Thomsonmedlin4595

PURPOSE This study focused on determining risks from stereotactic radiotherapy using flattening filter-free (FFF) beams for patients with cardiac implantable electronic device (CIEDs). Two strategies were employed a) a retrospective analysis of patients with CIEDs who underwent stereotactic radiosurgery (SRS)/SBRT at the Peter MacCallum Cancer Centre between 2014 and 2018 and b) an experimental study on the impact of FFF beams on CIEDs. METHODS A retrospective review was performed. Subsequently, a phantom study was performed using 30 fully functional explanted CIEDs from two different manufacturers. Irradiation was carried out in a slab phantom with 6-MV and 10-MV FFF beams. First, a repetition-rate test (RRT) with a range of beam pulse frequencies was conducted. Then, multifraction SBRT (48 Gy/4 Fx) and single-fraction SBRT (28 Gy/1 Fx) treatment plans were used for lung tumors delivered to the phantom. RESULTS Between 2014 and 2018, 13 cases were treated with an FFF beam (6 MV, 1400 MU/min or 10 MV, 2400 MUion of Physicists in Medicine.INTRODUCTION Necrotizing Periodontitis (NP) is an atypical and painful form of periodontal disease, it is described by a promptly progress of ulceration and destruction of periodontal tissues; the NP is commonly linked to HIV-positive patients. The aim of this report is to present a rare case of severe necrotizing ulcerative periodontitis treated non-surgically. CASE PRESENTATION A 28-year-old dark skin female patient was referred to a dentistry college with the main complaint of spontaneous gingival bleeding and enlargement, oral pain during deglutition and dental hypersensitivity. Clinical and radiographic examination revealed generalized severe periodontal destruction, extensive bleeding, increased biofilm presence and spontaneous suppuration. Medical exams were requested, red and white blood cells were evaluated and among those exams an enzyme-linked immunosorbent assay (ELISA) for HIV-1 antibodies, the result reveled reagent to HIV-1. The diagnosis of NP was assigned based on periodontal parameters such as necrosis and ulceration of the coronal portion of interdental papillae and gingival margin. Treatment established was scaling and root planining plus antibiotics. At three months of treatment the clinical and periodontal condition were stable. CONCLUSION This case report highlights a severe and generalized form of NP, where periodontal non-surgical associated with antimicrobials resulted in elimination of the gingival enlargement, necrosis and ulceration of the coronal portion of interdental papillae and significant improvement of periodontal parameters. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.OBJECTIVE Despite the known benefits of physical activity, high numbers of people with rheumatoid arthritis (RA) remain physically inactive and sedentary. Little is known about the determinants of sedentary behavior (SB) in RA. This cross-sectional study examined a range of pain characteristics and RA-related symptoms and their relationship with objectively measured SB. METHODS Seventy-six adults with RA wore an ActivPAL4™ accelerometer over a 7-day period. Pain characteristics (pain intensity, painful joint count, non-articular pain), fatigue, sleep, depression, anxiety and disease activity were assessed. Analyses were first conducted to evaluate correlations with sedentary time. The independent contribution of pain characteristics to variation in SB was analyzed with multivariable linear regression (adjusted for demographics and disease activity). RESULTS Participants with valid accelerometer data (n=72) spent an average (± SD) of 533.7 (±100.1) min/day in SB. Positive associations with daily SB were found for pain intensity (r = 0.31, p less then 0.01) and number of painful joints (r = 0.24, p less then 0.05), but not non-articular pain. In multivariable analyses pain characteristics were not independently associated with SB. Analyses indicated that disease activity had an indirect association with SB, mediated by pain intensity. Other correlates of daily SB included anxiety and depression but not fatigue or sleep. CONCLUSION Results suggest while pain and other RA-related factors do play a role in SB, they do not appear to have a significant influence after accounting for other variables. Future research should investigate SB and the role of factors unrelated to the symptoms of RA. This article is protected by copyright. All rights reserved.OBJECTIVE Magnetic resonance imaging (MRI) is pivotal in the assessment of early sacroiliitis in children. We aimed to evaluate the agreement between local radiology reports and central imaging reviewers for active inflammation and structural damage at the sacroiliac joints (SIJs). METHODS Eight hospitals each contributed up to 20 cases of consecutively imaged children and adolescents with juvenile idiopathic arthritis and suspected sacroiliitis. Studies were independently reviewed by 3 experienced musculoskeletal pediatric radiologists. Local assessments of global impression and lesions were coded from the local radiology reports by two study team members. Test properties of local reports were calculated using the central imaging team's majority as the reference standard. RESULTS For 120 evaluable subjects, median age was 14 years, half of cases were male, and median disease duration at time of imaging was 0.8 years (IQR 0-2). Sensitivity, 93.5% (95% CI 78.6-99.2%), and specificity, 69.7% (95% CI 59.0-79.0%), of local reports for inflammation were high and moderate, respectively, but positive predictive value (PPV) was low 51.8% (95% CI 38.0-65.3%). Twenty-seven (23%) cases had active inflammation reported locally but rated normal centrally, nineteen (70%) with subsequent medication changes. click here Sensitivity of local reports detecting structural damage was low, 45.7% (95% CI 