The relationship between cognitive style and event-related potentials during auditory and somatosensory Go/No-go paradigms

Cognitive style including field dependence/independence (FDI) is an important factor affecting individual personalities. The present study aimed to clarify the relationship between cognitive styles and the characteristics of cognitive processing using event-related potentials. We used the Embedded-Figures Test to assess the cognitive styles [field dependence (FD), field independence (FI)] of the individuals, and individuals performed auditory and somatosensory Go/No-go paradigms. Participants were divided into two groups (FD and FI) on the basis of EFT scores. Reaction times during auditory Go/No-go paradigms were significantly earlier in the FI group than in the FD group, and response variabilities and omission errors were significantly smaller in the FI group than in the FD group. Go-P300 and No-go-P300 amplitudes were significantly larger in the FI group than in the FD group, suggesting that the FI group exhibited greater neural activity for response executive and inhibitory processing. No significant differences were observed in the amplitudes or latencies of auditory N100 and somatosensory N140 components between the FI and FD groups, suggesting that auditory-related and somatosensory-related neural activities were not related to FDI cognitive styles. Our results showed that FDI cognitive styles were related to neural activity for response executive and inhibitory processing.

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Longitudinal analysis of motor symptoms and histopathology in woozy mice, a model of cerebellar ataxia

Woozy (wz) mice develop ataxia and carry a mutation in the Sil1 gene. Homozygous wz mice have been characterized histopathologically, but no details of their motor function have been reported. In the present study, to comprehensively understand the relationship between symptomatic progression and pathological feature, we evaluated motor function and neurodegeneration with age from presymptomatic to terminal stages. We evaluated the motor function of homozygous and heterozygous wz mice aged from 5 to 71 weeks. Motor function was evaluated using the rotarod test, the footprint test, and the parallel rod floor test. Furthermore, we carried out a histopathological analysis of the mice at several ages. Impairment of motor function in homozygous wz mice began at around 11 weeks of age and became markedly worse until around 14 weeks. Heterozygous wz mice did not show motor dysfunction until 71 weeks of age. Features of cerebellar ataxia were evaluated using the footprint test and the parallel rod floor test. In addition to the observation of ubiquitin-positive aggregates at 6 weeks of age, Purkinje cell loss at 9 weeks of age and cerebellar atrophy were confirmed by histopathology. Apart from the cerebellar changes, we detected no other pathology that could contribute toward ataxia. In heterozygous wz mice, only minimal formation of ubiquitin-positive aggregates was observed. Homozygous wz mice showed adult-onset ataxia with progressive neurodegeneration of the cerebellum. Homozygous wz mice might be useful as an animal model of diseases showing adult-onset ataxia because of cerebellar neurodegeneration.

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Early detection of neonatal hypoxic–ischemic white matter injury: an MR diffusion tensor imaging study

The purpose of this study was to compare diffusion tensor metrics in normal age-matched neonates with survivors of hypoxic–ischemic encephalopathy (HIE) and extracorporeal membrane oxygenation (ECMO). Thirty-five normal, 27 HIE, and 13 ECMO infants underwent MRI at 3 T. Neurodevelopmental assessments were performed. Fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) of the inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, anterior commissure, genu corpus callosum and splenium of the corpus callosum, anterior and posterior limb of the internal capsule, superior longitudinal fasciculus, and the centrum semiovale were analyzed with tract-based spatial statistics modified for use in neonates. Linear regression analysis was performed, and 95% confidence intervals were created for age effects on the tensor metrics with the control patients. Two-sample t-test was done to determine whether there was a difference in the tensor metrics between the normal and patient cohort. There was a statistically significant age effect on the FA and RD in the selected regions of the brain (F

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Effects of white noise on event-related potentials in somatosensory Go/No-go paradigms

Exposure to auditory white noise has been shown to facilitate human cognitive function. This phenomenon is termed stochastic resonance, and a moderate amount of auditory noise has been suggested to benefit individuals in hypodopaminergic states. The present study investigated the effects of white noise on the N140 and P300 components of event-related potentials in somatosensory Go/No-go paradigms. A Go or No-go stimulus was presented to the second or fifth digit of the left hand, respectively, at the same probability. Participants performed somatosensory Go/No-go paradigms while hearing three different white noise levels (45, 55, and 65 dB conditions). The peak amplitudes of Go-P300 and No-go-P300 in ERP waveforms were significantly larger under 55 dB than 45 and 65 dB conditions. White noise did not affect the peak latency of N140 or P300, or the peak amplitude of N140. Behavioral data for the reaction time, SD of reaction time, and error rates showed the absence of an effect by white noise. This is the first event-related potential study to show that exposure to auditory white noise at 55 dB enhanced the amplitude of P300 during Go/No-go paradigms, reflecting changes in the neural activation of response execution and inhibition processing.

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Temporal property of single-cell activity in response to motion-defined shapes in monkey dorsal and ventral cortical areas

In the primate brain, shape and motion are considered to be separately processed in the ventral and dorsal visual cortical areas, respectively. However, to achieve shape perception with a motion cue, shape and motion cannot be processed exclusively in separate cortical areas. Interactions between ventral and dorsal cortical areas are required, and yet, the neural mechanisms underlying motion-defined shape perception remain unclear. Here, we assessed the temporal properties of single-unit activity recorded from V4, the middle temporal area, and the anterior superior temporal sulcus while monkeys discriminated shapes defined by motion and luminance cues. Visual response latencies of V4 neurons were shorter in the luminance-cue condition than in the motion-cue condition. Meanwhile, the timings of initiation of shape selectivity were not different between cue conditions, indicating a difference in processing time. Middle temporal neurons were less shape modulated in the luminance-cue condition than in the motion-cue condition. Temporal properties of neural activities in the lower bank of anterior superior temporal sulcus were similar between cue conditions. These results suggest that an interaction of the ventral cortex with the dorsal cortex is required for shape discrimination with different visual cues.

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Frequency specificity and left-ear advantage of medial olivocochlear efferent modulation: a study based on stimulus frequency otoacoustic emission

The medial olivocochlear (MOC) bundle is an auditory nucleus that projects efferent nerve fibers to the outer hair cells (OHCs) for synaptic innervation. The aim of the present study was to investigate the possible existence of frequency and ear specificity in MOC efferent modulation, as well as how MOC activation influences cochlear tuning. Stimulus frequency otoacoustic emissions (SFOAEs) were used to study MOC efferent modulation. Therefore, the current experiment was designed to compare the degree of SFOAE suppression in the both ears of 20 individuals at 1, 2, 4, and 8 kHz. We also compared changes in Q10 values of SFOAE suppression tuning curves at 1, 2, and 4 kHz under contralateral acoustic stimulation (CAS) and no-CAS conditions. We observed a significant reduction in SFOAE magnitude in the CAS condition compared with the no-CAS condition at 1 and 2 kHz in the left ear. A significant difference in CAS suppression was also found between the left and right ears at 1 and 2 kHz, with larger CAS suppression in the left ear. CAS further produced a statistically significant increase in the Q10 value at 1 kHz and a significant reduction in Q10 values at 2 and 4 kHz. These findings suggest a left-ear advantage in terms of CAS-induced MOC efferent SFOAE suppression, with larger MOC efferent modulation for lower frequencies, and cochlear tuning was sharpened by means of MOC activation at lower frequencies and broadened at higher frequencies.

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Improvement of higher brain dysfunction after brain injury by repetitive transcranial magnetic stimulation and intensive rehabilitation therapy: case report

Repetitive transcranial magnetic stimulation (rTMS) and intensive cognitive rehabilitation (CR) were administered to two patients with cognitive dysfunction following brain injury. The first case was a 67-year-old man who presented with memory dysfunction, attention dysfunction, and decreased insight following diffuse axonal injury. High-frequency rTMS (10 Hz, 2400 pulses/day) targeting the anterior cingulate using a navigation system and CR were administered for 12 days at 1 year from the onset of injury. The patient showed improved neuropsychological performance and activities of daily living. In addition, single photon emission computer tomography with 99mTc-ECD showed improved perfusion in the anterior cingulate gyrus. The second case was a 68-year-old man who presented with dysfunction of memory, attention, and executive function following a cerebral infarction in the middle cerebral artery region within the right hemisphere. This patient received 12 days (except for Sundays) of low-frequency rTMS (1 Hz, 1200 pulses/day) targeting the left dorsolateral prefrontal cortex and the left posterior parietal cortex and CR. Following this intervention, the patient's neuropsychological performance and activities of daily living improved. Furthermore, single photon emission computer tomography showed changes in perfusion in the rTMS target sites and areas surrounding the targets. We have shown the safety and efficacy of rTMS therapy using a navigation system combined with intensive CR on two patients with cognitive dysfunction following brain injury. In addition, we observed changes in the areas around the rTMS target sites in brain imaging data.

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Excessive hemodynamic activity in the superior frontal cortex during the flanker task in children with attention deficit hyperactivity disorder

Near-infrared spectroscopy studies in children with attention deficit hyperactivity disorder (ADHD) have shown excessive prefrontal activity responsible for coping with interference. However, it is possible that the previous results were influenced by verbal, reading, and memory developments. The flanker task is an interference task that does not require a verbal response, reading, or memorization. We examined activity in the superior frontal cortex (SFC) during the flanker task in 12 children with ADHD and 14 children with typical development using near-infrared spectroscopy. SFC activity was significantly greater in children with ADHD than in those with typical development. The results showed excessive interference coping activity in children with ADHD irrespective of verbal, reading, and memory development. Moreover, SFC activity was positively correlated with the inattention subscale score of the ADHD rating scale. We suggest that children with ADHD need greater SFC activation to cope with interference, and the inefficient mechanism is demanding and hard to sustain, which causes inattention symptoms of children with ADHD.

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Memory-related functional connectivity in visual processing regions varies by prior emotional context

Memory retrieval involves the reactivation of processes that were engaged at encoding. Using a Generalized Linear Model to test for effects of valence, our prior study suggests that memory for information previously encoded in a negative context reengages sensory processing regions at retrieval to a greater extent than positive. Here, we used partial least squares analyses of the same dataset to determine whether this valence-specific processing was one of the dominant patterns in the retrieval data. Trials previously paired with a face revealed a strong pattern of emotion that did not vary by valence, but for trials previously paired with a scene, an extensive network of regions was active during recollection of trials paired with negative content. These same regions were negatively correlated with recollection of trials paired with positive content. These results confirm that, despite no emotional content present during the time of retrieval, strong patterns of emotional study context are present in the data. Moreover, at least for trials paired with scenes at encoding, valence-specific networks are linked to episodic memory recollection, providing further support for recapitulation of sensory processing during recollection of negative emotional information.

