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DCTN4 as a modifier of chronic Pseudomonas aeruginosa infection in cystic fibrosis Pseudomonas aeruginosa (Pa) infection in cystic fibrosis (CF) patients is associated with worse long-term pulmonary disease and shorter survival, and chronic Pa infection (CPA) is associated with reduced lung function, faster rate of lung decline, increased rates of exacerbations and shorter survival. By using exome sequencing and extreme phenotype design, it was recently shown that isoforms of dynactin 4 (DCTN4) may influence Pa infection in CF, leading to worse respiratory disease. The purpose of this study was to investigate the role of DCTN4 missense variants on Pa infection incidence, age at first Pa infection and chronic Pa infection incidence in a cohort of adult CF patients from a single centre. Polymerase chain reaction and direct sequencing were used to screen DNA samples for DCTN4 variants. A total of 121 adult CF patients from the Cochin Hospital CF centre have been included, all of them carrying two CFTR defects: 103 developed at least 1 pulmonary infection with Pa, and 68 patients of them had CPA. DCTN4 variants were identified in 24% (29/121) CF patients with Pa infection and in only 17% (3/18) CF patients with no Pa infection. Of the patients with CPA, 29% (20/68) had DCTN4 missense variants vs 23% (8/35) in patients without CPA. Interestingly, p.Tyr263Cys tend to be more frequently observed in CF patients with CPA than in patients without CPA (4/68 vs 0/35), and DCTN4 missense variants tend to be more frequent in male CF patients with CPA bearing two class II mutations than in male CF patients without CPA bearing two class II mutations (P = 0.06). Our observations reinforce that DCTN4 missense variants, especially p.Tyr263Cys, may be involved in the pathogenesis of CPA in male CF.
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Prevascularized silicon membranes for the enhancement of transport to implanted medical devices Recent advances in drug delivery and sensing devices for in situ applications are limited by the diffusion -limiting foreign body response of fibrous encapsulation. In this study, we fabricated prevascularized synthetic device ports to help mitigate this limitation. Membranes with rectilinear arrays of square pores with widths ranging from 40 to 200 μm were created using materials (50 μm thick double-sided polished silicon) and processes (photolithography and directed reactive ion etching) common in the manufacturing of microfabricated sensors. Vascular endothelial cells responded to membrane geometry by either forming vascular tubes that extended through the pore or completely filling membrane pores after 4 days in culture. Although tube formation began to predominate overgrowth around 75 μm and continued to increase at even larger pore sizes, tubes formed at these large pore sizes were not completely round and had relatively thin walls. Thus, the optimum range of pore size for prevascularization of these membranes was estimated to be 75-100 μm. This study lays the foundation for creating a prevascularized port that can be used to reduce fibrous encapsulation and thus enhance diffusion to implanted medical devices and sensors. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1602-1609, 2016.
|
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Seated maximum flexion: An alternative to standing maximum flexion for determining presence of flexion - relaxation? The flexion - relaxation phenomenon (FRP) in standing is a specific and sensitive diagnostic tool for low back pain. Seated flexion as an alternative could be beneficial for certain populations, yet the behavior of the trunk extensors during seated maximum flexion compared to standing flexion remains unclear. Compare FRP occurrences and spine angles between seated and standing flexion postures in three levels of the erector spinae muscles. Thirty-one participants free of back pain performed seated and standing maximum trunk flexion. Electromyographical signals were recorded from the bilateral lumbar (L3), lower-thoracic (T9), and upper-thoracic (T4) erector spinae and assessed for the occurrence of FRP. Spine angles corresponding to FRP onset and cessation were determined, and FRP occurrences and angles were compared between posture and muscle. FRP occurrence was similar in standing and seated maximum flexion across all muscles, with the lumbar muscles showing the greatest consistency. Standing FRP onset and cessation angles were consistently greater than the corresponding seated FRP angles. Considering the similar number of FRP occurrences, seated maximum flexion may constitute an objective criterion for low back pain diagnosis. Future work should seek to confirm the utility of this test in individuals with low back pain.
