Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174

Σάββατο 30 Σεπτεμβρίου 2017

Antioxidants, Vol. 6, Pages 76: S-Adenosylmethionine and Superoxide Dismutase 1 Synergistically Counteract Alzheimer’s Disease Features Progression in TgCRND8 Mice

Antioxidants, Vol. 6, Pages 76: S-Adenosylmethionine and Superoxide Dismutase 1 Synergistically Counteract Alzheimer's Disease Features Progression in TgCRND8 Mice

Antioxidants doi: 10.3390/antiox6040076

Authors: Rosaria Cavallaro Vincenzina Nicolia Maria Fiorenza Sigfrido Scarpa Andrea Fuso

Recent evidence emphasizes the role of dysregulated one-carbon metabolism in Alzheimer's Disease (AD). Exploiting a nutritional B-vitamin deficiency paradigm, we have previously shown that PSEN1 and BACE1 activity is modulated by one-carbon metabolism, leading to increased amyloid production. We have also demonstrated that S-adenosylmethionine (SAM) supplementation contrasted the AD-like features, induced by B-vitamin deficiency. In the present study, we expanded these observations by investigating the effects of SAM and SOD (Superoxide dismutase) association. TgCRND8 AD mice were fed either with a control or B-vitamin deficient diet, with or without oral supplementation of SAM + SOD. We measured oxidative stress by lipid peroxidation assay, PSEN1 and BACE1 expression by Real-Time Polymerase Chain Reaction (PCR), amyloid deposition by ELISA assays and immunohistochemistry. We found that SAM + SOD supplementation prevents the exacerbation of AD-like features induced by B vitamin deficiency, showing synergistic effects compared to either SAM or SOD alone. SAM + SOD supplementation also contrasts the amyloid deposition typically observed in TgCRND8 mice. Although the mechanisms underlying the beneficial effect of exogenous SOD remain to be elucidated, our findings identify that the combination of SAM + SOD could be carefully considered as co-adjuvant of current AD therapies.

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Accuracy of multi-unit implant impression: traditional techniques versus a digital procedure

Abstract

Objectives

The objective of this study was to evaluate the accuracy of different impression techniques on multiple implants.

Material and methods

A master cast simulating a jaw with four implants was used.

Eight impression techniques were tested: open tray-polyether#1, open tray plus splint of impression copings with acrylic resin-polyether#1, closed tray-polyether#1, open tray-polyether#2, open tray-splint-polyether#2, closed tray-polyether#2, open tray-impression plaster, and digital impression (DI).

Five impressions of the master cast were taken with each traditional impression (TI) technique, pouring 35 sample casts. Three different clinicians took 5 DI each (n = 15).

A three-dimensional coordinate measurement machine (CMM) was used to measure implant angulation and inter-implant distances on TI casts. TI data and DI Standard Tessellation Language datasets were compared with the master cast.

The best and the worst impressions made with TI and DI were selected to fabricate four milled titanium frameworks. Passive fit was evaluated through Sheffield test, screwing each framework on the master cast. Gaps between framework-implant analogs were measured through a stereomicroscope (×40 magnification).

Results

Statistically significant differences in accuracy were found comparing the different impression techniques by CMM (p < 0.01). DI performed the best, while TI techniques revealed a greater variability in the results.

Sheffield test revealed a mean gap of 0.022 ± 0.023 mm (the best TI), 0.063 ± 0.059 mm (the worst TI), 0.015 ± 0.011 mm (the best DI), and 0.019 ± 0.015 mm (the worst DI).

Conclusions

Within the limits of this in vitro study, the digital impression showed better accuracy compared to conventional impressioning.

Clinical relevance

The digital impression might offer a viable alternative to traditional impressions for fabrication of full-arch implant-supported prostheses with satisfactory passive fit.

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Comorbidity Profiles of Patients with Lung Cancer: A New Approach to Risk Stratification?

Comorbidity Profiles of Patients with Lung Cancer: A New Approach to Risk Stratification?