28.8-63.4%), and specificity, 88.2% (95% CI 79.4-94.2%), was high; PPV was low 61.5% (95% CI 40.6-79.8%). CONCLUSION Substantial variation exists in the interpretation of inflammatory and structural lesions at the SIJs in children. In order to reliably identify pathology, additional training in the MR appearance of the maturing SIJ is greatly needed. This article is protected by copyright. All rights reserved.The phytochrome B (phyB) photoreceptor plays a major role that inputs light signals to regulate seed dormancy and germination. PHYTOCHROME-INTERACTING FACTOR1 (PIF1) is a key transcription factor repressing phyB-mediated seed germination, while REVEILLE1 (RVE1) transcription factor functions as a curial regulator in controlling both seed dormancy and germination. However, the relationship between the PIF1- and RVE1-modulated signaling pathways remains mostly unknown. Here, we find that PIF1 physically interacts with RVE1. Genetic analysis indicates that RVE1 inhibition on seed germination requires PIF1; reciprocally, the repressive effect of PIF1 is partially dependent on RVE1. Strikingly, PIF1 and RVE1 directly bind to the promoter and activate the expression of each other. Furthermore, PIF1 and RVE1 coordinately regulate the transcription of many downstream genes involved in abscisic acid and gibberellin pathways. Moreover, PIF1 enhances the DNA-binding ability and transcriptional repression activity of RVE1 in regulating GIBBERELLIN 3-OXIDASE2, and RVE1 promotes PIF1's DNA-binding ability in modulating ABSCISIC ACID-INSENSITIVE3 expression. Thus, this study demonstrates that PIF1 and RVE1 form a transcriptional feedback loop that coordinately inhibits seed germination, providing a mechanistic understanding of how phyB-mediated light signal is transduced to the seeds. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.Placobranchus ocellatus is well known to produce diverse and complex γ -pyrone polypropionates. In this study, the chemical investigation of P. ocellatus from the South China Sea led to the discovery of ocellatusones A-D, a series of racemic non- γ -pyrone polyketides with novel skeletons, characterized by a bicyclo[3.2.1]octane ( 1 , 2 ), a bicyclo[3.3.1]nonane ( 3 ) or a mesitylene-substituted dimethylfuran-3(2 H )-one core ( 4 ). Extensive spectroscopic analysis, quantum chemical computation, chemical synthesis, and/or X-ray diffraction analysis were used to determine the structure and absolute configuration of the new compounds, including each enantiomer of racemic compounds 1 - 4 after chiral HPLC resolution. An array of new and diversity-generating rearrangements is proposed to explain the biosynthesis of these unusual compounds based on careful structural analysis and comparison with six known co-occurring γ -pyrones ( 5 - 10 ). Furthermore, the successful biomimetic synthesis of ocellatusone A ( 1 ) from its γ -pyrone precursor ( 5 ) confirmed the biosynthetic relationship of these two compounds and the proposed rearrangement through an unprecedented acid induced cascade reaction. Besides, an initially untargeted semisynthetic product, polycyclic lactone 11 with another novel carbocyclic skeleton was proved to be naturally occurring in the mollusk by comparative LC-MS/MS analysis, which provides a strategy to fish a vast number of novel trace components in Nature. © 2020 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.BACKGROUND Direct laryngoscopy and intubation are often difficult in children with Robin Sequence. Previous research characterizing anatomic airway differences has focused on parameters influencing airway patency; there is a paucity of data pertaining to intubation trajectories and depth. Such information could impact airway management approaches and decrease the incidence of endotracheal tube malpositioning. AIM The study goal was to examine whether longitudinal airway parameters pertaining to intubation are different in children with Robin Sequence compared to age-matched controls. METHOD This case-control study compared patients with RS less then 4 years of age who had computed tomography scans of the head and neck to age- and sex-matched controls. Measurements were made of the nasopharynx, oropharynx, hypopharynx, tongue, hyoid, as well as the front teeth to vocal cord, nares to vocal cord, and nasion-basion distances. Statistical analysis was performed using multiple ANCOVA models with the categorical s found to be 1.2 cm longer while the mean nares to vocal cord distance was found to be 0.8 cm longer controlling for subject length. Clinicians should account for these differences when selecting and placing endotracheal tubes, particularly those with a preformed bend. This article is protected by copyright. All rights reserved.Observers must select goal-directed stimuli in lieu of distractors in the environment for preferential information processing. This selection, according to the load theory of attention, is modulated by cognitive load, involving the frontal cortices, with more significant distractor interference under high cognitive load, with strained executive control resources. Evidence in support of this theory exists, however, working memory tasks were predominately used in these investigations. The influence of other types of cognitive load on distractor processing is largely unknown. An interleaved pro- and anti-saccade task has often been used to investigate executive control in which subjects are instructed in advance to either automatically look at the peripheral stimulus (pro-saccade), or to suppress the automatic response and voluntarily look in the direction opposite of the stimulus (anti-saccade). Distinct frontal preparatory activity has been clearly characterized during preparation for pro- and anti-saccades, with higher inhibition-related activity in preparation for anti-saccades than pro-saccades.