Τετάρτη, 19 Δεκεμβρίου 2018

Fwd: contrast media-induced nonrenal adverse drug reactions

Contrast media-induced nonrenal adverse drug reactions
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contrast media-induced nonrenal adverse drug reactions over the last three decades: A systematic review p. 131
Maurizio Sessa, Claudia Rossi, Annamaria Mascolo, Antonella Scafuro, Rosanna Ruggiero, Gabriella di Mauro, Salvatore Cappabianca, Roberto Grassi, Liberata Sportiello, Concetta Rafaniello
DOI:10.4103/jpp.JPP_92_18  
The aim of this study was to investigate the scientific contribution of Italian clinical research for contrast media-induced nonrenal adverse drug reactions over the last three decades. Ovid Embase, Ovid MEDLINE, Web of Science, and Cochrane Methodology Register were used as data sources to identify Italian descriptive studies, observational studies, meta-analyses, and clinical trials assessing contrast media-induced nonrenal adverse drug reactions as a safety outcome. The population of interest was men and women exposed to a contrast medium. Between 1990 and 2017, 24 original articles investigating contrast-induced nonrenal adverse drug reactions were identified. The cohort study was the most representative study design (10/24; 41.7%). The 24 studies were conducted mainly as monocenter studies (14/24; 58.3%) and without receiving funding (17/24; 70.8%). Seventeen out of 24 studies provided a level of evidence ranging from III-2 (11/24; 45.8%) to IV (6/24; 25.0%) on a Merlin scale. In total, 14 of 24 (58.3%) studies were published in a scientific journal ranked in the first quartile of their subject area. The 24 original articles mainly focused on adverse drug reactions already observed during clinical trials (i.e., idiosyncratic systemic reactions). In conclusion, during the last three decades and a burst was not observed in the Italian clinical research investigating contrast-induced nonrenal adverse drug reactions. High-quality clinical research is needed especially for procedures to prevent the onset of the aforementioned events, to identify risk factors, to minimize the risk of their occurrence, and to optimize their related prognosis.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Fwd: Gujarati hypertensives

Gujarati hypertensives
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: A cross-sectional study p. 153
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Sunil J Panjwani, Hirava B Munshi, Chinmay J Shah
DOI:10.4103/jpp.JPP_59_18  
Objective: To study the effect of different classes and combinations of antihypertensive agents on arterial stiffness and central hemodynamic parameters. Materials and Methods: A cross-sectional study was conducted in 446 treated apparently healthy hypertensives. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed in groups stratified by antihypertensive used. Study parameters were brachial hemodynamics (blood pressure (BP), heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work). Statistical significance was kept at P < 0.05. Results: All groups were selected by matching of age, gender, and body mass index. They were comparable with major confounding factors. There was no difference between study parameters in hypertensives taking exclusive angiotensin-converting enzyme inhibitor (ACEI), calcium channel blocker (CCB), or angiotensin II receptor blocker. Multitherapy showed better hemodynamics and monotherapy showed better stiffness parameters. Addition of CCB to ACEI did not make a difference except with diastolic BP. For most comparisons, most of the results lacked statistical significance. Conclusion: Discrete PWA parameters showed no class difference in hypertensives, treated by conventional monotherapy or combination, ACEI appears to be the best drug. This also indicates that early diagnosis and blood pressure control are more important than antihypertensive used.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Fwd: Precontrast T1 signal measurements of normal pituitary and microadenoma

The dynamic contrast enhanced magnetic resonance imaging (DCE MRI),Precontrast T1 signal measurements of normal pituitary and microadenoma
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:

 A retrospective analysis through DCE MRI signal time curves p. 380
Ishan Kumar, Tanya Yadav, Ashish Verma, Ram C Shukla, Surya K Singh
DOI:10.4103/ijri.IJRI_104_18  
Background: The dynamic contrast enhanced magnetic resonance imaging (DCE MRI) has currently become the most utilized technique for the detection of pituitary microadenoma. However, owing to differential enhancement of normal pituitary, high rate of false positivity remains a concern in its interpretation. Purpose: Our aim was to assess the utility of precontrast T1 signal intensity ratio (SIR) of the lesions suspected on DCE MRI, in prediction of presence of microadenoma. Materials and Methods: We retrospectively reviewed MRI of 23 patients referred for DCE MRI of pituitary (group 1, 15 patients with diagnosis of pituitary microadenoma; and group 2, patients not clinically labeled as microadenoma). STC were plotted and T1-SIR at t = 0 s was obtained at the suspicious zone of differential enhancement (SIR T) and normal pituitary (SIR P). SIR difference (SIR P − SIR T) and relative SIR difference (SIR P − SIR T/SIR P) were calculated for each patient and was compared between the two groups. Results: Mean T1 SIR is lower in patients with microadenoma than those without (P = 0.065). SIR difference and relative SIR difference was higher in patients with microadenoma (P = 0.003 and 0.005, respectively). Receiver-operated characteristic curve analysis demonstrated that a cut-off of 26 and 0.107 for SIR difference and relative SIR difference, respectively, could diagnose microadenoma with 100% specificity and reasonable sensitivities. Conclusion: The baseline precontrast T1 SIR evaluation of the lesion suspected to be microadenoma on DCE MRI, derived through STC curve, can increase diagnostic confidence in diagnosis of microadenoma.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus

The evaluation of hydrocephalus : 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus
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Role of 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus p. 385
Amarnath Chellathurai, Komalavalli Subbiah, Barakath Nisha Abdul Ajis, Suhasini Balasubramaniam, Sathyan Gnanasigamani
DOI:10.4103/ijri.IJRI_161_18  

Objective: The aim of our study was to evaluate the diagnostic utility of three-dimensional sampling perfection with application optimized contrast using different flip angle evolution (3D SPACE) sequence and Susceptibility Weighted Imaging (SWI) in hydrocephalus and to propose a refined definition and classification of hydrocephalus with relevance to the selection of treatment option. Materials and Methods: A prospective study of 109 patients with hydrocephalus was performed with magnetic resonance imaging (MRI) brain using standardized institutional sequences along with additional sequences 3D SPACE and SWI. The images were independently read by two senior neuroradiologists and the etiopathogenesis of hydrocephalus was arrived by consensus. Results: With conventional sequences, 46 out of 109 patients of hydrocephalus were diagnosed as obstructive of which 21 patients showed direct signs of obstruction and 25 showed indirect signs. In the remaining 63 patients of communicating hydrocephalus, cause could not be found out in 41 patients. Whereas with 3D SPACE sequence, 88 patients were diagnosed as obstructive hydrocephalus in which all of them showed direct signs of obstruction and 21 patients were diagnosed as communicating hydrocephalus. By including SWI, we found out hemorrhage causing intraventricular obstruction in three patients and hemorrhage at various sites in 24 other patients. With these findings, we have classified the hydrocephalus into communicating and noncommunicating, with latter divided into intraventricular and extraventricular obstruction, which is very well pertaining to the selection of surgical option. Conclusion: We strongly suggest to include 3D SPACE and SWI sequences in the set of routine MRI sequences, as they are powerful diagnostic tools and offer complementary information regarding the precise evaluation of the etiopathogenesis of hydrocephalus and have an effective impact in selecting the mode of management.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Olfactory fossa depth: CT analysis


Olfactory fossa depth: CT analysis
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Olfactory fossa depth: CT analysis of 1200 patients p. 395
Ashok Chirathalattu Babu, Mattavana Ramakrishna Pillai Balachandran Nair, Aneesh Mangalasseril Kuriakose
DOI:10.4103/ijri.IJRI_119_18  

Background: Olfactory fossa (OF) is a depression in anterior cranial cavity whose floor is formed by cribriform plate of ethmoid. Lateral lamella, which forms its lateral boundary, is a thin plate of bone and is at risk of injury during functional endoscopic sinus surgery, especially when fossa is deep/asymmetric. Aims: To measure the variations in the depth of OF and categorize Kerala population as per Keros classification using computed tomography (CT). Settings and Design: This study was conducted in our institution from January 2016 to August 2017. Patients >16 years of age undergoing CT scan of paranasal sinuses (PNS) were included. Materials and Methods: Coronal PNS CT scan studies of 1200 patients were reviewed. The depth of OF was measured from vertical height of lateral lamella. Statistical Methods: Results were analyzed according to gender and laterality using independent sample t-test and Chi-square test. Results: The mean depth of OF was 5.26 ± 1.69 mm. Statistically significant difference was seen in the mean depth of OF between males and females but not between right and left sides. Keros type I was found on 420 sides (17.5%), type II in 1790 (74.6%), and type III on 190 sides (7.9%). Type III Keros was more on the right (9%) than left (6.8%) side, more in males (9.5%) than females (5.9%), and more among males on the right side (11.4%). Asymmetry in OF depth between two sides was seen in 75% of subjects. Conclusion: Prevalence of the dangerous type III OF, even though low, is significant especially among males and on the right side. Therefore, preoperative assessment of OF depth must be done to reduce iatrogenic complications.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: High-altitude cerebral edema

