To compare outcomes of type II endoleak embolization involving embolization of the endoleak nidus only vs embolization of the endoleak nidus and branch vessels in patients treated with endovascular ...repair of abdominal aortic aneurysms.
Twenty-nine consecutive patients (mean age, 77.9 y; range, 63-88 y) with type II endoleak who underwent embolization from 2004 to 2015 were retrospectively reviewed. Patients were divided into 2 groups: embolization of endoleak nidus only (group A) and embolization of endoleak nidus and branch vessels (group B). Mean follow-up intervals were 20.5 months ± 14.7 in group A and 24.3 months ± 18.5 in group B. Outcomes were compared between groups by Mann-Whitney U and Pearson χ
tests.
Mean interval from endovascular aneurysm repair to embolization was 47.6 months ± 42.9, and mean presentation time of endoleak before embolization was 23.1 months ± 25.8. Coils (n = 28) and liquid embolic agents (n = 23) were used for embolization. There were no significant differences in rates of residual endoleak (50% vs 53.8%; P = .96) or sac decrease/stabilization (62.5% vs 61.5%; P = .64). Procedure time and radiation exposure in group B (132.3 min ± 78.1; 232.4 Gy·cm
± 130.7) were greater than in group A (63.4 min ± 11.9; 61.5 Gy·cm
± 35.5; P < .01). There were no procedure-related complications.
Embolization of the endoleak nidus and branch vessels is not superior to embolization of only the nidus in terms of occlusion of type II endoleak and change in sac size despite requiring longer procedure times and resulting in greater patient radiation exposure.
Introduction: Dexmedetomidine is an a2 agonist that causes deep sedation after bolus, and can be given as infusion while performing Magnetic Resonance Imaging (MRI) brain in paediatric patients. ...There are reports of increased incidences of bradycardia and hypotension with prolonged recovery when it was used in high doses of 2-3 mcg/kg bolus. Lower dose of bolus may enhance the recovery profile and reduce the chances of bradycardia, while maintaining the efficacy of sedation. Aim: To compare the induction of sedation, haemodynamics stability, success rate of the scan, efficacy of the drug and recovery profile of low dose dexmedetomidine and propofol infusion for MRI brain in paediatric patients. Materials and Methods: This randomised clinical trial was conducted at Lokmanya Tilak Municipal General Hospital and Medical College, Sion Mumbai, Maharashtra, India, from November 2012 to April 2014. Total 70 American Society of Anesthesiologists (ASA) grade I and II children aged 1-7 years posted for elective MRI brain were included in the study. Patients were divided into two groups i.e, dexmedetomidine group (n=35) and propofol group (n=35). Intranasal midazolam 0.2 mg/kg was given. Children in dexmedetomidine group were induced with 1 mcg/kg dexmedetomidine given over 10 minutes and maintained with dexmedetomidine at 1 mcg/kg/hr. Patients in propofol group received propofol bolus 2 mg/kg and infusion at 100 mcg/kg/min. Results: The MRI scan was completed in 34 (97.1%) and 35 (100%) of children in dexmedetomidine and propofol group, respectively. Time for complete recovery was 68.9±31.5 and 40.1±23 minutes in the dexmedetomidine and propofol group, respectively. Time for induction was 12.4±3.53 and 6.46±1.9 minutes in the dexmedetomidine and propofol group, respectively. Bradycardia was observed in 8 (22.9%) patients in dexmedetomidine group. Heamodynamic parameters were with in 20% of baseline in both the groups. Conclusion: Propofol is a better anaesthetics in terms of recovery and induction time when used as an infussion for MRI brain in paediatric patients. Dexmedetomidine has a high incidence of bradycardia so requires a more vigilant monitoring.
Understanding protein-protein interactions that occur between ACP and KS domains of polyketide synthases and fatty acid synthases is critical to improving the scope and efficiency of combinatorial ...biosynthesis efforts aimed at producing non-natural polyketides. Here, we report a facile strategy for rapidly reporting such ACP-KS interactions based on the incorporation of an amino acid with photocrosslinking functionality. Crucially, this photocrosslinking strategy can be applied to any polyketide or fatty acid synthase regardless of substrate specificity, and can be adapted to a high-throughput format for directed evolution studies.
