Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174: 11/20/17

Δευτέρα 20 Νοεμβρίου 2017

Basal ganglia cerebral blood flow associates with psychomotor speed in adults with type 1 diabetes

Abstract

Type 1 diabetes is associated with slower psychomotor speed, but the neural basis of this relationship is not yet understood. The basal ganglia are a set of structures that are vulnerable to small vessel disease, particularly in individuals with type 1 diabetes. Thus, we examined the relationship between psychomotor speed and resting state resting cerebral blood flow in a sample of adults with diabetes onset during childhood (≤ 17 years of age). The sample included 77 patients (39 M, 38 F) with a mean age of 47.43 ± 5.72 years, age of onset at 8.50 ± 4.26 years, and duration of disease of 38.92 ± 4.18 years. Resting cerebral blood flow was quantified using arterial spin labeling. After covarying for sex, years of education and normalized gray matter volume, slower psychomotor speed was associated with lower cerebral blood flow in bilateral caudate nucleus-thalamus and a region in the superior frontal gyrus. These results suggest that the basal ganglia and frontal cortex may underlie slower psychomotor speed in individuals with type 1 diabetes.

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Network-level dysconnectivity in patients with nasopharyngeal carcinoma (NPC) early post-radiotherapy: longitudinal resting state fMRI study

Abstract

In this study, we seek to longitudinally investigate the network-level functional connectivity (FC) alternations and its association with irradiation dose and cognition changes in the early stage post radiotherapy (RT) in nasopharyngeal carcinoma (NPC) patients. We performed independent component analysis (ICA) of resting state blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) from 39 newly diagnosed NPC patients before receiving treatment (baseline), and 3 months post-RT. the default mode network (DMN), salience network (SN), and executive control network (ECN) were extracted with well-validated software (GIFT). Inter-network connectivity was assessed using the functional network connectivity (FNC) toolbox. The inter- and intra-network FC was compared between time points, and the z value of FC alternation was correlated with the RT dose value and cognitive changes. Compared with baseline, the FC of the left anterior cingulate cortex (ACC) within the DMN, and the right insular within the SN, significantly reduced 3 months post-RT, with greater effects at higher doses in the right insular. Bilateral ECN FC was also significantly lower 3 months post-RT compared to the baseline. Chemotherapy was not associated with inter- and intra- network FC change. We found intra- and inter-network FC disruption in NPC patients 3 months post-RT, with the right insular showing a dose-dependent effect. Thus, this network-level FC may serve as a potential biomarker of the RT-induced brain functional impairments, and provide valuable targets for further functional recovery treatment.

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AHNS Series: Do you know your guidelines? Guideline recommendations for head and neck cancer of unknown primary site

Abstract

This article reviews the clinical practice guidelines for head and neck oncology focusing on the management of head and neck cancers of unknown primary (CUP). The primary purpose of this series is to raise awareness of the current guidelines in head and neck oncology by reviewing the recommendations and the evidence supporting such recommendations, particularly those published by the National Comprehensive Cancer Network (NCCN). We review the importance of a thorough history and physical examination, the impact of the American Joint Committee on Cancer (AJCC) eighth edition changes and the importance of immunohistochemistry, the timing and type of imaging, the role of panendoscopy and tonsillectomy (palatine and lingual), and the role of surgery, radiation, and chemotherapy in the primary management of these tumors.

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Clinical diagnosis and treatment outcomes for parapharyngeal space schwannomas: A single-institution review of 21 cases

Abstract

Background

Because the incidence of schwannoma arising from the parapharyngeal space (PPS) is very low, no studies have analyzed extirpation methods and postoperative neurological complications exclusively in PPS schwannomas.

Methods

The preoperative diagnosis and clinical outcomes of surgical treatment in 21 patients with PPS schwannoma who underwent surgery were investigated.

Results

Neurological deficit of the involved nerve developed in all patients regardless of the extirpation method used. However, the incidence of first bite syndrome in sympathetic chain schwannoma was significantly lower after intracapsular enucleation (40%) than after total resection (100%; P = .045). Furthermore, the incidence of postoperative complications unrelated to the involved nerve was lower after intracapsular enucleation (0%) than after total resection (42.9%; P = .055).

Conclusion

Although postoperative neurological deficit of the involved nerve was unavoidable in PPS schwannoma, intracapsular enucleation could be beneficial by reducing its severity and the incidence of complications unrelated to the involved nerve.

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Effects of implant length and 3D bone-to-implant contact on initial stabilities of dental implant: a microcomputed tomography study

Abstract

Background

The influences of potential bone-to-implant contact (BIC) area (pBICA), BIC area (BICA), and three dimensional (3D) BIC percentage (3D BIC%; defined as BICA divided by pBICA) in relation to the implant length on initial implant stability were studied. Correlations between these parameters were also evaluated.

Methods

Implants with lengths of 8.5, 10, 11.5, and 13 mm were placed in artificial bone specimens to measure three indexes of the initial implant stability: insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ). The implants and bone specimens were also scanned by microcomputed tomography, and the obtained images were imported into Mimics software to reconstruct the 3D models and calculate the parameters of 3D bone-to-implant contact including pBICA, BICA, and 3D BIC%. The Kruskal-Wallis test, Wilcoxon rank-sum test with Bonferroni adjustment, and Spearman correlations were applied for statistical and correlation analyses.

Results

The implant length affected ITV more than PTV and ISQ, and significantly affected pBICA, BICA, and 3D BIC%. A longer implant increased pBICA and BICA but decreased 3D BIC%. The Spearman coefficients were high (>0.78) for the correlations between the three 3D BIC parameters and the three indexes of the initial implant stability.

Conclusions

pBICA, BICA, and 3D BIC% are useful when deciding on treatment plans related to various implant lengths, since these 3D BIC parameters are predictive of the initial implant stability.

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Identity released of body recovered from Altamaha River in Wayne County

A man's body was recovered from the Altamaha River in Wayne County at about 10:30 a.m. on Monday. The man has been identified as Gary Lewis, who was in his mid-60s.

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Pain relief after a short course of palliative radiotherapy in pancreatic cancer, the Academic Medical Center (AMC) experience

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Clinicopathologic Predictive Factors of Cervical Lymph Node Metastasis in Differentiated Thyroid Cancer

Publication date: Available online 20 November 2017
Source:Acta Otorrinolaringológica Española
Author(s): Ronghao Sun, Hua Zhang, Kun Liu, Jinchuan Fan, Guojun Li, Xicheng Song, Chao Li
BackgroundCervical lymph node metastasis (LNM) has been proven to be a predictor for locoregional recurrence in differentiated thyroid carcinoma (DTC). Clinicopathological features could be effective predictive factors for central and lateral LNM of DTC, and provide references to surgeons for cervical neck dissection.MethodsRetrospective analysis of clinicopathological data was performed on 420 patients who underwent initial surgery from 2010 to 2015.ResultsThe incidence of central and lateral LNM was calculated. Of 420 patients, 247 (58.8%) exhibited central LNM, and 185 (44.1%) exhibited lateral LNM. There were 29 (6.9%) cases confirmed to have skip metastasis. Univariate and multivariate analysis revealed that tumour location, tumour size, multifocality, capsular invasion, affected lobes, and age were independent predictors of central LNM. Tumour location, capsular invasion, affected lobes, and tumour size were independent predictors of lateral LNM.ConclusionsOur findings suggest that tumour location, affected lobes, capsular invasion, age, tumour size and multifocality may be taken as predictive factors for cervical LNM of DTC. Meticulous perioperative evaluation of cervical LNM and prophylactic cervical lymph node dissection that aims to remove the occult lymph nodes may be an option for DTC with risk factors.