High-altitude cerebral edema
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Neuroimaging features of fatal high-altitude cerebral edema p. 401
Gorky Medhi, Tsella Lachungpa, Jitender Saini
DOI:10.4103/ijri.IJRI_296_18  
Acute high-altitude cerebral edema can occur in an unacclimatised individual on exposure to high altitudes and sometimes it can be fatal. Here we have described the neuroimaging features of a patient who suffered from fatal high altitude cerebral edema. Available literature is reviewed. Probable pathogenesis is discussed. The risk of acute mountain sickness is reported up to 25% in individuals who ascend to an altitude of 3500 meter and in more than 50% subjects at an altitude of 6000 meter. The lack of availability of advanced imaging facilities at such a higher altitude makes imaging of such condition a less described entity.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Isolated spontaneous cerebrospinal fluid rhinorrhoea as a rare presentation of idiopathic intracranial hypertension

Isolated spontaneous cerebrospinal fluid rhinorrhoea as a rare presentation of idiopathic intracranial hypertension
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: Case reports with comprehensive review of literature p. 406
Priti Soin, Umer M Afzaal, Pranav Sharma, Puneet S Kochar
DOI:10.4103/ijri.IJRI_228_18  
Isolated cerebrospinal fluid (CSF) rhinorrhoea as a sole presenting symptom of idiopathic intracranial hypertension (IIH) is extremely rare. IIH typically presents with headache, pulsatile tinnitus, dizziness, nausea, vomiting, and visual disturbance. We report two cases which presented with acute onset spontaneous CSF rhinorrhoea without any other symptom. In addition, we discuss in detail imaging features of IIH with review of its literature.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Ultrasound elastography findings in piriformis muscle syndrome

Piriformis muscle syndrome (PMS),Ultrasound elastography findings
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 p. 412
Adnan Demirel, Murat Baykara, Tuba Tülay Koca, Ejder Berk
DOI:10.4103/ijri.IJRI_133_18  
Background: Piriformis muscle syndrome (PMS) is relatively less known and underestimated because it is confused with other clinical pathological conditions. Delays in its diagnosis may lead to chronic somatic dysfunction and muscle weakness. Objective: Here, we aimed to evaluate the diagnostic performance of the ultrasound elastography (UE) as an easy, less-invasive, and cost-effective method for early diagnosis of PMS. Materials and Methods: Twenty-eight cases clinically diagnosed as PMS at the outpatient clinic were evaluated by UE. The elastographic strain ratio was calculated by dividing the strain value of the subcutaneous fat tissue by the mean stress value of the muscle beneath. The diagnostic performances of the strain rate measures were compared using the receiver operating characteristic curve analysis. Results: Twenty-one (N = 21) cases were female, and seven (N = 7) of the cases were male. The mean age was 45 years (ranged 24–62 years). The strain rates of piriformis muscle (PM) and gluteus maximus (GM) muscles were significantly higher on the PMS-diagnosed side (P < 0.001). The cutoff value of UE strain ratio for the PM and GM were 0.878 [95% confidence interval (CI) 0.774–0.981] and 0.768 (95% CI 0.622–0.913), respectively, and the sensitivity and specificity values were, respectively, 80.95% and 85.71% for the PM, and they were, respectively, 85.71% and 66.67% for the GM. Conclusion: We showed that the muscle elasticity and tissue hardening increased on the problematic side both on PM and GM. UE may provide early diagnosis of PMS, thereby increasing the possibility of treatment with less invasive methods.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Magnetic resonance imaging of ankle ligaments

Magnetic resonance imaging of ankle ligaments
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: A pictorial essay p. 419
Yogini Nilkantha Sawant, Darshana Sanghvi
DOI:10.4103/ijri.IJRI_77_16  
Ankle trauma is commonly encountered and is most often a sprain injury affecting the ligaments. Accurate diagnosis and appropriate treatment rest on knowledge of complex ligamentous anatomy of ankle and the entire spectrum of pathologies. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing ligament pathologies because of its multiplanar capability and high soft tissue contrast. With MRI, it is possible to triage and attribute the cause of post traumatic ankle pain to bone, ligament, or tendon pathologies, which otherwise overlap clinically. In this pictorial essay, emphasis is given to the intricate and unique anatomy and orientation of ankle ligaments. Pathologies of ankle ligaments have been elaborated.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: An accurate tool to detect cardiac amyloidosis


An accurate tool to detect cardiac amyloidosis
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Myocardial nulling pattern in cardiac amyloidosis on time of inversion scout magnetic resonance imaging sequence – A new observation of temporal variability p. 427
Harshavardhan Mahalingam, Binita Riya Chacko, Aparna Irodi, Elizabeth Joseph, Leena R Vimala, Viji Samuel Thomson
DOI:10.4103/ijri.IJRI_84_18  
Context: The pattern of myocardial nulling in the inversion scout sequence [time of inversion scout (TIS)] of cardiac magnetic resonance imaging (MRI) is an accurate tool to detect cardiac amyloidosis. The pattern of nulling of myocardium and blood at varying times post gadolinium injection and its relationship with left ventricular mass (LVM) in amyloidosis have not been described previously. Aims: The aim is to study the nulling pattern of myocardium and blood at varying times in TIS and assess its relationship with LVM and late gadolinium enhancement (LGE) in amyloidosis. Materials and Methods: This was a retrospective study of 109 patients with clinical suspicion of cardiac amyloidosis who underwent MRI. Of these, 30 had MRI features of amyloidosis. The nulling pattern was assessed at 5 (TIS5min) and 10 (TIS10min) minutes (min) post contrast injection. Nulling pattern was also assessed at 3min (TIS3min) in four patients and 7min (TIS7min) in five patients. Myocardial mass index was calculated. Mann-Whitney U test was done to assess statistical difference in the myocardial mass index between patients with and without reversed nulling pattern (RNP) at TIS5min. Results: RNP was observed in 58% at TIS5minand 89.6% at TIS10min. Myocardial mass index was significantly higher in patients with RNP at TIS5min[mean = 94.87 g/m2; standard deviation (SD) =17.63) when compared with patients with normal pattern (mean = 77.61 g/m2; SD = 17.21) (U = 18; P = 0.0351). Conclusion: In cardiac amyloidosis, TIS sequence shows temporal variability in nulling pattern. Earlier onset of reverse nulling pattern shows a trend toward more LVM and possibly more severe amyloid load.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Pulmonary atresia and ventricular septal defect,Coronary artery as the primary source of pulmonary blood flow


Pulmonary atresia and ventricular septal defect,Coronary artery as the primary source of pulmonary blood flow
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Collateral or fistula? Coronary artery as the primary source of pulmonary blood flow in a patient with pulmonary atresia and ventricular septal defect p. 433
Anurag Yadav, Salil Bhargava, T B S Buxi, Krishna Sirvi
DOI:10.4103/ijri.IJRI_489_17  
In patients with pulmonary atresia and ventricular septal defect (PA/VSD), a coronary artery being the primary source of pulmonary blood flow is a rare entity. We describe two cases of PA/VSD with coronary-to-pulmonary artery fistula with emphasis on the role of Computed Tomographic Angiography (CTA) in depicting all the sources of pulmonary blood supply, to predict surgical management and need for unifocalization of Major Aortopulmonary Collateral Arteries (MAPCA's).
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Evaluation of lung transplant perfusion using iodine maps from novel spectral detector computed tomography

Evaluation of lung transplant perfusion using iodine maps from novel spectral detector computed tomography
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p. 436
Nils Große Hokamp, Amit Gupta
DOI:10.4103/ijri.IJRI_35_18  
We report the case of a 51-year-old patient who underwent bilateral lung transplantation and presented with an unstable condition and sepsis 6 days after transplantation. The performed contrast enhanced spectral detector computed tomography (CT) using a dual-layer detector showed absence of perfusion in the left lung on iodine maps, although branches of the pulmonary artery were patent. This prompted retrospective evaluation of CT images and total venous occlusion of the left pulmonary veins was found. Here, iodine maps helped in raising conspicuity of loss of lung perfusion.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Atypical alveolar proteinosis

Atypical alveolar proteinosis
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 p. 439
Lova Hasina Rajaonarison Ny Ony Narindra, Emmylou Gabrielle Andrianah, Volahasina Francine Ranaivomanana, Christian Tomboravo, Hasina Dina Ranoharison, Jean Noel Bruneton, Ahmad Ahmad
DOI:10.4103/ijri.IJRI_170_18  
Alveolar proteinosis is a rare pulmonary disease characterized by intra-alveolar accumulation of surfactant composed of lipoproteinaceous material, related to a lack of surfactant resorption by alveolar macrophages. Crazy paving pattern is characteristic, but not specific. The multinodular forms of this affection remain exceptional.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: The normal pancreatic dimensions in pediatric age groups

