Background: The objective of this study was to test whether postoperative electroencephalographic (EEG) biomarkers, parietal alpha power and frontal-parietal connectivity, were associated with measures of clinical recovery in adult surgical patients. Methods: This is a secondary analysis of a prospective cohort study that analyzed intraoperative connectivity patterns in adult surgical patients (N=53). Wireless, whole-scalp EEG data were collected in the postanesthesia care unit and assessed...
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Background: The objective of this study was to test whether postoperative electroencephalographic (EEG) biomarkers, parietal alpha power and frontal-parietal connectivity, were associated with measures of clinical recovery in adult surgical patients. Methods: This is a secondary analysis of a prospective cohort study that analyzed intraoperative connectivity patterns in adult surgical patients (N=53). Wireless, whole-scalp EEG data were collected in the postanesthesia care unit and assessed...
No abstract available
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Journal of Neurotrauma, Ahead of Print.
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Journal of Neurotrauma, Ahead of Print.
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In response to the national opioid epidemic crisis, this study’s purpose was to measure changes in opioid and non-narcotic analgesic (NNA) prescribing practices over time after third molar (M3) removal.
Sebaceous carcinoma arising from the nasal vestibule is exceedingly rare, with 3 cases published in the literature. This report illustrates a case of a 69-year-old man with an indolent exophytic growth on the medial aspect of his right nasal vestibule. Incisional biopsy demonstrated sebaceous carcinoma. The clinical and pathologic features, in addition to surgical course and the postoperative outcome are discussed. A case based on a review of the literature is presented, focusing on the diagnosis...
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In response to the national opioid epidemic crisis, this study’s purpose was to measure changes in opioid and non-narcotic analgesic (NNA) prescribing practices over time after third molar (M3) removal.
Sebaceous carcinoma arising from the nasal vestibule is exceedingly rare, with 3 cases published in the literature. This report illustrates a case of a 69-year-old man with an indolent exophytic growth on the medial aspect of his right nasal vestibule. Incisional biopsy demonstrated sebaceous carcinoma. The clinical and pathologic features, in addition to surgical course and the postoperative outcome are discussed. A case based on a review of the literature is presented, focusing on the diagnosis...
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Background: The learning curve in paediatric oesophago-gastro-duodenoscopy (OGD) is unknown. Using ≥95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated. Methods: This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e-portfolio between...
Background: Although transition guidelines have been specified in pediatric inflammatory bowel disease (IBD), few IBD centers implement these into standard care. We describe a mixed qualitative and quantitative process of developing a needs-based transition program for adolescents and young adults with IBD. Methods: We enrolled 29 adolescents with IBD, 8 young adults with IBD in adult care, 14 pediatric gastroenterologists, and 58 adult gastroenterologists to provide input into barriers to...
Objective: Define chronic HBV phenotypes in a large, cohort of US and Canadian children utilizing recently published population-based upper limit of normal alanine aminotransferase levels (ULN ALT), compared to local laboratory ULN; identify relationships with host and viral factors. Background: Chronic hepatitis B virus (HBV) infection has been characterized by phases or phenotypes, possibly associated with prognosis and indications for therapy. Methods: Baseline enrollment data of...
Objective: To evaluate whether children with eosinophilic esophagitis (EoE) demonstrated an association between health-related quality of life (HRQoL) improvements and symptom reduction during 12 months of treatment; to examine age-related EoE discrete symptom presentation; and to describe residual symptom and HRQoL burden. Methods: Children ages 2 to 18-years-old with EoE were assessed at the onset of treatment and 12 months later at 4 tertiary care centers. Continuous measures of symptoms...
Objectives: Celiac disease (CD) is a common chronic condition with potential adverse physical and psychosocial implications for affected children. The study purpose was to characterize health-related quality of life (HRQOL) in a large sample of pediatric patients with newly diagnosed CD using the PedsQL™ 4.0 Generic Core Scales, and compare it to that of healthy children and children with non-celiac GI conditions using historic data. Methods: The PedsQL™ was administered to 159 children with...
Objectives: The determinants of gut microbiota composition and its effects on common childhood illnesses are only partly understood, especially in low-income settings. The aim of the present study was to investigate whether morbidity predicts gut microbiota composition in Malawian children and whether microbiota predicts subsequent morbidity. We tested the hypothesis that common infectious disease symptoms would be predictive of lower microbiota maturity and diversity. Methods: We used data...
