Abstract Statistically, significant numbers of central bone specimens of suppurative osteomyelitis of the jaws (SOJ), bisphosphonate induced osteonecrosis of the jaws (BIONJ), and osteoradionecrosis ...of the jaws (ORNJ) were compared. All three evidenced the common finding of necrotic bone with empty osteocytic lacunae, Haversian and Volkmann canals, but each showed a distinctive histopathologic pattern indicating a different disease mechanism and treatment options. Suppurative osteomyelitis was characterized by intense marrow inflammation and marrow vessel thrombosis with retention of viable osteoclasts and periosteum. Bisphosphonate induced osteonecrosis was characterized by an empty marrow space with empty Howship's lacunae and an absence of osteoclasts but viable periosteum. Osteoradionecrosis was characterized by a collagenous hypocellular, hypovascular marrow space and nonviable periosteum. Histologic evidence in SOJ indicates a microorganism provoked intense inflammation and marrow vascular thrombosis creating an environment conducive to continual bacterial proliferation. BIONJ is seen as a non-inflammatory drug toxicity to bone by osteoclastic death leading to over suppression of bone renewal, and ORN as another non-inflammatory condition caused by a high linear energy transfer that impairs or kills numerous cell types in the field of radiation including periosteum, bone, and all soft tissue.
Aortic valve reconstruction (AVRec) with neocuspidization or the Ozaki procedure with complete cusp replacement for aortic valve disease has excellent mid-term results in adults. Limited results of ...AVRec in pediatric patients have been reported. We report our early outcomes of the Ozaki procedure for congenital aortic and truncal valve disease.
A retrospective analysis was performed on all 57 patients with congenital aortic and truncal valve disease who had a 3-leaflet Ozaki procedure at a single institution from August 2015 to February 2019. Outcome measures included mortality, surgical or catheter-based reinterventions, and echocardiographic measurements.
Twenty-four patients had aortic regurgitation (AR), 6 had aortic stenosis (AS), and 27 patients had AS/AR. Two patients had quadricuspid valves, 26 had tricuspid, 20 had bicuspid, and 9 had unicusp aortic valves. Four patients had truncus arteriosus. Thirty-four patients had previous aortic valve repairs and 5 had replacements. Preoperative echocardiography mean annular diameter was 20.90 ± 4.98 cm and peak gradient for patients with AS/AR was 53.62 ± 22.20 mm Hg. Autologous, Photofix, and CardioCel bovine pericardia were used in 20, 35, and 2 patients. Eight patients required aortic root enlargement and 20 had sinus enlargement. Fifty-one patients had concomitant procedures. Median intensive care unit and hospital length of stay were 1.87 and 6.38 days. There were no hospital mortalities or early conversions to valve replacement. At discharge, 98% of patients had mild or less regurgitation and peak aortic gradient was 16.9 ± 9.5 mm Hg. Two patients underwent aortic valve replacement. At median follow-up of 8.1 months, 96% and 91% of patients had less than moderate regurgitation and stenosis, respectively.
The AVRec procedure has acceptable short-term results and should be considered for valve reconstruction in pediatric patients with congenital aortic and truncal valve disease. Longer-term follow-up is necessary to determine the optimal patch material and late valve function and continued annular growth.
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Electron paramagnetic resonance (EPR) is a powerful technique to investigate the electronic and magnetic properties of a wide range of materials. We present the first combined terahertz (THz) field ...and frequency domain electron paramagnetic resonance (HFEPR/FDMR) spectrometer designed to investigate the electronic structure and magnetic properties of molecular systems, thin films and solid state materials in a very broad frequency range of 85-1100 GHz. In this paper, we show high resolution frequency-field (Zeeman) maps (170-380 GHz by 0-15 T) recorded on two single-molecule magnets, Mn2(saltmen)2(ReO4)2 and Mn2(salpn)2(H2O)2(ClO4)2, which give direct access to the field-dependence of the energy level diagram. Furthermore, supression of standing waves in the described system and the sensitivity in field and frequency domain operations is evaluated and discussed.
Innovative solutions are required to provide mental health support at scale in low-resource humanitarian contexts. We aimed to assess the effectiveness of a facilitator-guided, group-based, self-help ...intervention (Self-Help Plus) to reduce psychological distress in female refugees.
