Physical oral care prevents ventilator-associated pneumonia in Vietnam: A prospective interventional study.

BACKGROUND: Ventilator-associated pneumonia (VAP) has emerged as a critical issue in the intensive care unit (ICU) because of its high burden on patients and medical staff. Here, we examined the potential for reducing VAP incidence through physical oral care interventions without any medication. METHODS: This prospective interventional study compared VAP incidence during an 8-month baseline period (usual oral care) and a 9-month intervention period (physical oral care with sponge brush) among patients who received mechanical ventilation for >48 h in a tertiary care hospital in Vietnam from 2017 to 2019. Physical oral care was provided by general ICU nurses who had been trained by dentists and infection control nurses. VAP was diagnosed using the Clinical Pulmonary Infection Score. RESULTS: In total, 423 patients were enrolled in the baseline group and 454 patients were enrolled in the intervention group; 303 and 300 patients, respectively, were included in the analysis. Two hundred thirty-eight VAP episodes were identified: 135 (44.6%) during the baseline period and 103 (34.3%) during the intervention period. Univariate analysis revealed significant reduction of VAP occurrence in the intervention period (odds ratio = 0.65; 95% confidence interval = 0.47-0.90; P = 0.010). The incidences of VAP per 1000 ventilator-days were 63.4 (135/2128) during the baseline period and 48.4 (103/2128) during the intervention period (P = 0.038). CONCLUSIONS: Physical oral care without any medication (e.g., chlorhexidine) reduced VAP incidence in the ICU. This method could be used to reduce VAP incidence, particularly in countries with limited medical resources.

The evolutionary background and functional consequences of the rs2071307 polymorphism in human tropoelastin.

Elastin is a major polymeric protein of the extracellular matrix, providing critical properties of extensibility and elastic recoil. The rs2071307 genomic polymorphism, resulting in the substitution of a serine for a glycine residue in a VPG motif in tropoelastin, has an unusually high minor allele frequency in humans. A consequence of such allelic heterozygosity would be the presence of a heterogeneous elastin polymer in up to 50% of the population, a situation which appears to be unique to Homo sapiens. VPG motifs are extremely common in hydrophobic domains of tropoelastins and are the sites of transient ß-turns that are essential for maintaining the conformational flexibility required for its function as an entropic elastomer. Earlier data demonstrated that single amino acid substitutions in tropoelastin can have functional consequences for polymeric elastin, particularly when present in mixed polymers. Here, using NMR and molecular dynamics approaches, we show the rs2071307 polymorphism reduces local propensity for ß-turn formation, with a consequent increase in polypeptide hydration and an expansion of the conformational ensemble manifested as an increased hydrodynamic radius, radius of gyration and asphericity. Furthermore, this substitution affects functional properties of polymeric elastin, particularly in heterogeneous polymers mimicking allelic heterozygosity. We discuss whether such effects, together with the unusually high minor allele frequency of the polymorphism, could imply some some evolutionary advantage for the heterozygous state.

Prevalence of plasma lipid disorders with an emphasis on LDL cholesterol in selected countries in the Asia-Pacific region.

Cardiovascular disease (CVD) is a major cause of mortality and morbidity within the Asia-Pacific region, with the prevalence of CVD risk factors such as plasma lipid disorders increasing in many Asian countries. As members of the Cardiovascular RISk Prevention (CRISP) in Asia network, the authors have focused on plasma lipid disorders in the six countries within which they have clinical experience: Indonesia, Malaysia, Philippines, Thailand, Vietnam, and Australia. Based on country-specific national surveys, the prevalence of abnormal levels of total cholesterol, low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively), and triglycerides (TG) are reported. An important caveat is that countries have used different thresholds to define plasma lipid disorders, making direct comparisons difficult. The prevalence of abnormal lipid levels was as follows: high total cholesterol (30.2-47.7%, thresholds: 190-213 mg/dL); high LDL-C (33.2-47.5%; thresholds: 130-135 mg/dL); low/abnormal HDL-C (22.9-72.0%; thresholds: 39-50 mg/dL); and high/abnormal TG (13.9-38.7%; thresholds: 150-177 mg/dL). Similarities and differences between country-specific guidelines for the management of plasma lipid disorders are highlighted. Based on the authors' clinical experience, some of the possible reasons for suboptimal management of plasma lipid disorders in each country are described. Issues common to several countries include physician reluctance to prescribe high-dose and/or high-intensity statins and poor understanding of disease, treatments, and side effects among patients. Treatment costs and geographical constraints have also hampered disease management in Indonesia and the Philippines. Understanding the factors governing the prevalence of plasma lipid disorders helps enhance strategies to reduce the burden of CVD in the Asia-Pacific region.

