Desmoplastic small round cell tumors of the pleura: a review of the clinical literature

Desmoplastic small round cell tumor of the pleura is a rare malignancy, with only a few cases reported in the scientific literature. The aim of the present review is to discuss the demographic, pathological, c...

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Annexin A2 contributes to cisplatin resistance by activation of JNK-p53 pathway in non-small cell lung cancer cells

Development of resistance to therapy continues to be a serious clinical problem in lung cancer management. We previously identified that Annexin A2 is significantly up-regulated in cisplatin-resistant non-smal...

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Assessing the potential role of next generation tyrosine kinase inhibitors in the treatment of cancers with acquired kinase domain mutations

Past few decades have seen the gradual replacement of standard cytotoxic therapy with molecular therapeutics, as the former was associated with significant general cell loss. Although molecular targeted therapies had proven to be highly effective, the duration of treatment efficacy is challenged by the growing resistance of cancer cells. The tyrosine kinase receptors are one of the better explored molecular targets in oncology. Cancer-positive for tyrosine kinase fusion genes has been targeted effectively with tyrosine kinase inhibitors (TKI).

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Evaluation of surgical decision making and resulting outcome in patients with highly eloquent glioblastoma: Results of a multicenter assessment

Publication date: Available online 8 September 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Jan Coburger, Mirjam Renovanz, Oliver Ganslandt, Florian Ringel, Christian Rainer Wirtz, Javier Segovia von Riehm
IntroductionTreatment of glioblastoma(GB) patients amenable only for a subtotal resection(STR) is controversial. Since outcome of patients is affected by surgical management, our aim was to assess surgical decision making and resulting outcome in patients with highly eloquent GBs.Patients and MethodsWe retrospectively assessed GB patients with intended sub-total resection (STR) or stereotactic biopsy (STX) of 3 neurooncological centers operated between 2008 and 2013. A volumetric assessment of overall extent of resection(oEoR), presence of complications, new permanent neurological deficits(nPNDs) was performed. A central reviewer reassessed all cases blinded and gave recommendation on surgical management and on a potential EoR(pEoR) based on imaging data. We compared outcome data using Mann-Whitney-U-test and Sign-Rank-Test. Survival was assessed based on Kaplan-Meier-estimates.Results97 patients were included. In 17 patients received STX, 70 patients a STR and 10 patients a near total resection (NTR, EoR >95%). Median OS was significantly different from STX patients only if NTR was reached (16 vs. 7 months, p=0.042). The central reviewer recommended a more aggressive strategy(NTR or STR resp.) in 41 patients and a less aggressive strategy in 13 patients. Overall, management recommendation was significantly different to clinical treatment (p <0.001). Mean pEoR was significantly higher than oEoR (85.7% vs. 71.3%,p=0.001). Regarding the different OR subgroups, no significant differences were found in the NTR group(12/13 ties, p=1) and in STX group (14/17 ties, p=0.125). In STR group, a significant difference was found (p=0.001). In 38/69 patients a NTR and in 13/77 patients a STX was recommended.ConclusionSurgery in GB patients with intended STR requires precise preoperative planning since potential EoR is mainly underestimated. Especially, patients with lesions amenable for a NTR should not be missed.



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A systematic review of synthetic CT generation methodologies for use in MRI-only radiotherapy

Publication date: Available online 8 September 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Emily Johnstone, Jonathan J. Wyatt, Ann M. Henry, Susan C. Short, David Sebag-Montefiore, Louise Murray, Charles G. Kelly, Hazel M. McCallum, Richard Speight
MRI offers superior soft tissue contrast as compared to CT, which is conventionally used for radiotherapy treatment planning (RTP) and patient positioning verification, resulting in improved target definition. The two modalities are co-registered for RTP, however this introduces a systematic error. Implementing an MRI-only radiotherapy workflow would be advantageous as this error would be eliminated, the patient pathway simplified and patient dose reduced. Unlike CT, in MRI there is no direct relationship between signal intensity and electron density, however various methodologies for MRI-only RTP have been reported. A systematic review of these methods was undertaken.The PRISMA guidelines(1) were followed. Embase and Medline databases were searched (1996-03/2017) for studies which generated synthetic CTs (sCT)s for MRI-only radiotherapy. 61 articles met the inclusion criteria.This review showed that MRI-only RTP techniques could be grouped into three categories: i]bulk density override ii]atlas-based and iii]voxel-based techniques, which all produce an sCT scan from MR image(s).Bulk density override techniques either used a single homogeneous or multiple tissue override. The former produced large dosimetric errors (>2%) in some cases and the latter frequently required manual bone contouring. Atlas-based techniques used both single and multiple atlases and included methods incorporating pattern recognition techniques. Clinically acceptable sCTs were reported, but atypical anatomy led to erroneous results in some cases. Voxel-based techniques included methods using routine and specialised MRI sequences, namely ultra-short echo time imaging. High quality sCTs were produced, however use of multiple sequences led to long scanning times increasing the chances of patient movement. Using non-routine sequences would currently be problematic in most radiotherapy centres.Atlas-based and voxel-based techniques were found to be the most clinically useful methods, with some studies reporting dosimetric differences of <1% between planning on the sCT and CT and <1mm deviations when using sCTs for positional verification.



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IGRT strategies for pelvic lymph node irradiation in high-risk prostate cancer: motion and margins

Publication date: Available online 8 September 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Lucy Kershaw, Laila van Zadelhoff, Wilma Heemsbergen, Floris Pos, Marcel van Herk
PurposeFor optimal irradiation of pelvic lymph nodes (LN) in high-risk prostate cancer, definition of margins to determine the planning target volume(s) is essential. Detailed quantification of the relative motion of the LN, seminal vesicles (SV) and prostate is currently lacking. This work aimed to quantify these motions and define margins for image-guided radiotherapy based on bony anatomy or prostate correction strategies for a 3 or 6 degrees-of-freedom couch.Material and MethodsNineteen patients had a planning CT followed by a mean of 11 repeated CTs during radiotherapy. The prostate, SV, external and internal iliac LN regions on the left and right were outlined on each CT. Systematic and random uncertainties were determined along with correlations between the motion of these regions. CTV-PTV margins required to take only motion into account were calculated for each guidance method.ResultsFor bone guidance, motion of prostate and LNs was largely uncorrelated. Margins to compensate for motion ((LR, SI, AP) in cm) based on a 3 degrees-of-freedom couch were; prostate: (0.2, 0.6, 0.8), SV: (0.4, 0.9, 1.0) and LN: (0.3, 0.4, 0.6). For prostate guidance, margins were calculated for correlated motion; prostate: (0, 0, 0), SV: (0.3, 0.5, 0.4) and LN: (0.3, 0.5, 0.9). For a 6 degrees-of-freedom couch, these margins were; prostate: (0.2, 0.6, 0.8), SV: (0.3, 0.9, 1.0) and LN: (0.3, 0.4, 0.3) for bone guidance. For prostate guidance, margins were; prostate: (0, 0, 0), SV: (0.2, 0.5, 0.4) and LN: (0.3, 0.6, 0.6)ConclusionsImage-guided radiotherapy based on bony anatomy requires larger prostate and SV margins, and guidance on prostate requires larger LN margins. Neither guidance strategy is optimal, and a combination of the two, or treatment adaption after a number of fractions might be preferable. Calculation of the total margin should also include delineation uncertainties.

Teaser

Definition of margins to determine the optimal image-guided radiotherapy (IGRT) strategy for pelvic lymph node irradiation is essential in high-risk prostate cancer. In this work, these margins were derived from systematic and random motions measured using repeated CT scans in 19 patients, based on matching to either bony anatomy or prostate for a 3 or 6 degrees-of-freedom (DOF) couch. When matching to bony anatomy, margins were smaller for lymph nodes than when matching to prostate, but larger for prostate and seminal vesicles. The prostate and seminal vesicle margins were unchanged when using a 3 vs 6 DOF couch, but lymph node margins were smaller in the anterior-posterior direction.


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Subcutaneous implant-based breast reconstruction, a modern challenge in post mastectomy radiation planning

Publication date: Available online 8 September 2017
Source:Practical Radiation Oncology
Author(s): Melissa P. Mitchell, Jamie Wagner, James Butterworth
As survival rates for breast cancer continue to improve, there has been increasing interest in reducing toxicity of therapy. In the field of breast surgery, we have seen advancements in the surgical approach from total mastectomy to skin and nipple sparing mastectomy. Nodal surgery has also been significantly impacted by a "less is more" approach, sparing patients with healthy lymph nodes the side effect of axillary lymph node dissection by performing sentinel lymph node dissection to accurately assess the draining nodal basin. More recently, there have been increasing reports of techniques to improve options for reconstruction. A growing trend has been use of acellular dermal matrix (ADM). This has been reported to improve cosmesis and reduce the number of surgical procedures required to obtain desired aesthetic results. Additionally, there have been increasing reports of use of prepectoral ADM covered implants. As compared to traditional methods of using submuscular tissue expanders, devices placed in the prepectoral plane have been reported to reduce animation deformities and postoperative pain. There is also the benefit that muscular function will be preserved with a subcutaneous expander. Furthermore, there is a growing push for single stage procedures made possible through the use of ADM. This benefits the patient by subjecting them to less operations and benefits the health care system by decreasing health care costs, as compared to multiple stage surgeries.



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Factors Associated with Fatigue in Prostate Cancer (PC) Patients Undergoing External Beam Radiation Therapy (EBRT)

Publication date: Available online 8 September 2017
Source:Practical Radiation Oncology
Author(s): Hann-Hsiang Chao, Abigail Doucette, David M. Raizen, Neha Vapiwala
PurposeFatigue is a common adverse effect among cancer patients undergoing external beam radiation therapy (EBRT), yet the underlying disease- and treatment-related factors influencing its development are poorly understood. We hypothesized that clinical, demographic, and treatment-related factors differentially affect fatigue and aimed to better characterize variables related to fatigue development in prostate cancer (PC) patients during EBRT.MethodsWe identified a 681 patient cohort with non-metastatic PC undergoing a 6–9week EBRT course. Patient fatigue scores (range 0–3) were prospectively recorded by providers during treatment visits using standardized criteria. Clinical and demographic factors including age, race, EBRT details, disease staging, smoking status, comorbidities, urinary symptoms, employment status, weight, and concurrent medication use were assessed for their relationship to fatigue levels. Significant differences in fatigue severity by each variable at the beginning and end of EBRT were assessed by non-parametric-means testing, and differences in the level of fatigue increase over the treatment course were assessed using an ordered logistic regression model.ResultsSignificant increases in reported fatigue severity were seen in patients with: age<60years (p=0.006), depressive symptoms (p<0.001) and use of androgen deprivation therapy prior to radiation start (p=0.04). In addition, the prescription of antiemetics prior to radiation start was associated with reduced fatigue severity (p=0.03).ConclusionsWe identify factors associated with increased (young age, depressive symptoms, androgen deprivation therapy) and decreased (antiemetic prescription) fatigue in a large cohort of PC patients receiving EBRT. Continued investigation is needed to further elucidate clinical drivers and biological underpinnings of increased fatigue to guide potential interventions.



