Τρίτη, 6 Δεκεμβρίου 2016

Assessment of adult measles cases followed at a military hospital during a measles epidemic: does forced migration increase infectious diseases such as measles that may affect public health?

2016-12-06T23-11-44Z
Source: Medicine Science | International Medical Journal
Ergenekon Karagoz, Umit Savasci.
In this study, our aim was to review the data of adult patients followed due to a measles diagnosis and the reasons for the measles cases, which has shown an increase because of the events of recent forced migration in our country. Adult patients who referred to the outpatient clinic of infectious diseases and clinical microbiology of our hospital between January and April 2013 and who were diagnosed with measles were retrospectively studied. Patients were diagnosed with measles in accordance with the presence of symptoms described by the World Health Organization (WHO) and in combination with the determination of measles IgM positivity by Enzyme Linked Immunosorbent Assay (ELISA). 16 patients did not have any information about their measles vaccination background. Only one patient reported that he received a single dose vaccination one year previously. Measles IgM positivity by ELISA was determined for all patients. When laboratory findings were assessed we found that leukopenia and thrombocytopenia developed respectively, in 4 and 4 patients. In addition, hepatitis developed in 4 patients, otitis media in 2 patients, pneumonia in 3 patients and a sinusitis complication in 2 patients. Measles is a very contagious disease with a high contagion rate but can be kept under control by maintaining vaccination rates high in the community. However, we must not forget that vaccinations may only provide 95% protection. Measles may become epidemic when sensitive individuals are present in the community at a certain ratio. Therefore, immunity rates must be accelerated in young adults in the community by vaccination campaigns (catch-up) while existing rates of childhood vaccinations are maintained. Especially when the population shows a tendency to increase, due to reasons such as migration or war, it is essential to comply with the mentioned precautions.


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Case reports of hyperthyroidism after kidney transplantation: a review of literature

2016-12-06T23-11-44Z
Source: Medicine Science | International Medical Journal
Alparslan Ersoy, Canan Ersoy.
Different disturbances of thyroid hormones in the absence of concurrent thyroid disease have been reported in patients on maintenance hemodialysis. After a successful kidney transplant, thyroid hormone metabolism normalizes. Although increased frequency of goiter and thyroid adenomas have been observed, hyperthyroidism is very rare. Herein, we report two kidney transplant recipients under immunosuppressive therapy that presents with hyperthyroidism.


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The effect of preanalytical mechanical mixing time on complete blood cell count parameters in the emergency laboratory

2016-12-06T23-11-44Z
Source: Medicine Science | International Medical Journal
Cigdem Yucel, Turan Turhan, Esin Calci.
Complete blood count (CBC) is one of the most common laboratory tests. Preanalytical factors like specimen homogenization affect the CBC test results. In the emergency laboratory, test time is a ciritcal parameter. Optimization of test procedures is of critical importance to give more accurate results in a shorter time period. This study was designed to evaluate the effects of preanalytical mechanical mixing times on CBC parameters and to optimize the mechanical mixing time for the analysis. Mechanical mixing time of 1 and 5 minutes (t= 1 and t=5 respectively) with a rotary type mixer and automatic mixing performed by the Coulter LH 780 (t=0) prior to complete blood count analysis were evaluated. Between t=0 and t=1 minutes of mechanical mixing, only a significant change in MPV values were obtained (p


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Human PRE-PIK3C2B, an intronic cis-element with dual function of activation and repression

Publication date: Available online 6 December 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Jayant Maini, Mohsen Ghasemi, Deepti Yandhuri, Suman S. Thakur, Vani Brahmachari
The Polycomb/Trithorax Responsive Elements (PRE/TREs) are the cis-regulatory sequences that interact with both repressive (PcG) as well as activating (TrxG) complexes. However, most of the mammalian PREs are demonstrated to interact with the repressive polycomb (PcG) complexes only. We have carried out an unbiased search for proteins interacting with human PRE-PIK3C2B (hPRE-PIK3C2B) based on DNA affinity purification followed by mass spectrometry and identified MLL, MLL4 and WDR87 among other proteins in three biological replicates in HEK, U87 and HeLa cell lines. The hPRE-PIK3C2B interacts with the members of multiple activating complexes (COMPASS-like). The increase in the interaction of MLL and MLL4 on depletion of YY1 and the increase in the enrichment of YY1 and EZH2 upon MLL knockdown at the hPRE-PIK3C2B indicate the dual occupancy and suggest a concentration dependent enrichment of the activator or the repressor complex at hPRE-PIK3C2B. Further, we show that the hPRE-PIK3C2B interacts with the Drosophila homologues of PcG and TrxG proteins in transgenic flies. Here, we found that there is an increased enrichment of Pc (Polycomb) in comparison to Trx (TrxG protein) at hPRE-PIK3C2B in the Drosophila transgenic flies and this seems to be the default state while the balance is tipped towards the trithorax complex in PcG mutants. To the best of our knowledge, this is one of the early demonstrations of human PRE acting as a TRE without any sequence alteration.



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Autologous augmentation of hiatal hernia repair with filtered platelet concentrate improves tissue remodeling in a swine model

Abstract

Introduction

Autologus augmentation of wound remodeling with platelet concentrate is a burgeoning field with promising results. We hypothesized that the addition of filtered platelet concentrate (fPC) to an acellular biologic graft would improve crural healing and tissue integrity in hiatal hernia repair.

Methods

Sixteen healthy Yorkshire female pigs were divided into three groups: hiatus repair (HR) (n = 7), HR with biologic graft (HRM; n = 8, and HR with biologic graft and fPC (fPC; n = 9). Surgeries were performed by a single surgeon. Animals were euthanized at 8 weeks, and the distal esophagus with hiatus was harvested en-block. Tissue was graded by a histopathologist on collagen deposition, vascularization, and inflammation at the graft–hiatal interface. Tensile strength testing was performed using the Teststar IIs (MTS), coupled with a strain extensometer (Epsilon). Samples of equal dimensions were preloaded to 1 N and deformed at a constant rate of 0.2 mm/s. Statistical analysis was performed via Kruskal–Wallis one-way analysis of variance.

Results

Aspirate analysis revealed a mean platelet count of 3 million platelets/1 mL of aspirate. Animals in the fPC group had significantly increased mean chronic inflammation (3.1 ± 1.1 vs. 1.8 ± 1.6, 1.2 ± 1.2, p = 0.04) compared to HR alone and HR + biologic graft. Vascular deposition did not differ between groups (p = 0.8). A trend toward increased collagen deposition was demonstrated for the fPC group (1.4 ± 1.1 vs. 2.0 ± 0.6 in HR group and 3.0 ± 1.2 in HRM group, p = 0.06). There was a statistically significant increase in tensile strength, yield force, and Young's modulus in the fPC group compared with HR and HR + biologic mesh (p < 0.01).