Objectives: The aim of this study was to investigate the efficacy and safety of endoscopic local infiltration of mitomycin C (MMC) after oesophageal dilation for children suffering from refractory post-corrosive oesophageal stricture (OS). Methods: Children referred to Cairo University Specialized Paediatric Hospital with refractory post-corrosive OS during the period from March 2016 to August 2017 were included in this study. MMC was infiltrated endoscopically at the stricture site by the...
Chronic liver disease places patients at increased risk of malnutrition that can be challenging to identify clinically and treat. Nutrition support is a key aspect of the management of these patients as it has an impact on their quality of life, morbidity, and mortality. There are significant gaps in the literature regarding the optimal nutrition support for patients with different types of liver diseases and the impact of these interventions on long-term outcomes. This Position Paper summarizes...
Objectives: To evaluate the use of steroids within the paediatric inflammatory bowel disease (PIBD) population at a tertiary paediatric centre over a year; to identify cases of steroid dependency; and assess factors associated with steroid excess. Methods: The prevalent PIBD population (01/05/17-30/04/18) were reviewed. Data was collected retrospectively from patient records and entered into an online steroid assessment tool (modified for paediatrics). Results: 229 patients (181 Crohn's...
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Objectives: Research on long-term use of mitomycin C (MC) for recurrent oesophageal stenoses is limited. We assessed the long-term efficacy and safety of local application of MC for recurrent oesophageal stenoses in children. Methods: This was a retrospective study of 39 patients (17 girls) with a median age of 19.5 months (range: 2.4–196.0) at the time of MC application. The aetiologies of stenosis were oesophageal atresia (n = 25), caustic ingestion (n = 9), congenital oesophageal stenosis...
Objectives: In case of hypertriglyceridemia (HiTG) during parenteral nutrition (PN), the 2018 ESPGHAN guidelines recommend an intravenous (IV) lipid titration, but its consequences in small preterm infants are largely unknown. We compared macronutrient and energy intakes, growth, diseases associated with prematurity and neurodevelopment in small preterm infants on PN who developed (cases) or did not develop HiTG (controls, CNTR). Methods: We retrospectively reviewed data of preterm infants...
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We report 2 patients with acute occlusion of middle cerebral artery successfully treated by mechanical thrombectomy performed via transbrachial access. Both patients had floating aortic arch thrombi precluding safe transfemoral access due to risk of further iatrogenic embolization. Moreover both patients were diagnosed with hypercoagulopathy secondary to lung malignancy (paraneoplastic etiology, Trousseau's syndrome) as the cause of both aortic thrombi and acute ischemic stroke. Mechanical thrombectomy...
A 57-year-old male presented with generalized seizure who received red blood cell (RBC) transfusion for the treatment of iron deficiency anemia (IDA). Neuroradiological findings revealed cerebral venous thrombosis (CVT) on the left frontal vein. He received anticoagulants, anticonvulsants, and iron supplements. He discharged without any neurological deficit. It should be noted that RBC transfusion might increase the risk of CVT in patients with IDA.
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Publication date: Available online 20 August 2019Source: Journal of Surgical EducationAuthor(s): Marleen Groenier, Leonie Brummer, Brendan P. Bunting, Anthony G. GallagherBACKGROUNDReliable performance assessment is a necessary prerequisite for outcome-based assessment of surgical technical skill. Numerous observational instruments for technical skill assessment have been developed in recent years. However, methodological shortcomings of reported studies might negatively impinge on the interpretation...
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A 58-year-old woman with past medical history significant for hidradenitis suppurativa (HS) and rosacea presented with a two-year history of numerous asymptomatic light brown to red lesions in the bilateral axillae and inframammary folds. She denied any worsening of her HS or any active or draining cysts. Physical examination revealed clusters of symmetrically distributed hyperkeratotic, red-brown papules with reticulated hyperpigmentation in the bilateral axillae and inframammary folds. Punch biopsy...
