Effectiveness of Shortwave Diathermy for Subacromial Impingement Syndrome and Value of Night Pain for Patient Selection: A Double-Blinded, Randomized, Placebo-Controlled Trial.

Objective: The aim of this study was to investigate the effectiveness of short wave diathermy (SWD) in patients with subacromial impingement syndrome. Design: In this double-blinded, randomized, placebo-controlled trial, 57 patients (aged 35-65 yrs) were classified into night pain positive (NP[+]) (n = 28) and night pain negative (NP[-]) (n = 29) groups. Both groups were randomly assigned to SWD (NP[+], n = 14; NP[-], n = 14) and sham (NP[+], n = 15; NP[-], n = 14) subgroups. Visual analog scale, Constant-Murley Scale (CS), and Shoulder Disability Questionnaire (SDQ) scores were used for evaluation. Results: There was only a significant difference in pain with activity at 1-mo (mean difference [MD], -1.65; 95% confidence interval, -3.01 to -0.28]) and 2-mo evaluations (MD, -2.1; 95% confidence interval, -3.51 to -0.69) between SWD versus sham groups. In the NP(+) SWD group, the CS pain score was significantly higher than in the NP(+) sham group at all evaluations after treatment. At 1 mo, the NP(-) SWD group showed significantly better pain, strength, total CS, and SDQ scores than the NP(-) sham group. At 2 mos, the pain, range of motion, strength, and total CS and SDQ scores were better in the NP(-) SWD group than in the NP(-) sham group (P

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Histopathology of Urticaria

Opinion statement

Purpose of review

Urticaria is a common skin manifestation with many different causes. It is characterized by local or generalized edematous erythema with itching and increased blood flow and vascular permeability. Individual urticaria lesions typically last less than 24 h (usually less than 12 h), but new lesions may appear and resolve sporadically. Since the diagnosis is usually made based on the history and clinical appearance of the lesions, skin biopsy is not necessarily performed, but it is recommended for evaluating patients with refractory eruptions or suspicion of other diseases exhibiting urticaria-like lesions. The histopathological features of urticaria are dermal edema and perivascular and interstitial inflammatory cell infiltration, and there is only minimal change in the epidermis. Cellular infiltrates are composed of lymphocytes, neutrophils, and eosinophils.

Recent findings

In our 64 patients with urticaria, severe edema was found in 48 cases (75%) with mixed cellular infiltration in 45 (70%), lymphocytic infiltration in 17 (27%), and neutrophilic infiltration in 2 cases (3%). Perivascular infiltration was found in 35 cases (55%), and the others were classified into the perivascular and interstitial infiltration type. Subcutaneous cellular infiltration has been shown to be associated with poor treatment response.

Summary

In this review, we summarize the histopathological findings of urticaria and its differential diagnosis. Evaluation of the histopathological features may provide further insight into the mechanism of urticaria and potentially provide valuable information to develop more effective treatments.

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Stereotactic Radiosurgery and Radiofrequency Rhizotomy for Trigeminal Neuralgia in Multiple Sclerosis: A Single Institution Experience

Publication date: Available online 7 September 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Marshall T. Holland, Nahom Teferi, Jennifer Noeller, Andrea Swenson, Mark Smith, John Buatti, Patrick W. Hitchon
ObjectivesFor patients with medically unresponsive trigeminal neuralgia (TN), surgical options include microvascular decompression (MVD), radiofrequency rhizotomy (RF), and stereotactic radiosurgery (SRS). Multiple sclerosis (MS) is a demyelinating condition that can be associated with TN, but is not amenable to treatment with MVD. We sought to identify the outcome differences of patients with TN in MS undergoing SRS or RFR in an attempt to identify factors that may influence outcomes. We also evaluated cost outcomes, both initially and over time, based on the index procedure. We performed a retrospective review of our experience with 17 cases.Patients and MethodsA single institution retrospective chart review was performed. Since 1997, 17 patients with TN and MS have been treated at our institution. All patients underwent a preoperative MRI to rule out a compressive lesion. Patients either underwent SRS (n=7) or RFR (n=10) as their index procedure and were evaluated as a group based on this first procedure. Outcome measures included preoperative Expand Disability Status Score (EDSS) scores, pre- and postoperative facial pain and medication use, post-intervention facial numbness, need for subsequent procedures, and duration of follow-up. Charges for the index procedure, subsequent interventions, and total costs were tabulated and analyzed in 2017 US dollars, adjusting for inflation.ResultsThe median age of patients at first operation in each group was 58.5±10.9 and 63.5±7.5 for SRS and RFR respectively. There were no significant differences in basic demographics. Overall, 71% of these patients had an excellent or good initial pain outcome. Over time, 60% of RFR and 29% of SRS patients required additional procedures to obtain satisfactory pain relief. The patients who underwent RFR as their index procedure required a significantly higher number of procedures to achieve adequate pain relief (RFR=2.7 vs SRS=2.0 [p=0.04]). The average index procedure costs in US dollars were significantly different (SRS=53,300±5,257 vs RFR=12,315±3,387). The average subsequent costs (costs incurred following the initial intervention) (SRS=8,320±17,842, RFR=36,002±46,767) and total costs (SRS=61,620±16,087, RFR=48,317±48,475) were not statistically significantly different.ConclusionTN in the setting of MS is highly difficult to treat medically with SRS and RFR being offered as options for these patients. Both can provide good initial pain relief. For patients who have RFR as their initial procedure, a larger number of procedures are required for relief compared to patients who initially underwent SRS. While there is a significant difference in the cost of the initial procedure, over time, with the cost of required subsequent interventions, there is no significant difference in total costs between the two groups.



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Physical training improves visceral adipose tissue health by remodelling extracellular matrix in rats with estrogen absence: a gene expression analysis

Summary

Adipose tissue development is associated with modifications involving extracellular matrix remodelling, and metalloproteinases play a significant role in this process. Reduced circulating sexual hormones cause impacts on the size, morphology and functions of the adipose tissue, increasing susceptibility to diseases. This study investigated whether exercise training may be an alternative strategy to combat the effects promoted by estrogen decay through modulation in gene expression patterns in the extracellular matrix (ECM) of visceral adipose tissue of ovariectomized rats. Nulliparous rats (n = 40) were randomly distributed into four groups (n = 10/group): sham sedentary (Sh-S), sham resistance training (Sh-Rt), ovariectomized sedentary (Ovx-S) and ovariectomized resistance training (Ovx-Rt). The Sh-S animals did not have any type of training. The body mass and food intake, ECM gene expression, gelatinase MMP-2 activity and adipocyte area were measured. A lack of estrogen promoted an increase in body mass, food intake and the visceral, parametrial and subcutaneous adipocyte areas. The ovariectomy upregulated the expression of MMP-2, MMP-9, TGF-β, CTGF, VEGF-A and MMP-2 activity. On the other hand, resistance training decreased the body mass, food intake and the adipocyte area of the three fat depots analysed; upregulated TIMP-1, VEGF-A and MMP-2 gene expression; downregulated MMP-9, TGF-β and CTGF gene expression; and decreased the MMP-2 activity. We speculate that resistance training on a vertical ladder could play an important role in maintaining and remodelling ECM by modulation in the ECM gene expression and MMP-2 activity, avoiding its destabilization which is impaired by the lack of estrogen.

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Anatomical study of occipital triangles: the ‘ inferior’ suboccipital triangle, a useful vertebral artery landmark for safe postero-lateral skull base surgery

Abstract

Background

Vertebral artery (VA) identification within the suboccipital triangle is a key step in craniocervical junction surgery. Often VA exposition at this level is arduous (space-occupying lesions, previous surgery); to identify VA more proximally may prove useful in complex cases. An alternative triangle is present just below the suboccipital one, where VA can be easily controlled; we named it the inferior suboccipital triangle (IST). The aim of the study is to identify IST anatomical relations and VA space orientation and evaluate its practical utility in surgery.

Methods

An anatomical study was performed on ten sides of five injected cadaverdic specimens. Relevant anatomical data were databased.

Results

The IST is limited superiorly by the inferior oblique muscle, inferolaterally by the posterior intertransversarii muscle and inferomedially by the C2 lamina; VA at this level has a vertical course with a slight medial to lateral direction (mean 10.8°) and minor posterior to anterior inclination (mean 3.4°). VA within the IST has a constant course without significant loops or kinkings; periarterial venous plexus is less represented at this level. The IST measures an average of 1.89 cm², and VA at this level has an average length of 98 mm.

Conclusions

IST is a significantly large anatomical space where the VA course is rather regular, and its length is sufficient for vascular proximal control purposes. Periarterial venous plexus is less evident at this level, easing the surgical exposure. VA exposition within the IST can be used as an alternative option when space-occupying lesions, scars and stabilisation devices make arterial dissection hazardous in more cranial V3 segments.

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Long-term follow-up after endoscopic trans-sphenoidal surgery or initial observation in clivus chordomas

Abstract

Background

Resection of clivus chordomas through extensive skull base approaches is associated with high mortality and morbidity even in experienced hands. We report our experience with endoscopic trans-sphenoidal surgery, or a "wait-and-scan" strategy in selected patients.

Method

Ten patients were diagnosed with clivus chordomas during an 8-year period. Six patients underwent primary treatment with endoscopic trans-sphenoidal surgery, followed by adjuvant proton-beam therapy in three of these patients. Four patients with minor symptoms were followed-up untreated. Mean follow-up was 91 months.

Results

Of the six patients operated on, total or gross total resection was achieved in four, partial resection in one and biopsy was taken in one. Preoperative cranial neuropathies resolved in three out of five patients, and no new cranial nerve palsies were encountered. Postoperative cerebrospinal fluid leak occurred in one patient. Four patients were initially followed-up without any treatment, and three of these have remained stable without tumour progression for a mean of 94 months. Due to a slow, though progressive growth of tumour, one patient was operated on after 80 months of initial observation.

Conclusions

The natural course of clivus chordomas has yet to be defined. The endoscopic trans-sphenoidal approach is a valid, minimally invasive alternative for the treatment of clival chordomas, and in selected patients a "wait and scan" strategy can be considered. Our long-term results show low mortality and good functional outcome. An endonasal endoscopic trans-sphenoidal approach should be a principal part of the armamentarium of surgeons treating clivus chordomas.

