Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Jesse Lowe, Alejandro J. Almarza
The inability of fibrocartilage, specifically the temporomandibular joint (TMJ) disc, to regenerate and remodel following injury presents a unique problem for clinicians. Tissue engineering then offers a potential regenerative therapy. In vitro testing provides a valuable screening tool for potential tissue engineered solutions. The conclusions drawn for TMJ in vitro research were compared against state of the art fibrocartilage studies in the knee meniscus, and annulus fibrosus of the intervertebral disc (IVD). For TMJ disc regeneration, in vitro tissue engineered approaches, focused on cellular therapies with fibrochondrocytes, have displayed an inability to produce enough collagen, as well as an inability to recapitulate native mechanical properties. Biomaterial approaches have recapitulated the native properties of the TMJ disc, but their in vivo efficacy has yet to be determined. By comparison, the knee meniscus field is the most progressive in the use of stem cells as a cell source. The knee meniscus field has moved away from measuring mechanical properties, and are instead more focused on biochemistry and gene expression. IVD studies mainly use electrospun scaffolds, and have produced the best success in mechanical properties. The TMJ field, in comparison to knee meniscus and IVD, needs to employ stem cell therapies, new biomaterials and manufacturing techniques, and cutting edge molecular assays, in future in vitro approaches to screen for viable technologies to move to in vivo studies.
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Σάββατο 5 Αυγούστου 2017
A review of in-vitro fibrocartilage tissue engineered therapies with a focus on the temporomandibular joint
A meta-analysis of randomized trials assessing the effects of probiotic preparations on oral candidiasis in the elderly
Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Ruixue Ai, Jiao Wei, Danhua Ma, Lu Jiang, Hongxia Dan, Yu Zhou, Ning Ji, Xin Zeng, Qianming Chen
ObjectiveOral candidiasis is the most common fungal infection and can be attributed in part to dysbiosis, an imbalance in the resident oral microflora. Therefore, probiotics, which counter pathogenic microorganisms through competitive, antagonistic, and immunological effects, have been used by some clinicians. To date, the effect of probiotics in preventing oral candidiasis in the elderly is controversial. A systematic review that summarizes and critically appraises the available clinical trials is therefore necessary.DesignElectronic searches were performed using the Pubmed, Embase, and Cochrane databases. Only randomized controlled trials were included. The Mantel–Haenszel test was used to appraise the odds ratio for single studies and an overall combined odds ratio for all studies combined.ResultsThree studies matched the inclusion criteria and were homogeneous. The data from one study that estimated candida growth from plaque and saliva were subdivided, thus a total of four studies with 595 people were included. The overall combined odds ratio was 0.54 (95% CI: 0.38–0.77). Three studies provided that active treatment reduced the risk of oral candidiasis more than placebo: Hatakka et al. (OR 0.51, 95% CI 0.26 to 0.97; 192 participants, plaque); Kraft-Bodi et al. (OR 0.46, 95% CI 0.24 to 0.86; 174 participants, palatal); Kraft-Bodi et al. (OR 0.50, 95% CI 0.26 to 0.98; 174 participants, plaque), while one study provided reverse result: Ishikawa et al. (OR 1.24, 95% CI 0.48 to 3.58; 55 participants, saliva).ConclusionProbiotics have a preventative effect on oral candidiasis in the elderly.
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Autophagy Analysis in Oral Carcinogenesis
Publication date: Available online 5 August 2017
Source:Pathology - Research and Practice
Author(s): T.B. de Lima, A.H.R. Paz, P.V. Rados, R. Leonardi, P. Bufo, M.C. Pedicillo, A. Santoro, S. Cagiano, G. Aquino, G. Botti, G. Pannone, F. Visioli
ObjectiveThe aim of this study was to evaluate the levels of autophagy in oral leukoplakia and squamous cell carcinoma and to correlate with clinical pathological features, as well as, the evolution of these lesions.Methodology7 Normal oral mucosa, 51 oral leukoplakias, and 120 oral squamous cell carcinomas (OSCC) were included in the study. Histological sections of the mucosa and leukoplakias were evaluated throughout their length, while the carcinomas were evaluated using Tissue Microarray. After the immunohistochemical technique, LC3-II positive cells were quantified in the different epithelial layers of the mucosa and leukoplakias and in the microarrays of the squamous cell carcinomas. The correlation between positive cells with the different clinical-pathological variables and with the evolution of the lesions was tested using the t test, ANOVA, and Kaplan-Meier survival analysis.ResultsWe observed increased levels of autophagy in the oral squamous cell carcinomas (p <0.001) in relation to the other groups, but without any association with poorer evolution or survival of these patients. Among the leukoplakias, we observed a higher percentage of positive cells in the intermediate layer of the dysplastic leukoplakias (p=0.0319) and in the basal layer of lesions with poorer evolution (p=0.0133).ConclusionThe levels of autophagy increased during the process of oral carcinogenesis and are correlated with poorer behavior of the leukoplakias.
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The theory of autoimmunity in Meniere’s disease is lacking evidence
Source:Auris Nasus Larynx
Author(s): Eerik Kangasniemi, Elina Hietikko
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. However, all studies have been small and lack positive replication. Studies concerning antibodies, HLA types and genetic polymorphisms have produced conflicting results and no single antibody, HLA type or polymorphism has been found in all or even in a significant subpopulation of MD patients. No convincing basic research evidence of autoimmunity in MD exists hence the field needs further study.
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Le lifting du visage sous anesthésie locale en ambulatoire
Source:Annales de Chirurgie Plastique Esthétique
Author(s): G. Vitale, S. Piereschi
Le lifting cervicofacial sous anesthésie locale : l'auteur expose son expérience et sa méthodologie développée pour opérer les liftings cervicofaciaux sous anesthésie locale afin de diminuer la morbidité opératoire et pouvoir opérer des personnes ne désirant pas d'anesthésie générale. La technique repose sur la connaissance de l'anatomie sensitive de la face ainsi que la pratique de blocs de conduction sensitive au niveau de la face, permettant de diminuer les doses d'anesthésiques locaux.Facelift under local anesthesia: the author recounts his experience and methodology developed to operate facelift under local anesthesia in order to reduce operative morbidity and be able to operate persons who do not desire general anesthesia. The technique is based on the knowledge of the sensitive anatomy of the face as well as the practice of sensitive conduction blocks at the level of the face allowing to decrease the doses of local anesthetics.
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Utility of PET scan in diagnosis and monitoring descending necrotizing mediastinitis complicating Lemierre's syndrome.
| Related Articles |
Utility of PET scan in diagnosis and monitoring descending necrotizing mediastinitis complicating Lemierre's syndrome.
Intern Emerg Med. 2017 Aug 03;:
Authors: Carandini T, Longari V, Mendogni P, Gaffuri M, Ceriani E
PMID: 28776174 [PubMed - as supplied by publisher]
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Innovation in neurosurgery: less than IDEAL? A systematic review
Abstract
Background
Surgical innovation is different from the introduction of novel pharmaceuticals. To help address this, in 2009 the IDEAL Collaboration (Idea, Development, Exploration, Assessment, Long-term follow-up) introduced the five-stage framework for surgical innovation. To evaluate the framework feasibility for novel neurosurgical procedure introduction, two innovative surgical procedures were examined: the endoscopic endonasal approach for skull base meningiomas (EEMS) and the WovenEndobridge (WEB device) for endovascular treatment of intracranial aneurysms.
Methods
The published literature on EEMS and WEB devices was systematically reviewed. Identified studies were classified according to the IDEAL framework stage. Next, studies were evaluated for possible categorization according to the IDEAL framework.
Results
Five hundred seventy-six papers describing EEMS were identified of which 26 papers were included. No prospective studies were identified, and no studies reported on ethical approval or patient informed consent for the innovative procedure. Therefore, no clinical studies could be categorized according to the IDEAL Framework. For WEB devices, 6229 articles were screened of which 21 were included. In contrast to EEMS, two studies were categorized as 2a and two as 2b.
Conclusion
The results of this systematic review demonstrate that both EEMS and WEB devices were not introduced according to the (later developed in the case of EEMS) IDEAL framework. Elements of the framework such as informed consent, ethical approval, and rigorous outcomes reporting are important and could serve to improve the quality of neurosurgical research. Alternative study designs and the use of big data could be useful modifications of the IDEAL framework for innovation in neurosurgery.
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Rod and frame test and posture under optokinetic stimulation used to explore two complementary aspects of the visual influence in postural control after stroke
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Sophie Tasseel-Ponche, Hélène Le Liepvre, Florence Colle, Cédric Andriantsifanetra, Pierre-Paul Vidal, Isabelle Véronique Bonan, Alain-Pierre Yelnik
BackgroundBalance rehabilitation should consider individual comportments according to visual input (VI). Indeed, visual dependence (VD), defined as the predominance given to the VI whatever the circumstances, frequent after stroke it could disturb balance. Because the term VD is a bit restrictive and cannot be deduced from clinical tests, the term visual sensitivity (VS) is preferred here.HypothesisVI could have different influence depending on the task for a given individual.MethodsWe retrospectively compared 2 VS tests routinely used: the rod and frame test (RFT) and optokinetic stimulation (OKS). In RFT, VS was defined by a misperception of the visual verticality induced by a tilted frame (VS RFT) and in OKS by tilted sitting posture induced by rotational OKS (VS OKS). We studied the relations between VS RFT and VS OKS.ResultsWe analysed data for 84 patients, mean age 55±10years, 45±30days after stroke. Scores for both tests were correlated with autonomy measured by the functional independence measure (r=−0.3, p=0.01 and r=−0.2, p=0.02). VS OKS score was also correlated with balance measured by the postural assessment scale for stroke (r=−0.3, p=0.03). VS RFT score was not correlated with VS OKS score (p=0.4, r=0.04).Discussion - conclusionA patient may display VS for one test without sensitivity for the other because these tests investigate different neural organisation — perception for RFT or action for OKS. Their relation to balance disorders should be further investigated to build individualized rehabilitation programs.
