text:
Publication date: Available online 9 January 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): A. Wood, B.I. Conn
We present two further cases of sclerosing microcystic adenocarcinoma occurring in the tongue of two female patients; one aged 68 years old and the other 49 years old. Histopathologically, both tumours were characterized by a diffusely infiltrative lesion consisting of small cuboidal cells arranged in discrete, dispersed cords, isolated tubules and bilayered strands with intervening microcystic lumina set in a sclerotic background. Both lesions showed striking neurotopism with perineural and intraneural infiltration. Extensive invasion of adjacent skeletal muscle was also observed. The tumour cells showed diffuse staining with antibodies to CK7. A dual population of ductal and myoepithelial cells was identified, with antibodies to CAM5.2 & CK5/6 decorating the inner epithelial layer and antibodies to p63, p40 and S100 staining the outer myoepithelial cell layer. The Ki-67 proliferation index in both cases was <5%. An initial diagnosis of adenocarcinoma NOS of salivary gland origin was made on both incisional biopsies with a possible metastatic origin, particularly from breast, also raised. A local minor salivary gland origin was confirmed after staging investigations and surgical resection. Both patients were treated by surgery alone and remain well five years and one year and two months post treatment respectively.
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Τρίτη, 9 Ιανουαρίου 2018
Sclerosing microcystic adenocarcinoma of the tongue: a report of two further cases and review of the literature.
Publication date: Available online 9 January 2018
Analysis of the evolution of gross alpha and gross beta activities in airborne samples in Valencia (Spain)
Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183
Author(s): Marina Sáez-Muñoz, María del Carmen Bas, Josefina Ortiz, Sebastián Martorell
Gross alpha (Aα) and gross beta activities (Aβ) were measured weekly in the airborne of the Universitat Politècnica de Valencia campus (in the east of Spain) during the period 2009–2015 (7 years). The geometric mean values of weekly Aα and Aβ were 0.53·10−4 Bq m−3 and 5.77·10−4 Bq m−3, respectively; with an average ratio Aα/Aβ of 0.097. This study highlights the heterogeneity of gross alpha and gross beta activities depending on the different periods of the year. Data show seasonal variations with the highest activity in summer months and the lowest one in winter months. Several atmospheric factors were considered in order to explain this intra-annual variation (wind speed, temperature, relative humidity, precipitations, dust content and prevailing wind directions). Multiple Linear Regression Analysis were performed in order to obtain information on significant atmospheric factors that affect gross α and gross β variability, which could be useful in identifying meteorological or atmospheric changes that could cause deviations in gross α and gross β activity depending on the seasons considered. Models obtained explain more than 60% of variability for global data, and also for winter and spring-autumn months. However, more research is needed to explain gross α and gross β variability in summer months, because the atmospheric factors considered in the MLR explain less than 35% of variability.
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Sclerosing microcystic adenocarcinoma of the tongue: a report of two further cases and review of the literature.
We present two further cases of sclerosing microcystic adenocarcinoma occurring in the tongue of two female patients; one aged 68 years old and the other 49 years old. Histopathologically, both tumours were characterized by a diffusely infiltrative lesion consisting of small cuboidal cells arranged in discrete, dispersed cords, isolated tubules and bilayered strands with intervening microcystic lumina set in a sclerotic background. Both lesions showed striking neurotopism with perineural and intraneural infiltration.
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The Barrel Vascular Reconstruction Device
Background and Purpose
The Barrel device is an electrolytically detachable laser cut, closed-cell microstent that is used for neck reconstruction in wide-necked bifurcation and branching aneurysms to support coiling. The key feature is a barrel section that herniates over the aneurysmal ostium. The objective was to evaluate the safety, feasibility and the immediate and mid-term occlusion results of this new device.
Material and Methods
The databases of two tertiary care centers were screened for all Barrel-based stent-assisted intracranial coil embolization of wide-necked aneurysms between June 2015 and September 2016. Case files and imaging data were retrospectively analyzed for angiographic and clinical outcome parameters, including immediate and mid-term modified Raymond-Roy aneurysm occlusion classification (RROC) rates and procedural complications.
A total of 21 patients comprising 21 intracranial aneurysms (20 unruptured, 1 ruptured) were treated with the Barrel device and additional coiling of the aneurysm sac. All aneurysms were wide-necked, saccular bifurcation aneurysms defined by a dome/neck ratio ≤2. Immediate complete occlusion (RROC1) was observed in 19/21 (90%). An intra-interventional in-stent thrombus formation in two cases (10%) was medically resolved without neurological sequelae. A single case of symptomatic in-stent stenosis (5%) was cleared by balloon angioplasty. Follow-up (FU) was available in 20/21 cases (95%) after a median of 282 days (range: 17–591 days). At follow-up 19/20 aneurysms (95%) were completely occluded (RROC1).
The Barrel device showed a satisfactory safety profile and a promising rate of immediate and mid-term complete aneurysm occlusion for stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms, warranting further investigation of the device.
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Morphometry of the Hand Knob Region and Motor Function Change in Eloquent Area Glioma Patients
The hand knob area is the cortical representation of motor hand function. The current study aimed to investigate the effects of eloquent area gliomas on the morphometry of the hand motor cortex and preoperative hand motor function.
A retrospective study of 320 glioma patients was conducted. Seventy-eight patients with gliomas involving motor functional area were finally enrolled. Using axial T2-weight magnetic resonance images, the width and height of the hand knob were measured in both hemispheres, and differences were compared between the affected and unaffected hemispheres. Receiver operating characteristic (ROC) curve and logistic regression analysis were used to estimate the degree of correlation between distance measurements and motor impairment.
The width and height of the hand knob in the affected and unaffected hemispheres were significantly different (p < 0.0001). The width, height and distance from the tumor to hand knob were reduced in the functionally impaired group compared to the unimpaired group (p = 0.0003, p < 0.0001, p = 0.0005, respectively). The three parameters were significantly correlated and remained significant in ROC and logistic regression analysis. The optimal cut-off value of width, height and distance for identifying preoperative hand muscle strength were 5.73 mm, 5.80 mm and 5.92 mm, respectively.
The morphometry of the hand knob is often changed by the infiltration or extrusion of the tumors that were located in or near the hand knob. The width, height of hand knob and the distance from tumor to hand knob could serve as anatomic biomarkers related to preoperative neurological motor deficits.
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Yttrium-90 Radioembolization for Unresectable Metastatic Neuroendocrine Liver Tumor: A Systematic Review
Publication date: Available online 9 January 2018
Source:European Journal of Radiology
Author(s): Zhongzhi Jia, Weiping Wang
ObjectiveTo evaluate the value of yttrium-90 (90Y) microspheres in the management of unresectable liver metastases secondary to neuroendocrine tumors (NETs).Materials and MethodsPubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the "gray" literature (Google Scholar) were searched for all studies related to 90Y therapy for unresectable liver metastases of NETs.ResultsA total of 11 studies and 7 abstracts involving 870 patients were included in the final analysis. In 11 of these studies, 19.8% (77/388) of patients had undergone transarterial bland embolization (TABE) or transarterial chemoembolization (TACE) before 90Y therapy. The median disease control rate among all patients was 86% at 3 months after 90Y therapy. The median survival was 28 months, with 1-, 2-, and 3-year survival rates of 72.5%, 57%, and 45%, respectively. The median survival values for patients who received resin- and glass-based 90Ytreatment were 27.6 and 31.7 months, respectively. The survival values for patients with carcinoid, pancreatic, and unclassified origin of NETs were 56, 31, and 28 months, respectively; the survival values for patients with grade I, II, and III NETs were 71, 56, and 28 months, respectively. Carcinoid syndrome was reported in 52.4% (55/105) of patients, and 69.1% of those with clinical symptoms demonstrated improvement in symptoms after 90Y radioembolization. Complications were reported in 9 studies, including radiation gastritis (n = 4), duodenal ulcer (n = 2), death due to liver failure (n = 1) and radiation cholecystitis (n = 1). The most common side effects were abdominal pain (median, 32.6%), nausea/vomiting (median, 32.5%), and fatigue (median, 30.4%).Conclusions90Y radioembolization can be used as an alternative therapy for unresectable liver metastases of NETs, with an improved survival rate and tumor response. This treatment is also effective for patients who have undergone unsuccessful TABE/TACE therapy and for the relief of symptoms in patients with carcinoid syndrome.
