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Purpose To assess the reliability and accuracy of an automated Cobb angle measurement (ACAM) using a convolutional neural network (CNN) for scoliosis evaluation and to compare measurement times. Materials and Methods ACAM was applied to spine radiographs in 411 patients suspected of scoliosis. Observer 1 (consensus of two musculoskeletal radiologists) and observer 2 (a radiology resident) measured Cobb angle (CA). CA measurements were categorized using observer 1’s measurements as the reference standard. Inter-observer reliability and correlation were assessed using intraclass correlation coefficient (ICC) and Spearman’s rank correlation coefficient, respectively. Accuracy and measurement time of ACAM and observers were evaluated. Results ACAM demonstrated excellent reliability and very high correlation with observer 1 (ICC = 0.976, Spearman’s rank correlation = 0.948), with a mean CA difference of 1.1. Overall accuracy was high (88.2%), particularly in mild (92.2%) and moderate (96%) scoliosis. Accuracy was lower in spinal asymmetry (77.1%) and higher in severe scoliosis (95%), although the CA was lower compared to the observers. ACAM significantly reduced measurement time by nearly half compared to the observers (p < 0.001). Conclusion ACAM using CNN enhances CA measurement for assessing mild or moderate scoliosis, despite limitations in spinal asymmetry or severe scoliosis. Nonetheless, it substantially decreases measurement time.

Abstract Cortical neuromodulation (CNM) is widely used to promote recovery after stroke. Despite the beneficial results of CNM, the roles played by different neuron types in the effects of current CNM techniques are unable to be differentiated. Our aim was to use selective optogenetic cortical stimulation to explore how different subpopulations of neuronal cells contribute to poststroke recovery. We transduced the sensory-parietal cortex (SPC) of rats with CamKII-ChR2 (pyramidal neurons), PV-ChR2 (parvalbumin-expressing inhibitory neurons), or hSyn-ChR2 (pan-neuronal population) before inducing photothrombotic capsular infarct lesions. We found that selective stimulation of inhibitory neurons resulted in significantly greater motor recovery than stimulation of excitatory neurons or the pan-neuronal population. Furthermore, 2-deoxy-2-[18F] fluoro-D-glucose microPET (FDG-microPET) imaging revealed a significant reduction in cortical diaschisis and activation of the corticostriatal neural circuit, which were correlated with behavioral recovery in the PV-ChR2 group. The spatial pattern of brain-derived neurotrophic factor (BDNF) expression was evident in the stimulated cortex and underlying cortico-subcortical circuit. Our results indicate that the plasticity of inhibitory neurons is crucial for functional recovery after capsular infarct. Modifying CNM parameters to potentiate the stimulation of inhibitory neurons could improve poststroke outcomes.

Abstract Background In cases with advanced glaucomatous disc changes, further changes associated with other optic neuropathies cannot be easily identified. We present a case of preexisting open-angle glaucoma and concurrent involvement of sarcoidosis-associated optic neuropathy. Case presentation A 53-year-old man presented with gradual visual loss in his left eye, which began 1 year ago and accelerated 3 months ago. The best-corrected visual acuity in the right eye was 20/20 and counting fingers in the left. Intraocular pressures (IOP) were 12 mmHg in the right eye and 34 mmHg in the left. We diagnosed him with advanced open-angle glaucoma in the left eye based on the advanced glaucomatous cupping of the left optic disc. The IOP in the left eye dropped to 10 mmHg and was well controlled with antiglaucomatous medication; however, his left optic disc developed pallor 3 months after the treatment. The patient was revealed to be diagnosed with sarcoidosis a month ago and had been treated with systemic corticosteroids thereafter by a pulmonologist. Orbital magnetic resonance imaging revealed sarcoidosis-associated optic neuropathy in the left eye. Subsequently, optic neuropathy occurred in his right eye. Conclusions In eyes with advanced glaucomatous disc change, detecting the coexistence of other optic neuropathies can be difficult. This report highlights the importance of careful ophthalmic examinations and investigation for etiologies of other optic neuropathies if non-glaucomatous changes are suspected even in eyes with advanced glaucoma.

There is increasing interest in the aquaculture of high-value shellfish species such as European lobster Homarus gammarus. Recent years have seen the development of extractive rearing equipment requiring no additional feed input, including novel sea-based container culture (SBCC) systems designed specifically for lobster mariculture. Here, we report the results of a study which assessed the impact of SBCC systems on the local ecology surrounding a pilot-scale lobster farm (Lobster Grower) integrated into an existing mussel farm in St Austell Bay, Cornwall, UK, across 2 monitoring surveys. We assessed the impact of SBCC systems on the macrobenthic, epifaunal, and mobile species ecology across the study area through benthic grab sampling, drop-down camera, and baited-remote underwater video (BRUV) monitoring. We detected no changes to local sediment composition around SBCC systems, nor changes in macrobenthic diversity or community structure. Increased detritus and biodeposition originating from SBCC systems may be attracting increased epifaunal scavengers, while the presence of the containers and associated infrastructure may act as fish-aggregating devices and provide additional foraging opportunities for mobile fish. These extractive systems may provide low-impact and low-carbon opportunities for coastal mariculture in the face of increased global demand for shellfish.

