Improving pregnancy outcome in obese women: the UK Pregnancies Better Eating and Activity randomised controlled Trial.

The study found that the UPBEAT intervention, an intense theoretically based intervention in obese pregnant women which combined dietary and PA advice, did not reduce the risk of gestational diabetes mellitus or large-for-gestational age infants, despite successfully reducing the dietary glycaemic load.

http://ift.tt/2suRo6I

When Doctors and Parents Disagree: Ethics, Paediatrics & the Zone of Parental Discretion.

http://ift.tt/2sZQq6c

Evaluation of the effectiveness and cost-effectiveness of lightweight fibreglass heel casts in the management of ulcers of the heel in diabetes: a randomised controlled trial.

Lightweight fibreglass heel casts did not improve healing of diabetic heel ulcer healing over usual care and the economic analysis showed that usual care was cheaper.

http://ift.tt/2svbJJ7

Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer study).

This pilot RCT of debt counselling in primary care terminated early due to low recruitment and identified lessons for future RCTs of complex interventions among deprived populations.

http://ift.tt/2sZXBex

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project.

The study has produced results that have significantly enhanced the existing knowledge and understanding of type 2 diabetes mellitus and impaired glucose regulation in people with intellectual disability.

http://ift.tt/2svjK0K

Social climate in forensic mental health settings: A systematic review of qualitative studies

Publication date: Available online 30 June 2017
Source:Aggression and Violent Behavior
Author(s): Patrick Doyle, Ethel Quayle, Emily Newman
Social climate is a commonly evaluated aspect of inpatient forensic mental health settings. However, there is little clarity in the literature on the components of social climate. To identify these components, qualitative studies of staff and patient experiences of social climate were systematically reviewed using best fit framework synthesis. An a priori framework was developed based on nine existing models of social climate. A systematic search identified twenty studies of sufficient quality to be included in the review. These studies included staff and patient perspectives across all levels of inpatient forensic settings. In all twenty-two themes were identified in the review papers. From these themes, a model of social climate was developed. Seven factors were identified as part of the social climate, including the therapeutic relationship, care and treatment orientation, the secure base and four aspects of the ward environment. The findings indicate that common measures of social climate may not fully represent the construct. Themes related to the patient group, the staff group, the physical environment and system level factors were identified as influencing social climate. The model described allows for consideration of interventions to positively influence social climate.



http://ift.tt/2tu9Pwy

Overt attacks and covert thoughts

Publication date: Available online 30 June 2017
Source:Aggression and Violent Behavior
Author(s): Giti Zahedzadeh
The process in which an individual moves from radical opinion to violent action is of immense interest to law enforcement and counterterrorism agencies. A deep understanding of these processes could help in the complex pursuit to thwart terrorism. Our goal is to gain insight into the thought processes of a lone wolf terrorist prior to an event. Herein, we consider the case of the Army psychiatrist Major Nidal Malik Hasan. Utilizing a novel web-based text analysis environment that helps visualize the distribution of words within a single text corpus, we analyze Hasan's presentation at Walter Reed Medical Center in 2007 and his secret messages to Anwar al-Awlaki in 2009. We show that the analysis of the content of Hasan's speech and his correspondence can reveal his intention and motivation. The use of a case analysis of Nidal Hasan is unique, in that he was directly corresponding with a senior member of al-Qaeda, while he was an active duty Army officer. Thus, this paper contributes to our understanding of intent and thought patterns of some lone wolf terrorists.



http://ift.tt/2usbi3T

Editorial Board ((ofc))

Publication date: June 2017
Source:Acta Histochemica, Volume 119, Issue 5





http://ift.tt/2tujDa1

VideoEndocrinology™ High-Impact Videos

VideoEndocrinology™
The Official Journal of: American Thyroid Association

FREE ACCESS through July 14, 2017.