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Issue Information
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DVD Review
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2017-2020 Editorial Board
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NMR Concepts
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Monte Carlo calculation of photo-neutron dose produced by circular cones at 18MV photon beams
Publication date: January–February 2018
Source:Reports of Practical Oncology & Radiotherapy, Volume 23, Issue 1
Author(s): Elham Hosseinzadeh, Nooshin Banaee, Hassan Ali Nedaie
AimThe aim of this study is to calculate neutron contamination at the presence of circular cones irradiating by 18MV photons using Monte Carlo code.BackgroundSmall photon fields are one of the most useful methods in radiotherapy. One of the techniques for shaping small photon beams is applying circular cones made of lead. Using this method in high energy photon due to neutron contamination is a crucial issue.Materials and methodsInitially, Varian linac producing 18MV photons was simulated and after validating the code, various circular cones were also simulated. Then, the number of neutrons, neutron equivalent dose and absorbed dose per Gy of photon dose were calculated along the central axis.ResultsNumber of neutrons per Gy of photon dose had their maximum value at depth of 2cm and these values for 5, 10, 15, 20 and 30mm circular cones were 9.02, 7.76, 7.61, 6.02 and 5.08 (ncm−2Gy−1), respectively. Neutron equivalent doses per Gy of photon dose had their maximum at the surface of the phantom and these values for mentioned collimators were 1.48, 1.33, 1.31, 1.12 and 1.08 (mSvGy−1), respectively. Neutron absorbed doses had their maximum at the surface of the phantom and these values for mentioned collimators sizes were 103.74, 99.71, 95.77, 81.46 and 78.20 (μGy/Gy), respectively.ConclusionsAs the field size gets smaller, number of neutrons, equivalent and absorbed dose per Gy of photon increase. Also, neutron equivalent dose and absorbed dose are maximum at the surface of phantom and then these values will be decreased.
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CAPTURE: Consistently Acquired Projections for Tuned and Robust EstimationA Self-Navigated Respiratory Motion Correction Approach
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CAPTURE: Consistently Acquired Projections for Tuned and Robust EstimationA Self-Navigated Respiratory Motion Correction Approach
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Correction to: MRI/US fusion-guided biopsy: performing exclusively targeted biopsies for the early detection of prostate cancer
In the original publication of the article, the first and last names of the second author were interchanged.
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Correction to: Mechanical Thrombectomy in Basilar Artery Occlusion
Correction to:
Clin Neuroradiol 2017
The original version of this article unfortunately contained a mistake. The presentation of Fig. 2 was incorrect. The corrected figure is given …
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In the Setting of Negative Mammogram, is Additional Breast Ultrasound Necessary for Evaluation of Breast Pain?
Publication date: Available online 9 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Eralda Mema, Emma Cho, Yun-Kyoung Ryu, Priya Jadeja, Ralph Wynn, Brett Taback, Richard Ha
PurposeTo evaluate whether in the setting of negative diagnostic mammogram for breast pain additional ultrasound is necessary.MethodsRetrospective IRB approved review of our database identified 8085 women who underwent ultrasound evaluation for breast pain from 1/1/2013 to 12/31/2013. Of 8085 women, 559 women had mammogram evaluation preceding the ultrasound and these women comprise the basis of this study. The patient′s age, type of mammogram exam (screening or diagnostic), BIRADS breast density, type of breast pain (focal, diffuse, cyclical, unilateral, bilateral), additional breast symptoms (palpable concern, nipple discharge, skin changes, others), mammogram/ultrasound findings and final BIRADS assessment, follow-up imaging and follow-up biopsy results were reviewed and recorded.ResultsThe median age of patients was 46 years old (range 27–97). Patients recalled from negative screening mammogram were 29.8% (167/559). Patients with preceding negative diagnostic mammogram were 70.2% (392/559). The BIRADS breast density (BD) distribution was BD1: 5.5%, BD2: 39.9%, BD3: 46.0%, BD4: 8.6%. Final BIRADS assessments were BIRADS 1/2 (79%), BIRADS3 (12.9%), BIRADS 4 (8.1%), BIRADS 5 (0%). Majority (66.9%, 374/559) of the patient had breast pain alone. Additional breast symptoms were also noted as follows: palpable concern (24%), nipple discharge (3.9%), skin changes/other (5.2%). On follow-up evaluation, 26 findings were recommended for tissue sampling yielding 2 malignancies (0.4%, 2/559) in 2 patients. In the setting of negative mammogram and clinical symptom of breast pain alone yielded no malignances (NPV, 100%, 374/374) and was not impacted by breast density. In patients with additional symptoms accompanying pain, malignancies were present despite negative mammogram in 2 patients; nipple discharge (4.5%, 1/22) and palpable concern (0.7%, 1/134).ConclusionIn the setting of negative mammogram and breast pain alone, additional evaluation with ultrasound is likely low yield and may be unnecessary. However, with additional symptoms such as palpable concern or nipple discharge, ultrasound is likely an important adjunct modality for identifying mammographically occult tumors.
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Transportation in a 100% renewable energy system
Publication date: 15 February 2018
Source:Energy Conversion and Management, Volume 158
Author(s): Antonio García-Olivares, Jordi Solé, Oleg Osychenko
A 100% renewable economy would give a lasting solution to the challenges raised by climate change, energy security, sustainability, and pollution. The conversion of the present transport system appears to be one of the most difficult aspects of such renewable transition. This study reviews the technologies and systems that are being proposed or proven as alternative to fossil-fuel based transportation, and their prospects for their entry into the post-carbon era, from both technological and energetic viewpoints. The energetic cost of the transition from the current transportation system into global 100% renewable transportation is estimated, as well as the electrical energy required for the operation of the new renewable transportation sector. A 100% renewable transport providing the same service as global transport in 2014 would demand about 18% less energy. The main reduction is expected in road transport (69%), but the shipping and air sectors would notably increase their consumptions: 163% and 149%, respectively. The analysis concludes that a 100% renewable transportation is feasible, but not necessarily compatible with indefinite increase of resources consumption. The major material and energy limitations and obstacles of each transport sector for this transition are shown.
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Bildgebende Diagnostik des Fußes
Klinisches/methodisches Problem
Schmerzsymptome im Bereich des Fußes sind bei langjährig bestehenden kongenitalen, erworbenen oder posttraumatischen Fußdeformitäten ein klinisch relevantes Problem.
Radiologische Standardverfahren
Anhand des klinischen Befunds und der orthopädischen Fragestellung werden zunächst Röntgenaufnahmen des Fußes im Stehen in 2 Ebenen, ergänzt durch eine anterior-posteriore Aufnahme des oberen Sprunggelenks durchgeführt. Die bildgebende Diagnostik des Fußes basiert auf der konventionellen Röntgendiagnostik und wird durch die Möglichkeit schnittbildgebender Verfahren noch präziser und differenzierter.
Die diagnostische Aussagekraft bildgebender Verfahren wird anhand klinischer Beispiele in dieser Übersicht diskutiert. Dabei können schnittbildgebende Verfahren dem Kliniker als weitere Entscheidungshilfe dienen und Fragen klären, ob eine operative Therapieoption wie beispielsweise bei degenerativen Veränderungen besteht.
Empfehlung für die Praxis
Primär sind vor jedem bildgebenden Verfahren die adäquate Anamnese, Inspektion, klinische Untersuchung und die Begutachtung des Gangbilds bei Patienten mit Fußschmerzen erforderlich. Die interdisziplinäre Kommunikation zwischen Orthopäden/Unfallchirurgen und Radiologen ist notwendig, um bei schwierigen Fragestellungen das passende bildgebende Verfahren auszuwählen und den resultierenden Bildbefund korrekt einzuordnen, um daraus eine therapeutische Konsequenz abzuleiten. Die Entscheidung, ob eine konservative Therapie oder ein operatives Verfahren empfohlen wird, wird in Abhängigkeit bisheriger Therapien und der Einschränkung der Lebensqualität gemeinsam mit dem Patienten getroffen.
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Benigne mesenchymale Tumoren des Abdomens
Benigne mesenchymale Tumoren des Abdomens sind, abgesehen von Hämangiomen, seltene Neoplasien, die mit vital bedrohlichen Komplikationen einhergehen können. Daher sind für den Radiologen die Kenntnis der wichtigsten Entitäten und das Wissen um deren Charakteristika in der Bildgebung fundamental.