Adult-onset Alexander Disease (AOAD) is a rare genetically determined leukoencephalopathy that presents with ataxia, spastic paraparesis, or brain stem signs including speech abnormalities, swallowing difficulties, and frequent vomiting. The diagnosis of AOAD is frequently proposed based on the findings on MRI. We demonstrate two cases (37-year-old female and 61-year-old female) with characteristic imaging findings and changes in follow-up MRI in patients with AOAD, which were confirmed via glial fibrillary acidic protein (GFAP ) mutation analysis. On MRI, the typical tadpole-like brainstem atrophy and periventricular white matter abnormalities were noted. The presumptive diagnoses were made based on the typical MRI appearances and, subsequently, confirmed via GFAP mutation analysis. Follow-up MRI demonstrated the progression of atrophy in the medulla and upper cervical spinal cord. Our report could help raise awareness of characteristic MRI findings of AOAD, thus helping clinicians use GFAP analysis for AOAD diagnosis confirmation.

Purpose The aim of this multicenter study was to investigate the malignancy risk of minimally cystic thyroid nodules (MCTNs) using cyto-histopathologic diagnoses as the reference standard. Methods From June 2015 to September 2015, 5,601 thyroid nodules (≥1 cm) from 4,989 consecutive patients who underwent thyroid ultrasonography (US) at 26 institutions were retrospectively analyzed. Each thyroid nodule was categorized according to its cystic proportion: purely solid, minimally cystic (≤10%), and partially cystic (>10%). The malignancy risk of MCTNs was compared with those of purely solid nodules and partially cystic thyroid nodules (PCTNs). The malignancy risk of MCTNs was assessed according to echogenicity and the presence of suspicious US features. Results The prevalence of MCTNs was 22.5%. The overall malignancy risk of MCTNs was 8.8%, which was significantly lower than that of purely solid nodules (29.5%) (P0.05). MCTNs were associated with a higher risk of malignancy in hypoechoic nodules than in isohyperechoic nodules and in nodules with suspicious US features than in those without suspicious US features (all P

Abstract Various risk stratification systems show discrepancies in the ultrasound lexicon of nodule echotexture and hypoechogenicity. This study aimed to determine the malignancy risk of thyroid nodules according to their echotexture and degree of hypoechogenicity. From June to September 2015, we retrospectively evaluated 5601 thyroid nodules with final diagnoses from 26 institutions. Nodules were stratified according to the echotexture (homogeneous vs. heterogeneous) and degree of hypoechogenicity (mild, moderate, or marked). We calculated the malignancy risk according to composition and suspicious features. Heterogeneous hypoechoic nodules showed a significantly higher malignancy risk than heterogeneous isoechoic nodules (P ≤ 0.017), except in partially cystic nodules. Malignancy risks were not significantly different between homogeneous versus heterogeneous nodules in both hypoechoic (P ≥ 0.086) and iso- hyperechoic nodules (P ≥ 0.05). Heterogeneous iso-hyperechoic nodules without suspicious features showed a low malignancy risk. The malignancy risks of markedly and moderately hypoechoic nodules were not significantly different in all subgroups (P ≥ 0.48). Marked or moderately hypoechoic nodules showed a significantly higher risk than mild hypoechoic (P ≤ 0.016) nodules. The predominant echogenicity effectively stratifies the malignancy risk of nodules with heterogeneous echotexture. The degree of hypoechogenicity could be stratified as mild versus moderate to marked hypoechogenicity.

Ischemic stroke is one of the manifestations of reversible cerebral vasoconstriction syndrome (RCVS). Many precipitants and associated disorders of RCVS have been suggested. However, few case reports have indicated an association between anemia and RCVS. Here, we report a case of a 66-year-old female with severe iron deficiency anemia (IDA), who presented with ischemic stroke and cerebral vasoconstriction, which gradually improved with conservative treatment. High-resolution vessel wall magnetic resonance imaging findings and reversibility suggested the possibility of RCVS. In patients with RCVS and ischemic stroke, IDA should be considered. Prompt management should be delivered to prevent disease progression and recurrence.