We did a cluster randomised trial in rural refugee settlements in northern Uganda. Participants were female South Sudanese refugees with at least moderate levels of psychological distress (cutoff ≥5 on the Kessler 6). The intervention comprised access to usual care and five 2-h audio-recorded stress-management workshops (20–30 refugees) led by briefly trained lay facilitators, accompanied by an illustrated self-help book. Villages were randomly assigned to either intervention (Self-Help Plus or enhanced usual care) on a 1:1 basis. Within 14 villages, randomly selected households were approached. Screening of women in households continued until 20–30 eligible participants were identified per site. The primary outcome was individual psychological distress, assessed using the Kessler 6 symptom checklist 1 week before, 1 week after, and 3 months after intervention, in the intention-to-treat population. All outcomes were measured at the individual (rather than cluster) level. Secondary outcomes included personally identified problems, post-traumatic stress, depression symptoms, feelings of anger, social interactions with other ethnic groups, functional impairment, and subjective wellbeing. Assessors were masked to allocation. This trial was prospectively registered at ISRCTN, number 50148022.
Of 694 eligible participants (331 Self-Help Plus, 363 enhanced usual care), 613 (88%) completed all assessments. Compared with controls, we found stronger improvements for Self-Help Plus on psychological distress 3 months post intervention (β −1·20, 95% CI −2·33 to −0·08; p=0·04; d −0·26). We also found larger improvements for Self-Help Plus 3 months post-intervention for five of eight secondary outcomes (effect size range −0·30 to −0·36). Refugees with different trauma exposure, length of time in settlements, and initial psychological distress benefited similarly. With regard to safety considerations, the independent data safety management board responded to six adverse events, and none were evaluated to be concerns in response to the intervention.
Self-Help Plus is an innovative, facilitator-guided, group-based self-help intervention that can be rapidly deployed to large numbers of participants, and resulted in meaningful reductions in psychological distress at 3 months among South Sudanese female refugees.
Research for Health in Humanitarian Crises (R2HC) Programme.
Abstract
High-protein low-carbohydrate diets have been widely used for adult maintenance dogs, as well as in specific weight loss diets and maintenance programs. However, increasing dietary protein ...may increase undigested protein in the hindgut, modifying intestinal fermentation and fecal metabolite concentrations. The aim of this study was to evaluate the effects of protein source and concentration on apparent total tract digestibility (ATTD) of nutrients, metabolizable energy (ME), fecal and urinary characteristics, and fecal metabolites of dogs. Twelve healthy adult dogs were distributed into six treatments (n = 6 per diet) in a balanced incomplete Latin square design consisting of three periods of 30 days each. Six diets, varying in protein source poultry byproduct meal (PBPM) and hydrolyzed chicken liver powder (HCLP) and concentration 24, 32, and 40% crude protein (CP) on dry matter (DM) basis were tested: PBPM24 (PBPM based diet with 24% CP); PBPM32 (PBPM with 32% CP); PBPM40 (PBPM with 40% CP); HCLP24 (HCLP based diet with 24% CP); HCLP32 (HCLP with 32% CP); HCLP40 (HCLP with 40% CP). The ATTD of CP was greater in dogs-fed HCLP and higher protein concentrations diets (P < 0.05). However, dogs-fed HCLP diets had lower ATTD of fat and carbohydrates, and ME (P < 0.05). Similarly, high-protein diets reduced the ATTD of DM, OM, fat, carbohydrates, and energy (P < 0.05). High-protein diets increased the daily fecal output and moisture (P = 0.004 and P < 0.05, respectively), as well as the fecal score (P < 0.0001), verified as soft, moist stools, but still within the ideal range. Fecal valerate concentration was greater in dogs-fed PBPM at 32% CP (P = 0.007). Fecal isobutyrate tended to increase in dogs-fed PBPM and high-protein diets (P < 0.10). Also, dogs-fed PBPM and high-protein diets had greater fecal concentrations of isovalerate, branched-chain fatty acids (BCFA), and ammonia (P < 0.05). Finally, the fecal lactate concentration increased in dogs-fed HCLP and high-protein diets (P < 0.05). The HCLP increased the ATTD of CP, being a highly digestible protein. Although the inclusion of HCLP slightly increased fecal score and moisture, it decreased the amount of fecal metabolites of protein fermentation ammonia and BCFA, both of which are associated with proteolytic fermentation in the colon.