Conclusion

A trend toward increased collagen deposition and vascularity of the fPC group was demonstrated. In addition, there was an increase in tensile strength and yield force in the fPC group. Use of autologous fPC appears a safe and promising adjunct to wound remodeling and healing in a swine model.



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Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial)

Abstract

Background

The aim of colonic stenting with self-expandable metallic stents in neoplastic colon obstruction is to avoid emergency surgery and thus potentially reduce morbidity, mortality, and need for a stoma. Concern has been raised, however, about the effect of colonic stenting on short-term complications and long-term survival. We compared morbidity rates after colonic stenting as a bridge to surgery (SBTS) versus emergency surgery (ES) in the management of left-sided malignant large-bowel obstruction.

Methods

This multicentre randomised controlled trial was designed with the endorsement of the European Association for Endoscopic Surgery. The study population was consecutive patients with acute, symptomatic malignant left-sided large-bowel obstruction localised between the splenic flexure and 15 cm from the anal margin. The primary outcome was overall morbidity within 60 days after surgery.

Results

Between March 2008 and November 2015, 144 patients were randomly assigned to undergo either SBTS or ES; 29/144 (13.9%) were excluded post-randomisation mainly because of wrong diagnosis at computed tomography examination. The remaining 115 patients (SBTS n = 56, ES n = 59) were deemed eligible for analysis. The complications rate within 60 days was 51.8% in the SBTS group and 57.6% in the ES group (p = 0.529). Although long-term follow-up is still ongoing, no statistically significant difference in 3-year overall survival (p = 0.998) and progression-free survival rates between the groups has been observed (p = 0.893). Eleven patients in the SBTS group and 23 in the ES group received a stoma (p = 0.031), with a reversal rate of 30% so far.

Conclusions

Our findings indicate that the two treatment strategies are equivalent. No difference in oncologic outcome was found at a median follow-up of 36 months. The significantly lower stoma rate noted in the SBTS group argues in favour of the SBTS procedure when performed in expert hands.



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Visual–perceptual mismatch in robotic surgery

Abstract

Background

The principal objective of the experiment was to analyze the effects of the clutch operation of robotic surgical systems on the performance of the operator. The relative coordinate system introduced by the clutch operation can introduce a visual–perceptual mismatch which can potentially have negative impact on a surgeon's performance. We also assess the impact of the introduction of additional tactile sensory information on reducing the impact of visual–perceptual mismatch on the performance of the operator.

Methods

We asked 45 novice subjects to complete peg transfers using the da Vinci IS 1200 system with grasper-mounted, normal force sensors. The task involves picking up a peg with one of the robotic arms, passing it to the other arm, and then placing it on the opposite side of the view. Subjects were divided into three groups: aligned group (no mismatch), the misaligned group (10 cm z axis mismatch), and the haptics-misaligned group (haptic feedback and z axis mismatch). Each subject performed the task five times, during which the grip force, time of completion, and number of faults were recorded.

Results

Compared to the subjects that performed the tasks using a properly aligned controller/arm configuration, subjects with a single-axis misalignment showed significantly more peg drops (p = 0.011) and longer time to completion (p < 0.001). Additionally, it was observed that addition of tactile feedback helps reduce the negative effects of visual–perceptual mismatch in some cases. Grip force data recorded from grasper-mounted sensors showed no difference between the different groups.

Conclusions

The visual–perceptual mismatch created by the misalignment of the robotic controls relative to the robotic arms has a negative impact on the operator of a robotic surgical system. Introduction of other sensory information and haptic feedback systems can help in potentially reducing this effect.



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Our experience with laparoscopic partial gastrectomy by the ‘lift-and-cut method’ for gastric gastrointestinal stromal tumor with maximal preservation of the remnant stomach

Abstract

Background

Wedge resection is the most commonly used method in laparoscopic partial gastrectomy for gastric gastrointestinal stromal tumor (GIST). However, this method can involve inadvertent resection of additional gastric tissue and cause gastric deformation. To minimize the volume of resected gastric tissue, we have developed a laparoscopic partial gastrectomy with seromyotomy which we call the 'lift-and-cut method' for gastric GIST. Here, we report a case series of this surgery.

Method

First, the seromuscular layer around the tumor is cut. Because the mucosa and submucosa are extensible, the tumor is lifted toward the abdominal cavity. After sufficient lifting, the gastric tissue under the tumor is cut at the submucosal layer with a linear stapler (thus 'lift-and-cut method'). Finally, the defect in the seromuscular layer is closed with a hand-sewn suture.

Results

From April 2011 to December 2015, 28 patients underwent laparoscopic partial gastrectomy by this method at Osaka Red Cross Hospital. Average operation time was 126 min (range 65–302 min) and average blood loss was 10 ml (range 0–200 ml). No intraoperative complications including tumor rupture or postoperative complications regarded as Clavien–Dindo Grade II or higher occurred. All patients took sufficient solid diet at discharge. Median postoperative hospital stay was 7 days (range 5–21 days). On median follow-up of 26.6 months (range 6–54 months), no recurrence was reported.

Conclusion

Laparoscopic partial gastrectomy by the lift-and-cut method is safe and simple, and widely applicable for gastric GIST.



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Cost analysis of laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis

Abstract

Background

Evidence from controlled trials and meta-analyses suggests that laparoendoscopic rendezvous (LERV) is preferable to sequential treatment in the management of common bile duct stones.

Materials and methods

With this retrospective analysis of a prospective database that included consecutive patients treated for cholecystocholedocholithiasis at our institution between January 2007 and July 2015, we compared LERV with sequential treatment. The primary endpoint was global cost, defined as the cost/patient/hospital stay, and the secondary end points were efficacy and morbidity. Fisher's exact test or Mann–Whitney test was used.

Results

Of a total of 249 consecutive patients, 143 underwent LERV (group A) and 106 a two-stage procedure (group B). Based on an average cost of €613 for 1 day of hospital stay in the General Surgery Department, the overall median cost of treatment was €6403 for group A and €8194 for group B (p < 0.001). Operative time was significantly shorter (p < 0.001), and length of hospital stay was significantly longer for group B (p < 0.001). No mortality in either group was observed. The postoperative complications rate was significantly higher in group B than in group A (24.5 vs. 10.5%; p = 0.003). No significant difference in the postoperative pancreatitis rate or the number of patients with increased serum amylase at 24 h was observed in either group.

Conclusion

Our study suggests that LERV is preferable to sequential treatment not only in terms of less morbidity, but also of lower costs accrued by a shorter hospital stay. However, the longer operative time raises multiple organizational issues in the coordination of surgery and endoscopy services.



