group did not exhibit a significant difference in μTBS (P>0.05), whereas the 3% and 5% nisin groups displayed decreased bond strength (P<0.05).



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Pre-Implant Outcome Predictors in Patients With Refractory Cardiogenic Shock Supported With VA-ECMO

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Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study

AbstractBackground

Atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) frequently co-exist despite adequate rate control. Existing randomized studies of AF and LVSD of varying etiologies have reported modest benefits with a rhythm control strategy.

Objectives

The goal of this study was to determine whether catheter ablation (CA) for AF could improve LVSD compared with medical rate control (MRC) where the etiology of the LVSD was unexplained, apart from the presence of AF.

Methods

This multicenter, randomized clinical trial enrolled patients with persistent AF and idiopathic cardiomyopathy (left ventricular ejection fraction [LVEF] ≤45%). After optimization of rate control, patients underwent cardiac magnetic resonance (CMR) to assess LVEF and late gadolinium enhancement, indicative of ventricular fibrosis, before randomization to either CA or ongoing MRC. CA included pulmonary vein isolation and posterior wall isolation. AF burden post-CA was assessed by using an implanted loop recorder, and adequacy of MRC was assessed by using serial Holter monitoring. The primary endpoint was change in LVEF on repeat CMR at 6 months.

Results

A total of 301 patients were screened; 68 patients were enrolled between November 2013 and October 2016 and randomized with 33 in each arm (accounting for 2 dropouts). The average AF burden post-CA was 1.6 ± 5.0% at 6 months. In the intention-to-treat analysis, absolute LVEF improved by 18 ± 13% in the CA group compared with 4.4 ± 13% in the MRC group (p < 0.0001) and normalized (LVEF ≥50%) in 58% versus 9% (p = 0.0002). In those undergoing CA, the absence of late gadolinium enhancement predicted greater improvements in absolute LVEF (10.7%; p = 0.0069) and normalization at 6 months (73% vs. 29%; p = 0.0093).

Conclusions

AF is an underappreciated reversible cause of LVSD in this population despite adequate rate control. The restoration of sinus rhythm with CA results in significant improvements in ventricular function, particularly in the absence of ventricular fibrosis on CMR. This outcome challenges the current treatment paradigm that rate control is the appropriate strategy in patients with AF and LVSD. (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction [CAMERA-MRI]; ACTRN12613000880741)

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JACC Instructions for Authors

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Catheter Ablation for Rate-Controlled Atrial Fibrillation: New Horizon in Heart Failure Treatment

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Reply: Loss-of-Function Mutations to Estimate Pharmacological ANGPTL3 Inhibition

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Prognostic Value of Cardiac Magnetic Resonance Tissue Characterization in Risk Stratifying Patients With Suspected Myocarditis

AbstractBackground

Diagnosing myocarditis is challenged by nonspecific clinical signs and symptoms and low accuracy of endomyocardial biopsy. Cardiac magnetic resonance imaging (CMR) provides both cardiac anatomy and tissue characterization in this setting, but the prognostic value of this method as a primary assessment tool in patients with suspected myocarditis remains limited.

Objectives

This study sought to determine cardiac event-free survival of a consecutive cohort with suspected myocarditis with regard to CMR findings.

Methods

Six hundred seventy patients with suspected myocarditis underwent CMR including late gadolinium enhancement (LGE) parameters between 2002 and 2015 and were included and followed. We performed multivariable model for major adverse cardiovascular events (MACE) and determined the continuous net reclassification improvement by LGE markers.

Results

At a median follow-up of 4.7 years (interquartile range [IQR]: 2.3 to 7.3 years), 98 patients experienced a MACE. Two hundred ninety-four (44%) patients showed LGE presence, which was associated with a more than doubling risk of MACE (hazard ratio [HR]: 2.22; 95% confidence interval [CI]: 1.47 to 3.35; p < 0.001). Annualized MACE rates were 4.8% and 2.1% corresponding to LGE presence and absence, respectively (p < 0.001). In the multivariable model, LGE presence maintained significant association with MACE (HR: 1.72; 95% CI: 1.08 to 2.76; p = 0.023). The computed continuous net reclassification improvement was 0.39 (95% CI: 0.10 to 0.67) when LGE presence was added to the multivariable model for MACE. Regarding location and pattern, septal and midwall LGE showed strongest associations with MACE (HR: 2.55; 95% CI: 1.77 to 3.83 and HR: 2.39; 95% CI: 1.54 to 3.69, respectively; both p < 0.001). A patchy distribution portended to a near 3-fold increased hazard to MACE (HR: 2.93; 95% CI: 1.79 to 4.80; p < 0.001). LGE extent (per 10% increase) corresponded to a 79% increase in risk of MACE (HR: 1.79; 95% CI: 1.25 to 2.57; p = 0.002). A normal CMR study corresponded to low annual MACE and death rates of 0.8% and 0.3%, respectively.

Conclusions

CMR tissue characterization provides effective risk stratification in patients with suspected myocarditis.

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Low-Dose Ticagrelor Versus Clopidogrel in Patients With Prior Myocardial Infarction

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Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function: ITAMY Study

AbstractBackground

The prognostic role of cardiac magnetic resonance (CMR) and late gadolinium enhancement (LGE) has not been clarified in acute myocarditis (AM) with preserved left ventricular (LV) ejection fraction (EF).

Objectives

This study sought to evaluate the role of CMR and LGE in the prognosis of AM with preserved LVEF.

Methods

This study analyzed data from ITAMY (ITalian multicenter study on Acute MYocarditis) and evaluated CMR results from 386 patients (299 male; mean age 35 ± 15 years) with AM and preserved LVEF. Clinical follow-up was performed for a median of 1,572 days. A clinical combined endpoint of cardiac death, appropriate implantable cardioverter-defibrillator firing, resuscitated cardiac arrest, and hospitalization for heart failure was used.

Results

Among the 374 patients with suitable images, LGE involved the subepicardial layer inferior and lateral wall in 154 patients (41%; IL group), the midwall layer of the anteroseptal wall in 135 patients (36%; AS [anteroseptal] group), and other segments in 59 patients (16%; other-LGE group), and it was absent in 26 patients (no-LGE group). The AS group had a greater extent of LGE and a higher LV end-diastolic volume index than other groups, but levels of inflammatory markers were lower than in the other groups. Kaplan-Meier curve analysis indicated that the AS group had a worse prognosis than the other groups (p < 0.0001). Finally, in multivariable analysis, AS LGE was the best independent CMR predictor of the combined endpoint (odds ratio: 2.73; 95% confidence interval: 1.2 to 5.9; p = 0.01).

Conclusions

In patients with AM and preserved LVEF, LGE in the midwall layer of the AS myocardial segment is associated with a worse prognosis than other patterns of presentation.

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Reply: The Benefit of Cardiac Resynchronization Therapy Is Not Hindered by the Number of Comorbidities

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Prognosis in Myocarditis: Better Late Than (N)ever!

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Correction

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Patients With Brugada Syndrome and Implanted Cardioverter-Defibrillators: Long-Term Follow-Up

AbstractBackground

Implantable cardioverter-defibrillator (ICD) indications for primary prevention in Brugada syndrome (BrS) are still debated.

Objectives

The authors investigated the long-term outcome after ICD implantation in a large cohort of BrS patients.

Methods

Of a total of 370 patients with BrS in follow-up (age 43 ± 14 years; 74% male), 104 patients (28.1%) were treated with ICDs. The authors analyzed the long-term incidence of shocks and complications.

Results

An ICD was implanted for secondary prevention in 10 patients (9.6%) and for primary prevention in 94 patients (90.4%). After a follow-up of 9.3 ± 5.1 years, 21 patients (20.2%) experienced a total of 81 appropriate shocks (incidence rate 2.2 per 100 person-years). The rate of appropriate shocks was higher in secondary prevention patients (p < 0.01). However, 4 of the 45 asymptomatic patients (8.9%) experienced appropriate ICD therapy, all with a spontaneous type 1 electrocardiogram and inducible ventricular arrhythmias. In the multivariable analysis, type 1 electrocardiogram with syncope (hazard ratio: 4.96; 95% confidence interval: 1.87 to 13.14; p < 0.01) and secondary prevention indication (hazard ratio: 6.85; 95% confidence interval: 2.29 to 20.50; p < 0.01) were significant predictors of appropriate therapy. Nine patients (8.7%) experienced 37 inappropriate shocks (incidence rate 0.9 per 100 person-years). Twenty-one patients (20.2%) had other ICD-related complications (incidence rate 1.4 per 100 person-years). Three patients (2.9%) died (1 electrical storm and 2 noncardiovascular deaths).