Metastases to the thyroid gland have rarely been reported in clinical settings, and the thyroid gland is an uncommon site for breast carcinoma metastasis. We report a case of a 64-year-old breast cancer patient diagnosed with metastatic breast carcinoma in the thyroid gland after performing ultrasonography (US)-guided core needle biopsy (CNB) and subsequent total thyroidectomy. On US, the thyroid lesion appeared to be mildly enlarged with multiple internal hypoechoic lines and a few microcalcifications without mass formation. Under US-guidance, CNB was performed by targeting the area with microcalcifications and subsequently diagnosed as metastatic breast carcinoma. Total thyroidectomy revealed that the patient had metastatic invasive ductal carcinoma of the breast with lymphatic spread involving both lobes and the isthmus of the thyroid gland. Although the thyroid gland is an uncommon metastatic site, the unusual features of thyroid metastasis can be observed on US; thus, US-guided CNB effectively aids the diagnosis of thyroid metastasis.

ABSTRACT Aim: Predict the elimination of chronic hepatitis C in Catalan prisons. Material and method: We analyzed the trend of the prevalence of HCV-RNA and anti-hepatitis C treatments prescribed in Catalonia in the period 2002-2016. Using linear exponential smoothing from the historical values in the time series, we estimate the time required to eliminate hepatitis C as a public health problem in prisons (prevalence of hepatitis C virus RNA

Palpable lesions of the scalp and face are common in clinical practice. They are usually small and benign, and the lesions tend to be treated simply according to the clinical symptoms. However, radiologic evaluation is often performed to determine the exact type and location of a lesion to ensure appropriate management. Ultrasonography is useful as a primary and definitive modality for evaluating small superficial lesions. CT and MRI are better for characterizing soft tissue features and provide superior soft tissue resolution. This article discusses various lesions and their imaging findings of the scalp and face that may present as superficially palpable masses.

Objectives/Hypothesis To investigate the clinical significance of three-dimensional-fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) findings in patients with Ramsay-Hunt syndrome (RHS). Study Design Case series. Methods We enrolled 28 consecutive patients of RHS with temporal bone MRI. Initial clinical findings and outcome were assessed by House-Brackmann (HB) scales, electroneuronography (ENoG), and pure tone audiometry (PTA). Two radiologists evaluated the presence of abnormalities on pre-/postcontrast 3D-FLAIR for the cranial nerve (CN)-VII, CN-VIII, inner ear (IE), and the posterior fossa by consensus. The relative signal intensity and enhancement degree (rED) of the structures were measured using ImageJ (). Statistical test correlated the clinical symptoms and the outcome with the analysis results of 3D-FLAIR images. Results 3D-FLAIR demonstrated enhancement of CN-VII in all patients. Precontrast hyperintensity and enhancement were seen in eight and 16 patients with IE, and in four and six with CN-VIII, respectively. Precontrast hyperintensity of IE or CN-VIII was significantly associated with the presence of vertigo ( P value < 0.05). Precontrast hyperintensity of IE or CN-VIII significantly correlated with clinical symptoms assessed by HB, ENoG, and PTA ( P value < 0.05, respectively). rED of the vestibule moderately correlated with initial HB scale ( r = 0.391, P = 0.039). There was no correlation between any of the 3D-FLAIR findings and the follow-up HB. Conclusions RHS shows frequent abnormalities of IE or CN-VIII, as well as CN-VII on pre-/postcontrast 3D-FLAIR images. Precontrast hyperintensity of IE/CN-VIII on 3D-FLAIR is significantly correlated with the severity of facial palsy, the presence of vertigo, and the degree of hearing impairment but not with clinical outcome. Level of Evidence 4. Laryngoscope, 125:950-955, 2015 [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To know the criteria of penitentiary professionals about the causes, management methods and improvement proposal, in the attention and care of inmates suffering non-serious mental disorders. Material and methods Activity developed from March to May 2015. In Catalonia, three prisons participated. Seven different models of anonymous and written questionnaires were distributed, designed by Italy, and aimed at directors, treatment teams, correctional officers, teachers, doctors, nursing staff and volunteers. They presented the degree of participation, descriptive characteristics of groups and main answers given. To study the association between qualitative variables, the Chi squared and the exact Fisher test was used. Results Questionnaires distributed among the 744 employees and there were obtained 174 filled (23.4%). There was more participation among health staff and treatment teams (88% and 36%). About the age of participants, doctors were the most senior group with meaningful differences (p

Background: Ficus auriculata (fig) has immense value of benefits with regards to their medicinal and therapeutic properties. It has been long used in traditional folk medicine, and one of the fruits mentioned in Al-Quran. Many scientific researches have proven the usage of this natural medicine in in vitro and in vivo studies, where anti-cancer is among of its recognized properties. Objective: To acquire further details on how F. auriculata (fig) inhibited cancer growth, we investigated the effects of its exposure on cell cycle profile. Methods: Subsequently we determined the type of cell death and the mechanism it induced using flow cytometer. Human lung adenocarcinoma cell line A549 was selected as the model of this study. Results: It is indicated significant decreased of A549 cells in G0/G1and concurrent accumulation of cells in G2/M phase. Cell death analysis revealed significant late apoptosis induced by F. auriculata (fig) via caspase independent pathway. Conclusion: Therefore, we concluded that F. auriculata (fig) is one of the promising natural medicines that can be used as cancer preventive strategy, as a result from its effects against cell cycle profile and apoptosis via caspase independent pathway.