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Technical standardization of laparoscopic repair of Morgagni diaphragmatic hernia in children: results of a multicentric survey on 43 patients

Abstract

Background

This study aimed to standardize the surgical correction technique of congenital Morgagni diaphragmatic hernia (CMDH), analyzing the results of an international multicentric survey.

Methods

The medical records of 43 patients (29 boys, 14 girls) who underwent laparoscopic repair of CMDH in 8 pediatric surgery units in a 5-year period were retrospectively reviewed. Their average age was 3.3 years. Ten patients (23.2%) presented associated malformations: 9 Down syndrome (20.9%) and 1 palate cleft (2.3%). Thirty-five patients (81.4%) were asymptomatic, whereas 8 patients (18.6%) presented symptoms such as respiratory distress, cough or abdominal pain. As for preoperative work-up, all patients received a chest X-ray (100%), 15/43 (34.8%) a CT scan, 8/43 (18.6%) a barium enema and 4/43 (9.3%) a US.

Results

No conversion to open surgery was reported. Average operative time was 61.2 min (range 45–110 min). In 38/43 (88.3%) patients, a trans-parietal stitch was positioned in order to reduce the tension during the repair. In 14/43 cases (32.5%), the sac was resected; in only 1/43 case (2.3%) a dual mesh of goretex was adopted to reinforce the closure. Average hospital stay was 2.8 days. The average follow-up was 4.2 years, and it consisted in annual clinical controls and chest X-ray. We recorded 2 complications (4.6%): one small pleural opening that required no drain and one recurrence (2.3%), re-operated in laparoscopy, with no further recurrence.

Conclusions

To the best of our knowledge, this is the largest series published in the literature on this topic. Laparoscopic CMDH repair is well standardized: The full-thickness anterior abdominal wall repair using non-resorbable suture with interrupted stitches is the technique of choice. Postoperative outcome was excellent. Recurrence rate was very low, about 2% in our series. We believe that children with CMDH should be always treated in laparoscopy following the technical details reported in this paper.



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Which causes more ergonomic stress: Laparoscopic or open surgery?

Abstract

Background

There is increasing awareness of potential ergonomic challenges experienced by the laparoscopic surgeon. The purpose of this study is to quantify and compare the ergonomic stress experienced by a surgeon while performing open versus laparoscopic portions of a procedure. We hypothesize that a surgeon will experience greater ergonomic stress when performing laparoscopic surgery.

Methods

We designed a study to measure upper-body muscle activation during the laparoscopic and open portions of sigmoid colectomies in a single surgeon. A sample of five cases was recorded over a two-month time span. Each case contained significant portions of laparoscopic and open surgery. We obtained whole-case electromyography (EMG) tracings from bilateral biceps, triceps, deltoid, and trapezius muscles. After normalization to a maximum voltage of contraction (%MVC), these EMG tracings were used to calculate average muscle activation during the open and laparoscopic segments of each procedure. Paired Student's t test was used to compare the average muscle activation between the two groups (*p < 0.05 considered statistically significant).

Results

Significant reductions in mean muscle activation in laparoscopic compared to open procedures were noted for the left triceps (4.07 ± 0.44% open vs. 2.65 ± 0.54% lap, 35% reduction), left deltoid (2.43 ± 0.45% open vs. 1.32 ± 0.16% lap, 46% reduction), left trapezius (9.93 ± 0.1.95% open vs. 4.61 ± 0.67% lap, 54% reduction), right triceps (2.94 ± 0.62% open vs. 1.85 ± 0.28% lap, 37% reduction), and right trapezius (10.20 ± 2.12% open vs. 4.69 ± 1.18% lap, 54% reduction).

Conclusions

Contrary to our hypothesis, the laparoscopic approach provided ergonomic benefit in several upper-body muscle groups compared to the open approach. This may be due to the greater reach of laparoscopic instruments and camera in the lower abdomen/pelvis. Patient body habitus may also have less of an effect in the laparoscopic compared to open approach. Future studies with multiple subjects and different types of procedures are planned to further investigate these findings.



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The effect of postoperative complications on survival of patients after minimally invasive esophagectomy for esophageal cancer

Abstract

Background

Minimally invasive esophagectomy (MIE) has been shown to be a feasible technique for the treatment of esophageal cancer; however, its postoperative morbidity remains high. This retrospective study aimed to evaluate the effect of postoperative complications on long-term outcomes in patients who have undergone MIE for esophageal squamous cell carcinoma (ESCC).

Methods

This retrospective study enrolled patients who had undergone MIE for ESCC between September 2009 and November 2014; all procedures were performed by a single surgical team. Relevant patient characteristics and postoperative variables were collected and evaluated. The disease-free survival (DFS) and disease-specific survival (DSS) were determined by the Kaplan–Meier method, and compared by log-rank tests. Possible predictors of survival were subjected to univariate analysis and multivariate Cox proportional hazard regression analysis.

Results

In all, data on 214 patients with ESCC were analyzed, including 170 men and 44 women. All study subjects had undergone thoracoscopic or thoracoscopic–laparoscopic esophagectomy and cervical esophagogastric anastomosis. One hundred and thirty patients (60.7%) had postoperative complications (Grades 1–4). The overall DFS and DSS rates were 80.0 and 88.9% at 1 year, 48.6 and 54.2% at 3 years, and 43.2 and 43.5% at 5 years, respectively. Univariate analysis and multivariate Cox proportional hazard regression analysis showed that T stage, N stage, and tumor grade were independent prognostic factors for long-term survival; however, postoperative complications had no significant effect on the DFS or DSS of this patient cohort (log-rank test, p = 0.354 and 0.160, respectively).

Conclusions

Postoperative complications have no significant effect on long-term survival in patients who have undergone MIE for ESCC.



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Laparoscopic and robotic skills are transferable in a simulation setting: a randomized controlled trial

Abstract

Background

Although surgical simulation provides an effective supplement to traditional training, it is not known whether skills are transferable between minimally invasive surgical modalities. The purpose of this study was to assess the transferability of skills between minimally invasive surgical simulation platforms among simulation-naïve participants.

Methods

Forty simulation-naïve medical students were enrolled in this randomized single-blinded controlled trial. Participants completed a baseline evaluation on laparoscopic (Fundamentals of Laparoscopic Surgery Program, Los Angeles, CA) and robotic (dV-Trainer, Mimic, Seattle, WA) simulation peg transfer tasks. Participants were then randomized to perform a practice session on either the robotic (N = 20) or laparoscopic (N = 20) simulator. Two blinded, expert minimally invasive surgeons evaluated participants before and after training using a modified previously validated subjective global rating scale. Objective measures including time to task completion and Mimic dV-Trainer motion metrics were also recorded.

