The 5th IEEE International Conference on Renewable Energy Research and Applications (ICRERA 2016)

Custom designing laryngoplasty implant using actual size CT scan images on a mobile device

Clinical Otolaryngology, EarlyView.

Synthesis and characterization of anthill-eggshell composite adsorbent for removal of hexavalent chromium from aqueous solution

Abstract

In this study, adsorption behavior of anthill-eggshell composite (AEC) for the removal of hexavalent chromium (Cr⁶⁺) from aqueous solution was investigated. The raw AEC sample was thermally treated at 864 °C for 4 h and characterized using Brunauer-Emmett-Teller (BET), scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), and X-ray fluorescence (XRF) techniques. The effects of adsorption process variables including initial Cr⁶⁺ concentration, contact time, and adsorbent dosage on the Cr⁶⁺ removal efficiency were investigated using central composite design (CCD) of response surface methodology (RSM). Equilibrium adsorption isotherm and kinetic were also studied. From the analysis of variance (ANOVA), the three variables proved to be significant and the optimum conditions for Cr⁶⁺ adsorption were obtained to be 150 mg/L initial Cr⁶⁺ concentration, 45.04-min contact time, and 0.5 g adsorbent dosage, which resulted in 86.21% of Cr⁶⁺ adsorbed. Equilibrium isotherm study showed that Freundlich model fitted well to the experimental data. The pseudo-second-order kinetic model appeared to better describe the experimental data. The study showed that mixed anthill-eggshell is a promising adsorbent for removing Cr⁶⁺ from aqueous solution.

The predominant phytoplankton of Pseudoanabaena holding specific biosynthesis gene-derived occurrence of 2-MIB in a drinking water reservoir

Abstract

With the increasing occurrence of water eutrophication and blooms, earthy-musty odor problems caused by cyanobacteria have been more and more apparent. These problems have a serious impact on aquatic ecosystems and drinking water safety and become one of the priorities of the water environment researches and managements. In the present study, genes associated with 2-MIB synthesis in cyanobacteria were studied by systematic investigation on molecular characterization and quantity of 2-MIB-producing cyanobacteria in China. Our results founded that Pseudoanabaena is an important 2-MIB-producing phytoplankton and predominant in summer in Qingcaosha reservoir, and the copy number of mic and 2-MIB concentration have strongly positive correlation. We also demonstrated that abundance of mic in water was significant correlation with that in sediment. These results will help us to understand the main taxa of the odoriferous cyanobacteria in the water bodies in China, understand the genetic basis of the odor substances in the cyanobacteria. Rapid, reliable monitoring and ecological research methods for the production of odor cyanobacteria in water bodies can be established based on these results.

Identification of Chronic Active Multiple Sclerosis Lesions on 3T MRI [ADULT BRAIN]

BACKGROUND AND PURPOSE:

MR imaging–pathologic studies have reported that paramagnetic rims on 7T susceptibility-based MR imaging identify, in vivo, the subset of MS lesions with compartmentalized inflammation at the lesion edge and associated remyelination failure. Here, we assessed the reliability of detecting these rims on high-resolution 3T phase images.

MATERIALS AND METHODS:

High-resolution T2* and phase MR imaging was collected in 20 patients with MS at 3T (3D segmented EPI, 0.65 mm³) and 7T (2D gradient-echo, 0.2 x 0.2 x 1 mm) MR imaging. In each case, 5 discrete chronic (nonenhancing) MS lesions were selected on T2 FLAIR images for rim evaluation. Five raters experienced in MS imaging contributed to the rim assessment, of whom 3 worked independently on 3T data, and 2, on 7T data. Consensus agreement was reached for both 3T and 7T rim evaluations. Discrepancies between 3T and 7T were discussed, and consensus was reached.

RESULTS:

Phase rims were seen in 34 lesions at 7T and in 36 lesions at 3T by consensus. Inter- and intrarater reliability were "substantial/good" both at 3T and 7T analysis (Cohen , >0.71). Based on consensus agreement, the reliability of rim visualization at 3T versus 7T was 0.78 () with a pair-wise agreement of 90%. More lesions were judged to be false-positive or false-negative at 3T than at 7T.