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Polarity-independent effects of transcranial direct current stimulation over the bilateral opercular somatosensory region: a magnetoencephalography study

The opercular somatosensory region (OP) plays an indispensable role in pain perception. In the present study, we investigated the neurophysiological effects of transcranial direct current stimulation (tDCS) over the OP. Somatosensory-evoked magnetic fields following noxious intraepidermal electrical stimulation to the left index finger (pain-SEFs) were recorded before and after tDCS with a single-blind, sham-controlled, cross-over trial design. Three tDCS conditions of left anodal/right cathodal tDCS, left cathodal/right anodal tDCS (each, 2 mA, 12 min), and sham tDCS (2 mA, 15 s) were applied. Despite the subjective pain sensation being unaltered, the two anodal (real) interventions significantly decreased OP activity associated with pain-SEFs. In conclusion, tDCS over the OP with the present parameters did not have a significant impact on pain sensation, but modulated its cortical processing.

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Analysis of neural crest cells from Charcot–Marie–Tooth disease patients demonstrates disease-relevant molecular signature

Charcot–Marie–Tooth disease (CMT) is the most common inherited neuropathy. The majority of CMT is demyelinating type (demyelinating CMT) caused by Schwann cell involvement. Although a large number of genes responsible for demyelinating CMT have been found, the common molecular target of the pathophysiology caused by these different genes in demyelinating CMT is still unknown. We generated induced pluripotent stem cells (iPSCs) from healthy controls and patients with demyelinating CMT caused by duplication in peripheral myelin protein 22 kDa (PMP22) or point mutations in myelin protein zero (MPZ) or early growth response 2 (EGR2). iPSCs were differentiated into neural crest cells, progenitors of Schwann cells, followed by purification using the neural crest cell markers p75 and human natural killer-1. To identify a disease-relevant molecular signature at the early stage of demyelinating CMT, we conducted global gene expression analysis of iPSC-derived neural crest cells and found that a glutathione-mediated detoxification pathway was one of the related pathways in demyelinating CMT. mRNA expression of glutathione S-transferase theta 2 (GSTT2), encoding an important enzyme for glutathione-mediated detoxification, and production of reactive oxygen species were increased in demyelinating CMT. Our study suggested that patient-iPSC-derived neural crest cells could be a cellular model for investigating genetically heterogeneous disease CMT and might provide a therapeutic target for the disease.

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Perturbing NR2B–PSD-95 interaction relieves neuropathic pain by inactivating CaMKII-CREB signaling

Neuropathic pain is characterized by central sensitization. The interaction between N-methyl-D-aspartate receptors (NMDARs) and postsynaptic density protein-95 (PSD-95) plays a major role in central sensitization. Here, we aimed to investigate the analgesic effect of disruption of the interaction between NMDAR and PSD-95. Chronic dorsal root ganglia compression model rats were used to mimic sciatica. Thermal hyperalgesia and mechanical allodynia were evaluated. The expression of spinal phospho-NR2B, PSD-95, calcium/calmodulin-dependent protein kinase II (CaMKII), and cAMP response element binding protein (CREB) was measured using western blotting. A mimetic peptide Myr-NR2B9c was injected intrathecally to disrupt the interaction between PSD-95 and NR2B and detected by coimmunoprecipitation. Chronic dorsal root ganglia compression surgery induced thermal hyperalgesia and mechanical allodynia, and upregulated pain-related proteins such as phospho-NR2B, PSD-95, CaMKII, and CREB expressions in the spinal cord. Myr-NR2B9c disrupted the interaction between NR2B-containing NMDARs and PSD-95 in the spinal cord. Intrathecal administration of Myr-NR2B9c attenuated neuropathic pain behaviors and downregulated the expressions of phospho-NR2B, PSD-95, CaMKII, and CREB in the spinal cord. The present study indicates that dissociation of NR2B-containing NMDARs from PSD-95 inactivates CaMKII and CREB signaling and relieves pain.

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Surveillance of the use of adrenaline auto-injectors in Japanese children

Publication date: Available online 4 August 2017
Source:Allergology International
Author(s): Komei Ito, Manabu Ono, Naoyuki Kando, Teruaki Matsui, Tomoko Nakagawa, Shiro Sugiura, Motohiro Ebisawa
BackgroundThe appropriate usage of an adrenaline auto-injector (AAI, Epipen^®) is a key aspect of patient and social education in the management of anaphylaxis. However, although AAIs are being prescribed increasingly frequently, there are few reports on their actual use.MethodsThe Anaphylaxis Working Group of the Japanese Society of Pediatric Allergy and Clinical Immunology requested that society members register cases in which AAIs were used. Two hundred and sixty-six cases were collected from March 2014 to March 2016.ResultsThe cases included 240 events of immediate-type food allergies caused by cow's milk (n = 100), hen's egg (n = 42), wheat (n = 40), and peanuts (n = 11). Exercise-related events were reported in 19 cases; however, the diagnosis of food-dependent exercise-induced anaphylaxis with a specific causative food was only made in 4 cases (wheat, n = 2; fish, n = 1; squid, n = 1). The frequent reasons for the causative intake included programmed intake (n = 48), failure to check the food labeling (n = 43), and consuming an inappropriate food (n = 26). AAIs were used at schools or nurseries in 67 cases, with school or nursery staff members administering the AAI in 39 cases (58%). On arriving at the hospital, the symptom grade was improved in 71% of the cases, while grade 4 symptoms remained in 20% of the cases. No lethal cases or sequelae were reported.ConclusionsAAIs were used effectively, even by school teachers. The need to visit a hospital after the use of an AAI should be emphasized because additional treatment might be required.



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Blocking protein quality control to counter hereditary cancers

Abstract

Inhibitors of molecular chaperones and the ubiquitin-proteasome system have already been clinically implemented to counter certain cancers, including multiple myeloma and mantle cell lymphoma. The efficacy of this treatment relies on genomic alterations in cancer cells causing a proteostatic imbalance, which makes them more dependent on protein quality control (PQC) mechanisms than normal cells. Accordingly, blocking PQC, e.g. by proteasome inhibitors, may cause a lethal proteotoxic crisis in cancer cells, while leaving normal cells unaffected. Evidence, however, suggests that the PQC system operates by following a better-safe-than-sorry principle and is thus prone to target proteins that are only slightly structurally perturbed, but still functional. Accordingly, implementing PQC inhibitors may also, through an entirely different mechanism, hold potential for other cancers. Several inherited cancer susceptibility syndromes, such as Lynch syndrome and von Hippel-Lindau disease, are caused by missense mutations in tumor suppressor genes, and in some cases the resulting amino acid substitutions in the encoded proteins cause the cellular PQC system to target them for degradation, although they may still retain function. As a consequence of this over-meticulous PQC mechanism, the cell may end up with an insufficient amount of the abnormal, but functional, protein, which in turn leads to a loss-of-function phenotype and manifestation of the disease. Increasing the amounts of such proteins by stabilizing with chemical chaperones, or by targeting molecular chaperones or the ubiquitin-proteasome system, may thus avert or delay the disease onset. Here we review the potential of targeting the PQC system in hereditary cancer susceptibility syndromes. This article is protected by copyright. All rights reserved.

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Cancer stem cell research in Iran: potentials and challenges

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2u9XniZ

Local therapy for triple-negative breast cancer: a comprehensive review

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vyLB5m

Serum metabolomics can predict the outcome of first systematic transrectal prostate biopsy in patients with PSA

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uals9j

Treatment of adult acute lymphoblastic leukemia with inotuzumab ozogamicin

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vz82Hy

Are peptide vaccines viable in combination with other cancer immunotherapies?

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uai26I

The importance for immunoregulation for long-term cancer control

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2u9Z5AW

“Is immunotherapy a viable option in treating mesothelioma?”

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vyUxYw

Cancer pain management: recommendations from a Latin-American experts panel

Future Oncology, Ahead of Print.


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A new indication for barbed threads: static reanimation of the paralyzed face

Publication date: Available online 5 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Victor Vlad Costan, Eugenia Popescu, Daniela Sulea, Ioan Sorin Stratulat
PurposeThe objective of this study is to present our experience in the area of static facial reanimation using a straightforward incisionless procedure adapted from techniques commonly used for performing minimally invasive face-lifts.MethodsA total of 17 patients were treated by static suspension using barbed sutures and all the resulting changes were reviewed. The technique used for suture placement is described in detail, as are the author's tips for achieving the best aesthetic and functional results. All patients had preoperative indication for physiotherapy and rehabilitation procedures (local massage and mirror therapy). Facial nerve function was evaluated using the Arianna Disease Scale (ADS).ResultsThe cosmetic outcome improved in all cases, with significant amelioration of the preoperative facial asymmetry. Oral competence was enhanced by elevating the oral commissure and reinforcing the cheek, while a reduction of the symptoms related to lagophthalmos was achieved through increased support and decreased pull on the inferior eyelid. The addition of physiotherapy procedures with specific rehabilitation exercises before the surgical intervention increased the success rate.ConclusionThis technique proved to be a good alternative to other static reanimation procedures due to its straightforward technique, availability, good outcomes, low complication rate and ability to perform minor adjustments and corrections at any time.



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Is SSND safer than SOHND for oral carcinoma patients with N0 neck in terms of shoulder morbidity and recurrence rate?

Publication date: Available online 5 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sanjay Rastogi, Ashish Sharma, Rupshikha Choudhury, Siddhi Tripathi, Hessa Al Wayli, Anand Amrithraj A, Mahendra P. Reddy
AimTo estimate the clinical and functional results of patients who experienced distinctive varieties of neck dissection, with particular consideration to the shoulder function, rate of recurrence, and quality of life in N0 neck patients.Material and MethodA randomized clinical trial was conducted from August 2014 to March 2017 in which 20 adult patients with T1 to T3 lesions of the oral cavity with N0 neck were included. The subjects were randomly allocated to either Group I (10, selective neck dissection) or Group II (10, super-selective neck dissection). All patients were evaluated objectively for degree of abduction of the arm and subjectively for quality of life in the form of questionnaire both pre and post operatively for 6 months. Also, loco-regional recurrence was investigated for 2.5 years. The data was scrutinized by applying mean standard deviation, unpaired T- test and Mann Whitney U test and Kaplan-Meier test.ResultThe mean values of arm abduction test and quality of life were statistically significant (p<.05) in super selective neck dissection i.e. group II as compared to selective neck dissection i.e. group I at all-time intervals. The data analyzed for loco-regional recurrence revealed that that there was a statistical notable differentiation found amid both the groups (p<0.05) i.e. group II has better outcome.ConclusionThe results depict less shoulder morbidity and improved quality of life for Super selective neck dissection (group II) compared to Selective neck dissection (group I). Furthermore, the group II is better in terms of loco-regional recurrence which determines the oncologic safety of the procedure.