Results

At baseline, there were no significant differences between the training groups as measured by objective and subjective measures for either simulation task. After training, participants randomized to the laparoscopic practice group completed the laparoscopic task faster (p < 0.003) and with higher global rating scale scores (p < 0.001) than the robotic group. Robotic-trained participants performed the robotic task faster (p < 0.001), with improved economy of motion (p < 0.001), and with higher global rating scale scores (p = 0.006) than the laparoscopic group. The robotic practice group also demonstrated significantly improved performance on the laparoscopic task (p = 0.02). Laparoscopic-trained participants also improved their robotic performance (p = 0.02), though the robotic group had a higher percent improvement on the robotic task (p = 0.037).

Conclusions

Skills acquired through practice on either laparoscopic or robotic simulation platforms appear to be transferable between modalities. However, participants demonstrate superior skill in the modality in which they specifically train.



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Does peritoneal flap closure technique following transabdominal preperitoneal (TAPP) inguinal hernia repair make a difference in postoperative pain? A long-term quality of life comparison

Abstract

Background

Transabdominal, preperitoneal (TAPP), laparoscopic inguinal hernia repair (IHR) requires the creation of a peritoneal flap (PF) that must be closed after mesh placement. Our previous study indicated that sutured PF closure resulted in less short-term postoperative pain at 2 and 4 weeks compared to tacks and staples. Therefore, the aim of this follow-up study was to compare short-term QOL with a greater sample size and long-term QOL at 2 years by method of PF closure.

Materials and methods

A prospective institutional hernia-specific database was assessed for all adult TAPP IHRs from July 2012 to May 2015. QOL outcomes were compared by PF closure method at 2 and 4 weeks and 6, 12, and 24 months as measured by the Carolinas Comfort Scale. Standard statistical tests were used for the whole population and then the Bonferroni Correction was used to compare groups (p < 0.0167). Multivariate analysis controlling for age, gender, recurrent hernias, and preoperative symptomatic pain was used to compare QOL by PF closure method.

Results

A total of 679 TAPP IHRs in 466 patients were analyzed; 253 were unilateral, and 213 were bilateral. PF closure was performed using tacks in 36.7 %, suture in 24.3 %, and staples in 39.0 %. There was no difference in hernia recurrence (only 1 patient at 36 months). There were no statistical differences in QOL between 2 and 4 weeks and 6- to 24-month follow-up. When resolution of symptoms from preoperative levels was examined, there was no difference in the three groups at any time point (p > 0.05). After controlling for confounding variables on multivariate analysis, there was no difference in QOL by PF closure method at any time point (p > 0.05).

Conclusion

Tacked, sutured, and stapled techniques for peritoneal flap closure following TAPP have no significant differences in operative outcomes, postoperative quality of life, or resolution of symptoms.



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Integration of motion energy from overlapping random background noise increases perceived speed of coherently moving stimuli

The perception of visual motion can be profoundly influenced by visual context. To gain insight into how the visual system represents motion speed, we investigated how a background stimulus that did not move in a net direction influenced the perceived speed of a center stimulus. Visual stimuli were two overlapping random-dot patterns. The center stimulus moved coherently in a fixed direction, whereas the background stimulus moved randomly. We found that human subjects perceived the speed of the center stimulus to be significantly faster than its veridical speed when the background contained motion noise. Interestingly, the perceived speed was tuned to the noise level of the background. When the speed of the center stimulus was low, the highest perceived speed was reached when the background had a low level of motion noise. As the center speed increased, the peak perceived speed was reached at a progressively higher background noise level. The effect of speed overestimation required the center stimulus to overlap with the background. Increasing the background size within a certain range enhanced the effect, suggesting spatial integration. The speed overestimation was significantly reduced or abolished when the center stimulus and the background stimulus had different colors, or when they were placed at different depths. When the center- and background-stimuli were perceptually separable, speed overestimation was correlated with perceptual similarity between the center- and background-stimuli. These results suggest that integration of motion energy from random motion noise has a significant impact on speed perception. Our findings put new constraints on models regarding the neural basis of speed perception.



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The response of the vestibulosympathetic reflex to linear acceleration in the rat

The vestibulosympathetic reflex (VSR) increases blood pressure (BP) upon arising to maintain blood flow to the brain. The optimal directions of VSR activation and whether changes in heart rate (HR) are associated with changes in BP are still not clear. We used manually activated pulses and oscillatory linear accelerations of 0.2–2.5 g along the naso-occipital, interaural, and dorsoventral axes in isoflurane-anesthetized, male Long-Evans rats. BP and HR were recorded with an intra-aortic sensor and acceleration with a three-dimensional accelerometer. Linear regressions of BP changes in accelerations along the upward, downward, and forward axes had slopes of 3–6 mmHg · g–1 (P < 0.05). Lateral and backward accelerations did not produce consistent changes in BP. Thus upward, downward, and forward translations were the directions that significantly altered BP. HR was unaffected by these translations. The VSR sensitivity to oscillatory forward-backward translations was 6–10 mmHg · g–1 at frequencies of 0.1 Hz (0.2 g), decreasing to zero at frequencies above 2 Hz (1.8 g). Upward, 70° tilts of an alert rat increased BP by 9 mmHg · g–1 without changes in HR, indicating that anesthesia had not reduced the VSR sensitivity. The similarity in BP induced in alert and anesthetized rats indicates that the VSR is relatively insensitive to levels of alertness and that the VSR is likely to cause changes in BP through modification of peripheral vascular resistance. Thus the VSR, which is directed toward the cardiovascular system, is in contrast to the responses in the alert state that can produce sweating, alterations in BP and HR, and motion sickness.



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Associations between polymorphisms in the NICD domain of bovine NOTCH1 gene and growth traits in Chinese Qinchuan cattle

Abstract

NOTCH1 is one of the four mammalian Notch receptors, which is involved in the Notch signaling pathway. Specifically, NOTCH1 promotes the proliferation of myogenic precursor cells, and the NICD domain of NOTCH1 can impair regeneration of skeletal muscles. However, similar research on the bovine NOTCH1 gene is lacking. In this study, we detected the polymorphisms of the bovine NOTCH1 gene in a total of 448 individuals from Chinese Qinchuan cattle with DNA pooling, forced PCR-RFLP, and DNA sequencing methods. Five novel SNPs were identified within the NICD domain, and eight haplotypes comprising combinations of these five SNPs were studied as well. The association analysis of SNPs' effects with growth traits revealed that g.A48250G was significantly associated with body height, body weight, and height at hip cross, and that g.A49239C only showed significant associations with body height. This suggests that the NOTCH1 gene is a strong candidate gene that could be utilized as a promising marker in beef cattle breeding programs.



