Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174: 10/23/17

Δευτέρα 23 Οκτωβρίου 2017

Quiste del conducto torácico superior: un hallazgo incidental

Publication date: Available online 23 October 2017
Source:Acta Otorrinolaringológica Española
Author(s): Regina María Sánchez Jiménez, Francisca Velázquez Marín

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Confusion about how Amber Athwal was monitored revealed at unprofessional conduct hearing

Dr. William Mather faces five counts of unprofessional conduct in his treatment of Amber Athwal. He pleaded guilty to three of those charges at the start of the hearing.

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Subtotal Parathyroidectomy and Relocation of the Parathyroid Remnant for Renal Hyperparathyroidism: modification of a traditional operation

Abstract

Background

We describe a modification of the conventional subtotal parathyroidectomy operation where the parathyroid gland(s) remnant is repositioned with intact vascular supply to a plane superficial to the infrahyoid strap muscles and immediately under the skin incision. This technique called Subtotal Parathyroidectomy and Remnant Relocation (SPARE) retains all the metabolic advantages of the conventional operation with the added advantage of easier identification of a recurrent hyperplastic remnant if re-exploration becomes necessary.

Methods

In the SPARE technique, four parathyroid glands were identified and the quality of each gland and the length of each vascular pedicle to the parathyroid glands were assessed. The optimal parathyroid gland was relocated to a plane superficial to the strap muscles. The remainder of the glands were removed.

Results

In total, 30 patients with hyperparathyroidism secondary to renal failure (HSRF) underwent parathyroidectomy with the SPARE technique. The mean age was 53.1±12.5 years and median follow-up was 17.1 months (range 1-78.9 months). There were no recurrent laryngeal nerve (RLN) injuries or hematomas. The pre- and post-operative value for corrected calcium and PTH were 158.4±109.4 pmol/L and 11.4±12.1 pmol/L, respectively (p < 0.05). Three recurrences were noted (10.0%), with a mean time to recurrence of 15.3±6.6 months. One patient had excision of the remnant parathyroid glands performed under local anaesthetic (29 min); one had re-exploration performed under general anaesthetic (81 min), and one was managed medically.

Conclusion

We described a novel parathyroidectomy technique for patients with HSRF, which provides the advantages of conventional subtotal parathyroidectomy while mitigating the challenges of thyroid bed re-exploration when recurrences arise.

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Quiste del conducto torácico superior: un hallazgo incidental

Publication date: Available online 23 October 2017
Source:Acta Otorrinolaringológica Española
Author(s): Regina María Sánchez Jiménez, Francisca Velázquez Marín

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Erratum

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Issue Information

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Issue Information

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Erratum

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Normative prosthodontic care need: does it impact the daily life of young Saudis with high level of oral diseases? A cross sectional study

Abstract

Background

Assessing the need for prosthodontic care previously included older age groups. There is less information about younger populations who may need this care because of high disease levels. The aim of this study was to assess the normative need for prosthodontic care in a young Saudi population with high oral disease levels, the associated factors and its impact on daily life.

Methods

A cross sectional study included Saudi adults in the Eastern Province in 2016. A questionnaire was used to assess personal background (confounders), risk factors affecting oral diseases (exposures) and the impact of oral problems on daily life. A clinical examination assessed tooth loss, the presence of prosthodontic appliances, the presence of untreated decay and need for periodontal care. Directed acyclic graphs identified the confounders to be included in regression models with separate outcomes: normative need for prosthodontic care (binary logistic model) and impact on 6 daily life aspects (ordinal regression models).

Results

Complete data were available for 574/ 700 = 82% and 46.7% needed prosthodontic care with 2 lost teeth on average among adults of mean age = 33.2 years. The confounders controlled for the need for prosthodontic care included socioeconomic status (SES), dental visits last year and health insurance. The confounders for the impact on daily life included age and SES. In adjusted models, normative need for prosthodontic care was significantly associated with untreated decay (OR = 2.09, 95% C.I. = 1.37, 3.19). The impact on daily life was not significantly associated with prosthodontic care need but with untreated decay, especially sleeplessness (regression coefficient = 0.53, 95% C.I. = 0.02, 1.04) and dropping daily activities (regression coefficient = 0.79, 95% C.I. = 0.13, 1.46). In addition, the need for periodontal care was associated with food avoidance (regression coefficient = 0.73, 95% C.I. = 0.28, 1.18).

Conclusions

In Saudi adults in the Eastern Province, there was a considerable normative need for prosthodontic care due to untreated decay. The impact on daily life was related to the underlying oral diseases rather than the need for prosthodontic care itself.

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Landfill fire and airborne aerosols in a large city: lessons learned and future needs

Abstract

Landfill fires are relatively frequent incidents that can result in severe environmental impacts. On the morning of January 15, 2016, a fire occurred at the Santa Marta landfill (Lf) in the metropolitan area of Santiago (SMA), Chile. The fire triggered public alarm. In the present work, the impact of the landfill fire on the air quality of the SMA and the possible impacts on human health are analyzed. According to the information collected, the fire began after a collapse in the landfill on January 15, 2016. The fire could not be controlled by the Lf operating company, and authorities acted late in responding. The results revealed that at the focal point of the fire, particulate matter with an aerodynamic diameter smaller than 2.5 μm (PM_2.5) reached concentration levels on the order of 1000 μg m⁻³. Three days after the start of the fire, hourly PM_2.5 concentration levels above 200 μg m⁻³ were recorded, at a distance approximately 20 km northeast of where the fire occurred. The PM_2.5 concentration levels recommended for the protection of the health of vulnerable persons were subsequently exceeded. These results suggest that a preventive measure should have been the evacuation of the most pollution-sensitive population. An inappropriate management of the emergency was demonstrated. Legislation should be improved by stipulating which sanitary Lfs should be equipped with firefighting equipment. Territorial planning should be improved by considering geographic and meteorological aspects.

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IJERPH, Vol. 14, Pages 1266: Association between Obesity and Puberty Timing: A Systematic Review and Meta-Analysis

IJERPH, Vol. 14, Pages 1266: Association between Obesity and Puberty Timing: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14101266

Authors: Wenyan Li Qin Liu Xu Deng Yiwen Chen Shudan Liu Mary Story

This systematic review and meta-analysis examined the associations between obesity and puberty timing based on scientific evidence. Eight electronic databases were searched up to February 2017 for eligible studies, and two reviewers screened the articles and extracted the data independently. A total of 11 cohort studies with 4841 subjects met the inclusion criteria. Compared with the group of normal-weight girls, the obese group had more girls with menarche (RR: 1.87, 95% CI: 1.59–2.19, 2 studies). The number of girls with early puberty was significantly higher in the obese group than the normal weight group (RR: 2.44, 95% CI: 1.32–4.52, 5 studies). However, no differences were detected between girls who were obese or normal weight at age of menarche (WMD: −0.53 years, 95% CI: −1.24–0.19, 2 studies). There is no consistent result in the relationship between obesity and timing of pubertal onset in boys. Obesity may contribute to early onset of puberty in girls, while in boys, there is insufficient data. Given the limited number of cohort studies included in this meta-analysis, high-quality studies with strong markers of puberty onset, as well as standardized criteria for defining obesity are needed.

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Thrombotic thrombocytopenic purpura possibly triggered by Graves’ disease

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a part of a spectrum of thrombotic microangiopathy syndromes which are mainly characterized by platelet aggregation causing microangiopathic hemolytic anemia, thrombocytopenia and microvascular occlusion. In literature, very few cases expressing a direct association between pre-existing Grave's disease and TTP have been described. A 37-year-old African–American woman with past medical history of Grave's disease and polysubstance abuse who presented with complaints of dyspnoea at rest and chest pain was diagnosed to have TTP on further evaluation. Patient also showed severely elevated thyroid hormones and suppressed thyroid stimulating hormone levels indicating severe thyrotoxicosis. Initiation of prompt management of TTP and thyrotoxicosis led to a favorable patient outcome. In conclusion, patients presenting with thyrotoxicosis, thrombocytopenia and microangioapthic hemolytic anemia without an alternative cause should be treated and screened for TTP due to the high fatality associated with untreated or untimely detection of this disease.

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Cognitive fatigue is associated with reduced anterior internal capsule integrity in veterans with history of mild to moderate traumatic brain injury

Abstract

No known studies have directly examined white matter microstructural correlates of cognitive fatigue post-TBI in a Veteran sample. We therefore investigated the relationship between cognitive fatigue and white matter integrity in Veterans with history of mild to moderate TBI (mmTBI). 59 Veterans (TBI = 34, Veteran Controls [VCs] = 25]) with and without history of mmTBI underwent structural 3T DTI scans and completed questionnaires related to cognitive fatigue and psychiatric symptoms. Tractography was employed on six regions of interest, including the anterior and posterior limbs of the internal capsule; genu; body and splenium of the corpus callosum; and cingulum bundle. Group analyses revealed that those with history of mmTBI displayed significantly greater levels of cognitive fatigue relative to those with no history of head injury (p = .02). Within the mmTBI group, independent of psychiatric symptoms, decreased white matter microstructural integrity of the left anterior internal capsule was associated with greater levels of cognitive fatigue (p = .01). Results show that the subjective experience of cognitive fatigue following neurotrauma may be linked to the disruption of striato-thalamo-cortical tracts that are important in mediating arousal and higher-order cognitive processes. These findings build upon those from existing functional neuroimaging studies in those with history of TBI, providing further evidence for the neural basis of cognitive fatigue in head injured adults.