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Dual lumbar bronchogenic and arachnoid cyst presenting with sciatica and left foot drop

Abstract

Introduction

Spinal bronchogenic cysts are rare findings, with only four cases of lumbar bronchogenic cysts reported in the literature. All of these bronchogenic cysts involved the conus medullaris. We present the first case of a lumbar bronchogenic cyst and arachnoid cyst arising from the cauda equina in a 68-year-old male. Uniquely, this bronchogenic cyst also contained components of an arachnoid cyst.

Methods

Magnetic resonance imaging (MRI) demonstrated a compressive cystic lesion at the level of the L3 vertebra splaying the cauda equina. An L3/L4 laminectomy was performed with marsupialisation of the cyst.

Results

Histological examination revealed pseudostratified ciliated columnar epithelium confirming the diagnosis of a bronchogenic cyst, as well as a pleated fibrovascular tissue lined by sparsely spaced small monomorphic arachnoidal cells, indicating an arachnoid cyst.

Conclusion

We demonstrate that bronchogenic cysts can be successfully treated with marsupialisation.

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Long-term monitoring of intracranial pressure in normal pressure hydrocephalus and other CSF disorders

Abstract

Long-term monitoring of intracranial pressure is a useful method in the diagnosis of complex hydrocephalus and CSF disorders. This editorial discusses various criteria for the interpretation of ICP monitoring in normal pressure hydrocephalus, idiopathic intracranial hypertension and in patients with implanted hydrocephalus shunts.

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Innovation in neurosurgery

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Constant dripping wears away the bone: intraosseous C2 and suboccipital intradiploic cerebrospinal fluid collection after Chiari I decompressive surgery

Abstract

The objective of decompressive surgery for Chiari I malformation is to create additional space to accommodate the ectopic cerebellar tonsils and to improve the flow of cerebrospinal fluid. To the best of our knowledge, we report the first case of a patient with previous Chiari I decompression presenting 5 years after surgery at the same time as an intraosseous C2 and a suboccipital intradiploic cerebrospinal fluid accumulation. Because of the progressive nature of the C2 cerebrospinal fluid collection causing bone destruction, surgical management was indicated. To avoid the erosion of the bone, we propose that the iatrogenic exposure of the diploe and the vertebral spongiosa that may come into contact with the cerebrospinal fluid should be sealed off with bone wax or a similar material.

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Bilateral chylothorax following anterior cervical spine surgery

Abstract

Bilateral chylothorax following anterior cervical spine surgery is very rare. This report documents the first case of chylothorax after anterior cervical spine surgery through a right-side surgical approach. Unidentified chyle leakage can easily remain unrecognized and, thus, is difficult to treat. For early diagnosis and treatment, it is very important to consider the possibility of chylothorax following anterior cervical spine surgery, even when using a right-side surgical approach.

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How I do it—optimizing radiofrequency ablation in spinal metastases using iCT and navigation

Abstract

Background

Exact positioning of the radiofrequency ablation (RFA) probe for tumor treatment under fluoroscopic guidance can be difficult because of potentially small inaccessible lesions and the radiation dose to the medical staff in RFA. In addition, vertebroplasty (VP) can be significantly high.

Method

Description and workflow of RFA in spinal metastasis using iCT (intraoperative computed tomography) and 3D-navigation-based probe placement followed by VP.

Conclusion

RFA and VP can be successfully combined with iCT-based navigation, which leads to a reduction of radiation to the staff and optimal probe positioning due to 3D navigation.

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Chordomas: Technologies, Techniques, and Treatment. (2017) Edited by Pamir et al., 235 pp., Hardback, 400 illustartions, €179.99/USD$199.99 ISBN: 9781626231597 eISBN: 9781626231603 Thieme Medical Publishers, Inc. New York/Stuttgart

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Combination of Irinotecan, Oxaliplatin and 5-Fluorouracil as a Rechallenge Regimen for Heavily Pretreated Metastatic Colorectal Cancer Patients

Abstract

Purpose

Our objective was to evaluate the benefit of re-exposing patients with refractory metastatic colorectal cancer (mCRC) to a combination of oxaliplatin, irinotecan and 5-fluorouracil treatment.

Methods

We retrospectively analysed patients with mCRC who received a combination of oxaliplatin, irinotecan and fluorouracil as a rechallenge regimen after progressing on the same drugs. Both FOLFOXIRI and FOLFIRINOX were used. Toxicity was evaluated for each treatment cycle, and survival analysis was performed using the Kaplan-Meier method.

Results

A total of 21 patients who were treated between January 2011 and December 2013 were selected for this study. Most of the patients (95.2%) had an ECOG status of 0–1. The median age at diagnosis was 52.1 years (range 36–77 years), and 14 (66.6%) patients had wild-type KRAS. Thirteen patients received FOLFIRINOX, and eight received FOLFOXIRI. Most patients had previously received at least three regimens, with 80% receiving anti-VEGF and 66% anti-EGFR antibodies. The response rate was 38%, and 24% patients had stable disease. The median time to disease progression was 4.0 months (range 1.0–9.1 months), and the median overall survival duration was 8.6 months (range 6.3–11.5 months). Most patients required dose adjustment and treatment delays. One patient experienced grade 5 neutropenic sepsis.

Conclusions

Both FOLFIRINOX and FOLFOXIRI are active and potentially feasible rechallenge treatment options for heavily pretreated patients with good performance status. With dose reduction and close monitoring for toxicity, the risk of serious adverse events can be minimised.

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AN-7, a butyric acid prodrug, sensitizes cutaneous T-cell lymphoma cell lines to doxorubicin via inhibition of DNA double strand breaks repair

Summary

We previously found that the novel histone deacetylase inhibitor (HDACI) butyroyloxymethyl diethylphosphate (AN-7) had greater selectivity against cutaneous T-cell lymphoma (CTCL) than SAHA. AN-7 synergizes with doxorubicin (Dox), an anthracycline antibiotic that induces DNA breaks. This study aimed to elucidate the mechanism underlying the effect of AN-7 on Dox-induced double-strand DNA breaks (DSBs) in CTCL, MyLa and Hut78 cell lines. The following markers/assays were employed: comet assay; western blot of γH2AX and p-KAP1; immunofluorescence of γH2AX nuclear foci; Western blot of repair protein; quantification of DSBs-repair through homologous recombination. DSB induction by Dox was evidenced by an increase in DSB markers, and DSBs-repair, by their subsequent decrease. The addition of AN-7 slightly increased Dox induction of DSBs in MyLa cells with no effect in Hut78 cells. AN-7 inhibited the repair of Dox-induced DSBs, with a more robust effect in Hut78. Treatment with AN-7 followed by Dox reduced the expression of DSB-repair proteins, with direct interference of AN-7 with the homologous recombination repair. AN-7 sensitizes CTCL cell lines to Dox, and when combined with Dox, sustains unrepaired DSBs by suppressing repair protein expression. Our data provide a mechanistic rationale for combining AN-7 with Dox or other DSB inducers as a therapeutic modality in CTCL.

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Histiocytoid cardiomyopathy and ventricular noncompaction presenting as sudden death in an adult male

Publication date: Available online 7 September 2017
Source:Pathology - Research and Practice
Author(s): J. Fernando Val-Bernal, Marta Mayorga, Clara Ortega, Emma Linares
Histiocytoid/oncocytic cardiomyopathy (HCM) is a rare, distinctive arrhythmogenic disorder that presents as arrhythmia or sudden death in infants and children. Ventricular noncompaction (VNC) is a rare cardiomyopathy characterized by a thickened endocardial layer of noncompacted myocardium and a thin epicardial layer of compacted myocardium. Only six cases of the association of both cardiomyopathies have been reported previously in the literature. All these cases were in children. To the best of our knowledge, a case of HCM has not been described in the adult. We report the case of a 45-year-old man with an increased heart weight and involvement of both ventricles by HCM and VNC cardiomyopathy. Besides, multiple foci of myocardial disorganization were detected. He died suddenly while hiking. The association of both processes HCM and VNC was an unexpected finding at autopsy. The death was linked to functional abnormalities of the cardiac histiocytoid cells, and it was favored by a state of abnormal development of the heart.



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Upregulation of uc.189 in patients with esophageal squamous cell carcinoma and its clinicopathologic value

Publication date: Available online 7 September 2017
Source:Pathology - Research and Practice
Author(s): Yan Guo, Chenghai Wang, Xin Miao, Siyu Chen, Yu Qian, Guoli Li, Ying Jiang
Ultraconserved elements (UCEs) encoding noncoding RNAs serve as important regulators in cancer biology. Until now, the role of the UCE uc.189 in human cancers remains undefined and the clinical significance of uc.189 in esophageal cancers remains unknown. This study was to identify the prognostic value of uc.189 expression in esophageal squamous cell carcinomas (ESCC). Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the expression level of uc.189 in matched cancerous tissues and adjacent noncancerous tissues from 152 patients with ESCC. The correlation of uc.189 with clinicopathological features and prognosis were also analyzed. The expression of uc.189 was significantly higher in human ESCC compared with the adjacent noncancerous tissues (122/152, 80.3%, p<0.01), and the high level of uc.189 expression was significantly correlated with invasion of the tumor (p=0.009), advanced clinical stage (p=0.000), lymph node metastasis (p=0.000), and poor prognosis. High expression of uc.189 might reflect poor prognosis of ESCC and indicate a potential diagnostic target in ESCC patients. Uc.189 might be considered as a novel molecule involved in ESCC progression, which provides a potential prognostic biomarker and therapeutic target.



