In the surgical management of oral cavity squamous cell carcinoma (OCSCC), radical resection with adequate margins is paramount in achieving local control. To obtain microscopically clear margins >0.5 cm, additional resection of normal tissue >1.0–1.5 cm from the gross tumor border is recommended [1,2]. Therefore, defect size is always significantly larger than the tumor itself, and reconstruction is commonly required to establish form and function in the resected organ, with the exception of some T1 and T2 OCSCCs.
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Πέμπτη 7 Δεκεμβρίου 2017
Reconstruction of oral cavity defect using versatile buccinator myomucosal flaps in the treatment of cT2–3, N0 oral cavity squamous cell carcinoma: Feasibility, morbidity, and functional/oncological outcomes
Prognostic value of masticatory muscle involvement in nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy
In 2017, the UICC/AJCC published the 8th edition of their staging manual for NPC, which has gained universal acceptance. This is a revision based on the UICC/AJCC's 7th edition and the 2008 Chinese staging system. There are three important adjustments for primary tumor site (T) classifications: (1) T0 is added for Epstein-Barr virus (EBV)-positive cancers with cervical lymph node involvement and no identifiable primary tumor; (2) New evidence has confirmed the prognostic value of the prevertebral muscle in NPC patients with tumors designated as T2; (3) The previous T4 criteria of "masticator space" and "infratemporal fossa" are now replaced by a specific description of soft tissue involvement and tumors that invade the medial pterygoid muscle (MP) and/or the lateral pterygoid muscle (LP) are now down-staged as T2 [1].
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Plasticity of oral mucosal cell sheets for accelerated and scarless skin wound healing
This study examined the potential utility of a newly developed oral mucosal cell sheet in skin excisional wounds. The oral mucosal cell sheet promoted wound healing with early wound closure and less scarring and demonstrated in vivo tissue plasticity through good adaptation in cutaneous wounds.
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Evaluation of the diagnostic efficacy and spectrum of autofluorescence of benign, dysplastic and malignant lesions of the oral cavity using VELscope
In individuals exposed to risk factors; the prevention and early detection of oral cancer play a significant role in increasing the survival rates [1,2]. In the absence of a definitive approach, screening of oral cancer is still largely based on conventional oral examination (COE) and scalpel biopsy in case of suspicious lesions [3,4]. Since visible changes in the oral mucosa are known to precede the development of virtually all oral squamous cell carcinomas (OSCCs), various adjunctive techniques have been introduced with the aim to assist in the detection of early cancerous mucosal changes that can be occult to visual inspection [5,6].
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Head and neck reconstruction with free flaps based on the thoracodorsal system
Evolution in the range of free flaps available for head and neck cancer has facilitated successful reconstructive surgery in increasingly demanding defects. Patients presenting with extensive primary or recurrent tumours, as well as cases of osteoradionecrosis, form a significant part of the head and neck reconstructive surgeon's practice. These cases often incorporate complex three-dimensional defects that include both osseous and soft tissue components as well as more than one epithelial surface (e.g.
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Results of a phase II randomized controlled clinical trial comparing efficacy of Cabazitaxel versus Docetaxel as second line or above therapy in recurrent head and neck cancer
Head and neck squamous cell cancer (SCCHN) is the fifth most common cancer worldwide and is the most common neoplasm in central Asia [1]. Head and neck malignancies are common in regions of the world where tobacco use and alcohol consumption is high [2]. The five-year survival ranges from 20 to 90% depending upon the subsite of origin and the clinical extent of disease [3]. Current therapy consists of surgery, radiotherapy and chemotherapy [3]. More than 60% patients develop recurrence in locally advanced head and neck cancer [4].
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Orthodontic treatment- can a vibrational stimulus shorten treatment times?
8 studies were included in this review of vibrational stimulus to accelerate orthodontic treatment. The studies were small and of short duration providing very low quality evidence to support any effect. Further high quality studies of longer duration are needed.
The post Orthodontic treatment- can a vibrational stimulus shorten treatment times? appeared first on National Elf Service.
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PARP1 facilitates EP300 recruitment to the promoters of the subset of RBL2-dependent genes
Publication date: Available online 5 December 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Agnieszka Robaszkiewicz, Ewelina Wiśnik, Zsolt Regdon, Kinga Chmielewska, László Virág
Differentiation of human monocytes is associated with proliferation arrest resulting from activation of the inter alia retinoblastoma protein family of gene repressors, which target gene promoters in an E2F-dependent manner. To investigate RBL2 contribution to defining monocyte phenotype and function, we used primer libraries. We identified genes encoding two surface receptors (CXCR1 and IL17RE) and two TLR signaling mediators (CD86 and NFKB2) that are repressed by the RBL2-E2F4-HDAC1-BRM complex. Surprisingly, PARP1 co-regulated 24 out of the 28 identified genes controlled by RBL2. Upon RBL2 silencing, PARP1 was recruited to one subset of RBL2-dependent genes, represented by MAP2K6 and MAPK3. RBL2 silencing also restored PARP1 transcription. Gene promoters enriched in PARP1 were characterized by increased histone acetylation and the replacement of HDAC1 with EP300. While PARP1 was dispensable for HDAC1 dissociation, EP300 was found only at gene promoters enriched in PARP1. EP300 activated transcription of PARP1/RBL2 co-regulated genes, but not genes solely controlled by RBL2. DNA was a prerequisite to the formation of an immunoprecipitated PARP1-EP300 complex, suggesting that PARP1 enabled EP300 binding, which in turn activated gene transcription. Notably, PARP1 overexpression failed to overcome the inhibitory effect of RBL2 on MAP2K6 and MAPK3 transcription. The same interdependence was observed in proliferating cancer cells; the low abundance of RBL2 resulted in PARP1-mediated EP300 recruitment to promoters of the MAP2K6 and MAPK3 genes. We conclude that RBL2 may indirectly regulate transcription of some genes by controlling PARP1-mediated EP300 recruitment.
Graphical abstract
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Cooperativity between different tRNA modifications and their modification pathways
Publication date: Available online 5 December 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Mikołaj Sokołowski, Roland Klassen, Alexander Bruch, Raffael Schaffrath, Sebastian Glatt
Ribonucleotide modifications perform a wide variety of roles in synthesis, turnover and functionality of tRNA molecules. The presence of particular chemical moieties can refine the internal interaction network within a tRNA molecule, influence its thermodynamic stability, contribute novel chemical properties and affect its decoding behavior during mRNA translation. As the lack of specific modifications in the anticodon stem and loop causes disrupted proteome homeostasis, diminished response to stress conditions, and the onset of human diseases, the underlying modification cascades have recently gained particular scientific and clinical interest. Nowadays, a complicated but conclusive image of the interconnectivity between different enzymatic modification cascades and their resulting tRNA modifications emerges. Here we summarize the current knowledge in the field, focusing on the known instances of cross talk among the enzymatic tRNA modification pathways and the consequences on the dynamic regulation of the tRNA modificome by various factors. This article is part of a Special Issue entitled: SI: Regulation of tRNA synthesis and modification in physiological conditions and disease edited by Dr. Boguta Magdalena.
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Regulation of tRNA gene transcription by the chromatin structure and nucleosome dynamics
Publication date: Available online 5 December 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Ashutosh Shukla, Purnima Bhargava
The short, non-coding genes transcribed by the RNA polymerase (pol) III, necessary for survival of a cell, need to be repressed under the stress conditions in vivo. The pol III-transcribed genes have adopted several novel chromatin-based regulatory mechanisms to their advantage. In the budding yeast, the sub-nucleosomal size tRNA genes are found in the nucleosome-free regions, flanked by positioned nucleosomes at both the ends. With their chromosomes-wide distribution, all tRNA genes have a different chromatin context. A single nucleosome dynamics controls the accessibility of the genes for transcription. This dynamics operates under the influence of several chromatin modifiers in a gene-specific manner, giving the scope for differential regulation of even the isogenes within a tRNA gene family. The chromatin structure around the pol III-transcribed genes provides a context conducive for steady-state transcription as well as gene-specific transcriptional regulation upon signaling from the environmental cues.This article is part of a Special Issue entitled: SI: Regulation of tRNA synthesis and modification in physiological conditions and disease edited by Dr. Boguta Magdalena.
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tRNA dynamics between the nucleus, cytoplasm and mitochondrial surface: Location, location, location
Publication date: Available online 28 November 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Kunal Chatterjee, Regina T. Nostramo, Yao Wan, Anita K. Hopper
Although tRNAs participate in the essential function of protein translation in the cytoplasm, tRNA transcription and numerous processing steps occur in the nucleus. This subcellular separation between tRNA biogenesis and function requires that tRNAs be efficiently delivered to the cytoplasm in a step termed "primary tRNA nuclear export". Surprisingly, tRNA nuclear-cytoplasmic traffic is not unidirectional, but, rather, movement is bidirectional. Cytoplasmic tRNAs are imported back to the nucleus by the "tRNA retrograde nuclear import" step which is conserved from budding yeast to vertebrate cells and has been hijacked by viruses, such as HIV, for nuclear import of the viral reverse transcription complex in human cells. Under appropriate environmental conditions cytoplasmic tRNAs that have been imported into the nucleus return to the cytoplasm via the 3rd nuclear-cytoplasmic shuttling step termed "tRNA nuclear re-export", that again is conserved from budding yeast to vertebrate cells. We describe the 3 steps of tRNA nuclear-cytoplasmic movements and their regulation. There are multiple tRNA nuclear export and import pathways. The different tRNA nuclear exporters appear to possess substrate specificity leading to the tantalizing possibility that the cellular proteome may be regulated at the level of tRNA nuclear export. Moreover, in some organisms, such as budding yeast, the pre-tRNA splicing heterotetrameric endonuclease (SEN), which removes introns from pre-tRNAs, resides on the cytoplasmic surface of the mitochondria. Therefore, we also describe the localization of the SEN complex to mitochondria and splicing of pre-tRNA on mitochondria, which occurs prior to the participation of tRNAs in protein translation. This article is part of a Special Issue entitled: SI: Regulation of tRNA synthesis and modification in physiological conditions and disease edited by Dr. Boguta Magdalena.