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Inter-individual similarities and variations in muscle forces acting on the ankle joint during gait
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Michalina Błażkiewicz, Ida Wiszomirska, Katarzyna Kaczmarczyk, Roozbeh Naemi, Andrzej Wit
Muscle forces acting over the ankle joint play an important role in the forward progression of the body during gait. Yet despite the importance of ankle muscle forces, direct in-vivo measurements are neither possible nor practical. This makes musculoskeletal simulation useful as an indirect technique to quantify the muscle forces at work during locomotion. The purpose of this study was to: 1) identify the maximum peaks of individual ankle muscle forces during gait; 2) investigate the order over which the muscles are sorted based on their maximum peak force. Three-dimensional kinematics and ground reaction forces were measured during the gait of 10 healthy subjects, and the data so obtained were input into the musculoskeletal model distributed with the OpenSim software. In all 10 individuals we observed that the soleus muscle generated the greatest strength both in dynamic (1856.1N) and isometric (3549N) conditions, followed by the gastrocnemius in dynamic conditions (1232.5N). For all other muscles, however, the sequence looks different across subjects, so the k-means clustering method was used to obtain one main order over which the muscles' peak-forces are sorted. The results indicate a common theme, with some variations in the maximum peaks of ankle muscle force across subjects.
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Hamstring and calf muscle activation as a function of bodyweight support during treadmill running in ACL reconstructed athletes
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Clint Hansen, Einar Einarson, Athol Thomson, Rodney Whiteley, Erik Witvrouw
Rehabilitation after injury and reconstruction to the anterior cruciate ligament is thought to require a gradual reintroduction of loading, particularly during resumption of running. One strategy to achieve this is via the use of a reduced-gravity treadmill but it is unknown, if and how muscle activity varies in the reduced gravity conditions compared to regular treadmill running. Nineteen healthy participants and 18 male patients at the end of their rehabilitation (8 with a bone-patellar-bone graft, 10 with a hamstring graft) participated in this multi-muscle surface electromyography (sEMG) running study. The hamstrings and triceps surae were evaluated during a 16km/h running while at 6 different relative bodyweight conditions from 50% (half weight-bearing) to 100% (full weight-bearing). Muscle activation was examined individually as well as normalized to a composite "entire" activation and considered across the entire gait cycle using Statistical Parametric Mapping. The healthy participants showed differences between the 50–100% BW and 60–100% conditions and in the hamstring graft group for 60–100% and 80–100% conditions. No differences were seen comparing all loading conditions in the bone-patellar-bone graft group. For the hamstrings, from 70% BW and above, there appear to be no difference in activation patterns for any of the groups.The activation patterns of the hamstrings was essentially the same from 70% indicated bodyweight through to full weight bearing when running at 16km/h. Accordingly, when running at this relatively high speed, we do not expect any adverse effects in terms of altered motor patterns during rehabilitation of these muscles.
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Foot structure is significantly associated to subtalar joint kinetics and mechanical energetics
Publication date: October 2017
Source:Gait & Posture, Volume 58
Author(s): Jayishni N. Maharaj, Andrew G. Cresswell, Glen A. Lichtwark
Introduction/aimFoot structure has been implicated as a risk factor of numerous overuse injuries, however, the mechanism linking foot structure and the development of soft-tissue overuse injuries are not well understood. The aim of this study was to identify factors that could predict foot function during walking.MethodsA total of eleven variables (including measures of foot structure, anthropometry and spatiotemporal gait characteristics) were investigated for their predictive ability on identifying kinematic, kinetic and energetic components of the foot. Three-dimensional motion capture and force data were collected at preferred walking speed on an instrumented treadmill. Mechanical measures were subsequently assessed using a custom multi-segment foot model in Opensim. Factors with significant univariate associations were entered into multiple linear regression models to identify a group of factors independently associated with the mechanical measures.ResultsAlthough no model could be created for any of the kinematic measures analysed, approximately 46% and 37% of the variance in the kinetic and energetic measures were associated with three or two factors respectively. Arch-height ratio, foot length and step width were associated with peak subtalar joint (STJ) moment, while greater STJ negative work was correlated to a low arch-height ratio and greater foot mobility.ConclusionThe models presented in this study suggest that the soft-tissue structures of a flat-arched, mobile foot are at a greater risk of injury as they have greater requirements to absorb energy and generate larger forces. However, as these associations are only moderate, other measures may also have an influence.
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Copyright-Page
Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
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Contributors
Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
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Contents
Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
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Forthcoming Issues
Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
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Transplantation
Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
Author(s): Aman Mahajan, Christopher Wray
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Overview of Immunosuppressive Therapy in Solid Organ Transplantation
Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
Author(s): Curtis D. Holt
Teaser
Mechanisms of rejection, new pharmacologic approaches, and genomic medicine are major foci for current research in transplantation. It is hoped that these new agents and personalized immunosuppression will provide for less toxic regimens that are effective in preventing both acute and chronic allograft rejection. Until new agents are available, practitioners must use various combinations of currently approved agents to find the best regimens for improved long-term outcomes.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vB8rcn
Vitamin D Receptor Gene Polymorphism: Association with Susceptibility to Early-Onset Breast Cancer in Iranian, BRCA1/2 -Mutation Carrier and non-carrier Patients
Abstract
Mounting evidences support that vitamin D insufficiency or deficiency is a risk factor of breast cancer. Vitamin D receptor (VDR) is expressed in more than 36 cell types in different organs as in cancerous cells. Numerous allelic variants of VDR gene have been identified in human populations. Association of FokI (rs2228570) and BsmI (rs1544410) single nucleotide polymorphisms (SNPs) in VDR gene with the risk of breast cancer have been investigated in several studies, however, the published data are still inconsistent. Here, we investigated BsmI and FokI polymorphisms in Iranian young (≤ 35 years old) breast cancer patient with known BRCA1/2 germline mutations. VDR gene polymorphisms were detected by restriction fragment length polymorphism (RFLP) analysis in a cohort of 203 breast cancer patients and 214 controls from Iran. There was a significant association between the bb and Bb genotypes of the BsmI and the increased risk of breast cancer (OR 1.74, CI 1.06–2.87 and OR 2.08, CI 1.31–3.29, respectively). This association was maintained in the subgroup of BRCA1/2 mutation non carriers (OR 1.90, CI 1.15–3.20 and OR 1.75, CI 1.07–2.87 for bb and Bb genotypes respectively) and in the subgroup of BRCA1/2 mutation non-carriers with a family history of breast and/or ovarian cancer (OR 1.81, CI 1.08–3.05 and OR 1.65, CI 1.00–2.70 for bb and Bb genotypes respectively). None of the FokI homozygous or heterozygous genotypes were associated with the risk of breast cancer. In summary, the BsmI polymorphism of VDR gene may be associated with the risk of breast cancer in Iranian women.
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Reduced immunoglobulin gene diversity in patients with Cornelia de Lange syndrome
Source:Journal of Allergy and Clinical Immunology
Author(s): Andrea Björkman, Likun Du, Mirjam van der Burg, Valerie Cormier-Daire, Guntram Borck, Juan Pié, Britt-Marie Anderlid, Lennart Hammarström, Lena Ström, Jean-Pierre de Villartay, David Kipling, Deborah Dunn Walters, Qiang Pan-Hammarström
Teaser
Altered IGH repertoires with reduced diversity, skewed VH gene usage and reduced frequency of somatic hypermutation were observed in CdLS patients.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2v9FVwo
Percutaneous Ultrasonic Tenotomy for Refractory Common Extensor Tendinopathy Following Failed Open Surgical Release: A Report of Two Cases
Common extensor tendinopathy (CET) is a common painful overuse and degenerative condition of the lateral elbow, affecting an estimated 2 million patients per year. Although many cases resolve with conservative treatment, recalcitrant cases may progress to open surgical intervention. For patients who fail to improve with surgical management, treatment options are extremely limited. In this manuscript, we present two cases of recalcitrant surgically treated CET successfully treated with sonographically guided percutaneous ultrasonic tenotomy (UT) with 1 year follow-up.
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Accuracy and reproducibility of a newly developed tool for volume measurements of the arm using 3D stereophotogrammetry
Lymph edema of the arm is a common complication after breast cancer treatment. To evaluate lymph edema volume and treatment outcome, an easy to use, objective quantification method of arm volume is necessary. Most of the times, water displacement is used to measure arm volume, as it is an easy and robust method that can be performed at any place with some simple equipment. However, when using water displacement, no exact localization of volume differences can be seen. To accurately measure hand and forearm volume separately, an in house developed device was made for accurate landmark placement.
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Risk of Major Limb Amputation in diabetic foot ulcer and accompanying disease: A meta-analysis
Limb amputation in diabetic patients raises important issues regarding lower quality of life and survival rates. This meta-analysis is aimed to identify predictive factors accompanying diseases with high major amputation rates in diabetic patients.
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Assessing the Effort Associated with Teaching Residents
Intraoperative resident education is an integral mission of academic medical centers and serves as the basis for training the next generation of surgeons. The actual effort associated with teaching residents, as it pertains to additional operative time, is unknown. Using a large validated multi-institutional dataset, this study aims to quantify the effect on operative time of having a resident present in common plastic surgery procedures. Future directions for developing standardized methods to record and report teaching time are proposed, which can help inform prospective studies.
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Invited Commentary: Analysis of Risk Factors Associated with Unplanned Re-Operations following Pediatric Plastic Surgery
Jubbal et al. have used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database to identify parameters associated with an increased likelihood of unplanned reoperation following plastic surgery in children under 18 years of age.1 To interpret this study, it is important to understand a little of the background to the database from which it was drawn.
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Impact of Diagnosing and Treating Obstructive Sleep Apnea on Health Care Utilization
Obstructive sleep apnea (OSA) contributes to an increased risk for multiple co-morbidities and decreased quality of life. As a result, OSA patients may have higher usage of healthcare resources which can be mitigated with effective treatment. This study evaluates changes in healthcare utilization (HCU) following the initiation of therapy for OSA.