Ann Am Thorac Soc. 2017 Oct;14(10):1512-1513

Authors: Sigel K, Wisnivesky JP

PMID: 28961028 [PubMed - in process]

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The Epworth Sleepiness Scale: Minimum Clinically Important Difference in Obstructive Sleep Apnea.

The Epworth Sleepiness Scale: Minimum Clinically Important Difference in Obstructive Sleep Apnea.

Am J Respir Crit Care Med. 2017 Sep 29;:

Authors: Patel S, Kon SSC, Nolan CM, Barker RE, Simonds AK, Morrell MJ, Man WD

PMID: 28961021 [PubMed - as supplied by publisher]

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Inadequate environment, resources, and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework.

Inadequate environment, resources, and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework.

J Clin Nurs. 2017 Sep 28;:

Authors: Jangland E, Teodorsson T, Molander K, Muntlin Athlin Å

Abstract
AIMS AND OBJECTIVES: The purpose was to explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework.
BACKGROUND: The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high- quality, person-centred care it is important to understand how these factors affect patients' experiences and care needs.
DESIGN: A focused ethnographic approach.
METHOD: A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis.
RESULTS: The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety.
CONCLUSION: Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership, and challenges to patients' safety. The findings highlight the crucial importance of prioritizing and valuing the patients' fundamental care needs for recovery.
RELEVANCE TO CLINICAL PRACTICE: Nursing leaders and nurses need to take the lead to re-conceptualize the value of fundamental care in the acute care setting. To improve clinical practice the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery. This article is protected by copyright. All rights reserved.

PMID: 28960702 [PubMed - as supplied by publisher]

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Association between anxious symptoms and sleeping medication use among US older adults.

Association between anxious symptoms and sleeping medication use among US older adults.

Int J Geriatr Psychiatry. 2017 Sep 29;:

Authors: Harris D, McNicoll L, Epstein-Lubow G, Thomas KS

Abstract
OBJECTIVE: To investigate the relationship between anxiety symptoms and sleeping medication use among a nationally representative sample of US older adults.
DESIGN: Cross-sectional design using data from the 2011 National Health and Aging Trends Study to examine the relationship between anxiety symptoms as rated by the Generalized Anxiety Disorder-2 and self-reported sleeping medication use. Survey weights were applied to account for complex survey design. Logistic regression was used to measure the association between anxiety symptoms and sleeping medication use after adjusting for sociodemographic factors, physical health, and other sleep-related issues.
RESULTS: In 2011, 13.1% of respondents experienced high anxiety symptoms and 29.0% reported taking a sleeping medication at least once a week during the last 30 days. Results estimate that approximately 4 million US older adults have clinically significant anxiety symptoms and approximately 10 million US older adults used a sleeping medication in the last 30 days. Adjusted results revealed that high anxiety symptoms are significantly associated with sleeping medication use compared to low anxiety symptoms (AOR = 1.57; 95% CI, 1.29-1.91). Depression symptoms were also associated with sleeping medication (AOR = 1.29; 95% CI, 1.08-1.55).
CONCLUSIONS: Results demonstrated that anxiety symptoms are significantly associated with sleeping medication use among US older adults. We also found that depressive symptoms, chronic conditions, and worse self-rated health are associated with sleeping medication use. As sleeping medications are associated with adverse health events, these results have clinical implications for treating anxiety symptoms among older patients.

PMID: 28960462 [PubMed - as supplied by publisher]

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Reasoning, evidence, and clinical decision-making: The great debate moves forward.

Reasoning, evidence, and clinical decision-making: The great debate moves forward.

J Eval Clin Pract. 2017 Oct;23(5):905-914

Authors: Loughlin M, Bluhm R, Buetow S, Borgerson K, Fuller J

Abstract
When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors to the literature on medical practice. Things have changed dramatically. Far from being derided or dismissed as a distraction from practical concerns, the discussion of such fundamental questions, and their implications for matters of practical import, is currently the preoccupation of some of the most influential and insightful contributors to the on-going evidence-based medicine debate. Discussions focus on practical wisdom, evidence, and value and the relationship between rationality and context. In the debate about clinical practice, we are going to have to be more explicit and rigorous in future in developing and defending our views about what is valuable in human life.