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HPV related Nasopharyngeal and Cervical Cancer in a Married Couple in North America

Publication date: Available online 8 September 2017
Source:Practical Radiation Oncology
Author(s): Daniel B. Vanderbilt, Quoc-Anh Ho, Uma Goyal, Robert C. Bell, Robert R. Klein, Sun K. Yi




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Downregulation of FOXP3 inhibits cell proliferation and enhances chemosensitivity to cisplatin in human lung adenocarcinoma

Publication date: Available online 8 September 2017
Source:Pathology - Research and Practice
Author(s): Chun Li, Liwei Sun, Rui Jiang, Peng Wang, Haogang Xue, Yudong Zhan, Xiaodong Gai
Our study aimed to investigate the biological role of FOXP3 expression in human lung adenocarcinoma (LAD) tissues and evaluate its involvement in cell proliferation and chemosensitivity to cisplatin in LAD cells. Paraffin-embedded tissues from 50 LAD patients were collected to detect FOXP3 and Ki-67 expression using immunohistochemistry (IHC). Downregulation of FOXP3 in A549 cells was performed using siRNA transfection. Real-time PCR or western blot assay was performed to analyze FOXP3 expression in A549 cells. Cell proliferation and cisplatin cytotoxicity test were assessed by CCK-8 assay. The expression of FOXP3 was significantly associated with lymph node metastasis and TNM stage of LAD patients. The FOXP3 expression was positively correlated with Ki-67 labelling index(LI)in LAD tissues. The downregulated expression of FOXP3 by siRNA transfection significantly inhibited cell proliferation and enhanced chemosensitivity to cisplatin in A549 cells. The expression of FOXP3 was significantly upregulated following cisplatin treatment in A549 cells. Our study indicates that FOXP3 may potentially be a novel molecular target in combating drug resistance in the chemotherapy of LAD.



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Long-term patient reported outcomes following radiation therapy for oropharyngeal cancer: cross-sectional assessment of a prospective symptom survey in patients ≥65 years old

Abstract

Background

Given the potential for older patients to experience exaggerated toxicity and symptoms, this study was performed to characterize patient reported outcomes in older patients following definitive radiation therapy (RT) for oropharyngeal cancer (OPC).

Methods

Cancer-free head and neck cancer survivors (>6 months since treatment completion) were eligible for participation in a questionnaire-based study. Participants completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Those patients ≥65 years old at treatment for OPC with definitive RT were included. Individual and overall symptom severity and clinical variables were analyzed.

Results

Of the 79 participants analyzed, 82% were male, 95% white, 41% T3/4 disease, 39% RT alone, 27% induction chemotherapy, 52% concurrent, and 18% both, and 96% IMRT. Median age at RT was 71 yrs. (range: 65–85); median time from RT to MDASI-HN was 46 mos. (2/3 > 24 mos.). The top 5 MDASI-HN items rated most severe in terms of mean (±SD) ratings (0–10 scale) were dry mouth (3.48 ± 2.95), taste (2.81 ± 3.29), swallowing (2.59 ± 2.96), mucus in mouth/throat (2.04 ± 2.68), and choking (1.30 ± 2.38) reported at moderate-severe levels (≥5) by 35, 29, 29, 18, and 13%, respectively. Thirty-nine % reported none (0) or no more than mild (1–4) symptoms across all 22 MDASI-HN symptoms items, and 38% had at least one item rated as severe (≥7). Hierarchical cluster analysis resulted in 3 patient groups: 1) ~65% with ranging from none to moderate symptom burden, 2) ~35% with moderate-severe ratings for a subset of classically RT-related symptoms (e.g. dry mouth, mucus, swallowing) and 3) 2 pts. with severe ratings of most items.

Conclusions

The overall long-term symptom burden seen in this older OPC cohort treated with modern standard therapy was largely favorable, yet a higher symptom group (~35%) with a distinct pattern of mostly local and classically RT-related symptoms was identified.

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Epidermal Inclusion Cyst in an Intra-pancreatic Accessory Spleen: a Differential Diagnosis for Pancreatic Cystic Neoplasms and Review of the Literature

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Calibration of a lactic-acid model for simulating biofilm-induced degradation of the dentin-composite interface

Publication date: Available online 8 September 2017
Source:Dental Materials
Author(s): Laikuan Zhu, Yuping Li, Carola A. Carrera, Yung-Chung Chen, Mingyu Li, Alex Fok
ObjectiveTo verify and calibrate a chemical model for simulating the degradation of the dentin-composite interface induced by multi-species oral biofilms in vitro.MethodsDentin-composite disks (5-mm dia.×2-mm thick) were made from bovine incisor roots and filled with either Z100™ (Z100) or Filtek™ LS (LS) composite. The disks, which were covered with nail varnish, but with one of the dentin-composite margins exposed, were immersed in lactic acid solution at pH 4.5 for up to 48h. Diametral compression was performed to measure the reduction in bond strength of the dentin-composite disks following acid challenge. Scanning electron microscopy (SEM) was used to examine decalcification of dentin and fracture modes of the disks. To better understand the degradation process, micro-computed tomography, in combination with a radiopaque dye (AgNO3), was used to assess interfacial leakage in 3D longitudinally, while SEM was used to determine the path of leakage. One-way analysis of variance (ANOVA) was used to analyze the results, with the level of statistical significance set at p<0.05. The results were compared with those obtained previously using multi-species biofilms for verification and calibration purposes.ResultsAfter 48h of acid challenge, the debonding load of both the LS- and Z100-filled disks reduced significantly (p<0.05). In the Z100-filled disks, debonding mostly occurred at the adhesive-dentin interface, while in the LS-filled disks, this happened at the adhesive-composite interface, instead. The degree of dentin demineralization, the reduction in debonding load and the modes of failure observed were very similar to those induced by multi-species oral biofilms found in the previous work. Leakage of AgNO3 occurred mainly along the hybrid layer. The specimens filled with Z100 had a thicker hybrid layer (∼6.5μm), which exhibited more interfacial leakage than those filled with LS.SignificanceThe chemical model with lactic acid used in this study can induce degradation to the dentin-composite interface similar to those produced by multi-species biofilms. With appropriate calibration, this could provide an effective in vitro method for ageing composite restorations in assessing their potential clinical performance.



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Extracellular vesicles from oral squamous carcinoma cells display pro- and antiangiogenic properties

Abstract

Background

A new intercellular communication mode established by neoplastic cells and tumor microenvironment components is based on extracellular vesicles (EVs). However, the biological effects of the EVs released by tumor cells on angiogenesis are not completed understood. Here we aimed to understand the biological effects of EVs isolated from two cell lines of oral squamous cell carcinoma (OSCC) (SCC15 and HSC3) on endothelial cell tubulogenesis.

Methods

OSCC-derived EVs were isolated with a polymer-based precipitation method, quantified using nanoparticle tracking analysis and verified for EV markers by dot-blot. Functional assays were performed to assess the angiogenic potential of the OSCC-derived EVs.

Results

The results showed that EVs derived from both cell lines displayed typical spherical-shaped morphology and expressed the EV markers CD63 and Annexin II. Although the average particle concentration and size were quite similar, SCC15-derived EVs promoted a pronounced tubular formation associated with significant migration and apoptosis rates of the endothelial cells, whereas EVs derived from HSC3 cells inhibited significantly endothelial cell tubulogenesis and proliferation.

Conclusion

The findings of this study reveal that EVs derived from different OSCC cell lines by a polymer-based precipitation method promote pro- or antiangiogenic effects.

This article is protected by copyright. All rights reserved.

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Rapamycin treatment attenuates age-associated periodontitis in mice

Abstract

Interventions that target biological mechanisms of aging have great potential to enhance quality of life by delaying morbidity and mortality. The FDA-approved drug rapamycin is a compelling candidate for such an intervention. In a previous study, it was reported that 3 months of rapamycin treatment is sufficient to increase life expectancy and remodel the gut microbiome in aged mice. Transient treatment with rapamycin or a rapamycin derivative has also been shown to delay immune stem cell senescence and rejuvenate immune function in aged mice and elderly people. Periodontal disease is an important age-related disease involving altered immune function, pathological changes to the oral microbiome, and systemic inflammation. Periodontal disease is defined clinically by loss of alveolar bone and by connective tissue degeneration. Here, we describe significant alveolar bone loss during aging in two different mouse strain backgrounds and report that rapamycin treatment is sufficient to reverse age-associated periodontal disease in mice. Partial restoration of youthful levels of alveolar bone is observed in 22-month-old rapamycin-treated mice as rapidly as 8 weeks after initiation of treatment. To the best of our knowledge, this represents the first intervention shown to substantially prevent or reverse age-associated alveolar bone loss. These findings suggest the possibility that inhibition of mTOR with rapamycin or other pharmacological agents may be useful to treat a clinically relevant condition for which there is currently no effective treatment.

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Skin Cancer-Sun Knowledge and Sun Protection Behaviors of Liver Transplant Recipients in Turkey

Abstract

The aim of this study was to compare liver transplant recipients (LTRs) with the general population regarding their knowledge of skin cancer, sun health, sun protection behaviors, and affecting factors. This cross-sectional study was conducted in Turkey between March 2016 and September 2016 with 104 LTRs and 100 participants from the general population group (GPG). The mean age of the LTRs was 53.2 ± 11.8 and that of the GPG was 42.7 ± 14.5. The LTRs' skin cancer and sun knowledge were significantly lower than in the GPG, but there was no difference between the two groups in terms of their sun protection behavior scores. The most commonly used sun protection behaviors of LTRs were not being outside and not sunbathing between 10 a.m. and 4 p.m., wearing clothing that covers the skin, and avoiding the solarium. Behaviors commonly practiced by the GPG were wearing sunglasses, wearing sunscreen with a sun protection factor of 15 or higher before going outside, wearing sunscreen at the beach, while swimming or doing physical activity outside, and reapplying it every 2 h. Results of our study will contribute to the development of education and training programs for LTRs on skin cancer. The results also demonstrated the importance of practicing adequate sun protection behaviors which will certainly impact their future health.