Es wird ein Überblick über die häufigsten benignen Weichteiltumoren des Abdomens und deren bildmorphologische Kriterien gegeben. Weitere, für die radiologische Praxis relevante Fakten zu den einzelnen Entitäten werden umrissen.
Material und Methoden
Eine Literaturrecherche sowie eine Auswertung der institutsinternen Bilddatenbank wurden durchgeführt.
Hämangiome, Desmoidtumoren sowie Lipome und deren Varianten werden vorgestellt. Typische Charakteristika und bildmorphologische Zeichen der einzelnen Entitäten (z. B. Irisblendenphänomen, "band sign", India-ink-Artefakt) werden erläutert und anhand von Bildbeispielen illustriert.
Auch wenn spezifische diagnostische Merkmale für die meisten der vorgestellten Entitäten fehlen, gibt es wegweisende Kriterien, die in vielen Fällen eine korrekte Diagnosestellung erlauben. In Zweifelsfällen ist zur Differenzierung von malignen Neoplasien eine histologische Sicherung anzustreben.
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Medizin im digitalen Zeitalter
Die zunehmende Digitalisierung unserer Lebens- und Arbeitswelt hat auch die Medizin erreicht und verändert den Beruf des Arztes. Die modernen Kommunikations- und Kooperationsformen des medizinischen Alltags verlangen neue Kompetenzen und Qualifikationen.
Ziel der Arbeit
Damit zukünftige Ärzte diesem digital-kompetenten Profil entsprechen können, wurde ein innovatives Blended-Learning-Curriculum entwickelt, das zum Sommersemester 2017 an der Universitätsmedizin Mainz implementiert wurde – Medizin im digitalen Zeitalter.
Material und Methoden
Das Unterrichtskonzept setzt sich aus 5 Lernmodulen zusammen, die jeweils aus einer E‑Learning-Einheit und einem 3‑stündigen Präsenzunterricht bestehen. Diese Publikation stellt das Lehrkonzept, die erstmalige Implementierung und die Evaluation zum Modul "Telemedizin" dar.
Die Kompetenzentwicklung zum Themengebiet Telemedizin zeigte sowohl für die Teilkomponente Wissen als auch für die Komponente Fertigkeiten einen deutlichen Anstieg. Die zu Beginn des Unterrichts vorhandene neutrale Haltung gegenüber der Telemedizin konnte nach dem Unterricht in eine positive Meinung gewandelt werden.
Die didaktische Vermittlung digitaler Kompetenzen ist ein relevanter Bestandteil der curricularen Weiterentwicklung des Medizinstudiums und darüber hinaus eine Herausforderung für die ärztliche Fort- und Weiterbildung.
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An Excel-Based System to Manage Radiation Safety for the Family of Patients Undergoing 131I Therapy.
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An Excel-Based System to Manage Radiation Safety for the Family of Patients Undergoing 131I Therapy.
J Nucl Med Technol. 2017 Jun;45(2):102-110
Authors: Steward PG
The purpose of this study was to develop spreadsheet workbooks that assist in the radiation safety counseling of 131I therapy patients and their families, providing individualized guidelines that avoid imposing overly conservative restrictions on family members and others. Methods: The mathematic model included biphasic patient radionuclide retention. The extrathyroidal component was a cylindric volume with a diameter corresponding to the patient's size and included patient self-absorption, whereas the thyroidal component was a point source whose transmission was reduced by self-absorption. A separate model in which the thyroid, extrathyroid, and bladder compartments fed serially from one to the next was developed to depict the radionuclide levels within the patient and to estimate the activity entering the environment at each urination. Results: The system was organized into a set of 4 workbooks: the first to be used with ablation patients prepared using thyrogen, the second with ablation patients prepared by deprivation, the third with hyperthyroid patients, and the fourth with the unusual hyperthyroid patient who finds the restrictions to be oppressive and returns 5-10 d after administration for a measurement and reassessment. The workbooks evaluated the radiation field strength external to the patient and indicated restrictions based on selected dose limits. To assist physicians in suggesting contamination precautions, the workbooks also evaluated the radioactivity present within the patient and the estimated discharge into the environment as a function of time. Conclusion: The workbooks that were developed assist the radiation safety counselor in individualizing radiation protection procedures for the family of patients undergoing 131I therapy. The workbook system avoids overly conservative assumptions while permitting selection of appropriate dose limits for each individual.
PMID: 28280126 [PubMed - indexed for MEDLINE]
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High-affinity von Willebrand factor binding does not affect the anatomical or hepatocellular distribution of factor VIII in rats.
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High-affinity von Willebrand factor binding does not affect the anatomical or hepatocellular distribution of factor VIII in rats.
J Thromb Haemost. 2016 Sep;14(9):1803-13
Authors: Øie CI, Roepstorff K, Behrens C, Bøggild Kristensen J, Karpf DM, Bolt G, Gudme CN, Kjalke M, Smedsrød B, Appa RS
UNLABELLED: Essentials Von Willebrand factor (VWF) stabilizes factor VIII (FVIII) and prevents its premature clearance. Rat anatomical and hepatocellular distribution studies assessed the VWF effect on FVIII clearance. Hepatocytes and liver sinusoidal endothelial cells play a key role in FVIII clearance. Anatomical and hepatocellular distribution of FVIII is independent of high-affinity VWF binding.
ABSTRACT: Background Von Willebrand factor (VWF) stabilizes factor VIII in the circulation and prevents its premature clearance. Objective To study the effects of VWF on FVIII clearance in rats with endogenous VWF. Methods Anatomical and hepatocellular distribution studies were performed in rats following intravenous administration of glycoiodinated recombinant FVIII (rFVIII) and a FVIII variant, FVIII-Y1680F, lacking high-affinity VWF binding. Radioactivity was quantified in organs, and in distinct liver cell populations. The role of VWF binding was also studied by immunohistochemical staining of rat livers perfused ex vivo with rFVIII alone or with a FVIII-binding VWF fragment. Results The liver was the predominant organ of rFVIII distribution, and a radioactivity peak was also observed in the intestines, suggesting FVIII secretion to the bile by hepatocytes. In the liver, ~60% of recovered radioactivity was associated with hepatocytes, 32% with liver sinusoidal endothelial cells (LSECs), and 9% with Kupffer cells (KCs). When calculated per cell, 1.5-fold to 3-fold more radioactivity was associated with LSECs than with hepatocytes. The importance of hepatocytes and LSECs was confirmed by immunohistochemical staining; strong staining was seen in LSECs, and less intense, punctate staining in hepatocytes. Minor staining in KCs was observed. Comparable anatomical and hepatocellular distributions were observed with rFVIII and FVIII-Y1680F, and the presence of the VWF fragment, D'D3A1, did not change the FVIII staining pattern in intact livers. Conclusions The present data support FVIII clearance via the liver, with hepatocytes and LSECs playing a key role. High-affinity VWF binding did not alter the anatomical or hepatocellular distribution of FVIII.
PMID: 27378673 [PubMed - indexed for MEDLINE]
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Cervical mass in a 3-year-old child: raising awareness of an unusual diagnosis.
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Cervical mass in a 3-year-old child: raising awareness of an unusual diagnosis.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Oct 18;:
Authors: Ma C, Fu S, Jiang J, He Y
PMID: 29307462 [PubMed - as supplied by publisher]
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Diagnostic Accuracy of Simulated Low-Dose Perfusion CT to Detect Cerebral Perfusion Impairment after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Analysis.
Diagnostic Accuracy of Simulated Low-Dose Perfusion CT to Detect Cerebral Perfusion Impairment after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Analysis.