G-protein-coupled receptor (GPCR) ligands function by stabilizing multiple, functionally distinct receptor conformations. This property underlies the ability of 'biased agonists' to activate specific ...subsets of a given receptor's signaling profile. However, stabilizing distinct active GPCR conformations to enable structural characterization of mechanisms underlying GPCR activation remains difficult. These challenges have accentuated the need for receptor tools that allosterically stabilize and regulate receptor function through unique, previously unappreciated mechanisms. Here, using a highly diverse RNA library combined with advanced selection strategies involving state-of-the-art next-generation sequencing and bioinformatics analyses, we identify RNA aptamers that bind a prototypical GPCR, the β2-adrenoceptor (β2AR). Using biochemical, pharmacological, and biophysical approaches, we demonstrate that these aptamers bind with nanomolar affinity at defined surfaces of the receptor, allosterically stabilizing active, inactive, and ligand-specific receptor conformations. The discovery of RNA aptamers as allosteric GPCR modulators significantly expands the diversity of ligands available to study the structural and functional regulation of GPCRs.
Purpose
– The purpose of this paper is to seek to clarify the conceptual building blocks of relationship building between non-governmental groups (NGOs) and news media, which is essential for the ...development of civil society where dialogue is a product of ongoing communication and relationships.
Design/methodology/approach
– The paper is based on an online survey with a sample size of 296 NGOs from India. The data are analyzed with SPSS to test six hypotheses related to dialogic orientation, media relations, relationship quality and the NGOs’ structural characteristics.
Findings
– The study found that an organization's dialogic orientation has a positive impact on media relations knowledge and strategy but not on the action dimension that focusses on providing information subsidies to journalists. A stronger dialogic orientation is also associated with better organization-media relationships. A stronger engagement in media relations also has a more positive impact on the quality of organization-media relationship. Theoretical and practical implications are discussed.
Research limitations/implications
– The findings of this study are limited to a sample of NGOs from India. Future research should address more diverse samples to better understand the dynamics of media relations in NGOs, and how their patterns of media relations, use of information subsidies, culture and media choice shape news coverage and their impact in developing civil society.
Originality/value
– By approaching media relations from an organizational perspective to investigate media relations in the NGO sector to address an under-researched area, the study is able to draw out the significant relationships between and among three distinct and yet connected conceptual building blocks of public relations.
Opinion statement
Neuroendocrine tumors (NETs) are relatively rare, with 12,000–15,000 new cases diagnosed annually in the USA. Although NETs are a diverse group of neoplasms, they share common ...molecular targets that can be exploited using nuclear medicine techniques for both imaging and therapy. NETs have traditionally been imaged with SPECT imaging using
111
In-labeled octreotide analogs to detect neoplasms with somatostatin receptors. In addition, certain NETs (pheochromocytomas, paragangliomas, and neuroblastomas) are also effectively imaged using
123
I- or
131
I-labeled metaiodobenzylguanidine (MIBG), an analog of guanethidine. More recently, PET imaging with
68
Ga-labeled somatostatin receptor (SSR) analogs allows neuroendocrine tumors to be imaged with much higher sensitivity.
68
Ga-DOTATATE was approved as a PET tracer by the FDA in June 2016. In addition to imaging, both MIBG and DOTATATE can be labeled with therapeutic radionuclides to deliver targeted radiation selectively to macroscopic and microscopic tumor sites. The incorporation of the same molecular probe for imaging and therapy provides a radio-theranostic approach to identifying, targeting, and treating tumors. Over the years, several centers have experience treating NETs with high-dose
131
I-MIBG.
177
Lu-DOTATATE was approved by the FDA in 2018 for treatment of gastroenteropancreatic NETs and constitutes a major advancement in the treatment of these diseases. In this paper, we provide an overview of imaging and treating neuroendocrine tumors using MIBG and SSR probes. Although uncommon, neuroendocrine tumors have provided the largest experience for targeted radionuclide imaging and therapy (with the exception of radioiodine treatment for thyroid disease). In addition to benefitting patients with these rare tumors, the knowledge gained provides a blueprint for the development of future paired diagnostic/therapeutic probes for treating other diseases, such as prostate cancer.