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Lymphatic malformation with acquired Horner syndrome in an infant

An infantpresented with right upper eyelid ptosis and was subsequently diagnosed with acquired Horner syndrome. Further evaluation revealed a right-sided cervicothoracic lymphatic malformation. At 13 weeks of age, the child underwent percutaneous intracystic sclerotherapy with a mixture of sodium tetradecyl sulphate and ethanol. Twenty-one weeks after initial treatment, ophthalmic examination showed complete resolution of the blepharoptosis and pupillary miosis. Percutaneous sclerotherapy not only effectively treated the space-occupying lymphatic malformation but also reversed the Horner syndrome that was presumably induced by neural tension (more likely) or compression.

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Leiomyosarcoma presenting as 'idiopathic unilateral lower limb lymphoedema

A 74-year-old woman presented with an 8-year history of unilateral swelling of her right lower limb, which was thought to be 'idiopathic' lymphoedema until she noticed a painless swelling in her right groin. Physical examination showed a painless, non-pulsatile, deep-seated mass in her right proximal thigh with significant lymphoedema distally. MRI scan showed a large mass at her right inguinal region, involving the common femoral vein. Histological examination on complete excision revealed leiomyosarcoma. It is important to exclude proximal obstructive lesion before making a diagnosis of unilateral idiopathic lower limb lymphoedema.

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Rhomboencephalosynapsis

Description

A baby boy was born to healthy, unrelated parents at 34 weeks gestation by caesarean section in view of an antenatal ultrasound diagnosis of hydrocephalus. Mother had a previous miscarriage at 13 weeks gestation of a twin pregnancy. At birth, the boy weighed 2.47 kg, was well and did not require resuscitation. Pregnancy was unremarkable with no significant events. At birth, a large head circumference was noted, but fontanelles were soft. The Apgar score was 9 at 1 and 10 min, baby had a good cry and was moving all four limbs. A CT scan of brain was done at 1-day old which showed obstructive hydrocephalus at the level of the cerebral aqueduct. A ventriculoperitoneal (VP) shunt was inserted at 1-week old. The boy showed slow development over the subsequent years, he never suffered from seizures, however required growth hormone therapy. A small atrial septal defect was noted on echocardiogram. An...

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Measurement of bone mineral density as an efficacy marker in denosumab treatment of giant cell tumour of bone

Three patients with giant cell tumour of bone (GCTB) in the lower extremity, where the only surgical treatment options were amputation or severe weakening of the bone, were treated with denosumab (D-mab) to strengthen the bone mass in the tumour. In order to quantify changes in bone mineral density (BMD) in the GCTB lesion during D-mab treatment, we did repeated dual-energy X-ray absorptiometry (DXA) scans. The patients underwent operation after 3, 4 and 8 months of D-mab treatment, respectively. The tumours in all three patients responded markedly to D-mab, and up to 50% BMD increase was observed. There was almost no BMD change in the control scans in the hip and spine of the same patients. DXA scans provide no information about local tumour response, but may be of value in evaluation of the time and size of the D-mab response in GCTB, and thereby aid in finding the best timing for surgery.

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Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms

Severe carcinoid syndrome and carcinoid heart disease in neuroendocrine tumours can have a significant impact on a patient's quality of life and are a major cause of morbidity and mortality. We present a novel approach to managing a patient with medically uncontrollable carcinoid syndrome. Inferior and superior vena cava placement of transcatheter heart valves has been used to treat patients with right heart failure due to severe tricuspid and pulmonary regurgitation. However, this procedure has not been attempted to specifically reduce hormone secretion, primarily from the liver, in order to control carcinoid syndrome symptoms. We attempted this procedure in a patient with severe carcinoid disease and tricuspid regurgitation as a bridge to later definitive therapy. The procedure was technically successful, but did not improve carcinoid symptoms. The possible reasons for the failure are discussed here.

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Birt-Hogg-Dube syndrome: awareness is important!

Birt-Hogg-Dubé (BHD) is a rare syndrome of inherited renal cell carcinomas, characterised by cutaneous lesions and pulmonary cysts and pneumothorax in a vast majority of the patients. Awareness of this syndrome is important in order to refer patients for genetic counselling and personalised follow-up as soon as possible. We describe a case of a 30-year-old female referred to our institution due to incidental discovery of solid bilateral renal masses. Renal biopsies were consistent with chromophobe tumour, and bilateral nephrectomy was performed. Gross examination revealed deformed kidneys with 28 brown and solid lesions, size variable between 0.1 and 6 cm, histologically corresponding to renal cell carcinomas, chromophobe type. Genetic test was required that showed a c.573delGAinsT frameshift mutation in heterozigosity at the folliculin gene, consistent with BHD diagnosis.

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Idiopathic catastrophic thrombosis with happy ending

A 59-year-old male patient suffered three life-threatening instent thromboses after an initial resuscitation due to an ST-segment elevation myocardial infarction of the anterior cardiac wall. With a high-risk profile for heparin-induced thrombocytopenia (HIT), he was placed on argatroban after the second reinfarction. Under this apparently appropriate treatment, a third reinfarction occurred, and the patient had to undergo high-risk cardiac bypass surgery. Later on, a deep vein thrombosis and an intracardiac thrombus formed. Despite a positive screening test for HIT and a single positive result in the heparin-induced platelet aggregation test, we are not convinced that HIT was the only underlying cause for this 'catastrophic thrombotic syndrome'. We speculate that a massive generation of thrombin, reflected in consistently high D dimers and the need of copious amounts of a direct thrombin inhibitor, triggered the set of events. With this case report, we want to raise awareness for cardiac complications in patients with complex clotting disorders and share our experience in the diagnostic and therapeutic management of such an unusual scenario.

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Neuroendocrine tumour in pancreatic dorsal agenesis: a rare association

Pancreatic dorsal agenesis (PDA) is a rare congenital anomaly, usually asymptomatic, that can present with abdominal pain, pancreatitis, diabetes mellitus and jaundice. Pancreatic tumours in PDA background are extremely rare, and when they occur are mainly pancreatic ductal adenocarcinoma. We present a case of a 48-year-old female patient with incidental detection of a 26x20 mm nodular lesion of the cephalic pancreas on ultrasound. Surgery was performed and gross examination revealed PDA with a tumour developed around the Wirsung duct. Histology showed a neuroendocrine tumour G1 with neural and vascular invasion. Two and half years later, the patient is alive and without tumour relapse. Awareness of the association of PDA and pancreatic tumours is fundamental in order to develop personalised follow-up programmes.

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Adverse reaction with suvorexant for insomnia: acute worsening of depression with emergence of suicidal thoughts

A 59-year-old woman on daily peritoneal dialysis for end-stage renal failure received care at an outpatient psychiatric clinic for her diagnoses that include major depressive disorder, generalised anxiety disorder and insomnia disorder. Although there was partial improvement in the patient's mood and anxiety symptoms with antidepressant treatment, insomnia remained a persistent complaint despite adequate trials of different sleep medications. The novel hypnotic, suvorexant (Belsomra, Merck & Co.) was then initiated at the recommended bedtime dose of 10 mg and was followed by a 15 mg dose the following night. Within an hour after taking her second suvorexant dose, the severity of patient's depression symptoms worsened and was accompanied by new onset of suicidal thoughts.

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Case of tumoral calcinosis on images: a rare clinicopathological entity

Description

We are presenting a case of tumoral calcinosis (TC) diagnosed on histopathology with characteristic X-ray, CT and MRI images. We acknowledge that although radiological and pathological descriptions are suggested as diagnostic criteria, mostly the term TC is saved for the condition caused by hereditary metabolic dysfunction of phosphate regulation associated with massive periarticular masses. Our patient had a normal phosphate. On review of literature, normophosphatemic TC has also been described.1

An 81-year-old Caucasian woman presented with left wrist pain and swelling, which first began approximately 3–4 years ago. As per patient, she saw her physician regarding this 1 year ago and was diagnosed with gout. Physical examination showed 4x3 cm left-sided volar ulnar wrist mass (figure 1).

Figure 1

Patient's picture showing swelling on the left wrist.

The patient's vital signs and rest of the examination were within normal limits....

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Metastatic meningioma: a rare cause of mediastinal lymphadenopathy.

Description

A 69-year-old man with known, stable atypical meningioma of the brain diagnosed 5 years previously presented with severe shortness of breath. The patient had previously been treated with surgery and radiotherapy to the brain. Chest X-ray revealed bulky mediastinal lymphadenopathy (figure 1). CT (figure 2) confirmed mediastinal and upper abdominal lymphadenopathy in addition to multiple pulmonary emboli. The patient underwent an endoscopic ultrasound and fine-needle aspiration (EUS-FNA), an established technique that enables prompt cytological sampling and assessment.1

Figure 1

Chest X-ray.

Figure 2

Contrast-enhanced CT image showing adenopathy at the level of the aortic arch.

The EUS-FNA preparations showed sheets and clusters of bland, polygonal epithelioid cells (figure 3). These demonstrated strong immunohistochemical positivity (figure 4) for epithelial membrane antigen. The final immunopanel was strongly supportive...