Healthy adult dogs had greater protein apparent total tract digestibility when fed diets with hydrolyzed chicken liver and high-protein concentrations than those fed diets with a traditional poultry byproduct meal. However, the inclusion of hydrolyzed chicken liver reduced fat, carbohydrates, and energy apparent total tract digestibility.
In addition, the concentrations of protein fermentation metabolites, such as ammonia and branched-chain fatty acids, decreased on the feces of dogs-fed diets with hydrolyzed chicken liver even at higher protein concentrations, suggesting less protein fermentation in the colon.
Lay Summary
Feeding companion animals with high-protein diets has been a demand of the market and pet owners. However, the protein quality and quantity consumed can interfere with the amount of undigested protein that reaches the hindgut and be fermented. Intestinal fermentation can be desired when well controlled. This study tested two protein sources (hydrolyzed chicken liver and poultry byproduct meal) combined at three dietary protein concentrations (24, 32, and 40% crude protein on dry matter basis) and their effects on the apparent total tract digestibility (ATTD), fecal and urinary characteristics, and fecal metabolites of healthy adult dogs. In summary, diets containing higher inclusion of hydrolyzed chicken liver had improved protein ATTD. However, the same diets impaired the ATTD of fat and carbohydrates and decreased metabolizable energy. High-protein diets retained more water in the feces and increased the fecal output. Fecal consistency was affected, scored as soft and moist stools, but remained within an acceptable score. Dogs-fed poultry byproduct meal diets had greater concentrations of fecal protein fermentation metabolites, such as ammonia and branched-chain fatty acids, possibly related to a greater amount of undigested protein that reached the hindgut and was fermented.
Summary Objective Much of what is known about the inflammatory response in the synovial membrane (SM) of patients with osteoarthritis (OA) comes from studies of synovial tissues from end-stage ...disease. In this study, we sought to better characterize the inflammatory infiltrate in symptomatic patients with early signs of knee OA, and to determine how inflammatory cell populations relate to the pattern of cytokine and degradative enzyme production. Methods Study populations comprised patients with degenerative meniscal tears and early cartilage thinning undergoing arthroscopic procedures (early OA) and patients undergoing total knee replacement for end-stage OA. Quantitative real-time polymerase chain reaction (PCR) was used to measure expression of SM cytokines and enzymes implicated in the pathogenesis of inflammatory arthritis and OA, as well as cell lineage-specific markers. We quantified synovial fluid (SF) cytokines and enzymes by enzyme-linked immunosorbent assay (ELISA) and SM cell populations by immunohistochemistry. Results We found increased levels of SF interleukin-15 (IL-15) protein in the early knee OA patients when compared to end-stage OA. Both SF IL-15 protein and numbers of CD8 cells within SM correlated with matrix metalloproteinase-1 (MMP-1) and three levels. TNF-α, IL-6 and IL-21 were also detectable in the SF of the majority of patients, and IL-15 levels were associated with IL-6 levels. Conclusion IL-15 is elevated in early knee OA, suggesting activation of an innate immune response in the SM. The association of IL-15 expression with CD8 transcripts and MMPs implicates this cytokine in OA pathogenesis and as a candidate therapeutic target.
