How to diagnose plantaris tendon involvement in midportion Achilles tendinopathy - clinical and imaging findings

Background: The purpose of this investigation was to evaluate if clinical assessment, Ultrasound + Colour Doppler (US + CD) and Ultrasound Tissue Characterisation (UTC) can be useful in detecting plantaris tendon involvement in patients with midportion Achilles tendinopathy. Methods: Twenty-three tendons in 18 patients (14 men, mean age: 37 years and 4 women: 44 years) (5 patients with bilateral tendons) with midportion Achilles tendinopathy were surgically treated with a scraping procedure and plantaris tendon removal. For all tendons, clinical assessment, Ultrasound + Colour Doppler (US + CD) examination and Ultrasound Tissue Characterisation (UTC) were performed. Results: At surgery, all 23 cases had a plantaris tendon located close to the medial side of the Achilles tendon. There was vascularised fat tissue in the interface between the Achilles and plantaris tendons. Clinical assessment revealed localised medial activity-related pain in 20/23 tendons and focal medial tendon tenderness in 20/23 tendons. For US + CD, 20/23 tendons had a tendon-like structure interpreted to be the plantaris tendon and localised high blood flow in close relation to the medial side of the Achilles. For UTC, 19/23 tendons had disorganised (type 3 and 4) echopixels located only in the medial part of the Achilles tendon indicating possible plantaris tendon involvement. Conclusions: US + CD directly, and clinical assessment indirectly, can detect a close by located plantaris tendon in a high proportion of patients with midportion Achilles tendinopathy. UTC could complement US + CD and clinical assessment by demonstrating disorganised focal medial Achilles tendon structure indicative of possible plantaris involvement

Lesion detection and Grading of Diabetic Retinopathy via Two-stages Deep Convolutional Neural Networks

We propose an automatic diabetic retinopathy (DR) analysis algorithm based on two-stages deep convolutional neural networks (DCNN). Compared to existing DCNN-based DR detection methods, the proposed algorithm have the following advantages: (1) Our method can point out the location and type of lesions in the fundus images, as well as giving the severity grades of DR. Moreover, since retina lesions and DR severity appear with different scales in fundus images, the integration of both local and global networks learn more complete and specific features for DR analysis. (2) By introducing imbalanced weighting map, more attentions will be given to lesion patches for DR grading, which significantly improve the performance of the proposed algorithm. In this study, we label 12,206 lesion patches and re-annotate the DR grades of 23,595 fundus images from Kaggle competition dataset. Under the guidance of clinical ophthalmologists, the experimental results show that our local lesion detection net achieve comparable performance with trained human observers, and the proposed imbalanced weighted scheme also be proved to significantly improve the capability of our DCNN-based DR grading algorithm

Serum cholesterol levels in neutropenic patients with fever

Hypocholesterolemia, which often accompanies infectious diseases has been suggested to serve as a prognostic marker in hospitalized patients. Even though patients with chemotherapyinduced leukopenia are at high risk of infection and mortality, only limited information is available on serum cholesterol levels in these patients. We therefore measured serum cholesterol levels in 17 patients with hematological malignancies during chemotherapyinduced neutropenia and correlated it with clinical outcome. Patients with fever (>38.5 degreesC) showed a significant decrease in serum cholesterol levels within 24 hours. Eight days after onset of the fever nonsurvivors had significantly lower serum cholesterol levels (median 2.09 mmol/l, range 0.492.79, n=6) compared to survivors (median 3.23 mmol/l, range 1.684.86, n=11). Cholesterol levels in survivors returned to baseline levels at the time of discharge from the hospital. At the onset of fever, serum levels of inflammatory cytokines interleukin-6, tumor necrosis factor (TNF) and soluble TNF receptors p55 and p75 were elevated in all patients, but only TNF and TNF receptor p75 levels were significantly different in survivors and nonsurvivors. Our data suggest that a decrease in serum cholesterol levels is a prognostic marker in neutropenic patients with fever. Release of inflammatory cytokines may in part be responsible for hypocholesterolemia in these patients

Harmonization of the intracellular cytokine staining assay

Active immunotherapy for cancer is an accepted treatment modality aiming to reinforce the T-cell response to cancer. T-cell reactivity is measured by various assays and used to guide the clinical development of immunotherapeutics. However, data obtained across different institutions may vary substantially making comparative conclusions difficult. The Cancer Immunotherapy Immunoguiding Program organizes proficiency panels to identify key parameters influencing the outcome of commonly used T-cell assays followed by harmonization. Our successes with IFNγ-ELISPOT and peptide HLA multimer analysis have led to the current study on intracellular cytokine staining (ICS). We report the results of three successive panels evaluating this assay. At the beginning, 3 out of 9 participants (33 %) were able to detect >6 out of 8 known virus-specific T-cell responses in peripheral blood of healthy individuals. This increased to 50 % of the laboratories in the second phase. The reported percentages of cytokine-producing T cells by the different laboratories were highly variable with coefficients of variation well over 60 %. Variability could partially be explained by protocol-related differences in background cytokine production leading to sub-optimal signal-to-noise ratios. The large number of protocol variables prohibited identification of prime guidelines to harmonize the assays. In addition, the gating strategy used to identify reactive T cells had a major impact on assay outcome. Subsequent harmonization of the gating strategy considerably reduced the variability within the group of participants. In conclusion, we propose that first basic guidelines should be applied for gating in ICS experiments before harmonizing assay protocol variables

