Predicting lung nodules malignancy.

BACKGROUND: It is critical to developing an accurate method for differentiating between malignant and benign solitary pulmonary nodules. This study aimed was to establish a predicting model of lung nodules malignancy in a real-world setting. METHODS: The authors retrospectively analysed the clinical and computed tomography (CT) data of 121 patients with lung nodules, submitted to percutaneous CT-guided transthoracic biopsy, between 2014 and 2015. Multiple logistic regression was used to screen independent predictors for malignancy and to establish a clinical prediction model to evaluate the probability of malignancy. RESULTS: From a total of 121 patients, 75 (62%) were men and with a mean age of 64.7 years old. Multivariate logistic regression analysis identified six independent predictors of malignancy: age, gender, smoking status, current extra-pulmonary cancer, air bronchogram and nodule size (p<0.05). The area under the curve (AUC) was 0.8573. CONCLUSIONS: The prediction model established in this study can be used to assess the probability of malignancy in the Portuguese population, thereby providing help for the diagnosis of lung nodules and the selection of follow-up interventions.

Durability and Wear Resistance of Laser-Textured Hardened Stainless Steel Surfaces with Hydrophobic Properties.

Hydrophobic surfaces are of high interest to industry. While surface functionalization has attracted significant interest, from both industry and research, the durability of engineered surfaces remains a challenge, as wear and scratches deteriorate their functional response. In this work, a cost-effective combination of surface engineering processes on stainless steel was investigated. Low-temperature plasma surface alloying was applied to increase surface hardness from 172 to 305 HV. Then, near-infrared nanosecond laser patterning was deployed to fabricate channel-like patterns that enabled superhydrophobicity. Abrasion tests were carried out to examine the durability of such engineered surfaces during daily use. In particular, the evolution of surface topographies, chemical composition, and water contact angle with increasing abrasion cycles were studied. Hydrophobicity deteriorated progressively on both hardened and raw stainless steel samples, suggesting that the major contributing factor to hydrophobicity was the surface chemical composition. At the same time, samples with increased surface hardness exhibited a slower deterioration of their topographies when compared with nontreated surfaces. A conclusion is made about the durability of laser-textured hardened stainless steel surfaces produced by applying the proposed combined surface engineering approach.

Time of copulation during estrus period on estrus duration and LH response in Boer goats.

The objectives of this investigation were to determine the effect of the time of copulation during the estrus period on estrus duration and luteinizing hormone (LH) response in goats. A controlled randomized study with two replicates (first = n = 12; second = n = 24), in which Boer does were divided at each replicate into three groups, was performed. Copulations at the beginning of estrus (two copulas within the first 4 h after estrus; COP-1; n = 12), copulations around the middle of estrus (two copulas around 16 h after estrus; COP-2; n = 12), and noncopulations (only mounts) throughout the estrus period (control group; CON; n = 12) were performed. Estrus duration for CON group was 41.3 ± 8.2 h; for COP-1, it was 34.0 ± 5.3 h, and for COP-2, it was 39.7 ± 6.9 h (P = 0.04). Differences were detected between COP-1 and CON groups (P = 0.01) and between COP-1 and COP-2 groups (P = 0.05) but not between CON and COP-2 groups (P = 0.56). The LH peak time for the CON group was 20.0 ± 8.0 h; for the COP-1 group, it was 13.0 ± 3.6 h, and for the COP-2 group, it was 20.5 ± 5.8 h (P = 0.04). The COP-1 group was different than the COP-2 (P = 0.02) and CON groups (P = 0.03), and no differences were detected between these last two groups (P = 0.87). It was concluded that copulation reduced estrus duration and hastened the LH peak time only when performed during the beginning of estrus.

A qualitative study exploring visible components of organizational culture: what influences the use of psychotropic medicines in nursing homes?