The normal pancreatic dimensions in pediatric age groups
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Percentile reference curves for normal pancreatic dimensions in Indian children p. 442
Dhanraj S Raut, Dhananjay V Raje, Vithalrao P Dandge, Dinesh Singh
DOI:10.4103/ijri.IJRI_189_18  
Objectives: This study aims at determining the normal pancreatic dimensions in pediatric age groups considering demographic parameters and thus developing percentile reference curves for normal pancreatic dimensions in Indian children. Setting and Design: It is a cross-sectional study. Materials and Methods: A hospital-based cross-sectional study was planned at a children hospital during July 2016–December 2017, in which the pancreatic dimensions of 1078 normal children in the age range of 1 month to 19 years were obtained through abdominal ultrasonography (USG). The demographic details like age and gender were obtained for each child. Statistical Analysis Used: Percentile reference curves were obtained with reference to age for each gender type independently. Generalized additive models for location, scale, and shape were used to obtain percentile plots for each pancreatic part. Results: The mean age of children was 6.65 ± 4.43 years and the male-to-female ratio was 1.63:1. The head, body, and tail dimensions increased with the age. For head, up to 25th percentile, the curves were similar for both genders, while subsequent curves were higher in males as compared to females. Similar was the observation for body of pancreas. For tail, up to 75th percentile, the curves were similar for both genders. Conclusion: The normal ranges can be supportive in diagnosis of illness related to pancreas. The dimensions within 5–95th percentile along with iso-echogenicity can be regarded as normal, while the dimensions beyond these limits along with change of echogenicity can be suspected for pancreatic disorders.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group


Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group
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Clinicoradiologicial aspects of secretory carcinoma breast: A rare pediatric breast malignancy p. 448
Aanchal Bhayana, Ritu N Misra, Sunil K Bajaj, Himani Bankhar
DOI:10.4103/ijri.IJRI_46_18  
Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group. We report imaging and clinicopathological features of secretory carcinoma breast with distant and axillary metastasis, in an 11-year-old girl, who presented with a painful lump in right breast. Ultrasound revealed a well-defined, partially microlobulated hypoechoic mass with skin and pectoralis muscle involvement and a suspicious morphology right axillary lymph node. Color Doppler revealed increased vascularity in both the breast mass and suspicious axillary node. Magnetic resonance imaging helped in better evaluation of pectoralis muscle involvement. Computed tomography (CT) neck, chest, and abdomen revealed multiple fibronodular opacities in bilateral lung fields. 18 Flouro-Deoxy-Glucose Positron Emission Tomography (FDG PET-CT) showed a hypermetabolic retroareolar breast mass with multiple hypermetabolic bilateral lung nodules suggesting lung metastasis. The histopathology confirmed the diagnosis of secretory carcinoma. The patient was offered chemotherapy for 2 years and put on follow-up since then.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects


Vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects
To:


VACTERL association – Ultrasound findings and autopsy correlation p. 452
Naman Kumar Gaur, Sudheer Gokhale
DOI:10.4103/ijri.IJRI_115_18  
VACTERL (vertebral, anal, cardiac, tracheoesophagus, renal, and limbs) is an abbreviation for the congenital group of abnormalities, including vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects. It is a rare association and not accidental event where several organs are affected by developmental defects during blastogenesis. The exact cause is unknown; however, several environmental and genetic factors are included in literature. Three components out of seven are used to label as VACTERL. The combination is necessary, but the patient may have other congenital malformations as well. We present here an antenatal scan with autopsy correlation of one of the forms of VACTERL association spectrum.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Campomelic dysplasia with 10 pairs of ribs


Campomelic dysplasia with 10 pairs of ribs
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Campomelic dysplasia with 10 pairs of ribs in a preterm neonate: A case report p. 456
Laxman Basani, Roja Aepala, Naresh Macha
DOI:10.4103/ijri.IJRI_173_18  
Campomelic dysplasia (CD) is a rare form of skeletal dysplasia (incidence 1:200,000 births) which is associated with characteristic phenotypes including bowing of the limbs, a narrow thoracic cage, 11 pairs of ribs, hypoplastic scapulae, macrocephaly, flattened supraorbital ridges and nasal bridge, cleft palate, and micrognathia. In addition to the skeletal abnormalities, hydrocephalus, hydronephrosis, and congenital heart disease have been reported. We describe a preterm neonate who presented with respiratory failure and clinical features of CD. Our case had only 10 pairs of ribs, and to the best of our knowledge this is the first case report of CD with 10 pairs of ribs.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Preoperative differentiation of benign from malignant thyroid nodules,Diffusion-weighted imaging (DWI) is highly accurate for discrimination between benign and malignant thyroid nodules.


Preoperative differentiation of benign from malignant thyroid nodules,Diffusion-weighted imaging (DWI) is highly accurate for discrimination between benign and malignant thyroid nodules.
To:


Differentiation between benign and malignant thyroid nodules using diffusion-weighted imaging, a 3-T MRI study p. 460
Leila Aghaghazvini, Hashem Sharifian, Nasrin Yazdani, Melina Hosseiny, Saina Kooraki, Pirouz Pirouzi, Afsoon Ghadiri, Madjid Shakiba, Soheil Kooraki
DOI:10.4103/ijri.IJRI_488_17  
Background: Preoperative differentiation of benign from malignant thyroid nodules remains a challenge. Aims: This study assessed the accuracy of diffusion-weighted imaging (DWI) for differentiation between benign and malignant thyroid nodules. Materials and Methods: Preoperative DWI was performed in patients with thyroid nodule by means of a 3-T scanner magnetic resonance imaging (MRI). Images were obtained at b value of 50, 500, and 1000 mm2/s to draw an ADC (apparent diffusion coefficient) map. Findings were compared with postoperative histopathologic results. Receiver operating characteristic curve was used to assess the accuracy of different cutoff points. Results: Forty-one thyroid nodules (26 benign and 15 malignant) were included in this study. None of static MRI parameters such as signal intensity, heterogeneity, and nodule border was useful to discriminate between benign and malignant lesions. Mean ADC value was (1.94 ± 0.54) × 10-3 mm2/s and (0.89 ± 0.29) × 10-3 mm2/s in benign and malignant nodules, respectively (P-value < 0.005). ADC value cutoff of 1 × 10-3 mm2/s yielded an accuracy, sensitivity, and specificity of 93%, 87%, and 96% to discriminate benign and malignant nodules. Conclusion: DWI is highly accurate for discrimination between benign and malignant thyroid nodules.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Normal adrenal gland thickness on computerized tomography


Normal adrenal gland thickness on computerized tomography
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 in an Asian Indian adult population p. 465
Reetu John, Tharani Putta, Betty Simon, Anu Eapen, Felix Jebasingh, Nihal Thomas, Simon Rajaratnam
DOI:10.4103/ijri.IJRI_129_18  

Context: The size and morphology of the adrenal glands are affected by several physiological and pathological conditions. Radiologists need to be aware of the normal thickness of adrenal gland to accurately assess patients with suspected adrenal pathology. However, there is limited data on the normal size of the adrenal glands. Moreover, this has not been studied in our population. Aims: To study the normal thickness of adrenal gland on computerized tomography (CT) in Indian adult population. Settings and Design: Retrospective study in a tertiary care hospital in Southern India. Subjects and Methods: Our study included 586 adults who underwent a CT abdominal angiogram over 15 months, and excluding patients with clinical or imaging evidence of adrenal disease. The measurements made included: the maximum thickness of the body, medial and lateral limbs, measured perpendicular to the long axis. Results: The median age was 51 (range: 18–85) years. The mean maximum thickness of the adrenal body, medial, and lateral limbs were 7.2 ± 1.8, 4.1 ± 1.1, and 4.3 ± 1.1 mm on the right side and 8.8 ± 1.9, 4.7 ± 1.1, and 4.9 ± 1.3 mm on the left. The cumulative thickness of the body and the limbs were 15.6 ± 3.7 mm and 18.4 ± 3.8 mm on the right and left sides, respectively. There was a statistically significant difference in all the measurements between the right and left adrenal glands (all P values = 0.000) and between men and women, being larger in men (P value <0.05). Among our patients 27% had at least one adrenal gland body measuring ≥10 mm in thickness. Conclusions: Our study has defined the normal range of adrenal gland thickness in an Asian Indian adult population, which may be used as a baseline reference for future research and as a reference for radiological reporting.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis


Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis
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Dealing with technical challenges in embolization of a rare aberrant left inferior bronchial artery arising from the left gastric artery in a patient with massive hemoptysis p. 476
Gaurav Gangwani, Ajit Yadav, Amit Dhamija, Arun Gupta
DOI:10.4103/ijri.IJRI_162_18  
Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis in a majority of patients. The source of bleeding in a majority of cases is systemic arteries – orthotopic bronchial arteries, anomalous bronchial arteries, or nonbronchial systemic collaterals. We report a case of an aberrant left inferior bronchial artery arising from the left gastric artery (LGA) in a patient with massive hemoptysis. Such origin from infradiaphragmatic vessels and specially left gastric arteries is very rare and needs to be considered by interventional radiologists and pulmonologists in case with hemoptysis disproportionate to supply by orthotopic arteries. Technical challenges were present in the present case in the form of an aneurysm in the aberrant artery and nontarget hepatic and gastric branches arising from LGA. Appropriate selection of hardware and embolic agents was done to deal with the clinical situation.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Ganglion impar injection approaches and outcomes for coccydynia Foye PM, Sajid N, D'Onofrio GJ - Indian J Radiol Imaging

Ganglion impar injection approaches and outcomes for coccydynia Foye PM, Sajid N, D'Onofrio GJ - Indian J Radiol Imaging
To:


We praise your journal and authors Gonnade et al., on the excellent recent publication titled, "Ganglion impar block in patients with chronic coccydynia."[1] Their study of patients with chronic coccydynia (coccyx pain) showed that ganglion impar injections with local anesthetic block and corticosteroid significantly decreased pain and disability scores even at the maximum length of study follow-up, which was 6-month postinjection.