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Idiopathic intracranial hypertension: ocular vestibular evoked myogenic potentials as a new evaluation tool
Patients with idiopathic intracranial hypertension (IIH) have an elevated intracranial pressure (ICP) in absence of any tumor or venous drain disorders. Diagnosis is based on the symptoms of elevated intracranial pressure (ICP) such as papillary edema, elevated cerebrospinal fluid (CSF) pressure in the spinal tap test of >25 cmH2O in absence of pathologic cellular or biochemical results in the spinal tap test, or structural or vascular abnormalities on cerebral MRI. For the clinical management and follow-up of patients with IIH, the possibility of non-invasively monitoring changes in ICP over time could potentially reduce the need for invasive diagnostic lumbar drainages (LD).
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New Recommendations of the IFCN: from scalp EEG to electrical brain imaging
The importance of a standardized electrode placement (1) based on specific measurements of skull landmarks, (2) labeled according to a universal designation, and (3) offering adequate coverage of all parts of the head, was proposed by Dr. Jasper a few years after the first scalp EEG recordings and readily adopted by the Second International EEG Congress (Second International EEG congress, 1950). The 10-20 electrode system was born (Klem et al., 1999)! This electrode placement system was so clinically and physiologically relevant that it has been used without any significant change ever since.
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A smoking-related background helps moderate smokers to focus: An Event-Related Potential study using a Go-NoGo Task
Smoking tobacco is known as being one of the most common health-damaging behaviors, which seems to persist, despite awareness of its negative consequences on health and intensive prevention and treatment efforts (Le Faou and Scemama, 2005). Indeed, tobacco seems to be the most addictive substance among addictive drugs (32% of users become dependent; Inserm, 2015) and a smoker dies, on average, 15 years earlier than a non-smoker (U.S. Department of Health and Human Services, 2010).
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The difficult management of radio-incuced head and neck sarcomas
Sarcomas are defined as "radio-induced" (RIS) when the histology is distinct from the primary lesion, when they arise in the irradiation field within several years (mean time: 10yrs) from radiation exposure [1,2]. Nevertheless, due to the lack of specific diagnostic criteria between radiation-induced sarcomas and sporadic sarcomas arising within the radiation field, some authors prefer to refer to these lesions as 'sarcomas in irradiated tissue' rather than 'radiation-induced sarcomas' [1,2], though the tissue morphology close to the lesion may be suggestive if radiation-related changes are shown (e.g., dense cellular fibrosis, atypical fibroblasts, alteration of the vascular architecture, and abundant fibrous stroma in the dermis adjacent to the sarcoma).
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Selenium Deficiency Augments the Levels of Inflammatory Factors and Heat Shock Proteins via the Redox Regulatory Pathway in the Skeletal Muscles of Mice
Abstract
Dietary selenium (Se) deficiency is known to cause myodynia syndrome and Se influences immune responses by changing the expression of inflammatory cytokines and heat shock proteins (Hsps), but the details are not completely elucidated. In the present study, 72 1-day-old mice were divided into two groups; the first group was fed a Se-sufficient diet, while the second group was fed a Se-deficient diet. Skeletal muscles and blood samples were taken from all mice after 42 days of treatment. The activities of glutathione peroxidase (GPX) and glutathione (GSH), mRNA and protein expression levels of inflammatory cytokines (including TNF-α, inducible NO synthase, cyclooxygenase-2, and prostaglandin E synthases), protein expression levels of NF-κB, and the mRNA expression levels of Hsps in the skeletal muscles of mice were examined. The results showed that GPX and GSH activities were decreased, while the mRNA and protein expression levels of inflammatory cytokines and the mRNA levels of Hsps were increased by Se deficiency in mouse skeletal muscles. In the present study, the protective role of Se in oxidative stress, inflammatory cytokines, and Hsps in the skeletal muscles of mice was summarized.
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Risk of Major Limb Amputation in diabetic foot ulcer and accompanying disease: A meta-analysis
Publication date: Available online 5 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Jin Yong Shin, Si-Gyun Roh, Basel Sharaf, Nae-Ho Lee
BackgroundLimb amputation in diabetic patients raises important issues regarding lower quality of life and survival rates. This meta-analysis is aimed to identify predictive factors accompanying diseases with high major amputation rates in diabetic patients.MethodsA systematic literature review and meta-analysis were performed using MEDLINE, EMBASE and Cochrane databases. Eight variables were extracted from the included studies and evaluated based on major amputation rates. The Newcastle-Ottawa scale (NOS) was utilized to assess the quality of the studies.ResultsThe search strategy identified 101 publications. After screening, 10 articles were selected for review. Hypertension, ischemic heart disease, cerebrovascular disease and peripheral vascular disease were identified as predictive variables of higher major amputation rate.ConclusionsAlthough further investigation of long-term and prospective studies is needed, we identified four variables as predisposing factors for higher major amputation in diabetic patients through meta-analysis.
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Accuracy and reproducibility of a newly developed tool for volume measurements of the arm using 3D stereophotogrammetry
Publication date: Available online 5 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A.C. Verhulst, T.S. Wesselius, H.H. Glas, R.D. Vreeken, D.J.O. Ulrich, T.J.J. Maal
BackgroundLymph edema of the arm is a common complication after breast cancer treatment. To evaluate lymph edema volume and treatment outcome, an easy to use, objective quantification method of arm volume is necessary. Most of the times, water displacement is used to measure arm volume, as it is an easy and robust method that can be performed at any place with some simple equipment. However, when using water displacement, no exact localization of volume differences can be seen. To accurately measure hand and forearm volume separately, an in house developed device was made for accurate landmark placement.MethodAn in house developed measurement tool was used to place artificial landmarks proximal of the wrist crease on ten healthy subjects. 3D images of the hand and forearm were acquired, and volume measurements of the hand and forearm were performed. Measurement were repeated to investigate the intra- and interrater variability caused by the landmark placement.ResultMeasuring volume of the hand and forearm while making use of artificial placed landmarks turned out to be a highly reproducible, quick and easy procedure. Both intra- and interrater variability showed a high reproducibility, both for hand (ICC = 0.96 and 0.98 respectively)and forearm (ICC = 0.99 and 0.99 respectively) volumes.ConclusionMeasuring volume of the hand and forearm while making use of artificial placed landmarks turned out to be a highly reproducible, quick and easy procedure. Using this device makes it possible to analyze the localization of lymphedema in a more detailed way.
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Invited Commentary: Analysis of Risk Factors Associated with Unplanned Re-Operations following Pediatric Plastic Surgery
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Catherine de Blacam
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Assessing the Effort Associated with Teaching Residents
Publication date: Available online 5 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Kelli R. Aibel, Tracy Truong, Ronnie L. Shammas, Eugenia H. Cho, Kate J. Buretta, Gina-Maria Pomann, Scott T. Hollenbeck
BackgroundIntraoperative resident education is an integral mission of academic medical centers and serves as the basis for training the next generation of surgeons. The actual effort associated with teaching residents, as it pertains to additional operative time, is unknown. Using a large validated multi-institutional dataset, this study aims to quantify the effect on operative time of having a resident present in common plastic surgery procedures. Future directions for developing standardized methods to record and report teaching time are proposed, which can help inform prospective studies.Study designThe 2006-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify seven isolated plastic surgical procedures that were categorized based on resident involvement and supervision. Linear regression models were used to calculate the difference in operative time with respect to resident participation while controlling for patient and operative factors.ResultsResident involvement was associated with higher operative times for muscle flap trunk procedures (53 minutes, 95% CI=[25, 80], p-value=0.0002) and breast reconstruction procedures with a latissimus dorsi flap (55 minutes, 95% CI=[22, 88], p-value=0.001). For 6 of the 7 surgeries evaluated, resident involvement was associated with longer operative times, compared with no resident involvement.ConclusionResident involvement is associated with an increase in operative time for certain plastic surgery procedures. This finding underscores the need for a mechanism to quantify the time and effort attending surgeons allocate towards intraoperative resident education. Further study is also necessary to determine the causal impact on patient care.
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Frontmatter
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: i-iii
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Endocrine aspects in cystic fibrosis
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 805-806
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A retrospective analysis of longitudinal changes in bone mineral content in cystic fibrosis
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 807-814
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Cystic-fibrosis related-diabetes (CFRD) is preceded by and associated with growth failure and deteriorating lung function
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 815-821
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Partial clinical remission in type 1 diabetes: a comparison of the accuracy of total daily dose of insulin of
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 823-830
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Concentrations of leptin, adiponectin and other metabolic parameters in non-obese children with Down syndrome
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 831-837
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Parent reported nutritional risk and laboratory indices of cardiometabolic risk and in preschool-aged children
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 839-846
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Multinodular goiter in children: treatment controversies
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 847-850
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Atopy as a risk factor for subclinical hypothyroidism development in children
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 851-856
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Mutation analysis of the NKX2.5 gene in Iranian pediatric patients with congenital hypothyroidism
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 857-862
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Health-related quality of life among children with Turner syndrome: controlled cross-sectional study
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 863-868
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Growth and pubertal patterns in young survivors of childhood acute lymphoblastic leukemia
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 869-877
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Clinical features and genotyping of patients with primary carnitine deficiency identified by newborn screening
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 879-883
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Sensitivity and specificity of cystic fibrosis-related diabetes screening methods: which test should be the reference method?
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 885-887
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Type 1 rhizomelic chondrodysplasia punctata with a homozygous PEX7 mutation
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 889-892
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Severe hypertriglyceridemia at new onset type 1 diabetes mellitus
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 893-897
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45,X/46,XY ovotesticular disorder of sex development revisited: undifferentiated gonadal tissue may be mistaken as ovarian tissue
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 899-904
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MRI in medium-chain acyl-coenzyme a dehydrogenase deficiency: neuroimaging during the first month
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 30
Issue: 8
Pages: 905-908
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Somatostatin Analogs: How we choose, and why
Publication date: Available online 4 August 2017
Source:Seminars in Oncology
Author(s): Diane Reidy-Lagunes, Nitya Raj, Leonard Saltz
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In reply
Publication date: Available online 4 August 2017
Source:Seminars in Oncology
Author(s): Michele Boisdron-Celle, Olivier Capitain, Roger Faroux, Christophe Borg, Jean Philippe Metges, Marie Pierre Galais, Mehdi Kaassis, Jaafar Bennouna, Karine Bouhier-Leporrier, Eric Francois, Isabelle Baumgaertner, Véronique Guerin-Meyer, Oana Cojocarasu, Celia Roemer-Becuwe, Claire Stampfli, Ludovic Rosenfeld, Thierry Lecompte, Virginie Berger, Alain Morel, Erick Gamelin
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Comparison of the RECIST and EORTC PET criteria in the tumor response assessment: a pooled analysis and review
Abstract
Purpose
The EORTC PET criteria (EORTC criteria) are used to assess metabolic tumor response in patients with solid tumors. We conducted this pooled study to compare tumor responses according to the RECIST and EORTC criteria.