Ultraviolet irradiation has been well-established to induce oxidative stress in the skin, that may lead to apoptosis, DNA damage, and inflammation. To assess the protective and reparative effects against UV-induced oxidation of a novel topical dual-serum system (LVS), a pilot clinical study was conducted. LVS includes a day serum (LVD) to provide protection against environmental factors and a night serum (LVN) to support skin reparative processes, detoxification and mitochondrial function. Twelve...
Melanoma-in-situ (MIS) is a neoplastic proliferation of melanocytes that is confined to the epidermis. Standard of care for the treatment of MIS is surgical removal via simple excision or slow Mohs (sMohs) depending on the location and characteristics of the lesion. The current guideline for treating MIS is removal with 5-mm margins. However, this is based on expert recommendations and there is a paucity of literature to support this recommendation. The recommendation for 5-mm margins has come into...
Hair aging is characterized by hair whitening, hair thinning, and hair density reduction leading to a global loss of hair volume. Oxidative stress is one of the key molecular mechanisms that induces cellular senescence and dysregulates cellular functions with age. It seems important, in order to prevent age-related hair density reduction, to protect hair follicle’s (HF) cells against oxidative stress and to promote the growing phase (anagen) of the HF. The aim of this study was to evaluate the effect...
An 80-year-old man with multiple cardiovascular comorbidities, insulin-dependent diabetes and end-stage renal disease (ESRD) was admitted for a one-month history of an exquisitely painful and progressively, necrotic plaque of the glans penis. Prior therapies with steroid cream and fluconazole were not effective. On exam, there was a circumferential necrotic eschar involving the glans penis. Presumptive diagnoses included calciphylaxis with overlying wet gangrene. Infectious disease was consulted...
Introduction: Cutaneous angiosarcoma (CAS) is a rare, malignant tumor of vascular mesenchymal origin accounting for < 1% of all sarcomas. We aimed to examine epidemiologic trends and outcomes in CAS.
Background/Purpose: Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory disease of the apocrine sweat glands. HS affects approximately 4% of the population and results in recurrent abscessing inflammation of the apocrine sweat glands. Defective keratinocyte function, and host innate and adaptive immune responses have been postulated to play a role in HS disease activity. Additionally, there is evidence that HS lesions exhibit altered levels of enzymes impacting production and breakdown...
Background: The pathogenesis of psoriasis may involve a breakdown of immune tolerance to cutaneous microorganisms. Guttate and chronic plaque psoriasis are associated with Streptococcus pyogenes colonization. In addition, Crohn disease and periodontitis, two diseases due to immune activation in response to microbiota, have been reported at a higher incidence in patients with psoriasis.
Behçet disease (BD), is a multisystemic, chronic vasculitis. Critical pathways in the yet unkown pathogenesis are TNF –alfa associated. Proinflammatory cytokines such as IL-8 and TNF- alfa are elevated with active disease. Neutrophils are a key player. PRGN is an endogeneous antagonist of TNF-alfa, and acts by competitively binding to TNFR. PRGN exerts potent anti-inflammatory effect. However, when degradaded by neutrophil proteases, an increase of IL-8 is seen, aggravating the neutrophilic inflamation.
Introduction: Tildrakizumab (TIL) is a high-affinity, anti–interleukin-23p19 monoclonal antibody approved for the treatment of moderate to severe chronic plaque psoriasis. An inverse efficacy–body weight relationship has been reported for multiple fixed-dose systemic agents in patients with psoriasis, who tend to be of greater weight than the general population. We conducted a post hoc analysis of pooled data from 2 randomized, placebo (PBO)-controlled, phase 3 trials (reSURFACE 1 [NCT01722331] and...
Visiting students at dermatology programs benefit from increased exposure to our specialty as well as instruction and mentorship from the department’s residents and faculty. A clinical away rotation also allows programs to assess student’s intangible attributes, such as work ethic, communication skills, personality, and interest in the specialty. This exposure likely contributes to a higher ranking and subsequent match rate for students who rotate within a given program than for students who do not.
Background: Topical corticosteroids may lose efficacy over time. Poor treatment outcomes may be due to poor adherence. We evaluated how frequently patients with psoriasis resistant to topical treatment respond to topical corticosteroids
The OPTIMISE study was a randomized, open-label, rater-blinded Phase 3b study designed to assess the efficacy and safety of maintenance regimens of an extended dose interval (every 6 wks [q6w]) in Psoriasis Area Severity Index (PASI) 90 responders and an intensified dose interval (every 2 wks [q2w]) in PASI ≥75 to < 90 responders vs the standard (every 4 wks [q4w]) dosing. Subjects (1,647) received subcutaneous secukinumab 300 mg at baseline, Wks 1, 2, 3, and 4, and q4w to Wk 24. At Wk 24, PASI...
