Extra-intestinal Manifestations at Diagnosis in Paediatric- and Elderly-onset Ulcerative Colitis are Associated With a More Severe Disease Outcome: A Population-based Study

BACKGROUND AND AIMS

Data on extra-intestinal manifestations [EIM] and their impact on the disease course of ulcerative colitis [UC] in population-based cohorts are scarce, particularly in paediatric- and elderly-onset UC patients. The aims of this population-based study were to assess: 1] the occurrence of EIM in paediatric- and elderly-onset UC; 2] the factors associated with EIM; and 3] their impact on long-term disease outcome.

METHODS

Paediatric-onset [< 17 years at diagnosis] and elderly-onset UC patients [> 60 years at diagnosis] from a French prospective population-based registry [EPIMAD] were included. Data on EIM and other clinical factors at diagnosis and at maximal follow-up were collected.

RESULTS

In all, 158 paediatric- and 470 elderly-onset patients were included [median age at diagnosis 14.5 and 68.8 years, median follow-up 11.2 and 6.2 years, respectively]. EIM occurred in 8.9% of childhood- and 3% of elderly-onset patients at diagnosis and in 16.7% and 2.2% of individuals during follow-up [p < 0.01], respectively. The most frequent EIM was joint involvement [15.8% of paediatric onset and 2.6% of elderly-onset]. Presence of EIM at diagnosis was associated with more severe disease course [need for immunosuppressants or biologic therapy or colectomy] in both paediatric- and elderly-onset UC (hazard ratio [HR] = 2.0, 95% confidence interval [CI]: 1.0-4.2; and HR = 2.8, 0.9-7.9, respectively). Extensive colitis was another independent risk factor in both age groups.

CONCLUSIONS

Elderly-onset UC patients had lower risk of EIM either at diagnosis or during follow-up than paediatric-onset individuals. EIM at diagnosis predicted more severe disease outcome, including need for immunosuppressive or biologic therapy or surgery, in both paediatric- and elderly-onset UC.

Single-center ventral hernia repair with porcine dermis collagen implant

INTRODUCTION

This study aims to evaluate the outcomes and utilization of porcine acellular dermal collagen implant (PADCI) during VHR at a large tertiary referral center.

METHODS

Records of 5485 patients who underwent VIHR from June 1995 to August 2014 were retrospectively reviewed to identify patients >18 years of age who had VIHR with PADCI reinforcement. Use of multiple mesh reinforcement products, inguinal hernias, and hiatal hernias were exclusion criteria. The primary outcome was hernia recurrence, and secondary outcomes were early complications and surgical site occurrences (SSOs). Uni- and multivariate analyses assessed risk factors for recurrence after PADCI reinforced VIHR.

RESULTS

There were 361 patients identified (54.5% female, mean age of 56.7 ± 12.5 years, and mean body mass index (BMI) of 33.0 ± 9.9 kg/m²). Hypertension (49.5%), diabetes (24.3%), and coronary artery disease (14.4%) were the most common comorbidities, as was active smoking (20.7%). Most were classified as American Association of Anesthesiologists (ASA) Class 3 (61.7%). Hernias were distributed across all grades of the ventral hernia working group (VHWG) grading system: grade I 93 (25.7%), grade II 51 (14.1%), grade III 113 (31.3%), and grade IV 6 (1.6%). Most VIHR were performed from an open approach (96.1%), and were frequently combined with concomitant surgical procedures (47.9%). Early postoperative complications (first 30 days) were reported in 39.0%, with 71 being SSO. Of the 19.7% of patients with SSO, there were 31 who required procedural intervention. After a mean follow-up of 71.5 ± 20.5 months, hernia recurrence was documented in 34.9% of patients. Age and male gender were predictors of recurrence on multivariate analysis.

CONCLUSION

To the best of our knowledge, this is the largest retrospective single institutional study evaluating PADCI to date. Hernias repaired with PADCI were frequently in patients undergoing concomitant operations. Reinforcement with PADCI may be considered a temporary closure, with a relatively high recurrence rate, especially among patients who are older, male, and undergo multiple explorations in a short perioperative period.