Objectives The goal of this study was to review results of a novel management strategy intended to rehabilitate the left heart (LH) in patients with LH hypoplasia who have undergone single-ventricle ...palliation (SVP). Background Management of patients with hypoplastic LH syndrome and borderline left ventricle (LV) involves 2 options: SVP or biventricular repair. We hypothesized that staged LV recruitment and biventricular conversion may be achieved after SVP by using a strategy consisting of relief of inflow and outflow tract obstructions, resection of endocardial fibroelastosis, and promotion of flow through the LV. Methods Patients with hypoplastic LH and borderline LV who underwent traditional SVP (n = 34) or staged LV recruitment (n = 34) between 1995 and 2010 were retrospectively analyzed and compared with a control SVP group. Results Mean initial z -scores for LH structures before stage 1 SVP were not significantly different between groups. Mortality occurred in 4 of 34 patients after LV recruitment and in 7 of 34 after traditional SVP. LH dimension z -scores increased significantly over time after LV recruitment, whereas they declined after traditional SVP, with significant interaction between stage of palliation and treatment group. Restriction of the atrial septum (conducted in 19 of 34 patients) was the only predictor of increase in left ventricular end-diastolic volume (p < 0.001). Native biventricular circulation was achieved in 12 patients after staged LV recruitment; all of these patients had restriction at the atrial septum. Conclusions In these patients with borderline LH disease who underwent SVP, it is possible to increase LH dimensions by using an LV recruitment strategy. In a subset of patients, this strategy allowed establishment of biventricular circulation.
▶ A controllable and rapid approach to synthesise CdS nanocrystals by using a new single source molecular precursor cadmium pyrrolidine dithiocarbamate Cd(pdtc)2. ▶ The synthesis of CdS nanocrystals ...is achieved by thermal decomposition of cadmium (II) pyrrolidine dithiocarbamate (Cd(pdtc)2) complex with hexadecylamine under conventional heating and microwave irradiation. ▶ In microwave irradiation, the monodispersed CdS nanoparticles were obtained whereas the nanorods were formed by conventional heating process. ▶ A comparison of the formation of different shapes and sized CdS prepared by both thermal decomposition and microwave irradiation and their structural and optical characterizations are presented. ▶ This novel method was expected to produce various semiconductor nanocrystals with high yield and purity.
The complex of cadmium with pyrrolidine dithiocarbamate Cd(pdtc)2 has been used as single source precursor for the synthesis of CdS nanoparticles. The formation of CdS nanostructures was achieved by thermal decomposition of the complex under microwave irradiation and conventional heating in presence of hexadecylamine. The CdS nanoparticles with disordered close-packed structure were obtained under microwave irradiation, whereas wurtzite hexagonal phase CdS nanorods were obtained by conventional heating method (up to 150°C). Scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDX) and high resolution transmission electron microscopy (HRTEM) studies also were carried out to study the structure and morphology of nanoparticles. The optical property of the CdS nanoparticles was studied by UV–visible and fluorescence emission spectral studies. Fluorescence measurements on the CdS nanoparticles show a strong emission spectrum with two sub bands that are attributed to band-edge and surface-defect emissions. The reduction of a suitable cadmium metal complex is considered to be one of the single pot methods to generate CdS semiconductor nanoparticles with different shapes and high yield.
Objective Early results for anatomic repair of congenitally corrected transposition of the great arteries (ccTGA) are excellent. However, the development of left ventricular dysfunction late after ...repair remains a concern. In this study we sought to determine factors leading to late left ventricular dysfunction and the impact of cardiac resynchronization as a primary and secondary (upgrade) mode of pacing. Methods From 1992 to 2012, 106 patients (median age at surgery, 1.2 years; range, 2 months to 43 years) with ccTGA had anatomic repair. A retrospective review of preoperative variables, surgical procedures, and postoperative outcomes was performed. Results In-hospital deaths occurred in 5.7% (n = 6), and there were 3 postdischarge deaths during a mean follow-up period of 5.2 years (range, 7 days to 18.2 years). Twelve patients (12%) developed moderate or severe left ventricular dysfunction. Thirty-eight patients (38%) were being paced at latest follow-up evaluation. Seventeen patients had resynchronization therapy, 9 as an upgrade from a prior dual-chamber system (8.5%) and 8 as a primary pacemaker (7.5%). Factors associated with left ventricular dysfunction were age at repair older than 10 years, weight greater than 20 kg, pacemaker implantation, and severe neo-aortic regurgitation. Eight of 9 patients undergoing secondary cardiac resynchronization therapy (upgrade) improved left ventricular function. None of the 8 patients undergoing primary resynchronization developed left ventricular dysfunction. Conclusions Late left ventricular dysfunction after anatomic repair of ccTGA is not uncommon, occurring most often in older patients and in those requiring pacing. Early anatomic repair and cardiac resynchronization therapy in patients requiring a pacemaker could preclude the development of left ventricular dysfunction.
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