Pyronaridine-artesunate Efficacy and Safety in Uncomplicated Plasmodium falciparum Malaria in Areas of Artemisinin-resistant Falciparum in Viet Nam (2017-2018).

BACKGROUND: Multidrug-resistant Plasmodium falciparum undermines the efficacy of currently deployed antimalarial therapies in southern Viet Nam. METHODS: Between May 2017 and December 2018, this prospective, open-label, single-arm, observational clinical trial, conducted in Binh Phuoc, Dak Nong, Gia Lai, Khanh Hoa, and Ninh Thuan provinces, evaluated the safety and efficacy of oral pyronaridine-artesunate once daily for 3 consecutive days in adults and children with microscopically confirmed P. falciparum malaria. Patients were treated as inpatients for Days 0-3, with follow-up visits on Days 7, 14, 21, 28, 35, and 42. The primary outcome was the proportion of polymerase chain reaction (PCR)-adjusted adequate clinical and parasitological response (ACPR) at Day 42. RESULTS: The cumulative incidence of PCR-adjusted ACPR at Day 42 was 96.1% (95% confidence interval [CI] 91.4-98.2; Kaplan-Meier). In the per-protocol analysis, the proportion of patients with Day 42 PCR-adjusted ACPR was 96.1% (147/153; 95% CI 91.7-98.5). The proportion of patients with parasitemia at Day 3 was 24.0% (40/167; 95% CI 17.7-31.2). The prevalences of the Kelch13 (C580Y) mutation were: in Binh Phuoc, 97.7% (43/44); in Dak Nong, 96.2% (25/26); in Gia Lai, 57.8% (37/64); in Khanh Hoa, 66.6% (6/9); and in Ninh Thuan, 3.6% (1/28). The majority of artemisinin-resistant isolates also had increased plasmepsin2 copy number (75.9%; 85/112). There was 1 isolate (Binh Phuoc) that had Kelch13 (C580Y) plus increased plasmepsin2 and Pfmdr1 copy numbers. Asymptomatic transient increases in alanine transaminase and aspartate transaminase were observed at Day 7, resolving by Day 28. CONCLUSIONS: Pyronaridine-artesunate can be used to diversify antimalarial therapy in areas of artemisinin-resistant P. falciparum in Viet Nam. CLINICAL TRIALS REGISTRATION: ACTRN12618001274268.

Efficacy of Microwave Ablation in the Treatment of Large (≥3 cm) Benign Thyroid Nodules.

BACKGROUND: Large (≥3 cm) benign thyroid nodules usually cause clinical symptoms or cosmetic concerns and therefore require treatment. Microwave ablation (MWA) is a potential valid non-surgical treatment alternative, but there is a lack of evidence. Thus, this study is to evaluate the safety and efficacy of MWA in the treatment of large benign thyroid nodules. METHODS: A retrospective study was conducted on 42 large benign thyroid nodules in 40 patients treated with MWA. We used the trans-isthmic approach and moving-shot technique to perform the procedure under ultrasound (US) guidance. Patients were followed by clinical and US examinations at 1, 3, 6, and 12 months after the MWA. Study outcomes were complications, volume reduction ratio (VRR), symptom and cosmetic scores, and the requirement of multiple MWA sessions. RESULTS: There were 31 females and 9 males, with a median age of 46 years. The medians of largest diameter and volume of the nodules were 40 mm and 22 ml. Four (10%) minor complications were observed. The mean VRR was 75.1, 85.2, and 96.4% after 3, 6, and 12 months. The mean symptom and cosmetic scores dropped from 8.0 and 3.8 (before treatment) to 2.8 and 2.3 (at 12 months), respectively. Thirteen nodules (31%) required two MWA sessions. CONCLUSIONS: MWA is safe, effective, and can be a good option to treat large benign thyroid nodules. More studies with large dataset and long follow-up are required to improve its safety and efficacy.