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Instrumental variable methods for a binary outcome were used to informatively address non-compliance in a randomised trial in surgery

Publication date: Available online 20 November 2017
Source:Journal of Clinical Epidemiology
Author(s): J.A. Cook, G.S. Maclennan, T. Palmer, N. Lois, R. Emsley
ObjectivesRandomisation can be used as an instrumental variable (IV) to account for unmeasured confounding when seeking to assess the impact of non-compliance with treatment allocation in a randomised trial. We present and compare different methods to calculate the treatment effect on a binary outcome as a rate ratio in a randomised surgical trial.Study design and settingThe effectiveness of peeling versus not peeling the internal limiting membrane of the retina as part of the surgery for a full thickness macular hole. We compared IV based estimates (non-parametric causal bound, and two stage residual inclusion approach [2SRI] with standard treatment effect measures (intention to treat [ITT], per protocol [PP] and treatment received [TR]). Compliance was defined in two ways (initial and up to time point of interest). Poisson regression was used for the model based approaches with robust standard errors to calculate the risk ratio with 95% confidence intervals.ResultsResults were similar for 1-month macular hole status across methods. For 3- and 6-month macular hole status, non-parametric causal bounds provided a narrower range of uncertainty than other methods, though still had substantial imprecision. For 3-month macular hole status, the TR estimate was substantially different from the other point estimates.ConclusionNon-parametric causal bound approaches are a useful addition to an IV estimation approach, which tend to have large levels of uncertainty. Methods which allow risk ratios to be calculated when addressing non-compliance in randomised trials exist and may be superior to standard estimates. Further research is needed to explore the properties of different IV methods in a broad range of RCT scenarios.

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Editorial Board

Publication date: November 2017
Source:Journal of Clinical Epidemiology, Volume 91

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Publication date: November 2017
Source:Journal of Clinical Epidemiology, Volume 91

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Current study design labels are confusing! Call for consensus on better terminology that clearly reflects specific features

Publication date: November 2017
Source:Journal of Clinical Epidemiology, Volume 91
Author(s): Peter Tugwell, J. André Knottnerus

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Editorial Board

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Current study design labels are confusing! Call for consensus on better terminology that clearly reflects specific features

Journal of Clinical Epidemiology is receiving more manuscripts on non-randomized studies and this is reflected in the recent series on quasi-experimental designs [1]. Contrary to popular belief, some Cochrane Reviews do include non-randomized studies of not only harm but also benefit. In this issue Polus et al. found 136 reviews published in the Cochrane Library in the 3 years 2012–2015 – these covered a range of types of interventions. However, this review confirms that there are major substantive problems in the way that non-randomized studies are classified and analyzed.

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Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference?

Programmes for Enhanced Recovery after Surgery (ERAS) accelerate recovery, reduce morbidity, and shorten hospital stay in a wide range of surgical specialties. We established a standardised multimodal ERAS pathway for patients who were being treated by free tissue transfer for head and neck cancer to evaluate its benefit. Our primary outcome was duration of hospital stay, and secondary outcomes included complications, number of days to first mobilisation, and readmission rates. We compared 100 consecutive patients who followed the ERAS programme with a control group of 40 consecutive patients who had free tissue transfer before the ERAS programme was introduced.

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Are patients satisfied with the head and neck skin cancer service? An evaluation of outpatient services with a review of published reports

Scientific publications place much emphasis on postoperative outcomes such as recurrence, but little attention to patients' satisfaction. The purpose of this evaluation was to find out patients' reported outcomes after their initial consultation, treatment, and follow-up appointments for non-melanoma skin cancer of the head and neck. We used an adapted version of the European Organisation for Research and Treatment of Cancer (EORTC) validated questionnaire for patients' satisfaction to collect data prospectively from consenting patients between September and December 2015.

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Don't delay dental coverage

Imagine spending eight years with a wicked toothache. That's the length of time Ontario adults on a low income have to wait before the province says it will include dental care in its free health coverage.

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San Antonio man's good deeds land him on TV game show

Dentist Ruben Mora of San Antonio, who's known for his generosity with patients, and his wife, UTSA alumna Sandy, compete on a special Thanksgiving week edition of NBC's hit game show "The Wall," hosted by Chris Hardwick. less Dentist Ruben Mora of San Antonio, who's known for his generosity with patients, and his wife, UTSA alumna Sandy, compete on a special Thanksgiving week edition of NBC's hit game show "The Wall," hosted by ... more A suspenseful moment for S.A. native Ruben Mora and his wife Sandy during a special Thanksgiving week edition of NBC's hit game show "The Wall," hosted by Chris Hardwick.

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The prevalence of muscle wasting (sarcopenia) in peritoneal dialysis patients varies with ethnicity due to differences in muscle mass measured by bioimpedance

The prevalence of muscle wasting (sarcopenia) in peritoneal dialysis patients varies with ethnicity due to differences in muscle mass measured by bioimpedance

The prevalence of muscle wasting (sarcopenia) in peritoneal dialysis patients varies with ethnicity due to differences in muscle mass measured by bioimpedance, Published online: 21 November 2017; doi:10.1038/s41430-017-0033-6

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Comorbidities in a community sample of narcolepsy

To assess comorbidities in a community-based cohort of narcolepsy.

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Association between Nighttime Sleep Duration, Midday Naps and Glycemic Levels in Japanese Patients with Type 2 Diabetes

To clarify the relationship between nighttime sleep duration, midday naps and glycemic control in Japanese patients diagnosed with type 2 diabetes (n=355) or impaired glucose tolerance (n=43).

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Laryngeal candidiasis: our experience from sixty biopsy specimens

Persistent throat symptoms, such as dysphonia, globus and throat pain, are highly prevalent and are a significant cause of morbidity¹. In a number of cases a clear cause of these symptoms is not identified and many patients are treated empirically with lifestyle advice and/or anti-reflux medication².

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Tributes to Newcastle professor who 'changed the way dental...

Tributes have been paid to a Newcastle dentist and university professor who "changed the way dental services are provided in the UK". Emeritus Professor Jimmy Steele was head of Newcastle University's School of Dental Sciences for seven years and spearheaded medical research for the Government which aimed to transform the quality of dental care in Britain.

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What your teeth can tell yo about diabetes

Living with diabetes means paying close attention to what you eat, taking care of your eyes and even being more mindful of your feet. The study found that nearly one in five people with severe gum disease had type 2 diabetes and didn't know it.

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Selling Bad Therapy to Trauma Victims

The American Psychological Association just issued guidelines for treating trauma . Patients and therapists would be wise to ignore them.

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A comparative study of cone beam computed tomography and conventional radiography in diagnosing the extent of root resorptions

Root resorptions are assessed and diagnosed using different radiographical techniques. A comparison of the ability to assess resorptions on two-dimensional (2D) and three-dimensional (3D) radiographs is, hithe...

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Fetal Exposure to Maternal Pregnancy Complications and Respiratory Health in Childhood

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.

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Vitamin D: missing link between hypertension and muscle mass

Vitamin D: missing link between hypertension and muscle mass

Vitamin D: missing link between hypertension and muscle mass, Published online: 20 November 2017; doi:10.1038/s41371-017-0004-3

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The prevalence of muscle wasting (sarcopenia) in peritoneal dialysis patients varies with ethnicity due to differences in muscle mass measured by bioimpedance

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Wild bonobos host geographically restricted malaria parasites including a putative new Laverania species

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Microscale cavitation as a mechanism for nucleating earthquakes at the base of the seismogenic zone

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In response to: “Pharmacokinetic modelling of modified acetylcysteine infusion regimens used in the treatment of paracetamol poisoning”

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Chemoprophylaxis for venous thromboembolism prevention in spine surgery patients

No abstract available

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The evolution of care improves outcome in blunt thoracic aortic injury: A Western Trauma Association multicenter study

BACKGROUND: The management of blunt thoracic aortic injury (BTAI) has evolved radically in the last decade with changes in the processes of care and the introduction of thoracic endovascular aortic repair (TEVAR). These changes have wrought improved outcome, but the direct effect of TEVAR on outcome remains in question as previous studies have lacked vigorous risk adjustment and long-term follow-up. To address these knowledge gaps, we compared the outcomes of TEVAR, open surgical repair, and nonoperative management for BTAI. METHODS: Eight verified trauma centers recruited from the Western Trauma Association Multicenter Study Group retrospectively studied all patients with BTAI admitted between January 1, 2006, and June 30, 2016. Data included demographics, comorbidities, admitting physiology, injury severity, in-hospital care, and outcome. RESULTS: We studied 316 patients with BTAI; 57 (18.0%) were in extremis and died before treatment. Of the 259 treated surgically, TEVAR was performed in 176 (68.0%), open in 28 (10.8%), hybrid in 4 (1.5%), and nonoperative in 51 (19.7%). Thoracic endovascular aortic repair and open repair groups had similar Injury Severity Scale score, chest Abbreviated Injury Scale score, Trauma and Injury Severity Score, and probability of survival, but differed in median age (open: 28 [interquartile range {IQR}, 19–51]; TEVAR: 46 [IQR, 28–60]; p

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Time to aortic occlusion: It’s all about access

INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less invasive method of proximal aortic occlusion compared with resuscitative thoracotomy with aortic cross-clamping (RTACC). This study compared time to aortic occlusion with REBOA and RTACC, both including and excluding time required for common femoral artery (CFA) cannulation. METHODS: This was a retrospective, single-institution review of REBOA or RTACC performed between February 2013 and January 2016. Time of skin incision to aortic cross-clamp for RTACC, time required for CFA cannulation by percutaneous and open methods, and time from guide-wire insertion to balloon inflation at Zone 1 for REBOA, were obtained from videographic recordings. RESULTS: Eighteen RTACC and 21 REBOAs were performed. Median (Q1, Q3) time from skin incision to aortic cross-clamping was 317 seconds (227, 551 seconds). Median (Q1, Q3) time from start of arterial access to Zone 1 balloon occlusion was 474 seconds (431, 572 seconds) (vs. RTACC, p = 0.01). All REBOA procedures were performed with the same device. The median time to complete CFA cannulation was 247 seconds (range, 164–343 seconds), with no difference between percutaneous or open procedures (p = 0.07). The median (Q1, Q3) time to aortic occlusion in REBOA once arterial access had been established was 245 seconds (179, 295.5 seconds), which was significantly shorter than RTACC (p = 0.003). CONCLUSIONS: Once CFA access is achieved, time to aortic occlusion is faster with REBOA. Time to aortic occlusion is less than the time required to cannulate the CFA either by percutaneous or open approaches, emphasizing the importance of accurate and expedient CFA access. Resuscitative endovascular balloon occlusion of the aorta may represent a feasible alternative to thoracotomy for aortic occlusion. Time to aortic occlusion will likely decrease with the advent of newer REBOA technology. The rate-limiting portion of REBOA continues to be obtaining CFA access. LEVEL OF EVIDENCE: Therapeutic, level V.

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Fibrinolysis shutdown is associated with a fivefold increase in mortality in trauma patients lacking hypersensitivity to tissue plasminogen activator

BACKGROUND: Fibrinolysis shutdown (SD) is an independent risk factor for increased mortality in trauma. High levels of plasminogen activator inhibitor-1 (PAI-1) directly binding tissue plasminogen activator (t-PA) is a proposed mechanism for SD; however, patients with low PAI-1 levels present to the hospital with a rapid TEG (r-TEG) LY30 suggestive SD. We therefore hypothesized that two distinct phenotypes of SD exist, one, which is driven by t-PA inhibition, whereas another is due to an inadequate t-PA release in response to injury. METHODS: Trauma activations from our Level I center between 2014 and 2016 with blood collected within an hour of injury were analyzed with r-TEG and a modified TEG assay to quantify fibrinolysis sensitivity using exogenous t-PA (t-TEG). Using the existing r-TEG thresholds for SD ( 2.9%) patients were stratified into phenotypes. A t-TEG LY30 greater than 95th percentile of healthy volunteers (n = 140) was classified as t-PA hypersensitive and used to subdivide phenotypes. A nested cohort had t-PA and PAI-1 activity levels measured in addition to proteomic analysis of additional fibrinolytic regulators. RESULTS: This study included 398 patients (median New Injury Severity Score, 18), t-PA-Sen was present in 27% of patients. Shutdown had the highest mortality rate (20%) followed by hyperfibinolysis (16%) and physiologic (9% p = 0.020). In the non–t-PA hypersensitive cohort, SD had a fivefold increase in mortality (15%) compared with non-SD patients (3%; p = 0.003) which remained significant after adjusting for Injury Severity Score and age (p = 0.033). Overall t-PA activity (p = 0.002), PAI-1 (p

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Featured Articles for CME Credit December 2017

No abstract available

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Contemporary management of subclavian and axillary artery injuries—A Western Trauma Association multicenter review

BACKGROUND: Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability. METHODS: A multicenter, retrospective review of patients with subclavian or axillary artery injuries from January 1, 2004, to December 31, 2014, was completed at 11 participating Western Trauma Association institutions. Statistical analysis included χ2, t-tests, and Cochran-Armitage trend tests. A p value less than 0.05 was significant. RESULTS: Two hundred twenty-three patients were included; mean age was 36 years, 84% were men. An increase in computed tomography angiography and decrease in conventional angiography was observed over time (p = 0.018). There were 120 subclavian and 119 axillary artery injuries. Procedure type was associated with injury grade (p

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Bigger is better: Comparison of alternative devices for tension hemopneumothorax and pulseless electrical activity in a Yorkshire swine model

BACKGROUND: Tension pneumothorax is a cause of potentially preventable death in prehospital and battlefield settings and 14-gauge angiocatheter (14G AC) decompression remains the current treatment standard, despite its high incidence of failure. Traumatic pneumothorax is often associated with hemothorax, but 14G AC has no proven efficacy for associated hemothorax. We sought to compare the 14G AC to three alternative devices for treatment of tension hemopneumothorax (t-H/PTX) in a positive-pressure ventilation swine model. METHODS: Our tension model was modified to incorporate a persistent air leak and pleural blood. Tension physiology was achieved with escalating carbon dioxide insufflation via transdiaphragmatic trocar, and 10% estimated blood volume was instilled into each chest. Intervention was randomized between 14G AC, 10-gauge angiocatheter (10G AC), modified Veress-type needle (mVN), and 3-mm laparoscopic trocar (LT). After recovery, serial tension-induced pulseless electrical activity (PEA) events were induced and decompressed. Success of rescue, time to rescue, and physiologic data were recorded. RESULTS: One hundred ninety-five t-H/PTX and 88 PEA events were conducted in 25 swine. Laparoscopic trocar and 10G AC were more successful and had faster median time to rescue for t-H/PTX compared with 14G AC, whereas mVN performed comparably. Following PEA, 14G AC and mVN succeeded at rescue only 50% and 57% of the time, whereas 10G AC and LT had 100% success at return of spontaneous circulation. Time to successful return of circulation following PEA did not differ between devices; however, there was a noticeable difference in the rate of meaningful hemodynamic recovery following PEA favoring LT and 10G AC. There were no significant injuries noted. CONCLUSIONS: While mVN performed comparably to 14G AC, both have unacceptable failure rates. Ten-gauge AC and LT performed superiorly in both t-H/PTX and PEA. We believe there is now ample evidence supporting replacement of the 14G AC with 10G AC in current treatment recommendations.

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Cervical spine evaluation and clearance in the intoxicated patient: A prospective Western Trauma Association Multi-Institutional Trial and Survey

BACKGROUND: Intoxication often prevents clinical clearance of the cervical spine (Csp) after trauma leading to prolonged immobilization even with a normal computed tomography (CT) scan. We evaluated the accuracy of CT at detecting clinically significant Csp injury, and surveyed participants on related opinions and practice. METHODS: A prospective multicenter study (2013–2015) at 17 centers. All adult blunt trauma patients underwent structured clinical examination and imaging including a Csp CT, with follow-up thru discharge. alcohol- and drug-intoxicated patients (TOX+) were identified by serum and/or urine testing. Primary outcomes included the incidence and type of Csp injuries, the accuracy of CT scan, and the impact of TOX+ on the time to Csp clearance. A 36-item survey querying local protocols, practices, and opinions in the TOX+ population was administered. RESULTS: Ten thousand one hundred ninety-one patients were prospectively enrolled and underwent CT Csp during the initial trauma evaluation. The majority were men (67%), had vehicular trauma or falls (83%), with mean age of 48 years, and mean Injury Severity Score (ISS) of 11. The overall incidence of Csp injury was 10.6%. TOX+ comprised 30% of the cohort (19% EtOH only, 6% drug only, and 5% both). TOX+ were significantly younger (41 years vs. 51 years; p 12 hrs) in 25%. The survey showed marked variations in protocols, definitions, and Csp clearance practices among participating centers, although 100% indicated willingness to change practice based on these data. CONCLUSION: For intoxicated patients undergoing Csp imaging, CT scan was highly accurate and reliable for identifying clinically significant spine injuries, and had a 100% NPV for identifying unstable injuries. CT-based clearance in TOX+ patients appears safe and may avoid unnecessary prolonged immobilization. There was wide disparity in practices, definitions, and opinions among the participating centers. LEVEL OF EVIDENCE: Diagnostic tests or criteria, level II.