Methods
Electronic databases were searched for eligible articles with the terms of "RECIST" or "EORTC criteria". We found seven articles with the data on the comparison of tumor responses by the RECIST and EORTC criteria.
Results
A total of 181 patients were recruited from the seven studies. Ninety-two patients (50.8%) received cytotoxic chemotherapy and 89 were treated with targeted agents. The agreement of tumor responses between the RECIST and EORTC criteria was moderate (k = 0.493). Of 181 patients, 66 (36.5%) showed disagreement in the tumor responses: tumor response was upgraded in 54 patients and downgraded in 12 when adopting the EORTC criteria. The estimated overall response rates were significantly different between the two criteria (52.5% by the EORTC vs. 29.8% by the RECIST, P < 0.0001). When comparing the two criteria according to the anti-cancer treatments (chemotherapy or targeted therapy), the levels of agreement in tumor responses were not excellent (k = 0.461 for chemotherapy and k = 0.524 for targeted therapy, respectively) regardless of therapeutic types.
Conclusion
This pooled study indicates that the concordance of tumor responses between the RECIST and EORTC criteria is not excellent. When adopting the EORTC criteria instead of the RECIST, the overall response rate was significantly increased.
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Supported Employment for Veterans with Traumatic Brain Injury: Provider Perspectives
Publication date: Available online 5 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Terri K. Pogoda, Kathleen F. Carlson, Katelyn E. Gormley, Sandra G. Resnick
ObjectiveIn 2006, 13 sites were provided with one-time pilot funding to provide supported employment (SE) to Veterans with traumatic brain injury (TBI) history. In 2014, we surveyed SE providers at pilot and non-pilot sites that did not receive this funding. Our objectives were to identify any pilot and non-pilot site differences regarding current: (1) provision of SE to Veterans with TBI; (2) staffing and communication between the SE and polytrauma/TBI teams; and (3) provider perceptions on facilitators and barriers to providing, and suggestions for improving, SE.SettingVeterans Health Administration (VHA) SE programs.DesignMixed methods cross-sectional survey study.ParticipantsProviders included a total of 54 SE supervisors and 90 vocational rehabilitation specialists (VRSs).InterventionsNot applicable.Main Outcome MeasuresWeb-based surveys of forced-choice and open-ended items included questions on SE team characteristics, communication with polytrauma/TBI teams, and experiences with providing SE to Veterans with TBI history.ResultsSE was provided to Veterans with TBI at 100% of pilot and 59.2% of non-pilot sites (p = .09). However, VRSs at pilot sites reported that communication with the polytrauma/TBI team about SE referrals was more frequent than at non-pilot sites (p = .003). In open-ended items, suggestions for improving SE were similar across pilot and non-pilot sites, and included increasing staffing for VRSs and case management, enhancing communication and education between SE and polytrauma/TBI teams, and expanding the scope of the SE program so that eligibility is based on employment support need, rather than diagnosis.ConclusionsThese findings may contribute to an evidence base that informs SE research and clinical directions on service provision, resource allocation, team integration efforts, and outreach to Veterans with TBI who have employment support needs.
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Mobility device quality impacts participation outcomes among people with disabilities: A structural equation modeling analysis
Publication date: Available online 5 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Susan Magasi, Alex W.K. Wong, Ana Miskovic, David Tulsky, Allen W. Heinemann
ObjectiveTo test the effect that indicators of mobility device quality have on participation outcomes among community dwelling adults with spinal cord injuries (SCI), traumatic brain injuries (TBI) and stroke using structural equation modeling.DesignSurvey, cross-sectional study, and model testing.SettingClinical research space at 2 academic medical centers and one free-standing rehabilitation hospital in the Midwestern United States (St. Louis, Ann Arbor, Chicago).ParticipantsCommunity-dwelling adults (mean age= 48 years(SD 14.3)) with SCI, TBI and Stroke (n=250).InterventionsNot applicableMain Outcomes MeasuresThe Mobility Device Impact Scale, PROMIS Social Health (v2.0) questionnaires, including Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities questionnaires and the 2 Community Participation Indicators' Enfranchisement Scales. Details about device quality (reparability, reliability, ease of maintenance) and device type were also collected.ResultsRespondents used ambulation aids (30%), manual (34%), and power wheelchairs (30%). Indicators of device quality had a moderating association with participation outcomes, with three device quality variables, ease of repairs and maintenance, and device reliability accounting for 20% of the variance in participation. Wheelchair users reported lower participation enfranchisement than persons using ambulation aids.ConclusionMobility device quality plays an important role in participation outcomes. It is critical that people have access to mobility devices and that these devices be reliable.
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Long-term treatment with leuprorelin for spinal and bulbar muscular atrophy: natural history-controlled study
Objective
To evaluate the prognosis and progression of spinal and bulbar muscular atrophy (SBMA), a rare X-linked motor neuron disorder caused by trinucleotide repeat expansion in the AR (androgen receptor) gene, after long-term androgen suppression with leuprorelin acetate treatment.
MethodsIn the present natural history-controlled study, 36 patients with SBMA treated with leuprorelin acetate for up to 84 months (leuprorelin acetate-treated group; LT group) and 29 patients with SBMA with no specific treatment (non-treated group; NT group) were analysed. Disease progression was evaluated by longitudinal quantitative assessment of motor functioning using the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R), and the modified Norris score. In addition, we selected two major clinical endpoint events, namely the occurrence of pneumonia requiring hospitalisation and death, to evaluate disease prognosis following long-term leuprorelin acetate treatment.
ResultsIn our analysis of the longitudinal disease progression using the random slope model, we observed a significant difference in the ALSFRS-R total score, the Limb Norris Score, and the Norris Bulbar Score (p=0.005, 0.026 and 0.020, respectively), with the LT group exhibiting a slower per-12-months decline compared with the NT group. As for the event analysis, the prognosis of the LT group was better in comparison to the NT group as for the event-free survival period (p=0.021).
ConclusionLong-term treatment with leuprorelin acetate appears to delay the functional decline and suppress the incidence of pneumonia and death in subjects with SBMA.
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Clinical, physiological and pathological characterisation of the sensory predominant peripheral neuropathy in copper deficiency
Introduction
Myelopathy is considered the most common neurological complication of copper deficiency. Concurrent peripheral neuropathy has been recognised in association with copper deficiency but has not been well characterised.
ObjectivesTo characterise the clinical, physiological and pathological features of copper-deficient peripheral neuropathy.
MethodsPatients with simultaneous copper deficiency (<0.78 μg/mL) and peripheral neuropathy seen at the Mayo Clinic from 1985 to 2005 were identified.
Results34 patients were identified (median age 55 years, range 36–78) including 24 women and 10 men. Myelopathy was found in 21 patients. Median serum copper level was 0.11 μg/mL (range 0–0.58). The most frequent clinical and electrophysiological pattern of neuropathy was a sensory predominant length-dependent peripheral neuropathy (71%). Somatosensory evoked potentials demonstrated central slowing supporting myelopathy (96%). Quantitative sensory testing demonstrated both small and large fibre involvement (100%). Autonomic reflex screens (77%) and thermoregulatory sweat test (67%) confirmed sudomotor dysfunction. 14 cutaneous nerve biopsies revealed loss of myelinated nerve fibres (86%), increased regenerative clusters (50%), increased rates of axonal degeneration (91%) and increased numbers of empty nerve strands (73%). 71% of biopsies demonstrated epineurial perivascular inflammation.
ConclusionsAn axonal, length-dependent sensory predominant peripheral neuropathy causing sensory ataxia is characteristic of copper deficiency usually co-occurring with myelopathy. Neurophysiological testing confirms involvement of large, greater than small fibres. The pathological findings suggest axonal degeneration and repair. Inflammatory infiltrates are common but are small and of doubtful pathological significance.
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Comparison of the RECIST and EORTC PET criteria in the tumor response assessment: a pooled analysis and review
Abstract
Purpose
The EORTC PET criteria (EORTC criteria) are used to assess metabolic tumor response in patients with solid tumors. We conducted this pooled study to compare tumor responses according to the RECIST and EORTC criteria.
Methods
Electronic databases were searched for eligible articles with the terms of "RECIST" or "EORTC criteria". We found seven articles with the data on the comparison of tumor responses by the RECIST and EORTC criteria.
Results
A total of 181 patients were recruited from the seven studies. Ninety-two patients (50.8%) received cytotoxic chemotherapy and 89 were treated with targeted agents. The agreement of tumor responses between the RECIST and EORTC criteria was moderate (k = 0.493). Of 181 patients, 66 (36.5%) showed disagreement in the tumor responses: tumor response was upgraded in 54 patients and downgraded in 12 when adopting the EORTC criteria. The estimated overall response rates were significantly different between the two criteria (52.5% by the EORTC vs. 29.8% by the RECIST, P < 0.0001). When comparing the two criteria according to the anti-cancer treatments (chemotherapy or targeted therapy), the levels of agreement in tumor responses were not excellent (k = 0.461 for chemotherapy and k = 0.524 for targeted therapy, respectively) regardless of therapeutic types.
Conclusion
This pooled study indicates that the concordance of tumor responses between the RECIST and EORTC criteria is not excellent. When adopting the EORTC criteria instead of the RECIST, the overall response rate was significantly increased.
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Cardiovascular Responses to Skeletal Muscle Stretching: “Stretching” the Truth or a New Exercise Paradigm for Cardiovascular Medicine?
