Τρίτη, 25 Ιουλίου 2017

Internal carotid, external carotid and vertebral artery blood flow responses to a 3-day of head-out dry immersion

Abstract

We have recently demonstrated that heterogeneous cerebral blood flow (CBF) response in each cerebral artery may contribute to the maintenance of circulatory homeostasis in the brain. However, to what extent weightlessness associated with fluid shift from peripheral to central circulations influences distribution of CBF in each cerebral artery remains unknown. We hypothesised that dry immersion-induced fluid shift (weightlessness condition) would cause heterogeneous CBF response in each cerebral artery. During and after a 3-day dry immersion, internal carotid (ICA), external carotid (ECA) and vertebral arteries (VA) blood flows were measured by Doppler ultrasonography using an 8-MHz linear transducer. Although the 3-day dry immersion and the 2-day recovery period did not change blood flow in each cerebral artery, both ICA and VA conductance decreased during dry immersion on day 2 and day 3 (ICA, 2.95 and 3.23 ml min−1 mmHg−1; VA, 1.10 and 1.05 ml min−1 mmHg−1) from the baseline (ICA, 3.47 ml min−1 mmHg−1, P = 0.027; VA, 1.23 ml min−1 mmHg−1, P = 0.004). In addition, Pearson correlation analysis demonstrated that the 3-day dry immersion-induced a decrease in cardiac output (P = 0.004) was associated with changes in ICA (P = 0.046) and VA blood flow (P = 0.021), but not ECA blood flow (P = 0.466). These findings suggest that short exposures to weightlessness via a cephalad redistribution of fluid volume and blood flow in the human body influenced cerebral vasculature in each cerebral artery but did not cause heterogeneous CBF response in each cerebral artery.

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Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in a young female athlete at 36 weeks gestation: a case report

Publication date: Available online 25 July 2017
Source:Pathology - Research and Practice
Author(s): Hae Yoon Grace Choung, Monika Vyas, Daniel Jacoby, Brian West
A 26year old east African professional athlete presented to the obstetric clinic for a routine visit at 36 weeks gestation. She had a history of Right Ventricular Outflow Tract − Ventricular Tachycardia (RVOT-VT) with an episode of cardiac arrest in the past, and had been treated with ablation 4 years earlier. Her current visit was uneventful, her pregnancy progressing normally. Following the visit she went to a local restaurant where she suffered a cardiac arrest that was unresponsive to therapy. Chest compressions were continued from the time of her collapse until an emergency caesarian section was performed, delivering a healthy female infant. At autopsy a focal area of subtle pallor and myocardial thinning was present at the apex of the right ventricle. Histology showed myocyte degeneration and loss with focal full thickness replacement of myocardium by adipose tissue, consistent with the fatty form of arrhythmogenic right ventricular cardiomyopathy (ARVC). Molecular studies revealed a variant of unknown significance in the MYBPC3 gene, but no variant known to be associated with ARVC. In view of the subtlety of the lesion on gross examination this diagnosis could have been easily missed, emphasizing the importance of performing histologic examination of subtle gross cardiac lesions.



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Pancreatic Heterotropia in wall of Extra-hepatic Choledochal Cysts: A Retrospective Analysis of Thirteen of such cases from North India

Publication date: Available online 25 July 2017
Source:Pathology - Research and Practice
Author(s): Pragya Sharma, Tripti Nakra, Gaurav Khanna, Rajni Yadav, Rajesh Panwar, Madhusudhan KS, Khushbu khetan, Nihar R Dash, Sujoy Pal, Peush Sahni, Siddhartha Datta Gupta, Prasenjit Das
IntroductionHeterotopic pancreas (HP) has rarely been identified in the wall of choledochal cyst (CC).MethodsRetrospectively we screened 200 excised specimens of CC received at our Institute over a period of last eight years and looked for presence of HP rests in them. All the specimens were processed in their entirety.ResultHP was identified in the wall of 13 (6.5%) CCs, out of which 11 were Heinrich Type 2, and two were Heinrich Type 1. In half of the cases peribiliary mucous glands were observed intermingled with the HP rests. Features of chronic fibrosing pancreatitis were identified in these rests, with ulceration of overlying cyst lining.ConclusionsHP rests in the wall of CC though rare; their coexistence with peribiliary glands may possibly indicate their common embryonic origin. As a common site of inflammation, HP rest may be one of the common causes of CC.



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Effects of NOx on the molecular composition of secondary organic aerosol formed by the ozonolysis and photooxidation of α-pinene

Publication date: October 2017
Source:Atmospheric Environment, Volume 166
Author(s): Jun-Hyun Park, Zaeem Bin Babar, Sun Jong Baek, Hyun Sik Kim, Ho-Jin Lim
The molecular composition of secondary organic aerosol (SOA), obtained from the ozonolysis and photooxidation of α-pinene, was investigated using ultrahigh-resolution Fourier transform-ion cyclotron resonance mass spectrometry (FT-ICR MS) in negative ion mode electrospray ionization (ESI). SOA formation was performed in an indoor smog chamber. The molecular formulae of individual species were identified on the basis of the measured ionic mass using guidelines, such as number of atoms, elemental ratios, and the nitrogen rule. In each of the SOAs obtained, 815–3501 monomeric and oligomeric (mainly dimeric) species were identified below m/z 800. From ozonolysis, mainly 95% of the typical oxygenated species (CHO) were detected, whereas from photooxidation under high NOx conditions, 32% of nitrogen-containing species (CHON) were detected. Several common intense species (e.g., C9H14O6, C10H14O6, C10H16O5, C17H26O7, C19H28O9, C10H15NO8, and C10H15NO9) could be listed as candidate tracers for the conventional tracers for α-pinene SOA. The increased percentage of CHON as a primary effect of NOx on the SOA composition evidently affected other physicochemical parameters, such as elemental ratios (i.e., O/C, H/C, and N/C), the double-bond equivalent (DBE), the carbon oxidation state (OSC), and the organic-mass-to-carbon ratio (OM/OC). The O/C and OM/OC for CHON were greater than those observed for CHO, indicating that nitrogen preferentially exists in the oxidized form (e.g., -ONO2). The complexity of oligomerization was observed in DBE and OM/OC according to the number of carbon atoms.

Graphical abstract

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Differences between emissions measured in urban driving and certification testing of heavy-duty diesel engines

Publication date: October 2017
Source:Atmospheric Environment, Volume 166
Author(s): Poornima Dixit, J. Wayne Miller, David R. Cocker, Adewale Oshinuga, Yu Jiang, Thomas D. Durbin, Kent C. Johnson
Emissions from eight heavy-duty diesel trucks (HDDTs) equipped with three different exhaust aftertreatment systems (ATS) for controlling nitrogen oxide (NOx) emissions were quantified on a chassis dynamometer using driving schedules representative of stop-and-go and free-flow driving in metropolitan areas. The three control technologies were: 1) cooled exhaust gas recirculation (CEGR) plus a diesel particulate filter (DPF); 2) CEGR and DPF plus advanced engine controls; and 3) CEGR and DPF plus selective catalytic reduction with ammonia (SCR). Results for all control technologies and driving conditions showed PM emission factors were less than the standard, while selected non-regulated emissions (ammonia, carbonyls, and C4–C12 hydrocarbons) and a greenhouse gas (nitrous oxide) were at measurement detection limits. However, NOx emission factors depended on the control technology, engine calibration, and driving mode. For example, emissions from engines with cooled-exhaust gas recirculation (CEGR) were 239% higher for stop-and-go driving as compared with free-flow. For CEGR plus selective catalytic reduction (SCR), the ratio was 450%. A deeper analysis was carried out with the assumption that emissions measured for a drive cycle on either the chassis or in-use driving would be similar. Applying the same NTE rules to the chassis data showed emissions during stop-and-go driving often exceeded the certification standard and >90% of the driving did not fall within the Not-To-Exceed (NTE) control area suggesting the NTE requirements do not provide sufficient emissions control under in-use conditions. On-road measurement of emissions using the same mobile lab while the vehicle followed a free-flow driving schedule verified the chassis results. These results have implications for scientists who build inventories using certification values instead of real world emission values and for metropolitan populations, who are exposed to elevated emissions. The differences in values between real world emissions and certification cycles should be narrowed. For example, one might use a different mix of cold and hot start testing to greater emphasize low temperature/load operation, a separate cycle to specifically characterize low-load operation, or broaden the in-use compliance testing requirements and associated conformity factors to incorporate a wider envelope of vehicle operation, especially at low load conditions. .



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New insights on humic-like substances associated with wintertime urban aerosols from central and southern Europe: Size-resolved chemical characterization and optical properties

Publication date: October 2017
Source:Atmospheric Environment, Volume 166
Author(s): Aristeidis Voliotis, Roman Prokeš, Gerhard Lammel, Constantini Samara
Although Humic-LIke Substances (HULIS) are important contributors to the mass of organic aerosol in airborne particulate matter (PM), little is known about their chemical composition, while, their size-resolved optical properties have not been studied yet. Here, HULIS fractions were isolated from size-resolved aerosol samples (≤0.49, 0.49–0.95, 0.95–3 and 3–10 μm) collected in urban and suburban environments of four European cities during wintertime. The bulk (i.e., sum of all size fractions) concentration of HULIS ranged between 1.29 and 2.80 μg m−3 across sites with highest values in the ≤0.49 μm particle size fraction. The contribution of the carbon mass of HULIS (HULIS-C) to the water-soluble organic carbon content (WSOC) of PM was 32–43%, which is typical for urban sites affected by biomass burning. The Mass Absorption Efficiency (MAE), which characterizes the efficiency of absorbing solar energy per carbon mass of HULIS decreased with particle size, suggesting that the finest size fractions contain more light-absorbing chromophores, which could affect the light-absorbing ability of organic aerosols. The good correlation of HULIS with effective biomass tracers such as K+, as well as with secondary inorganic aerosol components, proposed that HULIS had both primary (i.e., biomass burning) and secondary sources. The Fourier Transfer Infrared coupled to Attenuation Total Reflectance (FTIR-ATR) spectra demonstrated prevalence of aromatic over carboxylic functional groups in most HULIS fractions, indicating contribution from coal combustion emissions in addition to fresh biomass burning aerosol. The new findings add to better understanding the sources and chemical structure of HULIS in urban and suburban environments.