CONCLUSIONS:

Nearly all 7T paramagnetic rims can also be seen at 3T. Imaging at 3T opens the possibility of implementing paramagnetic rims as an outcome measure in multicenter, MR imaging–based clinical trials aimed at treating perilesional persistent inflammation and its potential effects on remyelination.

Role of the Apparent Diffusion Coefficient as a Predictor of Tumor Progression in Patients with Chordoma [HEAD & NECK]

BACKGROUND AND PURPOSE:

Diffusion-weighted imaging may aid in distinguishing aggressive chordoma from nonaggressive chordoma. This study explores the prognostic role of the apparent diffusion coefficient in chordomas.

MATERIALS AND METHODS:

Sixteen patients with residual or recurrent chordoma were divided postoperatively into those with an aggressive tumor, defined as a growing tumor having a doubling time of <1 year, and those with a nonaggressive tumor on follow-up MR images. The ability of the ADC to predict an aggressive tumor phenotype was investigated by receiver operating characteristic analysis. The prognostic role of ADC was assessed using a Kaplan-Meier curve with a log-rank test.

RESULTS:

Seven patients died during a median follow-up of 48 months (range, 4–126 months). Five of these 7 patients were in the aggressive tumor group, and 2 were in the nonaggressive tumor group. The mean ADC was significantly lower in the aggressive tumor group than in the nonaggressive tumor group (P = .002). Receiver operating characteristic analysis showed that a cutoff ADC value of 1.494 x 10^–3x mm²/s could be used to diagnose aggressive tumors with an area under the curve of 0.983 (95% CI, 0.911–1.000), a sensitivity of 1.000 (95% CI, 0.541–1.000), and a specificity of 0.900 (95% CI, 0.555–0.998). Furthermore, a cutoff ADC of ≤1.494 x 10^–3x mm²/s was associated with a significantly worse prognosis (P = .006).

CONCLUSIONS:

Lower ADC values could predict tumor progression in postoperative chordomas.

Diffusion-Weighted Imaging and Diffusion Tensor Imaging for Differentiating High-Grade Glioma from Solitary Brain Metastasis: A Systematic Review and Meta-Analysis [ADULT BRAIN]

BACKGROUND:

Accurate diagnosis of high-grade glioma and solitary brain metastasis is clinically important because it affects the patient's outcome and alters patient management.

PURPOSE:

To evaluate the diagnostic performance of DWI and DTI for differentiating high-grade glioma from solitary brain metastasis.

DATA SOURCES:

A literature search of Ovid MEDLINE and EMBASE was conducted up to November 10, 2017.

STUDY SELECTION:

Studies evaluating the diagnostic performance of DWI and DTI for differentiating high-grade glioma from solitary brain metastasis were selected.

DATA ANALYSIS:

Summary sensitivity and specificity were established by hierarchic logistic regression modeling. Multiple subgroup analyses were also performed.

DATA SYNTHESIS:

Fourteen studies with 1143 patients were included. The individual sensitivities and specificities of the 14 included studies showed a wide variation, ranging from 46.2% to 96.0% for sensitivity and 40.0% to 100.0% for specificity. The pooled sensitivity of both DWI and DTI was 79.8% (95% CI, 70.9%–86.4%), and the pooled specificity was 80.9% (95% CI, 75.1%–85.5%). The area under the hierarchical summary receiver operating characteristic curve was 0.87 (95% CI, 0.84–0.89). The multiple subgroup analyses also demonstrated similar diagnostic performances (sensitivities of 76.8%–84.7% and specificities of 79.7%–84.0%). There was some level of heterogeneity across the included studies (I² = 36%); however, it did not reach a level of concern.

LIMITATIONS:

The included studies used various DWI and DTI parameters.

CONCLUSIONS:

DWI and DTI demonstrated a moderate diagnostic performance for differentiation of high-grade glioma from solitary brain metastasis.

Imaging Differences between Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis: A Multi-Institutional Study in Japan [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Both clinical and imaging criteria must be met to diagnose neuromyelitis optica spectrum disorders and multiple sclerosis. However, neuromyelitis optica spectrum disorders are often misdiagnosed as MS because of an overlap in MR imaging features. The purpose of this study was to confirm imaging differences between neuromyelitis optica spectrum disorders and MS with visually detailed quantitative analyses of large-sample data.