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AEG-1 mRNA expression in non-small cell lung cancer is associated with increased tumor angiogenesis

Publication date: Available online 7 September 2017
Source:Pathology - Research and Practice
Author(s): Zhihong Ma, Yingrong Chen, Shunli Dong, Xuting Xu, Jin Liu, Pengtao Song, Caihua Yu, Licheng Dai
Astrocyte-elevated gene-1 (AEG-1) is implicated in the oncogenesis and angiogenesis of various types of human malignant disease. However, the angiogenesis roles of AEG-1 in non-small cell lung cancer (NSCLC) remain to be further elucidated. In the present study, the expression level of AEG-1 mRNA in seven human lung cell lines and 89 paired tissue samples (tumor tissues (TTs) and pair-matched normal adjacent tissues (PMNATs)) from NSCLC patients was detected by real-time PCR. Staining of vascular endothelial growth factor (VEGF) and intratumoral microvessel density (iMVD, labeled by CD105) were assessed by immunohistochemistry. Furthermore, cell migration and invasion were evaluated by wound healing assay and transwell assays. AEG-1 mRNA level was significantly higher in human lung cancer cells and TTs than that in human normal bronchial epithelial cell line 16HBE and PMNATs, respectively (P<0.001). Higher AEG-1 mRNA level in patients with NSCLC was correlated with clinical stages (P=0.028), differentiation (P=0.042), and lymph node metastasis (P=0.004). Moreover, Upregulated AEG-1 mRNA expression level was associated with higher tumor angiogenesis, reflected by the increase of VEGF expression and iMVD counting (P=0.021, P<0.001). However, 95D cell line transfected with AEG-1 siRNA oligos (siAEG-1) exhibited no significant decrease of cell invasion or migration capacities when compared with the control cells (P>0.05).These results suggested that AEG-1 may play important roles at the transcription level in malignant transformation and tumor angiogenesis in NSCLC, and anti-AEG-1 mRNA expression may be a novel potential strategy for anti-angiogenic therapy of NSCLC.



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Effects of sustained i.c.v. infusion of lupus CSF and autoantibodies on behavioral phenotype and neuronal calcium signaling

Systemic lupus erythematosus (SLE) is a potentially fatal autoimmune disease that is often accompanied by brain atrophy and diverse neuropsychiatric manifestations of unknown origin. More recently, it was obse...

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Tezepelumab in Adults with Uncontrolled Asthma

Asthma affects an estimated 315 million people worldwide, of whom approximately 70% have moderate-to-severe disease (Global Initiative for Asthma [GINA] step 3 to 5). In many of these patients, asthma can be controlled by increasing the dose of inhaled glucocorticoids. However, in some patients,…

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Severe and Difficult-to-Treat Asthma in Adults

Patients with severe asthma make up only 3% to 10% of the population of adults with asthma, but their care is estimated to account for more than 60% of the costs associated with asthma, which are primarily for medications. Health care costs per patient for severe asthma are higher than those for…

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Moving Upstream — Anti-TSLP in Persistent Uncontrolled Asthma

At least 15% of patients with asthma have a poor response to standard therapy with inhaled glucocorticoids and long-acting bronchodilators. Even after nonadherence to treatment and inadequate inhalation technique are addressed, a substantial percentage of patients continue to have frequent…

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Relationship between swallowing function and breathing/phonation

Clarification of the association between the swallowing function and respiratory and phonatory functions.

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Natural course of tonsillectomy pain: A prospective patient cohort study

The aim of this study was to determine the natural course of pain after tonsillectomy.

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Knowledge of food protein–induced enterocolitis syndrome among general pediatricians

Food protein–induced enterocolitis syndrome (FPIES) is a potentially severe, non–IgE-mediated food hypersensitivity. Typically, FPIES presents in infancy, either acutely with profuse emesis, dehydration, and lethargy 1 to 4 hours after intermittent ingestions; or insidiously with frequent, watery diarrhea, intermittent emesis, and failure to thrive with chronic ingestions.1 Common eliciting foods include cow's milk and soy proteins; solids (rice, oat, fish, poultry, fish, and shellfish) are also culprits.

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Lymphoproliferative responses to dendritic cell presentation of sensitizing allergens in atopic children with multiple allergies

Peripheral blood mononuclear cells (PBMCs) proliferate inconsistently, rendering current lymphoproliferation assays unreliable in diagnosis.

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Genetically modified products and food allergy

The effect of genetically modified (GM) products on human health is a timely and important topic. This month's CME Review does an excellent job providing background on this technology, outlining potential health concerns as they relate to food allergy, and summarizing evidence on this topic.1 The article addresses 2 issues that practicing physicians face. First is the increasing disconnect between scientific evidence and popularized fixed health care beliefs and concerns. The second is the many questions we face for which evidence is lacking.

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Information for Readers

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The national cost of asthma among school-aged children in the United States

Recent research has quantified the national health care resource use (HCRU) and health care expenditure (HCE) burden associated with adult asthma; however, estimates specific to school-aged children are more than 2 decades old.

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Instructions for Authors

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Editorial Board

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The allergenicity of genetically modified foods from genetically engineered crops

During the past 2 decades, the diagnosis of food allergy has increased in industrialized countries. Immunoglobulin E (IgE) food allergies affect an estimated 4% to 8% of the American population.1,2 The reason for this increase remains unclear, but food allergy has become an increasingly difficult challenge for patients and their physicians to manage. Repeated exposures lead to significant morbidity, life-threatening anaphylaxis, and substantial health care costs. Because proteins are the primary precipitant of many allergic reactions, some members of the public have become concerned that the proteins produced in genetically modified (GM) crops will lead to an increase in allergic reactions in people who consume those crops.

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An unusual cause of fever in a patient with common variable immunodeficiency

The patient is a 22-year-old man with a history of common variable immunodeficiency (CVID) associated with a heterozygous mutation in TNFRSF13B (TACI), granulomatous lymphocytic interstitial lung disease (GLILD), massive splenomegaly, immune thrombocytopenia, and autoimmune hemolytic anemia. He presented with a 5-day history of fever with temperatures up to 38.9°C, malaise, sinus congestion, intermittent headaches, and loose stools. He had no cough, dyspnea, vomiting, abdominal pain, joint pain, or rash.

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Penicillin skin testing

Although approximately 10% of the population carries a label of penicillin allergy, the vast majority of these individuals turn out to be tolerant of penicillins. The rate of positive penicillin skin test reactions in patients with a history of penicillin allergy seems to have been decreasing in the past 2 decades.1,2 For example, Jost et al1 reported a skin test positive rate of 6% from 1993 through 2003 compared with 27% from 1979 through 1992 in consecutive pediatric patients using the same full set of penicillin skin test reagents.

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Author's response

We would like to thank authors for their comments on our article,1 which are both valid and valuable to consider. We agree that the estimated odds ratios are biased away from the null hypothesis given the sparse data. We also agree that the use of the word independently is incorrect in the abstract. The odds ratios reported in the abstract and in table 4 are univariate odds ratios. The term independently associated should be reserved for results from a multivariable analysis in which we have adjusted for the other variables in the model.

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Unusual presentation of combined immunodeficiency in a child with homozygous DOCK8 mutation

Autosomal recessive hyper-IgE syndrome with combined immunodeficiency was first described in patients and linked to a mutation in the gene encoding the dedicator of cytokinesis 8 (DOCK8) in 2009.1,2 The DOCK8 gene is located on chromosome 9 and encodes for a protein that functions as a guanine nucleotide exchange factor, which interacts with the Rho family of GTPases.3 The activated Rho-GTPases are vital to cytoskeletal development, cell growth, migration, and adhesion. DOCK8 plays a critical role in immunologic synapse formation, linking the T-cell receptor to the actin cytoskeleton, thereby leading to T-cell activation and proliferation and T-, B-, and natural killer cell survival.

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Table of Contents

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Predictors of granulomatous lymphocytic interstitial lung disease in common variable immunodeficiency: Methodological issues

We read with great interest the article by Hartono et al1 that was published in the Annals of Allergy, Asthma & Immunology in May 2017. They intended to determine a set of clinical and/or laboratory parameters associated with granulomatous lymphocytic interstitial lung disease (GLILD). Based on univariable analysis, they stated that splenomegaly was independently associated with GLILD (odds ratio [OR] 17.3, 95% confidence interval [CI] 3.9–74.5). Although the study was useful and very interesting, some methodologic issues need to be considered.

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Single recombinant and purified major allergens and peptides

To review the current knowledge regarding recombinant and purified allergens and allergen-derived peptides.

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Sensitization profiles to peanut allergens across the United States

Measurement of IgE antibody to peanut components can aid in the prediction of allergic responses the food.

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Allergic sensitization and objective measures of sleep in urban school-aged children with asthma

Allergic sensitization is associated with increased child asthma morbidity and decreased pulmonary function. Nocturnal symptoms and/or awakenings typically are measured by self-report from diary data, whereas objective assessments of sleep in child asthma studies are lacking.

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Evaluating proteins for potential allergenicity using bioinformatic approaches

Ever since the introduction of a tougher tomato1 and, more recently, the discovery of a "DNA nanosurgery" system based on CRISPR-CAS,2 we are inexorably headed to a new world where genetically modified (GM) animals will consume GM plants, both of which will be labeled GM foods. These in turn will be (futuristically) consumed by GM humans. It is natural for allergists to wonder whether this could increase the incidence of allergy as we strive to primum non nocere and apply bioinformatics approaches to assess this at the bedside.

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Comparison of Localized and Systemic Otitis Media With ANCA-associated Vasculitis.

Objective: To investigate differences in immune activity based on the presence of multiple organ involvement in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and whether hearing outcomes are different between patients with AAV localized to the ear and patients with systemic AAV. Study Design: Retrospective case review. Setting: University hospital. Patients: Twenty patients with otitis media with AAV (OMAAV) who met the criteria proposed by the OMAAV study group in Japan. Main Outcome Measure(s): Serum levels of C-reactive protein, ANCA titer, soluble interleukin-2 receptor levels, and hearing outcome. Results: Thirteen patients had disease involvement of organs other than the ear (systemic OMAAV group); involvement was localized to the ear in seven patients (localized OMAAV group). Serum levels of C-reactive protein, ANCA titer, and soluble interleukin-2 receptor were not significantly different between the groups. Hearing levels at diagnosis and in remission were significantly worse in the localized OMAAV group compared with the systemic OMAAV group. Hearing gain was not significantly different between groups. Conclusion: It is suggested that immune activity in patients with AAV localized to the ear is equivalent to activity in patients with systemic AAV. Therefore, we may need treatment for OMAAV equal in intensity to that for systemic AAV. As the hearing level at diagnosis was worse in patients with AAV localized to the ear than in patients with systemic AAV, earlier diagnosis may be needed to improve hearing outcome. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Assessing Readability and Reliability of Online Patient Information Regarding Vestibular Schwannoma.