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Olfactory nerve hypertrophy: a clue to the presence of ipsilateral megalencephaly

Description

A boy aged 4 years presented with refractory focal seizures since 9 months of age. The seizures involved the left side of the body and consisted of clonic movements with frequent generalisation. MRI brain showed abnormal area with poor grey-white differentiation involving the right frontal lobe, especially the basifrontal region and the temporal lobe (figure 1A,B) suggesting the presence of a frontotemporal developmental malformation. Interestingly olfactory nerve hypertrophy was also noted on the same side (figure 1C,D). Video-electroencephalogram study demonstrated concurrence of the interictal (figure 2A) and ictal data (figure 2B) with the MRI defined abnormality. An 18-fluoro-2-deoxy-D-glucose positron emission tomography/CT of the brain showed severe right frontotemporal hypometabolism. The boy underwent a disconnection procedure involving the right frontal lobe sparing the motor cortex and the temporal lobe. Histopathology of the abnormal brain obtained during the surgery showed large...

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Necrotising pneumonia following influenza due to PVL-negative Staphylococcus aureus in a 64-year-old woman

Description

A 64-year-old immunocompetent woman presented to our institution during the 2016–2017 influenza A(H3N2) epidemic for cough and fever. She presented 10 days ago with an influenza syndrome, treated with ibuprofen 400 mg/day for 7 days. As the fever continued, with blood-streaked sputum, amoxicillin with clavulanic acid was prescribed for 3 days and then ceftriaxone (1 g/day). She had elevated transaminases and C reactive protein (184 mg/L). A chest X-ray was performed, showing a left pneumonia (figure 1A), and the patient was admitted in the infectious disease unit. There was no respiratory failure. Amphoric breath sound was heard at the top of the right lung. Antibiotics were modified, as levofloxacine (500 mg twice daily) was added to cefotaxime (1 g/8 hours). A CT scan of the chest was performed (figure 1B,C), showing a bifocal pneumonia involving the upper right and lower left lobes, and excavated bilateral nodules. The bronchoalveolar lavage showed a positive influenza...

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Correction: Out of the blue--finger ischaemia and occult colorectal cancer

Schattner A. Out of the blue finger ischaemia and occult colorectal cancer. BMJ Case Rep 2017 (Epub ahead of print 8 Mar 2017). doi:10.1136/bcr-2016-218779

The correct title of the article is: Out of the blue—finger ischaemia and occult colorectal cancer.

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Cognitive fatigue is associated with reduced anterior internal capsule integrity in veterans with history of mild to moderate traumatic brain injury

Abstract

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Acute Effects of Dynamic Stretching on Muscle Flexibility and Performance: An Analysis of the Current Literature

Abstract

Stretching has long been used in many physical activities to increase range of motion (ROM) around a joint. Stretching also has other acute effects on the neuromuscular system. For instance, significant reductions in maximal voluntary strength, muscle power or evoked contractile properties have been recorded immediately after a single bout of static stretching, raising interest in other stretching modalities. Thus, the effects of dynamic stretching on subsequent muscular performance have been questioned. This review aimed to investigate performance and physiological alterations following dynamic stretching. There is a substantial amount of evidence pointing out the positive effects on ROM and subsequent performance (force, power, sprint and jump). The larger ROM would be mainly attributable to reduced stiffness of the muscle–tendon unit, while the improved muscular performance to temperature and potentiation-related mechanisms caused by the voluntary contraction associated with dynamic stretching. Therefore, if the goal of a warm-up is to increase joint ROM and to enhance muscle force and/or power, dynamic stretching seems to be a suitable alternative to static stretching. Nevertheless, numerous studies reporting no alteration or even performance impairment have highlighted possible mitigating factors (such as stretch duration, amplitude or velocity). Accordingly, ballistic stretching, a form of dynamic stretching with greater velocities, would be less beneficial than controlled dynamic stretching. Notwithstanding, the literature shows that inconsistent description of stretch procedures has been an important deterrent to reaching a clear consensus. In this review, we highlight the need for future studies reporting homogeneous, clearly described stretching protocols, and propose a clarified stretching terminology and methodology.

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Drug Target Interference in Immunogenicity Assays: Recommendations and Mitigation Strategies

Abstract

Sensitive and specific methodology is required for the detection and characterization of anti-drug antibodies (ADAs). High-quality ADA data enables the evaluation of potential impact of ADAs on the drug pharmacokinetic profile, patient safety, and efficacious response to the drug. Immunogenicity assessments are typically initiated at early stages in preclinical studies and continue throughout the drug development program. One of the potential bioanalytical challenges encountered with ADA testing is the need to identify and mitigate the interference mediated by the presence of soluble drug target. A drug target, when present at sufficiently high circulating concentrations, can potentially interfere with the performance of ADA and neutralizing antibody (NAb) assays, leading to either false-positive or, in some cases, false-negative ADA and NAb assay results. This publication describes various mechanisms of assay interference by soluble drug target, as well as strategies to recognize and mitigate such target interference. Pertinent examples are presented to illustrate the impact of target interference on ADA and NAb assays as well as several mitigation strategies, including the use of anti-target antibodies, soluble versions of the receptors, target-binding proteins, lectins, and solid-phase removal of targets. Furthermore, recommendations for detection and mitigation of such interference in different formats of ADA and NAb assays are provided.

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Erratum to: Phase 1 study of darolutamide (ODM-201), a new-generation androgen receptor antagonist, in Japanese patients with metastatic castration-resistant prostate cancer

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Impetigo: A need for new therapies in a world of increasing antimicrobial resistance

Summary

What is known and objective

Impetigo is a highly contagious bacterial skin infection and is one of the most common skin infections in children. Antibiotics are the first-line treatment when multiple lesions exist, but with an increasing prevalence of antibiotic-resistant bacteria the successful management of impetigo in the future is an area of concern.

Comment

Current treatment options that favour the use of oral antibiotic therapy are increasingly problematic. Widespread use of these agents contributes to antimicrobial resistance and has adverse consequences for individuals and communities. There is a need for new topical antimicrobials and antiseptics as an alternative treatment strategy.

What is new and conclusion

To successfully treat impetigo into the future and ensure that therapy does not contribute to bacterial resistance, additional research is required to ascertain the usefulness of alternative agents, including new topical antimicrobials and antiseptics.

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Erratum to: Phase 1 study of darolutamide (ODM-201), a new-generation androgen receptor antagonist, in Japanese patients with metastatic castration-resistant prostate cancer

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A Tutorial Review on Multi-subject Decomposition of EEG

Abstract

Over the last years we saw a steady increase in the relevance of big neuroscience data sets, and with it grew the need for analysis tools capable of handling such large data sets while simultaneously extracting properties of brain activity that generalize across subjects. For functional magnetic resonance imaging, multi-subject or group-level independent component analysis provided a data-driven approach to extract intrinsic functional networks, such as the default mode network. Meanwhile, this methodological framework has been adapted for the analysis of electroencephalography (EEG) data. Here, we provide an overview of the currently available approaches for multi-subject data decomposition as applied to EEG, and highlight the characteristics of EEG that warrant special consideration. We further illustrate the importance of matching one's choice of method to the data characteristics at hand by guiding the reader through a set of simulations. In sum, algorithms for group-level decomposition of EEG provide an innovative and powerful tool to study the richness of functional brain networks in multi-subject EEG data sets.

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Different survival benefits of Chinese medicine for pancreatic cancer: How to choose?

Abstract

Objective

To assess the efficacy of Chinese medicine (CM) on patients with pancreatic cancer (PC) in a retrospective population-based study.

Methods

Between January 1, 2013, and August 30, 2016, according to whether received Western medicine treatment, the patients were included into either integrative medicine (IM) group or CM group. All enrolled patients were orally administrated with Gexia Zhuyu Decoction (膈下逐瘀汤) or Liujun Ermu Decoction (六君二母汤) by syndrome differentiation, twice a day, last for at least 2 months. The primary end point was overall survival (OS).

Results

A total of 174 patients with PC were enrolled in this study. In stage I/II, the median OS was 20.5 months in the IM group [95% confidence interval (CI), 12.499 to 28.501] and 11.17 months in the CM group (95% CI, 5.160 to 17.180, P=0.015). The 1- and 2-year survival rates for the two groups were 47.0%, 40.0% and 21.0%, 21.0%, respectively. In stage III/IV, median OS was 13.53 months (95% CI, 8.665 to 18.395) in the IM group versus 6.4 months (95% CI, 0.00 to 15.682) in the CM group, respectively (P=0.32). The 1- and 2-year survival rate for the IM and CM groups were 27.0%, 7.0% and 20.0%, 2.0%, respectively.

Conclusions

Intervention of CM contributes to the different survival benefits for PC in different stages. Multimodality treatment might be a promising strategy for PC patients in early stage. While, in advanced stage, CM might be an alternative candidate for PC patients.

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Microradiopharmaceutical for Metastatic Melanoma

Abstract

Purpose

The purpose of this article was to develop, characterize and test (in vivo) dacarbazine microparticles that may be labeled with 99mTc and Ra-223 for both use: diagnostic and therapy of metastatic melanoma.

Methods

We developed by double emulsion solvent evaporation methodology the microparticle. The characterization has been done using, Dynamic Light Scattering (DLS) and Scanning Electron Microscopy (SEM). The labeling with 99mTc and Ra-223 has been done by the direct labeling process. Also the formulation has been tested pre-clinically using Balb/c mice inducted with melanoma, performing the the biodistribution and planar imaging. Cytotoxicity evaluation was also done in M3 V cell line. In order to understand the safety aspects of the microparticles, microbiological study (endotoxin and sterility) has been done. Finally, planar imaging was performed to evaluate the diagnosing aspect.