Graphical abstract

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CFD modeling of particle dispersion and deposition coupled with particle dynamical models in a ventilated room

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Publication date: October 2017
Source:Atmospheric Environment, Volume 166
Author(s): Guangping Xu, Jiasong Wang
Two dynamical models, the traditional method of moments coupled model (MCM) and Taylor-series expansion method of moments coupled model (TECM) for particle dispersion distribution and gravitation deposition are developed in three-dimensional ventilated environments. The turbulent airflow field is modeled with the renormalization group (RNG) k–ε turbulence model. The particle number concentration distribution in a ventilated room is obtained by solving the population balance equation coupled with the airflow field. The coupled dynamical models are validated using experimental data. A good agreement between the numerical and experimental results can be achieved. Both models have a similar characteristic for the spatial distribution of particle concentration. Relative to the MCM model, the TECM model presents a more close result to the experimental data. The vortex structure existed in the air flow makes a relative large concentration difference at the center region and results in a spatial non-uniformity of concentration field. With larger inlet velocity, the mixing level of particles in the room is more uniform. In general, the new dynamical models coupled with computational fluid dynamics (CFD) in the current study provide a reasonable and accurate method for the temporal and spatial evolution of particles effected by the deposition and dispersion behaviors. In addition, two ventilation modes with different inlet velocities are proceeded to study the effect on the particle evolution. The results show that with the ceiling ventilation mode (CVM), the particles can be better mixed and the concentration level is also higher. On the contrast, with the side ceiling ventilation mode (SVM), the particle concentration has an obvious stratified distribution with a relative lower level and it makes a much better environment condition to the human exposure.



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Cholangioscopic Management of Mirizzi Syndrome in a Pediatric Patient.

No abstract available

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Hepatic Portocholecystostomy: 97 Cases From a Single Institution.

Objectives: About 20% of cases of biliary atresia (BA) do not involve the gallbladder, the cystic duct and the common bile duct. In these cases, a hepatoportocholecystostomy (HPC) may be performed instead of the classical hepatoportoenterostomy (HPE). Methods: We reviewed our cohort to investigate the efficacy of HPC as well as the associated surgical complications and clinical problems. Results: From 1984 to 2009, 97 patients underwent HPC in our institution. In the first 6 months of the postoperative period no patient presented with bacterial cholangitis. Nine patients had bile leakage and one patient had a gallbladder obstruction. For these ten patients, HPC was modified in HPE. Jaundice clearance was maintained after HPE, but four of the patients presented one or more cholangitis episodes. After six months, there were no cases of cholangitis recorded, two patients presented bile leakage and four patients experienced gallbladder obstruction. After 5 years of follow up, 46% of the patients were jaundice free with their native liver and 29.4% were transplanted. Conclusion: In patients with BA with patent extrahepatic bile ducts, hepatoportocholecystomy is a good surgical technique that can prevent cholangitis. These results are counterbalanced by specific surgical complications that need to be known and looked for in the postoperative period. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Attention Deficit Hyperactivity Disorder and Functional Defecation Disorders in Children.

Objectives: To assess the prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with functional defecation disorders (FDDs) and to assess the prevalence of FDDs in children with ADHD. Methods: A cross-sectional cohort study was carried out between September 2014 and May 2016. Group 1: Parents of children with FDDs according to the Rome III criteria completed the Child Behavior Checklist (CBCL) and the VvGK (Dutch questionnaire based on the American Disruptive Behavior Disorder rating scale). Patients with ADHD subarea scores >=70 on the CBCL and/or >=16 on the VvGK were referred for further psychiatric evaluation. Group 2: Parents of children treated for ADHD at a specialized ADHD-outpatient clinic completed a standardized questionnaire regarding their child's defecation pattern. Results: In group 1 (282 children with FDDs), 10.3% (7.1-13.5% BCaCI) were diagnosed with ADHD. Group 2 consisted of 198 children with ADHD, 22.7% (17.6-28.8 BCaCI) fulfilled the Rome III criteria for an FDD. Children with both an FDD and ADHD reported urinary incontinence significantly more often compared to children with an FDD or ADHD alone: 57.1% in FDD+ADHD vs. 22.8% in FDD alone (p

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Pediatric Gastroenterologists' Approach to Venous Thromboembolism Prophylaxis in Pediatric Inflammatory Bowel Disease.

The risk of venous thromboembolism (VTE) is significantly increased in inflammatory bowel disease (IBD) patients. For the adult population, prophylaxis guidelines exist to help guide physicians in their management of high-risk IBD patients. While it is known that children with IBD also experience increased rates of VTE, there is no clear consensus on how best to prevent these unwanted complications. We sought to better understand practicing pediatric gastroenterologists' awareness of this issue and practices surrounding prevention of VTE in their pediatric patients. We found that pediatric gastroenterologists are well aware of the increased risk for VTE in children with IBD, that anticoagulant prophylaxis is infrequently used for pediatric patients, and that the most commonly cited reason for not providing prophylaxis is the lack of available guidelines in the literature. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Quo vadis: tracing the fate of neural crest cells

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Publication date: December 2017
Source:Current Opinion in Neurobiology, Volume 47
Author(s): Luis Zurkirchen, Lukas Sommer
The neural crest is a transient structure in vertebrate embryos that produces migratory cells with an astonishing developmental potential. While neural crest fate maps have originally been established through interspecies transplantation assays, dye labeling, and retroviral infection, more recent methods rely on approaches involving transgenesis and genome editing. These technologies allowed the identification of minor neural crest-derived cell populations in tissues of non-neural crest origin. Furthermore, in vivo multipotency at the single cell level and stage-dependent fate acquisitions were demonstrated using genetic technologies. Finally, recent reports indicate that neural crest-derived cells become activated in response to injury to secrete factors supporting tissue repair. Thus, neural crest-derived cells apparently contribute to tissue formation and regeneration by cell autonomous and non-autonomous mechanisms.



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Anti-proteolytic property and bonding durability of mussel adhesive protein-modified dentin adhesive interface

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Publication date: Available online 25 July 2017
Source:Dental Materials
Author(s): Hui Fang, Quan-Li Li, Min Han, May Lei Mei, Chun Hung Chu
ObjectivesTo evaluate the effect of mussel adhesive protein (MAP) on collagenase activity, dentin collagen degradation and microtensile dentin bond strength (μTBS).MethodsThree groups were designed: 1. experimental group: treated with MAP; 2. positive control: treated with GM6001 (collagenase-inhibitor); 3. negative control: treated with distilled water (DW). For collagenase activity, Clostridiopeptidase-A was added to each group (n=5), and collagenase activity was assessed by colorimetric assay. For dentin collagen degradation, thirty dentin slabs were allocated to the three above groups (n=10). Dentin collagen degradation was evaluated by measuring released hydroxyproline by colorimetric assay after being incubated in Clostridiopeptidase-A for 7 days. For microtensile bond strength, sixty human third molars with flat dentin surfaces were etched by phosphoric acid and then assigned to the three above groups (n=20). An etch-and-rinse adhesive system was applied to all three groups as stated in standard clinic protocol. The test of μTBS was performed before and after thermocycling and collagenase challenge.ResultsThe collagenase activities (nmol/min/mg) in the group of MAP was significantly less inactive compared to the group of GM6001 and DW (MAP<GM6000<DW, p<0.01). The hydroxyproline concentrations (μg/mL) was significantly less in the group of MAP compared to the group of GM6001 and DW (MAP<GM6000<DW, p<0.01). While there was no significant difference in the immediate μTBS (MPa) among three groups (p>0.06), the value of μTBSs after thermocycling and collagenase challenge was significantly greater in the group of MAP and GM6001 compared to the group of DW (MAP, GM6000>DW, p<0.001).SignificanceMAP inhibits collagenase activity, prevents dentin collagen degradation, and delays the deterioration of the dentin bonding of composite restoration over time.



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Sleep apnea awareness among Latin-Americans

We have read the original article entitled: “Awareness and knowledge of obstructive sleep apnea among the general population” by Ching-Hui Sia, and co-investigators (1). In this noteworthy paper, the authors conducted a telephone survey to assess current awareness, knowledge, and attitudes towards OSA in the Singapore community. We have previously explored the same topic in the Latin American population (2); in our study, we defined awareness as a function of perception and knowledge. Perception was measured with a visual scale assessing the degree of agreement to three different statements implying the importance of the disease.

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Sleep and slow-wave activity in depressed adolescent boys: a preliminary study

Adolescence is a vulnerable period of life which is characterized by increasing incidence of depression. Sleep disturbance is one of the diagnostic symptoms of depressive disorder. Adolescence is also characterized by dramatic maturational changes in sleep and its regulation. The goal of this study was to assess sleep macroarchitecture and slow-wave activity (SWA) in depressed adolescent boys.

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Idiopathic Intracranial Hypertension Progressing to Venous Sinus Thrombosis, Subarachnoid Hemorrhage, and Stroke.

Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure (ICP), the absence of structural lesions on neuroimaging, and normal cerebrospinal fluid composition. Cerebral venous sinus thrombosis (CVST) is a common cause of increased ICP and can be differentiated from IIH with magnetic resonance venography. We describe a young woman with typical IIH who underwent lumbar puncture and was treated with a short course of high-dose corticosteroids followed by acetazolamide. She subsequently developed CVST, subarachnoid hemorrhage, and stroke. Risk factors that may have resulted in CVST are discussed. (C) 2017 by North American Neuro-Ophthalmology Society

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Role of Nocturnal Arterial Hypotension in Nonarteritic Anterior Ischemic Optic Neuropathy.