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Forehead and brow rejuvenation: definition of a surgical algorithm

Abstract

Background

Ptosis of the eyebrows, or a very high and wrinkled forehead, may be found in both young adults and the elderly. Static wrinkles can be effectively addressed by surgery in which the approach varies from endoscopic to open procedures. The absence of a unanimously accepted treatment algorithm creates difficulty in selecting the best option in every case. The aim of this study is to find the optimal treatment, given differently featured patients who are all seeking forehead rejuvenation.

Methods

We carefully reviewed the literature on forehead and brow rejuvenation. Furthermore, 123 brow lift cases in the first author's practice have been analyzed; as such, the algorithm we proposed here was applied.

Results

In a 10-year follow-up period, seven endoscopic cases have shown relapse. Scarring, the inevitable outcome of any surgical procedure, resulted in pathology in two cases, necessitating a "touch-up" to ameliorate some aesthetic issues. The relatively low complication rate suggests that proper indications have been conveyed; our algorithm demonstrated a high degree of effectiveness.

Conclusions

According to our experience, each technique is more applicable for certain patients. In this sense, our updated algorithm should be extremely helpful to young surgeons who are willing (and technically able) to handle forehead rejuvenation cases.

Level of Evidence: Level V, therapeutic study.

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The relationship of demographic and disease variables on schneiderian membrane thickness and appearance

Publication date: Available online 8 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Tuba Talo Yildirim, Güliz Nigar Güncü, Dincer Göksülük, Melek Didem Tözüm, Mehmet Colak, Tolga Fikret Tözüm
ObjectivesThe purpose of this study was to evaluate the prevalence of sinus mucosal thickness (MT) and mucosal appearance (MA) in a patient population as detected with cone beam computed tomography (CBCT) and to determine the associations of various disease and demographic factors on MT and MA.Study DesignThe retrospective study consisted of CBCT images of 1000 maxillary arches in 500 patients. The arches were divided into three groups (atrophic, partially atrophic, and non-atrophic) according to the type of the maxillary dental crest. The CBCT scans were assessed to detect the prevalence of maxillary sinus MT and MA. Chi-square analysis was used to determine the significance of association of periodontal bone loss (PBL), periapical status (PA), alveolar crest type, age, and gender on sinus MT and MA.ResultsMT was significantly associated with PBL (P=0.004), PA status (P=0.001), and gender (P<0.01). MA was significantly associated with PBL (P=0.038), PA status (P=0.009), and gender (P<0.020) There were no significant associations of age or crest type with either MT or MA.ConclusionsPeriodontal bone loss, periapical lesions, and gender may have an association with mucosal thickening of the maxillary sinus.



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Skin Cancer-Sun Knowledge and Sun Protection Behaviors of Liver Transplant Recipients in Turkey

Abstract

The aim of this study was to compare liver transplant recipients (LTRs) with the general population regarding their knowledge of skin cancer, sun health, sun protection behaviors, and affecting factors. This cross-sectional study was conducted in Turkey between March 2016 and September 2016 with 104 LTRs and 100 participants from the general population group (GPG). The mean age of the LTRs was 53.2 ± 11.8 and that of the GPG was 42.7 ± 14.5. The LTRs' skin cancer and sun knowledge were significantly lower than in the GPG, but there was no difference between the two groups in terms of their sun protection behavior scores. The most commonly used sun protection behaviors of LTRs were not being outside and not sunbathing between 10 a.m. and 4 p.m., wearing clothing that covers the skin, and avoiding the solarium. Behaviors commonly practiced by the GPG were wearing sunglasses, wearing sunscreen with a sun protection factor of 15 or higher before going outside, wearing sunscreen at the beach, while swimming or doing physical activity outside, and reapplying it every 2 h. Results of our study will contribute to the development of education and training programs for LTRs on skin cancer. The results also demonstrated the importance of practicing adequate sun protection behaviors which will certainly impact their future health.

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Biomarker-Stratified Phase III Clinical Trials: Enhancement with a Subgroup-Focused Sequential Design

Among various design approaches to phase III clinical trials with a predictive biomarker, the marker-stratified all-comers design is advantageous because it allows for establishing the utility of both treatment and biomarker, but it is often criticized for requiring large sample sizes, since the design includes both marker-positive and marker-negative patients. In this paper, we propose a simple but flexible subgroup-focused design for marker-stratified trials that allows both sequential assessment across marker-defined subgroups and adaptive subgroup selection, while retaining an assessment using the entire patient cohort at the final analysis stage, possibly using established marker-based multiple testing procedures. Numerical evaluations indicate that the proposed marker-stratified design has a robustness property in preserving statistical power for detecting various profiles of treatment effects across the subgroups, while effectively reducing the number of randomized patients in the marker-negative subgroup with presumably limited treatment efficacy. In contrast, the traditional all-comers and sequential enrichment designs could suffer from low statistical power for some possible profiles of treatment effects. The latter also need long study durations and a large number of marker screened patients. We also provide an application to SWOG S0819, a trial to assess the role of cetuximab in treating non-small cell lung cancers. These evaluations indicate that the proposed subgroup-focused approach can enhance the efficiency of the marker-stratified design for definitive evaluation of treatment and biomarker in phase III clinical trials.

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A comprehensive approach to evaluating and classifying sun-protective clothing

Abstract

Background

National standards for clothing designed to protect the wearer from the harmful effects of solar ultraviolet radiation (UVR) have been implemented in Australia/New Zealand, Europe, and the USA. Industry standards reflect the need to protect the skin by covering a considerable proportion of the potentially exposed body surface area (BSA) and by reducing UVR-transmission through fabric (the Ultraviolet Protection Factor; UPF).

Objectives

This research aimed to develop a new index for rating sun-protective clothing that incorporates the BSA coverage of the garment in addition to the UPF of the fabric.

Methods

A mannequin model was fixed to an optical bench and marked with horizontal lines at 1 cm intervals. An algorithm (the Garment Protector Factor; GPF) was developed based on the number of lines visible on the clothed versus unclothed mannequin and the UPF of the garment textile. This data was collected in 2015-16 and analysed in 2016.

Results

The GPF weights fabric UPF by BSA coverage above the minimum required by international sun-protective clothing standards for upper-body, lower-body and full-body garments. GPF increases with BSA coverage of the garment and fabric UPF. Three nominal categories are proposed for the GPF: 0 ≤ GPF < 3 for garments that 'meet' minimum standards; 3 ≤ GPF < 6 for garments providing 'good' sun-protection; and GPF ≥ 6 indicating 'excellent' protection.

Conclusions

Adoption of the proposed rating scheme should encourage manufacturers to design sun-protective garments that exceed the minimum standard for BSA coverage, with positive implications for skin cancer prevention, consumer education and sun-protection awareness.

This article is protected by copyright. All rights reserved.

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Risk of exclusion from stroke rehabilitation in the oldest-old

Publication date: Available online 7 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Paola Forti, Fabiola Maioli, Elisabetta Magni, Letizia Regazzoni, Roberto Piperno, Marco Zoli, Maura Coveri, Gaetano Procaccianti
ObjectiveTo investigate whether oldest-old age (≥85 yr) is an independent predictor of exclusion from stroke rehabilitation.DesignRetrospective cohort study.SettingStroke Unit (SU) of an Italian tertiary hospital.Participants1055 elderly patients (age 65-74 yr, n=230; age, 75-84 yr, n=432; age ≥ 85 yr, n=393), who, between 2009 and 2012, were admitted to SU with acute stroke and evaluated by a multiprofessional team for access to rehabilitation. The study excluded patients for whom rehabilitation was unnecessary or inappropriate.InterventionsNot applicable.Main Outcome MeasuresAccess to an early mobilization (EM) protocol during SU stay and subsequent access to post-acute rehabilitation after SU discharge. Analyses were adjusted for prestroke and stroke-related characteristics.Results32.2% of patients were excluded from EM. Multivariable-adjusted Odds Ratio (OR) of EM exclusion was 1.30 (95% CI: 0.76, 2.21) for age 75-84 yr and 2.07 (95% CI: 1.19, 3.59) for age ≥85 yr compared to age 65-74 yr. Of 656 patients admitted to EM and who, at SU discharge, had not yet fully recovered their prestroke functionally status, 18.4% were excluded from post-acute rehabilitation. For patients able to walk unassisted at SU discharge, probability of exclusion did not change across age groups. For patients unable to walk unassisted at SU discharge, OR of exclusion from post-acute rehabilitation was 3.74 (95% CI: 1.26, 11.13) for age 75-84 yr and 9.15 (95% CI: 3.05, 27.46) for age ≥85 yr compared to age 65-74 yr.ConclusionOldest-old age is an independent predictor of exclusion from stroke rehabilitation.



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The link between Parkinson’s disease and rapid eye movement sleep behavior disorder with dream enactment: Possible implications for early rehabilitation

Publication date: Available online 7 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Brian P. Johnson, Kelly P. Westlake
The purpose of this paper is twofold. First, to inform readers of the link between the loss of motor inhibition during rapid eye movement (REM) sleep dreaming, diagnosed as REM sleep behavior disorder (RBD), and the future onset of neurodegenerative disorders, such as Parkinson's Disease and dementia with lewy bodies. It has been reported that motor disinhibition during rapid eye movement sleep often precedes onset of these disorders by years or even decades. Second, to consider that identification of RBD and the early involvement of rehabilitation and/or development of home exercise plans may aid in prolonging and even increasing function, independence, and quality of life should such neurodegenerative disorders develop later in life.



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Masthead

Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Editorial Board

Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Table of Contents

Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Editors' Selections From This Issue: Volume 98 / Number 9 / September 2017

Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Retraction notice to ”Electrical Stimulation for Hemiplegic Shoulder Function: A Systematic Review and Meta-Analysis of 15 Randomized Controlled Trials“ [Arch Phys Med Rehabil. 97 (2016) 1588-94]

Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9
Author(s): Ping Gu, Juan-juan Ran
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://ift.tt/2sF4ZfT).This article has been retracted at the request of the co-Editors-in-Chief. The article plagiarizes a paper that was published in BioMed Research International, Volume 2015 (2015), Article ID 729768, 14 pages, http://ift.tt/2eMJDEM. Nearly the entire introduction and sections of the methods, limitations and conclusions duplicate the BioMed Research International paper. One of the conditions of submission of a paper to Archives of Physical Medicine and Rehabilitation is that authors declare explicitly that the paper is an original work and not duplicative of prior work unless that work is cited properly. The duplication in this manuscript is a severe abuse of the scientific publishing system. The scientific community takes a very strong view on this matter.



