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Journal of Clinical and Translational... Jul 2020Radiosurgery is employed for the treatment of brain metastases. The aim of this study is to evaluate the efficacy and tolerability of single-dose radiosurgery (SRS)...
BACKGROUND
Radiosurgery is employed for the treatment of brain metastases. The aim of this study is to evaluate the efficacy and tolerability of single-dose radiosurgery (SRS) compared to hypofractionated stereotactic radiotherapy (hFSRT).
MATERIALS AND METHODS
Between 2004 and 2018, we analyzed treatments of 97 patients with 135 brain metastases. Fifty-six patients were treated with SRS, and 41 patients were treated with hFSRT. Median dose was 16 Gy (12-20 Gy) for the SRS group and 30 Gy in 5-6 fractions for the hFSRT group. hFSRT was used for larger lesions and lesions located near critical structures. Kaplan-Meier curves were constructed for overall survival (OS) and local control (LC).
RESULTS
Median age was 64 years (range, 32-89 years). Median survival was 10 months (1-68 months). With a median follow-up of 10 months, no significant differences in OS between groups were found (=0.21). LC for all patients was 67%. Local progression-free survival (LPFS) at 6 months and 1 year was 71% and 60% for the SRS group, respectively, and 80% and 69% for the hFSRT group, respectively (=0.93). Although hFSRT was used for larger lesions and lesions in adverse locations, LPFS was not inferior compared to lesions treated with SRS. We observed acute toxicity grade 1-2 in 25 patients (25.8%). Late complications were observed in 11 patients (11.3%). Acute and late toxicity was similar in the SRS- and hFSRT-treated patients (=0.63 and =0.11, respectively). Brain recurrence occurred in 37.5% and 14.6% in the hFSRT and SRS group, respectively (=0.06).
CONCLUSIONS
Since patients treated with hFSRT exhibited similar survival and LPFS rates without differences in toxicity compared to those treated with SRS, hFSRT can be beneficial, particularly for patients with brain metastases.
RELEVANCE FOR PATIENTS
Hypofractionated schemes in stereotactic radiosurgery offers treatment alternatives to patients with large lesions or lesions near critical structures.
PubMed: 32875136
DOI: No ID Found -
Antimicrobial Agents and Chemotherapy Sep 2020Although remains the major etiological agent of invasive candidiasis, and other emerging species of are increasingly isolated. This species is the second most...
Although remains the major etiological agent of invasive candidiasis, and other emerging species of are increasingly isolated. This species is the second most prevalent cause of candidiasis in many regions of the world. However, clinical isolates of and can be misidentified and are underdiagnosed due to phenotypic traits shared with Little is known about the two cryptic species. Therefore, pathogenesis studies are needed to understand their virulence traits and their susceptibility to antifungal drugs. The susceptibility of to different species makes this nematode an excellent model for assessing host-fungus interactions. We evaluated the usefulness of as a nonconventional host model to analyze the virulence of , , and The three species caused candidiasis, and the highest virulence of was confirmed. Furthermore, we determined the efficacy of current antifungal drugs against the infection caused by these species in the model. Amphotericin B and azoles showed the highest activity against and infections, while echinocandins were more active for treating those caused by proved to be a useful model system for assessing the pathogenicity of these closely related species.
Topics: Animals; Antifungal Agents; Caenorhabditis elegans; Candida; Candida glabrata; Microbial Sensitivity Tests; Saccharomycetales; Virulence
PubMed: 32718968
DOI: 10.1128/AAC.00824-20 -
The Journal of Trauma and Acute Care... Dec 2020Open abdomen (OA) is a useful option for treatment strategy in many acute abdominal catastrophes. A number of temporary abdominal closure (TAC) methods are used with... (Comparative Study)
Comparative Study
BACKGROUND
Open abdomen (OA) is a useful option for treatment strategy in many acute abdominal catastrophes. A number of temporary abdominal closure (TAC) methods are used with limited number of comparative studies. The present study was done to examine risk factors for failed delayed primary fascial closure (DPFC) and risk factors for mortality in patients treated with OA.
METHODS
This study was a multicenter retrospective analysis of the hospital records of all consecutive patients treated with OA during the years 2009 to 2016 at five tertiary referral hospitals and three secondary referral centers in Finland.