No abstract available

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Horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3D CT data

Publication date: Available online 25 July 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Bo-Ram Yeo, Jeong-Joon Han, Seunggon Jung, Hong-Ju Park, Hee-Kyun Oh, Min-Suk Kook
Objectives.To evaluate horizontal changes of the proximal mandibular segment after mandibular setback surgery using three-dimensional computed tomography (3D CT).Study Design.This study included 66 patients who underwent bilateral sagittal split ramus osteotomy (BSSRO) for correction of mandibular prognathism Using 3D CT data obtained preoperatively (T1), immediately postoperatively (T2), and 6 months postoperatively (T3), horizontal changes of the proximal mandibular segment including intercondylar width (ICW), intergonial width (IGW), and frontal-ramal inclination (FRI) were evaluated.Results.The value of right-FRI was 11.43 ± 1.36° at T1, 11.91 ± 1.96° at T2, and 10.7 ± 1.5° at T3. The values of left-FRI were 6.10 ± 1.03° at T1, 8.17 ± 1.66° at T2, and 7.66 ± 1.65° at T3. The values of IGW were 99.67 ± 1.67 mm at T1, 98.24 ± 1.72 mm at T2, and 97.08 ± 1.71 mm at T3. IGW was significantly decreased at T3 compared with T1 (p < 0.001). The values of ICW were 123.51 ± 1.66 mm at T1, 123.9 ± 1.66 mm at T2, and 122.88 ± 1.58 mm at T3.Conclusion.Lower facial width at mandibular angle region decreased immediately after mandibular setback surgery and showed further decreases during the postoperative period.



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The influence of food consistency on chewing rate and muscular work

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Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): A. van der Bilt, J.H. Abbink
Food properties influence the parameters of the masticatory process, such as jaw movement, muscle activity and chewing rate. Firm foods will require more muscle activity than softer foods. However, the influence of food hardness on chewing rate is ambiguous as both slower and higher chewing rates have been reported for harder foods. Rheological characteristics of the food, such as plasticity and elasticity, may help to explain differences in chewing rate. The aim of our study was to determine the influence of food properties on chewing rate and muscular work in five phases of a chewing sequence. Eighty-four participants chewed on five foods, which strongly differed in consistency. Chewing gum was used as a reference food. The phase in the chewing sequence had a large significant effect on cycle duration for the five foods. A significant decrease in cycle duration at the beginning of chewing was followed by an increase in later phases, leading to U-shaped curves. Food type had a small effect on the average cycle duration. However, large significant differences in cycle duration were observed between the foods at the beginning of a chewing sequence. In that phase, the firm foods were chewed much slower than the soft foods. Muscular work was significantly influenced by both chewing phase and food type.



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Histopathological and clinical evaluation of chronic spontaneous urticaria patients with neutrophilic and non-neutrophilic cutaneous infiltrate

Publication date: Available online 25 July 2017
Source:Allergology International
Author(s): Cíntia Freitas Martins, Karina Lopes Morais, Pamela Figueroa, Natasha Favoretto Dias, Neusa Sakai Valente, Celina Wakisaba Maruta, Paulo Ricardo Criado
BackgroundChronic urticaria has an expressive prevalence in general population, especially in adults, and is defined by the presence of intermittent hives for six weeks or longer. Our study aims to characterize the histological patterns of chronic spontaneous urticaria, based on the inflammatory cell infiltrate, and correlate them to laboratory exams.MethodsIt was performed a retrospective analysis of laboratory, histopathology and direct immunofluorescence data of 93 patients with chronic urticaria. For histopathological analysis, cell count was performed in four fields at high magnification (×400) for each specimen. The resulting cell count medians were submitted to statistical analysis and, then, were correlated to laboratorial findings.ResultsWe found a female predominance (76.34%) of chronic urticaria cases, and an average age of 42.5 years (SD ± 15). Two histological groups were distinctive: 1) chronic urticaria with predominance of neutrophils or eosinophils – N (%) = 39 (42.4%) – and 2) chronic urticaria with predominance of lymphocytes – N (%) = 53 (57.6%). There was not significant correlation between histological groups and laboratorial tests. Moreover, direct immunofluorescence was positive in 21 (33,87%) from 62 patients.ConclusionsThere is not enough scientific evidence to support neutrophilic urticaria as a solid, separate entity.



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Host protein atlastin-1 promotes human immunodeficiency virus (HIV-1) replication

Abstract



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Does Nocturnal Hypotension Play a Causal Role in Nonarteritic Anterior Ischemic Optic Neuropathy?: Response.

No abstract available

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Extraocular Muscle Findings in Myasthenia Gravis Associated Treatment-Resistant Ophthalmoplegia: A Case Report.

We report the histopathological and ultrastructural tissue analysis of extraocular muscle (EOM) obtained from a patient with seronegative myasthenia gravis (MG) with treatment-resistant ophthalmoplegia for 3.5 years. The EOM demonstrated predominantly myopathic features and ultrastructural evidence of mitochondrial dysfunction, but the most striking features were increased endomysial collagen and adipocyte replacement of muscle fibers. By contrast, control EOM from a patient undergoing strabismus surgery for a sensory exotropia in a nonseeing eye and a similar duration of deviation, showed normal muscle histology. Although the histopathological and ultrastructural findings largely resemble those of limb muscle in MG, the abundant endomysial collagen may be nonspecific and secondary to poor force generation as a result of chronic ophthalmoplegia. (C) 2017 by North American Neuro-Ophthalmology Society

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Table of Contents

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Publication date: August 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 8





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Editors' Selections From This Issue: Volume 98 / Number 8 / August 2017

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Publication date: August 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 8





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Masthead

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Publication date: August 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 8





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Correction

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Publication date: August 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 8





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Learning curve of tonsillectomy

To determine the time required to sufficiently educate a well-trained surgeon to perform tonsillectomy.

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Noonan Syndrome: An Underestimated Cause of Severe to Profound Sensorineural Hearing Impairment. Which Clues to Suspect the Diagnosis?.

Objective: To highlight Noonan syndrome as a clinically recognizable cause of severe to profound sensorineural hearing impairment. Study Design: New clinical cases and review. Setting: Patients evaluated for etiological diagnosis by a medical geneticist in a reference center for hearing impairment. Patients: Five patients presenting with confirmed Noonan syndrome and profound sensorineural hearing impairment. Interventions: Diagnostic and review of the literature. Results: Five patients presented with profound sensorineural hearing impairment and molecularly confirmed Noonan syndrome. Sensorineural hearing impairment has been progressive for three patients. Cardiac echography identified pulmonary stenosis in two patients and was normal for the three other patients. Short stature was found in two patients. Mild intellectual disability was found in one patient. Inconspicuous clinical features as facial dysmorphism, cryptorchidism, or easy bruising were of peculiar interest to reach the diagnosis of Noonan syndrome. Conclusion: Profound sensorineural hearing impairment can be the main feature of Noonan syndrome. Associated features are highly variable; thus, detailed medical history and careful physical examination are mandatory to consider the diagnosis in case of a sensorineural hearing impairment. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Unique Case of Hearing Recovery After Otic Capsule Destruction and Complete Sensorineural Hearing Loss Caused by Langerhans Cell Histiocytosis.

: A 14-year-old woman presented with right-sided otologic and vestibular symptoms after presenting with hormonal disturbances earlier that year. Imaging showed a gross destruction of the temporal bone, mastoid air cells, and external acoustic meatus with invasion into the otic capsule. The patient experienced complete sensorineural hearing loss in the right ear. Biopsy diagnosed Langerhans cell histiocytosis (LCH) and the patient was treated with chemotherapy. After 1 year of treatment, the patient's hearing partially recovered and imaging showed reconstitution of the temporal bone including the otic capsule. Our case is the first report of complete sensorineural hearing loss with partial recovery after LCH treatment. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Stable Longitudinal Performance of Adult Cochlear Implant Users for More Than 10 Years.

Objective: To analyze the long-term performance of cochlear implant patients. Study Design: Retrospective longitudinal study. Setting: Tertiary referral center with a large cochlear implant program. Main Outcome Measure: Speech perception scores in quiet and in background noise in the short-term (1.12 +/- 0.15 yr) and long-term (12.61 +/- 2.34 yr) after implantation. Patients: Fifty-eight implanted ears from 55 patients with a mean age of 51.80 +/- 1.757 years at the time of implantation were included. Results: Speech perception scores were stable in the long-term for up to 20 years postimplantation. When alteration of speech perception over time was investigated in relation to the age at implantation, there was a deterioration of the scores in quiet in older patients (>60 years old at the time of surgery). In addition the speech comprehension in noise was negatively correlated with the age at the time of the test. Conclusion: The speech perception abilities of cochlear implant users are stable in the long-term and at the most may be affected by the age of the patients, as it is known from acoustic hearing. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Fingolimod (FTY-720) is Capable of Reversing Tumor Necrosis Factor Induced Decreases in Cochlear Blood Flow.