MATERIALS AND METHODS:

We retrospectively examined 89 consecutive patients with neuromyelitis optica spectrum disorders (median age, 51 years; range, 16–85 years; females, 77; aquaporin 4 immunoglobulin G–positive, 93%) and 89 with MS (median age, 36 years; range, 18–67 years; females, 68; relapsing-remitting MS, 89%; primary-progressive MS, 7%; secondary-progressive MS, 2%) from 9 institutions across Japan (April 2008 to December 2012). Two neuroradiologists visually evaluated the number, location, and size of all lesions using the Mann-Whitney U test or the Fisher exact test.

RESULTS:

We enrolled 79 patients with neuromyelitis optica spectrum disorders and 87 with MS for brain analysis, 57 with neuromyelitis optica spectrum disorders and 55 with MS for spinal cord analysis, and 42 with neuromyelitis optica spectrum disorders and 14 with MS for optic nerve analysis. We identified 911 brain lesions in neuromyelitis optica spectrum disorders, 1659 brain lesions in MS, 86 spinal cord lesions in neuromyelitis optica spectrum disorders, and 102 spinal cord lesions in MS. The frequencies of periventricular white matter and deep white matter lesions were 17% and 68% in neuromyelitis optica spectrum disorders versus 41% and 42% in MS, respectively (location of brain lesions, P < .001). We found a significant difference in the distribution of spinal cord lesions between these 2 diseases (P = .024): More thoracic lesions than cervical lesions were present in neuromyelitis optica spectrum disorders (cervical versus thoracic, 29% versus 71%), whereas they were equally distributed in MS (46% versus 54%). Furthermore, thoracic lesions were significantly longer than cervical lesions in neuromyelitis optica spectrum disorders (P = .001), but not in MS (P = .80).

CONCLUSIONS:

Visually detailed quantitative analyses confirmed imaging differences, especially in brain and spinal cord lesions, between neuromyelitis optica spectrum disorders and MS. These observations may have clinical implications.

Endovascular Treatment of Dural Arteriovenous Fistulas Using Transarterial Liquid Embolization in Combination with Transvenous Balloon-Assisted Protection of the Venous Sinus [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Sinus-preserving endovascular embolization was described as a promising treatment technique for dural arteriovenous fistulas. Our aim was to report our single-center experience in patients with dural arteriovenous fistulas who were treated with transarterial liquid embolization in combination with transvenous balloon-assisted protection of the affected venous sinus.

MATERIALS AND METHODS:

A retrospective analysis of a prospectively collected data base was performed. Demographic and clinical data, angiographic features of the dural arteriovenous fistulas, procedural parameters, complications, treatment success, follow-up imaging, and clinical outcome were assessed.

RESULTS:

Twenty-two patients were treated in 25 procedures. All patients were symptomatic, of whom 81.8% presented with tinnitus; 9.1%, with ocular symptoms; and 9.1%, with headache. Most fistulas were located at the transverse and/or sigmoid sinus. The most frequent fistula type was Cognard IIa+b (40.9%), followed by Cognard I (31.8%) and Cognard IIa (27.3%)/Borden I (59.1%), followed by Borden II (40.9%). The affected sinus could be preserved in all except for 1 patient in whom it was sacrificed in a second treatment procedure by coil embolization. The overall complete occlusion rate was 86.4%. The overall complication rate was 20%, with transient and permanent morbidity and mortality of 8%, 0%, and 0%, respectively. After a mean follow-up of 18 months, most patients (68.2%) achieved complete symptom remission, 27.3% showed symptom relief, and 4.6% had stable symptoms.

CONCLUSIONS:

Transarterial liquid embolization of dural arteriovenous fistulas in combination with transvenous balloon-assisted protection of the venous sinus is feasible and safe and offers high rates of occlusion and of symptom remission.