Bexarotene cannot reduce amyloid beta plaques through inhibition of production of amyloid beta peptides: in silico and in vitro study.

Recently, it has been reported that anti-cancer drug bexarotene can remarkably destroy amyloid beta (Aß) plaques in mouse models suggesting therapeutic potential for Alzheimer's disease. However, the effect of bexarotene on clearance of plaques has not been seen in some mouse models. One of the possible mechanisms explaining this phenomenon is that bexarotene levels up expression of apolipoprotein 4 (ApoE4) leading to intracellular clearance of Aß peptide. Therefore, an interesting question emerges of whether bexarotene can destroy Aß plaques by direct interaction with them or by preventing production of Aß peptides. In our previous work we have shown that bexarotene cannot clear amyloid aggregates due to their weak interaction using in silico and in vitro experiments. Here we explore the possibility of inhibiting Aß production through bexarotene binding to ß-secretase which can cleave Aß peptides from amyloid precursor protein. Using the molecular mechanics-Poisson-Boltzmann surface area method and all-atom simulations we have shown that bexarotene has a very low binding affinity to ß-secretase. This result has been also confirmed by our in vitro experiment implying that bexarotene cannot clear amyloid plaques through inhibition of Aß production. We have also shown that bexarotene tightly binds to both peroxisome proliferator-activated receptor γ (PPAR-γ) and retinoid X receptors (RXRs). Thus, our result does not contradict the hypothesis that the reduction of Aß plaques occurs due to bexarotene-induced overexpression of ApoE4.

Discovery of DNA dyes Hoechst 34580 and 33342 as good candidates for inhibiting amyloid beta formation: in silico and in vitro study.

Combining Lipinski's rule with the docking and steered molecular dynamics simulations and using the PubChem data base of about 1.4 million compounds, we have obtained DNA dyes Hoechst 34580 and Hoechst 33342 as top-leads for the Alzheimer's disease. The binding properties of these ligands to amyloid beta (Aß) fibril were thoroughly studied by in silico and in vitro experiments. Hoechst 34580 and Hoechst 33342 prefer to locate near hydrophobic regions with binding affinity mainly governed by the van der Waals interaction. By the Thioflavin T assay, it was found that the inhibition constant IC50 ≈ 0.86 and 0.68 µM for Hoechst 34580 and Hoechst 33342, respectively. This result qualitatively agrees with the binding free energy estimated using the molecular mechanic-Poisson Boltzmann surface area method and all-atom simulations with the AMBER-f99SB-ILDN force field and water model TIP3P. In addition, DNA dyes have the high capability to cross the blood brain barrier. Thus, both in silico and in vitro experiments have shown that Hoechst 34580 and 33342 are good candidates for treating the Alzheimer's disease by inhibiting Aß formation.

Additive and synergistic membrane permeabilization by antimicrobial (lipo)peptides and detergents.

Certain antibiotic peptides are thought to permeabilize membranes of pathogens by effects that are also observed for simple detergents, such as membrane thinning and disordering, asymmetric bilayer expansion, toroidal pore formation, and micellization. Here we test the hypothesis that such peptides act additively with detergents when applied in parallel. Additivity is defined analogously to a fractional inhibitory concentration index of unity, and the extent and mechanism of leakage is measured by the fluorescence lifetime-based vesicle leakage assay using calcein-loaded vesicles. Good additivity was found for the concerted action of magainin 2, the fungicidal lipopeptide class of surfactins from Bacillus subtilis QST713, and the detergent octyl glucoside, respectively, with the detergent C12EO8. Synergistic or superadditive action was observed for fengycins from B. subtilis, as well as the detergent CHAPS, when combined with C12EO8. The results illustrate two mechanisms of synergistic action: First, maximal leakage requires an optimum degree of heterogeneity in the system that may be achieved by mixing a graded with an all-or-none permeabilizer. (The optimal perturbation should be focused to certain defect structures, yet not to the extent that some vesicles are not affected at all.) Second, a cosurfactant may enhance the bioavailability of a poorly soluble peptide. The results are important for understanding the concerted action of membrane-permeabilizing compounds in biology as well as for optimizing formulations of such antimicrobials for medical applications or crop protection.