Abstract
Stretching is commonly prescribed with the intended purpose of increasing range of motion, enhancing muscular coordination, and preventing prolonged immobilization induced by aging or a sedentary lifestyle. Emerging evidence suggests that acute or long-term stretching exercise may modulate a variety of cardiovascular responses. Specifically, at the onset of stretch, the mechanical deformation of the vascular bed coupled with stimulation of group III muscle afferent fibers initiates a cascade of events resulting in both peripheral vasodilation and a heart rate-driven increase in cardiac output, blood pressure, and muscle blood flow. This potential to increase shear stress and blood flow without the use of excessive muscle energy expenditure may hold important implications for future therapeutic vascular medicine and cardiac health. However, the idea that a cardiovascular component may be involved in human skeletal muscle stretching is relatively new. Therefore, the primary intent of this review is to highlight topics related to skeletal muscle stretching and cardiovascular regulation and function. The current evidence suggests that acute stretching causes a significant macro- and microcirculatory event that alters blood flow and the relationship between oxygen availability and oxygen utilization. These acute vascular changes if performed chronically may result in improved endothelial function, improved arterial blood vessel stiffness, and/or reduced blood pressure. Although several mechanisms have been postulated, an increased nitric oxide bioavailability has been highlighted as one promising candidate for the improvement in vessel function with stretching. Collectively, the evidence provided in this review suggests that stretching acutely or long term may serve as a novel and alternative low intensity therapeutic intervention capable of improving several parameters of vascular function.
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Otoliths - Accelerometer and seismometer; Implications in Vestibular Evoked Myogenic Potential (VEMP).
| Related Articles |
Otoliths - Accelerometer and seismometer; Implications in Vestibular Evoked Myogenic Potential (VEMP).
Hear Res. 2017 Jul 27;353:26-35
Authors: Grant W, Curthoys I
Abstract
Vestibular otolithic organs are recognized as transducers of head acceleration and they function as such up to their corner frequency or undamped natural frequency. It is well recognized that these organs respond to frequencies above their corner frequency up to the 2-3 kHz range (Curthoys et al., 2016). A mechanics model for the transduction of these organs is developed that predicts the response below the undamped natural frequency as an accelerometer and above that frequency as a seismometer. The model is converted to a transfer function using hair cell bundle deflection. Measured threshold acceleration stimuli are used along with threshold deflections for threshold transfer function values. These are compared to model predicted values, both below and above their undamped natural frequency. Threshold deflection values are adjusted to match the model transfer function. The resulting threshold deflection values were well within in measure threshold bundle deflection ranges. Vestibular Evoked Myogenic Potentials (VEMPs) today routinely uses stimulus frequencies of 500 and 1000 Hz, and otoliths have been established incontrovertibly by clinical and neural evidence as the stimulus source. The mechanism for stimulus at these frequencies above the undamped natural frequency of otoliths is presented where otoliths are utilizing a seismometer mode of response for VEMP transduction.
PMID: 28777976 [PubMed - as supplied by publisher]
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Baseline vestibular and auditory findings in a trial of post-concussive syndrome
| Related Articles |
Baseline vestibular and auditory findings in a trial of post-concussive syndrome
Undersea Hyperb Med. 2016 Aug-Sept;43(5):567-584
Authors: Meehan A, Searing E, Weaver LK, Lewandowski A
Abstract
Previous studies have reported high rates of auditory and vestibular-balance deficits immediately following head injury. This study uses a comprehensive battery of assessments to characterize auditory and vestibular function in 71 U.S. military service members with chronic symptoms following mild traumatic brain injury that did not resolve with traditional interventions. The majority of the study population reported hearing loss (70%) and recent vestibular symptoms (83%). Central auditory deficits were most prevalent, with 58% of participants failing the SCAN3:A screening test and 45% showing abnormal responses on auditory steady-state response testing presented at a suprathreshold intensity. Only 17% of the participants had abnormal hearing (⟩25 dB hearing loss) based on the pure-tone average. Objective vestibular testing supported significant deficits in this population, regardless of whether the participant self-reported active symptoms. Composite score on the Sensory Organization Test was lower than expected from normative data (mean 69.6 ±vestibular tests, vestibulo-ocular reflex, central auditory dysfunction, mild traumatic brain injury, post-concussive symptoms, hearing15.6). High abnormality rates were found in funduscopy torsion (58%), oculomotor assessments (49%), ocular and cervical vestibular evoked myogenic potentials (46% and 33%, respectively), and monothermal calorics (40%). It is recommended that a full peripheral and central auditory, oculomotor, and vestibular-balance evaluation be completed on military service members who have sustained head trauma.
PMID: 28771392 [PubMed - as supplied by publisher]
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An online adaptive screening procedure for selective neuronal responses
Source:Journal of Neuroscience Methods
Author(s): S. Knieling, J. Niediek, E. Kutter, J. Bostroem, C.E. Elger, F. Mormann
BackgroundA common problem in neurophysiology is to identify stimuli that elicit neuronal responses in a given brain region. Particularly in situations where electrode positions are fixed, this can be a time-consuming task that requires presentation of a large number of stimuli. Such a screening for response-eliciting stimuli is employed, e.g., as a standard procedure to identify 'concept cells' in the human medial temporal lobe.New MethodOur new method evaluates neuronal responses to stimuli online during a screening session, which allows us to successively exclude stimuli that do not evoke a response. Using this method, we can screen a larger number of stimuli which in turn increases the chances of finding responsive neurons and renders time-consuming offline analysis unnecessary.ResultsOur method enabled us to present 30% more stimuli in the same period of time with additional presentations of the most promising candidate stimuli. Our online method ran smoothly on a standard computer and network.Comparison with an Existing MethodTo analyze how our online screening procedure performs in comparison to an established offline method, we used the Wave_Clus software package. We did not observe any major drawbacks in our method, but a much higher efficiency and analysis speed.ConclusionsBy transitioning from a traditional offline screening procedure to our new online method, we substantially increased the number of visual stimuli presented in a given time period. This allows to identify more response-eliciting stimuli, which forms the basis to better address a great number of questions in cognitive neuroscience.
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EM Nerd-An Addendum to the Case of the Tarnished Standard
In a previous post we discussed the use of IVC variation and the concept of fluid responsiveness. Despite a strong physiological basis, no studies examining the use of fluid responsiveness to guide resuscitative efforts in patients with septic shock have been shown to improve patient important outcomes. Shortly after this post was released, Critical Care […]
EMCrit by Rory Spiegel.
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The association of lifetime physical inactivity with head and neck cancer: a hospital-based case–control analysis
Abstract
Despite mounting epidemiological evidence suggesting an inverse association between recreational physical activity and cancer risk, evidence associated with head and neck cancer is scant. We conducted a case–control analysis to examine the associations of lifetime physical inactivity with the risk of head and neck squamous cell carcinoma (HNSCC). We utilized data from the Patient Epidemiology Data System at Roswell Park Cancer Institute (RPCI). Participants included 246 patients with HNSCC and 504 cancer-free controls who received medical services at RPCI between 1990 and 1998. Participants were considered physically inactive if they did not participate in any regular, weekly recreational physical activity throughout their lifetime, prior to diagnosis. Multivariate logistic regression models were utilized to estimate odds ratios (OR) and 95% confidence intervals (CI) representing the association between lifetime physical inactivity and HNSCC risk. We observed a significant positive association between recreational physical inactivity and HNSCC risk (OR = 2.73, 95% CI 1.87–3.99, p < 0.001). In subgroup analyses by body mass index (BMI) (underweight/normal-weight: OR = 3.40, 95% CI 1.89–6.12, p < 0.001; overweight/obese: OR = 2.40, 95% CI 1.43–4.02, p < 0.001) and smoking status (former smoker: OR = 3.12, 95% CI 1.89–5.14, p < 0.001; never smoker: OR = 2.71, 95% CI 1.21–6.05, p = 0.020; current smoker: OR = 1.61, 95% CI 0.66–3.95, p = 0.300), significant positive associations were also observed. Results of the current analyses suggest that lifetime physical inactivity associates with HNSCC independent of BMI. In addition, physical inactivity may be a modifiable risk factor among never smokers. These data add to the growing body of evidence suggesting that physical inactivity may be an independent risk factor for cancer.
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Influence of Northeast Monsoon cold surges on air quality in Southeast Asia
Source:Atmospheric Environment, Volume 166
Author(s): M.J. Ashfold, M.T. Latif, A.A. Samah, M.I. Mead, N.R.P. Harris
Ozone (O3) is an important ground-level pollutant. O3 levels and emissions of O3 precursors have increased significantly over recent decades in East Asia and export of this O3 eastward across the Pacific Ocean is well documented. Here we show that East Asian O3 is also transported southward to tropical Southeast (SE) Asia during the Northeast Monsoon (NEM) season (defined as November to February), and that this transport pathway is especially strong during 'cold surges'. Our analysis employs reanalysis data and measurements from surface sites in Peninsular Malaysia, both covering 2003–2012, along with trajectory calculations. Using a cold surge index (northerly winds at 925 hPa averaged over 105–110°E, 5°N) to define sub-seasonal strengthening of the NEM winds, we find the largest changes in a region covering much of the Indochinese Peninsula and surrounding seas. Here, the levels of O3 and another key pollutant, carbon monoxide, calculated by the Monitoring Atmospheric Composition and Climate (MACC) Reanalysis are on average elevated by, respectively, >40% (∼15 ppb) and >60% (∼80 ppb) during cold surges. Further, in the broader region of SE Asia local afternoon exceedances of the World Health Organization's air quality guideline for O3 (100 μg m−3, or ∼50 ppb, averaged over 8 h) largely occur during these cold surges. Day-to-day variations in available O3 observations at surface sites on the east coast of Peninsular Malaysia and in corresponding parts of the MACC Reanalysis are similar, and are clearly linked to cold surges. However, observed O3 levels are typically ∼10–20 ppb lower than the MACC Reanalysis. We show that these observations are also subject to influence from local urban pollution. In agreement with past work, we find year-to-year variations in cold surge activity related to the El Nino-Southern Oscillation (ENSO), but this does not appear to be the dominant influence of ENSO on atmospheric composition in this region. Overall, our study indicates that the influence of East Asian pollution on air quality in SE Asia during the NEM could be at least as large as the corresponding, well-studied spring-time influence on North America. Both an enhanced regional observational capability and chemical modelling studies will be required to fully untangle the importance of this long-range influence relative to local processes.
