Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174: 10/21/17

Σάββατο 21 Οκτωβρίου 2017

Scotland is Now Getting Electricity from the World's First Floating Wind Farm

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Located just over 15 miles off Scotland's coast, the 30 Megawatt (MW) wind farm is expected to power around 20,000 households.

-- Read more on ScientificAmerican.com

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Using 'Active Signposting to streamline general practitioner workload in two London-based practices

General practice is at the forefront of the National Health Service, but is currently being overwhelmed by ever-increasing patient demand and financial constraints. Telephone consultations (TCs) have been used as a method to ease pressure on general practice. Many of these consultations are booked with general practioners (GPs), despite occasions when the patient could have either been signposted to self-help or offered an alternative service. This quality improvement project (QIP) aimed to evaluate the nature of TCs undertaken by GPs at our two practices; and whether the patients' needs could have adequately been met without the involvement of a GP. Consultations where this was the case were deemed 'possibly avoidable', and those where involvement with a GP was the best option have been termed 'essential'. A retrospective analysis was undertaken to establish a baseline figure for the proportion of possibly avoidable TCs in two practices. A new intervention was then introduced, with reception staff following a set of protocols when booking in patients. Patients who did not require a GP to deal with their query were actively signposted by reception staff to other allied healthcare professionals, non-medical staff or an alternative service at the time of booking their appointment. Two practices were involved in the study. After 2 Plan, Do, Study, Act (PDSA) cycles, the proportion of essential consultations taking place at both practices increased from 28.6% and 27.3% at baseline, to 82.6% and 71.4%, respectively. A lower number of possibly avoidable TCs equates to more time for essential TCs and greater value for money for the practice. Patient access to care is also improved, with patients directed to alternative and often quicker services which still meet their needs adequately. With the current system of primary care unable to cope with the demands it faces, interventions such as active signposting provide value for both GP practices and patients alike.

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Reducing radiation hazard opportunities in neonatal unit: quality improvement in radiation safety practices

Aim

Guided by the ALARA - "As Low As Reasonably Achievable" principle in radiation safety, a quality improvement project to optimise the bedside diagnostic imaging process to the best standards of care was conducted over a six month period. The goal was too reduce the radiation hazard opportunities in the neonatal intensive care unit by at least 75% from the existing level at Q2/2015, within 6 months.

Methods

The existing bedside imaging process was critically analysed and the following quality improvement initiatives were implemented namely , mandatory lead protective gear to healthcare staff, gonadal shield for neonates, guidelines for optimal collimation of X-ray beam and optimal positioning of neonates. Radiation dosimetry results, regular staff awareness sessions and strong collaboration between neonatologists, radiologists, radiographers and neonatal nurses helped to ensure compliance to the revised imaging process. Radiation hazard opportunities were measured by analysing all radiographs done during the period under baby exposure and healthcare staff exposure categories.

Summary of results

Radiation hazard opportunities were reduced by 100% to healthcare staff and 75% to neonates, and the overall reduction was 83%. The rate of discordance between radiograph request forms and images taken was measured as a surrogate marker for compliance to the project initiatives and it declined by 77%. Mandatory orientation of staff to the revised policy on the standardised diagnostic imaging process, regular radiation awareness talks and staff feedback sessions are among several measures taken to sustain the project.

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Electronic medical record alert improves HCV testing for baby boomers in primary care setting: adults born during 1945-1965

Method

This project aims to implement the HCV birth cohort screening guidelines over a 9-month period in the primary care setting at the University of Kansas Health System General Internal Medicine Division.The project team measured the number of patients in the baby boomer population who received a one-time screen for HCV. An electronic medical record (EMR) intervention was implemented to identify baby boomers who did not have an HCV screening or diagnosis. Additionally, education was provided to all primary care providers in the clinic to increase awareness of the HCV birth cohort screening.

Results

The quality improvement methods increased the percentage of baby boomers who obtained a one-time screening test for HCV from a baseline of 30% to a 55% screening rate during the nine-month project period.

Conclusion

Identifying the HCV screening needs and creating a visual reminder in the EMR can be used to facilitate sustainable awareness and improvement of screening rates. The project team recognizes that continued work is required to close the HCV screening care gaps in the primary care setting.

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A quality improvement project to improve the Medicare and Medicaid Services (CMS) sepsis bundle compliance rate in a large healthcare system

Sepsis is a leading cause of mortality and morbidity in hospitalised patients. The Centers for Medicare and Medicaid Services (CMS) mandated that US hospitals report sepsis bundle compliance rate as a quality process measure in October 2015. The specific aim of our study was to improve the CMS sepsis bundle compliance rate from 30% to 40% across 20 acute care hospitals in our healthcare system within 1 year.

The study included all adult inpatients with sepsis sampled according to CMS specifications from October 2015 to September 2016. The CMS sepsis bundle compliance rate was tracked monthly using statistical process control charting. A baseline rate of 28.5% with 99% control limits was established. We implemented multiple interventions including computerised decision support systems (CDSSs) to increase compliance with the most commonly missing bundle elements.

Compliance reached 42% (99% statistical process control limits 18.4%–38.6%) as CDSS was implemented system-wide, but this improvement was not sustained after CMS changed specifications of the outcome measure. Difficulties encountered elucidate shortcomings of our study methodology and of the CMS sepsis bundle compliance rate as a quality process measure.

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Improving referral to psychological support unit at Saudi Red Crescent Authority in Riyadh Region

The Psychological Support Unit (PSU) performance in Saudi Red Crescent Authority (SRCA) showed that only a small number of case referred seeking psychological advice and management from PSU among all SRCA employees. However, research shows that between 28% and 52% of emergency medical services (EMS) providers usually seek psychological help in various EMS cultures, where 86% of them usually suffer from critical stress. Thus, we decided to design a quality improvement project that aims to improve the referral process by increasing cases referred to the PSU at SRCA in Riyadh Region by 75% in 2 months. A multidisciplinary team has been formed to analyse the problem using quality tools including, brainstorming, fishbone diagram and flow chart of the PSU processes. Several possible reasons have been identified, such as lack of awareness among the SRCA's employees about PSU and its services, and the concern about privacy and confidentiality during psychological consultations in the PSU, in addition to the long referring process to PSU. The team decided to test the following change ideas: increasing the awareness of employees about the PSU services, improving the privacy and confidentiality during the consultation using electronic channels, and finally re-engineering the referral process to make it lean and remove all the unnecessary steps. Several improvement interventions have been tested sequentially in three consecutive Plan-Do-Study-Act cycles on a weekly basis. The project findings demonstrated that the first change idea was successful but not reaching the target while the second change had led to huge impact exceeding our target but with short effect. On the other hand, although the third change idea of re-engineering the PSU referral process had led to negative result initially, over the following weeks of measurement the results turned to be positive and meeting our expectations. We concluded that re-engineering referral process is most effective improvement intervention among other change ideas in term of magnitude and sustainability of the effect on increasing the number of referral cases to the PSU. We recommend conducting further testing and measuring of these change ideas in other PSU across the SRCA to understand the diffident context in other regions of SRCA.

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Improving care collaboration for NICU patients to decrease length of stay and readmission rate

Background

Medically complex patients in neonatal intensive care units (NICUs) typically require long hospitalisations and care from multiple subspecialists. Scheduled multidisciplinary discussions could improve collaboration and continuity of care and thereby improve patient outcomes. The specific aims of the project were to decrease the average length of hospitalisation by at least 1 day and improve parent satisfaction ratings on a standard questionnaire by the end of our project's first year, and to maintain a stable (or decreased) cause-related (30-day) readmission rate.

Methods

We designed a quality improvement project to enhance collaboration and continuity of care for medically complex infants cared for in the NICU of Brenner Children's Hospital. Weekly multidisciplinary team meetings were held to discuss the long-term plan for patients who met specific criteria. Attendees included attending neonatologists, paediatric surgeons, a physical therapist, an occupational therapist, a speech therapist, a social worker, a nurse coordinator for palliative care, a family support coordinator, the NICU Nurse Manager, a hospital chaplain, mid-level providers, bedside nurses, a nurse quality improvement leader and the leaders and database manager for the quality improvement project. When needed for specific patients, a bioethicist was included.

Results

One year after implementing the project, the average duration of hospitalisation had decreased by 6.5 days. Cause-related readmission rates decreased from 3.33% to 0.95%. Parent satisfaction scores did not change significantly.

Conclusions

Weekly multidisciplinary meetings to coordinate and provide continuity of care for medically complex neonates in our NICU was associated with improved patient outcomes.

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Improving best possible medication history with vulnerable patients at an urban safety net academic hospital using pharmacy technicians

Background

Best possible medication history (BPMH) enhances the care of safety net patients, especially those with limited English proficiency and limited health literacy who are most vulnerable to medication error during the hospital admission process. Our large urban academic safety net centre faced numerous barriers to achieve BPMH among hospitalised patients including communication barriers that increase the time and complexity of eliciting BPMH, frequent provider turnover at our training institution and lack of an electronic health record (EHR) medication reconciliation tool to facilitate BPMH collection and monitoring.