BACKGROUND: The influence of organizational culture on how psychotropic medicines are used in nursing homes has not been extensively studied. Schein's theory provides a framework for examining organizational culture which begins with the exploration of visible components of an organization such as behaviors, structures, and processes. This study aimed to identify key visible components related to the use of psychotropic medicines in nursing homes. METHODS: A qualitative study was conducted in eight nursing homes in Sydney, Australia. Purposive sampling was used to conduct semi-structured interviews with 40 participants representing a broad range of health disciplines. Thematic analysis was used to derive concepts. RESULTS: Three visible components were related to psychotropic medicine use. These were drugs and therapeutics committee meetings, pharmacist led medication management reviews and formal and informal meetings with residents and their families. We found that only a few nursing homes utilized drugs and therapeutics committee meetings to address the overuse of psychotropic medicines. Pharmacist led medication management reviews provided a lever to minimize inappropriate psychotropic prescribing for a number of nursing homes; however, in others it was used as a box-ticking exercise. We also found that some nursing homes used meetings with residents and their families to review the use of psychotropic medicines. CONCLUSION: This study was the first to illustrate that visible components of organizational culture do influence the use of psychotropic medicines and explains in detail what of the culture needs to be addressed to reduce inappropriate psychotropic prescribing.

Relative expression analysis of IL-5 and IL-6 genes in tropical sheep breed Pelibuey infected with Haemonchus contortus.

Haemonchus contortus is a parasitic nematode of Pelibuey sheep, a meat breed used in tropical regions. Due to anthelmintic problems, the identification of hosts resistant to H. contortus is another option of control. The aim of this study was to analyse the relative expression of IL-5 and IL-6 genes in Pelibuey sheep after H. contortus infection. Nineteen lambs infected with H. contortus and three more lambs without infection were studied. The haemonchosis was determined by the number of eggs per gram of faeces (epg) and by the estimation of the percentage of the packed cell volume (%pcv). Peripheral blood mononuclear cells (PBMCs) were obtained to extract RNA at 0, 1, 2, 7, 14, 21 and 28 days after infection to quantify the relative expression of IL-5, IL-6 and GAPDH by real-time PCR. Five lambs were classified as low responders (lr) to haemonchosis with averages of 1519 ± 315·3 epg and 31·49 ± 5·13%pcv, and 14 lambs were identified as high responders (hr) with averages of 530 ± 132 epg and 34·88 ± 3·75%pcv. The expression ratio of IL-5 was significantly different compared with control lambs at 2, 7 and 14 days post-infection (PI), and IL-6 was significantly different after 14 days. The highest level of relative expression for IL-5 and IL-6 genes was 9·9-fold and 12-fold after 2 and 14 days for hr hosts (P < 0·05) compared with control group, respectively. In conclusion, the Pelibuey breed in grazing areas exhibited different expression of IL-5 and IL-6 obtained from PBMCs against H. contortus, suggesting the importance of these cytokines in regulating the nematode infection.

HASHIMOTO'S ENCEPHALOPATHY AS A RARE MANIFESTATION OF HYPOTHYROIDISM.

Hashimoto's Encephalopathy (HE) is a rare syndrome of steroid-responsive encephalopathy associated with elevated serum antithyroid antibody concentrations. The presentation of HE is highly variable making it difficult to recognize.

Differences in lipid profiles in two Hispanic ischemic stroke populations.