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Does guided bone regeneration prevents unfavurable bone shape in distraction gap ?

Publication date: Available online 5 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Umut Demetoglu, Alper Alkan., Erdem Kiliç, Mustafa Ozturk, Suheyb Bilge
PurposeComplications related to distraction osteogenesis may cause the degradation of newly regenerated bone. Additionally, an unfavorable shape of regenerated bone at the distraction gap can reduce the quantity of regenerated bone. The aim of this study was to prevent unfavorable shapes of regenerated bone with guided bone regeneration during distraction.Materials and methodsBilateral alveolar distraction was performed in 10 beagle dog mandibles. One side of the mandibles formed the experimental group and the other side served as the control group. In the experimental group, guided bone regeneration was performed simultaneously with distraction osteogenesis. In the control group, only alveolar distraction was applied. At the end of a 1-week latent period, all mandibles were distracted 10 mm (1 mm/d), and 3 months were then allowed for consolidation. After consolidation, all animals were sacrificed and the shape of regenerated bone was determined to be favorable or unfavorable. Densitometric evaluation and area measurements were performed with computed tomography. Statistical evaluation was performed using the independent t-test, with a significance level of p < 0.05.ResultsIn the experimental group, there was no unfavorable bone shape in the distraction gap and the new bone had similar surface and volume as the segments, whereas in the control group, four subjects had unfavorable bone shape in the distraction gap, and the other four subjects showed favorable bone healing with no defect. The surface area of the regenerating bone in the experimental group was significantly higher than that in the control group. Surface area differed significantly between the experimental and control groups (p < 0.05). Densitometric values did not differ between groups (p < 0.05).ConclusionsConcomitant use of guided bone regeneration with distraction osteogenesis may be considered an optimal way to generate a favorable bone shape within the distraction gap.



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Subcutaneous lipoatrophy and skin depigmentation, secondary to a TMJ intra-articular injection of corticosteroids

Publication date: Available online 5 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Nicolás Patricio Skármeta P, Fernando Ariel Hormazábal N, Juan Alvarado, Ana Maria Rodriguez
BackgroundChronic orofacial pain is a complex multidimensional experience that produces disability and impairment of normal mandibular functions. Overall estimations of chronic orofacial pain prevalence are between 7-11% of the general population. Temporomandibular disorders (TMD) are one of the most prevalent chronic orofacial pain conditions, as temporomandibular joint (TMJ) arthralgia accounted for 30.1% of TMD patients. Interventional procedures are often used in pain and palliative medicine to achieve reasonable and cost-effective pain relief. The use of intra-articular corticosteroids in relieving arthralgia and improving joint function is well documented.Case DescriptionThe authors will present a clinical case of an 84-year-old female patient who was derived to Hospital del Salvador Orofacial Pain service with preauricular pain, limited range of movement, provoked pain at palpation, and function in the preauricular region. The patient was diagnosed, following DC/TMD criteria, with left TMJ arthralgia and degenerative joint disease, which was later corroborated with a CBCT scan. An intra-articular injection of 10mg of methylprednisolone was programmed, and the patient underwent the procedure, according to Hospital del Salvador's intraarticular injection protocol. The intervention underwent without any inconvenience. At the three-week control, the authors noticed that the patient presented a depigmented depression zone adjacent to the site of injection. After doing an echotomography, the authors concluded that the patient presented a skin depigmentation and subcutaneous lipoatrophy that were consecutive to the intra-articular injection of methylprednisolone. To our knowledge, this is the first time that this complication is ever-reported secondary to an interventional procedure in the TMJ.ConclusionsClinicians should be aware and patients must be advised of this rare complication before performing an intra-articular intervention.



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Plasma cell granuloma of the jaw and the infratemporal fossa: a clinical case

Publication date: Available online 5 August 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): A. Vahedi, A. Moya–Plana, S. Guyot, G. Touré
IntroductionPlasma cell granuloma or inflammatory pseudotumour (IPT) is diagnosed by a process of elimination. The precise etiology is unknown, although it can occur following a bout of periodontal infection. Our observation presents the various stages of progression for this ailment.ObservationA 49-year-old female patient without any significant prior medical history presented with a recurrent periodontal abscess accompanied by progressive and severe destruction of the right maxilla. There was invasion of the infratemporal fossa and very tight trismus. Histological examination concluded it was a reactive plasma cell granuloma.DiscussionIPT is an entity recognized by the World Health Organization (WHO). A triggering infectious or inflammatory factor is often present. In the maxilla, progression is very aggressive. Treatment relies on corticotherapy, with or without radiotherapy, and administration of cyclosporine.



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Viral cancer therapies: are they ready for combination with other immunotherapies?

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vz30uF

Cancer stem cell research in Iran: potentials and challenges

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2u9XniZ

Local therapy for triple-negative breast cancer: a comprehensive review

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vyLB5m

Serum metabolomics can predict the outcome of first systematic transrectal prostate biopsy in patients with PSA

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uals9j

Treatment of adult acute lymphoblastic leukemia with inotuzumab ozogamicin

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vz82Hy

Are peptide vaccines viable in combination with other cancer immunotherapies?

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uai26I

Immunomodulatory effects of current cancer treatment and the consequences for follow-up immunotherapeutics

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vzaihV

The importance for immunoregulation for long-term cancer control

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2u9Z5AW

“Is immunotherapy a viable option in treating mesothelioma?”

Future Oncology, Ahead of Print.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vyUxYw

Cancer pain management: recommendations from a Latin-American experts panel

Future Oncology, Ahead of Print.


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Relationships between chewing rate, occlusion, cephalometric anatomy, muscle activity, and masticatory performance

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Brent A. Fulks, Kathryn X. Callaghan, Claire D. Tewksbury, Geoffrey E. Gerstner
ObjectiveMastication consists of rhythmic jaw openings and closings. Recent studies suggest that muscle mechanical properties determine the rhythmic rate; however, speed-accuracy tradeoffs may also play a role. This study evaluated how variation in chewing rate affected chewing performance, how masticatory muscle activity varied with chewing rate, and whether morphology and demographics contributed to performance.DesignChewing performance and muscle activity were sampled in 23 healthy, fully-dentate adults, who chewed a standardized test food to a metronome set at 0.5, 0.75, 1, 2 and 3 times their 'natural' chewing rates. Subjects produced ten chews per trial, and five trials for each of the five rates. Surface electromyographic (EMG) activity was sampled from masseter and temporalis muscles bilaterally. Demographic, occlusal, and cephalometric data were also obtained.ResultsChewing performance, defined by median particle size, was inversely related to chewing rate; however, performance was not remarkably improved at rates slower than the natural chewing rate. Above the natural chewing rate, variability in EMG bursts diminished, suggesting a reduction in muscle activity modulation at fast rates. Occlusal contacts and most morphological features appeared to play a limited or no role in performance.ConclusionsResults support the hypothesis that the 'natural' chewing rate is selected to be as fast as possible while providing sufficient time to allow EMG modulation for improved performance. The interplay between EMG modulation and individual variation in skeletal morphology is likely critical for optimal chewing performance.



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Salivary microbiome in non-oral disease: A summary of evidence and commentary

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Aneesha Acharya, Yuki Chan, Supriya Kheur, Li Jian Jin, Rory M. Watt, Nikos Mattheos
ObjectiveThe advent of high-throughput sequencing and 'omic' technologies is facilitating an 'open-ended' understanding of the human microbial community and its interplay with health. This commentary aims to present key perspectives and summarize current evidence from metagenomic studies of salivary microbiota in relation to general health and systemic diseases.DesignA narrative review of studies that described salivary microbiome composition in relation to various general health conditions was conducted and the main results were summarized.ResultsCurrently available evidence shows salivary microbial patterns and fingerprints as related to a range of metabolic, autoimmune and immunodeficiency associated conditions, similar to albeit at a far lower scale than similar studies in the gut microbiome.ConclusionsConsidering the relative ease of collection, emerging evidence of association with non-oral diseases may imply that saliva microbiome research may have potential diagnostic or prognostic value.



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Characterization of the clustered regularly interspaced short palindromic repeats sites in Streptococcus mutans isolated from early childhood caries patients

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Jing Chen, Tiancheng Li, Xuedong Zhou, Lei Cheng, Yuanyuan Huo, Jing Zou, Yuqing Li
ObjectiveThe aim of this study was to analyze the characteristics of the clustered regularly interspaced short palindromic repeats (CRISPR) sites in 45 clinical Streptococcus mutans strains and their relationship to the clinical manifestations of early childhood caries (ECC).MethodsForty-five S. mutans strains were isolated from the plaque samples taken from sixty-three children. CRISPR sites were sequenced and BLAST was used to compare these sites to those in the CRISPRTarget database. The association between the distribution of CRISPR sites and the manifestation of caries was analyzed by Chi-Square test. Further, biofilm formation (by crystal violet staining) and the synthesis of polysaccharide (by anthrone-sulfuric method) of all clinical isolated S. mutans strains with both CRISPR sites and no CRISPR site were comapared. Finally, acidogenicity and acidurity of two typical strains were determined using pH drop and acid tolerance assays. Biofilm formation and EPS synthesis by two typical strains were compared by 3D CLSM (Confocal Laser Scanning Microscope) assays and the expression of gtf genes were evaluated using qPCR.ResultsWe found that most of the spacers in the clinical S. mutans strains were derived from Streptococcus phages APCM01 and M102. The number of CRISPR sites in these strains was associated with the clinical manifestations of ECC. Moreover, we found that the biofilm formation and EPS synthesis ability of the S. mutans strains with both CRISPR sites was significant improved.ConclusionsAn association was found between the distribution of CRISPR sites and the clinical manifestations of caries. The CRISPR sites might contribute to the cariogenic potential of S. mutans.