Hypothesis: The aim of this study is to objectively assess the quality and readability of websites related to vestibular schwannomas. Background: Patients are increasingly seeking information on confirmed or suspected diagnoses through the Internet. Clinicians are often concerned regarding the accuracy, quality, and readability of web-based sites. Methods: Online information relating to vestibular schwannoma was searched using the three most popular search engines. The terms "acoustic neuroma" and "vestibular schwannoma" were used. The top 50 results from each site were assessed for readability using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and the Gunning-Fog Index. Quality of website information was scored using the DISCERN tool. Results: Of 300 search results analyzed, 58 separate appropriate websites were identified. The mean readability score using Flesch-Kincaid Grade Level was 10.27 (95% confidence interval [CI] 9.84-10.70). The mean Flesch Reading Ease Score was 48.75 (95% CI 46.57-50.92). The Gunning-Fog Index was 13.40 (95% CI 12.92-13.89). These scores equate to someone finishing secondary school/first year university student. DISCERN scores were highly variable but consistently demonstrated great variability in quality of information. Conclusion: Online patient information on vestibular schwannoma is highly variable in quality. Although there are a wide range of different websites easily available to patients on their condition and its treatment options, the information is written at a difficult level which may exceed the understanding level of many patients as it is written at a higher than average level of expected reading ability. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Comparison of an Electromagnetic Middle Ear Implant and Hearing Aid Word Recognition Performance to Word Recognition Performance Obtained Under Earphones.

Objective: To report the results of patients with the Maxum middle ear implant (MEI) and compare word recognition scores (WRS) and speech perception gap (SP Gap) of Maxum versus optimally fit hearing aids (HA). Study Design: Case series with chart review. Setting: Single, private otology clinic. Patients: Eleven ears, in nine adult patients (two women; average age 62.7 yr). Interventions: Twelve consecutive ears with moderate to severe (SNHL) underwent implantation of the Maxum system. One patient was not included due to inadequate preoperative testing. Main Outcome Measures: Primary outcome measures included word recognition score (WRS) and SP Gap (maximum word understanding [PB max] - WRSaided) improvement compared with HAs. Results: The average Maxum WRS was 64.7% (range, 28-94%), a 41.6% improvement (range, 10-66%) over HAs (p

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CD155T/TIGIT Signaling Regulates CD8+ T Cell Metabolism and Promotes Tumor Progression in Human Gastric Cancer

The T cell surface molecule TIGIT is an immune checkpoint molecule that inhibits T cell responses, but its roles in cancer are little understood. In this study, we evaluated the role TIGIT checkpoint plays in the development and progression of gastric cancer (GC). We show that the percentage of CD8 T cells that are TIGIT+ was increased in GC patients compared to healthy individuals. These cells showed functional exhaustion with impaired activation, proliferation, cytokine production and metabolism, all of which were rescued by glucose. In addition, GC tissue and cell lines expressed CD155, which bound TIGIT receptors and inactivated CD8 T cells. In a T cell-GC cell co-culture system, GC cells deprived CD8 T cells of glucose and impaired CD8 T cell effector functions; these effects were neutralized by the additional glucose or by TIGIT blockade. In GC tumor cells, CD155 silencing increased T cell metabolism and IFNγ production, whereas CD155 overexpression inhibited T cell metabolism and IFNγ production; this inhibition was neutralized by TIGIT blockade. Targeting CD155/TIGIT enhanced CD8 T cell reaction and improved survival in tumor bearing mice. Combined targeting of TIGIT and PD-1 further enhanced CD8 T cell activation and improved survival in tumor bearing mice. Our results suggest that GC cells inhibit CD8 T cell metabolism through CD155/TIGIT signaling, which inhibits CD8 T cell effector functions, resulting in hyporesponsive antitumor immunity. These findings support the candidacy of CD155/TIGIT as a potential therapeutic target in gastric cancer.

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FSTL1 promotes metastasis and chemoresistance in esophageal squamous cell carcinoma through NF{kappa}B-BMP signaling crosstalk

Esophageal squamous cell carcinoma (ESCC) has a generally poor prognosis and molecular markers to improve early detection and predict outcomes are greatly needed. Here we report that the BMP-binding follistatin-like protein FSTL1 is overexpressed in ESCCs where it correlates with poor overall survival. Genetic amplification of FSTL1 or chromosome 3q where it is located occurred frequently in ESCC, where FSTL1 copy number correlated positively with higher FSTL1 protein expression. Elevating FSTL1 levels by various means was sufficient to drive ESCC cell proliferation, clonogenicity, migration, invasion, self-renewal and cisplatin resistance in vitro and tumorigenicity and distant metastasis in vivo. Conversely, FSTL1 attenution by shRNA or neutralizing antibody elicited the opposite effects in ESCC cells. mRNA profiling analyses suggested that FSTL1 drives ESCC oncogenesis and metastasis through various pathways with deregulation of NF-κB and BMP signaling figuring prominently. Crosstalk between the NF-κB and BMP pathways was evidenced by functional rescue experiments using inhibitors of NF-κB and TLR4. Our results establish the significance of FSTL1 in driving oncogenesis and metastasis in ESCC by coordinate NF-κB and BMP pathway control, with implications for its potential use as a diagnostic or prognostic biomarker and a candidate therapeutic target in this disease setting.

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Discovery of human-similar gene fusions in canine cancers

Canine cancers represent a tremendous natural resource due to their incidence and striking similarities to human cancers, sharing similar clinical and pathological features as well as oncogenic events including identical somatic mutations. Considering the importance of gene fusions as driver alterations, we explored their relevance in canine cancers. We focused on three distinct human-comparable canine cancers representing different tissues and embryonic origins. Through RNA-Seq, we discovered similar gene fusions as those found in their human counterparts: IGK-CCND3 in B-cell lymphoma, MPB-BRAF in glioma, and COL3A1-PDGFB in dermatofibrosarcoma protuberans-like. We showed not only similar partner genes but also identical breakpoints leading to oncogene overexpression. This study demonstrates similar gene fusion partners and mechanisms in human-dog corresponding tumors and allows for selection of targeted therapies in preclinical and clinical trials with pet dogs prior to human trials, within the framework of personalized medicine.

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Genetic dissociation of glycolysis and the TCA cycle affects neither normal nor neoplastic proliferation

Rapidly proliferating cells increase glycolysis at the expense of oxidative phosphorylation (oxphos) to generate sufficient levels of glycolytic intermediates for use as anabolic substrates. The pyruvate dehydrogenase complex (PDC) is a critical mitochondrial enzyme that catalyzes pyruvate's conversion to acetyl coenzyme A (AcCoA), thereby connecting these two pathways in response to complex energetic, enzymatic and metabolic cues. Here we utilized a mouse model of hepatocyte-specific PDC inactivation to determine the need for this metabolic link during normal hepatocyte regeneration and malignant transformation. In PDC "knockout" (KO) animals, the long-term regenerative potential of hepatocytes was unimpaired, and growth of aggressive experimental hepatoblastomas (HB) was only modestly slowed in the face of 80-90% reductions in AcCoA and significant alterations in the levels of key TCA cycle intermediates and amino acids. Overall, oxphos activity in KO livers and HB was comparable to that of control counterparts, with evidence that metabolic substrate abnormalities were compensated for by increased mitochondrial mass. These findings demonstrate that the biochemical link between glycolysis and the TCA cycle can be completely severed without affecting normal or neoplastic proliferation, even under the most demanding circumstances.

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KDM4 inhibition targets breast cancer stem-like cells

Traditional treatments for breast cancer fail to address therapy-resistant cancer stem-like cells that have been characterized by changes in epigenetic regulators such as the lysine demethylase KDM4. Here we describe an orally available, selective and potent KDM4 inhibitor (QC6352) with unique preclinical characteristics. To assess the anti-tumor properties of QC6352, we established a method to isolate and propagate breast cancer stem-like cells (BCSC) from individual triple-negative tumors resected from patients after neoadjuvant chemotherapy. Limiting-dilution orthotopic xenografts of these BCSC regenerated original patient tumor histology and gene expression. QC6352 blocked BCSC proliferation, sphere formation and xenograft tumor formation. QC6352 also abrogated expression of EGFR which drives the growth of therapy-resistant triple-negative breast cancer cells. Our findings validate a unique BCSC culture system for drug screening and offer preclinical proof of concept for KDM4 inhibition as a new strategy to treat triple-negative breast cancer.

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Enhanced acid sphingomyelinase activity drives immune evasion and tumor growth in non-small cell lung carcinoma

The lipid hydrolase enzyme acid sphingomyelinase (ASM) is required for the conversion of the lipid cell membrane component sphingomyelin into ceramide. In cancer cells, ASM-mediated ceramide production is important for apoptosis, cell proliferation and immune modulation, highlighting ASM as a potential multimodal therapeutic target. In this study, we demonstrate elevated ASM activity in the lung tumor environment and blood serum of patients with non-small cell lung cancer (NSCLC). RNAi-mediated attenuation of SMPD1 in human NSCLC cells rendered them resistant to serum starvation-induced apoptosis. In a murine model of lung adenocarcinoma, ASM deficiency reduced tumor development in a manner associated with significant enhancement of Th1-mediated and cytotoxic T cell-mediated antitumor immunity. Our findings indicate that targeting ASM in NSCLC can act by tumor cell intrinsic and extrinsic mechanisms to suppress tumor cell growth, most notably by enabling an effective antitumor immune response by the host.

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Transplantation of iPS-derived tumor cells with a homozygous MHC haplotype induces GRP94 antibody production in MHC-matched macaques

Immune surveillance is a critical component of the anti-tumor response in vivo, yet the specific components of the immune system involved in this regulatory response remain unclear. In this study, we demonstrate that autoantibodies can mitigate tumor growth in vitro and in vivo. We generated two cancer cell lines, embryonal carcinoma and glioblastoma cell lines, from monkey induced pluripotent stem cells (iPSC) carrying a homozygous haplotype of major histocompatibility complex (MHC, Mafa in Macaca fascicularis). To establish a monkey cancer model, we transplanted these cells into monkeys carrying the matched Mafa haplotype in one of the chromosomes. Neither Mafa-homozygous cancer cell line grew in monkeys carrying the matched Mafa haplotype heterozygously. We detected in the plasma of these monkeys an IgG autoantibody against GRP94, a heat shock protein. Injection of the plasma prevented growth of the tumor cells in immunodeficient mice, whereas plasma IgG depleted of GRP94 IgG exhibited reduced killing activity against cancer cells in vitro. These results indicate that humoral immunity, including autoantibodies against GRP94, plays a role in cancer immune surveillance.