Hypothesis: The potential of Fingolimod (FTY-720), a sphingosine-1-phosphate analogue, to revoke the changes in cochlear blood flow induced by tumor necrosis factor (TNF) was investigated. Background: Impairment of cochlear blood flow has often been considered as the common final pathway of various inner ear pathologies. TNF, an ubiquitous cytokine, plays a major role in these pathologies, reducing cochlear blood flow via sphingosine-1-phosphate-signaling. Methods: Fifteen Dunkin-Hartley guinea pigs were randomly assigned to one of three groups (placebo/placebo, TNF/placebo, TNF/FTY-720). Cochlear microcirculation was quantified over 60 minutes by in vivo fluorescence microscopy before and after topical application of placebo or TNF (5 ng/ml) and after subsequent application of placebo or FTY-720 (200 [mu]g/ml). Results: Treatment with TNF led to a significant decrease of cochlear blood flow. Following this, application of placebo caused no significant changes while application of FTY-720 caused a significant rise in cochlear blood flow. Conclusions: FTY-720 is capable of reversing changes in cochlear blood flow induced by application of TNF. This makes FTY-720 a valid candidate for potential treatment of numerous inner ear pathologies. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Breast-feeding and Infant Hospitalization for Infections: Large Cohort and Sibling Analysis

imageObjectives: Breast-feeding may protect against infections, but its optimal duration remains controversial. We aimed to study the association of the duration of full and any breast-feeding with infections the first 18 months of life. Methods: The Norwegian Mother and Child study (MoBa) is a prospective birth cohort which recruited expecting mothers giving birth from 2000 to 2009. We analyzed data from the full cohort (n = 70,511) and sibling sets (n = 21,220) with parental report of breast-feeding and infections. The main outcome measures were the relative risks (RRs) for hospitalization for infections from 0 to 18 months by age at introduction of complementary foods and duration of any breast-feeding. Results: Although we found some evidence for an overall association between longer duration of full breast-feeding and lower risk of hospitalizations for infections, 7.3% of breast-fed children who received complementary foods at 4 to 6 months of age compared to 7.7% of those receiving complementary foods after 6 months were hospitalized (adjusted RR 0.95, 95% confidence interval 0.88–1.03). Higher risk of hospitalization was observed in those breast-fed 6 months or less (10.0%) compared to ≥12 months (7.6%, adjusted RR 1.22, 95% confidence interval 1.14–1.31), but with similar risks for 6 to 11 months versus ≥12 months. Matched sibling analyses, minimizing the confounding from shared maternal factors, showed nonsignificant associations and were generally weaker compared with the cohort analyses. Conclusions: Our results support the recommendation to fully breast-feed for 4 months and to continue breast-feeding beyond 6 months, and suggest that protection against infections is limited to the first 12 months.

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Systematic Review: Nutrition and Physical Activity in the Management of Paediatric Nonalcoholic Fatty Liver Disease

imageObjectives: The aim of the study was to evaluate efficacy of nutrition and physical activity interventions in the clinical management of paediatric nonalcoholic fatty liver disease. The prevalence of paediatric nonalcoholic fatty liver disease continues to rise alongside childhood obesity. Weight loss through lifestyle modification is currently first-line treatment, although supplementation of specific dietary components may be beneficial. Methods: Medline, CINAHL, EMBASE, Scopus, and Cochrane Libraries were systematically searched to identify randomized controlled trials assessing nutritional and physical activity interventions. Primary outcome measures were changes to liver biomarkers assessed by imaging, histology, or serum liver function tests. Study quality was evaluated using the American Dietetic Association Quality Criteria Checklist. Results: Fifteen articles met eligibility criteria investigating nutritional supplementation (vitamin E [n = 6], probiotics [n = 2], omega-3 fatty acids [n = 5]), dietary modification (low glycaemic load [n = 1] and reducing fructose intake [n = 1]). No randomized controlled trials examining physical activity interventions were identified. Vitamin E was ineffective at improving alanine transaminase levels, whereas omega-3 fatty acids decreased hepatic fat content. Probiotics gave mixed results, whereas reduced fructose consumption did not improve primary outcome measures. A low glycaemic load diet and a low-fat diet appeared equally effective in decreasing hepatic fat content and transaminases. Most studies were deemed neutral as assessed by the American Dietetic Association Quality Criteria Checklist. Conclusions: The limited evidence base inhibits the prescription of specific dietary and/or lifestyle strategies for clinical practice. General healthy eating and physical activity guidelines, promoting weight loss, should remain first-line treatment until high-quality evidence emerges that support specific interventions that offer additional clinical benefit.

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A Public Health and Data Crisis You Can Help Solve: CPSC's Critical Need for NASPGHAN's Data

No abstract available

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Elevated Hemoglobin Level Is Associated With Advanced Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease

imageObjectives: Hemoglobin (Hb) and red blood cell distribution width (RDW) have been reported to be a risk marker of metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). No study exists on pediatric populations. We aimed to determine the association between hematological parameters, and the severity of disease in children with biopsy-proven NAFLD. Methods: A total of 117 children (85 boys, mean age 12 years) with ultrasound evidence of NAFLD undergoing liver biopsy for diagnosis of nonalcoholic steatohepatitis (NASH), were prospectively enrolled between January 2011 and May 2013 in the setting of a tertiary care center. Children were screened for routine hematological and metabolic parameters, and causes of liver steatosis other than nonalcoholic were excluded, before liver biopsy was performed. Results: A total of 41 NAFLD (boys 29, mean age 11.2 years) and 76 NASH (boys 56, mean age 12.8 years) children were studied. Alanine transaminase levels were significantly higher in NASH group compared with NAFLD group (P = 0.05), and homeostatic model assessment of insulin resistance and triglycerides levels (P = 0.03 and 0.02, respectively). Regarding hematological components: red cell count, Hb, hematocrit, and RDW values were all significantly higher in NASH group compared with NAFLD group (P 

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Prevalence and Impact of Functional Abdominal Pain Disorders in Children With Inflammatory Bowel Diseases (IBD-FAPD)

imageObjectives: We sought to describe the prevalence of the overlap of functional abdominal pain disorders (FAPDs) in children with inflammatory bowel diseases (IBDs), a condition we have designated as IBD-FAPD. We also aimed to describe the psychological profile of this group, and to assess predictors of disease and the impact of IBD-FAPD on quality of life. Methods: This cross-sectional prospective study included patients ages 8 to 18 years with a diagnosis of IBD. Disease activity was assessed by physician's global assessment, laboratory studies, and abbreviated Pediatric Crohn's Disease Activity Index or Pediatric Ulcerative Colitis Activity Index scoring. Age-appropriate validated questionnaires were used to diagnose FAPDs according to the Rome III criteria, depression, anxiety symptoms, and quality of life. Results: There were 128 patients recruited. Eighty-one (63%) completed questionnaires (36 girls; 45 boys; mean age 14.4 ± 2.6 years) (62 Crohn disease, 19 ulcerative colitis). The prevalence of IBD-FAPD in clinical remission was 26% (17 Crohn disease, 4 ulcerative colitis; 95% confidence interval: 20.6%–79.4%), with significantly more girls having IBD-FAPD (P = 0.038). Anxiety symptoms were in 14.3% of patients with IBD-FAPD (P = 0.06) and depression in 23.8% (P = 0.006). The average Pediatric Quality of Life Inventory Gastrointestinal Symptoms score for the IBD-FAPD group was significantly lower than those without FAPDs (71 vs 86.5, P = 0.008). Conclusions: In our cohort, the prevalence of IBD-FAPD was 26%. This is the first study to assess all FAPDs using the Rome III criteria and to demonstrate increased anxiety, depression, and worse quality of life in children with IBD-FAPD. The identification of patients predisposed to IBD-FAPD may allow implementing strategies that could improve symptoms and quality of life.

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Validation of a Simple Stool Diary Used by Caregivers to Document Diarrhea Among Young Children in a Low-Income Country

imageObjectives: The aim of the study was the development and validation of a simple stool diary for caretakers collecting data on stool frequency and consistency among young children in a low-income country. Methods: Focus group studies evaluated how diarrhea was understood by caregivers (content validity). The sensitivity, reliability, and correlations between dehydration and diary scores (construct validity) were tested in a clinical trial. Results: Caregivers recognized and understood the concept and severity of diarrhea. Stool frequency and liquid consistency decreased in children admitted with diarrhea (P 

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Closer Look at the Nutritional Outcomes of Patients After Primary Repair of Congenital Diaphragmatic Hernia

imageObjectives: We hypothesize that the patients after primary repair of congenital diaphragmatic hernia (CDH) can have poor nutritional outcomes and plan to identify risk factors to further stratify these patients. Methods: Retrospective cohort of patients who had primary repair of CDH between 2000 and 2014 and had follow-up at our institution. Z scores (weight for age and weight for length) were calculated using the World Health Organization and Centers for Disease Control and Prevention growth standards. Results: For the 67 patients in the cohort, the median age at the time of repair was 3 days (interquartile range 2–5) and at the time of discharge was 20.5 days (interquartile range 16–30). Fifteen percent of the patients required supplemental tube feeding for inadequate oral intake and 69% required fortified feedings for inadequate growth at discharge (4 patients subsequently needed gastrostomy tube placement). The median z scores at discharge were −1.0 (−2.1 to −0.3) and −1.2 (−2.3 to −0.5) in weight for age and weight for length, respectively. The risk factors for low z scores included open repair and longer periods of postoperative intubation or hospitalization. The z scores were similar at 6 months of age compared to discharge, but then statistically improved at 12 months of age. Conclusions: Patients with primary repair of CDH are at risk for poor nutritional outcomes at the time of hospital discharge and require follow-up to ensure adequate growth. Patients at highest risk are those who had an open repair and had prolonged intubation or hospitalization.

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Clinical Presentation of Acute Gastroenteritis in Children With Functional Abdominal Pain Disorders

imageABSTRACT: Visceral hypersensitivity and abnormal coping are common in children with functional abdominal pain disorders (FAPDs). Thus, it would be expected that children with visceral hypersensitivity would report more pain if their gut is acutely inflamed. The aim of the study was to compare clinical symptoms and somatization of children with and without FAPDs at time of an episode of acute gastroenteritis. Seventy children with acute gastroenteritis and their parents completed the Rome III Diagnostic Questionnaire for Pediatric Functional GI Disorders and the Children's Somatization Inventory. Twenty-one percent of children were diagnosed with an FAPD. Children with FAPDs showed significantly more nongastrointestinal somatic symptoms than children without FAPDs. There were no significant differences in abdominal pain, nausea, vomiting, or school absenteeism between both groups at time of consultation.

