Rapidly Progressive Toxic Leukoencephalomyelopathy with Myelodysplastic Syndrome: a Clinicopathological Correlation

Neurological disorders induced by long-term exposure to organic solvents typically have a slowly progressive clinical course, which may be arrested or even reversed following discontinuation of exposure. We report an unusual case of rapidly progressive toxic leukoencephalomyelopathy in a 29-year-old man who had worked at a chemical factory that used toluene for the manufacture of nylon 66 for 5 years. He presented with progressive weakness of legs, recurrent seizures, and cognitive decline. Widespread white-matter changes in the brain and spinal cord, and myelodysplastic syndrome were noted. He died 6 months after the onset of his symptoms, and autopsy showed discrete multifocal demyelination and necrosis in the central nervous system, and dysplastic cells of erythroid, myeloid, and megakaryotic lineages in blood vessels. The co-occurrence of leukoencephalomyelopathy and myelodysplastic syndrome highlights the vulnerability of the white matter and bone marrow to injury from organic solvents. Intravascular congestion of dysplastic hematopoietic cells might have led to his unusually rapid progression of leukoencephalomyelopathy

Three-dimensional computational model of a blood oxygenator reconstructed from micro-CT scans

Cardiopulmonary bypass procedures are one of the most common operations and blood oxygenators are the centre piece for the heart-lung machines. Blood oxygenators have been tested as entire devices but intricate details on the flow field inside the oxygenators remain unknown. In this study, a novel method is presented to analyse the flow field inside oxygenators based on micro Computed Tomography (μCT) scans. Two Hollow Fibre Membrane (HFM) oxygenator prototypes were scanned and three-dimensional full scale models that capture the device-specific fibre distributions are set up for computational fluid dynamics analysis. The blood flow through the oxygenator is modelled as a non-Newtonian fluid. The results were compared against the flow solution through an ideal fibre distribution and show the importance of a uniform distribution of fibres and that the oxygenators analysed are not susceptible to flow directionality as mass flow versus area remain the same. However the pressure drop across the oxygenator is dependent on flow rate and direction. By comparing residence time of blood against the time frame to fully saturate blood with oxygen we highlight the potential of this method as design optimisation tool.In conclusion, image-based reconstruction is found to be a feasible route to assess oxygenator performance through flow modelling. It offers the possibility to review a product as manufactured rather than as designed, which is a valuable insight as a precursor to the approval processes. Finally, the flow analysis presented may be extended, at computational cost, to include species transport in further studies

Comparison of manual and artificial intelligence based quantification of myocardial strain by feature tracking - a cardiovascular MR study in health and disease

OBJECTIVES: The analysis of myocardial deformation using feature tracking in cardiovascular MR allows for the assessment of global and segmental strain values. The aim of this study was to compare strain values derived from artificial intelligence (AI)-based contours with manually derived strain values in healthy volunteers and patients with cardiac pathologies. MATERIALS AND METHODS: A cohort of 136 subjects (60 healthy volunteers and 76 patients; of those including 46 cases with left ventricular hypertrophy (LVH) of varying etiology and 30 cases with chronic myocardial infarction) was analyzed. Comparisons were based on quantitative strain analysis and on a geometric level by the Dice similarity coefficient (DSC) of the segmentations. Strain quantification was performed in 3 long-axis slices and short-axis (SAX) stack with epi- and endocardial contours in end-diastole. AI contours were checked for plausibility and potential errors in the tracking algorithm. RESULTS: AI-derived strain values overestimated radial strain (+ 1.8 ± 1.7% (mean difference ± standard deviation); p = 0.03) and underestimated circumferential (- 0.8 ± 0.8%; p = 0.02) and longitudinal strain (- 0.1 ± 0.8%; p = 0.54). Pairwise group comparisons revealed no significant differences for global strain. The DSC showed good agreement for healthy volunteers (85.3 ± 10.3% for SAX) and patients (80.8 ± 9.6% for SAX). In 27 cases (27/76; 35.5%), a tracking error was found, predominantly (24/27; 88.9%) in the LVH group and 22 of those (22/27; 81.5%) at the insertion of the papillary muscle in lateral segments. CONCLUSIONS: Strain analysis based on AI-segmented images shows good results in healthy volunteers and in most of the patient groups. Hypertrophied ventricles remain a challenge for contouring and feature tracking. CLINICAL RELEVANCE STATEMENT: AI-based segmentations can help to streamline and standardize strain analysis by feature tracking. KEY POINTS: • Assessment of strain in cardiovascular magnetic resonance by feature tracking can generate global and segmental strain values. • Commercially available artificial intelligence algorithms provide segmentation for strain analysis comparable to manual segmentation. • Hypertrophied ventricles are challenging in regards of strain analysis by feature tracking