Design

Leveraging opportunities afforded by the US federal incentive EHR programme, our multidisciplinary team designed an EHR-facilitated medication reconciliation programme by which pharmacy technicians engaged newly admitted patients and their caregivers at the bedside to develop and electronically document the BPMH.

Strategy

Prior to this intervention, pharmacy technicians had no role in BPMH. Providers collected home medications documented on paper notes without a consistent methodology. With each plan–do–study–act (PDSA) cycle since the programme began, the goal was to increase the per cent of BPMH completed by a pharmacy technician. Individual PDSA cycles targeted either the pharmacy technicians by expanding their pool of eligible patients or provider engagement with the pharmacy technician workflow.

Results

By optimising not only the health information technology platform but also the operational processes, the programme achieved a nearly 80% generation of BPMH completed by a highly trained pharmacy technician, surpassing its intended goal of 50% BPMH completion by a pharmacy technician on admission.

Conclusion

An EHR-facilitated tool improved BPMH at an urban academic safety net hospital using pharmacy technicians.

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How to reverse cavities and restore brain and heart health with vitamin K2

As a follow up to our recent analysis of several vitamin K2 supplements on the market, today let's explore the critical importance that vitamin K2 plays in not only our oral health, but so many systems throughout the body.

In this interview with Kiran Krishnan, a researcher and product developer who, for the past 15 years, has helped increase the global knowledge base on vitamin K2, we take a close look at the studies that suggest that vitamin K2 helps:

increase bone density helping us stop tooth decay
keep calcium out of soft tissues like our arteries
restore mitrochondrial function and literally reverse symptoms in Parkinson's disease and other neurological issues
improve cardiac output which directly supports heart health and increases athletic performance

Show notes

2:51 Why supplementing vitamin K2 is critically important, particularly for those of us consuming a Western diet

5:21 How statin drugs interfere with vitamin k2 recycling in arteries

7:00 Actual mechanism how K2 helps build bone

11:38 The role of k2 specifically in creating greater oral health

14:10 How K2 plays a significant role in stopping gum disease (not just tooth decay)

15:00 How if you have leaky gut, you may be compromising your ability to absorb K2 (and other fat soluble vitamins)

19:30 Incidence of subclinical K2 deficiency (greater than 90%)

31:30 What the research says regarding how much K2 is best?

32:50 What other minerals and vitamins help support K2 in doing its jobs

39:52 Who should be careful supplementing k2

43:30 How to test for K2 levels in your body (LabCorp tests for this!)

47:20 How often Kiran goes to the dentist

48:50 Why K2 is an anti-aging vitamin

49:30 The importance of K2 for heart health

54:40 Whether to take k2 with or without a meal

Warning: Poor video quality

Unfortunately, the day we recorded this expert interview, we had poor internet connectivity which resulted in a less than ideal video and audio quality at times in the interview.

If you'd like us to look into carrying the K2 supplement Kiran has created, please let us know in the comments below and we can see if we can get you a good price on Megaquinone.

Want to really take your ability to stop and reverse tooth decay to a new level? Here's your chance. Just download our FREE ebook "How to Stop Tooth Decay and Remineralize Your Teeth" today.

Helpful, Related Resources:

What's the best K2 supplement on the market and why? [article]
Is this the missing nutrient keeping you from living a cavity-free life? [interview]
An easy step toward a cavity-free life [article]

The post How to reverse cavities and restore brain and heart health with vitamin K2 appeared first on OraWellness.

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Identification of hereditary cancer in the general population: development and validation of a screening questionnaire for obtaining the family history of cancer

Abstract

One of the challenges for Latin American countries is to include in their healthcare systems technologies that can be applied to hereditary cancer detection and management. The aim of the study is to create and validate a questionnaire to identify individuals with possible risk for hereditary cancer predisposition syndromes (HCPS), using different strategies in a Cancer Prevention Service in Brazil. The primary screening questionnaire (PSQ) was developed to identify families at-risk for HCPS. The PSQ was validated using discrimination measures, and the reproducibility was estimated through kappa coefficient. Patients with at least one affirmative answer had the pedigree drawn using three alternative interview approaches: in-person, by telephone, or letter. Validation of these approaches was done. Kappa and intraclass correlation coefficients were used to analyze data's reproducibility considering the presence of clinical criteria for HCPS. The PSQ was applied to a convenience sample of 20,000 women of which 3121 (15.6%) answered at least one affirmative question and 1938 had their pedigrees drawn. The PSQ showed sensitivity and specificity scores of 94.4% and 75%, respectively, and a kappa of 0.64. The strategies for pedigree drawing had reproducibility coefficients of 0.976 and 0.850 for the telephone and letter approaches, respectively. Pedigree analysis allowed us to identify 465 individuals (24.0%) fulfilling at least one clinical criterion for HCPS. The PSQ fulfills its function, allowing the identification of HCPS at-risk families. The use of alternative screening methods may reduce the number of excluded at-risk individuals/families who live in locations where oncogenetic services are not established.

This manuscript describes the creation and validation of a questionnaire to identify individuals with possible risk for hereditary cancer predisposition syndromes (HCPS), using different strategies in a Cancer Prevention Service in Brazil. The questionnaire was applied to a convenience sample of 20,000 women of which 3121 (15.6%) reported the presence of cancer cases in the family and 1938 had their pedigrees drawn. The use of alternative screening methods may reduce the number of excluded at-risk individuals/families who live in locations where oncogenetic services are not established.

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Anthrax

Anthrax: A serious bacterial infection caused by Bacillus anthracis that occurs primarily in animals. Cattle, sheep, horses, mules, and some wild animals are highly susceptible. Humans and swine are generally quite resistant to anthrax. Humans become infected when the spores of B. anthracis enter the body by contact with animals infected with B. anthracis or from contact with contaminated animal products, insect bites, ingestion, or inhalation. Aerosolized ("weaponized") spores of B. anthracis can potentially be used (misused) for biological warfare and bioterrorism. Cutaneous anthrax is the most common form of the disease and is characterized by the development of a localized skin lesion with a central eschar surrounded by marked edema (swelling). Inhalation anthrax (woolsorters' disease) typically involves hemorrhagic mediastinitis (bleeding into the mid-chest), rapidly progressive systemic (bodywide) infection, and carries a very high mortality rate. Gastrointestinal anthrax is much rarer but is also associated with a high mortality rate.

Anthrax can, as mentioned, take different forms. One is the pulmonary (lung) form of the disease. It is contracted by inhaling a large dose of the anthrax spores, typically in an enclosed space protected from direct sunlight. (The spores are quickly killed by sunlight.) If pulmonary anthrax is untreated, it is usually fatal. An intestinal form of anthrax is caused by eating meat contaminated with anthrax.

But most human anthrax comes from skin contact with animal products contaminated by anthrax. Cutaneous (skin) anthrax was once well known among people who handled infected animals (farmers, woolsorters, tanners, brushmakers and carpetmakers in the days when the brushes and carpets were animal products).

The hallmark of skin anthrax is a carbuncle, a cluster of boils, that ulcerates. Typically, the carbuncle has a hard black center surrounded by bright red inflammation. This dramatic appearance accounts for its name, "anthrax", the Greek word for "coal", a burning coal.

The cutaneous form of anthrax is treated with antibiotics such as penicillin, tetracycline, erythromycin, and ciprofloxacin (Cipro).

The pulmonary form of anthrax is an emergency and calls for early continuous IV antibiotics (such as penicillin in combination with streptomycin).

There is an anthrax vaccine for persons at high risk (such as members of the armed forces). However, the only anthrax vaccine currently made in the USA is experiencing problems with production standardization.

Bioterrorism -- The General Accounting Office (GAO), the investigative arm of the US Congress, in a 1999 report considered anthrax as a "possible" biologic threat for terrorism, but noted that a virulent strain of the bacterium is difficult to acquire and that an attack would require sophistication to manufacture and disseminate the bacteria. The GAO considered the lethal effects of anthrax to be "very high."

In the autumn of 2001, anthrax was no longer a "possible" biologic threat for terrorism. With its distribution through the mail in the US, anthrax became a 21st-century agent of bioterrorism.

MedTerms (TM) is the Medical Dictionary of MedicineNet.com.
We Bring Doctors' Knowledge To You

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Texas dentist unexpectedly fixes woman's smile in heartbreaking video

A Texas dentist transformed the smile of Kyleigha Scott free of cost after one of her front teeth was damaged in a domestic violence dispute. A Texas dentist transformed the smile of Kyleigha Scott free of cost after one of her front teeth was damaged in a domestic violence dispute.

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The Impact of Sentinel Node-Mapping in Staging High-Risk Endometrial Cancer

Abstract

Background

This study aimed to determine the impact of sentinel lymph node (SLN)-mapping on the staging of high-risk endometrial cancer (endometrioid grade 3, serous, clear cell, carcinosarcoma, deep myometrial invasion, or angiolymphatic invasion).

Methods

The study analyzed a series of 236 patients treated at AC Camargo Cancer Center from June 2007 to February 2017. The compared 75 patients who underwent SLN-mapping (SLN group) with 161 patients who received pelvic ± para-aortic lymphadenectomy (N-SLN group). Patients with adnexal, peritoneal, or suspicious node metastases were excluded from the study.