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Milk protein polymorphisms and casein haplotypes in Butana cattle

Abstract

Butana is a Bos indicus dairy cattle breed that is well adapted to the local environment of Sudan. The breed has been gradually declining in number due to breed substitution. Therefore, conservation and improvement strategies are required to maintain this breed. The aim of the present study was to assess genetic variation that is characteristic for Butana cattle in the milk protein genes CSN1S1, CSN2, CSN1S2, CSN3, LALBA, and LGB. In a first step, genomic DNA of five unrelated individuals was comparatively sequenced across all exon and flanking sequences. Ninety-three single nucleotide polymorphisms (SNPs) were identified in Butana cattle compared with the Bos taurus reference sequence at Ensembl. We confirmed the recently identified protein variants CSN2*J, CSN2*L, and LALBA*E. Fifty-two SNPs in non-coding regions are novel. Among the novel SNPs, five are located in promoter regions, three of them are in putative transcription factor binding sites (TFBSs) of the CSN1S2 promoter. Fifteen SNPs potentially affect miRNA target sites. In a second step, 50 unrelated Butana cattle were genotyped. This allowed deriving haplotypes for the casein gene cluster on BTA6. The most frequent haplotype was CSN1S1*C-CSN2*A 2-CSN1S2*A-CSN3*A (C-A 2-A-A, frequency 0.1546). Considering the newly identified CSN1S2 promoter variants, the most frequent haplotype was C-A 2-TTC-A-A (0.1046), with TTC as the promoter variant. The information on protein and promoter variants can be used for the development of conservation and breeding strategies for this local breed.



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Ottawa Panel evidence-based clinical practice guidelines for structured physical activity in the management of juvenile idiopathic arthritis

Publication date: Available online 6 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sabrina Cavallo, Lucie Brosseau, Karine Toupin-April, George A. Wells, Christine A.M. Smith, Arlanna G. Pugh, Jennifer Stinson, Roanne Thomas, Sara Ahmed, Ciarán M. Duffy, Prinon Rahman, Inmaculada C. Àlvarez-Gallardo, Laurianne Loew, Gino De Angelis, Debbie Ehrmann Feldman, Annette Majnemer, Isabelle J. Gagnon, Désirée Maltais, Marie-Ève Mathieu, Glen P. Kenny, Susan Tupper, Kristi Whitney-Mahoney, Sarah Bigford
ObjectiveTo create guidelines focused on the use of structured physical activity (PA) in the management of juvenile idiopathic arthritis (JIA).Data SourcesA systematic literature search was conducted using the electronic databases Cochrane Central Register of Controlled Trials, Medline (Ovid), EMBASE (Ovid), and Physiotherapy Evidence Database (PEDro) for all studies related to PA programs for JIA from January 1966 until December 2014, and was updated in May 2015.Study SelectionStudy selection was completed independently by two reviewers. Studies were included if they involved individuals between the ages of 0 to ≤ 21 diagnosed with JIA taking part in therapeutic exercise or other physical activity interventions for which effects of various disease-related outcomes are compared to a control group (e.g. no physical activity program or activity of lower intensity).Data ExtractionTwo reviewers independently extracted information on interventions, comparators, outcomes, time period, and study design. The statistical analysis was reported using the Cochrane collaboration methods. The quality of the included studies was assessed according to the PEDro scale.Data SynthesisFive randomised controlled trials (RCTs) fit the selection criteria and, of these, 4 were high-quality RCTs. The following recommendations were developed: 1) Pilates for improving quality of life (QoL), pain, functional ability and range of motion (ROM) (grade A); 2) home exercise programme for improving QoL and functional ability (grade A); 3) aquatic aerobic fitness for decreasing the number of active joints (grade A); and 4) and cardio-karate aerobic exercise for improving ROM and number of active joints (grade C+).ConclusionsThe Ottawa Panel recommends the following structured exercises and physical activities for the management of JIA: Pilates, cardio-karate, home and aquatic exercises. Pilates showed improvement in a higher number of outcomes.



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Maximum Pain on Visual Analog Scales in Spinal Disorders

Determining pain intensity is largely dependent on the patient's report.

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7 steps to improving your approachability as a paramedic chief

Approachability: a word often used in leadership and management circles, but rarely defined, at least to any degree of clarity in my mind. It means to be "capable of being approached; accessible: specifically, easy to meet or deal with [1]." In my experiences, people will approach me as a leader with their thoughts, ideas, opinions, likes and dislikes only after they:

  • Trust me with their thoughts, ideas, opinions.
  • Believe I will take care of their thoughts, ideas, opinions.
  • Believe that I'll do what I say by keeping my promises.

It's up to me as a coach, champion, mentor and leader to make the first move in creating and nurturing those sentiments among my personnel.

Suggestions for improving your approachability
If you are frustrated with not getting important information on a timely basis from your EMS personnel, it helps to suspect your own level of approachability. This may be in your blind spot. Ask someone you trust if they think you might put people off more than you know. Give them permission to be frank with you about it.

Try this online quiz: Are you a good boss" If your self-assessment leads you to believe you may have an approachability issue, try these seven steps. Like anything, practice makes perfect.

1. Invest time in getting to know your people.
One-on-one time with the boss, above and beyond the communication necessary for the job, helps build the feeling in the individual that you care about them as a person. And who among us couldn't use some of that on a regular basis"

For starters, learn the names of their spouse or significant other and their children. Learn their birthdays and make it a point to give them a card when it rolls around. Learn why they got into EMS and if their reason for being in EMS has changed through their career.

2. People want to know you.
Getting to know each other is a two-way street. Share a story or two about yourself, especially those that show something about your character and integrity.

3. Display loyalty to the absent.
When you hear members of your team talking about one of their fellow team members "behind their back," put a stop to it immediately. If you let them talk about others who are not present, you're fostering the idea that you'll allow others to talk about them when they are not around. Extend this loyalty to personnel who might be out on injury leave, opted for early retirement or changed employers or careers.

4. Listen to understand, not to be understood.
Too often we can find ourselves listening while at the same time formulating our opinion about what we're hearing or what our response will be. As good as our brain is, it doesn't do those two things — listening and processing/responding — well simultaneously.

Also, be aware of distractions, like doing other things while people are talking to you. Nothing says, "I'm really not paying attention to what you're saying," like answering a phone call or reading a text message while one of your team members is talking to you. In the words of my late mom, "That's just plain rude."