Radiology. 2018 Jan 08;:162707
Authors: Afat S, Brockmann C, Nikoubashman O, Müller M, Thierfelder KM, Brockmann MA, Nikolaou K, Wiesmann M, Kim JH, Othman AE
Purpose To evaluate diagnostic accuracy of low-dose volume perfusion (VP) computed tomography (CT) compared with original VP CT regarding the detection of cerebral perfusion impairment after aneurysmal subarachnoid hemorrhage. Materials and Methods In this retrospective study, 85 patients (mean age, 59.6 years; 62 women) with aneurysmal subarachnoid hemorrhage and who were suspected of having cerebral vasospasm at unenhanced CT and VP CT (tube voltage, 80 kVp; tube current-time product, 180 mAs) were included, 37 of whom underwent digital subtraction angiography (DSA) within 6 hours. Low-dose VP CT data sets at tube current-time product of 72 mAs were retrospectively generated by validated realistic simulation. Perfusion maps were generated from both data sets and reviewed by two neuroradiologists for overall image quality, diagnostic confidence and presence and/or severity of perfusion impairment indicating vasospasm. An interventional neuroradiologist evaluated 16 vascular segments at DSA. Diagnostic accuracy of low-dose VP CT was calculated with original VP CT as reference standard. Agreement between findings of both data sets was assessed by using weighted Cohen κ and findings were correlated with DSA by using Spearman correlation. After quantitative volumetric analysis, lesion volumes were compared on both VP CT data sets. Results Low-dose VP CT yielded good ratings of image quality and diagnostic confidence and classified all patients correctly with high diagnostic accuracy (sensitivity, 99.0%; specificity, 99.5%) without significant differences regarding presence and/or severity of perfusion impairment between original and low-dose data sets (Z = -0.447; P = .655). Findings of both data sets correlated significantly with DSA (original, r = 0.671; low dose, r = 0.667). Lesion volume was comparable for both data sets (relative difference, 5.9% ± 5.1 [range, 0.2%-25.0%; median, 4.0%]) with strong correlation (r = 0.955). Conclusion The results suggest that radiation dose reduction to 40% of original dose levels (tube current-time product, 72 mAs) may be performed in VP CT imaging of patients with aneurysmal subarachnoid hemorrhage without compromising the diagnostic accuracy regarding detection of cerebral perfusion impairment indicating vasospasm. © RSNA, 2018 Online supplemental material is available for this article.
PMID: 29309735 [PubMed - as supplied by publisher]
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Methodologic Guide for Evaluating Clinical Performance and Effect of Artificial Intelligence Technology for Medical Diagnosis and Prediction.
Methodologic Guide for Evaluating Clinical Performance and Effect of Artificial Intelligence Technology for Medical Diagnosis and Prediction.
Radiology. 2018 Jan 08;:171920
Authors: Park SH, Han K
The use of artificial intelligence in medicine is currently an issue of great interest, especially with regard to the diagnostic or predictive analysis of medical images. Adoption of an artificial intelligence tool in clinical practice requires careful confirmation of its clinical utility. Herein, the authors explain key methodology points involved in a clinical evaluation of artificial intelligence technology for use in medicine, especially high-dimensional or overparameterized diagnostic or predictive models in which artificial deep neural networks are used, mainly from the standpoints of clinical epidemiology and biostatistics. First, statistical methods for assessing the discrimination and calibration performances of a diagnostic or predictive model are summarized. Next, the effects of disease manifestation spectrum and disease prevalence on the performance results are explained, followed by a discussion of the difference between evaluating the performance with use of internal and external datasets, the importance of using an adequate external dataset obtained from a well-defined clinical cohort to avoid overestimating the clinical performance as a result of overfitting in high-dimensional or overparameterized classification model and spectrum bias, and the essentials for achieving a more robust clinical evaluation. Finally, the authors review the role of clinical trials and observational outcome studies for ultimate clinical verification of diagnostic or predictive artificial intelligence tools through patient outcomes, beyond performance metrics, and how to design such studies. © RSNA, 2018.
PMID: 29309734 [PubMed - as supplied by publisher]
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Selection of X-chromosome Inactivation Model.
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Selection of X-chromosome Inactivation Model.
Cancer Inform. 2017;16:1176935117747272
Authors: Wang J, Talluri R, Shete S
To address the complexity of the X-chromosome inactivation (XCI) process, we previously developed a unified approach for the association test for X-chromosomal single-nucleotide polymorphisms (SNPs) and the disease of interest, accounting for different biological possibilities of XCI: random, skewed, and escaping XCI. In the original study, we focused on the SNP-disease association test but did not provide knowledge regarding the underlying XCI models. One can use the highest likelihood ratio (LLR) to select XCI models (max-LLR approach). However, that approach does not formally compare the LLRs corresponding to different XCI models to assess whether the models are distinguishable. Therefore, we propose an LLR comparison procedure (comp-LLR approach), inspired by the Cox test, to formally compare the LLRs of different XCI models to select the most likely XCI model that describes the underlying XCI process. We conduct simulation studies to investigate the max-LLR and comp-LLR approaches. The simulation results show that compared with the max-LLR, the comp-LLR approach has higher probability of identifying the correct underlying XCI model for the scenarios when the underlying XCI process is random XCI, escaping XCI, or skewed XCI to the deleterious allele. We applied both approaches to a head and neck cancer genetic study to investigate the underlying XCI processes for the X-chromosomal genetic variants.
PMID: 29308008 [PubMed]
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Upfront vs. no upfront neck dissection in primary head and neck cancer radio(chemo)therapy: Reply to Elicin et al.
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Upfront vs. no upfront neck dissection in primary head and neck cancer radio(chemo)therapy: Reply to Elicin et al.
Radiother Oncol. 2018 Jan 04;:
Authors: Nevens D, Duprez F, Bonte K, Deron P, Huvenne W, Laenen A, De Neve W, Nuyts S
PMID: 29307729 [PubMed - as supplied by publisher]
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Augmentation surgery on the cartilaginous portion of the vocal fold in a patient with cricoarytenoid joint ankylosis.
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Augmentation surgery on the cartilaginous portion of the vocal fold in a patient with cricoarytenoid joint ankylosis.
Auris Nasus Larynx. 2018 Jan 04;:
Authors: Fukahori M, Chitose SI, Sato K, Kamimura H, Sato K, On R, Umeno H
Surgical management of cricoarytenoid joint (CAJ) ankylosis is challenging and has the risk of worsening voice quality. In the present case, augmentation surgery was performed on the cartilaginous portion of the vocal fold in a patient with CAJ ankylosis. A 24-year-old man sustained blunt trauma to the anterior neck three years prior to developing severe breathiness. Posterior glottal insufficiency resulting from lateral fixation of the right vocal fold was observed during phonation under laryngoscopy. In addition, electromyography and CT scan revealed severe ankylosis of the right CAJ. Type I thyroplasty performed on the right vocal fold did not improve postoperative vocal function. Therefore, augmentation surgery on the cartilaginous portion of the right vocal fold was performed via endolaryngeal microsurgery under general anesthesia with jet ventilation. A piece of temporalis fascia was autotransplanted into the submucosal space created at the posterior cartilaginous portion of the right vocal fold. This resulted in the narrowing of the posterior glottal gap during phonation, leading to improvement in hoarseness. Microsurgical management with autologous fascia augmentation of the cartilaginous portion of the vocal fold can be effective in patients with lateral vocal fold fixation due to CAJ ankylosis.
PMID: 29307442 [PubMed - as supplied by publisher]
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Expression of miR-373 and its predicted target genes E-cadherin and CD44 in patients with laryngeal squamous cell carcinoma.
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Expression of miR-373 and its predicted target genes E-cadherin and CD44 in patients with laryngeal squamous cell carcinoma.
Cell Mol Biol (Noisy-le-grand). 2017 Dec 30;63(12):29-33
Authors: Timirci-Kahraman Ö, Verim A, Farooqi AA, Turan S, Özkan-Küçük NE, Yaylim İ
Laryngeal squamous cell carcinoma (LSCC) is a genomically complex disease that is difficult to target, and efforts have been made to identify new treatment strategies and molecular markers that might stratify patients and individualize options for treatment. miR-373 has diametrically opposed roles in different stages and types of cancers. miR-373 has been suggested to quantitatively control E-cadherin and CD44 expression. We studied the expression of miR-373, E-cadherin and CD44 in laryngeal squamous cell carcinoma and evaluated the association between the disease and clinical characteristics of patients. Tumor tissues were collected from 24 laryngeal cancer patients. Adjacent normal tissue samples were also obtained as controls. After RNA isolation, we assessed the miR-373, E-cadherin and CD44 levels. As endogenous controls, we used the small RNA U6 and GAPDH TaqMan® to normalize the levels of expression of miR-373, E-cadherin and CD44. The fold change in the expression of the genes in larynx tumor and control tissues was calculated using the 2-ΔΔCT method. miR-373 was significantly upregulated in seventeen tumor samples compared to controls. However, the expression levels of both E-cadherin and CD44 mRNA were found to be significantly downregulated in tumor versus control regions (p=0.026 and p=0.005, respectively). We did not find any significant difference in the expression levels of miR-373, E-cadherin or CD44 and cancer risk factors. miR-373, E-cadherin and CD44 may be involved in the etiopathogenesis of laryngeal cancer. It can be suggested that E-cadherin and CD44 are functional targets of miR-373, but we need further studies to investigate this hypothesis.