Insole optical fiber Bragg grating sensors network for dynamic vertical force monitoring

In an era of unprecedented progress in technology and increase in population age, continuous and close monitoring of elder citizens and patients is becoming more of a necessity than a luxury. Contributing toward this field and enhancing the life quality of elder citizens and patients with disabilities, this work presents the design and implementation of a noninvasive platform and insole fiber Bragg grating sensors network to monitor the vertical ground reaction forces distribution induced in the foot plantar surface during gait and body center of mass displacements. The acquired measurements are a reliable indication of the accuracy and consistency of the proposed solution in monitoring and mapping the vertical forces active on the foot plantar sole, with a sensitivity up to 11.06 ?? pm / N . The acquired measurements can be used to infer the foot structure and health condition, in addition to anomalies related to spine function and other pathologies (e.g., related to diabetes); also its application in rehabilitation robotics field can dramatically reduce the computational burden of exoskeletons’ control strategy. The proposed technology has the advantages of optical fiber sensing (robustness, noninvasiveness, accuracy, and electromagnetic insensitivity) to surpass all drawbacks verified in traditionally used sensing systems (fragility, instability, and inconsistent feedback).

A Probabilistic and Highly Efficient Topology Control Algorithm for Underwater Cooperating AUV Networks

The aim of the Smart and Networking Underwater Robots in Cooperation Meshes (SWARMs) project is to make autonomous underwater vehicles (AUVs), remote operated vehicles (ROVs) and unmanned surface vehicles (USVs) more accessible and useful. To achieve cooperation and communication between different AUVs, these must be able to exchange messages, so an efficient and reliable communication network is necessary for SWARMs. In order to provide an efficient and reliable communication network for mission execution, one of the important and necessary issues is the topology control of the network of AUVs that are cooperating underwater. However, due to the specific properties of an underwater AUV cooperation network, such as the high mobility of AUVs, large transmission delays, low bandwidth, etc., the traditional topology control algorithms primarily designed for terrestrial wireless sensor networks cannot be used directly in the underwater environment. Moreover, these algorithms, in which the nodes adjust their transmission power once the current transmission power does not equal an optimal one, are costly in an underwater cooperating AUV network. Considering these facts, in this paper, we propose a Probabilistic Topology Control (PTC) algorithm for an underwater cooperating AUV network. In PTC, when the transmission power of an AUV is not equal to the optimal transmission power, then whether the transmission power needs to be adjusted or not will be determined based on the AUV’s parameters. Each AUV determines their own transmission power adjustment probability based on the parameter deviations. The larger the deviation, the higher the transmission power adjustment probability is, and vice versa. For evaluating the performance of PTC, we combine the PTC algorithm with the Fuzzy logic Topology Control (FTC) algorithm and compare the performance of these two algorithms. The simulation results have demonstrated that the PTC is efficient at reducing the transmission power adjustment ratio while improving the network performance.

Dissociative Amnesia with Fugue vs. Shenjing Shuairuo: A Clinical Case Report. Are DSM-5 Distress Cultural Considerations Truly Transcultural Relevant?

Introduction

We present the case report of a 21-year-old Chinese female, who was brought to the emergency department. We open the debate between the operative criteria stablished by DSM-5 of the clinical entity dissociative amnesia and Shenjing Shuairuo - the Chinese “culture-bound syndrome”.

Objectives

To expose the relevance of the cultural formulation in the clinical evaluation of patients with a different non-Western culture in Psychiatry.

Aims

The Shenjing Shuairuo syndrome (“nervous system weakness”) was originally descripted in China, it has a gradual onset, usually after a stressful event. It involves a minimum 3 of 5 symptoms group: weakness, emotions, excitement, neurological pain and sleep. This complex group of symptoms overlap with dissociative syndrome such as dissociative amnesia.

Methods/results

The cultural formulation interview (CFI) was used for the diagnostic and subsequent treatment of dissociative amnesia with fugue in a different culture patient who met the clinical criteria of this two divergent clinic entities.

