Αρχειοθήκη ιστολογίου

Κυριακή 13 Αυγούστου 2017

Prehospital pathways of occipital stroke patients with mainly visual symptoms

Objectives

Occipital ischemic strokes typically cause homonymous visual field defects, for which means of rehabilitation are limited. Intravenous thrombolysis is increasingly and successfully used for their acute treatment. However, recognition of strokes presenting with mainly visual field defects is challenging for both patients and healthcare professionals. We studied prehospital pathways of occipital stroke patients with mainly visual symptoms to define obstacles in their early recognition.

Materials & methods

This observational, retrospective, registry-based study comprises occipital stroke patients with isolated visual symptoms treated at the neurological emergency department of Helsinki University Central Hospital in 2010-2015. We analyzed their prehospital pathways, including time from symptom onset to admission at the neurological emergency department (ODT), the number of points of care, the percentage of patients with ODT≤4.5 hours, and factors associated with delay.

Results

Among 245 patients, only 20.8% arrived within 4.5 hours and 6.5% received IV thrombolysis. Delayed arrival was most often due to patients' late contact to health care. Of the patients, 27.3% arrived through at least two points of care, and differential diagnostics to ophthalmologic disorders proved particularly challenging. ODT≤4.5 hours was associated with EMS utilization, direct arrival, and atrial fibrillation; a visit at an ophthalmologist and initial misdiagnosis were associated with ODT>4.5 hours. After multivariable analysis, only direct arrival predicted ODT≤4.5 hours.

Conclusions

Occipital stroke patients with visual symptoms contact health care late, are inadequately recognized, and present with complex prehospital pathways. Consequently, they are often ineligible for IV thrombolysis. This presents a missed opportunity for preventing permanent visual field defects.



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20Q: Cochlear Synaptopathy - Interrupting Communication from Ear to Brain

An overview of cochlear synaptopathy based on new insights from animal studies of noise-induced and age-related hearing loss, with implications for audiology practice.

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Using endoscopy to locate the round window membrane during cochlear implantation: Our experience with 25 patients

Abstract

Locating the round window membrane during cochlear implantation surgery is crucial to insert the electrode array correctly and to minimize intracochlear damage. However, it can be difficult to access the round window membrane in certain patients, especially in paediatric patients or patients with inner ear malformations. Recently, it has been demonstrated that endoscopy enables excellent visualization and exploration of the round window niche in ear surgery.

This article is protected by copyright. All rights reserved.



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Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”: A retrospective nationwide Italian study

Summary

Objective

To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of "low grade epilepsy associated neuroepithelial tumors" (LEATs).

Methods

We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor-associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis.

Results

Fifty-five (98.2%) of 56 patients with medically controlled epilepsy were seizure-free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug-resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012).

Significance

Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of pharmacoresistance and oriented to optimize epileptologic, neuropsychological, and oncologic outcomes should be warranted.



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Mesenchymal Stem Cells as Natural Bio-Factories for Exosomes Carrying miR-124a in the Treatment of Gliomas

Abstract
Background
MicroRNAs (miRs) are promising new therapeutics for glioblastoma. However, which miRs are most effective against glioblastomas and how these miRs should be delivered are major unanswered problems.
Methods
To identify potent anti-glioma miRs, we selected eight miRs based on a literature search and screened them against a panel of glioma stem cell lines (GSCs), representing all TCGA-defined glioblastoma subtypes. To address delivery, we tested the hypothesis that ex vivo-cultured bone marrow-derived mesenchymal stem cells (MSCs) can package miRs into exosomes and that these engineered exosomes can systemically deliver antiglioma miRs to glioblastomas.
Results
Of the screened miRs, we identified miR-124a as the most effective anti-glioma agent against GSCs. We then transduced MSCs with lentivirus vectors containing miR-124a and isolated vesicles from the medium. Electron microscopy, western blotting, and Nanosight™ proved that the isolated vesicles were exosomes. qPCR documented that these exosomes contained high levels of miR-124a, which was not present in control exosomes. In vitro treatment of GSCs with exosomes containing miR-124a (Exo-miR124) resulted in a significant reduction in viability and clonogenicity of GSCs compared with controls. In vivo treatment of mice harboring intracranial GSC267 with systemically delivered Exo-miR124 resulted in 50% of animals living long-term. No evidence of tumor was present on histological analysis of the survivors. Mechanistic studies showed that miR-124a acts by silencing FOXA2, resulting in aberrant intracellular lipid accumulation.
Conclusion
MSCs can be used as natural bio-factories to produce Exo-miR124, which is an effective antiglioma agent worthy of further clinical evaluation.