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Elongator—a tRNA modifying complex that promotes efficient translational decoding
Publication date: Available online 21 November 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Marcus J.O. Johansson, Fu Xu, Anders S. Byström
Naturally occurring modifications of the nucleosides in the anticodon region of tRNAs influence their translational decoding properties. Uridines present at the wobble position in eukaryotic cytoplasmic tRNAs often contain a 5-carbamoylmethyl (ncm5) or 5-methoxycarbonylmethyl (mcm5) side-chain and sometimes also a 2-thio or 2′-O-methyl group. The first step in the formation of the ncm5 and mcm5 side-chains requires the conserved six-subunit Elongator complex. Although Elongator has been implicated in several different cellular processes, accumulating evidence suggests that its primary, and possibly only, cellular function is to promote modification of tRNAs. In this review, we discuss the biosynthesis and function of modified wobble uridines in eukaryotic cytoplasmic tRNAs, focusing on the in vivo role of Elongator-dependent modifications in Saccharomyces cerevisiae. This article is part of a Special Issue entitled: SI: Regulation of tRNA synthesis and modification in physiological conditions and disease edited by Dr. Boguta Magdalena.
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The Molecular Pathway Regulating Bergmann Glia and Folia Generation in the Cerebellum
Abstract
Evolution of complex behaviors in higher vertebrates and primates require the development of sophisticated neuronal circuitry and the expansion of brain surface area to accommodate the vast number of neuronal and glial populations. To achieve these goals, the neocortex in primates and the cerebellum in amniotes have developed specialized types of basal progenitors to aid the folding of their cortices. In the cerebellum, Bergmann glia constitute such a basal progenitor population, having a distinctive morphology and playing a critical role in cerebellar corticogenesis. Here, we review recent studies on the induction of Bergmann glia and their crucial role in mediating folding of the cerebellar cortex. These studies uncover a key function of FGF-ERK-ETV signaling cascade in the transformation of Bergmann glia from radial glia in the ventricular zone. Remarkably, in the neocortex, the same signaling axis operates to facilitate the transformation of ventricular radial glia into basal radial glia, a Bergmann glia-like basal progenitor population, which have been implicated in the establishment of neocortical gyri. These new findings draw a striking similarity in the function and ontogeny of the two basal progenitor populations born in distinct brain compartments.
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Comparison of paired and single clinical placement models: a time-use analysis
Abstract
Background
To meet rising clinical placement demand caused by increasing health student numbers, the use of paired (two students) rather than single (one student) placement models has been proposed. There is, however, limited research available to inform placement providers about the relative effects of both models on healthcare services, including patient- and non-patient-related activities and patient occasions of service.
Aims
To investigate a key clinical question: Does clinical educator (supervisor) and student time use differ during paired placements compared with single placements? Also to examine the satisfaction levels of clinical educators (CEs) and students with paired and single clinical placement models.
Methods & Procedures
Queensland Health speech and language therapists (N = 44) and speech and language therapy students (N = 32) involved in paired or single clinical placements were recruited for this study. CEs and students completed time-use surveys for 3 days after the midpoint of placements; CEs also completed surveys for 3 matched days during a non-placement period 3 weeks or more following placements for comparative purposes. CEs and students additionally completed a satisfaction survey at the end of placements. Paired and single CE and student groups were compared for differences in their time-use and satisfaction levels using non-parametric statistics.
Outcomes & Results
The placement model did not impact on occasions of service provided by CEs (p = 0.931) or students (p = 0.776). It also had no effect on the percentage of time CEs or students engaged in patient-related activities (p = 0.577; 0.291) and non-patient-related activities (p = 0.559; 0.177). On clinical placement days, CEs spent a median 10 minutes longer at work regardless of whether or not it was a paired or single placement, compared with non-placement days (p = 0.107). CEs and students who had been involved in a paired placement reported the same high levels of placement satisfaction (various measures) as those who had been involved in a single placement.
Conclusions & Implications
The paired-placement model has the potential to increase student placement offers without negatively impacting on clinical service provision including occasions of service, patient or non-patient-related activities, or overall CE time spent at work.
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Structural insights into ankyrin repeat-mediated recognition of the kinesin motor protein KIF21A by KANK1, a scaffold protein in focal adhesion [Protein Structure and Folding]
Kidney ankyrin repeat-containing proteins (KANK1/2/3/4) belong to a family of scaffold proteins, playing critical roles in cytoskeleton organization, cell polarity and migration. Mutations in KANK proteins are implicated in cancers and genetic diseases, such as nephrotic syndrome. KANK proteins can bind various target proteins through different protein regions, including a highly conserved ankyrin repeat domain (ANKRD). However, the molecular basis for target recognition by the ANKRD remains elusive. In this study, we solved a high-resolution crystal structure of the ANKRD of KANK1 in complex with a short sequence of the motor protein kinesin family member 21A (KIF21A), revealing that the highly specific target-binding mode of the ANKRD involves combinatorial use of two interfaces. Mutations in either interface disrupted the KANK1/KIF21A interaction. Cellular immunofluorescence localization analysis indicates that binding-deficient mutations block recruitment of KIF21A to focal adhesions by KANK1. In conclusion, our structural study provides mechanistic explanations for the ANKRD-mediated recognition of KIF21A and for many disease-related mutations identified in human KANK proteins.
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RAD52 is required for RNA-templated recombination repair in post-mitotic neurons [DNA and Chromosomes]
It has been long assumed that post-mitotic neurons only utilize the error-prone non-homologous end joining (NHEJ) pathway to repair double strand breaks (DSBs) associated with oxidative damage to DNA, given the inability of non-replicating neuronal DNA to utilize a sister chromatid template in the less error-prone homologous recombination (HR) repair pathway. However, we and others recently have found that active transcription triggers a replication-independent recombinational repair mechanism in the G0/G1 phase of the cell cycle. Here we observed that the HR repair protein RAD52 is recruited to sites of DNA DSBs in terminally differentiated, post-mitotic neurons. This recruitment is dependent upon the presence of a nascent mRNA generated during active transcription, providing evidence that an RNA-templated HR repair mechanism exists in non-dividing, terminally differentiated neurons. This recruitment of RAD52 in neurons is decreased by transcription inhibition. Importantly, we found that high concentrations of amyloid beta (Aβ), a toxic protein associated with Alzheimer's disease (AD), inhibits the expression and DNA damage response of RAD52, potentially leading to a defect in the error-free, RNA-templated HR repair mechanism. This study shows a novel RNA dependent repair mechanism of DSBs in postmitotic neurons, and demonstrates that defects in this pathway may contribute to neuronal genomic instability and consequent neurodegenerative phenotypes such as seen in AD.
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A potent, selective and orally bioavailable inhibitor of the protein tyrosine phosphatase PTP1B improves insulin and leptin signaling in animal models [Metabolism]
The protein tyrosine phosphatase PTP1B is a negative regulator of insulin and leptin signaling, and a highly validated therapeutic target for diabetes and obesity. Conventional approaches to drug development have produced potent and specific PTP1B inhibitors, but these inhibitors lack oral bioavailability, which limits their potential for drug development. Here we report that DPM-1001, an analogue of the specific PTP1B inhibitor trodusquemine (MSI-1436), is a potent, specific and orally bioavailable inhibitor of PTP1B. DPM-1001 also chelates copper, which enhanced its potency as a PTP1B inhibitor. DPM-1001 displayed anti-diabetic properties that were associated with enhanced signaling through insulin and leptin receptors in animal models of diet-induced obesity. Therefore, DPM-1001 represents a proof of concept for a new approach to therapeutic intervention in diabetes and obesity. Although the PTPs have been considered undruggable, the findings of this study suggest that allosteric PTP inhibitors may help reinvigorate drug development efforts that focus on this important family of signal transducing enzymes.
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The intracellular immune receptor Rx1 regulates the DNA-binding activity of a Golden2-like transcription factor [Plant Biology]
Plant NLR proteins enable the immune system to recognise and respond to pathogen attack. An early consequence of immune activation is transcriptional reprogramming and some NLRs have been shown to act in the nucleus and interact with transcription factors. The Rx1 NLR protein of potato is further able to bind and distort double-stranded DNA. However, Rx1 host targets that support a role for Rx1 in transcriptional reprogramming at DNA are unknown. Here we report a functional interaction between Rx1 and NbGlk1, a Golden2- like transcription factor. Rx1 binds to NbGlk1 in vitro and in planta. NbGlk1 binds to known Golden2-like consensus DNA sequences. Rx1 reduces the binding affinity of NbGlk1 for DNA in vitro. NbGlk1 activates cellular responses to potato virus X, whereas Rx1 associates with NbGlk1 and prevents its assembly on DNA in planta unless activated by PVX. This study provides new mechanistic insight into how an NLR can co-ordinate an immune signalling response at DNA following pathogen perception.