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miR-193b-regulated signaling networks serve as tumor suppressors in liposarcoma and promote adipogenesis in adipose-derived stem cells

Well-differentiated and dedifferentiated liposarcomas (WDLS/DDLS) account for approximately 13% of all soft tissue sarcoma in adults and cause substantial morbidity or mortality in the majority of patients. In this study, we evaluated the functions of miRNA (miR-193b) in liposarcoma in vitro and in vivo. Deep RNA sequencing on 93 WDLS, 145 DDLS and 12 normal fat samples demonstrated that miR-193b was significantly underexpressed in DDLS compared to normal fat. Re-introduction of miR-193b induced apoptosis in liposarcoma cells and promoted adipogenesis in human adipose-derived stem cells (ASC). Integrative transcriptomic and proteomic analysis of miR-193b-target networks identified novel direct targets including CRK-like proto-oncogene (CRKL) and focal adhesion kinase (FAK). miR-193b was found to regulate FAK-SRC-CRKL signaling through CRKL and FAK. miR-193b also stimulated ROS signaling by targeting the antioxidant methionine sulfoxide reductase A (MSRA) to modulate liposarcoma cell survival and ASC differentiation state. Expression of miR-193b in liposarcoma cells was downregulated by promoter methylation resulting at least in part from increased expression of the DNA methyltransferase DNMT1 in WDLS/DDLS. In vivo, miR-193b mimetics and FAK inhibitor (PF-562271) each inhibited liposarcoma xenograft growth. In summary, miR-193b not only functions as a tumor suppressor in liposarcoma, but also promotes adipogenesis in ASC. Furthermore, this study reveals key tyrosine kinase and DNA methylation pathways in liposarcoma, some with immediate implications for therapeutic exploration.

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Blood monocytes sample MelanA/MART1 antigen for long-lasting cross-presentation to CD8+ T cells after differentiation into dendritic cells

Abstract

Human blood monocytes are very potent to take up antigens. Like macrophages in tissue, they efficiently degrade exogenous protein and are less efficient than dendritic cells at cross-presenting antigens to CD8⁺ T cells. Although it is generally accepted that dendritic cells take up tissue antigens and then migrate to lymph nodes to prime T cells, the mechanisms of presentation of antigens taken up by monocytes are poorly documented so far. In the present work, we show that monocytes loaded in vitro with MelanA long peptides retain the capacity to stimulate antigen-specific CD8⁺ T cell clones after 5 days of differentiation into monocytes-derived dendritic cells (MoDC). Tagged-long peptides can be visualized in electron-dense endocytic compartments distinct from lysosomes, suggesting that antigens can be protected from degradation for extended periods of time. To address the pathophysiological relevance of these findings, we screened blood monocytes from eighteen metastatic melanoma patients and found that CD14⁺ monocytes from 2 patients effectively activate a MelanA-specific CD8 T cell clone after in vitro differentiation into MoDC. This in vivo sampling of tumor antigen by circulating monocytes might alter the tumor-specific immune response and should be taken into account for cancer immunotherapy. This article is protected by copyright. All rights reserved.

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Breast conserving therapy and mastectomy revisited: Breast cancer-specific survival and the influence of prognostic factors in 129,692 patients

Abstract

This large population-based study compared breast-conserving surgery with radiation therapy (BCT) with mastectomy on (long-term) breast cancer-specific (BCSS) and overall survival (OS), and investigated the influence of several prognostic factors.

Patients with primary T1-2N0-2M0 breast cancer, diagnosed between 1999-2012, were selected from the Netherlands Cancer Registry. We investigated the 1999-2005 (long-term outcome) and the 2006-2012 cohort (contemporary adjuvant systemic therapy). Cause of death was derived from the Statistics Netherlands (CBS). Multivariable analyses, per time cohort, were performed in T1-2N0-2, and separately in T1-2N0-1 and T1-2N2 stages. The T1-2N0-1 stages were further stratified for age, hormonal receptor and HER2 status, adjuvant systemic therapy and comorbidity.

In total, 129,692 patients were included. In the 1999-2005 cohort, better BCSS and OS for BCT than mastectomy was seen in all subgroups, except in patients <40 years with T1-2N0-1 stage. In the 2006-2012 cohort, superior BCSS and OS were found for T1-2N0-1, but not for T1-2N2. Subgroup analyses for T1-2N0-1 showed superior BCSS and OS for BCT in patients >50 years, not treated with chemotherapy and with comorbidity. Both treatments led to similar BCSS in patients <50 years, without comorbidity and those treated with chemotherapy.

Although confounding by severity and residual confounding cannot be excluded, this study showed better long-term BCSS for BCT than mastectomy. Even with more contemporary diagnostics and therapies we identified several subgroups that may benefit from BCT. Our results support the hypothesis that BCT might be preferred in most breast cancer patients when both treatments are suitable. This article is protected by copyright. All rights reserved.

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Transcriptional repression of Aurora-A gene by wild-type p53 through directly binding to its promoter with histone deacetylase 1 and mSin3a

Abstract

In this study, we firstly showed that p53 transcriptionally represses Aurora-A gene expression through directly binding to its promoter. DNA affinity precipitation assay and chromatin immunoprecipitation assay indicated that p53 physically bound to the Aurora-A promoter. Moreover, the in vitro and in vivo assays showed that p53 directly bound to the Aurora-A promoter together with histone deacetylase 1 (HDAC1) and mSin3a as corepressors. Furthermore, we identified that the nucleotides -360 to -354 (CCTGCCC), upstream of the Aurora-A transcriptional start site, was responsible for the p53-mediated repression. Mutation within this site disrupted its interaction with p53, mSin3a and HDAC1, as well as attenuated the repressive effect of p53 on Aurora-A promoter activity. Treatment with trichostatin A (TSA), a HDAC1 inhibitor, disrupted the interaction of p53-HDAC1-mSin3a complex with the nucleotides -365∼-345 region, and enhanced the Aurora-A promoter activity and gene expression. Additionally, knockdown of p53 or mSin3a also drastically blocked the formation of p53-HDAC1-mSin3a repressive complex onto this promoter region and elevated the Aurora-A promoter activity and gene expression. Moreover, the p53-HDAC1-mSin3a repressive complex also involved in the inhibition of Aurora-A gene expression upon cisplatin treatment. Finally, the clinical investigation showed that Aurora-A and p53 exhibited an inverse correlation in both the expression level and prognostic status and the low p53/high Aurora-A showed the poorest prognosis of NSCLC patients. Our findings showed novel regulatory mechanisms of p53 in regulating Aurora-A gene expression in NSCLC cells.

Many types of cancer feature a boost in production of the kinase Aurora-A, and several studies have implicated the protein in transformation and tumorigenesis. Some evidence suggests that p53 affects Aurora-A expression, and in this study, the authors set out to describe that relationship. They found that p53 binds directly to the Aurora-A promoter, repressing transcription. Next, they showed that treatment with trichostatin A thwarts this repression, allowing Aurora-A transcription to proceed. Clinical investigation revealed that lung cancer patients with low p53 and high Aurora-A expression had the worst prognosis. This article is protected by copyright. All rights reserved.

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Recognition by Natural Killer cells of N6-isopentenyladenosine-treated human glioma cell lines

Abstract

Cancer cell stress induced by cytotoxic agents promote antitumor immune response. Here we observed that N6-isopentenyladenosine (iPA), an isoprenoid modified adenosine with a well established anticancer activity, was able to induce a significant upregulation of cell surface expression of NKG2D ligands on glioma cells in vitro and xenografted in vivo. Specifically suboptimal doses of iPA (0.1 and 1µM) control the selective upregulation of ULBP2 on p53wt-expressing U343MG and that of MICA/B on p53mut-expressing U251MG cells. This event made the glioblastoma cells a potent target for natural killer (NK) cell mediated recognition through a NKG2D restricted mechanism. p53 siRNA mediated knock-down and pharmacological inhibition (pifithrin-α), profoundly prevented the iPA action in restoring the immunogenicity of U343MG cells through a mechanism that is dependent upon p53 status of malignancy. Furthermore, accordingly to the preferential recognition of senescent cells by NK cells, we found that iPA treatment was critical for glioma cells entry in premature senescence through the induction of S and G2/M phase arrest.

Collectively, our results indicate that behind the well established cytotoxic and anti-angiogenic effects, iPA can also display an immune-mediated antitumor activity. The indirect engagement of the innate immune system and its additional activity in primary derived patient's glioma cell model (GBM17 and GBM37), fully increase its translational relevance and led to the exploitation of the isoprenoid pathway for a valid therapeutic intervention in anti-glioma research. This article is protected by copyright. All rights reserved.

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Potential for peritoneal cancer cell seeding in endoscopic full-thickness resection for early gastric cancer

During endoscopic full-thickness resection (EFTR) for cancers, whether exposure of the lumen to the abdominal cavity during the procedure is acceptable is controversial because of the potential risk of tumor cell seeding. To assess the possibility of transplantation due to contact with tumor cells during the procedure, we prospectively investigated the ability of cancer cells to be detached by touching the tumor surface.

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Morphometric analysis of the uncinate processes of the cervical vertebrae

Background: Uncinate processes (UPs) are distinct features unique to cervical vertebrae. They are consistently found on posterolateral aspect of the superior end plate of 3rd to 7th cervical vertebrae. In this study, we investigated the morphology of the UPs with a particular emphasis on the regional anatomy and clinical significance.

Materials and methods: The study included 63 vertebrae. The width, height and length of UPs were measured with a digital calliper. We also assessed inclination angle of UP relative to sagittal plane, angle between medial surface of UP and superior surface of vertebra, angle between long axis of the UP and frontal plane, angle between long axis of UP and sagittal plane.

Results: Average width of the UPs ranged from 4.25 mm at C3 to 6.33 mm at T1; average height ranged from 4.88 mm at T1 to 7.54 mm at C4; and average length ranged from 6.88 mm at T1 to 11.46 mm at C4. We measured the inclination angle of UP relative to sagittal plane, and found it to be relatively constant with T1 having the largest value. The average angle was 41.39°, and the range was 17° to 85°. The angle between the long axis of the UP and the sagittal plane was increasing signifi­cantly from C5 to T1. The average angle was 20.74° and the range was 6° to 65°.