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Peroral Endoscopic Myotomy in a Child With Achalasia Cardia

No abstract available

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Vestibular Function in Adults With Epilepsy of Unknown Etiology.

Objective: This study aimed to evaluate vestibular function in adults with chronic epilepsy of unknown etiology in the inter-ictal period. Background: Epilepsy is a chronic medical disorder. Life-long therapy may be required in one-third of patients. Epilepsy is associated with comorbid somatic conditions which impairs patients' quality of life. Methods: This cross-sectional study included 28 with generalized tonic clonic (GTC) convulsions and 14 and 3 with temporal (TLE) and frontal lobe (FLE) epilepsies with secondary generalization (all were on regular carbamazepine therapy) and 40 healthy control subjects. The patients' mean age was 34.97 +/- 7.35 years and the duration of illness was 18.75 +/- 7.99 years. All underwent videonystagmography (VNG). Results: Compared with controls, patients had frequent vestibular symptoms including dizziness (62.22%) (p = 0.0001) and sense of imbalance (44.44%) (p = 0.0001). Eleven patients (24.44%) had central vestibular dysfunction (p = 0.0001); 9 (20%) had mixed vestibular dysfunction and one (2.22%) had peripheral vestibular dysfunction (p = 0.0001). Abnormalities were observed in saccadic (44.4%) and pursuit (42.2%) eye movements, optokinetic nystagmus (42.2%) and positioning/positional (11.11%) and caloric (13.33%) testing. TLE and FLE were associated with more VNG abnormalities than GTC. No significant differences were observed in the demographic and clinical characteristics between patients with and without VNG abnormalities. Conclusion: Vestibular manifestations are frequent in patients with epilepsy. This may be a result of the permanent damaging effect of chronic epilepsy on the vestibular cortical areas and/or a toxic effect from prolonged carbamazepine therapy on the peripheral and central vestibular systems. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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The Middle Ear Cleft Status in a "Natural" Cohort With Eustachian Tube Dysfunction.

Background: The Eustachian tube (ET) has a major role in the middle ear (ME) pressure homeostasis. ET dysfunction is the accepted paradigm for pressure-related ME disorders. We studied the ME status in patients with severely diminished ET opening abilities, and anticipated to find ME disorders in most of them. Patients and Methods: ME status was evaluated in unconscious adults, who were hospitalized in a rehabilitation center with severe brain damage, requiring tracheotomy and gastrostomy. These patients were unable to swallow, produce valsalva, yawn, and needed oral suctioning. Examination included fiberoptic nasopharyngoscopy, gag reflex and soft palate assessments, otoscopy, and tympanometry. Results: Nineteen patients (38 ears) were evaluated: 14 men and 5 women, aged 18 to 93 years (average 59). Duration of gastrostomy and tracheotomy were between 3 months and 18 years. All the patients lacked gag reflex, palatal movements, or supraglottic sensation. Eighteen ears (47%) had otitis media with effusion (OME) (versus ~3% in the general population, p = 0.00001), none had significant tympanic membrane atelectasis, but 20 (53%) ears were normal. Twenty-two ears (59%) had tympanometry types B/C and 16 (41%) had type A. Cerumen impaction incidence (26 ears, 68%) was significantly higher than in normal adults (10%), mentally retarded (36%), and nursing homes residents (57%). Conclusions: A dysfunctional ET predisposed ME disorders. Yet, ~50% of the ears were normal, in contrast to the current paradigm. This implies that ME pressure homeostasis is maintained by factors that can compensate for ET dysfunction. Treating cerumen impaction and OME may be beneficial for rehabilitation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Dual Pathologies of Parathyroid Adenoma and Papillary Thyroid Cancer on Fluorocholine and Fluorodeoxyglucose PET/CT

Abstract

18F-Fluorocholine (FCH) PET/CT is evolving as a functional imaging modality for the preoperative imaging of abnormal parathyroid tissue(s) helping to localize eutopic and ectopic parathyroid tissue and limit the extent of surgery. FCH PET/CT may show incidental uptake in various thyroid lesions necessitating further evaluation, whereas the role of 18F-fluorodeoxyglucose (FDG) PET/CT in the detection of incidental thyroid nodules is well documented. The case of a middle-aged woman with dual pathology of parathyroid adenoma and papillary thyroid cancer detected on FCH and FDG PET/CT is presented.



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A review of chitosan's effect on oral biofilms: Perspectives from the tube to the mouth

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Publication date: Available online 25 July 2017
Source:Journal of Oral Biosciences
Author(s): Eduardo Manuel Costa, Sara Silva, Mariana Veiga, Freni Kekhasharú Tavaria, Maria Manuela Pintado
BackgroundThe oral cavity is a propitious environment for bacteria with different tissue tropisms to colonize and grow due to its diverse surfaces. For bacterial survival in the oral cavity, where tissues are continuously bathed in fluids, biofilm formation is necessary. Dental biofilm, i.e. dental plaque, is notoriously hard to inhibit and traditional oral care solutions are either ineffective at managing oral biofilms or cause secondary effects, such as teeth staining, that make them unattractive.HighlightChitosan has high biocompatibility and antimicrobial activity that is heralded by the pharmaceutical industry for its applicability in biofabrication. Therefore, this material is a potential substitute for the antimicrobials traditionally used in oral care.ConclusionCurrently, the body of work on chitosan and the oral cavity ranges from planktonic studies in vitro to biofilm control/removal studies in vivo. With a wide range of topics available for analysis, this review provides a working understanding of chitosan's role in the control and management of oral biofilms.



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Reduced Functional Connectivity between Ventromedial Prefrontal Cortex and Insula Relates to Longer Corrected QT Interval in HIV+ and HIV- Individuals

Despite the widespread availability of antiretroviral therapy, mortality from cardiovascular disease (CVD) has increased for persons infected with human immunodeficiency virus (HIV) (Enakpene et al., 2015). A large proportion of this CVD comorbidity has been attributed to sudden cardiac death (Tseng et al., 2012). The QT interval reflects the latency between the initiation of the QRS-complex and end of the T-wave and is used as a general marker of ventricular repolarization (Drew et al., 2010). Clinical presentation of ventricular arrhythmias (i.e., torsade de pointes) is partially attributed to prolongation of the QT interval (Viskin, 1999).

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Spatial constraints evoke increased number of steps during turning in Parkinsońs disease

A hallmark of parkinsonian gait phenomenology is the patients’ difficulty to perform standing or walking turns. Turns require the patients to repeatedly shift their weight, and this frequently contributes to falls (Robinovitch et al., 2013). A recent project evaluated objective home-recorded data which demonstrated that people with Parkinson’s disease (PwP) showed reduced performance in turning while the overall activity was similar compared to healthy controls (Mancini et al., 2015). Independently from turning, progressive deterioration of stepping, i.e.

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Impact of novel miR-145-3p regulatory networks on survival in patients with castration-resistant prostate cancer



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Tumour heterogeneity poses a significant challenge to cancer biomarker research



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Infradiaphragmatic irradiation and high procarbazine doses increase colorectal cancer risk in Hodgkin lymphoma survivors



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Mitochondria on the move: emerging paradigms of organelle trafficking in tumour plasticity and metastasis



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The role of primary tumour sidedness, EGFR gene copy number and EGFR promoter methylation in RAS/BRAF wild-type colorectal cancer patients receiving irinotecan/cetuximab



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CD47 overexpression is associated with decreased neutrophil apoptosis/phagocytosis and poor prognosis in non-small-cell lung cancer patients



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No additional prognostic value for MRE11 in squamous cell carcinomas of the anus treated with chemo-radiotherapy



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Commonly used medications and endometrial cancer survival: a population-based cohort study



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Chemotherapy with radiotherapy influences time-to-development of radiation-induced sarcomas: a multicenter study



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Extreme assay sensitivity in molecular diagnostics further unveils intratumour heterogeneity in metastatic colorectal cancer as well as artifactual low-frequency mutations in the KRAS gene



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Embracing model-based designs for dose-finding trials



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Oral squamous cell carcinoma patients can be differentiated from healthy individuals with label-free serum proteomics



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Human equilibrative nucleoside transporter 1 gene expression is associated with gemcitabine efficacy in advanced leiomyosarcoma and angiosarcoma



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Post-translational regulation contributes to the loss of LKB1 expression through SIRT1 deacetylase in osteosarcomas



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Emergence of MET hyper-amplification at progression to MET and BRAF inhibition in colorectal cancer



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Comprehensive analysis of copy number aberrations in microsatellite stable colon cancer in view of stromal component



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Characterisation of blood-derived exosomal hTERT mRNA secretion in cancer patients: a potential pan-cancer marker



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Reduced Functional Connectivity between Ventromedial Prefrontal Cortex and Insula Relates to Longer Corrected QT Interval in HIV+ and HIV- Individuals

Despite the widespread availability of antiretroviral therapy, mortality from cardiovascular disease (CVD) has increased for persons infected with human immunodeficiency virus (HIV) (Enakpene et al., 2015). A large proportion of this CVD comorbidity has been attributed to sudden cardiac death (Tseng et al., 2012). The QT interval reflects the latency between the initiation of the QRS-complex and end of the T-wave and is used as a general marker of ventricular repolarization (Drew et al., 2010). Clinical presentation of ventricular arrhythmias (i.e., torsade de pointes) is partially attributed to prolongation of the QT interval (Viskin, 1999).