Conclusions

ICD therapy is an effective therapy in high-risk patients with BrS. However, it is also associated with a significant risk of device-related complications. Special care during ICD implantation, adequate device programming, and regular follow-up may allow reducing the number of adverse events.

http://ift.tt/2wJRTg3

2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures

http://ift.tt/2wJ7yMQ

Brugada Syndrome: Lessons in Risk Tolerance, Communication, and Education?

http://ift.tt/2kBWlvW

Prediction of Mid-Term Outcomes in Adult Obstructive Hypertrophic Cardiomyopathy After Surgical Ventricular Septum Myectomy

http://ift.tt/2wJ7tZy

Glycated Apolipoprotein A-IV Induces Atherogenesis in Patients With CAD in Type 2 Diabetes

AbstractBackground

Nonenzymatic glycation of apolipoproteins plays a role in the pathogenesis of the vascular complications of diabetes.

Objectives

This study investigated whether apolipoprotein (apo) A-IV was glycated in patients with type 2 diabetes mellitus (T2DM) and whether apoA-IV glycation was related to coronary artery disease (CAD). The study also determined the biological effects of glycated apoA-IV.

Methods

The authors consecutively enrolled 204 patients with T2DM without CAD (Group I), 515 patients with T2DM with CAD (Group II), and 176 healthy subjects (control group) in this study. ApoA-IV was precipitated from ultracentrifugally isolated high-density lipoprotein, and its glycation level was determined based on Western blotting densitometry (relative intensity of apoA-IV glycation). ApoA-IV NE-(carboxylmethyl) lysine (CML) modification sites were identified by mass spectrometry in 37 control subjects, 63 patients in Group I, and 138 patients in Group II. Saline or glycated apoA-IV (g-apoA-IV) generated by glyoxal culture was injected into apoE^–/– mice to evaluate atherogenesis, and was also used for the cell experiments.

Results

The relative intensity and the abundance of apoA-IV glycation were associated with the presence and severity of CAD in patients with T2DM (all p < 0.05). The experiments showed that g-apoA-IV induced proinflammatory reactions in vitro and promoted atherogenesis in apoE^–/– mice through the nuclear receptor NR4A3. G-apoA-IV with mutations (K-A) at high-frequency glycation sites exhibited more weakened proinflammatory and atherogenic effects than did g-apoA-IV both in vitro and in vivo.

Conclusions

ApoA-IV glycation is associated with CAD severity in patients with T2DM, and g-apoA-IV induces atherogenesis through NR4A3 in apoE^–/– mice.

http://ift.tt/2wJ7Kf2

The Benefit of Cardiac Resynchronization Therapy Is Not Hindered by the Number of Comorbidities

http://ift.tt/2wIwlRf

The Role of Glycated Proteins on Cardiovascular Diabetic Complications: New Findings

http://ift.tt/2kBWi3e

Cardioprotective Properties of ANGPTL3 Deficiency

http://ift.tt/2wIaWaB

Development and preliminary validation of the Salzburg Stress Eating Scale

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Adrian Meule, Julia Reichenberger, Jens Blechert
Stress-related eating has long been a focus of study in several disciplines. Currently available psychometric scales conflate stress-related eating with emotional eating despite that not all stress states can be subsumed under some form of specific emotion. Moreover, existing measures primarily assess increased food intake in response to emotions and stress, thus ignoring evidence of decreased food intake in response to stress. Therefore, we drew from established stress concepts to develop the first genuine stress-related eating scale (Salzburg Stress Eating Scale [SSES]) in both German and English versions. In the SSES higher scores indicate eating more when stressed and lower scores indicate eating less when stressed. In study 1 (n = 340), the German SSES was found to have a one-factor structure (α = 0.89). SSES scores were weakly or moderately correlated with other eating-related constructs (e.g., emotional eating, body mass index [BMI]), and weakly correlated or uncorrelated with non-eating-related constructs (e.g., impulsivity, perceived stress); in addition, women had higher scores than men. Perceived stress moderated the association between stress eating and BMI, such that higher SSES scores were significantly related to higher BMI in individuals with high perceived stress, but not in individuals with low perceived stress. In studies 2 (n = 790) and 3 (n = 331), factor structure, internal consistency, and associations with sex and BMI were replicated for both German and English versions of the SSES. Hence, the SSES represents a psychometrically sound tool for the measurement of stress-related eating.



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Antidepressants promote formation of heterocomplexes of dopamine D2 and somatostatin subtype 5 receptors in the mouse striatum

Publication date: October 2017
Source:Brain Research Bulletin, Volume 135
Author(s): Kinga Szafran-Pilch, Agata Faron-Górecka, Magdalena Kolasa, Dariusz Żurawek, Marta Szlachta, Joanna Solich, Maciej Kuśmider, Marta Dziedzicka-Wasylewska
The interaction between the dopaminergic and somatostatinergic systems is considered to play a potential role in mood regulation. Chronic administration of antidepressants influences release of both neurotransmitters. The molecular basis of the functional cooperation may stem from the physical interaction of somatostatin receptor subtypes and dopamine D2 receptors since they colocalize in striatal interneurons and were shown to undergo ligand-dependent heterodimerization in heterologous expression systems. In present study we adapted in situ proximity ligation assay to investigate the occurrence of D2-Sst5 receptor heterocomplexes, and their possible alterations in the striatum of mice treated acutely and repeatedly (21days) with antidepressant drugs of different pharmacological profiles (escitalopram and desipramine). Additionally we analysed number of heterocomplexes in primary striatal neuronal cultures incubated with both antidepressant drugs for 1h and 6days. The studies revealed that antidepressants increase formation of D2-Sst5 receptors heterodimers. These findings provide interesting evidence that dopamine D2 and somatostatin Sst5 heterodimers may be considered as potential mediators of antidepressant effects, since the heterodimerization of these receptors occurs in native brain tissue as well as in primary striatal neuronal cultures where receptors are expressed at physiological levels.



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Polybrominated diphenyl ethers (PBDEs) in background air around the Aegean: implications for phase partitioning and size distribution

Abstract

The occurrence and atmospheric behavior of tri- to deca-polybrominated diphenyl ethers (PBDEs) were investigated during a 2-week campaign concurrently conducted in July 2012 at four background sites around the Aegean Sea. The study focused on the gas/particle (G/P) partitioning at three sites (Ag. Paraskevi/central Greece/suburban, Finokalia/southern Greece/remote coastal, and Urla/Turkey/rural coastal) and on the size distribution at two sites (Neochorouda/northern Greece/rural inland and Finokalia/southern Greece/remote coastal). The lowest mean total (G + P) concentrations of ∑₇PBDE (BDE-28, BDE-47, BDE-66, BDE-99, BDE-100, BDE-153, BDE-154) and BDE-209 (0.81 and 0.95 pg m⁻³, respectively) were found at the remote site Finokalia. Partitioning coefficients, K _P, were calculated, and their linear relationships with ambient temperature and the physicochemical properties of the analyzed PBDE congeners, i.e., the subcooled liquid pressure (P _L°) and the octanol-air partition coefficient (K _OA), were investigated. The equilibrium adsorption (P _L°-based) and absorption (K _OA-based) models, as well as a steady-state absorption model including an equilibrium and a non-equilibrium term, both being functions of log K _OA, were used to predict the fraction Φ of PBDEs associated with the particle phase. The steady-state model proved to be superior to predict G/P partitioning of BDE-209. The distribution of particle-bound PBDEs across size fractions < 0.95, 0.95–1.5, 1.5–3.0, 3.0–7.2, and > 7.2 μm indicated a positive correlation between the mass median aerodynamic diameter and log P _L° for the less brominated congeners, whereas a negative correlation was observed for the high brominated congeners. The potential source regions of PBDEs were acknowledged as a combination of long-range transport with short-distance sources.