The authors clearly described injecting the ganglion impar via the sacrococcygeal junction. We would like to point out that other needle approaches can also be done, depending on the patient's anatomy. Specifically, interventional physicians should be aware of alternative approaches via the first[2] or second[3] intracoccygeal joint (between coccygeal vertebral bodies one and two, or between coccygeal vertebral bodies three and fourth, respectively). These approaches have been referred to as being transcoccygeal, intracoccygeal, or coccygeal transdiscal. These newer approaches have some potential advantages. First, since the sacrococcygeal joint is fused in 51% of humans,[4] these newer approaches provide access through joints that are more likely to be patent. Second, human cadaver studies have shown that the ganglion impar is usually located at the upper coccyx, rather than at the sacrococcygeal joint.[5]

We noted that the authors excluded from treatment any patients who had imaging abnormalities that would explain their tailbone pain. This surprised us since our experience is that coccydynia patients often respond extremely well to these impar injections, regardless of whether they do or do not have coccygeal imaging abnormalities. We would be very interested in the authors' thoughts on their exclusion criteria.

We hope our comments and the authors' reply will provide even more insights on relieving pain via these injections.
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=482;epage=483;aulast=Foye

Fwd: Drug-induced changes in dentate nuclei of cerebellum Aswani Y, Aswani N, Sharma R - Indian J Radiol Imaging




We read with great interest the article titled "Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy" by Singh et al. in the April–June 2017 issue of the Indian Journal of Radiology and Imaging.[1] The article is highly informative and describes signal changes in splenium and dentate nuclei following metronidazole ingestion. In this article, we describe a few drugs that cause similar signal changes in the cerebellar dentate nuclei
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=480;epage=480;aulast=Aswani

Fwd: Role of proton MR spectroscopy in spinal cord lesions: A guarded espousal Agarwal A - Indian J Radiol Imaging

I read with great interest the article titled "3T proton MR spectroscopy evaluation of spinal cord lesions" by Sathyanathan et al. published in the July–September, 2018 issue of the Indian Journal of Radiology and Imaging.[1] The manuscript is well written and informative. The authors have narrated the MR spectroscopy (MRS) protocol and patterns in various intramedullary spinal lesions in a very efficient manner. However, I would like to make the following contributions and observations pertinent to the study.

In their study cohort of 50 patients, the authors have investigated spectral pattern on intramedullary spinal cord lesions. They designated four of them as schwannoma, which is an extramedullary lesion. Literature shows very few case reports of intramedullary schwannoma, which may be found in neurofibromatosis.[2],[3] Even in the subsequent discussion, the MRS pattern of these lesions is not elaborated. So, it will be of great help if authors could clarify my doubts in this regard.

The present study[1] defines the changes in the metabolites in different spinal lesions based on the deviation in their peak values from the normal spectra. In the previous few studies,[4],[5] the results have been expressed in terms of metabolite ratios, which is an absolute quantification method. Therefore, I would like to know about the authors' experience in evaluating the metabolite ratios and their feasibility pertaining to the study.

High signal-to-noise ratio is addressed in the present study[1] by the use of high magnetic field strength (3 T). However, there are spectral reliability indices such as Cramér–Rao lower bounds of each metabolite, mean, and standard deviation of the spectral line width, the coefficient of variations of the measurements, and the group average of the spectra.[5] These quality indicators can be used in future studies for enhancing the spectral quality and dependability.
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=481;epage=481;aulast=Agarwal

Hepatic Critical Care

No abstract available

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Hospital-Based Acute Care Within 7 Days of Discharge After Outpatient Arthroscopic Shoulder Surgery: Erratum

imageNo abstract available

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Alternatives for Pediatric Anticoagulation: The Case for Bivalirudin

imageNo abstract available

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In Response

No abstract available

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Are Peripheral Nerve Blocks Indicated in Ambulatory Knee Surgery?

No abstract available

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Psychometrics: Trust, but Verify

There is a continued mandate for practicing evidence-based medicine and the prerequisite rigorous analysis of the comparative effectiveness of alternative treatments. There is also an increasing emphasis on delivering value-based health care. Both these high priorities and their related endeavors require correct information about the outcomes of care. Accurately measuring and confirming health care outcomes are thus likely now of even greater importance. The present basic statistical tutorial focuses on the germane topic of psychometrics. In its narrower sense, psychometrics is the science of evaluating the attributes of such psychological tests. However, in its broader sense, psychometrics is concerned with the objective measurement of the skills, knowledge, and abilities, as well as the subjective measurement of the interests, values, and attitudes of individuals—both patients and their clinicians. While psychometrics is principally the domain and content expertise of psychiatry, psychology, and social work, it is also very pertinent to patient care, education, and research in anesthesiology, perioperative medicine, critical care, and pain medicine. A key step in selecting an existing or creating a new health-related assessment tool, scale, or survey is confirming or establishing the usefulness of the existing or new measure; this process conventionally involves assessing its reliability and its validity. Assessing reliability involves demonstrating that the measurement instrument generates consistent and hence reproducible results—in other words, whether the instrument produces the same results each time it is used in the same setting, with the same type of subjects. This includes interrater reliability, intrarater reliability, test–retest reliability, and internal reliability. Assessing validity is answering whether the instrument is actually measuring what it is intended to measure. This includes content validity, criterion validity, and construct validity. In evaluating a reported set of research data and its analyses, in a similar manner, it is important to assess the overall internal validity of the attendant study design and the external validity (generalizability) of its findings.

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Enhanced Recovery Pathways: Looking Into the Future

No abstract available

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Perioperative Considerations and Positioning for Neurosurgical Procedures: A Clinical Guide

No abstract available

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Foretelling Right Ventricular Failure After Left Ventricular Assist Device Implantation: The Tale of the Pulmonary Artery Pulsatility Index

No abstract available

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In Reply: Encouraging a Bare Minimum While Striving for the Gold Standard: A Response to the Updated WHO-WFSA Guidelines

No abstract available

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Predatory Journals Undermine Peer Review and Cheapen Scholarship

No abstract available

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Repeated Morphine Prolongs Postoperative Pain in Male Rats

imageBACKGROUND: Opioids are effective postoperative analgesics. Disturbingly, we have previously reported that opioids such as morphine can worsen inflammatory pain and peripheral and central neuropathic pain. These deleterious effects are mediated by immune mediators that promote neuronal hyperexcitability in the spinal dorsal horn. Herein, we tested whether perioperative morphine could similarly prolong postoperative pain in male rats. METHODS: Rats were treated with morphine for 7 days, beginning immediately after laparotomy, while the morphine was tapered in a second group. Expression of genes for inflammatory mediators was quantified in the spinal dorsal horn. In the final experiment, morphine was administered before laparotomy for 7 days. RESULTS: We found that morphine treatment after laparotomy extended postoperative pain by more than 3 weeks (time × treatment: P

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Total Intravenous Anesthetic Versus Inhaled Anesthetic: Pick Your Poison

imageNo abstract available

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Should Total Intravenous Anesthesia Be Used to Prevent the Occupational Waste Anesthetic Gas Exposure of Pregnant Women in Operating Rooms?

imageNo abstract available

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The More You Know: Identifying Factors Associated With Inpatient Mortality Related to Opioid Overdose Can Drive Progress in the Opioid Health Crisis

No abstract available

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Liver Anesthesiology and Critical Care Medicine, 2nd ed

No abstract available

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Clinical Practice Improvement: Mind the Gap or Fall Into the Chasm

No abstract available

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Labor Pain’s Relationship With Depression: From Whence, and What Shall be Done?