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Protein C receptor stimulates multiple signaling pathways in breast cancer cells [Cell Biology]
The protein C receptor (PROCR) has emerged as a stem cell marker in several normal tissues and has also been implicated in tumor progression. However, the functional role of PROCR and the signaling mechanisms downstream of PROCR remain poorly understood. Here, we dissected the PROCR signaling pathways in breast cancer cells. Combining protein array, knockdown, and overexpression methods, we found that PROCR concomitantly activates multiple pathways. We also noted that PROCR-dependent ERK and PI3k-Akt-mTOR signaling pathways proceed through Src kinase and trans-activation of insulin-like growth factor 1 receptor (IGF-1R). These pathway activities led to the accumulation of c-Myc and Cyclin D1. On the other hand, PROCR-dependent RhoA-ROCK-p38 signaling relied on coagulation factor II thrombin receptor (F2R). We confirmed these findings in primary cells isolated from triple negative breast cancer-derived xenografts (PDX) that have high expression of PROCR. To the best our knowledge, this is the first comprehensive study of PROCR signaling in breast cancer cells, and its findings also shed light on the molecular mechanisms of PROCR in stem cells in normal tissue.
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Evaluation of lipid-lowering effect of Cynara scolymus extract-loaded mesoporous silica nanoparticles on ultra-lipid-fed mice
Abstract
In current investigation, twenty mice were divided into 4 different equal groups as follows: group CS which received 0.1 ml Cynara scolymus extract (diluted in distilled water) at dose of 600 mg kg−1 daily for 3 weeks, group A which received 0.1 ml Atorvastatin 40 (diluted in distilled water) at dose of 20 mg kg−1 daily for 21 days, group T which received 0.1 ml of Cynara scolymus extract at dose of 600 mg kg−1 daily in nonporous (diluted in distilled water) during experimental period, and control group (group C) which received the same volume of normal saline. The supplements were gavaged in all animals, during experiment period, and blood samples were obtained after 21 days. Results showed that total cholesterol and triglyceride decreased significantly in the treatment group compared with the control and CS groups (p < 0.05). It seems that mesoporous silica nanoparticles improve drug delivery and therefore Cynara scolymus extract-loaded mesoporous silica nanoparticles has more effective lipid-lowering action than Cynara scolymus extract.
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Diagnostic Accuracy of Centrally Restricted Diffusion in the Differentiation of Treatment-Related Necrosis from Tumor Recurrence in High-Grade Gliomas [ADULT BRAIN]
BACKGROUND AND PURPOSE:
Centrally restricted diffusion has been demonstrated in recurrent high-grade gliomas treated with bevacizumab. Our purpose was to assess the accuracy of centrally restricted diffusion in the diagnosis of radiation necrosis in high-grade gliomas not treated with bevacizumab.
MATERIALS AND METHODS:In this prospective study, we enrolled patients with high-grade gliomas who developed a new ring-enhancing necrotic lesion and who underwent re-resection. The presence of a centrally restricted diffusion within the ring-enhancing lesion was assessed visually on diffusion trace images and by ADC measurements on 3T preoperative diffusion tensor examination. The percentage of tumor recurrence and radiation necrosis in each surgical specimen was defined histopathologically. The association between centrally restricted diffusion and radiation necrosis was assessed using the Fisher exact test. Differences in ADC and the ADC ratio between the groups were assessed via the Mann-Whitney U test, and receiver operating characteristic curve analysis was performed.
RESULTS:Seventeen patients had re-resected ring-enhancing lesions: 8 cases of radiation necrosis and 9 cases of tumor recurrence. There was significant association between centrally restricted diffusion by visual assessment and radiation necrosis (P = .015) with a sensitivity of 75% and a specificity of 88.9%, a positive predictive value 85.7%, and a negative predictive value of 80% for the diagnosis of radiation necrosis. There was a statistically significant difference in the ADC and ADC ratio between radiation necrosis and tumor recurrence (P = .027).
CONCLUSIONS:The presence of centrally restricted diffusion in a new ring-enhancing lesion might indicate radiation necrosis rather than tumor recurrence in high-grade gliomas previously treated with standard chemoradiation without bevacizumab.
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rAsp f 3 and rAsp f 4 are associated with bronchiectasis in allergic fungal airways disease
Allergy to thermotolerant filamentous fungi, particularly Aspergillus fumigatus, is closely associated with fixed airflow obstruction, bronchiectasis, and other radiologically defined abnormalities, such as mucus plugging.1 However, not all asthma patients who are immunoglobulin E (IgE) sensitized to A fumigatus develop these complications. To identify markers of poor outcomes in fungal allergy with asthma (and cystic fibrosis), the term allergic bronchopulmonary aspergillosis (ABPA) was coined.
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A longitudinal cohort study on the impact of the clobazam shortage on patients with epilepsy
Summary
Objective
Drug shortages are occurring at an increasing rate. From May to October 2016, there was a shortage of a level I critical antiepileptic drug, clobazam. We aimed to study the impact of this shortage on patients with epilepsy.
Methods
Adult patients from Calgary's Comprehensive Epilepsy Program who were taking clobazam were approached to participate in the study. Baseline data from the clinic prospective registry included clinical variables and presurvey patient-reported outcomes (PROs) such as the Global Assessment of Severity of Epilepsy, the Global Assessment of Disability Associated with Seizures, and the Quality of Life in Epilepsy questionnaire. We used a mixed-methods cross-sectional questionnaire via telephone. We analyzed quantitative data using descriptive methods and qualitative data using a phenomenological approach.
Results
Of the 85 eligible patients, 84% (n = 71) agreed to participate. Participants ranged from 18 to 78 years old, and 59.2% of participants were female. Overall, 80% of participants experienced some form of medication change due to the shortage. No significant differences were found in the pre- and during-shortage PRO data. However, 6 important themes emerged regarding the impact of the antiepileptic drug shortage on patients: (1) communication and awareness, (2) burden on patients and caregivers, (3) physical impact, (4) psychological impact, (5) health care provider assistance in navigating the shortage, and (6) policy change.
Significance
We examined the impact of the clobazam shortage on patients with epilepsy from the patient's perspective and identified 6 important themes. As a result, we were able to gain insight into what patients need to cope with drug shortages and make recommendations that can help mitigate the impact of shortages on patients in the future. Further research is needed to better understand drug shortages from the patient's perspective in various settings and conditions.
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Deep brain stimulation for drug-resistant epilepsy
Summary
Objectives
To review clinical evidence on the antiepileptic effects of deep brain stimulation (DBS) for drug-resistant epilepsy, its safety, and the factors influencing individual outcomes.
Methods
A comprehensive search of the medical literature (PubMed, Medline) was conducted to identify relevant articles investigating DBS therapy for drug-resistant epilepsy. Reference lists of these articles were used to source further articles.
Results
Stimulation of the anterior nucleus of the thalamus (ANT) and hippocampus (HC) has been shown to decrease the frequency of refractory seizures. Half of all patients from clinical studies experienced a 46%-90% seizure reduction with ANT-DBS, and a 48%-95% seizure reduction with HC-DBS. The efficacy of stimulating other targets remains inconclusive due to lack of evidence. Approximately three-fourths of patients receiving ANT, HC, or centromedian nucleus of the thalamus (CMT) stimulation are responders—experiencing a seizure reduction of at least 50%. The time course of clinical benefit varies dramatically, with both an initial lesional effect and ongoing stimulation effect at play. Improved quality of life and changes to cognition or mood may also occur. Side effects are similar in nature to those reported from DBS therapy for movement disorders. Several factors are potentially associated with stimulation efficacy, including an absence of structural abnormality on imaging for ANT and HC stimulation, and electrode position relative to the target. Certain seizure types or syndromes may respond more favorably to specific targets, including ANT stimulation for deep temporal or limbic seizures, and CMT stimulation for generalized seizures and Lennox-Gastaut syndrome.
Significance
We have identified several patient, disease, and stimulation factors that potentially predict seizure outcome following DBS. More large-scale clinical trials are needed to explore different stimulation parameters, reevaluate the indications for DBS, and identify robust predictors of patient response.
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Fenestrated endovascular aortic aneurysm repair using physician-modified endovascular grafts versus company-manufactured devices
Fenestrated endografts are customized, patient-specific endovascular devices with potential to reduce morbidity and mortality of complex aortic aneurysm repair. With approval from the U.S. Food and Drug Administration, our center began performing fenestrated endovascular aneurysm repair through a physician-sponsored investigational device exemption (IDE #G130210), using both physician-modified endografts (PMEGs) and company-manufactured devices (CMDs). Because these techniques are associated with specific advantages and disadvantages, we sought to investigate differences in outcomes between PMEG and CMD cases.
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Use of the Wound, Ischemia, foot Infection classification system in hemodialysis patients after endovascular treatment for critical limb ischemia
The Wound, Ischemia, foot Infection (WIfI) classification system is used to predict the amputation risk in patients with critical limb ischemia (CLI). The validity of the WIfI classification system for hemodialysis (HD) patients with CLI is still unknown. This single-center study evaluated the prognostic value of WIfI stages in HD patients with CLI who had been treated with endovascular therapy (EVT).