{beta}-Hydroxybutyrate Detection with Proton MR Spectroscopy in Children with Drug-Resistant Epilepsy on the Ketogenic Diet [PEDIATRICS]

BACKGROUND AND PURPOSE:

The ketogenic diet, including both classic and modified forms, is an alternative to antiepileptic medications used in the treatment of drug-resistant epilepsy. We sought to evaluate the utility of proton MR spectroscopy for the detection of β-hydroxybutyrate in a cohort of children with epilepsy treated with the ketogenic diet and to correlate brain parenchymal metabolite ratios obtained from spectroscopy with β-hydroxybutyrate serum concentrations.

MATERIALS AND METHODS:

Twenty-three spectroscopic datasets acquired at a TE of 288 ms in children on the ketogenic diet were analyzed with LCModel using a modified basis set that included a simulated β-hydroxybutyrate resonance. Brain parenchymal metabolite ratios were calculated. Metabolite ratios were compared with serum β-hydroxybutyrate concentrations, and partial correlation coefficients were calculated using patient age as a covariate.

RESULTS:

β-hydroxybutyrate blood levels were highly correlated to brain β-hydroxybutyrate levels, referenced as either choline, creatine, or N-acetylaspartate. They were inversely but more weakly associated with N-acetylaspartate, regardless of the ratio denominator. No strong concordance with lactate was demonstrated.

CONCLUSIONS:

Clinical MR spectroscopy in pediatric patients on the ketogenic diet demonstrated measurable β-hydroxybutyrate, with a strong correlation to β-hydroxybutyrate blood levels. These findings may serve as an effective tool for noninvasive monitoring of ketosis in this population. An inverse correlation between serum β-hydroxybutyrate levels and brain tissue N-acetylaspartate suggests that altered amino acid handling contributes to the antiepileptogenic effect of the ketogenic diet.

Clinical Outcomes of Endovascular Treatment within 24 Hours in Patients with Mild Ischemic Stroke and Perfusion Imaging Selection [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Endovascular thrombectomy has been accepted as the standard of care for patients with acute ischemic stroke. Our aim was to investigate the clinical outcomes of patients with mild ischemic stroke with acute proximal large-vessel occlusion after endovascular treatment within 24 hours of symptom onset.

MATERIALS AND METHODS:

Between January 2014 and August 2017, ninety-three Chinese patients with mild ischemic stroke (NIHSS scores, 0–8) and large-vessel occlusion with endovascular treatment were retrospectively enrolled from 7 comprehensive stroke centers. They were divided into 2 groups: ≤6 hours and 6–24 hours from symptom onset to groin puncture. We analyzed their modified Rankin Scale scores at 90 days, symptomatic intracranial hemorrhage at 48 hours, and mortality during 90 days. Multivariable linear regression analysis was used to identify predictors for NIHSS shift after discharge.

RESULTS:

Twenty-nine patients received endovascular treatment within 6–24 hours after symptom onset and had an imaging mismatch based on perfusion CT or diffusion-weighted MR imaging. There were no substantial differences between the 2 groups in 90-day functional independence (P = .54) and the risks of the combination of symptomatic intracranial hemorrhage and death (P = .72). Two significant indicators of NIHSS shift were 48-hour symptomatic intracranial hemorrhage (unstandardized β = 7.28; 95% CI, 3.48–11.1; P < .001) and baseline systolic blood pressure (unstandardized β = 0.08; 95% CI, 0.03–0.14; P = .005).

CONCLUSIONS:

Patients with mild ischemic stroke and large-vessel occlusion in the anterior circulation, an imaging mismatch, and endovascular treatment within 6–24 hours of initial symptoms showed no heterogeneity in the efficacy and safety outcome compared with those treated ≤6 hours from symptom onset.

Postcontrast T1 Mapping for Differential Diagnosis of Recurrence and Radionecrosis after Gamma Knife Radiosurgery for Brain Metastasis [ADULT BRAIN]

BACKGROUND AND PURPOSE:

The differential diagnosis of radionecrosis and tumor recurrence in brain metastases is challenging. We investigated the diagnostic efficiency of postcontrast T1 mapping in solving this problem.