http://ift.tt/2xtPniE

Tempo-spatial dynamics of water quality and its response to river flow in estuary of Taihu Lake based on GOCI imagery

Abstract

Knowledge of tempo-spatial dynamics of water quality and its response to river flow is important for the management of lake water quality because river discharge associated with rainstorms can be an important source of pollutants to the estuary. Total phosphorus (TP), chlorophyll a (Chl-a), and total suspended matter (TSM) are important indexes of water quality and important factors influencing eutrophication and algal blooms. In this study, remote sensing was used to monitor these indexes to investigate the effects of river discharge on the estuary of Taihu Lake by the largest inflow river which is Chendong River using a total of 136 Geostationary Ocean Color Images (GOCI). In situ datasets collected during the four cruise experiments on Taihu Lake between 2011 and 2015 were used to develop the TP, Chl-a, and TSM inversion models based on simple empirical algorithms: 154 points for TP (mg/L), 114 for Chl-a (μg/L), and 181 for TSM (mg/L). The spatial and temporal changes of the concentration of the three parameters in the Chendong River estuary were analyzed by combining the GOCI data, the flow of the Chendong River, and meteorological data throughout the year in 2014. The several key findings are as follows: (1) In summer and autumn, TP, Chl-a, and TSM contents were significantly higher than in winter and spring. TP and Chl-a have a few similar distribution characteristics. And organic suspended matter in summer was the main reason for the increase of the TSM concentration. (2) The severe surface erosion in the rivers cannot be ignored; the high erodibility is an important factor in the increase of TP and TSM concentrations in the estuary. The concentration of the water quality parameter showed exponential decay with distance from the shore. The concentration decreased slowly after 12 km and then remained essentially constant. (3) TP content in the Chendong River estuary decreased under steady flow inputs and dramatically increased when the flow became large. The increase in Chl-a content was linked to higher levels of TP and good weather conditions after the rain event. Higher flow rates mainly play a dilution role for the Chl-a concentration. Erosion of the surface soil via rainfall is a major source of TSM to the estuary. This paper firstly analyzes tempo-spatial dynamics of water quality and its response to river flow in estuary of Taihu Lake, helps to further understand the impact of river input on lake water quality, and is important for lake eutrophication.

http://ift.tt/2y8mRjP

Présentation atypique d’un lymphome du manteau

Publication date: Available online 6 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): L. Orgeolet, F. Staroz, M. Acquitter, P. Plantin, C. Fleuret




http://ift.tt/2za6bs4

Cosmétiques et médicaments topiques dans l’acné : où est la frontière ?

Publication date: Available online 6 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Poli, J.-P. Claudel, N. Auffret, M.-T. Leccia, B. Dréno
L'acné est une maladie chronique pouvant induire des séquelles telles que des cicatrices atrophiques ou hypertrophiques, ou de l'hyperpigmentation postinflammatoire. Les médicaments topiques ou systémiques ayant une activité pharmacologique et une autorisation de mise sur le marché sont les acteurs clés du traitement de l'acné. Ces traitements topiques ou systémiques induisent souvent des effets secondaires en lien avec l'altération de la barrière cutanée. Ils doivent donc être associés à des cosmétiques qui viseront à protéger la barrière cutanée. Avec l'arrivée sur le marché de produits cosmétiques contenant des ingrédients actifs évalués en laboratoire sur des cultures cellulaires ou des échantillons de tissus, et testés cliniquement sur un nombre souvent très limité de sujets, le monde des cosmétiques a changé. En utilisant le terme « dermo-cosmétique » et avec l'introduction d'ingrédients actifs dans les formulations, les cosmétiques se présentant aujourd'hui comme adaptés à une pathologie cutanée ne se limitent plus à l'entretien et l'hygiène de la peau, mais visent à apporter aux personnes souffrant de cette pathologie cutanée un produit complémentaire, voire une alternative aux médicaments. Le but de cet article est de mieux comprendre et clarifier le rôle respectif des médicaments topiques et des cosmétiques dans la prise en charge de l'acné.Acne is a chronic disease that may cause sequels such as atrophic or hypertrophic scars or post-inflammatory hyperpigmentation. Topical and systemic medications with proven pharmacologic activity and which have received marketing authorization are the key actors in the treatment of acne. However, these topical or systemic treatments frequently cause adverse effects related to impairment of the skin barrier, and cosmetics must therefore be used in combination to help protect the skin barrier. Nowadays, new cosmetic products containing active ingredients tested in vitro or in a small number of subjects have changed the world of cosmetics. In being described as "dermo-cosmetic" and in integrating active ingredients in their formulations, these cosmetics are now being presented as being specifically adapted for a given disease, and no longer limited to skin care and hygiene but suitable as an adjunctive or even an alternative to current medications. The aim of this article is to provide a better understanding of the respective roles of medications and cosmetics in the management of acne.



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Les syndromes d’Ehlers-Danlos

Publication date: Available online 9 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): D.-P. Germain
Les syndromes d'Ehlers-Danlos (SED) sont un groupe de maladies génétiques du tissu conjonctif caractérisées par une hyperélasticité cutanée, une hyperlaxité articulaire et une fragilité des tissus. Au-delà de ces caractéristiques communes, ils se distinguent les uns des autres par la présence ou l'absence de cicatrices cutanées, la variabilité des atteintes organiques et des variants génétiques différents. Il s'agit de maladies génétiques complexes, souvent invalidantes. La classification de Villefranche, établie en 1997, a défini 6 sous-types de SED mais de nombreuses autres formes rares ont été décrites depuis. À côté des classiques altérations de la synthèse du collagène sont à présent décrites des anomalies de la synthèse des glycosaminoglycanes ou de l'organisation de la matrice extracellulaire dues à des déficits enzymatiques et de nombreux SED rares ou apparentés sont de facto des maladies métaboliques. Il n'existe pas de traitement curatif des SED mais il importe de porter un diagnostic précoce pour une prise en charge symptomatique optimale des patients et une prévention des complications évitables. Une approche multidisciplinaire, dans un centre de référence, un centre de compétence, un service de dermatologie ou un service de génétique médicale, est souhaitable. Nous présentons un état actuel des connaissances sur ces pathologies que la génétique a permis de démembrer au fil des années.Ehlers-Danlos syndromes (EDS) are a heterogeneous group of inheritable connective tissue disorders characterized by skin hyperextensibility, joint hypermobility and cutaneous fragility with delayed wound healing. Over and above these common features, they differ in the presence or absence of various organ and tissue abnormalities, and differences in genetic causal mechanisms and degree of severity. They are complex and multisystem diseases, with the majority being highly disabling because of major joint problems and neurosensory deficiencies, and in some cases, they may be life-threatening due to associated complications, especially vascular disorders. In 1997, the Villefranche classification defined 6 subtypes of EDS. However, many other new variants have been described over the last years. The "historical" EDS were characterized by abnormalities in fibrillar collagen protein synthesis. More recently, disorders of synthesis and organization of the extracellular matrix have been shown to be responsible for other types of EDS. Thus, many EDS are in fact metabolic diseases related to enzymatic defects. While there is no curative treatment for any type of EDS, early diagnosis is of utmost importance in order to optimize the symptomatic management of patients and to prevent avoidable complications. Patients must be treated and monitored by multidisciplinary teams in highly specialized reference centers. In this article, we present the current state of knowledge on these diseases that continue to be elucidated thanks to new molecular genetic techniques.