Results

The results showed that a 559 nm microparticles was obtained with a spherical shape. The labeling process with 99mTc reached over 90% of efficacy. On the other hand, the labeling process with Ra-223 showed a 70% efficacy. The results in inducted animals demonstrated that the microparticles were able to reach the tumor with a high rate (20%). Also demonstrated a low recognition by the Mononuclear Phagocytic System. The cytotoxicity and the microbiological control, corroborates the safety aspect of these microparticles.

Conclusion

The planar image and the possible labeling with Ra-223, corroborates the use as a theragnostic agent for imaging and therapy of Metastatic Melanoma.

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Assessing Glomerular Filtration in Small Animals Using [ 68 Ga]DTPA and [ 68 Ga]EDTA with PET Imaging

Abstract

Purpose

Determining the glomerular filtration rate (GFR) is essential for clinical medicine but also for pre-clinical animal studies. Functional imaging using positron emission tomography (PET) allows repetitive almost non-invasive measurements. The aim of the study was the development and evaluation of easily synthesizable PET tracers for GFR measurements in small animals.

Procedures

Diethylenetriaminepentaacetic acid (DTPA) and ethylenediaminetetraacetic acid (EDTA) were labeled with Ga-68. The binding to blood cells and plasma proteins was tested in vitro. The distribution of the tracers in rats was analyzed by PET imaging and ex vivo measurements. From the time-activity-curve of the blood compartment (heart) and the total tracer mass excreted by the kidney, the GFR was calculated. These values were compared directly with the inulin clearance in the same animals.

Results

Both tracers did not bind to blood cells. [⁶⁸Ga]DPTA but not [⁶⁸Ga]EDTA showed strong binding to plasma proteins. For this reason, [⁶⁸Ga]DPTA stayed much longer in the blood and only 30 % of the injected dose was eliminated by the kidney within 60 min whereas the excretion of [⁶⁸Ga]EDTA was 89 ± 1 %. The calculated GFR using [⁶⁸Ga]EDTA was comparable to the measured inulin clearance in the same animal. Using [⁶⁸Ga]-DPTA, the measurements led to values which were 80 % below the normal GFR. The results also revealed that definition of the volume of interest for the blood compartment affects the calculation and may lead to a slight overestimation of the GFR.

Conclusions

[⁶⁸Ga]EDTA is a suitable tracer for GFR calculation from PET imaging in small animals. It is easy to be labeled, and the results are in good accordance with the inulin clearance. [⁶⁸Ga]DTPA led to a marked underestimation of GFR due to its strong binding to plasma proteins and is therefore not an appropriate tracer for GFR measurements.

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Applying Amide Proton Transfer MR Imaging to Hybrid Brain PET/MR: Concordance with Gadolinium Enhancement and Added Value to [ 18 F]FDG PET

Abstract

Purpose

The purpose of this study is to evaluate the diagnostic concordance and metric correlations of amide proton transfer (APT) imaging with gadolinium-enhanced magnetic resonance imaging (MRI) and 2-deoxy-2-[¹⁸F-]fluoro-D-glucose ([¹⁸F]FDG) positron emission tomography (PET), using hybrid brain PET/MRI.

Procedures

Twenty-one subjects underwent brain gadolinium-enhanced [¹⁸F]FDG PET/MRI prospectively. Imaging accuracy was compared between unenhanced MRI, MRI with enhancement, APT-weighted (APTW) images, and PET based on six diagnostic criteria. Among tumors, the McNemar test was further used for concordance assessment between gadolinium-enhanced imaging, APT imaging, and [¹⁸F]FDG PET. As well, the relation of metrics between APT imaging and PET was analyzed by the Pearson correlation analysis.

Results

APT imaging and gadolinium-enhanced MRI showed superior and similar diagnostic accuracy. APTW signal intensity and gadolinium enhancement were concordant in 19 tumors (100 %), while high [¹⁸F]FDG avidity was shown in only 12 (63.2 %). For the metrics from APT imaging and PET, there was significant correlation for 13 hypermetabolic tumors (P < 0.05) and no correlation for the remaining six [¹⁸F]FDG-avid tumors.

Conclusions

APT imaging can be used to increase diagnostic accuracy with no need to administer gadolinium chelates. APT imaging may provide an added value to [¹⁸F]FDG PET in the evaluation of tumor metabolic activity during brain PET/MR studies.

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Body composition determinants of radiation dose during abdominopelvic CT

Abstract

Objectives

We designed a prospective study to investigate the in-vivo relationship between abdominal body composition and radiation exposure to determine the strongest body composition predictor of dose length product (DLP) at CT.

Methods

Following institutional review board approval, quantitative analysis was performed prospectively on 239 consecutive patients who underwent abdominopelvic CT. DLP, BMI, volumes of abdominal adipose tissue, muscle, bone and solid organs were recorded.

Results

All measured body composition parameters correlated positively with DLP. Linear regression (R² = 0.77) revealed that total adipose volume was the strongest predictor of radiation exposure [B (95% CI) = 0.027(0.024–0.030), t=23.068, p < 0.001]. Stepwise linear regression using DLP as the dependent and BMI and total adipose tissue as independent variables demonstrated that total adipose tissue is more predictive of DLP than BMI [B (95% CI) = 16.045 (11.337-20.752), t=6.681, p < 0.001].

Conclusions

The volume of adipose tissue was the strongest predictor of radiation exposure in our cohort.

Main message

• Individual body composition variables correlate with DLP at abdominopelvic CT.

• Total abdominal adipose tissue is the strongest predictor of radiation exposure.

• Muscle volume is also a significant but weaker predictor of DLP.

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An update of pitfalls in prostate mpMRI: a practical approach through the lens of PI-RADS v. 2 guidelines

Abstract

Objectives

The aim of the current report is to provide an update in the imaging interpretation of prostate cancer on multiparametric magnetic resonance imaging (mpMRI), with a special focus on how to discriminate pathological tissue from the most common pitfalls that may be encountered during daily clinical practice using the Prostate Imaging Reporting and Data System (PI-RADS) version 2 guidelines.

Methods

All the cases that are shown in this pictorial review comply with the European Society of Urogenital Radiology (ESUR) guidelines for technical mpMRI requirements.

Results

Despite the standardised manner to report mpMRI (PI-RADS v. 2), some para-physiologic appearances of the prostate can mimic cancer. As such, it is crucial to be aware of these pitfalls, in order to avoid the under/overestimation of prostate cancer.

Conclusions

A detailed knowledge of normal and abnormal findings in mpMRI of the prostate is pivotal for an accurate management of the wide spectrum of clinical scenarios that radiologists may encounter during their daily practice.

Teaching Points

• Some para-physiologic appearances of the prostate may mimic cancer.

• Knowledge of normal and abnormal findings in prostate mpMRI is pivotal.

• Any radiologist involved in prostate mpMRI reporting should be aware of pitfalls.

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Body composition determinants of radiation dose during abdominopelvic CT

Abstract

Objectives

Methods

Results

Conclusions

The volume of adipose tissue was the strongest predictor of radiation exposure in our cohort.

Main message

• Individual body composition variables correlate with DLP at abdominopelvic CT.

• Total abdominal adipose tissue is the strongest predictor of radiation exposure.

• Muscle volume is also a significant but weaker predictor of DLP.

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Four-Dimensional Computed Tomography: Clinical Impact for Patients with Primary Hyperparathyroidism

Abstract

Background

In recent years, four-dimensional computed tomography (4DCT) has emerged as a new localization study for primary hyperparathyroidism (pHPT).

Objective

We aimed to assess the added value of 4DCT in our institution in the first 4 years of use.

Methods

A retrospective cohort study was conducted from February 2004 to June 2015. Since 2011, patients over 50 years of age without concordant sestamibi-SPECT (SeS) and ultrasound (US) findings underwent 4DCT. Imaging results, surgical findings, histopathology, and postoperative biochemistry were collected.

Results

A total of 536 parathyroid operations in 510 patients were performed during the study period. The overall cure rate was 99.2% after reoperation in some patients, and the overall sensitivity for SeS was 76.0%, and 74.8% for US. Since 2011, 100 patients without concordant SeS/US findings have undergone 4DCT, with a sensitivity of 72.9%. This is in comparison to the sensitivities for SeS (48.3%) and US (52.3%). 4DCT was more sensitive in patients with persistent/recurrent disease (60.0% compared with SeS 43.8% and US 36.4%) and patients with multigland disease (67.4% compared with SeS 40.9% and US 42.1%). Comparison between outcomes in the pre- versus post-CT era demonstrated no difference in the initial cure rate (95.4 vs. 95.9%, p = 0.85) or the rate of minimally invasive parathyroidectomies (74.5 vs. 79.9%, p = 0.22).

Conclusion

Parathyroid 4DCT can aid surgical planning in cases without concordant SeS/US findings; however, the introduction of 4DCT as a second-line test did not change our overall cure rate or rate of minimally invasive parathyroidectomy. The role of 4DCT as the primary localization study for pHPT merits further investigation.

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Pre-operative Axillary Ultrasound-Guided Needle Sampling in Breast Cancer: Comparing the Sensitivity of Fine Needle Aspiration Cytology and Core Needle Biopsy

Abstract

Background

Pre-operative ultrasound-guided needle sampling (UNS) of abnormal axillary lymph nodes in breast cancer can identify patients with axillary metastases and therefore rationalize patient care and inform decision-making. To obtain tissue diagnosis, UNS can be performed by either fine needle aspiration (FNA) or core needle biopsy (CNB). However, few studies have compared the sensitivity of these techniques and the majority show no difference.