Objective: Microfocused ultrasound with visualization [MFU-V, Merz North America] is a noninvasive procedure that is FDA-cleared to lift skin on the neck, on the eyebrow and under the chin as well as to improve lines and wrinkles on the décolletage. The purpose of this case series was to collect data on the customized treatment plans using MFU-V to treat the lower face and submentum and to assess a new comfort management option in real-world clinical use.
Background: Epidermolysis bullosa (EB) is a group of rare genetic skin diseases characterized by the gene mutations encoding adhesion proteins within the skin. These adhesion proteins are also present in normal hair follicles. Anecdotally, there have been reports of scalp alopecia as a complication of EB and there are scattered cases in the literature, but alopecia has generally been overlooked in severe blistering diseases because it is regarded as a cosmetic issue. Therefore, there is no consensus...
Background: The prevalence of at-home energy-based consumer devices is still low and this is a young and under developed market. A leading market research report [Kline Beauty Devices 2016] indicates that the worldwide market is valued at $1.9 billion (+11%). It estimates the rapidly growing home-use device (HUD) cosmetic segment will account for $3 billion by 2020 in sales worldwide for all indications (acne, cleansing, anti-aging, body, hair removal, hair growth and body).
Recurrent aphthous stomatitis (RAS) is a common oral ailment characterized by frequent attacks of painful oral ulcers that heal spontaneously. Severe form of RAS is known as complex apthosis (CA) which is an unfamiliar term for many. Characterized by almost always constant presence of ≥3 painful aphthae alone, with or without genital aphthosis AND exclusion of Behcet disease (BD). CA may be a reactive condition; thus, diagnosis is based on exclusion. Herein, we present an eight-year case of a primary...
This study used validated survey instruments to assess the reliability, quality, and readability of online information regarding acne. A Google search was performed, and the first 5 pages of websites were categorized as either academic, physician, product, or unaffiliated. After removing websites unrelated to this study, each website was assigned an objective quality, reliability, and readability score. Both the unaffiliated and academic websites proved most reliable, with an average score of 3.9...
Background: Behçet syndrome is a chronic, multisystem inflammatory disorder characterized by painful, recurrent oral ulcers (OU) that can impair quality of life (QoL). Apremilast (APR), an oral phosphodiesterase 4 inhibitor, demonstrated efficacy in the treatment of OU of Behçet syndrome in a phase III, multicenter, randomized, double-blind, placebo (PBO)-controlled study (RELIEF).
Lymphangiomas are uncommon benign malformations of the lymphatic system. Neuroblastomas have not been reported concomitantly in infants with lymphatic malformations. A 3-month-old male patient was diagnosed with an incidental neuroblastoma in the left adrenal gland during his preinterventional workup for his right chest wall lymphangioma. Whole body MRI confirmed that the cystic mass of the right chest wall was a lymphangioma and revealed a new left adrenal mass suggestive of a neuroblastoma. Following...
Introduction: Tyrosine kinase 2 (TYK2) activates signal transducer and activator of transcription–dependent cytokine signaling pathways involved in psoriasis (PsO) pathophysiology. BMS-986165 is a potent, highly selective oral TYK2 inhibitor. In a placebo-controlled, Phase 2 study (NCT02931838) in patients (pts) with plaque PsO, Psoriasis Area and Severity Index (PASI) 75 response at Week 12 (primary endpoint) with BMS-986165 was achieved by 67–75% of pts at doses ≥3 mg twice daily (BID), with generally...
Background: Lipomas are localized, subcutaneous tumors composed of mature adipocytes. They are the most common soft tissue tumor, occurring in 1% of the population. Traditional treatment includes surgical excision and liposuction. Deoxycholic acid is a secondary bile acid that possesses detergent properties that allow it to emulsify fat. We report the successful use of intralesional deoxycholic acid in reducing the size of a large lipoma prior to excision.