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Impact of Moringa oleifera seed aqueous extract on some biological, biochemical, and histological aspects of Biomphalaria alexandrina snails

Abstract

Schistosomiasis is one of the neglected tropical diseases. It is a snail-borne trematode infection, and Biomphalaria alexandrina snails are the intermediate host of Schistosoma mansoni in Egypt. The objective of this study is to evaluate the molluscicidal activity of the aqueous seed extract of Moringa oleifera against B. alexandrina snails. The results showed that this aqueous extract was lethal for B. alexandrina snails (LC₅₀ 0.27 g/l; LC₉₀ 0.41 g/l). Exposure of snails to the sublethal concentrations of this aqueous extract caused a considerable reduction in survival rates and hatchability rates of eggs of these snails. Moreover, it negatively affected some biochemical aspects, where it increased the levels of transaminases (ALT and AST), while it decreased the concentrations of total protein, albumin, and globulin concentration. Histological examinations of the digestive gland of snails exposed to the sublethal concentrations of aqueous seed extract of M. oleifera revealed severe damage in the digestive cells, where they lost their tips and some were degenerated, while the secretory cells increased in number. Regarding the hermaphrodite gland, there were losses of connective tissues and irregular sperms, and the eggs were degenerated. These findings prove the potent activity of aqueous seed extract of M. oleifera against the intermediate hosts of Schistosoma mansoni and provide a considerable scope in exploiting local indigenous resources for snails' molluscicidal agents.

http://ift.tt/2y4yf2l

Precursor processes of human self-initiated action

Publication date: 15 January 2018
Source:NeuroImage, Volume 165
Author(s): Nima Khalighinejad, Aaron Schurger, Andrea Desantis, Leor Zmigrod, Patrick Haggard
A gradual buildup of electrical potential over motor areas precedes self-initiated movements. Recently, such "readiness potentials" (RPs) were attributed to stochastic fluctuations in neural activity. We developed a new experimental paradigm that operationalized self-initiated actions as endogenous 'skip' responses while waiting for target stimuli in a perceptual decision task. We compared these to a block of trials where participants could not choose when to skip, but were instead instructed to skip. Frequency and timing of motor action were therefore balanced across blocks, so that conditions differed only in how the timing of skip decisions was generated. We reasoned that across-trial variability of EEG could carry as much information about the source of skip decisions as the mean RP. EEG variability decreased more markedly prior to self-initiated compared to externally-triggered skip actions. This convergence suggests a consistent preparatory process prior to self-initiated action. A leaky stochastic accumulator model could reproduce this convergence given the additional assumption of a systematic decrease in input noise prior to self-initiated actions. Our results may provide a novel neurophysiological perspective on the topical debate regarding whether self-initiated actions arise from a deterministic neurocognitive process, or from neural stochasticity. We suggest that the key precursor of self-initiated action may manifest as a reduction in neural noise.



http://ift.tt/2hXr6uq

Facial soft tissue volume decreases during metreleptin treatment in patients with partial and generalized lipodystrophy

Abstract

Purpose

Lipodystrophy (LD) patients suffer from loss or maldistribution of subcutaneous adipose tissue accompanied by dysregulation of several adipocyte-secreted factors, e.g., leptin. The effect of recombinant leptin (metreleptin) therapy on facial soft tissue volume in patients with non-human immunodeficiency virus LD has not been quantified to date.

Methods

Eight LD patients (six female, two male; six familial partial LD [FPLD], two generalized LD) were treated with metreleptin over 1 year. Anthropometric parameters and 3D stereophotogrammetric imaging of the patients´ faces were assessed at baseline and after 1 year of metreleptin treatment.

Results

Median fat mass was significantly reduced during metreleptin treatment from 22.3 kg at baseline to 20.0 kg at 1 year (p = 0.031); however, body weight, body mass index, and waist-to-hip ratio were not significantly affected. Five of the six patients with FPLD lost between 4 and 114 cm³ of facial soft tissue volume in the pre-auricular, buccal, and submandibular area during metreleptin treatment whereas a slight volume gain was seen in one FPLD patient. The two patients with generalized LD developed a volume loss of 20 and 8 cm³ in the buccal region between baseline and 1 year of metreleptin therapy, respectively.

Conclusions

Metreleptin replacement leads to loss of facial soft tissue volume in FPLD and generalized LD. However, volume changes in most patients are not visible by the naked eye.

http://ift.tt/2hZC7LI

Facial soft tissue volume decreases during metreleptin treatment in patients with partial and generalized lipodystrophy

Abstract

Purpose

Lipodystrophy (LD) patients suffer from loss or maldistribution of subcutaneous adipose tissue accompanied by dysregulation of several adipocyte-secreted factors, e.g., leptin. The effect of recombinant leptin (metreleptin) therapy on facial soft tissue volume in patients with non-human immunodeficiency virus LD has not been quantified to date.

Methods

Eight LD patients (six female, two male; six familial partial LD [FPLD], two generalized LD) were treated with metreleptin over 1 year. Anthropometric parameters and 3D stereophotogrammetric imaging of the patients´ faces were assessed at baseline and after 1 year of metreleptin treatment.

Results

Median fat mass was significantly reduced during metreleptin treatment from 22.3 kg at baseline to 20.0 kg at 1 year (p = 0.031); however, body weight, body mass index, and waist-to-hip ratio were not significantly affected. Five of the six patients with FPLD lost between 4 and 114 cm³ of facial soft tissue volume in the pre-auricular, buccal, and submandibular area during metreleptin treatment whereas a slight volume gain was seen in one FPLD patient. The two patients with generalized LD developed a volume loss of 20 and 8 cm³ in the buccal region between baseline and 1 year of metreleptin therapy, respectively.

Conclusions

Metreleptin replacement leads to loss of facial soft tissue volume in FPLD and generalized LD. However, volume changes in most patients are not visible by the naked eye.

http://ift.tt/2hZC7LI

Intra- and inter-specific variations in chitin in lichens along a N-deposition gradient

Abstract

The mechanisms of nitrogen (N) tolerance in lichens are not yet fully understood. Here, we investigated how the increase of chitin content is related with N excess at inter- and intra-specific levels, by using species with differing ecological N tolerances (the tolerant Xanthoria parietina and Parmotrema hypoleucinum and the sensitive Evernia prunastri and Usnea sp.) and thalli of X. parietina and P. hypoleucinum from sites with different availabilities of N of agricultural origin (livestock), as confirmed by lichen N content and δ¹⁵N. Nitrogen, chitin (N-containing compound), and ergosterol contents were measured in lichen thalli. Nitrogen and chitin contents were higher in tolerant species than those in sensitive ones (inter-specific level) and in thalli collected from the N-polluted site than in thalli from the clean site (intra-specific level). We suggest that chitin contributes to N stress tolerance in lichens, and that excess N can be partially stored as chitin (non-toxic form) in the cell walls of tolerant species.

http://ift.tt/2yaAqAC

Corrigendum to “Risk of Early Recurrent Stroke in Symptomatic Carotid Stenosis” [Eur J Vasc Endovasc Surg 49/2 (2015) 137–144]

Publication date: Available online 9 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Sofia Strömberg, Annika Nordanstig, Tobias Bentzel, Klas Österberg, Göran M.L. Bergström




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Response to ‘Re. Lesson Learned with the Use of Iliac Branch Devices: Single Centre 10 Year Experience in 157 Consecutive Procedures’

Publication date: Available online 9 October 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Gianbattista Parlani, Gioele Simonte, Fabio Verzini




http://ift.tt/2xud2dS

Dataset on preparation of the phosphorylated counterparts of a Momordica charantia protein for studying antifungal activities against susceptible dose-dependent C. albicans to antimycotics

Publication date: December 2017
Source:Data in Brief, Volume 15
Author(s): Yuanbiao Qiao, Li Song, Chenchen Zhu, Qian Wang, Tianyan Guo, Yanhua Yan, Qingshan Li
The data presented here are related to a research article entitled "Development of a phosphorylated Momordica charantia protein system for inhibiting susceptible dose-dependent C. albicans to available antimycotics: An allosteric regulation of protein" (Qiao et al., 2017) [1]. The data set includes three portions: (1) a relationship between reaction velocities of protein phosphorylation as a function of the substrate concentrations, determined in enzymatic reactions in aid of protein kinases; (2) a result of antifungal susceptibility testing of C. albicans after it is selected in antimycotics; and (3) a comparison of protein expression in the susceptible dose-dependent fungus relative to the wild C. albicans. In the first portion, the relationship of reaction velocities and substrate concentrations is expressed as an output from the inverse variation model. All data and analyses are made publicly available and citied in the research article using a style for the Data in Brief.