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Extracellular HSP72 induces proinflammatory cytokines in human periodontal ligament fibroblast cells through the TLR4/NFκB pathway in vitro

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Chihiro Arai, Yoshiaki Nomura, Masazumi Matsuzawa, Nobuhiro Hanada, Yoshiki Nakamura
ObjectiveThe aim of the present study was to examine the effect of extracellular heat shock protein (HSP) 72 on human periodontal ligament fibroblast cells (hPDLFs) in vitro.DesignhPDLFs were stimulated by recombinant human HSP72 (rhHSP72). TAK-242 was used to inhibit toll-like receptor 4 (TLR4) activity. Interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-α mRNA levels were analyzed by real-time PCR and protein levels were analyzed by enzyme-linked immunosorbent assay. p65/RelA phosphorylation was analyzed by western blot.ResultsIL-6, IL-8 and TNF-α mRNA and protein levels were significantly increased by rhHSP72 stimulation. These effects were inhibited by TAK-242 treatment. Additionally, p65/RelA phosphorylation was increased after 5-min rhHSP72 stimulation, which was inhibited by TAK-242 treatment.ConclusionExtracellular HSP72 induces proinflammatory cytokines through TLR4/NF-κB in hPDLFs.



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Sink or Collaborate: How the Immersive Model Has Helped Address Typical Adolescent and Young Adult Barriers at a Single Institution and Kept the Adolescent and Young Adult Program Afloat

Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.


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Nicht mehr Blutungen durch Ibuprofen nach Tonsillektomie

Die postoperative Schmerzkontrolle mit Ibuprofen nach einer Tonsillektomie steigert bei pädiatrischen Patienten nicht das Risiko für Blutungen. Wenn es allerdings blutet, fallen die Hämorrhagien oft heftiger aus, wie eine US-Studie ergeben hat.

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Kooperation bietet allen mehr Chancen als Nachteile

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Verschmäht und weggepackt

Nicht sehen trennt von den Dingen, nicht hören trennt von den Menschen — dieser Satz wird oft zitiert, wenn es um die Schwächen der menschlichen Sinne geht. Da verwundert es, wie unterschiedlich beliebt Seh- und Hörhilfen bei Menschen sind, die sie benötigen. Denn während die Brille als modisches Accessoire durchgeht, fristet das Hörgerät nicht selten ein verschämtes Dasein im Verborgenen.

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Rezidiv bei Kopf-Hals-Tumoren: SBRT mit Langzeitschäden?

Bei lokal rezidivierten, zuvor bestrahlten Kopf-Hals-Tumoren, die für eine Salvage-Operation ungeeignet sind, hat sich die Körperstereotaxie (SBRT) als effizient erwiesen. Doch wie steht es mit der Langzeittoxizität?

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Sensibilisierung gegen Katze und Hund erhöht Asthmarisiko deutlich

Wie stark sind Sensibilisierungen gegen Katzen- und Hunde-Epithelien mit Asthmasymptomen assoziiert? Bisher konnte der Zusammenhang nicht quantifiziert werden. Eine Studie aus einer milben- und schimmelpilzfreien Gegend liefert jetzt Daten.

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Gesundheitspolitik im Wahlkampf: Alles wie gehabt

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Haben Sie auch eine fachliche Frage?

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Chronische Rhinosinusitis: erhöhte Revisionsrate nach Sinus-Op bei Polypennachweis

Kanadische Ärzte um Dr. Luke Rudmik von der Universität von Calgary sind in einer retrospektiven Studie der Frage nachgegangen, wie sich bei Patienten mit chronischer Rhinosinusitis die Ergebnisse einer endoskopischen Sinus-Chirurgie (ESS, endoscopic sinus surgery) durch Ärzte an Kliniken in Alberta unterscheiden. Primärer Studienendpunkt war die Revisionsrate fünf Jahre nach dem Eingriff.

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M. Menière: intratympanale Gabe von Methylprednisolon so wirksam wie Gentamicin

Ein klassischer Therapieansatz bei Morbus Menière ist die intratympanale Gabe von Gentamicin. Dies führt dosisabhängig zu einem Untergang der vestibulären Rezeptoren und damit zu einem Ausfall der vestibulären Funktionen. Bei etwa 20 % der so behandelten Patienten kommt es auch zu einer Hörminderung oder sogar zu einem Hörverlust. Daher ist es dringend notwendig, andere Therapien zu entwickeln, bei denen die vestibulären Funktionen intakt bleiben und insbesondere kein Risiko für eine Hörminderung besteht.

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Hilft Kortison gegen die ototoxische Wirkung von Cisplatin?

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Wege zu einer barrierefreien Kommunikation

Barrierefreiheit ist nicht nur wichtig für Personen mit körperlichen Einschränkungen, sondern auch für Menschen mit Sinneseinschränkungen wie z.B. beim Vorliegen einer Schwerhörigkeit. Im Folgenden wird aufgezeigt, warum Hörassistenzsysteme notwendig sind und wie eine barrierefreie Kommunikation mit technischen Hörassistenzsystemen erschlossen werden kann.

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Inhaltsverzeichnis

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Todmüde ans Steuer?

Wer an Schlafapnoe leidet, hat nicht nur ein erhöhtes Risiko für Herz-Kreislauf-Erkrankungen, sondern auch ein höheres Unfallrisiko. Denn schwere Tagesschläfrigkeit und der berühmte Sekundenschlaf am Steuer sind Ursache vieler schwerer Verkehrsunfälle. Wie steht es also um die Fahreignung bei schlafbezogenen Atmungsstörungen?

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Viele Ärzte reagieren allergisch auf „Dr. Google“

Erst die Symptome googeln, dann zum Doktor: Immer mehr Patienten kommen derart vorinformiert in die Praxis. Viele Ärzte erachten diese Selbstdiagnostik aber als problematisch.

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Ärztebashing 130 Jahre vor Jameda & Co.

„Nun merkt auf, wie eine simple Geschichte Euch zu nichte macht". Dieses Zitat aus Shakespeares Heinrich IV hat Morell Mackenzie 1888 seiner Verteidigungsschrift zu seiner Rolle bei der Behandlung von Kaiser Friederich III vorangestellt. Er war tief gekränkt von den Unterstellungen und Verleumdungen in der Presse. Wäre Mackenzie heute ein Fall im Bewertungsportal Jameda? Dass auch ein gutmeinender Arzt an der Kritik in den Medien zerbrechen kann, galt gestern wie heute.

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Einfach mal skypen ist nicht erlaubt

Seit April können Ärzte Videosprechstunden als EBM-Leistung über ihre KV abrechnen. Allerdings nur, wenn die Kommunikationsdienste, die sie hierfür nutzen, strenge technische Voraussetzungen erfüllen. Und genau das hat noch einen Haken: Noch gibt es auf dem Markt nur eine überschaubare Zahl von Videodiensten, die das leisten.

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TARGETING RNA-POLYMERASE I IN BOTH CHEMOSENSITIVE AND CHEMORESISTANT POPULATIONS IN EPITHELIAL OVARIAN CANCER

Purpose: A hallmark of neoplasia is increased ribosome biogenesis, and targeting this process with RNA polymerase I (Pol I) inhibitors has shown some efficacy.  We examined the contribution and potential targeting of ribosomal machinery in chemotherapy resistant and sensitive models of ovarian cancer.<br /><br />Experimental Design: Pol I machinery expression was examined, and subsequently targeted with the Pol I inhibitor CX-5461, in ovarian cancer cell lines, an immortalized surface epithelial line, and patient derived xenograft (PDX) models with and without chemotherapy.  Effects on viability, Pol I occupancy of rDNA, ribosomal content, and chemosensitivity were examined.<br /><br />Results: In PDX models, ribosomal machinery components were increased in chemotherapy-treated tumors compared to controls. 13 cell lines were sensitive to CX-5461, with IC50s 25nM - 2μM.  Interestingly two chemoresistant lines were 10.5- and 5.5-fold more sensitive than parental lines  . CX-5461 induced DNA damage checkpoint activation and G2/M arrest with increased H2AX staining.  Chemoresistant cells had 2-4-fold increased rDNA Pol I occupancy and increased rRNA synthesis, despite having slower proliferation rates, while ribosome abundance and translational efficiency were not impaired.  In five PDX models treated with CX-5461, one showed a complete response, one a 55% reduction in tumor volume, and one maintained stable disease for 45 days. <br />   <br />Conclusions: Pol I inhibition with CX-5461 shows high activity in ovarian cancer cell lines and PDX models, with an enhanced effect on chemoresistant cells. Effects occur independent of proliferation rates or dormancy. This represents a novel therapeutic approach that may have preferential activity in chemoresistant populations.

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A Prospective Transcranial Doppler Ultrasound-Based Evaluation of the Acute and Cumulative Effects of Sport-Related Concussion on Neurovascular Coupling Response Dynamics

Journal of Neurotrauma , Vol. 0, No. 0.


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Response Inhibition Deficits and Altered Motor Network Connectivity in the Chronic Phase of Pediatric Traumatic Brain Injury

Journal of Neurotrauma , Vol. 0, No. 0.


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Novel Noninvasive Method of Cerebrovascular Blood Volume Assessment Using Brain Bioimpedance

Journal of Neurotrauma , Vol. 0, No. 0.


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The Ketone Metabolite β-Hydroxybutyrate Attenuates Oxidative Stress in Spinal Cord Injury by Suppression of Class I Histone Deacetylases

Journal of Neurotrauma , Vol. 0, No. 0.


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Prospective Assessment of Acute Blood Markers of Brain Injury in Sport-Related Concussion

Journal of Neurotrauma , Vol. 0, No. 0.


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Early Complications, Morbidity, and Mortality in Octogenarians and Nonagenarians Undergoing Posterior Intra-Operative Spinal Navigation-Based C1/2 Fusion for Type II Odontoid Process Fractures

Journal of Neurotrauma , Vol. 0, No. 0.


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The structural changes of pharyngeal airway contributing to snoring after orthognathic surgery in skeletal class III patients

Abstract

Background

Two-jaw surgery including mandibular and maxillary backward movement procedures are commonly performed to correct class III malocclusion. Bimaxillary surgery can reposition the maxillofacial bone together with soft tissue, such as the soft palate and the tongue base. We analyzed changes of pharyngeal airway narrowing to ascertain clinical correlations with the prevalence of snoring after two-jaw surgery.

Methods

A prospective clinical study was designed including a survey on snoring and three-dimensional (3D) computed tomography (CT) in class III malocclusion subjects before and after bimaxillary surgery. We conducted an analysis on changes of the posterior pharyngeal space find out clinical correlations with the prevalence of snoring.