Background Stroke involving the cerebral white matter (WM) has increased in prevalence, but most experimental studies have focused on ischemic injury of the gray matter. This study was performed to investigate the WM in a unique rat model of photothrombotic infarct targeting the posterior limb of internal capsule (PLIC), focusing on the identification of the most vulnerable structure in WM by ischemic injury, subsequent glial reaction to the injury, and the fundamental histopathologic feature causing different neurologic outcomes. Methods Light microscopy with immunohistochemical stains and electron microscopic examinations of the lesion were performed between 3 hours and 21 days post-ischemic injury. Results Initial pathological change develops in myelinated axon, concomitantly with reactive change of astrocytes. The first pathology to present is nodular loosening to separate the myelin sheath with axonal wrinkling. Subsequent pathologies include rupture of the myelin sheath with extrusion of axonal organelles, progressive necrosis, oligodendrocyte degeneration and death, and reactive gliosis. Increase of glial fibrillary acidic protein (GFAP) immunoreactivity is an early event in the ischemic lesion. WM pathologies result in motor dysfunction. Motor function recovery after the infarct was correlated to the extent of PLIC injury proper rather than the infarct volume. Conclusions Pathologic changes indicate that the cerebral WM, independent of cortical neurons, is highly vulnerable to the effects of focal ischemia, among which myelin sheath is first damaged. Early increase of GFAP immunoreactivity indicates that astrocyte response initially begins with myelinated axonal injury, and supports the biologic role related to WM injury or plasticity. The reaction of astrocytes in the experimental model might be important for the study of pathogenesis and treatment of the WM stroke.

Although advanced magnetic resonance imaging (MRI) techniques provide useful information for the differential diagnosis of intra-axial mass-like lesions, the specific diagnostic role of multimodal MRI over conventional magnetic resonance imaging (CMRI) alone in the differential diagnosis of mass-like lesions from a large heterogeneous cohort has not been studied. In this study, we aimed to determine the added value of a joint approach of diffusion-weighted imaging (DWI) and dynamic-susceptibility-contrast perfusion imaging (DSC-PWI) for diagnosis of intra-axial mass-like lesions, comparing them with CMRI alone. Furthermore, we performed these evaluations in a manner simulating clinical practice. Our institutional review board approved this retrospective study and waived the requirement for informed consent. A total of 1038 patients with intra-axial mass-like lesions were retrospectively recruited according to their histological and clinico-radiological diagnoses made between January 2005 and December 2014. All patients underwent CMRI, DWI and DSC-PWI. The diagnostic accuracy and confidence in diagnosing each type of intra-axial mass-like lesions, and for differentiating the intra-axial brain tumors from non-neoplastic lesions, were compared according to the MRI protocols. The disease-specific sensitivity of joint approach differed according to specific disease entities in diagnosing each disease category. Joint approach provided the best diagnostic accuracy for discriminating intra-axial brain tumors from non-neoplastic lesions, with high diagnostic accuracy (95.3-96.7%), specificity (82-84.0%), positive-predictive-value (97.0-97.3%), and negative-predictive-value (84.8-92.7%), with the reader's confidence values being significantly improved over those on CMRI alone (all p-values < 0.001). In conclusion, joint approach of DWI, DSC-PWI to CMRI helps to differentiate non-neoplastic lesions from intra-axial brain tumors, and improves diagnostic confidence compared with CMRI alone. The benefit from the combined imaging differs for each disease category; thus joint approach needs to be customized according to clinical suspicion.

The objective of this study was to evaluate the performance, carcass and parts yield, and blood changes in broilers fed different protein, carbohydrate, and lipid levels. Birds were fed a commercial diet until seven days of age. On day 8, birds were distributed according to a completely randomized experimental design in a 4 x 2 factorial arrangement (control diet, low protein diet, low carbohydrate diet or low lipid diet vs. supplementation of 0 or 0.3ppm organic selenium) with four replicates of 15 birds each. Broilers fed low protein presented lower body weight, feed intake, and worse feed conversion ratio on day 42, as well as lower carcass and breast yields, higher leg and abdominal fat yields, higher triglyceride and lower uric acid blood levels. Broilers fed the low carbohydrate diets presented low glucose levels on days 14 and 42.Creatine-kinase (CK) levels increased as birds aged. The livability of broilers fed the low protein diets improved and of those fed low carbohydrate diets worsened with dietary selenium addition on days 35 and 42. Selenium supplementation increased glucose levels in 42-d-old broilers. Changes in dietary protein caused more impact on broiler performance compared with carbohydrates and lipids. Changes in macronutrients caused metabolic changes in broilers. Selenium affected broiler livability as measured on days 35 and 42, and glucose blood levels.