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Identification of time-to-peak on dynamic 18 F-FET-PET as a prognostic marker specifically in IDH1/2 mutant diffuse astrocytoma

Abstract
Background
Stratification of glioma according to isocitrate dehydrogenase 1/2 (IDH1/2) mutation and 1p/19q co-deletion status has gained major importance in the new WHO classification. Parameters derived from 18F-FET-PET uptake dynamics such as minimal time-to-peak (TTPmin) allow discrimination between different prognostic glioma subgroups, too. The present study aimed at exploring whether TTPmin analysis provides prognostic information beyond the WHO classification.
Methods
Three-hundred patients with newly diagnosed WHO 2007 grade II-IV gliomas with 18F-FET-PET imaging at diagnosis were grouped into 4 subgroups (IDH1/2 mut/1p/19q co-del; IDH1/2 mut/1p/19q non co-del, IDH1/2 wildtype WHO grade II and III tumors, and glioblastoma). Clinical and imaging factors such as age, Karnofsky performance score, treatment, TTPmin and maximal tumor-to-brain ratio (TBRmax) were analyzed with regard to progression-free and overall survival (PFS and OS) via univariate and multivariate regression analysis.
Results
PFS and OS were longest in the IDH1/2 mut/1p/19q co-del subgroup followed by IDH1/2 mut/1p/19q non co-del, IDH1/2 wt patients and GBM (p<0.001). Further, outcome stratified by TTPmin with a cutoff of 17.5 minutes revealed significantly longer PFS and OS in patients with TTPmin >17.5 minutes (p<0.001 for PFS and OS). Lower TBRmax values or the absence of 18F-FET-uptake were also associated with favorable outcome in the entire group. In the subgroup analyses, longer median TTPmin was associated with improved outcome specifically in the IDH1/2 mut/1p/19q non co-del group.
Conclusion
18F-FET-PET-derived dynamic analysis defines prognostically distinct sub-groups of IDH1/2 mutant/ 1p/19q-non-co-deleted gliomas which cannot be distinguished as yet by molecular marker analysis.

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Consolidative Proton Therapy after Chemotherapy for Patients with Hodgkin Lymphoma

Abstract
Background: We investigated early outcomes for patients receiving chemotherapy followed by consolidative proton therapy (PT) for the treatment of Hodgkin lymphoma (HL).Patients and Methods: From June 2008 through August 2015, 138 patients with HL enrolled on either IRB-approved outcomes tracking protocols or registry studies received consolidative PT. Patients were excluded due to relapsed or refractory disease. Involved-site radiotherapy field designs were used for all patients. Pediatric patients received a median dose of 21 Gy(RBE) (range, 15-36 Gy[RBE]); adult patients received a median dose of 30.6 Gy(RBE) (range, 20-45 Gy[RBE]). Patients receiving PT were young (median age, 20 years; range 6 – 57). Overall, 42% were pediatric (≤18 years) and 93% were under the age of 40 years. Thirty-eight percent of patients were male and 62% female. Stage distribution included 73% with I/II and 27% with III/IV disease. Patients predominantly had mediastinal involvement (96%) and bulky disease (57%), while 37% had B symptoms. The median follow-up was 32 months (range, 5–92 months).Results: The 3-year relapse-free survival rate was 92% for all patients; it was 96% for adults and 87% for pediatric patients (p = 0.18). When evaluated by PET/CT scan response at the end of chemotherapy, patients with a partial response had worse 3-year progression-free survival compared with other patients (78% vs. 94%; p = 0.0034). No grade 3 radiation-related toxicities have occurred to date.Conclusion: Consolidative PT following standard chemotherapy in HL is primarily used in young patients with mediastinal and bulky disease. Early relapse-free survival rates are similar to those reported with photon radiation treatment, and no early grade 3 toxicities have been observed. Continued follow-up to assess late effects is critical.