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Mechanical and optical properties of monolithic CAD-CAM restorative materials
Source:The Journal of Prosthetic Dentistry
Author(s): Nazmiye Sen, Yesim Olcer Us
Statement of problemAchieving natural tooth appearance with sufficient mechanical strength is one of the most challenging issues of computer-assisted design and computer-assisted manufacturing (CAD-CAM) materials. However, limited evidence is available regarding their optical and mechanical properties for proper and evidence-based material selection in clinical practice.PurposeThe purpose of this in vitro study was to assess and compare the translucency and biaxial flexural strength of 5 monolithic CAD-CAM restorative materials.Material and methodsDisk-shaped specimens (n=30) of each material (Lava Ultimate [LU], Vita Enamic [VE], Vitablocs Mark II [VMII], Vita Suprinity [VS], and IPS e.max CAD [IPS]) with a diameter of 12 mm and a thickness of 1.2 ±0.05 mm were prepared. A spectrophotometer was used to measure the translucency parameter. The specimens were then subjected to a biaxial flexure test using 3 balls and loaded with a piston in a universal testing machine at a cross-head speed of 0.5 mm/min until failure occurred (International Organization for Standardization standard 6872). Weibull statistics were used to evaluate the characteristic strength and reliability of each material. Chemical compositions were analyzed using an energy dispersive spectrometer, and microstructural analysis was conducted using scanning electron microscopy. Data were analyzed using 1-way ANOVA and the Tukey honest significant difference test (α=.05).ResultsSignificant differences were found among the materials concerning translucency and biaxial flexural strength (P<.05). The highest mean transparency value was obtained in the VS group, whereas the lowest mean value was obtained in the VE group. The VS group produced the highest mean biaxial flexural strength, followed by the IPS, LU, VE, and VMII groups.ConclusionsBased on the results of the present study, zirconia-reinforced glass-ceramic revealed higher mean translucency and biaxial flexural strength than resin nanoceramic, feldspathic ceramic, lithium disilicate ceramic, and dual-network ceramic.
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Effect of thixotropic agents as additives on the mechanical properties of maxillofacial silicone elastomers
Source:The Journal of Prosthetic Dentistry
Author(s): Abdel Rahim M. Bibars, Zeid Al-Hourani, Yousef Khader, Mark Waters
Statement of problemThe incorporation of thixotropic agents to prevent slumping during the silicone packing procedure may alter some favorable mechanical properties of the silicone elastomers and could possibly influence the success of the prosthesis.PurposeThe purpose of this in vitro study was to evaluate the effect of adding thixotropic agents on the mechanical properties of 3 commonly used silicone elastomers.Material and methodsSpecimens of 3 maxillofacial silicones (M511, Z004; Technovent Ltd, and A2000; Factor II Inc) were prepared according to the manufacturers' instructions. Tear and tensile strength values and percentages of elongation and hardness were evaluated for each material with and without thixotropic agents. Data were analyzed using 1-way ANOVA and the Bonferroni post hoc test (α=.05).ResultsResults showed that the 3 types of silicone elastomers had significantly different (P<.001) tensile and tear strength and hardness values and percentages of elongation. Z004 silicone showed the highest tensile and tear strength followed by A2000 and M511, regardless of the addition of thixotropic agent. The addition of a thixotropic agent decreased the tear strength (P<.001) but not the tensile strength for all types of silicone. Percentage of elongation was the highest in M511 and the lowest in A2000 and was significantly higher (P<.001) for silicones with no added thixotropic agent. Hardness was highest in A2000 and lowest in M511. Adding a thixotropic agent decreased hardness significantly (P<.001) for Z004 and A2000 only.ConclusionsThe incorporation of thixotropic agents into the 3 maxillofacial silicone elastomers used in this study reduced some favorable mechanical properties, particularly tear strength and percentage of elongation. Z004 showed superior mechanical properties among the 3 tested silicones.
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Immediate implant placement and complete mouth rehabilitation with CAD-CAM titanium frameworks and cemented crowns for a patient with severe periodontal disease: A clinical report
Source:The Journal of Prosthetic Dentistry
Author(s): Pei Wang, Chunbo Tang, Yi Tang, Yunong Wu
The technique of immediate implantation has been widely used to reduce treatment time and bone loss after extraction. However, immediate implant placement in infected extraction sockets is generally contraindicated. This clinical report describes a treatment protocol for immediate implantation after the extraction of teeth with generalized chronic periodontitis. The technique used for the oral rehabilitation used computer-assisted design and computer-assisted manufacturing (CAD-CAM) titanium frameworks and cemented zirconia crowns. The titanium frameworks overcame suboptimal implant position and the cemented crowns provided excellent function and esthetics despite the locations of screw-access openings. No clinical complications occurred during a 13-month follow-up.
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Accuracy of stereolithography additive casts used in a digital workflow
Source:The Journal of Prosthetic Dentistry
Author(s): Hiba Al-Imam, Mia Gram, Ana R. Benetti, Klaus Gotfredsen
Statement of problemDespite the increasing demand for a digital workflow in the fabrication of indirect restorations, information on the accuracy of the resulting definitive casts is limited.PurposeThe purpose of this in vitro study was to compare the accuracy of definitive casts produced with digital scans and conventional impressions.Material and methodsChamfer preparations were made on the maxillary right canine and second molar of a typodont. Subsequently, 9 conventional impressions were made to produce 9 gypsum casts, and 9 digital impressions were made to produce stereolithography additive (SLA) casts from 2 manufacturers: 9 Dreve SLA casts and 9 Scanbiz SLA casts. All casts were then scanned 9 times with an extraoral scanner to produce the reference data set. Trueness was evaluated by superimposing the data sets obtained by scanning the casts with the reference data set. Precision was evaluated by analyzing the deviations among repeated scans. The root mean square (RMS) and percentage of points aligned within the nominal values (±50 μm) of the 3-dimensional analysis were calculated by the software.ResultsGypsum had the best alignment (within 50 μm) with the reference data set (median 95.3%, IQR 16.7) and the least RMS (median 25.8 μm, IQR 14.6), followed by Dreve and Scanbiz. Differences in RMS were observed between gypsum and the SLA casts (P<.001). Within 50 μm, gypsum was superior to Scanbiz (P<.001). Gypsum casts exhibited the highest precision, showing the best alignment (within 50 μm) and the least RMS, followed by Scanbiz and Dreve.ConclusionsThis study found that gypsum casts had higher accuracy than SLA casts. Within 50 μm, gypsum casts were better than Scanbiz SLA casts, while gypsum casts and Dreve SLA casts had similar trueness. Significant differences were found among the investigated SLA casts used in the digital workflow.
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Effects of image and education on the precision of the measurement method for evaluating prosthesis misfit
Source:The Journal of Prosthetic Dentistry
Author(s): Hang-Nga Mai, Kyeong Eun Lee, Jung-Hong Ha, Du-Hyeong Lee
Statement of problemVarious methods for measuring prosthesis misfit have been suggested. Although the cross-sectional images between the crown and abutment are used to evaluate the misfit, the effects of the image and the observer's knowledge on the precision of measurement are unknown.PurposeThe purpose of this in vitro study was to investigate the effects of the image and of education on the precision of prosthesis misfit measurement methods using inter- and intraobserver variability analyses.Material and methodsThe cross-sectional images in the margin were obtained using the computer-aided replica technique (CART), silicone replica technique (RT), and sectioning technique (ST). Twenty-five observers measured the absolute marginal discrepancy values in the images obtained from each group 4 times at an interval of 2 weeks; the observers went through different education sessions regarding the selection of the measurement points. The precision of measurement was determined and compared using the likelihood-ratio test statistic (α=.05) and the intraclass correlation coefficient with the linear mixed-effects model.ResultsThe CART group exhibited the smallest deviations in the measurement variations, followed by the ST and RT groups (P<.001). Additional education on misfit measurements generally decreased the deviation values in all the groups, but without any significant differences.ConclusionsThe cross-sectional image obtained from the measurement methods and education on the evaluation method affected the precision of the prosthesis misfit measurement. Digital methods might be a useful tool to significantly enhance the precision of the measurements.
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The association of lifetime physical inactivity with head and neck cancer: a hospital-based case–control analysis
Abstract
Despite mounting epidemiological evidence suggesting an inverse association between recreational physical activity and cancer risk, evidence associated with head and neck cancer is scant. We conducted a case–control analysis to examine the associations of lifetime physical inactivity with the risk of head and neck squamous cell carcinoma (HNSCC). We utilized data from the Patient Epidemiology Data System at Roswell Park Cancer Institute (RPCI). Participants included 246 patients with HNSCC and 504 cancer-free controls who received medical services at RPCI between 1990 and 1998. Participants were considered physically inactive if they did not participate in any regular, weekly recreational physical activity throughout their lifetime, prior to diagnosis. Multivariate logistic regression models were utilized to estimate odds ratios (OR) and 95% confidence intervals (CI) representing the association between lifetime physical inactivity and HNSCC risk. We observed a significant positive association between recreational physical inactivity and HNSCC risk (OR = 2.73, 95% CI 1.87–3.99, p < 0.001). In subgroup analyses by body mass index (BMI) (underweight/normal-weight: OR = 3.40, 95% CI 1.89–6.12, p < 0.001; overweight/obese: OR = 2.40, 95% CI 1.43–4.02, p < 0.001) and smoking status (former smoker: OR = 3.12, 95% CI 1.89–5.14, p < 0.001; never smoker: OR = 2.71, 95% CI 1.21–6.05, p = 0.020; current smoker: OR = 1.61, 95% CI 0.66–3.95, p = 0.300), significant positive associations were also observed. Results of the current analyses suggest that lifetime physical inactivity associates with HNSCC independent of BMI. In addition, physical inactivity may be a modifiable risk factor among never smokers. These data add to the growing body of evidence suggesting that physical inactivity may be an independent risk factor for cancer.