5. Acknowledge ideas and suggestions.
Approachable leaders regularly receive and solicit ideas and suggestions from their colleagues and teams. It doesn't take much, usually 10 words or less, such as, "I appreciate the heads up" or "Thank you, that update helped me" to show your appreciation.

Acknowledgement encourages further information and idea sharing. When you don't respond to ideas, people are likely to consider you to be apathetic.After a while, they'll stop talking to you.

6. Explain decisions to ignore input or recommendations.
Any time you ignore or don't implement an idea, especially the ones you solicited, explain your reasons to forgo the input or recommendations. Without that feedback, people develop their own narrative and it goes something like this, "The chief doesn't want my input, so why did the chief ask""

7. Understand communication styles and preferences.
Each of us has a different communication style and preference for how we communicate with co-workers and managers. As the leader, improve your approachability by making the extra effort to be gentle with team members and others who are easily intimidated. If you have some personnel that thrive on confrontation and are more likely to go toe-to-toe in their communication, then create those opportunities, but heated debates need to work toward a conclusion.

A case study
A real turning point in my career — in terms of my personal approachability — came when I read "It's Your Ship" by U.S. Navy Captain (Ret.) David Abrashoff's. It helped me understand the adage, "People don't care how much you know until they know how much you care."

I implemented one of the Abrashoff's tools whenever I took over a new unit. It involved asking everyone in the unit — firefighters, officers, civilian employees alike — the following three questions during one-on-one interviews.

  1. What do you like about working in this unit"
  2. What don't you like about working in this unit"
  3. If you had my job, what one thing would you change tomorrow"

Think that's too big of a task to take on in your world" Abrashoff interviewed every one of the 300+ sailors and officers in his world, aboard the U.S. Navy destroyer Benfold. In doing so, he and his people took the Benfold from worst to first in the entire U.S. Navy fleet (based on the Navy's evaluations of performance and combat readiness).

After I completed the one-on-one interviews, I typed up all the responses without names and shared the responses with everyone in the unit. Then I made it my mission to do things daily as a leader that:

  • Would reinforce their responses to question #1 (likes).
  • Sought solutions for their responses to question #2 (dislikes).
  • Sought ways to make their responses to question #3 (changes) a reality.

Was it a lot of work" You bet. Was it worth it" You bet.

So, what are you doing to improve your approachability today"

Further reading
4 reasons why leaders should listen more. http://ift.tt/2h3lkCJ

Forensic Magazine. The Importance of Being an Approachable Manager. http://ift.tt/2gPRovN

Good Reads. It's Your Ship: Management Techniques from the Best Damn Ship in the Navy. http://ift.tt/2h3nvGy

Unique Training & Development. Being an approachable leader. http://ift.tt/2gPUGj1

Reference
1. Merriam-Webster Dictionary On-line



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Erratum to: Robot-assisted and conventional therapies produce distinct rehabilitative trends in stroke survivors



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5 steps to improve EMS provider engagement

By Steve Wirth

An ongoing Gallup study, State of the American Workplace, covering over 30 years and 17 million workers found that there are essentially three types of staff members in every workplace. You will find these three types, based on their level of commitment and engagement with the work and the workplace, in your EMS agency.

Yes, it just comes down to three key types and understanding these types and how they affect others will go a long way in helping your leadership be more effective in motivating your staff to become better communicators, to do good work and to better serve the patient. This also helps to reduce risk and avoid unnecessary litigation, as most lawsuits in EMS are based on dissatisfaction with the patient experience and not actual negligence.

Here are the three engagement types and five steps for improving staff member engagement that can lead to improved morale and an enhanced patient experience.

The "Engaged"
The "engaged" staff members are the ideal role model individuals for your organization. They have passion for their work, a positive attitude toward EMS and your agency, and in positively interacting with others — particularly the patients.

They are the top-level performers who never cause you angst. They drive the innovation and ideas that fuel the organization's future. The engaged staff are individuals you want to see in leadership positions and to mentor each new generation of EMS providers.

Their positive energy can affect others in a significant way that will encourage them to want to do their best work. Unfortunately, only about 30 percent of your staff fit into this category, according to the Gallup study.

The "Not Engaged"
The "not engaged" staff members are the ones who do just enough to get by — and not much else. They lack the drive and commitment to improve the organization.

Unfortunately, about half of your staff members may be in this category, according to the Gallup study. The staff members who are not engaged don't have nearly the level of energy and passion as the engaged staff member, and border on being simply lazy.

The not-so-engaged staff requires considerable attention to keep them headed in the right direction. Staff members in this category can be influenced both positively and negatively.

The EMS agency's goal should be to surround the not engaged staff with engaged staff members that will serve as positive role models. That will help move these not engaged employees to become engaged.

The "Actively Disengaged"
The "actively disengaged" staff members are your problem personnel. They are the bad apples that can negatively affect those around them.

The problem is that they can often cause the not engaged to join their type, adding to your management nightmares and further bringing down morale. These staff members are too busy blaming others for their problems and lack an objective view of themselves.

The actively disengaged are particularly dangerous, because in acting out their unhappiness, they undermine what the engaged employees are trying to accomplish to advance your agency and its reputation in the community. Their actively negative behaviors lead to problems in communicating and getting along with others, including their co-workers and your patients.

Nearly 20 percent of your staff members are likely to be actively disengaged, according to the Gallup study. With this type of staff member, corrective counseling will not always result in a positive change. Unfortunately, in that case, termination from the organization may be the most effective action you can take to avoid the organizational infection of negativity that the actively disengaged can spread to others.

5 steps to improve staff member engagement
Actively engaged staff members are significantly more productive than their not engaged or disengaged colleagues — some studies say as much as 50 percent more productive. So, the goal should be to improve staff member engagement across the board. Here are five simple steps to help do just that.

1. Set expectations up front and remind often.
It is essential to set the stage for the workplace experience upfront by emphasizing the key personal qualities that are essential to success in your agency. Good communication skills, listening skills and a compassionate and sensitive approach to communicating with others should be emphasized in recruitment, job descriptions, orientation and throughout the EMS staff member's experience with your agency.

To measure whether the expectations are being met requires feedback. Fundamentally, everyone wants to perform well, yet leadership will often not let the individual know how they are doing in meeting the expectations and what they need to do to improve.

2. Assign a positive mentor.
New staff members should be assigned to one of the engaged staff members who can serve as a positive role model. This will also show the less engaged staff members the core qualities needed for success in your agency.

Never let two disengaged staff members work together. That is a recipe for disaster, including harm to the patient.

Try to keep a more engaged staff member partnered with a less engaged staff member to provide the positive influence necessary for improved engagement. Mentoring provides so many benefits, not just to the person being mentored, but also the mentor and the organization as well.