Conclusions: Anatomy of UPs is significant for surgeon who operates on the cervical spine. Hopefully, the information presented herein would decrease complications during surgical approaches to the cervical spine

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Reflective journals: unmasking student perceptions of anatomical education

Background: In medical education, reflection has been considered to be a core skill in professional competence. The anatomy laboratory is an ideal setting for faculty/ student interaction and provides invaluable opportunities for active learning and reflection on anatomical knowledge.

Materials and methods: This study was designed to record student attitudes regarding human cadaveric dissection, explore their experiences of anatomy through an analysis of their journal-reflective writings and determine whether this type of creative writing had a beneficial effect on those students who chose to complete them. A total of 75 journals from Medical and Allied Health Science students were collected and analysed.

Results: Results were categorised according to the following themes: (i) Dissecting room stressors (27.6%); (ii) Educational value of dissection (26.3%); (iii) Appreciation, Gratitude, Respect and Curiosity for the cadaver (18.9%); (iv) Positive and negative sentiments expressed in the dissecting room (25.8%); (v) Benefit of alternate teaching modalities (4.6%); (vi) Spirituality/Religious Beliefs (3.7%); (vii) Shared humanity and emotional bonds (3.69%); (viii) Acknowledgement of human anatomical variations (3.2%); (ix) Beauty and complexity of the human body (1.8%) and (x) Psychological detachment (0.9%). Students appreciated the opportunity to share their emotions and reflect on the humanistic dimension of anatomy as a subject. Student reflections illustrated clearly their thoughts and some of the difficult issues with which they wrestled.

Conclusions: The anatomy laboratory is seen as the budding clinician's first encounter with a patient, albeit a cadaver. This was the first time that reflective journals were given to students in the discipline. Reflective journals allow students to express themselves in an open-ended and creative fashion. It also assists students to integrate anatomy and clinical medicine and assists in applying their basic anatomical knowledge in an authentic, yet safe environment

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The Terminologia Anatomica matters: examples from didactic, scientific, and clinical practice

The proper usage of the anatomical terminology is of paramount importance to all medical professionals. Although a multitude of studies have been devoted to issues associated with the use and application of the recent version of the anatomical terminology in both theoretical medicine and clinical practice, there are still many unresolved problems such as confusing terms, inconsistencies, and errors, including grammar and spelling mistakes. The aim of this article is to describe the current situation of the anatomical terminology and its usage in practice, as well as explain why it is so important to use precise, appropriate, and valid anatomical terms during the everyday communication among physicians from all medical branches. In this review, we discuss some confusing, obsolete, and erroneous terms that are still commonly used by many clinicians, and surgeons in particular, during the process of diagnosis and treatment. The use of these ambiguous, erroneous, and obsolete terms enhances the risk of miscommunication. We also provide some edifying examples from everyday clinical practice.

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Prevalence and distribution of the fabella: a radiographic study in Turkish subjects

Background: The purpose of this study is to examine the plain knee radiographs in Turkish subjects in order to determine the prevalence of the fabella and analyse the differences between age, gender, laterality and its symmetry pattern.

Materials and methods: Bilateral antero-posterior and lateral knee radiographs of 500 patients (250 male and 250 female subjects, 1000 knee radiographs) were randomly selected from the clinical database and retrospectively evaluated. Data on patient age, gender, and knee laterality (right–left) were evaluated from hospital records. The differences between the sesamoid bones at a particular location and the side, sex and age groups were analysed.

Results: The overall prevalence of the fabella (unilateral or bilateral) was 22.8% (114 subjects). The fabella was present unilaterally in 38 (7.6%) subjects, while it was present bilaterally in 76 (15.2%) subjects. The prevalence of the fabella was similar between the body sides. The prevalence of the fabella was also similar between genders (unilateral or bilateral cases) and age groups.

Conclusions: We examined the prevalence, symmetry pattern, age and gender differences in Turkish population. It is the first study performed on Turkish population with the largest sample in current literature. Prevalence of fabella is found to be 22.8% which is quite similar with other Caucasian ethnic populations.

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Tongue and lingual salivary glands of the canary: scanning electron microscopy and histochemical study

In this study, morphological characteristics of the canary tongue were examined macroscopically and histologically besides using scanning electron microscopy. Furthermore, histochemical features of the lingual salivary glands of the canary were also examined. The results suggest that the tongue of the canary has an equilateral quadrangle shape is sloped towards the apex on its dorsal surface; where its sides are bounded by tall epithelial extensions. Additionally, histological examination showed that salivary glands were only present on the body of the tongue and there were no taste buds. However, the tongue has mechanical sen­sory cell groups in its subepithelial connective tissue. Histochemical examination, demonstrated that the salivary gland epithelial cells contained carbohydrates which were composed of acidic sialo-mucins.

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Variation in morphology and branching pattern of superior mesenteric artery

The anatomical variations of superior mesenteric artery branches are common. In this study we reported an extraordinary morphology and branching of superior mesenteric artery, during our routine dissection of a 38-year-old Sudanese male cadaver, where the superior mesenteric artery forms an arch over the confluence of inferior vena cava and left renal vein.

Other variations observed were: 1) The superior mesenteric artery shares the same origin of coeliac trunk; 2) The unusual origin of right hepatic artery.

We think that the knowledge of these variations plays an important role in conducting and planning of radiological and surgical procedures especially in hepatobiliary and pancreatic surgery. Morphology and branching patterns of this artery is anecdotic, which makes this case the most unique.

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Site-dependent acellularisation effects explain altered tissue mechanics: ultrastructural insights

Acellular scaffolds are used for the surgical repair of soft tissue injury forming a biological basis for cell remodelling. Previously tissue-dependent effects sodium-dodecyl-sulphate (SDS) have been determined on the extracellular matrix (ECM) of different tissue types. This short report aims at extending these findings onto a tissue-layer level with focus on the ECM. Porcine ureters, oesophagi and skin underwent acellularisation using SDS, whereas control samples remained in a native condition. The samples were investigated histologically and ultrastructurally electron microscopy. Dense collagen bundles were seen in all native samples throughout the layers, and moderate to strong decreases in collagen density in the acellular state, accompanied by clumping. Collagen bundles were altered differently. Transition from straightened into coiled alignment was observed in the ureters' intima and all oesophageal layers, the opposite was observed in the ureters' media and adventitia. Skin samples appeared discontinuously following acellularisation, with collagens curling in the subcutis and dermis and disruptions in the subepidermis. Collagen fibre integrity appeared unchanged. SDS-related alterations include tissue- and site-dependent alterations of the collagen bundles. These insights into the ECM provide further explanation of acellularisation-induced change in mechanical properties, resulting in increased stiffness in ureters, and stiffness in skin.

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The challenge of extra-intra craniometry: a computer-assisted three-dimensional approach on the equine skull

Background: The topographical correlations between certain extracranial and intracranial osseous points of interest (POIs), and their age-related changes, are indispensable to know for a diagnostical or surgical access to intracranial structures; however, they are difficult to assess with conventional devices.

Materials and methods: In this pilot study, the 3-dimensional coordinates of extra-/intracranial POIs were determined, thus avoiding perspective distortions that used to be intrinsic problems in 2-dimensional morphometry. The data sets were then analysed by creating virtual triangles. The sizes, shapes, and positions of these triangles described the extent and the directions of the age-related shifts of the POIs. A selection of extracranial and intracranial POIs were marked on half skulls of four warmblood horses in two age groups (young: 6 weeks, n = 2; old: 14 and 17 years, n = 2). The x-, y-, and z-coordinates of these POIs were determined with a measurement arm (FaroArm Fusion, FARO Europe®). Direct distances between the POIs as well as their indirect distances on the x-, y-, and z-axis, and angles were calculated.

Results: The analysed virtual triangles revealed that some parts of the skull grew in size, but did not change in shape/relative proportions (proportional type of growth, as displayed by POI A and POI B at the Arcus zygomaticus). The same POIs (A and B) remained in a very stable relationship to their closest intracranial POI at the Basis cranii on the longitudinal axis, however, shifted markedly in the dorso-lateral direction. In contrast, a disproportional growth of other parts of the cranium was, for example, related to POI C at the Crista nuchae, which shifted strongly in the caudal direction with age. A topographically stable reference point (so-called anchor point) at the Basis cranii was difficult to determine.

Conclusions: Two candidates (one at the Synchondrosis intersphenoidalis, another one at the Synchondrosis sphenooccipitalis) were relatively stable in their positions. However, the epicentre of (neuro-)cranial growth could only be pinpointed to an area between them.

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An investigation on cardioprotective potential of Marrubium vulgare aqueous fraction against ischaemia-reperfusion injury in isolated rat heart

Background: The aim of this study was to evaluate the cardioprotective effects of aqueous fraction of Marrubium vulgare hydroalcoholic extract on cardiac parameters in ischaemic-reperfused isolated rat hearts.

Materials and methods: The aerial parts of the plant were extracted with methanol 70% by maceration. The water-soluble portion of the total hydroalcoholic extract was prepared with liquid-liquid extraction (LLE). Afterwards, the antioxidant activity, total phenolic and flavonoids content of the aqueous fraction were determined. In order to evaluate the effects of the aqueous fraction on cardiac parameters and ischaemia-reperfusion (I/R) injury, the Langendroff method was used on male Wistar rats. Harvested hearts were cannulated immediately to the Langendroff apparatus and subjected into 30 min regional ischaemia and 2 h reperfusion, either by a modified Krebs-Henseleit buffer (KHB) solution or enriched KHB solution with plant extract (10, 20, 40 μg/mL).

Results: The aqueous fraction was found to be a scavenger of DPPH radical with RC50 value of 47 μg/mL. The total phenolic and flavonoids content of the fraction was 6.05 g gallic acid equivalent and 36.13 mg quercetin equivalent per 100 g of dry plant material. In addition, 40 μg/mL of Marrubium vulgare aqueous fraction significantly decreased infarct size in comparison to control group. All doses considerably reduced the total ventricular ectopic beats during 30 min of ischaemia. The extract at dose of 40 μg/mL noticeably decreased the arrhythmias during the first 30 min of reperfusion.