BACKGROUND AND PURPOSE: The study aims to compare lipid profiles among ischemic stroke patients in a predominantly Caribbean-Hispanic population in Miami and a Mestizo Hispanic population in Mexico City. METHODS: We analyzed ischemic stroke Hispanic patients with complete baseline fasting lipid profile enrolled contemporaneously in the prospective registries of two tertiary care teaching hospitals in Mexico City and Miami. Demographic characteristics, risk factors, medications, ischemic stroke subtype, and first fasting lipid profile were compared. Vascular risk factor definitions were standardized. Multiple linear regression analysis was performed to compare lipid fractions. RESULTS: A total of 324 patients from Mexico and 236 from Miami were analyzed. Mexicans were significantly younger (58 · 1 vs. 67 · 4 years), had a lower frequency of hypertension (53 · 4% vs. 79 · 7%), and lower body mass index (27 vs. 28 · 5). There was a trend toward greater prevalence of diabetes in Mexicans (31 · 5 vs. 24 · 6%, P = 0 · 07). Statin use at the time of ischemic stroke was more common in Miami Hispanics (18 · 6 vs. 9 · 4%). Mexicans had lower total cholesterol levels (169 · 9 ± 46 · 1 vs. 179 · 9 ± 48 · 4 mg/dl), lower low-density lipoprotein (92 · 3 ± 37 · 1 vs. 108 · 2 ± 40 · 8 mg/dl), and higher triglyceride levels (166 · 9 ± 123 · 9 vs. 149 · 2 ± 115 · 2 mg/dl). These differences remained significant after adjusting for age, gender, hypertension, diabetes, body mass index, smoking, ischemic stroke subtype, and statin use. CONCLUSION: We found significant differences in lipid fractions in Hispanic ischemic stroke patients, with lower total cholesterol and low-density lipoprotein, and higher triglyceride levels in Mexicans. These findings highlight the heterogeneity of dyslipidemia among the Hispanic race-ethnic group and may lead to different secondary prevention strategies.

Developing multipurpose reproductive health technologies: an integrated strategy.

WOMEN WORLDWIDE CONFRONT TWO FREQUENTLY CONCURRENT REPRODUCTIVE HEALTH CHALLENGES: the need for contraception and for protection from sexually transmitted infections, importantly HIV/AIDS. While conception and infection share the same anatomical site and mode of transmission, there are no reproductive health technologies to date that simultaneously address that reality. Relevant available technologies are either contraceptive or anti-infective, are limited in number, and require different modes of administration and management. These "single-indication" technologies do not therefore fully respond to what is a substantial reproductive health need intimately linked to pivotal events in many women's lives. This paper reviews an integrated attempt to develop multipurpose prevention technologies-"MPTs"-products explicitly designed to simultaneously address the need for both contraception and protection from sexually transmitted infections. It describes an innovative and iterative MPT product development strategy with the following components: identifying different needs for such technologies and global variations in reproductive health priorities, defining "Target Product Profiles" as the framework for a research and development "roadmap," collating an integrated MPT pipeline and characterizing significant pipeline gaps, exploring anticipated regulatory requirements, prioritizing candidates for problem-solving and resource investments, and implementing an ancillary advocacy agenda to support this breadth of effort.

Rectal swabs are suitable for quantifying the carriage load of KPC-producing carbapenem-resistant Enterobacteriaceae.

It is more convenient and practical to collect rectal swabs than stool specimens to study carriage of colon pathogens. In this study, we examined the ability to use rectal swabs rather than stool specimens to quantify Klebsiella pneumoniae carbapenemase (KPC)-producing carbapenem-resistant Enterobacteriaceae (CRE). We used a quantitative real-time PCR (qPCR) assay to determine the concentration of the bla(KPC) gene relative to the concentration of 16S rRNA genes and a quantitative culture-based method to quantify CRE relative to total aerobic bacteria. Our results demonstrated that rectal swabs are suitable for quantifying the concentration of KPC-producing CRE and that qPCR showed higher correlation between rectal swabs and stool specimens than the culture-based method.

Vaginal ring adherence in sub-Saharan Africa: expulsion, removal, and perfect use.