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Outcomes after early and delayed carotid endarterectomy in patients with symptomatic carotid artery stenosis
The objective of this study was to define outcomes after carotid endarterectomy (CEA) in patients with symptomatic carotid artery stenosis (CAS) when patients are operated on within 14 days after onset of symptoms.
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The association of statin therapy with the primary patency of femoral and popliteal artery stents
It has long been known that hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) broadly reduce cardiovascular events in patients with peripheral vascular disease. It was the goal of this study to determine whether there is an association between statin therapy and primary patency after stenting of superficial femoral and popliteal arteries.
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111In-DTPA-Octreotide SPECT (OctreoScan) Uptake in Metastatic Renal Cell Carcinoma to the Pancreas
Abstract We report a case of late presentation of metastatic renal cell carcinoma (RCC) demonstrating intense 111In-DTPA-octreotide uptake in pancreas without recurrence at the primary site. Immunohistochemistry study revealed somatostatin receptor subtype 2 of metastatic RCC preferentially expressed on tumor endothelial cells. The typical hypervascular features of RCC with intense homogeneous contrast enhancement in the arterial phase on CT should raise the possibility of metastatic RCC. This case illustrates that RCC can demonstrate high octreotide uptake in abdominal metastases.from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2nH6clC
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High-Energy Collimator Is Preferable to Medium-Energy Collimator for Evaluating 223Ra Uptake in Bone Metastasis at 2 Weeks Postinjection
Abstract An 80-year-old man with castration-resistant prostate cancer received 223Ra injection to treat bone metastases. Two weeks after the injection, the patient underwent static 223Ra scan of the chest with medium-energy and high-energy collimators for 30 minutes each. Images obtained with the 2 collimators showed that uptake in metastatic lesions was visually clearer and semiquantitatively higher with the high-energy collimator. The use of HE collimator for 223Ra imaging in the early phase has been reported, and the present case suggests that in the late phase HE collimator would also be preferable to medium-energy collimator in terms of lesion-based evaluation.from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2nHwFPQ
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Quality and Safety in Health Care, Part XXXI: Selected Risk Factors for Transcatheter Aortic Valve Replacement
Abstract The Transcatheter Valve Therapy Registry has been very helpful in providing data to better understand patient risk factors for transcatheter aortic valve replacement (TAVR). The outcome of TAVR depends on many patient indicators, some of which are given in this article, including the age, dependence on oxygen, classification of pulmonary disease, gender, and the speed of walking. Patient characteristics also help determine which approach will be used to place the device. There are models for the outcome of the TAVR procedure now and more being developed.
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68Ga–Prostate-Specific Membrane Antigen Uptake in Gastrointestinal Stromal Tumor
Abstract A 62-year-old man with recently diagnosed prostatic adenocarcinoma was referred for a whole-body 68Ga-prostate-specific membrane antigen (PSMA) PET/CT scan for staging. Although the scan did not reveal metastatic disease, it did reveal a PSMA-avid lesion in the upper abdomen located between the liver and the stomach. Histopathologic examination demonstrated a gastrointestinal stromal tumor. The lesion demonstrated increased uptake in the margins of the tumor with a central photopenic area, which we consider to be the typical pattern on PSMA images of a gastrointestinal stromal tumor, based on theoretical PSMA distribution in such a tumor and other reported cases.from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2A0lXWF
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Solitary Orbital Metastasis in Carcinoma Esophagus: Findings on Serial 18F-FDG PET/CT Scans
Abstract Orbital metastasis is an uncommon and atypical presentation of recurrent esophageal cancer that has been only seldom reported in literature. 18F-FDG PET/CT is routinely performed for staging and response assessment in patients with esophageal carcinoma. This case demonstrates use of follow-up FDG PET/CT scans in characterizing solitary metastatic disease in orbit and in evaluating response to therapy. It also highlights a key teaching point that postradiation-related inflammatory/infective changes may interfere in accurate assessment of PET/CT scan; however, frequently used clinical and radiological correlation may not be entirely sufficient to rule out pathological involvement.from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2zZrg8I
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Role of Various Metabolic Parameters Derived From Baseline 18F-FDG PET/CT as Prognostic Markers in Non–Small Cell Lung Cancer Patients Undergoing Platinum-Based Chemotherapy
Purpose The aim of this study was to prospectively evaluate the role of various quantitative and semiquantitative metabolic parameters derived from dynamic and static baseline 18F-FDG PET/CT in prediction of overall survival (OS) in non–small cell lung cancer (NSCLC) patients who were planned to undergo platinum-based chemotherapy. Methods Sixty patients (51 male and 9 female patients) with biopsy-proven NSCLC and mean age 59.55 ± 10.06 years who were planned to undergo platinum-based chemotherapy were enrolled in the study. Each patient underwent a baseline regional dynamic and a static whole-body 18F-FDG PET/CT after injecting 0.21 mCi/kg (5.18–7.77 MBq/kg) of 18F-FDG intravenously. Two dynamic PET/CT parameters, that is, net influx rate constant and glucose metabolic rate at 30 and 60 minutes, were evaluated. In addition, whole-body PET/CT parameters, that is, SUVmax, average SUV, tumor-to-background ratio, metabolic tumor volume (MTV), total lesion glycolysis (TLG) of the primary tumor, and MTV and TLG of whole-body tumor lesions, were evaluated. Best possible cutoffs for all parameters were calculated using receiver operating characteristic curve analysis. Survival analysis was performed using log-rank test, Kaplan-Meier curves, and Cox proportional hazards model to determine the prognostic markers for OS. Results The median follow-up period was 4.4 months (range, 8 days to 15.9 months). In univariate analysis, the 4 static whole-body PET/CT parameters, that is, MTV, TLG, and MTV and TLG of whole-body tumor lesions, were found to be significantly associated with OS with cutoff values of 120, 800, 160, and 1350 cm3 and hazard ratios of 3.64 (P = 0.001), 3.35 (P = 0.002), 2.51 (P = 0.019), and 2.69 (P = 0.008), respectively. In multivariate survival analysis, MTV was found to be an independent prognostic marker for OS. Conclusions Baseline MTV and TLG evaluated from primary tumor as well as the whole-body tumor lesions are reliable prognostic markers of OS in NSCLC patients undergoing platinum-based chemotherapy. However, other baseline whole-body PET/CT parameters (SUVmax, average SUV, and tumor-to-background ratio) and dynamic PET/CT parameters (net influx rate constant, glucose metabolic rate) have no prognostic value in these patients.from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2A1DE85
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18F-FDG PET/CT Imaging of Hidradenocarcinoma Arising From Preexisting Hidradenoma of the Knee
Abstract Malignant tumors of the sweat glands are exceedingly rare and aggressive tumors. We present here a case of a 60-year-old man with a malignant hidradenocarcinoma that developed in a background of preexisting benign hidradenoma on the lateral aspect of the knee that was initially resected, but rapidly recurred with associated inguinal lymphadenopathy. 18F-FDG PET/CT was performed as part of preoperative staging, which demonstrated abnormal inguinal lymph nodes and metastatic disease to the lungs. FDG PET/CT can play an invaluable role in the initial staging and follow-up of this rare malignancy.from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2A1M27w
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Incidental Case of Relapsing Polychondritis Detected by 18F-FDG PET/CT
Abstract A 78-year-old man had fever, persistent wheezing, and serum C-reactive protein elevation. Malignant lymphoma was suspected because of mediastinal lymph nodes swelling on CT and soluble interleukin 2 receptor elevation. Symmetric 18F-FDG uptake in the tracheobronchial tree and bilateral auricles was observed on PET/CT. He was finally diagnosed as having relapsing polychondritis by auricular cartilage biopsy. 18F-FDG PET/CT may have crucial role in evaluating the extent of inflammation and deciding the biopsy site of relapsing polychondritis.from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2A1uDft
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Simultaneous Brain and Lung Histiocytic Sarcoma Revealed on 18F-FDG PET/CT
Abstract A 52-year-old man with intermittent head motor tics, aphasia and right upper extremity weakness had an 18F-FDG avid left front lobe brain lesion, and a left upper lobe lung lesion on PET/CT. The brain lesion was surgically resected, and was diagnosed pathologically as a histiocytic sarcoma (HS). The lung lesion was also a HS via bronchial biopsy. HS is rare and generally involves nodes as shown on PET/CT in a few case reports. The current case with simultaneous brain and lung HS lesions adds new imaging pattern information of the disease to the literature.from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2A0lBiN
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Intracardiac Metastases Detected by 18F-FSPG PET/CT
Abstract PET/CT imaging is frequently used for cancer diagnosis and restaging as metabolically active cells, including cancer, utilize glucose for proliferation. 18F-FDG is the most commonly utilized radiopharmaceutical in PET/CT imaging. Limitations of 18F-FDG imaging include intense physiologic uptake in benign tissues such as the brain and myocardium. We present a case of non–small cell lung cancer with myocardial and pericardial metastases obscured by physiologic 18F-FDG cardiac uptake but detected with the investigational PET radiotracer (4S)-4-(3-18F-fluoropropyl)-L-glutamate (18F-FSPG), which targets a pathway associated with glutathione biosynthesis. This case demonstrates the added value of 18F-FSPG PET/CT imaging.from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2zZbJ8J
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Re: 18F-Fluorocholine PET/CT of Incidental Male Breast Cancer
No abstract availablefrom ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2A0iIya
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Local lawmaker pushes for state house hearing on water contamination
| Local lawmaker pushes for state house hearing on water contamination WZZMBrinks seeks oversight hearing on toxic tap water WOODTV.comFull coverage |
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Can Ultrasound Be Used to Improve the Palpation Skills of Physicians in Training? A Prospective Study
Accurate diagnosis of musculoskeletal disorders relies heavily upon the physical examination, including accurate palpation of musculoskeletal structures. The literature has suggested there has been deterioration of physical examination skills among medical students and residents in part due to increased reliance on advanced imaging. It has been shown that knowledge of musculoskeletal anatomy and physical examination skills improve with the use of ultrasound; however, the literature is limited.