Effective degradation of tetracycline in aqueous solution by an electro-Fenton process using chemically modified carbon/α-FeOOH as catalyst.

This study applied an electro-Fenton process using chemically modified activated carbon derived from rubber seed shells loaded with α-FeOOH (RSCF) as catalyst to remove tetracycline residues from aquatic environment. Catalyst characteristics were evaluated using SEM, EDS, XRD, and XPS, showing successful insertion of iron onto the activated carbon. The effects of the parameters were investigated, and the highest treatment efficiency was achieved at pH of 3, Fe: H2O2 ratio (w/w) of 500:1, catalyst dose of 1 g/L, initial TCH concentration of 100 mg/L, and electric current of 150 mA, with more than 90% of TCH being eliminated within 30 min. Furthermore, even after five cycles of use, the treatment efficiency remains above 90%. The rate constant is calculated to be 0.218 min-1, with high regression coefficients (R 2 = 0.93). The activation energy (Ea) was found to be 32.2 kJ/mol, indicating that the degradation of TCH was a simple reaction with a low activation energy. These findings showed that the RSCF is a highly efficient and cost-effective catalyst for TCH degradation. Moreover, the use of e-Fenton process has the advantage of high efficiency, low cost thanks to the recyclability of the catalyst, and environmental friendliness thanks to less use of H2O2.

Aortic regurgitation progression after mitral valve replacement for rheumatic heart disease.

OBJECTIVES: Little is known about the fate of untreated moderate aortic regurgitation after mitral valve replacement for rheumatic heart disease. The aim of this study was to compare the progression to significant aortic valve disease of untreated moderate and mild aortic regurgitation after mitral valve replacement for rheumatic heart disease. METHODS: Among patients who underwent mitral valve replacement for rheumatic heart disease without concomitant aortic valve intervention at our institution between January 2005 and December 2017, we selected 338 patients with pure aortic regurgitation (273 patients with mild and 65 patients with moderate aortic regurgitation). RESULTS: After a median follow-up of 10.0 years, 16 patients developed significant aortic valve disease. Freedom from significant aortic valve disease at 3 years, 8 years, and 14 years was 100%, 97.8 ± 1.1%, and 93.5 ± 2.3% in patients with mild aortic regurgitation, and 98.5 ± 1.5%, 94.5 ± 3.2%, and 80.6 ± 7.5% in patients with moderate aortic regurgitation (log-rank test: p = 0.007). Seven patients with mild aortic regurgitation and two patients with moderate aortic regurgitation underwent aortic valve replacement. CONCLUSIONS: After mitral valve replacement for rheumatic heart disease, untreated moderate aortic regurgitation progressed more frequently to significant aortic valve disease compared to untreated mild aortic regurgitation. A marked difference in freedom from significant aortic valve disease occurred after eight years. Aortic valve replacement was rarely needed.

Highly effective synthesis of 5-hydroxymethylfurfural from lignocellulosic biomass over a green and one-pot reaction in biphasic system.

In this study, different types of lignocellulosic biomas were used as substrates for the conversion to 5-HMF via biphasic reaction system that is composed of a reaction phase (aqueous phase) and an extraction phase (organic phase) under the catalysis of various metal salts. Deep eutectic solvents (DESs), ionic liquid [BMIM]Cl, aqueous choline chloride, aqueous betaine hydrochloride, and ethylamine hydrochloride were used as the reaction phase in the combination of dimethyl sulfoxide (DMSO) as organic solvents. The highest yields of 5-HMF obtained from pineapple stems in reactions with DES were 40.98%, 37.26%, and 23.44% for ChCl:Lac, ChCl:OA, and EaCl:Lac, respectively. Moreover, the combination of dimethyl sulfoxide, betaine hydrochloride aqueous solution, and AlCl3·6H2O with the pineapple stem conversion system resulted in a maximum yield of 61.04% ± 0.55% of 5-HMF. This study also demonstrated that AlCl3·6H2O and betaine hydrochloride could be effectively reused four times, which indicates a green and effective process.

Not just if, but how much: Children and adults use cost and need to make evaluations about generosity across contexts.