Results

Among 67 subjects, 12 subjects complained about snoring 5 weeks after the surgical correction, and examining the 12 subjects after 6 months, 6 patients complained about the snoring. The current findings demonstrated the attenuation of the largest transverse width (LTW), anteroposterior length (APL), and cross-sectional area (CSA) following bimaxillary surgery given to class III malocclusion patients, particularly at the retropalatal level. The average distance of maxillary posterior movements were measured to be relatively higher (horizontal distance 3.9 mm, vertical distance 2.6 mm) in case of new snorers.

Conclusions

This study found that bimaxillary surgery could lead to the narrowing of upper airway at the retropalatal or retroglossal level as well as triggering snoring in subjects with class III malocclusion. Based on the current clinical findings, we also found that upper airway narrowing at retropalatal level may contribute to increasing the probability of snoring and that polysonography may need to be performed before orthognathic surgery in subjects with class III malocclusion.

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Acoustic correlates of focus in Marathi: Production and perception

Publication date: November 2017
Source:Journal of Phonetics, Volume 65
Author(s): Preeti Rao, Niramay Sanghvi, Hansjörg Mixdorff, Kamini Sabu
Focus or prominence is an important linguistic function of prosody. The acoustic realisation of prominence in an utterance, in most languages, involves one or more acoustic dimensions while affecting one or more words in the utterance. It is of interest to identify the acoustic correlates as well as their possible interaction in the production and perception of focus. In this article, we consider the acoustics of focus in Marathi. Previous studies on Hindi, the more researched member of the Indo-Aryan family, have reported that the well-known rising F0 pattern on non-final content words in an utterance becomes hyper-articulated when the word is in focus. The associated F0 excursion, duration and intensity increase and are accompanied by post-focal compression of pitch range. A preliminary goal of the present study was to verify whether Marathi exhibits similar behaviour. We used Subject–Object–Verb (SOV) structured utterances with elicited focus on each word by 12 native Marathi speakers. We observed that each narrow focus location is accompanied by a distinct set of local and global acoustic correlates in F0, duration and intensity which closely parallel previous observations on Hindi. F0 cues were also examined via the accent command amplitudes of the Fujisaki model. F0 range, duration and intensity were found to vary significantly with focus condition prompting a study to examine their relative importance in the perceptual judgement of focus. Perception testing with synthetically manipulated utterances revealed that duration cues are interpreted in a categorical manner, relatively uninfluenced by the pitch cues. Only when duration is ambiguous, does the on-focus F0 cue appear to play a role. An explanation for this may lie in the normal F0-rise characteristic of the content words in Marathi, making pitch a less dependable functional cue for focus.



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A novel mutation at ANTXR1 in an indian GAPO patient

Publication date: Available online 4 August 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Esita Chattopadhyay, Sandip Ghose, Anindita Ray, Nishat Anjum, Anjana Mazumdar, Bidyut Roy
PurposeGAPO (OMIM ID 230740) is one of the rarest autosomal recessive syndromes, characterised by eponymic description of Growth retardation, Alopecia, Pseudo anodontia and Optic atrophy. It is characterized by many phenotypes such as wide anterior fontanel in head, frontal bossing in face, depressed nasal bridge etc. along with above mentioned four classical phenotypes. Recent reports identified nonsense, missense and splicing mutations at different exons of ANTXR1 to be responsible for GAPO syndrome in patients from different ethnic population. Here, we are reporting mutation at ANTXR1in a GAPO patient from India.Patients, Methods and ResultsWe describe an inherited mutation at ANTXR1 in a GAPO patient (6-year-old boy) from India. Genomic DNA from GAPO patient and other family members were screened for previously reported mutations at ANTXR1 by sequencing. A novel homozygous and heterozygous mutation in exon-3 of ANTXR1 (c.265G>A, p.Gly89Arg) has been identified in patient and other members of the family, respectively. But no mutated allele was identified in genomic DNA from unrelated healthy individuals. Bioinformatic analysis by different tools predicted deleterious, damaging or aberrant splicing effect of mutation on the protein.ConclusionFunctional inefficiency of ANTXR1due to mutation might have led to GAPO syndrome.



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The structural changes of pharyngeal airway contributing to snoring after orthognathic surgery in skeletal class III patients

Abstract

Background

Two-jaw surgery including mandibular and maxillary backward movement procedures are commonly performed to correct class III malocclusion. Bimaxillary surgery can reposition the maxillofacial bone together with soft tissue, such as the soft palate and the tongue base. We analyzed changes of pharyngeal airway narrowing to ascertain clinical correlations with the prevalence of snoring after two-jaw surgery.

Methods

A prospective clinical study was designed including a survey on snoring and three-dimensional (3D) computed tomography (CT) in class III malocclusion subjects before and after bimaxillary surgery. We conducted an analysis on changes of the posterior pharyngeal space find out clinical correlations with the prevalence of snoring.

Results

Among 67 subjects, 12 subjects complained about snoring 5 weeks after the surgical correction, and examining the 12 subjects after 6 months, 6 patients complained about the snoring. The current findings demonstrated the attenuation of the largest transverse width (LTW), anteroposterior length (APL), and cross-sectional area (CSA) following bimaxillary surgery given to class III malocclusion patients, particularly at the retropalatal level. The average distance of maxillary posterior movements were measured to be relatively higher (horizontal distance 3.9 mm, vertical distance 2.6 mm) in case of new snorers.

Conclusions

This study found that bimaxillary surgery could lead to the narrowing of upper airway at the retropalatal or retroglossal level as well as triggering snoring in subjects with class III malocclusion. Based on the current clinical findings, we also found that upper airway narrowing at retropalatal level may contribute to increasing the probability of snoring and that polysonography may need to be performed before orthognathic surgery in subjects with class III malocclusion.

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The theory of autoimmunity in Meniere’s disease is lacking evidence

The role of immunological factors in the pathophysiology of Meniere's disease (MD) has been hypothesized. In order to evaluate the current level of evidence on autoimmunity in MD, original articles relevant to the matter (1970–2016) were reviewed. The following has been considered to support the theory of autoimmunity in MD (1) the increased prevalence of autoimmune diseases among MD patients, (2) the elevated levels of antibodies and immunocomplexes in MD patients, (3) the association of MD with HLA-types and genetic polymorphisms and (4) the positive corticosteroid-responsiveness detected in some MD patients.

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Imaging of Intrathoracic Paragangliomas

Intrathoracic paragangliomas are uncommon and only represent 1–2% of paragangliomas. They are most commonly found in mediastinal compartments (aortopulmonary (AP) window or posterior mediastinum). Computed tomography, magnetic resonance and specific nuclear medicine radiotracers are routinely used to characterize these lesions and help exclude other more common conditions. Selective angiography is currently used for preoperative embolization and mapping of the vascular supply before surgical resection, rather than for diagnostic purposes alone.

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Localized amyloidosis of the epididymis: a previously unreported phenomenon

Localized amyloidosis has not been documented in the epididymis; we report this phenomenon for the first time.

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Comment on: ‘Impact of the method and success of pharyngeal reconstruction on the outcome of treating laryngeal and hypopharyngeal cancers with pharyngolaryngectomy: A national analysis’

Nouraei et al1 present an analysis of 1589 patients undergoing pharyngolaryngectomy in the UK between 2002–2012. This is a very interesting study that provides important information for reflection by specialist head and neck teams. Based upon the study findings, the authors conclude that alimentary conduits worsen short and long-term survival and advocate the centralisation of care within 3-4 specialised centres.

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Efficacy of endoscopic self-expandable metal stent placement versus surgical bypass for inoperable pancreatic cancer-related malignant biliary obstruction: a propensity score-matched analysis

Abstract

Background and aims

We explored the difference in treatment efficacy of endoscopic self-expendable metal stent (SEMS) and surgical bypass (SB) in the management of malignant biliary obstruction (MBO) secondary to pancreatic cancer.

Method

A retrospective analysis was conducted using consecutive patients who were admitted from 2008 to 2016 receiving either endoscopic SEMS or SB. Diagnosis other than pancreatic cancer and SEMS placement as a pre-operative drainage before Whipple's operation was excluded. Propensity score (PS) matching was performed to eliminate the confounding effect of heterogeneity between patients from two treatment groups. The rate of early, late treatment-related events, readmission and re-intervention, the duration of hospitalization, and the cost of treatment were compared.

Results

There were 98 patients undergoing endoscopic SEMS or SB in the study period. The median age was 68.5 years and 52% of the patients had metastatic disease with median survival of 6 months. After 1:1 PS matching, 30 patients from each group were analyzed. The hospital stay was significantly longer in the SB group (13 vs. 5 days, P < 0.001) with a trend of higher rate of early treatment-related events (24.1 vs. 6.7%, P = 0.113). None of the patients in SB group developed recurrent biliary obstruction. Higher readmission rate (36.7 vs. 3.3%, P = 0.004) and re-intervention rate (36.7 vs. 10%, P = 0.033) were found in the SEMS group. The 3-, 6-, and 9-month re-intervention rates for endoscopic SEMS and SB group were 24.9, 29.4, 45.7, and 11.2, 11.2, and 11.2%, respectively (P = 0.03). When all subsequent readmissions were taken into account, there was no significant difference in hospital stay in both groups (7.5 vs. 14 days, P = 0.359); however, the total cost of treatment in SB group was significantly higher than that in the SEMS group (13,307 vs. 7113 USD, P = 0.035).

Conclusion

Despite being more invasive and expensive, surgical bypass provides durable relief of biliary obstruction. Endoscopic SEMS is associated with minimal procedural risks and low re-intervention rate, which are important considerations for frail patients with limited life expectancy.

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Same day discharge for benign laparoscopic hiatal surgery: a feasibility analysis

Abstract

Background

Advances in minimally invasive surgery and the development of enhanced recovery pathways have favored the spread of day-surgery programs. Despite laparoscopic approaches being accepted as the standard of care for benign hiatal diseases, safety and feasibility of same day discharges for laparoscopic hiatal surgeries other than fundoplication has yet to be established.

Objective

This study aimed to assess the feasibility of same day discharge for primary and revisional laparoscopic hiatal surgeries including paraesophageal hernia repairs (PEHR), fundoplication for reflux, and Heller myotomy (±diverticulectomy).

Methods

A retrospective cohort study including all patients undergoing elective laparoscopic hiatal procedures in the division of Thoracic surgery between 2011 and 2016 at McGill University Health Centre was performed. Planned day-surgery (DAYCASE) was compared to planned inpatient (INPATIENT) cohorts with respect to operative and postoperative outcomes, length of stay, readmission, and emergency room visits.