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Archives of Physical Medicine and Rehabilitation Supplements

Publication date: September 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9





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Comparison of orthopantomography (OPG) and computed tomography (CT) accuracy in predicting inferior alveolar nerve injury following lower third molar surgical extraction.

Comparison of orthopantomography (OPG) and computed tomography (CT) accuracy in predicting inferior alveolar nerve injury following lower third molar surgical extraction.

Minerva Stomatol. 2017 Sep 05;:

Authors: Fusaro F, Costantinides F, Maglione M, Dalessadri D, Vettori E, DI Lenarda R

Abstract
BACKGROUND: The aim of this study was to compare OPG and CT accuracy in predicting inferior alveolar nerve (IAN) injury after lower wisdom teeth extraction.
METHODS: 23 patients with completely impacted lower third molar were enrolled in this study and OPG and CT exams were obtained before surgical intervention. Finally, a total of 26 lower third molars were extracted and cases of paresthesia following a IAN lesion have been registered. Then, OPG and CT images of the same patients have been randomly submitted to four experienced oral surgeons (with a seniority of at least 5 years) who were required to predict the possibility of a IAN injury by only evaluating the radiological exams. The images were anonymous and have been submitted to the surgeons without an order avoiding to influencing the answers. The agreement between the predicted and the real outcomes was statistically evaluated using the Positive Predictive Value (PPV), the Negative Predictive Value (NPV), Sensitivity, Specificity and the Spearman's rank correlation coefficient.
RESULTS: A perfect agreement between OPG-based prevision and the real development of paresthesia due to IAN injury has been observed. This agreement was only moderate when considering CT images, with several false negative results.
CONCLUSIONS: OPG is a first-level diagnostic exam that provides enough information for predicting IAN lesions after impacted lower third molars surgery. CT is a second-level radiological exam that provides more information on roots morphology and on the amount of the contiguity between roots and mandibular canal resulting useful in performing a minimally invasive surgery.

PMID: 28880060 [PubMed - as supplied by publisher]

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Dentin hypersensitivity and emerging concepts for treatments

Publication date: Available online 8 September 2017
Source:Journal of Oral Biosciences
Author(s): Ji won Kim, Joo-Cheol Park
BackgroundDentin hypersensitivity is a relatively common pain symptom caused by evaporative, chemical, thermal, tactile, or osmotic stimuli. Despite its high prevalence, many aspects of dentin hypersensitivity remain unknown. Current treatments for dentin hypersensitivity include desensitizers and adhesive materials. Several factors that occur in the oral cavity, such as occlusal force and intrapulpal pressure, cause microleakage, the primary defect of adhesive treatments.Highlight(1) This review article explains the etiology and pain mechanisms of dentin hypersensitivity. (2) Microleakage, a primary cause of restoration failures, is emphasized. (3) Current and ideal treatments for dentin hypersensitivity are described.ConclusionThe ideal treatment for dentin hypersensitivity should restore the original impermeability of the dentinal tubules. A novel way to treat dentin hypersensitivity is the regeneration of tubular dentin to overcome microleakage.



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Natural course of tonsillectomy pain: A prospective patient cohort study

Publication date: Available online 8 September 2017
Source:Auris Nasus Larynx
Author(s): Min-Su Kim, Hyo Geun Choi, Eun-Kyu Park, So Young Kim, Jin-Hwan Kim, Bumjung Park
ObjectiveThe aim of this study was to determine the natural course of pain after tonsillectomy.MethodsThis study included 119 patients that underwent tonsillectomy between November 2013 and November 2015. After undergoing tonsillectomy, patients scored their pain using the visual analogue scale three times daily (morning, midday, and evening) for 2 weeks. A linear mixed model was used for statistical analyses.ResultsIncreasing postoperative days was negatively associated with pain following tonsillectomy surgery (estimated value [EV] of visual analogue score [VAS]/day=−0.42, 95% confidence interval [CI]=−0.43 to −0.41, P<0.001); the post-tonsillectomy pain curve illustrated this negative correlation. Postoperative pain was less in children and adolescents (≤18years old) than in adults (>18 years old) (EV=−0.81, 95% CI=−1.56 to −0.08, P=0.031). Mean tonsillectomy-associated pain on postoperative day 1 was 6.4 VAS. It decreased slightly to 5.3 VAS until postoperative day 7, after which it reduced sharply to 3.7 VAS within 3 days; on postoperative day 14 it had decreased to 1.6 VAS. Pain assessments were higher in the morning (EV=0.59, 95% CI=0.50 to 0.69, P<0.001) compared with assessments conducted in the evening.ConclusionThe natural course of postoperative tonsillectomy pain follows a gradual decline for 1 week after surgery, but decreases more rapidly after this period.



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Relationship between swallowing function and breathing/phonation

Publication date: Available online 8 September 2017
Source:Auris Nasus Larynx
Author(s): Satoshi Yamaguchi, Mariko Ishida, Kanako Hidaka, Shinya Gomi, Sachiyo Takayama, Kazuki Sato, Yuma Yoshioka, Nozomu Wakayama, Kuwon Sekine, Shoji Matsune, Toshiaki Otsuka, Kimihiro Okubo
ObjectiveClarification of the association between the swallowing function and respiratory and phonatory functions.MethodsThe subjects were 30 patients with a chief complaint of swallowing disorder with clear consciousness capable of retaining a sitting position. Patients with organic and functional diseases of the larynx were excluded. Twenty-two and eight patients were male and female, respectively, and the mean age was 77.0±14.6years old. The chest expansion score was measured as an index of the respiratory function, and the maximum phonation time (MPT) was measured as an index of the phonatory function. The presence or absence of aspiration was judged using videoendoscopic swallowing study (VESS) and videofluoroscopic swallow studies (VFSS). The patients were divided into those with and without aspiration, and the chest expansion score and MPT were compared. In addition, the distance of laryngeal elevation was measured in the lateral view of VFSS, and its correlations with the chest expansion score and MPT were closely analyzed. To evaluate reliability of the test, the distance of laryngeal elevation and videoendoscopic score were compared between the presence and absence of aspiration.ResultsThe distance of laryngeal elevation was significantly shortened and the videoendoscopic score was significantly higher in the group with aspiration, as previously reported. On comparison of the chest expansion score between the groups with and without aspiration, no significant difference was noted at the axillary or xiphoid process level, and shortening was significant only at the 10th rib level in the group with aspiration. On comparison of MPT, it was significantly shortened in the group with aspiration. In addition, a significant positive correlation with the distance of laryngeal elevation was noted in both chest expansion score and MPT.ConclusionIt was suggested that declines of the respiratory and phonatory functions are risk factors of aspiration through limiting laryngeal elevation, and the chest expansion score at the 10th rib level and MPT are useful for screening of aspiration.



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Forehead and brow rejuvenation: definition of a surgical algorithm

Abstract

Background

Ptosis of the eyebrows, or a very high and wrinkled forehead, may be found in both young adults and the elderly. Static wrinkles can be effectively addressed by surgery in which the approach varies from endoscopic to open procedures. The absence of a unanimously accepted treatment algorithm creates difficulty in selecting the best option in every case. The aim of this study is to find the optimal treatment, given differently featured patients who are all seeking forehead rejuvenation.

Methods

We carefully reviewed the literature on forehead and brow rejuvenation. Furthermore, 123 brow lift cases in the first author's practice have been analyzed; as such, the algorithm we proposed here was applied.

Results

In a 10-year follow-up period, seven endoscopic cases have shown relapse. Scarring, the inevitable outcome of any surgical procedure, resulted in pathology in two cases, necessitating a "touch-up" to ameliorate some aesthetic issues. The relatively low complication rate suggests that proper indications have been conveyed; our algorithm demonstrated a high degree of effectiveness.

Conclusions

According to our experience, each technique is more applicable for certain patients. In this sense, our updated algorithm should be extremely helpful to young surgeons who are willing (and technically able) to handle forehead rejuvenation cases.

Level of Evidence: Level V, therapeutic study.

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Endoscopic Mucosal Resection is Superior to Rectal Suction Biopsy for Analysis of Enteric Ganglia in Constipation and Dysmotility

Patients with chronic constipation or motility disorders may be referred for rectal suction biopsy (RSB) to rule out Hirschsprung's disease (HD). RSB may not be successful beyond infancy due to the increased thickness of rectal mucosa. Endoscopic mucosal resection (EMR) could improve the diagnostic yield for HD when compared with traditional RSB because of the larger and deeper samples acquired for analysis.

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Atopowe zapalenie skóry. Czy zawsze choroba alergiczna?

Publication date: Available online 8 September 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Barbara Rogala




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Grzybica skóry gładkiej leczona jako alergia kontaktowa

Publication date: Available online 8 September 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Monika Sikorska, Roman Nowicki
Fungal skin infections are caused mainly by dermatophytes of the genus Trichophyton, Microsporum and Epidermophyton. Proper diagnosis based on clinical picture and mycological examination makes it possible to implement effective treatment – local, general or combination.Mycobacterial mycosis mostly develops on the skin of the scalp in the form of single or multiple lesions without inflammation. Zoophilic dermatophyte Microsporum canis is the most common causative pathogen, anthropophilic species such as Microsporum audouinii and Microsporum ferrugineum are observed occasionally. In case of zoonitic mycosis, a characteristic inflammation is formed on the periphery. Outside the scalp, skin of the face, neck, shoulders and the trunk can also be affected.Mycosis of smooth skin manifests in the form of oval or round erythematous patches or plaques with sharply defined borders, which spread circumferentially. The periphery of the lesion is inflamed with scaling and pustules, and centrally located resolution is observed. Pruritus in majority of the cases is a chief complaint. In most of the cases, a single lesion is observed, but over time, lesions tend to multiply and fuse together. Differential diagnosis of mycosis of the smooth skin includes seborrheic dermatitis, Gilbert's pink dandruff, mycosis fungoides, psoriasis and nummular dermatitis.The basis of treatment for microsporiasis is the use of topical preparations with antifungal agents. Local treatment is sufficient in most of the cases. General treatment (terbinafine, itraconazole, fluconazole or chleeprazole) is recommended if there is no improvement after topical treatment or in advanced disease stages.This article presents the case of a woman whose single facial fungal skin lesion was misdiagnosed as allergic contact dermatitis. Topical treatment with moderate-potent corticosteroids was used to achieve initial clinical improvement but discontinuation of therapy led to evolution of the lesion, which partially lost its original ring-shaped nature. The final diagnosis was based on mycological examination, and local and general antifungal treatment led to permanent cure.Not typical mycotic skin disease altered by immunosuppressive treatment is termed tinea incognito. Carelessly prescribing and using corticosteroids for infectious skin lesions results in complications as well as postponement of proper diagnosis and initiation of the treatment.