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Self-efficacy and Pressure Ulcer Prevention after Spinal Cord Injury – Results from a Nationwide Community Survey in Switzerland (SwiSCI)
Pressure ulcers (PUs) are a common and severe health condition in persons with spinal cord injury (SCI). Skin-care strategies for PU prevention are usually provided during first rehabilitation. However, individuals with SCI often do not perform these strategies continuously, especially after discharge. The influence of psychological factors such as general self-efficacy (GSE) on the performance of PU prevention behavior has not yet been sufficiently explored.
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Critical Review: XOMA (XOMA) & Soligenix (NASDAQ:SNGX)
| Critical Review: XOMA (XOMA) & Soligenix (NASDAQ:SNGX) Week HeraldFull coverage |
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Feasibility of Small Group Cognitive Rehabilitation in a Clinical Cancer Setting
(Source: Psycho-Oncology)
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A novel approach for comparing patterns of foreign body injuries across countries: A case study comparing European Countries and Bosnia and Herzegovina
The present study aimed at analyzing the characteristics of FB injuries from Bosnia and Herzegovina (B&H), a rapidly growing newly industrialized country, and to compare them with cases from other European countries.
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Polysomnography results versus clinical factors to predict post-operative respiratory complications following pediatric adenotonsillectomy
This letter is in reference to the manuscript titled "Polysomnography results versus clinical factors to predict post-operative respiratory complications following pediatric adenotonsillectomy," by Drs. Saur and Brietzke, which was published in your esteemed journal [1]. The manuscript focused on the rates of and risk factors for major respiratory complications following adenotonsillectomy in the treatment of pediatric obstructive sleep apnea syndrome (OSAS) and provided valuable information to clinical physicians.
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Response to letter to the editor regarding article titled “Polysomnography results versus clinical factors to predict postoperative respiratory complications following pediatric adenotonsillectomy”
We are pleased that Drs. Hsueh, Lee, Lee, and Kang found the article "Polysomnography results versus clinical factors to predict postoperative respiratory complications following pediatric adenotonsillectomy" interesting and useful [1]. We are happy to respond to their comments and questions below. However, we believe it may be useful to first restate our purpose in conducting this study. The notion that polysomnography (PSG) may be indicated pre-operatively for the discrete purpose of assessing post-operative risk of a respiratory complication following adenotonsillectomy (T/A) was recently proposed [2].
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A novel approach for comparing patterns of foreign body injuries across countries: A case study comparing European Countries and Bosnia and Herzegovina
The present study aimed at analyzing the characteristics of FB injuries from Bosnia and Herzegovina (B&H), a rapidly growing newly industrialized country, and to compare them with cases from other European countries.
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Polysomnography results versus clinical factors to predict post-operative respiratory complications following pediatric adenotonsillectomy
This letter is in reference to the manuscript titled "Polysomnography results versus clinical factors to predict post-operative respiratory complications following pediatric adenotonsillectomy," by Drs. Saur and Brietzke, which was published in your esteemed journal [1]. The manuscript focused on the rates of and risk factors for major respiratory complications following adenotonsillectomy in the treatment of pediatric obstructive sleep apnea syndrome (OSAS) and provided valuable information to clinical physicians.
from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2AFIZmw
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Response to letter to the editor regarding article titled “Polysomnography results versus clinical factors to predict postoperative respiratory complications following pediatric adenotonsillectomy”
We are pleased that Drs. Hsueh, Lee, Lee, and Kang found the article "Polysomnography results versus clinical factors to predict postoperative respiratory complications following pediatric adenotonsillectomy" interesting and useful [1]. We are happy to respond to their comments and questions below. However, we believe it may be useful to first restate our purpose in conducting this study. The notion that polysomnography (PSG) may be indicated pre-operatively for the discrete purpose of assessing post-operative risk of a respiratory complication following adenotonsillectomy (T/A) was recently proposed [2].
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Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study
Abstract
Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.
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Ct1
Discussion - (Source: Clinical Care Options Lymphoma)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
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Supersulfated low-molecular weight heparin synergizes with IGF1R/IR inhibitor to suppress synovial sarcoma growth and metastases
Synovial sarcoma (SS) is an aggressive tumor with propensity for lung metastases which significantly impact patients' prognosis. New therapeutic approaches are needed to improve treatment outcome. Targeting the heparanase/heparan sulfate proteoglycan system by heparin derivatives which act as heparanase inhibitors/heparan sulfate mimetics is emerging as a therapeutic approach that can sensitize the tumor response to chemotherapy. We investigated the therapeutic potential of a supersulfated low molecular weight heparin (ssLMWH) in preclinical models of SS.
from # All Medicine by Alexandros G. Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2BgdSRR
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Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study
Abstract
Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.
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Clinical Indicators of the Need for Telemetry Postoperative Monitoring in Patients With Suspected Obstructive Sleep Apnea Undergoing Total Knee Arthroplasty
Background and Objectives Obstructive sleep apnea is associated with increased complication rates postoperatively. Current literature does not provide adequate guidance on management of these patients. This study used the STOP-Bang questionnaire to diagnose patients with possible obstructive sleep apnea (score ≥3). We hypothesized that a STOP-Bang score of 3 or greater would significantly correlate with the number of oxygen desaturation episodes during the first 48 hours after total knee arthroscopy. Methods The STOP-Bang questionnaire was administered to 110 patients preoperatively. All patients underwent spinal-epidural anesthesia with a saphenous nerve block and sedation and were connected to the Nellcor OxiMax N-600x pulse oximeter for 48 hours postoperatively. Results Final analysis included 98 patients. There was no significant difference in the total number of desaturation events between STOP-Bang groups (score
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Intrathecal Morphine for Laparoscopic Segmental Colonic Resection as Part of an Enhanced Recovery Protocol: A Randomized Controlled Trial
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In vivo Functional Analysis of Drosophila Robo1 Fibronectin Type III Repeats
The repellant ligand Slit and its Roundabout (Robo) family receptors regulate midline crossing of axons during development of the embryonic CNS. Slit proteins are produced at the midline and signal through Robo receptors to repel axons from the midline. Disruption of Slit-Robo signaling causes ectopic midline crossing phenotypes in the CNS of a broad range of animals, including insects and vertebrates. While previous studies have investigated the roles of Drosophila melanogaster Robo1's five Immunoglobulin-like (Ig) domains, little is known about the importance of the three evolutionarily conserved Fibronectin (Fn) type-III repeats. We have individually deleted each of Drosophila Robo1's three Fn repeats, and then tested these Robo1 variants in vitro to determine their ability to bind Slit in cultured Drosophila cells and in vivo to investigate the requirement for each domain in regulating Robo1's embryonic expression pattern, axonal localization, midline repulsive function, and sensitivity to Commissureless (Comm) downregulation. We demonstrate that the Fn repeats are not required for Robo1 to bind Slit or for proper expression of Robo1 in Drosophila embryonic neurons. When expressed in a robo1 mutant background, these variants are able to restore midline repulsion to an extent equivalent to full-length Robo1. We identify a novel requirement for Fn3 in the exclusion of Robo1 from commissures and downregulation of Robo1 by Comm. Our results indicate that each of the Drosophila Robo1 Fn repeats are individually dispensable for the protein's role in midline repulsion, despite the evolutionarily conserved "5+3" protein structure.
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Genome-Wide Analysis of Grain Yield Stability and Environmental Interactions in a Multiparental Soybean Population
Genetic improvement towards optimized and stable agronomic performance of soybean genotypes is desirable for food security. Understanding how genotypes perform in different environmental conditions helps breeders develop sustainable cultivars adapted to target regions. Complex traits of importance are known to be controlled by a large number of genomic regions with small effects whose magnitude and direction are modulated by environmental factors. Knowledge of the constraints and undesirable effects resulting from genotype by environmental interactions is a key objective in improving selection procedures in soybean breeding programs. In this study, the genetic basis of soybean grain yield responsiveness to environmental factors was examined in a large soybean nested association population. For this, a genome-wide association to performance stability estimates generated from a Finlay-Wilkinson analysis and the inclusion of the interaction between marker genotypes and environmental factors was implemented. Genomic footprints were investigated by analysis and meta-analysis using a recently published multi-parent model. Results indicated that specific soybean genomic regions were associated with stability, and that multiplicative interactions were present between environments and genetic background. Seven genomic regions in six chromosomes were identified as being associated with genotype-by-environment interactions. This study provides insight into genomic assisted breeding aimed at achieving a more stable agronomic performance of soybean, and documented opportunities to exploit genomic regions that were specifically associated with interactions involving environments and subpopulations.
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Soft palate functional reconstruction with buccinator myomucosal island flaps
Oropharyngeal reconstruction after ablative surgery is a challenge. The results of a retrospective study of 17 patients who underwent total or sub-total soft palate reconstruction with a buccinator myomucosal island flap, between 2008 and 2016, are reported herein. An analysis of flap type and size, harvesting time, and postoperative complications was performed. Patients underwent standardized tests to assess the recovery of sensitivity, deglutition, quality of life (QoL), and donor site morbidity, at >6 months after surgery or the end of adjuvant therapy, if performed.