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Effect of hearing aids on static balance function in elderly with hearing loss.
| Related Articles |
Effect of hearing aids on static balance function in elderly with hearing loss.
Gait Posture. 2017 Jul 24;58:126-129
Authors: Negahban H, Bavarsad Cheshmeh Ali M, Nassadj G
Abstract
While a few studies have investigated the relationship between hearing acuity and postural control, little is known about the effect of hearing aids on postural stability in elderly with hearing loss. The aim was to compare static balance function between elderly with hearing loss who used hearing aids and those who did not use. The subjects asked to stand with (A) open eyes on rigid surface (force platform), (B) closed eyes on rigid surface, (C) open eyes on a foam pad, and (D) closed eyes on a foam pad. Subjects in the aided group (n=22) were tested with their hearing aids turned on and hearing aids turned off in each experimental condition. Subjects in the unaided group (n=25) were tested under the same experimental conditions as the aided group. Indicators for postural stability were center of pressure (COP) parameters including; mean velocity, standard deviation (SD) velocity in anteroposterior (AP) and mediolateral (ML) directions, and sway area (95% confidence ellipse). The results showed that within open eyes-foam surface condition, there was greater SD velocity in the off-aided than the on-aided and the unaided than the on-aided (p<0.0001 for SD velocity in AP and ML). Also, no significant differences were found between the off-aided and unaided group (p=0.56 and p=0.77 for SD velocity in AP and ML, respectively). Hearing aids improve static balance function by reducing the SD velocity. Clinical implications may include improving hearing inputs in order to increase postural stability in older adults with hearing loss.
PMID: 28772132 [PubMed - as supplied by publisher]
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Baseline vestibular and auditory findings in a trial of post-concussive syndrome
| Related Articles |
Baseline vestibular and auditory findings in a trial of post-concussive syndrome
Undersea Hyperb Med. 2016 Aug-Sept;43(5):567-584
Authors: Meehan A, Searing E, Weaver LK, Lewandowski A
Abstract
Previous studies have reported high rates of auditory and vestibular-balance deficits immediately following head injury. This study uses a comprehensive battery of assessments to characterize auditory and vestibular function in 71 U.S. military service members with chronic symptoms following mild traumatic brain injury that did not resolve with traditional interventions. The majority of the study population reported hearing loss (70%) and recent vestibular symptoms (83%). Central auditory deficits were most prevalent, with 58% of participants failing the SCAN3:A screening test and 45% showing abnormal responses on auditory steady-state response testing presented at a suprathreshold intensity. Only 17% of the participants had abnormal hearing (⟩25 dB hearing loss) based on the pure-tone average. Objective vestibular testing supported significant deficits in this population, regardless of whether the participant self-reported active symptoms. Composite score on the Sensory Organization Test was lower than expected from normative data (mean 69.6 ±vestibular tests, vestibulo-ocular reflex, central auditory dysfunction, mild traumatic brain injury, post-concussive symptoms, hearing15.6). High abnormality rates were found in funduscopy torsion (58%), oculomotor assessments (49%), ocular and cervical vestibular evoked myogenic potentials (46% and 33%, respectively), and monothermal calorics (40%). It is recommended that a full peripheral and central auditory, oculomotor, and vestibular-balance evaluation be completed on military service members who have sustained head trauma.
PMID: 28771392 [PubMed - as supplied by publisher]
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[Diagnostic criteria for Menière's disease according to the Classification Committee of the Bárány Society].
| Related Articles |
[Diagnostic criteria for Menière's disease according to the Classification Committee of the Bárány Society].
HNO. 2017 Aug 02;:
Authors: Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A
Abstract
This paper presents diagnostic criteria for Menière's disease jointly formulated by the Classification Committee of the Bárány Society, The Japan Society for Equilibrium Research, the European Academy of Otology and Neurotology (EAONO), the Equilibrium Committee of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and the Korean Balance Society. The classification includes two categories: definite Menière's disease and probable Menière's disease. The diagnosis of definite Menière's disease is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing, tinnitus and/or fullness) in the affected ear. Duration of vertigo episodes is limited to a period between 20 min and 12 h. Probable Menière's disease is a broader concept defined by episodic vestibular symptoms (vertigo or dizziness) associated with fluctuating aural symptoms occurring in a period from 20 min to 24 h.
PMID: 28770282 [PubMed - as supplied by publisher]
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1-Hz rTMS in the treatment of tinnitus: A sham-controlled, randomized multicenter trial
Source:Brain Stimulation
Author(s): Michael Landgrebe, Göran Hajak, Stefan Wolf, Frank Padberg, Philipp Klupp, Andreas J. Fallgatter, Thomas Polak, Jacqueline Höppner, Rene Haker, Joachim Cordes, Thomas Klenzner, Carlos Schönfeldt-Lecuona, Thomas Kammer, Erika Graf, Michael Koller, Tobias Kleinjung, Astrid Lehner, Martin Schecklmann, Timm B. Pöppl, Peter Kreuzer, Elmar Frank, Berthold Langguth
BackgroundChronic tinnitus is a frequent, difficult to treat disease with high morbidity.ObjectiveThis multicenter randomized, sham-controlled trial investigated the efficacy and safety of 1-Hz repetitive transcranial magnetic stimulation (rTMS) applied to the left temporal cortex in patients with chronic tinnitus.MethodsTinnitus patients were randomized to receive 10 sessions of either real or sham 1-Hz-rTMS (2000 stimuli, 110% motor threshold) to the left temporal cortex. The primary outcome was the change in the sum score of the tinnitus questionnaire (TQ) of Goebel and Hiller from baseline to end of treatment.ResultsA total of 163 patients were enrolled in the study (real rTMS: 75; sham rTMS: 78). At day 12, the baseline mean of 43.1 TQ points in 71 patients assigned to real rTMS changed by −0.5 points; it changed by 0.5 points from a baseline of 42.1 in 75 patients randomized to sham rTMS (adjusted mean difference between groups: −1.0; 95.19% confidence interval: −3.2 to 1.2; p = 0.36). All secondary outcome measures including measures of depression and quality of life showed no significant differences either (p > 0.11). The number of participants with side-effects or adverse events did not differ between groups.ConclusionReal 1-Hz-rTMS over the left temporal cortex was well tolerated but not superior compared with sham rTMS in improving tinnitus severity. These findings are in contrast to results from studies with smaller sample sizes and put the efficacy of this rTMS protocol for treatment of chronic tinnitus into question.Trial RegistrationControlled Trials: http://ift.tt/2vzTtn0.
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Effect of hearing aids on static balance function in elderly with hearing loss.
| Related Articles |
Effect of hearing aids on static balance function in elderly with hearing loss.
Gait Posture. 2017 Jul 24;58:126-129
Authors: Negahban H, Bavarsad Cheshmeh Ali M, Nassadj G
Abstract
While a few studies have investigated the relationship between hearing acuity and postural control, little is known about the effect of hearing aids on postural stability in elderly with hearing loss. The aim was to compare static balance function between elderly with hearing loss who used hearing aids and those who did not use. The subjects asked to stand with (A) open eyes on rigid surface (force platform), (B) closed eyes on rigid surface, (C) open eyes on a foam pad, and (D) closed eyes on a foam pad. Subjects in the aided group (n=22) were tested with their hearing aids turned on and hearing aids turned off in each experimental condition. Subjects in the unaided group (n=25) were tested under the same experimental conditions as the aided group. Indicators for postural stability were center of pressure (COP) parameters including; mean velocity, standard deviation (SD) velocity in anteroposterior (AP) and mediolateral (ML) directions, and sway area (95% confidence ellipse). The results showed that within open eyes-foam surface condition, there was greater SD velocity in the off-aided than the on-aided and the unaided than the on-aided (p<0.0001 for SD velocity in AP and ML). Also, no significant differences were found between the off-aided and unaided group (p=0.56 and p=0.77 for SD velocity in AP and ML, respectively). Hearing aids improve static balance function by reducing the SD velocity. Clinical implications may include improving hearing inputs in order to increase postural stability in older adults with hearing loss.
PMID: 28772132 [PubMed - as supplied by publisher]
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Baseline vestibular and auditory findings in a trial of post-concussive syndrome
| Related Articles |
Baseline vestibular and auditory findings in a trial of post-concussive syndrome
Undersea Hyperb Med. 2016 Aug-Sept;43(5):567-584
Authors: Meehan A, Searing E, Weaver LK, Lewandowski A
Abstract
Previous studies have reported high rates of auditory and vestibular-balance deficits immediately following head injury. This study uses a comprehensive battery of assessments to characterize auditory and vestibular function in 71 U.S. military service members with chronic symptoms following mild traumatic brain injury that did not resolve with traditional interventions. The majority of the study population reported hearing loss (70%) and recent vestibular symptoms (83%). Central auditory deficits were most prevalent, with 58% of participants failing the SCAN3:A screening test and 45% showing abnormal responses on auditory steady-state response testing presented at a suprathreshold intensity. Only 17% of the participants had abnormal hearing (⟩25 dB hearing loss) based on the pure-tone average. Objective vestibular testing supported significant deficits in this population, regardless of whether the participant self-reported active symptoms. Composite score on the Sensory Organization Test was lower than expected from normative data (mean 69.6 ±vestibular tests, vestibulo-ocular reflex, central auditory dysfunction, mild traumatic brain injury, post-concussive symptoms, hearing15.6). High abnormality rates were found in funduscopy torsion (58%), oculomotor assessments (49%), ocular and cervical vestibular evoked myogenic potentials (46% and 33%, respectively), and monothermal calorics (40%). It is recommended that a full peripheral and central auditory, oculomotor, and vestibular-balance evaluation be completed on military service members who have sustained head trauma.