No abstract available

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Intraoperative Hemodynamic and Echocardiographic Measurements Associated With Severe Right Ventricular Failure After Left Ventricular Assist Device Implantation

imageBACKGROUND: Severe right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation increases morbidity and mortality. We investigated the association between intraoperative right heart hemodynamic data, echocardiographic parameters, and severe versus nonsevere RVF. METHODS: A review of LVAD patients between March 2013 and March 2016 was performed. Severe RVF was defined by the need for a right ventricular mechanical support device, inotropic, and/or inhaled pulmonary vasodilator requirements for >14 days. From a chart review, the right ventricular failure risk score was calculated and right heart hemodynamic data were collected. Pulmonary artery pulsatility index (PAPi) [(pulmonary artery systolic pressure − pulmonary artery diastolic pressure)/central venous pressure (CVP)] was calculated for 2 periods: (1) 30 minutes before cardiopulmonary bypass (CPB) and (2) after chest closure. Echocardiographic data were recorded pre-CPB and post-CPB by a blinded reviewer. Univariate logistic regression models were used to examine the performance of hemodynamic and echocardiographic metrics. RESULTS: A total of 110 LVAD patients were identified. Twenty-five did not meet criteria for RVF. Of the remaining 85 patients, 28 (33%) met criteria for severe RVF. Hemodynamic factors associated with severe RVF included: higher CVP values after chest closure (18 ± 9 vs 13 ± 5 mm Hg; P = .0008) in addition to lower PAPi pre-CPB (1.2 ± 0.6 vs 1.7 ± 1.0; P = .04) and after chest closure (0.9 ± 0.5 vs 1.5 ± 0.8; P = .0008). Post-CPB echocardiographic findings associated with severe RVF included: larger right atrial diameter major axis (5.4 ± 0.9 vs 4.9 ± 1.0 cm; P = .03), larger right ventricle end-systolic area (22.6 ± 8.4 vs 18.5 ± 7.9 cm2; P = .03), lower fractional area of change (20.2 ± 10.8 vs 25.9 ± 12.6; P = .04), and lower tricuspid annular plane systolic excursion (0.9 ± 0.2 vs 1.1 ± 0.3 cm; P = .008). Right ventricular failure risk score was not a significant predictor of severe RVF. Post-chest closure CVP and post-chest closure PAPi discriminated severe from nonsevere RVF better than other variables measured, each with an area under the curve of 0.75 (95% CI, 0.64–0.86). CONCLUSIONS: Post-chest closure values of CVP and PAPi were significantly associated with severe RVF. Echocardiographic assessment of RV function post-CPB was weakly associated with severe RVF.

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In Response

No abstract available

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Ultrasound-Guided Perisutural Botulinum Toxin Injection for Chronic Migraine Headache: Initial Report With Technical Description

No abstract available

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Regulation of mitochondrial iron homeostasis by sideroflexin 2

Abstract

Mitochondrial iron is indispensable for heme biosynthesis and iron–sulfur cluster assembly. Several mitochondrial transmembrane proteins have been implicated to function in the biosynthesis of heme and iron–sulfur clusters by transporting reaction intermediates. However, several mitochondrial proteins related to iron metabolism remain uncharacterized. Here, we show that human sideroflexin 2 (SFXN2), a member of the SFXN protein family, is involved in mitochondrial iron metabolism. SFXN2 is an evolutionarily conserved protein that localized to mitochondria via its transmembrane domain. SFXN2-knockout (KO) cells had an increased mitochondrial iron content, which was associated with decreases in the heme content and heme-dependent enzyme activities. By contrast, the activities of iron–sulfur cluster-dependent enzymes were unchanged in SFXN2-KO cells. Moreover, abnormal iron metabolism impaired mitochondrial respiration in SFXN2-KO cells and accelerated iron-mediated death of these cells. Our findings demonstrate that SFXN2 functions in mitochondrial iron metabolism by regulating heme biosynthesis.



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Villus Growth, Increased Intestinal Epithelial Sodium Selectivity, and Hyperaldosteronism Are Mechanisms of Adaptation in a Murine Model of Short Bowel Syndrome

Abstract

Background

Short bowel syndrome results from extensive small bowel resection and induces adaptation of the remaining intestine. Ileocecal resection (ICR) is the most frequent situation in humans. Villus hypertrophy is one hallmark of mucosal adaptation, but the functional mechanisms of mucosal adaptation are incompletely understood.

Aims

The aim of the study was to characterize a clinically relevant model of short bowel syndrome but not intestinal failure in mice and to identify outcome predictors and mechanisms of adaptation.

Methods

Male C57BL6/J mice underwent 40% ICR and were followed for 7 or 14 days. Small bowel transection served as control. All mice underwent autopsy. Survival, body weight, wellness score, stool water content, plasma aldosterone concentrations, and paracellular permeability were recorded.

Results

Unlike controls, resected mice developed significant diarrhea with increased stool water. This was accompanied by sustained weight loss throughout follow-up. Villus length increased but did not correlate positively with adaptation. Plasma aldosterone concentrations correlated inversely with body weight at day 14. After ICR, intestinal epithelial (i.e., tight junctional) sodium permeability was increased.

Conclusions

40% ICR results in moderate to severe short bowel syndrome. Successful adaptation to the short bowel situation involves villus elongation but does not correlate with the degree of villus elongation alone. In addition, increased intestinal epithelial sodium permeability facilitates sodium-coupled solute transport. Hyperaldosteronism correlates with the severity of weight loss, indicates volume depletion, and counterregulates water loss.



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Clinical Insights into Superior Mesenteric Artery Syndrome with Multiple Diseases: A Case Report



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Robot‐assisted surgery and endoscopic management of gastrocolic fistula: A rare complication of acute pancreatitis in a patient who had undergone sleeve gastrectomy

Abstract

Ten years after undergoing sleeve gastrectomy, a 39‐year‐old man developed pancreatitis and, after recovery, presented with severe diarrhea. An image study showed barium contrast passing from the stomach to the colon. Before surgery, initial treatment consisted of parenteral nutrition and antibiotics. The patient then underwent robot‐assisted resection of a gastrocolic fistula and omentoplasty. However, 72 h after surgery, the amount of suction drainage suggested that the fistulous track repair was leaking. Therefore, we decided to perform endoscopy to place a self‐expanding covered stent at the gastroesophageal junction as well as a nasojejunal tube to continue nutritional supplementation. After the patient had fasted for 2 weeks, there was no evidence of leakage in the image studies. The patient was discharged after he had clinically improved, and the stent was removed at the end of 8 weeks. The combination of robot‐assisted surgery and endoscopic management is effective for treating gastrocolic fistula.



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Additive Manufacturing of Transparent Glass Structures

3D Printing and Additive Manufacturing, Volume 5, Issue 4, Page 269-283, December 2018.


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A Genome Wide Association Study Reveals Markers and Genes Associated with Resistance to Fusarium verticillioides Infection of Seedlings in a Maize Diversity Panel

Fusarium verticillioides infects maize, causing ear rot, yield loss and contamination by fumonisin mycotoxins. The fungus can be transmitted via kernels and cause systemic infection in maize. Maize resistance to the fungus may occur at different developmental stages, from seedling to maturity. Resistance during kernel germination is part of the plant-pathogen interaction and so far this aspect has not been investigated. In the present study, a genome wide association study (GWAS) of resistance to Fusarium during the seedling developmental stage was conducted in a maize diversity panel using 226,446 SNP markers. Seedling germination and disease phenotypes were scored on artificially inoculated kernels using the rolled towel assay. GWAS identified 164 SNPs significantly associated with the traits examined. Four SNPs were associated with disease severity score after inoculation, 153 were associated with severity in asymptomatic kernels and 7 with the difference between the severity ratings in inoculated and non-inoculated seeds. A set of genes containing or physically near the significant SNPs were identified as candidates for Fusarium resistance at the seedling stage. Functional analysis revealed that many of these genes are directly involved in plant defense against pathogens and stress responses, including transcription factors, chitinase, cytochrome P450, and ubiquitination proteins. In addition, 25 genes were found in high linkage disequilibrium with the associated SNPs identified by GWAS and four of them directly involved in disease resistance. These findings contribute to understanding the complex system of maize-F. verticillioides and may improve genomic selection for Fusarium resistance at the seedling stage.



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Comparison and correlation of fibrosis stage assessment by collagen proportionate area (CPA) and the ELF panel in patients with chronic liver disease

Fibrosis progression is the common consequence of most chronic liver diseases.

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Characteristics of Inflammatory Bowel Disease in Patients of Roma/Gypsy Ethnicity. A Case-Control Study

Peculiarities of Inflammatory Bowel Disease (IBD) have been explored in ethnic groups, such as Asians, Hispanics, and Afro-Americans, but not in other ethnic minorities, such as Roma/Gypsies.

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Comparison and correlation of fibrosis stage assessment by collagen proportionate area (CPA) and the ELF panel in patients with chronic liver disease

Fibrosis progression is the common consequence of most chronic liver diseases.