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Anti-cytokine autoantibodies in a patient with a heterozygous NFKB2 mutation
We report a family with a heterozygous NFKB2 mutation in which anti-cytokine autoantibodies were identified in one individual. Rituximab therapy for autoantibodies led to a reduction in anti-cytokine autoantibodies and a marked improvement in infectious susceptibility.
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Circulating allergen-specific Th2 lymphocytes: CCR4+ rather than CLA+ is the predominant phenotype in peanut allergic subjects
The skin and airway homing chemokine CCR4, but not CLA, emerged as the primary discriminating homing factor, of Th2 lymphocytes, suggesting that peanut sensitization occurs both via the skin and airways.
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Soft palate functional reconstruction with buccinator myomucosal island flaps
Oropharyngeal reconstruction after ablative surgery is a challenge. The results of a retrospective study of 17 patients who underwent total or sub-total soft palate reconstruction with a buccinator myomucosal island flap, between 2008 and 2016, are reported herein. An analysis of flap type and size, harvesting time, and postoperative complications was performed. Patients underwent standardized tests to assess the recovery of sensitivity, deglutition, quality of life (QoL), and donor site morbidity, at >6 months after surgery or the end of adjuvant therapy, if performed.
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Clinical Indicators of the Need for Telemetry Postoperative Monitoring in Patients With Suspected Obstructive Sleep Apnea Undergoing Total Knee Arthroplasty
Background and Objectives Obstructive sleep apnea is associated with increased complication rates postoperatively. Current literature does not provide adequate guidance on management of these patients. This study used the STOP-Bang questionnaire to diagnose patients with possible obstructive sleep apnea (score ≥3). We hypothesized that a STOP-Bang score of 3 or greater would significantly correlate with the number of oxygen desaturation episodes during the first 48 hours after total knee arthroscopy. Methods The STOP-Bang questionnaire was administered to 110 patients preoperatively. All patients underwent spinal-epidural anesthesia with a saphenous nerve block and sedation and were connected to the Nellcor OxiMax N-600x pulse oximeter for 48 hours postoperatively. Results Final analysis included 98 patients. There was no significant difference in the total number of desaturation events between STOP-Bang groups (score
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from ! Medicine by Alexandros G. Sfakianakis via als.fakia on Inoreader http://ift.tt/2k8f3ba
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Soft palate functional reconstruction with buccinator myomucosal island flaps
Oropharyngeal reconstruction after ablative surgery is a challenge. The results of a retrospective study of 17 patients who underwent total or sub-total soft palate reconstruction with a buccinator myomucosal island flap, between 2008 and 2016, are reported herein. An analysis of flap type and size, harvesting time, and postoperative complications was performed. Patients underwent standardized tests to assess the recovery of sensitivity, deglutition, quality of life (QoL), and donor site morbidity, at >6 months after surgery or the end of adjuvant therapy, if performed.
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Preserved sleep microstructure in blind individuals
The loss of vision, particularly when it occurs early in life, is associated with compensatory cortical plasticity not only in the visual cortical areas, but throughout the entire brain. The absence of visual input to the retina can also induce changes in entrainment of the circadian rhythm, as light is the primary zeitgeber of the master biological clock found in the suprachiasmatic nucleus of the hypothalamus. In addition, a greater number of sleep disturbances is often reported in blind individuals.
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Anti-mumps IgM antibody positive rate with sudden sensorineural hearing loss using second-generation enzyme immunoassay: A retrospective, multi-institutional investigation in Hokkaido, Japan
Although elevated anti-mumps IgM antibody levels were reported in 5.7%–7.2% of Japanese patients with sudden sensorineural hearing loss (SSNHL), there were several reports of false-positive cases, such as the continually IgM positive case and the IgM positive case in normal adults. To improve specificity, the new enzyme immuno assay (EIA) anti-mumps IgM antibody measurement kit was introduced in December 2009. This study re-examined the frequency of anti-mumps IgM antibody test positivity with SSNHL using the new measurement kit and compared the results with those from a previous report that used old kit.
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Discussion
Dr S. Keshavjee (Toronto, Canada). Michael, I would like to congratulate you on an excellent piece of work, again, and on your presentation, and particularly to your teacher standing on your left, who has prepared you so well and taught you so well to make a presentation. The idea of surgeons controlling the costs of an operation by making wise choices seems intuitive and not many people have really focused on it. It is going to become increasingly important, and I think that this underscores the importance of your study in moving the field forward in bringing this concept and showing people how to measure what they do.
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Gene Therapy Shows Beneficial Effect in Men With Hemophilia B
Reduction in annualized bleeding rate and in factor use with infusion of viral vector with transgene (Source: The Doctors Lounge - Oncology)
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Pharmacomechanical Thrombolysis No Benefit in DVT
Addition of pharmacomechanical catheter - directed thrombolysis resulted in higher risk of bleeding (Source: The Doctors Lounge - Oncology)
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Breast CA Risk Up With Recent Hormonal Contraceptive Use
Findings from nationwide study in Denmark show small absolute increase in breast cancer risk (Source: The Doctors Lounge - Oncology)
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Acupuncture May Ease Pain Tied to Breast Cancer Care
(Source: The Doctors Lounge - Oncology)
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A common virus may help inform treatment planning for stem cell transplant patients
(Virginia Commonwealth University) a team of scientists from VCU Massey Cancer Center have shown a genetic relationship between the reactivation of the human cytomegalovirus and the onset of graft-versus-host disease (GVHD), a potentially deadly condition in which the immune system attacks healthy tissue following a bone marrow or stem cell transplant. (Source: EurekAlert! - Cancer)
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Novel harvesting method rapidly produces superior stem cells for transplantation
(Massachusetts General Hospital) A new method of harvesting stem cells for bone marrow transplantation -- developed by a team of investigators from the Massachusetts General Hospital Cancer Center and the Harvard Stem Cell Institute -- may make the donation process more convenient and less unpleasant for donors while providing cells that are superior to those acquired by current protocols. (Source: EurekAlert! - Cancer)
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Research suggests new pathways for hyperaldosteronism
(Sanford-Burnham Prebys Medical Discovery Institute) Researchers have identified a mechanism that explains the development of hyperaldosteronism, a condition in which the adrenal glands produce too much aldosterone. The findings, published in JCI Insight, offer a path for drug discovery to treat the condition. (Source: EurekAlert! - Cancer)
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Community practices not following guidelines for MRI breast cancer screening
(Springer) Guidelines are not being followed to ensure that breast cancer screening of high risk women, such as those with a strong family history of breast cancer, includes an additional MRI (magnetic resonance imaging) scan. Deirdre A. Hill of the University of New Mexico School of Medicine led a study on this in the Journal of General Internal Medicine which is published by Springer. (Source: EurekAlert! - Cancer)
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Protamine neutralizes CSPG-mediated inhibition of oligodendrocyte differentiation
(National Institutes of Natural Sciences) The research group of researcher Akihiro Fujikawa and Professor Masaharu Noda of the National Institute for Basic Biology developed a screening method to obtain neutralizing agents for canceling the inhibitory effects of CSPGs on oligodendrocyte differentiation. The group found that the inhibitory activity of a representative extracellular matrix CSPG molecule, aggrecan, was neutralized by a polycationic peptide, protamine, that is clinically used to stop the anticoagulant effect of heparin. (Source: EurekAlert! - Cancer)
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Circulating allergen-specific Th2 lymphocytes: CCR4+ rather than CLA+ is the predominant phenotype in peanut allergic subjects
The skin and airway homing chemokine CCR4, but not CLA, emerged as the primary discriminating homing factor, of Th2 lymphocytes, suggesting that peanut sensitization occurs both via the skin and airways.
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Autophagy deficiency in myeloid cells exacerbates eosinophilic inflammation in chronic rhinosinusitis
Autophagy deficiency in myeloid cells, particularly macrophages, is linked to augmented production of PGD2 and eosinophilic inflammation in a murine model of ECRS. Thus, autophagy dysfunction has a causal role in the development of ECRS.
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Low level laser therapy (Photobiomodulation therapy) for breast cancer-related lymphedema: a systematic review
Breast cancer related lymphedema (BCRL) is a prevalent complication secondary to cancer treatments which significantly impacts the physical and psychological health of breast cancer survivors. Previous researc...
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Hairdressing hazards and the hand
A 59 year old hairdresser presented with painless lumps on his right index finger. He reported a 20 year history of recurrent infection of the lumps, treated with multiple antibiotics. Examination...
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Seven days in medicine: 29 November to 5 December 2017
ImmigrationScrap detention centres to protect migrant healthImmigration detention centres should be phased out and replaced with more humane means of monitoring people who face removal from the UK...