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Spatial constraints evoke increased number of steps during turning in Parkinsońs disease

A hallmark of parkinsonian gait phenomenology is the patients' difficulty to perform standing or walking turns. Turns require the patients to repeatedly shift their weight, and this frequently contributes to falls (Robinovitch et al., 2013). A recent project evaluated objective home-recorded data which demonstrated that people with Parkinson's disease (PwP) showed reduced performance in turning while the overall activity was similar compared to healthy controls (Mancini et al., 2015). Independently from turning, progressive deterioration of stepping, i.e.

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Latest Research Link Hearing Loss with Cognitive Decline, Alzheimer’s

Researchers found that hearing loss, hospitalizations, and decreases in verbal fluency are associated with cognitive decline. These findings were presented at the Alzheimer's Association International Conference (AAIC) in London earlier this month.

A University of Wisconsin study that included 783 middle-aged adults in the Wisconsin Registry for Alzheimer's Prevention (WRAP)—a registry of adults with a maternal history of Alzheimer's disease—found that 9.2 percent of the participants reported having hearing loss at baseline. These participants performed worse on cognitive tests four years after baseline assessment than those who did not report any hearing loss. They also had more than doubled risk of developing mild cognitive impairment (MCI) in five years. Based on this prospective cohort study, researchers concluded that hearing loss may not only be a risk factor for MCI, but its identification and treatment may also help detect and manage MCI earlier, thereby reducing future cases of Alzheimer's.

The study, entitled "Self-Reported Hearing Loss, Cognitive Performance, and Risk of MCI: Findings from the Wisconsin Registry for Alzheimer's Prevention," was presented last July 17.

In another University of Wisconsin study, researchers found that changes in speech such as increases in the use of non-specific language (more pronouns), hesitations, and fillers were associated with early onset of MCI. In this study, researchers analyzed two speech samples taken two years apart from 264 middle-aged adults enrolled in the WRAP. Those who had early MCI were found to have reduced verbal fluency that declined faster based on the samples collected.

Other risk factors of cognitive impairment were also discussed at AAIC, including those posed by unplanned visits to emergency units. Bryan James, PhD, of the Rush Alzheimer's Disease Center at Rush University Medical Center explained that emergency or urgent hospital visits, as opposed to planned visits, are associated with significant acceleration (about 60 percent) of mental decline in older adults.

Author information: Noah Glenn

Published: 7/25/2017 5:03:00 PM


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Ultrasound Imaging for Dorsal Ulnar Cutaneous Neuropathy With Extensor Carpi Ulnaris Tendinopathy.

No abstract available

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A Comparative Evaluation of Closed and Open Treatment in the Management of Unilateral Displaced Mandibular Subcondylar Fractures: A Prospective Randomized Study

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1603499

The aim of the study is to evaluate closed and open treatment in the management of unilateral displaced mandibular subcondylar fractures. Twenty patients with unilateral subcondylar fractures of the mandible were evaluated with degree of displacement of more than 20 degrees and ramal height shortening of more than 10 mm. They were informed of the need for 6-month follow-up. Patients were thoroughly informed, explaining the possible advantages and disadvantages of the open and closed treatment options. Radiographic parameters included the level of fracture, deviation of fragment, and ramal height shortening. Correct anatomical reduction is achieved by open treatment as compared with closed treatment. Regarding pain, mouth opening, and lateral excursion movement, statistically significant difference was found in both groups (p < 0.01). In radiographic assessment of ramal height shortening and fracture displacement, statistically significant difference was found (p < 0.01). And no significant complication is found in both treatment groups. The results of this study favor the open treatment for the management of displaced subcondylar fractures. However, the treatment results are also acceptable for closed group.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Ultrasound Imaging for Dorsal Ulnar Cutaneous Neuropathy With Extensor Carpi Ulnaris Tendinopathy.

No abstract available

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Anaphylaxis and intimate behaviour.

Purpose of review: Intimate behaviours may represent an unusual way of exposure to a culprit allergen, or the frame for sex-related allergies due to triggers typically linked to that situation. The present review aims at summarizing the state of the art about the topic, in order to spread the awareness and the basic know-how in the field of sexual-related allergies. Recent findings: Kiss-related IgE-mediated reactions are caused in sensitized partners mainly by the passive transport of allergenic molecules through saliva, skin or oral mucosa. It has also been recently suggested that kissing may act as an epicutaneous way for induction of allergic sensitization. Among food and drugs, not only but mostly, peanuts and beta-lactams, respectively, are the usual trigger. Although controversial, 1-hour wait before kissing and a proper mouth cleaning have been suggested as prevention strategies. Sexual intercourse related local or systemic symptoms can be caused by seminal plasma hypersensitivity, an IgE-mediated/type IV reaction due to prostate-specific antigen, which carries high homology to the canine prostatic kallikrein (Can f 5). Although applied to few patients, successful desensitization and immunotherapy protocols have been proposed. Summary: Intimate behaviours are possible modalities of contact with the allergen. The exact prevalence of such hypersensitivity reactions is not known, but for its implications on Quality of Life and reproductive wishes, the possible link between sex and allergy should become part of the personal culture of clinical allergists and every clinician, in order to extend and improve the diagnosis of unusual or unexplained conditions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Omalizumab Treatment in Chronic Inducible Urticaria: A Systematic Review of Published Evidence

Publication date: Available online 24 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marcus Maurer, Martin Metz, Randolf Brehler, Uwe Hillen, Thilo Jakob, Vera Mahler, Claudia Pföhler, Petra Staubach, Regina Treudler, Bettina Wedi, Markus Magerl
BackgroundOmalizumab, a recombinant anti-IgE antibody, effectively treats chronic spontaneous urticaria. Evidence is lacking in chronic inducible urticarias (CIndUs), which are frequently H1-antihistamine resistant.ObjectiveWe aimed to determine, from the current published literature, the strength of evidence for omalizumab efficacy and safety in the treatment of CIndUs.MethodsWe performed a PubMed® search to identify evidence on omalizumab use in the following nine CIndU subtypes: symptomatic dermographism, cold urticaria, delayed pressure urticaria, solar urticaria, heat urticaria, vibratory angioedema, cholinergic urticaria, contact urticaria and aquagenic urticaria.Results43 trials, case studies, case reports and analyses were identified. Our review indicates that omalizumab has substantial benefits in various CIndUs. The evidence is strongest for symptomatic dermographism, cold urticaria and solar urticaria. Little/no evidence was available on vibratory angioedema, aquagenic and contact urticaria. Our review supports the rapid onset of action, demonstrated through early symptom control in most cases, sometimes within 24 hours. Many patients gained complete/partial symptom relief and substantially improved quality of life. Adverse events were generally low with omalizumab being well tolerated by most patients including children.ConclusionsA strong body of evidence supports the use of omalizumab in the treatment of patients with therapy-refractory CIndU. More data from randomised controlled studies are warranted.



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Sputum autoantibodies in severe eosinophilic asthma

Publication date: Available online 24 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Manali Mukherjee, David C. Bulir, Katherine Radford, Melanie Kjarsgaard, Chynna Margaret Huang, Elizabeth A. Jacobsen, Sergei I. Ochkur, Ana Catuneanu, Hanah Lamothe-Kipnes, James Mahony, James J. Lee, Paige Lacy, Parameswaran K. Nair
BackgroundThe persistence of eosinophils in sputum despite high doses of corticosteroids indicates disease severity in asthma. Chronic inflamed airways over time may lose tolerance to immunogenic entities released upon frequent eosinophil degranulation, which further contributes to disease severity and necessitates increase in maintenance corticosteroids.ObjectivesTo investigate the possibility of a polyclonal autoimmune event in asthmatic airways, and identify associated clinical and molecular characteristics.MethodsPresence of autoantibodies against eosinophil peroxidase (EPX) and anti-nuclear antibodies (ANAs) was investigated in eosinophilic asthmatics maintained on high dose corticosteroids and/or prednisone. The ability of sputum immunoglobulins to induce eosinophil degranulation in vitro was assessed. In addition, the associated inflammatory micro-environment in patients with detectable autoantibodies was examined.ResultsWe report a “polyclonal” autoimmune event occurring in the airways of prednisone-dependent asthmatics with increased eosinophil activity and/or recurrent pulmonary infections, evident by the concomitant presence of sputum anti-EPX and ANAs of the IgG subtype. Extensive cytokine profiling of the sputum revealed a Th2-dominated micro-environment (eotaxin-2, IL-5, IL-18, IL-13), and increased signalling molecules that support the formation of ectopic lymphoid structures (B-cell activating factor, B-cell attracting chemokine-1). Immunoprecipitated sputum immunoglobulins from patients with increased autoantibodies triggered eosinophil degranulation in vitro, with release of extensive histone-rich extracellular-traps; an event unsuppressed by dexamethasone possibly contributing to the steroid-unresponsive nature of these eosinophilic patients.ConclusionThis study identifies an “autoimmune” endotype of severe asthma that can be identified by the presence of sputum autoantibodies against EPX and autologous cellular components.