Retroperitoneal Paraganglioma Resected Through the Posterior Retroperitoneoscopic Approach
Thanyawat Sasanakietkul, Tobias Carling

Survival in Patients with Medullary Thyroid Cancer After Less Extensive Operations
Reese W. Randle, Maria F. Bates, David F. Schneider, Rebecca S. Sippel, Susan C. Pitt

Personalized Selection Criteria for Radioiodine Administration in Low- and Intermediate-Risk Papillary Thyroid Carcinoma
Clinton D. Bahler, Viraj Maniar, Kristen N. Marley, Steven V. Kheyfets, Cheuk Fan Shum, Chandru P. Sundaram

 

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

http://ift.tt/2tsVjWq

Further human fossils from the Middle Stone Age deposits of Die Kelders Cave 1, Western Cape Province, South Africa

Publication date: August 2017
Source:Journal of Human Evolution, Volume 109
Author(s): Frederick E. Grine, Curtis W. Marean, J. Tyler Faith, Wendy Black, Carrie S. Mongle, Erik Trinkaus, Stephan G. le Roux, Anton du Plessis




http://ift.tt/2u6S5VY

Dynamic changes of plasma metabolites in pigs with GalN-induced acute liver failure using GC–MS and UPLC–MS

Publication date: September 2017
Source:Biomedicine & Pharmacotherapy, Volume 93
Author(s): Ermei Chen, Juan Lu, Deying Chen, Danhua Zhu, Yini Wang, Yimin Zhang, Ning Zhou, Jie Wang, Jianzhou Li, Lanjuan Li
Metabolomics facilitates investigation of the mechanisms of disease and screening for biomarkers. Here, a gas chromatography-mass spectrometry (GC-MS) and ultra-performance liquid chromatography-mass spectrometry (UPLC-MS)-based metabolomics approach was employed to identify plasma biomarkers of acute liver failure (ALF) in pigs. Blood was collected from pigs at 12h intervals during ALF. Hepatic injury was quantified by determining liver function and histopathology. Based on a multivariate data matrix and pattern recognition, two upregulated metabolites, namely, amino acids and conjugated bile acids, and two downregulated metabolites, lysophosphatidylcholines (LPCs) and phosphatidylcholines (PCs), were identified. All of these metabolites showed a strong relationship with the extent of liver injury. Amino acids were biomarkers of the severity of liver impairment, conjugated bile acids were predictive of early stage liver damage, and LPCs and PCs were related to the prognosis of liver injury. In conclusion, our results demonstrated the occurrence of marked metabolic disturbances during ALF and that integrated metabolomics analysis facilitates identification of biomarkers of disease.



http://ift.tt/2t95sVm

Successful corpus callosotomy for Doose syndrome

Publication date: Available online 30 June 2017
Source:Brain and Development
Author(s): Sotaro Kanai, Tohru Okanishi, Mitsuyo Nishimura, Kentaro Iijima, Takuya Yokota, Tomohiro Yamazoe, Ayataka Fujimoto, Hideo Enoki, Takamichi Yamamoto
Doose syndrome (epilepsy with myoclonic-atonic seizures) is an epilepsy syndrome with an incidence of approximately 1–2% of childhood-onset epilepsies. Although this syndrome is associated with multiple types of generalized seizures, the diagnosis is based on the presence of myoclonic-atonic seizures. Eighteen percent of patients have refractory seizures and intellectual disabilities. There have, however, been a few reports on the efficacy of surgical treatment for Doose syndrome.We describe a case of Doose syndrome in a 10-year-old boy. He developed generalized tonic–clonic seizures at 3years 8months of age and subsequently developed myoclonic-atonic, myoclonic, and tonic seizures. The frequent myoclonic seizures were refractory to multiple antiepileptic medications. His cognitive development was moderately delayed. Anterior four fifths corpus callosotomy was performed at 8years 5months of age. His seizures, especially myoclonic seizures, were markedly reduced. He was given vagus nerve stimulation therapy at 9years and 1month of age, which led to complete resolution of the myoclonic seizures. Corpus callosotomy can be a good treatment strategy in patients with Doose syndrome with medically refractory generalized seizures.



http://ift.tt/2t8QoHB

A polymorphism in the CYP17A1 gene influences the therapeutic response to steroidogenesis inhibitors in Cushing's syndrome

Abstract

Context

Steroidogenesis inhibitors, such as ketoconazole (KTZ) and metyrapone (MTP) are used to lower hypercortisolism in patients with Cushing's syndrome (CS). Cortisol normalization is not reached in all patients taking these medications.