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A Novel Reversible Logic Gate and Its Systematic Approach to Implement Cost-Efficient Arithmetic Logic Circuits Using QCA

Publication date: Available online 7 October 2017
Source:Data in Brief
Author(s): Peer Zahoor Ahmad, S.M.K. Quadri, Firdous Ahmad
Quantum-dot cellular automata, is an extremely small size and a powerless nanotechnology. It is the possible alternative to current CMOS technology. Reversible QCA logic is the most important issue at present time to reduce power losses. This paper presents a novel reversible logic gate called the F-Gate. It is simplest in design and a powerful technique to implement reversible logic. A systematic approach has been used to implement a novel single layer reversible Full-Adder, Full-Subtractor and a Full Adder-Subtractor using the F-Gate. The proposed Full Adder-Subtractor has achieved significant improvements in terms of overall circuit parameters among the most previously cost-efficient designs that exploit the inevitable nano-level issues to perform arithmetic computing. The proposed designs have been authenticated and simulated using QCADesigner tool ver. 2.0.3.



http://ift.tt/2xtZrmZ

Data demonstrating the role of peroxiredoxin 2 as important anti-oxidant system in lung homeostasis

Publication date: December 2017
Source:Data in Brief, Volume 15
Author(s): Enrica Federti, Alessandro Matte, Alessandra Ghigo, Immacolata Andolfo, Cimino James, Angela Siciliano, Christophe Leboeuf, Anne Janin, Francesco Manna, Soo Young Choi, Achille Iolascon, Elisabetta Beneduce, Davide Melisi, Dae Won Kim, Sonia Levi, Lucia De Franceschi
The data presented in this article are related to the research paper entitled "peroxiredoxin-2 plays a pivotal role as multimodal cytoprotector in the early phase of pulmonary hypertension" (Federti et al., 2017) [1]. Data show that the absence of peroxiredoxin-2 (Prx2) is associated with increased lung oxidation and pulmonary vascular endothelial dysfunction. Prx2^−/− mice displayed activation of the redox-sensitive transcriptional factors, NF-kB and Nrf2, and increased expression of cytoprotective system such as heme-oxygenase-1 (HO-1). We also noted increased expression of both markers of vascular activation and extracellular matrix remodeling. The administration of the recombinant fusion protein PEP Prx2 reduced the activation of NF-kB and Nrf2 and was paralleled by a decrease in HO-1 and in vascular endothelial abnormal activation. Prolonged hypoxia was used to trigger pulmonary artery hypertension (PAH). Prx2^−/− precociously developed PAH compared to wildtype animals.



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Drying kinetic of industrial cassava flour: Experimental data in view

Publication date: Available online 7 October 2017
Source:Data in Brief
Author(s): Oluwole A. Odetunmibi, Oluyemisi A. Adejumo, Pelumi E. Oguntunde, Hilary I. Okagbue, Adebowale O. Adejumo, Esivue A. Suleiman
In this data article, laboratory experimental investigation results on drying kinetic properties: the drying temperature (T), drying air velocity (V) and dewatering time (Te), each of the factors has five levels, and the experiment was replicated three times and the output: drying rate and drying time obtained, were observed. The experiment was conducted at National Centre for Agricultural Mechanization (NCAM) for a period of eight months, in 2014. Analysis of variance was carried out using randomized complete block design with factorial experiment on each of the outputs: Drying rate and drying times of the industrial cassava flour. A clear picture on each of these outputs was provided separately using tables and figures.It was observed that all the main factors as well as two and three ways interactions are significant at 5% level for both drying time and rate. This also implies that the rate of drying grated unfermented cassava mash, to produce industrial cassava flour, depend on the dewatering time (the initial moisture content), temperature of drying, velocity of drying air as well as the combinations of these factors altogether. It was also discovered that all the levels of each of these factors are significantly difference from one another. In summary, the time of drying is a function of the dewatering time which was responsible for the initial moisture content. The higher the initial moisture content the longer the time of drying, and the lower the initial moisture content, the lower the time of drying. Also, the higher the temperature of drying the shorter the time of drying and vice versa. Also, the air velocity effect on the drying process was significant. As velocity increases, rate of drying also increases and vice versa. Finally, it can be deduced that the drying kinetics are influenced by these processing factors.



http://ift.tt/2yAYDBM

Ixekizumab treatment for psoriasis: Integrated efficacy analysis of three double-blinded, controlled studies (UNCOVER-1, UNCOVER-2, UNCOVER-3)

Abstract

Background

Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin (IL)-17A, is approved for the treatment of moderate-to-severe psoriasis.

Objectives

This analysis represents an overview of the efficacy outcomes from three Phase 3 psoriasis studies.

Methods

Data were integrated from the 12-week induction period of three studies in which patients received ixekizumab 80 mg every 2 (IXE Q2W; N=1169) or 4 weeks (IXE Q4W; N=1165) after an initial 160-mg dose for both, etanercept (ETN) (50 mg biweekly; N=740; two studies), or placebo (PBO) (N=792). The co-primary endpoints were the percentages of patients with response of sPGA (0,1) and a 75% improvement in baseline psoriasis area severity index (PASI 75) at Week 12. Response rates were compared between treatments using the Cochran-Mantel-Haenszel test stratified by study. Treatment comparisons with placebo included data from three studies, whereas etanercept comparisons were based on two studies.

Results

Ixekizumab treatment was superior to placebo (p<0.001) and etanercept (p<0.001) on sPGA (0,1) and PASI 75, with significant differences in PASI improvement at Week 1. With IXE Q2W, at Week 12, the frequency of patients achieving PASI 75/90/100 was nearly 90%/70%/40%, respectively. Ixekizumab-treated patients showed significantly greater improvement versus placebo and etanercept in percent body surface area involvement and fingernail psoriasis. IXE Q2W was superior to IXE Q4W on all treatment outcomes.

Conclusions

Ixekizumab therapy at both dosing regimens demonstrated rapid onset and superior efficacy compared with placebo and etanercept, with IXE Q2W providing better outcomes than IXE Q4W during the first 12 weeks of treatment.

This article is protected by copyright. All rights reserved.

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No Elevated Risk for Depression, Anxiety, or Suicidality with Secukinumab in a Pooled Analysis of Data from 10 Clinical Studies in Moderate-to-Severe Plaque Psoriasis

Abstract

Concerns have emerged over the potential for brodalumab, a monoclonal antibody that binds to the human interleukin (IL)-17 receptor A and blocks the activity of multiple IL-17 isoforms, to increase risk of suicidal ideation and behaviour. Although the validity of this association has been questioned,^1,2 brodalumab has a boxed warning regarding suicidality in its US label and is only available through a Risk Evaluation and Mitigation Strategy. Regardless of the true association between suicidality and brodalumab, the demonstrated adverse impact of psoriasis on mental health necessitates careful assessment for possible psychiatric adverse effects of psoriasis therapies, including those that inhibit the IL-17 pathway.

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The prevalence of psychological co-morbidity in people with vitiligo: a systematic review and meta-analysis

Abstract

Background

Vitiligo is a chronic disorder causing skin depigmentation with global prevalence varying from 0.2 to 1.8%. UK guidelines recommend assessment of psychological state during clinical evaluation of vitiligo. However, the prevalence of psychological co-morbidity in people with vitiligo has not been described.

Objectives

We aimed to establish the prevalence of psychological symptoms or disorders in people with vitiligo and describe the outcome measures used.

Methods

We performed a comprehensive search of MEDLINE, Embase, CINAHL and PsychInfo to identify observational studies assessing the prevalence of psychological symptoms or disorders (December 2016). DerSimonian and Lard random-effects models were utilized to estimate the overall pooled prevalence.

