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Longterm use of a calcineurin inhibitor (CNI)-based regimen is one of the major reasons for chronic renal failure in liver transplantation recipients (LTRs). The Everolimus Liver registry (EVEROLIVER) evaluated renal function in LTRs who were converted to everolimus (EVR). This observational registry included all LTRs receiving EVR across 9 centers from France. Data are being collected in an electronic database over 10 years (12 visits/patient) to evaluate efficacy, renal function (estimated glomerular filtration rate [eGFR]), and safety of EVR use in clinical practice, and the current analysis is reporting up to 60 months of findings. Until September 2017, 1045 patients received EVR after a mean time of 3.6 ± 5.1 years. CNI withdrawal was feasible in 57.7% of patients as of month 60. Mean eGFR improved in patients with baseline eGFR less then 60 mL/minute/1.73 m2 and was maintained in those with baseline eGFR ≥60 mL/minute/1.73 m2 . Among patients with chronic kidney disease (CKD; baseline eGFR less then 60 mL/minute/1.73 m2 ), 55% converted to EVR within 3 months (early conversion) and 39.4% converted between 4 and 12 months after transplantation (mid-conversion) experienced improvement in eGFR (≥60 mL/minute/1.73 m2 ) at month 36. Only 20.9% and 17.4% among those converted beyond 12 months (late conversion) experienced improvement respectively at month 36 and 60. A logistic regression analysis in patients with CKD stage ≥3 demonstrated that late conversion, age, and female sex were associated with nonimprovement of eGFR (≥60 mL/minute/1.73 m2 ). Data from this real-life use of EVR indicate that renal function was maintained from the preconversion period until month 36 even in patients with advanced CKD. However, early rather than late conversion appears to be a safe approach to preserve longterm renal function in LTRs.The associations between built and food environments and childhood obesity have been studied extensively. However, the association between the natural environment and childhood obesity has received too little scholarly attention. This study reviewed the literature published before 1 January 2019, which described associations between a full range of natural environmental factors (e.g., rainfall, temperature, sunlight, natural disasters, flood and drought) and weight-related behaviours and childhood obesity. Five cross-sectional studies and one longitudinal study were identified. Measures of natural environmental factors varied across six included studies, falling into five broad categories weather conditions, altitude, natural disaster risk, air quality and day length. It was found that temperature was a significant weather indicator in most included studies and was associated with a reduction of daily physical activity. Children living in high-altitude areas were more likely to be shorter and heavier than their counterparts in low-altitude areas. Findings of this study will contribute to helping multiple stakeholders, including policy makers and urban planners, and formulate health policies and interventions to mitigate the detrimental impact of the natural environment on childhood obesity. More longitudinal studies should be designed to confirm these effects and explore the potential health effects of more natural environmental factors.The antiquity of the wolf/dog domestication has been recently pushed back in time from the Late Upper Paleolithic (~14,000 years ago) to the Early Upper Paleolithic (EUP; ~36,000 years ago). Some authors questioned this early dog domestication claiming that the putative (EUP) Paleolithic dogs fall within the morphological range of recent wolves. In this study, we reanalyzed a data set of large canid skulls using unbalanced- and balanced-randomized discriminant analyses to assess whether the putative Paleolithic dogs are morphologically unique or whether they represent a subsample of the wolf morpho-population. We evaluated morphological differences between 96 specimens of the 4 a priori reference groups (8 putative Paleolithic dogs, 41 recent northern dogs, 7 Pleistocene wolves, and 40 recent northern wolves) using discriminant analysis based on 5 ln-transformed raw and allometrically size-adjusted cranial measurements. Putative Paleolithic dogs are classified with high accuracies (87.5 and 100.0%, cross-validated) and randomization experiment suggests that these classification rates cannot be exclusively explained by the small and uneven sample sizes of reference groups. It indicates that putative Upper Paleolithic dogs may represent a discrete canid group with morphological signs of domestication (a relatively shorter skull and wider palate and braincase) that distinguish them from sympatric Pleistocene wolves. The present results add evidence to the view that these specimens could represent incipient Paleolithic dogs that were involved in daily activities of European Upper Paleolithic forager groups.Surface pre-reacted glass-ionomer (S-PRG) technology allows for the release of multiple ions. This study was performed to investigate the remineralization of etched enamel after removal of the bracket using a novel paste containing S-PRG filler. Surfaces of polished enamel were etched with phosphoric acid and then subdivided into two regions. Bracket bonding resin was thinly applied to one region. After 24-hr immersion in artificial saliva, the bonding resin on the enamel surfaces was removed by grinding with tungsten carbide bur at low-speed, followed by polishing with one of four different polishing systems (a) nonfluoridated paste (NF); (b) fluoridated paste (F); (c) S-PRG filler-containing paste (S-PRG); or (d) nonfluoridated plus S-PRG filler-containing paste (NF + S-PRG) (n = 15). learn more The polished specimens were then immersed in an artificial saliva solution for 7 