Teaser

We report a novel concept of an autoimmune inflammation localised to the airways of severe eosinophilic asthmatics. This is possibly steroid-insensitive, contributing to disease severity, and necessitates identification of these patients for appropriate therapeutic strategies. (35 words)


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Inflammatory Mediators Mediate Airway Smooth Muscle Contraction through a GPCR-TMEM16A-VDCC Axis and Contribute to Bronchial Hyperresponsiveness in Asthma

Publication date: Available online 25 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Pei Wang, Wei Zhao, Jie Sun, Tao Tao, Xin Chen, Yan-Yan Zheng, Cheng-Hai Zhang, Zhong Chen, Yun-Qian Gao, Fan She, Ye-Qiong Li, Li-Sha Wei, Ping Lu, Cai-Ping Chen, Ji Zhou, Da-Quan Wang, Liang Chen, Xiao-Hao Shi, Linhong Deng, Ronghua ZhuGe, Hua-Qun Chen, Min-Sheng Zhu
BackgroundAllergic inflammation has long been implicated in asthmatic hyperresponsiveness of airway smooth muscle (ASM), but its mechanism underlying remains incompletely understood. Serving as GPCR agonists, several inflammatory mediators can induce membrane depolarization, contract ASM and augment cholinergic contractile response. We hypothesized that the signal cascade integrating on membrane depolarization by the mediators might involve asthmatic hyperresponsiveness.ObjectiveWe sought to investigate the signalling transduction of inflammatory mediators in ASM contraction and assess its contribution in the genesis of hyperresponsiveness.MethodsWe assessed the capacity of inflammatory mediators to induce depolarization currents by electrophysiological analysis. We analysed the phenotypes of TMEM16A knockout mice, applied pharmacological reagents and measured the Ca2+ signal during ASM contraction. To study the role of the depolarization signalling in asthmatic hyperresponsiveness, we measured the synergistic contraction by acetylcholine and inflammatory mediators both ex vivo and in OVA-induced mouse modelResultsInflammatory mediators, such as 5-HT, histamine, U46619 and LTD4, are capable of inducing ClCa currents in ASM cells, and these currents are mediated by TMEM16A. A combination of multiple analysis revealed that a GPCR-TMEM16A-VDCC signalling axis was required for ASM contraction induced by inflammatory mediators. Block of TMEM16A activity may significantly inhibit the synergistic contraction of acetylcholine and the mediators, and hence reduces hypersensitivity.ConclusionsA GPCR-TMEM16A-VDCC axis contributes to inflammatory mediator-induced ASM contraction, and synergistically activating TMEM16A by allergic inflammatory mediators with cholinergic stimuli.

Graphical abstract

image

Teaser

The GPCR-TMEM16A-VDCC signalling axis plays important role in inflammatory mediator-induced ASM contraction and hypersensitivity. TMEM16A may be a prospective drug target of asthma.


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Idiopathic Intracranial Hypertension Progressing to Venous Sinus Thrombosis, Subarachnoid Hemorrhage, and Stroke.

Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure (ICP), the absence of structural lesions on neuroimaging, and normal cerebrospinal fluid composition. Cerebral venous sinus thrombosis (CVST) is a common cause of increased ICP and can be differentiated from IIH with magnetic resonance venography. We describe a young woman with typical IIH who underwent lumbar puncture and was treated with a short course of high-dose corticosteroids followed by acetazolamide. She subsequently developed CVST, subarachnoid hemorrhage, and stroke. Risk factors that may have resulted in CVST are discussed. (C) 2017 by North American Neuro-Ophthalmology Society

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Role of Nocturnal Arterial Hypotension in Nonarteritic Anterior Ischemic Optic Neuropathy.

No abstract available

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Does Nocturnal Hypotension Play a Causal Role in Nonarteritic Anterior Ischemic Optic Neuropathy?: Response.

No abstract available

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Extraocular Muscle Findings in Myasthenia Gravis Associated Treatment-Resistant Ophthalmoplegia: A Case Report.

We report the histopathological and ultrastructural tissue analysis of extraocular muscle (EOM) obtained from a patient with seronegative myasthenia gravis (MG) with treatment-resistant ophthalmoplegia for 3.5 years. The EOM demonstrated predominantly myopathic features and ultrastructural evidence of mitochondrial dysfunction, but the most striking features were increased endomysial collagen and adipocyte replacement of muscle fibers. By contrast, control EOM from a patient undergoing strabismus surgery for a sensory exotropia in a nonseeing eye and a similar duration of deviation, showed normal muscle histology. Although the histopathological and ultrastructural findings largely resemble those of limb muscle in MG, the abundant endomysial collagen may be nonspecific and secondary to poor force generation as a result of chronic ophthalmoplegia. (C) 2017 by North American Neuro-Ophthalmology Society

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National clinical practice guidelines for food allergy and anaphylaxis: an international assessment

Clinical practice guidelines are important tools to promote evidence-based clinical care, but not all countries have the capacity or infrastructure to develop these in-house. The European Academy of Allergy an...

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Role of Transesophageal Echocardiography in Surgery for Hemitruncus Arteriosus.

No abstract available

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Role of the Perioperative Surgical Home in Optimizing the Perioperative Use of Opioids.

Several federal agencies have recently noted that the United States is in the midst of an unprecedented "opioid epidemic," with an increasing number of opioid-related overdoses and deaths. Providers currently face 3 population-level, public health challenges in providing optimal perioperative pain care: (1) the continued lack of overall improvement in the excessive incidence of inadequately treated postoperative pain, (2) minimizing or preventing postoperative opioid-related side effects, and (3) addressing current opioid prescribing patterns, and the accompanying problematic surge in prescription opioid diversion, misuse, abuse, addiction, and overdose. In the Perioperative Surgical Home model, anesthesiologists and other pain medicine specialists are uniquely qualified and positioned to develop, implement, and coordinate a comprehensive perioperative analgesic plan, which begins with the formal preoperative patient assessment and continues throughout the postdischarge, convalescence period. The scope and practice of pain management within the Perioperative Surgical Home should thus (a) expand to include routine preoperative patient-level pain-risk stratification (including the chronic use of opioid and nonopioid analgesics), (b) address the multitude of biopsychosocial factors that contribute to interpatient pain variability, and (c) extend and be well coordinated across all 4 phases of the surgical pain experience (preoperative, intraoperative, postoperative, and postdischarge). Specifically, safe and effective perioperative pain management should include a plan of care that is tailored to the individual patient's underlying disease(s), presence of a chronic pain condition and preoperative use of opioids, and the specific surgical procedure- with evidence-based, multimodal analgesic regimens being applied in the vast majority of cases. An iteratively evolutionary component of an existing institutional Perioperative Surgical Home program can be an integrated Transitional Pain Service, which is modeled directly after the wellestablished prototype at the Toronto General Hospital in Ontario, Canada. This multidisciplinary, perioperative Transitional Pain Service seeks to modify the pain trajectories of patients who are at increased risk of (a) long-term, increasing, excessive opioid consumption and/or (b) developing chronic postsurgical pain. Like the Perioperative Surgical Home program in which it can be logically integrated, such a Transitional Pain Service can serve as the needed but missing linkage to improve the continuum of care and perioperative pain management for elective, urgent, and emergent surgery. Even if successfully and cost-efficiently embedded within an existing Perioperative Surgical Home, a new perioperative Transitional Pain Service will require additional resources. (C) 2017 International Anesthesia Research Society

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Perioperative Amino Acid Infusion for Preventing Hypothermia and Improving Clinical Outcomes During Surgery Under General Anesthesia: A Systematic Review and Meta-analysis.

Amino acid (AA) infusion is sometimes selected to avoid hypothermia during general anesthesia. However, the widespread clinical use of AA infusion therapy has not been established. This study aimed to clarify the evidence that AA infusion can increase patient body temperature and improve clinical outcomes using the Grading of Recommendations Assessment, Development, and Evaluation system. We searched MEDLINE (PubMed), Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (Japana Centra Revuo Medicina) in November 2015. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) involving AA infusion compared with placebos during surgery under general or combined general/epidural anesthesia. Study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system and the Cochrane methodology. The primary outcome was difference in body temperature before and after perioperative AA infusion. Shivering frequency, blood loss volume, postoperative intubation time, and hospitalization period were also assessed as clinical outcomes. We analyzed the outcome data using a random effect model. From 298 screened titles, 14 RCTs met our inclusion criteria, including 626 patients (327 in AA and 299 in placebo groups). In 626 participants from 14 RCTs, AA infusion increased body temperature by a mean difference (MD) of 0.46[degrees]C (95% confidence interval [CI], 0.31-0.62, low-quality evidence). Regarding other outcomes, AA infusion decreased shivering frequency by a risk ratio of 0.34 (95% CI, 0.12-0.94; 7 RCTs, 248 participants, very low-quality evidence), shortened postoperative intubation time by MD of -125 minutes (95% CI, -210 to -38.8; 2 RCTs, 158 participants, moderate-quality evidence), and shortened the hospitalization period by MD of -1.81 days (95% CI, -2.07 to -1.55; 3 RCTs, 230 participants, low-quality evidence) compared with placebo. There was no significant difference in the volume of blood loss between the 2 groups (standardized MD, -0.20, 95% CI, -0.44 to 0.04; low-quality evidence). There was no publication bias. AA infusion in the perioperative period increased patient body temperature and improved clinical outcomes compared with placebo. However, the evidence to support the use of AA infusion is limited, and further large-scale RCTs are required. (C) 2017 International Anesthesia Research Society

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Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative.

BACKGROUND: Wake Up Safe is a quality improvement initiative of the Society for Pediatric Anesthesia that contains a deidentified registry of serious adverse events occurring in pediatric anesthesia. The aim of this study was to describe and characterize reported medication errors to find common patterns amenable to preventative strategies. METHODS: In September 2016, we analyzed approximately 6 years' worth of medication error events reported to Wake Up Safe. Medication errors were classified by: (1) medication category; (2) error type by phase of administration: prescribing, preparation, or administration; (3) bolus or infusion error; (4) provider type and level of training; (5) harm as defined by the National Coordinating Council for Medication Error Reporting and Prevention; and (6) perceived preventability. RESULTS: From 2010 to the time of our data analysis in September 2016, 32 institutions had joined and submitted data on 2087 adverse events during 2,316,635 anesthetics. These reports contained details of 276 medication errors, which comprised the third highest category of events behind cardiac and respiratory related events. Medication errors most commonly involved opioids and sedative/hypnotics. When categorized by phase of handling, 30 events occurred during preparation, 67 during prescribing, and 179 during administration. The most common error type was accidental administration of the wrong dose (N = 84), followed by syringe swap (accidental administration of the wrong syringe, N = 49). Fifty-seven (21%) reported medication errors involved medications prepared as infusions as opposed to 1 time bolus administrations. Medication errors were committed by all types of anesthesia providers, most commonly by attendings. Over 80% of reported medication errors reached the patient and more than half of these events caused patient harm. Fifteen events (5%) required a life sustaining intervention. Nearly all cases (97%) were judged to be either likely or certainly preventable. CONCLUSIONS: Our findings characterize the most common types of medication errors in pediatric anesthesia practice and provide guidance on future preventative strategies. Many of these errors will be almost entirely preventable with the use of prefilled medication syringes to avoid accidental ampule swap, bar-coding at the point of medication administration to prevent syringe swap and to confirm the proper dose, and 2-person checking of medication infusions for accuracy. (C) 2017 International Anesthesia Research Society

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Surveying the Literature: Synopsis of Recent Key Publications.