Purpose: Laser liposuction is a modern, less aggressive than traditional liposuction technique to remove localized fat deposits. Laser energy is used to liquefy excess fat from the areas treated, followed by aspiration, additionally providing the advantage of collagenesis and skin tightening. In this case series we evaluated the efficacy and safety of the use of 1064nm Nd:YAG Laser in the treatment of local fat.
Background: Psoriasis and psoriatic arthritis (PsA) are associated with a high prevalence of metabolic syndrome and increased risk of diabetes. Apremilast, an oral phosphodiesterase 4 inhibitor, was efficacious in the treatment of patients (pts) with moderate to severe psoriasis in the phase 3 ESTEEM 1 and 2 (EST) and phase 3b LIBERATE trials and in the treatment of pts with active PsA in the phase 3 PALACE 1–3 trials (PAL). To explore the potential effect of apremilast on A1c concentrations, we...
Cutaneous T-cell lymphomas, CTCLs, comprise a group of malignancies largely represented by two subtypes, mycosis fungoides (MF) and Sézary syndrome (SS). The incidence of CTCL has increased appreciably since the 1970’s, but the pathogenesis is poorly understood. Recent studies have demonstrated clustering of CTCL patient in several geographic areas suggesting that environmental factors may play a role in CTCL pathogenesis. A retrospective chart review was conducted using the STAT data set from the...
Background/Objectives: The current literature supports mixed recommendations as to the role of metastatectomy in stage IV melanoma. The objective of this study was to determine if nonprimary site surgery is significantly associated with improved survival outcomes.
Background: Clinical and histologic findings in skin and mucous membranes are essential in the diagnosis of systemic amyloidosis, and have been described in up to 25-40% of cases, mostly AL amyloidosis. The mucocutaneous clinical profile of patients with amyloidosis in Latin America has been scarcely reported.
Onychomycosis is a common disorder that is difficult to cure. It has a prevalence ranging from 2-13% globally, across all age groups. Prevalence is lower in children (0.7%), but athletes are 2.5-fold more likely to develop the disease, with toenail infections 7 times more prevalent than infection of the fingernails. This is a concern for athletes as it can interfere with their performance. The risk of developing onychomycosis is increased by the warm environment of many sports activities, the use...
Background: Injection-site reactions (ISRs) are common with biologic therapies. This posthoc analysis explored patient (pt) perspectives on ISR symptoms in pts receiving ixekizumab (IXE) vs. etanercept (ETN) or placebo (PBO).
Background: Cutaneous hypopigmented mosaicism’s phenotype is highly variable and may be associated with extracutaneous anomalies
Pityriasis rubra pilaris (PRP) is a rare cutaneous papulosquamous inflammatory disease which often fails to respond to conventional therapies. The off-label use of adalimumab for the treatment of PRP, have been shown to be effective in case series and case reports. In a recent literature review on the treatment of PRP with biological agents, a total of 20 patients treated with adalimumab were found. These patients were all refractory to other therapies and adalimumab was administered subcutaneously...
Introduction: Alopecia areata (AA) is a common autoimmune patchy hair loss. Autoimmune diseases have been previously associated with increased risk of cardiac and metabolic diseases; however limited information exists regarding AA. We aimed to examine the prevalence of comorbidities in alopecia areata using a large deidentified composite patient database.
Introduction: Dermatology is one of the least diverse medical fields, partly due to limited guidance and match data available for international medical graduates. The purpose of this study was to determine and outline the factors that can increase competitiveness of international applicants interested in applying to dermatology residency in the U.S. Our secondary goal was to provide reliable data and evidence for mentors to better advise international applicants who are interested in pursuing a career...
Introduction: Vitiligo is a relatively common autoimmune disorder characterized by acquired loss of functional melanocytes resulting in depigmented areas on skin and mucosae. In the past, numerous topical and systemic agents have been used, either alone or in various combinations. Systemic steroids are often used to arrest the progression of the disease, but are associated with severe side effects. Recent studies done on the pathogenesis of vitiligo have shown it to be caused by targeted destruction...
Introduction: Clascoterone is a potent, topical androgen receptor (AR) antagonist under investigation for treatment of androgenetic alopecia (AGA). Herein, we summarize key findings from the in vitro and phase I and II trials that lead to the clascoterone solution dose-ranging AGA study currently underway.