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Wpływ środowiska wiejskiego na rozwój astmy i alergii u dzieci

Publication date: Available online 8 September 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Piotr Fuss, Katarzyna Bal-Gierańczyk, Joanna Jerzyńska, Iwona Stelmach
Children who grow up on dairy farms rarely develop asthma or allergies. Researchers suspect a key reason is that the kids breathe in air full of lipopolysaccharides, molecules from the cell wall of bacteria G-, known as endotoxins. Endotoxin-reduced epithelial cell cytokines activate dendritic cells (DCs), thus suppressing type 2 immunity to house dust mites and reducing the overall reactivity of the immune system and later protecting children from asthma. Schuijs et al showed that an enzyme involved in this defense, called A20, is made by the epithelial cells. Loss of the ubiquitin-modifying enzyme A20 abolished the protective effect. Thus, the farming environment protects from allergy by modifying the communication between barrier epithelial cells and DCs through A20 induction. Their study offers new support for the hygiene hypothesis, which posits that zeal for cleanliness and widespread use of antibiotics have purged the environment of microorganisms that once taught a child's developing immune system not to overreact to foreign substances. This paper is a summary of up-to-date information on hygiene hypothesis. The purpose is to review the important recent advances made in how innate immune cells, microbes, and the environment contribute to the expression of allergic disease, emphasizing the allergen-related signals that drive allergic responses.



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A randomized, phase 2 study of cetuximab plus cisplatin with or without paclitaxel for the first-line treatment of patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck

Abstract

Background

B490 (EudraCT# 2011-002564-24) is a randomized, phase 2b, noninferiority study investigating the efficacy and safety of first-line cetuximab plus cisplatin with/without paclitaxel (CetCis versus CetCisPac) in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN).

Patients and methods

Eligible patients had confirmed R/M SCCHN (oral cavity/oropharynx/larynx/hypopharynx/paranasal sinus) and no prior therapy for R/M disease. Cetuximab was administered on day 1 (2-h infusion, 400 mg/m²), then weekly (1-h infusions, 250 mg/m²). Cisplatin was given as a 1-h infusion (CetCis arm: 100 mg/m²; CetCisPac arm: 75 mg/m²) on day 1 of each cycle for a maximum of six cycles. Paclitaxel was administered as a 3-h infusion (175 mg/m²) on day 1 of each cycle. After six cycles, maintenance cetuximab was administered until disease progression or unacceptable toxicity. The primary end point was progression-free survival (PFS). We assumed a noninferiority margin of 1.40 as compatible with efficacy.

Results

A total of 201 patients were randomized 1 : 1 to each regimen; 191 were assessable. PFS with CetCis (median, 6 months) was noninferior to PFS with CetCisPac (median, 7 months) [HR for CetCis versus CetCisPac 0.99; 95% CI: 0.72–1.36, P = 0.906; margin of noninferiority (90% CI of 1.4) not reached]. Median overall survival was 13 versus 11 months (HR = 0.77; 95% CI: 0.53–1.11, P = 0.117). The overall response rates were 41.8% versus 51.7%, respectively (OR = 0.69; 95% CI: 0.38–1.20, P = 0.181). Grade ≥3 adverse event rates were 76% and 73% for CetCis versus CetCisPac, respectively, while grade 4 toxicities were lower in the two-drug versus three-drug arm (14% versus 33%, P = 0.015). No toxic death or sepsis were reported and cardiac events were negligible (1%).

Conclusion

The two-drug CetCis regimen proved to be noninferior in PFS to a three-drug combination with CetCisPac. The median OS of both regimens is comparable with that observed in EXTREME, while the life-threatening toxicity rate appeared reduced.

Clinical trial number

EudraCT# 2011-002564-24.

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P 95 Frequency-specific after-effects of transcranial alternating current stimulation (tACS) on motor learning

Motor learning is associated with changes in synchronized oscillatory activity at alpha (8–12Hz) and beta (12–30Hz) frequencies. Numerous studies demonstrated that tACS can entrain ongoing oscillatory activity (Antal and Herrmann, 2016) and modulate motor behavior (Pollok et al., 2015; Wach et al., 2013). However, the neurophysiological mechanisms underlying tACS (Antal and Paulus, 2013) and its modulatory effect on motor learning remain ambiguous. Thus, the purpose of the study was to investigate the effects of tACS on the learning of a bimanual visuomotor coordination task and the accompanied oscillatory activity.

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P 163 Combining TMS and EEG – a new tool to assess motor system integrity after stroke

Despite the wealth of neuroimaging studies regarding stroke pathophysiology and recovery after stroke, there is still a lack of clinically relevant biomarkers that allow to predict the potential of functional recovery and treatment response at individuals' level. Anovel approach is to test motor system integrity by means of combining transcranial magnetic stimulation (TMS) and electroencephalography (EEG). By recording TMS-evoked potentials (TEP), the cortical response to TMS, both local and network responses can be recorded and analyzed in individual subjects (Rogasch and Fitzgerald, 2012; Ferreri, 2011).

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Editorial Board

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P 12 Integrating nTMS motor mapping of the M1 tongue area into diffusion tractography to reconstruct motor-speech pathways

The preservation of important white matter tracts is extremely important to optimize the functional long-term outcome after brain tumour surgery. The integration of functional localizer data such as navigated transcranial magnetic stimulation (nTMS) as starting region of interest (ROI) within the primary motor cortex (M1) into diffusion-tensor-imaging- (DTI-) tractography algorithms represents a recent advancement of the methodology with regard to the reconstruction of the corticospinal tract (CST).

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P 167 The functional role of contralesional motor areas in the first days after stroke – an fMRI-guided online TMS-study

Neuroimaging studies in stroke patients with hemiparesis have shown altered brain activation in the contralesional hemisphere including the primary motor cortex (M1), dorsal premotor cortex (dPMC) and anterior intraparietal sulcus (aIPS) already in the first week after stroke (Rehme et al., 2011). The role of these regions for motor recovery is still under debate, with some studies suggesting a supportive influence (Lotze et al., 2006) while other point to a maladaptive role (Nowak et al., 2008).

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P 170 A potential signature for ongoing pain in mice

Chronic pain is a major health care problem nowadays with no convincing treatment yet (Apkarian et al., 2009). One challenge of research and treatment of pain is that it cannot be objectively quantified. Only indirect measurements like the Visual Analogue Scale for humans and responses to mechanical or thermal stimuli for animals are used. Electrophysiological changes in brain activity are a possible candidate for a direct measurement of pain and could be easily obtained by EEG recordings. However most of the studies with this scope are focused on evoked potentials of short lasting pain stimuli (ms to s) (Zhang et al., 2012) and only few studies have been conducted on longer lasting pain (Leblanc et al., 2014).

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P 165 Incidence, clinical characteristics and longterm course of headache in patients with stroke (DMKG multicenter study)

Post stroke headache is a symptom which is generally not further differentiated. According to previous European and American studies, it is a common phenomenon. Nevertheless, other symptoms of stroke, such as palsy or aphasia, are dominating clinical assessments. However, the symptom "headache" can be an essential part of the clinical picture as in subarachnoid bleeding or cerebral venous thrombosis and it is unclear which risk factors modulate the symptoms and the occurrence of headache in stroke.

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P 161 Coupling of brain arousal and autonomic regulation in the transition from wakefulness to sleep onset during an auditory oddball task in the resting state

Simultaneous downregulation of the autonomic and central nervous system activity enables the gradual physiological state change from wakefulness to sleep onset. Dysregulation of central or autonomic arousal has been found in neurological (Silvani et al., 2016) and psychiatric disorders (Hegerl and Hensch, 2014; Hegerl et al., 2012; Schulz et al., 2016; Schwabedal et al., 2016), often associated with dysregulated sleep-wake patterns.

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P 14 Motor component of speech errors in rTMS language mapping

Using neuronavigated repetitive transcranial magnetic stimulation (rTMS) to disrupt language function during an online-task (e.g., picture naming) is a novel mapping technique which has recently been introduced for presurgical diagnostics in brain tumor patients. However, the method has some limitations due to its rather low specificity. Beyond its dependency on the task, the distinct error categories may have a major effect on the mapping results. We, here, studied the reliability and the spatial localization of rTMS-induced naming errors related to motor-speech function in contrast to semantic language errors.

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P 13 Congruency between speech-related areas investigated by fMRI and three rTMS protocols with different frequencies

Recently, language mapping by repetitive transcranial magnetic stimulation (rTMS) has gained a lot of interest in preoperative planning to preserve language function. However, the improvement of rTMS protocols is still a matter of debate since rTMS-evoked speech-errors appear relatively widespread over the brain and are rather poorly reliable, depending on the type of the speech-errors. We, therefore, investigated how rTMS-evoked speech-errors of distinct categories are located relatively to speech-related functional MRI (fMRI) clusters (serving as a widely used method for language mapping).

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Contents

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P 172 Endogenous pain modulation in patients with syringomyelia

Syringomyelia is a rare disease affecting the spinal cord. Some patients have no symptoms, but often dissociated sensory disturbances and neuropathic pain can be found.Aim of this study was to analyse endogenous pain modulation and stress-induced analgesia in patients with syringomyelia.

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P 168 Prevalence and characteristics of headache induced by inhalation or ingestion of a cold stimulus (HICS) in a group of adult subjects

Headache attributed to ingestion or inhalation of a cold stimulus (HICS) is a well-known phenomenon. Previously published data documented the prevalence in healthy subjects in childhood. Also an association between HICS and migraine is assumed. HICS is classified as a primary headache (IHS 4.5.2). Data on prevalence in adults does not exist as of now.