Results

A total of 261 patients were identified, 161 female (62%); median age 62 (20). The case distribution was: PEHR (123; 47.1%), Heller myotomy (94;36%, 7 diverticulectomy), and fundoplication (44; 16.9%). Twenty patients had revisional procedures (7.7%). Same day discharge was planned in 98 cases (38%) and was successful in 80 (81.6%). Proportion of DAYCASE increased form 12% prior to 2013 to 67% in 2016. INPATIENTs were older (median 66 vs. 60 years), and had a higher proportion of PEHR (55 vs. 34%), p < 0.05. Both cohorts were comparable in gender proportion, ASA classification, and length of surgery. Complications, readmission, and emergency visits did not differ between the two cohorts. On multivariate analysis, female gender (OR 37, 95% CI 1.46–936, p = 0.028), surgery beginning after noon (OR 5.4, 95% CI 1.1–26.9, p = 0.038), intraoperative complications (OR 20.4 95% CI 1.5–286, p = 0.025), and postoperative complications (OR 52.1, 95% CI 4.5–602, p = 0.002) were independently associated with unplanned admission.

Conclusions

Day-case surgery for complex laparoscopic hiatal procedures is feasible and can be achieved in a significant number of patients without compromising safety.

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Barrett’s esophagus before and after Roux-en-Y gastric bypass for severe obesity

Abstract

Introduction

Barrett's esophagus (BE) has been associated with obesity and metabolic syndrome. Laparoscopic Roux-en-Y gastric bypass (LRYGB) may represent a surgical approach which addresses both severe obesity and BE. LRYGB diverts bile away from the gastric pouch and esophagus due to the long Roux limb, and very little acid is produced in the cardia-based gastric pouch. Furthermore, surgically induced weight loss may diminish systemic inflammation, which may contribute to metaplastic changes in the esophagus. Moreover, improved compliance with proton-pump inhibitor therapy, as a consequence of enrolling in a bariatric program, will decrease acid production further. Decreased duodeno-gastro-esophageal reflux should lead to decreased BE. In this study we examine the effect of LRYGB on regression of BE.

Methods and procedures

We performed a review of all patients with biopsy proven BE, who underwent LRYGB at our institution. A total of 19 patients were identified. A subset of those patients was identified who had at least 1 year of clinical, endoscopic, or histological data, comprising a total of 14 patients. Seven of these patients had symptoms of gastroesophageal reflux. All 19 patients had short-segment BE. One patient had low-grade dysplasia.

Results

Post-LRYGB, 6 of 14 (42.9%) patients had histologic regression of BE to normal esophageal mucosa, with no evidence of ongoing BE. 13 of 14 patients (92.8%) reported compliance with continuing PPI therapy for at least the first year after surgery. Body mass index for the group of 14 patients improved from 46.6 to 30.3 kg/m².

Conclusions

We recommend LRYGB as an effective combined bariatric and anti-reflux surgical procedure for patients with severe obesity and BE. In short-term follow-up, LRYGB achieved endoscopic and histologic regression to normal mucosa in a substantial number of the patients in our series. Long-term follow-up for patients with BE according to standard surveillance protocols is still recommended.

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Tailored approach to gastroparesis significantly improves symptoms

Abstract

Background

Gastroparesis is difficult to treat and many patients do not report relief of symptoms with medical therapy alone. Several operative approaches have been described. This study shows the results of our selective surgical approach for patients with gastroparesis.

Materials and methods

This is a retrospective study of prospective data from our electronic medical record and data symptom sheet. All patients had a pre-operative gastric emptying study showing gastroparesis, an esophagogastroduodenoscopy, and either a CT or an upper GI series with small bowel follow-through. All patients had pre- and post-operative symptom sheets where seven symptoms were scored for severity and frequency on a scale of 0–4. The scores were analyzed by a professional statistician using paired sample t test.

Results

58 patients met inclusion criteria. 33 had gastric stimulator (GES), 7 pyloroplasty (PP), 16 with both gastric stimulator and pyloroplasty (GSP), and 2 sleeve gastrectomy. For patients in the GSP group, the second procedure was performed if there was inadequate improvement with the first procedure. There was no mortality. The follow-up period was 6–316 weeks (mean 66.107, SD 69.42). GES significantly improved frequency and severity for all symptoms except frequency of bloating and postprandial fullness. PP significantly improved nausea and vomiting severity, frequency of nausea, and early satiety. Symptom improvement for GSP was measured from after the first to after the second procedure. GSP significantly improved all but vomiting severity and frequency of early satiety, postprandial fullness, and epigastric pain.

Conclusion

All procedures significantly improved symptoms, although numbers are small in the PP group. GES demonstrates more improvement than PP, and if PP or GES does not adequately improve symptoms GSP is appropriate. In our practice, gastrectomy was reserved as a last resort.

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Impedance-pH monitoring on medications does not reliably confirm the presence of gastroesophageal reflux disease in patients referred for antireflux surgery

Abstract

Introduction

The gold standard for the objective diagnosis of gastroesophageal reflux disease (GERD) is ambulatory-pH monitoring off medications. Increasingly, impedance-pH (MII-pH) monitoring on medications is being used to evaluate refractory symptoms. The aim of this study was to determine whether an MII-pH test on medications can reliably detect the presence of GERD.

Methods

Patients referred for persistent reflux symptoms despite pH confirmed adequate acid suppression (DeMeester score ≤14.7) were reviewed retrospectively. All patients who originally had MII-pH testing on medications were re-evaluated with an off medication Bravo-pH study. Acid exposure results (defined by off medication Bravo) were compared to the original on medication MII-pH.

Results

There were 49 patients who met study criteria (median age 51). Patients had normal acid exposure during their MII-pH test on medications (average DMS 4.35). Impedance was abnormal (normal ≤47) in 25 of the 49 patients (51%). On subsequent Bravo-pH off medications, 37 patients (75.7%) showed increased esophageal acid exposure (average DMS 36.4). Bravo-pH testing was abnormal in 84% of patients with abnormal MII testing and in 67% with normal MII testing. The sensitivity and specificity of an abnormal MII-pH on medications for increased esophageal acid exposure off medications was 56.8 and 66.7%, respectively. The positive predictive value of confirming GERD from an abnormal MII-pH on medications is 84%, while the negative predictive value is 33.3%. A receiver operating characteristic (ROC) curve was generated and the area under the curve was 0.71, indicating that MII-pH on medications is a fair test (0.7–0.8) in diagnosing pathologic GERD.

Conclusion

Compared to the gold standard, MII-pH on medications does not reliably confirm the presence of GERD. Excellent outcomes with antireflux surgery are dependent on the presence of GERD; thus, patients should not be offered antireflux surgery until GERD is confirmed with pH testing off medications.

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Advanced Roux-en-Y hepaticojejunostomy with magnetic compressive anastomats in obstructive jaundice dog models

Abstract

Background

Although commonly used procedure, Roux-en-Y hepaticojejunostomy (RYHJ) remains to be complicated, time consuming, and has a relatively poor prognosis. We designed the magnetic compressive anastomats (MCAs) to perform RYHJ more efficiently and safely.

Materials and methods

36 dogs were divided into two groups randomly. After obstructive jaundice model construction, RYHJ was performed with MCAs in study group or by hand-sewn in control group. Both groups were followed for 1, 3, and 6 months after RYHJ. The liver function and postoperative complications were recorded throughout the follow-up. At the end of each time point, dogs were sent for magnetic resonance imaging (MRI) and sacrificed. Anastomotic samples were taken for anastomotic narrowing rate calculation, histological analyses, tensile strength testing, and hydroxyproline content testing.

Results

The anastomotic construction times were 44.20 ± 23.02 min in study group, compared of 60.53 ± 11.89 min in control group (p < 0.05). The liver function recovered gradually after RYHJ in both groups (p > 0.05). All anastomats were expelled out of the body in 8.81 ± 2.01 days. The gross incidence of morbidity and mortality was 33.3% (6/18) and 16.7% (3/18) in study group compared with 38.9% (7/18) and 22.2% (4/18) in control group (p > 0.05), and there is no single case of anastomotic-specific complications happened in study group. The narrowing rates of anastomosis were 14.6, 18.5, and 18.7% in study group compared with 35.4, 36.9, and 34% in control group at 1st, 3rd, and 6th month after RYHJ (p < 0.05). In study group, preciser alignment of tissue layers and milder inflammatory reaction contributed to the fast and better wound healing process.

Conclusion

Perform RYHJ with MCAs is safer, more efficient than by hand-sewn method in obstructive jaundice dog models.

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Cleaved kininogen as a biomarker for bradykinin release in hereditary angioedema

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Zonne L.M. Hofman, Steven de Maat, Chiara Suffritti, Andrea Zanichelli, Cassandra van Doorn, Silvie A.E. Sebastian, Nora Veszeli, Dorottya Csuka, Thomas Renné, Gerard Pasterkamp, Marco Cicardi, Henriette Farkas, C. Erik Hack, Coen Maas

Teaser

Cleaved high-molecular weight kininogen (cHK) in plasma is a biomarker for bradykinin formation. We developed an immuno-assay to detect cHK in plasma. cHK plasma levels are increased in asymptomatic C1-INH-HAE patients, and increase further during angioedema attacks.


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A new allergen family involved in pollen food associated syndrome: snakin/gibberellin regulated proteins

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hélène Sénéchal, Jiří Šantrůček, Magdalena Melčová, Petr Svoboda, Jarmila Zídková, Denis Charpin, Laurence Guilloux, Youcef Shahali, Marie-Ange Selva, Rémy Couderc, Tomoyasu Aizawa, Pascal Poncet

Teaser

At least two pollen food associated syndromes were described with cypress pollen allergy involving peach and citrus. Snakin/gibberellin regulated proteins are described herein to be the cross-reactive allergens between Cupressus sempervirens pollen and fruit/vegetables.