Methods

All node-positive patients (those with micro- and macrometastases but not isolated tumor cells) treated at a tertiary referral center between January 2012 and December 2015 were retrospectively identified from pathology records. The result of the first axillary UNS performed on each patient was compared with postoperative histopathology results. The UNS method used was according to individual radiologist preference.

Results

A total of 215 patients underwent FNA (1 patient had bilateral breast cancer and underwent bilateral FNA), and 92 underwent CNB. Sensitivity of CNB was significantly higher than FNA (83.7 vs. 69.0%, P = 0.008). The false-negative rate in the FNA group was therefore higher than in the CNB group by a factor of 2.5. There was no difference in inadequacy rate between the two techniques. There were no complications in the FNA group, and only one hematoma (which did not require operative intervention) in the CNB group.

Conclusions

CNB is safe and should be the preferred technique for UNS to improve sensitivity.

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Long-Term Outcomes After R0 Resection of Synchronous Peritoneal Metastasis from Colorectal Cancer Without Cytoreductive Surgery or Hyperthermic Intraperitoneal Chemotherapy

Abstract

Background

The National Comprehensive Cancer Network (NCCN) guidelines for colon cancer recently added the following footnote regarding the therapeutic strategy for peritoneal metastases: "If R0 resection can be achieved, surgical resection of isolated peritoneal disease may be considered at experienced centers." This study investigated the efficacy of R0 resection of peritoneal metastasis from colorectal cancer without cytoreductive surgery or hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

This retrospective cohort study was conducted at a single-institution tertiary care cancer center. Among 496 consecutive M1c colorectal cancer patients, R0 resection was achieved for 94 patients (19%). The subjects were 78 consecutive patients with colorectal cancer and simultaneous peritoneal metastasis but no other distant metastases who underwent R0 resection at the National Cancer Center Hospital from 1971 to 2016 (16% of all M1c patients). Overall survival (OS) was investigated, and clinicopathologic variables were analyzed for prognostic significance.

Results

No perioperative mortality was noted. The 3-year OS rate was 45%, and the 5-year OS rate was 28.7%. The median survival time was 33.4 months. Notably, 17 patients survived for more than 5 years, and 9 of these patients did not receive any chemotherapy. Multivariate analysis showed cancer location in the colon and harvesting of 12 or more lymph nodes to be independent factors associated with a better prognosis.

Conclusions

From the perspective of long-term outcomes and no perioperative mortality, R0 resection of peritoneal metastasis from colorectal cancer, without complete peritonectomy or HIPEC, appeared to be an acceptable therapeutic option for some patients with peritoneal metastasis.

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Vulnerability of employees in businesses with fewer than five workers (micro-enterprises) to occupational safety and health problems

Introduction

We assessed the characteristics of micro-enterprises (businesses with fewer than five workers) focusing on occupational safety and health (OSH) issues.

Methods

We performed a secondary analysis of data from the Economically Active Population Supplementary Survey and the fourth Korean Working Conditions Survey of 2014.

Results

Relative to larger businesses, micro-enterprises employ more women, temporary workers, and older workers (>55 years). In addition, more workers in micro-enterprises held "elementary occupations" (unskilled or under-skilled) or "sales and service jobs." Key sectors of such employment included the sectors of "wholesale and retail trade" and "hotel and restaurants." Furthermore, lower skilled workers in such micro-enterprises more frequently reported exposure to ergonomic risk factors and subsequent musculoskeletal disorders, and they also experienced a much higher fatality rate due to occupational injuries.

Conclusion

Our results indicate that Korean workers in micro-enterprises are more vulnerable to OSH problems than workers in larger businesses.

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Tres Latin Foods Announces Voluntary Recall of Specific Code Dates of Kale & Pinto Bean 10 oz. Pupusas and Black Bean and Sweet Corn 10 oz. Pupusas Due to an Undeclared Milk Allergen

Tres Latin Foods is voluntarily recalling two batches of production of Kale & Pinto Bean 10 oz. pupusas and one batch of its Black Bean & Sweet Corn pupusas due to an undeclared milk allergen. People who have an allergy or severe sensitivity to milk run the risk of serious or life-threatening allergic reaction if they consume these products.

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Heart irradiation reduces microvascular density and accumulation of HSPA1 in mice

Abstract

Purpose

Improvement of radiotherapy techniques reduces the exposure of normal tissues to ionizing radiation. However, the risk of radiation-related late effects remains elevated. In the present study, we investigated long-term effects of radiation on heart muscle morphology.

Materials and methods

We established a mouse model to study microvascular density (MVD), deposition of collagen fibers, and changes in accumulation of heat shock 70 kDa protein 1 (HSPA1) in irradiated heart tissue. Hearts of C57BL/6 mice received a single dose of X‑ray radiation in the range 0.2–16 Gy. Analyses were performed 20, 40, and 60 weeks after irradiation.

Results

Reduction in MD was revealed as a long-term effect observed 20–60 weeks after irradiation. Moreover, a significant and dose-dependent increase in accumulation of HSPA1, both cytoplasmic and nuclear, was observed in heart tissues collected 20 weeks after irradiation. We also noticed an increase in collagen deposition in hearts treated with higher doses.

Conclusions

This study shows that some changes induced by radiation in the heart tissue, such as reduction in microvessel density, increase in collagen deposition, and accumulation of HSPA1, are observed as long-term effects which might be associated with late radiation cardiotoxicity.

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Long-Term Outcomes After R0 Resection of Synchronous Peritoneal Metastasis from Colorectal Cancer Without Cytoreductive Surgery or Hyperthermic Intraperitoneal Chemotherapy

Abstract

Background

Methods

Results

Conclusions

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Stereotactic Body Radiation Therapy for Isolated Local Recurrence After Surgical Resection of Pancreatic Ductal Adenocarcinoma Appears to be Safe and Effective

Abstract

Background

A standardized treatment regimen for unresectable isolated local recurrence (ILR) of pancreatic ductal adenocarcinoma has not been established. This study evaluated the outcomes for patients with ILR who underwent stereotactic body radiation therapy (SBRT).

Methods

The records of patients with ILR who underwent SBRT between 2010 and 2016 were retrospectively reviewed. Symptom palliation and treatment-related toxicity were recorded. Associations between patient or treatment characteristics and overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS) were assessed.

Results

The study identified 51 patients who received SBRT for ILR. Of the 51 patients, 26 (51%) had not received radiation therapy before SBRT. The median OS was 36 months after diagnosis. From the first day of SBRT, the median OS, PFS, and LPFS were respectively 16, 7, and 10 months. Patients with a recurrence-free interval of 9 months or longer after surgery had superior OS (P = 0.019). Maintenance chemotherapy after SBRT was associated with superior OS (P < 0.001) and LPFS (P = 0.027). In the multivariable analysis, poorly differentiated tumor grade [hazard ratio (HR) 11.274], positive surgical margins (HR 0.126), and reception of maintenance chemotherapy (HR 0.141) were independently associated with OS. Positive surgical margins (HR 0.255) and maintenance chemotherapy (HR 0.299) were associated with improved LPFS. Of 16 patients, 10 (63%) experienced abdominal pain relief after SBRT. Four patients (8%) experienced grade 3 gastrointestinal toxicity, and one patient experienced grade 4 gastrointestinal toxicity.

Conclusions

Use of SBRT for ILR improved pain for a majority of the patients with acceptable acute and late toxicity. The findings show that SBRT is a feasible treatment for select patients with ILR. For those who receive SBRT, maintenance chemotherapy should be considered.

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Morgellons disease

Morgellons disease: a little known disorder of unknown cause that is often associated with nonspecific skin, nerve, and psychiatric symptoms, Some refer to it as a fiber disease. Caucasian females from about 35 to 50 years old tend to develop this uncommon condition more than other groups. An analysis of the condition by a panel of experts concluded that no common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation.

According to the U.S. Centers for Disease Control and Prevention, "this condition is not currently recognized as a distinct clinical disorder with established diagnostic criteria that are generally accepted by the medical community and many dermatologists consider the condition to be synonymous with delusional parasitosis (DP). To date, most of what is known about the condition is based on isolated case reports or anecdotal accounts. A range of potential infectious (for example, Lyme disease, parasitic) and non-infectious causes has been postulated, but the etiology of this condition remains unknown and there have been no proven effective medical therapies." Continue Reading

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Adipose Tissue Metabolism and Cancer Progression: Novel Insights from Gut Microbiota?

Abstract

Purpose of Review

Obesity is strongly associated with the development of several types of cancers. This review aims to discuss the recent key mechanisms and actors underlying the link between adipose tissue metabolism and cancer, and the unequivocal common mechanisms connecting gut microbes to adipose tissue and eventually cancer development.

Recent Findings

Complex interactions among systemic and tissue-specific pathways are suggested to link obesity and cancer, involving endocrine hormones, adipokines, fatty acids, inflammation, metabolic alterations, and hypoxia. Emerging evidence also suggests that the gut microbiota, another key environmental factor, may be considered as a converging element. Studies have shown that cancer susceptibility may be induced in germ-free mice colonized with the gut microbiota from high-fat diet-fed mice. Suggested mechanisms may involve inflammation, immunity changes, lipogenic substrates, and adipogenesis.

Summary

Cancer development is a complex process that may be under the control of previously unthought factors such as the gut microbiota. Whether specific intervention targeting the gut microbiota may reduce adipose tissue-driven cancer is an interesting strategy that remains to be proven.