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P 166 Case presentation – apoplex due to partial occlusion of the medial cerebral artery with sinistral hemiparesis, word-finding disorder, memory impairment and writing disorder

S. had helped her sister to move. She experienced dizziness and everything went black. She choked on something to drink. Then she went out on the balcony, fell due to weakness of her right leg, and she could not move the right half of the body (right arm, right leg). The right angle of his mouth hung slightly with saliva, and she slurred her speech. She was put down. Then she was unconscious for about 5min and was hospitalised by the emergency physician with suspicion of epilepsy.Additional anamnestic data collected later: Was frequently beaten by a violent friend.

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P 164 Parietal stroke mimicking the Heidenhain variant of Creutzfeldt-Jakob Disease

The Heidenhain variant of Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative disease with an occipito-parietal focus.It initially presents with visual disturbances such as visual agnosia or cortical blindness (Kropp et al., 1999).After presentation of early visual symptoms, rapid progression of dementia and death follows.While the Heidenhain variant matches neuropathological criteria of CJD, differential diagnosis from other neurological disorders using biomarkers from electroencephalography (EEG), magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) reveal low sensitivity and specificity.As a consequence, these tools may lead to an erroneous diagnosis of the Heidenhain variant.

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P 162 Rhythmic Auditory Stimulation (RAS) as an additional treatment for chronic stroke patients in the outpatient setting: a randomized controlled trial

Rhythmic Auditory Stimulation (RAS) is a rhythmic sensory cueing to enhance gait patterns. Aim of the study was to research the effectiveness of RAS as an additional treatment for chronic stroke patients.

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Lack of evidence of a relationship between magnetic resonance signal intensity changes in the globus pallidus and dentate nucleus, and repeated administrations of gadoterate meglumine in children

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Japanese Sleep Questionnaire for Elementary Schoolers (JSQ-ES): validation and population-based score distribution

The Japanese Sleep Questionnaire for Elementary Schoolers (JSQ-ES) was developed to measure the sleep habits and disturbances of Japanese children. The current study aimed to present psychometric properties and describe the score distribution of the JSQ-ES. In addition, it examined correlations between the sleep and daytime behavior of school-aged children.

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Synchronous Reconstruction of a Total Mandibulectomy Defect with a Single Fibula Osteocutaneous Free Flaps

Publication date: Available online 8 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ramzey Tursun, J Marshall Green, Daniel Winokur, Andre Ledoux




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The neuropilins and their ligands in hematogenous metastasis from salivary adenoid cystic carcinoma - an immunohistochemical study

Publication date: Available online 7 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Qianwei Ni, Jinlong Sun, Chao Ma, Yun Li, Jun Ju, Moyi Sun
PurposeTo investigate the expression of neuropilin-1 (NRP1), neuropilin-2 (NRP2), vascular endothelial growth factor-A (VEGF-A), semaphorin-3A (Sema-3A) and semaphorin-3F (Sema-3F) in normal salivary gland (NSG) tissue, non-metastatic salivary adenoid cystic carcinoma (SACC) and metastatic SACC to better understand their role in intratumoral angiogenesis and hematogenous metastasis of SACC.MethodsThe study comprised 60 SACC patients, equally divided between non-metastatic SACC and metastatic SACC. Thirty NSG samples were used as control. Expression of cytokines were studied by immunohistochemistry and compared using integrated optical density (IOD). Relationship between NRP1, NRP2, VEGF-A, and Sema-3A expression and micro-vessel density (MVD) was analyzed in the three groups.ResultsIn metastatic SACC, the expression levels of NRP1 and VEGF-A were significantly higher than in non-metastatic SACC and NSG, while the expression of Sema-3A and Sema-3F was significantly lower than in non-metastatic SACC and NSG (p<0.0001). There were no significant differences in NRP2 expression among the three groups (p=0.43). The MVD of metastatic SACC was significantly higher than that of non-metastatic SACC and NSG (p<0.0001), while the lymphatic vessel density (LVD) of the three groups was not statistically different. The relationship between MVD and NRP1 or VEGF-A showed a significant positive correlation (p<0.0001 for both), while there was a significant negative correlation between MVD and Sema-3A or Sema-3F (p<0.0001 for both).ConclusionHematogenous metastasis of SACC is correlated with high expression of NRP1 and VEGF-A and low expression of Sema-3A and Sema-3F. The increased number of microvessels induced by VEGF-A signaling combined with NRP1 may be one of the key reasons leading to enhanced hematogenous metastasis in SACC.



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Is Formal Research Training Associated with Academic Success in Oral and Maxillofacial Surgery?

Publication date: Available online 7 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jesse T. Han, Mark A. Egbert, Thomas B. Dodson, Srinivas M. Susarla
PurposePursuing promotion in academic rank and seeking funded research opportunities are core elements of academic practice. This study's purpose was to assess whether formal research training influenced academic rank or National Institutes of Health (NIH) funding among full-time academic oral and maxillofacial surgeons (OMS).MethodsThis was a cross-sectional study of full-time academic OMS in the United States. The primary predictor variable was completion of formal research training, defined as a research fellowship or advanced non-clinical doctoral research degree (PhD, DMSc, DPH, DPhil, ScD). The outcome measures were current academic rank and successful acquisition of NIH funding (yes or no). Other study variables included MD degree, clinical fellowship training, years since completion of training, and H-index, a measure of academic productivity. We computed descriptive, bivariate, and multiple regression models and set a p-value < 0.05 as significant.ResultsTwo-hundred and ninety-nine full-time academic OMS comprised the study sample. Among these, 81 (27.1%) had formal research training. Surgeons with formal research training were less likely to have MD degrees (p = 0.004), had a greater mean time since completion of training (p = 0.01), had a higher mean H-index (p = 0.02). Formal research training was not associated with academic rank (p = 0.10), but was associated with increased likelihood of receiving NIH funding (p = 0.001). In a multiple logistic regression model, after adjusting for years since completing training and h-index, formal research training was associated with an increased likelihood of obtaining NIH funding (odds ratio = 3.22, 95% confidence interval = 1.15-9.00, p = 0.03).ConclusionAmong academic OMS, those with formal research training had greater success with obtaining NIH funding. Formal research training did not appear to influence current academic rank.



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Comparison of Clinical Efficacies of Preoperatively Initiated Naproxen Sodium + Codeine Phosphate Combination, Diclofenac Potassium and Benzydamine Hydrochloride over Pain, Edema and Trismus after Extraction of Impacted Lower Third Molar: A Randomized Double-Blind Study

Publication date: Available online 8 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Levent Cigerim, Cennet Neslihan Eroglu
PurposeThe immediate aim of this study is to compare the clinical efficacies of naproxen sodium + codeine phosphate combination, benzydamine hydrochloride, and diclofenac potassium for pain, edema, and trismus following lower third molar extraction.Material and Methods90 healthy volunteers who applied for impacted wisdom tooth extraction were randomly distributed into three groups. 1 hour prior to the tooth extraction process, patients were administered with one of the following drugs: naproxen sodium 550 mg + codeine phosphate 30 mg tablet; diclofenac potassium 50 mg coated pill; or benzydamine hydrochloride 50 mg coated pill. Pain assessment was conducted via the Visual Analog Scale, edema assessment by measuring the distances between predetermined facial landmarks, and trismus assessment by measuring interincisal distance. The number and the time of utilization regarding rescue analgesics (paracetamol 500 mg) by patients were recorded.ResultsNaproxen sodium + codeine phosphate was found to be more effective for pain, edema, and trismus compared to diclofenac potassium and benzydamine hydrochloride (P < 0.05). Benzydamine hydrochloride yielded similar clinical responses to diclofenac potassium (P > 0.05). No drug-related side effects were observed.ConclusionsNaproxen sodium + codeine phosphate constitutes the drug of choice following the extraction of a patient's impacted lower third molar. Benzydamine hydrochloride has similar efficacy when compared to diclofenac potassium, and it can be used as a nonsteroidal anti-inflammatory analgesic drug.



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Improving undergraduate pathology teaching: medical students' perspective

Publication date: Available online 7 September 2017
Source:Human Pathology
Author(s): Nikhil Aggarwal, Subothini Sara Selvendran, Sudeep Kumar Biswas




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Improving undergraduate pathology teaching: medical students’ perspective—reply

Publication date: Available online 7 September 2017
Source:Human Pathology
Author(s): YunXiang Chu, Richard N. Mitchell, Douglas A. Mata




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Passport to pathology: transforming the medical student pathology elective from a passive educational experience to an exciting, immersive clinical rotation

Publication date: Available online 8 September 2017
Source:Human Pathology
Author(s): Paras S. Minhas, Imarhia E. Enogieru, Richard N. Mitchell, Douglas A. Mata




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Johns Hopkins Study Shows the Real-Time Effects of Sleep Apnea on Metabolism

Sleep apnea, left untreated for even a few days, can increase blood sugar and fat levels, stress hormones and blood pressure, according to a new study of sleeping subjects. A report of the study's findings, published in the August issue of The Journal of Clinical Endocrinology & Metabolism, adds further support for the consistent use of continuous positive airway pressure (CPAP), a machine that increases air pressure in the throat to keep the airway open during sleep.

"This is one of the first studies to show real-time effects of sleep apnea on metabolism during the night," says Jonathan Jun, M.D., assistant professor of medicine at the Johns Hopkins University School of Medicine and the paper's senior author.

Read the full story here.

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Exercise-Induced Catecholamines Activate the Hippo Tumor Suppressor Pathway to Reduce Risks of Breast Cancer Development

Strong epidemiologic evidence documents the protective effect of physical activity on breast cancer risk, recurrence, and mortality, but the underlying mechanisms remain to be identified. Using human exercise–conditioned serum for breast cancer cell incubation studies and murine exercise interventions, we aimed to identify exercise factors and signaling pathways involved in the exercise-dependent suppression of breast cancer. Exercise-conditioned serum from both women with breast cancer (n = 20) and healthy women (n = 7) decreased MCF-7 (hormone-sensitive) and MDA-MB-231 (hormone-insensitive) breast cancer cell viability in vitro by 11% to 19% and reduced tumorigenesis by 50% when preincubated MCF-7 breast cancer cells were inoculated into NMRI-Foxn1nu mice. This exercise-mediated suppression of cell viability and tumor formation was completely blunted by blockade of β-adrenergic signaling in MCF-7 cells, indicating that catecholamines were the responsible exercise factors. Both epinephrine (EPI) and norepinephrine (NE) could directly inhibit breast cancer cell viability, as well as tumor growth in vivo. EPI and NE activate the tumor suppressor Hippo signaling pathway, and the suppressive effect of exercise-conditioned serum was found to be mediated through phosphorylation and cytoplasmic retention of YAP and reduced expression of downstream target genes, for example, ANKRD1 and CTGF. In parallel, tumor-bearing mice with access to running wheels showed reduced growth of MCF-7 (–36%, P < 0.05) and MDA-MB-231 (–66%, P < 0.01) tumors and, for the MCF-7 tumor, increased regulation of the Hippo signaling pathway. Taken together, our findings offer a mechanistic explanation for exercise-dependent suppression of breast cancer cell growth. Cancer Res; 77(18); 1–11. ©2017 AACR.