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The Relationship Between Distance and Post-operative Visit Attendance Following Medical Male Circumcision in Nyanza Province, Kenya To date, there is no research on voluntary medical male circumcision (VMMC) catchment areas or the relationship between distance to a VMMC facility and attendance at a post-operative follow-up visit. We analyzed data from a randomly selected subset of males self-seeking circumcision at one of 16 participating facilities in Nyanza Province, Kenya between 2008 and 2010. Among 1437 participants, 46.7 % attended follow-up. The median distance from residence to utilized facility was 2.98 km (IQR 1.31-5.38). Nearly all participants (98.8 %) lived within 5 km from a facility, however, 26.3 % visited a facility more than 5 km away. Stratified results demonstrated that among those utilizing fixed facilities, greater distance was associated with higher odds of follow-up non-attendance (OR 5.01-10km vs. 0-1km = 1.71, 95 % CI 1.08, 2.70, p = 0.02; OR >10km vs. 0-1 km = 2.80, 95 % CI 1.26, 6.21, p = 0.01), adjusting for age and district of residence. We found 5 km marked the threshold distance beyond which follow-up attendance significantly dropped. These results demonstrate distance is an important predictor of attending follow-up, and this relationship appears to be modified by facility type.
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Promoting lifestyle behaviour change and well-being in hospital patients: a pilot study of an evidence-based psychological intervention Lifestyle risk behaviours show an inverse social gradient, clustering in vulnerable groups. We designed and piloted an intervention to address barriers to lifestyle behaviour change among hospital patients. We designed our intervention using effective components of behaviour change interventions informed by psychological theory. Delivered by a health psychologist based at the Royal Free London NHS Foundation Trust, the 4-week intervention included detailed baseline assessment, personalized goal setting, psychological skills development, motivation support and referral to community services. Primary outcomes were feasibility and patient acceptability. We also evaluated changes to health and well-being. From 1 July 2013 to 31 September 2014, 686 patients were referred, 338 (49.3%) attended a first appointment and 172 (25.1%) completed follow-up. Furthermore, 72.1% of attenders were female with the median age 55 years and poor self-reported baseline health. After 4 weeks, self-efficacy, health and well-being scores significantly improved: 63% of lifestyle goals and 89% of health management goals were fully achieved; 58% of referrals to community lifestyle behaviour change services and 79% of referrals to other services (e.g. Citizen's Advice Bureau) were accepted; 99% were satisfied / very satisfied with the service. Our hospital-based intervention was feasible, acceptable and showed preliminary health and well-being gains.
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Combining electrostatic powder with an insecticide: effect on stored - product beetles and on the commodity The opportunity to reduce the amount of pirimiphos-methyl applied to grain by formulating it in an electrostatic powder was investigated. The insecticidal efficacy of pirimiphos-methyl in EC formulation or formulated using electrostatic powder (EP) as an inert carrier was investigated against Sitophilus oryzae (L.), Oryzaephilus surinamensis (L.), Rhyzopertha dominica (F.) and Tribolium confusum Jacquelin du Val. Furthermore, the adhesive properties of EP to rice, corn and wheat, together with the effect on bulk density and bread - and pasta - making properties, were investigated. The results showed that pirimiphos-methyl formulated with EP provided better efficacy against adults when compared with EC formulation for O. surinamensis and T. confusum, but there was no difference for R. dominica. Progeny production was consistently lower in grain treated with the EP formulation than in grain treated with the EC. Tests showed that EP adhered to the kernels for longer on hard wheat than on maize or rice. In most commodities, EP did not alter the bulk density. Finally, the addition of EP did not affect flour - and bread - making properties, nor the pasta -making properties. The results of the present study suggest that an EP could be used to reduce the amount of pirimiphos-methyl applied to grain for effective pest control, with no detrimental effects on grain quality. © 2016 Society of Chemical Industry.