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Plasma cell deficiency in humans with heterozygous mutations in SEC61A1

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Desirée Schubert, Marie-Christine Klein, Sarah Hassdenteufel, Andrés Caballero-Oteyza, Linlin Yang, Michele Proietti, Alla Bulashevska, Janine Kemming, Johannes Kühn, Sandra Winzer, Stephan Rusch, Manfred Fliegauf, Alejandro A. Schäffer, Stefan Pfeffer, Roger Geiger, Adolfo Cavalié, Hongzhi Cao, Fang Yang, Yong Li, Marta Rizzi, Hermann Eibel, Robin Kobbe, Amy L. Marks, Brian P. Peppers, Robert W. Hostoffer, Jennifer M. Puck, Richard Zimmermann, Bodo Grimbacher
BackgroundPrimary antibody deficiencies (PAD) are the most frequent primary immunodeficiencies in humans. The genetic causes for PADs are largely unknown. Sec61 translocon alpha 1 subunit (SEC61A1) is the major subunit of the Sec61 complex, which is the main polypeptide-conducting channel in the endoplasmic reticulum (ER) membrane. SEC61A1 is a target gene of XBP1s and strongly induced during plasma cell differentiation.ObjectiveCharacterization of a novel genetic defect and its pathological mechanism in eleven patients from two unrelated families with PAD.MethodsWhole exome sequencing (WES) and targeted sequencing were conducted to identify novel genetic mutations. Functional studies were carried out ex vivo in primary cells of patients and in vitro in different cell lines to assess the effect of SEC61A1 mutations on B cell differentiation and survival.ResultsWe investigated two families with patients suffering from hypogammaglobulinemia, severe recurrent respiratory tract infections and normal peripheral B- and T cell subpopulations. Upon in vitro stimulation, B cells showed an intrinsic deficiency to develop into plasma cells (PCs). Genetic analysis and targeted sequencing identified novel heterozygous missense (c.254T>A, p.V85D) and nonsense (c.1325G>T, p.E381*) mutations in SEC61A1, segregating with the disease phenotype. SEC61A1-V85D was deficient in co-translational protein translocation and it disturbed the cellular calcium homeostasis in HeLa cells. Moreover, SEC61A1-V85D triggered the terminal unfolded protein response (UPR) in multiple myeloma (MM) cell lines.ConclusionWe describe a monogenic defect leading to a specific plasma cell deficiency in humans, expanding our knowledge about the pathogenesis of antibody deficiencies.

Teaser

Heterozygous mutations in SEC61A1 are associated with plasma cell deficiency in patients with early-onset hypogammaglobulinemia and severe, recurrent respiratory tract infections but with normal B cell subpopulations in the peripheral blood.


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CDHR3 gene variation and childhood bronchiolitis

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): A. Husby, A. Pasanen, J. Waage, A. Sevelsted, H. Hodemaekers, R. Janssen, M.K. Karjalainen, J. Stokholm, B.L. Chawes, M. Korppi, G. Wennergren, A. Heinzmann, L. Bont, H. Bisgaard, K. Bønnelykke

Teaser

This genetic study combining data from five countries shows that the CDHR3 rs6967330 polymorphism is not associated to bronchiolitis triggered by RSV but might increase risk of bronchiolitis triggered by other infectious agents.


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Blocking Bcl-2 resolves IL-13–mediated mucous cell hyperplasia in a Bik-dependent manner

Publication date: Available online 4 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hitendra S. Chand, Yohannes A. Mebratu, Philip J. Kuehl, Yohannes Tesfaigzi




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Incidence and Classification of Chest Wall Deformities in Breast Augmentation Patients

Abstract

Although chest wall deformities (CWDs) are seen four times more often in males than in females, most patients who consult plastic surgery clinics in our country are females. Breast augmentation and augmentation mastopexy were performed with a total of 812 breast implants in 406 patients. Forty-three of these patients had various CWDs. The CWD patient ages ranged from 18 to 43 years. Patients were observed for 6 months to 8 years (mean of approximately 3 years). Pectus excavatum (PE) was present in 22 patients, pectus carinatum (PC) in five patients, Poland syndrome (PS) in two patients, sunken chest deformity (SCD) in three patients, barrel chest deformity (BCD) in five patients, body builder deformity (BBD) in three patients, and long upper chest wall (LCW) in three patients. None of the patients had functional or cardiac deformities. A total of 86 round, anatomically textured gel implants in various profiles were used within a range of implant volumes for all patients. There were no serious complications in the 43 CWD patients. The frequency of CWDs in the total population of 406 patients was approximately 10.6%. PE was present in 51% (22/43) of the patients with CWDs. The deformity rates among patients who underwent augmentation mammoplasty were as follows (%): PE, 5.4; PC, 1.23; PS, 0.5; SCD, 0.73; BCD, 1.23; BBD, 0.73; and LCW, 0.73. The three most common deformities observed in this study were PE, PC, and BCD. The least common deformity was PS. Patients with CWDs should be carefully evaluated preoperatively, and all the associated measurements and calculations must be meticulously performed. The implant selection may differ according to the deformity pattern. For example, in patients with PE, prostheses with larger base diameters cover the deformity better. Although high-profile prostheses are preferred on the affected side in cases of PS and SCD, low- or middle-profile prostheses are preferred on the opposite side. Despite this common consensus, there was an asymmetry of approximately 1 cm between the sides, as observed postoperatively. However, the patients did not express dissatisfaction with this situation. Low-profile prostheses should be preferred for PC and BCD protruding CWDs because asymmetry becomes more prominent and over-projection occurs more frequently in cases of high-profile prostheses. The BBD projection is also a problem. For this reason, high-profile prostheses should be preferred in these patients. It is possible to obtain satisfactory results by using appropriate breast implants in patients with CWDs.

Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Impact of Metabolic Syndrome on the Morbidity and Mortality of Patients Undergoing Panniculectomy

Abstract

Background

Metabolic syndrome (MetS) is defined as the concomitant disease process of obesity and at least two of the following variables: diabetes, hypertension, hypertriglyceridemia, or reduced high-density lipoprotein. These entities are well established as risk factors for complications following surgery. Obese patients are particularly prone to the development of MetS. The authors therefore aimed at elucidating the impact of MetS on the perioperative panniculectomy outcomes.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was analyzed for all primary procedures of panniculectomy from 2010 through 2015. The cases were stratified based on the presence or absence of MetS and evaluated for demographic data, intraoperative details, and their morbidity and mortality within 30 days after surgery.

Results

A total of 7030 cases were included in this study. Patients with MetS (6.2%) were of significantly worse health, required more emergency admissions (p = 0.022), longer hospitalization (p < 0.001), and more frequently inpatient procedures (p < 0.001) compared to the control group without MetS (3.8%). Plastic surgery was the predominant specialty operating on 79.5% of all cases. Surgical (23.3 vs. 8.7%) complications, readmission (8.7 vs. 3.0%), and reoperations (6.9 vs. 3.1%) rates were all significantly higher in patients with MetS that those without (p < 0.001). One fatality occurred in each cohort (0.23 vs. 0.02%, p = 0.010).

Conclusion

Comorbidities are not uncommon in patients undergoing panniculectomy, especially in those diagnosed with MetS. Health-care providers need to be aware of the increased morbidity and mortality in this high-risk subgroup and need to consider preoperative optimization and management before proceeding with surgery.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Invited Commentary on “A Simplified Method for Management of Platysmal Bands: Platysmotomy as an Office Procedure”

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Medial Osteoectomy as a Routine Procedure in Rhinoplasty: Six-Year Experience with an Innovative Technique

Abstract

Background

Medial osteotomy is an integral part of most rhinoplasty procedures, and when improperly performed, it is associated with postoperative complications and nasal contour deformities. In this article, we present a minimally traumatic and easy-to-perform medial osteoectomy technique with a pair of pliers, as a routine procedure, instead of the traditional medial osteotomy with osteotome and hammer. We report our experience with the use of the technique in a series of rhinoplasty procedures and review in brief the existing literature.

Methods

One hundred and thirty-five patients underwent rhinoplasty operations to correct aesthetic nose deformities, with the use of the suggested surgical technique. Two different types of medial osteoectomy, performed with the pliers, were used: Type I for dorsal nasal hump reduction and slight narrowing of the nose and type II for the management of a wide nasal dorsum along with or without hump removal.

Results

Postoperative results were favorable, by both clinical examination and comparison of preoperative and postoperative photographs, in 98.5% of patients. Only two patients with wide nasal dorsums had inadequate narrowing of their broad nose and underwent successful revision surgery.

Conclusions

The suggested technique is easy to perform, has a short learning curve, provides high accuracy over the location and amount of the nasal bone to be removed, but inflicts minimal trauma. As a result of the aforementioned advantages, the risk of postoperative complications is low, and most importantly, reliable, consistent, and aesthetically pleasing results are easily ensured.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Former Drug Company Executive Shkreli Is Convicted of Fraud

Martin Shkreli was convicted of fraud by jurors in a U.S. court in Brooklyn on Friday, in a blow for the controversial former drug company and hedge fund executive, who had forcefully and repeatedly proclaimed his innocence.
Reuters Health Information

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Unused Opioids Reported by Two Thirds of Surgery Patients

After surgery, most patients have leftover opioids and don't store or dispose of them properly, a study has found.
Medscape Medical News

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Vitiligo and Emerging Skin Repigmentation Options

Skin diseases have enormous social and emotional burdens. For vitiligo, a condition with no drug for repigmentation approved by the US Food and Drug Administration, new options are on the horizon.
Medscape Medical News

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Educational and vocational goal disruption in adolescent and young adult cancer survivors

Abstract

Objective

Cancer in adolescents and young adults (AYAs) can interrupt important developmental milestones. Absence from school and time lost from work, together with the physical impacts of treatment on energy and cognition, can disrupt educational and vocational goals. The purpose of this paper is to report on AYA cancer survivors' experiences of reintegration into school and/or work and to describe perceived changes in their educational and vocational goals.

Methods

AYAs recruited from seven hospitals in Australia, aged 15-26years and ≤24months post-treatment, were interviewed using the Psychosocial Adjustment to Illness Scale (PAIS). Responses were analysed to determine the extent of, and explanations for, cancer's effect on school/work.

Results

Forty-two AYA cancer survivors (50%female) participated. Compared with their previous vocational functioning, 12(28.6%) were scored as experiencing mild impairment, 14(33.3%) moderate impairment, and 3(7.1%) marked impairment. AYAs described difficulties reintegrating to school/work as a result of cognitive impacts such as concentration problems and physical impacts of their treatment, including fatigue. Despite these reported difficulties, the majority indicated that their vocation goals were of equal or greater importance than before diagnosis (26/42;62%), and most AYAs did not see their performance as compromised (23/42;55%). Many survivors described a positive shift in life goals and priorities. The theme of goal conflict emerged where AYAs reported compromised abilities to achieve their goals.

Conclusions

The physical and cognitive impacts of treatment can make returning to school/work challenging for AYA cancer survivors. AYAs experiencing difficulties may benefit from additional supports to facilitate meaningful engagement with their chosen educational/vocational goals.