PMID: 28960730 [PubMed - in process]

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Ulysses in the United Kingdom: Difficulties with a capacity-based justification for self-binding in bipolar disorder.

Ulysses in the United Kingdom: Difficulties with a capacity-based justification for self-binding in bipolar disorder.

J Eval Clin Pract. 2017 Oct;23(5):1038-1044

Authors: Kane NB

Abstract
There has been a recent proposal by Gergel and Owen for introduction of legally enforceable self-binding directives for persons with bipolar affective disorder in the United Kingdom. The model is rooted in presence or absence of decision-making capacity, and the notion of capacity used is an expansion of the usual notion of capacity, in that it is individualized and diachronic. In this article, I argue that an individualized notion of capacity either lacks a coherent foundation or exposes itself to a situation where epistemological error results in a double standard or unjustified enforcement of the directive. I also raise concern that the diachronic notion of capacity leads to an authenticity type account, which fails to incorporate differences in individual prognosis. I then present a rough sketch of an alternative account, more in keeping with current mental health legislation, which uses an individualized notion of "risk to self" to justify self-binding directives in bipolar disorder.

PMID: 28960728 [PubMed - in process]

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Economic Evaluation of Left Ventricular Assist Devices for Patients With End Stage Heart Failure Who Are Ineligible for Cardiac Transplantation.

http:--linkinghub.elsevier.com-ihub-imag

Economic Evaluation of Left Ventricular Assist Devices for Patients With End Stage Heart Failure Who Are Ineligible for Cardiac Transplantation.

Can J Cardiol. 2017 Oct;33(10):1283-1291

Authors: Chew DS, Manns B, Miller RJH, Sharma N, Exner DV

Abstract
BACKGROUND: Continuous flow (CF) left ventricular assist devices (LVADs) improve survival in end-stage heart failure patients who are ineligible for cardiac transplantation. Their use in this population (referred to as destination therapy) is increasing in many countries, yet they are not routinely funded for this indication in Canada. We assessed the cost-effectiveness of destination therapy CF-LVADs from the perspective of the Canadian health care payer.
METHODS: A Markov model was used to project the outcomes and costs of 2 treatment pathways, CF-LVAD implantation and medical management alone, in an end-stage heart failure patient cohort ineligible for transplantation. Clinical and cost input estimates were informed from the available literature. Model outcomes included costs (in 2015 Canadian dollars), quality-adjusted life-years (QALYs), and the cost per QALY gained.
RESULTS: Compared with medical management, CF-LVAD patients had higher costs ($284,287 vs $31,984) and QALYs (1.48 vs 0.39) over a lifetime horizon. The incremental cost per QALY gained was $230,692. The model was most sensitive to device implantation costs, and the clinical effectiveness of CF-LVADs on survival and quality of life. A scenario analysis using contemporary survival data resulted in a cost per QALY gained of $125,936. When applying contemporary LVAD survival trends, the model showed that the cost of initial LVAD implantation needed to be less than $123,000 to be considered cost-effective.
CONCLUSIONS: The incremental cost per QALY for destination therapy CF-LVADs is predicted to be above usual thresholds for funding in Canada. In some plausible scenarios, its cost-effectiveness is similar to dialysis for kidney failure, a therapy that is also immediately life-saving. Because of this, there will be likely ongoing pressure to fund CF-LVADs for a subset of patients ineligible for transplantation.

PMID: 28941608 [PubMed - indexed for MEDLINE]

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Inpatient Postpartum Long-Acting Reversible Contraception: Care That Promotes Reproductive Justice.

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Inpatient Postpartum Long-Acting Reversible Contraception: Care That Promotes Reproductive Justice.