Background: There is scanty data on the pattern of childhood urogenital malformations in many resource-poor countries, including Nigeria. Objective: To describe the pattern of occurrence of major urogenital malformations in children presenting in a tertiary health care centre in sub Saharan Africa. Design: Retrospective case review. Patients: All children with major urogenital malformations presented at the Department of Paediatrics of the University College Hospital, Ibadan, a large tertiary health care institution in South West Nigeria. In the period from July 1985 to December 1995. Main results: A total number of 125 cases of major urogenital malformations were seen during the study period. The commonest of these malformations were posterior urethral valves (40.0%), hypospedias(18.4%), ambiguous external genitalia (12.8%) andectopia vesicae (11.2%). Prenatal diagnosis was rare and most patients presented late. Mortality during first admission was14.4% (18/125), mostly accounted for by cases of posterior urethral valves. Conclusion: Posterior urethral valves accounted for the majority of major urogenital malformations seen in the setting studied. The high mortality probably reflected the severity of the lesions and late presentation of patients (which was related to the rarity of prenatal diagnosis). Increased awareness of these lesions among physicians practising in developing countries and greater use of ultrasonography in the third trimester of pregnancy may improve the prognosis by early detection and management.

Hepatic specificity of inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase may be achieved by efficient first-pass liver extraction resulting in low circulating drug levels, as with lovastatin, or by lower cellular uptake in peripheral tissues, seen with pravastatin. BMY-21950 and its lactone form BMY-22089, new synthetic inhibitors of HMG-CoA reductase, were compared with the major reference agent lovastatin and with the synthetic inhibitor fluindostatin in several in vitro and in vivo models of potency and tissue selectivity. The kinetic mechanism and the potency of BMY-21950 as a competitive inhibitor of isolated HMG-CoA reductase were comparable to the reference agents. The inhibitory potency (cholesterol synthesis assayed by 3H2O or [14C]acetate incorporation) of BMY-21950 in rat hepatocytes (IC50 = 21 nM) and dog liver slices (IC50 = 23 nM) equalled or exceeded the potencies of the reference agents. Hepatic cholesterol synthesis in vivo in rats was effectively inhibited by BMY-21950 and its lactone form BMY-22089 (ED50 = 0.1 mg/kg p.o.), but oral doses (20 mg/kg) that suppressed liver synthesis by 83-95% inhibited sterol synthesis by only 17-24% in the ileum. In contrast, equivalent doses of lovastatin markedly inhibited cholesterol synthesis in both organs. In tissue slices from rat ileum, cell dispersions from testes, adrenal, and spleen, and in bovine ocular lens epithelial cells, BMY-21950 inhibited sterol synthesis weakly in vitro with IC50 values 76- and 188-times higher than in hepatocytes; similar effects were seen for BMY-22089. However, the IC50 ratios (tissue/hepatocyte) for lovastatin and fluindostatin were near unity in these models. Thus, BMY-21950 and BMY-22089 are the first potent synthetic HMG-CoA reductase inhibitors that possess a very high degree of liver selectivity based upon differential inhibition sensitivities in tissues. This cellular uptake-based property of hepatic specificity of BMY-21950 and BMY-22089, also manifest in pravastatin, is biochemically distinct from the pharmacodynamic-based disposition of lovastatin, which along with fluindostatin exhibited potent inhibition in all tissues that were exposed to it.

ABSTRACT Objective: To know the criteria of penitentiary professionals about the causes, management methods and improvement proposal, in the attention and care of inmates suffering non-serious mental disorders. Material and methods: Activity developed from March to May 2015. In Catalonia, three prisons participated. Seven different models of anonymous and written questionnaires were distributed, designed by Italy, and aimed at directors, treatment teams, correctional officers, teachers, doctors, nursing staff and volunteers. They presented the degree of participation, descriptive characteristics of groups and main answers given. To study the association between qualitative variables, the Chi squared and the exact Fisher test was used. Results: Questionnaires distributed among the 744 employees and there were obtained 174 filled (23.4%). There was more participation among health staff and treatment teams (88% and 36%). About the age of participants, doctors were the most senior group with meaningful differences (p