In sub-Saharan Africa, HIV incidence and prevalence remain disproportionately high among women. Vaginal rings (VRs) have been formulated for the delivery of antiretroviral-based microbicides, and their favorable safety and tolerability profiles reported in clinical studies. Although the concept of drug release through a VR has existed since 1970, and VRs have been marketed since 1992 for contraceptive or hormone replacement purposes, VR use as a microbicide delivery system is a novel application. This is the first study to evaluate VR adherence among African women in the context of its potential use as an HIV prevention method, to examine predictors of adherence, and to describe clinical or contextual reasons for VR removals or nonadherence. This was a randomized trial of the safety and acceptability of a placebo VR worn for 12 weeks in 170 HIV-negative, African women aged 18-35 in four clinic sites in South Africa and Tanzania. The findings suggest that adherence to VR use in the context of HIV prevention trials in these communities should be high, thereby enabling more accurate assessment of an active microbicide safety and efficacy.

High acceptability of a vaginal ring intended as a microbicide delivery method for HIV prevention in African women.

Vaginal rings (VRs) are new methods for continuous delivery of microbicides. This is the first study to quantitatively and qualitatively explore the acceptability of rings in Africa: 157 HIV-negative, sexually active women aged 18-35 used a placebo silicone elastomer ring for 12 weeks. They completed product acceptability questionnaires every 4 weeks. We conducted 6 exit focus group discussions with a subset of 48 women and 19 in-depth interviews with male partners. Retention in the study was high (97 %). Initial insertion at the clinic was successful on first attempt for 81 % of participants. Most women were comfortable using the ring, and very few (≤2 %) could feel it during daily activities or had ring-related physical or emotional problems. In the qualitative interviews many participants reported that they initially had concerns about using the ring. However, only a minority of women actually reported concerns with the ring during the study. The most frequent concern was that the ring would get lost inside the body (20 %), and this was significantly correlated with study site, frequently thinking about the ring and reporting that the ring was not very easy to remove. Qualitative data suggest that informants grew to like the ring because it felt securely placed, was unnoticeable during daily activities, and felt "normal" during sex. The ring appeared to be highly acceptable for women and men. Initial concerns with this novel method suggest a need for enhanced product counseling when VRs are introduced.

[Metformin-associated lactic acidosis: incidence, diagnosis, prognostic factors and treatment]. / Acidosis láctica asociada a metformina: incidencia, diagnóstico, factores pronóstico y tratamiento.

We describe the case of a patient with severe lactic acidosis, as well as presenting some data on its incidence, diagnosis, prognostic factors, and the most appropriate treatment. A 76 year-old male patient with diabetes on treatment with metformin, hypertension, dyslipaemia, and with mild cognitive impairment, was admitted to the Intensive Care Unit in a state of circulatory shock, requiring aggressive treatment with vasopressors and volume. The patient had acute kidney injury with an anuria of 3 days, probably secondary to dehydration to vomiting and to NSAIDs. As a result of the acute renal damage, the patient suffered a severe metformin-associated lactic acidosis. The rest of the causes of metabolic acidosis with an increased anion gap were ruled out, as well as a possible sepsis or rhabdomyolysis. Metformin-associated lactic acidosis is an uncommon metabolic condition, but with a high mortality. To reduce the mortality of these patients, it is important to make an early diagnosis using the clinical records, physical examination, and laboratory tests, with an early resuscitation with volume, vasopressors, bicarbonate, and renal replacement therapy.

Acidosis láctica asociada a metformina: incidencia, diagnóstico, factores pronóstico y tratamiento / Metformin-associated lactic acidosis: incidence, diagnosis, prognostic factors and treatment

Describimos el caso de un paciente con acidosis láctica grave y presentamos algunos datos acerca de su incidencia, diagnóstico, factores pronósticos y tratamiento más adecuado. Un paciente varón de 76 años diabético en tratamiento con metformina, hipertenso, dislipémico y con ligero deterioro cognitivo, ingresó en la Unidad de Cuidados Intensivos en estado de shock circulatorio requiriendo tratamiento agresivo con vasopresores y volumen. El paciente presentaba un daño renal agudo con anuria de 3 días probablemente secundario a la deshidratación por vómitos y a la toma de AINES. A consecuencia del daño renal agudo el paciente padeció una acidosis láctica grave asociada a metformina. Se descartó el resto de causas de acidosis metabólica con anion gap aumentado, así como una posible sepsis o rabdomiolisis. La acidosis láctica asociada a metformina es una condición metabólica poco frecuente pero de alta mortalidad. Para disminuir la mortalidad de estos pacientes, es importante hacer un diagnóstico precoz mediante la historia clínica, la exploración física y la analítica con una rápida reanimación mediante volumen, vasopresores, bicarbonato y técnica de depuración extra-renal(AU)