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Issue Cover (August 2017)

Thumbnail image of graphical abstract

Cover image by Dr. Natalie Doig (MRC Brain Network Dynamics Unit, Department of Pharmacology, Oxford). The cover image is of a frontal section of mouse brain showing many regions of the basal ganglia. The section was triple-immunostained to reveal tyrosine hydroxylase (TH; cyan), parvalbumin (PV; green) and choline acetyltransferase (magenta).



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Re: Frontal Fibrosing Alopecia Severity Index (FFASI): a call for a more inclusive and globally relevant severity index for frontal fibrosing alopecia: reply from the authors



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A 42-Year-Old Man with AIDS and Multiple Incomplete Ring Enhancing Lesions



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Stratification of astrocytes in healthy and diseased brain

Abstract

Astrocytes, a subtype of glial cells, come in variety of forms and functions. However, overarching role of these cell is in the homeostasis of the brain, be that regulation of ions, neurotransmitters, metabolism or neuronal synaptic networks. Loss of homeostasis represents the underlying cause of all brain disorders. Thus, astrocytes are likely involved in most if not all of the brain pathologies. We tabulate astroglial homeostatic functions along with pathological condition that arise from dysfunction of these glial cells. Classification of astrocytes is presented with the emphasis on evolutionary trails, morphological appearance and numerical preponderance. We note that, even though astrocytes from a variety of mammalian species share some common features, human astrocytes appear to be the largest and most complex of all astrocytes studied thus far. It is then an imperative to develop humanized models to study the role of astrocytes in brain pathologies, which is perhaps most abundantly clear in the case of glioblastoma multiforme.



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A 54-Year-Old Male with Multiple Intracranial and Extracranial Masses



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SOCIETY NEWS



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Protein astrogliopathies in human neurodegenerative diseases and aging

Abstract

Neurodegenerative diseases are characterized by progressive dysfunction and loss of neurons associated with depositions of pathologically altered proteins showing hierarchical involvement of brain regions. The role of astrocytes in the pathogenesis of neurodegenerative diseases is explored as contributors to neuronal degeneration or neuroprotection pathways, and also as potential mediators of the transcellular spreading of disease-associated proteins. Protein astrogliopathy (PAG), including deposition of amyloid-β, prion protein, tau, α-synuclein, and very rarely transactive response DNA-binding protein 43 (TDP-43) is not unprecedented or unusual in neurodegenerative diseases. Morphological characterization of PAG is considered, however, only for the neuropathological diagnosis and classification of tauopathies. Astrocytic tau pathology is seen in primary frontotemporal lobar degeneration (FTLD) associated with tau pathologies (FTLD-Tau), and also in the form of aging-related tau astrogliopathy (ARTAG). Importantly, ARTAG shares common features with primary FTLD-Tau as well as with the astroglial tau pathologies that are thought to be hallmarks of a brain injury-related tauopathy known as chronic traumatic encephalopathy (CTE). Supported by experimental observations, the morphological variability of PAG might reflect distinct pathogenic involvement of different astrocytic populations. PAG might indicate astrocytic contribution to spreading or clearance of disease-associated proteins, however, this might lead to astrocytic dysfunction and eventually contribute to the degeneration of neurons. Here, we review recent advances in understanding ARTAG and other related forms of PAG.