Results

The groups did not differ in terms of age, histologic type, or presence of deep myometrial invasion. The overall detection rate for SLNs was 85.3%, and bilateral SLNs were observed in 60% of the patients. Of 20 positive SLNs, 8 (40%) were detected only after immunohistochemistry (IHC). The findings showed an overall sensitivity of 90%, a negative predictive value of 95.7%, and a false-negative predictive value of 4.3%. The SLN group had more pelvic node metastases detected than the N-SLN group (26.7 vs 14.3%; p = 0.02). However, the rate of para-aortic node metastases did not differ between the two groups (13.5 vs 5.6%; p = 0.12). Five patients (3.5%) in the N-SLN group had isolated para-aortic node metastases versus none in the patients with SLN mapped. Additionally, the SLN group received more adjuvant chemotherapy (48 vs 33.5%; p = 0.03).

Conclusions

The data suggest that SLN-mapping identifies more pelvic node metastases than lymph node dissection alone and increases the node detection rate by 12.5% after IHC. Furthermore, no isolated para-aortic node metastases are observed when SLN is detected.

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Vitamin Status and the Development of Postoperative Cognitive Decline in Elderly Surgical Oncologic Patients

Abstract

Background

This study aimed to evaluate the influence that serum levels of vitamin B12, folate, and homocysteine have on the development of short-term postoperative cognitive decline in the elderly surgical oncology patient.

Methods

This study was part of a prospective cohort study focused on postoperative cognitive outcomes for patients 65 years of age or older undergoing surgery for a solid malignancy. Postoperative cognitive decline was defined as the change in the combined results of the Ruff Figural Fluency Test and the Trail-Making Test Parts A and B. Patients with the highest change in scores 2 weeks postoperatively compared with baseline were considered to be patients with cognitive decline. Patients with the lowest change were considered to be patients without cognitive decline. To analyze the effect of vitamin levels on the changes in postoperative cognitive scores, uni- and multivariate logistic regression analysis were performed.

Results

The study enrolled 61 patients with and 59 patients without postoperative cognitive decline. Hyperhomocysteinemia was present in 14.2% of the patients. Patients with postoperative cognitive decline more often had hyperhomocysteinemia (27.9 vs 10.2%). Hyperhomocysteinemia was associated with a higher chance for the development of postoperative cognitive decline (odds ratio_adjusted, 11.9; 95% confidence interval, 2.4–59.4). Preoperative vitamin B12 or folate deficiency were not associated with the development of postoperative cognitive decline.

Conclusion

Preoperative hyperhomocysteinemia is associated with the development of postoperative cognitive decline. The presence of preoperative hyperhomocysteinemia could be an indicator for an increased risk of postoperative cognitive decline developing in the elderly.

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Performance Analysis of the American Joint Committee on Cancer 8th Edition Staging System for Retroperitoneal Sarcoma and Development of a New Staging Algorithm for Sarcoma-Specific Survival

Abstract

Background

The American Joint Committee on Cancer (AJCC) recently published the 8th edition of the AJCC Cancer Staging Manual. Major changes were made to the staging algorithm for retroperitoneal sarcoma; however, whether these changes improve staging system performance is questionable.

Methods

This retrospective cohort analysis of 3703 adult patients with retroperitoneal sarcoma in the Surveillance, Epidemiology, and End Results (SEER) database compares a novel staging system incorporating histologic subtype of sarcoma with current and prior AJCC soft tissue sarcoma staging systems using multiple statistical techniques. The effect of tumor size on sarcoma-specific survival was also assessed by flexible, non-linear Cox proportional hazard regression using restricted cubic splines and fractional polynomials.

Results

The relationship between the covariate-adjusted log hazard for disease-specific survival and tumor size is non-linear. Although the new AJCC T classification approximates this hazard fairly well, the overall prognostic impact of tumor size is limited after accounting for other predictive factors. Predictive accuracy and concordance indices of the AJCC 8th edition staging system for retroperitoneal sarcoma are significantly lower than the prior 7th edition. A proposed staging system incorporating histologic grade, tumor size, and histologic subtype is superior to both the AJCC 7th and 8th editions in predicting sarcoma-specific survival.

Conclusion

AJCC committees should not revise tumor staging algorithms unless the changes actually improve the staging system. A proposed staging scheme incorporating data regarding histologic subtype of sarcoma performs significantly better than both the 7th and 8th AJCC staging systems.

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Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

Abstract

Background

Approximately 5% of gastrointestinal stromal tumors (GISTs) originate in the rectum, and historically, radical resection was commonly performed. Little is known about the outcome for rectal GIST in the era of imatinib.

Methods

Using a prospectively maintained database, this study retrospectively analyzed 47 localized primary rectal GISTs treated at our center from 1982 to 2016, stratified by when imatinib became available in 2000. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were analyzed by the Kaplan–Meier method.

Results

Rectal GISTs represented 7.1% of 663 primary GISTs. The findings showed 17 patients in the pre-imatinib era and 30 patients in the imatinib era. The two groups had similar follow-up evaluation, age, gender, Miettinen risk, and distance to the anal verge. In the imatinib era, tumors were smaller at diagnosis (median 4 vs. 5 cm; p = 0.029), and 24 of the 30 patients received perioperative imatinib. In the high-risk patients, organ preservation and negative margins were more common among the 13 patients treated with neoadjuvant imatinib than among the 21 patients treated directly with surgery. High-risk patients who received perioperative imatinib (n = 15) had greater (or nearly significantly greater) 5-year OS, DSS, local RFS, and distant RFS than those who did not (n = 19) (91, 100, 100, and 71% vs. 47, 65, 74, and 41%; p = 0.049, 0.052, 0.077, 0.051, respectively). In the imatinib era, no patient has had a local recurrence or death due to GIST.

Conclusions

The use of imatinib is associated with organ preservation and improved oncologic outcome for patients with rectal GIST.

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Similar Significance of Lymphovascular Invasion with Different Treatment Modalities Among Esophageal Squamous Cell Carcinoma

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Gut Microbiota Contribute to Age-Related Changes in Skeletal Muscle Size, Composition, and Function: Biological Basis for a Gut-Muscle Axis

Abstract

Skeletal muscle is a highly plastic tissue that plays a central role in human health and disease. Aging is associated with a decrease in muscle mass and function (sarcopenia) that is associated with a loss of independence and reduced quality of life. Gut microbiota, the bacteria, archaea, viruses, and eukaryotic microbes residing in the gastrointestinal tract are emerging as a potential contributor to age-associated muscle decline. Specifically, advancing age is characterized by a dysbiosis of gut microbiota that is associated with increased intestinal permeability, facilitating the passage of endotoxin and other microbial products (e.g., indoxyl sulfate) into the circulation. Upon entering the circulation, LPS and other microbial factors promote inflammatory signaling and skeletal muscle changes that are hallmarks of the aging muscle phenotype. This review will summarize existing literature suggesting cross-talk between gut microbiota and skeletal muscle health, with emphasis on the significance of this axis for mediating changes in aging skeletal muscle size, composition, and function.

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Effects of Lanthanum Carbonate on Coronary Artery Calcification and Cardiac Abnormalities After Initiating Hemodialysis

Abstract

It is known that calcium-containing phosphate binders are more closely associated with the progression of vascular calcification than non-calcium-containing phosphate binders. In this study, we investigated the effect of the non-calcium-containing phosphate binder, lanthanum carbonate on the progression of coronary artery calcification and cardiovascular abnormalities compared to that of calcium-containing phosphate binder in chronic kidney disease patients during the early period after initiating hemodialysis. This was a randomized open-label study in which patients were divided into the calcium carbonate or lanthanum carbonate group. We evaluated blood samples, coronary artery calcification using high-resolution computed tomography, and cardiac abnormalities using echocardiography prior to and after initiating hemodialysis. Cardiac dimension and systolic function were significantly improved in the lanthanum carbonate group compared to those in the calcium carbonate group. Although statistically significant differences were not observed in all the patients, only among patients with moderate coronary artery calcification, the changes in coronary artery calcification score at 18 months were significantly smaller in the lanthanum carbonate group than those in the calcium carbonate group. The percent change in coronary artery calcification at 18 months was significantly correlated with the serum fibroblast growth factor 23 levels at 18 months (r = 0.245, P < 0.05). This significant correlation was particularly strong in patients with moderate coronary artery calcification (r = 0.593, P < 0.001). Our study suggests that lanthanum carbonate ameliorates cardiac abnormalities, and may slow coronary artery calcification development in patients with moderate coronary artery calcification, during the early period following hemodialysis initiation.

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The Impact of Sentinel Node-Mapping in Staging High-Risk Endometrial Cancer

Abstract

Background

Methods

Results

Conclusions

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Vitamin Status and the Development of Postoperative Cognitive Decline in Elderly Surgical Oncologic Patients

Abstract

Background

Methods

Results

Conclusion

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Performance Analysis of the American Joint Committee on Cancer 8th Edition Staging System for Retroperitoneal Sarcoma and Development of a New Staging Algorithm for Sarcoma-Specific Survival

Abstract

Background

Methods

Results

Conclusion

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Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

Abstract

Background

Methods

Results

Conclusions

The use of imatinib is associated with organ preservation and improved oncologic outcome for patients with rectal GIST.