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Biofilm formation is determinant in tomato rhizosphere colonization by Bacillus velezensis FZB42

Abstract

In this work, the behavior in tomato rhizosphere of Bacillus velezensis FZB42 was analyzed taking into account the surfactin production, the use of tomato roots exudate as substrates, and the biofilm formation. B. velezensis FZB42 and B. amyloliquefaciens S499 have a similar capability to colonize tomato rhizosphere. Little difference in this colonization was observed with surfactin non producing B. velezensis FZB42 mutant strains. B. velezensis is able to grow in the presence of root exudate and used preferentially sucrose, maltose, glutamic, and malic acids as carbon sources. A mutant enable to produce exopolysaccharide (EPS^-) was constructed to demonstrate the main importance of biofilm formation on rhizosphere colonization. This mutant had completely lost its ability to form biofilm whatever the substrate present in the culture medium and was unable to efficiently colonize tomato rhizosphere.

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Combined effects of binary antibiotic mixture on growth, microcystin production, and extracellular release of Microcystis aeruginosa : application of response surface methodology

Abstract

The interactive effects of binary antibiotic mixtures of spiramycin (SP) and ampicillin (AMP) on Microcystis aeruginosa (MA) in terms of growth as well as microcystin production and extracellular release were investigated through the response surface methodology (RSM). SP with higher 50 and 5% effective concentrations in MA growth was more toxic to MA than AMP. RSM model for toxic unit approach suggested that the combined toxicity of SP and AMP varied from synergism to antagonism with SP/AMP mixture ratio decreasing from reversed equitoxic ratio (5:1) to equitoxic ratio (1:5). Deviations from the prediction of concentration addition (CA) and independent action (IA) model further indicated that combined toxicity of target antibiotics mixed in equivalent ratio (1:1) varied from synergism to antagonism with increasing total dose of SP and AMP. With the increase of SP/AMP mixture ratio, combined effect of mixed antibiotics on MA growth changed from stimulation to inhibition due to the variation of the combined toxicity and the increasing proportion of higher toxic component (SP) in the mixture. The mixture of target antibiotics at their environmentally relevant concentrations with increased total dose and SP/AMP mixture ratio stimulated intracellular microcystin synthesis and facilitated MA cell lysis, thus leading to the increase of microcystin productivity and extracellular release.

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Isolation and characterization of culturable bacteria present in the spent nuclear fuel pool water

Abstract

A spent nuclear fuel (SNF) pool is a key facility for safe management of nuclear waste, where spent nuclear fuel rods are stored in a water pool. The spent fuel rods carry a significant amount of radioactivity; they are either recycled or stored for further processing. Pool water acts as a heat sink as well as a shield against the radiation present in spent/burned fuel rods. The water used in these pools is filtered by an ultra-filtration process which makes certain the purity of water. As the life span of these pools is approximately 20 to 40 years, the maintenance of pure water is a big challenge. A number of researchers have shown the presence of bacterial communities in this ultrapure water. The bacterial types present in SNF pool water is of increasing interest for their potential bioremediation applications for radioactive waste. The present study showed the isolation of six bacterial species in the SNF pool water samples, which had significant radio-tolerance (D₁₀ value 248 Gy to 2 kGy) and also biofilm-forming capabilities. These strains were also investigated for their heavy metal removal capacity. Maximum biofilm-mediated heavy metal (Co and Ni) removal (up to 3.8 μg/mg of biomass) was observed by three isolates (FPB1, FPB4, and FPB6). The ability of these bacterial isolates to survive in radioactive environments can be of great interest for remediation of radioactive contaminants.

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Prokaryotic community profiling of local algae wastewaters using advanced 16S rRNA gene sequencing

Abstract

Algae biomass-fed wastewaters are a promising source of lipid and bioenergy manufacture, revealing substantial end-product investment returns. However, wastewaters would contain lytic pathogens carrying drug resistance detrimental to algae yield and environmental safety. This study was conducted to simultaneously decipher through high-throughput advanced Illumina 16S ribosomal RNA (rRNA) gene sequencing, the cultivable and uncultivable bacterial community profile found in a single sample that was directly recovered from the local wastewater systems. Samples were collected from two previously documented sources including anaerobically digested (AD) municipal wastewater and swine wastewater with algae namely Chlorella spp. in addition to control samples, swine wastewater, and municipal wastewater without algae. Results indicated the presence of a significant level of Bacteria in all samples with an average of approximately 95.49% followed by Archaea 2.34%, in local wastewaters designed for algae cultivation. Taxonomic genus identification indicated the presence of Calothrix, Pseudomonas, and Clostridium as the most prevalent strains in both local municipal and swine wastewater samples containing algae with an average of 17.37, 12.19, and 7.84%, respectively. Interestingly, swine wastewater without algae displayed the lowest level of Pseudomonas strains < 0.1%. The abundance of some Pseudomonas species in wastewaters containing algae indicates potential coexistence between these strains and algae microenvironment, suggesting further investigations. This finding was particularly relevant for the earlier documented adverse effects of some nosocomial Pseudomonas strains on algae growth and their multidrug resistance potential, requiring the development of targeted bioremediation with regard to the beneficial flora.

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Macroinvertebrate communities in riverine systems of buffer areas of protected wildland, rangeland and city areas: implications for conservation of riverine systems on urbanising watersheds

Abstract

Riverine systems in developing countries continue to be degraded by anthropogenic pressures such as urbanisation. The responses of biota in watersheds surrounding a drainage divide may provide critical information that is required to protect the ecological condition of riverine systems. This study assessed the spatial variation of selected environmental variables together with macroinvertebrate communities in upper reaches of riverine systems across different land use categories of the Bulawayo region. Based on an a priori selection criterion, studied sites were grouped following an urban-wastewater disturbance gradient comprising of (i) heavily polluted city sites, (ii) moderately disturbed rangeland sites and (iii) less disturbed sites of the buffer areas of protected wildland. Most of the studied environmental variables and the macroinvertebrate community assemblages were significantly (ANOVA, p < 0.05) different and degraded within the city areas. In this study, the variance of environmental variables known to be associated with organic pollution like increased nutrients, embeddedness by particulates, salinity, COD, conductivity, turbidity and reduced dissolved oxygen was found to be related with the variation of macroinvertebrate communities across the studied sites. Besides affirming the effectiveness of macroinvertebrate-based bioassessment approaches, the results of our study demonstrate that an aggressive riverine protection policy that prohibits the discharge of poor-quality urban effluents and preservation of the less disturbed riverine systems needs to be part of the larger urban planning and regulatory framework in urbanising watersheds.

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Relay cropping of wheat ( Triticum aestivum L.) in cotton ( Gossypium hirsutum L.) improves the profitability of cotton-wheat cropping system in Punjab, Pakistan

Abstract

Delayed sowing of wheat (Triticum aestivum L.) in cotton-based system reduces the productivity and profitability of the cotton-wheat cropping system. In this scenario, relay cropping of wheat in standing cotton might be a viable option to ensure the timely wheat sowing with simultaneous improvement in wheat yields and system profitability. This 2-year study (2012–2013 and 2013–2014) aimed to evaluate the influence of sowing dates and relay cropping combined with different management techniques of cotton sticks on the wheat yield, soil physical properties, and the profitability of the cotton-wheat system. The experiment consisted of five treatments viz. (S1) sowing of wheat at the 7th of November by conventional tillage (two disc harrows + one rotavator + two plankings) after the removal of cotton sticks, (S2) sowing of wheat at the 7th of November by conventional tillage (two disc harrows + two plankings) after the incorporation of cotton sticks in the field with a rotavator, (S3) sowing of wheat at the 7th of November as relay crop in standing cotton with broadcast method, (S4) sowing of wheat at the 15th of December by conventional tillage (two disc harrows + one rotavator + two plankings) after the removal of cotton sticks, and (S5) sowing of wheat at the 15th of December by conventional tillage (two disc harrows + two plankings) after the incorporation of cotton sticks in the field with a rotavator. The highest seed cotton yield was observed in the S5 treatment which was statistically similar with the S3 and S4 treatments; seed cotton yield in the S1 and S2 treatments has been the lowest in both years of experimentation. However, the S2 treatment produced substantially higher root length, biological yield, and grain yield of wheat than the other treatments. The lower soil bulk density at 0–10-cm depth was recorded in the S2 treatment which was statistically similar with the S5 treatment during both years of experimentation. The volumetric water contents, net benefit, and benefit-cost ratio were the highest in the S3 treatment during both years of experimentation. Thus, relay cropping of wheat in standing cotton might be a viable option to improve the soil physical environment and profitability of the cotton-wheat cropping system.

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Assessing watercourse quality: challenges in implementing European and Swiss legal frameworks

Abstract

Hydro-climatic changes and the increasing release of pollutants into rivers by human activities tend to affect the quality of watercourses, to alter aquatic ecosystems and to reduce the amount of useable water. The ecological and chemical states of rivers and their evolution is thus of growing concern. In Europe and Switzerland, water policies are progressively shifting towards a holistic approach of river systems. The European Commission notably established a framework to highlight rivers' ecological deficits and to enhance regional or local water management plans. In Switzerland, a similar framework is currently under development. In this paper, both procedures are compared and implemented in a Swiss catchment dominated by agricultural activities. The aim is to define the challenges that still need to be addressed to assess and sustain river health. The hydromorphological, ecological, and ecotoxicological quality of the river was evaluated. Both frameworks highlighted the fact that no section of the river can currently be classified as being in a good environmental state and that the state deteriorates as tributaries and wastewater discharge flow into the main riverbed. Chemical issues and water quality changes due to hydro-climatic variations and management strategies were also pinpointed. Both frameworks are thus useful tools to survey changes in rivers quality in space and over time. However, challenges remain regarding the appropriate strategies to monitor and analyze chemicals, the definition of target values and conditions, the evaluation and integration of human-induced pressures, and the overall evaluation of the state of a river. The development of integrated indicators or of ecosystem services approaches is considered as a potential solution to explore river health and to define efficient restoration measures by water managers.