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Diversity of astroglial responses across human neurodegenerative disorders and brain aging

Abstract

Astrogliopathy refers to alterations of astrocytes occurring in diseases of the nervous system, and it implies the involvement of astrocytes as key elements in the pathogenesis and pathology of diseases and injuries of the central nervous system. Reactive astrocytosis refers to the response of astrocytes to different insults to the nervous system, whereas astrocytopathy indicates hypertrophy, atrophy/degeneration and loss of function and pathological remodeling occurring as a primary cause of a disease or as a factor contributing to the development and progression of a particular disease. Reactive astrocytosis secondary to neuron loss and astrocytopathy due to intrinsic alterations of astrocytes occur in neurodegenerative diseases, overlap each other, and, together with astrocyte senescence, contribute to disease-specific astrogliopathy in aging and neurodegenerative diseases with abnormal protein aggregates in old age. In addition to the well-known increase in glial fibrillary acidic protein and other proteins in reactive astrocytes, astrocytopathy is evidenced by deposition of abnormal proteins such as β-amyloid, hyper-phosphorylated tau, abnormal α-synuclein, mutated huntingtin, phosphorylated TDP-43 and mutated SOD1, and PrPres, in Alzheimer's disease, tauopathies, Lewy body diseases, Huntington's disease, amyotrophic lateral sclerosis and Creutzfeldt-Jakob disease, respectively. Astrocytopathy in these diseases can also be manifested by impaired glutamate transport; abnormal metabolism and release of neurotransmitters; altered potassium, calcium and water channels resulting in abnormal ion and water homeostasis; abnormal glucose metabolism; abnormal lipid and, particularly, cholesterol metabolism; increased oxidative damage and altered oxidative stress responses; increased production of cytokines and mediators of the inflammatory response; altered expression of connexins with deterioration of cell-to-cell networks and transfer of gliotransmitters; and worsening function of the blood brain barrier, among others. Increased knowledge of these aspects will permit a better understanding of brain aging and neurodegenerative diseases in old age as complex disorders in which neurons are not the only players.



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A 42-Year-Old Male with Diabetes Insipidus



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Introduction



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Erratum



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Issue Information



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An 57-Year-Old Female with Sudden onset of Transient Right Homonymous Hemianopsia



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Evaluation of Endoscopically Deployed Radiopaque Tumor Models in Bronchoscopy

imageBackground: Radiopaque markers and soft tissue models have been used extensively in clinical applications to target cancerous lesions and to calibrate and characterize imaging systems. However, the development of radiopaque, soft tissue models for pulmonary lesions is yet to be optimized. Such a material may improve endoscopic training techniques and also be useful to evaluate bronchoscopy navigation systems by the targeting and sampling of tumor models with computed tomography. Methods: This study investigates a modified agarose-based model and a novel contrast-infused tripe model to create clinically relevant pulmonary tumor models. An iodine-enhanced agarose model presents an injectable solution with high image contrast under computed tomography capable of reaching distal bronchial airways. The tripe solution presents a cheap and easily deployed method to quickly establish a fiducial marker that may be used during bronchial imaging system training and evaluation. Results: The iodine-enriched agarose model demonstrates desirable mechanical characteristics ex vivo, but has a number of limitations when administered in a live setting. The tripe solution presents a far more effective in vivo pulmonary tumor model and offers an effective radiopaque marker. However, the size of the tripe tumor samples required for effective insertion limits its ability to reach more distal airways. An iterative testing process was used to optimize the model composition, culminating in live animal investigations (n=3). Conclusion: Both contrast-infused agarose and tripe models present a promising analog to a pulmonary lesion and may act as a radiopaque marker for bronchoscopic training and biopsy evaluation.

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Response to: Ultrasonographic assessment of tonsillar volume in children.

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Response to: Ultrasonographic assessment of tonsillar volume in children.

Int J Pediatr Otorhinolaryngol. 2017 Aug 04;:

Authors: Asimakopoulos P, Pennell DJL, Mamais C, Veitch D, Stafrace S, Engelhardt T

PMID: 28801206 [PubMed - as supplied by publisher]



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Quantitative Evaluation of Head and Neck Cancer Treatment-Related Dysphagia in the Development of a Personalized Treatment De-Intensification Paradigm