Results

We identified 29 studies with 2530 people with vitiligo. Most studies included a measure of either depression (n=25) or anxiety (n=13).The commonest tools were the Hospital Anxiety and Depression Scale and the Centre for Epidemiology Studies Depression Scale. Ten studies provided information on thirteen other psychological outcomes. Pooled prevalence using depression-specific and anxiety-specific questionnaires was 0.29 (95%CI 0.21, 0.38) and 0.33 (95%CI 0.18, 0.49) respectively. Prevalence was lower for clinically diagnosed depression (0.21; 95%CI 0.15, 0.28) and anxiety (0.15; 95%CI 0.06, 0.24). When non-specific tools were used the prevalence remained similar for depression (0.27; 95%CI 0.08, 0.46) but increased for anxiety (0.46; 95% CI 0.39, 0.52). High heterogeneity was observed.

Conclusions

A range of psychological outcomes are common in people with vitiligo. The prevalence of anxiety was influenced by type of screening tool, suggesting validation of psychological outcome screening tools in the field of dermatology.

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Low dose naltrexone: a novel treatment for Hailey-Hailey disease

Summary

Hailey-Hailey disease (chronic benign familial pemphigus) is a rare inherited dermatosis typically characterised by erosions at intertriginous sites preceded by minor trauma or stress. We report a case of treatment resistant Hailey-Hailey disease, having failed topical and oral steroids, prophylactic acyclovir and doxycycline, and systemic therapies including dapsone, acitretin and ciclosporin. Low dose naltrexone (LDN) 4.5mg one daily was commenced following an incidental benefit in this patient's similarly affected sister. The clinical and psychological response to date has been considerable.

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Magnetic Resonance Imaging Appearance of Schwannomas from Head to Toe: A Pictorial Review

Jamie Crist, Jacob R Hodge, Matthew Frick, Fiona P Leung, Eugene Hsu, Ming Tye Gi, Sudhakar K Venkatesh

Journal of Clinical Imaging Science 2017 7(1):38-38

Schwannomas are benign soft-tissue tumors that arise from peripheral nerve sheaths throughout the body and are commonly encountered in patients with neurofibromatosis Type 2. The vast majority of schwannomas are benign, with rare cases of malignant transformation reported. In this pictorial review, we discuss the magnetic resonance imaging (MRI) appearance of schwannomas by demonstrating a collection of tumors from different parts of the body that exhibit similar MRI characteristics. We review strategies to distinguish schwannomas from malignant soft-tissue tumors while exploring the anatomic and histologic origins of these tumors to discuss how this correlates with their imaging findings. Familiarity with the MRI appearance of schwannomas can help aid in the differential diagnosis of soft-tissue masses, especially in unexpected locations.

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Bedside Ultrasound in the Diagnosis and Treatment of Children with Respiratory Difficulty Following Cardiac Surgery

Hussam Kanaan Hamadah, Mohamed Salim Kabbani

Journal of Clinical Imaging Science 2017 7(1):37-37

Many children frequently fail extubation or require a prolonged period of positive pressure ventilation support after cardiac surgery. Pediatric cardiac Intensive Care Unit (PCICU) ultrasound (US) stands as a simple, basic bedside tool that can be performed by trained intensivists for the diagnosis with immediate implication on therapeutic decisions in multiple scenarios that physicians may face in PCICU. Bedside US is widely available, convenient, and inexpensive. This educational article based mainly on our own experience is highlighting the role of US in detecting the most common causes of respiratory weaning difficulties and extubation failure in postoperative cardiac children through proposed illustration and algorithm.

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Liver Perivascular Epithelioid Cell Tumor with an Unusual Location: Diagnostic Characteristics with Multidetector Computed Tomography and Magnetic Resonance Imaging

Koray Hekimoglu, Murat Haberal

Journal of Clinical Imaging Science 2017 7(1):36-36

Primary perivascular epithelioid cell tumor (PEComa) of the liver is a very rare tumor that originates from mesenchyma. Gastrointestinal tract with perivascular distribution is the most common anatomic sites of these tumors. Only few cases of hepatic PEComa have been described so far. Malignant PEComas exhibit aggressive behavior with poor prognosis, making early diagnosis crucial. Hereby, we report a 79-year-old female with unusually located mass in the liver. A partial curative hepatectomy has been done, and PEComa was diagnosed histopathologically. No evidence of recurrence was observed during the 6-month follow-up.

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Brain energetics during the sleep–wake cycle

Publication date: December 2017
Source:Current Opinion in Neurobiology, Volume 47
Author(s): Mauro DiNuzzo, Maiken Nedergaard
Brain activity during wakefulness is associated with high metabolic rates that are believed to support information processing and memory encoding. In spite of loss of consciousness, sleep still carries a substantial energy cost. Experimental evidence supports a cerebral metabolic shift taking place during sleep that suppresses aerobic glycolysis, a hallmark of environment-oriented waking behavior and synaptic plasticity. Recent studies reveal that glial astrocytes respond to the reduction of wake-promoting neuromodulators by regulating volume, composition and glymphatic drainage of interstitial fluid. These events are accompanied by changes in neuronal discharge patterns, astrocyte–neuron interactions, synaptic transactions and underlying metabolic features. Internally-generated neuronal activity and network homeostasis are proposed to account for the high sleep-related energy demand.



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An adult with atrial septal defect presenting with a brain abscess

Bijesh Ravindran Nair, Edmond Jonathan, Ranjith Krishna Moorthy, Vedantam Rajshekhar, Oommen George

Asian Journal of Neurosurgery 2017 12(4):743-745

The common heart diseases resulting in a brain abscess are associated with a right to left shunt and include tetralogy of Fallot and transposition of great vessels. Atrial septal defect (ASD) is almost always associated with the left to right shunt and therefore is not a commonly considered risk factor for brain abscess. We report the case of a 29-year-old male, with no symptoms of cardiac disease, who presented with the left posterior frontal pyogenic abscess which led to the detection of a silent ASD. Our case emphasizes the need for a careful evaluation of the source of infection in patients with a brain abscess.

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Pure intra-optic canal schwannoma: Report of two cases

Sayuru Miyamura, Satoshi Yamaguchi, Masaaki Takeda, Takafumi Mitsuhara, Masahiro Hosogai, Kazuhiko Sugiyama, Kaoru Kurisu

Asian Journal of Neurosurgery 2017 12(4):797-800

We report two cases of "pure intra-optic-canal schwannoma." The first patient was a 67-year-old female who presented with a visual field defect and visual impairment in the right eye, and the second patient was a 17-year-old female with progressive visual impairment. Both patients underwent tumor resection through frontotemporal craniotomy combined with extradural anterior clinoidectomy and unroofing of the optic canal. The tumors were not attached to the optic nerve (ON) and were located exclusively inside the optic canal. In both cases, the histological diagnosis was schwannoma. Although the origin of pure intra-optic-canal schwannoma is controversial, intra-operative findings suggested that in these cases, the tumors arose from the sympathetic nerve around the ON.

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Organized chronic subdural hematomas treated by large craniotomy with extended membranectomy as the initial treatment

Mustafa Balevi

Asian Journal of Neurosurgery 2017 12(4):598-604

Objective: The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH). Materials and Methods: We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance – mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24–72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH). Results: Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients (n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%. Conclusion: Large craniotomy and extended membrane excision for OSDH still carry a high rate of mortality and morbidity in elderly patients. TP, RSH, and postoperative seizures are frequently seen complications in elderly patients.

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Calvarial-orbital metastasis of prostate carcinoma which was diagnosed with sixth cranial nerve palsy

Zühtü Ozbek, Emre Özkara, Deniz Arik, Metin Atasoy Ant

Asian Journal of Neurosurgery 2017 12(4):769-771

Sixth nerve palsy is frequently due to infectious orbital lesions, trauma, elevated intracranial pressure, brainstem lesions, and vasculopathies. Here, we describe a rare cause of sixth cranial nerve (CN) palsy secondary to calvarial and orbital metastasis of prostate carcinoma. The diagnosis of the prostate carcinoma with sixth CN palsy is a very rare condition. A 66-year-old male patient presented with complaints of blurred vision, double vision, and inability to move outward in the right eye for 3 weeks. Magnetic resonance imaging revealed a right orbitocalvarial mass and the mass surgically removed completely. Pathologic findings were compatible with prostate adenocarcinoma metastasis. After surgical removal, significant improvement in sixth CN palsy was observed.