Conclusions

In our clinical practice, we will deal with different culture patients, who could present common clinical entities or with the so-called “culture-bound syndromes”. The cultural formulation of the clinical cases will help the clinicians to diagnose and have better treatment's options in clinical manifestations do not correspond to the conventional entities included in mostly Western-based nomenclatures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Evaluation of Three Devices for the Isolation of the Stromal Vascular Fraction from Adipose Tissue and for ASC Culture: A Comparative Study

Adipose-derived stem/stromal cells (ASCs) reside in the stromal vascular fraction (SVF) of adipose tissue (AT) and can be easily isolated. However, extraction of the SVF from lipoaspirate is a critical step in generating ASC, and semiautomated devices have been developed to enhance the efficacy and reproducibility of the outcomes and to decrease manipulation and contamination. In this study, we compared the reference method used in our lab for SVF isolation from lipoaspirate, with three medical devices: GID SVF-1™, Puregraft™, and Stem.pras®. Cell yield and their viability were evaluated as well as their phenotype with flow cytometry. Further on, we determined their proliferative potential using population doublings (PD), PD time (PDT), and clonogenicity assay (CFU-F). Finally, we checked their genetic stability using RT-qPCR for TERT mRNA assay and karyotyping as well as their multilineage potential including adipogenic, chondrogenic, and osteogenic differentiation. Our results demonstrate that all the devices allow the production of SVF cells with consistent yield and viability, in less time than the reference method. Expanded cells from the four methods showed no significant differences in terms of phenotype, proliferation capabilities, differentiation abilities, and genetic stability.

Phenanthrene degradation in soil by ozonation: Effect of morphological and physicochemical properties

The aim of this study was to characterize the ozone reaction with phenanthrene adsorbed in two types of soils (sand and agricultural). The effect of soil physicochemical properties (texture, bulk density, particle density, porosity, elemental composition, permeability, surface area and pore volume) on the phenanthrene decomposition was evaluated. Commercial sand has a uniform morphology (spherical) with a particle size range between 0.178 and 0.150 mm in diameter, regular elemental composition SiO₂, specific density of 1701.38 kg/m³, a true density of 2492.50 kg/m³, with an effective porosity of 31%. On the other hand, the agricultural soil had heterogeneous morphology, particle size between 0.1779 and 0.05 mm in diameter, elemental composition was montmorrillonite silicon oxide, apparent density of 999.52 kg/m³, a true density of 2673.55 kg/m³, surface area of 34.92 m²/g and porosity of 57%. The percentage of phenanthrene decomposition in the sand was 79% after 2 h of treatment. On the other hand, the phenanthrene degradation in the agricultural soil was 95% during the same reaction time. The pore volume of soil limited the crystal size of phenanthrene and increased the contact surface with ozone confirming the direct impact of physicochemical properties of soils on the decomposition kinetics of phenanthrene. In the case of agricultural soil, the effect of organic matter on phenanthrene decomposition efficiency was also investigated. A faster decomposition of initial contaminant and byproducts formed in ozonation was obtained in natural agricultural soil compared to the sand. The partial identification of intermediates and final accumulated products produced by phenanthrene decomposition in ozonation was developed. Among others, phenanthroquinone, hydroquinone, phenanthrol, catechol as well as phthalic, diphenic, maleic and oxalic acids were identified.

Mid-term oncologic outcome of a novel approach for locally advanced colon cancer with neoadjuvant chemotherapy and surgery

PURPOSE

Neoadjuvant chemotherapy is being actively tested as an emerging alternative for the treatment of locally advanced colon cancer (LACC) patients, resembling its use in other gastrointestinal tumors. This study assesses the mid-term oncologic outcome of LACC patients treated with oxaliplatin and fluoropyrimidines-based preoperative chemotherapy followed by surgery.

METHODS AND PATIENTS

Patients with radiologically resectable LACC treated with neoadjuvant therapy between 2009 and 2014 were retrospectively analyzed. Radiological, metabolic, and pathological tumor response was assessed. Both postoperative complications, relapse-free survival (RFS), and overall survival (OS) were studied.

RESULTS

Sixty-five LACC patients who received treatment were included. Planned treatment was completed by 93.8 % of patients. All patients underwent surgery without delay. The median time between the start of chemotherapy and surgery was 71 days (65-82). No progressive disease was observed during preoperative treatment. A statistically significant tumor volume reduction of 62.5 % was achieved by CT scan (39.8-79.8) (p < 0.001). It was also observed a median reduction of 40.5 % (24.2-63.7 %) (p < 0.005) of SUV_max (Standard Uptake Value) by PET-CT scan. Complete pathologic response was achieved in 4.6 % of patients. Postoperative complications were observed in 15.4 % of patients, with no cases of mortality. After a median follow-up of 40.1 months, (p ₂₅-p ₇₅: 27.3-57.8) 3-5 year actuarial RFS was 88.9-85.6 %, respectively. Five-year actuarial OS was 95.3 %.