Publication date: Available online 12 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Harry Quon, Xuan Hui, Zhi Cheng, Scott Robertson, Luke Peng, Michael Bowers, Joseph Moore, Amanda Choflet, Alex Thompson, Mariah Muse, Ana Kiess, Brandi Page, Carole Fakhry, Christine Gourin, Jolyne O'Hare, Peter Graham, Michal Szczesniak, Julia Maclean, Ian Cook, Todd McNutt
ObjectiveWe hypothesize that quantifying swallow function with multiple patient-reported outcome (PRO) instruments is an important strategy to yield insights in the development of personalized de-intensified therapies seeking to reduce the risk of head and neck cancer treatment-related dysphagia (HNCTD).MethodsIrradiated HNC subjects seen in follow-up care (4/2015 to 12/2015) prospectively completed the Sydney Swallow Questionnaire (SSQ) and the MD Anderson Dysphagia Inventory (MDADI) concurrently on the web-interface to our Xxxxxxxxx database were evaluated. A correlation matrix quantified the relationship between the SSQ and MDADI. Machine-learning unsupervised cluster analysis using the elbow criterion and CLUSPLOT analysis to establish its validity was performed.ResultsWe identified 89 subjects. The MDADI and SSQ scores were moderately but significantly correlated (correlation coefficient -0.69). K-means cluster analysis demonstrated that three unique statistical cohorts (elbow criterion) could be identified with CLUSPLOT analysis confirming that 100% of variances were accounted. Correlation coefficients between the individual items in the SSQ and the MDADI demonstrated weak to moderate negative correlation except for SSQ17 (QoL question).ConclusionsPilot analysis demonstrates the MDADI and SSQ are complementary. Three unique clusters of patients can be defined suggesting that a unique dysphagia signature for HNCTD may be definable. Longitudinal studies relying on only a single PRO such as MDADI may be inadequate for classifying HNCTD.



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Long-term clinical outcomes of Pencil Beam Scanning Proton Therapy for benign and non-benign intracranial meningiomas

Publication date: Available online 12 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Fritz R. Murray, James W. Snider, Alessandra Bolsi, Antony J. Lomax, Marc Walser, Ulrike Kliebsch, Ralf A. Schneider, Damien C. Weber
Since 1996, 96 patients with complex intracranial meningiomas have been treated with pencil beam scanning proton therapy (PBSPT) at XXXX. The long-term results of the present study demonstrate PBSPT as an effective and safe treatment modality for the definitive, adjuvant, postoperative, and salvage treatment of highly complex intracranial meningiomas. In addition, multiple risk factors influencing local control and overall survival were identified.



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Experimental validation of predicted application accuracies for computer-assisted (CAS) intraoperative navigation with paired-point registration.

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Experimental validation of predicted application accuracies for computer-assisted (CAS) intraoperative navigation with paired-point registration.

Int J Comput Assist Radiol Surg. 2017 Aug 11;:

Authors: Perwög M, Bardosi Z, Freysinger W

Abstract
PURPOSE: The target registration error (TRE) is a crucial parameter to estimate the potential usefulness of computer-assisted navigation intraoperatively. Both image-to-patient registration on base of rigid-body registration and TRE prediction methods are available for spatially isotropic and anisotropic data. This study presents a thorough validation of data obtained in an experimental operating room setting with CT images.
METHODS: Optical tracking was used to register a plastic skull, an anatomic specimen, and a volunteer to their respective CT images. Plastic skull and anatomic specimen had implanted bone fiducials for registration; the volunteer was registered with anatomic landmarks. Fiducial localization error, fiducial registration error, and total target error (TTE) were measured; the TTE was compared to isotropic and anisotropic error prediction models. Numerical simulations of the experiment were done additionally.
RESULTS: The user localization error and the TTE were measured and calculated using predictions, both leading to results as expected for anatomic landmarks and screws used as fiducials. TRE/TTE is submillimetric for the plastic skull and the anatomic specimen. In the experimental data a medium correlation was found between TRE and target localization error (TLE). Most of the predictions of the application accuracy (TRE) fall in the 68% confidence interval of the measured TTE. For the numerically simulated data, a prediction of TTE was not possible; TRE and TTE show a negligible correlation.
CONCLUSION: Experimental application accuracy of computer-assisted navigation could be predicted satisfactorily with adequate models in an experimental setup with paired-point registration of CT images to a patient. The experimental findings suggest that it is possible to run navigation and prediction of navigation application accuracy basically defined by the spatial resolution/precision of the 3D tracker used.