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Similar Significance of Lymphovascular Invasion with Different Treatment Modalities Among Esophageal Squamous Cell Carcinoma

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Influence of attention and bolus volume on brain organization during swallowing

Abstract

It has been shown that swallowing involves certain attentional and cognitive resources which, when disrupted can influence swallowing function with in dysphagic patient. However, there are still open questions regarding the influence of attention and cognitive demands on brain activity during swallowing. In order to understand how brain regions responsible for attention influence brain activity during swallowing, we compared brain organization during no-distraction swallowing and swallowing with distraction. Fifteen healthy male adults participated in the data collection process. Participants performed ten 1 ml, ten 5 ml, and ten 10 ml water swallows under both no-distraction conditions and during distraction while EEG signals were recorded. After standard pre-processing of the EEG signals, brain networks were formed using the time–frequency based synchrony measure. The brain networks formed were then compared between the two sets of conditions. Results showed that there are differences in the Delta, Theta, Alpha, Beta, and Gamma frequency bands between no-distraction swallowing and swallowing with distraction. Differences in the Delta and Theta frequency bands can be attributed to changes in subliminal processes, while changes in the Alpha and Beta frequency bands are directly associated with the various levels of attention and cognitive demands during swallowing process, and changes in the Gamma frequency band are due to changes in motor activity. Furthermore, we showed that variations in bolus volume influenced the swallowing brain networks in the Delta, Theta, Alpha, Beta, and Gamma frequency bands. Changes in the Delta, Theta, and Alpha frequency bands are due to sensory perturbations evoked by the various bolus volumes. Changes in the Beta frequency band are due to reallocation of cognitive demands, while changes in the Gamma frequency band are due to changes in motor activity produced by variations in bolus volume. These findings could potentially lead to the development of better understanding of the nature of dysphagia and various rehabilitation strategies for patients with neurogenic dysphagia who have altered attention or impaired cognitive functions.

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Limitations of pediatric supraglottic airway devices as conduits for intubation - an in vitro study

Abstract

Purpose

Supraglottic airway devices (SGAs) can be used as conduits for intubation, but data and manufacturers' recommendations for pediatric SGA are incomplete and sometimes misleading. This situation can result in the use of incompatible combinations of SGAs and endotracheal tubes (ETTs). To address this mismatch possibility, we performed an in vitro study to establish an overview of possible combinations of SGAs and ETTs.

Methods

We tested the passage of ETTs through SGAs in vitro and subsequent SGA removal with eight pediatric SGAs and six ETTs of different sizes in vitro. Results were compared with manufacturers' recommendations. Outcome parameters were the feasibility of passing the ETT through the SGA and then removing the SGA over the ETT.

Results

The Air-Q® and the Air-Q®sp™ SGAs showed the best compatibility with ETTs across all sizes. Whenever intubation was possible, removal was possible for all SGAs with uncuffed ETTs. With many cuffed ETTs, however, SGA removal was impossible because the ETT cuff's pilot balloon was larger than the inner diameter of the SGA. Thus, although intubation was possible, removal of the SGA was not. The manufacturers' booklets do not warn of this limitation.

Conclusions

The use of combinations of SGA and ETTs with a size mismatch can lead to airway complications during intubation or to accidental extubation and tearing of the cuff pilot balloon line when removing the SGA. To avoid these problems, we devised a table that simplifies the choice of an appropriate SGA and ETT combination.

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Recognizing the 75th anniversary of the Canadian Anesthesiologists’ Society: a special series of “Images” from our past

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Transmucosal Delivery of Nicotine in Combination with Tincture of Benzoin Inhibits Apoptosis

Abstract

Background and Objective

The aim of this study was to test the hypothesis that tincture of benzoin (TOB) facilitates immediate transmucosal nicotine absorption while simultaneously promoting a safe and sustained delivery of the nicotine.

Methods

In combination with TOB, nicotine toxicity and diffusion across human mucosal cells were measured using a 3-D human mucosal tissue model.

Results

Nicotine was delivered 2.1 times more quickly in combination with TOB than in combination with saline (p < 0.05). Despite the increased diffusion, nicotine in combination with TOB significantly increased mucosal cell survival (p < 0.05) by reducing the release of mitochondrial cytochrome c into the cytoplasm when compared with nicotine without TOB. The average percentage distribution of cytochrome c in the cytosolic fraction over time of nicotine + 79% ethyl alcohol (ETOH) versus nicotine plus TOB (79% ETOH) was significantly different over 120 min (60.0 ± 29.9% cytosol, 16.1 ± 9.4% cytosol, p = 0.03). Related to the reduction of cytochrome c release into the cytoplasm, TOB suppressed caspase-3 and -9 activity, thereby preventing intrinsic apoptosis and providing cytoprotection of the mucosal cells (ETOH + nicotine vs ETOH + nicotine + TOB: p = 0.008 for caspase 3, p < 0.001 for caspase 9).

Conclusion

Two hours of TOB (17–24% benzoin, 79% ETOH) plus nicotine promotes diffusion of nicotine across human mucosal cells and simultaneously prevents human mucosal cell toxicity by inhibiting cytochrome c release into the cytosol, thereby preventing caspase 3 and 9 activity and subsequent intrinsic apoptosis.

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Revitalization of plant growth promoting rhizobacteria for sustainable development in agriculture

Publication date: Available online 17 October 2017
Source:Microbiological Research
Author(s): Sushanto Gouda, Rout George Kerry, Gitishree Das, Spiros Paramithiotis, Han-Seung Shin, Jayanta Kumar Patra
The progression of life in all forms is not only dependent on agricultural and food security but also on the soil characteristics. The dynamic nature of soil is a direct manifestation of soil microbes, bio-mineralization, and synergistic co-evolution with plants. With the increase in world's population the demand for agriculture yield has increased tremendously and thereby leading to large scale production of chemical fertilizers. Since the use of fertilizers and pesticides in the agricultural fields have caused degradation of soil quality and fertility, thus the expansion of agricultural land with fertile soil is near impossible, hence researchers and scientists have sifted their attention for a safer and productive means of agricultural practices. Plant growth promoting rhizobacteria (PGPR) has been functioning as a co-evolution between plants and microbes showing antagonistic and synergistic interactions with microorganisms and the soil. Microbial revitalization using plant growth promoters had been achieved through direct and indirect approaches like bio-fertilization, invigorating root growth, rhizoremediation, disease resistance etc. Although, there are a wide variety of PGPR and its allies, their role and usages for sustainable agriculture remains controversial and restricted. There is also variability in the performance of PGPR that may be due to various environmental factors that might affect their growth and proliferation in the plants. These gaps and limitations can be addressed through use of modern approaches and techniques such as nano-encapsulation and micro-encapsulation along with exploring multidisciplinary research that combines applications in biotechnology, nanotechnology, agro biotechnology, chemical engineering and material science and bringing together different ecological and functional biological approaches to provide new formulations and opportunities with immense potential.

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SawR a new regulator controlling pyomelanin synthesis in Pseudomonas aeruginosa

Publication date: January 2018
Source:Microbiological Research, Volume 206
Author(s): Yossi Ben-David, Elena Zlotnik, Itzhak Zander, Gal Yerushalmi, Sivan Shoshani, Ehud Banin
Surface Acoustic Waves (SAW) were previously shown to inhibit biofilm formation, increase bacterial susceptibility to antibiotic treatment and alter the transcription pattern of Pseudomonas aeruginosa. Here we characterize one gene, sawR (PA3133), that is highly overexpressed when P. aeruginosa is exposed to SAW. SawR is a putative transcription factor belonging to the TetR regulator family. When overexpressed sawR causes numerous phenotypes, including the accumulation of a brown pigment which we identified as pyomelanin. In this study we describe how sawR regulates pyomelanin synthesis. We show that sawR down-regulates the expression levels of hmgA and this causes the accumulation of homogentisic acid which in turn undergoes oxidation and polymerization to pyomelanin. Using bioinformatics, we were able to identify a specific amino acid, arginine 23, which is found within the sawR DNA binding domain and is crucial for its regulatory activity. Our results indicate that sawR does not affect any other genes in the phenylalanine/tyrosine metabolic pathway and its repressive ability on hmgA is not mediated by the hmgA repressor PA2010 (i.e. hmgR). Taken together, our results shed light on the regulatory cascade controlling pyomelanin synthesis and uncover yet another unknown regulator involved in its regulation.