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Characteristics of Inflammatory Bowel Disease in Patients of Roma/Gypsy Ethnicity. A Case-Control Study

Peculiarities of Inflammatory Bowel Disease (IBD) have been explored in ethnic groups, such as Asians, Hispanics, and Afro-Americans, but not in other ethnic minorities, such as Roma/Gypsies.

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How to calculate the EMS value equation for chronic inebriates

A data-driven approach can be applied to determine the value of a community paramedic intervention for specific types of frequent EMS transports

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How to calculate the EMS value equation for chronic inebriates

A data-driven approach can be applied to determine the value of a community paramedic intervention for specific types of frequent EMS transports

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Alcohol-related calls: 7 reminders for this weekend

Keep the following tips in mind when you encounter a patient who went out of his/her way to overindulge this holiday

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Lieutenant - Clinical - Fort Bend County Emergency Medical Service - FORT BEND COUNTY E M S

#### FORT BEND COUNTY #### DEPARTMENT: ++EMERGENCY MEDICAL SERVICE++ **JOB TITLE: **++**LIEUTENANT – CLINICAL**++ **JOB SUMMARY:** Works collaboratively to develop, deliver, and evaluate continuing education, protocols, and procedures to facilitate the highest quality of pre-hospital patient care. Provides positive support to our members. Participates in planning of programs, protocols or objectives ...

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The National EMS Management Association’s EMS Officer Credentialing Exams at EMS Today

Only 3 weeks left to complete your application! This year at the annual EMS Today conference, NEMSMA will be providing its credentialing examinations for Supervisory (SPO), Managerial (MPO) and Executive (Fellow) level Paramedic Officer certifications. These are the only EMS officer credentials that adhere to the NEMSMA national standardized comprehensive competencies, accepted by the industry...

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How to calculate EMS value equation for chronic inebriates

A data-driven approach can be applied to determine the value of a community paramedic intervention for specific types of frequent EMS transports

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Technique for endoscopic thyroidectomy with selective lateral neck dissection via a chest–breast approach

Abstract

Background

Endoscopic thyroidectomy has been widely accepted because it can effectively avoid neck scarring. However, there are seldom reports concerning completely endoscopic lateral neck dissection approaches. In this study, we introduced a technique for performing endoscopic thyroidectomy with lateral neck dissection via a chest–breast approach.

Methods

We retrospectively reviewed 18 patients who underwent endoscopic total thyroidectomy along with levels II, III, IV, and VI dissection. All major outcomes, such as cosmetic effect, operative time and complications, etc., were analyzed. In addition, another 20 patients who underwent traditional open surgery (open group) were enrolled in the study to conduct a contrasting analysis between patients treated with the endoscopic technique (endoscopic group) and open group patients, in terms of demographic data and main operative outcomes, to evaluate the feasibility of this technique.

Results

All 18 endoscopic surgery cases were successfully performed, and no patient was converted to the open procedure intra-operatively. There were no significant differences between the two groups regarding age (P = 0.209), Body Mass Index (P = 0.479), sex (P = 0.218), drainage time (P = 0.153), operation time (P = 0.065), intra-operative blood loss (P = 0.139), post-operative pain (P = 0.114), and number of dissected lateral lymph nodes (II: P = 0.201; III + IV: P = 0.107). The mean total and lateral lymph nodes dissection (LLND) time in the endoscopic group were longer than those of the open group (P = 0.002; 235 ± 35 vs. 182 ± 20 min, P = 0.000; 125 ± 21 vs. 80 ± 14 min, P = 0.000). The primary lesion diameter of the endoscopic group was smaller than that of the open group (1.7 ± 0.8 vs. 2.9 ± 1.3 cm, P = 0.002). The scores for cosmetic satisfaction in the endoscopic group were higher than those in the open group (8.3 ± 0.7 vs. 4.4 ± 0.9, P = 0.000). Among the complications, there was no significant difference between the two approaches in transient vocal cord paresis (1/18 vs. 0/20, P = 0.474), transient hypoparathyroidism (4/18 vs. 4/20, P = 1.000), post-operative lymphatic leakage (1/18 vs. 3/20, P = 0.606), and intra-operative large blood vessel injury (2/18 vs. 0/20, P = 0.218). There was no incidence of uncontrolled bleeding, mental nerve injury, permanent hypoparathyroidism, permanent recurrent laryngeal nerve (RLN) injury, skin bruise on the neck, asphyxia/dyspnea or other complications like tracheal injury, esophageal injury, etc., nor was there any death or recurrence in either of the two groups during the short follow-up period.

Conclusion

It is feasible to perform LLND (levels II, III, IV, and VI) with endoscopic thyroidectomy via a chest–breast approach. In particular, this technique avoids a large scar on the patient's neck and has well operative outcomes compared with open surgery. Accordingly, this technique may offer one more option for selective patients.



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Ambulance services bring patients home for the holidays

AMR representatives offer tips for giving back by reuniting patients with their loved ones during the holiday season

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Effects of Food Supplementation During Pregnancy on Maternal Weight Gain, Hemoglobin Levels and Pregnancy Outcomes in Iran

Abstract

Objectives In this study, the effects of food supplementation during pregnancy on maternal weight gain, hemoglobin (Hb) levels, and pregnancy outcomes were evaluated. Methods In this randomized controlled trial, we recruited 1360 pregnant women with a gestational age of 10 weeks who had BMI < 18.5 and hemoglobin < 10.5/dL from rural areas of the east Azerbaijan province in Iran. Rural areas were randomly assigned into two groups: food-supplemented and control areas. In food-supplemented areas the food supplement was provided (1500 kcal/d) from 10 weeks of pregnancy through to the end. Information on demographic data were collected and anthropometric and Hb measurements were taken using standard instruments. Results The average weight gain was 9.1 ± 1.8 kg and 7.9 ± 1.6 kg in supplemented and control groups respectively, which was significantly different (p = 0.001). Also, a significant time × treatment interaction in maternal average weight gain (p = 0.001) was observed. The mean Hb decreased from 12 mg/dl and 12.1 mg/dl in week 10 to 11.9 mg/dl and 11.7 mg/dl in week 20 in the supplemented and control groups respectively, which was significant only for the control group. Between-group comparisons revealed significant differences in the rates of low birth weight (LBW) infants (p = 0.001) and preterm births (p = 0.013). Conclusion for practice Food supplementation significantly reduced the prevalence of poor maternal weight gain, infants with low birth weight, and preterm births compared to no intervention.



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Wearable tech: Detecting arrhythmia, falls with the Apple Watch

An Apple Watch update can detect abnormal heart rhythms and even call 911 for the user; learn how it works

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Degree requirements, Pink Floyd, and a seat at the adults’ table

Despite the growing pains and staffing shortages, degree requirements will improve EMS in the long-run

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Quick Take: Introducing the 2018 National EMS Scope of Practice model

The scope of practice expert panel examined evidence to determine if a procedure or skill is beneficial to patients and can be done safely by EMS providers

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3D-Printed Conformal Array Patch Antenna Using a Five-Axes Motion Printing System and Flash Light Sintering

3D Printing and Additive Manufacturing, Ahead of Print.


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Cognitive reappraisal and psychological wellbeing but not autism spectrum disorder symptomatology is related to resting heart rate variability

Publication date: Available online 19 December 2018

Source: International Journal of Psychophysiology

Author(s): Ru Ying Cai, Amanda L. Richdale, Cheryl Dissanayake, Mirko Uljarević

Abstract

Heart rate variability (HRV) has been separately shown to be associated with ASD symptomatology, psychological wellbeing and emotion regulation (ER) in specific samples consisting of either individuals with ASD, those without ASD, or combined. However, no study has examined these constructs together or incorporated habitual ER strategy use. Hence, the aim of this study was to examine the relationships between resting HRV, ASD symptomatology, ER strategy use (reappraisal and suppression), and psychological wellbeing (anxiety, depression and positive wellbeing) in a combined sample of adults with and without ASD. Twenty-four adults with ASD (Mage = 31.36; SDage = 14.84) and twenty without ASD (Mage = 35.45; SDage = 12.19) completed the ER Questionnaire (ERQ), Diagnostic and Statistical Manual of Mental Disorders-5 Cross-cutting Dimensional Scale, Patient Health Questionnaire-9, Warwick-Edinburgh Mental Well-being Scale, and Autism-Spectrum Quotient-Short. Participants' resting HRV data were also collected via short-term electrocardiogram. Self-reported use of reappraisal was associated with higher resting HRV. Additionally, reappraisal predicted variance in all three HRV indices above and beyond ASD symptomatology and medication use. These preliminary findings can inform the design of future studies to determine the extent to which reappraisal impacts autonomic flexibility.