PMID: 28801767 [PubMed - as supplied by publisher]



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Safety of Onyx Transarterial Embolization of Skull Base Dural Arteriovenous Fistulas from Meningeal Branches of the External Carotids also Fed by Meningeal Branches of Internal Carotid or Vertebral Arteries.

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Safety of Onyx Transarterial Embolization of Skull Base Dural Arteriovenous Fistulas from Meningeal Branches of the External Carotids also Fed by Meningeal Branches of Internal Carotid or Vertebral Arteries.

Clin Neuroradiol. 2017 Aug 11;:

Authors: Abud TG, Houdart E, Saint-Maurice JP, Abud DG, Baccin CE, Nguyen AD, Abdala N

Abstract
PURPOSE: To analyze the angiographic and clinical results of transarterial embolization with Onyx (Medtronic-Covidien, Irvine, CA) in dural arteriovenous fistulas (DAVFs) partially fed by arteries arising from the carotid siphon or the vertebral arteries.
METHODS: We isolated 40 DAVFs supplied by either the tentorial artery of the internal carotid artery (ICA) or the posterior meningeal artery of the vertebral artery. These DAVFs were embolized with Onyx through the middle meningeal artery or the occipital artery. We reviewed the occurrence of reflux into the arteries of carotid or vertebral origin.
RESULTS: In all the cases, reflux occurred into the first millimeters of the DAVF arterial feeders arising from carotid or vertebral arteries but slowly enough to be controlled by interruption of Onyx injection. Reflux was always minimal and Onyx never reached the ostium of the arteries. No cerebral ischemic complications occurred in our series.
CONCLUSION: The behavior of Onyx is clearly different from that of cyanoacrylate glue, resulting in superior control during injection. Reflux into arteries arising from the ICA or vertebral artery during DAVF treatment always carries a risk of unintentional non-target embolization of normal cerebral vasculature but Onyx appears to be safe in this situation.

PMID: 28801711 [PubMed - as supplied by publisher]



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Stentless endoscopic repair of congenital choanal atresia: is it enough for maintaining choanal patency?

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Stentless endoscopic repair of congenital choanal atresia: is it enough for maintaining choanal patency?

Eur Arch Otorhinolaryngol. 2017 Aug 11;:

Authors: Tatar EÇ, Öcal B, Doğan E, Bayır Ö, Saka C, Özdek A, Korkmaz MH

Abstract
The aim of choanal atresia (CA) surgery is to achieve bilateral nasal patency. Among the different methods of CA repair, the endoscopic transnasal approach has gained recent popularity with the advent of endoscopic instruments and techniques. This article describes our experience regarding CA repair that was done either using or not using a stent in different periods of time in our department. Between February 2006 and February 2016, a total of 29 patients aged 2 days-53 years underwent endoscopic transnasal CA repair. While in early years stents were used to maintain nasal patency, since 2010, all cases were repaired endoscopically without stenting. Of the 29 patients, 8 were excluded because of inadequate follow-up data. The mean follow-up time for the remaining 21 patients after surgery averaged 53 months (range 12-111 months). Intranasal stents were used in 5 of 21 patients for 8 out of 32 operative sides. Of the 8 stented neochoanae, 6 (75%), restenosed at a mean time of 15.2 weeks (5-24). The restenosis rate was 25% (6/24 nasal sides) in 16 patients who underwent stentless repair. In unilateral CA, 2 of 10 (20%) patients underwent atresia repair using stents and only these cases restenosed after surgery in this group. Of the 11 patients with bilateral disease, 5 (45.4%) underwent revision surgeries. In the bilateral group, 2 of 3 (66.6%) stented patients required revision surgeries, whereas 3 of 8 (37.5%) patients who underwent stentless repair relapsed. In one patient, we have experienced an alar cartilage injury intraoperatively caused by drilling. The transnasal endoscopic repair has proved to be effective and yielded long-term satisfactory results. The use of stent seems to have no advantage over a stentless repair regarding maintenance of a patent nasal airway. Patients experienced restenosis more frequently with stenting.