Pyoderma gangrenosum (PG) is a sterile, idiopathic, ulcerative, neutrophilic dermatosis that can be associated with trauma or systemic diseases. The lesion typically begins as a pustule that later progresses to an ulcer or deep erosion with violaceous undermined borders. Diagnosis of PG is based on histopathology as well as exclusion of other diagnoses. Approximately 50% of PG cases are associated with systemic diseases, which include inflammatory bowel disease (IBD), rheumatoid arthritis, and hematologic...
Proper photoprotective practices are critical for skin cancer prevention. A significant proportion of data on these practices is yielded from intake forms distributed during free skin cancer screenings. However, it is possible that the knowledge, perceptions, and practices of populations who seek free screenings may differ from the general public. We sought to examine these differences by surveying pedestrians in a major city and attendees of a skin cancer screening. An IRB approved 9 question survey...
Since 2004, anti-interferon-gamma autoantibody-associated immunodeficiency is an emerging medical issue mostly found in East Asians. These patients, without human immunodeficiency virus (HIV) infection, suffered from unusual infection, predominantly disseminated nontuberculous mycobacterial (NTM) infection and other opportunistic pathogens. Moreover, they often presented with concomitant reactive and infective dermatosis. Here, we present a case of a patient carrying autoantibodies to IFN-gamma with...
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Hepatocellular carcinoma is the second most deadly cancer with late presentation and limited treatment options, highlighting an urgent need to better understand HCC to facilitate the identification of early-st...
Neointimal hyperplasia and its related arterial stiffness are the crucial pathophysiological features in atherosclerosis and in-stent restenosis. Cluster of differentiation 147 (CD147), a member of the immunog...
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The objective of this study was to report the 5-year outcomes of the Food and Drug Administration investigational device exemption clinical trial of endovascular aneurysm repair (EVAR) with the Ovation (Endologix, Irvine, Calif) stent graft for elective treatment of abdominal aortic aneurysm (AAA).
The U.S. Preventive Services Task Force guidelines for abdominal aortic aneurysm (AAA) screening are based mainly on studies of older white men from non-U.S. populations. This study was designed to analyze the findings of a large, all-inclusive AAA screening program in the United States.
Percutaneous transluminal angioplasty (PTA) of the infrainguinal arteries was the first endovascular technique for improving lower extremity circulation. The procedure involves the inflation of a balloon-tipped catheter in stenotic or occluded vessels to improve perfusion and to increase downstream blood flow. New techniques are frequently compared with the results of PTA, making valid and robust PTA data essential. Our objective was to identify papers that present PTA outcomes and to perform a systematic...
Readmission to the hospital after revascularization for peripheral artery disease (PAD) is frequently reported. No consensus exists as to the exact frequency and risk factors for readmission. This review aimed to determine the incidence of and risk factors for 30-day readmission after revascularization for PAD.
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A detailed method is provided here describing the purification, refolding, and characterization of self-assembling protein nanoparticles (SAPNs) for use in vaccine development.
Quantitative Multiplex Immunoprecipitation (QMI) uses flow cytometry for sensitive detection of differences in the abundance of targeted protein-protein interactions between two samples. QMI can be performed using a small amount of biomaterial, does not require genetically engineered tags, and can be adapted for any previously defined protein interaction network.
The presence of cancer stem cells have been associated with relapse or poor outcomes after radiotherapy. This manuscript describes the methods to study the radiosensitivity of cancer stem cells in lung cancer cell lines.
Here, we describe a step-by-step strategy for isolating small RNAs, enriching for microRNAs, and preparing samples for high-throughput sequencing. We then describe how to process sequence reads and align them to microRNAs, using open source tools.
Microbial biofilms form complex architectures at interphases and develop into highly scale-dependent spatial patterns. Here, we introduce an experimental system (hard- and software) for the automated acquisition of 3D optical coherence tomography (OCT) datasets. This toolset allows the non-invasive and multi-scale characterization of biofilm morphogenesis in space and time.
This is a protocol to isolate tissue extracellular vesicles (EVs) from the liver. The protocol describes a two-step process involving collagenase perfusion followed by differential ultracentrifugation to isolate liver tissue EVs.
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