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Endophytism or saprophytism: Decoding the lifestyle transition of the generalist fungus Phomopsis liquidambari

Publication date: January 2018
Source:Microbiological Research, Volume 206
Author(s): Jun Zhou, Xin Li, Peng-Wei Huang, Chuan-Chao Dai
Filamentous ascomycete Phomopsis sp. are common inhabitants of natural ecosystems and, as saprophytes, are largely responsible for the destructive decay of litterfall, promoting the carbon and nitrogen cycles. Phomopsis liquidambari B3 can establish mutualistic symbiosis with a broad spectrum of crop plants. Colonizing dynamics observations and a growth promotion assay of rice and Arabidopsis thaliana revealed that the B3 colonization strategy is host-adapted and resulted in different growth promotions influenced by N availability. However, the biochemical mechanisms and underlying genetics of the saprophyte transition to an endophyte are poorly understood. Here, the transcriptome features of generalist P. liquidambari and highlighted gene sets involved in the lifestyle transition from saprophytism to endophytism were reported. Most notable were genes for translation, ribosome biogenesis and MAPK signaling, several of which were only up-regulated in endophytic B3. Coordinated up-regulation of genes encoding enzymes involved in phenylalanine, tyrosine and tryptophan biosynthesis were preceded by secondary metabolite induction, which was encountered with host defense. Quantitative PCR validates the reliability of RNA-seq. Dissection at the molecular level facilitated a deeper understanding of P. liquidambari adaptation to hosts and the complex natural environment to play a role in sustainable agriculture and carbon and nitrogen cycles.

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Composition of lactic acid bacteria during spontaneous curly kale (Brassica oleracea var. sabellica) fermentation

Publication date: Available online 16 October 2017
Source:Microbiological Research
Author(s): Magdalena Michalak, Klaudia Gustaw, Adam Waśko, Magdalena Polak-Berecka
The present work is the first report on spontaneous fermentation of curly kale and characteristics of autochthonous lactic acid bacteria (LAB). Our results indicate that curly kale fermentation is the new possibility of the technological use of this vegetable. Bacteria representing ten different species were isolated from three phases of curly kale fermentation and identified by MALDI-TOF mass spectrometry and 16S rRNA gene sequencing. Among them, four species were identified as Lactobacillus spp. (Lb. plantarum 332, Lb. paraplantarum G2114, Lb. brevis R413, Lb. curvatus 154), two as Weissella spp. (W. hellenica 152, W. cibaria G44), two as Pediococcus spp. (P. pentosaceus 45AN, P. acidilactici 2211), one as Leuconostoc mesenteroides 153, and one as Lactococcus lactis 37BN. The functional properties of isolates, i.e. acid, NaCl and bile salt tolerance, enzyme activities, adhesion to hydrocarbons, and antibiotic resistance, were examined. Among the tested strains, Lb. plantarum 332, Lb. paraplantarum G2114, P. pentosaceus 2211, and Lb. brevis R413 exhibited the best hydrophobicity value and high tolerance to bile salts, NaCl, and low pH.

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Phosphatidylcholine absence affects the secretion of lipodepsipeptide phytoxins in Pseudomonas syringae pv. syringae van Hall CFCC 1336

Publication date: January 2018
Source:Microbiological Research, Volume 206
Author(s): Fang Cao, Min Xiong, Shunyi Li, Huawan Cai, Yufang Sun, Sheng Yang, Xin Liu, Rong Zhu, Xuejing Yu, Xingguo Wang
Pseudomonas syringae pv. syringae van Hall CFCC 1336 (Pss 1336) is the causal agent of bacterial disease of stone fruit trees, and also able to elicit hypersensitive response (HR) in non-host tobacco. It is known that this pathogen uses PCS-pathway to synthesize phosphatidylcholine (PC), and mutation of the pcs gene abolishes bacterial PC synthesis. Previous study also found that the 1336 pcs⁻ mutant lacking PC in its membrane phospholipids was unable to secrete HrpZ harpin and elicit HR in non-host plants. In this study, we further analyzed virulence of lipodepsipeptide phytoxins of Pss 1336 wild type (pcs⁺), the 1336RM (pcs−/+) and the 1336 pcs− mutant, and found that the 1336 pcs− mutant was unable to cause necrosis of Chinese date fruits and inhibit fungal growth. HPLC analysis also showed that the 1336 pcs− mutant markedly reduced its secretion of lipodepsipeptide phytoxins. Analysis of semi-quantitative RT-PCR revealed that PC presence or absence did not affect gene expressions of SyrD, PseABC and PseEF efflux systems at transcriptional level. However, western blotting assays found that PseE and PseF present only in the cytoplasmic fractions but undetectable in the membrane extract of the 1336 pcs− mutant. PC absence obviously interrupted the translocation of two membrane-associated proteins PseE and PseF from cytoplasm to cell membranes to form an intact PseEF efflux system in bacterial membranes. Failure to form PseEF efflux system could be a major factor for less lipopeptide-phytoxin secretion. Our results demonstrate that PC in bacterial membrane phospholipids plays an important role in maintaining physiological functions of PseEF efflux system.

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The outer membrane protein OprF and the sigma factor SigX regulate antibiotic production in Pseudomonas fluorescens 2P24

Publication date: Available online 16 October 2017
Source:Microbiological Research
Author(s): Xu Li, Gao-Qi Gu, Wei Chen, Li-Juan Gao, Xue-Hong Wu, Li-Qun Zhang
Pseudomonas fluorescens 2P24 produces 2,4-diacetylphloroglucinol (2,4-DAPG) as the major antibiotic compound that protects plants from soil-borne diseases. Expression of the 2,4-DAPG biosynthesis enzymes, which are encoded by the phlACBD locus, is under the control of a delicate regulatory network. In this study, we identified a novel role for the outer membrane protein gene oprF, in negatively regulating the 2,4-DAPG production by using random mini-Tn5 mutagentsis. A sigma factor gene sigX was located immediately upstream of the oprF gene and shown to be a positive regulator for oprF transcription and 2,4-DAPG production. Genetic analysis of an oprF and sigX double-mutant indicated that the 2,4-DAPG regulation by oprF was dependent on SigX. The sigX gene did not affect PhlA and PhlD expression, but positively regulated the level of malonyl-CoA, the substrate of 2,4-DAPG synthesis, by influencing the expression of acetyl-CoA carboxylases. Further investigations revealed that sigX transcription was induced under conditions of salt starvation or glycine addition. All these findings indicate that SigX is a novel regulator of substrate supplements for 2,4-DAPG production.

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The Effects of One Amino Acid Substitutions at the C-Terminal Region of Thermostable L2 Lipase by Computational and Experimental Approach

Abstract

The substitutions of the amino acid at the predetermined critical point at the C-terminal of L2 lipase may increase its thermostability and enzymatic activity, or even otherwise speed up the unfolding of the protein structure. The C-terminal of most proteins is often flexible and disordered. However, some protein functions are directly related to flexibility and play significant role in enzyme reaction. The critical point for mutation of L2 lipase structure was predicted at the position 385 of the L2 sequence, and the best three mutants were determined based on I-Mutant2.0 software. The best three mutants were S385E, S385I and S385V. The effects of the substitution of the amino acids at the critical point were analysed with molecular dynamics simulation by using Yet Another Scientific Artificial Reality Application software. The predicted mutant L2 lipases were found to have lower root mean square deviation value as compared to L2 lipase. It was indicated that all the three mutants had higher compactness in the structure, consequently enhanced the stability. Root mean square fluctuation analysis showed that the flexibility of L2 lipase was reduced by mutations. Purified S385E lipase had an optimum temperature of 80 °C in Tris–HCl pH 8. The highest enzymatic activity of purified S385E lipase was obtained at 80 °C temperature in Tris–HCl pH 8, while for L2 lipase it was at 70 °C in Glycine–NaOH pH 9. The thermal stability of S385V lipase was enhanced as compared to other protein since that the melting point (T _m) value was at 85.96 °C. S385I lipase was more thermostable compared to recombinant L2 lipase and other mutants at temperature 60 °C within 16 h preincubation.

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Developing an Islamic Research Ethics Framework

Abstract

In surveying the medical literature on Islamic principles of research ethics, it is apparent that attempts to identify ethical principles are replete with issues of standards and gaps in knowledge of the uses of scriptural sources. Despite this, attempts at creating an Islamic ethical framework for research ethics may improve current practices in research in Muslim-majority countries and contribute to the growing canon of secular bioethics. This paper aims to identify principles and considerations within Islam that (1) overlap with current corpora on research ethics, and (2) further informs the current research ethics discourse.

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Procaspase-activating compound-1 induces apoptosis in Trypanosoma cruzi

Abstract

Some therapeutics for parasitic, cardiac and neurological diseases activate apoptosis. Therefore, the study of apoptotic proteins in pathogenic organisms is relevant. However, the molecular mechanism of apoptosis in unicellular organisms remain elusive, despite morphological evidence of its occurrence. In Trypanosoma cruzi, the causative agent of Chagas disease, metacaspase 3 (TcMCA3), seems to have a key role in parasite apoptosis. Accordingly, this work provides data concerning TcMCA3 regulation through its interaction with procaspase-activating compound 1 (PAC-1), a procaspase 3 activator. Indeed, PAC-1 reduced T. cruzi epimastigote viability with an IC₅₀ of 14.12 µM and induced loss of mitochondrial potential and exposure of phosphatidylserine, features of the apoptotic process. Notwithstanding, those PAC-1-inducible effects were not conserved in metacyclic trypomastigotes. Moreover, PAC-1 reduced the viability of mammalian cells with a greater IC₅₀ (25.70 µM) compared to T. cruzi epimastigotes, indicating distinct modes of binding between caspases and metacaspases. To shed light on the selectivity of metacaspases and caspases, we determined the structural features related to the PAC-1 binding sites in both types of proteins. These data are important for improving the understanding of the apoptosis pathway in T. cruzi so that TcMCA3 could be better targeted with future pharmaceuticals.