PMID: 28801718 [PubMed - as supplied by publisher]



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Solasodine inhibits human colorectal cancer cells via suppression of AKT/GSK-3β/β-catenin pathway

Summary

Solasodine is a main active component isolated from Solanum incanum L, who performs a wide range of functions containing anti-oxidant, anti-infection and neurogenesis promotion. In this study, we explored the influence of solasodine on three types of human colorectal cancer (CRC) cell lines. The consequences displayed that solasodine apparently prohibited CRC cell proliferation dose- and time-dependently and impeded CRC cell motility by downregulating Matrix metalloprotease (MMPs). Besides, solasodine was investigated to fuel caspase-cascade reaction and increase the ratio between Bax and Bcl-2 so as to induce CRC cell apoptosis. When cells got pretreated with AKT activator (IGF-1) followed by solasodine application, solasodine-induced apoptosis was partially confronted by IGF-1. Moreover, Solasodine hindered tumor development and stimulated similar mechanisms in vivo. In general, our study provides the first evidence that solasodine has a suppressive efficient on CRC cells and that this agent may have potency to be a novel therapeutic drug for CRC treatment.

This article is protected by copyright. All rights reserved.



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[Toward new modalities of surveillance in lung cancer patients?]

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[Toward new modalities of surveillance in lung cancer patients?]

Bull Cancer. 2017 Aug 08;:

Authors: Domblides C, Chaabane N, Wislez M

PMID: 28801133 [PubMed - as supplied by publisher]



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Tumor DNA: an emerging biomarker in head and neck cancer.

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Tumor DNA: an emerging biomarker in head and neck cancer.

Cancer Metastasis Rev. 2017 Aug 12;:

Authors: Bellairs JA, Hasina R, Agrawal N

Abstract
Head and neck cancer (HNC) includes a diverse range of malignancies arising commonly from mucosal epithelia of the upper aerodigestive tract. Head and neck squamous cell carcinoma (HNSCC), the most common form of HNC, develops in the oral cavity, pharynx, and larynx and is associated with tobacco exposure, alcohol abuse, and infection with oncogenic viruses. Despite global advances in cancer care, HNSCC often presents with advanced disease and is associated with poor 5-year survival of ~50%. Genotyping tumor tissue to guide clinical decision-making is becoming commonplace in modern oncology, but in the management of HNSCC, tissue biopsies with cytopathology or histopathology remain the mainstay for diagnosis. Furthermore, conventional biopsies are temporally and spatially limited, often providing a brief snapshot of a single region of a heterogeneous tumor. In the absence of a useful biomarker, both primary and recurrent HNSCCs are diagnosed with conventional imaging and clinical examination. As a result, many patients are diagnosed with advanced disease. Tumor DNA is an emerging biomarker in HNSCC. DNA fragments are constantly being shed from tumors and metastatic lesions, and can therefore be detected in blood and other bodily fluids. Utilizing next-generation sequencing techniques, these tumor DNA can be characterized and quantified. This can serve as a minimally invasive liquid biopsy allowing for specific tumor profiling, dynamic tumor burden monitoring, and active surveillance for disease recurrences. In HNSCC, analysis of tumor DNA has the potential to enhance tumor profiling, aid in determining patient prognosis, and guide treatment decisions.

PMID: 28801876 [PubMed - as supplied by publisher]



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Paraneoplastic mucous membrane pemphigoid with ocular and laryngeal involvement.

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Paraneoplastic mucous membrane pemphigoid with ocular and laryngeal involvement.