CONCLUSION

Preoperative chemotherapy in LACC patients is safe and able to induce major tumor regression. Survival times are encouraging, and further research seems warranted.

Regulation of black-hole accretion by a disk wind during a violent outburst of V404 Cygni

Accretion of matter onto black holes is universally associated with strong radiative feedback and powerful outflows. In particular, black-hole transients have outflows whose properties are strongly coupled to those of the accretion flow. This includes X-ray winds of ionized material, expelled from the accretion disk encircling the black hole, and collimated radio jets. Very recently, a distinct optical variability pattern has been reported in the transient stellar-mass black hole V404 Cygni, and interpreted as disrupted mass flow into the inner regions of its large accretion disk. Here we report observations of a sustained outer accretion disk wind in V404 Cyg, which is unlike any seen hitherto. We find that the outflowing wind is neutral, has a large covering factor, expands at one per cent of the speed of light and triggers a nebular phase once accretion drops sharply and the ejecta become optically thin. The large expelled mass (>10(-8) solar masses) indicates that the outburst was prematurely ended when a sizeable fraction of the outer disk was depleted by the wind, detaching the inner regions from the rest of the disk. The luminous, but brief, accretion phases shown by transients with large accretion disks imply that this outflow is probably a fundamental ingredient in regulating mass accretion onto black holes.

Thermodynamics of the structural transition in metal–organic frameworks

A thermodynamic study of the structural large-pore (LP) to narrow pore (NP) transition in various Metal Organic Frameworks (MOFs) is presented.

Quantification of obeche wood allergen: Development of a sensitive sandwich-ELISA for occupational exposure assessment

Obeche wood is a prominent cause of allergic occupational asthma. To reduce the risk of immunoglobulin E (IgE)-mediated sensitization it is important to assess airborne obeche wood allergen concentrations at exposed workplaces. Therefore, a highly sensitive obeche wood allergen immunoassay was developed and applicability was proven on airborne passive dust samples in Spanish wood workshops. Obeche wood sandwich enzyme-linked immunosorbent assay (ELISA) polyclonal antibodies (pAbs) were developed. Test specificity was verified by different wood and mold extracts. Obeche wood allergen monitoring was conducted in four Spanish wood workshops, including wood-dust-exposed and nonexposed areas inside and outside the workplaces, as well as controls. Dust was collected with electrostatic dust collectors (EDC). Measuring range of the obeche wood sandwich-ELISA was between 36 pg/ml and 1.6 µg/ml. The test system showed only marginal reactivity to other hardwoods and no reactivity to softwoods and molds. Obeche allergen was detected in all EDC from workplaces. The highest concentration was measured in the workshop with the longest obeche wood exposure (geometric mean [GM]: 7548 µg/m²); shorter obeche wood processing periods resulted in lower amounts of allergen (GM: 29 µg/m²). Obeche wood allergen transfer from exposed workplaces to nonexposed areas inside and outside the workshop was assessed. In control EDC from nonexposed facilities/homes no obeche wood allergen was found. The new obeche wood sandwich-ELISA is a valid tool to quantify obeche allergen exposure. Evidence indicates it will be possible to monitor obeche allergen exposure during different processes, as well as transfer effects in nonexposed areas.

Intradermal injection of human adipose-derived stem cells accelerates skin wound healing in nude mice

Background

The use of stem cells from adipose tissue or adipose-derived stem cells (ASCs) in regenerative medicine could be an interesting alternative to bone marrow stem cells because they are easily accessible and available in large quantities. The aim of this study was to evaluate the potential effect of ASCs on the healing of 12 mm diameter-excisional wounds (around 110 mm²) in nude mice.

Methods

Thirty nude mice underwent surgery to create one 12-mm excisional wound per mouse (spontaneous healing, n = 6; Cytocare® 532, n = 12; ASCs, n = 12). The Galiano wound model was chosen to avoid shrinkage and thus slow the spontaneous healing (SH) of mouse skin, making it closer to the physiology of human skin healing. Transparent dressings were used to enable daily healing time measurements to be taken. Immunohistochemistry, histological and blood perfusion analysis were carried out on the healed skin.