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Temporal dynamics of hedonic and eudaimonic reward processing: An event-related potentials (ERPs) study

Publication date: Available online 18 December 2018

Source: International Journal of Psychophysiology

Author(s): Yangmei Luo, Hongda Jiang, Xuhai Chen, Yue Zhang, Xuqun You

Abstract

Reward or pleasure can be achieved from a hedonic approach (pleasure attainment) or eudaimonic approach (meaning and self-realization). However, the neurodynamics of hedonic and eudaimonic reward processing remain unclear. By operationalizing hedonic reward as "win money for oneself" and eudaimonic reward as "win money for charity", the current study used the monetary incentive delay task to parse hedonic and eudaimonic reward dynamics into the anticipatory and consummatory stages while event-related potentials (ERPs) were recorded. 24 participants (12 women) were recruited in this study. The results showed that in the anticipatory stage, the amplitudes evoked by hedonic and eudaimonic reward did not differ during early cue recognition (P2, N2), but they separated during late cue elaboration (cue-P3). In the consummatory stage, hedonic reward elicited a larger FRN effect, but eudaimonic reward elicited a larger fb-P3 effect. In addition, we also used the neural indices of hedonic and eudaimonic reward processing to predict participants' longitudinal changes in well-being (depression and positive emotion) across 6 months as exploratory in nature. Preliminary regression evidence suggested that greater differential amplitude of cue-P3 elicited by eudaimonic reward anticipation versus neutral anticipation positively predicted longitudinal increases in positive emotion. The findings elucidated specific substages of hedonic and eudaimonic reward processing and explored their potential roles in longitudinal changes in well-being.



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Viscoelastic Monitoring to Guide the Correction of Perioperative Coagulopathy and Massive Transfusion in Patients with Life-Threatening Hemorrhage

Publication date: Available online 19 December 2018

Source: Anesthesiology Clinics

Author(s): Kevin P. Blaine, Marc P. Steurer



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Recognizing Preventable Death: Is There a Role of Survival Prediction Algorithms?

Publication date: Available online 19 December 2018

Source: Anesthesiology Clinics

Author(s): Oliver C. Radke, Catherine Heim



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Pain Management in Trauma in the Age of the Opioid Crisis

Publication date: Available online 19 December 2018

Source: Anesthesiology Clinics

Author(s): Jessica Lynn Gross, Alison R. Perate, Nabil M. Elkassabany



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The Lifetime Effects of Injury: Postintensive Care Syndrome and Posttraumatic Stress Disorder

Publication date: Available online 19 December 2018

Source: Anesthesiology Clinics

Author(s): Meghan B. Lane-Fall, Catherine M. Kuza, Samir Fakhry, Lewis J. Kaplan



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Trauma Airway Management: Induction Agents, Rapid Versus Slower Sequence Intubations, and Special Considerations

Publication date: Available online 19 December 2018

Source: Anesthesiology Clinics

Author(s): Stephen R. Estime, Catherine M. Kuza



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Future Trends in Trauma Care: Through the Lens of the Wounded How Lessons from the Battlefield May Be Used at Home

Publication date: Available online 19 December 2018

Source: Anesthesiology Clinics

Author(s): Matthew D'Angelo, Matthew Welder, Ravi Chauhan, Michel J. Kearns



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The Anesthesiologist’s Response to Hurricane Natural Disaster Incidents: Hurricane Harvey

Publication date: Available online 19 December 2018

Source: Anesthesiology Clinics

Author(s): Christopher T. Stephens, Jaime Ortiz, Evan G. Pivalizza



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Incidence and risk factors of intrauterine transmission among pregnant women with chronic hepatitis B virus infection

Journal of Clinical Gastroenterology

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Depression in cirrhosis – A prospective evaluation of the prevalence, predictors and development of a screening nomogram

Alimentary Pharmacology and Therapeutics

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A comparison by meta-analysis of papillary early gastric carcinoma to its tubular counterpart for the risk of lymph node metastasis and submucosal invasion

Journal of Clinical Gastroenterology

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Long-term risk of colorectal cancer and related deaths after a colonoscopy with normal findings

JAMA Internal Medicine

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Incidence and predictors of new persistent opioid use following inflammatory bowel disease flares treated with oral corticosteroids

Alimentary Pharmacology and Therapeutics

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Comorbid immune-mediated diseases in inflammatory bowel disease: A nation-wide population-based study

Alimentary Pharmacology and Therapeutics

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Race, age, and geography impact hepatitis c genotype distribution in the United States

Journal of Clinical Gastroenterology

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Colonoscopy in patients with postmyocardial infarction gastrointestinal bleeding: A Nationwide Analysis

Journal of Clinical Gastroenterology

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Nonalcoholic fatty liver is contributing to the increase in cases of liver disease in US Emergency Departments

Journal of Clinical Gastroenterology

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Long-term outcomes among patients discharged from the hospital with moderate anemia: A retrospective cohort study

Annals of Internal Medicine

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Helicobacter pylori and low-dose aspirin ulcer risk: A meta-analysis

Journal of Gastroenterology and Hepatology

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Hepatitis B virus relapse rates in chronic hepatitis B patients who discontinue either entecavir or tenofovir

Alimentary Pharmacology and Therapeutics

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Results of a community-based, randomized study comparing a clear liquid diet with a low-residue diet using a magnesium citrate preparation for screening and surveillance colonoscopies

Journal of Clinical Gastroenterology

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Predictors of suicidal ideation among IBD outpatients

Journal of Clinical Gastroenterology

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Ascitic cholesterol is superior to serum-ascites albumin gradient in the detection of non-portal hypertensive ascites and the diagnosis of mixed ascites

Alimentary Pharmacology and Therapeutics

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Diagnostic yield of 2 strategies for adult celiac disease identification in primary care

Journal of Clinical Gastroenterology

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Severe vitamin D deficiency is a prognostic biomarker in autoimmune hepatitis

Alimentary Pharmacology and Therapeutics

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Abdominal ultrasound does not reveal significant alterations in patients with nonceliac wheat sensitivity

Journal of Clinical Gastroenterology

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Community public safety data management

Integrate data from EMS, fire and law enforcement to identify trends and community needs across disciplines

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How Does the Healthfulness of the US Food Supply Compare to International Guidelines for Marketing to Children and Adolescents?

Abstract

Objectives Food marketing to children is pervasive and linked to increased preference and intake of unhealthy foods. The World Health Organization (WHO) developed the only multi-country nutrient criteria, and Chile recently released the world's most comprehensive regulation to identify foods that should not be marketed to children. Our objective was to examine the proportion of US packaged food and beverage products eligible for marketing to children under the WHO Europe Nutrient Profile Model (NPM) and the 2019 Chilean regulation. Methods Data for this study are from Label Insight's 2017 Open Access branded food database. Each product was assigned to one of 13 food categories, and nutritional content compared to both the NPM and Chilean criteria. The proportion of US products meeting criteria for marketing to children using both schemes was examined overall and by category. Agreement between the two criteria was examined using Cohen's Kappa. Results Of 17,740 US products, 21% were eligible to be marketed to children using the WHO criteria and 26% using the Chilean criteria. 'Egg and egg products' and 'Seafood' had the highest proportion of products eligible for marketing to children under both schemes. 'Confectionery' and 'Snack foods' had the lowest proportion eligible. Conclusions for practice The WHO NPM and Chilean criteria both restrict less healthy items from being marketed to children. Regulatory agencies in the US developing policies should consider the implementation of nutrient criteria to restrict the marketing of less healthy foods and beverages to children and adolescents.



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Integrated Brief Intervention for PTSD and Substance Use in an Antepartum Unit

Abstract

Purpose To evaluate the efficacy of a brief education session affecting patient perspectives on follow up care of substance use and trauma treatment in pregnant women admitted to a medical hospital. Description Participants (N = 31) were recruited from the antepartum unit at Magee-Women's Hospital at the University of Pittsburgh who had current substance use and history of trauma. A voluntary individual educational session was offered that discussed the diagnosis and treatment of substance use and trauma, fundamental coping skills, and local resources. Utility of the session, knowledge of PTSD, and barriers of care were evaluated through a pre- and post- session questionnaire. Assessment All participants found the session improved their knowledge of PTSD, substance use, safe coping skills, and increased their likelihood of pursuing further follow up treatment. Conclusion Brief educational interventions that are integrated in the medical hospital are found to be useful by patients and reported to influence their decision to seek further treatment. Further studies are needed to analyze the long-term outcomes of brief interventions.