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Prognostic value of programmed death ligand 1, p53, and Ki-67 in patients with advanced stage colorectal cancer

Publication date: Available online 4 August 2017
Source:Human Pathology
Author(s): Lisha Wang, Zebing Liu, Kurt W. Fisher, Fei Ren, Jiaojie Lv, Darrell D. Davidson, Lee A. Baldridge, Xiang Du, Liang Cheng
Current prognostic indicators are ineffective for identifying advanced stage colorectal cancer (CRC) patients with high risk of recurrence after surgical resection. We investigated the prognostic value of p53, Ki-67, and programmed death ligand 1 (PD-L1) in 254 patients with stage II and III CRC. The expression of p53 was positive in 63% of cases. Up-regulation of p53 was associated with smaller tumor size (P=.001) and higher Ki-67 labeling index (LI) (P=.031). The tumor Ki-67 LI was high (≥ 20%) in 197 (78%) of the patients. High Ki-67 LI was associated with higher TNM stage (P=.031), positive p53 expression (P=.031), and negative PD-L1 expression (P=.003). The five-year relapse-free survivals (RFS) were 53% and 89%, respectively, for the p53-positive and Ki-67 LI-high patients and the p53-negative and Ki-67 LI-low patients (P<.001). In univariate analysis, negative p53 (P=.001), low Ki-67 LI (P=.006), low PD-L1 expression (P=.044), low TNM stage (P<.001), recto-sigmoid location (P=.026), and small size (P=.013) were significantly related to RFS. In multivariate Cox regression analysis, positive p53 expression (hazard ratio [HR]: 2.48; 95% confidence interval: 1.34–4.59, P=.004), high Ki-67 LI (HR: 2.62; 95% CI: 1.12–6.14, P=.027) and high TNM stage (HR: 2.598, 95% CI: 1.55–4.37, P<.001,) were independent predictors of unfavorable prognosis. In summary, PD-L1, Ki-67, and p53 staining individually had significant prognostic value for patients with stage II and III CRC. Moreover, combining p53 H-score≥35 and Ki-67 LI≥20% identifies patients with poor clinical outcome.



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The differential diagnosis between pleural sarcomatoid mesothelioma and spindle cell/pleomorphic (sarcomatoid) carcinomas of the lung: Evidence-Based guidelines from the International Mesothelioma Panel and the MESOPATH National Reference Center

Publication date: Available online 4 August 2017
Source:Human Pathology
Author(s): Alberto M. Marchevsky, Nolwenn LeStang, Kenzo Hiroshima, Giuseppe Pelosi, Richard Attanoos, Andrew Churg, Lucien Chirieac, Sanja Dacic, Aliya Husain, Andras Khoor, Sonja Klebe, Silvie Lantuejoul, Victor Roggli, Jean-Michel Vignaud, Birgit Weynand, Jennifer Sauter, Douglas Henderson, Kazuki Nabeshima, Francoise Galateau-Salle
Immunohistochemistry is used to distinguish sarcomatoid malignant mesotheliomas (SMM) from spindle cell and pleomorphic carcinomas (SPC) but there are no guidelines on how to interpret cases that show overlapping or equivocal immunohistochemical findings. A systematic literature review of the immunophenotype of these lesions was performed and the experience with 587 SMM and 46 SPC at MESOPATH was collected. Data were analyzed with Comprehensive Meta-Analysis 2.0 software (Biostast, Englewood N.J.). There were insufficient data to evaluate the differential diagnosis between SPC and localized SMM or peritoneal SMM. Meta-analysis showed considerable overlap in the immunophenotype of these neoplasms and significant data heterogeneity amongst many of the results. Survival data from MESOPATH patients showed no significant differences in overall survival between SMM and SPC patients. Best-available evidence was used to formulate several evidence-based guidelines for the differential diagnosis between pleural SMM and SPC. These guidelines emphasize the need to correlate the histopathological findings with clinical and imaging information. Diffuse SMM can be diagnosed with certainty in the presence of malignant spindle cell pleural lesions showing immunoreactivity for cytokeratin and mesothelial markers and negative staining for epithelial markers. Criteria for the interpretation of various other combinations of immunoreactivity for cytokeratin, mesothelial and/or epithelial markers are proposed. Localized sarcomatoid mesotheliomas can only be diagnosed in the presence of spindle cell malignancies that exhibit immunoreactivity for cytokeratin and mesothelial markers and negative immunoreactivity for epithelial lesions, in patients that show no multifocal or diffuse pleural spread and no evidence for extrapleural lesions.



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Comment on: ‘Impact of the method and success of pharyngeal reconstruction on the outcome of treating laryngeal and hypopharyngeal cancers with pharyngolaryngectomy: A national analysis’

Publication date: Available online 4 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Daniel P. Butler, Simon H. Wood




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Inside EMS Podcast: Why does skill degradation happen in EMS?

Download this podcast on iTunes, SoundCloud or via RSS feed ​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss the topic of skill degradation. The debate ranges from it being secondary to a lack of confidence, poor core knowledge, or is it really because of not using the skill" They also give some tips on how to keep your skills sharp. And after listening make ...

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Transanal Endoscopic Operation Versus Conventional Transanal Excision for Rectal Tumors: Case-Matched Study with Propensity Score Matching

Abstract

Backgrounds

Although transanal endoscopic surgery is practiced worldwide, there is no consensus on comparative outcomes between transanal endoscopic operation (TEO) and transanal excision (TAE). In this study, we reviewed our experiences with these techniques and compared patients who underwent TEO and TAE using propensity score matching (PSM).

Methods

A total of 207 patients underwent local rectal tumor excision between January 2008 and November 2015. To overcome selection bias, we used PSM to achieve a one-to-one TEO: TAE ratio. We included baseline characteristics, age, sex, surgeon, American Society of Anesthesiologists score, tumor location (clockwise direction), involved circumference quadrants, tumor size, and pathology.

Results

After PSM, 72 patients were included in each group. The tumor distance from the anal verge was higher in the TEO group (8.0 [5–10] vs. TAE: 4.0 [3–5], p < 0.001). Complication rates did not differ between the groups (TEO: 8.3% vs. TAE: 11.1%, p = 0.39). TEO was associated with a shorter hospital stay (3.01 vs. 4.68 days, p = 0.001), higher negative margin rate (95.8 vs. 86.1%, p = 0.039), and non-fragmented specimen rate vs. TAE (98.6 vs. 90.3%, p = 0.029).

Conclusions

TEO was more beneficial for patients with higher rectal tumors. Regardless of tumor location, involved circumference quadrants, and tumor size, TEO may more effectively achieve negative resection margins and non-fragmented specimens. Consequently, although local excision method according to tumor distance may be important, TEO will become the standard for rectal tumors.

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Endoscopic Central Lymph Node Dissection via Breast Combined with Oral Approach for Papillary Thyroid Carcinoma: A Preliminary Study

Abstract

Objective

To investigate the feasibility and necessity of endoscopic thyroidectomy with central lymph node dissection via the combined breast and trans-oral approaches.

Methods

Six patients with papillary thyroid carcinoma who underwent endoscopic total thyroidectomy with central node dissection via combined breast and trans-oral approaches from November 2014 to January 2015 in Zhongshan Hospital, Xiamen University, were analyzed.

Results

After completion of endoscopic central lymph node dissection via the traditional breast approach, eight pieces of lymph nodes could still be dissected via the trans-oral approach. Two of these eight pieces were positive for thyroid cancer metastasis.

Conclusions

It is advisable to perform endoscopic central lymph node dissection for thyroid carcinoma via the breast approach combined with the trans-oral approach.

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Laparoscopic Versus Open Resection for Gastric Gastrointestinal Stromal Tumors (GISTs): A Size–Location-Matched Case–Control Study

Abstract

Background

Laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) is technically feasible, but the long-term effect remains uncertain. This study aims to compare the long-term oncologic outcomes of laparoscopic versus open resection of GISTs by larger cases based on tumor size–location-matched study.

Methods

Between 2006 and 2015, 63 consecutive patients with a primary gastric GIST undergoing laparoscopic resection were enrolled in and matched (1:1) to patients undergoing open resection by tumor size and location. Clinical and pathologic parameters and surgical outcomes associated with each surgical type were collected and compared.

Results

The operation time, intraoperative blood loss, return of bowel function and oral intake, nasogastric tube retention time and postoperative stay were all shorter/faster in laparoscopic group than those in open group (P < 0.001). Postoperative complications were comparable except for the higher incidence of abdominal/incision pain in open group (9.52 vs 27%, P = 0.01). There was no statistical difference in recurrence rate (9.52 vs 15.87%, P = 0.29) and long-term recurrence-free survival between the two groups (P = 0.39).

Conclusions

The long-term oncologic outcome of laparoscopic resection of primary gastric GISTs is comparable to that of open procedure, but laparoscopic procedure has the advantage of minimal invasion and is superior in postoperative recovery.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wfFCjF

Impact of a Novel Bioabsorbable Implant on Radiation Treatment Planning for Breast Cancer

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2v4H4qF

Pen Torch Transillumination: Difficult Venepuncture Made Easy

Abstract

Introduction

Our novel technique of pen torch transillumination (PTI) uses a cheap and easily available instrument (Penlite-LP212^®, Energizer^®, Missouri, USA) to visualize superficial veins invisible to the naked eye. We evaluate the efficacy of PTI in improving venepuncture success rate (SR) for patients with poor venous access.

Methods

This prospective randomized controlled trial looked at adult patients (n = 69) aged 21–90 with difficult venous access (history of ≥3 consecutive attempts required for successful cannulation during the current admission) requiring non-emergent venepuncture. Patients underwent venepuncture over the upper-limb using one of the following: conventional venepuncture (control); Veinlite^® EMS (TransLite^®, Texas, USA), a commercial transillumination device; PTI. Outcome measures were: successful cannulation within 2 attempts and total duration of venepuncture. Fisher's exact and Kruskal–Wallis tests were performed.

Results

A significantly larger number of patients had successful venepuncture within 2 attempts using PTI (22/23, 95.7%) and Veinlite (23/23, 100%), compared to the controls (7/23, 30.4%) (p < 0.05). The total duration required for successful venepuncture was significantly shorter for Veinlite (mean 3.7 min, 1.0–5.3 min) and PTI (mean 8.5 min, range 1.08–27 min) compared to the controls (mean 23.2 min, range 1.88–46.5 min) (p < 0.05).

Conclusions

PTI allows users to visualize veins invisible to the naked eye. Thrombosed/tortuous veins, branch points and valves, are easily identified and avoided. It has comparable efficacy to Veinlite^® and is cheaper (Veinlite^®-USD 227 vs. Penlite-LP212^®-USD 7.00) and more easily available. PTI improves patient care, especially in developing regions where costs are a concern.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wf2znh