RESULTS
Six hundred seventy-six patients treated with OA were included in the study. Vacuum-assisted closure with continuous mesh-mediated fascial traction (VACM) was the most popular TAC method used (N = 398, 59%) followed by VAC (N = 128, 19%), Bogota bag (N = 128, 19%), and self-designed methods (N = 22, 3%). In multivariate analysis, enteroatmospheric fistula and the number of needed TAC changes increased the risk for failed DPFC (odds ratio [OR], 8.9; 95% confidence interval [CI], 6.2-12.8; p < 0.001 and OR, 1.1; 95% CI, 1.0-1.3; p < 0.001, respectively). Instead, VACM and ruptured abdominal aortic aneurysm as cause for OA both decreased the risk for failed DPFC (OR, 0.1; 95% CI, 0.0-0.3; p < 0.001 and OR, 0.2; 95% CI, 0.1-0.7; p = 0.012). The overall mortality rate was 30%. In multivariate analysis for mortality, multiorgan dysfunction (OR, 2.4; 95% CI, 1.6-3.6; p < 0.001), and increasing age (OR, 4.5; 95% CI, 2.0-9.7; p < 0.001) predicted increased mortality. Institutional large annual patient volume (OR, 0.4; 95% CI, 0.3-0.6; p < 0.001) and ileus and postoperative peritonitis in comparison to severe acute pancreatitis associated with decreased mortality (OR, 0.2; 95% CI, 0.1-0.4; p < 0.001; OR, 0.5; 95% CI, 0.3-0.8; p = 0.009). Kaplan-Meier analysis showed increased survival in patients treated with VACM in comparison with other TAC methods (LogRank p = 0.019).
CONCLUSION
We report superior role for VACM methodology in terms of successful primary fascial closure and increased survival in patients with OA.
LEVEL OF EVIDENCE
Therapeutic/care management, level IV.
Topics: Abdomen; Abdominal Wound Closure Techniques; Adolescent; Adult; Aged; Aged, 80 and over; Female; Finland; Hernia, Ventral; Humans; Male; Middle Aged; Multivariate Analysis; Negative-Pressure Wound Therapy; Postoperative Complications; Retrospective Studies; Surgical Mesh; Time Factors; Traction; Young Adult
PubMed: 32701909
DOI: 10.1097/TA.0000000000002889 -
Neural Networks : the Official Journal... Jun 2020In the following paper we present a new type of optimization algorithms adapted for neural network training. These algorithms are based upon sequential operator...
In the following paper we present a new type of optimization algorithms adapted for neural network training. These algorithms are based upon sequential operator splitting technique for some associated dynamical systems. Furthermore, we investigate through numerical simulations the empirical rate of convergence of these iterative schemes toward a local minimum of the loss function, with some suitable choices of the underlying hyper-parameters. We validate the convergence of these optimizers using the results of the accuracy and of the loss function on the MNIST, MNIST-Fashion and CIFAR 10 classification datasets.
Topics: Algorithms; Neural Networks, Computer
PubMed: 32248007
DOI: 10.1016/j.neunet.2020.03.018 -
Polymers Mar 2020The design of new materials with antimicrobial properties has emerged in response to the need for preventing and controlling the growth of pathogenic microorganisms...
The design of new materials with antimicrobial properties has emerged in response to the need for preventing and controlling the growth of pathogenic microorganisms without the use of antibiotics. In this study, partially reduced graphene oxide decorated with silver nanoparticles (GO-AgNPs) was incorporated as a reinforcing filler with antibacterial properties to poly(vinyl alcohol) (PVA) for preparation of poly(vinyl alcohol)/graphene oxide-silver nanoparticles nanocomposites (PVA/GO-AgNPs). AgNPs, spherical in shape and with an average size of 3.1 nm, were uniformly anchored on the partially reduced GO surface. PVA/GO-AgNPs nanocomposites showed exfoliated structures with improved thermal stability, tensile properties and water resistance compared to neat PVA. The glass transition and crystallization temperatures of the polymer matrix increased with the incorporation of the hybrid. The nanocomposites displayed antibacterial activity against and in a filler content- and time-dependent manner. showed higher susceptibility to PVA/GO-AgNPs films than Inhibitory activity was higher when bacterial cells were in contact with nanocomposite films than when in contact with leachates coming out of the films. GO-AgNPs based PVA nanocomposites could find application as wound dressings for wound healing and infection prevention.
PubMed: 32214025
DOI: 10.3390/polym12030723 -
Nanomaterials (Basel, Switzerland) Feb 2020Drug resistance of pathogenic microorganisms has become a global public health problem, which has prompted the development of new materials with antimicrobial...