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ATG5 mediates a positive feedback loop between Wnt signaling and autophagy in melanoma

Autophagy mediates resistance to various anticancer agents. In melanoma, resistance to targeted therapy has been linked to expression of Wnt5A, an intrinsic inhibitor of β-catenin, which also promotes invasion. In this study, we assessed the interplay between Wnt5A and autophagy by combining expression studies in human clinical biopsies with functional analyses in cell lines and mouse models. Melanoma cells with high Wnt5A and low β-catenin displayed increased basal autophagy. Genetic blockade of autophagy revealed an unexpected feedback loop whereby knocking down the autophagy factor ATG5 in Wnt5Ahigh cells decreased Wnt5A and increased β-catenin. To define the physiological relevance of this loop, melanoma cells with different Wnt status were treated in vitro and in vivo with the potent lysosomotropic compound Lys05. Wnt5Ahigh cells were less sensitive to Lys05 and could be reverted by inducing β -catenin activity. Our results suggest the efficacy of autophagy inhibitors might be improved by taking the Wnt signature of melanoma cells into account.

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Genotypic characterization of Streptococcus mutans in Child-mother pair − A PCR based study

Publication date: Available online 8 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Dhanalakshmi Ravikumar, Mahesh Ramakrishna, Sharna Ningthoujam, Waikhom Robindro, Gayathri R, Vishnu Priya V
ObjectivesAt present, there is lack of evidence in literature regarding the transmission of Streptococcus Mutans from a caries-free mother to child by genetic methods, so the present study aimed to identify the genetic characterization of Streptococcus Mutans strains isolated from caries-free and caries active children and their mother being caries-free in both the groups and also to identify the genetic patterns of Streptococcus Mutans between caries-free and caries-active individuals.MethodsTwenty child-mother pair were selected and divided into 2 groups and the mothers being caries-free in both the groups. Saliva samples were collected using a sterile tube, followed by microbial culture of Streptococcus mutans, DNA isolation and PCR amplification. The molecular weights of each band were converted into a binary data and data were entered into SPSS software version 20.0 to generate similarity dendrograms.ResultsAmplified products of Streptococcus Mutans demonstrated a same genetic distance between the mother-child pair, indicative of a closely related species. Dendrogram interpretation represented a greater genetic polymorphism of Streptococcus Mutans between caries-free and caries-active children.ConclusionsIdentical genetic distance between child-mother pair showed that, these Streptooccus Mutans were closely related and could have vertically transmitted from their mothers. Different genotypic pattern between caries-free and caries active subjects showed a genetic polymorphism among the Streptococcus Mutans strains.



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Prevalence of oral tori and exostosis in Malaysian population – A cross-sectional study

Publication date: Available online 8 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Ashish Kumar Singh, Srinivas Sulugodu Ramachandra, Shelly Arora, Daniel Devaprakash Dicksit, C.G. Kalyan, Priyanshi Singh
IntroductionOral tori and exostosis are non-pathological bony protuberances seen on the alveolar surfaces of the jaw bones. These are commonly seen on the palatal surfaces of the maxilla [torus palatinus (TP)] and around the premolars in the lingual surface of the mandible [torus mandibularis (TM)]. The aim of this cross-sectional study was to determine the prevalence of tori/exostosis in the Malaysian population.MethodologyA total of 2666 patients were examined for the presence of tori and exostosis in the maxilla and mandible and were categorized into TP, TM, and exostosis (facial/labial). Collected data was analysed for obtaining descriptive statistics.Results882 subjects were noticed with oral tori/exostosis among the population studied with a prevalence rate of 33%. TP was seen more in females (35%), compared to males (20%), and this difference was statistically significant (p value<0.001). Highest prevalence of TP was seen in Malays (43%), followed by Chinese (31%) and Indians (21%), which was statistically significant (p value<0.00).DiscussionHigh prevalence of tori and exostosis was seen in the population studied. Though harmless, in certain circumstances, their presence necessitates changes in the denture design during fabrication of prosthesis, which the dentist should be mindful.



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Catheterization of post infection parotid duct sialocele with paediatric Ryles tube: A case report

Publication date: Available online 7 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Parul Tandon, Harish Saluja, Seemit Shah, Anuj Dadhich, Shivani Sachdeva
Sialocele is a cavity filled with saliva, usually as a result of trauma, complication of surgery, sialolithiasis or bacterial infection residing inside the duct. Many cases of parotid sialocele have been reported in the literature, but only very few cases of parotid duct sialocele have been reported. We report a case of an unusual facial swelling over buccal mucosa at the route of Stenson's duct with poor oral hygiene, a case of parotid duct sialocele with secondary infection and describe its diagnosis and management.



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Evaluation of fracture toughness of zirconia silica nano-fibres reinforced feldespathic ceramic

Publication date: Available online 8 September 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Ahila Singaravel Chidambara Nathan, Rajdeep Tah, Muthu Kumar Balasubramanium
BackgroundDental ceramics exhibit great optical properties and better esthetics due to their translucency. Concern with this material is its brittleness, which accounts for its failure. Feldspathic ceramic is the most widely used veneering ceramic.Aim and objectivesTo evaluate and compare the fracture toughness of pressable feldspathic ceramics reinforced with zirconia silica nano-fibres with conventional pressable feldspathic ceramics.Materials and methodAccording to ISO 6872, a master die was prepared from which, Bar shaped samples were formed in acrylic resin with the specified dimensions of 4.0mm in width ×1.2mm thickness ×25.0mm. The zirconia silica nano-fibres were prepared by sol gel electro-spinning followed by calcination then they were incorporated into feldspathic ceramic through ball milling process. The samples were prepared with addition of 0, 2.5, 5, 7.5 weight % nano-fibres. The fracture toughnes was evaluated using the indentation strength method. The values were statistically analysed using the one sample Kolmogorov-Smirnoff test, Kruskal Wallis test and pair wise group comparison was done using Mann Whitney test with Bonferroni correction.ResultsThe fracture toughness values for 2.5 wt% and 5 wt% groups were higher than control group, while the values for 7.5 wt% groups were lower compared to control group.ConclusionThe fracture toughness values of feldspathic ceramic samples reinforced with zirconia silica nanofibers by 2.5 and 5 weight % were statistically significant when compared to samples reinforced with 7.5 weight %.



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Research on advanced intervention using novel bone marrOW stem cell (RAINBOW): a study protocol for a phase I, open-label, uncontrolled, dose-response trial of autologous bone marrow stromal cell transplantation in patients with acute ischemic stroke

Stroke is a leading cause of death and disability, and despite intensive research, few treatment options exist. However, a recent breakthrough in cell therapy is expected to reverse the neurological sequelae o...

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Supernumerary phantom limb in a patient with basal ganglia hemorrhage - a case report and review of the literature

Supernumerary phantom limb (SPL) is a rare neurologic phenomenon, in which a patient misperceives an extra limb in addition to the original set of limbs. We report a case of SPL in a patient with a right basal...

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Post-Traumatic Growth and Resilience in Adolescent and Young Adult Cancer Patients: An Overview

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


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Überdenken der Radiochirurgie von Resektionshöhlen nach kompletter Resektion von 1–3 Hirnmetastasen

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Metastatic cancer in the Middle Age: the possible case of a female skeleton from Bormio (Italy)

Abstract

Secondary signs of cancer are difficult to assess in the archaeological context, as other lesions may mimic metastases on dry bones. Furthermore the low life expectancy, lower level of environmental cancer risk factors and pollution than the present times can contribute in limiting the frequency of signs of cancer in archaeological populations.

This study focuses on a female adult skeleton from the necropolis of Bormio (North-Italy), dating back to Middle Ages, which shows multiple lytic lesions on cranium, upper limbs, ribs and pelvis; lesions are oval in shape, with a diameter ranging from 1-2 mm to 80 mm. The lesions appearance and distribution at macroscopic and radiographic level, together with sex and age indications suggest the diagnosis of metastatic cancer. Possible diagnostic hypotheses of the possible sites of original cancer were performed as well, based on modern epidemiological data.

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Kaiso is highly expressed in TNBC tissues of women of African ancestry compared to Caucasian women

Abstract

Purpose

Triple-negative breast cancer (TNBC) is most prevalent in young women of African ancestry (WAA) compared to women of other ethnicities. Recent studies found a correlation between high expression of the transcription factor Kaiso, TNBC aggressiveness, and ethnicity. However, little is known about Kaiso expression and localization patterns in TNBC tissues of WAA. Herein, we analyze Kaiso expression patterns in TNBC tissues of African (Nigerian), Caribbean (Barbados), African American (AA), and Caucasian American (CA) women.

Methods

Formalin-fixed and paraffin embedded (FFPE) TNBC tissue blocks from Nigeria and Barbados were utilized to construct a Nigerian/Barbadian tissue microarray (NB-TMA). This NB-TMA and a commercially available TMA comprising AA and CA TNBC tissues (AA-CA-YTMA) were subjected to immunohistochemistry to assess Kaiso expression and subcellular localization patterns, and correlate Kaiso expression with TNBC clinical features.

Results

Nigerian and Barbadian women in our study were diagnosed with TNBC at a younger age than AA and CA women. Nuclear and cytoplasmic Kaiso expression was observed in all tissues analyzed. Analysis of Kaiso expression in the NB-TMA and AA-CA-YTMA revealed that nuclear Kaiso H scores were significantly higher in Nigerian, Barbadian, and AA women compared with CA women. However, there was no statistically significant difference in nuclear Kaiso expression between Nigerian versus Barbadian women, or Barbadian versus AA women.

Conclusions

High levels of nuclear Kaiso expression were detected in patients with a higher degree of African heritage compared to their Caucasian counterparts, suggesting a role for Kaiso in TNBC racial disparity.

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Robot-Assisted Transaxillary Thyroidectomy (RATT): A Series Appraisal of More than 250 Cases from Europe

Abstract

Background

Robot-assisted transaxillary thyroidectomy (RATT) is widely accepted in Asian countries. However, concerns regarding the balance between its real advantages and safety and cost have been raised by North American authorities. In Europe, assessments have been limited by small numbers since now. The purpose here is to report a large European experience with RATT.