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Endoscopic third ventriculostomy in normal pressure hydrocephalus and symptomatic long-standing overt ventriculomegaly

Mustafa Balevi

Asian Journal of Neurosurgery 2017 12(4):605-612

Objectives: The aim of this study is to define the role and effectiveness for an endoscopic third ventriculostomy (ETV) in patients with seconder normal pressure hydrocephalus(SNPH), idiopathic normal pressure hydrocephalus (INPH) and symptomatic longstanding overt ventriculomegaly (SLOVA). Materials and Methods: 3 patients with SLOVA, 3 patients with INPH and 3 patients with SNPH underwent ETV were studied retrospectively. The patients had a follow-up of 1-6 years. Preoperative CT or/and MRI of the brain was done in all cases.Tap test was done in all cases. Clinical examination finding were classified according to the by Japanese Committee for Scientific Research (JCSS) on intractable Hydrocephalus. Patients were studied to evaluate of the patency of ventriculosthomy and aqueduclus slyvius by a Cine PC MR and CSF_DRİVE T2 Sequence MRI after 1-6 years. Results: Headache, gait disturbance and pollakiuria improved in three patients with SNPH underwent ETV, but dementia didn't improve in one patient. Pollakiuria and headache improved in three patients with INPH underwent ETV but preoperative gait disturbance grade three remained unchanged in one patient. Headache improved in three patients with SLOVA underwent ETV. Preoperative gait disturbance grade 3 remained unchanged in one patient, but improved pollakiuria. We confirmed the patency of a third ventriculostomy and decreasing degrees of CSF flow into the aquaductus sylvius. Conclusions: In properly selected patients with SNPH, SLOVA and INPH who had headache ,slight gait disturbance and pollakiuria , mainly those with a short duration of symptoms, ETV may provide good results.

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Occipital intraparenchymal myxopapillary ependymoma: Case report and literature review

Tushit Bharat Mewada, Ishu Hetram Bishnoi, Hukum Singh, Daljit Singh

Asian Journal of Neurosurgery 2017 12(4):731-734

Myxopapillary ependymoma (MPE) is a histological variant of ependymoma found in the conus medullaris or filum terminale region. Intracranial occurrence of the tumor is a rarity. The most characteristic histological feature of myxopapillary tumors is the abundance of intercellular and perivascular mucin and the arborizing vasculature, which tends to form papillae. We are reporting a 14-year-old patient presented with seizures caused by the right occipital region intraparenchymal lesion. Histopathology confirmed it to be MPE. Lesion was excised completely. Literature reviews on the topic are discussed regarding the histological findings, natural history, and outcome of surgically treated MPE. This is the fifth reported case of cerebral intraparenchymal primary MPE.

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Formulation and characterization of nanomedicine (solid lipid nanoparticle) associate with the extract of Pterospermum acerifolium for the screening of neurochemicals and neuroendocrine effects

Ankur Choubey, Ritu Gilhotra, Santosh Kumar Singh, Gopal Garg

Asian Journal of Neurosurgery 2017 12(4):613-619

Background: Nanotechnology has given the likelihood of conveying medications to particular cells utilizing nanoparticles. Nanosystems can convey the dynamic constituent at an adequate fixation amid the whole treatment time frame, guiding it to the fancied site of activity. Traditional medications do not meet these necessities. The fundamental motivation behind creating elective medication conveyance advancements is to expand effectiveness of medication conveyance and security during the time spent medication conveyance and give more accommodation to the patient. Objectives: Pterospermum acerifolium, basic plant in India, is viewed as carminative, stimulant, and emmenagogue. The improvement of control discharge conveyance systems could prompt huge preferences in the clinical employments of these medications to diminish the toxicities. The point of this study was to figure another conveyance framework for impacts of neurochemicals by the joining of concentrate of P. acerifolium into strong lipid nanoparticles (SLNs). Methods: SLN formulations were prepared by Ethanolic extract, lipid layer was liquefied by warming at 5°C above liquefying purpose of the lipid. After that, SLNs were separated and dried. Shape and surface morphology of the SLNs were pictured by checking scanning electron microscopy. Particle size and size distribution were dictated by photon connection spectroscopy. Results and Discussion: The change of molecule charge was contemplated by zeta potential estimations. Treatment with SLN with concentrate was found to altogether diminish the serum levels of adrenocorticotropic hormone (ACTH), corticosterone and-endorphin and in addition the cerebrum and serum level of norepinephrine. Moreover, SLN with concentrate could essentially turn around the constant anxiety by diminishing the cerebrum and serum levels of the monoamine neurotransmitters dopamine, 5-hydroxytryptamine. Conclusion: The outcomes got from this study recommended that the memory-improving impact of SLN with concentrate was interceded through directions of neurochemical and neuroendocrine frameworks.

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Thrombosed giant “True” posterior communicating artery aneurysm treated by trapping and thrombectomy

Yuichi Mochizuki, Akitsugu Kawashima, Koji Yamaguch, Yoshikazu Okada

Asian Journal of Neurosurgery 2017 12(4):757-759

Giant "true" posterior communicating artery (PCOM) aneurysms are rare and the best surgical treatment for them is unclear. We present a case of 85-year-old woman with this type of lesion, 35 mm in diameter, successfully treated by trapping and thrombectomy via pterional approach without complications. There were no perforating arteries originating from the aneurysmal wall. The patient had an uneventful postoperative course. The key for successful treatment for such lesions is preservation of perforators, as trapping may result in ischemic complications. However, our case indicates that trapping and thrombectomy might have relatively low risks for development of such complications, supposing that the thrombosis within the giant "true" PCOM aneurysm induced spontaneous obliteration of perforators, arising from the aneurysmal dome, and that collateral flow from the posterior cerebral artery already compensated the corresponding territories.

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Outcomes of minimally invasive surgery compared to open posterior lumbar instrumentation and fusion

Low Yong Lee, Zamzuri Idris, Tan Boon Beng, Teo Yian Young, Wong Chung Chek, Jafri Malin Abdullah, Wong Sii Hieng

Asian Journal of Neurosurgery 2017 12(4):620-637

Introduction: Degenerative spine disease is increasingly common. There are many spinal fusion techniques used to treat degenerative spine disease. This study aims to compare the functional outcome of open versus minimally invasive surgery (MIS) technique in posterior lumbar instrumentation and fusion in degenerative spine disease and to evaluate the perioperative outcome and complications between MIS and open surgery. Materials and Methods: This is an observational cross-sectional study conducted on all degenerative spine disease patients who underwent both methods of posterior lumbar instrumentation and fusion from 2010 to 2014 by the Orthopedic and Neurosurgery Department, Sarawak General Hospital. The analyzed variables were method of surgery and the levels involved, demographic data, estimated blood loss, duration of operation, length of hospitalization, visual analog scale of back pain and radicular pain preoperative, postoperative 1 month, 3 months, 6 months, 1 year, and functional outcome. Results: One hundred and twenty-two patients underwent posterior lumbar instrumentation and fusion from 2010 to 2014. Seventy patients were subjected to MIS transforaminal lumbar interbody fusion (TLIF) and 52 open TLIF. Total 89 patients underwent single level of lumbar fusion with sixty patients in MIS group and 29 in open surgeries. MIS TLIF has less estimated blood loss and shorter hospitalization and longer operation time compared to open TLIF, which were statistically significance. MIS TLIF has statistically significance better functional outcome based on Oswestry disability index, Modified NASS score, and RAND 36-item Health Survey 1.0 score. Complications such as infection, new onsets of neurological, and dural tear are equal in both methods of surgery. Conclusion: This study concluded that MIS has better functional outcome compared to open TLIF with shorter hospitalization, faster return to work, and less estimated blood loss.

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A case of high-dose adenosine usage for anterior communicating artery aneurysm clip ligation: What is the dose limit for a resistant response?