PMID: 29307338 [PubMed - in process]
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Impact of Nicotine Exposure on Hair Cell Toxicity and Embryotoxicity During Zebrafish Development.
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Impact of Nicotine Exposure on Hair Cell Toxicity and Embryotoxicity During Zebrafish Development.
Clin Exp Otorhinolaryngol. 2018 Jan 06;:
Authors: Yoo MH, Rah YC, Park S, Goun S, Im GJ, Chae SW, Jung HH, Choi J
Objectives: Nicotine has various adverse effects including negative impacts associated with maternal exposure. In the current study, we examined nicotine-induced damage of hair cells and embryotoxicity during zebrafish development.
Methods: Zebrafish embryos were exposed to nicotine at several concentrations (5, 10, 20, and 40 μM) and embryotoxicity were evaluated at 72 hours, including hatching rate, mortality, teratogenicity rate, and heart rate. Hair cells within the supraorbital (SO1 and SO2), otic (O1), and occipital (OC1) neuromasts were identified at 120 hours. Apoptosis and mitochondrial damage of hair cells were analyzed using TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling) and DASPEI (2-[4-(dimethylamino)styryl]-N-ethylpyridinium iodide) assays, respectively, and changes of ultrastructure were observed by scanning electron microscopy.
Results: The control group without nicotine appeared normal with overall mortality and teratogenicity rate <5%. The hatching rate and mortality rate was not significantly different according to nicotine concentration (n=400 each). The abnormal morphology rate (n=400) increased and heart rate (n=150) decreased with increasing nicotine concentration (P<0.05). Nicotine-induced hair cell damage significantly increased as nicotine concentration increased. A significantly greater number of TUNEL-positive cells (P<0.01) and markedly smaller DASPEI area (P<0.01) were shown as nicotine concentration increased.
Conclusion: The current Results suggest that nicotine induces dose-dependent hair cell toxicity in embryos by promoting apoptosis and mitochondrial and structural damage.
PMID: 29307133 [PubMed - as supplied by publisher]
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Staphylococcus Aureus V8 protease disrupts the integrity of the airway epithelial barrier and impairs IL-6 production in vitro.
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Staphylococcus Aureus V8 protease disrupts the integrity of the airway epithelial barrier and impairs IL-6 production in vitro.
Laryngoscope. 2018 Jan;128(1):E8-E15
Authors: Murphy J, Ramezanpour M, Stach N, Dubin G, Psaltis AJ, Wormald PJ, Vreugde S
OBJECTIVE: Staphylococcus aureus (S. aureus) infection is known to contribute to the severity and recalcitrance of chronic rhinosinusitis (CRS), and its secreted products have been shown to alter the airway barrier. Extracellular proteases secreted by S. aureus are thought to be important in epithelial infection and immune evasion; however, their effect on airway mucosal barrier function is not known.
METHODS: To investigate the impact of extracellular proteases on airway epithelial integrity, the purified S. aureus proteases V8 protease, Staphopain A, Staphopain B, Exfoliative toxin A, and serine protease-like A-F were applied to human nasal epithelial cell air-liquid interface (HNEC-ALI) cultures. Transepithelial electrical resistance (TEER), permeability (Papp) measurements, and immuno-localization of the tight junction proteins claudin-1 and ZO-1 were used to assess barrier integrity. Effects of the proteases on inflammation and cell viability were measured using interleukin-6 (IL-6) ELISA and a lactate dehydrogenase assay.
RESULTS: Application of V8 protease to HNEC-ALI cultures caused a significant concentration and time-dependent decrease in TEER (22.67%, P < 0.0001), a reciprocal Papp increase (20.14-fold, P < 0.05), and a discontinuous ZO-1 immuno-localization compared to control. IL-6 production was significantly reduced in V8 protease-treated cells (153.5 pg/mL, P = 0.0069) compared to control (548.3 pg/mL), whereas no difference in cell viability was observed.
CONCLUSION: S. aureus V8 protease causes dysfunction of mucosal barrier structure and function indicative of a leaky barrier. A reduction in IL-6 levels suggests that the mucosal immunity is impaired by this protease and thus has the potential to contribute to CRS recalcitrance.
LEVEL OF EVIDENCE: NA. Laryngoscope, 128:E8-E15, 2018.
PMID: 28994126 [PubMed - indexed for MEDLINE]
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Shared Humanity.
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Shared Humanity.
Ann Intern Med. 2017 Sep 05;167(5):359
Authors: Goshua G
PMID: 28869981 [PubMed - indexed for MEDLINE]
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Repairing the vibratory vocal fold.
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Repairing the vibratory vocal fold.
Laryngoscope. 2018 Jan;128(1):153-159
Authors: Long JL
OBJECTIVE: A vibratory vocal fold replacement would introduce a new treatment paradigm for structural vocal fold diseases such as scarring and lamina propria loss. This work implants a tissue-engineered replacement for vocal fold lamina propria and epithelium in rabbits and compares histology and function to injured controls and orthotopic transplants. Hypotheses were that the cell-based implant would engraft and control the wound response, reducing fibrosis and restoring vibration.
STUDY DESIGN: Translational research.
METHODS: Rabbit adipose-derived mesenchymal stem cells (ASC) were embedded within a three-dimensional fibrin gel, forming the cell-based outer vocal fold replacement (COVR). Sixteen rabbits underwent unilateral resection of vocal fold epithelium and lamina propria, as well as reconstruction with one of three treatments: fibrin glue alone with healing by secondary intention, replantation of autologous resected vocal fold cover, or COVR implantation. After 4 weeks, larynges were examined histologically and with phonation.
RESULTS: Fifteen rabbits survived. All tissues incorporated well after implantation. After 1 month, both graft types improved histology and vibration relative to injured controls. Extracellular matrix (ECM) of the replanted mucosa was disrupted, and ECM of the COVR implants remained immature. Immune reaction was evident when male cells were implanted into female rabbits. Best histologic and short-term vibratory outcomes were achieved with COVR implants containing male cells implanted into male rabbits.
CONCLUSION: Vocal fold cover replacement with a stem cell-based tissue-engineered construct is feasible and beneficial in acute rabbit implantation. Wound-modifying behavior of the COVR implant is judged to be an important factor in preventing fibrosis.
LEVEL OF EVIDENCE: NA. Laryngoscope, 128:153-159, 2018.
PMID: 28771731 [PubMed - indexed for MEDLINE]
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We're looking forward to attending 10th BGIICC in Egypt this month to film. https://t.co/z8TxEVJaoA https://t.co/vLEWScxuLU
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Innovationen in der chirurgischen Behandlung solider Tumoren im Kindesalter
Die Gesamtüberlebensrate von Kindern mit einem soliden Tumor hat sich in den letzten Jahrzehnten dank des Fortschritts in allen an der Therapie beteiligten Fachdisziplinen deutlich verbessert. Eine Herausforderung sind weiterhin eine schlechte Prognose im fortgeschrittenen Erkrankungsstadium und die mit dem therapeutischen Vorgehen verbundene Morbidität. Innovationen in der chirurgischen Behandlung solider Tumoren können dazu beitragen, die Überlebensrate betroffener Kinder zu erhöhen und die therapiebedingte Morbidität zu verringern. Anhand von vier Beispielen wird die erfolgreiche Umsetzung von Innovationen unter diesen Aspekten aufgezeigt. (1) Die Tumornephrektomie war lange Zeit der Standardeingriff beim Wilms-Tumor (Nephroblastom). Modifikationen der Operationstechniken ermöglichen eine nierenerhaltende Tumorresektion und Verminderung der Langzeitfolgen nach Nephrektomie. (2) Die Therapie von Hochrisiko-Hepatoblastomen sieht in den aktuellen Protokollen der Internationalen Gesellschaft für Pädiatrische Onkologie (SIOP) eine Lebertransplantation vor. Mithilfe neuer Softwareprozessoren ist mittels virtueller Bildgebungsmethoden eine exaktere und individuelle Operationsplanung möglich, die eine organerhaltende Tumorresektion erlaubt und so eine Transplantation vermeidet. (3) Zur kurativen Therapie von Rhabdomyosarkomen sind zum Teil mutilierende Operationen notwendig. Durch eine Kombination von Chirurgie und Brachytherapie, können mutilierende Eingriffe im Urogenitalbereich vermieden werden. (4) Durch die CT-gesteuerte präoperative Markierung von Lungenmetastasen mittels "Coils" werden diese der minimalinvasiven Resektion zugänglich. Dies spart in ausgesuchten Fällen eine Thorakotomie ein und verringert durch den kürzeren postoperativen Verlauf die Zeit bis zur anschließenden adjuvanten Therapie.