Drug resistance of pathogenic microorganisms has become a global public health problem, which has prompted the development of new materials with antimicrobial properties. In this context, antimicrobial nanohybrids are an alternative due to their synergistic properties. In this study, we used an environmentally friendly one-step approach to synthesize graphene oxide (GO) decorated with silver nanoparticles (GO-AgNPs). By this process, spherical AgNPs of average size less than 4 nm homogeneously distributed on the surface of the partially reduced GO can be generated in the absence of any stabilizing agent, only with ascorbic acid (L-AA) as a reducing agent and AgNO as a metal precursor. The size of the AgNPs can be controlled by the AgNO concentration and temperature. Smaller AgNPs are obtained at lower concentrations of the silver precursor and lower temperatures. The antimicrobial properties of nanohybrids against Gram-negative bacteria and , Gram-positive , and the yeast were found to be concentration- and time-dependent. and showed the highest susceptibility to GO-AgNPs. These nanohybrids can be used as nanofillers in polymer nanocomposites to develop materials with antimicrobial activity for applications in different areas, and another potential application could be cancer therapeutic agents.
PubMed: 32098083
DOI: 10.3390/nano10020376 -
Techniques in Coloproctology Mar 2020The aim of this study was to report the outcomes of sacral neuromodulation (SNM) in chronic pelvic pain (CPP) patients in the Finnish national cohort.
BACKGROUND
The aim of this study was to report the outcomes of sacral neuromodulation (SNM) in chronic pelvic pain (CPP) patients in the Finnish national cohort.
METHODS
This was a register-based retrospective study, involving all the centers that provide SNM treatment in Finland. The data of all patients treated with SNM for CPP were gathered from Oulu-, Turku-, Tampere- and Helsinki University Hospitals, as well as Jyväskylä and Seinäjoki Central Hospitals. All patients who had been tested for SNM implantation prior to April 2017 were included in the study.
RESULTS
A total of 51 patients were selected for SNM treatment due to CPP from 2004 until 2017. The mean follow-up time was 13.8 months (SD 22.9 months). A total of 28 patients (57%) advanced from testing to permanent stimulator implantation. There were 21 patients (41%) who had a working modulator implanted at the end of follow-up. Patients with endometriosis-related pain had a significantly higher permanent implantation rate than the overall implantation rate (88% vs. 57%; p = 0.01). The endometriosis patients also had a higher overall success rate by the end of the follow-up (75% vs. 41%; p = 0.026) CONCLUSIONS: SNM may be a viable treatment option for patients with CPP due to endometriosis. Further research on SNM treatment for endometriosis patients with refractory CPP is needed.
Topics: Electric Stimulation Therapy; Electrodes, Implanted; Female; Finland; Humans; Lumbosacral Plexus; Pelvic Pain; Retrospective Studies; Sacrum; Treatment Outcome
PubMed: 31965400
DOI: 10.1007/s10151-020-02148-2 -
American Journal of Physical... May 2020Syphilis was perceived to be a new disease in Europe in the late 15th century, igniting a debate about its origin that continues today in anthropological, historical,... (Review)
Review
Syphilis was perceived to be a new disease in Europe in the late 15th century, igniting a debate about its origin that continues today in anthropological, historical, and medical circles. We move beyond this age-old debate using an interdisciplinary approach that tackles broader questions to advance the understanding of treponemal infection (syphilis, yaws, bejel, and pinta). How did the causative organism(s) and humans co-evolve? How did the related diseases caused by Treponema pallidum emerge in different parts of the world and affect people across both time and space? How are T. pallidum subspecies related to the treponeme causing pinta? The current state of scholarship in specific areas is reviewed with recommendations made to stimulate future work. Understanding treponemal biology, genetic relationships, epidemiology, and clinical manifestations is crucial for vaccine development today and for investigating the distribution of infection in both modern and past populations. Paleopathologists must improve diagnostic criteria and use a standard approach for recording skeletal lesions on archaeological human remains. Adequate contextualization of cultural and environmental conditions is necessary, including site dating and justification for any corrections made for marine or freshwater reservoir effects. Biogeochemical analyses may assess aquatic contributions to diet, physiological changes arising from treponemal disease and its treatments (e.g., mercury), or residential mobility of those affected. Shifting the focus from point of origin to investigating who is affected (e.g., by age/sex or socioeconomic status) and disease distribution (e.g., coastal/ inland, rural/urban) will advance our understanding of the treponemal disease and its impact on people through time.