Results

The in vivo results showed the effectiveness of using ASCs on reducing the time needed for complete healing to 21.2 days for SH, 17.4 days for vehicle alone (Cytocare® 532) and 14.6 days with the addition of ASCs (p < 0.001). Moreover, cutaneous perfusion of the healed wound was significantly improved in ASC-treated mice compared to SH group, as shown by laser Doppler flowmetry and the quantitation of blood vessels using immunohistochemistry of αsmooth muscle actin.

Conclusions

The tolerance and efficacy of cryopreserved ASCs to accelerate the complete closure of the wound by increasing the maturation of the skin and its blood perfusion, shows their therapeutic benefit in the wound healing context.

Providers' beliefs about the effectiveness of the HPV vaccine in preventing cancer and their recommended age groups for vaccination: Findings from a provider survey, 2012

BACKGROUND

The human papillomavirus (HPV) vaccine was recommended in 2007 by the Advisory Committee on Immunization Practices (ACIP) to preadolescent and adolescent girls. Vaccination initiation was recommended at age 11-12 years with the option to start at age 9. Catchup vaccination was recommended to females aged 13-26 previously not vaccinated. However, vaccination coverage remains low. Studies show that the HPV vaccine can prevent cervical, vulvar, vaginal, anal and some oropharyngeal cancers and that provider recommendation of vaccines can improve low vaccination rates.

METHODS

Using data from 2012 DocStyles, an annual, web-based survey of U.S. healthcare professionals including physicians and nurse practitioners (n=1753), we examined providers' knowledge about the effectiveness of the HPV vaccine in preventing cancer and their vaccine recommendation to all age-eligible females (9-26 years). Descriptive statistics and Chi-square tests were used to assess differences across specialties.

RESULTS

Knowledge about HPV vaccine effectiveness in preventing cervical cancer was highly prevalent (96.9%), but less so for anal, vaginal, vulvar and oropharyngeal cancers. Only 14.5% of providers recommended the vaccine to all age-eligible females and 20.2% recommended it to females aged 11-26 years. Knowledge assessment of cancers associated with HPV and vaccination recommendations varied significantly among providers (p<0.01). Providers more frequently recommended the vaccine to girls older than 11-12 years.

CONCLUSIONS

Improving providers' knowledge about HPV-associated cancers and the age for vaccination initiation, communicating messages focusing on the vaccine safety and benefits in cancer prevention and on the importance of its delivery prior to sexual onset, may improve HPV vaccine coverage.

Using microbubble sonographic contrast agent to enhance the effect of high intensity focused ultrasound for the treatment of uterine fibroids

OBJECTIVE

To evaluate the effects of the ultrasound contrast agent SonoVue in enhancing the ablative effects of Ultrasound-Guided high-intensity focused ultrasound (HIFU) on different sub-types of uterine fibroids.

MATERIALS AND METHODS

In this study, 390 fibroids from 319 patients were retrospectively evaluated, among which 155 were treated with SonoVue and 235 were without SonoVue during HIFU ablation. The efficacy of HIFU was evaluated using magnetic resonance scanning (MRI) in all patients.

RESULTS

The total ablation time to achieve the same non-perfused volume was significantly shortened with SonoVue. The average energy used and the acoustic energy for treating 1 mm(3) (EEF) was less when SonoVue is used as enhancing agent. The non-perfused volume (NPV) was measured by post-HIFU MRI and the mean fractional ablation was calculated. Mean NPV was 74% (range: 15%-100%) in the HIFU-only group and 75% (range: 17%-100%) in the HIFU+ SonoVue group. However, for T2 MRI low intensity signal fibroids, NPV in the SonoVue group reached 83% (range: 20%-100%) that was significantly higher than in the HIFU-only group, which was 76% (range: 15%-100%). No differences in adverse events were observed between the two groups.

CONCLUSIONS

Our observations demonstrate that the use of therapeutic SonoVue during the HIFU procedure can significantly decrease the ablation time and the energy requirement for the treatment of the same fibroid volume in all types of fibroids.