Conclusions: The results of the study indicated aqueous fraction of Marrubium vulgare possesses a protective effect against I/R injuries in isolated rat hearts

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Location of the narrowest area of the pharynx regarding body mass index and obstructive sleep apnoea severity

Background: Among authors studying morphological determinants of the obstructive sleep apnoea (OSA) controversies exist on the location of the narrowest area within the pharynx, critical for development of obstruction. Those disagreements primarily revolve around differences between obese and nonobese OSA patients. Determination whether the location and size of the narrowest area within the pharynx differentiates the obese and nonobese OSA patients.

Materials and methods: A population of 55 subjects was investigated after being diagnosed with OSA in the Polysomnography Laboratory of the Department and Clinic of Otolaryngology in the Medical University of Warsaw, Poland. Additionally a head computed tomography (CT) was performed in all the subjects. The CT images were used to do several crucial measurements which described the geometry of the facial skeleton as well as soft tissues of the head. The obtained results were correlated with apnoea-hypopnoea index (AHI) and body mass index (BMI) values. The data were statistically analysed.

Results: The distance between the hard palate and posterior pharyngeal wall parallel to the horizontal plane as well as the shortest distance between the soft palate and posterior pharyngeal wall significantly differentiated patients in the subgroups by AHI but not by BMI.

Conclusions: Pharyngeal obstruction at the level of the hard and soft palate differentiates patients with severe OSA from patients with mild and moderate OSA regardless of BMI.

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The expression of inhibitor of nuclear factor kappa-B kinase epsilon (IKKe) in human aortic aneurysm

Background: Aortic aneurysm (AA) is one of the most common causes of sudden death among elderly people. Although AA can be detected by non-invasive imaging techniques, there are no pharmacological treatments currently available to prevent progression at any stage of the disease. In this study we will explore the expression of inhibitor of nuclear factor kappa-B kinase epsilon (IKKe) in AA and its potential underlying molecular mechanism in AA.

Materials and methods: Human aortic tissue was taken from 14 patients who underwent surgical repair of AA for the AA group and another 11 patients with normal aorta who underwent aortic valve replacement surgery for the control group. After excision, we used haematoxylin-eosin staining, Masson staining, immunohistochemistry analysis and Western blot analysis to observe the expres­sion, location and morphological changes of the IKKe, P50 and the extracellular matrix within the AA.

Results: In the AA group, haematoxylin-eosin staining revealed a loss of medial integrity and inflammatory cell infiltration. Masson staining confirmed the degradation of the extracellular matrix in the AA group. Immunohistochemistry analysis showed increased infiltration of inflammatory cells and up-regulation of proinflammatory cytokines in the AA group when compared to the control group. Based on immunohistochemistry and Western blot analysis, there was clearly over-expression of IKKe, P50 and MMP2 in AA group, mainly in the intrinsic aortic cells of the media.

Conclusions: The over-expression of IKKe may play an important role in the ori­gination and progression of AA and might be a vital target for their treatment.

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Triple arterial blood supply to the liver and double cystic arteries

A rare combination of variations in the arterial supply of the liver and gallbladder was encountered in a male cadaver. The simultaneous occurrence of an accessory left hepatic artery and an accessory right hepatic artery from which double cystic arteries arose (one of which was low-lying). This combination has not yet been reported. The accessory left hepatic artery originated from the left gastric artery. The accessory right hepatic artery originated from the superior mesenteric artery. Such arterial variations are caused by differences in embryological development. This, however, may lead to complications related to diagnostic and therapeutic procedures in the upper abdomen.

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Intracranial region of the vertebral artery: morphometric study in the context of clinical usefulness

Background: The aim of this study was to analyse the morphometry of the intracranial segment of the vertebral artery in the context of clinical usefulness. The results were compared with published data available in full-text archived medical journals.

Materials and methods: More than 100 digital subtraction angiography (DSA) and 3-dimensional (3D) angio-computed tomography (CT) examinations were used to measure the following parameters: the whole and partial length of V4 in characteristic anatomical points, the diameter in three places (on the level of foramen magnum, in point of exit to the posterior inferior cerebellar artery, and in the vertebro-basilar junction), the angle of connection to the vertebral arteries, and all anatomical variations including fenestration, duplication, dolichoectasia or absent artery.

Results: The left V4 section was predominant over the right artery, which is manifested by length, width, cases of ectasia and fewer cases of hypoplasia. The incidences of V4 ectasia were identified more often than those documented in the accessible literature, and they were found in the natural location of formation of saccular aneurysms.

Conclusions: The presented knowledge of anatomical variation and abnormali­ties of vertebral circulation can improve the accuracy and "safety" of the surgical procedures in this region, help to determine the range of surgical approach and avoid associated complications. The radiological examinations using 3D CT, DSA reveal unlimited observation of anatomical structures in contrast to studies based on cadavers, and can complement the morphometry in anatomical preparations.

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Diversity among posterior thalamoperforating branches originated from P1 segment: systematic review

Background: The P1 segment of the posterior cerebral artery (PCA) begins at the termination of the basilar artery and ends at the origin of posterior commu­nicating artery, within the interpeduncular cistern. Perforating branches arising from this segment are called posterior thalamoperforating arteries (TPAs) and the main and biggest artery among those is called TPA. Perforating branches are a crucial component of cerebrovascular system supplying the posterior part of the thalamus, subthalamus, hypothalamus, substantia nigra, perforated substance, posterior part of internal capsule and the nucleus of III and IV cranial nerve. It is very important for neurosurgeon to know the anatomy of perforating branches because of their susceptibility to injury. The aim of this study is to determine the morphometry of posterior TPAs and allow a better understanding of their bran­ching patterns and relation to basilar artery.

Materials and methods: An extensive search was undertaken in order to identify published literature related to the posterior cerebral circulation system and the anatomy of posterior TPAs using key words. Medline, Embase, Ovid and Google Scholar databases were searched for publications dated from 1970 until July 2016. We collected and analysed all the data describing the mean number of branches per P1 segment, range of branches, number of analysed PCA, largest diameter of TPA, mean diameter of TPA and average distance from the basilar artery bifurcation.

Results: Thirteen cadaver studies were analysed and the data was extracted. We focused on the mean number of branches arising from P1 segment, perforators range, mean diameter of perforating branches, largest diameter of perforating branches.

Conclusions: Mean number of branches per hemisphere was 2.91 (min. 1.51, max. 4.1). In more than half of analysed studies, authors did not find any pre­sence of posterior TPAs. Mean diameter of those perforators was 0.51 mm (min. 0.125 mm, max. 0.8 mm). Average distance from basilar artery bifurcation was 2.29 mm (min. 1.93 mm, max. 2.75 mm). There were many branching patterns presented by different authors.

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Three-dimensional computed tomography angiography of the pulmonary veins and their anatomical variations: involvement in video-assisted thoracoscopic surgery-lobectomy for lung cancer

Background: Identification and section of pulmonary veins are an essential part of anatomical pulmonary resections. Intraoperative misunderstandings of pulmonary venous anatomy can lead to serious complications such as bleeding and delayed lung infarction or necrosis. We evaluated principally the rate of pulmonary veno­us anatomical variations, and secondarily the reliability and clinical outcomes of a preoperative morphological analysis.

Materials and methods: Between November 2012 and October 2013, we studied 100 consecutive patients with highly suspected or diagnosed stage I-II primitive lung cancer lesion. The surgical procedure initially retained was video-assisted thoracoscopic surgery (VATS) pulmonary resections and we studied preoperatively the proximal pulmonary venous anatomy using 64 channels multi- -detector computed tomography (CT)-scan angiography to describe the venous anatomical variations.

Results: There were 65 men and 35 women with a mean age of 63 years. A pulmonary venous anatomical variation was present in 36 (36%) patients, and right-sided anatomical variations were more frequent than on left-sided ones (25% vs. 11%). The most frequent variation encountered on the right side was the existence of three separate pulmonary veins (16%), and on the left side a single pulmonary vein (8%). Surgical conversion occurred in 21% and we didn't experience a pulmonary venous lesion (0%) or a post-operative lung infarction (0%).

Conclusions: We described pulmonary venous anatomical variations and their frequency. Anatomical variations exist and preoperative assessment of pulmo­nary venous anatomy using CT scan is a useful tool in VATS lobectomy to avoid unnecessary extension of pulmonary resections or iatrogenic complications in lung cancer surgery.

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Foramen magnum, occipital condyles and hypoglossal canals morphometry: anatomical study with clinical implications

Background: Current study examines morphometric alterations of the foramen magnum (FM), occipital condyles (OCs) and hypoglossal canals (HCs) and highlights all the morphometric parameters of the FM area that present side asymmetry, gender dimorphism and are affected by the ageing.

Materials and methods: One hundred and forty-one (73 male and 68 female) Greek adult dry skulls were examined.

Results: Short and long OCs were detected in 27.7% and 26.2%. A combination of short OCs and long HCs was presented in 27.5%. A complete septum was found in 23.6% of the HCs and osseous spurs in 12.9%. Side asymmetry was detected regarding the HCs length (p = 0.046), the maximum extracranial (p = 0.001) and minimum intracranial (p = 0.001) diameters. Mean FM anteroposterior and transverse diameters, FM perimeter and FM surface area were significantly larger in male than in female skulls (p = 0.001 for each parameter). Similarly, the OCs length (right, p = 0.004 and left, p = 0.024) and width (right, p = 0.008 and left, p = 0.006) the left distance HC-OC posterior border (p = 0.048), the anterior (p = 0.011) and posterior (p = 0.001) intercondylar distances and the HCs right length (p = 0.046) were significantly greater in males. A significant decrease was observed with ageing in FM anteroposterior diameter (p = 0.038), FM surface area (p = 0.05), anterior intercondylar distance (p = 0.014) and HC-OC posterior border (p = 0.013).

Conclusions: The study confirmed that only specific HC dimensions showed side asymmetry (HCs maximum extracranial and minimum intracranial diameters and HCs length), gender dimorphism (HCs right length and left distance HC-OC posterior border) and age influence (HC-OC posterior border and HC left extracranial minimum diameter) among young, adults and elderly individuals. FM and OCs dimensions presented gender dimorphism and the age influenced only FM anteroposterior diameter and surface area and the anterior intercondylar distance. The safe zone of OCs drilling in Greeks, calculated by the distance HC-OC posterior border represents the maximum HC depth and is among the lowest values reported in the literature. The significant decrease of this distance with ageing confirms the existence of a drilling safe zone for young, adults and elder individuals. Regarding OCs length, the same probability exists dealing with a short or a long OC during condylectomy. Before planning a transcondylar approach, the coexistence of short OCs and long HCs should be taken into account. These outcomes will be useful for a safe surgery in the craniocervical region in Greeks.