Evaluations of others' generosity are critical for selecting quality social partners, yet the factors which systematically affect these evaluations and whether they vary across development are still relatively unclear. Here, we establish that two key dimensions adults and children (aged 4 to 7 years) consider are the cost associated with a giving action and the need of the recipient, through six pre-registered experiments with Canadian and U.S. American participants. Experiments 1 and 2 demonstrate that adults' and children's third-party evaluations of generosity are sensitive to variations in each factor, across several operationalizations of cost and need in both comparative and standalone contexts, suggesting cost and need can be spontaneously evoked. However, children's responses were more consistent for need scenarios than cost scenarios. In Experiments 3 and 4, we modified our scenarios to evaluate whether variations in cost and need are considered simultaneously in both generosity evaluations and affiliative preferences. Adults' and older children's (ages 6 to 7) evaluations of generosity and affiliative preferences were sensitive to both factors, but younger children did not utilize this information systematically. Importantly, in Experiments 5 and 6, adults' and older children's generosity evaluations were only sensitive to information about cost and need when the giver's actions conferred utility to a recipient, but not when actions were self-serving. Taken together, we establish robust evidence that cost and need are considered in generosity evaluations by demonstrating that Canadian and U.S. American adults and children utilize this information consistently, spontaneously, and simultaneously.

Combination of deep eutectic solvent and functionalized metal-organic frameworks as a green process for the production of 5-hydroxymethylfurfural and furfural from sugars.

Biomass is an abundant and sustainable resource that can be converted into energy and chemicals. Therefore, the development of efficient methods for the conversion of biomass into platform intermediates is crucial. In this study, the one-pot conversion of sugars into 5-hydroxymethylfurfural (HMF) and furfural was achieved using the metal-organic framework combined with metal ions [MIL-101(Cr)] as a high-activity catalyst, and a deep eutectic solvent (choline chloride and lactic acid) as a green solvent. The optimal temperature, time, amount of catalyst used, and amount of deep eutectic solvent used were all determined. The highest HMF yield of 49.74% and furfural yield of 55.90% were obtained. The recyclability of the catalysts and deep eutectic solvent was also investigated. After three reaction runs, the HMF yield was still nearly 30.00%. Finally, the MIL-101(Cr) catalytic system was selected to study the kinetic mechanism underlying the conversion of glucose into HMF.

Superiority of left heart deformation in early anthracycline-related cardiac dysfunction detection.

OBJECTIVE: This study aimed to assess the incidence of early cancer therapy-related cardiac dysfunction (CTRCD) and the characteristics of left and right heart deformations during anthracycline chemotherapy. METHODS: We prospectively enrolled a cohort of 351 chemotherapy-naïve women with breast cancer and cardiovascular risk factors who were scheduled to receive anthracycline. The left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LV-GLS) and right ventricular and left atrial longitudinal strains were evaluated using echocardiography at baseline, before every subsequent cycles and at 3 weeks after the final anthracycline dose. CTRCD was defined as a new LVEF reduction by ≥10 percentage points to an LVEF<50% and/or a new relative decline in GLS by >15% from the baseline value. RESULTS: Eighteen (5.1%) patients had evidence of asymptomatic CTRCD during anthracycline treatment, and 50% developed CTRCD before completing the chemotherapy regimen. In the CTRCD group, while LV-GLS decrease significantly after the first dose of anthracycline, the reduction of right ventricular free-wall longitudinal strain and left atrial reservoir strain were observed after the second dose. Other strain indices could not be used to identify early CTRCD. CONCLUSIONS: Cardiotoxicity appeared soon after the initiation of anthracycline chemotherapy. Among the left-heart and right-heart mechanics, LV-GLS remains the best deformation indicator for detecting early CTRCD.

The Correlation Between Angiopoietin-Like 3 and Metabolic Markers of Some Lipid and Glucose in Type 2 Diabetes Mellitus Patients at the First Diagnosis.