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Characteristic Chromatogram: A Method of Discriminate and Quantitative Analysis for Quality Evaluation of Uncaria Stem with Hooks
Planta Med
DOI: 10.1055/s-0043-123827
It remains a challenge to establish new monographs for herbal drugs derived from multiple botanical sources. Specifically, the difficulty involves discriminating and quantifying these herbs with components whose levels vary markedly among different samples. Using Uncaria stem with hooks as an example, a characteristic chromatogram was proposed to discriminate its five botanical origins and to quantify its characteristic components in the chromatogram. The characteristic chromatogram with respect to the components of Uncaria stem with hooks with the five botanical origins was established using 0.02% diethylamine and acetonitrile as the mobile phase. The total analysis time was 50 min and the detection wavelength was 245 nm. Using the same chromatogram parameters, the single standard to determine multicomponents method was validated to simultaneously quantify nine indole alkaloids, including vincosamide, 3α-dihydrocadambine, isocorynoxeine, corynoxeine, isorhynchophylline, rhynchophylline, hirsuteine, hirsutine, and geissoschizine methyl ether. The results showed that only the Uncaria stem with hooks from Uncaria rhynchophylla, the most widely used in the herbal market, showed the presence of these nine alkaloids. The conversion factors were 1.27, 2.32, 0.98, 1.04, 1.00, 1.02, 1.26, 1.33, and 1.25, respectively. The limits of quantitation were lower than 700 ng/mL. The total contents of 31 batches of Uncaria stem with hooks were in the range of 0.1 – 0.6%, except for Uncaria hirsuta Havil and Uncaria sinensis (Oliv.) Havil. The results also showed that the total content of indole alkaloids tended to decrease with an increase in the hook diameter. This showed that the characteristic chromatogram is practical for controlling the quality of traditional Chinese medicines with multiple botanical origins.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Indoor and outdoor air quality analysis for the city of Nablus in Palestine: seasonal trends of PM 10 , PM 5.0 , PM 2.5 , and PM 1.0 of residential homes
Abstract
Nablus city is an important urban and industrial center in the West Bank, Palestine. The topography of the city, combined with multiple sources of air pollution, creates a potential air quality problem that might affect human health. The indoor and outdoor particle concentration distributions of PM10, PM5.0, PM2.5, and PM1.0 were measured using a Grimm aerosol spectrometer from December 2014 to November 2015, at four roadsides and four urban homes in Nablus. The results of the annual averages of PM10 and PM2.5 concentrations were found to be at least three times higher than that of the European Air Quality Standards both in indoors and outdoors. The difference in the results between both the roadside and the urban areas was attributed to human and industrial activities in Nablus. The results revealed that the highest concentrations of the particulate matters are during summer, especially June and July, in the roadside areas due to heavy industrial activities during these months. The same behavior was noticed for urban areas during summer and due to other human activities. The results of indoor/outdoor (I/O) ratios were found to be less than, but very close to, 1 for both roadside and urban areas in summer and winter months. In winter times, areas with poor ventilation indicated the existence of additional sources of PM within the indoor environments, especially when smoking cigarettes and using fuel-based heaters such as fireplaces gas and kerosene heaters.
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Preserved sleep microstructure in blind individuals
The loss of vision, particularly when it occurs early in life, is associated with compensatory cortical plasticity not only in the visual cortical areas, but throughout the entire brain. The absence of visual input to the retina can also induce changes in entrainment of the circadian rhythm, as light is the primary zeitgeber of the master biological clock found in the suprachiasmatic nucleus of the hypothalamus. In addition, a greater number of sleep disturbances is often reported in blind individuals.
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Preserved sleep microstructure in blind individuals
The loss of vision, particularly when it occurs early in life, is associated with compensatory cortical plasticity not only in the visual cortical areas, but throughout the entire brain. The absence of visual input to the retina can also induce changes in entrainment of the circadian rhythm, as light is the primary zeitgeber of the master biological clock found in the suprachiasmatic nucleus of the hypothalamus. In addition, a greater number of sleep disturbances is often reported in blind individuals.
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Anti-mumps IgM antibody positive rate with sudden sensorineural hearing loss using second-generation enzyme immunoassay: A retrospective, multi-institutional investigation in Hokkaido, Japan
Although elevated anti-mumps IgM antibody levels were reported in 5.7%–7.2% of Japanese patients with sudden sensorineural hearing loss (SSNHL), there were several reports of false-positive cases, such as the continually IgM positive case and the IgM positive case in normal adults. To improve specificity, the new enzyme immuno assay (EIA) anti-mumps IgM antibody measurement kit was introduced in December 2009. This study re-examined the frequency of anti-mumps IgM antibody test positivity with SSNHL using the new measurement kit and compared the results with those from a previous report that used old kit.
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Replacement of Sedentary Time with Physical Activity: Impact on Lipoproteins
Purpose Limited data on the relationship between physical activity and lipoprotein particle profiles exist. Our objective was to investigate associations between objectively measured physical activity and lipoprotein particle size and number, and specifically whether substituting daily sedentary behaviour with light activity or moderate to vigorous physical activity (MVPA), is associated with beneficial alterations to the lipoprotein profile among adults and those at increased cardiometabolic risk (obese and insulin resistant subjects). Methods Sedentary behaviour and physical activity intensity and duration were measured for 7-consecutive days using the GENEActiv accelerometer in a cross-sectional adult cohort (n=396, mean age 59.6±5.5 years). Lipoprotein particle size and subclass concentrations were determined using nuclear magnetic resonance (NMR) spectroscopy. Isotemporal substitution regression modelling quantified the associations between replacing 30 minutes per day of sedentary behaviour with equal amounts of light activity and MVPA on lipoprotein profiles. Results Daily duration of MVPA was inversely associated with large VLDL particles and lipoprotein insulin resistance scores (LP-IR) (P
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The Precision of eCAP Thresholds Derived From Amplitude Growth Functions
Objective: An amplitude growth function (AGF) shows the amplitude of an electrically evoked compound action potential (eCAP) as a function of the stimulation current. AGFs can be used to derive the eCAP threshold, which represents the minimum amount of current needed to elicit a measurable eCAP. eCAP thresholds have been widely used clinically to, for example, assist with sound processor programming. However, no eCAP precision has been included to date. The aim of this study was to investigate the precision of eCAP thresholds and determine whether they are precise enough for clinical use. Design: The study is retrospective, and the data comprised 826 AGFs, intraoperatively measured in 111 patients implanted with a HiRes90K cochlear implant (Advanced Bionics). For each AGF, the eCAP threshold was determined using two commonly used methods: linear extrapolation (LE) toward the x axis and detection of the last visible (LV) eCAP. Subsequently, the threshold confidence interval (TCI) of each eCAP threshold was calculated to serve as a metric for precision, whereby a larger TCI means a lower precision or reliability. Additionally, the eCAP thresholds results were compared with most recent behavioral fitting thresholds (T profile) to put the eCAP threshold analysis in clinical context. Thereby, the association between eCAP and behavioral thresholds was calculated, both for all subjects together (group analysis) and, in contrast to previous studies, within individual subjects. Results: Our data show that the TCIs were larger with the LE method than with the LV method. The eCAP thresholds estimated by the LE method were systematically smaller than those estimated by the LV method, while the LE thresholds with the smallest TCIs correlated best with the LV thresholds. Correlation analysis between eCAP and behavioral thresholds revealed correlation coefficients of r = 0.44 and r = 0.54 for the group analysis of LE and LV thresholds, respectively. Within individual subjects, however, the correlation coefficients varied from approximately −1 to +1 for both LE and LV thresholds. Further analysis showed that across subjects, the behavioral thresholds fell within the TCIs of the eCAP threshold profiles. Conclusion: This study shows that eCAP thresholds have an uncertainty that can be estimated using TCIs. The size of the TCI depends on several factors, for example, the threshold estimation method and measurement conditions, but it is often larger than one would expect when just looking at the threshold values. Given these large TCIs, future research on eCAP thresholds should be accompanied by a measure of precision to correctly apply eCAP thresholds in clinical practice. Comparing our eCAP threshold results with T profiles indicates that the eCAP thresholds are possibly not precise enough to predict T profiles. ACKNOWLEDGMENTS: This study was supported by the Dutch Technology Foundation STW and Advanced Bionics. The authors have no conflicts of interest to disclose. Address for correspondence: Johan H. M. Frijns, ENT Department, Leiden University Medical Centre, PO BOX 9600, 2300 RC Leiden, The Netherlands. E-mail: j.h.m.frijns@lumc.nl Received October 24, 2016; accepted October 7, 2017. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Replacement of Sedentary Time with Physical Activity: Impact on Lipoproteins
Purpose Limited data on the relationship between physical activity and lipoprotein particle profiles exist. Our objective was to investigate associations between objectively measured physical activity and lipoprotein particle size and number, and specifically whether substituting daily sedentary behaviour with light activity or moderate to vigorous physical activity (MVPA), is associated with beneficial alterations to the lipoprotein profile among adults and those at increased cardiometabolic risk (obese and insulin resistant subjects). Methods Sedentary behaviour and physical activity intensity and duration were measured for 7-consecutive days using the GENEActiv accelerometer in a cross-sectional adult cohort (n=396, mean age 59.6±5.5 years). Lipoprotein particle size and subclass concentrations were determined using nuclear magnetic resonance (NMR) spectroscopy. Isotemporal substitution regression modelling quantified the associations between replacing 30 minutes per day of sedentary behaviour with equal amounts of light activity and MVPA on lipoprotein profiles. Results Daily duration of MVPA was inversely associated with large VLDL particles and lipoprotein insulin resistance scores (LP-IR) (P
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Iovance Biotherapeutics to Webcast Analyst Day on Wednesday, December 13, 2017
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Head and Neck cancer (HNC Market Report for Developing Business Strategies
| Head and Neck cancer (HNC Market Report for Developing Business Strategies MilTechFull coverage |
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Do You Know These 5 Types Of Bad Breath Could Be Telling You Something About Your Health?