BMJ Case Rep. 2017 Aug 11;2017:

Authors: Lambiel S, Dulguerov P, Laffitte E, Leuchter I

Abstract
A 73-year-old woman was treated 8 years previously for synchronous breast and uterine neoplasms. She presented with a severe sore throat, odynophagia, dysphonia, dyspnoea, ocular irritation and weight loss over the last 3 months. Physical examination revealed ulcerations in the oral cavity, posterior pharyngeal wall and supraglottic larynx, nasal crusting, bilateral conjunctivitis and three cutaneous blisters. A diagnosis of anti-laminin 5 mucous membrane pemphigoid was retained, based on skin biopsy, direct immunofluorescence and immunoprecipitation. A positron emission tomography (PET)-CT detected multiple adenopathies. Cytology revealed adenocarcinoma with an immunocytology compatible with a breast origin and this was considered as a late metastatic recurrence of her previous breast cancer. A treatment of prednisone, dapsone and hormonotherapy was introduced, but intravenous immunoglobulin and rituximab were added due to new mucosal lesions. Despite treatment, a posterior laryngeal scar and bilateral symblepharon were developed. After 3 years, the patient is still alive and reports a satisfactory quality of life.

PMID: 28801511 [PubMed - in process]



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Paraneoplastic mucous membrane pemphigoid with ocular and laryngeal involvement.

Related Articles

Paraneoplastic mucous membrane pemphigoid with ocular and laryngeal involvement.

BMJ Case Rep. 2017 Aug 11;2017:

Authors: Lambiel S, Dulguerov P, Laffitte E, Leuchter I

Abstract
A 73-year-old woman was treated 8 years previously for synchronous breast and uterine neoplasms. She presented with a severe sore throat, odynophagia, dysphonia, dyspnoea, ocular irritation and weight loss over the last 3 months. Physical examination revealed ulcerations in the oral cavity, posterior pharyngeal wall and supraglottic larynx, nasal crusting, bilateral conjunctivitis and three cutaneous blisters. A diagnosis of anti-laminin 5 mucous membrane pemphigoid was retained, based on skin biopsy, direct immunofluorescence and immunoprecipitation. A positron emission tomography (PET)-CT detected multiple adenopathies. Cytology revealed adenocarcinoma with an immunocytology compatible with a breast origin and this was considered as a late metastatic recurrence of her previous breast cancer. A treatment of prednisone, dapsone and hormonotherapy was introduced, but intravenous immunoglobulin and rituximab were added due to new mucosal lesions. Despite treatment, a posterior laryngeal scar and bilateral symblepharon were developed. After 3 years, the patient is still alive and reports a satisfactory quality of life.

PMID: 28801511 [PubMed - in process]



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Manoeuvre to aid Endoscopic division of aryepiglottic folds (Aryepiglottoplasty)

Laryngomalacia, a congenital malformation of larynx is the commonest cause of stridor in young infants. Ninety percent of cases resolve by the age of 2 years without any active intervention (1).The most consistent abnormality seen in non-resolving cases is shortening of the aryepiglottic folds (picture 1).(2)

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Consultation for Simple Laceration Repair When On-Call in the Emergency Department: Potential Quagmire

Summary: What are the forces obligating a plastic surgeon who is on-call for the emergency department to respond to a consultation request for repair of a simple laceration? Although the duties are clear in cases of obvious surgical emergency, ambiguity and subsequent conflict may arise when the true nature of the emergency is less clear. Does the consultant's clinical discretion dictate the obligation in the case of a simple laceration; or is it subservient to either the discretion of the requesting health-care provider or even the patient? Do federal statutes such as the Emergency Medical Treatment and Labor Act, or perhaps more local rules apply, such as the by-laws of the hospital? It would behoove all medical practitioners to familiarize themselves with both the legal and moral implications of these issues. Having legitimate policies in place which actively address those situations where the consultative obligation is unclear is critical to resolve potential conflict.

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Large Eyelid Defect Repair Using a Free Full-Thickness Eyelid Graft

imageSummary: Large eyelid full-thickness defects are traditionally repaired using flaps with a blood-supplying pedicle, for the reconstruction of the anterior or posterior lamella or both. This is a 2-stage procedure involving occlusion of vision in the affected eye for 4–8 weeks, as the flap pedicle is not divided until vascularization is deemed adequate. However, the importance of using a flap with a pedicle to ensure adequate perfusion of the graft has recently been questioned.

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Editorial Board

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Publication date: September 2017
Source:Critical Reviews in Oncology/Hematology, Volume 117





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