Portuguese validation of the Bergen Facebook Addiction Scale: an Empirical Study

Previous research on Social Networking Sites (SNSs) addiction have suggest the need to improve assessment of this behavioral addiction. The present study aimed at validating a Portuguese version of the Bergen Facebook Addiction Scale (BFAS), a widely used instrument to assess addiction to Facebook. A study was conducted in a sample of 509 Portuguese adolescent using an online survey. The psychometric properties (construct validity, criterion validity, and reliability) of the Portuguese BFAS was scrutinized. The results from the psychometric analyses suggested that the new validated instrument had excellent psychometric properties. The CFA confirmed the original one-factor solution of the BFAS and criterion validity was warranted. The reliability of the BFAS was supported by satisfactory levels of internal consistency as measured by the Cronbach’s alpha (α = .83), composite reliability (CR = .82), and factor determinacy (FD = .91). Overall, the results provided empirical support for the validity and reliability of the Portuguese BFAS. Moreover, the results were highly comparable with the findings of the original development study of the BFAS and cross-cultural support for the scale was obtained

Efectos y beneficios del entrenamiento de fuerza en pacientes con cáncer: revisión sistemática de la literatura

Introduction: cancer is among the diseases having the greatest mortality rates and the cause of many disabilities worldwide. The practice of exercise is developed as an adjuvant therapy along with the cancer treatment to reduce mortality and disability in the different types of cancer.Objective: to identify the effects of strength training on cancer patients.Methods: a complete review of the medical literature was conducted until December 2018, scientific articles published in indexed bases from 2015 to 2018. The studies included were in population over 18 years old with cancer diagnosis regardless of sociodemographic characteristics, type or stage of cancer. The data extracted were on the population, intervention and control groups, type of cancer, period, frequency of intervention and results.Results: during the first search 36071 titles of clinical study were found in specialized journals. 10 experimental studies were chosen. Multiple positive effects were found, as well as components that should be taken into account when performing strength training on cancer patients or cancer survivors.Conclusions: strength training in patients with cancer or survivors of this disease, helps them to improve their symptoms as well as their quality of life, strength, improved mobility and pain, among others. Also, strength training is beneficial to patients without causing adverse effects or long-term complications.Introducción: El cáncer se encuentra entre las enfermedades con mayor mortalidad y causante de un gran número de discapacidades a nivel mundial. El ejercicio surge como un coadyuvante del tratamiento oncológico para disminuir la mortalidad y discapacidad en los diferentes tipos de cáncer.Objetivo: Identificar los efectos del entrenamiento de fuerza en pacientes con cáncer.Método:  Se realizó una revisión de la literatura hasta diciembre del 2018, de artículos científicos publicados en bases de indexadas desde 2015 y hasta 2018. Los estudios incluidos fueron en población mayor a 18 años con diagnóstico de cáncer sin importar características sociodemográficas, tipo o estadio del cáncer. Los datos extraídos fueron sobre la población, grupos de intervención y control, tipo de cáncer, periodo, frecuencia de la intervención y resultados.Resultados: Durante la primera búsqueda 36071 títulos de estudios clínicos fueron encontrados en revistas especializadas. Al final 10 estudios de carácter experimental fueron seleccionados. En dichos estudios, múltiples efectos fueron encontrados, así como componentes que se deben tener en cuenta a realizar un entrenamiento de fuerza en pacientes con cáncer o sobrevivientes del mismo.Conclusiones: El entrenamiento de fuerza en pacientes con cáncer o sobrevivientes de esta enfermedad, les ayuda a mejorar su sintomatología al igual que su calidad de vida, fatiga, fuerza, mejoría en la movilidad y el dolor, entre otros. Así mismo, el entrenamiento de fuerza es beneficioso para los pacientes sin causar efectos adversos o complicaciones a largo plazo

A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment

Purpose: The study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment. Methods: Focus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post-surgery. Results: Breast cancer patients’ experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content. Conclusions: bWell, a novel app for arm and shoulder exercises was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness. Implications for Cancer Survivors: Mobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care

Problematic social media use: results from a large-scale nationally representative adolescent sample