Objective

To test the hypothesis that variants in genes affecting steroidogenesis contribute to different responses to KTZ and/or MTP in patients with CS.

Patients and methods

Fifty-four CS patients [46 women; mean (±SD) age, 39.7±12.7; 83% with Cushing's disease (CD) and 17% with an adrenal adenoma] preoperatively treated with KTZ (20%), MTP (37%) or a combination of both (43%). Thirty-nine of these (72%) were described in a previous study investigating the outcome of preoperative treatment with KTZ or MTP in CS patients. Following single-nucleotide polymorphisms (SNPs) were analyzed: rs6410 (CYP11B1 gene), rs1799998 and rs4546 (CYP11B2 gene), and rs6163 (CYP17A1 gene). The associations between SNPs and cortisol levels at the end of medical treatment were evaluated.

Results

Normalization of urinary free cortisol (UFC) was achieved in 50% of patients after 5 months of treatment. Patients carrying the CC genotype of SNP rs6163 were more likely to be controlled than AC/AA [OR 0.25 (95%CI, 0.075-0.88); p=0.031]. When only patients reaching eucortisolism after medical treatment were analyzed, median (IQR) duration of treatment was shorter in patients carrying the CC genotype of SNP rs6163 as compared with AA/AC carriers [4 (4.57) vs. 5.2 (6.1) months; p=0.026]

Conclusions

A polymorphism in the CYP17A1 gene was associated with the response to steroidogenesis inhibitors in CS. Genetic differences in the steroidogenic enzymes might account for inter-individual variations in the responsiveness to adrenal blocking agents.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tsp89i

Monte Carlo dosimetric characterization of the Flexisource Co-60 high-dose-rate brachytherapy source using PENELOPE

Publication date: Available online 29 June 2017
Source:Brachytherapy
Author(s): Julio F. Almansa, Rafael Guerrero, Javier Torres, Antonio M. Lallena
Purpose⁶⁰Co sources have been commercialized as an alternative to ¹⁹²Ir sources for high-dose-rate (HDR) brachytherapy. One of them is the Flexisource Co-60 HDR source manufactured by Elekta. The only available dosimetric characterization of this source is that of Vijande et al. [J Contemp Brachytherapy 2012; 4:34–44], whose results were not included in the AAPM/ESTRO consensus document. In that work, the dosimetric quantities were calculated as averages of the results obtained with the Geant4 and PENELOPE Monte Carlo (MC) codes, though for other sources, significant differences have been quoted between the values obtained with these two codes. The aim of this work is to perform the dosimetric characterization of the Flexisource Co-60 HDR source using PENELOPE.Methods and MaterialsThe MC simulation code PENELOPE (v. 2014) has been used. Following the recommendations of the AAPM/ESTRO report, the radial dose function, the anisotropy function, the air-kerma strength, the dose rate constant, and the absorbed dose rate in water have been calculated.ResultsThe results we have obtained exceed those of Vijande et al. In particular, the absorbed dose rate constant is ∼0.85% larger. A similar difference is also found in the other dosimetric quantities. The effect of the electrons emitted in the decay of ⁶⁰Co, usually neglected in this kind of simulations, is significant up to the distances of 0.25 cm from the source.ConclusionsThe systematic and significant differences we have found between PENELOPE results and the average values found by Vijande et al. point out that the dosimetric characterizations carried out with the various MC codes should be provided independently.



http://ift.tt/2tsufq1

Role of contrast-enhanced ultrasound to define prognosis and predict response to biotherapy in pancreatic neuroendocrine tumors

Abstract

Purpose

The incidence of neuroendocrine tumors (NETs) is progressively increasing. Most cases arise from the digestive system, where ileum, rectum and pancreas represent the commonest site of origin. Liver metastases are frequently detected at diagnosis or during the follow-up. Contrast-enhanced ultrasound (CEUS) is used in patients with pancreatic NETs (P-NETs) and liver metastases from P-NET but its role has not been standardized. The aim of this retrospective study was to investigate CEUS in patients with P-NETs and liver metastases from P-NET both as prognostic factor and predictor of response to therapy with somatostatin analogues (SSAs).

Methods

CEUS was performed at the diagnosis of NET and 3, 6 and 12 months after the beginning of SSAs. CEUS pattern was compared with contrast-enhanced computed tomography (CT) pattern.