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Comment on clinical features of 27 shark attack cases on La Réunion Island

No abstract available

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REBOA for the IVC? Resuscitative balloon occlusion of the inferior vena cava (REBOVC) to abate massive hemorrhage in retrohepatic vena cava injuries

BACKGROUND: The use of resuscitative endovascular balloon occlusion as a maneuver for occlusion of the aorta is well described. This technique has life-saving potential in other cases of traumatic hemorrhage. Retrohepatic inferior vena cava (IVC) injuries have a high rate of mortality, in part, due to the difficulty in achieving total vascular isolation. The purpose of this study was to investigate the ability of resuscitative balloon occlusion of the IVC to control suprahepatic IVC hemorrhage in a swine model of trauma. METHODS: Thirteen swine were randomly assigned to control (seven animals) versus intervention (six animals). In both groups, an injury was created to the IVC. Hepatic inflow control was obtained via clamping of the hepatoduodenal ligament and infrahepatic IVC. In the intervention group, suprahepatic IVC control was obtained via a resuscitative balloon occlusion of the IVC placed through the femoral vein. In the control group, no suprahepatic IVC control was established. Vital signs, arterial blood gases, and lactate were monitored until death. Primary end points were blood loss and time to death. Lactate, pH, and vital signs were secondary end points. Groups were compared using the χ2 and the Student t test with significance at p

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Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation: A propensity matched study

BACKGROUND: Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing DC versus craniotomy only (CO) for the evacuation of ICH. METHODS: We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups, those who underwent CO and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow Coma Scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (skilled nursing facility), discharge GCS and Glasgow Outcome Scale scores, and complications. RESULTS: We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score matching, we included 99 of those patients in our study (DC, 33; CO, 66). Matched groups were similar in age (p = 0.68), admission GCS score (p = 0.50), Injury Severity Score (p = 0.70), head Abbreviated Injury Scale score (p = 0.32), and intracranial bleeding characteristics. Overall, 26.3% (n = 26) of the patients died and 62.6% (n = 62) were discharged to Rehab/skilled nursing facility. There was no difference in the mortality rate (27.3% vs. 25.0%; p = 0.99), adverse discharge disposition (45% vs. 33%; p = 0.66), GCS score (p = 0.53), and Glasgow Outcome Scale (p = 0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days. CONCLUSION: This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH. LEVEL OF EVIDENCE: Therapeutic, level III.

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Quantifying and exploring the recent national increase in surgical stabilization of rib fractures

BACKGROUND: Surgical stabilization of rib fractures (SSRF) has become pivotal in the management of severe chest injuries. Recent literature supports improved outcomes and mortality in severe fracture and flail chest patients who undergo SSRF compared with nonoperative management (NOM). A 2014 National Trauma Data Bank review provided a point prevalence of 0.7% SSRF in flail patients. We hypothesize that this prevalence is increasing and that temporal, regional, and American College of Surgeons (ACS) trauma designation vary in SSRF utilization. METHODS: Retrospective National Trauma Data Bank data were extracted for years 2007 to 2014 for patients with rib fractures. Cases were divided into SSRF versus NOM. SSRF frequencies were analyzed across year, region, and ACS level. Patient demographics, injury severity score, number of fractured ribs, and hospital characteristics were identified for multivariable analysis. RESULTS: Between 2007 and 2014, 687,137 rib fracture patients were identified; 29,981 (4.36%) underwent SSRF. SSRF increased by 76% nationally during the review period (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.50–1.67; p

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Attempting to validate the overtriage/undertriage matrix at a Level I trauma center

BACKGROUND: The Optimal Resources Document mandates trauma activation based on injury mechanism, physiologic and anatomic criteria and recommends using the overtriage/undertriage matrix (Matrix) to evaluate the appropriateness of trauma team activation. The purpose of this study was to assess the effectiveness of the Matrix method by comparing patients appropriately triaged with those undertriaged. We hypothesized that these two groups are different, and Matrix does not discriminate the needs or outcomes of these different groups of patients. METHODS: Trauma registry data, from January 2013 to December 2015, at a Level I trauma center, were reviewed. Overtriage and undertriage rates were calculated by Matrix. Patients with Injury Severity Score (ISS) of 16 or greater were classified by activation level (full, limited, consultation), and triage category by Matrix. Patients in the limited activation and consultation groups were compared with patients with full activation by demographics, injuries, initial vital signs, procedures, delays to procedure, intensive care unit admission, length of stay, and mortality. RESULTS: Seven thousand thirty-one patients met activation criteria. Compliance with American College of Surgeons tiered activation criteria was 99%. The Matrix overtriage rate was 45% and undertriage was 24%. Of 2,282 patients with an ISS of 16 or greater, 1,026 were appropriately triaged (full activation), and 1,256 were undertriaged. Undertriaged patients had better Glasgow Coma Scale score, blood pressure, and base deficit than patients with full activation. Intensive care unit admission, hospital stays, and mortality were lower in the undertriaged group. The undertriaged group required fewer operative interventions with fewer delays to procedure. CONCLUSION: Despite having an ISS of 16 or greater, patients with limited activations were dissimilar to patients with full activation. Level of activation and triage are not equivalent. The American College of Surgeons Committee on Trauma full and tiered activation criteria are a robust means to have the appropriate personnel present based on the available prehospital information. Evaluation of the process of care, regardless of level of activation, should be used to evaluate trauma center performance. LEVEL OF EVIDENCE: Therapeutic and care management, level III.

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Human neutrophil elastase mediates fibrinolysis shutdown through competitive degradation of plasminogen and generation of angiostatin

BACKGROUND: A subset of trauma patients undergo fibrinolysis shutdown rather than pathologic hyperfibrinolysis, contributing to organ failure. The molecular basis for fibrinolysis shutdown in trauma is incompletely understood. Elastase released from primed/activated human neutrophils (HNE) has historically been described as fibrin(ogen)olytic. However, HNE can also degrade plasminogen (PLG) to angiostatin (ANG), retaining the kringle domains but not the proteolytic function, and could thereby compete for generation of active plasmin by tissue plasminogen activator (tPA). We hypothesized that HNE can drive fibrinolysis shutdown rather than fibrinolysis. METHODS: Turbidometry was performed using light scatter (λ = 620 nm) in a purified fibrinogen + PLG system and in healthy citrate plasma clotted with Ca2+/thrombin ± tPA, ±HNE, and ±ANG to evaluate HNE effects on fibrinolysis, quantified by time to transition midpoint (Tm). ΔTm from control is reported as percent of control ±95% CI. Purified HNE coincubated with PLG or tPA was analyzed by western blot to identify cleavage products. Exogenous HNE was mixed ex vivo with healthy volunteer blood (n = 7) and used in TEG ± tPA to evaluate effects on fibrinolysis. RESULTS: HNE did not cause measurable fibrinolysis on fibrin clots, clotted plasma, or whole blood as assessed by turbidometry or TEG in the absence of tPA. Upon tPA treatment, all three methods of evaluating fibrinolysis showed delays and decreases in fibrinolysis caused by HNE relative to control: fibrin clot turbidometry ΔTm = 110.7% (CI 105.0–116.5%), clotted citrate plasma (n = 6 healthy volunteers) ΔTm = 126.1% (CI 110.4–141.8%), and whole blood native TEG (n = 7 healthy volunteers) with ΔLY30 = 28% (p = 0.043). Western blot analysis of HNE–PLG co-incubation confirmed that HNE generates angiostatin K1–3, and plasma turbidity assays treated with angiostatin K1–3 delayed fibrinolysis. CONCLUSION: HNE degrades PLG and generates angiostatin K1–3, which predominates over HNE cleavage of fibrin(ogen). These findings suggest that neutrophil release of elastase may underlie trauma-induced fibrinolytic shutdown.