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Incidence of variations in human cadaveric renal vessels

Background: Awareness of discrepancies of renal vasculature is crucial for some medical procedures. The present study investigated origin and course of aberrant and accessory renal vessels and any associated variations.

Materials and methods: Renal blood vessels of 63 cadavers were examined. Number of renal veins and arteries, arrangement, location where the vasculature attached to the kidneys, and presence of variations were recorded. Incidence of renal vasculature variations was determined, and associations were tested with age at death, sex, and cause of death and whether variations were more common on a specific side.

Results: Variations were found in 7 (11%; 95% confidence interval [CI] 5–22%) cadavers. For renal veins, double, triple, and quadruple veins unilaterally (5; 8%) and veins that drained the superior pole (1; 2%) or inferior pole only (5; 8%) were found. For renal arteries, double and triple arteries unilaterally (3; 5%) and arteries attached to the superior pole only (1; 2%) or inferior pole only (2; 3%) were found. Other variations (polycystic kidney, variations in the common iliac or gonadal veins) were observed. Only renal failure as a cause of death was different between those with or without variations (4/7 [57%] vs. 1/56 [2%]; p < 0.001).

Conclusions: The present study found many variations in renal vasculature. Awareness of such variations may be useful for physicians concerned with this region.

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Differences of craniotype distribution and types of face among apparently healthy men from different regions of Ukraine

Established peculiarities of craniotype distribution and types of face in somatically healthy men depend on regional affiliation. In all regions of Ukraine, markedly greater brachycephaly percentage was found, indicating the trend towards brachycephalisation and prevalence of men with narrow and very narrow face, which confirms gracilisation. The study showed a small number of regional differences in the distribution of specific types of the skull and face, indicating that the population of Ukraine is very homogeneous in anthropological composition and none of the presented Ukrainian regional types is beyond anthropological type, common to people in general.

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Common and separate origins of the left and right inferior phrenic artery with a review of the literature

In a 94-year-old male cadaver, upon which routine dissection was being conducted, a rare variation was found in the gastrophrenic trunk (GPT), the common trunk of the left gastric artery (LGA), right inferior phrenic artery (RIPA), and left inferior phrenic artery (LIPA); the GPT arises from the abdominal aorta. A hepatosplenic trunk accompanied the variation. In this variation, the RIPA first branched from the GPT and then to the LIPA and LGA. Variations in the common trunk of the LIPA and RIPA in the GPT are common, but to our knowledge, a variation (separate inferior phrenic artery in the GPT) similar to our findings has not been previously reported. We discuss the incidence and developmental and clinical significance of this variation with a detailed review of the literature. Knowledge of such a case has important clinical significance for invasive and non-invasive arterial procedures. Therefore, different variations concerning the LGA and inferior phrenic artery should be considered during surgical and non-surgical evaluations.

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Morphological approach of the sternal foramen: an anatomic study and a short review of the literature

Background: The sternal foramen (SF) constitutes a specific anatomic defect in sternum, indicating an impaired fusion of ossificated segments, which occurs either in an anatomical part of the sternum or in sternal joints. The aim of this article is to provide baseline statistical data about the variations of the SF, to present a short review of the relevant literature and to compare results with other studies and populations.

Materials and methods: We review relevant literature, and we present data obtai­ned from skeletal samples of known population and sex. A total of 35 well-preserved dried sterna from the prefecture of Eastern Macedonia and Thrace, Greece, were selected: 20 men and 15 women with a mean age of 55 ± 6 years old. Measurements were made with a sliding calliper and photographic documentation.

Results: The incidence of the SF in the 35 dried specimens was 14.2%, 4 men (20% of male sample) and 1 woman (6.6% of female sample) and 80% of sternal foramina were observed in male individuals. The SF was found in the sternum body (2 cases, 40% of foramina), in xiphoid process (2 cases, 40% of foramina) and in sternoxiphoidal junction (1 case, 20% of foramina). All of the sterna presented 1 single visible SF. Two anatomically unique cases were identified throughout these 5 sterna, both belonging in male subjects.

Conclusions: The SF constitutes a relatively common variation with great radiological, clinical, and forensic significance. Presence of a SF with irregular bony margins complicates considerably radiological differential diagnosis. Awareness of this important anatomic variation is fundamental for clinicians and autopsy pathologists, in order to avoid severe fatal complications and elucidate the exact cause of death, respectively.

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Secondary Linburg-Comstock syndrome: a case report

Abstract

Linburg-Comstock syndrome is characterized by an inability to flex the interphalangeal joint of the thumb without simultaneous flexion of the distal interphalangeal joint of the index finger due to hereditary interconnections between the flexor pollicis longus (FPL) and the index flexor digitorum profundus (iFDP) resulting in discomfort and symptoms of flexor tenosynovitis. In addition to this anatomic anomaly, our clinical findings suggest that the interconnection can also result secondarily as a consequence of tenosynovial hyperplasia producing adhesions from any cause including previous surgery or trauma using the example of forearm laceration with dissection of the two tendons.

Level of Evidence: Level V, diagnostic study.

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Cryopreserved Cadaveric Arterial Allograft for Arterial Reconstruction in Patients with Prosthetic Infection

Publication date: Available online 7 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Anne Lejay, Charline Delay, Elie Girsowicz, Bettina Chenesseau, Emilie Bonnin, Mohamed-Zied Ghariani, Fabien Thaveau, Yannick Georg, Bernard Geny, Nabil Chakfe
ObjectiveThe aim of this study was to report outcomes of cryopreserved arterial allografts used as a vascular substitute in the setting of prosthetic material infection.MethodsA retrospective analysis of prospectively collected data was conducted including all consecutive interventions performed with cryopreserved arterial allografts used for vascular reconstruction in the setting of prosthetic material infection between January 2005 and December 2014. Five year outcomes included allograft related re-interventions, survival, primary patency, and limb salvage rates.ResultsFifty-three procedures were performed using cryopreserved allografts for vascular prosthetic infection: 25 procedures (47%) were performed at aorto-iliac level (Group 1) and 28 procedures (53%) at peripheral level (Group 2). The mean follow-up was 52 months. Five year allograft related re-intervention was 55% in Group 1 (6 allograft ruptures and 5 allograft aneurysm degenerations) and 33% in Group 2 (2 allograft ruptures and 7 allograft aneurysm degenerations). Five year survival was 40% and 68%, primary patency was 89% and 59% and limb salvage was 100% and 89% for Group 1 and 2 respectively.ConclusionUse of cryopreserved arterial allografts provides acceptable results but is tempered by suboptimal 5 year outcomes with high re-intervention rates.



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Corrected Cephalometric Analysis to Determine the Distance and Vector of Distraction Osteogenesis for Syndromic Craniosynostosis.

Background: The purpose of this study was to confirm the utility of a corrected cephalometric analysis to facilitate the planning of distraction osteogenesis with Le Fort III osteotomy for syndromic craniosynostosis. Methods: This prospective study involved 4 male and 2 female patients (mean patient age, 8 years 9 months; age range, 4 years 6 months to 13 years 2 months) with Crouzon syndrome who were treated with Le Fort III maxillary distraction using our previously described system of analysis of a corrected cephalogram and who underwent clinical follow-up. Lateral cephalograms were obtained immediately after device removal. Results: Distraction of orbitale moved the vector downward to the adult profile, but there was slightly less elongation than the adult profile for the distraction distance. The desired and real mean angles after distraction of point A were 29.2 +/- 7.9[degrees] and 6.1 +/- 8.5[degrees], respectively, and the desired and the real mean distances after distraction of point A were 30.6 +/- 12.7 mm and 29.4 +/- 4.1 mm, respectively. Conclusions: Using the corrected cephalometric analysis, the distance and vector of distraction osteogenesis with Le Fort III osteotomy could be determined in patients with syndromic craniosynostosis. The distraction system brought the patients' facial bones to the planned position using controlling devices. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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Copyright

Publication date: October 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 4





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Contributors

Publication date: October 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 4





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Contents

Publication date: October 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 4





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Forthcoming Issues

Publication date: October 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 4





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Volume 2: Rehabilitation, Reconstruction, and Recovery

Publication date: October 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 4
Author(s): Charles Scott Hultman, Michael W. Neumeister




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Burn Care: Rehabilitation, Reconstruction, and Recovery

Publication date: October 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 4
Author(s): Charles Scott Hultman, Michael W. Neumeister




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Of These, Faith, Hope, and Love

Publication date: October 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 4
Author(s): Roja Garimella, Harold G. Koenig, David L. Larson, Charles Scott Hultman

Teaser

Burn treatment has grown increasingly advanced and technologically capable. Clinicians must take into account, however, multidimensional patient needs that factor into long-term burn recovery. Important psychosocial factors associated with burn care include psychiatric comorbidities, such as anxiety and depression, healthy family relationships, social support, and community involvement. Spiritual factors and resources, such as time spent praying and/or meditating and access to pastoral services, are also important to consider. Further study is needed to identify specific psychosocial and spiritual needs of patients and to develop interventions or therapies that specifically provide for these needs.


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Outcome Metrics After Burn Injury

Publication date: October 2017
Source:Clinics in Plastic Surgery, Volume 44, Issue 4
Author(s): Jonathan S. Friedstat, Colleen M. Ryan, Nicole Gibran

Teaser

Outcomes research is important because it allows us to critically evaluate our results and strive for quality improvement, share our experiences with our colleagues, and improve the care and results delivered to the patient. This article focuses on outcomes research in burns from a historical perspective, highlights some of the current innovations, and previews future directions for outcomes-based research in burn care.


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Diagnostic Errors in Patients With Skin Findings

Dr Graeme Lipper presents five cases that typically present to primary care but aren't as straightforward as they initially seem.
Medscape Internal Medicine

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Tezepelumab in Adults with Uncontrolled Asthma

Asthma affects an estimated 315 million people worldwide, of whom approximately 70% have moderate-to-severe disease (Global Initiative for Asthma [GINA] step 3 to 5). In many of these patients, asthma can be controlled by increasing the dose of inhaled glucocorticoids. However, in some patients,…

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