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The pattern of paediatric blast injury in Afghanistan

Introduction

Between 2009 and 2015, 3746 children died, and 7904 were injured as a result of armed conflict within Afghanistan. Improvised explosive devices (IEDs) and explosive remnants of war accounted for 29% of child casualties in 2015. The aim of this study was to review the burden of paediatric blast injuries admitted to Camp Bastion, Afghanistan, and to investigate the hypothesis that children suffer proportionally more head injuries than adults.

Method

A retrospective analysis was undertaken of prospectively collected data derived from the UK Joint Theatre Trauma Registry of ambulant paediatric (aged 2–15 years) admissions with blast injuries at the Role 3 Field Hospital, Camp Bastion from June 2006 to March 2013. The data set included demographic information, injury profile and severity (New Injury Severity Score) and operative findings. The pattern of injuries were investigated by looking at trends in the number and severity of injuries sustained by each body region.

Results

During this period, 295 admissions were identified, 76% of whom were male, with an overall mortality rate of 18.5%. The most common blast mechanism was an IED (68%) causing 80% of fatalities. The lower extremities were the most commonly injured body region, accounting for 31% of total injuries and occurring in 62% of cases. 24.3% of children between 2 and 7 years suffered severe head or neck injuries compared with 19.8% of children aged between 8 and 15 years. 34% of head injuries were rated unsurvivable and accounted for 88% of fatalities. 77% of cases required an operation with a mean operating time of 125 min. The most common first operations were debridement of soft tissues (50%), laparotomy (16%) and lower limb amputation (11%).

Conclusion

Although paediatric blast casualties represented a small percentage of the overall workload at Camp Bastion Role 3 Medical Facility, the pattern of injuries seen suggests that children are more likely to sustain severe head, face and neck injuries than adults.

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Major incident triage and the implementation of a new triage tool, the MPTT-24

Introduction

The Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool and in comparison with existing tools demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations. To improve its applicability, we proposed to increase the upper respiratory rate (RR) threshold to 24 breaths per minute (bpm) to produce the MPTT-24. Our aim was to conduct a feasibility analysis of the proposed MPTT-24, comparing its performance with the existing UK Military Sieve.

Method

A retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult (>18 years) patients presenting between 2006–2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they received one or more LSIs. Using first recorded hospital RR in isolation, sensitivity and specificity of the ≥24 bpm threshold was compared with the existing threshold (≥22 bpm) at predicting P1 status. Patients were then categorised as P1 or not-P1 by the MPTT, MPTT-24 and the UK Military Sieve.

Results

The MPTT and MPTT-24 outperformed existing UK methods of triage with a statistically significant (p<0.001) increase in sensitivity of between 25.5% and 29.5%. In both populations, the MPTT-24 demonstrated an absolute reduction in sensitivity with an increase in specificity when compared with the MPTT. A statistically significant difference was observed between the MPTT and MPTT-24 in the way they categorised TARN and JTTR cases as P1 (p<0.001).

Conclusions

When compared with the existing MPTT, the MPTT-24 allows for a more rapid triage assessment. Both continue to outperform existing methods of primary major incident triage and within the military setting, the slight increase in undertriage is offset by a reduction in overtriage. We recommend that the MPTT-24 be considered as a replacement to the existing UK Military Sieve.

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The Asymptotic Behaviours of a Class of Neutral Delay Fractional-Order Pantograph Differential Equations

By using fractional calculus and the summation by parts formula in this paper, the asymptotic behaviours of solutions of nonlinear neutral fractional delay pantograph equations with continuous arguments are investigated. The asymptotic estimates of solutions for the equation are obtained, which may imply asymptotic stability of solutions. In the end, a particular case is provided to illustrate the main result and the speed of the convergence of the obtained solutions.

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Health sciences libraries in the United States: new directions

Abstract

This article is the third in a series in this regular feature. The intention of the series is to look at important global developments in health science libraries. These articles will serve as a road map, describing the key changes in the field and exploring factors driving these changes. The present article by the current president of the Medical Library Association outlines two important developments in the United States. The topics chosen for consideration are national initiatives in the United States impacting health sciences libraries and librarians and enhanced roles for U.S. health sciences librarians in providing support for research.

J.M.

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The Prefiltering Techniques in Emotion Based Place Recommendation Derived by User Reviews

Context-aware recommendation systems attempt to address the challenge of identifying products or items that have the greatest chance of meeting user requirements by adapting to current contextual information. Many such systems have been developed in domains such as movies, books, and music, and emotion is a contextual parameter that has already been used in those fields. This paper focuses on the use of emotion as a contextual parameter in a tourist destination recommendation system. We developed a new corpus that incorporates the emotion parameter by employing semantic analysis techniques for destination recommendation. We review the effectiveness of incorporating emotion in a recommendation process using prefiltering techniques and show that the use of emotion as a contextual parameter for location recommendation in conjunction with collaborative filtering increases user satisfaction.

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Adaptive Compressive Sensing of Images Using Spatial Entropy

Compressive Sensing (CS) realizes a low-complex image encoding architecture, which is suitable for resource-constrained wireless sensor networks. However, due to the nonstationary statistics of images, images reconstructed by the CS-based codec have many blocking artifacts and blurs. To overcome these negative effects, we propose an Adaptive Block Compressive Sensing (ABCS) system based on spatial entropy. Spatial entropy measures the amount of information, which is used to allocate measuring resources to various regions. The scheme takes spatial entropy into consideration because rich information means more edges and textures. To reduce the computational complexity of decoding, a linear mode is used to reconstruct each block by the matrix-vector product. Experimental results show that our ABCS coding system provides a better reconstruction quality from both subjective and objective points of view, and it also has a low decoding complexity.

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Improving Rolling Bearing Fault Diagnosis by DS Evidence Theory Based Fusion Model

Rolling bearing plays an important role in rotating machinery and its working condition directly affects the equipment efficiency. While dozens of methods have been proposed for real-time bearing fault diagnosis and monitoring, the fault classification accuracy of existing algorithms is still not satisfactory. This work presents a novel algorithm fusion model based on principal component analysis and Dempster-Shafer evidence theory for rolling bearing fault diagnosis. It combines the advantages of the learning vector quantization (LVQ) neural network model and the decision tree model. Experiments under three different spinning bearing speeds and two different crack sizes show that our fusion model has better performance and higher accuracy than either of the base classification models for rolling bearing fault diagnosis, which is achieved via synergic prediction from both types of models.

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Consensus Kernel -Means Clustering for Incomplete Multiview Data

Multiview clustering aims to improve clustering performance through optimal integration of information from multiple views. Though demonstrating promising performance in various applications, existing multiview clustering algorithms cannot effectively handle the view's incompleteness. Recently, one pioneering work was proposed that handled this issue by integrating multiview clustering and imputation into a unified learning framework. While its framework is elegant, we observe that it overlooks the consistency between views, which leads to a reduction in the clustering performance. In order to address this issue, we propose a new unified learning method for incomplete multiview clustering, which simultaneously imputes the incomplete views and learns a consistent clustering result with explicit modeling of between-view consistency. More specifically, the similarity between each view's clustering result and the consistent clustering result is measured. The consistency between views is then modeled using the sum of these similarities. Incomplete views are imputed to achieve an optimal clustering result in each view, while maintaining between-view consistency. Extensive comparisons with state-of-the-art methods on both synthetic and real-world incomplete multiview datasets validate the superiority of the proposed method.

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Geofluid Systems of Koryaksky-Avachinsky Volcanoes (Kamchatka, Russia)

The Koryaksky-Avachinsky volcanogenic basin, which has an area of 2530 km2, is located 25 km from Petropavlovsk-Kamchatsky City and includes five Quaternary volcanoes (two of which, Avachinsky (2750 masl) and Koryaksky (3456 masl), are active), and is located within a depression that has formed atop Cretaceous basement rocks. Magma injection zones (dikes and chamber-like shapes) are defined by plane-oriented clusters of local earthquakes that occur during volcanic activity (mostly in 2008–2011) below Koryaksky and Avachinsky volcanoes at depths ranging from −4.0 to −2.0 km and +1.0 to +2.0 km, respectively. Water isotopic (δD, δ18O) data indicate that these volcanoes act as recharge areas for their adjacent thermal mineral springs (Koryaksky Narzans, Isotovsky, and Pinachevsky) and the wells of the Bystrinsky and Elizovo aquifers. Carbon δ13С data in СО2 from CO2 springs in the northern foothills of Koryaksky Volcano reflect the magmatic origin of CO2. Carbon δ13С data in methane CH4 reservoirs penetrated by wells in the Neogene-Quaternary layer around Koryaksky and Avachinsky volcanoes indicate the thermobiogenic origin of methane. Thermal-hydrodynamic TOUGH2 conceptual modeling is used to determine what types of hydrogeologic boundaries and heat and mass sources are required to create the temperature, pressure, phase, and CO2 distributions observed within the given geological conditions of the Koryaksky-Avachinsky volcanic geofluid system.