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Effect of zero-valent iron and trivalent iron on UASB rapid start-up

Abstract

In order to realize the rapid start-up of upflow anaerobic sludge blanket (UASB) reactor, the iron ion in different valence state was added to UASB. The results indicated that the start-up time of R3 (FeCl₃) was 48 h faster than that of R2 (zero-valent iron (ZVI)). It was because the FeCl₃ could rapidly promote granulation of sludge as a flocculant. However, ZVI released Fe²⁺ through corrosion slowly, and then the Fe²⁺ increased start-up speed by enhancing enzyme activity and enriching methanogens. In addition, the ZVI and FeCl₃ could promote hydrolysis acidification and strengthen the decomposition of long-chain fatty acids. The detection of iron ions showed that iron ions mainly existed in the sludge. Because the high concentration of Fe²⁺ could inhibit anaerobic bacteria activity, excess Fe³⁺ could be changed into iron hydroxide precipitation to hinder the mass transfer process of anaerobic bacteria under the alkaline condition. The FeCl₃ was suitable to be added at the initial stage of UASB start-up, and the ZVI was more fitted to be used in the middle stage of reactor start-up to improve the redox ability.

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210 Po and 210 Pb bioaccumulation and possible related dose assessment in parasol mushroom ( Macrolepiota procera )

Abstract

Presented are results of a study on accumulation and distribution of ²¹⁰Po and ²¹⁰Pb in the fruitbodies of parasol mushroom (Macrolepiota procera) and risk to human consumer due to exposure from highly radiotoxic decay particles emitted by both radionuclides. Mushrooms were collected from 16 forested places in central and northern regions of Poland. Activity concentrations of ²¹⁰Po and ²¹⁰Pb were determined after radiochemical separation of nuclides and subsequent measurement using validated method and alpha spectrometer. Results showed on spatially heterogeneous distribution of the ²¹⁰Po and ²¹⁰Po activity concentrations in M. procera and two interpolation maps were prepared. Activity concentrations of nuclides in dried caps of M. procera were in the range from 3.38 ± 0.41 to 16.70 ± 0.33 Bq∙²¹⁰Po ∙kg⁻¹ and from 5.11 ± 0.21 to 13.42 ± 0.30 Bq∙²¹⁰Pb ∙kg⁻¹. Consumption of M. procera foraged in central and northern Poland should not contribute significantly to the annual effective radiation doses from ²¹⁰Po and ²¹⁰Pb due to amount of both nuclides accumulated by fungus in caps.

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Photocatalytic degradation of organic pollutant aldicarb by non-metal-doped nanotitania: synthesis and characterization

Abstract

The current study focused on pollution control by titania through photocatalytic degradation of aldicarb pesticide in aqueous medium. Titania, which is an efficient photocatalyst, can bring about degradation of aqueous organic pollutants under UV and visible light irradiation. Here, we prepared titania by sol-gel method from titanium tetraisopropoxide and doped non-metals like N and S from sources such as urea and thiourea, respectively. The prepared catalyst was characterized by XRD, UV-Vis.DRS, TEM, XPS, etc. Photocatalytic activity of the catalyst was evaluated from extend of degradation of aldicarb pesticide by measuring its concentration with the help of HPLC. It was found that the modified catalyst showed better photocatalytic degradation than pure titania in visible light.

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Multivariate curve resolution of organic pollution patterns in mangrove forest sediment from Qeshm Island and Khamir Port—Persian Gulf, Iran

Abstract

Straight-chain alkanes (n-alkanes) have been proposed as biomarkers to assess petroleum pollution sources in marine environments. In this work, three sampling sites were selected along Iranian-protected mangrove forests in the Persian Gulf. Sample sites were chosen to represent different compositions and sources of n-alkanes in surface sediments (0–5 cm) from different locations in the Khamir Port, in the middle part of the Gulf, and in the Qeshm Island. Samples were analyzed by gas chromatography-mass spectrometry (GC–MS), and the obtained n-alkanes concentrations were analyzed by principal component analysis (PCA) and multivariate curve resolution alternating least squares (MCR-ALS) to deduce their possible sources and distribution patterns. Results revealed that n-alkanes have a dominant biogenic source in marginal Qeshm Island stations, which changed from biogenic to petrogenic sources in the Khamir Port areas. Sediment samples from the Khamir Port showed the significant presence of oil pollution due to transportation. These samples are being exposed to basic Persian Gulf currents entering from the Hormuz Strait causing oil pollution spread over the entire Gulf area. Sediment samples of the Middle Part stations located between two other sites show a combined condition of the two previous sections, with petrogenic and biogenic contributions. The present study demonstrates that the Hara Protected Area was already contaminated by background oil pollution as a result of continuous oil spills and war conflicts in the Persian Gulf.

Additionally, the MCR-ALS method is shown to be a powerful chemometric tool for the investigation, resolution, identification, and description of pollution patterns distributed over a particular geographical area and environmental compartment. They can be used as well as parameters like unresolved to resolved ratio (U/R), pristane to phytane (Pr/Ph), n-C₁₇/Pr, n-C₁₈/Ph, and unresolved complex mixture (UCM) to assess petroleum pollution sources in the sediments.

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Corn industrial wastewater (nejayote): a promising substrate in Mexico for methane production in a coupled system (APCR-UASB)

Abstract

In Mexico, the corn tortilla is a food of great economic importance. Corn tortilla production generates about 1500–2000 m³ of wastewater per 600 tons of processed corn. Although this wastewater (also known as nejayote) has a high organic matter content, few studies in Mexico have analyzed its treatment. This study presents fresh data on the potential methane production capacity of nejayote in a two-phase anaerobic digestion system using an Anaerobic-Packed Column Reactor (APCR) to optimize the acidogenic phase and an up-flow anaerobic sludge blanket (UASB) reactor to enhance the methanogenic process. Results indicate that day 8 was ideal to couple the APCR to the UASB reactor. This allowed for a 19-day treatment that yielded 96% COD removal and generated a biogas containing 84% methane. The methane yield was 282 L kg⁻¹ of COD_removed. Thus, two-phase anaerobic digestion is an efficient process to treat nejayote; furthermore, this study demonstrated the possibility of using an industrial application by coupling the APCR to the UASB reactor system, in order to assess its feasibility for biomethane generation as a sustainable bioenergy source.

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Occurrence of multi-class surfactants in urban wastewater: contribution of a healthcare facility to the pollution transported into the sewerage system

Abstract

Healthcare facility discharges, by their nature, are often considered as non-domestic effluent, which can provide significant pollution comparatively to other domestic sources. In this context, a total of 12 monthly sampling campaigns were collected from a healthcare facility as well as the output of a sewerage system of Site Pilote de Bellecombe (SIPIBEL) observatory. This study focuses more specifically on 12 surfactants and biocides: four anionics, four cationic, two non-ionic, one zwitterionic, and one dispersive agent, among the most commonly used commercial surfactants. Particular attention was also provided to routine wastewater quality parameters. Both effluents were heavily contaminated by most anionic surfactants; they displayed median concentrations up to 1 to 2 mg/L for linear alkylbenzene sulfonates and between 10 and 100 μg/L for other sodium sulfate congeners (lauryl and laureth). Overall, for the majority of surfactants, the healthcare facility contribution to the total flux reaching the wastewater treatment plant ranges between 5 and 9%.

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Environmental impact assessment of municipal solid waste management options using life cycle assessment: a case study

Abstract

The goal of this study is to use life cycle assessment (LCA) tool to assess possible environmental impacts of different municipal solid waste management (MSWM) scenarios on various impact categories for the study area Dhanbad City, India. The scenarios included in the present study are collection and transportation (denoted as S1); baseline scenario consisting of recycling, open burning, open dumping, and finally unsanitary landfilling without energy recovery (denoted by S2); composting and landfilling (denoted by S3); and recycling and composting followed by landfilling of inert waste without energy recovery (denoted by S4). One ton of municipal solid waste (MSW) was selected as the functional unit. The primary data were collected through sampling, surveys, and literatures. Background data were obtained from Eco-invent data of SimaPro 8.1 libraries. The scenarios were compared using the CML 2 baseline 2000 method, and the results indicated that the scenario S1 had the highest impact on marine aquatic ecotoxicity (1.86E + 04 kg 1,4-DB eq.) and abiotic depletion (2.09E + 02 kg Sb eq.). S2 had the highest impact on global warming potential (9.42E + 03 kg CO₂ eq.), acidification (1.15E + 01 kg SO₂ eq.), eutrophication (2.63E + 00 kg PO₄³⁻ eq.), photochemical oxidation (2.12E + 00 kg C₂H₄ eq.), and human toxicity (2.25E + 01 kg 1,4-DB eq.). However, S3 had the highest impact on abiotic depletion (fossil fuels) (2.71E + 02 MJ), fresh water aquatic ecotoxicity (6.54E + 00 kg 1,4-DB eq.), terrestrial ecotoxicity (3.36E − 02 kg 1,4-DB eq.), and ozone layer depletion (2.73E − 06 kg CFC-11 eq.). But S4 did not have the highest impact on any of the environmental impact categories due to recycling of packaging waste and landfilling of inert waste. Landfilling without energy recovery of mixed solid waste was found as the worst disposal alternative. The scenario S4 was found as the most environmentally suitable technology for the study area and recommended that S4 should be considered for strategic planning of MSWM for the study area.