Cr(VI) Removal from Aqueous Solution Using a Magnetite Snail Shell

© 2020, Springer Nature Switzerland AG. In this study, magnetic snail shell (MSS) prepared by impregnating of iron oxide onto snail shell (SS) powder was used for removing Cr(VI) from aqueous solution. Among six different mass ratios of Fe/SS powder studied, the MSS25 produced at a ratio of 25% achieved the highest Cr(VI) adsorption capacity. Batch adsorption experiments were conducted to investigate the adsorption isotherm, kinetics, and mechanism of Cr(VI) onto MSS25. The results illustrated that adsorption of Cr(VI) onto MSS25 reached equilibrium after 150 min at pH 3. The adsorption kinetics could be well described by the pseudo-second order model (R2 = 0.986). The Langmuir model (R2 = 0.971) was the best-fitting model that described the adsorption isotherm of Cr(VI) onto MSS25. The maximum adsorption capacity was 46.08 mg Cr(VI) per gram of MSS25. Ion exchange, electrostatic attraction, and adsorption-coupled reduction were determined as the main adsorption mechanisms of Cr(VI) onto MSS25. The high percentages of CaCO3 and Fe3O4 found in the MSS25 structure made a significant contribution to the Cr(VI) adsorption process

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple-dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post-extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids, epinephrine nebulization and inhalation of a helium/oxygen mixture are potentially effective, although this has not been confirmed by randomized controlled trials. The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality

Rainfall-driven sex-ratio genes in African buffalo suggested by correlations between Y-chromosomal haplotype frequencies and foetal sex ratio

Background - The Y-chromosomal diversity in the African buffalo (Syncerus caffer) population of Kruger National Park (KNP) is characterized by rainfall-driven haplotype frequency shifts between year cohorts. Stable Y-chromosomal polymorphism is difficult to reconcile with haplotype frequency variations without assuming frequency-dependent selection or specific interactions in the population dynamics of X- and Y-chromosomal genes, since otherwise the fittest haplotype would inevitably sweep to fixation. Stable Y-chromosomal polymorphism due one of these factors only seems possible when there are Y-chromosomal distorters of an equal sex ratio, which act by negatively affecting X-gametes, or Y-chromosomal suppressors of a female-biased sex ratio. These sex-ratio (SR) genes modify (suppress) gamete transmission in their own favour at a fitness cost, allowing for stable polymorphism. Results - Here we show temporal correlations between Y-chromosomal haplotype frequencies and foetal sex ratios in the KNP buffalo population, suggesting SR genes. Frequencies varied by a factor of five; too high to be alternatively explained by Y-chromosomal effects on pregnancy loss. Sex ratios were male-biased during wet and female-biased during dry periods (male proportion: 0.47-0.53), seasonally and annually. Both wet and dry periods were associated with a specific haplotype indicating a SR distorter and SR suppressor, respectively. Conclusions - The distinctive properties suggested for explaining Y-chromosomal polymorphism in African buffalo may not be restricted to this species alone. SR genes may play a broader and largely overlooked role in mammalian sex-ratio variatio

Characteristics and mechanisms of cadmium adsorption onto biogenic aragonite shells-derived biosorbent: Batch and column studies

© 2018 Elsevier Ltd Calcium carbonate (CaCO3)-enriched biomaterial derived from freshwater mussel shells (FMS) was used as a non-porous biosorbent to explore the characteristics and mechanisms of cadmium adsorption in aqueous solution. The adsorption mechanism was proposed by comparing the FMS properties before and after adsorption alongside various adsorption studies. The FMS biosorbent was characterized using nitrogen adsorption/desorption isotherm, X-ray diffraction, scanning electron microscopy with energy dispersive spectroscopy, Fourier-transform infrared spectroscopy, and point of zero charge. The results of batch experiments indicated that FMS possessed an excellent affinity to Cd(II) ions within solutions pH higher than 4.0. An increase in ionic strength resulted in a significant decrease in the amount of Cd(II) adsorbed onto FMS. Kinetic study demonstrated that the adsorption process quickly reached equilibrium at approximately 60 min. The FMS biosorbent exhibited the Langmuir maximum adsorption capacity as follows: 18.2 mg/g at 10 °C Cd2+ > Cu2+ > Cr3+ > Zn2+. For column experiments, the highest Thomas adsorption capacity (7.86 mg/g) was achieved at a flow rate (9 mL/min), initial Cd(II) concentration (10 mg/L), and bed height (5 cm). The Cd(II) removal by FMS was regarded as non-activated chemisorption that occurred very rapidly (even at a low temperature) with a low magnitude of activation energy. Primary adsorption mechanism was surface precipitation. Cadmium precipitated in the primary (Cd,Ca)CO3 form with a calcite-type structure on the FMS surface. A crust of rhombohedral crystals on the substrate was observed by SEM. Freshwater mussel shells have the potential as a renewable adsorbent to remove cadmium from water