Topics: Archaeology; Biological Evolution; Europe; History, 15th Century; History, 16th Century; History, Ancient; History, Medieval; Treponema pallidum; Treponemal Infections
PubMed: 31956996
DOI: 10.1002/ajpa.23988 -
BMC Genomics Jan 2020Spirochetal organisms of the Treponema genus are responsible for causing Treponematoses. Pathogenic treponemes is a Gram-negative, motile, spirochete pathogen that...
BACKGROUND
Spirochetal organisms of the Treponema genus are responsible for causing Treponematoses. Pathogenic treponemes is a Gram-negative, motile, spirochete pathogen that causes syphilis in human. Treponema pallidum subsp. endemicum (TEN) causes endemic syphilis (bejel); T. pallidum subsp. pallidum (TPA) causes venereal syphilis; T. pallidum subsp. pertenue (TPE) causes yaws; and T. pallidum subsp. Ccarateum causes pinta. Out of these four high morbidity diseases, venereal syphilis is mediated by sexual contact; the other three diseases are transmitted by close personal contact. The global distribution of syphilis is alarming and there is an increasing need of proper treatment and preventive measures. Unfortunately, effective measures are limited.
RESULTS
Here, the genome sequences of 53 T. pallidum strains isolated from different parts of the world and a diverse range of hosts were comparatively analysed using pan-genomic strategy. Phylogenomic, pan-genomic, core genomic and singleton analysis disclosed the close connection among all strains of the pathogen T. pallidum, its clonal behaviour and showed increases in the sizes of the pan-genome. Based on the genome plasticity analysis of the subsets containing the subspecies T pallidum subsp. pallidum, T. pallidum subsp. endemicum and T. pallidum subsp. pertenue, we found differences in the presence/absence of pathogenicity islands (PAIs) and genomic islands (GIs) on subsp.-based study.
CONCLUSIONS
In summary, we identified four pathogenicity islands (PAIs), eight genomic islands (GIs) in subsp. pallidum, whereas subsp. endemicum has three PAIs and seven GIs and subsp. pertenue harbours three PAIs and eight GIs. Concerning the presence of genes in PAIs and GIs, we found some genes related to lipid and amino acid biosynthesis that were only present in the subsp. of T. pallidum, compared to T. pallidum subsp. endemicum and T. pallidum subsp. pertenue.
Topics: Genome, Bacterial; Genomic Islands; Humans; Phylogeny; Syphilis; Treponema pallidum
PubMed: 31924165
DOI: 10.1186/s12864-019-6430-6 -
Candida albicans biofilms on different materials for manufacturing implant abutments and prostheses.Medicina Oral, Patologia Oral Y Cirugia... Jan 2020Morphological, physical and chemical properties of both implants and prostheses can determine the biofilm formation on their surface and increase the risk of biological...
BACKGROUND
Morphological, physical and chemical properties of both implants and prostheses can determine the biofilm formation on their surface and increase the risk of biological complications. The aim of this study was to evaluate the capacity of biofilm formation of Candida albicans on different materials used to manufacture abutments and prostheses.
MATERIAL AND METHODS
Biofilm formation was analyzed on cp grade II titanium, cobalt-chromium alloy and zirconia, silicone, acrylic resin (polymethylmethacrylate) and nano-hybrid composite. Some samples were partially covered with lithium disilicate glass ceramic to study specifically the junction areas.C. albicans was incubated in a biofilm reactor at 37 °C with agitation. The biofilm formation was evaluated at 24 and 48 hours. In addition, the morphology of the biofilm was evaluated by scanning electron microscopy.
RESULTS
C. albicans developed biofilms on the surface of all materials tested. Cobalt-chromium alloy showed the lowest density of adhered biofilm, followed by zirconia and titanium. Silicone and resin showed up to 20 times higher density of biofilm. A higher biofilm formation was observed when junctions of materials presented micropores or imperfections.
CONCLUSIONS
The biofilm formed in the three materials used in the manufacture of abutments and prostheses showed no major differences, being far less dense than in the resins. Two clinical recommendations can be made: to avoid the presence of resins in the subgingival area of implant prostheses and to design prostheses placing cobalt-chromium alloy/ceramic or titanium/ceramic junctions as far as possible from implants.
Topics: Biofilms; Candida albicans; Dental Implants; Microscopy, Electron, Scanning; Surface Properties; Titanium
PubMed: 31880295
DOI: 10.4317/medoral.23157