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Big for small: Validating brain injury guidelines in pediatric traumatic brain injury

BACKGROUND: Brain injury guidelines (BIG) were developed to reduce overutilization of neurosurgical consultation (NC) as well as computed tomography (CT) imaging. Currently, BIG have been successfully applied to adult populations, but the value of implementing these guidelines among pediatric patients remains unassessed. Therefore, the aim of this study was to evaluate the established BIG (BIG-1 category) for managing pediatric traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH) without NC (no-NC). METHODS: We prospectively implemented the BIG-1 category (normal neurologic examination, ICH ≤ 4 mm limited to one location, no skull fracture) to identify pediatric TBI patients (age, ≤ 21 years) that were to be managed no-NC. Propensity score matching was performed to match these no-NC patients to a similar cohort of patients managed with NC before the implementation of BIG in a 1:1 ratio for demographics, severity of injury, and type as well as size of ICH. Our primary outcome measure was need for neurosurgical intervention. RESULTS: A total of 405 pediatric TBI patients were enrolled, of which 160 (NC, 80; no-NC, 80) were propensity score matched. The mean age was 9.03 ± 7.47 years, 62.1% (n = 85) were male, the median Glasgow Coma Scale score was 15 (13–15), and the median head Abbreviated Injury Scale score was 2 (2–3). A subanalysis based on stratifying patients by age groups showed a decreased in the use of repeat head CT (p = 0.02) in the no-NC group, with no difference in progression (p = 0.34) and the need for neurosurgical intervention (p = 0.9) compared with the NC group. CONCLUSION: The BIG can be safely and effectively implemented in pediatric TBI patients. Reducing repeat head CT in pediatric patients has long-term sequelae. Likewise, adhering to the guidelines helps in reducing radiation exposure across all age groups. LEVEL OF EVIDENCE: Therapeutic/care management, level III.

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Peritoneal cavity lavage reduces the presence of mitochondrial damage associated molecular patterns in open abdomen patients

BACKGROUND: Mitochondrial damage-associated molecular patterns (mtDAMPs), such as mitochondrial DNA and N-formylated peptides, are endogenous molecules released from tissue after traumatic injury. mtDAMPs are potent activators of the innate immune system. They have similarities with bacteria, which allow mtDAMPs to interact with the same pattern recognition receptors and mediate the development of systemic inflammatory response syndrome (SIRS). Current recommendations for management of an open abdomen include returning to the operating room every 48 hours for peritoneal cavity lavage until definitive procedure. These patients are often critically ill and develop SIRS. We hypothesized that mitochondrial DAMPs are present in the peritoneal cavity fluid in this setting, and that they accumulate in the interval between washouts. METHODS: We conducted a prospective pilot study of critically ill adult patients undergoing open abdomen management in the surgical and trauma intensive care units. Peritoneal fluid was collected daily from 10 open abdomen patients. Specimens were analyzed via quantitative polymerase chain reaction (qPCR) for mitochondrial DNA (mtDNA), via enzyme immunoassay for DNAse activity and via Western blot analysis for the ND6 subunit of the NADH: ubiquinone oxidoreductase, an N-formylated peptide. RESULTS: We observed a reduction in the expression of ND6 the day after lavage of the peritoneal cavity, that was statistically different from the days with no lavage (% change in ND6 expression, postoperative from washout: −50 ± 11 vs. no washout day, 42 ± 9; p

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Loop ileostomy for Clostridium difficile infection: Know thy enemy

No abstract available

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Valproic acid decreases brain lesion size and improves neurologic recovery in swine subjected to traumatic brain injury, hemorrhagic shock, and polytrauma

BACKGROUND: We have previously shown that treatment with valproic acid (VPA) decreases brain lesion size in swine models of traumatic brain injury (TBI) and controlled hemorrhage. To translate this treatment into clinical practice, validation of drug efficacy and evaluation of pharmacologic properties in clinically realistic models of injury are necessary. In this study, we evaluate neurologic outcomes and perform pharmacokinetic analysis of a single dose of VPA in swine subjected to TBI, hemorrhagic shock, and visceral hemorrhage. METHODS: Yorkshire swine (n = 5/cohort) were subjected to TBI, hemorrhagic shock, and polytrauma (liver and spleen injury, rib fracture, and rectus abdominis crush). Animals remained in hypovolemic shock for 2 hours before resuscitation with isotonic sodium chloride solution (ISCS; volume = 3× hemorrhage) or ISCS + VPA (150 mg/kg). Neurologic severity scores were assessed daily for 30 days, and brain lesion size was measured via magnetic resonance imaging on postinjury days (PID) 3 and 10. Serum samples were collected for pharmacokinetic analysis. RESULTS: Shock severity and response to resuscitation were similar in both groups. Valproic acid–treated animals demonstrated significantly less neurologic impairment between PID 1 to 5 and smaller brain lesions on PID 3 (mean lesion size ± SEM, mm3: ISCS = 4,956 ± 1,511 versus ISCS + VPA = 828 ± 279; p = 0.047). No significant difference in lesion size was identified between groups at PID 10 and all animals recovered to baseline neurologic function during the 30-day observation period. Animals treated with VPA had faster neurocognitive recovery (days to initiation of testing, mean ± SD: ISCS = 6.2 ± 1.6 vs ISCS + VPA = 3.6 ± 1.5; p = 0.002; days to task mastery: ISCS = 7.0 ± 1.0 vs ISCS + VPA = 4.8 ± 0.5; p = 0.03). The mean ± SD maximum VPA concentrations, area under the curve, and half-life were 145 ± 38.2 mg/L, 616 ± 150 hour·mg/L, and 1.70 ± 0.12 hours. CONCLUSIONS: In swine subjected to TBI, hemorrhagic shock, and polytrauma, VPA treatment is safe, decreases brain lesion size, and reduces neurologic injury compared to resuscitation with ISCS alone. These benefits are achieved at clinically translatable serum concentrations of VPA. LEVEL OF EVIDENCE: Therapeutic (preclinical study).

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August 2001 Volume 51 Supplement 2, Part 1: Erratum

No abstract available

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Remote ischemic conditioning preserves cognition and motor coordination in a mouse model of traumatic brain injury

INTRODUCTION: Management of traumatic brain injury (TBI) is focused on minimizing or preventing secondary brain injury. Remote ischemic conditioning (RIC) is an established treatment modality that has been shown to improve patient outcomes in different clinical settings by influencing inflammatory insults. In a clinical trial, RIC showed amelioration of SB100 and neuron-specific enolase. The aim of our study was to further elucidate the mechanisms and outcome when applying RIC in a mouse model of traumatic brain injury. METHODS: We subjected 100 male C57BL mice to a closed-skull cortical-controlled impact injury. Two hours after the TBI, the animals were allocated to either the RIC group (n = 50) or the sham group (n = 50). By clamping the exposed femoral artery, we induced RIC by six 4-minute cycles of ischemia and reperfusion. Circulating levels of S100-B, neuron-specific enolase, and glial fibrillary acidic protein were measured at multiple time points. Animals were additionally observed daily for cognition and motor coordination via novel object recognition and rotarod. Brain sections were stained and evaluated for neuronal injury at post-TBI Day 5. RESULTS: The RIC animals had a significantly higher recognition index than did sham at 24, 48, and 72 hours after intervention. Rotarod latency was higher in the RIC animals compared to the sham animals at all-time points, and statistically significant at 120 hours after intervention. The RIC group demonstrated preserved cognitive function and motor coordination compared to the sham. On hematoxylin and eosin and immunohistochemical staining of brain sections, there was less area of neuronal degeneration and astrocytosis, respectively, in the RIC group compared to the sham group. There was no significant difference in systemic neuronal markers between the RIC and sham animals. CONCLUSION: Remote ischemic conditioning 2 hours after injury preserved cognitive functions and motor coordination in a mouse model of TBI. Remote ischemic conditioning can preserve viability of neurons and astrocytes after TBI and has potential as a clinically noninvasive and relatively easy method to improve outcome after TBI. LEVEL OF EVIDENCE: Therapeutic studies, randomized controlled trial, level I.

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Language-specific strategy for programming hearing aids — A double-blind randomized controlled crossover study

Voice-aligned compression (VAC) is a method used in Oticon's hearing aids to provide more comfortable hearing without sacrificing speech discrimination. The complex, non-linear compression curve for the VAC strategy is designed based on the frequency profile of certain spoken Western languages. We hypothesized that hearing aids could be further customized for Japanese-speaking users by modifying the compression curve using the frequency profile of spoken Japanese.

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Pediatric type 1 cartilage tympanoplasty outcomes: A comparison of short and long term hearing results

Tympanoplasty is a commonly used procedure in children as in adults. The purposes of this study were to evaluate and report the long term results of type 1 cartilage tympanoplasty in pediatric population. Short term and long term hearing outcomes were compared according to age and perforation location.

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Compliance with the Australian 24-hour movement guidelines for the early years: associations with weight status

For effective public health and surveillance it is important to document the proportion of young children who meet the new Australian Integrated 24 h Movement Guidelines for the Early Years and how these assoc...