Development, validity and responsiveness of the Clinical COPD Questionnaire

BACKGROUND: The new Global Obstructive Lung Disease (GOLD) guidelines advice to focus treatment in Chronic Obstructive Pulmonary Disease (COPD) on improvement of functional state, prevention of disease progression and minimization of symptoms. So far no validated questionnaires are available to measure symptom and functional state in daily clinical practice. The aim of this study was to develop and validate the Clinical COPD Questionnaire (CCQ). METHODS: Qualitative research with patients and clinicians was performed to generate possible items to evaluate clinical COPD control. Thereafter, an item reduction questionnaire was sent to 77 international experts. Sixty-seven experts responded and the 10 most important items, divided into 3 domains (symptoms, functional and mental state) were included in the CCQ (scale: 0 = best, 6 = worst). RESULTS: Cross-sectional data were collected from 119 subjects (57 COPD, GOLD stage I-III; 18 GOLD stage 0 and 44 (ex)smokers). Cronbach's α was high (0.91). The CCQ scores in patients (GOLD 0-III) were significantly higher than in healthy (ex)smokers. Furthermore, significant correlations were found between the CCQ total score and domains of the SF-36 (ρ = 0.48 to ρ = 0.69) and the SGRQ (ρ = 0.67 to ρ = 0.72). In patients with COPD, the correlation between the CCQ and FEV(1)%pred was ρ =-0.49. Test-retest reliability was determined in 20 subjects in a 2-week interval (Intra Class Coefficient = 0.94). Thirty-six smokers with and without COPD showed significant improvement in the CCQ after 2 months smoking cessation, indicating the responsiveness of the CCQ. CONCLUSION: The CCQ is a self-administered questionnaire specially developed to measure clinical control in patients with COPD. Data support the validity, reliability and responsiveness of this short and easy to administer questionnaire

Evolution and connectivity in the world-wide migration system of the mallard: Inferences from mitochondrial DNA

<p>Abstract</p> <p>Background</p> <p>Main waterfowl migration systems are well understood through ringing activities. However, in mallards (<it>Anas platyrhynchos</it>) ringing studies suggest deviations from general migratory trends and traditions in waterfowl. Furthermore, surprisingly little is known about the population genetic structure of mallards, and studying it may yield insight into the spread of diseases such as Avian Influenza, and in management and conservation of wetlands. The study of evolution of genetic diversity and subsequent partitioning thereof during the last glaciation adds to ongoing discussions on the general evolution of waterfowl populations and flyway evolution. Hypothesised mallard flyways are tested explicitly by analysing mitochondrial mallard DNA from the whole northern hemisphere.</p> <p>Results</p> <p>Phylogenetic analyses confirm two mitochondrial mallard clades. Genetic differentiation within Eurasia and North-America is low, on a continental scale, but large differences occur between these two land masses (<it>F</it>_ST= 0.51). Half the genetic variance lies within sampling locations, and a negligible portion between currently recognised waterfowl flyways, within Eurasia and North-America. Analysis of molecular variance (AMOVA) at continent scale, incorporating sampling localities as smallest units, also shows the absence of population structure on the flyway level. Finally, demographic modelling by coalescence simulation proposes a split between Eurasia and North-America 43,000 to 74,000 years ago and strong population growth (~100fold) since then and little migration (not statistically different from zero).</p> <p>Conclusions</p> <p>Based on this first complete assessment of the mallard's world-wide population genetic structure we confirm that no more than two mtDNA clades exist. Clade A is characteristic for Eurasia, and clade B for North-America although some representatives of clade A are also found in North-America. We explain this pattern by evaluating competing hypotheses and conclude that a complex mix of historical, recent and anthropogenic factors shaped the current mallard populations. We refute population classification based on flyways proposed by ornithologists and managers, because they seem to have little biological meaning. Our results have implications for wetland management and conservation, with special regard to the release of farmed mallards for hunting, as well as for the possible transmission of Avian Influenza by mallards due to migration.</p