Results

There was a significant association between CEUS and CT pattern (X ² = 79.0; p < 0.0001). A significant association was found between CEUS pattern and Ki-67 index (X ² = 24.6; p < 0.0001). The hypervascular homogeneous CEUS typical pattern was associated with low tumor grading (G1 or G2) (X ² = 24.0; p < 0.0001). CEUS pattern changed from hypervascular homogeneous in baseline to hypovascular/hypervascular inhomogeneous after SSA therapy, with a significant association between tumor response at CT scan and appearance of hypervascular inhomogeneous pattern at CEUS evaluation (6 months: X ² = 57.0; p < 0.0001; 12 months: X ² = 49.8; p < 0.0001).

Conclusions

In patients with P-NET, CEUS pattern correlates with tumor grading, being homogeneous in G1–G2 but not in G3 tumors. After therapy with SSAs, CEUS is predictive of response to SSAs. These findings seem to support a role of CEUS as prognostic and predictive factor of response.

http://ift.tt/2txRCPo

VALUE AND QUALITY INNOVATIONS IN ACUTE AND EMERGENCY CARE. WILER JL, PINES JM, WARD MJ. CAMBRIDGE, CAMBRIDGE UNIVERSITY PRESS, 2017, 232 PAGES, PAPERBACK, $89.99.

Publication date: Available online 29 June 2017
Source:The Journal of Emergency Medicine
Author(s): Edward J. Otten




http://ift.tt/2sZ0kVB

Participation of hypothalamic CB1 receptors in reproductive axis disruption during immune challenge

Abstract

It is known that immune challenge inhibits reproductive function and that endocannabinoids (eCB) modulate sexual hormones. However, no studies have been performed to assess whether the endocannabinoid system mediates the inhibition of hormones that control reproduction due to immune system activation during systemic infections. For that reason, we evaluated the participation of the hypothalamic cannabinoid receptor CB1 on hypothalamic-pituitary-gonadal (HPG) axis activity in rats submitted to immune challenge. Male adult rats were treated via intracerebroventricular (i.c.v.) administration with a CB1 antagonist/inverse agonist, (AM251, 500 ng/5 ul), followed by an intraperitoneal (i.p.) injection of lipopolysaccharide (LPS, 5 mg/kg) 15 min later. Plasmatic, hypothalamic and adenohypophyseal pro-inflammatory cytokines, hormones and neuropeptides were assessed 90 or 180 min post-LPS. Plasma concentration of TNFα and adenohypophyseal mRNA expression of Tnfα and Il1β increased 90 and 180 min post i.p. administration of LPS. However, cytokine mRNA expression in the hypothalamus increased only 180 min post-LPS, suggesting an inflammatory delay in this organ. CB1 receptor blockade with AM251 increased LPS inflammatory effects, particularly in the hypothalamus. LPS also inhibited the HPG axis by decreasing gonadotropin-releasing hormone (GnRH) hypothalamic content and plasma levels of luteinizing hormone (LH) and testosterone (T). These disruptor effects were accompanied by decreased hypothalamic Kiss1 mRNA expression and prostaglandin E2 (PGE2) content, as well as by increased gonadotropin-inhibitory hormone (Rfrp3) mRNA expression. All these disruptive effects were prevented by the presence of AM251. In summary, our results suggest that in male rats, eCB mediate immune challenge-inhibitory effects on reproductive axis at least partially via hypothalamic CB1 activation. In addition, this receptor also participates in homeostasis recovery, by modulating the inflammatory process taking place after LPS administration.

This article is protected by copyright. All rights reserved.

http://ift.tt/2sZ3R6l

Pemphigus : vers une réduction drastique de la corticothérapie grâce au rituximab

Publication date: Available online 29 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Joly




http://ift.tt/2t8O1o2

Éducation thérapeutique du patient dans la dermatite atopique : où en est-on ?

Publication date: Available online 29 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): S. Barbarot




http://ift.tt/2soEqMM

La photographie en dermatologie. Questions éthiques

Publication date: Available online 29 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Moyal-Barracco, J.-M. Debarre, A. Petit, L. Haddad, L. Martin, D. Penso-Assathiany




http://ift.tt/2t8n2co