No abstract available

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Improving Adherence to Intraoperative Lung-Protective Ventilation Strategies at a University Medical Center.

BACKGROUND: Intraoperative lung-protective ventilation (ILPV) is defined as tidal volumes 65 kg. Surveyed providers demonstrated stronger agreement to having knowledge and practice consistent with ILPV after interventions. CONCLUSIONS: Our interventions improved anesthesia provider adherence to low tidal volume ILPV. IBW was found to be an important factor related to provider adherence to ILPV. Provider attitudes about their knowledge and practice consistent with ILPV also changed with our interventions. (C) 2017 International Anesthesia Research Society

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Estimation of Stroke Volume and Stroke Volume Changes by Electrical Impedance Tomography.

BACKGROUND: Electrical impedance tomography (EIT) is a noninvasive imaging method that identifies changes in air and blood volume based on thoracic impedance changes. Recently, there has been growing interest in EIT to measure stroke volume (SV). The objectives of this study are as follows: (1) to evaluate the ability of systolic impedance variations ([DELTA]Zsys) to track changes in SV in relation to a baseline condition; (2) to assess the relationship of [DELTA]Zsys and SV in experimental subjects; and (3) to identify the influence of body dimensions on the relationship between [DELTA]Zsys and SV. METHODS: Twelve Agroceres pigs were instrumented with transpulmonary thermodilution catheter and EIT and were mechanically ventilated in a random order using different settings of tidal volume (VT) and positive end-expiratory pressure (PEEP): VT 10 mL[middle dot]kg-1 and PEEP 10 cm H2O, VT 10 mL[middle dot]kg-1 and PEEP 5 cm H2O, VT 6 mL[middle dot]kg-1 and PEEP 10 cm H2O, and VT 6 mL[middle dot]kg-1 and PEEP 5 cm H2O. After baseline data collection, subjects were submitted to hemorrhagic shock and successive fluid challenges. RESULTS: A total of 204 paired measurements of SV and [DELTA]Zsys were obtained. The 4-quadrant plot showed acceptable trending ability with a concordance rate of 91.2%. Changes in [DELTA]Zsys after fluid challenges presented an area under the curve of 0.83 (95% confidence interval, 0.74-0.92) to evaluate SV changes. Conversely, the linear association between [DELTA]Zsys and SV was poor, with R2 from linear mixed model of 0.35. Adding information on body dimensions improved the linear association between [DELTA]Zsys and SV up to R2 from linear mixed model of 0.85. CONCLUSIONS: EIT showed good trending ability and is a promising hemodynamic monitoring tool. Measurements of absolute SV require that body dimensions be taken into account. (C) 2017 International Anesthesia Research Society

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Venovenous Bypass Is Associated With a Lower Incidence of Acute Kidney Injury After Liver Transplantation in Patients With Compromised Pretransplant Renal Function.

BACKGROUND: Although the hemodynamic benefits of venovenous bypass (VVB) during liver transplantation (LT) are well appreciated, the impact of VVB on posttransplant renal function is uncertain. The aim of this study was to determine if VVB was associated with a lower incidence of posttransplant acute kidney injury (AKI). METHODS: Medical records of adult (>=18 years) patients who underwent primary LT between 2004 and 2014 at a tertiary hospital were reviewed. Patients who required pretransplant renal replacement therapy and intraoperative piggyback technique were excluded. Patients were divided into 2 groups, VVB and non-VVB. AKI, determined by the Acute Kidney Injury Network criteria, was compared between the 2 groups. Propensity match was used to control selection bias that occurred before VVB and multivariable logistic regression was used to control confounding factors during and after VVB. RESULTS: Of 1037 adult patients who met the study inclusion criteria, 247 (23.8%) received VVB. A total of 442 patients (221 patients in each group) were matched. Aftermatch patients were further divided according to a predicted probability AKI model using preoperative creatinine (Cr), VVB, and intraoperative variables into 2 subgroups: normal and compromised pretransplant renal functions. In patients with compromised pretransplant renal function (Cr >=1.2 mg/dL), the incidence of AKI was significantly lower in the VVB group compared with the non-VVB group (37.2% vs 50.8%; P = .033). VVB was an independent risk factor negatively associated with AKI (odds ratio, 0.1; 95% confidence interval, 0.1-0.4; P = .001). Renal replacement in 30 days and 1-year recipient mortality were not significantly different between the 2 groups. The incidence of posttransplant AKI was not significantly different between the 2 groups in patients with normal pretransplant renal function (Cr

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Lack of Association Between the Use of Nerve Blockade and the Risk of Persistent Opioid Use Among Patients Undergoing Shoulder Arthroplasty: Evidence From the Marketscan Database.

BACKGROUND: Persistent opioid use following surgery has received increasing attention from policymakers, researchers, and clinicians. Perioperative nerve blockade has been hypothesized to decrease the risk of persistent opioid use. We examined whether nerve blockade was associated with a decreased risk of persistent opioid use among patients undergoing shoulder arthroplasty, a procedure with high rates of persistent postoperative pain. METHODS: Using health care claims data, we constructed a sample of 6695 patients undergoing shoulder arthroplasty between 2002 and 2012 and used billing data to identify the utilization of nerve blockade. We then used a multivariable logistic regression to estimate the association between nerve blockade and 2 measures of opioid use: having filled at least 1 prescription for an opioid between postoperative days (PODs) 0 and 90, and between POD 91 and 365. This regression adjusted for a variety of potential confounders, such as preoperative opioid use and medical history. RESULTS: There was no association between nerve blockade and our 2 measures of persistent opioid use: adjusted odds ratio, 1.12 (97.5% confidence interval, 0.939-1.34; P = .15) for opioid use between POD 0 and 90, and adjusted odds ratio, 0.997 (97.5% confidence interval, 0.875-1.14; P = .95) for opioid use between POD 91 and 365. CONCLUSIONS: Although the use of perioperative nerve blockade may offer short-term benefits, in this study, it was not associated with a reduction in the risk of persistent opioid use for patients undergoing shoulder arthroplasty. (C) 2017 International Anesthesia Research Society

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Quality and Safety in Anesthesia and Perioperative Care.

No abstract available

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A Novel Method of Evaluating Key Factors for Success in a Multifaceted Critical Care Fellowship Using Data Envelopment Analysis.

BACKGROUND: The current system of summative multi-rater evaluations and standardized tests to determine readiness to graduate from critical care fellowships has limitations. We sought to pilot the use of data envelopment analysis (DEA) to assess what aspects of the fellowship program contribute the most to an individual fellow's success. DEA is a nonparametric, operations research technique that uses linear programming to determine the technical efficiency of an entity based on its relative usage of resources in producing the outcome. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: Critical care fellows (n = 15) in an Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship at a major academic medical center in the United States. METHODS: After obtaining institutional review board approval for this retrospective study, we analyzed the data of 15 anesthesiology critical care fellows from academic years 2013-2015. The input-oriented DEA model develops a composite score for each fellow based on multiple inputs and outputs. The inputs included the didactic sessions attended, the ratio of clinical duty works hours to the procedures performed (work intensity index), and the outputs were the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) score and summative evaluations of fellows. RESULTS: A DEA efficiency score that ranged from 0 to 1 was generated for each of the fellows. Five fellows were rated as DEA efficient, and 10 fellows were characterized in the DEA inefficient group. The model was able to forecast the level of effort needed for each inefficient fellow, to achieve similar outputs as their best performing peers. The model also identified the work intensity index as the key element that characterized the best performers in our fellowship. CONCLUSIONS: DEA is a feasible method of objectively evaluating peer performance in a critical care fellowship beyond summative evaluations alone and can potentially be a powerful tool to guide individual performance during the fellowship. (C) 2017 International Anesthesia Research Society

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Absent Pulmonary Valve in a Case of Tetralogy of Fallot: An Incidental Discovery on Intraoperative Transesophageal Echocardiography.

No abstract available

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Do Not Fear the Difficult IV.

No abstract available

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In Response.

No abstract available

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End-Expiratory Occlusion Test Predicts Fluid Responsiveness in Patients With Protective Ventilation in the Operating Room.

BACKGROUND: End-expiratory occlusion test (EEOT) has been proposed to predict fluid responsiveness in mechanically ventilated intensive care unit patients. The utility of this test during low-tidal-volume ventilation remains uncertain. This study aimed to determine whether hemodynamic variations induced by EEOT could predict the effect of volume expansion in patients with protective ventilation in the operating room. METHODS: Forty-one patients undergoing neurosurgery were included. Stroke volume and pulse pressure variations were continuously recorded using pulse contour analysis before and immediately after a 30-second EEOT and after volume expansion (250 mL saline 0.9% given over 10 minutes). Patients with an increase in stroke volume >= 10% after volume expansion were defined as responders. RESULTS: Twenty patients were responders to fluid administration. EEOT induced a significant increase in stroke volume, which was correlated with the stroke volume changes induced by volume expansion (r2 = 0.55, P

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Pain Management, An Issue of Anesthesiology Clinics.

No abstract available

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Erratum



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Erratum



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