A wealth of information is available on extreme heat and humidity associated with mortality for cities of the developed world, but there is a dearth in the literature for coastal cities of the ...developing world. The aim of the present study was to assess the effect of ambient heat on all-cause mortality on the urban population of Surat, a coastal city in India. Retrospective analysis of all cause mortality data with temperature and humidity was performed for the summer months (March–May) for the period 2001–12. Student's t-test and correlation coefficient were used to study the relationship between ambient heat and mortality. A total of 36,167 deaths for 961 summer days (2001–12) were analysed. Mean daily mortality was estimated at 37.6 ± 9.4 for the study period. There is an increase of 11% mortality when the temperature crosses 40°C. However, there is an increase of 3 (9%) deaths per day during danger-level heat-risk days and 6 (18%) deaths per day during high-risk heat days (extreme danger) respectively. Mortality seems to be well correlated with the high temperature (P < 0.001) and high heat index (HI) values (P < 0.001). The effect of extreme heat on mortality is at a peak on day-2 of the maximum temperature. The study concludes that the impact of ambient heat in the increase of all cause mortality is clearly evident and HI is more important than maximum temperature (18% deaths/day versus 11% deaths/day). Therefore, emphasis should be given to develop measures of adaptation towards ambient heat. This analysis may fulfil the needs of policy makers and apply strategies like integrated coastal zone management. Extreme heat-related mortality merits further analysis in order to reduce harmful health effects among Surat's most vulnerable urban population.
Purpose
To compare clinical efficacy, subjective radiologist preference, and complication rates for two different core biopsy needles, the Achieve® and Marquee®.
Methods
Retrospective review included ...consecutive patients who underwent 18 gauge non-targeted core liver biopsy, 30 with Achieve® (Merit Medical) and 30 with Marquee® (BD Bard) Pathologist (blinded to needle type) reviewed specimen total length, maximum width, and portal triad count. Sixteen radiologists subjectively rated (1 to 5(best)) each needle for cocking, firing, recoil, chamber exposure, handling, and overall. A medical records search of all (targeted and non-targeted) core liver biopsies 1/1/17–9/30/2020 compared rates of major (requiring transfusion and/or embolization) and minor (self-limited bleeding) hemorrhagic complications. Comparison between needle types was performed using t-test.
Results
For Achieve® and Marquee® needles, the respective mean (SD) for total length(mm) was 29.7(7.0) and 31.9(4.6),
p
= 0.1; max width(mm) was 0.78(0.1) and 0.85(0.1),
p
< 0.01; and number of portal triads was 15.3(5.3) and 17.3(5.3),
p
= 0.2. Radiologists subjectively preferred the Marquee® for several measures including cocking, chamber exposure, and overall (
p
< 0.02 for each), while the needles were rated similarly for firing, recoil, and handling. Review of 800 cases showed no difference in major (1.0% Achieve®, 1.9% Marquee®,
p
= 0.5) or minor (1.5% Achieve®, 0.5% Marquee®,
p
= 0.3) rates of hemorrhagic complications.
Conclusion
Liver biopsy specimens were significantly wider with Marquee® compared to Achieve®. Radiologists preferred the Marquee® for multiple tactile measures, while the major complication rate was not significantly different. While both needles have a similar side-notch design, the Marquee® needle demonstrates better sample quality and higher user preference, without compromising safety.
Graphic abstract
The demographic transition with rapid urbanisation corresponds with the challenges of urban infrastructure development. Urban health is an outcome of complex interaction of many urban factors ...including governance and finance. Coupled with this, climate change has overarching influence on these factors and a challenge to development, health and survival. Therefore, understanding impact of climate change with reference to urban health and development should be on high priority.
Changes in climatic patterns may alter the distribution of vector species and increase its spread in new areas. An increase in temperature and relative humidity may enlarge the transmission window. Effluent emissions to water bodies and salination of rivers through sea level rise may increase the incidence of water borne diseases. Deaths due to heat wave are reported from several parts of the country. Every city is different and success of city specific urban health programme depends on city specific planning as well as public health preparedness for climate change. Hence, study of Climate and Health brings out threshold levels of climate resilience.
Surat city experience of Urban health revealed that good governance and Finance were considered most important factors including Urban health system, community participation, Inter-sectoral convergence, disease surveillance, health information system, Public–private partnership, participation of academic institutions and cross learning. One of the major advocacy areas UHCRC is embarking in is ‘Inclusion of Climate resilience in Health and Health in Climate Resilience Planning’.
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