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Meeting new Canadian 24-Hour Movement Guidelines for the Early Years and associations with adiposity among toddlers living in Edmonton, Canada

Canada has recently released guidelines that include toddler-specific recommendations for physical activity, screen-based sedentary behaviour, and sleep. This study examined the proportions of toddlers meeting...

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Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep

The Canadian Society for Exercise Physiology convened representatives of national organizations, research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline de...

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Proportion of preschool-aged children meeting the Canadian 24-Hour Movement Guidelines and associations with adiposity: results from the Canadian Health Measures Survey

New Canadian 24-Hour Movement Guidelines for the Early Years have been released in 2017. According to the guidelines, within a 24-h period, preschoolers should accumulate at least 180 min of physical activity (of...

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Proportion of infants meeting the Australian 24-hour Movement Guidelines for the Early Years: data from the Melbourne InFANT Program

Little information is available on the movement behaviours of infants, despite evidence that these are important for development. The release of new Australian 24-hour Movement Guidelines provides an opportuni...

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Inter-rater reliability of STOPPFrail [Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy] criteria amongst 12 physicians

Abstract

Purpose

STOPPFrail is an explicit tool, developed by Delphi consensus, to assist physicians with deprescribing medications in frail older adults with poor survival prognosis. This study aimed to determine the inter-rater reliability (IRR), amongst physicians, of STOPPFrail application.

Methods

Twenty clinical cases were collated to represent frail older patients. Eighteen cases met STOPPFrail inclusion criteria. They had a mean age of 79.5 (SD6) years and a median of 7 (IQR6–8.25) comorbidities and were prescribed a median of 9 (IQR7.75–11.25) medications. Two of the STOPPFrail originators reached complete agreement (gold standard) in determining 91 of 165 medications (55.2%) as inappropriate. Twelve physicians (6 geriatricians, 3 general practitioners and 3 palliative care physicians) independently applied STOPPFrail criteria. IRR between physicians and gold standard (GS) assessment was determined using Cohen's kappa statistic.

Results

Eighteen of the 20 cases that met STOPPFrail inclusion criteria were correctly identified by 9 of 12 physicians (75%). The average time taken per clinical case was 2.7 (SD0.94) minutes. The kappa co-efficient between physicians and GS assessment ranged from 0.71 (substantial) to 0.86 (good), with a mean kappa value of 0.758 (SD0.059). The Fleiss kappa coefficients between GS assessment and geriatricians, GPs and palliative care physicians were 0.80 (SD0.6), 0.77 (SD0.9) and 0.75 (SD0.1), respectively. No significant difference was noted, between groups or between participants within groups, as determined by one-way ANOVA, (df (2, 9) = 0.712, p = 0.516).

Conclusions

IRR of STOPPFrail criteria between physicians, practising in different specialties, is substantial, despite no prior knowledge of the criteria.

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SLC52A2 mutations cause SCABD2 phenotype: A second report

Autosomal recessive cerebellar ataxias (ARCAs) are a large group of neurodegenerative disorders that manifest mainly in children and young adults. Most ARCAs are heterogeneous with respect to age at onset, severity of disease progression, and frequency of extracerebellar and systemic signs.

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Primary cervical leiomyoma: A rare cause of a posterior neck mass in a pediatric patient

A 13-year-old male presents for evaluation of a right-sided posterolateral neck mass, first noted four years prior to presentation; incisional biopsy two years ago suggested a benign lymph node. Recent growth and increased pain prompted referral to our tertiary care center. MR imaging revealed a densely calcified mass in the right posterior paraspinous muscles with intense enhancement with gadolinium contrast, approximately 5 cm × 2.8 cm x 4.6 cm. Incisional biopsy showed leiomyoma with extensive dystrophic calcifications.

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Instrumental variable methods for a binary outcome were used to informatively address non-compliance in a randomised trial in surgery

Randomisation can be used as an instrumental variable (IV) to account for unmeasured confounding when seeking to assess the impact of non-compliance with treatment allocation in a randomised trial. We present and compare different methods to calculate the treatment effect on a binary outcome as a rate ratio in a randomised surgical trial.

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Extreme weather forecast for North America

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Students get a jump on careers while staying on top of graduation

The senior at Chiawana High School, whose mom attended dental hygienist school, is getting a jump start on her career by taking a 2 "Coming here to Tri-Tech, it's only been a few months, and I already realized this is what I want to do for the rest of my life," Gass said. While the course at the Kennewick center giving Gass a head start on her future, it's also helping with her high school career.

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An unexpected but underestimated case of disseminated toxoplasmosis

Abstract

Toxoplasma gondii is a ubiquitous intracellular parasite that can cause disseminated infection following reactivation in immunocompromised hosts. We describe a 58-year-old man who died of refractory shock because of disseminated toxoplasmosis. The diagnosis was only made post-mortem on autopsy. We discuss the importance of considering toxoplasmosis on the differential diagnosis in high-risk patients, and review the role of screening and chemoprophylaxis in preventing infection.

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Impact of low-level BK polyomavirus viremia on intermediate-term renal allograft function

Abstract

Background

BK polyomavirus (BKPyV)-associated nephropathy (PyVAN) is a significant cause of premature renal transplant failure. High-level BKPyV viremia is predictive for PyVAN, however, low-level BKPyV viremia does not necessarily exclude the presence of PyVAN.

As data are limited whether or not low-level BKPyV viremia has an effect on intermediate-term graft outcome, this study analyzes the impact of low-level BKPyV viremia on intermediate-term graft function and outcome compared to high-level viremia and non-viremic patients.

Methods

All renal transplant patients received follow-up examinations at the Department of Nephrology, University Hospital Essen. Patients were screened for BKPyV viremia and stratified into 3 groups according to their maximum BKPyV load in serum (low-level viremia, high-level viremia, and no viremia).

Results

In 142 of 213 (67%) patients, BKPyV was never detected in serum; 42 of 213 (20%) patients were found positive for low-level viremia (≤10⁴ copies/mL); and 29 of 213 (13%) patients showed high-level viremia with (>10⁴ copies/mL). No significant differences regarding transplant function and graft failure was observed between patients without BKPyV viremia (delta estimate glomerular filtration rate [eGFR] +0.1 mL/min [month 1 vs last visit at month 44]) and patients with low-level BKPyV viremia (delta eGFR -1.7 mL/min). In patients with high-level viremia, transplant function was significantly restricted (delta eGFR -6.5 mL/min) compared to low-level viremia until the last visit at 44 +/- 9.7 months after transplantation. Although the graft function and graft loss was worse in the high-level viremia group compared to no viremia (eGFR 37 vs 45 mL/min) the difference was not significant.

Conclusions

High-level viremia was associated with impaired graft function. In contrast, low-level BKPyV viremia had no significant impact on intermediate-term graft function.

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Multiple transmissions of chromosomally integrated human herpesvirus-6 in one family

Abstract

Chromosomally integrated human herpesvirus-6 (ciHHV-6) can be transmitted from parent to child or via allogeneic hematopoietic cell transplantation (HCT). We report a case of ciHHV-6 transmitted via syngeneic HCT, and vertically across three generations. ciHHV-6 was transmitted from a parent to the patient and her identical twin, and from the patient to her son. The patient underwent syngeneic HCT as rescue from chemotherapy-induced aplasia during which ciHHV-6 was re-transmitted to her, this time from her identical twin. This is the first report, to our knowledge, of a patient acquiring ciHHV-6 once via germline from a parent and again via syngeneic HCT from an identical twin.

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Building Global Epidemiology and Response Capacity with Field Epidemiology Training Programs

D. S. Jones et al.

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Strengthening Global Surveillance for Antimicrobial Drug–Resistant Neisseria gonorrhoeae through the Enhanced Gonococcal Antimicrobial Surveillance Program

E. J. Weston et al.

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Application of genome editing technologies in rats for human disease models

Application of genome editing technologies in rats for human disease models

Application of genome editing technologies in rats for human disease models, Published online: 20 November 2017; doi:10.1038/s10038-017-0346-2

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Role of HAMP Genetic Variants on Pathophysiology of Iron Deficiency Anemia

Abstract

Hepcidin is a 25-amino acid peptide hormone produced by hepatocytes and plays a key role in body iron metabolism. Hepcidin deficiency is the cause of iron overload in hereditary hemochromatosis, iron-loading anemia, and its excess is associated with anemia of inflammation, chronic disease and iron deficiency anemia (IDA). The aims of this study was to evaluate HAMP gene mutation, namely IVS2 + 1(–G) (c.148–150 + 1del) and Gly71 Asp (c.212G > A (rs104894696) association with iron status in IDA conditions. Our study participants were 500 IDA patients and 550 age and sex-matched healthy controls. Hepcidin, ferritin and CRP analysis was done by ELISA method while ESR analysis was done according to Wintrobe method. CBC analysis was done by auto-analyzer. Two mutations in the HAMP genes were analysed by PCR RFLP method. Among the IDA patients, 7 were heterozygous for Met50del IVS2 + 1(–G) mutation. Nine IDA patients were heterozygous for G71D G–A mutation and homozygous were not identified in both mutations.Controls were showing heterozygous frequency 1.8 and 2.1% of Met50del IVS2 + 1(–G) and G71D G–A mutations respectively. Mutation of HAMP (Met50del IVS2 + 1(–G) and G71D G–A) were clinically associated with IDA and act as modulator of disease.