Obstet Gynecol. 2017 Oct;130(4):783-787

Authors: Moniz MH, Spector-Bagdady K, Heisler M, Harris LH

Abstract
Inpatient insertion of long-acting reversible contraceptives (LARC) (intrauterine devices and implants) is increasingly offered to women immediately after childbirth. Enthusiasm for this approach stems from robust safety, effectiveness, and cost-effectiveness data and responsiveness to women's needs and preferences. Although clinical evidence for immediate postpartum LARC is well-established, the ethical implications of enhancing access to this care have not been fully considered. Contraceptive policies and practices often embody a tension between fostering liberal availability and potentially coercive promotion of some methods. Historical contraceptive policies and contemporary disparities in LARC use point to the need to consider whether health policies and health care practices support all women's reproductive wishes. Immediate postpartum LARC services need to be designed and implemented with the goal of ensuring autonomy and equity in postpartum contraceptive care. To this end, these services should include strategic plans to promote universal availability, prevent coercion, and enable device removal.

PMID: 28885401 [PubMed - indexed for MEDLINE]

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Looking ahead and behind at supplemental oxygen: A qualitative study of patients with pulmonary fibrosis.

Looking ahead and behind at supplemental oxygen: A qualitative study of patients with pulmonary fibrosis.

Heart Lung. 2017 Sep - Oct;46(5):387-393

Authors: Graney BA, Wamboldt FS, Baird S, Churney T, Fier K, Korn M, McCormick M, Vierzba T, Swigris JJ

Abstract
RATIONALE: Supplemental oxygen is prescribed to patients with pulmonary fibrosis to normalize oxygen saturations, decrease symptoms and improve quality of life. Along with potential benefits, patients face challenges as they incorporate oxygen into their lives.
OBJECTIVE: Our aim was to better understand the perceptions and experiences of patients with pulmonary fibrosis as they confronted the possibility and realities of using supplemental oxygen.
METHODS: We performed a mixed-methods study in which we conducted a series of four structured telephone interviews with five patients with pulmonary fibrosis enrolled in a longitudinal observational study. Questionnaires were administered at the time of the interviews, which were conducted at enrollment in the longitudinal study, immediately prior to starting supplemental oxygen, one month and then 9-12 months after starting oxygen. We used conventional content analysis to analyze interview data for themes within and across the four time points.
RESULTS: Prior to starting supplemental oxygen, participants uniformly expected it would improve their physical function and quality of life. They also expected practical and psychological limitations, which after starting oxygen, they found to be more pronounced than anticipated. Despite the challenges, participants attributed benefits in symptoms, confidence and mobility to oxygen and came to a reluctant acceptance of it. Their expectations for guidance and support were inadequately met.
CONCLUSIONS: For patients with pulmonary fibrosis, starting and using supplemental oxygen on an everyday basis confers benefits while also presenting a significant number of challenges. The process could be improved by providing them with clearer expectations and trustworthy educational resources. Oxygen case managers could help patients incorporate supplemental oxygen more seamlessly into their lives.

PMID: 28774655 [PubMed - indexed for MEDLINE]

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Determining the longitudinal validity and meaningful differences in HRQL of the PedsQL™ Sickle Cell Disease Module.

Determining the longitudinal validity and meaningful differences in HRQL of the PedsQL™ Sickle Cell Disease Module.

Health Qual Life Outcomes. 2017 Jun 12;15(1):124

Authors: Panepinto JA, Paul Scott J, Badaki-Makun O, Darbari DS, Chumpitazi CE, Airewele GE, Ellison AM, Smith-Whitley K, Mahajan P, Sarnaik SA, Charles Casper T, Cook LJ, Leonard J, Hulbert ML, Powell EC, Liem RI, Hickey R, Krishnamurti L, Hillery CA, Brousseau DC, Pediatric Emergency Care Applied Research Network (PECARN)