This work attempts to design an effective sleep staging system, making the best use of the available signals, strategies, and features in the literature. It must not only perform well on different datasets comprising healthy and clinical populations but also achieve good accuracy in cross-dataset experiments. Toward this end, we propose a model comprising multiple binary classifiers in a hierarchical fashion, where, at each level, one or more of EEG, EOG, and EMG are selected to best differentiate between two sleep stages. The best set of 100 features is chosen out of all the features derived from selected signals. The class imbalance in data is addressed by random undersampling and boosting techniques with decision trees as weak learners. Temporal context and data augmentation are used to improve the performance. We also evaluate the performance of our model by training and testing on different datasets. We compare the results of five approaches: using only EEG, EEG+EOG, EEG+EMG+EOG, EEG+EMG, and selective modality with a specific combination of EEG, EMG, and/or EOG at each level. The best results are obtained by considering features from EEG+EMG+EOG at each hierarchical level. The proposed model achieves average accuracies of 83.1%, 90.0%, 84.4%, 82.1%, 81.5%, 79.9%, and 73.7% on Sleep-EDF, Exp Sleep-EDF, ISRUC-S1, S2 and S3, DRMS-SUB, and DRMS-PAT datasets, respectively. For all the datasets except DRMS-SUB, the proposed method outperforms all the state-of-the-art approaches. Cross-dataset performance exceeds 80% for all datasets except DRMS-PAT; independent of whether the test data is from normal subjects or patients.

Carbapenems are commonly used to treat infections caused by multidrug-resistant (MDR) bacteria. Unfortunately, carbapenem resistance is increasingly reported in many gram-negative bacteria, especially Acinetobacter baumannii . Diazabicyclooctane (DBO) β-lactamase inhibitors, such as avibactam (AVI), when combined with sulbactam successfully restore sulbactam susceptibility against certain carbapenem-resistant A. baumannii (CRAB) isolates. In the present study, we tested zidebactam, a novel DBO with an additional mechanism of action, in combination with sulbactam against CRAB isolates, including strains that exhibited resistance against sulbactam/avibactam combination. A panel of 43 geographically and genetically distinct CRAB isolates recovered from different hospitals and containing different mechanisms of resistance were included in the present study. We also tested three reference strains (AB0057, AB5075, and AYE). Minimum inhibitory concentrations (MICs) for sulbactam (range 0.12-512 mg/l) and sulbactam plus 4 mg/l zidebactam were performed using microdilution according to CLSI Standards. A decrease ≥2 dilutions in sulbactam MICs was observed in 84% of the isolates when tested in combination with zidebactam. The sulbactam/zidebactam combination was able to restore sulbactam susceptibility in 91% of the isolates, including isolates that were resistant to sulbactam/avibactam combination. These data encouraged us to further explore sulbactam/zidebactam in other experimental models especially against CRAB isolates resistant to other DBOs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Cedano, Baez, Pasteran, Montaña, Ra, Fua, Corso, Tolmasky, Bonomo and Ramírez.)

Phonological categories in articulated speech are defined based on the place and manner of articulation. In this work, we investigate whether the phonological categories of the prompts imagined during speech imagery lead to differences in phase synchronization in various cortical regions that can be discriminated from the EEG captured during the imagination. Nasal and bilabial consonant are the two phonological categories considered due to their differences in both place and manner of articulation. Mean phase coherence (MPC) is used for measuring the phase synchronization and shallow neural network (NN) is used as the classifier. As a benchmark, we have also designed another NN based on statistical parameters extracted from imagined speech EEG. The NN trained on MPC values in the beta band gives classification results superior to NN trained on alpha band MPC values, gamma band MPC values and statistical parameters extracted from the EEG.Clinical relevance: Brain-computer interface (BCI) is a promising tool for aiding differently-abled people and for neurorehabilitation. One of the challenges in designing speech imagery based BCI is the identification of speech prompts that can lead to distinct neural activations. We have shown that nasal and blilabial consonants lead to dissimilar activations. Hence prompts orthogonal in these phonological categories are good choices as speech imagery prompts.

An increasing number of untreatable infections are recorded every year. Many studies have focused their efforts on developing new β-lactamase inhibitors to treat multi-drug resistant (MDR) isolates. In the present study, sulbactam/avibactam and sulbactam/relebactam combination were tested against 187 multi-drug resistant (MDR) Acinetobacter clinical isolates; both sulbactam/avibactam and sulbactam/relebactam restored sulbactam activity. A decrease ≥2 dilutions in sulbactam MICs was observed in 89% of the isolates when tested in combination with avibactam. Sulbactam/relebactam was able to restore sulbactam susceptibility in 40% of the isolates. In addition, the susceptibility testing using twenty-three A. baumannii AB5075 knockout strains revealed potential sulbactam and/or sulbactam/avibactam target genes. We observed that diazabicyclooctanes (DBOs) β-lactamase inhibitors combined with sulbactam restore sulbactam susceptibility against carbapenem-resistant Acinetobacter clinical isolates. However, relebactam was not as effective as avibactam when combined with sulbactam. Exploring novel combinations may offer new options to treat Acinetobacter spp. infections, especially for widespread oxacillinases and metallo-β-lactamases (MBLs) producers.