| Do You Know These 5 Types Of Bad Breath Could Be Telling You Something About Your Health? 360Nobs.comFull coverage |
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Anemia in pregnancy and its associated factors among primary care clients in Sagamu, Southwest, Nigeria: A facility-based study
Oluwafolahan Olugbenga Sholeye, Victor Jide Animasahun, Tessie O Shorunmu
Journal of Family Medicine and Primary Care 2017 6(2):323-329
Introduction: In Nigeria, anemia in pregnancy is one of the leading causes of poor pregnancy outcomes. This study, therefore, determined the prevalence of anemia and its associated factors, among pregnant primary care clients in Sagamu, Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out among 400 pregnant, primary care clients in Sagamu, selected through multi-stage sampling. Data were collected with the aid of an interviewer-administered, semi-structured questionnaire, a stadiometer, measuring tape, and a hemoglobinometer. Data were analyzed using SPSS version 17.00. Relevant descriptive and inferential statistics were calculated. Participation was fully voluntary. Results: The mean age of respondents was 25.4 ± 4.2 years. Most respondents (51.8%) were traders. About a third (32.5%) of respondents were anemic; of these, 72.1% were mildly anemic, while 27.1% were moderately anemic. Anemia was associated with household food security (P = 0.044) and level of food insecurity (P = 0.001) but not with age, occupation, educational status, household size, number of previous pregnancies, body mass index, mid-upper arm circumference, snacking, vegetable intake, and food avoidance (P > 0.05). Conclusion: Anemia in pregnancy is still high among respondents and associated with household food insecurity. Interventions targeted at improving household food security, dietary intake, and socioeconomic conditions will significantly reduce the prevalence and severity of anemia in pregnancy.
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Journal of Family Medicine and Primary Care 2017 6(2):323-329
Introduction: In Nigeria, anemia in pregnancy is one of the leading causes of poor pregnancy outcomes. This study, therefore, determined the prevalence of anemia and its associated factors, among pregnant primary care clients in Sagamu, Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out among 400 pregnant, primary care clients in Sagamu, selected through multi-stage sampling. Data were collected with the aid of an interviewer-administered, semi-structured questionnaire, a stadiometer, measuring tape, and a hemoglobinometer. Data were analyzed using SPSS version 17.00. Relevant descriptive and inferential statistics were calculated. Participation was fully voluntary. Results: The mean age of respondents was 25.4 ± 4.2 years. Most respondents (51.8%) were traders. About a third (32.5%) of respondents were anemic; of these, 72.1% were mildly anemic, while 27.1% were moderately anemic. Anemia was associated with household food security (P = 0.044) and level of food insecurity (P = 0.001) but not with age, occupation, educational status, household size, number of previous pregnancies, body mass index, mid-upper arm circumference, snacking, vegetable intake, and food avoidance (P > 0.05). Conclusion: Anemia in pregnancy is still high among respondents and associated with household food insecurity. Interventions targeted at improving household food security, dietary intake, and socioeconomic conditions will significantly reduce the prevalence and severity of anemia in pregnancy.
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The spice route's perspective on family medicine via the social media project “#1WordforFamilyMedicine”
Kyle Hoedebecke, Tasneem Borhany, Sanam Shah, Zakiur Rahman, Hiranthini De Silva, Bipin Nepal, Bhavna Matta
Journal of Family Medicine and Primary Care 2017 6(2):180-181
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Journal of Family Medicine and Primary Care 2017 6(2):180-181
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Validity of Indian Diabetes Risk Score and its association with body mass index and glycosylated hemoglobin for screening of diabetes in and around areas of Lucknow
Mohammad Mustufa Khan, Gyanendra Kumar Sonkar, Roshan Alam, Sudhir Mehrotra, M Salman Khan, Ajay Kumar, Satyendra Kumar Sonkar
Journal of Family Medicine and Primary Care 2017 6(2):366-373
Objectives: The present study aimed to assess the validity of Indian Diabetes Risk Score (IDRS) and its association with body mass index (BMI) and glycosylated hemoglobin (HbA1c) for screening of diabetes and obesity. Methodology: A cross-sectional study was designed, and samples were randomly enrolled from Lucknow and its adjoining areas. Totally, 405 subjects were included in the study. We used diabetes risk factors (age, waist circumference, physical activity, and family history of diabetes) for screening of diabetes and abdominal obesity (AO) and BMI for screening of general obesity. HbA1c was used for confirming the diabetes patients in this population. Statistical analysis was applied to all data using SPSS software (version 20.0). P < 0.05 was considered statistically significant. Results: All 405 subjects were assessed for diabetic risk factors, BMI, and glycated hemoglobin. Of these, 56.3% subjects were aged ≥50 years. 1° and 2° AO was found in 47.9% and 40% subjects, respectively. About 27.1% subjects were found to have sedentary lifestyle, and 72.6% were found to have no family history of diabetes. According to IDRS, 272 subjects (67.2%) were found at high risk of diabetes (score ≥60). Based on BMI calculation, 198 subjects were obese, of which 79.3% were found at high risk for diabetes. A significant association was found between subjects with higher risk score and BMI (P < 0.001). Assessment of HbA1c showed that 97 (23.9%) were prediabetic and 204 (50.4%) were diabetic, of which 63.9% and 77%, respectively was at high risk for diabetes as per IDRS. A significant association was found between subjects with higher risk score and HbA1c (P < 0.001). Conclusion: Our study fully supports the validity of IDRS, as it can be used as a cost-effective tool for primary mass screening of diabetes. Moreover, its combination with BMI value and HbA1c can be used for strict monitoring for diabetes and obesity at primary health care centers to reduce the early development of diabetes complications and severe obesity comorbidities.
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Journal of Family Medicine and Primary Care 2017 6(2):366-373
Objectives: The present study aimed to assess the validity of Indian Diabetes Risk Score (IDRS) and its association with body mass index (BMI) and glycosylated hemoglobin (HbA1c) for screening of diabetes and obesity. Methodology: A cross-sectional study was designed, and samples were randomly enrolled from Lucknow and its adjoining areas. Totally, 405 subjects were included in the study. We used diabetes risk factors (age, waist circumference, physical activity, and family history of diabetes) for screening of diabetes and abdominal obesity (AO) and BMI for screening of general obesity. HbA1c was used for confirming the diabetes patients in this population. Statistical analysis was applied to all data using SPSS software (version 20.0). P < 0.05 was considered statistically significant. Results: All 405 subjects were assessed for diabetic risk factors, BMI, and glycated hemoglobin. Of these, 56.3% subjects were aged ≥50 years. 1° and 2° AO was found in 47.9% and 40% subjects, respectively. About 27.1% subjects were found to have sedentary lifestyle, and 72.6% were found to have no family history of diabetes. According to IDRS, 272 subjects (67.2%) were found at high risk of diabetes (score ≥60). Based on BMI calculation, 198 subjects were obese, of which 79.3% were found at high risk for diabetes. A significant association was found between subjects with higher risk score and BMI (P < 0.001). Assessment of HbA1c showed that 97 (23.9%) were prediabetic and 204 (50.4%) were diabetic, of which 63.9% and 77%, respectively was at high risk for diabetes as per IDRS. A significant association was found between subjects with higher risk score and HbA1c (P < 0.001). Conclusion: Our study fully supports the validity of IDRS, as it can be used as a cost-effective tool for primary mass screening of diabetes. Moreover, its combination with BMI value and HbA1c can be used for strict monitoring for diabetes and obesity at primary health care centers to reduce the early development of diabetes complications and severe obesity comorbidities.
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Past, present, and future of iodine deficiency disorders in India: Need to look outside the blinkers
Gurmeet Kaur, Tanu Anand, Nidhi Bhatnagar, Abhimanyu Kumar, Diwakar Jha, Shekhar Grover
Journal of Family Medicine and Primary Care 2017 6(2):182-190
Iodine deficiency disorders (IDDs) have been recognized as one of the major nutritional disorders throughout the world affecting 200 million people who are at risk and another 71 million suffering from goiter and other IDDs. These groups of disorders can affect every stage of life, but most vulnerable age group is between 6 and 12 years and these disorders together constitute the single largest preventable cause of brain damage leading to learning disabilities and psychomotor impairment. The existence of endemic goiter in an extensive belt along the southern slopes of the Himalayas, Alps, and Andes has long been described, but consistently high prevalence of IDDs outside the endemic zones and failure to attain goals set by the National Iodine Deficiency Disorder Control Program questions the strategy and achievements till date. Therefore, the present article is an attempt to critically examine the program since inception in India.
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Journal of Family Medicine and Primary Care 2017 6(2):182-190
Iodine deficiency disorders (IDDs) have been recognized as one of the major nutritional disorders throughout the world affecting 200 million people who are at risk and another 71 million suffering from goiter and other IDDs. These groups of disorders can affect every stage of life, but most vulnerable age group is between 6 and 12 years and these disorders together constitute the single largest preventable cause of brain damage leading to learning disabilities and psychomotor impairment. The existence of endemic goiter in an extensive belt along the southern slopes of the Himalayas, Alps, and Andes has long been described, but consistently high prevalence of IDDs outside the endemic zones and failure to attain goals set by the National Iodine Deficiency Disorder Control Program questions the strategy and achievements till date. Therefore, the present article is an attempt to critically examine the program since inception in India.
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