Abstract
BACKGROUND: Detecting change in health status over time and ascertaining meaningful changes are critical elements when using health-related quality of life (HRQL) instruments to measure patient-centered outcomes. The PedsQL™ Sickle Cell Disease module, a disease specific HRQL instrument, has previously been shown to be valid and reliable. Our objectives were to determine the longitudinal validity of the PedsQL™ Sickle Cell Disease module and the change in HRQL that is meaningful to patients.
METHODS: An ancillary study was conducted utilizing a multi-center prospective trial design. Children ages 4-21 years with sickle cell disease admitted to the hospital for an acute painful vaso-oclusive crisis were eligible. Children completed HRQL assessments at three time points (in the Emergency Department, one week post-discharge, and at return to baseline (One to three months post-discharge). The primary outcome was change in HRQL score. Both distribution (effect size, standard error of measurement (SEM)) and anchor (global change assessment) based methods were used to determine the longitudinal validity and meaningful change in HRQL. Changes in HRQL meaningful to patients were identified by anchoring the change scores to the patient's perception of global improvement in pain.
RESULTS: Moderate effect sizes (0.20-0.80) were determined for all domains except the Communication I and Cognitive Fatigue domains. The value of 1 SEM varied from 3.8-14.6 across all domains. Over 50% of patients improved by at least 1 SEM in Total HRQL score. A HRQL change score of 7-10 in the pain domains represented minimal perceived improvement in HRQL and a HRQL change score of 18 or greater represented moderate to large improvement.
CONCLUSIONS: The PedsQL™ Sickle Cell Disease Module is responsive to changes in HRQL in patients experiencing acute painful vaso-occlusive crises. The study data establish longitudinal validity and meaningful change parameters for the PedsQL™ Sickle Cell Disease Module.
TRIAL REGISTRATION: ClinicalTrials.gov (study identifier: NCT01197417 ). Date of registration: 08/30/2010.

PMID: 28606098 [PubMed - indexed for MEDLINE]

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Physical health-related quality of life in relation to metabolic health and obesity among men and women in Germany.

Physical health-related quality of life in relation to metabolic health and obesity among men and women in Germany.

Health Qual Life Outcomes. 2017 Jun 10;15(1):122

Authors: Truthmann J, Mensink GBM, Bosy-Westphal A, Hapke U, Scheidt-Nave C, Schienkiewitz A

Abstract
BACKGROUND: This study examined sex-specific differences in physical health-related quality of life (HRQoL) across subgroups of metabolic health and obesity. We specifically asked whether (1) obesity is related to lower HRQoL independent of metabolic health status and potential confounders, and (2) whether associations are similar in men and women.
METHODS: We used cross-sectional data from the German Health Interview and Examination Survey 2008-11. Physical HRQoL was measured using the Short Form-36 version 2 physical component summary (PCS) score. Based on harmonized ATPIII criteria for the definition of the metabolic health and a body mass index ≥ 30 kg/m(2) to define obesity, individuals were classified as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Sex-specific analyses including multivariable linear regression analyses were based on PCS as the dependent variable, metabolic health and obesity category as the independent variable with three categories and MHNO as the reference, and age, education, lifestyle and comorbidities as confounders.
RESULTS: This study included 6860 participants (3298 men, 3562 women). Compared to MHNO, all other metabolic health and obesity categories had significantly lower PCS in both sexes. As reflected by the beta coefficients [95% confidence interval] from bivariable linear regression models, a significant inverse association with PCS was strongest for MUO (men: -7.0 [-8.2; -5.8]; women: -9.0 [-10.2; -7.9]), intermediate for MUNO (men: -4.2 [-5.3; -3.1]; women: -5.6 [-6.8; -4.4]) and least pronounced for MHO (men: -2.2 [-3.6; -0.8]; women -3.9 [-5.4; -2.5]). Differences in relation to MHNO remained statistically significant for all groups after adjusting for confounders, but decreased in particular for MUNO (men:-1.3 [-2.3; -0.3]; women: -1.5 [-2.7; -0.3].
CONCLUSIONS: Obesity was significantly related to lower physical HRQoL, independent of metabolic health status. Potential confounders including age, educational status, health-related behaviors, and comorbidities explained parts of the inverse relationship. Associations were evident in both sexes and consistently more pronounced among women than men.

PMID: 28601090 [PubMed - indexed for MEDLINE]

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Depression and health behaviors in women with Peripartum Cardiomyopathy.

Depression and health behaviors in women with Peripartum Cardiomyopathy.