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Radiofrequency ablation of posteroseptal accessory pathways associated with coronary sinus diverticula Posteroseptal accessory pathways may be associated with a coronary sinus (CS) diverticulum. Our purpose was to describe the clinical characteristics, mapping and ablation of these pathways. This was a retrospective study of all patients who underwent ablation of posteroseptal accessory pathways in a single centre. Patients with a diverticulum of the CS or one of its tributaries were included in group I, while the other patients formed group II. Clinical presentation, ablation procedure and outcome were compared between the two groups. A total of 51 patients were included, 16 in group I and 35 in group II. There were no significant differences in age or sex distribution. Atrial fibrillation (AF) and previous unsuccessful ablation were more common in group I. A negative delta wave in lead II was the ECG finding with best sensitivity and specificity for the presence of a diverticulum. A pathway potential was common at the successful site in group I, and the interval between local ventricular electrogram and delta wave onset was shorter (19.5 ± 8 vs 33.1 ± 7.6 ms, p < 0.001). There was a trend toward lower procedural success rate and higher recurrence rate in group I, although this was not significant. CS diverticula should be suspected in patients with manifest posteroseptal accessory pathways who have a previous failed ablation, documented AF or typical electrocardiographic signs. A discrete potential is frequently seen at the successful site, but the local ventricular electrogram is not as early as in other accessory pathways.
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1502
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1509
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1529
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1534
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1544
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1560
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1589
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1630
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1631,
1635
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[
1636,
1637
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[
1638,
1646
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] |
Association of RBP4 levels with increased arterial stiffness in adolescents with family history of type 2 diabetes The aim of this study was to explore the impact of family history of type 2 diabetes (FH2D) on arterial stiffness in young people and its relationship to adipocytokines. This case-control study included 52 adolescents (male / female 28/24) with FH2D (FH2D+) and 40 adolescents (male / female 21/19) without FH2D (FH2D-). Anthropometric measurements, including height, weight, waist circumference (WC), and blood pressure, were obtained. Blood samples were collected, fasting plasma glucose (FPG), serum lipids, Retinol Binding Protein 4 (RBP4), C reactive protein (CRP), adiponectin and visfatin were examined. Brachial-ankle pulse wave velocity (baPWV) was used to evaluate arterial stiffness. Visceral fat area (VFA) was measured by computerized tomography. Compared with FH2D- group, FH2D+ group had a significantly higher oral glucose tolerance test (OGTT) 2-hour insulin, RBP4 and baPWV levels, a lower adiponectin and glucose infusing rate (GIR) (P<0.05). BaPWV was positively correlated with age, systolic blood pressure (SBP), diastolic blood pressure (DBP), 2-hour (OGTT) insulin, RBP4, and VFA, and negatively correlated with GIR in FH2D+ group. After multivariate analysis, age, SBP, RBP4 and VFA maintained an independent association with baPWV in FH2D+ group (P<0.05), while only age, SBP, and VFA were independent predictors of baPWV in FH2D- group (P<0.05). These findings led to the conclusion that RBP4 level was associated with increased arterial stiffness in young subjects with family history of type 2 diabetes.