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Chirurgische Innovationen in der Therapie des metastasierten kolorektalen Karzinoms
Kolorektale Lebermetastasen (KLM) mit extensivem, bilobärem Verteilungsmuster bzw. kritischer intrahepatischer Lage benötigen für eine kurative Zielsetzung komplexe chirurgische Resektionstechniken.
Ziel der Arbeit
In der vorliegenden Arbeit beschreiben wir aktuelle Techniken der hepatoonkologischen Chirurgie, mit denen auch bei vermeintlich grenzwertig kleinem gesundem Leberrest eine kurative Resektionsstrategie verfolgt werden kann. Es werden die Methoden der Pfortaderembolisation/-ligatur, der Kombination aus Resektion und Ablation, der zweizeitigen Resektionsstrategie und der "In-situ-split"-Resektion, auch unter "ALPPS" ("associating liver partition and portal vein ligation for staged hepatectomy") bekannt, diskutiert. Kurz wird auch auf die extrahepatische oligometastasierte Situation eingegangen.
Material und Methoden
Revision aktueller Literatur und Diskussion des an unserer Klinik entwickelten Verfahrens des "in situ split".
In den letzten Jahren wurden die chirurgischen Techniken, kolorektale Metastasen kurativ zu resezieren, signifikant erweitert, wodurch auch bei extensiver Metastasierung kurative Resektionen möglich wurden.
Eingebettet in ein multimodales Therapiekonzept ist es essenziell, dass die Resektabilität kolorektaler Metastasen auch in vermeintlich "aussichtslosen" Fällen durch einen erfahrenen, hepatobiliären Chirurgen beurteilt wird.
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Scientists identify breast cancer patients who may develop incurable secondary cancers
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New biomarkers predict outcome of cancer immunotherapy
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Modified nanoscale virus to delivers peptide drugs to cells and tissues
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Die Auswirkungen des Brexit auf den Europäischen Pass für CRR-Kreditinstitute und Wertpapierhandelsunternehmen
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Repellent Activity of TRIG (N-N Diethyl Benzamide) against Man-Biting Mosquitoes
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The Efficacy of Conventionally Fractionated Radiation in the Management of Osseous Metastases from Metastatic Renal Cell Carcinoma
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Impact of Fitness Status on the Optically Measured Hemodynamic Indexes
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Higher-Order Spectral Analysis to Identify Quadratic Nonlinearities in Fluid-Structure Interaction
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Corrigendum to "A New Neurocognitive Interpretation of Shoulder Position Sense during Reaching: Unexpected Competence in the Measurement of Extracorporeal Space"
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Uniform Local Binary Pattern for Fingerprint Liveness Detection in the Gaussian Pyramid
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Robust Command Filtered Adaptive Backstepping Control for a Quadrotor Aircraft
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Integrative Analysis of Surface Runoff and Macropore Flow for Slopes under Rainfall Conditions
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Stereological analysis of individual lung lobes during normal and aberrant mouse lung alveolarisation
The quantitative assessment of the lung architecture forms the foundation of many studies on lung development and lung diseases, where parameters such as alveoli number, alveolar size, and septal thickness are quantitatively influenced by developmental or pathological processes. Given the pressing need for robust data that describe the lung structure, there is currently much enthusiasm for the development and refinement of methodological approaches for the unbiased assessment of lung structure with improved precision. The advent of stereological methods highlights one such approach. However, design-based stereology is both expensive and time-demanding. The objective of this study was to examine whether 'limited' stereological analysis, such as the stereological analysis of a single mouse lung lobe, may serve as a surrogate for studies on whole, intact mouse lungs; both in healthy lungs and in diseased lungs, using an experimental animal model of bronchopulmonary dysplasia (BPD). This served the dual-function of exploring BPD pathobiology, asking whether there are regional (lobar) differences in the responses of developing mouse lungs to oxygen injury, by examining each mouse lung lobe separately in the BPD model. Hyperoxia exposure resulted in decreased alveolar density, alveoli number, and gas-exchange surface area in all five mouse lung lobes, and increased the arithmetic mean septal thickness in all mouse lung lobes except the lobus cardialis. The data presented here suggest that – in healthy developing mice – a single mouse lung lobe might serve as a surrogate for studies on whole, intact mouse lungs. This is not the case for oxygen-injured developing mouse lungs, where a single lobe would not be suitable as a surrogate for the whole, intact lung. Furthermore, as the total number of alveoli can only be determined by an analysis of the entire lung, and given regional differences in lung structure, particularly under pathological conditions, the stereological assessment of the whole, intact lung remains desirable.
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Arguments against prolonged training placements
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"Revise before review; Reject without review; Reject after review": why manuscripts are rejected
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New WHO classification of pituitary adenomas (4th edition): assessment of pituitary transcription factors and the prognostic histological factors
WHO classification of pituitary adenomas was revised in 2017. The two major and significant changes are discussed. (1) The new classification focuses on adenohypophysial-cell lineage for the designation of adenomas, and thus, assessment of pituitary transcription factors is recommended. Its appropriate use has a complementary role in obtaining an accurate diagnosis, particularly in hormone-negative adenomas. Subclassification of nonfunctioning adenomas was revised accordingly and, consequently, null cell adenomas became quite rare. (2) "Atypical adenoma", a previous category, was eliminated due to the poor reproducibility and predictive value. Assessment of tumor proliferation marker and other clinical parameters such as invasion are recommended to predict aggressiveness. "High-risk adenomas" are those with rapid growth, radiological invasion, and a high Ki-67 proliferation index, whereas some special adenoma subtypes commonly show aggressive behavior.
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Bericht zur Sitzung der AG Neolithikum im Rahmen des 6. deutschen Archäologenkongresses in Mannheim
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Bericht über die gemeinsame Sitzung von AG Neolithikum und AG Bronzezeit im Rahmen der Jahrestagung des Mittel- und Ostdeutschen Verbandes für Altertumsforschung e. V. in Greifswald (23.-25.03.2009)
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Interaction of the Tobacco mosaic virus movement protein with microtubules during the cell cycle in tobacco BY-2 cells
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Structural variability of edge dislocations in a SrTiO3 low-angle [001] tilt grain boundary
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PASA - Primary Appraisal Secondary Appraisal - Ein Fragebogen zur Erfassung von situationsbezogenen kognitiven Bewertungen
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Correction: Der physiologische und der pathologische Schluckvorgang
Im o. g. CME-Beitrag wurden leider zwei Literaturangaben falsch zitiert, die Artikel sind hier mit der korrekten Autorenschaft nochmals …
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IARC Monographs Volume 113: DDT, Lindane, and 2,4-D
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IJERPH, Vol. 15, Pages 96: The Zika Virus Epidemic in Brazil: From Discovery to Future Implications
IJERPH, Vol. 15, Pages 96: The Zika Virus Epidemic in Brazil: From Discovery to Future Implications
International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010096
Authors: Rachel Lowe Christovam Barcellos Patrícia Brasil Oswaldo Cruz Nildimar Honório Hannah Kuper Marilia Carvalho
The first confirmed case of Zika virus infection in the Americas was reported in Northeast Brazil in May 2015, although phylogenetic studies indicate virus introduction as early as 2013. Zika rapidly spread across Brazil and to more than 50 other countries and territories on the American continent. The Aedes aegypti mosquito is thought to be the principal vector responsible for the widespread transmission of the virus. However, sexual transmission has also been reported. The explosively emerging epidemic has had diverse impacts on population health, coinciding with cases of Guillain–Barré Syndrome and an unexpected epidemic of newborns with microcephaly and other neurological impairments. This led to Brazil declaring a national public health emergency in November 2015, followed by a similar decision by the World Health Organization three months later. While dengue virus serotypes took several decades to spread across Brazil, the Zika virus epidemic diffused within months, extending beyond the area of permanent dengue transmission, which is bound by a climatic barrier in the south and low population density areas in the north. This rapid spread was probably due to a combination of factors, including a massive susceptible population, climatic conditions conducive for the mosquito vector, alternative non-vector transmission, and a highly mobile population. The epidemic has since subsided, but many unanswered questions remain. In this article, we provide an overview of the discovery of Zika virus in Brazil, including its emergence and spread, epidemiological surveillance, vector and non-vector transmission routes, clinical complications, and socio-economic impacts. We discuss gaps in the knowledge and the challenges ahead to anticipate, prevent, and control emerging and re-emerging epidemics of arboviruses in Brazil and worldwide.