MATERIALS AND METHODS:

Between March 2016 and June 2017, fifty-six patients with brain metastases who underwent contrast-enhanced cerebral T1 mapping were recruited for this prospective study. The findings revealed new enhancement after gamma knife radiosurgery. The subjects were assigned to radionecrosis and recurrence groups based on follow-up (median, 11.5 months) and histopathologic results. T1 values of lesions 5 (T1_5min) and 60 (T1_60min) minutes after administration of contrast agent and their difference (T1_differ) were compared between the 2 groups with the 2-tailed Mann-Whitney U test. Receiver operating characteristic curves were used to determine the optimum cutoff values for differential diagnosis.

RESULTS:

There were significant differences between the 2 groups in T1_5min, T1_60min, and T1_differ values (P = .012, P = .004, and P < .001, respectively). Relative to T1_5min and T1_60min, T1_differ exhibited greater sensitivity and specificity (P < .001, respectively) in identifying radionecrosis. The optimum T1_differ value for differential diagnosis was 71.1 ms (area under the curve = 0.97; 95% CI, 0.93–1.00), with sensitivity and specificity of 81.5% and 96.5%, respectively.

CONCLUSIONS:

Postcontrast T1 mapping is optimal for the differential diagnosis of radionecrosis and tumor recurrence. Among T1 parameters, T1_differ is the most powerful parameter for differential diagnosis. Advantages in terms of quantitative analysis and high resolution portend the wide use of postcontrast T1 mapping in the future.

CSF Pressure Change in Relation to Opening Pressure and CSF Volume Removed [SPINE]

BACKGROUND AND PURPOSE:

Idiopathic intracranial hypertension is a complex neurologic disorder resulting from increased intracranial pressure. Our aim was to determine whether a correlation exists between the CSF pressure-volume relationship, specifically the craniospinal elastance and pressure-volume index, in patients with idiopathic intracranial hypertension and whether opening pressure affects this relationship.

MATERIALS AND METHODS:

Lumbar punctures performed for suspected idiopathic intracranial hypertension from 2006 to 2017 were identified. Opening and closing pressures, CSF volume removed, and clinical diagnosis of idiopathic intracranial hypertension were obtained from the medical records. The craniospinal elastance (pressure change per milliliter of CSF removed) and pressure-volume index were calculated, and the Pearson correlation coefficients between both the craniospinal elastance and pressure-volume index and opening pressure were determined. Linear regression models of craniospinal elastance and the pressure-volume index and interaction terms with opening pressure were assessed for covariate influence on this association.

RESULTS:

One hundred sixteen patients were included in the final analysis. The mean craniospinal elastance according to opening pressure group was 0.52 ± 0.18 for <20 cm H₂O, 0.57 ± 0.20 for 20–29 cm H₂O, 0.91 ± 0.28 for 30–39 cm H₂O, and 1.20 ± 0.25 for ≥40 cm H₂O. There was a positive linear association between opening pressure and craniospinal elastance with a 0.28 cm H₂O/mL increase in craniospinal elastance (standard error = 0.03, P < .001) for every 10 cm H₂O increase in opening pressure. Of the covariables analyzed, only age older than 50 years and total volume of CSF removed affected this association.

CONCLUSIONS:

As opening pressure increases, the craniospinal elastance increases in a linear fashion while the pressure-volume index decreases. Further studies are needed to determine whether these changes relate to the underlying pathophysiology of idiopathic intracranial hypertension or simply represent established CSF volume pressure dynamics.

Brian C. Bowen, MD, PhD [MEMORIAL]

In situ synthesis of g-C 3 N 4 /TiO 2 heterojunction nanocomposites as a highly active photocatalyst for the degradation of Orange II under visible light irradiation