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Purification of Hg 0 from flue gas by wet oxidation method and its mechanism: a review

Abstract

The vast majority of Hg²⁺ can be removed while elemental mercury (Hg⁰) can hardly be removed due to its characteristic of high volatility and insolubility in water. Till now, how to oxidize Hg⁰ to Hg²⁺ is the key for the purification of Hg⁰, especially when there are others pollutants, such as HCl, SO₂, and NOx. In this review, the method and mechanism of Hg⁰ purification from flue gas by H₂O₂, KMnO₄, NaClO₂, and O₃ are reviewed comprehensively. It is concluded that the oxidation of Hg⁰ mainly depends on the electronic supply efficiency from the solution. The Fenton reagent, composed of H₂O₂ and metal cations, is superior to O₃ and the solution of KMnO₄ and NaClO₂. Moreover, HCl, SO₂, and NOx in the flue gas can influence the oxidation and purification mechanism of Hg⁰. It is found that HCl in flue gas had obvious auxo-action on the oxidation of mercury, and SO₂ and NOx have different effects on the oxidation of Hg⁰ with the change of compositions and concentration of pollutants in the flue gas. In general, SO₂ and NOx can slightly promote the oxidation of Hg⁰ due to the synergistic effect.

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Existing forms and changes of nitrogen inside of horizontal subsurface constructed wetlands

Abstract

Horizontal zeolite subsurface constructed wetland system (HZCWs) and horizontal limestone subsurface constructed wetland system (HLCWs) were applied to the removal of nitrogen in lightly polluted wastewater, and the existing forms, changes, and removal mechanism of nitrogen in the constructed wetlands were analyzed. The results indicated that compared with HLCWs, HZCWs exhibited better nitrogen removal effect, and the maximum removal rates of ammonia nitrogen and total nitrogen could reach 96.97 ± 5.29 and 93.12 ± 3.35%, respectively. Besides, analysis of the removal effect on nitrogen in different existing forms on different substrate heights in the constructed wetlands showed that variation of nitrogen removal efficiency had certain regularities, which were related to the interior construction features of the wetland systems, and agreed with the regularities in the changes of the influential factors such as DO inside of the wetlands. In addition, degradation mechanism of pollutions was also analyzed, and the results indicated that the quantity of microorganisms and enzymes, including FDA, catalase, and urease, on the surface of the substrates had significant influence on the removal regularities and effects of the major pollutions in constructed wetlands.

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Heavy metal and nutrient uptake in plants colonizing post-flotation copper tailings

Abstract

Copper ore mining and processing release hazardous post-flotation wastes that are difficult for remediation. The studied tailings were extremely rich in Cu (1800 mg kg⁻¹) and contaminated with Co and Mn, and contained very little available forms of P, Fe, and Zn. The plants growing in tailings were distinctly enriched in Cu, Cd, Co, Ni, and Pb, and the concentration of copper achived the critical toxicity level in shoots of Cerastium arvense and Polygonum aviculare. The redundancy analysis demonstrated significant relationship between the concentration of available forms of studied elements in substrate and the chemical composition of plant shoots. Results of the principal component analysis enabled to distinguish groups of plants which significantly differed in the pattern of element accumulation. The grass species Agrostis stolonifera and Calamagrostis epigejos growing in the tailings accumulated significantly lower amounts of Cu, but they also had the lowest levels of P, Fe, and Zn in comparison to dicotyledonous. A. stolonifera occurred to be the most suitable species for phytostabilization of the tailings with regard to its low shoot Cu content and more efficient acquisition of limiting nutrients in relation to C. epigejos. The amendments improving texture, phosphorus fertilization, and the introduction of native leguminous species were recommended for application in the phytoremediation process of the tailings.

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The impact of foreign direct investment on CO 2 emissions in Turkey: new evidence from cointegration and bootstrap causality analysis

Abstract

Pollution haven hypothesis (PHH), which is defined as foreign direct investment inducing a raising impact on the pollution level in the hosting country, is lately a subject of discussion in the field of economics. This study, within the scope of related discussion, aims to look into the potential impact of foreign direct investments on CO₂ emission in Turkey in 1974–2013 period using environmental Kuznets curve (EKC) model. For this purpose, Maki (Econ Model 29(5):2011–2015, 2012) structural break cointegration test, Stock and Watson (Econometrica 61:783–820, 1993) dynamic ordinary least square estimator (DOLS), and Hacker and Hatemi-J (J Econ Stud 39(2):144–160, 2012) bootstrap test for causality method are used. Research results indicate the existence of a long-term balance relationship between FDI, economic growth, energy usage, and CO₂ emission. As per this relationship, in Turkey, (1) the potential impact of FDI on CO₂ emission is positive. This result shows that PHH is valid in Turkey. (2) Moreover, this is not a one-way relationship; the changes in CO₂ emission also affect FDI entries. (3) The results also provide evidence for the existence of the EKC hypothesis in Turkey. Within the frame of related findings, the study concludes several polities and presents various suggestions.

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Pre-emptive Diclofenac Versus Ketoprofen as a Transdermal Drug Delivery System: How They Face

Abstract

Aim

To compare the analgesic efficacy of Diclofenac vis-a-vis Ketoprofen transdermal patch, in the management of immediate post-operative pain following orthognathic procedures.

Material and Method

A prospective, double-blinded, randomised controlled study was conducted among 50 subjects, between 2012 and 2015. These patients were diagnosed clinically and cephalometrically as skeletal and dental class II malocclusion and underwent bi-jaw surgical procedure. In total, 25 Diclofenac and 25 Ketoprofen transdermal patches, sealed in envelopes and numbered, were administered to subjects. The patches used, contained 100 mg of either Diclofenac or Ketoprofen and administered by a nurse prior to induction. Duration of analgesia, severity of pain using Visual Analog Scale, necessity of rescue analgesia (spontaneous pain > 5 on a 10-cm scale) and any other adverse effect associated with the drug were evaluated.

Results

Mean duration of analgesia was significantly higher in the Ketoprofen group (20 h), compared to Diclofenac group (13 h) (p = 0.001). Rescue analgesia was required in 12% of subjects who received Diclofenac patch, compared to 4% in Ketoprofen group. None of the subjects showed any allergic reactions.

Conclusion

The study was designed to evaluate the efficacy of transdermal patch in reduction of post-operative pain in subjects undergoing bi-jaw surgeries. Subjects in both groups were comfortable and returned to early function. However, Ketoprofen transdermal patch had an edge over the Diclofenac transdermal patch with respect to analgesic efficacy.

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The Relationship Between the Permeability and the Performance of Carrier-Based Dry Powder Inhalation Mixtures: New Insights and Practical Guidance

Abstract

The permeability of a powder bed reflects its particle size distribution, shape, packing, porosity, cohesivity, and tensile strength in a manner relevant to powder fluidization. The relationship between the permeability and the performance of carrier-based dry powder inhalation (DPI) mixtures has, however, aroused controversy. The current study sought to gain new insights into the relationship and to explore its potential applications. We studied eight lactose materials as DPI carriers. The carriers covered a broad permeability range of 0.42–13.53 D and moreover differed in particle size distribution, particle shape, crystal form, and/or porosity. We evaluated the performance of inhalation mixtures of each of these carriers and fluticasone propionate after aerosolization from an Aerolizer®, a model turbulent-shear inhaler, at a flow rate of 60 L/min. Starting from the high permeability side, the inhalation mixture performance increased as the carrier permeability decreased until optimum performance was reached at permeability of ~ 3.2 D. Increased resistance to air flow strengthens aerodynamic dispersion forces. The inhalation mixture performance then decreased as the carrier permeability further decreased. Very high resistance to air flow restricts powder dispersion. The permeability accounted for effects of carrier size, shape, and macroporosity on the performance. We confirmed the relationship by analysis of two literature permeability–performance datasets, representing measurements that differ from ours in terms of carrier grades, drug, technique used to determine permeability, turbulent-shear inhaler, and/or aerosolization flow rate. Permeability provides useful information that can aid development of DPI mixtures for turbulent-shear inhalers. A practical guidance is provided.

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Modeling of Lymphogenous and Hematogenous Metastasizing from Murine В16 Melanoma in Rats

We developed a model of experimental melanoma. Intralienal xenogeneic transplantation of a suspension of melanoma cells B16 in physiological saline (0.1 ml; 1:10) was conducted to outbred male rats. In 6 months, histologically confirmed melanoma B16 in the spleen and its metastases in the liver, intestine, pancreas, adrenal glands, and lungs (hematogenous metastasis), as well as in the thymus and lymph nodes (lymphogenous metastasis) were revealed in rats. The proposed rat model of melanoma B16 metastasizes by the hematogenous and lymphogenous pathways, develops over 6 months, and allows receiving sufficient volume of material for analysis.

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Αρχειοθήκη ιστολογίου

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Δευτέρα 23 Οκτωβρίου 2017

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