Heart Lung. 2017 Sep - Oct;46(5):363-368

Authors: Rosman L, Salmoirago-Blotcher E, Cahill J, Wuensch KL, Sears SF

Abstract
BACKGROUND: Depression and health behavior engagement are a critical issue for recovery and secondary prevention in heart failure patients. No prior studies have examined these important clinical outcomes in young women diagnosed with Peripartum Cardiomyopathy (PPCM). We sought to characterize the prevalence of depression and health behaviors in PPCM patients and examine whether depression is associated with reduced engagement in health behaviors.
METHODS: A nation-wide, cohort of 177 PPCM patients (mean age of 34.8 ± 5.7 years; median time since diagnosis of 3.0 ± 4.3 years) from a web-based quality of life registry completed questionnaires about depression (Patient Health Questionnaire; a cutoff score ≥10 was used for depression screening) and health behaviors. T-tests, chi-square and linear regression were used to compare clinical characteristics and health behaviors among depressed and non-depressed women.
RESULTS: The prevalence of clinical depression at enrollment was 32.3% and was associated with use of antihypertensive medications, disability insurance status, higher BMI, history of arrhythmia and current or past use of psychotropic medication. Health behavior engagement for diet, physical activity, and tobacco cessation were low in the overall sample and depressed PPCM patients were significantly less likely to attend medical appointments than non-depressed women.
CONCLUSIONS: Nearly 1 in 3 PPCM survivors reported symptoms of clinical depression which was associated with worse attendance at medical follow-up visits. Further research is needed to develop risk stratification models and patient-centered interventions to improve clinical outcomes for PPCM survivors.

PMID: 28583376 [PubMed - indexed for MEDLINE]

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Impact of First Eye versus Second Eye Cataract Surgery on Visual Function and Quality of Life.

Impact of First Eye versus Second Eye Cataract Surgery on Visual Function and Quality of Life.

Ophthalmology. 2017 Oct;124(10):1496-1503

Authors: Shekhawat NS, Stock MV, Baze EF, Daly MK, Vollman DE, Lawrence MG, Chomsky AS

Abstract
PURPOSE: To compare the impact of first eye versus second eye cataract surgery on visual function and quality of life.
DESIGN: Cohort study.
PARTICIPANTS: A total of 328 patients undergoing separate first eye and second eye phacoemulsification cataract surgeries at 5 veterans affairs centers in the United States. Patients with previous ocular surgery, postoperative endophthalmitis, postoperative retinal detachment, reoperation within 30 days, dementia, anxiety disorder, hearing difficulty, or history of drug abuse were excluded.
METHODS: Patients received complete preoperative and postoperative ophthalmic examinations for first eye and second eye cataract surgeries. Best-corrected visual acuity (BCVA) was measured 30 to 90 days preoperatively and postoperatively. Patients completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) 30 to 90 days preoperatively and postoperatively. The NEI-VFQ scores were calculated using a traditional subscale scoring algorithm and a Rasch-refined approach producing visual function and socioemotional subscale scores.
MAIN OUTCOME MEASURES: Postoperative NEI-VFQ scores and improvement in NEI-VFQ scores comparing first eye versus second eye cataract surgery.
RESULTS: Mean age was 70.4 years (±9.6 standard deviation [SD]). Compared with second eyes, first eyes had worse mean preoperative BCVA (0.55 vs. 0.36 logarithm of the minimum angle of resolution (logMAR), P < 0.001), greater mean BCVA improvement after surgery (-0.50 vs. -0.32 logMAR, P < 0.001), and slightly worse postoperative BCVA (0.06 vs. 0.03 logMAR, P = 0.039). Compared with first eye surgery, second eye surgery resulted in higher postoperative NEI-VFQ scores for nearly all traditional subscales (P < 0.001), visual function subscale (-3.85 vs. -2.91 logits, P < 0.001), and socioemotional subscale (-2.63 vs. -2.10 logits, P < 0.001). First eye surgery improved visual function scores more than second eye surgery (-2.99 vs. -2.67 logits, P = 0.021), but both first and second eye surgeries resulted in similar improvements in socioemotional scores (-1.62 vs. -1.51 logits, P = 0.255).
CONCLUSIONS: Second eye cataract surgery improves visual function and quality of life well beyond levels achieved after first eye cataract surgery alone. For certain socioemotional aspects of quality of life, second eye cataract surgery results in comparable improvement to first eye cataract surgery.