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Fixed Point Theorems for Generalized -Contractions in -Metric Spaces
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Effects of Ginger (Zingiber officinale Roscoe) on Type 2 Diabetes Mellitus and Components of the Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Low Birth Weight, Cumulative Obesity Dose, and the Risk of Incident Type 2 Diabetes
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Physicochemical Characteristics and Microbiological Quality of Honey Produced in Benin
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Natural Products Targeting on Oxidative Stress and Inflammation: Mechanisms, Therapies, and Safety Assessment
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LSTM-Based Hierarchical Denoising Network for Android Malware Detection
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The Protective Effect of Total Flavones from Rhododendron simsii Planch. on Myocardial Ischemia/Reperfusion Injury and Its Underlying Mechanism
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Strain and Vibration in Mesenchymal Stem Cells
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Adsorption Mechanism of Typical Gases Exhaled by Lung Cancer Patients on the Anatase TiO2 (101) Surface
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Issue Information
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The trouble with public health: HIV/AIDS in Canada as a case in point
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IJMS, Vol. 19, Pages 196: Dissecting Time- from Tumor-Related Gene Expression Variability in Bilateral Breast Cancer
IJMS, Vol. 19, Pages 196: Dissecting Time- from Tumor-Related Gene Expression Variability in Bilateral Breast Cancer
International Journal of Molecular Sciences doi: 10.3390/ijms19010196
Authors: Maurizio Callari Matteo Dugo Patrizia Miodini Silvia Veneroni Giampaolo Bianchini Maria Daidone Vera Cappelletti
Metachronous (MBC) and synchronous bilateral breast tumors (SBC) are mostly distinct primaries, whereas paired primaries and their local recurrences (LRC) share a common origin. Intra-pair gene expression variability in MBC, SBC, and LRC derives from time/tumor microenvironment-related and tumor genetic background-related factors and pairs represents an ideal model for trying to dissect tumor-related from microenvironment-related variability. Pairs of tumors derived from women with SBC (n = 18), MBC (n = 11), and LRC (n = 10) undergoing local-regional treatment were profiled for gene expression; similarity between pairs was measured using an intraclass correlation coefficient (ICC) computed for each gene and compared using analysis of variance (ANOVA). When considering biologically unselected genes, the highest correlations were found for primaries and paired LRC, and the lowest for MBC pairs. By instead limiting the analysis to the breast cancer intrinsic genes, correlations between primaries and paired LRC were enhanced, while lower similarities were observed for SBC and MBC. Focusing on stromal-related genes, the ICC values decreased for MBC and were significantly different from SBC. These findings indicate that it is possible to dissect intra-pair gene expression variability into components that are associated with genetic origin or with time and microenvironment by using specific gene subsets.
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IJMS, Vol. 19, Pages 198: Understanding the Role of Intrinsic Disorder of Viral Proteins in the Oncogenicity of Different Types of HPV
IJMS, Vol. 19, Pages 198: Understanding the Role of Intrinsic Disorder of Viral Proteins in the Oncogenicity of Different Types of HPV
International Journal of Molecular Sciences doi: 10.3390/ijms19010198
Authors: Elvira Tamarozzi Silvana Giuliatti
Intrinsic disorder is very important in the biological function of several proteins, and is directly linked to their foldability during interaction with their targets. There is a close relationship between the intrinsically disordered proteins and the process of carcinogenesis involving viral pathogens. Among these pathogens, we have highlighted the human papillomavirus (HPV) in this study. HPV is currently among the most common sexually transmitted infections, besides being the cause of several types of cancer. HPVs are divided into two groups, called high- and low-risk, based on their oncogenic potential. The high-risk HPV E6 protein has been the target of much research, in seeking treatments against HPV, due to its direct involvement in the process of cell cycle control. To understand the role of intrinsic disorder of the viral proteins in the oncogenic potential of different HPV types, the structural characteristics of intrinsically disordered regions of high and low-risk HPV E6 proteins were analyzed. In silico analyses of primary sequences, prediction of tertiary structures, and analyses of molecular dynamics allowed the observation of the behavior of such disordered regions in these proteins, thereby proving a direct relationship of structural variation with the degree of oncogenicity of HPVs. The results obtained may contribute to the development of new therapies, targeting the E6 oncoprotein, for the treatment of HPV-associated diseases.
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Dermatology 2017;233:259
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Sagen dysfunktionale Kognitionen den Therapieerfolg voraus?
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Martyrium für die Nation. Der slawische Balkan in der ostmitteleuropäischen Malerei des 19. Jahrhunderts
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Concentration-compactness phenomena in the higher order Liouville's equation
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A threshold phenomenon for embeddings of {H^m_0} into Orlicz spaces
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An application of Q-curvature to an embedding of critical type
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La intervenció arqueològica al jaciment del neolític final de l'Espina C (Tàrrega, l'Urgell)
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Diagnostic accuracy of level IV portable sleep monitors versus polysomnography for obstructive sleep apnea: a systematic review and meta-analysis
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. In-laboratory, overnight type I polysomnography (PSG) is the current "gold standard" for diagnosing OSA. Home sleep apnea testing (HSAT) using portable monitors (PMs) is an alternative testing method offering better comfort and lower costs. We aimed to systematically review the evidence on diagnostic ability of type IV PMs compared to PSG in diagnosing OSA.
Participants: patients ≥16 years old with symptoms suggestive of OSA;intervention: type IV PMs (devices with < 2 respiratory channels); comparator: in-laboratory PSG; outcomes: diagnostic accuracy measures;studies: cross-sectional, prospective observational/experimental/quasi-experimental studies; information sources: MEDLINE and Cochrane Library from January 1, 2010 to May 10, 2016. All stages of review were conducted independently by two investigators.
We screened 6054 abstracts and 117 full-text articles to select 24 full-text articles for final review. These 24 studies enrolled a total of 2068 patients with suspected OSA and evaluated 10 different PMs with one to six channels. Only seven (29%) studies tested PMs in the home setting. The mean difference (bias) between PSG-measured and PM-measured apnea-hypopnea index (AHI) ranged from − 14.8 to 10.6 events/h. At AHI ≥ 5 events/h, the sensitivity of type IV PMs ranged from 67.5–100% and specificity ranged from 25 to 100%.
While current evidence is not very strong for the stand-alone use of level IV PMs in clinical practice, they can potentially widen access to diagnosis and treatment of OSA. Policy recommendations regarding HSAT use should also consider the health and broader social implications of false positive and false negative diagnoses.
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text:
According to a new Huffington Post Poll, only 25% of women believe the accusations against Brett Kavanaugh.
HuffPost/YouGov poll:
-28% say accusations against Kavanaugh are not credible
-26% say accusations are credible
-Only 25% of women find the accusations crediblehttps://t.co/tXGMgWLTFj pic.twitter.com/xQojGLQX1S
— Ryan Saavedra 🇺🇸 (@RealSaavedra) September 22, 2018
This poll shows that the accusations by Christine Ford don't provide enough proof for people to believe them. This also explains why the Democrats are trying their best to search for another accuser to 'finish the job' on stopping Brett Kavanaugh from being confirmed.
Embed from Getty Images

subset: commoncrawl


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Planning a wedding is in many ways, according to those who have completed the process, a joyful experience.
To those still in the midst of it, putting together such an event (especially without the aid of a wedding planner) essentially requires taking all of the free hours on your calendar and, for months at a time, blocking them off. I use the black color. It makes the whole thing more dramatic. Occasionally I'll leave an hour here and there blank, just to give myself the illusion of hope, and then something – be it wrapping gifts or plotting transportation schedules or trying to make the vows rhyme – will appear, as if by some dark magic, and sap away that time.