PMID: 28771392 [PubMed - as supplied by publisher]
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The association of lifetime physical inactivity with head and neck cancer: a hospital-based case–control analysis
Abstract
Despite mounting epidemiological evidence suggesting an inverse association between recreational physical activity and cancer risk, evidence associated with head and neck cancer is scant. We conducted a case–control analysis to examine the associations of lifetime physical inactivity with the risk of head and neck squamous cell carcinoma (HNSCC). We utilized data from the Patient Epidemiology Data System at Roswell Park Cancer Institute (RPCI). Participants included 246 patients with HNSCC and 504 cancer-free controls who received medical services at RPCI between 1990 and 1998. Participants were considered physically inactive if they did not participate in any regular, weekly recreational physical activity throughout their lifetime, prior to diagnosis. Multivariate logistic regression models were utilized to estimate odds ratios (OR) and 95% confidence intervals (CI) representing the association between lifetime physical inactivity and HNSCC risk. We observed a significant positive association between recreational physical inactivity and HNSCC risk (OR = 2.73, 95% CI 1.87–3.99, p < 0.001). In subgroup analyses by body mass index (BMI) (underweight/normal-weight: OR = 3.40, 95% CI 1.89–6.12, p < 0.001; overweight/obese: OR = 2.40, 95% CI 1.43–4.02, p < 0.001) and smoking status (former smoker: OR = 3.12, 95% CI 1.89–5.14, p < 0.001; never smoker: OR = 2.71, 95% CI 1.21–6.05, p = 0.020; current smoker: OR = 1.61, 95% CI 0.66–3.95, p = 0.300), significant positive associations were also observed. Results of the current analyses suggest that lifetime physical inactivity associates with HNSCC independent of BMI. In addition, physical inactivity may be a modifiable risk factor among never smokers. These data add to the growing body of evidence suggesting that physical inactivity may be an independent risk factor for cancer.
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Stereotactic Radiosurgery with or without Whole Brain Radiotherapy for Limited Brain Metastases: A Secondary Analysis of the NCCTG N0574 (Alliance) Randomized Controlled Trial
Publication date: Available online 5 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Thomas M. Churilla, Karla V. Ballman, Paul D. Brown, Erin L. Twohy, Kurt Jaeckle, Elana Farace, Jane H. Cerhan, S. Keith Anderson, Xiomara W. Carrero, Yolanda I. Garces, Fred G. Barker, Richard Deming, Jesse G. Dixon, Stuart H. Burri, Caroline Chung, Cynthia Ménard, Volker W. Stieber, Bruce E. Pollock, Evanthia Galanis, Jan C. Buckner, Anthony L. Asher
BackgroundThere are conflicting data regarding a potential survival benefit to adjuvant whole brain radiotherapy (WBRT) among patients with limited brain metastases treated with stereotactic radiosurgery (SRS). We sought to determine if WBRT is associated with improved overall survival among non-small cell lung cancer (NSCLC) patients with favorable prognoses at diagnosis.MethodsIn the N0574 trial, patients with 1-3 brain metastases were randomized to receive SRS or SRS+WBRT with a primary endpoint of cognitive deterioration. We calculated diagnosis-specific graded prognostic assessment (DS-GPA) scores for NSCLC patients and evaluated overall survival according to receipt of WBRT and DS-GPA score using two separate cut-points (> 2.0 vs. <2.0 and > 2.5 vs. < 2.5).ResultsA total of 126 NSCLC patients were included for analysis with median follow up of 14.2 months. Data for DS-GPA calculation was available for 86.3% of all enrolled NSCLC patients. Overall, 50.0% of patients had DS-GPA score > 2.0 and 23.0% of patients had DS-GPA scores > 2.5. The SRS and SRS+WBRT groups were well balanced with regard to prognostic factors. The median survival according to receipt of WBRT was 11.3 months (+WBRT) and 17.9 months (-WBRT) for patients with DS-GPA > 2.0 (favorable prognoses, p=0.63; HR, 0.86; 95%CI, 0.47-1.59). Median survival was 3.7 months (+WBRT) and 6.6 months (-WBRT) for patients with DS-GPA < 2.0 patients (unfavorable prognoses, p=0.85; HR, 0.95; 95%CI, 0.56-1.62). Outcomes according to the receipt of WBRT and DS-GPA remained similar utilizing DS-GPA > 2.5 as a cutoff for favorable prognoses. There was no interaction between the continuum of the DS-GPA groups and WBRT on overall survival (p=0.53).ConclusionsWe observed no significant differences in survival according to receipt of WBRT in favorable prognosis NSCLC patients. This study further supports the approach of SRS alone in the majority of patients with limited brain metastases.
Teaser
There are conflicting data regarding whether adjuvant whole brain radiotherapy (WBRT) improves survival among patients with 1-3 brain metastases and favorable prognostic factors. Our post-hoc analysis of the N0574 trial demonstrated that overall survival did not differ according to the use of WBRT among non-small cell lung cancer patients with favorable (p=0.63) or unfavorable (p=0.85) diagnosis-specific graded prognostic assessment scores. In patients with limited (1-3) brain metastases, stereotactic radiosurgery alone remains a preferred treatment approach.from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2whe9hJ
The association of lifetime physical inactivity with head and neck cancer: a hospital-based case–control analysis
Abstract
Despite mounting epidemiological evidence suggesting an inverse association between recreational physical activity and cancer risk, evidence associated with head and neck cancer is scant. We conducted a case–control analysis to examine the associations of lifetime physical inactivity with the risk of head and neck squamous cell carcinoma (HNSCC). We utilized data from the Patient Epidemiology Data System at Roswell Park Cancer Institute (RPCI). Participants included 246 patients with HNSCC and 504 cancer-free controls who received medical services at RPCI between 1990 and 1998. Participants were considered physically inactive if they did not participate in any regular, weekly recreational physical activity throughout their lifetime, prior to diagnosis. Multivariate logistic regression models were utilized to estimate odds ratios (OR) and 95% confidence intervals (CI) representing the association between lifetime physical inactivity and HNSCC risk. We observed a significant positive association between recreational physical inactivity and HNSCC risk (OR = 2.73, 95% CI 1.87–3.99, p < 0.001). In subgroup analyses by body mass index (BMI) (underweight/normal-weight: OR = 3.40, 95% CI 1.89–6.12, p < 0.001; overweight/obese: OR = 2.40, 95% CI 1.43–4.02, p < 0.001) and smoking status (former smoker: OR = 3.12, 95% CI 1.89–5.14, p < 0.001; never smoker: OR = 2.71, 95% CI 1.21–6.05, p = 0.020; current smoker: OR = 1.61, 95% CI 0.66–3.95, p = 0.300), significant positive associations were also observed. Results of the current analyses suggest that lifetime physical inactivity associates with HNSCC independent of BMI. In addition, physical inactivity may be a modifiable risk factor among never smokers. These data add to the growing body of evidence suggesting that physical inactivity may be an independent risk factor for cancer.
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Brexanolone as Adjunctive Therapy in Super-Refractory Status Epilepticus
ABSTRACT
Objective: Super-refractory status epilepticus (SRSE) is a life-threatening form of status epilepticus that continues or recurs despite 24 hours or more of anesthetic treatment. We conducted a multi-center, phase 1/2 study in SRSE patients to evaluate the safety and tolerability of brexanolone (USAN; formerly SAGE-547 Injection), a proprietary, aqueous formulation of the neuroactive steroid allopregnanolone. Secondary objectives included pharmacokinetic assessment and open-label evaluation of brexanolone response during and after anesthetic third-line agent (TLA) weaning.
Methods: Patients receiving TLAs for SRSE control were eligible for open-label, one-hour brexanolone loading infusions, followed by maintenance infusion. After 48 hours of brexanolone infusion, TLAs were weaned during brexanolone maintenance. After four days, the brexanolone dose was tapered. Safety and functional status were assessed over 3-weeks of follow-up.
Results: Twenty-five patients received open-label study drug. No serious adverse events (SAEs) were attributable to study drug, as determined by the Safety Review Committee. Sixteen patients (64%) experienced ≥1 SAE. Six patient deaths occurred, all deemed related to underlying medical conditions. Twenty-two patients underwent ≥1 TLA wean attempt. Seventeen (77%) met the response endpoint of weaning successfully off TLAs before tapering brexanolone. Sixteen (73%) were successfully weaned off TLAs within five days of initiating brexanolone infusion without anesthetic agent reinstatement in the following 24-hours.
Interpretation: In an open-label cohort of limited size, brexanolone demonstrated tolerability among SRSE patients of heterogeneous etiologies and was associated with a high rate of successful TLA weaning. The results suggest the possible development of brexanolone as an adjunctive therapy for SRSE requiring pharmacologic coma for seizure control. This article is protected by copyright. All rights reserved.
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Very high frequency oscillations: Novel biomarkers of the epileptogenic zone
Abstract
Objective: In the present study, we aimed to investigate depth EEG recordings in a large cohort of patients with drug resistant epilepsy and to focus on interictal very high frequency oscillations (VHFOs) between 500 Hz and 2 kHz. We hypothesized that interictal VHFOs are more specific biomarkers for epileptogenic zone compared to traditional HFOs.
Methods: Forty patients with focal epilepsy who underwent presurgical stereo-electroencephalography (SEEG) were included in the study. SEEG data have been recorded with sampling rate of 25 kHz and 30 minutes of resting period was analyzed for each patient. Ten patients met selected criteria for analyses of correlations with surgical outcome - detection of interictal ripples (R), fast ripples (FR) and VHFOs, resective surgery, and at least one-year post-operative follow-up. Using power envelope computation and visual inspection of power distribution matrixes, electrode contacts with HFOs and VHFOs were detected and analyzed.
Results: Interictal very fast ripples (VFR; 500-1000 Hz) were detected in 23 out of 40 patients and ultra fast ripples (UFR; 1000-2000 Hz) in almost half of investigated subjects (N=19). VFR and UFR were observed only in patients with temporal lobe epilepsy and were recorded exclusively from mesiotemporal structures. The UFR were more spatially restricted in the brain then lower frequency HFOs. When compared to R oscillations, significantly better outcomes were observed in patients with higher percentage of removed contacts containing FR, VFR, and UFR.
Interpretation:
Interictal VHFOs are relatively frequent abnormal phenomena in patients with epilepsy, and appear to be more specific biomarkers for epileptogenic zone when compared to traditional HFOs. This article is protected by copyright. All rights reserved.
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