Abstract

As a highly active photocatalyst, g-C₃N₄/TiO₂ heterojunction nanocomposites were in situ synthesized by simple ultrasonic mixing and calcination by using TiO₂ and melamine as precursors. The morphology and structure of the prepared photocatalysts were characterized by field emission scanning electron microscopy, transmission electron microscopy, X-ray diffraction, Fourier-transform infrared spectroscopy, UV-Vis diffuse reflectance spectroscopy, and X-ray photoelectron spectroscopy. The photocatalytic activities of g-C₃N₄/TiO₂ nanocomposites to degrade Orange II (AO7) under visible light irradiation were evaluated. Results showed that the photocatalytic rate of the prepared g-C₃N₄/TiO₂ photocatalyst to degrade AO7 was about three times than that of pristine TiO₂ and g-C₃N₄. The g-C₃N₄/TiO₂ composite with a ratio of 1:4 had the highest degradation efficiency for AO7 solution. Its degradation efficiency under acidic conditions was significantly higher than that under alkaline conditions. The enhancement of photocatalytic activity can be attributed to the formation of heterojunctions between g-C₃N₄ and TiO₂, which leads to rapid charge transfer and the efficient separation of photogenerated electron-hole pairs. The recycling experiment indicated that the photocatalyst of g-C₃N₄/TiO₂ nanocomposites still maintained good photochemical stability and recyclability after five cycles; this finding was important for its practical applications. A series of free radical trapping experiments showed that •O₂⁻ played a crucial role in the degradation of AO7.

Graphical Abstract

ᅟ

Maintenance of therapeutic response over one year using apremilast combination therapy compared to monotherapy for the treatment of plaque psoriasis: a multicenter, retrospective study

Color Atlas of Oral Diseases, 4th Edition

Folgen für Kinder nach zytotoxischer Therapie in der Schwangerschaft

Zusammenfassung

Hintergrund

Eine bösartige Erkrankung in der Schwangerschaft ist selten, tritt jedoch zunehmend häufiger auf, da das Alter von Erstgebärenden zunimmt. Mit einer notwendigen Therapie soll nicht bis zum Ende der Schwangerschaft gewartet werden. Das Wissen über die Folgen einer Chemotherapie in der Schwangerschaft basiert allerdings lediglich auf Fallberichten, kleinen Serien und relativ kurzen Nachbeobachtungszeiträumen.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed sowie einer Auswertung von Expertenempfehlungen.

Ziel

Der Beitrag fasst die vorhandene Evidenz bezüglich Kurz- und Langzeitfolgen für Kinder nach Chemotherapieexposition in utero zusammen.

Schlussfolgerungen

Eine Chemotherapie in der Schwangerschaft hat nach Abschluss des ersten Trimesters geringe Folgen für die Kinder. Frühgeburten sind häufiger, jedoch meist iatrogen bedingt und sollten auf Grund der erhöhten neonatalen Morbidität möglichst vermieden werden. In den vorhandenen Daten zeigt sich kein negativer Einfluss einer Chemotherapie auf die neurologische und kognitive Entwicklung der Kinder. Auch zeigen vorhandene Langzeitdaten keine erhöhten kardialen Risiken. Zusätzliche Studien sind jedoch notwendig, um die Risiken einer Chemotherapie während der Schwangerschaft weiter einzuschätzen, iatrogene Frühgeburten zu vermeiden und die Langzeitfolgen im Erwachsenenalter, insbesondere für neu entwickelte Chemotherapeutika, dessen Einsatz in der Schwangerschaft noch nicht untersucht wurde, zu verstehen.

Endosseous Implantation After Reconstruction of the Mandible for Osteoradionecrosis

This cohort study compares the outcomes of primary vs secondary dental implantation after a fibula free tissue transfer for osteoradionecrosis and osteonecrosis of the mandible.

Local Anesthesia Shortages—Adapting to a New Way of Life

To the Editor Over the past several months, there have been increasing numbers of medication shortages throughout North America, exacerbated (but not solely caused) by Hurricane Maria's effect on the pharmaceutical manufacturing industry on the island of Puerto Rico. Medication shortages are affecting health care facilities in new ways on a weekly basis without imminent solutions. In particular, within the field of facial plastic and reconstructive surgery, we have noted a shortage in formulations of lidocaine and bupivacaine. We have received various sizes of bottles of these anesthetics in varying concentrations with varying concentrations of epinephrine, further complicating our "typical" anesthesia protocol. Our clinic's typical anesthesia was a 1:1 mixture of lidocaine, 1%, with a dilutional ratio of 1:100 000 and bupivacaine, 0.5%, with a dilutional ratio of 1:200 000.