days. Nanoindentation testing of enamel surfaces was performed and their mechanical properties were compared. Representative specimens were examined with scanning electron microscope. In all specimens, the mechanical properties of the enamel surfaces were markedly degraded by acid etching. However, the mechanical properties of both regions (etched and resin-infiltrated enamels) showed recovery after polishing and 7-day immersion. Polishing with NF + S-PRG paste led to significant recovery of mechanical properties compared to polishing with NF or S-PRG paste alone, and remineralization was equivalent to that seen with F paste. Porous etched enamel surfaces were filled with a remineralization layer after each polishing procedure and 7-day immersion in all polishing groups. Polishing using NF + S-PRG paste can facilitate enamel remineralization after bracket removal.Like all macroorganisms, plants have to control bacterial biofilm formation on their surfaces. On the other hand, biofilms are highly tolerant against antimicrobial agents and other stresses. Consequently, biofilms are also involved in human chronic infectious diseases, which generates a strong demand for anti-biofilm agents. Therefore, we systematically explored major plant flavonoids as putative anti-biofilm agents using different types of biofilms produced by Gram-negative and Gram-positive bacteria. In Escherichia coli macrocolony biofilms, the flavone luteolin and the flavonols myricetin, morin and quercetin were found to strongly reduce the extracellular matrix. These agents directly inhibit the assembly of amyloid curli fibres by driving CsgA subunits into an off-pathway leading to SDS-insoluble oligomers. In addition, they can interfere with cellulose production by still unknown mechanisms. Submerged biofilm formation, however, is hardly affected. Moreover, the same flavonoids tend to stimulate macrocolony and submerged biofilm formation by Pseudomonas aeruginosa. For Bacillus subtilis, the flavonone naringenin and the chalcone phloretin were found to inhibit growth. Thus, plant flavonoids are not general anti-biofilm compounds but show species-specific effects. However, based on their strong and direct anti-amyloidogenic activities, distinct plant flavonoids may provide an attractive strategy to specifically combat amyloid-based biofilms of some relevant pathogens.
Paraspinal vein misplacement is an uncommon complication of central venous catheterization via lower extremities, most of which have been reported in case reports.
To determine the clinical characteristics of paraspinal vein misplacement.
This was a systematic review.
A systematic literature search in the PubMed, EMBASE, Scopus, and Web of Science databases was performed from their inception to 18 June 2019. Case reports and small case series describing central venous catheter misplacement in the paraspinal vein were included. Data on the catheterization procedure, catheter tip position, complications, and radiographic features of misplacement were extracted.
Thirty studies with a total of 36 patients were included. The ascending lumbar vein accounted for the majority of misplacements (n = 30), followed by the lumbar vein (n = 4), iliolumbar vein (n = 1), and vertebral venous plexus (n = 1). Six patients had eventful catheterization procedures. Twenty-six patients experienced misplacement-induced coities.
Litigation against the National Health Service (NHS) in England is rising. The aim of this study was to determine the incidence and characteristics of otorhinolaryngology clinical negligence claims in England.
A retrospective review was undertaken of all clinical negligence claims in England held by NHS Resolution relating to otorhinolaryngology between April 2013 and April 2018. Analysis was performed using information for cause, patient injury and claim cost. Where claim information was adequately detailed, the authors categorised claims by subspecialty, diagnosis and surgery.
A total number of 727 claims were identified with an estimated potential cost of £108million. Out of these, 463 were closed claims. Including open claim reserves, the mean cost of a claim was £148923. Head and neck surgery was the subspecialty with the highest number of claims (n=313, 43%) and highest cost (£51.5million) followed by otology (n=171, £24.5 million) and rhinology (n=171, £13.6 million). Over half of claims were ass This study highlights the importance of robust pathways in out-patient diagnostics and the consenting process in order to deliver better patient care and reduce the impact of litigation. Keywords informed consent, malpractice, clinical negligence claims, litigation, otolaryngology.The thermodynamically unstable, colourless closed-ring isomer of spiropyran can be stabilized in water by the anti-configurational isomer of amide naphthotube. The influence of the binding on the thermodynamics and kinetics of spiropyran have been studied. The complex was further used to prepare a test paper that allows naked-eye detection of toxic paraoxon.Cellular responses to hypertonic stress and how these are linked to the induction of or sensitisation to cell death signals are incompletely understood and rarely studied in cancer. Using cell lines derived from head and neck squamous cell carcinoma (HNSCC), Heimer et al. demonstrate that hypertonic environments neutralise the antiapoptotic Bcl-2 family member Mcl-1 by upregulating its antagonist Noxa. Consequently, hypertonically stressed HNSCC cells rely solely on Bcl-xL for survival and succumb to apoptosis when challenged by pharmacological Bcl-xL inhibition. Similar findings were reported in colorectal cancer cells in related manuscripts, suggesting that a common and conserved mechanistic link might exist between hyperosmotic stress and cellular sensitisation to apoptosis.
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