Now, unfortunately, reality does not take your predicament into account and politely suspend all other things until your wedding is complete. Bills, insignificant as they may seem in the face of such looming monstrosity as one's nuptials, must still be paid. Work, the kind that pays you in dollars rather than love, must continue. Art must be produced. Sales must be run. Hours in the chair scrubbing passive-aggressive wedding commentary from the current novel must be spent.
So, how am I surviving?
Not perfectly, let me point out. I don't think, with any major life event, it's possible to happily continue on with your current schedule. If that was the case, my hunch is the event would not be considered "major".
The first, and most important thing, is accepting a decrease in your productivity. You'll be stressed, whether you're the bride or groom, and the weight of all of the myriad things will make it difficult to concentrate. You won't be able to jump into your story as quickly as before (or after). You won't be able to wake up in the morning with the only item on your agenda the traitorous twist in chapter 23. No, you'll need to arrange the timing for the late night snacks and what beers will be served during the cocktail hour. And how many of those delicious crab cakes you want for yourself rather than as passed apps.
Adjusting your schedule to accommodate the extra stress and work is crucial because otherwise you're going to fall behind, and then you're going to be stressed that you're falling behind, and it's just a vicious cycle. Believe it or not, weddings, so I've heard, are meant to be fun for you. If you're an angry monster because your latest novel is going to take a few extra weeks, well, it's not going to be much fun for your spouse.
Secondly, make hard lists of what you want to do every day, leaving room for surprises. This, of course, is something that's worth doing all the time, but is especially necessary when your task list balloons from "Write the Next Chapter" and "Tweet" to fifty different things. I've found a lot of success by guarding those hours in the morning when I'm most creative and, yes, sacrificing afternoons and evenings (normally marketing time) to wedding stuff. This way, while I'm not doing everything I normally would, I'm still making progress on my books and I'm not stewing in a wordless hell for months.
Third, don't stop writing. Above, I noted I saved my writing time. My word counts might go down, but I'm still writing every day. Even if it's a chapter. Even if it's a 1000 words instead of 5k. Heck, even if it's a blog post like this. Point being – it's all too easy to declare the battle lost and give up on your words. Don't do it. Get what you can into every day, and then be satisfied with it, and move on. Put together that seating chart. Go to that dance lesson. Ponder which flavor of cake is the right one (carrot cake, obviously).
Anyway, I'm almost halfway through the next novel. A new series. It's a blend of sci fi and thriller, with some other elements thrown in there because… that's where the story went. I'm having fun, though, and that's what matters.


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text:
Dan brings more than 33 years of marketing, business development, sales and sales management leadership experience to Clear Thoughts Foundation. He is currently serving as an Enterprise Account Manager for a Global IT company called Hitachi Ltd. Prior to Hitachi Ltd, Dan held numerous successful sales and sales management positions at HP, Oracle, Dell, Inacom, Data General & Datapoint. Dan is a graduate of Kent State University with a dual degree in Business and Marketing. Away from work, Dan relishes spending time with his family, working around the house and finding time to stay fit and healthy.
Dan currently lives in Franklin Park, PA with his wife Amy Groetsch-Tarchick and daughter Olivia. He is a parishioner at Saint John & Paul Catholic Church in Sewickley where he sits on various charity fund raising committees. With the devastation of losing his mother to dementia, Dan will be focusing on sales/marketing and fundraising activities to help CTF find a cure for dementia in his lifetime.


text:
Our Mission
The Mission of the New England Independent Booksellers Association is to further the success of professional independent booksellers in New England and to foster a vital and supportive bookselling community.
Who We Are
NEIBA is the non-profit trade association for the retail book industry in New England. Serving independent booksellers since 1973, NEIBA has over 200 members representing more than 150 bookstores. NEIBA is governed by an elected Board of Directors that meets regularly with the Advisory Council and Executive Director. NEIBA's office consists of two full-time employees: Executive Director, Beth Ineson and Marketing Coordinator, Ali Schmelzle.
What We Do
NEIBA promotes independent bookselling in the six New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont) and New York through an annual Fall Conference, educational programming, publications, resources, and promotional programs.


text:
Adaptive Bikeshare in San Francisco Launches this Week through November
Dear Colleagues and Community Members,
Bay Wheels and BORP Adaptive Sports are thrilled to announce that handcycles and trikes for people with disabilities will, for the first time, be available on a regular schedule for use in San Francisco. We are especially excited to offer these adaptive cycles in Golden Gate Park during the weekly Sunday street closures when the park's roads are transformed into a community celebration of mobility. The program will include handcycles, adaptive trikes, and a side-by-side tandem bike. Staff from BORP, the region's leading provider of accessible recreation and adaptive sports for people with mobility-related disabilities, will be on-hand to fit, train, and assist riders on how to use the adaptive cycles. The program starts July 28 and will run every Sunday through November in Golden Gate Park from 11 am – 4 pm.
About Bay Wheels
The Bay Wheels system, operated by Lyft, is an integral part of the Bay Area's transportation network. With more than 300 stations and nearly 4,000 bikes on the ground across San Francisco, San Jose, Berkeley, Oakland, and Emeryville, the system has generated over three million rides since launching in June 2017.
About Bay Area Outreach & Recreation Program (BORP)
BORP Adaptive Sports provides challenging sports and recreation for people with disabilities of all ages and from all over the San Francisco Bay Area. BORP's Adaptive Cycling Center in Berkeley has over 50 different types of adaptive cycles and has been breaking down barriers to Cycling for people with disabilities for 15 years.
For More Information Please Contact
Greg Milano at BORP (415)271-0647 or email@example.com


text:
Want to Escape Global Warming? These Cities Promise Cool Relief
"We're not seeing worse heat waves or longer heat waves or more of those long nights that don't fall below 75 degrees," Dr. Blumenfeld said. "Instead, what we're seeing is warmer winters, fewer days during winter where we get to negative 30 Fahrenheit."
Because the region will remain relatively cool, it will have a lower wildfire risk than the West or the Southeast. Wildfires thrive in hotter temperatures, which dry out plants and make them easier to ignite.
And, because Duluth is inland, it's mostly protected from the effects of sea level rise.
Duluth, which sits at the western end of Lake Superior, the greatest of the Great Lakes by volume, also has fresh water. A lot of it. Superior is so voluminous that, if poured out, it would submerge North and South America under a foot of water.
"At the end of the day, it's really about fresh water," Dr. Keenan said. "It's that simple. You've got to have fresh water."
You've got to have quite a bit, in fact. To meet our minimum needs, from drinking to cooking and cleaning, the World Health Organization says we need 13 to 26 gallons of water a day, or about 50 to 100 liters. The average American uses 80 to 100 gallons.
The city hasn't formally adopted Dr. Keenan's climate refuge plan so far, but it has the attention of the mayor, Emily Larson. "This idea that we have this national researcher who has identified Duluth as a place that has kind of a secret sauce when it comes to being a place for refuge and sustainability and resiliency, that is something you want to be a part of," she said.
For the plan to work, people would need to actually move to Duluth. The city's infrastructure can accommodate 150,000 people, but the current population is just 86,000. From 2010 to 2016, though, the city added only 56 people.
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text:
The Physical and Moral Condition of the Children and Young Persons employed in Mines and Manufactures, 1843
This 1843 report, The Physical and Moral Condition of the Children and Young Persons employed in Mines and Manufactures, is an off-shoot publication from the official Report of the Children's Employment Commission of 1842.
The official report investigated the state of children working in mines and factories in England, Ireland, Scotland and Wales, and is one of the most important documents in British industrial history. Comprising thousands of pages of oral testimony (sometimes from children as young as five), the report's findings shocked society and swiftly led to legislation to secure minimum safety standards in mines and factories, as well as general controls on the employment of children.
- Full title:
- The Physical and Moral Condition of the Children and Young Persons employed in Mines and Manufactures Illustrated by extracts from the reports of the Commissioners for inquiring into the employment of children and young persons in mines and collieries, etc
- Published:
- 1843, London
- Format:
- Book / Report / Illustration / Image
- Creator:
- Unknown
- Usage terms
- Public Domain
- Held by
- British Library
- Shelfmark:
- 1390.g.19.
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