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A role for subducted super-hydrated kaolinite in Earth’s deep water cycle

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Greenhouse gas emission curves for advanced biofuel supply chains

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Increased rainfall volume from future convective storms in the US

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What genomic data can reveal about eco-evolutionary dynamics

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Links between sediment consolidation and Cascadia megathrust slip behaviour

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Ordovician oxygen and biodiversity

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The architecture of mutualistic networks as an evolutionary spandrel

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Mapping synergies and trade-offs between energy and the Sustainable Development Goals

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Detecting macroecological patterns in bacterial communities across independent studies of global soils

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Near doubling of storm rainfall

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Oxygenation as a driver of the Great Ordovician Biodiversification Event

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Recently amplified arctic warming has contributed to a continual global warming trend

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Granular flows at recurring slope lineae on Mars indicate a limited role for liquid water

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As climate talks end, it is time for action

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A brief visit from a red and extremely elongated interstellar asteroid

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Vitamin D: missing link between hypertension and muscle mass

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Reply to the Letter to the Editor: “Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience”

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Peroxisome proliferator activated receptor-gamma stimulation for prevention of 5-fluorouracil-induced oral mucositis in mice

Abstract

Background

Oral mucositis is a side effect of treatment regimens containing 5-fluorouracil (5-FU). The purpose of this study was to present our evaluation to see if rosiglitazone (RGZ) protected normal tissues from chemotherapy-induced oral mucositis.

Methods

C57BL/6J mice were treated with 5-FU for 5 days, with or without RGZ. Mice were euthanized after 5, 8, 11, or 15 days, and mucosal segments were collected.

Results

The RGZ did not affect the 5-FU-induced decrease in mouse body weight. The 5-FU caused loss of epithelial architecture, collagen fiber impairment, and inflammatory infiltration. The RGZ reduced leukocyte infiltration, preserved tissue structure, and dampened the 5-FU-induced expression of p53 and matrix metalloproteinase (Mmp)-2 after 5 days, and of Mmp-2 and interleukin (Il-1β after 15 days. The RGZ inhibited the 5-FU-induced increase of transforming growth factor-beta (TGF-β) and nuclear factor-kappa B (NF-κB) proteins and restored collagen protein levels.

Conclusion

The RGZ had a protective effect on oral mucosa damaged by chemotherapy. These data encourage the further study of RGZ for the prevention of 5-FU-induced mucositis in patients with cancer.

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Free gracilis muscle transfer for smile reanimation after treatment for advanced parotid malignancy

Abstract

Background

The purpose of this study was to characterize the outcomes of free gracilis muscle transfer for delayed smile reanimation after radical parotidectomy.

Methods

A retrospective chart review of patients who underwent free gracilis muscle transfer for smile reanimation after radical parotidectomy between 2003 and 2016 was performed. Patient-reported quality of life (Facial Clinimetric Evaluation Scale [FaCE]), physician-reported facial function ("eFACE" facial grading scale), and oral commissure excursion were compared preoperatively and postoperatively.

Results

Twelve patients were identified with prior surgery and adjuvant therapy (radiotherapy in 6 cases and chemoradiotherapy in 6 cases). Significant postoperative improvements were demonstrated for ipsilateral commissure excursion with smile (preoperatively: −2.2 mm [SD 2.3 mm] vs postoperatively: 7.9 mm [SD 2.5 mm]; P = .002), with meaningful smile achieved in 11 of 12 cases (91.7%). The average duration of facial paralysis before intervention was 72 months (range 12-204 months).

Conclusion

Free gracilis muscle transfer is an option for dynamic smile reanimation in select patients who have undergone treatment for advanced parotid malignancy.

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Intensity-modulated radiotherapy for elderly patients with nasopharyngeal carcinoma

Abstract

Background

The purpose of this study was to evaluate the clinical outcomes and patterns of failure after intensity-modulated radiotherapy (IMRT) for elderly patients with nasopharyngeal carcinoma (NPC).

Methods

Fifty-two patients treated with IMRT were eligible for study inclusion. Comorbidity was rated using the Adult Comorbidity Evaluation-27 (ACE-27) system.

Results

Twenty-six patients (50.0%) had an ACE-27 score of 1; and 6 (11.5%) had an ACE-27 score of 2. Eleven patients had died and 5 (45.5%) of them died of NPC. Two patients had developed local recurrence only, 1 had developed regional recurrence only, and 7 had developed distant metastasis only. The locoregional failure-free survival, distant failure-free survival, cancer-specific survival (CSS), and overall survival (OS) rates at 5 years were 92.6%, 83.7%, 84.9%, and 69.4%, respectively.

Conclusion

The results of treating elderly patients with NPC by IMRT were excellent. Distant metastasis remains the most difficult treatment challenge for elderly patients with NPC.

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Safety and effectiveness of endovascular embolization or stent-graft reconstruction for treatment of acute carotid blowout syndrome in patients with head and neck cancer: Case series and systematic review of observational studies

Abstract

Background

Indications for treatment and outcomes after endovascular management of carotid blowout syndrome for patients with head and neck cancer are not well defined. We investigated the safety and effectiveness of endovascular embolization and stent-graft reconstruction.

Methods

A literature review was performed for studies published between 2001 and 2015 with relevance to treatment outcomes. Our institutional database was examined to identify patients treated with endovascular techniques.

Results

A total of 266 patients were included. Rates of procedural stroke were higher after embolization of internal carotid artery (ICA)/common carotid artery (CCA) compared to stent graft (embolization 10.3%; stent graft 2.5%; P < .02). Stent graft of ICA/CCA was associated with higher rates of recurrent bleeding (embolization 9.1%; stent graft 31.9%; P < .01).

Conclusion

Both embolization and stent grafts are safe therapeutic options for acute carotid blowout syndrome. Embolization for ICA/CCA carotid blowout syndrome was associated with higher risks of procedural stroke and lower recurrent bleeding compared to stent grafts.

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Letter to the Editor regarding “Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience”

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Application of genome editing technologies in rats for human disease models

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Multiple Imputation for Incomplete Data in Epidemiologic Studies

Abstract

Epidemiologic studies are frequently susceptible to missing information. Omitting observations with missing variables remains a common strategy in epidemiologic studies, yet this simple approach can often severely bias parameter estimates of interest if the values are not missing completely at random. Even when missingness is completely random, complete case analysis can reduce efficiency of estimated parameters, because large amounts of available data are simply tossed out with the incomplete observations. Alternative methods to mitigate missing information, such as multiple imputation, are becoming an increasing popular strategy to retain all available information, reduce potential bias, and improve efficiency in parameter estimation. In this paper, we describe the theoretical underpinnings of multiple imputation, and we illustrate application of this method in a collaborative challenge to assess the performance of various techniques to dealing with missing data. We detail the steps necessary to perform multiple imputation on a subset of the Collaborative Perinatal Project, where the goal is to estimate the odds of spontaneous abortion associated with smoking during pregnancy.

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Inverse Probability Weighted Estimation for Monotone and Nonmonotone Missing Data

Abstract

Missing data is of common occurrence in epidemiologic research. In this paper, three data sets with induced missing values from the Collaborative Perinatal Project, a multisite United States study conducted from 1959 to 1974, are provided as examples of prototypical epidemiologic studies with missing data. Our goal is to estimate the effect of maternal smoking behavior on spontaneous abortion while adjusting for numerous confounders. At the same time, we do not necessarily wish to evaluate the joint distribution among potentially unobserved covariates, which is seldom the subject of substantive scientific interest. The inverse probability weighting approach preserves the semiparametric structure of the underlying model of substantive interest, and clearly separates the model of substantive interest from the model used to account for the missing data. However, inverse probability weighting often will not result in valid inference if the missing data pattern is nonmonotone, even if the data are missing at random. We describe a recently proposed approach to model nonmonotone missing data mechanisms under missing at random for use to construct the weights in inverse probability weighted complete-case estimation, and we illustrate the approach in the three data sets described in the companion manuscript (Am J Epidemiol. 2017;000(0):000-000) of this issue of the journal.