Purpose: Angiopoietin-Like3 is a protein that plays an important role in regulating plasma triglyceride concentrations by inhibiting the enzyme lipoprotein lipase. Lipid metabolism and glucose metabolism are closely related and interact with each other. ANGPTL3 may also be a factor involved in blood glucose regulation through an increase in free fatty acids generated from enhanced lipolysis in adipose tissue leading to insulin resistance. This study aimed to investigate plasma ANGPTL3 concentrations and their correlation with lipid and glucose metabolic markers in newly diagnosed type 2 Diabetes Mellitus patients. Subject and Methods: A cross-sectional descriptive study was conducted on 98 healthy subjects (control group) and 103 patients with type 2 diabetes at the first diagnosis, without any treatment (patient group). Plasma ANGPTL3 concentration was quantified by the ELISA method. The study determines the correlation of ANGPTL3 concentration with some indicators reflecting lipid and glucose metabolism. Results: The concentration of ANGPTL3 in the newly diagnosed type 2 Diabetes Mellitus patient group was lower than in the control group, the difference was statistically significant with p < 0.05. In the patient group: there was an inverse correlation between ANGPTL3 concentration and HDL-C concentration (r = -0.37; p<0.001), and a positive correlation with triglyceride concentration (r = 0.275; p < 0.05). There was no correlation between plasma ANGPTL3 levels and anthropometric indices, total cholesterol, HDL-C, glucose, HbA1C, insulin, and HOMA-IR. In the control group: there was no correlation between ANGPTL3 and any of the indicators mentioned above. Conclusion: ANGPTL3 levels in newly diagnosed type 2 diabetes mellitus patients were statistically significantly lower than in healthy subjects. Plasma ANGPTL3 was positively correlated with triglyceride levels and inversely correlated with HDL-C levels in newly diagnosed type 2 Diabetes mellitus patients.

Amyloid ß Dodecamer Disrupts the Neuronal Membrane More Strongly than the Mature Fibril: Understanding the Role of Oligomers in Neurotoxicity.

The amyloid cascade hypothesis states that senile plaques, composed of amyloid ß (Aß) fibrils, play a key role in Alzheimer's disease (AD). However, recent experiments have shown that Aß oligomers are more toxic to neurons than highly ordered fibrils. The molecular mechanism underlying this observation remains largely unknown. One of the possible scenarios for neurotoxicity is that Aß peptides create pores in the lipid membrane that allow Ca2+ ions to enter cells, resulting in a signal of cell apoptosis. Hence, one might think that oligomers are more toxic due to their higher ability to create ion channels than fibrils. In this work, we study the effect of Aß42 dodecamer and fibrils on a neuronal membrane, which is similar to that observed in AD patients, using all-atom molecular dynamics simulations. Due to short simulation times, we cannot observe the formation of pores, but useful insight on the early events of this process has been obtained. Namely, we showed that dodecamer distorts the lipid membrane to a greater extent than fibrils, which may indicate that ion channels can be more easily formed in the presence of oligomers. Based on this result, we anticipate that oligomers are more toxic than mature fibrils, as observed experimentally. Moreover, the Aß-membrane interaction was found to be governed by the repulsive electrostatic interaction between Aß and the ganglioside GM1 lipid. We calculated the bending and compressibility modulus of the membrane in the absence of Aß and obtained good agreement with the experiment. We predict that the dodecamer will increase the compressibility modulus but has little effect on the bending modulus. Due to the weak interaction with the membrane, fibrils insignificantly change the membrane elastic properties.

Investigating the Immunomodulatory Potential of Dental Pulp Stem Cell Cultured on Decellularized Bladder Hydrogel towards Macrophage Response In Vitro.

Mesenchymal stem cells (MSCs) possess immunomodulatory properties and capacity for endogenous regeneration. Therefore, MSC therapy is a promising treatment strategy for COVID-19. However, the cells cannot stay in the lung long enough to exert their function. The extracellular matrix from porcine bladders (B-ECM) has been shown not only to regulate cellular activities but also to possess immunoregulatory characteristics. Therefore, it can be hypothesized that B-ECM hydrogel could be an excellent scaffold for MSCs to grow and could anchor MSCs long enough in the lung so that they can exhibit their immunomodulatory functions. In this study, ECM degradation products and a co-culture system of MSCs and macrophages were developed to study the immunomodulatory properties of ECM and MSCs under septic conditions. The results showed that B-ECM degradation products could decrease pro-inflammatory and increase anti-inflammatory cytokines from macrophages. In an in vivo mimicking co-culture system, MSCs cultured on B-ECM hydrogel exhibited immunomodulatory properties at both gene and protein levels. Both B-ECM degradation products and MSC conditioned medium supported the wound healing of alveolar epithelial cells. The results from the study could offer a basis for investigation of immunomodulation by ECM and MSCs before conducting in vivo experiments, which could later be applied in regenerative medicine.