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Applying Two-Stage Neural Network Based Classifiers to the Identification of Mixture Control Chart Patterns for an SPC-EPC Process

The effective controlling and monitoring of an industrial process through the integration of statistical process control (SPC) and engineering process control (EPC) has been widely addressed in recent years. However, because the mixture types of disturbances are often embedded in underlying processes, mixture control chart patterns (MCCPs) are very difficult for an SPC-EPC process to identify. This can result in problems when attempting to determine the underlying root causes of process faults. Additionally, a large number of categories of disturbances may be present in a process, but typical single-stage classifiers have difficulty in identifying large numbers of categories of disturbances in an SPC-EPC process. Therefore, we propose a two-stage neural network (NN) based scheme to enhance the accurate identification rate (AIR) for MCCPs by performing dimension reduction on disturbance categories. The two-stage scheme includes a combination of a NN, support vector machine (SVM), and multivariate adaptive regression splines (MARS). Experimental results reveal that the proposed scheme achieves a satisfactory AIR for identifying MCCPs in an SPC-EPC system.

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trans-Cinnamaldehyde Inhibits Microglial Activation and Improves Neuronal Survival against Neuroinflammation in BV2 Microglial Cells with Lipopolysaccharide Stimulation

Background. Microglial activation contributes to neuroinflammation and neuronal damage in neurodegenerative disorders including Alzheimer's and Parkinson's diseases. It has been suggested that neurodegenerative disorders may be improved if neuroinflammation can be controlled. trans-cinnamaldehyde (TCA) isolated from the stem bark of Cinnamomum cassia possesses potent anti-inflammatory capability; we thus tested whether TCA presents neuroprotective effects on improving neuronal survival by inhibiting neuroinflammatory responses in BV2 microglial cells. Results. To determine the molecular mechanism behind TCA-mediated neuroprotective effects, we assessed the effects of TCA on lipopolysaccharide- (LPS-) induced proinflammatory responses in BV2 microglial cells. While LPS potently induced the production and expression upregulation of proinflammatory mediators, including NO, iNOS, COX-2, IL-1β, and TNF-α, TCA pretreatment significantly inhibited LPS-induced production of NO and expression of iNOS, COX-2, and IL-1β and recovered the morphological changes in BV2 cells. TCA markedly attenuated microglial activation and neuroinflammation by blocking nuclear factor kappa B (NF-κB) signaling pathway. With the aid of microglia and neuron coculture system, we showed that TCA greatly reduced LPS-elicited neuronal death and exerted neuroprotective effects. Conclusions. Our results suggest that TCA, a natural product, has the potential of being used as a therapeutic agent against neuroinflammation for ameliorating neurodegenerative disorders.

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Measuring Coupling of Rhythmical Time Series Using Cross Sample Entropy and Cross Recurrence Quantification Analysis

The aim of this investigation was to compare and contrast the use of cross sample entropy (xSE) and cross recurrence quantification analysis (cRQA) measures for the assessment of coupling of rhythmical patterns. Measures were assessed using simulated signals with regular, chaotic, and random fluctuations in frequency, amplitude, and a combination of both. Biological data were studied as models of normal and abnormal locomotor-respiratory coupling. Nine signal types were generated for seven frequency ratios. Fifteen patients with COPD (abnormal coupling) and twenty-one healthy controls (normal coupling) walked on a treadmill at three speeds while breathing and walking were recorded. xSE and the cRQA measures of percent determinism, maximum line, mean line, and entropy were quantified for both the simulated and experimental data. In the simulated data, xSE, percent determinism, and entropy were influenced by the frequency manipulation. The 1 : 1 frequency ratio was different than other frequency ratios for almost all measures and/or manipulations. The patients with COPD used a 2 : 3 ratio more often and xSE, percent determinism, maximum line, mean line, and cRQA entropy were able to discriminate between the groups. Analysis of the effects of walking speed indicated that all measures were able to discriminate between speeds.

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Relationship between Activities of Daily Living and Readmission within 90 Days in Hospitalized Elderly Patients with Heart Failure

Aims. To examine the relationship between activities of daily living (ADL) and readmission within 90 days and assess the cutoff value of ADL to predict readmission in hospitalized elderly patients with heart failure (HF). Methods. This cohort study comprised 589 consecutive patients with HF aged ≥65 years, who underwent cardiac rehabilitation from May 2012 to May 2016 and were discharged home. We investigated patients' characteristics, basic attributes, and ADL (motor and cognitive Functional Independence Measure [FIM]). We analyzed the data using the unpaired t-test, χ2 test, Cox proportional hazard model, receiver operating characteristic (ROC) curve, and Kaplan-Meier method. Results. Of 589 patients, 113 met the criteria, and they were divided into the nonreadmission () and readmission groups (). Age, body mass index, New York Heart Association class, hemoglobin level, and motor FIM score were significantly different between the two groups (). The body mass index (hazard ratio [HR]: 0.87; ) and motor FIM score (HR: 0.94; ) remained statistically significant. The cutoff value for the motor FIM score determined by ROC curve analysis was 74.5 points (area under the curve = 0.78; ). Conclusion. The motor FIM score in elderly patients with HF was an independent predictor of rehospitalization within 90 days.

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Prevention of Memory Impairment and Neurotrophic Factors Increased by Lithium in Wistar Rats Submitted to Pneumococcal Meningitis Model

The aim of this study was to investigate the effects of lithium on brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and glial cell line-derived neurotrophic factor (GDNF) expression in the hippocampus and on memory in experimental pneumococcal meningitis. The mood-stabilizer lithium is known as a neuroprotective agent with many effects on the brain. In this study, animals received either artificial cerebrospinal fluid or Streptococcus pneumoniae suspension at a concentration of 5 × 109 CFU/mL. Eighteen hours after induction, all animals received ceftriaxone. The animals received saline or lithium (47.5 mg/kg) or tamoxifen (1 mg/kg) as adjuvant treatment, and they were separated into six groups: control/saline, control/lithium, control/tamoxifen, meningitis/saline, meningitis/lithium, and meningitis/tamoxifen. Ten days after meningitis induction, animals were subjected to open-field habituation and the step-down inhibitory avoidance tasks. Immediately after these tasks, the animals were killed and their hippocampus was removed to evaluate the expression of BDNF, NGF, and GDNF. In the meningitis group, treatment with lithium and tamoxifen resulted in improvement in memory. Meningitis group showed decreased expression of BDNF and GDNF in the hippocampus while lithium reestablished the neurotrophin expression. Lithium was able to prevent memory impairment and reestablishes hippocampal neurotrophin expression in experimental pneumococcal meningitis.

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Comparison of Simulated Drift Rates of Common ALS-Inhibiting Rice Herbicides to Florpyrauxifen-Benzyl on Soybean

Acetolactate synthase- (ALS-) herbicides are among the most commonly used sites of action (SOA) in rice production. Many herbicides used in rice can cause carryover to soybean, which is commonly grown near to or rotated with rice. Florpyrauxifen-benzyl (Rinskor™ Active) brings an alternative SOA to rice production. The objective of this study was to compare the effects of simulated drift rates of florpyrauxifen-benzyl to commonly used ALS-inhibiting rice herbicides on soybean. A field study was conducted at two locations examining five ALS-inhibiting rice herbicides as well as florpyrauxifen-benzyl at a 1/20x and 1/80x simulated drift rate. Crop injury, height, and yield were evaluated at 14, 21, and 35 days after treatment (DAT). Florpyrauxifen-benzyl and bispyribac showed high injury levels at both drift rates. At 35 DAT florpyrauxifen-benzyl caused 76% and 17% visible damage to soybean whereas bispyribac caused 35 and 9% injury at 1/20x and 1/80x, respectively. These treatments resulted in a reduction in soybean height and yield. Although this alternative SOA herbicide in rice may be effective for weed control, our research demonstrates it to be injurious to soybean at both drift rates tested. Thus, proper precautions should be taken to avoid injury by ensuring that the label is followed.

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Left Brachiocephalic Vein Stenosis due to the Insertion of a Temporal Right Subclavian Hemodialysis Catheter

Central vein stenosis/occlusion is a common well-described sequel to the placement of hemodialysis catheters in the central venous system. The precise mechanisms by which central vein stenosis occurs are not well known. Current concepts in central vein stenosis pathophysiology focus on the response to vessel injury model, emphasizing the process of trauma. A case of left brachiocephalic vein stenosis due to the insertion and function of a temporary right subclavian hemodialysis catheter is presented. The purpose of the manuscript is to emphasize that, with the introduction of a temporary subclavian hemodialysis catheter via the right subclavian vein apart from causing concurrent stenosis/infarction of the right subclavian and right brachiocephalic vein, it is also possible to cause stenosis of the left brachiocephalic vein (close to its contribution to the superior vena cava) although the catheter tip is placed in the correct anatomical position in the superior vena cava.