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Principled Approaches to Missing Data in Epidemiologic Studies

Abstract

Principled methods to appropriately analyze missing data have long existed; however, broad implementation of these methods remains challenging. In this and companion papers, we discuss issues of missing data in the epidemiologic literature. We provide details regarding missing data mechanisms and nomenclature and motivate principled analyses through a detailed comparison of multiple imputation and inverse probability weighting. We do so in the setting of a masked data-analytic challenge with missing data induced by known mechanisms to data from the Collaborative Perinatal Project, a multisite US study conducted from 1959 to 1974. We illustrate the deleterious effects of missing data with naïve methods and show how principled methods can sometimes mitigate such effects. For example when data were missing at random, naïve methods showed a spurious protective effect of smoking on spontaneous abortion, odds ratio (OR) of 0.43 (95% confidence interval, CI: 0.19, 0.93) while implementing principled methods multiple imputation (OR = 1.30, CI: 0.95, 1.77) or augmented inverse probability weighting (OR = 1.40, CI: 1.00, 1.97) provided estimates closer to the "true" full data effect (OR = 1.31, CI: 1.05, 1.64). We call for greater acknowledgement of and attention to missing data and for the broad use of principled missing data methods in epidemiologic research.

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Exoplanet hunters rethink search for alien life

2017_23NovNEWS_PlanetaryHabitability_800

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Dr. Donald E. Carpenter

He promised to love her forever, and he did. Beloved husband, father, and grandfather, Donald Elmore Carpenter passed from this world into the arms of Our Lord and his Magdalena in Heaven on October 30, 2017.

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Maximize the impacts of space science

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Prescription duration and treatment episodes in oral glucocorticoid users: application of the parametric waiting time distribution

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US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity

US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity

US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity, Published online: 20 November 2017; doi:10.1038/ijo.2017.287

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Adipocytes sustain pancreatic cancer progression through a non-canonical WNT paracrine network inducing ROR2 nuclear shuttling

Adipocytes sustain pancreatic cancer progression through a non-canonical WNT paracrine network inducing ROR2 nuclear shuttling

Adipocytes sustain pancreatic cancer progression through a non-canonical WNT paracrine network inducing ROR2 nuclear shuttling, Published online: 20 November 2017; doi:10.1038/ijo.2017.285

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Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk

Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk

Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk, Published online: 20 November 2017; doi:10.1038/ijo.2017.289

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High fat diet consumption differentially affects adipose tissue inflammation and adipocyte size in obesity-prone and obesity-resistant rats

High fat diet consumption differentially affects adipose tissue inflammation and adipocyte size in obesity-prone and obesity-resistant rats

High fat diet consumption differentially affects adipose tissue inflammation and adipocyte size in obesity-prone and obesity-resistant rats, Published online: 20 November 2017; doi:10.1038/ijo.2017.280

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Association of plasma phospholipid polyunsaturated and trans fatty acids with body mass index: Results from the multi-ethnic study of atherosclerosis

Association of plasma phospholipid polyunsaturated and trans fatty acids with body mass index: Results from the multi-ethnic study of atherosclerosis

Association of plasma phospholipid polyunsaturated and <i>trans</i> fatty acids with body mass index: Results from the multi-ethnic study of atherosclerosis, Published online: 20 November 2017; doi:10.1038/ijo.2017.282

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Diet-resistant obesity is characterized by a distinct plasma proteomic signature and impaired muscle fiber metabolism

Diet-resistant obesity is characterized by a distinct plasma proteomic signature and impaired muscle fiber metabolism

Diet-resistant obesity is characterized by a distinct plasma proteomic signature and impaired muscle fiber metabolism, Published online: 20 November 2017; doi:10.1038/ijo.2017.286

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Gene expression profiles indicate tissue-specific obesity regulation changes and strong obesity relevant tissues

Gene expression profiles indicate tissue-specific obesity regulation changes and strong obesity relevant tissues

Gene expression profiles indicate tissue-specific obesity regulation changes and strong obesity relevant tissues, Published online: 20 November 2017; doi:10.1038/ijo.2017.283

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Owandy Radiology’s I-Max 2D Wall-Mounted, Panoramic Digital Radiography Unit Receives FDA 510 (k) Clearance

The Lightest, Smallest and Most Comprehensive Panoramic System on the Market Will be Featured During GNYDM

Owandy Radiology Inc., a global leader in the manufacture of dental radiology hardware and imaging software recently received FDA 510 (k) Clearance for its game-changing I-Max 2-D wall-mounted panoramic digital radiography unit. The company will be showcasing the I-Max 2D during the upcoming Greater New York Dental Meeting in booth #4419.

According to Owandy Radiology spokesperson Boris Loyez, "We did a complete re-thinking of what a panoramic unit of the future should be, and came up with the

I-Max wall-mounted concept, which is setting the pace in tomorrow's pan units."

The I-Max 2D provides the perfect balance of value and functionality. For example:

The lightest wall-mounted digital panoramic unit on the market comes fully-assembled and can be easily installed in tight, previously underutilized spaces.

Automatic Layers Integration System (ALI-S) ensures exceptional image quality and automatically selects the best images.

24 programs (including adult and child versions) enable a full range of examinations required by today's dental practice.

Includes an intuitive, user-friendly program interface.

According to Owandy company spokesperson Boris Loyez, "We're excited about receiving FDA clearance and look forward to demonstrating the affordable, high-performance I-Max 2D during the Greater New York Dental Meeting."

Since GNYDM is the final major dental meeting of the year, this may be the last chance for dental practice owners to take advantage of the Section 179 tax deduction when they purchase any Owandy Radiology unit. Owandy is also offering the following promotions:

Free Apple Watch Series 3 with the purchase of any Owandy I-Max or I-Max Touch 2D.
Free iPhone X with the purchase of any Owandy 3D unit

For more information about the I-Max 2-D wall-mounted panoramic digital radiography unit, visit www.Owandy.com , call 203-745-0575 or e-mail at Sales@OwandyUs.com. Dealer and distributor inquiries welcome.

About Owandy Radiology, Inc.:

Headquartered in Croissy-Beaubourg France, and serving North America from Middlebury, Connecticut, Owandy Radiology is a global leader in the manufacture of dental radiology hardware and imaging software. A wide range of Owandy's digital radiology solutions are used by dentists in 50 countries, on every continent.

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Enjoy a canine cuddle during your teeth treatment

There's nothing particularly pleasant about a teeth cleaning, but one dental hygienist just outside St. John's is trying to make the experience a little more enjoyable - with the help of a four-legged friend. Unlike a dentist, Nicole Kielly doesn't drill or fill; she scrapes and pokes.

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Changes to Yucatán Peninsula precipitation associated with salinity and temperature extremes of the Caribbean Sea during the Maya civilization collapse

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Characterization and Separation Performance of a Novel Polyethersulfone Membrane Blended with Acacia Gum

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Convergent evolution of plant and animal embryo defences by hyperstable non-digestible storage proteins

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Analysis of the gut microbiome and plasma short-chain fatty acid profiles in a spontaneous mouse model of metabolic syndrome

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Competing tradeoffs between increasing marine mammal predation and fisheries harvest of Chinook salmon

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High fat diet consumption differentially affects adipose tissue inflammation and adipocyte size in obesity-prone and obesity-resistant rats

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Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk

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Diet-resistant obesity is characterized by a distinct plasma proteomic signature and impaired muscle fiber metabolism

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Association of plasma phospholipid polyunsaturated and trans fatty acids with body mass index: Results from the multi-ethnic study of atherosclerosis

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Adipocytes sustain pancreatic cancer progression through a non-canonical WNT paracrine network inducing ROR2 nuclear shuttling

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Gene expression profiles indicate tissue-specific obesity regulation changes and strong obesity relevant tissues

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US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity

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Αρχειοθήκη ιστολογίου

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Δευτέρα 20 Νοεμβρίου 2017

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