PMID: 28526550 [PubMed - indexed for MEDLINE]

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Examining the Efficacy of a Family Peer Advocate Model for Black and Hispanic Caregivers of Children with Autism Spectrum Disorder.

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Examining the Efficacy of a Family Peer Advocate Model for Black and Hispanic Caregivers of Children with Autism Spectrum Disorder.

J Autism Dev Disord. 2017 May;47(5):1314-1322

Authors: Jamison JM, Fourie E, Siper PM, Trelles MP, George-Jones J, Buxbaum Grice A, Krata J, Holl E, Shaoul J, Hernandez B, Mitchell L, McKay MM, Buxbaum JD, Kolevzon A

Abstract
Autism spectrum disorder (ASD) affects individuals across all racial and ethnic groups, yet rates of diagnosis are disproportionately higher for Black and Hispanic children. Caregivers of children with ASD experience significant stressors, which have been associated with parental strain, inadequate utilization of mental health services and lower quality of life. The family peer advocate (FPA) model has been utilized across service delivery systems to provide family-to-family support, facilitate engagement, and increase access to care. This study used a randomized controlled design to examine the efficacy of FPAs in a racially and ethnically diverse sample. Results demonstrate significantly increased knowledge of ASD and reduced levels of stress for caregivers who received the FPA intervention as compared to treatment as usual.

PMID: 28168677 [PubMed - indexed for MEDLINE]

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Antibiotics-First Versus Surgery for Appendicitis: A US Pilot Randomized Controlled Trial Allowing Outpatient Antibiotic Management.

Antibiotics-First Versus Surgery for Appendicitis: A US Pilot Randomized Controlled Trial Allowing Outpatient Antibiotic Management.

Ann Emerg Med. 2017 Jul;70(1):1-11.e9

Authors: Talan DA, Saltzman DJ, Mower WR, Krishnadasan A, Jude CM, Amii R, DeUgarte DA, Wu JX, Pathmarajah K, Morim A, Moran GJ, Olive View–UCLA Appendicitis Study Group

Abstract
STUDY OBJECTIVE: Randomized trials suggest that nonoperative treatment of uncomplicated appendicitis with antibiotics-first is safe. No trial has evaluated outpatient treatment and no US randomized trial has been conducted, to our knowledge. This pilot study assessed feasibility of a multicenter US study comparing antibiotics-first, including outpatient management, with appendectomy.
METHODS: Patients aged 5 years or older with uncomplicated appendicitis at 1 US hospital were randomized to appendectomy or intravenous ertapenem greater than or equal to 48 hours and oral cefdinir and metronidazole. Stable antibiotics-first-treated participants older than 13 years could be discharged after greater than or equal to 6-hour emergency department (ED) observation with next-day follow-up. Outcomes included 1-month major complication rate (primary) and hospital duration, pain, disability, quality of life, and hospital charges, and antibiotics-first appendectomy rate.
RESULTS: Of 48 eligible patients, 30 (62.5%) consented, of whom 16 (53.3%) were randomized to antibiotics-first and 14 (46.7%) to appendectomy. Median age was 33 years (range 9 to 73 years), median WBC count was 15,000/μL (range 6,200 to 23,100/μL), and median computed tomography appendiceal diameter was 10 mm (range 7 to 18 mm). Of 15 antibiotic-treated adults, 14 (93.3%) were discharged from the ED and all had symptom resolution. At 1 month, major complications occurred in 2 appendectomy participants (14.3%; 95% confidence interval [CI] 1.8% to 42.8%) and 1 antibiotics-first participant (6.3%; 95% CI 0.2% to 30.2%). Antibiotics-first participants had less total hospital time than appendectomy participants, 16.2 versus 42.1 hours, respectively. Antibiotics-first-treated participants had less pain and disability. During median 12-month follow-up, 2 of 15 antibiotics-first-treated participants (13.3%; 95% CI 3.7% to 37.9%) developed appendicitis and 1 was treated successfully with antibiotics; 1 had appendectomy. No more major complications occurred in either group.
CONCLUSION: A multicenter US trial comparing antibiotics-first to appendectomy, including outpatient management, is feasible to evaluate efficacy and safety.