Diagnostic imaging in a patient with an isolated blunt traumatic gallbladder injury.

Isolated gallbladder injuries are very uncommon in blunt abdominal trauma due to its small size. Further, they are well protected by the surrounding liver, omentum, and the rib cage. A case of traumatic gallbladder injury in a 47-year-old man with progressive right hypochondrial pain is presented. The gallbladder injury was caused due to a blunt abdominal trauma after a motor vehicle accident. The patient had a history of chronic alcoholism and narcotics abuse. The patient was also human immunodeficiency virus-positive and was on stable treatment for tuberculosis. A diagnosis of gallbladder contusion with intramural dissection was made after an ultrasound and computed tomography scan. However, the patient refused surgery and thus, an ultrasound-guided percutaneous transhepatic drainage of the gallbladder was performed as a temporary treatment. Subsequently, a successful cholecystectomy was performed. Isolated traumatic gallbladder injury has been reviewed due to the rarity of this condition and the diagnostic challenges it poses.

Predictability of Fused 3D-T2-SPACE and 3D-TOF-MRA Images in Identifying Conflict in Trigeminal Neuralgia.

PURPOSE: To evaluate the efficacy of fused three-dimensional T2 sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) and three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) sequences for detecting neurovascular compression (NVC) in patients presenting with trigeminal neuralgia (TN). METHODS: A prospective study was carried in 33 consecutive patients (m/f: 17/16; mean age, 56.3 ± 10.4 years) with unilateral TN confirmed NVC and consensus by two experienced radiologists on fused 3D-SPACE and 3D-TOF-MRA sequences of 3-tesla (3-T) MRI. All patients underwent microvascular decompression (MVD), using photos and video in surgery as documents compared with MRI. Both the MRI and MVD were reported for three grades (contact, compression, distortion), vessel types (artery or vein), identification of offending vessel, site (juxtapontine, cisternal, and juxtapetrous), and location (cranial, caudal, medial, lateral). Agreement between preoperative MRI visualization and surgical findings was assessed using the kappa (K) statistic. RESULTS: The k-values for the agreement were excellent for the grade of NVC (k=0.82), vessel types (k=0.78), and location of conflict (k=0.74), and good for identification of the offending vessel (0.65) and the site-affected vessel (k=0.69). CONCLUSION: The fused D3-SPACE and 3D-TOF-MRA images are highly effective tools for the evaluation and treatment planning of NVC in TN patients.

Correlation between the ankle-brachial index and microalbuminuria with certain risk factors in type 2 diabetes patients.

The ankle-brachial index (ABI) is a fast, simple, noninvasive method that provides accurate results in the early diagnosis of peripheral artery disease. Microalbuminuria is considered a predictor of renal and cardiovascular complications in patients with diabetes. This study was conducted to determine the correlation between ABI and microalbuminuria with certain risk factors in patients with type 2 diabetes. SUBJECTS AND RESEARCH METHODS: A cross-sectional descriptive study was performed on 62 inpatients with type 2 diabetes. All patients were measured for ABI as well as microalbuminuria, HbA1c, glucose and lipidemia in the blood. RESULTS: The study results showed that in patients with dyslipidemia, the risk of having microalbuminuria (+) increased 5.7 times and ABI ≤0.90 increased 8.6 times (P = 0.004 and 0.021, respectively). Fasting blood glucose >7.2 mmol/L had 5.7 times higher microalbuminuria (+) risk and 8.6 times higher ABI ≤0.90 (P = 0.004 and 0.021, respectively). Patients with HbA1c ≥7% were 2.9 times more likely to have microalbuminuria (+) and ABI ≤0.90 (P = 0.043 and 0.048, respectively). CONCLUSIONS: Peripheral vascular disease risk factors such as hypertension, dyslipidemia and waist circumference and the effectiveness of fasting blood glucose and HbA1c control increased the risk of high microalbuminuria and ABI in patients with type 2 diabetes.