|
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The effect of total hip arthroplasty on sagittal spinal - pelvic-leg alignment and low back pain in patients with severe hip osteoarthritis Sagittal spinopelvic malalignment has been reported in spinal disorders such as low back pain (LBP), and restoration of normal alignment is targeted when treating these disorders. Abnormal sagittal spinal - pelvic-leg alignment has been reported in patients with severe hip osteoarthritis (OA), who have a high prevalence of associated LBP. This prospective longitudinal study aimed to investigate changes in sagittal spinal - pelvic-leg alignment after total hip arthroplasty (THA) in patients with severe hip OA, and whether these changes contribute to LBP relief. Patients undergoing primary THA due to severe unilateral hip OA were recruited. Physical examination and X-ray films were taken to rule out any spinal disorder. Sagittal alignment of pelvis, hip, and spine was analyzed on lateral radiographs taken before (baseline) and 1 year after (follow-up) THA. Functional instruments were completed by patients including: visual analog scale (VAS) for LBP, Roland-Morris Disability Questionnaire (RMDQ), and Harris Hip Score (HHS). Comparisons were carried out at baseline and follow-up, and between patients with and without LBP. The recruited 69 patients showed significantly reduced hip flexion and improved global spinal balance at follow-up compared with baseline. LBP was reported by 39 patients (56.5 %) before surgery; at follow-up, 17 reported complete resolution, while 22 reported significant relief. Significant decreases in VAS and RMDQ scores in lumbar spine and increase in hip HHS were observed. THA in patients with severe hip OA could help correct abnormal sagittal spinal - pelvic-leg alignment and relieve comorbid LBP. Improvements in hip flexion and global spinal balance might be involved in the mechanism of LBP relief.
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Impact of totally laparoscopic combined management of colorectal cancer with synchronous hepatic metastases on severity of complications: a propensity-score -based analysis Thanks to widespread diffusion of minimally invasive approach in the setting of both colorectal and hepatic surgeries, the interest in combined resections for colorectal cancer and synchronous liver metastases (SCLM) by totally laparoscopic approach (TLA) has increased. Aim of this study was to compare outcome of combined resections for SCLM performed by TLA or by open approach, in a propensity-score-based study. All 25 patients undergoing combined TLA for SCLM at San Raffaele Hospital in Milano were compared in a case-matched analysis with 25 out of 91 patients undergoing totally open approach (TOA group). Groups were matched with 1:2 ratio using propensity scores based on covariates representing disease severity. Main endpoints were postoperative morbidity and long-term outcome. The Modified Accordion Severity Grading System was used to quantify complications. The groups resulted comparable in terms of patients and disease characteristics. The TLA group, as compared to the TOA group, had lower blood loss (350 vs 600 mL), shorter postoperative stay (9 vs 12 days), lower postoperative morbidity index (0.14 vs 0.20) and severity score for complicated patients (0.60 vs 0.85). Colonic anastomosis leakage had the highest fractional complication burden in both groups. In spite of comparable long-term overall survival, the TLA group had better recurrence-free survival. TLA for combined resections is feasible, and its indications can be widened to encompass a larger population of patients, provided its benefits in terms of reduced overall risk and severity of complications, rapid functional recovery and favorable long-term outcomes.
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] |
Application of an Analytical Solution as a Screening Tool for Sea Water Intrusion Sea water intrusion into aquifers is problematic in many coastal areas. The physics and chemistry of this issue are complex, and sea water intrusion remains challenging to quantify. Simple assessment tools like analytical models offer advantages of rapid application, but their applicability to field situations is unclear. This study examines the reliability of a popular sharp-interface analytical approach for estimating the extent of sea water in a homogeneous coastal aquifer subjected to pumping and regional flow effects and under steady-state conditions. The analytical model is tested against observations from Canada, the United States, and Australia to assess its utility as an initial approximation of sea water extent for the purposes of rapid groundwater management decision making. The occurrence of sea water intrusion resulting in increased salinity at pumping wells was correctly predicted in approximately 60% of cases. Application of a correction to account for dispersion did not markedly improve the results. Failure of the analytical model to provide correct predictions can be attributed to mismatches between its simplifying assumptions and more complex field settings. The best results occurred where the toe of the salt water wedge is expected to be the closest to the coast under predevelopment conditions. Predictions were the poorest for aquifers where the salt water wedge was expected to extend further inland under predevelopment conditions and was therefore more dispersive prior to pumping. Sharp-interface solutions remain useful tools to screen for the vulnerability of coastal aquifers to sea water intrusion, although the significant sources of uncertainty identified in this study require careful consideration to avoid misinterpreting sharp-interface results.
|
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