Reconstructive surgery (RS) is necessary before implant placement to regenerate bone defects. Success rate of implants is related to RS and to the correct position of implants in residual crest. The most popular surgical procedures of RS are bone grafts, guided bone regeneration. Bone graft is the gold standard technique to achieve RS of edentulous crests. RS is a surgical technique that uses barrier membranes to promote osteoblast cells proliferation. RS is often combined with bone grafting procedures. Sinus floor elevation procedures are elective treatments when there is insufficient bone height for implant insertion in maxilla. Bone osteogenesis distraction is the process of RS between two bone segments in response to tensile stress. The aim of this short review is to analyze the different methods of RS: bone grafts, guided bone regeneration, maxillary sinus floor elevation, and bone osteogenesis distraction., (Copyright 2020 Biolife Sas. www.biolifesas.org.)

Disruption of the histone-like nucleoid structuring protein (H-NS) was shown to affect the ability of Gram-negative bacteria to regulate genes associated with virulence, persistence, stress response, quorum sensing, biosynthesis pathways, and cell adhesion. Here, we used the expression of metallo-β-lactamases (MBLs), known to elicit envelope stress by the accumulation of toxic precursors in the periplasm, to interrogate the role of H-NS in Acinetobacter baumannii , together with other stressors. Using a multidrug-resistant A. baumannii strain, we observed that H-NS plays a role in alleviating the stress triggered by MBL toxic precursors and counteracts the effect of DNA-damaging agents, supporting its role in stress response. IMPORTANCE Carbapenem-resistant A. baumannii (CRAB) is recognized as one of the most threatening Gram-negative bacilli. H-NS is known to play a role in controlling the transcription of a variety of different genes, including those associated with the stress response, persistence, and virulence. In the present work, we uncovered a link between the role of H-NS in the A. baumannii stress response and its relationship with the envelope stress response and resistance to DNA-damaging agents. Overall, we posit a new role of H-NS, showing that H-NS serves to endure envelope stress and could also be a mechanism that alleviates the stress induced by MBL expression in A. baumannii This could be an evolutionary advantage to further resist the action of carbapenems., (Copyright © 2020 Huang et al.)

Background and Importance: Myxoid liposarcoma is not an uncommon form of sarcoma. However, it usually affects the lower extremity long bones. Scapular involvement is extremely rare, as is a metastasis to the parasellar region. We present a case of liposarcoma of the skull base originating in the scapular region and metastasizing to the sellar and parasellar regions and provide a review of the pertinent literature., Clinical Presentation: A 43-year-old female patient diagnosed with left scapular myxoid liposarcoma was treated with surgical resection. She had clear resection margins and was treated pre- and postoperatively with radiotherapy to the region. She remained asymptomatic for 2 years following surgery, after which she abruptly developed diplopia with right lateral gaze. There were no symptoms of raised intracranial pressure or impaired vision. Her examination was normal apart from complete right sixth nerve palsy. Imaging studies of the brain showed a large mass in the clivus eroding into the floor of the sella, encircling the right internal carotid artery in the cavernous sinus. The mass also displaced the sellar contents superiorly. An endonasal, endoscopic skull base approach was undertaken, and a subtotal resection was performed in an effort to avoid multiple cranial nerve pareses., Conclusion: Our literature search revealed that this case report is the first to document liposarcoma metastasis to the skull base originating from the scapular region. Subtotal surgical resection resulted in minimal improvement of the patient's sixth nerve palsy. Postoperative radiation was undertaken. A multidisciplinary approach on an individual patient basis is recommended., (Copyright © 2017 by the Congress of Neurological Surgeons)

Despite considerable research efforts on the relationship between arterial geometry and cardiovascular pathology, information is lacking on the pulsatile geometrical variation caused by arterial distensibility and cardiomotility because of the lack of suitable in vivo experimental models and the methodological difficulties in examining the arterial dynamics. We aimed to investigate the feasibility of using a chick embryo system as an experimental model for basic research on the pulsatile variation of arterial geometry. Optical microscope video images of various arterial shapes in chick chorioallantoic circulation were recorded from different locations and different embryo samples. The high optical transparency of the chorioallantoic membrane (CAM) allowed clear observation of tiny vessels and their movements. Systolic and diastolic changes in arterial geometry were visualized by detecting the wall boundaries from binary images. Several to hundreds of microns of wall displacement variations were recognized during a pulsatile cycle. The spatial maps of the wall motion harmonics and magnitude ratio of harmonic components were obtained by analyzing the temporal brightness variation at each pixel in sequential grayscale images using spectral analysis techniques. The local variations in the spectral characteristics of the arterial wall motion were reflected well in the analysis results. In addition, mapping the phase angle of the fundamental frequency identified the regional variations in the wall motion directivity and phase shift. Regional variations in wall motion phase angle and fundamental-to-second harmonic ratio were remarkable near the bifurcation area. In summary, wall motion in various arterial geometry including straight, curved and bifurcated shapes was well observed in the CAM artery model, and their local and cyclic variations could be characterized by Fourier and wavelet transforms of the acquired video images. The CAM artery model with the spectral analysis method is a useful in vivo experimental model for studying pulsatile variation in arterial geometry.