We describe the case of a patient with severe lactic acidosis, as well as presenting some data on its incidence, diagnosis, prognostic factors, and the most appropriate treatment. A 76 year-old male patient with diabetes on treatment with metformin, hypertension, dyslipaemia, and with mild cognitive impairment, was admitted to the Intensive Care Unit in a state of circulatory shock, requiring aggressive treatment with vasopressors and volume. The patient had acute kidney injury with an anuria of 3 days, probably secondary to dehydration to vomiting and to NSAIDs. As a result of the acute renal damage, the patient suffered a severe metformin-associated lactic acidosis. The rest of the causes of metabolic acidosis with an increased anion gap were ruled out, as well as a possible sepsis or rhabdomyolysis. Metformin-associated lactic acidosis is an uncommon metabolic condition, but with a high mortality. To reduce the mortality of these patients, it is important to make an early diagnosis using the clinical records, physical examination, and laboratory tests, with an early resuscitation with volume, vasopressors, bicarbonate, and renal replacement therapy(AU)

Creating Realistic Virtual Textures from Contact Acceleration Data.

Modern haptic interfaces are adept at conveying the large-scale shape of virtual objects, but they often provide unrealistic or no feedback when it comes to the microscopic details of surface texture. Direct texture-rendering challenges the state of the art in haptics because it requires a finely detailed model of the surface's properties, real-time dynamic simulation of complex interactions, and high-bandwidth haptic output to enable the user to feel the resulting contacts. This paper presents a new, fully realized solution for creating realistic virtual textures. Our system employs a sensorized handheld tool to capture the feel of a given texture, recording three-dimensional tool acceleration, tool position, and contact force over time. We reduce the three-dimensional acceleration signals to a perceptually equivalent one-dimensional signal, and then we use linear predictive coding to distill this raw haptic information into a database of frequency-domain texture models. Finally, we render these texture models in real time on a Wacom tablet using a stylus augmented with small voice coil actuators. The resulting virtual textures provide a compelling simulation of contact with the real surfaces, which we verify through a human subject study.

Conserved peptide sequences bind to actin and enolase on the surface of Plasmodium berghei ookinetes.

The description of Plasmodium ookinete surface proteins and their participation in the complex process of mosquito midgut invasion is still incomplete. In this study, using phage display, a consensus peptide sequence (PWWP) was identified in phages that bound to the Plasmodium berghei ookinete surface and, in selected phages, bound to actin and enolase in overlay assays with ookinete protein extracts. Actin was localized on the surface of fresh live ookinetes by immunofluorescence and electron microscopy using specific antibodies. The overall results indicated that enolase and actin can be located on the surface of ookinetes, and suggest that they could participate in Plasmodium invasion of the mosquito midgut.

[Extracorporeal membrane oxygenation in acute respiratory distress syndrome after a liver transplant]. / Oxigenación extracorpórea en un síndrome de distrés respiratorio agudo tras trasplante hepático.

Extracorporeal membrane oxygenation (ECMO) is used in the treatment of severe respiratory failure that is potentially reversible. This mode of therapy reduces ventilator-associated lung injury. Although ECMO is costly and not free of complications, its early application by experienced multidisciplinary teams can improve survival. We report a case of acute respiratory distress syndrome in a patient who had received a liver transplant. Respiratory failure was unresponsive to conventional treatment and the patient required ECMO until recovery.