3. Open channels of communication.
EMS agencies should have multiple methods of upward and downward communications. Transparency in the EMS workplace with everyone practicing active listening should be the goal.

Staff members should be encouraged to ask questions, provide input and contribute to the success of the organization. Leadership must be non-defensive in response to staff member questions, concerns and suggestions. This helps encourage the positive behaviors that contribute to engagement with EMS work and in the organization.

4. Tolerate nothing less than respect and dignity in all interactions.
A healthy EMS agency is one that has healthy relationships between staff members that are respectful, caring and compassionate. When staff members respect each other, they respect their patients. And that is the ultimate goal as mutual respect leads to good communication, good patient care and a positive patient experience with fewer complaints and lawsuits.

Staff members in leadership roles must demonstrate respect in all that they do, and call out those who do not respect their colleagues or their patients. Far too often, leadership members will look the other way rather than confront disrespectful or actively disengaged behaviors because it can be difficult and challenging to do so. But that is a critical responsibility of the EMS leader.

5. Provide regular communications skills training.
EMS continuing education programs are great when it comes to the clinical aspects of our work. But we often fall short on addressing the key human attributes that are most likely to lead to success in EMS and a high-quality experience for the patient — positive interpersonal communications. We need to incorporate interpersonal skills training for all members of the organization so that the proper climate can be set to enhance staff member engagement, which leads to improving the patient's experience.

Most importantly, improving staff member engagement must start at the top of the organization.

Leadership at all levels must not only "talk the talk," but they must "walk the talk" in a visible and meaningful way. Leaders who are effective at improving staff member engagement model the positive engagement attributes that lead to improved morale and increased staff member commitment to EMS work, your agency and, most importantly, to the patients and communities that you serve.



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Paramedic - Tualatin Valley Fire & Rescue

You Can Answer the Call. Tualatin Valley Fire & Rescue wants you to join our dedicated and compassionate team. We are seeking candidates from a variety of backgrounds and experiences who are ready for a career that makes a difference! In this new role with the District, PARAMEDICS will be responsible for operating a fire department medical unit responding to emergency and non-emergency medical incidents ...

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Sanovas Launches Intubation Science, Inc. Invents New and Improved Endotracheal Intubation System

SAUSALITO, Calif., Dec., 2016 /PRNewswire/ -- Sanovas, Inc., a life science asset holding company and medical technology accelerator, announced today the launch of its wholly owned subsidiary, Intubation Science, Inc., and its LightSpeed Intubation System™ (LSI). There are over 40 million Endotracheal Intubations performed annually in the U.S., making it the single largest interventional procedure ...

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Contribution of radioactive 137Cs discharge by suspended sediment, coarse organic matter, and dissolved fraction from a headwater catchment in Fukushima after the Fukushima Dai-ichi Nuclear Power Plant accident

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 3
Author(s): Sho Iwagami, Yuichi Onda, Maki Tsujimura, Yutaka Abe
Radiocesium (137Cs) migration from headwaters in forested areas provides important information, as the output from forest streams subsequently enters various land-use areas and downstream rivers. Thus, it is important to determine the composition of 137Cs fluxes (dissolved fraction, suspended sediment, or coarse organic matter) that migrate through a headwater stream. In this study, the 137Cs discharge by suspended sediment and coarse organic matter from a forest headwater catchment was monitored. The 137Cs concentrations in suspended sediment and coarse organic matter, such as leaves and branches, and the amounts of suspended sediment and coarse organic matter were measured at stream sites in three headwater catchments in Yamakiya District, located ∼35 km northwest of Fukushima Dai-ichi Nuclear Power Plant (FDNPP) from August 2012 to September 2013, following the earthquake and tsunami disaster. Suspended sediment and coarse organic matter were sampled at intervals of approximately 1–2 months. The 137Cs concentrations of suspended sediment and coarse organic matter were 2.4–49 kBq/kg and 0.85–14 kBq/kg, respectively. The 137Cs concentrations of the suspended sediment were closely correlated with the average deposition density of the catchment. The annual proportions of contribution of 137Cs discharge by suspended sediment, coarse organic matter, and dissolved fraction were 96–99%, 0.0092–0.069%, and 0.73–3.7%, respectively. The total annual 137Cs discharge from the catchment was 0.02–0.3% of the deposition.



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Temporal changes in radiocesium deposition in various forest stands following the Fukushima Dai-ichi Nuclear Power Plant accident

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 3
Author(s): Hiroaki Kato, Yuichi Onda, Keigo Hisadome, Nicolas Loffredo, Ayumi Kawamori
In this study, we investigated the transfer of canopy-intercepted radiocesium to the forest floor following the Fukushima Dai-ichi Nuclear Power Plant accident. The 137Cs content of throughfall, stemflow, and litterfall were monitored in two coniferous stands (plantations of Japanese cedar) and a deciduous mixed broad-leaved forest stand (oak with red pine) from July 2011 to December 2012. The forest floor of cedar stands had received higher levels of additional 137Cs deposition compared with the mixed broad-leaved stand during the sampling period. The cumulative 137Cs deposition during the study period was 119 kBq m−2 for the mature cedar stand, 105 kBq m−2 for the young cedar stand, and 41.5 kBq m−2 for the broad-leaved stand. The deposition of 137Cs to the forest floor occurred mainly in throughfall during the first rainy season, from July to September 2011 (<200 d after the initial fallout); thereafter, the transfer of 137Cs from the canopy to forest floor occurred mainly through litterfall. A double exponential field-loss model, which was used to simulate the removal of 137Cs from canopies, was the best fit for the temporal changes in the canopy 137Cs inventory.



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Plutonium, 137Cs and uranium isotopes in Mongolian surface soils

Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 1
Author(s): K. Hirose, Y. Kikawada, Y. Igarashi, H. Fujiwara, D. Jugder, Y. Matsumoto, T. Oi, M. Nomura
Plutonium (238Pu and 239,240Pu), 137Cs and plutonium activity ratios (238Pu/239,240Pu) as did uranium isotope ratio (235U/238U) were measured in surface soil samples collected in southeast Mongolia. The 239,240Pu and 137Cs concentrations in Mongolian surface soils (<53 μm of particle size) ranged from 0.42 ± 0.03 to 3.53 ± 0.09 mBq g−1 and from 11.6 ± 0.7 to 102 ± 1 mBq g−1, respectively. The 238Pu/239,240Pu activity ratios in the surface soils (0.013–0.06) coincided with that of global fallout. The 235U/238U atom ratios in the surface soil show the natural one. There was a good correlation between the 239,240Pu and 137Cs concentrations in the surface soils. We introduce the migration depth to have better understanding of migration behaviors of anthropogenic radionuclides in surface soil. We found a difference of the migration behavior between 239,240Pu and 137Cs from 137Cs/239,240Pu – 137Cs plots for the Mongolian and Tsukuba surface soils; plutonium in surface soil is migrated easier than 137Cs.