Methods

A retrospective analysis was conducted of 257 patients who underwent RATT for nodular disease between February 2012 and September 2016. Data collected included patient demographics, diagnosis, ultrasound-estimated mean thyroid volume and nodule size, type of resection, operative time, postoperative pain and morbidity, and the hospital length of stay. Pain was assessed by visual analog scale score 12 h postoperatively (on the first postoperative day, before discharge). Feasibility, effectiveness, and safety were the outcomes of interest. Follow-up of thyroid carcinoma patients was carried out measuring thyroglobulin levels and ultrasound examination (median follow-up 24 months (6–48 months)). First control after 12 months and successively once a year.

Results

There were 253 women and 4 men, with a mean age of 37.3 years. Indications included benign disease in 116, papillary carcinoma in 56, and indeterminate nodule in 85. Mean thyroid volume was 16.8 mL, and nodule size was 25.3 mm. A hemithyroidectomy was performed in 138 patients and total thyroidectomy in 118. The mean operative time was 77.5 min for the former and 99.7 min for the latter. One conversion was required. Complications included transient hypoparathyroidism in 7/118 (total thyroidectomy) patients (5.9%), transient vocal fold palsy in 3/257 (1.1%), 1 delayed tracheal injury (0.4%), and 3 postoperative hematoma (1.1%). Mean visual analog scale score was 1.79, and the mean length of stay was 1.6 days for hemithyroidectomy and 1.9 days for total thyroidectomy.

Conclusion

RATT is safe and effective and could serve as a viable treatment modality in selected cases.

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Why One California County Went Surgery Shopping

Fed up with high hospital costs and limited competition, Santa Barbara County sends willing employees out of town for better bargains. Local governments are slowly joining private employers in aggressively seeking out the best care for the lowest price.
Kaiser Health News

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Emerging Technologies for Enhanced Recovery Programs

How might the latest digital innovations, non-invasive technologies and wearable sensors improve compliance to enhanced recovery programs before, during and after surgery?
British Journal of Anaesthesia

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Validation of the MASK-rhinitis visual analogue scale on smartphone screens to assess allergic rhinitis control

Abstract

Background

Visual Analogue Scale (VAS) is a validated tool to assess control in allergic rhinitis patients.

Objective

The aim of the present study was to validate the use of VAS in the MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) App (Allergy Diary) on smartphones screens to evaluate allergic rhinitis symptoms and disease control.

Methods

Each user filled 4 different VAS measuring overall, nasal, ocular and asthma symptoms at least once. Following COSMIN guidelines, we evaluated internal consistency, (Cronbach's alpha-coefficient and test-retest), reliability (intraclass correlation coefficients), sensitivity and acceptability, of the MASK-Rhinitis VAS.

Results

Between August 1^st, 2015 and July 31^st, 2016, the app was used 14,612 times in 15 countries. 1,225 users used it more than once, during the evaluated period. The tool resulted to be statistically satisfactory, showing excellent internal consistency (Cronbach's test >0.84, test-retest >0.7), reliability (>0.9) and acceptability. In addition, the tool had a good sensitivity when users (n=521) answered the VAS twice in less than three hours.

Conclusions & Clinical Relevance

The MASK-rhinitis VAS is a reliable and valid tool to assess allergic control on smartphone screens, at the population level.

This article is protected by copyright. All rights reserved.

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Clinical, histological, and immunohistochemical markers of resistance to Methyl-aminolevulinate Photodynamic therapy in Bowen's disease

Abstract

Bowen's disease (BD) is an intraepidermic squamous cell carcinoma (SCC), which principally appears on photoexposed areas.¹ Methyl-aminolevulinate (MAL) photodynamic therapy (PDT) is an excellent option for the treatment of BD (strength of recommendation, A; quality of evidence, 1). However, despite good response rates, some tumors prove non-responsive due to primary or acquired resistance.² The present study sought to identify clinical, histological, and molecular variables implicated in the response to MAL-PDT in BD.

This article is protected by copyright. All rights reserved.

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Polyclonal hyperglobulinemia and elevated acute phase reactants in hidradenitis suppurativa

Abstract

Hidradenitis suppurativa (HS) is a chronic, painful inflammatory skin disease characterized by recurrent nodules and abscesses affecting intertriginous areas including the axilla, inframammary, and anogenital regions. Hurley staging (I-III) is commonly used to classify patients, with mild disease limited to inflammatory cystic nodules (stage I), that may be connected by isolated tunnels/sinuses (stage II), or form a network of bridging tunnels/sinuses (stage III) associated with odiferous, purulent drainage. The cause of HS is unknown but it is generally considered to be multifactorial. It appears that an aberrant innate immune response initiates cutaneous inflammation in early lesions and recruitment of the adaptive immune system may be involved in maintaining HS chronicity.¹ Only a few published studies have focused on the humoral immune system in HS. The sera of patients with advanced HS revealed elevations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IgE.^2-4 Significantly increased levels of C-reactive protein (CRP) have been found across all three Hurley stages.⁵

This article is protected by copyright. All rights reserved.

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Variation in dermoscopic features of basal cell carcinoma as a function of anatomic location and pigmentation status

Abstract

Detecting basal cell carcinomas (BCCs) early and at relatively small sizes may expand therapeutic choices and enable less invasive treatment options. To this end, dermoscopy is a useful tool to diagnose BCC at early stages with high sensitivity and specificity.¹ Superficial BCCs have been shown to be independently associated with location on the trunk and extremities and nodular BCCs have been independently associated with a head/neck location.^2,3 Few studies have evaluated dermoscopic variation in BCC morphology as a function of anatomic location and pigmentation status.^4,5 Herein, we evaluate BCC dermoscopic morphology based on pigmentation status and anatomic location.

This article is protected by copyright. All rights reserved.

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Treatment of superficial basal cell carcinoma by topical photodynamic therapy with fractionated 5-aminolevulinic acid 20% versus two stage topical methylaminolevulinic acid: results of a randomized controlled trial

Summary

Background

Basal cell carcinoma (BCC) is the most common type of skin cancer with growing incidence rates. Photodynamic therapy (PDT) is a frequently used treatment, especially for superficial BCC (sBCC). Two topical photosensitizing agents are currently used to treat sBCC: 5-aminolevulinic acid (ALA) and its methyl-ester (MAL). Previous research showed a high efficacy of ALA-PDT using a 2-fold fractionated illumination scheme in which two light fractions of 20 and 80 J/cm2 are delivered, four and six hours after ALA application.

Objectives

To evaluate whether this 2-fold ALA-PDT is superior to conventional MAL-PDT for sBCC.

Methods

We performed a single blind, randomized multi-centre trial in the Netherlands.

Results

162 patients were randomized to either conventional MAL-PDT or 2-fold ALA-PDT. After 12 months a total of 6 treatment failures occurred after ALA-PDT and 13 after MAL-PDT. The 12 months cumulative probability of remaining free from treatment failure was 92.3% (95% CI [83.7-96.5]) and 83.4 (95% CI [73.1-90.0]), respectively (p=0.091).

Conclusions

The 2-fold ALA-PDT scheme resulted in fewer recurrences, although the difference between both treatment groups was not statistically significant. On the contrary, it resulted in higher pain scores and more post-treatment side-effects compared to MAL-PDT.

This article is protected by copyright. All rights reserved.

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Can the extent of heart rate reduction predict the clinical response of infantile hemangiomas to propranolol?

Abstract

Propranolol is the first-line medical treatment of complicated infantile hemangiomas (IH)¹. It was suggested that a heart rate (HR) reduction of more than 20% compared to baseline HR might be an early marker of response to propranolol². We aim to explore the relationship between the extent of HR reduction and clinical response of IH to propranolol.

This article is protected by copyright. All rights reserved.

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Social anxiety and attentional biases: A top-down contribution?

Abstract

Selective attention toward threatening facial expressions has been found to precipitate and maintain symptoms of social anxiety. However, the automaticity of this bias is under debate. In the present study, we aimed to test whether top-down (controlled) engagement and disengagement of attention toward threatening faces is associated with social anxiety. This was examined by testing the impact of a secondary working memory (WM) load on attentional biases. In a variation of the dot-probe task, participants' attention was initially cued to the left or right of fixation before an upright face paired with an inverted face was presented (displaying a disgust or neutral expression), and participants responded to a subsequently presented probe. The task was performed under no-load, low-load (one-digit memory task), and high-load (six-digit memory task) conditions. Social anxiety was not found to be associated with delayed disengagement from threat. However, surprisingly, high social anxiety was associated with an engagement bias away from threat, whereas low social anxiety was associated with a bias toward threat. These results were unaffected by the WM load manipulation. This indicates that engagement with threatening facial expressions has minimal contributions from top-down mechanisms, since it is likely that orienting to facial expressions occurs relatively automatically.

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Theoretical method for evaluation of therapeutic effects and adverse effects of epidermal growth factor receptor tyrosine kinase inhibitors in clinical treatment

Abstract

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are used for non-small cell lung cancer patients with an EGFR gene mutation. However, skin disorders are known as adverse events. In the present study, we investigated whether EGFR-TK occupancy is useful as an index for assessing clinical efficacy and adverse events for the proper use and development of EGFR-TKIs. Average binding occupancies (Φ _ss) of EGFR-TKIs, gefitinib and erlotinib, for the EGFR-TK of cancer or skin cells were calculated. The relationships of Φ _ss with response rate (RR) or frequency of rash were analyzed using the ternary complex model. Then, the relationships between the dose of EGFR-TKIs and RR or frequency of rash were examined. Gefitinib showed a greater difference for Φ _ss value for both wild-type and mutant EGFR as compared to erlotinib at usual dose. The RR increased in a nonlinear manner rapidly rising when Φ _ss exceeded 95%. It was thought that a very high Φ _ss value might be needed to obtain the therapeutic effect of EGFR-TKIs. Meanwhile, the frequency of rash increased in a linear manner along with elevation of Φ _ss. It was shown that the K _d ratio (K _d for mutant/K _d for wild type) was less than 0.001, when the high RR and low frequency of rash were obtained simultaneously. The results showed that the therapeutic effects and skin disorder can be assessed by using Φ _ss. Furthermore, it is likely that a proper choice of drug and dose can be made by using Φ _ss in EGFR-TKI therapy.

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