Despite social media use being one of the most popular activities among adolescents, prevalence estimates among teenage samples of social media (problematic) use are lacking in the field. The present study surveyed a nationally representative Hungarian sample comprising 5,961 adolescents as part of the European School Survey Project on Alcohol and Other Drugs (ESPAD). Using the Bergen Social Media Addiction Scale (BSMAS) and based on latent profile analysis, 4.5% of the adolescents belonged to the at-risk group, and reported low self-esteem, high level of depression symptoms, and elevated social media use. Results also demonstrated that BSMAS has appropriate psychometric properties. It is concluded that adolescents at-risk of problematic social media use should be targeted by school-based prevention and intervention programs

State of the Antarctic and Southern Ocean Climate System

This paper reviews developments in our understanding of the state of the Antarctic and Southern Ocean climate and its relation to the global climate system over the last few millennia. Climate over this and earlier periods has not been stable, as evidenced by the occurrence of abrupt changes in atmospheric circulation and temperature recorded in Antarctic ice core proxies for past climate. Two of the most prominent abrupt climate change events are characterized by intensification of the circumpolar westerlies (also known as the Southern Annular Mode) between ∼6000 and 5000 years ago and since 1200–1000 years ago. Following the last of these is a period of major trans-Antarctic reorganization of atmospheric circulation and temperature between A.D. 1700 and 1850. The two earlier Antarctic abrupt climate change events appear linked to but predate by several centuries even more abrupt climate change in the North Atlantic, and the end of the more recent event is coincident with reorganization of atmospheric circulation in the North Pacific. Improved understanding of such events and of the associations between abrupt climate change events recorded in both hemispheres is critical to predicting the impact and timing of future abrupt climate change events potentially forced by anthropogenic changes in greenhouse gases and aerosols. Special attention is given to the climate of the past 200 years, which was recorded by a network of recently available shallow firn cores, and to that of the past 50 years, which was monitored by the continuous instrumental record. Significant regional climate changes have taken place in the Antarctic during the past 50 years. Atmospheric temperatures have increased markedly over the Antarctic Peninsula, linked to nearby ocean warming and intensification of the circumpolar westerlies. Glaciers are retreating on the peninsula, in Patagonia, on the sub-Antarctic islands, and in West Antarctica adjacent to the peninsula. The penetration of marine air masses has become more pronounced over parts of West Antarctica. Above the surface, the Antarctic troposphere has warmed during winter while the stratosphere has cooled year-round. The upper kilometer of the circumpolar Southern Ocean has warmed, Antarctic Bottom Water across a wide sector off East Antarctica has freshened, and the densest bottom water in the Weddell Sea has warmed. In contrast to these regional climate changes, over most of Antarctica, near-surface temperature and snowfall have not increased significantly during at least the past 50 years, and proxy data suggest that the atmospheric circulation over the interior has remained in a similar state for at least the past 200 years. Furthermore, the total sea ice cover around Antarctica has exhibited no significant overall change since reliable satellite monitoring began in the late 1970s, despite large but compensating regional changes. The inhomogeneity of Antarctic climate in space and time implies that recent Antarctic climate changes are due on the one hand to a combination of strong multidecadal variability and anthropogenic effects and, as demonstrated by the paleoclimate record, on the other hand to multidecadal to millennial scale and longer natural variability forced through changes in orbital insolation, greenhouse gases, solar variability, ice dynamics, and aerosols. Model projections suggest that over the 21st century the Antarctic interior will warm by 3.4° ± 1°C, and sea ice extent will decrease by ∼30%. Ice sheet models are not yet adequate enough to answer pressing questions about the effect of projected warming on mass balance and sea level. Considering the potentially major impacts of a warming climate on Antarctica, vigorous efforts are needed to better understand all aspects of the highly coupled Antarctic climate system as well as its influence on the Earth\u27s climate and oceans

Nordic Seas polynyas and their role in preconditioning marine productivity during the Last Glacial Maximum.

Arctic and Antarctic polynyas are crucial sites for deep-water formation, which helps sustain global ocean circulation. During glacial times, the occurrence of polynyas proximal to expansive ice sheets in both hemispheres has been proposed to explain limited ocean ventilation and a habitat requirement for marine and higher-trophic terrestrial fauna. Nonetheless, their existence remains equivocal, not least due to the hitherto paucity of sufficiently characteristic proxy data. Here we demonstrate polynya formation in front of the NW Eurasian ice sheets during the Last Glacial Maximum (LGM), which resulted from katabatic winds blowing seaward of the ice shelves and upwelling of warm, sub-surface Atlantic water. These polynyas sustained ice-sheet build-up, ocean ventilation, and marine productivity in an otherwise glacial Arctic desert. Following the catastrophic meltwater discharge from the collapsing ice sheets at ~17.5 ka BP, polynya formation ceased, marine productivity declined dramatically, and sea ice expanded rapidly to cover the entire Nordic Seas