PMID: 27974169 [PubMed - indexed for MEDLINE]

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Three-dimensional reconstruction with serial whole-mount sections of oral tongue squamous cell carcinoma: a preliminary study.

Three-dimensional reconstruction with serial whole-mount sections of oral tongue squamous cell carcinoma: a preliminary study.

J Oral Pathol Med. 2017 Sep 28;:

Authors: Wang Y, Chen S, Ni Y, Magee D, Pu Y, Zhou Q, Wang Z, Zhang L, Huang X, Hu Q

Abstract
OBJECTIVES: Margin status and invasion pattern are prognostic factors for oral tongue squamous cell carcinoma (OTSCC). Current methods to identify these factors are limited to 2D observation, it is necessary to explore 3D reconstruction with whole-mount sample to improve analysis accuracy. This study aimed to study the tissue-preparation, section generation and 3D reconstruction with whole-mount OTSCC specimen.
STUDY DESIGN: Two OTSCC samples were retrieved from Nanjing Stomatological Hospital, Medical School of Nanjing University. One sample was sliced into 3 equal-sized pieces and subjected to different processing schedules to determine the best method. The second sample was processed accordingly. Serial whole-mount sections of the second sample were generated, stained with HE/anti-cytokine antibody in intersection manner and scanned into digital images. Digital images were aligned and reconstructed into 3D images with Hetero Genius Medical Image Manager 3D Pathology Add-On [HGMIM3D].
RESULTS: Successful serial whole-mount sections of comparable quality to traditional sections were generated. 3D images with serial whole-mount sections were successfully generated.
CONCLUSIONS: Whole-mount histopathological 3D reconstruction of OTSCC was successfully generated, providing a solid foundation for comprehensive margin and invasion analysis. Though future study and improvement was needed, whole-mount histopathological 3D reconstruction proved to be a promising method in OTSCC study. This article is protected by copyright. All rights reserved.

PMID: 28960470 [PubMed - as supplied by publisher]

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Viruses, Vol. 9, Pages 282: 3D Spatially Resolved Models of the Intracellular Dynamics of the Hepatitis C Genome Replication Cycle

Viruses, Vol. 9, Pages 282: 3D Spatially Resolved Models of the Intracellular Dynamics of the Hepatitis C Genome Replication Cycle

Viruses doi: 10.3390/v9100282

Authors: Markus Knodel Sebastian Reiter Paul Targett-Adams Alfio Grillo Eva Herrmann Gabriel Wittum

Mathematical models of virus dynamics have not previously acknowledged spatial resolution at the intracellular level despite substantial arguments that favor the consideration of intracellular spatial dependence. The replication of the hepatitis C virus (HCV) viral RNA (vRNA) occurs within special replication complexes formed from membranes derived from endoplasmatic reticulum (ER). These regions, termed membranous webs, are generated primarily through specific interactions between nonstructural virus-encoded proteins (NSPs) and host cellular factors. The NSPs are responsible for the replication of the vRNA and their movement is restricted to the ER surface. Therefore, in this study we developed fully spatio-temporal resolved models of the vRNA replication cycle of HCV. Our simulations are performed upon realistic reconstructed cell structures—namely the ER surface and the membranous webs—based on data derived from immunostained cells replicating HCV vRNA. We visualized 3D simulations that reproduced dynamics resulting from interplay of the different components of our models (vRNA, NSPs, and a host factor), and we present an evaluation of the concentrations for the components within different regions of the cell. Thus far, our model is restricted to an internal portion of a hepatocyte and is qualitative more than quantitative. For a quantitative adaption to complete cells, various additional parameters will have to be determined through further in vitro cell biology experiments, which can be stimulated by the results deccribed in the present study.

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Benefits of home-based multidisciplinary exercise and supportive care in inoperable non-small cell lung cancer – protocol for a phase II randomised controlled trial

Lung cancer is one of the most commonly diagnosed cancers, and is a leading cause of cancer mortality world-wide. Due to lack of early specific symptoms, the majority of patients present with advanced, inopera...

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