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Community public safety data management

Integrate data from EMS, fire and law enforcement to identify trends and community needs across disciplines

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Estimation of radon release rate for an underground uranium mine ventilation shaft in China and radon distribution characteristics

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Qingzhi Zhou, Senlin Liu, Lechang Xu, Hui Zhang, Detao Xiao, Jun Deng, Ziqiang Pan

Abstract

Radon, known to be a human carcinogen, is one of the most concerned radionuclides in uranium mining which need to be monitored and controlled. A large amount of radon is discharged to the atmosphere mainly through underground ventilation shafts for underground uranium mining. There are many studies on radon release of uranium mine, but the differences of the measured radon results are very big. In this paper, a typical underground uranium mine in China is chosen as a case study. This study finds that distribution of radon concentration and airflow speed inside the ventilation shaft are extremely uneven, but the distributions are respectively stable and regular for a fixed cross-section at the wellhead depth of 0–1 m. There is also a stable numerical relationship between the radon release rate and the product of radon concentration and airflow speed at the center for any cross-section in the shaft. Based on this regulation, a multipoint interpolation-integration method and a one-point method for calculating radon release from underground ventilation shaft are proposed in this paper. The results show that the difference between these two methods is 2–10%, the one-point method is more suitable and convenient to be applied for the long-term monitoring radon release rate from uranium mine ventilation. The research results in this paper can be applied in the estimation of radon release rate for other underground uranium ventilation shafts.



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Is non-human species radiosensitivity in the lab a good indicator of that in the field? Making the comparison more robust

Publication date: Available online 18 December 2018

Source: Journal of Environmental Radioactivity

Author(s): Karine Beaugelin-Seiller, Claire Della-Vedova, Jacqueline Garnier-Laplace

Abstract

Ecological risk assessment has globally become the basis for environmental decision-making within government and industry for chemical substances. Regarding radioactive substances, recently revised International and European Basic Safety Standards are pushing the development of member state policy on environmental regulation in the field of radiological protection. Within this framework, existing derived effect benchmarks for ionising radiation and non-human species need to be more robust to reinforce their credibility when used as levels of exposure considered to be safe for the environment. Actually, the derivation of such benchmarks has mainly relied on laboratory studies from a limited number of species. Moreover lab species would be apparently less radiosensitive than for example terrestrial wildlife chronically exposed to ionising radiation in the Chernobyl Exclusion Zone. Additionally to the results of such comparison that still need to be confirmed, another way to challenge benchmarks is to improve the quality/quantity of radiotoxicity data constituting the basis for a statistically-based comparison. This is the major focus of this paper where we demonstrate through various examples how to make the comparison more robust (i) by analysing the discrepancy between lab and field at the taxonomic level rather than at the ecosystem level, (ii) by extending the knowledge base making use of acute radiotoxicity data, (iii) by identifying environmental factors modifying radiological dose-effect relationship in the field.



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A Population-Based Study of School Readiness Determinants in a Large Urban Public School District

Abstract

Objectives We examined biologic and social determinants of school readiness in an urban population and whether childcare altered these associations. Methods A retrospective cohort study was conducted using school readiness data linked to birth certificates of first-time kindergarten students (n = 39,463) in a large, urban public-school district during 2002–2012. Multivariate linear regression models compared mean readiness scores (MRS) for students born low birthweight (LBW) or preterm (PTB) and by childcare type, adjusting for other student and parent risk factors. Results MRSs for moderately LBW (1000–2499 g), extremely LBW (< 1000 g), moderately PTB (28–36 weeks), early-term (37–38 weeks) and post-term (42 + weeks) students were significantly lower than scores for their normal weight or full-term peers, adjusting for childcare type and other student and parent characteristics. Childcare was an important predictor of MRSs. MRSs were highest for district prekindergarten (PK) students and for students of mothers with greater years of education. Conclusions for Practice Social and biologic differences in MRSs for children entering school in a large urban public-school district suggest the need for greater attention to family and child health backgrounds. Increased enrollment in formal childcare may improve school readiness in these settings.



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The South Carolina Multigenerational Linked Birth Dataset: Developing Social Mobility Measures Across Generations to Understand Racial/Ethnic Disparities in Adverse Birth Outcomes in the US South

Abstract

Objectives To describe the creation of a multigenerational linked dataset with social mobility measures for South Carolina (SC), as an example for states in the South and other areas of the country. Methods Using unique identifiers, we linked birth certificates along the maternal line using SC birth certificate data from 1989 to 2014, and compared the subset of records for which linking was possible with two comparison groups on sociodemographic and birth outcome measures. We created four multi-generational social mobility measures using maternal education, paternal education, presence of paternal information, and a summary score incorporating the prior three measures plus payment source for births after 2004. We compared social mobility measures by race/ethnicity. Results Of the 1,366,288 singleton birth certificates in SC from 1989 to 2014, we linked 103,194, resulting in 61,229 unique three-generation units. Mothers and fathers were younger and had lower education, and low birth weight was more common, in the multigenerational linked dataset than in the two comparison groups. Based on the social mobility summary score, only 6.3% of White families were always disadvantaged, compared to 30.4% of Black families and 13.2% of Hispanic families. Moreover, 32.8% of White families were upwardly mobile and 39.1% of Black families were upwardly mobile, but only 29.9% of Hispanic families were upwardly mobile. Conclusions for Practice When states are able to link individuals, birth certificate data may be an excellent source for examining population-level relationships between social mobility and adverse birth outcomes. Due to its location in the Deep South, the multigenerational SC dataset may be particularly useful for understanding racial/ethnic difference in social mobility and birth outcomes.



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Characteristics of Mothers and Infants Living in Homeless Shelters and Public Housing in New York City

Abstract

Introduction Homelessness can result in poor health. The number of families with children living in NYC homeless shelters increased 55% from 2008 to 2014. Half of children living in shelter in 2014 were younger than 6 years old. We compared demographics and health outcomes of mothers and infants residing in NYC homeless shelters to those residing in public housing in this cross-sectional study. Methods Addresses of NYC Department of Homeless Services shelters and NYC Housing Authority (NYCHA) developments were matched to NYC Department of Health birth certificate data for the years 2008–2013. Sociodemographic and health characteristics of newborns residing in shelters were compared to newborns in NYCHA housing using Chi square tests. Results Mothers residing in shelters were younger, more likely to be black and less likely to be Hispanic, more likely to have been born outside NYC and reside in the Bronx. Babies born to mothers living in shelter were more likely to have low birth weight (< 2500 g), be born preterm (< 37 gestational weeks), require assisted ventilation immediately following delivery, have a NICU admission, and use Medicaid. They were less likely to breastfeed within 5 days of delivery and be discharged to their residence. Discussion Homeless mothers and infants had poorer health outcomes compared with those living in public housing. Understanding the health disparities of homeless infants can provide guidance for developing future policies and research initiatives, which may be used to inform the development of new policies to improve health outcomes of homeless infants and their mothers.



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Noninvasive continuous arterial pressure monitoring with Clearsight during awake carotid endarterectomy

BACKGROUND Continuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a less invasive alternative compared with invasive intra-arterial monitoring for awake patients during carotid endarterectomy (CEA) under regional anaesthesia. OBJECTIVE We investigated the agreement of blood pressure (BP) recorded with invasive and CNBP methods during awake CEA. DESIGN A prospective observational study for assessing agreement with Bland–Altman plots, agreement-tolerability indices (ATI), concordance and interchangeability. SETTING Azienda Ospedaliera Universitaria G. Martino, Messina, a University tertiary referral centre in Italy. PATIENTS In 30 consecutive patients, we recorded continuously ipsilateral invasive and noninvasive BPs, from 3 min before carotid cross-clamping to 5 min after unclamping. MAIN OUTCOME MEASURES Primary outcome was bias, 95% limits of agreement, ATI, concordance and interchangeability for mean arterial pressure (MAP). Secondary outcomes were agreements for systolic arterial pressure and diastolic arterial pressure. Tracking of changes was assessed with four-quadrant polar plots and the trend interchangeability method. Optimal bias was defined as 5 mmHg or less. RESULTS A total of 2672 invasive and CNBP paired measurements (93% of overall data) were analysed, with a median of 92 readings per patient [IQR 76 to 100]. Mean (SD) bias for MAP, systolic arterial pressure and DAP were −6.8 (6.7), −3.0 (9.7) and −9.0 (5.4) mmHg, respectively. The ATIs were 0.88, 0.95 and 0.71, respectively, where ATI of 1.0 or less and at least 2.0 defined acceptable, marginal and unacceptable agreements. The four-quadrant plot analysis for beat-to-beat differences showed concordance rates of 97.3%, 99.98% and 96.4%, respectively. Polar plot analysis showed 95% limits of agreement of −3 to 3, −2 to 2 and −2 to 2 mmHg respectively. Trend interchangeability method showed an interchangeability rate of 95% for MAP. CONCLUSION During CEA performed under regional anaesthesia, CNBP offers a less invasive approach for BP monitoring. We found acceptable agreement for MAP defined by an ATI of 0.88 and an excellent 95% global interchangeability rate. A suboptimal bias of 7 mmHg was found with CNBP for MAP. Correspondence to Alberto Noto, Department of Anaesthesia and Intensive Care, Messina University, Messina, Italy Tel: +00 39 3471981248; e-mail: alberto.noto@unime.it © 2018 European Society of Anaesthesiology

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