Shahid M Nimjee, David L McDonagh, Abhishek Agrawal, Gavin W Britz

Asian Journal of Neurosurgery 2017 12(4):783-786

Intraoperative adenosine is used to induce asystole to facilitate clip ligation of intracranial aneurysms. Typically, 5–10 mg doses are used per administration and approximately 30 mg is used for a given case. An obvious concern with using adenosine is that the patient can remain in asystole or that prolonged hypotension can result in cerebral or cardiovascular ischemia. The upper limit of adenosine administration remains unclear. We present a case of a patient with a large anterior communicating artery aneurysm requiring large doses of adenosine, far exceeding previously reported cases. The patient received a 90 mg dose of adenosine to achieve 5 s of asystole as well as 30 s of hypotension that facilitated vessel dissection and clip application. Moreover, in order to successfully clip his aneurysm, he received a total of 744 mg of adenosine. After each administration of adenosine, his heart rate and blood pressure returned to baseline without the need for chest compressions or other interventions. He tolerated the procedure and had a good neurological outcome. This case is the first report of using such a high dose of adenosine in intracranial aneurysm surgery and suggests that more aggressive administration of adenosine during aneurysm clipping is feasible. Transient hypotension, as seen in this report, can provide surgeons the crucial moments they need to safely secure an aneurysm from circulation.

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Intraoperative anatomical and hemodynamic analysis of intracerebral arteriovenous malformations by semi-quantitative color-coded indocyanine green videoangiography

Yoko Kato, Yasuhiro Yamada, Akiyo Sadato, Mohsen Nouri, Iype Cherian, Teppei Tanaka, Joji Inamasu

Asian Journal of Neurosurgery 2017 12(4):638-643

Objective and Background: To evaluate possible roles for indocyanine green (ICG)-based FLOW 800 software in surgical treatment of cerebral arteriovenous malformations (AVMs). Methods: We perform ICG videoangiography several times for each step of AVM resection to elucidate feeders, drainers, and cerebral perfusion. Results: Since 2010, 22 AVM surgeries in our department have been conducted using FLOW 800 intraoperatively. We demonstrated ICG angiograms, color-coded images, and semi-quantitative curves for AVMs. By reviewing all these modalities, we would define vascular structure of the AVM, proceed with resection, and finally recheck for any remnant. Conclusions: ICG FLOW 800 software helps the surgeon to recognize feeding and draining vessels of an AVM intraoperatively. Further studies to evaluate semi-quantitative acquired data regarding blood flow and tissue perfusion are warranted.

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Trigeminal neuralgia

Yad Ram Yadav, Yadav Nishtha, Pande Sonjjay, Parihar Vijay, Ratre Shailendra, Khare Yatin

Asian Journal of Neurosurgery 2017 12(4):585-597

Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Type 1 as intermittent and Type 2 as constant pain represent distinct clinical, pathological, and prognostic entities. Although multiple mechanism involving peripheral pathologies at root (compression or traction), and dysfunctions of brain stem, basal ganglion, and cortical pain modulatory mechanisms could have role, neurovascular conflict is the most accepted theory. Diagnosis is essentially clinically; magnetic resonance imaging is useful to rule out secondary causes, detect pathological changes in affected root and neurovascular compression (NVC). Carbamazepine is the drug of choice; oxcarbazepine, baclofen, lamotrigine, phenytoin, and topiramate are also useful. Multidrug regimens and multidisciplinary approaches are useful in selected patients. Microvascular decompression is surgical treatment of choice in TN resistant to medical management. Patients with significant medical comorbidities, without NVC and multiple sclerosis are generally recommended to undergo gamma knife radiosurgery, percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation procedures. Partial sensory root sectioning is indicated in negative vessel explorations during surgery and large intraneural vein. Endoscopic technique can be used alone for vascular decompression or as an adjuvant to microscope. It allows better visualization of vascular conflict and entire root from pons to ganglion including ventral aspect. The effectiveness and completeness of decompression can be assessed and new vascular conflicts that may be missed by microscope can be identified. It requires less brain retraction.

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Predictive value of motor evoked potential monitoring during surgery of unruptured anterior circulation cerebral aneurysms

Yasuhiro Yamada, Yoko Kato, Mohsen Nouri, Tsukasa Ganaha, Motoki Oheda, Kohei Ishihara, Shigeta Moriya, Akiyo Sadato, Joji Inamasu, Yuichi Hirose

Asian Journal of Neurosurgery 2017 12(4):644-647

Objective and Background: Surgery of unruptured aneurysms is always a great challenge to neurovascular surgeons because no postoperative neurological deficits should be expected postoperatively as the patients are fully asymptomatic before the surgery. Here, we present our experience with selective motor evoked potential (MEP) monitoring of our patients in a 2-year time window. Patients and Methods: From 2012 to 2014, 27 patients with unruptured intracranial aneurysms were operated in our institute with the help of MEP monitoring. All patients underwent endoscope-assisted microsurgery with pre- and post-clipping indocyanine green angiography. Results: In this period, no mortality was observed, but 18.5% of the patients developed postoperative deficits which showed good recovery in all cases. Overall, MEP showed about 90% accuracy in predicting postoperative deficits. Conclusions: MEP as a part of multimodality monitoring of aneurysm surgeries is a valuable tool to improve the outcome. However, we should know its limitations as its results are not always consistent with the outcome.

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Scrotal migration of tubing: An unusual complication after ventriculo-peritoneal shunt

Monika Bawa, Saurabh Garge, Ravi Garg, Katragadda Lakshmi Narasimha Rao

Asian Journal of Neurosurgery 2017 12(4):738-740

Scrotal migration of peritoneal end of ventriculo-peritoneal (VP) shunt into the patent processus vaginalis (PPV) is a rare complication. Its exact incidence is not mentioned in the literature till date. This may be because of the rarity of this complication, and also because all previous articles related to the complication were case reports. We, in our series, had an incidence of 0.9%. This prospective study has been conducted on 437 patients in the age group of 1 month–3 years who underwent VP shunt for hydrocephalus over a period of 5 years from 2007 to 2011. The incidence of a hernia manifesting after shunt insertion has been reported to be around 16.8%. The average age of patients at the time of insertion of the shunt was 27.25 months (3–48 months). All our patients presented with swollen right sided scrotum after an average of 4 months (3–5 months) after shunt insertion. Shunt migration was more common on the right which is consistent with the incidence of hernias in children. The proper management of such cases includes repositioning of the catheter with the proper closure of the PPV. Usually, shunt revision is not required. We discuss the etiology, treatment and preventive measures of this rare entity.

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Contributing factors for coagulopathy in traumatic brain injury

Ajit Shrestha, Ramesh Man Joshi, Upendra Prasad Devkota

Asian Journal of Neurosurgery 2017 12(4):648-652

Context: In traumatic brain injury patients, coagulation disorder causes secondary brain injury, thereby increasing mortality and morbidity. Aims: The aim of this study is to identify the factors responsible for coagulopathy in traumatic brain injury. Settings and Design: This prospective longitudinal study from June 2012 included 100 patients with moderate and severe head injury presenting to National Institute of Neurological and Allied Sciences, Kathmandu, over 1-year period. Subjects and Methods: Patients were evaluated for the development of coagulopathy, defined as collectively three abnormal hemostatic parameters, and associated risk factors for coagulopathy. They were then analyzed for correlation with coagulopathy. Statistical Analysis Used: SPSS version 16 was used for the analysis of data. For identification of contributing factors, a stepwise logistic regression analysis was performed, including the factors with P < 0.05 from the analysis. Results: Among the 100 patients, coagulopathy was present in 63% of cohort. Forty-three patients had severe head injury, and 76.7% (n = 33) of them had coagulopathy compared to 52.7% (n = 30) in 57 patients with moderate head injury (P = 0.013). Statistically significant correlation with coagulopathy was present with polytrauma, severity of head injury, blood transfusion, surgical intervention, and Marshall's classification of CT of the head; however, stepwise logistic regression analysis showed that blood transfusion, surgical intervention, polytrauma, and severity of head injury were significant independent variables responsible for the development of coagulopathy. Conclusions: Traumatic brain injury is complicated with coagulopathy in up to 63% of patients. Blood transfusion, surgical intervention, polytrauma, and severity of head injury are significant independent variables responsible for coagulopathy.

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