Background: The prognostic impact of the first ever episode of spontaneous bacterial peritonitis (SBP) on patient outcomes is not well described. Our aim was to compare the clinical outcomes of cirrhotic patients with ascites, and with or without a first episode of SBP., Methods: Consecutive patients with cirrhosis and ascites were prospectively enrolled. Demographics, liver and renal function, and hemodynamics were documented at baseline, at resolution of SBP, and thereafter at 4 monthly intervals for 12 months. Complications of cirrhosis and survival were noted., Results: Twenty-nine cirrhotic patients with a first ever episode of SBP (group A) and 123 control patients slightly younger but similar in gender who never had SBP (group B) were enrolled. At SBP diagnosis, group A had worse liver and renal function (Model of End-Stage Liver Disease : 21.1±10.6 vs. 14.4±5.0), lower serum sodium concentrations, and a more hyperdynamic circulation compared with group B (all P<0.001). SBP resolution resulted in improvement in all measures to baseline levels. During follow-up, group A required more frequent hospital admissions than group B (58% vs. 43%), developed more cirrhotic complications, including further SBP (31% vs. 3%*), hyponatremia (12% vs. 0.8%*), acute kidney injury (50% vs. 23%*), hepatorenal syndrome type 1 (46% vs. 7%*), liver transplantation (62% vs. 30%*), and had a worse overall 1-year survival (38% vs. 70%*) (*P<0.05)., Conclusions: A first SBP episode is commonly followed by multiple complications, and overall worse prognosis. Consideration should be given to assess cirrhotic patients for liver transplant after the first episode of SBP.

Introduction: Inflammatory bowel disease (IBD) patients are at increased risk of venous thromboembolism (VTE) especially during hospitalization. We assessed the safety and predictors of VTE prophylaxis in this population., Methods: We conducted a retrospective study of 974 IBD admissions between February 2010 and May 2012. We abstracted data on clinical characteristics, VTE prophylaxis and bleeding events, and conducted multivariate analysis to determine predictors of prophylaxis., Results: Pharmacological VTE prophylaxis was administered to 80% of admissions; 63% were within 24h of admission. Patients on the surgical service (adjusted OR [aOR], 3.82; 95% CI: 2.00-7.29) and general medicine (aOR, 2.40; 95% CI: 1.39-4.12) were more likely to receive VTE prophylaxis compared to those on the gastroenterology service. Rectal bleeding on admission was associated with lower prophylaxis (aOR, 0.58; 95% CI: 0.35-0.97). The VTE prophylaxis rate increased from 47% to 73% (P<0.001) on non-surgical services with the introduction of a pharmacist advocate. The rates of major and minor bleeding were similar between patients who did and did not receive VTE prophylaxis (0.26 vs. 0 per 1000 person-days, P=0.7; 4.18 vs. 2.53 per 1000 person-days, P=0.4 respectively), and the major bleeding events (n=2) were post-operative. VTE prophylaxis was not associated with major postoperative bleeding (0.4% vs. 0%, P=0.96)., Conclusions: VTE prophylaxis was more frequent on the surgical service, where standardized protocols exist. The introduction of a pharmacist advocate greatly increased VTE prophylaxis on the non-surgical services. Prophylactic anticoagulation is safe in IBD despite the presence of rectal bleeding on admission., (Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.)

Iron is one among the major metals present in the earth's crust and is essential for sound sustenance of human body. Its deficiency leads to various health ailments. Contemporary medicine advises iron supplements in iron deficiency anemia. Ayurvedic classics also quote significant information about administration of iron. Lauha Kalpas are the unique compound herbo-mineral formulations where iron (Lauha) is used as a major ingredient. Relevant literature (Bhaishajya Ratnavali, Charaka Samhita, Rasendra Sara Samgraha etc.) reviewed to gather information about Lauha Kalpas. Critical analysis of these Lauha Kalpas reveals that ancient seers administered iron in a better acceptable form. Unlike popular understanding these are not only Khalviya preparations; but Churna (powders), Avaleha (confectionaries), Rasakriya (solidified decoctions), and Putapaka (incinerated) form of preparations are also found. Apart from solid dosage forms, semisolid dosage forms mentioned in classics are very much useful. Unfortunately most of the formulations are not found in the market. Hence Pharmaceutical firms may bring these unique dosage forms in to the market to supply the healthcare needs of the community. It is interesting that iron preparations are used in Ayurveda in different medical conditions apart from anemia (Pandu). This leaves a scope for further researches on different dosage forms of iron and their indications.