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Estimating the impact from Fukushima in Southern Spain by 131I and Accelerator Mass Spectrometry detection of 129I

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 1
Author(s): J.M. Gómez-Guzmán, J.M. López-Gutiérrez, R. García-Tenorio, L. Agulló, J.I. Peruchena, G. Manjón, M. García-León
After the Fukushima accident, large amounts of radionuclides were discharged to the atmosphere. Some of them travelled long distances and were detected in places as far from Japan as Spain a few days after the accident. One of these radionuclides was 131I. Its isotope 129I (T1/2 = 15.7 × 106 years) was also expected to follow the same pathway. In this work, we present the results for the 129I concentration in the same atmospheric samples from Seville (Spain) where 131I activity was measured in 2011 by Baeza et al. (2012). 129I concentrations in aerosol and gaseous samples showed concentrations in the order of 104 and 105 atoms/m3, typically higher in the gaseous form with respect to the aerosol form. Also 129I in rainwater was measured, showing concentrations in the order of 108 atoms/L. The results show a very good agreement with the 131I profile, showing that, if background from other sources is not relevant, it is possible to estimate the impact of similar events years after them thanks to the sensitivity of techniques like Accelerator Mass Spectrometry.



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Influence of iodine supply on the radiation-induced DNA-fragmentation

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 1
Author(s): F. Sudbrock, A. Herrmann, T. Fischer, B. Zimmermanns, W. Baus, A. Drzezga, K. Schomäcker
The protective effect of stable iodide against radiation on thyroid cells was investigated. One physiological effect of stable iodine is well-rooted: stable iodine leads to a reduced thyroid uptake of radioactive iodine. This work wants to focus on an intrinsic effect of stable iodine by which DNA-damage in cells is prevented.To investigate this intrinsic effect thyroid cells (FRTL-5) were externally irradiated by use of a linear accelerator (LINAC) applying energy doses of 0.01 Gy–400 Gy and by incubation with various activity concentrations of 131I (0.1–50 MBq/ml for 24 h). We added stable iodine (NaI) to the cells prior to external irradiation and investigated the effect of the concentration of stable iodine (1, 5, 15 μg/ml). In order to clarify whether thyroid cells have a distinctive and iodine-dependent reaction to ionizing radiation, keratinocytes (HaCaT) without NIS were exposed in the same way. As indicators for the cellular reaction, the extent of DNA fragmentation was determined (Roche, Mannheim, Germany).Both cell types showed distinct ability for apoptosis as proven with camptothecin. The addition of "cold" iodine from 1 to 15 μg/ml without irradiation ("negative control") did not change the response in both cell types. Plausibly, the radio-sensitivity of both cell types did increase markedly with increasing radiation dose but the radiation effect is diminished if iodine is added to the thyroid cells beforehand. The DNA-damage in thyroid cells after addition of cold iodine is reduced by a factor of 2–3. The skin cells did not show an significant change of radio-sensitivity depending on the presence of cold iodine. Elementary iodine possibly acts as a radical scavenger and thus markedly reduces the secondary radiation damage caused by the formation of cytotoxic radicals. This intrinsic radioprotective effect of iodine is seen only in cells with NIS.



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Dynapenia and metabolic health in obese and nonobese adults aged 70 years and older: The LIFE study

Journal of the American Medical Directors Association

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Korean multicenter registry of transcatheter arterial chemoembolization with drug-eluting embolic agents for nodular hepatocellular carcinomas: six-month outcome analysis

Journal of Vascular and Interventional Radiology

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Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): A randomised, double-blind, placebo-controlled, phase 3 trial

The Lancet

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Efficacy of sterile fecal filtrate transfer for treating patients with Clostridium difficile infection

Gastroenterology

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The cost-effectiveness of testing for NS5a resistance-associated polymorphisms at baseline in genotype 1a-infected (treatment-naïve and treatment-experienced) subjects treated with all-oral elbasvir/grazoprevir regimens in the United States

Alimentary Pharmacology and Therapeutics

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Comparison of the outcomes of free jejunal flap reconstructions of pharyngoesophageal defects in hypopharyngeal cancer and corrosive injury patients

Microsurgery

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Budesonide oral suspension improves symptomatic, endoscopic, and histologic parameters compared with placebo in patients with eosinophilic esophagitis

Gastroenterology

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Improvement in self-reported eating-related psychopathology and physical health-related quality of life after laparoscopic sleeve gastrectomy: A pre-post analysis and comparison with conservatively treated patients with obesity

Eating Behaviours

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Effects of zinc or synbiotic on the duration of diarrhea in children with acute infectious diarrhea

The Turkish Journal of Gastroenterology

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Anti-tnf therapy is able to stabilize bowel damage progression in patients with Crohn’s disease. A study performed using the Lémann Index

Digestive and Liver Diseases

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EUS-guided paclitaxel injection as an adjunctive therapy to systemic chemotherapy and concurrent external beam radiation before surgery for localized or locoregional esophageal cancer: A multicenter prospective randomized trial

Gastrointestinal Endoscopy

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Utility of MRCP in clinical decision making of suspected choledocholithiasis: An institutional analysis and literature review

The American Journal of Surgery

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Gamma-glutamyl transpeptidase-to-platelet ratio is an independent predictor of hepatitis B virus-related liver cancer

Journal of Gastroenterology and Hepatology

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Inadvertent splenectomy during resection for colorectal cancer does not increase long-term mortality in a propensity score model: A nationwide cohort study

Diseases of the Colon and Rectum

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An isoperistaltic jejunum-later-cut overlap method for esophagojejunostomy anastomosis after totally laparoscopic total gastrectomy: A safe and feasible technique

Annals of Surgical Oncology

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Preoperative endoscopy prior to bariatric surgery: A systematic review and meta-analysis of the literature

Obesity Surgery

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Impact of Facility Type and Surgical Volume on 10-Year Survival in Patients undergoing Hepatic Resection for Hepatocellular Carcinoma

Journal of the American College of Surgeons

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Gene amplification of CCNE1, CCND1 and CDK6 in gastric cancers detected by multiplex ligation-dependent probe amplification and fluorescence in situ hybridization

Human Pathology

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Intrahepatic distant recurrence after radiofrequency ablation for hepatocellular carcinoma: Precursor nodules on pre-procedural gadoxetic acid-enhanced liver magnetic resonance imaging

Acta Radiologica

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How important is the gut microbiome? It may depend on your genetics

Joslin Diabetes Center News

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