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Exploring the Concept of Degrees of Maternal Morbidity as a Tool for Surveillance of Maternal Health in Latin American and Caribbean Settings

Objectives. To assess a birth registry to explore maternal mortality and morbidity and their association with other factors. Study Design. Exploratory multicentre cross-sectional analysis with over 700 thousand childbirths from twelve Latin American and Caribbean countries between 2009 and 2012. The WHO criteria for maternal morbidity were employed to split women, following a gradient of severity of conditions, into (1) maternal death (MD); (2) maternal near miss (MNM); (3) potentially life-threatening conditions (PLTC); (4) less severe maternal morbidity (LSMM); (5) any maternal morbidity; and (6) women with no maternal morbidity. Their prevalence and estimated risks of adverse maternal outcomes were assessed. Results. 712,081 childbirths had a prevalence of MD and MNM of 0.14% and 3.1%, respectively, while 38% of women had experienced morbidity. Previous maternal morbidity was associated with higher risk of adverse maternal outcomes and also the extremes of reproductive ages, nonwhite ethnicity, no stable partner, no prenatal care, smoking, drug and alcohol use, elective C-section, or induction of labour. Poorer perinatal outcomes were proportional to the severity of maternal outcomes. Conclusions. The findings corroborate WHO concept regarding continuum of maternal morbidity, reinforcing its importance in preventing adverse maternal outcomes and improving maternal healthcare in different settings.

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A Two-Step Global Maximum Error Controller-Based TPWL MOR with POD Basis Vectors and Its Applications to MEMS

In our previous study, we have proposed a linearization point (LP) selection method based on a global maximum error controller for the trajectory piecewise-linear (TPWL) method. It has been demonstrated that this method has many advantages over other existing methods. In this paper, a more efficient version of this method is presented, which introduces a preliminary LP selection procedure and constructs projection matrix by the proper orthogonal decomposition (POD) method. Compared with the original method, the improved method takes much less time for extracting a reduced-order model (ROM) of similar quality and gets some other benefits (such as being easier to implement, having lower memory requirement, and enhanced flexibility). The effectiveness of the new method is fully demonstrated by a diode transmission line RLC circuit. And then, the method is applied to three more complicated microelectromechanical systems (MEMS) devices, which are a micromachined switch, an electrostatic micropump diaphragm, and a thermomechanical in-plane microactuator.

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Comparative Analysis of Spontaneous and Stimulus-Evoked Calcium Transients in Proliferating and Differentiating Human Midbrain-Derived Stem Cells

Spontaneous cytosolic calcium transients and oscillations have been reported in various tissues of nonhuman and human origin but not in human midbrain-derived stem cells. Using confocal microfluorimetry, we studied spontaneous calcium transients and calcium-regulating mechanisms in a human ventral mesencephalic stem cell line undergoing proliferation and neuronal differentiation. Spontaneous calcium transients were detected in a large fraction of both proliferating (>50%) and differentiating (>55%) cells. We provide evidence for the existence of intracellular calcium stores that respond to muscarinic activation of the cells, having sensitivity for ryanodine and thapsigargin possibly reflecting IP3 receptor activity and the presence of ryanodine receptors and calcium ATPase pumps. The observed calcium transient activity potentially supports the existence of a sodium-calcium antiporter and the existence of calcium influx induced by depletion of calcium stores. We conclude that the cells have developed the most important mechanisms governing cytosolic calcium homeostasis. This is the first comparative report of spontaneous calcium transients in proliferating and differentiating human midbrain-derived stem cells that provides evidence for the mechanisms that are likely to be involved. We propose that the observed spontaneous calcium transients may contribute to mechanisms involved in cell proliferation, phenotypic differentiation, and general cell maturation.

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The Asymptotic Behaviours of a Class of Neutral Delay Fractional-Order Pantograph Differential Equations

Complex Monitoring of Biochemical and Radionuclide Parameters in Patients with Metastatic Renal Cell Carcinoma during Immunotherapy

Study Objective. To study the effectiveness of complex monitoring of the kidney function, based on biochemical and radionuclide methods in patients with metastatic renal cell carcinoma (mRCC). Materials and Methods. 41 mRCC patients after nephrectomy received nivolumab (n = 23) and interferon-α (n = 18) from 2015 to 2017. At baseline and 2 months after, all patients underwent blood chemistry, urinalysis, Rehberg test, and ELISA to determine serum levels of IL-17A, TGF-β, and erythropoietin. The monitoring of the renal function and urodynamics by complex renal scintigraphy (CRS) was used for all patients using a dual-detector gamma camera and simultaneous data recording in 2 projections. The interpretation of CRS data used the original SENS CRS technology. Study Results. Statistically significant correlations were established between IL-17A, TGF-β, and D (excretion rate of 99mTc-technephore from the parenchyma) and Rnfsc (a stable sign of nephrosclerosis), respectively. A significant correlation was established between the parameters of the complex functional monitoring with the prognosis for the risk of renal failure (RF) and efficacy of immunotherapy in mRCC. Conclusions. All mRCC patients after nephrectomy were recommended to undergo biochemical monitoring with inclusion of TGF-β and IL-17A, as well as radionuclide monitoring (CRS) to determine the RF risk at an early stage.

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Practices at Billings VA dental clinic led to delayed care - Sat, 21 Oct 2017 PST

Practices at the Billings Veterans Affairs dental clinic led to delays in care and in some cases risked patients' health, according to a federal investigation. Billings dentist Kelly Hale complained in 2016 that former chief of dental services Robert Bourne didn't allow staff dentists in Billings to access a computerized system to log requests for consultation and treatment for veterans outside the VA system, the Billings Gazette reported.

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PreOp® Breast Center Special text message to you

PreOp Breast Center Special • Patient Education & Engagement
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This video represents the 1) Breast Self Examination 2) Breast incision Biopsy 3) Modified Radical Mastectomy 4) Handwashing and 5) Basic Wound Care

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Emergence of ArmA, a 16S rRNA methylase in highly aminoglycoside-resistant clinical isolates of Klebsiella pneumoniae and Klebsiella oxytoca in Okinawa, Japan

Publication date: Available online 21 October 2017
Source:Journal of Infection and Chemotherapy
Author(s): Kohei Uechi, Tatsuya Tada, Kayo Shimada, Isamu Nakasone, Tetsu Sonozaki, Teruo Kirikae, Jiro Fujita
This study describes highly aminoglycoside-resistant Klebsiella pneumoniae and Klebsiella oxytoca clinical isolates obtained from an inpatient in Okinawa, Japan, with no known record of traveling overseas. The minimum inhibitory concentrations of amikacin and arbekacin against these strains were >1024 μg/ml. Whole-genome sequencing analysis revealed that these isolates harbored armA, which encodes a 16S rRNA methylase, ArmA, that confers pan-aminoglycoside resistance. This is the second report of K. pneumoniae harboring armA and the first report of K. oxytoca harboring a 16S rRNA methylase encoding gene in Japan.

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Impact of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) on central line-associated bloodstream infections (CLABSIs) in department of hematology at single university hospital in Japan

Publication date: Available online 21 October 2017
Source:Journal of Infection and Chemotherapy
Author(s): Yukiko Kato, Mao Hagihara, Ai Kurumiya, Tomoko Takahashi, Miki Sakata, Yuichi Shibata, Hideo Kato, Arufumi Shiota, Hiroki Watanabe, Nobuhiro Asai, Yusuke Koizumi, Yuka Yamagishi, Hiroshige Mikamo
BackgroundCentral line-associated bloodstream infections (CLABSIs) are among the most serious complications especially in blood cancer patients. In January 2013, Centers for Disease and Prevention (CDC) introduced a new surveillance definition of mucosal barrier injury-associated laboratory-confirmed bloodstream infection (MBI-LCBI). This study was to determine the impact of MBI-LCBI on CLABSIs and compare the clinical characteristics of MBI versus non-MBI-LCBI cases.Patients and methodsWe retrospectively reviewed the records of 250 consecutive patients. They were admitted in department of hematology at Aichi Medical University Hospital. We applied the revised 2013 CLABSI surveillance protocol to all CLABSI cases identified during the 47-months period from May 2012 through June 2016.ResultsA total of 44 CLABSIs were identified. The median patient age was 65 years (range, 12 to 89). Among 44 patients, 31 patients were diagnosed as leukemia (70.5%) and 12 patients as lymphoma (27.3%). Six patients underwent bone transplantation for leukemia or myelodysplastic syndrome (13.6%). A total of 20 patients (45.5%) were classified as MBI-LCBI and 24 (54.5%) were classified as non-MBI-LCBI. The primary disease type (P = 0.018), neutropenic within 3 days before CLABSI (MBI-LCBI vs. non-MBI-LCBI: 95.0% vs. 26.3%, P = <0.0001), line(s) removed owing to CLABSI (15.0% vs. 54.2%, P = 0.011) and Gram-negative organisms cultured (70.0% vs. 37.5%, P = 0.004) showed significantly difference between the groups.ConclusionOur data showed that MBI-LCBI cases account for 45.5% of the CLABSI cases identified in blood cancer patients, and constituted a significant burden to this high-risk patient population.

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Σάββατο 21 Οκτωβρίου 2017

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